Outcome assessment of the rehabilitation of the visually impaired.

The purposes of this project are to establish the psychometric properties of instruments used to gather data relevant to blind rehabilitation outcomes, to refine the scaling and scoring protocols for the instruments, and to revise and refine the outcome instruments. This 3-year project will gather outcome and demographic data from an estimated 1,200 visually impaired veterans per year, along with a companion sample an estimated 1,200 visually impaired nonveterans per year, using the following core measures: Blind Rehabilitation Service Follow-up Outcome Survey (BRSFOutSur) measuring functional performance, Blind Rehabilitation Service Data Base (BRSDBase) recording subject characteristics, and Blind Rehabilitation Service Satisfaction Survey (BRSSatSur) measuring satisfaction with rehabilitation. As of July 1999, data from 2,624 veterans have been collected for the demographic instrument, from 1,630 veterans for the functional outcomes instrument, and from 1,655 veterans for the satisfaction instrument. Data collection and analysis are currently ongoing. These findings and the further development of outcome instruments in this area will contribute to greater efficiency and effectiveness of the delivery of blind rehabilitation services by the Department of Veterans Affairs.

Head extension and age-dependent posturographic instability in normal subjects.

We have investigated the role of head extension in posturographic testing of normal subjects. We especially wished to determine the number of falls that occurred in the "normal" elderly so as to distinguish them from elderly patients with abnormal neurologic and vestibular patterns. We tested 144 normal subjects ages 22 to 85, the majority older than 60 years, with the NeuroCom Equitest sensory posturography protocol: first with their heads erect and then with their heads extended 55 degrees. None of our subjects younger than age 59 experienced a fall during sensory posturography tests with their heads erect. However, 35 of the 101 older subjects exhibited a total of 79 falls during these same tests. When the tests were repeated with the head extended 55 degrees, the number of falls for the whole group increased from 79 to 171. Where only 24% of all the subjects fell with head erect, 52% fell with head extended. The increase was especially notable among the elderly. Head extension increases the difficulty of performing certain posturography tests and has been useful in uncovering compensated deficits in equilibrium in young and middle-aged patients. However, because head extension significantly increases falls among normal elderly subjects, this does not seem to be an effective tool to determine abnormality in this age group.

Abnormalities in posturography and estimations of visual vertical and horizontal in multiple sclerosis.

Twenty-seven patients with mild multiple sclerosis were tested with the dynamic posturography protocol used in the NeuroCom Equitest procedure. The purpose of this study was to determine if the standard test procedure elicited a pattern of responses that would suggest the possibility of multiple sclerosis during differential diagnosis of a patient with dysequilibrium. In addition, the patients' ability to align a light bar to vertical and horizontal was tested with the head erect and with the head tilted 45 degrees to the right and left shoulder. There was a pattern of abnormality in the Equitest motor coordination tests. Only one patient produced normal scores in both the latency and adaptation tests. No pattern of error was noted in the sensory organization tests. In the visual alignment tests, only 3 of the 27 patients tested produced values that were within normal limits for the three different head positions. Visual alignment and the motor coordination tests are not specific for multiple sclerosis, but poor performance probably indicates a disruption of the integration of visual, vestibular, and somatosensory information. Although patients with early multiple sclerosis and patients with purely vestibular disorders often have similar complaints, they have quite different profiles of abnormalities in posturography testing.

Intracompartmental pressure measurements in the normal forearm.

In 20 normal subjects, intracompartmental pressure measurements were made at three different sites in the volar forearm: half the distance between the medial epicondyle and ulnar styloid and at points 4 cm proximal and 4 cm distal. The pressure measurements were made using a hand-held digital compartment pressure monitor. The study demonstrated that in the uninjured volar compartment, clinically significant (5 mm Hg) intracompartmental pressure differences exist over distances as little as 4 cm.

Effectiveness of the Mini-Mult in detecting MMPI pathology in the blind.

The Mini-Mult and MMPI were administered in random order to 60 blind male veterans admitted to a residential rehabilitation program. Mini-Mult scores predicted the presence or absence of MMPI pathology in 81.7% of the cases. Correlations between the individual Mini-Mult and MMPI scales were significant at the p less than .01 level, but not of sufficient magnitude to permit their interchangeability or to allow for profile diagnosis on the basis of Mini-Mult scores. Analysis of the false negatives raises questions about the clinical significance of an abnormal MMPI in the population studied. The results support the value of the Mini-Mult as a screening device, but not as a substitute for a detailed psychological assessment of the blind.