Objective: To determine the differences in postural stability measures and neurocognitive function between sport-related concussion, also known as mild head injury (MHI), subjects and healthy subjects. To determine the correlating factors of postural stability and neurocognitive function. Design and Setting: This descriptive study design assessed postural stability and neurocognitive function within 7 days of athletes sustaining a sport-related MHI and compared the group to a control group of healthy subjects. All testing was completed at the University of Pittsburgh Neuromuscular Research Laboratory. Subjects: Twenty subjects (10 healthy, 10 MHI) participated. Measurements: All subjects completed a single testing session consisting of a computerized neurocognitive test and postural stability assessment, including kinematics and force plate data collection, during which two balance tasks were performed three times each. Results: There were no significant differences in postural stability between groups. There were no significant differences in neurocognitive function. Additionally, no relationship existed between postural stability and neurocognitive function. Conclusions: Although not significant, hip flexion and extension was larger in the control subjects, indicating that there may be difficulty for MHI subjects to adopt either a hip or ankle strategy to maintain postural stability. While no significance was found in the study, there may be trends to suggest that visual memory (p=0.11) and reaction time (p=0.17) are different. The low number of subjects and time of testing with relation to injury may be contributing factors in the lack of significant results in the majority of test variables.

Several studies have been conducted investigating the biomechanics of pitching [1-9]. These previous studies all report high compressive and distractive forces for shoulder external rotation, elbow flexion with a maximum varus torque, shoulder adduction torque, and elbow extension. These characteristics may be exacerbated with increased pitch counts. The purpose of this study was to quantify changes in shoulder and elbow mechanics as a result of increased pitch count, by evaluating joint angles, accelerations, and velocities. Subjects each completed one testing session. Intercollegiate baseball pitchers pitched a simulated game, with 17 pitches per inning over the course of 9-innings. Shoulder and elbow kinematic data were evaluated for a fastball every tenth pitch of the simulated pitch count for each subject. Our overall hypothesis was that as the pitch count increased, abnormal throwing mechanics would result.

Transfers are crucial for independent mobility. However, transfers can cause problems if appropriate precautions are not considered. For instance, transfers can result in skin damage, overstretching of the low back, wrist and fingers, excessive motion in unstable spinal segments, and shoulder injury. The purpose of this study was to develop and evaluate a transfer measurement system, to determine an objective method to delineate the different phases of a transfer, and to determine the peak dynamic joint forces and moments at the wrist, elbow, and shoulder experienced by wheelchair users with paraplegia during a level tub bench transfer. A transfer measurement system was developed which consists of a steel frame, two unistruts, two handrail attachments, two aluminum-mounting plates and two force-plates. A mock trial was conducted to determine whether the transfer systems performed correctly. The types of the transfer surfaces that we can evaluate include a tub bench, a toilet seat, and car seat. The phases of transfer from wheelchair to tub bench and back were identified based on force plate data and position and velocity of trunk marker (C7). The phase identification method was used to identify the approximate force coming on the hand during tub bench transfer using force plate data. We studied nine paraplegic subjects transferring from wheelchair to level tub bench and back. We modeled the arm as a serial linkage mechanism in analyzing the peak dynamic joint forces and moments. It was found that peak net joint dynamic forces at the joints are greater in the trailing arm than in the leading arm. It was observed that the peak joint forces were minimum at the wrist and maximum at the shoulder in all nine subjects with paraplegia. The moments at the wrist were lower than the moments at the shoulder. In wheelchair to tub bench transfer, there was an inverse relationship between wrist force and transfer time. Examining leading and trailing arm forces in conjunction with transfer time may assist in modifying transfer styles in individuals with weakness, strength imbalance and shoulder pathologies.

Rehabilitation counselors work with the clients family, friends, and employer to increase employment opportunities by means of their roles as counselor, coordinator, and consultant. Increasing employment opportunities often includes purchasing and learning to use assistive technology devices, equipment modification, improving accessibility, etc. The objective of this research is to examine knowledge and experience of OVR counselors in a common area of assistive technology: wheeled mobility device. A survey, given to public rehabilitation counselors in Pennsylvania, obtained information about counselors caseloads, their knowledge of wheeled mobility and their use of good evaluation and selection strategies. This study shows that counselors with in-depth knowledge of AT devices seem more likely to: (1) support their clients in making informed choices about their technology needs, (2) consider the relationship between wheelchair features and job demands, and (3) listen to their clients opinion. Further study is needed on the relationship between OVR counselors knowledge about AT devices and factors that influence recommending or purchasing wheeled mobility devices.

There is a current focus on job satisfaction and how it is related to occupational injury, specifically musculoskeletal disorders (MSD) since they are the most common injuries employees experience. Job satisfaction has been defined as an employees satisfaction with the reinforcers found on the job (Weiss, Dawis, England, & Lofquist, 1967). Numerous reinforcers exist, but the Minnesota Satisfaction Questionnaire (MSQ) has been developed to measure what has been found to be most involved in gauging employees level of job satisfaction. This study attempted to compare the job satisfaction of hospital employees with a history of occupational MSD to their non-injured counterparts. Problems with recruitment, which resulted in a small study sample, forced the specific aims of this study to be modified. The findings showed only a few areas of statistically significant difference between groups of employees in levels of satisfaction for the 21 attributes measured by the MSQ. These findings, however, must be viewed with caution because of the small sample size and subsequent subgroups used for the analyses. Two of the subscales of the MSQ were found to be correlated with age. Isolation of the dissatisfied employees did not indicate that history of MSD was affecting the satisfaction scores of any of the attributes. Results of this study may be useful for rehabilitation counselors working with individuals who are working with individuals who have, or are interested in, careers in healthcare. The attributes seen as high and low satisfaction areas for the study sample may carry over to the general population of healthcare workers, giving some insight into what the client values as important in a job. Differences found between groups may have clinical significance, alerting a counselor to focus more on these areas with certain individuals. Information gained from this study can also assist with the formulation, or modification, of an employee return to work program to increase the chances for a successful return to work.

The primary objective of this study was to collect descriptive data on the mobility characteristics and activity levels of manual wheelchair users in two different environments: at the National Veterans Wheelchair Games (NVWG) and in the subjects residential setting. This was accomplished using a custom data logging device. A secondary objective was to identify demographic factors that might influence the mobility characteristics and activity levels of the wheelchair users in their home environment. Thirty nine subjects were recruited to participate in this study over a two year period. A data logging device was instrumented on each subjects wheelchair for a total of six days at the NVWG and an additional one or two weeks in the home environment, depending on year of enrollment. The participants were also asked to complete a brief demographic survey. It was found that subjects traveled significantly (P=0.000) further and were active for significantly (P=0.000) more hours during an average day at the NVWG compared to their residential setting. The subjects traveled on average 6566.84 ± 3203.90 meters and were active for an average 12.00 ± 3.56 hours per day at the NVWG. In their home environment, subjects traveled an average distance of 1994.09 ± 1851.20 meters and were active for 7.13 ± 4.85 hours per day. When comparing the speed traveled in the two environments, no significant differences were found. It was found that the activity levels of the subjects at the NVWG were significantly greater when compared to their home environment. Analysis of demographic factors revealed that subjects who used a wheelchair for more years were found to travel significantly further and accumulate more minutes of movement per day. Also, employment was found to be a demographic factor that influenced wheelchair usage in the home environment. The findings of this study provide a more objective measure of wheelchair usage patterns in two real world environments: one that facilitates participation in activities and one that contains barriers that the subjects need to overcome. The results also indicate that there are demographic factors that influence wheelchair usage patterns in the residential setting.

Objective: The goal of this project was to describe the characteristics related to motor vehicle transportation among wheelchair users, who remain in their wheelchair while in the vehicle. Particular focus was placed on identifying how these individuals utilize occupant restraint and wheelchair securement devices. Also, the study examined the epidemiology of motor vehicle related injuries, and reports on the relationship between these injuries and the identified use of occupant restraint and wheelchair securement systems. Methods: A 12-page survey was completed, via mail, by 336 wheelchair users, who self-reported that they remain seated in their wheelchair at least some point in their transportation use. These individuals were recruited through various nationwide disability related service and advocacy organizations, as well as through disability related internet message boards. Descriptive, chi-square and t-test analysis was completed using SPSS statistical software. Results: The results of this study show that traveling as a private vehicle passenger is the most common manner in which motor vehicle transportation is used by wheelchair occupants, with 70.2% of the sample population reporting to using this mode within the past month and 50.0% reporting this mode as their primary means of transportation. Limited significant difference existed in regard to subjects gender, age, disability or wheelchair type and the reported use of either an occupant restraint device or a wheelchair securement system. There were also limited significant findings seen in regard to the use of either an occupant restraint device or wheelchair securement system and the occurrence/severity of a motor vehicle crash, or non-crash related injury. Finally, in regard to motor vehicle related adverse events that resulted in an injury, descriptive statistics showed that there were limited events (crash: n = 15, non-crash: n = 71), with even less resulting in an injury requiring the need to seek medical attention (crash: n = 10, non-crash: n = 9). Conclusion: This study is one of the first efforts to describe the real-world transportation characteristics of wheelchair-seated passengers, as well as an examination of the relationship between the use of either occupant restraints or wheelchair securement devices and the occurrence of motor vehicle related injuries. These data demonstrate that private vehicles are the most widely used form of motor vehicle transportation, suggesting that research focused in this area may be beneficial. Also, limited significant findings were seen in regard to the relationships between the use of either an occupant restraint or wheelchair securement, independent of each other, and the occurrence of motor vehicle related injuries. These results may be interpreted in two ways 1) that these safety systems are not being used effectively, or 2) that use of an occupant restraint and wheelchair securement independent of one another may not reduce injury risk in a motor vehicle crash or non-crash incident. The analysis of the use of a 3-point occupant restraint, together with a forward facing wheelchair securement system, as recommended by the SAE J2249, may produce different results. It should also be noted that based on descriptive statistics alone, it is evident that for those individuals who were injured severely enough in a non-crash incident to require medical attention, there was limited reported usage of wheelchair securement and occupant restraints. These findings may suggest that the use of such devices may decrease the number of severe non-crash related injuries. Based on the limitations of this study and trends seen within the descriptive statistics, more research in this area is required to develop more inferential findings between the use of these devices and the occurrence of injuries related to motor vehicle transportation.

Employment is considered to be an important predictor of life satisfaction and success. Statistics on unemployment rates are of concern among our society, especially when the statistics involve individuals with disabilities. In an era where the American with Disabilities Act and Rehabilitation Act have pushed for the community and workforce to become more accessible, unemployment rates among individuals with disabilities still remain high. Spinal cord injury (SCI) is an interesting population in that individuals, who want to work, can work with the appropriate technology and accommodations. Yet, over half of the individuals with SCI who worked prior to their injury remain unemployed years later. Many of the past and current studies investigating employment recruit subjects who are at least 18 years of age, with some recruiting individuals who are 16 years of age. Children with disabilities have a plethora of resources and services offered to them within the school district. From Individualized Education Programs (IEP) to transition services, many individuals work with the child to help them become an active participant in society. This study looks specifically at SCI of pediatric-onset. Examining already existing data collected by the NSCID, we investigated: a) employment and education rates among individuals with pediatric-onset SCI (PO-SCI) compared with adult-onset SCI (AO-SCI); b) variables that may contribute to vocational outcomes among this population; and c) if acquiring an SCI at a young age is positively correlated with higher rates of employment and levels of education. Statistical results yielded no difference between PO-SCI and AO-SCI with respect to employment rates (working vs. not working). Differences were noted in level of education achieved between PO-SCI and AO-SCI, with individuals who had PO-SCI more likely to pursue additional education and higher levels of education post-injury. Results do indicate that post-injury level of education does correlate with post-injury employment status; higher levels of education yielded higher employment levels at follow-up. Results from the study also indicate that individuals with spinal cord injury, regardless of age at injury, still remain unemployed years after their injury. Rehabilitation counselors can play a crucial role in helping individuals with SCI overcome employment barriers.

The goal of this project was to test the influence of a pushrim activated power-assisted wheelchair (PAPAW) on the functional capabilities of individuals with cervical level spinal cord injuries (tetraplegia). This repeated measures design type study was divided into two phases, which included testing in two different laboratory settings: a biomechanics laboratory and an activities of daily living laboratory. Fifteen participants included in both phases were fulltime manual wheelchair users (MWUs) with tetraplegia. The purpose of the first phase of the study was to determine the differences in metabolic demands, stroke frequency, and upper extremity joint range of motion, during PAPAW propulsion and traditional manual wheelchair propulsion. Participants propelled both their own manual wheelchairs and a PAPAW through three different resistances (slight, moderate and high), on a computer controlled wheelchair dynamometer. Variables analyzed during this phase included: mean steady state oxygen consumption, ventilation, heart rate, mean stroke frequency, maximum upper extremity joint range of motion, and propulsion speed. Results from the first phase of the study revealed a significant improvement in kinematic, speed, and metabolic variables when participants were propelling with a PAPAW. In Phase II, participants propelled both their own manual wheelchairs and a PAPAW three times over an activities of daily living course. The course was constructed to reflect certain obstacles that a manual wheelchair user might encounter in his or her daily routine. PAPAWs received higher user ratings than the participants own manual wheelchair for 10 out of 18 obstacles. Additionally, when using a PAPAW, participants were able to complete the course in the same amount of time while maintaining a lower mean heart rate. For individuals with tetraplegia, PAPAWs have the potential to decrease metabolic demands during propulsion, while increasing or maintaining function within ADLs. Use of this device could help MWUs maintain overall physical capacity while reducing the risk for pain and injuries to the upper extremities, which are often seen among manual wheelchair users with tetraplegia. Future studies with this device should focus on the ability of MWUs with tetraplegia to perform necessary activities of daily living within their home environment and community.

The intelligent screen reader system observes a user¡¯s keystrokes when he or she is performing tasks, and infers an underlying plan structure. The system then generates an optimized script that allows the user to perform the same task more efficiently in the future. The intelligent screen reader system is particularly beneficial for visually impaired computer users. The JAWS for Windows screen reader was chosen for this prototype, since the JAWS scripting language provides flexibility to users for customizing their tasks within a specific application. The JAWS macro recorder, developed by Freedom Scientific Inc., records all the user¡¯s actions. Automated Synthesis of Plan Recognition Networks (ASPRN), developed by Intelligent Reasoning Systems Inc., takes a plan or a script representation as input and outputs a specially-constructed belief network that supports plan recognition. The Script Generation Interface, developed by the University of Pittsburgh, allows users to modify the actions recorded by the JAWS macro recorder and generate an optimized script. Development of the SGI involved integrating the SGI with the JAWS macro recorder, integrating the SGI with ASPRN, and implementing the SGI user interface. Preliminary usability testing involving the intelligent screen reader system was conducted with visually impaired users. Within limited actions and tasks, the results are satisfactory. Users felt the SGI was easy to learn and operate, and that it was efficient to create useful scripts with the intelligent screen reader system. Future work includes adding more plans to the plan library and creating a tutorial system.