Iowa Division of Vocational Rehabilitation Services Strategic Plan, 2011-2014

Strategic Plan for the Iowa Division of Vocational Rehabilitation Services

Fear of Falling Appearing after Post-Acute Rehabilitation is Associated with Reduced Functional Status

Objective: To investigate the association between fear of falling appearing within one month after discharge from post-acute rehabilitation and functional status in elderly patients. Methods: Participants (N=180, mean age 81.37.1 years, 75.6% women) were patients consecutively admitted to rehabilitation over a 6-month period. Demographics, functional, cognitive and affective status were assessed upon admission; functional status was assessed at discharge; history of falls since discharge, functional and affective status were assessed by phone one month after discharge. Fear of falling was assessed using the question: "Are you afraid of falling?". Results: Among patients without fear of falling at discharge (N=95), 20.0% (N=19) reported new fear of falling one month after discharge. Living alone (adjOR=4.9, 95%CI 1.04-23.16, P=.045), functional status at discharge (adjOR=0.5, 95%CI 0.32-0.88, P=.014), and depressive symptoms (adjOR=5.4, 95%CI 1.20-24.32, P=.028) independently predicted fear of falling at one month. There was weak evidence that history of falls since discharge (adjOR=4.1, 95%CI 0.81-21.31, P=.088) was associated with new fear of falling. Developing fear of falling was also associated with reduced functional status at one month (mean basic ADL score: fearful 5.20.8; confident: 5.80.4,P<.001). This association remained after controlling for demographics, functional status at discharge, depressive symptoms, and history of falls since discharge (coef =-0.4, 95%CI -0.73 to -0.16, P=.003). Conclusion: Fear of falling appearing within one month after discharge from post-acute rehabilitation was associated with reduced functional status in elderly patients. Further studies should determine whether early interventions targeting specifically fear of falling in these patients would improve their functional status.

Iowa Vocational Rehabilitation Services Performance Plan, FY2015

Agency Performance Plan, Iowa Vocational Rehabilitation Services

Iowa Vocational Rehabilitation Services Biennial Report, 2011-2012

The division shall report biennially to the governor the condition of vocational rehabilitation within the state, designating the educational institutions, establishments, plants, factories, and other agencies in which training is being given, and include a detailed statement of expenditures of the state and federal funds in the rehabilitation of individuals with disabilities.

Iowa Vocational Rehabilitation Services Biennial Report, 2013-2014

The division shall report biennially to the governor the condition of vocational rehabilitation within the state, designating the educational institutions, establishments, plants, factories, and other agencies in which training is being given, and include a detailed statement of expenditures of the state and federal funds in the rehabilitation of individuals with disabilities.

Courtyard Houses and Other Complex Buildings in the Protohistory of Southern Gaul: From Architectural to Social Changes

Courtyard houses are attested at several sites in southern Gaul between the 5th and the 1st centuries BC. They represent a new concept when compared to the traditional protohistoric houses of the region and have often been interpreted in terms of Mediterranean, Greek or Italic influences. Regardless of their origin, exogenous influences or evolution, these houses suggest the emergence of social differentiation and elites in several of the main settlements. This article analyses the significance of the various courtyard house categories in the context of local, indigenous societies, while trying to understand the social implications of this new type of residence. In a wider context, the development of domestic architecture during the Iron Age is analysed alongside the relationships between changing uses of space and social changes.

Pressure Relief and Other Joint Rehabilitation Techniques, HR-1042, 1987

A study of four major concrete pavement joint rehabilitation techniques has been conducted, including: pressure relief joints, full-depth repairs, partial-depth repairs and joint resealing. The products of this research include the following for each technique: a summary of published research, detailed documentation of the design and performance of the 36 projects, conclusions and recommendations of the state highway engineers panel, "Design and Construction Guidelines" and "Guide Specifications." The latter two products are prepared for use by state highway agencies. The results of this study are based upon a review of literature, extensive field surveys and analysis of 36 rehabilitation projects, and the experience of an expert panel of state highway engineers.

Rehabilitation of Concrete Pavements Utilizing Rubblization and Crack and Seat Methods (Phase II): Performance Evaluation of Rubblized Pavements in Iowa, TR-550, 2008

This Phase II follow-up study of IHRB Project TR-473 focused on the performance evaluation of rubblized pavements in Iowa. The primary objective of this study was to evaluate the structural condition of existing rubblized concrete pavements across Iowa through Falling Weight Deflectometer (FWD) tests, Dynamic Cone Penetrometer (DCP) tests, visual pavement distress surveys, etc. Through backcalculation of FWD deflection data using the Iowa State University's advanced layer moduli backcalculation program, the rubblized layer moduli were determined for various projects and compared with each other for correlating with the long-term pavement performance. The AASHTO structural layer coefficient for rubblized layer was also calculated using the rubblized layer moduli. To validate the mechanistic-empirical (M-E) hot mix asphalt (HMA) overlay thickness design procedure developed during the Phase I study, the actual HMA overlay thicknesses from the rubblization projects were compared with the predicted thicknesses obtained from the design software. The results of this study show that rubblization is a valid option to use in Iowa in the rehabilitation of portland cement concrete pavements provided the foundation is strong enough to support construction operations during the rubblization process. The M-E structural design methodology developed during Phase I can estimate the HMA overlay thickness reasonably well to achieve long-lasting performance of HMA pavements. The rehabilitation strategy is recommended for continued use in Iowa under those conditions conducive for rubblization.

Timber Abutment Piling and Back Wall Rehabilitation and Repair, TR-616, 2012

Based on previous National Bridge Inventory data, the state of Iowa has nearly 20,000 bridges on low-volume roads (LVRs). Thus, these bridges are the responsibility of the county engineers. Of the bridges on the county roads, 24 percent are structurally deficient and 5 percent are functionally obsolete. A large number of the older bridges on the LVRs are built on timber piling with timber back walls. In many cases, as timber abutments and piers age, the piling and back wall planks deteriorate at a rate faster than the bridge superstructure. As a result, a large percentage of the structurally deficient bridges on LVRs are classified as such because of the condition of the timber substructure elements. As funds for replacing bridges decline and construction costs increase, effective rehabilitation and strengthening techniques for extending the life of the timber substructures in bridges with structurally sound superstructures has become even more important. Several counties have implemented various techniques to strengthen/repair damaged piling, however, there is minimal data documenting the effectiveness of these techniques. There are numerous instances where cracked and failed pilings have been repaired. However, there are no experimental data on the effectiveness of the repairs or on the percentage of load transferred from the superstructure to the sound pile below. To address the research needs, a review and evaluation of current maintenance and rehabilitation methods was completed. Additionally, a nationwide survey was conducted to learn the methods used beyond Iowa. Field investigation and live-load testing of bridges with certain Iowa methods was completed. Lastly, laboratory testing of new strengthening and rehabilitation methods was performed.

Special investigation of the University of Iowa Health Care, Department of Orthopaedics and Rehabilitation, for the period July 1, 1999 through December 31, 2014

Special investigation of the University of Iowa Health Care, Department of Orthopaedics and Rehabilitation, for the period July 1, 1999 through December 31, 2014

Iowa System of Bridge Deck Rehabilitation with Cathodic Protection, HR-1044, 1986

Bridge deck and substructure deterioration due to the corrosive effects of deicing chemicals on reinforcing steel is a problem facing many transportation agencies. The main concern is protection of older bridges with uncoated reinforcing steel. Many different methods have been tried over the past years to repair bridge decks. The Iowa system of bridge deck rehabilitation has proven to be very effective. It consists of scarifying the deck surface, removing any deteriorated concrete, and overlaying with low slump dense concrete. Another rehabilitation method that has emerged is cathodic protection. It has been used for many years in the protection of underground pipelines and in 1973 was first installed on a bridge deck. Cathodic protection works by applying an external source of direct current to the embedded reinforcing steel, thereby changing the electrochemical process of corrosion. The corroding steel, which is anodic, is protected by changing it to a cathodic state. The technology involved in cathodic protection as applied to bridge decks has improved over the last 12 years. One company marketing new technology in cathodic protection systems is Raychem Corporation of Menlo Park, California. Their system utilizes a Ferex anode mesh that distributes the impressed direct current over the deck surface. Ferex mesh was selected because it seemed readily adaptable to the Iowa system of bridge deck rehabilitation. The bridge deck would be scarified, deteriorated concrete removed, Ferex anode mesh installed, and overlaid with low slump dense concrete. The Federal Highway Administration (FHWA) promotes cathodic protection under Demonstration Project No. 34, "Cathodic Protection for Reinforced Concrete Bridge Decks."

Pavement Management and Rehabilitation of Portland Cement Concrete Pavements, MLR-80-01, 1981

None provided.

Surgical results in patients with chronic low back pain who failed multidisciplinary rehabilitation with cognitive intervention

Introduction¦Surgery for chronic low back pain (CLBP) is a controversial topic. One randomized controlled¦trial (RCT) showed superiority of surgery to physiotherapy only, whereas two more RCTs¦failed to show that surgery was better than multidisciplinary rehabilitation including cognitive¦intervention. The latter is therefore regarded as the golden standard of conservative¦treatment and in our unit it is whenever possible offered to patients prior to lumbar surgery¦for CLBP.¦The objective of this study was to compare results of lumbar surgery between one group of¦patients who failed to improve despite such rehabilitation and a second group of patients who¦underwent surgery following usual conservative therapies. Our hypothesis is that patients¦who failed such a comprehensive treatment would respond poorly to surgery.¦Patients and Methods¦43 patients (age 41.2±8.1 years, number of men 20) were operated between 2003 and 2009¦by a single surgeon for CLBP due to degenerative disc disease (36) or isthmic¦spondylolisthesis (7). Patients with sciatica or neurological abnormalities were excluded.¦Seventeen (40%) patients were operated having failed to improve following the¦aforementioned rehabilitation programme (Surgery following rehabilitation group) whereas¦the remaining 26 (60%) were operated having failed to improve with physiotherapy of varying¦intensity (Surgery following physiotherapy group). Oswestry disability index (ODI) pre¦operatively and at 2 years following surgery was prospectively evaluated. Fisher's exact test¦was used to compare groups.¦Results¦At two years following surgery, with an average follow up of 22 month, a 15 points ODI¦improvement was achieved for 9 (53%) patients of the surgery following rehabilitation group¦and in 15 (58%) patients of the surgery following physiotherapy group (p=1.0). A 50% ODI¦improvement was observed for 6 (35%) and 12 (46%) patients respectively (p=0.54).¦Discussion¦The main finding of this study was that surgery following failed multidisciplinary rehabilitation¦yields similar results to those of patients who only received usual physiotherapy treatment for¦CLBP prior to surgery. But surprisingly we found that it is possible with surgery to improve¦the quality of life of those CLBP sufferers who failed to respond to a comprehensive¦rehabilitation program and with a similar success rate to those reported in other series.¦But rehabilitation should still be offered as a treatment option in all CLBP patients prior to¦surgery, given that it is devoid of complications and that it will spare the need of surgery to a¦significant proportion of CLBP patients while not compromising surgical results in the¦remaining subjects who failed to improve.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.