bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for perceptual problems in acute stroke patients
Authors: Barer DH , Edmans JA , Lincoln NB
Published: July 2008

Simple screening tests for visual and tactile inattention were used to assess the frequency, associated features and rate of resolution of gross perceptual impairment in a group of 362 conscious patients, assessed within 48 hours of a cerebral hemisphere stroke. Two-thirds of the patients initially showed impairment on at least one of the tests, but by the end of the first week only half of the survivors still showed a deficit, and after a month this proportion had fallen below 30%. In 84 patients the results of the screening tests were compared with those of a more detailed assessment, the Rivermead Perceptual Assessment Battery (RPAB), performed one month after the stroke. The RPAB scores were strongly associated with the results of both screening tests, and particularly with those of the test for visual inattention/hemianopia. The results of the screening tests on admission to hospital predicted which patients would and would not develop significant perceptual problems later on. Thus, less than 10% of those with normal visual fields on day one achieved low scores on more than half the RPAB tests. All three indicators of perceptual impairment were associated with markedly worse outcome at six months, the RPAB scores having the greatest and visual fields the least prognostic value.
Age-related slowing and fragmentation of a complex movement quantified by optoelectronic kinesiology
Authors: Valls M. , Ingvarsson P. , Johnels B. , Steg G. , Thorselius M. , Svanborg A.
Published: July 2008

Computer-assisted optoelectronic movement analysis has opened a new field in quantitative laboratory studies of motor function in freely moving humans. In order to establish a method for objective and quantitative documentation of age-related change of a complex movement, a lifting task composed of rising, gait and arm movements was designed. The motor performance of 44 healthy subjects in three age groups was recorded optoelectronically. The change in motor function in the age interval of 40-75 years was mainly due to slower motor performance. In a majority of the subjects aged 85, a movement fragmentation also occurred, indicating deficient co-ordination of rising, gait and arm movements in this age group. The method was found to be well suited to clinical studies of movement pattern and disturbances in elderly subjects. The design of specific tests measuring different aspects of the age-related change in motor function may be of value for sociomedical planning of care and prevention.
Pressure sores: the views and practices of senior hospital doctors
Authors: Sutton Jane C , Wallace W. Angus
Published: July 2008

A survey of 34 senior hospital doctors in Nottingham, in the Department of Orthopaedic and Accident Surgery and the Health Care of the Elderly Department, was undertaken by interview to discover their views on the management of pressure sores. The majority of doctors (85%) favoured the 'team' approach to pressure sore management, but the other responses suggest that, in fact, they see nurses as having a greater role than themselves in prevention and care. They also favoured greater nursing input rather than the use of pressure relieving devices in pressure sore management. The predicted problems of maintaining nurse staffing levels and an increase in the population at risk of sustaining pressure sores would combine to make the doctors' wishes impossible to achieve.
The nurse in rehabilitation after severe brain injury
Authors: Henderson Elizabeth J , Morrison Judith A , Young Elizabeth A , Pentland Brian
Published: July 2008

Severe traumatic brain injury (TBI) may result in complex disabilities in those who survive which have important implications for nursing staff responsible for their early care. A detailed survey was made of 100 consecutive TBI admissions to a neurorehabilitation unit over a two-year period. Most patients were young men, and the great majority were direct transfers from acute neurosurgical units. About two-thirds were admitted for rehabilitation within three months of injury. Ninety-five patients had at least one neurological deficit, the commonest being limb paresis; 83 were dependent on nurses for one or more activity of daily living; 79 had problems with orientation or memory; and 28 exhibited aggressive behavioural disturbance. The case for specific facilities for these patients, the need for an expansion in the role of the nurse in the interprofessional team and the implications for nurse staffing and training are discussed in the light of these findings.
Which elderly admissions are referred for speech therapy? An audit and an intervention
Authors: Wimbury Richenda , McMaster Catherine , Briggs Roger
Published: July 2008

Referrals for speech therapy were monitored in 1781 patients aged over 65 years admitted to medical and geriatric wards during a 10.5 month period, before and after the introduction of an assessment programme. Low referral rates of admissions before (4.1 %) and after (4.7%) the programme, compared to 15.8% during the programme, suggest that ward staff may not perceive disorders of communication and swallowing without regular contact with a speech therapist.
Functional assessment in spinal cord injury: a comparison of the Modified Barthel Index and the 'adapted' Functional Independence Measure
Authors: Roth Elliot , Davidoff Gary , Haughton John , Ardner Mary
Published: July 2008

The Modified Barthel Index (MBI) and the Functional Independence Measure (FIM) have been used to provide objective measures of functional status and change of spinal cord injured (SCI) patients. To compare rating scores on the MBI and FIM, the functional abilities of 41 SCI patients were rated by one trained nurse-clinician using both scales at admission to initial rehabilitation (ADM), discharge from rehabilitation (DC) and at follow-up (FU) 12 months after rehabilitation. An 'adapted' FIM score was used, and total MBI and FIM scores were divided into self-care and mobility subscores. Comparisons were made between each MBI score and each FIM score at each point in time (ADM, DC, FU) using simple linear regression, which was also used to compare changes in the MBI and FIM scores from ADM to DC and from DC to FU. Excellent correlations ( p<0.0005) were found between MBI and FIM scores at all points in time and between changes in MBI scores and changes in FIM scores over each time interval.
Does drug treatment have a placebo effect on programmed training in intermittent claudication? A randomized clinical trial
Authors: Lepäntalo Mauri , Kalajo Katariina , Lilius Gustaf
Published: July 2008

We have previously observed that programmed physical training improved walking tolerance in intermittent claudication, even after temporary discontinuation of the training programme, in the presence both of active drug and placebo treatment. We therefore established the effect of physical training alone and in combination with placebo on intermittent claudication. Of the 23 patients recruited forthe study aged 47-76 years, 17 completed the six-month supervised training programme. In this randomized parallel group study the treatment with placebo did not appear to affect the overall improvement in walking tolerance achieved during the programmed training; the mean final pain-free walking distance was 4.2 times the initial level. Furthermore, when retrospectively comparing those who increased their physical activity including submaximal walking and dynamic leg exercises more than one hour daily to those whose increase was one hour or less a clear trend towards further improvement in walking tolerance could be observed. Thus our present results corroborate the beneficial effect of programmed training and emphasize the significance of patient compliance, although we are unable to disclose any placebo effect attributable to drugs in the conservative treatment of intermittent claudication - this is at least partly due to the small size of the patient sample.
The orthotic ambulation performance of paraplegic myelomeningocele children using the ORLAU ParaWalker treatment system
Authors: Stallard J. , Major RE , Butler PB
Published: July 2008

The ORLAU ParaWalker has been established since 1983 as a routine clinical treatment to enable paraplegic patients to ambulate. During its development as an orthotic device, a review of 27 spina bifida patients showed that it produced significant improvements in Hoffer's Classification of handicapped gait in comparison with their performance in conventional orthoses. Following an additional period of development, during which the philosophy was evolved of making the device part of a treatment system, a further review of patients routinely supplied by ORLAU was conducted. This shows that the performance of patients has significantly improved, with 34% of children using the ParaWalker now achieving community status as compared with 7% in the earlier study. This improvement is attributed to the introduction of a treatment system which includes training regimes and regular follow-up of patients as well as better engineering specification.
Policies on the management of patients with head injury: the experience of Oxford Region
Authors: Wade Derick T
Published: July 2008

Policies on the management of head injury are being discussed widely. This article draws upon experience in the Oxford Region and discusses policies covering all aspects of the management of head injury from prevention to long-term care. The main recommendations are as follows.

1) Health Authorities should promote prevention as far as possible.

2) Each Health Authority should have a policy on the emergency management of patients with severe trauma, stressing the management of head injury.

3) Each casualty department should have written policies covering:

- the use of skull X-rays;

- who should be admitted;

- who needs urgent CT-scans and referral to neurosurgery:

- preparation of patients for transfer to neurosurgery.

4) All adult patients with head injury should be admitted to a specialized ward which has written policies covering:

- observations to be made AND actions to be taken;

- discharge and follow-up;

— referral to District neurological disability team;

- referral to Regional rehabilitation centre;

— management of behaviourally disturbed patients.

5) Most rehabilitation should be the responsibility of a District disability service specialized in neurological disability, but there should be a Regional centre for patients with unusual or severe disabilities.

6) There should be a named consultant in each District responsible for:

— clinical management of patients with moderate to severe disability;

- formulating and monitoring District policies for head injury.

7) Districts and Regions should consider how to manage patients:

-with severe acute behavioural problems, especially aggression;

-with long-term behavioural or cognitive problems.

8) Paediatric services for head injury should receive similar attention, with additional emphasis on liaison with schools.

9) Education of all staff should be a very high priority.

10) Close liaison and co-operation with all other agencies is essential.
A clinical trial of the re-education of movement in patients with Parkinson's disease
Authors: Yekutiel Margaret P , Pinhasov Asher , Shahar Gila , Sroka Hava
Published: July 2008

Methods of physiotherapy in general use for Parkinson patients, in so far as they have been evaluated, have been found to lack therapeutic effect. This is attributable to the use of methods developed for other conditions and inappropriate for the special needs of these patients.

Observation and analysis of Parkinson patients' movement problems led to the working hypothesis that they lack the manoeuvring of the body's centre of gravity, i.e. the whole-body movement, which normally precedes and accompanies action. A programme of therapy was developed for teaching whole-body movement and conscious strategies for overcoming obstacles to movement in daily life. Twelve Parkinson patients, in Hoehn-Yahr stages III-IV, were treated twice a week for three months. Standardized mobility tests, filmed before and after treatment, showed a statistically significant mean decrease of over 40% in total test time.
Relationship between active range of motion deficits and muscle strength and tone at the elbow in patients with hemiparesis
Authors: Bohannon Richard W
Published: July 2008

The purpose of this study was to describe the relationship between deficits in active range of motion (ROM) at the elbow and both agonist muscle strength and antagonist muscle tone in patients with stroke. Twenty-three patients with non-flaccid hemiparesis participated. Active elbow flexion and extension ROM were measured gravity eliminated bilaterally and ROM deficits were calculated for the paretic side. Isometric elbow flexion and extension strength were measured on the paretic side using a hand-held dynamometer. Elbow flexor and extensor muscle tone were graded manually using the Modified Ashworth Scale. The Spearman correlations between active elbow flexion ROM deficits and elbow flexion force, and between active elbow extension ROM deficits and elbow extension force were -.929 and -.772 respectively. The correlations between the elbow flexion ROM deficits and elbow extensor muscle tone, and between the elbow extension ROM deficits and elbow flexor muscle tone were .287 and .480 respectively. Regression analysis revealed a curvilinear relationship between active elbow flexion ROM deficits and elbow flexion force (R =.881), and a linear relationship between active elbow extension ROM deficits and elbow extension force (R = .771). In patients like those tested, agonist muscle force (strength) may be more important than passive antagonist restraint (tone) as a determinant of ROM deficits. Because a limited amount of muscle force is required for full active ROM, increases in muscle strength beyond some threshold will not be accompanied by further improvements in active ROM.
The unreliability of sensory assessments
Authors: Lincoln NB , Crow JL , Jackson JM , Waters GR , Adams SA , Hodgson P.
Published: July 2008

The intra- and inter-rater reliability of a standardized assessment of sensory impairment were investigated. Twenty stroke patients were assessed at home by the same physiotherapist on two occasions. There was good consistency overtime on most items. Twenty patients in hospital were assessed by two physiotherapists. The results indicate poor agreement between assessors. Twenty-five patients were assessed by a physiotherapist and a doctor. Results indicate low agreement between these assessors. Results indicate poor inter-rater reliability on a standardized assessment. It is suggested that this may also be a problem for clinical assessments of sensory impairment after stroke.
Head injury follow-up: is the Sickness Impact Profile a useful clinical tool?
Authors: Smith Helen E
Published: July 2008

Twenty adults who had sustained severe head injury completed the Sickness Impact Profile questionnaire and the Leeds Scales of anxiety and depression five or more years after the injury. All but one of the subjects reported persistent problems, and all but eight were either unemployed or working in a reduced capacity. Patients' reports were supported by those of relatives. It is argued that both patients and relatives should be followed up regularly, for more than just the first year, and that the Sickness Impact Profile would serve this purpose well. The advantages and limitations of this instrument for clinical use are discussed.
The feasibility of indicators and targets for rehabilitation services
Authors: McLellan DL
Published: July 2008

The costs and burdens of disability are extremely high. It is reasonable to expect that both will be reduced by meeting appropriate targets for rehabilitation services which will also result in an improved quality of life and the prevention of further disability and unnecessary suffering. Targets which require collaboration between services are particularly powerful as agents of change because better collaboration will inevitably lead to the resolution of further problems outside the immediate target area at no additional cost.

There is general agreement that the most important goals for these services are the same as the goals formulated by disabled people themselves and relate to self-care, communication, mobility, continence, fulfilling activities (particularly employment), 'equivalent resources', the needs of those with complex disability and the needs of informal carers. Choice of treatment, and of residential options, needs to be open to the consumer for a fully satisfactory outcome to be assured.

This paper identifies 11 goal areas and argues for the selection of key indicators for this initial round of target setting. A target is suggested for each indicator. In turning this strategy into action, it is essential to ensure that health authorities and other government departments are charged with meeting these objectives and that appropriate rewards and penalties are employed to ensure reasonable compliance. Setting targets at this stage would greatly increase the information available to the Government at the next round of target-setting, and would stimulate the generation of ideas for research. Tangible improvements would be demonstrated within four years.
Gait analysis: a step in the right direction
Authors: Duncan G. , Currie GD , Evans AL , Gartnavel W Gilchrist
Published: July 2008

Tri-axial accelerometery has recently been shown to produce reliable gait parameters in normal subjects. This study reports the use of this device in patients with pathological gait. Thirty-three patients with a variety of mobility-limiting disorders were studied. All patients were independently mobile with or without a walking aid. Gait was recorded by attaching the tri-axial accelerometer over the patient's sacrum with the patient walking at their usual pace along a 6m path. Gait speed was measured in all 33 patients and ranged from 0.11 m/s to 0.82m/s. Gait parameters could not be calculated in eight patients. In the remaining 25 patients, gait cycle time, cadence, stride length and mean right and left step times could be calculated. Interobserver variation was 2%. Comparison of right and left step times enabled lateralization of the gait abnormality. This portable technique allows rapid qualitative and quantitative assessment of gait within a normal ward environment.
Knee extension power, velocity and torque: relative deficits and relation to walking performance in stroke patients
Authors: Bohannon Richard W
Published: July 2008

This study of hemiparetic stroke patients aimed to determine the nature and usefulness of dynamometer measurements of knee extension power compared to knee extension velocity and torque. Twenty subjects (mean age 63.7 years, time since stroke 70 days) performed maximum knee extension efforts on a Lido dynamometer. Specifically measured on each side were power and velocity during maximum velocity efforts and peak torque during isometric efforts. Subjects were timed while walking 7m at their 'most comfortable' and 'maximum safe' speeds. The mean knee extension performance deficits on the paretic side, compared to the nonparetic side, were 58.4% for power, 30.0% for velocity, and 44.5% for torque. The deficits were significantly different from one another. All muscle performance measures were correlated significantly with the gait speed measurements (paretic side r = 0.633-0.752; nonparetic side r = 0.448-0.650). Power measures were not clearly superior to velocity or torque measures for explaining gait speed. Measures of the paretic side, however, were superior to measures of the nonparetic side for predicting gait speed.
The professional competence of speech therapists. I: introduction and methodology
Authors: Davies Philip , van der Gaag Anna
Published: July 2008

This paper is the first of a four part report on a study of the professional competence of speech therapists in the United Kingdom. It considers some of the methodological approaches to the study of professional competence, and describes the methods adopted for this study. A combination of consultative and survey techniques were used to determine which knowledge, skills and attitudes were considered essential to the competence of speech therapists working in three specialities; children, learning difficulties, and elderly/adults with acquired neurological disorders. Sixty-eight speech therapy 'experts' were consulted using Delphi and Nominal Group techniques. The items of knowledge, skills and attitudes generated by these experts were then distributed to 657 specialist speech therapists in order that the lists could be validated by a larger sample of clinicians.
Outcome evaluation
Authors: Geddes Joanna ML , Chamberlain M Anne
Published: July 2008

At the present time 'better health care' is one of the two main government objectives for the National Health Service. Since this implies future improvement it is essential to be able to describe current practice. This article describes the outcome (current practice), principally in terms of Barthel score, for stroke patients receiving rehabilitation on a specialized ward and puts forward a suggestion for a minimum data set which could be used to describe current practice on all rehabilitation wards.
Performance of stroke patients on the Middlesex Elderly Assessment of Mental State
Authors: Shiel A. , Wilson BA
Published: July 2008

As the population of elderly people rises, so too does the incidence of stroke. Cognitive impairment is considered to be a strong predictor of outcome following stroke, and elderly patients may have pre-existing, undiagnosed cognitive impairment as well as impairment caused by the stroke. The present study describes the performance of patients with unilateral hemispheric stroke (right hemisphere, n = 38; left hemisphere, n = 17) on the Middlesex Elderly Assessment of Mental Status (MEAMS), which was developed as a screening tool of cognitive dysfunction for elderly patients.1 Patients had no documented evidence of premorbid cognitive impairment. All patients with scores at borderline or below (n = 7) had language impairment and thus had difficulty with the language-oriented tests. Differences between right and left hemisphere groups are also presented and their performance on the various subtests discussed. It is concluded that the MEAMS is a useful instrument in screening stroke patients for cognitive impairment.
Insight and progress in rehabilitation after brain injury
Authors: Malia Kit B , Torode Stewart , Powell Graham E
Published: July 2008

The importance of insight processes after brain injury is stressed. Research in a general rehabilitation population has shown relations between insight and rehabilitation gain only when insight is defined in terms of pessimism or optimism, with optimists making more progress. The aim of this study was to examine these findings within a brain-injured population. Eighteen subjects with acquired brain injury completed ratings across four domains of function: cognitive, physical, executive and psychosocial. These ratings were compared with professional ratings on the same scales. Despite the use of carefully defined and measured indices of insight, no correlations were found with rehabilitation gain. Previous studies are re-examined in the light of these findings and it is concluded that the concept of insight requires further elaboration and research before definitive statements can be made about its influence on rehabilitation gain.
Facilitation of handwriting in a case of dystonic writer's cramp: a kinesiological EMG study
Authors: Arroyo Jésus F , Blanc Yves
Published: July 2008

Dyskinetic disorders can affect fine manual motor skills, particularly handwriting. We have developed a one-finger device to aid handwriting. This paper reports a case in which dystonic posturing has been prevented with the simplification of the handwriting motor task. Additional kinesiological EMG recordings show a significant alteration in the pattern and quantity of electrical muscle signals using this device.
A controlled, multicentre trial of manual therapy with steroid injections in low-back pain: functional variables, side effects and complications during four months follow-up
Authors: Blomberg S. , Tibblin G.
Published: July 2008

Outpatients with acute or subacute low-back pain were randomly allocated to one of two treatment groups. One group (n = 53) was given standardized but optimized conventional activating treatment by primary health care teams. The other group (n = 48) received specific manual treatment such as manipulation, specific mobilization, muscle stretching, autotraction and cortisone injections. There were significant differences on 15 disability rating scores and complaints in everyday life due to low-back problems in favour of the group receiving manual treatment, indicating that this treatment was superior to conventional treatment. The patients given manual treatment had a more positive view of treatment than those in the conventionally treated group. The experimental treatment was more painful than the conventional treatment, due to injections and muscle stretching. Only a few patients experienced manipulation and specific mobilization as painful. No persisting deterioration or complications were reported due to the experimental treatment.
Validation studies of the OPCS scale — more useful than the Barthel Index?
Authors: McPherson K. , Sloan RL , Hunter J. , Dowell CM
Published: July 2008

The OPCS scales of disability were developed as a survey tool to estimate the prevalence of disability amongst adults in the UK. This study evaluates the use of the OPCS scales in a clinical setting. A total of 265 patients attending a rehabilitation unit and wheelchair centre were assessed. The OPCS scales were validated against the standard Barthel Index and sensitivity to change over time was examined. An inter-rater reliability study was also performed. The results showed good correlation between the OPCS scales and Barthel Index (0.82, p < 0.001, n = 265) and it was shown that the OPCS scales were sensitive to clinical change over a six-month period. Inter-rater reliability was also good (0.96, p < 0.001, n = 120). The 95% confidence limits were also examined. The 'ceiling' effect of the Barthel Index is not found in the OPCS scales of disability. The results of the study support further use of the OPCS scales and suggest that it has a place in the assessment of rehabilitation outcome.
Communication disorders in a hospital elderly population
Authors: Sweeney T. , Sheahan N. , Rice I. , Malone J. , Walsh JB , Coakley D.
Published: July 2008

There is a paucity of information regarding the prevalence and causes of communication disorders in the elderly. Patients admitted to the acute ward of a department of medicine for the elderly were screened to ascertain the number of people presenting with communication disorders and to identify the underlying cause of the disorder. Patients were screened for deficits in speech, language, vision, hearing and cognition. The results indicate that 73% of the elderly population screened had speech and/or language problems, 11 % had visual deficits, 36% had hearing problems and 56% had a cognitive deficit on admission to hospital. These results have implications for patient care and staff training.
Visual feedback after stroke with the balance performance monitor: two single-case studies
Authors: Sackley CM , Baguley BI
Published: July 2008

Research over the past decade had indicated the effectiveness of visual feedback as a method of training stance symmetry and weight-transference after stroke. This study was carried out to assess the efficacy of the Balance Performance Monitor (BPM) in providing feedback. A reversal ABAB single-case experimental design was used with two patients at different stages poststroke. Assessments of motor function and independence in functional tasks (ADL) were made, as well as the measures of stance symmetry. The results indicated large improvements in symmetry, with both patients achieving levels within the normal range after five treatments. Functional skills also improved. Although the limitations of single-case studies are recognized, such dramatic improvements suggest that the BPM is an effective method of providing feedback and that this approach to treatment enhances the effects of physiotherapy and could be used more frequently after stroke.
Review article : An overview of isokinetic dynamometry with specific reference to the upper limb
Authors: Walmsley Roy P , Pentland Wendy
Published: July 2008

Isokinetic dynamometry offers distinct advantages, both clinically and for research, in the evaluation and treatment of muscle performance. The concepts of isokinetic muscle contractions are outlined and the operation and utilization of isokinetic dynamometers explained. The literature examining the reliability and validity of isokinetic protocols is reviewed. Application of this modality is discussed both from the clinical and research perspective. The existing, but limited, literature on isokinetic dynamometry with the upper limb is reviewed, and recommendations are made as to areas requiring further investigation.
A study of wrist pain in industry — theories of causation
Authors: Grieve Elizabeth F
Published: July 2008

Arm pain has been reported in industry as a major reason for absence, particu larly amongst those whose jobs are heavy or repetitive. The purpose of this study was to identify the precise anatomical sites and nature of the conditions affecting industrial subjects. A modular physical examination was devised with an introductory module performed 'blind' to minimize bias, and a series of optional sub-modules to cope with the great variety of conditions.

The results of the examination of 332 subjects (220 with arm pain and 112 with none) demonstrated joint dysfunctions in 60% of 70 subjects reporting wrist pain. Some 20% of the wrist joint dysfunctions were 'hidden', which may explain the reports of 'nil findings'. In contrast to this there were lower than expected frequencies of tendinitis, tenosynovitis and carpal tunnel syndrome.

Theories of causation are discussed together with the implications for industry, and suggestions are made for assessment procedures.
Muscle vibration alters the trajectories of voluntary movements in cerebellar disorders — a method of counteracting impaired movement accuracy?
Authors: Lövgreen B. , Cody Fwj , Schady W.
Published: July 2008

The alterations of voluntary wrist extension movements (30 degree target amplitude, one second movement time) induced by the application of vibration (125 Hz, 0.75 mm peak-to-peak displacement) to a flexor muscle, an antagonist being passively lengthened by active extensor contraction, have been studied in 12 patients with cerebellar dysfunction and an equal number of age-matched healthy subjects. Cerebellar patients generally perform wrist movements inaccu rately : thus, such movements are suitable for investigating the abnormalities of the rate and range (dysmetria) of their movements. Vibration elicited a significant reduction in the end-position of the relatively slow movements investigated, and a consequent undershooting of target trajectories in both patients and control subjects ( p < 0.01, Wilcoxon test). The extent of vibration-induced undershooting was similar in the two groups. Nonvibrated extension movements were produced in both groups by progressive increases in extensor (prime- mover) electromyographic (EMG) activity with little antagonist co-contraction. Vibration-induced undershooting resulted principally from a sustained reduction in extensor activity. These findings support two main conclusions. First, the dysmetria shown by our patients cannot be simply attributed to the failure of a proprioceptive feedback loop. Secondly, the provision of vibratory stimulators, controlled by goniometers sensing joint angle, is a potentially viable approach to counteracting cerebellar dysmetria, e.g. by limiting excessive movement in certain situations.
Wheelchair tyre pressure: a community survey and an investigation of effect of low pressure on physiological energy expenditure during self- propulsion
Authors: Henriksen PA , Hunter J. , Warren PM
Published: July 2008

Wheelchairs issued on prescription are of a generic design and only accommodate individual requirements to a limited extent. Basic maintenance, for example use of the recommended tyre pressure to minimize rolling resistance, may therefore help reduce the energy expenditure of propulsion for patients issued with these standard wheelchairs. In a community survey of 145 wheelchairs (99 self-propulsion and 46 attendant-propulsion models) we found that only 4% of the self-propulsion wheelchairs had the recommended tyre pressure. Overall, 14% had pressures ≤ 5 pounds per square inch (psi) and a further 37% were between six and 15 psi. In 10 able-bodied subjects, we also found a significant rise (p < 0.01) of approximately 20% in the physiological energy expenditure of self-propelling a standard wheelchair, as assessed by minute ventilation, gas exchange and heart rate, when tyre pressure was reduced from 45 psi to ≤ 5 psi. Introduction of solid synthetic tyres, therefore, will have considerable advantages for patients who do not maintain even the lowest pressure needed to minimize energy expenditure. Use of this material for tyres of self-propulsion wheelchairs is also highly desirable.
Asymmetrical trunk posture, unilateral neglect and motor performance following stroke
Authors: Taylor D. , Ashburn A. , Ward CD
Published: July 2008

It has been observed that some patients, often with unilateral neglect, have difficulty sitting with their trunk symmetrically and tend to lean towards their affected side. The aim of the study was to see whether this inability to achieve midline sitting existed, and if it did whether there was any relationship with motor function and unilateral neglect.

The sample consisted of 38 stroke patients assessed at one, three and six weeks post stroke. Of these 17 had a right hemiplegia and 21 a left hemiplegia. Data were collected using the Rivermead Motor Assessment (RMA), star cancellation tests and a measure of midline position.

By six weeks most (28) of the subjects sat with their trunk in the midline or towards their unaffected side (group A). Nine subjects sat with their trunk leaning to their affected side (group B). Most of this group (eight) showed signs of unilateral neglect. Chi-square statistics showed that there were more subjects with unilateral neglect in group B than group A ( p <0.001).

In the gross function section of the RMA Mann-Whitney statistics showed that group B scored significantly worse than group A at three and six weeks post stroke ( p = 0.029, p = 0.008). There were no differences in the groups in terms of leg/trunk or arm scores.

The findings suggest that there is a group of stroke patients who tend to sit with their trunk leaning towards their affected side and that these patients tend to have unilateral neglect and a poorer functional outcome.
Failure to deliver the formal therapy prescribed in an NHS rehabilitation unit
Authors: Hanspal R. , Wright M. , Proctor D. , Peggs S. , Whitaker J. , McLellan DL
Published: July 2008

The objectives of the study were to ascertain the extent to which short-term goals of therapy were achieved and to assess the discrepancy, if any, between the therapy prescribed and the therapy delivered.

The weekly therapy prescribed and delivered over a two-month period was recorded. The outcome of goal setting was assessed in relation to the predicted time set for achieving the goal.

All patients admitted to a rehabilitation ward in an NHS teaching hospital during the two months were studied.

No patients received the full treatment prescribed. The percentage of prescribed treatment given to patients ranged from 33.3% to 66.4%. Over 95% of the goals set during the period were achieved but only 60% were achieved on time and 37% were achieved later than expected.

The therapy prescribed for patients was not being delivered due to inadequate resourcing of therapy time. A 5% increase in funding to the rehabilitation ward would generate a 50% increase in the amount of formal therapy given which would be likely to shorten patients' stay in hospital.
Does intereferential therapy affect blood flow?
Authors: Lamb Sarah , Mani Raj
Published: July 2008

Interferential therapy (IT) is an electrothrapeutic technique widely used in physiotherapy departments to treat pain and soft-tissue injuries. It has been suggested that IT has a dose-related effect on blood flow, and as such, can be used in the management of a variety of circulatory disorders. There is no satisfactory evidence to support these claims. The aim of this study was to establish noninvasive methods of measuring the response of the arterial and microcirculation concomitantly; and to document the circulatory response in the adult human volunteer. Three frequencies of IT were tested (0-30 Hz, 45-90 Hz and 100-150 Hz). The results suggest that IT currents can be used to increase arterial and microcirculatory blood flow; and that the response is dose-related.
Aerobic training in brain-injured patients
Authors: Wolman Roger L , Cornall Catherine , Fulcher Kathy , Greenwood Richard
Published: July 2008

A pilot study was performed to assess the value of aerobic training as part of the rehabilitation programme for patients with a single incident brain injury requiring admission to an inpatient neurological rehabilitation unit.

The cohort consisted of six patients with a combination of impairments including weakness, spasticity, taxia and cognitive problems. Each patient performed an exercise test at the beginning and end of the study to assess changes in aerobic fitness and performance. The aerobic training programme consisted of 20-30 minute sessions on an exercise bike three times a week for eight to 12 weeks.

The post-training exercise test showed significant increases in duration ( p < 0.01) and in workload ( p < 0.025) compared to the pretraining test. There were no adverse effects from the training programme.

Aerobic training should be considered in the rehabilitation programmes devised for patients with recent brain injury. Further research is needed to determine the best way to integrate this with other aspects of rehabilitation.
Ipsilateral upper and lower extremity response time among stroke patients
Authors: Yaretzky Abraham , Raviv Shulamit , Jacob Tamar , Netz Yael , Low Marcelo , Finkeltov Bronia
Published: July 2008

This case control study assesses ipsilateral response time (RT) of both upper extremities (UEs) and lower extremities (LEs) of stroke patients to visual and auditory stimuli. The RT of 17 right and 12 left hemiparetic patients was compared with that of the corresponding sides of 33 controls. Analysis of covariance by group and side with sex and age as covariates, as well as separate analysis of variance were administered for each test, so as to measure differences for group by age, side and sex. The findings showed impaired ipsilateral RT of the right UE and LE and left LE in the stroke patients. Differences were noted between patients and controls on both visual and auditory tests. Males performed better than females, mainly regarding the left UE and the LEs. 'Old' patients were slower to perform with the UEs and LEs than 'young' subjects. The findings warrant further exploration of limb performance of stroke patients, especially those of the LEs.
Observing seated posture after stroke: a reliability study
Authors: Carr EK , Kenney FD
Published: July 2008

Encouraging patients to adopt 'reflex inhibiting' postures after a stroke has long been thought to enhance their recovery. However, the efficacy of this rehabilitative strategy has never been evaluated. The development of a simple, reliable means of recording information about resting posture is prerequisite to the design of such an evaluative study. This paper describes the preliminary findings of a study designed to test the reliability of such a method. Using a simple observational tool, two observers made simultaneous observations of each of 20 aspects of the posture of a sample of 13 seated stroke patients. Each patient was observed up to five times, such that a total of 50 pairs of observations were made for each aspect of posture. For 18 (90%) of the aspects of posture the coefficients of agreement were satisfactory. While further testing using other positions is required, the results suggest that the tool has the potential for use in future research.
Evaluational and counselling interventions provided by a vocational rehabilitation unit
Authors: Brejc Tone
Published: July 2008

The objective of this exploratory investigation was to evaluate the benefits of evaluation and counselling interventions provided by the Vocational Rehabilitation Unit of Ljubljana University Rehabilitation Institute. Relative benefits ratio/quotient (RBQ), i.e. the ratio between gains in economic independence, social integration and subjective satisfaction of the client, degree of case difficulty, and amount of programme provided by the Unit were obtained for 75 clients.

No relationship existed between the benefits resulting from the Unit interventions, degree of difficulty of client problems (case difficulty), and the amount of programme. The findings supported the idea that intensive rehabilitation efforts did not have a linear and immediate influence on the results. The clients achieved greater economical and social than personal benefits, while their dissatisfaction with nonvocational consequences of the programme, especially those related to the narrowing social interactions was also obvious.

The relative benefits ratio, developed for this investigation, proved to be a fairly simple and practical tool for the assessment of rehabilitation work. However, it requires further improvement by establishing reliability and validity of the assessment criteria, and defining relative importance of the case difficulty indicators.
A five-year follow-up of stroke survivors: motorfunction and activities of daily living
Authors: Lindmark Birgitta , Hamrin Elisabeth
Published: July 2008

At the University Hospital, Uppsala, a study was conducted to assess and follow the changes in motor activities, primary activities of daily living (ADL) and instrumental ADL over a five-year period. The functional level of 280 acute stroke patients was assessed over five years.

One year after the stroke 193 patients (68%) were alive, and after five years 113 patients (40%). Of the latter, 101 patients were assessed. During the first year after the stroke, a significant improvement was shown in all the assessed variables. However, most of the variables had deteriorated significantly between one and five years post-stroke. The activities that were best preserved were primary ADL and locomotion. The ability to perform active movements, maintain balance, walk and perform some household tasks and some psychosocial activities had declined. Five years post-stroke approximately one-quarter had substantial motor loss and one-third were moderately impaired. Three-quarters managed their primary ADL without or almost without help. Differences were found between men and women in instrumental ADL behaviour, the women showing more deterioration post-stroke. In spite of this most of the patients felt satisfied with their health and life situation.
Barthel ADL Index: a comparison of administration methods
Authors: Yeo D. , Faleiro R. , Lincoln NB
Published: July 2008

The Barthel ADL Index is routinely used to assess elderly patients after discharge from hospital. Its inter-rater reliability and criterion validity have been well established. However, the inter-method reliability in administering this scale has not been sufficiently documentated. This study compares post, telephone and interview (visit) methods of administration to investigate their agreement. The index was administered by the three methods in random order after patients were discharged from acute geriatric wards. Results suggest that these three methods are reliable and agree well with each other in the total scores obtained. Analyses of individual item scores indicate poor agreement on one item (stairs). Suggestions on improving the guidelines for this item are outlined.
The effect of dairy products on the viscosity of saliva
Authors: Enderby Pam , Crow Esther
Published: July 2008

Some patients with dysarthria and dysphagia complain of increased viscosity of saliva. Occasionally this is thought to contribute to dribbling and speech difficulty, as the saliva is more difficult to swallow. Therapists often suggest a change in diet to see whether this reduces the stickiness. This study examines the effects of high dairy intake, low dairy intake and a normal diet on the viscosity of saliva. The results show that these changes to the diet do have an effect on viscosity and that this may be related to calcium.
Evaluating equipment for people with disabilities: user and technical perspectives on basic commodes
Authors: Ballinger C. , Pickering RM , Bannister S. , Gore S. , McLellan DL
Published: July 2008

Disabled people often do not use the equipment supplied to them. Past work indicates that there are many reasons for this, including the low priority given to user views by the designers and manufacturers of such equipment. A number of different methodologies have been used to evaluate equipment. This paper describes an evaluation of basic commodes, a project funded by the Medical Devices Agency, Department of Health, in which both a user survey and technical tests were employed.

A sample of 18 basic commodes, divided into four categories, was evaluated by 40 users, a questionnaire being administered to determine user views. A series of 13 technical tests was also carried out.

The results showed that the preferred commodes as indicated by the users did not necessarily perform well in the technical tests, with at least one of the products having potentially serious design faults. It is suggested that users, therapists and engineers each have an essential contribution to make in the evaluation of equipment for disabled people.
Discussion of segmental stability with implications for motor learning
Authors: Major Richard E , Butler Penelope B
Published: July 2008

Consideration of the degree of natural stability of an articulated structure can give insight into the required control demands and the energy cost of movement. This paper considers the human structure from this fundamental biomechanical position and goes on to hypothesize a method by which control demands might be minimized. Some consequences for motor learning are explored.
Clinical and psychological effects of hydrotherapy in rheumatic diseases
Authors: Ahern Michael , Nicholls Elizabeth , Simionato Eddy , Clark Michael , Bond Malcolm
Published: July 2008

Objectives: To assess the objective and subjective effects of a hydrotherapy programme for patients with rheumatoid arthritis (RA) or osteoarthritis (OA). Methods: Ninety patients entered a four-consecutive-day hydrotherapy programme. Seventy-two patients completed this programme. At the end of the four-day course, 22 patients were randomized to continue hydrotherapy for a further six weeks and eight patients were observed and acted as a control group. Results: Throughout the study there were no changes in functional assessment or range of movement of target joints. The most significant changes in the four-day course were improvements in self-efficacy for function and pain with resulting improvements in pain and stiffness scores. Those patients continuing hydrotherapy maintained the improvements achieved as a result of the four- day course, while in the control group most of the variables had returned to pretreatment values by four weeks.

Conclusion: These results suggest that hydrotherapy has beneficial effects in patients with RA and OA through improvements in self-efficacy.