bluuebunny/crossref_metadata_2025 huggingface dataset:
Lactobezoar in Prematurity
Authors: Tolia Vasundhara , Dubois Reuben S.
Published: July 2008

Lactobezoar is a foreign body produced in the gastrointestinal tract by the presence and accumulation of undigested milk curds. It is seen most com monly in low-birth-weight, premature infants fed with 24-calorie formulas. Conventional therapy includes withholding feedings, repeated gastric lavage, and maintenance of nutrition and hydration by the parenteral route. Most cases respond to this regimen within 48 to 72 hours. We present a case of gastric lactobezoar in a premature, small for gestational age infant who was fed a 24-calorie formula but failed to respond to conventional therapy for more than ,a week. Historical background and pathophysiology of lactobezoar are discussed.
Actinobacillus Endocarditis Associated with Periodontal Disease
Authors: Anolik Robert , Berkowitz Robert J. , Campos Joseph M. , Friedman Allan D.
Published: July 2008

Actinobacillus actinomycetemcomitans, an organism associated with rapidly destructive periodontal disease (periodontitis), is a rare cause of endocarditis in children. This report presents a case of A. actinomycetemcomitans endo carditis in a 6-year-old child with rapidly destructive periodontal disease. A leukotoxic antigen was documented in the strain of A. actinomycetemcomitans isolated from the patient's blood.
Radiographic Findings and Etiologic Diagnosis in Ambulatory Childhood Pneumonias
Authors: McCarthy Paul L. , Spiesel Sydney Z. , Stashwick Carole A. , Ablow Ronald C. , Masters Stuart J. , Dolan Thomas F.
Published: July 2008

The chest roqntgenograms of 128 consecutive ambulatory children with radiologic pneumonia were read independently and without clinical informa tion by a faculty general pediatrician (Ped), a pediatric radiologist (R-P) and a general radiologist (R-G). The films were classified as normal, indicative of a viral or bacterial process, or indeterminate. Readings were compared with re sults of viral titers and bacterial cultures.

Agreement between any two observers in classifying films, measured by unweighted Kappa, while statistically significant (p < 0.001) for any pair, was low.There was no significant difference between the agreement scores of Ped/R- P, Ped/R-G, and R-P/R-G.

Twenty-one patients had fourfold viral titer increases (N = 16) or positive bacterial cultures of blood or pulmonary aspirate (N = 5).'The sensitivity of viral readings for titer increases varied from 19% to 68% depending on observer type; the sensitivity of bacterial readings for positive bacterial cultures varied from 60% to 80%. The three observers agreed on a correct reading in only three children with viral and three with bacterial pneumonia.

Because of poor observer agreement and appreciable false-negative errors when viral and bacterial readings were compared to titer increases and positive bacterial cultures, respectively, we conclude that radiographic findings are poor indicators of etiologic diagnosis in ambulatory childhood pneumonias and, of themselves, are an insufficient data base for making therapeutic decisions.
Growth Status of Children with and without Sickle Cell Trait
Authors: Naghma-e-Rehan
Published: July 2008

Because of the suggestions that children with sickle cell trait (Hb/AS) are smaller and lighter, the anthropometric measurements of 50 such children from polygamous families were compared with a matched group of 50 children with normal hemoglobin (Hb/AA) who were offsprings of the same fathers and were living under identical conditions. This technique was adopted to minimize the effects of heredity and nutrition. When these hereditary and nutritional effects were excluded, there were no significant differences between the anthropometric measurements of the two groups.
Low-Birth-Weight and Congenital Rubella Syndrome
Authors: Ueda Kohji , Hisanaga Sachio , Nishida Yukiaki , Shepard Thomas H.
Published: July 2008

Birth weights of 42 full-term patients with congenital rubella syndrome were analyzed. All of these infants were products of pregnancies in which the exact dates of the maternal first day of last menstrual period and of the time of onset of the mothers' rubella rash were known. The range of time of maternal rubella associated with low-birth-weight was in the gestational age interval from 16 to 100 days. Low-birth-weight may have a relationship with time of maternal rubella rather than with the type of defects, i.e., cataract, heart disease, and deafness.
Characteristics of Prenatal Interviews Provided by Pediatricians
Authors: Sprunger Lewis W. , Preece Elizabeth W.
Published: July 2008

A questionnaire regarding use of pediatric prenatal interviews was mailed to 235 pediatricians. From 197 responses, we identified 118 practicing pediatricians who see a minimum of 25 newborns per year. Eighty-six (73%) of this group of 118 physicians conduct prenatal visits. In the practices of these physicians, an average of 22% of mothers (or couples) have a prenatal visit. Physicians unanimously favored fathers' presence at the visit. Prenatal visits were more frequently done by urban than by nonurban physicians. Only 15% charge for a prenatal visit, despite spending an average of 20 office minutes as compared to 16 office minutes for a well-baby visit. Pediatricians have positive attitudes about the use of prenatal interviews, regardless of whether or not they conduct them. High consensus regarding the importance of these visits combined with the low prevalence of their actual use suggest the need for more parent and physician education on this aspect of pediatric care.
Psychogenic Chest Pain in Children
Authors: Asnes Russell S. , Santulli Robert , Bemporad Jules R.
Published: July 2008

Thirty-six children with psychogenic chest pain were studied. A specific stressful situation causally related to the onset of symptoms could be identified in most patients with psychogenic chest pain. Fifty-five per cent of children with psychogenic chest pain had a history of other recurrent somatic com plaints and 30% had a history of significant sleep disturbances.
What It Means to "Spoil" a Baby
Authors: Wilson Ann L. , Witzke Donald B. , Volin Ann
Published: July 2008

Discussion concerning spoiling a baby frequently takes place in pediatric- care settings and may occur without a clear understanding of how parents define the word "spoil" when baby care is discussed. This study presents data from 531 parents asked to respond to a questionnaire on spoiling babies. The majority of mothers and fathers believe a baby can be spoiled, but considerable variation exists in perceptions of how this takes place, what a spoiled baby is like, and the present and future effects of spoiling. The younger and less educated parents have more rigid and negative views about the effects of spoiling babies.
Facing Violence: Everyday Risks in an American Housing Project
Authors: Blokland Talja
Published: July 2008

Many manage risks of urban violence through constructing of no-go areas — not so the residents there. How do they manage risks of violence? This paper approaches this question through the concepts of risk and (dis)trust of Sztompka (1999) and within a framework of disadvantage in a`matrix of oppression'(Collin 2000). Based on ethnography, the paper asks how people experience risks of `street violence' and `personal violence', how they manage them, and how their discourses about it relate to institutional discourses of how to solve problems of violence. I show that violence is being accepted and rejected in their specific relation to identity enhancement and respect within a context of intersecting forms of oppression along lines of race, class and gender.Through a discourse of fate, residents tell that violence concerns the wider context of stigmatization and exclusion — which does not match with the approach of local institutions.
Women, Men and Social Class Revisited: An Assessment of the Utility of a `Combined' Schema in the Context of Minority Ethnic Educational Achievement in Britain
Authors: Rothon Catherine
Published: July 2008

The last quarter of the 20th century gave rise to debate in this journal and elsewhere regarding the treatment of women in class analysis. It is argued here that the question of minority ethnic achievement has given new impetus to arguments in favour of taking account of mother's occupation in class schemas.The article constructs three different class schemas and tests their utility in this context. It then uses one schema to assess the importance of social class in explaining achievement differentials among minority ethnic pupils in Britain. Class background is found to be a key factor for all groups.The analysis finds significant differences between ethnic groups even when pupils from the same social class background are compared. When disparities within ethnic groups are examined, however, it is found that the effect of moving one place down the social class structure is similar.
Modernity, Mortality and Re-Enchantment: The Death Taboo Revisited
Authors: Lee Raymond L.M.
Published: July 2008

The death taboo has been depicted as modernity's burial of the question of human mortality. Death is prejudged as a `pornographic' event that should be veiled. Critics argue that this taboo has been exaggerated and the sequestration of death reflects a crisis of meaning in modernity. However, sources of re-enchantment in modernity have continually undermined the death taboo by keeping alive the meaning of transcendence. New Age redefinition of death as spiritual transition and representation of near-death experiences as affirmation of the afterlife have revived the quest for transcendence over the silence perpetrated by the taboo. As part of the quest for transcendence, re-enchantment emasculates death as a foe in order to redefine it as a vehicle of emancipation.
Reflections and observations: An interview with the UK's first Chief Government Social Researcher
Authors: Burnett Judith , Duncan Sue
Published: July 2008

Sue Duncan's civil service career spans thirty years; she has held posts in Communities and Local Government, the Department for Work and Pensions, the Cabinet Office and HM Treasury. While at the Cabinet Office, she worked in the Prime Minister's Strategy Unit and was Director of Policy Studies in the Centre for Management and Policy Studies, where she was responsible for good practice in policy making, research and evaluation and for evidence-based policy making.

For much of her career she was in the Government Social Research (GSR) service, where she worked closely with senior civil servants and Ministers, providing research-based advice and policy analysis to inform government decision making. Her GSR career culminated in her appointment as the first ever Chief Government Social Researcher, responsible for the thousand or so social researchers working across government.

Sue is an active player in the wider research community and has served on numerous committees in the academic, commercial and public sector. She was a Commissioner and a Fellow of the Market Research Society, a member of the Social Research Association and an Honorary Fellow of Cardiff University. She has written and lectured widely on policy, research, research utilization and evidence-based policy making and now works as an independent consultant.

The interview which follows draws out the themes of Sue's presentation as part of the Plenary Panel, `Sociology, Politics and Public Policy in 21st Century Britain' given to the British Sociological Association Annual Conference 2007 at the University of East London. In the interview, Sue reflects upon the connections between research, politics, sociology, and policy making as well as her own role in taking forwards the Modernising Government agenda of the `New' Labour governments.
Public sociology? Between heroic immersion and critical distance: Personal reflections on academic engagement with political life
Authors: Keith Michael
Published: July 2008

This article attempts to disrupt some of the ways in which engaged social science at times is forced to choose between the technocratic workings of the state and the political world of civil society. In disrupting the common sense distinction between `critical distance' and `heroic immersion' in the everyday life of the city, the piece tries to reframe an understanding of what the `public sociology' powerfully advocated by Michael Burawoy, when chair of the American Sociological Association, might achieve. Rather than conceptualize the ways in which particular knowledges enter into the public realm, we might alternatively think through the manner in which these forms of knowledge themselves constitute publics, congregate audiences around particular forms of expertise that need to be drawn on pragmatically and instrumentally in attempts both to achieve the good society and to link the academy to the civil realm. To do so we might also need to refigure the relation between the sentimental and the rational in the operating of state bureaucracy and the powerful economization of everyday life that sets precedent for the more influential forms of public engagement.
`Careless talk': A critique of Dench, Gavron and Young's The New East End
Authors: Moore Robert
Published: July 2008

The task of revisiting Young and Willmott's Family and Kinship in East London was probably impossible. Dench, Gavron and Young extended the geographical coverage of their study area to include some fundamentally different zones adjacent to Bethnal Green. The study extended over a decade but the authors' The New East End fails to make clear dates, actors and locations. The theoretical framework is incoherent and especially so when referring to actors outside the area of study who the authors claim have considerable power and influence in the East End. Local people are static informants and so as a `community study' the book fails to provide a narrative or analysis rooted in local events during a very eventful period of its history. The discussion of social policy changes, which form the background to this study is partial and tendentious. Although there is an illuminating section discussing migration from Sylhet the book is simply bad sociology. One outcome of the publication of The New East End has been that more general readers (including both the BNP and the Chairman of the Commission for Racial Equality) have been able to draw whatever conclusions from the book suit their own agendas.
The `Celtic Lion' and social policy: Some thoughts on the SNP and social welfare
Authors: Mooney Gerry , Scott Gill , Mulvey Gareth
Published: July 2008

In May 2007 the Scottish National Party emerged as the largest single party in the Scottish Parliament and with contingent support from the Greens it now forms a minority Scottish government. This paper considers the ways in which social policy making is being approached by the SNP and the extent to which this represents divergence from the policies of the previous New Labour—Liberal Democrat administration. The paper argues that while the SNP has no tradition of policy making in the field of social welfare there are already some signs emerging of the direction it is likely to follow. Tensions between economic development and social justice agendas are highlighted with a concern that social justice could take even more of a second place than it has in the recent past. Finally it is argued that a neo-liberal vision of Scotland informs current as well as past policy making and explains why the promotion of social justice is more than likely to take second place to the pursuit of economic growth, reflected in the SNP's goal of transforming Scotland as a `Celtic Lion' economy.
Idiopathic gait disorders of the elderly
Authors: Hogan David B , Berman Peter , Fox Roy A , Hubley-Kozey CL , Turnbull George , Wall James
Published: July 2008

Changes in mobility are a frequent concomitant of ageing. In a proportion of those presenting with mobility problems no specific diagnosis can be made, and these individuals are stated to be suffering from idiopathic gait disorder of the elderly (IGDE). In order to better describe this entity we examined 15 non-impaired individuals (mean age 77.8 years) and contrasted them to 14 individuals (mean age 80.2 years) suffering from IGDE. Evaluation included detailed physical examination including sensory evaluation, strength testing, upper extremity dexterity testing, and formal gait analysis. There were no significant differences between the two groups with regard to the physical examination, strength testing, or upper extremity function. Both groups were equivalently able to learn a new neuromuscular task involving their upper extremities. There were significant differences with regard to gait parameters between the two groups - IGDE subjects were significantly slower, had a shorter stride, and spent more time in double support. From our study we conclude that: (1) IGDE disproportionately affects lower extremity function with relative sparing of upper extremity function, and (2) IGDE subjects appear to have adequate sensory input, muscle strength, and are able to learn new neuromuscular tasks suggesting that this disorder would be remediable to appropriate therapy.
Disabled patients in acute hospital wards
Authors: Sklaroff SA , Ian Atkinson F.
Published: July 2008

Seventy-five patients who had a clinically diagnosed disabling disease and who usually had difficulty with one or more activities of selfcare were identified in a 10-month survey of the acute wards of a large teaching hospital. Their dependence on assistance for specific activities at home and in the acute wards was recorded by a research nurse in interviews carried out in the patient's home within two weeks of hospital discharge. The study showed that although most of the disabled patients were able to continue with their daily selfcare activities, their increased dependence on assistance in hospital in comparison with their home was often due to limitations in the provision and use of ward facilities. The effects of these limitations on the selfcare of disabled patients are illustrated. It is concluded that disabled patients would enjoy greater independence in selfcare activities in acute wards and could be less dependent on nursing staff if there was improvement in ward design and the provision of aids and equipment whilst the abilities of disabled patients for selfcare were recognised by ward staff.
Sphagnum moss and wound healing I
Authors: Varley Sarah J , Barnett Sheila E
Published: July 2008

Sphagnum mosses are widespread in temperate regions and provide the basis for most peat formation. They have upright stems bearing whorls of leafy branches. Due to the structure of its cells, sphagnum has a high capacity for fluid uptake and retention. It is this property that is chiefly responsible for its widespread medical exploitation over many centuries. The reported uses of sphagnum as a wound dressing for over 800 years are reviewed.
Sphagnum moss and wound healing II
Authors: Varley Sarah J , Barnett Sheila E
Published: July 2008

Interest in the use of sphagnum moss as a wound dressing has recently been revived due to technological advances but, to date, there have been no reported controlled trials with histological evaluation. This paper describes recent experiments using moss on full and partial thickness wounds, with and without occlusion. It is demonstrated that, even without enclosure in a cover stock, sphagnum moss can produce optimal conditions at the wound surface.
Morbidity survey of lower limb amputees
Authors: Stephen PJ , Hunter J. , Aitken Rcb
Published: July 2008

A prospective study of morbidity among 55 lower limb amputees was carried out by multiprofessional teams in two rehabilitation units in Lothian. The aim of treatment was the restoration of independence rather than concentration solely on walking training, although this was important in that 90% of patients were fitted with a temporary artificial limb. The problems and progress of these patients varied, but 90% returned successfully to the community where they made moderate demands on community services. Important differences in professional assessment were noted. The physiotherapists judged that 73% of the patients studied were mobile without help prior to discharge, whereas nurses placed only 46% of the same group at this level of independence. The occupational therapist assessed more of the patients (68%) as fully independent in selfcare than the nurses (44%). This difference between what the patient can do when assessed in therapy and what he actually does when observed in the ward was resolved in case conferences.

Forty of the 46 patients who survived for one year replied to a postal questionnaire. Of these, 29 reported independence in mobility indoors and 20 reported total independence in activities of daily living, indicating that as a group they had achieved the level of function predicted. Only two patients required institutional care; two patients (17% of those previously employed) had returned to work.

Successful rehabilitation of patients with multiple problems requires a holistic approach. This study demonstrates the need for multiprofessional case discussions so that appropriate decisions on discharge and future management can be made.
Inpatient rehabilitation in rheumatoid arthritis: one year follow up
Authors: Jaeckel Wilfried H , Cziske Reinhard , Jacobi Eckart
Published: July 2008

Inpatient rehabilitation with medical, psychological, physical and occupational therapy is an expensive approach to rheumatoid arthritis and information about its influence on patients' health status is so far unavailable. Therefore, changes in patients' health status after inpatient rehabilitation were examined in 48 patients with definite or classical rheumatoid arthritis using a multidimensional questionnaire which had been derived from the Arthritis Impact Measurement Scales from Boston University. At discharge, health status was improved in almost all of its physical and all psychological dimensions, whereas in a preliminary study of 20 outpatients we did not find any significant improvement during a four-week period. The improvements achieved decreased during the following year showing the most stable results for decreased pain, anxiety and depression. One year after discharge overall health status was still higher than at admission in 21 of the patients. In a subgroup of patients with shorter duration of the disease improvements were more pronounced. This finding suggests that inpatient rehabilitation is especially useful in the beginning of the disease.
Performance testing in rehabilitation: influence of context and cognitive function on mobility
Authors: Kirk JC , Atkinson GA , Royston JP , O'Neill Cja , Denham MJ , Dobbs SM
Published: July 2008

The accuracy of routine information on the response of a patient to rehabilitation was questioned. At the multidisciplinary ward round there may be on the one hand an inhibitory effect on the patient's performance due to the presence of a large team, but on the other reluctance of nurses and therapists to concede that all their efforts may only have maintained status quo. We present a randomised, controlled, crossover study of the effect of the ward round on a test of the ability to stand, walk a fixed distance, turn and sit down. Surprisingly, performance was not inhibited by the round: the 20 patients studied performed the test with equal skill, but greater speed, on the round than in a more private context. Cognitive function had a greater influence on the amount of help needed in standing and sitting safely, than on ability to walk and turn independently.
A maze learning test for the assessment of memory with physically disabled patients
Authors: Lincoln Nadina B , Staples Diana
Published: July 2008

A test of memory which did not involve manual dexterity was felt to be necessary for use with severely physically disabled people, who are unable to draw and have insufficient vision to complete standardized tests or have communication problems. A maze test was designed which was found to be a valid measure of memory and to have adequate test-retest reliability. Non-brain damaged orthopaedic inpatients were assessed to obtain test norms, which are categorized according to three levels of intelligence.
Approach to cardiac rehabilitation
Authors: Imperial Elias S
Published: July 2008

Cardiac rehabilitation is now considered an integral part of the management of cardiac disease. However, the approach to objectives has been variable and not well defined. To have a more structured approach towards the goals and objectives of cardiac rehabilitation, this paper discusses the interrelationship of the different factors which determine quality of life, who are the candidates for rehabilitation, the effectiveness of the various modes of intervention, the interface between the rehabilitation process and traditional medical modes of intervention and evaluation of outcome.
The relationship between static standing capacity and lower limb static strength in hemiparetic stroke patients
Authors: Bohannon Richard W
Published: July 2008

This study was undertaken to determine if static standing capacity in 81 hemiparetic stroke patients was related to the static strength of seven muscle groups of both the paretic and nonparetic lower extremities. Standing capacity was graded using an ordinal scale. Static strength was measured using a hand held dynamometer. Standing capacity was correlated ( p<0.01) with the strength of six muscle groups of each lower extremity. Regression analysis revealed that standing capacity was predictable by the strength of the paretic muscle groups (adjusted R2 = 0.193, F = 3.74, p = 0.002), but not the nonparetic muscle groups (adjusted R2 = 0.121, F = 2.57, p = 0.020). Because of the distribution of standing scores in this study and the limited explanation of standing capacity by the strength measurements, further study is important if the factors responsible for standing capacity are to be identified. Such identification should help direct the choice of treatment strategies.
An extended activities of daily living scale for stroke patients
Authors: Nouri FM , Lincoln NB
Published: July 2008

A ranked assessment of daily living (ADL) scale has been developed to assess activities which may be important to stroke patients who have been discharged home. A questionnaire incorporating 22 ADL activities in four sections was sent by post to 80 consecutively registered stroke patients. Gutmann scaling was carried out on the returned questionnaires, producing acceptable coefficients of reproducibility and scalability. The revised questionnaire was then sent to 20 stroke patients. The same patients were sent an identical questionnaire two weeks later. The overall level of agreement between the two assessments was satisfactory. The extended ADL scale could therefore be used as a postal questionnaire to assist in the follow-up of patients discharged home after a stroke. Due to the scaling properties of the assessment, patient's progress can be monitored and patients can also be compared on the basis of their scale score.
A partial recovery following delayed surgical treatment of normal pressure hydrocephalus
Authors: Mashiah Tonni , Mashiah Aharon , Hod Israel
Published: July 2008

A 66-year-old woman with a history of total hysterectomy (1953) and healed myocardial infarction (1978) first complained in 1981 of signs and symptoms suggestive of normal pressure hydrocephalus. The condition was followed up and in 1983 was confirmed by Computer Assisted Tomography (CT). She was treated by ventriculo-peritoneal shunt only in 1986. Rehabilitation was started as early as possible postoperatively. Of the major neurological signs, namely gait abnormality, incontinence and dementia, only gait abnormality showed some improvement although gait-related cerebellar dysfunction remained unchanged. Thus progression of the disease was halted by the surgical procedure and subsequent rehabilitative therapy was partially effective despite the prolonged delay in operative treatment of the disease in this patient.
Modifying the denial of symptoms following severe head injuries
Authors: Johnson Roger P
Published: July 2008

Patients who do not recognise their disabilities are extremely difficult to treat and manage. This paper describes a method by which feedback about errors was provided for a patient who could not acknowledge that his intellectual function was impaired following a severe head injury. This brought about a shift in his attitude and aided his successful resettlement. The nature of denial following brain injury is discussed.
Review article : The late effects of poliomyelitis: aetiology and rehabilitation
Authors: Summers GD , Cochrane GM
Published: July 2008

Decades after their acute infection, many polio survivors are suffering renewed muscle weakness, increasing respiratory difficulties, musculoskeletal pain, fatigue and cold intolerance which lead to a 'second disability'. Some symptoms are due to chronic mechanical strain caused by using joints rendered unstable after the acute infection. The cause of others, such as postpoliomyelitis muscular atrophy, is . unknown although overuse, ageing, disuse atrophy and metabolic fatigue of axon sprouts in the abnormally large motor units may play a role. The aim of rehabilitation is to halt the progress of the condition and reduce its physical and psychological impact. Reduction in strenuous activity is important. The use of orthoses or a wheelchair may help to reduce pain and the energy cost of mobility. Respiratory aids such as the cuirasse can improve health. Counselling and peer group support can help the patient to accept his physical limitations.
Use of the family genogram technique with spinal cord injured patients
Authors: Engelman Suzanne R
Published: July 2008

Previous studies have investigated the relationship between premorbid and postinjury copying styles of the spinal cord injured person. Although it is common to find reference to the family genogram in family therapy literature, a review of the literature dealing with spinal cord injury does not show that the genogram has been used. The purpose of this paper is to demonstrate how the family genogram technique may be used in the rehabilitation setting. Through the illustration of three family genograms, this paper will show how the genogram technique may be a useful adjunctive psychological technique to demonstrate how postinjury coping styles are linked to preinjury styles. Psychological interventions used with each family situation will be briefly discussed to illustrate how the team may work with the family coping styles to facilitate current coping in the rehabilitation process.
The prevalence and nursing dependency of patients with stroke in hospital
Authors: Payman Barbara C , Hawthorn Pamela J , Jewitt Penny
Published: July 2008

A stroke prevalence study was carried out in five hospitals within the Nottingham Area Health Authority on a selected day in May 1985, using both the acute medical and health care of the elderly wards. The data were gathered by the nursing staff. Of 913 patients, 187 (20.5%) had been admitted to hospital as a direct consequence of stroke and a further 83 (9.1 %) had a history of stroke unrelated to their current hospitalization. Approximately one in three patients on health care of the elderly wards had sustained a stroke as compared with approximately one in eight of those on medical wards. Dependency in each of seven activities was significantly correlated with the number of strokes sustained.
The use of a computer in aiding functional skill training: a single case study
Authors: Clark-Wilson Jo
Published: July 2008

This study investigates the use of a computer training program to facilitate learning in a head-injured patient with a severe memory disturbance. The patient, DP, was taught to perform the individual steps in a morning washing and dressing routine but was unable to carry out the sequence of steps independently, in the absence of verbal prompts. A specially-constructed computer program was designed to teach these sequential links. DP was thus able to practise on the computer up to four times a day over a period of 11 weeks. Under these circumstances, the patient made rapid progress in learning the sequence of his morning routine which was shown to generalize into the functional setting. By this method DP achieved 58% success. Other memory training procedures were then instigated to fill the remaining gaps in DP's learning, thereby promoting further independence in his daily washing and dressing routine.
Rolling to the nonplegic side: influence of teaching and limb strength in hemiplegic stroke patients
Authors: Bohannon Richard W
Published: July 2008

This study was undertaken to determine in patients with hemiplegia; (1) the influence of patient teaching on independence in rolling to the nonplegic side; and (2) the relationship between limb muscle strength and independence in rolling. Twenty patients who had experienced cerebrovascular accidents were studied. Their capacity to roll to the nonplegic side before, immediately after, and five minutes after instruction was measured. Also measured, but with a hand-held dynamometer, was the static strength of seven muscle groups of each extremity. The mean strength of each extremity's muscle groups was calculated and normalized against (divided by) body weight. Correlations were calculated between normalized strength scores and rolling capacity. The Cohran Q test demonstrated that the proportion of subjects rolling independently was significantly different before and after teaching. Rolling capacity during every trial was significantly correlated with the static strength of the limbs of the nonparetic side. The results suggest that teaching may be beneficial for increasing patient independence in rolling, but that such capacity is not independent of the patient's strength.
Evaluation of a voice activated environmental control system for disabled people
Authors: Summers GD , Cochrane GM
Published: July 2008

Advances in speech recognition technology may in future allow the severely disabled to gain greater control over their environment. VADAS (Voice activated domestic appliance system) is a voice recognition and mains signalling system that was marketed for use by the disabled. We have evaluated VADAS using 19 severely disabled patients living in the community. Only seven of the 19 found VADAS to be an effective environmental control system over a period of four weeks. Major difficulties in achieving voice recognition leading to annoyance and frustration were experienced by the remaining 12. Only one of the eight long-term users of Possum PSU 3 preferred VADAS. The over-the-mains signalling system functioned well in 18 of the 19 homes. We suggest that over-the-mains signalling should be incorporated into 'standard' environmental control systems available from the DHSS, allowing a reduction in cost and size. VADAS is one available option for switching, although further development work is necessary to make it easier and safer to operate.
Walking rehabilitation possibilities in the Orlau ParaWalker
Authors: Patrick John H
Published: July 2008

The fundamental requirements for successful human gait have been identified, the orthotic compensations necessary for its reproduction in an acceptable form by complete thoracic level paraplegics are proposed and a possible solution is described. Continuous research has developed the Parawalker solution beyond purely mechanical limits to provide electronic 'assists' as a hybrid orthosis. This still adheres to the fundamentals identified, but allows the objective of lowering the energy cost of walking to be pursued.
Footwear worn by the over 80's: a community survey
Authors: White EG , Mulley GP
Published: July 2008

We have visited 96 people aged 80 or more, living at home, to assess patterns of footwear usage and difficulties associated with buying and wearing shoes. Of the 96 people, 55 spent most of the day wearing shoes and 41 usually wore slippers. Of 20 housebound subjects, 16 wore slippers for most of the day. Three quarters of the old people seen were able to buy shoes in person. 80% of the men wore lace-up shoes but half the women chose a slip-on style. Leather remains the material of choice for shoes worn by the elderly. Only five subjects complained of discomfort from their shoes and six had difficulty putting shoes on. A shoe horn was used by 20% of subjects. Special or surgical shoes were worn by only three people.
A comparison of uniform patterned and eutrophic electrotherapies in a clinical procedure of rehabilitation of some movements in the arthritic hand
Authors: Kidd Geoffrey L , Oldham Jacqueline A , Stanley John K
Published: July 2008

The relative effectiveness of two different electrotherapies for hand rehabilitation was measured in 18 patients with muscle atrophy associated with rheumatoid arthritis, three of whom acted as controls and receiving no electrotherapy during the course of the trial. Both forms of electrotherapy were applied for between one and three hours each day for ten weeks. In the first electrotherapy, the stimuli were presented in a uniform pattern at a frequency of 10 stimuli/second (10 Hz). The electrotherapy for comparison (eutrophic electrotherapy) reproduced as stimuli the natural action potential firing pattern of a fatigue resistant motor unit in the first dorsal interosseus (1 st DI) of a normal hand.

Comparison was based on the relative improvement during and following 10 weeks of electrotherapy, with the two patterns of electrotherapy in seven different parameters of hand function: angular deviation at 1 st MCP joint in ulnar drift; hand grip strength; pulp-to-pulp pinch strength; key pinch strength; button-unbutton test; the maximal voluntary force 1 st DI could produce when acting isometrically; and in abduction, the endurance shown by 1 st DI in generating such force.

In all the parameters measured, eutrophic elecrotherapy was seen to be significantly more effective than a uniform patterned electrotherapy of 10 Hz. The greatest comparative effect of eutrophic electrotherapy was seen on endurance in force generation by 1 st DI and on hand grip strength, and the least on the reduction of the angular deviation of ulnar drift.
Selected determinants of ambulatory capacity in patients with hemiplegia
Authors: Bohannon Richard W
Published: July 2008

This study was performed to investigate, in 33 stroke patients, the relationships between gait speed, cadence, distance, and independence, and to determine whether five nonstrength and selected lower extremity strength variables, were indicative of present and/or future gait performance measured by the four gait variables. The gait variables were all correlated significantly with one another ( p<.001). Balance was correlated significantly with all present and future gait measures ( p<.01). All muscle group strength measures on the paretic side were related significantly to gait performance at the time of assessment and across assessment times ( p<.01). Most of the nonparetic muscle group strength measures were correlated significantly with gait performance. Balance and lower extremity muscle group strength measures therefore appear to be indicative of gait performance and appropriate targets for therapeutic interventions and more specific investigations.
The functional shoulder orthosis in hemiplegic shoulder subluxation: a pilot study
Authors: Roy Christopher W , Blamire JG
Published: July 2008

Hemiplegic shoulder pain is a common problem and in many cases is due to subluxation. Existing treatments are often unsatisfactory. The Functional Shoulder Orthosis has been reported to be effective in this condition and we sought to reproduce the results of the originator of the orthosis. We had a great deal of difficulty in identifying patients who satisfied the selection criteria. The patients we studied found it cumbersome, and it offered little advantage over a sling. We cannot recommend this orthosis for widespread use.
A simple measurement of speed of index finger movement
Authors: Worthington JA , De Souza LH
Published: July 2008

A simple 10s test to measure the speed of index finger tapping has been developed. The equipment used was simple and portable, being only a pocket calculator and a stop watch.

Forty-two control subjects were tested to determine the lower limit of normal for the test using dominant and nondominant hands. Fifty-six patients with multiple sclerosis were also tested and the results showed that 55% were below normal with the dominant hand, and 61 % were below normal with the nondominant hand.

It was concluded that the index finger tapping test provides a consistent and simple objective measure for a feature of movement which is quite difficult to assess correctly by eye.
Insight and progress in rehabilitation
Authors: Herbert Camilla M , Powell Graham E
Published: July 2008

The literature on the effect of insight on rehabilitation success is reviewed. Its role as a possible motivating factor is considered in the context of the development of the concept of motivation. The difficulties of research in this field are discussed. The aim of the present study is stated as an attempt to clarify the effect of insight on rehabilitation success by exploring the relationship between insight and motivation. In this study accuracy of insight was not found to be related to rehabilitation success. Clients who overrated their abilities, i.e., were optimistic, did better than the underconfident or pessimistic clients. Optimistic clients were more highly motivated in that they saw scope for improvements and were sure of achieving these gains without too much effort. Previous studies are reexamined in the light of these findings and possible explanations for the discrepant results are presented.
Restoration of balance in stroke patients: a single case design study
Authors: de Weerdt W. , Crossley SM , Lincoln NB , Harrison MA
Published: July 2008

The effect of visual feedback on the relative weight distribution while standing was studied in two patients with balance problems. An ABAB single case experimental design was used. During the A phase, EMG biofeedback for the arm was given while the patient was sitting. During the B phase, visual feedback of the weight distribution was used as a means of improving balance reactions. The Rivermead assessment revealed no change in overall motor performance in either patient. There was, however, a marked improvement in balance and in some characteristics of the walking pattern during the experimental (B) phase. This effect was sustained over time.
The effect of using the dominant or nondominant hand on performance of the Rivermead Perceptual Assessment Battery
Authors: Cramond Heather J , Clark Michael S , Smith Dennis S
Published: July 2008

The Rivermead Perceptual Assessment Battery (RPAB) claims to be a standardized and validated test of visual perception. However, the published evidence suggests that several areas have not been considered by the authors of the test. One of these is whether the dominant or nondominant hand is used, particularly for those aspects of the test which require either pencil skills or the fine manipulation of objects. The purpose of this study was to conduct subtests of the RPAB on a group drawn from a nonclinical population to determine whether or not there are differences in performance between the dominant and nondominant hand. The study involved 35 first year university students who were right-hand dominant for writing. Each subject completed the four subtests twice, once with the right hand and once with the left. Statistically significant differences were found between right and left hand performance in both the score achieved and the time taken for right left copying shapes (RLCS) and right left copying words (RLCW), tests 11 and 12, and for time alone in cancellation (CA), test 15. No significant differences were found in 3D copying (test 13). Test 12 is of particular concern, as 24 subjects failed this test when using their nondominant hand. These findings have implications for the interpretation of test results when the RPAB is administered to stroke patients who, due to the nature and site of their lesions, may be forced to use the nondominant hand.
Rehabilitation of a below-knee amputee with a diving limb
Authors: Saadah Esm
Published: July 2008

The idea of a diving limb was born by the need of one of my patients, who is a below-knee amputee. He is quite an enthusiastic diver and because of his age, he was determined to enjoy his hobby to the full. This patient, like other divers, prefers to use a wet suit for diving because of its availability and its insulation properties, therefore he uses his diving artificial limb outside his diving suit (Figure 1). The new diving artificial limb was designed to fulfil the following criteria:

a) It is made from lightweight waterproof material so as not to hinder movement under water;1

b) It remains attached to the amputation stump at different depths;

c) It has the correct weight and balance to prevent it from floating or falling off.2
Neurogenic para-articular heterotopic ossification: a retrospective su rvey of 48 cases occu rri ng after brain damage
Authors: Greenwood Richard , Luder Robert , Gilchrist Elizabeth
Published: July 2008

Heterotopic ossification (HO) was looked for in the radiographs of the 1495 patients with cerebral events treated since 1963. HO was found in 48 patients. The highest incidence was in those with head injury (7%) compared to only 1 % of those with stroke. The severity of HO was also greater in those with brain injury compared with the other pathologies. Other conditions where HO was found were subarachnoid haemorrhage, encephalitis and cerebral hypoxia. The HO was found almost exclusively in the large proximal joints, especially in the elbow after head injury. Neither the severity of the radiological changes nor the number of joints involved appeared to be related to the duration of unconsciousness in head injured patients.
Rating the motivation of elderly patients on a rehabilitation ward
Authors: King Paul , Barrowclough Christine
Published: July 2008

Patient motivation is often cited as being important in rehabilitation. The purpose of this study was to determine whether there is consistency between rehabilitation staff's ratings of patients' motivation and also what criteria they use to make these rating decisions. It was found that staff showed poor agreement in their motivation ratings, despite conceptualizing motivated behaviours in similar ways. It is concluded that motivation is an unhelpful concept and that rehabilitation decisions would be better facilitated by describing specific behaviours which staff associate with motivation, e.g. mobility, self-care, independence.
Mental status and occupational therapy outcome in teaching dressing skills to the disabled elderly
Authors: Davies Ann DM , Gargaro Paula , Dodd Adrienne , Smith Christine
Published: July 2008

Two groups of elderly disabled patients referred to an occupational therapy (OT) department, one of higher and one of impaired cognitive status, defined by the mini-mental state examination (MMS), were assessed before and after one month's OT to see if mental status predicted improvement in dressing skills. The Kuriansky Activities of Daily Living performance test (KPT), the Set test (ST) and a specially designed dressing skills task (DST) were administered before and after treatment. Cognitive status as measured by the MMS and the ST were related to the global measure of activities of daily living (KPT) before treatment but not to the specific dressing skills task.

There was no significant relationship between cognitive status and OT outcome either in terms of dressing, KPT performance or discharge. The therapist's prediction of outcome at the initial assessment was accurate. A subsidiary study found that all patients entering the hospital over a six week period, likely to benefit from OT were in fact referred.