bluuebunny/crossref_metadata_2025 huggingface dataset:
Language change in young Panjabi/English children: implications for bilingual language assessment
Authors: Martin Deirdre , Krishnamurthy Ramesh , Bhardwaj Mangat , Charles Reeva
Published: November 2003

This paper reports some of the more frequent language changes in Panjabi, the first language of bilingual Panjabi/English children in the West Midlands, UK. Spontaneous spoken data were collected in schools across both languages in three formatted elicitation procedures from 50 bilingual Panjabi/English-speaking children, aged 6–7 years old. Panjabi data from the children is analysed for lexical borrowings and code-switching with English. Several changes of vocabulary and word grammar patterns in Panjabi are identified, many due to interaction with English, and some due to developmental features of Panjabi. There is also evidence of pervasive changes of word order, suggesting a shift in Panjabi word order to that of English. Lexical choice is discussed in terms of language change rather than language deficit. The implications of a normative framework for comparison are explored. A psycholinguistic model interprets grammatical changes in Panjabi
Second language learnability and the acquisition of the argument structure of English locative verbs by Korean speakers
Authors: Joo Hye-Ri
Published: November 2003

The present research focuses on Korean English as a foreign language (EFL) learners’ knowledge of the locative alternation (e.g., John loaded hay onto the wagon/John loaded the wagon with hay) and its relationship to theories of language-particular and language-universal properties. Korean, the native language of the participants, has a locative alternation resembling that of English. However, although Korean and English are similar in terms of broad-range constraints, they are dissimilar in terms of narrow-range constraints for locative alternations. This study investigates whether the acquisition of such constraints in English locatives by Korean speakers, and whether the first language (L1) influences the second language (L2) acquisition of locative alternations. Two instruments are used in the experiment: a forced-choice picture-description task and a forced-choice sentence selection task. The study investigates an experimental group of Korean learners of English and a control group of native speakers of English. The results are discussed with reference to universality of linking, to the transfer of argument structure and to Pinker’s learnability theory. The primary results are:

• The Korean learners of English had acquired the constructional meaning of the locative construction (which is related to Pinker’s (1989) concept of broad-range rules and broad conflation classes), a property claimed to be universal.

• They had not achieved native-speaker knowledge of language-particular properties - which narrow conflation class verbs belong to - so that they did not reject ungrammatical sentences; and

• Significant L1 transfer effects were not found.
Does cardiopulmonary bypass still represent a good investment? The biomaterials perspective
Authors: Gourlay T , Connolly P
Published: November 2003

Cardiopulmonary (CPB) bypass is 50 years old this year, and has undergone considerable change in that time, particularly with regard to developing technology. However, in recent years the routine application of CPB, as the treatment of choice for patients undergoing reparative heart surgery, has been challenged by new, evolving techniques, particularly Off-Pump Coronary Artery Bypass (OPCAB) and stenting. This paper considers whether CPB still represents a sound investment prospect, with particular emphasis on the biomaterial developments currently taking place. Whilst we accept that routine application of CPB is shrinking under pressure from less invasive techniques, we suggest that this may represent an opportunity to deliever a more highly evolved perfusion to the core of very sick and complex patients who may not be suitable candidates for OPCAB or stenting. These patients will benefit from the application of new technologies currently under development, such as smaller perfusion circuits, improved biomaterial surfaces, smart membranes, and biosensor technology, all aimed at making clinical perfusion a safer and more predictable procedure for the patient. All things conssidered, we feel that CPB, although shrinking in absolute size, still represents a good investment.
The effects of intermittent prebypass heparin dosing in patients undergoing coronary artery bypass grafting
Authors: Grima Carmel
Published: November 2003

In this study, 10 patients (Group B) were given three consecutive prebypass doses of heparin (100 IU/kg) with a 4 min interval prior to cardiopulmonary bypass (CPB) institution. They were compared with 10 patients (Group A) receiving the standard single prebypass heparin dose (300 IU/kg). The haemostatic response and anticoagulant monitoring during the perioperative period were investigated by point-of-care and several coagulation tests. Results of both groups were also correlated to blood loss. Three patients in Group B required additional heparin during bypass as compared with six patients in Group A. This suggests that intermittent prebypass heparin dosing is more effective in maintaining adequate levels of anticoagulation during CPB. Group B had a lower mean decrease in factor VIII (13.9% versus 43.2%), fibrinogen (38.5% versus 46.6%), antithrombin III (34.7% versus 40.1%) and platelet count (23.2% versus 28.9%) during bypass while only one unit of red cell concentrate was required postoperatively as compared with four units in Group A. In one patient, high fibrinolytic assays were associated with a haemorrhagic pericardial effusion occurring beyond 24 hours postsurgery.
The Capiox RX05 oxygenator: pediatric clinical observations
Authors: Tinius J A , Dragomer D , Klutka F , VanBebber A , Cerney K
Published: November 2003

Terumo Cardiovascular Systems has released the X-Coated™ Capiox® RX05 or Baby RX™ oxygenator. This oxygenator is designed for neonate and infant patient populations. The device was integrated into our current perfusion practice and our clinical observations are described here. The Baby RX™ has a prime volume of 43 mL with a maximum flow of 1.5 L/min. The integrated hardshell venous reservoir has independent venous and cardiotomy filters, as well as a very low minimal operating level of 15 mL. A variety of options provide exceptional versatility for the device. The Baby RX proves to be a low-prime, high-flow oxygenator, enabling us to use it on a wide range of pediatric patients. It will be a useful tool for reducing our neonate and infant circuit priming volumes.
Carbon dioxide field flooding versus mechanical de-airing during open-heart surgery: a prospective randomized controlled trial
Authors: Kalpokas Mario V , Nixon Ian K , Kluger Roman , Beilby David S , Silbert Brendan S
Published: November 2003

Removal of intracardiac air during valvular surgery should be accomplished in the most effective manner. We conducted a prospective randomized controlled trial to compare mechanical de-airing and carbon dioxide (CO2) field flooding in 18 patients undergoing elective valvular surgery. Transoesophageal echocardiography was used to record intracardiac bubbles, and this was assessed postoperatively by two independent echocardio-graphers blinded to treatment group. Both assessors graded the bubble count higher in the mechanical de-airing group compared with the CO2 flooding group, and there was good agreement between assessors. CO2 field flooding is more effective than mechanical de-airing in removing intracardiac bubbles following valvular surgery.
Mechanical circulatory support: state of the art and future perspectives
Authors: Wheeldon D R
Published: November 2003

Mechanical circulatory support (MCS) has been viewed, until recently, as a rescue therapy to be applied when all else fails. Not surprisingly, this has resulted in suboptimal outcomes. Fortunately, the perseverance of a few dedicated groups has produced improved outcomes and the concept of MCS as an elective therapy is now steadily gaining acceptance. This is particularly true in the postcardiotomy setting, where a large number of new options are now available. The recently completed REMATCH study has demonstrated the feasibility and efficacy of permanent MCS as a therapy for end-stage heart failure, despite a high rate of device complications. Donor availability is decreasing and biological solutions will not be available for many years. New generation implantable rotary pumps, a fully implantable left ventricular assist device and a total artificial heart are all undergoing clinical evaluation, and several new exciting designs are in preclinical evaluation. A new paradigm for the treatment of terminal heart failure is emerging, where an unpredictable and expensive medically managed death in an intensive care unit setting is being exchanged for a more predictable high-cost, front-loaded therapy with management from the outpatient clinic. The perfusionist community has much to contribute to this emerging life support field, not only in the perioperative period, but also in providing ongoing technical support to hospital staff, recipients and their families.
Myocardial protection: an expanding or contracting discipline?
Authors: Wechsler Andrew S , Brockman Stanley K
Published: November 2003

For the past thirty years cardiac surgeons have had a unique opportunity to study the consequences of myocardial ischemia and reperfusion. With the advent of an ability to intervene in acute myocardial syndromes, cardiologists have vigorously joined that effort as have fundamental scientists. Exogenous myocardial protective strategies have emerged as have novel strategies that take advantage of endogenous mechanisms of myocardial protection. As a consequence of improved myocardial protection, operative mortality and morbidity, in particular the low output syndrome, have diminished. However, despite important increases in the knowledge base referable to myocardial ischemia and reperfusion, major advances in myocardial protection have slowed in the past several years. This article explores potential untapped options for augmenting myocardial protection and focuses on the potential adverse interactions between cardiopulmonary bypass and myocardial protection as a prime target for future investigations leading to improved myocardial management during heart operations.
The evolution of perfusion education in America
Authors: Toomasian John M , Searles Bruce , Kurusz Mark
Published: November 2003

Clinical cardiopulmonary perfusion has evolved significantly during its 50 years. The science, technology and educational processes related to cardiopulmonary bypass have undergone continual change and metamorphosis. Perfusionists were initially trained on the job or in the laboratory, but with the advent of myocardial revascularization and the explosion in cardiac surgery, the need for formal educational training programs became apparent. The American Society of Extracorporeal Technology began the arduous processes of credentialing and developing certification guidelines that have continued under the American Board of Cardiovascular Perfusion. Licen-sure has also been adopted in many states during the past 10 years where nearly 50% of all perfusionists are covered by some legislative act. One additonal challenge has been developing minimal standards in which perfusionists practice. The initial standards included the use of a checklist and have evolved to monitoring and recording the significant events and parameters of each clinical procedure. The education of perfusionists will continue to be a challenge related primarily to reduced fiscal resources, the applicant pool and the ever-changing demands for extracorporeal circulation services. According to demographic and census information, it is expected the overall number of cardiovascular interventions will increase dramatically towards the latter end of the current decade in the US. The question arises as to what role perfusionists will play, as treatment strategies continue to change. If the number of education programs and new graduates continue to decline, the total number of perfusionists will decline, especially as many senior perfusionists leave the field or retire. It may be difficult to predict the total number of cardiovascular interventions that will be required in the next several years. However, if the total number of cardiovascular interventions that require perfusion services increase as a function of the aging population and if the overall incidence of cardiovascular treatment does not change, it will be imperative that perfusion education ramp up and train more perfusionists to meet the supply and demand or a shortage of skilled personnel may develop.
Hemodynamic troubleshooting for mechanical malfunction of the extracorporeal membrane oxygenation systems using the PPP triad of variables
Authors: Faulkner Sherry C , Johnson Charles E , Tucker Juan L , Schmitz Michael L , Fasules James W , Drummond-Webb Jonathan J
Published: November 2003

Prolonged usage of disposable extracorporeal membrane oxygenation (ECMO) circuitry increases the risk of mechanical complications due to breakdown or malposition of the circuit elements. Often, such complications are life threatening for the critically ill patient. Such problems need to be rapidly identified and corrected. Algorithms can be especially helpful in such acute, life-threatening situations. We have outlined an algorithm that uses the relationship between three hemodynamic variables that can be used to rapidly identify mechanical dysfunctions associated with use of the ECMO circuit. These hemodynamic variables are premembrane pressure, pump flow, and patient mean systemic arterial pressure (the PPP triad). These variables are interrelated as a change in one variable results in a change in another. Mechanical malfunction can eliminate this relationship. Changes in one variable only suggest mechanical impairment or failure of the ECMO system. When such a change is detected, a checklist can be rapidly reviewed that directs an immediate logical assessment of potential mechanical causes of hemodynamic compromise.
Departmental use of perfusion crisis management drills: 2002 survey results
Authors: Ginther Richard , Fillingham Roy , Searles Bruce , Darling Edward
Published: November 2003

Serious complications during the performance of cardiopulmonary bypass (CPB) are an infrequent event. However, when potentially fatal technical complications, such as oxygenator or pump failure, do occur, it necessitates a swift and well-co-ordinated response. Periodic performances of drills that simulate various CPB crises are a way to improve individual perfusionist proficiency during disaster situations. The purpose of this study is to determine the utilization of crisis management drills in perfusion departments. Every open-heart program listed by the American Hospital Association in the New England states (Maine, Massachusetts, Rhode Island, Vermont, New Hampshire, Connecticut) and New York were contacted by telephone. Of the 61 contacted, 59 participated for a response rate of 97%. Demographically, the survey represents 312 perfusionists and 47 227 cases annually. While 97% of the perfusion departments believed that regular practice and performance of crisis management drills would improve individual proficiency, only 17% of the programs mandated that their perfusionists perform crisis management drills as a matter of departmental policy. Reasons expressed for not having a formal written policy regarding performance crisis management drills were as follows: left up to the individuals to maintain proficiency 19 (39%), not motivated 11 (22%), confident of proficiency 9 (19%), no time 8 (17%), dubious value 1 (2%), and cost prohibitive 1 (2%). While it is nearly universally accepted that periodically practicing perfusion crisis management drills in a `wet lab' environment would improve proficiency, only a minority of perfusion teams deem this a high enough priority to make it a matter of formal departmental policy.
The effect of oxygenator membranes on blood: a comparison of two oxygenators in open-heart surgery
Authors: Noora Joseph , Lamy Andre , Smith Kelly M , Kent Rosanne , Batt Dianne , Fedoryshyn John , Wang Xiaoyin
Published: November 2003

Open-heart surgery (OHS) requires cardiopulmonary bypass (CPB) in most patients. Membrane oxygenators are a critical component of the CPB system. Despite advancements in CPB technology, injury to blood components during CPB still occurs and may result in complications after surgery. The purpose of the present study was to evaluate the performance of the Medtronic Affinity NT® with Trillium coating and the Cobe Optima XP® oxygenators and compare their influence on blood components.

Two hundred and fifty-six male and female patients scheduled for urgent or elective cardiac surgery with CPB were randomly assigned to either the Affinity NT or the Optima XP oxygenators. Outcomes included platelets, hemoglobin, leukocyte counts, and O2 transfer, measured preoperatively and at 15, 45 and 75 min of CPB time. Blood loss was measured at six and 12 hours postoperatively. A modified intention-to-treat analysis was conducted.

The two groups were similar for age, sex, height, weight, body surface area, and blood components at baseline. There were no differences between the Affinity NT and Optima XP for any outcome measure, although a significant change with time was seen in platelets, hemoglobin, hematocrit and leukocytes, as well as O2transfer for both groups ( p <0.001). The Affinity NT oxygenator had a significantly lower difference in pressure across the membrane ( p <0.001) compared with the Optima XP.

In conclusion, the two oxygenators performed similarly with respect to their impact on blood components, O2transfer, and blood loss postoperatively during OHS with CPB. The Affinity NT had the smaller transmembrane pressure drop of the two.
Peripheral cardiopulmonary bypass with modified assisted venous drainage and transthoracic aortic crossclamp: optimal management for robotic mitral valve repair
Authors: Sobieski Michael A , Slaughter Mark S , Hart David E , Pappas Patroklos S , Tatooles Antone J
Published: November 2003

The purpose of this study was to evaluate peripheral cardiopulmonary bypass (CPB) with modified assisted venous drainage (MAVD) and transthoracic aortic cross-clamping to maintain a bloodless surgical field, adequate myocardial protection, systemic flow and pressure during robotic surgical repair of the mitral valve. Peripheral CPB was established with a standard Duraflo®-coated closed circuit with femoral arterial and venous cannulation. An additional 17 Fr wire-bound cannula was inserted into the right internal jugular vein and drainage rates of 200-400 mL/min were regulated using a separate roller-head pump. A transthoracic aortic crossclamp with antegrade cardioplegia was used for myocardial protection. Mitral valve (MV) repair was then performed through two 1-cm ports for the robotic arms and a 4-cm intercostal incision for the camera and passing suture. From October 2001 to October 2002, 25 patients underwent robotic MV repair. Average surgical times include leaflet resection and repair, 20 min, and insertion of annuloplasty ring, 28 min; average perfusion times, crossclamp 88 min and total bypass time of 126 min. There were no incisional conversions, no reoperations for bleeding and no deaths, strokes or perioperative myocardial infarctions. Twenty-one (84%) patients were extubated in the operating room. Average LOS was 2.7 days with eight (32%) patients discharged home in less than 24 hours. In conclusion, peripheral CPB with gravity drainage of the lower body and MAVD of the upper body allow safe and effective support during robotically assisted minimally invasive MV repair. This approach may be applied to other forms of minimally invasive cardiac surgery that requires CPB.
Expanding the role of perfusionists in the era of new treatment options for cardiovascular disease
Authors: Sistino Joseph J
Published: November 2003

Treatment for cardiovascular disease has dramatically changed the surgical patient population over the past 10 years. Advances in medical management and interventional cardiovascular procedures have delayed surgery in many adults, and the surgical pool has begun to decrease despite an aging population. This affects perfusionists in terms of new psychological and technical challenges, and has serious consequences and implications for the future of the profession.

This study will review the changing patterns of diagnosis and treatment of cardiovascular disease in the USA over the past 10 years by examining the annual surgical procedure rates and correlating them with the number of practicing perfusionists and new student graduates. The purpose of this review is to project the future employment opportunities for perfusionists.

The second part of the paper will look at the alternative roles perfusionists have expanded into as a result of changes in the treatment of cardiovascular disease. The results of an e-mail survey of perfusionists will be presented to identify new applications of perfusion technology.
Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity
Authors: Chiu Thomas Tai Wing , Lo Sing Kai
Published: November 2003

Objective: To examine the test–retest reliability and construct validity of cervical active range of motion and isometric neck muscle strength as measured by the Multi Cervical Rehabilitation Unit (Hanoun Medical Inc., Ontario).

Design: A cross-sectional study.

Setting: Institutional practice.

Subjects: Twenty-one patients with neck pain and 25 healthy volunteers.

Methods: After a trial-run session, active range of motion (AROM) was measured in the subsequent two sessions, with 2–3 days in between. During each session, three measurements were taken for each direction (flexion, extension, lateral flexions and rotations). The measurement of isometric strength was after a 15-minute break following completion of the measurement of AROM. Three measurements were made for each of the six directions (flexion, extension, lateral flexions, protraction and retraction). The software of the Multi Cervical Rehabilitation Unit automatically recorded and calculated the maximum AROM and isometric strength.

Results: There was a good to high level of reliability in the measurement of AROM for both groups of subjects, with intraclass correlation coefficients (ICCs) ranging from 0.81 to 0.96. Results also demonstrated very good to excellent reliability in isometric strength measurement (ICCs ranged from 0.92 to 0.99). Moreover, there was a significant difference in isometric neck muscle strength ( p = 0.001) and in AROM ( p = 0.034) between the two groups.

Conclusions: The Multi Cervical Rehabilitation Unit was found to be reliable and valid for testing the cervical active range of motion and isometric neck muscle strength for both normal and patient subjects.
Setting priorities for a discharge plan for stroke patients entering nursing home care
Authors: Sackley Cath , Pound Kate
Published: November 2003

Objective: To agree priorities for the structure and content of the discharge process for stroke patients entering nursing home care.

Design: A formal priority-setting exercise using the Nominal Group Technique.

Participants: A panel of 12 members of a multidisciplinary team from a hospital and community setting with experience in the management of stroke patients on a daily basis.

Results: Agreement was good and improved during the process (Kendall coefficient of concordance ‘ W’ increased from 0.48 to 0.58 for physical care needs, 0.45 to 0.75 for care needs and 0.56 to 0.72 for the discharge process). The priorities for discharge were:

1) Plans need to be co-ordinated by one person

2) Clear written information on medication should be provided

3) Clear written information on nutritional needs should be provided.

Conclusion: Agreement was reached by a panel of clinicians on an evidencebased discharge plan for stroke patients entering nursing home care.
Systematic review of conservative interventions for subacute low back pain
Authors: Pengel Heloise M , Maher Chris G , Refshauge Kathryn M
Published: November 2003

Objective: To evaluate the effect of conservative interventions on clinically relevant outcome measures for patients with subacute low back pain. This is particularly important because effective treatment for subacute low back pain will prevent the transition to chronic low back pain, a condition that is largely responsible for the high health care costs of low back pain.

Design: Systematic review of randomized controlled trials.

Main outcome measures: Methodological quality of each trial was assessed. Effect sizes and 95% confidence intervals were calculated for pain and disability and risk ratios for return to work.

Results: Thirteen trials were located, evaluating the following interventions: manipulation, back school, exercise, advice, transcutaneous electrical nerve stimulation (TENS), hydrotherapy, massage, corset, cognitive behavioural treatment and co-ordination of primary health care. Most studies were of low quality and did not show a statistically significant effect of intervention. For the strict duration of low back pain (six weeks to three months), no evidence of high internal validity was found but when other methodological criteria were considered, evidence was found for the efficacy of advice. Furthermore, there is evidence that when a broader view is taken of the duration of subacute low back pain (seven days to six months), other treatments (e.g. manipulation, exercise, TENS) may be effective.

Conclusions: Our review identified a major gap in the evidence for interventions that are currently recommended in clinical practice guidelines for the treatment of subacute low back pain. Lack of a uniform definition of subacute low back pain further limited current evidence.
The effects of patellar taping on pain and neuromuscular performance in subjects with patellofemoral pain syndrome
Authors: Ng Gabriel YF , Cheng Jenny MF
Published: November 2003

Objective: To examine the immediate effects of patellar taping on pain and relative activity of vastus medialis obliquus to vastus lateralis in subjects with patellofemoral pain and patellofemoral joint malalignment.

Design: Pre-and post-treatment design, with order of testing determined randomly.

Setting: Outpatient physiotherapy department.

Subjects: Fifteen subjects with patellofemoral joint pain and malalignment.

Interventions: With and without patellar taping with a standard force of application.

Main outcome measures: Pain and surface EMG activity ratio of vastus medialis obliquus to vastus lateralis during single-legged semi-squat with 20% of extra body weight loading.

Results: There was a significant decrease in anterior knee pain ( p < 0.001) and vastus medialis obliquus to vastus lateralis activity ratio ( p = 0.05) during single-legged standing after patellar taping.

Conclusions: Patellar taping can reduce pain in people with patellofemoral pain syndrome and patellofemoral malalignment but it decreases the relative activity of vastus medialis obliquus to vastus lateralis. Such a decrease in relative activity of vastus medialis obliquus after taping implies that it may not be suitable to combine patellar taping with vastus medialis obliquus facilitative exercise training.
Deciding whether a change in a patient's performance is a genuine change
Authors: Valentine John , Simpson Janet M
Published: November 2003

Our purpose is to help clinicians decide whether a measured change in a patient's performance, usually in the direction of improvement, is likely to represent a true change. We set out the calculations to derive a minimal statistically signi'cant change in certain measures commonly used in evaluating the outcome of rehabilitation. Many of these test measurements, e.g. walking time, are likely to show increased variability within patients as the mean level of performance increases in magnitude. We pay particular attention to the calculations in this case as the data should be transformed to remove the relationship by taking their natural logarithm. Con'dence interval calculations for single measurements and for differences between two measurements (using the repeatability coef'cient) are given both for data that show and for data that do not show a relation between variation and level of performance.
Reliability and validity of the Cantonese version of the Test of Everyday Attention among normal Hong Kong Chinese: a preliminary report
Authors: Chan Raymond CK , Hoosain Rumjahn , Lee Tatia MC
Published: November 2003

Objective: To validate the translated Cantonese version of an ecologically valid clinical test of attention – the Test of Everyday Attention (TEA).

Design: A cross-sectional study was conducted on a sample of 49 healthy participants with a mean age of 25.9 years in the Hong Kong Chinese setting.

Outcome measures: These included the Color Trails Test, Stroop Colour-Word Test, Symbol Digit Modalities Test, Word Fluency Test, Design Fluency Test, Digits Backward Span Test and Modified Six Elements Test. In addition, the Cognitive Failures Questionnaire and Dysexecutive Questionnaires were also administered to the participants.

Results: The TEA was found to have a good range of test–retest reliability. The convergent validity of the instrument was established by correlation of the TEA with various measurements of attention, whereas the divergent validity was demonstrated by the insignificant correlation with tests of other cognitive functioning. Factor analysis of the TEA subtests replicated the major factor structure of the original version.

Conclusion: The present study indicates that the translated TEA represents a culturally appropriate tool for measuring everyday life attention performance among the healthy Hong Kong Chinese.
Is stair negotiation measured appropriately in functional assessment scales?
Authors: van Iersel Marianne B , Rikkert Marcel GM Olde , Mulley Graham P
Published: November 2003

Background: A decline in mobility may result in problems with the negotiation of stairs, which can potentially be hazardous. In practice, stair negotiation is an important aspect of daily living and therefore needs to be assessed carefully.

Methods: We conducted a systematic literature review to identify the way functional assessment scales assess stair negotiation. We evaluated whether stair negotiation could be assessed in a valid and reliable way with these scales.

Results: Forty-three of the 92 identified scales have an item on stair negotiation. In these scales, the definition of ‘negotiation of stairs’ varies, as does the definition of independence. Important aspects such as safety on stairs are missing from all scales. In contrast to older scales, newer scales consist of items that have been tested for validity and reliability. In none of the scales was the stair negotiation item tested separately for validity. Only two scales examined test–retest reliability and only one measured inter-observer agreement.

Discussion: In current functional assessment scales stair negotiation is measured with great heterogeneity and insufficient validity. In patients and in studies in which assessment of stair negotiation ability is a key part of functional assessment, an improved, well-validated scale is needed. This scale should include not only the subject's physical ability to negotiate stairs, but also safety and change in ability over time.
Intensive, time-series measurement of upper limb recovery in the subacute phase following stroke
Authors: Goodwin Nicola , Sunderland Alan
Published: November 2003

Objectives: To discover if intensive monitoring of wrist extension would produce consistent recovery curves during the subacute period, and whether any impact of additional physiotherapy could be detected. We also investigated improved approaches to statistical analysis in single-case experiments.

Design: A randomized multiple-baseline experiment with very frequent assessment.

Setting: Stroke rehabilitation unit.

Subjects: Four patients with some active wrist movement less than seven weeks after stroke.

Interventions: Wrist extension was measured twice daily with an electrogoniometer for 3–4 weeks. Additional upper limb physiotherapy (15 minutes, twice per day) commenced after a randomly determined period.

Main outcome measures: Speed and range of wrist movement.

Results: A logarithmic function was fitted to the data to produce recovery curves. In all cases, active range and maximum velocity of wrist extension rose gradually over time. Mean variability in range was <5%, but with occasional outliers. Range of passive movement decreased in two cases in association with pain and increased tone. There were no large improvements coinciding with additional physiotherapy but autoregression analysis indicated statistically significant changes in three cases. A randomization test confirmed an increase in active range associated with additional physiotherapy.

Conclusions: Intensive electrogoniometry provided a detailed recovery pattern for each of these patients. The data were surprisingly consistent over time, showing that it is feasible to use a time-series approach to investigate subacute recovery. Changes associated with additional physiotherapy were observed on some measures, demonstrating the potential of this approach for exploratory evaluation of interventions.
A systematic review of exercise trials post stroke
Authors: Meek C , Pollock A , Potter J , Langhorne P
Published: November 2003

Objective: To perform a systematic review of exercise trials post stroke.

Design: A systematic review of controlled clinical trials.

Search strategy: MEDLINE, EMBASE, CINAHL, Amed, Sports Discus, Cochrane controlled trials register and PEDro were searched for relevant trials.

Inclusion criteria: Studies – randomized or quasi-randomized controlled clinical trials. Participants – Adults of any age with a clinical diagnosis of stroke. Interventions – Any cardiovascular exercise intervention aimed at improving cardiovascular fitness and/or function.

Outcomes: Impairment: gait speed, strength, endurance, balance, flexibility, tonus and exercise capacity. Disability: global dependency, functional independence. Extended activities of daily living. Quality of life. Death.

Data collection and analysis: Two independent reviewers categorized selected trials, documented the methodological quality and extracted the relevant data. Comparisons of cardiovascular exercise interventions versus no cardiovascular intervention were made. Statistical comparisons were carried out using a random effects model to calculate standardized mean differences.

Results: We identified three eligible trials. Small numbers and heterogeneous outcomes limited the analyses and comparisons. Based on the limited data available, we found that cardiovascular exercise post stroke was no better than no exercise with respect to disability, impairment, extended activities of daily living, quality of life and death.

Conclusion: Insufficient evidence was identified to establish if cardiovascular exercise has a positive effect on disability, impairment, extended activities of daily living, quality of life and case fatality post stroke.
Treating sensory impairments in the post-stroke upper limb with intermittent pneumatic compression. Results of a preliminary trial
Authors: Cambier D C , De Corte E , Danneels L A , Witvrouw E E
Published: November 2003

Objective: To evaluate the efficacy of intermittent pneumatic compression (IPC) in treating sensory impairments in the hemiplegic upper limb in stroke patients.

Design: Twenty-three stroke patients were enrolled in a randomized, controlled preliminary trial that compared the application of intermittent pneumatic compression with a passive treatment strategy.

Setting: Four Belgian day centers for treatment of neurological disabilities. Four acute and rehabilitation care wards specialized in neurological treatment.

Subjects: Twenty-three stroke patients.

Interventions: The experimental group ( n = 11) received standard physiotherapy combined with intermittent pneumatic compression treatment (10 cycles of 3 minutes with a peak of 40 mmHg) for their hemiplegic upper limb. The control group ( n = 12) received supplementary to their conventional physiotherapy a placebo treatment, namely sham short-wave therapy on the hemiplegic shoulder for 30 minutes.

Main outcome measures: Sensory impairments were clinically assessed at three occasions over a period of four weeks using the Nottingham Sensory Assessment scale.

Results: Both groups improved in somatosensation over time, but the experimental group improved more than the control group ( p = 0.036) or 81.1% improvement versus 30.9%.

Conclusions: The use of intermittent pneumatic compression in the rehabilitation of stroke patients may be of clinical importance for the restoration of sensory function.
Effects of multisensory stimulation in people with Huntington's disease: a randomized controlled pilot study
Authors: Leng Tanya R , Woodward Melanie J , Stokes Maria J , Swan Anthony V , Wareing Lesley-Ann , Baker Roger
Published: November 2003

Objective: To investigate whether behavioural, motor and physiological responses of individuals with Huntington's disease (HD) to a controlled multisensory environment (MSE) are effective as a therapeutic (sustained effects) or leisure (immediate effects) activity.

Design: Pilot study – a randomized, controlled, two-group design. Setting: Specialist residential unit for people with mid-late stage HD.

Subjects: Twelve patients with HD (one subject from each group dropped out during the study after week 8 due to medical complications).

Interventions: Patients attended eight, 30-minute sessions over a four-week period, of multisensory stimulation (MSE, treatment group) or relaxation activities (control group).

Main outcome measures: Between-group comparisons for changes between assessment sessions for two behavioural assessments: Rehabilitation Evaluation – Hall and Baker (REHAB), Behaviour and Mood Disturbance Scale (BMD); a motor assessment: the dyskinesia section of the St Hans Rating Scale (SHRS); physiological measures: blood pressure, heart rate and respiratory rate. Secondary measures during intervention sessions included behavioural assessment using the Interact.

Results: There were no significant differences found between the groups for any main outcome measures made between sessions. The MSE group showed some positive effects within-sessions, with the Interact showing significant between-group differences in immediate effects on mood ( p = 0.028). There was also a significantly different change over time for within-session changes in stimulation levels ( p = 0.0002) and mood ( p = 0.0001) between the groups. No physiological effects were observed in relation to sessions in either group. Two MSE subjects underwent changes in medication during the study period.
Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4–8 years
Authors: Blundell S W , Shepherd R B , Dean C M , Adams R D , Cahill B M
Published: November 2003

Objective: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy.

Design: A nonrandomized ABA trial.

Setting: Sydney school.

Subjects: Eight children with cerebral palsy, aged 4–8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic quadriplegia.

Intervention: Four weeks of after-school exercise class, conducted for one hour twice weekly as group circuit training. Each work station was set up for intensive repetitive practice of an exercise. Children moved between stations, practising functionally based exercises including treadmill walking, step-ups, sit-to-stands and leg presses.

Main outcome measures: Baseline test obtained two weeks before training, a pre-test immediately before and a post-test following training, with follow-up eight weeks later. Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test; functional performance by Motor Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk test.

Results: Isometric strength improved pre- to post-training by a mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD 15). Children walked faster over 10 m, with longer strides, improvements of 22% and 38% respectively. Sit-to-stand performance had improved, with a reduction of seat height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training all improvements had been maintained.

Conclusions: A short programme of task-specific strengthening exercise and training for children with cerebral palsy, run as a group circuit class, resulted in improved strength and functional performance that was maintained over time.
Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature
Authors: Meijer R , Ihnenfeldt D S , de Groot I JM , van Limbeek J , Vermeulen M , de Haan R J
Published: November 2003

Objective: To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke.

Design: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines.

Methods: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration.

Results: From 1027 potentially relevant studies 26 studies involving a total of 7850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage.

Conclusions: The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.
Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery
Authors: Pandyan A D , Cameron M , Powell J , Stott D J , Granat M H
Published: November 2003

Background: Contractures are common in a stroke population, yet there is little information on the time course of development.

Objectives: Investigate quantitatively changes associated with contracture formation in an acute stroke population.

Study design: Longitudinal study on 22 subjects who were 2–4 weeks post stroke.

Outcome measures: Contractures were assessed by quantifying the resting posture, resistance to passive movement and passive range of movement. Upper limb function was measured using the Action Research Arm Test and the Nine-Hole Peg Test. Active range of extension, wrist extension strength (isometric), grip strength and neglect were also measured.

Repeated measures: Following an initial assessment, repeated measurements were taken at 4, 8, 20 and 32 weeks after recruitment.

Results: Two distinct subgroups, one capable of some functional movement (F group; 8 subjects) and another which was not (NF group; 14 subjects), were identified at the start of the study. The NF group showed changes associated with contracture formation at the wrist, i.e., reduction in the passive range of movement, an increase in resistance to passive movement and a worsening of the flexion posture. Changes were observed from the time of recruitment even though neglect improved. The F group showed improvements in upper limb function and there was no evidence to support contracture formation.

Conclusions: Subjects most prone to contracture formation were those who showed no signs of early functional recovery (2–4 weeks after the stroke). Changes consistent with adaptive shortening were seen from week 4 of the study period.
A 2½-year-old girl with reflex sympathetic dystrophy syndrome (CRPS type I): case report
Authors: Güler-Uysal F , Başaran S , Geertzen J HB , Göncü K
Published: November 2003

An unusual case of a 2½-year-old girl with reflex sympathetic dystrophy (RSD) of the left arm is described. She is the youngest RSD case ever presented in the literature. Upper extremity involvement is also rare in childhood RSD. She had both physical and psychological trauma in an earthquake preceding the disease. The association of RSD with a psychological disorder is stressed and awareness of the condition to the general paediatrician is recommended for early diagnosis and successful treatment.
Clinically significant benign pneumoperitoneum as a complication of percutaneous endoscopic gastrostomy
Authors: Bradley L J , Greenwood R J , Silk D BA
Published: November 2003

Benign pneumoperitoneum is a complication of percutaneous endoscopic gastrostomy (PEG) feeding tube placement. The rate of occurrence is reported as up to 25%. It is usually an incidental finding that arises immediately following the procedure. We report a case of pneumoperitoneum that developed a significant time after the initial procedure. The patient developed intractable vomiting and had to be fed parenterally. The pneumoperitoneum resolved and the gastrostomy tube feed was re-started.
Changing patterns of cognitive-motor interference (CMI) over time during recovery from stroke
Authors: Cockburn Janet , Haggard Patrick , Cock Josephine , Fordham Claire
Published: November 2003

Objective: To explore the extent and nature of change in cognitive-motor interference (CMI) among rehabilitating stroke patients who showed dual-task gait decrement at initial assessment.

Design: Experimental, within-subjects, repeated measures design.

Setting: Rehabilitation centre for adults with acquired, nonprogressive brain injury.

Subjects: Ten patients with unilateral stroke, available for reassessment 1–9 months following their participation in a study of CMI after brain injury.

Measures: Median stride duration; mean word generation.

Methods: Two x one-minute walking trials, two x one-minute word generation trials, two x one-minute trials of simultaneous walking and word generation; 10-metre walking time; Barthel ADL Scale score.

Results: Seven out of ten patients showed reduction over time in dual-task gait decrement. Three out of ten showed reduction in cognitive decrement. Only one showed concomitant reduction in gait and word generation decrement.

Conclusion: Extent of CMI during relearning to walk after a stroke reduced over time in the majority of patients. Effects were more evident in improved stride duration than improved cognitive performance. Measures of multiple task performance should be included in assessment for functional recovery.