bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebral Ischemic Events After Diagnosis of Mitral Valve Prolapse
Authors: Avierinos Jean-Francois , Brown Robert D. , Foley David A. , Nkomo Vuyisile , Petty George W. , Scott Christopher , Enriquez-Sarano Maurice
Published: May 2003

Background and Purpose—

Association of mitral valve prolapse (MVP) with ischemic neurological events (INEs) is uncertain.

Methods—

In the community of Olmsted County (Minn), we identified all MVP diagnosed (1989 to 1998) in patients in sinus rhythm with no prior history of INE. We measured INE rates and compared them with expected rates in our community to define the excess risk of INE.

Results—

Among 777 eligible subjects (age, 49±20 years; 66% female; follow-up, 5.5±3.0 years), 30 patients had at least 1 INE during follow-up (at 10 years, 7±1%). Compared with expected INEs in the same community, subjects with MVP showed excess risk of lifetime INE (relative risk [RR], 2.2; 95% CI, 1.5 to 3.2;
P
<0.001) and during follow-up under purely medical management (RR, 1.8; 95% CI, 1.1 to 2.8;
P
=0.009). Independent determinants of INE were older age (RR, 1.08 per year; 95% CI, 1.04 to 1.11;
P
<0.001), mitral thickening (RR, 3.2; 95% CI, 1.4 to 7.4;
P
=0.008), atrial fibrillation (AFib) during follow-up (RR, 4.3; 95% CI, 1.9 to 10.0;
P
<0.001), and need for cardiac surgery (RR, 2.5; 95% CI, 1.1 to 5.8;
P
=0.03). INE 10-year rates were low in patients <50 years of age (0.4±0.4%,
P
=0.60 versus expected) but were excessive in patients >50 years of age (16±3%,
P
<0.001 versus expected) or with thickened leaflets (7±2%,
P
<0.001 versus expected). Predictors of follow-up AFib were age, mitral regurgitation, and left atrium diameter (all
P
<0.01).

Conclusions—

In the community, subjects with MVP display a lifetime excess rate of INE compared with expected. Clinical (older age) and echocardiographic (leaflets thickening) characteristics define patients with MVP at high risk for INE, and subsequent AFib or need for cardiac surgery, both related to the degree of mitral regurgitation, increase the risk of INE.
Does a Relationship Exist Between Carotid Stenosis and Lacunar Infarction?
Authors: Tejada J. , Díez-Tejedor E. , Hernández-Echebarría L. , Balboa O.
Published: May 2003

Background and Purpose—

The presence of carotid stenosis (CS) in a patient with lacunar stroke is usually considered an indication of atherosclerosis and not directly related to the development of this infarction subtype. This study was designed to determine the relationship between CS and lacunar infarction (LI) and to assess the differences between single and multiple LIs.

Methods—

We classified 330 patients with a first-ever cerebral infarction in the carotid territory into LI and non-LI (NLI) groups. In the LI group, patients with a single LI and those with multiple LIs were identified. In this last subgroup, 2 patterns were identified: 1 subtype with lacunar lesions distributed in both cerebral hemispheres, and another with lesions predominantly in 1 hemisphere.

Results—

In the LI group, isolated CS was significantly more frequent on the homolateral side than on the contralateral side (odds ratio [OR], 5.5; 95% CI, 1.2 to 23;
P
=0.03). A significant relationship between the pattern of distribution of the infarctions in only 1 hemisphere and homolateral CS >70% was observed (OR, 4.4; 95% CI, 0.9 to 19;
P
=0.03). In a multivariate analysis, the following variables were found to predict unilateral multiple LI: left ventricular hypertrophy (OR, 9.1; 95% CI, 2.5 to 33.6) and homolateral CS >75% (OR, 14.4; 95% CI, 2.0 to 99.6).

Conclusions—

The significant incidence of isolated ipsilateral CS in patients with LI located in the carotid territory and the relationship of CS to ipsilateral multiple LI suggest that CS has a very important role in the development of LI.
Dissociating Explicit and Implicit Category Knowledge with fMRI
Authors: Reber Paul J. , Gitelman Darren R. , Parrish Todd B. , Mesulam M. Marsel
Published: May 2003

Neuroimaging of healthy volunteers identified separate neural systems supporting the expression of category knowledge depending on whether the learning mode was intentional or incidental. The same visual category was learned either intentionally or implicitly by two separate groups of participants. During a categorization test, functional magnetic resonance imaging (fMRI) was used to compare brain activity evoked by category members and nonmembers. After implicit learning, when participants had learned the category incidentally, decreased occipital activity was observed for novel categorical stimuli compared with noncategorical stimuli. In contrast, after intentional learning, novel categorical stimuli evoked increased activity in the hippocampus, right prefrontal cortex, left inferior temporal cortex, precuneus, and posterior cingulate. Even though the categorization test was identical in the two conditions, the differences in brain activity indicate differing representations of category knowledge depending on whether the category had been learned intentionally or implicitly.
An Overview of Research on Gender in Spanish Society
Authors: VALIENTE CELIA
Published: May 2003

This article presents an overview of research on gender in Spanish society. Six areas of literature are examined including families, education, work, politics, sexuality, and men. The author argues that political factors have shaped the development of sociology of gender in Spain and that there are still important gaps in coverage in this area of sociological inquiry.
It's Not Only “Who You Know” that Matters
Authors: HUFFMAN MATT L. , TORRES LISA
Published: May 2003

Previous research has shown that personal contacts are powerful intermediaries in transmitting job lead information for both job seekers and employers and therefore could contribute to various forms of gender inequality by, for example, providing higher-quality job leads to men than to women. The authors use a unique data set that includes information on the quality and source of individual job leads to explore whether the overall quality of job lead information depends solely on various attributes of recipients' contacts or whether job lead quality is also conditional on gender. These data are based on a diverse sample of professional, technical, and managerial workers from California. Findings indicate that the overall quality of the respondent's job leads is a product of their gender and that of the person providing the lead. In addition, net of a variety of factors, women and men with young children at home receive significantly lower-quality job leads.
Designing Women
Authors: GAGNÉ PATRICIA , McGAUGHEY DEANNA
Published: May 2003

This article draws on Foucault's concept of the exercise of power and Gramsci's concept of hegemony to examine how women used cosmetic surgery to exercise power over their bodies and lives. The analysis is rooted in two feminist perspectives on cosmetic surgery. The first argues that women who elect to have their bodies surgically altered are victims of false consciousness whose bodies are disciplined by the hegemonic male gaze. The second asserts that women who undergo elective cosmetic surgery exercise free choice in controlling their bodies and lives. By examining sites wherein power is exercised by and over women, the authors argue for a synthesis of these two perspectives. They find that the women achieved greater power and control over their bodies and lives when they embodied hegemonic ideals of feminine beauty. Cosmetic surgery can be empowering for individual women while reinforcing the hegemonic ideals that oppress women as a group.
BCL6 gene translocation in follicular lymphoma: a harbinger of eventual transformation to diffuse aggressive lymphoma
Authors: Akasaka Takashi , Lossos Izidore S. , Levy Ronald
Published: May 2003

Follicular lymphoma (FL) is characterized by a relatively indolent clinical course, but the disease often transforms into a more aggressive large cell lymphoma with a rapidly progressive clinical course. In the present study, we analyzed 41 cases of FL known to have subsequently transformed to aggressive lymphoma and an additional 64 FL samples from patients not subsequently transformed. We studied BCL6 gene rearrangement by the methodology of long-distance inverse polymerase chain reaction (LDI-PCR). Of the 41 cases known to transform, 16 (39.0%) harbored BCL6 translocation or deletion at the time of FL diagnosis. Among 64 cases not known to transform, BCL6 translocation was detected in 9 (14.1%). The prevalence of BCL6 translocation in the group known to transform was significantly higher (P = .0048). Among the transformation cases, the partners of the BCL6 translocation were identified in 13 cases and included IGH, CIITA, U50HG, MBNL, GRHPR, LRMP, EIF4A2, RhoH/TTF, and LOC92656 (similar to NAPA), whereas in the control group the BCL6 partners were IGH, CIITA, SIAT1, and MBNL. In 13 cases paired specimens before and after transformation were available. Among these paired specimens, a loss (3 cases) or a gain (1 case) of BCL6 translocation was observed after the transformation. Analysis of clonality showed that all of these cases represented the evolution of a subclone of the original tumor population. Our study demonstrated that BCL6 translocation is not necessary for transformation but that BCL6 translocation in FL may constitute a subgroup with a higher risk to transform into aggressive lymphoma.
Contribution of β-2 microglobulin levels to the prognostic stratification of survival in patients with myelodysplastic syndrome (MDS)
Authors: Gatto Simona , Ball Greg , Onida Francesco , Kantarjian Hagop M. , Estey Elihu H. , Beran Miloslav
Published: May 2003

Prospective analysis of the importance of the plasma levels of β-2 microglobulin (B2M) in 553 patients with myelodysplastic syndrome (MDS) found that B2M is an independent prognostic variable for survival with weighted significance second only to the karyotype. The incorporation of the B2M covariate into risk assessment of MDS patients added significantly to the power of the IPSS to stratify MDS patients into risk categories. Our results further document that the 2 objectively measured covariates that display the highest power to predict survival, that is, karyotype and B2M, can alone be used for risk stratification. While the results must be verified in an independent and comparable population, our data strongly recommend routine measurement of B2M in patients with MDS.
Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning
Authors: Barker Juliet N. , Weisdorf Daniel J. , DeFor Todd E. , Blazar Bruce R. , Miller Jeffrey S. , Wagner John E.
Published: May 2003

Reduced-intensity conditioning may reduce transplantation-related mortality in high-risk adults undergoing hematopoietic transplantation. We investigated unrelated donor umbilical cord blood (UCB) transplantation after such conditioning in 43 patients (median age, 49.5 years; range, 22-65 years) with a primary end point of donor engraftment. The first 21 patients received busulfan 8 mg/kg, fludarabine 200 mg/m2, and 200 cGy of total body irradiation (Bu/Flu/TBI). Subsequent patients (n = 22) received cyclophosphamide 50 mg/kg, fludarabine 200 mg/m2, and 200 cGy TBI (Cy/Flu/TBI). UCB grafts (93%) were 1-2 HLA antigen–mismatched with the recipient and contained a median cryopreserved cell dose of 3.7 × 107 (range, 1.6 × 107-6.0 × 107) nucleated cells per kilogram of recipient body weight (NC/kg). Graft versus host disease (GVHD) prophylaxis was cyclosporin A to day 180 plus mycophenolate mofetil to day 30. The cumulative incidence of sustained donor engraftment was 76% (95% confidence interval [CI], 56%-96%) for Bu/Flu/TBI recipients and 94% (95% CI, 84%-100%) for Cy/Flu/TBI recipients. The median day of neutrophil recovery (at least 0.5 × 109/L) for engrafting Bu/Flu/TBI recipients was 26 days (range, 12-30 days) and for Cy/Flu/TBI recipients was 9.5 days (range, 5-28 days). Incidence of grades III-IV acute GVHD was 9% (95% CI, 1%-17%), and survival at 1 year was 39% (95% CI, 23%-56%). These data demonstrate that 0-2 antigen mismatched UCB is sufficient to engraft most adults after reduced-intensity conditioning and is associated with a low incidence of severe acute GVHD.
Functional comparison of DCs generated in vivo with Flt3 ligand or in vitro from blood monocytes: differential regulation of function by specific classes of physiologic stimuli
Authors: Jefford Michael , Schnurr Max , Toy Tracey , Masterman Kelly-Anne , Shin Amanda , Beecroft Tina , Tai Tsin Yee , Shortman Ken , Shackleton Mark , Davis Ian D. , Parente Phil , Luft Thomas , Chen Weisan , Cebon Jonathan , Maraskovsky Eugene
Published: May 2003

Dendritic cells (DCs) are a family of leukocytes that initiate T- and B-cell immunity against pathogens. Migration of antigen-loaded DCs from sites of infection into draining lymphoid tissues is fundamental to the priming of T-cell immune responses. In humans, the major peripheral blood DC (PBDC) types, CD1c+ DCs and interleukin 3 receptor–positive (IL-3R+) plasmacytoid DCs, are significantly expanded in vivo with the use of Flt3 ligand (FL). DC-like cells can also be generated from monocyte precursors (MoDCs). A detailed comparison of the functional potential of these types of DCs (in an autologous setting) has yet to be reported. Here, we compared the functional capacity of FL-expanded CD1c+ PBDCs with autologous MoDCs in response to 3 different classes of stimuli: (1) proinflammatory mediators, (2) soluble CD40 ligand trimer (CD40L), and (3) intact bacteria (Escherichia coli). Significant differences in functional capacities were found with respect to changes in phenotype, migratory capacity, cytokine secretion, and T-cell stimulation. MoDCs required specific stimuli for the expression of functions. They responded vigorously to CD40L or E coli, expressing cytokines known to regulate interferon-γ (IFN-γ) in T cells (IL-12p70, IL-18, and IL-23), but required prostaglandin E2 (PGE2) during stimulation to migrate to chemokines. In contrast, PBDCs matured in response to minimal stimulation, rapidly acquired migratory function in the absence of PGE2-containing stimuli, and were low cytokine producers. Interestingly, both types of DCs were equivalent with respect to stimulation of allogeneic T-cell proliferation and presentation of peptides to cytotoxic T lymphocyte (CTL) lines. These distinct differences are of particular importance when considering the choice of DC types for clinical applications.
In vitro generation of T lymphocytes from embryonic stem cell–derived prehematopoietic progenitors
Authors: de Pooter Renée F. , Cho Sarah K. , Carlyle James R. , Zúñiga-Pflücker Juan Carlos
Published: May 2003

Embryonic stem (ES) cells can differentiate into most blood cells in vitro, providing a powerful model system to study hematopoiesis. However, ES cell–derived T lymphocytes have not been generated in vitro, and it was unresolved whether such potential is absent or merely difficult to isolate. Because the latter case might result from rapid commitment to non–T-cell fates, we isolated ES cell–derived prehematopoietic precursors for reconstitution of fetal thymic organ cultures. We found a transient Flk1+CD45– subset of these precursors generated T lymphocytes in vitro, and the use of reaggregate thymic organ cultures greatly enhanced reconstitution frequency. These findings reveal that ES cells can exhibit in vitro T-cell potential, but this is restricted to early stages of ES cell differentiation. Moreover, the results support the notion that the thymic microenvironment can induce T-cell differentiation from a subset of prehematopoietic progenitors and suggest deficient migration into intact thymi hindered previous attempts to generate T cells in vitro from ES cell–derived progenitors. These findings demonstrate that a defined subset of ES cells has the potential to generate T cells in vitro and could contribute to greater understanding of the molecular events of hematopoietic induction and T-cell lineage commitment.
Factors associated with strain in co-resident spouses of patients following stroke
Authors: Blake Holly , Lincoln Nadina B
Published: May 2003

Objective: To identify the factors associated with carer strain following stroke.

Design: Co-resident spouses of stroke patients were sent questionnaire measures of their perceptions of strain, stress, mood, handicap, adjustment, social support, life satisfaction and personality, and patient's mood and independence in activities of daily living.

Setting: Stroke spouses were identified from the stroke register at City Hospital, Nottingham.

Results: In a sample of 222 carers, 37% had significant strain. Strain was highly correlated with negative affectivity on the Positive and Negative Affectivity Scale, carer mood on the General Health Questionnaire-12 (GHQ-12) and carer's perceptions of patient's independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). Logistic regression analysis of 96 of these carers supported the correlations and showed three factors, carer GHQ-12, patient EADL and negative affectivity, were independently associated with carer strain.

Conclusion: The relationship between these factors and strain needs to be tested prospectively. Early identification of carers who may be at risk of strain later on will enable services to be targeted at prevention rather than cure.
Treatment of hemiplegic shoulder pain in the Netherlands: results of a national survey
Authors: Snels Ingrid AK , Beckerman Heleen , Lankhorst Gustaaf J , Bouter Lex M
Published: May 2003

Objective: To describe the methods of treatment applied by physiotherapists, occupational therapists, rehabilitation physicians, nursing-home physicians and neurologists for hemiplegic shoulder pain, and to investigate their beliefs about the effectiveness of triamcinolone acetonide injections for this diagnosis.

Design: Postal questionnaire with structured and open-ended questions. If necessary, a written reminder was sent after 2–3 weeks.

Subjects: One hundred physiotherapists, 100 occupational therapists, 100 rehabilitation physicians, 100 nursing-home physicians and 100 neurologists in the Netherlands. These healthcare workers were all active in the rehabilitation of stroke patients.

Results: The response was 351 (70.2%), ranging from 58% (neurologists) to 83% (physiotherapists). Fifty-four different (combinations of) treatments were mentioned and were classified into eight treatment groups. The frequency of the first choice of treatment was: physiotherapy (32%), prevention/ instruction/education (22%), oral medication (8%), local injection (7%), sling (4%), referral (3%), other therapies (4%), and different combinations (20%).

In total, 86 respondents had applied local injections: 70 rehabilitation physicians, 10 nursing-home physicians and 6 neurologists. The injections used were: corticosteroids alone (51.2%), in combination with a local anaesthetic (37.2%) or a local anaesthetic only (9.3%). Belief in the effectiveness of triamcinolone injections, measured on a 0–100 point scale, was: physiotherapists median 62.5 (IQR 29.75–71.75), occupational therapists median 50.0 (IQR 43.0–63.0), rehabilitation physicians median 70.0 (IQR 56.5–80.0), nursing-home physicians median 35.0 (IQR 21.0–64.5), neurologists median 47.0 (IQR 20.0–63.0).

Conclusions: As preventive measures and physiotherapy, or a combination of both, were found to be the favourite methods of treatment for hemiplegic shoulder pain in this survey, it seems that most physicians and therapists rely on a mechanical approach to hemiplegic shoulder pain. Rehabilitation physicians used additional local (anti-inflammatory) injections.
Ground reaction force after a sideways push as a measure of balance in recovery from stroke
Authors: Holt R R , Simpson D , Jenner J R , Kirker S G B , Wing A M
Published: May 2003

Objective: To investigate if measuring ground reaction force after a sideways push at the hips gives a measure of standing balance in stroke subjects.

Methods: Fifteen control subjects and 13 right hemiparetic subjects who were able to stand independently stood with their feet on a single forceplate. Horizontal sideways pushes of 3% body weight were delivered to each side of the pelvis with the subjects held firmly in a semi-rigid belt. Measurements were made of lateral pelvic displacement (sway) and the lateral sheer component of ground reaction force (GRF).

Results: Right hemiparetic subjects showed significantly greater sway after a sideways push ( p < 0.01) and later onset of GRF ( p < 0.01) when pushed to their weak side compared with control subjects. There was also a positive correlation between sway after a sideways push and the onset latency of GRF in both strokes (0.41) and controls (0.61). The hemiparetic subjects swayed more ( p < 0.01) when pushed to their weak side compared with their stronger side and their GRF latency was longer, but this latter measurement failed to reach statistical significance. No difference was seen between sides in sway or GRF latency in controls.

Conclusions: The latency of GRF onset after a push at the hips in controls and in stroke subjects is related to sway and both measurements increase after a stroke. This test offers a method of measuring balance after a stroke, and serial testing of an individual after a stroke may prove a useful measure of an individual's recovery of balance.
Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes
Authors: Donkervoort M , Dekker J , van den Ende E , Stehmann-Saris J C
Published: May 2003

Objective: To investigate the prevalence of apraxia in patients with a first left hemisphere stroke.

Subjects: Left hemisphere stroke patients staying at an inpatient care unit of a rehabilitation centre or nursing home and receiving occupational therapy (n = 600).

Measures: A short questionnaire on general patient characteristics and stroke-related aspects was completed by occupational therapists for every left hemisphere stroke patient they treated. A diagnosis of apraxia or nonapraxia was made in every patient, on the basis of a set of clinical criteria.

Results: The prevalence of apraxia among 492 first left hemisphere stroke patients in rehabilitation centres was 28% (96/338) and in nursing homes 37% (57/154). No relationship was found between the prevalence of apraxia and age, gender or type of stroke (haemorrhage or infarct).

Conclusions: This study shows that approximately one-third of left hemisphere stroke patients has apraxia.
An optimization of the Waterlow score using regression and artificial neural networks
Authors: Anthony Denis , Clark Michael , Dallender Janie
Published: May 2003

Objectives: To optimize the ability of the Waterlow Scale to predict individuals vulnerable to developing pressure ulcers.

Design: Prospective cohort study.

Setting: Two acute care UK National Health Service (NHS) providers.

Subjects: Four hundred and twenty-two inpatients across five specialities (general medicine, general surgery, orthopaedics, oncology and rehabilitation).

Interventions: Waterlow scores recorded weekly for 14 days post admission to hospital.

Main outcome measure: Development of a pressure ulcer.

Results: Nonlinear analysis using neural networks did not outperform linear methods. Only five items out of 11 in the Waterlow Scale appeared to have any classification ability in this patient population.

Conclusions: The Waterlow score when modelled as a linear equation appears as effective as more complicated nonlinear mappings using neural networks. Only a subset of the variables of the Waterlow Scale have predictive value in this patient population, but this is a different subset to those found in a previous study of a different client group (wheelchair users).
Longitudinal changes in bone in men with spinal cord injury
Authors: de Bruin Eling D , Dietz Volker , Dambacher Maximilian A , Stüssi Edgar
Published: May 2003

Introduction: Quantitative bone assessment today is primarily based on the analysis of bone mineral density (BMD). The geometric and structural properties of bone, which are important parameters for skeletal strength, are generally not considered in the routine clinical assessment of spinal cord injury-related osteopenia.

Objective: To study changes in structural and geometric properties of tibia bone longitudinally by means of peripheral quantitative computerized tomography and a biomechanical test method (bone stiffness measurement device Swing) in 12 subjects with spinal cord injury.

Design: Measurements were conducted in the 5th week and around the 104th week after the spinal cord injury in a university hospital.

Results: Paired Student's t-tests showed a significant decrease in trabecular ( p < 0.05) and cortical bone ( p < 0.05), as well as a significant decrease in geometric properties of tibia bone ( p < 0.05) within two years after the spinal cord injury. Phase velocity propagation changed in three subjects within two years following the spinal cord injury.

Conclusions: This study indicates that beside changes in tissue composition, changes in bone geometric indices and in structural properties occur in the lower extremity after a spinal cord injury. In the tibia, consideration of geometric and biomechanical parameters of bone combined with bone mineral density measurements could result in an improved screening for spinal cord injury-related osteopenia and the prediction of fracture risk in spinal cord injury.
Criterion validity of lower extremity Motricity Index scores
Authors: Cameron Denise , Bohannon Richard W
Published: May 2003

Objective: To examine the criterion validity of lower extremity Motricity Index scores.

Design: Retrospective cross-sectional comparison of lower extremity Motricity Index scores and hand-held dynamometer measurements obtained from 15 patients with stroke.

Results: For individual actions (ankle dorsiflexion, knee extension and hip flexion) and all actions combined, Pearson correlations were good to excellent ( r = 0.78–0.91), significant ( p < 0.001), and of high power (9%).

Conclusions: The findings of this study support the criterion validity of the lower extremity Motricity Index.
The Frontal Lobe Score: part II: evaluation of its clinical validity
Authors: Wildgruber Dirk , Kischka Udo , Faßbender Klaus , Ettlin Thierry M
Published: May 2003

Objective: To evaluate the ability of the Frontal Lobe Score (FLS) to differentiate patients with frontal lobe lesions from those with nonfrontal lesions and normal controls.

Design: In a prospective, blind setup, the sensitivity and specificity of the Frontal Lobe Score was compared with the Wisconsin Card Sorting Test (WCST) and the Stroop Test.

Patients: A sample of 108 subjects (26 patients with cerebral lesions confined to the frontal lobes, 28 patients with cerebral lesions without involvement of the frontal lobes, 31 patients with mixed frontal/nonfrontal lesions, 23 controls without cerebral lesions) was examined.

Measures: Frontal Lobe Score, Wisconsin Card Sorting Test, Stroop Test.

Results: The Frontal Lobe Score detected pure frontal lesions with a sensitivity of 92.3%. It discriminated patients with frontal lesions from normal controls with a specificity of 100%; differentiation from patients with nonfrontal lesions was obtained with a specificity of 75.0%. For the WCST, sensitivity for detection of pure frontal lesions was 65.4%, while specificity was 60.9% compared with normal controls and 53.6% compared with nonfrontal lesions. The Stroop Test showed a sensitivity of 30.8%, a specificity compared with normal controls of 95.7% and compared with nonfrontal lesions of 92.9%.

Conclusion: The Frontal Lobe Score has clinical usefulness for screening of effects of frontal lobe damage superior to that of the WCST and the Stroop Test.
Inter-rater reliability of the Nottingham method of stereognosis assessment
Authors: Gaubert C S , Mockett S P
Published: May 2003

Objective: To investigate the inter-rater reliability of stereognosis assessment in stroke patients, as measured by the Nottingham Sensory Assessment (NSA).

Subjects: Twenty stroke patients consented to participate in the study. The subjects were aged between 40 and 93 years, and were no more than three months post stroke.

Design: The stereognostic ability of the subjects was assessed by two of three examiners within a 24-hour period. The method laid out by the NSA was followed throughout the study.

Analysis: Point to point agreement of scores and therefore reliability levels were assessed between examiners using the kappa coefficient of agreement.

Results: The majority of subjects ( n = 13) were found to have impaired stereognosis on their affected side. A good level of reliability was found for the majority of items ( n = 32), with kappa values being rated as substantial or higher for most of the objects tested. In eight cases the reliability was fair or moderate. These cases included the glass, biro and 10p coin when the affected side was assessed by examiners 1 and 2, and the pencil when the same side was assessed by examiners 1 and 3. These levels of reliability were acceptable, but were not as high as the researchers had hoped.

Conclusion: It is concluded that the Nottingham method of stereognosis assessment is a reliable assessment tool between raters.
What is the association between the different components of stroke rehabilitation and health outcomes?
Authors: Alexander Helen , Bugge Carol , Hagen Suzanne
Published: May 2003

Objectives: To describe the rehabilitation input stroke patients received from health professionals during the early post stroke period and to explore possible associations between health outcomes and these rehabilitation inputs.

Design: Community-based study with prospective identification of stroke patients from a random sample of 24 general practices stratified by geographical area and practice size.

Setting: Ayrshire and Arran Health Board area, West of Scotland.

Interventions: All physiotherapy, occupational therapy, dietetics, podiatry, speech and language therapy and community nursing inputs given to stroke patients in the course of normal treatment were recorded.

Outcome measures: Barthel Index and Medical Outcomes Study Short Form-36 (SF-36). Both recorded at one, three and six months post stroke.

Results: Of the 152 people providing data, more had received physiotherapy than any other rehabilitation input at all three follow-ups (81%, 47%, 39%), with occupational therapy being the next most common service (65%, 44%, 25%). Amount of rehabilitation input was significantly negatively correlated with health outcomes measured at each discrete time point: those patients with the poorest outcomes received greatest input. However, regression analysis of change in outcome scores showed that increasing amounts of rehabilitation input were significantly associated with a reduction in disability, particularly between one and three months post stroke.

Conclusions: Not only have we shown that those stroke patients with poorest outcomes received most rehabilitation input, but, from analysis of the individual rehabilitation inputs, we have identified some rehabilitation inputs that significantly predict improved outcomes. This suggests that there would be merit in further investigation of these associations.
Position-matching in the upper limb: professional ballet dancers perform with outstanding accuracy
Authors: Ramsay Jill RE , Riddoch M Jane
Published: May 2003

Objectives: To investigate the accuracy in position-matching in the upper limb in two groups of subjects who were physically fit and movement aware.

Design: A mixed-group design was used. Objective measurement of the accuracy in position-matching at the shoulder and elbow in both dominant and nondominant arms consisted of photographic record of the position-matching test, with goniometric measurement.

Settings: Physiotherapy department at the Birmingham Royal Ballet and School of Health Science, University of Birmingham.

Subjects: Two subject groups: physiotherapy students (n = 10), professional ballet dancers (n = 10).

Results: A mixed design analysis of variance found significant differences between the accuracy in position-matching at both the shoulder and elbow joints in the two groups (p < 0.05), with the ballet dancers having greater accuracy then the physiotherapy students. A significant difference in the joint positions tested were demonstrated (p < 0.05) with the positions of abduction at the shoulder and extension of the elbow showing greatest accuracy in matching. There was no significant difference found between the dominant and nondominant upper limb in position-matching.

Conclusion: Professional ballet dancers demonstrated greater accuracy in position-matching the upper limb, implying that mass and continuing practice can improve a motor sensory skill.
The Parkinson's Disease Activities of Daily Living Scale: a new simple and brief subjective measure of disability in Parkinson's disease
Authors: Hobson J P , Edwards N I , Meara R J
Published: May 2003

Objective: To develop a brief, valid and reliable self-report scale for the assessment of activities of daily living in Parkinson's disease (PD).

Design: Self-report questionnaire development.

Subjects: One hundred and seventy subjects with a diagnosis of clinically probable PD living in the community.

Measures: The self-rating scale – Parkinson's Disease Activities of Daily Living Scale (PADLS), Webster Scale, CAMCOG neuropsychological test,15-item Geriatric Depression Scale (GDS-15) and the self-rated Parkinson's Disease Quality of Life (PDQL) questionnaire.

Methods: The PADLS was initially validated and test–retest reliability assessed in a group of PD patients (n = 38). Next a convenience sample of 132 patients was drawn from a community-based PD register. Subjects were invited to complete the PADLS, PDQL, GDS-15, Webster scale and CAMCOG test.

Results: The PADLS correlated significantly with increasing age, duration of illness, disease severity, increasing depression, impaired cognition and poorer health-related quality of life.

Conclusion: The PADLS was found to be a reliable and valid measure of ADL, demonstrating acceptable internal consistency and strong associations with existing measurers of disease severity, depression, cognitive screening and health-related quality of life. The PADLS allows patients to subjectively report the impact that PD has upon daily activities and will complement existing formal clinical measures in PD.
The internal consistency and validity of the Self-assessment Parkinson's Disease Disability Scale
Authors: Biemans M A J E , Dekker J , van der Woude L H V
Published: May 2003

Objective: To test the consistency and validity of the Self-assessment Parkinson's Disease Disability Scale in patients with Parkinson's disease living at home.

Design: Patients with Parkinson's disease responded to a set of questionnaires. In addition, an observation of the performance of daily activities was carried out on a subgroup.

Setting and subjects: Patients with Parkinson's disease living at home (n = 142).

Measures: The Self-assessment Parkinson's Disease Disability Scale (SPDDS), the Hoehn & Yahr Rating Scale (H&Y), and the Sickness Impact Profile (SIP68). The observation concerned nine activities that correspond to items of the SPDDS questionnaire.

Results: Internal consistency of the SPDDS was very high (Cronbach's alpha = 0.97; reliability rho = 0.97). The items of the SPDDS are hierarchical (Loevinger's H = 0.64): patients had least difficulty with ‘washing’ and ‘brushing teeth’ and most difficulty with ‘turning in bed’, ‘travelling by public transport’ and ‘writing a letter’. Validity of the SPDDS was good: the relationship between the SPDDS questionnaire and the H&Y rating scale, the SIP68 and the results of the observation was strong and significant.

Conclusion: The SPDDS is a unidimensional instrument measuring disabilities in Parkinson's disease patients living at home.
Quantifying associated reactions in the paretic arm in stroke and their relationship to spasticity
Authors: Bhakta Bipin B , Cozens J Alastair , Chamberlain M Anne , Bamford John M
Published: May 2003

Objectives: (1) To present a measurement protocol for assessing associated reactions (AR) in the paretic arm and (2) to use it to investigate the pattern of AR and its association with spasticity.

Setting: Inpatient rehabilitation unit.

Design: Associated reactions in 49 adults with stroke were measured in terms of force generated, electrical muscle activity and wrist movement in the paretic arm using hand dynamometry, surface electromyography and electrogoniometry respectively. Simultaneous recording of the effort used to elicit the associated reaction was made using a second hand dynamometer. The magnitude and persistence of AR was compared with the clinical assessment of spasticity (using the modified Ashworth Scale, MAS).

Results: There was poor correlation between peak AR and MAS, suggesting that AR are not confined to patients with severe spasticity. Co-activation of forearm flexors and extensors was evident during the AR. AR fluctuated during a single period of effort in some patients. Only 12 out of 31 patients who maintained uniform effort over the measurement period produced a uniform AR. AR often persisted for some time after effort had ceased. Eight were classified as minimal (median AR 0.23 N), 25 as mild (median AR 2.7 N), 11 as moderate (median AR 6.4 N) and 3 as severe (median AR 11.0 N). AR tended to persist in patients with higher MAS although this result was not statistically significant.

Conclusion: The magnitude, profile and persistence of AR varied considerably between individuals. Associated reactions were present in people with minimal spasticity. As this technique allows the magnitude of AR to be quantified in relation to effort it has the potential to be a useful outcome measure in clinical trials evaluating the treatments (e.g. physiotherapy) directed at reducing associated reactions.
Functional electrical stimulation by means of the ‘Ness Handmaster Orthosis’ in chronic stroke patients: an exploratory study
Authors: Hendricks H T , Ijzerman M J , de Kroon J R , in 't Groen F A C G , Zilvold G
Published: May 2003

Objective: To gain experience with ‘Ness Handmaster Orthosis’ treatment in chronic stroke patients, to identify suitable patients, and to study the effects of treatment.

Design: Exploratory, uncontrolled trial with measurement of motor functions and muscle tone of the upper extremity prior to, during, upon completion, and six weeks after a treatment period.

Setting: A rehabilitation centre in the Netherlands.

Subjects: Eighteen chronic stroke patients (more than six months post stroke), who exhibited upper extremity dysfunction due to spastic paresis.

Intervention: A 10-week therapy programme of functional electrical stimulation by means of the ‘Ness Handmaster Orthosis’.

Results: The results of 15 patients were available for analysis. The differences in motor score and muscle tone before and at the end of treatment were statistically significant (p = 0.008 and 0.021, respectively). The follow-up measurements showed that the effects on motor functions and muscle tone decreased after therapy completion. Stratification of the patients in two subgroups indicated that patients with initial high motor scores benefited most during the intervention period.

Conclusion: The present study suggests that Handmaster treatment possesses therapeutic opportunities in chronic stroke patients with spastic paresis of the upper extremity.
Fine motor assessment in chronic wrist pain: the role of adapted motor control
Authors: Smeulders Mark JC , Kreulen Michiel , Bos Kurt E
Published: May 2003

Objective: To show whether a difference in fine motor control exists between patients with chronic, undiagnosed wrist pain (CUWP) and healthy controls. Furthermore, a method to assess fine motor function of the wrist is evaluated.

Design: A case–control study.

Setting: The Academic Medical Center in Amsterdam, the Netherlands.

Subjects: Twenty-seven CUWP patients were compared with 50 healthy control subjects.

Interventions: Subjects performed horizontal stroke patterns on a digital writing tablet connected to a computer. The control subjects were tested twice to obtain test–retest reliability. A visual analogue scale was used to assess subjective pain.

Main outcome measures: Fluency of movement and average velocity were measured. Intraclass correlation, ANOVA repeated measures statistics and Pearson correlation were calculated.

Results: There is a significant difference in fluency of motion between patients and controls, possibly due to a disturbed motor control, since there is no relationship between pain and test score, nor do CUWP patients have any abnormality in the wrist that can explain the disturbance in motor function. The test method is reliable (ICC = 0.78) and valid.

Conclusions: The disturbed fine motor control in CUWP patients is suggested to maintain chronic wrist pain through ‘strain injury, causing’ pain evasive adaptation of the motor control system. This might lead to new perspectives regarding treatment of CUWP patients.
Unpacking the black box of nursing and therapy practice for post-stroke shoulder pain: a precursor to evaluation
Authors: Pomeroy V M , Niven D S , Barrow S , Faragher E B
Published: May 2003

Objectives: To describe current nursing and therapy interventions for the prevention and treatment of post-stroke shoulder pain and to explore the extent of their reported use in England.

Design: Semi-structured, themed interviews followed by a postal questionnaire.

Participants: Six nurses, five occupational therapists (OTs) and six physiotherapists (PTs) were interviewed. Twelve nurses, 12 OTs and 12 PTs were sent the pilot questionnaire and the main questionnaire was posted to 332 nurses, 332 OTs and 332 PTs.

Setting: NHS Trusts in England which provide acute stroke care/rehabilitation.

Procedure: Two researchers independently condensed the transcripts of the interviews into a list of interventions which were then transformed into a pilot postal questionnaire. Following the pilot small changes were made. Participants sent the main questionnaire were given three weeks to return it before being posted a reminder. After a further two weeks a researcher gave a telephone reminder.

Results: One hundred and seventy-five different types of interventions were identified. The main questionnaire (57.8% response rate) found that all of the interventions were used by at least one respondent and that only 22.9% of the interventions were used to the same extent by nurses, OTs and PTs. The data also suggest variation in reported use within professions.

Conclusions: This study has found a large number of interventions for post-stroke shoulder pain which are reported to be used. This might reflect different causes of shoulder pain or variation between clinicians. Answers to these questions are expected to guide future evaluative research.
Mobility of people with lower limb amputations: scales and questionnaires: a review
Authors: Rommers Gerardus M , Vos Luc D W , Groothoff Johan W , Eisma Willem H
Published: May 2003

Objective and design: A systematic literature review to compare mobility scales used for lower limb amputees. A literature search was carried out by computerized search of biomedical literature including Medline and Embase. The studies included were published between 1978 and 1998 and including the following keywords: amputation, artificial limbs, prosthesis, lower limb, activities of daily living, mobility.

Results: Thirty-five studies were identified; 19 had a measurement of separate levels of mobility comparable to each other. Sixteen studies used ordinal and ratio scales without separate levels of mobility. The widest range of measurement found was the scale from ‘walking with prosthesis without a walking aid’ to ‘totally confined to bed’. The Stanmore Harold Wood mobility scale was published most frequently. None of the 35 studies presented give a continuous measurement of mobility.

Conclusion: A multitude of measurement scales and questionnaires are available for differ in methods and measuring range. Measuring mobility by a scale has been shown to have limitations. Several authors did extensive research but they all measure only a number of aspects of mobility. Consensus about the measurement of mobility of lower limb amputees is not available in the recent literature.
Children with asthma and physical exercise: effects of an exercise programme
Authors: van Veldhoven N HMJ , Vermeer A , Bogaard J M , Hessels M GP , Wijnroks L , Colland V T , van Essen-Zandvliet E EM
Published: May 2003

Objective: To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis.

Design: Intervention study: a randomized pretest–post-test control group design.

Setting and subjects: Forty-seven children with clinically diagnosed asthma participated in the intervention study, including 34 boys and 13 girls, from 8 to 13 years of age (mean age 10.6).

Interventions: The physical exercise programme consisted of regular group exercises and home exercises for a period of three months. It was based on a theoretical model describing the relationships between physical competence (condition), perceived physical competence, self-esteem and coping behaviour.

Main outcome measures: Maximum incremental exercise test, endurance test, the Self-Perception Profile for Children (CBSK), the Asthma Coping Test (ACBT), lung function and exercise-induced bronchoconstriction.

Results: The results showed significant effects of the intervention programme on physical condition. There was a significant improvement of 15 W on the maximal workload (Wmax) (p < 0.001), of 7% on VO2max (oxygen uptake) (p = 0.002) and a significant decrease on heart rate submaximal of 6% (p = 0.001). There was also a significant improvement of 50% in running time measured with the endurance test (p = 0.021). Furthermore, a significant effect of the intervention was seen on coping with asthma (p = 0.003).

Conclusion: It was concluded that participation in the physical exercise programme not only enhanced physical fitness, but also improved coping behaviour with asthma.
A new, comprehensive normative database of lumbar spine ranges of motion
Authors: Troke Michael , Moore A P , Maillardet F J , Hough A , Cheek E
Published: May 2003

Aims and objectives: To generate gender-specific and broadly based agerelated indices for normative lumbar ranges of motion for all planes of movement.

Design: This was a repeated measures prospective study of spinal range of motion in a sample of volunteer subjects utilizing a portable modified CA6000 Spine Motion Analyzer (Orthopedic Systems Inc., Union City, CA, USA).

Setting: Data collection was carried out in a variety of community locations including fire, police and ambulance stations, offices and community centres.

Subjects: A total of 405 asymptomatic subjects (196 female, 209 male) were recruited, aged 16–90 years, from sedentary, mixed and physically demanding occupations.

Methodology: Indices of lumbar spine ranges of motion were measured in standing following a standardized protocol for sagittal flexion/extension, coronal lateral flexion and horizontal axial rotation movements.

Results: Male and female normative flexion ranges declined by approximately 40% (72–40 degrees) across the age spectrum. Extension declined the greatest, by approximately 76% (29–6 degrees) overall. In lateral flexion male and female ranges declined approximately 43% (29–15 degrees) in each direction (total 58–30 degrees). In axial rotation no age-related decline was observed and ranges of motion remained at approximately 7 degrees in each direction (total 14 degrees) across all the ages of the subject group. Conclusions: Data have been generated that provide comprehensive, gender-specific, broadly based and age-related indices for normative lumbar ranges of motion in all planes of movement. These are applicable to individuals throughout adult life, from adolescence through to old age.