bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Flow Velocity Immediately After Reperfusion Reflects Myocardial Microcirculation in Canine Models of Acute Myocardial Infarction
Authors: Wakatsuki Tetsuzo , Oki Takashi , Sakabe Koichi , Shinohara Hisanori , Ikata Jiro , Tabata Tomotsugu , Nishikado Akiyoshi , Ito Susumu , Yamaguchi Tetsu
Published: July 2008

Recent reports indicate that the coronary microcirculation is sometimes injured, despite successful reperfusion in acute myocardial infarction (AMI). However, it is difficult to evaluate the coronary microcirculation immediately after reperfusion by using only angiography. The purpose of this study was to examine the relationship between the pattern of coronary blood flow velocity and myocardial microcirculatory injury immedi ately after reperfusion in AMI. The authors recorded the left circumflex coronary flow velocity by using the Doppler guide wire method 10 minutes after reperfusion in a canine model of AMI. In addition, myocardial contrast echocardiography was performed with the injection of contrast medium into the left circumflex coronary artery before clamping of the coronary artery and 15 minutes after release of the clamp. From these images, the ratio of the normalized gray-level postreperfusion to preclamping in the contrast- enhanced area was determined. It was compared with coronary flow velocity variables. In the 10 dogs with a diastolic-to-systolic velocity ratio (DSVR) < 4.0, this velocity ratio 10 minutes after reperfusion correlated positively (r = 0.75, p < 0.01) with the normal ized gray-level ratio. However, the remaining three dogs with a DSVR ≥ 4.0 markedly deviated from this pattern. Coronary flow velocities in the three dogs were characterized by a greater decrease in systolic flow velocity and occurrence of early systolic retrograde flow. Myocardial contrast echocardiographic images in these three dogs demonstrated a lower normalized gray-level ratio. In conclusion, the coronary flow velocity pattern imme diately after reperfusion may reflect myocardial microcirculatory injury.
Medial Arterial Calcification Is Frequently Found in Patients with Microalbuminuria
Authors: Psyrogiannis Agathoklis , Kyriazopoulou Venetsana , Vagenakis Apostolos G. , Vagenakis Apostolos G.
Published: July 2008

The presence of medial arterial calcification (MAC), often referred to as Moncheberg's sclerosis, was sought in patients with long-standing diabetes mellitus. One hundred patients aged 22-50 years were initially divided into two groups, those with neuropathy and those without. As expected, the incidence of MAC was significantly higher in the neuropathy group (40% vs 20%) . When the patients were divided into two groups, those with MAC and those without, it appeared that the incidence of MAC was very high in patients who had microalbuminuria (57% vs 13%) and particularly when microalbuminuria was combined with neuropathy (40% vs 7%). It is concluded that microalbuminuria is a strong predicting factor of medial arterial sclerosis independent of neuropathy.
Angiographic Study of Coronary Artery Disease in Diabetic Patients in Comparison with Nondiabetic Patients
Authors: Melidonis Andreas , Dimopoulos Vassilis , Lempidakis Emmanuel , Hatzissavas John , Kouvaras George , Stefanidis Alexander , Foussas Stefanos , Foussas Stefanos
Published: July 2008

Diabetes mellitus is known to be a major risk factor for the development of coronary artery disease (CAD). The aim of this study was to investigate angiographically the coronary arteries of diabetic persons, focusing on the type and distribution of CAD, sex differences in CAD anatomy, and the size of the coronary vessels. This was a randomized study and included two groups of patients with angiographically demonstrated CAD. Group A included 463 diabetics, aged 60.3 years, and Group B 210 nondiabetic patients, aged 58.5 years. The two groups were matched by age, sex, weight, and classic risk factors. The authors evaluated the regional location of CAD, left ventricular (LV) function, and the width of the lumen of coronary arteries. The diabetics had three-vessel disease more frequently (p < 0.001) and one-vessel disease less frequently (p < 0.001). The CAD was more extensive in Group A (mean 2.2 vessels, compared to 1.8 vessels in Group B, p < 0.01). The right coronary artery was affected more often in diabetics (p < 0.01), as was the anterior descending artery in three-vessel disease (p < 0.05). The male diabetics had the same angiographic CAD severity as the females, although the latter had a better LV ejection fraction (p < 0.05). The female diabetics < 55 years old had CAD findings comparable with those from women 4 years older in Group B. Diabetics show more diffuse and severe CAD than the general population. There are no sex-related differences in the severity of CAD.
Sudden Infant Death Syndrome Risk Factors
Authors: Lewak Norman , van den Berg Bea J. , Beckwith J. Bruce
Published: July 2008

Prospective data from a population of newborn infants were searched for risk factors for Sudden Infant Death Syndrome (SIDS). Maternal smoking, younger maternal age, short intervals between pregnancies, gestational age of less than 40 weeks, birth weight of less than 3000 g, lower socioeconomic status and male sex were factors found to be associated with SIDS. Race, blood type, maternal hemoglobin level, placental abnormality and newborn condition were not associated with SIDS in this population. Scoring systems to predict which infants will die of SIDS are not yet sensitive enough for clinical use.
The White Cell Ratio in the Very Low Birth Weight Infant
Authors: Prober Charles G. , Stevenson David K. , Neu Josef , Johnson John D.
Published: July 2008

The purpose of this study was to assess the usefulness of the white cell ratio of immature neutrophils (PMNs) to total (immature plus mature) PMNs as an indication of infection in the very small premature infant. We retrospectively reviewed the charts of 59 premature infants ≤ 1,250 g admitted to our Newborn Intensive Care Unit over a one-year period who had at least one white count determined. Twenty-three were born after rupture of membranes for ≥ 24 hours (PROM), 47 had a one-minute Apgar score ≤ 6 and 31 had a five-minute Apgar scores ≤ 6, 38 had respiratory distress syndrome (RDS), and 4 had con firmed infection. Thirty-one of the infants had a ratio ≥ .15 in the first day of life, a value which has been suggested in the literature as being abnormal and an indication to suspect sepsis. This ratio bore no statistical relationship to PROM, low Apgar scores, or RDS. We analyzed these same relationships using a ratio ≥.25, another ratio derived from data in the literature which has been said to suggest infection. No statistical correlation was found for low Apgars or RDS, but there was a significant relationship between PROM and attainment of a ratio ≥.25 (p < .005). It is notable that 2 out of the 4 infants with infection had a ratio <.15. We wish to cast doubt on the applicability of the currently defined WBC ratios in the literature as they apply to the infant with birth weight < 1,250 g and emphasize the apparent effect of PROM as a factor upon these ratios.
Anuria in Childhood due to Bilateral Urolithiasis
Authors: Aladjem Mordechai , Many Moshe , Boichis Hayim , Scapa Eitan , Orda Sara , Hertz Marjorie
Published: July 2008

Four children with anuria due to occlusion of both ureters by calculi are presented. A plain film of the abdomen revealed faintly radiopaque urinary. calculi bilaterally in three patients. In the fourth case, one calculus was visualized in the right ureter, but further contralateral expiration showed an obstructing ureteral calculus in the left ureter as well. It is concluded that in children with acute anuria, the possibility of bilateral ureteral obstruction due to calculi should be the physician's first consideration.
The Wandering Spleen in Infancy and Childhood
Authors: Thompson Jay S. , Ross Ronald J. , Pizzaro Sally T.
Published: July 2008

The wandering spleen is an unusual entity, which has been described rarely in infants and children. Although patients may be asymptomatic, some may present with torsion of the spleen with associated vovulus and vascular infarcation. Two asymptomatic patients with wandering spleen are described. Radiographic signs and isotopic scan findings of wandering spleen are dis cussed and the literature is reviewed.
Pelvic Inflammatory Disease
Authors: Smith Mark Scott , Eschenbach David A.
Published: July 2008

Pelvic inflammatory disease (PID), a bacterial infection centered in the fal lopian tubes, is increasingly encountered among adolescents seen by the pedia trician. This review describes two cases representative of gonococcal and non gonococcal PID and the pathophysiology, epidemiology, diagnosis and treat ment of this disorder are discussed. Emphasis is placed on management by the primary care pediatrician and indications for gynecologic consultation.
Recurrent Group C Streptococcal Tonsillitis in an Adolescent Male Requiring Tonsillectomy
Authors: Fulginiti Vincent A. , Ey John L. , Ryan Kenneth J.
Published: July 2008

A 15-year-old boy had repeated episodes of tonsillitis with group C strepto cocci over a four-month period. The tonsillitis cleared with antibiotic therapy but was followed by a recurrence within a few days. Tonsillectomy resulted in a permanent cure and group C streptococcus was found in the tonsils. A literature search has failed to reveal similar cases and a brief review of the existing literature is given.
Gastroesophageal Reflux
Authors: Weissbluth Marc
Published: July 2008

Gastroesophageal reflux (GER) may produce vomiting, failure to gain weight, esophagitis, heartburn, or pulmonary symptoms. Medical or surgical manage ment depends on the severity of the symptoms. Newer diagnostic procedures such as esophageal manometry, esophageal pH probes, and nuclear scans may confirm the presence of GER. The mechanism by which GER produces different symptoms is not well understood.
Residency Training in Community Pediatrics
Authors: Bass Joel L. , Mehta Kishor A. , Alpert Joel J. , Pelton Stephen
Published: July 2008

A required PL-3 rotation in community pediatrics, including assignments to preschool and school settings, private pediatric offices, and in-hospital re sponsibilities, is described. A university-affiliated community hospital pro vides the organizational base for the program. After 14 PL-3 rotations, analysis of program content, as well as resident and community response, shows the experience to be a practical and workable model for incorporating community pediatrics into residency training.
Hearing Assessment of At-risk Infants
Authors: Thompson Gary , Folsom Richard
Published: July 2008

This study reports hearing status on a consecutive series of infants who had required neonatal intensive care. A relatively high percentage of infants demonstrated hearing impairment. Results are discussed in terms of their implications for the pediatrician who often serves a "case manager" role for families. An underlying assumption is that pediatricians are better equipped to advise parents and make referral decisions if they have an awareness of the current audiologic assessment strategies for infants and young children. The strengths and limitations of the currently employed methodologies are defined and discussed.
Intracardiac Extension of Wilms' Tumor
Authors: Sabio Hernan
Published: July 2008

A case of Wilms' tumor presenting with direct intracardiac extension is described. The clinical features of this unusual complication are described from a review of previous cases. The presence of cardiac abnormalities in a child with a right-sided Wilms' tumor can suggest direct intracardiac extension.
Congenital Right Diaphragmatic Hernia
Authors: Stahl Gary E. , Stuart Warren W. , Rosenberg Henrietta , Spackman Thomas J. , Schnaufer Louise
Published: July 2008

Congenital right diaphragmatic hernia can present a difficult diagnostic problem. An illustrative case is reviewed in which the diagnosis was not con sidered during the initial hospitalization because chest radiographs were inter preted as showing an atelectatic and pneumonic process. Once suspected, the diagnosis was made by fluoroscopy, which showed an immobile right hemi diaphragm, and by liver scan, which demonstrated herniation of the liver into the right thorax. The tendency of congenital right diaphragmatic hernias to present after the neonatal period and to mimic pulmonary parenchymal dis ease is discussed. Several alternative means of diagnosis of right diaphragmatic hernias are reviewed.
Prolonged Remission of Weber-Christian Syndrome in an Infant
Authors: Taylor George A.
Published: July 2008

An infant with Weber-Christian syndrome is described in whom a sus tained remission was achieved with a short course of corticosteroids. In pre vious reports, children less than 2 years of age have continued to have frequent relapses over prolonged periods, but this case illustrates that sustained re- missions may be attained in infants with Weber-Christian syndrome.
Hypophosphatemic Rickets in an Adolescent Cured by Excision of a Nonossifying Fibroma
Authors: Asnes Russell S. , Berdon Walter E. , Bassett C. Andrew
Published: July 2008

An adolescent girl complaining of chronic heel pain was found to have acquired hypophosphatemic rickets and a nonossifying fibroma of the femur. The hypophosphatemic rickets was completely corrected by surgical excision of the bone lesion. This case represents another example of tumor-induced osteomalacia.
Adolescents with Abnormal Cervical Cytology
Authors: Schydlower Manuel , Greenberg Harvey , Patterson Peter H.
Published: July 2008

Cytologic screening is an important diagnostic tool to detect precancerous and cancerous lesions of the uterine cervix. Cervical intraepithelial neoplasia (CIN) represents a continuum of neoplastic alterations, from mild dysplasia to carcinoma in situ. Our high incidence of 32/1,000 adolescent girls with abnormal cervical cytology, suggestive of CIN, supports studies showing that major cervical pathology does exist in this age group. The importance of this problem, previous experiences, reliability of screening, management, and associated risk factors are reviewed. We advocate that the sexually active older adolescent, 18 to 21, have PAP smears at least yearly. It is also our feeling that sexually active adolescents under 18 should have annual PAP smears, even though our studies revealed a paucity of significantly abnormal findings in this age group.
Eosinophilic Cystitis
Authors: Tauscher John W. , Shaw David C.
Published: July 2008

Eosinophilic cystitis is an uncommon inflammatory disease of the urinary bladder characterized by irritative urinary symptoms and eosinophilia of the involved tissue and often of the peripheral blood. Parasitic bladder infiltration has been suggested as the etiologic agent, but review of the literature revealed only one case in which this was proven. A 3.5-year-old boy with eosinophilic cystitis was extensively investigated, but there was no evidence of parasitism. Several immunologic reactions may cause eosinophilia in both tissues and peripheral blood, but no specific allergen could be found in this patient.
A Comparison of Victim, Offender, and Event Characteristics of Alcohol- and Non-Alcohol- Related Homicides
Authors: Pridemore William Alex , Eckhardt Krista
Published: July 2008

The authors used narrative data from court and police records of homicides in Russia to compare alcohol- and non-alcohol-related incidents on victim, offender, and event characteristics. Binary logistic regression models were estimated for neither participant drinking, offender drinking, victim drinking, and both drinking. Consistent differences were found between alcohol- and non-alcohol-related homicides across the models. Alcohol-related homicides were significantly more likely to occur overnight, to occur on weekends, and to result from acute arguments and significantly less likely to occur between strangers, to be profit motivated or premeditated, and to be carried out to hide other crimes. No significant differences between the drinking and nondrinking samples were found for victim's gender, primary weapon used, or event location. The authors place these findings into the literature on the situational context of crime and create a tentative typology of homicide events, grounded in the results of their inductive approach, based on alcohol use by homicide offenders and victims.
Theorizing the Democratic Gaze: Visitors' Experiences of the New Welsh Assembly
Authors: Housley William , Wahl-Jorgensen Karin
Published: July 2008

This article, based on an interview study of public engagement with the new Welsh Assembly building — the Senedd — theorizes the limits and opportunities of `political tourism', or visits to sites of political importance. To understand visitors' engagement with the assembly building, we explore how they account for their reasons to visit, and their perceptions and expectations of the new building and institution. We identify two principal types of vocabulary displayed by members of the public in making sense of the building, those of political engagement and tourist consumption. Both are informed by what we refer to as practices of the `democratic gaze'. Both vocabularies reveal, to varying degrees, the social mechanics of the gaze, and the inscription and interpretation of agency around the building's design. We conclude by exploring how this study can inform discussions of political engagement and tourism practices.
Performance characteristics of intermittent pneumatic compression systems
Authors: Sayegh A. , Rithalia Svs , Andrews K.
Published: July 2008

Intermittent pneumatic compression is widely used in the prevention of deep vein thrombosis and treatment of chronic oedema and peripheral vascular disease. The effect depends on the ability of the equipment to produce sufficient inflation pressure in the inflatable garment during a specified time interval. The performance characteristics of four intermittent compression systems intended for hospital use were assessed at inflation pressures ranging from 30 to 100 mmHg. Considerable differences in the shape of the pressure/time curves were found between the various machines.

Clinical results from various researchers should, therefore, be interpreted within the context of the equipment performance and the shape of the pressure/time cycles generated by each pump. The characteristics often recommended to produce optimum venous pulsatility and prevention of deep vein thrombosis were achieved by only one of the pumps tested.
The causes, pattern and effects of spinal injury in Singapore
Authors: Eng Seng Tan  , Balachandran N.
Published: July 2008

A retrospective study of all spinal injury cases admitted to the Department of Rehabilitation Medicine at the Tan Tock Seng Hospital, Singapore, between 1973 and 1984 was carried out. As this department is the only one in Singapore which manages all unstable spinal fractures, it would be reasonable to assume that the data collected over these 12 years would suffice to reflect the causes, pattern and effects of spinal injuries in Singapore.

Altogether 813 cases were collected for this study, of which 83.9% (682) were males and 16.1% (131) were females. Of these, 71.1% (583) were within the productive age group of 45 and below. The most common causes of spinal injuries in Singapore were industrial accidents (34.5% or 280) and road traffic accidents (33.1% or 269). We have more cervical injuries than in the USA and Australia; 44.1% had cervical injuries, 29.6% had thoracolumbar injuries (TIO-LI), 20.8% had lumbar injuries and 0.9% had sacral injuries. 75% had neurological deficits ranging from loss of skin sensation to complete tetraplegia. Compression fracture was the most common type of fracture (42.8% or 438). Our emphasis on early admission to the Centre to ensure better chance of recovery resulted in 53.9% (438 cases) being admitted from the various hospitals within one week of injury, and this in turn helped us to discharge 72.8% (592 cases) home within three months of stay in the Centre. On discharge 82.4% (670 cases) were independent in activities of daily living and 52.4% (426 cases) were independent in ambulation. Of the 610 cases who were gainfully employed before their injuries, 53% (325) were able to return to gainful employment within one year after the onset of the accident and 17% (106) returned to work after more than a year.
Reducing abnormal drinking patterns in the severely disabled: a multiple baseline study
Authors: Petersen Paul , Ottenbacher Kenneth J , Gervelinger Marcia , Grahn Valarie , Tiffany Trina , Richards-Gannon Celeste
Published: July 2008

The therapeutic effectiveness of an adapted cup combined with a programme of differential reinforcement was examined in three individuals with severe developmental disabilities. A multiple baseline design across subjects was employed. The intervention programme produced a partial improvement in drinking ability for two of the subjects. One subject with extensive oral motor dysfunction did not exhibit any positive response to the intervention. The argument is made that single subject strategies can assist rehabilitation specialists in documenting clinical change for individual patients and that future research should focus on the investigation of subject characteristics that influence treatment outcome.
Changes in central motor conduction with physiotherapy in multiple sclerosis: a case report
Authors: Kandler RH , Childs J.
Published: July 2008

Magnetic stimulation was used to assess central motor conduction times in a patient with multiple sclerosis before and after physiotherapy. A significant change in central motor conduction corresponding to clinical improvement was noted after physiotherapy.
An investigation of the effects of cervical traction. Part 1: Clinical effectiveness
Authors: Klaber Moffett JA , Hughes GI , Griffiths P.
Published: July 2008

Cervical traction is one of the most common methods of treating neck and arm pain, but its effects are poorly understood. This study tested the hypothesis, firstly, that mechanical traction is effective in relieving clinical symptoms and, as a secondary part of a study described elsewhere,1 that the mechanism may be a reduction in muscle tension. One hundred patients with neck and arm pain were randomly allocated to one of two treatment groups: (1) weighted cervical traction (6-15lbs) applied according to a technique commonly used by physiotherapists; (2) placebo traction, applied in exactly the same way, but producing a force of not more than 11b on the head. Both groups were given neck-care education. The weighted traction group tended to improve slightly more than the placebo group on measures of pain, sleep disturbance, social dysfunction, ADL and range of movement at the neck. No significant post-treatment differences were found between the two treatment groups except on flexion and right-side flexion.
The Rivermead Perceptual Assessment Battery: its application to stroke patients and relationship with function
Authors: Jesshope Heather J , Clark Michael S , Smith Dennis S
Published: July 2008

The Rivermead Perceptual Assessment Battery (RPAB) was developed to identify deficits in visual perception. This study sought to examine the relationship of the RPAB to performance in activities of daily living (ADL), and to investigate the concurrent validity of the RPAB. Subjects were 101 stroke patients admitted for inpatient rehabilitation. The RPAB was administered on admission to rehabilitation; prior to this, the treating therapists used the RPAB categories to provide a consensus opinion of the presence of perceptual deficits. The Australian ADL Index was administered on admission to and discharge from rehabilitation. ADL performance improved for all patients during rehabilitation, but patients identified by the RPAB as having perceptual deficits performed more poorly at both admission and discharge than did patients without deficits. However, scores on individual RPAB categories and cognate ADL activities were not consistently related. There was little agreement between the RPAB and the therapists' expert opinion. This result was interpreted in the context of an informal evaluation, made by the testing therapist, of the reasons for failing individual subtests. It was concluded that diagnostic use of the RPAB should combine test scores with observations made during testing, and that the validity of the RPAB must still be questioned.
A specific orthotic device to aid handwriting
Authors: Arroyo Jesus F
Published: July 2008

Orthotic devices can be useful in overcoming some functional handicaps which are produced by many pathological conditions. When impaired function affects the fine motor activity of the hands, handwriting can be totally disrupted. A special orthotic device has been developed to supply specific help for patients with handwriting difficulties. This method, which needs only one finger, or part of a finger, aids written communication and the development of functional motor skills, even when using the nondominant hand.
Qualitative reports of hearing aid benefit
Authors: Stephens Sdg , Meredith R.
Published: July 2008

A simple open-ended questionnaire asking about the benefits and shortcomings of their hearing aid fitting was administered to a series of elderly patients over three months after discharge from a rehabilitation programme. Two-thirds of their benefit responses indicated a reduction in disability and one-third a reduction in handicap. The commonest benefits were with the television, general and one to one conversation and hearing in church and chapel. Main drawbacks were acoustical and practical with few reporting psychological or cosmetic problems. It is concluded that this approach has useful potential in the assessment of hearing impaired patients following rehabilitation and could form a part of the audit process.
Development of a disability team in general practice
Authors: Ward Christopher D , Crates Patricia , Skeates Stuart
Published: July 2008

On the assumption that team-work, follow-up monitoring and the involvement of a neurologist would contribute to the management of chronic disabling conditions, a project to promote these aims was operated for two years in four general practices serving a rural population of 35 000. Physically disabled adults posing management problems were discussed (in their absence) at meetings attended by general practitioners, nurses, therapists, social workers and district- based staff including a neurologist. The majority of the 138 patients reviewed had neurological diagnoses. Team-work and routine surveillance of patients were generally favoured by therapists, health visitors and others more than by GPs and district nurses. Nevertheless, the project demonstrated how a community disability team can function at minimal cost, with potential benefits to patients.
The views of elderly people on emergency alarm use
Authors: Davies Keren N , Mulley Graham P
Published: July 2008

A survey of residents living in local authority (LA) and private housing association (PHA) sheltered accommodation was undertaken to examine and compare the frequency of use and acceptability of the installed alarm system. The majority (80%) of residents had been taught how to use their alarm by the resident warden, but only 35% had received any information on when to use the alarm. In a perceived emergency, 19 (20%) residents did not use the alarm to summon assistance. When the alarm was used, 94% of residents received help within 10 minutes of the call. Over one-third of those questioned had never used their alarm. None of the patients supplied with a portable trigger wore it, either because it was perceived as too sensitive or the appearance was deemed unattractive. Nonetheless, most of the residents (81 %) felt that the alarms were useful and provided reassurance. There should be greater selectivity in the alloca tion of alarms, more education of alarm users to improve the usefulness of these systems, and better design of portable triggers to make them more acceptable to the wearers.
The reliability of stroke outcome measures
Authors: Gompertz Patrick , Pound Pandora , Ebrahim Shah
Published: July 2008

Assessments of outcome in stroke should include measures of the broader aims of rehabilitation, such as handicap, mood and perceived health, and these measures should be reliable. This study compared the test-retest reliability of the Barthel, Nottingham Extended Activities of Daily Living, Geriatric Depression Score (GDS) and the Nottingham Health Profile (NHP) by postal survey of 21 stroke patients six months after their stroke. There was significant variation between test and retest scores in all the scales but the NHP and GDS were much less reliable than the disability measures, perhaps because they measure less objective or more intrinsically variable quantities. Unreliability is important because it adds to the observed variance of any study population, making it more difficult to detect real differences between groups. Analysis of test-retest reliability should be an essential part of the development of questionnaires. Currently recommended outcome measures require further development to improve reliability.
Biomechanical assessment of paraplegic locomotion with hip guidance orthosis (HGO)
Authors: Ferrarin Maurizio , Pedotti Antonio , Boccardi Silvano , Palmieri Roberta
Published: July 2008

An evaluation protocol to analyse the biomechanics of paraplegic patients walking with mechanical orthosis (hip guidance orthosis) has been developed and tried out on a group of patients with thoracic lesions due to spinal cord injury. It includes the analysis of kinematic, kinetic and electromyograph (EMG) data acquired simultaneously during walking. Spatio-temporal parameters and kinetic parameters have been established and are presented stressing the differences between patients 'skilled' and 'unskilled' in the use of orthosis. The inertial impli cations of this kind of walking pattern are taken into consideration. Data from the procedure provide useful information for the improvement of rehabilitative treatment, for the quantitative comparison between different walking restoration techniques and for the optimal adaptation of the individual patient to orthosis.
Dysphagia and multiple sclerosis: a study and discussion of its nature and impact
Authors: Hughes JC , Enderby PM , Hewer R. Langton
Published: July 2008

Dysphagia by any cause is at least unpleasant, may be frightening and can be life-threatening. This study attempted to highlight dysphagia as a symptom of multiple sclerosis.

Seven patients were identified with multiple sclerosis and dysphagia. Their notes were reviewed. One patient was deceased; the six remaining were visited at home. This enabled a detailed questionnaire to be applied and simple examination to be performed. The home visit allowed carers to be interviewed also and provided insight into the full impact of this symptom.

By these means we delineated several types of swallowing problem, choking being predominant. The pattern of the problem was shown to vary, being continuous or intermittent. Associated symptoms were noted to reflect brain stem involvement. We looked at the consequences of the symptom, which ranged from embarrassment and distress to pneumonia and death. We discussed with the patients and their carers compensating mechanisms.

Our study suggests the importance of this easily overlooked symptom in multiple sclerosis. It should be actively sought even in early multiple sclerosis, particularly where other brain stem features exist, since it may be palliated by simple, conservative means.

More research on the nature, prevalence and palliation of dysphagia in multiple sclerosis is required because of its effects on patients, families and carers.
Workload of an inpatient cardiac rehabilitation service in Edinburgh: a five year survey
Authors: Skelton Carol E , McL Weir Alastair , Cay Elizabeth L , Pentland Brian
Published: July 2008

When the cardiac rehabilitation programme at Astley Ainslie Hospital, Edinburgh, UK, was instituted in 1976, it served predominantly patients under 65 years of age who had suffered a recent myocardial infarction. We describe a detailed survey of the medical records of all cardiac admissions to the Rehabilitation Medicine Unit of the hospital during 1986-1990. This survey stresses the changing face of cardiac rehabilitation which has now developed fundamentally into a post cardiac surgical rehabilitation service, catering to an increasingly elderly group of patients. Perhaps this is a logical development as cardiologists and general physicians become more aware of the rehabilitation needs of patients post myocardial infarction and these are instituted both in the acute setting and as an outpatient service. In contrast, cardiothoracic surgical units with the need for high technology and specialist intensive care skills are perhaps environments less suited to the institution of rehabilitation services.
Inter-rater reliability of the Ashworth scale in multiple sclerosis
Authors: Nuyens G. , De Weerdt W. , Ketelaer P. , Feys H. , De Wolf L. , Hantson L. , Nieuwboer A. , Spaepen A. , Carton H.
Published: July 2008

A study of 30 patients with multiple sclerosis was undertaken to determine the inter-rater reliabilty of the Ashworth scale for the clinical assessment of spasticity in the lower limbs. Scores of two physiotherapists were compared. Kendall's tau correlation coefficients higher than 0.60 were found for M soleus, M gastrocnemius and for the M psoas. For the adductors and the internal rotators of the hip, the interrater reliability according to Kendall's tau was lower than 0.55. For the M quadriceps and the flexors of the knee, Kendall's tau correlations were higher on the left side than on the right side. No explanation could be found for this inconsistent finding. It was concluded that the Ashworth scale may be used as a reliable scale for some muscles but not for others. More research is needed to find out if differences in ratings could be explained by fluctuations or differences in the clinical assessment of the muscle tone.
A comparison of neuropsychological and functional outcome, and uptake of rehabilitation services, following severe and moderate head injury
Authors: Anderson Shirley I , Taylor Robert , Jones Patricia A , Miller J Douglas
Published: July 2008

We undertook a prospective outcome study of 61 patients with head injuries of differing severities who had been admitted to a neurosurgical unit and who survived for six months or more. Patients and relatives were interviewed and patients were neuropsychologically assessed six months from the time of injury. Details of the uptake of rehabilitation services were also collected. Three- quarters of the patients with severe head injury and two-thirds of those with moderate head injury remained severely or moderately disabled at follow-up. Both groups showed evidence of cognitive impairment and were reported by relatives to be suffering emotional and psychological problems. Whereas 54% of the severely head injured received inpatient rehabilitation, this was true of only 23% of those with moderate head injury.
Assessing quadriceps muscles recruitment order using rectified averaged surface EMG in young normals and 'weak' and healthy elderly subjects
Authors: Smith GP , Howe TE , Oldham JA , Petterson T. , Tallis RC , Vickers GA
Published: July 2008

The purpose of this study was to investigate whether measurement of the surface electromyogram (EMG) reveals a specific quadriceps femoris (QF) recruitment pattern during various activities and whether this pattern is affected by age and QF wasting.

Surface EMG from the rectus femoris (RF1, vastus lateralis (VL) and vastus medialis oblique (VMO) was recorded in 24 subjects (eight young normals, eight healthy elderly and eight 'weak' elderly) during isometric QF activations at 90° and 0° flexion and simple functional activities such as standing from a seated position and stepping up onto a low block. The raw EMG from each muscle during each activity was full-wave rectified and averaged over successive 10 ms periods to produce a running average EMG signal. The recruitment times of the three muscles were determined at the points at which the EMG signal departed from the baseline recorded prior to the activity. A total of 216 measures of muscle recruitment times were made and the differences between recruitment times were analysed to assess whether they were significantly different.

Results within each subject group failed to reveal significant differences, at the p<0.05 level, in the times of recruitment of the three muscles studied during the activities tested. Close visual inspection of both the raw and averaged electromyograms appeared to indicate that VL and VMO are activated almost simultaneously.
Long-lasting effects of electrical stimulation upon muscles of patients suffering from progressive muscular dystrophy
Authors: Zupan A. , Gregorič M. , Valenčic V.
Published: July 2008

Ten patients with different forms of muscular dystrophy were included in the stimulation programme of the right tibialis anterior muscle for two to three months. Stimulation frequency of 8 Hz was used in six, and of 20 Hz in the other four patients. Muscle strength was estimated by means of an ankle brace which allowed measurements of torques in the ankle during short attempts (two to three seconds) of maximal voluntary isometric contraction in the direction of dorsal flexion of the foot. Muscle fatigue was assessed by the decrease of force during sustained (1 minute) maximal voluntary contraction. The measurements were carried out before the beginning of the stimulation programme (first), immediately after its conclusion (second) and 15-16 months later (third). At the end of the stimulation programme the mean increase of maximal torques was 24.9% in the stimulated, and 8.2% in the nonstimulated, extremity. Comparison of the results of the first and third measurements showed an average decrease of maximal torques of 12% in the stimulated, and of 21.3% in the nonstimulated, extremity. There was no change in fatigue.
Towards interdisciplinary rehabilitation: further developments at Rivermead Rehabilitation Centre
Authors: McGrath Joanna R , Marks Julie A , Davis Alison M
Published: July 2008

This article reports on the continuing development of a client-centred, handicap- based, interdisciplinary approach to goal planning at a neurological rehabilitation centre. Training initiatives and the development of standard documentation are described. Evaluation of the goal-planning process based on this documentation has provided evidence of a good level of staff competence in and commitment to the approach.
Patterns of urine flow and electrolyte excretion in patients following traumatic brain injury
Authors: Novak Stephen , Greenwood Richard
Published: July 2008

This study was conducted to determine how commonly, following a traumatic brain injury (TBI), patients might lose their circadian rhythm of urine production and to explore possible causes. In health, an adult would be expected to have a daytime rate of urine production twice that of the night. Seven patients, all more than three months post-TBI, who were either continent or in whom continence could be achieved by use of an external device (convene) were investigated. For each patient, over a five-day period, the mean daytime and night-time rates of urine production were measured. These values were expressed as a ratio. In three of the seven patients this ratio did not differ significantly from 1, suggesting that they had lost their normal circadian rhythm of urine production. Screening of pituitary function implicated hypothalamic dysfunction in six of the seven patients, offering a possible explanation for the loss of circadian rhythm seen.
Burden and coping among the relatives and carers of brain-injured survivors
Authors: Mitchley N. , Gray JM , Pentland B.
Published: July 2008

The relatives/carers of 23 traumatic brain injury patients were interviewed around one year after patients' discharge from postacute rehabilitation to determine the nature of the residual problems, the nature of the relatives' and carers' responses, and the strain on relatives and carers. Relatives were under very considerable strain. Some response styles were associated with increased stress, but there was little evidence for the effectiveness of positive coping strategies in reducing stress.
The long-term consequences of subarachnoid haemorrhage. 1: Prevalence of impairments
Authors: Lindberg Margareta , Fogelsjöö Anna , Angguist Karl-Axel , Larsson Christer , Fugl-Meyer Axel R
Published: July 2008

This investigation focuses on the prevalence of motor, language, perceptual and memory impairments in long-term survivors of subarachnoid haemorrhage. The prevalence of different impairments was as follows: language 10%, motor 25%, perception 45% (a prevalence that may be age-dependent), and memory 73%. A total of 82% of the subjects had at least one impairment, and impairments of perception and long-term memory were particularly common with a ruptured anterior communicant artery. A factor analysis showed that perceptual function/impairment could be separated into two entities: lower- versus higher-order perception. Another factor analysis separated higher-order perception from memory, casting doubt upon assessment methods that aggregate these two entities.
Behaviour problems after brain injury: incidence and need for treatment
Authors: Johnson Roger , Balleny Heather
Published: July 2008

The aim of this study was to identify the incidence and nature of behaviour problems following severe head injury. All severe head injuries in a known population were identified from a three-year period. Sixteen patients were assessed for behavioural problems shortly after injury, while still in hospital. The relatives' judgements of behavioural change observed at home, for a total of 33 patients from three consecutive years, was collected to compare the extent of behavioural problems during the years following injury.

More behavioural problems were reported at home, by families, than by nursing and therapy staff in hospital. Relatives identified behaviour change in about 80% of the patients and significant practical problems were reported at home in about half of all severely head-injured people. Symptoms appeared to be persistent and tended to worsen over a three-year period following the injury. In particular, aggressive behaviour increased. Behaviour change did not correlate with either age or the severity of the injury as measured by post-traumatic amnesia.

The results of this study draw attention to the need for treatment and support for the families of brain-injured patients showing behavioural disturbance, at home, after they have been discharged from hospital.
Home rehabilitation project for home-bound physically disabled people in Yokohama
Authors: Hakuno A. , Ito T. , Koike J. , Matsuba T. , Watanabe S. , Fujii S.
Published: July 2008

Objective: To evaluate the effectiveness of home-visit rehabilitation.

Design: Before/after trial.

Setting: Home-visit rehabilitation in Yokohama city.

Subjects: Four hundred and seventy-five of 601 cases that received services during 1992, and 141 of 186 cases that received sequential visits.

Interventions: Comprehensive home-visit rehabilitation.

Main outcome measures: (1) Carer's response on change in care burden; (2) improvement in personal care performance.

Results: Care burden decreased in 40.8% of 475 subjects. All of the 141 cases that received sequential visits gained proficiency in personal care.

Conclusion: Improved performance of daily activities and reduction of care burden were found for most subjects after the rehabilitation visits.
Hip muscle strength and function in very elderly women
Authors: Smith Rachael , Scott Oona M , Skelton Dawn , Young Archie
Published: July 2008

Objective: To establish normative data for hip abductors and extensors and to investigate the relationship between these muscles, quadriceps femoris and functional ability.

Subjects: Twenty healthy elderly women, mean age 84 ± 3.1 years took part; test-retest reliability was established in six healthy elderly women, mean age 75 ± 9.1 years.

Main outcome measures: Isometric hip abductor, hip extensor and quadriceps femoris strength, leg extensor power (LEP), walking speed over 6 m, functional reach and stepping on to blocks of differing height.

Results: Intraclass correlations of 0.98 and 0.99 and coefficient of variations (CV) between occasions of 4.7% and 7.2% were established for hip abductor and extensor measurements. The best correlations were between walking speed and strength of quadriceps femoris (p <0.001), between function reach and LEP (p <0.001). LEP was the most significant predictor of functional reach and step height climbed; quadriceps strength was the most significant predictor of walking speed.

Conclusions: The data provide a baseline for future studies with less healthy women.
Daily functioning of the lower extremity amputee: an overview of the literature
Authors: Pernot Hfm , de Witte LP , Lindeman E. , Cluitmans J.
Published: July 2008

The aim of this paper is to review the existing literature on the incidence, morbidity and mortality of lower limb amputation. The functional level of the lower limb amputee and the predictive factors for functioning with a prosthesis are reviewed, both for unilateral and for bilateral amputees. The reported incidence of lower extremity amputation (LEA) varies considerably between different Western countries. The mean survival of LEA patients ranges between two and five years. Assessment of functional outcome is carried out differently. Studies are not comparable and most concern selected groups of amputees. Increasing age, concurrent disease and poor compliance are prognostic factors for a low functional level. For optimal planning of rehabilitation it is necessary to study a complete cohort of amputees with respect to these prognostic factors.
Outcome after stroke rehabilitation in Hong Kong
Authors: Sim TC , Lum CM , Sze Frank K , Or KH , Woo J.
Published: July 2008

Objective: To determine the outcome of patients discharged to the community after stroke rehabilitation.

Methods: One hundred and eighty-five consecutive patients discharged after stroke rehabilitation were enrolled for follow-up 12 months after discharge from a hospital in Hong Kong. A telephone interview to determine disability and place of residence was conducted. Disability was assessed by the Barthel Index and ratings of activities of daily living and mobility on a 4-point scale.

Results: One hundred and thirty-one patients or their carers were contacted (70.1 %). This comprised 19 patients (10.3%) who died and 112 patients or their carers (60.5%) who were interviewed. Fifty-four patients (29.2%) were lost to follow-up. Comparison of the patients contacted and those lost to follow-up did not detect membership bias. Median Barthel Index of the surviving patients who were contacted rose from 90.0 (interquartile range 78.75-100.0) at discharge to 100.0 (interquartile range 85.0-100.0) at 12 months. Ratings of activities of daily living and mobility were maintained, with significant improvement in toileting. After rehabilitation 77.3% of the patients were discharged home and there was no significant change in residence at 12 months. Elderly patients (≥ 70 years old) had higher rates of institutionalization after hospital discharge and more disability although they achieved similar gains in Barthel Index and had similar lengths of hospital stay compared to younger patients.

Conclusions: These results suggest that stroke patients were able to maintain their gains achieved during inpatient rehabilitation up to one year after discharge from hospital.