bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of severely head-injured people in the Southampton health district
Authors: Wilkinson Stephen M , Fisher Lorna R , Bromfield Pauline
Published: July 2008

A survey was conducted to identify the needs of the severely head-injured people (SHI) in the Southampton health district, who were known to the medical or social services. The study identified 62 patients with SH I and of these 48 were assessed. The results were similar to previous reports, showing that this group of relatively young individuals (mean age 36.5 years) had considerable residual disability many years after the original accident (mean duration 8.7 years). Over 50% of the study group had multiple impairment of a physical, cognitive and behavioural nature. Cognitive and behavioural problems presented the greatest difficulties for family and social adjustment.

This study identified less than 10% of the predicted number of patients suffering from disability following SHI, suggesting that further prospective studies of outcome of SHI are needed at district level. Moreover, current services were not judged to be providing adequate social and vocational activities even for the minority of patients assessed. It is further suggested that a specialized brain-injury team is needed to monitor patients' early and long term management.
Nurses' attitudes to and use of patient hoists in hospital
Authors: Connolly MJ , Wilkinson E. , Flanagan S. , Mulley GP
Published: July 2008

A questionnaire on patient hoists was circulated to all 220 qualified nurses working in a geriatric department. A survey of the provision and state of repair of the hoists was carried out on the unit. Despite being aware of the value of hoists, 41 % of the 134 nurses who responded to the questionnaire never or rarely used them. An important reason for this was inadequate instruction in hoist use, 65% of nurses feeling that their instruction had been inadequate. Instruction in hoist use had rarely been given by occupational therapists or physiotherapists. Thirty-five per cent of nurses were unaware of any of the basic safety factors in hoist operation. Those who considered their instruction to have been inadequate were more likely to have unfavourable impressions of hoists (p < 0.01) and more likely to be unaware of safety factors (p < 0.01). There was a nonsignficant trend to a greater prevalence of previous back injury in nurses who never or rarely used hoists. The hoists themselves were generally in reasonable working order, although minor faults were found in 60% of the 22 hoists surveyed. They were generally used (with rigid seats) as bath hoists only, and the provision of appropriate slings might greatly increase their usefulness at minimal extra expense.
Arm activity i n everyday life after stroke: measu rement using modified automatic-wind wrist watches ('actometers')
Authors: Sunderland A. , Tinson DJ , Bradley EL
Published: July 2008

This study investigates the validity of actometers as a method of monitoring arm movement in everyday life after stroke. Ten stroke patients with impaired arm function and 10 normal people of similar age wore actometers on each wrist for up to 10 hours on two separate days. The actometers successfully detected reduced average activity of the affected arm after stroke. They also gave higher average readings for the dominant arm of normal subjects when compared to the nondominant side. However, there were suggestions of limits to the validity of the actometers: not every stroke patient or normal subject produced the expected results; test-retest reliability was only moderate; and stroke patients showed only a weak relationship between actometer readings and performance on arm function tests. The low cost and unobtrusiveness of actometers means that despite limitations on their validity, actometers may be a valuable tool in rehabilitation therapy.
Significant relationships exist between muscle group strengths following stroke
Authors: Bohannon Richard W
Published: July 2008

The purpose of this study of 26 patients with stroke was to determine whether the forces produced by nine muscle groups were significantly correlated on the paretic and on the nonparetic sides. The hemiparetic patients had a mean age and time since stroke of 67.8 years and 49.9 days respectively. Strength of upper and lower extremity muscle groups was measured with a hand-held dynamometer. Pearson product moment correlations were calculated between the muscle groups of each side. All muscle groups of each side were significantly correlated with one another. The mean correlations of the nonparetic and paretic sides were .781 and .696 respectively. Such correlations suggest that strokes might be considered as having some generalized motor effects. It may therefore be acceptable to test a limited number of muscle groups to gain an indication of the paresis resulting from stroke.
Prospective follow-up study of elderly patients discharged from an accident and emergency department
Authors: Roberts NA
Published: July 2008

One hundred patients aged 75 years and over who were discharged from an accident and emergency department were selected at random for follow-up at home. Over half of the patients had suffered minor trauma, but 26 had increased dependency in one or more activities of daily living. Increased support was provided by the relatives for the majority of patients, by friends and neighbours in seven cases, and by a district nurse in 14, whilst only one patient received increased home help. Eight patients were known to be readmitted to hospital within 14 days of discharge. Staff in accident and emergency departments need to be aware that the functional consequences of an apparently minor injury in an elderly person may be severe, and that discharge must be carefully planned.
The choice of self-propelling wheelchairs for spinal patients
Authors: Fyfe Ncm , Wood J.
Published: July 2008

This abstract demonstrates that in England, wheelchairs provided by the Government are the core of mobility support to spine-injured patients who have retained self-propelling ability. They provide for all indoor mobility needs during early rehabilitation and, for over half of such patients, indefinitely. Yet 45% of patients stated that they were not satisfied with these wheelchairs, and even 39% of the patients who were satisfied had sought alternative provision. A group of young, active patients exists who need lighter, higher performance chairs which are only available commercially at present. Because of the high cost of these alternative chairs, patients should be advised to wait until they are well adapted in all respects to the consequences of their disability before making a major decision.
Review article : Rehabilitation of memory after brain injury: is there an effective technique?
Authors: Leng Nrc , Copello AG
Published: July 2008

Memory impairment is one of the commonest results of brain injury. This paper outlines the main cognitive approaches to treatment which have been made; it is concluded that there is little evidence that repeated or rote learning is an effective strategy. Mnemonic techniques such as visual imagery may help with certain kinds of information, but their use with brain-injured patients is limited. It is recommended that more emphasis be placed upon the utilization of suitable external aids, and that rehabilitation strategies are more likely to be of benefit if they draw on patients' residual learning abilities.
Assessing everyday memory in patients with perceptual deficits
Authors: Cockburn Janet , Wilson Barbara A , Baddeley Alan , Hiorns Robert
Published: July 2008

The multidimensional nature of the deficits presented by patients referred for neurological rehabilitation poses problems for therapists in selecting appropriate assessments. Although many patients will exhibit memory problems on admission, most will also show signs of other impairment, such as visuoperceptual deficit; but few tests exist that take into account the effect of such influences. The Rivermead Behavioural Memory Test, which was developed to measure and monitor everyday memory problems in patients with acquired brain damage, has been modified to provide a subscale of items that are sensitive to memory impairment but insensitive to perceptual deficit. Revised norms are presented, based on a sample of 100 brain-injured subjects. Results indicate that use of the subscale reduces the likelihood of overestimating the severity of memory deficit in perceptually impaired patients.
Rehabilitation needs of patients attending social work day centres for physical disability
Authors: Mattison PG , Aitken Rcb , McAndrew LJ , Swarbrick P.
Published: July 2008

The requirement for medical and paramedical services in 364 physically disabled adults attending social work day centres within the Lothian Region was assessed by one of a team of physicians experienced in rehabilitation medicine. Deficiencies in the provision of services were noted, particularly in relation to specialist neurological and orthopaedic needs as well as in physiotherapy, clinical psychology and some nursing requirements. Occupational therapy was generally well provided, although much of this was diversional in nature. Social work day centres could be an important focus for continuing community-based rehabilitation, but in order for them to function in this way greater input from medical and paramedical services is required. This clearly has financial implications for local authority and health service planning of services for disabled people.
Parkinson's disease - functional impairment and who helps
Authors: Strudwick Alison , Mutch Royal WJ , Dingwall-Fordyce Ianthe
Published: July 2008

A total of 227 patients with Parkinson's disease, and their age, sex-matched, non-Parkinsonian controls were assessed for their ability to cope with everyday activities. Fifty-four patients and 21 controls were living in a hospital or residential home for the elderly. The help given by informal and formal carers of the remaining 173 patients and 206 controls living in their own homes was also noted. The speech of 32 (14%) patients and four (2%) controls was unintelligible. Seventy patients were housebound compared with 26 controls. Consistently greater numbers of patients were dependent for self-care tasks such as eating a meal and bathing. Similarly more patients were dependent in household tasks. One hundred and nine (63%) patients and 139 (68%) controls had practical help from their families more than once a week. Parkinson's sufferers received more statutory support, but fewer were able to live alone. Patients with Parkinson's disease are considerably more disabled in all aspects of everyday life, but receive similar family support as patients without the disease.
Foot problems in the elderly
Authors: Barlow AM , Braid SJ , Jayson Miv
Published: July 2008

A survey of foot abnormalities was carried out on elderly subjects, aged 75 years and over, in four general practices in Salford ; 536 out of a total of 952 elderly people were seen, 87% of whom had foot abnormalities. One or more bony deformities were seen in 81 % of subjects, the most common being hallux valgus, clawed and retracted toes, hammered second toes and hallux rigidus. Subcutaneous tissue abnormalities such as contracture of the extensor hallucis longus tendon were common, but bursae over the hallux valgus deformities were relatively rare. Corns and callous were frequent, and over half the subjects had nail abnormalities. Foot problems interfered with mobility in only 5.8% of patients, but 78.7% of all subjects required some form of chiropodial help. Of these, only 16.8% were not receiving treatment.
Investigation of the effect of hydrotherapy in the treatment of osteoarthritic hips
Authors: Sylvester Karen L
Published: July 2008

This pilot study compares the treatment of osteoarthritic hips by hydrotherapy with that of short wave diathermy and exercises. Fourteen patients were randomly allocated to one of the treatment groups. Outcome measures of pain ratings, function and life satisfaction scales, range of motion and gait assessment by pedabarography were used. There were no significant differences between the groups prior to treatment, but at the end of treatment there were significant differences in pain, function and life satisfaction. Following treatment, pain had decreased significantly ( p < 0.02) in both groups. Functional ability had improved in the group treated by hydrotherapy ( p < 0.05), who also reported a higher score on the life satisfaction scale. Gait and range of motion did not show any statistically significant changes with either treatment.
Clinical trial of body-contoured wheelchair cushioning
Authors: Michael SM , Walker PS
Published: July 2008

The preliminary trial of a body-contoured wheelchair cushioning system is described. Ten wheelchair users were tested on individually contoured and on flat cushions. A subjective assessment method was used to compare the cushions. The contoured cushions produced higher median comfort rating than the flat ones. The differences in comfort were found to be significant at the 10% level both over the buttocks and overall.
The use of individualized booklets after a stroke
Authors: Pain Hsb , McLellan DL
Published: July 2008

An attempt was made to maintain or improve the level of independence in stroke patients going home from hospital by giving them individually orientated booklets to help them retain the skills acquired in hospital. These contained information on their condition, consequent problems and the rehabilitation measures specific to each patient, illustrated with pertinent photographs. Measures of independence and social functioning were used at discharge and three months later to assess any difference in outcome between a group which was issued booklets and a group which was not. There was no statistically significant difference between the physical and social functioning of the trial and control groups, but many subjects felt the booklets had been of help.
The two-minute walking test: a sensitive index of mobility in the rehabilitation of elderly patients
Authors: Stewart DA , Burns Jma , Dunn SG , Roberts MA
Published: July 2008

The usefulness of a timed walking test adapted for use as an index of mobility in elderly subjects undergoing rehabilitation was assessed. The 95% confidence interval for repeatability in 27 subjects was found to be -27% to +38%. The test was able to detect a significant improvement ( p < 0.01) in a group of subjects undergoing active rehabilitation, whereas no improvement was detected by a conventional rating scale. The two-minute walking test is a simple and sensitive index of mobility in the elderly.
Energy costs of one-arm-drive wheelchair propulsion: use of one arm versus one arm and ipsilateral leg
Authors: Warren Patricia M , Lawrie Anne-Therese , Reid Maureen , Hunter John
Published: July 2008

Patients disabled by a stroke may be prescribed a one-arm-drive wheelchair. However, these patients tend to use their good arm and leg to propel themselves rather than one arm only. In 11 normal subjects, we have found that the energy cost of self-propelling a one-arm-drive wheelchair at approximately 1 mph on a track which incorporated a component of steering was less when using both one arm and ipsilateral leg than when using one arm only. The converse was found during exercise on a treadmill where the steering component was eliminated. These differences were significant ( p < 0.02) during propulsion at approximately 2mph ( n = 8). Qualitatively similar results were obtained in six disabled patients exercising at approximately 1 mph. We conclude that additional use of a leg reduces energy expenditure by helping to steer the wheelchair. In stroke patients, however, ease of use consequent on cognitive impairment will also affect the choice of mode of propulsion.
The verbal administration of the gross function scale of the Rivermead Motor Assessment
Authors: Sackley CM , Lincoln NB
Published: July 2008

The Rivermead Motor Assessment is a standardized assessment of physical recovery after stroke. One part, the gross function scale, was tested to see if it was reliable if administered verbally. Forty-nine volunteers were recruited six months after a stroke and asked to rate their own ability verbally and perform the test items with an independent assessor. There was a significant level of agreement between the scores using the Spearman Rank Correlation ( rs = 0.979; p < 0.001). It can be concluded that the gross function scale of the Rivermead Motor Assessment is reliable when administered verbally with patients late after stroke.
Review article : Exercise training variables influencing the enhancement of voluntary muscle strength
Authors: Bohannon Richard W
Published: July 2008

That muscle strength is important to the performance of functional activities and can be increased by exercise training is well accepted. The extent to which training is able to enhance muscle strength, however, is dependent on a number of training variables. Among these variables are training intensity, frequency and duration. The importance of these variables is the subject of this review. Although the review is based primarily on studies of healthy individuals, it has implications for clinicians working with rehabilitation patients.
A comprehensive rehabilitation service-produced by integration of existing facilities
Authors: Stephen PJ , Lightbody IM , Shaw D.
Published: July 2008

In 1984 two parallel arms of a rehabilitation service for elderly people were established using the resources of two geriatric wards and an adjacent rehabilitation centre. In the first four years 143 patients (median age 74) whose ultimate outcome for resettlement in the community was doubtful were managed jointly by the geriatric and rehabilitation services and were given a fully integrated programme of intensive rehabilitation in the rehabilitation centre (rehabilitation group). The majority of this group had suffered a cerebrovascular accident. A more frail group of 328 patients (median age 81) with various diagnoses received physiotherapy and occupational therapy in the ward setting (ward group). By the end of the first four years 63% of the rehabilitation group and 48% of the ward group had been discharged to the community. Only 3% of the former and 4% of the latter required long-term hospital care. Median attendance at the rehabilitation centre was 10 weeks and the median total inpatient stay for the rehabilitation group was 13 weeks, compared with seven weeks for the ward group.
Factor analysis of activities of daily living scores: culturally determined versus vegetative components
Authors: Caradoc-Davies TH , Dixon GS
Published: July 2008

Certain components of the Wakari activities of daily living (ADL) scale change over a period of rehabilitation. The data from two studies using this tool were reanalysed using factor analysis to define these components. Study 1 assessed the stress among the caregivers of people admitted to a geriatric assessment and rehabilitation unit (A&R unit) from the community, and included 94 selected patients. Study 2 included all patients admitted over a four-month period to the A&R unit, and studied 205 people. Patients were divided into those who were discharged to the community (group 1) and those who were discharged to a rest home or hospital (group 2). Admission and discharge ADL scores were significantly higher in group 2 than group 1.

ADL abilities which are required for survival have been called 'vegetative', while those acquired in response to the needs of society have been called 'cultural'. Factor analysis of ADL scores on admission revealed two factorial groupings: nursing time, mobility and dressing were called 'cultural', while feeding and rationality were called 'vegetative'. The factor components of discharge scores were similar in the cultural area (nursing time, mobility and dressing), but the vegetative included rationality, feeding, dressing and continence of both urine and faeces. The cultural components improved during the rehabilitation period; vegetative components did not, apart from feeding in some subjects discharged to the community. We suggest that many elderly patients were unable to improve vegetative abilities due to frailty and cognitive impairment.

Combining the studies, 25 subjects with low dependency scores below nine were discharged to rest homes or hospitals, while six of 31 with very high scores of more than 18 were discharged to live with a caregiver. The contribution of admission and discharge ADL scores to decisions about discharge placement is significant, but factors unrelated to patient dependence have a major effect on discharge placement. We suggest that interventions such as education and the development of coping skills should be directed toward the caregiver if one is present, and that more attention be given to interventions dealing with vegetative aspects of the patient's ADL ability.
Parkinsonism following head injury: rehabilitation outcome with and without pharmacological treatment
Authors: Philip Puliyodil A
Published: July 2008

Parkinsonism following head injury is a rare occurrence. This study describes the rehabilitation outcome in a 16-year-old male with hemiplegia and parkinsonism resulting from head injury. A trial using repeated treatment design with six phases was established to measure the effect of rehabilitation with and without treatment using Sinemet (carbidopa/levodopa). Measurements of functional changes in mobility and activities of daily living, speech production, swallowing and hand dexterity were carried out using the modified Barthel Index, dysarthria severity rating scale, dysphagia severity rating scale and nine-hole peg test respectively. There was significant improvement in function including return of speech production while on Sinemet, but this attained function was completely lost upon withdrawal of Sinemet. Resumption of treatment with Sinemet resulted in improved level of function. At the completion of rehabilitation the modified Barthel Index score was 100/100, swallowing was normal, there was mild dysarthria and the patient required only 33 seconds to complete a nine-hole peg test- he remains functionally independent eight years later. Pharmacological management, in conjunction with rehabilitation, effectively improved functional outcome.
Stroke in Nottingham: provision of nursing care and possible implications for the future
Authors: Barer DH
Published: July 2008

Although the care of stroke patients accounts for a considerable proportion of Health Service resources, there have been few attempts to measure this burden directly. A survey was therefore performed in Nottingham (approximate population 700 000) during a two-week period to find out the total number and dependency levels of stroke patients receiving professional nursing care, whether in hospital, nursing homes or at home from the Community Nursing Service. Altogether 822 patients were surveyed, of whom 232 were in hospital (46 in general medical, 171 in geriatric wards and 15 on the stroke unit), 221 were in nursing homes and 369 at home with district nurse support. Of this total, 61 % were aged over 75 and 18% over 85; nearly half of the latter group being in nursing homes. Overall levels of dependency were greatest in nursing homes and the prevalence of severe disability was highest amongst the oldest patients. Two-thirds of all patients had had their strokes over six months before and 39% over two years before and 31 % had suffered more than one stroke. Thus, the main demand for nursing services is amongst the old and those with longstanding stroke disease. The rapid increase in the number of old people and changes in medical practice which reduce fatality in the early stages of stroke are both likely to increase the numbers of disabled elderly stroke survivors, and a large proportion of these may be cared for in private nursing homes. Simple cross-sectional studies of this kind should be repeated every few years so that these trends can be accurately plotted.
Methodology of a stroke rehabilitation trial
Authors: Young JB , Forster A.
Published: July 2008

The effectiveness of rehabilitation after stroke remains largely unproven. Attempts have been made to evalute domiciliary therapy,1 community stroke teams2 and the intensity of therapy,3 but much of the evidence is inconclusive. We have been engaged in a randomized comparison trial of day hospital and home physiotherapy for elderly stroke patients discharged from hospital. This paper describes the background to the study and the pilot work from which the methodology was determined.
Development of a questionnaire for detecting everyday problems in stroke patients with unilateral visual neglect
Authors: Towle Deborah , Lincoln Nadina B
Published: July 2008

Unilateral Visual Neglect can affect everyday behaviours such as reading, but there have been few attempts at measuring subjective accounts of these difficulties. The present study reports on the reliability and validity of a questionnaire designed to detect the problems experienced by patients with visual neglect. Sixty-four right hemisphere lesioned stroke patients and 49 of their relatives completed a questionnaire concerning problems in everyday life. The neglect subjects did not report significantly more problems than the non-neglect subjects. However, on the relative's questionnaire, neglect subjects were seen as having significantly more difficulties. The most frequently reported problems were similar for both subject groups. Scores on the neglect questionnaire were correlated with performance on a star cancellation test, indicating the validity of the questionnaire. The possible application of this type of questionnaire is discussed.
Weight distribution and postural sway in healthy adults
Authors: Sackley Catherine M , Lincoln Nadina B
Published: July 2008

An investigation of postural sway and bodyweight distribution in standing was carried out using the Nottingham Balance Platform (NBP). The aims were to provide normative data for subsequent studies on stroke patients and to show the effect of age and sex on these variables. Male and female volunteers were recruited from hospital workers, hospital visitors and members of a local community centre. Each subject was assessed using the N BP, a limb load monitor based on load cells and a microcomputer. Weight distribution was expressed as the balance coefficient, which is the mean proportion of body weight on the left leg calculated over 30 seconds. Postural sway was calculated from the deviation from that mean and expressed as the sway coefficient. The 403 volunteers included 269 women and 134 men, age range 18-87 years (mean 50). There was a significant difference between the sexes for both postural sway ( p < 0.05) and weight distribution ( p < 0.01) and significant correlations between age and postural sway ( p < 0.001) and age and weight distribution (p < 0.001). The results provided baseline data allowing for age and sex differences for further studies with stroke patients.
Preliminary study of measurements of sway in an elderly community population
Authors: Downton JH , Sayegh A. , Andrews K.
Published: July 2008

Postural control seems to deteriorate with advancing age but it is not clear why this happens. As part of a larger epidemiological study of community elderly, a representative sample of 85 people aged 75 and over living at home had assessments of physical and psychological function and measurements of sway and base of support carried out, using a portable force plate. Sway increased with increasing age but there was no difference in sway between men and women. Significant positive associations were found between greater sway and impaired visual acuity, poor nutritional state and reduced mobility. Subjects with various physical impairments tended to have worse balance. Subjects who had had falls did not sway more than non-fallers, but subjects with symptoms of 'dizziness' had a significantly smaller base of support and larger sway than those without, demonstrating an association between objectively impaired balance and subjective symptoms of imbalance.
Neuromuscular complications following electrical injury — incidence and special problems in rehabilitation
Authors: Varghese George , Mani Mani M , Redford JB
Published: July 2008

Among the 1206 burn patients admitted on a five-year period, 116 were as a result of high tension electrical injuries. These cases were analyzed for neuromuscular complications. The incidence of neurological complication was 44%, amputations 26% and significant muscle damage 24%. Many patients had combinations of neurological involvement and musculoskeletal involvement. The detection of the neurological complications is often difficult in these patients with multisystem trauma. It is our feeling that neurological lesions, especially spinal cord injury following electrical accidents, are more frequently encountered than is generally recognized. Sometimes clinical manifestations are transient and may go unnoticed. Rehabilitation of patients with electrical injuries are often complicated because of the combination of the disabilities. Awareness of some of the common complications and evaluation of these complications in the early stages will help initiation of the rehabilitation programme before any permanent deformities have set in.
The outcome of pneumonia in the elderly: a hospital survey
Authors: Gladman Jrf , Barer D. , Venkatesan P. , Berman P. , Macfarlane JT
Published: July 2008

We studied the premorbid characteristics and outcomes of 73 consecutive elderly patients (median age 79 years) admitted to hospital with community-acquired pneumonia. Eighty-six per cent of all patients had previously suffered from chronic diseases (mainly respiratory), 54% had been restricted in outdoor mobility due to breathlessness and 22% had limited self-care ability (Barthel score 15/20 or less). By six weeks 33% had died. Amongst the 49 survivors, nine patients (18%) were in hospital and eight had required a change of residence on discharge indicating a greater level of dependency. Fourteen of these 17 patients had previously lived alone. Amongst those who had returned to private addresses, the prevalence of significant disability (Barthel score 15/20 or less) rose from 20% before the pneumonia to 30% at six weeks. Amongst the less disabled survivors, the perceived health, measured by the Nottingham Health Profile, was similar to that found in a community survey of chronically ill elderly people. In addition to a high fatality rate, community acquired pneumonia in the elderly carries a substantial morbidity in terms of increased dependency and disability.
The rehabilitation of a ventilator dependent child using diaphragmatic stimulation
Authors: Stephens RM , Potter DR , Howard ER , Hallett R.
Published: July 2008

The rehabilitation of a male child who remained tetraplegic and ventilator dependent after Haemophilus influenzae meningitis at the age of 18 months is described. Diaphragm pacing, per phrenic electrical stimulation of the diaphragm, has been used in the USA, but at the time only one patient had been managed with this technique in the UK. Successful rehabilitation of this adult patient at King's College Hospital prompted the application of the technique to the child here described. At the age of 34 months the integrity of the phrenic nerves had been confirmed, and bilateral phrenic electrodes and pacing receivers were implanted. The patient is now 12 years old, and has been using diaphragm pacing for nine years. His rehabilitation, social integration, and education have relied on this method of artificial ventilation, the advantages and disadvantages of which are described.
The design of a functional assessment and gait analysis facility for rehabilitation studies
Authors: Minns RJ , Hogarth S. , Bainbridge A. , Pembroke S.
Published: July 2008

A general functional assessment and gait facility has been designed for use in all aspects of measurement of handicap. The functional assessment course contains various features to assess the ability of subjects with different handicaps to sit, take off and apply orthotic or prosthetic devices, climb ramps and steps, negotiate corners, and doors with different locking and opening mechanisms. Incorporated in the middle of the walking section of the course is a force plate to assess the mechanical function of orthoses or prostheses by a force vector visualization system. A visual analogue scoring system of the quality of performance of the various tasks encountered on the functional assessment course as well as the freely selected speed and fastest walking in a straight line has been adopted. This visual analogue score is marked after analysing the video record obtained from a mobile colour camera. The doors, ramps and walking area are wide enough to assess wheelchair use. We have adopted a 'gait graph' for the gait analyses using a 10m straight walkway and measuring the temporal parameters at free speed walking and the fastest walking speed. Energy cost is measured using heart rate monitoring by telemetry on the functional assessment course and during gait analysis.

It is proposed to use this facility for the assessment and management of lower limb bracing in children, patients undergoing corrective surgery on the lower limb and for wheelchair users.
The recovery of perceptual problems after stroke and the impact on daily life
Authors: Edmans JA , Towle D. , Lincoln NB
Published: July 2008

The frequency of perceptual problems in stroke patients and the impact of daily life, were assessed at one month and two years after onset of the stroke. Ninety patients were assessed on the Rivermead Perceptual Assessment Battery (RPAB) and an Activities of Daily Living (ADL) scale. Perceptual problems were identified in 69% of patients on the one month assessment and in 74% of patients on the two-year assessment. There was no significant difference in the frequency or severity of perceptual problems, between the two assessments. Significant improvement occurred in activities such as mobility, preparing a hot drink and crossing a road. There remained a significantly high correlation between perceptual problems and independence in activities of daily living.
Prosthetic rehabilitation of upper limb amputees: a five year review
Authors: Datta D. , Ibbotson V.
Published: July 2008

A review of 55 upper limb amputees, acquired and congenital, referred to a subregional centre for amputee rehabilitation in a five year period is presented. Ninety-six per cent of the amputees were provided with prostheses. Seventy-three per cent of these patients have successfully accepted their prostheses with a minimum follow-up period of two years. The importance of a multidisciplinary approach in providing a comprehensive rehabilitation programme cannot be overemphasized. Patient's views and needs must be at the forefront in formulating the rehabilitation programme. Success of the prostheses should not be determined only on the grounds of active use, as cosmetic replacement may also play a major role in the total rehabilitation of upper limb amputees.
The Rapid Assessment Clinic for Elders
Authors: Davies Keren , Sangster Graeme , Rowe Jed
Published: July 2008

An audit of domiciliary visits suggested that many were inappropriate and that patients could be served better by immediate admission or urgent assessment in the day hospital. Consequently, a structured referral system was introduced with an alternative option, the 'Rapid Assessment Clinic for Elders'. This has led to a dramatic fall in home assessments. A reduction was also noted in the number of

patients whose admission was delayed by prior assessment, whilst more patients were managed at a single contact. No additional resources were required and the clinic has been well received by patients, hospital staff and general practitioners. We describe the establishment of the service and report the first 21 months' experience.
The Star Cancellation Test in acute stroke
Authors: Friedman Paul J
Published: July 2008

Forty-one right-handed elderly subjects performed star cancellation within 30 days of stroke. Eighteen subjects had impaired star cancellation as defined by star score ≤44/54. Fourteen of these 18 subjects had a lateralizing defect based on the star ratio (ratio of stars cancelled in the left half of the stimulus sheet divided by star score). Thirteen of the 14 with lateralizing spatial neglect had left spatial neglect. Star score was significantly correlated to other tests of spatial neglect, but not to limb power, cognitive score or age. Star score and star ratio were useful predictors of functional outcome as measured by Barthel ADL score at hospital discharge. Multivariate models of functional outcome included leg power and either star score, star ratio or ability to draw pentagons.
A comparison of the assessment of spasticity by the Wartenberg pendulum test and the Ashworth grading scale in patients with multiple sclerosis
Authors: Leslie GC , Muir Catherine , Part NJ , Roberts RC
Published: July 2008

The Wartenberg pendulum test is an objective quantitative method for the assessment of muscle tone. We have compared the results of measurements of muscle tone using this method with traditional clinical assessments graded on the Ashworth scale. Two indices ( R1 and R2) were measured from the Wartenberg test. Both were related to readings from the Ashworth scale. The ratio R2 (the ratio of the amplitude of the first swing to the difference in angle between the start and finish positions), however, showed a linear relationship throughout the range of spasticity tested in contrast to the curvilinear relationship shown by R1 (the ratio of the amplitude of the first swing to the difference between the rebound angle and the start angle). Significant changes in the ratio R2 without any corresponding change in the Ashworth grading were observed. It is concluded that the Wartenberg ratio R2 and the Ashworth scale assess similar features of the muscle and/or its motor control, but that the pendulum test provides a more finely graded observer- independent measurement.
A national survey of wheelchair users
Authors: Kettle Melvyn , Rowley Corinne , Chamberlain M Anne
Published: July 2008

In 1990 the Disablement Services Authority commissioned a national survey of wheelchair users in England to determine the user's degree of satisfaction with (a) his/her wheelchair and (b) the service provided by the DSA generally and approved repairers in particular. A total of 3082 wheelchair users (2048 women and 1026 men) participated in the survey (58% response rate), most of whom were between 60 and 90 years of age.

Although most users expressed satisfaction with their wheelchairs, an overriding problem was that assessment was generally limited to making sure that the individual 'fitted' his or her wheelchair (although even this was not always achieved). In the main, it was the demands of the social and physical environment in which a wheelchair was to be used that were so often overlooked. Also, a significant minority of people were without adequate information about their wheelchair or instruction on how to use it. Furthermore, just under half of the respondents had not heard of their approved repairer and two-thirds had not heard of their local Disablement Services Centre.

The survey concluded, inter alia, that the multidisciplinary approach, in which an occupational therapist and/or physiotherapist takes a pivotal role, which is being developed within many wheelchair centres, needed to become universal.
Minor injury resulting in lower-limb loss in diabetic patients
Authors: Isakov Eli , Sussak Zeev , Eldar Reuben
Published: July 2008

Objective: to identify diabetic patients who had undergone recent amputation of the lower limb, and in whom a possibly avoidable minor injury to the foot had caused infection and gangrene necessitating surgical intervention.

Design: questionnaires, administered to consecutively admitted recent lower-limb amputees, addressing demographic, socio-economic and medical data and containing specific questions on circumstances or events that might have caused a foot lesion that started the infection, gangrene and eventually amputation.

Setting: department of orthopaedic rehabilitation in a rehabilitation hospital.

Patients: 218 recent, lower-limb amputees - due to occlusive arterial disease, with or without diabetes - admitted for prosthetic rehabilitation during 30 months (January 1989 to June 1991).

Results: 56 diabetic and 10 non-diabetic amputees were identified in whom a minor injury had caused the sequence leading to amputation which could have been avoided by adequate attention to the feet and their care.

Conclusions: All diabetic individuals need education regarding self-care and attention to the feet, irrespective of their demographic or socio-economic variables and disease severity. The view is expressed that such an education — particularly when linked to the provision of necessary health services - would be able to reduce the risk of amputation in diabetes mellitus considerably.
Rehabilitation needs after haemorrhagic brain injury: are they similar to those after traumatic brain injury?
Authors: Soryal I. , Sloan RL , Skelton C. , Pentland B.
Published: July 2008

A retrospective survey of 78 patients with spontaneous haemorrhagic brain injury admitted to a regional neurorehabilitation centre over a three-year period is described. Residual neuropsychological impairments and the need for assistance in activities of daily living (ADL) were assessed. Little difference was found in terms of impairment or extent of disability between the 53 subarachnoid haemorrhage and 25 intracerebral haemorrhage survivors who comprised the study population. This population is compared to the findings in traumatically brain-injured patients managed in the same unit. Although there were some neuropsychological differences between the two groups, these were not reflected in the degree of dependence in ADL, which was remarkably similar. The length of stay for haemorrhagic brain injury patients on the unit was longer than that of the head injured. Haemorrhagic brain injury therefore, represents a major demand on rehabilitation services and similar provisions should be made for them as are advocated for the traumatically brain injured.
Is there a central executive deficit after severe head injury?
Authors: Hartman A. , Pickering RM , Wilson BA
Published: July 2008

This study examines whether head-injured people have a central executive deficit, and if this is correlated with performance on frontal-lobe tests. Twenty-five severely head-injured (HI) patients and 25 matched controls performed five tasks:(1) visual-motor tracking, (2) digit span, (3) visual-motor tracking with verbal encouragement from the experimenter, (4) visual-motor tracking whilst holding a conversation with the experimenter, and (5) visual-motor tracking with a simultaneous digit-span task. In addition, all subjects were assessed on three frontal-lobe tests. HI patients were significantly worse overall than controls. The most striking difference was in tracking with conversation, in which HI patients (but not controls) showed a marked decrement in performance. Scores from tests of frontal lobe functioning were significantly correlated with (1) tracking during conversation and (2) tracking with digits. The results are broadly consistent with a central executive deficit in head-injured patients.
The effects of chiropody on the gait speed of a frail elderly population
Authors: Burns Jma , Black J. , Martin BJ
Published: July 2008

There is a high incidence of foot deformities in the elderly population accompanied by difficulties in self-care. Chiropody is widely recommended but there have been no studies looking at its effects on mobility in the elderly. This study examined 55 elderly patients attending the Glasgow Eastern District Geriatric Services. Gait speed was measured before and after chiropody to see if there was any beneficial effect on mobility. There was no significant difference in gait speed before and after chiropody (medians 0.21 m/s versus 0.34m/s; 95% confidence interval for the difference between the medians, -0.17-0.08m/s). The subjective impression of the patients is that 60% thought that their foot condition had affected mobility and that their walking had been improved by chiropody. Although there has been no objective change in gait speed, this does not preclude other changes in mobility level which may be identified in further studies.
The outcome of a second stroke: the impact on hemispheric functioning
Authors: Ring Haim , Feder Monica , Rahmani Levy
Published: July 2008

A total of 238 patients admitted to Loewenstein Rehabilitation Hospital (LRH) after a second stroke were included in a preliminary study on the outcome of rehabilitation. The patients were examined for activities of daily living (ADL), locomotion, hand function, elementary cognitive abilities, and communication. The practical goal was to examine the rehabilitation prognosis of patients who suffered brain stroke for a second time. On the theoretical plane, the study aimed to broaden knowledge of the functional relationships between the two cerebral hemispheres from a rehabilitation perspective. A major finding is that recovery from a recurrent stroke is a multifactorial affair. Communication and spatial abilities are directly related to hemispheric specialization, whereas locomotion and hand functioning are rather organismic functions.
The efficacy of music for stimulation in prolonged coma — four single case experiments
Authors: Wilson Sarah L , Cranny Siun M , Andrews Keith
Published: July 2008

Four pilot studies using single case experimental design were carried out to examine the immediate effect of music as a form of stimulation in the treatment of patients in persistent vegetative state. In two of the studies there were significant behaviour changes which suggested increased arousal, one showed decreased arousal after the stimulation period and one no change.
Fatigue effects of rest intervals during electrical stimulation of the human quadriceps muscle
Authors: Rankin RR , Stokes MJ
Published: July 2008

Optimal rest intervals required between contractions and treatment sessions to allow recovery from fatigue after electrical stimulation of muscle are not known. In eight volunteers (aged 23-38 years), fatigue of the quadriceps was examined during and after three therapeutic stimulation protocols which were performed one week apart. Protocols consisted of 10 isometric contractions at 30% maximum voluntary force. The contractions lasted 10 seconds each, and were separated by rests of either 10, 50 or 120 seconds. Force responses to stimulation at 20 Hz and 50 Hz (for two seconds each) were used as a test to monitor recovery.

All three therapeutic stimulation protocols caused significant fatigue during activity. The shorter the rest interval, the greater the fatigue and hence, less work (i.e. integrated force) completed. Recovery was also influenced by the rest intervals. One hour after activity, force at 20 Hz was approximately 50% of initial values (p < 0.01), increasing to 70-80%at 24-hours, and to 90% at 48-hours. Force at 50 Hz was 68-80% after the first hour, had recovered 24-hours after the 10 second protocol but not the 50 and 120 second protocols, and full recovery had been reached by 48-hours. Persistence of both high and low frequency fatigue after these therapeutic protocols was greater than expected. Studies are required to determine whether stimulation of fatigued muscle produces therapeutic or adverse effects, and to establish the degree of recovery required for these effects.
Rehabilitation: where are we going and how do we get there?
Authors: McGrath Joanna R , Davis Alison M
Published: July 2008

An account of the process and aims of the rehabilitation of the adult with multiple needs is presented. It is argued that rehabilitation is usefully viewed as a goal driven problem solving activity. The selection of goals is discussed in the light of responses to a questionnaire by staff at a neurological rehabilitation centre. It is argued that the aims of rehabilitation should be stated in terms of reduction of handicap or enhancement of valued rôle assumption. The implications for working practice are considered.