bluuebunny/crossref_metadata_2025 huggingface dataset:
Suppression of Tuberculin Reactivity During Natural Rubella
Authors: Ueda Kohji , Nishima Sankei , Sasaki Fusa , Yoshikawa Hiromi , Goya Nagahide
Published: July 2008

Fifty-four patients with previously positive tuberculin reactions were fol lowed for tuberculin sensitivity, between the incubation period of natural rubella and the 40th day after the onset of rash. In many instances, tuberculin sensitivity was partially or completely depressed beginning in the incubation period and extending for up to 4 weeks after rash onset. Two of 3 cases of subclinical rubella infection also showed this phenomenon. The highest inci dence of negative reactions was 83 per cent in the first 3 days after rash onset. A few subjects had a larger skin reaction to tuberculin than the baseline reading during the 2 to 5 weeks after rash onset.
Adoptive Families
Authors: Sokoloff Burton
Published: July 2008

Adoption is an on-going process which affects each member of the adoptive family during each phase of the adoptee's maturation. Specific factors, such as insecurities of the adoptive parents, the child's awareness of his adoption in relation to his age and fantasies, and recently, the introduction of the possibility that the adoptee may arrange to meet his birth-parents later in life tend to add more perplexities to problems existing in these families. The normally turbulent age of adolescence increases anxieties in these vulner able families. The pediatrician must understand the various factors uniquely inherent in adoption so that he can more effectively provide counsel to these patients.
Isolated Acute Meningococcal Arthritis
Authors: Opitz James C.
Published: July 2008

Isolated, acute, suppurative meningococcal arthritis is reported in a five- month-old infant. It should be differentiated from arthritis associated with chronic meningococcemia and acute systemic meningococcemia.
Chronic Foreign Body Aspiration Diagnosed by Lung Scan
Authors: Holland Neil J. , Trumbull H.R.
Published: July 2008

The case of a two-year.old child with foreign body aspiration is presented. It was complicated by a delay in diagnosis and treatment. Lung scan was helpful in eventually establishing the diagnosis. Key points in the manage ment of patients with foreign body aspiration are reviewed and patho physiologic mechanisms are discussed.
Collaborative Research Between a Department of Pediatrics and Its Clinical Faculty
Authors: Hoekelman Robert A.
Published: July 2008

Collaborative research involving members of the full-time and clinical faculties of a Department of Pediatrics increases our knowledge of problems encountered in primary care practice by bringing the practitioner's perspective on the nature of such problems and the population of patients he serves to the investigative arena. For the practitioner, active involvement in collaborative research is rewarding because he or she formulates the questions to be addressed and takes part in planning and implementing the research and re porting results. Through such collaboration, the academician gains im measurably by being able to study common clinical problems in primary care settings, where they are encountered most often. To be successful, collaborative research must be a joint effort with ongoing communication and sharing of responsibilities between academicians and practitioners.
The Routine "Well Child" Examination
Authors: Sturner Raymond A. , Granger Richard H. , Klatskin Ethelyn H. , Ferholt Julian B.
Published: July 2008

The practice of well child care by pediatricians has been a subject of increas ing controversy. Previous reports in the literature have indicated a low yield of significant organic or psychological findings. In the present study, three post-residency pediatricians, working in the general pediatric unit of an HMO setting at different times, evaluated the developmental and psychological problems of patients seen in consecutive well child examinations. The nature of their problems was measured by the actual degree of intervention re quired of the pediatrician, rather than by standard mental health terminology or diagnosis. The combined results of these evaluations (with close individual agreement among the three examiners) contradicted previous pediatric reports by indicating that 38 per cent of the children seen had definable develop mental or psychological problems requiring some action or intervention by the pediatrician. Eleven per cent of the cases required major intervention— either 3 or more visits or referral to a mental health facility. These results indicate a wide prevalence of significant developmental and/or psychological problems in children and demonstrate the capability of general pediatricians working in a standard pediatric setting to detect them.
The Developmental Case Conference as a Method of Teaching Pediatricians About Child Development on an Inpatient Service
Authors: Drotar Dennis , Malone Charles
Published: July 2008

Teaching pediatricians about child development on an inpatient service can pose difficult problems for the psychologist-consultant. This paper describes the evolution of a weekly case conference devoted to teaching child develop ment to the pediatric staff on a hospital division devoted to the care of young infants. A format involving live demonstration of developmental assessment is seen as a stimulating and effective way to convey information about child development to pediatricians. A case example illustrates the advantages of this conference in facilitating pediatric observations, and early recognition of developmental problems.
Family-acquired Respiratory Disease in High-Risk Infants
Authors: Nelson David B. , Nelson Robert M. , Schlosser Wayne
Published: July 2008

Five infants who had been patients in the same Neonatal Intensive Care Unit (NICU) were readmitted with respiratory illness. The illness was charac terized by cough, congestion, apnea, and infiltration of the lungs revealed by radiographic examination. Only one infant was febrile. All five patients recovered; however, one infant required prolonged intubation and mechani cally assisted ventilation. Investigation revealed that the illness was associated with prematurity and contact with ill family members. Illness was not associated with exposure to ill personnel in the NICU, low birth weight, or previous lung disease. This outbreak demonstrates the dangers involved in sending premature infants home when respiratory illness is prevalent in the family.
Febrile Convulsions
Authors: Surpure J.S.
Published: July 2008

We present our experience with children with febrile convulsions admitted to a large teaching hospital. Elective admission on a routine basis increases the tendency for unnecessary additional tests. Hospital admission should be reserved for children with severe multiple febrile seizures, or the underlying serious disease or where parental anxiety and other social circumstances indicate. Workups should be done only in selected cases consistent with clinical findings. The yield of such workup is marginal, even in a hospitalized child with multiple febrile seizures.
Ineffectiveness of Laetrile in the Treatment of Acute Lymphoblastic Leukemia
Authors: Mehta Paulette
Published: July 2008

Much controversy remains over the use of laetrile in the treatment of leukemia. Public opinion has been responsible for several state legislatures enacting bills allowing the use of laetrile for patients with leukemia and other malignancies. We recently cared for a 3½-year-old child with acute lympho blastic leukemia, who had low initial white blood cell count, limited organo megaly, and absence of T or B cell markers. A good prognosis was anticipated. Conventional therapy was interrupted for long periods of time with laetrile. Laetrile was ineffective in maintaining or inducing remission. Despite favor able prognosis, the child developed several relapses and died with widespread infiltration of leukemia in the central nervous system, bone marrow and viscera.
Osteopathia Striata Syndrome
Authors: Bass Harold N. , Weiner Jay R. , Goldman Alan , Smith Lorraine E. , Sparkes Robert S. , Crandall Barbara F.
Published: July 2008

Osteopathia striata, an autosomal dominant disorder, has been diagnosed in a 19-year-old mildly retarded woman. In addition, she has macrocephaly, a leonine facies, disfigurement of the lower jaw, a cleft palate and mixed hear ing loss. Roentgenograms of the skull and long bones show thickening of the calvarium, particularly at the base, mandibular hyperplasia, and striations in the long bones and pelvis. Except for the cleft palate, which has not been previously reported, and the retardation, which appears to be quite uncommon in this condition, these findings are characteristic of osteopathia striata. Be cause the disorder may resemble several other conditions, the differential diagnosis should include osteopoikilosis, the autosomal dominant form of osteopetrosis, and hyperostosis corticalis generalisata.
High Pulmonary Vascular Resistance After Birth
Authors: Rudolph Abraham M.
Published: July 2008

The clinical syndrome known as persistent fetal circulation, or persistent pulmonary hypertension of the newborn, is characterized by maintenance of a high pulmonary vascular resistance after birth. The small pulmonary arteries of the fetus have a thick muscular medial layer; they are very reactive, being actively constricted by the low PO2 levels normally present during fetal life. The pulmonary vascular smooth muscle layer is hypertrophied in conditions that result in chronic fetal hypoxia, or a maintained increase in pulmonary arterial pressure. Normally, pulmonary vasodilation occurs rapidly after birth, partly related to physical expansion with gas, but mainly due to the increased PO2 associated with ventilation with air. Based on these developmental considerations, the factors responsible for an increased pulmonary vascular resistance after birth may be classified in three main groups: (A) Acute vaso constriction due to postnatal hypoxia and aggravated by acidemia; (B) Prenatal increase in pulmonary vascular smooth muscle development; and (C) Decreased cross sectional area of the pulmonary vascular bed due to inadequate numbers of vessels. The various mechanisms that may promote these responses are presented.
"Acquired" Congenital Diaphragmatic Hernia Following Early Onset Group B Streptococcal Pneumonia
Authors: Giacoia George P. , Jegathesen Subramania
Published: July 2008

A newborn baby who presented with neonatal pneumonia due to group B streptococcus and who required artificial ventilation is described. After the infant was weaned from the respirator, increasing respiratory distress led to the diagnosis of posterolateral diaphragmatic hernia.
Human Milk Banking
Authors: Pittard William B. , Bill Kathleen
Published: July 2008

The storage of human milk at 4 C for 48 hours after expression resulted in a significant (p < 0.02) loss of cellular viability. Further, the concentration of milk macrophages and neutrophils decreased significantly (p < 0.02), pre sumably via cell adhesion to the milk container or cytolysis. The milk lymphocyte concentration, however, was not significantly affected by storage. Milk passage through a nasogastric feeding catheter had no additional effect on cell viability or concentration. Thus, while current banking methodologies allow greater availability of breast milk's resistance factors to newborn infants, they do so with significant, but not serious, alterations in both the quantity and quality of these components.
Mallory-Weiss Syndrome in a 16-Week-Old Infant
Authors: Baptist Errol C. , Arenberg Mary E. , Baskin William N.
Published: July 2008

The Mallory-Weiss syndrome is a recognized cause of upper gastrointestinal bleeding in adults. It is a very rare entity in the pediatric age group. The case discussed outlines the reasons for its rarity and the modalities used for its diagnosis.
The Electric Blanket Syndrome
Authors: Karofsky Peter S. , Keith David V.
Published: July 2008

One pattern of dysfunctional family interaction is described as a syndrome. Four case histories are presented in which different family members take polar positions on various continua. In one instance the continuum is oral com munication, with garrulousness on one side and silence on the other. Another continuum is family responsibility, where one member of the family takes total responsibility and another takes almost none. The symbolic continuum is an electric blanket with hot at one extreme and cold at the other. In all cases, family therapy was performed by a pediatrician. Guidelines are discussed for treatment and for appropriate consultation with mental-health professionals.
Serum Group I Pepsinogens in Children with Recurrent Abdominal Pain
Authors: Liebman William M.
Published: July 2008

Recurrent abdominal pain (RAP) is a common, frustrating problem in child hood. A commonly mentioned cause has been acid hypersecretion without evidence of actual ulceration. Recently, a radioimmunoassay specific for group I pepsinogens (PgI), one of two immunochemically distinct groups of human pepsinogens or precursor zymogens of pepsin, has been developed. Serum PgI levels have been demonstrated to reflect the acid secretory capacity of gastric mucosa, specifically the maximal and peak acid outputs (MAO, PAO), as well as the basal acid output (BAO), thus providing an accurate, tubeless determination of acid secretion. The present study of children with and without RAP has revealed no significant difference in serum Pgl levels in these groups. These results suggest that acid hypersecretion cannot be demonstrated in RAP; therefore its relationship to RAP is questionable.
Effect of Method of Delivery on Heart Rate Pattern in the Early Newborn
Authors: Fleming Curtis , Riordon Terrance P. , Ortiz Amil , Woods James R.
Published: July 2008

The relationship of fetal heart rate (FHR) to neonatal heart rate (NHR) was examined in 81 uncomplicated term (>37 weeks) deliveries. Average base line FHR during the 30 minutes before delivery was compared with baseline NHR obtained on the same infants at 5 and 10 minutes, 1, 12, and 24 hours after delivery. Fetal status and gestational age were determined by Apgar score and Dubowitz examination. Five minutes following delivery, a 30 percent increase in NHR over FHR baseline was noted in 75 neonates (93%). The NHR returned to FHR within 12 to 24 hours. There were no differences in heart rate patterns of neonates, whether delivered vaginally or by cesarean section. Neonates delivered spontaneously or with forceps also had comparable HR patterns. It appears that the events of labor and delivery are not responsible for the increased heart rate observed in the early newborn.
Perinatal Hemorrhage Associated with the Kassa bach-Merritt Syndrome
Authors: Bowles Larry J. , Kostopoulos-Farri Evangelia , Papageorgiou Apostolos N.
Published: July 2008

The case of a newborn infant with the Kassabach-Merritt syndrome who presented with a significant intrauterine ocular and skin hemorrhage, followed shortly after birth by a massive hematemesis, is reported. The presence of cavernous hemangioma at birth should be a reminder of the risk of major hemorrhagic complications due to thrombocytopenia secondary to platelet trapping.
Levamisole Treatment in Acute Hepatitis
Authors: Özsoylu Sinasi , Sargin Canan , Kocak Nurten
Published: July 2008

Fifty-six and forty patients with acute icteric hepatitis were given levamisole and placebo, respectively, for the first 3 days of a week of the disease for 2 weeks, and continued through the third and fourth weeks if their hepatitis was not resolved. Liver functions of the levamisole-treated patients became normal slightly faster than the controls'. The normalization time of trans aminases was found barely significantly shorter in the levamisole-treated group than in. the controls (p < 0.05). Additional studies with larger groups of antigenetically different types of hepatitis are warranted to determine whether treatment with levamisole might lessen the chances of developing chronic hepatitis.
Epiblepharon
Authors: Lemke Bradley N. , Stasior Orkan George
Published: July 2008

Epiblepharon is a common, often unrecognized cause of epiphora and ocular irritation in the child. Epiblepharon consists of an extra fold of eyelid skin and orbicularis muscle overlying an eyelid margin. Occasionally an epibleph aron can push the lashes against the sensitive corneas, especially in down gaze. This paper illustrates epiblepharon and stresses the need for eyelid margin examination in downgaze in the child with epiphora or conjunctivitis.
Anemia in Children and Adolescents with Hypothyroidism
Authors: Chu Jen-Yih , Monteleone James A. , Peden Virginia H. , Graviss Edward R. , Vernava Anthony M.
Published: July 2008

In a review of 17 adolescents and children (excluding newborns) with definite clinical signs, symptoms, and laboratory findings of hypothyroidism, 11 patients (65%) had anemia. The mean corpuscular volume (MCV) of the red blood cells was either macrocytic or normocytic. The hemoglobin did not correlate with the serum thyroxine level. Anemia occurred only in those patients with heights below the third percentile, but there was no similar correlation with weights. Of the 10 patients who had radiographs for bone age, all showed severe delay (47 to 103 months) and had heights below the third percentile. Nine of these patients were anemic, but the severity of the anemia did not correlate with the delay in bone age. Neither microcytic anemia nor pernicious anemia, noted in many adult hypothyroid patients, was found in the children and adolescents with hypothyroidism studied here. The "uncompli cated" anemia secondary to hypothyroidism responded to thyroid replacement therapy alone. Anemia can be the most prominent feature of hypothyroidism. In patients with mild to moderate anemia of unknown origin, especially those with fall-off in linear growth and increased MCV, hypothyroidism should be considered in the differential diagnosis of the anemia.
Diagnostic Dilemmas and Principles of Management
Authors: Herzog David B. , Harper Gordon
Published: July 2008

Unexplained disability in childhood challenges the physician diagnostically and therapeutically. Clinical presentation is typically that of a chronically ill and increasingly disabled child, often with positive physical findings and erratic response to usual medical management. The physician experiences great pressure to diagnose, to counsel, and to cure. Family characteristics include an inability to speak in psychological terms, denial of the family's involvement in the child's symptoms, and an emphasis on equivocal bio medical findings. Diagnostic and therapeutic tools specific to these disabilities are defined, with clinical illustrations provided.
Role of Psychosocial Stress in the Cause of Pica
Authors: Singhi Sunit , Singhi Pratibha , Adwani Gul B.
Published: July 2008

Fifty children with iron deficiency anemia with pica and 50 children with iron deficiency anemia without pica were studied to detail their psychosocial environment. Children in two groups were individually matched for age, sex, socioeconomic class, and degree of anemia. The pica group had significantly greater stress scores (7.6 ± 2.8) as compared to the control group (4.1 + 2.1; t = 5.05; p < 0.001). The stress factors that were significantly associated with pica were maternal deprivation (p < 0.01), child's caretaker other than the mother (p < 0.001), parental separation (p < 0.01), parental attitude of neglect, joint family (p < 0.001), child beating (p < 0.01), too little mother-child inter action (p < 0.01), and too little father-child interaction (p < 0.001). Hence, in the management of pica, a thorough evaluation of the psychosocial setting in which the child lives and an effort to alleviate psychosocial stress are important.
Chorea Associated with the Use of Oral Contraceptives
Authors: Wadlington W.B. , Erlendson I.W. , Burr I.M.
Published: July 2008

A 17-year-old black female developed Sydenham's chorea 8 weeks after inaugurating the daily use of an oral contraceptive. Two weeks after she stopped the oral contraceptive, her signs and symptoms of chorea dis appeared. Other causes of chorea were eliminated by various lab tests and a 4-year follow-up on the patient. Phenytoin sodium and methadone are cited as two other medications that have been associated with drug-induced chorea. Some theories are presented about altered dopaminergic sensitivity by various drugs that could produce choreic movements. The literature of chorea asso ciated with oral contraceptives is reviewed. The pediatrician is reminded to consider side effects of oral contraceptives when dealing with a sick teenager.
Social Networks, Social Support and Social Capital: The Experiences of Recent Polish Migrants in London
Authors: Ryan Louise , Sales Rosemary , Tilki Mary , Siara Bernadetta
Published: July 2008

There is growing interest in the role of migrants' social networks as sources of social capital. Networks are, however, often conceptualized rather loosely and insufficient attention has been paid to how migrants access existing networks or establish new ties in the `host' society.The assumption that migrants are able to access dense networks within close-knit local communities simplifies the experiences of newly arrived migrants, underestimating difficulties they may face in accessing support. Exploring the work of Putnam, as well as Coleman and Bourdieu, we critically engage with the conceptualization of bonding and bridging social capital, and the relationship between them, through an exploration of Polish migrants' networking skills and strategies. In examining the different types and levels of support derived through social ties, this article contributes to understandings of social networking by arguing for a greater differentiation and specification of networks both vertically and horizontally, but also spatially and temporally.
Slashing the Fiction of Queer Theory
Authors: Dhaenens Frederik , Van Bauwel Sofie , Biltereyst Daniel
Published: July 2008

The popularity of slash fiction, a productive strand of fan fiction in which same-sex television or film characters are subversively made into queer subjects, has grown in recent years. The practice of queer readings, which is about repositioning texts outside the borders of heteronormativity, very much resembles some of the basic premises of queer theory, the post-structural theory that contests strict categorical views on gender and sexuality. Unfortunately, slash fiction as well as audience reception practices do not appear to be high on the agenda of queer film theorists. This article argues that queer-sensitive audiences cannot be ignored in research on queer representations and reception in media studies. Moreover, the authors argue for a multidisciplinary approach that includes queer theory frameworks and insights from audience and reception studies as demonstrated by queer readings of non—queer-coded texts such as slash fiction.
Improvement of respiratory resistance by hot water immersing exercise in adult asthmatic patients
Authors: Asanuma Yoshihide , Fujiya Shuichi , Ide Hajime , Agishi Yuko
Published: July 2008

Acute effect of hot water immersing exercise on respiratory resistance (RR) was investigated in 12 adult asthmatics and six healthy males. They underwent mild exercise with comparable heart rates (HR = 120) in a hot water pool (water temp. 38°C) for 10 minutes. RRs were measured before and until 40 minutes after the exercise. Mean RRs of the patients before exercise (0.36 Kpa/l/s) reduced to less than 0.32 during 15 to 30 minutes after exercise (p<0.05). RRs of healthy subjects (0.19 Kpa/l/s) did not decrease significantly. Analysis of humoral factors relating to exercise metabolism and autonomic nervous system function of the patients suggested that the influence of sympathetic nervous activation persisted until 20 minutes after exercise. This physiotherapy had a specific feasibility for adult asthmatics in preventing exercise-induced wheezing.
A new motorized seat for a patient with juvenile polyarticular arthritis
Authors: Minns RJ , Oliver R. , Loftus MJ , Gault FR
Published: July 2008

A 42-year-old patient with multiple joint involvement including bilateral hip replacement and no movement of the knees or ankles required a custom made chair to enable her to be seated from a standing position by only allowing flexion of both hips. A motorized chair was designed and made that had a moveable footrest and seat unit powered by a linear actuator that allowed the patient to stand on the footrests when this unit was vertical and the seat angled at 45°. On activating the actuator by a joystick mounted on the armrest the footrests rolled forward along the floor whilst the seat fell to the horizontal in the final seated position. Two moveable axilla supports allowed the patient to share the load du ring seating between the shoulders and feet and away from the hips and knees as well as providing assurance against falling forward during upward movement of the seat.
The improvement of different motor functions after stroke
Authors: Lindmark Birgitta
Published: July 2008

As part of a multidisciplinary study on patients with acute stroke, 183 patients were followed up for one year after the onset of the stroke regarding improvement in different motor functions. Evaluations were made on six occasions during the year, with use of a modified chart for assessment of motor capacity developed by the present author. The improvement, expressed as the median score of the whole patient group in functions such as ability to perform active movements, mobility, walking ability and balance, occurred most rapidly before discharge and continued at a slower rate up to three months after the onset of stroke. These improvements were statistically significant. Between three months and one yearthere was slight further improvement, but this was not significant. In patients with minor impairment the improvement was mainly during the first week, and those with moderate or moderately severe impairment improved more continuously for up to three months. The few surviving patients with severe impairment continued to improve somewhat after three months, especially in balance and mobility. Coordination, balance and walking did not improve as well as other functions. Older patients with severe functional loss seemed to improve more slowly and not as well as younger patients with equivalent impairment.
Should diuretics be prescribed for idiopathic carpal tunnel syndrome? Results of a controlled trial
Authors: Pal B. , Mangion P. , Hossain MA , Wallace AS , Diffey BL
Published: July 2008

Diuretics are often prescribed to treat carpal tunnel syndrome (CTS) but their beneficial effect is unproven. In this double-blind controlled trial of bendrofluazide given for one month in 48 patients with the idiopathic CTS, treated and control patients showed similar clinical improvement, but the treated group showed more improvement than controls on electrophysiological tests. We conclude that bendrofluazide 5mgm daily for one month does not confer additional clinical benefit in the idiopathic CTS, but further trials with stronger diuretics and/or longer periods of treatment are warranted.
Staffing provision for early head injury rehabilitation
Authors: Pentland Brian , Barnes Michael P
Published: July 2008

A questionnaire was sent to seven rehabilitation units in the UK which were recognized for expertise in the early rehabilitation of head injury patients. Information was obtained about the type of patients treated in the units, the number of beds available and staffing levels. In addition, the consultants' opinions were sought on optimal staffing levels for a hypothetical 20-bed unit for the early management of severe head injury.

There was a wide variation in the staffing levels in the different neurorehabilitation units. The average therapy time available varied from six to 24.6 hours per week. The views of the four consultants who gave opinions about optimal staffing levels were similar and paralleled the levels recommended by other professional bodies.
Cold water immersion for the oedematous hand in stroke patients
Authors: Moon Agnes H , Gragnani John A
Published: July 2008

One of the therapeutic effects of cold application is to decrease oedema through local vasoconstriction. The oedematous hand of the hemiplegic side in the stroke patient is common and usually due to the dependency and the lack of motor function of the hand, or as a result of reflex sympathetic dystrophy. The objective of this study was to determine the effectiveness of cold water immersion therapy for the oedematous hand by measurement of hand volume before and after the therapy. To determine the experimental error in measurement of hand volume, 13 normal subjects were tested as the control study, 10 times each, by measurement of the overflow of water when the hand was immersed. A water tank with a temperature control was designed to maintain a constant temperature during each experiment. The water temperature was between 49°F (9.4°C) and 52°F (11.1 °C) depending on the patient's tolerance to the cold. Hand volume was measured before and after immersion. The hand was placed into the cold water intermittently, as the patient tolerated it, for 30 minutes. There were 14 experiments in nine stroke patients. It was found that experimental error in measurement of hand volume in the normal subjects varied from 3.2ml to 12.3ml, with the mean value of 6.4ml. One patient did not show any hand volume change. In eight stroke patients, the decrease in hand volume ranged from 1 0ml to 45ml after the cold water immersion. Since it is easy and readily available, cold water immersion should be taught to stroke patients for home treatment of the oedematous hemiplegic hands.
Outcome of activities of daily living in upper limb amputees
Authors: Sener Gül , Algun Candan , Karaduman Ayse , Yakut Yavuz
Published: July 2008

Activities of daily living were evaluated on 30 unilateral upper limb amputees. Although independence was more obvious in the amputees who have had distal amputations, all the amputees reached an adequate functional level in the activities of daily living. The treatment period for upper extremity amputees was shorter for distal than for more proximal amputations.
Functional electrical stimulation and the reduction of co-contraction in spastic biceps brachii
Authors: Lagassé Pierre P , Roy Michel-André
Published: July 2008

This study was undertaken to test the effects of a functional electrical stimulation (FES) training programme on the co-contraction level of spastic hemiparetic patients during a maximal speed forearm extension movement. Twelve males participated in 24 sessions of FES treatments applied to the triceps and biceps of the hemiparetic limb. The pattern of electrical stimulation was adjusted individually, after mathematical modelling of the EMG parameters, obtained at the execution of the task by the nonaffected limb. Pre- and posttest measurements included movement amplitude, time to maximal movement amplitude and peak amplitude of EMG activity in the triceps and biceps. All parameters were modified significantly (p < .01) following FES and the triceps to biceps ratio of EMG activity was also changed (p < .01). The FES treatment induced a reduction in the antagonist co-contraction level associated with spasticity and these findings further support the use of FES for neurological retraining after a cerebrovascular accident.
A pilot study of patient rated disability and the need for aids in Parkinson's disease
Authors: Mutch WJ , Swallow MW , Baker M. , Beazley J. , Oxtoby M.
Published: July 2008

In a questionnaire survey 71/96 members of the Belfast branch of the Parkinson's Disease Society reported their use of existing aids and their need for new aids. They selfrated their disability over a wide range of day-to-day functions, including transferring and turning in bed, selfcare, general mobility, independent living and communication.

Thirty-one people had a particularly helpful aid. Only 16 people mentioned problems where a new aid might be helpful, but a number of these were already available. Comments were in general not about aids but rather the need for therapy, problems with drugs and the variability of the disease. Large numbers of patients were dependent in many daily tasks including 55% and 44% respectively needing help to bathe and dress. 31 % were dependent walking indoors and 73% could not use public transport by themselves.

Clues to both the usefulness and limitations of aids were provided and require further exploration. There is a need for an overall support strategy in which expert assessment of daily living tasks and the provision of appropriate aids can play an important part. Doctors, therapists and patients all require more information on these topics.
The Leeds Family Placement Scheme: an evaluation of its use as a rehabilitation resource
Authors: Geddes Jml , Clayden AD , Chamberlain MA
Published: July 2008

The Leeds Family Placement Scheme (FPS) was designed to provide short term support for vulnerable stroke patients on discharge from hospital. Suitable patients were discharged into the care of 'substitute families': lay carers recruited from the community and trained by staff of a rehabilitation unit. Patients received care from their substitute family for an average of eight weeks during which time specific targets were met and a phased return home organized. Placements were supervised, guided and monitored by a key worker: an occupational therapist with counselling skills.

All patients taking part in the FPS showed improvement during placement. Comparison of a group of 10 placed patients and a control group of 61 unplaced patients, all with recent stroke, showed a statistically significant increase between three and twelve month poststroke Barthel scores in placed patients (mean scores 73.0 and 87.0 respectively). No overall improvement was observed in the control group (mean scores 74.4 and 75.7 respectively). The decline in social and home-based activities following stroke was comparable in the two groups.

While recognizing the limitations of this small study, it is suggested that the use of trained lay carers and a key worker can maximize the benefits gained by intensive hospital rehabilitation.
Initial experience with a telemeterized gait analysis system
Authors: Young JB , Perkins P. , Atkinson S. , Chamberlain MA
Published: July 2008

The M I E gait analysis system has been developed to allow a range of objective gait measurements to be readily obtained in a clinical setting. The equipment and its use are described together with a series of repeatability studies. The results suggest that the system is easy to operate and sufficiently reliable for use in clinical departments.
Review article : Medical complications in acute rehabilitation unit: immobilization hypercalcaemia
Authors: Dalgleish Debra C , Semble Elliott L , Miller Catherine N
Published: July 2008

Immobilization hypercalcaemia has been documented in adolescents on prolonged bed rest, particularly after traumatic fractures or spinal cord injuries. The exact pathophysiological mechanisms which produce the syndrome are unknown. Unstressed bone relinquishes calcium stores and the resulting hypercalcaemia leads to disturbances of many organ systems. Medical emergencies may occur if hypercalcaemia is unchecked. Medical management does not alter the underlying bone resorption, which follows a self-limited course, but can prevent serious complications and permanent renal damage. Acute rehabilitation professionals should be knowledgeable regarding immobilization hypercalcaemia as vague symptom presentations make recognition difficult. Also, immobilization hypercalcaemia occurs in time frames which coincide with most acute rehabilitation efforts and the syndrome can impede progress in reaching rehabilitation goals. Mobilization remains the only effective means to halt hypercalcaemia, although other therapeutic interventions may lessen its deleterious effects.
Improving recall of health service information
Authors: Wilson Barbara
Published: July 2008

A group of health service professionals was asked to listen to tape recorded summaries of four health related problems (memory impairment, visual object agnosia, unilateral visual neglect and behaviour disorder). Each summary was presented in one of the following ways: 1) using professional terms and jargon; 2) using simplified language; 3) categorizing the material; 4) combining simplified language and categorization. The order of presentation was counterbalanced across subjects.

Following a distractor task, each subject was asked to write down as much as he or she could remember. Results were scored 'blind'. The use of professional terms and jargon resulted in significantly poorer recall than the other methods. Simplification and categorization were not significantly different from each other in terms of the amount of information recalled. The combined method was superior to all other methods. It is hoped that this study will enable health workers to recognize the importance of presenting information in a simplified and structured manner.
Support collars: a preliminary survey of their benefits and problems
Authors: Teale C. , Mulley GP
Published: July 2008

Many support collars are prescribed despite the lack of controlled evidence as to their benefits, or the problems they may produce. We report a preliminary survey of 50 rheumatology, medical and ear, nose and throat outpatients prescribed a support collar during a two-month period. Of these, 27 (54%) completed a structured telephone interview two to four months later. Instructions received by patients about collar use varied widely, including advice to wear it continuously, intermittently, or only by day or night. Of the patients, 21 out of 26 (81 %) reported at least moderate relief of pain; four out of 14 (24%) reduction in paraesthesia; and five out of nine (57%) lessening of dizziness. Eighteen (67%) said that the collar caused significant discomfort, 14 (25%) had difficulty keeping their collar clean, and seven (26%) were unable to fit the collar themselves. Despite these problems compliance was good, with only three patients (11 %) of those interviewed abandoning their collar because of lack of benefit. We believe this small survey to be important as a stimulus to further work in this little-studied area.
Designing district disability services -the Oxford experience
Authors: Wade Derick T
Published: July 2008

This article gives a personal approach to the design of district services for people with severe, usually neurological, disability. It outlines some background concepts and facts, discusses the design of disability services and gives a description of the aims, objectives and working practices of the services in Oxford.
Thalidomide-induced limb malformations — a prosthetic review
Authors: Mustapha Nabil M
Published: July 2008

The embryopathy-producing drug 'thalidomide' resulted in an estimated 349 babies born in the UKwith congenital malformations during the period 1959-62. All known affected babies were registered, and a 'Thalidomide Society and Trust' was formed to administer the financial settlements offered by the manufacturers of the drug and the British Government. Individual prosthetic centres found great difficulty at the time in dealing with the complicated malformations these children presented, and it was found necessary to set up four specialized centres to develop new prosthetic/orthotic designs and fitting techniques. It was possible to review only 27 adults, as the majority were lost to follow-up. Those reviewed were all well adjusted (even those who had four limb malformations) and relatively independent. Their range of lifestyles is comparable with their nondisabled peers. The financial awards, proper home adaptations and adequate provision of aids to mobility and activities of daily living all contributed significantly to an enhanced quality of life. A peripatetic team, in consultation with the patients and the local team, offered suggestions and improvements in both prosthetic aids (making use of recent developments) and other aids to mobility and activities of daily living. The results of the study highlight the need for such a peripatetic team of experts to periodically review the prosthetic needs of complex multiple limb handicap.
Happiness and domain-specific life satisfaction in adult northern Swedes
Authors: Fugl-Meyer Axel R , Bränholm Inga-Britt , Fugl-Meyer Kerstin S
Published: July 2008

Levels of satisfaction with life as a whole (happiness) and with eight different domains were investigated using mailed questionnaires in four age cohorts (25-, 35-, 45- and 55-year-olds) of men and women. With a few exceptions (vocational and financial satisfaction) levels of global and domain-specific satisfaction were not age-dependent and few gender differences were found. The generally high levels of satisfaction correspond well to those found in the USA and in Germany. Satisfaction with expressive (emotion-related) domains was greater in women than in men, and the provider items - satisfaction with vocational and financial situation -were influenced by age. The eight domains formed three meaningful factors: the first characterized satisfaction derived from expressive goals; the second from spare-time goals; and the third factor was instrumental (performance-related), characterizing satisfaction derived from provider goals. The three factors predicted gross level of happiness (happy/not happy) for 82% of subjects with complete answers, all three factors being significant predictors.
A survey of lower leg braces worn by the over-60s
Authors: Hanger HC , Mulley GP
Published: July 2008

Fifty-five older subjects, who had been prescribed a lower leg brace (below knee orthosis - BKO) were interviewed to assess patient satisfaction and compliance. Over 80% of subjects were still using their brace: the majority (81 %) found them comfortable and a similar proportion said they were beneficial to their walking. Nearly half of the subjects (45%) were unable to put on their brace independently. Many of these individuals were very disabled, usually as a result of a stroke. Inability to apply the orthosis was related to disability, but not to patient age nor to the type of brace. Difficulties encountered by users included discomfort caused by the orthosis, problems with clothing and footwear and difficulties getting the orthosis modified or repaired. Improvements in brace design and service provision would help to minimize these problems.
Occupational therapy in elderly patients with rheumatoid arthritis
Authors: McAlpine CH , Woodhouse E. , MacDonald J. , Hunter J.
Published: July 2008

This study aimed to assess the value of periodic review by an occupational therapist (OT) of elderly patients with rheumatoid arthritis (RA). Twenty-four patients aged over 65 years who had longstanding RA and had had at least one previous contact with an OT completed a modified health assessment questionnaire (HAQ)1.2 to give an assessment of their self perceived functional ability then had a formal OT assessment. Two months later the patients completed a second HAQ to assess the effect of the OT assessment and assistance. Only three of the 24 patients were felt by the OT to have no need of intervention by her; 17 of the patients felt that the OT contact had been useful. Possible intervention to improve quality of life was not predicted by the patient's perception of limitations nor by the HAQ score. There were no significant changes in HAQ scores despite OT assessment and intervention. Other assessments of disability or wellbeing merit investigation in the context of OT intervention but the need for OT review of elderly patients with RA is clear.
Review articles : Pressure sores: methods used for the assessment of patient support surfaces
Authors: Rithalia Shyam VS
Published: July 2008

In the seriously ill, the paralysed and the elderly patient, many factors such as poor skin blood flow, malnutrition and immobility predispose to a high incidence of decubitus ulcers or pressure sores. The development of a sore is a complex process, but skin distortion and localized pressure are considered important precipitating factors. Over the last two decades manufacturers have produced a large variety of support surfaces claiming to be effective in prevention as well as treatment of sores. However, a review of available literature shows that none of the test methods used by different investigators has provided a comprehensive means of determining which device is appropriate for a particular patient.
Functional outcome of lower limb amputees with peripheral vascular disease
Authors: Collin Christine , Wade Derick T , Cochrane George M
Published: July 2008

A series of 40 patients accepted for prosthetic rehabilitation after lower limb amputations for peripheral vascular disease were reviewed nine to 27 months later. Two have since died, one has not been traced, and 37 have been assessed. Fourteen were successful full-time limb users ('walkers'), 10 were partial users ('partial walkers') and 13 were wheelchair-dependent ('none walkers' or 'wheelchair users'). Of the walkers, 85% completed a 10-metre walk in under 30 seconds (mean 20s), whereas 90% of the partial walkers took over 30 seconds (mean 79s). The Barthel Activities of Daily Living (ADL) Index, a measure of independence in self-care, correlated closely with outcome status and walking speed. Other items that correlated well with outcome included grip strength, assessed using a simple hand-held dynanometer, and cardiovascular fitness, the measure being time taken for the pulse to return to resting baselme after exercise. This was less than two minutes in 85% of the walkers (mean 94s) and two minutes or more in 100% of the partial walkers (mean 240s). Age did not indicate whether prosthetic training would be successful, but in those who were walking it correlated closely with speed. The partial walkers had lower kitchen and domestic activity scores, which were due to lack of environmental modification for wheelchair use, it being assessed that their walking status conferred ability to do tasks whilst standing. These patients can easily be identified by measuring their walking speed and Barthel ADL Index.
Prevention of long-term immobilization in treatment of cervical spinal cord injuries
Authors: Kiwerski Jerzy
Published: July 2008

Prolonged immobilization results in many complications which are particularly serious and pronounced in patients with severe cervical spinal cord injury. Two groups of cervical spinal cord injured patients, one with complete and the other with incomplete paralysis, were allocated to one of two treatment groups. One group was conservatively treated, usually by skull traction and passive standing followed by a delayed intensive rehabilitation programme; the other group was treated surgically within the first few days after injury, followed by immediate attempts at gradual passive standing and an early active rehabilitation programme. Better neurological and functional outcome, a smaller number of complications and shorter hospitalization time were recorded in those in the surgically treated group. This study confirms the importance of active early mobilization.
A memory group for individuals with brain injury
Authors: Evans JJ , Wilson BA
Published: July 2008

Five patients with memory impairments resulting from brain injury attended a memory group which ran weekly for 11 months. The group focused on helping patients find ways of utilizing memory aids to help with everyday memory problems. Memory games were used to encourage patients to devise strategies for dealing with novel problems. One aim was to facilitate social support amongst patients and opportunities were taken to address the emotional consequences of memory impairment. There were changes in the pattern of use of memory aids and these are discussed. Memory functioning as measured by a memory test (RBMT) did not show any significant improvements. There were some reductions in levels of general anxiety and depression over the course of the group. Patients' feedback indicated that being in a group with others with similar difficulties was both helpful and enjoyable. The advantages of a group run over a longer period than is usual are discussed.