bluuebunny/crossref_metadata_2025 huggingface dataset:
The persistent vegetative state: a 'fate worse than death'
Authors: Freeman EA
Published: July 2008

Patients who pass into prolonged coma and then into the 'vegetative state' (VS) or 'persistent vegetative state' (PVS),1 are medical enigmas. These terms are often used interchangeably, and are frequently considered to refer to an irrecoverable condition, synonymous with neocortical death. The case history of a patient diagnosed as vegetative and caught within the medical and legal systems is presented. The problems of diagnosis as well as the difficulties in management in such a patient are shown to have significant repercussions on the patient, the family and the community. Since every VS patient may cause enormous expenditure for life-time care, governments will be obliged to look at methods to reduce both the incidence and the severity of severe brain injury. Every effort must be made to prevent VSs from occurring. To resolve the problems of the research and management of prolonged coma and the VS it is proposed that (1) coma care units, (2) a coma register, (3) acute coma care review committees, and (4) chronic coma care review committees be established.
The effect of personal care training at a medical department: a study in occupational therapy
Authors: Söderback Ingrid , Guidetti Susanne
Published: July 2008

The effectiveness of ADL (activities of daily living) training was evaluated in 26 older adult patients who received medical care and nursing on seven wards at a Swedish medical department. The patients were selected consecutively following their referral to the occupational therapists and were assigned alternately to an experimental group ( n=14) who underwent ADL training 2-13 times during an average of 12 days, and a control group ( n=12). The patients' level of dependence in ADL was assessed using the Klein-Bell ADL scale before and after the ADL training (experimental group) and at corresponding points for the control group. A significant difference between the experimental group and the control was demonstrated in the ADL area Bathing/Hygiene (F(1,22) = 8.29; p = 0.009). There were strong tendencies towards significant differences between the groups in the variables 'mobility' (F(1,22) = 3.69; p = 0.07) and 'Eating' (F(1,22) = 4.05; p = 0.06).
Repeatability of electro- and acoustic myographic activity during a fatigue test of normal lumbar paraspinal muscles
Authors: Lee DJ , Stokes MJ
Published: July 2008

The repeatability of acoustic myography (AMG) and electromyography (EMG) of the paraspinal muscles of 15 healthy subjects was investigated during a fatigue test involving a sustained horizontal hold of the upper body against gravity. The AMG and EMG signals were full-wave rectified and integrated (IAMG, IEMG). The variability of recordings made during a 60-second isometric contraction performed on three different days was assessed by analysis of variance (ANOVA) and coefficients of variation (CVs) were calculated from the ANOVA. The IAMG: IEMG ratio was calculated to assess electromechanical uncoupling during fatigue and the IAMG and I EMG values were also normalized to a percentage of initial activity. At the beginning of the fatigue test, absolute values for IAMG and the IAMG:IEMG ratio were not as repeatable between days as IEMG (CVs = IAMG 18%, IEMG 11 %, IAMG: IEMG ratio 23.5%). Absolute values at the end of the test showed similar degrees of repeatability for each variable (CVs = IAMG 21 %, IEMG 10%, IAMG: IEMG ratio 24%). Normalized values at the end of the fatigue test were repeatable (CVs = AMG 6%, EMG 6%, AMG : EMG ratio 9%), but variability was observed during the contraction. The present results indicate that absolute values of EMG are more repeatable than AMG for assessing paraspinal muscle activity on different days in healthy subjects. The changes in normalized values were variable during fatiguing activity but repeatable at the end of the test. Further control of the AMG recording technique is required to refine the fatigue test before it can be applied as a clinical assessment tool.
Reasons for persistent disability in Guillain-Barre syndrome
Authors: Lennon SM , Koblar S. , Hughes Rac , Goeller J. , Riser AC
Published: July 2008

The reasons for persistent disability in 10 Guillain-Barre syndrome patients were investigated. Patients were assessed between 11 and 35 months after disease onset with impairment, disability and handicap scales, a standard neurological examination and nerve conduction studies. All patients showed persistent limb weakness which affected independence in self-care in three patients and the pursuit of leisure and work activities in eight patients. The implications for clinical practice are discussed.
Transcutaneous electrical nerve stimulation in the management of painful muscle spasm in patients with multiple sclerosis
Authors: Mattison PG
Published: July 2008

Transcutaneous electrical nerve stimulation (TENS) was used to treat eight patients with multiple sclerosis who presented with painful lower limb muscle spasms. All eight had experienced a deterioration in functional ability following initial treatment with spasmolytic agents which had produced an undesirable fall in resting muscle tone. Six of the eight patients experienced a significant improvement in symptoms with TENS treatment. It is suggested that this is an effective method of treating painful muscle spasm in multiple sclerosis. Further studies are underway to investigate the physiological effects of TENS in multiple sclerosis patients.
A pilot study on the effect of exercise and abdominal massage on bowel habit in continuing care patients
Authors: Resende TL , Brocklehurst JC , O'Neill PA
Published: July 2008

In this pilot study the effects of exercise and abdominal massage on intestinal transit time, bowel habit, faecal incontinence and the use of laxatives and enemas were determined in 12 immobile, longstay patients for 12 weeks. Daily records of bowel habit, faecal incontinence and the use of laxatives and enemas were made for six weeks before and for 12 weeks during the programme. No significant differences ( p = 0.26) were found in the transit times before and after treatment. Episodes of faecal incontinence were significantly decreased ( p = 0.0002), with a significant increase in the number of bowel motions ( p = 0.0006). The number of enemas given was reduced ( p < 0.0001) and just one patient took one laxative. In the absence of a control group, these results could simply be due to discontinuing bowel medication, rather than exercise and massage. Further definitive research should be carried out to establish the effectiveness of exercise and abdominal massage in treating constipation in the continuing care unit.
Recovery from physical disability after stroke: profiles for different levels of starting severity
Authors: Partridge Cecily J , Morris Lorna W , Edwards M Susan
Published: July 2008

This study aimed to follow up a preliminary study and collect further information about the profiles of recovery from physical disabilities of people who had suffered a stroke. Prospective monitoring of 348 patients with stroke referred to physiotherapy in health districts throughout the UK was undertaken for a six-week period and a distinct time-related pattern of recovery from disability was again found. Significant differences related to age were identified, but were not found in relation either to side of stroke or sex. These profiles of recovery, together with earlier work monitoring recovery in 368 patients with stroke, provide important information not previously available about indices of recovery directly related to phsyiotherapy. A database on over 700 patients is now available, and can be used to monitor any changes which occur as a result of interventions by therapists. It is also suggested that the development of recovery curves may be a useful way of monitoring quality of care in the physiotherapy treatment and management of a number of conditions involving physical disability.
Recovery curves for patients who have suffered very severe brain injury
Authors: Powell Graham E , Wilson Sarah L
Published: July 2008

Twenty-nine patients were admitted to a study of recovery of function following very severe brain injury and contributed detailed information towards the plotting of recovery curves. The patients were followed up longitudinally for periods of up to one year two months, and comprised three cohorts: those entering the study zero to 12 months, 13-24 months and 25 plus months post injury. Every two weeks, nurses completed a structured observation schedule containing 13 scales. Also every two weeks, patients were directly observed using a time sampling technique with 12 categories of behaviour. Recovery upon entry into the study was steeper in the first three months and then slowed, but did not asymptote in the period of observation, and recovery was best for those in the zero to 12 months post injury group. An overall recovery curve from the time of injury was plotted, which showed a steeper rise in the first year, but recovery clearly continued for three or four years. Marked individual differences were noted. Most recovery related to attempts to communicate, general alertness, motor control and more normalized mood. Implications for treatment are discussed.
The changing pattern of wheelchair provision
Authors: Dudley NJ , McMahon M.
Published: July 2008

The last 20 years has seen a substantial increase in the number of wheelchair users: in 1973, Fenwick estimated that 137 000 wheelchairs were on loan in England and Wales; in 1990, Kettle and Rowley estimated that 500 000 chairs were on ioan from the Disablement Services Authority.

In a survey of requests for new wheelchairs over two separate one-month periods, it was found that 310 requests resulted in the supply of 302 wheelchairs. Females received 66.6% of the chairs. The ages of the recipients ranged from three to 98 years old (average 71). Patients aged 60 and over received 79.8% of all chairs supplied. Attendant-propelled chairs accounted for 75.2% of chairs supplied, and 19.2% were self-propelled. The leading diagnostic groups for provision were: arthritis (21.5%); cerebrovascular disease (19.2%); chronic obstructive airways disease/asthma (16.5%); and ischaemic heart disease/congestive cardiac failure (13.6%)

When compared with the earlier two national surveys there have been changes in the age of wheelchair users, the diagnoses necessitating the use of a wheelchair, and the type of wheelchair used. These changes are inter-related and are likely to be driven by an increasingly elderly population.
Tibialis anterior surface EMG parameters change before force output in multiple sclerosis patients
Authors: Jones R. , Rees DP , Campbell MJ
Published: July 2008

Neuromuscular function has been studied in multiple sclerosis patients with differing levels of disability. Force during maximal voluntary ankle dorsiflexion and surface EMG in tibialis anterior for weakest and strongest legs in 31 patients was compared with 16 control subjects. In the most mildly affected patients strength of dorsiflexion for the strongest leg was not significantly different from that of controls, but integrated mean EMG and median frequency of the power spectrum were significantly lower. In all other patient groups, all parameters measured were different from control values. Results indicate an important change in neuromuscular parameters which precedes loss of the ability to recruit normal force levels. Such changes may imply that the muscles of multiple sclerosis patients are affected even before there is significant evidence of neural motor dysfunction.
Preliminary findings on the everyday use of a robotic aid to eating
Authors: Pinnington LL , Hegarty JR
Published: July 2008

This paper presents preliminary results from a systematic clinical study in which the abilities of 20 children with severe neurological impairments were traced whilst making use of a robotic aid to eating. The study provided the opportunity to assess the medium-term reliability of the device and to evaluate its impact on oral-motor and related functional skills. Results show that all except two children could use the aid, with varying degrees of adult support and documents the preconditions for effective use in rehabilitative or domestic settings. Changes observed in the children's oral-motor skills consequent upon using the device will be evaluated in subsequent reports.
Patterns of recovery for lower limb amputation
Authors: Ham Rosalind , de Trafford June , Van de Ven Catherine
Published: July 2008

Following the identification of functional activities to record the recovery patterns of the amputee, a preliminary survey was carried out over a 12-month period, to monitor these patterns following lower limb amputation. Four hundred and fifty-nine returns were received and the profile of the sample was found to be in line with the UK amputee data.

The results show that basic bed activities that is, moving about the bed, moving from the lying to sitting position and being able to sit up unaided, were the easiest activities for the sample to achieve independently and took between one to two weeks. Transferring the upper body and dressing the upper body independently were more difficult and took between three to four weeks to achieve and dressing the lower body took, on average, three to five weeks to master following the amputation.

A number of the patients were either transferred or discharged from the site of the operation from the second week postoperatively and were not followed up by the physiotherapists at the acute site. This resulted in the data on the later milestones of recovery, either using an early walking aid or a prosthesis, being less accurate. A further study that takes these facts into account is recommended to conclusively establish the milestones of recovery for this group of disabled patients.
Electrotherapeutic rehabilitation of the quadriceps in elderly osteoarthritic patients: a double blind assessment of patterned neuromuscular stimulation
Authors: Oldham JA , Howe TE , Petterson T. , Smith GP , Tallis RC
Published: July 2008

Recent studies, in combination with advances in modern electronics, suggest a role for electrotherapy in reversing muscle wasting. However, its effects on human subjects are not always clear-cut. The authors propose that conventional uniform frequency stimulation may deprive the muscle of adaptive information normally encoded in the nonuniform discharge of its motoneuron. This hypothesis was tested in a double blind control trial by stimulating the quadriceps femoris (QF) of elderly subjects with osteoarthritis of the knee. A stimulation pattern replicating that occurring in a normal, fatigued QF motor unit (patterned neuromuscular stimulation) was compared with uniform stimulation of the same mean frequency and random pattern stimulation (created by shuffling the order of the interpulse intervals in the replicated stimulus train). A'sham' stimulation protocol provided an effective placebo. Subjects were assessed at the level of impairment (muscle strength, endurance and cross-sectional area), disability (timed 10-metre walk, timed sit-to-stand) and handicap (part II of the Nottingham Health Profile).

Following stimulation, some descriptive improvements in outcome measures were observed in favour of PNMS, particularly in functional tests such as walking speed and sit-to-stand time. No stimulation pattern emerged as being significantly better than another, although statistically significant ( p ≤ 0.05) differences between individual stimulation patterns were observed at a number of assessment weeks.
The effect of shoulder pain on outcome of acute hemiplegia
Authors: Roy CW , Sands Madeleine R , Hill Linda D , Harrison A. , Marshall S.
Published: July 2008

The aim of this study was to decide whether shoulder pain in stroke is a marker of severity, or an independent predictor of poor outcome. The study was prospective observational in design from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the subjects were 76 patients acutely admitted to hospital with a first stroke.

The main outcomes measured were length of stay in hospital, Barthel Index, Frenchay Arm Test, Motricity Index and discharge placement. After controlling for other indicators of stroke severity, shoulder pain on movement was the most important predictor of poor recovery of arm power and function, and an important contributor to length of stay in hospital. Urinary incontinence was the strongest indicator of length of stay and Barthel Index scores. Patients with subluxation and malalignment of the shoulder fared much more poorly than those with normal shoulder alignment. The results concluded that shoulder pain appears to influence outcome of stroke independent of severity. We recommend that this symptom receive careful attention.
Trunk muscle strength is impaired multidirectionally after stroke
Authors: Bohannon Richard W , Cassidy Diane , Walsh Susan
Published: July 2008

This study was undertaken to describe and compare the forward and lateral trunk flexion strength of 20 patients with stroke and hemiparesis and 20 matched controls. Trunk flexion strength was measured with a hand-held dynamometer while subjects were seated upright. Analysis of variance procedures showed trunk strength, whether lateral or forward, to be decreased significantly in the patients relative to controls. The greatest difference between groups was in forward flexion strength. The patients also demonstrated weakness of the trunk on the paretic relative to the nonparetic side. The results show that trunk muscle strength is impaired multidirectionally in patients with stroke. Such impairments have the potential to affect function.
Dyskinesia in chronic schizophrenia: an examination of the psychiatric nurse's perspective and its implications for physiotherapy
Authors: Lynn Sharon A , Plant Rowena D
Published: July 2008

The emerging biological explanation for dyskinesia in schizophrenia may allow physiotherapists to become involved in their treatment. However, this could be influenced by the views of psychiatric nurses who are major referers to physiotherapy. The aim of this study was to explore nurses' views on the aetiology and management of dyskinesia in schizophrenia. Four out of six nurses (randomly selected from a population of 83) took part in an unstructured group interview. Content analysis of transcripts identified five abnormal movement categories (oro-facial, posture, hand tremors, gait, and head, trunk and limbs) and five aetiological symbols (drugs, abnormal mental state, eclectic, mood, and behaviour). Contingency analysis revealed that drugs were the most consistent aetiological factor in all movement categories. Organic causes were not mentioned. An acknowledgement of these biological explanations by nursing staff may enhance the future development of physiotherapy intervention in mental illness.
An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single-blind randomized controlled trial
Authors: Callaghan MJ , Oldham JA
Published: July 2008

Osteoarthritis (OA) of the knee is a major public health problem in the United Kingdom and various forms of physiotherapy are used in the treatment of this condition despite the lack of studies evaluating its efficacy. The purpose of this study was to compare the efficacy of two different forms of physiotherapy exercise management with a control group.

Twenty-seven patients with OA knee were recruited from routine orthopaedic clinics and were on the waiting-list for physiotherapy. Patients were randomly allocated to three groups. Group 1 ( n = 9) consisted of a control group; Group 2 ( n = 8) consisted of supervised sessions of exercises; Group 3 ( n = 10) consisted of an advice and instruction session plus a functional home exercise regime.

Parameters measured were: pain; range of motion; quadriceps strength; knee joint swelling; exercise tolerance.

Results were analysed using a Kruskal-Wallis analysis of variance and a Mann-Whitney U-test with the significance level set at p <0.05. The results showed no significant difference ( p >0.05) between any of the outcome measures of the three groups. This study concludes that patients with OA knee can be helped most economically by one session of advice and a functional home exercise regime. This can be done in a group setting under supervision of one physiotherapist.
A survey of factors affecting the capacity to work in patients with rheumatoid arthritis in South Wales
Authors: Camilleri JP , Jessop AM , Davis S. , Jessop JD , Hall M.
Published: July 2008

A survey was undertaken during 1992-93 to identify factors associated with the severity of rheumatoid arthritis and its management which might be modified to improve the patient's ability to continue to work. Two hundred and twenty patients taking part in a trial of second-line therapy were sent a postal questionnaire. Seventy-four per cent returned valid forms and these patients were subsequently medically examined. The unemployment rate in males was 71 % and in females 69%, compared to the average for the whole of Wales of 27% and 42% respectively in the same age range for the year in question. The data obtained suggested that improvements could be made with respect to disease control, organization of medical care and better use of rehabilitation services to optimize ability to work.
A regional specialty policy for pressure sores
Authors: Rowe Jed , Barer David
Published: July 2008

A survey of pressure sores in Mersey's geriatric units revealed almost universal access to high technology equipment but limited availability of specialist skills and knowledge. Many wounds were treated with toxic or inappropriate agents. Consequently a regional specialty policy for pressure sores, incorporating a tissue viability formulary, was introduced. A second audit investigated its effects.

The prevalence, grade, ages and anatomical sites affected were very similar in the two studies. Patients receiving a pressure sore risk assessment increased, from 157/170 (92%) to 186/187 (99.5%) ( p <0.0005). Prior to the introduction of the policy 74/272 (27%) pressure sores had an unsuitable cleanser, cavity filler or dressing compared with 51/309 (16%) subsequently ( p <0.005).

This regional specialty audit has improved the management of pressure sores in 10 units.
The effect of stump length on the rehabilitation outcome in unilateral below-knee amputees for vascular disease
Authors: Subbarao KV , Bajoria S.
Published: July 2008

The optimal stump length for prosthetic fitting in a below-knee amputee is considered to be not less than 12.5 cm. However, such long stumps may be associated with delay or failure of wound healing in lower limb amputees for vascular disease. This is often the cause of considerable morbidity, slow progress with rehabilitation, and long hospital stay.

In the present study the rehabilitation outcomes in patients with short (10 cm or less) and long (more than 10 cm) stumps who had a unilateral below-knee amputation for peripheral vascular disease were compared. Each group consisted of 25 patients. There was no significant difference in the rehabilitation outcome (as measured by three different assessment scales) between the two groups. It is concluded that relatively short stumps (e.g. 8-10 cm long), which are likely to heal quicker and are associated with less risk of reamputation than long stumps, may be an advantage in this group of patients.
A pilot study to examine the potential impact of professional social work input into a chronic spinal clinic
Authors: Law Christopher SD , Hamlyn Peter J
Published: July 2008

The potential impact of professional social work input in patients attending a tertiary neurosurgical chronic spinal clinic was assessed over a period of one year. Two hundred and sixty-four patients were booked into the clinic, and 206 attended (78%). Of these, 93 follow-up patients were selected at random and were interviewed (45%). Forty-two (45%) were male and 51 (55%) female. The median age was 50. Advice was found wanting in 35%. At follow-up (6-18 months later), 76% of those receiving it had acted successfully upon the advice given.

In addition to identifying the extent of need, a simple scheme to allow easy identification of the most needy group was tested. Lack of employment was the most significant predictor of need, though a larger and more detailed study is required to assess other factors.
Evaluation of walking speed and functional ambulation categories in geriatric day hospital patients
Authors: Martin BJ , Cameron M.
Published: July 2008

Functional ambulation categories (0-5) were recorded on 105 patients on the first and last days of a day hospital physiotherapy programme. Walking speed was measured in patients capable of walking without physical support from another person (functional ambulation categories 3-5). Patients attended for a median of 10 therapy days. Ambulation categories improved in 26 patients, deteriorated in three patients and there was no change in 76 patients. Mean walking speed, measured in 61 patients who did not change walking aid, increased from 0.38 to 0.44 metres per second (p = 0.003). Forty-three patients who did not show improvement in functional ambulation category had an increase in mean walking speed from 0.37 to 0.43 metres per second (p = 0.015). Both measurements are valuable, complementary and suitable for routine use in day hospital practice. Together they provide a basis for assess ing effectiveness of therapy.
The long-term consequences of subarachnoid haemorrhage. 2: Prevalence of instrumental ADL disabilities
Authors: Lindberg Margareta , Fugl-Meyer Axel R
Published: July 2008

A total of 244 long-term survivors of subarachnoid haemorrhage (SAH) were examined at a follow-up concerning change in instrumental activities of daily living (IADL). A decrease from previous independence prevailed for 51 % of the sample. As expected, home-maintenance activities were more common pre-SAH for women than for men, and for these activities post-SAH disabilities were most frequently recorded for married/cohabiting women. Using factor analysis, IADL items could be grouped into three different factors characterizing: (a) domestic and social activities, (b) administrative chores and (c) handling money or the telephone. Two of these factors were logically associated with two or three impairments (language, motor, perception, long- and short-term memory). Since IADL disabilities are common among long- term survivors of SAH, the need for rehabilitation and occupational therapy is discussed briefly.
Sleep problems in stroke patients: relationship with shoulder pain
Authors: Küçükdeveci Ayse A , Tennant Alan , Hardo Philip , Chamberlain M Anne
Published: July 2008

This study was designed to document the occurrence and the type of sleep problems in stroke patients and to examine the importance of shoulder pain in stroke in relation to sleep disturbances. Forty-six stroke patients were evaluated for the presence of sleep disturbances, general health problems (Nottingham Health Profile) and anxiety-depression (Hospital Anxiety Depression Scale) and compared with 47 age- and sex-matched subjects who had not had strokes. A four-item sleep questionnaire was used to assess different components of insomnia disorders through the previous month. The results showed that stroke patients had significantly more problems in initiating sleep than controls (p < 0.01). Other components of insomnia, difficulty in maintaining sleep or nonrestorative sleep did not differ between the two groups (p < 0.05). Factors found to be associated with poor sleep such as pain (p < 0.01), anxiety (p < 0.01) and depression (p < 0.01) were more common in the patient group but these did not otherwise result in a significant increase in all components of insomnia, probably because of the high level of benzodiazepine and tricyclic antidepressant intake amongst patients. Stroke patients with shoulder pain showed significantly more sleep disturbances (p < 0.01 ) and less general well-being ( p < 0.05) than patients without shoulder pain. It is concluded that attention must be paid to shoulder pain and to ensuing sleep disturbances among stroke patients.
Functional assessment of urinary incontinence: the perineal pad test
Authors: Devreese Annemie M , De Weerdt Willy J , Feys Hilde M , Dewulf Mieke , Alaerts Renilde , Vereecken Raoul , Van Assche André
Published: July 2008

Perineal pad tests are simple, noninvasive functional tests which have been recommended for the evaluation of patients with urinary incontinence. Most are based on the one-hour pad test introduced by Sutherst and co-workers and standardized by the International Continence Society. The major problem with the one-hour pad test is its lack of sensitivity. Therefore a stringent test procedure was developed, whereby the limit of patient tolerance was reached. Mean end volumes of 568 ml (648 ml) immediately after the test (retest) confirmed that the patients had been examined with full bladders. Yet one in three of the incontinent patients remained dry during formal assessment. The use of the one-hour perineal pad test for clinical or research purposes should be seriously questioned.
Long-term consequences of minor head injury on family members
Authors: Telford Rosemary , Wright John C
Published: July 2008

The emotional impact of a minor head injury on 25 relatives was investigated at interview six months after the event. Two and a half years later, eight of the relatives agreed to be reassessed. Psychological distress was identified at six months and appeared to persist for up to three years. This study was limited by the small number of participants, and further exploration with a larger sample is recommended.
The scalability of the Rivermead Motor Assessment in acute stroke patients
Authors: Adams SA , Ashburn A. , Pickering RM , Taylor D.
Published: July 2008

Objective: To examine the scalability of the Rivermead Motor Assessment with hospitalized acute stroke patients.

Design: This was a prospective study of hospitalized stroke patients.

Subjects: Fifty-one selected stroke patients, including those over the age of 65, were assessed at one, three and six weeks post-stroke using the Rivermead Motor Assessment. Coefficients of scalability and reproducibility were calculated for each of the three sections of the Rivermead Motor Assessment at each assessment.

Results: The items in the gross function and arm sections met scaling criteria at all three assessments which meant that they were in appropriate order of difficulty. There was an overall increase in the proportion of subjects passing each item at successive assessments, suggesting that patients in the study were recovering. The leg and trunk section did not meet scale criteria with these acute stroke patients.

Conclusions: We recommend that only the gross function and arm sections should be used as hierarchical scales with selected acute stroke patients. The leg and trunk section should only be used as an assessment checklist.
Relationships between measures of function, strength and walking speed in patients with diabetes and transmetatarsal amputation
Authors: Salsich Gretchen B , Mueller Michael J
Published: July 2008

Objective: To determine the correlation between strength and functional measures, and the intercorrelation between the functional measures themselves, in a group of subjects with diabetes mellitus (DM) and transmetatarsal amputation (TMA).

Design: Correlational study.

Setting: The subjects were tested in the Applied Kinesiology Laboratory of the Program in Physical Therapy at Washington University School of Medicine, St Louis, MO, USA.

Subjects: Thirty subjects with DM and TMA (mean age 61.7 ± 11.3 years) were studied.

Main outcome measures: Function was measured using the Functional Reach Test (FR), the Physical Performance Test (PPT), the Sickness Impact Profile (SIP), and walking speed (WS) for 15.24 m. Strength measurements were taken using a hand-held dynamometer.

Results: Highest correlations were found between hip extension strength and PPT: r = 0.69, FR: r = 0.45, and WS: r = 0.76, between knee extension strength and PPT: r = 0.48, and WS: r = 0.51, between hip flexion strength and PPT: r = 0.51, FR: r = 0.47, and WS: r = 0.59, between knee flexion strength and PPT: r = 0.57, and WS: r = 0.63, and between dorsiflexion strength and PPT: r = 0.49, and WS: r = 0.63. The following intercorrelations between functional measures were significant; PPT and FR: r = 0.66, PPT and SIP: r = -0.54, PPT and WS: r = 0.77, FR and WS: r = 0.54, SIP and WS: r = -0.47.

Conclusions: The relationship between measures of hip and knee muscle strength and function provides some evidence that rehabilitation should focus on strengthening hip and knee extensors and flexors to improve function. The relationships between walking speed and strength, PPT, FR and SIP suggest that the simple measure of walking speed is a useful functional test in the clinic.
A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study
Authors: Kjendahl Astrid , Säliström Susanne , Østen Per Egil , Stanghelle Johan Kvalvik , Borchgrevink Christian F
Published: July 2008

Objective: We recently reported that acupuncture treatment of stroke patients in the subacute stage gave additive therapeutic benefit. The purpose of the present study was to determine, approximately one year after discharge from the rehabilitation hospital, whether the group differences still remained.

Design: The patients were randomized into two groups: one acupuncture group and one control group, considering gender and side of hemispheral localization of lesion. With regard to the main parameters the groups were comparable at baseline.

Setting: Initially, 45 stroke patients admitted to Sunnaas Rehabilitation Hospital were included in the study: median 40 days post stroke.

Subjects: Forty-one of the patients were available one year after the treatment period: 21 patients in the acupuncture group and 20 controls.

Intervention: All subjects received an individually adapted, multidisciplinary rehabilitation programme. The acupuncture group received additional treatment with classical acupuncture for 30 min three to four times weekly for six weeks.

Main outcome measures: The patients were evaluated at inclusion, after six weeks and approximately 12 months after discharge from the rehabilitation hospital. The Motor Assessment Scale (MAS) for stroke patients, Sunnaas Index of Activity of Daily Living (ADL) and Nottingham Health Profile (NHP) were used. In addition, the social situations of the patients were recorded at one year follow-up.

Results: The results show that the acupuncture group improved significantly more than the controls, both during the treatment period of six weeks, and even more during the following year, both according to MAS, ADL, NHP and the social situation.

Conclusion: Although the mechanism of the effects is debatable, there seems to be a positive long-term effect of acupuncture given in the subacute stage post stroke.
Pelvic floor rehabilitation is effective in patients with multiple sclerosis
Authors: Vahtera T. , Haaranen M. , Viramo-Koskela AL , Ruutiainen J.
Published: July 2008

Objective: To determine the effect of pelvic floor muscle exercises combined with electrical stimulation of pelvic floor on lower urinary tract dysfunction in multiple sclerosis (MS) patients with near normal (<100 ml) postvoid residual volumes.

Design: Open, controlled, randomized study in two parallel groups.

Setting: Rehabilitation centre for MS patients.

Subjects: Fifty women and 30 men with definite MS and current symptoms of lower urinary tract dysfunction.

Outcome: The muscle activity of the pelvic floor muscles was tested using surface EMG. Subjective urinary symptoms were assessed using a questionnaire.

Interventions: Pelvic floor muscles were stimulated using electrical stimulation at six sessions. During and after the final session the patients were taught to exercise their pelvic floor muscles and advised to continue these exercises regularly for at least six months. The control group was not treated.

Results: The maximal contraction power and endurance of the pelvic floor muscles increased after six sessions of electrical stimulation with interferential currents. Symptoms of urinary urgency, frequency and incontinence were significantly less frequent in the treated group than in the untreated subjects. Male patients appeared to respond better to the treatment than female patients. Compliance with the pelvic floor exercises was over 60% at the end of a follow-up for six months. Most drop-outs were due to the disappearance of urinary tract symptoms or to severe relapses in MS.

Conclusions: The present study indicates that pelvic floor muscle exercises combined with electrical stimulation of the pelvic floor constitute an effective treatment for lower urinary tract dysfunction at least in male patients with MS.
Evaluation of a shortened version of the Abbreviated Mental Test in a series of elderly patients
Authors: Swain David G , Nightingale Peter G
Published: July 2008

Objective: To determine whether a shortened version of the Abbreviated Mental Test is as effective as the Abbreviated Mental Test (AMT) itself in assessing cognition in elderly patients.

Design: A shortened four-item version of the Abbreviated Mental Test (AMT4) was constructed using the following items: (1) Age, (2) Date of birth, (3) Place, and (4) Year, with impaired cognition indicated by an AMT4 score of less than four. Patients were assessed with the AMT. The AMT4 scores were then determined and matched against AMT scores. The performance of all 210 possible four-item combinations derivable from the AMT was assessed and ranked according to predictive efficiency (the percentage of patients whose cognition as judged by the AMT was correctly categorized by each four-item combination).

Setting: Inner-city teaching hospital.

Subject: Two hundred consecutive elderly patients seen on domiciliary visits, in the clinic or as orthogeriatric referrals.

Results: The AMT4 score showed a statistically significant correlation with AMT score (Somers' d statistic 0.90: p < 0.001). The AMT4 had a predictive efficiency of 91 % and ranked 7=/210 possible four-item combinations.

Conclusions: The AMT4 may be useful in the initial assessment of cognition in elderly patients, with little loss of accuracy in detecting marked cognitive impairment when compared to the AMT.
The use of standardized outcome measures in rehabilitation centres in the UK
Authors: Turner-Stokes Lynne , Turner-Stokes Tabitha
Published: July 2008

Objective: To ascertain which standardized instruments are currently most commonly used as outcome measures for rehabilitation in routine clinical practice in the UK.

Design: The study used a postal questionnaire which was sent out to members of two major societies of rehabilitation professionals in the UK.

Results: Of 182 rehabilitation centres represented by respondents, 140 (77%) collected at least one standardized measure and 42 did not. Principal reasons for not recording measures were lack of time and not knowing what to collect. As had been anticipated, a very wide range of different measures were used by different centres, however some clear favourites emerged including the 10 m Walk, the Motricity Index and the Nine-hole Peg Test. One hundred and twenty-three centres used one or more global disability measure of which the commonest were the Barthel Index or one of its modifications and the Functional Independence Measure (FIM) and/or Functional Assessment Method (FAM). Among units that used handicap or extended activities of daily living (EADL) scales, the Nottingham EADL, the London Handicap Scale and the General Health Questionnaire (GHQ-22 or 12) were most popular. Outside neurorehabilitation, the Harold Wood/Stanmore mobility grades were used by 10/18 amputee rehabilitation centres and the Health Assessment Questionnaire (HAQ) was used by 15/48 units providing musculoskeletal rehabilitation.

Conclusions: It is clear that no one measure is suitable in all settings and services, but the most popular measures from this survey may reasonably form the basis for a 'basket of recommended instruments' that may help to guide units wishing to collect outcome data but not knowing which to choose.
The Impact of Implementing a Quality Circles Intervention on Employee Task Perceptions
Authors: Head Thomas C. , Molleston Julie L. , Sorensen Peter F. , Gargano Joseph
Published: July 2008

This study utilized four plants of a large manufacturing organization to assess what impact implementing a Quality Circle program has on employee task and affective outcome response perceptions. The literature (nonempirical) supports the theory that employees' attitudes would improve following QC implementation. The Job Diagnostic Survey was used to obtain before/after measures on two plants that received Quality Circle intervention. In addition, two plants that did not receive QCs were used as comparison groups. The results indicated that there were no significant changes in employee perceptions following QC implementation. However, a trend analysis found a marginal decline in the variables, in that eight of twelve declined after QC implementation.
Toleration, Pluralism, and Truth
Authors: Roshwald Mordecai
Published: July 2008

This paper deals with three guiding principles of contemporary Western civilization. It explores the compatibility of Toleration, Pluralism and Truth, as well as their application to diverse domains of cultural activity and creation. There is no place for toleration, let alone pluralism, in the realm of logic and mathematics. Scientific conclusions allow diverse degrees of certainty. The realm of monotheistic religions excludes pluralism, but necessitates toleration. The domains of ethics and its related social institutions allow diversity in secondary matters, but essentially should be guided by universally valid principles. In the case of aesthetics, a diversity of taste suggests a virtually unlimited pluralism. Yet, a universal basic principle of aesthetic evaluation is suggested which would greatly reduce tolerable pluralism, although this assertion is made with less confidence than the insistence on basic norms in ethics.
Mathematical Universalism
Authors: Cartier Pierre
Published: July 2008

This paper presents a historical view of the rise of mathematical universalism in modern times. It argues that 20th century mathematical revolution laid the foundations for a new universalism which extended to physics, economics, informatics, and recently biology. It describes the role played by the organization of mathematical work for closer co-operation among scientists on an international scale throughout the century, and stresses the importance of mathematics in the education process.
Scientific Rationality and Cultural Diversity
Authors: Mvé-Ondo Bonaventure
Published: July 2008

This paper examines the dynamics between scientific reason and cultural diversity by: a) analyzing the epistemic structure of ‘universalism' as conceived by science, both theoretically and through its historical determination; and b) focusing on the situation of science in Africa, presenting its limits and challenges. It calls for a coconstruction of science at an international scale, which represents a key factor of development and cultural transmission, in particular, transmission of scientific scholarship.
Modeling and Prediction of Erosion Response of Glass Reinforced Polyester-Flyash Composites
Authors: Patnaik Amar , Satapathy Alok , Mahapatra S.S. , Dash R.R.
Published: July 2008

Solid particle erosion of polymer composites is a complex surface damage process, strongly affected by material properties and operational conditions. To avoid repeated experimentation, it is important to develop predictive equations to assess material loss due to erosion wear under any impact conditions. This paper presents the development of a mathematical model for estimating erosion damage caused by solid particle impact on flyash filled glass fiber reinforced polyester composites. The model is based upon conservation of particle kinetic energy and relates the erosion rate with composite properties and test conditions. Another correlation derived from the results of Taguchi experimental design is proposed as a predictive equation for erosion wear of these fiber reinforced composites. Further, considering the complexity and high degree of nonlinearity in the erosion process, an artificial neural networks (ANN) technique is implemented as an effective tool for prediction of wear response of these composites in a larger space. Finally, the results of a mathematical model and the ANN model are compared with those obtained from experimentation.
Emergence of Circadian and Photoperiodic System Level Properties from Interactions among Pacemaker Cells
Authors: Beersma Domien G. M. , van Bunnik Bram A. D. , Hut Roelof A. , Daan Serge
Published: July 2008

Daily patterns of behavior and physiology in animals in temperate zones often differ substantially between summer and winter. In mammals, this may be a direct consequence of seasonal changes of activity of the suprachiasmatic nucleus (SCN). The purpose of this study was to understand such variation on the basis of the interaction between pacemaker neurons. Computer simulation demonstrates that mutual electrical activation between pacemaker cells in the SCN, in combination with cellular electrical activation by light, is sufficient to explain a variety of circadian phenomena including seasonal changes. These phenomena are: self-excitation, that is, spontaneous development of circadian rhythmicity in the absence of a light-dark cycle; persistent rhythmicity in constant darkness, and loss of circadian rhythmicity in pacemaker output in constant light; entrainment to light-dark cycles; aftereffects of zeitgeber cycles with different periods; adjustment of the circadian patterns to day length; generation of realistic phase response curves to light pulses; and relative independence from day-to-day variation in light intensity. In the model, subsets of cells turn out to be active at specific times of day. This is of functional importance for the exploitation of the SCN to tune specific behavior to specific times of day. Thus, a network of on-off oscillators provides a simple and plausible construct that behaves as a clock with readout for time of day and simultaneously as a clock for all seasons.