bluuebunny/crossref_metadata_2025 huggingface dataset:
Exclusion, Internalization, Harm
Authors: Mookherjee Monica
Published: August 2003

The article outlines a way in which internally pluralistic political communities might deal justly with apparently harmful gender-specific practices. It begins by demonstrating the inability of Walzer's recent theory of thin minimalism to integrate concerns for gender equality and cultural recognition. By focusing on the case of widow immolation in India, I show that an important problem lies in Walzer's failure to demonstrate that this is a `hard case'. This is due to his inability to identify two types of harm in this practice; namely, harmful exclusion and harmful internalization. On the basis of these harms, I redefine widow immolation as a `contrastive hard case'. Deriving from the recent work of Tully and Nussbaum, this reconceptualization is more attractive than Walzer's account, since it provides a culturally sensitive defence of minority women's capacity to contest the entailments of their religious beliefs in public.
Justice in Ethnically Diverse Societies
Authors: O'Neill Shane
Published: August 2003

The article presents a normative principle of constitutional justice that acknowledges ethnocultural and ethnonational diversity by addressing the injustice of political alienation. It is suggested that this principle could be the subject of a methodological overlapping consensus among several comprehensive normative-theoretical frameworks that are influential in current debates. The main implication of the principle for ethnically diverse societies is that it demands a deconstruction of hierarchical group relations among citizens along with the simultaneous achievement of an inclusive political culture. I apply this normative framework to the struggle for constitutional justice in the ethnonationally divided context of Northern Ireland. The principle would seem to demand a binational egalitarian arrangement and it is argued that this would be most effectively achieved under joint British-Irish sovereignty. I conclude by considering how to minimize the risk that such institutional recognition of national identities could further alienate citizens who do not belong to either of the main national groups.
Ways of Belonging
Authors: Baumeister Andrea
Published: August 2003

Recent campaigns for recognition by ethnic religious and national minorities have highlighted the limitations of the dominant unitary conception of the nation state. While the model of `differentiated citizenship' advocated by Taylor and Carens constitutes an innovative response to these challenges, the difficulties that surround this model underline the dilemma that confronts many modern states. Although a commitment to equal citizenship implies that the state should acknowledge the different histories, needs and goals of the various communities that constitute it, a multicultural society must at the same time develop a genuinely shared culture. These difficult questions surrounding political stability and the equality of citizens cannot be easily resolved. However, one potentially promising avenue is indicated by Parekh's emphasis upon intercultural dialogue. In cases concerned with the mediation of individual rights and certain intergroup and intragroup power relations, such dialogue can be fostered via imaginative institutional mechanisms such as Shachar's model of `transformative accommodation'.
Context and Diffusion of Knowledge
Authors: Fals-Borda Orlando , Mora-Osejo Luis E.
Published: August 2003

On January 4, 2001, in Bogota, Colombia, the authors issued a self-described `manifesto'1 to Colombian scholars inviting them to rescue local values of self-esteem and creativity and to resist intellectual colonialism by European and North American colleagues. After months of discussion, they decided to revise the document and publish an expanded text. Eyebrows were raised not only because this is an interdisciplinary document (signed by a biologist and by a sociologist without any visible signs of disagreement on such sensible matters) but also because both are known to have been trained and given doctorates during the 1950s at the University of Florida and Mainz Johannes-Gutenberg University respectively.
Framing Practice-Research Engagement for Democratizing Knowledge
Authors: Brown L. David , Bammer Gabriele , Batliwala Srilatha , Kunreuther Frances
Published: August 2003

Practice research engagement (PRE) is increasingly important for producing knowledge and innovations in practice for complex social problem-solving. We pose several questions: Why do PRE? What is required to organize effective PRE? And what is needed for PRE to contribute to democratizing knowledge? We present a framework to encourage researchers to think systematically about organizing PRE that focuses on: 1) frameworks, goals and interests, 2) relationships and organization, 3) strategies and methods, and 4) contextual forces and institutions. We describe challenges to effective engagement posed by these elements and identify a few approaches to dealing with them. We illustrate the concept and the challenges with four case studies - Gender Relations in India; Heroin Prescriptions in Australia; Inter-sectoral Cooperation in Africa and Asia; and Building Grassroots Movements in the US. We argue that PRE that contributes to the democratization of knowledge must pay special attention to social change theories, power relations, long-term domain development strategies and building friendly institutional bases.
Commentary about the Terrorist Acts of September 11, 2001
Authors: SCURFIELD RAYMOND MONSOUR
Published: August 2003

Like many people in the United States and internationally, the author was profoundly affected by the terrorist attacks on September 11th and the massive deaths in New York City, Washington, D.C., and Pennsylvania. The unprecedented numbers of innocents murdered and the massive media coverage combined to form an extraordinarily indelible imprint on hundreds of millions of people worldwide. The objectives of this commentary are to identify (a) the range of normal and expectable reactions to the acts that have been and are being experienced by millions of Americans—and especially those who were distant from the trauma sites, and (b) the relationship between people's personal reactions to the acts and several related social and national policy issues and choices Americans are facing. The author offers this from his perspectives as a proud third-generation Syrian American, Vietnam veteran, social worker, and someone with a long-standing involvement in the field of post-traumatic stress disorder.
Measurement Issues in Child Maltreatment and Family Violence Prevention Programs
Authors: DEVOE ELLEN R. , KANTOR GLENDA KAUFMAN
Published: August 2003

In this article, the authors provide an overview of measurement issues relevant to monitoring and evaluation of child maltreatment and family violence prevention programs. This review originally was developed for use in a family violence prevention program in a military setting but can be adapted to similar programs, such as early intervention and family support efforts, that seek to prevent maltreatment and enhance family well-being. The multiple purposes of measurement, including use as screening, clinical assessment, or outcome tools, are discussed. Guidelines for selecting appropriate domains for evaluation are discussed, and specific information on a sampling of instruments is provided, including standardized measures of family and child well-being, parenting, stress and coping, and family violence. Suggestions for measures of key individual and family constructs are included.
Guardian Support of Sexually Abused Children
Authors: BOLEN REBECCA M.
Published: August 2003

The support provided by the nonoffending guardian of a sexually abused child after disclosure is a critical consideration. Although a number of studies have assessed guardian support after disclosure, no known article has closely examined the construct of guardian support. The purpose of this article is to consider how the construct of guardian support is defined and operationalized, as well as to consider its intervening variables. This analysis found that approximately 75% of non-offending guardians are partially or fully supportive after disclosure. The four primary groups of intervening variables for guardian support appear to be grouped within immediate stressors or buffers, the child's previous abuse history, the believability of the disclosure, and the guardian's relationship with the offender. More problematic is the definition of guardian support across most studies, which is seldom grounded in theoretical literature but instead appears to be driven by the needs of the child protection system.
Prevention of Child Sexual Abuse
Authors: RENK KIMBERLY , LILJEQUIST LAURA , STEINBERG ARI , BOSCO GEORGETTA , PHARES VICKY
Published: August 2003

In response to an increase in public awareness and interest in the problem of child sexual abuse, programs have been developed to promote the awareness, prevention, and treatment of sexual abuse. These programs have been varied in scope, focus, and effectiveness. This article reviews the child sexual abuse literature, with particular emphasis on efforts aimed at the prevention of child sexual abuse. Prevention efforts targeting potential victims as well as parents, teachers, and offenders, are reviewed and evaluated. Overall, there is not enough adequate work being done to prevent child sexual abuse. More efforts need to address child sexual abuse prevention by targeting adults who can help children avoid such an experience and adults who may perpetrate against children. Suggestions about future preventive endeavors, based on this review, are offered.
Treating Traumatized Children
Authors: COHEN JUDITH A. , PEREL JAMES M. , DEBELLIS MICHAEL D. , FRIEDMAN MATTHEW J. , PUTNAM FRANK W.
Published: August 2003

There is growing evidence that child maltreatment and posttraumatic stress disorder result in numerous neurobiological alterations in children and adolescents, including abnormalities in brain structure and functioning. This article reviews several psychobiological systems with regard to their functioning under normal stress and in the presence of posttraumatic stress disorder, with a focus on recent research findings in children and adolescents, and the implications these findings have on clinical intervention for traumatized children. The importance of early identification and treatment of traumatized children and the need to empirically evaluate psychopharmacological interventions for childhood posttraumatic stress disorder are discussed in detail. Research and policy priorities are also addressed.
Experiences of Covictims of Homicide
Authors: ARMOUR MARILYN PETERSON
Published: August 2003

Covictims of homicide are a hidden and sparsely researched group whose needs, as crime victims, are neglected and subsumed by the state's agenda for retributive justice. Likewise, their unique and distinct problems are given little consideration in the literature. This article appraises the relevance of the literature on trauma, bereavement, and meaning-making to this population; examines the research on covictims; and discusses the implications for research, practice, and policy. The review shows that trauma reactions are considered the major criterion of severity of victimization consequences. The emphasis on trauma, however, eclipses the significance of an invalidating social milieu and the efforts of covictims to regain their footing.
Gender-Bias Hate Crimes
Authors: MCPHAIL BEVERLY A.
Published: August 2003

Currently, hate crimes and hate crime policy are receiving increased public and scholarly attention. Much of the attention has been focused on crimes committed out of bias toward a victim's membership in a group based on race, religion, sexual orientation, or ethnicity/national origin. However, more recently, gender has been included as a status category, often causing heated debate. This article looks at the history of the initial exclusion, then inclusion, of gender in the hate crime domain. The reasons for the uneasy fit of gender as a status category are recounted, as well as arguments both for and against inclusion of gender within the hate crime model. The problem of gender essentialism is examined, which results in the marginalization of the multiple category statuses of many women. The article concludes with implications for research, policy, and practice.
The Effects of Client Violence on Child-Protection Networks
Authors: LITTLECHILD BRIAN
Published: August 2003

This article examines the literature and research evidence concerning the impact of threatened and actual violence on social workers' well-being, assessments, and interventions in child-protection work. It is proposed that client violence can have serious effects on the child-protection worker themselves, as well as having specific effects on child-protection assessments and the management of interventions. It is argued that client violence toward child-protection staff and others in the violent client's networks needs to be taken into account in a systematic manner, which may affect the protection of children involved. The potential for increased recognition of such elements within risk assessment, case planning and policy development and review is addressed. The article draws mainly on sources of evidence in England, North America, and Australia, but the findings are applicable to child-protection work in different countries.
No Safe Haven
Authors: YAN ELSIE , SO-KUM CATHERINE , YEUNG TANG DANNII
Published: August 2003

This review summarizes the literature on aging and elder abuse in contemporary Chinese societies. There is evidence that the younger generation of Chinese is less adherent to traditional Confucian principles of filial piety, and elderly Chinese are no longer guaranteed prestige, power, and care in the family. Carers of elderly Chinese also experience caregiver burden and are frequently caught in a caring dilemma. Furthermore, elderly Chinese often report distressful adjustment in their older age. Available studies indicate that elder abuse in the family does exist in Chinese societies, and various forms of elder abuse as identified by Western countries are also present. Risk factors and negative impacts of Chinese elder abuse resonate with those found in Western countries. In particular, elderly people's increasing dependence on their adult offspring may make them more vulnerable to the latter's abusive behaviors. Research, practical, and policy implications of this review are also discussed.
Do Partners Agree about the Occurrence of Intimate Partner Violence?
Authors: ARMSTRONG TISHA GANGOPADHYAY , WERNKE JULIA Y. , MEDINA KRISTA LISDAHL , SCHAFER JOHN
Published: August 2003

Intimate partner violence (IPV) is a serious public health concern, and thus it is necessary to obtain accurate estimates of IPV. National surveys use two main methods of data collection: the proxy method and/or a method that obtains information from both members of the couple. There is controversy as to whether couples agree about the occurrence of IPV. Determining the extent to which partners agree about this is essential for gaining accurate prevalence rates. This article reviews literature on agreement within this field. The authors surveyed the major studies that have reported couple-level data. Agreement between the couples has been assessed in all of the reviewed research, with varying results. The majority of studies under consideration suggest that there is disagreement between partners about IPV. The authors propose that agreement levels should be high (indicated by several indexes) if the proxy method is to be used to assess prevalence rates.
The Impact of Community Violence on Children and Parents
Authors: PHELPS LORI F. , MCCART MICHAEL R. , DAVIES W. HOBART
Published: August 2003

Urban youth are exposed to staggering amounts of community violence, and researchers have identified psychological ramifications associated with this exposure. Yet some have found no relationship between exposure and distress and have argued for habituation. Little attention, however, has focused on how assessment methods have contributed to these conflicting findings. Although most of the research has relied on self-report measures, these assessment tools have systematic limitations. First, these measures are susceptible to a defensive test-taking approach, characterized by a denial of stress-related symptoms. Second, symptom-based assessment tools may have limited utility with youth experiencing affective blunting associated with post-traumatic stress disorder. Third, these instruments are context free and fail to consider environmental influences on behavior. To address these concerns, we advocate using Goldfried and D'Zurilla's behavior analytic model to create tools to identify how youth and their parents cope with context-specific problems following exposure to violence.
Intergenerational Transmission of Intimate Partner Violence
Authors: HINES DENISE A. , SAUDINO KIMBERLY J.
Published: August 2003

Because intimate violence tends to run in families, social learning theory posits that children learn to be violent through watching their parents and through being reinforced for their own aggressive behaviors. This account of intimate partner violence considers only environmental influences on familial resemblance, but familial resemblance may also be due to genetic factors. A genetically sensitive design is required to examine the extent to which genetic and environmental factors contribute to individual differences in intimate violence. This article reviews evidence for the intergenerational transmission of intimate violence and discusses why a genetically sensitive design is needed. It reviews behavioral genetic research that shows that aggression is genetically influenced and discusses how this research is pertinent to the study of intimate violence from a behavioral genetic perspective. It is urged that behavioral genetic studies of intimate violence be undertaken so that we may have a better understanding of this behavior.
Inmate-to-Inmate Prison Sexuality
Authors: HENSLEY CHRISTOPHER , TEWKSBURY RICHARD
Published: August 2003

For the past 90 years, sociologists, psychologists, and penologists have been studying inmate-to-inmate prison sexuality. These researchers have made great strides in advancing the study of prison sexuality. Although many may consider the issue to be deviant, prison sex researchers have made positive contributions to the study of one of the most controversial issues in corrections. In this review, the authors seek to provide readers with an understanding of not only what researchers have uncovered about inmate sexual behavior and the dynamics of institutional sex but also how this field of inquiry has developed and evolved. The discussion that follows is divided into four primary sections, male and female inmate consensual homosexual behavior and male and female inmate coerced sexual activity.
Adolescent Sex Offenders
Authors: VENEZIANO CAROLM , VENEZIANO LOUIS
Published: August 2003

Research over the past 20years indicates that adolescent sex offenders account for a significant number of child sexual abuse perpetrators. Studies indicate that this group has a variety of severe family problems, including neglect and physical and sexual abuse. Academic and behavior problems, psychopathology, and social isolation tend to characterize adolescent sexual offenders. The research also indicates that juvenile sexual offenders are a heterogeneous population with diverse characteristics and treatment needs. A number of typologies have been developed to classify various types of offenders, but more empirical research is needed. Because of the diversity of the population, careful assessment is needed before treatment plans are developed and implemented. Most treatment programs have been modeled after treatment programs found to be effective with adult sex offenders, but new programs are aimed more specifically at juveniles. Based on the research, recommendations are made with respect to important target areas for treatment.
The Tactical Topography of Stalking Victimization and Management
Authors: SPITZBERG BRIAN H.
Published: August 2003

A meta-analysis of 108 samples across 103 studies of stalking-related phenomena, representing almost 70,000 participants, reveals an average prevalence across studies of 23.5% for women and 10.5% for men, with an average duration of almost 2 years. The average proportion of female victims across studies was 75%, and 77% of stalking emerged from some form of prior acquaintance, with 49%originating from romantic relationships. New typologies of stalking behavior, coping responses to stalking, and symptomology due to stalking victimization are reported. Across 42 studies, the average physical violence incidence was 33%, and 17 studies produced an average sexual violence incidence of slightly greater than 10%. A summary of 32 studies of restraining orders indicated that they are violated an average of 40% of the time and are perceived as followed by worse events almost 21% of the time.
Personal Vulnerability to Victimization of People with Mental Retardation
Authors: NETTELBECK TED , WILSON CARLENE
Published: August 2003

People with mental retardation are more vulnerable to victimization. This is a consequence of cultural, institutional, and other environmental circumstances but may include victim characteristics. To recognize this is not `to blame the victim.' Instead, acknowledgment can help identify contributory factors and improve understanding of why victimization occurs. Consistent with this viewpoint, recent research has found that although IQ and adaptive skills did not distinguish victims from nonvictims, victims reported aggressive, confrontational tendencies and acquiescing to unreasonable requests. The authors therefore advocate an interactive schema of victimization that extends current theory, which has primarily limited focus to contributory environmental factors. Some individual risk variables cannot be changed (intellectual disabilities) or are difficult to change (living situation). However, other victim characteristics reflecting interpersonal competence should be amenable to behavioral intervention. Identifying potential victim characteristics and training before victimization occurs may reduce incidence of victimization and guide development of protective procedures.
Childhood Traumatic Grief
Authors: COHEN JUDITH A. , MANNARINO ANTHONY P. , GREENBERG TAMRA , PADLO SUSAN , SHIPLEY CARRIE
Published: August 2003

Childhood traumatic grief refers to a condition in which characteristic trauma-related symptoms interfere with children's ability to adequately mourn the loss of a loved one. Current concepts of this condition suggest that it overlaps with but is distinct from uncomplicated bereavement, adult complicated grief, and posttraumatic stress disorder. This article describes the core features of childhood traumatic grief; differentiates it from these related conditions; and reviews the current research status of suggested diagnostic criteria, assessment instruments, and treatments for this condition. Implications for future clinical practice, research, and policy are also addressed.
Pharmacologic Options for the Management of Multiple Sclerosis Symptoms
Authors: Schapiro Randall T.
Published: August 2003

Multiple sclerosis (MS) is a disease with a wide-ranging impact on physical functioning. Although pharmacotherapy plays an indispensable role in the management of MS symptoms, optimal disease management requires a multidisciplinary approach that combines medication, rehabilitation, and patient education. Successful control of symptoms is critical to quality of life for MS patients. Immunomodulating drugs provide a means of controlling the underlying disease process, but they are not a cure. This places responsibility on health care providers to control a patient’s MS-related symptoms to limit disability and delay impairment in the activities of daily living. Owing to the importance of symptom control, comprehensive patient evaluations should be performed at regular intervals to determine the extent of neurological damage and disease progression and to address changing patient needs. The goal of interventions should be not only to treat the primary and secondary symptoms of MS but also to provide access to the psychosocial support that will help MS patients and their families continue to cope as disease status changes.
The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties
Authors: Gladstone David J. , Danells Cynthia J. , Black Sandra E.
Published: August 2003

Measurement of recovery after stroke is becoming increasingly important with the advent of new treatment options under investigation in stroke rehabilitation research. The Fugl-Meyer scale was developed as the first quantitative evaluative instrument for measuring sensorimotor stroke recovery, based on Twitchell and Brunnstrom’s concept of sequential stages of motor return in the hemiplegic stroke patient. The Fugl-Meyer is a well-designed, feasible and efficient clinical examination method that has been tested widely in the stroke population. Its primary value is the 100-point motor domain, which has received the most extensive evaluation. Excellent interrater and intrarater reliability and construct validity have been demonstrated, and preliminary evidence suggests that the Fugl-Meyer assessment is responsive to change. Limitations of the motor domain include a ceiling effect, omission of some potentially relevant items, and weighting of the arm more than the leg. Further study should test performance of this scale in specific subgroups of stroke patients and better define its criterion validity, sensitivity to change, and minimal clinically important difference. Based on the available evidence, the Fugl-Meyer motor scale is recommended highly as a clinical and research tool for evaluating changes in motor impairment following stroke.
Narrative and Procedural Discourse Production by Severely Aphasic Patients
Authors: Weinrich Michael , McCall Denise , Boser Katharina I. , Virata Telana
Published: August 2003

Five chronically aphasic subjects were trained on a computerized iconographic communication system (C-VIC). Their performance in producing single sentences, scripts, and narratives was assessed using both spoken English and C-VIC. The requisite vocabulary necessary and the narrative complexity of the target productions were controlled. Subject performance using C-VIC indicates that the ability to construct discourse at the macrostructural level is largely intact. Despite significant improvements in spoken production after C-VIC training, especially at the single sentence level, the subjects’ spoken discourse remains severely impaired by their failures at the microlinguistic level. These results point to the limits of currently available approaches to the remediation of aphasia and suggest avenues for future research.
Hand Motor Recovery after Stroke: A Transcranial Magnetic Stimulation Mapping Study of Motor Output Areas and Their Relation to Functional Status
Authors: Bastings Eric P. , Greenberg Jason P. , Good David C.
Published: August 2003

The respective contributions of the stroke and undamaged hemispheres to motor recovery after stroke remains controversial. The aim of this article is to evaluate the relationship between location and size of cortical motor areas and outcome after stroke. Twelve controls and 12 stroke patients were studied. Hand cortical motor output areas were determined using transcranial magnetic stimulation. Motor-evoked potentials were recorded simultaneously from both hands. Functional motor abilities were evaluated using well-validated measures. Surface area, weighted surface area, and center of gravity of motor output areas were calculated. Different patterns of motor output areas to the paretic hand were observed; there was no motor output from the stroke hemisphere in patients with poor outcome, contrasting to large motor output area in the stroke hemisphere in patients with good outcome, regardless of infarct size or location. A significant correlation was found between measures of motor outcome in the stroke-affected upper extremity and both the surface area and weight of the central motor output area in the stroke hemisphere. No ipsilateral motor response was obtained after stimulation of either hemisphere. These data support an association between preservation of cortical motor output area to the paretic hand in the stroke hemisphere and good motor outcome.
Unrelated cord blood transplantation for adult patients with de novo acute myeloid leukemia
Authors: Ooi Jun , Iseki Tohru , Takahashi Satoshi , Tomonari Akira , Takasugi Kashiya , Shimohakamada Yoko , Yamada Toshiki , Ishii Koji , Ohno Nobuhiro , Nagamura Fumitaka , Uchimaru Kaoru , Tojo Arinobu , Asano Shigetaka
Published: August 2003

We report the results of unrelated cord blood transplantation (CBT) for 18 adult patients with de novo acute myeloid leukemia (AML). The median age was 43 years, the median weight was 55.2 kg, and the median number of cryopreserved nucleated cells was 2.51 × 107/kg. Seventeen patients had myeloid reconstitution and the median time to more than 0.5 × 109/L absolute neutrophil count was 23 days. A self-sustained platelet count more than 50 × 109/L was achieved in 16 patients at a median time of 49 days. Acute graft-versus-host disease (GVHD) above grade II occurred in 11 of 17 evaluable patients and chronic GVHD occurred in 14 of 17 evaluable patients. Fourteen patients are alive and free of disease at between 185 and 1332 days after transplantation. The probability of disease-free survival at 2 years was 76.6%. These results suggest that adult AML patients without suitable related or unrelated bone marrow donors should be considered as candidates for CBT.
Mactinin: a modulator of the monocyte response to inflammation
Authors: Luikart Sharon D , Krug Hollis E , Nelson Robert D , Hinkel Timothy , Majeski Peter , Gupta Pankaj , Mahowald Maren L , Oegema Theodore
Published: August 2003

During inflammatory processes, monocytes leave the blood stream at increased rates and enter inflammation tissue, where they undergo phenotypic transformation to mature macrophages with enhanced phagocytic activity. α-Actinin, a cytoskeletal protein, is present in focal adhesion complexes and left in the microenvironment as a result of cell movement. Mactinin, a 31 kDa amino-terminal fragment of α-actinin, is generated by the degradation of extracellular α-actinin by monocyte-secreted urokinase. We have previously demonstrated that mactinin promotes monocyte/macrophage maturation. We now report that 0.5–10 nM mactinin has significant chemotactic activity for monocytes. Mactinin seems to be present in inflammatory arthritis synovial fluid, because affinity-purified antisera reacted with a protein of the expected molecular mass in various types of arthritis fluids that were immunoaffinity-purified and subjected to Western analysis. Thus, six of seven samples from patients with psoriatic arthritis, reactive arthritis, gout, or ankylosing spondylitis contained mactinin at levels that are active in vitro. Initially, mactinin was not found in affinity-purified rheumatoid arthritis samples. However, it was detectable after the dissociation of immune complexes, suggesting that it was complexed to anti-microfilament auto-antibodies. In addition, mactinin was found in the lavage fluid from the arthritic knee joints of rabbits with antigen-induced arthritis and was absent from the contralateral control knee fluids. We conclude that mactinin is present in several types of inflammatory arthritis and might modulate mononuclear phagocyte response to inflammation.
Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome?
Authors: Rodgers Helen , Mackintosh Joan , Price Christopher , Wood Ruth , McNamee Paul , Fearon Tracy , Marritt Anna , Curless Richard
Published: August 2003

Objective: To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome.

Design: A randomized controlled trial.

Setting: A stroke unit which provides acute care and rehabilitation for all stroke admissions.

Subjects: One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days.

Intervention: The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist, commencing within 10 days of stroke, and available up to 30 minutes/day, five days/week for six weeks. The control group received stroke unit care.

Main outcome measures: The primary outcome measure was the Action Research Arm Test (ARAT) three months after stroke. Secondary outcome measures: Motricity Index; Frenchay Arm Test; upper limb pain; Barthel ADL Index; Nottingham E-ADL Scale; and costs to health and social services at three and six months after stroke.

Results: There were no differences in outcomes between the intervention and control groups three and six months after stroke. During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as inpatients. The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001). There were no differences in service costs.

Conclusions: An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke. The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias.
No benefit from D-amphetamine when added to physiotherapy after stroke: a randomized, placebo-controlled study
Authors: Treig Thomas , Werner Cordula , Sachse Martin , Hesse Stefan
Published: August 2003

Objective: To assess the effect of D-amphetamine on the recovery of activities of daily living and motor functions after stroke,

Design: Randomized, placebo-controlled study,

Setting: Inpatient rehabilitation centre,

Subjects: Twenty-four stroke survivors after a first ischaemic supratentorial stroke within six weeks before study onset, severely to moderately affected, with a Barthel Index (0–100) ranging from 25 to 50, no severe concomitant internal, neurological or psychiatric diseases, and participating in a comprehensive rehabilitation programme of 10–12 weeks,

Interventions: Ten sessions with 10 mg D-amphetamine (or placebo) every fourth day totalling 100 mg in a time period of 36 days combined with physical therapy according to the neurodevelopmental concept within 60 minutes after drug intake.

Main outcome measures: Barthel Index (0–100) served as the primary outcome measure and the Rivermead Motor Assessment Score with its three sections (gross function, leg and trunk, and arm) as the secondary outcome measure, assessed at days 0, 20, 36, 90, 180 and 360.

Results: The two groups did not differ with respect to clinical data and outcome measures at study onset. All patients improved significantly except for arm function over the intervention period and up to day 90 after study onset. The comparison between groups did not reveal any difference at any time; amphetamine-treated patients did not show any increase in motor function or ADL compared with the control group.

Conclusions: The placebo-controlled study failed to show any effect of D-amphetamine on stroke recovery compared with control. The small number of patients, the timing and content of physical therapy were limiting factors of the present study. Further trials are warranted.
Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: a randomized controlled pilot trial
Authors: Morioka Shu , Yagi Fumio
Published: August 2003

Objective: To investigate the effect of perceptual learning exercises for hardness discrimination by the soles on standing balance in stroke patients with hemiplegia.

Subjects: Twenty-eight subjects were randomly assigned to an experimental or a control group and participated in a rehabilitation programme.

Intervention: The experimental group received perceptual learning exercises on hardness discrimination using three different levels of hardness of a rubber sponge for 10 days.

Main measures: Length, enveloped area and rectangular area of the parameter of postural sway were measured by a stabilometer on entry into the study and after 10 days.

Results: Twenty-six subjects completed the study. Data indicate that more parameters indicating postural sway were significantly decreased in the experimental group than in the control group. Also, there was a significant difference between the groups in change scores (pre-exercise minus postexercise) of length and enveloped area.

Conclusion: The plantar perception exercise used as a method in this study is considered to be effective as a supplemental exercise for standing balance. The possibility of clinical application using the hardness discrimination task with rubber as a balance exercise is therefore suggested.
A study on additional early physiotherapy after stroke and factors affecting functional recovery
Authors: Fang Yannan , Chen Xiaohua , Li Hua , Lin Jianwen , Huang Ruxun , Zeng insheng
Published: August 2003

Objective: To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients.

Design: A prospective, randomized, controlled study.

Setting: One stroke ward and an acute stroke unit in a large teaching hospital, southern China.

Subjects: Patients with first-onset stroke consecutively admitted to the stroke centre.

Interventions: One group ( n = 78) received additional early physiotherapy (AEP) for 45 minutes, five days a week for four weeks starting within the first week since stroke onset; the routine therapy (RT) group ( n = 78) received no professional rehabilitation therapy.

Main outcome measures: Glasgow Coma Scale, Mini-Mental State Examination, Fugl-Meyer Assessment of Motor Recovery, Clinical Neurological Deficit Scale and Modified Barthel Index (MBI).

Results: Patients from the AEP group had a high drop-out rate ( n = 28), but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI. Multiple linear regression analysis revealed that cognitive disturbance, aphasia, double incontinence, site of lesion and sensory impairment might affect functional recovery after stroke.

Conclusions: Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study. Cognitive disturbance, aphasia, double incontinence, site of lesion as well as sensory impairment might affect functional outcome after stroke.
Effects of thermal therapy in improving the passive range of knee motion: comparison of cold and superficial heat applications
Authors: Lin Y H
Published: August 2003

Objective: To assess the effect of applying a hot pack followed by a cold pack (COLD) on the passive range of knee flexion in subjects with restricted knee motion, specifically comparing this treatment to the application of a hot pack (HEAT) alone.

Design: Seventy-one subjects were randomized into two groups to conduct a clinical randomized before–after trial.

Interventions: Each subject received either (1) cold pack or (2) hot pack during passive knee joint stretching.

Main outcome measure: Goniometry was used to measure the passive knee flexion at the baseline (KROM1), before (KROM2) and after (KROM3) applications of a hot pack with/without a cold pack.

Results: Repeated ANOVA measurements revealed a marked increase in the passive range of knee flexion in the two study groups ( p < 0.001). Moreover, the paired t-test displayed statistical increments of knee flexion across the different measurement phases, except for the treatment phase without the cold pack. The range of knee flexion following the treatment with the application of a cold pack significantly exceeded that after treatment without a cold pack.

Conclusion: Cold pack application had a limited but significant effect during mechanical stretching for restricted knee motion.
The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache
Authors: Narin S Osün , Pinar L , Erbas D , Oztürk V , Idiman F
Published: August 2003

Objective: To observe the effects of moderate aerobic exercise on migraine headache, to assess exercise-related changes in blood nitric oxide (NO) levels, and to examine the impact of such changes on migraine attacks.

Design: Controlled clinical trial.

Setting: School of Physical Therapy and Rehabilitation.

Subjects: Forty women with general migraine attending the Neurology Department of the Faculty of Medicine Faculty of Dokuz Eylül University.

Intervention: Patients were assigned alternately into two groups: exercise group undertaking 1 hour aerobic exercise three times weekly, and a control group.

Main outcome measures: Patients were assessed before and after treatment using three clinical scales – visual analogue scale for headache, Pain Disability Index and Quality of Life Scale – and chemiluminescence analysis for plasma nitric oxide.

Results: After the eight-week therapy period, patient complaints concerning the intensity, frequency and duration of pain had decreased significantly in both groups; however, visual analogue scale scoring showed better pain relief in the exercised group than in the controls (from 8.8 ± 1.7 to 4.0 ± 1.4 and from 8.5 ± 0.8 to 7.0 ± 0.9 respectively). Quality of life measures also revealed better migraine relief in the exercised women than in those who received medical treatment only. Blood NO rose significantly from pre to post-therapy in the exercised group, but the change was not significant in the control group.

Conclusion: The study showed that regular long-term aerobic exercise reduced migraine pain severity, frequency and duration possibly due to increased nitric oxide production.
The effectiveness of intensive group exercise on patients with ankylosing spondylitis
Authors: Analay Yildiz , Ozcan Emel , Karan Ayse , Diracoglu Demirhan , Aydin Resa
Published: August 2003

Objective: To compare, in patients with ankylosing spondylitis (AS), the effectiveness on pain, functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme.

Design: Fifty-one patients with AS were randomly allocated into study and control groups. The study was designed as a prospective, double-blind study.

Setting: Outpatient department, Istanbul Medical Faculty.

Subjects: Patients who consulted with complaints of pain, morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis.

Interventions: Before exercise, both groups were given an education programme about AS. For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks. Group II patients had to practise exercises individually at home.

Main outcome measures: Both groups were evaluated and compared for pain, functional and psychological status before treatment, at the end of treatment and three months after treatment using a visual analogue scale (VAS) for pain, Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index (BASFI).

Results: Six patients withdrew, four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment. Values showed a statistical significant difference in favour of group I.

Conclusion: Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis.
The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial
Authors: Knapen J , Van de Vliet P , Van Coppenolle H , David A , Peuskens J , Knapen K , Pieters G
Published: August 2003

Objective: To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept.

Design: Randomized controlled parallel-group trial with repeated measures.

Setting: Three treatment units of a university psychiatric hospital in Belgium.

Subjects: One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders.

Interventions: A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks.

Outcome measures: The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile.

Results: After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values <0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness ( p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept ( p from 0.01 to <0.0001). However, these improvements were not related to the progress in physical fitness.

Conclusions: The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.