bluuebunny/crossref_metadata_2025 huggingface dataset:
First steps towards an interdisciplinary approach to rehabilitation
Authors: Davis Alison , Davis Sally , Moss Nicola , Marks Julie , McGrath Joanna , Hovard Linsey , Axon Janet , Wade Derick
Published: July 2008

This article examines how a change in working practices at a rehabilitation centre was implemented by moving from a multidisciplinary to an interdisciplinary approach. The issues raised, problems encountered, and part solutions are described. A client orientated method of goal planning is proposed incorporating a user-friendly method of setting goals. Guidelines and recommendations for goal planning are outlined. Future steps include developing a valid measure of handicap for evaluation purposes.
Speech and swallowing dysfunction in multisystem atrophy
Authors: Smith CH , Bryan KL
Published: July 2008

Speech and swallowing functioning was assessed in 10 patients diagnosed as having the degenerative disease multisystem atrophy (MSA). Swallowing was assessed using clinical and radiographic examinations. The results showed that three of the 10 subjects were aspirating. The aspiration was silent and therefore not evident on clinical swallowing assessment, although there were indications of laryngeal dysfunction. The remaining subjects all had some degree of swallowing dysfunction and presented with at least a mild dysarthria. This suggests that any MSA patient presenting with even mild dysarthria should have a detailed swallowing assessment. The role of the speech therapist in the multidisciplinary management of patients with MSA is discussed.
Working conditions among men before and after their first myocardial infarction: implications for a rehabilitative care strategy
Authors: Fridlund Bengt , Hansson Hakan , Ysander Lars
Published: July 2008

Disability after myocardial infarction (MI) is a long-lasting problem with multidimensional consequences. The ability to work after an MI is one significant measure of whether rehabilitation is successful or not. A survey study was performed with the aim of surveying men's working situations one year before and one year after their first MI. Data was taken retrospectively from 131 health care and public health insurance files covering one decade. The study showed that individuals over 60 years of age had the most serious difficulties at work both before and after an MI ( p < 0.002 and p < 0.001 respectively). An increased number of early retirements or disability pensions was found after MI, especially among blue-collar employees (p < 0.011). The study indicates that work environment and social class affiliation are two crucial factors when examining why elderly and blue-collar employees are affected. It seems possible that an insufficient coping capacity has developed from a 'bad fit' between the individual and his work environment. This may be a crucial overall factor in triggering ill health and disease.
Torque fluctuations during maximal voluntary knee extension efforts after stroke
Authors: Bohannon Richard W , Puharic Terri
Published: July 2008

The purpose of this study of 18 ambulatory hemiparetic stroke patients was to describe the differences in torque fluctuations between sides (paretic and nonparetic) and also to determine the implications of such fluctuations on gait performance relative to other knee extension torque variables. Bilateral measurements of torque during maximal voluntary isometric knee extension efforts of about four seconds were obtained using an isokinetic dynamometer. The amplitude of the associated torque curves was measured at 0.1 second intervals and statistically manipulated to provide information about actual and percentage fluctuations. The nonparetic side displayed significantly higher actual fluctuations whereas the paretic side demonstrated significantly higher percentage fluctuations. The reliability of the torque fluctuation measurements was questionable. The correlations of the fluctuation measurements with gait performance were low, especially when compared to the significant correlations of peak and average torque with gait performance. Given the results of this study, we find little reason to focus on torque fluctuations among patients with stroke who are undergoing rehabilitation.
The professional competence of speech therapists. III: skills and skill mix possibilities
Authors: Davies Philip , van der Gaag Anna
Published: July 2008

This paper reports on the skills of speech therapists and the possibilities for sharing these skills with other professionals and speech therapy assistants. This is the third paper of a four-part report on a study of the professional competence of speech therapists. The consultative methods used in this study combined the Delphi and Nominal Group techniques with a postal questionnaire survey of specialist speech therapists in the UK. Details of the methodology can be found in a separate paper. This study identified a broad range of speech therapists' skills, including therapeutic, teaching, interpersonal and administrative skills. The consensus, however, was that not all of these skills had to be undertaken by a qualified speech therapist. At the same time the consensus amongst specialist clinicians was that only a small number of skills could be shared with speech therapy assistants or with other professionals. A simple majority analysis identified a wider range of skills that can be undertaken by speech therapy assistants or other professionals.
The professional competence of speech therapists. IV: attitude and attribute base
Authors: van der Gaag Anna , Davies Philip
Published: July 2008

This paper reports on an empirical study of the attitude and attribute base of speech therapy. This is the final part of a four-part report on a study of the professional competence of speech therapists. The consultative methods used in this study combined the Delphi and Nominal Group techniques with a postal questionnaire survey of specialist clinicians in the UK, the details of which are reported elsewhere. The present discussion of the attitude base of speech therapy concluded that there was a strong consensus of agreement amongst speech therapists on the attitudes and attributes considered essential to professional competence. However, it would appear that these attitudes and attributes are not exclusive to speech therapists, but are common to many professional groups.
Ordinal and timed balance measurements: reliability and validity in patients with stroke
Authors: Bohannon Richard W , Walsh Susan , Joseph Maria C
Published: July 2008

The aim of this study of 38 patients with stroke was to describe the intrasession and intersession reliability and validity of ordinally graded and timed balance tests. Patients had a mean age and time since stroke of 67 years and 21 days respectively. Balance and gait were both timed with a stop-watch and given an ordinal score. Balance was timed for four different task levels: feet apart, feet together and unilateral stance (either limb first). Subjects who demonstrated the ability to complete the task for 60 seconds proceeded to the next, more difficult, task level. Most subjects remained within an ordinal balance category during a session; 81.6% for session 1 and 86.8% for session 2. The distribution of ordinal balance scores between sessions revealed that 31 of the 38 subjects remained within the same ordinal balance score, with the remainder of subjects scoring higher during session 2. The weighted Kappa coefficient for these scores was 0.858, indicating excellent reliability. The magnitude of the intrasession and intersession intraclass correlation coefficients for unilateral balance times indicated acceptable reliability. The Spearman correlations showed that balance measurements were a valid indicator of walking performance regardless of whether timed or ordinal measurements were used to characterize balance and gait. Given the findings of this study relevant to reliability and validity, the use of the more precise timed balance times cannot be advocated.
Measurement of spasticity and associated reactions in stroke patients before and after physiotherapeutic intervention
Authors: Dvir Zeevi , Panturin Elia
Published: July 2008

The purpose of this study is to present two methods of measuring the related phenomena of spasticity and associated reactions (ARs) in the plegic upper limb of stroke patients before and after treatment according to the Bobath approach. Thirty-three hemiplegic patients participated in the study. Spasticity of the elbow flexors and extensors was measured in 13 patients using the passive mode of the KinCom isokinetic dynamometer. The AR in the elbow was measured using a goniometer in all patients while at rest and following an exertion. The isokinetic measurements revealed a highly significant relationship (p <0.001) between spastic resistance and the test angular velocity for both flexors and extensors, but did not demonstrate an improvement following treatment. The ARs scores improved significantly following treatment. The merits and limitations of using isokinetic dynamometry and ARs for measuring spasticity are discussed.
FES system for self-activation: an electrical stimulator and instrumented walker
Authors: Isakov Eli , Mizrahi Joseph
Published: July 2008

Restoring independence in performing daily functions is the main goal following spinal cord injury. Different rehabilitation methods aim to permit the paraplegic some degree of independence. One such method is the application of functional electrical stimulation (FES) to the muscles of the lower limbs. In this paper we describe a system for the functional activation of spinal cord-injured patients. The system combines a microcomputer-controlled electrical stimulator and an instrumented walker. It enables the following functions: strengthening exercises for the muscles of the lower limbs; standing up from the sitting position; maintaining the standing position; and performing reciprocate gait while using a specially adapted walker. These functions can be accomplished by the user, without any external assistance. The system components and function are described.
Methodological difificulties in rehabilitation research
Authors: Pollock C. , Freemantle N. , Sheldon T. , Song F. , Mason JM
Published: July 2008

This paper presents an overview of some of the pitfalls and suggests ways of improving the quality of research into rehabilitation after stroke. The aims of rehabilitation are outlined and methodological problems inherent in this area discussed, including spontaneous recovery, multidimensional outcomes, definition of treatment and placebo effects. Major weaknesses found in the rehabilitation literature are identified and recommendations for improvement made, including the need for comparable controls, adequate numbers, appropriate outcome measures, clear definition of therapy, generalizability, and a concern for the cost-effectiveness of stroke rehabilitation packages. The field of rehabilitation is still relatively new and idiosyncratic in form and content. Thus it still provides opportunities for research into its relative effectiveness before current practices in rehabilitation become entrenched in medical practice and folklore. Adequate funding support for improved, multicentre clinical trials in rehabilitation is essential.
Impact of factors indicating a poor prognosis on stroke rehabilitation effectiveness
Authors: Saeki Satoru , Ogata Hajime , Okubo Toshiteru , Takahashi Ken , Hoshuyama Tsutomu
Published: July 2008

This study examines the impact of factors indicating a poor prognosis on rehabilitation effectiveness of 124 first stroke patients admitted to a comprehensive rehabilitation unit in Kitakyushu, Japan. A multiple regression model, employing a forced entry of variables guided by prior studies on these factors, found four significant factors. Lack of motivation, urinary incontinence, each 10 years of age, and each day's delay from stroke onset to the commencement of rehabilitation reduced the rehabilitation effectiveness by 20%, 15%, 4%, and 0.1% respectively. The values of beta-coefficients showed that onset-rehabilitation delay and lack of motivation were relatively important in our model. These findings are consistent with clinical impressions and provide useful information for planning stroke rehabilitation programmes.
Differentiation of motor planning ability in normal and learning-disabled children
Authors: Seyhan S. , Kayihan H.
Published: July 2008

Twenty children with learning disabilities (LD) and 40 normal children aged from seven to 12 years were studied to examine the relation between motor planning ability and learning disabilities. It was expected that children with LD would score significantly lower on a test of praxis than normal children, and different types of apraxia would be identified in LD children. In addition, the relation between apraxia and writing disability, speaking disability, distractibility, hand dominance and socio-economic factors was explored. Results indicated that the motor planning ability of children with LD is disturbed and that different types of apraxia occur. The child's failure on these tests has an influence on academic performance and daily life.
Use of myometry in the assessment of neuropathic weakness: testing for reliability in clinical practice
Authors: Lennon SM , Ashburn A.
Published: July 2008

The myometer has been recommended as a quantitative method of measuring muscle strength in clinical practice. The reliability of the myometer was tested in a clinical environment by physiotherapists and a form incorporating the testing positions was designed. An intensive training programme for examiners was instigated and piloted on normal subjects. The study tested the reliability of paired examiners in recording the muscle strength of 20 Guillain-Barre syndrome patients at different stages in their recovery. Ten patients were tested in the first experiment. The error rate between observers was large and unacceptable. Procedures for improving reliability were implemented. Testing was repeated on 10 more patients but no improvement in reliability was observed. The implications for clinical practice are discussed.
Monitoring wheelchair and seating provision
Authors: Ham RO
Published: July 2008

Following the establishment of the Disablement Services Authority in 1987, a survey was carried out to monitor local wheelchair requirements and their supply. The results show that the majority of requests are for standard models (80%) and that the delivery time for manual and electric wheelchairs is 27 days and 168 days respectively. When the results are compared to an earlier survey it can be seen that the number of chairs requested has increased by 15%, the number of accessories by 29% and that the delivery period has fallen by only four days. A pilot wheelchair seating clinic was also started in 1987 and the experience and results of this clinic are discussed.
Assessment of need for special seating and/or electronic control systems for wheelchairs among people with severe physical disabilities
Authors: Lachmann SM , Greenfield Eve , Wrench Alan
Published: July 2008

The aim of this study was to establish how many people with severe physical handicap in the Cambridge Health Authority had special seating, how many still needed a seating system and to investigate the demand for electronic controls for powered wheelchairs and the overall need for something other than standard controls. A quantitative and qualitative study was conducted between September 1991 and March 1992 in health, educational, residential and domestic establishments in the Cambridge District Health Authority. A total of 215 people with no sitting or trunk balance were assessed on the Chailey seating scale where the need for special seating and/or electronic controls was assessed. Of the 215 people found who had no sitting balance, 164 sat in a wheelchair for at least half the day. Eighty three had special seating systems and 43 had special cushions or wedges. Thirteen did not have but needed special seating and 16 needed special electronic controls. The numbers who needed but did not have special seating or electronic controls for powered wheelchairs in the Cambridge HA was lower than expected. However, referral is paramount and is reliant on the knowledge and expertise of professionals working with the patients in the community. The majority of those thought to need special controls were in fact able to use adapted, standard controls rather than requiring the development of new systems.
The effect of physiotherapy input on mobility skills of elderly people with severe dementing illness
Authors: Pomeroy VM
Published: July 2008

This study is part of an investigation into whether the provision of physiotherapy input improves or maintains mobility skills in elderly people with a dementing illness. Sixteen subjects were randomly allocated to either physiotherapy treatment followed by a no-treatment phase or vice versa. Ages ranged from 65 to 91 years. All subjects were severely demented. Physiotherapy input comprised music and movement groups, body awareness and functional mobility training. Each subject was videod and their mobility scored independently by three experienced physiotherapists. In comparison with the end of the control phase, the treatment phase showed a significant improvement ( p=0.043). These results encourage a positive management approach to elderly people with severe dementing illness and justify larger-scale trials.
Does verbal encouragement work? The effect of verbal encouragement on a muscular endurance task
Authors: Bickers Margaret J
Published: July 2008

Verbal encouragement (VE) is commonly used to encourage patients to perform to their maximum potential during exercise sessions or for various assessment procedures. This controlled trial investigated the effectiveness of VE during a motor endurance performance. Subjects in the experimental ( n = 32) and control group ( n = 26) performed two trials of a leg-holding task, one on each leg. The control group were simply timed, while the experimental group performed one trial in the manner of the control group and one where they were verbally encouraged. These subjects thus acted as their own control. Results of a MANOVA showed that the size of effect was different between the two leg-holding trials depending upon the group ( F(1,50) = 12.59, p < 0.001). Verbal encouragement significantly increased performance compared to the control group by 39% and by 33.5% compared to the subject's own control trial. Results are discussed in terms of the previous literature and suggestions are made for future investigations.
Relevance of social class and smoking in lower limb amputees
Authors: Kulkarni JR , Kearsley M.
Published: July 2008

This study set out to determine the relevance of social class status and smoking status in lower limb amputees attending a subregional prosthetic rehabilitation centre. Lower limb amputations are more common in social classes III and V and a majority of the amputees are smokers. Inequalities in health and health damaging behaviour in lower social classes are important factors in these at-risk groups.
Muscle activation patterns in aided gait
Authors: Crosbie Jack
Published: July 2008

This paper reports the sequence and amplitude of muscle activation around the shoulder during different aided gait patterns. Twenty healthy subjects simulated four different gaits, ambulating at their preferred speed. Data were collected from seven muscles in the shoulder complex using surface EMG; axial loading through the walking aids was measured simultaneously. Results indicated that the activity of muscles around the shoulder is extensive during the loading phase of aided gait and that, in certain gait patterns significant reductions in muscle activity could be obtained by minor modification of the crutch-shaft orientation.
Increasing patient engagement in rehabilitation activities
Authors: Ellul J. , Watkins C. , Ferguson N. , Barer D. , Rowe J.
Published: July 2008

Despite evidence that intensive rehabilitation speeds recovery from acute illness, several studies on British rehabilitation units have shown that the time spent by patients in therapeutic activities is low and that levels of 'engagement' are poor. We carried out an observational study of patient activity on four rehabilitation wards for the elderly (51 patients observed at half-hourly intervals between 8 a.m. and 5 p.m. on five successive days).

Patients were found to be engaged in therapeutically useful activities at only 17% of the observation points. When time spent in the therapy departments (where activities were not monitored) was excluded the proportion of useful activities fell to 11%. Similar patterns of activity were seen in all patient subgroups.

An intervention scheme was therefore devised, whereby an hourly activities programme tailored to the needs of each patient was worked out by therapists and ward staff, to be supervised by nurses. One nurse also organized regular group activities. The intervention programme, which required no extra resources, was instituted on two of the four wards.

A repeat survey conducted two months later showed a 55% increase in the proportion of time spent in useful activities on the two intervention wards but no change on the other two wards.
Spinal and shoulder complex posture. I: measurement using the 3Space lsotrak
Authors: Culham Elsie , Peat Malcolm
Published: July 2008

This study examined the use of the 3Space Isotrak for the measurement of static posture of the spine and the shoulder complex. The Isotrak sensor (stylus) was used to digitize bony landmarks on the subjects' spine and shoulder complex as they stood erect with their arms relaxed by their side. Measures of thoracic posture and the resting position of the right shoulder complex were calculated from the coordinates of these points. System accuracy was examined by repeated measures of known angles in each plane on a plexiglass model. Intraclass correlation coefficients (ICC) were above 0.99 for all comparisons of measured to known angles. Interday reliability of measures in 20 subjects was also examined using ICCs. With the exception of one measure, humeral position in the coronal plane, all correlations exceeded 0.75. It was concluded that the system was accurate and that spinal and shoulder complex posture are reproducible when measured on different days.
Physiological cost index of walking in able-bodied adolescents and adults
Authors: Nene AV
Published: July 2008

Fifty-four able-bodied adolescents and 40 adults were assessed in the gait laboratory using an infrared telemetry system. Physiological Cost Index (PCI) of walking ranged from 0.15 beats/metre (b/m) to 0.65 b/m (mean 0.35 b/m, SD 0.09) in adolescents and from 0.2 b/m to 0.55 b/m (mean 0.36 b/m, SD 0.08) in adults. There was no significant difference between median values of PCI in the two study groups. It would appear that the range of PCI values is similar for all age groups. Adult males showed lower PCI than adult females (males 0.31 b/m, SD 0.07 and females 0.4 b/m, SD 0.07; p < 0.001). Quetelet Index of each subject was taken into consideration in order to standardize subjects' body mass and height. There was no correlation between the PCI and the Quetelet Index in either group.

Estimation of PCI is a convenient and reliable method to monitor changes in the energy expenditure of walking, is relatively easy and does not require elaborate instrumentation.
Rehabilitation engineering courses for rehabilitation professionals — an investigation of demand and requirements
Authors: Cutts A. , Johnson GR , Fielding SA
Published: July 2008

A two-stage market research investigation (postal questionnaire followed by telephone interview) was carried out to determine the demand for courses in rehabilitation engineering. Thirty six per cent of a random sample of 200 rehabilitation professionals (physiotherapists, occupational therapists, chiropo dists, orthopaedic surgeons and rheumatologists) indicated an interest in such courses; interest levels were similar amongst recently qualified and established practitioners. Specific interests within the spectrum of rehabilitation engineering were wide ranging, indicating that comprehensive or selective courses were required. Most professionals felt that they needed a refresher course in basic mechanics before tackling any specialized rehabilitation engineering topics. Problems in attending courses were identified - study leave is difficult to obtain, with courses in day release format being most attractive. Funding of further education also presents difficulties, and although many professionals do finance courses themselves, few are willing to pay more than £200 per year.
Patients' satisfaction with stroke services
Authors: Pound Pandora , Gompertz Patrick , Ebrahim Shah
Published: July 2008

Patient satisfaction with stroke services is a key aspect of the evaluation of the quality of services but there are no adequate means of assessing satisfaction in this area. A questionnaire derived from in-depth interviews was piloted on two samples. The resulting questionnaire consisted of two sections, one on inpatient services (Hospsat) and the other on services in the community (Homesat). It was sent to 219 patients, who had had a stroke six months previously, along with postal versions of the Barthel ADL index, the Nottingham Extended ADL Scale, the Nottingham Health Profile, the short form of the Geriatric Depression Scale and the Faces Scale. The response rate for the questionnaires was 87%.

Test-retest reliability and tests of internal consistency of the satisfaction scales were carried out on a subsample of this population. Convergent and discriminant validity were explored by examining correlations with the above measures.

The satisfaction questionnaire had construct validity with significant correla tions between the Barthel ADL Index ( r = 0.39), the Nottingham Extended ADL Scale ( r= 0.38) and the physical mobility subsection of the Nottingham Health Profile ( r= -0.36). Internal consistency was high for both sections (Cronbach's Alpha: Hospsat 0.86; Homesat 0.77). Test-retest reliability was fair; the mean difference for total scores was 0.59 (SD = 2.4) for Hospsat, and 0.32 (SD = 2.1) for Homesat.

A high level of dissatisfaction was uncovered. Just under half (48%) of people were dissatisfied with some aspect of the care they received in hospital and over half (53%) were dissatisfied with some aspect of the services they received in the community. The highest rate (54%) of dissatisfaction was with the amount of therapy received.

Good patient satisfaction measures are useful since they complement 'objective' outcome measures and may highlight areas in need of evaluation and improvement.
Is chronic fatigue syndrome treatable in an NHS environment?
Authors: Cox Diane L , Findley Leslie J
Published: July 2008

The combined approach of graded activity and cognitive behaviour therapy in the treatment and management of chronic fatigue syndrome within an inpatient NHS neurology ward is discussed. A retrospective medical audit of 28 patients indicated that 57% had an increased activity level six months following discharge. Controlled clinical studies are required to examine the benefit and effect of the combined treatment approach discussed.
Automatic and voluntary lateral weight shifts in rehabilitation of hemiparetic patients
Authors: Dickstein Ruth , Dvir Zeevi , Ben Jehosua Efrat , Rois Miri , Pillar Thomas
Published: July 2008

One of the main objectives of exercise therapy for hemiparetic patients is the rehabilitation of their impaired ability to accept and bear bodyweight on the involved lower extremity. The purpose of this study was to compare two types of therapeutic exercises, automatic and voluntary weight shifts, used as treatment for this problem.

Thirteen hemiparetic patients and nine age-matched healthy controls participated in the study. Criterion variables were four: (1) body sway; (2) location of the centre of pressure; (3) activation pattern of the gluteus medius and medial gastrocnemius muscles; and (4) magnitude of activation of these two muscles. Each subject was tested three times: (1) during static stance; (2) while standing on a moving platform that imposed automatic lateral weight shifts; and (3) while standing on a stationary base and voluntarily shifting bodyweight from one lower limb to the other. Values of sway and location of the centre of pressure on the mediolateral axis were collected by the Chattecx balance system; magnitude and modulation of the muscular activity in both lower extremities were recorded with surface electromyography.

The findings showed significant differences between patients and controls in all four variables. Regarding differences between exercise modes, the main finding pointed to larger sways in voluntary as compared to automatic weight shifts. Presumably, body fixation during automatic perturbations was manifested in a decreased body sway. Stance symmetry and the EMG activation profile of the paretic muscles were not improved by either exercise mode.
The inter-rater reliability and construct validity of the Functional Independence Measure for multiple sclerosis subjects
Authors: Brosseau Lucie , Wolfson Christina
Published: July 2008

The functional independence measure (FIM) is a new assessment scale, which has been extensively used in the uniform data system (UDS) throughout the United States. Eighty-one multiple sclerosis (MS) subjects were assessed by two trained physiotherapists using the FIM. Inter-rater reliability was found to be high for the total score (intraclass correlation coefficient [ICC] = 0.83 and moderate to substantial for items assessing physical disability (Kappa = 0.70-0.50), except for the item concerned with assessing independence in walking or in wheelchair (Kappa = 0.16). The inter-rater agreement of FIM items in the communication and social cognition subsections was only fair. The internal consistency of the FIM assessment scale was found to be high, with a Cronbach's alpha of at least 0.94. Relatively high Spearman rank correlation coefficients were found between total FIM and total Expanded Disability Status Scale (EDSS). The present reliability and validity study on FIM provides scientific data for a sample of MS patients with differing levels of disability. The FIM assessment appears to be reliable and valid tool to assess general physical needs in MS. Its use to assess neuropsychological needs is, however, questionable with MS subjects.
Improving social outcome after stroke: an evaluation of the volunteer stroke scheme
Authors: Geddes Joanna ML , Chamberlain M Anne
Published: July 2008

Data were obtained on all referrals of stroke patients to the speech therapy departments of two adjoining Health Authorities, Leeds West and Leeds East. Only Leeds West had a Volunteer Stroke Scheme (VSS) available. Qualified speech and language therapists in both Health Authorities classified patients as dysphasic and/or dysarthric and identified those they thought likely to benefit from support from the VSS. From these latter patients, three groups were identified: Leeds West patients receiving support from the VSS ( n = 34); Leeds West patients who refused VSS support ( n = 9); and Leeds East patients with no VSS support available ( n = 10).

All patients were followed up for one year and changes in Barthel Index, Frenchay Activities Index (FAI) and carers' Hospital Anxiety and Depression scores were recorded. Only those patients who received VSS support demonstrated a statistically significant increase in FAI over the year.
Occupational therapy after hip fracture: a pilot study of the clients, the care and the costs
Authors: Hagsten Birgit E , Söderback Ingrid
Published: July 2008

The effects of extended occupational therapy rehabilitation were assessed over four months in 17 elderly hip-fracture patients. The programme included home visits and adaptations of the home environment. On five occasions postoperatively, the patients' activities of daily living (ADL) performance was assessed using the Klein-Bell ADL scale and their pain and apprehension using visual analogue scales. Significant and maintained improvements were shown in 'dressing', 'hygiene/bathing' and 'mobility'. Patients estimated that their ability had increased for all ADL activities studied, but that 'hair washing', 'making the bed' and 'buying food' remained the most difficult. The mean per capita cost of the occupational therapy programme was US $1461.
Post-concussion symptoms: is stress a mediating factor?
Authors: Moss Nicola E , Crawford Sue , Wade Derick T
Published: July 2008

The Oxford Head Injury Service is a new service investigating the benefit of providing early follow up, including information, advice and support, initially at seven to 10 days post head injury, with continued intervention as needed. The intention is to reach those patients who would normally receive no formal follow-up service. This study is a pilot investigation into the initial presentation of post-concussion symptoms and the influence of stress, in the form of return to normal activity, to see whether this aggravates the symptoms. Twenty-one patients were initially seen in hospital between one and four days post injury and then followed up six to 19 days after discharge. A post-concussion symptom questionnaire was completed on each occasion and on the second assessment the presence or absence of stress, as defined above, was ascertained. At follow up it was found that 71 % ( n = 15) were still experiencing symptoms and in 29% ( n = 6) of the total sample the symptoms had become worse. The study reveals that it would be clinically unwise to rely on an assessment taken in the relatively protected hospital ward environment as an indicator of future recovery. The influence of stress was not found to be significant but our measure was crude and the sample small and therefore we would suggest that this question is still open.
Reliability of the Stroke Drivers Screening Assessment
Authors: Lincoln NB , Fanthome Y.
Published: July 2008

The Stroke Drivers Screening Assessment (SDSA) was designed to predict driving performance after stroke. The test-retest reliability was checked to ascertain the practice effect of repeated assessment. Thirty-six stroke patients were assessed on the SDSA on two occasions six weeks apart. Results indicate that significant improvements occur on individual tests of the SDSA but no patient improved from a 'fail' to a 'pass' category as a result of practice.
Negative symptoms in the traumatically brain-injured during the first year postdischarge, and their effect on rehabilitation status, work status and family burden
Authors: Gray John M , Shepherd Margaret , McKinlay William W , Robertson Ian , Pentland Brian
Published: July 2008

Approximately one year after discharge from postacute rehabilitation, 47 severely head-injured patients showed physical, cognitive, subjective, emotional and behavioural changes from their preinjury status, according to relatives/carers. Negative symptoms were prominent, and were related to employment status, overall rehabilitation status and relatives'/carers' levels of stress and psychological morbidity.
Measuring motor goals in children with cerebral palsy
Authors: Bower E. , McLellan DL
Published: July 2008

Four children aged two to three years with four limb cerebral palsy and apparently 'normal' intellect received randomized periods of conventional amounts of physiotherapy and a period of intensive physiotherapy directed at goals with both functional and pattern motor skill objectives. Using a single case experimental design, functional motor change was found to be continuous throughout the study period in all four children. Changes in the pattern of movement were difficult to detect or grade objectively and none of these goals was achieved, in contrast to the functional goals of which 58% were achieved. Intensive physiotherapy directed at goals that could not be achieved was associated with an increase in unco-operative behaviour in some children.
Early supported discharge for elderly trauma patients: a report on a preliminary study
Authors: Currie CT , Tierney AJ , Closs SJ , Fairtlough HL
Published: July 2008

To cope with increasing numbers of elderly patients in acute orthopaedic units, various schemes have been introduced to expedite early rehabilitation and discharge. This paper reports a study undertaken in a large Scottish teaching hospital in order to assess the potential and requirements for a local scheme of early supported discharge for elderly trauma patients. Over a four-month period, data were collected from and about elderly patients (70+) admitted from home to the orthopaedic unit (overall sample of 282, detailed subsample of 100). Existing arrangements were shown to allow the apparently satisfactory direct discharge home of a substantial proportion (45%) of these patients in spite of their age (mean 80.2 years) and the fact that previous frailty was common and many (59%) lived alone. Findings of the study suggested that the number of discharges directly home could be increased with improved early rehabilitation, better pain control, systematic discharge planning, occupational therapy input and stronger links between the orthopaedic ward and the community services. Early clinical predictions of individual potential for direct discharge were unreliable. In a Scheme of Early Supported Discharge now in operation following the preliminary study, all patients admitted directly from home are considered.
A postal version of the Barthel Index
Authors: Gompertz Patrick , Pound Pandora , Ebrahim Shah
Published: July 2008

The Barthel Index is the best known and most popular activities of daily living (ADL) scale. Many studies have confirmed its validity and it has been validated for many different methods of administration. These include direct observation, interview of patient carer or nurse and telephone. The aim of this study was to devise and test the reliability of a self-completed postal version of the Barthel Index for use in surveys and outcome studies.

The items were changed into multiple choice questions, taking into account the published guidelines and knowledge of common areas of confusion when administering the Barthel by interview. The test retest reliability over two weeks of the resulting questionnaire was evaluated using a consecutive series of 21 patients from a stroke register, who had responded without prompting to a postal survey six months after stroke. All the items had κ statistics indicating at least moderate reliability, the toilet and mobility items being the worst. The mean difference in total scores was -0.5 out of 20, standard deviation 2.1. The 95% limits of agreement were -4.6 to 3.6, corresponding to a change in dependence of up to two ADL items. This study demonstrates that the postal self-report questionnaire version of the Barthel is reliable and practical. Further studies are needed to establish its validity in comparison with interview administration.
Validity of the extended activities of daily living scale
Authors: Gompertz Patrick , Pound Pandora , Ebrahim Shah
Published: July 2008

Scales that measure independence in the basic self-care activities of daily living (ADLs) suffer from ceiling effects when applied to an outpatient population. The instrumental activities of daily living (IADL) measures, which assess the performance of tasks required for independence at home are more appropriate. However, validity evaluation of IADL measures seldom goes beyond content validity and little is known about their sensitivity to change. The aim of this study was to evaluate the construct validity of the extended ADL scale (EADL) and to test its sensitivity to change. Three hundred and sixty-one consecutive acute stroke admissions were recruited and surveyed at one, six and 12 months after stroke, using the EADL. There were the expected correlations with the Barthel Index, Nottingham Health Profile, Geriatric Depression Score and the London Stroke Satisfaction Score. Logistic regression analysis showed that, although men were more mobile, they were less likely to carry out domestic and kitchen tasks. Also, nonwhites were more disabled, owner-occupiers had higher leisure scores and those living alone had higher kitchen scores. Analysis of effect sizes showed that the EADL is sensitive to the changes that occur after stroke and would be sensitive to the effect of an intervention that produced a change in independence of two or more ADLs. The EADL is a valid measure of the performance of instrumental ADLs and is sensitive to clinically important changes.
The availability and reliability of information on the premorbid functional status of stroke patients in hospital
Authors: Benbow SJ , Watkins C. , Sangster G. , Ellul J. , Barer D.
Published: July 2008

In order to predict outcome after a stroke and set realistic targets for rehabilitation, it is essential to have reliable information on the patient's premorbid functional status. We assessed the availability of information on premorbid continence, mobility and mental status by examining the medical and nursing notes, one week after admission to a teaching hospital, of 164 stroke patients. Simple rating scales were used and results compared to information obtained from patients' relatives. Useful information on previous mobility was obtained from the notes in 58% of cases, on continence in 47%, and mental state in 44%. Although agreement between medical and nursing notes was reasonable (possibly due to sharing of information), agreement with the same information obtained from relatives was very poor. Information on the premorbid functional status of stroke patients is often not available in hospital notes, and when recorded is often inaccurate. Such data should be routinely obtained using standardized measures.
Autotraction treatment for low-back pain in pregnancy: a pilot study
Authors: Tesio Luigi , Raschi Alessandra , Meroni Mario
Published: July 2008

Back pain affects about 50% of pregnant women, for whom most of the conventional treatments may be contraindicated. We ran a pilot study to test safety and potential effectiveness of a modified version of autotraction (AT), a treatment combining active pulling efforts with the upper limbs and automatical mobilization of the spine.

We treated 16 women during weeks 13-26 of pregnancy (median 20), suffering from back and/or sciatica pain unremitting for 4-20 weeks (median 8). Treatment was given in three 25-minute outpatient periods, one every third day. During the first session heart rate and blood pressure were monitored: these never raised by more than 15 bpm and 20 mmHg, respectively. In three cases surface EMG signals recorded unilaterally from rectus abdominis and lumbar paraspinal muscles were compared during Valsalva manoeuvres and AT sessions, in order to obtain indirect information on changes of intra-abdominal pressure. Trunk muscles appeared to act to a comparable extent during both types of manoeuvre.

Self report of overall improvement, peak intensity of pain (0-100 score on 100 mm visual analogue scale [VAS]) and its qualitative severity (0-45 score on the short form of McGill Pain Questionnaire [MPQ]) were taken as outcome indicators. AT manoeuvres were always painless.

Thirteen out of 16 patients reported to be improved after treatment, whereas three were unchanged. In the responders, the median VAS and MPQ pain scores dropped, as a median, from 50/100 (range 25-77) to 19/100 (0-80) and from 8.5/40 (2-20) to 3.5/45 (0-14), respectively (p<0.001, Wilcoxon signed-rank test). One month after treatment 15 patients were pain free and one reported her improvement to be stable. The deliveries had been normal and the babies healthy.
Shoulder pain in acutely admitted hemiplegics
Authors: Roy Christopher W , Sands Madeleine R , Hill Linda D
Published: July 2008

The objective of this study was to determine the frequency of shoulder pain in the first 12 weeks after acute stroke, and its relationship to functional outcome. The study was prospective observational in design, carried out weekly over 12 weeks from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the 76 included patients admitted to hospital with a first documented episode of stroke resulting in neurological deficit lasting more than seven days.

The main outcomes measured were frequency and severity of pain using visual analogue scores; arm function (by Frenchay Arm Test and Motricity Index) and length of stay in hospital. Fifty-five patients (72%) experienced shoulder pain at some stage, most commonly on movement. Length of stay in those with pain was 82 days and those without pain 39 days (p < 0.001). All patients requiring continuing care, or dying after inclusion in the study, suffered shoulder pain. Patients with pain showed greater weakness and poorer arm function at study entry and at study termination, the rate of recovery of arm function being slower in those with pain than those without.

The results concluded that shoulder pain is a common phenomenon in acute hemiplegia and is strongly associated with prolonged hospital stay, and poor recovery of arm function in the first 12 weeks of illness.
The stress experienced by caregivers of stroke survivors: is it all in the mind, or is it also in the body?
Authors: Tyman Ruth Victoria
Published: July 2008

With a growing awareness that caring for an individual disabled by stroke may lead to stress-related health problems, fifteen major studies of the health status of carers of stroke survivors have been conducted since 1979. Although general stress theory indicates that stress-related health problems may be physical or psychological, in most of the studies reviewed psychological health is emphasized. Possible explanations for this bias are outlined in the present paper including: (a) how the backgrounds of the investigators involved may have influenced the nature of their research; (b) the effect of differences in the availability of standardized physical and psychological health measures; and (c) the possibility that the stress experienced by carers of stroke victims is primarily psychological. The commentary concludes with suggestions for future research to redress the imbalance and discusses some of the methodological difficulties potentially involved.
Individual and staff professional development in a multidisciplinary team: some needs and solutions
Authors: Skeil Debbie A
Published: July 2008

Professional development has long been recognized as essential for the maintenance of a high standard of medical and therapeutic care. Rehabilitation brings together professionals who have experienced a broad range of specialist training, and whose departments will support various forms of continuing professional development. The medical profession has excellent opportunities that facilitate the acquisition of postgraduate examinations and the continued opportunity for staying abreast of therapeutic advances, written into the National Health Service Terms and Conditions of Service,1 and taking the form of paid study leave and expenses. Unfortunately few other healthcare professionals can access such resources, although many have a more structured approach to continuing education than doctors.2 Professional development within a multidisciplinary team has many different facets to it, including training for each discipline plus training for the team. Using observations from a Regional Rehabilitation Centre we consider different approaches possible for professional development with some possible influencing factors.