bluuebunny/crossref_metadata_2025 huggingface dataset:
The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients
Authors: Trigg Richard , Wood Victorine A
Published: May 2003

Objective: To develop a measure of social integration following stroke.

Design: Question and response scale generation from qualitative interview-based work followed by item and factor analytic methods of test construction. Analysis of the psychometric properties of final index.

Measures: Frenchay Activities Index, Nottingham Health Profile, Wakefield Depression Inventory, Barthel Index.

Setting: Community setting, Bath, UK.

Subjects: Two hundred and sixty survivors of stroke, discharged at least six months previously from a general hospital.

Results: A 10-item Subjective Index of Physical and Social Outcome (SIPSO) was developed. Each question is scored on a scale of 0–4 with a low score indicating a poor level of integration. From the 157 completed questionnaires, total scores ranged from 0 to 40 with a median of 24 (interquartile range 15–32). Initial testing of the psychometric properties of the SIPSO suggest that it is able to provide assessment of two distinct areas of patient integration. From analysis of completed questionnaires it is suggested that questions 1–5 on the SIPSO measure a factor related to physical functioning/mobility whilst questions 6–10 measure a factor related to social/emotional functioning. Internal consistency, test–retest reliability and construct validity were established.

Conclusions: The SIPSO provides a brief, valid and reliable assessment of an individual's ability to reintegrate to a ‘normal’ lifestyle. The SIPSO differs from other measures in that it provides assessment of both quantity and quality of activities and interaction, reflecting an individual’s ability to reintegrate to his/her own satisfaction. As a 10-item self-report questionnaire the SIPSO can be administered quickly and cheaply to large numbers of patients.
Quadriceps muscle weakness following acute hemiplegic stroke
Authors: Harris M L , Polkey M I , Bath P MW , Moxham J
Published: May 2003

Objective: To determine whether quadriceps muscle weakness develops on the side ipsilateral to the brain lesion in the first week following acute ischaemic hemiplegic stroke.

Design: A prospective study of muscle strength.

Setting: Acute stroke unit (ASU) in a teaching hospital.

Subjects: Ten patients admitted within 48 hours of stroke onset, and 10 healthy age-matched controls.

Interventions: Repeat nonvolitional measurements of quadriceps muscle strength of the unaffected limb in patients and the right leg in normal subjects using magnetic femoral nerve stimulation (MS), prospectively one week apart. In addition the level of voluntary activation was assessed during a maximum voluntary contraction (MVC) manoeuvre. The Trunk Control Test (TCT) was measured in the patients.

Results: The median (95% confidence interval, (CI)) baseline quadriceps twitch tension (Tw Q) and MVC in the control group were 9.4 kg (6.1–12.5 kg) and 37.2 kg (23.8–54.6 kg), and in the stroke group were 7.6 kg (4.4–9.9 kg) and 12.15 kg (7.9–30.8 kg). The median (95% CI) change in Tw Q and MVC respectively between baseline and one week later were 1.75% (–9.8 to 8%) and 5.45% (–15.1 to 22.7%) (NS) in the control group and –16.2% (–6 to –25.9%) and –30.45% (0 to –78.6%) (p < 0.01) in the stroke patients. There was a significant correlation between the percentage fall in Tw Q and both change in TCT (rs = 0.83, p < 0.01) and percentage change in body weight (rs = 0.83, p < 0.01).

Conclusion: In the first week after acute hemiplegic stroke, weakness develops in the unaffected leg.
Too many pre-discharge home assessment visits for older patients? A postal questionnaire survey
Authors: Patterson C J , Viner J , Saville C , Mulley G P
Published: May 2003

Objective: To investigate current practice of pre-discharge home assessment visits for older patients.

Design: Postal questionnaire survey.

Setting: NHS Trust hospitals in the United Kingdom.

Subjects: Occupational therapy departments in 265 NHS Trust hospitals which admit acutely ill older patients.

Main outcome measures: The number of pre-discharge home visits done, who went, and therapy time spent on home visits.

Results: Of 265 NHS Trusts contacted, 239 (90%) replied. Of 238 units, 155 (65%) do between 11 and 40 visits per month, with 25 (11%) doing more than 60. The equivalent of one day per week or more is spent doing home visits by Senior I occupational therapists in 107 (45%) units and by Senior II staff in 126 (53%) units. Carers or relatives, unqualified occupational therapists, social workers and home care managers accompany the patient and occupational therapist on most home visits.

Conclusion: Therapy perception is that pre-discharge home assessment visits are increasing in number, complexity and involvement of professional time despite little evidence for their effectiveness. Controlled trials are required to assess which patients are likely to benefit.
The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions
Authors: Tyson S F , Thornton H A
Published: May 2003

Objective: To assess the effect of a hinged ankle foot orthosis (AFO) on functional mobility and gait impairments in people with a severe hemiplegia undergoing rehabilitation, and to investigate the patients' views of the hinged AFO.

Design: With/without group comparison, and face-to-face questionnaire.

Subjects and setting: Twenty-five subjects over 18 years, with a hemiplegia following cerebrovascular accident (CVA) undergoing rehabilitation in a regional rehabilitation unit.

Outcome measures: Functional Ambulation Categories as a measure of disability. Paper walkways to measure gait impairments – stride length, step length, symmetry, cadence and velocity. Face-to-face questionnaire to determine the users' opinion of the hinged AFO.

Results: Comparison of gait with and without the hinged AFO showed significant improvements in functional mobility (p = 0.000) and in some gait impairments; stride length of the weak (p < 0.005, 95% CI –8.1, –1.6) and sound legs (p < 0.014, 95% CI –8, –1), velocity (p = 0.00, 95% CI –0.1, –0.03) and cadence (p < 0.002, 95% CI –15.1, –3.8). No effect was found for step length in the weak or sound leg or symmetry. The subjects' response was positive, 24 (96%) felt they walked better with the AFO and found it comfortable. Twenty-three (92%) were unbothered by the appearance and 16 (64%) could doff and don it.

Conclusion: The hinged AFO improved objective measures of gait impairments and disability and patients were positive about it.
Base rate of post-concussion symptoms among normal people and its neuropsychological correlates
Authors: Chan Raymond CK
Published: May 2003

Objective: To explore the base rate of symptoms similar to those of post-concussion symptoms (PCS) among a group of participants without head injury. The effect of subjective complaints upon cognitive functioning was also examined.

Design: A cross-sectional study.

Participants: A total of 85 participants without head injury, other identifiable neurological diseases or psychiatric diseases were recruited.

Outcome measures: These included Rivermead Post-concussion Symptoms Checklist, Cognitive Failures Questionnaire, Colour Trails Test, Stroop Word-Colour Test, Paced Auditory Serial Addition Test, Symbol Digits Modality Test, Word Fluency Test, Design Fluency Test, Digits Forward and Backward Span Test, and Modified Six Elements Test.

Results: A relatively high proportion of the participants reported symptoms similar to those of patients with PCS. These included longer time to think (65.9%), forgetfulness (58.9%), poor concentration (58.9%), fatigue easily (53.5%), and sleep disturbances (50.6%). Gender effect was not significant for either the individual item or the total score of the Rivermead Post-concussion Symptoms Checklist. Moreover, there was no difference found between low symptom reporters and high symptom reporters in terms of attention, working memory, mental fluency, and strategy allocation.

Conclusion: The base rates of symptoms were consistent with previous studies among the nonclinical groups. However, persons reporting a high score of concussion-like symptoms did not perform less well than those reporting a low score of symptoms in attention, working memory, mental fluency and strategy allocation.
Weight-bearing, pain and walking velocity during primary transtibial amputee rehabilitation
Authors: Jones M E , Bashford G M , Bliokas V V
Published: May 2003

Objective: To explore the relationships between weight-bearing, pain and walking velocity in the first four weeks of prosthetic training.

Subjects: Consecutively referred transtibial amputees (n = 27).

Design: Longitudinal study.

Setting: Inpatient rehabilitation centre.

Interventions: Measurements of static weight-bearing (SWB), perceived pain during the SWB test and self-selected walking velocity (VEL) were taken at entry, and at four weeks into the prosthetic training programme. Path analysis was conducted using a series of linear regression analyses to determine predictors of walking velocity at week 4.

Results: Significant improvements from week 1 to week 4 were found in SWB, reported pain and velocity. SWB at week 4, when coupled with age, predicted 66% of the variance in walking velocity at week 4. Pain did not directly predict velocity. However, SWB at entry and perceived pain at week 4 predicted 56% of the variance in SWB at week 4.

Conclusions: These analyses suggested a model in which SWB and age were both significantly related to velocity, and further, that pain played a role in velocity through a relationship mediated by its direct effect on SWB. Unlike age, SWB is a predictor of velocity that might be altered through pain reduction, wound-healing and rehabilitative interventions.
Medically unexplained disability – a misnomer, and an opportunity for rehabilitation
Authors: Wade Derick T
Published: May 2003

Patients with disability that is not fully accounted for by known pathology commonly consult within health care systems, and their diagnosis and management present challenges. This editorial puts the phenomenon in a historical context, and then discusses three such challenges: explanation, labelling and management. It suggests that the World Health Organization (WHO) ICIDH-2 model of illness would predict the existence of illness without pathology and consequently it suggests that a new name, sinepathy (i.e. without disease), would be appropriate. It also suggests that a standard rehabilitation approach with a focus on cognitive behavioural therapy might be the best management for patients with sinepathic disability.
Walking speed over 10 metres overestimates locomotor capacity after stroke
Authors: Dean Catherine M , Richards Carol L. , Malouin Francine
Published: May 2003

Objective: To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and individuals after stroke and to assess the level of disability associated with poor walking endurance after stroke.

Design: Descriptive study in which comfortable walking speed over 10 m and distance covered in 6 minutes (6-minute walk test) were compared between healthy subjects and subjects after stroke.

Subjects: Twelve healthy subjects and 14 subjects after stroke.

Main outcome measures: Walking speed and 6-minute distances were compared between groups. In addition, for each group, actual distance walked in 6 minutes was compared with the distance predicted by the 10-m walking speed test and the distance predicted by normative reference equations.

Results: Subjects after stroke had significant reductions in 10-m speed and 6-minute distance compared with healthy subjects (p < 0.05). Subjects after stroke were not able to maintain their comfortable walking speed for 6 minutes, whereas healthy subjects walked in excess of their comfortable speed for 6 minutes. The average distance walked in 6 minutes by individuals after stroke was only 49.8 ± 23.9% of the distance predicted for healthy individuals with similar physical characteristics.

Conclusion: In our subjects after stroke, walking speed over a short distance overestimated the distance walked in 6 minutes. Both walking speed and endurance need to be measured and trained during rehabilitation.
A pilot study of attention deficits, balance control and falls in the subacute stage following stroke
Authors: Stapleton Tadhg , Ashburn Ann , Stack Emma
Published: May 2003

Objectives: To (1) identify and monitor changes in deficits of attention and balance in the subacute stage following stroke, (2) investigate fall events, (3) explore relationships between deficits of attention, balance and falling post stroke.

Design: A prospective observational study.

Setting: Hospitalized patients with stroke were recruited from a rehabilitation ward.

Subjects: Fourteen subjects were recruited, 13 subjects (age 21–80 years) completed all assessments. Ten had right and three had left hemispheric lesions. Eight subjects were male.

Main outcome measures: Subjects were assessed on two occasions during a six-week period. Standardized tests were used to measure unilateral visual neglect, sustained and selective attention and balance. Fall histories were collected by chart review and semi-structured interview.

Results: At the initial assessment six subjects had sustained auditory attention deficit, eight had deficits of auditory selective attention, 12 had visual selective attention deficits and seven subjects presented with visual inattention. Scores for visual inattention and visual selective attention improved over time (p = 0.006, p = 0.026 respectively) as did scores for balance control (p = 0.001). Auditory selective attention scores at the first assessment were found to correlate with measures of balance (p < 0.01), subjects with normal attention scores achieved better balance scores. Four subjects fell at least once during the six weeks. Scores for attention and balance of fallers were not found to be significantly different from the scores of nonfallers.

Conclusions: The sample size was small but high levels of attention deficit were identified. Findings suggest a weak or no relationship between attention deficits and falls. Further studies are required to explore the extent of attention deficits post stroke and its impact on balance control and falling.
Can the site of brain lesion predict improved motor function after Low-TENS treatment on the post-stroke paretic arm?
Authors: Sonde Lars , Bronge Lena , Kalimo Hannu , Viitanen Matti
Published: May 2003

Objectives: Previous reports suggest that afferent stimulation improves arm motor function in patients suffering from stroke. The aim of this pilot study was to test the hypothesis that the brain lesion location determines the response to low-frequency (1.7 Hz) transcutaneous electric nerve stimulation (Low-TENS) therapy.

Design: Magnetic resonance imaging (MRI) was performed on 14 patients who had previously received Low-TENS on the paretic arm after stroke.

Methods: MR images were classified with two different methods. First, lesions in the cortical and the subcortical areas were registered. Secondly, any change in a described periventricular white matter (PVWM) area was recorded. Interactions between the lesion site, as detected by MRI, and response to Low-TENS treatment were analysed.

Results: Arm motor function after Low-TENS treatment in relation to lesion in different brain areas showed that absence of lesions in the PVWM area increased the possibility for improved motor capacity after afferent stimulation.

Conclusions: The site of lesion may play a role in prognosis/outcome after Low-TENS treatment but this hypothesis should be further tested in a larger prospective study.
Quadriceps strength and timed motor performances in myotonic dystrophy, Charcot–Marie–Tooth disease, and healthy subjects
Authors: Lindeman Eline , Leffers Pieters , Reulen Jos , Spaans Frank , Drukker Jan
Published: May 2003

Background and purpose: The leading hypothesis was that a relation exists between muscular strength and functional abilities. Therefore a study was undertaken to quantify such a relationship in a population of subjects with different muscular strengths. This population consisted of healthy subjects and subjects with slowly progressive neuromuscular disorders.

Methods: The study included 33 patients with myotonic dystrophy, 29 patients with Charcot–Marie–Tooth disease and 20 healthy subjects. Isokinetic and isometric knee torques were measured on an isokinetic dynamometer at various velocities. The following activities were timed: descending and ascending stairs, rising from a chair, rising from supine, walking at natural speed and walking at maximum speed.

Results: The population covered a wide range of the variables: whereas the healthy subjects performed best (i.e. had the highest knee torques and performed the activities most quickly), the myotonic dystrophy group included the subjects with the lowest knee torques. The natural logarithms (ln) of isokinetic extension torque at the highest velocity (120°/s) and those of the time taken to perform the described activities showed the highest levels of correlation. It was found that after correction for age and weight, 56% (walking at natural speed) to 73% (descending stairs) of the variance in the ln of the time taken could be attributed to the variance in the ln of the torques.

Conclusion and discussion: A strong relation between quadriceps strength and timed motor performances were demonstrated. The impact of strength reduction on time taken was most obvious in subjects with considerably decreased strength. Therefore, it is feasible to try to influence muscle strength in patients with relevant strength reduction in order to achieve better functional ability.
What do patients and their carers want to know about stroke? A two-year follow-up study
Authors: Hanger H C , Walker G , Paterson L A , McBride S , Sainsbury R
Published: May 2003

Objective: To clarify what issues are important to stroke patients and their carers. To determine whether these issues change over time.

Design: Prospective study of consecutive patients admitted to hospital with a diagnosis of an acute stroke. Each participant had interviews at six and 24 months. In addition, a subgroup of these patients (consecutive discharges over a two-month period) were also seen at two weeks post discharge.

Setting and subjects: Hospital-based cohort of stroke survivors. Interviewed in their own homes.

Main outcome measures: Documentation of the questions asked.

Results: At two weeks, six and 24 months, a median of three, two and three questions were asked by each patient respectively. Enquiries about basic aspects of stroke were common but diminished over time. Fear of recurrence was apparent at all three interview periods. Enquiries about the psychological sequelae of stroke became more prevalent at six and 24 months. At two years, 32% of respondents asked about concentration/memory difficulties with smaller numbers commenting on tiredness, depression and frustration. At two years, 18% of the sample were still uncertain of their chances of further recovery.

Conclusions: Patients with stroke continue to have unanswered questions even two years after their stroke. The types of questions asked changed over time.
The impact of an information pack on patients with stroke and their carers: a randomized controlled trial
Authors: Mant Jonathan , Carter Judy , Wade Derick T , Winner Simon
Published: May 2003

Objectives: To assess the impact of information packs on patients with stroke and their carers, and to pilot some of the methodology for a trial of a Family Support Organiser (FSO).

Subjects: Seventy-one patients admitted to Oxford hospitals with acute stroke during February–July 1995, and 49 informal carers of these patients.

Design: Randomized controlled trial. Intervention group received an information pack containing various Stroke Association publications one month after their stroke, or at discharge from hospital, whichever was sooner. Control group received nothing. Follow-up was by interview at the place of residence of the patients six months after their stroke.

Measures: Outcome measures assessed knowledge about stroke; satisfaction with information received; patient behaviour in terms of access to community services and benefits; and health status and quality of life.

Results: Patients and carers in the intervention group tended to know more about stroke, but these differences were not significant once adjusted for age. Patients in the intervention group (but not carers) tended to be more satisfied with the information that they had received, but the differences were not significant. There were no differences with regard to any aspects of quality of life in patients in the intervention group, though carers in the intervention group were found to have significantly better mental health ( p = 0.04).

Conclusions: While the study was too small to generate firm conclusions, information leaflets may lead to improved knowledge about stroke several months after they have been distributed. This finding is worth following up with larger studies. The stroke knowledge questionnaire that was piloted in this trial seems to be able to detect differences between groups.
Environmental influences on the cumulative structure of instrumental ADL: an example in osteoporosis patients in a Swedish rural district
Authors: Iwarsson Susanne
Published: May 2003

Introduction: The ADL Staircase is a hierarchical instrument for the assessment of dependence/independence in personal and instrumental activities of daily living (P-ADL and I-ADL). Previous results indicated that environmental factors might affect assessment results, and revisions for use in rural areas have been tested with a gerontological population sample.

Objective: To investigate further the cumulative structure of I-ADL in osteoporosis patients in a Swedish rural district.

Method: Patients were interviewed consecutively concerning their pre-injury dependence in P-ADL and I-ADL, using a revised version of the ADL Staircase ( n = 276).

Results: In contrast to results from urban areas, ‘transportation' was the activity generating the most dependence among the respondents. In addition, different gender-specific cumulative orders among I-ADL were demonstrated. Guttman's scaling analysis confirmed the cumulativity of the revised scale (C of R = 0.94/0.97, C of S = 0.77/0.88).

Conclusion: Environmental factors influence the validity of instruments as well as the prevalence of disability.
The views of therapists on the use of a patient-held record in the care of stroke patients
Authors: Ayana Mulunish , Pound Pandora , Ebrahim Shah
Published: May 2003

Objective: To explore the views of therapists working with stroke patients on the use of a patient-held record (PHR) for stroke patients. A PHR was developed in the form of a pocket-sized booklet (21 cm × 14.5 cm) in which staff recorded information relating to the patient's management. The aim of the PHR was to facilitate communication and involve patients more directly in their care.

Methods: Six semi-structured group interviews were conducted with therapists (25 in total) from one inner city hospital.

Results: The following themes emerged from the content analysis: (1) Therapists were supportive of plans for a PHR, citing the benefits of greater patient involvement. (2) However, they questioned its feasibility, in particular the issue of patient responsibility and its use with the cognitively impaired. (3) They also questioned its ability to facilitate communication among health professionals because of existing differences in perspectives. (4) These therapists revealed concerns about the effect that information may have on patients. (5) They also raised practical issues about finding the time to make entries, wording and content of entries in the PHR.

Conclusion: Responsibility for the PHR may enhance patients' understanding and involvement in their care, yet ownership alone does not guarantee the confidence needed to encourage dialogue between patients and care providers. Furthermore, it is doubtful whether a PHR can hope to overcome the fundamental differences in the philosophies of care which the therapists reported.
Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel Activities of Daily Living (ADL) Index score following stroke
Authors: Tekeolu Y'brahim , Adak Burhan , Göksoy Turgut
Published: May 2003

Objective: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) and placebo TENS on the level of activities of daily living (ADL) of stroke patients.

Setting: A university hospital. Patients: Patients who had had a stroke 30–240 days before entry to a university rehabilitation centre.

Design: Controlled design with block randomization and blinded assessment. Intervention: All patients had Todd–Davies exercises. In group 1 ( n = 30) TENS with frequency of 100 Hz was used at an intensity that the patient could tolerate; in group 2 ( n = 30) patients were given placebo TENS. The treatment protocol consisted of 40 sessions (eight weeks).

Outcomes: The Barthel Index for daily living activities was used to measure functional changes over time, and the Ashworth Scale was used to measure spasticity in the elbow, knee and ankle. These measurements were made prior to and following the treatment by assessors unaware of the patient's group allocation.

Results: There were 30 patients in each group. Patients in group 1 (active TENS) were more disabled at entry to the study. Statistically significant improvements were recorded in all parameters such as feeding, transfer, hygiene, toileting, bathing, walking, climbing stairs, dressing, bowel and bladder care for group 1 ( p<0.001) but only in some items in group 2. The change in total score was significant in both groups but the difference in the change score between the two groups was statistically significant ( p<0.001). Spasticity was reduced in the active treatment group.

Conclusion: TENS appears to be an effective adjunct in the regaining of motor functions and improving ADL in hemiplegic patients, but the accidental imbalance in severity of disability at entry makes interpretation uncertain.
Measuring outcome in community-based rehabilitation services for people who have suffered traumatic brain injury: the Community Outcome Scale
Authors: Stilwell Philippa , Stilwell John , Hawley Carol , Davies Carol
Published: May 2003

Objective: To develop a way of measuring long-term outcomes after traumatic brain injury (TBI) that takes account of individual circumstances.

Design: Reports by head-injured people and their families about problems and coping strategies were elicited via semi-structured interviews. Specially designed computer software was used to record problems and strengths and to measure their impact for the individual on four handicap dimensions.

Setting: Interviews took place in the respondents' homes.

Subjects: Between 1992 and 1997 the services at 10 rehabilitation centres in England were evaluated. Subjects were men and women aged between 16 and 65 who had suffered TBI and who had been referred for treatment to one of the centres under study.

Interventions: Head-injured people and their families were interviewed three months, 18 months and in some cases 36 months after recruitment.

Main outcome measures: The Hospital Anxiety and Depression Scale (HAD) and the Functional Independence/Assessment Measure (FIM/FAM) were used to validate relevant dimensions of the new scale.

Results: A measure of long-term outcome was developed and called the Community Outcome Scale. Relevant dimensions of the scale showed significant correlation with the HAD and with items of the FIM/FAM.

Conclusion: The scale captures information which no other instrument does, and merits further validation.
Assault, post-traumatic amnesia and other variables related to outcome following head injury
Authors: Wenden F J , Crawford S , Wade D T , King N S , Moss N EG
Published: May 2003

Objective: To estimate how many patients who sustain a head injury might benefit from intervention and support each year and to consider whether relationships can be found between demographic data relating to patients' circumstances at the time of head injury, and their outcomes six months later.

Design: Data collected on 625 patients through follow-up interviews and assessments by the Oxford Head Injury Service for a randomized controlled trial of intervention conducted in 1993–94.

Setting: A mixed rural and urban Health District with a population of approximately 560 000.

Patients: Patients were aged between 16 and 65 years and resident in Oxfordshire. They presented over 13 months to accident and emergency departments, or were admitted to hospital. All were diagnosed as having suffered a head injury.

Outcome measures: The Rivermead Head Injury Follow Up Questionnaire and the Rivermead Post Concussion Symptoms Questionnaire.

Results: Data are given on age, sex, social circumstances, employment, cause of injury, severity of associated injuries, post-traumatic amnesia (PTA), anticonvulsants, postconcussion symptoms and activities of everyday life. Outcome at six months was significantly worse for those who had been assaulted as against all other causes of injury combined ( p = 0.0001); and/or had been admitted to hospital ( p = 0.0001); and/or had sustained more severe additional injuries ( p = 0.04); and/or had experienced any PTA ( p = 0.00001). The minimum incidence of such injuries in those aged 16–65, calculated for Oxfordshire, is 292 per annum (74/100 000 aged 16–65 per year).

Conclusions: In the general population 52/100 000 patients per annum will experience more serious head injuries as indicated by hospital admission and/or one or more fractures and/or any length of PTA and/or having been assaulted. This group may benefit from monitoring and support and their needs should be considered when planning services.
The use of one-arm crank ergometry in the prediction of upper body aerobic capacity
Authors: Birkett W A , Edwards D F
Published: May 2003

Objective: To determine whether a submaximal one-arm cranking test could be used to predict an individual's upper body aerobic capacity. This issue has potential importance for the fitness assessment of individuals with neurological disease or damage who have hemiplegia.

Methods: Nine healthy male volunteers (33 ± 2.4 years) and nine female volunteers (27 ± 1.9 years) performed a two-arm maximal, two-arm submaximal test and a one-arm submaximal arm crank ergometry test. Heart rate (HR) was monitored via a three-lead electrocardiogram (ECG) and expired air was analysed every 30 seconds throughout. Prediction of peak oxygen consumption ( V O2peak) was calculated by linear extrapolation to an age-adjusted HRpeak.

Results: Heart rate and VO2 were highly correlated in each test, and there were no significant differences between the VO2peak values obtained from maximal cranking and VO2peak predicted from one-and two-arm submaximal tests for males and females. As expected, males were found to have significantly ( p<0.001) higher actual and predicted VO2peak values, indicating that separate regression equations should be used for males and females.

Conclusions: Heart rate values obtained during one-arm submaximal cranking have the potential to predict arm cranking VO2peak, and therefore provide an estimation of an individual's aerobic capacity, in addition to those obtained from the more traditional two-arm tests.
A study of the factors which influence the length of hospital stay of stroke patients
Authors: Hakim E A , Bakheit A MO
Published: May 2003

Objective: To examine the factors which influence the length of hospitalization of stroke patients.

Design: Analysis of the relative importance of 10 preselected variables on the length of hospital stay of all patients admitted with a clinical diagnosis of stroke. The data were collected prospectively.

Setting: Two teaching hospitals serving the city of Southampton and southwest Hampshire, England (approximate population 450 000).

Subjects: Forty-six consecutive stroke patients.

Results: Data were complete on 38 patients. The mean and (median) length of hospital stay was 74.9 (80.5) days for men and 74.7 (73.5) for women. The mean age of women in the study sample was higher than that of men (73.2 vs 71.6). Patients who were less than 70 years of age stayed shorter periods in hospital than older subjects. Other factors associated with shorter hospitalization were a stroke type other than total anterior circulation infarct, a Barthel score of 12 or more on admission or at the time of discharge and a frequency of consultants' ward rounds of more than one per week. A delay in the provision of equipment and home adaptations and waiting for placement in a private nursing home were the best predictors of long hospital stays of stroke patients.

Conclusions: Early liaison of rehabilitation staff with Social Services in order to secure the quick provision of environmental aids and adaptations or placement in residential care of stroke patients with a poor prognosis for functional recovery would probably reduce the unnecessary hospitalization of these patients.
Predictors of outcome of rehabilitation of elderly stroke patients in a geriatric ward
Authors: Thommessen Bente , Bautz-Holter Erik , Laake Knut
Published: May 2003

Purpose: To identify predictors of outcome after 12 months in elderly stroke patients rehabilitated in a geriatric ward.

Design: Prospective with evaluation in the subacute phase and after 12 months.

Setting: Geriatric ward and outpatient clinic.

Subjects: All stroke patients admitted from the acute unit to a geriatric ward for rehabilitation during a 16-month period ( n = 171). Main outcome measures: Place of living, mortality and social functioning (Frenchay Activities Index) 12 months following stroke.

Results: Age, urinary incontinence and cognitive function were significantly associated with place of living (home versus nursing home) 12 months post stroke in bivariate analyses. However, using multivariate logistic regression analyses, only age ( p = 0.005) and urinary incontinence at baseline ( p = 0.028) remained independent predictors of place of living. Mortality during the first year was significantly predicted by urinary incontinence and gender (men doing worse), whereas the Barthel Activities of Daily Living (ADL) Index sumscore was the only significant independent predictor of social activities.

Conclusion: Urinary incontinence at baseline seems to be a most important predictor of outcome 12 months post stroke in geriatric patients. However, with regard to social activities (Frenchay Activities Index), functional impairment in the initial phase as reflected by the Barthel ADL Index supersedes other predictors.
The development of a scale of the Guttman type for the assessment of mobility disability in multiple sclerosis
Authors: De Souza L H
Published: May 2003

Objective: To develop a valid and reliable scale of the Guttman type for the assessment of mobility disability in multiple sclerosis (MS).

Subjects: Sixty-eight subjects with a definite diagnosis of MS participated. They were living in the community and attending as outpatients at a MS unit at a District General Hospital. Thirty had the primary progressive pattern of disease, and 38 had the relapsing–remitting pattern.

Methods: Formal assessments used for neurological disability were inspected, and 14 test items of gross motor function were extracted and ordered according to criteria. These were that tests required trunk control and did not require isolated movement at a single limb or body segment, that actions progressed from lying, to sitting, to standing and walking tasks, proceeding from broader to narrower bases of support. All subjects carried out all test items which were scored as ‘pass’ or ‘fail'.

Analysis: Data were tested for internal consistency, reliability, inter-item correlation, reproducibility and scalability. On the basis of the results, the items were reordered in rank, and reduced to 11 tests. The 11-item scale was reanalysed.

Results: Results showed that the scale had an internal consistency of 0.88 (α coefficient) and a coefficient of reproducibility (CR) of 0.95 and above for both MS subject groups. The coefficient of scalability (CS) for items was 0.78 for primary progressive subjects and 0.74 for the relapsing–remitting group. Reliability ranged from moderate (kappa = 0.49) for one item, to perfect for six items.

Conclusion: The scale was demonstrated to be a hierarchical scale of the Guttman type exhibiting homogeneity and good reliability. The high CR indicated that scores may be summed, and the very acceptable levels of CS indicated that the cumulative scores are meaningful within the defined concept of hierarchy used in this study.
Sensitivity of Shah, Vanclay and Cooper's modified Barthel Index
Authors: Hocking Clare , Williams Maynard , Broad Joanna , Baskett Jonathan
Published: May 2003

Objective: To investigate whether Shah, Vanclay and Cooper's modification of the Barthel Index improved its sensitivity to change.

Design: Correlational study.

Setting: School of Occupational Therapy at Auckland Institute of Technology, Auckland, New Zealand.

Subjects: One hundred subjects requiring rehabilitation following a stroke.

Main outcome measures: Change in function which was measured using Shah, Vanclay and Cooper's (1989) modified Barthel Index and walking speed over 10 metres.

Results: Five statistical analyses were undertaken, none of which demonstrated clear superiority of one measure over the other.

Conclusions: The study did not indicate the modified Barthel Index to be more sensitive to change than the 20-point Barthel Index for this population. The statistical analysis strategies utilized are recommended for similar studies.
A systematic review of the evidence base for lifestyle planning in adults with learning disabilities: implications for other disabled populations
Authors: Rudkin Angharad , Rowe Dermot
Published: May 2003

Objective: To carry out the first systematic review of the evidence base for lifestyle planning (LP) approaches in adults with learning disability/developmental disorder and to discuss implications for other handicapped/disabled groups.

Method: Exhaustive review of relevant electronic databases, supplemented by appropriate hand-searching of journals and correspondence with key researchers. We gathered information from any papers reporting clear outcome measures. Quantitative and qualitative aspects of relevant studies are appraised.

Results: There are no randomized controlled trials of lifestyle planning in adults with learning disability/developmental disorder. There was one controlled trial. Five studies, with a total of 108 subjects clearly identified, report on some outcome data.

Conclusions: There is surprisingly little evidence to support any form of lifestyle planning or lifestyle planning in general in the learning disability population. No statistically significant findings on positive outcomes with good statistical power exist. Limited data are presented to suggest certain desirable features of some methods of lifestyle planning in terms of process or outcome. However, there may be good ethical reasons for pursuing lifestyle planning with certain patient groups. Suggestions are made as to how further research may add to the evidence base for or against effective outcomes in different forms of lifestyle planning.
Patients' perceptions of the Odstock Dropped Foot Stimulator (ODFS)
Authors: Taylor Paul N , Burridge Jane H , Dunkerley Anna L , Lamb Amanda , Wood Duncan E , Norton Jonathan A , Swain Ian D
Published: May 2003

Objective: To determine the perceived benefit, pattern and problems of use of the Odstock Dropped Foot Stimulator (ODFS) and the users' opinion of the service provided.

Design: Questionnaire sent in a single mailshot to current and past users of the ODFS. Returns were sent anonymously.

Setting: Outpatient-based clinical service.

Subjects: One hundred and sixty-eight current and 123 past users with diagnoses of stroke (CVA), multiple sclerosis (MS), incomplete spinal cord injury (SCI), traumatic brain injury (TBI) and cerebral palsy (CP).

Intervention: Functional electrical stimulation (FES) to correct dropped foot in subjects with an upper motor neuron lesion, using the ODFS.

Main outcome measures: Purpose-designed questionnaire.

Results:• Return rate 64% current users (mean duration of use 19.5 months) and 43% past users (mean duration of use 10.7 months). • Principal reason cited for using equipment was a reduction in the effort of walking. • Principal reasons identified for discontinuing were an improvement in mobility, electrode positioning difficulties and deteriorating mobility. • There were some problems with reliability of equipment. • Level of service provided was thought to be good.

Conclusion: The ODFS was perceived by the users to be of considerable benefit. A comprehensive clinical follow-up service is essential to achieve the maximum continuing benefit from FES-based orthoses.
An open socket technique for through-knee amputations in relation to skin problems of the stump: an explorative study
Authors: Otter N , Postema K , Rijken R AJ , van Limbeek J
Published: May 2003

Objective: To compare the conventional socket for through-knee amputees with an open socket system for skin problems and other relevant items.

Design: All data were collected during three visits to the prosthetic clinic. At the second visit the conventional socket was replaced by the open socket. The use of both socket types was evaluated with a questionnaire and stump inspection.

Setting: The subjects were evaluated at the Rehabilitation Centre, St Maartenskliniek, Nijmegen, the Netherlands.

Subjects: Twenty subjects with a unilateral through-knee amputation were included and 13 subjects had a trial with the open socket.

Results: There is a significant decrease of hyperhydrosis when wearing the open socket, there is no significant decrease in skin irritation or ulcers. The open socket also gives more comfort in sitting position.

Conclusion: A further trial is needed in a selected group of prosthesis users among through-knee amputees to establish the long-term acceptance and benefits of the prosthesis with an open socket.
Feasibility study of a novel approach to sore prevention in patients with spinal cord lesions: the computerized dynamic control Matrix 200 system
Authors: Catz A , Philo O , Gilad N , Barel O , Geva T
Published: May 2003

Objective: To evaluate the feasibility of a computerized mattress system based on a novel concept in sore prevention: continuous monitoring and adjustment of the interface pressure in small segments of contact between the skin and the supporting surface.

Design: A preliminary observational study.

Setting: The Spinal Department, Loewenstein Rehabilitation Hospital, Raanana, Israel.

Subjects: Twelve patients with spinal cord lesions.

Interventions: Patients were examined for signs of impending sores after lying on the mattress for up to 4 successive hours. The pressure within each of the mattress's air cells was continuously measured and adjusted.

Results: No evidence of redness or excessive perspiration was found in any of the areas considered to be high risk for bed sores. Maximal interface pressure was 22–30 mmHg in most of the examinations. Most of the patients felt comfortable on the mattress and the staff adapted easily to its operation.

Conclusions: The system is apparently safe, and at least as efficient as other existing means for preventing sores. In addition, it may allow for increased intervals between bed positionings. We conclude that this approach of pressure control has the potential to improve bed sore prevention in a rehabilitation hospital setting.
Current practice and clinical relevance of somatosensory assessment after stroke
Authors: Winward Charlotte E , Halligan Peter W , Wade Derick T
Published: May 2003

Objective: To examine the perceived clinical relevance, current practice and knowledge of somatosensory testing in three professional groups involved in the management and rehabilitation of stroke.

Design: Structured postal questionnaire sent to therapists and doctors. Subjects: One hundred and eighty occupational therapists from the National Association of Neurological Occupational Therapists (NANOT), 180 physiotherapists from the Association of Chartered Physiotherapists with an Interest in Neurology (ACPIN) and 360 doctors from the Association of British Neurologists (ABN) and the British Geriatrics Society (BSG).

Setting: Hospitals and rehabilitation centres in the UK.

Results: Replies were obtained from 84 occupational therapists (47%), 98 physiotherapists (55%) and 78 doctors (22%). Sixty-four occupational therapists (77%), 82 physiotherapists (84%) and 66 doctors (87%) indicated that they routinely performed somatosensory assessment as part of their clinical assessment. The two most commonly used measures were proprioception and light touch. Seventy-eight occupational therapists (93%), 88 physiotherapists (90%) and 67 doctors (91%) regarded sensory assessment as clinically significant in determining prognosis after stroke.

Conclusions: Despite published reservations concerning its usefulness and reliability, most therapists and doctors routinely assess somatosensory loss after stroke. All three professions agreed that somatosensory testing presented useful information for prognosis. Furthermore, all professional groups believe somatosensory assessment to be clinically relevant.
Stationary iterated tessellations
Authors: Maier Roland , Schmidt Volker
Published: May 2003

The iteration of random tessellations in ℝd is considered, where each cell of an initial tessellation is further subdivided into smaller cells by so-called component tessellations. Sufficient conditions for stationarity and isotropy of iterated tessellations are given. Formulae are derived for the intensities of their facet processes, and for the expected intrinsic volumes of their typical facets. Particular emphasis is put on two special cases: superposition and nesting of tessellations. Bernoulli thinning of iterated tessellations is also considered.
The nature of discrete second-order self-similarity
Authors: Gefferth A. , Veitch D. , Maricza I. , Molnár S. , Ruzsa I.
Published: May 2003

A new treatment of second-order self-similarity and asymptotic self-similarity for stationary discrete time series is given, based on the fixed points of a renormalisation operator with normalisation factors which are not assumed to be power laws. A complete classification of fixed points is provided, consisting of the fractional noise and one other class. A convenient variance time function approach to process characterisation is used to exhibit large explicit families of processes asymptotic to particular fixed points. A natural, general definition of discrete long-range dependence is provided and contrasted with common alternatives. The closely related discrete form of regular variation is defined, its main properties given, and its connection to discrete self-similarity explained. Folkloric results on long-range dependence are proved or disproved rigorously.
First passage times of a jump diffusion process
Authors: Kou S. G. , Wang Hui
Published: May 2003

This paper studies the first passage times to flat boundaries for a double exponential jump diffusion process, which consists of a continuous part driven by a Brownian motion and a jump part with jump sizes having a double exponential distribution. Explicit solutions of the Laplace transforms, of both the distribution of the first passage times and the joint distribution of the process and its running maxima, are obtained. Because of the overshoot problems associated with general jump diffusion processes, the double exponential jump diffusion process offers a rare case in which analytical solutions for the first passage times are feasible. In addition, it leads to several interesting probabilistic results. Numerical examples are also given. The finance applications include pricing barrier and lookback options.