bluuebunny/crossref_metadata_2025 huggingface dataset:
Routine screening of brain-damaged patients: a comparison of the Rivermead Perceptual Assessment Battery and the Chessington Occupational Therapy Neurological Assessment Battery
Authors: Sloan RL , Downie C. , Hornby J. , Pentland B.
Published: July 2008

Thirty-two brain damaged patients undergoing rehabilitation were assessed independently by the Rivermead Perceptual Assessment Battery (RPAB) and the Chessington Occupational Therapy Neurological Assessment Battery (COTNAB). The detection of perceptual deficits was similar with both batteries. The RPAB was quicker and slightly easier to use but the COTNAB was considered to give considerably more information. This led us to conclude that the COTNAB was the preferred battery for routine use in our clinical setting. Patients found both batteries acceptable with no particular preference for one over the other.
The Bradford community stroke trial: eight week results
Authors: Young John B , Forster Anne
Published: July 2008

To evaluate two commonly practised methods of stroke aftercare we have conducted a randomized comparison trial of day hospital (DH) and home physiotherapy (HPT). Patients over 60 years discharged from hospital following a new stroke event were eligible. One hundred and twenty-four patients were recruited, stratified by disability measured on the Barthel Index and by length of time since stroke onset, then randomized to attend a DH twice weekly or to receive HPT. Outcome measurements included the Barthel Index, Motor Club Assessment, Frenchay Activities Index, Nottingham Health Profile and the General Health Questionnaire.

One hundred and seven patients completed an eight week course of treatment. Both the DH and the HPT treated patients showed a significant but small further improvement in functional abilities with the HPT patients being significantly more able on stairs. Social function of both groups was poor but the HPT treated patients were significantly less so. More than a third of patients in each treatment group were depressed and more than a quarter of the carers were 'stressed'. The HPT patients received significantly less physiotherapy and virtually no occupational therapy compared to the DH group.

The findings suggest that HPT is slightly more effective for stroke aftercare than DH attendance and is considerably more resource efficient.
Seating in the outpatient clinic: the elderly patient's perspective
Authors: Hanger HC , Ball MC , Mulley GP
Published: July 2008

To assess the adequacy of seating provided for elderly outpatients, 97 subjects attending Medicine for the Elderly clinics were interviewed. Most patients rated the chairs of average or better comfort and seat height was judged to be appropriate by 77 (79%) patients.

However, over one half (54%) had difficulty when attempting to stand. Ten patients could not stand without assistance from another person. There were no significant differences in the ease of rising from those chairs with and those without armrests ( p > 0.10). Despite this, many subjects appeared to benefit from the use of armrests and 25% of subjects thought that all of the chairs provided should have armrests.

We recommend that all chairs in an outpatient clinic for elderly people should have armrests of appropriate design and height. This may prevent many elderly patients being unnecessarily dependent on others when attending hospital clinics.
Relation between handgrip strength, upper limb disability and handicap among elderly women
Authors: Turner David P , Ebrahim Shah
Published: July 2008

Age-related reductions in physical performance are important when thresholds required for independent activity are approached. Much rehabilitation aims to alleviate disability by improving physical performance (e.g. range of movement or strength), but information about the relation between impairments and disabilities and about the levels of relevant thresholds is very limited. This study aimed to examine the relation between impairment of handgrip strength, dexterity disability and handicap. Eighteen female day centre clients (mean age 78.9, SD 9.9 years) were assessed using the following measurements: a handgrip dynamometer, a standarized task of moving a saucepan of different weights, the Office of Population Censuses and Surveys' scale of severity of dexterity disability and self-perceived health status using the Nottingham Health Profile. Strong correlations were observed between impairment of handgrip force and dexterity ( r = —0.7251, P <0.001), but not between impairment/disability and handicap variables. A threshold effect was observed: four out of 18 subjects with a low handgrip strength per total forearm volume (<0.10 N/ml) were unable to perform a saucepan task and had low dexterity ability. The impact of a training regimen directed towards improving the handgrip force of those approaching the threshold required for independent activity should be evaluated.
Wheelchair-related accidents
Authors: Dudley NJ , Cotter Dhg , Mulley GP
Published: July 2008

This study set out to determine the prevalence of wheelchair-related accidents, the circumstances in which they occur, the nature of injuries sustained, and to identify types of accident which are potentially avoidable. A postal questionnaire was sent to a random sample of 250 of the 4334 wheelchair users in the Leeds Eastern Health District. Those reporting accidents to themselves or their attendant were then interviewed by telephone. Of the 174 wheelchair users who completed the postal questionnaire, 48 reported accidents to themselves or others. Of wheelchair occupants 18% had had wheelchair-related accidents, falls being the most frequently reported with five users sustaining a fracture. Accidents involving wheelchair attendants were reported by 15.5% of users. It is concluded that wheelchair-related accidents are not uncommon and whilst most are minor, serious injuries can result. There is scope for prevention of many of these accidents for both wheelchair users and attendants.
Perspectives of motor neurone disease
Authors: Cox Diane L
Published: July 2008

This preliminary study explores the everyday needs and requirements of patients with motor neurone disease (MND) and indicates similarities and differences between the patient's viewpoint, that of their main carer and that of their occupational therapist (OT). The study highlights differences between the three subject groups. The MND subjects' views centred on physical needs, the carers on the emotional and psychological impact of MND and caring, while that of the OTs focused on the co-ordination of physical and psychological aspects of MND, both for patient and carer. The primary need agreed upon by all subject groups was the essential role of the carer in the management of MND.
Segmental reflex therapy for neurogenic contractures— a clinical study
Authors: Sonnen Victor G
Published: July 2008

The relaxation of spastic contracted muscles by the application of topical anaesthesia with benzocaine solution to the overlying skin was described by Sabbahi et al. in 1981, but was not confirmed by other authors. In 1989, Wolf and Minsk challenged Sabbahi et al.'s findings, bringing controversy to the subject. In this study, topical anaesthesia was repeated with one important modification: benzocaine was applied not only to the skin overlying the muscle, but segmentally to the entire dermatome, including the paravertebral area. The observed effect was seen in muscular relaxation at least equal to that described by Sabbahi et al., but surpassing it by far in duration. Case presentations are given. Segmental anaesthesia of the skin using the dermatomo-myotomic reflex is a simple and efficient procedure which deserves to be accepted in the management of neurogenic contractures.
The role of psychotropic drugs in the elderly with hip fractures
Authors: Adunsky A. , Hershkowitz M.
Published: July 2008

Psychotropic drug therapy, which represents an important aspect of health promotion in the elderly, is considered to be associated with a high incidence of falls and hip fractures. In this retrospective case-control study, the interaction was tested between psychotropic drug use (short-and long-acting anxiolytics/hypnotics, antidepressants and antipsychotics), sex and hip fractures in 196 consecutive cases of community-dwelling elderly with hip fractures and 133 healthy age- and sex-matched community-residing controls. A total of 20% of the cases and 21% of the controls were receiving psycho-active medications. No association was found between fracture occurrence and use of psychotropics ( p = 0.73). In addition, no significant interaction was found between sex and the incidence of fracture. Psychotropic drug use may be less important than previously assumed in connection with the occurrence of hip fractures in the elderly.
Transcutaneous electrical nerve stimulation (TENS) in the treatment of postoperative pain and prevention of paralytic ileus
Authors: Akyüz G. , Kayhan O. , Babacan A. , Gener F Atalay
Published: July 2008

This study was performed on 30 patients who had undergone various gynaecological operations. Transcutaneous electrical nerve stimulation (TENS) was used on 17 patients and placebo TENS on the remaining 13. Pain severity, the need for analgesic drugs and the presence of paralytic ileus were evaluated in all patients during the first three postoperative days. There was no significant difference in pain severity between the two groups in the immediate postoperative period ( p > 0.5). However, evaluations performed at the end of the first, second and third postoperative days revealed a very significant difference in pain severity ( p < 0.01) and analgesic drug use in the two groups. A comparison of postoperative complications showed paralytic ileus in seven patients in the placebo group (54%); only two patients in the TENS group (12%) showed the same symptoms. Significant analgesia, an important reduction in analgesic drug use and a decrease in the incidence of paralytic ileus were observed as a result of the application of TENS in the postoperative period.
Symmetry of anterior tibial muscle size measured by real-time ultrasound imaging in young females
Authors: Kelly SJ , Stokes MJ
Published: July 2008

The between-limb symmetry of anterior tibial muscle size was examined in 40 healthy females, aged 18-35 years (20.7 ± 3.9). Real-time ultrasound imaging was used to measure the cross-sectional area (CSA) of the muscle group. With the subject half-lying, bilateral scans were taken and measurements of CSA were made by tracing the muscle group outline using an onscreen electronic calliper. On each scan, two CSA measurements were made and the mean of the two measurements was used in the analysis. Between-side comparisons were made by expressing the CSA of the smaller muscle as a percentage of that of the larger muscle and the mean, standard deviation and range for the 40 subjects were calculated. The paired t-test was used to compare the raw data between-sides, i.e. larger versus smaller muscle. The smaller muscle was approximately 93% of the size of the larger muscle with a mean difference of 7.2% ± 5% and a range of 0.1-20%. The differences between the raw values for CSA were significantly different ( p < 0.001). The degree of symmetry of anterior tibial muscle size has been documented in a group of normal young females using real-time ultrasound scanning, which could be used to examine wasting in patients with unilateral leg injuries or pathology. The degree of normal symmetry for other subject groups of both sexes and different ages needs to be documented.
Scaling the Barthel: a 10-point hierarchical version of the activities of daily living index for use with stroke patients
Authors: Barer David H , Murphy Jeremy J
Published: July 2008

In summed indices of ADL, such as the widely used Barthel Index, scores may not form a truly ordinal scale since patients with different patterns of disability can achieve the same total score. This problem could be overcome if activities could be shown to have a consistent hierarchy of difficulty. We therefore examined the hierarchical properties of the Barthel Index in a large group of stroke patients, using Guttman-scaling analysis. We also examined a simplified 10-point version of the Barthel, as well as the 10-point Nottingham scale which was designed as a hierarchical ADL scale for stroke patients. The items of the full 20-point Barthel Index did not form a consistent hierarchical scale, but when each activity was graded simply as 'pass or fail', thus forming a 10-point scale, the criteria of Guttman-scaling were satisfied. This simplification of the Barthel Index produced an ordinal scale without significant loss in information content. The hierarchical properties of the Nottingham scale were also confirmed, but its prognostic value appeared to be slightly lower than that of the Barthel. The 10-point hierarchical version of the Barthel Index should be useful in large epidemiological or audit studies, where complete information is hard to obtain, but it is probably too crude to be useful in managing individual patients. We emphasize that our results apply only to stroke and that the hierarchy of ADL might be different for other conditions.
Spinal and shoulder complex posture. II: thoracic alignment and shoulder complex position in normal and osteoporotic women
Authors: Culham Elsie , Peat Malcolm
Published: July 2008

Thoracic spine and shoulder complex posture were measured in 57 women over the age of 50. On the basis of thoracic spine measures, the women were divided into normal posture ( n = 27), thoracic kyphosis ( n = 18) and thoracolumbar kyphosis ( n = 12) posture groups. Analysis of variance was used to determine if shoulder complex postural measures differed in the three groups. In the sagittal plane, both abnormal posture groups had significantly greater forward angulation of the scapula and humeral extension compared with the normal posture group. In the transverse plane, scapular protraction and the angle between the scapular spine and clavicle were significantly greater in the thoracic kyphosis group compared with the other two groups. In the coronal plane, the abduction angle of the humerus was significantly less in the thoracic kyphosis group compared with the normal posture group. No difference was found in scapular position in this plane. Although differences were apparent between the posture groups, many of the clinical hypotheses regarding the effect of spinal posture on shoulder complex position were not substantiated by the results of this study.
Acupuncture in the treatment of hand paresis in chronic and acute stroke patients - improvement observed in all cases
Authors: Naeser Margaret A , Alexander Michael P , Stiassny-Eder Denise , Lannin Linda Nobles , Bachman David
Published: July 2008

This study reports the effect of acupuncture on the treatment of hand paresis in stroke patients who had no other proximal arm or leg paresis following stroke. The location of the area of infarction on a chronic CT scan was analysed in all cases.

Eight chronic stroke patients were treated with acupuncture beginning after six months to eight years following stroke; and three acute stroke patients were treated with acupuncture beginning after two months following stroke. Patients received 20 or 40 acupuncture treatments over a two- or three-month period. All patients had good response defined as improvement on at least four of six hand tests after 20 or 40 acupuncture treatments. Among the eight chronic cases, significant improvement was observed in timed hand dexterity tests, as well as pinch and grip strength tests. Most of the improvement was sustained for at least two months after the completion of acupuncture treatments. All patients had lesion in only half, or less than half of the motor pathway areas on CT scan.

Results suggest that acupuncture may be an additional beneficial treatment modality for stroke patients with hand paresis, even when started as late as five to eight years following stroke. The CT scan findings and results from this study support those from our previous acupuncture research with stroke patients where good response was observed in patients with lesion in less than half of the motor pathway areas and in patients with only mild/moderate hemiparesis. More controlled research with a larger number of patients appears warranted.
Problems of vocational integration after cancer
Authors: Weis Joachim , Koch Uwe , Kruck Peter , Beck Andreas
Published: July 2008

The study aimed to provide a descriptive analysis of work-related problems and problems of occupational integration following cancer, in the view of patients. Cancer patients ( n = 566) of two rehabilitation clinics were asked by questionnaire for their work-related problems and changes in work situation due to cancer as well as their evaluation of outcome of medical rehabilitation with regard to their occupational situation.

The results show that in general, most patients seem either to take recourse to early retirement or are able to resume their occupational activity without special occupational training. Specific measures in vocational rehabilitation played almost no part in the experience of our survey population. From the point of view of patients, medical rehabilitation had a negligible influence on vocational integration. We found no significant differences between different cancer diagnostic groups, with regard to restrictions in work performance and other work-related problems. However, in line with similar results reported in the literature, blue-collar workers in our study returned less frequently to their former places of work, being more likely to take early retirement. The results are discussed concerning the methodological problems of the study.
Immobility and severe dementia: when is physiotherapy treatment appropriate?
Authors: Pomeroy VM
Published: July 2008

Research of the effects of physiotherapy treatment on the mobility skills of elderly people with a dementing illness is limited. Seven out of 16 patients of a long-term care hospital ward (psychiatric) completed all phases of an ABAB single case study. Mobility skills increased in six of these when physiotherapy (consisting of body awareness, music and movement and functional mobility training) was introduced for the first time. Latency of change was between one and six weeks with five to nine weeks of treatment given before optimal response was obtained. When treatment was withdrawn and reintroduced again these participants were inconsistent in their mobility response. Nine of the 16 patients withdrew because of deteriorating health. Results suggest that sitting balance on initial assessment may be associated with withdrawal. This study supports previous findings of improvement in mobility following physiotherapy treatment. Further research is required to test the generalizability of these results.
A study of the North Staffordsh i re you ng adult service forthe physically handicapped school leaver and young adult
Authors: Aung TS , Boughey A. , Ward AB
Published: July 2008

Studies have shown that the expectations of physically disabled school leavers are low when they have nothing to do and they fail to develop even further. It has also been shown that where there is a service for young physically disabled school leavers, there is benefit for the young people. We performed an evaluation of our own service using a questionnaire and additionally looked at areas of unmet need. The study showed that the team's activities were useful, and young people obtained benefit from the service which they would not otherwise have had, for lack of proper assessment. It was realized that a number of services, which were requested, did not take place and these related to communication between our team and the community health service. We have adapted our service to address these problems and now plan to look more formally at ways to promote clients' desired lifestyles.
Process and outcome of care: comparison of two inpatient geriatric rehabilitation settings
Authors: Bentur Netta , Eldar Reuben , Davies Michael A
Published: July 2008

The objective of this study was to compare the process of care and outcome of rehabilitation in geriatric hospitals and in geriatric wards of general hospitals. It was longitudinal in design. Patients were interviewed on admission and on discharge. Data were retrieved from medical records and a questionnaire on the process of care was administered to staff members. Geriatric wards in four general hospitals and four independent geriatric hospitals in Israel provided the setting and approximately 50 consecutive admissions of patients with hip fracture or stroke, a total of 410 patients, were recruited from each setting. Four process indices and three outcome indices were used to measure quality of care. %

The main outcome showed that the functional status of the study population was higher on discharge than on admission and most patients were discharged to their former residence. When controlling for other variables, geriatric hospitals contributed more to higher functional status on discharge than did geriatric wards in general hospitals. Yet satisfaction with treatment was higher in geriatric wards in general hospitals than in geriatric hospitals. The main factors affecting patient satisfaction were functional status on discharge and the amount of rehabilitative treatment given.
An automatic device to measure time spent upright
Authors: Diggory P. , Gorman M. , Schwarz J. , Helme R.
Published: July 2008

Objective measurements of time spent standing or walking would be of benefit in assessing response to therapy. We have tested a device consisting of a mercury tilt switch attached to an electronic counter to measure time spent upright. Eleven subjects, six male and five female age 67-88 years (mean 76 years) undergoing rehabilitation were studied. Diagnoses included: Parkinson's disease, dementia, stroke and femoral fracture. The device was fitted with the tilt switch on the lateral aspect of thigh. Measurements compared stopwatch readings made by an observer and the device. Study periods were of one to three hours. There was excellent correlation between stopwatch and device measurements of time spent standing (t = 0.994; p < 0.001). The device functioned well during physiotherapy and ward activities although measurements were inaccurate when subjects used an exercise bicycle or climbed steps greater than 20 cm in height. The device should prove useful for monitoring activity and response to mobilization therapy.
Driving assessment - a case of need
Authors: Barnes Michael P , Hoyle Elizabeth A
Published: July 2008

The ability to drive a car is important for the retention of independence within modern Western society. However, the assessment of car-driving ability is not normally part of a rehabilitation programme. This study has made an assessment of the demand for such a service in a random selection of disabled people in Newcastle upon Tyne. A total of 11 000 people were screened using the OPCS disability questionnaire. The disabled population identified with a predominant physical disability aged 16-80-years-old was sent a further questionnaire regarding driving status. One-hundred-and-nine current disabled drivers were identified, very few of whom had received any advice on car choice or car adaptations. Twenty per cent of the disabled population felt they would have benefited from advice from a driving assessment centre. A subgroup of 39 people attended for a more detailed driving assessment. Twenty-three people in this group were current drivers and it was felt that 17 could have benefited from further advice, particularly regarding car and control adaptations. A total of 16 ex- drivers or nondrivers were also evaluated and 11 of this group were felt capable of driving after appropriate advice. Overall this study has demonstrated the need for access to advice on ability to drive and car adaptation. A large number of the disabled population proposed that driving assessment and advice should be an integral part of a rehabilitation programme. There should be an increase in the number of properly equipped driving assessment centres in this country.
Late rehabilitation for closed head injury: clinical psychologists' interventions
Authors: McDowell Ilona , Anderson Shirley , Wilson Claire , Pentland Brian , Robertson Ian
Published: July 2008

Neuropsychologists have been criticized for concentrating upon the assessment and recording of the psychological consequences of head injury while providing little, if any, direct intervention to assist in the rehabilitation of traumatically brain- injured people. The authors describe the experience of a clinical psychologist's attempt to provide a comprehensive outpatient service to a group of head-injury survivors discharged from a rehabilitation unit. Of 54 patients, 50 were seen at least once by the psychologist while 22 were seen on four or more occasions. A substantial part of the workload was accounted for by contacts with relatives or other principal carers, with more than half of the carers being seen. Another major activity was liaising with other professionals or agencies; in eleven patients, six or more contacts of this nature proved necessary. The authors concluded that there was an indication for the provision and careful evaluation of an expanded psychological service for people in their first two years after head injury.
Determinants of rehabilitation following fracture of the hip in elderly patients
Authors: Eldar Reuben , Tamir Ada , Susak Zeev
Published: July 2008

The objective of the study was to explore the relationships between rehabilitation outcomes in elderly patients admitted to a rehabilitation hospital following a surgically treated hip fracture and independent variables. Prefracture function, and independent patients' variables and particulars regarding the fracture were recorded. Functional and mental status as well as motivation and co-operativeness were assessed on admission to rehabilitation, during rehabilitation and six months after discharge. Data were transferred to structured questionnaires for analysis.

A total of 112 patients with a mean age of 74.8 years, made up of 75% females and 25% males, were admitted consecutively for rehabilitation after a surgically treated hip fracture sustained in a fall, during a two-year period (1989-91). Of these, 11 patients (9.8 per cent) died during rehabilitation; 86% of the 101 survivors returned to their prefracture residence, but 25% of survivors had not attained their prefracture functional status by discharge. Motivation, co-operativeness and unimpaired mental function on admission to rehabilitation were found to be the most important determinants of satisfactory outcomes.

It was concluded that attention should be paid to the elderly person who has sustained the fracture and not only to the fracture itself. Motivation and co- operativeness should be constantly monitored during the rehabilitation process.
Validity of a self-administered version of the Barthel Index in patients with rheumatoid arthritis
Authors: Bakheit Amo , Harries SR , Hull RG
Published: July 2008

The Barthel Index (BI) in its original format must be completed by a therapist. To overcome this disadvantage a self-administered version of the BI was designed, the modified Barthel Index (MBI). In the present study the MBI was validated against the original BI and also the Stanford Health Assessment Questionnaire (HAQ) in 33 patients with rheumatoid arthritis (RA). There was a close correlation between BI and MBI in eight out of the 10 items of the scale and in the overall score. Similarly, there was a good correlation between MBI and HAQ but only in patients with mild disability. Further analysis of data showed that the HAQ overestimated the degree of disability in patients with RA and may be less reliable than the MBI in measuring functional independence in these patients.
Late functional recovery with a novel community rehabilitation programme after herpes simplex encephalitis
Authors: Brett Matthew , Greenwood Richard , Powell Jane , Morris Peter
Published: July 2008

A 15-year-old boy had severe persisting behavioural and cognitive deficits after herpes simplex encephalitis in 1980 despite 18 months of early inpatient rehabilitation, two and a half years at home and 16 months' inpatient treatment in a behavioural unit. Following discharge from the behavioural unit in 1987, a behavioural programme was continued in the home using an untrained daytime care worker under the supervision of a community psychologist. This was associated with significant and continuing functional recovery in many areas including continence, wandering, washing and dressing. Possible reasons for the success of this inexpensive novel programme and the implications for long-term rehabilitation of brain-injured patients are discussed.
Lack of influence of EMG biofeedback in relaxation training for spasmodic torticollis
Authors: Duddy J. , McLellan DL
Published: July 2008

Reports in the American and Japanese literature have suggested that electromyographic (EMG) biofeedback is effective in the treatment of spasmodic torticollis but no conclusive evidence has been reported from controlled studies. A controlled study was therefore undertaken in 11 subjects with spasmodic torticollis. Five patients were randomly allocated to a course of television- monitored relaxation while the remaining six were treated with television- monitored relaxation plus EMG biofeedback. The effects of intervention were assessed by questionnaires, clinical assessment and measurement of integrated EMG activity in both sternomastoid muscles during a five-minute observation period under controlled conditions. The subjects' range of voluntary neck movements and their capacity to suppress their involuntary movements were measured using a computer-assisted movement detection system (Coda 3, Charnwood Dynamics) and standardized videotape recordings, the latter being assessed by two experienced clinicians who did not know the sequence of the recordings. Subjective improvements in symptoms were reported in both groups of subjects, who appeared to gain from the opportunity to discuss harrowing aspects of their experience. However, these subjective results were not associated with any significant changes in the objective measures used and thus provided no support for the use of EMG biofeedback in torticollis.
Treatment of the neglect syndrome in stroke patients using a contingency electrical stimulator
Authors: Prada Gabriel , Tallis Raymond
Published: July 2008

Two patients with major infarcts in the right middle cerebral artery territory associated with severe perceptual problems including tactile neglect were treated with a contingency electrical stimulator. This delivered electrical stimuli to the forearm skin on the neglected side whenever the patient moved the contralateral normal arm, with the intention of drawing the patient's attention to the neglected side. The effect of this treatment was assessed in a single case design using the Rivermead Perceptual Assessment Battery.

Both patients had a statistically significant improvement in tests of perceptual function during the period of the study. In addition, there was a significant difference between the treatment and the baseline periods: the differences between the slopes of the regression lines fitted to the scores were statistically significant, favouring the treatment periods. This supported the inference that the changes were at least in part due to the treatment rather than merely the natural history of the disease.

These results suggest that this approach to treating an otherwise intractable condition should be further investigated.
Evaluation of dressing practice for stroke patients after discharge from hospital: a crossover design study
Authors: Walker MF , Drummond Aer , Lincoln NB
Published: July 2008

Objective: To determine whether giving dressing practice to patients at home with unresolved dressing problems following stroke reduces the problems.

Design: A randomized crossover study design was used, randomly allocating patients to receive no intervention for three months followed by three months' treatment, or the reverse.

Setting: All patients were at home, and treatment was given in the home.

Subjects: Patients at home with problems in dressing six months after acute stroke, having been discharged from hospital.

Intervention: A senior occupational therapist gave regular dressing practice to patients with their families. Specific techniques depended upon the problem.

Outcome measures: An independent assessor used the Nottingham Stroke Dressing Assessment, the Rivermead ADL, self-care section, and the Notting ham Health Profile to measure outcome.

Results: Fifteen patients were included in each group. Both groups showed statistically significant improvement during the treatment phase (Wilcoxon matched pairs test: z = 2.47, p = 0.01; z = 3.01, p = 0.002). Neither group showed any change during the non-treatment phase. Patients who received treatment in the first three months maintained their improvement (z= 0.90, p = 0.36).

Conclusion: Dressing practice given at home to patients who have residual problems in dressing six months after acute stroke leads to a sustained reduction in their problems.
Stroke rehabilitation in the elderly: analysis of six years' experience
Authors: Friedman Paul J
Published: July 2008

Objective: To evaluate changes to a system consisting of a stroke unit and a stroke registry to follow elderly stroke subjects from admission until six months poststroke.

Methods: The inputs, outputs and outcomes of stroke for all persons aged 60 and above were measured over six years (1987-92).

Results: An average of 212 persons with acute stroke were registered each year. Demographic features of stroke subjects did not change appreciably during the six-year study period. Indices of stroke severity and case fatality remained similar. Hospital length of stay, however, fell by 45% from 1987 to 1992 (p <0.0001) without any decline in functional outcome, as measured by Barthel ADL scores at discharge or maximal recovery and discharge residence. The percentage of subjects transferred to the stroke unit rose from 43% in 1987 to 64% in 1992. The stroke unit operated with minimal selection.

Conclusions: Stroke units using minimal selection criteria warrant further study as an alternative to more highly selective stroke units.
Controlling assistive technology with head movements - a review
Authors: Dymond Elizabeth , Potter Roger
Published: July 2008

A significant proportion of severely disabled people need to use head movements to control assistive equipment such as communication aids, environmental control systems and powered wheelchairs. It is useful to review what head movement interfaces are commercially available or the focus of research and development and their most appropriate clinical application. Such interfaces are usually required by the most severely physically disabled people and members of the rehabilitation team may come across such interfaces rarely and be unsure of their appropriate use in a given situation.
The problem-oriented multidisciplinary approach in Dutch nursing home care
Authors: Hertogh Cmpm , Deerenberg-Kessler W. , Ribbe MW
Published: July 2008

In The Netherlands, nursing home medicine is an important branch of geriatric medicine. Therapeutic emphasis in this field is placed on function rather than disease. Multidisciplinary geriatric rehabilitation and long-term care are provided on an inpatient as well as on a semi-outpatient (day hospital) and outpatient ('substitution care') basis. This article discusses the reasons for the adoption of a problem-oriented approach in this field of geriatric medicine. It also outlines the modifications that were necessary to make the method suitable for application in the care of chronically ill elderly patients and describes how it can be used. The teaching of the problem-oriented approach is a cornerstone of the postacademic training programme for nursing home physicians and this method is currently being implemented in university- affiliated nursing homes.
The use of a multidisciplinary rehabilitation assessment clinic as an alternative to hospital admission
Authors: Bakheit Amo , Ward CD , Morris S. , Walker P.
Published: July 2008

An interdisciplinary outpatient rehabilitation clinic was set up to assess patients with severe and complex disabilities. The rehabilitation team consisted of a physician, a nurse, a community liaison occupational therapist, a community physiotherapist and a speech and language therapist. Each patient was assessed in the clinic for half a day. The patients' carers were encouraged to attend. A total of 25 consecutive new patients were studied. The findings of the study suggest that the range of therapeutic interventions carried out during the outpatient clinic visit were comparable to the standard model of care. To evaluate the effectiveness of this service in preventing hospital admissions the case histories of the study patients were presented to three consultants in rehabilitation medicine who were asked to give their management decision on each case, but were not told the objectives of the study. Analysis of the consultants' decisions showed that there was agreement between all consultants that five patients needed admission to hospital for evaluation or treatment and two out of the three physicians said that they would have admitted a further eight patients. In fact, none of our patients was admitted, which suggests that the model of outpatient multi disciplinary assessment service proposed here may reduce the need for admissions to hospital.
Botulinum toxin type A for the treatment of arm and hand spasticity in stroke patients
Authors: Sampaio Cristina , Ferreira Joaquim J , Pinto Ana A , Crespo Manuela , Ferro José M , Castro-Caldas Alexandre
Published: July 2008

Background: Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect for botulinum toxin A (BTX-A) for relief of spasticity.

Objective: To evaluate the safety and efficacy of BTX-A in the treatment of spasticity in a homogeneous group of stroke patients.

Methods: In this phase III open label trial 19 stroke patients stable for at least six months were enrolled (mean age 53.1 (SD 3.27) years; range 26-72). There were 16 males and 4 females.

Assessments: Clinical (Ashworth spasticity rating scale, scores for joint mobility, pain and frequency of spasms, Frenchay arm test (FAT)) and subjective (semi-quantitative rating scale filled out by the patient). Only hand and finger flexors were injected. The maximum dosage was 150 U BOTOX® (25 U/muscle), the mean dosage was 92.1 ± 31.6 U BOTOX®.

Results: Ashworth rating scale and joint mobility scores improved from a median value of 2 at baseline to a median value of 1 one month after treatment, FAT scores also improved from a median value of 0 at baseline to a median value of 1 one month after treatment (Kruskall-Wallis test p < 0.01). Two-thirds of the patients rated their functional improvement as none or mild.

Conclusions: Our study confirmed that BTX-A has an anti-spastic effect but its functional impact needs further evaluation.
A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients
Authors: Logan PA , Ahern J. , Gladman Jrf , Lincoln NB
Published: July 2008

Objective: To determine whether stroke patients referred to the Social Service occupational therapy service would benefit from an enhanced service compared to the usual service.

Design: Randomized controlled study allocating patients to the enhanced service or the usual service.

Subjects: Stroke patients discharged home from hospital and referred to Social Service occupational therapy department.

Outcome measures: The sections and total score from the Nottingham Extended Activities of Daily Living Scale (EADL), the Barthel Index, the General Health Questionnaire (GHQ) and the number of pieces of equipment provided were analysed.

Results: One hundred and eleven stroke patients were recruited to this study. Fifty-three were randomly allocated to the enhanced service and 58 to the usual service. Patients receiving the enhanced service were seen more quickly after referral, for longer, and received significantly more visits (p <0.01 ) than those receiving the usual service. Three months after entry to the study the enhanced service group had better EADL (p <0.01 ) than the usual service group. This benefit remained significant in only the mobility section of the EADL at six months. Carers of the stroke patients in the enhanced group had lower GHQ scores (p <0.05) than those in the usual group at six months. Conclusions: This trial supports the use of domiciliary occupational therapy for stroke patients after discharge from hospital in terms of improvements in functional outcomes in the short term, but the long-term benefits remain unclear.
Setting handicap goals with elderly people: a pilot study of the Life Strengths Interview
Authors: Pomeroy VM , Conroy MC , Coleman PG
Published: July 2008

Objective: To assess whether the Life Strengths Interview (LSI) is a useful clinical framework to identify handicap goals.

Design: Clinical case studies.

Settings: Two elderly care rehabilitation hospitals.

Subjects: Five people, whose ages ranged from 73 to 90 years. All participants were aware of their likely resultant disability, scored 25+ out of a possible 30 with the Mini-Mental State Examination, were able to communicate effectively and were due to be discharged home in approximately one month.

Interventions: Each participant undertook the LSI process with the research occupational therapist.

Main outcome measures: Identified rehabilitation goals and their achievement.

Results: Goals were focused around families and other support networks. Six to eight weeks following discharge, achievement of goals varied.

Conclusions: This pilot study suggests that the LSI may be a useful clinical framework but further research needs to investigate whether a modified clinical version may be more suitable.
Are there gender differences in functional outcome after stroke?
Authors: Wyller Torgeir Bruun , Sødring Karen Margrethe , Sveen Unni , Ljunggren Anne Elisabeth , Bautz-Holter Erik
Published: July 2008

Purpose: To study gender differences in functional outcome unexpectedly observed in a follow-up study of stroke patients.

Design: Prospective study of hospitalized stroke patients, with evaluations in the subacute phase and after one year.

Setting: Geriatric and general medical wards, and geriatric outpatient clinic of a university hospital serving as general hospital for a defined population.

Subjects: All stroke patients admitted during a six-month period (n = 165) were considered for inclusion, of whom 87 could be assessed in the subacute phase and 65 after one year.

Main outcome measures: Motor function assessed by the Sodring Motor Evaluation of Stroke Patients; cognitive function by the Assessment of Stroke and other Brain Damage; and activities of daily living (ADL) function by the Barthel Index. Nursing-home residency registered after one year.

Results: Men achieved a significantly better score than women on most of the scales used. The age-adjusted odds for a man to have a higher Barthel score than a woman was 3.1 (95% confidence interval (CI) 1.3-7.0) in the subacute phase and 3.3 (95% CI 1.2-9.0) after one year. Differences of the same magnitude were seen on the subscales of the motor and cognitive tests. The same trend was observed on all items of the Barthel Index. The males had a lower likelihood to be permanent nursing-home residents after one year, the age-adjusted odds ratio for nursing-home residency for females versus males being 6.3 (95% CI 1.2-65.3).

Conclusion: Women seem to be functionally more impaired by stroke than men.
A review of outcome indicators in the treatment of chronic limb oedema
Authors: Sitzia J. , Stanton Awb , Badger C.
Published: July 2008

Objectives: To provide an overview of physical and psychological outcome indicators which have been used to evaluate conservative treatments for chronic oedema.

Methods of finding papers: Papers were located via the MedLine, CINAHL and GEARS databases, and the British Lymphology Interest Group Key References lists.

Issues reviewed: The literature reveals that only a small amount of work has addressed conceptual issues in outcome evaluation. Above all, outcome indicators have been adopted in clinical practice in a haphazard manner, with little discussion regarding the purpose of outcome assessment/measurement and little agreement on the most appropriate assessment/measurement techniques.

Results: Eleven outcome indicators appear in the literature, each of which is discussed in terms of instrumentation and application in clinical practice. Practitioners have focused on objective measures, with change in limb volume the outcome measure most commonly used.

Conclusion: It is concluded that more rigour is needed in many aspects of outcome evaluation. Practitioners and researchers in this field should become more questioning of existing evaluation practices, and should explore the many potential outcome indicators, such as limb movement and limb function, which have to date been neglected.
The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report
Authors: Richardson D. , Edwards S. , Sheean GL , Greenwood RJ , Thompson AJ
Published: July 2008

Objective: To investigate the benefits of the focal use of botulinum toxin in spasticity in the forearm seen after incomplete spinal cord injury.

Design: A single case study with standardized assessment before and at three-week intervals after injection.

Intervention: EMG-guided selective injection of botulinum toxin.

Subject: A 23-year-old man, 18 months post injury.

Measures: Rivermead Motor Assessment; grip strength; Jebsen hand tests; visual analogue scale; Ashworth spasticity scale.

Results: Weakness was seen as expected with some functional losses, but the patient made gains in the areas of concern: shaking hands, typing, using the hand to drink. These gains were sustained at 12 weeks.

Conclusion: Selective use of botulinum toxin to weaken muscles can lead to functional benefit.
A pilot study to determine the efficiency of lightweight carbon fibre orthoses in the management of patients suffering from post-poliomyelitis syndrome
Authors: Lewis M Heim , Yaacobi E. , Azaria M.
Published: July 2008

Objectives: To assess the usage of carbon fibre orthoses in assisting post- polio syndrome patients who reported advancing weakness and difficulty in maintaining their independent ambulatory status.

Design and interventions: Carbon fibre orthoses that are 30% lighter than metal braces were constructed.

Subjects: Thirty patients who complained of difficulty in maintaining their ambulation using long-leg braces were provided with lightweight orthoses.

Results: Seventy per cent of the patients reported satisfaction with their braces. There were, however, problems in construction and use.

Conclusions: Ambulation can be preserved in some patients who report advancing weakness because of post-polio syndrome.