bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic changes in upper limb short latency somatosensory-evoked potentials following stroke in the dominant hemisphere
Authors: Keren O. , Ring H. , Pratt H. , Groswasser Z.
Published: July 2008

Repeated upper limb short latency somatosensory-evoked potential (USSEP) studies were performed in 19 post-stroke patients and correlated with the clinical evaluation. Examinations were performed on admission to the rehabilitation centre, and again about 10 weeks later. Data analysis focused on the temporal changes occurring in each patient, and the relationship of these changes to the patient's clinical condition. In seven of the 19 patients, no cortical potentials could be detected on admission or follow-up. These patients had the worst clinical outcome. Whenever a cortical potential was found in the first examination, it was also detected in the second. Dynamic changes between examinations were mainly seen in the central conduction time (CCT) and showed an opposite trend in each hemisphere. In the second examination, the average CCT lengthened over the damaged hemisphere ( p < 0.03) but shortened (insignificantly) over the nonaffected hemisphere, relative to the CCT in the first test. A positive correlation ( p < 0.03) was found between the increase in NI/PI amplitude - measured peak-to-peak between the major negative component (NI) of the cortical response and the subsequent positive wave (PI)-and improvement in communication ability, especially comprehension.

The USSEP can serve as an auxiliary tool in monitoring the recovery process of stroke patients. Changes in USSEP components occur over both hemispheres and may serve as markers of brain plasticity.
Elderly people at risk of falling: do they want to be taught how to get up again?
Authors: Simpson Janet M , Mandelstam Halcyon
Published: July 2008

The purpose of this multicentre, prospective study was to examine the reactions of elderly people at risk of falling to being taught how to get up from the floor. Physiotherapists working in geriatric medicine units (five day units, 18 wards across 12 hospitals) identified a total of 552 potential fallers (44% of all patients available during the study period). Of these people, 105 (19.0%) were capable of being taught how to get up again, (mean age 83.5; SD 5.0, range 64-96). Sixty-six patients (63%) agreed to be taught, 24 (23%) refused and 15 (14%) reluctantly agreed. Willingness to be taught was not related to age, memory test score or time spent on the floor after the last fall but was related to patients' confidence in their own ability to get up again (chi-square 7.54; p = 0.023). This confidence was unrelated to subsequent practical performance.

Although two-thirds of the elderly people who were fit to learn how to get up from the floor were willing to do so, most of those who refused or only reluctantly agreed were not facing up to their risk of falling. Besides taking measures to prevent further falls, all people at risk should have their coping strategies checked, and where necessary helped to confront this problem and rehearsed in how to cope with a fall should it occur.
The impact of the Community Care Act on bed turnover in a rehabilitation unit
Authors: Bakheit Amo , McLellan DL
Published: July 2008

A significant proportion of hospital beds is usually occupied by patients awaiting placement, home adaptations or other care provisions by Social Services. Anecdotal evidence suggests that the number of 'acute bed-blockers' has fallen since the implementation of the Community Care Act (CCA). The aim of the present study was to examine the validity of this claim.

Records of patients discharged from Southampton Rehabilitation Unit in the twelve months before and after the implementation of the CCA ( n = 72) were analysed. Contrary to previous reports, there was no difference in the overall length of hospital stay or the time patients spent awaiting discharge after they had achieved functional independence. The reasons for the inappropriate hospitalization were also similar in the two groups and were mainly due to shortage of residential care places for patients with disabilities and delays in the provision of equipment, services and home adaptations.
Prescribing wheelchairs: the opinions of wheelchair users and their carers
Authors: Smith Caroline , McCreadie Michele , Unsworth Jim
Published: July 2008

The first stage in the process of developing an audit tool for wheelchair services was a study to examine the expectations of wheelchair users and their carers. The findings demonstrate an expectation that the wheelchair will improve their quality of life, enable them to maintain or attain a level of mobility, and help the user to achieve an acceptable level of independence. Wheelchair users also required a wheelchair that was comfortable, easy to propel, that had an acceptable appearance and was safe. For the carer/attendant the main requirements were for a chair that was easy to push and lightweight for lifting. They also hoped that the wheelchair would improve the quality of both their life and that of the user, and improve or maintain their health status. The results also suggest that information on carers may not be routinely collected during assessment, and that there is a need to formalize a sensitive approach to assessing the expectations of users and their carers. The authors conclude that a correctly prescribed wheelchair benefits both user and carer.
Occupational therapy for stroke patients at home
Authors: Clarke PA , Collins H. , Gladman Jrf
Published: July 2008

The provision of occupational therapy for stroke patients by the social services was examined in 327 patients who had been discharged from hospital. Two- thirds (64%) of the patients were referred to the social service occupational therapist (SSOT). The occupational therapist visited a median of seven days from referral, treated the patient twice and then closed the case.

The SSOT provided a range of equipment and adaptations to encourage independence in the community. Half of the patients visited received a bath- board and a quarter received an extra stair-rail to assist with mobility.

Patients who had been referred to the SSOT and who also received therapy from an experimental domiciliary rehabilitation team received significantly more grab handles than those who were referred to the SSOT and also treated by the hospital-based rehabilitation teams.

The SSOT provided a limited service to the group of stroke patients studied, mainly delivering equipment. The equipment was relatively cheap and may have been more appropriately administered by the hospital-based occupational therapist before the patient was discharged.
The emotional consequences of falls for older people and their families
Authors: Liddle Jane , Gilleard Chris
Published: July 2008

The emotional impact on elderly patients and their relatives of falls has not been widely studied. The authors of this study interviewed a consecutive series of 69 elderly patients admitted to hospital after a fall, together with their carers, to assess the significance of any fear of future falls and to examine other variables that might be associated with such fears. Whilst 25% of the patients expressed a significant fear of falling, 58% of the carers interviewed reported a great fear that their relative/friend might fall again. Fear of falling was primarily related to the emotional rather than the physical status of the patient. An attempt was made to contact all the patients and relatives one month after discharge and further interviews were conducted with those who were successfully followed up. Of the 46 patients re-interviewed, the proportion still reporting a fear of falling had dropped to 19% although the proportion of carers expressing such fears had risen to 66%. Finally there was no evidence that a fear of falling had influenced rehabilitation outcome.
Bell's palsy: the effect on self-image, mood state and social activity
Authors: Weir AM , Pentland B. , Crosswaite A. , Murray J. , Mountain R.
Published: July 2008

Twenty patients with idiopathic lower motor neurone paralysis, Bell's palsy, were graded clinically for severity of palsy and subjected to a battery of questionnaires to assess self-image, mood and functional disability. A range of severity of palsy was represented and a variety of disturbance with facial self-image, social activity and emotional state was found. In particular 16 expressed dissatisfaction with at least one aspect of facial appearance, seven reported disturbance of face-to-face conversation and 12 described a change in other people's attitude to them. It was concluded that there is evidence of considerable social handicap in a proportion of patients afflicted by this otherwise relatively benign condition.
The efficacy of low-level laser therapy in supraspinatus tendinitis
Authors: Saunders Liz
Published: July 2008

Twenty-four subjects were randomly assigned to two groups to assess the effectiveness of low-power laser therapy for supraspinatus tendinitis. A low- power laser using a 820 nm, 40 mW probe operating at 5000 Hz to produce a dose of 30 J/cm2 was used to treat one group (L); the other group was treated with a similar, but dummy, laser (DL). The design of the trial was double-blind; patients, therapists and assessors being ignorant of the form of treatment used. The two groups each received a course of nine treatments and identical advice and educational material. Perceived pain was assessed and tenderness and secondary muscle weakness measured before and after the course of treatment.

The data revealed that the L group had less pain (p < 0.05), less secondary weakness (p < 0.01) and tenderness (p < 0.05) after the treatment than before. No such changes occurred in the DL group; indeed, secondary weakness and tenderness increased slightly in the latter group after treatment.

The degree of pain, tenderness and weakness of the two groups was similar before treatment. Comparing the two groups after treatment, L had less pain (p < 0.05) and less weakness (p < 0.001) than DL.

These data suggest that, in this small group of patients, laser therapy, advice and education improved certain symptoms of supraspinatus tendinitis, while the same advice and education but treatment with a dummy laser had no such beneficial consequences. Based on the results, low-power laser therapy with the parameters and dosage used in this study is recommended as a useful treatment for tendinitis, but the trial was limited by small numbers.
Multiple sclerosis and sexual functioning - a review
Authors: Dupont Simon
Published: July 2008

Although sexual dysfunction affects between 50-90% of individuals with multiple sclerosis (MS), its diagnosis and treatment are still very much in their infancy. Myths, stereotypes and discrimination limit thorough research and therapy studies in the area. This review focuses on the present state of knowledge regarding aetiology, prevalence, symptoms and impact on partners of sexual problems among the MS population. It finishes with a discussion on current treatment options available to health care professionals.
Delivery of rehabilitation services — an integrated hospital-community model
Authors: Bakheit Amo
Published: July 2008

The present models of delivery of rehabilitation services in the United Kingdom do not take into account the recent reorganization of the National Health Service (NHS) into purchaser and provider units, or the Community Care Act. Furthermore, these models are based almost entirely on hospital practice with minimal emphasis on long-term community support for the disabled.

An alternative model, which takes into account the recent changes in planning and resource allocation in the NHS, and the new role of local government in community care provision for people with disabilities, is proposed in this paper. The model also attempts to bridge the gap between hospital and community rehabilitation services. It is based on a philosophy of multidisciplinary team work, clients' autonomy and recognition of the contribution and needs of informal carers. It emphasises the importance of creating a partnership with local authorities and voluntary bodies which care for the disabled.

To ensure the continuity of rehabilitation care provision in the community, the model adopts a system of follow-up which is based on three levels of assessment of the needs of disabled clients living in the community. It is suggested that disabled clients with high care needs, e.g. disabled school leavers, are reviewed routinely by the rehabilitation physician. Subjects with mild or stable disability and adequate social support may only need to be reviewed on ad hoc basis, whilst those with intermediate needs could be monitored by a therapist by telephone or home visits.
Problems of seating and mobility encountered by children with developmental dysplasia of the hip
Authors: Cox Sara L , Mollan Rab
Published: July 2008

The parents of 11 children who were either undergoing or had undergone treatment for 'late-diagnosed' developmental dysplasia of the hip were surveyed by questionnaire to discover the problems associated with activities of daily living. Within this survey, special emphasis was placed on the problems of seating and mobility. The results of the analysis show that there was a deficiency in the equipment available to cope with children in splintage and plaster; there was a need for products to help in seating, particularly with regard to enhancing mobility. This pilot study confirmed the need for focused research to provide such products and a definitive study has now been undertaken.
The benefit of inpatient neurorehabilitation in multiple sclerosis
Authors: Kidd D. , Howard RS , Losseff NA , Thompson AJ
Published: July 2008

The role of an inpatient neurorehabilitation unit in the management of multiple sclerosis (MS) remains unclear. A necessary first step is the demonstration of benefit in those who are admitted. In order to address this question, 79 patients with MS admitted over a 16-month period for multidisciplinary rehabilitation were studied using assessment scales as measures of disability and handicap. Fourteen patients were recovering from a recent relapse and the remaining 65 were in the progressive phase of the disease. The patients were clinically assessed and rated on admission and discharge using Kurtzke's Disability Status Scale (DSS), the Barthel Index (BI) and the Environmental Status Scale (ESS). A statistically significant functional improvement was seen in 65% of patients as determined by the Barthel Index and 44% improved on the ESS. Improvement was most marked in those in whom a reduction in impairment had occurred during recovery from relapse but also occurred in 63% of those who had not changed neurologically. These results suggest a beneficial effect from admission to a neurorehabilitation unit for patients with MS, including those in the progressive phase of the disease, although its role in the long-term management of MS remains to be defined.
An evaluation of a multiple sclerosis liaison nurse
Authors: Kirker Sgb , Young E. , Warlow CP
Published: July 2008

The workload and benefits of a new liaison nurse service for multiple sclerosis patients were assessed by retrospective examination of the nurse's records, interviews with patients and carers, and a postal questionnaire survey of general practitioners (GPs). The average number of contacts with 136 patients in two years was 14. Twenty-one to forty-four per cent of patients were referred to various therapists and 17% for respite care. Eighty-eight per cent of patients found the nurse helpful and 39-54% reported improved coping, mood, confidence and knowledge of multiple sclerosis (MS). Carers reported similar benefits. GPs found the nurse helpful with 66% of their patients, and she detected unrecognized disabilities in 23%. Twenty-three per cent of GPs learnt something about MS from her and 40% of GPs said they would purchase her service from their budget. Patients, carers and GPs felt that the service was helpful and that it improved patients' and families' psychological well-being, reduced GPs' workload and increased patients' and doctors' knowledge of the management of multiple sclerosis.
An objective assessment of knee function
Authors: Lennox Iac , Murali R. , Scott J. , Williams D. , Wytch R.
Published: July 2008

In order to evaluate the benefit produced by treating an osteoarthritic knee, clinicians have devised various subjective knee-scoring systems but these often do not correlate well with clinical practice. An objective method of assessing knee function was developed which is simple to perform, noninvasive and reproducible. Various parameters of knee function were measured in a group of normal volunteers and a group of patients with a known knee pathology, and a graph was developed incorporating selected knee function parameters. This graph can be used to show the severity of a knee pathology and to determine the benefits of any subsequent treatment.
A subjective memory assessment questionnaire for use with elderly people after stroke
Authors: Davis Alison M , Cockburn Janet M , Wade Derick T , Smith Philip T
Published: July 2008

The aim of this study was to develop a subjective memory questionnaire for use with elderly people after stroke. A 13-item questionnaire was devised using items identified by 10 stroke patients and taken from existing memory questionnaires. It was tested on 50 elderly stroke patients and 50 elderly control subjects. Validation was carried out using the Rivermead Behavioural Memory Test (RBMT) and a significant positive correlation was obtained ( r= 0.71 ; p <0.001). The correlation between the subjective rating for the normal elderly subjects and the RBMT was not significant. It was concluded that the questionnaire is valid for use with elderly people after stroke but not for normal elderly subjects. The reasons for this discrepancy are discussed.
The impact of job characteristics on work-related well- being of handicapped employees in relation to pain
Authors: van Oel Clarine J , Schmidt Sonja H , Oort-Marburger Dorothee , Meijman Theo F
Published: July 2008

The present study examined the effects of pain complaints (none, moderate, severe pain), job demands and decision latitude on indices of work-related well-being among 165 subjects with functional impairments induced by a disease and/or an injury. After controlling for age, working hours and level of job demands, decision latitude significantly predicted the level of work reluctancy and recovery need. After controlling for age and working hours, recovery need is predicted not only by enduring severe pain and by job demands, but, in addition, to that by decision latitude. Heavy job demands in combination with low decision latitude place a load on all workers, confirming the job demand/control model of Karasek. Moreover, employees suffering from severe pain benefit more from perceived control over their work than those with moderate or no pain complaints.
Occupational therapy for stroke patients after hospital discharge — a randomized controlled trial
Authors: Corr Susan , Bayer Antony
Published: July 2008

A randomized controlled trial was conducted with the aim of evaluating the influence of continued rehabilitative intervention by an occupational therapist on stroke patients after their discharge from a stroke unit. One hundred and ten patients were recruited and randomly allocated to either an intervention group, who were reviewed regularly by an occupational therapist in addition to receiving normal follow-up services, or a control group who received no special intervention. The two groups were compared at one year poststroke. Although there were few significant differences between the two groups at one year in terms of activities of daily living, extended activities of daily living, mood, and perceived quality of life, the number of aids (toilet aids and stair-rails) received by the intervention group was significantly greater (p = 0.05) and the number of readmissions to hospital was significantly smaller (p = 0.03). The provision of a follow-up service by an occupational therapist benefits stroke patients by addressing any problems they have postdischarge, ensuring they receive all necessary aids and helping to maintain them at home.
Repeatability of position sense measurements in persons with osteoarthritis of the knee: a pilot study
Authors: Marks Ray
Published: July 2008

Several reports have described a position sense deficit in persons with osteoarthritis of the knee. For purposes of future comparison, this study determined the agreement between serial measurements of knee position sense conducted over a 10-day period for eight persons of mean age 67.87 ± 7.36 years with stable knee-joint disease. The knee angles used to determine position sense were recorded in the seated position using a potentiometer. The outcome measure was the mean absolute error between five set angles and their matching angles. The intra-class correlation coefficients (ICCS) used to assess reliability of the mean absolute error measurements within and between sessions ranged from 0.57 to 0.52 with an average standard error of measurement of 1.18 degrees. It is concluded that while fairly reliable, clinicians should interpret changes in knee position sense of less than 2.31 degrees carefully in these patients before concluding that a true improvement or deterioration in their knee positioning accuracy has occurred.
Eye movements in patients with visual neglect following right hemisphere stroke
Authors: Fanthome Yvette , Lincoln Nadina B
Published: July 2008

Failure to move the eyes to the side of space contralateral to a brain lesion may account for some aspects of visual neglect. Eye movements were recorded in four groups of right hemisphere stroke patients: 18 patients with no neglect or hemianopia; nine patients with neglect and no hemianopia; three patients with hemianopia but no neglect; and 16 patients with both neglect and hemianopia. In addition, a normal control group of 20 subjects was studied. Patients with no neglect or hemianopia spent significantly longer observing the left side of five slides than normal controls, or those with visual neglect. There were no significant differences between control and neglect patients, but neglect patients looked significantly more to the right than non-neglect patients. Patients with most severe neglect tended to be those who failed to search the left side of space. Severity of neglect as assessed on the Behavioural Inattention Test was the best predictor of bias in eye movements.
Low-level laser therapy does not aid the management of tennis elbow
Authors: Papadopoulos ES , Smith RW , Cawley Mid , Mani R.
Published: July 2008

The value of low-level laser therapy (LLLT) as a therapy for painful tennis elbow is dubious since evidence for its efficacy is conflicting. This report presents the results of a randomized, double-blind, controlled study on patients with tennis elbow (n = 29) using a gallium aluminium arsenide laser. Two different methods of assessing pain, visual analogue scores and a Marcy Wedge Pro® exerciser, were used. No significant differences were found between the treatment and placebo groups. This suggests that LLLT at the dosage and duratiion used in this study is without benefit in the short-term management of painful tennis elbow.
Treatment with desmopressin in nocturia and nocturnal enuresis following traumatic brain injury
Authors: Novak Stephen
Published: July 2008

A trial of intranasal desmopressin was conducted in a patient with nocturia and nocturnal enuresis following a severe traumatic brain injury. Desmo pressin proved to be a safe and effective treatment. The frequency of nocturia and disturbed nights was significantly reduced (p <0.05) without any change in the frequency of micturition during waking hours. No side-effects were encountered.
The effectiveness of chemical neurolysis in the treatment of lower limb muscle spasticity
Authors: Bakheit Amo , Badwan Dah , McLellan DL
Published: July 2008

The use of phenol and alcohol nerve blocks in the treatment of localized muscle spasticity is well established. However, a number of questions relating to this procedure are still unanswered. This article presents experience of the effectiveness of chemical neurolysis in the treatment of severe lower limb muscle spasticity in 28 patients who had a total of 56 nerve blocks performed during a follow-up period of between four and 18 months.
Staff satisfaction with team conferences: development of a questionnaire
Authors: Jelles F. , van Bennekom Cam , Lankhorst GJ , Bouter LM
Published: July 2008

The Rehabilitation Activities Profile (RAP) is part of RAP-TEAM which is a novel method for structuring multidisciplinary team conferences. As such, RAP-TEAM is intended to facilitate interdisciplinary team work in rehabilitation medicine. Before the effects of RAP-TEAM in team conferences can be studied, an assessment method had to be chosen. A questionnaire was considered the most appropriate. The present study describes the develop ment of this questionnaire and its psychometric evaluation. Questions were drafted from three sources: literature, team conference observations, and discussion with professionals from various disciplines. Questions were divided among five dimensions: (1) problem analysis, (2) planning intervention, (3) evaluation, (4) organization, and (5) common viewpoint. For psychometric evaluation the questionnaire was completed by 39 professionals of various rehabilitation disciplines. After analysis of homogeneity (values of Cronbach's alpha range from 0.70 to 0.84), the predesigned dimension structure of the questionnaire was studied. The predesigned dimension structure could not be confirmed. Only one new dimension appears to be present which is post hoc defined as 'a professional's satisfaction with team conferences'. Homogeneity of this singular dimension is 0.92. Face and content validity of questions were established during construction of the questionnaire. Response to the ques tionnaire was not biased by social desirability. It is concluded that the ques tionnaire can be used to study the effects of RAP-TEAM.
Fluctuations of spasticity in the lower limbs in patients with multiple sclerosis
Authors: Nuyens G. , De Weerdt W. , Spaepen A. , Ketelaer P. , Feys H. , De Wolf L. , Hantson L. , Nieuwboer A.
Published: July 2008

A study of 25 patients with multiple sclerosis was performed to observe fluctuations of spasticity in the lower limbs during the day. Six muscle groups were tested on the left and right side, including the extensors, the adductors and the internal rotators of the hip, the flexors and extensors of the knee and the plantar flexors of the ankle. Spasticity was evaluated in supine position with the Ashworth scale four times during one day between 7.30 a.m. and 8.00 p.m. The data were analysed with the Friedman test. No statistically significant fluctuations in muscle tone were disclosed (α = 0.05) except for the knee extensors on the right side. An additional analysis with statistics of concordance based on the comparison of consecutive scores confirmed the finding that no major changes of spasticity were registered with the Ashworth scale for the 25 patients during the period of testing. The general opinion of clinicians, that spasticity is a variable phenomenon, was not supported statistically by the results of the present study, possibly because of the standardization of the test situation. The fact that standardization of the test situation might be enough to obtain steady scores on the Ashworth scale could be interesting in studies of the effects of treatments on spasticity.
Does the Volunteer Stroke Scheme improve social outcome after stroke? A response to Geddes and Chamberlain
Authors: Marshall Jane , Sacchett Carol
Published: July 2008

A recent study by Geddes and Chamberlain (Clin Rehabil 1994;8: 116-26) claimed that the Volunteer Stroke Scheme was particularly effective in bringing about 'social recovery' in patients with communication problems after stroke. This response argues that Geddes and Chamberlain present very little evidence to support this claim. Failings are identified in the group design, the selection of evaluation measures and the analysis of results. It is also argued that, in the current market climate of the National Health Service, such inflated claims from evaluation studies could seriously mislead purchasers. In conclusion, alternative methodologies for this type of evaluation are suggested.
Orthotic management of haemophilic arthropathy of the ankle joint
Authors: Tanaka S. , Hachisuka K. , Ogata H.
Published: July 2008

Twenty haemophiliacs (34 ankles) who were prescribed ankle-foot orthoses (AFOs) or foot orthoses (FOs) were evaluated to confirm whether an orthosis improves the haemophilic arthropathy of the ankle joint. The guideline for the orthosis was the following: shoe modification for enquinus deformity, pain or occasional haemorrhages; elastic ankle supporter with a calcaneal silicone pad for occasional haemorrhages; flexible plastic AFO for frequent haemorrhages and AFO with double uprights for frequent haemorrhages in conjunction with the ankle joint deformity. One year after prescribing the orthosis, the frequency of bleeding in the ankle joint with an ankle supporter was reduced, and the range of motions and X-ray findings of the ankle joint had not deteriorated. Therefore, it was concluded that orthotic management for haemophilic arthropathy in addition to prophylactic therapy might be effective.
An unusual method of managing a difficult pressure sore
Authors: Bamji AN , Hook EA
Published: July 2008

A patient with multiple sclerosis developed an awkward perineal pressure sore, which was difficult to manage not only because of its site, but also because severe muscle spasm caused great difficulty in positioning. A hoist used in an unusual way enabled the sore to heal satisfactorily.
Correlations between sensory-motor functions and motor performance measured by optoelectronic kinesiology in 75-year-olds
Authors: Matousek M. , Frändin K. , Gause-Nilsson I. , Johnels B. , Steg G. , Steen B.
Published: July 2008

The motor performance in an everyday motor task, lifting an object from the floor and placing it on a shelf - the Posturo-Locomotor-Manual test (PLM test) - was recorded using optoelectronic kinesiology in 150 subjects within a broader study measuring functional capacity in 75-year-olds (the NORA 75 study). The results were correlated in all persons to tests for isometric muscle strength, visual acuity, postural balance, vibrotactile threshold, reaction time, pulmonary function and maximal walking speed. The PLM test performance correlated well with the isometric muscle strength measurements in men and strong individuals were consequently faster than weaker persons. A moderate correlation was found with pulmonary function in men. The association between the PLM test parameters and muscle strength was poor in women. Subjects with slower psychomotor and walking speed moved significantly slower in the PLM test in both sexes. No association was found with visual acuity, postural balance or vibrotactile threshold. The PLM test might be used to identify individuals at risk of disability caused by decline in muscle strength.
The effect of graded effort on the severity of associated reactions in hemiplegic patients
Authors: Dvir Zeevi , Penturin Elia , Prop Iris
Published: July 2008

The main purpose of this study was to examine the relationship between controlled levels of effort induced in the nonplegic forearm and the associated reactions (ARs) elicited in the plegic forearm of poststroke patients. Twenty hemiplegic patients, eight women and 12 men, were asked to isometrically contract their forearm flexors, on the unaffected side, at levels equal to 100%, 75% and 50% of the maximal effort. Exerting submaximal effort was accomplished by monitoring the digitally displayed force levels which were measured by dynamometer. The ARs were measured using a goniometer. Findings revealed a direct relationship between the effort level and severity of the ARs, namely, contracting the flexors at 50%, 75% and 100% was associated with an average increase in the elbow angle of 13°, 29° and 47° respectively. Owing to the large inter-trial variations in the ARs, this trend did not reach statistical significance. The implications of the technique are discussed.
Assessing mobility in multiple sclerosis using the Rivermead Mobility Index and gait speed
Authors: Vaney C. , Blaurock H. , Gattlen B. , Meisels C.
Published: July 2008

Measurement tools assessing disability in MS patients are essential to evaluate the effect of the growing number of drug treatments and to measure rehabilitation outcome. However, the most widely used EDSS (Expanded Disability Status Scale) has been shown to be insensitive to minor changes. The assessment of disability with simple measures such as the Rivermead Mobility Index (RMI) and gait speed timed over 10 m has been suggested. Two hundred MS patients attending a rehabilitation centre were assessed at the beginning and at the end of a four-week period (median 28.2 days; interquartile range (IQR) 1.8 days) using these two measures as well as the EDSS and the Ambulation Index (AI). The RMI was the most sensitive scale and measured changes in 39% of the patients, whereas AI changed in 18.5% and EDSS in only 7.5% of the patients. The RMI assessed more precisely ambulatory patients needing walking aids, for which EDSS proposes only two options (EDSS 6.0/6.5). To measure the variability of the 10 m walking time, 25 of the 115 ambulant patients were asked to cover the distance at five different times on the same day chosen at random. Variability within one patient on test-retest was calculated by dividing the standard deviation of the five measures by the mean value of the measures. In spite of its great variability of 20 ± 8%, gait speed timed over 10 m was as sensitive as the AI and measured changes in 16.5% of these ambulatory patients (AI in 15.6%). The RMI and gait speed timed over 10 m should be used more widely to assess disability and to measure the physiotherapeutic effort devoted to improving mobility of MS patients.
Evidence for a central mechanism in the process of fatigue in people with multiple sclerosis
Authors: Kersten P. , McLellan DL
Published: July 2008

The study aimed to establish quantitative and qualitative aspects of fatigue among a group of people with multiple sclerosis (MS) who had identified fatigue as a troublesome symptom and a control group of healthy adults. An interview, a fatigue diary and a fatigue-inducing experiment were designed and the Nottingham Health Profile was employed. People with MS experienced significantly more fatigue than healthy adults, on a daily basis. Factors noted to cause and to relieve fatigue were similar in people with MS and healthy adults. The only differences were that a hot bath improved fatigue in healthy adults and accentuated it in people with MS and that more of the healthy adults mentioned lack of sleep as a cause of fatigue. Physiological muscular fatigue during a quadriceps test was of similar magnitude in the two studied groups but the perceived fatigue levels were disproportionally high in the patient group. The results support the view that central mechanisms are responsible both for muscle weakness and for the sense of fatigue experienced so frequently in multiple sclerosis. This central mechanism is likely to reside in motor pathways within the nervous system. Further studies, measuring corticomotor conduction times, motor unit firing frequencies and metabolic factors, are recommended.
The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk
Authors: Jones L. , Lewis Y. , Harrison J. , Wiles CM
Published: July 2008

Objective: The aim of the study was to evaluate the effectiveness of therapy intervention in reducing impairment and disability due to upper limb and trunk ataxia in chronic multiple sclerosis (MS).

Design: The change in performance scores of two patient groups - an inpatient group who received two weeks' therapy intervention and an outpatient 'control' group awaiting a similar admission - were compared.

Subjects: Thirty-seven (out of a total of 62) patients with clinically definite or laboratory-supported definite MS, with ataxia of the upper limbs and/or trunk, and who had stable or slowly progressive disease.

Intervention: The (inpatient) treatment group (n = 28) received eight half-hour sessions each of occupational therapy and physiotherapy over eight consecutive working days. Treatment approaches used were aimed at improving dynamic posture and appropriate adaptation of the environment. The control group (n = 9) received no intervention.

Assessments: Patients were assessed the day before therapy began and the day after it ended: the control group were assessed at the same (two-week) interval. Assessments used included the Jebsen Test of Hand Function (JTHF), the Kurtzke Functional Systems Scale (FSS) and Expanded Disability Status Scale (EDSS), the Northwick Park Index of activities of daily living (NPI), and patient and assessor visual analogue scales. Assessors were independent of patient treatment.

Results: There were no significant differences between the two groups at entry to the study with respect to age, sex and scores on the FSS (exception bowel function). The NPI scores were not significantly different except for walking and feeding, whereas the control group was slightly better (Mann-Whitney U-test; p = 0.048; p = 0.037).

No significant difference between the change scores of the two groups was found on the JTHF and FSS neurological scores. The treatment group showed significant improvement compared to controls in the NPI scores and on the self and assessor visual analogue scales.

Conclusion: The findings support the clinical impression that therapy used to improve dynamic posture and methods of performing functional tasks can result in improvement of functional ability in patients with MS where spontaneous improvement would not otherwise be expected.
Value of measuring perceived problems in a stroke population
Authors: van Bennekom Coen AM , Jelles Frank , Lankhorst Gustaaf J , Kuik Dirk J
Published: July 2008

Functional status assessments mainly concentrate on difficulty in performance and/or dependency on other people. Very few assessments document the perceived problems of the patient regarding the assessed activities. This study evaluates the added value of measuring perceived problems using a parallel assessment method: the Rehabilitation Activities Profile. The study population consisted of 57 stroke patients living at home, six months after stroke. Thirty-three were receiving therapy (physiotherapy or rehabilitation day care). The patients indicated that they perceived a number of problems, especially on the items 'walking', 'using transport', 'leisure activities' and 'relation with friends/acquaintances'. The perceived problem scores did not relate in a uniform way to the disability scores. The perceived problem scores were dichotomized. The proportions of persons with perceived problems showed statistically significant differences between the therapy group and the nontherapy group for 15 out of 21 items (p <0.02). The cumulative relative frequency distributions showed that the therapy group indicated significantly more problems than the nontherapy group (p <0.01). It was concluded that it is at least as important to measure perceived problems as it is to measure disabilities.
The Mobility Scale for Acute Stroke Patients: intra-rater and inter-rater reliability
Authors: Simondson Janine , Goldie Pat , Brock Kim , Nosworthy Jill
Published: July 2008

Objective: With increasing pressure for accountability in the Australian health service, clinicians require reliable and valid measurement tools for assessing the physical status of stroke patients in the acute setting prior to entering rehabilitation, so that predictions can be made about the potential length of stay in rehabilitation and level of outcome. In response to the lack of suitable measures of physical disability for acute stroke patients, the Mobility Scale for Acute Stroke Patients was developed. The aim of this paper was to investigate the intra-rater and inter-rater reliability of the scale.

Method: Five tasks, which incorporate functional movements from lying to walking, were assessed using a six-point scale based on the level of assis tance. Stroke patients were filmed while being assessed by an experienced examiner using the Mobility Scale. Twenty-one clinicians viewed 10 video- taped performances of each activity.

Results: The intra-rater reliability from the viewing sessions one month apart was excellent for 92% of the judgements (weighted kappa >0.75). The weighted kappa values for inter-rater reliability were all in the excellent agreement range above 0.75.

Conclusion: The results of this study showed that the Mobility Scale has a high degree of reliability using this testing procedure. The reliability of the Mobility Scale in the clinical setting and its validity in predicting length of stay and outcome are being investigated.
Evaluation of disability in multiple sclerosis patients: a comparative study of the Functional Independence Measure, the Extended Barthel Index and the Expanded Disability Status Scale
Authors: Marolf MV , Vaney C. , König N. , Schenk T. , Prosiegel M.
Published: July 2008

This study was conducted to compare the Extended Barthel Index (EBI) to the Functional Independence Measure (FIM) and the Expanded Disability Status Scale (EDSS) as a measure used to assess changes in a patient's need for help with activities of daily living. One hundred patients with multiple sclerosis were evaluated by the same person upon arrival in a rehabilitation clinic and four weeks later. EBI and FIM both proved to be far more sensitive in detecting changes than the EDSS (29% of patients changed their EBI score, 32% their FIM score, 5% their EDSS score). EBI and FIM showed a very high correlation (Spearman correlation coefficient rs = 0.9705). Both scales correlated somewhat less with the EDSS ( rs = -0.7624, resp. -0.7611). Considering the high correlation and equal sensitivity of EBI and FIM, the study recommends the use of the EBI, since it has a simpler rating system and the elimination of some redundant FIM items increases user-friendliness and compliance.
The 'S' test - a preliminary study of an instrument for selecting the most appropriate mobility aid
Authors: Prajapati C. , Watkins C. , Cullen H. , Orugun O. , King D. , Rowe J.
Published: July 2008

Objective: To develop and evaluate a qualitative and quantitative instrument for selecting the ideal mobility aid for those with mobility disorders.

Setting: A district general hospital-based geriatric unit.

Subjects: Elderly inpatients and outpatients with mobility disorders.

Interventions: Structured assessments with different mobility aids to select the most suitable.

Outcome measures: Safety, stance, stability, step/stride pattern and speed were considered.

Results: The 'S' test successfully selected an aid for all 49 subjects. For most this aid offered marked improvement in qualitative and quantitative aspects of gait when compared with the subject's usual aid.

Conclusions: The 'S' test is an effective tool for selecting mobility aids within an institutional setting.
Technical aids in hemiparetic patients: prescription, costs and usage
Authors: Hesse S. , Gahein-Sama AL , Mauritz K-H.
Published: July 2008

Objective: The purpose of the study was to document the amount and sorts of technical aids prescribed for hemiparetic stroke patients treated within a one-year period in a German rehabilitation centre.

Design: A retrospective study checking the medical records, and sending a questionnaire asking for level of satisfaction with the use of technical aids, frequency of use, punctuality of delivery, and cost coverage to patients after discharge.

Setting: A department of a neurological rehabilitation clinic (Klinik Berlin) in Germany.

Subjects: All stroke patients treated in one year.

Results: The medical records of 466 patients were checked: 194 (42%) of them received at least one technical aid with a mean of 2.1 items per person, totalling ECU 690 per person. These 194 patients were sent questionnaires at home six to ten months after discharge: 121 (62.3%) questionnaires were returned. Ninety-four patients used their technical aids regularly, 19 occasionally and eight had abandoned usage of wheelchairs and orthoses due to improvement in gait ability and/or poor fit. Eighty-five per cent of patients had a satisfaction level of over 50%. Except for lightweight wheelchairs, technical aids were delivered in time according to patients' estimations, and in most cases costs were fully covered by the regular health insurance (some private insurance schemes do not cover the (full) costs of certain technical aids). Compared with other countries, fewer technical aids were prescribed and fewer home visits (n = 23) were conducted.

Conclusion: The data provide useful information for health care planning and support the need for future prescription of technical aids to consider not only the ability of the user, but also the living environment and, where relevant, the ability of carers. In this regard more home visits could probably increase the efficient provision of technical aids and subsequently produce a higher level of satisfaction from the users.
Postconcussive symptoms and psychological distress
Authors: Wright John C , Telford Rosemary
Published: July 2008

This study assessed the presence of postconcussive symptoms in 50 people who had sustained a minor head injury six months previously. A follow-up of 21 people was carried out. Symptoms persisted and a significant relationship with psychological distress was found. The clinical implications of the results are discussed.