bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autotraction treatment for low-back pain in pregnancy: a pilot study
Authors: Tesio Luigi , Raschi Alessandra , Meroni Mario 
Published: July 2008

Back pain affects about 50% of pregnant women, for whom most of the conventional treatments may be contraindicated. We ran a pilot study to test safety and potential effectiveness of a modified version of autotraction (AT), a treatment combining active pulling efforts with the upper limbs and automatical mobilization of the spine. We treated 16 women during weeks 13-26 of pregnancy (median 20), suffering from back and/or sciatica pain unremitting for 4-20 weeks (median 8). Treatment was given in three 25-minute outpatient periods, one every third day. During the first session heart rate and blood pressure were monitored: these never raised by more than 15 bpm and 20 mmHg, respectively. In three cases surface EMG signals recorded unilaterally from rectus abdominis and lumbar paraspinal muscles were compared during Valsalva manoeuvres and AT sessions, in order to obtain indirect information on changes of intra-abdominal pressure. Trunk muscles appeared to act to a comparable extent during both types of manoeuvre. Self report of overall improvement, peak intensity of pain (0-100 score on 100 mm visual analogue scale [VAS]) and its qualitative severity (0-45 score on the short form of McGill Pain Questionnaire [MPQ]) were taken as outcome indicators. AT manoeuvres were always painless. Thirteen out of 16 patients reported to be improved after treatment, whereas three were unchanged. In the responders, the median VAS and MPQ pain scores dropped, as a median, from 50/100 (range 25-77) to 19/100 (0-80) and from 8.5/40 (2-20) to 3.5/45 (0-14), respectively (p<0.001, Wilcoxon signed-rank test). One month after treatment 15 patients were pain free and one reported her improvement to be stable. The deliveries had been normal and the babies healthy.
Shoulder pain in acutely admitted hemiplegics
Authors: Roy Christopher W , Sands Madeleine R , Hill Linda D 
Published: July 2008

The objective of this study was to determine the frequency of shoulder pain in the first 12 weeks after acute stroke, and its relationship to functional outcome. The study was prospective observational in design, carried out weekly over 12 weeks from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the 76 included patients admitted to hospital with a first documented episode of stroke resulting in neurological deficit lasting more than seven days. The main outcomes measured were frequency and severity of pain using visual analogue scores; arm function (by Frenchay Arm Test and Motricity Index) and length of stay in hospital. Fifty-five patients (72%) experienced shoulder pain at some stage, most commonly on movement. Length of stay in those with pain was 82 days and those without pain 39 days (p < 0.001). All patients requiring continuing care, or dying after inclusion in the study, suffered shoulder pain. Patients with pain showed greater weakness and poorer arm function at study entry and at study termination, the rate of recovery of arm function being slower in those with pain than those without. The results concluded that shoulder pain is a common phenomenon in acute hemiplegia and is strongly associated with prolonged hospital stay, and poor recovery of arm function in the first 12 weeks of illness.
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.
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 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.
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.
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.
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.
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.
Interventions and service need following mild and moderate head injury: the Oxford Head Injury Service
Authors: King NS , Crawford S. , Wenden FJ , Moss Neg , Wade DT 
Published: July 2008

Objective: To describe the interventions given by the Oxford Head Injury Service (OXHIS) to patients seen after head injury, predominantly mild or moderate, over the first six months after their injuries. Design: Descriptive data of the amounts of early intervention provided by OXHIS in relation to severity of head injury and the amount of service need identified at six month follow-up. Setting: OXHIS aimed to register all patients aged 16-65 with a head injury of any severity, resident in Oxfordshire. It contacted and provided interventions for a random half of those registered at 7-10 days post-injury as part of a randomized controlled trial to investigate the effectiveness of early follow-up. At six months post-injury, independent assessment of all those registered was undertaken to evaluate outcome and identify continuing service needs. Subjects: The data come from the 579 patients (of the 1156 registered), randomized to receive the new service at 7-10 days post-injury. All but eight of these received some form of service, and 252 of the randomized patients were available for interview at six months post-injury to assess their continuing service need. Results: In the first five months after head injury: 240 patients received postal information alone and were not otherwise in contact with the service; 127 had telephone contact, advice and information; 93 were seen in person, assessed and given advice and information; 78 needed more help and support from the OXHIS team over the telephone; and 33 required further face-to-face contact either from OXHIS or other services. Extensive use was made of standardized leaflets but only accompanied by individualized assessment and advice. At six months 252 of the 579 patients were interviewed: 101 had no problems; 136 needed further reassurance; and 15 required further intervention. Patients with longer periods of post-traumatic amnesia (PTA) were more likely to receive a higher level of service, but the majority of patients who received the more extensive services were those with 'mild' and 'moderate' head injuries. Conclusions: Although the amount of service provided at 7-10 days post injury increased with severity of head injury, most service was in fact given to patients with milder head injuries which were much more common. The majority of patients seen at six months post-injury needed reassurance, advice or other services, and monitoring of patients for some time after their head injuries does seem warranted. A population of 560 000 people could receive service from three whole-time equivalent (WTE) staff using these assessment and management protocols.
Grade 4 in manual muscle testing: the problem with submaximal strength assessment
Authors: Dvir Zeevi 
Published: July 2008

Objective: To compare the static moment of force required for a muscle group to support a limb segment against gravity with the maximal dynamic moment it can generate. Design: Based on anthropometric measures of both sexes and theoretical calculations, the estimated anti-gravity static muscular moments (MGM) at the shoulder, elbow, hip and knee joints were compared with published data relating to the isokinetic strength (MIM) of the same muscle groups. Results: The ratio of static to dynamic moment, MGM/MIM, was drastically higher in muscles operating on the proximal compared with the more distal joints. In women, the values of this ratio in the shoulder, hip, elbow and knee muscles were 7-27%, 5-65%, 7% and 5-10% respectively. The corresponding figures in men were 7-21 %, 4-44%, 8-10% and 5-8%. The ratios relating to the abductors, flexors and extensors of the hip joint were substantially higher in women than in men. Conclusions: Since MGM and MIM correspond to grades 3 and 5 in manual muscle testing, the findings of this theoretical analysis indicate that elbow and knee muscles assessed as having grade 4 may generate as low as 10% of their maximal strength. With regard to shoulder and hip muscles the corresponding values are typically around 20% and 30-40%. Coupled with the very limited human precision in sensing of force, these findings indicate that where quantitative targets in muscle strength conditioning are set or when an accurate measure of impairment is being sought, grade 4 cannot and should not serve as a valid criterion.