bluuebunny/crossref_metadata_2025_split huggingface dataset:
Policies on the management of patients with head injury: the experience of Oxford Region
Authors: Wade Derick T 
Published: July 2008

Policies on the management of head injury are being discussed widely. This article draws upon experience in the Oxford Region and discusses policies covering all aspects of the management of head injury from prevention to long-term care. The main recommendations are as follows. 1) Health Authorities should promote prevention as far as possible. 2) Each Health Authority should have a policy on the emergency management of patients with severe trauma, stressing the management of head injury. 3) Each casualty department should have written policies covering: - the use of skull X-rays; - who should be admitted; - who needs urgent CT-scans and referral to neurosurgery: - preparation of patients for transfer to neurosurgery. 4) All adult patients with head injury should be admitted to a specialized ward which has written policies covering: - observations to be made AND actions to be taken; - discharge and follow-up; — referral to District neurological disability team; - referral to Regional rehabilitation centre; — management of behaviourally disturbed patients. 5) Most rehabilitation should be the responsibility of a District disability service specialized in neurological disability, but there should be a Regional centre for patients with unusual or severe disabilities. 6) There should be a named consultant in each District responsible for: — clinical management of patients with moderate to severe disability; - formulating and monitoring District policies for head injury. 7) Districts and Regions should consider how to manage patients: -with severe acute behavioural problems, especially aggression; -with long-term behavioural or cognitive problems. 8) Paediatric services for head injury should receive similar attention, with additional emphasis on liaison with schools. 9) Education of all staff should be a very high priority. 10) Close liaison and co-operation with all other agencies is essential.
A clinical trial of the re-education of movement in patients with Parkinson's disease
Authors: Yekutiel Margaret P , Pinhasov Asher , Shahar Gila , Sroka Hava 
Published: July 2008

Methods of physiotherapy in general use for Parkinson patients, in so far as they have been evaluated, have been found to lack therapeutic effect. This is attributable to the use of methods developed for other conditions and inappropriate for the special needs of these patients. Observation and analysis of Parkinson patients' movement problems led to the working hypothesis that they lack the manoeuvring of the body's centre of gravity, i.e. the whole-body movement, which normally precedes and accompanies action. A programme of therapy was developed for teaching whole-body movement and conscious strategies for overcoming obstacles to movement in daily life. Twelve Parkinson patients, in Hoehn-Yahr stages III-IV, were treated twice a week for three months. Standardized mobility tests, filmed before and after treatment, showed a statistically significant mean decrease of over 40% in total test time.
The feasibility of indicators and targets for rehabilitation services
Authors: McLellan DL 
Published: July 2008

The costs and burdens of disability are extremely high. It is reasonable to expect that both will be reduced by meeting appropriate targets for rehabilitation services which will also result in an improved quality of life and the prevention of further disability and unnecessary suffering. Targets which require collaboration between services are particularly powerful as agents of change because better collaboration will inevitably lead to the resolution of further problems outside the immediate target area at no additional cost. There is general agreement that the most important goals for these services are the same as the goals formulated by disabled people themselves and relate to self-care, communication, mobility, continence, fulfilling activities (particularly employment), 'equivalent resources', the needs of those with complex disability and the needs of informal carers. Choice of treatment, and of residential options, needs to be open to the consumer for a fully satisfactory outcome to be assured. This paper identifies 11 goal areas and argues for the selection of key indicators for this initial round of target setting. A target is suggested for each indicator. In turning this strategy into action, it is essential to ensure that health authorities and other government departments are charged with meeting these objectives and that appropriate rewards and penalties are employed to ensure reasonable compliance. Setting targets at this stage would greatly increase the information available to the Government at the next round of target-setting, and would stimulate the generation of ideas for research. Tangible improvements would be demonstrated within four years.
A study of wrist pain in industry — theories of causation
Authors: Grieve Elizabeth F 
Published: July 2008

Arm pain has been reported in industry as a major reason for absence, particu larly amongst those whose jobs are heavy or repetitive. The purpose of this study was to identify the precise anatomical sites and nature of the conditions affecting industrial subjects. A modular physical examination was devised with an introductory module performed 'blind' to minimize bias, and a series of optional sub-modules to cope with the great variety of conditions. The results of the examination of 332 subjects (220 with arm pain and 112 with none) demonstrated joint dysfunctions in 60% of 70 subjects reporting wrist pain. Some 20% of the wrist joint dysfunctions were 'hidden', which may explain the reports of 'nil findings'. In contrast to this there were lower than expected frequencies of tendinitis, tenosynovitis and carpal tunnel syndrome. Theories of causation are discussed together with the implications for industry, and suggestions are made for assessment procedures.
Asymmetrical trunk posture, unilateral neglect and motor performance following stroke
Authors: Taylor D. , Ashburn A. , Ward CD 
Published: July 2008

It has been observed that some patients, often with unilateral neglect, have difficulty sitting with their trunk symmetrically and tend to lean towards their affected side. The aim of the study was to see whether this inability to achieve midline sitting existed, and if it did whether there was any relationship with motor function and unilateral neglect. The sample consisted of 38 stroke patients assessed at one, three and six weeks post stroke. Of these 17 had a right hemiplegia and 21 a left hemiplegia. Data were collected using the Rivermead Motor Assessment (RMA), star cancellation tests and a measure of midline position. By six weeks most (28) of the subjects sat with their trunk in the midline or towards their unaffected side (group A). Nine subjects sat with their trunk leaning to their affected side (group B). Most of this group (eight) showed signs of unilateral neglect. Chi-square statistics showed that there were more subjects with unilateral neglect in group B than group A ( p <0.001). In the gross function section of the RMA Mann-Whitney statistics showed that group B scored significantly worse than group A at three and six weeks post stroke ( p = 0.029, p = 0.008). There were no differences in the groups in terms of leg/trunk or arm scores. The findings suggest that there is a group of stroke patients who tend to sit with their trunk leaning towards their affected side and that these patients tend to have unilateral neglect and a poorer functional outcome.
Failure to deliver the formal therapy prescribed in an NHS rehabilitation unit
Authors: Hanspal R. , Wright M. , Proctor D. , Peggs S. , Whitaker J. , McLellan DL 
Published: July 2008

The objectives of the study were to ascertain the extent to which short-term goals of therapy were achieved and to assess the discrepancy, if any, between the therapy prescribed and the therapy delivered. The weekly therapy prescribed and delivered over a two-month period was recorded. The outcome of goal setting was assessed in relation to the predicted time set for achieving the goal. All patients admitted to a rehabilitation ward in an NHS teaching hospital during the two months were studied. No patients received the full treatment prescribed. The percentage of prescribed treatment given to patients ranged from 33.3% to 66.4%. Over 95% of the goals set during the period were achieved but only 60% were achieved on time and 37% were achieved later than expected. The therapy prescribed for patients was not being delivered due to inadequate resourcing of therapy time. A 5% increase in funding to the rehabilitation ward would generate a 50% increase in the amount of formal therapy given which would be likely to shorten patients' stay in hospital.
Aerobic training in brain-injured patients
Authors: Wolman Roger L , Cornall Catherine , Fulcher Kathy , Greenwood Richard 
Published: July 2008

A pilot study was performed to assess the value of aerobic training as part of the rehabilitation programme for patients with a single incident brain injury requiring admission to an inpatient neurological rehabilitation unit. The cohort consisted of six patients with a combination of impairments including weakness, spasticity, taxia and cognitive problems. Each patient performed an exercise test at the beginning and end of the study to assess changes in aerobic fitness and performance. The aerobic training programme consisted of 20-30 minute sessions on an exercise bike three times a week for eight to 12 weeks. The post-training exercise test showed significant increases in duration ( p < 0.01) and in workload ( p < 0.025) compared to the pretraining test. There were no adverse effects from the training programme. Aerobic training should be considered in the rehabilitation programmes devised for patients with recent brain injury. Further research is needed to determine the best way to integrate this with other aspects of rehabilitation.
Evaluational and counselling interventions provided by a vocational rehabilitation unit
Authors: Brejc Tone 
Published: July 2008

The objective of this exploratory investigation was to evaluate the benefits of evaluation and counselling interventions provided by the Vocational Rehabilitation Unit of Ljubljana University Rehabilitation Institute. Relative benefits ratio/quotient (RBQ), i.e. the ratio between gains in economic independence, social integration and subjective satisfaction of the client, degree of case difficulty, and amount of programme provided by the Unit were obtained for 75 clients. No relationship existed between the benefits resulting from the Unit interventions, degree of difficulty of client problems (case difficulty), and the amount of programme. The findings supported the idea that intensive rehabilitation efforts did not have a linear and immediate influence on the results. The clients achieved greater economical and social than personal benefits, while their dissatisfaction with nonvocational consequences of the programme, especially those related to the narrowing social interactions was also obvious. The relative benefits ratio, developed for this investigation, proved to be a fairly simple and practical tool for the assessment of rehabilitation work. However, it requires further improvement by establishing reliability and validity of the assessment criteria, and defining relative importance of the case difficulty indicators.
A five-year follow-up of stroke survivors: motorfunction and activities of daily living
Authors: Lindmark Birgitta , Hamrin Elisabeth 
Published: July 2008

At the University Hospital, Uppsala, a study was conducted to assess and follow the changes in motor activities, primary activities of daily living (ADL) and instrumental ADL over a five-year period. The functional level of 280 acute stroke patients was assessed over five years. One year after the stroke 193 patients (68%) were alive, and after five years 113 patients (40%). Of the latter, 101 patients were assessed. During the first year after the stroke, a significant improvement was shown in all the assessed variables. However, most of the variables had deteriorated significantly between one and five years post-stroke. The activities that were best preserved were primary ADL and locomotion. The ability to perform active movements, maintain balance, walk and perform some household tasks and some psychosocial activities had declined. Five years post-stroke approximately one-quarter had substantial motor loss and one-third were moderately impaired. Three-quarters managed their primary ADL without or almost without help. Differences were found between men and women in instrumental ADL behaviour, the women showing more deterioration post-stroke. In spite of this most of the patients felt satisfied with their health and life situation.
Evaluating equipment for people with disabilities: user and technical perspectives on basic commodes
Authors: Ballinger C. , Pickering RM , Bannister S. , Gore S. , McLellan DL 
Published: July 2008

Disabled people often do not use the equipment supplied to them. Past work indicates that there are many reasons for this, including the low priority given to user views by the designers and manufacturers of such equipment. A number of different methodologies have been used to evaluate equipment. This paper describes an evaluation of basic commodes, a project funded by the Medical Devices Agency, Department of Health, in which both a user survey and technical tests were employed. A sample of 18 basic commodes, divided into four categories, was evaluated by 40 users, a questionnaire being administered to determine user views. A series of 13 technical tests was also carried out. The results showed that the preferred commodes as indicated by the users did not necessarily perform well in the technical tests, with at least one of the products having potentially serious design faults. It is suggested that users, therapists and engineers each have an essential contribution to make in the evaluation of equipment for disabled people.
Clinical and psychological effects of hydrotherapy in rheumatic diseases
Authors: Ahern Michael , Nicholls Elizabeth , Simionato Eddy , Clark Michael , Bond Malcolm 
Published: July 2008

Objectives: To assess the objective and subjective effects of a hydrotherapy programme for patients with rheumatoid arthritis (RA) or osteoarthritis (OA). Methods: Ninety patients entered a four-consecutive-day hydrotherapy programme. Seventy-two patients completed this programme. At the end of the four-day course, 22 patients were randomized to continue hydrotherapy for a further six weeks and eight patients were observed and acted as a control group. Results: Throughout the study there were no changes in functional assessment or range of movement of target joints. The most significant changes in the four-day course were improvements in self-efficacy for function and pain with resulting improvements in pain and stiffness scores. Those patients continuing hydrotherapy maintained the improvements achieved as a result of the four- day course, while in the control group most of the variables had returned to pretreatment values by four weeks. Conclusion: These results suggest that hydrotherapy has beneficial effects in patients with RA and OA through improvements in self-efficacy.
Survey of a domiciliary stroke rehabilitation service
Authors: Gladman Jrf , Juby LC , Clarke PA , Jackson JM , Lincoln NB 
Published: July 2008

A previous randomized controlled comparison of hospital-based and domiciliary rehabilitation for stroke patients discharged from hospital (the DOMINO study) found home therapy to be beneficial in a subgroup who had been in hospital on a stroke unit before entering the trial, whereas no benefit was seen in patients who had been on ordinary geriatric or general medical wards. In this study, to explain the findings of the DOMINO study further, the therapy records kept during the DOMINO study of the amount and type of rehabilitation provided by the domiciliary rehabilitation team were examined. More patients who had been on the stroke unit before entering the trial received therapy and they received more and longer visits than those who had been on geriatric or medical wards. The group from the stroke unit were more likely to receive practice in activities of daily living (ADL), assessment for and instruction in the use of aids and appliances, gait re-education, mobility practice and facilitation of normal muscle tone. One possible deduction is that home rehabilitation services should aim to deliver an average of 15-20 visits in six months, since only this amount of therapy was associated with a measurable benefit. The active components of home therapy may be ADL practice, assessment for and instruction in the use of aids and appliances, gait re-education, mobility, mobility practice and facilitation of normal muscle tone.
A survey of predischarge occupational therapy home assessment visits for stroke patients
Authors: Clarke PA , Gladman Jrf 
Published: July 2008

Home assessment visits are a part of inpatient stroke rehabilitation programmes, but surprisingly little has been written about how often they are used or what they achieve. This study describes the use of home visits in 327 patients in a study of stroke rehabilitation after discharge from hospital. Home visits were noted in 149 (50%). A median of five problems were identified, most commonly involving mobility inside the property and the height of furniture hampering transfers. A median of four solutions were recorded, most commonly the provision of aids and equipment. Representatives of the community social and nursing services were present in a minority of visits. An occupational therapist (OT) from the Social Services was present in half the home visits in addition to the hospital OT. The study concludes that several important problems are identified on home visits and that simple solutions can be found in most cases. Social and health services, in Nottingham at least, should develop more rational working practices for home visits, so that liaison between hospital and community services is improved and duplication of work is avoided.
The relationship between the severity of Alzheimer's disease and recovery of independent mobility after treatment for proximal femoral fracture
Authors: Eastwood HD 
Published: July 2008

A case-controlled study of previously mobile female patients with Alzheimer's disease who had sustained a proximal femoral fracture was carried out to determine the influence of the degree of mental impairment on the prospects of regaining independent mobility after treatment. Matched groups of 46 female patients (one group remaining immobile a month after surgery, the other successfully remobilizing) were evaluated for the degree of mental impairment by means of the Blessed Mental Test Score. Patients with severe mental impairment were 17 times (95% confidence interval, 10-27) more likely to remain immobile as compared with those with moderate impairment scores. Two-thirds of the severely impaired had failed to remobilize a month after surgical treatment of their proximal femoral fracture. For patients with severe mental impairment who came from residential care, failure to remobilize was of major importance in precluding return to the same home. Current results of treatment are poor in this group of patients if measured by the return of mobility and the chances of being relocated on leaving hospital.
The effects of a stroke unit on activities of daily living
Authors: Drummond Aer , Miller N. , Colquohoun M. , Logan PC 
Published: July 2008

Objective: To determine whether specific daily activities are improved more by treatment in a specialized stroke unit for patients seen after stroke. Design: Randomized controlled study allocating patients to management in a stroke unit or on conventional hospital wards. Setting: District general hospital medical or geriatric wards, or a hospital stroke unit. Subjects: Patients who within five weeks of acute stroke were considered suitable for intensive stroke unit rehabilitation (if so randomized). Interventions: Standard rehabilitation as delivered in the medical/geriatric wards or as delivered in the stroke unit. Outcome measures: All individual items from the Barthel activities of daily living (ADL) scale, all items from the Rivermead ADL scales (self-care and household sections) and all items from the Nottingham Extended ADL scale were analysed. Results: One hundred and seventy-six patients were seen in the stroke unit and 139 on the conventional wards. At entry the stroke unit had more women and stroke unit patients had less good arm function; otherwise the groups were comparable. The main differences were in the areas of feeding, dressing and household activities. Conclusions: Stroke unit rehabilitation seems to improve feeding, dressing and household activities more than occurs on conventional wards; mobility was improved equally in both settings.
The efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis on spasticity of the leg in stroke patients: results of a randomized clinical trial
Authors: Beckerman H. , Becher J. , Lankhorst GJ , Verbeek Alm , Vogelaar TW 
Published: July 2008

Objective: To investigate the efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis (AFO) on spasticity of the leg in stroke patients with a spastic equinus or equinovarus foot. Design: A placebo-controlled randomized clinical trial with a 2 x 2 factorial design. Setting: Outpatient clinic, Department of Rehabilitation Medicine, Academisch Ziekenhuis Vrije Universiteit Amsterdam. Subjects: 60 stroke patients (17 women, 43 men), with a median age of 58 years and a median period of 34 months poststroke, with at least independent walking capacities at home. Main outcome measures: Change in spasticity, muscle tone, ankle clonus, Achilles tendon reflex, ankle range of motion (ROM), motor function of the leg, and balance, measured six and 15 weeks after randomization. Results: Thermocoagulation, rather than the AFO, reduced spasticity, muscle tone, Achilles tendon hyperexcitability, and ankle clonus. At six-week follow- up, the effects on Achilles tendon reflex and ankle clonus were the most pronounced; reflex excitability was reduced in 59% of the patients treated with thermocoagulation, as compared to 14% of the placebo-treated patients, whereas ankle clonus was reduced in 55% and 0% of the patients, respectively. Reduced spasticity was found in 35% of the actively treated, as compared to 10% of the placebo-treated patients. For muscle tone, the percentages of improved patients in each group were 45% and 24%, respectively. After 15 weeks the differences between the groups were smaller. No clinically relevant improvement was found with regard to ROM, the Fugl-Meyer lower extremity and balance scores, walking ability and walking speed. Conclusion: Thermocoagulation is effective for the reduction of spasticity in stroke patients with a spastic equinus or equinovarus foot. No effect on spasticity of the AFO could be demonstrated. When the efficacy of thermocoagulation and the AFO are judged in terms of functional abilities, however, the effects seem of little value.