bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery
Authors: Pandyan A D , Cameron M , Powell J , Stott D J , Granat M H 
Published: November 2003

Background: Contractures are common in a stroke population, yet there is little information on the time course of development. Objectives: Investigate quantitatively changes associated with contracture formation in an acute stroke population. Study design: Longitudinal study on 22 subjects who were 2–4 weeks post stroke. Outcome measures: Contractures were assessed by quantifying the resting posture, resistance to passive movement and passive range of movement. Upper limb function was measured using the Action Research Arm Test and the Nine-Hole Peg Test. Active range of extension, wrist extension strength (isometric), grip strength and neglect were also measured. Repeated measures: Following an initial assessment, repeated measurements were taken at 4, 8, 20 and 32 weeks after recruitment. Results: Two distinct subgroups, one capable of some functional movement (F group; 8 subjects) and another which was not (NF group; 14 subjects), were identified at the start of the study. The NF group showed changes associated with contracture formation at the wrist, i.e., reduction in the passive range of movement, an increase in resistance to passive movement and a worsening of the flexion posture. Changes were observed from the time of recruitment even though neglect improved. The F group showed improvements in upper limb function and there was no evidence to support contracture formation. Conclusions: Subjects most prone to contracture formation were those who showed no signs of early functional recovery (2–4 weeks after the stroke). Changes consistent with adaptive shortening were seen from week 4 of the study period.
Changing patterns of cognitive-motor interference (CMI) over time during recovery from stroke
Authors: Cockburn Janet , Haggard Patrick , Cock Josephine , Fordham Claire 
Published: November 2003

Objective: To explore the extent and nature of change in cognitive-motor interference (CMI) among rehabilitating stroke patients who showed dual-task gait decrement at initial assessment. Design: Experimental, within-subjects, repeated measures design. Setting: Rehabilitation centre for adults with acquired, nonprogressive brain injury. Subjects: Ten patients with unilateral stroke, available for reassessment 1–9 months following their participation in a study of CMI after brain injury. Measures: Median stride duration; mean word generation. Methods: Two x one-minute walking trials, two x one-minute word generation trials, two x one-minute trials of simultaneous walking and word generation; 10-metre walking time; Barthel ADL Scale score. Results: Seven out of ten patients showed reduction over time in dual-task gait decrement. Three out of ten showed reduction in cognitive decrement. Only one showed concomitant reduction in gait and word generation decrement. Conclusion: Extent of CMI during relearning to walk after a stroke reduced over time in the majority of patients. Effects were more evident in improved stride duration than improved cognitive performance. Measures of multiple task performance should be included in assessment for functional recovery.
Target board test for the quantification of ataxia in tremulous patients
Authors: Alusi S H , Glickman S , Patel N , Worthington J , Bain P G 
Published: November 2003

Objective: The objective was to develop and assess the validity and reliability of a target board test (TBT) for quantifying ataxia and measuring dysmetria in the presence of tremor. Design: Each subject was instructed to reach out and mark a target placed at arm's length with a pen (10 times with each hand). Ten patients performed the test twice. Setting: A hospital-based multiple sclerosis (MS) unit. Subjects: Fifty-three patients with MS and upper limb tremor/ataxia and 20 healthy control subjects. The MS patients were classified into four subgroups: MS control group ( n = 13), MS tremor group ( n = 9), MS dysmetria group ( n = 6), MS mixed (tremor and dysmetria) group ( n = 25). Main outcome measures: The main outcome measures were the average radial distance away from the target (mean R) and the mean directional error (mean V) of the 10 contact points from the target. From these a dysmetria tremor index (DTI) was calculated by dividing mean V by mean R. Also used were a dysmetria scale, a dysdiadochokinesia scale and a fingertapping test. Results: Mean R correlated significantly with dysmetria, dysdiadochokinesia, kinetic tremor and (inversely) with the finger-tapping test (all p < 0.005). The median difference between two measurements of mean R for all 10 contact points was 11.3% and 19.0% and for mean V 48.3% and 63.4% and DTI 57.2% and 50.5% for the right- and left-hand sides respectively, indicating the considerable directional variability within ataxia. Conclusion: The TBT provides simple quantitative objective measurements of upper limb ataxia.
Life goals: the concept and its relevance to rehabilitation
Authors: Nair K P Sivaraman 
Published: November 2003

Objective: Life goals are desired states that people seek to obtain maintain or avoid. These goals may influence motivation to participate in the rehabilitation process. The aim of this paper is to review the literature on life goals and the influence of life goals on the rehabilitation process. Methods: The MEDLINE, EMBASE, Psychlit and CINAHL databases were searched with the keywords goals, life goals, aim of life, meaning of life, motivation, assessment (identification) of life goals, goal planning, disability, coping and rehabilitation. Results: The initial search produced 917 abstracts. After going through these abstracts, 39 articles were selected for inclusion in the review. Age, gender, personality, experiences and society and environment influence life goals. Pursuit and attainment of life goals affect sense of well-being. Life goals are accessible to conscious awareness and can be identified. Several questionnaires are available for assessment of life goals. Different questionnaires assess different aspects of life goals. All except one of these questionnaires need to be tested for validity and reliability in a rehabilitation setting. Disabilities interfere with goal striving and result in emotional distress. Motivation to participate in a rehabilitation programme depends on concurrence between a patient's life goals and treatment goals. Incorporation of a subject's life goals into a management programme resulted in better outcomes in various physical and psychiatric disorders. There are no data on the efficacy of life goal-orientated rehabilitation programmes. Conclusions: Life goals influence patients’ motivation to participate in and compliance with treatment programmes. We still do not know whether rehabilitation programmes focusing on life goals make any difference in outcome. There is need for further studies in this area.
Use of unconventional therapies by individuals with multiple sclerosis
Authors: Nayak Sangeetha , Matheis Robert J , Schoenberger Nancy E , Shiflett Samuel C 
Published: November 2003

Objective: To examine the prevalence and patterns of use of complementary and alternative medicine (CAM) among individuals with multiple sclerosis (MS) in the USA and to explore the reasons for use, symptoms treated and perceived effectiveness of these therapies. Methods: Surveys were mailed to the entire mailing list of the MS Foundation, constituting 11 600 individuals with MS or their family members; 3140 adults with MS returned surveys, yielding a response rate of 27.1%. Results: More than half of the responding sample (57.1%) had used at least one CAM modality. The longer that people had MS and the less satisfied they were with conventional health care the more likely they were to use CAM therapies. The most common reasons for using CAMs were the desire to use holistic health care (i.e., treatments that recognized the interrelatedness of mind, body and spirit) and dissatisfaction with conventional medicine. Ingested herbs were the most frequently used CAM modalities (26.6%), followed by chiropractic manipulation (25.5%), massage (23.3%) and acupuncture (19.9%). Women were 25% more likely than men and whites were 30% more likely than non-whites to use CAM therapies. There was no significant relationship between the frequency of use and the reported efficacy of the CAM techniques ( r = 0.17, p > 0.10). Conclusions: The prevalence of CAM use in this population warrants more research on the efficacy and safety of these therapies, especially those with high usage or high efficacy ratings, such as herbs, chiropractic manipulation and massage, but for which there is little or no research evidence for efficacy or safety.
Effects of ankle-foot orthoses on hemiparetic gait
Authors: Gök Haydar , Küçükdeveci Ayse , Altinkaynak Haydar , Yavuzer Günes , Ergin Süreyya 
Published: November 2003

Objective: Ankle-foot orthoses (AFOs) are widely used to provide optimal ambulation in people with hemiplegia. In this study we evaluated the mechanical effects of metallic and plastic AFOs on severely hemiparetic stroke patients. Methods: Twelve hemiparetic patients were analysed on a Vicon 370 Motion Analysis System. Spatiotemporal, kinematic and kinetic parameters were measured. Results: The two types of orthoses generally had similar positive effects on hemiplegic gait parameters, increasing cadence, walking speed, single and double step length, ankle dorsiflexion angle at heel strike and swing. The metallic AFO was better at increasing the ankle dorsiflexion angle than the plastic AFO. Conclusion: Hemiplegic gait was improved by both orthoses. However, metallic AFOs provided better stabilization of the ankle, allowing improved heel strike and push-off.
Agreement between physiotherapists on quality of movement rated via videotape
Authors: Pomeroy V M , Pramanik A , Sykes L , Richards J , Hill E 
Published: November 2003

Background: Although achieving quality of movement after stroke is an important aim of physiotherapy it is rarely measured objectively or described explicitly. Objective: To test whether physiotherapists agree on a composite measure of quality of movement. Setting: A movement analysis laboratory Subjects: Ten stroke patients and 10 healthy age-matched volunteers. Design: Prospective correlational. Procedure: All subjects were videofilmed performing three trials of six standardized functional tasks. Two videotapes were made, each with a different randomized order of appearance of the trials. Ten senior physiotherapists independently rated the videotapes twice using a 100-mm visual analogue scale. Analysis: Analysis of variance models were fitted to transformed data. Estimates of components of variance were calculated and presented as a percentage of the total variance for differences, within subjects (intra-subject), between raters (inter-rater) and within raters (intra-rater). An acceptable percentage was set at less than 10%. Results: The percentage of intra-subject variance ranged from 1% (pick up box and walking) to 9% (step on block). The percentage of inter-rater variance ranged from 18% (pick up pencil) to 38% (sit to stand). The percentage of intra-rater variance was less than 1% for all tasks. Conclusions: Although physiotherapists disagreed with each other on quality of movement they were more consistent in their own scoring.
A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity
Authors: Pandyan Anand D , Price Christopher IM , Barnes Michael P , Johnson Garth R 
Published: November 2003

Objective: To investigate the criterion validity of the modified Ashworth Scale. Population: Volunteers from a stroke population admitted to a district general hospital stroke unit diagnosed with a first ever stroke less than 26 weeks previously. Outcome measures: Resistance to passive movement about the elbow was simultaneously quantified (biomechanically) and graded (modified Ashworth Scale). Passive range of movement and peak instantaneous velocity during passive movement were also measured. Analysis: Criterion validity was investigated as convergent construct validity (using the Spearman's correlation coefficient) and concurrent validity (using analysis of variance). Results: One hundred measurements were taken on 63 subjects. Correlation between the modified Ashworth Scale and resistance to passive movement was 0.511. Resistance to passive movement and velocity showed significant differences between the modified Ashworth score of ‘0’ and a modified Ashworth score greater than ‘0’ ( p < 0.01). There were no significant differences between MAS ‘1’, ‘1+’ and ‘2’. Resistance to passive movement in the impaired arm was significantly higher than in the nonimpaired arm ( p < 0.01). Conclusion: The modified Ashworth Scale does not provide a valid measure of spasticity at lower grades but it may provide a measure of resistance to passive movement.
Shoulder pain in people with a stroke: a population-based study
Authors: Ratnasabapathy Yogini , Broad Joanna , Baskett Jonathan , Pledger Megan , Marshall Jane , Bonita Ruth 
Published: November 2003

Objective: To measure the occurrence of shoulder pain after stroke. To identify the factors that predict risk of shoulder pain after stroke. Design: Auckland Stroke Study, population-based case-cohort study. Setting and subjects: All cases of stroke, including those managed outside hospital, over a 12-month period ending February 1992 were considered in Auckland. Outcome measures: Self-reported shoulder pain at one week, one month and six months after the onset of stroke for each person. Results: A total of 1761 stroke events were identified. Self-reported shoulder pain among survivors increased from 256/1474 (17%) at one week, to 261/1336 (20%) at one month and 284/1201 (23%) at six months. Shoulder pain was positively associated with motor deficit, side of deficit and severity of deficit. In those surviving to six months after stroke, the risk of shoulder pain was higher in those with severe upper limb motor deficit (odds ratio (OR) 4.94; 95% confidence interval (CI) 3.06–7.98) and in diabetics (OR 1.57, 95% CI 1.15–2.14). Risk of shoulder pain increased with time and was lower for those in institutional care. Conclusion: Shoulder pain after stroke is common, especially in patients with severe sensorimotor deficits, diabetics and those living at home. Appropriate management may reduce the rate of occurrence.
Caregiver strain in spouses of stroke patients
Authors: Blake Holly , Lincoln Nadina B , Clarke David D 
Published: November 2003

Objective: To test the ability of a previously generated logistic regression model to predict caregiver strain from carer mood, negative affectivity and perceived patient functional ability.Design: Postal prospective survey.Setting: Spouses of community-residing patients identified from hospital stroke registers.Method: Spouses were assessed at three and six months after stroke. A previously derived equation was used to make predictions at three months of their level of strain at six months, which were compared with observed outcomes.Measures: Spouses were asked to complete the Caregiver Strain Index (CSI), the General Health Questionnaire (GHQ-12), the Positive and Negative Affectivity Schedule (PANAS) and to assess patients' independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL).Results: Of 409 stroke patients, 276 had an identifiable co-resident spouse and 116 (42%) completed the measures. At three months after stroke, 39 carers (34%) were under significant strain with 40 (35%) under strain at six months. The predictive model using the GHQ-12, PANAS and EADL at three months was 78% accurate in predicting levels of caregiver strain at six months.Conclusion: Carers at risk of later strain could be identified for further followup. Services to provide emotional support to carers might be effective in the reduction of carer strain.
An exploratory study of the consistency of balance control and the mobility of people with Parkinson's disease (PD) between medication doses
Authors: Campbell F , Ashburn A , Thomas P , Amar K 
Published: November 2003

Objective: To evaluate the consistency of balance control, mobility and perceived difficulties with functional tasks by people on carefully controlled anti-parkinsonian medication programmes, between doses on a single day and across days using standard clinical measures. Design: Small group prospective study. Setting: A hospital outpatient physiotherapy department. Subjects: Subjects, recruited from a specialist Parkinson's disease (PD) clinic, had to be independently mobile, diagnosed with PD at least five years previously and on a stable drug regime. Method: Assessments (timed up and go, functional reach and a tap test) were completed 30 minutes prior to medication and hourly for 4 hours. They were repeated on a second day within a seven-day period. The self- assessment of functional disability was completed during the worst and best periods of the drug cycle. A general linear model (repeated measures analysis of variance) was used to analyse the data. Results: Nine subjects (8 males) with PD (grade III Hoehn and Yahr, average duration of symptoms eight years), average age 72 years, were recruited to the study. Four subjects had worse Hoehn and Yahr scores (grade 4) during the worst phase of the L-dopa cycle. Balance and mobility data did not change significantly over the medication cycle. Tests on day 2 were similar to day 1 with only the tap test showing a significant mean difference ( p = 0.02) (2.6, 95% confidence interval (CI) 0.5–4.8). Individuals perceived significantly greater difficulty (mean difference = 7.9, 95% CI 3.6–12.2) ( p < 0.001) in achieving functional tasks at the end of dose than peak dose of the medication cycle. Conclusion: Measures of balance and mobility remained stable over the cycle. Fluctuations in the perception of difficulties with daily functional tasks were not accompanied by observed fluctuations in performance. The improvement in the mean of the tap test over the days could reflect a learning effect.
Falls risk following discharge from a geriatric day hospital
Authors: Spilg Edward G , Martin Brendan J , Mitchell Sarah L , Aitchison Tom C 
Published: November 2003

Objective: To assess the predictive validity of the Elderly Mobility Scale (EMS), Functional Reach (FR) and the Barthel Index (BI) in identifying recurrent fallers following discharge from a geriatric day hospital (GDH). Subjects: Seventy-six GDH patients with identified mobility problems. Methods: Each patient was assessed by an independent physiotherapist before and after a programme of physiotherapy using the EMS, FR and BI and a ‘falls follow-up’ assessment was performed after four months. Results: Fifty-four per cent (29 out of 54) of patients had reduced mobility at follow-up. Twenty-five per cent (18 out of 71) of patients had two or more falls post discharge. Using logistic regression analysis for EMS, FR and BI at discharge, each of these variables individually was significantly associated with the risk of having two or more falls ( p = 0.008, 0.017 and 0.031 respectively). A prognostic tree was developed for GDH patients identifying high-risk and low-risk groups. Conclusion: EMS, FR and BI were all significantly associated with GDH patients with mobility problems having two or more falls. A prognostic tree identified high and low-risk groups of GDH patients and should now be tested prospectively. Introduction
The needs and experiences of caregivers of individuals with multiple sclerosis: a systematic review
Authors: McKeown L P , Porter-Armstrong A P , Baxter G D 
Published: November 2003

Primary objective: To appraise recent studies regarding the needs and experiences of caregivers of individuals with multiple sclerosis (MS).Design: The following computerized databases were searched: CINAHL, BIDS IBSS, ASSIA, MEDLINE, PSYCHINFO, British Nursing Index, ISI Web of Science, Zetoc, AMED (1990–April 2002). The computer-based search was supplemented by manual searches of the reference lists of all retrieved studies and review articles. Inclusion and exclusion criteria were formulated.Results: Twenty-four studies from across the world that met the inclusion criteria were reviewed. The majority of studies were descriptive in nature. The studies covered a variety of topics, including how carers assist people with MS, the effect of providing care on a carer's physical and psychological wellbeing, social life, financial situation and overall quality of life, and how carers cope with the stresses of providing care.Conclusions: Providing care for a person with MS has a major impact on all areas of the caregiver's life. Perceived social support has been shown to have a beneficial impact on the caregiver. Limitations in design and variation in methodology of studies limits the generalizability of findings. There is a need for further research, in particular the development of reliable and valid disease-specific caregiver assessment instruments.
Specific effects of balance and gait exercises on physical function among the frail elderly
Authors: Shimada Hiroyuki , Uchiyama Yasushi , Kakurai Shuichi 
Published: November 2003

Objective: To evaluate the specific effects of balance and gait exercises among frail elderly individuals. Design: A randomized three-group parallel controlled study. Setting: Geriatric health services facility in Japan. Subjects: Thirty-four frail elderly subjects attending the care facility were randomized into a control group, an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education. Interventions: The two exercise groups received balance or gait exercise for 40 minutes, 2–3 times weekly, for 12 weeks. Main outcome measures: One Leg Standing Test, Functional Reach Test, Manual Perturbation Test, Functional Balance Scale, Performance-Oriented Mobility Assessment, Timed ‘Up and Go’ Test and Stair Climbing/Descending Test. These assessments were performed before and after 12-week intervention. Results: Comparison of the performance before and after intervention demonstrated significant improvement in One Leg Standing Test, Functional Reach Test and Functional Balance Scale in the balance exercise group, and Functional Balance Scale, Timed ‘Up and Go’ Test and Stair Descending Test showed improvement in the gait exercise group. All test items showed no significant differences in the control groups. Among the three groups, the balance exercise group showed more significant improvement in Functional Balance Scale, and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group. The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group. Conclusions: Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.