bluuebunny/crossref_metadata_2025_split huggingface dataset:
A double-blind placebo-controlled study of botulinum toxin in upper limb spasticity after stroke or head injury
Authors: Smith S J , Ellis E , White S , Moore A P 
Published: May 2003

Objective: To assess dose–response relationships to a single dose of botulinum toxin ‘A’ in upper limb spasticity associated with stroke or head injury. Design: A double-blind placebo-controlled randomized dose ranging study. Setting: A regional centre for neuroscience and a neurorehabilitation outpatient clinic. Subjects: Twenty-one hemiplegic patients with troublesome upper limb spasticity. Nineteen with stroke and two with head injury. Main outcome measures: Spasticity (modified Ashworth), range of movement, posture (postural alignment and finger curl), disability (upper body dressing time and Frenchay Arm Test), patient-reported global assessment scale. Results: Combining data from all doses of botulinum toxin there was a significant reduction in spasticity at the wrist and fingers associated with a greater range of passive movement at the wrist and less finger curl at rest. There was a tendency for a further reduction in spasticity at elbow and wrist to occur with increasing dose but not for finger spasticity or curl. Effects present at six weeks were lost by 12 weeks except for a small improvement in elbow range of movement at the 1500 Mu dose. There was no change in upper limb disability but a significant increase in patients' global assessment of benefit. Conclusion: Botulinum toxin produced beneficial effects in spasticity and passive range of movement in the hemiplegic upper limb. Increasing the dose increased the magnitude of response for impairments in some muscle groups but had little effect on duration of response.
Ulnar nerve lesions: functional outcome after five years
Authors: van Nispen Fcm , Dijkstra P U , Geertzen J HB , Groothoff J W , Eisma W H 
Published: May 2003

Objective: To analyse perceived impairments, disability, job restrictions and job changes in subjects with a neurapraxia and neurotmesis of the ulnar nerve five years after trauma. Design: Retrospective, descriptive follow-up study. Setting: Department of Rehabilitation of a University Hospital. Subjects: Sixteen subjects with a neurotmesis (NT-group) and 20 subjects with a neurapraxia (NP-group) were compared by means of a structured interview assessing perceived impairments and change in job and a questionnaire assessing disabilities (Groningen Activity Restriction Scale: GARS). Results: The NP-group perceived significantly more pain, loss of strength and sensation, loss of dexterity and perceived more job-related restrictions than the NT-group. The NP-group had significantly higher scores on the GARS. There was a moderate correlation between the visual analogue score of the pain and the GARS in the NP- and NT-groups. No significant difference was found between the groups with respect to job changes. Conclusions: This study shows that subjects with a neurapraxia of the ulnar nerve perceive more impairments and disabilities compared with those subjects with a neurotmesis.
Distribution of muscle strength impairments following stroke
Authors: Andrews A Williams , Bohannon Richard W 
Published: May 2003

Objective: The purpose of this study was to quantify the distribution of strength impairments soon after stroke. We were specifically interested in differences in impairments between proximal and distal actions, flexion and extension actions, and upper and lower limb actions. Design: We conducted a retrospective chart review of strength scores of patients with acute stroke. Setting: Inpatient rehabilitation unit. Subjects: Forty-eight patients with a primary diagnosis of stroke underwent initial testing on admission; 31 of the same patients underwent final testing prior to discharge. Main outcome measures: The strength of eight muscle actions was assessed bilaterally using hand-held dynamometry. Force measurements obtained were expressed in newtons and as a percentage of normal. Results: Strength was impaired bilaterally but more so on the side contralateral to the brain lesion. Distal muscle actions were less impaired than proximal muscle actions on the stronger side. Extension actions were less impaired than flexion actions bilaterally but primarily in the upper limbs. Upper limb actions were less impaired than lower limb actions only on the stronger side. Conclusions: With a few exceptions, our results do not support common clinical assumptions regarding the distribution of strength impairments following stroke.
An observational study of the Stroke Association family support organizer service
Authors: Harding Jennifer , Lincoln Nadina B 
Published: May 2003

Objective: The aim was to investigate the role of Stroke Association family support organizers, in order to decide what outcome measures would be appropriate for evaluating their service. Design: Family support organizers (FSOs) were observed on home and hospital visits by an independent observer. Every two minutes recordings were made of the location, individuals present and activity taking place. Setting: FSOs working in the North-West and Midland regions of Britain. Results: The majority (71%) of visits took place in the patient's home, with both patients and carers (39%). The most frequently occurring activities were enquiry (17%), task-related conversation (14%) and support-related conversations (14%). Comparison of FSOs showed variation in the time dedicated to each activity. Conclusions: FSOs spend more time engaged in practical rather than emotional activities. The role of the FSO is multifaceted. Evaluation of the FSO service needs to measure the patient's mood and functional abilities, the carer's mood and strain, and patients' and carers' knowledge and satisfaction with information and services.
A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke
Authors: Parker C J , Gladman J RF , Drummond A ER , Dewey M E , Lincoln N B , Barer D , Logan P A , Radford K A 
Published: May 2003

Objective: To evaluate the effects of leisure therapy and conventional occupational therapy (OT) on the mood, leisure participation and independence in activities of daily living (ADL) of stroke patients 6 and 12 months after hospital discharge. Design: Multicentre randomized controlled trial. Setting and participants: Four hundred and sixty-six stroke patients from five UK centres. Main outcome measures: The General Health Questionnaire (12 item), the Nottingham Extended ADL Scale and the Nottingham Leisure Questionnaire, assessed by post, with telephone clarification. Results: Four hundred and forty (94%) and 426 (91%) subjects were alive at 6 and 12 months, respectively. Three hundred and seventy-four (85% of survivors) and 311 (78% of survivors) responded at 6 and 12 month follow-up respectively. At six months and compared to the control group, those allocated to leisure therapy had nonsignificantly better GHQ scores (–1.2: 95% CI –2.9, +0.5), leisure scores (+0.7, 95% CI –1.1, +2.5) and Extended ADL scores (+0.4: 95% CI –3.8, +4.5): the ADL group had nonsignificantly better GHQ scores (–0.1: 95% CI –1.8, +1.7) and Extended ADL scores (+1.4: 95% CI –2.9, +5.6) and nonsignificantly worse leisure scores (–0.3: 95% CI –2.1, +1.6). The results at 12 months were similar. Conclusion: In contrast to the findings of previous smaller trials, neither of the additional OT treatments showed a clear beneficial effect on mood, leisure activity or independence in ADL measured at 6 or 12 months.
Functional level of young adults with cerebral palsy
Authors: van der Dussen L , Nieuwstraten W , Roebroeck M , Stam H J 
Published: May 2003

Objective: To acquire insight into the level of functioning of young adults with cerebral palsy (CP). Design: Descriptive cross-sectional study. Setting: Rehabilitation Centre Den Haag, The Netherlands. Method: A structured questionnaire, including the Barthel Index was mailed to 134 young adults (aged 21–31 years) with cerebral palsy. Results: Eighty subjects responded (60%). Of these, 60 (75%) were largely or fully independent in activities of daily living, 72 (90%) moved independently indoors, 56 (70%) outdoors. In 67 (77.5%) of the group the level of communication was adequate for telephone conversation. Twenty-four (30%) lived with their parents, 10 (12.5%) with a partner and 26 (32.5%) lived alone. Almost half lived in an unadapted house. Forty-two (53%) completed some form of secondary education and 29 (36.3%) had paid employment. Conclusion: Despite their considerable impairments, the large majority of this group of young adults with cerebral palsy are independent in activities of daily living, mobility and communication. Regarding the level of education, participation in paid employment and sports activities, however, young adults with CP are poorly integrated.
Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review
Authors: Price C IM , Pandyan A D 
Published: May 2003

Background: Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain. Objectives: The objective of this review was to determine the efficacy of any form of surface ES in the prevention and/or treatment of pain around the shoulder at any time after stroke. Search strategy: We searched the Cochrane Stroke Review Group trials register and undertook further searches of Medline, Embase and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES. Selection criteria: We considered all randomized trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain. Data collection and analysis: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. Main results: Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (odds ratio (OR) 0.64; 95% CI 0.19–2.14) or change in pain intensity (standardized mean difference (SMD) 0.13; 95% CI –1.0–1.25) after ES treatment compared with control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (weighted mean difference (WMD) 9.17; 95% CI 1.43–16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD –1.13; 95% CI –1.66 to –0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI –0.14–0.62) or upper limb spasticity (WMD 0.05; 95% CI –0.28–0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder.
An audit of the provision of environmental control systems in Northern Ireland, 1992–1997
Authors: Maguire S M , McCann J P , Swallow M 
Published: May 2003

Objective: To evaluate the provision of environmental control systems (ECS) in Northern Ireland with regard to assessment and prescription, installation and review and propose guidelines for future service delivery. Design: Structured interview, physical examination, Barthel ADL Index, demonstration and assessment of suitability of ECS for patient. Subjects: Prescriptions for ECS from April 1992 to 1997 were identified from centrally held records. Current users were assessed in their own homes. Results: Forty-six out of 49 current users identified were assessed. All were severely disabled (Barthel 0–9); 24% were living alone; 7 (15%) were not utilizing the system; 96% were satisfied with their initial assessment. Prior to prescription 52% had information about ECS and 20% had a practical demonstration; 78% felt that this would have been useful; 52% of users were not under routine clinical review; 41% of ECS had been altered since installation. Repairs had taken longer than 7 days in 11% of cases. In 45 cases the ECS was essential and in 43 it was appropriate to the users' needs and abilities. Conclusions: ECS are a valuable tool for severely disabled persons and are appropriately prescribed in Northern Ireland. A multidisciplinary team should perform assessment and prescription. All patients should have a practical trial of the equipment to assist in prescriptions. Regular review by the team should be performed to identify changes in need and alter systems appropriately. Users who live alone should represent a priority for repairs.
A randomized efficacy and feasibility study of imagery in acute stroke
Authors: Page Stephen J , Levine Peter , Sisto SueAnn , Johnston Mark V 
Published: May 2003

Objective: To compare the feasibility and efficacy of a programme combining imagery and occupational therapy with a programme of therapy only. Design: Randomized, controlled case series. Setting: Subacute outpatient clinic. Subjects: Thirteen consecutively admitted patients between four weeks and one year post stroke exhibiting stable motor deficits in their affected upper limbs. Intervention: All patients received an hour of therapy three times a week for six weeks administered by the same physical and occupational therapists. During the same period, eight patients participated in 10-minute guided imagery sessions after each therapy session, as well as practising imagery at home twice each week. Five patients participated in a control intervention consisting of exposure to stroke information. Main outcome measures: The Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer) and Action Research Arm Test (ARA). Results: After intervention, Fugl-Meyer and ARA scores of patients in the therapy only group remained virtually the same; therapy plus imagery group scores improved by 13.8 and 16.4 points, respectively, on the Fugl-Meyer and ARA. Conclusions: Imagery is a clinically feasible, cost-effective complement to therapy that may improve outcomes more than participation in therapy only.
Translation and adaptation of a questionnaire to assess the group processes of rehabilitation team conferences
Authors: Roelofsen Eline E , Lankhorst Gustaaf J , Bouter Lex M 
Published: May 2003

Objective: To investigate the internal consistency, the domain structure and the influence of social desirability with regard to a questionnaire translated and adapted to assess the quality of rehabilitation team conferences in the Netherlands. Study design: A questionnaire to determine group decision-making processes was translated and adapted to rehabilitation and completed by 44 rehabilitation professionals. Results: The internal consistency of the domains Personal participation, Negative socio-emotional behaviour, Result satisfaction and Process satisfaction was found to be satisfactory (Cronbach’s α ranges from 0.70 to 0.84). The domain structure is confirmed by item–total and item–rest correlations. From the original English questionnaire, one question concerning the domain Personal participation was omitted. The domain Informal leadership has been deleted from the questionnaire, because informal leadership is not an issue in a situation in which the Chairman is already known. Response to the questionnaire did not seem to be biased by social desirability. Conclusion: The translated and adapted questionnaire can be used to assess the group processes of rehabilitation team conferences. Results from the literature concerning the original questionnaire suggest that the translated and adapted questionnaire might be able to detect changes in the group process of rehabilitation team conferences.
Do associated reactions in the upper limb after stroke contribute to contracture formation?
Authors: Ada Louise , O'Dwyer Nicholas 
Published: May 2003

Objective: To establish (1) whether associated reactions could contribute to contracture formation and (2) whether the presence of spasticity was essential for their expression, after stroke. Subjects: Subjects were 24 hemiparetics within 13 months of a stroke, unselected for contracture or spasticity. Main outcome measures: Associated reactions were identified by the presence of muscle activity in the affected biceps brachii and quantified as the amount of affected elbow flexor torque produced during a moderate contraction of either the contralateral biceps brachii or the contralateral quadriceps muscles. Contracture was measured as loss of elbow joint range of motion and spasticity as the presence of abnormal reflex activity. Results: Associated reactions were present in at least one testing condition in seven subjects. During contractions of the contralateral biceps brachii, the median amount of elbow flexor torque produced was 0.39 (interquartile range, IQR 2.5) Nm while during contractions of the contralateral quadriceps muscle it was 0.19 (IQR 1.6) Nm. Associated reactions were not associated with contracture (p = 0.39) which was present in over half of the subjects. The incidence of associated reactions was about the same as that of spasticity, but the two were not related (p = 0.61). Conclusions: Even though associated reactions were present in 29% of the subjects during moderate contraction of the contralateral muscles, they were not large, nor were they associated with contracture or spasticity, suggesting that this phenomenon is not usually a major problem for everyday function after stroke.
Effectiveness of dynamic cognitive intervention in rehabilitation of clients with schizophrenia
Authors: Hadas-Lidor N , Katz N , Tyano S , Weizman A 
Published: May 2003

Objective: To examine the efficacy of dynamic cognitive treatment in rehabilitation of schizophrenic clients. Subjects: Fifty-eight schizophrenic clients that were matched equally into two groups: a study group (n = 29) (treated by Instrumental Enrichment) and a control group (treated with traditional occupational therapy methods). Setting: The subjects were treated in a day rehabilitation centre in the community. Study design: The programme lasted one year, the same schedule was provided for both groups. Subjects were randomly assigned and assessed before and after intervention with the same battery and at a follow-up six months later, work and residence status were evaluated. Main outcome measures: Instruments included: (1) memory and thought processes, measured by a battery of structured tests from the Learning Potential Assessment Device (LPAD), Raven Progressive Matrices and General Aptitude Test Battery (GATB); (2) functional outcomes, instrumental activities of daily living (IADL), measured by a questionnaire; work and residence status; (3) self-concept measured with Fitts questionnaire. Results: Results showed significant differences between the groups on almost all the cognitive tests (MANOVA revealed significant differences between the two groups for both memory and thought process (F(2.52) = 13.75, p < 0.001; and F(1.46) = 7.28, p < 0.001, respectively) as well as in work (χ2 = 14.30, p < 0.001), and residence (χ2 = 3.86, p < 0.05) status. There were no significant differences in IADL questionnaire or the self-concept scale. Conclusions: The successful outcome points to the importance of including long-term cognitive intervention in rehabilitation of schizophrenic clients. This work suggests that the classic view of schizophrenia as a progressive irreversible decline that cannot be altered may be wrong.
Differences in treatment outcome between subgroups of patients with chronic low back pain using lumbar dynamometry and psychological aspects
Authors: Hutten M MR , Hermens H , Zilvold G 
Published: May 2003

Objective: To investigate whether subgroups of patients with chronic low back pain show differences in treatment outcome, measured with the Roland Disability Questionnaire. (RDQ). Setting: The study was carried out in a rehabilitation centre. Subjects: Eighty-four patients with chronic low back pain participated in this study. Intervention: Patients followed a multidisciplinary treatment programme that primarily targets physical aspects. Design and main outcome measure: Based on pretreatment lumbar dynamometry results and Symptom Checklist (SCL-90) scores, patients were divided into subgroups. The dynamometry subgroups were: performances lower than healthy subjects (expected performance), performances comparable with those of healthy subjects (normal performance) and inconsistent performances (submaximal performance). The SCL-90 subgroups were: a total score of ‘average’ or lower compared with a population of chronic pain patients (low psychological score) and a total score of ‘above average’ or higher compared with this population (high psychological score). Patients answered the RDQ in the week before (RDQ1; n = 84) and after treatment (RDQ2; n = 78) to investigate whether the subgroups show differences in outcome expressed as the percentage change between RDQ2 and RDQ1 (%RDQ2–1). A%RDQ2–1 ≥ 20% was classified as an improvement. Results: Improvement on disability level ≥20% is shown in 64% and 55% of the patients with ‘normal’ and ‘expected’ lumbar dynamometry performances and low psychological scores compared with only 33% and 25% of those with high psychological scores. Patients with submaximal performances show hardly any changes in disability level and there are no differences between those with low psychological scores (14%) and those reporting high scores (0%). Conclusion: The fact that patient subgroups with differences in treatment outcome can be defined using lumbar dynamometry and psychological questionnaires suggests that these instruments might facilitate treatment indication in clinical practice.
The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial
Authors: Shiel A , Burn J PS , Henry D , Clark J , Wilson B A , Burnett M E , McLellan D L 
Published: May 2003

Objective: The objective was to investigate the effect of increased intensity of rehabilitation therapy provided to brain-injured subjects on the rate at which independence was regained and the duration of hospital admission. Design: A two-centre, prospective, controlled study with random allocation to groups. Setting: Two district general hospitals on the south coast of England. Subjects: Fifty-six people with moderate and severe head injury consecutively admitted to Southampton and Poole hospitals between June 1995 and September 1997. Interventions: Increased intensity of rehabilitation therapy input without change in content. Results: Subjects receiving more intensive therapy made more rapid progress and were discharged home sooner. The different intensities of therapy employed in this study showed no evidence of a ‘ceiling’ effect and the ‘intervention group’ made significantly more rapid progress on tests of dependency during the period of admission. A clear response to increased therapy input was seen in one of the centres with more rapid functional improvement and a shorter length of hospital stay. This centre already had more therapy and better community facilities. No such benefits were seen at the other centre where the intervention group had a longer hospital stay than the routine group. Conclusion: Increasing the hours per week of therapy given to adults recovering from brain injury in hospital can accelerate the rate of recovery of personal independence and result in their being discharged from hospital sooner. Increased rehabilitation therapy after brain injury is associated with enhanced functional recovery and shorter hospital stay if provided in the context of an integrated service that can provide ongoing community support. There is no evidence of any ceiling effect of therapeutic intensity beyond which no further response is observed.