https://www.archives-pmr.org/article/0003-9993(89)90068-3/pdf

Symptoms and clinical impressions of patients seen in a postpolio clinic

There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no-intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post-stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.

Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation.

• Histopathological and virological studies were performed on autopsy tissue from a 47-year-old man who had a history of acute poliomyelitis at age 15 years and died after a three-year course of amyotrophic lateral sclerosis (ALS). The poliovirus serologic tests suggested prior infection with poliovirus type 3 but no ongoing poliovirus infection. The CNS showed typical features of ALS with no inclusion bodies or inflammatory cells. Attempts to isolate poliovirus in the CNS were unsuccessful and results of immunofluorescence studies for poliovirus antigen were negative. Molecular hybridization experiments using a DNA copy of the complete poliovirus genome failed to demonstrate poliovirus-related RNA or DNA sequences in the CNS. These studies, using sensitive techniques, indicate that there was no evidence of the continuing presence of poliovirus in this patient with ALS and antecedent poliomyelitis.

Amyotrophic lateral sclerosis with antecedent poliomyelitis.

purpose of this review is to evaluate the scientific literature regarding the clinical use of knee-ankle-foot orthoses (KAFOs) and hip-knee- ankle-foot orthoses (HKAFOs) for ambulation to establish what is known and what requires further research to optimize the application of these orthoses. A search of the literature was carried out using a number of computerized databases. Based on their abstracts, publications were included and ranked when they were written in English and evaluated some aspect of ambulation with (H)KAFOs (KAFO and HKAFO). A total of 240 articles were identified that met the inclusion and exclusion criteria; however, there were only two systematic reviews and two randomized control trials located. A selection of recent cross-sectional studies and non-systematic reviews were also considered. The results of this review indicate that, while a reasonable amount of literature has been written regarding (H)KAFOs, the level of evidence regarding the use of (H)KAFOs for ambulation is generally low. There was some evidence (grade C recommendation) that use of HKAFOs diminishes with time in both adults and children with paraplegia and that when orthoses are used they are used mostly for therapeutic purposes. There was also some evidence that regardless of orthotic device used walking speed is slow and energy cost high in people with paraplegia. The main limitation of most studies of (H)KAFOs for ambulation was small sample size and inadequate study design. This review evaluates the scientific literature regarding the clinical use of knee-ankle-foot orthoses (KAFOs) and hip-knee-ankle-foot orthoses (HKAFOs) for ambulation to establish what is known and what requires further research to optimize the application of these orthoses. This review includes unilateral and bilateral KAFOs, as well as those that are incorporated into more proximal lower limb orthoses such as HKAFOs and the various reciprocating gait orthoses (RGOs). The focus is on custom-made devices intended for long-term use and not prefabricated items that are worn for less than 1 year. Orthoses whose primary function is not to enhance ambulation, such as fracture braces and post- operative immobilization devices, are excluded from this review. BACKGROUND are used when mechanical control of the knee joint is required in weight-bearing due to weak or absent muscle function or joint deformity. As the name implies, KAFOs physically encompass the foot, ankle, and knee, providing direct control of each of those joints. KAFOs can be worn unilaterally or bilaterally as required. Hip stability is not provided by the orthosis but can be augmented when necessary by shifting the trunk center of mass posteriorly so that the ground reaction force is oriented posterior to the hip joints, creating tension in the anterior Y ligament of the hip joint and internally stabilizing the hip joints. This posture allows for stable standing in adults but is not recommended for children as the Y ligament is not yet mature.

http://analisedemarcha.com/papers/o_p/AAOP_A%20Review%20of%20the%20Literature%20Pertaining%20to%20KAFOs%20and%20HKAFOs.pdf

A review of the literature pertaining to KAFOs and HKAFOs for ambulation

Background/Objective: To collect data from therapists regarding criteria for use and activities that individuals with C4-C5 tetraplegia can perform using a mobile arm support (MAS) that they otherwise could not. Reasons for nonuse, equipment design limitations, and therapist training needs were also studied. Methods: A modified Delphi approach was used to conduct an e-mail survey for which the response to each question was analyzed and used to formulate the subsequent question.Setting: Rehabilitation centers.Participants: Eighteen occupational therapists (most affiliated with 1 of the federally designated Model Spinal Cord Injury Systems) with extensive experience in the treatment of individuals with spinal cord injury (SCI).Results: The key physical prerequisite for successful use of the MAS was at least minimal strength of the deltoid and biceps muscles; 92% of respondents indicated that they would fit an MAS for motivated patients having very weak (< 2/5) biceps and deltoid muscles. According t...

Mobile Arm Supports: Evidence-Based Benefits and Criteria for Use

The results of a follow-up survey of 124 patients fitted with mobile arm supports at Mary Marlborough Lodge between 1970 and 1976 are presented. Of the patients fitted with mobile arm supports 33% are known to have used them for over one year, and 47% of those who were contacted were still using them. The reasons for non-use and the implications of the necessity for readjustments are discussed.

Mobile arm supports: an evaluation

The number of hoists recommended from Mary Marlborough Lodge has increased considerably between 1970 and 1976. This paper reports on the recommendation of hoists and slings for 233 severely disabled patients and the use made of them at follow-up by 146 patients. Electric hoists accounted for 42% of all recommendations and were more frequently used by patients in their homes than manual ones. Manual hosts were more reliable than electric ones but generated a greater number of complaints. The selection of hoists and the type of training given are considered.

Hoists in the home: their recommendation and use

Late onset of respiratory insufficiency after poliomyelitis. A preliminary communication.

Swivel walkers. Experiences in fitting swivel walkers to children with severe lower-limb deformities.

Seriously disabled women patients who complained of severe premenstrual tension and/or difficulty in coping with the menstrual flow were offered suppression of their periods. Over 15 months 20 patients accepted the offer. The method of suppression chosen was a modification of 1 which had been successfully used in the treatment of women suffering from endometriosis. It involved the uninterrupted administration of a combined estrogen-progestogen tablet Metrulen. The dosage schedule adopted was the oral administration of 1 tablet daily for 9 months without remission increasing the dose only if vaginal spotting occurred and then holding it at a level sufficient to ensure the complete suppression of vaginal bleeding. Of the 20 patients who accepted the offer for hormonal suppression of menstruation 3 completed the full interval of suppression had a withdrawal bleed a normal period and then restarted with Metrulen. 5 patients are still taking Metrulen during their first 9 month interval of suppression 8 patients started Metrulen treatment and later stopped for various reasons; 3 patients decided having initially accepted the treatment not to start; and 1 patient could not be traced at follow-up. Of those women still taking the tablets all patients expressed the wish to continue with the tablets and stressed their pleasure with the increased well-being independence at period time improved personal hygiene and freedom from premenstrual tension which they now experience.

P. J. R. Nichols

Papers

Mobile arm supports: an evaluation

Hoists in the home: their recommendation and use

Late onset of respiratory insufficiency after poliomyelitis. A preliminary communication.

Swivel walkers. Experiences in fitting swivel walkers to children with severe lower-limb deformities.

The problem of period control in disabled women