Showing papers in "American Journal of Physical Medicine & Rehabilitation in 2003"
TL;DR: How the levels of analysis considered in rehabilitation (disease, impairment, activity, and participation) and the role of theory shape the definition of treatment are considered, and the need to develop protocol-based treatments and tools to objectively verify their contents is addressed.
Abstract: Research on treatment efficacy and effectiveness requires that the treatments of interest be objectively defined. Such definitions are relatively straightforward for pharmacologic and surgical treatments, in which the active ingredients can be specified in terms of chemical structure or anatomic result. Definitions of treatment are more difficult for the many experience-based interventions employed in rehabilitation. This has led to the criticism that much clinical rehabilitation research has characterized the treatments of interest as a "black box," allowing little insight into the active ingredients contained therein. Moreover, rehabilitation care may involve the simultaneous application of multiple different treatments, raising the question of whether to define the individual components or the service delivery system. In this article, we consider how the levels of analysis considered in rehabilitation (disease, impairment, activity, and participation) and the role of theory shape the definition of treatment, and we address the need to develop protocol-based treatments and tools to objectively verify their contents. Rigorous definition of rehabilitation treatments, supported by theory, will facilitate needed efficacy research, will allow replication of that research, and will ultimately foster dissemination of effective treatments into clinical practice.
283 citations
TL;DR: The alterations in respiratory mechanics resulting from a spinal Cord injury are reviewed and the contribution of respiratory complications to morbidity and mortality associated with various types of spinal cord injury is examined.
Abstract: There are >200,000 persons living with a spinal cord injury in the United States, with approximately 10,000 new cases of traumatic injury per year. Advances in the care of these patients have significantly reduced acute and long-term mortality rates, although life expectancy remains decreased. This article will review the alterations in respiratory mechanics resulting from a spinal cord injury and will examine the contribution of respiratory complications to morbidity and mortality associated with various types of spinal cord injury.
253 citations
TL;DR: This large prospective cohort study indicates the risk of sustaining a cerebral concussion is nearly six times greater forindividuals with a history of concussion than for individuals with no such history.
Abstract: Zemper ED: Two-year prospective study of relative risk of a second cerebral concussion. Am J Phys Med Rehabil 2003;82:653–659.ObjectiveTo prospectively measure the relative risk of cerebral concussion among those with a history of concussion compared with those having no previous concussions
197 citations
TL;DR: The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.
Abstract: Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH: Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003;82:925–935.ObjectiveGait patterns vary among stroke patients. This study attempted to discover gait performance
157 citations
TL;DR: The results suggest that patients with hemiparesis tend to fall easily and that the risk of falls toward the paretic side is high.
Abstract: Ikai T, Kamikubo T, Takehara I, Nishi M, Miyano M: Dynamic postural control in patients with hemiparesis. Am J Phys Med Rehabil 2003;82:463–469.ObjectiveDecreased postural stability is a common problem associated with hemiparesis secondary to stroke. The purpose of this study was to evaluate
151 citations
TL;DR: Hemiplegic stroke patients, who could stand up within 4.5 sec or who had a maximal vertical force difference of less than 30% of body weight between both legs, had better gait performance than the others did.
Abstract: Chou SW, Wong AMK, Leong CP, Hong WS, Tang FT, Lin TH: Postural control during sit-to-stand and gait in stroke patients Am J Phys Med Rehabil 2003;82:42–47ObjectiveTo investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patientsDesignA total of 40 chronic
145 citations
TL;DR: An organized and specific physical therapy program was effective in improving the status of patients with neck pain and delineated algorithm-based clinical reasoning strategies for evaluating and treating patients with cervical pain.
Abstract: Wang WTJ, Olson SL, Campbell AH, Hanten WP, Gleeson PB: Effectiveness of physical therapy for patients with neck pain: An individualized approach using a clinical decision-making algorithm. Am J Phys Med Rehabil 2003;82:203–218.ObjectiveThe purpose of this study was to determine the effectiv
129 citations
TL;DR: Muscle imbalance in abductor and adductor muscles is apparent in hallux valgus deformity, and this imbalance may be the reason or the result of joint deformity.
Abstract: Arinci Incel N, Genc H, Erdem HR, Yorgancioglu ZR: Muscle imbalance in hallux valgus: An electromyographic study. Am J Phys Med Rehabil 2003;82:345–349.ObjectiveHallux valgus is a very common foot deformity in modern societies. Muscle imbalance in abductor and adductor muscles was cited as a
124 citations
TL;DR: The results suggest that the 6-min walk test can be used reliably in the assessment of functional ambulation in persons with acquired brain injury.
Abstract: Mossberg KA: Reliability of a timed walk test in persons with acquired brain injury. Am J Phys Med Rehabil 2003;82:385–390.ObjectiveThe purpose of this study was to assess the reliability of a 6-min walk test in individuals with acquired brain injury.DesignA total of 23 clients (14 men, 9 women) par
106 citations
TL;DR: Whether the functional ambulation profile (FAP), calculated from walkway data, is a sensitive measure in the characterization of dissimilar patients with chronic hemiparesis due to stroke is assessed.
Abstract: Titianova EB, Pitkanen K, Paakkonen A, Sivenius J, Tarkka IM: Gait characteristics and functional ambulation profile in patients with chronic unilateral stroke. Am J Phys Med Rehabil 2003;82:778 –786. Objective: Recent technical progress in gait analysis has resulted in portable walkways with embedded pressure-sensitive sensors. Often claims are made in connection with new equipment of their straightforward clinical use. The purpose of the present study was to assess whether the functional ambulation profile (FAP), calculated from walkway data, is a sensitive measure in the characterization of dissimilar patients with chronic hemiparesis due to stroke. Design: We investigated the relationships between FAP and the type of stroke, patients’ functional disability, and spatial and temporal variables of gait obtained with the pressure sensor system walkway. Gait variables and FAP scores were compared in 25 patients with residual hemiparesis due to stroke and in 31 healthy subjects. Results: A prolonged swing phase in the affected side and a prolonged stance phase in the nonaffected side were found in patients. Footprint pressure data revealed reduced peak pressure of the affected-side metatarsal area in patients, probably reflecting foot paresis. Higher Barthel Index score and lower Rankin Scale score were reflected in FAP scores. Conclusions: The FAP scores of patients reflected well their characteristic spatio-temporal gait variations; however, the FAP score seemed a reliable measure of gait normality/abnormality only in rather unhurried gait. Thus, it is useful when a single number is needed.
105 citations
TL;DR: This study demonstrates the potential benefits of EMG biofeedback in conjunction with neurophysiologic rehabilitation technique to maximize the hand function in hemiplegic patients.
Abstract: Armagan O, Tascioglu F, Oner C: Electromyographic biofeedback in the treatment of the hemiplegic hand: A placebo-controlled study. Am J Phys Med Rehabil 2003;82:856–861.ObjectiveTo evaluate the efficacy of electromyographic (EMG) biofeedback treatment in the functional recovery of the hemipl
TL;DR: Gait parameters in the elderly and osteoarthritis knee patients were characterized by slower walking velocity, lower cadence, shorter step length, longer stride time, and longer double-support time, with more loading force onto the midfoot during midstance.
Abstract: Chen CPC, Chen MJL, Pei YC, Lew HL, Wong PY, Tang SFT: Sagittal plane loading response during gait in different age groups and in people with knee osteoarthritis. Am J Phys Med Rehabil 2003;82:307–312.ObjectiveTo investigate the gait patterns and the sagittal ground reaction forces in differ
TL;DR: Within-group comparisons suggest improvements in several areas of the participants’ overall health behaviors, and the potential role of health behaviors in positively influencing long-term health outcomes and quality of life is emphasized.
Abstract: Objective To test the effectiveness of a holistic (comprehensive and integrated) wellness program for adults with spinal cord injury. Design A total of 43 adults with spinal cord injury were randomly assigned to intervention or control groups. The intervention group attended six half-day wellness workshops during 3 mos, covering physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcome measures included several physical measures and standard psychosocial measures. Statistical analyses included paired t tests, used to determine within-group differences, and multiple regression conducted to assess between-group differences. Results When comparing within-group baseline and final results, the intervention group reported fewer and less severe secondary conditions by the end of the study. Similarly, significant improvements were found in health-related self-efficacy and health behaviors. No significant changes in physiologic variables were observed. Although no significant between-group differences were observed, regression analyses suggested participation in the wellness program may be associated with improved health behaviors. Conclusion Within-group comparisons suggest improvements in several areas of the participants' overall health behaviors. These findings, although preliminary, emphasize the potential role of health behaviors in positively influencing long-term health outcomes and quality of life.
TL;DR: DVT prevalence and risk was higher among patients with hemorrhagic strokes in comparison with patients with thromboembolic strokes, and the number of patients placed on prophylactic therapy was higher than expected.
Abstract: Gregory PC, Kuhlemeier KV: Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke. Am J Phys Med Rehabil 2003;82:364–369.ObjectiveDeep venous thromboembolism (DVT) is an important health issue in the hospitalized geriatric population that leads to increased lengt
TL;DR: There is a widespread perception that spinal muscular atrophy type 1 children have a poor quality of life, but this perception is not shared by their care providers.
Abstract: Bach JR, Vega J, Majors J, Friedman A: Spinal muscular atrophy type 1 quality of life. Am J Phys Med Rehabil 2003;82:137–142.
To compare healthcare professionals’ assessment of the quality of life of spinal muscular atrophy type 1 children with that of the care providers for the children.
The care providers of all 53 surviving spinal muscular atrophy type 1 children managed in one neuromuscular disease clinic were sent Likert-scale surveys of six quality of life issues and ten polar-adjective pairs. The quality of life estimations were compared with those of 67 clinicians and with those of 30 parents considering their unaffected children.
One hundred care providers from 46 out of the 53 families (87%) responded. Although the clinicians’ mean estimate of the children’s quality of life was 2.85 ± 0.2/10, the care providers’ estimate was 7.81 ± 0.2/10 (P < 0.0001). The care providers also found life with the children to be satisfying (6.0 ± 0.2/7), interesting (6.6 ± 0.1/7), friendly (6.1 ± 0.1/7), enjoyable (6.3 ± 0.1/7), worthwhile (6.7 ± 0.1/7), full (6.6 ± 0.1/7), hopeful (5.9 ± 0.2/7), and rewarding (6.4 ± 0.1/7), and they estimated the children to be happy (8.5 ± 0.2/10) and their lives worth living (9.6 ± 0.1/10). However, 69 of 104 felt that their lives were hard rather than easy, and 56 of 104 reported feeling tied down rather than free. Although the effort they felt for raising the child was high (8.3 ± 0.3 by comparison with 5 for an unaffected child), the burden they felt in doing so was not (5.8 ± 0.3/5). When asked whether they would or would not recommend ventilator use, 31 clinicians (45.5%) indicated they would, 24 (36.4%) would not, and 12 (18.2%) chose not to respond to this question. Care provider responses did not differ significantly from the responses of the parents of unaffected children except for the easy/hard semantic differential (care providers, 3.80 ± 1.75 vs. controls, 5.27 ± 1.14, P < 0.001).
Although there is a widespread perception that spinal muscular atrophy type 1 children have a poor quality of life, this perception is not shared by their care providers.
TL;DR: There were significant improvements in neurologic (sensory and motor), functional, and FIM™ scores in the acupuncture group compared with the initial admission period when assessed during the time of hospital discharge and the 1-yr postinjury follow-up.
Abstract: Wong AMK, Leong CP, Su TY, Yu SW, Tsai WC, Chen CPC: Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil 2003;82:21–27.ObjectiveTo examine whether electrical acupuncture therapy through adhesive surface electrodes and concomitant auricular acupuncture
TL;DR: The fact that walking balance function did not correlate with standing balance function indicates that multifaceted evaluation is important to comprehend dynamic balance function while standing and walking.
Abstract: Shimada H, Obuchi S, Kamide N, Shiba Y, Okamoto M, Kakurai S: Relationship with dynamic balance function during standing and walking. Am J Phys Med Rehabil 2003;82:511-516.ObjectiveTo investigate the relationship between dynamic balance functions in young adults and elderly adults while stan
TL;DR: Compared with the healthy age- and sex-matched controls, patients with total hip replacement did not have any proprioceptive deficit, and proper sexual counseling is necessary in postoperative care.
Abstract: Nallegowda M, Singh U, Bhan S, Wadhwa S, Handa G, Dwivedi SN: Balance and gait in total hip replacement: A pilot study. Am J Phys Med Rehabil 2003;82:669–677.ObjectiveEvaluation of balance, gait changes, sexual functions, and activities of daily living in patients with total hip replacement
TL;DR: Neuromuscular electrical stimulation, when applied to the peripheral muscles, seems to have a direct effect on the cerebral cortex.
Abstract: Han BS, Jang SH, Chang Y, Byun WM, Lim SK, Kang DS: Functional magnetic resonance image finding of cortical activation by neuromuscular electrical stimulation on wrist extensor muscles. Am J Phys Med Rehabil 2003;82:17–20.ObjectiveTo investigate the effects that neuromuscular electrical stim
TL;DR: Although median nerve SEP continues to make reliable prediction of ominous outcome in severe traumatic brain injury, the addition of the speech-evoked ERPs may be helpful in predicting favorable outcomes.
Abstract: Lew HL, Dikmen S, Slimp J, Temkin N, Lee EH, Newell D, Robinson LR: Use of somatosensory-evoked potentials and cognitive event-related potentials in predicting outcomes of patients with severe traumatic brain injury. Am J Phys Med Rehabil 2003;82:53–61.ObjectiveThis study was performed to ev
TL;DR: For ventilator-dependent patients with amyotrophic lateral sclerosis, mechanical insufflation-exsufflation via a tracheostomy tube with an inflated cuff may be more effective in eliminating airway secretions than conventional tracheal suctioning.
Abstract: Sancho J, Servera E, Vergara P, Marin J: Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: A pilot study. Am J Phys Med Rehabil 2003;82:750–753.ObjectiveTo compare the effects of mechanical insufflation-exsuff
TL;DR: Improvements in functional performance and disability were modest compared with robust increases in strength and power and specific modes of training or behavioral strategies may be necessary to optimize improvements in these outcomes.
Abstract: Sayers SP, Bean J, Cuoco A, LeBrasseur NK, Jette A, Fielding RA: Changes in function and disability after resistance training: Does velocity matter? A pilot study. Am J Phys Med Rehabil 2003;82:605–613.ObjectiveTo compare the effects of high- and low-velocity resistance training on functional perfor
TL;DR: The results demonstrate the importance of the D2 receptor in cognitive recovery after traumatic brain injury and illustrate that some classes of antipsychotic drugs may influence cognitive recovery, and further research is needed to determine the optimal pharmacologic treatment of aggression, agitation, and other pathologic behaviors in patients withtraumatic brain injury.
Abstract: Wilson MS, Gibson CJ, Hamm RJ: Haloperidol, but not olanzapine, impairs cognitive performance after traumatic brain injury in rats. Am J Phys Med Rehabil 2003;82:871– 879. Objective: Traumatic brain injury can cause a variety of impairments, including persistent alterations in personality, mood, and cognition. Antipsychotic agents are frequently used to treat pathologic behaviors in traumatic brain injury patients, but the influence of prolonged administration of such drugs on cognition after injury is unknown. The effects of two antipsychotic drugs on cognitive recovery after traumatic brain injury were assessed using the fluid percussion model in rats. Design: The typical antipsychotic, haloperidol, and the third-generation antipsychotic, olanzapine, were administered via intraperitoneal injection beginning 24 hr after injury and continuing daily for the duration of the study. Morris water maze performance was assessed on days 11–15 postinjury. Results: Haloperidol, an antagonist acting on D2-like dopamine receptors, exacerbated the cognitive deficits induced by injury, as injured rats treated with 0.30 mg/kg haloperidol performed worse in the Morris water maze than injured rats treated with vehicle. Conclusions: Our results demonstrate the importance of the D2 receptor in cognitive recovery after traumatic brain injury. Also, the data illustrate that some classes of antipsychotic drugs may influence cognitive recovery, and further research is needed to determine the optimal pharmacologic treatment of aggression, agitation, and other pathologic behaviors in patients with traumatic brain injury.
TL;DR: This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.
Abstract: Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. Pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. Pudendal nerve entrapment was diagnosed clinically, with computed tomography-guided nerve blocks providing temporary relief. A prolonged left pudendal nerve distal motor latency on electrodiagnostic testing later confirmed the diagnosis. At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.
TL;DR: Across all impairment groups, the intraclass correlation for the total score and the subscales of CHart-R were high and the CHART-R discriminated among the impairment categories in a direction that parallels increasing disability.
Abstract: Walker N, Mellick D, Brooks CA, Whiteneck GG: Measuring participation across impairment groups using the Craig Handicap Assessment Reporting Technique. Am J Phys Med Rehabil 2003;82:936–941.ObjectiveTo assess the efficacy, across a range of disability groups, of the Craig Handicap Assessment and Rep
TL;DR: Outcome is best measured at the level of behavior (activities), with other measures being used to aid interpretation, and there is no validated or even widely accepted method of relating this to benefit in a fair, open, and rational way.
Abstract: Choosing outcome measures in rehabilitation research depends on the standard research skills of clear thinking, attention to detail, and minimizing the amount of data collected. In rehabilitation, outcome is more difficult to measure because (1) usually several outcomes are relevant, (2) relevant outcomes are affected by multiple factors in addition to treatment, and (3) even good measures rarely reflect the specific interest of any individual patient or member of the rehabilitation team, leading to some dissent. Measurement of general quality of life is not possible because there is little agreement as to the nature of the construct; moreover, measurement of relevant aspects of quality of life would probably give similar results. Cost in terms of resources can be estimated, but there is no validated or even widely accepted method of relating this to benefit in a fair, open, and rational way. Outcome is best measured at the level of behavior (activities), with other measures being used to aid interpretation.
TL;DR: High-span PIP+PEEP is indicated for all infants diagnosed with spinal muscular atrophy who demonstrate paradoxical breathing for the purpose of promoting more normal lung and chest development.
Abstract: To demonstrate the elimination of pectus excavatum and promotion of more normal lung growth and chest wall development by the use of high-span positive inspiratory pressure plus positive end-expiratory pressure (PIP+PEEP), patients with spinal muscular atrophy type 1 with paradoxical breathing were placed on high-span PIP+PEEP when sleeping from the point of diagnosis of spinal muscular atrophy. Although the appearance of pectus excavatum is ubiquitous in untreated infants with spinal muscular atrophy type 1, after institution of high-span PIP+PEEP, pectus resolves and lungs and chest walls grow more normally. High-span PIP+PEEP is indicated for all infants diagnosed with spinal muscular atrophy who demonstrate paradoxical breathing for the purpose of promoting more normal lung and chest development.
TL;DR: Noninvasive positive-pressure ventilation provides a long-lasting benefit on symptoms and quality of life indicators for amyotrophic lateral sclerosis patients and should be offered to all patients with symptoms of sleep disordered breathing or inspiratory muscle dysfunction.
Abstract: Butz M, Wollinsky KH, Wiedemuth-Catrinescu U, Sperfeld A, Winter S, Mehrkens HH, Ludolph AC, Schreiber H: Longitudinal effects of noninvasive positive-pressure ventilation in patients with amyotrophic lateral sclerosis. Am J Phys Med Rehabil 2003;82:597–604.ObjectiveTo evaluate the duration of benef
TL;DR: The results of the studies suggest that the nature of stroke motor therapy itself can be altered to be more task-specific while remaining within the typical contact time parameters, yet can be more efficacious than more traditional motor rehabilitative approaches.
Abstract: Page SJ: Intensity versus task-specificity after stroke: How important is intensity? Am J Phys Med Rehabil 2003;82:730–732.Recent evidence suggests that intense training regimens can increase the use and function of the more affected limbs of stroke patients. The efficacy of these intense regimens h
TL;DR: This study provides a first step in defining the prevalence and significance of NP among wheelchair users and suggests Clinicians who work with this population need to ask subjects about symptoms and consider a myofascial origin for that pain when considering treatment.
Abstract: Objective Despite the fact that wheelchair users are exposed to risk factors for neck and upper back pain (NP), little is known about the impact and possible diagnoses associated with NP. The purpose of this study was to examine the significance of NP in wheelchair users and to determine if a portion of the NP may be myofascial in origin. Design Cross-sectional cohort study using questionnaires and physical exams to evaluate NP in a convenience sample of wheelchair users from the National Veteran’s Wheelchair Games. Main outcome measures included reported NP, visual analog scale of neck complaints, Neck Disability Index, and physical examination findings of trigger points. Results Sixty-six percent of subjects reported NP since becoming a wheelchair user and, 60% reported pain during the past month. Neither age nor length of time in a wheelchair was significantly different between those subjects who did and those subjects who did not report pain. Of those respondents who reported NP, 60% visited the doctor about the pain and 40% limited their daily activities due to the pain. Trigger-point palpation reproduced pain in 54% of those respondents who experienced pain in the past month (n = 34). Conclusion This study provides a first step in defining the prevalence and significance of NP among wheelchair users. Clinicians who work with this population need to ask subjects about symptoms and consider a myofascial origin for that pain when considering treatment.