Showing papers in "Clinical Rehabilitation in 2005"

Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study

Abstract: Objectives: To establish: (1) inter-rater and test–retest reliability of standardized guidelines for the Fugl-Meyer upper limb section, Action Research Arm Test and Box and Block Test in patients with paresis secondary to stroke, multiple sclerosis or traumatic brain injury and (2) correlation between these arm motor scales and more general measures of impairment and activity limitationDesign: Multicentre cohort studySetting: Three European referral centres for neurorehabilitationSubjects: Thirty-seven stroke, 14 multiple sclerosis and five traumatic brain injury patientsMain measures: Scores of the Fugl-Meyer Test (arm section), Action Research Arm Test, and Box and Block Test derived from video informationResults: All three motor tests showed very high inter-rater and test–retest reliability (ICC and rho for main variables>095) Correlation between the motor scales was very high (rho>092) Motor scales correlated moderately highly with the Hemispheric Stroke Scale, a measure of impairment (rho=0

Effects of external rhythmical cueing on gait in patients with Parkinson's disease: a systematic review

Abstract: Objective: To critically review studies evaluating the effects of external rhythmical cueing on gait in patients with Parkinson's disease.Methods: Articles published from 1966 to January 2005 were searched by two physiotherapists in MEDLINE, PiCarta, PEDRo, Cochrane, DocOnline, CINAHL and SUMSEARCH. To be included, articles had to investigate the effects of external rhythmical cueing (i.e., auditory, visual or tactile cueing) on gait parameters in patients with idiopathic Parkinson's disease. Both controlled and noncontrolled studies were included. Based on the type of design and methodological quality a meta-analysis or best-evidence synthesis was applied.Results: Twenty-four studies (total number of patients = 626) out of the 159 screened studies were evaluated in this systematic review. Two out of 24 were randomized controlled trails (RCT), both of high methodological quality. One RCT did not focus specifically on external rhythmical cueing of individual patients with Parkinson's disease, but on group ...

Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire

Abstract: Objectives: To provide further evidence of reliability and internal and external construct validity of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), which measures severity of postconcussion symptoms following head injury.Design and setting: A cross-sectional study of consecutive patients presenting with a head injury in two urban teaching hospitals and a community trust.Patients: Three hundred and sixty-nine patients returned a questionnaire from 1689 consecutive adult patients (18 years and above) referred to radiology for a skull X-ray following a head injury, and those who were currently under the care of a community-based multidisciplinary head injury team.Method: Internal construct validity tested by fit to the Rasch Measurement model; external construct validity tested by correlations with Rivermead Head Injury Follow-up Questionnaire (RHFUQ); test-retest reliability tested by correlations at two-week intervals.Outcome measures: Rivermead Post-Concussion Symptoms Questionnaire and Riv...

Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study

Abstract: Objective: To assess and to compare the reliability of the Modified Tardieu Scale with the Modified Ashworth Scale in patients with severe brain injury and impaired consciousness.Design: Cross-sectional observational comparison study.Setting: An early rehabilitation centre for adults with neurological disorders.Subjects: Thirty patients with impaired consciousness due to severe cerebral damage of various aetiologies.Measurement protocol: Four experienced physical therapists rated each patient in a randomized order once daily for two consecutive days. Shoulder, elbow, wrist, hip, knee and ankle spasticity were assessed by the use of Modified Tardieu Scale and Modified Ashworth Scale data collection procedures.Main outcome measures: Test - retest and inter-rater reliability (k=kappa value) of the Modified Tardieu Scale and the Modified Ashworth Scale.Results: The test-retest reliability of the Modified Ashworth Scale was moderate to good (k = 0.47-0.62) and of the Modified Tardieu Scale moderate to very goo...

Effects of whole-body vibration in patients with multiple sclerosis: a pilot study:

Abstract: Objective: To examine whether a whole-body vibration (mechanical oscillations) in comparison to a placebo administration leads to better postural control, mobility and balance in patients with multiple sclerosis.Design: Double-blind, randomized controlled trial.Setting: Outpatient clinic of a university department of physical medicine and rehabilitation.Subjects: Twelve multiple sclerosis patients with moderate disability (Kurtzke's Expanded Disability Status Scale 2.5-5) were allocated either to the intervention group or to the placebo group.Interventions: In the intervention group a whole-body vibration at low frequency (2.0-4.4 Hz oscillations at 3-mm amplitude) in five series of 1 min each with a 1-min break between the series was applied. In the placebo group a Burst-transcutaneous electrical nerve stimulation (TENS) application on the nondominant forearm in five series of 1 min each with a 1-min break between the series was applied as well.Main outcome measures: Posturographic assessment using the S...

Manual muscle testing: does it meet the standards of an adequate screening test?

Abstract: Objective: To describe the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of manual muscle testing.Design: Secondary analysis of cross-sectional strength data.Setting: Acute rehabilitation unit.Participants: Convenience sample of 107 consecutive qualifying rehabilitation inpatients.Intervention: Not applicable.Main outcome measures: Knee extension forces measured by manual muscle testing and hand-held dynamometry.Results: The ability of manual muscle testing to detect 15, 20, 25 and 30% between-side differences and deficits in knee extension force was described. Although the specificity of manual muscle testing was acceptable (mostly>80%), its sensitivity to differences between sides and to deficits relative to normal never exceeded 75%. Its diagnostic accuracy was never greater than 78%.Conclusion: The results of this study cast doubt on the suitability of manual muscle testing as a screening test for strength impairments.

Falls and injury prevention should be part of every stroke rehabilitation plan

Abstract: Objective: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed.Design: Prospective cohort study.Setting: Community.Subjects: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study.Main measures: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM).Results: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People require...

Chronic low back pain in traumatic lower limb amputees

Abstract: Objective: To ascertain the prevalence of back pain amongst traumatic lower limb amputees attending a regional rehabilitation centre and to determine the possible causes of back pain.Design: All traumatic lower limb amputees given a semi-structured questionnaire to complete and a comparative subgroup of amputees with back pain and without back pain underwent physical examination, gait analysis, magnetic resonance scanning (MRI) and gait/standing stability analysis.Setting: A subregional amputee rehabilitation centre.Results: Transfemoral amputees were more likely to suffer from back pain (81%) than transtibial amputees (62%) (p≤0.05) and of those suffering from severe back pain, 89% and 81% also suffered from severe pain in the phantom limb and severe stump pain respectively. In two comparative subgroups of amputees there was no significant difference between back pain and pain-free groups except those with pain were more likely to have a body mass index (BMI) ratio above 50% of the recommended ratio. No ...

Describing rehabilitation interventions

Abstract: Rehabilitation is an effective process for reducing the morbidity and sometimes the mortality associated with many illnesses. This statement is supported by much evidence, but there is less evidence to support most specific actions undertaken in rehabilitation. In part this is inevitable because there are so many interventions. However the lack of an adequate system to classify and describe the complex interventions that constitute rehabilitation is also a great hindrance. This is in marked contrast to the detailed specification used in pharmacological research and reasonable description available for some surgical interventions. This editorial puts forward a classification system that is derived from two models relevant to rehabilitation: the World Health Organization's International Classification of Functioning model of illness and a model of rehabilitation described here. Interventions may be described in terms of the situations where these actions are applied, the immediate goals of any action, the l...

Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial:

Abstract: Objective: To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke.Design: Randomized controlled trial.Setting: Medical centre.Subjects: Twenty-five subjects with stroke, who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis, randomly allocated to two groups, control (n = 12) and experimental (n = 13).Interventions: Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks. Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week.Main measures: Gait was measured using the Stride Analyzer. Gait parameters of interest were walking speed, cadence, stride length, gait cycle and symmetry index. Measures were made at baseline before commencement of training (pre-training) and at the end of the three-week training period (post-training).R...

Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study

Abstract: Objective: To study the efficacy of cognitive rehabilitation combined with acetylcholinesterase inhibitor (AChE-I) treatment in patients with mild Alzheimer's disease and their relatives.Method: Thirteen patients with mild Alzheimer's disease treated with rivastigmine 6-12 mg/day for more than two months started cognitive rehabilitation training. Before and after the cognitive rehabilitation training patients were assessed through cognitive tests, activities of daily living scale, neuropsychological battery and scales to evaluate caregivers' depressive and anxiety symptoms. Six patients were randomized to a combined treatment group (AChE-I plus cognitive rehabilitation and caregiver support) and seven patients to a control group (AChE-I only) and followed up for five months.Results: Mini-Mental State Examination (MMSE) scores (p=0.047) and backward digit span scores (p=0.018) were significantly different between the groups on follow-up. The combined treatment group showed a better positive treatment effec...

Determinants of functional independence and quality of life in children with spina bifida

Abstract: Objective: To investigate determinants of functional independence and study which functional abilities were determinants for ‘health-related quality of life’ in children with myelomeningocele.Design: Cross-sectional study by means of clinical assessment, ‘disability’ measurement and questionnaires. Uniand multivariate logistic regression models were used to investigate factors that were determinants for these outcomes. Results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI).Setting: Outpatient spina bifida clinic at a university hospital.Subjects: One hundred and twenty-two children with myelomeningocele. Mean age 7.9; range 1-18 years.Main measures: Functional independence as measured by the Pediatric Evaluation of Disability Inventory (PEDI), and quality of life as measured by the Spina Bifida Health Related Quality of Life Questionnaire.Results: Lesion level below L3 (OR 0.4, 95% CI 0.1-1.0), mental status of IQ] - 80 (OR 4.2, 95% CI 1.2-14.9), having no contractures in lower e...

Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations

Abstract: Objective: To examine the effects of an ankle-foot orthosis (AFO) on balance performance in patients with hemiparesis of short and long duration.Design: Within-subject random order of intervention, cross-sectional study design.Settings: Medical centres and district hospitals.Subjects: Forty-two subjects with hemiparesis of short duration (B=six months) and 61 subjects of long duration (=12 months).Measurements: The balance and gait ability of subjects were evaluated both with an AFO and without. The static and dynamic balance activities were evaluated by the Balance Master System, whereas the functional balance was assessed with the Berg Balance Scale. The speed and cadence were also measured during a 10-metre walk. Paired t-test was used to determine the effect of the AFO.Results: In subjects with hemiparesis of short duration, we found that subjects wearing an AFO showed significant improvements in (1) weight-bearing distribution during quiet standing (p / 0.042, 95% confidence interval (CI) 0.521, 7.32...

Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial

Abstract: Objective: To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training (Arm BASIS training) in stroke patients with arm severe paresis.Design: Single blind, multicentre randomized control trial.Setting: Three inpatient neurorehabilitation centres.Subjects: Sixty-two anterior circulation ischaemic stroke patients.Interventions: Random assignment to three group: (A) no augmented exercise therapy time, (B) augmented exercise therapy time as Bobath therapy and (C) augmented exercise therapy time as Arm BASIS training.Main measures: Main outcome measure: Fugl-Meyer arm motor score. Secondary measure: Action Research Arm Test (ARA). Ancillary measures: Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale (elbow flexors).Results: An overall effect of augmented exercise therapy time on Fugl-Meyer scores after four weeks was not corroborated (mean and 95% confidence interval (CI) of change scores: no augmented e...

A pilot study of the effect of aerobic exercise on people with moderate disability multiple sclerosis

Abstract: Objective: A pilot study to investigate the effect of aerobic exercise on the mobility and function of people with moderate disability multiple sclerosis (MS).Design: A small group, comparative, pre-and post-intervention study.Setting: A gymnasium within a general hospital.Subjects: Eight subjects, all female, average age 45 years (range 33-61) with moderate disability MS (Kurtzke scale 4-6), were recruited; six completed the study.Intervention: Intervention consisted of bi-weekly sessions of 30 min cycling on a static bike at their maximal level of exertion for 12 weeks.Main measures: The stability of each individual's condition was established pre-intervention using three baseline assessments over two weeks. A battery of tests (the 10-metre and 6-min walk tests, the Functional Reach, the Gulick and the Guys Neurological Disability Scale) were completed pre and post intervention. Potential negative effects were recorded on the Fatigue Severity Scale and the Modified Ashworth Scale. An independent rater c...

Therapy and support services for people with long-term stroke and aphasia and their relatives: a six-month follow-up study

Abstract: Objective: To evaluate the impact of attending an aphasia therapy centre on quality of life and communication skills in people with stroke and aphasia and their relativesDesign: Before and after study, six months durationSetting: Community-based aphasia therapy centre in the United KingdomParticipants: Thirty-eight men and women with aphasia following a stroke, and 22 of their relatives Mean time since stroke was 33 months (SD 241)Interventions: A range of group therapies for people with aphasia and their relatives and counselling for individuals and couplesOutcome measures: Quantitative outcome measures were ratings of quality of life and communication for people with aphasia, and relatives' independent ratings of communication and coping with caring Qualitative outcomes were perceptions of quality of life and communication skills using semi-structured interviewsResults: Improvement was detected on all outcomes at six months There were significant changes from baseline on the quality of life me

A randomized clinical trial of TENS and exercise for patients with chronic neck pain

Abstract: Objective: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on acupuncture points and neck exercise in chronic neck pain patients.Design: A randomized clinical trial.Setting: Hospital-based practice.Subjects: Two hundred and eighteen patients with chronic neck pain.Interventions: Subjects were randomized into three groups, receiving either (1) TENS over the acupuncture points plus infrared irradiation (TENS group); (2) exercise training plus infrared irradiation (exercise group); or (3) infrared irradiation alone (control); twice a week for six weeks.Outcome measures: The values of verbal numeric pain scale, Northwick Park Neck Pain Questionnaire, and isometric neck muscle strength were assessed before, at the end of the six-week treatment, and at the six-month follow-up.Results: Results demonstrated that after the six-week treatment, significant improvement in the verbal numerical pain scale was found only in the TENS group (0.60±2.54, p=0.027) and the exercise group (1.57±...

A qualitative study investigating patients' beliefs about cardiac rehabilitation

Abstract: Background: The opportunity to attend a cardiac rehabilitation course is usually offered to patients who have suffered a myocardial infarction However, despite referral, many patients fail to attendObjective: To elicit patients' beliefs about the role of the cardiac rehabilitation course following myocardial infarctionDesign: Qualitative study using in-depth semi-structured interviewsSetting: London Teaching HospitalSubjects: Thirteen patients were interviewed after discharge from hospital following myocardial infarction, but prior to attendance at cardiac rehabilitationMain outcome measures: Patients' beliefs about cardiac rehabilitation that may act as barriers to attendanceResults: Themes identified included: the content of cardiac rehabilitation, perceptions of exercise, benefits of cardiac rehabilitation, explicit barriers to attendance and cardiac knowledge Whilst some patients viewed cardiac rehabilitation as an important and necessary part of recovery others expressed doubt that it was app

Continuous passive motion improves shoulder joint integrity following stroke

Abstract: Objective: In a pilot study of patients with a first stroke and hemiparesis, we sought to determine whether treatment of the upper limb with continuous passive motion (CPM) that was device delivered would alter impairment, disability or the associated adverse symptoms of shoulder joint instability, pain and tone.Design: Patients were randomly assigned to receive daily CPM treatments or participate in self-range of motion groups under the supervision of an occupational therapist. All patients received standard daily poststroke therapy for 3.5 h per day. A blinded evaluator at admission and discharge assessed patients using standardized scales of impairment, disability and adverse symptoms.Setting: Specialized stroke unit of an acute rehabilitation hospital.Subjects: Two hundred and eighty consecutive patients were screened and 35 of these with a first unilateral stroke, 139-6 days following the acute event, provided informed consent and were randomly assigned to CPM treatment or supervised group self-range...

A randomized controlled trial of botulinum toxin on lower limb spasticity following acute acquired severe brain injury

Abstract: Objective: To determine whether serial casting combined with botulinum toxin reduces the development of calf contracture after severe head injury.Design: A double-blind placebo-controlled trial of three parallel treatments for lower limb spasticity.Setting: Acute general hospital in the UK.Subjects: Adults aged 17–70 years admitted to hospital following a severe brain injury.Interventions: Current physical treatment (group I), lower leg casting plus injections with either saline (group II), or with botulinum toxin (group III) into gastrocnemius and soleus muscles.Measures: Limit of ankle dorsiflexion at entry and exit after up to 12 weeks, the Glasgow Outcome Scale (GOS) and Modified Ashworth Scale (MAS).Results: Two hundred and fifty-three patients were screened and 35 were entered into the trial. Three patients died and four failed to complete the trial. Eighty-eight per cent of those entering the randomized part of the study developed spasticity within 14 days of their injury and the mean range of impr...

The reproducibility of the Canadian Occupational Performance Measure

Abstract: Objective: To assess the reproducibility (reliability and inter-rater agreement) of the client-centred Canadian Occupational Performance Measure (COPM).Design: The COPM was administered twice, with a mean interval of seven days (SD 1.6, range 4-14), by two different occupational therapists. Data analysis was based on intraclass correlation coefficients, the Bland and Altman method and Cohen's weighted kappas.Setting: Occupational therapy departments of two university medical centres.Subjects: Consecutive clients, with various diagnoses, newly referred to the outpatient clinic of two occupational therapy departments, were included. They were all over 18 years of age and perceived limitations in more than one activity of daily life. Complete data on 95 clients were obtained: 31 men and 64 women.Results: Sixty-six per cent of the activities prioritized at the first assessment were also prioritized at the second assessment. The intraclass correlation coefficients were 0.67 (95% confidence interval (CI) 0.54-0...

Reliability of simple portable tests of physical performance in older people after hip fracture

Abstract: Objective: To investigate the test–retest reliability of measures of strength, balance, gait and functional performance when used with older people following hip fracture.Subjects: Thirty people (16 hospital inpatients and 14 community dwellers).Design: Subjects underwent two assessments: one day apart for the hospital inpatients and one week apart for the community dwellers.Measurement: Strength (dynamometer, sphygmomanometer, spring balance, lateral step-up ability), balance (sway-meter, Functional Reach Test, single leg stance time, Step Test), gait (timed 6-m walk with steps taken, base of support and step length), and functional performance (PPME total score and timed supine-to-sit and sit-to-stand) were measured.Results: Eleven of the 14 continuously scaled measurement tools achieved excellent reliability (intraclass correlation coefficient (ICC)>0.75) for one or more tests. A hand-held dynamometer was found to be the tool with the highest test–retest reliability for measuring hip muscle strength (I...

Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews

Abstract: Objective: To summarize the research evidence available from systematic reviews of the efficacy of occupational therapy (OT) for practitioners, researchers, purchasing organizations and policy-makers. Data source: The search for systematic reviews was conducted in PubMed and the Cochrane Library (October 2004). Methods: The reviews included were those that utilized a systematic search for evidence with regard to OT for specific patient groups. Data were summarized for patient group, interventions, outcome domains, type of study designs included, method of data synthesis and conclusions. Results: Fourteen systematic reviews were included. Three reviews related to rheumatoid arthritis, four reviewed stroke and four focused on elderly people. Reviews of Parkinson's disease, multiple sclerosis, Huntington's disease, cerebral palsy and mental illnesses were also identified. The reviews of rheumatoid arthritis, stroke and elderly people showed evidence of the efficacy of OT in increasing functional abilities. Positive results were presented for quality of life and social participation in elderly people and stroke respectively. The efficacy of OT in all other patient groups is unknown due to insufficient evidence. Conclusion: This summary shows that elderly people and people with stroke or rheumatoid arthritis can expect to benefit from comprehensive OT. Evidence of the efficacy of specific interventions is sparse and should be addressed in future research. The evidence that does exist should be incorporated into OT practice.

‘If only I manage to get home I'll get better’-Interviews with stroke patients after emergency stay in hospital on their experiences and needs:

Abstract: 'If only I manage to get home I'll get better' - interviews with stroke patients after emergency stay in hospital on their experience and needs

The effects of progressive resistance training for children with cerebral palsy

Abstract: Objectives: To investigate the effects of progressive resistance training of quadriceps and hamstrings muscles in children with cerebral palsy (CP).Design: Pilot study using a repeated measures design with measurements at baseline, immediately after six weeks training then at four-week follow-up.Setting: The project was undertaken within the physiotherapy department of two special schools in Glasgow.Subjects: A convenience sample of eight children aged between six and 12 years, with hypertonic CP.Intervention: The subjects participated three times per week in a six-week, progressive, free-weight, strengthening programme.Outcome measures: Maximum isometric muscle strength and resistance to passive stretch were measured with a hand-held myometer. The Gross Motor Function Measure and a 10-metre timed walking test, were used to assess function and gait parameters respectively.Results: Muscle strength increased, with the quadriceps to hamstrings strength ratio moving towards normal. These changes were retained...

The effect of botulinum toxin type A treatment of the lower extremity on the level of functional abilities in children with cerebral palsy: evaluation with goal attainment scaling:

Abstract: Objective: To measure the effect of botulinum toxin type A (BTX-A) treatment in children with cerebral palsy with regard to individual goals concerning functional abilities, using goal attainment scaling.Design: A single-blind randomized multiple baseline/treatment phase design across subjects.Setting: The paediatric department of a rehabilitation centre.Subjects: Eleven children with cerebral palsy participated.Intervention: BTX-A treatment of the lower extremity.Main measures: A six-point goal attainment scaling of three individual treatment goals at the level of functional abilities. Standardized video-tapes of each goal were recorded weekly for a period of 14 weeks. Rating on the predetermined goal attainment scaling was blinded.Results: Nine of the 11 subjects showed significant improvement in 18 out of 33 goals. Seven subjects showed clinically relevant improvement (at least 2 points on the goal attainment scaling) in 11 goals. Testing the difference between all medians of baseline measurements (aft...

Somatosensation, circulation and stance balance in elderly dysvascular transtibial amputees

Abstract: Objective: To establish the relationship between poor lower limb somatosensory and circulatory status with standing balance, falls history, age and mobility level in dysvascular transtibial amputees (TTAs). Design: Within-subjects evaluation of somatosensation, circulation and stance balance measures in dysvascular transtibial amputees. Setting: Physiotherapy department of a tertiary metropolitan hospital in Australia. Participants: Twenty-two community-dwelling unilateral dysvascular transtibial amputee volunteers, aged between 54 and 86 recruited from a metropolitan hospital outpatient amputee clinic. Main outcome measures: Lower limb vibration sense, light touch sensation and circulatory status were related to centre of pressure excursion during quiet stance, dynamic balance measures of forward and lateral reach distance, and demographic information such as falls history and mobility level. Results: Overall, poor somatosensory status was associated with poor stance balance. There was an association between poor vibration and circulation and increased centre of pressure excursion in quiet stance and reduced reach distance, whereas poor light touch was linked with even weight-bearing in quiet stance. Poor vibration sense was associated with a history of frequent falls. Conclusions: Compromised lower limb somatosensation and circulation was linked with poor balance and a history of frequent falls in the elderly dysvascular amputee population.

Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis

Abstract: Objectives: To investigate the test-retest reliability of the following clinical diagnostic characteristics of myofascial trigger points: taut band, spot tenderness, jump sign, pain recognition, referred pain and local twitch responses (LTRs).Design: Test-retest reliability study.Setting: This study was undertaken in an outpatient physiotherapy department.Subjects: Fifty-eight patients (31 males and 27 females) with rotator cuff tendonitis were recruited into this study.Intervention: Rotator cuff muscles were assessed by an expert for the presence or absence of the main clinical diagnostic characteristics of trigger point assessment. The process was then repeated three days later by the same expert.Main measures: Outcomes included the presence or absence of: a taut band, spot tenderness, jump sign, pain recognition, referred pain and LTRs.Results: Kappa values between testing situations for the taut band, spot tenderness, jump sign and pain recognition were 1. Kappa scores for referred pain ranged between...

Hand dominance and side of stroke affect rehabilitation in chronic stroke

Abstract: Objective: To examine the difference between upper extremity deficits in subjects with left versus right hemispheric lesions at baseline and after bilateral arm training.Design: A one-way ANOVA was used to detect group differences and a least square means analysis used to determine significance in pre-to-post scores for each group.Setting: Testing was in the Physical Therapy and Rehabilitation Science Department Research Laboratory, University of Maryland, Baltimore. Training was at the Senior Exercise Rehabilitation Center in the Veterans Administration Hospital, Baltimore.Subjects: Twenty-two (11 left hemispheric lesion, 11 right hemispheric lesion) right-handed subjects with chronic stroke.Interventions: A six-week nonprogressive repetitive bilateral arm training with rhythmic auditory cueing (BATRAC).Main measuresy: Fugl-Meyer Upper Extremity Test, Wolf Motor Arm Test, University of Maryland Arm Questionnaire for Stroke (UMAQS), isometric strength and active and passive range of motion for both sides....

Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation

Abstract: Objective: To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF).Design: Consecutive assessment of the three forms of care was completed.Subjects: The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward.Intervention: (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors.Results: MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using...