Showing papers in "Journal of Rehabilitation Medicine in 2001"

Intra- and inter-tester reliability and reference values for hand strength.

Abstract: The intra- and inter-tester reliability for measurement of handgrip strength and indexgrip strength using the Jamar dynamometer was investigated in 32 healthy volunteers, and the intra-tester relia ...

The responsiveness of the action research arm test and the fugl-meyer assessment scale in chronic stroke patients

Abstract: The responsiveness of the Action Research Arm (ARA) test and the upper extremity motor section of the Fugl-Meyer Assessment (FMA) scale were compared in a cohort of 22 chronic stroke patients undergoing intensive forced use treatment aimed at improvement of upper extremity function. The cohort consisted of 13 men and 9 women, median age 58.5 years, median time since stroke 3.6 years. Responsiveness was defined as the sensitivity of an instrument to real change. Two baseline measurements were performed with a 2-week interval before the intervention, and a follow-up measurement after 2 weeks of intensive forced use treatment. The limits of agreement, according to the Bland-Altman method, were computed as a measure of the test-retest reliability. Two different measures of responsiveness were compared: (i) the number of patients who improved more than the upper limit of agreement during the intervention; (ii) the responsiveness ratio. The limits of agreement, designating the interval comprising 95% of the differences between two measurements in a stable individual, were -5.7 to 6.2 and -5.0 to 6.6 for the ARA test and the FMA scale, respectively. The possible sum scores range from 0 to 57 (ARA) and from 0 to 66 (FMA). The number of patients who improved more than the upper limit were 12 (54.5%) and 2 (9.1%); and the responsiveness ratios were 2.03 and 0.41 for the ARA test and the FMA scale, respectively. These results strongly suggest that the ARA test is more responsive to improvement in upper extremity function than the FMA scale in chronic stroke patients undergoing forced use treatment.

Guidelines to statistical evaluation of data from rating scales and questionnaires.

Abstract: Questionnaires and rating scales are commonly used to measure qualitative variables, such as feelings, attitudes and many other behavioural and health-related variables. There are different types of instruments ranging from single scales to multidimensional, multi-item questionnaires. The scaling of the responses can vary from the dichotomous alternatives “yes” and “no” to a mark on a line, as in the visual analogue scale (VAS). Numerical labels are commonly used for the recordings. Nevertheless, irrespective of the type of scaling, the item responses indicate only an ordered structure and not a numerical value in a mathematical sense. Such data are often called ordered categorical or ordinal (1–4). Statistical methods for data from rating scales must take account of the rank-invariant propertiesof ordinal data, whichmeans that the methodsmust be unaffected by a relabelling of the scale categories. Hence, statistical methods applicable to data from rating scales differ completely from the traditional methods for quantitative variables, since calculations based on adding or subtracting ordinal data are not appropriate. Sum scores of multi-item assessments, the mean value, standard deviation and calculation of differences for description of change in score do not have an interpretable meaning and must be avoided in the statistical evaluation of data from rating scales and questionnaires (4–6). Traditionally, in applied research, there is a temptation to treat data from rating scales as numerical on an interval level (4, 5). It should be emphasized, however, that data on an interval level are quantitative, which means that such data have the mathematical properties of well-deŽ ned size and equidistance, but the same variable does not have the same ratio when it is measured in different units (1). Hence, qualitative data could never gain the properties required for being treated as interval data. Statistical methods for quantitative data are valid only when data have the mathematical properties of well-deŽ ned size and distance, and conclusions drawn from such analyses are solely interpretable and reliable for quantitative data. However, quantitative data such as blood pressure could be treated as ordinal when categorized as “low”, “normal” and “high”. Such categorization changes the choice of appropriate statistical methods of analysis. GUIDELINES FOR STUDIES INCLUDING RATING SCALES AND/OR QUESTIONNAIRES

Reliability and responsiveness of three different pain assessments.

Abstract: The visual analogue scale (VAS) and ordered categorical scales, i.e. numeric rating scales (NRS), are commonly used in the assessment of pain. However, these scales are bounded by fixed endpoints and thus the range of measurement is limited. The disparity in repeated assessments of perceived pain intensity with the VAS, NRS, and electrical stimulation applied as a matching stimulus was studied in 69 patients (48 women and 21 men, 19-72 years) with chronic nociceptive or neurogenic pain. Responsiveness with transcutaneous electrical nerve stimulation (TENS) using the same measurement procedures was evaluated in the same patients. Comparison of results from the three pain assessments showed that the painmatcher is at least as reliable and responsive as VAS and NRS. None of the three measurements showed evidence for systematic disagreement and had only significant random individual disagreement. They also showed evidence for responsiveness.

Effects of muscle strengthening and physical conditioning training on temporal, kinematic and kinetic variables during gait in chronic stroke survivors.

Abstract: The purpose of this study was to evaluate the impact of a combined program of muscle strengthening and physical conditioning on gait performance in subjects with chronic stroke, using a single group pre- and post-test design. Thirteen subjects were recruited for the 10-week program (3 days/week), which consisted of warm-up, aerobic exercises, lower extremity muscle strengthening and cool-down. Data from cinematographic film and a force plate obtained during multiple walking trials were used in a four-segment kinetic model to yield spatiotemporal, kinematic and kinetic variables. Gait analysis revealed that the 10 week training resulted in significant increases in gait speed associated with improvements in walking patterns as determined by increases in selected kinematic and kinetic measures. After training, subjects were able to generate higher levels of powers and demonstrated increases in positive work performed by the ankle plantar flexor and hip flexor/extensor muscles.

The use of outcome measures in physical medicine and rehabilitation within Europe.

Abstract: The aim of the study was to survey the use of outcome measures in rehabilitation within Europe. It was envisaged that this would provide the basis for further studies on the cross-cultural validity of outcome measures. A postal questionnaire was distributed in November 1998 to 866 units providing rehabilitation. In total, 418 questionnaires were returned, corresponding to a response rate of 48%. These 418 centres treated an estimated 113,000 patients annually, undertaking 360,000 assessments. The survey focused on nine diagnostic groups: hip and knee replacement, low back pain, lower limb amputees, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke and traumatic brain injury. It identified a relatively small number of dominant outcome assessments for each diagnostic group and some variation in the preference for measures across regions. A large number of measures, however, are being used in one or a small number of locations and with relatively few patients. For rehabilitation of orthopaedic patients the majority of assessments undertaken are at the impairment level. For patients with neurological disorders the emphasis is mostly upon measures of disability.

Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study.

Abstract: In a cross-sectional postal questionnaire study we compared individuals with localized low back pain (LBP) with individuals with LBP as part of widespread musculoskeletal pain, according to demographic and lifestyle characteristics and functional ability. All the inhabitants in Ullensaker county born 1918‐ 20, 1928‐ 30, 1938‐ 40, 1948‐ 50, 1958‐ 60 and 1968‐ 70 were sent a questionnaire in 1994. The study population comprised 2893 responders. LBP as part of widespread pain indicated reduced functional ability, and the groups differed in several demographic and lifestyle characteristics.

Fracture risk in patients with muscular dystrophy and spinal muscular atrophy.

Abstract: We aimed at studying fracture risk in patients with Duchenne's muscular dystrophy (DMD), Becker's muscular dystrophy (BEMD), and spinal muscular atrophy type II and III (SMA II and III). A self-administered questionnaire was mailed to 293 patients with DMD, BEMD, SMA II or SMA III of which 229 returned the questionnaire. Each respondent was compared with an age- and gender-matched control subject. The mean age was 23.9 +/- 15.9 years for the patients and 23.3 +/- 16.5 years for the controls. There were significantly more fractures among patients than controls after the diagnosis was made (RR = 1.9), but not before. The patients had more fractures of the femurs, lower legs, and upper arms than the controls. Low energy fractures were more frequent in patients than controls (9% vs 0%). Many fractures in the femurs (40%), lower legs (35%), and feet and toes (44%) led to a permanent loss of function. Loss of ambulation was the major risk factor for fractures. In conclusion, fracture risk is increased in neuromuscular disease.

No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home-care personnel.

Abstract: The effects of two different prevention programmes on: (1) reported neck, shoulder and back pain, (2) perceived physical exertion at work and perceived work-related psychosocial factors, were evaluated by questionnaires after 12 and 18 months. Female nursing aides and assistant nurses (n = 282) working in the home-care services, were randomly assigned to one of three groups for: (1) individually designed physical training programme, (2) work-place stress management, (3) control group. Results revealed no significant differences between the three groups. However, improvements in low back pain were registered within both intervention groups for up to 18 months. Perceived physical exertion at work was reduced in the physical training group. Improvements in neck and shoulder pain did not differ within the three groups. Dissatisfaction with work-related, psychosocial factors was generally increased in all groups. As the aetiology of neck, shoulder and back disorders is multifactorial, a combination of the two intervention programmes might be preferable and should be further studied.

The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI).

Abstract: The development and testing of an observational gait assessment instrument, the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) is described. To assess validity and reliability, 22 subjects with incomplete spinal cord injury were scored by four raters. Raters scored each subject three times, once live (LS) and twice from videotaped records (VS1, VS2). A moderate-good negative correlation (r = -0.742 and -0.700, for VS1 and VS2, respectively) was found between the gait score and time required to walk a demarcated path. Inter-rater reliability was moderate-good for the live score and the videotaped records (ICC = 0.703, 0.800, and 0.840, respectively). Intra-rater reliability was good (ICC = 0.903, 0.960, 0.942, and 0.850 for Raters 1-4, respectively). To assess sensitivity, another group of 19 subjects with SCI were assessed prior to and following participation in an intensive walking program. A moderate correlation was found between change in gait score and change in lower extremity strength (Pearson r = 0.58). These results indicate that the SCI-FAI is a reliable, valid and sensitive measure of walking ability in individuals with spinal cord injury. In addition, the results suggest that gait analysis using this instrument is equally reliable whether the observation is performed live or from videotaped records.

Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.

Abstract: A randomized, controlled, single-blind study was performed on 20 patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia. Ten patients each were randomly assigned to one of two groups, one training with air and the other training with oxygen. There were no significant differences between the groups regarding values measured prior to the study. The patients trained 3 times per week for 30 minutes each time for a duration of 8 weeks. The training consisted of interval walking on a treadmill (intensity set according to Borg ratings) with either air or oxygen administered through a nasal cannula at a rate of 5 l/min. Training significantly improved the 6-minute walking distance by 20% and 14% in the air and oxygen group, respectively, when the patients were tested on air. In the same test the air group significantly decreased Borg ratings for perceived exertion. Borg ratings for dyspnoea and perceived exertion significantly decreased in the oxygen group when they were tested on oxygen. It was concluded that oxygen supplementation did not further improve the training effect, compared with training with air, in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.

The effect of a home physiotherapy program for persons with Parkinson's disease

Abstract: The purpose of this study was to evaluate the effect of a home physiotherapy program for persons with Parkinson's disease. Thirty-three patients took part in the study using a within-subject controlled design. Functional activities including walking and carrying out transfers were measured at home and in the hospital before and after a 6-week baseline period, after 6 weeks home physiotherapy and after 3 months follow-up. Spatiotemporal and plantar force variables of gait were determined with video and pododynography. Treatment provided by community physiotherapists consisted of teaching cueing and conscious movement control 3 times a week. The study revealed that patients had significantly higher scores on a functional activity scale after treatment in the home setting and to a lesser degree in hospital, a result, which was partly sustained at follow-up. However, duration of the transfer movements, spatiotemporal and plantar force variables were not significantly improved except for stride length. The results support application and development of the treatment concept and highlight that physiotherapy aimed at improving function in Parkinson's disease is best provided in the home situation.

Chest physiotherapy after coronary artery bypass graft surgery--a comparison of three different deep breathing techniques.

Abstract: The effectiveness of three deep breathing techniques was evaluated in 98 male patients after coronary artery bypass graft surgery in a randomized trial. The techniques examined were deep breathing with a blow bottle-device, an inspiratory resistance-positive expiratory pressure mask (IR-PEP) and performed with no mechanical device. Pulmonary function and roentgenological changes were evaluated. Four days post-operatively there were significantly decreased vital capacity, inspiratory capacity, forced expiratory volume in 1 second, functional residual capacity, total lung capacity and single-breath carbon monoxide diffusing capacity in all three groups (p < 0.0001). No major differences between the treatment groups were found, but the impairment in pulmonary function tended to be less marked using the blow bottle technique. The Blow bottle group had significantly less reduction in total lung capacity (p = 0.01) compared to the Deep breathing group, while the IR-PEP group did not significantly differ from the other two groups.

The relationships between trunk function and the findings of transcranial magnetic stimulation among patients with stroke.

Abstract: In this study, we investigated the relationship between the motor evoked potentials obtained from trunk muscles and the clinical function of trunk muscle. Twenty patients with unilateral hemispheric stroke and 11 healthy adults were examined. The responses of the bilateral external oblique muscles and the erector spinae muscles to the magnetic stimulation of multiple sites over both cortical hemispheres were recorded. Trunk muscle performance was assessed using the Trunk Control Test and Stroke Impairment Assessment Set. In the stroke group, stimulation of the affected hemisphere resulted in a motor evoked potential in only one patient, while the other 19 stroke patients produced no response to stimulation of the affected hemisphere. Stimulation of the unaffected hemisphere evoked bilateral responses in 19 patients. Further, stimulation of the unaffected hemisphere in the stroke group produced larger motor evoked potentials in the ipsilateral muscles than the motor evoked potentials recorded in the ipsilateral muscles of the control group. The clinical assessment scores of trunk function (i.e. Trunk Control Test and trunk items of Stroke Impairment Assessment Set) were correlated with the amplitudes of the motor evoked potentials of the ipsilateral external oblique muscle that were evoked by stimulation of the unaffected hemisphere. Our results suggest that the recovery of trunk function after stroke is associated with an increase in ipsilateral motor evoked potentials in the external oblique muscle upon stimulation of the unaffected hemisphere, suggesting a role for compensatory activation of uncrossed pathways in recovery of trunk function.

Effects on physical performance and pain from three dynamic training programs for women with work-related trapezius myalgia.

Abstract: To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.

Activities of daily living and quality of life in persons with muscular dystrophy.

Abstract: The study concerns 77 adults with muscular dystrophy (mean age 49 years) in two counties in Sweden. The purpose was to investigate activities of daily living, quality of life and the relationship between these. Data collection was performed with "the Activity of Daily Living Staircase", "the Self-report Activity of Daily Living" and the Quality of Life Profile. The results indicated that over half of the subjects were dependent on others, chiefly in activities requiring mobility. Muscular dystrophy had mostly negative consequences, and nearly half stated that life would have offered more without it. Few significant diagnosis-related (no gender-related) differences emerged regarding activities of daily living and quality of life. Lower quality of life can only partly be explained by greater disability (r=0.30-0.54). Therefore quality of life as a measurement of rehabilitation outcomes might be based both on physical status, disability and psychosocial factors in terms of positive and negative consequences.

Ability and perceived difficulty in daily activities in people with poliomyelitis sequelae.

Abstract: Polio involvement and its relation to ability in terms of independence and perceived dife culty in activities in daily living (ADL) were studied in outpatients (median age 57 years) with poliomyelitis sequelae ( n = 133) The use and need of assistive devices and housing conditions were recorded The subjects had a high degree of independence in personal ADL, whereas more than 50% were dependent on cleaning, shopping and transportation A considerable number of subjects independent in ADL reported dife culties in daily activities The majority of interventions in the form of housing adaptation and assistive devices were provided for persons severely weakenedby polio Ratings of perceived dife culty indicated need of interventions to prevent overload and increased dependence in ADL However, about half of the recommended mobility assistive devices were rejected The results indicate that polio subjects try to maintain their independence despite perceived dife culties and may be reluctant to use assistive devices

Low effectiveness of prescribed partial weight bearing. Continuous recording of vertical loads using a new pressure-sensitive insole.

Abstract: To enable objective measurements of weight bearing in hip replacement patients a portable instrument set-up with an on-line registering pressure-sensitive insole was developed. Six men and 9 women, median age 58 (48-67) years, who had been operated on with a cementless or hybrid hip arthroplasty were studied. All patients were independent and functional. A physiotherapist instructed the patients to use crutches in order to support 30% of their body weight. The patients then walked a standardized distance with crutches over five different types of terrain: level, uphill, downhill, upstairs and downstairs. The trial was repeated once. In both men and women most of the steps taken resulted in a load of >30% of body weight. None of the patients managed to comply with the directive, even though five of them thought they did. The type of terrain had no significant influence on the pattern of load. Our findings indicate that the effectiveness of prescribing limited weight bearing is questionable.

Assessment of chronic pain behaviour: reliability of the method and its relationship with perceived disability, physical impairment and function.

Abstract: The aim of the present study was to develop a reliable assessment of pain behaviour performed during the execution of a range of functional assessment measures. For the initial reliability study 18 subjects (consecutive referrals) were assessed. Subjects were observed and videotaped during a variety of physical tasks and demonstrations of pain behaviour were recorded; the videotapes were scored by two independent observers on two occasions. The relationships between pain behaviour, distress and physical function and impairment were also investigated in a group of 51 patients with chronic back pain. Self-report of disability and pain intensity were assessed using the Finnish version of Oswestry disability questionnaire and the pain visual analogue scale (VAS). Depression and somatic perception were assessed using the modified Zung and modified somatic perception questionnaire. The Tampa scale for kinesiophobia was used to evaluate fear of movement and (re)injury. The results of the intra- and interobserver reliability study demonstrate good to excellent levels of agreement. The exception was facial expression (kappa 0.29), which was excluded from the final instrument. There was a strong correlation between pain behaviour and subjective pain report and disability (p < 0.01). The correlations between total pain behaviour and performance of physical function tasks is striking (p < 0.01). Subjective disability was analysed by means of multiple regression analysis. Pain measured on the VAS was the most important variable explaining 36% of the variance, pain behaviour and pain combined explained 48% of the variance for self reported disability. In conclusion, this functional videobased assessment of pain behaviour is a reliable measure of pain behaviour. The total scores for pain behaviour correlate with tasks that involve the back; tests involving upper limbs were not affected. This test is suitable for the assessment of those with pain problems specifically involving the back. Furthermore, in the group studied pain and pain behaviour were the two most important determinants of self-reported disability.

"Active back school", prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial.

Abstract: The purpose of the present study was to investigate the long-term effect of the Active Back School programme on minimizing recurrences of episodes of low back pain. Forty-three subjects were randomly allocated to the Active Back School group and 38 to the control group. There were no significant differences between the groups with regard to baseline characteristics. The Active Back School programme comprised 20 lessons each divided into a 20-min theoretical and a 40-min exercise part during a 13-week period. Nine participants (11%) dropped out during the study period. Recurrence of new low back pain episodes was significantly less (p = 0.04), and the time from inclusion to the first new low back pain episode was significantly on the side of the Active Back School group (p < 0.01). The duration of sick leave was found to be significantly shorter (p < 0.01) in the Active Back School group compared to the control group. The Active Back School reduced the recurrence and severity of new low back pain episodes at 36 months' follow-up.

Comparison of two physical exercise programs for the early intervention of pain in the neck, shoulders and lower back in female hospital staff

Abstract: The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO2max) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity significantly increased in the ET group, whereas no change was observed in the SP group, and a significant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was significantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey confirmed the beneficial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

Physical performance and health-related quality of life in men on a liver transplantation waiting list.

Abstract: Twenty-six men on a liver transplant waiting list (12 had alcoholic cirrhosis, 8 suffered from posthepatitic cirrhosis, and 6 from cirrhosis of other etiologies) were eligible for this observation. Nineteen subjects underwent exercise testing to determine oxygen uptake at anaerobic threshold. In all patients dynamometry was performed to determine isokinetic muscle strength of knee extensor muscles, and handgrip. Quality of life was evaluated in all patients with the MOS SF-36 questionnaire. Child-Pugh A patients showed 54 +/- 8%, Child-Pugh B patients 36 +/- 2%, and Child-Pugh C patients 31 +/- 4% of VO2 max predicted at the anaerobic threshold (Kruskal-Wallis ANOVA, p < 0.05). Isokinetic muscle strength of the quadriceps femoris (left/right) was 149 +/- 20/134 +/- 14 Nm in Child-Pugh A, 108 +/- 16/114 +/- 19 Nm in Child-Pugh B, and 89 +/- 10/81 +/- 11 Nm in Child-Pugh C patients (Kruskal-Wallis ANOVA, p < 0.05). MOS-SF36 revealed a Child-Pugh class dependent reduced functional status (Kruskal-Wallis ANOVA, p < 0.05). No significant differences in target parameters were found when analysed according to the etiology of cirrhosis. Patients on the liver transplant waiting list do have a stage dependent reduction in physical health. These data are the basis for longitudinal studies measuring the effects of preoperative rehabilitation programs in these patients.

Factors associated with successful vocational rehabilitation in a Swedish rural area.

Abstract: The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

Gait improvement in unilateral transfemoral amputees by a combined psychological and physiotherapeutic treatment

Abstract: A conscious therapeutic approach was used combining methods in physiotherapy with psychological awareness to re-educate nine transfemoral amputees during 10 months in outdoor environments. All were rehabilitated trauma or tumour cases, mean age 33 years, and had worn their prostheses for more than 18 months. The method aimed at integrating the prosthesis in normal movements and increasing body awareness. Gait was measured with a three-dimensional motion analysis system. Self-selected comfortable and brisk gait speed increased from mean 0.95 m/s and 1.29 m/s before to 1.40 m/s and 1.65 m/s after treatment, respectively. The results remained at a 6-month follow-up. Before treatment three participants used walking-aids and all had problems with low-back pain. After treatment none needed walking-aids and almost all low-back pain had disappeared. Seven participants learnt to jog. Results indicate that this new approach may add skills, mostly on participation level, to lead a relatively normal life.

Cross-cultural adaptation of the Minnesota Living with Heart Failure Questionnaire for German-speaking patients.

Abstract: We performed a cross-cultural adaptation of the “ Minnesota Living with Heart Failure Questionnaire” (LHFQ) for use in German-speaking chronic heart failure patients. The instrument was translated and back translated, pre-tested and reviewed by a committee. The German version was tested in 114 patients with chronic heart failure. Reliability was assessed by a test-retest procedure and Cronbach’ s coefe cient alpha of internal consistency (0.94). To assess concurrent validity, we compared the LHFQ sum scores with the New York Heart Association classie cation rating (r = 0.53; p < 0.0001), the 6-minute walk (r = i0.39; p < 0.0001), the left ventricular ejection fraction (r = i0.24; p = 0.011) and big-endothelin (r = 0.27; p = 0.004). Construct validity on the LHFQ scores in comparison with the Medical Outcomes Study SF-36 Health Survey (MOS SF36) was signie cant ( i0.41 to i0.74; all p < 0.0001). The reliability and validity of the German version of the LHFQ was proved; the questionnaire can be recommended for use in future clinical trials.

Evaluation of grip strength with a sustained maximal isometric contraction for 6 and 10 seconds.

Abstract: The grip strength in which subjects sustained a maximal isometric contraction for 6 seconds (the 6-second test) was compared with that for 10 seconds (the 10-second test) to clarify a reliable sustained grip strength test procedure. Fifty healthy students (22+/-4 years, 25 men and 25 women) participated in this study. Strength was measured continuously by the Dexter (Cedaron Medical Inc.). The maximal grip strength, the peak time, and the momentary strength every second during a trial were evaluated. For both tests, the reliable maximal strength and a typical strength-time curve consisting of an early peak time and a decrease in the strength after the peak gradually over time were obtained. In the 6-second test, the momentary strength after 5 seconds that was 82+/-10 approximately 87+/-7% of the peak strength showed good reliability. This variable may be effective in assessing the ability to sustain maximal grip strength.

Key dimensions of client satisfaction with assistive technology: a cross-validation of a canadian measure in the netherlands

Abstract: The purpose of this study was to conduct a cross-validation of the bidimensional structure of a satisfaction measure with assistive technology. Data were drawn from a follow-up study of 243 subjects who had been administered the Dutch version of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Ratings related to 12 satisfaction items were analysed. Factor analysis results showed that the underlying structure of satisfaction with assistive technology consists of two dimensions related to assistive technology, Device (eight items) and Services (four items), accounting for 40% of the common variance. This finding was consistent with a previous Canadian study and was interpreted as supporting the adequacy and stability of the QUEST measure of satisfaction. Although the structure is delineated, further studies are recommended to support its use in European countries.

Disabilities in children with Duchenne muscular dystrophy: a profile.

Abstract: Proper assessment of disabilities is essential for rehabilitation of patients with Duchenne muscular dystrophy. The aim of this study was to identify and quantify the disabilities in children with Duchenne muscular dystrophy and correlate them with impairment. Thirty-one patients with Duchenne muscular dystrophy of age four years and above were studied. The motor functions were evaluated using total motor score, upper and lower extremity function grades and timed function tests. Disability was quantified with Barthel index. The mean scores of motor scales were: total motor score -52 +/- 7.8, total functional grade -4.4 +/- 1.9 and timed function score -12.5 +/- 5.8. Barthel index scores ranged from 45-95 with a mean of 70.8 +/- 12.7. Motor scales correlated with each other and with Barthel index. Thirty children had disabilities in multiple spheres of life, which were significantly influenced by the motor power. Barthel index was useful in identifying and quantifying specific areas of disabilities in these children. Evaluation of disabilities using specific measures may be crucial for planning comprehensive management.

Augmentative and alternative communication methods in locked-in syndrome.

Abstract: Locked-in syndrome is a neurological condition due to a brain disease or an injury affecting the brain stem. The symptoms are tetraplegia, double-sided facial paresis, anarthria/dysarthrophonia, dysphagia and reactive involuntary laughing and crying. Vertical eye movements are the only commonly remaining voluntary motor function. Although the linguistic abilities as well as intellectual and emotional functions as a whole remain intact, all the motor abilities of self expression are lost. Seventeen chronic locked-in syndrome patients referred to Kapyla Rehabilitation Centre between 1979-2000 are reported. The multidisciplinary rehabilitation team developed an individual alternative communication method for all patients and trained them to use it by minor movements of e.g. thumb, chin or head. An alternative communication method enabled most of the patients to interact with other people using practical as well as theoretical thinking and decision making.