Impairment,disability, and the ICIDH model II: The nature of the underlying condition and patterns of impairment

This paper presents a further exploration of the conceptual scheme proposed in the International Classification of Impairments, Disabilities, and Handicaps which links underlying condition, impairment and disability. It examines the proposal that three general patterns of impairment profile might be expected depending on whether the underlying condition affects control (as in stroke or multiple sclerosis), mechanical performance (as in arthritis) or energy (as in cardiorespiratory conditions). Examination of patterns of functional limitation shows more resemblance between conditions in each of these groups than between the groups lending support to the proposal.     

Driving after stroke: A controlled laboratory investigation

The importance of illness or disability for traffic safety is unknown. By means of a mock car, 46 individuals suffering from left-sided hemiparesis and 67 with right-sided hemiparesis after stroke were compared with 109 healthy controls. Only patients without complicating disorders were included in the study groups. They coped far worse than the control group in almost all respects. Reaction times were longer, not merely for the paretic but also for the contralateral extremities. Strength in the ‘healthy’ part of the body was also significantly reduced. Sometimes patients completely failed to react to given signals. In right-sided hemiparesis a high frequency of directional errors was observed. Neuropsychological functional disorders were well in accordance with the number of erroneous reactions, but to only a minor extent with reaction times. The results of the mock car test could not be predicted on the basis of mere clinical examination.     

Treatment of neuromuscular and musculoskeletal problems in cerebral palsy

Cerebral palsy typically involves a variety of neuromuscular and musculoskeletal problems. These problems include spasticity, dystonia, contractures, abnormal bone growth, poor balance, and loss of selective motor control. These problems can interfere with function and treating them can improve function. The treatments include physical and occupational therapy, bracing, oral medications, neurolytic blocks, neurosurgical procedures, orthopaedic surgery and others. Using a multidisciplinary treatment team with a good understanding of cerebral palsy, the best treatment options can be determined and functional outcomes maximized.     

The stages of recovery from severe head injury with special reference to late outcome

Ten years research into the physical and psychosocial consequences of severe brain damage in adults has revealed substantial information about the process of recovery. The main features are evidence that the greater part of physical and mental recovery occurs within six months of injury and that in most cases the mental consequences of injury outweigh the physical ones and place the greater burden upon the injured person's relatives. Impairment of memory is the most common cognitive disorder and alterations in personality often occur also and are the most taxing of the mental deficits for all concerned.

The process of recovery has three stages, in the first the patient is unconscious, in the second he or she regains full consciousness signified by the end of the period of post traumatic amnesia and continues to show evidence of rapid improvement in basic physical and mental functions. The rate of recovery shows within six months of injury in most cases and this represents the end of the second stage. In the third stage, which may last for many months, both the patient and his or her relatives adapt to the residual disabilities of the former. Methods of managing the three stages should include physical, psychological and social techniques and the way in which they may be linked to the patients’ differing physical and psychosocial needs during the three stages of recovery are briefly discussed.     

Understanding people's needs in a commercial public space: About accessibility and lived experience in social settings

Adapting public spaces for persons with disabilities can be both physically and socially challenging. The two pilot studies presented explore the existing physical conditions of the mall and the social experiences of the mall users as these are documented and experienced by them. The research goals include understanding the physical characteristics of the mall, how access happens, what people experience in real time when going to the mall and what this might mean in terms of issues of social construction of space and personal lived experiences. In both pilot studies, the methods included visual documentation and content analysis of the existing spaces and their design, followed by live in-mall walk-abouts with participants, during which narratives of the experiences were recorded. Researchers engaged collaboratively with participants to understand the experiences, challenges and situations they experienced. Participants include persons with reduced vision or severe vision loss and persons in motorized wheelchairs. Results reveal issues of lack of accessibility, poor contrast and issues of way-finding. Social stigmas add to mall experiences and participants nevertheless reveal the value of the social experiences despite the mall elements hampering their access.     

Activity rating scales in adult muscle disease: What do they actually measure?

Introduction: There is a diversity of rating scales that assess function in muscle disease. Definitive knowledge of the content covered by these scales would help in making choices. Methods: We searched for activity rating scales used for muscle disease and assessed their content by linking scale items to the International Classification of Functioning, Disability and Health (ICF) and the muscle regions they cover. Results: Of the 119 scales found, 19 muscle disease–specific and 9 generic scales were prioritized for analysis. These 28 scales contained 457 items, from which 1145 concepts were identified and 160 were unique. Of these concepts, 97.8% could be linked to the ICF, most to the activities and participation domain (68.7%), followed by environmental factors (22.5%) and body functions (6.6%). Global muscle function was assessed most frequently, followed by lower and upper extremity function. Conclusions: This content comparison should allow for a better‐informed choice of activity rating scales for muscle disease. Muscle Nerve 50 : 14–23, 2014     

Accelerometers for objective evaluation of physical activity following spine surgery

With the potential of bias from subjective evaluation scores in spine surgery, there is a need for practical and accurate quantitative methods of analysing patient recovery. In recent years, technologies such as accelerometers and global positioning systems have been introduced as potential objective measures for pain and symptoms following spine surgery. Overall, this perspective article aims to discuss and critique currently utilised methods of monitoring spine surgical outcomes. After analysing current modalities it will briefly analyse new potential methods before examining the place for accelerometers in the field of spine surgery. A literature review was performed on the use of accelerometers for objective evaluation of symptoms and disability after spine surgery, and perspectives are summarised in this article. Physical activity measurement with the use of accelerometers following spine surgery patients is practical and quantitative. The currently available accelerometers have the potential to transform the way functional outcomes from spine surgery are assessed. One key advantage is the collection of standardised objective measurements across studies. Future studies should aim to validate accelerometer data in relation to traditional measures of functional recovery, patient outcomes, and physical activity.     

Hopkins Verbal Learning Test – Revised: Norms for Elderly African Americans

The Hopkins Verbal Learning Test – Revised (HVLT-R) is a memory test commonly used in neuropsychological evaluations, but for which there are currently no normative data for elderly African Americans. The current study examined the influence of demographic characteristics on HVLT-R performance measures in a community-dwelling sample of 237 African American older adults (60–84 years). Age, gender, and education accounted for moderate amounts of variance in HVLT-R performance. Based on these results, normative tables for HVLT-R scores, stratified by age and with score adjustments for education and gender, are provided.