Long-Term Outcome of Patients Discharged to a Nursing Home After Aneurysmal Subarachnoid Hemorrhage

Greebe P, Rinkel GJ, Algra A. Long-term outcome of patients discharged to a nursing home after aneurysmal subarachnoid hemorrhage.

Objective

To study long-term outcome in patients with aneurysmal subarachnoid hemorrhage (SAH) who are relatively young.

Design

Retrospective cohort study.

Setting

Nursing homes.

Participants

Patients with SAH (N=92) admitted to our hospital from 1996 to 2006 who were discharged to a nursing home.

Interventions

Not applicable.

Main Outcome Measures

Death, discharge from nursing home, and functional status at end of follow-up.

Results

Of the 92 patients included, 45 had died after a median of 1.1 years (range, 0.0-8.5y), 35 were discharged to home or a sheltered housing or rehabilitation center after a median of 0.6 years (range, 0.1-9.6y), and 12 remained in a nursing home after a median of 4.8 years (range, 2.2-12.0y). Forty-four (43%) had survived longer than 5 years, and 29 (31%) had regained functional independence within the initial 2 years after admission to the nursing home. Early discharge tended to occur more often in patients admitted from 2001 to 2006 than in those admitted from 1996 to 2001 (hazard ratio=1.8; 95% confidence interval, 0.9-3.7) and in those with an aneurysm not in the anterior communicating artery (hazard ratio=1.9; 95% confidence interval, 0.9-3.9).

Conclusions

The prognosis for patients with SAH after admission to a nursing home is not gloomy. The type of rehabilitation that offers best chances to these patients needs to be investigated.     

Impact of Surface Type, Wheelchair Weight, and Axle Position on Wheelchair Propulsion by Novice Older Adults

Cowan RE, Nash MS, Collinger JL, Koontz AM, Boninger ML. Impact of surface type, wheelchair weight, and axle position on wheelchair propulsion by novice older adults.

Objective

To examine the impact of surface type, wheelchair weight, and rear axle position on older adult propulsion biomechanics.

Design

Crossover trial.

Setting

Biomechanics laboratory.

Participants

Convenience sample of 53 ambulatory older adults with minimal wheelchair experience (65-87y); men, n=20; women, n=33.

Intervention

Participants propelled 4 different wheelchair configurations over 4 surfaces: tile, low carpet, high carpet, and an 8% grade ramp (surface, chair order randomized). Chair configurations included (1) unweighted chair with an anterior axle position, (2) 9.05kg weighted chair with an anterior axle position, (3) unweighted chair with a posterior axle position (Δ0.08m), and (4) 9.05kg weighted chair with a posterior axle position (Δ0.08m). Weight was added to a titanium folding chair, simulating the weight difference between very light and depot wheelchairs. Instrumented wheels measured propulsion kinetics.

Main Outcome Measures

Average self-selected velocity, push frequency, stroke length, peak resultant and tangential force.

Results

Velocity decreased as surface rolling resistance or chair weight increased. Peak resultant and tangential forces increased as chair weight increased, as surface resistance increased, and with a posterior axle position. The effect of a posterior axle position was greater on high carpet and the ramp. The effect of weight was constant, but was more easily observed on high carpet and ramp. The effects of axle position and weight were independent of one another.

Conclusion

Increased surface resistance decreases self-selected velocity and increases peak forces. Increased weight decreases self-selected velocity and increases forces. Anterior axle positions decrease forces, more so on high carpet. The effects of weight and axle position are independent. The greatest reductions in peak forces occur in lighter chairs with anterior axle positions.     

Sleep-Disordered Breathing in Patients Enrolled in an Inpatient Stroke Rehabilitation Program

Brooks D, Davis L, Vujovic-Zotovic N, Boulias C, Ismail F, Richardson D, Goldstein RS. Sleep-disordered breathing in patients enrolled in an inpatient stroke rehabilitation program.

Objective

To report the prevalence of sleep-disordered breathing in an inpatient stroke rehabilitation unit and to explore correlations with functional status and health-related quality of life.

Design

Cross-sectional study.

Setting

Rehabilitation center.

Participants

Consecutive patients (N=45; mean age, 67±12y) (28 men) enrolled in inpatient rehabilitation after ischemic (84%) or hemorrhagic stroke (16%).

Interventions

Not applicable.

Main Outcome Measures

Overnight respiratory polysomnography was performed on all subjects. Interviewer-administered scales of sleepiness (Epworth Sleepiness Scale) and functional status (FIM, Barthel Index) were completed. Health-related quality of life was assessed by using a general questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]).

Results

Of the 45 subjects tested, only 4 (9%) had an apnea-hypopnea index of less than 10 per hour. The mean apnea-hypopnea index was 32.2 (19.4) per hour; most events were obstructive. There was no relationship between the respiratory index and the components of SF-36 (P values>.2).

Conclusions

There was a dramatically high prevalence of respiratory events in patients after stroke enrolled in an inpatient stroke rehabilitation unit. The awareness of this will influence patient evaluation and management.     

Kinematic and Electromyographic Analysis of Wheelchair Propulsion on Ramps of Different Slopes for Young Men With Paraplegia

Chow JW, Millikan TA, Carlton LG, Chae W, Lim Y, Morse MI. Kinematic and electromyographic analysis of wheelchair propulsion on ramps of different slopes for young men with paraplegia.

Objective

To gain insight into the biomechanics of upslope wheelchair stroking by examining the changes in kinematic and electromyographic characteristics of wheelchair propulsion over ramps of different slopes.

Design

Repeated-measures design. Each subject pushed up a wooden ramp (7.3m long) 3 times at self-selected normal and fast speeds for each of these slopes: 0°, 2°, 4°, 6°, 8°, 10°, and 12°.

Setting

A biomechanics laboratory.

Participants

Young men (N=10) with paraplegia.

Interventions

Not applicable.

Main Outcome Measures

Electromyographic activity of extensor carpi radialis, triceps brachii, antero-middle and postero-middle deltoids, pectoralis major, and latissimus dorsi, and stroking kinematics.

Results

Forward lean of the trunk increased as the slope increased. The triceps brachii, antero-middle deltoid, and pectoralis major were more active during the push phase, while the postero-middle deltoid was more active during the recovery phase. Both extensor carpi radialis and latissimus dorsi were active throughout a stroke. Major adjustments in stroking kinematics and significant increases in muscle activity occurred at slopes between 4° and 10°.

Conclusion

In addition to a decrease in stroking speed, the stroking pattern becomes more compact (decreased push angle and relative recovery time, increased stroke frequency) and the trunk becomes more active with increasing slope.     

Primary closure of cutaneous abscesses: a systematic review

Background

Cutaneous abscesses have traditionally been treated with incision and drainage followed by secondary healing. Primary closure after incision and drainage is an alternative mode of therapy practiced in some parts of the world. The current study reviews the experience with primary closure of abscesses.

Methods

A systematic literature review was conducted using search terms abscess and primary closure. The databases searched included MEDLINE, PubMED, EMBASE, CINHAL, and the Cochrane Library between 1950 and 2009. The reference lists of the retrieved studies were also manually searched for additional studies. We performed a meta-analysis of all randomized clinical trials in which patients were randomized to either primary or secondary closure of incised and drained abscesses using Review Manager software.

Results

Of 33 articles retrieved, there were 7 randomized controlled trials in which 915 patients were randomized to primary (n = 455) or secondary (n = 460) closure. Many abscesses were located in the anogenital region and drained by surgeons. The time to healing after primary closure (7.8 days [95% confidence interval {CI}, 7.3-8.3]) was significantly shorter than that after secondary closure (15.0 days [95% CI, 14.3-15.7]; absolute difference, 7.3 days [95% CI, 6.9-7.6]). The rates of abscess recurrence after primary closure (7.6% [95% CI, 4.6-10.6]) were similar to those after secondary closure (11.1 days [95% CI, 7.5-14.7]; odds ratio, 0.66 [95% CI, 0.35-1.15]).

Conclusions

Studies from 4 countries suggest that primary closure of incised and drained abscesses results in faster healing and similar low abscess recurrence rates than after secondary closure. These studies provide a foundation for which clinical trials can be conducted in the United States.     

Restoration of Voluntary Muscle Strength After 3 Weeks of Cast Immobilization is Suppressed in Women Compared With Men

Clark BC, Manini TM, Hoffman RL, Russ DW. Restoration of voluntary muscle strength after 3 weeks of cast immobilization is suppressed in women compared with men.

Objective

To investigate sex-related differences in the loss and recovery of voluntary muscle strength after immobilization.

Design

Longitudinal, repeated measures.

Setting

Research laboratory.

Participants

Healthy men (n=5) and healthy women (n=5).

Intervention

Three weeks of forearm immobilization.

Main Outcome Measures

Voluntary wrist flexion muscle strength was assessed at baseline and weekly during the immobilization protocol and 1 week after cast removal. Central activation was assessed before and after immobilization and after 1 week of recovery to determine what percentage of the muscle could be activated voluntarily.

Results

Men and women lost voluntary strength at a similar rate during immobilization. However, after 1 week of recovery voluntary strength had returned to within 1% of baseline in the men, but remained approximately 30% less than baseline in the women (P=0.03). Both sexes displayed reduced central activation after immobilization (P=0.02), but the decrease was similar in both sexes (P=0.82).

Conclusions

These findings suggest sex-dependent adaptations to and recovery from limb immobilization, with voluntary strength recovering slower in women. As such, sex-specific rehabilitation protocols may be warranted, with women requiring additional or more intensive rehabilitation programs after periods of disuse. Future work is needed to determine the extent and mechanisms of these differences.     

Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study

Background

Although approximately half of adults with heart failure (HF) are women, relatively little is known about gender differences and similarities in HF self-care.

Aims

The aim of this study was to describe HF self-care in men and women and to identify gender-specific barriers and facilitators influencing HF self-care.

Methods

A total of 27 adults (8 women) with chronic HF participated in a cross-sectional, comparative mixed methods study. An analysis of in-depth interviews was used to describe gender-specific barriers and facilitators of self-care. After the interview data were analyzed, the results were confirmed in quantitative data obtained from the same sample and at the same time. Concordance between qualitative and quantitative data was assessed.

Results

There were no consistent gender-specific differences in self-care practices but there were distinct gender differences in the decisions made in interpreting and responding to symptoms. The men were better than the women at interpreting their symptoms as being related to HF and in initiating treatment. These differences were associated with differences in self-care confidence, social support, and mood.

Conclusion

Gender-specific differences in self-care behaviors are minimal. However, gender-specific barriers and facilitators greatly influence the choice of self-care behaviors.     

Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement

Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.

Objective

To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.

Design

Case control.

Setting

Sports medicine research laboratory.

Participants

Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.

Results

The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).

Conclusions

The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat.     

Health-related quality of life in women with coronary artery disease

Background

Women with coronary artery disease (CAD) have reported worse health-related quality of life (HRQOL) than men.

Objectives

The purpose of this study was to explore HRQOL in women with CAD undergoing coronary angiography. Specifically, the effects of age and depressive symptoms on HRQOL were examined.

Method

Data were obtained from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. A total of 1034 women underwent coronary angiography between February, 2004 and January, 2005. Questionnaires measuring HRQOL and depressive symptoms were mailed within 1 week of index cardiac catheterization.

Results

There were 437 women (42.3%) who responded to the questionnaires. After adjusting HRQOL scores for sociodemographic and clinical variables, depressive symptoms were the strongest predictor of HRQOL; increased age was associated with worse physical functioning and positive disease perception; higher BMI with anginal stability; revascularization with anginal stability and treatment satisfaction.

Conclusion

Overall, the variables measured accounted for a small proportion of the variance in HRQOL. Further research is needed to understand the complex relationship among age, depressive symptoms, and HRQOL in women with CAD.     

The Ability of Ultrasonography, Magnetic Resonance Imaging and Bone Mineral Densitometry to Predict the Strength of Human Achilles' Tendons

Devitt D, Koike Y, Doherty GP, Ramachandran N, Dinh L, Uhthoff HK, Lecompte M, Trudel G. The ability of ultrasonography, magnetic resonance imaging and bone mineral densitometry to predict the strength of human Achilles' tendons.

Objective

To assess the value of ultrasonography (US), magnetic resonance imaging (MRI), and bone mineral densitometry (BMD) in evaluating human Achilles' tendon strength.

Design

Cross-sectional observational study.

Setting

Tertiary care hospital.

Participants

Ninety-eight Achilles' tendons from 49 consecutive cadavers (26 men and 23 women with a mean age of 66.6 years) undergoing hospital autopsy were assessed.

Interventions

Not applicable.

Main Outcome Measures

Tendon dimensions on US and MRI, and T1-weighted optical density were measured. Areas of hypodensity, hyperdensity, calcification, and heterogeneity were identified on US. The BMD of each calcaneus was recorded. The tendons were mechanically tested to determine peak load at failure.

Results

Sixteen patients (32.7%, 27 tendons) had abnormalities in 1 or both tendons on US and/or MRI (17 on US, 17 on MRI). Fifty-seven tendons (58%) ruptured in their midsubstance, at an average peak load of 4722±990N. Tendons with and without abnormalities on imaging had similar strengths (P>.05). Calcaneal BMD correlated weakly with peak load at failure (r=.21, P<.05).

Conclusions

The prevalence of Achilles' tendons abnormalities on US or MRI was 32.7% in our study group. Abnormalities on clinical imaging (US or MRI) were not predictive of the load at failure. Therefore, tendons with imaging abnormalities are not necessarily weaker, and one cannot predict the likelihood of rupture based on imaging results. Further, higher-powered studies could explore the ability of BMD to detect minimal clinically important differences and to predict Achilles' tendon weakness.     

The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomized clinical trial

Background

Over the past three decades, research has been carried out on the effects of exercise on chronic kidney disease patients for improving their physical potential.

Objectives

The purpose of this study is to evaluate the effect of intradialytic leg ergometry exercise for improving fatigue and daily physical activity levels among chronic kidney disease patients.

Design

A quasi-experimental clinical trial.

Setting

Two hemodialysis units in a medical center in northern Taiwan.

Method

The leg ergometry exercise was performed within the first hour of each hemodialysis session for 30 min for 8 weeks. There were 36 subjects in the experimental group and 35 subjects in the control group who completed the study. Measurement on a fatigue scale and a physical activity log were done at the time of enrollment, and again on the fourth and eighth weeks.

Result

Active subjects demonstrated significantly less fatigue and higher physical activity levels than those with a sedentary lifestyle at baseline. During the 8 weeks of intervention, subjects in both the active and sedentary groups reduced their fatigue levels significantly, with the exception of sedentary subjects in the control group. Only active subjects in the experimental group demonstrated an increase in activity levels. The 36 subjects performed 3456 leg ergometry exercise sessions with three early terminations (<.01%) among the sedentary subjects.

Conclusions

Intradialytic leg ergometry is a safe exercise that is effective to reduce fatigue and improve physical fitness in already active chronic kidney disease patients and it also reduces fatigue in sedentary patients. Interventions to motivate sedentary patients to become active require further investigation.

Implication for nursing practice

Exercise during hemodialysis does not cost patients extra time and is effective in reducing fatigue and increasing physical activity potential as demonstrated by our study; 30 min of intradialytic leg ergometer exercise can be considered as routine care while delivering hemodialysis.     

Rehabilitation Consumers' Use and Understanding of Quality Information: A Health Literacy Perspective

Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective.

Objectives

To explore consumers' use and understanding of quality information about postacute rehabilitation facilities.

Design

Thematic, semistructured interviews.

Setting

Two skilled nursing facilities and 2 inpatient rehabilitation facilities in a large Midwestern city.

Participants

Rehabilitation inpatients (n=17) with stroke, hip fractures, and joint replacements and care partners (n=12) of rehabilitation inpatients.

Intervention

None.

Main Outcome Measure

None.

Results

Health literacy imposed barriers to participants' understanding of quality information. Using the Institute of Medicine's Health Literacy Framework, we identified specific barriers that limited participants' abilities to (1) obtain quality information, (2) process and understand quality information, and (3) make appropriate decisions about the quality of a rehabilitation facility. Participants tended to rely on informal and nonquality information when choosing a rehabilitation facility.

Conclusions

Given the barriers imposed by low health literacy, rehabilitation providers have a responsibility to present quality information in a way that consumers, especially those with low health literacy, can use and understand.     

Modality-Specific, Multitask Locomotor Deficits Persist Despite Good Recovery After a Traumatic Brain Injury

McFadyen BJ, Cantin J-F, Swaine B, Duchesneau G, Doyon J, Dumas D, Fait P. Modality-specific, multitask locomotor deficits persist despite good recovery after a traumatic brain injury.

Objective

To study the effects of sensory modality of simultaneous tasks during walking with and without obstacles after moderate to severe traumatic brain injury (TBI).

Design

Group comparison study.

Setting

Gait analysis laboratory within a postacute rehabilitation facility.

Participants

Volunteer sample (N=18). Persons with moderate to severe TBI (n=11) (9 men, 3 women; age, 37.56±13.79y) and a comparison group (n=7) of subjects without neurologic problems matched on average for body mass index and age (4 men, 3 women; age, 39.19±17.35y).

Interventions

Not applicable.

Main Outcome Measures

Magnitudes and variability for walking speeds, foot clearance margins (ratio of foot clearance distance to obstacle height), and response reaction times (both direct and as a relative cost because of obstacle avoidance).

Results

The TBI group had well-recovered walking speeds and a general ability to avoid obstacles. However, these subjects did show lower trail limb toe clearances (P=.003) across all conditions. Response reaction times to the Stroop tasks were longer in general for the TBI group (P=.017), and this group showed significant increases in response reaction times for the visual modality within the more challenging obstacle avoidance task that was not observed for control subjects. A measure of multitask costs related to differences in response reaction times between obstructed and unobstructed trials also only showed increased attention costs for the visual over the auditory stimuli for the TBI group (P=.002).

Conclusions

Mobility is a complex construct, and the present results provide preliminary findings that, even after good locomotor recovery, subjects with moderate to severe TBI show residual locomotor deficits in multitasking. Furthermore, our results suggest that sensory modality is important, and greater multitask costs occur during sensory competition (ie, visual interference).     

Canadian Laboratory Initiative on Pediatric Reference Interval Database (CALIPER): Pediatric reference intervals for an integrated clinical chemistry and immunoassay analyzer, Abbott ARCHITECT ci8200

Objectives

A comprehensive set of age- and gender-specific pediatric reference intervals is essential for accurate interpretation of laboratory tests in a pediatric setting.

Design and methods

1459 serum/plasma from children attending select outpatient clinics and deemed to be metabolically stable, were collected from five age groups; 0-12 months, 1-5 years, 6-10 years, 11-14 years and 15-20 years. Samples were analyzed for 24 chemistries and 15 immunoassays on ARCHITECT ci8200.

Results

Reference intervals were established according to CLSI/IFCC C28-P3 guidelines by the Robust statistical method. The ranges reflect the central 95% confidence intervals for the population tested. Age and gender were partitioned using the Harris-Boyd method.

Conclusions

While these intervals are ci8200 method specific, they not only provide robust intervals for users of this system but are also useful for any laboratory requiring pediatric intervals if they can be shown to be transferable and if validated for the local patient population.     

Evaluating Displacement of the Coracoacromial Ligament in Painful Shoulders of Overhead Athletes Through Dynamic Ultrasonographic Examination

Wu C-H, Wang Y-C, Wang H-K, Chen W-S, Wang T-G. Evaluating displacement of the coracoacromial ligament in painful shoulders of overhead athletes through dynamic ultrasonographic examination.

Objective

To evaluate displacement of the coracoacromial ligament (CAL), using dynamic ultrasonography (US), for detecting instability-related impingement caused by overhead activities.

Design

Between-group survey.

Setting

Department of Physical Medicine and Rehabilitation in a tertiary care center.

Participants

Volunteer high school volleyball players with unilateral shoulder pain (n=10) and volunteer asymptomatic high school volleyball players with identical training activities as control subjects (n=16).

Interventions

Not applicable.

Main Outcome Measure

The displacement of the CAL was measured during throwing simulation using dynamic US. Both shoulders of all subjects were evaluated.

Results

During throwing simulation, the displacement of the CAL in the painful shoulders of overhead athletes increased significantly greater than the displacement in the asymptomatic shoulder (3.0±0.7mm and 2.2±0.4mm, respectively; P=.017). No difference was identified between the displacements of the CALs of bilateral shoulders of the control group subjects.

Conclusions

Dynamic US, by measuring the displacement of the CAL during simulation of throwing, may be helpful in detecting abnormal humeral head upward migration in overhead athletes.     

Plasma precursors of brain catecholaminergic and serotonergic neurotransmitters in rehabilitation patients with ischemic stroke

Aquilani R, Verri M, Iadarola P, Arcidiaco P, Boschi F, Dossena M, Sessarego P, Scocchi M, Arrigoni N, Pastoris O. Plasma precursors of brain catecholaminergic and serotonergic neurotransmitters in rehabilitation patients with ischemic stroke. Arch Phys Med Rehabil 2004;85:779-84.

Objective

To determine levels of plasma amino acid tyrosine and tryptophan, precursors of brain catecholamine and serotonin neurotransmitters, respectively, in rehabilitative patients with ischemic stroke.

Design

Controlled, pre-post analysis, consecutive sample.

Setting

Rehabilitation center.

Participants

Twenty men with ischemic stroke (age, 68±11.3y) consecutively admitted into rehabilitation 15±10 days (range, 7-28d) after an acute cerebrovascular insult; 15 healthy sedentary subjects (controls 1); and 13 healthy hypoactive individuals who had recently had knee arthroplasty (controls 2). Both control groups were matched to stroke subjects for age, gender, and body weight.

Interventions

At 8:00 am, after overnight fasting, venous blood samples were drawn from patients to determine plasma tyrosine and tryptophan levels. A nutritional evaluation, including nitrogen balance, was made. The same procedures were repeated after 45 days of rehabilitation. Amino acid data were compared with those obtained from the controls.

Main outcome measure

Plasma concentrations of amino acids.

Results

Patients with ischemic stroke, on admission, had lower plasma tyrosine concentration than did both controls 1 (P<.0005) and controls 2 (P<.001), but a similar tryptophan level. The plasma content of tyrosine was similar between the 2 control groups. After 45 days of rehabilitation, the stroke patients’ tyrosine and tryptophan levels remained virtually unchanged, as did nutritional parameters. Nutritional intakes were adequate to meet body needs but insufficient to correct plasma tyrosine.

Conclusions

Patients experiencing a recent stroke may have low plasma tyrosine levels and, therefore, reduced brain catecholamine formation. It is possible that an imbalance of brain neurotransmitters may occur.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.

Objective

To determine whether oxygen consumption (V˙o₂) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.

Design

Exploratory case-control study.

Setting

Medical school exercise physiology laboratory.

Participants

Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).

Intervention

None.

Main Outcome Measures

V˙o₂ on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).

Results

Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.

Conclusion

V˙o₂ on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.     

Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To describe and compare the quality of life (QOL) of persons with lower-limb amputation (LLA) at admission (T1), discharge (T2), and 3 months after rehabilitation discharge (T3) and to explore the relationships between QOL and demographic and clinical variables including body image.

Design

Longitudinal case series.

Setting

Inpatient rehabilitation facility.

Participants

Consecutive sample of 19 unilateral persons with LLA (14 men, mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Generic and specific QOL measures and perception of body image at T1, T2, and T3.

Results

Subjective QOL was relatively high at T1, T2, and T3 (0.87/2, 1.1/2, and 1.0/2, respectively) except for items related to physical functioning. There was no significant change over time for all but 1 QOL satisfaction measure (ability to go outside, P=.024). Prosthesis-related QOL was high at discharge and follow-up. Body-image disturbances were absent over the study period. QOL satisfaction and prosthesis satisfaction were strongly related to lower-limb pain and psychosocial factors (eg, body image).

Conclusions

QOL of persons with LLA was high and remained relatively stable during inpatient rehabilitation and 3 months after discharge.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.