Postural Responses to Dynamic Perturbations in Amputee Fallers Versus Nonfallers: A Comparative Study With Able-Bodied Subjects

Vanicek N, Strike S, McNaughton L, Polman R. Postural responses to dynamic perturbations in amputee fallers versus nonfallers: a comparative study with able-bodied subjects.

Objectives

To quantify postural responses in amputee fallers versus nonfallers by using computerized dynamic posturography.

Design

All participants completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest.

Setting

Human performance laboratory in a university in the United Kingdom.

Participants

Transtibial amputees (n=9) and able-bodied subjects (n=9) (all categorized into fallers and nonfallers according to their falls history in the previous 9mo).

Interventions

Not applicable.

Main Outcome Measures

Equilibrium and strategy scores on the SOT. Postural response latency and weight distribution on the MCT.

Results

Equilibrium scores were highest when somatosensory information was accurate, but there were no differences between the groups. Strategy scores were lower when visual cues and somatosensory information were inaccurate, and the fallers and nonfallers used a combination of ankle and hip strategies to prevent a loss of balance. The amputee nonfallers indicated they had a greater reliance on visual input even when it was inaccurate compared with the amputee fallers, whereas the control fallers used the hip strategy significantly more compared with the control nonfallers (SOT condition 6: 56±22 vs 72±10, P=.01). Weight distribution symmetry showed that the amputee nonfallers bore significantly more weight through their intact limb compared with the amputee fallers during backward and forward translations (P<.05).

Conclusions

The SOT and MCT appeared to be population specific and therefore did not reliably identify fallers among transtibial amputees or distinguish between community-dwelling control fallers and nonfallers. Amputee and control fallers can prevent a fall during challenging static and dynamic conditions by adapting their neuromuscular responses. The results from this study have important implications for amputee gait rehabilitation, falls prevention, and treatment programs.     

Static and Dynamic Postural Balance After Successful Mobile-Bearing Total Ankle Arthroplasty

Lee KB, Park YH, Song EK, Yoon TR, Jung KI. Static and dynamic postural balance after successful mobile-bearing total ankle arthroplasty.

Objective

To investigate static and dynamic postural balance after successful total ankle arthroplasty by using dynamic posturography.

Design

A controlled trial study.

Setting

A national university orthopedic and rehabilitation hospital.

Participants

Patients (n=30, 21 men, 9 women; mean age, 58y) and age- and sex-matched healthy controls (n=30).

Interventions

Thirty patients who underwent unilateral total ankle arthroplasty with a cementless mobile-bearing ankle prosthesis and 30 age- and sex-matched healthy control subjects were included.

Main Outcome Measures

Using computerized dynamic posturography, sensory (sensory organization test [SOT]), and motor (limit of stability [LOS], rhythmic weight shift [RWS], and weight bearing) impairment assessments were performed at an average of 15 months after total ankle arthroplasty.

Results

In the SOT, results of the SOT-2 test reflecting mainly proprioception showed no significant difference between patients and controls, but patients demonstrated significantly lower scores for SOT-4, -5, and -6 as a measure of dynamic postural balance and required more hip movement to maintain balance. In the motor-control tests, patients showed significantly lower measures in indices of LOS test except the mean reaction time and the forward/backward directional control and on-axis velocity of the RWS test. Weight bearing was observed asymmetrically in patients.

Conclusions

Patients had a higher degree of dynamic postural imbalance and relied less on ankle strategy to maintain balance than controls. Also, patients showed the deficit of motor control ability as compared with age- and sex-matched healthy controls.     

Effects of Tai Chi Intervention on Dual-Task Ability in Older Adults: A Pilot Study

Hall CD, Miszko T, Wolf SL. Effects of Tai Chi intervention on dual-task ability in older adults: a pilot study.

Objective

To determine if a 12-week program of Tai Chi that has been shown to reduce falls incidence in older adults would improve the ability to allocate attention to balance under dual-task conditions.

Design

Pre-/posttest experimental research design.

Setting

Movement studies research laboratory.

Participants

Community dwelling older adults (N=15; range, 62-85y) participated in either Tai Chi training or health education classes (controls) for 12 weeks.

Interventions

Participants in the Tai Chi group attended a twice-weekly, 1.5-hour class taught by an experienced instructor. The control group attended a biweekly, 1-hour class for lectures on health-related topics.

Main Outcome Measures

Two cognitive tasks (responding to auditory or visual stimulus as quickly as possible) were performed concurrently while maintaining static balance during the Sensory Organization Test (SOT) and while avoiding obstacles while walking. The percent change in performance relative to the single-task condition was calculated and defined as the dual-task cost. The dual-task cost was calculated for both the postural and cognitive measures.

Results

There was no improvement in the performance of postural stability or cognitive task under dual-task conditions for the SOT for Tai Chi versus controls. There was no improvement in avoiding obstacles under dual-task conditions for Tai Chi versus controls.

Conclusions

Contrary to our hypothesis, the findings of this study did not support a benefit of Tai Chi on the ability to allocate attention to balance under dual-task conditions.     

The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke

Blennerhassett JM, Jayalath VM. The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.

Objective

To examine if the Four Square Step Test (FSST), a previously reported clinical test of dynamic standing balance, which involves stepping over obstacles and turning, was a feasible and valid test, and sensitive to change during stroke rehabilitation.

Design

Prospective observational cohort study over a 4-week duration.

Setting

Rehabilitation hospital.

Participants

People with stroke (N=37) who could walk at least 50m with minimal assistance were recruited consecutively when attending physical therapy during rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Dynamic standing balance was examined at 2 weekly intervals using 2 clinical tests: the FSST and the Step Test. Falls events were monitored using a falls diary and by an audit of medical histories.

Results

Strong agreement was observed between performance scores for the FSST and Step Test obtained within the same testing session (intraclass correlation coefficient_3,k, .94-.99). A moderate to strong inverse relationship (Spearman ρ=−.73 to −.86) was observed between the FSST and Step Test scores at each assessment. Scores from both tests revealed significant improvements in dynamic balance across the 4-week period (P<.001-.010). Five of the participants reported falls during the study. These 5 people had low scores for both clinical tests and difficulty clearing their foot when stepping over objects in the FSST.

Conclusions

The FSST is a feasible and valid test of dynamic standing balance that is sensitive to change during stroke rehabilitation.     

A Study of Bone Mineral Density in Adults With Disability

Smith ÉM, Comiskey CM, Carroll ÁM. A study of bone mineral density in adults with disability.

Objectives

To examine prevalence of low bone mineral density (BMD) among adults with disability, using World Health Organization diagnostic categories.

Design

Cross-sectional study.

Setting

National Rehabilitation Hospital, Dublin, Ireland.

Participants

Patients (N=255; 178 men, 77 women) who were disabled for at least 3 months because of acquired brain injury, spinal cord injury, other neurologic condition, or lower-limb amputation.

Interventions

None.

Main Outcome Measures

Laboratory investigations including intact parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and sex hormones; and BMD of lumbar spine and at least 1 hip, measured by dual-energy x-ray absorptiometry and expressed as T scores and z scores.

Results

Mean age ± SD of participants was 48.7±15.6 years. Vitamin D deficiency, 25-OHD level 50nmol/L or less, occurred in 154 (62.9%); insufficiency, a level between 51 and 72nmol/L, occurred in 36 (14.7%). Based on T scores, 108 participants (42.4%) had osteopenia, and 60 (23.5%) had osteoporosis. A z score of −1 or less but more than −2 occurred in 76 (29.8%); a further 52 (20.4%) had a z score of −2 or less. On multiple linear regression analysis, ambulatory status and duration of disability were independent predictors of BMD at neck of femur (β=.152, P=.007; β=−.191, P=.001, respectively) and total proximal femur (β=.170, P=.001; β=−.216, P<.001, respectively).

Conclusions

Osteopenia and osteoporosis are very common in adults with disability participating in rehabilitation, compared with the general young adult population. Duration since onset of disability and mobility status are independent predictors of BMD at the hip. Bone health monitoring should form part of the long-term follow-up in adults with newly acquired disabilities.     

A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial

Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial.

Objective

To compare the effects of bilateral task training with unilateral task training on upper-limb outcomes in early poststroke rehabilitation.

Design

A single-blinded randomized controlled trial, with outcome assessments at baseline, postintervention (6wk), and follow-up (18wk).

Setting

Inpatient acute and rehabilitation hospitals.

Participants

Patients were randomized to receive bilateral training (n=56) or unilateral training (n=50) at 2 to 4 weeks poststroke onset.

Intervention

Supervised bilateral or unilateral training for 20 minutes on weekdays over 6 weeks using a standardized program.

Main Outcome Measures

Upper-limb outcomes were assessed by Action Research Arm Test (ARAT), Rivermead Motor Assessment upper-limb scale, and Nine-Hole Peg Test (9HPT). Secondary measures included the Modified Barthel Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile. All assessment was conducted by a blinded assessor.

Results

No significant differences were found in short-term improvement (0−6wk) on any measure (P>.05). For overall improvement (0−18wk), the only significant between-group difference was a change in the 9HPT (95% confidence interval [CI], 0.0−0.1; P=.05) and ARAT pinch section (95% CI, 0.3−5.6; P=.03), which was lower for the bilateral training group. Baseline severity significantly influenced improvement in all upper-limb outcomes (P<.05), but this was irrespective of the treatment group.

Conclusions

Bilateral training was no more effective than unilateral training, and in terms of overall improvement in dexterity, the bilateral training group improved significantly less. Intervention timing, task characteristics, dose, and intensity of training may have influenced the results and are therefore areas for future investigation.     

Step length appears to be a strong discriminant gait parameter for elderly females highly concerned about falls: a cross-sectional observational study

Objective

To determine if gait parameters and the Timed Up and Go test can discriminate between elderly females with high and low concern about falls. Knowledge of these parameters could help in the development of rehabilitation programmes focused on the prevention of falls, fear of falling and functional decline.

Design

Cross-sectional, observational study.

Setting

Human motion laboratory.

Participants

One hundred and fifty-four elderly females (aged 64 to 83 years), divided into two groups based on their Falls Efficacy Scale International score: high concern (n = 81) and low concern (n = 73) about falls.

Main outcome measures

Eight gait parameters recorded with the GAITRite system and the Timed Up and Go test score.

Results

Factor 2 (composed of step length, gait velocity and Timed Up and Go mobility test) explained 20% of the variability of the data and was the only factor to discriminate between the groups, with 63% correct classifications. Step length proved to be the variable with the greatest discriminant ability, with a much higher discriminant coefficient (0.889) than the Timed Up and Go test (−0.369) and gait velocity (−0.268).

Conclusions

High concern about falls is primarily associated with decreased step length. Step length could be used as a screening tool to identify elderly women with low and high concern about falls in order to target these groups in a rehabilitation programme aimed to slow reduction in gait velocity and mobility.     

Student nurses’ de-escalation of patient aggression: A pretest-posttest intervention study

Background

Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak.

Objective

This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients.

Design

Pretest-posttest within-and-between-groups design.

Setting

A School of Nursing in Germany.

Participants

Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n = 78, mean age = 22).

Methods

In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results.

Results

The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p < .001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test p < .001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann-Whitney-U-test p < .001). No significant differences were found in the pretest results irrespective the students’ age or duration of previous nursing education.

Conclusions

Aggression management training is able to improve nursing students’ performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely.     

Stability Limits, Single-Leg Jump, and Body Awareness in Older Tai Chi Practitioners

Gyllensten AL, Hui-Chan CWY, Tsang WWN. Stability limits, single-leg jump, and body awareness in older Tai Chi practitioners.

Objective

To compare stability limits, single-leg jumping, and body awareness in older Tai Chi practitioners and healthy older controls and to determine possible interrelationships among these variables.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

Tai Chi practitioners (n=24; age±SD, 68.5±6.6y) and control subjects (n=20; age, 71.3±6.7y) were recruited.

Interventions

Not applicable.

Main Outcome Measures

Measures included the following: (1) subjects' intentional weight shifting to 8 different spatial positions within their base of support using the limits of stability test, (2) the ability to leave the floor in single-leg jumping and to maintain balance on landing using force platform measurements, and (3) body awareness and movement behaviors using the Body Awareness Scale-Health (BAS-H).

Results

The findings showed that Tai Chi practitioners had a significantly better ability to lean further without losing stability and better directional control (P<0.01). They had a better ability to jump off the floor (P<0.05) and to maintain a longer single-leg stance after landing (P<.05) and better overall body awareness (P<.001). The single-leg jumps also correlated significantly with limits of stability measures of movement velocity, endpoint excursions, and maximum excursions but not with directional control. The BAS-H scores correlated significantly with the limits of stability measures except directional control. They also correlated significantly with the ability to jump off the floor and maintain stability after landing.

Conclusions

When compared with healthy controls, Tai Chi practitioners had better stability limits, increased ability to perform a single-leg jump, and more stability in landing on 1 leg as well as better body awareness. Significant correlations among limits of stability measures, single-leg jumping tests, and the BAS-H scores indicate the importance of body awareness in limits of stability, single-leg jumping, and landing.     

Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke

Yu E, Abe M, Masani K, Kawashima N, Eto F, Haga N, Nakazawa K. Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke.

Objective

To determine center of mass (COM) acceleration usefulness in the evaluation of postural control during quiet standing.

Design

Three-group comparison design.

Setting

A research laboratory.

Participants

Poststroke subjects (n=12), healthy elderly subjects (n=22), and healthy young subjects (n=25).

Interventions

Not applicable.

Main Outcome Measures

With a force platform, postural sway was evaluated by using the standard deviations of COM acceleration and center of pressure (COP) and COM (COP-COM) in which COP-COM represents the distance between the COP and the COM.

Results

COM acceleration and COP-COM variables were greater in the poststroke group than in the healthy groups (elderly and young) in the mediolateral (ML) direction. Both variables in the anteroposterior (AP) direction were greater in the poststroke group and the elderly group than in the young group. Furthermore, the correlations between COM acceleration and COP-COM in each group in each direction were shown to be significantly high (r range, .906-.979; P<.001).

Conclusions

COM acceleration was useful in the evaluation of postural control during quiet standing when comparing the young, the elderly, and poststroke patients. Additionally, COM acceleration and COP-COM in both the AP and ML directions during quiet standing were significantly and highly correlated. Thus, we proposed that COM acceleration can be an alternative and convenient measure instead of COP-COM in the evaluation of postural control.     

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.     

Pain-Related Fear Contributes to Self-Reported Disability in Patients With Foot and Ankle Pathology

Lentz TA, Sutton Z, Greenberg S, Bishop MD. Pain-related fear contributes to self-reported disability in patients with foot and ankle pathology.

Objective

To determine the unique influence of pain-related fear of movement on foot and ankle disability, after accounting for pain, demographic, and physical impairment variables.

Design

Cross-sectional study using retrospective chart review.

Setting

Outpatient rehabilitation clinic.

Participants

Referred sample of subjects with foot- and ankle-related disability (N=85, 40 men; mean age, 33y; range, 16-77y).

Interventions

Not applicable.

Main Outcome Measures

Lower Extremity Functional Scale (LEFS), Shortened Tampa Scale of Kinesiophobia (TSK-11).

Results

Hierarchical regression analysis determined the proportions of explained variance in disability (LEFS). Demographic variables were entered into the model first, followed by pain intensity and range-of-motion (ROM) deficit, and finally, TSK-11. Demographics collectively contributed 9% (P=.015) of the variance in disability scores. Pain intensity and overall ROM deficit contributed an additional 11% (P<.001) of the variance, and TSK-11 scores contributed an additional 14% (P<.001). In the overall model, age (β=−.29, P=.004), chronicity of symptoms (β=.23, P=.024), ROM deficit (β=−.28, P=.003), and TSK-11 (β=−.41, P<.001) explained 34% of the variance in the LEFS score (P<.001).

Conclusions

Age, chronicity of symptoms, ROM deficit, and TSK-11 scores all significantly contributed to baseline foot and ankle self-reported disability. Pain-related fear of movement was the strongest single contributor to disability in this group of patients.     

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

Objective

To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.

Design

Pre-post interventional study.

Setting

General community.

Participants

Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.

Intervention

After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.

Main Outcome Measures

Falls risk (Falls Risk of Older People—Community Setting) and balance measures.

Results

Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).

Conclusions

An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.     

Interactive effects of nurse-experienced time pressure and burnout on patient safety: A cross-sectional survey

Background

Global nursing shortages have exacerbated time pressure and burnout among nurses. Despite the well-established correlation between burnout and patient safety, no studies have addressed how time pressure among nurses and patient safety are related and whether burnout moderates such a relation.

Objectives

This study investigated how time pressure and the interaction of time pressure and nursing burnout affect patient safety.

Design-setting participants

This cross-sectional study surveyed 458 nurses in 90 units of two medical centres in northern Taiwan.

Methods

Nursing burnout was measured by the Maslach Burnout Inventory-Human Service Scale. Patient safety was inversely measured by six items on frequency of adverse events. Time pressure was measured by five items. Regressions were used for the analysis.

Results

While the results of regression analyses suggest that time pressure did not significantly affect patient safety (β = −.01, p > .05), time pressure and burnout had an interactive effect on patient safety (β = −.08, p < .05). Specifically, for nurses with high burnout (n = 223), time pressure was negatively related to patient safety (β = −.10, p < .05).

Conclusion

Time pressure adversely affected patient safety for nurses with a high level of burnout, but not for nurses with a low level of burnout.     

Effects of resistance training on lower-extremity impairments in older people with hip fracture

Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M, Kiviranta I, Sipilä S. Effects of resistance training on lower-extremity impairments in older people with hip fracture.

Objective

To study the effects of resistance training on muscle strength parameters, mobility, and balance.

Design

Randomized controlled trial.

Setting

Research laboratory and senior gym.

Participants

Population-based sample of eligible 60- to 85-year-old community-dwelling men and women 0.5 to 7.0 years after hip fracture. Forty-six people had no contraindications and were willing to participate in the exercise trial.

Intervention

Twelve-week intensive progressive strength-power training (n=24), aiming to reduce asymmetric deficit in leg muscle strength and power, or no intervention (n=22).

Main Outcome Measures

Isometric knee extension torque (KET) and leg extension power (LEP) measured in the weaker and stronger leg and the asymmetric deficit ([weak/sum both legs] × 100%), 10-m walking speed, dynamic balance test, and self-reported outdoor mobility.

Results

KET increased in both legs (P<.021), LEP tended to increase in the weaker leg (P=.071), and asymmetric LEP deficit decreased (P=.010) after training compared with the control group. LEP of the stronger leg, asymmetric KET deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training. The compliance to the training was over 90%, and few adverse events (n=4; mainly musculoskeletal) were likely to be caused by the training.

Conclusions

Intensive resistance training is feasible for people with a hip fracture and improved muscle strength and power. More intensive training especially for the weaker leg may be needed to obtain more marked effects on asymmetric deficit, mobility, and balance. Also, the timing and duration of training program should be considered. (ISRCTN identifier ISRCTN34271567.)     

Relationship Between Age and Spasticity in Children With Diplegic Cerebral Palsy

Pierce SR, Prosser LA, Lauer RT. Relationship between age and spasticity in children with diplegic cerebral palsy.

Objective

To examine the relationship between passive torque, reflex activity, co-contraction, and age during the assessment of spasticity of knee flexors and extensors in children with spastic diplegic cerebral palsy (CP).

Design

Retrospective.

Setting

Pediatric orthopedic hospital.

Participants

Children (N=36) with spastic diplegic CP.

Interventions

Not applicable.

Main Outcome Measures

Spasticity of the knee flexors and knee extensors (as measured by peak passive torque, mean passive torque, reflex activity of the medial hamstrings, reflex activity of vastus lateralis, and co-contraction) was assessed during passive movements completed using an isokinetic dynamometer with concurrent electromyography.

Results

A significant positive relationship was found between age and mean knee flexor passive torque (P<.05), while a significant negative relationship was found between age and mean percentage of the range of motion with co-contraction (P<.05).

Conclusions

Our results suggest that passive stiffness may play a larger role in spasticity than reflex activity as children with spastic diplegic CP age. Additional research is needed to determine whether subject age could influence the effectiveness of interventions, such as serial casting or botulinum toxin, for spasticity in children with spastic diplegic CP.     

The Patient-Specific Functional Scale: validity in workers' compensation claimants

Gross DP, Battié MC, Asante AK. The Patient-Specific Functional Scale: validity in workers' compensation claimants.

Objective

To examine the construct and predictive validity of the Patient-Specific Functional Scale (PSFS) in workers' compensation claimants.

Design

Prospective cohort study with 1-year follow-up.

Setting

A workers' compensation rehabilitation facility.

Participants

Subjects included 294 claimants with a variety of musculoskeletal disorders. The sample was predominantly male (70%), with a mean age of 44 years. Subjects completed a battery of measures at baseline including the PSFS, the Pain Disability Index (PDI), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).

Interventions

Not applicable.

Main Outcome Measures

Outcomes for determining predictive validity included administrative indicators of timely return to work and recovery during the 1-year follow-up. Analysis included Pearson correlation and multivariable Cox and logistic regression.

Results

At baseline, the PSFS correlated moderately (r range, 0.3−0.5) with other indicators of functional limitation (PDI, SF-36 role−physical subscale) but negligibly with the SF-36 mental health and role−emotional subscales. The PSFS was associated with timely recovery (adjusted hazard ratio, 1.16; 95% confidence interval, 1.07-1.27) with increasing functional limitation related to delayed recovery.

Conclusions

Results provide construct and predictive validity evidence for the PSFS as an indicator of functional limitation in workers' compensation claimants.     

Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer

Hale LA, Pal J, Becker I. Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer.

Objective

To investigate the reliability, validity, and utility of a triaxial accelerometer to measure physical activity in the free-living environment in adults with and without neurologic dysfunction.

Design

Repeated-measures design.

Setting

General community.

Participants

Volunteer sample of 17 men and 30 women (age range, 28−91y) living in the community with stroke of greater than 6 months in duration (n=20), Parkinson disease (n=7), or multiple sclerosis (n=11), and healthy but sedentary controls (n=9).

Interventions

Not applicable.

Main Outcome Measures

Physical activity measured with the TriTrac RT3 accelerometer, 7-day recall questionnaire, and activity diary.

Results

The accelerometer reliably measured free-living physical activity (intraclass correlation coefficient, .85; 95% confidence interval, .74−.91; P=.000). The standard error of measurement indicated that a second test would differ from a baseline test by ±23%. Mean daily RT3 data collected in the first 3 days differed significantly from that of the mean daily RT3 data collected over 7 days. The RT3 appeared to distinguish level of mobility better than the 7-day recall questionnaire, and participants found the RT3 to be a user-friendly and acceptable measure of physical activity.

Conclusions

The triaxial accelerometer provided a stable measure of free-living physical activity, was found to distinguish between people with varying levels of mobility, and was well tolerated by participants. The results indicate that collecting data for 3 days was not reflective of data collected over 7 days.     

The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: An observational, cross-sectional study

Objectives

To investigate the difference in attitudes: (1) between first and fourth year physiotherapy students towards functioning in individuals with back pain; and (2) between physiotherapy students and non-healthcare students towards functioning in individuals with back pain.

Design

Observational, cross-sectional study.

Setting

Glasgow Caledonian University, Scotland, UK.

Participants

First year physiotherapy (n = 61) and non-healthcare students (n = 61), and fourth year physiotherapy (n = 62) and non-healthcare students (n = 62).

Main outcomes

All participants completed the Health Care Providers’ Pain and Impairment Relationship Scale (range 15 to 105). This questionnaire measures attitudes towards functioning in individuals with back pain.

Results

Fourth year physiotherapy students had more positive attitudes towards functioning in individuals with back pain than first year physiotherapy students [57.4 vs 66.6 (mean difference −9.2, 95% confidence interval −12.2 to −6.1, P < 0.01)]. Similarly, fourth year non-healthcare students had more positive attitudes towards functioning in individuals with back pain compared with first year non-healthcare students [69.2 vs 65.3 (mean difference −3.9, 95% confidence interval −7.2 to −0.5, P = 0.03)]. Physiotherapy students had more positive attitudes than non-healthcare students in the first year [66.6 vs 69.2 (mean difference −2.6, 95% confidence interval −5.5 to 0.4, P = 0.08)] and the fourth year [57.4 vs 65.3 (mean difference −7.9, 95% confidence interval −11.4 to −4.4, P < 0.01)] of study.

Conclusion

These findings suggest that physiotherapy education brings about positive student attitudes towards functioning in individuals with back pain. This may be partly attributable to receiving a university degree education, but would appear to be further enhanced by specifically receiving a physiotherapy degree. This may facilitate students to become more evidence-based practitioners following qualification.