Wheelchair skills training for occupational therapy students: comparison of university-course versus “boot-camp” approaches

Abstract

Objective: To test the hypothesis that occupational therapy students who receive wheelchair skills training education using a distributed-practice university-course approach versus a condensed-practice boot-camp approach results in greater improvements post-intervention in relevant outcomes.

Design: A quasi-experimental, nonequivalent control group design.

Setting: A university occupational therapy program.

Participants: Occupational therapy students (experimental group) and recent occupational therapy graduates (control group) (N?=?58).

Interventions: A 15-week, 45-hour wheelchair provision course in which a total of 24?hours were dedicated to wheelchair skills testing and training education (experimental group) versus an 8-hour wheelchair skills training boot-camp (control group).

Main outcome measures: Assessments were conducted pre- and post-intervention using the Wheelchair Skills Test Questionnaire (WST-Q), Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon) and Self-Efficacy on Assessing, Training and Spotting wheelchair skills (SEATS).

Results: Compared to baseline, the WST-Q, WheelCon and SEATS scores improved significantly for both groups (p?<?.001). There were no significant differences in change scores (post-intervention – baseline values) between the groups for WST-Q, WheelCon or SEATS scores, however, the experimental group demonstrated a trend (p?<?.051) of higher scores for all outcome measures.

Conclusions: Occupational therapy students who received wheelchair skills training using either a distributed-practice university-course or condensed-practice boot-camp approach demonstrated significant post-training improvements in their WST-Q, WheelCon and SEATS scores, but no significant differences were found between groups.

• Implications for Rehabilitation

• Both a distributed-practice university-course approach and a condensed-practice bootcamp approach for training wheelchair skills to occupational therapy students results in large post-intervention improvements in wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills.

• The pre-education (optional course) wheelchair skill, wheelchair confidence and self-efficacy to test, train, spot and document wheelchair skills scores found in this cohort of occupational therapy students confirms the need to include this wheelchair content in mandatory occupational therapy curricula.

     

Is an educational lecture a critical component of communication partner training?

Abstract

Purpose: Little is known about the critical ingredients of successful Communication Partner Training (CPT) programmes. The aim of this randomised controlled trial was to investigate the effects of including an educational component before a conversation with a person with aphasia compared to a conversation only.

Method: Thirty-eight speech–language pathology students were randomly allocated to either the Full programme or Conversation only groups. The Full programme group received a lecture about communication strategies then participated in a conversation with a person with aphasia, while the other group participated in the conversation only. Both groups received feedback on performance from the people with aphasia. Students completed a customised mixed-methods questionnaire at study commencement and following the conversation.

Result: Generalised linear models indicated confidence ratings improved after receiving either the Full programme or Conversation only (p?<?0.001), however, greater improvements were observed following the Full programme (p?<?0.001). More communication strategies were identified after the interventions (p?=?0.001) with greater improvement occurring among the Full programme group (p?<?0.01).

Conclusion: An educational lecture before a conversation with a person with aphasia is a critical component of CPT programmes, enhancing their knowledge base and increasing their confidence levels compared to only a conversation.     

Daily functioning of dyspnea,self-esteem and physical self in patients with moderate COPD before,during and after a first inpatient rehabilitation program

Purpose. Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge.

Methods. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV₁ = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge.

Results. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p < 0.001]. Dyspnea ratings improved (p < 0.001), as did the self-esteem and physical self scores between the two home periods (p < 0.001). The group showed less instability (SD and range) in their assessments of physical self-worth at home post-discharge compared to pre-admission (p < 0.01). Before rehabilitation, the correlation coefficients between dyspnea, and self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p < 0.05).

Conclusions. The results suggest that a first rehabilitation program increases the mean physical self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.     

The relationship between fear of movement,pain and fatigue severity,dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease

Purpose: Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess levels of kinesiophobia among stable COPD patients and evaluate the relationship between kinesiophobia and pain and fatigue severity, dyspnea level, and comorbidities in this patient group.

Material and Methods: Thirty-one patients with moderate/severe COPD and thirty-one age- and sex-matched healthy controls participated in the study. All participants were assessed using Visual Analog Scale for pain severity, Fatigue Severity Scale, modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia.

Results: Ninety-three percent of the patients with COPD had a high degree of kinesiophobia (Tampa Scale of Kinesiophobia score >37). The modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia scores of patients with COPD was significantly higher than those of healthy subjects (p?<?0.001). Tampa Scale of Kinesiophobia score was significantly associated with modified Medical Research Council Dyspnea Scale score (r?=?0.676, p?<?0.001), Charlson Comorbidity Index score (r?=?0.746, p?<?0.001) and fatigue severity level (r?=?0.524, p?=?0.005).

Conclusion: Most moderate/severe COPD patients express fear of movement. Kinesiophobia is strongly associated with dyspnea perception, fatigue severity, multisystemic comorbidities in COPD. Further studies are needed to determine the effects of kinesiophobia on the success of pulmonary rehabilitation.

• Implications for rehabilitation

• Most of moderate-to-severe chronic obstructive pulmonary disease patients have fear of movement.

• Increase fear of movement in moderate–severe chronic obstructive pulmonary disease is associated with increased dyspnea perception and fatigue severity and multisystemic comorbidities.

     

Investigating the Effects of an Otago-Based Program among Individuals Living with Dementia

Abstract

Aim: To examine the impact of an Otago-based exercise program (OEP) on physical function in patients living with mild cognitive impairment (MCI) or dementia receiving home heath physical therapy.

Methods: 34 patients (mean age 88.3?years; 62% female; mean Mini-Cog 1.76) completed the following assessments: Four-Stage Balance test, Timed Up & Go, 30-Second Chair Stand test, and Tinetti Gait and Balance. Assessments were completed at baseline and an average of 4.79 (2.29) visits later, with a mean of 1.74 (0.79) months between assessments. The OEP-based exercises were individually tailored and progressed based on performance as recommended by the program protocol.

Results: A paired samples t-test revealed significant differences in scores for the Four-Stage Balance Test (p?<?0.001), the Timed Up & Go (p?=?0.002), and the Tinetti Gait and Balance (p?=?0.002).

Conclusion: The OEP can potentially be used for individuals living with cognitive impairments to improve performance outcomes such as balance and functional mobility.     

Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke

Purpose.?To evaluate the clinical efficacy of functional electrical stimulation (FES) therapy of the tibialis anterior (TA) muscle on gait restoration and enhancing motor recovery with stroke patients.

Method.?Thirty hemiparetic participants with spastic foot-drop impairments who were at least 3 months post-stroke were recruited from a rehabilitation institute and were assigned either to a control group or a FES group. Both the groups participated in a conventional stroke rehabilitation program for 60?min per day, 5 days a week, for 12-weeks. The FES group received the electrical stimulation to the TA muscle for correction of foot-drop.

Results.?Functional electric stimulation (FES) resulted in a 26.3% (p?<?0.001) improvement of walking speed measured with 10-m walkway, whereas the improvement in the control group was only 11.5% (p?<?0.01). The FES group also showed significantly greater improvements compared to control group in other gait parameters (e.g. cadence, step length), physiological cost index (PCI), ankle range of motion, spasticity of calf muscle, Fugl–Meyer scores, and the maximum value of the root mean square (RMS_max), which reflects the capacity of the muscle output.

Conclusions.?These findings suggest that, the FES therapy combined with conventional therapy treatment more effectively improves the walking ability and enhances the motor recovery when compared with conventional therapy alone in stroke survivors.     

Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds,quality of life,fatigue, pain intensity,quality of sleep,anxiety, and depression in patients with fibromyalgia syndrome

Purpose: To compare the effectiveness of dry needling versus myofascial release on myofascial trigger points pain in cervical muscles, quality of life, impact of symptoms pain, quality of sleep, anxiety, depression, and fatigue in patients with fibromyalgia syndrome.

Method: A single-blind randomized controlled trial was conducted. Sixty-four subjects with fibromyalgia were randomly assigned to a dry needling group or a myofascial release group. Pain pressure thresholds of myofascial trigger points were evaluated in the cervical muscles. In addition, quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, impact of fatigue at baseline and post treatment after four weeks of intervention were evaluated.

Results: Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group compared to myofascial release (p?<?0.05). Similarly, these differences between groups were found for the components of quality of life of physical function (F?=?12.74, p?=?0.001), physical role (F?=?11.24, p?=?0.001), body pain (F?=30.26, p?<?0.001), general health (F?=?15.83, p?<?0.001), vitality (F?=?13.51, p?=?0.001), social function (F?=?4.73, p?=?0.034), emotional role (F?=?8.01, p?=?0.006), and mental health (F?=?4.95, p?=?0.030). Similar results were achieved for total impact of FMS symptoms (F?=?42.91, p?<?0.001), quality of sleep (F?=?11.96, p?=?0.001), state anxiety (F?=?7.40, p?=?0.009), and trait anxiety (F?=??14.63, p?<?0.001), hospital anxiety and depression (F?=?20.60, p?<?0.001), general pain intensity (F?=?29.59, p?<?0.001), and fatigue (F?=??25.73, p?<?0.001).

Conclusion: The dry needling therapy showed higher improvements in comparison with myofascial release therapy for pain pressure thresholds, the components of quality of life of physical role, body pain, vitality and social function, as well as the total impact of FMS symptoms, quality of sleep, state and trait anxiety, hospital anxiety-depression, general pain intensity and fatigue.

• Implications for rehabilitation

• Dry needling therapy reduces myofascial trigger point pain in the short term in patients with fibromyalgia syndrome.

• This therapeutic approach improves anxiety, depression, fatigue symptoms, quality of life, and sleep after treatment.

• Dry needling and myofascial release therapies decrease intensity of pain, and the impact of fibromyalgia symptoms in this population.

• These intervention approaches should be considered in an independent manner as complementary therapies within a multidisciplinary setting.

     

Evaluation of patients with severe pulmonary disease before and after pulmonary rehabilitation

Purpose:?The purpose was to evaluate the impact of inpatient pulmonary rehabilitation program upon changes in anxiety, depression, psychological outlook, and dyspnea. A secondary purpose was to predict changes in psychological outlook, depression, anxiety, and dyspnea by using three pulmonary function tests and age.

Methods:?The design consisted of an observational study with pre–post comparisons. Forty-five patients with severe pulmonary disease, mean age 67.4 years (SD 9.2), mean FEV₁?=?31.44% predicted, 13 men, 32 women were compared on four measures before and after 3 weeks of rehabilitation. Measures were Beck Depression Inventory, Hamilton Anxiety Scale, Goldberg Scale, and Modified Borg Scale. In addition, a linear multiple regression model using age, gender, % predicted FEV₁, FEV₁/FVC, % predicted DLCO as independent variables were used to predict changes.

Results: Patients who completed the pulmonary program showed significant changes in favour of post scores on all four scales at p?<?0.001. The program significantly reduced anxiety and depression, and increased positive psychological outlook in severe pulmonary disease. Perceived breathlessness on the Borg Scale was significantly reduced (p?<?0.0001). The multiple regression model was not statistically significant for prediction of any of the changes.

Conclusions:?Patients with severe pulmonary disease can significantly improve their psychological outlook and decrease anxiety and depression when they complete an inpatient pulmonary rehabilitation program. Psychological gains and perception of breathlessness improve with rehabilitation, even though FEV₁ and other pulmonary function tests may not predict these changes. A second implication is that rehabilitation improves psychological outlook with both severely ill patients and a group with mixed pulmonary and cardiac disease.     

Mastery motivation: a way of understanding therapy outcomes for children with unilateral cerebral palsy

Abstract

Purpose: To investigate the impact of mastery motivation on occupational performance outcomes immediately following upper limb (UL) training and 6 months post-intervention for school-aged children with unilateral cerebral palsy. Method: This prediction study was a post-hoc analysis of a matched pairs randomized comparison trial (COMBiT Trial Registration: ACTRN12613000181707). The Canadian Occupational Performance Measure (COPM) was administered at baseline, 13 and 26 weeks post-intervention. Parents completed the Dimensions of Mastery Questionnaire (DMQ), Parenting Scale and a demographic questionnaire. Children’s UL capacity and performance was assessed using the Melbourne Assessment of Unilateral UL Function and assisting hand assessment (AHA). Regression models were fitted using generalized estimating equations to baseline, 13 and 26 week measurements. Results: Forty-six children (7.78 years SD 2.27 years, 31 males, Manual Ability Classification System I?=?23, II?=?23) participated. Higher levels of bimanual performance (AHA: β?=?0.03, p?<?0.001), greater object-oriented persistence (DMQ: β?=?0.31, p?=?0.05), and treatment group allocation (Standard Care: β?=?0.24, p?=?0.01) were positively associated with COPM performance scores post-intervention. Conclusions: Children’s bimanual performance and persistence with object-oriented tasks significantly impact occupational performance outcomes following UL training. Predetermining children’s mastery motivation along with bimanual ability may assist in tailoring of intervention strategies and models of service delivery to improve effectiveness.

• Implications for Rehabilitation

• Children’s object persistence and bimanual performance both impact upper limb training outcomes

• Working with children’s motivational predispositions may optimize engagement and therapy outcomes.

• Supporting positive parenting styles may enhance a child’s mastery motivation and persistence with difficult tasks.

     

Efficacy of short-term intrapulmonary percussive ventilation in patients with chronic obstructive pulmonary disease

Abstract

Purpose: We evaluated the effectiveness of intrapulmonary percussive ventilation (IPV) compared to traditional standard chest physical therapy (CPT) in patients with chronic obstructive pulmonary disease (COPD) and productive cough.

Methods: We conducted a quasi-experimental clinical trial. Twenty patients, 40% female (mean?±?SD age: 70?±?8 years), with COPD and productive cough received a multimodal respiratory treatment including IPV and CPT or a control intervention CPT for 10 days. Outcomes: P_Imax, P_Emax, heart rate, respiratory rate, SBP, DBP, Likert scale, Borg dyspnea scale and arterial blood gas analysis: PO₂, PCO₂, pH, HCO₃ and SpO₂ measurements. All measures were collected at baseline and at the end of the intervention. We used repeated ANOVA to examine the effects of interventions within groups, between-subjects and the within-subjects.

Results: A significant effect of time interaction (F?=?7.27; p?=?0.015, F?=?6.16; p?=?0.02 and F?=?7.41; p?=?0.014) existed for PO₂, SpO₂ and dyspnea over the moderate COPD and productive cough immediately after the intervention (all, p?<?0.02). Both treatments are similarly effective in P_Imax and P_Emax. No significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way.

Conclusions: This study provides evidence that a short-term combination of IPV and CPT improves PO₂, SpO₂ and perceived dyspnea than a traditional standard CPT in patients with COPD and productive cough.

• Implications for Rehabilitation

• We suggest that it could improve the oxygenation level on chronic obstructive pulmonary disease (COPD) patients. Beyond that, the intrapulmonary percussive ventilation (IPV) is a safety non-pharmacologic airway clearance therapy that can be used on patients with different sorts of respiratory diseases, and there are still questions to be answered, especially concerning the volume of secretion removed and its superiority when compared with other techniques.

     

“Strong and steady”: a community-based strength and balance exercise group for children with cerebral palsy

Abstract

Purpose: This study investigated the effect of an eight-week community-based strength and balance exercise group for children with cerebral palsy (CP). Method: Ten children with CP participated in the study (8–15 years; six male; GMFCS I?=?6, II?=?4; five diplegia; five hemiplegia). Muscle strength was assessed using dynamometry and functional strength tests (seated throw, distance jump, vertical jump). Balance was assessed using the Bruninks–Oseretsky Test of Motor Proficiency, the Movement Assessment Battery for Children (MABC), lateral and forward reach tests and the Timed-up and Go. Results: Muscle strength improved in dominant side elbow flexors, hip abductors, ankle dorsiflexors and ankle plantarflexors (p?=?0.018–0.042). Functional strength improved in seated throw (t?=?2.7; p?=?0.024), distance jump (t?= ?2.8; p?=?0.025) and lateral step-up (p?<?0.05). Balance improved on the MABC (t?=?2.4; p?=?0.040), lateral (p?<?0.05) and forward reach (p?<?0.05). Conclusion: This feasibility study translated research into sustainable practice, showing that a community-based, low dose, group exercise program can improve the balance and strength of children with CP within current funding capacity.

• Implications for Rehabilitation

• It has been known that strength and balance training in the clinical research setting with specialized equipment is effective for children with CP, but this study demonstrates the translation of research into clinical practice in a low-cost, low-dose group program.

• Significant gains in both muscle strength and balance can be achieved in an eight-week community-based gym group using simple equipment.

     

Long-lasting improvements in health-related quality of life among women with chronic pain,following multidisciplinary rehabilitation

Purpose: To determine whether observed health-related quality-of-life improvements after four-week traditional multidisciplinary pain management program and additional neuroscience education and mindfulness-based cognitive therapy for chronic pain are sustained at six-month follow-up.

Method: This observational longitudinal follow-up study, with complete follow-up of 75 women, 61.5% of initial traditional approach group (treated 2001–2005) and 56 (62.2%) receiving the new approach (treated 2006–2009). Pain intensity and quality of life were measured at baseline and six months after interventions. Analysis of variance (ANOVA) and paired samples t-tests were used for statistical analysis.

Results: Both groups showed sustained improvements in pain intensity (traditional approach?=??10.6 [p?<?0.001]; new approach?=??14.5 [p?p?p?p?=?0.066]), whereas all other domains among both groups were sustained. Significant decline was observed from discharge to six month among both groups with the exception of the sleep domain among the traditional approach group, pain intensity among the new approach and financial status among both groups. No baseline differences were revealed between responders and nonresponders.

Conclusions: Multidisciplinary interventions for women with chronic pain conditions improved quality of life and pain intensity with lasting improvements observed half a year after treatment completion.

• Implications for rehabilitation

• Intensive multidisciplinary biopsychosocial rehabilitation is essential for chronic pain conditions.

• This follow-up study shows sustained improvement in health-related quality of life and pain intensity six months after such rehabilitation was completed.

• Emphasizing mindfulness-based cognitive therapy and neuroscience patient education may contribute to less decline in pain intensity from discharge to six-month follow-up compared with a more traditional approach.

     

The effects of connective tissue manipulation and Kinesio Taping on chronic constipation in children with cerebral palsy: a randomized controlled trial

Purpose: The aim of this study was to investigate the effects of connective tissue manipulation (CTM) and Kinesio Taping^® (KT) on constipation and quality of life in children with cerebral palsy (CP).

Method: This study was designed as a randomized controlled trial. Forty children diagnosed with chronic constipation based on Rome III criteria were randomly assigned to CTM group [6 females, 7 males; 8 y 6?mo (SD = 3y 4?mo)], KT group [7 female, 7 male; 8y 7?mo (SD =3y 5?mo)] or control group [6 female, 7 male; 8y 3?mo (SD = 3y 6?mo)]. All patients were assessed with 7-day bowel diaries, Bristol Stool Form Scale (BSFS), Visual Analog Scale (VAS), and Pediatric Quality of Life Inventory (PEDsQL). Kruskal-Wallis, Wilcoxon’s signed-rank, and Mann–Whitney U tests were used to determine intra-group and inter-group differences. The level of significance was p?Results: Among the CTM, KT, and control groups, there were statistically significant differences regarding the changes in defecation frequency (2.46, 3.00, 0.30, ES 1.16, p?p?=?0.003), BSFS (1.84, 2.14, 0.07, ES 0.91, p?p?p?Conclusions: This study revealed that CTM and KT seem equally effective physiotherapy approaches for the treatment of pediatric constipation and these approaches may be added to bowel rehabilitation program.

• Implications for rehabilitation

• CTM and KT have similar effectiveness in alleviating the constipation-related symptoms and improving quality of life in children with CP.

• CTM and KT can be integrated into bowel rehabilitation programs.

• Considering the characteristics of patients, these treatment options can be used as an alternative of each other by physiotherapists.

     

Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study

Abstract

Objectives: The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being. A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress. Application of these findings to a physical therapy setting is provided.

Methods: One hundred and thirty participants with a variety of medical complaints completed an eight-week MBSR program at Vanderbilt University’s Osher Center for Integrative Medicine. Prior to the intervention and at the eight-week time point, participants completed measures for emotional distress (Brief Symptom Inventory), stress (Perceived Stress Scale-10), mindfulness (Mindfulness Attention and Awareness Scale), and self-compassion (Self-Compassion Scale). Wilcoxon signed-rank test was used to evaluate changes in outcomes after MBSR. Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress.

Results: Following MBSR, participants reported significant reductions in emotional distress (p < 0.001). Additionally, participants reported improvements in mindfulness and self-compassion (p < 0.001). Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress (p < 0.001).

Discussion: An MBSR program conducted by non-psychologist clinicians was associated with improvements in emotional distress, stress, and self-compassion. MBSR is a promising adjunct intervention in which principles can be integrated within a physical therapy approach for chronic conditions.

Level of Evidence: 3B     

Emergency management of chlorine gas exposure – a systematic review

Introduction: Chlorine exposure can lead to pulmonary obstruction, reactive airway dysfunction syndrome, acute respiratory distress syndrome and, rarely, death.

Objective: We performed a systematic review of published animal and human data regarding the management of chlorine exposure.

Methods: Three databases were searched from 2007 to 2017 using the following keywords “(“chlorine gas” OR “chlorine-induced” OR” chlorine-exposed”) AND (“therapy” OR “treatment” OR “post-exposure”)”. Forty-five relevant papers were found: 22 animal studies, 6 reviews, 19 case reports and 1 human randomized controlled study.

General management: Once the casualty has been removed from the source of exposure and adequately decontaminated, chlorine-exposed patients should receive supportive care.

Humidified oxygen: If dyspnea and hypoxemia are present, humidified oxygen should be administered.

Inhaled bronchodilators: The use of nebulized or inhaled bronchodilators to counteract bronchoconstriction is standard therapy, and the combination of ipratropium bromide with beta₂-agonists effectively reversed bronchoconstriction, airway irritation and increased airway resistance in experimental studies.

Inhaled sodium bicarbonate: In a randomized controlled trial, humidified oxygen, intravenous prednisolone and inhaled salbutamol were compared with nebulized sodium bicarbonate. The only additional benefit of sodium bicarbonate was to increase the forced expiratory volume in one second, 2 and 4?h after administration.

Corticosteroids: Dexamethasone 100?mg/kg intraperitoneally (IP) reduced lung edema when given within 1?h of chlorine inhalation and when administered within 6?h significantly decreased (p?Antioxidants: An ascorbic acid/deferoxamine combination (equivalent to 100?mg/kg and 15?mg/kg, respectively) was administered intramuscularly 1?h after chlorine exposure, then every 12?h up to 60?h, then as an aerosol, and produced a significant reduction (p?p?Sodium nitrite: Sodium nitrite 10?mg/kg intramuscularly (IM), 30?min post-chlorine exposure in mice and rabbits significantly reduced (p?Dimethylthiourea: Dimethylthiourea 100?mg/kg IP significantly decreased (p?AEOL 10150: Administration of AEOL10150 5?mg/kg IP at 1?h and 9?h post-chlorine exposure reduced significantly the neutrophil (p?p?Transient receptor potential vanilloid 4 (TRPV4): IM or IP TRPV4 reduced significantly (p?Reparixin and triptolide: In experimental studies, triptolide 100–1000 µg/kg IP 1?h post-exposure caused a significant decrease (p?Rolipram: Nanoemulsion formulated rolipram administered intramuscularly returned airway resistance to baseline. Rolipram (40%)/poly(lactic-co-glycolic acid) (60%) 0.36?mg/mouse given intramuscularly 1?h post-exposure significantly reduced (p?t?+?6?h.

Prophylactic antibiotics: Studies in patients have failed to demonstrate benefit.

Sevoflurane: Sevoflurane has been used in one intubated patient in addition to beta₂-agonists. Although the peak inspiratory pressure was decreased after 60?min, the role of sevofluorine is not known.

Conclusions: Various therapies seem promising based on animal studies or case reports. However, these recommendations are based on low-level quality data. A systematic list of outcomes to monitor and improve may help to design optimal therapeutic protocols to manage chlorine-exposed patients.     

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

Abstract

Purpose: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. Method: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. Results: Higher Constant score was observed in the MI than in the control group (p?=?0.04). Participants in the MI group further displayed greater movement amplitude (extension (p?<?0.001); flexion (p?=?0.025); lateral rotation (p?<?0.001). Finally, the MI group showed greater pain decrease (p?=?0.01). Conclusion: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery.

• Implications for Rehabilitation

• Adding motor imagery training to classical physical therapy in a stage II impingement syndrome:

• Helps in alleviating pain

• Enhances shoulder mobility

• Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

     

The importance of cannabis culture in young adult cannabis use

Abstract

Background: Research into drug use initiation has focussed on drug use as risky behaviour. Qualitative research suggests that a culturally derived set of beliefs about the positive effects of cannabis play an important role in the production and maintenance of cannabis use.

Methods: An online survey questionnaire was designed to measure both perceived positive and negative effects of cannabis. The questionnaire was submitted to a factor analysis, and two factors were extracted: a positive and a negative effect scale. Using regression analyses, associations with cannabis use, perception of general use and perception of general acceptance of use were assessed.

Results: After removing respondents based on age and responses to questions, 1416 valid survey questionnaires were collected. In bivariate analyses, both positive effects and negative effects were associated with use (p?<?0.001), perceived normative use (p?<?0.001) and acceptance of use (p?<?0.001). In multivariate analyses, only glorification remained consistently associated with perceived use, acceptance and all categories of use (p?<?0.001).

Conclusions: Positive beliefs about the effects of cannabis use are important and form part of a cannabis culture, which are essential for understanding initiation and maintenance of cannabis use. These findings have important ramifications for cannabis preventive work and also call on further investigation into the relation between cannabis culture and individual use.     

Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial

Purpose: The purpose of this study is to compare the efficacy of constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy in the treatment of hand dysfunction. Methods: Sixty-eight children with hemiplegic cerebral palsy were randomly allocated to constraint therapy, constraint therapy plus electrical stimulation, and occupational therapy group. Three groups received 2 weeks of treatment. All participants were measured at baseline and 2 weeks, 3 and 6 months after treatment using measures of active ROM, grip strength, nine-peg hole test, upper extremity functional test, Peabody developmental motor scales (PDMS), globe rating scale, and social life ability scale. Results: Three groups improved significantly (p < 0.05). The mean improvements between baseline and the end of follow-up were respectively 12.4, 11.4 and 11.3 degrees for active ROM; 12.8, 10.5 and 8.8 mmHg for grip strength; ?22.3, ?30.7 and ?14.0 s for nine-peg hole test; 15.3, 10.3 and 10.4 for upper extremity functional test scores; 2.2, 1.8 and 1.8 for grasping scores of PDMS; 5.8, 3.7 and 2.8 for visual-motor integration scores of PDMS; 2.0, 2.5 and 0.9 for globe rating scale scores; 7.7, 5.7 and 5.3 for social life ability scale scores in constraint therapy plus electrical stimulation, constraint therapy, and occupational therapy group. The constraint therapy plus electrical stimulation group showed greater rate of improvement in upper extremity functional test scores (p < 0.05) and visual-motor integration scores of PDMS (p < 0.05) than the other two groups after treatment for 6 months. Conclusions: Constraint therapy plus electrical stimulation is likely to be best in improving hand performance in children with hemiplegic cerebral palsy.

Implications for Rehabilitation

• Children with hemiplegic cerebral palsy have major hand dysfunction problems that not only restrict activity and participation but also lead to secondary impairment.

• Constraint therapy, constraint therapy plus electrical stimulation and occupational therapy, is the technique available to these children. However, strong evidence for efficacy of the three interventions is still lacking.

• This study shows that all the three interventions improve hand performance and perceived changes. However, constraint therapy plus electrical stimulation is the most effective. Use of constraint therapy is advantageous in improving involved hand function and perceived changes.

     

Brain atrophy evaluated by computed tomography in independent and institutionalized hip fracture patients

Purpose: To examine if there is an association between brain computed tomography (CT) findings and place of residence in a series of hip fracture patients.

Method: The CT scans taken immediately after hip fracture of 215 patients (mean age 81.6 years) living in their own homes or otherwise independently (home-dwelling group) and 95 patients (mean age 82.5 years) permanently institutionalized (institutionalized group) were analysed.

Results: The institutionalized patients had significantly more cortical cerebral (frontal, p?=?0.004; temporal, p?=?0.007; parietal, p?<?0.001) and central cerebral (third ventricle width, p?<?0.001; frontal horn width, p?<?0.001; midbody width, p?<?0.001) atrophy than the home-dwelling ones. This was also true of atrophy in the white-matter (WM) area (p?<?0.001). The institutionalized patients also had more atrophy of the cerebellar hemisphere (atrophy of the cerebellopontine angle cistern, p?=?0.002, greater fourth ventricle width, p?=?0.020). No significant difference was seen in the incidence of brain infarcts.

Conclusions: Hip fracture patients living in institutions have more brain atrophy than those living independently. The brain atrophy may be one factor in the multiple mechanism underlying their institutional admission.     

Effects of thyroid hormone withdrawal on natriuretic peptides during radioactive iodine therapy in female patients with differentiated thyroid cancer

Objective: We aimed to investigate the effects of thyroid hormone withdrawal on N-terminal prohormone forms of atrial natriuretic peptide (NT-proANP) and brain natriuretic peptide (NT-proBNP) during radioiodine therapy in female patients with differentiated thyroid cancer (DTC).

Methods: Serum concentrations of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), NT-proANP and NT-proBNP were measured in 51 female patients with DTC (48.7?±?4.2 years) at three time-points: day of radioiodine therapy (t1 – under acute hypothyroidism), 5 days after radioiodine (t2 – under acute hypothyroidism) and 3 months after radioiodine (t3 – under TSH suppression). Thirty healthy euthyroid women served as controls (42.8?±?5.6 years).

Results: At t1/t2/t3, median NT-proANP was 5.2/1.7/487?pmol/L vs. 297.7?pmol/L in control group (p?p?p?r?=?0.38, p?=?0.005), NT-proANP/NT-proBNP ratios (r?=?0.47, p?=?0.001), heart rate (r?=?0.39, p?=?0.005), and negatively with mean arterial blood pressure (r?=??0.58, p?Conclusions: Our results indicate that NT-proANP reflects more accurately direct thyroid hormone effects than NT-proBNP. Thyroid hormone-dependent hemodynamic effects seem to be overlapped on the direct stimulatory effect of thyroid hormones on NT-proANP secretion by cardiac myocytes.