Explaining daily functioning in young adults with obstetric brachial plexus lesion

Abstract

Purpose: To study the influence of obstetric brachial plexus lesion (OBPL) on arm–hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. Method: Adults with unilateral OBPL who consulted the brachial plexus team at the VU University Medical Center in the past were invited to participate. Daily functioning was measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the SF36, pain with VAS Pain Scales and arm-hand function with the Nine Hole Peg Test (9-HP-test) and the Action Research Arm Test (ARAT). Scores of the affected arm were compared to those of the non-affected arm or norm values for healthy controls. Results: Twenty-seven persons (mean age 22, SD 4.2 years), of whom 10 men, participated. The ARAT and 9-HP-test scores for the affected arm were significantly worse than those for the non-affected arm. Moderate to severe pain in the affected arm, the non-affected arm or the back was reported by 50% of the participants. The DASH general, sports/music and SF36 physical functioning scores were significantly worse than norm values. The ARAT/9-HP-test and daily functioning showed little association. Low to moderate associations were found between pain and daily functioning. Conclusions: Many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations.

• Implications for Rehabilitation

• Obstetric brachial plexus lesion (OBPL) is caused by traction to the brachial plexus during labour, resulting in denervation of the muscles of the arm and shoulder girdle.

• Adults with OBPL are hardly seen in rehabilitation medicine.

• This study shows that many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations.

• Fifty percent of the participants complained about moderate or severe pain, which was located in the affected arm, the back and the non-affected arm. There seems an age-related increase in pain prevalence.

• Persons who had undergone plexus surgery had a significantly worse arm-hand function, but comparable scores on daily functioning scales compared to persons without plexus surgery.

• When limitations in daily functioning or pain occur, referral to a rehabilitation physician is indicated.

     

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders

Abstract

Purpose: To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). Method: A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Results: Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges?=?0.77–0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma?=??0.51 to ?0.58) were found between the changes in SPADI/DASH and changes in global rating scale. Conclusions: The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention.

• Implications for Rehabilitation

• Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis.

• The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings.

• The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

     

Shoulder pain after stroke – experiences,consequences in daily life and effects of interventions: a qualitative study

Purpose: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions.

Method: A qualitative interview study including 13 community-dwelling persons (six women; median age 65?years) with persistent shoulder pain after stroke.

Results: Three categories emerged from the content analysis. In “Multiple pain characteristics” an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In “Limitations caused by the pain” it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In “Multiple pain interventions with various effects” a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported.

Conclusions: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person’s life, multidisciplinary rehabilitation interventions are important.

• Implications for rehabilitation

• Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand

• Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions

• Self-management interventions with gentle movements are perceived most effective

• As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed

     

Ranges of active joint motion for the shoulder,elbow, and wrist in healthy adults

Purpose: The aim of this study was to show highly reliable normal values and three-dimensional characteristics for final range of motion during active movements of the upper extremity joints, and to develop a database from healthy participants, with the advantage of this database lying in the methods of defining shoulder axial rotation angle and of compensating for soft tissue artifacts. Methods: We used an electromagnetic tracking system (FASTRAK) to measure three-dimensional motions of the shoulder (thoracohumeral), elbow/forearm, and wrist in 20 healthy adults (age range: 18–34 years) during active joint motion tasks of the upper extremity. Results: Joint angles of the upper extremity at the final position of joint motion tasks were determined. Highly reliable data for shoulder axial rotation angle were obtained, using a new definition of joint angle and regression analysis to compensate for estimation errors. Conclusions: These results should be useful in setting goals for the treatment of upper extremity joint functions in the fields of rehabilitation, orthopedics, and sports medicine.

Implications for Rehabilitation

• Complex joint motions that occur naturally (unconsciously) about some axes should be taken into account in interventions for range of joint motion (ROM).

• The data obtained through this study simultaneously indicating multiple interrelated angles can be used as reference values for maximum active ROM.

• ROM in the directions of motion involved in the various tasks (for example, elevation angle during shoulder flexion) may have a role to play in evaluating and setting goals for patients with impaired ROM of the arm joints.

     

Higher pain sensitivity and lower muscle strength in postmenonpausal women with early rheumatoid arthritis compared with age-matched healthy women – a pilot study

Purpose: The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA. Methods: Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed. Results: Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups. Conclusions: Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported.

Implications for Rehabilitation

• Difference in muscular strength between postmenopausal women with and without (rheumatoid arthritis) RA is present in early disease despite low disease activity.

• Women with RA have decreased pressure pain thresholds and hyperalgesia, but no dysfunction of segmental and plurisegmental pain inhibitory mechanisms.

• The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity in this group of 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.

     

Effectiveness of neuromuscular taping on painful hemiplegic shoulder: a randomised clinical trial

Purpose: The purpose of this trial was to investigate changes in pain, the range of motion (ROM) and spasticity in people with painful hemiplegic shoulder (PHS) after the application of an upper limb neuromuscular taping (NMT). Methods: We conducted a randomised clinical trial. The study included 32 people, 31% female (mean?±?SD age: 66?±?9 years), with PHS after stroke with pain at rest and during functional movements. The experimental group received the application of NMT and a standard physical therapy programme (SPTP), whereas the control group received SPTP. The groups received four 45-minute long sessions over four weeks. The VAS, ROM and spasticity were assessed before and after the intervention with follow-up at four weeks. Results: The experimental group had a greater reduction in pain compared to the control group at the end of the intervention, as well as at one month after the intervention (p?Conclusion: Our study demonstrates that NMT decreases pain and increases the ROM in subjects with shoulder pain after a stroke.

• Implications for Rehabilitation

• Painful hemiplegic shoulder is a frequent complication after stroke with negative impacts on functional activities and on quality of life of people, moreover restricts rehabilitation intervention.

• Neuromuscular taping is a technique introduced by David Blow for the treatment of neuromuscoloskeletal problems.

• This study shows the reduction of pain and the improvement of range of motion after the application of an upper limb neuromuscular taping.

• Rehabilitation professionals who are involved in the management of painful hemiplegic shoulder may like to consider the benefits that neuromuscular taping can produce on upper limb.

     

Shoulder function,pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type

Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey, 110 patients diagnosed with JHS/EDS-HT and 140 gender- and age-matched healthy controls from Statistics Norway participated. Shoulder function, pain and HRQol were registered by Western Ontario Shoulder Instability Index (WOSI), Numerical Rating Scale (NRS), pain drawings, 36-item Short Form (SF-36). Results Eighty-one individuals responded, with response rate 34% (JHS/EDS-HT: 53%, controls: 21%). JHS/EDS-HT had lower shoulder function (WOSI total: 49.9 versus 83.3; p?p?p?Conclusions Adults with JHS/EDS-HT have impaired shoulder function, increased pain intensity, as well as reduced physical HRQoL compared with controls. Although neck and shoulder were most frequently rated as painful, significantly more JHS/EDS-HT also reported generalized pain compared to controls.

• Implications for Rehabilitation

• Adults with JHS/EDS-HT have impaired shoulder function, and most often painful areas in the neck and shoulder joints, which need to be targeted in the treatment strategy.

• Compared with the general population adults with JHS/EDS-HT have reduced physical HRQoL, supporting a physical approach for this group.

• Adults with JHS/EDS-HT may present with both specific painful joints and generalized pain.

     

Pain and daily activities in rheumatoid arthritis

Aim: The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method: Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results: Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it. Conclusion: The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

Implications for Rehabilitation

• Pain in RA needs to be comprehensively analyzed and treated in the context of the patients’ perspective and needs.

• The relation between pain and performance of activities in RA highlights the importance of rehabilitative interventions to reduce pain in order to facilitate daily activity.

• The complexity of pain implies the need for multimodal approach in rehabilitation.

     

Effect of mirror therapy on hand function in patients with hand orthopaedic injuries: a randomized controlled trial

Abstract

Purpose: To investigate the effects of mirror therapy (MT) in restoring hand function in patients with active range of motion (AROM) impairments following orthopaedic injuries. Method: In a randomized controlled trial (RCT), 30 patients with active ROM impairment (8 men and 22 women; mean age: 38 years) were measured. Intervention group received MT, 30?min a day, five days a week for three weeks, as well, half an hour conventional rehabilitation after each MT session. Patients in the control group received the same treatment programme, but instead of mirror, they observed directly the affected hand. In addition, both groups performed a 15?min home programme, including MT for intervention group and AROM with direct observation of the affected hand for control group, twice daily. Outcome measures, including total active motion (TAM) and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, were administered pre- and post-treatment and three weeks later. This study was registered as an RCT, no. NCT01503762 in http://clinicaltrials.gov/. Results: Final analysis was performed on 23 patients. The mean (SD) changes at post-test from baseline TAM was 154 (32) in the MT (N?=?12) and 61 (24) in the control group (N?=?11); mean difference (95% CI) 93 (68–118), p?=?0.001. The mean (SD) change at post-test from baseline DASH was ?34 (7) in the MT (N?=?12) and ?15 (11) in the control group (N?=?11); mean difference (95% CI) 19 (?27 to ?11), p?=?0.001. Conclusions: Despite significant improvement at post-test in both groups and maintenance of improvement during the follow-up period, MT combined with conventional rehabilitation produced more improvement in hand function than control group.

• Implications for Rehabilitation

• Hand orthopaedic injuries can result in disabilities in activities of daily living.

• Mirror therapy (MT) provides perception of two healthy limbs through reflection of the healthy limb as the injured limb.

• In a randomized controlled trial, our study shows positive effects of MT combined with a classical rehabilitation programme to improve hand function in patients with orthopaedic injuries.

     

Self-rated disability,fear-avoidance beliefs,nonorganic pain behaviors are important mediators of ranges of active motion in chronic whiplash patients

Abstract

Purpose: The influence of self-rated disability and fear-avoidance beliefs on whiplash sufferers in their performance of active ranges of motion has not been studied well. We undertook a cross-sectional study to determine this. Methods: Chronic whiplash subjects completed a standard clinical examination. They completed the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK) and pain visual analog scale (VAS). Active ranges of motion (goniometer) and cervical nonorganic simulation signs (C-NOSS) were obtained by the examiner. Univariate and multivariable analyses were conducted on these scores. Results: Sixty-four subjects (37 female) with a mean age of 41.4 (SD 16.1) years completed all scores. NDI, pain VAS and C-NOSS correlated significantly with ROM. In a multivariable model, only the NDI score contributed significantly to the variance of the ROM scores (14%). Conclusion: As chronic whiplash sufferers perform ROM in a clinical examination, these ranges are importantly influenced by their self-perceived disability. Cervical nonorganic simulation signs can be helpful in distinguishing high from very high levels of disability and motion restriction. The lack of correlation with the TSK may present a challenge to the Fear Avoidance Model in whiplash.

• Implications for Rehabilitation

• Self-ratings of disability in chronic whiplash sufferers are influenced by their fear-avoidance beliefs.

• While self-ratings of disability are known to predict chronicity of whiplash, there is less known about how these ratings affect impairment assessment during recovery.

• This study shows that self-ratings of disability influence the presentation of impairment by chronic whiplash sufferers with respect to their ranges of neck motion.

• Signs of nonorganic behavior also influence ranges of motion and self-ratings of disability.

• These findings should be incorporated into the interpretation of impairment findings in chronic whiplash sufferers in order to improve management.

     

Physiotherapy treatment of the diabetic shoulder: a longitudinal study following patients with diabetes and shoulder pain using a pre-post treatment design

Abstract

Purpose: The aim of this study was to describe and evaluate a physiotherapy program targeted to reduce pain intensity and improve the daily functioning of diabetics with shoulder problems. It was hypothesized that patients receiving specific physiotherapy treatment improved more frequently and rapidly than diabetic patients followed up without specific physiotherapeutic intervention. Method: A pre-post treatment design was completed for a group of 10 subjects. The treatment protocol, also applied during the daily activities of the subjects, was aiming at reducing pain intensity and shoulder stiffness and improving impaired functioning in daily activities by muscle relaxation, light-load exercise and enhancing proper shoulder co-ordination. Results: The group analysis showed significant decrease of pain intensity level as well as improved shoulder functioning and sustained level of subject self-efficacy beliefs throughout the study period. Conclusions: The results suggest that it is possible to relieve shoulder pain intensity and improve daily activities of patients with diabetes-related shoulder problems by employing a physiotherapy program focusing on muscle relaxation, light-load exercise and on the enhancement of proper shoulder co-ordination in daily activities.

• Implications for Rehabilitation

• A physiotherapy program can be effective in reducing pain and improving shoulder function in diabetics with shoulder problems.

• The treatment should focus on muscle relaxation, light-load exercise and on the enhancement of proper shoulder co-ordination in daily activities.

     

Physical functioning and activities of daily living in adults with amyoplasia,the most common form of arthrogryposis. A cross-sectional study

Abstract

Background: Amyoplasia, the most common form of arthrogryposis is characterized by typical deformities of the joints and replacement of skeletal muscles by fibrous tissue and fat. There is sparse literature on adaptation to adult life with amyoplasia.

Purpose: To describe physical function and activity strategies in adults with amyoplasia, as this knowledge is important for relevant function-enhancing measures.

Materials and methods: Twenty-two adults (20–91?years) with amyoplasia participated. Demographic factors and clinical history were registered. Body proportions were measured. Joint mobility and muscle strength in the upper limbs were examined. The Functional Independent Measure was used to assess performance of activities of daily living. Compensatory strategies were described.

Results: The majority had undergone comprehensive conservative and surgical treatment. Mean height was below typical. Range of motion was below lower limit of normal in most joints, passive range of motion was mainly larger than active. Muscle strength was reduced for most movements. Seven were independent in all activities. Need of assistance was highest regarding bathing and dressing. A variety of compensatory strategies were used.

Conclusions: Adults with amyoplasia are heterogeneous regarding function. Independence in everyday life requires a combination of muscle strength to move against gravity, ability to passive joint motion, and use of compensatory strategies.

• Implications for rehabilitation

• The ability to joint motion in the upper extremities is essential for independency in activities of daily living, especially when the muscle strength is impaired.

• Training of muscle strength is recommended, whenever possible, as muscle strength to move against gravity makes the performing of everyday tasks easier.

• The use of compensatory techniques, adaptions to the environment and relevant, often custom made, assistive devices is required to perform activities of daily living.

• Living an active life with physical challenges like in amyoplasia requires flexible and individually adapted solutions.

     

Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial

Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340?mJ/mm², 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T₀), immediately after treatment (T₁) and one hour after the end of the treatment (T₂). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T₁, but there was no significant effect on H_max/M_max ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability.

• Implications for Rehabilitation

• One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability.

• The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT.

• The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus.

• The rESWT had no significant effects on alpha motorneuron excitability.

     

Psychometric properties of the performing arts module of the Disabilities of the Arm,Shoulder, and Hand questionnaire

Abstract

Background: The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) offers an optional performing arts module. The goal was to examine the psychometric properties of this module in musicians.

Methods: This study is a secondary analysis of a randomized controlled trial on the effectiveness of a biopsychosocial intervention to prevent or reduce playing-related disability in conservatory students. Baseline data were used to examine internal consistency and discriminative validity of the performing arts module of the DASH questionnaire. Construct validity was analyzed by hypotheses testing. The performing arts module outcomes were compared to scores from the general DASH questionnaire, pain disability index, Short-Form 36, playing-related musculoskeletal disorder (PRMD) intensity, and pain intensity.

Results: Questionnaires completed by 130 conservatory students were analyzed, 55% of the population was female. Median age was 20 years (IQR 4). The performing arts module showed good internal consistency (Cronbach’s alpha 0.893). Discriminative validity between students with and without PRMDs was good. Three out of six hypotheses were accepted, indicating moderate construct validity.

Conclusions: The performing arts module showed good internal consistency, good discriminative validity and moderate construct validity in a population of conservatory students.

• Implications for Rehabilitation

• Musicians suffer frequently from musculoskeletal disorders, mostly in the upper extremity.

• The Disabilities of the Arm, Shoulder, and Hand questionnaire is a well-known outcome measure, which also includes a performing arts module.

• This study is the first to explore psychometric properties of the performing arts module.

• The performing arts module of the Disabilities of the Arm, Shoulder, and Hand questionnaire showed good internal consistency, good discriminative validity, and moderate construct validity.

     

Muscle load in reaching movements performed by a wheelchair user: a case study

Abstract

Purpose: The aim of this study was to analyse the load on the shoulder muscles during reaching movements that are specific to wheelchair users in relation to the risk of impingement. Method: Three activities of daily living were performed: putting a book on a shelf in front and at the side and putting a pack of water bottles on a table. The AnyBody shoulder model was used to calculate the activity and forces of the shoulder muscles. Results: Handling the pack of bottles caused the highest forces in the deltoideus, trapezius, serratus anterior and rotator cuff muscles. For handling the book, the highest forces were found in the deltoideus (scapular part) and the serratus anterior, especially during the put phase. Conclusions: Handling heavy objects such as a pack of bottles or a wheelchair produces high forces on the rotator cuff muscles and can lead to early fatigue. Therefore, these activities seem to be associated with a high risk of developing impingement syndrome.

• Implications for Rehabilitation

• In a single patient, this study demonstrates that the load on the rotator cuff is high during reaching movements.

• Handling a pack of water bottles, which resembles wheelchair handling, represents an activity associated with a high risk of developing impingement syndrome.

• Shoulder muscles must be trained in a balanced way to provide stabilization at the shoulder joint and prevent fatigue.

     

Validity,reliability and ease of use of the disabilities of arm,shoulder and hand questionnaire in adults following stroke

Purpose: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire is a patient reported outcome measure for evaluating upper limb function in people with musculoskeletal conditions. While the DASH has good psychometric properties when used with people with musculoskeletal conditions, it has not been tested with adults after stroke.

Methods: Data for n?=?61 adults following stroke (aged 32–93 years, 44% male) were analyzed to test validity and reliability of the DASH for use with a stroke population. Data included demographic and clinical attributes, DASH scores (baseline and four weeks later) and Patient Rated Wrist Evaluation (PRWE) measures.

Results: Internal consistency was good (Cronbach alpha 0.92, SEM 6.65). Factor analysis and Rasch modeling suggested that the questionnaire comprised three subscales: pain, impact and function. Concurrent validity between the DASH and PRWE (Spearman’s Rho r_s?=_?0.41) was moderate. The scale was perceived by clinicians to be useful, quick and simple to administer. The DASH had low four-week test-retest reliability (ICC 0.56 [95% Cl 0.05–0.79]).

Conclusions: The DASH is considered to have acceptable validity when used with adults following stroke. Test–retest reliability was low but further research is needed to establish whether this is a result of condition-related change or the stability of the measure.

• Implications for Rehabilitation

• The DASH questionnaire examines upper limb function in task performance and appears to be a useful tool, which is simple to administer in the clinical setting with adults following stroke.

• Upper limb function post stroke can be meaningfully assessed using the DASH as it has good internal consistency and moderate concurrent validity.

• Rasch analysis and factor analysis suggests that the tool appears to consist of three subscales: pain, impact and function. The total score of the DASH may be less meaningful than the totals of these subscales.

• The test–retest reliability of the DASH requires further research; over a four-week period DASH stability was poor in a group of people with moderate to severe upper limb impairment.

     

The efficacy of electrical stimulation in reducing the post-stroke spasticity: a randomized controlled study

Purpose: The purpose of this study is to evaluate the efficacy of surface electrical stimulation on the spasticity occurring in the wrist flexor muscles after a cerebrovascular event. Method: Hemiplegic patients with stage 2–3 spasticity in the wrist muscles based on the Ashworth scale were divided into two groups. Both groups were applied stretching. One group was additionally administered neuromuscular electrical stimulation (NMES) to the wrist extensors, in the form of pulsed current, 100 Hz, with a pulse duration of 0.1 msec, and a resting duration of 9 seconds, for 15 minutes to provide the maximum muscular contraction. The efficacy of the treatment was evaluated using the following: modified Ashworth scale (MAS), Fmax/Mmax ratio, Hmax/Mmax ratio, wrist extension range of motion (ROM). The daily activities were assessed by Functional Independence Measurement (FIM) and the motor recovery was evaluated by Brunnstrom motor staging. Results: Both groups revealed a significant recovery after the treatment based on the MAS, the electrophysiological evaluation results, wrist ROM, FIM and Brunnstrom motor staging. The group receiving the combined treatment showed a better recovery in terms of MAS, wrist ROM, FIM and Brunnstrom motor staging compared to the group doing the stretching alone. Conclusions: The results of this study showed that NMES given together with stretching of the wrist extensor muscles was more effective than stretching of the wrist extensor muscles alone in reducing spasticity.

Implications for Rehabilitation

• There is a wide range of treatment options for spasticity, from conservative treatments (medications, splint, physical treatment modalities, and exercise) to surgery.

• The efficacy of electrical stimulation in spasticity is still controversial.

• Electrical stimulation treatment applied together with wrist extensor muscles passive stretching exercise is effective in reducing spasticity.

     

Long-term functional outcome of patients with longitudinal radial deficiency: cross-sectional evaluation of function,activity and participation

Purpose: To evaluate all functional aspects of patients with longitudinal radial dysplasia and to clarify the relationship between body functions on the one hand and limitations in activity and participation on the other hand. Methods: Thirty-one arms of seventeen adult patients with longitudinal radial dysplasia were analysed. Body function was assessed by measuring grip and pinch strength and active range of motion (ROM) of the hand. Activities were measured using the “Sequential Occupational Dexterity Assessment “, to measure perceived restrictions in participation the “Impact on Participation and Autonomy questionnaire” was used. Relationships between severity of dysplasia, body function, participation and activity were determined. Results: Patients with a severe type scored significantly lower in body function scores than patients with a mild form. Patients with limited active finger joint motion performed worse on activities. We found no significant differences in activity and participation between mild or severe types and found no correlation in participation scores. Conclusion: Although considerable restrictions in joint mobility and strength were revealed, little or no limitations on the activity and participation level were found. Limitations in body functions hardly influenced capacity on activity level and did not influence participation in societal roles.

Implications for Rehabilitation

• People with LRD learn to accomplish many of the everyday tasks without great difficulty and do not report a low quality of participation in major life activities.

• Professionals working in rehabilitation medicine should focus on activity and participation rather than on body structure or functions. Therapy focused solely on increasing joint motion or strength does not lead to further improvement.

• For parents it will be reassuring to know that children with severe radial deficiencies can satisfactory fulfill social roles in later life.

     

Examination of contraction-induced muscle pain as a behavioral correlate of physical activity in women with and without fibromyalgia

Abstract

Purpose: This study aimed to compare muscle pain intensity during a sustained isometric contraction in women with and without fibromyalgia (FM), and examine the association between muscle pain and self-reported levels of physical activity. Methods: Fourteen women with FM and 14 healthy women completed the study, where muscle pain ratings (MPRs) were obtained every 30?s during a 3?min isometric handgrip task at 25% maximal strength, and self-reported physical activity was quantified using the Baecke Physical Activity Questionnaire. Results: Women with FM were less physically active than healthy controls. During the isometric contraction, MPR progressively increased in both groups at a comparable rate, but women with FM generally reported a greater intensity of muscle pain than healthy controls. Among all women, average MPR scores were inversely associated with self-reported physical activity levels. Conclusions: Women with FM exhibit augmented muscle pain during isometric contractions and reduced physical activity than healthy controls. Furthermore, contraction-induced muscle pain is inversely associated with physical activity levels. These observations suggest that augmented muscle pain may serve as a behavioral correlate of reduced physical activity in women with FM.

• Implications for Rehabilitation

• Women with fibromyalgia experience a greater intensity of localized muscle pain in a contracting muscle compared to healthy women.

• The intensity of pain during muscle contraction is inversely associated with the amount of physical activity in women with and without fibromyalgia.

• Future studies should determine whether exercise adherence can be improved by considering the relationship between contraction-induced muscle pain and participation in routine physical activity.