An evaluation of the hemiplegic subject based on the Bobath approach. Part I: The model

An evaluation, based on the Bobath approach to treatment has been developed. A model, substantiating this evaluation is presented. In this model, the three stages of motor recovery presented by Bobath have been extended to six, to better follow the progression of the patient. Six parameters have also been identified. These are the elements to be quantified so that the progress of the patient through the stages of motor recovery can be followed. Four of these parameters are borrowed from the Bobath approach, that is: postural reaction, muscle tone, reflex activity and active movement. Two have been added: sensorium and pain. An accompanying paper presents the evaluation protocol along with the operational definition of each of these parameters.     

Principal components analysis of an evaluation of the hemiplegic subject based on the Bobath approach.

An evaluation based on the Bobath approach to treatment has previously been developed and partially validated. The purpose of the present study was to verify the content validity of this evaluation with the use of a statistical approach known as principal components analysis. Thirty-eight hemiplegic subjects participated in the study. Analysis of the scores on each of six parameters (sensorium, active movements, muscle tone, reflex activity, postural reactions, and pain) was evaluated on three occasions across a 2-month period. Each time this produced three factors that contained 70% of the variation in the data set. The first component mainly reflected variations in mobility, the second mainly variations in muscle tone, and the third mainly variations in sensorium and pain. The results of such exploratory analysis highlight the fact that some of the parameters are not only important but also interrelated. These results seem to partially support the conceptual framework substantiating the Bobath approach to treatment.     

An evaluation of the hemiplegic subject based on the Bobath approach. Part III. A validation study

Sixty-two hemiplegic subjects were treated with the Bobath approach for a period of three months. During this time they were evaluated on three occasions. The testing battery consisted of a Bobath evaluation, the Brunnstrom scale, the Fugl-Meyer test, the Upper Extremity Functional Test (UEFT) and the Present Pain Intensity (PPI) of the McGill pain questionnaire. A Friedman analysis of variance showed that, except for pain, all the protocols used disclosed significant progress (p less than 0.001) over time in terms of motor recovery. Except for pain, the results of the Bobath evaluation were significantly correlated (Spearman's Rho, p less than 0.001) with the results of the other testing procedures. It is concluded that the new Bobath evaluation proposed in a previous paper is as sensitive in depicting progress in motor recovery over time as are the other testing procedures used. Furthermore, this new evaluation seems to be measuring similar properties to the other tests. However, pain (PPI) appears not to be an important dependent variable.     

Ultrasound versus magnetic resonance imaging in fetal evaluation

Ultrasound is the screening modality of choice for fetal imaging. However, there are circumstances in which an alternate imaging modality is needed for additional information regarding fetal anatomy or pathology. Fast magnetic resonance imaging (MRI) is increasingly being used as a correlative imaging modality in pregnancy because it uses no ionizing radiation, provides excellent soft-tissue contrast, and has multiple planes for reconstruction and a large field of view. However, sonographic evaluation of the fetus still is important to select the appropriate fetuses for magnetic resonance (MR) examination and to guide the protocol of the examination. Performance of high-quality sonographic and MR examinations as well as interpretation by individuals familiar with prenatal diagnosis are important factors for optimal parental counseling. MRI frequently adds additional information beyond that available with ultrasound. This information commonly changes patient counseling and, at times, patient management.     

An evaluation of the hemiplegic patient based on the Bobath approach: a reliability study.

The intra- and inter-rater reliability of a motor function evaluation of stroke patients, based on the Bobath approach, was studied. The intraclass correlation coefficient (ICC) was used to determine the degree of agreement between repeated measurements on the same patient taken by the same rater and between measurements taken by three raters on the same patient. In the intra-rater study, each of 19 patients was evaluated in three different sessions by one of 19 raters. In the inter-rater study 18 patients were each evaluated by three different raters. The intra-rater data were highly reliable, with ICCs of 0.95 and 0.97 for the upper and lower limbs respectively. For the inter-rater study, the ICCs were 0.79 and 0.77 for the upper and lower limbs respectively. It can therefore be concluded that this instrument, previously demonstrated to quantify patient progress, is also reliable both in intra- and inter-rater dimensions.     

Efficacy of intrathecal baclofen in the treatment of spasticity in stroke]

OBJECTIVE: To determine whether intrathecal administration of baclofen reduced spastic hypertonia in a hemiplegic patient after hemorrhagic stroke. METHODS: A trial of intrathecal administration of baclofen was carried out with bolus injections of 50 and 75 microg baclofen and clinical and functional evaluation (Aschworth, articular amplitude) before and after injection in a patient with hemorrhagic stroke. After these trials, the placement of a pump was proposed to the patient. RESULTS: Aschworth score improved from 4 to 3 on triceps, quadriceps and adductus, with functional improvement of gait quality and perimeter and position in the wheelchair. Cephalgia, present before the treatment, increased after the implantation of the pump. The patient had some ejaculation trouble with the treatment, as well as some neurological pains after the pump implantation but experienced no effect on upper limbs. DISCUSSION: The intrathecal administration of baclofen has been used in some studies of hemiplegic patients, with reduced spasticity and improved the kinematic parameters of gait. The intrathecal baclofen administration could complement other treatment to control spasticity after stroke. CONCLUSION: Intrathecal baclofen administration could be an interesting complementary therapeutic among patients with important spasticity not controlled by the usual treatments.     

Vector diagrams in the evaluation of human gait

From recordings of reaction forces on the feet in the vertical (z) and horizontal for-aft (x) direction during walking, x-z vector-diagrams (VDG) are constructed for the purpose of clinical use in the evaluation of gait. Such use presupposes the existence of reference values. The parameters of VDG, ie, the maximal coordinates of the vectors, are dependent on weight, speed of walking, age, step length, and physical condition. A requirement of studies on reference values is that these variables as well as height are accounted for. VDG were applied to evaluation of gait of hemiplegic subjects: slow speeds, alterations in the functions of the limbs and irregularities due to instability were noted.     

针刺配合Bobath疗法改善脑卒中后肢体痉挛状态的临床研究

目的探讨针刺配合Bobath技术对脑卒中患者偏瘫痉挛状态的影响。方法83例患者随机分为治疗组(42例)和对照组(41例)。在脑卒中常规治疗的基础上,治疗组采用针刺配合Bobath疗法,对照组采用单纯Bobath疗法,分别观察治疗前及治疗后8周时改良Ashworth评级的变化。结果治疗8周时,两组患者痉挛程度均减轻,但治疗组优于对照组(P<0.05)。结论针刺能促进Bobath技术改善脑卒中患者偏瘫肢体的痉挛状态。     

The current theoretical assumptions of the Bobath concept as determined by the members of BBTA

The Bobath concept is a problem-solving approach to the assessment and treatment of individuals following a lesion of the central nervous system that offers therapists a framework for their clinical practice. The aim of this study was to facilitate a group of experts in determining the current theoretical assumptions underpinning the Bobath concept.A four-round Delphi study was used. The expert sample included all 15 members of the British Bobath Tutors Association. Initial statements were identified from the literature with respondents generating additional statements. Level of agreement was determined by using a five-point Likert scale. Level of consensus was set at 80%. Eighty-five statements were rated from the literature along with 115 generated by the group. Ninety-three statements were identified as representing the theoretical underpinning of the Bobath concept. The Bobath experts agreed that therapists need to be aware of the principles of motor learning such as active participation, opportunities for practice and meaningful goals. They emphasized that therapy is an interactive process between individual, therapist, and the environment and aims to promote efficiency of movement to the individual's maximum potential rather than normal movement. Treatment was identified by the experts as having "change of functional outcome" at its center.     

Echocardiography in the use of noninvasive hemodynamic monitoring

Invasive pulmonary artery catheter measurements are the standard method for assessment of hemodynamic evaluation at the present time. However, this invasive approach is associated with an increase in patient morbidity and without evidence of a reduction in mortality. Doppler echocardiography is a noninvasive method that provides robust data regarding patients' hemodynamic indices. Several parameters are available for noninvasive hemodynamic evaluation using Doppler echocardiography. Most of these measurements are easily obtained and provide a safe alternative to invasive hemodynamic assessment. As Doppler echocardiography is able to provide additional valuable information, such as cardiac systolic and diastolic function, and the presence of pericardial and pleural effusions, which can play a significant role in the patients’ hemodynamic status, using this noninvasive modality in the daily practice for hemodynamic assessment can prove an alternative to invasive measures in selected patients as well as a complementary tool for those still in need of invasive monitoring.     

Office evaluation of female urinary incontinence

The diagnosis and therapy of urinary incontinence in the female patient demand an orderly approach to this complex problem. In this article, the authors suggest a classification that can simplify the approach to the differential diagnosis; review the "catheterization test," a simple diagnostic modality; and briefly discuss some of the surgical and nonsurgical options for therapy. The primary emphasis is on the evaluation of the loss of urine per urethra.     

Evaluation of two support methods for the subluxated shoulder of hemiplegic patients

One of the most troublesome complications in the rehabilitation of hemiplegic patients is inferior subluxation of the glenohumeral joint. The purpose of this study was to determine which of two shoulder supports, the Bobath shoulder roll or the Henderson shoulder ring, would be more effective in the management of hemiplegic patients with a subluxated glenohumeral joint. To determine the degree of subluxation and the amount of reduction after application of a shoulder support, radiographs were taken of 26 hemiplegic patients with subluxated shoulders. Radiographs of the unsupported affected shoulder were compared with radiographs of the same shoulder with each support applied. Radiographs of the unaffected shoulder were used as a comparison in determining the amount of subluxation. An analysis of variance revealed no significant difference in the reduction of inferior subluxation between the two types of shoulder support. A significant difference in subluxation, however, existed between measurements of the unsupported affected shoulder and the unaffected shoulder (p less than .001) and between measurements of the unsupported affected shoulder and the supported affected shoulder (p less than .001). The results of this study demonstrate the benefits of the Bobath shoulder roll and the Henderson shoulder ring in the management of hemiplegic patients with subluxated shoulders.     

Symptom perception and evaluation in childhood asthma

BACKGROUND: Inaccuracies in symptom perception may contribute to morbidity and mortality in childhood asthma. OBJECTIVE: To systematically examine the accuracy of symptom perception on the part of children with asthma and their parents, as well as their interpretation and evaluation of the symptoms. METHOD: Twenty-eight patient/parent pairs from suburban and underserved urban pediatric populations participated in a 5-week protocol tracking subjective assessments of asthma severity (visual analog scales) and peak expiratory flow rates. Relationships between perceptual accuracy and demographic and disease factors were investigated. RESULTS: Adolescents were more accurate than school-aged children, more accurate children had better morbidity outcomes, and African American parents were more accurate than Caucasian parents. Socioeconomic status did not affect accuracy. Both children and parents missed early symptoms and waited too long prior to intervening in an exacerbation. CONCLUSIONS: There are multiple opportunities for error in symptom perception and evaluation. Identification of the source of error is critical to the effective utilization of education on self-management.     

The influence of treatment modality and ethnicity on attitudes in type 2 diabetes

OBJECTIVE: The study examines diabetes attitude differences by treatment modality (insulin vs. no insulin), race/ethnicity, and the interaction of these two variables for people with type 2 diabetes. RESEARCH DESIGN AND METHODS: Data were collected with the Diabetes Care Profile (DCP), an instrument that assesses psychosocial factors related to diabetes. Participants (n = 672) were recruited in the metropolitan Detroit, Michigan, area from 1993 to 1996. A total of 68% of these participants were African-Americans with type 2 diabetes, and 32% were Caucasians with type 2 diabetes. Analyses of covariance were performed to examine the effects of race/ethnicity, treatment, and their interaction for each DCP scale. RESULTS: The four patient categories (two ethnicities by two treatment modalities) differed by age, years with diabetes, education, and sex distribution. Treatment modality had a significant effect on 6 of the 16 DCP scales (Control, Social and Personal Factors, Positive Attitude, Negative Attitude, Self-Care Ability, and Exercise Barriers). Ethnicity was a significant effect for three scales (Control, Support, and Support Attitudes). The interaction of race/ethnicity and treatment modality was a significant effect for two related attitude scales (Positive Attitude and Negative Attitude). CONCLUSIONS: The results suggest that attitudes toward diabetes are similar for African-American and Caucasian patients with type 2 diabetes. The results also suggest that treatment modality has a greater effect on attitudes than either race/ethnicity or the interaction effect. However, Caucasian patients using insulin differed from the other patient groups by having the least positive and the most negative attitudes regarding diabetes.     

Imaging evaluation of chronic ankle and hindfoot pain in athletes

Acute ankle and hindfoot injuries are common in athletes and typically are treated conservatively. Persistent pain that has not responded to appropriate conservative treatment and prevents the patient from returning to play is more problematic for the athlete and the treating sports clinician. Making a specific clinical and imaging diagnosis in these patients can be quite challenging. This article discusses the imaging evaluation of chronic ankle and hindfoot pain related to osseous and soft-tissue injuries in athletes. MR imaging is the preferred imaging modality in most of the presented cases.     

神经肌肉关节促进法对脑梗死偏瘫患者下肢肌张力的影响

目的 探讨神经肌肉关节促进法（NJF）对脑梗死偏瘫患者下肢肌张力的治疗作用及效果。方法 收集脑梗死患者136例,根据是否使用NJF治疗分为治疗组（66例）与对照组（70例）。分别在治疗前、治疗10 d后采用改良Ashworth量表评定2组患者偏瘫侧的下肢肌张力,Brunnstrom分期评定2组患者偏瘫侧下肢运动功能,根据转移时所需帮助量的程度评定患者的转移能力（包括卧坐转移、坐站转移）,Bobath法平衡功能评定患者平衡能力,Holden功能性步行量表评定患者步行能力。结果 治疗10 d后治疗组患者下肢高肌张力降低比例为21.2%,高于对照组的1.4%(P <0.001);治疗组患者坐站转移能力好转比例为47.0%,高于对照组的27.1%(P <0.05)。结论 NJF治疗有利于降低脑梗死偏瘫患者下肢的高肌张力,使其趋于正常水平,有助提高其坐站转移能力。