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1.
Anita D. Mountain R. Lee Kirby Donald A. MacLeod Kara Thompson 《Archives of physical medicine and rehabilitation》2010,91(4):639-643
Mountain AD, Kirby RL, MacLeod DA, Thompson K. Rates and predictors of manual and powered wheelchair use for persons with stroke: a retrospective study in a Canadian rehabilitation center.
Objectives
To determine the rates of manual and powered wheelchair use at discharge for people with stroke admitted to a rehabilitation center and to determine whether any predictors of wheelchair use at discharge could be identified.Design
Retrospective cohort study.Setting
Rehabilitation center.Participants
Consecutive former inpatients (N=100) with a primary diagnosis of stroke, a sample of convenience.Interventions
None.Main Outcome Measures
We reviewed the inpatient health records to determine the rates of wheelchair use at discharge and to record some readily available demographic and clinical data that might serve as predictors of wheelchair use.Results
At discharge, 40 people (40%) were using manual wheelchairs, 1 person (1%) was using a powered wheelchair, and 59 (59%) were not using a wheelchair. Of the patients who were walkers on admission (ie, walking FIM scores of 6 or 7), none (0%) used wheelchairs at discharge. Of those with nonwalking FIM scores (1-5) on admission, 56% were using wheelchairs at discharge. Multivariate analyses revealed that the adjusted odds ratios of using a wheelchair (manual or powered) were 3.33 (95% confidence interval [CI], 1.33-8.33) for those with left-hemisphere versus right-hemisphere strokes (P=.010), .94 (CI, .91-.96) for each point rise in the total raw FIM score on admission (P<.0001), and 19.46 (CI, 6.33-59.81) if the total admission FIM score was less than 80 versus greater than or equal to 80 (P<.0001).Conclusions
On discharge from our rehabilitation center, 40% of people with stroke were using manual wheelchairs and 1% powered wheelchairs. People who were not walking on admission, those with left-hemisphere strokes, and those with lower total admission FIM scores were more likely to use a wheelchair. These findings may permit clinicians to predict wheelchair use better early in the rehabilitation process, when it can affect rehabilitation planning. 相似文献2.
Kirby RL Corkum CG Smith C Rushton P MacLeod DA Webber A 《Archives of physical medicine and rehabilitation》2008,89(3):480-485
Kirby RL, Corkum CG, Smith C, Rushton P, MacLeod DA, Webber A. Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial.
Objective
To test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely.Design
A randomized controlled study.Setting
A rehabilitation center.Participants
Participants (N=30) including 16 able-bodied and 14 wheelchair users.Intervention
Participants were provided with wheelchair skills training (up to 2.4h).Main Outcome Measures
Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training.Results
For the C-RAD and Arc-RAD groups, the mean ± standard deviation RAD-relevant WST scores were 32.3%±8.5% and 85.1%±18.9% (Kruskal-Wallis, P<.001). Of the 23 RAD-relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical significance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm-high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group.Conclusions
The new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety. 相似文献3.
Brose SW Boninger ML Fullerton B McCann T Collinger JL Impink BG Dyson-Hudson TA 《Archives of physical medicine and rehabilitation》2008,89(11):2086-2093
Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, Dyson-Hudson TA. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.
Objectives
To investigate the presence of ultrasound (US) abnormalities in manual wheelchair users with spinal cord injury (SCI) using a quantitative Ultrasound Shoulder Pathology Rating Scale (USPRS). To investigate physical examination (PE) findings using a quantitative Physical Examination of the Shoulder Scale (PESS), and to obtain data about pain and other subject characteristics such as age, years with SCI, and weight.Design
Case series.Setting
National Veterans' Wheelchair Games 2005 and 2006.Participants
Volunteer sample of manual wheelchair users with SCI participating in the National Veterans' Wheelchair Games.Interventions
Not applicable.Main Outcome Measures
Presence of relationships between US findings, PE findings, pain, and subject characteristics.Results
The USPRS correlated with age, duration of SCI, and weight (all P<.01), and showed a positive trend with the total Wheelchair User's Shoulder Pain Index (WUSPI) score (r=.258, P=.073). Several US findings related to presence of PE findings for specific structures. The PESS score correlated with the WUSPI (r=.679, P<.001) and duration of SCI (P<.05). The presence of untreated shoulder pain that curtailed activity was noted in 24.5% of subjects, and this was related to increased WUSPI scores (P=.002).Conclusions
PE and US abnormalities are common in manual wheelchair users with SCI. The USPRS and PESS demonstrated evidence for external validity and hold promise as research tools. Untreated shoulder pain is common in manual wheelchair users with SCI, and further investigation of this pain is indicated. 相似文献4.
Timothy A. Reistetter James E. Graham Anne Deutsch Carl V. Granger Samuel Markello Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2010,91(3):345-350
Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.
Objective
To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke.Design
Retrospective cross-sectional design.Setting
Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation.Participants
Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007.Interventions
Not applicable.Main Outcome Measure
Discharge FIM rating and discharge setting (community vs institutional).Results
Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77).Conclusions
Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings. 相似文献5.
Audrey L. Nelson Shirley Groer Polly Palacios Douglas Mitchell Sunil Sabharwal R. Lee Kirby Deborah Gavin-Dreschnack Gail Powell-Cope 《Archives of physical medicine and rehabilitation》2010,91(8):1166-1173
Nelson AL, Groer S, Palacios P, Mitchell D, Sabharwal S, Kirby RL, Gavin-Dreschnack D, Powell-Cope G. Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
Objectives
(1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.Design
This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.Setting
Three Veterans' Administration hospitals.Participants
Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).Interventions
Not applicable.Main Outcome Measures
Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.Results
Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.Conclusions
This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment. 相似文献6.
Edward D. Lemaire Patricia A. O'Neill Marcel M. Desrosiers D. Gordon Robertson 《Archives of physical medicine and rehabilitation》2010,91(10):1516-1523
Lemaire ED, O'Neill PA, Desrosiers MM, Robertson DG. Wheelchair ramp navigation in snow and ice-grit conditions.
Objective
To explore manual wheelchair propulsion strategies for ramp ascent and descent in snow and snow-ice-grit conditions.Design
Cross-sectional study.Setting
Climatic Engineering and Testing Chamber (Ottawa, Canada).Participants
Manual wheelchair users (N=11) who typically self-propel their wheelchair in winter.Interventions
Ramp ascent and descent at 3 grades (1:10, 1:12, 1:16) and 2 winter conditions (packed snow, packed snow with a freezing rain cover, and traction grit).Main Outcomes Measures
Type of ascent and descent strategy, success rate, number and severity of obstructions, average speed, and perceived ramp navigation rating. A questionnaire regarding the subject's past experiences with wheelchair propulsion in winter.Results
Snow accumulation on ramps at 1:10 grade will render the ramp inaccessible for many wheelchair users who do not have external assistance. For snow conditions, the transition area from the level group to the first 2m of ramp incline were the most difficult to traverse for both ascent and descent. All subjects were able to ascend and descend the ramp for the ice-grit condition. Two-railing propulsion is a preferred strategy for ice-grit ramp navigation because of enhanced trajectory control and reducing the potential for wheel-slip problems. Backwards ramp ascent was a successful strategy for ascent in soft-snow conditions.Conclusions
The 1:16 grade is preferred for winter ramp navigation. Backwards ramp ascent for snow conditions should be considered for people with sufficient shoulder and trunk range of motion. Two handrails are recommended for exterior ramps for both propulsion and wheelchair extraction from ruts and other snow-related obstacles. For ice ramp navigation, the amount of grit required and the effective time (ie, time to when grit becomes embedded in snow-ice, becoming much less effective) should be addressed in further research. Front wheels typically available with manual wheelchairs are not appropriate for soft-snow conditions. 相似文献7.
Watanabe S, Amimoto K. Generalization of prism adaptation for wheelchair driving task in patients with unilateral spatial neglect.
Objectives
To verify the efficacy of prism adaptation as a practical means of rehabilitation for subjects with unilateral spatial neglect by conducting goal-directed tasks in the presence of similar visual flankers in the right hemispace using an activity of daily living, namely, wheelchair operation.Design
Prospective cohort study.Setting
Rehabilitation center located in Japan.Participants
Patients with unilateral spatial neglect (N=10).Intervention
Prism adaptation.Main Outcome Measures
A midpoint-directed task in which the subject faces the center of 2 symbols placed in front and moves the wheelchair toward it, and a goal-directed task in which the subject must differentiate a single target from multiple symbols and move the wheelchair toward it.Results
In the midpoint-directed task, there was a significant shift in the reach position bias from +27.7cm prior to prism adaptation to +3.1cm after prism adaptation (P<.01). In the goal-directed task, the time taken to reach the outer left target decreased from 21.2 seconds prior to prism adaptation to 11.8 seconds after prism adaptation, and the difference between placement of the targets was eliminated.Conclusions
Prism adaptation exhibited the potential to generalize the effects on activities of daily living such as driving a wheelchair and to ameliorate unilateral spatial neglect even in the presence of right-hemispace flankers. Prism adaptation is an effective therapeutic modality in rehabilitation because it prevents the appearance of neglect symptoms despite situational or contextual changes. 相似文献8.
Blennerhassett JM Jayalath VM 《Archives of physical medicine and rehabilitation》2008,89(11):2156-2161
Blennerhassett JM, Jayalath VM. The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.
Objective
To examine if the Four Square Step Test (FSST), a previously reported clinical test of dynamic standing balance, which involves stepping over obstacles and turning, was a feasible and valid test, and sensitive to change during stroke rehabilitation.Design
Prospective observational cohort study over a 4-week duration.Setting
Rehabilitation hospital.Participants
People with stroke (N=37) who could walk at least 50m with minimal assistance were recruited consecutively when attending physical therapy during rehabilitation.Interventions
Not applicable.Main Outcome Measures
Dynamic standing balance was examined at 2 weekly intervals using 2 clinical tests: the FSST and the Step Test. Falls events were monitored using a falls diary and by an audit of medical histories.Results
Strong agreement was observed between performance scores for the FSST and Step Test obtained within the same testing session (intraclass correlation coefficient3,k, .94-.99). A moderate to strong inverse relationship (Spearman ρ=−.73 to −.86) was observed between the FSST and Step Test scores at each assessment. Scores from both tests revealed significant improvements in dynamic balance across the 4-week period (P<.001-.010). Five of the participants reported falls during the study. These 5 people had low scores for both clinical tests and difficulty clearing their foot when stepping over objects in the FSST.Conclusions
The FSST is a feasible and valid test of dynamic standing balance that is sensitive to change during stroke rehabilitation. 相似文献9.
Jan YK Jones MA Rabadi MH Foreman RD Thiessen A 《Archives of physical medicine and rehabilitation》2010,91(11):1758-1764
Jan Y-K, Jones MA, Rabadi MH, Foreman RD, Thiessen A. Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury.
Objective
To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in wheelchair users with spinal cord injury (SCI).Design
Repeated-measures, intervention, and outcomes-measure design.Setting
A university research laboratory.Participants
Wheelchair users with SCI (N=11; 9 men, 2 women; mean ± SD age, 37.7±14.2y; body mass index, 24.7±2.6kg/m2; duration of injury, 8.1±7.5y).Interventions
Protocols (N=6) of various wheelchair tilt-in-space and recline angles were randomly assigned to participants. Each protocol consisted of a 5-minute sitting-induced ischemic period and a 5-minute wheelchair tilt-in-space and recline pressure-relieving period. Participants sat in a position without tilt or recline for 5 minutes and then sat in 1 of 6 wheelchair tilted and reclined positions, including (1) 15° tilt-in-space and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and 100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120° recline, and (6) 35° tilt-in-space and 120° recline. A 5-minute washout period (at 35° tilt-in-space and 120° recline) was allowed between protocols.Main Outcome Measures
Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity in response to changes in body positions caused by performing wheelchair tilt-in-space and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized to skin perfusion of the upright seated position (no tilt/recline).Results
Combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant increase in skin perfusion compared with the upright seated position (no tilt/recline; P<.05), whereas there was no significant increase in skin perfusion at 15° and 25° tilt-in-space (not significant). Combined with 120° recline, wheelchair tilt-in-space at 15°, 25°, and 35° showed a significant increase in skin perfusion compared with the upright seated position (P<.05).Conclusions
Our results indicate that wheelchair tilt-in-space should be at least 35° for enhancing skin perfusion over the ischial tuberosity when combined with recline at 100° and should be at least 25° when combined with recline at 120°. Although smaller angles of wheelchair tilt-in-space and recline are preferred by wheelchair users for functional purposes, wheelchair tilt-in-space less than 25° and recline less than 100° may not be sufficient for effective pressure reduction for enhancing skin perfusion over the ischial tuberosity in people with SCI. 相似文献10.
Bradley G. Impink Michael L. Boninger Heather Walker Jennifer L. Collinger Christian Niyonkuru 《Archives of physical medicine and rehabilitation》2009,90(9):1489-1494
Impink BG, Boninger ML, Walker H, Collinger JL, Niyonkuru C. Ultrasonographic median nerve changes after a wheelchair sporting event.
Objectives
To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response.Design
Case series.Setting
Research room at the National Veterans Wheelchair Games.Participants
Manual wheelchair users (N=28) competing in wheelchair basketball.Intervention
Ultrasound images collected before and after a wheelchair basketball game.Main Outcome Measures
Median nerve cross-sectional area, flattening ratio, and swelling ratio and changes in these after activity. Comparison of median nerve characteristics and patient characteristics between participants with and without positive physical examination findings and with and without symptoms of CTS.Results
Significant changes in median nerve ultrasound characteristics were noted after activity. The group as a whole showed a significant decrease in cross-sectional area at the radius of 4.05% (P=.023). Participants with positive physical examinations showed significantly different (P=.029) and opposite changes in swelling ratio compared with the normal group. Subjects with CTS symptoms had a significantly (P=.022) greater duration of wheelchair use (17.1y) compared with the asymptomatic participants (9y).Conclusions
Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS. 相似文献11.
12.
Lindquist NJ Loudon PE Magis TF Rispin JE Kirby RL Manns PJ 《Archives of physical medicine and rehabilitation》2010,91(11):1752-1757
Lindquist NJ, Loudon PE, Magis TF, Rispin JE, Kirby RL, Manns PJ. Reliability of the performance and safety scores of the Wheelchair Skills Test Version 4.1 for manual wheelchair users.
Objective
To evaluate the interrater, intrarater, and test-retest reliability of the total performance and safety scores of the Wheelchair Skills Test version 4.1 (WST 4.1) for manual wheelchairs operated by adult wheelchair users.Design
Cohort study.Setting
University research setting.Participants
People (N=11) who used manual wheelchairs for community locomotion.Interventions
Not applicable.Main Outcome Measure
Participants were videotaped as they completed the WST 4.1 (30 skills) on 2 separate occasions 1 to 2 weeks apart. Subsequently, raters scored the WST 4.1 from the video recordings and each participant received a total score for performance and safety. Using those scores, interrater, intrarater, and test-retest reliability were determined by using intraclass correlation coefficients (ICCs). Percentages of agreement between raters for individual skills also were calculated.Results
Mean ± SD overall WST 4.1 scores for performance and safety were 80.1%±8.5% and 98.0%±2.8%. ICCs for the interrater, intrarater, and test-retest reliability of the performance component were .855, .950, and .901 (P<.001). Safety component ICC scores were .061 (P=.243), .228 (P=.048), and .254 (P=.041). Percentages of agreement between raters for each test item for both the performance and safety scales ranged from 68% to 100%.Conclusions
Reliability of the performance component of the WST 4.1 was excellent, whereas ICCs for the safety component indicated only slight to fair agreement, probably because of the low variability in safety scores. Additional study is needed to further evaluate the reliability of the safety component with a larger and more diverse sample group. 相似文献13.
Gary P. Epstein-Lubow Christopher G. Beevers Duane S. Bishop Ivan W. Miller 《Archives of physical medicine and rehabilitation》2009,90(6):947-955
Epstein-Lubow GP, Beevers CG, Bishop DS, Miller IW. Family functioning is associated with depressive symptoms in caregivers of acute stroke survivors.
Objective
To determine whether family functioning is uniquely associated with caregiver depressive symptoms in the immediate aftermath of stroke.Design
Cross-sectional data from the baseline assessment of an intervention study for stroke survivors and their families.Setting
Neurology inpatient service of a large urban hospital.Participants
Stroke survivors (n=192), each with a primary caregiver. The mean age of stroke survivors was 66 years, and most, 57%, were men (n=110). The mean age of caregivers was 57 years, and 73% (n=140) of the caregivers were women. Eighty-five percent of caregivers were white.Interventions
Not applicable.Main Outcome Measures
Measures were chosen to assess caregivers' depressive symptoms (Centers for Epidemiologic Studies Depression Scale), family functioning (Family Assessment Device), and additional factors such as health status (Medical Outcomes Study 36-Item Short-Form Health Survey) and stroke survivors' cognitive abilities (modified Mini-Mental State Examination) and functional impairments (FIM and Frenchay Activities Index).Results
Depressive symptoms were mild to moderate in 14% and severe in 27% of caregivers. Family functioning was assessed as unhealthy in 34% of caregiver-patient dyads. In statistical regression models, caregiver depression was associated with patients' sex, caregivers' general health, and family functioning.Conclusions
Forty-one percent of caregivers experienced prominent depressive symptoms after their family member's stroke. Higher depression severity in caregivers was associated with caring for a man, and having worse health and poor family functioning. After stroke, the assessment of caregivers' health and family functioning may help determine which caregivers are most at risk for a depressive syndrome. 相似文献14.
Rachel E. Cowan Mark S. Nash Jennifer L. Collinger Alicia M. Koontz Michael L. Boninger 《Archives of physical medicine and rehabilitation》2009,90(7):1076-1083
Cowan RE, Nash MS, Collinger JL, Koontz AM, Boninger ML. Impact of surface type, wheelchair weight, and axle position on wheelchair propulsion by novice older adults.
Objective
To examine the impact of surface type, wheelchair weight, and rear axle position on older adult propulsion biomechanics.Design
Crossover trial.Setting
Biomechanics laboratory.Participants
Convenience sample of 53 ambulatory older adults with minimal wheelchair experience (65-87y); men, n=20; women, n=33.Intervention
Participants propelled 4 different wheelchair configurations over 4 surfaces: tile, low carpet, high carpet, and an 8% grade ramp (surface, chair order randomized). Chair configurations included (1) unweighted chair with an anterior axle position, (2) 9.05kg weighted chair with an anterior axle position, (3) unweighted chair with a posterior axle position (Δ0.08m), and (4) 9.05kg weighted chair with a posterior axle position (Δ0.08m). Weight was added to a titanium folding chair, simulating the weight difference between very light and depot wheelchairs. Instrumented wheels measured propulsion kinetics.Main Outcome Measures
Average self-selected velocity, push frequency, stroke length, peak resultant and tangential force.Results
Velocity decreased as surface rolling resistance or chair weight increased. Peak resultant and tangential forces increased as chair weight increased, as surface resistance increased, and with a posterior axle position. The effect of a posterior axle position was greater on high carpet and the ramp. The effect of weight was constant, but was more easily observed on high carpet and ramp. The effects of axle position and weight were independent of one another.Conclusion
Increased surface resistance decreases self-selected velocity and increases peak forces. Increased weight decreases self-selected velocity and increases forces. Anterior axle positions decrease forces, more so on high carpet. The effects of weight and axle position are independent. The greatest reductions in peak forces occur in lighter chairs with anterior axle positions. 相似文献15.
16.
Samuel J. Howarth Jan M. Polgar Clark R. Dickerson Jack P. Callaghan 《Archives of physical medicine and rehabilitation》2010,91(3):436-442
Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.
Objectives
To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.Design
Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.Setting
Biomechanics laboratory.Participants
Healthy novice wheelchair users (N=13; 6 men) from a university student population.Interventions
Not applicable.Main Outcome Measures
Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.Results
Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.Conclusions
Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition. 相似文献17.
Objectives
Although unilateral neglect (ULN) can affect a person's ability to engage in and benefit from rehabilitation, little attention has been given to the assessment and diagnosis of this disorder by physiotherapy clinicians. The purpose of this study was to identify the procedures used by physiotherapists to assess and diagnose ULN after stroke.Design
Qualitative research design employing focus groups and one-to-one interviews.Setting
Healthcare and university departments, Melbourne, Australia.Participants
Thirty-three physiotherapists, comprising both experienced neurological physiotherapists and novice clinicians.Methods
Participants were asked to describe in detail how they determine whether a person has ULN, and how they differentially diagnose the different types of neglect as well as differentiating neglect from other impairments. Measurement and documentation were also discussed.Results
The findings revealed that observation is a key component of the assessment and that physiotherapists rely heavily on real task performance to evaluate the patient. Although physiotherapists are primarily concerned with the functional implications of ULN, the functional impact of the disorder is rarely measured. Physiotherapists appear to use both hypothesis testing and pattern recognition approaches to clinical reasoning in the assessment of ULN.Conclusions
The physiotherapy clinicians in this sample do not routinely differentiate the different types of neglect during patient assessment. Education on the different types of neglect and the range of valid tools available to measure functional implications may be warranted. 相似文献18.
Toby B. Cumming Prudence Plummer-D'Amato Thomas Linden Julie Bernhardt 《Archives of physical medicine and rehabilitation》2009,90(11):1931-1936
Cumming TB, Plummer-D'Amato P, Linden T, Bernhardt J. Hemispatial neglect and rehabilitation in acute stroke.
Objectives
To compare 2 methods for determining neglect in patients within 2 days of stroke, and to investigate whether early neglect was related to rehabilitation practice, and whether this relationship was affected by an early, intensive mobilization intervention.Design
Data were collected from patients participating in a phase II randomized controlled trial of early rehabilitation after stroke.Setting
Acute hospital stroke unit.Participants
Stroke patients (N=71).Intervention
The 2 arms of the trial were very early mobilization (VEM) and standard care (SC).Main Outcome Measures
Neglect was assessed using the Star Cancellation Test and the National Institutes of Health Stroke Scale (NIHSS) inattention item within 48 hours of stroke onset, and therapy details were recorded during the hospital stay.Results
Assessing neglect so acutely after stroke was difficult: 29 of the 71 patients were unable to complete the Star Cancellation Test, and agreement between this test and the NIHSS measure was only .42. Presence of neglect did not preclude early mobilization. SC group patients with neglect had longer hospital stays (median, 11d) than those without neglect (median, 4d); there was no difference in length of stay between patients with and without neglect in the VEM group (median, 6d in both).Conclusion
Early mobilization of patients with neglect was feasible and may contribute to a shorter acute hospital stay. 相似文献19.
Jacqueline Bloomfield 《International journal of nursing studies》2010,47(3):287-294
Background
High quality health care demands a nursing workforce with sound clinical skills. However, the clinical competency of newly qualified nurses continues to stimulate debate about the adequacy of current methods of clinical skills education and emphasises the need for innovative teaching strategies. Despite the increasing use of e-learning within nurse education, evidence to support its use for clinical skills teaching is limited and inconclusive.Objectives
This study tested whether nursing students could learn and retain the theory and skill of handwashing more effectively when taught using computer-assisted learning compared with conventional face-to-face methods.Design
The study employed a two group randomised controlled design. The intervention group used an interactive, multimedia, self-directed computer-assisted learning module. The control group was taught by an experienced lecturer in a clinical skills room. Data were collected over a 5-month period between October 2004 and February 2005. Knowledge was tested at four time points and handwashing skills were assessed twice.Setting and participants
Two-hundred and forty-two first year nursing students of mixed gender; age; educational background and first language studying at one British university were recruited to the study. Participant attrition increased during the study.Results
Knowledge scores increased significantly from baseline in both groups and no significant differences were detected between the scores of the two groups. Skill performance scores were similar in both groups at the 2-week follow-up with significant differences emerging at the 8-week follow-up in favour of the intervention group, however, this finding must be interpreted with caution in light of sample size and attrition rates.Conclusion
The computer-assisted learning module was an effective strategy for teaching both the theory and practice of handwashing to nursing students and in this study was found to be at least as effective as conventional face-to-face teaching methods. 相似文献20.
Sumiko Shiba Hiroyuki Okawa Hiroyasu Uenishi Yumi Koike Katuya Yamauchi Ko Asayama Taro Nakamura Fumihiro Tajima 《Archives of physical medicine and rehabilitation》2010,91(8):1262-1266
Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.