An investigation into the predictive ability of rehabilitation clinicians

Purpose: There is increasing pressure by providers, purchasers and recipients of service within the United Kingdom for a more accurate prediction of rehabilitation outcomes. The purpose of this research was to investigate how accurately clinicians were predicting rehabilitation outcomes. Method: The study was carried out among 47 patients admitted to a general rehabilitation unit. The Functional Independence Measure and Functional Assessment Measure (FAM) were used as the outcome measure. Results: The results showed a statistically significant positive correlation between goal scores and discharge scores as a total population using Spearmans correlation co-efficient. When breaking the sample into an orthopaedic and CVA population, the predictive ability for the orthopaedic population was consistently higher than for the CVA population. Conclusions: The results of this study suggest that the predictive ability of clinicians is good for the rehabilitation population although the prediction is consistently better with the orthopaedic population than the CVA population.     

Evaluation of arm and prosthetic functioning in children with a congenital transverse reduction deficiency of the upper limb.

OBJECTIVE: To assess upper extremity functioning of children with unilateral transverse upper limb reduction deficiency, using standardized instruments, and to investigate their validity and reliability. DESIGN: Cross-sectional study. SUBJECTS: Twenty subjects aged 4-12 years; 9 prosthetic users and 11 non-users. METHODS: The Assisting Hand Assessment, Unilateral Below Elbow Test, Prosthetic Upper extremity Functional Index and ABILHAND-Kids were assessed in all children. Users were tested with and without their prosthesis. We compared results of users and non-users, and of users with and without their prosthesis. Validity was determined by testing hypotheses and correlations with other measures. Test-retest reliability was assessed from repeated measurements in 10 children. RESULTS: Children with an upper limb reduction deficiency performed well on daily activities. They could use their prosthesis in 68% of the activities, but were currently using it in only 30%. Children find their prosthesis useful for specific activities, rather than for daily activities in general. The Assisting Hand Assessment and Prosthetic Upper extremity Functional Index showed best validity; test-retest reliability was good to excellent. CONCLUSION: The use of standardized instruments adds relevant information on functioning of children with an upper limb reduction deficiency. We found additional support for validity and reliability of, in particular, the Assisting Hand Assessment and Prosthetic Upper extremity Functional Index.     

Assessment of arm activity using triaxial accelerometry in patients with a stroke

van der Pas SC, Verbunt JA, Breukelaar DE, van Woerden R, Seelen HA. Assessment of arm activity using triaxial accelerometry in patients with a stroke.

Objective

To study the validity of accelerometry in the assessment of arm activity of patients with impaired arm function after stroke.

Design

Cross-sectional concurrent validity study.

Setting

Rehabilitation center.

Participants

Patients (N=45) at different stages after stroke.

Interventions

Not applicable.

Main Outcome Measures

All patients wore 2 triaxial accelerometers around their wrists during 3 consecutive days. Arm activity was assessed, based on unilateral (activity of the affected arm) and bilateral accelerometry (ratio between the activity of the affected and nonaffected arm). The Motor Activity Log-26 (MAL-26) Amount of Use (AOU) scale was used as the main external criterion to test the concurrent validity of arm accelerometry. In addition, the MAL-26 Quality of Movement (QOM) scale and the Stroke Impact Scale (SIS) subscale Hand Function were used. To test the divergent validity, the SIS subscale Mobility was used. Spearman correlation coefficients were calculated. In an additional regression analysis, the hypothesized confounding influence of spasm, therapy intensity, and interobserver differences was studied.

Results

Both unilateral (ρ=.58, P<.001) and bilateral (ρ=.60, P<.001) accelerometry were significantly related to the MAL-AOU scale. Associations of both unilateral and bilateral accelerometry with the MAL-QOM and SIS subscale Hand Function corroborated these findings. The SIS subscale Mobility was not significantly associated with unilateral accelerometry (ρ=.41, P=.01) or bilateral accelerometry (ρ=.23, P=.11). None of the hypothesized confounders influenced these associations significantly.

Conclusions

Based on the results, both the concurrent and divergent validity of unilateral and bilateral arm accelerometry for measuring arm activity after stroke are good.     

上肢力量训练对脑瘫患儿手功能和日常生活活动能力的影响

目的:观察上肢力量训练对痉挛型偏瘫的脑瘫患儿上肢、手功能及日常生活活动能力的影响.方法:痉挛型偏瘫脑瘫患儿60例随机分成观察组和对照组,每组30例,其中对照组采用常规的作业治疗方案,观察组在对照组的基础上介入上肢力量训练.治疗前和治疗2、4及6个月后分别采用改良的Ashworth量表、电子握力计、Car-roll手功能...     

对截肢患者肌电假手的功能训练和评定的临床研究

目的　探讨截肢患者肌电假手生物反馈训练的最佳方法及其效果评定。方法　 14例上肢截肢者 ,共 16只肌电假手 ;男 11例 ,女 3例 ;年龄 (2 5± 8.69)岁 ;右侧截肢 11例 ,左侧截肢 1例 ,双侧截肢 2例。肌电假手生物反馈训练分为 :基础电信号训练、视觉反馈训练和日常生活能力训练。训练时间为 4～ 6周。结果　 16只肌电假手均能按照截肢者的意愿实现开手 /闭手及旋腕动作 ,完成穿衣、洗漱、进餐、写字等日常功能。结论　欲使肌电假手达到预期设定的目标 ,其训练有 2个关键 :一是寻找残肢肌肉的最强肌电信号 ;二是不断强化生物反馈过程 ,使视觉和肌电假手的动作协调自如     

留置导尿管夹管后无尿意患者的护理干预

目的 预防拔出尿管后的尿潴留。方法 将34例患者，按住院手术顺序分为2组单数设为对照组，双数设为观察组．各17例。观察组患者在无尿意的情况下夹住尿管，待膀胱充盈并感到腹胀后打开尿管夹，用力合膀胱治疗仪进行膀胱投影区和骶尾区不同强度和密度的低频电脉冲刺激，40min／次，2～4次／d，放尿过程中嘱患者最好不断地做排尿动作，以助开放尿道括约肌，在有2～3次尿意感且膀胱充盈后，消毒尿道口抽出尿管球囊内液体，拔出尿管，并再做1次膀胱仪治疗。对照组采用定时排放尿液法训练膀胱功能。2组拔出尿管后根据排尿情况进行护理干预。结果 观察组拔出尿管后排尿情况优于对照组（X^2值=11．2，P值=0．004），首次排尿时间短于对照组（X^2值=12．6，P值=0．002）。结论 留置尿管夹管后无尿意的患者在拔管前应用力合膀胱治疗仪的低频电脉冲刺激进行护理干预后，可有效预防拔管后尿潴留。     

自制护臂夹板在唇腭裂修复术后的应用

目的改进传统唇腭裂修复术后需手扶助的护理缺陷。方法护臂夹板在临床应用于唇腭裂修复术后患儿150例,进而推广应用于120例患儿静脉输液及患儿外科术后护理,对护理效果进行观察。结果护臂夹板的应用减少了伤口碰伤及感染的机会,减少了静脉重注次数。结论护臂夹板的应用是对唇腭裂修复术后等需手扶助护理的改进,它的应用提高了护士工作效率及患者满意度。     

手内在肌训练对手外伤术后患儿手部精细动作恢复的影响

目的：每组探讨手内在肌训练对手外伤术后患儿手部精细动作恢复的影响。方法将64例手外伤术后患儿随机分为试验组与对照组,每组各32例。两组患儿伤后均在6～8 h内完成清创、骨折内固定术和肌腱吻合术,其中试验组进行手内在肌功能训练及传统康复护理治疗,对照组采.用传统康复护理治疗。分别于治疗第2、3个月后采.用尼苏达手灵巧度评定方法（minnesota manual dexterity test,MMDT）和普渡手精细运动评定方法（purdue pegboard test,PPT）进行测评。结果治疗后2个月与3个月后,试验组与对照组同时期的MMDT和PPT结果比较,均P＜0.01,差异具有统计学意义。结论儿童手外伤术后进行手内在肌训练,可促进手部精细动作的恢复。     

Application of a volar static splint in poststroke spasticity of the upper limb

OBJECTIVE: To evaluate clinical and neurophysiologic effects of 3-month reflex inhibitory splinting (RIS) for poststroke upper-limb spasticity. DESIGN: Pretest-posttest trial. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Forty consecutive patients with hemiplegia and upper-limb spasticity after stroke that had occurred at least 4 months before. INTERVENTION: Patients wore an immobilizing hand splint custom-fitted in the functional position for at least 90 minutes daily for 3 months. MAIN OUTCOMES MEASURES: Patients underwent measurement of (1) spasticity at the elbow and wrist according to Modified Ashworth Scale; (2) passive range of motion (PROM) at the wrist and elbow; (3) pain at the shoulder, elbow, and wrist using a visual analog scale; (4) spasms; and (5) comfort and time of splint application. The instrumental measure of spasticity was the ratio between the maximum amplitude of the H-reflex and the maximum amplitude of the M response (Hmax/Mmax ratio). RESULTS: A significant improvement of wrist PROM (F=8.92, P=.001) with greater changes in extension than in flexion, and a reduction of elbow spasticity (F=5.39, P=.002), wrist pain (F=2.89, P=.04), and spasms (F=4.33, P=.008) were observed. The flexor carpi radialis Hmax/Mmax ratio decreased significantly (F=4.2, P=.007). RIS was well tolerated. CONCLUSIONS: RIS may be used as an integrative treatment of poststroke upper-limb spasticity. It can be used comfortably at home, in selected patients without functional hand movements, and in cases of poor response or tolerance to antispastic drugs.     

Bobath技术对缓解偏瘫上肢屈肌痉挛即刻效应的作用

目的:观察健康人采用Bobath压手时手部的压力及其压力/体重的百分比、性别、利手的关系;同时观察压力大小与缓解偏瘫患者上肢痉挛即刻效应之间的关系。方法:健康人组共27例,分成男、女两个组;偏瘫组患者共14例,分别测量Bobath压手时的手部压力、压力/体重百分比和体重。评估采用机械性健康秤测量体重和手部压力,用改良的Ashworth量表(Modified Ashworth Scale,MAS),对偏瘫患者上肢肱二头肌牵伸前后的张力进行评估,分析即刻效应。结果:健康男性组利手的压力大于非利手,差异具有显著性意义(P<0.05)。健康男、女两组之间的手部压力、压力/体重的差异亦具有显著性(P<0.05)。偏瘫组中缓解痉挛有效与无效组之间的手部压力,虽有差异但无显著性意义(P>0.05);而在偏瘫组中,解痉有效组中的中青年男性患者手部压力、压力/体重比值均大于解痉无效组,且差异具有显著性意义(P<0.05)。结论:Bobath压手时的手部压力、压力/体重百分比直接影响偏瘫患者的解痉效果。其中年龄、性别、利手因素可能影响Bobath压手的效果。     

应用磁共振扩散张量成像技术评价手-臂双侧强化训练对痉挛型偏瘫患儿上肢功能的临床效果

目的:研究手-臂双侧强化训练(HABIT)治疗痉挛型偏瘫患儿后大脑功能代偿情况以及上肢功能的改善情况。方法:将痉挛型偏瘫患儿随机分为研究组和对照组,每组各10例,2组均给予常规作业康复治疗,研究组在常规作业康复治疗的基础上采用HABIT治疗。在治疗前后对所有偏瘫患儿采用磁共振扩散张量成像技术评估各向异性系数(FA),进行上肢功能试验(UEFT)、Peabody运动发育量表-2(PDMS-2)量表评估。结果:治疗21d后,2组患儿的FA值、UEFT评分、PDMS-2抓握及视觉运动评分均较治疗前明显提高(均P<0.05),治疗后研究组上述评分均较对照组明显提高(均P<0.05)。结论:手-臂双侧强化训练可以明显改善痉挛型偏瘫患儿的上肢功能。     

循证护理干预应用于乳腺癌上臂港对患者康复及生活质量的影响分析*[1]

Objective:To analyze the effect of evidence-based nursing intervention on the rehabilitation and quality of life in breast cancer patients with arm ports. Methods: Methods 224 cases of breast cancer patients with upper arm in our hospital from January 2020 to January -2021 were randomly divided into control group (112 cases), using routine nursing and observation group (112 cases) with evidence-based nursing intervention. The quality of life and nursing satisfaction were compared. Results: After evidence-based nursing intervention, the two comparative indexes in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion: Evidence-based nursing focuses on comprehensive risk assessment and targeted postoperative care, effectively carry out nursing intervention, improve nursing programs, and improve patients" life quality and satisfaction.     

艾盐包热熨手三阳经对脑卒中偏瘫患者上肢运动功能的影响

目的 观察艾盐包热熨手三阳经对脑卒中偏瘫患者上肢运动功能、上肢关节活动度和偏瘫手功能分级的影响。方法选取2021年3—9月收住福建中医药大学附属康复医院神经康复科的脑卒中后偏瘫患者86例,随机分为试验组和对照组,每组各43例。对照组进行常规内科治疗、护理与康复训练,试验组在对照组的基础上进行艾盐包手三阳经热熨,1次/d,30 min/次,5次/周,连续干预4周。于干预前、干预2周后及干预4周后评估患者上肢运动功能、上肢关节活动度、偏瘫手功能分级。结果 最终81例完成试验,试验组40例,对照组41例。结果显示,干预2周后试验组的上肢运动功能与对照组比较,差异无统计学意义（P>0.05）;干预4周后试验组的上肢运动功能优于对照组（P<0.05）。上肢关节活动度方面,干预2周后试验组肩前屈、肩后伸、肩外展、肩内旋和肘屈的活动度均优于对照组（P<0.05）,干预4周后试验组肩前屈、肩后伸、肩外展、肩内旋、肩外旋、肘屈、腕掌屈和腕背伸的关节活动度均优于对照组（P<0.05）;干预2周、干预4周后,2组偏瘫手功能分级比较,差异无统计学意义（P>0.05）。结论艾盐包热...     

简易上肢屈肌痉挛抑制器结合肌电生物反馈治疗对脑卒中后手功能康复的影响

目的探讨简易上肢屈肌痉挛抑制器结合肌电生物反馈治疗对脑卒中后手功能康复的影响。方法将60例脑卒中偏瘫患者随机分成治疗组30例和对照组30例,两组均常规进行康复训练和肌电生物反馈治疗,治疗组在进行肌电生物反馈治疗时佩戴上肢屈肌痉挛抑制器。对每例患者患侧手功能在入组时和疗程2个月后分别进行Fugl—Meyer手功能（FMA）和改良Ashworth痉挛量表评定。结果两组治疗前后比较和治疗后组间比较均有显著性差（P〈0．01）;两组的变化均数比较,治疗组2个月后简式Fugl—Meyer手功能评分和改良Ashworth痉挛评定积分均优于对照组（P〈0．01）。结论肌电生物反馈结合上肢屈肌痉挛抑制器治疗有助于改善脑卒中后偏瘫患者上肢手功能。     

Kinematic upper extremity performance in people with near or fully recovered sensorimotor function after stroke

Background: Clinical scales for upper extremity motor function may not capture improvement among higher functioning people with stroke. Objective: To describe upper extremity kinematics in people with stroke who score within the upper 10% of the Fugl-Meyer Assessment (FMA-UE) and explore the ceiling effects of the FMA-UE. Design: A cross-sectional study design was used. Participants: People with stroke were included from the Stroke Arm Longitudinal Study at University of Gothenburg together with 30 healthy controls. The first analysis included participants who achieved FMA-UE score > 60 within the first year of stroke (assessed at 3 days, 2 weeks, 4 weeks, 3 months, or 12 months post stroke). The second analysis included participants with submaximal FMA-UE (60–65 points, n = 24) or maximal FMA-UE score (66 points, n = 21) at 3 months post stroke. Measurements: The kinematic analysis of a standardized drinking task included movement time, velocity and strategy, joint angles of the elbow, and shoulder and trunk displacement. Results: The high FMA-UE stroke group showed deficits in seven of eight kinematic variables. The submaximal FMA-UE stroke group was slower, had lower tangential and angular peak velocity, and used more trunk displacement than the controls. In addition, the maximal FMA-UE stroke group showed larger trunk displacement and arm abduction during drinking and lower peak angular velocity of the elbow. Conclusions: Participants with near or fully recovered sensorimotor function after stroke still show deficits in movement kinematics; however, the FMA-UE may not be able to detect these impairments.     

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

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

Implications for Rehabilitation

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

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

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

     

Health-related quality of life in adults with congenital unilateral upper limb deficiency in Norway. A cross-sectional study

Purpose: To examine subjective health-related quality of life (HRQoL) in adults with congenital unilateral upper limb deficiency (UULD) in Norway and to explore the associations between demographic and clinical factors and HRQoL.

Method: Cross-sectional study comparing HRQoL, measured by SF-36, among adults with UULD and an age- and gender-matched control group from the Norwegian general population (NGP).

Results: Seventy-seven respondents, median age 42 years (range: 20–82); 71% were women. Most had left-sided (61%), below elbow (53%), transverse (73%) deficiency. Compared to the NGP, the UULD group reported reduced HRQoL on all SF-36 subscales except for the role emotional (RE) scale (p=0.321), mental health (MH) (p=0.055) and mental component summary (MCS) (p=0.064). The greatest difference was on the bodily pain (BP) scale (point difference of 20.0). Multiple linear regression models showed significant association between several physical- and mental SF-36 subscales and occupational status, occurrence of comorbidity and chronic pain.

Conclusions: Persons with UULD reported reduced HRQoL on most SF-36 subscales, mostly in the physical health domain. Employment status, occurrence of comorbidity and chronic pain seem to have a negative impact on the HRQoL. Measures that can reduce pain and loss of function should be given particular attention in UULD rehabilitation.

• Implications for Rehabilitation

• Persons with congenital unilateral upper limb deficiency (UULD) who experience pain and discomfort should seek professional help for evaluating their everyday coping strategies.

• Professionals who meet persons with UULD should examine anomalies, comorbidity, pain and employment status before choosing advices and actions.

• Individually adapted grip-improving devices, environments, physical exercise and pain management programs should be implemented early to reduce pain, loss of function and decreased HRQoL.

• A multidisciplinary approach is often necessary when counseling persons with UULD.

     

Assessing arm and hand function after stroke: a validity test of the hierarchical scoring system used in the motor assessment scale for stroke

OBJECTIVE: To evaluate the validity of the scoring hierarchy for the 3 upper-limb items on the Motor Assessment Scale (MAS). DESIGN: Application of Rasch analysis to 3 independent measurement scales, each representing the upper-arm function, hand movements, and advanced hand activities items of the MAS. SETTING: Inpatient and outpatient occupational therapy (OT) programs in a department of rehabilitation of an urban hospital center. PARTICIPANTS: One hundred patients (67 men, 33 women; average age, 54.3+/-14.4 y; average time since stroke onset, 104 d) attending OT for stroke rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The MAS for stroke (upper-arm function, hand movements, and advanced hand activities sections). RESULTS: Rasch analysis provided support for the validity of hierarchical scoring criteria for the upper-arm scale. This analysis, however, identified inconsistencies in the hierarchical scoring criteria for the hand function and advanced hand activities scales and, when considering measurement error, only small differences in difficulty level between several behavioral criteria. CONCLUSIONS: The findings lead to suggestions for changes in the behavioral criteria hierarchy for upper-limb items on the MAS and highlight the importance of using statistical analyses to test the validity of proposed hierarchies of behavioral criteria in functional assessments.     

中文版上肢技巧质量量表在脑性瘫痪患儿上肢功能评定中的信度和效度

目的:评估中文版上肢技巧质量量表(quality of upper extremity skills test,QUEST)在痉挛型脑瘫患儿上肢功能评定中的信度和效度。方法:将英文版QUEST翻译并完善成中文版,研究对象为75例在我院就诊的痉挛型脑瘫儿童,检测其重测信度及评定者间信度。同时进行Peabody运动发育量表的精细运动部分(peabody developmental motor scale fine motor,PDMS-FM),精细运动能力(fine motor function measure scale,FMFM),分析PDMS-FM原始分、FMFM各区分数与中文版QUEST各分测试项原始分之间的相关性,评估量表的平行效度。结果:中文版QUEST分测试项得分及总分具有优良的重测信度及评估者间信度(ICC值均0.890),中文版QUEST分测试项原始分与PDMS-FM、FMFM各区原始分间具有较好的平行效度(Pearson/Spearson秩相关系数分别为r1=0.563—0.816、r2=0.389—0.830)。结论:中文版QUEST量表具有良好的信度和效度,可以作为评估痉挛型脑瘫患儿上肢运动功能的首选方法。