An evaluation of the hemiplegic subject based on the Bobath approach. Part II: The evaluation protocol

A protocol of evaluation of the hemiplegic patient based on the Bobath approach to treatment is presented. Six parameters are evaluated: sensorium, muscle tone, reflex activity, active movement, postural reactions and pain. The first and last of these are included because of their possible effects on the motor recovery process of the hemiplegic patient. The other four are directly borrowed from the Bobath modality of treatment. For each of these parameters, the procedures are given for its evaluation along with its respective rating scales. These scales are of an ordinal nature ranging from 0 to 3. It is suggested that this new evaluation protocol is fully compatible with the therapeutic modality developed by Bobath and as well is adequate to quantify patient progress in the principle aspects treated by this well used rehabilitation approach.     

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.     

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 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.     

Nursing care of the stroke patient using Bobath principles. An approach to altered movement

Rehabilitation nursing care of the stroke patient is a challenge. When the nurse understands and practices rehabilitative nursing care based on neurophysiologic and neurodevelopmental principles of normal movement, the care of the stroke patient is most rewarding. The nurse becomes an equal member of the rehabilitation team because there is a sharing of knowledge of how well each patient is achieving goals outlined for and with him or her by the team. Potentially, rehabilitation goals can be achieved early; however, there is a tremendous need for research in all areas of rehabilitation nursing to build on a scientific foundation of rehabilitation nursing research.     

The office approach to the sexually transmitted diseases: Part I

Sexually transmitted diseases (STDs) are diagnosed in 10 million patients per year in the United States. The infected individuals come from all walks of life and all age groups. They may present with either genital or nongenital signs and symptoms. Most individuals are treated as outpatients, but more than a quarter of a million hospital admissions for STDs are necessary each year. These numbers will rise precipitously as the number of AIDS cases increases. More than 10,000 deaths per year are caused by STDs, primarily because of AIDS, cervical carcinoma, and hepatitis B induced cirrhosis and hepatoma. Physicians must become highly skilled in the diagnosis and treatment of the common STDs caused by herpes simplex virus, Neisseria gonorrhoeae, and Chlamydia trachomatis. Simple office microscopic skills are needed for the diagnosis of vaginitis, cervicitis, and urethritis, and all physicians should be encouraged to develop these skills. Physicians will need to keep abreast of the rapidly evolving changes in the diagnosis and treatment of STDs.     

An Internet primer. Part I

The Internet provides electronic communications and access to information around the globe. In only one decade of public use this format has emerged as the method of rapid access to information, and projections are for continued growth. The WWW consists of over 40,000,000 servers containing billions of pages of information on virtually every conceivable subject. This doesn't include news servers, FTP servers, bulletin boards, and other online information sources. The home healthcare nurse, now and in the future, needs knowledge about and access to this system, to tap into the most current government recommendations about medications and treatment protocols, to access health statistics, consumer information, and additional educational, professional, and client-centered articles and opportunities. We hope this new Home Healthcare Nurse feature, "Staying Connected," will develop into a source of ongoing, up-to-date information to assist you in accessing and utilizing this valuable resource. Next month, we'll provide some specific directions for navigating the information superhighway.     

Transient ischemic attacks: Part I. Diagnosis and evaluation

Transient ischemic attack is no longer considered a benign event but, rather, a critical harbinger of impending stroke. Failure to quickly recognize and evaluate this warning sign could mean missing an opportunity to prevent permanent disability or death. The 90-day risk of stroke after a transient ischemic attack has been estimated to be approximately 10 percent, with one half of strokes occurring within the first two days of the attack. The 90-day stroke risk is even higher when a transient ischemic attack results from internal carotid artery stenosis. Most patients reporting symptoms of transient ischemic attack should be sent to an emergency department. Patients who arrive at the emergency department within 180 minutes of symptom onset should undergo an expedited history and physical examination, as well as selected laboratory tests, to determine if they are candidates for thrombolytic therapy. Initial testing should include complete blood count with platelet count, prothrombin time, International Normalized Ratio, partial thromboplastin time, and electrolyte and glucose levels. Computed tomographic scanning of the head should be performed immediately to ensure that there is no evidence of brain hemorrhage or mass. A transient ischemic attack can be misdiagnosed as migraine, seizure, peripheral neuropathy, or anxiety.     

An evaluation of population pharmacokinetics in therapeutic trials. Part I. Comparison of methodologies

NONMEM, a computer program that uses the method of extended least-squares analysis, has been advocated as a means of obtaining estimates of population pharmacokinetic parameters when only fragmentary information can be obtained from subjects. To assess the performance of this program, we compared NONMEM with traditional methods for the estimation of population pharmacokinetic parameters with data collected during a phase III clinical trial of alprazolam. NONMEM estimates of the population mean clearance and its coefficient of variation were identical to the estimates obtained with traditional pharmacokinetic techniques. Moreover, NONMEM estimates of these parameters remained stable even when a few as three data points were available per subject. NONMEM estimates of the mean volume of distribution and its coefficient of variation appear to be overestimated, apparently because of the sampling scheme used to generate data for the NONMEM analysis. Suggestions for the effective use of NONMEM in clinical trials, to maximize the benefits of this approach, are provided. Our results lend further support for the use of NONMEM to estimate population pharmacokinetic parameters of a drug from data generated during phase III clinical trials.     

Hand and wrist injuries: Part I. Nonemergent evaluation

Diagnosis of upper extremity injuries depends on knowledge of basic anatomy and biomechanics of the hand and wrist. The wrist is composed of two rows of carpal bones. Flexor and extensor tendons cross the wrist to allow function of the hand and digits. The ulnar, median, and radial nerves provide innervation of the hand and wrist. A systematic primary and secondary examination of the hand and wrist includes assessment of active and passive range of motion of the wrist and digits, and dynamic stability testing. The most commonly fractured bone of the wrist is the scaphoid, and the most common ligamentous instability involves the scaphoid and lunate.     

Program evaluation. Part 2: A responsive model proposal

While program evaluation is necessary for understanding and improving educational programs in nursing, it is frequently surrounded by a climate of unease and perplexity. The first article (September/October 1990) in this two-part series reviewed models of program evaluation. This second article examines the state-of-the-art of program evaluation in nursing education and proposes implementation of a responsive model of evaluation in schools of nursing. The series aims to foster more dynamic, efficient program analysis, thereby enhancing the effectiveness of nursing education programs.     

平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响

目的：探讨平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响。方法：将符合试验条件的住院卒中患者分层随机分为试验组（20例）和对照组（20例）,两组对象在试验开始前Berg平衡得分（BBS）、“起立-走”计时试验（Up＆Go）比较差异无显著性意义。试验组的平衡训练使用平衡仪视觉反馈法,对照组平衡训练使用Bobath平衡训练法,测试指标采用BBS和Up＆Go,在试验开始前和训练6周后各评定1次。结果：训练6周后试验组的BBS、Up＆Go均优于对照组比较差异具有显著性意义。结论：使用平衡仪训练对改善脑卒中患者的平衡和行走功能比单纯的Bobath平衡训练法更有效。     

Ethnomethodology. I: An approach to nursing research.

This is the first of two papers outlining and demonstrating an ethnomethodological perspective upon nursing research. The aim of this paper is to introduce the reader to some of the basic ideas of ethnomethodology, and to stimulate nursing researchers into questioning some of the presuppositions involved in their work. To this end ethnomethodology is explored through a series of contrasts between the conventional approach to the sociology of nursing and an ethnomethodological approach. To conclude, some of the areas of interest for ethnomethodological nursing research are outlined.     

Methodological aspects of the evaluation of postoperative cancer surveillance. Part I: Validity

This contribution deals with problems of determining the validity and efficacy of diagnostic procedures used in postoperative cancer surveillance. While there is a large number of follow-up studies attempting to estimate sensitivity, specificity, or the predictive values of follow-up tests, the methodological aspects of validation are rarely addressed adequately in these publications, and the estimations of validity are often not well-founded. In the first part of this paper we analyze aspects of validity and validation studies. In particular, the following problems are addressed: a) Validity depends on the context; in particular, it depends on the characteristics of the population, the embedding of the test in a diagnostic strategy, the uncertainty of the test itself, the gold standard, and the criterion for positive test results. b) Global, time-independent measures of validity are hardly adequate. In particular, any attempt to incorporate a positive lead-time in the definition of the sensitivity is incompatible with an exhaustive classification matrix and with a meaningful definition of predictive values. c) Published estimations of sensitivity mostly suffer from numerous biases. First, there is work-up bias, which arises if positive and negative test-results are verified in a different way (in fact, this implies the use of two different gold standards). Next, test-review bias may occur unless the determination of the test result and the gold standard are mutually blinded. Finally, in quantitative tests, like tumor markers, there is a risk of resubstitution bias if the sample used for defining the cutoff level is identical to the validation sample. Several practical recommendations are given for designing validation studies. In the second part, problems of the efficacy of follow-up programs in regard to patient survival are discussed. Five necessary conditions must be satisfied in order to make such an effect possible. Taking these aspects into account, it can be shown that the usual arguments advanced in favor of diagnostic monitoring are not stringent. As for the design of studies on the efficacy of cancer surveillance, non-randomized studies are inconclusive given that they suffer from a variety of specific biases. It can be shown that the demand, often found in recent publications, that comparative studies of more versus less intensive monitoring be designed so as to permit the detection of a survival advantage in the subgroup of patients who relapse, is unjustified. In the final sections, an overview over published randomized studies and meta-analyses on the efficacy of postoperative monitoring of breast and colorectal cancer is given.