Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity

OBJECTIVE: To evaluate the reliability of the Ashworth Scale and the Disability Assessment Scale (DAS) in poststroke patients with upper-limb spasticity and functional disability. DESIGN: Single-center trial. SETTING: University medical center. PARTICIPANTS: Nine patients > or = 6 months poststroke with upper-limb spasticity and impairment in the areas of hygiene, dressing, limb posture, or pain were included in the analysis. INTERVENTIONS: Ten experienced medical professionals rated each patient in randomized order twice on the same day (results based on mean of evaluations at times 1 and 2). Elbow, wrist, finger, and thumb flexion tones were assessed by using the Ashworth score (range, 0-4), and functional disability was assessed using the DAS (range, 0-3). MAIN OUTCOME MEASURES: Intra- and interrater reliability of the Ashworth Scale and DAS. RESULTS: For the Ashworth parameters, 38 of 40 evaluations indicated excellent (weighted kappa > or = .75) or good (weighted kappa > or = .4) intrarater reliability. For DAS parameters, 31 of 40 evaluations indicated excellent or good intrarater reliability. The interrater reliability was also good for both the Ashworth Scale (Kendall W=.598-.792) and DAS (Kendall W=.494-.772) with statistically significant agreement found among raters (all P<.001). CONCLUSIONS: In patients with upper-limb spasticity after stroke, the Ashworth Scale and DAS had good intra- and interrater reliability when used by trained medical professions.     

The painful os intermetatarseum

The os intermetatarseum is an uncommon accessory bone of the foot, usually found between the bases of the first and second metatarsal bones. Two cases of a painful os intermetatarseum in athletes are reported. Surgical excision of the os intermetatarseum relieved the pain in both patients. Case reports concerning athletes with a painful os intermetatarseum are rare. An os intermetatarseum should be taken under consideration when evaluating dorsal midfoot pain.     

Feasibility study of the engineering problems in a multi-electrode visual cortex stimulation system

This paper reports the results of a feasibility study of the engineering problems in a multi-electrode visual cortex stimulation system. By using radio links and pulse-code-modulation for data transfer, as well as serial/parallel stimulation techniques, results show that a high density electrode system for visual cortex stimulation research is feasible. To demonstrate the system design concept and to face the practical engineering problems in detail, a bench model was designed, built and tested. The model contains 64 simulated electrodes with only 4 radio links (8 wires) for interfacing the external control and the internal stimulating system. Stimulating parameters such as amplitude, polarity, pulse width, pulse train and pulse frame are externally controllable. MOS FET complementary circuits and other micropower circuit design techniques were employed. The nonconventional circuits and their design procedures are described in this paper to provide information for those interested in duplicating, modifying, or extending the system for their research. The techniques described need not be limited to application in an implantable system. They may be useful also for skin stimulation or other complex multiple-channel measurement systems.     

Planning for rural community health nursing needs: the experience of Ecuador

One of the most prevalent and enduring health care delivery problems in the Third World and less developed countries is the lack of skilled medical personnel. This is particularly true in Ecuador where there are serious deficiencies at the community health level. This paper describes the health problems which have resulted from this situation. A planning model is then presented which Ecuador is beginning to follow for improving its rural community health nursing capabilities. Other countries or developing regions with similar problems might consider the model and its implementation in resolving their own community health problems.     

Imaging diagnostics of the pharynx and larynx

The pharynx and larynx represent very sophisticated regions and may be involved in a diverse range of pathologic conditions. Evaluation of the head and neck has developed significantly with the establishment of CT and MRI as they provide true insights into the endoscopically blind areas as well as depth of tumor infiltration, its submucosal growth and contralateral involvement, cartilage invasion, bone marrow invasion, and nonpalpable adenopathy. Inflammations in the head and neck region are only exceptionally imaged with CT or MRI; indications are the diagnosis of retrotonsillar and parapharyngeal abscesses and ensuing complications. The different imaging modalities of malignant pharyngeal and laryngeal tumors and their differential diagnosis are presented in this paper.     

Developing nursing guidelines for the PTCA patient.

Developing guidelines for the care of complicated patients is not an easy task. This article describes how a group of critical care nurses produced guidelines for the nursing care of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Guidelines are important in guiding nursing actions without the legal restrictions implicit in using standards.     

Effects of selected opioid agonists and antagonists on DMT-and LSD-25-induced disruption of food-rewarded bar pressing behavior in the rat

Several opioid agonists and antagonists interact with N,N-dimethyltryptamine (DMT) and lysergic acid diethylamide-25 (LSD) in adult male Holtzman rats trained on a positive reinforcement, fixed ratio 4 (FR₄) behavioral schedule, i.e., a reward of 0.01 ml sugar-sweetened milk was earned on every fourth bar press. DMT (3.2 and 10.0 mg/kg) and LSD (0.1 mg/kg) given IP with 0.9% NaCl pretreatment, disrupted food-rewarded FR4 bar pressing. Animals were pretreated IP (10–15 min) with predetermined, behaviorally noneffective doses of morphine, methadone, naltrexone, and the (+)-and (-)-enantiomers of naloxone prior to receiving DMT or LSD. Dose-dependent effects were shown with opioid agonist pretreatment. Morphine (0.32–1.0 mg/kg) and methadone (0.32 mg/kg) significantly antagonized the bar pressing disruption induced by DMT and LSD. Larger doses of morphine (3.2 mg/kg) and methadone (1.0–3.2 mg/kg) potentiated only LSD-induced effects, with no effect on DMT-treated groups. The opioid antagonists (-)-naloxone and naltrexone potentiated the disruption of bar pressing induced by DMT and LSD. Failure of (+)-naloxone to potentiate the DMT effects was attributed to a stereospecific opioid antagonist effect of (-)-naloxone.