Activities Of Daily Living Test Research Articles

Cardiac, ventilatory, and metabolic adjustments in chronic obstructive pulmonary disease patients during the performance of Glittre activities of daily living test.

Functional status and quality of life are measures of the chronic obstructive pulmonary disease (COPD) patient's health status and can demonstrate the impact of the disease on the patient's ability to perform activities of daily living (ADLs). The Glittre-ADL test was developed to evaluate the functional status of COPD patients and their ability to perform activities of daily life. The objective of this study was to evaluate the cardiac, respiratory, and metabolic adjustments and reproducibility of the Glittre ADL test performed by COPD patients. Twenty-two mild to severe COPD patients (forced expiratory volume in 1 second (FEV1): 56.6 ± 19.9% predicted; mean age: 66.3 ± 9.18 years old) were enrolled in this study. Metabolic (oxygen uptake (VO2), carbon dioxide production (VCO2), pulmonary ventilation (VE)/VCO2, and VE/VO2), ventilatory (tidal volume, respiratory rate, and VE), and cardiovascular (pulse oxygen saturation, VO2/heart rate (HR), and HR) variables, lower limbs fatigue, and dyspnea (Borg score) after each lap of two Glittre ADL test were analyzed. All metabolic, ventilatory, and cardiac variables increased their values up to the third lap and remained stable (plateau) until the end of the test (five laps; multivariate analysis); there was no difference among the time spent to complete each of the five laps in each test and between tests (total time of second test: 4 minutes and 3 seconds); the second test was 17.8 seconds (6.6%) shorter than the first one (NS). All variables were highly reproducible in the two tests (NS). At the end of the test, patients reached 87.7% of the VO2 max, 81% of VE peak, and 88.5% of the HR peak obtained from an incremental maximal test on a treadmill. The Glittre ADL test is easy for COPD patients to perform and is a highly reproducible test in COPD patients with mild to severe stages of the disease. In addition, our results suggest that it is possible to demonstrate the patient's functional capacity with a single test of only three laps, making it faster and easier to apply and less stressful for some patients.

Nintendo Wii rehabilitation (“Wii-hab”) provides benefits in Parkinson's disease

Parkinson's disease (PD) impairs both activities of daily living (ADLs) and motor function and has adverse effects on mood in many patients. While dopaminergic medications are quite helpful for motor and ADLs impairments in PD, complementary therapies are also important in helping patients achieve maximum benefits and quality of life. We hypothesized that the Nintendo Wii (Wii) is a useful tool in improving motor and non-motor aspects in patients with PD, given its ability to drive functional movements and interactive nature. We enrolled twenty subjects with early to mid-stage PD in an open-label within-subjects study design where each subject was evaluated at baseline and then re-evaluated after playing the Wii three times per week for four weeks. Subjects were then re-evaluated one month later after not playing the Wii for a month to see if effects carried over. Subjects demonstrated significant improvements in the primary outcome measure (Nottingham Extended Activities of Daily Living Test (NEADL)), quality of life (PDQ-39) and motor function (UPDRS), and a trend toward improved mood (HAM-D) after four weeks of Wii therapy. Follow-up assessments one month later showed continued improvement for quality of life and UPDRS scores. The results demonstrate that Wii therapy provides short-term motor, non-motor, and quality of life benefits in PD. Further studies are needed to determine if there are long-term benefits of Wii therapy in PD.

Apolipoprotein E ε4 is superior to apolipoprotein E ε2 in predicting cognitive scores over 30 months

BackgroundThe purpose of this study was to compare apolipoprotein E ε4 (Apo E ε4) and apolipoprotein E ε2 (Apo E ε2) as predictors of cognitive and functional trajectories over 30 months.MethodsThis prospective cohort study included 287 community-dwelling memory clinic patients with dementia, mild cognitive impairment, or no cognitive impairment. The Addenbrooke Cognitive Examination, Mini-Mental State Examination, Montreal Cognitive Assessment, Delirium Index, and Nottingham Instrumental Activities of Daily Living tests were administered to each subject.ResultsOne hundred and nine subjects (40%) carried Apo E ε4 and 48 (16.7%) carried Apo E ε2. One hundred and nine ε4-positive subjects differed significantly from 178 ε4-negative subjects in 19/52 comparisons (36.5%), whereas 46 Apo E ε2-positive subjects had 0/52 significant differences from 239 ε2-negative subjects (P < 0.0001). The variables most affected by ε4 were the Delirium Index and Mini-Mental State Examination. Instrumental Activities of Daily Living score and residence were unrelated to Apo E ε4 or ε2.ConclusionApo E ε4 positivity predicted four cognitive scores measured every 6 months over 30 months. Apo E ε2 scores predicted none of 52 comparisons.

The impact of neuropsychological performance on everyday functioning between older and younger adults with and without HIV.

In this cross-sectional study, a community-based sample of 162 younger and older adults with and without HIV was compared on neuropsychological and everyday-functioning measures. In the HIV sample, the relationship between cognition, everyday functioning, and HIV biomarkers was also examined. A battery of cognitive tests was completed along with two laboratory measures of everyday functioning and one measure of HIV medication adherence. Main effects for age and HIV were found on several neuropsychological measures and on the Timed Instrumental Activities of Daily Living test; those who were older or who had HIV exhibited poorer performance. Although age-by-HIV interactions were not observed, older adults with HIV as a group performed worse on eight out of the nine neuropsychological and everyday functioning measures. Few of these neuropsychological and everyday measures were related to HIV biomarkers (e.g., CD4+ T cell count). Implications for nursing practice and research are posited.

How should we train the upper limbs?

The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease (COPD). Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and/or arm fatigue. Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation (PR), resulting in improvements in arm exercise capacity, arm function and muscle strength. However, there is limited evidence on what type of training should be performed. The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR. The study is a randomized controlled trial (RCT) that aimed to compare the effects of arm endurance training; arm strength training, a combination of arm endurance and strength training; and no arm training (control group) on endurance arm exercise capacity, functional arm exercise capacity and health-related quality of life (HRQL) in individuals with mild-tovery severe COPD. The authors found a significant improvement in arm endurance time (arm endurance capacity) between the endurance group and control group. There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group. In terms of symptoms, the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups. When the combined group was compared with the other two intervention groups, the improvement in HRQL (measured using the St George’s Respiratory Questionnaire) exceeded the minimum clinically important difference of 4 units, although it did not reach statistical significance. Until the beginning of the century, several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD. However, there were considerable variations in the exercise protocols rendering it impossible to determine the optimal training regimen for these patients. Moreover, the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic reviews. More recently, four RCTs examining the effects of arm exercise training in individuals with COPD have been published. Holland and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone. The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone. Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with standard PR. The authors demonstrated improvement in arm functional exercise capacity (measured using the 6-minute pegboard and ring test) and in performance during activities of daily living (ADL) measured by an ADL field test. In addition, the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group. Our

Cognitive and Everyday Functioning in Older and Younger Adults With and Without HIV

The purpose of this study was to: (1) examine cognitive performance differences in older and younger adults with and without HIV, and (2) determine if such differences were related to a laboratory measure of instrumental activities of daily living. Ninety-eight HIV-positive (69 younger, 29 older) and 103 HIV-negative (84 younger, 19 older) adults were evaluated on a number of cognitive measures. Controlling for a number of confounders, age by HIV status interactions were found on two cognitive measures, indicating poorer cognitive performance for those aging with HIV. Poorer performance on these cognitive measures corresponded with poorer performance on the Timed Instrumental Activities of Daily Living test. These findings suggest that as adults age with HIV, they may be at risk for cognitive declines that would impair their ability to engage in activities important for maintaining independent living.

Development of a Novel Questionnaire Evaluating Disability in Activities of Daily Living in the Upper Extremities of Patients Undergoing Maintenance Hemodialysis

The aim of the present study was to develop a novel questionnaire evaluating disability in the activities of daily living in the upper extremities of hemodialysis (HD) patients (QDUE-HD). We recruited 83 patients (40 males and 43 females) aged 66 ± 8 years, and measured their muscle strength and range of motion in the upper extremities. Moreover, 14 patients performed a six-week exercise training regimen (the exercise group) and were compared with 15 patients not performing such training (the control group). In an initial questionnaire consisting of 37 items, 30 were taken from the Disabilities of the Arm, Shoulder and Hand questionnaire and the Activities of Daily Living Test, and the remaining seven were selected from activities that HD patients perceived as impossible or extremely difficult to perform. The principal factor analysis focused on 11 items, as 26 showing floor and ceiling effects were excluded. These 11 items were divided into two categories consisting of six items termed "light work" and five termed "holding activities". The scores for light work and holding activities correlated significantly and positively with both muscle strength and range of motion in the upper extremities. These scores increased significantly after the six-week exercise training as compared with those before training in the exercise group. We conclude that the QDUE-HD is clinically useful for evaluating disability in activities of daily living in the upper extremities of HD patients because of its high reliability, validity and responsiveness.

Exercises Commonly Used in Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Cardiopulmonary Responses and Effect Over Time

van Helvoort HA, de Boer RC, van de Broek L, Dekhuijzen R, Heijdra YF. Exercises commonly used in rehabilitation of patients with chronic obstructive pulmonary disease: cardiopulmonary responses and effect over time. Objectives To compare conventional exercise-based assessment of pulmonary rehabilitation (PR) with improvement in training exercises employed during a PR program, and to describe the cardiopulmonary response of different training exercises during PR of patients with chronic obstructive pulmonary disease (COPD). Design Observational study. Setting Inpatient PR. Participants Patients with moderate to very severe COPD (N=18). Interventions Not applicable. Main Outcome Measures Cardiopulmonary responses to interval cycling, arm exercise, and a test of functional activities of daily living (ADLs) were evaluated during the PR training program using a mobile telemetric breath-by-breath system. The effects of PR were evaluated by comparing pre-PR and post-PR training activities, incremental and constant work-rate cycling, and a 6-minute walk test. Results Interval cycling and the ADLs test were moderate-intensity to heavy-intensity exercises (70%–80% of maximal oxygen consumption), while the arm exercise was a low-intensity activity (40% of maximal oxygen consumption). After 12 weeks of PR, cycle load, arm weights, and walking distances during training activities had increased alongside increased muscle mass. At iso-intensities, no cardiopulmonary changes in the training exercises were observed. Exercise duration of constant work-rate cycling and 6-minute walk distance increased by 160% and 14%, respectively, after PR, with concurrent right-shifts of anaerobic threshold and a decrease in heart rate. Conclusions Supervised increases in weight, load, and walking distance during training activities were useful clinical outcomes for patients, demonstrating the beneficial effects of progressive training on physical performance. However, for physiologic evaluation of PR, conventional tests, such as maximal incremental cycling, endurance cycling, and a 6-minute walk test, had greater validity. Physiologic evaluation of the training exercises showed that the training program complied with the training recommendations for PR.

Psychometric Properties of the PAT: An Assessment Tool for ADL Performance of Older People Living in Residential Homes

Background: As the world population ages, the number of people with diminished performance on the Activities of Daily Living (ADL) increases. A reliable and valid measure needs to be developed to determine the effects of interventions focused at increasing self-care abilities. We developed the Performance ADL Test (PAT) for this purpose. Objective: The aim of this study was to investigate the reliability and validity of the PAT in older people living in residential homes. Methods: The PAT contains 16 test items, covering the entire range of Basic ADL and Instrumental ADL performance in elderly people. For this assessment, 40 older people (mean age of 85 ± 7.5 years) participated. All 40 subjects lived in residential institutions in the Netherlands, were able to walk at least 10 m, could understand instructions spoken in Dutch, and had no cognitive impairment. During the first test session, subjects completed the PAT, the Groningen Activity Restriction Scale (GARS), and performance-based physical fitness tests. Two weeks later, subjects were retested on the PAT. Results: Factor analysis revealed three subscales: Organization of Performance, Gross Motor Function, and Fine Motor Function. Internal consistency (Cronbach’s α) of all scales and subscales ranged from 0.731 to 0.881. Test-retest reliability (intraclass correlation) ranged from 0.316 to 0.950. Paired sample t-tests revealed no significant differences between subject performance obtained during the two test periods. Pearson’s correlations between the PAT and the GARS ranged from 0.490 to 0.831, and between the PAT and the fitness tests from 0.317 to 0.781. Conclusion: Although the number of participants was limited (n = 40), the PAT seems to be a useful instrument for assessing ADL performance in older people living in residential homes. In general, internal consistency, test-retest reliability, and validity were satisfactory.

Three-year Follow-up of the Fall Risk and Physical Function Characteristics of the Elderly Participating in a Community Exercise Class

This study targeted the elderly participating in community exercise classes implemented by the local government, and followed their fall risk and physical function characteristics for three years. This study aimed to compare these changes between low and high fall risk individuals. The participants consisted of 34 male and 163 female Japanese elderly people aged 60 years or over who participated in a community exercise class once a week for three years. Physical fitness and activities of daily living (ADL) capability were evaluated by the physical fitness test of the Ministry of Education, Culture, Sports, Science and Technology in Japan. The fall risk was evaluated using a Fall Assessment Chart (Suzuki, 2000), and if the total score was >or=5, the subject was assessed as a high fall risk. Significant changes in the fall risk characteristics were examined by McNemar's test. Significant changes in physical function characteristics (Physical fitness and ADL tests) were examined by two-way (fall risk group and pre-post) ANOVA. The fall risk and number of falling incidents decreased only for the high risk group. In addition to the observed decrease in risk and incidents, it was found that the elderly who exercised were able to maintain their physical function (ADL capability level) with regard to muscular strength, walking, and maintaining and changing posture over the course of the three-year study. Effectiveness of the exercise class implemented by the local government for fall prevention was found for the high fall risk elderly. These findings indicate the possibility that health promotion activities based on exercise classes may be a prevention strategy for falls within the community-dwelling elderly by incorporating more diverse activities adapted to an individual's functional level.

An evaluation of two different exercise regimes during the first year following stroke: A randomised controlled trial

The purpose of this randomised controlled trial was to evaluate the effects of two different exercise approaches during the first 12 months post stroke on Instrumental Activities of Daily Living (IADL), motor function, gait performance, balance, grip strength, and muscle tone. This study is a double-blind longitudinal randomised trial of first-time-ever stroke patients. Seventy-five patients were included: 35 in an intervention group and 40 in a self-initiated exercise group. After discharge from acute rehabilitation, patients assigned in the intervention group had physiotherapy for a minimum amount of 80 hours during the first year. Patients in the self-initiated exercise group were not recommended any specific therapy besides treatment when needed. Main outcome measures were Instrumental Activities of Daily Living according to Fillenbaum, Motor Assessment Scale, 6-Minute Walk Test, Berg Balance Scale, Timed Up-and-Go Test, grip strength, Modified Ashworth Scale, and pulse monitoring. The patients were tested on admission, at discharge, and after 3, 6, and 12 months post stroke by an experienced investigator, blinded to group assignment. Twelve months post stroke showed higher levels of independence in all items of the Instrumental Activities of Daily Living Test and improvements in the results of Motor Assessment Scale, 6-Minute Walk Test, Berg Balance Scale, Timed Up-and-Go, and grip strength in both groups. Only a few significant differences were seen between groups, and they were in favour of the self-initiated exercise group (e.g., ability to use the telephone independently). Attending examination sessions following each intervention phase appeared to be strong motivators for training, irrespective of group allocation.

Psychomotor, cognitive and social interactions in elderly and old Italians. Preliminary report

It was the aim of this pilot study to investigate effects of motor activity on psychosocial and functional-physical conditions (using an assisted multidimensional questionnaire) of 53 (39 female, 14 male) free living elderly and old subjects in Florence, Italy. In addition, ADL (test of Activities of Daily Living) and Pfeiffer test (short portable mental status questionnaire) were applied to test autonomy of everyday life and presence of intellectual disturbance of organic origin. Motor activity appeared to influence significantly psychosocial and functional-physical conditions, i. e. motor activity was significantly correlated with subjective feeling of autonomy and independence, and with the variable to have hobbies, as well as with good posture and walking. From ADL and Pfeiffer tests resulted absence of respective pathologies.

Research Corner: Outcome Measures in Cardiopulmonary Physical Therapy: Focus on the Glittre ADL-Test for People with Chronic Obstructive Pulmonary Disease

The primary goal of physical rehabilitation for people with chronic lung disease, including chronic obstructive lung disease (COPD), is to improve function. In terms of the International Classification of Functioning, Disability and Health (ICF),1 physical therapy typically focuses on improving activity, which may result in increased participation in pursuits that are meaningful to the individual. A commonly used and related concept is functional status. Keith2 described functional status as “physical function including activity restrictions and fitness; psychological function including affective and cognitive functioning, social function including limitations in usual roles or major activity, social integration, social contact, and intimacy.” There are 2 primary methods of assessing functional status—questionnaires and performance-based tests. The most frequently used tools are questionnaires. Generic questionnaires such as the Functional Status Questionnaire,3 Extended Activities of Daily Living scale,4 and the SF-365 are available. However, disease specific questionnaires such as the Chronic Respiratory Questionnaire,6 the St. George's Respiratory Questionnaire,7 and the Pulmonary Functional Status and Dyspnea Questionnaire8 are commonly used for people with chronic lung disease. Questionnaires are generally inexpensive, quick to administer, and allow patients to express their perception of their function. However, there are a number of disadvantages associated with the use of questionnaires.9–12 Specifically, patients' responses may be affected by social and personal expectations of the purpose of the questionnaire. Also, responses may change depending on a patient's cognition or psychological status. In some circumstances, patients may state that they are capable of completing a task but do not consider the time required to complete the activity. Without additional information that is difficult to quantify, a patient may appear to function well when this is not the case. Another difficulty associated with the use of questionnaires is that disease progression in people with a chronic disease may result in activity limitation that could decrease the symptoms of interest. Such a change could erroneously be interpreted as an improvement in health status. For instance, people who experience dyspnea while climbing stairs may stop doing this activity and take the elevator instead. When questioned, this person may no longer report dyspnea when climbing stairs. The person may not be trying to hide the truth, but may have forgotten the discomfort once it no longer occurs. Objective, performance-based tests avoid many of the difficulties noted above. The six-minute walk test (6MWT) is the most frequently used objective test of functional capacity for people with respiratory disease.13 Patients are told to walk as far as possible, in 6 minutes, over a 100 foot, level, indoor course. The psychometric properties of the test have been examined in detail and the test has been shown to be a reliable measure of the distance walked in people with COPD when it is conducted according to standardized guidelines.13,14 The length of the hallway used for the walk,15 the instructions given to the subject,16 the type and amount of encouragement given,16 and the number of learning trials17 have all been shown to affect test performance and reliability. The test is simple to administer and generally well accepted by patients but it does not assess how walking ability affects functional status or participation, as it is defined in the ICF model. Furthermore, it does not assess how dyspnea during unsupported arm activities8,18,19 such as making beds, shelving dishes and doing the laundry affects functional status. As the prevalence of COPD in women increases20–23 the definition and assessment of function will likely need to expand to include more of these activities of daily living (ADL). Most objective tests of physical performance, like the 6MWT, focus on mobility dysfunction or on people having severe limitations.24–27 In contrast, the Assessment of Motor and Process Skills (AMPS) is a 26 item test that measures the quality of a person's activities of daily living (ADL).28 Unfortunately, the test is time consuming to conduct and it would be exhausting for many people with COPD. Furthermore, the assessment of process ability that is an integral part of this test is not usually relevant for people with COPD. The AMPS has not been validated in people with COPD in whom dyspnea plays a significant role in limiting function. Thus the Glittre ADL test was developed to address the need for a more representative, objective assessment of function in people with COPD.12

Relationship Between Executive Functioning and Activities of Daily Living in Patients With Relatively Mild Dementia

There is very little research regarding the relationship between tests of executive functioning and actual functional ability in patients with dementia. Thirty-three patients diagnosed with dementia and 35 age- and education-matched healthy controls were administered tests of executing functioning and an observation- and informant-based activities of daily living (ADL). As expected, the results revealed that the controls outperformed the dementia patients on the executive and ADL tests. Additionally, executive functioning correlated significantly with aspects of functional ability in patients with dementia. This relationship was strongest for tests of verbal fluency and a complex test of cognitive flexibility and reasoning ability (i.e., Wisconsin Card Sorting Test). These findings suggest that some executive function tests are more sensitive than others for predicting specific functional abilities and that they may be most useful to healthcare professionals for treatment planning.

Therapy of Activities of Daily Living in Patients with Apraxia

A test of three activities of daily living (ADL) was administered to 35 patients who had aphasia and right-sided hemiplegia after left hemisphere stroke. The number of errors correlated strongly with clinical measures of limb apraxia. Evaluation of the test distinguished between fatal errors, which prevented successful completion of the activity, and reparable errors. Fifteen patients who had made fatal errors on at least two of the three activities were admitted to a therapy study: each week they completed an ADL test. Between tests, one of the three activities was trained whereas maximal support but no therapeutic advice was given when the patients had to perform the other activities in their daily routines. In the following week anotheractivity was trained, and in the thirdweek the remaining activity. The cycle was repeated if there were still fatal errors after a first run. At the end of therapy, 10 of the patients could perform all three activities without fatal errors, and three made only one fatal error. Fatal errors were eliminated exclusively in the weeks when an activity was trained. The absence of any simultaneous improvement in non-trained activities indicates that there was no generalisation of training effects from trained to non-trained activities. We were able to re-examine seven patients more than six months later. The success of ADL training was preserved only in those patients who had practised the activities in their daily routines at home. The results are discussed in relation to a distinction between knowledge about prototypical use of familiar objects and the ability to infer directly function from structure. We believe that ADL training taught the patients “instructions of use” adapted to the constraints posed by hemiplegia but did not restore their ability to solve mechanical problems by inferring functions from structure.

めまい・平衡障害例の平衡訓練成績

Some patients with acute or chronic vestibular disorders continue to complain of dizziness and disequilibrium. Although treated with medication, their activities of daily living (ADL) and occupational activities are restricted. Equilibrium training is applied to reduce the disability of the patients.Methods: Before training is started, the degree of impairment, disability and handicaps of the patients were evaluated. To evaluate subjective and objective disabilities, the ADL were investigated by questionnaire and equilibrium function tests were performed.Three times a day at home, patients performed several somewhat difficult exercises selected from their defective movements. Training continued until their disabilities were reduced.The effects of training were assessed by ADL, equilibrium function tests, stabilometry and gait test.Subjects: The subjects were 8 patients with unilateral vestibular disorders, 4 with postoperative acoustic neurinoma, and 8 with bilateral vestibular disorders.Results: Equilibrium training was effective in all 8 patients with unilateral vestibular dysfunction, in all 4 patients with postoperative acoustic neurinoma, and in 7 of the 8 with bilateral vestibular dysfunction. It was difficult to evaluate the effect of the training in a case of bilateral Meniere's disease.Conclusion: We found many differences in disability among patients with similar impairments, and were able to plan an individual training program suitable for each patient. ADL and equilibrium function tests were useful for evaluating disability and the effect of training.We considered equilibrium training effective for patients with unilateral vestibular disorders who showed chronic disability persisting for more than several weeks after onset, for patients with postoperative acoustic neurinoma who had persistent disability 4 weeks after surgery and for patients with bilateral vestibular disorders with disability persisting for more than 8 weeks.

Upper Extremity Exercise Training in Chronic Obstructive Pulmonary Disease

Many patients with chronic obstructive pulmonary disease (COPD) report greater limitation for activities involving the upper extremities than the lower extremities. Exercise training has generally emphasized lower-extremity exercise. We designed and evaluated two simple, practical, and widely applicable upper-extremity training programs in 45 patients with COPD participating concurrently in a comprehensive, multidisciplinary pulmonary rehabilitation program. Patients were randomly assigned to one of the following three groups: (1) gravity-resistance (GR) upper-extremity training; (2) modified proprioceptive neuromuscular facilitation (PNF) upper-extremity training; or (3) no upper-extremity training (control). Patients were evaluated before and after at least six weeks of uninterrupted training. Twenty-eight patients completed the study. Compared to controls, both GR and PNF patients demonstrated improved performance on tests specific to the training performed (upper-extremity performance test, maximal level and endurance on isokinetic arm cycle). There were no significant changes on isotonic arm cycle, ventilatory muscle endurance, or simulated activities of daily-living tests. Ratings of perceived breathlessness and fatigue decreased significantly in all groups for several tests. We conclude that specific upper-extremity training may be beneficial in the rehabilitation of patients with COPD and warrants further investigation.

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Mental status of elderly hospital patients related to occupational therapist's assessment of activities of daily living.

The mental state of 100 female geriatric inpatients (whose physical handicaps did not interfere with the examinations) was related to tests of activities of daily living (ADL) given by the occupational therapist. Of the simple mental assessments used, the mental status questionnaire correlated best with the ADL test results, and could stand on its own as a good predictor of current ability in simple self-care.