American Congress Of Rehabilitation Medicine Research Articles

17.3 Procedural versus declarative learning in gaitrehabiltation after stroke: A pilot study

Albert T, Yelnik A, Colle F, Bonan I, Lassau JP. Anatomic motor point localization for partial quadriceps block in spasticity. Arch Phys Med Rehabil 2000;81:285-7. Objective: To identify the location of the vastus intermedius nerve and its motor point (point M) and to precisely identify its coordinates in relation to anatomic surface landmarks. Design: Descriptive study. Setting: Anatomy institute of a university school of medicine. Participants: Twenty-nine adult cadaver limbs immobilized in anatomic position. Intervention: Anatomic dissection to identify point M. Anatomic surface landmarks were point F, the issuing point of femoral nerve under the inguinal ligament; point R, the middle of superior edge of the patella; segment FR, which corresponds to thigh length; point M′, point M orthogonal projection on segment FR. Mean Outcome Measure: Absolute vertical coordinate, distance FM, relative vertical coordinate compared to the thigh length, FM′/FR ratio; absolute horizontal coordinate, distance MM′. Results: The absolute vertical coordinate was 11.7 ± 2cm. The relative vertical coordinate was at.29 ±.04 of thigh length. The horizontal coordinate was at 2 ±.5cm lateral to the FR line. Conclusion: Point M can be defined with relative precision by two coordinates. Application and clinical interest of nerve blocking using these coordinates in quadriceps spasticity should be studied. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Evidence-Based Practice and the Limits of Rational Rehabilitation

Cicerone KD. Evidence-based practice and the limits of rational rehabilitation. Arch Phys Med Rehabil 2005; 86:1073–4. Both the American Congress of Rehabilitation Medicine and the field of physical medicine and rehabilitation have entered an age of evidence-based rehabilitation. Despite some concerns over the difficulties in applying the methods of evidence-based practice to rehabilitation research, there is little question that we will continue to move in this direction. This will also require the translation of scientific evidence into clinical practice. Rather than representing opposing approaches to practice, the integration of the best available scientific evidence with clinical experience and judgment represent 2 of the pillars of evidence-based practice. However, we also need to recognize the subjective nature of clinical decision making as a fundamental aspect of human judgments. Finally, we need to acknowledge the subjective meanings of illness and disability to the patients we serve. Any efforts to build our practice based on the best available systematic evidence are unlikely to succeed unless we include patients’ values and beliefs and incorporate this perspective into our rehabilitation research. This aspect of evidence-based rehabilitation raises important questions about our fundamental roles and how we will choose to practice and define our field in the future.

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Engelbert RH, Gulmans VA, Uiterwaal CS, Helders PJ. Osteogenesis imperfecta in childhood: perceived competence in relation to impairment and disability. Arch Phys Med Rehabil 2001;82:943-8. Objectives: To examine the perceived competence of children with different types of osteogenesis imperfecta (OI) and to investigate the possible relationships between their perceived competence and impairment parameters. Design: Cross-sectional study. Setting: National referral center (hospital) for the treatment of children with OI. Patients: Forty children with OI (type I = 17; type III = 11; type IV = 12) with a mean age ± standard deviation of 12.6 ± 3.2 years. Interventions: Measured joint range of motion (ROM) in the upper extremities (UEs), and lower extremities (LEs), muscle strength, functional skills, ambulation, and perceived competence. Main Outcome Measures: Joint ROM in UE and LE; muscle strength (using the manual muscle testing criteria of the Medical Research Council); functional skills using the Pediatric Evaluation of Disability Inventory in 3 domains (self-care, mobility, social function). Ambulation (according to Bleck and classified as nonwalking, therapy walking, household walking, neighborhood walking, community walking with or without the use of crutches), and perceived competence (using the Harter Self-Perception Profile for Children, which was cross-culturally validated for Dutch children). Results: In children with type I, joint ROM and muscle strength were almost comparable to the healthy population. In children with type III, a severe decrease in joint ROM was measured, especially in the LEs, and muscle strength was severely decreased in the UEs and LEs. In children with type IV, joint ROM and muscle strength decreased, especially in the LEs. In all types, fairly to strongly positive perceived competence was measured except for fairly negative perceived competence in the athletic performance subscale in type I and a fairly negative perceived competence in the romance subscale in type III. No correlations were found between (1) joint ROM and athletic performance and physical appearance, (2) muscle strength and athletic performance or physical appearance, or (3) the functional skills, concerning self-care and mobility, with the subscales of the perceived competence. Conclusions: Although joint ROM, muscle strength, and functional and walking ability were related to the severity of the disease and differed significantly between the different types of OI, overall perceived competence in children with OI was fairly to strongly positive, without significant differences between the different types of OI. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The American congress of rehabilitation medicine: where do we go from here?

Grabois M. The American Congress of Rehabilitation Medicine: where do we go from here? Arch Phys Med Rehabil 2003;84:1097–9. This presidential address reflects on my last 2 years as president of American Congress of Rehabilitation Medicine (ACRM). It recognizes those individuals who have been of significant help and support. The address discusses choices I have made in my professional life including selecting physical medicine and rehabilitation as a subspecialty; committing to an academic career; and choosing to get involved in local, state, national, and international physical medicine and rehabilitation societies. I review my presidential speech of 2001 when I spoke about the path we choose—to succeed or not to succeed. ACRM has come a long way in trying to succeed but continued opportunities remain in obtaining financial security, increased membership, and cost-effective and efficient management. This address includes 11 suggestions designed not only to keep the organization viable but also to allow ACRM to succeed. These suggestions include a new commitment to our strategic plan and the implementation of prioritized goals, reorganization of ACRM’s national office, and adherence to a realistic budget. Finally, we must continue to move the agenda of research in rehabilitation forward much more aggressively.

Issues in the development of an item bank

Bode RK, Lai J-S, Cella D, Heinemann AW. Issues in the development of an item bank. Arch Phys Med Rehabil 2003;84 Suppl 2:S52-60. Objective: To describe and illustrate 2 issues involved in the development of an item bank that can be used to improve measurement across settings and over time. Design: Secondary (psychometric) analysis of data collected on existing quality of life (QOL) instruments. Setting: Five cancer clinics in hospital settings in various parts of the United States; 523 solo or group practices in 3 major US cities; and an inpatient rehabilitation hospital in a large metropolitan area. Participants: Illustration 1: 399 persons being treated for or having a history of cancer, 170 persons being treated for human immunodeficiency virus (HIV), 328 persons with stroke assessed during and after acute rehabilitation, and 433 persons being treated for multiple sclerosis. Illustration 2: 1714 persons with cancer and/or HIV participating in a large-scale multisite study, 3429 persons with prevalent treatable chronic health conditions, and 125 persons with stage IV metastatic breast cancer. Interventions: Not applicable. Main Outcomes Measures: QOL as measured by 10 different instruments. Results: The illustrations show that (1) core items, which functioned similarly across 4 diagnostic groups, can be identified and used to construct instruments measuring physical function that are tailored to each of these groups, and (2) items from 3 separate datasets can be linked to create a dataset that can serve as an initial pain item bank. Conclusion: The methodology exists to develop item banks to develop better measures of QOL. [copy ] 2003 by the American Congress of Rehabilitation Medicine

Seat-interface pressure: A pilot study of the relationship to gender, body mass index, and seating position

Stinson MD, Porter-Armstrong A, Eakin P. Seat-interface pressure: a pilot study of the relationship to gender, body mass index, and seating position. Arch Phys Med Rehabil 2003;84:405-9. Objectives: To investigate the relationship between interface pressure and gender, body mass index (BMI), and seating positions, and to evaluate the implications for clinical practice. Design: Group design. Setting: Pressure mapping laboratory. Participants: Sixty-three student volunteers (44 women, 19 men; mean age, 22.2[plusmn]5.1y). Interventions: Seated-interface pressure was measured using the Force Sensing Array pressure mapping system. Seating positions used included recline (10[deg ], 20[deg ], 30[deg ]), foot support, and foot elevation. Main Outcome Measures: Interface pressure in the form of both average pressure (mean of the pressure sensor values) and maximum pressure (highest individual sensor value). Results: Both average and maximum pressures were independent of gender, while average pressure had a significant positive correlation with BMI ( r=.381, [alpha ]=.01 level). Recline of the chair by 30[deg ] significantly reduced average pressure ( P[lt ].001), whereas recline by 10[deg ] or 20[deg ] had no significant effect. Recline by 10[deg ], 20[deg ], and 30[deg ] did not significantly alter maximum pressure. Elevation of the feet on a footstool reduced average pressure to a level approaching statistical significance, while supporting participants' feet versus leaving them unsupported significantly increased average pressure at a 0[deg ], 10[deg ], 20[deg ], and 30[deg ] recline ( P[lt ].01) and maximum pressure at 0[deg ], 10[deg ] ( P[lt ].01), and 30[deg ] ( P[lt ].05). Conclusions: Elevating clients' feet and reclining their chair by 30[deg ] reduced interface pressure and the associated risk of pressure ulcer development. Additional research is required, however, to replicate this study with participants at increased risk of pressure ulcer development. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: Implications for treatment matching

Turner AP, Bombardier CH, Rimmele CT. A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching. Arch Phys Med Rehabil 2003;84:358-64. Objective: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. Design: Cross-sectional cohort survey. Setting: Acute inpatient rehabilitation program in a level I trauma center. Participants: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews. Interventions: Not applicable. Main Outcome Measures: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions. Results: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. Conclusion: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Upper-extremity deep vein thrombosis and paralysis: A case report

Shah MK, Black-Schaffer RM. Upper-extremity deep vein thrombosis and paralysis: a case report. Arch Phys Med Rehabil 2003;84:458-9. Upper-extremity deep venous thrombosis (DVT) has been understudied in the rehabilitation population. Patients undergoing rehabilitation often have many risk factors that predispose them to DVT. It is important to recognize upper-extremity DVT, because recent studies have shown it to pose a significant risk for pulmonary embolus and death. This is the first reported association of an upper-extremity DVT with paralysis. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection

Hurvitz EA, Conti GE, Brown SH. Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection. Arch Phys Med Rehabil 2003;84:444-54. Objective: To examine the longitudinal effects of botulinum toxin injection on movement characteristics of the spastic upper extremity in children by using motor control testing (MCT) techniques and standard clinical measures. Design: Open-label clinical trial. Setting: Motor control laboratory at an academic medical center. Participants: A convenience sample of 9 subjects (5 boys, 4 girls; age range, 7[ndash ]16y) with cerebral injury (stroke or cerebral palsy) and asymmetric upper-extremity function because of spasticity. Eight subjects had right-sided involvement. Interventions: Botulinum toxin injection to the involved upper extremity, involving elbow, wrist, and finger flexors, depending on clinical presentation. Main Outcome Measures: Clinical measures included range of motion (ROM), the Ashworth Scale, FIM[trade ] instrument, Pediatric Evaluation of Disability Inventory, portions of the Bruininks-Oseretsky Test of Motor Proficiency, and the Purdue pegboard. MCT consisted of visually guided reaching, bilateral finger-to-nose movements, hand tapping, and isometric pinch force tasks. Kinematic assessments were made before and at 2, 4, 6, 12, 18, and 24 weeks after botulinum toxin injection. Results: All subjects had increased ROM and decreased Ashworth values throughout the testing period. In motor control tasks, improvement typically occurred earlier in the least complex movements, such as hand tapping, with 6 of 9 subjects showing a maximum, although transient, unilateral tapping speed by 6 weeks. A similar time course was observed for pinch force tasks. Improvement in more complex, forward-reaching tasks occurred much later (week 12 or later) or did not occur at all. As with the hand tasks, improved reach performance declined toward the end of the testing period. All subject showed minimal or no improvement in bilateral finger-to-nose movements. Neither maximum changes in ROM or Ashworth values correlated with improvements in functional elbow extension during sit and reach tasks, with 3 subjects with normal active ROM showing late onset or no change in reach. Conclusions: Although botulinum toxin reduced tone and increased ROM of the spastic upper extremity, the time course and degree of motor improvement appears to depend on the complexity of the task. Future research should focus on the value of adjunct therapy, such as task-specific training, in addition to botulinum toxin treatments to facilitate functional improvement of the spastic upper extremity. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

An assessment of gait and balance deficits after traumatic brain injury

Basford JR, Chou L-S, Kaufman KR, Brey RH, Walker A, Malec JF, Moessner AM, Brown AW. An assessment of gait and balance deficits after traumatic brain injury. Arch Phys Med Rehabil 2003;84:343-9. Objective: To assess the sensations of instability that many patients report after traumatic brain injury (TBI). Design: A controlled study. Setting: A motion analysis and vestibular and balance laboratory. Participants: Twenty subjects, 10 with TBI and complaints of instability, and 10 without TBI. Interventions: Balance and gait analysis. Main Outcome Measures: Dizziness Handicap Inventory (DHI), caloric irrigation, optokinetic testing, Dix-Hallpike Test, posturography, and center of mass (COM) movement. Results: Subjects were well matched in terms of age, height, weight, and gender. DHI scores of those with and without TBI differed significantly (32.2[plusmn]23.0 vs 0.2[plusmn]0.63, P[lt ].001). Caloric and optokinetic circularvection testing were abnormal only in subjects with TBI (8/10 and 4/10, respectively). Benign paroxysmal positioning vertigo was present in only 3 subjects with TBI, and this either resolved spontaneously (n=1) or was successfully treated (n=2). Composite posturography scores of those with and without TBI differed significantly (69.6[plusmn]35.8 vs 79.5[plusmn]40.5, P=.02). Gait parameters also differed significantly between the groups ( P=.05), with the subjects with TBI having lower anterior and posterior and higher medial and lateral COM displacements and velocities. Conclusions: Patients' complaints of instability after TBI may have objective correlates and may be rectifiable. Balance and gait testing in these patients is warranted. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

A computer adaptive testing simulation applied to the FIM instrument motor component

Dijkers MP. A computer adaptive testing simulation applied to the FIM instrument motor component. Arch Phys Med Rehabil 2003;84:384-93. Objective: To determine whether computer adaptive testing (CAT) can be used to decrease the number of FIM[trade ] instrument motor component items administered in assessing persons with spinal cord injury (SCI). Design: For a CAT simulation, a 3-step algorithm was used to select 6 FIM items for each individual; items were selected according to the subject's motor ability as estimated by 2 initial items. Separate estimates of motor ability for admission, discharge, and follow-up data (plus combined time points) derived from 6 items were compared statistically with estimates derived from 14 items (walking and wheelchair mobility were split). Setting: Records from the Spinal Cord Injury Model Systems (SCIMS). Participants: Patients served by the SCIMS, for whom complete motor FIM information was available for rehabilitation admission (N=5969), discharge (N=5964), or follow-up at a first or later anniversary (N=5176). Interventions: Not applicable. Main Outcome Measures: Similarity of mean, standard deviation, skewness, kurtosis, and Rasch reliability and separation of persons and items based on 6 and 13 items; intraclass correlation coefficient (ICC) for parallel estimates. Results: Calibrations for FIM items and FIM steps differed for the 3 time points, but showed sufficient agreement (ICC, [gt ].90) that combined calibration was feasible. Means and other distribution characteristics differed minimally between the 6- and 13-item estimates. The person and item separations and reliabilities were somewhat lower and the mean measurement errors somewhat higher for the 6-item estimates, but only marginally so. ICCs between 6- and 13-item estimates were .95 or higher. Conclusion: CAT can be used to reduce data collection time; the level of precision of estimates is minimally less than that provided by traditional assessment approaches. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Disability motivates patients with ankylosing spondylitis for more frequent physical exercise

falkenbach A. Disability motivates patients with ankylosing spondylitis for more frequent physical exercise. Arch Phys Med Rehabil 2003;84:382-3. Objective: To evaluate whether patients with ankylosing spondylitis who perform disease-specific exercises more frequently have fewer functional limitations and disability than those who exercise more often. Design: Cross-sectional; retrospective chart review. Setting: Rehabilitation center in Austria. Participants: A sample of 1500 patients with ankylosing spondylitis (1163 men, 337 women; mean age [plusmn] standard deviation, 50[plusmn]12y; disease duration, 21[plusmn]11y) grouped by how many times per week they performed disease-specific exercises for at least 5 minutes: group A (n=542), less than 1 time; group B (n=691), 1 to 3 times; and group C (n=267), more than 3 times. Interventions: Not applicable. Main Outcome Measures: Self-report of exercise frequency and a German version of the Health Assessment Questionnaire for the spondyloarthropathies (HAQ-S). Results: The HAQ-S showed significant differences among the groups (analysis of variance on ranks, P[lt ].001). In pairwise multiple comparison, group A showed significantly less disability (median, 0.5; interquartile range [IQR], 0.2[ndash ]0.8) than group B (median, 0.6; IQR, 0.3[ndash ]0.9) or group C (median, 0.7; IQR, 0.3[ndash ]1.0). Conclusion: Patients with less disability exercised less than their more disabled counterparts. The reasons for this difference, particularly the issue of motivation, deserve more attention. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Young traffic victims' long-term health-related quality of life: Child self-reports and parental reports

Sturms LM, van der Sluis CK, Groothoff JW, ten Duis HJ, Eisma WH. Young traffic victims' long-term health-related quality of life: child self-reports and parental reports. Arch Phys Med Rehabil 2003;84:431-6. Objectives: To describe the long-term health-related quality of life (HRQOL) reported by young traffic injury victims and to assess the child-parent agreement on the child's HRQOL. Design: Cohort study with a mean follow-up of 2.4 years. Setting: Traumatology department in a university hospital in The Netherlands. Participants: All traffic injury victims treated at the traumatology department in 1996[ndash ]1997 and aged 8 to 15 years at follow-up (N = 254). The data of 157 child-parent pairs were available for analysis (mean follow-up age, 12[plusmn]2.4y; 57% boys; 24% hospitalized). Interventions: Not applicable. Main Outcome Measure: TNO-AZL Children's Quality of Life parent and child questionnaires. Results: Young traffic injury victims reported a significantly lower HRQOL in the motor and autonomy scales compared with contemporaries in the reference group. The child-parent agreement ranged from low to moderate (intraclass correlations, .35[ndash ].67). A comparison made between the children and their parents found that the children were more negative regarding the physical complaints and the motor, autonomy, and positive-emotion scales. Conclusions: Young traffic injury victims reported a reasonably good long-term HRQOL, and, surprisingly, few psychologic problems were revealed. Physicians who rely only on parental reports may overestimate the child's HRQOL, especially when assessing the physical functioning. The child's own reports should not be neglected in the assessment of a comprehensive picture of the child's HRQOL. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Overnight use of continuous low-level heatwrap therapy for relief of low back pain

Nadler SF, Steiner DJ, Petty SR, Erasala GN, Hengehold DA, Weingand KW. Overnight use of continuous low-level heatwrap therapy for relief of low back pain. Arch Phys Med Rehabil 2003;84:335-42. Objective: To evaluate of the efficacy and safety of 8 hours of continuous, low-level heatwrap therapy administered during sleep. Design: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. Setting: Two community-based research facilities. Participants: Seventy-six patients, aged 18 to 55 years, with acute, nonspecific low back pain. Interventions: Subjects were stratified by baseline pain intensity and gender and randomized to one of the following treatments: evaluation of efficacy (heatwrap, n=33; oral placebo, n=34) or blinding (unheated wrap, n=5; oral ibuprofen, n=4). All treatments were administered for 3 consecutive nights with 2 days of follow-up. Main Outcome Measures: Primary: morning pain relief (hour 0) on days 2 through 4 (0[ndash ]5-point verbal response scale). Secondary: mean daytime pain relief score (days 2[ndash ]4, hours 0[ndash ]8), mean extended pain relief score (day 4, hour 0; day 5, hour 0), muscle stiffness, lateral trunk flexibility, and disability (Roland-Morris Disability Questionnaire). Results: Heatwrap therapy was significantly better than placebo at hour 0 on days 2 through 4 for mean pain relief ( P=.00005); at hours 0 through 8 on days 2 through 4 for pain relief ( P[lt ].001); at hour 0 on day 4 and at hour 0 on day 5 for mean pain relief ( P[lt ].001); on day 4 in reduction of morning muscle stiffness ( P[lt ].001); for increased lateral trunk flexibility on day 4 ( P[lt ].002); and for decreased low back disability on day 4 ( P=.005). Adverse events were mild and infrequent. Conclusions: Overnight use of heatwrap therapy provided effective pain relief throughout the next day, reduced muscle stiffness and disability, and improved trunk flexibility. Positive effects were sustained more than 48 hours after treatments were completed. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Characteristics of effective and efficient rehabilitation programs

Johnston MV, Wood KD, Fiedler R. Characteristics of effective and efficient rehabilitation programs. Arch Phys Med Rehabil 2003;84:410-8. Objective: To investigate the characteristics of rehabilitation hospitals and units correlated with gains in motor and cognitive function, after adjusting for case severity of the patients admitted and for length of stay (LOS). Design: The Uniform Data System for Medical Rehabilitation (UDS MR) database was first analyzed to develop a method of adjusting for patient case severity on admission. Rehabilitation programs were surveyed to assess characteristics commonly thought to be associated with efficiency and effectiveness. Data on these characteristics were linked to UDS MR data on patient characteristics and functional gain. Setting: Seventy-seven rehabilitation hospitals across the United States. Participants: A total of 37,692 inpatients from the participating rehabilitation hospitals. Intervention: Comprehensive rehabilitation programs not altered by researcher. Main Outcome Measures: Program effectiveness was estimated by gains in motor and cognitive subscale scores of the FIM[trade ] instrument between admission and discharge, adjusted for indicators of caseload severity at admission. Efficiency was estimated by adjusting gains for LOS as well. Results: Primary factors affecting both motor and cognitive gains included admission function (treated curvilinearly), age, certain diagnostic distinctions, onset-admission interval, admission class, and LOS. Correlations between staffing intensity and numerous other program characteristics with functional gain were meager, each accounting for less than 2% of variance. LOS was predicted by a number of factors, notably by the percentage of managed care cases ( r=[minus ].20), but not by staffing intensity. Conclusions: Relationships between rehabilitation practices and functional gains by patients do not appear to be simple or overt. Continued research is needed to identify reliable connections between rehabilitative processes and patient outcomes in practice. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Analyses of gait, reaching, and grasping in children after traumatic brain injury

Kuhtz-Buschbeck JP, Stolze H, G[ouml ]lge M, Ritz A. Analyses of gait, reaching, and grasping in children after traumatic brain injury. Arch Phys Med Rehabil 2003;84:424-30. Objective: To evaluate motor behavior in children after traumatic brain injury (TBI) with quantitative instrumented measures of gait and of functional hand movements (reaching, grasping) and with clinical assessments. Design: Case-control study. Setting: Tertiary pediatric trauma rehabilitation center in Germany. Participants: Twenty children (age range, 6[ndash ]13y) with moderate or severe TBI were examined 1[plusmn]1.2 years (mean [plusmn] standard deviation) postinjury. Fifteen were reexamined 2 months later. Control data were obtained from 20 healthy children and matched for age, gender, and school grade. Interventions: Not applicable Main Outcome Measures: Quantitative measures included 10 spatiotemporal gait parameters and 6 variables describing reaching and grasping. Qualitative scores of gait and upper-limb movements were also obtained. Results: Gait velocity and step and stride lengths were significantly smaller in children after TBI than in control subjects (Mann-Whitney U test, P[lt ].05). Reach-to-grasp movements of the TBI children were characterized by a significantly longer reaction time (Mann-Whitney U test, P[lt ].05) and movement duration, reduced velocity, and coordination deficits. The instrumented measures did not change significantly in 2 months. Several significant correlations between clinical and instrumented measures were obtained. Conclusion: Functional motor behavior is affected in children after moderate or severe TBI. To supplement clinical assessments with objective data, impairments of gait, reaching, and grasping movements can be recorded with instrumented measures. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

A single-blind investigation into the hypoalgesic effects of different swing patterns of interferential currents on cold-induced pain in healthy volunteers

Johnson MI, Tabasam G. A single-blind investigation into the hypoalgesic effects of different swing patterns of interferential currents on cold-induced pain in healthy volunteers. Arch Phys Med Rehabil 2003;84:350-7. Objective: To compare the analgesic effects of differing swing patterns of interferential current (IFC) on cold-induced pain. Design: Single-blind intervention study in which subjects completed 6 cycles of the cold-induced pain test[mdash ]2 pretreatment, 2 during treatment, and 2 posttreatment. Setting: Laboratory. Participants: Forty healthy volunteers. Interventions: Subjects were randomly allocated to receive 1 of 4 IFC treatment interventions: 1[int ]1, 6[int ]6, 6[and ]6, or burst. IFC was administered for 20 minutes via 4 electrodes attached to the forearm (quadripolar application) at a strong but comfortable intensity using amplitude-modulated frequencies of 1 to 100Hz. Main Outcome Measures: Change in pain threshold and self-report of pain intensity and unpleasantness from pretreatment baseline. Results: Two-way repeated-measure analysis of variance found significant effects for time and group by time interaction ( P[lt ].01), but effects for groups failed to reach statistical significance ( P=0.1). This suggests that when all groups are considered together, subjects experience a rise in pain threshold when IFC devices are switched on but not when they are switched off. However, the rise in pain threshold was not dependent on the swing pattern employed. Analysis of pain intensity and unpleasantness ratings found no effects for group or group by time interaction. Conclusions: There were no differences in the hypoalgesic effects of different swing patterns. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Effect of fatigue on torque output and electromyographic measures of trunk muscles during isometric axial rotation

Ng JK-F, Parnianpour M, Richardson CA, Kippers V. Effect of fatigue on torque output and electromyographic measures of trunk muscles during isometric axial rotation. Arch Phys Med Rehabil 2003;84:374-81. Objectives: To examine the changes in torque output resulting from fatigue, as well as changes in electromyographic measures of trunk muscles during isometric axial rotation and to compare these changes between directions of axial rotation. Design: Subjects performed fatiguing right and left isometric axial rotation of the trunk at 80% of maximum voluntary contraction while standing upright. Setting: A rehabilitation center. Participants: Twenty-three men with no history of back pain. Interventions: Not applicable. Main Outcome Measures: Surface electromyographic signals were recorded from 6 trunk muscles bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were also measured. Results: During the fatiguing axial rotation contraction, coupling torques of both sagittal and coronal planes were slightly decreased and no difference was found between directions of axial rotation. Decreasing median frequency and an increase in electromyographic amplitude were also found in trunk muscles with different degrees of changes in individual muscles. There were significant differences ( P[lt ].05) between right and left axial rotation exertions in median frequency slope of external oblique, internal oblique, latissimus dorsi, and iliocostalis lumborum muscles, but no such difference was found in median frequency slope of rectus abdominis and multifidus muscles. This could be attributed to different functional roles among the muscles. Similar differences ( P[lt ].05) between right and left axial rotation in median frequency slope were also detected in the electromyographic amplitude slope of the trunk muscles. Coefficient of variation of the torque output and electromyographic activation in most of the trunk muscles increased during the fatigue process. Conclusion: The changing coupling torque, different fatigue rate, and activation changes of trunk muscles, as well as the increase in variability during fatiguing axial rotation exertion, could affect the internal loading and stability of the spine; this needs to be further quantified in future studies. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Continuous low-level heatwrap therapy for treating acute nonspecific low back pain

Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Abeln SB, Weingand KW. Continuous low-level heatwrap therapy for treating acute nonspecific low back pain. Arch Phys Med Rehabil 2003;84:329-34. Objective: To evaluate the efficacy of 8 hours of continuous low-level heatwrap therapy for the treatment of acute nonspecific low back pain (LBP). Design: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. Setting: Five community-based research facilities. Participants: Two-hundred nineteen subjects, aged 18 to 55 years, with acute nonspecific LBP. Intervention: Subjects were stratified by baseline pain intensity and gender and randomized to one of the following groups: evaluation of efficacy (heatwrap, n=95; oral placebo, n=96) and blinding (oral ibuprofen, n=12; unheated back, wrap n=16). All treatments were administered for 3 consecutive days with 2 days of follow-up. Main Outcome Measures: Primary: day 1 mean pain relief (0- to 5-point verbal response scale). Secondary: muscle stiffness (101-point numeric rating scale), lateral trunk flexibility (fingertip-floor distance), and Roland-Morris Disability Questionnaire over 3 days of treatment and 2 days of follow-up. Results: Heatwrap therapy was shown to provide significant therapeutic benefits when compared with placebo during both the treatment and follow-up period. On day 1, the heatwrap group had greater pain relief (1.76[plusmn].10 vs 1.05[plusmn].11, P [lt ].001), less muscle stiffness (43.1[plusmn]1.21 vs 47.6[plusmn]1.21, P=.008), and increased flexibility (18.6[plusmn].44cm vs 16.5[plusmn].45cm, P=.001) compared with placebo. Disability was also reduced in the heatwrap group (5.3 vs 7.4, P=.0002). Adverse events were mild and infrequent. Conclusion: Continuous low-level heatwrap therapy was shown to be effective for the treatment of acute, nonspecific LBP. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Repetitive stretch induces c- fos and myogenin mRNA within several hours in skeletal muscle removed from rats

Ikeda S, Yoshida A, Matayoshi S, Tanaka N. Repetitive stretch induces c- fos and myogenin mRNA within several hours in skeletal muscle removed from rats. Arch Phys Med Rehabil 2003;84:419-23. Objective: To investigate what effect repetitive stretch has on gene transcription in muscle tissues removed from rats. Design: Case-control study. Setting: University laboratory. Animals: Eight female 8-week-old Wistar rats. Interventions: Rat anterior tibial and soleus muscles were removed and repetitively stretched about 20% of the muscle length by using the Magnus method in Krebs-Ringer solution. Stretch-relax cycles 15 times per minute were continued for 2 hours in 1 group and 4 hours in another group. Contralateral muscles removed from the same rat were incubated without stretch as the control. Main Outcome Measures: After repetitive stretch, total ribonucleic acid (RNA) was extracted from the muscles and Northern blotting was carried out using c- fos and myogenin oligonucleotide as probes. Results: Repetitive stretch during 2 hours significantly increased the expression of c- fos messenger RNA (mRNA) in both the tibialis anterior and soleus muscles. Increased expression of myogenin mRNA in both muscles was observed with repetitive stretch for 4 hours. Because of the initial increase of immediate early gene c- fos mRNA and the subsequent increase of myogenic transcription factor myogenin mRNA, it appears that repetitive muscle stretch induces sequential progression of gene transcription toward muscle hypertrophy. Conclusions: Mechanical repetitive stretch for a few hours would be one of the stimulating factors for muscle growth and should be available for muscle training in clinical rehabilitation. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation