Minimal Functional Disability Research Articles

Digital Cognitive Assessment Leveraging the Boston Process Approach Can Flag Emergent Cognitive Decline in Individuals with Subtle and Mild Functional Disability

AbstractBackgroundEarly detection of Mild Cognitive Impairment (MCI) and Alzheimer’s Disease and Related Dementias (ADRD) is key to optimal management. Digital tests allow for the reliable capture of meaningful, process‐based neuropsychological test parameters that traditional paper/pencil measures fail to detect, thus enabling earlier detection. We assessed how subtle functional decline relates to process features extracted from the digital Clock Drawing Test (dCDT) and the digital Trail Making Test‐Part B (dTrB).Methods629 community dwelling participants (58.5% female) were assessed with the Functional Assessment Questionnaire (FAQ), the MMSE, the digital clock drawing test (dCDT) and the digital Trail Making Test‐Part B (dTrB). Three FAQ groups were constructed: FAQ = 0‐2 (minimal functional disability, n = 490); FAQ = 3‐5 (subtle functional disability, n = 90); FAQ = 6‐8 (mild functional disability, n = 49).ResultsParticipants with minimal functional disability were younger (p = 0.027) and scored better on the MMSE (p = 0.001) than other groups. Groups were equated for education. dCDT command/copy component placement was more accurate among participants with minimal functional disability compared to other groups (command dCDT p = 0.001 versus mild functional disability; copy dCDT p = 0.006 versus both subtle and mild functional disability). On the dTrB, participants with minimal disability drew faster than those with subtle or mild disability (mean stroke velocity, p = 0.001). Analyses for percent pen lift time found no difference between participants with minimal versus subtle disability; however, both groups differed from participants with mild disability (p = 0.001). Optimal group classification using stepwise nominal regression with the minimal functional disability group as the reference was achieved using dCDT copy component placement and dTrB mean stroke velocity (X 2 = 28.37, p = 0.001), where dTrB mean velocity entered first (X 2 = 17.73, p = 0.001) followed by dCDT copy component placement (X 2 = 11.19, p = 0.004). Both variables contributed comparably to group classification (Wald statistic range 5.82‐8.88, p = 0.012, respectively).ConclusionsThe digital assessment described above, targeting executive, scanning, visuoconstructional and motor domains, captures highly nuanced, discrete behaviors with precision/ operationalism heretofore unattainable. Consequently, it is reasonable to posit that digital cognitive assessments leveraging the Boston Process Approach can both objectively detect emergent cognitive impairment and infer its likely impact on functional activities, critical for practical assessment in clinical care.

LOW BACK PAIN AMONG OCCUPATIONAL THERAPISTS AND ITS ASSOCIATED RISK FACTORS

Low back pain (LBP) is one of the most common work–related health problems, affecting health care professionals. In Malaysia, research data on the prevalence of low back pain, and its associated risk factors, among occupational therapists, is currently lacking. In view of this situation this study is aimed at identifying the prevalence, associated risk factors, and effects of LBP, among occupational therapists in Malaysia. This cross-sectional study involves a total of 287 occupational therapists. The instruments used in this study include demographic information, a Nordic Musculoskeletal Questionnaire, and an Oswestry Low Back Pain Disability Questionnaire. Data were collected online, and processed with the use of SPSS-21. This study revealed a high lifetime (79.4%), and one-year (71.1%) LBP prevalence among occupational therapists, in comparison to the point LBP prevalence (28.6%). The significant risk factors associated to LBP were identified as gender, exercise status, work stress level, and a poor working posture. Among those afflicted with LBP, 53.4% experienced a reduction in work activity, while 81.6% were affected by a minimal functional disability. A substantial proportion of occupational therapists in Malaysia, endure functional disability associated with LBP, which consequently has a negative effect on their leisure time and working life. As such, efforts should be directed at introducing multilevel interventions, for the prevention and control of LBP, in terms of this highly vulnerable occupational group.

Atividade física comunitária: efeitos sobre a funcionalidade na lombalgia crônica

Objective: To evaluate the pain intensity, lumbar strength and functionality of individuals presenting chronic non-specific low back pain and taking part in a public physical exercise program. Methods: Exploratory, cross-sectional and quantitative survey conducted in 2017 with 130 women from 30 to 60 years of age and without history of spinal surgery. The Oswestry Low Back Pain Disability Questionnaire (ODQ) was applied for assessment of the disability related to the lumbar spine. The pain was quantified through the visual analog scale (VAS) and the lumbar muscle strength through lumbar dynamometry (Takei®). Results: Of the 130 participants, 97.7% (n=127) presented minimal functional disability related to the lumbar spine (ODQ). In respect to strength, 16.9% (n=10) presented normal values and 83.1% (n=120) were below the reference values, presenting muscle weakness. As for the pain intensity, 47.7% (n=67) of the participants showed mild intensity, 45.5% (n=59) presented moderate intensity and 6.9% (n=9), severe. Conclusion: The program has characteristics that contribute to maintaining under control the pain intensity, which has been slight, as well as the significant functional disability of the individuals. The muscle weakness in the lumbar region, presented by the participants without association with functionality, and the pain as well, might be factors that perpetuate the chronic low back pain. The findings suggest the need to revise the therapeutic prescription of the exercises of the implemented program.

AB1164-HPR Correlation of Dynamic Postural Control and Hip Muscle Strength

BackgroundChondromalacia patellae is a common cause of anterior Knee pain, especially in young athletes or sedentary [1]. These individuals often have diminished muscle strength of the hip extensor, abductor, responsible...

Effective dysphonia detection using feature dimension reduction and kernel density estimation for patients with Parkinson's disease.

Detection of dysphonia is useful for monitoring the progression of phonatory impairment for patients with Parkinson’s disease (PD), and also helps assess the disease severity. This paper describes the statistical pattern analysis methods to study different vocal measurements of sustained phonations. The feature dimension reduction procedure was implemented by using the sequential forward selection (SFS) and kernel principal component analysis (KPCA) methods. Four selected vocal measures were projected by the KPCA onto the bivariate feature space, in which the class-conditional feature densities can be approximated with the nonparametric kernel density estimation technique. In the vocal pattern classification experiments, Fisher’s linear discriminant analysis (FLDA) was applied to perform the linear classification of voice records for healthy control subjects and PD patients, and the maximum a posteriori (MAP) decision rule and support vector machine (SVM) with radial basis function kernels were employed for the nonlinear classification tasks. Based on the KPCA-mapped feature densities, the MAP classifier successfully distinguished 91.8% voice records, with a sensitivity rate of 0.986, a specificity rate of 0.708, and an area value of 0.94 under the receiver operating characteristic (ROC) curve. The diagnostic performance provided by the MAP classifier was superior to those of the FLDA and SVM classifiers. In addition, the classification results indicated that gender is insensitive to dysphonia detection, and the sustained phonations of PD patients with minimal functional disability are more difficult to be correctly identified.

FRI0471-HPR Evaluation of muscle fatigue of lumbar multifidus and activation of transversus abdominis in subjects with lumbar disc herniation

BackgroundChronic low back pain (cLBP) is defined as back pain lasting more than 12 weeks in the lumbar and sacral levels of the spine. The intervertebral disc herniation into the...

FRI0576-HPR Static and dynamic postural control in individuals with chondromalacia patellae

BackgroundChondromalacia patellae is a common cause of anterior Knee pain, especially in young athletes or sedentary [1]. These individuals often have muscle weakness of the quadriceps and gluteus medius, responsible...

Musculoskeletal health of subjects with hemophilia A treated with tailored prophylaxis: Canadian Hemophilia Primary Prophylaxis (CHPS) Study

Full-dose prophylaxis is very effective at minimizing joint damage but is costly. Tailored prophylaxis has been proposed as a way of reducing costs while still protecting joints. To report detailed findings in index joints of 56 subjects with severe hemophilia A entered into the Canadian Hemophilia Prophylaxis Study, and treated with tailored prophylaxis, after 13 years. Boys with severe hemophilia A (< 2% factor) and normal joints were enrolled between the ages of 1 and 2.5 years. Initial treatment consisted of once-weekly factor infusions, with the frequency escalating in a stepwise fashion when breakthrough bleeding occurred. During the first 5 years, subjects were examined every 3 months using the modified Colorado Physical Evaluation (PE) scale; subsequently, every 6 months. The Childhood Health Assessment Questionnaire (CHAQ) was administered at each visit. Median age at study entry was 19 months (range 12-30 months); median follow-up was 92 months (range 2-156). The median PE score was 2, 3 and 3 at ages 3, 6 and 10 years. Persistent findings were related to swelling, muscle atrophy and loss of range of motion. The median score for each of these items (for the six index joints) was 0 at ages 3, 6 and 10 years. The median overall CHAQ score was 0 at ages 3, 6 and 10 years, indicating excellent function. Canadian boys treated with tailored primary prophylaxis exhibit minimal joint change on physical examination and minimal functional disability.

Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain

BackgroundThe goals of this study were to examine the trajectory of pediatric chronic postsurgical pain (CPSP) over the first year after surgery and to identify acute postsurgical predictors of CPSP.MethodsEighty-three children aged 8–18 years (mean 13.8, standard deviation 2.4) who underwent major orthopedic or general surgery completed pain and pain-related psychological measures at 48–72 hours, 2 weeks (pain anxiety and pain measures only), and 6 and 12 months after surgery.ResultsResults showed that 1 year after surgery, 22% of children developed moderate to severe CPSP with minimal functional disability. Children who reported a Numeric Rating Scale pain-intensity score ≥ 3 out of 10 two weeks after discharge were more than three times as likely to develop moderate/severe CPSP at 6 months and more than twice as likely to develop moderate/severe CPSP at 12 months than those who reported a Numeric Rating Scale pain score < 3 (6-month relative risk 3.3, 95% confidence interval 1.2–9.0 and 12-month relative risk 2.5, 95% confidence interval 0.9–7.5). Pain unpleasantness predicted the transition from acute to moderate/severe CPSP, whereas anxiety sensitivity predicted the maintenance of moderate/severe CPSP from 6 to 12 months after surgery.ConclusionsThis study highlights the prevalence of pediatric CPSP and the role played by psychological variables in its development/maintenance. Risk factors that are associated with the development of CPSP are different from those that maintain it.

Guidelines for management of essential tremor

Essential tremor (ET) is a common movement disorder, and approximately 50% of the cases are inherited as an autosomal dominant trait.[1] The incidence of ET increases with age, may manifest at any age (childhood to adulthood), and those with a positive family history have an earlier age of onset.[2] The tremor involves mainly the upper limbs distally and is postural or kinetic type. The less common parts involved with tremor are the head, lower limbs, voice, tongue, face, and the trunk. The tremor amplitude increases with time, and patients experience difficulty in writing, eating, holding objects and doing fine motor tasks, dressing, and speaking.[3] Although ET usually does not reduce life expectancy or cause other symptoms, many patients have severe psychosocial disability.[3] Tremor often increases with anxiety, stress, and in situations involving interaction with others. Patients with head and voice tremor often suffer severe embarrassments, and may develop depression. ET should be differentiated from the other types of tremors, especially tremor of Parkinson's disease, tremor associated with hyperthyroidism, and dystonic tremor of head in patients with isolated head tremor. Once a diagnosis is made, the severity of functional and psychosocial disabilities should be assessed by objective scales, which will help to determine the need for pharmacotherapy. The management of a patient with ET includes (a) behavioral techniques and physical therapy, (b) medical therapy, and (c) surgical treatment. The patient should be explained about the disease, the long-term outcome, and what the therapies can achieve. All therapies are essentially symptomatic and will not cure or change the course of the disease. If there is minimal functional disability, the patient need not take treatment. Even if the tremor is controlled by medical therapy, stress and anxiety can increase the symptoms. An outline of the management of ET is given in Figure 1. Figure 1 A flow chart showing the steps in the management of essential tremor

Tumor de Pancoast con lesión hipofísiaria sincrónica

Pancoast tumor with synchronous hypofisiary lesion Pancoast tumors represent a rare presentation of lung cancer. Their particular location delays diagnosis and makes resection difficult. Nevertheless recent advances in surgical techniques and multi-modality therapy (chemo-radiation followed by surgery) had increased resection rates and achieved long term survival. We present the case of a 62-year-old woman with an extensive Pancoast tumor and a synchronous hypofisiary lesion. We carried out an exhaustive staging workout determining that the infratentorial lesion was a hypofisiary adenoma. She underwent induction chemo-radiotherapy and posterior surgery. A complete resection was possible with prolonged survival and minimal functional disability. We present the evolution in management of Pancoast tumors and our approach to patients with suspicious metastases in potentially resectable tumors.

Internal Distraction Plating of Distal Radius Fractures

Internal distraction plating can be used for the treatment of highly comminuted distal radius fractures especially in elderly patients. The technique involves the use of 3.5, 2.7, or 2.5 dynamic compression plates. The instrumentation is applied in distraction dorsally from the radial diaphysis, bypassing the comminuted segment, and fixed distally to the long metacarpal. The advantages of this technique are: a) it can be used as an alternative for managing difficult fractures in the elderly population; b) it is indicated in patients with osteoporotic bone; c) complications associated with external pins are avoided; and d) the stability of the plate allows patients to use the extremity for transfer and activities of daily living. On the other hand, possible disadvantages to be considered are: a) the need of a second operation to remove the plate; and b) the prolonged duration of immobilization. Elderly patients with osteoporotic bone who undergo treatment of comminuted distal radius fractures may result in poor outcomes with high rates of complications if external fixation or standard internal fixation is used. The current approach represents an alternative that provides union of the fracture with excellent alignment, functional range of motion, and minimal functional disability.

The external approach for submucosal lesions of the larynx

Objective: The surgical excision of benign submucosal lesions of the larynx can be performed using a variety of techniques including direct laryngoscopy and external approaches. We propose that small submucosal lesions of the larynx can be removed via the external approach without a tracheotomy. Study design: Retrospective chart review. Setting: Six patients at The Long Island Jewish Medical Center and at the New York University School of Medicine underwent an external approach for the removal of benign submucosal laryngeal lesions without tracheotomies. Lesions included a mixed laryngopyocele, an internal laryngopyocele, a mixed laryngocele, a paraganglioma, a neurilemmoma and a lymphoma. Follow-up ranged from 1 to 9 years. Results: All patients were female with an average age of 72. No patient required a tracheotomy. One patient remained intubated for 24 hours postoperatively to ensure an adequate airway. Mild dysphagia was noted in all patients, but it was short-lived and did not require alternate methods of alimentation. There have been no recurrences of disease. Conclusion: The external approach without tracheotomy allows for good exposure with minimal functional disability for the removal of benign submucosal lesions of the larynx. (Otolaryngol Head Neck Surg 2001;125:370-3.)

Tissue repair after Mohs surgery. A plastic surgeon's view.

Goals of the treatment for skin cancer include completeness of removal of the lesion, minimal functional disability, and a good aesthetic result. With increasing standards for the quality assurance and the demand for cost-effectiveness, assessment of resource-consuming treatment modalities, especially those involving multidisciplinary approaches, seems appropriate. The purpose of this study was to review the strategy of management and the approaches to tissue repair following cutaneous micrographic surgery from the plastic surgeon's point of view. Retrospective review of personal experience based on approximately 800 patients treated between 1989 and 1996 and current plastic surgery literature. Teamwork with the Mohs surgeon, recognition of the post-Mohs' procedure wound components, and familiarity with reconstructive techniques are essential for the multidisciplinary practice success. The pitfalls of the reconstructive approaches are discussed.

Pitfalls and Complications of Fractures of the Distal Radius and Ulna in Childhood

Fortunately, most bone forearm fractures in children heal with minimal functional disability. My approach to management of the most common injuries is presented. By following the guidelines outlined in this article, the generalist as well as the most sophisticated upper extremity surgeon should be able to avoid pitfalls and complications when managing forearm fractures in children.

An update on malignant salivary gland tumors treated with neutrons at fermilab

One hundred and thirteen cases of recurrent and/or unresectable malignant salivary gland tumors, treated with fast neutron therapy at Fermilab between September 1976 and December 1984, are analyzed for local control, sites of failure, and treatment-related morbidity. Sixty-three patients had major and 55 had minor salivary gland tumors. Local control was achieved in 67% of patients with major and 58% of patients with minor salivary gland tumors. In the subgroup of patients with oropharyngeal and oral cavity lesions, 19/24 (80%) had local control. However, only four of 15 patients with maxillary antrum tumors had successful control of their disease. Seventy-four percent of patients with lesions measuring 5 cm or less and 30% of patients with larger lesions had their local disease controlled. Histology did not influence the local control rate. Both observed and adjusted median survival for patients with major salivary gland tumors was 36 months. Disease-free survival was 31 months. Observed and adjusted median survivals for patients with minor salivary gland tumors are 48 and 57 months respectively. Twenty of 86 patients (23%) had major morbidity; this was directly related to the total dose delivered. In the dose range 20–24 Gy the complication rate was 16%. Most of these complications were successfully managed with minimal functional disability. We have concluded that fast neutron irradiation is an appropriate treatment for malignant salivary gland tumors.

Isolated Complete Paralysis of the Tensor fasciae latae Muscle

We report on an isolated complete paralysis of the tensor fasciae latae muscle, which led to a minimal functional disability.