Outpatient Rehabilitation Department Research Articles

Hand trauma: Epidemiology and functional outcome in an outpatient rehabilitation department

Hand trauma: Epidemiology and functional outcome in an outpatient rehabilitation department

Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial

BackgroundThere was an increasing requirement for novel treatments of osteoarthritis (OA). The aim was to compare the efficacy of intraarticular Botulinum toxin type A (BoNT-A) and intraarticular hyaluronate plus rehabilitation exercise in patients with ankle OA.MethodsThis was a prospective, randomized, assessor-blinded study with a 6-month follow-up period, conducted in the outpatient rehabilitation department at a university-affiliated tertiary care medical center. Seventy-five patients with symptomatic ankle OA (Kellgren-Lawrence grade 2) were randomized to receive either a single 100-unit BoNT-A injection into the target ankle (n = 38) or a single hyaluronate injection plus 12 sessions of rehabilitation exercise (30 minutes/day, 3 times/week for 4 weeks) (n = 37). The primary outcome measure was the Ankle Osteoarthritis Scale (AOS). Secondary outcome measures included American Orthopedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score, visual analog scale (VAS) for ankle pain, single leg stance test (SLS), Timed “Up-and-Go” test (TUG), consumption of rescue analgesics and global patient satisfaction.ResultsThere were no significant between-group differences in total AOS scores, pain subscale and disability subscale scores (adjusted mean difference AMD = -0.2, 95% CI = (-0.5, 0.2), p = 0.39; AMD = -0.1, 95% CI = (-0.5, 0.3), p = 0.57; AMD = -0.2, 95% CI = (-0.6, 0.2), p = 0.36). The 2 groups showed no significant differences in AOFAS, VAS, SLS, TUG scores and consumption of rescue analgesics at each follow-up visit, except that the hyaluronate group improved more in SLS than the BoNT-A group at 1-month follow-up. Patients’ satisfaction rate was high, with no serious adverse events. There was no difference in adverse events between the two groups (p = 1.00).ConclusionsTreatment with intraarticular BoNT-A or hyaluronate injection plus rehabilitation exercise was associated with improvements in pain, physical function and balance in patients with ankle OA. These effects were rapid at 2 weeks and might last for at least 6 months. There was no difference in effectiveness between the two interventions.Trial registrationThe trial was registered at clinical trials.gov (Registry number NCT01760577).

Effects of whole body vibration training in patients with severe chronic obstructive pulmonary disease

To determine if whole body vibration training (WBVT) improves muscular force and modifies functional capacity parameters in patients with severe chronic obstructive pulmonary disease (COPD). We performed a randomized controlled trial in the outpatient Physical Medicine and Rehabilitation Department of a general hospital. Sixty stable male patients with COPD and mean forced expiratory volume in 1 s (FEV1) 34.3% (predicted) were enrolled with 51 patients completing the study. Participants were randomized into two groups: Whole Body Vibration Training Group (WBVTG), (n = 26) undergoing three sessions per week for a total of 6 weeks and a Control Group (CG) (n = 25) without intervention. The main outcome measures were isokinetic knee flexor and extensor testing in a concentric-concentric regime and exercise capacity measured by the 6-min walking test (6MWT). Secondary outcomes were pulmonary muscular assessment with maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). No significant differences were observed between groups in maximum moment of isokinetic knee flexor/extensor testing force in a concentric-concentric regime. In contrast, WBVTG patients showed a significant increase in the 6MWT (81.2 ± 9.2) meters; mean ± SD; P < 0.001). There was also a significant decrease in maximum oxygen desaturation in the 6MWT after 6 weeks of training (3.1 ± 1.1; P = 0.01). There were significant differences between groups in MIP and MEP at the end of the study in favour of the WBVTG. WBVT provided significant improvements in functional capacity in severe COPD patients without changes in muscular force.

Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial

BackgroundNon-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment.Methods/designStudy design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment.Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program.Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each.Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment.Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: ‘involvement in a life situation’) 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs of the pre-treatment intervention, productivity losses, and healthcare utilization. Potential moderators and active ingredients of MI are explored. For the process evaluation, parameters such as MI fidelity, feasibility, and experiences are explored.DiscussionThe results of this study will provide evidence on the effectiveness of this MI-based pre-treatment in pain rehabilitation. Furthermore, a cost-effectiveness analysis and exploration of moderating and working mechanisms of MI and an extensive process evaluation takes place.Trial registrationNederlands trial register NTR3065

ACTIVLIM-Stroke: A Crosscultural Rasch-Built Scale of Activity Limitations in Patients With Stroke

This study describes the development of a Rasch-built scale measuring activity limitations in stroke patients, named ACTIVLIM-Stroke. This new Rasch-built measure was constructed based on stroke patients' perceptions of difficulty in performing daily activities. Patients were recruited from inpatient and outpatient rehabilitation departments in Belgium and Benin. A 73-item questionnaire was completed by 204 participants. A random subsample of 83 subjects was given the questionnaire a second time. Data were analyzed using RUMM2030 software. After successive Rasch analyses, the ACTIVLIM-Stroke questionnaire, a unidimensional and linear 20-item measure of activity limitations, was constructed. All 20 items fulfilled Rasch requirements (overall and individual item fit, category discrimination, invariance, local response independence, and nonredundancy in item difficulty). This simple patient-based scale encompasses a large range of activities related to self-care, transfer, mobility, manual ability, and balance. The ACTIVLIM-Stroke questionnaire exhibited high internal validity, excellent internal consistency, and good crosscultural validity. The test-retest reliability of item difficulty hierarchy (intraclass correlation coefficient=0.99) and patient location (intraclass correlation coefficient=0.92) were both excellent. Furthermore, it showed good external construct validity using correlations with the Functional Independence Measure motor and the Barthel Index and a higher discriminating capacity than either of these widely used indices. The ACTIVLIM-Stroke questionnaire has good psychometric qualities and provides accurate measures of activity limitations in patients with stroke. It is recommended for evaluating clinical and research interventions in patients with stroke, because it provides a higher discrimination and might be more sensitive to change.

A PT INTERVENTION FOR A PATIENT WITH SENSORY ATAXIA IN THE ACUTE CARE ONCOLOGY SETTING

L. Ruppert, T. Kendig, Outpatient Rehabilitation Department, Memorial Sloan Kettering Cancer Center, New York, NY. Platform

Lower limbs function and pain relationships after unilateral total knee arthroplasty

The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was measured, and pain was evaluated. Gait characteristics, walking velocity, and knee joint's extension improved and pain diminished considerably 3 months after arthroplasty, nevertheless did not reach control group level. In conclusion, single support phase and gait velocity change reflect the recovery of gait function after total knee arthroplasty. Beside the affected knee joint's range of motion, attention should be paid to the restoration of the functional reserve of the adjacent joints and joints of contralateral lower extremity after total knee arthroplasty. Affected knee joint pain perceived during level walking influenced the gait velocity of patients before total knee arthroplasty but not 3 months after arthroplasty.

Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up

Objective: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. Design: Randomized trial, 12-month follow-up. Setting: Outpatient rehabilitation department. Participants: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 ± 14 years. Interventions: Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20’-sessions once-a-week. Outcome: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. Results: 205 patients completed the study. At discharge, disability score decreased by 3.7 ± 4.1 for back school, 4.4 ± 3.7 for individual physiotherapy, 6.7 ± 3.9 for manipulation; pain score reduction was 0.9 ± 1.1, 1.1 ± 1.0, 1.0 ± 1.1, respectively. At 12 months, disability score reduction was 4.2 ± 4.8 for back school, 4.0 ± 5.1 for individual physiotherapy, 5.9 ± 4.6 for manipulation; pain score reduction was 0.7 ± 1.2, 0.4 ± 1.3, and 1.5 ± 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P<0.001); pain recurrences and drug intake were also reduced compared to back school (P <0.05) or individual physiotherapy (P <0.001). Conclusions: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

Promoting physical activity in an adolescent and a young adult with physical disabilities

Background We sought to describe the design of the Active Lifestyle and Sports Participation (ALSP) intervention for adolescents and young adults with physical disabilities, and to present the first 2 cases. Methods A 17-year-old boy with myelomeningocele and hydrocephalus and a 23-year-old woman with unilateral cerebral palsy were enrolled into the ALSP intervention, a personalized intervention designed to improve physical activity and fitness levels. Main outcome measures were self-reported physical activity and aerobic fitness. Fitness was determined by submaximal 6-minute walk or wheel test and by maximal cycle or arm ergometer-exercise test. Participants rated satisfaction with the intervention on a Likert-type numeric scale from 1 to 10. Results Improvements in self-reported physical activity were 51% and 75% for the male and female participant, respectively. Respective improvements in submaximal exercise were 16% and 9%. Maximal exercise increased 39% in the male participant but did not increase in the female participant. Satisfaction with the intervention was rated moderate-good to excellent. Conclusion Data for the first 2 cases suggested that ALSP intervention seemed feasible to offer in an outpatient rehabilitation department, and the effectiveness may be promising. Future studies should determine the short- and long-term effectiveness of the intervention.

Rehabilitation Outcomes of Terror Victims With Multiple Traumas

Schwartz I, Tsenter J, Shochina M, Shiri S, Kedary M, Katz-Leurer M, Meiner Z. Rehabilitation outcomes of terror victims with multiple traumas. Objectives To describe the rehabilitation outcomes of terror victims with multiple traumas, and to compare those outcomes with those of patients with nonterror-related multiple traumas treated in the same rehabilitation facility over the same time period. Design Retrospective chart reviews. Setting Rehabilitation department in a university hospital in Jerusalem, Israel. Participants Between September 2000 and September 2004, we treated 72 victims of terrorist attacks who had multiple traumas. Among them, 47 (65%) had multiple traumas without central nervous system involvement (MT subgroup), 19 (26%) had multiple traumas with traumatic brain injury (TBI subgroup), and 6 (8%) had multiple traumas with spinal cord injury (SCI subgroup). We matched, according to their types of injury and demographic data, each terror victim with a control patient treated in the same period in our rehabilitation department. Intervention Interdisciplinary inpatient and outpatient rehabilitation. Main Outcome Measures Hospital length of stay (LOS) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (FIM instrument score), occupational outcome (returning to previous occupation), and psychologic outcome (Solomon PTSD [post-traumatic stress disorder] Inventory). Results The mean LOS of terror victims was 218±131 days; for the nonterror group it was 152±114 days ( P<.01). In comparison with the control subgroups, the MT subgroup of terrorist victims had significantly longer LOS in the acute care and outpatient rehabilitation departments ( P=.06) and the terror TBI subgroup had a longer LOS in outpatient department only ( P<.05). The LOS of the SCI patients, both terror victims and control patients, was significantly longer than that of the other 2 subgroups. The difference between FIM value at entry and discharge (ΔFIM) was significantly higher for terror victims than for the controls (41.1±21.6 vs 30.8±21.8, P=.002). This difference was mainly the result of the significantly higher ΔFIM achieved by the terror MT subgroup than by the MT controls. The rate of PTSD was higher among terror victims than among controls (40.9% vs 24.2%, P=.04). The rate of return to previous occupations was similar between terror victims and nonterror patients (53% vs 46.9%, respectively). Conclusions Victims of terror spent longer periods in rehabilitation than the nonterror group; however, they regained most activity of daily living functions similar to the nonterror group. Despite the higher rate of PTSD, terror victims succeeded in returning to their previous occupations at a similar rate to that of the nonterror group.

Functional vs. Strength Training in Disabled Elderly Outpatients

To determine whether high-intensity functional training (FT) or strength training (ST) better enables impairment, disability, and functional gains among disabled community-dwelling elders. Randomized, blinded, prospective clinical trial in a large, tertiary care outpatient rehabilitation department. Fifteen elders (62-85 yrs old) referred for physical therapy with one or more impairments, including lower-limb arthritis, participated in 6 wks of FT (weekly outpatient and three to five times per week of home practice in rapid and correct execution of locomotor activities of daily living, including gait, stepping, and sit to stand) or progressive resistive ST using elastic bands with intensity, therapist contact, and home practice similar to those of FT. Both groups significantly improved their combined lower-extremity strength (hip abduction, ankle dorsiflexion, knee flexion, ankle plantarflexion, and knee extension) (P = 0.003), but no statistical difference between the ST and FT group gains (P = 0.203) was found. Subjects in both interventions improved their gait speed, but the FT group improved more than the ST group (P = 0.001). During chair rise, the FT group improved their maximum knee torque more than the ST group (P = 0.033), indicating that they employed a more controlled and efficient movement strategy. These data suggest that an intensive FT intervention results in strength improvements of comparable magnitude as those attained from ST and that FT also confers greater improvements in dynamic balance control and coordination while performing daily life tasks.

A randomized controlled pilot study to obtain the best estimate of the size of the effect of a thermoplastic resting splint on spasticity in the stroke-affected wrist and fingers

Objective: To obtain the best estimate of the size of the effect of a thermoplasticresting splint on spasticity in the stroke-affected upper limb. Design: A randomized controlled intervention involving 14 adults affected by stroke,allocated to two groups. Setting: Inpatient and outpatient rehabilitation departments. Intervention: Following one week of baseline when neither group wore a splint, group 1 continued without a splint for week 2 and then wore a splint during week 3.Group 2 wore a splint during weeks 2 and 3. Both groups then wore a splint through weeks 4-7. Main measures: A computerized torque apparatus was used to measure resistance at the wrist in newtons at every one-degree angle through the range of extension.Amount and rate of change in resistance was compared between the groups to obtain the best estimate of the size of the effect of splinting. Results: Effect sizes were small and failed to reach the suggested smallest clinically worthwhile effect size for amount and rate of change in resistance in the short term. However, the average estimated size of the effect for rate of change with longer term splinting exceeded the smallest clinically worthwhile effect. Conclusions: These findings and the fact that confidence intervals overlapped the smallest clinically worthwhile size of the effect for amount and rate of change in both short and long term suggest that a study with a larger sample is warranted.

The Relation Between Ankle Impairments and Gait Velocity and Symmetry in People With Stroke

Lin P-Y, Yang Y-R, Cheng S-J, Wang R-Y. The relation between ankle impairments and gait velocity and symmetry in people with stroke. Objective To identify the most important factor among the ankle impairments on gait velocity and symmetry in stroke patients. Design Cross-sectional, descriptive analysis of convenience sample. Setting Patients from outpatient rehabilitation and neurovascular neurology departments in medical centers and municipal hospitals in Taiwan. Participants Sixty-eight subjects with hemiparesis poststroke with the ability to walk independently. Interventions Not applicable. Main Outcome Measures Maximal isometric strength of plantarflexors and dorsiflexors were examined by a handheld dynamometer. Spasticity index, slope magnitudes between electromyographic activities, and muscle lengthening velocity of gastrocnemius during lengthening period of stance phases were measured to represent the dynamic spasticity. Passive stiffness of pantarflexors was indicated by degrees of dorsiflexion range that were less than normative values. Position error was measured by the degree of proprioceptive deficits of ankle joint by evaluating the joint position sense. Gait velocity, symmetry, and other gait parameters were measured by the GAITRite system. Results Regression analyses revealed that the dorsiflexors strength was the most important factor for gait velocity and temporal symmetry ( R 2=.30 for gait velocity, P<.001; R 2=.36 for temporal asymmetry, P<.001). Dynamic spasticity was the most important determinant for gait spatial symmetry ( R 2=.53, P<.001). Conclusions Gait velocity and temporal asymmetry are mainly affected by the dorsiflexors strength, whereas dynamic spasticity of plantarflexors influenced the degree of spatial gait asymmetry in our patients who were able to walk outdoors. Treatment aiming to improve different aspects of gait performance should emphasize on different ankle impairments.

Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: a 6-month follow-up study using clinical tests

To investigate the effects of intraarticular hyaluronic acid (HA) (Artzal, Seikagaku Corp., Japan) in geriatric participants with unilateral knee osteoarthritis (OA). This was a prospective, observer-blind study with 6 months follow-up done in the setting of an outpatient rehabilitation department in a university-affiliated tertiary care medical center. Sixty-eight patients, aged 65 years or above, with symptoms and radiographic evidence of unilateral knee OA for at least 6 months were recruited. Patients received five weekly intraarticular injections of Artzal into symptomatic knees. Fifty-six participants completed the study. Fifty age-, body mass- and gender-matched healthy individuals were selected as control. Visual analog scale (VAS), Lequesne index and four balance tests including single-leg stance test (SLS), function reach test (FRT), timed "Up-and-Go" test (TUG) and Berg balance scale (BBS) were assessed before injection and at each follow-up visit in the OA group. Four balance tests were obtained on healthy participants for data comparison. Before Artzal injections, the OA group showed significantly worse VAS, Lequesne index and four balance tests scores than did the control group (P < 0.001). Significant improvement in all outcome measures were noted at 1 week, 1, 3 and 6 months post the fifth injection compared with baseline before injection. Local adverse events were reported in four patients (7.1%). Significant improvement in pain, physical function and balance tests was demonstrated after five weekly Artzal injections in geriatric patients with knee OA. The effect had rapid onset at 1 week and may last for 6 months.

The community rehabilitation unit in Leeds: A resource for people with long-term conditions

Community rehabilitation is a well established and valuable part of the service response to the needs of people with long-term conditions. The authors explored the value of a Leeds-based community rehabilitation programme, before more formal evaluation, through two case reports of people living with long-term neurological conditions. Interventions were delivered not only in patients' homes and an outpatient rehabilitation department, but also in a facility where patients can stay overnight and access 24-hour nursing support and daily therapy input. This facility is not present in many parts of the country. Two women with a range of impairments received complex multidisciplinary interventions, incorporating repeated systematic analyses of problems by various combinations of professionals, with treatment delivered over several consecutive days across several rehabilitation disciplines. The particular benefit of the short period of focused inpatient treatment, where sustained interventions are given simultaneously by staff with complementary skills to enhance an individual’s function and maximize the gains provided by other parts of the service, is highlighted. These cases illustrate how a range of interventions, including short inpatient admissions, can be provided in a community setting to enhance participation.

Loss of strength contributes more to physical disability after stroke than loss of dexterity.

The major contributors to physical disability after stroke are considered to be the negative impairments of loss of dexterity (defined here as loss of the ability to co-ordinate muscle activity in the performance of any motor task) and loss of strength. The aims of this study were: (1) to determine the relative contributions of strength and dexterity to function during recovery after stroke; and (2) to determine the predictive value of initial strength, dexterity and function on long-term function after stroke. A longitudinal descriptive study. The inpatient and outpatient rehabilitation departments of two metropolitan hospitals. Twenty-two patients undergoing rehabilitation after acute stroke participated. Strength and dexterity of the elbow flexors and extensors were measured, along with arm function, at 3, 5, 7, 9, 11, 15, 19, 23 and 27 weeks after stroke. Standard multiple linear regression analysis demonstrated that strength and dexterity in total contributed significantly to function at all times (r2 = 0.66-0.82, p < 0.0001). Furthermore, strength always made an additional separate contribution to function (r2 = 0.05-0.26, p < 0.05). Function at week 3 was the best clinical predictor of function at week 27 (r2 = 0.55, p < 0.001). Loss of strength is a more significant contributor than loss of dexterity to physical disability after stroke. This suggests that, where significant weakness is present, exercise designed to increase strength will be required to decrease disability.

Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: A noninvasive evaluation

Price CI, Rodgers H, Franklin P, Curless RH, Johnson GR. Glenohumeral subluxation, scapula resting position, and scapula rotation after stroke: a noninvasive evaluation. Arch Phys Med Rehabil 2001;82:955-60. Objectives: To determine whether scapular downward tilt (ScDT) and dynamic scapular lateral rotation (ScLR) in subjects with and without stroke is associated with subluxation, and to prove the reliability of a Scapula Locator System in an elderly population. Design: Repeated measures of ScLR by 2 observers. Setting: Outpatient rehabilitation department of a district general hospital. Participants: To test device reliability, 5 healthy men (mean age ± standard deviation, 72 ± 5yr). To test scapula position, 30 stroke patients (19 men, 11 women; mean age, 73 ± 6yr) and 15 healthy controls (12 men, 3 women; mean age, 62 ± 6yr). Interventions: The control subjects' ScDT was compared with stroke subjects' ScDT after stratification according to 3 patterns of ScLR symmetry and the presence of palpable glenohumeral subluxation. Main Outcome Measures: For device reliability, 3-way analysis of variance. For scapula position, triangulated location by Scapula Locator System of acromion, inferior angle, and root of the scapular spine; then measurement of scapula motion to determine symmetry, lag, or lead. Results: The inter- and intraobserver reliability of the Scapula Locator System device was high (1% of variance each). Normal ScDT was positive (left side: 10.94° ± 2.62°; right side: 9.69° ± 4.36°), indicating a downward-facing glenoid fossa. This finding was unchanged by stroke (10.46° ± 2.42°). All controls and 16 stroke subjects had symmetry between shoulders for ScLR rate and ScDT. Two other patterns (p <.01) of ScLR were found after stroke: 8 subjects had a slower rate of affected arm ScLR (lag) with a correspondingly greater ScDT on the affected side (2.61° ± 6.7°); 6 subjects had a faster rate of affected arm ScLR (lead) but with an upward-facing glenoid fossa on the affected side (ScDT: −11.84° ± 8.48°). No significant inter- or intrasubject difference in ScDT existed in the 6 cases of glenohumeral subluxation. Conclusions: The scapula normally tilts downward with or without stroke. The effect of stroke is similar on tonic (ScDT) and phasic (ScLR) control of scapula position. Subluxation is not linked with a particular scapular resting position after stroke. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Is postural control associated with mental functioning in the persistent postconcussion syndrome?

Objective: To investigate whether balance is associated with mental functioning after mild traumatic brain injury (MTBI). Design: Experimental two-group design. Setting: Outpatient rehabilitation department. Patients and Other Participants: From a consecutive sample of referred MTBI patients, 15 subjects who complained of imbalance were included (8 men and 7 women, age 35.9 ± 8.6yrs). Subjects with detectable neurologic impairments were excluded. Twenty healthy control subjects of the same age group also were tested. Main Outcome Measures: In both groups, a force platform recorded center-of-pressure (CP) fluctuations during standing and weight shifting in different conditions. For the patients, attention and mental speed were assessed with the Symbol-Digit Substitution Test of the Wechsler Adult Intelligence Scale (Dutch version), verbal learning and memory were assessed with the 15-Words Test, and emotional distress was assessed with the Symptom Checklist-90. Results: Compared with controls, patients showed an overall increase of 60% in CP velocity and an overall weight-shifting speed 25% slower ( p < .005), indicating static and dynamic postural instability. Only performance on the Symbol-Digit Substitution Test was associated with both static and dynamic balance ( p < .02), giving an explained variance of over 40%. Conclusion: The results indicate a possible association of balance with cognitive performance but not with emotional well-being after MTBI, suggesting an organic rather than a functional cause of postural instability. Further research is needed to assess the possible clinical implications.

The Vocational Rehabilitation Continuum: Maximizing Outcomes through Bridging the Gap from Hospital to Community-Based Services

Objective: To describe and examine the effects of a specialized brain injury vocational service delivery model on vocational outcome for individuals with traumatic or other acquired brain injury. Design: A prospective case series was used. Setting: Inpatient and outpatient rehabilitation departments at a large midwest regional trauma center. Participants: Eighty adults with traumatic or other acquired brain injury were residents of the state of Minnesota, did not have a primary psychiatric or substance abuse diagnosis, and did not live in a residential care facility. Main Outcome Measures: Vocational Outcome Scale (VOS), Client Satisfaction Survey, and data on participant's level of independent living, job type and setting, rate of pay, and number of hours worked per week. Results: Through emphasizing early vocational intervention, closely integrating this with medical rehabilitative treatment, and providing a smooth transition from medical to community-based services, 40% of project participants were placed in a job within the first 3 months of project participation; about 70% were placed within 12 months of project participation. Those placed have an average rate of pay of $7.70 per hour and a 90-day job retention rate of 100%. Conclusions: Results indicate that this system of specialized brain injury vocational service delivery is effective.

Fire retardants

To develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT).A prospective cohort study.An outpatient rehabilitation department in a general hospital.Seventy-five patients with PHP.After completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement.Twenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%.A CPR has been developed to identify patients with PHP likely to benefit from BAPT.