Rehabilitation Medicine Unit Research Articles

Oxygen-ozone therapy for pain relief in patients with trapeziometacarpal osteoarthritis: a proof-of-concept study

Purpose Trapeziometacarpal osteoarthritis (TMC-OA) is a prevalent hand disorder affecting a growing number of people worldwide. While a multidisciplinary approach might provide additional advantages, the analgesic and anti-inflammatory role of intra-articular oxygen-ozone (O2O3) injections combined with physical therapy is still unknown. To assess the impact of a multimodal therapeutic approach combining O2O3 injections with physical therapy in patients with TMC-OA. Materials and methods A prospective open-label study conducted in the Physical and Rehabilitation Medicine Unit of the "Renato Dulbecco" University Hospital of Catanzaro. We assessed patients with TMC-OA who had not responded to standard medical therapy. Participants received O2O3 therapy and targeted physical therapy for 4 weeks. Pain relief, muscle strength, and physical functioning were assessed at baseline and after 4, 12 and 24 weeks (respectively T0, T1, T2, and T3) Results Seventeen patients with a mean age of 67.1 ± 6.1 years were included in the study. Short-term improvements in pain intensity were observed (T0: 6.221 ± 1.514; T1: 3.172 ± 1.1451; p < .001) and were maintained over a 24-week follow-up period (T0: 6.221 ± 1.514; T3: 4.393 ± 1.438; p: 0.006). Significant changes were reported also in terms of muscle strength and physical functioning. O2O3 therapy was well-tolerated with no adverse effects. Conclusions A combination of O2O3 injections and physical therapy might be considered in patients with TMC-OA. Further investigation is warranted to assess the effectiveness of O2O3 therapy in managing TMC-OA.

A Forgotten Pupil of Sir Ludwig Guttmann: Ralph Spira, M.D.(Paris) , LRCP &amp;Surg (Edin.), and LRCPS (Glas). (1913 Krakow, Poland-1997, Tel Aviv, Israel)

Dr. Ralph Spira (1913 Krakow, Poland-1997, TelAviv, Israel ) studied medicine in Paris and, in 1938,moved to London to work in emergency medicineand surgery. During the War, he volunteered to servewith the British Royal Navy and in a few generalhospitals. Later on, he was affiliated with the rehabilitation medicine units, and in 1948, he wassent to join Dr. Ludwig Guttmann's at the firstNational Spinal Unit, Stoke Mandeville Hospital,Aylesbury, Bucks. In 1952, he immigrated to Israeland is regarded as one of the first rehabilitationmedicine physicians in the newly established state.

Quality of life, exercise capacity, cognition, and mental health of Chilean patients after COVID-19: an experience of a multidisciplinary rehabilitation program at a physical and rehabilitation medicine unit.

Post-COVID disabilities, encompassing physical, cognitive, and psychological aspects, constitute the primary health sequelae for survivors. While the rehabilitation needs post COVID-19 are now well understood, each country possesses unique characteristics in terms of populations, healthcare systems, social dynamics, and economic profiles, necessitating context-specific recommendations. This study aims to address two main objectives: (1) analyze the impact of an 8-week multidisciplinary rehabilitation program on the quality of life, functional capacity, cognition, and mental health adaptations in adults recovering from COVID-19 in northern Chile, and (2) propose a personalized model for predicting program dropouts and responses. A total of 44 subjects were enrolled, forming two groups during the study: a treatment group (n = 32) and a dropout group (n = 12). The treatment group participated in the 8-week multidisciplinary rehabilitation program. The results indicate that (1) After 8 weeks, the quality of life of the patients in the treatment group exhibited significant improvements reflected in all aspects of the Short Form-36 Health Survey (SF36, p < 0.005) and the total score (p < 0.001), with a concurrent decrease in dysfunctionality (p < 0.001). (2) Significant improvements were also observed in various physical performance tests, including the: 6-minute walk test, 1-min sit-to-stand, dynamometry, Tinetti balance, and Berg score (p < 0.001). Moreover, physical therapy led to a reduction in neuropathic symptoms and pain, psychological therapy reduced anxiety and depression, and language therapy enhanced memory and speech (all p < 0.05). (3) Demographic and clinical history characteristics did not predict responses to rehabilitation. (4) A regression model for predicting changes in SF-36 total score, based on physical function, physical role, general health, and mental health, was established based on the data from study (p < 0.01, adjusted R2 = 0.893). (5) Classification models for predicting dropouts achieved 68% accuracy, with key predictors of treatment adherence including diabetes, hypertension, and dyslipidemia, Tinetti balance, physical role, and vitality of SF36, and performance on the 6-minute walk test and 1-minute sit-to-stand. This study demonstrates significant enhancements in quality of life, improved functional performance, and reductions in mental and cognitive burdens within an 8-week rehabilitation program. Additionally, it is possible to identify patients at risk of dropping out using cost-effective, outpatient, and clinically applicable tests.

Spinal Cord Injury Rehabilitation: Basics and Beyond

This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review” explored the use of orthotic intervention among the elderly with SCI in 25 published articles. The “Demographic Characteristic of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital” aimed to explore the demographic characteristics among the referrals for rehabilitation among spinal cord injury populations in that tertiary hospital. The “Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma” highlighted the complicated conditions of managing concurrent Autonomic dysreflexia and orthostatic hypotension in a patient with high cervical spinal cord injury. “A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient” presented a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. The “Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury” showcased a case of young traumatic paraplegia who has been successfully treated with Mirabegron as an alternative to anticholinergics in treating overactive bladder for its better tolerability and comparable efficacy. “A Retrospective Pilot Study on the Prevalence of Acceptability for Teleconsultation among Spinal Cord Injury Patients” observed the acceptability of teleconsultation among SCI patients in a major tertiary rehabilitation hospital with a description of their clinical and demographic features. “Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions” emphasized the importance to educate healthcare workers for identifying the limitations and leniency in Islam related to performing prayer (solah) and understand the conditions of the validity of the performed prayer as means to equip patients with the right knowledge and method. The ”Sharing of Experience of Teleconsultation with Spinal Cord Injury Patients” proven that the use of teleconsultation is a beneficial service among SCI patients during the COVID-19 pandemic. “Fleet Enema-Induced Autonomic Dysreflexia in Spinal Cord Injured Patient” reported the use of fleet enema in spinal cord injured patients that can cause autonomic response leading to severe complication of a generalized tonic-clonic seizure. The “An Uncommon Case Post-traumatic Syringobulbia: A Case Report” showed that the formation of syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. The accepted abstracts are presented in the following sections of this issue. Readers are welcome to contact us for any comments or queries.

Spinal Cord Injury Rehabilitation: Basics and Beyond

This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review” explored the use of orthotic intervention among the elderly with SCI in 25 published articles. The “Demographic Characteristic of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital” aimed to explore the demographic characteristics among the referrals for rehabilitation among spinal cord injury populations in that tertiary hospital. The “Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma” highlighted the complicated conditions of managing concurrent Autonomic dysreflexia and orthostatic hypotension in a patient with high cervical spinal cord injury. “A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient” presented a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. The “Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury” showcased a case of young traumatic paraplegia who has been successfully treated with Mirabegron as an alternative to anticholinergics in treating overactive bladder for its better tolerability and comparable efficacy. “A Retrospective Pilot Study on the Prevalence of Acceptability for Teleconsultation among Spinal Cord Injury Patients” observed the acceptability of teleconsultation among SCI patients in a major tertiary rehabilitation hospital with a description of their clinical and demographic features. “Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions” emphasized the importance to educate healthcare workers for identifying the limitations and leniency in Islam related to performing prayer (solah) and understand the conditions of the validity of the performed prayer as means to equip patients with the right knowledge and method. The ”Sharing of Experience of Teleconsultation with Spinal Cord Injury Patients” proven that the use of teleconsultation is a beneficial service among SCI patients during the COVID-19 pandemic. “Fleet Enema-Induced Autonomic Dysreflexia in Spinal Cord Injured Patient” reported the use of fleet enema in spinal cord injured patients that can cause autonomic response leading to severe complication of a generalized tonic-clonic seizure. The “An Uncommon Case Post-traumatic Syringobulbia: A Case Report” showed that the formation of syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. The accepted abstracts are presented in the following sections of this issue. Readers are welcome to contact us for any comments or queries.

Nutritional status in patients with advanced-stage multiple sclerosis.

Motor and swallowing dysfunctions in multiple sclerosis (MS) unbalance calorie intake and energy expenditure, modifying nutritional status. Only one study has described nutritional status in MS patients at early disease stages (median Expanded Disability Status Scale [EDSS]=3), but this has never been assessed in the most severe cases. The goal of the present study was to describe nutritional status in advanced-stage MS. The study was a non-interventional retrospective analysis of a prospective registry. We reviewed medical files of consecutive MS patients admitted for annual follow-up in a physical and rehabilitation medicine unit between May 2016 and October 2018. Malnutrition for frail people, according to the French Health Authority (Haute Autorité de Santé [HAS]) definition, was our composite primary outcome criterion: body mass index (BMI) <21kg/m2 and/or albumin<35g/L. First, we performed a descriptive analysis of the nutritional status. Second, we studied the association between malnutrition and MS characteristics in univariate and multivariate analyses. A total of 163 patients with median EDSS=8 [7; 8.5] were included. Ninety-three patients (57%) met HAS malnutrition criteria (36% with albumin <35g/L, 31% with BMI <21kg/m2 and 10% with both). Malnutrition was associated in univariate analysis with MS severity (EDSS ≥8.5, p=0.0003), primary progressive type of MS (p=0.01) and swallowing disorders (p=0.002). Multivariate analysis showed that low disability status (EDSS <7) was the only independent (protective) factor associated with malnutrition (OR=0.2, p=0.03). Malnutrition is frequent in advanced stages of MS and is probably a key point for therapeutics, which has never been demonstrated previously. A standardized evaluation should be developed to improve nutritional therapeutic strategies in this population.

Ultrasonographic Examination: The "X-Factor" in Physiatry.

IRCCS Rizzoli Orthopaedic Institute Department of Biomedical and Neuromotor Science Physical and Rehabilitation Medicine Unit Bologna, Italy Hacettepe University Medical School Department of Physical and Rehabilitation Medicine Ankara, Turkey

A Technical Note for Ultrasound Imaging of the Peripheral Nerve Mass Lesions

Department of Biomedical and Neuromotor Science Physical and Rehabilitation Medicine Unit IRCCS Rizzoli Orthopaedic Institute Bologna, Italy Department of Physical and Rehabilitation Medicine Hacettepe University Medical School Ankara, Turkey

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years.

The usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department. This was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics. We reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%-10%; P<0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P<0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P<0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P<0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P<0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P<0.05). Disabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.

Physical Activity Level Among Stroke Patients Hospitalized in a Rehabilitation Unit

BackgroundThe current literature contains little information about the level of physical activity of hospitalized patients who have had a stroke. Improving knowledge in the area could help optimize rehabilitation. ObjectivesTo determine the level of physical activity of hospitalized patients who have had a stroke to discover if they achieved the recommended 30 minutes of physical activity per day (equivalent to 142 kcal) during sessions of 10 consecutive minutes. SettingPhysical and Rehabilitation Medicine Unit of the Jean Rebeyrol Hospital, Limoges, France. ParticipantsAll patients (N = 88) who had sustained a stroke within the previous 6 months were included over a period of 7 months. Main Outcome MeasuresThe duration of physical activity and related energy expenditure were estimated using a SenseWear armband (BodyMedia [Jawbone]). Subjects wore the sensor on the nonparetic arm for 2 consecutive days from 9 am to 4:30 pm, corresponding to the period spent daily on rehabilitation. The Fisher simple correlation test and Mann-Whitney nonparametric test were performed. ResultsA total of 88 patients aged 66 ± 17 years with a mean poststroke period of 43 ± 34 days and a mean Barthel Index of 61 ± 25/100 were enrolled in the study. Between 9 am and 4:30 pm, patients took part in an average of 23 ± 30 minutes of physical activity (equivalent to 91 ± 122 kcal). Correlations were found between physical activity time in the hospital and physical activity before the stroke occurred (r = 0.345, P < .0001), the Barthel Index (r = 0.284, P = .0002), body mass index (r = −0.440, P < .0001), and time to hospital release (r = −0.183, P = .0194). ConclusionIt was found that 62% of patients did not achieve the recommended amount of physical activity. Sessions dedicated to physical activity could motivate patients who have had a stroke and help them meet recommendations before leaving the rehabilitation unit.

Fluoxetine and depression in hemiplegic patients: Study in Casablanca physical and rehabilitation medicine unit

Fluoxetine and depression in hemiplegic patients: Study in Casablanca physical and rehabilitation medicine unit

Adherence to hand hygiene in an Italian long-term care facility

In an Italian long-term-care facility (LTCF), we observed a 17.5% adherence to hand hygiene (HH), as well as 47.5% rate of glove use. Performing a procedure at high risk for cross-transmission of germs was the factor most strongly associated with noncompliance (odds ratio = 13.3; 95% confidence interval = 6.2 to 28.8; P < .0001). No significant differences in compliance related to health care worker category were found. Adherence to HH in the LTCF was similar to that found in a rehabilitation medicine unit of an acute care hospital (15.8%) but significantly lower than that reported in an infectious disease unit (53.7%; P < .0001). Our findings indicate that compliance with HH is a similar problem in LTCFs as in acute care facilities.

Poster 137: A Retrospective Audit of Inpatient Referral Consultations to a Rehabilitation Medicine Unit in an Acute Hospital in Singapore

Poster 137: A Retrospective Audit of Inpatient Referral Consultations to a Rehabilitation Medicine Unit in an Acute Hospital in Singapore

Poster 162: Depression assessment in rehabilitation patients with communication difficulties: the Cornell depression scale.

Objective: To use the Cornell Depression Scale (CDS) to diagnose major depression in rehabilitation inpatients with communication difficulties, using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), as standard assessment tool. Design: Prospective clinical trial. Setting: Rehabilitation medicine unit in a tertiary teaching hospital. Participants: Consecutive general rehabilitation patients (61.8% strokes, others being head injuries, spinal cord injuries, deconditioning) admitted between May and August 2002. Patients who did not complete their rehabilitation program for various reasons (including medical instability) were excluded from analysis. Interventions: All 78 patients admitted were screened by the same investigator for depressive signs and symptoms using DSM-IV criteria on admission, and then on a weekly basis until discharge. Of the 68 patients who completed rehabilitation, 14 (20.6%) had communication difficulties (defined as a score of <5 for comprehension and/or expression on the initial FIM™ instrument score) and were also assessed using the CDS. Main Outcome Measure: Presence or absence of major depression, as determined by the CDS and/or DSM-IV criteria. Results: 13 (19.1%) of the 68 patients were diagnosed with major depression using the DSM IV. Of these, 4 patients had communication difficulty; they also fulfilled the criteria for major depression on the CDS. Importantly, the remaining 10 patients with communication difficulty did not have depression as assessed by the DSM-IV and the CDS. There was hence a 100% correlation between the 2 tools. Conclusions: Diagnosis of major depression in the presence of communication difficulties can be challenging. The CDS, a nonverbal assessment tool focusing on observers’ ratings and originally constructed for patients with dementia, showed accurate correlation with the well-established DSM-IV and may hence be useful in rehabilitation patients with communication difficulties. A larger study, to ensure accuracy and statistical significance of this correlation, is necessary.

Predicting upper limb recovery after stroke: The place of early shoulder and hand movement

Objective: To assess the predictive value of early shoulder and hand movement after stroke for subsequent hand movement and function. Design: An inception cohort design following 71 patients for 3 months after first stroke. Setting: Rehabilitation medicine units in three Sydney teaching hospitals. Patients: A consecutive sample of 71 first-stroke patients, mean age 67 years, was assessed for upper limb function. Those with preexisting impairment in the hemiplegic limb, early good recovery in hand function, or impaired comprehension were excluded. Data were available for 65 patients at 1 month, 50 at 2 months, and 46 at 3 months. Main Outcome Measures: Hand movement and hand function were assessed at 1, 2, and 3 months. A standardized hand movement scale and four specific hand function tasks were used. The outcome variables were (1) “good” hand movements, ie, independent index finger extension or opposition of finger/s to thumb and (2) ability to perform one of the specified hand function tasks. Results: Initial shoulder shrug predicted good hand movement (odds ratios 7.3, 7.0, 6.0) and hand function (odds ratios 13.8, 5.3, 11.3) at 1, 2, and 3 months, respectively. Initial presence of synergistic hand movement predicted good hand movement (odds ratios 10, 13.8, 12.2) at 1, 2, and 3 months and hand function (odds ratios 27.9, 7.5) at 1 and 2 months. Initial active shoulder abduction predicted good hand movement at 1 month and hand function at 1 and 2 months only. Conclusions: Early shoulder shrug and synergistic hand movements are useful bedside predictors of hand outcome after stroke.

Workload of an inpatient cardiac rehabilitation service in Edinburgh: a five year survey

When the cardiac rehabilitation programme at Astley Ainslie Hospital, Edinburgh, UK, was instituted in 1976, it served predominantly patients under 65 years of age who had suffered a recent myocardial infarction. We describe a detailed survey of the medical records of all cardiac admissions to the Rehabilitation Medicine Unit of the hospital during 1986-1990. This survey stresses the changing face of cardiac rehabilitation which has now developed fundamentally into a post cardiac surgical rehabilitation service, catering to an increasingly elderly group of patients. Perhaps this is a logical development as cardiologists and general physicians become more aware of the rehabilitation needs of patients post myocardial infarction and these are instituted both in the acute setting and as an outpatient service. In contrast, cardiothoracic surgical units with the need for high technology and specialist intensive care skills are perhaps environments less suited to the institution of rehabilitation services.

Evaluation of disability and of results of rehabilitation with the use of the Barthel index and Russek's classification.

At a rehabilitation medicine unit for mainly vascular lower-limb amputees the use of simple and comparable methods of evaluation of gait performance (Russek's classification) and activities of daily living (the Barthel index) have been studied. Results of the two methods correlate and both have prognostic value concerning rehabilitation outcome.

Patient-administered drugs in a municipal hospital

In rehabilitation programs patients are instructed in ambulation, wheelchair skills, and self-care. Self-administration of medication, however, has yet to be adopted as a standard restorative modality. Regular practice sessions correct and reinforce learning and develop safe practice. But within any group of patients with physical impairments, some patients have chronic diseases that require long-term drug therapy. For these persons, accurate self-medication becomes an essential daily activity. Their well-being, over time, may be directly related to their adherence to the drug regimen. Our 30-bed rehabilitation medicine unit is located in a large, innercity municipal hospital. Our patient population has a high incidence of hypertension, diabetes, and factors that contribute to cardiovascular disease, such as stress, obesity, and hypercholesterolemia. Many of these patients have no one at home to assist them. From earlier experience we expect a number of them to be rehospitalized for additional disabling events related to cardiovascular pathology. In 1978, we introduced a pro-

The president's view

ARN JournalVolume 1, Issue 4 p. 1-1 The president's view Sue Novak R.N., Sue Novak R.N. President Sue Novak. R.N., a graduate of Northwestern (Chicago-Wesley) Memorial Hospital School of Nursing, is Head Nurse of the Rehabilitation Medicine Unit at Lutheran General Hospital. Park Ridge, Illinois.Search for more papers by this author Sue Novak R.N., Sue Novak R.N. President Sue Novak. R.N., a graduate of Northwestern (Chicago-Wesley) Memorial Hospital School of Nursing, is Head Nurse of the Rehabilitation Medicine Unit at Lutheran General Hospital. Park Ridge, Illinois.Search for more papers by this author First published: May‐June 1976 https://doi.org/10.1002/j.2048-7940.1976.tb00024.x AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume1, Issue4May‐June 1976Pages 1-1 RelatedInformation