ISRN Rehabilitation The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Spine Curve Measures Taken in Individuals with Osteoporosis and Osteopenia Using the IONmed Mobile Phone Application Are Highly Consistent with Digital Inclinometer Measures Thu, 17 Apr 2014 09:29:44 +0000 Introduction. This study determined the agreement between measures of standing posture in individuals at risk of osteoporotic fracture obtained using the IONmed mobile phone application and a digital inclinometer. Methods. One experienced rater assessed 20 adults, aged 55–88 years, attending an outpatient osteoporosis clinic. A standardized protocol was duplicated to acquire a single measure of spine curvature (lumbosacral angle, lordosis, kyphosis) using the IONmed mobile phone application and a digital inclinometer. Interdevice agreement was determined using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) and standard error of the measurement (SEM) with 95% CI and Bland-Altman plots. Results. ICC (95% CI) for lumbosacral angle, lordosis, and kyphosis is 0.97 (0.92, 0.99), 0.97 (0.92, 0.99), and 0.99 (0.98, 1.0), respectively. SEM (95% CI) for lumbosacral angle, lordosis, and kyphosis is 0.99° (0.75, 1.44), 1.33° (1.01, 1.94), and 1.23° (0.94, 1.80), respectively. Measurement bias is small. Conclusions. In our sample, the IONmed mobile phone application provides measures highly consistent with the digital inclinometer measures of standing posture. This method offers clinicians a quick, convenient way of identifying alterations in spine alignment which require followup and remediation. Norma J. MacIntyre, Chris P. Recknor, and Julie C. Recknor Copyright © 2014 Norma J. MacIntyre et al. All rights reserved. Injured Workers Perspectives on Recovery following Non-Life-Threatening Acute Orthopaedic Trauma: A Descriptive Study Sun, 23 Feb 2014 07:20:23 +0000 Background. Little is known about the recovery process following non-life-threatening acute orthopaedic trauma from the viewpoint of the injured person. A better understanding could facilitate optimal rehabilitative planning. Objective. To explore patients’ views on factors important to them in recovery following non-life threatening acute orthopaedic trauma. Methods. Descriptive study utilizing content analysis and chi-square analysis. To better understand recovery expectations, 168 adults who had sustained non-life threatening acute orthopaedic trauma were surveyed at 2, 12, and 26 weeks after injury and invited to respond to the following question “what are the most important things necessary for you to best recover?” Results. According to participant’s responses, major themes on recovery involved a return to health and a return to health but with an ongoing plan, and for a minority (12%) recovery involved a focus on their current status. The study found that some recovery expectations changed over time. Conclusion. The journey to recovery is complex, often prolonged, and highly individual. Responses suggest that some injured persons need more assistance for a successful recovery than others. Those who appeared “caught in the moment” of the injury may benefit from clinical and rehabilitative management focusing on long-term recovery and acceptance of the injury event. Fiona J. Clay, Swati Shourie, Priscilla Robinson, Donna McKenzie, and Emily Kerr Copyright © 2014 Fiona J. Clay et al. All rights reserved. Effect of Box Taping as an Adjunct to Stretching-Strengthening Exercise Program in Correction of Scapular Alignment in People with Forward Shoulder Posture: A Randomised Trial Mon, 20 Jan 2014 08:54:34 +0000 Objective. The objective of this study was to provide preliminary estimates of effects of box taping as an adjunct to stretching-strengthening exercise program on scapular alignment in healthy subjects with forward shoulder posture (FSP). Methods. Sixty subjects were screened and 38 asymptomatic subjects with FSP were allocated into box taping and standard treatment group using block randomization. Both groups received a supervised stretching-strengthening exercise program and postural advice for 15 sessions over 3 weeks. In addition, box taping was applied to the intervention group. Static and dynamic scapular alignment was recorded at baseline, 7th and 15th sessions. Differences over time and between the treatment groups were determined using repeated measures of analysis of variance (ANOVA). Results. Twenty subjects completed the study. Both interventions were well tolerated and resulted in improvements in static and dynamic postural indicators over time in both groups () except for dynamic scapular alignment by the 15th session. We were under powered to detect differences between the groups (). Conclusions. This study suggests postural exercises improve scapular alignment; but a large RCT is required to determine whether the addition of box taping is indicated, and whether this preventative approach reduces the incidence of upper quarter musculoskeletal disorders. This trial is registered with CTRI/2013/10/004095. Neha Dewan, Kavitha Raja, Ganesh Balthillaya Miyaru, and Joy C. MacDermid Copyright © 2014 Neha Dewan et al. All rights reserved. Supportive Care Needs following Cancer Treatment: A Comparison of Breast and Brain Cancer in an Australian Cohort Mon, 20 Jan 2014 06:41:44 +0000 Objective. To assess and identify patient-reported supportive care needs following definitive treatment in persons with breast cancer (BC) and primary brain tumours (gliomas) (BT) in an Australian community cohort and to assess the commonalities and/or discrepancies of the reported needs in these oncological populations. Methods. A prospective cross-sectional survey of persons with BC () and BT () using questionnaires for supportive care needs, psychological morbidity, and quality of life. Results. BT participants were younger than BC patients (mean ages 51 and 57 years). The median time since diagnosis for both groups was over 2 years. The level of psychological morbidity, mainly depression, was high in both groups: BC (22%) and BT (20%). Participants in both groups reported at least one need (“met” or “unmet”). The BC patients reported higher numbers of “needs” and “unmet” needs compared with BT patients (mean 13.7 versus 11.6 needs; “unmet” needs mean 6.0 versus 4.1). The common “met” and “unmet” needs highlighted by both groups were comparable; the domain for most “met” needs included comprehensive cancer care, while “unmet” needs related to existential survivorship issues. Conclusion. Despite successful treatment many cancer survivors experience unmet supportive care needs in longer term. Understanding the impact of these beyond the acute phase is important as care shifts to community settings. More research in existential survivorship issues is needed. Bhasker Amatya, Fary Khan, Louisa Ng, and Mary Galea Copyright © 2014 Bhasker Amatya et al. All rights reserved. Differences in Symptoms among Adults with Canal versus Otolith Vestibular Dysfunction: A Preliminary Report Thu, 09 Jan 2014 14:22:40 +0000 Despite the importance of symptomatology in the diagnosis of vestibular dysfunction, the qualitative nature of the symptoms related to semicircular canal (canal) versus otolith dysfunction is not fully understood. The purpose of this study was to compare symptoms, and their severity, in individuals with canal versus otolith peripheral vestibular dysfunction. A subjective tool, the Descriptive Symptom Index (DSI), was developed to enable categorization of symptoms as rotary, linear, imbalance or falls, and nondistinct. Fourteen adults were recruited and grouped based on vestibular function testing: canal only dysfunction, otolith only dysfunction, or canal and otolith dysfunction. Also, the Dizziness Handicap Inventory (DHI) was used to grade the severity of perceived limitations due to symptoms. The DSI was reliable and differentiated those with canal (rotary symptoms) versus otolith (linear symptoms) dysfunction. Most individuals with otolith only dysfunction did not report rotary symptoms. DHI scores were significantly higher in those with otolith dysfunction, regardless of canal functional status. All who experienced falls had otolith dysfunction and none had canal only dysfunction. Results support the importance of using linear and rotary descriptors of perceived disorientation as part of diagnosing vestibular dysfunction. Lisa Farrell and Rose Marie Rine Copyright © 2014 Lisa Farrell and Rose Marie Rine. All rights reserved. Horizontal and Declined Squats in Healthy Individuals: A Study of Kinematic and Muscle Patterns Mon, 30 Dec 2013 18:40:55 +0000 Squats are frequently incorporated in physiotherapy programmes and performed in different ways. Accordingly, muscle and kinematic patterns also differ. The objective was to compare the kinematics and EMG patterns of the major muscles of knee and ankle joints during different squat exercises on horizontal (HP) and 25° decline (DP) boards. Seventeen healthy individuals performed squats on HP and DP with bilateral support and restriction of trunk movements in the sagittal plane. The knee and ankle angular displacements in the sagittal plane and the EMG activities of the major muscles of the lower limb in four subphases of movement were recorded and analyzed. For the descending phase of the HP squats, the angular excursion, as well as the initial and final positions, was smaller for the knee () but larger for the ankle (). For the ascending phase of the HP squats, the initial and final positions were larger for the ankle () and the final position was smaller for the knee (). All muscles remained activated and showed similarity between the tasks (), except for the tibialis anterior in both squat exercises (). The HP and DP squats produced different kinematics (knee and ankle joints) but did not modify the EMG strategy for both movement phases. Valdeci Carlos Dionisio, Bruna Maria Silva Azevedo, and Daniela Abrahão Siqueira Copyright © 2013 Valdeci Carlos Dionisio et al. All rights reserved. Clinical Features of Bell’s Palsy in Children and Outcomes of Physical Therapy: A Retrospective Study Thu, 26 Dec 2013 14:58:49 +0000 The aim of this study was to describe clinical features of Bell’s palsy (BP) in children and outcomes of physical therapy interventions. Medical records of 186 patients with diagnosis of BP were reviewed. The severity of facial nerve dysfunction was graded according to House Brackmann Facial Nerve Grading Scale (HB FGS). After one month, patients who had HB FGS grade three or more were included in a physical therapy programme consisting of superficial heat, massage, exercises, and electrical stimulation. Among 186 children with BP, 167 children had a severity of HB FGS grade three or more and 19 had the incomplete type at the time of the diagnosis. After one month follow-up, 144 patients fully recovered, 35 patients recovered partially, while 7 patients had no recovery. Patients who had not fully recovered one month after onset of paralysis were included in the physical therapy programme. There was statistically significant difference between pretreatment and posttreatment HB FGS scores in patients who had not fully recovered one month after onset of paralysis. We concluded that the prognosis of BP in children seems to be good with higher recovery rate and physical therapy programme might be an effective method to facilitate recovery in patients with poor prognosis. Duygu Cubukcu, Unsal Yilmaz, Hakan Alkan, Ferda Metinkisi, and Muazzez Ozcan Copyright © 2013 Duygu Cubukcu et al. All rights reserved. Psychometric Evaluation of the Perceived Stress Scale in Multiple Sclerosis Sun, 22 Dec 2013 13:04:38 +0000 Multiple sclerosis (MS) is a progressive disease characterized by neurological symptoms and sometimes heightened levels of distress. The Perceived Stress Scale (PSS) is often used in MS samples to measure stress but has not been validated in this population. Participants () completed the PSS as well as measure of depression, anxiety, and mental and physical health. Factor analyses indicated that the general factor of a bifactor model accounted for a large amount of the variance in the 14-item and 10-item versions of the PSS. The 4-item PSS had two factors, the Stress subscale and the Coping subscale, but a one-factor model also fits the data well. Total scores and both subscales had sufficient reliability and validity for all versions of the PSS, although a few items of the 14-item PSS had low item-total correlations. This study supports the use of the total score of the PSS in MS but also suggests that the 10-item PSS had better psychometric properties than the 14-item PSS. Salene M. Wu and Dagmar Amtmann Copyright © 2013 Salene M. Wu and Dagmar Amtmann. All rights reserved. An Exploratory Study of the Elements of Successful Service Dog Partnerships in the Workplace Thu, 12 Dec 2013 14:53:43 +0000 The use of service or assistance dogs has increased over the past three decades but is still considered by many to be an emerging concept for assisting people with disabilities to navigate a number of environments. This is predominately due to the minimal research that has been done on the effect and promising practices. One area, employment, has been completely overlooked in research related to service dogs. This research project undertook an exploratory study to gather data on the elements of service dog partnerships that have been successful in the workplace. A structured methodology using mixed methods was used to gather ideas from a diverse group of stakeholders, people with service dogs, trainers, vocational rehabilitation counselors, and other healthcare professionals, to form a common framework for addressing the issue in future research and development of interventions. The results identified 68 elements that respondents perceived and rated to be important or highly important to the phenomenon. They were categorized into six clusters: (1) dog preparation, (2) monitoring, (3) employee competence, (4) legal knowledge, (5) information and education, and (6) coworker preparation. The discussion identified key points that might support the development of successful employment outcomes for people working with service dogs. Margaret K. Glenn Copyright © 2013 Margaret K. Glenn. All rights reserved. Metronome-Cued Stepping in Place after Hemiparetic Stroke: Comparison of a One- and Two-Tone Beat Sun, 17 Nov 2013 14:43:48 +0000 Hemiparetic gait is characterised by temporal asymmetry and variability, and these variables are improved by auditory cueing. Stepping in place incorporates aspects of gait and may be a useful tool for locomotor training. The aim of this pilot study was to investigate the use of a single-tone and dual-tone metronome to cue stepping in place after hemiparetic stroke. Eight participants completed an uncued baseline stepping condition and two cued stepping conditions utilising a single-tone and a dual-tone metronome. Step times were determined from force plate data, and asymmetry and variability were calculated for the three conditions. Step time asymmetry was significantly reduced in the single-tone condition compared to baseline, and paretic step time variability was significantly reduced in both cued conditions. The single-tone metronome appeared to be preferred to the dual-tone metronome based on participant feedback. The results of this pilot study suggest that metronome cueing produces similar benefits on stepping in place to previously reported findings in walking. Further research on whether stepping in place to a metronome can be used for locomotor training is needed. Rachel L. Wright, Afia Masood, Elinor S. MacCormac, David Pratt, Catherine M. Sackley, and Alan M. Wing Copyright © 2013 Rachel L. Wright et al. All rights reserved. Rehabilitation of Back Extensor Muscles' Inhibition in Patients with Long-Term Mechanical Low-Back Pain Tue, 27 Aug 2013 15:56:47 +0000 This study investigated the effect of static or dynamic back extensors endurance exercise in combination with McKenzie Protocol (MP) in patients with Long-term Mechanical Low-Back Pain (LMLBP). This randomized controlled trial involved 84 patients, who were assigned into MP Group (MPG), MP plus Static Back Extensors Endurance (SBEE) Exercise Group (MPSBEEG), or MP plus Dynamic Back Extensors’ Endurance (DBEE) Exercise Group (MPDBEEG). Twenty-five, 22, and 20 participants in MPG, MPSBEEG, and MPDBEEG, respectively, completed the thrice weekly eight-week study (drop-out rate = 20.2%) and outcomes were measured in terms of SBEE, DBEE, and Back Muscles Fatigue (BMF) at the 4th and 8th week, respectively. There were significant differences in groups mean change scores on SBEE (, and  sec), DBEE (, , and rep), and BMF (, , and ) at week 4, and SBEE (, , and  sec), DBEE (, , and reps), BMF (, , and ) at week 8, respectively (). It was concluded that MP alone, or in combination with SBEE or DBEE, exercise was effective in the rehabilitation of back extensors’ endurance and fatigability in patients with LMLBP. However, the addition of SBEE to MP led to significantly higher positive effects. Chidozie Emmanuel Mbada, Olusola Ayanniyi, Samuel Olusegun Ogunlade, Elkanah Ayodele Orimolade, Ajibola Babatunde Oladiran, and Abiola Oladele Ogundele Copyright © 2013 Chidozie Emmanuel Mbada et al. All rights reserved. Risk Factors for Falls and Fragility Fractures in Community-Dwelling Seniors: A One-Year Prospective Study Mon, 19 Aug 2013 11:37:51 +0000 Objective. To evaluate risk factors for falls and fragility fractures in healthy seniors. Methods. Assessing 50 ambulatory community-dwelling volunteers ≥65 for demographics, BMI, bone mineral density (BMD) (DEXA), fracture risk (FRAX), balance (Biodex), fear of falling (Modified Falls Efficacy Scale (MFES)), and activity level (RAPA). One-year followup was done through phone interviews. Results. Most participants (17 males, 33 females; mean age years) had normal BMD and were active with little to no fear of falling. Balance did not correlate with FRAX or fear of falling. Activity level did not correlate with FRAX, but the active group had less fear of falling. Most scored below age specific norms on balance testing. Fear of falling was not significantly different between genders but did correlate with FRAX, indicating that patients with higher fracture risk were also more afraid of falling. Individuals who fell after one year had increased fear of falling and decreased activity levels. Conclusions. Community-dwelling seniors with higher risk of future fractures were more afraid of falling. Although healthy and active, this cohort had poor balance compared to age matched norms. Further research on how to best assess fall risk and improve balance to prevent fractures is needed. Sacha Song, Joy C. MacDermid, and Ruby Grewal Copyright © 2013 Sacha Song et al. All rights reserved. Clinical Characteristics and Course of Patients Entering Cardiac Rehabilitation with Chronic Kidney Disease: Data from the Italian Survey on Cardiac Rehabilitation Sun, 21 Jul 2013 08:28:30 +0000 This survey shows the clinical risk profile, resource utilization, pharmacologic treatment, and course of cardiac rehabilitation (CR) programs in patients with chronic kidney disease (CKD). Data from 165 CR units in Italy were collected online from January 28 to February 10, 2008. The study cohort consisted of 2281 patients: 200 CKD patients and 2081 non-CKD patients. CKD patients were older and showed more comorbidity and complications during CR, a more complex clinical course and interventions with less functional evaluation, and a different pattern of drug therapy at hospital discharge. CKD patients had higher mortality during CR programs due to heart failure, respiratory insufficiency, and cognitive impairment. These findings suggest that patients with CKD should not be denied access to CR, provided careful attention to clinical status, possible complications, optimization of drug therapy, and close followup. Francesco Giallauria, Francesco Fattirolli, Roberto Tramarin, Marco Ambrosetti, Raffaele Griffo, Carmine Riccio, and Carlo Vigorito Copyright © 2013 Francesco Giallauria et al. All rights reserved. Elder Chinese Martial Art Practitioners Have Higher Radial Bone Strength, Hand-Grip Strength, and Better Standing Balance Control Tue, 09 Jul 2013 13:09:35 +0000 This study explored the feasibility of using Ving Tsun (VT) martial art as a fall-prevention exercise for male seniors. We compared the radial bone strength, hand-grip strength, and standing balance control of senior VT practitioners and nonpractitioners under various sensory environments. Sixteen male VT practitioners (mean age ± SD: years) and 17 sex- and age-matched control adults (mean age ± SD: years) participated in the study. The bone strength of the distal radius, hand-grip strength, and standing balance control were assessed using an ultrasound bone sonometer, a Jamar dynamometer, and sensory organization test (SOT) on the NeuroCom Balance Master, respectively. A multivariate analysis of variance (MANOVA) was used to compare the outcome variables between the two groups. Results revealed that VT practitioners had significantly higher radial bone strength (-score) on the dominant side (), hand-grip strength (dominant side, ; nondominant side, ), and standing balance control (SOT composite equilibrium score, ) than the control participants. Male elder VT practitioners had higher radial bone strength, hand-grip strength, and better standing balance control than nonpractitioners. Our findings shed light on the use of VT exercise to prevent falls and fall-related fractures of the distal radius in male elders. Shirley S. M. Fong, X. Guo, Alice P. M. Cheung, Alex T. L. Jo, Gary K. W. Lui, Dennis K. C. Mo, Shamay S. M. Ng, and William W. N. Tsang Copyright © 2013 Shirley S. M. Fong et al. All rights reserved. First-Year Outcomes after Stroke Rehabilitation: A Multicenter Study in Thailand Sun, 07 Jul 2013 09:56:10 +0000 Stroke affects the long-term quality of life and the well-being of patients and families. Stroke patients gain benefits from rehabilitation. Authors reported 1-year outcomes of stroke rehabilitation in 327 patients registered to the Thai Stroke Rehabilitation Registry. The outcomes included death rate, readmission rate, functional ability score (Barthel Index, BI), and factors affecting BI score. Of 327 patients, 214 (65.4%) had adequate follow-up data for analysis. The average age was 62.1 ± 12.5 years, and 57.9% were male. The mortality rate was 2.5% and the readmission rate was 11.2%. The number of the patients who could function independently increased from 5.5% at discharge to 22.9% and 25.5% at month 6 and month 12, respectively. The change in functional ability level of 214 patients included improvement (51.5%), deterioration (12.8%), and equivocal (35.7%). The low functional score at month 12 was significantly correlated with longer length of stay (LOS), longer onset to admission interval, and higher depression score at month-12. In conclusion, approximately half of the patients had an improvement in the disability level for at least one grade at 1-year follow-up. The low functional score by the end of the first year is associated with longer LOS during the first admission, delay in rehabilitation program, and psychological depression. Vilai Kuptniratsaikul, Apichana Kovindha, Krisna Piravej, and Piyapat Dajpratham Copyright © 2013 Vilai Kuptniratsaikul et al. All rights reserved. Can Written Disclosure Reduce Psychological Distress and Increase Objectively Measured Injury Mobility of Student-Athletes? A Randomized Controlled Trial Wed, 26 Jun 2013 08:04:19 +0000 Injured students-athletes took part in a randomized controlled trial to test whether written disclosure could reduce psychological distress and improve injury mobility. Writing took place alongside prescribed physical rehabilitation and consisted of three 20-minute writing sessions, once a week for three consecutive weeks. Participants in the experimental injury-writing group followed a structured form of written disclosure, called the guided disclosure protocol (GDP). They firstly, wrote about the onset of their injury in a chronological manner, secondly, they explicitly labelled their emotions and described the impact of the injury, finally they wrote about future coping and psychological growth. Controls wrote about nonemotional and noninjury related topics. In addition to self-report measures, a physiotherapist, blind to experimental condition, assessed mobility at the injury site. Although self-report indices remained unchanged, the GDP group evidenced a significant improvement in injury mobility compared to controls. Elaine Duncan, Yori Gidron, and David Lavallee Copyright © 2013 Elaine Duncan et al. All rights reserved. In Vivo Identification of Skeletal Muscle Dynamics with Nonlinear Kalman Filter: Comparison between EKF and SPKF Sun, 02 Jun 2013 10:31:04 +0000 Skeletal muscle system has nonlinear dynamics and subject-specific characteristics. Thus, it is essential to identify the unknown parameters from noisy biomedical signals to improve the modeling accuracy in neuroprosthetic control. The objective of this work is to develop an experimental identification method for subject-specific biomechanical parameters of a physiological muscle model which can be employed to predict the nonlinear force properties of stimulated muscle. Our previously proposed muscle model, which can describe multiscale physiological system based on the Hill and Huxley models, was used for the identification. The identification protocols were performed on two rabbit experiments, where the medial gastrocnemius was attached to a motorized lever system to record the force by the nerve stimulation. The muscle model was identified using nonlinear Kalman filters: sigma-point and extended Kalman filter. The identified model was evaluated by comparison with experimental measurements in the cross-validation manner. The feasibility could be demonstrated by comparison between the estimated parameter and the measured value. The estimates with SPKF showed 5.7% and 2.9% error in each experiment with 7 different initial conditions. It reveals that SPKF has great advantage especially for the identification of multiscale muscle model which accounts for the high nonlinearity and discontinuous states between muscle contraction and relaxation process. Mitsuhiro Hayashibe, David Guiraud, and Philippe Poignet Copyright © 2013 Mitsuhiro Hayashibe et al. All rights reserved. Quality of Life in Mothers of Children with Cerebral Palsy Thu, 16 May 2013 16:18:14 +0000 Objective. To investigate health-related quality of life (HRQoL) in mothers of children with cerebral palsy (CP) and to determine factors into HRQoL. Materials and Method. Participants comprised 137 mothers of children with spastic-type CP, and controls comprised 140 mothers with healthy children. Functional levels of children with CP were evaluated using Gross Motor Function Classification System (GMCFS). HRQoL of mothers with CP children and control groups was assessed with 36-Item Short-Form Health Survey (SF-36) and depression levels with Beck Depression Inventory (BDI). Results. Social function, mental health, role limitation emotional, and vitality as subscale of mental component of SF-36 were found to be lower in CP children’s mothers than controls. BDI scores were higher in CP children’s mothers than controls. Among mothers with CP children, a negative correlation was detected between BDI scores and all subscale scores of SF-36 and age rate of mothers and physical function, bodily pain, and physical component scale scores, among subscales of SF-36. Conclusion. Our study indicates that HRQoL is impaired in CP children’s mothers, and depression is a significant symptom affecting HRQoL of mothers with CP children. Therefore, to increase HRQoL, mothers of children with CP should be motivated to join social activities related to their interests, and mothers with depressive symptoms should be psychologically supported. Halim Yilmaz, Gulten Erkin, and Alparslan Ali İZKİ Copyright © 2013 Halim Yilmaz et al. All rights reserved. Gait Performance and Lower-Limb Muscle Strength Improved in Both Upper-Limb and Lower-Limb Isokinetic Training Programs in Individuals with Chronic Stroke Thu, 02 May 2013 10:09:10 +0000 Background. Limited improvement in gait performance has been noted after training despite a significant increase in strength of the affected lower-limb muscles after stroke. A mismatch between the training program and the requirements of gait could explain this finding. Objective. To compare the impact of a training program, matching the requirements of the muscle groups involved in the energy generation of gait, to a control intervention, on gait performance and strength. Methods. 30 individuals with chronic stroke were randomly assigned into two groups (n = 15), each training three times/week for six weeks. The experimental group trained the affected plantarflexors, hip flexors, and extensors, while the control group trained the upper-limb muscles. Baseline and posttraining values of gait speed, positive power (muscles’ concentric action during gait), and strength were retained and compared between groups. Results. After training, both groups showed a similar and significant increase in gait speed, positive power of the hip muscles, and plantarflexors strength. Conclusion. A training program targeting the lower-limb muscles involved in the energy generation of gait did not lead to a greater improvement in gait performance and strength than a training program of the upper-limb muscles. Attending the training sessions might have been a sufficient stimulus to generate gains in the control group. Marie-Hélène Milot, Sylvie Nadeau, Denis Gravel, and Daniel Bourbonnais Copyright © 2013 Marie-Hélène Milot et al. All rights reserved. Assessing the Discriminative Ability and Internal Consistency of the School Outcomes Measure Thu, 04 Apr 2013 14:08:13 +0000 The School Outcomes Measure (SOM) measures the outcomes of students who receive school-based occupational and physical therapies in the USA. This study examined the SOM’s discriminative ability and internal consistency. Descriptive data from a previous study of 73 students, classified by gross motor function classification (GMFCS) level of disability, was computed to determine the frequency of use of the SOM items and differences in subscale scores by students with various ages and levels of disability. There were no differences in mean subscale scores based on age; however students with less severe disabilities (GMFCS I–III) had higher mean scores in all subscales except expresses learning all students and behavior. Cronbach’s alpha coefficient was used to examine the internal consistency of items of the SOM. The correlations between many of the items within the subscales were high (.87–.99). Lower alpha coefficients were noted when the SOM was applied to students in GMFCS Levels II and III on two subscales when compared to GMFCS Levels I, IV, and V. On the basis of this evaluation, we revised the SOM to prepare it for a national field testing to measure its construct validity. Sandra H. Arnold, Thubi H. A. Kolobe, David M. Thompson, and Lindsay Boeckman Copyright © 2013 Sandra H. Arnold et al. All rights reserved. The Influence of Self-Efficacy on Mood States in People with Spinal Cord Injury Wed, 06 Mar 2013 11:42:52 +0000 Objective. Negative mood is prevalent in people with a neurological injury such as spinal cord injury (SCI). However, research is needed for determining those people with SCI who are vulnerable to negative mood states, as well as establishing the influence of self-efficacy, that is, expectations of their control over their lives. The objective of this research was to investigate the protective role that self-efficacy may play in adult people with SCI compared to able-bodied controls. Methods. Participants included 41 adults with SCI living in the community and 41 able-bodied controls similar in age, sex ratio, and education. All participants completed a psychological assessment regimen in a relaxed environment. Measures consisted of validated measures of self-efficacy and negative mood states. Results. The SCI group was found to have significantly elevated levels of depressive mood, anxiety, stress, and poor self-efficacy. SCI participants with low levels of self-efficacy were shown to have significantly elevated levels of depressive mood and anxiety in comparison to those SCI participants with high levels of self-efficacy and able-bodied controls. Conclusions. People with a neurological injury such as SCI are vulnerable to experiencing clinically elevated negative mood states if they have poor expectations of control over their lives. Implications for SCI rehabilitation are discussed. Ashley Craig, Nirupama Wijesuriya, and Yvonne Tran Copyright © 2013 Ashley Craig et al. All rights reserved. An Overview of Cognitive Remediation Therapy for People with Severe Mental Illness Sun, 03 Feb 2013 08:55:58 +0000 Cognitive remediation refers to nonpharmacological methods of improving cognitive function in people with severe mental disorders. Cognitive remediation therapy (CRT) can be delivered via computerised programs, of varying length and complexity, or can be undertaken one-on-one by a trained clinician. There has been a considerable interest in cognitive remediation, driven by recognition that cognitive deficits are a major determinant of outcome in people with severe, chronic mental illnesses. CRT has been shown to be effective, especially if combined with vocational rehabilitation. Cherrie Galletly and Ashlee Rigby Copyright © 2013 Cherrie Galletly and Ashlee Rigby. All rights reserved. Rehabilitation Considerations for Children Dependent on Long-Term Mechanical Ventilation Mon, 24 Dec 2012 15:53:39 +0000 The purposes of this paper are as follows (1) to describe the prevalence, etiology, and care settings for children dependent on long-term mechanical ventilation (MV); (2) to provide a brief introduction to MV and weaning; (3) to explore health care utilization and cost of care; and, primarily, (4) to discuss the rehabilitation needs of children dependent on long-term MV including activities of daily living, mobility, communication, psychosocial needs, and recreation and leisure. Children with ventilator dependence are a growing segment of the population of children with special health care needs and often require rehabilitation services. MV is a form of life-saving technology that substitutes for or assists a child’s respiratory efforts. Goals for use of MV vary and there are many combinations of MV elements that can obtain desirable results. No standards of care exist for the rehabilitation examination or interventions utilized for children with long-term MV dependence and it remains unclear what effect MV has on the achievement of developmental milestones, daily activities, and participation in daily life. Helene M. Dumas Copyright © 2012 Helene M. Dumas. All rights reserved. Intratherapist Reliability in the Rating of Scapula Posture in Multiple Planes of Reference Mon, 10 Dec 2012 08:03:41 +0000 Background. Evaluation of scapular posture is a fundamental component in the clinical evaluation of the upper quadrant. This study examined the intrarater reliability of scapular posture ratings. Methods. A test-retest reliability investigation was undertaken with one week between assessment sessions. At each session physical therapists conducted visual assessments of scapula posture (relative to the thorax) in five different scapula postural planes (plane of scapula, sagittal plane, transverse plane, horizontal plane, and vertical plane). These five plane ratings were performed for four different scapular posture perturbating conditions (rest, isometric shoulder; flexion, abduction, and external rotation). Results. A total of 100 complete scapular posture ratings (50 left, 50 right) were undertaken at each assessment. The observed agreement between the test and retest postural plane ratings ranged from 59% to 87%; 16 of the 20 plane-condition combinations exceeded 75% observed agreement. Kappa (and prevalence adjusted bias adjusted kappa) values were inconsistent across the postural planes and perturbating conditions. Conclusions. This investigation generally revealed fair to moderate intrarater reliability in the rating of scapular posture by visual inspection. However, enough disagreement between assessments was present to warrant caution when interpreting perceived changes in scapula position between longitudinal assessments using visual inspection alone. Steven M. McPhail, Lars Nagelstad Dalland, Kaja Naess, Marte Lund, Tore Johan Ytre-Hauge, Sigrid Reiersen Holm, and Shaun O'Leary Copyright © 2012 Steven M. McPhail et al. All rights reserved. Exploring the Causes of Neck Pain and Disability as Perceived by Those Who Experience the Condition: A Mixed-Methods Study Wed, 14 Nov 2012 12:02:11 +0000 Designing effective treatment protocols for neck-related disability has proven difficult. Disability has been examined from structural, emotional, and cognitive perspectives, with evidence supporting a multidimensional nature. The patient’s perspective of their condition has found increasing value for patient-centred, evidence-informed care. This cross-sectional study utilized descriptive thematic analysis to examine perceptions of causation in 118 people with neck pain. The Brief Illness Perceptions Questionnaire was used to capture perceptions of causation for neck pain symptoms. The Neck Disability Index, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale, and the P4 pain intensity numeric rating scale were also collected. Eight main themes were found for the cause(s) of neck pain: posture and movement, structure and mechanism, emotions, predisposition and lifestyle, symptoms, fatigue and insomnia, treatment, and environment. A series of regression models stratified by perceived cause suggested that disability could be explained by different constructs across the larger of the main themes. The findings are discussed in terms of the false view that mechanical neck pain should be considered a homogenous condition and potential application to treatment decision making based on patient perspectives. David M. Walton, Bradley Balsor, and Evelyn Etruw Copyright © 2012 David M. Walton et al. All rights reserved. Effects and Adherence of Mirror Therapy in People with Chronic Upper Limb Hemiparesis: A Preliminary Study Wed, 14 Nov 2012 11:35:44 +0000 Mirror therapy is a promising therapy with some benefit for motor recovery in people with chronic hemiparesis. However, there has been little investigation on the effect on upper limb sensory impairments, activity limitations, and participation restrictions. A within-subject, repeated-measures study with 12 people with chronic hemiparesis was conducted. Participants underwent a thirty minute sensorimotor mirror therapy home-based exercise program, conducted three times per week for six weeks. Compliance with the program and the effect on sensory outcomes were determined. Light touch threshold and proprioceptive error, upper limb activity limitations, and participation restrictions were measured at baseline (Week 0), immediately after (Week 6), and six weeks (Week 12) following the intervention. Compliance with the program was fair, 66% of supervised and 62% of unsupervised sessions were completed. The paretic hand performed worse compared to nonparetic hand at baseline with no difference in sensory measures demonstrated over time. Activity limitations and participation restrictions improved by Week 12 (). This sensorimotor mirror therapy home-based exercise program showed small improvements in light touch threshold and proprioception that appear to be functionally important for this group of people with chronic hemiparesis. Mirror therapy may be a useful tool for clinicians particularly for patient independent use. Suzanne S. Kuys, Tara Edwards, and Norman R. Morris Copyright © 2012 Suzanne S. Kuys et al. All rights reserved. Proprioceptive Neuromuscular Facilitation Improves Balance and Knee Extensors Strength of Older Fallers Wed, 14 Nov 2012 11:33:27 +0000 Falls are one of the major problems for elderly people and proprioceptive exercises have been suggested as an alternative in rehabilitation and preventive programs. The purpose of this study was to investigate the influence of a proprioceptive neuromuscular facilitation (PNF) exercise program on balance, knee extension and flexion isometric torque, and knee extension rate of force development (RFD). Fourteen older faller subjects (>60 years) were equally assigned into two groups: a control group (CG: ) and a training group (TG: ). The PNF training program was performed for 10 weeks on TG, with a frequency of three times per week. Patients were assessed before and after the PNF program, with respect to balance (Berg Balance Scale score—BBS), knee maximal isometric extension and flexion torque, knee extensor RFD, and knee extensors and flexors neuromuscular activation level and coactivation level around the knee. After 10 weeks, balance () and knee extension torque () were improved in TG while no differences were found for CG. These improvements were mainly attributed to central nervous system adaptations, since no differences were found for neuromuscular activation level and coactivation. Marcelo Pinto Pereira and Mauro Gonçalves Copyright © 2012 Marcelo Pinto Pereira and Mauro Gonçalves. All rights reserved. Long-Term Multimodal Exercise Program Enhances Mobility of Patients with Parkinson’s Disease Wed, 14 Nov 2012 10:19:24 +0000 Objective. This study aimed to evaluate the effect of a long-period multimodal exercise program on balance, mobility and clinical status of patients with Parkinson’s disease (PD). Methods. Thirty-three PD patients were assigned into two groups: a training group (; aged years) and a control group (; aged years). The TG patients were enrolled in a 6-month multimodal exercise program. This program was designed to improve physical capacity components and to reduce PD impairments. Balance and mobility were assessed immediately before and after the training protocol using the Berg Balance Scale (BBS), the “Timed up and go” (TUG), and the Posture Locomotion Test (PLM). Also, clinical variables were assessed (disease stage and impairments). Results. The TG showed an improvement in the TUG () while CG were not influenced by the 6-months period. Both groups showed no differences for BBS and PLM and for their disease impairments—assessed through the Unified Parkinson’s disease Scale. Conclusions. Long-term multimodal exercise programs are able to improve mobility of patients with Parkinson’s disease and therefore should be used on clinical day life. Marcelo Pinto Pereira, Maria Dilailça Trigueiro de Oliveira Ferreira, Maria Joana Duarte Caetano, Rodrigo Vitório, Ellen Lirani-Silva, Fabio Augusto Barbieri, Florindo Stella, and Lilian Teresa Bucken Gobbi Copyright © 2012 Marcelo Pinto Pereira et al. All rights reserved. Coping with a Lower Limb Amputation due to Vascular Disease in the Hospital, Rehabilitation, and Home Setting Wed, 14 Nov 2012 09:54:18 +0000 Objectives. To explore the coping strategies used following a lower limb amputation and their relationship to adjustment in the hospital, rehabilitation, and home setting. Method. Sixteen individuals who had a lower limb amputation due to vascular disease completed questionnaires, including the Ways of Coping Questionnaire (WCQ), during hospitalization (T1), at the end of rehabilitation (T2), and 2-3 months after discharge from rehabilitation (T3). A subsample () also participated in three semistructured interviews analyzed using the approach of Miles and Huberman. Results. Self-controlling was the coping strategy used most, followed by seeking social support and positive reappraisal. Three additional coping strategies not found in the WCQ were identified in the qualitative data: noticing progress, learning new things, and using humor. Confrontive coping (T1) and escape-avoidance (T1, T2, and T3) were related to adjustment problems while positive reappraisal (T1 and T3), seeking social support (T1 and T3), and planful problem solving (T3) were associated with positive adjustment. Conclusion. Coping strategies used to deal with the amputation seem to vary across settings, thus signifying the complexity of the coping process following a lower limb amputation due to vascular disease. Mélanie Couture, Johanne Desrosiers, and Chantal D. Caron Copyright © 2012 Mélanie Couture et al. All rights reserved. Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulitis Wed, 24 Oct 2012 09:49:26 +0000 Objective. To study the effectiveness of Maitland techniques in the treatment of idiopathic shoulder adhesive capsulitis. Methods. total of 40 patients diagnosed with idiopathic shoulder adhesive capsulitis were recruited and randomly allocated into two groups. In Group A () subjects were treated with Maitland mobilization technique and common supervised exercises, whereas subjects in Group B () only received common supervised exercises. Variables. Shoulder pain and disability index (SPADI), VAS and shoulder ROM (external rotation and abduction) were variables of the study. These were recorded before and after the session of the training. Total duration of the study was four weeks. Result. Statistical analysis of the data revealed that within-group comparison both groups showed significant improvement for all the parameters, whereas between-group comparison revealed higher improvement in Group A compared to the Group B. Conclusion. The study confirmed that addition of the Maitland mobilization technique with the combination of exercises have proved their efficacy in relieving pain and improving R.O.M. and shoulder function and hence should form a part of the treatment plan. Abhay Kumar, Suraj Kumar, Anoop Aggarwal, Ratnesh Kumar, and Pooja Ghosh Das Copyright © 2012 Abhay Kumar et al. All rights reserved.