Rehabilitation Research and Practice The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Development and Initial Psychometric Evaluation of the Post-Acute Acuity Rating for Children Mon, 02 Nov 2015 11:59:21 +0000 The Post-Acute Acuity Rating for Children (PAARC) is the first known acuity rating intended to reflect medical severity based on age, reason for admission, diagnoses, dependence in activities of daily living, and technology reliance for children admitted to post-acute care rehabilitation hospitals. Content validity was tested using an expert panel scoring the Content Validity Index (CVI). Concurrent validity was examined using clinician’s opinion of acuity at admission, the Complexity Index, and All Patient Refined Diagnosis Related Group (APR-DRG) codes. Predictive validity was examined with acute care readmission within 30 days. Interrater reliability was assessed using admission histories from closed cases. Content validity was established and concurrent validity was moderate to high with clinician opinion (rho = .76, ), the Complexity Index (rho = .76, ), and APR-DRGs (rho = .349, ). Predictive validity was moderate (rho = .504, ) and returns to acute care within 30 days. Interrater reliability was excellent (ICC = 0.97; 95% CI = 0.92–0.90, ). Experts agreed that the PAARC’s content is relevant, simple, and representative of the population. The PAARC measured well against indicators of medical complexity for pediatric outpatient care and medical record coding and was reliable between raters. This work supports proceeding with additional development and validity testing of the PAARC. Jane E. O’Brien and Helene M. Dumas Copyright © 2015 Jane E. O’Brien and Helene M. Dumas. All rights reserved. Effects of Functional Limb Overloading on Symmetrical Weight Bearing, Walking Speed, Perceived Mobility, and Community Participation among Patients with Chronic Stroke Tue, 27 Oct 2015 08:37:01 +0000 Background. Stroke is a leading cause for long-term disability that often compromises the sensorimotor and gait function accompanied by spasticity. Gait abnormalities persist through the chronic stages of the condition and only a small percentage of these persons are able to walk functionally in the community. Material and Method. Patients with chronic stroke were recruited from outpatient rehabilitation unit at Department of Neurology & Neurosurgery, All India Institute of Medical Sciences, having a history of first stroke at least six months before recruitment, with unilateral motor deficits affecting gait. The patients were randomly assigned to either the functional limb overloading (FLO) or Limb Overloading Resistance Training (LORT) group and provided four weeks of training. Result. We found that there was an improvement in gait performance, weight bearing on affected limb, and perceived mobility and community participation. Conclusion. To the best of our knowledge, this is the first study that has evaluated the effects of functional limb overloading training on symmetric weight bearing, walking ability, and perceived mobility and participation in chronic hemiplegic population. The study demonstrated a beneficial effect of training on all the outcomes, suggesting that the functional limb overloading training can be a useful tool in the management of gait problems in chronic stroke patients. Sami S. Alabdulwahab, Fuzail Ahmad, and Harpreet Singh Copyright © 2015 Sami S. Alabdulwahab et al. All rights reserved. Randomized, Placebo-Controlled, Double-Blind Pilot Study of D-Cycloserine in Chronic Stroke Mon, 26 Oct 2015 08:12:01 +0000 Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment. N-Methyl-D-aspartate receptors (NMDA-R) have been shown to play a role in synaptic plasticity when activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory. We hypothesized that D-cycloserine, when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants () were randomized to D-cycloserine plus RAP or placebo plus RAP. Functional, cognitive, and quality-of-life measures were used to assess recovery. There was significant improvement in grip strength of the affected hand within both groups from baseline to 3 weeks (95% confidence interval for mean change, 3.95 ± 2.96 to 4.90 ± 3.56 N for D-cycloserine and 5.72 ± 3.98 to 8.44 ± 4.90 N for control). SIS mood domain showed improvement for both groups (95% confidence interval for mean change, 72.6 ± 16.3 to 82.9 ± 10.9 for D-cycloserine and 82.9 ± 13.5 to 90.3 ± 9.9 for control). This preliminary study does not provide evidence that D-cycloserine can provide greater gains in learning compared with placebo for stroke survivors. Andrew J. Butler, Justiss Kallos, Stephen N. Housley, Michelle C. LaPlaca, Stephen F. Traynelis, and Steven L. Wolf Copyright © 2015 Andrew J. Butler et al. All rights reserved. Prediction of Advisability of Returning Home Using the Home Care Score Tue, 29 Sep 2015 12:02:16 +0000 Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care. Akiyoshi Matsugi, Keisuke Tani, Yoshiki Tamaru, Nami Yoshioka, Akira Yamashita, Nobuhiko Mori, Kosuke Oku, Masashi Ikeda, and Kiyoshi Nagano Copyright © 2015 Akiyoshi Matsugi et al. All rights reserved. Perceptions of Participants in a Group, Community, Exercise Programme for People with Multiple Sclerosis Sun, 27 Sep 2015 09:00:08 +0000 Purpose. The purpose of this study was to explore the perceptions of people with multiple sclerosis of a community based, group exercise programme. Method. A pragmatic programme evaluation approach using qualitative research design was adopted. Focus groups were used to gather data from 14 participants who had taken part in a RCT of community based exercise interventions for PwMS who used at most a stick to walk outdoors. Data were transcribed verbatim and thematic analysis was used to first identify categories and then to group them into themes. Results. Three themes emerged, psychological benefits, physical benefits, and knowledge gained. The psychological benefits included the role of the group as a social and motivational factor, empowerment, confidence, hope, sense of achievement, and pride. Physical benefits were improved energy and reduced fatigue and improved ability and participation. Knowledge gained caused a shift from thoughts that exercise might do harm, to sufficient knowledge that would give participants confidence to exercise themselves. The role of the group was a key element in the positive outcomes. Conclusions. The qualitative analysis supports the findings of the main trial confirming positive effects of community exercise interventions by reducing the impact of MS and fatigue and improving participation. Rosemary Clarke and Susan Coote Copyright © 2015 Rosemary Clarke and Susan Coote. All rights reserved. Effect of a Home-Based Virtual Reality Intervention for Children with Cerebral Palsy Using Super Pop VR Evaluation Metrics: A Feasibility Study Thu, 17 Sep 2015 11:50:12 +0000 Objective. The purpose of this pilot study was to determine whether Super Pop VR, a low-cost virtual reality (VR) system, was a feasible system for documenting improvement in children with cerebral palsy (CP) and whether a home-based VR intervention was effective. Methods. Three children with CP participated in this study and received an 8-week VR intervention (30 minutes × 5 sessions/week) using the commercial EyeToy Play VR system. Reaching kinematics measured by Super Pop VR and two fine motor tools (Bruininks-Oseretsky Test of Motor Proficiency second edition, BOT-2, and Pediatric Motor Activity Log, PMAL) were tested before, mid, and after intervention. Results. All children successfully completed the evaluations using the Super Pop VR system at home where 85% of the reaches collected were used to compute reaching kinematics, which is compatible with literature using expensive motion analysis systems. Only the child with hemiplegic CP and more impaired arm function improved the reaching kinematics and functional use of the affected hand after intervention. Conclusion. Super Pop VR proved to be a feasible evaluation tool in children with CP. Yuping Chen, Sergio Garcia-Vergara, and Ayanna M. Howard Copyright © 2015 Yuping Chen et al. All rights reserved. The Canadian Cardiac Rehabilitation Registry: Inaugural Report on the Status of Cardiac Rehabilitation in Canada Tue, 18 Aug 2015 09:08:00 +0000 Introduction. There are over 200 Cardiovascular Rehabilitation (CR) programs in Canada, providing services to more than 50,000 new patients annually. The objective of this study was to describe the impact of CR in Canada. Methods. A retrospective analysis of Canadian CR Registry data is presented. There were 12 programs participating, with 4546 CR participants. Results. The average wait time between patient referral and CR admission was 68 ± 64 days. Participants were 66.3 ± 11.5 years old, 71% male, and 82% White. The three leading referral events were coronary artery bypass graft surgery, percutaneous coronary intervention, and acute coronary syndrome. At discharge, data were available for ~90% of participants. Significant improvements in blood pressure (systolic pre-CR 123.5 ± 17.0, post-CR 121.5 ± 15.8 mmHg; ), lipids, adiposity, and exercise capacity (peak METs pre-CR 6.5 ± 2.8, post-CR 7.2 ± 3.1; ) were observed. However, target attainment for some risk factors was suboptimal. Conclusions. This report provides the first snapshot of the beneficial effects of CR in Canada. Not all patients are equally represented in these programs, however, leaving room for more referral of diverse patients. Greater attainment of risk reduction targets should be pursued. Sherry L. Grace, Trisha L. Parsons, Kristal Heise, and Simon L. Bacon Copyright © 2015 Sherry L. Grace et al. All rights reserved. Subjective Experiences of Speech and Language Therapy in Patients with Parkinson’s Disease: A Pilot Study Wed, 08 Jul 2015 09:14:07 +0000 Purpose. Parkinson’s disease can produce a range of speech-language pathologies, which may require intervention. While evaluations of speech-language therapy have been undertaken, no work has been undertaken to capture patients’ experiences of therapy. This was the aim of the present study. Methods. Semistructured interviews, using themes derived from the literature, were conducted with nine Parkinson’s disease patients, all of whom had undergone speech-language therapy. Participants’ responses were analysed in accordance with Thematic Network Analysis. Results. Four themes emerged: emotional reactions (frustration, embarrassment, lack of confidence, disappointment, and anxiety); physical impact (fatigue, breathing and swallowing, and word production); practical aspects (cost of treatment, waiting times, and the actual clinical experience); and expectations about treatment (met versus unmet). Conclusions. While many benefits of speech-language therapy were reported, several negative issues emerged which could impact adversely on rehabilitation. Parkinson’s disease is associated with a range of psychological and physical sequelae, such as fatigue and depression; recognising any individual experiences which could exacerbate the existing condition and incorporating these into treatment planning may improve rehabilitation outcomes. Laura Spurgeon, Carl E. Clarke, and Cath Sackley Copyright © 2015 Laura Spurgeon et al. All rights reserved. Sensory Feedback Training for Improvement of Finger Perception in Cerebral Palsy Mon, 01 Jun 2015 11:44:21 +0000 Purpose. To develop and to test a feedback training system for improvement of tactile perception and coordination of fingers in children and youth with cerebral palsy. Methods. The fingers of 7 probands with cerebral palsy of different types and severity were stimulated using small vibration motors integrated in the fingers of a hand glove. The vibration motors were connected through a microcontroller to a computer and to a response 5-button keyboard. By pressing an appropriate keyboard button, the proband must indicate in which finger the vibration was felt. The number of incorrect responses and the reaction time were measured for every finger. The perception and coordination of fingers were estimated before and after two-week training using both clinical tests and the measurements. Results. Proper functioning of the developed system in persons with cerebral palsy was confirmed. The tactile sensation of fingers was improved in five of seven subjects after two weeks of training. There was no clear tendency towards improvement of selective use of fingers. Conclusion. The designed feedback system could be used to train tactile perception of fingers in children and youth with cerebral palsy. An extensive study is required to confirm these findings. Tobias Blumenstein, Ana Alves-Pinto, Varvara Turova, Simon Aschmann, Ines Lützow, and Renée Lampe Copyright © 2015 Tobias Blumenstein et al. All rights reserved. Subjective Visual Vertical during Caloric Stimulation in Healthy Subjects: Implications to Research and Neurorehabilitation Tue, 26 May 2015 08:01:08 +0000 Background. The subjective visual vertical (SVV) is a perception often impaired in patients with neurologic disorders and is considered a sensitive tool to detect otolithic dysfunctions. However, it remains unclear whether the semicircular canals (SCCs) are also involved in the visual vertical perception. Objective. The aim of this study was to analyze the influence of horizontal SCCs on SVV by caloric stimulation in healthy subjects. Methods. SVV was performed before and during the ice-cold caloric stimulation (4°C, right ear) in 30 healthy subjects. Results. The mean SVV tilts before and during the caloric stimulation were 0.31° ± 0.39 and −0.28° ± 0.40, respectively. There was no significant difference between the mean SVV tilts before and during stimulation . Conclusion. These results suggest that horizontal SCCs do not influence SVV. Therefore, investigations and rehabilitation approaches for SVV misperceptions should be focused on otolithic and cognitive strategies. Martha Funabashi, Aline I. Flores, Amanda Vicentino, Camila G. C. Barros, Octavio M. Pontes-Neto, João P. Leite, and Taiza E. G. Santos-Pontelli Copyright © 2015 Martha Funabashi et al. All rights reserved. Perceived Cause, Environmental Factors, and Consequences of Falls in Adults with Cerebral Palsy: A Preliminary Mixed Methods Study Mon, 23 Feb 2015 14:36:58 +0000 Objective. Describe perceived cause, environmental influences, and consequences of falls or near-falls in ambulant adults with cerebral palsy (CP). Methods. Adults with CP completed postal surveys and follow-up semistructured interviews. Surveys sought information on demographic data, self-nominated Gross Motor Function Classification Score (GMFCS-E&R), falls, and near-falls. Interviews gathered additional information on falls experiences, near-falls, and physical and psychosocial consequences. Results. Thirty-four adults with CP participated. Thirty-three participants reported at least one fall in the previous year. Twenty-six participants reported near-falls. Most commonly, falls occurred indoors, at home, and whilst engaged in nonhazardous ambulation. Adults with CP experienced adverse falls consequences, lower limb injuries predominant (37%), and descriptions of fear, embarrassment, powerlessness, and isolation. Discussion. Adults with CP may experience injurious falls. Further investigation into the impact of falls on health-related quality of life and effective remediation strategies is warranted to provide comprehensive falls prevention programs for this population. Prue Morgan, Rachael McDonald, and Jennifer McGinley Copyright © 2015 Prue Morgan et al. All rights reserved. Velocity during Strength and Power Training of the Ankle Plantar and Dorsiflexor Muscles in Older Patients Attending Day Hospital Rehabilitation Mon, 23 Feb 2015 06:30:46 +0000 Power training has been proposed as a more effective type of resistance training for older adults for functional performance. It is not yet known whether older adults respond appropriately to instructions for power versus strength training. The purpose of this study was to determine the velocity during strength and power training, with elastic resistance bands, in older adults attending a geriatric rehabilitation day program. It was hypothesized that power training would be faster than strength training, but that there would be large interindividual differences. Nine older patients (70 to 86 years) performed power and strength training of the ankle dorsiflexor and plantar flexor muscles using elastic resistance bands. Training sessions were filmed to assess the velocity of training. Power training occurred at faster velocities as compared to strength training () for both muscle groups. However, a wide variation was observed between participants in the training velocities. Older adults attending geriatric rehabilitation do have the potential to develop faster contractions during power training as compared to strength training. Nevertheless, the actual velocities achieved differed between individuals. This could explain some of the mixed findings of studies on power training. Hence, researchers should monitor velocity when comparing different types of resistance training. Pavithra Rajan and Michelle M. Porter Copyright © 2015 Pavithra Rajan and Michelle M. Porter. All rights reserved. The Bunkie Test: Descriptive Data for a Novel Test of Core Muscular Endurance Wed, 11 Feb 2015 13:00:29 +0000 The Bunkie test, a functional performance test consisting of 5 test positions (performed bilaterally), has been used to assess aspects of muscular function. Current performance measures are based on clinical recommendations. The purpose of this study was to report normative data for a healthy population. One hundred and twelve subjects (mean age years) were recruited from a university setting. Subjects completed a demographic questionnaire prior to testing. Hold times for each position was measured in seconds. Subjects were able to hold many of the positions for a mean score of approximately 40 seconds. There were no side-to-side differences in test position hold times per gender. Males were able to hold some positions significantly longer than their female counterparts. Males with a lower BMI were able to hold 8 of the 10 positions significantly longer than those with a higher BMI. Bunkie test scores in subjects with a prior history of musculoskeletal injury were similar to those with no history of injury. The normative data presented in this study may be used by rehabilitation professionals when assessing and rehabilitating their patients. Jason Brumitt Copyright © 2015 Jason Brumitt. All rights reserved. Assessment of the Exercise Intensity of Short Stick Exercises in Elderly Individuals Tue, 03 Feb 2015 10:03:43 +0000 The present study was to obtain basic data for applying the short stick exercises to frail elderly individuals. A total of 20 individuals aged ≥60 years (10 men, and 10 women) with independence in activities of daily living participated in a short stick exercise program. During the exercise program, the time required and the number of times the short stick was dropped were investigated. The exercise intensity was also evaluated based on expired gas and heart rate measurements. The mean exercise intensity of the short stick exercises was 1.9 ± 0.3 metabolic equivalents (METs), equivalent to talking while standing or walking indoors. Compared to the early elderly (those aged 60 to 74 years), the late elderly (those aged ≥75 years) had a significantly higher number of stick drops and significantly lower increase in heart rate from resting to the warming-up exercise. The short stick exercises had a low exercise intensity and can be applicable to exercise interventions of the frail elderly individuals. However, in the case of the late elderly, the high frequency of short stick drops and the change in heart rate during warming up must be considered. Shigeki Kurasawa, Katsushi Yokoi, Nobuyuki Miyai, Kouichi Yoshimasu, Shigeki Takemura, and Kazuhisa Miyashita Copyright © 2015 Shigeki Kurasawa et al. All rights reserved. Game Analysis, Validation, and Potential Application of EyeToy Play and Play 2 to Upper-Extremity Rehabilitation Thu, 25 Dec 2014 00:10:04 +0000 Objective. To describe and analyze the potential use of games in the commercially available EyeToy Play and EyeToy Play 2 on required/targeted training skills and feedback provided for clinical application. Methods. A summary table including all games was created. Two movement experts naïve to the software validated required/targeted training skills and feedback for 10 randomly selected games. Ten healthy school-aged children played to further validate the required/targeted training skills. Results. All but two (muscular and cardiovascular endurance) had excellent agreement in required/targeted training skills, and there was 100% agreement on feedback. Children’s performance in required/targeted training skills (number of unilateral reaches and bilateral reaches, speed, muscular endurance, and cardiovascular endurance) significantly differed between games . Conclusion. EyeToy Play games could be used to train children’s arm function. However, a careful evaluation of the games is needed since performance might not be consistent between players and therapists’ interpretation. Yu-ping Chen, Michelle Caldwell, Erica Dickerhoof, Anastasia Hall, Bryan Odakura, Kimberly Morelli, and Hsin-Chen Fanchiang Copyright © 2014 Yu-ping Chen et al. All rights reserved. Evaluation of a Community Reintegration Outpatient Program Service for Community-Dwelling Persons with Spinal Cord Injury Tue, 09 Dec 2014 12:14:07 +0000 Objective. To evaluate the effectiveness of a community reintegration outpatient (CROP) service for promoting well-being and community participation following spinal cord injury (SCI). Participants. Community-dwelling adults with traumatic and nontraumatic SCI. Interventions. The CROP service is a 12-week (1 × week; 120 minutes) interprofessional closed therapeutic education service. Main Outcome Measure(s). Moorong Self-Efficacy Scale (MSES); Impact on Participation and Autonomy (IPA); Positive Affect and Negative Affect Scale (PANAS); Coping Inventory of Stressful Situations (CISS); World Health Organization Quality of Life (WHOQOL-BREF); semistructured qualitative interviews. Methods. Twenty-one participants were recruited from two subsequent CROP services, with only 14 persons completing all data assessments. Data were collected at baseline (week 0), at exit (week 12), and at a three-month follow-up. Semistructured interviews were conducted at exit. Results. Self-efficacy (MSES) and positive affect (PANAS) improved from baseline to exit , but the changes were not maintained at follow-up. Qualitative analysis identified four major themes related to therapeutic benefits: (1) role of self; (2) knowledge acquisition; (3) skill application; and (4) group processes. Conclusions. Participation in a therapeutic education service has the potential to improve well-being in persons with SCI, but there is a need to identify strategies to maintain long-term gains. Alana Zinman, Nicole Digout, Patricia Bain, Sylvia Haycock, Debbie Hébert, and Sander L. Hitzig Copyright © 2014 Alana Zinman et al. All rights reserved. Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation Tue, 21 Oct 2014 12:52:06 +0000 The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research. Amol M. Karmarkar, James E. Graham, Timothy A. Reistetter, Amit Kumar, Jacqueline M. Mix, Paulette Niewczyk, Carl V. Granger, and Kenneth J. Ottenbacher Copyright © 2014 Amol M. Karmarkar et al. All rights reserved. How Important Are Social Support, Expectations and Coping Patterns during Cardiac Rehabilitation Mon, 15 Sep 2014 00:00:00 +0000 Purpose. To investigate the predictive role of relevant social and psychosocial determinants on emotional distress among patients after cardiac rehabilitation. Methods. A longitudinal prospective study examined short-term (6 months) and long-term (2 years) impact of predictors on anxiety and depression complaints in 183 patients with 6-months follow-up data attending a four-week rehabilitation stay at the Krokeide Centre in Bergen, Norway. The patients mainly suffered from coronary heart disease. Emotional distress, coping, social support, socioeconomic status, and negative expectations were measured by means of internationally validated questionnaires. A composite score of anxiety and depression complaints was used as the outcome measure in the study. Results. This study revealed that task-oriented coping improved emotional status in long-term followup, and negative expectations were associated with emotional distress in short-term followup. A higher socioeconomic status and more social support predicted improved emotional status in short- as well as long-term followup. Conclusions. Fewer negative expectations and functional coping along with social support are important factors for the prevention of emotional distress after cardiac disease. Such elements should be addressed and encouraged in patients during cardiac rehabilitation. Maria J. C. Blikman, Hege R. Jacobsen, Geir Egil Eide, and Eivind Meland Copyright © 2014 Maria J. C. Blikman et al. All rights reserved. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial Mon, 15 Sep 2014 00:00:00 +0000 Topical menthol gels are classified “topical analgesics” and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS). We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze) or placebo (gel with a menthol scent) during the working day and 48 hours later the other treatment (crossover design). Participants rated arm/hand pain intensity during the last hour of work (scale 0–10) immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC) in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol ( and , resp.). Pain intensity of the arm/hand decreased by −1.2 (CI 95%: −1.7 to −0.6) following topical menthol compared with placebo, corresponding to a moderate effect size of 0.63. In conclusion, topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain. Emil Sundstrup, Markus D. Jakobsen, Mikkel Brandt, Kenneth Jay, Juan Carlos Colado, Yuling Wang, and Lars L. Andersen Copyright © 2014 Emil Sundstrup et al. All rights reserved. Understanding the Burden on Caregivers of People with Parkinson’s: A Scoping Review of the Literature Sun, 14 Sep 2014 07:18:07 +0000 Caregivers are healthcare assets because they care for patients at home; however, when clinicians focus solely on patients, caregivers’ needs may not be recognized. The purpose of this scoping literature review is to identify the burdens on caregivers of people with Parkinson’s disease. CINAHL and PubMed databases were searched to locate thirteen original articles, one systematic review, and one meta-analysis within the last five years that highlighted caregivers’ burdens. Results indicate the need to identify practical interventions that decrease caregivers’ physical, psychological, and socioeconomic burdens. Correlates of Parkinson’s caregiver burdens are not clearly available. Caregivers’ contextual demographic information is missing, as is an understanding of how caregivers negotiate day-to-day caregiving activities. Gaps exist about how caregivers reconcile multiple medications and manage rehabilitation needs of the patient at home. A recommendation for practice is a systematic evaluation of the caregivers’ capacity at the time of clinic visit. Rozina Bhimani Copyright © 2014 Rozina Bhimani. All rights reserved. The Effects of Two Different Ankle-Foot Orthoses on Gait of Patients with Acute Hemiparetic Cerebrovascular Accident Tue, 09 Sep 2014 09:23:17 +0000 Objective. To compare the effects of two types of ankle-foot orthoses on gait of patients with cerebrovascular accident (CVA) and to evaluate their preference in using each AFO type. Design. Thirty individuals with acute hemiparetic CVA were tested without an AFO, with an off-the-shelf carbon AFO (C-AFO), and with a custom plastic AFO (P-AFO) in random order at the time of initial orthotic fitting. Gait velocity, cadence, stride length, and step length were collected using an electronic walkway and the subjects were surveyed about their perceptions of each device. Results. Subjects walked significantly faster, with a higher cadence, longer stride, and step lengths, when using either the P-AFO or the C-AFO as compared to no AFO (). No significant difference was observed between gait parameters of the two AFOs. However, the subjects demonstrated a statistically significant preference of using P-AFO in relation to their balance, confidence, and sense of safety during ambulation (). Moreover, if they had a choice, % of the participants preferred the P-AFO and % preferred the C-AFO. Conclusions. AFO use significantly improved gait in patients with acute CVA. The majority of users preferred the P-AFO over the Cf-AFO especially when asked about balance and sense of safety. Noel Rao, Jason Wening, Daniel Hasso, Gnanapradeep Gnanapragasam, Priyan Perera, Padma Srigiriraju, and Alexander S. Aruin Copyright © 2014 Noel Rao et al. All rights reserved. Clinical Understanding of Spasticity: Implications for Practice Thu, 04 Sep 2014 00:00:00 +0000 Spasticity is a poorly understood phenomenon. The aim of this paper is to understand the effect of spasticity on daily life and identify bedside strategies that enhance patient’s function and improve comfort. Spasticity and clonus result from an upper motor neuron lesion that disinhibits the tendon stretch reflex; however, they are differentiated in the fact that spasticity results in a velocity dependent tightness of muscle whereas clonus results in uncontrollable jerks of the muscle. Clinical strategies that address function and comfort are paramount. This is a secondary content analysis using a qualitative research design. Adults experiencing spasticity associated with neuromuscular disorder were asked to participate during inpatient acute rehabilitation. They were asked to complete a semistructured interview to explain and describe the nature of their experienced spasticity on daily basis. Spasticity affects activities of daily living, function, and mobility. Undertreated spasticity can lead to pain, immobility, and risk of falls. There were missed opportunities to adequately care for patients with spasticity. Bedside care strategies identified by patients with spasticity are outlined. Uses of alternative therapies in conjunction with medications are needed to better manage spasticity. Patient reports on spasticity are important and should be part of clinical evaluation and practice. Rozina Bhimani and Lisa Anderson Copyright © 2014 Rozina Bhimani and Lisa Anderson. All rights reserved. Whole Body Vibration Exercises and the Improvement of the Flexibility in Patient with Metabolic Syndrome Wed, 03 Sep 2014 07:43:56 +0000 Vibrations produced in oscillating/vibratory platform generate whole body vibration (WBV) exercises, which are important in sports, as well as in treating diseases, promoting rehabilitation, and improving the quality of life. WBV exercises relevantly increase the muscle strength, muscle power, and the bone mineral density, as well as improving the postural control, the balance, and the gait. An important number of publications are found in the PubMed database with the keyword “flexibility” and eight of the analyzed papers involving WBV and flexibility reached a level of evidence II. The biggest distance between the third finger of the hand to the floor (DBTFF) of a patient with metabolic syndrome (MS) was found before the first session and was considered to be 100%. The percentages to the other measurements in the different sessions were determined to be related to the 100%. It is possible to see an immediate improvement after each session with a decrease of the %DBTFF. As the presence of MS is associated with poorer physical performance, a simple and safe protocol using WBV exercises promoted an improvement of the flexibility in a patient with MS. Danúbia da Cunha Sá-Caputo, Pedro Ronikeili-Costa, Rafaelle Pacheco Carvalho-Lima, Luciana Camargo Bernardo, Milena Oliveira Bravo-Monteiro, Rebeca Costa, Janaina de Moraes-Silva, Dulciane Nunes Paiva, Christiano Bittencourt Machado, Paula Mantilla-Giehl, Adriano Arnobio, Pedro Jesus Marin, and Mario Bernardo-Filho Copyright © 2014 Danúbia da Cunha Sá-Caputo et al. All rights reserved. Perceived Cognitive Decline in Multiple Sclerosis Impacts Quality of Life Independently of Depression Mon, 01 Sep 2014 07:25:13 +0000 Background/Aim. The aim of this study is to examine the effects of perceived cognitive dysfunction and of depression, on self-reported QoL, in a Greek population sample of MS patients. Methods. One hundred outpatients diagnosed with MS completed the Short-Form-36 Health Survey (SF-36), as well as the Perceived Deficits Questionnaire (PDQ) and the Depression subscale of the Mental Health Inventory (MHI), as part of a clinical evaluation which included the Expanded Disability Status Scale (EDSS) estimation. Multiple linear regression was conducted to determine the best linear combination of age, gender, education, EDSS, depression, attention/concentration, retrospective memory, prospective memory, and planning/organization, for predicting QoL scores. Results. In the multivariate regression analysis models, EDSS (), depression (), perceived planning/organization (), and perceived retrospective memory dysfunction () independently predict quality of life scores. Age, sex, education level, and perceived attention/concentration dysfunction, as well as perceived prospective memory dysfunction, do not independently predict quality of life scores. Conclusions. Perceived planning/organization impairment and perceived retrospective memory impairment in MS patients predict QoL independently of the severity of disease and the severity of depression and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation. Lampros Samartzis, Efthymia Gavala, Yiannis Zoukos, Achilleas Aspiotis, and Thomas Thomaides Copyright © 2014 Lampros Samartzis et al. All rights reserved. Preoperative Predictors of Ambulation Ability at Different Time Points after Total Hip Arthroplasty in Patients with Osteoarthritis Sun, 10 Aug 2014 13:18:42 +0000 The aims of this study were to identify the preoperative factors influencing ambulation ability at different postoperative time points after total hip arthroplasty (THA) and to examine the cutoff values of predictive preoperative factors by receiver operating characteristic (ROC) curves. Forty-eight women with unilateral THA were measured for hip extensor, hip abductor, and knee extensor muscle strength in both legs; hip pain (visual analog scale, VAS); and the Timed Up and Go (TUG) test pre- and postoperatively. Multiple regression analysis indicated that preoperative knee extensor strength at 3 weeks, hip abductor strength at 4 months, and age at 7 months were strongly associated with postoperative ambulation, measured using the TUG test. Optimal preoperative cutoff values for ambulation ability were 0.56 Nm/kg for knee extensor strength, 0.24 Nm/kg for hip abductor strength, and 73 years of age. Our results suggest that preoperative factors predicting ambulation ability vary by postoperative time point. Preoperative knee extensor strength, hip abductor strength, and age were useful predictors of ambulation ability at the early, middle, and late time points, respectively, after THA. Akiko Kamimura, Harutoshi Sakakima, Fumio Tsutsumi, and Nobuhiko Sunahara Copyright © 2014 Akiko Kamimura et al. All rights reserved. Functional Stretching Exercise Submitted for Spastic Diplegic Children: A Randomized Control Study Sun, 20 Jul 2014 11:36:19 +0000 Objective. Studying the effect of the functional stretching exercise in diplegic children. Design. Children were randomly assigned into two matched groups. Setting. Outpatient Clinic of the Faculty of Physical Therapy, Cairo University. Participants. Thirty ambulant spastic diplegic children, ranging in age from five to eight years, participated in this study. Interventions. The control group received physical therapy program with traditional passive stretching exercises. The study group received physical therapy program with functional stretching exercises. The treatment was performed for two hours per session, three times weekly for three successive months. Main Outcome Measure(s). H∖M ratio, popliteal angle, and gait parameters were evaluated for both groups before and after treatment. Results. There was significant improvement in all the measuring variables for both groups in favor of study group. H∖M ratio was reduced, popliteal angle was increased, and gait was improved. Conclusion(s). Functional stretching exercises were effectively used in rehabilitation of spastic diplegic children; it reduced H∖M ratio, increased popliteal angle, and improved gait. Mohamed Ali Elshafey, Adel Abd-Elaziem, and Rana Elmarzouki Gouda Copyright © 2014 Mohamed Ali Elshafey et al. All rights reserved. Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study Sun, 15 Jun 2014 00:00:00 +0000 Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce ( (0.60–0.92)) whereas unemployment at the time of surgery had no impact on return to the workforce ( (0.78–1.18)). Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit. Kirsten Fonager, Søren Lundbye-Christensen, Jan Jesper Andreasen, Mikkel Futtrup, Anette Luther Christensen, Khalil Ahmad, and Martin Agge Nørgaard Copyright © 2014 Kirsten Fonager et al. All rights reserved. Effects of Posteroanterior Thoracic Mobilization on Heart Rate Variability and Pain in Women with Fibromyalgia Thu, 29 May 2014 13:15:55 +0000 Fibromyalgia (FM) has been associated with cardiac autonomic abnormalities and pain. Heart rate variability (HRV) is reduced in FM with autonomic tone dominated by sympathetic activity. The purpose of this study was to evaluate the effects of one session of a posteroanterior glide technique on both autonomic modulation and pain in woman with FM. This was a controlled trial with immediate followup; twenty premenopausal women were allocated into 2 groups: (i) women diagnosed with FM and (ii) healthy women . Both groups received one session of Maitland mobilization grade III posteroanterior central pressure glide, at 2 Hz for 60 s at each vertebral segment. Autonomic modulation was assessed by HRV and pain by a numeric pain scale before and after the intervention. For HRV analyses, heart rate and RR intervals were recorded for 10 minutes. FM subjects demonstrated reduced HRV compared to controls. Although the mobilization technique did not significantly reduce pain, it was able to improve HRV quantified by an increase in rMSSD and SD1 indices, reflecting an improved autonomic profile through increased vagal activity. In conclusion, women with FM presented with impaired cardiac autonomic modulation. One session of Maitland spine mobilization was able to acutely improve HRV. Michel Silva Reis, João Luiz Quagliotti Durigan, Ross Arena, Bruno Rafael Orsini Rossi, Renata Gonçalves Mendes, and Audrey Borghi-Silva Copyright © 2014 Michel Silva Reis et al. All rights reserved. A Pilot Project of Early Integrated Traumatic Brain Injury Rehabilitation in Singapore Wed, 21 May 2014 11:13:45 +0000 Objective. Document acute neurosurgical and rehabilitation parameters of patients of all traumatic brain injury (TBI) severities and determine whether early screening along with very early integrated TBI rehabilitation changes functional outcomes. Methods. Prospective study involving all patients with TBI admitted to a neurosurgical department of a tertiary hospital. They were assessed within 72 hours of admission by the rehabilitation team and received twice weekly rehabilitation reviews. Patients with further rehabilitation needs were then transferred to the attached acute inpatient TBI rehabilitation unit (TREATS) and their functional outcomes were compared against a historical group of patients. Demographic variables, acute neurosurgical characteristics, medical complications, and rehabilitation outcomes were recorded. Results. There were 298 patients screened with an average age of years. The most common etiology was falls (77.5%). Most patients were discharged home directly (67.4%) and 22.8% of patients were in TREATS. The TREATS group functionally improved (). Regression analysis showed by the intervention of TREATS, that there was a statistically significant FIM functional gain of 18.445 points (95% CI −30.388 to −0.6502, ). Conclusion. Our study demonstrated important epidemiological data on an unselected cohort of patients with TBI in Singapore and functional improvement in patients who further received inpatient rehabilitation. Siew Kwaon Lui, Yee Sien Ng, Annie Jane Nalanga, Yeow Leng Tan, and Chek Wai Bok Copyright © 2014 Siew Kwaon Lui et al. All rights reserved. Retracted: Therapeutic Management of the Hallux Rigidus Wed, 21 May 2014 08:47:38 +0000 Rehabilitation Research and Practice Copyright © 2014 Rehabilitation Research and Practice. All rights reserved.