Rehabilitation Research and Practice The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Impact of a Revised Curriculum Focusing on Clinical Neurology and Musculoskeletal Care on a Required Fourth-Year Medical Student Physical Medicine and Rehabilitation Clerkship Tue, 29 Nov 2016 09:19:08 +0000 Background. A Required Fourth-Year Medical Student Physical Medicine and Rehabilitation (PM&R) Clerkship was found to increase students’ knowledge of PM&R; however the students’ overall rotation evaluations were consistently lower than the other 8 required clerkships at the medical school. Objective. To describe the impact of a revised curriculum based upon Entrustable Professional Activities and focusing on basic pain management, musculoskeletal care, and neurology. Setting. Academic Medical Center. Participants. 73 fourth-year medical students. Methods. The curriculum changes included a shift in the required readings from rehabilitation specific topics toward more general content in the areas of clinical neurology and musculoskeletal care. Hands-on workshops on neurological and musculoskeletal physical examination techniques, small group case-based learning, an anatomy clinical correlation lecture, and a lecture on pain management were integrated into the curriculum. Main Outcome Measurements. Student evaluations of the clerkship. Results. Statistically significant improvements were found in the students’ evaluations of usefulness of lecturers, development of patient interviewing skills, and diagnostic and patient management skills . Conclusions. This study suggests that students have a greater satisfaction with a required PM&R clerkship when lecturers utilize a variety of pedagogic methods to teach basic pain, neurology and musculoskeletal care skills in the rehabilitation setting rather than rehabilitation specific content. John W. Norbury, Clinton E. Faulk, Kelly M. Harrell, Luan E. Lawson, and Daniel P. Moore Copyright © 2016 John W. Norbury et al. All rights reserved. Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial Mon, 21 Nov 2016 14:16:13 +0000 Background. We need to understand more about how DNF performs in different contexts and whether it affects the pain threshold over myofascial trigger points (MTrPs). Purpose. The objectives were to investigate the effect of neck muscles training on disability and pain and on pain threshold over MTrPs in people with chronic neck pain. Methods. Patients with chronic neck pain were eligible for participation with a Neck Disability Index (NDI) score of over 5/50 and having at least one MTrP on either levator scapulae, upper trapezoid, or splenius capitis muscle. Patients were randomly assigned into either DNF training, superficial neck muscle exercise, or advice group. Generalized linear model (GLM) was used to detect differences in treatment groups over time. Results. Out of 67 participants, 60 (47 females, mean age: 39.45 ± 12.67) completed the study. Neck disability and neck pain were improved over time between and within groups (). However, no differences were found within and between the therapeutic groups () in the tested muscles’ PPTs and in cervicothoracic angle over a 7-week period. Conclusion. All three groups improved over time. This infers that the pain pathways involved in the neck pain relief are not those involved in pain threshold. Pavlos Bobos, Evdokia Billis, Dimitra-Tania Papanikolaou, Constantinos Koutsojannis, and Joy C. MacDermid Copyright © 2016 Pavlos Bobos et al. All rights reserved. Effectiveness of Moderate Intensity Interval Training as an Index of Autonomic Nervous Activity Thu, 10 Nov 2016 09:18:31 +0000 The purpose of this study was to examine the effects of moderate intensity interval training from the change of the autonomic nervous activity. Ten male volunteers aged 21-22 years were studied. After 10-minute rest in a seated position, the subjects were asked to perform the strength of moderate cycling exercise in ergometer. Cycling rate was done in 50 times/min. Load resistance of the ergometer was set to 2.0 kgm. Subjects paused the exercise when the heart rate becomes 120 beats/min. Subjects have resumed the exercise when the heart rate returns to the value at rest. This trial was repeated twice. The experiment was ended when the heart rate of the subjects has returned to resting level. When the heart rate during exercise is maintained to less than 120 beats/min, sympathetic nerve activity during exercise did not work actively compared to the baseline. Vagus nerve activity after exercise cessation exceeds the baseline. It is clarified that the exercise as well as activating the vagus nerve activity stimulates the total autonomic nervous activity. It has revealed that at the time of interval training at moderate load the vagus nerve activity can be carried out. Satoru Kai, Koji Nagino, Takayoshi Ito, Rie Oi, Kazushi Nishimura, Shuhei Morita, and Riyo Yaoi Copyright © 2016 Satoru Kai et al. All rights reserved. Corrigendum to “Functional Stretching Exercise Submitted for Spastic Diplegic Children: A Randomized Control Study” Sun, 18 Sep 2016 08:50:43 +0000 Mohamed Ali Elshafey, Adel Abd-Elaziem, and Rana Elmarzouki Gouda Copyright © 2016 Mohamed Ali Elshafey et al. All rights reserved. Short-Term Effects of Hydrokinesiotherapy in Hospitalized Preterm Newborns Thu, 08 Sep 2016 12:02:58 +0000 Background. In the neonatal intensive care unit (NICU) environment, preterm newborns are subject to environmental stress and numerous painful interventions. It is known that hydrokinesiotherapy promotes comfort and reduces stress because of the physiological properties of water. Objective. To evaluate the short-term effects of hydrokinesiotherapy on reducing stress in preterm newborns admitted to the NICU. Materials and Methods. Fifteen preterm newborns underwent salivary cortisol measurement, pain evaluation using the Neonatal Infant Pain Scale (NIPS), and heart rate, respiratory rate, and peripheral oxygen saturation measurements before and after the application of hydrokinesiotherapy. Results. The mean gestational age of the newborns was weeks, and the mean weight was  g. Immediately after application of hydrokinesiotherapy, a significant reduction was observed in salivary cortisol , heart rate , and respiratory rate and a significant increase was observed in peripheral oxygen saturation . However, no significant difference was observed in the NIPS score . Conclusion. In the present study, neonatal hydrotherapy promoted short-term relief from feelings of stress. Neonatal hydrokinesiotherapy may be a therapeutic alternative. However, this therapy needs to be studied in randomized, crossover, and blinded trials. This trial is registered with NCT02707731. Welcy Cassiano de Oliveira Tobinaga, Cirlene de Lima Marinho, Vera Lucia Barros Abelenda, Paula Morisco de Sá, and Agnaldo José Lopes Copyright © 2016 Welcy Cassiano de Oliveira Tobinaga et al. All rights reserved. Effects of Seated Postural Stability and Trunk and Upper Extremity Strength on Performance during Manual Wheelchair Propulsion Tests in Individuals with Spinal Cord Injury: An Exploratory Study Thu, 18 Aug 2016 13:49:00 +0000 Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation. Dany H. Gagnon, Audrey Roy, Sharon Gabison, Cyril Duclos, Molly C. Verrier, and Sylvie Nadeau Copyright © 2016 Dany H. Gagnon et al. All rights reserved. Corrigendum to “Subjective Experiences of Speech and Language Therapy in Patients with Parkinson’s Disease: A Pilot Study” Wed, 17 Aug 2016 09:44:52 +0000 Laura Spurgeon, Carl E. Clarke, and Cath Sackley Copyright © 2016 Laura Spurgeon et al. All rights reserved. Addressing Work-Related Issues in Medical Rehabilitation: Revision of an Online Information Tool for Healthcare Professionals Tue, 16 Aug 2016 12:15:29 +0000 Background. Medical rehabilitation increasingly considers occupational issues as determinants of health and work ability. Information on work-related rehabilitation concepts should therefore be made available to healthcare professionals. Objective. To revise a website providing healthcare professionals in medical rehabilitation facilities with information on work-related concepts in terms of updating existing information and including new topics, based on recommendations from implementation research. Method. The modification process included a questionnaire survey of medical rehabilitation centers (); two workshops with experts from rehabilitation centers, health payers, and research institutions (); the selection of new topics and revision of existing text modules based on expert consensus; and an update of good practice descriptions of work-related measures. Results. Health payers’ requirements, workplace descriptions, and practical implementation aids were added as new topics. The database of good practice examples was extended to 63 descriptions. Information on introductory concepts was rewritten and supplemented by current data. Diagnostic tools were updated by including additional assessments. Conclusions. Recommendations from implementation research such as assessing user needs and including expert knowledge may serve as a useful starting point for the dissemination of information on work-related medical rehabilitation into practice. Web-based information tools such as the website presented here can be quickly adapted to current evidence and changes in medicolegal regulations. Matthias Lukasczik, Hans-Dieter Wolf, Christian Gerlich, Roland Küffner, Heiner Vogel, and Silke Neuderth Copyright © 2016 Matthias Lukasczik et al. All rights reserved. Cross-Cultural Adaptation and Validation of the Jebsen-Taylor Hand Function Test in an Italian Population Mon, 18 Jul 2016 11:56:42 +0000 Objective. This paper describes the Italian translation and adaptation to the Italian culture of the original version of the Jebsen-Taylor hand function test and conveys the procedure for testing its validity and reliability. Design. The cultural adaptation process and validation were based on data from a group of people with no clinical evidence of disease or impairment of the upper limbs. The process required a forward and reverse translation in its original language. The scale obtained was reviewed by 8 experts in the field of psychometrics dealing with statistical methods that are useful for the behavioral and social sciences. The Italian adapted version of the JTHFT was then produced and validated. Participants. The test was submitted to 320 people with no clinical evidence of disease in order to test its acceptability and consistency. Results. The total time required to perform each subtest was 80.16 ± 43.13 seconds for the nondominant hand (NDH) and seconds for the dominant hand (DH). The internal consistency (assessed with Pearson’s ) and the reliability or the construct validity (assessed with Cronbach’s alpha) are significative. Conclusions. This is the first study reporting the result of the translation, cultural adaptation, and validation protocols of the JTHFT in Italian. It provides a new tool for Italian professionals to measure the functionality of the hand in participants with various upper limb pathologies. Greta Culicchia, Marta Nobilia, Marilyn Asturi, Valter Santilli, Marco Paoloni, Rita De Santis, and Giovanni Galeoto Copyright © 2016 Greta Culicchia et al. All rights reserved. Experiences of Rehabilitation Professionals with the Implementation of a Back School for Patients with Chronic Low Back Pain: A Qualitative Study Sun, 03 Jul 2016 07:45:42 +0000 A standardized curriculum back school (CBS) has been recommended for further dissemination in medical rehabilitation in Germany. However, implementation of self-management education programs into practice is challenging. In low back pain care, individual factors of professionals could be decisive regarding implementation fidelity. The study aim was to explore attitudes and experiences of professionals who conducted the back school. Qualitative interviews were led with 45 rehabilitation professionals. The data were examined using thematic analysis. Three central themes were identified: (a) “back school as a common thread,” (b) “theory versus practice,” and (c) “participation and patient-centeredness.” The CBS and its manual were frequently described positively because they provide structure. However, specified time was mentioned critically and there were heterogeneous perceptions regarding flexibility in conducting the CBS. Theory and practice in the CBS were discussed concerning amount, distribution, and conjunction. Participation and patient-centeredness were mainly mentioned in terms of amount and heterogeneity of participation as well as the demand for competences of professionals. Factors were detected that may either positively or negatively influence the implementation fidelity of self-management education programs. The results are explorative and provide potential explanatory mechanisms for behavior and acceptance of rehabilitation professionals regarding the implementation of biopsychosocial back schools. Stefan Peters, Hermann Faller, Klaus Pfeifer, and Karin Meng Copyright © 2016 Stefan Peters et al. All rights reserved. The Activity of Surface Electromyographic Signal of Selected Muscles during Classic Rehabilitation Exercise Tue, 19 Apr 2016 08:22:31 +0000 Objectives. Prone bridge, unilateral bridge, supine bridge, and bird-dog are classic rehabilitation exercises, which have been advocated as effective ways to improve core stability among healthy individuals and patients with low back pain. The aim of this study was to investigate the activity of seven selected muscles during rehabilitation exercises through the signal of surface electromyographic. Approaches. We measured the surface electromyographic signals of four lower limb muscles, two abdominal muscles, and one back muscle during rehabilitation exercises of 30 healthy students and then analyzed its activity level using the median frequency method. Results. Different levels of muscle activity during the four rehabilitation exercises were observed. The prone bridge and unilateral bridge caused the greatest muscle fatigue; however, the supine bridge generated the lowest muscle activity. There was no significant difference () between left and right body side muscles in the median frequency slope during the four rehabilitation exercises of seven muscles. Conclusions. The prone bridge can affect the low back and lower limb muscles of most people. The unilateral bridge was found to stimulate muscles much more active than the supine bridge. The bird-dog does not cause much fatigue to muscles but can make most selected muscles active. Jinzhuang Xiao, Jinli Sun, Junmin Gao, Hongrui Wang, and Xincai Yang Copyright © 2016 Jinzhuang Xiao et al. All rights reserved. Physical and Psychosocial Functions of Adults with Lower Limb Congenital Deficiencies and Amputations in Childhood Mon, 18 Apr 2016 14:18:50 +0000 Objectives. (1) To describe the epidemiological and medical features of a sample with LLA and LLD in childhood and (2) to explore their relationship with subsequent physical and psychosocial functions in adulthood. Methods. Cross-sectional survey. Demographics, medical data, Locomotor Capabilities Index (LCI), and Discomfort-Engagement in Everyday Activities Involving Revealing the Body Scale (D-EEARB) were collected from thirty-two adults who suffered from LLA in childhood or LLD. Results. Most of the sample (53.1% males) was working (84.4%), living independently (75%), and single (75%). Mean age was 33.16 (SD = 7.64, range 18–50). Leading causes for LLA were traumatic (40.6%) and oncologic (25%). LLD was present in 6 cases (18.8%). LCI scores revealed a high performance among males (, ). D-EEARB scores showed that 56.25% stated feeling “quite” or “totally comfortable” in situations which involved revealing their body, but 43.75% stated the contrary (“uncomfortable” or “very uncomfortable”). LLD and traumatic LLA show higher scores in D-EEARB than vascular and oncological LLA (, df = 3, ). Conclusions. Adults suffering from LLDs and LLAs during childhood seem to perform well once they are adults. However, 43.75% of patients express considerable discomfort in situations that involve revealing the body. Ll. Montesinos-Magraner, D. Issa-Benítez, E. Pagès-Bolíbar, M. Meléndez-Plumed, M. A. González-Viejo, and C. Castellano-Tejedor Copyright © 2016 Ll. Montesinos-Magraner et al. All rights reserved. Prevalence of Vitamin D Deficiency in Elderly Patients Admitted to an Inpatient Rehabilitation Unit in Tropical Singapore Mon, 22 Feb 2016 12:53:56 +0000 Background. Data on hypovitaminosis D in elderly patients admitted to rehabilitation units in tropical countries are scarce. Objective. To assess the prevalence of vitamin D deficiency and its associated risk factors in elderly patients admitted to a rehabilitation unit in tropical Singapore. Methods. Prospective, cohort study of 134 subjects ≥ 65 years old admitted to a tertiary rehabilitation centre. Serum 25-hydroxyvitamin D3 (25OHD3) was measured on rehabilitation admission. Results. Mean age was years, and stroke was the commonest rehabilitation diagnosis (49.3%). Low 25OHD3 levels were present in 115 patients (85.6%) and 59 patients (44%) were deemed to be vitamin D deficient. The mean PTH level was significantly higher in patients with low 25OHD3 levels. () Age, gender, vitamin D supplementation, premorbid ambulatory status, and admission/discharge Functional Independence Measure scores were not significantly associated with vitamin D deficiency. Malays/Indians () and recurrent fallers () were at significantly higher risk of vitamin D deficiency. Conclusions. Despite the tropical weather, vitamin D deficiency is common in elderly subjects admitted to a rehabilitation unit in Singapore. Routine assessment of vitamin D levels is recommended especially in those with a history of recurrent falls and patients of Indian/Malay ethnicity. Jong J. Neo and Keng H. Kong Copyright © 2016 Jong J. Neo and Keng H. Kong. All rights reserved. The Use of Computer-Assisted Home Exercises to Preserve Physical Function after a Vestibular Rehabilitation Program: A Randomized Controlled Study Thu, 11 Feb 2016 17:10:03 +0000 Objective. The purpose of this study was to evaluate whether elderly patients with vestibular dysfunction are able to preserve physical functional level, reduction in dizziness, and the patient’s quality of life when assistive computer technology is used in comparison with printed instructions. Materials and Methods. Single-blind, randomized, controlled follow-up study. Fifty-seven elderly patients with chronic dizziness were randomly assigned to a computer-assisted home exercise program or to home exercises as described in printed instructions and followed for tree month after discharge from an outpatient clinic. Results. Both groups had maintained their high functional levels three months after finishing the outpatient rehabilitation. No statistically significant difference was found in outcome scores between the two groups. In spite of moderate compliance levels, the patients maintained their high functional level indicating that the elderly should not necessarily exercise for the first three months after termination of the training in the outpatient clinic. Conclusion. Elderly vestibular dysfunction patients exercising at home seem to maintain their functional level, level of dizziness, and quality of life three months following discharge from hospital. In this specific setup, no greater effect was found by introducing a computer-assisted training program, when compared to standard home training guided by printed instructions. This trial is registered with NCT01344408. Michael Smaerup, Uffe Laessoe, Eric Grönvall, Jens-Jacob Henriksen, and Else Marie Damsgaard Copyright © 2016 Michael Smaerup et al. All rights reserved. Dosage Parameters in Pediatric Outcome Studies Reported in 9 Peer-Reviewed Occupational Therapy Journals from 2008 to 2014: A Content Analysis Tue, 02 Feb 2016 13:00:42 +0000 Occupational therapists determine the dosage when establishing the plan of care for their pediatric clients. A content analysis was conducted using 123 pediatric occupational therapy outcomes studies from 9 scholarly international occupational therapy journals. The parameters of dosage were calculated using descriptive statistics in order to obtain a representation of dosage available within the current collage of pediatric occupational therapy outcomes studies. The results revealed that most studies reported portions of dosage parameters within the published studies. The average findings for the subcomponents related to dosage were session length (minutes) , duration of plan of care (weeks) , session frequency (per week) , and total hours of therapy (hours) . This first attempt at describing and calculating dosage related to pediatric occupational therapy practice indicates that evidence is lacking within the published literature to adequately guide OT dosage decisions. Further research related to dosage in pediatric occupational therapy practice is needed. Bryan M. Gee, Kimberly Lloyd, Nancy Devine, Erin Tyrrell, Trisha Evans, Rebekah Hill, Stacee Dineen, and Kristin Magalogo Copyright © 2016 Bryan M. Gee et al. All rights reserved. Shouldering the Burden of Evidence-Based Practice: The Experiences of Physiotherapists Partaking in a Community of Practice Sun, 24 Jan 2016 09:05:24 +0000 The study aim was to elicit the motivators, barriers, and benefits of participation in a Community of Practice (CoP) for primary care physiotherapists. We used a qualitative approach using semistructured interviews. The participants were twelve physiotherapists partaking in a newly formed Shoulder CoP. A desire for peer support was the strongest motivator for joining, with improving clinical practice being less apparent. Barriers to participation included time and work pressures and poor research skills. The structure of the CoP, in terms of access to meetings and the provision of preparation work and deadlines for the journal clubs, was reported to be a facilitator. Multiple benefits ensued from participation. The role of teamwork was emphasised in relation to reducing isolation and achieving goals. The majority of participants reported positive clinical practice changes in terms of improved patient education, increased confidence, and availability of new resources. All participants reported some element of personal growth and development, in particular in their evidence-based practice skills. The results provide support for the use of CoPs as a means of continuing professional development for physiotherapists in the workplace, as significant benefits are gained in terms of evidence-based practice (EBP), patient care, and therapist personal development. Karen McCreesh, Louise Larkin, and Jeremy Lewis Copyright © 2016 Karen McCreesh et al. All rights reserved. Psychometric Properties of the Hindi Version of the Disabilities of Arm, Shoulder, and Hand: A Pilot Study Thu, 31 Dec 2015 15:31:52 +0000 Objectives. To culturally adapt and translate the Disabilities of Arm, Shoulder, and Hand questionnaire into Hindi (DASH-H) and assess its reliability, validity, and responsiveness in adult patients with shoulder tendonitis. Study Design. Descriptive methodological research, using longitudinal design. Setting. Outpatient clinic. Participants. 30 adult patients aged 53.3 ± 6.9 y with shoulder tendonitis. Data Analyses. DASH-H, visual analogue scales for pain (VAS-P) and disability (VAS-D), and shoulder active range of motion (AROM) were assessed at baseline, 2-3 days later, and 4-5 weeks after baseline. Intraclass correlation coefficients (ICC) assessed test-retest reliability of these scales and responsiveness was examined by calculating effect sizes (ES) and standardized response means (SRM). Cronbach’s alpha (CA) was used to examine internal consistency of DASH-H. Convergent construct validity of DASH-H with VAS scales and shoulder AROM was determined using Pearson’s Correlation Coefficients (). Results. DASH-H demonstrated good test-retest reliability and internal consistency (ICC and CA both > 0.75) and excellent responsiveness (ES = 2.2, SRM = 6.1). DASH-H showed high concordance (, ) with AROM-flexion and moderate concordance (, ) with VAS scales and AROM-external rotation. Conclusion. Analyses indicate that DASH-H demonstrates good test-retest reliability, validity, and responsiveness in patients with shoulder tendonitis. Saurabh P. Mehta, Ramesh Tiruttani, Manraj N. Kaur, Joy MacDermid, and Rania Karim Copyright © 2015 Saurabh P. Mehta et al. All rights reserved. Low Back Pain in Athletes Is Associated with General and Sport Specific Risk Factors: A Comprehensive Review of Longitudinal Studies Sun, 13 Dec 2015 13:45:14 +0000 We aimed to examine systematically the available evidence on risk factors of low back pain (LBP) in athletes. We performed search without language restriction in PubMed, Ovid, Google Scholar, Scopus, and CINAHL. Longitudinal studies that examined possible risk factors of LBP in athletes were included in this systematic review. Based on methodological quality of studies, a best-evidence synthesis was conducted. Seven longitudinal studies were included, four of which had high methodological quality. Results showed that previous LBP, decreased lumbar flexion, and decreased lumbar extension are positively associated with LBP. There was moderate evidence for hip flexor tightness and high body weight as a risk factor. We found insufficient evidence for association between forward bending, previous injury, and amount of training per week, active years, age, and sex with LBP. In conclusion this study would provide a list of risk factors for LBP in athletes, though it showed a strong evidence for only a few including decrease lumbar flexion or extension, previous LBP, and high body weight. This review indicated a high heterogeneity of study characteristics including assessed risk factors and statistical techniques might limit the quality of evidence. Vahideh Moradi, Amir-Hossein Memari, Monir ShayestehFar, and Ramin Kordi Copyright © 2015 Vahideh Moradi et al. All rights reserved. Training a Spinal Cord Injury Rehabilitation Team in Motivational Interviewing Sun, 06 Dec 2015 12:08:12 +0000 Background. An acute spinal cord injury (ASCI) is a severe condition that requires extensive and very specialized management of both physical and psychological dimensions of injured patients. Objective. The aim of the part of the study reported here was twofold: (1) to describe burnout, empathy, and satisfaction at work of these professionals and (2) to explore whether a tailored program based on motivational interviewing (MI) techniques modifies and improves such features. Methods. This paper presents findings from an intervention study into a tailored training for professionals () working in a spinal cord injury (SCI) unit from a general hospital. Rehabilitation professionals’ empathy skills were measured with the Jefferson Scale of Physician Empathy (JSPE), burnout was measured with the Maslach Burnout Inventory (MBI), and additional numeric scales were used to assess the perceived job-related stress and perceived satisfaction with job. Results. Findings suggest that professionals are performing quite well and they refer to satisfactory empathy, satisfaction at work, and no signs of burnout or significant stress both before and after the training. Conclusions. No training effect was observed in the variables considered in the study. Some possible explanations for these results and future research directions are discussed in depth in this paper. The full protocol of this study is registered in (identifier: NCT01889940). Pilar Lusilla-Palacios and Carmina Castellano-Tejedor Copyright © 2015 Pilar Lusilla-Palacios and Carmina Castellano-Tejedor. All rights reserved. Spatiotemporal Changes Posttreatment in Peripheral Arterial Disease Thu, 03 Dec 2015 07:52:53 +0000 Accumulating evidence suggests revascularization of peripheral arterial disease (PAD) limbs results in limited improvement in functional gait parameters, suggesting underlying locomotor system pathology. Spatial and temporal (ST) gait parameters are well studied in patients with PAD at baseline and are abnormal when compared to controls. The purpose of this study was to systematically review and critically analyze the available data on ST gait parameters before and after interventions. A full review of literature was conducted and articles were included which examined ST gait parameters before and after intervention (revascularization and exercise). Thirty-three intervention articles were identified based on 154 articles that evaluated ST gait parameters in PAD. Four articles fully assessed ST gait parameters before and after intervention and were included in our analysis. The systematic review of the literature revealed a limited number of studies assessing ST gait parameters. Of those found, results demonstrated the absence of improvement in gait parameters due to either exercise or surgical intervention. Our study demonstrates significant lack of research examining the effectiveness of treatments on ST gait parameters in patients with PAD. Based on the four published articles, ST gait parameters failed to significantly improve in patients with PAD following intervention. Sara A. Myers, Neil B. Huben, Jennifer M. Yentes, John D. McCamley, Elizabeth R. Lyden, Iraklis I. Pipinos, and Jason M. Johanning Copyright © 2015 Sara A. Myers et al. All rights reserved. The Impact of Diagnosis on Job Retention: A Danish Registry-Based Cohort Study Tue, 01 Dec 2015 07:02:37 +0000 Background. In 1998, Denmark introduced the flex job scheme to ensure employment of people with a permanent reduced work capacity. This study investigated the association between select diagnoses and the risk of disability pension among persons eligible for the scheme. Methods. Using the national DREAM database we identified all persons eligible for the flex job scheme from 2001 to 2008. This information piece was linked to the hospital discharge registry. Selected participants were followed for 5 years. Results. From the 72,629 persons identified, our study included 329 patients with rheumatoid arthritis, 10,120 patients with spine disorders, 2179 patients with ischemic heart disease, and 1765 patients with functional disorders. A reduced risk of disability pension was found in the group with rheumatoid arthritis (hazard ratio = 0.69 (0.53–0.90)) compared to the group with spine disorders. No differences were found when comparing ischemic heart disease and functional disorders. Employment during the first 3 months of the flex job scheme increased the degree of employment for all groups. Conclusion. Differences in the risk of disability pension were identified only in patients with rheumatoid arthritis. This study demonstrates the importance of obtaining employment immediately after allocation to the flex job scheme, regardless of diagnosis. Rasmus Espersen, Vibeke Jensen, Martin Berg Johansen, and Kirsten Fonager Copyright © 2015 Rasmus Espersen et al. 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.