{"title":"Subacute brain injury rehabilitation: a program description and a study of staff program evaluation.","authors":"A Finset","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The concept of continuity of care is introduced and briefly discussed. Three aspects of subacute rehabilitation of patients with Traumatic Brain Injury (TBI) are discussed: the need for differentiated treatment programs, for team integration and emphasis on environmental or milieu factors to accomplish treatment success. The so called Wing Team Model at the TBI Unit at Sunnaas Rehabilitation Hospital is described. In our program the patients are divided in three groups: the North Wing Program, for slow to recover patients, the East Wing program for patients with severe sequelae after TBI and the South Wing Program for ambulatory patients mainly with cognitive sequelae. A questionnaire study of how staff members evaluate certain aspects of the program is presented. The study indicates that the staff members have in general a positive attitude towards the treatment model, but they wish an improved team coordination of the individual programs.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"26 ","pages":"25-33"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12659293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hip fracture patients. Background factors and function.","authors":"G B Jarnlo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The incidence of hip fractures increased from 3.3 per 1,000 inhabitants in 1966 to 5.1 in 1986 for persons more than 50 years old. The incidence almost doubled in persons more than 80 years old, from 13.3 to 25.6 per 1,000. The proportional increase was largest in men with cervical fractures. A higher incidence was found in the city compared to the rural area. The city of Lund had a lower incidence in comparison with larger cities, such as Stockholm, Göteborg and Uppsala. The early rehabilitation at home of hip fracture patients in cooperation with primary health care, rendered good results and a low consumption of resources, compared to continued care at the Orthopedic Department or in a nursing home. About 60 per cent of the patients returned directly to their own home. Most of them regained, within four months, their former capacity of daily life, in spite of their hip fracture and high age. Patients with hip fractures reported more signs of diseases, lower capacity for managing their daily life and were more often afraid of falling than the controls. Most falls, 75 per cent, preceding the fracture, occurred during walking or when rising from or sitting down on a chair. Two thirds of the hip fracture patients had fallen sideways. A test battery for assessing standing balance on a computerized force platform was evaluated. Postural sway in healthy subjects indicated that age and sex were important, when analysing the results. Men and older subjects had larger postural sway than women and younger subjects, respectively. Middle-aged patients with a previous hip fracture showed larger postural sway (= lower balance capacity), lower perceived balance and a lower walking speed than healthy controls. Eighteen 70-year-old women trained their postural control for five weeks. They had significantly better results in the tests after the training period than the controls. These balance tests are simple and applicable in clinical practice. Training of postural control might prevent some hip fractures, which is of the utmost importance both for the elderly person and society.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"24 ","pages":"1-31"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13107378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Muscle adaptation and disability in late poliomyelitis.","authors":"G Einarsson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Persons who suffered poliomyelitis 3 or more decades ago now report functional decline and symptoms designated as \"post-polio syndrome\". The objects of this investigation were to identify subjects fulfilling the criteria of this syndrome, to describe their motor impairment and resulting disabilities/handicaps, to study the adaptive changes in the muscle structure and effects of a resistance exercise program. Forty-one late-polio subjects, 40-65 years old, volunteered for the studies of motor impairment, subgroups of those volunteered to further studies of long-term and short-term adaptations. Seventy-five per cent of the subjects met the criteria for the post-polio syndrome. Complete manual muscle tests and dynamometer measurements of knee muscle strength revealed severe motor impairment predominantly in the lower extremities, the strength of the latter correlating to the degree of mobility handicap. In biopsies from the vastus lateralis muscle, type grouping was frequent. Half of the subjects demonstrated over 70% occurrence of type I fibers with negative significant correlation to strength in the female subjects. Cross-section areas of muscle fibers were on average twice the normal, with negative significant correlation to strength values in male subjects. Muscle enzymatic activity values showed large individual variations; oxidative activities (citrate synthase) were low or very low, while average glycolytic activities were nearly normal. Macro EMG and single-fiber EMG measurements in the vastus lateralis muscle demonstrated large macro motor unit potentials and increased fiber density. Neuromuscular transmission was disturbed as identified by jitter and blockings in most subjects regardless of the occurrence of new muscular symptoms. A statistically significant increase in strength (25-30%) resulted from a 6 weeks' heavy resistance exercise program, utilizing a dynamometer, without any obvious side-effects. Strength improvement was maintained for 6-12 months after training while fatigue index increased. A substantial impact on intermediate (secondary or instrumental) ADL, most severely affecting the quality of mobility, was generally found, while little effect was found on primary ADL as revealed by the Katz' ADL index, the Functional Status Questionnaire and the WHO ICIDH Classification of Handicap. The impaired motor function confirms findings in earlier studies. It also corresponds with the locomotor disabilities and handicaps. The negative correlation of strength to cross-section fiber area might result from excessive use of remaining fibers leading to a prominent hypertrophy in the weakest subjects. Enzyme activities probably reflect the pattern of everyday activities with little demands on endurance.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"25 ","pages":"1-76"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13001150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"After the myocardial infarction. A medical and psychological study with special emphasis on perceived illness.","authors":"J G Maeland, O E Havik","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Each year, more than 10,000 persons are admitted to Norwegian hospitals for a myocardial infarction (MI). The purpose of this study was to examine the medical, psychological, and social consequences of a MI, with special emphasis on the role of cognitive factors for the readjustment and coping process. Three hundred and eighty-three MI-patients below 67 years of age were followed by means of self- administered questionnaires during hospitalization and 1-2 weeks, 6 weeks, 6 months, and 3-5 years after the MI. In addition, a quasi- experimental evaluation of an in-hospital educational program was carried out. A high participation rate, relatively high reliability coefficients for methods developed for this study, and good correspondence with proxy information indicate satisfactory quality of data. Special attention was given to patients' cardiac health knowledge and expectations; two central aspects of perceived illness. Knowledge was represented by three scales covering basic understanding, lifestyle related aspects, and common misconceptions about coronary heart disease. Expectations were represented by four scales, pertaining to the subjective estimates of, respectively, reduced physical ability, autonomy, emotional control, and work capacity. Knowledge and expectations were only moderately correlated. Level of cardiac knowledge among the MI patients was primarily determined by socioeconomic status and amount of standardized information received during hospitalization. More negative expectations were strongly associated with hopelessness and a worse self-rated pre-MI health status. Self-assessed health was clearly reduced after the MI compared with pre-MI levels. About two-thirds of the patients were limited in their physical activities by chest pain or breathlessness. Over the 3-5 years follow-up period, about half of the surviving patients were readmitted to hospital; in more than two-thirds of the cases for heart-related reasons. Almost one third had a major recurrence, either death (17%) or a non-fatal reinfarction (14%). However, long-term use of physician consultations did not exceed that of the general population. Within 6 months, 73% of previously employed patients had returned to work with a mean sick-leave period of 15 weeks. Of previous smokers, 41% had resumed smoking 6 months after the MI whereas 49% smoked at the 3-5 years follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"22 ","pages":"1-87"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13791324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Energy cost of level walking.","authors":"E Mattsson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Devices and methods have been developed for determining speed and oxygen cost of level walking. Speed was recorded and controlled using a speedometer cart. Oxygen uptake was determined with an argon-dilution method using a mixing box mounted on a backpack. The method was found valid, coefficient of variation (cv) less than 2.1%, and to give excellent reproducibility with regard to self-selected speed, cv less than 1.9%, predetermined speed, cv less than 1.3%, and to oxygen cost, cv less than 3.2%. Artificially arranged immobility of the knee or instability of the ankle decreased comfortable walking speed 23% and 4% respectively. Oxygen cost increased 23% and 10% respectively. Stabilizing splints allowing some flexion could if possible be advocated, particularly with elderly patients. Patients with coxarthrosis were studied before and after THA. One year after surgery the Harris hip score had increased from 35 to 85 points and maximal walking speed from 62 to 80 m min-1 Oxygen cost had decreased from 0.267 to 0.221 ml kg-1m-1. The onset of and the recovery from complications, as well as differences between patients with uni- and bilateral diseases, were reflected in change in oxygen cost but not in clinical scoring. Patients with moderate gonarthrosis were studied before and after unicompartmental knee prosthetic replacement. No major benefit of preoperative physical therapy, mainly aiming to improve thigh muscle strength, was observed three months after surgery. One year after surgery the patients had improved in clinical score rating and recovered an almost normal walking ability. Measurements of pain and self-selected walking speed were found to be sufficient for assessing effects of treatment in these patients. Patients with severe gonarthrosis had improved in clinical score rating one year after TKR. Oxygen cost of walking was unchanged. An acquired uneconomic walking pattern was considered to be the reason for unimproved walking efficiency. Patients with spastic paraparesis were treated with long-term stretch of the hip adductor muscles. Either the oxygen cost or the blood lactate level was decreased during walking, indicating that even during moderate exercise blood lactate must be taken into consideration when energy cost is measured in these patients. Measurements of walking speed and oxygen cost of level walking were found to be useful objective parametres for assessing walking and to be a valuable supplement to clinical assessment of effects of treatment in patients with walking disorders.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"23 ","pages":"1-48"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13774936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intraoperative electrical stimulation for functional posterior rhizotomy.","authors":"V A Fasano, G Broggi, S Zeme","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intraoperative electrical stimulation of dorsal spinal roots from L1 to S1 bilaterally was performed in 80 patients affected by cerebral palsy, in whom spasticity was the main symptom. Clinical examination and EMG recordings showed three main features of reflex responses. We know that they indicate respectively a normal presence, a defect or an excess of inhibitory activity within the spinal circuits examined. Only those roots or rootlets involved in circuits where normal inhibitory processes are reduced or absent are surgically sectioned. Therefore these circuits are interrupted. The theoretical bases and long-term results indicate that this method is a useful and correct approach to the neurosurgical therapy of spasticity. It allows us to utilize a new important criterion to identify the roots or rootlets to be sectioned, based not on the anatomic, but on the functional selection.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"17 ","pages":"149-54"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14293879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Söderström, A Fogelsjöö, K S Fugl-Meyer, S Stensson
{"title":"A program for crisis-intervention after traumatic brain injury.","authors":"S Söderström, A Fogelsjöö, K S Fugl-Meyer, S Stensson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A model for crisis-intervention and family therapy is presented. Each patient admitted to the neurosurgical wards with a diagnosis of acute cerebral contusion is contacted by one member of the psychotherapeutic team within 10 days. When the patient is psychotherapeutically approachable, he is offered crisis-intervening therapy followed by family therapy when considered appropriate. The effect of the crisis-intervention is gauged one and two years after the trauma. At the same time the treated and non-treated patients' psycho-social functioning is investigated. The preliminary results suggest that patients who participated in the program achieved an overall better adjustment to life after the traumatic brain injury than did those without psychotherapy.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"17 ","pages":"47-9"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14293882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Malezic, M Gregoric, E Kljajić, R Aćimović-Janezic
{"title":"EMG monitoring of stimulating electrode position in implantation of subcutaneous peroneal stimulators.","authors":"M Malezic, M Gregoric, E Kljajić, R Aćimović-Janezic","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Implantation of subcutaneous peroneal stimulators requires careful positioning to obtain a good response. With the patient lying down during the surgical procedure, ankle dorsal flexion was not always satisfactory during gait. Instead of dorsal flexion the stimulus could give an excessive eversion or a coactivation of ankle antagonists. To select the correct electrode position, the responses to single stimulation pulses were monitored in the tibialis anterior, peroneus longus and triceps surae muscles by surface EMG electrodes. With the patient standing, a strong contraction of the anterior tibial muscle without excessive contraction of the peroneus longus muscle was first determined by surface stimulation. The EMG responses were then recorded with the patient lying in the position required for implantation. The records were used as a guideline during surgery, during which positioning of the electrodes was monitored by the EMG responses. The method, tested on 2 healthy adults and 13 patients, resulted in reliable positioning of the stimulating electrodes.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"17 ","pages":"111-4"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14389525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The new surgical rehabilitation of arm-hand function in the tetraplegic patient.","authors":"E Moberg","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"17 ","pages":"131-2"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14294243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Microsurgical procedures in the peripheral nerves and the dorsal root entry zone for the treatment of spasticity.","authors":"M Sindou, Y Keravel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>When spasticity becomes severe and harmful, in spite of physical and medical therapy, neurosurgery can give functional improvement. This paper deals with the long term results of Selective Peripheral Neurotomies of the Tibial Nerve and Selective Posterior Rhizotomies in the Dorsal Root Entry Zone, in 123 patients with spastic disorders localized to the limbs. The micro-techniques and intra-operative electro-stimulation for identification of the nervous structures responsible for the spastic components, can give a substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory functions. The results were effective, with a 1 to 13 year follow-up (5 on average), in 89% of 47 Selective Peripheral Neurotomies of the tibial nerve for spastic foot, in 92% of 53 Selective Posterior Rhizotomies for paraplegia and in 87% of 23 Selective Posterior Rhizotomies for hemiplegia. In the most severe situations (\"comfort\" indications), correction of the abnormal postures and relief of pain facilitated nursing and physiotherapy. Sometimes there was reappearance of some useful voluntary movements. In the less affected patients (\"functional\" indications), the suppression of the harmful spastic components made the persistant capacities more effective.</p>","PeriodicalId":76524,"journal":{"name":"Scandinavian journal of rehabilitation medicine. Supplement","volume":"17 ","pages":"139-43"},"PeriodicalIF":0.0,"publicationDate":"1988-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14294245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}