The relative importance of motor, perceptual, and some cognitive functions for self-care ability was analyzed in a representative sample of 109 subjects within 2 weeks of acute stroke. Forty-nine patients (45%) were dependent or partly dependent in self-care. Profound motor dysfunction was present in 39%, low-order perceptual deficits in 10%, high-order perceptual deficits in 60%, and disorientation in time and space in 13% of the patients. There was a significant covariation between motor function and self-care ability and between low-order perception and orientation function. Low-order and high-order perception covaried only weakly. Discriminant analyses showed that the actual level of self-care proficiency could be correctly predicted in 70% of the cases by the 4 indexes of motor function, low-order perception, high-order perception, and orientation. The dominating predictor was motor function, and the next highest was high-order perception. When a program for early training is designed with the aim to alleviate long-term self-care disability after stroke, correct assessment of motor and perceptual functions in the individual stroke patient is essential.
To describe the prevalence of self-reported changes in life satisfaction after multiple trauma, to analyse associations between satisfaction with life as a whole and with domains in life, and to identify important contributors for satisfaction with life.Retrospective follow-up study.Rehabilitation hospital three years after multiple trauma.Sixty-nine subjects with severe multiple trauma (ISS > or = 16).Clinical examinations to reveal prevalences of impairments and disabilities. Questionnaires about satisfaction with life as a whole and eight domains of life, both for the time before trauma, and for the actual situation; sense of coherence (SOC-13); social network.A total of 87% experienced a decrease in at least one of the nine life satisfaction items from before to after trauma (six-graded scale). After trauma significantly fewer subjects reported to be satisfied with life as a whole, as well as the domains sexual life, ADL, contact with friends, leisure, vocational and financial situation. Satisfaction with family life and partner relationship did not decrease significantly. The most important domains after trauma were satisfaction with leisure, family life and vocation. Vocational and leisure disability after trauma were important determinants for satisfaction with life as a whole. A strong sense of coherence and sufficient social network quality had significant impact on satisfaction with life as a whole and some of the domain-specific satisfactions.Both personal resources (a strong sense of coherence) and the presence of a qualitatively sufficient social network can buffer the negative influence of disabilities on life satisfaction after trauma.
Maximum torques, total work and mean power of isokinetic plantar flexions were measured with simultaneous registrations. The integrated electromyograms (iEMG) were obtained by surface electrodes from all three heads of the m. triceps surae. The method applied offers possibilities for adequate description of dynamic muscular work which in the case of plantar flexion in trained man declines as a negative exponential function of angular motion velocity. The decline is parallel to that of maximum torques. The summed triceps surae iEMG was inversely proportional to the velocity and direct proportional to time suggesting that structural rather than neural factors determine the relationships between velocity of angular motion and maximum torque/total work of single Mmaneuvers. Moreover, the fact that maximum mean power as well as maximum electrical efficiency were reached at the functional velocity of toe-off during gait suggests an influence of pragmatic demands on plantar flexion mechanical output.
The principal aim of this investigation was to relate perceived confidence in task performance without falling and observer-assessed balance, both to each other and to motor function at three different times after a fi rst stroke. Sixty-two patients 24-65 years of age participated in this study. Perceived confidence in task performance was self-reported using a Swedish modification of the Falls-Efficacy Scale (FES(S)). For observer assessments the Berg Balance Scale and the balance and motor function sections of the Fugl-Meyer Stroke Assessment Instrument were used. Assessments were performed on admission, at discharge, and at a 10-month follow-up. FES(S) was significantly associated with observer-assessed balance (rho = 0.46-0.68) and motor function (rho = 0.45-0.56) onadmission and on discharge (rho = 0.38-0.51). At follow-up these correlations were generally weaker, ranging from 0.20-0.49. We conclude that self-reported confidence in task performance is a valuable measure in clinical practice, adding information to that gained from objective assessments.
In 1976, Fasano, et al., described a new technique of posterior rhizotomy for treatment of spasticity. They stimulated electrically fascicles of the posterior roots in spastic patients and found that some fascicles responded to stimulation with tonic muscle contractions. They cut these fascicles, preserving those with a weaker or no reaction. The present authors have used a fairly similar technique in the treatment of eight patients with spasticity of the legs and one patient with spasticity of the arm: all fascicles of the posterior roots T12-Sl and C6-8, respectively, were stimulated electrically during surgery under general anesthesia. Approximately 60% to 80% of the fascicles responded to stimulation with tonic muscle jerks, and only these fascicles were cut. All nine patients showed a good reduction of spasticity. The residual cutaneous and joint sensation remained unchanged. Motility of the limbs usually improved.
At three occasions during a year, the ratio of contractional work (output)/integrated electromyographic activity (input), that is, CW/iEMG, was measured during repetitive maximum isokinetic manoeuvres for m. quadriceps and m. triceps surae in male elite orienteers. Running velocity at the onset of blood lactate accumulation ( V obla ), which was considered as a measure of running performance, and maximal oxygen uptake (V O 2 max) were analysed at each test. Type and amount of training were continuously registered. For m. quadriceps there was a decline in CW/iEMG during the first 30 manoeuvres, followed by an unchanged plateau level. In contrast, m. triceps surae showed a plateau level of virtually unaltered CW/iEMG ratio from the start to the end of the experiment. The differences might be explained by structural causes, but also by local muscle adaptation to training. The plateau level of CW/iEMG of m. quadriceps was positively correlated to V O 2 max. An increase in the plateau level of CW/iEMG was found for both tested muscle groups after the winter training period (mainly low intensity road running) when both V obla and V O 2 OBLA increased. During the competition period (mainly high intensity forest running), the whole group increased while some orienteers lowered their V obla . During this period, no changes in the plateau level of CW/iEMG of any muscle group or in V O 2 OBLA occurred. The changes in the plateau level of CW/iEMG might express local muscle adaptations to changes in running technique and aerobic/anaerobic demands during low intensity road running versus high intensity forest running.
