In the Netherlands ankle-foot orthoses (AFO), standing frames (SF), knee-ankle-foot orthoses (KAFO) and orthopaedic footwear are frequently prescribed for patients with Duchenne muscular dystrophy. Little is known, however, about the prescription pattern and the experience of patients. A questionnaire was sent to 25 rehabilitation physicians treating 53 patients with Duchenne muscular dystrophy. The use of orthoses and the patients' experience was measured during 1 year of follow-up. Our results show prescription of AFO 91 %, of SF 61% and of KAFO 22%. Indications were limited passive dorsiflexion and Vignos classification 6.1 Patient-related factors were reasons to discontinue or to refrain from using orthoses. The prescribed duration for KAFO varied greatly. Patients' experience scores for SF and KAFO were high. The time that the orthoses were worn differed greatly from the recommended time. Ready-made shoes were prescribed for equinovarus during ambulation. Similarly, ready-made shoes or custom-made shoes were advised for wheelchair-dependent patients. This study shows no uniform prescription pattern for AFO, SF, KAFO and orthopaedic footwear. The prescription pattern was influenced by patient-related factors and actual use greatly differed from the recommended time.
Purpose: To assess the long-term motor and functional recovery of arm function after stroke. Design: Cohort study. Subjects: Fifty-four patients with a first stroke, who underwent inpatient rehabilitation, were measured early after stroke, after 16 weeks and after 4 years. Measures: Fugl-Meyer Motor Assessment (FM, upper extremity), Action Research Arm Test (ARA), Barthel Index, Arm Function Questionnaire, shoulder pain and range of motion, sensory function, Ashworth Scale and a perceived problem score. Results: Although most of the improvement occurred during the first 16 weeks after stroke, improvement in the FM score continued after 16 weeks in 10 patients. In 13 patients the recovery of arm function only started after 16 weeks. After 4 years a fair to good recovery of arm motor function (FM score 20) was found in 31 patients. Twenty-seven patients had fair to good functional abilities of the hemiplegic arm (ARA 25). Submaximal ARA scores for the unaffected arm were found in 11 patients. Barthel scores 60 were found in 52 patients. Serious shoulder pain persisted in 11 patients. Intact sensory function was found in only 14 patients. It was associated with good motor recovery (FM score 35 in 11 patients). Loss of arm function was perceived as a major problem by 36 patients. Conclusion: This is the first study to investigate the recovery of arm function after stroke over a period of 4 years. It is encouraging to note that even after 16 weeks improvement still occurred in some patients. However, considerable long-term loss of arm function, associated disability and perceived problems were found. There is an obvious need to develop effective treatment methods for hemiplegic arm function.
AbstractAn innovative method to structure multidisciplinary team conferences in rehabilitation medicine was developed: Rehabilitation Activities Profile report system (RAP-TEAM). Experiences with introduction of RAP-TEAM and the study of its effects on the satisfaction of professionals are described. RAP-TEAM was introduced in three teams. RAP-TEAM did not influence the satisfaction of professionals in two teams; satisfaction in the third team even decreased. Nevertheless, professionals report more benefits than disadvantages of RAP-TEAM. Several possible explanations for these results and the methodological problems with this kind of evaluation study are discussed. The most important explanation is that introduction of an innovative method should be allowed sufficient time before it could become effective. Recommendations for a successful introduction of innovative changes are made. All people concerned must be aware that a process of change is not simple, and needs the full attention of all.Key Words: team conferencesRehabilitation Activities Profile (RAP)
A simple feasibility study of the ICIDH was conducted: 1148 patients were classified by their physician, the opinion of the physicians about the feasibility of the ICIDH was recorded, and finally 21 patients were classified twice to assess reliability. The results suggest that the I code is feasible for patients with locomotor disorders. The use of the D code presented several problems. It is very time-consuming and reliability of D code assignments seems to be low. The feasibility of the D code can probably be improved if the numerical framework is reshaped. The H code seems to allow for simple meaningful scorings, although we tended to use it as a substitute for the impractical D code, rather than as an indicator of handicap.
Psychological functioning in two types of multiple sclerosis (MS) patients is assessed: primary progressive (PP) and secondary progressive (SP) patients. On the basis of differences in clinical course and underlying pathology we hypothesized that primary progressive patients and secondary progressive patients might have different psychological functioning. Seventy patients treated in an MS centre were examined cross‐sectionally. Forty had an SP course of MS and 30 a PP course. The 33 male and 37 female patients had a mean age of 48.4 years (SD 11.2) and mean age of onset of MS of 30.7 years (SD 11.1). Patients completed questionnaires measuring among others the following aspects of psychological functioning: depression (BDI, SCL‐90), anxiety (STAI, SCL‐90), agoraphobia (SCL‐90), somatic complaints (SCL‐90), hostility (SCL‐90) and attitude towards handicap (GHAS). Patients with a PP‐MS scored significantly better on 5 out of 14 subscales than patients with SP‐MS ( p <.05). On the basis of our operationalizations of psychological functioning, the findings support the conclusion that on average 18 years after diagnosis of MS, amongst patients attending an MS unit, primary progressive patients were found to have better psychological functioning.
This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase, and Cinahl, including the keywords 'spasticity', 'child', and 'cerebral palsy', to identify articles in which a clinical method to measure spasticity was reported. Thirteen clinical spasticity assessment instruments were identified and evaluated using predetermined criteria. This review consists of reports on the standardization applied for assessment at different velocities, testing posture, and quantification of spasticity. Results show that most instruments do not comply with the concept of spasticity; standardization of assessment method is often lacking, and scoring systems of most instruments are ambiguous. Only the Tardieu Scale complies with the concept of spasticity, but this instrument has a comprehensive and time-consuming clinical scoring system.
