Biomedical subjects

Kathleen M Gill-Body

Publications and source records attributed to Kathleen M Gill-Body.

9 recordsLinked to original sources

PubMed2006

Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.

OBJECTIVE: To define the minimal clinically important difference (MCID) for the FIM instrument in patients poststroke. DESIGN: Prospective case series discharged over a 9-month period. SETTING: Long-term acute care hospital. PARTICIPANTS: Patients with stroke (N=113). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Admission, discharge, and change scores were calculated for the total FIM, motor FIM, and cognitive FIM. Assessments of clinical change were rated at discharge on a 15-point (-7 to +7) Likert scale by attending physicians, with MCID defined at a cutoff score of 3. The FIM change scores associated with MCID were identified from receiver operating characteristic curves. Bayesian analysis was used to determine the probability of individual patients achieving MCID. RESULTS: FIM change scores associated with MCID were 22, 17, and 3 for the total FIM, motor FIM, and cognitive FIM, respectively. The accuracy of the MCID was greater when subjects were categorized based on admission FIM scores than when considering the sample as a whole. Larger FIM change scores were related to MCID in subjects with lower admission FIM scores. CONCLUSIONS: These findings will assist in the interpretation of FIM change scores relative to physicians' assessments of important clinical change.

Activities of Daily Living↗

PubMed2006

An integrated framework for decision making in neurologic physical therapist practice.

Decision-making frameworks are used by clinicians to guide patient management, communicate with other health care providers, and educate patients and their families. A number of frameworks have been applied to guide clinical practice, but none are comprehensive in terms of patient management. This article proposes a unifying framework for application to decision making in the management of individuals who have neurologic dysfunction. The framework integrates both enablement and disablement perspectives. The framework has the following attributes: (1) it is patient-centered, (2) it is anchored by the patient/client management model from the Guide for Physical Therapist Practice, (3) it incorporates the Hypothesis-Oriented Algorithm for Clinicians (HOAC) at every step, and (4) it proposes a systematic approach to task analysis for interpretation of movement dysfunction. This framework provides a mechanism for making clinical decisions, developing clinical hypotheses, and formulating a plan of care. Application of the framework is illustrated with a case example of an individual with neurologic dysfunction.

Algorithms↗

PubMed2004

Can Tai Chi improve vestibulopathic postural control?

OBJECTIVES: To evaluate the rationale and scientific support for Tai Chi as an intervention for vestibulopathy and to offer recommendations for future studies. DATA SOURCES: A computer-aided search, including MEDLINE and Science Citation Index, to identify original Tai Chi studies published in English; relevant references cited in the retrieved articles were also included. STUDY SELECTION: A preliminary screening selected all randomized controlled trials (RCTs), non-RCTs, case-control studies, and case series that included Tai Chi as an intervention and had at least 1 outcome variable relevant to postural stability. DATA EXTRACTION: Authors critically reviewed studies and summarized study designs and outcomes in a summary table. DATA SYNTHESIS: Twenty-four Tai Chi studies met screening criteria. No studies specifically studying Tai Chi for vestibulopathy were found. Collectively, the 24 studies provide sometimes contradictory but generally supportive evidence that Tai Chi may have beneficial effects for balance and postural impairments, especially those associated with aging. Ten RCTs were found, of which 8 provide support that Tai Chi practiced alone, or in combination with other therapies, can reduce risk of falls, and/or impact factors associated with postural control, including improved balance and dynamic stability, increased musculoskeletal strength and flexibility, improved performance of activities of daily living (ADLs), reduced fear of falling, and general improvement in psychologic well-being. Studies using other designs support the results observed in RCTs. CONCLUSIONS: At present, few data exist to support the contention that Tai Chi specifically targets the impairments, functional limitations, disability, and quality of life associated with peripheral vestibulopathy. There are, however, compelling reasons to further investigate Tai Chi for vestibulopathy, in part because Tai Chi appears useful for a variety of nonvestibulopathy etiologic balance disorders, and is safe. Especially needed are studies that integrate measures of balance relevant to ADLs with other psychologic and cognitive measures; these might help identify specific mechanisms whereby Tai Chi can remedy balance disorders.

Humans↗

PubMed2004

A yoga-based exercise program for people with chronic poststroke hemiparesis.

BACKGROUND AND PURPOSE: This was a preliminary investigation of the effects of a yoga-based exercise program on people with chronic (greater than 9 months) poststroke hemiparesis. Many people who have had a stroke report an impaired health status because of a reduced level of activity. Proponents of yoga contend that it offers a gentle alternative exercise program that can be easily adapted for people who have had a stroke. SUBJECTS AND METHODS: Four subjects with chronic poststroke hemiparesis participated in this single-case study. The primary outcome measures were the Berg Balance Scale (BBS) and the Timed Movement Battery (TMB). A secondary outcome measure was the Stroke Impact Scale (SIS). The baseline testing phase varied for each subject and ranged from 4 to 7 weeks. The 8-week intervention phase consisted of 1.5-hour yoga sessions, 2 times per week, in the subject's home. The primary outcome data were collected each week, and the secondary outcome data were collected before the baseline testing phase and before and after the intervention phase. RESULTS: Subjects 1, 2, and 4 had improved TMB scores, and subjects 3 and 4 had improved BBS scores. DISCUSSION AND CONCLUSION: The results suggest that yoga may be beneficial to people who have had a stroke. Further investigation is warranted to further examine the effects of yoga in this population.

Aged↗

PubMed2003

Vestibular rehabilitation: useful but not universally so.

OBJECTIVE: Although vestibular rehabilitation (VR) is gaining popularity, few data support its utility in improving locomotor stability, and no good predictors exist of whom will benefit most. STUDY DESIGN AND SETTING: A double-blind, placebo-controlled randomized trial of vestibular rehabilitation was conducted at a large tertiary care hospital on 124 patients (59 +/- 18 years old) with unilateral (n = 51) or bilateral (n = 73) vestibular hypofunction, of whom 86 completed a 12-week intervention. Of these 86, 27 returned for long-term (1-year) follow-up testing. The primary outcome measure was locomotor stability. RESULTS: Group A (6 weeks of VR) significantly (P < 0.01) increased their gait velocity and stability compared with group B (6 weeks of strengthening exercise), but there was a smaller difference (P = 0.05) between groups at 12 weeks, when both had had VR; there were no group differences at 1 year. Of the 86 who completed the intervention, 52 (61%) had clear locomotor gains. CONCLUSION AND SIGNIFICANCE: VR is helpful for most patients in providing locomotor stability, but further work is needed to determine the factors that prevent VR from being effective for all patients with vestibulopathy.

Adolescent↗

PubMed2003

Item-specific functional recovery in children and youth with acquired brain injury.

PURPOSE: The purpose of this study was to examine changes in item-specific functional activities and caregiver support in children and youths with acquired brain injury (ABI) in an inpatient setting using the Pediatric Evaluation of Disability Inventory (PEDI). METHODS: The PEDI was administered by therapy staff at admission and discharge to a consecutive sample of 94 children and youths with brain injury (62 males and 32 females; age range = one to 19 years of age) admitted to the inpatient service at Franciscan Children's Hospital and Rehabilitation Center during a two-year, 10-month period. Individual PEDI item scores were abstracted from the medical records. RESULTS: Using the Wilcoxon matched-pairs signed rank test (two-tailed), significant differences between admission and discharge scores were found for most mobility, self-care, and social activity item groups and for all domains of caregiver support. Patterns of activity-specific improvements were contrasted between children with traumatic ABI and those with nontraumatic ABI. CONCLUSIONS: Recovery in children with ABI can be detected during inpatient rehabilitation across many areas of functioning as represented by item content of the PEDI. Changes at the item level may serve as a guide for defining specific physical therapy goals for inpatient episodes. Item groups in which changes are not detected provide information about sections of the PEDI that are less relevant for hospital-based recovery of children with ABI.

Journal Article↗

PubMed2003

Measuring functional change in children with acquired brain injury (ABI): comparison of generic and ABI-specific scales using the Pediatric Evaluation of Disability Inventory (PEDI).

BACKGROUND AND PURPOSE: The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. SUBJECTS: Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1-20) with ABI during inpatient rehabilitation admissions were included. METHODS: Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. RESULTS: Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. DISCUSSION AND CONCLUSION: The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.

Activities of Daily Living↗

PubMed2003

Determinants of balance confidence in community-dwelling elderly people.

BACKGROUND AND PURPOSE: The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study. SUBJECTS: The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (mean=81.7, SD=6.7). METHODS: Balance was measured using the Berg Balance Scale. Functional mobility was measured using the Timed Up Go Test. The Activities-specific Balance Scale was used to assess balance confidence. Data were analyzed using Pearson correlation, multiple regression analysis, and t tests. RESULTS: Fifty-seven percent of the variance in balance confidence could be explained by balance performance. Functional mobility and subject characteristics examined in this study did not contribute to balance confidence. DISCUSSION AND CONCLUSION: Balance performance alone is a strong determinant of balance confidence in community-dwelling elderly people.

Accidental Falls↗

PubMed2002

Is base of support greater in unsteady gait?

BACKGROUND AND PURPOSE: We investigated dynamic interfoot distance (IFD) throughout the gait cycle in people with unsteady gait caused by vestibulopathy and in people without known neuromuscular pathology. We expected that the subjects with unsteady gait would use a greater IFD than subjects without neuromuscular pathology and that this IFD would be correlated with other measures of locomotor stability. SUBJECTS AND METHODS: Simultaneous whole-body (11-segment) dynamic kinematic data were collected from 22 subjects with vestibulopathy and 22 subjects without known neuromuscular pathology who were matched for age, height, weight, and body mass index. Two trials each of the participants' gait at preferred speed and paced gait at 120 steps/min were analyzed with a repeated-measures design with multiple dependent variables. Quantitative data were analyzed descriptively and with inferential statistics. RESULTS: Interfoot distance at preferred gait speed did not differentiate unsteady subjects with vestibulopathy from the comparison subjects. Paced gait IFD total range and IFD in single-limb support differed between groups, but IFD at heel-strike did not. However, IFD at heel-strike, the traditional measure of "base-of-support width," was correlated with measurements of whole-body center-of-gravity stability (r=.32-.55). DISCUSSION AND CONCLUSION: Gait at preferred speed permitted the unsteady subjects and the comparison subjects to select similar IFD values, but at the cost of slower gait in the unsteady subjects. When required to walk at a "normal" pace of 120 steps/min, subjects with vestibulopathy increased their IFD. These data suggest that wide-based gait alone cannot differentiate between subjects with and without balance impairments. Base of support and other whole-body kinematic variables are mechanical compensations of vestibulopathic instability. Further studies are needed to determine whether development of active control of these whole-body control variables can occur after vestibular rehabilitation.

Adult↗