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PubMed2002

Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study.

BACKGROUND AND PURPOSE: The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. METHODS: This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern. A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. RESULTS: The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (P=0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. CONCLUSIONS: The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

Body Weight↗

PubMed1995

Inaccuracies in the estimation of functional relationships using self-monitoring data.

When evaluating self-monitoring data, most behavior therapists form subjective estimates of the magnitude of the functional relationships between controlling factors and target behaviors. These estimates are, however, subject to correlation misestimation. In this study, upper-level clinical psychology graduate students were asked to estimate the magnitude of correlations between a set of controlling variables and target behaviors for a hypothetical client. The findings suggested that intuitive correlation estimates among controlling factors and target behaviors are generally inaccurate.

Behavior↗

PubMed2006

Higher education provision for professionals working with people with dementia: a scoping exercise.

This paper reports on the first national UK survey of higher education provision related to dementia care. A questionnaire was distributed to lecturers in Higher Education Institutions (HEIs) in England and Wales seeking information about the amount of coverage of dementia within their pre-registration and pre-qualifying courses for health and social care professionals, and continuing professional development (CPD) courses on dementia care. Information was sought regarding the content of courses, and their relation to a published "dementia curriculum" [Pulsford et al., The contribution of higher education to dementia care, Journal of Dementia Care 11(4) (2003) 27-29]. Results show that coverage of dementia within the mental health branch of pre-registration nursing programmes is very variable, and may be related to the presence of an experienced and committed lecturer within the HEI. Coverage of dementia on adult branch programmes is limited, and sometimes non-existent, despite reported deficits in the ability of general nurses to work effectively with people with dementia. Occupational Therapists and Social Workers receive similar input to adult branch nurses. CPD courses are provided by around 70% of HEIs overall, but there is a shortage of specialised diploma and degree level courses on dementia care. Most areas of the dementia curriculum are covered in both pre-registration and CPD courses, but culture and diversity, young onset dementia, and physical health care may be less well addressed. Recommendations are made for developing higher education provision for professionals working with this group of people.

Attitude of Health Personnel↗

PubMed2005

Constructions of therapist-client sex: a comparative analysis of retrospective victim reports.

Former patients' (n=24) accounts of their experience during a sexual liaison with their psychotherapist (Therapist-Client Sex, TCS) could be classified as either romantic (TCS-Romance) or as an abusive encounter (TCS-Abuse). During TCS, individuals in the TCS-Romance group reported having experienced overall better emotional states and more favorable perceptions of both the perpetrating therapists and the treatments they provided. Pre-TCS assessments showed that initially TCS-Romance subjects may have had a relatively higher regard for their perpetrators and the quality of their treatments than TCS-Abuse subjects, but these between-group differences disappeared when the same variables were assessed for two post-TCS periods. These periods were marked in both groups by deteriorated indices of psychological well-being. These findings suggest that a romantic narrative of TCS could have a shielding, albeit temporary, impact on the subjective experience of what is otherwise considered an abusive relationship.

Adult↗

PubMed1977

Assessment of muscle strength in Duchenne muscular dystrophy.

Muscle strength in 23 patients with Duchenne dystrophy was tested against gravity and manual resistance during an 8-year period. The data show striking linearity in rate of loss of strength with age for any given patient. The tempo does not appear altered during growth spurts, bracing, or loss of ambulation. Variability in disease severity was documented clearly by 7 years of age and appears to be related to earlier age at onset of symptoms. This long ignored method of muscle strength assessment provides a precise measure of disease progression and, since the technique is widely used by physical therapists, it should be incorporated in clinical studies and therapeutic trials.

Age Factors↗

PubMed2001

Flexural wave propagation velocity and bone mineral density in females with and without tibial bone stress injuries.

STUDY DESIGN: Case-control nonexperimental design. OBJECTIVES: To compare flexural wave propagation velocity (FWPV) and tibial bone mineral density (BMD) in women with and without tibial bone stress injuries (BSIs). BACKGROUND: Physical therapists, particularly in military and sports medicine settings, routinely diagnose and manage stress fractures or bone stress injuries. Improved methods of preparticipation quantification of tibial strength may provide markers of BSI risk and thus potentially reduce morbidity. METHODS AND MEASURES: Bone mineral density, FWPV, bone geometry, and historical variables were collected from 14 subjects diagnosed with tibial BSIs and 14 age-matched controls; all 28 were undergoing military training. RESULTS: No difference was found between groups in FWPV and tibial BMD when analyzed with t tests (post hoc power = 0.89 and 0.81, respectively). Furthermore, no difference was found in tibial length, tibial width, femoral neck BMD, and lumbar spine BMD among the groups. There were no differences between the 2 groups in smoking history, birth control pill use, and onset of menarche. Finally, sensitivity and positive likelihood ratios for FWPV (0.14 and 0.63), tibial BMD (0.0 and 0.0), and lumbar BMD (0.18 and 2.0) were low, while specificity was high (0.77, 0.93, and 0.91, respectively). CONCLUSION: Current bone analysis devices and methods may not be sensitive enough to detect differences in tibial material and structure; local stresses on bone may be more important in the development of BSIs than the overall structural stiffness.

Absorptiometry, Photon↗

PubMed1996

[Adaptation to the community by young adults after one or more psychiatric hospitalizations].

This longitudinal study aimed at elaborating a model explaining the adaptation to the community of young adults suffering from mental illness. During their sick leave, an interview evaluated their social support, the stress experienced, coping strategies and emotional distress. Six months later, therapists were interrogated as to the recourse of these young adults to psychiatric services, their loyalty to therapeutic and medical treatment as well as how they kept busy during that period. Analyses by structural equations (LISREL) have allowed to develop a model which adequately reproduces relations observed between variables and explains 43% of the total variance. This model also indicates that the level of psychological distress has a direct impact on a psychiatric rehospitalization.

Adolescent↗

PubMed2005

Time out! Is timepiece variability a factor in critical care?

BACKGROUND: Accurate documentation of time is essential in critical care for treatments, interventions, research, and medicolegal and quality improvement activities. OBJECTIVES: To assess use of timepieces in critical care and to determine practical methods for improving their accuracy. METHODS: Providers were surveyed to identify timepieces used during routine and emergency care. Times displayed on standard unit and personal timepieces were compared with coordinated universal time. Four models of atomic clocks were assessed for drift for 6 weeks and for resynchronization for 1 week. Bedside monitors were manually synchronized to coordinated universal time and were assessed for drift. RESULTS: Survey response was 78% (149/190). Nurses (n = 93), physicians (n = 32), and respiratory therapists (n = 24) use wall clocks (50%) and personal timepieces (46%) most frequently during emergencies. The difference from coordinated universal time was a median of -4 minutes (range, -5 minutes to +2 min) for wall clocks, -2.5 minutes (-90 minutes to -1 minute) for monitors, and 0 minutes (-22 minutes to +12 minutes) for personal timepieces. Kruskal-Wallis testing indicated significant variations for all classes of timepieces (P<.001) and for personal timepieces grouped by discipline (P=.02). Atomic clocks were accurate to 30 seconds of coordinated universal time for 6 weeks when manually set but could not be synchronized by radiofrequency signal. Drift of bedside monitors was 1 minute. CONCLUSIONS: Timepieces used in critical care are highly variable and inaccurate. Manually synchronizing timepieces to coordinated universal time improved accuracy for several weeks, but the feasibility of synchronizing all timepieces is undetermined.

Critical Care↗

PubMed1992

Goal attainment scaling as a measure of change in infants with motor delays.

Goal attainment scaling (GAS) is an individualized criterion-referenced measure of change that has several unique features, compared with the behavioral objective, and five possible levels of attainment for each goal. The validity of GAS as a measure of motor change was investigated in 65 infants, 3 to 30 months of age, with motor delays. For each infant, two goals to be attained within a 6-month period of intervention were established. After the 6-month period, the mean GAS T-score of 55.4 was significantly higher than the expected mean of 50. This finding indicated that the infants' motor change exceeded the therapists' expectations. Neither the type nor the category of goal influenced the therapists' ability to select outcomes that the infants were capable of achieving. Because moderate and low correlations were found between GAS T-scores and Peabody gross motor and fine motor change scores, the two assessments appear to measure different aspects of motor development. Selected child, family, and program variables were examined as sources of bias in GAS T-scores. Motor delay was the only variable that biased GAS T-scores; infants who were less delayed had higher GAS T-scores. The results indicate that GAS was responsive to change in individualized motor goals and support the model of GAS as an idiosyncratic measure. The unique features of GAS offer advantages for measurement of motor change compared with the behavioral objective and norm-referenced developmental scales.

Bias↗

PubMed1997

Muscle balance at the knee--moment arms for the normal knee and the ACL-minus knee.

Forces, moments and stresses at the knee are dependent upon external and internal loading factors including muscle forces, segmental position and velocity, load carried, and the moment arms (mechanical advantage) of the muscle-tendon units. Requisite to prediction of forces and moments is a detailed understanding of effective moment arms throughout the knee range-of-motion (ROM). Existing muscle models for the knee are based upon limited static studies of only a few preserved specimens. The objectives of this report are to develop a comprehensive description of muscle-tendon moment arms for the normal knee and the anterior cruciate ligament (ACL)-minus knee during flexion-extension motion. Recent research results describe two nonorthogonal, nonintersecting axes of motion for the knee--one describing flexion-extension (FE) and the other longitudinal rotation (LR, equivalent to internal-external rotation). The effective flexion-extension moment arms of the muscles crossing the knee were developed with respect to the FE axis in 15 fresh, hemi-pelvis cadaver specimens. The normal moment arms for each of 13 muscles plus the patellar tendon exhibited variable, yet repeatable and recognizable patterns throughout the ROM. For most muscles there was no significant difference between the normal and ACL-minus moment arms. The results provide a basis for more accurate predictions of joint reaction forces and moments as well as useful knowledge for practitioners and therapists to assist in the assessment of muscle balance at the knee following injury, repair, and throughout rehabilitation.

Adult↗

PubMed1992

The formal mode of the science of psychoanalysis: studies of two patient/therapist systems.

This paper has introduced three mathematically based models that are part of a burgeoning new formal mode of the science of psychoanalysis: (1) The Power Spectral Density Function, which investigates the vicissitudes of cyclical power; (2) Work and Force, which lead to measurement of the instantaneous power of a session; and (3) Entropy or Complexity, a measurement of the accumulated complexity or redundancy of the communications from patients and therapists in the course of a therapy session. An additional statistical measurement was included, that of the Measure of Linear Influence or Cross-Correlation Function, which was used with a ten-minute window. Each of these measurements were applied to quantitative data that involved ratings of five variables of emotional communication: Newness of Themes, Extent of Narrative/Imagery, Positively Toned Themes and Images, Negatively Toned Themes and Images, and Continuity of Dialogue within a therapy. The paper compares two psychotherapies using these four measurements. They differentiated the two treatment situations, revealing distinctive properties of each. The implications of these preliminary results are discussed.

Adult↗

PubMed1993

Effect of age on progression through temporary prostheses after below-knee amputation.

Forty six patients that underwent below knee amputation for diabetes, trauma/osteomyelitis or peripheral vascular disease were studied. Healing was estimated by the rate of progression through temporary prostheses as determined weekly by the amputee rehabilitation team (physiatrist, orthopedist, physical therapist, nurse, and prosthetist). For all groups combined, mean days +/- standard error from amputation to above knee cast with pylon and foot (AKPy) were 22.9 +/- 1.9, to below knee cast with pylon and foot (BKPy) 41.6 +/- 2.8 and to laminated temporary prostheses 66.5 +/- 4.5. A regression analysis of these variables on age (range: 29 to 84 yr) showed significant positive correlations for AKPy (r = 0.34, P = 0.0214) and BKPy (r = 0.40, P = 0.0056). An analysis of variance with contrasts (Tukey's protected t) showed significant lower values (P < 0.05) for amputation to BKPy in the trauma/osteomyelitis group when compared to diabetes or peripheral vascular disease and no difference among the last two groups. However, when variables were adjusted for age (analysis of covariance with age as a covariate), the differences among groups disappeared (covariance F(2,44) = 0.9, P > 0.4). In conclusion, age, not the cause of the amputation, correlated with healing after below knee amputation as estimated by the rate of progression through temporary prostheses.

Adult↗

PubMed2006

Adaptive force regulation of muscle strengthening rehabilitation device with magnetorheological fluids.

In rehabilitation from neuromuscular trauma or injury, strengthening exercises are often prescribed by physical therapists to recover as much function as possible. Strengthening equipment used in clinical settings range from low-cost devices, such as sandbag weights or elastic bands to large and expensive isotonic and isokinetic devices. The low-cost devices are incapable of measuring strength gains and apply resistance based on the lowest level of torque that is produced by a muscle group. Resistance that varies with joint angle can be achieved with isokinetic devices in which angular velocity is held constant and variable torque is generated when the patient attempts to move faster than the device but are ineffective if a patient cannot generate torque rapidly. In this paper, we report the development of a versatile rehabilitation device that can be used to strengthen different muscle groups based on the torque generating capability of the muscle that changes with joint angle. The device is low cost, is smaller than other commercially available machines, and can be programmed to apply resistance that is unique to a particular patient and that will optimize strengthening. The core of the device, a damper with smart magnetorheological fluids, provides passive exercise force. A digital adaptive control is capable of regulating exercise force precisely following the muscle strengthening profile prescribed by a physical therapist. The device could be programmed with artificial intelligence to dynamically adjust the target force profile to optimize rehabilitation effects. The device provides both isometric and isokinetic strength training and can be developed into a small, low-cost device that may be capable of providing optimal strengthening in the home.

Adaptation, Physiological↗

PubMed1988

Determining predictor variables for running-related pain.

The purpose of this study was to determine whether specific predictor variables exist for particular running-related injuries. Data on 134 patients with running-related injuries were evaluated to establish the factors that were associated with specific pain sites. Patient data consisted of a brief running history and measurements of 72 anatomical variables that have been cited in the literature as predisposers to running-related injuries. The descriptive statistics indicated certain associations of variables with each pain group. A factor analysis was used to eliminate multicollinearity and to reduce the 72 variables to 9 factors. The results of a discriminant function analysis using factor scores indicated that patients' membership in one of six pain groups could be predicted correctly in 29.1% of the cases. We concluded that the factors used in this study were not good predictors of pain groups. Physical therapists, however, should publish their data on runners' injuries, treatment, and rehabilitation to supplement the published data that relate anatomical and biomechanical factors to running-related injuries.

Athletic Injuries↗

PubMed2005

Infidelity in committed relationships I: a methodological review.

Infidelity is perhaps the most complex issue encountered by couple therapists. Although clinical literature, opinion, and speculation on this topic are abundant, research literature is sparse. What little available research exists is, in most cases, neither robust nor helpful to the practicing therapist. This article provides, in both narrative and table format, a comprehensive methodological review of the available research literature on infidelity from 1980 to present. Topics addressed in the narrative include the lack of a consensus on the definition of infidelity; design challenges, such as retrospective research, confidentiality, measures, and variables, and sampling issues, such as diversity and randomization. Throughout the article, we offer suggestions for future research.

Extramarital Relations↗

PubMed1980

Environmental interactions in psychiatric occupational therapy--some inferences.

Five inferences drawn from research studies in the social sciences on the assessment of psychiatric ward atmospheres are presented as a frame of reference for psychiatric occupational therapists. The studies, based on a model stating that behavior results from the interaction of person and environment, suggest procedures for increasing successful treatment outcomes in occupational therapy. Such procedures include matching patients and staff to behavioral settings according to individual response traits and the development of programs emphasizing such variables as spontaneity, autonomy, and involvement.

Humans↗

PubMed2005

A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus. A contraindication for manipulation of the cervical spine?

OBJECTIVE: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. INTERVENTION AND OUTCOME: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. DISCUSSION: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. CONCLUSION: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.

Cadaver↗

PubMed1998

A comparative survey of beliefs about "normal" childhood sexual behaviors.

OBJECTIVE: This study sought to collect data on what adults believe constitutes normal childhood sexual behaviors, and how variables, such as role, gender, and life experience might contribute to the formation of one's beliefs. METHODS: A survey describing 20 different scenarios of children under the age of 13 interacting with themselves or other children in a sexual manner was administered to four groups of adults: sexual abuse experts; therapists involved in a sexual abuse training program; medical students attending a human sexuality program; and group facilitators of the human sexuality program. RESULTS: Behaviors that involved oral, vaginal, or anal penetration were judged by a majority of adults to be abnormal sexual behaviors in children under 13 years of age. Professionals working with sexually abused children rated certain sexual behaviors as more abnormal than adults participating in a human sexuality course. Both sexual abuse trainees and facilitators of the human sexuality course showed more directional biases than other groups, with trainees always rating behaviors in the direction of abnormal and facilitators always rating behaviors in the direction of normal. Females also judged many of the sexual behaviors to be more abnormal than males. CONCLUSIONS: Role and gender significantly influence what adults believe constitutes normal and abnormal childhood sexual behavior.

Adolescent↗