Efficacy of hand made silicone gel cushion in interface pressure reduction.

Objective: The purpose of the study was to evaluate the performance of two low cost hand-made silicone gel cushions designed for low income communities, called Silicone 1 and Silicone 2. Methods: Two silicone gel cushions were made with the same formula. The barrier surrounding of the Silicone 1 and the Silicone 2 were cross-linked poly-dimethylsiloxane (PDMS) and a polypropylene plastic bag respectively. Their pressure reducing characteristics were compared with the Reston® gel cushion now used in the Siriraj Hospital. A sample of 17 healthy volunteers tested the three cushions to evaluate the peak interface pressure in supine, semi-Fowler, lateral bending and sitting positions. All of the subjects are blinded to the types of the cushion. Results: It was shown that the peak interface pressures decreased significantly after the cushions were applied between the subjects and the standard hospital mattress in supine and lateral bending positions and between the subjects and wheelchair seat in sitting position. In semi-Fowler, only the Silicone 1 could reduce the peak pressure significantly (P< 0.05). Multiple comparison by Bonferrini test showed that in supine position both silicone gel cushions could significantly reduce peak interface pressure better than Reston® cushion (P<0.05), but there was no statistical difference between the two hand-made silicone cushions. There was no significant difference in peak interface pressure between these three cushions in semi-Fowler, lateral bending and sitting positions. Conclusion: Based on these findings, we concluded that the most advantageous cushion was the hand made silicone cushion covered with cross-linked PDMS.

Effectiveness of physical therapy for patients with adhesive capsulitis: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of a combined technique of physical and ibuprofen for the treatment of adhesive capsulitis with ibuprofen alone. MATERIAL AND METHOD: 122 subjects were randomly allocated to have 3 weeks treatment either with ibuprofen (n=61) or ibuprofen and a combined technique of physical therapy (n=61). Outcome measures were carried out 3 weeks and 12 weeks after randomization. Primary outcome measures were the success of treatment measured by improvement in the Shoulder Pain and Disability Index, and global rating. RESULTS: At 3 weeks, 21 (35.0%) of 60 patients in the study group were considered to have had successful treatment compared with 11 (18.6%) of 59 in the control group (difference between groups 16.4%, 95% CI: 4.0-31.3, p=0.044). There was no significant difference in the success rate between the two groups at the 12th week follow-up. CONCLUSION: The results of this study support the use of physical therapy for patients with adhesive capsulitis.

Effectiveness of an elastic knee sleeve for patients with knee osteoarthritis: a randomized single-blinded controlled trial.

OBJECTIVES: To study the effectiveness of elastic sleeves in patients with knee osteoarthritis (knee OA). METHOD: Patients with knee OA attending the outpatient clinic of Siriraj Hospital, who met the eligibility criteria, were randomly allocated to receive an 8-week treatment protocol. The control group received acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and education. The study group received the same treatment, in combination with a daytime elastic knee sleeve. Primary outcome variable included change in aggregated functional performance time (AFPT). RESULTS: In the immediate period after treatment, the study group had a mean improvement in AFPT of 1.63 seconds more than the control group (95% CI: 0.21-3.05, p = 0.025). At the end of the 8th week, the changes of AFPT were not statistically different between the two groups. CONCLUSION: This study shows small short-term beneficial effects of an elastic sleeve in patients with knee OA in cases with acute exacerbation.

Researches and theses entitled with physically disabled persons and rehabilitation in Thailand during 1992-1996.

Researches and these entitled with physically disabled persons and rehabilitation during 1992-1996 were collected and analyzed. Total number of 5-year period was 240 articles. Thirty-eight, 37, 58, 44 and 63 articles were published in 1992, 1993, 1994, 1995 and 1996 respectively. The majority of the researches were published in the subspecialty journals and journals of associated paramedics. Of those 178 papers studied in disabled persons, the most common topics entitled with rehabilitation in musculoskeletal pain (14.0%), followed by disease of peripheral nerve (13.9%), brain disease (12.9%) and disabled from spinal cord problems (10.7%). Most of the papers in the first and second groups were associated health care system. On contrary, the majority of the third and fourth groups were conducted to predict the treatment outcome. The least common topics were rehabilitation in persons with ischemic heart disease (2.8%), cerebral palsy (2.2%) and chronic obstructive pulmonary disease (1.1%). The studies concerning epidemiology and risk factors of all groups of diseases leading to disabilities were still lacking.

Living conditions of rehabilitated spinal cord injury persons in Thailand.

The living situation of 151 people (136 males and 15 females) with spinal cord injury (SCI) who had completed rehabilitation were surveyed. The average age of the respondents was 34 years with 99 percent living in a private residence, and 87.3 percent remaining married. Of 92 subjects who could not walk, 13 percent could not use a wheelchair in their houses because of structural obstacles. In the case of cervical cord and cauda equine injuries, those with incomplete injuries were able to go out more than those who had complete injuries. Only two persons had special cars for the disabled. Of those who were working at the time of their injury, 49 percent regained employment. The factors influencing their employment were the severity of the spinal cord injury and their ability to walk.

Lower extremity bracing in paraplegia-A follow-up study.

The use of bracing was studied in 76 patients with spinal injuries by a questionnaire survey. A total of 37 responses were deemed to be complete and acceptable. The responses included 35 males and 2 females, whose ages ranged from 19 to 56 years (mean = 30.6 years, SD = 9.7). Only 11 of the whole group (29.7 percent) were still using braces at the time of the study. All the spinal injury patients in this group used braces for exercise, while the cauda equine cases also used braces for ambulating. Inconvenience was the main reason for discontinuing the use of braces by the spinal injury patients. However, some of the cauda equine injury patients were able to ambulate without braces, while the others considered braces to be cumbersome and useless. The results of the resent study indicate that bracing should be prescribed at a later stage, after patients had returned home and require it for use in their home environments. This would make brace prescription more effective and appropriate for each patient.

Thermoregulatory problem of quadriplegics in the summer of Thailand.

Research was carried out on the changes in body temperature of patients suffering from high spinal injury. The tests were carried out during Thailand, hot season to compare the normal person’s body temperature with that of the patients’. The work was done on three patients (complete C4 lesion, complete C6, incomplete C7 lesion) primarily, by obtaining the room and body temperatures from time to time during the period from 07.00 to 16.00 hours. It was aligned for the patients to be lying in bed beside the wall for one day and to be close to the window for the following day. One of the patients (incomplete C7 lesion) was re-experimented on for another two days in late summer, (lying in bed beside the wall). Altogether there were 10 studies. Prior to and in between the sessions, any situation that would have assisted in increasing or decreasing the body temperature change of these patients was removed. It was found that the three patients’ core and surface temperatures increased. From morning till midday, two out of the three patients’ body temperature rose to 38 centigrade and as late afternoon approached, they were distressed whereas the other whose body temperature rose only to 37.65 + 0.05 centigrade was only uncomfortable.

A study of interface pressure of four pressure relieving devices.

This study evaluates the pressure reducing capability of four mattresses overlays comparison to the two standard mattresses hospital. These are as follows: Reston cushion, PV bed, Grant Dyna-care and Aeropad. A series of six mattresses were tested on 18 subjects of varying body builds to determine the interface pressures that are generated under the most common pressure sore sites by using body pressure measurement model PAT-P. The results of this study indicated that there is some variability in the effectiveness of traditional mattress overlays. PV bed offer the greatest pressure reducing potential in healthy adults. However, there should be more research work in this field in order to be able to utilize efficiently at the clinic.