ABSTRACT
The purpose of this study was to investigate the relationship between the modified Ashworth scale (MAS) scores and alpha motoneuron excitability indicators. Thirty-one post-stroke patients were assessed for this object. The main outcome measures were the MAS and electro physiologic assessments. The latter was performed using both conventional (Hmax/Mmax) and new (Hslope/Mslope) measures of spinal excitability. Data on thirty-one adult subjects with hemiplegia (twenty-five men and six women) were analysed. The soleus Hmax/Mmax ratio appeared to correlate directly with the MAS scores (r = 0.36; P < 0.05). Correlation between the MAS scores and either Hslope/Mslope ratio or H-reflex latency was not significant (P > 0.05). In seventeen patients whose H-reflex could be evoked bilaterally, spinal excitability indicators showed significant difference between the affected and non-affected sides (P < 0.05). Based on the results of this study, there is no relationship between the MAS scores and the preferred measure of alpha motoneuron excitability. This research suggests that the MAS could not distinguish between the reflexive and non-reflexive components of the hypertonicity in ankle plantar flexors.
Subject(s)
Hemiplegia/physiopathology , Motor Neurons/physiology , Muscle, Skeletal/physiopathology , Range of Motion, Articular/physiology , Adult , Ankle Joint/physiopathology , Electromyography , Female , H-Reflex/physiology , Hemiplegia/etiology , Humans , Leg , Male , Muscle Spasticity/etiology , Muscle Spasticity/physiopathology , Reproducibility of Results , Stroke/complicationsABSTRACT
We reviewed the medical and economic burden of thalassaemia major with emphasis on prenatal diagnosis for disease prevention as the most economic health care policy approach. The current programme in the Islamic Republic of Iran screens couples just before marriage, identifies carriers and refers them for genetic counselling. We searched the current literature for a refined model and enquired into compliance issues in interviews with physicians, couples and families with affected children. The programme was unsatisfactory in comparison with comparable programmes in the Mediterranean region. We devised a simple decision tree that incorporates cost-effectiveness and technical, methodological and social issues that affect compliance. While revisions to the policy could improve efficiency, follow-up is needed, especially to provide prenatal diagnosis for carrier couples.
Subject(s)
Genetic Testing/organization & administration , Health Policy , National Health Programs/organization & administration , beta-Thalassemia/diagnosis , Aftercare , Age Distribution , Child , Cost of Illness , Cost-Benefit Analysis , Decision Trees , Efficiency, Organizational , Female , Genetic Counseling , Health Services Needs and Demand , Health Services Research , Humans , Incidence , Iran/epidemiology , Male , Prevalence , Program Evaluation , Referral and Consultation , Registries , Sex Distribution , beta-Thalassemia/epidemiology , beta-Thalassemia/genetics , beta-Thalassemia/prevention & controlABSTRACT
We reviewed the medical and economic burden of thalassaemia major with emphasis on prenatal diagnosis for disease prevention as the most economic health care policy approach. The current programme in the Islamic Republic of Iran screens couples just before marriage, identifies carriers and refers them for genetic counselling. We searched the current literature for a refined model and enquired into compliance issues in interviews with physicians, couples and families with affected children. The programme was unsatisfactory in comparison with comparable programmes in the Mediterranean region. We devised a simple decision tree that incorporates cost-effectiveness and technical, methodological and social issues that affect compliance. While revisions to the policy could improve efficiency, follow-up is needed, especially to provide prenatal diagnosis for carrier couples
