Gait variables of patients after lower extremity burn injuries.

Functional ambulation is an expected outcome of physical therapy after burn injuries on the lower extremities. The purpose of this study was to document temporal and spatial gait parameters of adult patients with the use of the GAITRite system (CIR Systems Inc, Clifton, NJ) after the patients were burned on their lower extremities and to compare these results with previous data reported for normal subjects. Twenty-five adults with lower extremity burns (19 men and 6 women; mean age, 35.6+/-8.3 years) were evaluated within 5 days of discharge from an acute care facility. The GAITRite system, which consists of an electronic walkway that contains 6 sensor pads encapsulated in a rolled-up carpet, was used to collect temporal and spatial variables. The patients walked at their preferred rate of ambulation and completed 2 passes; the 2 passes were then averaged by the software to determine the patients' gait parameters. A 2-tailed t test was used for comparison of the mean values for the patients and the previously published data. The results indicated that for both men and women, cycle time and base of support were significantly higher (P < or = .01) in the patients with burn injuries than in normal subjects. For men, all of the remaining parameters were significantly lower (P < or = .01) in the patients with burns except stride length, which was not significantly different (P > .05). For women, stance time as a percentage of the gait cycle and cadence, velocity, step length, and stride length, were all significantly lower (P < or = .01) in the patients with burn injuries, whereas double support as a percentage of the gait cycle was not significantly different (P > .05) between the 2 groups. These results indicate that immediately after an acute care hospitalization, patients with lower extremity burns have significantly different gait patterns than gender-and age-matched normal subjects. Future studies are necessary to determine whether these impairments in gait limit the functional abilities of a patient.

The physical, functional, and developmental outcome of pediatric burn survivors from 1 to 12 months postinjury.

Fifty-one children with an average age of 27 months and who had sustained a burn injury were tested at 1, 6, and 12 months postinjury to determine their physical, functional, and developmental outcomes. Most parents were either African-American or Hispanic, lived on public assistance, and had a high school education or less. Most children had normal range of motion and were appropriate for their age in self-care skills. On the basis of the Home Screening Questionnaire, 48% of the children came from suspect home environments. Developmental delays were noted in language acquisition that persisted over the first year postburn. Although the outcomes of these burn injuries were good in physical and functional areas, the developmental findings raised concerns. The results alert clinicians to screen for potential developmental problems during the burned child's recovery phase and to include appropriate developmental activities and parental guidance in the treatment plan.

The value of pain drawings in the care of neck and back pain.

The magnetic resonance imaging (MRI) reports and pain questionnaires of 100 patients with complaints of lower back or neck pain were reviewed. Prior to physician examination, each patient had completed a questionnaire which included pain drawings and a rating on a pain scale. The information given on the drawings and questionnaires was compared to the MRI reports. The levels of agreement between them were analyzed. The results show that the pain questionnaire with drawing is a useful tool in the evaluation of patients when the diagnoses of herniated nucleus pulposis (HNP) or spinal stenosis are in question. The levels of agreement between the pain drawings and the MRI findings were stronger for the cervical spine than for the lumbar spine and also stronger for the presence of HNP than for central canal spinal stenosis. Particularly useful was the negative predictive power for ruling out cervical and lumbar pathology.

A survey of the prevalence and application of chest physical therapy in U.S. burn centers.

The purpose of this study was to determine the prevalence and application of chest physical therapy (CPT) in burn centers. Respiratory therapists primarily administered CPT, and suctioning and coughing were the most frequently used modalities. Further study of the efficacy of treatment techniques is needed to develop congruous standards for CPT after a burn injury.

Compliance with pressure garment use in burn rehabilitation.

Pressure garment use is recommended 23 to 24 hours a day for hypertrophic scar control after a burn injury. Compliance with this treatment has not been documented. A 52-question survey was administered to 101 adult outpatient burn survivors to rate compliance with this program. The average compliance of each patient was assessed. The framework of the Health Belief Model was used to identify the patients' beliefs and factors reported to interfere with compliance. Strategies patients believed to enhance garment use were identified. Forty-one percent of the patients reported total compliance. The difficulties with garment use such as discomfort and activity limitations appeared to promote low compliance. The primary strategies patients believed would enhance compliance were seeing outcome pictures of scars and having contact with other survivors. This step toward identifying compliance rates and factors that affect them will guide the health care worker in techniques to facilitate adherence to the scar management program.

The neuromotor behavior of preterm and full-term children by three years of age: quality of movement and variability.

Thirty-six preterm and full-term children were seen during the first year of life and at 3 years old. The Neuromotor Behavioral Inventory (NBI)-Version for 3 Year Olds (a 5-category measure of Gross Motor and Fine Motor Development, Reaction to Movement, Neurological Reflexes and Reactions, and Neuromotor Outcome) was used with three groups: healthy preterm, sick preterm, and healthy full term. The groups differed in gross motor, fine motor, reaction to movement, and neuromotor outcome at 3 years of age with the greatest difference between the sick preterm group and the other groups. Quality of movement deteriorated between 12 months and 3 years. Increased frequency of "suspect" or "abnormal" outcomes during the first year was associated with an unfavorable outcome at 3 years of age. Variability, i.e., a change in outcome from one time to another, was not associated with an unfavorable outcome when frequency of unfavorable outcome during the first year was taken into account. Prematurity, perinatal illness, and frequency of unfavorable outcome during the first year were found to have an adverse impact on neuromotor behavior.

Occupational therapy in pediatric rehabilitation.

Occupational therapy in pediatric rehabilitation focuses on the effects of diseases and of the environment on a child's abilities to function successfully in daily life settings (home, school and playground) and roles (family member, student, etc.). In this paper, the process of pediatric occupational therapy, from assessment to discharge planning, is briefly described. Pediatric occupational therapy intervention strategies including treatment, environmental adaptation, and systems change are presented and illustrated. Three case studies highlighting occupational therapy intervention are discussed.

Occupational therapy treatment practices with infants in early intervention.

This paper explores occupational therapy treatment practices for infants (birth to age 2 years) in early intervention programs. Generic treatment is viewed as the facilitation of the infant's independence through improved motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills, and play. Treatment practices in specialized settings, that is, in a neonatal intensive care unit and in a follow-up program for high-risk infants, are outlined. The efficacy of intervention is discussed in light of recent research findings and of the comments made by critics of early intervention.

Neuromotor development of preterm and full-term infants.

The Neuromotor Behavioral Inventory (NBI), a 16-category measure of muscle tone, developmental motor abilities, quality of movement, neurological reflexes and reactions, and neuromotor outcome was used with 38 infants divided into three groups: healthy preterm (HPT), sick preterm (SPT), and healthy full-term (HFT) infants. Infants were tested at five time points: 40 weeks postconception (newborn) and 3, 6, 9 and 12 months of age post-term. The intent of the study was two-fold: to determine whether there are developmental differences among the groups of infants and whether the differences persist during the first year of life. Results indicate that HFT and HPT infants score higher than SPT infants in the neuromotor categories of: muscle tone, upper extremity development, head control, and neuromotor outcome rating. HFT infants scored higher than both preterm groups in: trunk rotation, reaction to movement, visual and auditory attention, and fixing. Differences persisted among the groups during the first year of life in the following: the developmental motor ability of trunk rotation, fixing, adaptability, and the neuromotor outcome rating. It appears that neonatal health status is a contributing factor to infant neuromotor development, particularly in the quality of movement reactions.

Trends in neuromotor behavior of preterm and fullterm infants in the first year of life: a preliminary report.

A follow-up study of 150 fullterm and preterm infants was conducted to determine the similarities and differences in neuromotor behavior during the first year of life. Three groups (healthy fullterm, healthy preterm, sick preterm) were compared at three, six, nine and 12 months of age. In general, fullterm infants were more similar in their responses to the Neuromotor Behavioral Inventory and more consistently advanced than some preterm infants at all four examinations. The greatest distinction between fullterm and both preterm groups occurred at three and six months. By nine and 12 months fullterm and healthy preterm infants had more similar development, but some sick preterm infants continued to develop differently. It appeared that the influence of prematurity on neuromotor behavior, regardless of whether the infant was healthy or sick, was greatest before nine months of age. After nine months, health appeared to be a contributing factor to the infants' development.