Analysis of upper extremity movement in four sitting positions: a comparison of persons with and without cerebral palsy.

The purposes of this study were to compare the arm movements of persons with and without cerebral palsy and to determine if the alteration of the seat angle of a chair affected the quality of those movements. Twelve subjects--3 men and 3 women with spastic cerebral palsy and 3 men and 3 women without any known anomalies that could affect arm movements--were studied. The number of movement elements constituting a reach was used to measure the quality of movements. The findings demonstrated significant differences in the number of movement elements used by the subjects with and without cerebral palsy regardless of position. No significant differences could be attributed to the seating positions. Implications are discussed in relation to the method used in the analysis of movements and the effect of the findings for research and treatment.

Electromyographic analysis of reach in individuals with cerebral palsy.

Electromyographic analysis in both the time domain (root mean square EMG) and the frequency domain (mean power frequency EMG) of the biceps, triceps, wrist extensors and wrist flexors were analysed in six young cerebral palsied adults and six normal individuals. The subjects sat in a Rifton positioning chair. Each subject's right arm was positioned with the shoulder adducted, the elbow at 90 degrees and the hand resting on the arm rest. The subject then reached the right arm forward to grasp a dowel which was placed at shoulder level in front of the subject. There was no significant difference between the time it took the two groups to do the required movement. The RMS analysis indicated the muscle activation was variable among subjects, with evidence of concontraction of the antagonist muscles for the disabled group. The frequency analysis indicated that the disabled group had significantly lower mean power for the biceps and the wrist extensor muscles compared to the normal group. Neurological differences or fibre type abnormalities may account for these differences.

Development of a level I fieldwork evaluation.

The Wisconsin Council on Education (Wiscouncil) developed and pilot tested an evaluation of student performance for Level I fieldwork to be use for both occupational therapy and occupational therapy assistant students. Data were gathered from 259 students, fieldwork supervisors, and faculty who rated the form on a number of variables. The majority of students and clinical faculty believed the form was good to excellent in meeting their needs, in being useful in a variety of settings, in being applicable for both occupational therapy and occupational therapy assistant students, and in overall efficiency. On the basis of the results of the 1-year pilot study, short (23-item) and long (38-item) versions of the form were developed. Implications for use and the importance of future research to determine reliability and validity are discussed.

Wrist muscle tone and self-care skill in persons with hemiparesis.

The purpose of this research was to investigate the interaction between muscle tone at the wrist and self-care function in persons with hemiparesis. Dynamic and static muscle tone measurements were taken at the wrist. Self-care ability was measured with a chart review and the Klein-Bell Scale. The results of the study did not support the assumption that there is a significant relationship between muscle tone and activities of daily living for persons with hemiparesis. Perhaps other variables such as the general state of health, cognition, and perception should also be considered during the treatment of self-care.

Grip strength and dexterity in adults with developmental delays.

The purpose of this study was to determine the usefulness of dexterity and grip strength assessments by comparing the scores of adults with developmental delays with adult norms. A second purpose was to determine the correlations among the assessment instruments. Fifty-six developmentally disabled adults performed the box and block test, the nine hole peg test, and grip strength. Males performed significantly better on grip strength than females, but there was no significant difference on dexterity scores. Males scored significantly lower than established norms on all tests except the left nine hole peg test. Females scores were significantly lower than norms on all tests except the left and right nine hole peg test. Dexterity test scores on one side of the body were highly correlated with those on the other side, but grip strength was not highly correlated with dexterity. This suggests that occupational therap~sts need to treat dexterity and grip as separate entitles. The present results may provide guidelines to determine average performance for adults with developmental delays.

Jebsen Hand Function Test: performance of the uninvolved hand in hemiplegia and of right-handed, right and left hemiplegic persons.

The Jebsen Hand Function Test was administered to 50 hemiplegic patients within three weeks of their admission to a rehabilitation center. Participants in the study demonstrated significantly slower performance on all items of the test for both the nonparetic and paretic hands when comparisons of scores were made with previously published norms. A further analysis of test results was made among all right-handed subjects. The left hemiplegic group performed all subtest items more slowly than right hemiplegic subjects with the weak hand. Performance with the nonparetic hand was significantly different between left and right hemiplegic subjects only on the writing subtest. These differences cannot be exclusively explained by either hand dominance or hemispheric specialization.

Effect of volume of water taken with diazepam tablets on absorption.

Thirty-three patients received either 10 ml (group A) or 50 ml (group B) of water with diazepam tablets as premedication while in the supine position. Plasma diazepam concentrations were measured, a delay in the attainment of the peak plasma concentration being taken as an indication of delayed absorption and oesophageal hold-up. There was no difference between the two groups, although in an important minority (16.7% (group A) and 20% (group B], absorption was delayed to beyond 60 min. There was a wide scatter of plasma diazepam concentrations in both groups. Dysphagia during swallowing did not appear to delay absorption.

Muscle tone: objective evaluation of the static component at the wrist.

A device measuring the flexion of the hand from an extended position was evaluated as a technique for assessing the passive component of muscle tone. Wrist measurements of 23 individuals, ten able-bodied, eight with spastic and five with flaccid wrists, were collected for three days of each week for three weeks, to determine the interrater, test-retest reliability, and construct validity of the device. Findings demonstrated high interrater reliability, inadequate test-retest reliability for single daily score comparisons, but an acceptable level of test-retest reliability for composite weekly score comparisons. Construct validity was supported since measurements of the involved limbs of individuals with spastic and flaccid wrists and the able-bodied group were significantly different from each other. This technique may provide useful objective information for therapists.

Dynamic splint to reduce the passive component of hypertonicity.

A study was conducted to test the effectiveness of a newly designed dynamic splint in reducing the passive component of hypertonus. Splinting and P-ROM exercise were compared among eight elderly subjects matched by age and sex with hemiparesis, one year after cerebrovascular accident. Spring-weighted scale measurements of the passive force of the wrist from 0 degrees flexion/extension towards flexion were used as dependent measures. Measurements were taken three days per week for six weeks. Data demonstrated that a significant reduction of hypertonus occurred among the splinted group but not the P-ROM group. A further comparison with previously published data on the effects of static splinting demonstrated that dynamic splinting led to a greater reduction of hypertonus than static splinting and P-ROM exercises.

A comparison of dorsal and volar resting hand splints in the reduction of hypertonus.

Ten adults with hypertonic wrist flexors volunteered as subjects in an experiment comparing the effectiveness of dorsal and volar resting hand splints in the reduction of abnormal muscle tone. Subjects were randomly assigned to two groups of five each. Individuals in one group were fitted with dorsal splints, and individuals in a second group with volar splints. Measurements by spring-weighted scales were taken to assess the efficiency of each splint design in the reduction of hypertonus. Results demonstrated no significant differences between the volar and dorsal splints in reducing hypertonus. However, the age of the subjects was found to be an intervening variable: The older subjects of both groups demonstrated a gradual but not significant decline in hypertonus, whereas the younger adults demonstrated a significant decline in hypertonus over a 6-week period.

Objective evaluation of a splint designed to reduce hypertonicity.

Snook's spasticity reduction splint was evaluated objectively with five severely and profoundly handicapped subjects. The force of spastic wrist flexors in pounds of pull was measured on a spring-weighted scale. Findings demonstrated that the device designed for this study was useful in measuring hypertonus; splint wearing resulted in a reduction of the passive component of muscle tone and that this reduction was related to the length of time the subjects wore splints; the effects of splint wearing were not necessarily permanent. Components that contribute to the condition of hypertonicity are discussed, as well as the implications of the study findings for occupational therapists.