Preliminary Validation of a Two-Point Estimation Task for the Measurement of Sensory Dissociation in Patients with Chronic Low Back Pain.

OBJECTIVES: Sensory dissociation (SEDI), the discrepancy between perception and actual size or shape of a painful body part, is a frequently observed finding in patients with chronic low back pain. However, the current methods of evaluating SEDI have several limitations, such as a qualitative nature and weak evidence supporting their reliability. In the current study, the reliability of two versions (manual and verbal) of a novel test, a two-point estimation task (TPE), was investigated. METHODS: To perform the manual version of the task, patients estimated the distance between two tactile stimuli delivered to their back using callipers, whereas in the verbal version they verbally reported the estimated distance. RESULTS: The manual version of TPE showed greater interexaminer reliability than the verbal version, and the mean of the two repeated measurements was sufficient for reaching excellent reliability for the pain-free (intraclass correlation coefficient [ICC] = 0.91, 95% confidence interval [CI] = 0.77-0.97) and painful (ICC = 0.86, 95% CI = 0.65-0.94) sides. Intra-examiner reliability was moderate to excellent (ICC = 0.66-0.96) for the manual version performed at the pain-free and painful sides. Distribution, duration, and intensity of pain significantly predicted SEDI and accounted for 42% of the total variance (corrected R2 = 0.42, P < 0.01). CONCLUSIONS: TPE showed higher reliability coefficients compared with tools previously suggested in the literature and can therefore be used clinically and experimentally by one or more examiners. Further research is required to investigate the validity of this new test.

The effects of mirror therapy on arm and hand function in subacute stroke in patients.

The aim of this study was to evaluate the effect of mirror therapy on arm and hand function in subacute stroke in patients. The study included 60 hemiparetic right-handed patients after ischemic stroke 8-10 weeks after onset. They underwent stationary comprehensive rehabilitation in the rehabilitation centre. They were divided into two randomly assigned groups: mirror (n=30) and control (n=30). For both groups, two subgroups were created: one that included patients with right arm paresis (n=15) and the other that included patients with left arm paresis (n=15). The mirror group received an additional intervention: training with a mirror for 5 days/week, 2 sessions/day, for 21 days. Each single session lasted for 15 min. The control group (n=30) underwent a conventional rehabilitation program without mirror therapy. To evaluate self-care in performing activities of daily living, the Functional Index 'Repty' was used. To evaluate hand and arm function, the Frenchay Arm Test and the Motor Status Score were used. Measurements were performed twice: before and after 21 days of applied rehabilitation. No significant improvement in hand and arm function in both subgroups in Frenchay Arm Test and Motor Status Score scales was observed. However, there was a significant improvement in self-care of activities of daily living in the right arm paresis subgroup in the mirror group measured using the Functional Index 'Repty'. Mirror therapy improves self-care of activities of daily living for patients with right arm paresis after stroke.

Facilities of early rehabilitation after stroke in Poland 2010.

The aim of this work was to survey the contemporary facilities for early poststroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for poststroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging healthcare planners to look for new organizational solutions of services that could enable rehabilitation as early as possible after disease onset. Early poststroke rehabilitation includes many elements that provide for early-onset rehabilitation and its continuation after discharge from the stroke unit. Two questionnaires evaluating neurorehabilitation of individuals who had stroke were designed and distributed: the first questionnaire was distributed to 221 neurological wards and the second questionnaire was distributed to 154 rehabilitation departments in Poland. We obtained information about delay before admission from neurological wards to rehabilitation departments, the number of sessions per day, the time duration of one session, the number of sessions per week, the average length of stay in department, the methods of outcome measurement, etc. We sent out 375 questionnaires and received 129 (35%) responses, 78 from neurological wards and 51 from rehabilitation departments. Only 25% of all patients were moved from neurological wards to the rehabilitation department after stroke (15% directly). Of those moved to rehabilitation departments, only 54% were treated early after stroke; that is, within 3 months of stroke. Considering that about half of stroke survivors will require rehabilitation (30 days after stroke onset), the current facilities of early poststroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation services such as early home-supported discharge after stroke, which is currently not available in Poland. Although we have focused on resources in Poland, we anticipate that similar patterns may be found in other countries in the region.

[Questionnaire impact on participation and autonomy (IPA)]. / Kwestionariusz wplywu na uczestnictwo i autonomie--impact on participation and autonomy (IPA).

There are many problems which can decrease the quality of life of disabled persons. It means either social condition, family life, education, vocational status, sport, recreation and psychological implications. The Impact on Participation and Autonomy Questionnaire (IPA) is a valid, reliable and acceptable measure of participation and autonomy in people with a range of conditions, especially with multiple sclerosis, spinal cord injury and rheumatoid arthritis. The psychometric properties of IPA are promising and indicate that IPA has potential to be developed further. Most respondents believe that the IPA items are easy or very easy to understand, relevant and not embarrassing. In review report the own translation of IPA into Polish language has been presented.

Walking index for spinal cord injury.

This review reports on the contemporary possibilities of objective evaluation of walking ability in patients with paraplegia following a spinal cord injury. Current methods of evaluation of walking function, i.e. the ASIA Classification, Functional Independence Measure (FIM), Barthel Index and Spinal Cord Independence Measure (SCIM) are described. The latest classification, known as the WISCI (Walking Index for Spinal Cord Injury) is described in detail. WISCI is the most detailed scale that is also the most sensitive to changes in the patient's walking ability compared to the other scales.