The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke.

PURPOSE: The purpose of this study was to explore the effect of modified constraint-induced movement therapy (CIMT) in a real-world clinical setting on spasticity and functional use of the affected arm and hand in patients with spastic chronic hemiplegia. METHOD: A prospective consecutive quasi-experimental study design was used. Twenty patients with spastic hemiplegia (aged 22-67 years) were tested before and after 2-week modified CIMT in an outpatient rehabilitation clinic and at 6 months. The Modified Ashworth Scale (MAS), active range of motion (AROM), grip strength, Motor Activity Log (MAL), Sollerman hand function test, and Box and Block Test (BBT) were used as outcome measures. RESULTS: Reductions (p<0.05-0.001) in spasticity (MAS) were seen both after the 2-week training period and at 6-month follow-up. Improvements were also seen in AROM (median change of elbow extension 5°, dorsiflexion of hand 10°), grip strength (20 Newton), and functional use after the 2-week training period (MAL: 1 point; Sollerman test: 8 points; BBT: 4 blocks). The improvements persisted at 6-month follow-up, except for scores on the Sollerman hand function test, which improved further. CONCLUSION: Our study suggests that modified CIMT in an outpatient clinic may reduce spasticity and increase functional use of the affected arm in spastic chronic hemiplegia, with improvements persisting at 6 months.

Functional outcome after high tibial osteotomy: a study using individual goal achievement as the primary outcome variable.

Functional outcome after high tibial osteotomy (HTO) was evaluated with respect to both improvement and goal achievement. Fifty-seven subjects, 32 men and 25 women, with a mean age of 55 years were examined with the Functional Assessment System (FAS) 6 and 12 months after surgery. The FAS is an evaluation system, specifically designed to monitor lower extremity dysfunction. It shows a profile with preoperative status, individual goal, and postoperative status. Statistically significant improvement was seen in 6/20 variables after 6 months, and in 10/20 variables after 12 months. When goal achievement was examined, the results were not as impressive. The treatment goal was not reached on the group level for almost all variables. On the individual level, only 20\N40% of the patients achieved the goal as a result of surgery in most variables. Exceptions were pain and leisure time/hobbies, where there was a high degree of goal achievement. It is possible that postoperative training was inadequate. The authors recommend a new randomized study, where patients who receive specific individual training related to the individual goal and functional profile are compared with a control group.

Worse functional status among old people when admitted for arthroplasty--an evaluation with a new assessment system.

The aim of this study was to investigate whether there is a difference in functional status between younger and elderly people referred to an orthopaedic clinic for total joint replacement. A total of 709 patients with osteoarthritis of the hip or knee (aged 27-91 years) and 42 healthy controls (aged 42-83 years) were examined with a new Functional Assessment System (FAS) for lower extremity dysfunction. Age effects were explored by one-way analysis of variance. Older people showed higher dysfunction scores in almost all variables, with the exception of pain, where there was an inverse relationship, i.e, old people had lower disability scores. This age-related increase in disability scores was not observed in the control group. Old people seem to be referred for joint replacement on different grounds from those of younger people, despite the fact that age was not included in the criteria for arthroplasty. The results may indicate a hidden, age-related criterion in the selection of patients for arthroplasty. Different interpretations are discussed.

Validity and reliability of a new assessment of lower-extremity dysfunction.

BACKGROUND AND PURPOSE: A 20-variable assessment system for evaluation of lower-extremity dysfunction has been constructed with special consideration of the needs of the physical therapist. The variables are classified into five subgroups: hip impairment, knee impairment, physical disability, social disability, and pain. SUBJECTS: One hundred five patients with osteoarthrosis of the hip and knee, all accepted for total joint replacement arthroplasty, were tested. The mean age of the patients was 69 years (SD = 9.0, range = 46-91). METHODS: The original grouping of the variables was analyzed for content validity with a factor analysis. The results from a subgroup of 42 patients were tested for intertester reliability with the Goodman-Kruskal gamma coefficient. RESULTS: The factor analysis indicated a factor solution consistent with the primary grouping except for two variables. The correlation between two independent physical therapists was .99 to 1.00 for different variables, indicating excellent intertester reliability. CONCLUSION AND DISCUSSION: In the authors' opinion, the new assessment system provides a reasonably valid, reliable, inexpensive, and easy-to-use measurement and fulfills the needs of the physical therapist for functional evaluation of the lower extremity.

Musculoskeletal complaints in dental hygiene: a survey study from a Swedish county.

PURPOSE: Musculoskeletal complaints in dental hygienists all employed by the National Dental Service in a Swedish county were evaluated with a standardized questionnaire. METHODS: During an ergonomics course, a questionnaire similar to standardized Nordic questionnaires was completed by all 28 participants. The questionnaire elicited demographic data and the presence and location of musculoskeletal complaints. Standard descriptive statistical methods were used to analyze the data. RESULTS: Subjects were all women, with a mean age of 40 years and a mean time of employment of five years. Most respondents worked part-time (mean 80%). Neck and shoulder complaints showed a clear predominance over other locations. Sixty-two percent of the subjects reported complaints associated with the neck and 81% with one or both shoulders during the previous 12 months. The frequency of complaints was higher on the right side. CONCLUSIONS: Most neck, shoulder, arm, and back complaints were considered work-related according to the dental hygienists themselves. The frequency of lower extremity complaints was low, and only a few of these complaints were considered work-related.