Validation of the stroke drivers screening assessment for people with traumatic brain injury.

Cognitive impairments resulting from brain injury affect driving performance. The question of fitness to drive often arises during rehabilitation. Healthcare professionals need reliable criteria against which decisions about driving fitness can be made. Nouri et al. developed the Stroke Drivers Screening Assessment (SDSA), which was found predictive of on-road driving performance in stroke patients. The purpose of this study was to determine whether the SDSA, either alone or combined with other tests, predicted fitness to drive in brain injured people. Fifty-two participants were assessed on the SDSA plus additional cognitive tests. Their fitness to drive was examined on the public road. The SDSA predictions based on equations developed for stroke patients were not an accurate predictor of road test performance. Discriminant analysis was used to identify tests predictive of fitness to drive. Results indicated that a combination of the SDSA, the Stroop and the AMIPB Information Processing tasks correctly classified 87% of cases and may be useful predictors of driving fitness following brain injury. However, cross-validation on an independent sample of people with brain injury is required.

Atlantoaxial instability in Down's syndrome: a five year follow up study.

In 1986 all 90 children aged 4-19 years with Down's syndrome attending school in the area served by the Southern Derbyshire Health Authority underwent radiography to identify atlantoaxial instability (AAI). This study details repeat observations five years later. Full results were available on 67 (74%), information on health status was available on the remaining 19 (21%); four (4%) were untraced. There was an overall significant reduction in the atlanto-axial gap over five years. No one developed AAI on repeat testing who had not had it earlier. One child who had previously had normal neck radiography developed acute symptomatic AAI after ear, nose, and throat surgery. Radiographs were done on three occasions on the same day in 49 individuals, ensuring full flexion of the upper neck. There were no significant differences between the radiographs, even in five subjects with AAI. Management of AAI in Down's syndrome is discussed in the light of these findings. Radiography can reliably detect children with chronic AAI who may be at risk of gradually developing symptoms; this may justify a screening programme. This must be distinguished from those who develop symptoms after acute trauma or anaesthesia, for which specific precautions are needed, and previous screening radiographs are unhelpful.

Stature loss from sustained gentle body loading.

The effects of low levels of loading on spinal creep have been investigated in nine young men aged between 19 and 24 years. The stimulus for the project was an interest in the potential use of stadiometry in evaluating selected classes of patients with spinal disorders. Underlying the experiment was the view that if gentle spinal loadings cannot be differentiated sensitively in normal young adults then the feasibility of using stadiometric measurements to identify patients with decreased lability is questionable. Subjects were measured on a precision stadiometer before and after 25 minutes of free standing and quiet walking, and the resultant stature losses compared with the more substantial losses observed following steady running. All measurements were made following the same presession routine, at exactly the same time on three separate mornings. It was observed that while no appreciable stature loss followed standing (mean = 0.01 mm; SE = 0.65 mm; p > 0.05) even quiet walking had a measurable and statistically significant effect (mean = 1.82 mm; SE = 0.49 mm; p < 0.01). Compared with these, steady running produced almost 2 1/2 times as great a loss (mean = 4.32 mm; SE = 0.83 mm; p < 0.01). It is concluded: (a) that erect standing provides a useful neutral baseline from which the changes associated with spinal loading and unloading may be measured; (b) that the effects of even gentle spinal loadings may be differentiated sensitively by precision stadiometry; and (c) that easy walking is one such gentle stimulus with detectable effects in normal young men.

Experience of a self-care unit as part of a hospital-based rehabilitation service.

The nature, advantages and disadvantages, and cost of a hospital-based self-care unit as part of a rehabilitation service are described. The unit's operational policy is critically examined after analysing the records of 40 patients admitted consecutively over a 2-year period and conducting interviews with 27 patients between 4 and 48 weeks after discharge. It is concluded that, compared with a hospital ward, a self-care unit is inexpensive to run and helps to prevent patients from giving up their homes and being admitted to residential homes prematurely. In addition to an assessment and confidence-building role, the unit provides a more appropriate and acceptable environment for patients waiting housing alteration or rehousing than a hospital ward.

Mu-heavy chain and monoclonal IgG K paraproteinaemia in systemic lupus erythematosus.

We report the association of monoclonal mu-heavy chain and a monoclonal IgG K paraprotein in a patient with systemic lupus erythematosus (SLE). This association and the apparently benign nature of this biclonal gammopathy has not been previously reported.

Diurnal stature variation in ankylosing spondylitis.

The feasibility of using the measurement of diurnal stature loss as a clinical measurement tool in the study of ankylosing spondylitis was assessed. Diurnal stature loss was observed in two groups of subjects using a very accurate method for the measurement of stature. The first group consisted of 18 normal subjects, the second of 22 men and women with definite ankylosing spondylitis diagnosed against the New York criteria. Results showed that diurnal stature loss was significantly reduced in ankylosing spondylitis (P<0·01), and this was assumed to be due to the osseous changes within the intervertebral discs and spinal ligaments of the patients. This reduction in stature loss was also evident in subjects with relatively short case histories; some subjects had symptoms of under 2 years' duration, implying that the technique may aid the early diagnosis of ankylosing spondylitis. Diurnal stature loss did not correlate with either anterior flexion or chest expansion, although both are also reduced in the disease.

Long-term evaluation of naproxen suspension in juvenile chronic arthritis.

Twenty-six children suffering from juvenile chronic arthritis were entered into a 6-month open evaluation of naproxen suspension. Sixteen patients completed 6-months' treatment, 6 were lost to follow-up and 4 dropped out, 2 because of side-effects (rash, and burning on swallowing the formulation), 1 for lack of efficacy and 1 because of no further need of treatment. Pain severity scores were significantly reduced from admission levels at all monthly follow-up visits and significant overall improvement since the last visit was noted up to third month of treatment, as assessed by doctor and parent/patient. Transient indigestion was reported by 2 patients. No clinically significant trends were noted in any of the laboratory investigations carried out. The results add to the accumulation of data on the use of naproxen in children and underline its long-term efficacy and tolerance.

The spine in sport and veteran military parachutists.

Spinal injuries and symptoms were studied in 109 ex-military parachutists and 112 sport (free fall) parachutists by means of postal questionnaires. 46 ex-military parachutists aged 50 years or over had a radiological examination of the lumbar spine and 58 sport parachutists had a radiological examination of the cervical spine as part of the survey. A history of back pain was significantly (P<0.01) associated with body weight in sport parachutists but not with the number of descents or with the subject's age. In the older ex-military group neither age, weight, nor the number of descents was significantly associated with backache. Of those ex-military parachutists x-rayed, 10 (21.7%) were found to have vertebral body fractures (most frequently at D12), and 8 of these were unaware of these lesions. Vertebral fractures caused no disability and did not permanently curtail parachuting activities in either the sport or ex-military group. Of the ex-military parachutists x-rayed, 84.7% had lumbar disc degeneration of all grades of severity, 17.4% had moderate changes, and 10.8% had severe changes. The frequency of moderate and severe disc degeneration was significantly related to age but not to body weight or to the number of descents. Spondylolysis was found in 2 subjects (4.3%) and spondylolisthesis unassociated with spondylolysis in 4 (8.7%). Spondylolisthesis was always associated with a history of back pain.A low prevalence of radiological cervical intervertebral disc degeneration of all grades of severity of 8.7% was found among the free fall parachutists (mean age 33 years). 2 cases of cervical vertebral body fracture were seen, one related to a parachute landing injury and the other to a parachute opening injury. This study does not implicate parachuting as a cause of intervertebral disc degeneration, either cervical or lumbar, nor as a cause of spondylolysis or spondylolisthesis. Serious long-term disability from pain appears to be uncommon among parachutists despite the frequency of the spinal trauma they sustain.

The knees and ankles in sport and veteran military parachutists.

112 actively parachuting sport (free fall) parachutists with more than 200 descents each and 109 veteran military parachutists no longer active returned a postal questionnaire about their parachuting activities, injuries, and current and past musculoskeletal symptoms. A high frequency of fractures and injuries was reported by each group, both in relation to parachuting and to other activities. 58 sport parachutists aged 23 to 57 years (mean 33 - 3 years) had weight-bearing anteroposterior and lateral radiographs taken of each knee. These showed a prevalence of radiological osteoarthrosis of 10 - 4% which was mild in degree in all but one knee in one subject. 46 ex-military parachutists aged 50 to 70 years (mean 55 - 2 years) had weight-bearing anteroposterior radiographs taken of both knees and showed a prevalence of radiological osteroarthrosis of 41 - 3%. Moderate and severe changes were found in 10 - 9%. In both groups of parachutists six of the eight knee joints showing either moderate or severe radiological osteroarthrosis had been subjected to a previous meniscectomy. Forty ex-military parachutists had anteroposterior radiographs of the ankles (talotibial articulation) and showed a prevalence of osteoarthrosis of 17 - 5%, with the majority showing mild changes. There was a poor correlation between radiological osteoarthrosis, ankle symptoms, and previous fractures. With the reservation that the great majority of the sport group are still young (95% aged less than 50 years), it is concluded that parachutists as a group do not show an increased prevalence of radiological osteoarthrosis of the knee or ankle.