Effects of vestibular rehabilitation and social reinforcement on recovery following ablative vestibular surgery.

This study investigated the relative effects of vestibular rehabilitation (VR) and social reinforcement (SR) on recovery following ablative vestibular surgery. Twenty-four subjects were randomly assigned to three treatment groups of either VR with SR, VR without SR, or general range of motion (ROM) exercises with SR. Outcome measures included equilibrium scores in dynamic posturography, asymmetry index in rotation testing, motion sensitivity quotient (MSQ), and dizziness handicap inventory (DHI). A multiple comparison of the overall outcome measures showed no significant differences in group performance over an 8-week period. When individual outcome measures were compared, MSQ and DHI results at the end of the 8-week treatment period revealed less motion sensitivity and dizziness handicap in groups who received VR, with or without SR, as compared with the group who received ROM exercises. These results suggest that after a vestibular injury most patients can effectively utilize central compensation mechanisms to recover from such an injury, regardless of the type of therapeutic intervention used. On the other hand, the reduction in motion sensitivity and dizziness handicap for patients who received VR could indicate a more rapid and complete recovery for these patients. This investigation is continuing as a long-term follow-up study to determine whether there are any long-term benefits in participating in a VR program.

Injury and proprioception in the lower back.

No known research has attempted to quantify proprioception of the lower back or to examine the relationship between injury and proprioception in this region. The primary purpose of this study was to explore relationships between low back injury and proprioception of the lower back. Subjects were 88 working male firefighters from public emergency medical service departments. Three types of lower back proprioception (passive motion threshold, directional motion perception, and repositioning accuracy) were tested. Each type of proprioception was examined in the three primary planes of motion using a device designed by the author. Some anthropometric and personal variables were statistically controlled. All variables underwent multiple correlation analysis. The primary findings were: 1) longevity factors [age (r = .30, p < .01) and years of experience (r = .35, p < .001)] were best correlated with proprioceptive deficits in the sagittal plane; 2) injuries were correlated (p < .05) with proprioceptive deficits in the coronal (r = .22) and sagittal planes (r = .17) and with deficits in multiple planes (r = .19); 3) proprioceptive asymmetries were associated with injuries; and 4) the factor most highly correlated with the history of low back injuries was the presence of a spinal disorder (r = .40, p < .001). Impaired proprioception resulting from injury may degrade lumbar motor function, increasing workers' risk of reinjury. Restoring proprioception of the lumbar spine after injury should be a goal of treatment.

Reliability of isokinetic measurements of hip muscle torque in young boys.

The purpose of this study was to determine the reliability of measurements of hip muscle torque obtained with the Cybex II isokinetic dynamometer from healthy young boys. Twenty-nine healthy boys, aged 6 to 10 years, were tested two times at one- to two-week intervals. Torque of the hip flexors and extensors and the hip abductors and adductors was assessed at angular velocities of 30 degrees and 90 degrees/sec. The torque generated by each muscle group at 30 degrees/sec was similar to the torque generated at 90 degrees/sec. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability for measurements of each of the muscle groups at both angular velocities. The ICCs were higher for hip flexion and extension than they were for hip abduction and adduction. The highest ICC (ICC = .84) was found for hip extension at 90 degrees/sec. The ICCs for hip abduction and adduction at both angular velocities were less than .60. Factors that possibly contributed to the relatively low reliability in hip abduction and adduction are discussed.

Developing problem-solving skills in the classroom.

The purposes of this article are 1) to describe a series of classroom activities emphasizing problem-solving skills that was designed for physical therapy students in their first year of professional course work and 2) to examine the students' initial attitudes toward the learning experiences. Simulated patient information was presented in writing, on videotape, or by role-playing. Students defined the case problem, developed and ranked clinical problems, set goals, and considered treatment possibilities. Completion of a problem-oriented "subjective, objective, assessment, plan" patient-status note, based on the information derived from the problem-solving activities, was part of the learning experience. Changes in course design that were made during a three-year period are identified. A discussion of the difficulties related to student acceptance of and interest in problem-solving activities is included.

Force-time measurements of knee muscle functions of subjects with multiple sclerosis.

The purpose of this study was to determine whether the time-rate of muscle tension development, the muscle tension-maintaining capacity, and the reciprocal inhibition time of muscles in subjects with multiple sclerosis were significantly different from those of healthy subjects. An isokinetic dynamometer was used to evaluate the quadriceps femoris and hamstring muscles of 15 Experimental Group subjects with multiple sclerosis and 17 healthy Control Group subjects. The muscles were tested isometrically at 45 degrees of knee flexion and isokinetically at speeds of 30 degrees/sec and 90 degrees/sec. The subjects with multiple sclerosis demonstrated a significant (p less than .001) slowing of the time-rate of muscle tension development and a significant (p less than .005) decrease in muscle tension-maintaining capacity when compared with healthy subjects. The difference in the reciprocal inhibition time of muscles of the Experimental and Control Groups was not significant. When the reciprocal inhibition time of muscles was expressed as a percentage of the total torque curve, however, a significant prolongation (p less than .001) was observed in the subjects with multiple sclerosis.

Problem-solving approach to clinical education.

A problem-solving method to provide appropriate clinical learning experiences was developed for physical therapy students enrolled in their first year of professional course work. Clinicians from selected facilities were asked to participate in a clinical rotation over a two-quarter period. Using a problem-solving format, each clinician was responsible for a two-hour presentation relating to a disease or disability. Each rotation was repeated weekly for seven different groups of 10 students. During the rotation, the clinician presented a patient with a particular disability or disease and worked with the students to identify patient problems, establish treatment goals, and discuss methods used to achieve the goals. The difficulties encountered with the clinical experiences and the positive aspects of the experiences are discussed.

Values of activities of daily living. A survey of stroke patients and their home therapists.

People's values influence their actions and efforts. Based on the assumption that a patient's values can be a guide to successful rehabilitation, the values of 15 activities of daily living as perceived by stroke patients and their home therapists were studied. Twenty-six stroke patients living at home and their 10 visiting occupational and physical therapists participated in the study. The study results indicated that the relative importance of each activity of daily living perceived by the patient group and by the therapist group was similar. Among the 29 therapist-patient pairs, however, only 1 pair showed significantly similar views regarding the values of these activities to the patient. Patients' age, gender, income level, duration since onset of stroke, impaired body side, and independence level in activities were significantly related to their values of certain activities of daily living. The relative value stroke patients living at home place on each activity of daily living could serve as a guide for sequencing learning steps during activities of daily living training in a hospital or rehabilitation setting. Determining patient rehabilitation goals as influenced by personal values may shorten rehabilitation time, be more cost-effective, and aid in the retention of gains made in the rehabilitation setting.

Implementation of the problem-oriented progress note in a skilled nursing facility.

Problem-oriented style progress notes were implemented in a skilled nursing facility where problem-oriented medical records were not in use. The problem-oriented note consists of subjective information, objective information, analysis or assessment of the problems, and plan for treatment, and is called a SOAP note. Six physical and occupational therapists used the method of note writing for an eight-week trial period. The author audited the records for errors in using the SOAP note throughout the experimental period. Therapists responded to a questionnaire following the study to assess their attitudes on using the SOAP note. Implementation of the problem-oriented progress note was satisfactory, with the exception of defining the problem list. The therapists reacted positively toward using the problem-oriented method of recording patient progress or status and recommended that its use be taught to physical and occupational therapy students.

Human figure drawings by children with Duchenne's muscular dystrophy.

Seventy-two human figure drawings by forty-three patients who had a diagnosis of Duchenne's muscular dystrophy were examined. The study includes a description of these human figure drawings according to eleven emotional indicators and according to directionality quadrants. When the human figure drawings were used as a projective tool, four personality traits of some of the children were identified: physical inadequacy, immaturity, body anxiety, and insecurity. Both the emotional indicators and the quadrant in which the figures appeared were examined in relation to stages of the disease process to see if the human figure drawings of the children might reflect more stress and anxiety at a particular stage of the disease. Suggestions for improvements and recommendations for future study are given.