Skill evaluator and trainer for electrically operated devices: an evaluation of the SET.

Our hypothesis was that the abilities of disabled people to control electrically-powered assistive devices could be reliably and objectively assessed by means of a portable, lightweight and inexpensive device, the Skill Evaluator and Trainer (SET), and that training on the SET would improve skill. Our approach was to use SET with a variety of interfaces and subject groups. SET produced a valid assessment of the skills of disabled people with particular interfaces, it improved skills when used as a training aid, and it was well accepted by clients and therapists.

Progression of equinus deformity in Duchenne muscular dystrophy.

This study investigated the influence of orthoses, regular passive stretching, and surgery on progression of equinus deformity in Duchenne muscular dystrophy. The extent of passive dorsiflexion on the right foot of ambulant and wheelchair-ambulatory patients was measured monthly with an electronic ankle goniometer calibrated to an accuracy of 1 degree. The mean rate of equinus progression was 0.4 degree per month during the 12-month study. Progression was less in those boys who had prior surgery and were older. Progression was slowest during the first five months of the study (when night splints were used more frequently) and greatest during a long vacation when regular passive stretching by physiotherapists and supervision of splinting were unavailable. These results, although based on a limited patient sample size, indicate that gains from use of orthoses and passive stretching can be lost in the absence of professional supervision.

Carrier detection in Duchenne muscular dystrophy using computed tomography.

In Duchenne dystrophy computed tomography of muscles shows total or partial replacement of normal muscle by low density tissue, presumably representing fat. It was hypothesised that female carriers would have increased fat deposition, and hence lower density readings in certain muscle groups when compared with controls. Three C.T. scans, two through the thigh and one through the calf, were obtained on 9 obligate carriers, 12 "possible" carriers, and 10 controls. A total of 15 density readings in different muscle groups were obtained for each subject. The results, analysing the mean densities in Hounsfield units, show that the obligate carriers have statistically significant lower density readings than controls. The 9 obligate carriers and 10 controls were correctly allocated using discriminant function analysis of muscle density readings. An attempt to assign the "possible" carriers was made. The use of C.T. scanning in addition to creatine kinase (C. K.) estimations will significantly improve accuracy of genetic counselling and has the advantage of being non-invasive.

Progression of muscular dystrophy assessed by computed tomography.

To determine whether computerised tomography (CT) offers an accurate means of following the progression of Duchenne muscular dystrophy, CT scans through the thigh and calf were done on two occasions, six months apart, for 13 boys with the disease. The results suggest that CT scans of muscles may be used as an adjunct to other methods in the accurate assessment of progression.

Hand function in cerebral palsy: the effect of hip-flexion angle.

This study tested the hypothesis that increasing hip flexion above 90 degrees would improve hand function in seated cerebral-palsied children with extensor spasticity. Hand function was measured objectively at four hip-flexion angles in an experimental group and a control group. The results showed no significant differences in performance. However, seat angles 10 degrees and 20 degrees above horizontal were least often described as uncomfortable. The results show that, contrary to current belief, increasing hip-flexion angle in seating for a child with cerebral palsy and extensor spasticity appears to have no effect on hand function.

Tactile-evoked potentials in schizophrenia. Interhemispheric transfer and drug effects.

EEG potentials evoked by tactile stimulation of the forearm (tactile-evoked potentials or TEPs) were recorded simultaneously from both cerebral hemispheres in a group of schizophrenics and a group of healthy control subjects. Differences between the groups were found for the early waves of the TEPs: in the control subjects the first two positive waves (P25 and P50) and the first negative wave (N35) recorded from the hemisphere on the same side as the stimulation were slower (i.e. had longer latency) than those recorded from the hemisphere contralateral to the stimulation. This 'lateralization effect' was not seen in the schizophrenic subjects. It was concluded that the TEPs recorded from the hemisphere ipsilateral to the stimulus were not being transmitted from the other hemisphere via the corpus callosum and must therefore have been transmitted via direct ipsilateral pathways from the periphery. In a second experiment the drug pindolol was administered to schizophrenic subjects but differences in P50 latency between ipsilateral and contralateral hemispheres were found equally in both drug and placebo groups. We also found slight evidence to suggest that the more severely ill the patient the more similar the TEP latencies recorded from the contralateral and the ipsilateral hemispheres.

Biofeedback therapy to achieve symmetrical gait in children with hemiplegic cerebral palsy: long-term efficacy.

The hypothesis investigated in this study was that the symmetry of gait achieved with biofeedback therapy was maintained at follow-up, which ranged from 18 to 24 months later. The approach adopted was to measure average heel force on the hemiparetic side and to measure the temporal asymmetries in gait from video recordings. It was found that most of the therapy gains had been lost since treatment ended. It was concluded that the improvements acquired during biofeedback therapy are not maintained over time without maintenance strategies, and are liable to be situation-specific.

Evaluation of rehabilitation services: the use of goal attainment scaling.

Goal attainment scaling (GAS) is a procedure for evaluating the effectiveness of intervention in human service programmes. The theory and procedure of GAS are described, and its strict requirements are discussed. An example application of GAS in a rehabilitation centre for physically disabled children is reported. Problems with the application of GAS as an evaluation procedure are discussed, and suggestions are made for dealing with these problems.

Phoneme discrimination in schizophrenia.

Ear differences on a task involving a simple phonetic judgement were investigated in schizophrenic subjects using both healthy normal and depressed patient control groups. A deficit in phonemic differentiation was demonstrated and appeared to be specific to the schizophrenic group. The result is interpreted as supporting the hypothesis of a central dysfunction lateralized to the left hemisphere in schizophrenia.

Biofeedback therapy to achieve symmetrical gait in hemiplegic cerebral palsied children.

To test the hypothesis that the gait pattern of hemiplegic children can be made more symmetrical by a program of biofeedback therapy, 4 hemiplegic cerebral palsied children aged between 7 and 11 years were provided with auditory feedback from load-sensitive insole inserted in the shoe on the hemiparetic side. By providing the child with feedback derived from the load being borne by his hemiparetic heel while walking and by encouraging him to increase that load, a significant improvement in symmetry of load bearing was achieved. For the 2 children for whom video records were taken there was a concomitant improvement in the symmetry of the temporal aspects of the gait cycle. These changes were maintained after treatment ended. It is suggested that this form of biofeedback therapy provides a significant addition to the armamentarium of physical therapies available for treatment of gait abnormalities in hemiplegic cerebral palsied children.

Perceptual deficit in schizophrenia: a defect in redundancy utilization, filtering or scanning?

The perception by schizophrenic patients of stimuli with more than one feature (dimension) was investigated using psychiatric and non-psychiatric control groups. Indices of the ability (a) to make use of redundant stimulus cues, (b) to 'screen out' or filter irrelevant stimulus features, and (c) to scan the perceptual field for relevant stimulus features, indicated that only filtering was consistently poor in schizophrenia. It has been suggested that the schizophrenic patient may tend to perceive his environment in an undifferentiated holistic manner rather than in an analytic manner and the implication for the theory of left hemisphere pathology in schizophrenia is discussed. However, the performance of the schizophrenic subjects did not differ significantly from that of the group of depressed patients, which suggests that the selective attention deficits previously observed in schizophrenia are not specific to the disorder.