The Stroke Activity Scale: results of a validity study.

PURPOSE: To establish the concurrent validity and time to complete of the Stroke Activity Scale (SAS) a recently developed stroke motor disability scale designed for use in a busy clinical setting. METHOD: Forty-one stroke patients with residual hemiplegia were recruited and assessed on a single occasion using both the SAS (five items) and modified Motor Assessment Scale (MMAS) (eight items) by a research physiotherapist. Performance was videotaped and assessed subsequently by a second physiotherapist. RESULTS: Pearson's correlation coefficient between the two measures was 0.91. The SAS was significantly quicker to complete than the MMAS (2.8 vs. 10.4 min, p < 0.0001). CONCLUSION: The SAS had high concurrent validity with the MMAS but was much quicker to complete and therefore more suitable for use in clinical environments where time is at a premium.

Validating the Orpington Prognostic Score in an Irish in-patient stroke population.

An accurate assessment of stroke severity and the ability to predict prognosis is important for determining rehabilitation needs and long term management of patients after stroke. The Orpington Prognostic Score (OPS) is a clinically derived stroke severity scale that can be used to stratify patients into different severity groups. The aim of this study was to validate the Orpington Prognostic Score (OPS) in an Irish in-patient stroke population. Fifty 'first stroke' patients (21 male, median age 72.5 [range 31-93] years) were assessed within two weeks following stroke onset. Subjects were stratified into mild, moderate and severe groups using previously established cut-offs for the OPS. Outcomes were determined prospectively and compared to initial severity groups. Patients in the severe group had a significantly increased chance of dying (Odds ratio [95%CI] 2.16 [1.72-2.72] and this persisted after adjustment for age and gender. Length of stay increased significantly with increasing stroke severity group (F ratio 7.0 p=0.0025) and this association remained after adjusting for age and gender. The odds of being discharged home or of being able to walk independently by time of discharge decreased significantly (all p<0.001) as stroke severity increased and adjusting for age and gender did not alter these associations. A higher OPS score within 2 weeks of stroke onset was significantly associated with longer length of stay, increased mortality, reduced mobility at discharge and a reduced likelihood of discharge home. The OPS is a valid measure of stroke severity in Irish stroke in-patients.

A new stroke activity scale-results of a reliability study.

PURPOSE: To investigate the internal consistency, inter-rater and intra-rater reliability of a disability stroke activity scale (SAS) for stroke patients. Its intended use is as a measure of motor function at the level of disability in stroke patients. METHOD: Twelve stroke in-patients were video-recorded performing the five activities from the SAS. Seven senior physiotherapists, experienced in stroke care, independently rated the recordings on two occasions, three weeks apart, using the SAS. Twelve hospital inpatients participated in the study. The subjects were aged between 48 and 86 and were between 6 and 87 days post stroke. RESULTS: Reliability for total scores was found to be excellent (generalizability correlation co-efficient (GCC) values> or =0.95) and reliability for individual item scores was good (kappa> or =0.7). Internal consistency reliability using Cronbach's alpha was also good (0.68 at time 1 and 0.68 at time 2). CONCLUSION: The stroke activity scale is a reliable instrument for hospital stroke patients. It can be administered in less than 10 minutes and requires minimal equipment and training. Further work on the validity and responsiveness of the SAS is in progress.

Referral to physiotherapy as part of a general practitioner's management of back pain.

The aim of this survey was to investigate how general practitioners (GPs) manage their back pain patients and if they refer them for physiotherapy. The research instrument was a self-administered postal questionnaire. This was sent to 580 GPs, one quarter of the GPs in the Republic of Ireland. Two hundred and ninety three questionnaires (n=293)were returned, which constituted a 50.5% response rate. Two hundred and sixty one questionnaires (n=261) were usable. The main findings of the study were that the respondents consider that physiotherapy has a major role in the management of back pain. However there was limited availability of physiotherapy for the GPs' public patients. One hundred and thirteen GPs (over 43% of respondents) have referred back pain patients to alternative practitioners for manipulation. One hundred and forty four respondents (52%) believe that physiotherapists should not treat back pain patients without the patient first consulting their doctor.

Motor recovery following stroke: a basis for evaluation.

Health professionals devote much time to the treatment of stroke patients yet little is known about the extent to which recovery is influenced, and the effectiveness of rehabilitation methods continues to be a much-debated subject. The aim of this study was to identify whether changes in the motor recovery of 42 acute stroke patients could be detected by qualitatively scoring 25 items of functional mobility over a 14-week period. The results of the study identified that this method was sensitive in detecting weekly changes in early motor recovery. Three recovery groups were identified, and within each group it was possible to describe important time periods in which patients demonstrated varied rates of recovery. A qualitative and objective measure of stroke recovery could provide a basis for evaluating patient progress and the outcome of therapeutic interventions.

A survey of the work practices of physiotherapists in the community.

The aim of this study was to find out what kind of physiotherapy service is available in the community. Two groups were studied (i) private practitioners and (ii) community physiotherapists employed by health boards. The results indicate that the private practitioners provide a service in the community to a mainly young, or middle-aged and mobile population. The conditions treated were mostly of an acute nature, viz. sports injuries, low back pain and whiplash injuries. The community physiotherapy service provided by the health boards served mainly the very young, i.e. 0-15 years and the elderly. The conditions seen were mostly long-term, viz. strokes and cerebral palsy. The community physiotherapist saw 50% of cases in the patient's own home, while the private practitioners saw 93% of cases in the practice premises.

Whole rolled sunflower seeds with or without additional limestone in lactating dairy cattle rations.

Thirty lactating Holstein cows were in a continuous trial from 21 to 120 days postpartum to evaluate diets containing whole, rolled sunflower seeds with or without additional limestone. Cows were fed individually total mixed rations of (dry matter) 47% corn silage, 9% alfalfa hay, and 44% concentrate. Concentrates were corn and soybean meal (control); corn, soybean meal, and 22% sunflower seeds; or corn, soybean meal, and sunflower seeds plus 3.5% additional limestone. Milk yield (32.2, 32.0, and 32.8 kg/day) was similar among rations. Yield of 4% fat-corrected milk was lower for cows fed sunflower seeds without additional limestone (30.2, 28.1, and 30.2 kg/day) because of lower milk fat percentages (3.57, 3.19, and 3.51). Milk protein percentage tended to be lower for cows fed sunflower seeds with additional limestone (3.01, 2.97, and 2.90). Milk, flavor score was acceptable but tended to be lower for milk from cows fed sunflower seeds with additional limestone (8.4, 8.5, and 7.9). Milk fat from cows fed sunflower seed rations contained less carbon-14:0, 16:0, and 16:1 fatty acids but more carbon-18:0. Dry matter intakes were 21.0, 18.4, and 20.0 kg/day. Dry matter digestibilities, body weight changes, and ruminal volatile fatty acid concentrations were similar among treatments. Total cholesterol in blood serum was elevated in cows fed sunflower seed rations. Insoluble salts of fatty acids were increased in ruminal fluid dry matter from cows fed sunflower seeds but were not increased further by additional limestone. Concentrations of nonesterified carbon-18:1 fatty acids in ruminal fluid dry matter were lower for cows fed sunflower seeds with additional limestone.

The gypsy moth caterpillar: a significant new occupational and public health problem.

Seventeen workers in a laboratory where research with the gypsy moth was being performed were subjected to a questionnaire and to skin tests in an attempt to clarify the extent of allergy-like reactions in these workers. Ten of 17 reported dermatologic and/or pulmonary reactions associated with exposure to the caterpillar. Of the subjects with reactions, seven (70%) had reactions to allergens in the past. When all the workers were skin tested with various extracts, there was a strong relationship between reactions to the skin tests and clinical symptoms. The documentation of this problem helps to explain the outbreak of cutaneous reactions seen in the general population during the massive gypsy moth outbreak in spring 1981 in the Northeast.

Morphine persistence in rat brain and serum after single doses.

The disposition of morphine in rat brain and serum was determined over 48 hr after subcutaneous doses. Free morphine was measured by a specific assay using 3H-labeling together with high-pressure liquid chromatography separation, with a sensitivity of 1 nM (0.3 ng of morphine per ml). This study revealed the persistence of free morphine in nanomolar concentrations over at least 24 hr after a single analgesic dose. The terminal half-life of morphine elimination was 5 hours. Total radioactivity was retained in the body at much higher concentrations. Similar disposition of [C-1-3H]morphine and [N-14CH3] morphine ruled out any major metabolic alterations at these positions, including N-demethylation. Irreversible binding to insoluble tissue components, which has previously been linked to tolerance, was observed only to the extent of less than 20% of total tissue radioactivity and was not unique to brain tissue. The persistence of morphine and its metabolites may be related to protracted opiate effects such as withdrawal symptoms after addiction.

Tissue distribution of 3H-canrenoate potassium in rabbits.

Plasma and various organ concentrations of canrenone, canrenoate, and total 3H-activity were measured following single doses of 20 mg of 3H-canrenoate/kg iv to rabbits. Organs studied included heart, lungs, brain, kidneys, liver, adrenal glands, and spleen. Canrenoate was shown to be in rapid equilibrium with canrenone. Both were eliminated from plasma and other tissues with a half-life of about 1 hr. Plasma concentrations of both drugs were equal as early as 10 min after intravenous drug administration. Canrenone was concentrated about 10-fold in organ tissues when compared to plasma, while no such preferential uptake was found with canrenoate. Total 3H-activity declined slowly in all tissues with a half-life of approximately 15 hr, indicating extensive metabolism and metabolite retention in the rabbit.

Chemical structure and aldosterone receptor affinity of canrenoate-potassium metabolites in rabbits.

Two new major metabolites of canrenoate-potassium (III) were isolated from rabbit livers, in addition to the known metabolite canrenone (II). One metabolite (MA) contains two additional oxygen atoms of unknown location. The second metabolite (MB), which was previously shown to interfere with a plasma aldosterone radioimmunoassay, is identified as 20-hydroxy canrenone. Canrenone (II) and metabolite MB showed significant affinity to rat kidney cytosol aldosterone receptors and might both contribute to the pharmacological effects of canrenoate-K (III).

Aldosterone plasma radioimmunoassay interference by a spirolactone metabolite.

The plasma aldosterone radioimmunoassay developed by Ito et al. was found to be non-specific for aldosterone following administration of the spirolactones, spironolactone and canrenoate-K, in rabbits, dogs and humans. The assay interfering principle was identified as a hydroxylated derivative (M-B) of canrenone, which itself is a metabolite common to both spironolactone and canrenoate-K. The metabolite M-B possessed a high cross-reactivity to the 21-hemisuccinate aldosterone antibody relative to other spirolactones. A modified procedure was developed specific for plasma aldosterone in the presence of M-B. Following single doses of spironolactone and canrenoate-K, aldosterone plasma levels were unchanged in humans and in dogs and decreased in rabbits.