Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs.

This was a controlled study of the efficacy of two forms of therapy on upper limb functions of hemiparetic patients--one heavily behavioral and the other based on Bobath therapeutic exercises. It arose from an earlier pilot study comparing EMG biofeedback with physical therapy from which it was concluded that both the elapsed time since the acute stroke and the severity of residual disability were particularly important factors. Of 29 patients included and randomly assigned to one or the other heavily systematized therapies, 18 were classified as having early-severe and 11 as late-mild conditions. Multiple function tests by a "blinded" special technician in another location revealed that overall both forms of therapy obtained worthwhile clinical and statistical improvement, which was maintained at nine-month recheck testing; but there was no statistically significant superiority of one therapy over the other under the very specific circumstances of the research design. Ease of delivering care and other socioeconomic considerations become important factors in choosing either or both of these methods.

Wheelchair users' problems with community living.

Those confined to wheelchairs face many frustrations when attempting to become more active in their communities. Many community and health facilities are inaccessible and available transportation is limited. Wheelchair users may have difficulty obtaining appropriate wheelchair prescriptions. Their quality of life and health may be jeopardized by pressure sores. Painful conditions in the arms may further increase the degree of disability. A special approach to fitness training may be required. The wheelchair user's self-image will be affected by society's general negativism toward the disabled. Knowledgeable and sympathetic medical care can reduce the stresses inevitable for patients confined to wheelchairs.