ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A large majority of physical medicine and rehabilitation residencies have chief resident positions, but little has been written about the expectations of the program directors and the training of the chief resident to fulfill those expectations. A 20-item questionnaire was mailed to 73 program directors in physical medicine and rehabilitation in May 1992. The participants were asked about selection methods, their perception of the duties of the chief resident(s), their concerns about the chief resident(s) position, the training and the evaluation of the chief resident(s). An 85% (62/73) response rate was achieved. There was a chief resident position(s) in 98% of the programs responding. Chief resident selection was made mostly by appointment of the chairman and/or program director and/or the vote of the faculty. The program directors perceived the most important duties of the chief resident to be: act as a liaison between faculty and the residents, act as a role model, do scheduling, build teamwork and give constructive feedback. The most important skills were considered to be leadership and stress management. Causes of concern were time pressure, abuse of power, stress and work overload. Opportunities to develop leadership and administrative/ management skills were considered the most exciting aspects of the position. It was surprising, however, that only 15 of 61 (25%) provided some formal training. Only 28 of 61 (46%) had a position description.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Rehabilitation researchers are frequently interested in comparing the results of two tests that measure the same function. There are practical as well as financial advantages to having more than one method of assessing a particular component of function. Investigations examining the results of two tests are referred to as method comparison studies and commonly analyzed using the Pearson product moment correlation coefficient (r). Several researchers have argued that the Pearson r is a measure of linear association (co-variation) between variables and does not provide accurate estimates of direct agreement. We compared several commonly used quantitative methods to establish agreement and have demonstrated that the Pearson r is not appropriate for use in studies where the purpose is to determine whether two instruments are interchangeable. An alternative to the Pearson r for analyzing data from method comparison studies is presented. The new procedure, referred to as the limits of agreement method, is easy to compute and emphasizes the clinical comparability of two instruments (or raters) instead of focusing solely on the statistical relationship.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This study investigated predictors of psychologic distress at 1 year after injury. The brief symptom inventory, a symptom checklist that provides an overall index of distress, was administered to 119 spinal cord-injured patients. All patients had diagnoses of recent, traumatic SCI and had been admitted for initial inpatient rehabilitation between 1985 and 1990. Results showed levels of psychologic distress to be significantly higher 1 year after injury when compared with results obtained on admission and at discharge from the inpatient rehabilitation program. The prevalence rate for elevated distress after injury was 28%. Significant predictors of psychologic distress 1 year after injury included level of distress at admission, neurologic completeness of SCI, type of rehabilitation insurance payor (catastrophicvnoncatastrophic), occupational status before SCI and participation status in an inpatient independent living program. A multiple regression model with nine independent variables was specified that explained 63% of the variance in psychologic distress measured after injury.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This report describes a simple method to quantify changes in the activities of daily living (ADLs) over a 6-month time period in long-stay VA nursing home populations. In these institutions, each resident receives a score of one to five every 6 months describing the degree of dependence in eating, mobility, transfer and toileting (“patient assessment instrument” or PAI). From these data, quantitative indicators can be calculated for the studied population: the average score for each ADL at the beginning and end of the period, and the average 6-month change in this score; the proportions of all residents whose ADL score improved, remained unchanged or worsened; the proportion of initially independent residents whose ADL score worsened, and the proportion of initially dependent residents whose score improved.The method was applied in two VA nursing homes (A and B). The profiles of ADL outcomes in the two nursing homes differed in several respects. For example, in nursing home A, 80% or more of the population either remained unchanged or improved in ADLs and only 2 to 18% deteriorated. In nursing home B, on the other hand, only 50 to 60% of the population remained unchanged or improved and 36 to 50% deteriorated. For the initially independent residents, the frequency of deterioration of ADLs in nursing home B was several times greater than that in nursing home A.The described method of quantifying ADL outcomes could readily be applied to the PAI data that are available in all VA nursing homes. This would provide the staff of each institution with a semiannual quantitative overview of the ADL outcomes in their facility.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Central fever is a known complication of traumatic brain injury (TBI), particularly in association with brain stem involvement. Chronic deficits in thermoregulation after TBI have not been reported. We describe a patient who had central fevers acutely after injury, but developed intermittent temperature elevations during thermal stress in the post-acute phase. A prospective evaluation of the patient's temperature control was conducted. The patient stayed in the laboratory for two half-day evaluation sessions. On the first day, the room temperature was raised by 10° F each hour and rectal temperature was recorded hourly. On the second day, the room temperature was lowered by 10° each hour in a similar fashion. The patient's core temperature rose above normal in the warm environment but did not drop in the cold environment. This suggests that the patient had a chronic deficit in either sensing temperature elevations or activating heat dissipation mechanisms under thermal stress.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Rats pretrained to walk a narrow balance beam received unilateral sensorimotor cortex lesions, resulting in a contralateral transient paresis that lasted 14 days. In a dose-dependent manner, a single injection of the antidepressant trazodone given 24 hours after injury transiently slowed motor recovery compared with injured controls. After final recovery level of motor function, a reinjection of trazodone reinstated the hemiparesis for up to 6 hours. In other animals, a single injection of the antidepressant desipramine significantly facilitated motor performance when compared with injured controls. Desipramine had no deleterious motor effect when administered to animals that had recovered on the beam-walking task. These findings would suggest that the predominately noradrenergic neurotransmitter effects of desipramine may facilitate, and those of the predominately serotonergic trazodone may hinder, the recovery of locomotor performance after cortical injury in rats. Further studies appear indicated, including applying these findings to the clinical setting.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The purpose of this study was to determine the effect of different TENS stimulus characteristics on ulnar motor nerve conduction velocity (MNCV) in the forearm and on forearm and ring finger skin temperatures. Thirty-one healthy women consented to receive conventional, acupuncture-like and placebo TENS: one treatment being randomly administered on each of 3 separate days within 1 week. No significant difference in MNCV (m/s) was observed between the three treatments at any of the six times of measurement (P>0.05). Post-treatment MNCVs were, however, significantly slower than pretreatment velocities (time main effect;P<0.01), although the differences were only about 3% in magnitude. No significant differences in finger or in forearm skin temperature were observed between the three treatments at any of the six times of measurement (P>0.05). However, forearm skin temperatures were significantly higher than were ring finger skin temperatures, and only finger temperature changed over time (site X time interaction;P<0.01). The small changes in MNCV and finger skin temperature were attributed to subject inactivity during testing. Acupuncture-like and conventional TENS do not have different or unique effects on motor nerve conduction velocity when applied at clinical levels of stimulus intensity.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A method for quantifying the stability of a patient using a walking frame is presented. Data collected from a walker-dependent patient recovering from surgical amputation of his right leg were used to demonstrate the derivation and interpretation of a proposed walker user risk index (WURI). WURI curves express risk to the walker user in terms of how much the upper extremities contribute to overall patient support. The WURI analysis of the walker stride presented here quantified the expected clinical impression that this patient was least reliant on the walker immediately after the advance of his prosthetic leg and most reliant when standing on his prosthesis and swinging his nonamputated leg. The analysis also revealed unexpectedly high upper body loads and specific phases in the gait cycle where the patient's balance was at risk.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This paper reports motor index scores on motor complete (Frankel A, B), C4- T1, quadriplegic patients at admission, 72 h to 1 week and 6 months after spinal cord injury. This study is designed to test the hypothesis that the 72-h to 1-week motor index score (referred to as 72-h motor score) is superior to motor scores recorded within the first 24 h in predicting 6 month motor scores. Twenty-seven quadriplegic subjects, ages 15-70 years, were followed prospectively using manual muscle test to document motor recovery. Biceps, wrist extensors, triceps, flexor digitorum profoundus and first dorsal interossei were tested within 24 h, 72 h-1 week and 6 months after injury to comprise the motor index score. Average total motor scores for both upper extremities at admission were 14.0, at 72 h 13.9, and at 6 months 19.3 (ANOVA,P<0.01). Total bilateral motor scores changed by 5.3 from admission to 6 months and by 5.4 from 72 h to 6 months. No significant difference existed between the admission and post 72-h motor score in predicting the 6-month motor score (Newmann-KeulsP>0.05). Thus, despite significant change in motor score after spinal cord injury, both admission and 72-h motor scores equally predicted 6 month motor recovery of C4-T1 motor complete quadriplegic patients.

ISSN:0894-9115    

出版商:OVID    

年代:1993

数据来源: OVID