An exploration of the experiences of Brazilian hemiplegic manual wheelchair users.

Purpose: The objective of this research was to explore the experiences of 11 hemiplegic users with their manual wheelchairs.Method: The phenomenological approach explored the subjective experiences of Brazilian hemiplegic manual wheelchair users in order to identify and describe the factors that affected their relationship with their wheelchair. Using in depth semistructured interviews. The data were analysed using thematic analysis. The health records from the physiotherapy service of the Health Department of Itajaí were reviewed to identify hemiplegic wheelchair users.Results: The results identified 4 key themes: heteronomy, inadequate/inappropriateness of wheelchair design, poor state of the pavements and roads prohibiting wheelchair use and lack of suitable wheelchair provision.Conclusion: The findings confirm that current manual wheelchair provision, both new and secondhand, for this group of users is inadequate and they highlighted the issues and problems arising from the current provision. A novel finding was the identification of heteronomy that resulted from the provision of unsuitable equipment.Implication for rehabilitationAdding into physiotherapy and occupational therapy education, the importance of matching technology to the user in their environment.The importance of involving the user in decisions made about wheelchair provision.Sharing findings with wheelchair manufacturers to improve manual wheelchair design for hemiplegic users.

Use of outcome measures in children with severe cerebral palsy: A survey of U.K. physiotherapists.

OBJECTIVES: To investigate the use of outcome measures for children with cerebral palsy (CP) by paediatric physiotherapists (PTs) who are based in the United Kingdom, as limited research exists regarding their use in this population, and to explore therapists' use of measures within different Gross Motor Function Classification System (GMFCS) levels and for different types of CP. METHODS: A six-item online survey was advertised through two paediatric therapy special interest groups inviting physiotherapists to participate. Descriptive statistics (range, frequencies, and percentages) were used to analyse survey data. RESULTS: Two hundred and seven physiotherapists returned completed survey questionnaires. One hundred and seventy-six (85%) therapists reported using a wide variety of outcome measures (57). Eighty-one per cent of therapists' responses for having "most difficulty" in identifying responsive outcome measures were for children with impaired mobility at GMFCS Levels IV-V and children with more significant body involvement (76%), for example, spastic quadriplegia or dyskinesia. Eighty-six per cent of therapists' responses for having "greatest ease" of identifying responsive outcome measures were for children within GMFCS Levels I-III and for children with less significant body involvement (72%), for example, hemiplegia. The variety of outcome measures used by therapists with children within GMFCS IV-V was less (16). CONCLUSIONS: The majority (85%) of the PTs surveyed used outcome measures with children with CP, but 81% perceived a difficulty in identifying responsive measures for children with more severe impairments who are classified as GMFCS IV-V. The reasons for this perceived difficulty warrant investigation and may suggest a need for training regarding relevant measures and/or a need to develop new measures for this group of children.

The Perception of Disability Among Mothers Living With a Child With Cerebral Palsy in Saudi Arabia.

The purpose of this study was to explore the perceptions of disability among Saudi mothers and to understand the implication of the meaning for the mothers of children with disability. A critical ethnographic approach was employed using focus groups and follow-up interviews with the mothers. Three primary themes were identified that specifically influenced and affected the mothers' experiences: (a) culture and religion, (b) motherhood and disability, and (c) community stigma and discrimination. The study reveals much-needed knowledge and sheds light on a topic, the details of which are rarely available in research literature from the Middle East. The findings further endorse the need for clinicians to listen to the mothers to consider their beliefs and the impact of these beliefs on their experiences. This, in turn, may provide a valuable conceptual lens for health care practitioners to use the family-centered model when working with cerebral palsy children.

Play Experiences of Children With a High Level of Physical Disability.

IMPORTANCE: This research provides practitioners with an understanding of play from the perspective of children with a high level of physical disability. OBJECTIVE: To explore the experience of play for children who have a high level of physical disability as a result of cerebral palsy. DESIGN: Interpretative phenomenological analysis. Children participated in three interviews each to discuss their experience of play. Visual methods, such as use of video and drawings, enabled a greater depth of discussion. SETTING: Participants' homes. PARTICIPANT: : Six children ages 6-11 yr with a high level of physical disability, recruited via snowball sampling and charities working with children with cerebral palsy. RESULTS: We found that making choices and controlling play were important for the children, that they often experienced play differently than their peers, and that they connected with others in play through humor and communication skills. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners can respond to the findings by understanding the embodied unit, recognizing vista play, enabling expression of each child's imagined self, supporting negotiation of identity and disability, recognizing participation in play through watching, enabling opportunities for belonging, enabling development of component skills for play, and supporting strategies for connection. WHAT THIS ARTICLE ADDS: This article provides occupational therapy practitioners and other professionals with an understanding of play from the perspective of children who have a high level of physical disability.

A percepção de qualidade de vida de pessoas com deficiência motora: diferenças entre cadeirantes e deambuladores / La percepción de la calidad de vida de las personas con discapacidad motora: las diferencias entre los con silla de ruedas y los deambuladores / Quality of life perception of people with motor disability: differences between wheelchair dependent and ambulatory patients

RESUMO A rotina das pessoas com deficiência física inclui o uso de diferentes recursos de tecnologia assistiva, que podem auxiliar em seu desenvolvimento físico e intelectual, afetando diretamente sua qualidade de vida. O objetivo deste estudo foi avaliar a percepção da qualidade de vida de pessoas cadeirantes e deambuladoras com deficiência física no município de Itajaí, Santa Catarina. Trata-se de uma pesquisa descritiva de corte transversal e caráter exploratório quantitativo, cuja. amostra foi constituída por 163 participantes (91 cadeirantes e 72 deambuladores), que responderam a um questionário estruturado com informações socioeconômicas e de saúde e ao instrumento do World Health Organization Quality of Life Instruments (WHOQOL-bref), para mensurar a qualidade de vida. Na avaliação dos domínios físico e psicológico não foram observadas diferenças significativas entre os dois grupos, portanto a percepção da qualidade de vida não foi afetada pela utilização da cadeira de rodas. No entanto, examinando-se o domínio de relações sociais e meio ambiente, a percepção da qualidade de vida foi significativamente menor para cadeirantes com paresias, em relação às plegias e à amputação.

RESUMEN La rutina diaria de las personas con discapacidad incluye el uso de recursos de tecnología asistencial diversos, que les pueden ayudar en su desarrollo físico e intelectual, afectando directamente su calidad de vida. Este estudio pretende evaluar la percepción de la calidad de vida de las personas en sillas de ruedas y las deambuladoras con discapacidades físicas en la ciudad de Itajaí, Santa Catarina (Brasil). Se trata de un estudio descriptivo de cohorte transversal y de tipo exploratorio cuantitativo, con una muestra de 163 participantes (91 en silla de ruedas y 72 deambuladores), que respondieron a un cuestionario estructurado con datos socioeconómicos y de salud y al instrumento World Health Organization Quality of Life Instruments (WHOQOL-bref) para medir la calidad de vida. En la evaluación de los dominios físico y psicológico, no se observaron diferencias significativas entre los dos grupos, por lo que la percepción de la calidad de vida no fue afectada por el uso de la silla de ruedas. Sin embargo, al examinar el dominio relaciones sociales y medio ambiente, la percepción sobre la calidad de vida fue significativamente menor a los usuarios de silla de ruedas cuanto a las paresias, plejías y amputación.

ABSTRACT The routine of people with physical disabilities includes the use of different assistive technology resources that can aid in their physical and intellectual development, which directly affects their quality of life. The objective of this study was to evaluate the life quality perception of Wheelchair users and non-Wheelchair users living in the municipality of Itajaí, in the state of Santa Catarina. This is a cross-sectional study with exploratory and quantitative analysis. The sample consisted of 163 participants, of whom 91 were wheelchair users and 72 were non-wheelchair users. Participants responded to a structured questionnaire with socioeconomic and health information and the World Health Organization Quality of Life Instrument, WHOQOL_bref, to measure quality of life. In the evaluation of the physical and psychological domains, no significant differences were observed between the two groups. Therefore, in these two areas, the perception of quality of life was not affected by the use of wheelchair. However, by examining the social relations and environment domain the perception of quality of life was significantly lower for wheelchair users with paresis, regarding the plegias and amputation.

Manual Feeding Device Experiences of People With a Neurodisability.

OBJECTIVE: Neurological bilateral upper limb weakness can result in self-feeding difficulties and reliance on care providers. Mealtimes become time consuming and frustrating. In this exploratory inquiry, we examined the experiences of users of a feeding device. METHOD: Semistructured interviews were either conducted by telephone or administered via email to explore quality of life, changes to independence, benefits and limitations, and psychological impact of the equipment. RESULTS: Thematic analysis gave rise to five themes: independence and positivity, emotions, impact on family and social life, equipment functionality, and motivation. CONCLUSION: This exploratory inquiry has contributed new qualitative evidence to the knowledge and understanding of users' experiences of a manual feeding device. Users reported that the need for assistance was reduced and that their quality of life, independence, and freedom improved. Time and resources savings for the family, care providers, and staff appeared to result in a more equal relationship between user and care provider.

Comparison of activities of daily living (ADLs) in two different one arm drive wheelchairs: a study of individuals/participants with hemiplegia.

AIMS: This pilot study measured activities of daily living performance in individuals/participants with hemiplegia propelling both a standard dual handrim Action 3 wheelchair and a standard Action 3 wheelchair with a Neater Uni-Wheelchair kit attachment. The kit consists of a steerable front. RESEARCH QUESTIONS: Does the use of the NUW affect the performance quality of activities of daily living in individuals/participants with hemiplegia. Is there a difference in the motor and process skills during activities of daily living performance, and in the time taken to complete the activities. METHODS: Four individuals/participants with hemiplegia were used in a cross over, repeated measures trial. Assessment of Motor and Process Skills of users undertaking making a bed and laying a table "Swedish style", tasks were measured and time taken to complete each task were recorded. RESULTS: Bed making completion time was quicker in the Neater Uni-wheelchair (p < 0.03). Motor skills were significantly higher than the process ability skills (p < 0.05). CONCLUSION: Activities of daily living tasks in the Neater Uni-wheelchair were completed more efficiently with no loss in quality of motor and process skills performance. This suggests that the Neater Uni-wheelchair is a viable alternative to current one arm drive provision. Implications for Rehabilitation Inappropriate wheelchair provision can result in capacity limitation and poorer quality of ADL motor skill as well-lowered process performance skill. AMPS can help to explain motor and process skill differences in complex activities.

Measurement of hand/handrim grip forces in two different one arm drive wheelchairs.

PURPOSE: The aim of this study was to explore the total and regional grip forces in the hand when propelling two different manual one arm drive wheelchairs: the Neater Uni-wheelchair (NUW) and a foot steered Action3 wheelchair. METHODS: 17 nondisabled users were randomly assigned to each wheelchair to drive around an indoor obstacle course. The Grip, a multiple sensor system taking continuous measurement of handgrip force, was attached to the propelling hand. Total grip force in each region of the hand and total grip force across the whole hand were calculated per user per wheelchair. RESULTS: The Action3 with foot steering only generated significantly greater total grip force in straight running compared to the NUW and also in the fingers and thumb in straight running. CONCLUSIONS: The results suggest that the Action3 with foot steering generated greater grip forces which may infer a greater potential for repetitive strain injury in the upper limb. Further work is required to explore whether the difference in grip force is of clinical significance in a disabled population.

Changes in mood state after day case forefoot surgery.

Limited published data exploring patients' emotional recovery after day case foot surgery are available. The aim of the present study was to explore the changes in patient mood from preoperatively to 8 weeks postoperatively after outpatient forefoot surgery. The patients completed the Profile of Mood States-Bipolar™ questionnaire, Speilberger State-Trait Anxiety Inventory, and a 10-cm visual analog scale to measure pain preoperatively and again at 1, 2, and 8 weeks postoperatively. Of the 6 mood subscales, 3 showed statistically significant improvements by 8 weeks postoperatively: composed-anxious (Student's t test, t = -5.319; df = 84; p = .05); confident-unsure (t = -2.074; df = 84; p = .02); and clearheaded-confused (t = -2.46; df = 84; p = .007). Furthermore, the decrease in anxiety and pain was statistically significant after foot surgery. These findings have contributed to the understanding of patients' psychological needs in relation to outpatient day case foot surgery, and foot and ankle surgeons' understanding of patients' mood and anxiety levels can contribute to improving patient care and enhancing patient-practitioner relationships, which, in turn, could improve patients' perceived outcomes of their surgery.

A comparison of vertical reaction forces during propulsion of three different one-arm drive wheelchairs by hemiplegic users.

PURPOSE: The aim of this pilot study was to compare the vertical reaction forces (N) generated in three different Action 3 manual one-arm drive wheelchairs: dual handrim, a lever drive and a Neater Uni-wheelchair (NUW). A CONFORmat® Pressure measurement mat, placed on top of the users' prescribed cushion, measured vertical force at the buttock/seat interface on both hemiplegic and non-hemiplegic sides in each wheelchair. METHODS: Fifteen hemiplegic users were randomly assigned each wheelchair to drive around an indoor obstacle course. During propulsion of a multiple sensor, continuous measurement of force was recorded. Time taken to complete the circuit was recorded. Mean force and confidence intervals for each buttock were calculated per user per wheelchair. RESULTS: The dual handrim produced the highest vertical force during propulsion under the right buttock (x= 484.43; SD = 55.4; p < 0.001) and the lever drive produced the least force (x= 368.05; SD = 53.55; p < 0.01). The NUW completed the course quickest (p < 0.01). CONCLUSIONS: The dual-handrim wheelchair requires the greatest vertical force during propulsion. Since increases in this seat vertical reaction force may be related to the propulsive force. Further investigation is indicated as this may be a significant factor for clinicians when prescribing one-arm drive wheelchairs. Implications for Rehabilitation Review of clinical reasoning in prescribing wheelchairs. Addition of the Neater Uni-wheelchair to wheelchair services prescribing lists.

Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy.

AIM: The aim of this study was to develop a valid classification system to describe eating and drinking ability in people with cerebral palsy (CP), and to test its reliability. METHOD: The Eating and Drinking Ability Classification System (EDACS) was developed in four stages in consultation with individuals with CP, parents, and health professionals: Stage 1, drafting informed by literature and clinical experience; Stage 2, modification by nominal groups; Stage 3, refinement in an international Delphi survey; and Stage 4, testing of agreement and reliability between classifications made by speech and language therapists (SaLTs), and between SaLTs and parents. RESULTS: Seven nominal groups involved 56 participants; 95 people participated in two rounds of the Delphi survey. Using the version of EDACS produced from this process, SaLTs in pairs classified 100 children. The rate of absolute agreement was 78% (kappa=0.72; intraclass correlation coefficient [ICC]=0.93; 95% confidence interval [CI] 0.90-0.95). Any disagreement was only by one level, with one exception. SaLTs and parents classified 48 children. The rate of absolute agreement was 58% (kappa=0.45, ICC=0.86; 95% CI 0.76-0.92). Parents either agreed with SaLTs or rated their children as more able by one level. INTERPRETATION: The EDACS provides a valid and reliable system for classifying eating and drinking performance of people with CP, for use in both clinical and research contexts.

A systematic review of ordinal scales used to classify the eating and drinking abilities of individuals with cerebral palsy.

AIM: The aim of this review was to examine systematically the scope, validity, and reliability of ordinal scales used to classify the eating and drinking ability of people with cerebral palsy (CP). METHOD: Six electronic databases were searched to identify measures used to classify eating and drinking ability; in addition, two databases were used to track citations of key texts. The constructs assessed by each measure were examined in relation to the World Health Organization International Classification of Functioning, Disability and Health. Evidence of validity and reliability of the identified scales was appraised from peer-reviewed studies using standard criteria. RESULTS: Fifteen scales were identified in 23 papers. Clinician or researcher assessment was required for 13 scales; nine scales made use of information from parents and carers through interviews or questionnaires. Eight scales used the terms mild, moderate, and severe (with varying definitions) to describe different aspects of eating and drinking impairment. There was an assessment of either content validity and/or reliability for five scales; however, none met the recommended psychometric quality standards. INTERPRETATION: Currently, there is a lack of evidence of the validity and reliability of ordinal scales of functional eating and drinking abilities of people with CP.

Patients' expectations of private osteopathic care in the UK: a national survey of patients.

BACKGROUND: Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. METHODS: The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen". RESULTS: 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP. CONCLUSIONS: The findings reflected the complexity of providing osteopathic care and meeting patients' expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.

Comparison of activities of daily living in two different one arm drive wheelchairs: a controlled trial.

AIMS: This pilot study measured activities of daily living (ADLs) in users propelling both a standard dual handrim Action 3 wheelchair and a standard Action 3 wheelchair with a Neater Uni-Wheelchair (NUW) kit attachment. The kit consists of a steerable front castor and a single pushrim propelling both rear wheels via a differential. HYPOTHESIS: There would be a difference in the efficiency of ADL skill performance, speed and heart rate. METHODS: Twenty non-disabled participants simulating hemiplegia were used in a cross over, repeated measures trial. Assessment of Motor and Process Skills (AMPS) of users undertaking making a bed and laying a table 'Swedish style', tasks, were measured. Heart rate at rest and post-task and time taken to complete each task were recorded. RESULTS: Heart rate when laying the table was lower in the NUW (p < 0.005) and task completion time was quicker (p < 0.0001). There was no difference in motor and process ability skills. CONCLUSION: ADL tasks in the NUW were completed more efficiently with no loss in quality of motor and process skills performance. This suggests that the NUW is a viable alternative to current one arm drive provision.

Changing self-efficacy in individuals following a first time stroke: preliminary study of a novel self-management intervention.

OBJECTIVE: To examine the effects of a self-management workbook intervention designed for use with individuals disabled after first time stroke. DESIGN: Multiple-participant two-phase (baseline followed by treatment) single subject design. The intervention was introduced at a randomly generated time-point. SETTING: Community. SUBJECTS: Seven men and three women, with a mean age of 61.5 years (SD 8.15), on average 24.2 weeks (SD 18.29) following first stroke, all with residual restriction of activity and participation. INTERVENTION: An individualized self-management workbook based on self-efficacy principles, incorporating sections to increase mastery, vicarious experience and feedback. MAIN MEASURES: Stroke Self-Efficacy Questionnaire, General Self-Efficacy Scale, Recovery Locus of Control Scale, Rivermead Mobility Index, Rivermead Activities of Daily Living Scale, Subjective Index of Physical and Social Outcome and the Hospital Anxiety and Depression Scale. Individual data were analysed with weighted mean trend test and two standard deviation band test. Group data were analysed with a randomization test. RESULTS: Visual inspection of the data over the 14-week period showed steady improvement for all of the 10 participants on the majority of variables. A randomization test indicated a statistically significant change in Stroke Self-Efficacy Questionnaire scores and Recovery Locus of Control Scale scores which followed introduction of the intervention. Measures of activity, participation and mood scores did not show a statistically significant change. CONCLUSION: There is preliminary evidence that the use of an individualized stroke self-management intervention is acceptable and can lead to a change in self-efficacy in this small sample.

Hip subluxation and dislocation in cerebral palsy - a prospective study on the effectiveness of postural management programmes.

BACKGROUND AND PURPOSE: Hip subluxation and dislocation are common sequelae in children with bilateral cerebral palsy and are currently managed by surgical interventions. This study aimed to investigate the effectiveness of early postural management programmes on hip subluxation and dislocation at five years, and the need for treatment in children with bilateral cerebral palsy, and to compare these findings with a historical control group. METHODS: A prospective cohort study followed 39 children who commenced using postural management equipment under 18 months of age. Levels of ability, type and amount of equipment use and treatments were recorded every three months. At 30 and 60 months, the hips were X-rayed and the hip migration percentage was measured. The results were compared with the historical control group. RESULTS: Children who used equipment at recommended and moderate levels had significantly less chance of both hips being subluxed than those using equipment at minimal levels (two-tailed Fisher's exact chi(2) p = 0.024). The frequency of children with hip problems was significantly less in the intervention group in comparison to the historical control group at five years (chi(2) = 11.53, df = 2, p = 0.006). The frequency of children receiving bilateral or unilateral treatments, i.e. surgery, use of a hip and spinal orthosis and/or botulinum toxin injections, in the intervention group was significantly less compared to the historical control group (two-tailed Fisher's exact p = 0.001). CONCLUSION: The early provision of postural management equipment has a role to play in reducing the number of hip problems and therefore the need for treatment of hip subluxation/dislocation in cerebral palsy at five years of age.

Measures of energy expenditure and comfort in an ESP wheelchair: a controlled trial using hemiplegic users'.

AIM: The aim of this pilot study using hemiplegic subjects was to measure energy expenditure, hand position and ride comfort, in a standard dual handrim Sunrise Breezy wheelchair compared to one modified with a novel ergonomic self-propelled steering (ESP) mechanism kit. A previous study by Mandy et al. (Disabil Rehabil Assist Technol 2007;2:255-260) reported that the attachment of the ESP kit to a standard Sunrise Breezy wheelchair provided a more ergonomically efficient mechanism for wheelchair steering and propulsion for non-disabled individuals. METHODS: Thirteen hemiplegic stroke users participated in a repeated measures trial by driving two manual wheelchairs--a standard manual dual handrim wheelchair and one fitted with the ESP steering conversion kit. Wheelchairs were randomly assigned, to participants who drove each wheelchair around a designated circuit. Oxygen consumption, carbon dioxide and heart rate were measured as indicators of ergonomic efficiency using a Cosmed analyser. Comfort for each wheelchair was measured using a validated questionnaire. RESULTS: Oxygen consumption (O(2)mls/min) and exhaled carbon dioxide (CO(2)mls/min) were significantly lower in the modified wheelchair (p < 0.004 and p < 0.04, respectively). Time taken to complete the course was significantly faster in the ESP (p < 0.001). There was no significant difference in heart rate readings between the wheelchairs. All comfort ratings were reported to be significantly greater in the ESP (p < 0.01). CONCLUSIONS: The ESP conversion kit transforms a standard Sunrise Breezy wheelchair into one that is ergonomically more efficient and comfortable for hemiplegic subjects.

Reasons for recovery after stroke: a perspective based on personal experience.

PURPOSE: The purpose of this study was to learn more about individual beliefs and personal strategies used to support the period of recovery after stroke. It sought to identify the factors that were perceived to be enablers as well as challenges to recovery. Personal actions or experiences, which were perceived to be effective in influencing progress, would be identified. METHOD: Qualitative in-depth interviews were carried out with 10 participants (mean age 61.8 years). Time following stroke onset ranged between 6 weeks and 13 months. All participants had some residual activity limitation and three participants had varying degrees of aphasia. The interviews were approximately 60 - 90 minutes and all data was subjected to content analysis. RESULTS: Analyses of interview data identified two main themes which were perceived to have influenced progress after stroke. The first related to internal factors such as personal control over progress, optimism and fears of dependency and the second included more external factors, such as the influence of therapeutic interactions and success with a specified marker of independence such as dressing, washing and walking. CONCLUSION: An important finding of this study was that individuals all identified a number of specific factors which had supported or hindered their own recovery. There were a diversity of both internal/personal and external factors which may not be surprising, given the complexity of stroke, but all participants stressed the importance of both factors. The findings from this study are preliminary and relate only to this particular group of participants, as such they cannot be generalizable to the stroke population as a whole. However, the interaction between the two themes identified requires further exploration, especially in relation to therapy which could have both a positive and negative influence on personal control. There is a clear need to understand how professionals can, in the first place, take time to identify each individual's preferences and personal goals and secondly, make sure that these are fully addressed in a planned treatment programme. This will ensure that progress in individuals after stroke is supported by professionals with a more eclectic, individualized approach.

Energy expenditure, and comfort in a modified wheelchair for people with hemiplegia: a controlled trial.

AIM: The aim of this pilot study using non-disabled subjects was to measure energy expenditure, hand position and ride comfort, in a standard dual handrim Sunrise Breezy Wheelchair compared to one modified with a novel ergonomic self propelled steering (ESP) mechanism kit. The clinical reasoning underpinning the engineering design of the ESP kit was to develop a more ergonomically efficient mechanism for wheelchair steering and propulsion for individuals who had sustained cerebral vascular accidents. METHODS: Ten non-disabled males participated in a repeated measures trial by driving two manual wheelchairs - a standard manual dual handrim wheelchair and one fitted with the steering conversion kit. Wheelchairs were randomly assigned, to participants who drove each wheelchair around a designated circuit. Oxygen consumption, carbon dioxide and heart rate were measured as indicators of ergonomic efficiency using a Cosmed analyser. Comfort for each wheelchair was measured using a validated questionnaire. RESULTS: Heart rate (bpm), oxygen consumption (O2 ml/min) and exhaled carbon dioxide (CO2 ml/min) were significantly lower in the modified wheelchair (P < 0.001, P < 0.006 and P < 0.014, respectively). All comfort ratings were reported to be significantly greater in the ESP (P < 0.05). CONCLUSIONS: The ESP conversion kit transforms a standard Sunrise Breezy Wheelchair into one that is ergonomically more efficient and comfortable for non-disabled subjects.

Burnout and occupational stress: comparison between United Kingdom and Australian podiatrists.

Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation to podiatric medicine, although two recent studies have reported high levels of burnout expressed by podiatric medical practitioners. This study was undertaken to compare the levels of burnout in newly qualified practitioners in Australia and the United Kingdom. The results suggest that levels of burnout are higher in these groups than indicated by the published normative medical data. Occupational stress was associated with lack of professional status and with geographic and professional isolation. Within these two themes, there were clear differences between the two groups.