''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial.

AIM: To evaluate the effects of ''Playstation EyeToy Games'' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke. METHODS: The authors designed a randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 3 months. A total of 20 hemiparetic inpatients (mean age 61.1 years), all within 12 months post-stroke, received 30 minutes of treatment with ''Playstation EyeToy Games'' per day, consisting of flexion and extension of the paretic shoulder, elbow and wrist as well as abduction of the paretic shoulder or placebo therapy (watching the games for the same duration without physical involvement into the games) in addition to conventional program, 5 days a week, 2-5 hours/day for 4 weeks. Brunnstrom's staging and self-care sub-items of the functional independence measure (FIM) were performed at 0 month (baseline), 4 weeks (post-treatment), and 3 months (follow-up) after the treatment. RESULTS: The mean change score (95% confidence interval) of the FIM self-care score (5.5 [2.9-8.0] vs 1.8 [0.1-3.7], P=0.018) showed significantly more improvement in the EyeToy group compared to the control group. No significant differences were found between the groups for the Brunnstrom stages for hand and upper extremity. CONCLUSION: ''Playstation EyeToy Games'' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients.

The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial.

AIM: To investigate the effects of balance training, using force platform biofeedback, on motor recovery, mobility and activity level of hemiparetic patients with stroke. METHODS: In this randomized, controlled, assessor-blinded trial 41 inpatients [mean (+/-SD) age of 60.9 (+/-11.7) years] with hemiparesis after stroke (median time since stroke 6 months) were randomly assigned to an experimental or a control group. The control group (n=19) participated in a conventional stroke inpatient rehabilitation program, whereas the experimental group (n=22) received 15 sessions of balance training (using force platform biofeedback) in addition to the conventional program. Main outcome measures were motor recovery of the lower extremity (Brunnstrom staging), mobility (Rivermead Mobility Index, RMI) and activity level (Functional Independence Measure, FIM) that performed one week before and after the experimental treatment program. RESULTS: Both groups were similar in terms of baseline clinical characteristics. Motor recovery, mobility and activity level improved significantly in both groups (P<0.05). Between-group difference of mean change score was not significant for the Brunnstrom stages (0.23 vs 0.26), RMI (2.9 vs 2.2) and FIM score (10.7 vs 11.5). CONCLUSION: In our group of stroke patients, balance training combined with a conventional rehabilitation program does not provide additional benefit in terms of lower extremity motor recovery, mobility and activity level.

Spatio-temporal and kinematic asymmetry ratio in subgroups of patients with stroke.

AIM: To determine the spatio-temporal and kinematic gait asymmetry in hemiparetic patients after stroke, and to compare the subgroups in terms of asymmetry ratio. METHODS: Spatio-temporal and kinematic characteristics of gait in 100 patients (37 females, 63 males) with hemiparesis after stroke were retrospectively evaluated. The mean+/-SD age was 57.9+/-12.1 years (range 18-80) and time since stroke was 5.75+/-5.9 months (range 1-36). Subgroups were based on age, gender, side of paresis, lesion type, motor recovery level, sensory status, time since stroke and walking velocity. RESULTS: The older patients (65 years) had a higher temporal asymmetry in terms of single-support time whereas the younger patients (<65 years) had a higher kinematic asymmetry in terms of ankle joint kinematics at both stance and swing phases (P<0.05). In the poor motor recovery group, asymmetry ratios of step length, hip and knee extension at stance, and ankle kinematics were significantly higher than those of the good motor recovery group (P<0.05). In the slow walking group, step length showed a greater asymmetry than in the fast walking group (P<0.05). Gait asymmetry was similar among the patients when they were grouped according to their gender, side of paresis, lesion type, proprioception, and time since stroke. CONCLUSION: For better interpretation of quantitative gait data and to offer appropriate rehabilitation programs, clinicians should consider that spatio-temporal and kinematic asymmetry might vary according to age, motor recovery level and walking speed of hemiparetic patients after stroke.

Gait deviations of patients with diabetes mellitus: looking beyond peripheral neuropathy.

AIM: The aim of this paper was to define the gait deviations in patients with diabetes mellitus (DM), to investigate the associations between electrophysiological findings and gait characteristics, and to interpret the findings in preventive and therapeutic rehabilitation protocols. METHODS: Forty-six patients with DM and 20 healthy control subjects were enrolled into this controlled study. Electrophysiological studies and computerized gait analysis were performed. Gait deviations of DM patients with diabetic peripheral neuropathy (DPN) (n=20), without diabetic peripheral neuropathy (NDPN) (n=26) and healthy control subjects (C) (n=20) were compared, and associations between electrophysiological findings and gait characteristics were investigated. RESULTS: NDPN, but not DPN, group revealed slower gait, shorter steps, limited knee and ankle mobility, lower ankle plantar flexor moment and power than C group, and the difference was statistically significant. HbA1c levels and F-wave latency were significantly correlated with ankle mobility, peak ankle plantar flexion moment and power. CONCLUSION: Neuropathy may not be the only reason for gait deviations in DM patients. Considering the spectrum of hyperglycemic complications including the mechanical characteristics of bones, muscles and soft tissues, patients with DM should start mobility and strengthening exercises in early stages.

Multidimensional health-status assessment of chronic hemodialysis patients: the impact on quality of life.

AIM: This study was designed to define impairment of body functions and structures, limitations in activity, restrictions in participation, and health-related quality of life of chronic hemodialysis (HD) patients, in order to assign proper rehabilitation programs. METHODS: Forty-five patients with end-stage renal disease (ESRD) from the Dialysis Unit of the Trescore Balneario's Hospital were enrolled into the study. Clinical characteristics of the disease and Tinetti's test were used to assess impairment of body structures/functions. Limitations in activities were evaluated by functional independence measure (FIM). Marital status, living environment, employment status and recreational activities were questioned; short form-36 (SF-36) was used to measure health-related quality of life. RESULTS: Mean age of the patients (27 male, 18 female) was 63.8+/-11 years. ESRD was mainly caused by glomerulonephritis (22%). Tinetti's test showed that 11% of HD patients could not walk without help. On the day of dialysis the total FIM score of HD patients dropped about 40 points. Only 2 patients (4.5%) were able to live alone and 6 patients (13%) have gone for vacation since they started dialysis treatment. Compared to the general population sample (91.99+/-23.41), HD patients (50.08+/-22.56) scored significantly lower total SF-36 scores (P<0.001). CONCLUSION: HD patients had to face increased limitations in functional independence on the day of dialysis, as well as highly restricted social participation. Preventive and rehabilitative programs including medical management, nursing care and a range of multidisciplinary services can promote quality of life of patients with ESRD on HD.

Reporting on reliability and validity of outcome measures in medical rehabilitation research.

PURPOSE: To evaluate the degree to which published medical rehabilitation research offers evidence of reliability, validity and other clinimetric qualities of the data reported. METHOD: Descriptive study of published intervention research papers published in six US medical rehabilitation journals in 1997 and 1998. Selected characteristics of the papers and the outcome measures used were abstracted by one or two raters. RESULTS: The 171 papers identified included 651 outcome measures. Some type of data reliability information was provided for 20.1% of these measures; for validity, this was 6.9%. However, this information was based on data collected for the sample studied for only 7.7% (reliability) and 0.6% (validity). CONCLUSIONS: Most rehabilitation research falls short of standards, including the Standards promulgated by an American Congress of Rehabilitation Medicine Advisory Group. Authors, peer reviewers and editors need to change their practices to improve this situation.

A tale of two countries: environmental impacts on social participation after spinal cord injury.

STUDY DESIGN: Comparative analysis of survey data produced in two countries. OBJECTIVES: To assess the degree to which environmental barriers impact social participation, and to identify the aspects of participation most affected. SETTING: Community-dwelling individuals with spinal cord injury in the USA and Turkey. METHODS: Subjects completed the Functional Independence Measure (FIM) motor score, the Craig Hospital Inventory of Environmental Factors (CHIEF), and the Craig Handicap Assessment and Reporting Technique (CHART). Analysis of co-variance was used to analyze CHIEF and CHART differences within and between country. RESULTS: US subjects reported higher participation scores (CHART) and lower barriers (CHIEF), however, when controls for age, gender, time since injury and motor ability (FIM) were applied, country differences in reports of barriers were limited. Motor ability was the major predictor of participation, which was minimally affected by barriers. CONCLUSION: Conceptualization and measurement issues may have been the reason for the minimal support for the hypothesis that environment affects participation. Suggestions for future research are made. SPONSORSHIP: National Institute on Disability and Rehabilitation Research, Centers for Disease Control and Prevention.

Encephalocraniocutaneous lipomatosis associated with iris coloboma, chorioretinitis and spinal cord involvement: a case report.

A 9-year-old boy with a history of lipoma excision and laminectomy at the Th10-11 levels, resulting in incomplete paraparesis and neurogenic bladder, was admitted for a comprehensive rehabilitation programme. Physical examination revealed an ipsilateral focal dermal hypoplastic defect within an area of alopecia and a subcutaneous lipomatous tissue on the left temporo-parietal region of the scalp. Iris coloboma and chorioretinitis were diagnosed on the left eye. He also had mild mental retardation and triparesis. Magnetic resonance imaging of the brain and the spine demonstrated hyperintense masses which were consistent with lipoma. Although in the literature three cases of encephalocraniocutaneous lipomatosis (ECCL) concomitant with spinal cord involvement have been reported, to our knowledge iris coloboma and chorioretinitis in ECCL have not been reported previously. In conclusion, we would like to stress that aside from known ophthalmological malformations, iris coloboma and chorioretinitis may also be observed in ECCL and that all patients who have been diagnosed as having ECCL should be examined for spinal cord involvement.

Adaptation of the Functional Independence Measure for use in Turkey.

OBJECTIVE: To adapt the Functional Independence Measure (FIM) for use in Turkey and to assess its validity and reliability. DESIGN: After the translation procedure, reliability was assessed using internal consistency, inter-rater reliability (kappa) and the intraclass correlation coefficient (ICC). Construct validity was tested by association with impairments and by fit of data to the Rasch model. SETTING: The study was undertaken in an inpatient rehabilitation unit of the Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara. SUBJECTS: Consecutive stroke (n = 51) and spinal cord injury (SCI) (n = 62) patients admitted for rehabilitation over a period of three years were assessed at admission and discharge. RESULTS: Internal consistency was good for stroke, and for SCI. The level of agreement between two raters was sufficient with kappa levels of above 0.48 for SCI and above 0.44 for stroke. Minimum ICC found was 0.90. Construct validity showed expected associations with the impairment scales. However, Rasch analysis showed that bladder and bowel items compromise unidimensionality in the motor scale. CONCLUSION: Adaptation of the FIM has been successful and it can be used in Turkey as long as the limitations are recognized.

Rehabilitation of stroke patients: clinical profile and functional outcome.

OBJECTIVE: To describe the nature of functional recovery of 67 Turkish survivors of first-episode stroke who were referred for inpatient rehabilitation and to identify the variables that best predict discharge functional status of these patients. DESIGN: A retrospective, descriptive study of the demographic and clinical profile and the functional status of patients with first-episode stroke. RESULTS: The mean age was 60 (11.8, SD) yr, and 35.8% were men. The mean onset-admission interval and length of stay were 62.9 and 97.1 days, respectively. The mean functional status score, as measured by the FIM instrument, at the time of admission was 75 compared with 86.7 at the time of discharge, showing a mean improvement of 11.7. Although rehabilitation gains were similar for the right- and left-side involved groups, patients with right-side paresis had lower FIM scores at the time of admission than did the left-side involved group. Significant predictors of functional status at the time of discharge were admission functional status score and onset-admission interval. CONCLUSION: Knowledge of these predictors can contribute to more appropriate treatment and discharge planning.

Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey.

The aim of this study was to adapt the modified Barthel Index for Turkey and to determine its reliability and validity. After the translation procedure, 50 stroke patients and 50 spinal cord injury patients, undergoing inpatient rehabilitation were assessed by the newly adapted index at admission and discharge. Reliability was tested using internal consistency, inter-rater reliability and the intra-class correlation coefficient. Construct validity was assessed by association with impairments (Brunnstrom motor stages in stroke, American Spinal Injury Association motor/sensory scores and impairment scale in spinal cord injury) and by Rasch analysis. Internal consistency was good at 0.93 for stroke, and 0.88 for spinal cord injury. The level of agreement between two raters was sufficient with Kappa levels of above 0.5 for spinal cord injury and above 0.6 for stroke. Intra-class correlation coefficients were 0.99 and 0.77 for stroke and spinal cord injury, respectively. The newly adapted index showed expected associations with the impairment scales, confirming its construct validity. However, Rasch analysis showed that bladder and bowel items compromise unidimensionality. In conclusion, adaptation of the modified Barthel Index has been successful and it can be used in Turkey as long as its limitations are recognized.

The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire.

This study was undertaken to translate and adapt the Fibromyalgia Impact Questionnaire (FIQ) into the Turkish language and investigate its validity and reliability for Turkish female fibromyalgia (FM) patients. After translation into Turkish, we administered the FIQ and Health Assessment Questionnaire (HAQ) to 51 women with fibromyalgia. As well as sociodemographic characteristics, the severity of relevant clinical symptoms, e.g., pain intensity, fatigue, and sleep disturbance, were assessed by visual analog scales. A tender point score (TPS) was calculated from tender points conducted by thumb palpation. Test-retest reliability, internal consistency, and concurrent and construct validities of FIQ were evaluated. Test-retest reliability and internal consistency were good at 0.81 and 0.72, respectively. Correlation between FIQ and HAQ scores was 0.43, which was low but statistically significant. Significant moderate correlations were obtained between the FIQ items and severity of clinical symptoms (0.63-0.77), except TPS, 0.31. The FIQ is a reliable and valid instrument for measuring functional disability in Turkish female FM patients.

Compliance with bladder management in spinal cord injury patients.

STUDY DESIGN: Retrospective analysis of medical records on spinal cord injury (SCI) patients with neuropathic bladder. OBJECTIVE: To determine SCI patients' compliance with the method of bladder management they used on discharge from inpatient rehabilitation. SETTING: Ankara University Medical School, Department of Physical Medicine and Rehabilitation, Spinal Cord Injury Unit, which treats patients referred from throughout Turkey. METHODS: The bladder management method of 50 new SCI patients was noted at admission, discharge and follow-up. Reasons for changing the initial method were documented. For analysis, patients were grouped by gender, level and completeness of injury. Compliance with bladder management method was compared between these groups by chi-square test. RESULTS: The method of bladder management at admission was indwelling catheter (IC) for 86% of the patients. Most were switched to clean intermittent catheterisation (CIC) by rehabilitation discharge. Of 38 patients (76%) on CIC at discharge, 20 (52%) discontinued this method and reverted to IC during follow-up. Compliance with CIC was lower for women, for tetraplegics, and for those with complete injury. Dependence on care givers, severe spasticity interfering with catheterisation, incontinence despite anticholinergic agents, and lack of availability of external collective devices for female patients were the main reasons for low compliance with CIC. CONCLUSION: The bladder management method of SCI patients should be selected so as to be suitable to the patients' life style. Besides reducing morbidity, it also has to enhance the quality of life.

Short versions of the telephone motor Functional Independence Measure for use with persons with spinal cord injury.

OBJECTIVE: To determine if the motor ability of persons with spinal cord injury (SCI) can be reliably estimated using a subset of the 13 Functional Independence Measure (FIM) items. STUDY DESIGN: FIM item subsets of 5, 6, or 7 items were selected using one of five strategies: random, coefficient alpha maximization, spread across the range of item difficulties, optimization by neurologic category, and individual optimization. Motor ability estimated by these 15 subsets was compared to the 13-item estimate, using intraclass correlation coefficient (ICC), Rasch calibration person reliability estimate, and other indices of reliability. SUBJECTS: Subjects were 4,128 persons with SCI, 1 to 25 years postinjury, interviewed for annual research follow-up using the FIM. RESULTS: All subsets had high ICC reliability (>.90). Subsets of 7 items performed generally better than those of 6 or 5 items. The best performance was provided by individual optimization subsets. The ICC for the 7-item set thus selected was .99. CONCLUSION: In annual follow-up, the number of FIM motor items can be reduced almost 50% while maintaining reliable estimates of subjects' motor ability. This approach may also be useful for other applications of interviewing to obtain FIM data, eg, for program evaluation.

The effect of cocaine on traumatic brain injury outcome: a preliminary evaluation.

The effect of acute cocaine use on the functional and neuropsychological outcome of persons with traumatic brain injury, (TBI) was examined by comparing persons with TBI who tested positive for cocaine at the time of admission with persons with negative drug and alcohol screens. Subjects were matched for age, admission GCS score, level of education, and aetiology of injury (closed vs penetrating head injury). Dependent measures were: the Disability Rating Scale, the Functional Independence Measure, and selected neuropsychological tests. No group differences were found in DRS, FIM, FIM subsets, or FIM change. However, the cocaine group scored significantly lower than the no-drug group on the Rey Auditory Verbal Learning Test, but did not differ on any of the other neuropsychological tests.