A progressive-individualized midstance gait perturbation protocol for reactive balance assessment in stroke survivors.

Restoration of balance control is a primary focus of rehabilitation after a stroke. The study developed a gait perturbation, treadmill-based, balance assessment protocol and demonstrated that it can be used to quantify improvements in reactive balance responses among individuals post-stroke. The protocol consists of a sequence of fifteen 90-second treadmill walking trials, with a single perturbation applied during the middle third of each trial. Gait was perturbed by rapid acceleration-deceleration of the treadmill belt at mid-stance of the unaffected leg during a randomly selected gait cycle. The initial perturbation magnitude was based on the participant's maximum walking speed and increased or decreased in each trial, based on success or failure of recovery, as determined from an instrumented harness. The protocol was used before and after a 10-week period of therapy in twenty-four stroke survivors. Outcomes included maximum recoverable perturbation (MRP), self-selected gait speed, levels progressed through the algorithm, and falls versus recoveries.Participants were able to take recovery steps in response to the perturbation. Twelve participants completed the full assessment protocol before and after the therapeutic intervention. After the intervention, they had fewer falls and more recoveries (p < 0.001), progressed through more algorithm levels (p = 0.043), had a higher MRP (p = 0.005), and had higher gait speeds. The protocol was found to be feasible in stroke survivors with moderate gait deficits. The data supports the conclusion that this protocol can be used in clinical research to quantify improvements in balance during walking.

Is there a shortage of neurosurgeons in the United States?

BACKGROUND: Neurosurgical workforce decision-making is typically driven by the 1 neurosurgeon per 100,000 population ratio proposed in 1977 in the Study on Surgical Services for the United States report. The actual ratio has always been higher than suggested. OBJECTIVE: We evaluated whether the 1:100,000 ratio from the Study on Surgical Services for the United States report is still valid, whether there are enough neurosurgeons in the United States to meet patient needs, and whether demand is driven by patient need. METHODS: For our analysis, the distribution of practicing US neurosurgeons was merged with census data to yield density indices of neurosurgeons by state; a survey assessing practice characteristics was e-mailed to practicing neurosurgeons; and a compilation of job advertisements for US neurosurgeons was evaluated. RESULTS: Multivariant statistical analyses yielded inconclusive results regarding patient demand because existing data sets are not designed to establish patient demand and many neurosurgeons are subspecialized. The data indicated that the ratio of neurosurgeons to total US population is 1:65,580. In the survey responses, neurosurgeon-to-patient ratios varied dramatically by state and were inconsistently correlated with whether neurosurgeons indicated they were overworked or underworked. The 305 job advertisements may indicate a shortage. Twenty-four percent of advertising practices indicated that they are recruiting only for emergency department coverage, and an additional 26% indicated that they might not be recruiting if not for the need for emergency coverage. CONCLUSION: Demand ratios should be reevaluated by region and subspecialty to consider changes in neurosurgery practice. A "shortage" in the employment market may reflect factors other than patient need.

PTSD, depression and help-seeking patterns following the Miyake Island volcanic eruption.

Assessing help-seeking patterns following disaster provides useful information about who needs professional help the most, who is willing to seek help, and who is reluctant to seek help. 231 Japanese evacuees from the Miyake Island volcanic eruption (2000) participated in this study (ages 20-93, average age 59.52). Ten months after the evacuation, participants were mailed questionnaires which elicited demographic data, disaster experiences, help-seeking patterns, and psychological symptoms (Post-traumatic stress disorder and depression). Help-seeking patterns were categorized as: professionals (physicians, nurses, psychotherapists/counselors, telephone consultation, social workers, priests and monks, and others); or informal (family, relatives, friends, neighbors, and others) and, (information, advice, tangible, and emotional). The findings indicate that younger and/or female victims frequently sought help from informal sources while male and/or older victims frequently sought help from professionals. Severity of PTSD and depression symptoms were positively correlated with help-seeking from physicians, but not psychologists or mental health professionals. Very high rates of utilizing medical assistance rather than mental health treatment were also identified among these disaster victims, and appeared related to cultural norms regarding shame and self disclosure of emotional distress.