Fatigue in persons who have lived with spinal cord injury for >20 years.

OBJECTIVES: This study aims to assess the prevalence of fatigue among persons who have lived with traumatic spinal cord injury (SCI) for >20 years, and to compare the results with fatigue scores found among the general population (GP). Another objective was to study the association between fatigue and clinical variables, including mental health, among the study population. DESIGN: A cross-sectional study. SETTING: Sunnaas Rehabilitation Hospital (SunRH), Norway. MATERIALS AND METHODS: All SCI survivors (n=237) admitted for rehabilitation at SunRH between 1961 and 1982 were asked to participate. Fatigue was measured with the Fatigue Questionnaire (FQ). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS). Linear regressions were used to examine those variables with the potential to contribute to fatigue. RESULTS: A total of 153 persons responded to the FQ, and in 39 cases the scores were consistent with fatigue. Surprisingly, the prevalence of fatigue (total fatigue (TF)) did not differ between the study population and the norm. However, the results indicated statistically significantly higher score of physical fatigue (PF) and statistically significantly lower score of mental fatigue among the SCI group when compared with the GP. Higher fatigue scores were associated with fatigue-causing pharmaceuticals and with higher scores on the HADS-depression subscale. CONCLUSIONS: The prevalence of fatigue was 25% among persons who had lived with SCI for >20 years, and similar to that in the GP. Our results point to medications and mental health aspects as possible contributors to PF severity in SCI.

The efficacy of rehabilitation for patients with rheumatoid arthritis: comparison between a 4-week rehabilitation programme in a warm and cold climate.

OBJECTIVES: To investigate the long-term effect (week 16) of a 4-week rehabilitation programme for patients with rheumatoid arthritis (RA) and to compare the effect of this intervention given in a Mediterranean or a Norwegian climate. METHODS: A randomized, controlled, parallel group design, where 124 RA patients applying for rehabilitation were randomized to a rehabilitation programme either in Norway or in a Mediterranean climate. The participants were examined clinically immediately before (week 0) and after (week 4) the rehabilitation period as well as in week 16 and answered a mailed questionnaire in week 28. The 28-Joint Disease Activity Score (DAS28), American College of Rheumatology (ACR) response and physical tests were used to measure clinical response. RESULTS: The baseline DAS28 value 4.45 (1.16) was reduced by -0.95 (1.05) in the Mediterranean climate and the baseline DAS28 value 4.18 (1.17) was reduced by -0.37 (0.92) in the Norwegian climate at week 16 (p = 0.003). An ACR20 improvement was achieved in 25% of the patients treated in the Mediterranean climate and in 15% of those treated in the Norwegian climate. Sustained improvement in all ACR core components at week 16 and in patient's assessment of health status at week 28 was found in the patients treated in the Mediterranean climate only. Tests of physical function, the 6-Minute Walk Test (6MWT) and the Timed Up and Go (TUG), showed comparable improvements in patients treated in both climates. CONCLUSIONS: RA patients showed immediate positive effects with regard to disease activity, physical function, and symptoms during a 4-week rehabilitation programme. The effects on disease activity and symptoms were larger and better maintained at least 3 months after rehabilitation in a warm rather than in a cold climate.

Coping potential and disability--sense of coherence in adults with cerebral palsy.

PURPOSE: The aim of the present study was to investigate sense of coherence (SOC) in adults with cerebral palsy (CP) compared to the general population. METHOD: A questionnaire was sent to a representative sample of adults with CP, including the 3-item version of SOC and items on their life situation and follow-up programmes. The study included persons over 18 years of age with CP and without intellectual disability. The results were compared with the results from a reference group. RESULTS: The 406 respondents with CP (48.5% females, 51.5% males) were 18-72 years of age. The distribution of the different types of CP coincided with international epidemiological studies. Mean SOC was significantly lower in the adults with CP than in the reference group. The largest difference was found in the domain of comprehensibility. The factors most important in relation to SOC were level of education, marital status, life satisfaction and fatigue. CONCLUSIONS: Early experiences of predictability, balance between challenges and personal resources and finding these challenges worthy of investment, are prerequisites for developing sense of coherence. The present study suggests that these factors are less present in early socialization of persons with CP compared to the general population, and underlines the need for follow-up programmes that emphasize existential aspects and coping strategies.

Treatment of patients with postpolio syndrome in a warm climate.

PURPOSE: Treatment in warm climate of various patient groups including patients with postpolio syndrome is controversial. METHOD: Eighty-eight patients with postpolio syndrome (61 women) were recruited, stratified according to sex, age (above/below 60 years old) and use/not use of electrical wheelchair, and randomized to three groups. Group 1 (n=30) underwent treatment in a rehabilitation centre in Tenerife for four weeks in November/December 1999. Group 2 (n=29) were treated in two similar centres in Norway for the same period of time, while Group 3 (n=29), the control group, followed their ordinary health care programme. All patients were tested at the start of study, and 3 and 6 months later, including physical tests and several questionnaire and qualitative interviews. Patients in Group 1 and 2 were also tested after the rehabilitation period. RESULTS: Group 1 and 2 improved significantly both in physical tests and subjective ratings. The positive effects in Group 1 tended to exceed the positive effects in Group 2, and the effects lasted longer. Six minutes walking distance in the two groups was 347 m and 316 m, respectively, before the treatment period, 429 m and 362 m immediately after, and 431 m and 356 m 3 months later. Subjective rating of pain (VAS-scale) was 42 and 43, respectively, before treatment, 17 and 31 immediately after, and 28 and 44 3-months later. In the control group, only minor changes were found. CONCLUSIONS: The study seems to document a positive effect of treatment of patients with postpolio syndrome in warm climate.

Walking deterioration and gait analysis in adults with spastic bilateral cerebral palsy.

Walking deterioration occurs frequently in adults with spastic bilateral cerebral palsy (CP), but their gait characteristics are largely unknown. The study aims were (1) to compare selected gait analysis variables between those reporting and those not reporting walking deterioration, and (2) to characterise the overall gait deviations and classify the gait patterns. Participants (N=16) were recruited from a follow-up study, had spastic bilateral CP, <40 years in 2006, GMFCS levels I-III, and could walk at least 10 m without support. Eight reported walking deterioration (cases) and eight did not (controls). A theoretical framework linking work of walking, fatigue and deterioration in walking was developed. It was hypothesised that higher energy requirements during gait and larger gait deviations would be associated with deterioration in walking. Three-dimensional gait analysis was used to obtain centre of mass work, mechanical joint work, lower limb kinematics, movement analysis profile (MAP), and gait profile scores (GPS). There were no differences between the cases and controls in centre of mass work, joint work, or in the GPS. The largest MAP deviations were seen in sagittal pelvis, hip, and knee angles and foot progression. Crouch and asymmetric gait were common patterns. Walking deterioration could not be explained by these work and kinematic variables. An individual's perception of deterioration in walking is subjective, and may be experienced and interpreted differently across people. Larger, longitudinal studies on the natural history of walking in spastic CP are needed. Qualitative studies on the subjective experiences of walking deterioration are also warranted.

Effect of multilayer high-compression bandaging on ankle range of motion and oxygen cost of walking.

OBJECTIVE: To evaluate the effects of multilayer high-compression bandaging on ankle range of motion, oxygen consumption and subjective walking ability in healthy subjects. METHOD: A volunteer sample of 22 healthy subjects (10 women and 12 men; aged 67 [63-83] years) were studied. The intervention included treadmill-walking at self-selected speed with and without multilayer high-compression bandaging (Proforeº), randomly selected. The primary outcome variables were ankle range of motion, oxygen consumption and subjective walking ability. RESULTS: Total ankle range of motion decreased 4% with compression. No change in oxygen cost of walking was observed. Less than half the subjects reported that walking-shoe comfort or walking distance was negatively affected. CONCLUSION: Ankle range of motion decreased with compression but could probably be counteracted with a regular exercise programme. There were no indications that walking with compression was more exhausting than walking without. Appropriate walking shoes could seem important to secure gait efficiency when using compression garments.

Physical exercise for patients with cystic fibrosis: a review.

Cystic fibrosis (CF) is an inherited, chronic disease which mainly affects the lungs and the nutrition. Intensive treatment has gradually improved the outcome for the patients. Exercise therapy has been increasingly advocated to be included in the CF regimen. Our own studies indicate that both short-term and long-term training ameliorate the physical conditions for CF patients, that there is no danger for well-trained CF patients--both boys and girls--to take part even in vigorous, prolonged exercises, and that CF patients might have a positive attitude toward physical activities. Of course, all physical activities have to be individually designed. A review of the literature is also given: The specific ventilatory factors in CF, the limitations of exercise, the problem with exercise-induced asthma, the training effect on lung drainage, on lung function, on infections, on biochemical and hormonal variables, on nutrition and the gastrointestinal tract, on the musculoskeletal apparatus, and on the mind. Nearly all these reports are favorable for a carefully monitored, high activity in CF patients. Practical considerations for activities are given.

[Diving of patients with spinal cord injuries]. / Dykking hos pasienter med ryggmargsskade.

Three patients with traumatic spinal cord injuries of a level below Th 5 have been certified as sports divers in Norway, and an increasing number of other paraplegics and tetraplegics have shown an interest for diving. The article reviews possible complications for these patients during diving. It is concluded that diving is not unsuitable for patients with spinal cord injuries, even for tetraplegics, but these persons run greater risk of complications than healthy divers do. However, on the basis of present knowledge, we have prohibited diving to below 20 m, and patients with spinal cord injuries over Th 5 have so far been advised not to dive. All diving must be performed only after comprehensive training and adaptation.

[Patients with postpoliomyelitis syndrome in a rehabilitation hospital]. / Pasienter med postpoliosyndrom i rehabiliteringssykehus.

An increasing number of patients with suspected post-polio syndrome are referred to Sunnaas Rehabilitation Hospital. Using a case history as illustration, the article presents the model used for examination and treatment of these patients, based upon clinical observations, functional tests and comprehensive judgement by the rehabilitation team.

Postpolio syndrome: a 5 year follow-up.

The purpose of this investigation was to study subjective symptoms, medical and social situation, pulmonary function and physical work capacity during a period of 3-5 years in patients with the postpolio syndrome. We evaluated 68 patients consecutively admitted to our hospital because of postpolio syndrome, and re-evaluated 63 of the same patients 3-5 years later, 43 women and 20 men with mean age 55 +/- 10 (1 SD) years at the second evaluation. The patients answered a questionnaire about their subjective symptoms and medical and social situation, and underwent spirometry as well as symptom-limited exercise stress testing. Most patients experienced increasing symptoms and physical disability related to their polio, while the majority reported that their mental health were unchanged or improved. The lung function was in average moderately reduced of restrictive type, and only minor changes were found during the 3-5 years. A pronounced reduction in peak oxygen uptake was seen at the first evaluation, especially in women. At the second examination, peak oxygen uptake was further decreased, especially in men, more than predicted from increasing age. The patients increased their body mass index significantly during the same period. These results indicate that subjective symptoms and physical disability related to polio increased with increasing age in these patients with the post-polio syndrome, and cardiorespiratory deconditioning and weight gain also became increasing problems in most patients. However, the mental status of the patients remained stable or improved, possibly due to our comprehensive re-rehabilitation and educational programme.

[Physiotherapy after stroke--a randomized controlled trial]. / Fysioterapi etter hjerneslag--en randomisert kontrollert studie.

BACKGROUND: This study examines whether two different physiotherapy regimes used in rehabilitation after acute stroke have any differences in outcome. MATERIAL AND METHODS: A double-blind study of patients with acute first-ever stroke. 61 patients were consecutively included, block-randomized into two groups and stratified according to gender and hemispheric location. Group 1 (33 patients) received physiotherapy in the hospital's stroke unit according to the Motor Relearning Programme (MRP), group 2 (28 patients) according to the Bobath method. Supplemental treatment did not differ. The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL (Activities of Daily Living) Index, and the Nottingham Health Profile (NHP) were used as outcome measures. The following variables were also registered: length of stay in hospital, use of assistive devices for mobility, and patients' accommodation after discharge. RESULTS: Patients treated according to the MRP had shorter stays in hospital compared to those treated according to Bobath (mean 21 days vs. 34 days, p < 0.01). Both groups improved on MAS and SMES, but motor functions improved significantly better in the MPP group. Both groups improved on the Barthel Index; there were no significant differences between the groups, though women treated by MRP improved more than women treated by Bobath. There were no differences between the groups in NHP scores, use of assistive devices or accommodation after discharge. INTERPRETATION: This study indicates that physiotherapy according to the MRP is preferable to the Bobath programme in the rehabilitation of stroke patients.

Fatigue in polio survivors.

OBJECTIVES: Fatigue is commonly reported among polio survivors. The aims of the present study were to examine the incidence of perceived fatigue among a sample of Norwegian polio survivors, and to examine the association between the level of fatigue and sociodemographic and health variables. MATERIALS AND METHODS: A mailed questionnaire containing, among others, Fatigue Questionnaire, Fatigue Severity Scale, sociodemographic and health variables were sent to a representative group of 312 Norwegian polio survivors. 276 subjects (88%) answered the questionnaire. RESULTS: The incidence of fatigue among the polio survivors were considerably higher than in the normative data. Physical fatigue, more than mental fatigue, represented the major problems. Polio subjects who reported severe fatigue had significantly more other diseases and health problems than the normative group. CONCLUSIONS: The diagnosis and treatment of other or related physical conditions should be given higher priority in the management of persons with late effects of poliomyelitis, as these conditions probably can be the reasons for fatigue more than poliomyelitis sequelae alone.

[Five year follow-up of patients with postpoliomyelitis syndrome]. / Fem års etterundersøkelse av pasienter med postpoliosyndrom.

The purpose of this investigation was to study subjective symptoms, medical and social situation, pulmonary function and physical work capacity over a period of 3-5 years in patients with post-polio syndrome. We assessed a consecutive series of 68 patients admitted to our hospital because of post-polio syndrome, and re-assessed 63 of these patients 3-5 years later; 43 women and 20 men with mean age 55 +/- 10 (1 SD) years at the second evaluation. The patients answered a questionnaire about their subjective symptoms and medical and social situation, and underwent spirometry and symptom-limited exercise stress testing. Most patients experienced more serious symptoms and physical disability connected with their polio, while the majority reported that their psychological health was unchanged or had improved. Lung function was on average moderately reduced and of restrictive type, and only minor changes were found over the 3-5 years. A pronounced reduction in peak oxygen uptake was seen at the first evaluation, especially in women (59% of predicted). At the second examination, peak oxygen uptake was further reduced, especially in men, more than predicted by increasing age. The body weight and body mass index of the patients increased significantly during the same period. These results indicate that subjective symptoms and physical disability connected with polio increased with increasing age in these patients with post-polio syndrome, and cardio-respiratory deconditioning and weight gain also became more serious problems in most patients. The psychological status of the patients remained stable, however, or improved, possibly due to our comprehensive re-rehabilitation and educational programme.

[Rehabilitation with proper physical activities--what happens with patients' quality of life?]. / Rehabiliteringsopphold med tilpasset fysisk aktivitet--hva skjer med pasientenes livskvalitet?

During their rehabilitation stay at Beitostølen Healthsports Centre patients daily participate in varied forms of adapted physical activities, physiotherapy, and leisure and social activities. Support for mental and social problems is offered. A total of 189 patients were invited for quality of life assessment; 132 consented to participate, and 107 completed the investigation. Nottingham Health Profile (NHP), Life Satisfaction Scale (LiSat) and three questions regarding self-rated physical and mental health and disability were used for assessment. For NHP total score, satisfaction with life as a whole (LiSat), and questions regarding self-rated physical/mental health and disability improvements from one month before until three months after the stay were statistically significant. Improvements were also significant for subscales regarding emotional reactions, energy, pain, sleep, sexual life, family life, hobbies/interests, leisure situation and social isolation. Although this study did not include controls, the results indicate that a rehabilitation stay with adapted physical activities improves the quality of life of the patients until at least three months after the stay. Effects are probably mediated through improvement of self-efficacy.

Angina pectoris and cold.

Ten patients with angina pectoris and a history of cold intolerance performed symptom limited work tests at +18 degrees C and at -17 degrees C. At -17 degrees C the work capacity was found to be 20% lower than at +18 degrees C. In nine of the patients the work load necessary to elicit anginal pain was lower in the cold. Nitroglycerine given before cycling increased the work capacity in the cold to levels obtained in room temperature, mainly due to a decrease in the systolic blood pressure.

Cystic fibrosis patients running a marathon race.

This article presents three male marathon runners with cystic fibrosis (CF) who successfully completed the New York Marathon 1984 in warm environments in 6.10.33, 4.42.22, and 4.32.15, respectively. The characteristics of the CF patients and their companions as well as a presentation of their runs are given.

Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study.

OBJECTIVE: To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke. DESIGN: A double-blind study of patients with acute first-ever stroke. Sixty-one patients were consecutively included, block randomized into two groups, and stratified according to gender and hemiplegic site. Group 1 (33 patients) and group 2 (28 patients) had physiotherapy according to Motor Relearning Programme (MRP) and Bobath, respectively. The supplemental treatment did not differ in the two groups. MAIN OUTCOME MEASURES: The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index and the Nottingham Health Profile (NHP) were used. The following parameters were also registered: length of stay in the hospital, use of assistive devices for mobility, and the patient's accommodation after discharge from the hospital. RESULTS: Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath (mean 21 days versus 34 days, p = 0.008). Both groups improved in MAS and SMES, but the improvement in motor function was significantly better in the MRP group. The two groups improved in Barthel ADL Index without significant differences between the groups. However, women treated by MRP improved more in ADL than women treated by Bobath. There were no differences between the groups in the life quality test (NHP), use of assistive devices or accommodation after discharge from the hospital. CONCLUSION: The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients.

The successful completion of the Oslo Marathon by a patient with cystic fibrosis.

Metabolic consequences of prolonged, severe exercise were investigated in a well trained 16-year-old boy with cystic fibrosis (CF) who completed the Oslo Marathon (42 195 m). His CF was diagnosed 6 years earlier. He had minimal radiological lung changes and a maximal oxygen uptake of 63.0 ml/kg/min. Several blood, urine and lung function parameters as well as body weight, fluid intake and rectal temperature were measured. None of the findings differed from those reported in healthy marathoners. Interestingly, no changes were found in the serum concentrations of electrolytes.

Cross-country skiing in coronary patients.

Since 1979, 33 coronary patients have participated altogether 52 times in the Ridderrenn, a 22 km cross-country ski race for handicapped persons. No complications occurred during the races. The authors conclude that cross-country skiing as a recreational activity can be enjoyed by many coronary patients, provided that extremes of cold and high-intensity exercise are avoided.

[Urinary problems among patients with stroke. Are these problems underestimated?]. / Vannlatingsproblemer hos hjerneslagpasienter. Blir problemene viet nok oppmerksomhet?

The article, based on a survey and a study of the literature, focuses on the problems of urinary disorders in patients who have suffered a stroke. The incidence of incontinence and other urination disorders was studied upon admission and six weeks later in ten stroke patients admitted consecutively to a hospital for rehabilitation. The results of the present study agreed with those of other studies, indicating that urination disorders, especially motoric urge incontinence, are common among stroke patients. The literature indicates that urinary incontinence has a negative influence on the rehabilitation process. Therefore the rehabilitation team should be particularly aware of such problems, and carry out both diagnostic and therapeutic procedures.