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Monday, 26 December 2011

Physical Function Following Hip Replacement Surgery Improved By Walking Skills Program

Researchers in Norway report that patients who receive walking skills training following total hip arthroplasty for osteoarthritis show improved physical function. The physical therapy program displayed a positive effect on walking distance and stair climbing which continued 12 months following hip replacement surgery. Results of the study appear in Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR). 

Osteoarthritis (OA) is a joint disease where loss of cartilage in affected joints such as the knees, hips, fingers or spine causes pain and stiffness that can be disabling. In some cases, the only treatment option for OA is total replacement of the joint, known as arthroplasty. The World Health Organization (WHO) estimates that 10% of men and 18% of women 60 years of age and older suffer from OA. In the U.S., the National Hospital Discharge Survey reported that 230,000 Americans had hip replacement surgery in 2007.


Thursday, 22 December 2011

New stroke therapy shows promise on kids

Using non-invasive electronic stimulation, coupled with occupational therapy, researchers say they are hoping kids can increase hand function.

s it possible to experience elation putting in your own ponytail or firmly shaking hands with a stranger?
Just look at Maddy Evans' beaming face for the answer. Maddy, 16, completed a study at the University of Minnesota and Gillette Children's Specialty Healthcare, using a combination of brain stimulation and occupational therapy to help children who have had a stroke increase their hand function. Maddy now buttons her coat with both hands, can put in her own ponytail and, yes, reaches for a stranger's hand with her right one. She never used to use her right hand.
"It helped. If anything, it helped with my confidence," the 16-year-old from Lakeville said in an interview last week. "I'm using it a lot more than I used to."
The new stimulation therapy uses a noninvasive magnetic field on the healthy side of the brain. Gillette, with 2010 revenue of $164 million, has a long history of innovation in pediatric medicine.
But what the folks who ran the study cannot say yet is whether the therapy is boosting gains children achieve from occupational therapy. They need 30 children between the ages of 8 and 16 to complete the study. Seventeen children have completed it; 13 more are needed by August 2012, when funding runs out.

Thursday, 15 December 2011

Moderate exercise such as walking 'boosts memory power'

Walking for 40 minutes a few times a week is enough to preserve memory and keep ageing brains on top form, research shows.
Moderate exercise increased the size of the hippocampus, an area of the brain that makes memories, in 120 volunteers.
The year-long trial, published in Proceedings of the National Academy of Sciences, showed performance on memory tests also improved.
Exercise may buffer against dementia as well as age-related memory loss.
The latest work looked at healthy people in their 60s rather than people with Alzheimer's or other forms of dementia.
But the findings have important implications for ageing societies faced with a dementia time bomb.

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Even modest exercise may improve memory and help protect the brain from normal decline caused by ageing”
Dr Simon Ridley of the Alzheimer's Research Trust
In the UK, 820,000 people have dementia, and this figure is set to double by 2030.
Until a cure is discovered, finding cheap and simple ways to reverse this trend is imperative, say experts.
Little and often
Professor Kirk Erickson and colleagues from the University of Pittsburgh in the US set out to investigate the impact that even moderate exercise might have on preserving memory.
They split their 120 volunteers into two groups. One group was asked to begin an exercise regimen of walking around a track for 40 minutes a day, three days a week, while the others were limited to doing simple stretching and toning exercises.
Brain scans and memory tests were performed at the start of the study, halfway through the study and again at the end.
Scans revealed hippocampus volume increased by around 2% in people who did regular aerobic exercise. The same region of the brain decreased in volume by 1.4% in those who did stretching exercises, consistent with the decrease seen in normal ageing.
Both groups showed some improvement over time on memory tests. In the walking group, the improvement appeared to be linked with increased size of the hippocampus.
Professor Erickson said: "We think of the atrophy of the hippocampus in later life as almost inevitable. But we've shown that even moderate exercise for one year can increase the size of that structure.
"The brain at that stage remains modifiable."
Dr Simon Ridley of the Alzheimer's Research Trust said that although the study does not look at memory loss in Alzheimer's or dementia, it suggests "it's never too late to start exercising to help keep our brains healthy".
"Even modest exercise may improve memory and help protect the brain from normal decline caused by ageing.
"Increasing evidence suggests regular exercise and a healthy diet may help reduce our risk of developing dementia as well as reaping numerous other benefits from living a healthy lifestyle."

Wednesday, 14 December 2011

Brain changes seen in cabbies who take 'The Knowledge'

The structure of a London taxi driver's brain changes during the gruelling process of learning the quickest way around the capital, scans reveal.
Dozens of trainee drivers had MRI scans before and after they acquired "The Knowledge", memorising hundreds of journeys and street names.
The University College London team, writing in Current Biology, found brain parts linked to memory grew bigger.
They said it proved the brain could adapt to new tasks, even in adulthood.
'Plastic' brains
Earlier studies of the brain of the cabbie had already noted the increase in "grey matter" in the hippocampus, an area found at the base of the brain.
However this research tried to work out if the change had happened during the intensive learning period prior to starting work, or on the job itself.
They scanned a total of 79 trainees, just before they started to learn the "All-London" Knowledge, which can take between two and four years to complete.

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This offers encouragement for adults who want to learn new skills later in life”
Prof Eleanor Maguire,UCL
Would-be taxi drivers have to learn 320 routes within a six mile radius of Charing Cross, which covers a mind-boggling 25,000 streets and 20,000 landmarks and places of interest.
Throughout the process, any changes to their brains were mapped by regular MRI scans.
Compared with similar scans from non-taxi drivers, those who had attempted the Knowledge had increased the size of the posterior hippocampus - the rear section of the hippocampus which lies at the front of the brain.
As would be expected, they were better at memory tasks involving London landmarks than the non-cabbies, but this advantage appeared to come at a price, as the non-cabbies outperformed them in other memory tasks, such as recalling complex visual information.
Prof Eleanor Maguire, who led the study, said: "The human brain remains 'plastic', even in adult life, allowing it to adapt when we learn new tasks.
"By following the trainee taxi drivers over time as they acquired - or failed to acquire - the Knowledge, a uniquely challenging spatial memory task, we have seen directly and within individuals how the structure of the hippocampus can change with external stimulation.
"This offers encouragement for adults who want to learn new skills later in life."
The reasons why the brain was able to adapt remain unclear, although the hippocampus is one of the few areas of the brain in which new cells can grow.
Dr John Williams, head of neuroscience and mental health at the Wellcome Trust, which helped fund the research, said: "Only a few studies have shown direct evidence for plasticity in the adult human brain related to vital functions such as memory, so this new work makes an important contribution."

Tuesday, 13 December 2011

Chronic fatigue syndrome 'affects one in 100 pupils'

By James Gallagher Health reporter, BBC News

One in 100 secondary school pupils could be missing classes because of chronic fatigue syndrome, also known as Myalgic Encephalomyelitis (ME), say researchers.
A study following 2,855 pupils at three schools, published in the online journal BMJ Open, found 28 missed school with chronic fatigue syndrome.
The researchers said the effect was "potentially devastating".
A charity said the true figure was likely to be even higher.
The cause of chronic fatigue syndrome is unknown and there is no known cure. It is a medical condition rather than just schoolchildren staying up too late. It results in extreme tiredness as well as problems with memory and concentration.
The researchers looked at every pupil between the age of 11 and 16 at three secondary schools in Bath. The 461 pupils who were absent for at least a day a week in a six-week term were investigated further.
Five had already been diagnosed with chronic fatigue and a further 23 cases were identified.

Friday, 9 December 2011

Yoga Eases Back Pain in Largest U.S. Yoga Study to Date

ScienceDaily (Oct. 24, 2011) — Yoga classes were linked to better back-related function and diminished symptoms from chronic low back pain in the largest U.S. randomized controlled trial of yoga to date, published by the Archives of Internal Medicine as an "Online First" article on October 24. But so were intensive stretching classes.

"We found yoga classes more effective than a self-care book -- but no more effective than stretching classes," said study leader Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. Back-related function was better and symptoms were diminished with yoga at 12 weeks; and clinically important benefits, including less use of pain medications, lasted at least six months for both yoga and stretching, with thorough follow-up of more than nine in 10 participants.
In the trial, 228 adults in six cities in western Washington state were randomly assigned to 12 weekly 75-minute classes of either yoga or stretching exercises or a comprehensive self-care book calledThe Back Pain Helpbook. Nine in 10 of them were primary-care patients at Group Health Cooperative. Participants in the trial typically had moderate -- not severe -- back pain and relatively good mental health, and most had been at least somewhat active before the trial started.
The class participants received instructional videos and were encouraged to practice at home for 20 minutes a day between their weekly classes. Interviewers who didn't know the patients' treatment assignments assessed their back-related function and pain symptoms at six weeks, 12 weeks, and six months.
In 2005, Dr. Sherman and her colleagues conducted a smaller study that found yoga effective for easing chronic low back pain. "In our new trial," she said, "we wanted both to confirm those results in a larger group and to see how yoga compared to a different form of exercise of comparable physical exertion: stretching.
Both the yoga and stretching classes emphasized the torso and legs:
  • The type of yoga used in the trial, called viniyoga, adapts the principles of yoga for each individual and physical condition, with modifications for people with physical limitations. The yoga classes also used breathing exercises, with a deep relaxation at the end.
  • The stretching classes used 15 different stretching exercises, including stretches of the hamstrings and hip flexors and rotators. Each was held for a minute and repeated once, for a total of 52 minutes of stretching. Strengthening exercises were also included.
"We expected back pain to ease more with yoga than with stretching, so our findings surprised us," Dr. Sherman said. "The most straightforward interpretation of our findings would be that yoga's benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles."
But the stretching classes included a lot more stretching than in most such classes, with each stretch held for a relatively long time. "People may have actually begun to relax more in the stretching classes than they would in a typical exercise class," she added. "In retrospect, we realized that these stretching classes were a bit more like yoga than a more typical exercise program would be." So the trial might have compared rather similar programs with each other.
"Our results suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain," Dr. Sherman concluded. "But it's important for the classes to be therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants' individual physical limitations."
In an invited commentary, Timothy S. Carey, MD, MPH, of the University of North Carolina, Chapel Hill, called Dr. Sherman's study "an excellent example of a pragmatic comparative effectiveness trial," noting that the Institute of Medicine has identified chronic back pain as a priority condition for such studies.
The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, funded the trial.
Dr. Sherman's coauthors were Daniel C. Cherkin, PhD, Robert D. Wellman, MS, Andrea J. Cook, PhD, Rene J. Hawkes, and Kristin Delaney, MPH, of Group Health Institute; and Richard A. Deyo, MD, MPH, of Oregon Health and Science University in Portland. Drs. Sherman, Cherkin, and Cook are also on the faculty of the University of Washington School of Public Health

Tuesday, 6 December 2011

Language Skills In Stroke Patients Improve With Magnetic Treatment

A study by The University of Queensland has revealed that language skills of individuals who survived a stroke with aphasia could be improved with magnetic stimulation of the brain. The study was conducted by Dr. Caroline Barwood, who recently completed her PhD at the University of Queensland School of Health and Rehabilitation Sciences. Barwood discovered that the language skills of stroke patients following Transcranial Magnetic Stimulation (TMS) were significantly improved. 

TMS is a non-invasive technique that aims to target activity in the brain in order to help restructuring brain areas with the goal of changing language behaviors. 

Monday, 28 November 2011

High blood pressure increases risk of cognitive decline

Published 7 November 2011
Vascular risk factors, including high blood pressure and signs of heart disease, increase your chance of developing cognitive problems according to a study published in Neurology on 7 November.
Since 2003 researchers in the United States have been following more than 30,000 people aged 45 and older to track their risk of stroke and monitor their cognitive health.
Existing evidence shows that stroke increases the risk of cognitive decline anddementia. However, this study reveals that people who have not experienced a stroke are still at increased risk if they have vascular risk factors.
Alzheimer's Society comment:
'We've known for some time that high blood pressure increases your chances ofdeveloping dementia. High blood pressure narrows the blood vessels making it harder for blood to reach the brain which restricts oxygen and kills brain cells. This study adds weight to the fact that high blood pressure must be treated early, even if the condition is not so severe as to lead to a stroke. We estimate that effective treatment could reduce the number of people dying from dementia by 15,000 a year.
'Having a low salt diet, maintaining a healthy weight, taking regular exercise and regulating your alcohol intake can help. If you are over 40 with a family history of dementia or cardiovascular disease you should get your blood pressure and cholesterol checked regularly.'
Dr Anne Corbett
Research Manager
Alzheimer's Society
Research Reference: Unverzagt FW et al. "Vascular Risk Factors and Cognitive Impairment in a Stroke-free Cohort." Neurology, Nov. 8, 2011, Vol. 77 (19), p. 1729

Saturday, 26 November 2011

Study suggests link between early Alzheimer's disease and low body mass index (BMI)

Published 22 November 2011
People in the earliest stages of Alzheimer's disease may be more likely to have a lower body mass index according to a study published in Neurology (Monday 21 November 2011).
Scientists at the Department of Neurology and School of Medicine, University of Kansas Medical Centre, used advanced brain imaging techniques and analyses of cerebrospinal fluid to look for biomarkers for Alzheimer's disease in 506 people.
The study found that people with a low BMI were more likely to have biomarkers forAlzheimer's disease, whether they had mild cognitive impairment or not.
Alzheimer's Society comment:
'As yet it is unclear whether a low BMI is actually part of Alzheimer's, or a side effect caused by the disease. Although this study shows a link between it and changes in the brain common to Alzheimer's, there was no association between BMI and symptoms of the disease such as memory loss. More work is needed before we can say if these findings could be used to develop better ways ofdiagnosing the early stages of the condition.
What we do know is that living well will reduce your risk of developing Alzheimer's disease. Alzheimer's Society recommends people eat healthily and exercise regularly.'

Dr Anne Corbett
Research Manager
Alzheimer's Society
Research Reference:
Alzheimer disease biomarkers are associated with body mass index by J.M Burns et al in NEUROLOGY® the medical journal of the American Academy of Neurology.

How can musicians keep playing despite amnesia?

Scientists are trying to understand how amnesiacs can lose all memory of their past life - and yet remember music. The answer may be that musical memories are stored in a special part of the brain.

When British conductor and musician Clive Wearing contracted a brain infection in 1985 he was left with a memory span of only 10 seconds.
The infection - herpes encephalitis - left him unable to recognise people he had seen or remember things that had been said just moments earlier.
But despite being acknowledged by doctors as having one of the most severe cases of amnesia ever, his musical ability and much of his musical memory was intact.
Now aged 73, he is still able to read music and play the piano and once even conducted his former choir again.
Now researchers believe they are closer to understanding how musical memory is preserved in some people - even when they can remember almost nothing of their past.
At a Society for Neuroscience meeting in Washington this month, a group of German neurologists described the case of a professional cellist, referred to as PM, who contracted herpes encephalitis virus in 2005.
He was unable to retain even simple information, such as the layout of his apartment.
But Dr Carsten Finke of Charite University Hospital in Berlin says he was "astonished" that the cellist's musical memory was largely intact and that he was still able to play his instrument.
The brain's medial temporal lobes, which are largely destroyed by severe cases of herpes encephalitis are "highly relevant" for remembering things such as facts and how, where and when an event happened.
"But this case and also the Clive Wearing case suggest that musical memory seems to be stored independently of the medial temporal lobes," Dr Finke says.

Monday, 21 November 2011

Financial Aid for Study Online for Developing Countries, University of Manchester

Distance Learning Scholarships for International Students from Developing Countries 2012, University of Manchester, UK. Scholarship for Study by Distance Learning starting Jan 2012

Course: MSc Management and Information Systems, University of Manchester, UK
Study Type: Online
Brief Scholarship Description: The School of Environment and Development invites applications for a fully-funded scholarship for candidates from developing countries for Master’s study by distance learning on our MSc Management & Information Systems.
The scholarship will cover all study costs including tuition and examining fees and course material costs.
MSc Management and Information Systems
The MSc in M&IS develops the “hybrid” mix of management and information systems skills that we know from experience is essential to the successful and strategic application of information and communication technologies by today’s organisations. Follow this link for full details of the MSc Management and Information Systems: Change and Development by Distance Learning programme.
Who can Apply?
The scholarships are intended to support students from developing countries who would not otherwise be able to study for a UK qualification. Applicants should:
# Applicants must not have previously studied abroad;
# Be a national of and resident in a developing country of Africa, Asia, the Caribbean, Latin America or Oceania;
# Have at least two years’ work experience in a post relevant to their MSc M&IS studies;
# Hold a UK Second Class Honours, Upper Division, or above, or its international equivalent, in their Bachelor’s degree. To verify the equivalency of international qualifications applicants should refer to information on the University’s website at:
Applicants must also not have previously studied in a developed country (short/language courses excluded).
How to apply:
You can apply online here.
Important: You must follow Step 1, 2 and 3 to complete your application described on this page.
About University of Manchester:
Based on any analysis of the results, Manchester emerges amongst the country’s top four or five major research universities and is proving competitive with the University College London and Imperial College and just behind Oxford and Cambridge. The University of Manchester, which is renowned for excellence in both teaching and research, combines a rich academic heritage with innovative plans for the future.

Read more: Financial Aid for Study Online for Developing Countries, University of Manchester, UK : College Scholarships, PhD Scholarships, Postdoctoral, Graduate International Scholarships Fellowships 

Tuesday, 15 November 2011

Attention runners: Increase speed and power while preventing injury

Whether your sport is soccer, basketball, lacrosse, tennis, football, baseball or track and field improving your speed, power and agility will make you a better player. Recent studies have shown that plyometric exercises can help to improve all of these elements. Beyond this, this type of exercise can also help to prevent an injury of the lower extremity.

Plyometric exercise involves a rapid muscle lengthening movement (eccentric phase), followed by a short resting phase (amortization phase), and then an explosive muscle shortening movement (concentric phase). Overall, plyometric movements help to train our fast twitch muscles (muscle fibers involved in short bursts of speed), which are responsible for quickness, agility, and power.

Plyometric exercise also improves the reaction time of muscles around a given joint. This increased reaction time of muscle contraction helps to prevent injury of the ankle, knee, and hip.

Wednesday, 9 November 2011

Omega-3 Fatty Acids Shown To Prevent Or Slow Progression Of Osteoarthritis

New research has shown for the first time that omega-3 in fish oil could "substantially and significantly" reduce the signs and symptoms of osteoarthritis. 

According to the University of Bristol study, funded by Arthritis Research UK and published in the journal Osteoarthritis and Cartilage, omega-3-rich diets fed to guinea pigs, which naturally develop osteoarthritis, reduced disease by 50 per cent compared to a standard diet. 

The research is a major step forward in showing that omega-3 fatty acids, either sourced from fish oil or flax oil, may help to slow down the progression of osteoarthritis, or even prevent it occurring, confirming anecdotal reports and "old wives' tales" about the benefits of fish oil for joint health. 

Measuring Quality Of Life Important In Cancer Survival Research

Cancer survival studies should treat questions about how well people are surviving with the same importance as how long: putting quality of life on an equal footing with survival years, say researchers writing in a scientific journal this month.

Effective and reliable quality of life measures offer increasingly valuable information for cancer patients and their doctors when they discuss treatment options, their potential consequences and the likely rehabilitation needs, write Drs Paul B. Jacobsen and Heather S. Jim, of the Department of Health Outcomes and Behavior at the Moffitt Cancer Center in Tampa, Florida, in the October issue of Cancer Epidemiology, Biomarkers and Prevention.

Quality of life is often as keenly discussed as cancer survival in years, and has a number of important applications in research on cancer survivorship. 

But just how to measure quality of life for cancer survivors is still being developed, say the authors, who give an overview of how quality of life is defined and constructed as a scientific measure, and the ways it is commonly used in research involving adult cancer survivors.

In conclusion, they offer several priorities for future research, including how quality of life should be measured, in whom, and how such measures should be used by clinicians caring for cancer survivors.
Read full article:

Saturday, 5 November 2011

Manual Wheelchair Use, Exercise, And Calorie Burning

A person who uses a manual wheelchair can burn up to 120 calories in half an hour while wheeling at 2 mph on a flat surface, which is three times as much as someone doing the same action in a motorized wheelchair. 

The same person can expend 127 calories while mopping and as much as 258 calories while fencing in a thirty-minute timeframe if the activities are done in a manual wheelchair. 

This is according to a review article written by Professor David R. Bassett Jr. of the Department of Kinesiology, Recreation, and Sport Studies at the University of Tennessee, Knoxville. It calculates the calorie costs of various physical activities for people who use manual wheelchairs and summarizes them into a single source - a first of its kind. 

The article, which Bassett co-authored with former UT graduate student Scott A. Conger, was published this month in Adapted Physical Activity Quarterly, a journal issued by Human Kinetics Inc. 
Read full article:

Sunday, 30 October 2011

Palpation: Is It Necessary?

 Palpation is the act of examining by touch to help diagnose illness or disease in people.  Physical therapists often use palpation to help decide on the best treatment strategy for their patients.
Palpation can be used to feel muscles, tendons, bones or ligaments to test for trigger points, hypermobility, or hypomobility.  Sometimes palpating tissue can detect warmth, indicating possible inflammation or infection.    In the evaluation and treatment of low back pain, palpation is often used to assess spinal segmental motion and pain over various structures in the back.
But is the information gathered by palpating a body part reliable?
Most published studies indicate that the answer is "no."
A study in the Journal of Manipulative and Physiological Therapeutics investigated the inter-rater reliability of spinal palpation for lumbar segmental mobility and pain provocation.  Two clinicians palpated spinal segments and sacroiliac joints of 39 patients and independently assessed pain provocation, segmental mobility, and instability.
The findings: there was poor inter-rater agreement for spinal segmental motion testing.  In fact, the statistical results indicated negative kappa coefficients.  Here's the skinny on kappa: When two people are rating something, a kappa value equal to 1 means they are in agreement and very little chance is involved.  A kappa value equal to 0 means that there is no agreement between the raters other than what is expected by chance.
A negative kappa value pretty much means that you could flip a coin to assess spinal segmental motion and do better than palpation as an assessment.
For those of you keeping score:  in the study, pain provocation kappa values ranged from .21 to .73 and instability testing was .54.  Not great reliability, but not too bad either.
What does this all mean?  It means that if you have low back pain and your physical therapist palpates your back and finds hypermobility, another therapist may find hypomobility.  Palpation is just not a great tool to assess the condition of your back and make clinical decisions.  Any information gathered from palpation should be considered, but considered lightly.  Other tests and measures, like range of motion, repeated motion testing, and strength are more reliable.

Meninges Is Source Of Self-Renewing Stem Cells, Potential For Spinal Cord Injury Treatment

In a study published in STEM CELLS, Italian and Spanish scientists have provided the first evidence to show that meninges, the membrane which envelops the central nervous system, is a potential source of self-renewing stem cells. Whilst studying the use of stem cells for treating spinal cord injuries, the researchers learnt to understand cell activation in central nervous system injuries, enabling research to advance into new treatments for spinal injuries and degenerative brain disorders. 

Wednesday, 26 October 2011

World OT Day

The World Federation of Occupational Therapists (WFOT) launched World Occupational Therapy Day in 2010.  This important day is celebrated annually on October 27, 2011. World OT Day is fast approaching and I encourage you to take this opportunity to get involved.

World Occupational Therapy Day - 24 hour Virtual Exchange - A group of six occupational therapists (Susan Burwash, Merrolee Penman, Angela Hook, Sarah Bodell, Anita Hamilton and Karen Jacobs) who are passionate about using online technology will again host a free 24 hour virtual exchange in celebration of World Occupational Therapy Day. For more information, please visit: or follow them on Twitter: @OTVirtualExchng  or hashtag #OT24vx

Playing Computer Games Helps Parkinson's Patients

More than half of the people with Parkinson's disease who took part in a small pilot study led by the University of California - San Francisco (UCSF) School of Nursing and Red Hill Studios showed small improvements in walking speed, balance and stride length after three months of playing computer-based physical therapy games.

A UCSF press release dated 19 October describes how the specialized games are not like off-the-shelf computer games. They have been designed to encourage scientifically tested physical movements to help people whose motor skills have been affected, for instance as in Parkinson's disease.


Tuesday, 18 October 2011

Cognitive Rehabilitation Therapy May Be Beneficial For Treating Traumatic Brain Injury

Cognitive Rehabilitation Therapy May Be Beneficial For Treating Traumatic Brain Injury, But Further Research Needed

There is some evidence about the potential value of cognitive rehabilitation therapy (CRT) for treating traumatic brain injury(TBI), but overall it is not sufficient to develop definitive guidelines on how to apply these therapies and to determine which type of CRT will work best for a particular patient, says a new report from the Institute of Medicine.

Research has yielded promising data on the effectiveness of some forms of CRT for helping patients with TBI, but the majority of the evidence is limited due to methodological shortcomings in the studies and challenges in studying the use of CRT in this patient population, said the committee that wrote the report. Obtaining the necessary evidence requires improvements to the way those data are collected and standardization of the terms used to describe these personalized therapies and their outcomes. 


No Benefit of Occupational Therapy After Wrist Fracture

No Benefit of Occupational Therapy After Wrist Fracture

Last Updated: October 13, 2011.

For patients with an unstable distal radial fracture treated with open reduction and volar locking plate fixation, surgeon-directed independent exercises, but not those under supervision of an occupational therapist, improve average motion and disability score of the wrist, according to a study published in the Oct. 5 issue of The Journal of Bone & Joint Surgery.

THURSDAY, Oct. 13 (HealthDay News) -- For patients with an unstable distal radial fracture treated with open reduction and volar locking plate fixation, surgeon-directed independent exercises, but not those under supervision of an occupational therapist, improve average motion and disability score of the wrist, according to a study published in the Oct. 5 issue of The Journal of Bone & Joint Surgery.
J. Sebastiaan Souer, M.D., from the Massachusetts General Hospital in Boston, and colleagues investigated whether wrist function and arm-specific disability six months after open reduction and volar plate fixation of 94 unstable distal radial fractures differed in patients who received occupational therapist-supervised exercises or surgeon-directed independent exercises. Combined wrist flexion and extension were measured six months after surgery. Wrist motion, grip strength, Gartland and Werley scores, Mayo wrist scores, and Disabilities of Arm, Shoulder and Hand (DASH) scores were measured at three and six months after surgery.
The investigators found that the mean arc of wrist flexion and extension six months after surgery was significantly improved in those patients prescribed independent exercises. A significant difference was observed in mean pinch strength, grip strength, and Gartland and Werley score at three months after surgery, and in the mean results of wrist extension, ulnar deviation, supination, grip strength, and Mayo score at six months after surgery, and favored independent exercises. No differences were found in the DASH score at any time point.
"Prescription of formal occupational therapy does not improve the average motion or disability score after volar locking plate fixation of a fracture of the distal part of the radius," the authors write.
One or more of the study authors disclosed a financial relationship with the biomedical industry.


Thursday, 13 October 2011

Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation.

Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation.


School of Psychology, Applied Cognitive Neuroscience Research Centre, Griffith University, Brisbane, Australia.



To investigate the clinical utility of the Canadian Occupational Performance Measure (COPM) for community-based individuals with acquired brain injury (ABI).


Thirty-four individuals with ABI (M = 5.32 years post-injury, SD = 3.92) were administered the COPM with self- and relative ratings of performance and satisfaction obtained. Relatives completed the Brain Injury Community Rehabilitation Outcome 39 (BICRO-39) scales. Measures of awareness of deficits, emotional status and cognitive function were obtained. A sub-group of participants was randomly allocated into a no-intervention group (n = 15) or an 8-week treatment group (n = 10). Initial assessments and 8-week follow-up assessments were conducted.


A pre- and post-assessment comparison for the treatment group identified a significant improvement on most COPM ratings (p < 0.05), but not the BICRO-39 (p > 0.05). However, self-ratings of satisfaction improved for the no-intervention group (p < 0.05). Self-ratings of satisfaction were significantly correlated with anxiety (r = -0.42, p < 0.05), although there were no other significant associations between COPM ratings and awareness, mood state and cognitive function.


The findings generally support the utility of the COPM in community-based rehabilitation; however, the need for self-ratings to be interpreted in the context of other outcome indicators is recommended.

[PubMed - indexed for MEDLINE]


Occupational therapy and achievement of self-identified goals

Occupational therapy and achievement of self-identified goals by adults with acquired brain injury: phase II.


Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Massachusetts 02215, USA.



The purpose of this study was to investigate the association between participation in goal-specific outpatient occupational therapy and improvement in self-identified goals in adults with acquired brain injury.


Thirty-one persons with traumatic brain injury of mixed chronicity participated at three sites located in different regions of the United States. Using a repeated-measures design, therapy that usually was offered at each site to achieve specific goals was followed by a no-treatment period. Participants completed the Canadian Occupational PerFormance Measure Performance subscale (COPM-P) and Satisfaction subscale (COPM-S), and the Community Integration Questionnaire (CIQ) at admission, discharge, and 1 to 18 weeks after discharge. Goal attainment scales were developed at admission and scored at discharge; the differences for each site were tested, using dependent t tests. Gains for the treatment period (admission to discharge) in COPM subscales and the CIQ were compared with gains during the no-treatment period (discharge to follow-up) for each site, using dependent t tests. The results were synthesized meta-analytically across the sites.


The participants identified a total of 149 goals, 81% of which were achieved. Goal attainment T scores improved significantly (Z = 7.52, p < .001), and the combined effect size was large (r = .94). The COPM-P (Z = 4.13, p < .001) and COPM-S (Z = 4.25, p < .001) showed significantly greater gains during the treatment (average 15.3 weeks) versus the no-treatment (average 9.9 weeks) period. Effect size estimates were large: .71 and .76, respectively. Gain scores of the CIQ did not differ significantly (Z = .75, p = .22, r = .29) between periods.


Participation in goal-specific outpatient occupational therapy that focused on teaching compensatory strategies was strongly associated with achievement of self-identified goals and reduction of disability in adults with mild to moderate brain injury.

[PubMed - indexed for MEDLINE]