Cecily Partridge

A Review of Low Level Laser Therapy: Part I: Background, Physiological Effects and Hazards

Summary Therapeutic laser is a relatively new method of electrical treatment available to therapists in Great Britain; it has been in use in Eastern Europe, however, for thirty years. Much early work was unsatisfactory, reports often being anecdotal and lacking detail. Recent years have shown a significant increase in the quality and volume of work in this area; the physical behaviour and physiological effects of laser are considered and the possible hazards reviewed in this paper.

Review article : Physiotherapy in the rehabilitation of stroke: a review

The treatment of patients disabled by stroke is a major work commitment in rehabilitation units. Studiesl,2 show that 96% and 79% of patients, admitted to hospital with a stroke, have physiotherapy or occupational therapy, or both. However, the amount of time spent in such activity is limited. It has been reported3,4 that stroke patients in a typical British general hospital spend much of their time inactive sitting on wards.

RECOVERY FROM PHYSICAL DISABILITY AFTER STROKE: NORMAL PATTERNS AS A BASIS FOR EVALUATION

In 368 patients with residual hemiplegia after stroke, monitoring of recovery over eight weeks showed a distinct time-related pattern. Patterns of this sort could provide useful baselines in various conditions entailing physical disability, allowing comparison of individual scores with the average for that phase of the illness, the setting of precise goals, and the examination of factors that influence recovery.

Shoulder pain in hemiplegia—a literature review

Shoulder pain in patients with hemiplegia is a common phenomenon which may impede the process of rehabilitation. Reports of its incidence and prevalence vary widely, possibly due to selective sampling and to a lack of a clear definition of shoulder pain. Many authors acknowledge that its real causes have not yet been clearly identified. A variety of possible causes have been suggested in the literature, often based on clinical observations, rationale and/or correlational studies, but few objective studies have been found to document its aetiology, quantity, characteristics and localisation. Shoulder pain in hemiplegia is thought by some to be entirely preventable by paying attention to the biomechanical aspects of the hemiplegic shoulder. Numerous treatment approaches to shoulder pain have been reported, but they are rarely accompanied by any scientific evidence of their effectiveness. Clear objective information, collected with a sound methodology is needed about all aspects concerned.

Review of Shortwave Diathermy Continuous and Pulsed Patters

Summary Both continuous and pulsed forms of shortwave diathermy (SWD) are used by physiotherapists in the treatment of a range of conditions including soft tissue lesions and the arthritises. The known physiological effects, clinical efficacy and hazards associated with the use of these two forms of SWD are considered and the need for further research both in the field of basic science and clinical application is highlighted.

Characteristics of the Forced Expiration Technique

Summary The forced expiration technique (FET) has been misinterpreted in many parts of the world. Work was undertaken to clarify definitions and identify the characteristics of an effective and an ineffective technique. Senior clinicians experienced in respiratory care and representatives of the Centre for Physiotherapy Research came together and items characterising effective and ineffective FET were decided on by the clinicians. Their definitions were sent to a random sample of physiotherapists in Britain and to a few overseas. The opinions of these 150 physiotherapists were taken into account in providing the final definitions of the characteristics of effective and ineffective huffing and breathing control. It is hoped that these clear definitions will encourage good practice. It is suggested that this model could be used in other areas of physiotherapy practice where agreed definitions are so often lacking.

Treatment Schedules for Research A Model for Physiotherapy

Summary Recognition of the lack of appropriate methods of standardising physiotherapy for clinical trials led to the development of inclusive treatment schedules for use in research. The aim of the schedules is to provide a range of techniques which reflect current clinical practice so that the physiotherapists can use their clinical judgement in the treatment situation, yet be able to record what has been done. Development of the schedules is based on the literature about the technique to be used, and peer agreement of suitable experienced physiotherapists. Information is provided about the development of two schedules for a clinical trial of physiotherapy for hemiplegic shoulder pain, using the Bobath approach and cryotherapy. It is suggested that this concept could be used in other studies evaluating physiotherapy treatment and management.

Recovery from physical disability after stroke: profiles for different levels of starting severity

This study aimed to follow up a preliminary study and collect further information about the profiles of recovery from physical disabilities of people who had suffered a stroke. Prospective monitoring of 348 patients with stroke referred to physiotherapy in health districts throughout the UK was undertaken for a six-week period and a distinct time-related pattern of recovery from disability was again found. Significant differences related to age were identified, but were not found in relation either to side of stroke or sex. These profiles of recovery, together with earlier work monitoring recovery in 368 patients with stroke, provide important information not previously available about indices of recovery directly related to phsyiotherapy. A database on over 700 patients is now available, and can be used to monitor any changes which occur as a result of interventions by therapists. It is also suggested that the development of recovery curves may be a useful way of monitoring quality of care in the physiotherapy treatment and management of a number of conditions involving physical disability.

Recovery Curves as a Basis for Evaluation

Summary It is suggested that recovery curves could be developed by collecting information about the timed recovery from the physical disability of different conditions. Data were collected from 368 patients who had suffered a stroke, noting the time taken to regain specific predetermined milestones. There were 16 items of performance of movement central to the disability of stroke. The data showed distinct time-related patterns of recovery for patients of different levels of starting severity. This method of monitoring patterns of recovery in substantial numbers of patients with conditions involving physical disability could be used as a basis against which recovery of patients with similar conditions, but receiving different methods of treatment and evaluation, could be compared and evaluated.

Adverse Effects of Electrotherapy Used by Physiotherapists

A system was set up to collect reports of adverse effects on patients receiving electrotherapy from physiotherapists in NHS hospitals in England and Wales. Report cards were circulated to 200 hospital departments and 148 completed forms were returned over an 18-month period. There were reports of local effects such as burns and rashes and increased pain (87); and general effects such as nausea and fainting (98). A number of different agents were implicated but the largest number of reports were related to the use of interferential. These results, though not enough to demonstrate a causal link, are of concern and suggest caution in the use of some agents in vulnerable patients. A small number of patients (5) with neurological conditions reported serious side effects and because of this a survey of 1 in 10 members of the Association of Chartered Physiotherapists with an Interest in Neurology was undertaken. The results showed that members rarely used the physical agents implicated in the reports of adverse effects in this study, and they recommended caution in their use with neurological patients. For patient safety and best practice more information needs to be collected in a systematic way about the occurrence of adverse side effects of electrotherapy used by physiotherapists.