Dl McLellan

The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury:

Objective: To develop a behavioural assessment based on observations of patients recovering after severe head injury whereby data could be collected by observation and by testing everyday tasks. Design: A prospective observational study of a cohort of 88 consecutive hospital admissions with severe head injury. Setting: Two district general hospitals in the UK. Patients: Eighty-eight consecutive admissions with severe traumatic head injury. Ages ranged from 14 to 67 years, mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Results: Fifty-eight items of behaviour were identified. Paired preference analysis was used to identify a sequence of recovery of these behaviours. The sequence began with arousal and led on to behaviours signalling recovery of social interaction and communication. Subsequent behaviours indicated increasing cognitive organization and return of orientation and memory. The behaviours on the scale are hierarchical and range from coma to emergence from PTA. Conclusions: A scale to assess patients and monitor cognitive recovery after severe head injury has been developed. While individual patients will show some departures from the sequence identified, the scale helps to make explicit the earliest stages of natural recovery patterns after head injury.

The use of individualized booklets after a stroke

An attempt was made to maintain or improve the level of independence in stroke patients going home from hospital by giving them individually orientated booklets to help them retain the skills acquired in hospital. These contained information on their condition, consequent problems and the rehabilitation measures specific to each patient, illustrated with pertinent photographs. Measures of independence and social functioning were used at discharge and three months later to assess any difference in outcome between a group which was issued booklets and a group which was not. There was no statistically significant difference between the physical and social functioning of the trial and control groups, but many subjects felt the booklets had been of help.

The effectiveness of chemical neurolysis in the treatment of lower limb muscle spasticity

The use of phenol and alcohol nerve blocks in the treatment of localized muscle spasticity is well established. However, a number of questions relating to this procedure are still unanswered. This article presents experience of the effectiveness of chemical neurolysis in the treatment of severe lower limb muscle spasticity in 28 patients who had a total of 56 nerve blocks performed during a follow-up period of between four and 18 months.

Evidence for a central mechanism in the process of fatigue in people with multiple sclerosis

The study aimed to establish quantitative and qualitative aspects of fatigue among a group of people with multiple sclerosis (MS) who had identified fatigue as a troublesome symptom and a control group of healthy adults. An interview, a fatigue diary and a fatigue-inducing experiment were designed and the Nottingham Health Profile was employed. People with MS experienced significantly more fatigue than healthy adults, on a daily basis. Factors noted to cause and to relieve fatigue were similar in people with MS and healthy adults. The only differences were that a hot bath improved fatigue in healthy adults and accentuated it in people with MS and that more of the healthy adults mentioned lack of sleep as a cause of fatigue. Physiological muscular fatigue during a quadriceps test was of similar magnitude in the two studied groups but the perceived fatigue levels were disproportionally high in the patient group. The results support the view that central mechanisms are responsible both for muscle weakness and for the sense of fatigue experienced so frequently in multiple sclerosis. This central mechanism is likely to reside in motor pathways within the nervous system. Further studies, measuring corticomotor conduction times, motor unit firing frequencies and metabolic factors, are recommended.

Evaluating equipment for people with disabilities: user and technical perspectives on basic commodes:

Disabled people often do not use the equipment supplied to them. Past work indicates that there are many reasons for this, including the low priority given to user views by the designers and manufacturers of such equipment. A number of different methodologies have been used to evaluate equipment. This paper describes an evaluation of basic commodes, a project funded by the Medical Devices Agency, Department of Health, in which both a user survey and technical tests were employed. A sample of 18 basic commodes, divided into four categories, was evaluated by 40 users, a questionnaire being administered to determine user views. A series of 13 technical tests was also carried out. The results showed that the preferred commodes as indicated by the users did not necessarily perform well in the technical tests, with at least one of the products having potentially serious design faults. It is suggested that users, therapists and engineers each have an essential contribution to make in the evaluation of equipment for disabled people.

Symptomatic and functional improvement of foot dystonia with medial popliteal nerve block

The patient is a 56-year-old female who has had what she described as ’spasm’ of her left foot since early childhood. At the age of 3 years she was noticed to have ’turning in’ of her left foot and by the age of 7 the other foot was similarly but less severely affected. She was initially able to correct the dystonic posture voluntarily but her condition started to deteriorate gradually in her late twenties following her first pregnancy. On examination she walked with an unsteady gait and a stiff left leg. Her left foot was strongly inverted and her big toe was dorsiflexed. At rest the left foot was inverted and there were involuntary movements of both feet. The rest of the general physical and neurological examination