Douglas Carroll

A quantitative test of upper extremity function

Abstract An evaluation of upper extremity function in patients with severe hand disabilities in terms of pinch, grasp, grip, elbow flexion and extension, forearm pronation and supination was performed and scored. Scores on this basic test correlated fairly well with scores on a conventional hand activities of daily living test. The test has sufficient reliability and consistency to measure improvement or deterioration in function when performed serially. Application of the test to a large number of nursing home type patients has shown that upper extremity activity is meaningless without knowledge of the patients overall physical and mental functioning. The hand evaluation can be used in properly selected patients to determine what functions of the upper extremity are impaired and need treatment. It can also be used to measure changes in hand function with advancing disease, surgical or other treatment.

The disability in hemiplegia caused by cerebrovascular disease: Serial studies of 98 cases

Abstract A simple method of estimating the degree of independence has been used to investigate the functional disability initially and during recovery from hemiplegia in ninety-eight patients hospitalized for acute hemiplegia caused by thrombosis, hemorrhage or cerebral embolism. The degree of independence can be scored on a scale of 100. The use of such a scoring system measures the degree of improvement in independence and also focuses attention on what disabilities are in need of treatment. The overall mortality rate at the end of two years was 60 per cent. In the group with the lowest Score for Activities of Daily Living the mortality rate was 81 per cent. The majority of deaths during the follow-up period occurred in the first six months. Using the conventional methods of physical medicine and rehabilitation, little improvement in independence occurred after one month in those patients who did improve. Twenty per cent of all patients achieved complete independence.

Hand function in hemiplegia

Abstract 1. Static upper extremity impairments . Following a hemiplegia owing to cerebral infarction, the upper extremity may regain normal function, partial function, or no significant function. Study of the group with partial hand function showed that they could be arranged in a spectrum of increasing usefulness of the hand depending roughly on the number of fingers involved. This group was characterized by general weakness as measured by the Smedley Dynamometer, and variable degrees of loss of finger function best indicated by ability to pick up small spheres (pinch). If a finger was impaired, the ones ulnar to it were almost always involved more severely, while the fingers radial to it were less involved. The greater the number of fingers involved, the greater the disability of the thumb, supinators and pronators. 2. Improving upper extremity function . In patients showing improvement under serial observation, there was greatest improvement in the index finger and thumb and decreasing improvement in the middle, ring and small fingers respectively. The prediction of how much functional improvement will occur in an upper extremity depends on the severity and duration of the paralysis and the temporal profile of return of function. If complete paralysis of the upper extremity lasts for longer than several hours, return of significant function is unlikely. There is generally little return of significant upper extremity function if grasp, pinch or lateral prehension of slight degree has not developed within the first few days. Exceptions occur, however, and treatment should be directed toward taking advantage of any function which may occur. Prevention of painful shoulder may be accomplished by adequate support of the upper extremity and passage of the joints through full range of motion several times daily.

Survey of 230 medical patients in the Baltimore city chronic disease hospital

Abstract A survey of 230 medical patients in a Chronic Disease Hospital was made, with particular attention to the functional status of the heart, extremities, mentation, senses (hearing, speech, and sight), bowels and bladder. The primary diagnosis and rehabilitation potential were recorded in each case. The information collected showed that the patients fall into three fairly stable groups: (1) those requiring mainly nursing home facilities; (2) those requiring constant medical and nursing care; and (3) those with some hope of discharge to home or to a domiciliary type of institution provided intensive medical and/or rehabilitation procedures can be applied. The survey showed that 139 (60.4 per cent) patients were nursing care patients, 42 (18.3 per cent) needed constant medical and nursing care, and 49 (21.3 per cent) showed possibilities of discharge with rehabilitation or intensive medical care. Correlations of age, time in the hospital, diagnosis, and functional capacity with rehabilitation potential show that functional capacity is far more important in predicting a patients potential return of function than any other item.