Elisabeth Bürge

Neutral Functional Realignment Orthosis Prevents Hand Pain in Patients With Subacute Stroke: A Randomized Trial

OBJECTIVE To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits. DESIGN Randomized trial. SETTING Rehabilitation center. PARTICIPANTS Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program. INTERVENTION The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily. MAIN OUTCOME MEASURES Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups. RESULTS At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups. CONCLUSIONS Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.

Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: A survival analysis

Different factors influence ADL performance among nursing home (NH) residents in long term care. The aim was to investigate which factors were associated with a significant change of ADL performance in NH residents, and whether or not these factors were gender-specific. The design was a survival analysis. The 10,199 participants resided in ninety Swiss NHs. Their ADL performance had been assessed by the Resident Assessment Instrument Minimum Data Set (RAI-MDS) in the period from 1997 to 2007. Relevant change in ADL performance was defined as 2 levels of change on the ADL scale between two successive assessments. The occurrence of either an improvement or a degradation of the ADL status) was analyzed using the Cox proportional hazard model. The analysis included a total of 10,199 NH residents. Each resident received between 2 and 23 assessments. Poor balance, incontinence, impaired cognition, a low BMI, impaired vision, no daily contact with proxies, impaired hearing and the presence of depression were, by hierarchical order, significant risk factors for NH residents to experience a degradation of ADL performance. Residents, who were incontinent, cognitively impaired or had a high BMI were significantly less likely to improve their ADL abilities. Male residents with cancer were prone to see their ADL improve. The year of NH entry was significantly associated with either degradation or improvement of ADL performance. Measures aiming at improving balance and continence, promoting physical activity, providing appropriate nourishment and cognitive enhancement are important for ADL performance in NH residents.

ICF: Clinical relevance for physiotherapy? A critical review

The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the rehabilitation disciplines with a universal language. However, the ICF is still highly complex and questions remain about its practicability. The aims of this review were to (i) identify how the ICF is integrated in the clinical activity of physiotherapists, (ii) discuss advantages and limits of the use of the ICF, and (iii) suggest further possibilities for implementing the ICF by physiotherapists. A literature search on Medline, Cochrane, CINAHL and PEDro (key words: ICF, physiotherapy, physical therapy, clinical application, clinical use) was carried out, together with a check for articles on Google Scholar. Of 155 identified articles, 22 were specific to physiotherapy. These articles described the utility of the ICF to facilitate decision-making for physiotherapists; to classify the evaluation of therapy outcomes; to ensure that all aspects of human functioning are represented while testing the effectiveness and the reliability of these outcomes; to structure the documentation of assessments and interventions, as well as to ameliorate the communication. ICF has a clinical relevance for physiotherapists, although the limited reliability of the qualifier system for the feasibility of its implementation was shown. The authors emphasize that the ICF is a tool that facilitates the decision of what to measure but not how to measure.

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.

Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial.

BACKGROUND Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward. METHODS A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later. RESULTS Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items. CONCLUSIONS ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.

The Heterogeneity of Disability Trajectories in Later Life: Dynamics of Activities of Daily Living Performance Among Nursing Home Residents

Objective: This study investigated the variability in activities of daily living (ADL) trajectories among 6,155 nursing home residents using unique and rich observational data. Method: The impairment in ADL performance was considered as a dynamic process in a multi-state framework. Using an innovative mixture model, such states were not defined a priori but inferred from the data. Results: The process of change in functional health differed among residents. We identified four latent regimes: stability or slight deterioration, relevant change, variability, and recovery. Impaired body functions and poor physical performance were main risk factors associated with degradation in functional health. Discussion: The evolution of disability in later life is not completely gradual or homogeneous. Steep deterioration in functional health can be followed by periods of stability or even recovery. The current condition can be used to successfully predict the evolution of ADL allowing to set and target different care priorities and practices.

Das Perpetuum mobile

Der Ubende soll lernen, die Huftgelenke reaktiv hubarm extensorisch/ adduktorisch und flexorisch/abduktorisch zu mobilisieren (mobilisierende Variante), die Huftmuskulatur, die das Becken am Oberschenkel verankert, vorbereitend fur die Standbeinphase beim Gehen reaktiv zu aktivieren (stabilisierende Variante).

Der Salamander und die Krabbe

Der Ubende lernt, reaktiv die Wirbelsaule hubarm in Lateralflexion zu mobilisieren und die Stutzfunktion von Arm und Bein zu uben. Alternierend wird entweder das Spielbein am Becken oder das Becken am Standbein verankert, und der Spielarm wird am Brustkorb bzw. der Brustkorb am Stutzarm verankert.

Eslein streck dich

Der Ubende lernt, die Wirbelsaule, besonders die Brustwirbelsaule, in jedem Abschnitt schonend passiv in Extension zu mobilisieren.

Der Seeigel und der Goldfisch

Der Ubende lernt, die Wirbelsaule, Huft- und Kniegelenke bei labilisierter Gleichgewichtslage reaktiv und in nahtlosem Wechsel flex-/extensorisch zu mobilisieren. Dabei wird die Bauch- und Ruckenmuskulatur in hoher Variabilitat trainiert. Der Schultergurtel wird bei standig wechselnder Flexionsstellung in den Schultergelenken reaktiv auf dem Brustkorb dynamisch stabilisiert, und die Beine werden extensorisch am Becken verankert.