Johan K. Stanghelle

Bobath or Motor Relearning Programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study:

Objective: To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke. Design: A double-blind study of patients with acute first-ever stroke. Sixty-one patients were consecutively included, block randomized into two groups, and stratified according to gender and hemiplegic site. Group 1 (33 patients) and group 2 (28 patients) had physiotherapy according to Motor Relearning Programme (MRP) and Bobath, respectively. The supplemental treatment did not differ in the two groups. Main outcome measures: The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index and the Nottingham Health Profile (NHP) were used. The following parameters were also registered: length of stay in the hospital, use of assistive devices for mobility, and the patients accommodation after discharge from the hospital. Results: Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath (mean 21 days versus 34 days, p = 0.008). Both groups improved in MAS and SMES, but the improvement in motor function was significantly better in the MRP group. The two groups improved in Barthel ADL Index without significant differences between the groups. However, women treated by MRP improved more in ADL than women treated by Bobath. There were no differences between the groups in the life quality test (NHP), use of assistive devices or accommodation after discharge from the hospital. Conclusion: The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients.

MUSCULOSKELETAL PAIN IN ADULTS WITH CEREBRAL PALSY COMPARED WITH THE GENERAL POPULATION

OBJECTIVE To examine prevalence and localization of musculo-skeletal pain in adults with cerebral palsy compared with the general population and to investigate variables potentially associated with pain. DESIGN A postal survey. SUBJECTS Persons with cerebral palsy and no intellectual disabilities, 18 years or more, living in Norway. METHODS A multidimensional questionnaire, including items on musculo-skeletal pain, was sent to 766 adults with cerebral palsy. RESULTS In total 406 persons responded, 49% females and 51% males age range 18-72 years (mean 34 years). All categories of cerebral palsy were represented. Nearly one-third of the adults with cerebral palsy had chronic pain, vs 15% in the general population. Mean scores of domain of bodily pain on Short Form 36 were significantly lower from an earlier age in adults with cerebral palsy. Back pain was the most common in both groups. Pain in adults with cerebral palsy was significantly associated with gender, chronic fatigue, low life satisfaction and deteriorating physical function. CONCLUSION Musculo-skeletal pain is a pronounced problem in adults with cerebral palsy from an early age, and should be addressed specifically in the follow-up programs, and in further clinical studies on potential causal pathways.

Locomotion skills in adults with cerebral palsy

Objectives: To investigate self-reported locomotion skills in persons with cerebral palsy (CP) and to investigate variables potentially associated with deterioration of walking skills. Design: Cross-sectional retrospective survey. Setting and subjects: A multidimensional mailed questionnaire was sent to 766 persons with CP, 18 years or over, without intellectual disabilities, living in Norway. Main outcome measures: The questionnaire consisted of demographic and diagnostic items, items on locomotion skills, and physical function (SF-36). Results: In total 406 persons, 51% males and 49% females from 18 to 72 years (mean 34 years, SD 11 years) with all categories of CP responded. Median age for reported walking debut was 3 years, with a range from 1 to 14 years. In total 216 respondents (53%) walked without support, 104 persons (25%) walked with support, 39 persons (10%) had lost their walking skills, and 47 (12%) had never been able to walk. Mean level of physical function (SF-36) was 53 out of 100. There were 97 persons (27%) who reported improvement of walking skills, mainly before 25 years, 102 (28%) reported no change, and 160 (44%) reported deterioration, mainly before 35 years of age. Deterioration was significantly associated with older age, delayed walking debut and severe neurological impairment. Self-reported causes of deterioration were pain, fatigue and lack of adapted physical activity. Conclusion: Deterioration of locomotion skills is a significant problem in persons with CP from an early age, documenting the need for life-long follow-up. The predictors above should be investigated in further clinical studies, searching for potential causal pathways.

Walking function, pain, and fatigue in adults with cerebral palsy: a 7-year follow-up study.

Aim  To compare walking function, pain, and fatigue in adults with cerebral palsy (CP) 7 years after an initial survey.

Fatigue in adults with cerebral palsy in Norway compared with the general population

Fatigue is commonly reported among adults with cerebral palsy (CP) and in the general population. The aim of this study was to examine the prevalence of perceived fatigue in adults with CP compared with the general Norwegian population. A multidimensional questionnaire, containing among other instruments the Fatigue Questionnaire, was sent to persons with CP aged 18 years or older with no intellectual disabilities documented in their medical records. Results were compared with recently published results of a study of fatigue in the general population in Norway. There were 406 respondents (209 males, 197 females; mean age 34 years, SD 11 years; age range 18 to 72 years). Distribution of the different types of CP coincided with international epidemiological studies on CP. Adults with CP reported significantly more physical, but not more mental fatigue, than the general population. The strongest predictors associated with fatigue were bodily pain, deterioration of functional skills, limitations in emotional and physical role function, and low life satisfaction. Fatigue was not significantly associated with type of CP but was most prevalent in persons with a self‐reported moderate grade of CP. Results of the present study indicate that physical fatigue is a pronounced problem in adults with CP, which has an impact on the preservation of functional skills and life satisfaction. Fatigue and factors related to fatigue should be addressed specifically in follow‐up programmes for persons with CP.

Long-term prevalence of impairments and disabilities after multiple trauma.

The prevalence of impairments and disabilities in activities of daily living (ADL), nonwork activities, and work were registered in a consecutive series (n = 69) of subjects with severe injuries. At follow-up 3 years after trauma, residual impairments prevailed in 80%. Only a few (6%) were ADL-dependent. Seventy-six percent had lost at least one nonwork activity, while vocational disability caused by the trauma occurred in 19%. Cognitive impairment was significantly associated with vocational disability, while physical impairment and pain were significantly associated with nonwork disability. Other parameters that influenced vocational disability negatively were age and blue-collar employment status. Although overall changes in social network quantity and quality were small, significantly more subjects with cognitive impairment or vocational disability experienced a decline in the quality and quantity of their social network after trauma. Furthermore, 25% of the subjects reported an increase in feelings of loneliness after trauma. We recommend the design of individualized, multidisciplinary rehabilitation plans before discharge from departments of surgery.

Mortality after spinal cord injury in Norway

OBJECTIVES To study mortality, cause of death and risk indicators for death in Norwegian patients with spinal cord injury. DESIGN A cross-sectional study with retrospective data. SUBJECTS All patients (n=387) with traumatic spinal cord injury admitted to Sunnaas Rehabilitation Hospital, Norway, during the period 1961-82. METHODS Medical records were reviewed retrospectively. Causes of death were collected from Statistics Norway and death certificates. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. To explore risk indicators for death, a Cox regression model was used. RESULTS During the observation period, 1961-2002, 142 patients died. The main causes of death were pneumonia/influenza (16%), ischaemic heart diseases (13%) and urogenital diseases (13%). SMR was 1.8 for men and 4.9 for women. Cause-specific SMRs were markedly elevated for urogenital diseases, suicide, pneumonia/influenza, urogenital cancer, and diseases of the digestive system. Risk indicators for death were: higher age at injury, tetraplegia, functionally complete spinal cord injury, pre-injury cardiovascular disease, alcohol or substance abuse and psychiatric diagnosis. CONCLUSION The SMRs show that life expectancy is reduced in chronic spinal cord injury in Norway, more for women than for men. Cause-specific SMRs and risk indicators suggest that the high mortality rates after spinal cord injury to a certain degree are related to preventable aetiologies. To maximize longevity in chronic spinal cord injury, more attention must be paid to co-morbidity.

Is sense of coherence stable after multiple trauma

Objectives: To explore whether sense of coherence (SOC) is stable over time after multiple trauma. The associations between SOC and satisfaction with life as a whole, as well as aspects of psychological well-being, were explored. Finally, an overriding aim was to assess whether SOC has long-term prognostic value for global life satisfaction or psychological well-being. Design: Prospective study. Setting: Sunnaas Rehabilitation Hospital. Subjects: Twenty-six subjects with severe multiple trauma, without neuropsychological deficits. Main outcome measures: Questionnaires that were answered at admission, at discharge and at follow-up 1–3 years after trauma were: Sense of Coherence Scale 13 items (SOC-13), satisfaction with life as a whole, General Health Questionnaire 20 items (GHQ-20), Hospital Anxiety and Depression Scale (HAD). Results: While median SOC scores were fairly stable, individual scores were not stable over time, and for some subjects showed large variations. SOC score had neither long-term prognostic value for satisfaction with life as a whole nor for psychological well-being, at least not in the first years after severe multiple trauma. However, SOC was closely associated with overall life satisfaction when measured simultaneously. Furthermore, a weak SOC correlated with scores on psychological distress, anxiety and depression. SOC scores were also significantly related to being or not being in a state of anxiety, but not to being or not being depressed. Global life satisfaction was considerably reduced from before trauma (reported at admission) to the time of follow-up. Conclusion: SOC was not stable over time after severe multiple trauma. SOC measured at admission could neither predict future satisfaction with life as a whole nor future psychological well-being. Measured simultaneously, overall life satisfaction and occurrence of anxiety were significantly associated with SOC.

Fatigue in polio survivors

Objectives: Fatigue is commonly reported among polio survivors. The aims of the present study were to examine the incidence of perceived fatigue among a sample of Norwegian polio survivors, and to examine the association between the level of fatigue and sociodemographic and health variables.Materials and methods: A mailed questionnaire containing, among others, Fatigue Questionnaire, Fatigue Severity Scale, sociodemographic and health variables were sent to a representative group of 312 Norwegian polio survivors. 276 subjects (88%) answered the questionnaire.Results: The incidence of fatigue among the polio survivors were considerably higher than in the normative data. Physical fatigue, more than mental fatigue, represented the major problems. Polio subjects who reported severe fatigue had significantly more other diseases and health problems than the normative group.Conclusions: The diagnosis and treatment of other or related physical conditions should be given higher priority in the management of persons with late effects of poliomyelitis, as these conditions probably can be the reasons for fatigue more than poliomyelitis sequelae alone.Spinal Cord (2001) 39, 243–251.

Exercise and health-related quality of life during the first year following acute stroke. A randomized controlled trial

Purpose: To evaluate the impact of two different physiotherapy exercise regimes in patients after acute stroke on health-related quality of life (HRQoL) and to investigate how the degree of motor and balance function, gait capacity, activities of daily living and instrumental activities of daily living influenced HRQoL. Methods: A longitudinal randomized controlled stratified trial of two interventions: the intensive exercise groups with scheduled intensive training during four periods of the first year after stroke and the regular exercise group with self-initiated training. Results: There was a tendency of better HRQoL in the regular exercise group on NHP total score (p= 0.05). Patients with low scores in activities of daily living, balance and motor function and inability to perform 6-minute walk test on admission, scored lower on self-perceived health than patients with high scores and ability to perform the walking test. At 1 year post-stroke, total scores on NHP were moderately associated with motor function (r= −0.63), balance (r= −0.56), gait (r= −0.57), activities of daily living (r= −0.57) and instrumental activities of daily living (r= −0.49–0.58). The physical mobility sub-scale of NHP had the strongest association ranging from r= −0.47–0.82. Conclusion: The regular exercise group with self-initiated training seemed to enhance HRQoL more than the intensive exercise group with scheduled intensive training. The degree of motor function, balance, walking capacity and independence in activities of daily living is of importance for perceived HRQoL.