Karen L. Harburn

Clinical applicability and test-retest reliability of an external perturbation test of balance in stroke subjects

We address the test-retest reliability and clinical applicability of an adapted external perturbation balance assessment, ie, the Postural Stress Test (PST). Repeated-measures were designed to assess the clinical features of a component of balance disorder in stroke. Twenty ambulatory stroke patients and 20 age-, gender-, height-, and weight-matched healthy control subjects participated in this study. Stroke patients were tested (using the adapted PST) on 4 separate days; matched control subjects were tested on one occasion. With the subject standing, backward perturbation forces were applied at the level of the center of gravity. Postural reactions to the test were scored in real-time and from videotape, from two different viewing angles, ie, 45 degrees and 90 degrees to the saggital plane. Scores (out of a maximal of 81) were ascertained using a 10-point subjective-observational scale. None of the control subjects fell during testing; four of the hemiplegic subjects fell. Subjects were protected from potential injury by a custom-designed safety harness system. For the hemiplegic subjects, intraclass correlation coefficients (ICCs), calculated as the reliability of any one occasion, ranged from 0.71 to 0.77, whereas those calculated as the reliability of the mean of the first two occasions ranged from 0.83 to 0.93. Although scores on the fourth occasion were significantly greater than those on the third occasion, both being significantly greater than those on the first and second test occasions (p < .05), differences were less than 5 points on the 81-point scale.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability of Non-normalized and Normalized Integrated EMG During Maximal Isometric Contractions in Females

The purpose of this investigation was to examine the test-retest reliability of non-normalized (absolute or raw units of mV . s) and normalized (percentage ratio) scores using integrated electromyography (IEMG) in voluntary maximal isometric contractions. Bipolar surface electrodes on the vastus medialis (VM) and vastus lateralis (VL) muscles were used to record IEMG (mV . s) on two occasions, 2-8 days apart. While, positioned supine, 20 healthy young women (mean age 24 +/- 2 yr) performed: (a) maximal voluntary unilateral quadriceps setting (QS) (i.e. isometric knee extension with the knee in 0 degrees ) with the ankle joint in a neutral position and the ankle musculature relaxed, and (b) maximal unilateral OS with the ankle joint in maximal dorsiflexion and the ankle dorsiflexors maximally contracted (QSD). The QS exercise was used to normalize IEMG (QSD: QS ratio for each of the two muscle heads) and the VM muscle was also used to normalize IEMG to the other head of the vasti (VL: VM ratio for each exercise). Reliability coefficients were excellent for test-retest reliability of non-normalized IEMG (mV . s) and for IEMG normalized to another muscle: (intraclass correlation coefficients (ICCs) > 0.86). However, IEMG normalized to another exercise was characterized by poor reliability (ICCs < 0.34), even when determined as the reliability of data averaged over two occasions. Regardless of whether absolute or normalized IEMG was used, 95% confidence intervals were wide, suggesting that precise, interday prediction of an individuals performance using the present protocol is questionnable.

An upper body musculoskeletal assessment instrument for patients with work-related musculoskeletal disorders: a pilot study.

OBJECTIVES To examine the reliability and validity of a new outcome measure, the Upper Body Musculoskeletal Assessment (UBMA). DESIGN Twenty subjects physician-diagnosed as having work-related musculoskeletal disorders (WRMD) and ten healthy subjects were assessed using the UBMA on three separate occasions. All subjects with WRMD attributed their injury to equipment use on their job. RESULTS The WRMD group had significantly higher UBMA scores on the side of equipment use than on the other side (p <0.01), whereas the healthy group had similar scores on both sides (p> 0.05). UBMA scores for the WRMD group were significantly greater on both sides of the body than scores for the healthy group (p<0.01). Only one test occasion was required to produce excellent reliability coefficients (ICCs>0.88). Although group reliability was excellent, changes of 24% for patients with WRMD and 44% for healthy subjects would be required for confidence that UBMA scores for individual patients on the side of equipment use had changed from baseline. CONCLUSIONS Although testing on one occasion produced reliable UBMA scores, healthy subjects could be distinguished from patients with WRMD, and the side of equipment use could be distinguished from the other side in patients with WRMD, prediction of individual UBMA scores was poor. In its present form, the UBMA is useful for making decisions about groups but not about individual patients. Modifications of the current UBMA are required to reduce measurement error.

Occupational Therapy Research in Canada. Report from the Association of Canadian Occupational Therapy University Programs

The Association of Canadian Occupational Therapy University Programs held a workshop in May, 1988. The purpose of that discussion was to describe the current status and needs of occupational therapy research and to consider principles to direct further research. Currently, research in occupational therapy is very limited. The reasons for this lack of development are the isolation of present researchers, the small number of trained researchers, difficulty in obtaining external funding, and the inadequacy of quantitative research methodologies to answer questions in occupational therapy. This group presented a number of strategies intended to further the development of research in our profession. These strategies include increasing the number of trained researchers through the development of graduate programs in occupational therapy, use of varied methodologies, including quantitative and qualitative means, which fit the types of research questions asked. More collaboration is recommended which should increase successful procurement of external funding. Finally, occupational therapists are encouraged to focus research efforts on the specification and support of the scientific basisof our practice. The purpose of this paper is to describe the current status and needs of occupational therapy research in Canada, to bring forward for discussion principlesto direct future occupational therapy research and to state the position of the Association of Canadian Occupational Therapy University Programs (ACOTUP) on strategies to increase research productivity in occupational therapy.

Voorkeursactivering van de vastus medialis obliquus, vastus lateralis, en heupadductoren tijdens isometrische oefeningen bij vrouwen

De vastus medialis (vm) wordt gezien als de belangrijkste spier voor de knie–extensie en patellaire stabiliteit en als de enige spier die direct en actief laterale beweging van de patella tegengaat. In gevorderde gevallen van het patellofemorale pijnsyndroom blijkt de vm inderdaad tijdens de laatste graden knie–extensie minder actief te zijn dan de vastus lateralis (vl), en dit kan samenhangen met een gebrekkig neuromusculair mechanisme.

Investigation of the Use of Manual Muscle Testing in Occupational Therapy

Undergraduate occupational therapy students learn the theory and mechanics of functional strength assessment and manual muscle testing in order to measure the effectiveness of their physical treatments and to ascertain the functional level of their patients. However, it is important to determine how practicing therapists are actually assessing strength. This information would help both in directing curriculum teaching efforts at the undergraduate level and in assessing the needs of the profession in the use of clinical strength measurement systems. The present study sought to determine the therapy areas and extent of use of functional and manual muscle tests by occupational therapists across Canada. Information was also gained about the factors related to the use of manual muscle testing by practicing clinicians. The results of the survey indicated that occupational therapists do use manual muscle testing, but to a lesser extent than functional assessments. A large number of therapists stated they relied on other co-workers, such as physical therapists, to perform manual muscle tests on their patients. Though they did not perform the manual muscle tests themselves, occupational therapists thought that occupational therapy students should have a thorough knowledge of manual muscle testing in order to work effectively as a team member in the clinic. The study also found that University of Manitoba graduates used manual muscle testing with the greatest percentage of their patients than any of the other Canadian graduates surveyed. Of interest is the finding that manual muscle testing use increased when instruction occurred on the job in addition to the University teaching of the skill.