Martin J Watson

Refining the Ten-metre Walking Test for Use with Neurologically Impaired People

Summary The remediation of gait problems is a key feature of neurological physiotherapy. The ten-metre walking test is a frequently used outcome measure in this clinical area. Despite its simplicity and apparent popularity, the ten-metre walking test does not have an established operational procedure. This article proposes a procedure, together with a brief account of its origins and features. Using the procedure, acceptable levels of inter-rater reliability were found, with a 95% CI for agreement of −0.38 to +0.38 seconds for normal young subjects and −0.36 to +0.49 seconds for traumatic brain-injured subjects. The ten-metre test results for two groups of head-injured patients are also reported. A focus of the discussion is how the test might best be used in clinical practice, as well as indications for future research still needed. An overall aim of the paper is to commend the continued considered use of the test by physiotherapists working in neurology.

An evaluation of the effects of a dynamic lycra® orthosis on arm function in a late stage patient with acquired brain injury

Primary objective: The aim of this study was to assess the effect of a dynamic lycra® orthosis in the management of upper limb paresis in a late stage stroke patient. Research design: A single case experiment, adopting a 3-phase ABA withdrawal design (without follow-up), ∼6-weeks per phase, intervention being delivered in the middle/B phase. Method and procedures: Assessment of arm function was carried out on a weekly basis for the 18-weeks, using a battery of upper limb tests. The subject was prescribed a tailor-made lycra® orthosis which was worn daily during the middle phase of the trial. Main outcomes and results: Orthosis wear appeared to result in improvements in active range of movement, self-rated function and one component of a writing test, with some suggestion of a carryover effect when treatment was withdrawn. No intervention-related changes were seen in a dressing test. Ambiguous results were seen in a further writing test and a peg board manipulation assessment. Irrespective of intervention, the subject made positive changes in scores in the majority of assessments used, throughout the 18-week period. Conclusions: The findings suggest that a lycra® orthosis may have some beneficial effects on upper limb function late after brain injury. Results were however equivocal, suggesting (a) that effect mechanisms may be quite complex and (b) that future evaluations may require careful construction.

Electromyographic Power Spectral Analysis of the Paraspinal Muscles

Summary Background and Purpose Despite previous studies on the reliability of median frequency (MF) and median frequency slope (MFS) as specific surface electromyography (SEMG) measures of back muscle function, there is still no general consensus regarding the results. A reliability study was carried out to determine the test-retest reliability (within and between-days) of SEMG power spectral analysis of paraspinal muscle activity in healthy subjects. Methods Fifteen volunteer subjects with no history of low back pain were tested. The unsupported trunk holding position was used to measure initial MF and MFS three times. Two measurements were taken on the same day with five minutes interval and the third was taken one week later. Results For initial MF, the high ICC values (0.82-0.92) and high level of agreement between measurements for multifidus and iliocostalis indicated high within and between-days reliability. For MFS, the ICC values (0.65-0.82) and high (for multifidus) to moderate (for iliocostalis) level of agreement between measurements demonstrated high within-day reliability for multifidus and moderate for iliocostalis. Between-days reliability of MFS was found to be good for multifidus and moderately good for iliocostalis with ICC values of 0.60-0.85 and high to moderate level of agreement. Conclusion In this study the SEMG power spectral analysis was shown to be a reliable method of measuring back muscle activity in an unsupported trunk holding test, when measurements are taken in healthy subjects by the same investigator.

An evaluation of therapist's ability to perform graded mobilization on a simulated spine

The purpose of this study was to determine whether physiotherapists could perform posteroanterior passive oscillatory movements (POMs) graded according to Maitland (1986, 2001) on apparatus analogous to the lumbar spine. Ten post-graduate physiotherapists specialising in manual therapy performed the equivalent of grade I to IV posteroanterior POMs on apparatus analogous to the lumbar spine. The displacement and amplitude of each oscillation was recorded at four trials. Considerable overlap was observed between the grades, for both measures. In particular grades I and II overlapped greatly with III and IV. For every grade the contribution to variance due to physiotherapist and due to trial were highly significant ( p =0.000). Further, between 53% and 83% of the variance of the displacement and up to 80% of the variance in amplitude was due to differences between physiotherapists. These percentages were greater for the higher grades. Within a trial physiotherapists showed very little variability. The validity of Maitlands grading system as a tool for measurement and replication between physiotherapists is challenged.

A Degree in Occupational Therapy: How Do Traditional and Non-Traditional Entry Routes Compare?

There are different entry qualification routes to an honours degree course in occupational therapy. These differences, coupled with the considerable age-range of applicants, mean that students commence their courses from widely different starting points, which may have a bearing on their academic career. This study examined some chosen starting points briefly and, by retrospective analysis of 47 student progress files, looked at how students fared over their university careers. In particular, it examined whether certain pre-entry factors were associated with good degree results. A secondary focus was the relevance of A-level biology as an entrance criterion. The results indicated that students coming into occupational therapy via both traditional and non-traditional routes did equally well and that A-level biology was not associated with degree performance.

Inter-Rater Reliability of Connective Tissue Zones Recognition

Summary Inter-rater reliability of the identification of the separate components of connective tissue reflex zones was measured across a group of novice practitioners of connective tissue manipulation. Recognition of the visual, palpatory and tissue mobility components of ten connective tissue zones across five subjects were monitored in seven models. Percentage agreement was high (89/150 80% agreement or higher) but the kappa coefficient statistic which takes account of chance was low. These results suggest that a trend of agreement was demonstrated but percentage agreement scores should be treated with caution unless a large group of raters is involved. Possible explanations for the results are made with suggestions for further research.

Path tree analysis as a tool for describing motor recovery following acquired brain injury: An exploratory study

Purpose. Knowledge of the likely sequence of motor recovery following brain injury has obvious usefulness within rehabilitation. Research has tended to focus on establishing the linearity of the recovery sequence. This study aimed to ascertain the usefulness of path tree analysis as a graphical means of exploring inter-subject variation in routes followed during motor recovery. Method. Data were collected via physiotherapist questionnaire, ascertaining recovery sequence of 14 motor milestones across 80 adults with severe traumatic brain injury (TBI). An adapted version of the Rivermead Mobility Index (RMI) was used. Data were analysed to establish inter-subject agreement regarding recovery sequence. A path tree diagram was then composed to explore inter-subject variation. Results. Putative order of recovery for the 14 motor milestones appeared to have face validity. Guttman coefficients of reproducibility ((0.954) and scalability (0.948) were good, suggesting intrinsic order. Composition of a path tree suggested considerable variation in recovery paths between individuals, with 34 combinations of test items being evident. Conclusions. Motor recovery following severe TBI follows a distinct pattern, but path tree analysis emphasises the variety of routes which individuals can follow. Additional research should ascertain the scope of this method to document the natural history of the recovery process.

A pilot mixed methods investigation of the use of Oswestry standing frames in the homes of nine people with severe multiple sclerosis.

Abstract Purpose: People with multiple sclerosis (MS) commonly experience muscle weakness which limits their ability to stand. Supported standing may minimise the secondary complications of prolonged sitting but evidence for this is scarce. This study investigated the effects of regular standing in an Oswestry frame on some secondary complications of immobility and explored the lived experience of standing. Methods: Nine people with MS participated in a mixed-methods study over 48 weeks. Single-case experiments were used. Outcomes included: Amended Motor Club Assessment, Canadian Occupational Performance Measure, Penn Spasm Scale, bowel frequency and a numerical pain-scale. The qualitative strand used a case-study approach with a phenomenological perspective. Results: Significant improvements (p < 0.05) were demonstrated for individuals in strength, ADL and spasms but not in bowel frequency or pain. Subjective improvements occurred in continence, clonus and fall-rate. Being upright or strengthened by standing enabled participants to re-engage with activities and re-establish themselves within relationship roles. This engendered a sense of achievement and increased optimism. Conclusion: This study provides preliminary evidence of the effectiveness of regular frame-standing in improving strength, function, spasms, continence and fall-rate in people with severe MS. Standing reinstated a sense of belonging and optimism by restoring important life-roles and feelings of normality as participants regained previously valued activities. Implications for Rehabilitation Regular standing in an Oswestry frame may improve functional ability in people with severe MS. Regular frame standing may have a positive psychological effect on people with severe MS. Self-management of a standing regime may be feasible.

Clinical Reasoning in Neurology: Perry's Model

Summary In a previous paper (Watson, 1995), the author considered some of the issues and problems inherent in striving towards a common, shared and agreed understanding of certain aspects of neuro-physiotherapy practice. In this paper, the theme is continued, with a particular focus on describing a simple model. This has been mainly used in undergraduate teaching, to underpin aspects of neuro-physiotherapeutic learning and clinical reasoning.