Martin Watson

Effects of dynamic elastomeric fabric orthoses on children with cerebral palsy

This phase 1 exploratory study aimed to establish proof of concept of the effects of dynamic elastomeric fabric orthoses (DEFOs) on the gait of children with spastic diplegic cerebral palsy. Replicated single case experiments employing an ABA methodology were carried out on eight subjects (median age 5.5 years, range 3–13 years; 4 girls/boys) utilizing quantitative/qualitative data collection. Outcome measures were: Ten metre walking test (10MWT); physiological cost index (PCI); visual analogue scale (VAS) scoring of perceived gait changes; functional mobility changes using Patient Specific Functional Scale (PSFS); subject/carer perceptions recorded in daily diaries. Results identified following analysis of quantitative data indicated a treatment effect from the orthoses which could be corroborated by participant subjective impressions and comments. Statistically significant (p < 0.05) intervention-related improvements in gait velocity and gait consistency were identified respectively in 5/8 and 4/8 subjects. Power calculations support the feasibility of a larger controlled study to further investigate this orthotic intervention. This study indicates that DEFO leggings can confer beneficial effects on the gait of some children with spastic diplegia resulting from CP. These findings have implications for orthotic intervention with this subject group.

A review of behavioural assessment scales for monitoring recovery in and after coma with pilot data on a new scale of visual awareness

Abstract The monitoring of behavioural events during and after coma is important in determining the nature and pace of recovery, in detecting early signs of deterioration, in the evaluation of coma stimulation and other rehabilitation programmes, and in identifying the persistent vegetative state. There are a number of difficulties in constructing objective, reliable, valid measures of significant behavioural events which are also easy to administer by the bedside. This paper reviews the many behavioural scales which have been developed in the search for quantifiable data on recovery, and presents some pilot data on a new scale of visual awareness.

Can patients in coma following traumatic head injury learn simple tasks

Abstract Initial observations that patients in coma showed a variety of responses when a cloth was placed over their faces generated a study investigating whether these patients could learn to remove the cloth. A method of backward chaining was used to teach the patients. Three experiments are reported. In the first study, five patients learned to remove the cloth while still in coma. In the second study, patients with a much lower Glasgow Coma Scale (GCS) score underwent the same procedure and all three removed the cloth while still in coma. The third experiment aimed to develop this procedure and two patients were trained to carry out other tasks using the same backward chaining technique. Both carried out the tasks while still in coma. The results of the study demonstrate that patients in coma following traumatic head injury developed increasingly reliable responses to specific stimuli. The theoretical and practical implications of these results are discussed.

The Use of a Dynamic Elastomeric Fabric Orthosis to Manage Painful Shoulder Subluxation: A Case Study

Across a variety of patient groups, the painful subluxed shoulder is a notoriously difficult clinical problem to manage. A number of treatment strategies have been proposed, which generally have mixed success. Dynamic Elastomeric Fabric Orthoses (DEFOs) represent an emerging treatment strategy for movement and postural control problems. Their use in the management of the painful subluxed shoulder has not, however, been previously documented. The case report provides a brief account of a young man with a painful subluxed shoulder as a result of a manual handling injury. At the end of an initial period of conservative management, the clinical problem had worsened, hindering the prospects for further active rehabilitation. A DEFO was prescribed for this client to provide physical support and facilitate physical activity. Full recovery (as judged by radiographic evidence) was achieved within a relatively short period of time after orthotic prescription. It is proposed that this intervention may be a useful adjunct to the management of this recurring clinical problem and that it warrants further investigation.

Complexity, Occupational Therapy, Unpredictability and the Scientific Method: a Response to Creek et al (2005) and Duncan et al (2007)

Two recent articles in this journal have discussed complex systems and differing views of occupational therapy as a complex intervention. This opinion piece develops the discussion of complex adaptive systems and complex interventions further, concluding that all health professions can claim to be complex. Complexity implies a degree of unpredictability. Within patient-centred systems, this means not that complexity cannot and should not be studied, but merely that variability will be experienced and needs to be understood and examined. The Medical Research Council framework provides a rational way of doing so. Research by occupational therapists should grasp this nettle to develop the professions evidence base.

A score of zero

The patient with a head injury may have a variety of impairments which interact to cause functional limitation. There may be deficits in everyday skills, ranging from self-care tasks to those tasks which require differing degrees of alertness, information processing, planning and execution. Even when the patient is capable of using these skills independently of each other, e.g. of planning an activity without having to execute it, head-injured patients are frequently unable to integrate skills, that is to say to select and use the skills sequentially to solve real-life problems. The sequelae of head injury were described in Chapter 9.