Mitchell Batavia

Changing chairs: anticipating problems in prescribing wheelchairs.

Purpose: This article presents a framework for prescribing, ordering, and adapting a new wheelchair, focusing on individual, environmental and wheelchair factors that must be taken into consideration to ensure optimal function. Method: A review and analysis was conducted of all factors relevant to the transition to a new wheelchair. Without appropriate planning and implementation, this transition can result in unnecessary expenses, duplication of effort, and possibly even injury to the user and abandonment of the wheelchair. Results: Recommendations are provided to manufacturers, therapists, technicians, users, insurers and physicians, who must work together throughout this process. To the extent feasible, the authors suggest that major changes from the previous wheelchair should be avoided, particularly for people with substantial functional limitations. Therapists and technicians must measure the user accurately, and anticipate those factors that can impede a smooth transition. Insurers and other payors must recognize that changing wheelchairs will often require substantial professional assistance, including several fittings to adjust the new chair to the needs of the user. Conclusion: Additional research and case reporting on outcomes of adjusting to a new wheelchair appear warranted.PURPOSE This article presents a framework for prescribing, ordering, and adapting a new wheelchair, focusing on individual, environmental and wheelchair factors that must be taken into consideration to ensure optimal function. METHOD A review and analysis was conducted of all factors relevant to the transition to a new wheelchair. Without appropriate planning and implementation, this transition can result in unnecessary expenses, duplication of effort, and possibly even injury to the user and abandonment of the wheelchair. RESULTS Recommendations are provided to manufacturers, therapists, technicians, users, insurers and physicians, who must work together throughout this process. To the extent feasible, the authors suggest that major changes from the previous wheelchair should be avoided, particularly for people with substantial functional limitations. Therapists and technicians must measure the user accurately, and anticipate those factors that can impede a smooth transition. Insurers and other payors must recognize that changing wheelchairs will often require substantial professional assistance, including several fittings to adjust the new chair to the needs of the user. CONCLUSION Additional research and case reporting on outcomes of adjusting to a new wheelchair appear warranted.

An Augmented Auditory Feedback Device

An augmented auditory feedback device is described. The device can be easily and economically constructed and implemented during a patients physical rehabilitation. The rationale is to provide an external source of information to the user in order to correct errors during weight-bearing activities. Possible applications of the augmented auditory feedback device include increasing symmetry and weight distribution during sitting, standing, and gait. Instructions regarding its construction are provided, and a case study using the device is presented. Improved midline alignment and weight distribution in sitting for a 2-hour duration was achieved by a stroke patient using the augmented auditory feedback device in conjunction with physical therapy.

Dynamic stability during walking following unilateral total hip arthroplasty

The purpose of this study was to examine dynamic stability, defined as the vertical projection of the center of mass (COM) to the base of support (BOS) mediolaterally during walking in 16 healthy and 16 unilateral total hip arthroplasty (THA) persons. There was a significant effect of side for double limb support (DLS) for the healthy group and between groups but not significant for single limb support. The dynamic stability pattern for the THA group was to hold the COM in the midline during a longer DLS phase demonstrating a different motor control strategy compared to healthy adults.

Disability, chronic condition, and iatrogenic illness

People with disabilities and chronic conditions are disadvantaged by the US health care system. Some people receive too few of the services they need; others receive too many services from practitioners who do not understand their disability-related needs and thus subject them to iatrogenic illnesses (health problems arising from the health care process). We explore this deprivation and excess and focus on 3 categories of iatrogenic illness that can harm this patient population and impede their ability to live independently. Empirical studies of iatrogenic illness in people with disabilities and chronic illnesses are needed. Physiatrists must play a central role in conducting such studies and in helping these persons access needed care while avoiding potential health problems associated with such care.

Test-retest reliability of the functional rotation test in healthy adults.

Test-retest reliability and concurrent validity for a Functional Rotation Test, developed as a clinical tool for quantifying the extent of body rotation while sitting or standing, were evaluated with healthy adults in this study. Participants, ages 20 to 72 years (n = 36) donned laser-pointing devices, stood or sat in the center of a room calibrated for the test, and actively turned and pointed to the right (or left) as far as they could comfortably. The locations of the lasers were recorded and subsequently scored. Testing was repeated after a brief rest. Concurrent measurements between a clinical goniometer and the Functional Rotation Test were also compared. Intraclass correlation coefficients (ICCs) indicated good to excellent test-retest reliability indices, ranging from .89 to .96 for standing and .87 to .95 for sitting tests. Agreement between the Functional Rotation Test and the goniometer was excellent (ICC = 1.0). The relevance and possible applications of the Functional Rotation Test are discussed.

Contraindications for therapeutic massage: do sources agree?

Abstract Objectives : To explore the extent to which professional sources agree on contraindications (CIs) and precautions for therapeutic massage. Methods : Textbook and peer-reviewed journal sources containing CIs on therapeutic massage in English within the past 10 years were searched (January 1992–July 2002). Descriptive statistics and stacked bar graphs were employed to illustrate agreement of categorical data. Results : Twenty-one sources listed anywhere from 3 to 86 CIs and precautions for therapeutic massage. Over half of the sources failed to indicate a CI or precaution for the majority of patient conditions. Seventy-six percent of the sources failed to cite references to support CI claims. Conclusion : Sources markedly varied regarding what conditions were considered contraindicated for massage. Advisory panels and greater reliance on evidence-based data may help to enhance consistency when documenting future CIs.

Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

OBJECTIVE To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. DESIGN Randomized, repeated-measures, mixed analysis of variance. SETTING Outpatient clinic. PARTICIPANTS Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). INTERVENTIONS Four-week arm training protocol on a robotic device (12 sessions). MAIN OUTCOME MEASURES Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up. RESULTS There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). CONCLUSIONS There were no differences in retention of motor skills between EF and IF participants 4 weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

Karaoke for quads: a new application of an old recreation with potential therapeutic benefits for people with disabilities

Purpose : Karaoke is a recreational activity whereby individuals sing into a microphone along with the melodies and lyrics provided both visually and auditorily by a machine. Methods : The potential therapeutic benefits of karaoke are explored in terms of increased respiratory strength, endurance, control, and capacity, as well as emotional and physical release for people with disabilities. Results : Although many individuals with disabilities could benefit from this activity, it is likely to be particularly beneficial to people with compromised respiratory systems, such as persons with high-level quadriplegia (tetraplegia). Conclusion : This article examines theoretical considerations and proposes a research agenda. Empirical research would be valuable to confirm the potential benefits of karaoke for people with disabilities.

Chapter 1 – Blood Pressure Assessment

(Cont. on Back) All of the organs in the body need oxygen in order to function, and oxygen is carried to the organs by blood moving though the circulatory system. Blood pressure is the amount of force your blood puts on your arteries when it moves through the body. Blood pressure does not stay the same all of the time. It lowers when you sleep and rises when you exercise or are nervous or excited. When blood pressure is above the normal range most of the time, there is risk of health problems such as heart disease, stroke, and kidney failure. Because high blood pressure (also called hypertension) usually has no symptoms, it is referred to as “The Silent Killer.”

Test-retest reliability of the seated Functional Rotation Test in people with Parkinson's disease: a preliminary study.

This study established the test-retest reliability of a seated Functional Rotation Test monitoring hand-pointing, together with head and trunk-rotation performance, in people with Parkinsons disease. An ancillary purpose was to establish the concurrent validity between the Functional Rotation Test and an electrogoniometer. 10 males with Parkinsons disease (M age = 70.5 yr.; Hoehn and Yahr staging severity ranging from II to IV) were recruited. Subjects were fitted with laser-pointing devices, sat in the Functional Rotation room, and were instructed to turn actively and point to their right (or left) as far as they could comfortably manage. Tagged projections were scored (in degrees). Testing was repeated after a brief interval. Electrogoniometer projected locations were compared with Functional Rotation Test scores. Intraclass correlation coefficients (.91 to .97) indicated excellent test-retest reliability. There was also excellent agreement between electrogoniometric and Functional Rotation Test values (Intraclass correlation coefficients = .99). Thus the Functional Rotation Test provides a replicable measure of axial rotation of head, trunk, and hand-pointing in seated subjects with Parkinsons disease.