Peter A.C. Lim

Performance-based gait tests for acute stroke patients

OBJECTIVE Qualitative measures may not differentiate severity of deficits after an acute or subacute stroke. The aim of this study was to contrast the utility of performance-based gait tests with qualitative measures in a sample of acute stroke patients. DESIGN Twenty acute stroke subjects had their performance-based gait measured by gait speed, walking distance, gait energy expenditure, and gait energy cost. They were also qualitatively evaluated for cognition, functional outcomes, motor impairment, and Functional Ambulation Category. RESULTS Strong and significant correlations were observed among performance-based gait tests. Qualitative scales indicated moderate to minimal deficits in each domain evaluated, although they were not correlated among themselves, except for Functional Ambulation Category and FIM and FIM and Mini-Mental State Exam. Functional Ambulation Category correlated with performance-based gait tests. CONCLUSIONS Performance-based gait tests are feasible to conduct during early recovery after a stroke and allow better discrimination among the patients than qualitative measures.

Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome.

Lim PA, Ng YS, Tay BK. Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome. Arch Phys Med Rehabil 2004;85:1365–70. Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.

Rehabilitation of orthopedic and rheumatologic disorders. 4. Musculoskeletal disorders

This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with orthopedic and musculoskeletal disorders. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses new advances in such topics as idiopathic scoliosis, nontraumatic shoulder pain, rotator cuff tendinitis, and Dupuytrens disease.

Rehabilitation of orthopedic and rheumatologic disorders. 1. Osteoporosis.

This self-directed learning module reviews and summarizes recent literature on osteoporosis. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The areas covered include pathophysiology of primary and secondary osteoporosis, effects of various pharmacologic treatments on bone metabolism, and the utility of available diagnostic tests. Management strategies for perimenopausal women as compared with postmenopausal women with established osteoporosis are discussed. This is followed by an evaluation and management plan for the older man with acute osteoporotic fracture.

Rehabilitation of orthopedic and rheumatologic disorders. 3. Degenerative joint disease

This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with osteoarthritis. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include updates on conservative and operative treatment of lumbar spinal stenosis and pediatric hip diseases, prophylactic therapy for thromboembolic disease after lower limb joint replacement, new therapies for osteoarthritis, and the impact of exercise on outcome following hip replacement in active persons.

Rehabilitation of orthopedic and rheumatologic disorders. 2. Connective tissue diseases

This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with connective tissue diseases. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include the management of patients who have polymyalgia rheumatica, juvenile rheumatoid arthritis, ankylosing spondylitis, rheumatoid cervical spine, and rheumatoid hand.

Poster 162: Depression assessment in rehabilitation patients with communication difficulties: the Cornell depression scale.1

Abstract Objective: To use the Cornell Depression Scale (CDS) to diagnose major depression in rehabilitation inpatients with communication difficulties, using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), as standard assessment tool. Design: Prospective clinical trial. Setting: Rehabilitation medicine unit in a tertiary teaching hospital. Participants: Consecutive general rehabilitation patients (61.8% strokes, others being head injuries, spinal cord injuries, deconditioning) admitted between May and August 2002. Patients who did not complete their rehabilitation program for various reasons (including medical instability) were excluded from analysis. Interventions: All 78 patients admitted were screened by the same investigator for depressive signs and symptoms using DSM-IV criteria on admission, and then on a weekly basis until discharge. Of the 68 patients who completed rehabilitation, 14 (20.6%) had communication difficulties (defined as a score of Main Outcome Measure: Presence or absence of major depression, as determined by the CDS and/or DSM-IV criteria. Results: 13 (19.1%) of the 68 patients were diagnosed with major depression using the DSM IV. Of these, 4 patients had communication difficulty; they also fulfilled the criteria for major depression on the CDS. Importantly, the remaining 10 patients with communication difficulty did not have depression as assessed by the DSM-IV and the CDS. There was hence a 100% correlation between the 2 tools. Conclusions: Diagnosis of major depression in the presence of communication difficulties can be challenging. The CDS, a nonverbal assessment tool focusing on observers’ ratings and originally constructed for patients with dementia, showed accurate correlation with the well-established DSM-IV and may hence be useful in rehabilitation patients with communication difficulties. A larger study, to ensure accuracy and statistical significance of this correlation, is necessary.