International disability studies最新文献

The importance of illness or disability for traffic safety is unknown. By means of a mock car, 46 individuals suffering from left-sided hemiparesis and 67 with right-sided hemiparesis after stroke were compared with 109 healthy controls. Only patients without complicating disorders were included in the study groups. They coped far worse than the control group in almost all respects. Reaction times were longer, not merely for the paretic but also for the contralateral extremities. Strength in the 'healthy' part of the body was also significantly reduced. Sometimes patients completely failed to react to given signals. In right-sided hemiparesis a high frequency of directional errors was observed. Neuropsychological functional disorders were well in accordance with the number of erroneous reactions, but to only a minor extent with reaction times. The results of the mock car test could not be predicted on the basis of mere clinical examination.

The pain syndrome repetition strain injury (RSI) has been variously interpreted as a psychogenic disorder, an overuse injury of upper limb musculature, and a state of peripheral neural irritability. A review of the history of work-related upper limb disorders was undertaken to ascertain whether RSI is a new medical phenomenon or an older syndrome in a new guise. In the mid-nineteenth century these disorders were known as either craft palsies or writer's and other occupational cramps. Not withstanding clinical evidence suggesting that most were associated with peripheral neural or muscular dysfunction, a body of influential medical opinion considered them all to be disorders of the central nervous system, appropriately termed the occupation(al) neuroses. During the twentieth century, as discrete occupational upper limb nerve lesions were delineated and the spasmodic form of writer's cramp was recognized as a torsion dystonia, a unifying concept of aetiology for the occupational neuroses of the nineteenth century became untenable. The RSI syndrome of the 1980s can be identified from early case descriptions of both scrivener's palsy and the neuralgic variety of writer's cramp. Contemporary hypotheses proposed to explain RSI are remarkably similar to those proposed for the occupation(al) neuroses.

Objective: To investigate the effectiveness of group treatment for memory problems.

Design: A cross-over design was employed to compare the memory improvement of subjects while attending a weekly memory therapy session with a waiting period.

Setting: Outpatients.

Treatment: A variety of memory strategies were taught, and practical advice was provided in the use of external aids.

Results: No improvement in memory function was detected on the Behavioural Memory Test or Subjective Memory Questionnaire. There was an increase in the number of memory aids reported as being used after attending the group (p less than 0.05). The number of items reported on the Subjective Memory Questionnaire as 'bothering' the patient decreased in frequency (p less than 0.05) after group treatment.

Conclusions: Attendance at a memory group increased the use of memory aids but did not affect memory impairment.

Normative data on isometric back strength (IBS) are presented. The IBS of both sexes increased with chronological age, peaked at the third decade of life, and gradually declined thereafter. Males were significantly (p less than 0.001) stronger than females in all age groups, the difference ranging between 16 and 56%. A multiple regression equation was derived to predict IBS, as follows: Male IBS (kgf) = -77.71 - 0.91 age (yrs) + 0.67 height (cm) + 1.50 weight (kg) + 0.24 Quetelet index (R2 = 0.78; SE +/- 16.67 kgf) Female IBS (kgf) = -72.42 - 0.39 age (yrs) + 10.65 height (cm) + 0.08 weight (kg) + 1.04 Quetelet index (R2 = 0.62; SE +/- 10.75 kgf).

A consecutive series of 195 individuals who had had a stroke or brain trauma in 1986 responded in 1989 to a questionnaire about the consequences of the incident for occupational performance. The questionnaire contained 86 questions organized to correspond to the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH). The questions were distributed over 11 areas of occupational performance: work, leisure activities/social role, life satisfaction, sensori-motor, perceptual, intellectual, emotional function, sleep, personal care, domestic/housework/gardening, and temporal adaptation. None of the individuals considered they had attained the same level of occupational performance in all 11 areas as before the incident. Eight patterns of occupational performance were identified: 35% considered that they performed personal care at the same level and had the same temporal adaptation as before the incident, and that they had minimal impairment/disability in the other areas of occupational performance; 27% thought that they had a considerable degree of disability in all areas of occupational performance except for temporal adaptation; 8% thought that they had imbalance in temporal adaptation and severe performance difficulties in all 11 areas of occupational performance; 4% were dissatisfied with their life situation, and had a changed family role, did not practise the leisure activities they wanted, and had severe sleep problems; and for 9% the levels of performance varied a great deal and depended on the particular area of performance. The consequences of stroke or brain trauma for function and activity 3 years afterwards are considerable.

A population survey with the aim of obtaining information to facilitate the planning of services for younger physically disabled people provided the opportunity to explore the use of physical independence handicap in this context. A Phase 1 sift questionnaire was sent to one in three (25,167) occupied households in Calderdale, a district in Yorkshire, England, with a final 87% response rate. A Phase 2 in-depth interview was carried out on a stratified random sample of those identified as disabled in Phase 1. Interviews were obtained with 570 individuals aged 16-64 years, 93% of those available. The measure of physical independence handicap was derived from data obtained in the interview indicating need for help at infrequent or short intervals and immediate-needs dependence. The estimated prevalence of dependent people aged 16-64 in Calderdale is 26.6 per 1000 population (95% CI: 24.9-28.3). Rates were higher in females, and both prevalence and level of dependence increased with age. Disability in activities of daily living and locomotion was linked to the level of physical independence handicap. Problems with housework and collecting (including shopping) were most frequent for those who needed help on an infrequent basis, while self-care needs were substantial for the short and immediate-needs dependence groups. Only a small proportion reported receiving services in their home during the previous 12 months; 20% received services from a nurse and 10% the services of a local authority home help. Overall, 91% reported contact with the primary health care team within the previous 12 months and 68% with hospital and rehabilitation services.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifty-six patients with rheumatoid arthritis (RA) were assessed on two occasions three months apart. They completed two health status instruments--the Arthritis Impact Measurement Scales (AIMS) and the Nottingham Health Profile (NHP)--and the Beck Depression Inventory. In addition, clinical and serological data were gathered in order to calculate severity of disease according to the Mallya and Mace index. Health status instruments and the severity of disease index showed agreement in the assessment of mobility; similar agreement was found for different assessments of emotions. However, the two instruments provided social interaction scores with little agreement either cross-sectionally or in terms of change over time. It is argued that the generic NHP may be a valid instrument as an outcome measure in RA but the NHP and AIMS assess different aspects of social interaction. Care is needed in the selection of outcome measures to evaluate interventions.

Single-subject design and n of 1 randomized clinical trials are being advocated as methods of conducting clinical research in rehabilitation environments. The traditional procedure for interpreting data from such designs is visual analysis. This study examined the effect of including trend lines on the visual judgements made from single-subject data. Twenty-four hypothetical single-subject A-B designs were presented to 20 rehabilitation therapists for visual interpretation. The graphs represented traditional single-subject designs, including a baseline and treatment phase. Trend lines were computed and included in both phases of the design as an adjunct to visual analysis. The interrater reliability of the visual judgements was calculated using the intraclass correlation coefficient and ranged from 0.54 to 0.90. The results suggest that adding trend lines to graphed data presented in single-subject designs can improve the consistency of visual judgements. Implications for using adjuncts to graphing data points in single-subject rehabilitation research are discussed.

This paper reports on a development of the Rivermead Motor Assessment Gross Function scale, the Rivermead Mobility Index (RMI), a new measure of mobility disability which concentrates on body mobility. An early development included a second scale concentrating on elective mobility, but the results showed this to be unreliable. The RMI comprises a series of 14 questions and one direct observation, and covers a range of activities from turning over in bed to running. Its inter-observer reliability was tested on two groups of patients (n = 23 and 20 respectively) and it is reliable to a limit of 2 points (out of 15). Its validity as a measure of mobility after head injury and stroke was tested by concurrent measurement of mobility using gait speed and endurance, and by standing balance. The RMI does form a scale. It is short, simple, and clinically relevant, and can be used in hospital or at home.