International disability studies最新文献

At final follow-up 2-7 years after their first stroke, 328 survivors from the Oxfordshire Community Stroke Project register were assessed for mobility disability. Patients were classified as being either mobile or immobile, according to defined criteria. Of the 190 immobile patients, only 60 could be entered into a trial of physiotherapy. The major causes of attrition were refusal to participate (97 patients) and the absence of any stroke impairment causing the immobility (18). Arthritis (67) and dementia (39) were common in patients with mobility disability. Immobile patients were older and had suffered a more severe index stroke. This study stresses the relatively low frequency of long-term immobility following stroke directly due to stroke-induced impairments.

A total of 364 patients attending day centres for the physically disabled had ERSS and Barthel scores recorded during the course of assessment. In addition, 100 of the patients had PULSES profile scores recorded. Correlation of total scores for all three scales confirmed that all three succeeded in measuring disability and all three were significantly related. There were, however, weak correlations between some of the individual subscales of each score, indicating that each of the assessment tools was measuring some dimensions of disability not adequately considered by the other scales. The results suggest that while progress is being made towards better measurement of disability and handicap, further refinement of these particular measurement tools is required.

Patients were questioned 40-78 weeks after stroke to ascertain their previous and current levels of leisure participation. The results indicate a decrease with regard to both the number of activities and the frequency of participation when compared to reported pre-stroke leisure activity.

Two-dimensional (fore-aft and vertical) acceleration of locomotion was measured in 10 normal subjects and 13 patients with idiopathic olivopontocerebellar atrophy who were ataxic but able to walk without any assistance. Accelerometers were tightly placed on the third lumbar vertebra. Asymmetry and unsmoothness indices of locomotion defined from the line spectra of the accelerometric data were computed. Reproducibility of the indices was checked in the normal subjects and patients. The index values were significantly correlated with visual rating of gait unsteadiness in the patients. The indices for vertical components were significantly increased when subjects walked slowly. Effects of weights and bandages on gait were analysed by the fore-aft components of the indices. They were attached to both lower extremities. Weighting or bandaging did not change, or even increased the index values in most of the normal subjects. The indices were also unchanged in the patients. However, some of the patients showed significant improvement with weights or bandages. Mechanisms of therapeutic effects of weighting and elastic bandages on ataxia are discussed.

In 1979 a 30-bed spinal injuries unit was opened at Burwood Hospital in Christchurch, New Zealand. The design of the building included built-in environmental control facilities for tetraplegic patients. This paper outlines 10 years of experience with environmental controls in a hospital setting, and discusses some of the problems encountered. Special mention is made of ease of setting up equipment, patient interface switches, patient acceptance, and a major upgrade and modification of the original control system. Although not utilized as much as originally anticipated, a definite need for environmental controls with the spinal injuries unit has become firmly established.

The Frenchay Activities Index (FAI), a brief scale developed to measure lifestyle in stroke patients, was given to 119 community-dwelling people, aged 70 years or older, in order to obtain a baseline estimate of social, domestic, and leisure activity among older people. Factor analysis identified three main factors, similar in composition to those previously reported. A general linear models regression analysis of selected variables indicated that both fluid intelligence and memory test performance were significantly associated with level of activity. There was no significant association with age or crystallized intelligence in this sample. An apparently strong bias towards higher levels of activity among female respondents was diluted when marital status was included in the equation. This study suggests that the FAI is appropriate for measuring levels of activity in community-dwelling older people and that such activity is related to current cognitive abilities.

Graphical analysis procedures have been developed to improve interpretation of sensory-motor tests from individual subjects following acute brain damage. The procedures have been applied to 11 unilateral stroke patients assessed serially over 12 months on a computerized quantitative sensory-motor test battery of which grip strength, arm speed, and tracking have been chosen for illustrative purposes. The results indicate that four graphs are necessary to fully demonstrate neurologic impairment and recovery of each sensory-motor function, although fewer graphs would be satisfactory in some applications. Such analyses have proven valuable in the display of serial performance of individual patients but demonstration of impairment and recovery is much more difficult than for group analyses.

The focus of this paper is the opportunity structure for rehabilitation and subsequent outcome for disabled women, in comparison with disabled men. From evidence cited in the literature the differential provision of rehabilitation and other supportive services to disabled women suggests variation in outcome, based on two analytic service utilization models of rehabilitation: medical and psychosocial. Aggregate trend data (1972 and 1978) were used in the analysis of adult disabled groups, by gender and selected disabling conditions. There are two striking results from the analysis of these data sets. One indicates that receipt of rehabilitation is greatly influenced by sociodemographic factors, particularly gender and age. A detailed examination of the combination effects of gender and other sociodemographic variables shows that there are subtleties, such as an interaction between race and gender and education and gender, as well as between age and gender, that put uneducated, younger, white women at a disadvantage in their access to rehabilitation resources. The analysis of these sociodemographic factors over two points in time, however, demonstrates what can be considered a diffusion of the distinctions of social inequality, probably due to changes in rehabilitation legislation that redefined eligibility criteria for rehabilitation services and expanded programme goals. The second result of note is that neither form of rehabilitation is associated with a positive outcome, in this case ability to work. In the earlier data set (1972), indications were that neither the medical model of rehabilitation nor the psychosocial model were effective in returning the individual to the work role. This was true for both men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

Gait and balance disturbances are recognized risk factors for falls among elderly persons. The prevention of falls and their adverse complications is one of the challenges in geriatric care, requiring the early detection of risk factors. Heretofore, gait assessment procedures have required considerable investment in equipment for sophisticated biomechanical testing. This has limited the use of gait-testing procedures to the laboratory or clinic. We describe a simple and effective method for at-home or community gait testing, ELGAM (extra-laboratory gait assessment method). ELGAM was field-tested as part of a study of 36 community-dwelling elderly in Beer Sheba, Israel. The ELGAM parameters studied included step length, walking speed, initial starting style of walking, ability to turn head while walking, and static balance. Slow walking speed (less than 0.5 m/s), small steps, difficulty in turning the head, and impaired balance were significantly associated (chi-square analyses, p less than 0.01) with unstable gait. The parameters were also positively associated one with another, except for head turning. The ELGAM parameters were significantly related to self-assessed fall frequency, and reported 'near falls' among women only. In addition, among women only, slow walking speed was associated with depressive symptoms as detected by a validated screening test, the Short Geriatric Depression Scale, and with poor subjective health rating. Among 58% of this independently living elderly sample, ELGAM detected one or more risk factors. ELGAM is a 'low-tech', functionally based, effective method for direct recording of gait parameters that is applicable for community studies of the early detection of risk factors for falls and mobility problems.