Clinical Rehabilitation

The frequency of perceptual problems in stroke patients was assessed using a standardised assessment, The Rivermead Perceptual Assessment Battery.¹ One hundred and fifty stroke patients (75 right hemiplegic and 75 left hemiplegic), admitted consecutively to two general hospitals, were assessed one month after stroke, to identify the proportion with perceptual difficulties. Perceptual difficulties were identified in 71 % of right hemiplegic stroke patients and 81 % of left hemiplegic patients. They were identified in 97% of dysphasic right hemiplegic patients, compared to 47% of nondysphasic right hemiplegic patients and 84% of female hemiplegic patients, compared to 67% of male hemiplegic patients. Unilateral neglect was identified in both right and left hemiplegic patients. The proportion of patients with neglect varied according to the measure chosen. The results indicate that perceptual problems are common following both right and left hemiplegic stroke, with unilateral neglect accounting for a relatively small proportion of the problems.

Pulmonary infections, possibly due to poor pulmonary functions, are common in individuals with muscular dystrophy. In order to evaluate the relative effects of seating devices on pulmonary function the forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and forced expiratory time (FET) in eight adults aged between 12 and 21 years with Duchenne Muscular Dystrophy was measured while seated in an adaptive and a nonadaptive seating device. The results showed a 28.0% increase in FVC, a 14.5% increase in FEV₁, and a 17.3% increase in FET in the adaptive seating system compared to the nonadaptive system. This result emphasizes the need for proper seating as an important way of maximising pulmonary function and minimizing pulmonary complications in this population.

This study was undertaken to determine if static standing capacity in 81 hemiparetic stroke patients was related to the static strength of seven muscle groups of both the paretic and nonparetic lower extremities. Standing capacity was graded using an ordinal scale. Static strength was measured using a hand held dynamometer. Standing capacity was correlated (p<0.01) with the strength of six muscle groups of each lower extremity. Regression analysis revealed that standing capacity was predictable by the strength of the paretic muscle groups (adjusted R ² = 0.193, F = 3.74, p = 0.002), but not the nonparetic muscle groups (adjusted R ² = 0.121, F = 2.57, p = 0.020). Because of the distribution of standing scores in this study and the limited explanation of standing capacity by the strength measurements, further study is important if the factors responsible for standing capacity are to be identified. Such identification should help direct the choice of treatment strategies.

There is little information available about the characteristics of patients admitted to geriatric units with high and low turnover rates of patients. It is often suggested that high turnover units do not admit the more physically disabled person. This study set out to investigate whether this view is true. Six geriatric units with different patient discharge rates were investigated. Those units with a high turnover of patients tend to admit more severely immobile people per bed, when compared to those units with below average throughput. Although these immobile people admitted to high turnover units suffered a higher mortality rate, a significantly greater proportion regained the ability to transfer themselves independently from bed to chair and to the toilet.

A ranked assessment of daily living (ADL) scale has been developed to assess activities which may be important to stroke patients who have been discharged home. A questionnaire incorporating 22 ADL activities in four sections was sent by post to 80 consecutively registered stroke patients. Gutmann scaling was carried out on the returned questionnaires, producing acceptable coefficients of reproducibility and scalability. The revised questionnaire was then sent to 20 stroke patients. The same patients were sent an identical questionnaire two weeks later. The overall level of agreement between the two assessments was satisfactory. The extended ADL scale could therefore be used as a postal questionnaire to assist in the follow-up of patients discharged home after a stroke. Due to the scaling properties of the assessment, patient's progress can be monitored and patients can also be compared on the basis of their scale score.

The first impressions formed by 91 therapists shown silent videorecordings of four patients with idiopathic Parkinson's disease and four with ischaemic heart disease were assessed using visual analogue scales directed at aspects of mood, personality and intellect. Although both patient groups showed no abnormalities in terms of affect, personality and intelligence by standardised psychological tests, the Parkinsonian patients appeared more anxious, hostile, suspicious, unhappy, bored and tense than the cardiac cases; they came across as less intelligent, more introverted and passive, less stable and tough minded; they seemed to enjoy and maintain their part in the conversation less well and relate less to the interviewer and overall they were rated as less likeable. These findings are related to the known effects of speech impairment on impression formation in Parkinson's disease and are discussed in terms of the possible effects on therapeutic relationships and their bearing on diagnosis of psychiatric disturbance in the condition.

A 66-year-old woman with a history of total hysterectomy (1953) and healed myocardial infarction (1978) first complained in 1981 of signs and symptoms suggestive of normal pressure hydrocephalus. The condition was followed up and in 1983 was confirmed by Computer Assisted Tomography (CT). She was treated by ventriculo-peritoneal shunt only in 1986. Rehabilitation was started as early as possible postoperatively. Of the major neurological signs, namely gait abnormality, incontinence and dementia, only gait abnormality showed some improvement although gait-related cerebellar dysfunction remained unchanged. Thus progression of the disease was halted by the surgical procedure and subsequent rehabilitative therapy was partially effective despite the prolonged delay in operative treatment of the disease in this patient.

Patients who do not recognise their disabilities are extremely difficult to treat and manage. This paper describes a method by which feedback about errors was provided for a patient who could not acknowledge that his intellectual function was impaired following a severe head injury. This brought about a shift in his attitude and aided his successful resettlement. The nature of denial following brain injury is discussed.

Decades after their acute infection, many polio survivors are suffering renewed muscle weakness, increasing respiratory difficulties, musculoskeletal pain, fatigue and cold intolerance which lead to a 'second disability'. Some symptoms are due to chronic mechanical strain caused by using joints rendered unstable after the acute infection. The cause of others, such as postpoliomyelitis muscular atrophy, is . unknown although overuse, ageing, disuse atrophy and metabolic fatigue of axon sprouts in the abnormally large motor units may play a role. The aim of rehabilitation is to halt the progress of the condition and reduce its physical and psychological impact. Reduction in strenuous activity is important. The use of orthoses or a wheelchair may help to reduce pain and the energy cost of mobility. Respiratory aids such as the cuirasse can improve health. Counselling and peer group support can help the patient to accept his physical limitations.