Satisfaction with and usage of a hand neuroprosthesis

OBJECTIVE: To measure the satisfaction with, clinical impact of, and use of an implantable hand neuroprosthesis. SETTING: Eight different medical centers. PARTICIPANTS: Thirty-four individuals with spinal cord injuries at the C5 or C6 motor level. INTERVENTIONS: Participants were implemented with a hand neuroprosthesis that provides grasp and release. The neuroprosthesis includes a surgically implanted stimulator, implanted electrodes sutured to the hand and forearm muscles, and an externally mounted controller. MAIN OUTCOME MEASURE: A survey was mailed to study participants, who were asked to respond to statements such as "If I had it to do over, I would have the hand system implanted again," using a 5-level Likert scale ("strongly agree" to "strongly disagree"). RESULTS: Eighty-seven percent of participants were very satisfied with the neuroprosthesis, 88% reported a positive impact on their life, 87% reported improvements in activities of daily living, and 81% reported improved independence. Participants reported using the neuroprosthesis a median of 5.5 days per week; 15 participants used the neuroprosthesis 7 days per week, and 5 participants reported not using the device. CONCLUSIONS: The neuroprosthesis was used by most participants. The neuroprosthesis performed satisfactorily, increased users' ability to perform activities of daily living and independence, and improved their quality of life.     

The impact of slower walking speed on activities of daily living in patients with multiple sclerosis

Aims: To identify the relevance and impact of walking speed (WS) over a short distance on activities of daily living (ADLs) in patients with multiple sclerosis (MS). Methods: An internet‐administered survey of MS patients in four countries was distributed to 605 individuals in 2010. Participants had MS for > 5 years and must have reported difficulty walking as a result of MS. The impact of MS on walking and the effects of WS on ADLs were assessed based upon responses (scored on a scale of 1–10) to five questions and categorised post hoc as: high (8–10), moderate (4–7) or low (1–3) impact/importance. Results: Of the participants who completed the survey (n = 112), 60% were female patients, 63% were aged ≥ 45 years, and 55% had relapsing‐remitting MS. Approximately, half of participants reported a high impact of MS on their general walking ability (46%) and their ability to increase WS over a short distance (55%). Up to 53% of participants reported avoiding ADLs because of concerns about WS; within this cohort, older male patients and patients with secondary‐progressive MS were highly represented. Discussion: These results, which highlight the importance of WS to patients with MS and emphasise the impact of WS on health‐related quality of life and ADLs, underscore the importance of clinical measures of WS, such as the timed 25‐foot walk, in assessing walking in MS patients. Conclusion: Walking speed over a short distance has a significant impact on ADLs for patients with MS.     

Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study

OBJECTIVE: To evaluate an implanted neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand. DESIGN: Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the neuroprosthesis activated. SETTING: Tertiary spinal cord injury (SCI) care centers, 8 in the United States, 1 in the United Kingdom, and 1 in Australia. PARTICIPANTS: Fifty-one tetraplegic adults with C5 or C6 SCIs. INTERVENTION: An implanted neuroprosthetic system, in which electric stimulation of the grasping muscles of 1 arm are controlled by using contralateral shoulder movements, and concurrent tendon transfer surgery. Assessed participants' ability to grasp, move, and release standardized objects; degree of assistance required to perform activities of daily living (ADLs), device usage; and user satisfaction. MAIN OUTCOME MEASURES: Pinch force; grasp and release tests; ADL abilities test and ADL assessment test; and user satisfaction survey. RESULTS: Pinch force was significantly greater with the neuroprosthesis in all available 50 participants, and grasp-release abilities were improved in 49. All tested participants (49/49) were more independent in performing ADLs with the neuroprosthesis than they were without it. Home use of the device for regular function and exercise was reported by over 90% of the participants, and satisfaction with the neuroprosthesis was high. CONCLUSIONS: The grasping ability provided by the neuroprosthesis is substantial and lasting. The neuroprosthesis is safe, well accepted by users, and offers improved independence for a population without comparable alternatives.     

The immediate and short-term effects of a wrist extension orthosis on upper-extremity kinematics and range of shoulder motion.

OBJECTIVE: The purpose of this study was to investigate upper-extremity kinematics and range of shoulder motion while wearing a wrist extension orthosis compared to the free hand at initial testing and after a week's wear. METHOD: A convenience sample of healthy women, ages 20-50 years, performed a stacking task and a pouring task, freehanded and splinted, at two times, 1 week apart in this counterbalanced, repeated measures design. A Motion Analysis 3-D system measured quality of movement and range of motion variables. A 2 by 2 analysis of variance (splinted vs. freehanded by time of testing) was used to analyze each variable. RESULTS: In both tasks, participants tended to move more slowly (p = 0.005) with less direct movements (p < .001) when wearing the orthosis. In stacking, splinted movements were also less smooth than when free-handed (p < .0001). When splinted both tasks required more shoulder abduction (p < .0001) and pouring required more shoulder flexion (p < .0001). Participants demonstrated several improvements in quality of movement and amount of shoulder motion used after a weeks' orthotic wear, indicating some adaptation to the orthosis with use. CONCLUSION: In this study, a wrist extension orthosis interfered with the quality of upper-extremity movement and required more range of shoulder movement compared to the free hand. Future research is needed to determine whether persons with upper-extremity conditions (i.e., arthritis, carpal tunnel syndrome) respond similarly to wrist orthoses. Therapists should consider discussing with patients how their wrist splint could affect their hand performance and help patients learn techniques to reduce stress on their proximal joints.     

Electrically stimulated elbow extension in persons with C5/C6 tetraplegia: a functional and physiological evaluation

OBJECTIVE: To measure the effect of electrically stimulated triceps on elbow extension strength, range of motion, and the performance of overhead reaching tasks. SETTING: Clinical research laboratory. PARTICIPANTS: Four individuals with spinal cord injuries at the C5 or C6 motor level. INTERVENTIONS: The participants, who already had an implanted upper extremity neuroprosthesis, were provided with elbow extension through functional electrical stimulation (FES) of the triceps brachii. MAIN OUTCOME MEASURES: Comparisons of stimulated elbow extension to voluntary elbow extension: (1) evaluations of impairment such as range of motion and strength; (2) performance of a set of functional overhead reaching tasks that required elbow extension; (3) a usage survey (conducted by telephone) to examine use of triceps stimulation in the home and community. RESULTS: All participants achieved greater range of motion and strength of elbow extension with stimulated triceps versus without. Overall functional task performance improved in 100% of the tasks tested for all but one participant, who showed improvement in 60% of the tasks. Participants reported using the triceps in at least one activity for at least 90% of the days the neuroprosthesis was donned.     

Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living

OBJECTIVES: To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: General community, international. PARTICIPANTS: Volunteers (N=352) with SCI for more than 20 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The need for more help with ADLs. RESULTS: The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI. CONCLUSIONS: People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.     

Intradiscal Thermal Annuloplasty for Discogenic Pain: An Outcome Study

Objectives: Published studies of intradiscal thermal annuloplasty (IDTA) have shown at most 50% pain relief as an improved outcome with little focus on functional improvement in the treatment of discogenic pain. Previous studies have used a number of criteria for patient selection including low back pain unresponsive to conservative care, no compressive radiculopathy, positive provocative discography and absence of previous surgery at the same symptomatic level. The purpose of present study is to examine the hypothesis that additional inclusion criteria for patient selection such as disc height, absence of degenerative disc disease (DDD) in untreated discs, absence of herniated nucleus pulposus or lumbar canal stenosis may improve the outcome of treatment. Methods: In this prospective case‐series study additional criteria of patient selection were introduced, namely disc height of at least 50%, no lumbar canal stenosis, one or two levels of DDD, no evidence of nucleus pulposus herniation on magnetic resonance image. Thirty‐four patients were enrolled in the study and 32 of them were followed over a period of 12 months. The visual analog scale (VAS) pain score and seven activities of daily living (ADLs) were followed and reported on a scale from 0 to 10. Results: Sustained decrease of the VAS pain scores was observed from 3 to 12 months following IDTA. ADLs improved in all patients between 3 and 12 months post‐treatment. Patients in the Bureau of Workers Compensation (BWC) group had a higher VAS score but showed the same level of improvement in ADLs as compared to commercial insurance or self‐pay patients. In the non‐BWC patient group an average VAS pain score decrease of more than 6 points on a 10‐point scale was reported at 6 to 12 months following IDTA. Conclusions: We found dramatic improvement of pain scores and ADLs following IDTA when strict patient selection was applied. We believe that IDTA is an effective, minimally invasive treatment for discogenic pain in properly selected patients.     

Fear of pain influences outcomes after exercise-induced delayed onset muscle soreness at the shoulder

OBJECTIVES: This study investigated whether anxiety, fear of pain, or pain catastrophizing were predictive of pain-related outcomes after induced delayed onset muscle soreness (DOMS) at the shoulder. METHODS: Healthy participants (19 males and 23 females) were eligible for participation if they had (a) no history of neck or shoulder pain, (b) no sensory or motor impairments of the upper-extremity, (c) not regularly participating in upper-extremity weight training, (d) not currently or regularly taking pain medication, and (e) no history of upper-extremity surgery. Participants completed self-report measures for fear of pain, pain catastrophizing, and anxiety. Then, participants underwent a standard fatigue protocol to induce DOMS in the shoulder external rotator muscles. Participants were reassessed 24 hours after DOMS induction on clinical and evoked pressure pain reports, muscle force production, self-report of upper-extremity disability, and kinesiophobia. Stepwise regression models considered sex, anxiety, pain intensity, fear of pain, and pain catastrophizing as outcome predictors. RESULTS: Fear of pain alone explained 16% (P=0.008) of the variance in clinical pain and 10% (P=0.047) evoked pressure pain intensity. Clinical pain intensity alone explained 11% (P<0.031) of the variance in muscle force production. Clinical pain intensity and fear of pain explained 50% (P<0.001) of the variance in upper-extremity disability, whereas fear of pain and sex accounted for 26% (P=0.005) of the variance in kinesiophobia. CONCLUSIONS: With the exception of muscle force production, fear of pain had a consistent influence on shoulder DOMS outcomes, even after controlling for pain intensity. This study suggests fear of pain may be a relevant psychologic factor to consider in clinical studies investigating the development and treatment of chronic shoulder pain.     

Impact of home modification services on ability in everyday life for people ageing with disabilities.

OBJECTIVE: To examine the impact of home modifications on self-rated ability in everyday life from various aspects for people ageing with disabilities. METHODS: The study sample was recruited from an agency providing home modification services in Sweden and comprised 73 subjects whose referrals had been approved and who were scheduled to receive home modifications (intervention group) and 41 subjects waiting for their applications to be assessed for approval (comparison group). The subjects rated their ability in everyday life using the Client-Clinician Assessment Protocol Part I on 2 occasions: at baseline and follow-up. The Client-Clinician Assessment Protocol Part I provides data on the clients' self-rated independence, difficulty and safety in everyday life. The data were first subjected to Rasch analysis in order to convert the raw scores into interval measures. Further analyses to investigate changes in self-rated ability were conducted with parametric statistics. RESULTS: Subjects who had received home modifications reported a statistically significant improvement in their self-rated ability in everyday life compared with those in the comparison group. Subjects who had received home modifications reported less difficulty and increased safety, especially in tasks related to self-care in the bathroom and transfers, such as getting in and out of the home. CONCLUSION: Home modifications have a positive impact on self-rated ability in everyday life, especially on decreasing the level of difficulty and increasing safety.     

Upper-extremity torque production in men with paraplegia who use wheelchairs

OBJECTIVES: To study maximal upper-extremity torque values and agonist/antagonist torque ratios in a sample of individuals with paraplegia and to compare these values with a sample of age-, gender-, and weight-matched able-bodied individuals. DESIGN: Cross-sectional, case-control study. SETTING: A biomechanics laboratory. PARTICIPANTS: A convenience sample of 15 men with complete (American Spinal Injury Association class A) T5-L2 paraplegia and 15 able-bodied control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal isometric torques of 12 upper-extremity muscle groups (shoulder, elbow, and wrist flexion and extension; shoulder abduction and adduction; shoulder internal and external rotation; elbow pronation and supination) were measured with custom dynamometers. RESULTS: Maximal torque values and agonist/antagonist torque ratios for the shoulder, elbow, and wrist functions did not differ between the control subjects and those with complete paraplegia, with the exception of the supination/pronation torque ratio, which was significantly higher in the able-bodied control group. CONCLUSION: Wheelchair propulsion and other functional activities, such as transfers, do not significantly affect maximum torque production of the upper extremities in individuals with paraplegia. On the basis of these findings, arguments that upper-extremity muscle imbalances are important contributory factors to upper-extremity pain and dysfunction in this group may be too simplistic.     

Oropharyngeal dysphagia: the experience of patients with non-head and neck cancers receiving specialist palliative care

BACKGROUND: Difficulty swallowing is a well-documented symptom in head and neck cancer and oesophageal malignancy. The frequency of oropharyngeal swallowing difficulties in the palliative phase of other malignancies is less reported. AIM: 1) To describe the patient experience of swallowing and associated difficulties while receiving specialist palliative care for malignancies other than those affecting the head and neck and 2) to identify the quality of life issues for the participants with dysphagia and compare with normative and dysphagic data provided by SWAL-QOL. DESIGN: Four month prospective pilot study - questionnaire design. SETTING: Acute teaching hospital. PARTICIPANTS: Eleven patients receiving specialist palliative care. METHODS: Participants were interviewed using a modified version of the SWAL-QOL, a validated quality of life assessment tool for use specifically with people with oropharyngeal dysphagia. Eight quality of life domains were explored as well as fourteen dysphagic symptoms. RESULTS: Seven of the 11 participants had dysphagic symptoms detailed in the SWAL-QOL and a further two patients reported transient dysphagic symptoms since diagnosis of their disease. Nine participants reported an impact on their quality of life and three reported a considerable impact in four or more domains. Eight of the 11 participants had self-selected softer textured foods. A notable group were three patients with lung cancer and one with lung metastases with a history of vocal fold motion impairment, all of who had experienced dysphagic symptoms since diagnosis. CONCLUSIONS: Patients with cancers not affecting the head and neck are at risk of developing symptoms of oropharyngeal dysphagia and subsequently, compromized nutrition, hydration and quality of life. Areas for further research are suggested.     

The cooling-suit: case studies of its influence on fatigue among eight individuals with multiple sclerosis

AIM OF THE STUDY: To study if the use of a cooling-suit by individuals with multiple sclerosis (MS) influenced their experience of fatigue and consequent restrictions in daily life. BACKGROUND: The majority of MS patients consider fatigue as one of their most disabling symptoms and as having a significant impact on their daily lives. Fatigue often increases in a warm environment. A cooling-suit has been reported as a practical method of cooling, but the effect on fatigue has not yet been studied. RESEARCH METHODS: Eight individuals used a cooling-suit in their own homes during a test-period. In a single case-control design, their experience of fatigue was studied before and after. Quantitative and qualitative methods were used: self-assessments using the Fatigue Impact Scale (FIS), open-ended interviews and semi-structured diaries. RESULTS: All study participants reported a reduction in fatigue during the test period. On the FIS, they scored reductions in the physical, cognitive and psycho-social dimensions of daily life. They experienced fatigue less often and for shorter periods. In their diaries and interviews they described decreased muscular strain, less sense of fatigue in relation to intake of food and positive effects on cognitive, social or affective problems related to fatigue. DISCUSSION: The cooling-suit is a practical method for cooling. It gives freedom and flexibility and can be used regardless of setting. Nurses who meet heat-sensitive individuals with MS have the opportunity to give information on cooling methods, including how to use a cooling-suit. In this pilot study we found that individuals with MS who suffered from fatigue reported a number of improvements in quality of daily life. CONCLUSIONS: The result indicates that use of a cooling-suit by individuals with MS may decrease their sense of fatigue. In this sample positive outcomes on daily life situations were reported. Further studies are needed to support these results.     

Does reflexology impact on cancer patients' quality of life?

AIM: The objective of this study was to determine whether reflexology has an impact on the quality of life of patients in the palliative stage of cancer. METHOD: Twelve patients in the palliative stage of cancer with various tumour types were randomised into two groups. They were randomly assigned to receive either reflexology or placebo reflexology. All participants completed a linear analogue self-assessment scale relating to quality of life. All participants then received three sessions of either reflexology or placebo reflexology. The same person, a qualified reflexologist, provided the interventions for both groups. The participants were not aware of which intervention they were receiving. All participants then completed a second linear analogue self-assessment scale relating to quality of life. RESULTS: All participants felt that their quality of life had improved, even those who had received the placebo treatment. The reflexology group, however, reported more benefit than the placebo group. There was a significant difference (p = 0.004) between the reflexology group and the placebo group. CONCLUSION: This study showed that reflexology does have an impact on the quality of life of patients in the palliative stage of cancer.     

Dissatisfaction with medical services among Medicare beneficiaries with disabilities

OBJECTIVE: To test the hypothesis that Medicare beneficiaries who have difficulties performing activities of daily living (ADLs) are more likely to report dissatisfaction with their health care than those without ADL difficulties. DESIGN: Cross-sectional study. SETTING: Sample from the 1998 Medicare Current Beneficiaries Survey. PARTICIPANTS: A population-based sample (N=19,650) of noninstitutionalized Medicare beneficiaries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Satisfaction with overall quality and 9 specific aspects of medical services received in the last year. RESULTS: After adjusting for sociodemographic, behavioral, and system characteristics and compared with those without ADL difficulties, Medicare enrollees were more likely to report dissatisfaction with the overall quality of their health care as their number of activity restrictions increased (1-2 ADLs: odds ratio [OR]=1.5; 95% confidence interval [CI], 1.2-2.0; 3-4 ADLs: OR=1.7; 95% CI, 1.2-2.4; 5-6 ADLs: OR=1.9; 95% CI, 1.4-2.8). Analysis of satisfaction with the 9 specific aspects of care yielded similar results. CONCLUSION: Disability is a significant independent risk factor for dissatisfaction with health care in the Medicare population. Efforts should be made to identify individuals with ADL difficulties and to improve their ease and convenience of getting to a doctor, the availability of care off hours, the access to specialists, and the follow-up care received.     

Perceived effects of Tango Argentino on body experience in persons with Parkinson’s disease (PD)—A qualitative study with affected persons and their partners

BackgroundPersons with Parkinson’s disease (PD) experience somatic and psycho-emotional limitations. As a neurodegenerative disease with increasing motor symptoms, PD changes the body experience. Embodied activities like dancing are beneficial to individuals with PD regarding mobility, balance and body feeling. The objective of this study was to assess the impact of Tango Argentino (TA) on body experience in individuals with PD.MethodsThis qualitative study was conducted among 12 individuals with PD and their dance partners participating in TA courses for persons with PD and uses semi-standardized interviews. The heterogeneity of the sample was mainly based on the number of TA classes, so that participants were distinguished in participants with 10 h (beginners) and participants with more than 10 h (advanced). Further variance was due to different age groups and duration of disease.ResultsParticipants reported change on five categories of body experiences: body awareness, motor symptoms and movement, general feelings, body sensations and disease-related feelings. Participants cited a shift in body awareness and improved stability, walking safety, enhanced mobility and amelioration in gestures and facial expressions. In general, participants described reduced body fatigue, anxiety, shame and frustration and increase in joy, pride, curiosity as well as reinforcement of partnership. With regard to perception, positive and negative feelings, ease, relaxation and increase of inner congruence were reported. The experience of normality and health helped to generate greater acceptance of disease burdens and to develop self-confidence and self-assurance. Dance partners confirmed the perceptions of the dancers with PD.ConclusionThe perceived effects of TA courses may be linked to a positive body awareness and body control which may be related improved motor symptoms, social and everyday life. These perceived effects should be controlled in relation to the long time change in embodied activity and body experience in persons with PD.     

Temporal structure of variability decreases in upper extremity movements post stroke

Background

The objective of this study was to determine movement variability in the more-affected upper-extremity in chronic stroke survivors. We investigated two hypotheses: (1) individuals with stroke will have increased amount of variability and altered structure of variability in upper-extremity joint movement patterns as compared to age-matched controls; and (2) the degree of motor impairment and joint kinematics will be correlated with the temporal structure of variability.

Methods

Sixteen participants with chronic stroke and nine age-matched controls performed three trials of functional reach-to-grasp. The amount of variability was quantified by computing the standard deviation of shoulder, elbow, wrist and index finger flexion/extension joint angles. The temporal structure of variability was determined by calculating approximate entropy in shoulder, elbow, wrist and index finger flexion/extension joint angles.

Findings

Individuals with stroke demonstrated greater standard deviations and significantly reduced approximate entropy values as compared to controls. Furthermore, motor impairments and kinematics demonstrated moderate to strong correlations with temporal structure of variability.

Interpretation

Changes in the temporal structure of variability in upper-extremity joint angles suggest that movement patterns used by stroke survivors are less adaptable. This knowledge may yield additional insights into the impaired motor system and suggest better interventions that can enhance upper-extremity movement adaptability.     

Neuromuscular electrical stimulation-assisted grasp training and restoration of function in the tetraplegic hand: a case series

OBJECTIVE. This study investigated the immediate effects of repetitive neuromuscular electrical stimulation (NMES)-assisted grasp-and-release activities on the hand of patients with tetraplegia.METHOD. Three participants with C-5-C-6 tetraplegia underwent grasp training with sequential application of NMES to wrist extensors, finger flexors, and finger extensors to assist participants in grasping and then releasing balls. Before the intervention, participants were assessed with the Jebsen-Taylor Hand Function Test and the Box and Block Test. They were evaluated with the same measures after the first and eighth sessions of intervention. Participants participated in eight 30-min sessions over 14 days.RESULTS. Within-participant improvements in performance were observed in all outcome measures. Subtests of the Jebsen-Taylor Hand Function Test requiring grasping function showed the greatest improvements. Participants reported reduction of spasticity and more effective grasp.CONCLUSION. NMES-assisted grasp paired with repetitive task practice resulted in improved performance on functional tests and subjectively improved hand function in the participants.     

Effect of Life Review on Quality of Life For Older Adults Living in Nursing Homes

Aim: To examine the effects of life review on daily activities, social participation, outlook on life, and perceptions of living in a nursing home measured by life satisfaction and quality of life in older adults. Method: The study design was a two-phase quasi-experimental pre-post-tests including development and testing of a life review protocol. Nine residents, age ≥65, participated in a life review group once weekly for 6 weeks. Outcomes were analyzed using the Life Satisfaction Index-Z (LSI-Z) and pre-post surveys. Results: LSI-Z scores improved post-intervention and survey outcomes indicated participation in activities of daily living (ADLs), socialization, outlook on life, and living in a nursing home perceptions improved for all participants. Conclusion: The study demonstrates the effectiveness of a life review protocol to improve ADLs, social participation, and enhancing perceptions of outlook on life and living in a nursing home enhancing QOL and life satisfaction for older adult nursing home residents.