Brain lesions may disturb hand functioning in children with cerebral palsy (CP), making it difficult or even impossible for them to perform several manual activities. Most conventional treatments for ...hand dysfunction in CP assume that reducing the hand dysfunctions will improve the capacity to manage activities (i.e., manual ability, MA). The aim of this study was to investigate the directional relationships (direct and indirect pathways) through which hand skills influence MA in children with CP. A total of 136 children with CP (mean age: 10 years; range: 6-16 years; 35 quadriplegics, 24 diplegics, 77 hemiplegics) were assessed. Six hand skills were measured on both hands: touch-pressure detection (Semmes-Weinstein esthesiometer), stereognosis (Manual Form Perception Test), proprioception (passive mobilization of the metacarpophalangeal joints), grip strength (GS) (Jamar dynamometer), gross manual dexterity (GMD) (Box and Block Test), and fine finger dexterity (Purdue Pegboard Test). MA was measured with the ABILHAND-Kids questionnaire. Correlation coefficients were used to determine the linear associations between observed variables. A path analysis of structural equation modeling was applied to test different models of causal relationships among the observed variables. Purely sensory impairments did seem not to play a significant role in the capacity to perform manual activities. According to path analysis, GMD in both hands and stereognosis in the dominant hand were directly related to MA, whereas GS was indirectly related to MA through its relationship with GMD. However, one-third of the variance in MA measures could not be explained by hand skills. It can be concluded that MA is not simply the integration of hand skills in daily activities and should be treated per se, supporting activity-based interventions.
The aim of this research was to investigate the physical functioning of patients with myopathy and to measure its influence on quality of life (QoL). Previous studies have observed a lower QoL in ...myopathy than in control patients but its relationship with physical functioning as not yet been evaluated. We hypothesized that motor abilities evolution would predict a lower physical and psychological QoL.
Twenty-five patients with adult-form myopathy were included: 14 patients with myotonic dystrophy type 1, 6 with facioscapulohumeral dystrophy, 2 with limb girdle muscular dystrophy, 1 with mitochondrial myopathy, 1 with Central Cores myopathy, 1 with Ullrich muscular dystrophy (population description in Table 1, n=25).
They all answered two questionnaires of QoL: Medical Outcomes Short-Form 36 (SF-36) which gives a physical and a mental score and the Quality of Life of genetics neuromuscular diseases (QoL-gNMD) which gives three under-scores: Body symptom, Self-perception, Activity and participation. The physical functioning was evaluated with two measures by physiotherapists: balance with the Berg Scale and walking range with the 6 Minute Walk Test.
Linear regression analysis showed the 6 Minute Walk Test was significantly predictor of the three scores of QoL-gNMD and the physical score of SF-36. The under-score “Activity and Participation” was also predicted by a balance trouble (Table 2). None independent variable was linked with the mental score of SF-36.
Results reveal the negative influence of the physical function lost on QoL, especially the walking range. Effects are observed in body aspects like symptom or social relationship as well as deeper psychological aspects as the self-perception. So, it appears very important to take into account the motor abilities evolution of each patient in order to recommend an adapted rehabilitation, and if necessary, a psychological support to optimally preserve their quality of life.
To allow different views on motor learning to inform rehabilitation research, the authors aimed to explicate a frequently missed yet fundamental difference in starting point of such views. By ...considering how rehabilitation in practice answers the question of what parts an activity consists of, reductive and emergent approaches to motor learning are identified and traced throughout rehabilitation practice. The authors show that when a task is cut up along reductive dimensions while also apparently relying on emergent components, this unequally favors the reductive approach and acts to limit the views on motor learning available. By showing the approaches in practice, the authors hope to inspire an awareness that brings both approaches the opportunity to independently inform research so that new theories and practices can proliferate.
Abstract Homonymous visual field defects (HVFDs) are a common consequence of posterior brain injury. Most patients do not recover spontaneously and require rehabiliation. To determine whether a ...certain intervention may help an individual patient, it is necessary to predict the patient's level of functioning and the effect of specific training. We provide an overview of both the existing literature on HVFDs in terms of the International Classification of Functioning, Disability, and Health (ICF) components and the variables predicting the functioning of HVFD patients or the effect of treatment. We systematically analyzed 221 publications on HVFD. All variables included in these articles were classified according to the ICF, as developed by the World Health Organization, and checked for their predictive value. We found that ICF helps to clarify the scope of the existing literature and provides a framework for designing future studies, which should consider including more outcome measures related to Activities and Participation. Although several factors have been described that predict HVFD patients' level of functioning or the effects of training, additional research is necessary to identify more.
Purpose. To validate the body functions and activities and participation part of the extended International Classification of Functioning, Disability, and Health (ICF) core set for stroke with a ...Swedish population in the first 3 months post-stroke.
Method. At 6 weeks and at 3 months post-stroke, stroke survivors were evaluated by 59 ICF categories of body functions, 59 categories of activities and participation from the stroke ICF core set (extended version).
Results. The study sample included 99 stroke survivors (54% women) with an average age of 72 years. Statistical significant problems were identified in 28 ICF categories of body functions and in 41 ICF categories of activities and participation at both time points, at 6 weeks and at 3 months. About 17 ICF categories were reported as problems in independent (i.e. modified Rankin Scale (mRS) ≤2) and about 34 categories in dependent (i.e. mRS > 2) stroke survivors.
Conclusions. The results suggest a possible reduction of the stroke ICF core set from 59 to 28 categories of body functions and from 59 to 41 categories of activities and participation. Hence, feasibility of the core set for multiprofessional assessment increases and the core set might find more integration in clinical practice. The number of problems in mobility and self-care mainly distinguished between independent and dependent stroke survivors.
The purpose of this short commentary is to explain a European-based Body Function Therapy (BFT) facilitation technique that could be used in therapeutic recreation settings. BFT draws from the ...postmodern theory of leisure axioms of hedonistic pleasure and the pursuit of bodily experience and includes leisure that stimulates the five senses of sight (ophthalmoception), hearing (audioception), taste (gustaoception), smell (olfacoception or olfacception) and touch (tactioception).
Background: Family-centred ideology is increasingly regarded as a conceptual foundation in services to children with disabilities.
Objective: First, to examine the extent to which parents and ...therapists perceive the service as family-centred; second, to explore factors affecting parents' perceptions of the service; and third, to explore how parents understood service aspects typically characterising family-centred services (FCS), such as the goal-setting process.
Material and methods: Parents of 236 children and 25 therapists completed questionnaires (MPOC-32; MPOC-SP). Five parents shared their experiences in an open interview.
Results: On average parents and professionals consider the service to be family-centred from a 'fairly great' extent (Respectful and Supportive Care/Treating People Respectfully) to a 'small' extent (Providing General Information). Parents' experiences were influenced by their child's age, functional performance, and type of disability. Analysis of interview data revealed three categories: Experiencing trust and respect, Collaborating or just following instructions?, and Balancing therapy with daily activities.
Conclusion: Parents praise interpersonal relations but lack of information limits their possibilities to make informed choices about services. In order to translate better into the daily life of the family the intervention should focus more on their activities, routines and participation within the communities they live in.
Purpose. To determine the relationship between body functions, comorbidity and cognitive functioning on the one side and limitations in activities on the other, in elderly patients with ...osteoarthritis (OA) of the hip or knee.
Method. A cross-sectional cohort study was conducted in which 288 patients with hip or knee OA were included. Patients were recruited from rehabilitation centres and hospitals (Departments of Orthopedics, Rheumatology or Rehabilitation). Apart from demographic and clinical data, information about limitations in activities, body functions (pain, muscle strength, range of joint motion), comorbidity and cognitive functioning was collected by questionnaires and tests. Statistical analyses included univariate and stepwise multivariate regression analysis.
Results. Self-reported limitations in activities (Western Ontario and McMaster Universities Osteoarthritis Index) were significantly associated with pain, muscle strength knee extension, range of motion (ROM) hip flexion and morbidity count. Performance-based limitations in activities (timed walking test) were significantly associated with ROM (knee flexion, hip flexion and knee extension), muscle strength hip abduction, pain, cognitive functioning and age.
Conclusions. Self-reported limitations in activities in hip or knee OA are largely dependent on pain and to a lesser extent on range of joint motion, muscle strength and comorbidity. Performance-based limitations in activities are largely dependent on range of joint motion and muscle strength, and to a lesser extent on pain, cognitive functioning and other factors. These findings point to the role of body functions in limitations in activities in OA of the hip or knee. Although less important, comorbidity and cognitive functioning play a role as well.
Purpose: The aim of this study was to investigate the relations between the ICF components from a subjective perspective. Method: Data on health condition and perceived functioning were collected ...among 2941 individuals with at least one chronic disease or disorder. Path analysis was used with perceived level of participation as the final denominator. Three models were tested: one with the number of chronic diseases and disorders as an indicator of health condition, one with perceived health as indicator of health condition, and one with perceived health as part of the personal factors. Results: Although all models showed a good fit, the model with the best fit was that with perceived health as an indicator of health condition. Conclusions: From a patient's perspective, components of the ICF scheme appear to be associated with each other, with perceived health being the best indicator of the health condition.
Implications for Rehabilitation
The International Classification of Functioning, Disability and Health (ICF) is a international accepted framework to describe human functioning from a health perspective.
In research the ICF components are mostly operationalized using objective measures, for instance Performance tests.
This large scale study shows that also with perceived measures and independent of a specific health condition relations between the ICF components can be found.
Allogenic solid organ transplantation has become the routine procedure in patients with end stage organ disease. Although the transplanted organ compensates deficient body functions, its allogenic ...nature requires institution of immune tolerance, nowadays provided by immunosuppressive drug administration. Both the safety and efficacy of immunosuppressive treatment depend on many factors, and maintaining levels of immunosuppressants within therapeutic range is the essential target for success in graft function preservation. It is obvious that drug and metabolite concentrations depend on efficiency of individual patient metabolism. Recently, many studies were undertaken to investigate the relationship between genetic factors, drug pharmacokinetics and therapy outcome, and interindividual variability apparently can be explained, at least in part, by genetically determined polymorphisms of xenobiotic-metabolizing enzymes, transport proteins and also in some cases, drug targets. This review presents the recent state of knowledge in the field of pharmacogenetics related to solid organ transplantation.
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