A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol

Background

Knee osteoarthritis (OA) is a prevalent chronic musculoskeletal condition with no cure. Pain is the primary symptom and results from a complex interaction between structural changes, physical impairments and psychological factors. Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST) particularly in other chronic pain conditions. Though typically provided separately, there are symptom, resource and personnel advantages of exercise and PCST being delivered together by a single healthcare professional. Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management. No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population. The primary aim of this multisite randomised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA.

Methods/design

This will be an assessor-blinded, 3-arm randomised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice. Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and randomized into one of three groups: exercise alone, PCST alone, or integrated PCST and exercise. Randomisation will be stratified by city (Melbourne or Brisbane) and gender. Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale. Secondary outcomes include global rating of change, muscle strength, functional performance, physical activity levels, health related quality of life and psychological factors. Measurements will be taken at baseline and immediately following the intervention (12 weeks) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects. Specific assessment of adherence to the treatment program will also be made at weeks 22 and 42. Relative cost-effectiveness will be determined from health service usage and outcome data.

Discussion

The findings from this randomised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone.

Trial registration

Australian New Zealand Clinical Trials Registry reference number: ACTRN12610000533099

Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up

Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive-behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.

Development of a short form of the Örebro Musculoskeletal Pain Screening Questionnaire

STUDY DESIGN

A longitudinal design where the questionnaire was completed at a pretest and predictive ability evaluated with a 1-year follow-up. A second sample was employed to provide a replication.

OBJECTIVE

The aim of the study was to validate a short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMSPQ).

SUMMARY OF BACKGROUND DATA

Several studies demonstrate the research and clinical utility of the ÖMSPQ. Calls have been made for a shorter form that requires less time in administering.

METHODS

The short version was constructed by taking two items from each of the five factors shown to have predictive power. It was then tested against the long form in two samples of people with musculoskeletal pain where one reflects an occupational health care population (N = 324) and the other a primary care population (N = 183) thus providing a built-in replication. All participants completed the ÖMSPQ and were then followed over the course of a year to evaluate disability as measured by sick leave.

RESULTS

The correlation between the short and long forms was 0.91. The receiver operating characteristic curve was nearly identical for the long and short versions of the questionnaire (e.g., primary care sample: 0.84 vs. 0.81; occupational sample: 0.72 vs. 0.70). Of those who developed disability, a cutoff of 50 on the short version identified 85% in the occupational and 83% in the primary care samples which was nearly as good as the full version.

CONCLUSION

The short form of the ÖMSPQ is appropriate for clinical and research purposes, since it is nearly as accurate as the longer version.

Patterns of chronic pain in the New Zealand population

AIM

This study describes the prevalence and impact of chronic and recent pain in the New Zealand population and the groups most likely to report and use treatment for their chronic pain. Results are compared with international estimates.

METHODS

Data from the 2006/07 New Zealand Health Survey were analysed covering chronic pain, sociodemographic characteristics, chronic pain treatment use and health related quality of life. Prevalence estimates are presented. Chi-squared and logistic regression analyses were used to identify factors most strongly associated with chronic pain.

RESULTS

One in six (16.9%) New Zealanders reported chronic pain. Prevalence increased with age from 8.6% to 28.1%. People in the lowest two levels of three economic living standards categories had much higher adjusted odds (3.5 and 1.9) of reporting chronic pain than those with high economic living standards. Pacific and Asian peoples had much lower odds of reporting chronic pain compared with European/Other. Over a third (36%) did not use any treatment for their chronic pain while nearly half (48%) used some form of medical treatment. People with greater severity of recent pain, women and older age groups had much higher odds of using medical treatment for their chronic pain. A substantial minority did not report any treatment for their chronic pain. Higher numbers of chronic pain sites and greater severity of recent pain were associated with much lower scores across all the SF-36 physical and mental health domains.

CONCLUSIONS

Patterns of chronic pain in the New Zealand are similar to those found internationally and indicate that chronic pain represents a major health issue in New Zealand.

Acoustical scattering by multilayer spherical elastic scatterer containing electrorheological layer

A computational procedure for analyzing acoustical scattering by multilayer concentric spherical scatterers having an arbitrary mixture of acoustic and elastic materials is proposed. The procedure is then used to analyze the scattering by a spherical scatterer consisting of a solid shell and a solid core encasing an electrorheological (ER) fluid layer, and the tunability in the scattering characteristics afforded by the ER layer is explored numerically. Tunable scatterers with two different ER fluids are analyzed. One, corn starch in peanut oil, shows that a significant increase in scattering cross-section is possible in moderate frequencies. Another, fine poly-methyl methacrylate (PMMA) beads in dodecane, shows only slight change in scattering cross-sections overall. But, when the shell is thin, a noticeable local resonance peak can appear near ka=1, and this resonance can be turned on or off by the external electric field.

Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain

PURPOSE

Most working adults with low back pain (LBP) continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent LBP, to be used as a framework for the development of a workplace group intervention to prevent back disability.

METHOD

Workers with LBP (n = 38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes.

RESULTS

Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway.

CONCLUSIONS

To retain workers with LBP, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.

The surgical care practitioner: a critical analysis

The role of the surgical care practitioner has been in existence for many years in some form or another with a variety of job titles and a wide range of duties. With the adoption of the European Working Time Directive and the need for skilled assistance, not only at the operating table but also pre and post surgery, the role is becoming formalised with voluntary codes of conduct, performance, ethics, standards and scope of practice.

A fatal case of Lassa fever in London, January 2009

In January 2009, the eleventh case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified.

A fatal case of Lassa fever in London, January 2009

In January 2009, the eleventh [corrected] case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified.

Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial

Background

Chronic low back pain remains a major health problem in Australia and around the world. Unfortunately the majority of treatments for this condition produce small effects because not all patients respond to each treatment. It appears that only 25–50% of patients respond to exercise. The two most popular types of exercise for low back pain are graded activity and motor control exercises. At present however, there are no guidelines to help clinicians select the best treatment for a patient. As a result, time and money are wasted on treatments which ultimately fail to help the patient.

Methods

This paper describes the protocol of a randomised clinical trial comparing the effects of motor control exercises with a graded activity program in the treatment of chronic non specific low back pain. Further analysis will identify clinical features that may predict a patient's response to each treatment. One hundred and seventy two participants will be randomly allocated to receive either a program of motor control exercises or graded activity. Measures of outcome will be obtained at 2, 6 and 12 months after randomisation. The primary outcomes are: pain (average pain intensity over the last week) and function (patient-specific functional scale) at 2 and 6 months. Potential treatment effect modifiers will be measured at baseline.

Discussion

This trial will not only evaluate which exercise approach is more effective in general for patients will chronic low back pain, but will also determine which exercise approach is best for an individual patient.

Trial registration number

ACTRN12607000432415

The agistment market in the northern Australian rangelands: failings and opportunities

Agistment is the practice of temporarily moving stock between properties, and is used by pastoralists both to strategically develop their enterprises and as a response to environmental heterogeneities such as variation in rainfall. This paper considers the agistment market in the northern Australian rangelands using the ‘market failure framework’. This form of economic analysis identifies failings in a market, thus, provides a rigorous basis for designing interventions intended to improve market performance. Drawing on interviews with pastoralists from the Dalrymple Shire in Queensland we conclude that, although agistment is widely used, there are several failings in the existing market which are likely to result in overall agistment activity being far less than optimal. The market failure analysis indicates that key issues relate to the lack of a common marketplace, asymmetric information on the characteristics of the other party in an agreement, and a lack of mutual expectations at the outset. Innovations with the potential to overcome these failings, while minimising the transaction costs involved in entering an agistment agreement, are discussed.

Causality and the velocity of acoustic signals in bubbly liquids

Several versions of the dispersion formula governing the acoustic propagation in bubbly liquids are shown to exhibit acausal behavior. The cause of this behavior is due to the inappropriate application of a low frequency approximation in the determination of the extinction of the signal from radiative scattering. Using a corrected causal formula, several principles of wave propagation in bubbly media consistent with the general theory of wave propagation in dispersive media are demonstrated: There exist two precursors to any finite signal. Both propagate without regard to the source characteristics at velocities, frequencies, and amplitudes dependent wholly upon the characteristics of the medium supporting the wave motion. The first travels at the infinite frequency phase velocity that is coincident with the infinite frequency limit of the group velocity. That part of a propagating wave oscillating at the source frequency arrives at a time determined by the signal velocity. Analogous to the well known signal velocity of electromagnetic wave propagation in conducting media, the value of the signal velocity depends on the detailed structure of the dispersion formula in the complex frequency plane.

Responsiveness of pain and disability measures for chronic whiplash

STUDY DESIGN

Cohort study.

OBJECTIVE

To evaluate the responsiveness of common pain and disability measures in a cohort of patients with chronic whiplash.

SUMMARY OF BACKGROUND DATA

Pain and disability are routinely measured in clinical practice and clinical research. However, to date, a head-to-head comparison of competing measures for whiplash patients has not been performed.

METHODS

Pain (pain intensity, bothersomeness, and SF-36 bodily pain score) and disability (Patient Specific Functional Scale, Neck Disability Index, Functional Rating Index, Copenhagen Scale, and SF-36 physical summary) measures were completed by 132 patients with chronic whiplash at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Internal responsiveness was evaluated by calculating effect sizes and standardized response means, and external responsiveness by correlating change scores with global perceived effect scores and by ROC curves.

RESULTS

The ranking of responsiveness was consistent across the different analyses. Pain bothersomeness was more responsive than pain intensity, which was more responsive than the SF-36 pain measure. The Patient Specific Functional Scale was the most responsive disability measure, followed by the spine-specific measures, with the SF-36 physical summary measure the least responsive.

CONCLUSION

Pain bothersomeness and the Patient Specific Functional Scale provide the most responsive measures of pain and disability, respectively, in patients with chronic whiplash.

Randomized controlled trial of exercise for chronic whiplash-associated disorders

Whiplash-associated disorders are common and incur considerable expense in social and economic terms. There are no known effective treatments for those people whose pain and disability persist beyond 3 months. We conducted a randomized, assessor-blinded, controlled trial at two centres in Australia. All participants received 3 advice sessions. In addition the experimental group participated in 12 exercise sessions over 6 weeks. Primary outcomes were pain intensity, pain bothersomeness and function measured at 6 weeks and 12 months. Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months. The effect of exercise on the 0-10 pain intensity scale was -1.1 (95%CI -1.8 to -0.3, p=0.005) at 6 weeks and -0.2 (0.6 to -1.0, p=0.59) at 12 months; on the bothersomeness scale the effect was -1.0 (-1.9 to -0.2, p=0.003) at 6 weeks and 0.3 (-0.6 to 1.3, p=0.48) at 12 months. The effect on function was 0.9 (0.3 to 1.6, p=0.006) at 6 weeks and 0.6 (-0.1 to 1.4, p=0.10) at 12 months. High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months. In the short-term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash. Exercise is more effective for subjects with higher baseline pain and disability.

Workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research

INTRODUCTION

The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented.

METHODS

This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions.

RESULTS

Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders' involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. The role of the researcher in engaging stakeholders, and ethical aspects associated with that process are discussed.

CONCLUSIONS

Recommendations for future research include developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders' interests.

Advice or exercise for chronic whiplash disorders? Design of a randomized controlled trial

BACKGROUND

Whiplash-associated disorder (or "whiplash") is a common condition incurring considerable expense in social and economic terms. A lack of research on effective therapy for patients with chronic whiplash associated disorders prompted the design of the current study. The primary aim of this randomised controlled trial is to determine the effects of a physical activity program for people with chronic (symptoms of > 3 months duration) whiplash. A secondary aim is to determine if pain severity, level of disability and fear of movement/(re)injury predict response to a physical activity program.

METHODS/DESIGN

This paper presents the rationale and design of a randomised controlled trial examining the effects of advice and individualized sub-maximal exercise programs in the treatment of whiplash associated disorders.

DISCUSSION

This paper highlights the design, methods and operational aspects of a significant clinical trial in the area of whiplash and chronic pain.

The matched-phase coherent multi-frequency matched-field processor

Coherent multi-frequency matched-field processing is investigated using a matched-phase coherent matched-field processor. Its main difference from previous coherent processors is that the relative phases of the Fourier components contained within the recorded signal are not assumed to be known a priori. Rather they are considered free parameters that can be determined using a global functional minimization algorithm. Additionally, this processor uses only the cross-frequency terms, making it less susceptible to the detrimental effects of ambient noise; in one example, this processor shows a five decibel improvement over a similar coherent processor. Along with its increased sensitivity with respect to the broadcast source levels, this coherent processor exhibits superior range resolution as compared with multi-frequency incoherent processors, due to the cross-frequency interference of the vertical eigenmodes. Within this work we explore the efficacy of the algorithms used to determine the relative phases along with the performance of the matched-phase coherent processor itself, performed within the context of data collected during an event from the SWellEx-96 experiment. Performance comparisons between this processor, an incoherent processor, and another coherent processor are demonstrated using this data set.

Collective oscillations of fresh and salt water bubble plumes

Bubble plumes of various void fractions and sizes were produced by varying the flow velocity of a water jet impinging normally on a water surface. The bubbles entrained at the surface were carried downwards by the fluid flow to depths ranging from 33 to 65 cm, and formed roughly cylindrical plumes with diameters ranging from 12 to 27 cm. The acoustic emissions from the plumes were recorded onto digital audio tape using a hydrophone placed outside the cloud at distances ranging from 50 cm to 16.0 m. Closeup video images of the individual bubbles within the plume were also taken in order to gain knowledge of the bubble size distributions. The experiments were performed in both fresh-water and salt-water environments. The fresh-water clouds emitted sounds with a modal structure that was significantly different from that produced by the salt-water clouds. Furthermore, the smaller bubbles present in the salt-water clouds have a fundamental effect on the amplification of turbulence noise, generating sound at significant levels for frequencies up to several hundred Hertz.

Advantages of heterogeneous therapy groups in the psychotherapy of the traumatically abused: treating the problem as well as the person

The authors combine a social-constructionist perspective with a psychodynamic one in discussing the problem of trauma and its treatment. They argue that effective treatment of traumatic physical, sexual, and psychological abuse must do more than alleviate the pain of the sufferer. Factors that cause and perpetuate abuse must be addressed by the abused person in conjunction with other nontraumatized persons who may have been abusive or passive in the face of abuse. An argument is made for heterogeneous therapy groups as a context for this to occur.

Verb Naming in Normal Aging

Few studies have examined verb naming in normal aging, although decline in the ability to name nouns has been well documented. In this study, we examined longitudinal performance on the Action Naming Test (ANT), a confrontation naming test for verbs. The purpose of this study was to confirm the verb naming deficit associated with aging, which was previously seen only in cross-sectional studies, and to provide additional normative data on verb naming ability that may prove useful to studies on verb naming in populations with brain dysfunction. Sixty-six healthy men and women aged 30 to 79 were each tested with the ANT 3 times over a 7-year span. ANT performance showed a significant decline over time for all participants except the youngest group. Longitudinal methodology supports the conclusion that this finding of a decline in verb naming ability arises from true age-related changes and not from cohort differences.

Lesions and identification of crystalline precipitates of glycoprotein IIb-IIIa antagonists in the rat kidney

Two glycoprotein IIb-IIIa antagonists (xemilofiban, SC-54684A, and orbofiban, SC-57099B), which are platelet aggregation inhibitors, caused crystalline precipitates in the kidney tubules of rats at high dosages. Dogs were not affected. Depending on the degree of the precipitation, which was dosage dependent, and the location, which differed somewhat between the two compounds, the lesions varied from acute obstruction with tubule cell necrosis, nephron dilation, and sudden death with no inflammation to severe chronic pyogranulomatous inflammation. In order to understand the relevance of the lesions, it was important to identify the precipitates. This was technically challenging because the crystals were water soluble (dissolving in routine fixing and staining techniques) and were present in insufficient quantity to physically isolate. Techniques were devised to evaluate the crystals in situ in unstained frozen sections prepared without directly embedding the tissues in supporting medium, which interfered with the analyses. The crystals were analyzed in situ by infrared and Raman spectroscopy and time-of-flight secondary ion mass spectroscopy (TOF-SIMS). Uroliths found in the renal pelvis of one animal were analyzed by liquid chromatography/mass spectrometry. The resulting spectra showed that the crystals were the de-esterified acids of the parent compounds. This knowledge allowed us to predict that the crystalline precipitates would not be a hazard to humans because of the large multiples of the human dosage at which they occurred and because of differences in renal physiology between rats, dogs, and humans.

Lesion site patterns in severe, nonverbal aphasia to predict outcome with a computer-assisted treatment program

OBJECTIVE

To test whether lesion site patterns in patients with chronic, severe aphasia who have no meaningful spontaneous speech are predictive of outcome following treatment with a nonverbal, icon-based computer-assisted visual communication (C-ViC) program.

DESIGN

Retrospective study in which computed tomographic scans performed 3 months after onset of stroke and aphasia test scores obtained before C-ViC therapy were reviewed for patients after receiving C-ViC treatment.

SETTING

A neurology department and speech pathology service of a Department of Veterans Affairs medical center and a university aphasia research center.

PATIENTS

Seventeen patients with stroke and severe aphasia who began treatment with C-ViC from 3 months to 10 years after onset of stroke.

MAIN OUTCOME MEASURE

Level of ability to use C-ViC on a personal computer to communicate.

RESULTS

All patients with bilateral lesions failed to learn C-ViC. For patients with unilateral left hemisphere lesion sites, statistical analyses accurately discriminated between those who could initiate communication with C-ViC from those who were only able to answer directed questions. The critical lesion areas involved temporal lobe structures (Wernicke cortical area and the subcortical temporal isthmus), supraventricular frontal lobe structures (supplementary motor area or cingulate gyrus 24), and the subcortical medial subcallosal fasciculus, deep to the Broca area. Specific lesion sites were also identified for appropriate candidacy for C-ViC.

CONCLUSIONS

Lesion site patterns on computed tomographic scans are helpful to define candidacy for C-ViC training, and to predict outcome level. A practical method is presented for clinical application of these lesion site results in combination with aphasia test scores.

On the nature of naming errors in aging and dementia: a study of semantic relatedness

This study investigated the nature of naming errors produced on the Boston Naming Test by patients with mild and moderate Alzheimer's disease (AD) and elderly and young controls, using a newly devised scoring system. This new approach involved ratings of error responses on a scale of semantic relatedness to the target name. Error responses of both mild and moderate AD subjects were no less semantically related to target names than were responses of age- and education-matched controls. We conclude that some available evidence of semantic loss in AD may be an artifact of the methodology chosen for evaluating naming errors.

Drawing to communicate: a case report of an adult with global aphasia

Treatment for adults with global aphasia has typically involved the use of verbal treatment methods or alternative communication techniques including communication boards, word lists and notebooks. However, many adults with aphasia are unable to communicate verbally and alternative communication techniques can be limited, as a result of the restricted number and type of concepts that can be adequately depicted and expressed. Another viable means of communication for the globally aphasic adult is drawing. However, few individuals with severe aphasia initiate communication through this modality without specific training. In this case report we present several successful treatment methods that were used to train an adult with global aphasia to communicate more effectively through drawing. Several of his drawings are presented to illustrate the results of training in the use of drawing as an alternative means of communication.

Emotional and non-emotional facial behaviour in patients with unilateral brain damage

Aspects of emotional facial expression (responsivity, appropriateness, intensity) were examined in brain-damaged adults with right or left hemisphere cerebrovascular lesions and in normal controls. Subjects were videotaped during experimental procedures designed to elicit emotional facial expression and non-emotional facial movement (paralysis, mobility, praxis). On tasks of emotional facial expression, patients with right hemisphere pathology were less responsive and less appropriate than patients with left hemisphere pathology or normal controls. These results corroborate other research findings that the right cerebral hemisphere is dominant for the expression of facial emotion. Both brain-damaged groups had substantial facial paralysis and impairment in muscular mobility on the hemiface contralateral to site of lesion, and the left brain-damaged group had bucco-facial apraxia. Performance measures of emotional expression and non-emotional movement were uncorrelated, suggesting a dissociation between these two systems of facial behaviour.

Effect of emotional context on bucco-facial apraxia

Patients with left- and right-hemisphere cerebrovascular pathology and normal adult controls were videotaped while executing tasks of bucco-facial praxis in emotional and nonemotional conditions. Each practic movement was assessed for accuracy and motor execution. Left-brain-damaged patients were significantly impaired on these tasks relative to right-damaged patients and controls. When emotional context was provided, apractic performance improved significantly.

The expression and perception of facial emotion in brain-damaged patients

This study examined the expression and perception of facial emotion in patients with unilateral cerebrovascular pathology. Subjects were 12 right brain-damaged (RBD), 15 left brain-damaged (LBD) aphasic, and 16 normal control (NC) right-handed males. Expressions were elicited during posed and spontaneous conditions. Both positive and negative emotions were studied. RBDs were significantly impaired, relative to LBDs and NCs, in expressing and perceiving facial emotion. There were no group differences as a function of condition, but there were differences as a function of emotional valence. Qualitative performance differences also were observed. There was no evidence that the ability to produce a particular emotion was related to the ability to identify the same emotion. Overall, these findings support the notion that the right cerebral hemisphere is dominant for expressing and perceiving facial emotion.

Lexical retrieval in healthy aging

Lexical retrieval for common nouns and verbs was measured using 2 picture naming tests in 162 healthy female and male subjects aged 30 to 79 years. Responses were scored for correctness, responsivity to cueing, and response type. The ability to name both word types declined with age, especially after age 70 in healthy subjects. More errors were made on object names than action names, especially for older subjects. Subjects of all ages were equally able to utilize phonemic cues. With increasing age subjects produced more circumlocutions and fewer semantic errors. Response type difference need not reflect qualitative differences in lexical retrieval; rather, they reflect the quantitatively greater difficulty of the task for healthy older people as compared to younger adults. The naming difficulty for healthy aging, we conclude, is at the label retrieval stage.

On comprehension across the adult lifespan

To test whether healthy elderly subjects develop language comprehension strategies to compensate for decreases in pure-tone audition, we tested 128 healthy subjects aged 30-79 on two tasks: (1) Comprehension materials from the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1972) presented over babble noise with and without the speaker's face visible; and (2) the Kalikow et al. (1977) Speech Perception in Noise test, which assesses the effect of semantic predictability on sentence-final word intelligibility. Whereas, as predicted, overall performance decreased with advancing age, it appeared, unexpectedly, that older and younger adults were equally affected by the absence of visual input and the absence of semantic predictability.

Channels of emotional expression in patients with unilateral brain damage

The contribution of facial, intonational, and speech channels to spontaneous emotional expression was examined in right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) subjects. Subjects were videotaped while viewing and responding to a series of emotionally laden slides; the videotapes were then rated for the three channels of communication. Overall, RBDs used facial expression and intonation less frequently than the other two groups. When the speech output channel was analyzed, oral expression of feelings in the RBDs, relative to the LBDs and NCs, was less appropriate, more propositional than prosodic, and more descriptive than affective. When the ratings for the three channels of communication were examined, facial expression and intonation were significantly correlated for all subjects.

Non-consultant peripheral clinics: a new approach to diabetic care

A system of non-consultant peripheral clinics (NCPCs) established on the Isle of Wight is described. For the first phase of the study 182 diabetics attending the consultant clinic were allocated to the appropriate peripheral clinic (group 1). In the second phase, 152 new referrals were prospectively allocated between the consultant and appropriate peripheral clinics (group 2). Evaluation was made of the patients' random blood sugar and glycosylated haemoglobin. The savings in cost and time to patients resulted in over 90% of patients preferring the peripheral clinics. NCPCs are discussed in relation to hospital-based clinics and to other alternative systems of care. It is concluded that NCPCs could be incorporated into the diabetic service in other regions in the United Kingdom with advantages to diabetics and hospital services alike. These peripheral clinics are suited to all types of diabetics and perhaps the only clinical restriction is the desirability for metabolic deterioration to be managed by a consultant clinic until the patient is satisfactory.

Is there a bias in size measurements taken from mirror-reversed photographs of body parts?

This study compared measurements of hands, feet, and hemifaces taken from original and mirror-reversed photographs to determine whether a hemispace-bias exists in size measurements. Posers were adult right- and left-handers (50% female). In 80% of the measurement comparisons (total N = 84), there was complete agreement; there were no instances of right-left reversals among the discrepant comparisons. The side of the body measured as larger was independent of the side of space in which it appeared. The lack of such bias in physical measurements is discrepant with data suggesting a left-hemispace preference in psychological judgments of visual material.

Asymmetries in body part size, mobility, and usage. Relationship between structure and function

Asymmetries in structure (size) and function (usage or mobility) for the upper and lower face, hands, and feet were investigated in 42 left- and right-handed male and female college students. Size measurements were taken from photographs, mobility was rated from videotapes, and usage was assessed by questionnaire. Size asymmetries were typical, and independent of handedness, but were not consistent across body parts; usage asymmetries varied as a function of handedness. No systematic relationships were found between structure and function.

Two decades of change: Glenside Hospital population surveys 1960-80

Results of the fifth quinquennial survey of the patients of Glenside Hospital, Bristol, when compared with five yearly surveys over the past 20 years, show that the "run-down" of the hospital continues. There is still an accumulation of long-stay patients, mainly for non-medical reasons. They remain in hospital because of the failure to provide community facilities adequate to their needs. It is suggested that local authorities will never be able to cope with them and that the NHS should be enabled to extend their hospital services into "nursing homes" in the community.

'Dissolution of the mental hospital': fifteen years on

The pattern of decline of a mental hospital population over fifteen years is described. Continuing problems are commented on, particularly the presence of 'old' long-stay patients and the accumulation of 'new chronic patients'. The number of beds required for each of these categories is estimated. The dissolution of the mental hospital service by degradation is deplored, and a suggestion is made that some of the good points of the old service might be salvaged before it is too late.

The rehabilitation of long-stay schizophrenic patients who have had a leucotomy

Leucotomy has been used to treat many patients with schizophrenia. Although some patients seem to have derived considerable benefit from the operation, a number have shown little or no improvement (Board of Control, 1947, Tooth et al., 1961). An appreciable number of schizophrenic patients who have had a leucotomy remain long-stay patients in mental hospitals. In the last few years there has been an increased emphasis on the rehabilitation of chronically disabled psychiatric patients and the purpose of this paper is to assess the response to rehabilitation of long-stay schizophrenic patients several years after a leucotomy operation.

The rehabilitation of long-stay schizophrenic patients

An appreciable number of chronic schizophrenic patients otherwise destined to remain long-stay patients in mental hospitals, are able to live in the community if they undergo active rehabilitation. In this paper, an attempt is made to correlate the post-rehabilitation progress of long-stay schizophrenic patients with observations made during their rehabilitation.