The Molift Partner 230: An innovative hybrid patient lifter

Whether in the acute sector or in social care, diverse clients present many differing moving and handling needs.

This article looks at the Molift Partner 230, in light of whether one piece of equipment can meet the needs of such clients.

Efficacy of transcutaneous electrical nerve stimulation (tens) for chronic low-back pain in a multiple sclerosis population: a randomized, placebo-controlled clinical trial

OBJECTIVE

This study was designed to investigate the hypoalgesic effects of self-applied transcutaneous electrical nerve stimulation (TENS) on chronic low-back pain (LBP) in a multiple sclerosis (MS) population.

METHODS

Ninety participants with probable or definite MS (aged 21 to 78 y) presenting with chronic LBP were recruited and randomized into 3 groups (n=30 per group): (1) low-frequency TENS group (4 Hz, 200 micros); (2) high-frequency TENS group (110 Hz, 200 micros); and (3) placebo TENS. Participants self-applied TENS for 45 minutes, a minimum of twice daily, for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10, and 32. Primary outcome measures included: Visual Analog Scale for average LBP and the McGill Pain Questionnaire. Secondary outcome measures included: Visual Analog Scale for worst and weekly LBP, back and leg spasm; Roland Morris Disability Questionnaire; Barthel Index; Rivermead Mobility Index; Multiple Sclerosis Quality of Life-54 Instrument, and a daily logbook. Data were analyzed blind using parametric and nonparametric tests, as appropriate.

RESULTS

Results indicated a statistically significant interactive effect between groups for average LBP (P=0.008); 1-way analysis of covariance did not show any significant effects at any time point once a Bonferonni correction was applied (P>0.05). However, clinically important differences were observed in some of the outcome measures in both active treatment groups during the treatment and follow-up periods.

DISCUSSION

Although not statistically significant, the observed effects may have implications for the clinical prescription and the use of TENS within this population.

Tools for daily living: An equipment guide

Assistive equipment and devices should enable those with disabilities to engage in, and carry out every day tasks. There are many different types of tools available that can be employed within the home to make tasks such as, eating, drinking, getting up and down the stairs, in and out of the bath and bed much easier

This article will focus on the different areas of the home, looking at the most suitable types of equipment available that can be used to solve mobility issues and general impairments of function.

New roles in rehabilitation--the implications for nurses and other professionals

RATIONALE, AIMS AND OBJECTIVES

The development of rehabilitation and intermediate care services, and roles therein, is part of current UK health policy to meet the demands of the ever-growing older population. One new role is the rehabilitation assistant (RA). This is a generic support worker trained at a basic level in nursing, physiotherapy, occupational therapy and social work who works under the supervision of the referring professionals, to deliver integrated rehabilitation programmes. RAs were introduced in one region in the north-west of England to increase the rehabilitation activity for patients. An empirical qualitative study was recently undertaken to evaluate the impact of the RAs from the perspectives of patients and associated nurses, therapists, managers and the RAs.

METHODS

Fifty-five semi-structured interviews were used to collect data, which was then inductively analysed into categories and then themes. The categories included variations in role, benefits of role, acceptance and integration of role, difficulties with role, training and retention. This paper focuses on the benefits and difficulties of the role.

RESULTS

It was found that patients, professionals and the RAs expressed great satisfaction with the new role. However, barriers to effective rehabilitation were reported owing to ward routines and organizational systems that interrupted and caused inconsistencies with the rehabilitation care programmes for patients.

CONCLUSIONS

If it is agreed that the majority of patients (unless end stage terminally ill, unwilling or unable) could benefit from some degree of rehabilitation, then there is an issue around how such skills could be widely implemented. This paper discusses the barriers to effective rehabilitation, the benefits and drawbacks of looking at new ways of working and the need for a unified approach by all care workers in rehabilitative care.

Examining barriers and supports to community living and participation after a stroke from a participatory action research approach

This participatory action research study focused on identifying community participation goals, barriers, and supports/strategies in partnership with people who have experienced a stroke. Goals demonstrate that participation is more than activity performance in context; instead, it relates to "being a part of" the community and having access to participation opportunities and supports. Results of community site audits from the first 20 participants document environmental (physical, cognitive, social) and system level barriers, as well as effective strategies for promoting participation via environmental modification and systems level changes. A consumer-directed, Web-based tool for documenting participation barriers and sharing strategies is discussed.

Community neurorehabilitation: a synthesis of current evidence and future research directions

Over the past decade, community neurorehabilitation has emerged as a promising extension of neurological rehabilitation. The goal of community neurorehabilitation is to maximize functional ability and quality of life through multidimensional rehabilitation that occurs while the individual is living in a home versus acute or transitory care setting. Because of its multidisciplinary focus, many variations of community neurorehabilitation teams have been implemented. Critical gaps exist, however, in understanding of the influence of structural and procedural differences among programs, as well as patient level variables such as social support, on recovery. This paper examines the current evidence of the effectiveness of community neurorehabilitation through a review of the findings of systematic reviews and meta-analyses of four neurological conditions: stroke, multiple sclerosis, traumatic brain injury, and Parkinson's disease. It focuses in particular on the data regarding physical therapy and occupational therapy, which are two of the primary components of community neurorehabilitation programs.

Psychoneuroimmunology and occupational therapy for inflammatory disorders

The occupational therapy profession was founded in 1917 on the notion that occupations contribute to psychological well being and physical adaptation. The credibility of occupational therapy has been threatened because the scientific basis of this notion is not always evident. The focus of occupational therapy in many physical settings has therefore shifted away from its original ethos towards one of physical problem solving and discharge facilitation.

Psychoneuroimmunology (PNI) is a developing branch of science that provides a theoretical framework to support the profession’s return to its original ethos of using occupations to promote health. This paper is an analysis of psychoneuroimmunological evidence to support occupational therapy for inflammatory disorders. A broad literature search revealed mind-body inflammatory pathways including anatomical links, nerve growth factor, adrenocorticotrophin, cortisol, somatostatin and substance-P.

Choosing a powered wheelchair: The options

Powered wheelchairs allow those with mobility problems to move around independently and participate in day-to-day activities, thus becoming active members of society.

This article will look at the importance of a thorough assessment of the user's needs in order to select the most appropriate piece of equipment to suit the individual's requirements.

There is a wide variety of powered wheelchairs on the market and this article will help those considering purchasing such equipment to navigate through the many choices and options available.

Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial

QUESTION

What is the effect of mime therapy on facial symmetry and severity of paresis in people with facial nerve paresis?

DESIGN

Randomised controlled trial.

PARTICIPANTS

50 people recruited from the Outpatient department of two metropolitan hospitals with facial nerve paresis for more than nine months.

INTERVENTION

The experimental group received three months of mime therapy consisting of massage, relaxation, inhibition of synkinesis, and co-ordination and emotional expression exercises. The control group was placed on a waiting list.

OUTCOME MEASURES

Assessments were made on admission to the trial and three months later by a measurer blinded to group allocation. Facial symmetry was measured using the Sunnybrook Facial Grading System. Severity of paresis was measured using the House-Brackmann Facial Grading System.

RESULTS

After three months of mime therapy, the experimental group had improved their facial symmetry by 20.4 points (95% CI 10.4 to 30.4) on the Sunnybrook Facial Grading System compared with the control group. In addition, the experimental group had reduced the severity of their paresis by 0.6 grade (95% CI 0.1 to 1.1) on the House-Brackmann Facial Grading System compared with the control group. These effects were independent of age, sex, and duration of paresis.

CONCLUSION

Mime therapy improves facial symmetry and reduces the severity of paresis in people with facial nerve paresis.

Suitable moving and handling equipment: A guide

The regular transfer and lifting of patients can place added stresses on carers. The high incidence of injury among care staff has resulted in an increase in the use of mechanical devices, designed to reduce musculoskeletal strain.

This article looks at the various mobility aids, options and hoists available to aid carers involved in the essential task of moving and handling people. Contact details for the manufacturers and suppliers of such mechanical aids will be provided.

Bathing and showering equipment: A product guide

Bathing should be seen as a pleasant and relaxing experience for all those concerned. This should not be any different for a child with a disability. Bathing and showering equipment tailored to meet the specific need of the child and the extent of the disability can ease the burden on the carer and encourage the independence of the child.

This article explores the range of assistive products available on the market and the factors that need to be taken into consideration before purchasing such equipment.

Therapist's influence on the design of Invacare's Flo-Tech Solution Xtra

The trend for inclusive design appears to becoming stronger, and an area that clinicians are urged to participate in. Combining clinical and technical expertise can often be a demanding challenge and this paper looks to show the results of how a modular postural cushion was designed and evaluated by Invacare Ltd. The Flo-Tech Solution Xtra modular system was conceived through joint collaboration between manufacturer and therapists following discussion and demand from NHS wheelchair services (WCS) in the UK. Concept, rationale and design of the cushion are discussed from a clinical perspective, which underpins the manufacturing process from conception through to the finished product. The seating system was designed to address the postural requirements primarily of the neurological population and consequently the cushion underwent clinical trial at the Royal Hospital of Neuro-Disability, Putney, London.

Seven subjects were identified as suitable for the evaluation by the postural team at Putney and three were trialed independently by Invacare Ltd. The main focus of this study was identifying and meeting the individual's therapeutic aims of posture and pressure through using the Solution Xtra. Even though the study size was small and the results subjective in nature, there was an overall favourable outcome of using the modular system as a seating intervention, and it was also rated highly by the clinicians involved.

Reducing disparities in the access and use of Internet health information. a discussion paper

Internet health information is rated highly by users and is used to compensate for gaps in health information provided by health professionals. Greater understanding of health issues and changes to personal health management has been reported as a consequence of Internet use. However, there are significant disparities in the access and use of Internet health information linked to income, education and ethnicity. In this paper a case is presented that on-line health information particularly benefits the already privileged in terms of health care; well-educated people with access to economic resources. Several intervention points are suggested to improve Internet health information accessibility and use for all population groups. Interventions at an institutional level include improving equity of Internet access through the provision of free services at strategic sites and improving the readability and cultural acceptability of health information. Individually focused interventions involve skill development to enable effective navigation of Internet sites, identification of patient and families' information needs and support to develop evaluation skills. The effectiveness of these interventions in reducing disparities is reliant on nurses and other health professionals' expertise in accessing, evaluating and using Internet health information in their clinical practise. On-line health information is a powerful medium for quick and dynamic knowledge distribution. The challenge for nurses and other health professionals is directing that knowledge to the groups most disadvantaged in the current health care systems, with an agenda of reducing inequalities in access to health information.

Speech and language therapy provision for people with Parkinson's disease

Few details are known about the experience of people with Parkinson's disease (PD) and their carers in relation to their need for and access to speech and language therapy (SLT). This study investigated the perceptions of need in relation to maintaining communication and the nature and experience of SLT. Questionnaires were sent to 141people with PD and 78carers living in the community, of whom 123 and 68 respectively responded. Twenty-five people with PD (20%) had had contact with SLT, of whom 71% felt referral was at the right time and 80% felt SLT had helped. Eighty-three percent of all respondents with PD felt that referral should occur before changes posed a problem. Easier and increased access to SLT was needed, focusing on overall management of communication rather than specific impairments. This study contributes to the PD National Institute of Health and Clinical Excellence Guideline (2006) recommendation to articulate best practice in SLT.

Helping people to live independently in the home

This article offers information on how standard furniture around the house can be adapted and devices used to make activities of daily living easier for those who need assistance, removing the need for specialist furniture and major alterations to the home environment. Contact details for the manufacturers and suppliers of such equipment are provided. The article aims to provide a useful guide for occupational therapists who are assessing and giving advice and information on equipment to people who need daily living assistance, to promote their independence.

Technology, job satisfaction, and retention: rural mental health practitioners

CONTEXT

Job satisfaction as it relates to retention of mental health professionals is a major problem in rural areas. Several authors have suggested that technology can positively influence job satisfaction and thus improve retention.

OBJECTIVES

This study examined technology use and technology expertise in relationship to job satisfaction. It is based on a theoretical framework that asserts as technology use increases, communication among providers and access to educational and consultative resources increase as well, resulting in a boost in professional support and a reduction in isolation.

METHODS

Surveys were sent to 320 providers in rural southeast Ohio; 163 returned usable surveys.

FINDINGS

There was a statistically significant relationship between the combination of technology use and expertise and job satisfaction. Use alone, however, was not significant. Despite the fact that over 90% of respondents had access to both a computer and the Internet, just 45% used technology to communicate with peers and nearly 96% indicated that they never or rarely used the Internet for educational programs.

CONCLUSIONS

The results challenge the assertion that technology plays a major role in job satisfaction and rural retention since access and perceived expertise did not guarantee technology usage. Decisions to stay or leave a rural practice involve a complex array of factors. Technology, with its ability to link providers to resources outside the geographic bounds of an individual's practice, may play a role, but since its adoption can be costly in both time and money, future studies need to determine its place in the retention model.

Moving and handling patients safely: A product guide

Buying suitable equipment for moving and handling people is essential, as manual lifting can place a severe strain on those assisting and put them at risk of developing a work-related musculoskeletal injury.

This article offers information on the different types of mobility aids and hoists available and provides contact details for the manufacturers and suppliers of such equipment. It aims to provide a useful guide for therapists and carers involved in handling people, and for those who are able to independently transfer with the use of the right mechanical aid.

Apparatus for enhancing sensory processing in children

The process of the brain organizing and interpreting information from the environment is called sensory integration. The occupational therapy team in Peterborough, UK, has used a sensory integration approach for pre-school and school-aged children with motor, sensory and/or attentional difficulties for over 10 years. Sensory integration provides a crucial foundation for later, more complex learning and behaviour. The children are seen individually or in groups in schools, nurseries and specialist units. Advice is given to parents for strategies to support children's behaviour regulation at home. Under direction from paediatric occupational therapists, many primary schools run sensory circuits, which involve the use of some sensory integration equipment as well as physical education equipment normally found in mainstream schools.

This article describes some of the common sensory integration pieces of equipment that are used for enhancing children's sensory processing.

Flooding treatment of phobia to having her feet touched by physiotherapists, in a young woman with Down's syndrome and a traumatic brain injury

This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems.

The safety and dignity of patients and nurses during patient handling

Since the implementation of the Moving and Handling Operations Regulations (Health and Safety Executive, 1992) there has been considerable effort to reduce back injury among nurses by developing patient handling policy that eliminates actual manual handling. Recently, however, there have been challenges to 'no manual handling' policies by patients as an issue of dignity and human rights. This article offers a literature-based discussion of patient handling in relation to safety and dignity for both patients and nurses. The literature does not offer a solid evidence base for handling practice, and research, involving patents, is limited. However, nurses' handling practice is governed by legislation and NHS Trust policies. Patient handling that is safe and dignified for both patient and handler is a vital skill that requires knowledge and competence. This article suggests ways of developing practice that is safe and dignified for both patient and handler.

Identifying patients at risk of nursing home admission: The Leeds Elderly Assessment Dependency Screening tool (LEADS)

Background

Discharge from hospital to a nursing home represents a major event in the life of an older person and should only follow a comprehensive functional and medical assessment. A previous study identified 3 dependency scales able to discriminate across outcomes for older people admitted to an acute setting. We wished to determine if a single dependency scale derived from the 3 scales could be created. In addition could this new scale with other predictors be used as a comprehensive tool to identify patients at risk of nursing home admission.

Methods

Items from the 3 scales were combined and analysed using Rasch Analysis. Sensitivity and specificity analysis and ROC curves were applied to identify the most appropriate cut score. Binary logistic regression using this cut-off, and other predictive variables, were used to create a predictive algorithm score. Sensitivity, specificity and likelihood ratio scores of the algorithm scores were used to identify the best predictive score for risk of nursing home placement.

Results

A 17-item (LEADS) scale was derived, which together with four other indicators, had a sensitivity of 88% for patients at risk of nursing home placement, and a specificity of 85% for not needing a nursing home placement, within 2 weeks of admission.

Conclusion

A combined short 17-item scale of dependency plus other predictive variables can assess the risk of nursing home placement for older people in an acute care setting within 2 weeks of admission. This gives an opportunity for either early discharge planning, or therapeutic intervention to offset the risk of placement.

Sources of stress in undergraduate podiatry students in the UK and Australia

High sources of stress have been reported in health-care students, including physiotherapy students. However, there are no studies investigating stress in podiatry students. This study was undertaken to examine the sources of stress in undergraduate podiatry students in universities in both the UK and Australia. The Undergraduate Sources of Stress (USOS) questionnaire, comprising 18 items in three subscales (academic demands, financial issues, personal issues), was administered to students in all years of the bachelor programmes in the UK (n=54/97, response rate=56%) and Australia (n=56/94, response rate=60%).

Academic concerns were rated highest for all students, particularly the amount to learn, time demands and intellectual demands of the course. UK levels of academic stress are greatest when students are in their first year, when academic demands are combined with clinical education placements. The university fees were significantly higher for Australian students (P=0.001). In total, 64% of podiatry students in Australia worked in paid employment while studying, compared with 41% of the UK podiatry students. Mean hours of paid employment were 5.3hours for UK students and 7.0hours for Australian students. However, there was no correlation between any of the stress subscales on number of hours worked. High levels of academic stress reported by podiatry students are consistent with other student health-care professions.

Strategies used by people with Parkinson's disease who report difficulty turning

PURPOSE

Difficulty turning (DT) is common in Parkinson's disease (PD). We set out to answer the questions: (1) do people who do and do not report DT differ in postural stability, heel strike, the use of support and step count when performing functional turns during everyday tasks, (2) is the structured observation of functional tasks an ecologically valid way of assessing an individual's ability to turn and (3) does a history of DT predict freezing and/or falls.

METHOD

At home, 75 people (median age 75 years; PD duration 7 years) answered questions about DT, freezing and falls and completed a standard 180 degrees turn test and an everyday task necessitating spontaneous turns, later rated from video by blinded assessors.

RESULTS

Forty-two people reported DT, of whom 86% reported frequent freezing and/or falls. Twenty-six people with DT and 15 without completed the functional task. Greater proportions of the former appeared Unstable (12 vs 1; P = 0.014), lacked Heel Strike (25 vs 9; P = 0.006) and Used Support (7 vs 0; P = 0.035): the former took more Turning Steps (medians 6 vs 4; P = 0.001). The 95% limits of agreement between step counts (functional vs standard turns) ran from -6.3 to 3.6 steps. Of 49 people with a history of freezing and/or falls, 36 (73%) reported frequent DT.

CONCLUSIONS

People who report DT turn differently to those who report no problems. Standard turn tests poorly reflect step count during real-life turning, whereas unobtrusive structured observation reveals the turning strategies people use, so can guide rehabilitation. Reported DT is a sensitive indicator of freezing and/or falling, both indicators for physiotherapy.

Analysis of stroke patients' and carers' reading ability and the content and design of written materials: recommendations for improving written stroke information

OBJECTIVE

This study (a) evaluated the reading ability of patients following stroke and their carers and the reading level and content and design characteristics of the written information provided to them, (b) explored the influence of sociodemographic and clinical characteristics on patients' reading ability, and (c) described an education package that provides well-designed information tailored to patients' and carers' informational needs.

METHODS

Fifty-seven patients and 12 carers were interviewed about their informational needs in an acute stroke unit. Their reading ability was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The written information provided to them in the acute stroke unit was analysed using the SMOG readability formula and the Suitability Assessment of Materials (SAM).

RESULTS

Thirteen (22.8%) patients and 5 (41.7%) carers had received written stroke information. The mean reading level of materials analysed was 11th grade while patients read at a mean of 7-8th grade. Most materials (89%) scored as only adequate in content and design. Patients with combined aphasia read significantly lower (4-6th grade) than other patients (p=0.001).

CONCLUSION

Only a small proportion of patients and carers received written materials about stroke and the readability level and content and design characteristics of most materials required improvement.

PRACTICE IMPLICATIONS

When developing and distributing written materials about stroke, health professionals should consider the reading ability and informational needs of the recipients, and the reading level and content and design characteristics of the written materials. A computer system can be used to generate written materials tailored to the informational needs and literacy skills of patients and carers.

Improvements in performance following optometric vision therapy in a child with dyspraxia

SS, an 8-year-old boy with dyspraxia, presented for behavioural optometry assessment. He had been diagnosed with a subtle form of dyspraxia by his paediatric occupational therapist, based on poor proprioception, delayed bilateral integration and poor visual perception. A full visual assessment was carried out. SS was given a programme of reflex inhibition exercises for 3 months. Then, a programme of optometric vision therapy (OVT) exercises was prescribed at home and in practice for a period of 8 months. SS was assessed using a battery of occupational therapy Sensory Integration and Praxis Tests (SIPT) before optometric intervention, and after OVT. There were significant improvements in fusional reserves, accommodative facility and oculomotor control of pursuit and saccadic eye movements. His reading level had changed by 4 years in 11 months. The SIPT results showed improvements in the visual and motor/visual perception subtests, confirming the significant changes in visual perceptual performance. Consideration is given to treatment modalities for dyspraxia, and the studies confirming their effectivity of approach. This case study provides evidence supporting the use of OVT eye exercises in dyspraxia, ocular motility, accommodative dysfunction, learning difficulties and sports performance. The need for further research and inter-professional working is discussed.

Assistive equipment around the home: Tools for daily living

In today's society, people are heavily dependent upon devices to help them manage their lives effectively. There is a vast array of labour-saving devices available on the high street that disabled people can use and many specialist disability equipment outlets.

It can be difficult to keep up to date with new developments. However, therapists need a general knowledge of the range of equipment that exists and the most appropriate type of equipment to meet specific needs. In addition, therapists have the opportunity to work with product suppliers to ensure that new products meet the needs of disabled people.

This article provides guidance on resources and explains the criteria by which local councils determine who may be eligible for a particular service.

Functional and neuromotor performance in older adults: effect of 12 wks of aerobic exercise

OBJECTIVE

There is little information regarding the effect of aerobic exercise on physical and neuromotor performance in older adults. The aim of this randomized, controlled trial was to determine the effects of a 12-wk aerobic exercise program on functional and neuromotor performance in inactive healthy older adults.

DESIGN

A total of 22 inactive healthy older adults, aged 60-75 yrs, voluntarily participated in the study and were randomly assigned to a progressively increased high-intensity aerobic exercise group (n = 12) or to a control group (n = 10). The aerobic exercise group exercised three times per week for 12 wks on nonconsecutive days. Both groups were evaluated before and after the exercise period in the one-repetition maximum of knee extensors and flexors, 6-min walk distance, chair-rising time, and whole-body reaction time.

RESULTS

Multivariate analysis of variance repeated measures (2 x 2) revealed significant (P < 0.05) time by group interaction for one-repetition maximum knee extension and flexion strength, 6-min walk distance, chair-rising time, and whole-body reaction time. For the aerobic exercise group, the following variables improved significantly (P < 0.05) after the exercise period: the one-repetition maximum knee extensors (12%) and flexors (19%) muscle strength, 6-min walk distance (17%), chair-rising time (8%), and whole-body reaction time (20%). No significant differences were observed in the control group.

CONCLUSIONS

The results of the present study show that short-term progressively increased high-intensity aerobic exercise improved the physical and neuromotor performance in inactive healthy older adults. These findings suggest that the participation in a progressively increased high-intensity aerobic exercise program may improve mobility and ability to carry out activities of daily living in older adults.

Defining the Bobath concept using the Delphi technique

BACKGROUND AND PURPOSE

The Bobath concept, based on the work of Berta and Karel Bobath, offers therapists working in the field of neurological rehabilitation a framework for their clinical interventions. It is the most commonly used approach in the UK. Although they recognize that over the last half-century the concept has undergone considerable developments, proponents of the Bobath concept have been criticized for not publishing these changes. The aim of the present study was to use the Delphi technique to enable experts in the field to define the current Bobath concept.

METHOD

A four-round Delphi study design was used. The sample included all members of the British Bobath Tutor's Association, who are considered experts in the field. Initial statements were identified from the literature, with respondents generating additional statements during the study. The level of agreement was determined using a five-point Likert scale. The respondents were then provided with feedback on group opinions and given an opportunity to re-rate each statement. The level of group consensus was set at 80%.

RESULTS

Fifteen experts took part. The response rate was 85% in the first round, and 93% in each subsequent round. Ten statements from the literature were rated with a further 12 generated by the experts. Thirteen statements achieved consensus for agreement and seven for disagreement.

CONCLUSIONS

The Delphi study was an effective research tool, maintaining anonymity of responses and exploring expert opinions on the Bobath concept. The experts stated that Bobath's work has been misunderstood if it is considered as the inhibition of spasticity and the facilitation of normal movement, as described in some literature. They agreed that the Bobath concept was developed by the Bobaths as a living concept, understanding that as therapists' knowledge base grows their view of treatment broadens.

The effects of therapeutic taping on gross motor function in children with cerebral palsy

PURPOSE

Therapeutic taping to address dysfunctional sitting control in children with cerebral palsy (CP) was investigated in this study.

METHODS

Eighteen children with quadriplegic CP, Gross Motor Function Classification System for Cerebral Palsy levels IV (n = 9) and V (n = 9) participated in the 12-week program. Subjects were assigned randomly to one of two groups: therapeutic taping + physical therapy or physical therapy only. Therapeutic taping was applied for periods of up to 72 hours over the paraspinal region. The effects were assessed with the Gross Motor Function Measure (GMFM-88) at baseline, six weeks, and 12 weeks. A factorial analysis of variance was used to examine group differences over time.

RESULTS

No significant differences were found for the GMFM-88 scores between groups over time.

CONCLUSION

Therapeutic taping does not evoke a positive functional change in the seated postural control of children with quadriplegic cerebral palsy. Subjective observation, however, suggested that one child with athetosis benefited from therapeutic taping over the paraspinal region.

Assisting people with disabilities to bathe and shower

Some people with disabilities require advice, assisitive equipment or adaptations to their homes in order to be able to wash their bodies. A wide range of bathing and showering aids and specialist baths and showers is available to help with this personal care activity and it is important for occupational therapists to know what equipment is available so they can help service users to make an informed choice.

This article explores some of the bathing and showering equipment currently available. It emphasizes the importance of empowering individuals to make the right choice for themselves. The key to providing a good service is to ensure that advice provided follows an appropriate assessment that takes into account individual needs.

Smoking in a forensic psychiatric service: a survey of inpatients' views

Smoking in a forensic psychiatric service: a survey of inpatients' views Very little is known concerning the views and beliefs of psychiatric inpatients about smoking in hospital. We conducted a survey of inpatients from the forensic wards of a large independent psychiatric hospital using a structured interview to collect data about their views on smoking. Of 102 patients eligible to participate, 45 (44.1%) agreed to do so. Most participants (34, 75.6%) were current smokers. Most smokers thought it was just too difficult to give up smoking (25, 73.5%). They cited seeing staff and other patients smoking, as well as the smoky atmosphere on the ward, as barriers to quitting. The majority of participants (35, 77.8%) thought that staff should be allowed to smoke with patients. Smokers held more liberal views about smoking than non-smokers. A smaller proportion of non-smokers than smokers were happy with the hospital smoking policy, as reflected in the ward rules about smoking. The results of this survey suggest that a change in attitude and culture towards smoking may be needed in psychiatric units. Smokers should be regularly offered help and encouragement to quit. Psychiatric care staff should carefully consider whether their own smoking behaviour undermines their patients' attempts to stop smoking. More attention should be given to the views and needs of non-smokers.

Purchasing electric profiling beds: Benefits and challenges

Pressure ulcer prevention and treatment has relied on the provision of special beds and mattresses in the past. When patients spend most of their time in bed, it is essential to ensure that they are as comfortable as possible, can change position, are at a reduced risk of sustaining pressure damage and ultimately, are able to get in and out of bed with ease. The correct choice of bed is paramount as it will provide a safe working environment for carers and a better quality of care for the patient.

The aim of this article is to raise the awareness of organizations to the benefits of electric profiling beds and highlight the pitfalls of implementing a electric profiling bed replacement programme. The article concludes that purchasing an electric profiling bed is not as straightforward as it may appear: for organizations implementing a bed replacement programme, it requires systems in place that enable best value for money, are cost-effective and have cost improvements.

A guide to choosing children's daily living equipment

Children with disabilities may need supportive equipment to enhance their ability to manage with activities of daily living. Assessments form an essential component in the provision of equipment.

This article will consider some of the fundamental issues surrounding the assessment and the provision of equipment for seating, drinking, eating and sleeping. Some useful products are recommended.

Improving hospital compliance with the Disability Discrimination Act through use of an audit

The 1995 Disability Discrimination Act protects disabled people from discrimination in access to services, facilities and goods, as well as in education and employment. All hospitals have an inherent duty to enable access to services, but this will now be enshrined in law. As the health sector has most contact with disability, it may be expected that most hospitals would already be in a good position to comply with the Act, especially one treating many patients with disability. However, the authors of this article identified many problems in a rehabilitation hospital setting by means of a simple access audit in March 2004. Recommendations were made and by March 2005, considerable improvements had been made, costing £100 000.

This article details the results of the survey and the measures taken to improve compliance. It also discusses the constraints and opportunities to improve facilities for people with disability. Although many necessary changes will be expensive, not all problems identified require costly correction. Many simply involve a change in staff attitudes and practices. The authors recommend that all hospitals start to identify the changes needed under the Act by means of a simple access audit that can be carried out by hospital staff with no specialist equipment.