Factors associated with coping in persons undergoing alcohol and drug detoxification

In order to identify factors associated with the coping styles of detoxifying alcohol and drug patients, the coping styles of 137 alcohol and drug patients drawn from three city, suburban, and rural rehabilitation programs were examined in relation to various indices, including depression and anxiety. The results showed that depression was a moderately useful predictor of wishful thinking--the highest coping style utilized by patients. The relatively infrequent use of problem-focused coping across a range of stressful situations suggests that alcohol and drug patients may benefit from therapeutic programs designed to train them in the use of problem-focused coping strategies.

The Australian Vascular Quality of Life Index (AUSVIQUOL): An Improved Clinical Quality of Life Tool for Peripheral Vascular Disease

OBJECTIVES

To validate the Australian Vascular Quality of Life Index (AUSVIQUOL) as a quality of life (QOL) tool appropriate for peripheral vascular disease patients in the clinical setting.

DESIGN

Cross-sectional study.

MATERIALS

The study group consisted of 71 patients with vascular claudication of varying severity attending a tertiary hospital outpatient department.

METHODS

The results of the AUSVIQUOL and Medical Outcomes Short Form Health Survey (SF-36) were compared through factor and regression analyses. A group of 12 patients was then reassessed to compare the reliability and internal consistency of the two indices.

RESULTS

The AUSVIQUOL took less time to complete than the SF-36 (3.27 v 10.79 min; p<0.0001) and fewer patients found the questions confusing (2% v 26%). The AUSVIQUOL was easier to administer and had a higher level of patient acceptance than the SF-36. The regression analysis showed that for each of the domains in the AUSVIQUOL there was a significant correlation with measures in the SF-36 (adjusted R-squared 0.420, 0.480 and 0.331). The AUSVIQUOL demonstrated a good level of internal consistency when compared to the SF-36 (Cronbach's alpha 0.8702 vs 0.6307).

CONCLUSION

In comparison with the SF-36, the AUSVIQUOL is an improved tool for the QOL assessment of patients with peripheral vascular disease in the clinical setting.

The challenge of tetradic relationships in medically interpreted pediatric primary care visits: A descriptive study of communication practices

OBJECTIVE

To examine spoken interactions between pediatricians and community-based interpreters speaking with adolescents and parents with Limited English proficiency (LEP) in primary care to identify the challenges of interpreting in a four-person or tetradic visit, its sources of co-constructed errors, and specific practices for educational intervention.

METHODS

As part of a larger study of vaccine decision-making at six clinical sites in two states, this descriptive study used discourse analysis to examine 20 routine primary care visits in a Latino Clinic in interactions between adolescents, parents, community-based interpreters, and pediatricians. Specific patterns of communication practices were identified that contributed to inaccuracies in medical interpretation

RESULTS

Practices needing improvement were tallied for simple frequencies and included: omissions; false fluency; substitutions; editorializing; added clarification, information, or questions; medical terminology; extra explanation to mother; and, cultural additions. Of these speaking practices, omissions were the most common (123 out of 292 total) and the most affected by pediatricians.

CONCLUSION

The dynamics of both pediatricians and interpreters contributed to identification of areas for improvement, with more adolescent participation in bilingual than monolingual visits.

PRACTICE IMPLICATIONS

These observations provide opportunities for mapping a communication skills training intervention based on observations for future testing of an evidence-based curriculum.

Feasibility and acceptability of a culinary nutrition programme for adults with mild-to-moderate intellectual disability: FLIP Food and Lifestyle Information Programme

BACKGROUND

Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness.

METHOD

Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality.

RESULTS

Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess.

CONCLUSIONS

Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.

Paretic propulsion changes with handrail Use in individuals post-stroke

Background

Roughly 800,000 people experience a stroke every year in the United States, and about 30% of people require walking assistance (walker, cane, etc.) after a stroke. Gait training on a treadmill is a common rehabilitation activity for individuals post-stroke and handrails are typically used to assist with walking during this training, however individual interaction with these handrails are not usually considered and quantitatively reported. Individuals may exert force onto the handrails to aid with propulsive force, but the relationship between limb propulsive force and handrail propulsive force are not known.

Research question

How do individuals post-stroke alter paretic propulsive force when using an assistive device, such as handrails on a treadmill?

Methods

Twenty-one individuals post-stroke (eight current assistive device users and thirteen individuals who do not use an assistive device) walked on a treadmill for 3 min during three conditions: no handrail use, light handrail use (<5% BW) and self-selected handrail use. Three multilevel models were used to compare percent handrail, paretic and nonparetic propulsion between handrail conditions and assistive device groups.

Results

The handrail propulsive impulse was more during the self-selected handrail condition compared to the light handrail condition (p = 0.002). The assistive device use group and the handrail condition fixed effects significantly improved the model fit for paretic propulsive impulse (p = 0.01). The interaction between assistive device use group and handrail condition significantly improved the model fit for nonparetic propulsive impulse (p < 0.001).

Significance

These results suggest that handrail use may impact paretic propulsive impulse. Our initial results suggest that if the goal of rehabilitation treadmill training is to increase the paretic propulsive impulse, having the clinician encourage walking with the handrails may be optimal to promote paretic propulsion.

Adults with cerebral palsy exhibit uncharacteristic cortical oscillations during an adaptive sensorimotor control task

Prior research has shown that the sensorimotor cortical oscillations are uncharacteristic in persons with cerebral palsy (CP); however, it is unknown if these altered cortical oscillations have an impact on adaptive sensorimotor control. This investigation evaluated the cortical dynamics when the motor action needs to be changed "on-the-fly". Adults with CP and neurotypical controls completed a sensorimotor task that required either proactive or reactive control while undergoing magnetoencephalography (MEG). When compared with the controls, the adults with CP had a weaker beta (18-24 Hz) event-related desynchronization (ERD), post-movement beta rebound (PMBR, 16-20 Hz) and theta (4-6 Hz) event-related synchronization (ERS) in the sensorimotor cortices. In agreement with normative work, the controls exhibited differences in the strength of the sensorimotor gamma (66-84 Hz) ERS during proactive compared to reactive trials, but similar condition-wise changes were not seen in adults with CP. Lastly, the adults with CP who had a stronger theta ERS tended to have better hand dexterity, as indicated by the Box and Blocks Test and Purdue Pegboard Test. These results may suggest that alterations in the theta and gamma cortical oscillations play a role in the altered hand dexterity and uncharacteristic adaptive sensorimotor control noted in adults with CP.

Social support systems: contributors to the incidence of schizophrenia

The present article considers the recent increase in community-based support systems for psychiatric patients. Although these systems appear to offer some short-term benefits, the long-term consequences have received little attention. Here, the case is examined for such systems actually facilitating the reproductive rates and hence general incidence of genetically transmitted disorders such as schizophrenia.

Functional heart and brain changes in acute coronary syndromes

Aims

To investigate whether there are functional brain differences, or differences in global network measures, between patients with acute coronary syndrome (ACS) and non-obstructive coronary arteries and patients with an ST-elevation myocardial infarction (STEMI) and healthy controls.

Methods and results

In this single centre, prospective cohort study, all patients &lt;80 years who presented to a tertiary cardiac centre with a suspected acute coronary syndrome and who had non-obstructive coronary arteries on invasive angiography were approached for inclusion. Age and sex matched patients presenting with a STEMI and a further group of healthy volunteers were recruited as control groups. All patients received routine clinical care and investigations and underwent additional psychological questionnaires, cardiac magnetic resonance imaging and functional brain imaging within 14 days of admission. Image pre-processing and analysis was undertaken in a blinded fashion.

72 participants, in addition to 27 STEMI controls and 28 healthy controls, were recruited. Median age in the participant group was 57 years (IQR 47–66 years) and patients were scanned 6 days (IQR 3–8 days) from admission. Patients with ACS and non-obstructive arteries had increased functional connectivity in the default mode network and reduced connectivity in the central executive network compared to controls (Figure 1). They also had higher anxiety scores compared to STEMI and healthy controls and higher depression and stress scores compared to healthy controls (Figure 2). There was no difference in any global network measure between participants and age and sex matched controls however high anxiety or stress scores were associated with lower global efficiency in patients with ACS and non-obstructive coronary arteries but not in controls (Figure 2).

Conclusion

Patients with ACS and non-obstructive coronary arteries are distinct from both the STEMI and healthy population in terms of their psychological and neurofunctional state and this may have important future therapeutic implications for patients.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): James Tudor FoundationRosetrees Trust

A portable visual biofeedback device can accurately measure and improve hip extension angle in individuals post-stroke

BACKGROUND

Visual biofeedback has shown success in improving gait mechanics in individuals post-stroke but has typically been restricted to use on a treadmill or a short walkway. Using real-time visual biofeedback during overground walking could increase the ease of clinical translation of this method. The objective was to investigate the reliability of a real-time hip extension feedback device during unconstrained, overground walking. We hypothesized that the peak hip extension angle outcome of our device would be comparable to peak hip extension angle measured from a common motion capture system. In addition, we hypothesized that individuals post-stroke would increase their hip extension angle after a single walking bout with visual biofeedback of their hip extension angle.

METHODS

Fourteen individuals with chronic stroke walked for one six-minute walking bout with the visual biofeedback device. Before (pre-training) and after (post-training) the feedback walking bout, participants walked in a straight line at their self-selected speed for at least five steps per foot.

FINDINGS

Our device was reliable in measuring peak hip extension angle when compared to 3D motion capture equipment (R2 = 0.99). Individuals increased their hip extension angle after one session with the visual biofeedback (+2.886 ± 2.189 deg) compared to a control walking bout (+1.550 ± 1.629 deg) (Z = -2.103, p = 0.035).

INTERPRETATION

Our novel and inexpensive biofeedback method may provide benefit for individuals post-stroke and expand the possibilities for feedback in rehabilitation.

Ankle stiffness modulation during different gait speeds in individuals post-stroke

BACKGROUND

Neurotypical individuals alter their ankle joint quasi-stiffness in response to changing walking speed; however, for individuals post-stroke, the ability to alter their ankle quasi-stiffness is unknown. Individuals post-stroke commonly have weak plantarflexor muscles, which may limit their ability to alter ankle quasi-stiffness. The objective was to investigate the relationship between ankle quasi-stiffness and propulsion, at two walking speeds. We hypothesized that in individuals post-stroke, there would be no difference in their paretic ankle quasi-stiffness between walking at a self-selected versus a fast speed. However, we hypothesized that ankle quasi-stiffness would correlate with gait speed and propulsion across individuals.

METHODS

Twenty-eight participants with chronic stroke walked on an instrumented treadmill at their self-selected and fast-walking speeds. Multilevel models were used to determine the relationships between ankle quasi-stiffness, speed, and propulsion.

FINDINGS

Overall, ankle quasi-stiffness did not increase within individuals from a self-selected to a fast gait speed (p = 0.69). A 1 m/s increase in speed across participants predicted an increase in overall ankle quasi-stiffness of 0.02 Nm/deg./kg (p = 0.03) and a 1 N/BW change in overall propulsion across participants predicted a 0.265 Nm/deg./kg increase in overall ankle quasi-stiffness (p < 0.0001).

INTERPRETATION

Individuals post-stroke did not modulate their ankle quasi-stiffness with increased speed, but across individuals there was a positive relationship between ankle quasi-stiffness and both speed and peak propulsion. Walking speed and propulsion are limited in individuals post-stroke, therefore, improving either could lead to a higher functional status. Understanding post-stroke ankle stiffness may be important in the design of therapeutic interventions and exoskeletons, where these devices augment the biological ankle quasi-stiffness to improve walking performance.

Treadmill Handrail-Use Increases the Anteroposterior Margin of Stability in Individuals' Post-Stroke

Treadmills are important rehabilitation tools used with or without handrails. The handrails could be used to attain balance, prevent falls, and improve the walking biomechanics of stroke survivors, but it is yet unclear how the treadmill handrails impact their stability margins. Here, we investigated how 3 treadmill handrail-use conditions (no-hold, self-selected support, and light touch) impact stroke survivors' margins of stability (MoS). The anteroposterior MoS significantly increased for both legs with self-selected support while the mediolateral MoS of the unaffected leg decreased significantly when the participants walked with self-selected support in comparison to no-hold in both cases. We concluded that the contextual use of the handrail should guide its prescription for fall prevention or balance training in rehabilitation programs.

Radiographic calibration for pubic diastasis assessment in bladder exstrophy-epispadias complex: a phantom study

BACKGROUND

The assessment of pubic diastasis is important for the surgical planning of patients with bladder exstrophy-epispadias complex. Understanding how the diastasis changes during surgical follow-up may help predict patient morbidity. Radiography can follow diastasis but may be affected by patient and technical imaging factors including body size, imaging protocol, and equipment. Using imaging calibration and anatomic ratios may mitigate differences due to these aspects.

OBJECTIVE

Use imaging phantoms to assess the effect of radiographic calibration on measurements of pubic diastasis and an internal anatomic ratio as a child grows.

MATERIALS AND METHODS

Radiographic images were obtained of three different sizes of computed tomography phantoms (older child, child, and infant) using three imaging techniques that include the osseous pelvis in children. All phantoms were imaged with abdomen and pelvis techniques. The infant phantom was additionally imaged using a thoracoabdominal technique. These exposures were all repeated with systems from three manufacturers. Linear measurements were made between radiographic markers placed to simulate pubic diastasis and sacral width. A ratio was also created between these distances. Measurements with and without image calibration were made by two pediatric radiologists using rulers placed at the time of image acquisition.

RESULTS

There was excellent interrater agreement for measurements, ICC >0.99. Anterior distances were more affected by magnification than posterior ones with a significant difference between uncalibrated versus calibrated anterior distances (p=0.04) and not for posterior ones (p=0.65). There was no difference between radiographic equipment manufacturers without or with calibration (p values 0.66 to 0.99). There was a significant difference in simulated pubic distance between thoracoabdominal and abdomen (p=0.04) as well as pelvic (p=0.04) techniques which resolved with calibration, each p=0.6. The ratio between the simulated pubic diastasis and sacral width differed by phantom size (all p<0.01) and imaging technique (p values 0.01 to 0.03) with or without calibration. However, the numerical differences may not be clinically significant.

CONCLUSION

Image calibration results in more uniform measurements that are more accurate than uncalibrated ones across patient size, imaging techniques, and equipment. Image calibration is necessary for accurate measurement of inter-pubic distances on all projection imaging. Small differences in the pelvic ratio likely are not clinically significant, but until there is a better understanding, image calibration may be prudent.

Real-Time Visual Kinematic Feedback During Overground Walking Improves Gait Biomechanics in Individuals Post-Stroke

Treadmill-based gait rehabilitation protocols have shown that real-time visual biofeedback can promote learning of improved gait biomechanics, but previous feedback work has largely involved treadmill walking and not overground gait. The objective of this study was to determine the short-term response to hip extension visual biofeedback, with individuals post-stroke, during unconstrained overground walking. Individuals post-stroke typically have a decreased paretic propulsion and walking speed, but increasing hip extension angle may enable the paretic leg to better translate force anteriorly during push-off. Fourteen individuals post-stroke completed overground walking, one 6-min control bout without feedback, and three 6-min training bouts with real-time feedback. Data were recorded before and after the control bout, before and after the first training bout, and after the third training bout to assess the effects of training. Visual biofeedback consisted of a display attached to eyeglasses that showed one horizontal bar indicating the user's current hip angle and another symbolizing the target hip extension to be reached during training. On average, paretic hip extension angle (p = 0.014), trailing limb angle (p = 0.025), and propulsion (p = 0.011) were significantly higher after training. Walking speed increased but was not significantly higher after training (p = 0.089). Individuals demonstrated a greater increase in their hip extension angle (p = 0.035) and propulsion (p = 0.030) after the walking bout with feedback compared to the control bout, but changes in walking speed did not significantly differ (p = 0.583) between a control walking bout and a feedback bout. Our results show the feasibility of overground visual gait feedback and suggest that feedback regarding paretic hip extension angle enabled many individuals post-stroke to improve parameters important for their walking function.