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[060] OPTOKINETIC TESTING FOR DIAGNOSIS AND REHABILITATION OF BALANCE DISORDERS
Janet E. Shanks, PhD; Robert H.I. Blanks, PhD Cynthia G.
Fowler, PhD
VA Medical Center, Long Beach, CA 90822; Department of
Anatomy/Neurobiology, University of California, Irvine,
Irvine, CA 92697; Department of Communicative Disorders,
University of Wisconsin-Madison, Madison, WI 53706; email:
Shanks.Janet_E@LongBeach.VA.GOV;
Rhblanks@UCI.Edu;
Cgfowler@Facstaff.WiScEdu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #C691-2RA)
PURPOSE--The purpose of this study is to generate data on postural sway induced by horizontal optokinetic stimulation in subjects standing on a fixed platform. Postural sway consists of forward-backward and lateral motions, largely about the ankle joints. Sway induced by horizontal optokinetic patterns has not been studied extensively and may provide a challenge to the vestibular and proprioceptive systems, thereby extending the diagnostic value of fixed-platform posturography.
METHODOLOGY--Basic audiologic evaluations and vestibular function questionnaires were completed for each subject. The posturography system consists of a fixed platform with two independent foot plates with force transducers that resolve the forward-backward and lateral changes in the center of force of a standing subject; a 180° curvilinear projection screen, 1 m from the subject; a shadow projector for visual stimuli; and a support harness to prevent falls. Postural sway is recorded with eyes closed, eyes open, and optokinetic stimuli moving at 20, 40, 60, 80, and 100°/s to the right or left. The moving background consists of a random bar (1×8° visual angle) optokinetic pattern covering 180° in the horizontal plane and 40° in the vertical plane. Each trial consists of a 30 s period of testing, followed by a 30 s rest period. Optokinetic stimuli are presented binocularly and randomized to prevent order effects. Subjects are given an alerting task to maintain vigilance and instructed to stand in a relaxed vertical posture, hands at their sides and looking toward the screen.
Postural sway is measured as changes in "center of force," a time-varying vector defined in the horizontal plane, and computed as a weighted average of the output from six force transducers (three in each foot plate). Data are transferred to a spreadsheet program for analysis and displays of positional sway and sway velocity.
PROGRESS--Testing has been completed on 133 subjects, of whom 69 have hearing normal for their age and no complaints of dizziness; 9 reported dizziness/vertigo; 3 were postsurgical for acoustic neuroma removal; 10 participated in a test-retest protocol; 15 had a sensorineural hearing loss, and 27 completed a pilot study to determine the influence of exercise on balance in the well elderly.
RESULTS--Statistical analysis of the group with normal hearing for their age and normal vestibular function revealed no significant differences in balance as a function of age. Subjects with sensorineural hearing loss revealed no statistically significant differences from the normal control population. Of the 9 subjects with vestibular complaints, diagnoses at the time of testing included BPPV, Meniere's disease, cervical sprain, history of drug/alcohol abuse, labyrinthitis, peripheral neuropathy, and otitis media. Only 3 subjects (labyrinthitis; peripheral neuropathy; otitis media) fell outside the normal range in the eyes open, closed, and/or the 60 left condition. Although an interesting pattern of responses was seen within the remaining six subjects, their responses fell within two standard deviations of the normal mean. Analysis of the data as a function of the relative relation between conditions (eyes open, closed, stimulus left and right) may improve the diagnostic application of this protocol. Analysis of test-retest and post acoustic neuroma removal subjects has not been completed. Data analysis for the 27 subjects who completed the exercise protocol revealed significant changes in single limb support (i.e., eyes open, standing on left leg and right leg, and eyes closed, standing on left leg).
Preliminary results from all the study groups suggest that evaluation of postural sway could be used for diagnostic evaluation, post-surgical monitoring of vestibular compensation, and as a possible indicator for individuals at risk for falls in the well elderly.
[061] VIDEO-BASED FUNCTIONAL PERFORMANCE ASSESSMENT AND TRAINING TOOL: A PILOT STUDY
H.F. Machiel Van der Loos, PhD; Charles Burgar,
MD
Rehabilitation R&D Center, VA Palo Alto Health Care
System, Palo Alto, CA 94304-1200; email:
vdl@roses.stanford.edu;
Web:
http://guide.stanford.edu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Pilot Project #B2047-PA)
PURPOSE--The clinical objective of the Functional Performance Assessment and Training (F-PAT) project is to examine the effectiveness of a personalized home-use videotape, containing footage of the client performing transfers incorrectly and correctly in the clinic, compared to traditional instructional materials. The technical objective of F-PAT is to develop a simplified computer-based data and video-manipulation software tool to aid clinical professionals in the process of developing annotated, graphics-enhanced video for clinical assessment and client training. In this project we are using F-PAT to enhance the early rehabilitation of people with cerebral vascular accident (CVA or stroke) through personalized, function-oriented, multimedia-based client and caregiver training. The initial inpatient rehabilitation period after stroke relies heavily on therapist-intensive, hands-on instruction. Afterward, the recovery process continues largely in the home with family and caregivers, with the extent of carry-over of the earlier therapy training having a significant effect on the course of recovery. Efforts to bring the rehabilitation expertise to the home rely on texts, brochures, mass-produced instructional videotapes, home therapy, and, when possible, in-clinic training of family members. In this project, we apply modern and proven concepts of multimedia training to the practice of rehabilitation through personal videotape-based instruction.
METHODOLOGY--For the 1-year pilot project, we hypothesize that the therapist, using commercial video and office computer hardware and software, will be able to create a personalized videotape from video clips of persons performing transfer tasks. The tape will be used subsequently in their home therapy program.
PROGRESS--In collaboration with clinicians at the Comprehensive Rehab Program (CRP), we have defined the types of transfers appropriate for the F-PAT videotaping, based on the current procedure for training people to do transfers. We are compiling critical factors and other relevant data to provide the right information via the videoclip voice-overs. The project staff has developed a template, using a video digitizing and editing computer program, to perform videoclip cataloguing and computer-based videoclip manipulation so that a final videotape, containing personalized information, overlaid graphics, and spoken instruction, can be produced by the therapist with some knowledge of video-editing techniques. A complete first videotape of generic transfers performed by a physical therapist is currently under production.
PRELIMINARY RESULTS--The F-PAT computer database has been modified to be entirely WWW-based (http://guide.stanford.edu/Projects/FPAT/intro.html), so that clinicians with the appropriate password can view a patient chart on-line, complete with videoclips. Using multiple windows, videoclips from different points in time or from different patients can be compared, and the therapist can make review notes and generate patient progress reports.
FUTURE PLANS--Patients in the CRP are being screened by the staff for possible invitation to participate in this study. As per the grant proposal, we will invite 15 people in the upcoming months to receive one of three types of information packets for their take-home instruction in transfers. The clinical evaluation of the effectiveness of these packets will conclude this pilot project.
In future, we plan to test the hypothesis that the personalized videotape will be more effective in promoting retention and accurate training than conventional instructional materials. We will test this hypothesis by the qualitative analysis of client, caregiver, and clinician satisfaction with F-PAT and by quantitative analysis of the impact of F-PAT on clinician time and of transfer-related accidents in the home occurring to the person who has had a stroke as well as to family members and caregivers.
[062] POST-STROKE REHABILITATION: A PILOT STUDY
Pamela W. Duncan, PhD, PT; Lori Richards PhD, OT; Dennis
Wallace PhD; Joni Stoker, PT; Abna Ogle MD; Stephanie
Studenski, MD, MPH
VA Medical Center, Kansas City MO 64128; Center on
Aging, University of Kansas Medical Center, Kansas City, KS
66160-7117; email: pduncan@kumc.edu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Pilot Project #E1852-PA)
PURPOSE--This research intended to answer the question: does intensive physical therapy training improve long-term outcome after stroke? The majority of stroke survivors have minimal to moderate deficits. These persons are physically deconditioned and have a high prevalence of cardiovascular risk factors that may be potentially modifiable with exercises. However, they receive the least amount of rehabilitation and may not recover to an optimal level. For the most part, physical interventions for stroke are targeted to functional training such as transfers, gait, dressing, and weight-bearing activities: rarely do they include a cardiovascular training component. Exercise studies in geriatric populations suggest balance, strength, or endurance programs have been successful in modifying impairments and functional deficits. No study has ever combined all three components (strength, balance, and endurance) into one intervention program for the elderly or individuals with stroke. The purposes of this pilot study were: 1) to develop a balance, strength, and endurance program based on principles of exercise physiology and motor learning and to deliver it in the home to individuals with mild or moderate strokes; 2) to evaluate the feasibility of recruitment and retention; and 3) to assess the effect of the interventions.
METHODOLOGY--This was a randomized, controlled pilot study. Twenty persons with minimal and moderate stroke impairment (mean Orpington Score 2.7, mean age 67, 11 RCVA, 8 LCVA, 1 Brainstem; 11 males, 9 females; 14 whites, 6 African-Americans) who had completed inpatient rehabilitation and who were 30 to 90 days post-stroke were randomized to usual care or to a therapist-supervised 8 week, thrice-weekly, home-based exercise program of progressive strength, balance, endurance, and bimanual exercises. The control group received usual care as prescribed by their personal physicians. Baseline and post-intervention assessments included the Fugl-Meyer Motor Assessment, Barthel ADL, Lawton IADL, Medical Outcomes Study-36 Health Status Measurement. Functional assessments of balance and gait included 10-m walk, 6-min walk, and Berg Balance Scale. Upper extremity function was evaluated with the Jebsen Hand Test.
PROGRESS--We contacted 22 patients who met study criteria; 2 refused to participate. No subjects dropped out of the study. Subjects tolerated the 1.5 hour intervention and were able to progress in intensity and duration of exercises. Clinical staff were cooperative in monitoring usual care.
RESULTS--The intervention group tended to improve more that the control group in motor function, (Fugl-Meyer UE median change score 10 vs. 5), Fugl-Meyer LE 5 vs. -0.5) gait velocity ( median change 0.27 m/sec vs. 0.11 m/sec), 6 min walk (164 ft vs. 108 ft), Berg balance score (7.5 vs. 5) and MOS physical function (22.5 vs. 5). There were no trends in differences in change scores for Jebsen hand scores, Barthel ADLs, and Lawton IADLS.
IMPLICATIONS--This study demonstrates gains in recovery due to specific intervention programs to improve strength, balance, endurance, and bimanual activities. The preliminary findings are important because they demonstrated that a very specific intevention in mild and moderate patients may enhance recovery beyond that which occurs spontaneously. The functional consequences of these gains are not known and will require a larger sample size where interactions may be tested. Some important interacting factors may be depression, comorbidities, and self-efficacy.
[063] DEVELOPMENT OF QUALITY OF LIFE MEASURES FOR USE IN DYSPHAGIA
Colleen A. McHorney, PhD; Jay Rosenbek, PhD; JoAnne
Robbins, PhD
Departments of Preventive Medicine and Communicative
Disorders and Neurology, University of Wisconsin-Madison
School of Medicine; Wm. S. Middleton Memorial Veterans
Hospital, Madison WI 53705; email:
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #C2016-RA)
PURPOSE--We seek to conceptualize, develop, and validate a subject-based quality-of-life and quality-of-care tool specific for persons with dysphagia. This tool should be of value in outcomes research, clinical trials, health services research, and quality assurance.
METHODOLOGY--The project is taking place across three phases of investigation:
Phase I. We obtained qualitative data, using focus groups, on quality-of-life and quality-of-care outcomes from dysphagic persons and their caregivers. Focus groups are small, carefully planned discussion groups guided by an experienced facilitator with the objective of comprehending participant's experiences on a given topic. Focus groups are ideal for understanding perceptions of disease and treatment because group interaction tends to produce insights that would not surface in individual interviews. Persons with dysphagia were recruited at VA hospitals and affiliated university medical centers in Madison WI and Chicago IL. Phase I activities include development of the focus group agenda, subject recruitment, conduct of the focus groups, and data analysis. Using the focus group data, a large number of questionnaire items will be generated and a standardized, condition-specific questionnaire (SWAL-QOL) that measures experiences of health outcomes of persons with dysphagia will be constructed.
Phase II. We shall pretest the SWAL-QOL upon dysphagic subjects in Madison WI, Chicago IL, and Tomah WI, and conduct preliminary psychometric analyses. The SWAL-QOL will be revised on the basis of these analyses, both to reduce the length of the tool and to improve the quality of retained items.
Phase III. We shall field test the revised SWAL-QOL and conduct thorough psychometric tests. A total of 400 completed surveys will be needed because many of the psychometric tests are based on large-sample statistics. The field test will take place across five VA hospitals and affiliated university medical centers in Madison WI, Chicago IL, Little Rock AR, Houston TX, and Long Beach CA. These sites have active swallowing programs and can contribute a diverse mix of subjects. In the final 6 mo, we will develop a User's Manual and submit manuscripts on the SWAL-QOL for peer review.
PROGRESS--All of Phase I activities have been completed. Phase II activities will be completed in the first month of 1998, and Phase III activities will begin February 1998.
RESULTS--We conducted 13 focus groups (11 in Madison WI and 2 in Chicago IL) to obtain qualitative data on quality-of-life and quality-of-care outcomes from persons with dysphagia and their caregivers. All totaled, our focus group participants included 45 subjects across 9 groups and 15 caregivers across 4 focus groups. A total of 470 pages of transcripts were derived from all 13 groups. These transcripts were carefully analyzed by several different scientists, and a full-day group-consensus meeting was held among study investigators to delineate the major conceptual dimensions for the SWAL-QOL (based on the participant perspective as well as clinical judgment). From the transcripts and our conceptual blueprint, hundreds of questionnaire items were written to represent each domain, using the subjects' own words and conceptions to form the content of the question. These questions underwent dozens of iterations of revisions to yield a "pilot" survey of 192 questions. This preliminary version of the SWAL-QOL was fielded in autumn 1997. We obtained 106 usable pilot surveys. Psychometric analyses are currently underway to identify the most discriminating and highest quality items for inclusion in the final version of the SWAL-QOL, which will undergo extensive psychometric validation, including biomechanical criteria, spring 1998. We expect the SWAL-QOL to be ready for widespread dissemination in summer 1999.
[064] CHARACTERIZATION OF GLOBAL SYNKINESES IN HEMIPARETIC SUBJECTS USING STATIC BI-ARTICULAR MULTIDIRECTIONAL DYNAMOMETRY AND ELECTROMYOGRAPHY
Patrick Boissy, MSc; Daniel Bourbonnais, PhD, OT; Denis
Gravel, PhD, PT; Bertrand Arsenault, PhD, PT
Research Center, Montréal Rehabilitation Institute
and School of Rehabilitation, University of Montréal,
Montréal, Québec, Canada, H3S 2J4; email:
Boissyp@ere.umontreal.ca
Sponsor: Fonds de la recherche en santé du Québec (FRSQ)
PURPOSE--Global synkineses (GS) are unvoluntary movements of the affected limbs occurring during forceful contractions on the nonaffected side of hemiparetic subjects (HS). GS hinder the execution and coordination of voluntary movements in HS. Although it is generally considered that the capacity of these persons to control GS is an index of their motor performance, few studies have used quantitative measures to characterize them.
METHODOLOGY--A bi-articular dynamometer allowing the simultaneous measurement of multidirectional torques exerted at the shoulder, elbow, and forearm was developed. Orthogonal forces are measured at the arm and wrist with two multidirectional strain-gauge transducers interfaced with a laboratory computer. A software program, using lever arms and forces values, calculates the joint torques in real time according to static equilibrium equations. Surface EMG was used to complement the torque measurements.
PROGRESS--The GS of the affected upper limb of HS and the right or left side of controls was characterized during progressive maximal grip exertions on the nonaffected side. While no significant contralateral torques or EMGs were noted in controls, the magnitude of contralateral torques and EMGs in HS was graded with the severity of the motor deficit and the spasticity. GS started to increase at hand grip force thresholds corresponding approximatively to 70 percent of the MVC. The highest levels of hand grip force generated produced the most GS in HS with severe motor deficits. The most prevalent and strongest torque recorded was in elbow flexion.
PRELIMINARY RESULTS--This experimental approach has also been used successfully to characterize the electromyographic patterns of GS in HS during various tasks. Results indicate that upper limb GS are present during both grip exertions on the nonaffected side and bilateral ankle exertions but that they are more pronounced in elbow flexor muscles during grip exertions. This suggests that GS are task specific and that this specificity is probably related to different neurophysiological mechanisms. Recently, the stability of the kinematic and electromyographic patterns of upper limb GS in chronic HS was assessed. GS in elbow flexion and EMG activity of biceps brachii were found to be stable across multiple trials and sessions.
FUTURE PLANS--Electrophysiological testing of HS in conjunction with measurements taken from static dynamometry and surface electromyography will be used to study the neurophysiological mechanisms involved in GS and evaluate the effectiveness of therapeutic interventions aimed at reducing GS and their effects on the functional performance of HS.
[065] QUANTIFICATION AND ASSISTANCE OF MOVEMENT DISORDERS
Daniel S. Hsu, MS; Cameron N. Riviere, PhD; Nitish V.
Thakor, PhD
Human Machine Interface Laboratory, Department of
Biomedical Engineering, Johns Hopkins University, Baltimore
MD, 21205; email: dhsu@bme.jhu.edu
Sponsor: National Institute of Disability and Rehabilitation Research, Washington, DC 22202
PURPOSE--The objective of this study is to quantify and assist movement disorders. The diseases studied include, essential tremor, Parkinson's disease, myoclonus, Huntington's disease, and stroke. The specific problem which the research concentrates upon is twofold: 1) the impairment of handling computer interfaces such as a mouse and pen-like devices, and 2) the impairment of handwriting. The two aspects of the problem are not exclusive of each other as our approach is a synthesis of the two; that is, to develop technology for an assistive computer interface which can aid in basic computer use as well as written communication. Before any assistance can be accomplished, the movement disorders must be assessed and quantified.
METHODOLOGY--For the quantification portion of the research, target tracking tests and writing samples are utilized. Target tracking consists of a mouse/pen that is used to control a cursor on a screen to track a moving target. Accuracy, curvature, and coherence are some of the quantifications that can be obtained from such tests. For the writing samples, functional assessment is accomplished through the use of optical character recognition (OCR), the ability for a computer to recognize and read text or handwritten letters. The computer's capacity to read handwritten characters can be used to gage the functional ability of a motor impaired person. A digitizing tablet is used to take recordings for these tests.
For the assistance portion of the research, filtering algorithms designed to cancel out involuntary movements are implemented into software. A user's movements of a mouse/pen may be unsteady, but when the movements are processed by the computer, the cursor/arrow movements on the computer screen become smoother and more controllable.
PROGRESS--Large quantities of data have been obtained from control and movement-impaired people. The aforementioned quantification techniques have been used to yield revealing results.
PRELIMINARY RESULTS--A statistically valid degradation in performance has been found in the movement impaired. We have found that performance in some motor-disabled subjects may be well less than a half that of control subjects. Depending on the type of affliction, legibility may fall below 40 percent compared to a control's 80 percent and above legibility.
FUTURE PLANS--Further quantitative results are desired for a complete and comprehensive data set. The assistive algorithms developed must be tested to see if they raise performance levels of the motor disabled. Also, the potential of portable digital assistants (PDA) are being considered. PDAs that utilize OCR technology may be a powerful tool for the motor-disabled population as an all-purpose communication device.
[066] MEASURING FUNCTIONAL ABILITIES OF WHEELCHAIR USERS: DESIGN CRITERIA FOR WHEELCHAIR SECUREMENT
Thomas Adams, ME; Steven Reger, PhD, CP; Georgette Sly,
OTR; Ed Terrell, BS; Gu Yandong, MS; Vinod Sahgal, MD
Department of Rehabilitation Medicine, Cleveland Clinic
Foundation, Cleveland OH 44195
Sponsor: National Institute of Health, Bethesda, MD 20892; The Cleveland Clinic Foundation, Cleveland, OH 44195
PURPOSE--The greater independence of wheelchair travelers on public transit requires the development of user-controlled wheelchair securement systems. There is a need for a clear definition of the accessible regions for wheelchair users and of the securement tasks they can perform. The variations in user abilities also indicate the requirement for criteria to associate the functional abilities of users with operational requirements of securement systems.
METHODOLOGY--Data were collected on users who had sufficient hand and arm function to perform the range of motion (ROM) tests. The individual tasks needed to operate a securement system were identified: maneuver the wheelchair into position, grasp the rear components, attach the rear securements to the wheelchair, grasp the front components, attach the front securements to the wheelchair, and operate controls (lock, tension, release).
The performance of these tasks requires systems that are operated within the ROM, strength, and dexterity of the user. ROM was measured by placing a scale (graduated dowel) 30.5 cm behind and 91.4 cm in front of the intersection of the wheelchair seat and back, simulating the front and rear edges of the ADA specified wheelchair bay. The subject was instructed to grasp the scale as low as possible. The height of the center of the palm was recorded at each location. The distances that the individual could reach forward and overhead (while seated upright) were also measured to identify areas where vehicle-mounted controls could be located.
The hand grip and finger pinch strength was measured in a neutral sitting posture in the wheelchair using a Jamar;tm dynamometer and pinch meter. The strength measurements were repeated at the grasp height and locations to measure the effect of reaching on strength of the user. To evaluate dexterity, three different types of karabiner hooks and one open hook were given to the subjects for attachment to a steel ring held in front of them. The degree of difficulty accomplishing these tasks was recorded.
PRELIMINARY RESULTS--Six women and 10 men (average age 37±8 yr) using 10 manual wheelchairs, 4 power wheelchairs, and 2 scooters were tested. The results indicated that user-accessible securement components should be located between 38 and 152 cm above floor level, no more than 30.5 cm inches behind or 61 cm in front of the back of the seat. The grip strength (20.4±15.4 kg) and pinch strength (5±3.6 kg) varied greatly and were substantially less than the typical values for the nondisabled population (36.3 kg grip strength, 7.25 kg pinch strength). These strength values indicated sufficient capacity that force-operated devices may be considered for securement design. Simultaneous application of force and dexterity, however, appeared to present some control difficulties. Both the operating force and geometry affected the difficulty of the attachment operation. Individuals with stronger pinch strength performed the tasks with less difficulty than those lacking finger pinch strength.
FUTURE WORK--Additional bilateral data are needed to begin to differentiate populations for whom independent securement is feasible. This information will have significant influence on securement system design for independent operation by wheelchair users.
[067] RELIABILITY OF THE UPPER BODY MUSCULOSKELETAL ASSESSMENT (UBMA) IN DIAGNOSIS OF WORK-RELATED MUSCULOSKELETAL DISORDERS (WRMD)
Karen L. Harburn, PhD; Patrick Potter; J.F. Kramer; M.
Speechley; G. Rollman; D. Evans
Schools of Occupational Therapy and Physical Therapy,
Faculty of Health Sciences, The Departments of Physical
Medicine and Rehabilitation, Faculty of Medicine and
Dentistry, and of Epidemiology and Biostatistic, Faculty of
Medicine, and of Psychology, Faculty of Social Sciences, The
University of Western Ontario, London, ON, Canada N6G 1H1;
Department of Physical Medicine and Rehabilitation, Parkwood
Hospital, London, Ontario, Canada Southwest Region Health
Information Partnership (SRHIP), UWO Research Park, London,
ON, Canada; email: kharburn@julian.uwo.ca
Sponsor: the Vice-President Research Grant Competition Fund, The University of Western Ontario, London, ON, Canada.
PURPOSE--The purpose of this study was to assess the between-day reliability of an upper body musculoskeletal assessment (UBMA) of strength, range of motion, neurological symptoms, pain, and discomfort. It was developed to assess work-related musculoskeletal disorders (WRMD) in both a physician-diagnosed group of subjects and a control group.
METHODOLOGY--Twenty-five female subjects have participated to date in this ethically approved study: 15, mean age(±sd)=33(±5.25) yr were physician-diagnosed as having WRMDs. Ten subjects acted as healthy (self-described) controls, mean age=30(±2.2) yr. The WRMDs subjects were all working either part- or fulltime, at jobs that were identical or similar to their preinjury employment. The controls were all working fulltime. With the guidance of the physician on our research team, the UBMA was developed to objectively assess pain and discomfort for the neck, shoulders, elbows, and wrists bilaterally. This was done by asking subjects to actively move their limbs through complete movement ranges with the therapist/testor applying resistance at the end of range, then scoring the reported pain on a 5-point scale from 0=no pain to 4=worst pain ever experienced. Passive movement limitations were also scored for all regions as described above. Several shoulder/arm pressure points were assessed for tenderness scores, with the presence of tenderness scoring a 2. Several neurological assessments done bilaterally included those for carpal tunnel syndrome as well as sensation of the finger tips. Forearm swelling was included in the index. Discomfort was assessed for each limb in terms of duration, frequency and intensity each using a 7-point scale. A cumulative score bilaterally gave a maximal score of 190. Two graduate students (one physical therapist and one occupational therapist) collected the data after being trained by the research team physician to assess and score correctly. Subjects were tested on three separate occasions each separated by 1, but no more than 2, days. Sessions lasted 20-30 min. Data were summed for each of the right and left sides and a three-way analysis of variance (ANOVA: 2 groups×2 sides×3 occasions) was applied. Generalizability theory was utilized to calculate the reliability coefficients (RCs) to describe the intersession reliability. Maximal scores were 190 per side with a total of 380 for both sides.
PROGRESS--This study is still in progress. We intend to collect data from five more WRMD subjects.
RESULTS--Of the 15 WRMDs, 10 were affected unilaterally and 5 bilaterally; all were right-handed. In addition, 2 of the 10 controls had minimal symptoms of pain and discomfort (i.e., <10/190 on the UBMA). ANOVA results indicated no interaction effects between the 3 groups. There were also no differences between the three testing occasions. However, there was a difference between the right and left sides of the WRMDs; the right sides were significantly (p<0.05) different in UBMA score from the controls. All RCs were in the excellent (RC>0.9) range for all combinations of occasions. Therefore, between-session reliability was consistently high. Therefore, one testing occasion using the UBMA, either with the WRMDs or control groups, showed excellent reliability. This suggested that the UBMA was a good choice for upper body musculoskeletal assessment if reliability and time-efficiency are assessment requirements. Our findings also supported other work reporting that many jobs (e.g., number inputting via vieodisplay terminals) involve more movements of the dominant side, and therefore place this side more at risk for WRMD development.
FUTURE PLANS--We plan to collect data on five more WRMD subjects and redo our analyses. In addition, we plan to utilize the UBMA to assess WRMDs in heavy videodisplay terminal users at their worksites, and to ascertain the relationship between this measure and other physical and psychosocial measures over a lengthy time period, to track the success of a workplace training regime with heavy VDT users.
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Last revised Fri 04/30/1999