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Biomedical subjects

A Helewa

Publications and source records attributed to A Helewa.

27 records · Page 2Linked to original sources
PubMed1977

"Independent assessor" and "pooled index" as techniques for measuring treatment effects in rheumatoid arthritis.

To conduct studies of therapy of rheumatoid patients at the primary care level two new assessment techniques were developed. The "independent assessor" (IA) was a nonmedical person trained to gather information using a questionnaire, a guided count of tender joints, grip strength, and blood tests. The "polled index" was a statistical device for summarizing all abailable information, constructed by transformation of various clinical measures of treatment effects to a common scale, based on standard deviation units. A validation study is reported, which involved 33 rheumatoid patients, each studied by four trained observers plus the IA, before and after 10 days of hospital therapy. Major gains in sensitivity and reliability were achieved by the pooled index. The IAs total assessment provided 84% of the information available in the pooled index, and was more sensitive and reliable than any other single clinical measure. The efficacy of a brief period of hospital therapy for rheumatoid patients was also strikingly demonstrated.

Analysis of Variance↗
PubMedDate not supplied

Evaluation of quality of patient care in physiotherapy.

Government control over health spending and public demands for improved services have increasingly stimulated professional activity in methods of evaluating the quality of patient care. This paper discusses three distinct approaches to evaluation: evaluation of structure, process and outcome. A well-rounded system of quality appraisal should probably include concurrent or co-ordinated assessments of all three methods, to the extent that each of these is observable and measurable under the constraints inherent in any given setting. The greatest value of developmental and methodological tasks in this area may be that they channel creative activity into a critical appraisal of the content and effect of professional practice. Nonetheless, the challenge ahead is our ability to demonstrate experimentally that these activities do indeed improve the quality of care.

Canada↗
PubMedDate not supplied

Physiotherapy into the 80's.

During the 80's, physiotherapists will have to deal with many important issues such as effective legislation; the basic educational requirement for CPA membership; changes in the code of ethics; accreditation of educational and clinical programs; and standards for quality of care. The greatest challenge for physiotherapists may, however, lie in provision of cost-effective treatment. As governments shift from bedded to non-bedded services, the opportunities for physiotherapists to provide outpatient services may lie in increased private practice operations and the expanded services of community health centres, home care unit, and mobile clinics traveling to remote rural communities. Increasing demands by government and consumer groups for quality control of services provided will create a need for clinical research, to make certain that treatments are effective. Physiotherapists must continue to ensure that increases in the profession's basic educational requirement, body of knowledge, level of specialization, leadership development, resources, and status in the health team are adequate to meet the future expectations of the public sector. The problems facing physiotherapists in the '80s revolve around their credibility--as a professional groups, as clinicians and researchers in a specific field, and as members of a helping profession.

Canada↗
PubMedDate not supplied

Spasticity measurement in stroke: a pilot study.

The ability to objectively measure spasticity, related to cerebral stroke, is important in the rehabilitation therapies since many therapeutic modalities have been developed over the years to reduce spasticity. The unproven clinical expectation is that function would be improved were spasticity to be reduced. Unfortunately, the ability to measure spasticity to conduct efficacy studies of spasticity-reducing therapies is not possible. This relates to the multi-variable nature of the spastic syndrome with the result that no clinical measurement technique has been proven to be sensitive, valid and reliable. Therefore, it is important to develop a research-oriented spasticity measurement system to meet this need. We describe the current development of such a system. Details of our pilot study of a reflex excitability technique, designed to measure certain components of cerebral spasticity, are presented. The technique combined biomechanical and electrophysiological measures to investigate a homogenous stroke sample (n = 6); it incorporated the H-reflex in soleus, during passive ankle movements, as a measure of faulty neural inhibition. This component significantly (p < .05) differentiated the stroke sample from a matched, healthy control group (n = 6). Evocation of a cutaneous reflex in soleus was a condition that was problematic and it had to be dropped from the protocol. Joint stiffness, which is thought to affect measures of spasticity during passive movement, did not contaminate the measures. Further research in this direction is required to delineate and measure other neural components of spasticity while taking into account related non-neural variables. The final objective in this line of research is to develop a valid, reliable and sensitive spasticity measurement system that could be used to judge the efficacy of physical neurorehabilitation treatments currently employed to reduce spasticity following stroke.

Aged↗
PubMedDate not supplied

A reflex technique to measure presynaptic inhibition in cerebral stroke.

The purpose of this study was to evaluate the feasibility of reflex excitability measurement techniques in the partial measurement of spasticity related to cerebral stroke. Techniques involved the testing of the soleus H-reflex at specific ankle positions during passive dorsiflexing movements with and without background plantarflexing contractions; conditions attempted to simulate the terminal stance phase of gait. Testing of 12 stroke subjects, having cerebrovascular lesions related only to occlusion of the middle cerebral artery, demonstrated significantly (p < 0.01) less inhibition of the H-reflex during passive ankle dorsiflexion compared to 12 matched, healthy controls. However, evocation of the H-reflex during a low-level, voluntary plantarflexing contraction concomitant with passive dorsiflexion, did not reflect a statistical difference between the two groups. The two conditions were thought to each represent measures of faulty presynaptic inhibition as indicators of cerebral spasticity. A Chi-square calculation of sensitivity for the passive ankle movement without background plantarflexing contraction condition, was shown to significantly differentiate (p < 0.05) between the stroke and normal groups. A positive, but weak, correlation was found for stroke subjects between this reflex measure and the Ashworth clinical measure of spasticity (r = 0.49). Although stroke subjects exhibited increased joint stiffness when the full range of passive ankle dorsiflexion movement was considered, in comparison to the matched healthy control subjects, no significant increase in passive stiffness was found at the joint position of the reflex evocation. Size of the cerebral lesion, as determined from CT or MRI scan, was not related to the spasticity measures. Therefore, in a homogeneous stroke sample, a component of cerebral spasticity i.e., faculty Ia presynaptic inhibition, has been measured during a simulated functional movement in the lower extremity and was shown to differentiate this group from a matched, healthy, control sample. Joint stiffness did not contaminate the measures.

Aged↗