PURPOSE: This case study of an elderly women with Rett syndrome is used to consider whether observed changes may be related to physiological processes involved in ageing or environmental adaptations, which is important for delivery of rehabilitation. METHOD: The life story of a woman with Rett syndrome who lived to the age of 60 is presented. It is based on medical records, older and more recent videotapes, and interviews with her sister and care staff. RESULTS: After 21 years without walking, following intensive physiotherapy, she regained the ability to walk without support. She also showed improvement in hand use a few years before she died. During the early regression she appeared to lose social interest. The interest improved after some time, but she remained wary of people she did not know. CONCLUSION: The walking and hand use indicate that these functions may have been present to a greater extent than assumed by people in the environment and that her poor function reflects dyspraxia and lack of opportunity and training rather than lack of ability. Although more studies of elderly women with Rett syndrome is needed to answer whether the observed changes were due to physiological processes involved in ageing or environmental adaptations, the present case story demonstrates that identification of females with Rett syndrome is important at all age levels.

Activities of Daily Living↗

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Deciding on injection sites.

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Arm↗

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Implications of muscular defense in testing for the anterior drawer sign in the knee. A stress radiographic investigation.

This study was performed with the aim of shedding some light on the effect of muscular guarding during clinical testing of the knee for anteroposterior laxity. Twenty physicians were tested on a knee phantom, for force used during testing for the anterior drawer sign. The force used averaged 109 N (range, 70 to 180 N). Fifteen patients were examined by stress radiography. Radiographs were taken with the knee flexed to 90 degrees (the drawer test position) and with the knee flexed to 15 degrees (the Lachman position). A comparison was made between the laxity measured on forward traction in the relaxed knee, and during traction while the patient was instructed to counteract the forward displacement of the tibia by tensing the hamstrings, thus simulating muscular defense. The test procedure was executed first with 80 N and then with 160 N applied. The opposing effect of tensing the hamstrings on the anterior shift of the tibia was significantly less at 15 degrees of knee flexion (with 80 N, P less than 0.02; with 160 N, P less than 0.05) than at 90 degrees. With the hamstrings tensed and the knee flexed to 90 degrees, no statistically significant gain in drawer sign was achieved by increasing the force from 80 to 160 N. With the knee in the Lachman position, increasing the force produced a significantly greater anterior drawer sign (P less than 0.01).

Biomechanical Phenomena↗

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A simple rig for stress radiography of the knee.

A simple rig for obtaining stress radiographic measurements of the knee is presented. Lateral instability (varus), medial (valgus), anterior and posterior (drawer), as well as rotatory instability can be measured. The rig works by means of weights over pulleys, and the same forces are applied as when using a hydraulically-operated machine. The rig is small and inexpensive. A group of subjects showed values of stability within the same 'normal' area as those obtained with the hydraulically-operated stress machine. Data were processed on a microcomputer.

Adult↗

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The course of differently treated isolated ruptures of the anterior cruciate ligament as observed by prospective stress radiography.

In a prospective stress radiographic study of the course of 21 isolated anterior cruciate ligament (ACL) injuries, primary suture was performed in eight patients and reconstruction due to chronic instability was performed in six patients. Seven patients were treated by exploratory arthrotomy only. After a follow-up period of seven years the anterior drawer sign had disappeared in five of the 14 patients who had shown this sign prior to operation, but in some of these patients progressive rotatory instabilities developed, so that the total abnormal instability did not improve in any of the three therapeutic groups. Only ten patients obtained a completely symptom-free knee. A well performed Jones procedure could reduce a chronic anterior drawer instability, but in several of the patients troublesome patellofemoral pain developed later. Acute suture of isolated anterior cruciate ligament injuries afforded the best results in this series and is recommended.

Adolescent↗