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Biomedical subjects

W H Eisma

Publications and source records attributed to W H Eisma.

At least 37 records · Page 2Linked to original sources
PubMed2000

Prediction of functional outcome after spinal cord injury: a task for the rehabilitation team and the patient.

STUDY DESIGN: Descriptive analysis of data gathered in an information system. OBJECTIVES: To explore the predictions of professionals and patients regarding functional outcome after spinal cord injury related to the final results after inpatient rehabilitation, in order to make prognostics of rehabilitation outcome more successful and enlarge the role of the patient in selecting realistic rehabilitation goals. METHODS: Data from 55 patients with spinal cord injury admitted to the rehabilitation centre. Expectations of the rehabilitation team and the patients regarding future independence in performing six daily activities were compared to the functional results at discharge. The results of patients with different level and extent of lesion were analyzed. RESULTS: In 52% of all performed skills, independence was achieved at discharge. Professionals and patients made similar predictions. If they both expected independence after rehabilitation. 90% of the skills were performed independently at discharge. If they both did not expect independence only 3% of the functional results were positive. Of all combined predictions 64% was correct. Correct predictions were most often found regarding self-care skills of patients with paraplegia and regarding mobility of patients with complete lesions. Prediction of self-care outcome of patients with tetraplegia is far more complicated. There was a considerable variation in predictions of mobility potential, especially regarding patients with incomplete lesions. If the team and patients agreed upon expected independence in mobility skills of these patients, the final results were mostly positive. CONCLUSIONS: Prediction of functional outcome after spinal cord injury was most successful if the expectations of the team and patients were combined. Prognosis of self-care outcome of patients with paraplegia and mobility potential of patients with complete spinal cord lesions was usually clear at admission. However, selection of realistic goals concerning self-care skills of patients with tetraplegia and mobility skills of patients with incomplete lesions is far more complicated. Gradual adjustment of objectives is needed during the rehabilitation process in close collaboration between the professionals and the patients.

Activities of Daily Living↗
PubMed2000

Lower limb deficient children in The Netherlands: epidemiological aspects.

Information on the characteristics of children with limb deficiencies and amputations in The Netherlands is largely lacking. The present study aimed to collect data about the prevalence of congenital deficiencies, the ratio of congenital to acquired limb deficiencies, types of lower leg deficiency or amputation and male/female ratios. Data were obtained from a regional birth defects registry for the northern part of The Netherlands (EUROCAT-NNL) and from a national survey. Inclusion criteria for the selection of the EUROCAT data were: children/foetuses with lower leg deficiencies born in 1981-1986. Inclusion criteria for the survey data were: children aged 1-18 years with congenital deficiencies or acquired amputations of the leg, excluding toe deficiencies/amputations. Both the regional birth defects registry and the national survey only yielded small numbers of children, which limits the validity of the authors' findings. The Eurocat data show a prevalence of lower leg deficiencies at birth of 2.07/10,000. Fifty-five (55) children/foetuses were included in the present study. The male/female ratio was 1:1. Of the live-born children, 30% also had defects of the upper limbs, while 38% had bilateral lower limb deficiencies. The national survey included 89 children, of whom 73% had congenital deficiencies, while the others had undergone amputations: of which 37% were due to malignancies, 29% to traumata, 13% to infections and 21% to other pathology. The male/female ratio was 7:3 for the children with congenital deficiencies versus 6:4 for the children with acquired amputations. In the group of congenital deficiencies, fibula deficiency was most frequently seen (36%), while in the group with acquired amputations trans-femoral amputation, knee disarticulation and trans-tibial amputation were seen with equal frequency (21%). In 40% of the children with congenital deficiency and in 8% of the children with acquired amputations the arm was also affected. Both legs were affected in 37% of the children with congenital deficiencies and in 8% of the children with acquired amputations.

Adolescent↗
PubMed2000

Children with congenital deficiencies or acquired amputations of the lower limbs: functional aspects.

The aim of the study was to evaluate the use of prostheses, some secondary complications and functional aspects among children who had a congenital leg deficiency or an acquired leg amputation. Rehabilitation physicians were asked to refer children, aged 1-18 years, with a leg deficiency or amputation. Mentally retarded children, children who had only had a toe amputated and children within one year after amputation were excluded. A total of 88 children were included; 64 with a congenital deficiency and 24 with an acquired amputation. In 25 of these 88, both legs were affected; 28 children also had an arm deficiency or amputation. A structured interview was held and the Child-HAQ assessed. Five (5) questions from the Child-HAQ, all relating to leg functions, were analysed. All but 7 children had had a prosthesis fitted, most (89%) using it for almost the entire day. In the children with congenital deficiencies, the first prosthesis had been fitted at an average age of approximately 18 months. Four (4) of the 7 children without prostheses used orthopaedic footwear. The 10 children with congenital deficiencies necessitating prostheses with articulated knees had the first knee of this type fitted at an average age of approximately 37 months. Forty-seven (47) of the 88 children had needed one or more (secondary) operations. In the children with congenital deficiencies, this was usually a conversion procedure, while the children with an acquired amputation had usually been operated on for osseous overgrowth. Twenty (20) of the 88 children experienced or had previously experienced phantom sensations, 5 children phantom pain. Skin problems were common. Most children (95%) were able to walk, most of them (93%) more than 100 m and 93% of the children aged 4 years or over were able to cycle. Most children (94%) aged 6 years or over were able to don and doff their prostheses independently. Some 90% of the children aged 4 years or over attended a normal primary or secondary school. Most (93%) of the children were able to take part in the physical education programme at school, although frequently (47%) with some degree of difficulty. The functional abilities of 88 Dutch children with congenital leg deficiencies or leg amputations were found to be generally satisfactory. Most of the children used prostheses in their daily activities. Secondary complications were, however, frequent.

Adolescent↗
PubMed2000

A study of technical changes to lower limb prostheses after initial fitting.

There is little published material in recent years about the use of lower limb prostheses in an elderly amputee population. In this study the authors were interested in the technical changes to lower limb prostheses after a first limb fitting procedure in a post-rehabilitation population in The Netherlands. The process of fitting a prosthesis and the technical changes to the artificial limb in the first year afterwards are studied.

Aged↗
PubMed2000

Ulnar nerve lesions: functional outcome after five years.

OBJECTIVE: To analyse perceived impairments, disability, job restrictions and job changes in subjects with a neurapraxia and neurotmesis of the ulnar nerve five years after trauma. DESIGN: Retrospective, descriptive follow-up study. SETTING: Department of Rehabilitation of a University Hospital. SUBJECTS: Sixteen subjects with a neurotmesis (NT-group) and 20 subjects with a neurapraxia (NP-group) were compared by means of a structured interview assessing perceived impairments and change in job and a questionnaire assessing disabilities (Groningen Activity Restriction Scale: GARS). RESULTS: The NP-group perceived significantly more pain, loss of strength and sensation, loss of dexterity and perceived more job-related restrictions than the NT-group. The NP-group had significantly higher scores on the GARS. There was a moderate correlation between the visual analogue score of the pain and the GARS in the NP- and NT-groups. No significant difference was found between the groups with respect to job changes. CONCLUSIONS: This study shows that subjects with a neurapraxia of the ulnar nerve perceive more impairments and disabilities compared with those subjects with a neurotmesis.

Adult↗
PubMed2000

Measurement of severity of sports injuries: an epidemiological study.

OBJECTIVE: To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity. SUBJECTS: A total of 12403 patients, 4-50 years old, who were treated in the trauma department of the Groningen University Hospital for a sports injury, from January 1990 until January 1997. METHOD: All patients treated because of an injury entered the study. A distinction was made between injuries caused by playing sports, home and leisure accidents, traffic accidents and violence. The severity of the injuries was assessed by using the criteria of rate of admission, Injury Severity Scale (ISS). Finally the sports injuries were analysed with regard to type of sport. RESULTS: In total, 57760 injuries were registered. After injuries due to home and leisure accidents (44%; 25228) sports injuries (21%; 12 403) were the most frequent cause of injury. Of the patients with a sports injury, 7.9% (980) were admitted, which is more than with home and leisure accidents (6.7%; 1690) but less than with traffic accidents (21.5%; 2202) and violence (9.3%; 364). In a majority of cases, admission was related to a limited number of types of sport. The mean ISS of sports injuries was low, as with injuries following home and leisure accidents and violence. The percentage of sports injuries with an ISS higher than or equal to 16 and the percentage mortality were both low in comparison to injuries due to violence or traffic accidents. CONCLUSIONS: Sports injuries rank second highest in terms of cause of injury, after home and leisure accidents; and rank third in terms of severity, after traffic accidents and violence. Even though the ISS is low, sports injuries may have serious consequences.

Adolescent↗
PubMed2000

Diabetic neuropathy examination: a hierarchical scoring system to diagnose distal polyneuropathy in diabetes.

OBJECTIVE: Existing physical examination scoring systems for distal diabetic polyneuropathy (PNP) do not fulfill all of the following criteria: validity, manageability, predictive value, and hierarchy The aim of this study was to adapt the Neuropathy Disability Score (NDS) to diagnose PNP in diabetes so that it fulfills these criteria. RESEARCH DESIGN AND METHODS: A total of 73 patients with diabetes were examined with the NDS. Monofilaments and biothesiometry were used as clinical standards for PNP to modify the NDS. RESULTS: A total of 43 men and 30 women were studied; mean duration of diabetes was 15 years (1-43), and mean age was 57 years (19-90). A total of 24 patients had type 1 diabetes, and 49 patients had type 2 diabetes. Clinically relevant items were selected from the original 35 NDS items (specific item scored positive in >3 patients). The resulting 8-item Diabetic Neuropathy Examination (DNE) score could accurately predict the results of the clinical standards and is strongly hierarchical (H value 0.53). The sensitivity and specificity of the DNE at a cut-off level of 3 to 4 were 0.96 and 0.51 for abnormal monofilament scores, respectively. For abnormal vibration perception threshold scores, these values were 0.97 and 0.59, respectively. Reproducibility as assessed by inter- and intrarater agreement was good. CONCLUSIONS: The DNE is a sensitive and well-validated hierarchical scoring system that is fast and easy to perform in clinical practice.

Adult↗
PubMed1999

The Timed "up and go" test: reliability and validity in persons with unilateral lower limb amputation.

OBJECTIVE: To determine the interrater and intrarater reliability and the validity of the Timed "up and go" test as a measure for physical mobility in elderly patients with an amputation of the lower extremity. DESIGN: To test interrater reliability, the test was performed for two observers at different times of the same day in an alternating order. To test intrarater reliability, the patients performed the test for one observer on two consecutive visits with an interval of 2 weeks. To test validity, the results of the Timed "up and go" test were compared with the results on the Sickness Impact Profile, 68-item version (SIP68), and the Groningen Activity Restriction Scale (GARS). PATIENTS: Thirty-two patients, age 60 yrs or older, with unilateral transtibial or transfemoral amputation because of peripheral vascular disease. RESULTS: The Timed "up and go" test showed good intrarater and interrater reliability (r = .93 and .96, respectively). A moderate relationship exists between the Timed "up and go" test and the GARS, a good relationship exists with the "physical subscales" of the SIP68, and there is no relationship with the "mental subscales" of the SIP68. CONCLUSIONS: The Timed "up and go" test is a reliable instrument with adequate concurrent validity to measure the physical mobility of patients with an amputation of the lower extremity.

Activities of Daily Living↗
PubMed1999

Repeated passive stretching: acute effect on the passive muscle moment and extensibility of short hamstrings.

OBJECTIVE: To examine the response of short hamstring muscles to repeated passive stretching. DESIGN: A repeated measures design. SETTING: A university laboratory for human movement analysis in a department of rehabilitation. SUBJECTS: Students (7 men, 10 women) from the Department of Human Movement Sciences. MAIN OUTCOME MEASURES: The lift force, range of motion, pelvic-femoral angle, first sensation of pain, and electromyogram of the hamstrings were measured. RESULTS: Comparison of the data of the test group (n = 17) after five successive passive stretch tests by means of an instrumental straight-leg raising test showed no significant change of the variables passive muscle stiffness and extensibility (p>.05). CONCLUSION: The acute effect of repeated passive stretching of short hamstring muscles is negligible. With an instrumental straight-leg raising test, the relevant muscle variables can be examined noninvasively.

Adult↗
PubMed1999

Time off work due to scaphoid fractures and other carpal injuries in The Netherlands in the period 1990 to 1993.

This study assessed the epidemiology, treatment, disability and time off work due to carpal injuries in the Netherlands in the period from 1990 to 1993. Most injuries were scaphoid fractures and carpal instabilities were rare. The time off work was considerable (mean, 155 days; median, 105 days; range, 12-1708 days). Patients with non-scaphoid fractures had the shortest time off work, followed by those with scaphoid fractures; patients with carpal instabilities had the longest time off work. Despite the significant time off work, the prognosis for return to work was excellent.

Adult↗
PubMed1999

Functional outcome of patients with spinal cord injury: rehabilitation outcome study.

OBJECTIVE: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals. DESIGN: Descriptive analysis of data gathered in an information system. SETTING: Rehabilitation centre in The Netherlands with special department for patients with spinal cord injuries. SUBJECTS: Fifty-five patients with traumatic spinal cord lesions admitted to the rehabilitation centre from 1988 to 1994. MAIN OUTCOME MEASURES: The functional improvement was presented in terms of progress in independence in nine daily activity skills. Independence was rated on a four-point scale. RESULTS: From admission to discharge, lesions in 100% of patients with tetraplegia and 96% of patients with paraplegia remained complete. Significant progress in independence was made in self-care, ambulation and bladder and bowel care. Differences were found in the extent of functional improvement between subgroups of patients with different levels and extent of lesion. Contrary to expectations based on theoretical models, patients with complete paraplegia did not achieve maximal independence in self-care. Independent walking was only attained by patients with incomplete lesions. Regarding outcome of bladder and bowel care, poor results were found, especially the independence in defaecation and toilet transfers. CONCLUSIONS: The results of this study provided more insight into the functional outcome of a group of patients with traumatic spinal cord injury. More research is needed to evaluate the rehabilitation programmes for these patients.

Activities of Daily Living↗
PubMed1998

Long-term physical, psychological and social consequences of a fracture of the ankle.

The long-term physical, psychological and social outcomes of 68 patients with an ankle fracture were investigated by using a postal questionnaire 6 years after injury. Patients were treated at a level I Trauma Centre between January 1989 and December 1989. Where applicable, the outcomes were compared with the outcomes of severely injured patients who were investigated previously. Physically, the patients were suffering from problems in the extremities and the spine. Surprisingly, half of them (52 per cent) had psychological complaints due to the initial injury. Eighty-nine per cent of the patients returned to work. This result seems to be only slightly better than the return to work in severely injured patients (74 per cent). Those with an ankle fracture needed less time to return to work (3 months versus 13 months in the severely injured patients). Further social changes (marital status, leisure activities) were mostly found in the severely injured patients. Patients with an ankle fracture as well as severely injured patients are affected by long-term consequences. The differences between the two groups are not as pronounced as is generally assumed. Probably, the consequences of lesser injuries are frequently disregarded, whereas severely injured patients are doing better than expected.

Adolescent↗
PubMed1998

Long-term physical, psychological and social consequences of severe injuries.

This 6 year follow-up study was designed to evaluate the long-term physical, psychological and social outcomes of severely injured patients (Injury Severity Score of greater than or equal to 16). Patients were treated at the University Hospital Groningen, the Netherlands, between January 1989 and December 1989. Outcomes were assessed using a postal questionnaire. After injury, the 55 respondents had predominantly complaints of the extremities, the spine and the head. Psychological complaints were present in 84 per cent of patients and mainly concerned fatigue, slowness and memory impairments. Despite these physical and psychological complaints, 74 per cent of patients were able to return to work and the memory succeeded in complying with job requirements. Injuries of the extremities and the spine were risk factors for failing to return to work. Social consequences were also reflected in broken marriages (6/22) and changes of leisure activities (45 per cent). On the basis of the impairments and disabilities revealed, we conclude that further improvement of the long-term outcomes of severely injured patients may be achieved by advancements in the treatment of injuries to the head, spine or extremities, comprehensive psychological support and vocational rehabilitation.

Adolescent↗
PubMed1998

Variation in measurements of grip strength. A study in reflex sympathetic dystrophy patients.

The clinical picture of reflex sympathetic dystrophy (RSD) is characterized by a combination of the triad: autonomic, motor and sensory changes. In this study, the grip strength is measured in 29 upper extremity RSD patients. We used the generalizability theory to assess the extent of the disagreement or differences (errors in measurement) within or between observers and interactions between observer-session and repetition of the measurements. The aims of our study were to determine the different sources of variation in grip strength tests and the smallest detectable differences (SDD) as well as the reliability of upper extremity grip strength tests in RSD patients. The main sources of variation of measurement errors were observer, patient/observer interactions and patient/session/observer interaction and a random source. We found that the generalizability theory is useful for estimating the sources of measurement error. Clinical examinations for muscle strength measurements, as a part of a total clinical examination, for example for a disability payment or worker's compensation in case of RSD patients should be done by more than one observer in more than one session and more than once.

Analysis of Variance↗
PubMed1998

Variation in measurements of range of motion: a study in reflex sympathetic dystrophy patients.

OBJECTIVE: To quantify the amount of variation attributed to different sources of variation in measurement results of upper extremity range of motion, and to estimate the smallest detectable difference (SDD) between measurements in reflex sympathetic dystrophy (RSD) patients. DESIGN: Two observers each measured in two sessions the range of motion of several upper extremity joints of RSD patients participating in an outcome study. SETTING: Department of Rehabilitation of a university hospital. SUBJECTS: Twenty-nine upper extremity RSD patients. MAIN OUTCOME MEASURES: The range of motion of forward flexion and external rotation of the shoulder, extension, flexion and supination of the elbow, palmar, dorsiflexion and ulnar, radial deviation of the wrist of affected and nonaffected sides, using a two-armed goniometer and an inclinometer. The measurement results were analysed using an analysis of variance according to the generalizability theory. RESULTS: The results indicate that observer and patient-observer were important sources of variation. The random error was the most important source of variation. Averaged over all ranges of motion the observer contributed 3.9% to the total variation, patient-observer interactions contributed 5.2% and the random error 20.3%. The SDD was smallest for elbow flexion, 7.1 degrees and 9.6 degrees and was largest for external rotation of the shoulder, 24.8 degrees and 28.7 degrees. The SDD was smaller for the nonaffected side as compared to the affected side for the majority of ranges of motion except elbow extension, wrist dorsiflexion, and radial and ulnar deviation. CONCLUSION: Clinically, our results indicate that range-of-motion measurements in RSD patients are subject to considerable variation and indicate that results of medical examinations in order to assess disability on the basis of range-of-motion measurements are subject to the same variation.

Arm↗
PubMed1998

Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study.

OBJECTIVE: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. DESIGN: A long-term follow-up study of upper extremity RSD patients. SETTING: A university hospital. SUBJECTS: Sixty-five patients, 3-9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). MAIN OUTCOME MEASURES: Impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. RESULTS: After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL (IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. CONCLUSION: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap.

Activities of Daily Living↗
PubMed1998

Effects of day-hospital rehabilitation in stroke patients: a review of randomized clinical trials.

The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were collected by a computer-aided search of published randomized trials. Fifteen articles reporting on seven randomized controlled trials were selected. Data extraction included a score for quality of the methods, based on four categories: "study population", "interventions", "effects" and "data presentation and analysis". To each criterion a weight was attached and the maximum score was set at 100 points. In judging the methodological quality of the selected studies, one study proved insufficient. Of the remaining studies the sum score varied from 34 to 67, with a mean of 50. Comparison of the results of the studies is complicated by different definitions of DHR, different natures of the control group and the study population, and the variety of measurement instruments applied. Often instruments were applied whose reliability and validity was not proven. As of now it is not possible to prove that DHR for stroke patients is effective. In future research a standardized definition of DHR, a uniform control group, and acceptable research methodology and adequate measurement instruments must be applied.

Aged↗