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Durkan gauge and carpal compression test: accuracy and diagnostic test properties.

STUDY DESIGN: A prospective, criterion-based validity study. OBJECTIVES: To assess the diagnostic properties of the carpal compression test (CCT) when performed with the Durkan carpal tunnel syndrome (CTS) gauge, and to determine the measurement validity of the gauge. BACKGROUND: The CCT has been reported to be highly sensitive (.87-.89) and specific (.93-1.0) in the diagnosis of CTS when it is done with thumb pressure. The accuracy of measurements with the Durkan CTS gauge, however, has not been established and the diagnostic sensitivity and specificity of the CCT when the gauge is used has not been independently confirmed. METHODS AND MEASURES: The study sample included 33 women and 19 men, aged 18 to 85 years (45.7 +/- 13.5 years). The accuracy of the gauge was determined with a force dynamometer and holding frame. Standard nerve conduction studies (NCS) and the CCT were performed on the symptomatic extremity of all subjects. A compatible history and the NCS results were used to confirm CTS. RESULTS: The Durkan gauge registered pressures of 11.94 psi and 15.25 psi at the 12 and 15 psi gauge marks, respectively. Test sensitivity and specificity were .36 (95% CI = .17-.54) and .57 (95% CI = .39-.74), respectively. CONCLUSIONS: Pressure measurements obtained with the Durkan CTS gauge were accurate. The CCT when performed with the Durkan gauge, however, was neither sensitive or specific for the diagnosis of CTS.

Adolescent↗

British standard (BS) 5750--quality assurance?

BS5750 is the British Standard on "Quality Systems". Its equivalent in European Standards is EN29000 and in the International Standards Organisation ISO9000. This paper points out that these standards lay down formalised procedures and require documentation but do not ipso facto lead to quality assurance. The author points to the Japanese post-war industrial success as being an example of Total Quality Management within the framework provided by the philosophy of Dr. W. Edwards Deming (1988 and 1993). This philosophy on the management of "systems" to provide high quality products and services is briefly outlined. The author argues that improvement in prosthetic and orthotic services will not be reached through implementation of BS5750 but rather through radical rethinking and the adoption and application of the Deming philosophy.

England↗

Visual motor rehabilitation in children with cerebral palsy.

Cerebral palsied (CP) children were given intensive visuo-oculomotor training in order to improve their visuo-oculomotor control, using children's films as a visual stimulus. A comparative study was conducted on a group of normal children of the same age. Results showed that training does improve visuo-oculomotor system control as illustrated by (1) a marked increase in smooth pursuit precision and maximum velocity, (2) an improvement of saccadic movement precision and stability, and (3) a shortening of the saccadic reaction time. The highest performance was observed under conditions in which the child pointed at and followed the visuo-acoustic target with his arm extended.

Adolescent↗

Recent advances in the management of amblyopia.

Methods of detection and treatment of amblyopia as a developmental visual defect are reviewed. Traditional occlusion therapy is compared with recent therapy techniques using square-wave grating patterns as stimuli to increase visual sensitivity. Both methods can help manage amblyopia particularly during stages of early visual development. It is found that the grating pattern stimuli are not in themselves therapeutic, but rather it is probably occlusion in combination with demanding visual tasks which help reduce amblyopia.

Amblyopia↗

Contrast sensitivity function of sound eye after occlusion therapy in the amblyopic children.

To verify the changes of mesopic and photopic contrast sensitivity function of sound eye whose visual acuity was kept the same after occlusion therapy in the amblyopic children. Fourteen sound eyes of amblyopic children (mean; 7.67 years; S.D., 1.50 years) who kept their visual acuity the same after the occlusion therapy were tested. The children had 6 hours of part-time patch therapy for 3 months prior to this examination. Among 14 amblyopic children, 8 were anisometric and 6 were strabismic amblyopes. Using the visual capacity analyzer which measures the minimal contrast level at from low to high spatial frequencies, the contrast sensitivity of sound eye was measured, under both photopic and mesopic condition, before and after 3 months of occlusion therapy. Comparing the contrast sensitivity of sound eye after the occlusion therapy to that before the occlusion, there was no statistical difference in photopic condition. When it comes to mesopic condition, the contrast sensitivity decreased at the intermediate spatial frequency level (3-13 c.p.d, p=0.028) after the occlusion therapy. The occlusion caused statistically significant decrease in mesopic contrast sensitivity, when the visual acuity was not changed after the occlusion therapy. It may indicate that mesopic contrast sensitivity can be considered as a useful tool for early detection of hidden occlusion amblyopia.

Amblyopia↗

Surgical therapy of convergence insufficiency.

Fourteen cases of intractable convergence insufficiency were surgically treated by resection of both medial rectus muscles. All 14 patients showed dramatic relief of severe asthenopic symptoms. Temporary diplopia due to consecutive esotropia is a necessary part of this surgery and is relieved by fresnel prisms. Exophoria at near will return, occasionally to the original angle of deviation, but the symptoms do not return. The preoperative symptoms can be of severity out of proportion to the deviation. Bimedial resection is a most efficacious surgical method for treatment of intractable convergence insufficiency.

Accommodation, Ocular↗

Use of a video-game/stripe presentation for amblyopia therapy.

A variation of "stripe therapy" for amblyopia is described, using a composite video presentation of a television game with horizontal or vertical moving stripe backgrounds. The initial study has been carried out with two groups of amblyopic subjects, one group exposed to stripe backgrounds while playing the television games, and a small control group playing the games without any striped backgrounds. A wide range of results was obtained over several weekly exposure sessions, from possibly significant improvement to essentially no change in visual acuity. The results obtained from the group exposed to striped backgrounds do not appear to be markedly better than those obtained from the control group.

Adolescent↗

Assessment of vision and amblyopia by preferential looking tests after early surgery for unilateral congenital cataracts.

Preferential looking tests obtained over the first 3 years were used to evaluate the development of visual acuity of 21 patients who underwent surgery for unilateral congenital cataracts and fitting of contact lenses before age 6 months. Mean acuity of the aphakic eyes improved rapidly in the first year; however, between the end of the first year and the end of the third year there was no improvement in mean aphakic acuity. Consistent with this, the percentage of patients who were amblyopic by the criterion interocular difference in acuity (IOD) of 0.5 octaves (oct) or greater was 94% at the first test age near the onset of occlusion therapy, decreased to 72% at the end of year 1, and increased to 89% by the end of year 3. Variations in occlusion therapy appear to account for these results: mean hours of occlusion per day were 6.2 in year 1, 4.4 in year 2, and 2.7 hours in year 3. Furthermore, the IOD at age 1 year was negatively correlated with hours of occlusion in the first year and the IOD at age 3 years was negatively correlated with cumulated hours of occlusion over all 3 years. That is, the less the amount of occlusion therapy, the greater the IOD. The patients' ages at time of surgery did not account for any further variance in these results than that accounted for by occlusion therapy. This study demonstrates that PL acuity measurement can aid in monitoring the response to occlusion therapy of infants with deprivation amblyopia due to unilateral congenital cataracts.

Amblyopia↗

The use of part-time occlusion for early onset unilateral exotropia.

Eleven patients (9 months to 5 years of age) with intermittent or constant exotropia of predominantly one eye on distant gaze were studied to investigate the effect of part-time occlusion. No patient had constant exotropia on near fixation. Visual acuity was found to be equal in both eyes. All patients were treated by part-time patching of the non-deviating eye from four to six hours a day and tapered as appropriate. If exotropia recurred after conversion to a heterophoria, part-time occlusion was reinstated. With occlusion, all patients converted to hetero- or orthophoria, at least temporarily. Mean follow-up (to last visit or surgical intervention) was 22 months (range 3 to 37 months). Three patients (27%) later developed constant exotropia (mean 28.3 months after beginning occlusion) and underwent surgery. Three patients (27%) became and remain orthophoric without further patching. Part-time occlusion for preschool patients with exodeviations that are predominantly unilateral can postpone surgical intervention and convert exotropia to orthophoria or exophoria.

Child, Preschool↗

Maternal observations of ocular alignment in infants.

Seventy-five infants of state-registered orthoptists were observed by their mothers from birth to at least 6 months of age, with particular attention paid to the nature of any deviations noticed in the first few weeks. Most of the infants showed brief periods of inaccurate vergence during the first 2 months, with a wide variation in the amount of deviation seen, despite going on to develop normal binocular single vision. Most deviations were transient, unilateral, alternating esodeviations. There was a statistically significant relationship between the time that deviations were noticed and the development of demonstrable binocular convergence. Few exodeviations were found, contrasting with previous studies, and it is suggested that neonates are more likely to achieve binocular single vision when interacting with their mothers.

Convergence, Ocular↗

Convergence insufficiency in thyroid eye disease.

The incidence of convergence insufficiency in patients with thyroid ophthalmopathy and their response to convergence exercise is unknown. Twenty-seven consecutive patients with thyroid eye disease (TED) were evaluated prospectively. Six patients with symptomatic convergence insufficiency obtained varying degrees of subjective and objective benefit from treatment. None of the six had other TED-related complaints that required therapeutic intervention. The study findings should alert the clinician to consider convergence insufficiency in patients with TED and nonspecific ophthalmic symptoms.

Adolescent↗

Usefulness of the preoperative prism adaptation test in patients with intermittent exotropia.

PURPOSE: To investigate whether the preoperative prism adaptation test is useful in patients with intermittent exotropia. METHODS: Sixty-five consecutive patients with basic-type intermittent exotropia <40 prism diopters (PD) comprised the study population in this prospective study. Patients were divided into two groups based on the results of the prism adaptation test. Patients with a negative response comprised group 1 and patients with a positive response comprised group 2. Group 1 patients (n=26) underwent surgery according to the original angle, and group 2 patients (n=27) underwent surgery in accordance with the change in the angle of deviation with prisms. RESULTS: Satisfactory motor alignment (+/- 5 PD of orthophoria) was achieved in 14 (53.8%) group 1 patients and 24 (88.8%) group 2 patients (P=.01). Mean residual deviation was 9.8 PD in group 1 and 4.5 PD in group 2 (P < or = .05). CONCLUSION: The prism adaptation test may be helpful in achieving a favorable surgical outcome in intermittent exotropia.

Adaptation, Ocular↗