RehabWire - Volume 6, Number 8, October 2004

October is National Physical Therapy Month, sponsored by the American Physical Therapy Association. The projects and articles highlighted in this edition of RehabWire focus on PT and its role in treatment and recovery.

NIDRR Projects: Research in the New Millennium.

University of Washington Burn Injury Rehabilitation Model System. University of Washington (H133A020103) led by Loren H. Engrav, MD. Theresa San Agustin, MD, Project Officer.
Abstract: This model system conducts several research projects including the Effect of Virtual Reality on Active Range-of-Motion During Physical Therapy. This project uses distraction via immersive virtual reality as an adjunctive non-pharmacologic analgesic. This study tests the hypothesis that virtual reality allows patients to tolerate greater stretching during physical therapy compared to no distraction, and that in spite of achieving greater range-of-motion, patients still experience lower pain levels while in virtual reality.
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Rehabilitation Research and Training Center on Secondary Prevention Through Exercise: A Participatory Approach for People with Spinal Cord Injury. National Rehabilitation Hospital/MedStar Research Institute (H133B031114) led by Suzanne L. Groah, MD. Kristi E. Wilson, PhD, Project Officer.
Abstract: This project systematically and comprehensively addresses the role and impact of physical activity in the prevention of secondary conditions in people with spinal cord injury (SCI). Initially, the project establishes critical, yet-undefined physiological responses to exercise in SCI and comprehensively examines cardiovascular disease risk in individuals with SCI applying accepted guidelines used in the able-bodied population. The project develops exercise formats specifically designed according to severity of SCI and chronicity of SCI to address the prevention of and knowledge regarding osteoporosis and other secondary conditions. In addition, the project determines whether regular exercise is related to fewer secondary conditions. These research findings feed into four training activities that include a peer mentoring program for newly injured people with SCI, a consumer-driven education curriculum for physical therapy and medical students, a state-of-science and training conference, and the development of a virtual resource network on exercise and prevention.
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Advanced Rehabilitation Research Training. University of Illinois at Chicago (H133P000005) led by Tamar Heller, PhD. Margaret Campbell, PhD, Project Officer.
Abstract: This project provides an intensive interdisciplinary postdoctoral training program for disability and rehabilitation research scholars. The program combines immediate immersion in an ongoing research program with a focused didactic training experience, providing trainees with knowledge of the critical values, current issues, and innovative approaches in contemporary disability research. The training is offered through a cooperative effort of three units within the College of Health and Human Development Sciences: the Department of Disability and Human Development, Department of Occupational Therapy, and the Department of Physical Therapy. These departments have an established record of successful collaboration in advanced training, including creating the Interdisciplinary in Disability Studies at UIC, a unique interdisciplinary doctoral program that addresses the multidimensional nature of disability. A central theme of this program is that the current fragmentation of knowledge regarding disability can be rectified only by preparing future scholars and researchers who have a coherent, integrated, and in-depth knowledge of the multidimensional nature of disabilities. All three academic units offering this advanced research training have senior faculty with established, ongoing research programs capable of guiding postdoctoral training in three specialized content areas of disability research: disability measurement, disability experience, and disability service and policy.
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Interdisciplinary Rehabilitation Research Post-Doctoral Program. University of Florida (H133P020005) led by William C. Mann, PhD. Margaret Campbell, PhD, Project Officer.
Abstract: This project addresses the shortage of rehabilitation researchers through an interdisciplinary postdoctoral training program in rehabilitation research. The focus is on recruiting and training postdoctoral fellows with backgrounds in professions of high need, specifically rehabilitation engineering, physical therapy, and occupational therapy. There is also a strong focus on recruiting members of groups that have been traditionally underrepresented in rehabilitation research positions. The participating faculty for this program have large funded programs of rehabilitation research and also have considerable experience in serving as mentors for advanced research training. The program offers postdoctoral fellowships from two to three years to qualified individuals interested in rehabilitation research. Postdoctoral fellows focus in an area related to one of the levels of these models: neurological rehabilitation, rehabilitation engineering, and rehabilitation outcomes research.
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October is National Disability Employment Awareness Month! You’re Hired! Success Knows No Limitations! is the theme for 2004. Visit the Office of Disability Employment Policy for information and resources:

New Research: Selections from REHABDATA

Chen, C. C., Heinemann, A. W., Bode, R. K., Granger, C. V., Mallinson, T. (2004) Impact of pediatric rehabilitation services on children’s functional outcomes. American Journal of Occupational Therapy (AJOT), 58(1), 44-53. NARIC Accession Number: J47159.
Abstract: Study retrospectively reviewed the records of rehabilitation therapies and functional assessments of 814 children who received inpatient rehabilitation during 1996, 1997, and 1998. Analyses were conducted to compare functional gains across impairment groups and to examine the relationship between amount of treatment and functional outcomes. Results showed that occupational therapy and physical therapy were the primary rehabilitation services received across impairment groups. Across the domains of self-care, mobility, and cognition, children who were older than 7 years and those with traumatic injuries made the largest gains. Functional gains were significantly related to the amount of discipline-specific treatment (OT alone, PT alone, or speech therapy alone) received, after controlling for age, impairment, and functional status at admission.

Page, S. J., Sisto, S., Levine, P., McGrath, R. E. (2004) Efficacy of modified constraint-induced movement therapy in chronic stroke: A single-blinded randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85(1), 14-18. NARIC Accession Number: J47204.
Abstract: Study examined the efficacy of modified constraint-induced movement therapy (mCIMT) on the affected limb use and function in patients with stroke. Participants were randomly assigned to one of three condition groups: mCIMT, traditional rehabilitation, or no treatment. Subjects in the mCIMT groups participated in half-hour sessions of physical therapy and occupational therapy 3 times a week for 10 weeks. Their less-affected arms were also restrained five days a week for five hours each day. Outcome measures included the Fugl-Meyer Assessment of Motor Recovery (FMA), the Action Research Arm (ARA) test, and the Motor Activity Log (MAL). Results indicated that the mCIMT patients showed greater motor changes on the FMA and ARA than regular therapy or control patients. Amount and quality of arm use, measured by the MAL, improved only in mCIMT patients.

Waugh, E. J., Jaglal, S. B., Davis, A. M., Tomlinson, G., Verrier, M. (2004) Factors associated with prognosis of lateral epicondylitis after eight weeks of physical therapy. Archives of Physical Medicine and Rehabilitation, 85(2), 308-318. NARIC Accession Number: J47243.
Abstract: Study identified factors associated with outcome after physical therapy (PT) for lateral epicondylitis (tennis elbow). After a physical therapist performed a baseline clinical assessment, patients completed the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and a pain visual analog scale (VAS), two self-report outcome measures, which were completed again after eight weeks. Female sex and self-reported nerve symptoms were associated with higher DASH and VAS scores. Women and patients who report nerve symptoms were more likely to have a poorer short-term outcome after PT for tennis elbow. Women were more likely than men to have work-related onset, repetitive keyboarding jobs, and cervical joint signs.

Wise, H. H., Brotherton, S. S., Thomas, K. J., Krause, J. S. (2004) Employment outcomes: Health factors and the role of the physical therapist. Topics in Spinal Cord Injury Rehabilitation, 9(4), 11-18. NARIC Accession Number: J47565.
Abstract: Study examined the relationship between the employment status of individuals with spinal cord injury and health factors associated with physical activity and body weight. All data were collected by self-report using the Life Situation Questionnaire-Revised. Logistic regression analyses revealed that perceptions of general health, lifestyle, and endurance were significant predictors of employment. These findings emphasize the role that physical therapists play in designing rehabilitation programs that focus on behaviors associated with employment.

Stein, J. (2004) Motor recovery strategies after stroke. Topics in Stroke Rehabilitation, 11(2), 12-22. NARIC Accession Number: J47671.
Abstract: Article describes a number of exercise techniques that have been incorporated into traditional stroke rehabilitation and have been shown to improve motor function after stroke. These strategies include: constraint induced movement therapy, robot-aided rehabilitation, virtual reality, treadmill training, biofeedback, functional electrical stimulation, exercise intensity, and acupuncture. Medications to enhance recovery, growth factors, and stem cells have been proposed as possible adjunctive treatments.

Sherrington, C., Lord, S. R., Herbert, R. D. (2004) A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Archives of Physical Medicine and Rehabilitation, 85(5), 710-716. NARIC Accession Number: J47697.
Abstract: Study compared the effects of weight-bearing and non-weight-bearing home exercise program to those of a no-intervention control program on physical ability (strength, balance, gait, functional ability) in older people who had completed usual care after a hip fracture. Physical assessments were conducted before the intervention, and at 1 month and 4 months after the initial assessment. Results showed between-group differences for balance and functional ability but not for strength and gait, with the weight-bearing exercise group showing the greatest improvement.

Trudelle-Jackson, E., Smith, S. S. (2004) Effects of a late-phase exercise program after total hip arthroplasty: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85(7), 1056-1062. NARIC Accession Number: J48118.
Abstract: Study examined the efficacy of a late-phase exercise program initiated 4 to 12 months after total hip arthroplasty (THA). Efficacy was assessed by comparing muscle strength of the hip, postural stability, fear of falling, and self-perceived function before and after an 8-week intervention program of weight-bearing exercises with a control program of basic isometric and active range of motion exercises. Results showed a statistically significant improvement for all measures of muscle strength, postural stability, and self-perceived function in the intervention group and no significant change in the control group. Neither group had signficant changes in fear of falling measures.