Life satisfaction and self-reported impairments in persons with late effects of polio.

OBJECTIVE: Decades after an acute poliomyelitis infection many persons experience new symptoms or impairments which may affect their life satisfaction. The objective of this study was to investigate the association between life satisfaction and self-reported impairments in persons with late effects of polio. MATERIAL AND METHODS: One hundred and sixty-nine persons (104women and 65men) with prior polio responded on admission to rehabilitation to the Life Satisfaction Questionnaire (LiSat-11) assessing satisfaction with life as a whole and 10 domains of life satisfaction and to a 13-item questionnaire assessing self-reported impairments related to late effects of polio. RESULTS: A majority was to some degree satisfied with life as a whole and with all 10 domains of life satisfaction in LiSat-11, but less than 20% was very satisfied or satisfied with their somatic health. Muscle fatigue, muscle weakness, general fatigue, muscle and/or joint pain during physical activity and cold intolerance were the most frequently reported impairments. Overall, those who rated themselves as not satisfied (according to LiSat-11) reported significantly higher degrees of impairment than those who were satisfied. The relationships between the items of life satisfaction in LiSat-11 and the items in the self-report questionnaire varied from -0.01 to -0.64. CONCLUSION: Satisfaction with life as a whole, and different domains of life satisfaction are low to moderately associated with self-reported impairments. This implies that rehabilitation interventions must address not only self-reported impairments but also activity limitations and participation restrictions in order to enhance life satisfaction in people with late effects of polio

Measurement variability of quantitative sensory testing in persons with post-stroke shoulder pain.

OBJECTIVE: To evaluate the measurement variability of quantitative sensory testing (QST) in persons with post-stroke shoulder pain. DESIGN: A test-retest design. PARTICIPANTS: Twenty-three persons with post-stroke shoulder pain (median age 65 years).METHODS: Thermal detection thresholds (cold and warm), pain thresholds (cold and heat) and mechanical pain thresholds (pressure and pin prick) were assessed twice in both arms, 2–3 weeks apart. Measurement variability was analysed with the intraclass correlation coefficient (ICC2.1), the change in mean (đ) with 95% confidence interval (logarithmic scales), and the relative standard error of measurement (SEM%; re-transformed scales). RESULTS: The ICCs for thermal thresholds ranged from 0.48 to 0.89 in the affected (painful) arm and from 0.50 to 0.63 in the unaffected arm, and for mechanical pain thresholds from 0.66 to 0.90 in both arms. No systematic changes in the mean (đ) were found. The SEM% ranged from 4% to 10% for thermal detection and heat pain thresholds, and from 17% to 42% for cold pain and mechanical pain thresholds in both arms.CONCLUSION: QST measurements, especially cold pain thresholds and mechanical pain thresholds, vary in persons with post-stroke shoulder pain. Before QST can be used routinely to evaluate post-stroke shoulder pain, a test protocol with decreased variability needs to be develope

The Reproducibility of Berg Balance Scale and the Single-Leg Stance in Chronic Stroke and the Relationship Between the Two Tests.

OBJECTIVE: To assess the reproducibility of the Berg Balance Scale (BBS) and the Single-leg Stance (SLS), and the validity of the SLS as an independent test of upright postural control in patients with chronic stroke. DESIGN: An intra-rater test-retest reproducibility study. The BBS and the SLS were assessed twice, 7 days apart. SETTING: A university hospital. PARTICIPANTS: Fifty individuals; 6-46 months after a stroke. MAIN OUTCOME MEASUREMENTS: The reproducibility of the BBS and the SLS was evaluated with intraclass correlation coefficient (ICC(2,1)), the mean difference between the 2 test sessions (d̄) with 95% confidence interval (95% CI), the standard error of measurement (standard error of measurement [SEM]%), the smallest real difference (SRD%), and the Bland-Altman graphs. To assess validity of SLS, the relationship between the SLS and the BBS was analyzed by the Pearson correlation coefficient. RESULTS: The ICC(2,1) was 0.88 for the BBS, and the ICC(2,1) values were 0.88 for the nonparetic limb and 0.92 for the paretic lower limb for the SLS. The smallest change that indicates a real improvement for a group of individuals, SEM%, was 3% for BBS, 15% for the nonparetic limb and 27% for the paretic limb for SLS. The smallest real difference for a single individual was 8% for BBS but was higher for SLS, at 42% for the nonparetic limb, and 74% for the paretic limb. There was a significant relationship between the SLS and the BBS (r = 0.65-0.79; P < .001). CONCLUSIONS: The BBS and the SLS are reproducible measurements in patients with chronic stroke, but only the BBS is sensitive enough to follow changes over time or after an intervention. The SLS is strongly related to the BBS and can be used as an independent test to measure upright postural control after a stroke

Long-term benefits of progressive resistance training in chronic stroke: A 4-year follow-up.

OBJECTIVES: To evaluate the long-term benefits of progressive resistance training in chronic stroke. DESIGN: A 4-year follow-up of a randomized controlled trial of progressive resistance training. SUBJECTS: Eighteen women and men (mean age 66 (standard deviation 4) from the original group of 24 post-stroke participants. METHODS: The training group (n = 11) had participated in supervised progressive resistance training of the knee extensors and flexors (80% of maximum) twice weekly for 10 weeks, whereas the control group (n = 7) had continued their usual daily activities. Muscle strength was evaluated isotonically and isokinetically (60º/s; Biodex), muscle tone with the Modified Ashworth Scale, gait performance by the Timed Up and Go test, the Fast Gait Speed test and 6-Minute Walk test, and perceived participation with the Stroke Impact Scale (Participation domain). RESULTS: Four years after the intervention, the improvements in muscle strength in the training group were maintained, and there was no reduction in strength in the control group. Compared with baseline there were still significant between-group differences for both isotonic and isokinetic strength. No significant between-group differences were found in muscle tone, gait performance or perceived participation. CONCLUSION: The results indicate that there is a long-term benefit of progressive resistance training in chronic stroke. This implies that progressive resistance training could be an effective training method to improve and maintain muscle strength in a long-term perspective

State-Dependent Probability Distributions in Non Linear Rational Expectations Models

In this paper, we provide solution methods for non-linear rational expectations models in which regime-switching or the shocks themselves may be "endogenous", i.e. follow state-dependent probability distributions. We use the perturbation approach to find determinacy conditions, i.e. conditions for the existence of a unique stable equilibrium. We show that these conditions directly follow from the corresponding conditions in the exogenous regime-switching model. Whereas these conditions are diffcult to check in the general case, we provide for easily verifiable and sufficient determinacy conditions and first-order approximation of the solution for purely forward-looking models. Finally, we illustrate our results with a Fisherian model of inflation determination in which the monetary policy rule may change across regimes according to a state-dependent transition probability matrix.Dans ce papier, nous proposons une méthode de résolution de modèles non linéaires à anticipations rationnelles dans lesquels les changements de régimes ou les chocs eux-même peuvent être "endogènes", c'est-à-dire suivre des distributions de probabilités dépendant de l'état de l'économie. Par une méthode de perturbation, nous trouvons des conditions de détermination, i.e. des conditions d'existence d'un unique équilibre stable. Nous montrons que ces conditions découlent directement des conditions correspondantes dans le modèle à changements de régimes exogènes. Bien que ces conditions soient difficiles à vérifier dans le cas général, nous donnons, dans le cas des modèles à changements de régimes purement tournés vers le futur, des conditions de détermination faciles à calculer et une approximation au premier ordre de la solution. Enfin, nous illustrons nos résultats avec un modèle de Fisher de détermination d'inflation dans lequel la règle de politique monétaire change entre les régimes selon une matrice de transition dépendant de l'état de l'économie

A method for extending planar axis-symmetric parallel manipulators to spatial mechanisms

This paper investigates axis-symmetric parallel manipulators, composed of a central base column and an arm system able to rotate around this column. The arm system includes several actuated upper arms, each connected to a manipulated platform by one or more lower arm linkages. Such manipulators feature an extensive positional workspace in relation to the manipulator footprint and equal manipulator properties in all radial half-planes defined by the common rotation-axis of the upper arms. The similarities between planar manipulators exclusively employing 2-degrees-of-freedom (2-DOF) lower arm linkages and lower mobility spatial manipulators only utilising 5-DOF lower arm linkages are analysed. The 2-DOF linkages are composed of a link with a 1-DOF hinge on both ends whilst the 5-DOF linkages utilise 3-DOF spherical joints and 2-DOF universal joints. By employing a proposed linkage substitution scheme, it is shown how a wide range of spatial axis-symmetric parallel manipulators can be derived from a limited range of planar manipulators of the same type

Mode of hand training determines cortical reorganisation: A randomized controlled study in healthy adults

Objective: To evaluate two commonly used forms of hand training with respect to influence on dexterity and cortical reorganization. Subjects: Thirty healthy volunteers (mean age 24.2 years). Methods: The subjects were randomized to 25 min of shaping exercises or general activity training of the non-dominant hand. The dexterity and the cortical motor maps (number of excitable positions) of the abductor pollicis brevis muscle were evaluated pre- and post-training by the Purdue Peg Board test and transcranial magnetic stimulation, respectively. Results: After shaping exercises the dexterity increased significantly (p <= 0.005) for both hands, mostly so in the non-dominant hand. The cortical motor map of the abductor pollicis brevis muscle shifted forwardly into the pre-motor area without expanding. After general activity training, no significant improvements in dexterity were found for the non-dominant hand. The cortical motor map of the non-dominant abductor pollicis brevis muscle expanded significantly (p = 0.03) in the posterior (sensory) direction. Conclusion: These results indicate that shaping exercises, but not general activity training, increase dexterity of the trained non-dominant hand in parallel with a shift of location of active transcranial magnetic stimulation positions. Shifts of active cortical areas might be important for the interpretation of brain plasticity in common behavioural tasks

Test-retest reliability of the Shape/Texture Identification testTM in people with chronic stroke

To evaluate the test-retest reliability of the Shape/Texture Identification test (STI-test(TM)) in persons with chronic stroke