Subtle Problems in Activities of Daily Living after a Transient Ischemic Attack or an Apparently Fully Recovered Non-disabling Stroke

Little is known about the effects on the performance of activities of daily living (ADL) and quality of life (QoL) of transient ischemic attack (TIA) or a nondisabling stroke (NDS) with a full recovery in 72 hours. The present study evaluated ADL performance and QoL, as well as symptoms of anxiety and depression, in patients at 1 and 6 months after a TIA or an NDS. Consecutive hospitalized TIA/NDS patients not requiring rehabilitation were assessed at 1 and 6 months after discharge from a hospital or emergency department. ADL performance was evaluated using the Assessment of Motor and Process Skills (AMPS), QoL was assessed with the Short Form 36 (SF-36), and depression and anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). A total of 45 patients completed the follow-up. At 1 month after TIA/NDS, all patients were independent in ADL performance but had AMPS and SF-36 scores below the norm. In addition, 12 patients (27%) had anxiety symptoms, and 9 patients (20%) had symptoms of depression. Although initially considered fully recovered, 23 patients (51%) required rehabilitation after the first follow-up. After 6 months, their AMPS, SF-36, and HADS scores were lower than those of the patients who did not require rehabilitation after the first screening. Half of the patients with a TIA or an NDS who were initially considered fully recovered exhibited ADL limitations, decreased QoL, and symptoms of anxiety or depression after 6 month

Shoulder contracture and osseous deformity in obstetrical brachial plexus injuries

The purposes of this study were to determine the prevalence of and the association between shoulder contracture and osseous deformity in a cohort of children with an obstetrical brachial plexus injury and to identify the risk factors for these complications. In a retrospective cohort study, all children with an obstetrical brachial plexus injury who had been born between January 1991 and January 1998 at one academic medical center and all those with the same diagnosis who had been born elsewhere during the same period and were referred to the medical center within six weeks after delivery were evaluated at fixed time-intervals by one examiner. The patients underwent a final orthopaedic, neurological, and radiographic examination at a mean age of 3.7 years (range, one to seven years). Shoulder contracture was defined as a decrease in the passive range of motion in one or more directions compared with the range on the unaffected side. Osseous deformity was defined as a nonspherical humeral head or an abnormal glenoid. The prevalence of a shoulder contracture of >10 degrees was 56% (twenty-nine of fifty-two patients), and the prevalence of an osseous deformity was 33% (sixteen of forty-eight patients with complete radiographic follow-up). In the children in whom complete neurological recovery was delayed (i.e., recovery was more than three weeks after birth), the prevalence of shoulder contracture was 54% (thirteen of twenty-four patients) and the prevalence of osseous deformity was 26% (six of twenty-three patients). A strong association was noted between shoulder contracture and osseous deformity (p = 0.004). Directly after birth, the presence of a clavicular fracture was the only factor that was associated (p = 0.016) with the development of an osseous deformity (but not with a shoulder contracture). At a later stage, speed and extent of neurological recovery were related to shoulder contracture and osseous deformity. An asymmetric appearance was noticed in children who had a contracture, including those who had complete neurological recovery. The prevalence of shoulder contracture and osseous deformity in children with obstetrical brachial plexus injury was high, even in those with complete neurological recovery. These complications were strongly associated with one another. No symptom that appeared immediately after birth was identified as a factor that would predict the development of future shoulder contracture. A clavicular fracture was found to be significantly associated with the development of an osseous deformity at a later stag

High prevalence of hand- and wrist-related symptoms, impairments, activity limitations and participation restrictions in children with juvenile idiopathic arthritis

To determine the prevalence of hand- and wrist-related symptoms and impairments, with resulting activity limitations and participation restrictions in children being treated for juvenile idiopathic arthritis. Cohort study of children, diagnosed in our hospitals between 2003 and 2008 with juvenile idiopathic arthritis, who received standard treatment with regular follow-ups in the same institutions. Patients were asked about hand and wrist symptoms, and underwent a standardized physical examination. For activity limitations, they were asked to complete the Dutch version of the Childhood Health Assessment Questionnaire (CHAQ). Concerning participation restrictions, children were asked about any hand- and/or wrist-related difficulties during daily activities. Of all 152 eligible patients, 121 (80%) participated in the study; 34 boys and 87 girls, mean age 13.7 years (standard deviation (SD) 4.2), mean disease duration 2.6 years (SD 1.4), mean Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71) score 8 (SD 8), indicating low disease activity. Of these 121, 84 (69%) had at least 1 symptom and 40% had at least 1 impairment. The median CHAQ-total score was 0.5 (mean 0.75 (SD 0.77)), indicating mild-to-moderate activity limitations; and 54% reported having hand- and/or wrist-related problems at school. Despite low disease activity, many children appeared to have hand- and/or wrist-related symptoms and impairments, with resulting moderate to severe levels of activity limitations and participation restrictions at schoo

Neurological recovery in obstetric brachial plexus injuries: an historical cohort study

An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be goo

Interobserver reliability of the Amsterdam Severity Scale in Stenosing Tenosynovitis (ASSiST)

STUDY DESIGN: Interobserver reliability study. INTRODUCTION: A scale was developed to measure the severity of stenosing tenosynovitis: the Amsterdam Severity Scale in Stenosing Tenosynovitis (ASSiST). PURPOSE OF THE STUDY: To study the interobserver reliability of the ASSiST. METHODS: Patients suffering from various impairments in hand function were referred to our outpatient hand clinic. The grading of stenosing tenosynovitis was assessed independently. The observers were blinded for each other's results. The ASSiST distinguishes between a nodular and a diffuse form. The severity was graded from grades 0 to 3. RESULTS: Kappa coefficient for the distinction between the four grades was 0.72 (95% confidence interval [CI] 0.59-0.85) and for the distinction between the nodular and the diffuse forms 0.16 (95% CI 0.13-0.18). CONCLUSION: The ASSiST can be used to reliably assess the severity of stenosing tenosynovitis in both nodular and diffuse forms, but it does not differentiate between these two forms. LEVEL OF EVIDENCE: Not applicabl