Gait re-education in transfemoral amputees The training programme, gait analysis, oxygen consumption and coping

A gait re-education programme, combining physiotherapy with a psychologically conscious therapeutic approach, was applied to nine unilateral transfemoral amputees, whose amputation was caused by trauma or tumour. The participants trained once a week for a mean 10 months. The median age was 33 years (range 16– 51). They had worn a prosthesis for more than 18 months and had completed conventional rehabilitation. Before treatment, walking ability was limited and three used walking aids. All had problems with low-back pain. The effects of training on gait pattern and gait speed were evaluated with a three-dimensional motion analysis system. Oxygen consumption and energy cost were measured by analysing expired gas and heart rate was measured by electrocardiogram. Semi-structured interviews were performed to describe coping strategies in the acute phase and over time. Results showed normalized gait speed comparable to healthy non-amputees of similar age, due to improved gait technique and walking skills. After treatment none needed walking aids and almost all low-back pain had disappeared. In addition, seven participants learnt to jog. Results indicate that this new approach may add skills, mostly on participation level, for leading a relatively normal life. The positive results remained at a six-month follow-up. The participants’ strategies for coping in the acute phase were denial and avoidance. Over time they used downward comparisons, positive comparisons and repression. Only one participant had fully accepted the situation and adjusted to the new norm. Future research will show whether these results can be generalized in a controlled study

Physiotherapists’ experiences of the meaning of movement quality in autism: a descriptive phenomenological study

Introduction: Movement quality, represented in unrestricted movements, flow and pleasure, is often lacking in people with autism. One aspect is the non-verbal expression of the present emotional and psychological state of an individual. Purpose: To describe the meaning of movement quality in autism, as experienced by specialized physiotherapists. Method: Ten physiotherapists were interviewed. The data were recorded, transcribed verbatim, and analyzed using Giorgi᾽s descriptive phenomenological method. Findings: The general structure of movement quality in people with autism included eight key constituents: 1) reduced postural control; 2) deviant muscle tone and tension; 3) deviant sensory processing; 4) a lack of conscious awareness; 5) difficulties with body boundaries; 6) coordinating movements (including breathing); 7) lack of anticipatory preparations of movements; and 8) need of cognitive thoughts to control movements. Conclusions: This study provide an understanding of how movement quality in people with autism is expressed. Their lived bodies constantly need to protect themselves from sensory impressions from within or the surroundings, causing emotional distress and obscuring the meaning of their movements. Their bodily expression becomes restrained, fragmented, and hesitant. Understanding movement patterns and emotional reactions following their struggle with movements may facilitate constructive interaction and communication, which give important implications when designing physiotherapy interventions

Perceived consequences of ageing with late effects of polio and strategies for managing daily life : A qualitative study

Background: New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life. Methods: Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation. Results: The latent analysis resulted in three categories 'Various consequences of ageing with LEoP', 'Limitations in everyday activities and participation restrictions', and 'Strategies for managing daily life when ageing with LEoP' and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance. Conclusion: Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP

Experiences of falls and strategies to manage the consequences of falls in persons with late effects of polio : A qualitative study

Objective: To explore how persons with late effects of polio experience falls and what strategies they use to manage the consequences of falls. Design: A qualitative study with face-To-face interviews. Data were analysed by systematic text condensation. Participants: Fourteen ambulatory persons (7 women; mean age 70 years) with late effects of polio. Results: Analysis resulted in one main theme, "Everyday life is a challenge to avoid the consequences of falls", and 3 categories with 7 subcategories. Participants perceived that falls were unpredictable and could occur anywhere. Even slightly uneven surfaces could cause a fall, and increased impairments following late effects of polio led to reduced movement control and an inability to adjust balance quickly. Physical injuries were described after the falls, as well as emotional and psychological reactions, such as embarrassment, frustration and fear of falling. Assistive devices, careful planning and strategic thinking were strategies to prevent falls, together with adaptation and social comparisons to mitigate the emotional reactions. Conclusion: Experiences of falls greatly affect persons with late effects of polio in daily life. To reduce falls and fall-related consequences both problemfocused and emotion-focused strategies are used. In order to increase daily functioning, these findings should be included in a multifaceted falls management programme

Self-reported impairments among people with late effects of polio : a mixed-method study

Objective: To determine how much people with late effects of polio are bothered by various impairments and their influence on everyday life. Design: A mixed-methods design. Subjects/patients: Seven women and 7 men (mean age 70 years) with late effects of poli. Methods: Self-reported Impairments in Persons with late effects of Polio (SIPP) scale and face-to-face interviews. In SIPP, the participants rated, from 1 (not at all) to 4 (extremely), how much they had been bothered by late effects of polio-related impairments. Qualitative data were analysed using systematic text condensation. Each quotation was deductively analysed based on its conceptual representation regarding perceived influence on everyday life. Results: Participants were most bothered by muscle and/or joint pain during physical activity, muscle weakness and general fatigue, which corresponded with the number of interview quotations. The impairments negatively influenced daily life, such as household chores, walking, riding a bicycle and social participation. Increased impairments and reduced functioning on the less-affected side also caused worry and distress. Conclusion: Common late effects of polio-related impairments greatly affected participants' activity and participation. By using both the SIPP scale and face-to-face interviews, an increased understanding of how late effects of polio-related impairments influence everyday life was achieved

Growing up with a disability following paralytic poliomyelitis : experiences from persons with late effects of polio

Purpose: To describe the experiences of growing up after acute paralytic poliomyelitis and strategies used to adapt to the new situation. Methods: Seven women and seven men (mean age 70 years, min-max 61-78 years) with late effects of polio, who had contracted paralytic polio in their childhood. Data were collected using semi-structured interviews, transcribed verbatim, and analyzed by systematic text condensation. Results: Memories of contracting acute paralytic poliomyelitis involved being immobilized and sent away from home for surgical and physiotherapeutic treatment. Growing up in a social context that was often tough and unfriendly resulted in the development of strategies, such as optimistic thinking, trying to blend in, trusting one's ability to manage, and to handle the preconceptions and expectations of others. At the onset of late effects of polio, some of these strategies were still functioning, whereas overachieving, disregarding pain, and weariness were not. Conclusion: The challenges of growing up with a disability following paralytic polio led to the development of various psychological strategies for managing daily life. By understanding these experiences and strategies, knowledge may be gained in assisting rehabilitation professionals to better support persons with late effects of polio in adapting to the new situation. Implications for rehabilitation. At the onset of late effects of polio, strategies developed earlier in life, such as overachieving, disregarding pain, and weariness, may not function anymore. Understanding the experiences of growing up with poliomyelitis can support rehabilitation professionals to provide targeted interventions for people with late effects of polio and enable them to develop new adaptive strategies. Developing new strategies, such as accepting increased symptoms, and augmenting self-esteem and self-efficacy, may improve daily functioning among people with late effects of polio

Malnutrition and risk of falling among elderly without home-help service - A cross sectional study

Objectives: The aim of this study was to explore the frequency of malnutrition risk and associated risk of falling, social and mental factors among elderly without home-help service. The aim was also to explore factors associated with risk of falling. A cross-sectional design was used. Elderly persons own homes. Data were collected during preventive home visits to 565 elderly (age range 73-90 years) without home-help service. Those with complete SCREEN II forms were included in the study (n=465). Measurements included rating scales regarding malnutrition risk (SCREEN II) and risk of falling (Downton). In addition, single-items: general health, satisfaction with life, tiredness, low-spiritedness, worries/anxiety and sleeping were used. According to the SCREEN II, 35% of the sample had no malnutrition risk, 35% had moderate risk and 30% had high malnutrition risk. In an ordinal regression analysis, increased malnutrition risk was associated with being a woman living alone (OR 4.63), male living alone (OR 6.23), lower age (OR 0.86), poorer general health (OR 2.03-5.01), often/always feeling tired (OR 2.38), and an increased risk of falling (OR 1.21). In a linear regression analysis, risk of falling was associated with higher age (B 0.020), not shopping independently (B 0.162), and low meat consumption (B 0.138). There are complex associations between malnutrition risk and the gender-cohabitation interaction, age, general health, tiredness, and risk of falling. In clinical practice comprehensive assessments to identify those at risk of malnutrition including associated factors are needed. These have to be followed by individual nutritional interventions using a holistic perspective which may also contribute to reducing the risk of falling

Experiences of People with Cardiovascular Disease during COVID-19 in Sweden: A Qualitative Study

Although people with cardiovascular conditions were subjected to more rigorous restrictions during the COVID-19 pandemic, there is limited knowledge of how the restrictions affected their lives and well-being. Thus, the aim of this study was to describe how people with cardiovascular conditions experienced their life situation and physical and mental health during the second wave of the pandemic in Sweden. Fifteen participants (median age 69 years; nine women) were individually interviewed, and data were analyzed with systematic text condensation. The findings revealed that some of the participants were fearful of contracting COVID-19 as their medical condition made them vulnerable. Additionally, the restrictions changed their daily routines and their ability to take part in social activities, as well as their access to specialized outpatient care (medical check-ups and physiotherapy). Although emotional and psychological distress were present, several participants found strategies that reduced their worries, such as exercising and meeting friends outdoors. However, some had adopted a more sedentary lifestyle and unhealthy diets. These findings indicate that healthcare professionals should provide individualized support to persons with cardiovascular diseases in order to find well-functioning emotion- and problem-focused strategies aimed at improving physical and mental health during crises such as pandemics