Psychometric evaluation of the functional walking test for children with cerebral palsy.

Purpose. This study examined the psychometric properties of the functional walking test (FWT). Method. Fifty-six subjects with cerebral palsy (CP) (21 females and 35 males, mean age 9 years 6 months, SD 3 years 9months, range 4-17 years) were assessed on two occasions, 6 months apart, using both the FWT and the gross motor function measure (GMFM). Results. Generalisability correlation coefficients (GCC) for all 11 items were high (0.91-0.99). Inter-rater reliability was also high with excellent consensus in the scores given by the eight raters (intra-class correlation coefficient and GCC 0.99). Intra-rater reliability was equally high (GCC 0.99). The internal consistency of the FWT was estimated using Cronbach\u27s α as 0.95 and 0.94 at Time 1 and 2, respectively. The FWT had a high degree of correlation with the GMFM, when total scores were compared at Time 1 and 2 (Pearson\u27s r = 0.86 and 0.87, n = 56, p \u3c 0.01). The FWT also found statistically significant differences in total scores between the three Gross Motor Function Classification System (GMFCS) levels. The correlation between the FWT scores and GMFCS was -0.70 at Time 1 and -0.76 Time 2 (p \u3c 0.01) indicating the construct validity of the FWT. Conclusions. This study has demonstrated that the FWT has sound psychometric properties and is valid and reliable in a sample population of ambulant children with CP

Long term outcome of stroke: Stroke is a chronic disease with acute events.

Long term outcome of stroke: Stroke is a chronic disease with acute events

Irish Heart Foundation National Audit of Stroke Care

Stroke is the third leading cause of death and disability worldwide. It constitutes a formidable burden of disability for patients, their families, health professionals and the wider community. It combines aspects of both acute and chronic disease, and there is increasing evidence that those affected by stroke can benefit to a very significant extent from organised stroke care throughout the course of the illness. Delivering this care requires a unique combination of skills, drawing on neurosciences, cardiovascular medicine, general medicine, the science of ageing, rehabilitation, vascular surgery, and public health. Local and timely evidence on the service performance is essential to assess quality of care and to improve services. This has not been available to date in Ireland. The aim of this project was to conduct a national audit of stroke care in hospital and the community in the Republic of Ireland. This was achieved by completing six separate surveys and by drawing conclusions based on complementary information across the studies. The six surveys are described next. Where possible, audit systems used in the UK’s Sentinel audit were used to provide an opportunity for comparison of relative, as well as absolute, levels of achievement of recommended standards of care

National Survey of Stroke Survivors: Documenting the Experiences and Levels of Self-Reported Long-Term Need in Stroke Survivors in the First 5 years.Systematic Review:Factors Associated with Community Re-integration in the First 12 months Post Stroke: A Qualitative Synthesis.

Introduction In Ireland it is estimated that there are 30,000 persons living with residual effects of stroke.1 The Irish National Audit of Stroke Care, carried out in 2007, identified substantial deficits in a number of areas including discharge planning, rehabilitation, on-going secondary prevention, and communication with patients and families.2 The present study builds on the findings of the audit. It explores in detail the current needs of people post stroke in Ireland who are living in the community. It also provides a profile of many possible problems that stroke can cause. In addition it provides a comprehensive review of the literature. Aim This report contains two distinct pieces of research: Firstly, a systematic review and qualitative synthesis (metasynthesis) of the literature was conducted. The aim of the systematic review was to identify perceived barriers and facilitators to community re-integration in the first 12 months after stroke, from the perspective of persons with stroke Secondly, a national survey of stroke survivors who experienced their stroke up to 5 years previously was carried out. The aim of the survey was to document the experiences and levels of self-reported long-term need among community-dwelling stroke survivors in Ireland Methods of the National Survey Stroke survivors were recruited to take part in the survey primarily though the Irish Heart Foundation National Stroke Support Group Network and non-statutory organisations that provide support after acquired brain injury. The survey was also advertised online to a broader stroke population. A questionnaire was developed to assess respondents’ own perceptions of their recovery, community re-integration and on-going needs from existing validated questionnaires with the permission of the original authors.3 Data collection took place between June and October 2013. Main findings: Systematic Review Eighteen articles, using qualitative methodology, were included in the final review. Four primary themes that were perceived to act as barriers or facilitators to community re-integration for individuals in the first year after stroke were identified from the included studies: Primary effects of stroke Personal factors Social factors Relationships with professionals National Survey A total of 196 stroke survivors, aged between 24 and 89 years, responded to the surve Mobility difficulties were reported by eighty-three per cent of respondents. Emotional problems, fatigue, concentration and arm dysfunction were reported almost as commonly Of the 150 individuals with emotional difficulties only eleven per cent received psychological services Sixty per cent of respondents felt that their household finances were affected by their stroke. Thirty-six per cent of respondents reported paying privately for rehabilitation. Thirty-four per cent of respondents had to pay privately to adapt their home Over half of respondents needed help with personal care and two thirds needed help with household tasks since their stroke. Family provided most of this help Forty-two per cent of respondents who were in a relationship at the time of the survey felt that it has been significantly affected by their stroke Less than a quarter of respondents under the age of 66 have worked in a full or part-time capacity since their stroke, while sixty per cent of drivers have returned to driving Conclusions Stroke had a personal, social and economical impact on the lives of many respondents. Successful return to work levels after stroke, as reported, were particularly low. Emotional distress and fatigue were common and were barriers to many activities. Satisfaction with the level of help available for these problems was poor

A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital.

Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample to profile elderly fallers referred for physiotherapy in ED. Forty-subjects were assessed over 14 weeks. Mean age was 84.88 years (s.d. 7.3) and 31 (77.5%) were female. All demonstrated slow walking speed and 26 (65%) demonstrated poor grip strength. A quarter of subjects reported fear of falling and 30 (75%) were classified as frail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosis had been diagnosed in 9 (22.5%) subjects--a low prevalence compared with international research, but 25 (62.5%) subjects had never had a DEXA scan. The prevalence of frailty in the sample of elderly fallers in this study was very high (75%)

Stroke Knowledge in an Irish Semi-Rural Community-Dwelling Cohort and Impact of a Brief Education Session.

Poor knowledge of stroke risk factors and failure to recognize and act on acute symptoms hinders efforts to prevent stroke and improve clinical outcomes. Levels of stroke knowledge are poorly established within Ireland. This study was conducted to establish levels of knowledge among men and women aged \u3e40 years in an Irish community, and also to determine the impact of a single education session on stroke knowledge. Subjects from 2 separate geographical locations were allocated to an intervention group (n = 200), who received stroke information over a 90-minute session, or a control group (n = 200). Both groups completed a stroke knowledge questionnaire at baseline and at 4 weeks after the educational session. Overall, the initial response rate was 70% (280/400); 52% of the respondents knew that the brain is affected by stroke, 58% could list 2 or more risk factors but only 27% could list 2 or more warning signs, 50% would call 999 (emergency number in Ireland) in response to stroke, 17% had heard of thrombolytic therapy, but only 1% knew the time frame for receiving thrombolytics. The response rate to the resurvey following the educational session was 57%, with 47 of 117 subjects in the intervention group (40%) attending the session. Stroke knowledge scores improved by 50% in the intervention group (P \u3c .001). Overall, the knowledge of stroke risk factors, warning signs, and thrombolytic therapy was poor in this Irish community-dwelling cohort. Our study demonstrates that a single educational session can improve short-term knowledge of stroke symptoms and thrombolytic therapy

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in polio survivors: protocol for a randomised controlled trial.

ABSTRACT: BACKGROUND: Many Polio survivors have reduced mobility, pain and fatigue, which make access to conventional forms of aerobic exercise difficult. Inactivity leads to increased risk of health problems, many of which are prevalent among Polio survivors. Aerobic exercise programmes in Polio survivors should utilise stable muscle groups and should be designed to minimise exacerbation of pain and fatigue. A home-based arm ergometry aerobic exercise programme may represent an affordable and accessible exercise modality, incorporating exercise prescription principles in this group.Methods/design: This is a prospective, single blinded, randomised controlled trial. There are two arms; exercise intervention using arm ergometers and control. Polio survivors meeting eligibility criteria will be recruited and randomly allocated to intervention or control groups. Participants allocated to the intervention group will receive a small arm ergometer and a polar heart rate monitor. They will carry out a home-based moderate intensity (50-70% HRMax) aerobic exercise programme for eight weeks, following instruction by the treating physiotherapist. Assessments will occur at baseline and after eight weeks and will include tests of physical fitness, activity, energy cost of walking, fatigue and quality of life. Clinically feasible assessment tools including the Six Minute Arm Test, the Physical Activity Scale for People with Physical Disabilities questionnaire, the Physiological Cost Index, Fatigue Severity Scale and the SF-36v2 will be utilised. DISCUSSION: The efficacy of a home-based arm ergometry programme in Polio survivors will be examined. No previous trial has examined such a programme using a wide range of outcome measures pertinent to Polio survivors. This study will provide new information on the impact of arm ergometry on physical fitness, activity, body composition, fatigue, pain, muscle strength, and health related quality of life. Also, the study will provide information, which at present is lacking, on safety of aerobic exercise in Polio, as potential negative outcomes of activity including loss of muscle strength, increased pain and fatigue will be closely monitored.Trial registration: Clinicaltrials.gov identifier: NCT01271530

Proximity Study of a UWB Directional Conformal Antenna on Water Pipe

A preliminary study on the conformal properties of an antipodal exponentially tapered antenna placed on the surface of a flow meter system in the UWB range is presented. It was observed that the water effect can be mitigated by shifting the antenna away from the pipe surface

Footwear Antennas for Body Area Telemetry

Antennas designed to link footwear sensors within body centric networks are introduced with two small UWB antennas, one directional and another quasi-omnidirectional. The radiating characteristics are evaluated for three positions on a sample sports shoe using a detailed simulation model and measurements with a homogenous foot phantom. Antenna performance is assessed for resilience to close proximity loading by the footwear materials and the phantom foot

Anatomical Loading on a UWB Antenna for Shoe Toe Box

A UWB 6.0-8.5 GHz monopole antenna for mounting on the toe­box area of footwear is designed using a detailed model of a running shoe and a foot-shaped phantom. Variation of anatomical features between individual people gives rise to different proximity and permittivity loads on the antenna. To take account of environment, the antenna design optimization considers different proximity distances for impact on the reflection coefficient and on the radiation efficiency