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Publications in this journal

• The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: A systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework.

  Authors: Inge Franki, Kaat Desloovere, Josse De Cat, Hilde Feys, Guy Molenaers, Patrick Calders, Guy Vanderstraeten, Eveline Himpens, Christine Van Broeck

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):385-395.

  Objective: This systematic review provides an overview of the effectiveness of basic techniques used in lower limb physical therapy of children with cerebral palsy. It aims to support the developmentObjective: This systematic review provides an overview of the effectiveness of basic techniques used in lower limb physical therapy of children with cerebral palsy. It aims to support the development of clinical guidelines for evidence-based physical therapy planning for these children. Data sources and study selection: A literature search in 5 electronic databases extracted literature published between January 1995 and December 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health. Data extraction: Three independent evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system. Data synthesis: A total of 83 studies was selected and divided into categories (stretching, massage, strengthening, electrical stimulation, weight-bearing, balance-, treadmill- and endurance training). Interventions targeting problems at body function and structure level generally influenced this level without significant overflow to activity level and vice versa. Conclusion: The more recent studies evaluating strength training mainly demonstrated level II evidence for improved gait and gross motor function. There was limited evidence for specific information on intensity, duration and frequency of training.

• Development of a framework identifying domains and elements of importance for arthritis rehabilitation.

  Authors: Mari Klokkerud, Kåre Birger Hagen, Ingvild Kjeken, Ann Bremander, Kim Hørslev-Petersen, Thea Vliet Vlieland, Margreth Grotle

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):406-413.

  Background: Rehabilitation is effective and beneficial for patients with arthritis. The lack of a common structure for describing the content of rehabilitation makes it difficult to compare, transferBackground: Rehabilitation is effective and beneficial for patients with arthritis. The lack of a common structure for describing the content of rehabilitation makes it difficult to compare, transfer and implement research evidence into clinical practice. Objective: To develop a framework comprising domains and elements of importance when describing arthritis rehabilitation. Methods: On the basis of a systematic literature search and review, the framework was developed through a 9-step development process, including 5 Delphi consensus rounds within the Scandinavian Team Arthritis Register - European Team Initiative for Care Research (STAR-ETIC) collaboration, a group of clinicians, researchers and patients from northern Europe. Results: Based on Donabedian's healthcare model, the Inter-national Classification of Function, Disability and Health, and a rehabilitation model by D. T. Wade, 4 domains (context, structure, process and outcome) were defined. Within each domain, the most important and relevant key elements for describing rehabilitation were selected. This framework contains 1 key element under context, 9 under structure, 3 under process, and 9 under outcome. Conclusion: The STAR-ETIC framework can be used to describe arthritis rehabilitation, by emphasizing key elements in 4 main domains. A common framework may facilitate comparisons of rehabilitation programmes across countries and different levels of care, and may improve the implementation of rehabilitation research in clinical practice.

• How did rehabilitation professionals act when faced with the Great East Japan earthquake and disaster? Descriptive epidemiology of disability and an interim report of the relief activities of the ten Rehabilitation-Related Organizations.

  Authors: Meigen Liu, Masahiro Kohzuki, Akinori Hamamura, Makoto Ishikawa, Masami Saitoh, Masaki Kurihara, Kazuto Handa, Haruki Nakamura, Junichi Fukaura, Ryuji Kimura, Takao Ito, Nobuou Matsuzaka

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):421-428.

  Objective: Inter-organizational coordination is important for rehabilitation disaster relief. The 2011 Great East Japan Earthquake and Disaster was unprecedented, being geographically widespread andObjective: Inter-organizational coordination is important for rehabilitation disaster relief. The 2011 Great East Japan Earthquake and Disaster was unprecedented, being geographically widespread and multifaceted. Faced with the crisis, rehabilitation professionals established the 10 Rehabilitation-Related Organizations of Rehabilitation Support Service (10-RRO). The objectives of this paper are to provide descriptive epidemiology and assess the activities of 10-RRO. Design: Descriptive. Methods: Epidemiological data on disability were collected, mainly from official sources. Relief activities were reviewed from daily reports, and the preparedness, initial response and functioning of 10-RRO were assessed with a questionnaire directed at 36 executives of individual organizations. Results: The disaster was characterized by a very low ratio of injuries to death of 0.372, and an odds ratio of deaths among disabled persons of 2.32. 10-RRO provided relief activities at 3 shelters. The total number of dispatch days ranged from 107 to 146, and the cumulative number of professionals and evacuees served was 1,202 and 7,300, respectively. Support activities included prevention of immobilization, daily life support, environmental improvement and transition to temporary housing. The questionnaire survey revealed poor preparedness, satisfactory initial response and support activities, and problems of data collection and advocacy. Conclusion: The disaster was characterized by minimal trauma and a great need for preventing immobilization. This first collaborative endeavour was successful.

• Arterial hypertension: A clinically relevant problem in physical medicine and rehabilitation?

  Authors: Martin Nuhr, Veronika Fialka-Moser, Mohammad Keilani, Richard Crevenna, Michael M Hirschl

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):436-439.

  Objective: Arterial hypertension is the most frequently observed vascular risk factor. Physical and rehabilitative interventions may affect arterial blood pressure. The frequency of hypertensiveObjective: Arterial hypertension is the most frequently observed vascular risk factor. Physical and rehabilitative interventions may affect arterial blood pressure. The frequency of hypertensive patients in an outpatient clinic of physical medicine is unknown. Design: Prospective data collection. Patients: Overall, 3,826 patients admitted to the outpatient clinic for physical and rehabilitative interventions were included to assess arterial blood pressure, additional vascular risk factors, history of cardiovascular events and antihypertensive drug treatment. Methods: Arterial blood pressure was measured using an oscillometric method on the non-dominant arm. The patients were divided into sufficiently treated (< 140/90 mmHg, drug treatment), insufficiently treated (≥ 140/90 mmHg, drug treatment and history of hypertension) or de novo hypertensive patients (≥ 140/90 mmHg, no history of hypertension). Results: Arterial hypertension was observed in 48% of all patients (n = 1,840). In 719 (19%) of patients blood pressure above normal values. Due to significant hypertension 189 (5.2%) patients were either not permitted to start treatment or had to interrupt their physical treatment. Conclusion: Insufficiently treated hypertension or previously undiagnosed hypertension is relatively common in a physical medicine clinic. We therefore recommend the implementation of arterial blood pressure measurement into the admission procedures in order to reduce such events.

• Monitoring of spasticity and functional ability in individuals with incomplete spinal cord injury with a functional electrical stimulation cycling system.

  Authors: Werner Reichenfelser, Harald Hackl, Josef Hufgard, Josef Kastner, Karin Gstaltner, Margit Gföhler

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):444-449.

  Background: The aim of this study was to investigate the integration of motor function and spasticity assessment of individuals with spinal cord injury into cycling therapy. Methods: Twenty-threeBackground: The aim of this study was to investigate the integration of motor function and spasticity assessment of individuals with spinal cord injury into cycling therapy. Methods: Twenty-three participants with incomplete spinal cord injury performed 18 training sessions (standard deviation (SD) 14) on an instrumented tricycle combined with functional electrical stimulation. Each therapy session included a power output test to assess the participants' ability to pedal actively and a spasticity test routine that measures the legs' resistance to the pedalling motion. In addition, the required time for the therapy phases was monitored. Results: The results of the power output test showed a monthly increase in power output of 4.4 W (SD 13.7) at 30 rpm and 18.2 W (SD 23.9) at 60 rpm. The results of the spasticity assessment indicate a 12.2 W (SD 9.7) reduction in resistance at 60 rpm after the FES training for the subject group with spasticity. Conclusion: In clinical use over a time-period of 2 years this combined form of therapy and motor function assessment was well accepted by participants. The active power output test and the spasticity test routine offered a proper tool to monitor participants' progress in functional rehabilitation and changes in spasticity.

• Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation.

  Authors: Patrick J Theeven, Bea Hemmen, Richard P J Geers, Rob J E M Smeets, Peter R G Brink, Henk A M Seelen

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):454-461.

  Objective: To assess the effects of two types of microprocessor-controlled prosthetic knee joints (MPKs) on perceived performance and everyday life activity level. Design: Randomized cross-overObjective: To assess the effects of two types of microprocessor-controlled prosthetic knee joints (MPKs) on perceived performance and everyday life activity level. Design: Randomized cross-over trial. Subjects: Thirty persons with a unilateral above-knee amputation or knee disarticulation classified as Medicare Functional Classification Level-2. Methods: Participants were measured in 3 conditions, i.e. using a mechanically controlled prosthesis, an MPK featuring a microprocessor-controlled stance and swing phase (MPKA), and an MPK featuring a microprocessor-controlled stance phase (MPKB). Subjects' perceived performance regarding prosthesis use was measured with the Prosthesis Evaluation Questionnaire. Subjects' activity level was quantified using accelerometry. As high within-group variability regarding subjects' functional performance was expected to impede detection of possible effects of an MPK, data were analysed for the total group and for 3 subgroups of participants. Results: Participants' perception regarding ambulation, residual limb health, utility, and satisfaction with walking were significantly higher in the MPKA condition compared with the mechanical knee joint condition. Participants' activity level was similar in all knee joint conditions. Conclusion: Although Medicare Functional Classification Level-2 amputees report benefitting in terms of their performance from using an MPK, this is not reflected in their actual daily activity level after one week of using an MPK.

• Should we exclude elderly patients with chronic obstructive pulmonary disease from a long-time ambulatory pulmonary rehabilitation programme?

  Authors: Jean-Louis Corhay, Delphine Nguyen, Bernard Duysinx, Cédric Graas, Freddy Pirnay, Thierry Bury, Renaud Louis

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):466-472.

  Objective: To assess the outcomes of a 6-month comprehensive multidisciplinary outpatient pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease according to age.Objective: To assess the outcomes of a 6-month comprehensive multidisciplinary outpatient pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease according to age. Design: Prospective cohort study. Patients: A total of 140 patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3-4) admitted to our centre for pulmonary rehabilitation. Methods: Patients were divided into 3 groups: group A (< 65 years), group B (65-74 years) and group C (≥ 75 years). All the patients received an education and individualized training programme. Pulmonary rehabilitation efficacy was evaluated at 6 months of treatment and 12 months post-treatment. Results: A total of 116 patients completed the pulmonary rehabilitation programme: 59 in group A (85.5%), 40 in group B (80%) and 17 in group C (80.9%). All the parameters studied (number of sessions, 6-min walking distance, isometric quadriceps strength, health-related quality of life, maximal load, peak oxygen uptake, maximal inspiratory and expiratory pressures) were significantly improved in each of the groups at 3 and 6 months compared with baseline. Moreover, percentage changes from baseline at 6 months for all of the parameters studied were not significantly different between age-groups. Conclusion: Pulmonary rehabilitation is efficient in elderly patients with severe and very severe chronic obstructive pulmonary disease, and their compliance with pulmonary rehabilitation was similar to that seen in younger groups. Therefore, elderly patients with chronic obstructive pulmonary disease should not be denied pulmonary rehabilitation.

• The evidence-base for conceptual approaches and additional therapies targeting lower limb function in children with cerebral palsy: A systematic review using the ICF as a framework.

  Authors: Inge Franki, Kaat Desloovere, Josse De Cat, Hilde Feys, Guy Molenaers, Patrick Calders, Guy Vanderstraeten, Eveline Himpens, Christine Van Broeck

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):396-405.

  Objective: This systematic review provides an overview of the effectiveness of conceptual approaches and additional therapies used in lower limb physical therapy of children with cerebral palsy andObjective: This systematic review provides an overview of the effectiveness of conceptual approaches and additional therapies used in lower limb physical therapy of children with cerebral palsy and supports the development of clinical guidelines. Data sources and study selection: A literature search in 5 electronic databases was performed, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF). Data extraction: Three evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system. Data synthesis: A total of 37 studies used conceptual approaches (neurodevelopmental treatment (NDT), conductive education, Vojta therapy, sensory integration, functional training and goal-oriented therapy) and 21 studies focused on additional therapies (aquatic therapy and therapeutic horse-riding). Conclusion: Level II evidence was found for the effectiveness of therapeutic horse-riding on posture and for NDT and functional training on gross motor function. Goal-oriented therapy and functional training were effective on the attainment of functional goals and participation. With level IV evidence, NDT was effective on all levels of the ICF.

• Meeting the challenges of spinal cord injury care following sudden onset disaster: lessons learned.

  Authors: Anthony S Burns, Colleen O'Connell, Farooq Rathore

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):414-420.

  Improved disaster response has led to higher survival rates and an increasing number of injuries in relation to deaths (injury to death ratio). Recent earthquakes, in particular, have led toImproved disaster response has led to higher survival rates and an increasing number of injuries in relation to deaths (injury to death ratio). Recent earthquakes, in particular, have led to unprecedented numbers of spinal cord injuries. Meeting the needs of individuals with spinal cord injuries is particularly challenging when disaster strikes a low resource environment. Clinicians who care for spinal cord injuries can learn from prior experiences and proactively address how to best meet needs in future disasters. Here we review and propose measures targeted to specific challenges including: coordination and mobilization; identification and procurement of required expertise; initial survey and assessment; health care delivery; community reintegration and health maintenance; and sustainability and capacity building.

• The ScreeLing: Occurrence of linguistic deficits in acute aphasia post-stroke.

  Authors: Hanane El Hachioui, Mieke W M E Sandt-Koenderman, Diederik W J Dippel, Peter J Koudstaal, Evy G Visch-Brink

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):429-435.

  Objective: To investigate the occurrence of semantic, phonological and syntactic deficits in acute aphasia with the ScreeLing after the establishment of its psychometric properties. To examine theObjective: To investigate the occurrence of semantic, phonological and syntactic deficits in acute aphasia with the ScreeLing after the establishment of its psychometric properties. To examine the relationship between these deficits and: (i) overall aphasia severity; and (ii) quality of Spontaneous Speech. Methods: The reliability and validity of the ScreeLing was established by investigating 141 subjects with acute aphasia (2 weeks after stroke), 23 with chronic aphasia, and 138 healthy controls. In addition, the acute patients were assessed with the Token Test and a Spontaneous Speech rating (Aphasia Severity Rating Scale). Results: The ScreeLing was found to be valid and reliable for assessing the presence and severity of aphasia and linguistic deficits at 12 days after stroke. In 22.4% of the patients deficits were found in only 1 of the 3 linguistic levels; phonology was most frequently disturbed (16.3%), compared with semantics (2.7%), and syntax (3.4%). The number of impaired linguistic levels was related to aphasia severity: patients with a 3-level disorder had the lowest Token Test scores; patients with a selective phonological disorder had the highest Spontaneous Speech ratings. Phonology alone explained 54.6% of the variance in the Spontaneous Speech rating. Conclusion: In the acute stage, linguistic-level deficits are already present independently of each other, with phonology affected most frequently.

• Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury.

  Authors: Peter Flank, Kerstin Wahman, Richard Levi, Martin Fahlström

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):440-443.

  Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectionalObjective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectional study. Subjects: A total of 135 individuals, age range 18-79 years, with chronic (≥ 1 year) post-traumatic paraplegia. Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category. Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women. Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.

• Accuracy of botulinum toxin type A injection into the gastrocnemius muscle of adults with spastic equinus: Manual needle placement and electrical stimulation guidance compared using ultrasonography.

  Authors: Alessandro Picelli, Paola Bonetti, Carla Fontana, Martina Barausse, Francesca Dambruoso, Francesca Gajofatto, Stefano Tamburin, Paolo Girardi, Raffaele Gimigliano, Nicola Smania

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):450-452.

  Objective: To investigate the accuracy of manual needle placement and electrical stimulation guidance, compared using ultrasonography, for injection of botulinum toxin type A into the gastrocnemiusObjective: To investigate the accuracy of manual needle placement and electrical stimulation guidance, compared using ultrasonography, for injection of botulinum toxin type A into the gastrocnemius muscle of adults with spastic equinus. Design: Prospective clinical study. Subjects: A total of 81 adults with stroke who were scheduled to receive botulinum toxin type A injection into the gastrocnemius muscle. Methods: After randomization into two groups, each patient was injected into two sites at each head of the gastrocnemius muscle. The manual needle placement group (n = 42) underwent injections using anatomical landmarks and palpation. The electrical stimulation guidance group (n = 39) underwent injections under electrical stimulation guidance. The accuracy of needle placement and muscle thickness at each injection site were compared by means of ultrasonography. Results: The overall accuracy of manual needle placement and electrical stimulation guidance, measured using ultrasonography, was significantly higher for the gastrocnemius medialis than for the lateralis (92.0% vs 79.0%). The gastrocnemius medialis was significantly thicker than the lateralis (mean 13.25 mm (standard deviation (SD) 1.86 mm) vs 10.84 mm (SD 1.52 mm). Conclusion: Electrical stimulation guidance may be useful for injections into the gastrocnemius lateralis of adults with spastic equinus. However, neither manual needle placement nor electrical stimulation guidance showed complete accuracy, when measured using ultrasonography.

• Validation and reliability of the Physical Activity Scale for the Elderly in Chinese population.

  Authors: Shirley P C Ngai, Roy T H Cheung, Priscillia L Lam, Joseph K W Chiu, Eric Y H Fung

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):462-465.

  Objectives: Physical Activity Scale for the Elderly (PASE) is a widely used questionnaire in epidemiological studies for assessing the physical activity level of elderly. This study aims to translateObjectives: Physical Activity Scale for the Elderly (PASE) is a widely used questionnaire in epidemiological studies for assessing the physical activity level of elderly. This study aims to translate and validate PASE in Chinese population. Design: Cross-sectional study. Subjects: Chinese elderly aged 65 or above. Methods: The original English version of PASE was translated into Chinese (PASE-C) following standardized translation procedures. Ninety Chinese elderly aged 65 or above were recruited in the community. Test-retest reliability was determined by comparing the scores obtained from two separate administrations by the intraclass correlation coefficient. Validity was evaluated by Spearman's rank correlation coefficients between PASE and Medical Outcome Survey 36-Item Short Form Health Survey (SF-36), grip strength, single-leg-stance, 5 times sit-to-stand and 10-m walk. Results: PASE-C demonstrated good test-retest reliability (intraclass correlation coefficient  = 0.81). Fair to moderate association were found between PASE-C and most of the subscales of SF-36 (rs = 0.285 to 0.578, p < 0.01), grip strength (rs = 0.405 to 0.426, p < 0.001), single-leg-stance (rs = 0.470 to 0.548, p < 0.001), 5 times sit-to-stand (rs = -0.33, p = 0.001) and 10-m walk (rs = -0.281, p = 0.007). Conclusion: PASE-C is a reliable and valid instrument for assessing the physical activity level of elderly in Chinese population.

• Associations of demographic and injury-related factors with return to work among job-injured workers with disabilities in South Korea.

  Authors: Soo Kyung Park

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(5):473-476.

  Objective: The aim of this study was to examine the associations between the type of return-to-work and demographic and injury-related characteristics among South Korean workers with permanentObjective: The aim of this study was to examine the associations between the type of return-to-work and demographic and injury-related characteristics among South Korean workers with permanent disabilities due to occupational injury. Design: Retrospective cohort study. Subjects: A total of 13,078 injured workers aged 20-55 years who were legally registered in 2005 as having permanent disabilities due to occupational injuries. Methods: Workers' compensation databases were used to identify the retrospective cohort and to abstract demographic and injury-related variables. Return-to-work information was obtained from an unemployment insurance database and by telephone interview. Multinomial multivariate logistic regression analysis was used to test the association between the type of return-to-work (pre-injury job, self-employment, employment at a new firm) and independent variables. Results: Those subjects most likely to return to pre-injury jobs were male, aged 30-39 years, college educated with minor disabilities, and treated medically for one year or less. Findings were similar for those with a different employer after injury. However, the probability of self-employment was higher, particularly for males with moderate disabilities, but relatively lower among those under the age of 30 years. Conclusion: Special attention needs to be directed to demographic and injury-related characteristics when designing return-to-work programmes for injured workers with disabilities in South Korea.

• A position paper on Physical & Rehabilitation Medicine programmes in post-acute settingsUnion of European Medical Specialists Section of Physical & Rehabilitation Medicine (in conjunction with the European Society of Physical & Rehabilitation Medicine).

  Authors: Anthony Ward, Christoph Gutenbrunner, Alessandro Giustini, Alain Delarque, Veronika Fialka-Moser, Carlotte Kiekens, Mihai Berteanu, Nicolas Christodoulou

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):289-98.

  Physical & Rehabilitation Medicine (PRM) programmes in post-acute settings cover interventions for the rehabilitation of people with a variety of disabling health conditions. The setting of thePhysical & Rehabilitation Medicine (PRM) programmes in post-acute settings cover interventions for the rehabilitation of people with a variety of disabling health conditions. The setting of the intervention is more important than the timing and these programmes can be carried out in a variety of facilities. This paper describes the role of PRM services and of PRM specialists in delivering rehabilitation programmes to people, who have initially been admitted to hospital. The emphasis is on improving patients' activities and addressing participation issues. PRM programmes in post-acute settings provide a range of treatments and have a major influence in the long-term on the pace and extent of return of function and recovery from ill-health. This paper will define the meaning of post-acute settings and will describe the patient's journey through the post-acute setting. In particular, it addresses the standards of care across Europe that patients should expect. This paper also examines the general principles of funding such programmes within the context of different health care systems across Europe. Coordinated care improves outcomes and economic profiles for both payers and providers of services. This paper describes the value of PRM interventions and PRM specialist-led teams in promoting better outcomes for people with disabilities with complex needs.

• Robot-assisted walking vs overground walking in stroke patients: An evaluation of muscle activity.

  Authors: Pieter Coenen, Guido van Werven, Michiel Nunen, Jaap Dieën, Karin Gerrits, Thomas Janssen

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):331-7.

  Objective: There is increasing evidence that robot-assisted treadmill training might be useful for gait rehabilitation after stroke. The aim of this study was to evaluate the muscle activity ofObjective: There is increasing evidence that robot-assisted treadmill training might be useful for gait rehabilitation after stroke. The aim of this study was to evaluate the muscle activity of stroke patients during robot-assisted walking and overground walking, and of a group of able-bodied subjects during overground walking. Design: Case-control observational study. Subjects: Ten stroke subjects and 10 able-bodied control subjects. Methods: Electromyography measurements of 7 lower-limb muscles were made in 3 trials: robotic walking, in which stroke subjects walked in a robot-assisted gait orthosis; overground walking for the same group of stroke subjects; and overground walking for control subjects. Trials were compared with respect to electromyography amplitude of selected leg muscles. Results: Higher muscle activity during overground walking compared with robotic walking was found in several muscles during several phases of the gait cycle. A significant trial × leg interaction revealed smaller differences in muscle activity between the paretic and non-paretic leg during robotic walking compared with overground walking. Furthermore, the muscle activity pattern was not significantly different between control walking and robotic walking, while it was different between control walking and overground walking. Conclusion: Despite lower muscle activity, robot-assisted treadmill training may elicit a more symmetrical pattern of leg muscle activity, which approaches that of able-bodied individuals. Key words: gait; paresis; electromyography; robotics; walking.

• Cough assistance device for patients with glottis dysfunction and/or tracheostomy.

  Authors: Won Ah Choi, Jung Hyun Park, Dong Hyun Kim, Seong-Woong Kang

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):351-4.

  Objective: To estimate the efficiency of a cough assistance device, the Cough Aid, in patients with weak respiratory muscles with bulbar palsy and/or tracheostomy. The Cough Aid is a device that hasObjective: To estimate the efficiency of a cough assistance device, the Cough Aid, in patients with weak respiratory muscles with bulbar palsy and/or tracheostomy. The Cough Aid is a device that has been developed to substitute for glottis function. Design: Before-after trial. Subjects/patients: A total of 74 patients with bulbar palsy and/or tracheostomy, as well as respiratory muscle weakness, were recruited. Methods: Forced vital capacity, unassisted cough peak flow, lung insufflation capacity, and assisted cough peak flow were measured via tracheostomy or oronasal interface. Lung insufflation capacity and assisted cough peak flow were measured using the Cough Aid. Results and conclusion: In all 74 subjects, lung insufflation capacities measured with the device were significantly higher than forced vital capacities (p < 0.01). Assisted cough peak flows measured using the device were also significantly higher than unassisted cough peak flows (p < 0.01). The Cough Aid is effective in helping to increase cough flow and assisting in the air stacking exercise by substituting the function of the glottis in patients who have glottis dysfunction or a tracheostomy tube.

• The added value of an actuated ankle-foot orthosis to restore normal gait function in patients with spinal cord injury: A systematic review.

  Authors: Saartje Duerinck, Eva Swinnen, Pieter Beyl, Friso Hagman, Ilse Jonkers, Peter Vaes, Peter Van Roy

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):299-309.

  Objective: To provide an overview of robot-assisted rehabilitation devices developed for actuation of the ankle-foot complex and their ability to influence the attributes of normal gait in patientsObjective: To provide an overview of robot-assisted rehabilitation devices developed for actuation of the ankle-foot complex and their ability to influence the attributes of normal gait in patients with spinal cord injury. Methods: A search was conducted in MEDLINE, Web of Knowledge, National Academic Research and Collaborations Information System, and Physiotherapy Evidence Data-base (1985-2011), using, "ankle", "foot", "robotics", "orthotics" and "spinal cord injury" as most relevant keywords. Article inclusion was performed in 3 stages; at the level of: (i) title, (ii) abstract and (iii) full text. Results: The actuated ankle-foot orthoses currently available are characterized by several combinations of an actuator and a control mechanism. Both the actuator and the control strategy substantially influence human-machine interaction and therefore the potential of the device to assist in modifying locomotor function and potentially modify the underlying motor control mechanisms. Conclusion: Due to small sample sizes, limited studies in patients with spinal cord injury, and limitations in study design, it is difficult to draw firm conclusions on the effect of different types of actuated ankle-foot orthoses. Based on the limited data available, pneumatic artificial muscles in combination with proportional myoelectric control are suggested to have the potential to meet most of the preconditions to restore the attributes of normal gait and therefore facilitate neuroplasticity.

• Usability testing of two e-learning resources: Methods to maximize potential for clinician use.

  Authors: Anita Menon, Nicol Korner-Bitensky, Mark Chignell, Sharon Straus

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):338-45.

  Rationale and Objectives: Rigorous usability testing of e-learn-ing resources is an important prerequisite to their wide-spread use among clinicians. This study demonstrates the application of anRationale and Objectives: Rigorous usability testing of e-learn-ing resources is an important prerequisite to their wide-spread use among clinicians. This study demonstrates the application of an evidence-based approach to usability testing of two stroke-related e-learning resources (StrokEngine). Methods: 14 stroke rehabilitation clinicians (occupational therapists and physiotherapists) from Ontario, Canada participated in a 1.5 h in-person testing session. Clinicians navigated StrokEngine in search of information to answer questions on stroke assessment/intervention. Their search patterns were observed and clinicians provided verbal/written feedback about StrokEngine. Content analysis was used to generate themes and categorize them under two broad categories: facilitators and barriers to use. Results: Five key facilitators and three key barriers to Strok-Engine use were identified and related to screen format, layout/organization, ease of navigation, quality of content, likelihood of using StrokEngine in the future, and system dysfunctions. All 14 clinicians were very or extremely satisfied with the layout/organization, quality and clinical relevance of the content, stating that they were likely to use StrokEngine in the future. Conclusion: All identified barriers from this study were addressed with website modifications in order to maximize the usability and navigability of StrokEngine. This rigorous methodology for usability testing can be applied during the design process of any e-learning resource.

• Transcranial direct current stimulation of the left prefrontal cortex improves attention in patients with traumatic brain injury: A pilot study.

  Authors: Eun-Kyoung Kang, Dae-Yul Kim, Nam-Jong Paik

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):346-50.

  Objective: To determine whether a single session of anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex improves attention in patients with traumatic brainObjective: To determine whether a single session of anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex improves attention in patients with traumatic brain injury. Design: Double-blinded, cross-over design. Patients: Nine patients with attention deficit after traumatic brain injury. Methods: Patients underwent a computerized contrast reaction time task before and after the administration of real transcranial direct current stimulation (2 mA for 20 min) or sham transcranial direct current stimulation (2 mA for 1 min) to the left dorsolateral prefrontal cortex in a double-blind, crossover manner. Results: Immediately post-stimulation, the transcranial direct current stimulation group showed a tendency of shortened reaction time relative to baseline (87.3 ± 7.8%), whereas the sham stimulation group (122.4 ± 715.5%) did not (p = 0.056). However, this difference was not significant 3 or 24 h after stimulation (p > 0.05). The numbers of correct responses were not changed at any time after stimulation. Conclusion: Anodal transcranial direct current stimulation applied to the left dorsolateral prefrontal cortex improves attention compared with sham stimulation in patients with traumatic brain injury, which suggests a potential role for this intervention in improving attention during cognitive training after traumatic brain injury. A further prospective randomized trial is required to confirm the benefits conferred by transcranial direct current stimulation in this patient population.

• Association between clinical and work-related interventions and return-to-work for patients with musculoskeletal or mental disorders.

  Authors: Charlotte Wåhlin, Kerstin Ekberg, Jan Persson, Lars Bernfort, Birgitta Oberg

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):355-62.

  Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjectsObjective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed. Design: A prospective cohort study. Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43). Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group. Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.

• Delayed recovery of gait function in a patient with intracerebral haemorrhage.

  Authors: Hyeok Kwon, Sung Ho Jang

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):378-80.

  Objective: We report here on a patient with intracerebral haemorrhage (ICH), who showed unusually delayed motor recovery of the leg, which started at 6 months after ICH onset. Case report: AObjective: We report here on a patient with intracerebral haemorrhage (ICH), who showed unusually delayed motor recovery of the leg, which started at 6 months after ICH onset. Case report: A 53-year-old man underwent craniotomy and drainage for a right putaminal ICH. The patient presented with complete paralysis of the left extremities at ICH onset. Despite having undergone rehabilitation starting at 7 weeks after onset, the patient did not show significant motor recovery of the left extremities until 6 months after onset, when the affected left leg began to show motor recovery to the point that he was able to extend his hip and knee without gravity 7 months after onset. As a result, he was able to walk independently on an even floor 9 months after onset. Results: On 6-month diffusion tensor tractography, the right corticospinal tract showed disruption with Wallerian degeneration to the pontomedullary junction. Conclusion: This case study highlights the extensive potential for the human brain to aid in the recovery of walking after injury. In conclusion, clinicians should attempt to determine the causes of difficulty walking when examining patients with ICH and then perform intensive rehabilitation for the recovery of walking.

• Effectiveness of multidisciplinary early rehabilitation in reducing behaviour-related risk factors.

  Authors: Mikhail Saltychev, Katri Laimi, Ashraf El-Metwally, Tuula Oksanen, Jaana Pentti, Marianna Virtanen, Anne Kouvonen, Mika Kivimäki, Jussi Vahtera

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):370-7.

  Objective: To evaluate the effect of a 4-week primary prevention programme on health-risk behaviours amongst employees at increased risk of work incapacity. Methods: Based on survey data and healthObjective: To evaluate the effect of a 4-week primary prevention programme on health-risk behaviours amongst employees at increased risk of work incapacity. Methods: Based on survey data and health records from 53,416 public sector employees in Finland, we identified 872 employees who participated in early rehabilitation after the baseline survey. We selected 2,440 propensity-score-matched controls for these rehabilitants. Changes in the prevalence of physical inactivity, obesity, heavy drinking, and smoking, as well as in the intensity of leisure-time physical activity, weight, and alcohol consumption after the intervention were examined between the baseline and two subsequent surveys representing short-term (mean follow-up 1.7 years) and long-term (mean 5.8 years) follow-ups. Results: There were no statistically significant differences between the rehabilitants and controls in terms of changes in weight, alcohol consumption, intensity of leisure-time physical activity, or prevalence of obesity, heavy drinking and physical inactivity during short-term or long-term follow-ups. During short-term follow-up, a higher rate of smoking cessation was observed for rehabilitants than controls (31.7% vs. 20.2%, p = 0.037). Conclusion: Vocationally oriented multidisciplinary early rehabilitation had little effect on health risk behaviours.

• Compensation allows recovery of functional independence in people with severe motor impairments following spinal cord injury.

  Authors: Jennifer D Hastings, Lisa A Harvey, Joy A Bruce, Martha F Somers

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine.

  Abstract is missing (letter).

• Musculoskeletal ultrasonography in physical and rehabilitation medicine.

  Authors: Levent Ozçakar, Fatih Tok, Martine De Muynck, Guy Vanderstraeten

  Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. 44(4):310-8.

  Musculoskeletal ultrasound has gained a significant place in the diagnosis and management of various musculoskeletal disorders due to its several advantages (being convenient, inexpensive,Musculoskeletal ultrasound has gained a significant place in the diagnosis and management of various musculoskeletal disorders due to its several advantages (being convenient, inexpensive, non-invasive, repeatable, providing dynamic imaging and not requiring any exposure to radiation). It has also become a valuable tool in the daily clinical practice of physical and rehabilitation medicine physicians; the musculoskeletal ultrasound probe having become synonymous with the physician's stethoscope. In this paper, aside from drawing attention to this growing issue in the agenda of PRM physicians, we will touch upon its basic technical features and certain aspects as regards muscle, tendon, ligament, nerve, joint lesions and ultrasound guided interventions.

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