LLLT gave more effective short-term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure.
US and sEMG measurements can be used for objective TrA/LM assessment. Correlation results suggest that the relative change of the muscle thickness could be used as the indicator of the muscle activity. Insight into the activity of TrA/LM in pain-free individuals and LBP patients during and after painful episodes may clarify the role of functional abnormalities of these muscles in LBP.
Both experienced and trained novice raters provided reliable measurements of TrA and LM thickness in participants with LBP and healthy participants, during rest and contraction. One-time measurements were similar to averaged measurements. Small absolute errors were observed. Public trial registry: Australian New Zealand Clinical Trials Registry ACTRN12613001077752.
Background
Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, “best‐of” meta‐tool. The EU‐COST initiative “Pain in impaired cognition, especially dementia” aimed to do this by selecting items out of existing observational scales and critically re‐assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task.
Methods
Items from existing observational pain scales were tested for “frequency of occurrence (item difficulty),” “reliability” and “validity.” This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions.
Results
Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations).
Conclusions
The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed‐on meta‐tool for Pain Assessment in Impaired Cognition, the PAIC‐15 scale.
Significance
Using a meta‐tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).
We designed a new surface multi-pad electrode for the electrical stimulation of the forearm that is effective in controlling functional grasp in hemiplegic patients. The electrode shape and size were designed on the basis of the surface stimulation map of the forearm, determined from measurements in seven hemiplegic patients who had limited or absent voluntary movements of the fingers, thumb and wrist. The stimulation map for each patient was assessed with a conventional set of single pad Pals Platinum electrodes. Since the sites for the stimulation varied greatly between patients, the end result was a rather large multi-pad electrode. Modulating multi-pad electrode size, shape, position and individual pad stimulation parameters allows us to accommodate the diversity of the neural tissues in patients that need to be activated for functional grasp. This also allows asynchronous activation of different portions of the muscle and dynamic adaptation of the stimulation sites to appropriate underlying tissues during functional use. The validity of the determined stimulation map was tested in the same group of hemiplegic patients. The selected set of active pads resulted in fully functional and reproducible palmar and lateral grasps similar to healthy-like grasps.
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