The impact of 'half shoes' in the treatment of neuropathic forefoot ulcers was studied in two groups of diabetic patients, who were treated either by standard treatment alone (retrospective controls, n = 22), or by standard treatment plus 'half shoes' (cases, n = 26). The groups were matched for sex, age, type, and duration of diabetes and ulcer grading. The 'half-shoe' cases' vs controls' median overall healing time was 70 vs 118 days, the median difference being 48 (95% CI: -5 to 82) days (NS). In the case group, hospitalization was required in 1/26 (4%) of patients, vs 9/22 (41%) of the control patients (chi-square, p < 0.01). The home nursing service was required in 23% of the cases vs 18% of the controls (NS). It is concluded that the use of half-shoes, in conjunction with standard treatment provided by a specialized diabetic foot clinic, may reduce the overall healing time and does reduce the hospitalization rate. This has implications for a rational strategy of treating unilateral diabetic neuropathic foot ulcers.
GMPMGross Impaired gross motor development and function are defining features of cerebral palsy (CP). 1 Interventions aim to optimize what the child can do (functional skills) and how they do it (movement quality).2 Both are important prerequisites for advanced motor skills related to activity and participation. Enhancement of quality of movement may be an important precursor to attainment of new gross motor skills.2 While function is the ultimate goal, identifying challenges in quality of movement helps to guide therapists to develop individualized therapy approaches to enhance function. Without measuring movement, quality changes can only be inferred from improvements in other aspects of function, such as timed walk tests, acquisition of new motor skills, or indications of greater functional skill independence. Clinicians and researchers, therefore, remain uncertain about what aspects of quality are changing and when, how, and why. 'No difference' findings in trials that failed to assess quality of movement may have missed important changes in this underlying component of motor skill.Instrumented systems quantify selected attributes of movement quality (e.g. force, amplitude, speed), but their use is limited to specialized centres. Paediatric physiotherapists typically rate quality of performance through clinical observation and Gestalt perceptions of movement.3,4 The absence of appropriate clinical instruments to evaluate movement quality was the impetus to the development of the Gross Motor Performance Measure (GMPM), 3 created through an expert consensus approach as a companion to the original Gross Motor Function Measure (GMFM-88). 5The GMPM was designed to quantify key aspects of movement quality and evaluate change in children with CP and acquired brain injury. 6 Five attributes (Alignment, and it detected change with interventions (orthopaedic surgery, rhizotomy, and ankle orthoses). 11,12The GMPM remains the only published measure that addresses multiple components of quality of gross motor skills for children with CP. Other published upper or lower extremity/total body quality of movement scales are outlined in Table SI (online supporting information). Three concerns about the GMPM are its lack of item-specific response option descriptions, the need for highly experienced raters, 8 and the small representation of motor skills (20 GMFM-88 items). While the GMPM may be suitable for a therapist who is working with a child on basic motor skills that have quality components to them (e.g. Co-ordination and Dissociated movement are relevant attributes to assess for lying/rolling and crawling skills), its evaluation of movement quality across all aspects of motor function does not align well with goals of children who are working specifically on ambulation-based skills. For these children in Gross Motor Function Classification System (GMFCS) levels I to III, evaluation of movement quality should be intensely focused on standing and walking skills with a sufficient number of items to give a complete picture of...
100 healthy persons were investigated to find out whether there is a correlation between a lymphocyte stimulation (3H-thymidine incorporation in the lymphocyte transformation test) with phytohaemagglutinin, pokeweed mitogen and concanavalin A and the in vivo reactivity to intracutaneous phytohaemagglutinin application (measured as medium diameter of infiltrates). Further we searched for an influence of positive or negative reactivity to the specific antigens trichophytin, candidin and streptokinase-streptodornase. 1. There is a good qualitative correlation in normal persons between in vitro lymphocyte stimulation by phytohaemagglutinin, pokeweed mitogen and concanavalin A and the medium diameter of infiltrates after intracutaneous application of 2 mug phytohaemagglutinin. Using lower doses of phytohaemagglutinin no such correlation could be found. A quantitative correlation between the medium diameter of infiltrates and lymphocyte transformation by phytohaemagglutinin and pokeweed mitogen cannot be demonstrated. For concanavalin A there is a negative correlation significant at the 99% level. 2. In vivo reactivity to phytohaemagglutinin does not differ in persons with negative and positive reactions to the specific antigens. 3. Lymphocyte stimulation by phytohaemagglutinin, pokeweed mitogen and concanavalin A of persons with positive reactions to trichophytin, candidin and streptokinase-streptodornase is significantly greater than in those with negative reactivity. 4. The results indicate in vivo phytohaemagglutinin testing as a good screening method to judge cell-mediated immunocompetence. The general applicability for differentiation of immunodeficient and immunocompetent patients is to be further investigated.
Hemi-intensiv-tHerapie-Camp CIMT wird in unterschiedlichster Form und Intensität praktiziert. Ein Therapeuten-Team aus München hat in einem Hemi-Intensiv-Therapie-Camp untersucht, wie sich neun Tage Therapie und Abenteuer auf die Hemiparese der Kinder und Jugendlichen auswirken.
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