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Daily Function (daily + function)
Selected AbstractsA randomized clinical trial of strength training in young people with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2003Karen J Dodd PhD This randomized clinical trial evaluated the effects of a home-based, six-week strength-training programme on lower limb strength and physical activity of 21 young people (11 females, 10 males; mean age 13 years 1 month, SD 3 years 1 month; range 8 to 18 years) with spastic diplegic cerebral palsy (CP) with independent ambulation, with or without gait aids; (Gross Motor Function Classification System levels I to III). Compared with the 10 controls, the 11 participants in the strength-training programme increased their lower limb strength (combined ankle plantarflexor and knee extensor strength as measured by a hand-held dynamometer) at 6 weeks (F(1,19)=4.58, p=0.046) and at a follow-up 12 weeks later (F(1,18)=6.25, p=0.041). At 6 weeks, trends were also evident for improved scores in Gross Motor Function Measure dimensions D and E for standing, running and jumping, and faster stair climbing. A relatively short clinically feasible home-based training programme can lead to lasting changes in the strength of key lower-limb muscles that may impact on the daily function of young people with CP. [source] Differential associations of Head and Body Symptoms with depression and physical comorbidity in patients with cognitive impairmentINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2004Roberta Riello Abstract Objective To test the hypothesis that physical symptoms referred to the head might be specifically associated with depression in patients with cognitive impairment. Methods Subjects were taken from those enrolled in ,The Mild Project' a prospective study on the natural history of mild dementia (Mini Mental State Examination,,,18) and with a diagnosis of Alzheimer's disease, vascular dementia, and mild cognitive impairment. A total of 129 subjects were included in the study. Physical symptoms were assessed with a checklist investigating nine different body organs or apparati. Physical symptoms were grouped into those referred to the head (Head Symptoms: ear and hearing; eyes and sight; and head and face) and all the others (Body Symptoms). Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) and physical comorbidity with Greenfield's Index of Disease Severity (IDS). Results The number of patients reporting one or more Head Symptoms linearly increased with increasing depression severity (Mantel-Haenszel test,=,6.497, df,=,1, p,=,0.011), while the number of patients reporting one or more Body Symptoms linearly increased with increasing physical comorbidity (Mantel-Haenszel test,=,4.726, df,=,1, p,=,0.030). These associations were confirmed in multivariate logistic regression models with adjustment for potential confounders (age, gender, education, cognitive performance, daily function, and diagnosis). Conclusions Head Symptoms are specifically associated with depression while Body Symptoms with physical comorbidity, in patients with cognitive impairment. Recognizing these associations in individual patients may help clinicians decide whether to initiate or continue antidepressant therapy or whether to carry out physical instrumental investigations. Copyright © 2004 John Wiley & Sons, Ltd. [source] Alzheimer's Disease: Current Pharmacotherapy in the Context of Patient and Family NeedsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5s2 2003David S. Geldmacher MD The objective of this paper is to review current evidence and treatment patterns for pharmacotherapy in Alzheimer's disease (AD), with an emphasis on outcomes considered important to patients and families. The sources for the information are the peer-reviewed literature, Food and Drug Administration-approved package labeling for acetylcholinesterase inhibitors (AChEIs), expert opinions expressed at the First Annual Dementia Congress, and clinical experience. Three AChEI agents are in routine use in the United States. They are considered part of the standard of care for patients with mild-to-moderate AD. There are differences in metabolism, pharmacokinetics, side effects, and ease of use that may influence the prescriber's choice of agent and dosage. The three approved agents have similar outcomes in cognition and global clinician ratings of effectiveness in double-blind placebo controlled trials. Persistent therapy with effective doses of AChEIs is associated with reduced risk for, or delayed, nursing home placement, which is a stated priority of AD caregivers. Agents from this class of drugs have also been shown to be associated with statistically significant preservation of daily function and benefits in treatment of adverse behaviors in AD. Numerous additional choices are available to the clinician for pharmacotherapy of adverse behaviors. Community-based psychoeducational support is also of value to caregivers. [source] Apathy in Alzheimer's DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2001Allan M. Landes MA Apathy, or loss of motivation, is arguably the most common change in behavior in Alzheimer's disease (AD) but is underrecognized. Apathy represents a form of executive cognitive dysfunction. Patients with apathy suffer from decreased daily function and specific cognitive deficits and rely on families to provide more care, which results in increased stress for families. Apathy is one of the primary syndromes associated with frontal and subcortical pathology, and apathy in AD appears to have multiple neuroanatomical correlates that implicate components of frontal subcortical networks. Despite the profound effects of this common syndrome, only a few instruments have been designed to specifically assess apathy, and these instruments have not been directly compared. Assessment of apathy in AD requires clinicians to distinguish loss of motivation from loss of ability due to cognitive decline. Although apathy may be misdiagnosed as depression because of an overlap in symptoms, current research has shown apathy to be a discrete syndrome. Distinguishing apathy from depression has important treatment implications, because these disorders respond to different interventions. Further research is required to clarify the specific neuroanatomical and neuropsychological correlates of apathy and to determine how correct diagnosis and treatment of apathy may improve patient functioning and ease caregiver burden. [source] Long-term benefits of rivastigmine in dementia associated with Parkinson's disease: An active treatment extension studyMOVEMENT DISORDERS, Issue 4 2006Werner Poewe MD Abstract In patients with dementia associated with Parkinson's disease (PD), the efficacy and safety of rivastigmine, an inhibitor of acetylcholinesterase and butyrylcholinesterase, were previously demonstrated in a 24-week double-blind placebo-controlled trial. Our objective was to determine whether benefits were sustained over the long term. Following the double-blind trial, all patients were permitted to enter an active treatment extension study, during which they received rivastigmine 3,12 mg/day. Standard safety assessments were performed. Efficacy assessments included the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog) and other measures of cognition, daily function, neuropsychiatric symptoms, and executive function. Of 433 patients who completed the double-blind trial, 334 entered and 273 completed the active treatment extension. At 48 weeks, the mean ADAS-cog score for the whole group improved by 2 points above baseline. Placebo patients switching to rivastigmine for the active treatment extension experienced a mean cognitive improvement similar to that of the original rivastigmine group during the double-blind trial. The adverse event profile was comparable to that seen in the double-blind trial. Long-term rivastigmine treatment appeared well tolerated and may provide sustained benefits in dementia associated with PD patients who remain on treatment for up to 48 weeks. © 2005 Movement Disorder Society [source] 3421: Straylight and visionACTA OPHTHALMOLOGICA, Issue 2010TJTP VAN DEN BERG Purpose Straylight is considered an important source of patient complaints. They can be voiced like halos, glare, hazy vision and blinding at night. With visual acuity, contrast sensitivity and slit lamp examination little may be found. Yet increased large angle light scattering in the eye media not detected by common tests, may degrade the image projected on the retina, thus decreasing the quality of vision. Aging changes to the crystalline lens and cataract are the most common causes of increased straylight. This study aimed to quantify the importance of straylight for daily life on the basis of patient complaint scores. Methods In a duocenter setting questionnaires were administered before and after cataract surgery. The 37 questions VFQ as well as a self developed 5 question straylight questionnaire were used. A comparison was made between the importance of visual acuity and of straylight to explain the questionnaire outcomes. Results A total of 214 patients were included in the study. For the comparison correlation coefficients were calculated between a weighted average of the 2 functional measures visual acuity and straylight on the one hand, and the questionnaire outcomes on the other. In all 4 cases (2 questionnaires x 2 visits) correlation was lowest for both visual acuity and straylight used in isolation. When visual acuity and straylight were combined to one combined score, correlation improved. Maximum correlation was found when visual acuity and straylight were combined 1:1 (preop) to 2:1 (postop), for both questionnaires. Conclusion For cataract patients, straylight is of about equal importance compared to visual acuity for their appreciation of daily function. In this comparison both were quantified as logarithms (logMAR and log(s)). [source] Self-reported functional ability predicts three-year mobility and mortality in community-dwelling older personsGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2002Ryuichi Kawamoto Background:, A comprehensive evaluation of the functions of community-dwelling older persons was conducted in 1988. Three years after the 1988 study commenced, the relationship between these background factors and changes during the subsequent 3 years were examined. Methods: ,The study was a comprehensive evaluation of the daily functions of community-dwelling elderly people, and encompassed age, gender, mode of living, marital status, financial status, family relationships, basic activities of daily living, visual and hearing impairment, a history of disease, self-related feeling, social role, social support, habits and physical exercise and the relationship between independence and survival for 3 years after the basic study. The subjects were 2274 community-dwelling elderly people who participated in the first survey in July 1998 and who were aged 65 years and over at that time. Unassisted questionnaire sheets were used for the first survey and changes since the first survey. Results:, Thirty men and 60 women died during the 3 year period. Data were also gathered about the daily activity levels of 1709 persons (75.2%) with 1499 (87.7%) ranking J for independence and 210 persons (12.3%) ranking A to C for dependence. Age, gender, basic activities of daily living (BADL), history of falls, self-related happiness, participation in community events and physical-exercise habits were found to be explanatory variables for independence after three years; as were age, gender, and BADL for survival. Conclusion: , The explanatory variables relating to independence and prognosis of life of the elderly obtained in this study will be important in future considerations of the issue of care-taking and measures to enable it. [source] Psychological well-being in rheumatoid arthritis: a review of the literatureMUSCULOSKELETAL CARE, Issue 2 2010Lynda Gettings BSc (Hons) Abstract The psychological well-being of patients with rheumatoid arthritis (RA) is an important issue, and the advent of measurement tools has led to a better understanding of the mental aspects associated with this chronic illness. Patients with RA are more likely to suffer from anxiety, depression and low self-esteem, with high levels of associated mortality and suicide. The loss of the ability to carry out daily functions owing to RA is also associated with the onset of depressive symptoms. Furthermore, the psychological effects of RA can extend to the partners, families and carers of sufferers. Conventional treatment has focused on treating the symptoms of RA and containment of disease progression, but may not necessarily address the psychological issues associated with the condition. Furthermore, patient perception of RA and of the support offered to them can cause further unnecessary psychological distress. Access to psychological support for RA patients has been shown to be inconsistent and haphazard. It is now being recognized that what is needed is a multidisciplinary team approach to treat psychological distress in RA alongside conventional treatment, involving alternative therapies tailored to the psychological needs of the patient. The benefits of treatments such as cognitive behavioural therapy, meditation and exercise are clear and these treatments should be actively encouraged, thereby enabling patients with RA to better manage the psychological burden associated with this chronic condition. Copyright © 2010 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||