Hideyuki Nagaoki (Dept. of PM&R, National Defense Medical College Hospital)
Evaluation of spasticity is quite important for management of spasticity. Although Modified Ashworth scale (MAS) is utilized for clinical practice, we did not have any established methods to measure objectively.
We have developed the equipment to measure forces on the foot plate which moved 40 degrees with different speed (60 degrees / see). The movement of plate was wave of rectangular (move 0.7 sec - stop 3.0 sec).
Subjects were sitting on the chair. The foot was fixed to the footplate with bands and knee was 30 degrees in flexion. The output was the angular movement of the footplate and exerted force on the plate. EMGs were monitored with the surface electrodes on the gastrocnemius, tibialis anterior, and rectus femoris. Pendulum test of the knee was also examined. MAS and clonus were also examined.
Those who have spasticity showed peak force (3.1±1.6 kg) when the footplate moved to dorsiflexion of ankle and that of normal group was 1.0±0.5 kg. The amount of peak force was higher in the severe MAS group (0:1.0, I: 2.7, I+:3.2, II:3.8, III:5.4 kg). The R2 index of pendulum test was in proportion to the peak force. We could evaluate the effect of spasticity treatment such as medications by using this equipment.
PREDICTORS OF LATE VOCATIONAL OUTCOME FOLLOWING TBI
Zeev Groswasser (Loewenstein Rehabilitation Hospital, Ra'anana, Sackler Faculty of Medicine, Tel-Aviv Univesity, Tel-Aviv, Israel)
The present study aimed at finding the predictors of long term actual occupational status of severe traumatic brain injured patients within the age group of 18-65 at the time of follow-up, 8-13 years post discharge from a rehabilitation center. Late follow-up information was gathered for 199 patients out of the original study group of 281 patients (70.8%). Clinical team evaluation prediction at discharge was that 74.5% of patients resume gainful employment but only 55.7% were found to be gainfully employed.
The logistic model was used to assess various parameters in predicting occupational. Only older age, longer periods of unconsciousness and presence of behavioral disturbances were found to be of significant negative predictive values in relation to predicted occupational outcome at discharge. Late appearance of physical complaints like headache, hypersensitivity to noise, dizziness and sleep disorders, usually attributed to mild TBI patients, had a negative impact on vocational outcome. Combining early predictors and late postconcussive complaints in a model disclosed that the significant factors for late gainful employment were duration of unconscousness, behavior, hypersensitivity to noise and sleep disturbances.