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July 2004

CI THERAPY EFFECTIVE FOR CEREBRAL PALSY
According to a study in the February 2004 issue of Pediatrics, constrained-induced movement (CI) therapy may be an effective treatment for children with spastic hemiparesis cerebral palsy.

Spastic hemiparesis affects an arm or leg on one side of a patient’s body. It accounts for 70% to 80% of spastic cerebral palsy cases. Generally, children with spastic hemiparesis learn not to use the weaker limb because it does not work well. CI therapy, however, forces patients to use their weak limb by suspending the stronger limb.

In this new study, 18 children ranging from 7 months to 8 years were divided into two groups; one group received standard rehabilitation, while the other group received CI therapy. The stronger limb of the children in the CI group was placed in a light cast, which extended from the shoulder to just past the fingertips, for 21 days. They received intensive therapy (disguised as play) for 6 hours a day. Researchers used standardized questionnaires and evaluations of videotaped sessions to track the children’s progress.

Results showed considerable improvement in the CI group, especially in the younger children who displayed new patterns of movement and behavior in their weaker limbs, such as crawling and picking up objects.

CI therapy was started originally for stroke patients by Edward Taub, PhD, director of the Taub Therapy Clinic and professor of psychology at the University of Alabama at Birmingham. Taub followed the children of this study for 6 months and stated that the gain in their motor ability skills remained. According to Taub, the central nervous system of children is pliable enough to reorganize itself to adapt to impairments if treatments such as CI therapy are applied.

TREATING ARTHRITIS CAN HELP IN FINDING JOBS
Rheumatoid arthritis can have debilitating effects on a person’s ability to perform daily tasks, and could possibly lead to job loss, says a report in the Journal of Rheumatology.

Researchers at the University of California, San Diego, evaluated the relationship between functional disability, joint damage, and employment status of 428 patients. They also reviewed the impact of improved physical functioning after therapy on the person’s ability to get a job, their overall health care costs, and quality of life.

Data showed that at the start of the study, the level of a person’s functional status was significant to their employment status; patients with severe joint damage were less likely to have a full-time job than those with lesser degrees of joint damage. When examined after 54 weeks, patients who had clinical improvements in the degree of rheumatoid arthritis also showed improvements in their job prospects.

According to the authors of the report, the results of the study showed that effective treatment for rheumatoid arthritis is beneficial economically and in the quality of life for patients.

BILL MAKES CARE MORE ACCESSIBLE TO CHILDREN
The Family Opportunity Act recently passed on a voice vote in the US Senate. The bill increases accessibility of health care for disabled children without the families being forced to remain at poverty-level status.

Currently, families must lose their Medicaid assistance unless they fall under poverty levels. The new bill gives families the option of participating in Medicaid and paying a sliding scale while continuing to work.

The Family Opportunity Act is one of many bills passed since the late 1990s to help families with disabled members raise their income levels without losing medical benefits. The bill still has to pass in the House.

REPORT EXAMINES NEW SCI TREATMENT
People who suffer from partial damage to their spinal cord may find improvements in magnetic stimulation of the brain, according to a study in the May 2004 issue of Spinal Cord.

In the report, British physicians say they found that magnetic stimulation of the brain led to improvements in muscle motion and ability to feel sensations in patients with incomplete spinal cord injuries. The magnetic stimulation involved an electromagnet placed on the scalp to generate brief magnetic pulses, stimulating the cerebral cortex.

In a prepared statement, study coauthor, Dr Nick Davey, said the reason the treatment may work is that it strengthens the information leaving the brain through the undamaged neurons in the spinal cord, activating the surviving nerves to strengthen their connections.

IN THE HEADLINES...
For amputee patients returning from service in Iraq, sports programs allow individuals to challenge themselves and learn what they are capable of despite their disabilities. A May 19 USA Today article highlighted the activities of the wheelchair basketball clinic at the Walter Reed Medical Center, Washington, DC. The clinic is sponsored by the US Olympic Committee, its Paralympics Division, and the Wheelchair Foundation.

Participants in the sports clinic said that the games provided a physical challenge, proving to the amputees that they had abilities and strengths that may have not otherwise been recognized. Staff Sergeant Heath Calhoun, 24, a member of the US Army’s 101st Airborne, lost both legs in a rocket-propelled grenade attack in Mosul. He says wheelchair basketball “opened his eyes” to new possibilities.

Disability sports programs highlighted in the story include the BlazeSports Club of America, the Challenged Athletes Foundation, the National Sports Center for the Disabled, and Disabled Sports USA.

According to an article in The Wall Street Journal on April 20, golfers no longer have to accept lower back pain as a normal condition when playing the sport. New research shows that effective treatment for the hip can reduce the occurrence of back pain for golfers.

The study, published in a recent issue of the American Journal of Sports Medicine, found that golfers who suffered from back pain had far less flexibility in their lead hip, the hip that pivots during a golf swing. When the lead hip muscles are too tight, the golf swing cannot be performed right; the torque that would have been absorbed by the hip is instead absorbed by the back.

The findings suggest that physicians and golfers may be dealing with the back pain the wrong way, since the cause of the pain is not associated with the hip. To treat this chronic condition in golfers, physical therapists and sports medicine physicians now offer golf rehabilitation programs, which offer high-tech swing analysis and custom-designed golf clubs.

The new San Francisco county supervisor, Michela Alioto-Pier, is causing a stir—not only because of her fiery personality and distinguished family name in San Francisco politics, but because she is the first supervisor in the city’s history to use a wheelchair. According to a May 14 article in the Los Angeles Times, disability rights advocates hope she will help bring their issues to the forefront of the city’s agenda.

Alioto-Pier, however, does not want to be pigeonholed into only taking on the causes of people with disabilities. She says, “People with disabilities are smart, thinking, caring individuals who have a lot of other concerns. So it is insulting to everybody to think our world revolves around our disability.”

Disability activists are hoping Alioto-Pier’s presence on the city’s Board of Supervisors will expedite processes on issues concerning them, such as low-vibration sidewalks. There is one item that may be on top of her priority list: installing a lift or ramp in the board’s chambers so she can sit on the elevated dais.

An article in The Wall Street Journal (June 1) explains the reasons for raising public awareness of lymphedema. As many rehab professionals know, this often dismissed condition faced by many cancer patients causes painful swelling of the arm or leg and can occur months or years after cancer treatment.

When detected early, lymphedema can be treated by physical therapy and compression garments. Physical therapists (with specialized training) use gentle massage to help drain the fluid away from the painful arm or leg. The treatment is usually needed a few times a week for several weeks, and compression garments and bandages must be worn. Delaying treatment can leave patients with an irreversible form of the disease.

The story emphasized the importance of detecting and treating the disease in its early phases, stating that the reason the symptoms are not recognized is that some physicians forget to warn their patients about it or they do not know about it. They often mistakenly prescribe diuretics to reduce the swelling, which in fact exacerbates the condition.

According to the article, 20% to 45% of patients who are at risk for lymphedema will eventually develop it.

NEWS BRIEFS

SPINAL NETWORK: UNIQUE GUIDE FOR WHEELCHAIR USERS

The third edition of the Spinal Network, a resource guide for people who use wheelchairs, is now available for purchase.

The nearly 600-page volume provides a wealth of helpful information including profiles of people who have overcome injury and disease, medical descriptions of conditions and treatments, and an overview of spinal cord injury research now being conducted. There are also dozens of chapters on sports available to wheelchair users, suggestions on the best ways to travel, advice on relationships and parenthood issues, a guide to computers and assistive technology, and an over-view of legal and employment rights.

The personal stories in the volume provide great insight into the subjects most important to wheelchair users, and could aid in communication with clients with disabilities of all kinds. For more information, call (888) 850-0344, ext 109.

GOOD SHEPHERD RECEIVES $25,000 PROGRAM GRANT
The Christopher Reeve Paralysis Foundation recently presented the Good Shepherd Rehabilitation Network, Allentown, Pa, with a Quality of Life grant of $25,000 to further develop its Spinal Cord Injury Health and Wellness Program; the program helps people who are recovering from spinal cord injuries lead independent, active lives.

With the grant money, Good Shepherd will be able to purchase more equipment to expand the Health and Wellness Program as part of a new ambulatory center. Spinal cord injury patients are encouraged to maintain their fitness lifelong in the Health and Wellness Program after completing Good Shepherd’s inpatient and outpatient programs.

APTA ENCOURAGES IN-FLIGHT EXERCISES
Passengers cramped into coach seats during long plane flights may experience leg swelling and cramping, and, sometimes, more serious conditions such as deep vein thrombosis. To decrease the occurrence of these symptoms, the American Physical Therapy Association (APTA) has released an In Flight Fitness Guide, which features a selection of recommended exercises for long plane trips.

“Performing these exercises will keep the leg muscles from contracting and will help relieve stiffness during the flight. The exercises also will help prevent fluid build-up in the legs,” said Marilyn Moffat, PT, PhD, FAPTA, CSCS, former president of the APTA. “Stretching the back and the muscles around the torso will prevent stiffening.”

Exercises featured in APTA’s In Flight Fitness Guide include heel raises, toe lifts, ankle circles, and overhead stretches. A complete list can be found on APTA’s web site.

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