HI, I am a home health OTR/L working with a bilateral CVA patient (46 yrs) with hign extensor tone upper and lower extremities. I have been using a distal to proximal approach, as the reverse has not produced results, and have been doing tigeminal nerve stimulation to decrease tone (which has been moderatly sucessful).and PNF patterns D1 and D2. I would appreciate any additional approaches from the list, that might break this tone. He is not able to get into quadrqped, and is most often seen in bed.He does have 1/4 finger flexion right hand and 1/4 thumb flexion right. He has a very supportive family that are currently participating in his home exercise progtam, which includes gentle biltateral joint mobilization and prolonged stretching. any suggestions would be greatly appreciated. Peace, Pat Leegan, MS,OTR/L
Ron Carson <[EMAIL PROTECTED]> wrote: Hello All: Nice to finally see a little "traffic" on the OTlist. Interestingly, I was JUST on Cochrane.org and one of their Evidence Summaries is about preventing falls in the elderly. Given that their information is in the public domain, I'll post it here. Of course, you can also read it on their website. Ron ################################################################# Abstract BACKGROUND: Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention. Objectives To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care). SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (www.controlled-trials.com accessed 11 July 2003) and reference lists of articles. No language restrictions were applied. Further trials were identified by contact with researchers in the field. SELECTION CRITERIA: Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate. MAIN RESULTS: Sixty two trials involving 21,668 people were included. Interventions likely to be beneficial: * Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1 trial, 439 participants, cluster-adjusted incidence rate ratio 0.60, 95%CI 0.50 to 0.73) * A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98) * Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81) * Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74) * Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI -9.40 to -1.00) * A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73). Interventions of unknown effectiveness: * Group-delivered exercise interventions (9 trials, 1387 participants) * Individual lower limb strength training (1 trial, 222 participants) * Nutritional supplementation (1 trial, 46 participants) * Vitamin D supplementation, with or without calcium (3 trials, 461 participants) * Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants) * Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants) * Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants) * Home hazard modification for older people without a history of falling (1 trial, 530 participants) * Hormone replacement therapy (1 trial, 116 participants) * Correction of visual deficiency (1 trial, 276 participants). Interventions unlikely to be beneficial: * Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants). Authors' conclusions: Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall-related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is important. Some potential interventions are of unknown effectiveness and further research is indicated. ####################################################################### -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. 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