Faculty Bibliography

The purpose of this project was to develop a streamlined upper extremity examination to be used in a company-based upper extremity CTD management program. Thirty-six symptomatic employees were examined by an occupational health nurse and categorized into those requiring further medical evaluation or those appropriate for conservative management. Backward logistic regression showed that the Appearance and Symmetry (AS) and the Neurological and Special Tests (NST) sections of the examination together explained 86.1 % (p = 0.002) of the nurses categorical decisions. Based on these preliminary development data, a short screening examination was proposed

This article reviews the evidence for using modalities and/or exercise treatment in patients with nonspecific low back pain. Poor evidence of efficacy exists for the use of modalities in this patient group. Exercises are beneficial for patients with subacute and chronic nonspecific low back pain. Further studies are needed for type, frequency, duration, and intensity of exercises

A study was undertaken to analyse the prevalence of low back pain (LBP) and confounding factors in primary school children in the city of Antwerp. A total of 392 children aged 9 were included in the study. All children completed a validated three-page questionnaire and they all underwent a specific lumbar spine oriented medical examination during their annual routine medical school control. This examination was performed by the city school doctors. The questionnaire was composed of easy 'yes/no' questions and visual analogue scales. Statistical analysis was performed using Student's t-test and chi-squared test at the significance level P < 0.05. The prevalence of LBP was high. No gender difference was found. A total of 142 children (36%) reported having suffered at least one episode of LBP in their lives. Of these, 33 (23%) had sought medical help for LBP from a doctor or physiotherapist. Sixty-four percent of children reporting LBP said that at least one of their parents suffered from or complained of LBP. This was significantly higher than for the children who did not report having suffered LBP. The way in which the school satchel was carried (in the hand, on the back) had no bearing on the incidence of LBP. There was significantly more LBP in children who reported playing video games for more than 2 h per day, but this was not so for television watchers. The visual analogue scales concerning general well-being were all very significantly correlated with self-reported LBP, with children who reported LBP being more tired, less happy, and worse sleepers. Of the 19 clinical parameters taken down during the medical examination, only one was significantly more prevalent in the group of children reporting LBP: pain on palpation at the insertion site on the iliac crest of the ilio-lumbar ligament. From this study we can establish that there are few clinical signs that can help to single out school children with LBP

1. It is an old observation that non-volitional arm abduction movements accompanied by a sensation of arm lightness often occur as an after-effect following forceful voluntary arm abductor contractions against a restraint. In the present study we have tested the hypothesis that such non-volitional, so-called 'postural after-contractions' are tonic reflex responses to an enhanced resting discharge in primary muscle spindle afferents which in turn is a consequence of thixotropy-dependent enhanced stiffness of intrafusal muscle fibres. 2. Results obtained in ten volunteers show that the arm abductor after-contraction phenomenon in man is most readily evoked by a type of conditioning procedure which in various respects mimics the procedure proven in animal experiments to be particularly effective in producing thixotropy-dependent excitation of primary spindle endings. 3. It is also shown that changes in arm abductor intramuscular temperature affect the strength of the after-contractions in a direction predicted by the thixotropy hypothesis. 4. Attention is drawn to several similarities between the after-contraction phenomenon with accompanying sensory illusions and the tonic reflex responses and illusions that can be induced when primary spindle endings are excited by muscle vibration. 5. The results support our hypothesis that postural after-contractions are induced by activity in primary muscle spindle afferents as a consequence of thixotropic properties of intrafusal muscle fibres. Central excitability changes following the conditioning voluntary effort may contribute to the phenomenon

The purpose of this chapter is to promote a model to prevent chronicity and disability from non-specific low back pain (NSLBP). Delayed recovery is defined in this chapter as the period between 4 and 8 weeks after onset of NSLBP during which a patient has not yet returned to work. The recognition of predictors associated with delayed recovery at onset of the problem helps health care providers in their treatment plan. An algorithm can be useful for health care providers and employers in guiding the employee back to work. A multidisciplinary return to work programme is an essential part of the algorithm

Problem situations in the patient-health care relationship may relate to the patient or to the health care provider characteristics or to the way they interact; they may also relate to the general social context. Such situations force the clinician dealing with non-specific low back pain patients to look beyond the traditional biomedical model that assumes a linear connection between pathology and symptomatology. The introduction of the biopsychosocial model approximately 10 years ago has improved the understanding of common low back pain. This chapter gives some insight into areas relating to factors that may hamper the patient-therapist relationship and thus complicate treatment and recommendation outcomes. It emphasizes the necessity to involve the patient in the decision-making. Recognizing the patients' psychological, social and cultural background as well as the level of education and employability are important to make successful recommendations. This knowledge is not new but the difficulty is to implement it in today's cost effectiveness driven society. However the benefit at the end may be the decrease of chronicity and/or permanent disability, suffering for the patient and frustration for the clinician. Identifying the underlying cause of non-compliance or of unexpected delayed recovery is an exciting issue. The cause may or may not be biomedical. If a specific cause can be identified, it has to be diagnosed and evaluated. If the clinical examination has ruled out specific or emergency conditions, another perspective may be needed and the course of action could then be determined

Uncertainty is the rule rather than the exception when it comes to the underlying causes of 'common' or 'non-specific' low back pain. It may be called many names, depending on whether the diagnostic term is descriptive, anatomopathological or physiopathological. Classifications have been devised, including various criteria: symptoms and signs, duration, treatment, consequences of low back pain on the patients' daily life, etc. Because back pain frequently runs a recurrent course, functional and pain outcomes need to be considered separately: chronic disability and chronic pain may not be parallel. Thus, pain duration (e.g. acute, transient, recurrent, chronic) is only one element in the definition of chronicity. These difficulties in defining and classifying non-specific low back pain may lead to communication problems among health professionals as well as between patients and health professionals. These difficulties raise questions such as: what kind of diagnostic term should we use to avoid dramatization of non-specific low back pain? how can we improve the definition of long-term low back pain? and how can we assure and reassure the patient that this condition is benign in the majority of the population?

A pilot study was conducted on a residential unit in an institution for individuals with severe multiple physical and mental disabilities in order to compare the perceptions of direct care and professional staff members on the functional performance of wheelchairs. The study was a part of a collaborative research project with the OMRDD and School of Education, New York University that focused on enhancing the quality of life of those disabled individuals through the application of assistive technology. The results of the study showed a considerable discrepancy in the perceptions of wheelchair functional performance between two categories of care providers on the unit. The members of the direct care staff perceived the wheelchairs as low functioning in contrast to the members of the professional staff who perceived the same wheelchairs to be close to fully functional. The possible causes of the differences between the members of both categories of care providers on the unit regarding the functional performance of wheelchairs and their accommodation to the specific needs of the clients are discussed.