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Abstract Background Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurodegenerative disorder affecting motor neurons in the spinal cord, brainstem and motor cortex, leading to muscle weakness. Muscle weakness may result in the avoidance of physical activity, which exacerbates disuse weakness and cardiovascular deconditioning. The impact of the grave prognosis may result in depressive symptoms and hopelessness. Since there is no cure for ALS, optimal treatment is based on symptom management and preservation of quality of life (QoL), provided in a multidisciplinary setting. Two distinctly different therapeutic interventions may be effective to improve or preserve daily functioning and QoL at the highest achievable level: aerobic exercise therapy (AET) to maintain or enhance functional capacity and cognitive behavioural therapy (CBT) to improve coping style and cognitions in patients with ALS. However, evidence to support either approach is still insufficient, and the underlying mechanisms of the approaches remain poorly understood. The primary aim of the FACTS-2-ALS trial is to study the effects of AET and CBT, in addition to usual care, compared to usual care alone, on functioning and QoL in patients with ALS. Methods / Design A multicentre, single-blinded, randomized controlled trial with a postponed information model will be conducted. A sample of 120 patients with ALS (1 month post diagnosis) will be recruited from 3 university hospitals and 1 rehabilitation centre. Patients will be randomized to one of three groups i.e. (1) AET + usual care, (2) CBT + usual care, (3) Usual care. AET consists of a 16-week aerobic exercise programme, on 3 days a week. CBT consists of individual psychological support of patients in 5 to 10 sessions over a 16-week period. QoL, functioning and secondary outcome measures will be assessed at baseline, immediately post intervention and at 3- and 6-months follow-up. Discussion The FACTS-2-ALS study is the first theory-based randomized controlled trial to evaluate the effects, and the maintenance of effects, of AET and CBT on functioning and QoL in patients with ALS. The results of this study are expected to generate new evidence for the effect of multidisciplinary care of persons with ALS. Trial registration Dutch Trial Register NTR1616.

Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis fitting and the use of replacement parts.Objectives: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 2 focuses on rehabilitation process and prosthetics.Study Design: Systematic literature design.Methods: Literature search in five databases and quality assessment on the basis of evidence-based guideline development.Results: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity.Conclusion: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for treatment and reintegration of patients undergoing amputation of a lower extremity and can be used to provide patient information.Clinical Relevance: This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. [ABSTRACT FROM AUTHOR]

Background: Surgeons still use a range of criteria to determine whether amputation is indicated. In addition, there is considerable debate regarding immediate postoperative management, especially concerning the use of 'immediate/delayed fitting' versus conservative elastic bandaging.Objectives: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 1 focuses on amputation surgery and postoperative management.Study Design: Systematic literature design.Methods: Literature search in five databases. Quality assessment on the basis of evidence-based guideline development.Results: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity.Conclusion: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for diagnosis, referral, assessment, and undergoing amputation of a lower extremity and can be used to provide patient information.Clinical Relevance: This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. [ABSTRACT FROM AUTHOR]

Background. In patient-centered practice, instruments need to assess outcomes that are meaningful to patients with hand conditions. It is unclear which assessment tools address these subjective perspectives best. Objective. The aim of this study was to establish the construct validity of the Canadian Occupational Performance Measure (COPM) in relation to the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) in people with hand conditions. It was hypothesized that COPM scores would correlate with DASH and MHQ total scores only to a moderate degree and that the COPM, DASH questionnaire, and MHQ would all correlate weakly with measures of hand impairments. Design. This was a validation study. Methods. The COPM, DASH questionnaire, and MHQ were scored, and then hand impairments were measured (pain [numerical rating scale], active range of motion [goniometer], grip strength [dynamometer], and pinch grip strength [pinch meter]). People who had received postsurgery rehabilitation for flexor tendon injuries, extensor tendon injuries, or Dupuytren disease were eligible. Results. Seventy-two participants were included. For all diagnosis groups, the Pearson coefficient of correlation between the DASH questionnaire and the MHQ was higher than .60, whereas the correlation between the performance scale of the COPM and either the DASH questionnaire or the MHQ was lower than .51. Correlations of these assessment tools with measures of hand impairments were lower than .46. Limitations. The small sample sizes may limit the generalization of the results. Conclusions. The results supported the hypotheses and, thus, the construct validity of the COPM after surgery in people with hand conditions. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine factors independently associated with successful rehabilitation of patients with lower limb amputation in skilled nursing facilities (SNFs). Methods: All patients admitted to one of the 11 participating SNFs were eligible. Multidisciplinary teams collected the data. Successful rehabilitation was defined as discharge to an independent living situation within 1 year after admission. Functional status at discharge, as measured with the Barthel index (BI), was a secondary outcome. Multivariate regression analyses were used to assess the independent contribution of each determinant to the two outcome measures. Results: Of 55 eligible patients, 48 were included. Mean age was 75 years. Sixty-five percent rehabilitated successfully. Multivariate analyses showed that presence of diabetes mellitus (DM) (OR 23.87, CI 2.26-252.47) and premorbid BI (OR 1.37, CI 1.10-1.70) were the most important determinants of successful rehabilitation, whereas 78% of the variance of discharge BI was explained by premorbid BI, BI on admission, and 1-leg balance. Conclusion: The presence of DM and high premorbid BI were associated with discharge to an independent living situation within 1 year after admission. Premorbid BI, admission BI, and 1-leg balance were independently associated to discharge BI. [ABSTRACT FROM AUTHOR]

Background: The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities (SNFs) are scarce.Objectives: To predict prosthetic use and physical mobility in geriatric patients admitted to SNFs for rehabilitation after lower limb amputation and the impact of multimorbidity.Study Design: Prospective design.Methods: Univariate and multivariate logistic and linear regression analyses were used to identify determinants that were independently related to prosthetic use and the timed-up-and-go test (TUG test).Results: Of 55 eligible patients, 38 had complete assessments on admission and at discharge. Fifty per cent was provided with a prosthesis. Multimorbidity was present in 53% of the patients. Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain determined prosthetic use (R2=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associated with the TUG test (R2=82%).Conclusions: Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis when having an independent ambulation after transtibial amputation, without phantom pain. These patients should be considered for prosthetic training.Clinical relevanceThis study gives more insight into the outcomes of geriatric patients with lower limb amputation after rehabilitation in skilled nursing facilities. This is the first study that focuses on determinants of prosthetic use in these elderly patients, often with multimorbidity. [ABSTRACT FROM AUTHOR]

Objective: In a descriptive study we present the CAT-scan norm data of pelvic sizes in Caucasian men and women. The study was performed to investigate possible differences in pelvic sizes between men and women and the inter-individual range of pelvic sizes. The data may be useful as a guide in the development of orthoses and prostheses. Methods: Pelvis CAT-scans of 40 subjects, 20 males (23-66 years) and 20 females (20-72 years) were investigated. The research was approved by the regional ethics committee. Results: The angle of the ramus ossis ischii (ROI) with the line of progression in the transverse plane (angle a) was 38.6° (SD 3.4) in females and 31.8° (SD 4.4) in males. This difference was statistically significant (Student's t-test (p < 0.0001). The ROI angle in the coronal plane (angle b) was negative or zero both in males and females. The horizontal distance between the medial border of the ROI and the lateral border of the femur (RF distance) was slightly smaller in females (95 mm) compared to males (107 mm), but this difference was not statistically significant. The distance between the midfemoral line and the anterior surface of the leg was also slightly smaller in females (89 mm) than in males (106 mm) but the difference was not statistically significant. We found a linear relation between the total AP soft tissue distance and the soft tissue circumference of the proximal leg at the level of the ROI. Conclusion: There are significant gender differences in pelvic size and shape. The medial plane of the ROI is not in a slight angle of inclination towards the midline but appears to be zero. The medial contour of the ROI in the AP direction is slightly curved. [ABSTRACT FROM AUTHOR]

This article provides an overview of AT&T's MPLS OAM architecture, and gives examples of operational experience. Hallmarks of the architecture are a single, converged, and integrated MPLS/optical network, and the evolution to fully automated, zero-touch network operation. The Concept of One converged IPIMPLS architecture will reduce operations, development, and capital costs. The Concept of Zero aims to bring full automation for every human-to-computer interaction currently required for setting up and maintaining network services, delivering services to customers in real time with zero defects and cycle time, and supporting both a network as well as an operational environment with six nines reliability. This approach effectively opens the network to the customer, enabling new levels of customer network management, service creation, and ordering, and empowering enterprise customers with the tools to create their own network services as they transform their own internal networks. In the article we describe AT&T's MPLS-enabled services, the corresponding MPLS operations architecture (including MPLS MIBs), our MPLS OAM operational experience, and MPLS OAM evolution needs for MPLS MIB enhancements and new network capabilities. By applying technologies such as artificial intelligence, self-healing/self-identifying network elements, expert systems, rules-based processes, and automatic speech recognition, the architecture will migrate from a predictive network that monitors, correlates, and recommends action; to an adaptive network that monitors, correlates, and takes action; to a cybernated network that has integrated components that dynamically manage by business rules and policies. We give several examples of how AT&T is already investing in and implementing this future vision, and conclude by challenging network researchers, developers, and key industry players to apply new technologies in fully realizing the operational vision. [ABSTRACT FROM AUTHOR]