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This article has attempted to present an overview of how pain and disability interact, the incidence and cost of disability secondary to painful conditions, a review of the current disability systems, how pain should be evaluated, and some thoughts on the future of disability and pain. Most people are unhappy with the present process from an administrative, logistical, and cost-effective point of view. However, there is a continuing concern that change will be driven largely by cost containment rather than other important aspects of disability.

Arteriovenous malformation of the vein of Galen (AMVG) has been associated with poor prognosis secondary to its cerebral steal effect. This report describes the cognitive profile of a 38-year-old man who presented to acute rehabilitation with a congenital vein of Galen malformation. Cognitive and behavioral impairments are described and correlated with neuroanatomic involvement. Physiatrists and allied health care professionals must recognize that with the improvement of neurosurgical technology, AMVG can be associated with favorable short-term rehabilitation outcome. Prospective studies are needed to determine long-term outcome.

Objectives: The goals of this study were to verify the reliability and safety of new methods for evaluating trunk muscle endurance, and to compare the differences between healthy subjects and patients with chronic low-back pain., Design: Randomized and controlled study., Setting: A referral center and institutional practice, and outpatient care., Subjects: Ninety healthy subjects (37 men and 53 women average age 46.2 years) and 100 patients with CLBP (40 men and 60 women; average age 45.3 years) participated in this study., Main Outcome Measures: During trunk flexor and extensor endurance tests, the subjects were asked to maintain the original positions for as long as possible. The performance time (seconds) for which subject could maintain the position was compared between two groups. Test-retest correlation (r) was also analyzed. The degree of lumbar lordosis was compared in conventional and new methods., Results: All test-retest correlations were significantly high in both groups (p < .01). The performance time was much longer in the healthy subjects than in the patients with CLBP during any procedures (p < .01). Lumbar lordosis was significantly less in our method than in the Kraus-Weber test (p < .01)., Conclusions: This study demonstrated that our methods for measuring trunk flexor and extensor endurance had high reliability, reproducibility, and safety, and were easy to perform, with no need for special equipment. This study also showed that trunk muscles in patients with CLBP were more easily fatigued, compared with those in healthy subjects.

Two hundred forty-seven patients with spinal cord injuries living in Hokkaido, the northern part of Japan, were mailed a questionnaire relating to winter outdoor activities. One hundred eight patients responded to the questionnaire, 98 males and 10 females, with ages ranging from 30 to 79 (mean, 53.3) yr. Injury levels of patients were: cervical in 23 patients, thoracic and thoracolumbar in 47, and lumbar in 38. All respondents were unable to walk independently because of quadriplegia or paraplegia. Approximately 90 percent of respondents found it necessary to go outside during the winter season. Eighty-five percent were outside during the coldest period. The most common reasons for outdoor activities were shopping and routine doctor's appointments. The main method of ambulating outside was a manual and/or electrically operated wheelchair, sometimes in conjunction with an automobile. However, there were many problems reported in using wheelchairs; for example, wheels and casters were very slippery on the snow and ice, casters were easily buried in the snow, and wheelchair rims were very cold to handle. It was also pointed out that exposure to cold weather induced physical problems such as muscle spasticity, pain, and numbness of lower extremities. This survey revealed that spinal cord-injured patients would benefit from a wheelchair specifically designed for winter conditions.

The purpose of this study was to determine the influence of test postures on trunk muscle strength, and to clarify the difference between concentric and eccentric strength of healthy subjects and patients with chronic low-back pain (CLBP). Volunteered and controlled trials took place at a university hospital, which is a referral center and is also open to the general community. The patients were selected from the outpatient care in the university hospital. Fifty healthy subjects (25 men and 25 women; average age 25.7 years, ranging from 23 to 34 years) and 48 patients with CLBP (26 men and 22 women; average age 33.5 years, ranging from 26 to 39 years) volunteered for this study. The main outcome measures were flexor and extensor peak torque/body weight, and flexor/extensor peak torque ratio during concentric and eccentric contractions; Eccentric/concentric peak torque ratio in flexor and extensor. Trunk-muscle strength was significantly greater in the sitting posture when measured with the subjects' feet against the floor (p < .05). Some patients complained of a slight low-back pain during testing, although the pain was not aggravated in any patients. In both concentric and eccentric contraction modes, the patients with CLBP had greater flexor/extensor ratios than the healthy subjects (p < .01). This implies that extensors are more affected in these patients. However, a great imbalance between concentric and eccentric strength of the patients was found, not only in extensors, but also in flexors (p < .01). The current study shows that one should consider the test posture carefully when measuring trunk-muscle strength.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives: The purpose of this study was to analyze the ability of the patients with idiopathic scoliosis to transfer the body weight in the frontal plane., Design: Randomized and controlled study., Setting: A referral center and institutional practice and outpatient care., Subjects: Fifty patients with idiopathic scoliosis (three men and forty-seven women; average age 15.3 years) and 15 normal women (average age 17.3 years) participated in this study. Thirty patients were treated with underarm braces., Main Outcome Measures: Computer-assisted force plates were used to evaluate the laterally shifted weight and the time period during side-shift on sitting., Results: During both slow and fast side-shifts, shifted weight in the patients with idiopathic scoliosis was significantly less than in the normal controls (p < 0.05). The shifted weight was less on the concave side than on the convex one. The time for the shift to the concave side was longer in the patients than in the normal controls (p < 0.05). The brace was effective in correcting the imbalance of shifted weight in the patients with idiopathic scoliosis., Conclusions: The current study demonstrated the different patterns of weight side-shift between normal subjects and patients with idiopathic scoliosis. The patients transferred less weight laterally than the normal subjects during slow and fast random movements. The patients also showed slower side-shift patterns than the normal subjects during the fast random movement.

At a certain position of trunk flexion, there is a sudden onset of electrical silence in back muscles. This is called "flexion-relaxation (F-R) phenomenon." The goals of this study were (1) to evaluate the relationship between flexion angle and activity of back muscles during flexion movement and (2) to determine what the difference is between healthy subjects and patients with chronic low back pain (CLBP). Twenty-five healthy subjects (13 males and 12 females; average age, 28.3 yr) and 20 patients with CLBP (12 males and 8 females; average age, 34.1 yr) volunteered for this study. The subjects were asked to flex forward maximally from the erect position and to maintain full flexion, followed by returning to the initial upright position. Flexion angle of trunk and hip was measured during the examination. Electromyographic activity of erector spinae was also monitored simultaneously. F-R phenomenon was observed in all healthy subjects before reaching the maximum flexion. Electrical silence continued even after extending the trunk began. In contrast, no patients with CLBP demonstrated F-R phenomenon. A significant difference in muscular activities of erector spinae between the groups was obtained when returning to the erect position from the maximum flexion. Moreover, time lag between trunk and hip movement was much greater in patients than in healthy subjects. This study demonstrated that neuromuscular coordination between trunk and hip could be abnormal in patients with CLBP.

Posture to avoid hyperextension of the lumbar spine during isometric trunk muscle exercises has been widely recommended. However, there are no common standards for cervical and pelvic alignment during exercises. To investigate the effects of four different techniques regarding cervical and pelvic alignment, electromyographic (EMG) and radiological studies were performed on 30 healthy subjects. The four different postures were: (1) maximally extended neck, (2) neutral neck, (3) maximally flexed neck, and (4) maximally flexed neck with pelvic stabilization through muscle contraction. During flexion exercises, the largest increase in EMG activity in the abdominal muscles was observed with the flexed neck with pelvic stabilization (p < .01). During extensor exercises, the largest increase in EMG activity in the erector spinae was also obtained in the same position (p < .01). An increase of EMG activity in antagonist muscles (eg, erector spinae on flexion, and rectus and oblique muscles on extension) was also greatest with the flexed neck and pelvic stabilization. From the radiographic study, degrees of lumbar lordosis were least with the flexed neck and pelvic stabilization (p < .01). This study showed that neck and pelvic alignment can influence the EMG activity of trunk flexors and extensors during isometric trunk exercises. For isometric trunk muscle exercises, a maximum flexed neck with pelvic stabilization through muscle contraction seems to be the most optimal posture for decreasing the lumbar lordosis and for activating trunk flexors and extensors most effectively.

Human Immunodeficiency Virus (HIV) is frightening and fatal. The great fear of acquiring HIV magnifies ethical issues concerning patients and health care workers. Practitioners in the field of rehabilitation medicine will become increasingly aware of these issues, because at least 50% of patients with HIV-related illnesses develop neurological disorders. Many will need physical, emotional, social, psychological or vocational restoration. This article explores some of the ethical issues related to Acquired Immune Deficiency Syndrome (AIDS) rehabilitation, including confidentiality, risk of exposure to infected patients or infected health care workers, treatment of patients and the rights of patients and health care workers.

Education of medical students is an important component of physical medicine and rehabilitation training programs. A one-day combined lectures/rotating stations conference was designed to introduce physical medicine and rehabilitation to third year medical students during the academic years 1991 through 1993. Pre- and post-testing allowed objective measurement of student knowledge of physical medicine and rehabilitation. The lectures and rotating stations were evaluated, and the feedback was used to improve subsequent conferences. Pre- and post-tests indicated increased student knowledge, and interest in physical medicine and rehabilitation doubled in each class that participated. This instructional method increases third year medical student exposure to physical medicine and rehabilitation in a cost-effective and efficient manner.

Rehabilitation of the elderly can reverse the trend toward greater dependence and escalating costs if the staff is specially trained.