Purpose/Hypothesis: Current methods for assessing static balance impairments in patients with spinal cord injury (SCI) are not sensitive enough to document change particularly when applied with the unique focus of documenting recovery below the level of the spinal cord lesion. The purpose of this study was to document the intra- and inter-rater reliability of the use of a hand-held dynamometer (HHD) to assess static sitting balance in persons post-SCI since this is a new application of the HHD device. Number of Subjects: Sixteen subjects post-SCI, mean age = 29.3 ± 6.9 years, level of SCI (C3-4 to L1), ASIA scores (7-A, 5-B, 3-C, 1-D). Raters were two student- and two experienced-physical therapists. Materials/Methods: Subjects sat with the trunk as erect as possible, feet on foor, hips/knees 90 degrees either supported or unsupported by their upper extremities. Anterior, posterior, and right/left lateral forces using a HHD were applied to mid-sternum, mid-back, and acromion, respectively. Instructions were to “hold, do not let me move you” (break test) or “push as hard as you can into my hand” (make test) with a gradual increase and decrease in force (over 4–5 seconds) until the subject was displaced approximately one inch. Data analysis included descriptive statistics, intra-class correlation coefficients (ICC) (2-way mixed model, absolute agreement), and 2 (test 1 and 2) × 4 (raters) ANOVA with repeated measures and Bonferroni post hoc tests. Results: When testing balance in four directions, there were no significant peak force differences between test 1 and 2 (intra-rater reliability) (p=0.21–0.91) or the four raters (inter-rater reliability) (p=0.85–0.95) and no significant (p=0.83–0.97) interactions. There was significant variability in the force generated between subjects in the four directions since subjects with a range of balance abilities were included in this study. Static balance testing using a HHD had excellent (ICC=0.89–0.97) intra-rater reliability for raters 1, 2, and 4, moderate-good (ICC=0.71–0.89) intra-rater reliability for rater 3 (student) and excellent inter-rater reliability (ICC=0.93–0.99). Conclusions: Inter-rater reliability when using a HHD to document static sitting balance was excellent regardless if the rater was a student or an experienced physical therapist and regardless if a make or break test was utilized. Intra-rater reliability was excellent for the two experienced therapists and one student therapist; the other student therapist appeared to improve over the duration of the study or with practice. Specific procedures will be outlined with the aim of standardizing HHD static balance testing and improving reliability. Clinical Relevance: Static balance is often documented by subjectively judging the amount of manual resistance that the patient can withstand without moving/falling and/or the amount of time the patient can maintain the position. In order to better quantify static sitting balance, a HHD can be used since it has moderate-excellent intra-rater and excellent inter-rater reliability.

1From the Rehabilitation Institute of Michigan, Department of Physical Medicine & Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan. The Clinical Rehabilitation Research Unit (CRRU) and projects conducted on the CRRU have been made possible in part by funding from the Del Harder Rehabilitation Fund and the United Way. 2 All correspondence and requests for reprints should be addressed to: Research Department, Room 520, Rehabilitation Institute of Michigan, 261 Mack Boulevard, Detroit, Michigan 48201.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in joint and connective tissue diseases in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses treatment and outcome in rheumatoid arthritis, musculoskeletal involvement in human immunodeficiency virus infection, scleroderma, systemic lupus erythematosus, and intraarticular injection of corticosteroids.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in joint and connective tissue diseases in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses the following: differential features, diagnostic strategy, and rehabilitation management of hip, knee, foot, and shoulder pain; indications, contraindications, and postsurgical management for joint arthroplasty; management of gout acid chondrocalcinosis; and rehabilitation issues related to hip and shoulder fracture.(C) 1995 by the American Academy of Physical Medicine and Rehabilitation

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in joint and connective tissue diseases in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses ankylosing spondylitis and spinal stenosis, including differential features, diagnostic strategy, rehabilitation management, spinal complications of ankylosing spondylitis, and pathophysiology of spinal stenosis.

Spasticity commonly occurs after a spinal cord injury and is characterized by increased resistance to passive movement of peripheral joints. This study examined the effect of an antispasticity medication on stiffness from the myotatic reflex response generated by passive sinusoidal ankle motion. A repeated measures, multiple base-line, single-subject, double-blind design was employed. The independent variable was spasticity medication treatment, where the levels were 40 mg/day and 80 mg/day of baclofen v placebo treatment. Viscous and elastic stiffness measurements were taken at the ankle joint during a placebo base-line phase and during treatment with baclofen for five adult males with traumatic spinal cord injuries. Ankle sinusoidal oscillation frequencies were from 3 to 12 Hz during test sessions. Mean viscous and elastic stiffness scores for all frequencies were calculated for each phase of the study. Randomization tests of mean changes in stiffness measurements between each treatment phase of the study failed to provide any convincing evidence of a significant treatment effect for reduction of spasticity in the traumatic spinal cord injured subjects studied. Further testing is needed to exclude potential confounding factors before this conclusion can be confirmed. The results suggest that baclofen is not a universal treatment of choice for all individuals with spasticity resulting from traumatic spinal cord injury.

This self-directed learning module highlights advances in transfer and mobility skills, and community reentry. It is part of the chapter on physiatric therapeutics for the Self-Directed Medical Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains essential information on bed mobility, dependent or assisted bed transfers, assisted and independent wheelchair transfers, advanced wheelchair skills, mobility in the community, activities of daily living and advanced living skills, communication, social support, adjustment to disability, prevocational and vocational issues, options for community living, and public policies regarding people with disabilities.

This self-directed learning module highlights the general concepts and advances in therapeutic heat and cold, electrotherapy, and therapeutic exercise. This article is part of the chapter on physiatric therapeutics for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Special advances include lasers in medicine and the description of the appropriate type of exercise for weight control.