Editors' Selections From This Issue

Article Outline

• Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty
• Longer Versus Shorter Daily Durations of Electrical Stimulation During Task-Specific Practice in Moderately Impaired Stroke
• Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application
• Building on Transformative Learning and Response Shift Theory to Investigate Health-Related Quality of Life Changes Over Time in Individuals With Chronic Health Conditions and Disability

Thoralf R. Liebs, MD

Wolfgang Herzberg, MD

Wolfgang Rüther, MD, PhD

Jörg Haasters, MD, PhD

Martin Russlies, MD, PhD

Joachim Hassenpflug, MD, PhD

on behalf of the Multicenter

Arthroplasty Aftercare Project

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Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty 

The optimum time to initiate therapy remains a controversial issue. Liebs and colleagues addressed 1 aspect of this question by assessing pain, joint stiffness, and quality of life of 465 subjects who had undergone an aquatic therapy program following a total hip (THA) or knee arthroplasty (TKA). The authors found over a 2-year follow-up period no differences in outcome between those beginning therapy either 6 or 14 days following surgery. Analysis of the THA and TKA subjects separately, while not showing statistically significant differences, suggested that patients with knee replacements that began therapy earlier did better than those starting at 14 days. The converse was true for the THA recipients. The authors conclude that while their findings do not provide a clear indication of when to initiate therapy, they do support the need for a careful consideration of the timing of physiotherapeutic interventions. • SEE THE FULL ARTICLE AT PAGE 192

Stephen J. Page, PhD, MS, S/OT

Linda Levin, PhD

Valerie Hermann, MS, OTR/L

Kari Dunning, PhD, PT

Peter Levine, BA, PTA

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Longer Versus Shorter Daily Durations of Electrical Stimulation During Task-Specific Practice in Moderately Impaired Stroke 

Page and colleagues note that while electrical stimulation is often used in conjunction with stroke rehabilitation that the most advantageous intensity of its use remains unknown. These investigators addressed this lack in a randomized controlled trial in which 32 adults with moderately severe strokes were divided into 4 groups. All participated in an 8-week, 5 day/week program, with 3 groups receiving 30, 60, or 120 minute sessions of repetitive upper extremity task specific practice augmented by use of an electrical stimulation neuroprosthesis or a 30-minute session home exercise program. Evaluation at the trial's completion revealed that only the subjects in the 120-minute group demonstrated significant improvements in their Fugl-Meyer, Arm Motor Ability Test, Action Research Arm Test, or Box and Block scores. The authors conclude that, at least for their design, the 120 minute session electrical stimulation regimen appeared the most beneficial. • SEE THE FULL ARTICLE AT PAGE 200

Sebastian H. Doeltgen, PhD

Maggie-Lee Huckabee, PhD

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Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application 

Doeltgen and Huckabee report on a growing shift in the focus of the swallowing rehabilitation community from the modification of swallowing biomechanics to more of an emphasis on taking advantage of brain plasticity and using neuro-stimulation techniques to enhance swallowing function. The authors begin with a review of the various neuromodulation techniques in use (such as magnetic/electrical transcranial and neuromuscular electrical stimulation). They then discuss the differing approaches in more detail and conclude with an exploration of the potential impact these approaches on speech pathologists' training and practice as well as their ethical and clinical consequences. • SEE THE FULL ARTICLE AT PAGE 207

Ruth Barclay-Goddard, PhD

Judy King, PhD

Claire-Jehanne Dubouloz, PhD

Carolyn E. Schwartz, ScD

on behalf of the Response Shift

Think Tank Working Group

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Building on Transformative Learning and Response Shift Theory to Investigate Health-Related Quality of Life Changes Over Time in Individuals With Chronic Health Conditions and Disability 

Self-management is gaining importance in the treatment of people living with chronic illness or disability. Barclay-Goddard and colleagues explain how both “transformative learning”–an adult education concept–and “response shift,” a theory used in health-related quality of life research, have important similarities in that both are triggered by crises which result in deep and personal change. Central to these views is the idea that as people make these adjustments, their expectations of life and internal standards may change, and, thus, affect their self-assessment of their health related quality of life. The authors discuss these 2 theories and their implications for the care of people with chronic health conditions and disability. • SEE THE FULL ARTICLE AT PAGE 214