Modified pediatric Bentall procedure: A novel technique in a rare case

Gananjay G Salve, Satish R Javali, Bharat V Dalvi, Shivaprakash Krishnanaik

Annals of Pediatric Cardiology 2016 9(3):244-247

Aneurysms of ascending aorta are rarely seen in pediatric age group. Only few cases with Marfans syndrome have been reported in the literature. Preferred treatment for these children has been the standard Bentall procedure (aortic root replacement with composite graft prosthesis). We report a 4-year-old male child with huge aneurysm of ascending aorta and aortic root dilation with severe aortic regurgitation, having phenotypic features of Loeys-Dietz syndrome type I. He underwent Bentall procedure with a novel modification (medial trap-door technique for coronary reimplantation). Short-term result of this procedure is encouraging and he is asymptomatic for the last 14 months of follow-up.

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Multiple pericardial abscesses in a child with known chronic granulomatous disease

Ayse U Kalyoncu, Hatice A Habibi, Mine Aslan, Deniz Alis, Deniz F Aygun, Yildiz Camcioglu, Ibrahim Adaletli

Annals of Pediatric Cardiology 2016 9(3):272-273



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It's in our interests not to be in conflict - of interest, that is

N/A

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Connective tissue regeneration in skeletal muscle after eccentric contraction-induced injury

Human skeletal muscle has the potential to regenerate completely after injury induced under controlled experimental conditions. The events inside the myofibres as they undergo necrosis, followed closely by satellite cell mediated myogenesis, have been mapped in detail. Much less is known about the adaptation throughout this process of both the connective tissue structures surrounding the myofibres, and the fibroblasts, the cells responsible for synthesising this connective tissue. However, the few studies investigating muscle connective tissue remodelling demonstrate a strong response that appears to be sustained for a long time after the major myofibre responses have subsided. While the use of electrical stimulation to induce eccentric contractions versus voluntary eccentric contractions appears to lead to a greater extent of myofibre necrosis and regenerative response, this difference is not apparent when the muscle connective tissue responses are compared, although further work is required to confirm this. Pharmacological agents (growth hormone and angiotensin II type I receptor blockers) are considered in the context of accelerating the muscle connective tissue adaptation to loading. Cautioning against this however is the association between muscle matrix protein remodelling and protection against re-injury, which suggests that a (so far undefined) period of vulnerability to re-injury may exist during the remodelling phases. The role of individual muscle matrix components and their spatial interaction during adaptation to eccentric contractions is an unexplored field in human skeletal muscle and may provide insight into the optimal timing of rest vs. return to activity after muscle injury.

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Mast cell degranulation and de novo histamine formation contribute to sustained post-exercise vasodilation in humans

In humans, acute aerobic exercise elicits a sustained post-exercise vasodilation within previously active skeletal muscle. This response is dependent on activation of histamine H₁ and H₂ receptors, but the source of intramuscular histamine remains unclear. We tested the hypothesis that interstitial histamine in skeletal muscle would be increased with exercise and would be dependent on de novo formation via the inducible enzyme histidine decarboxylase and/or mast cell degranulation. Subjects performed 1 h of unilateral dynamic knee-extension exercise or sham (seated rest). We measured the interstitial histamine concentration and local blood flow (ethanol washout) via skeletal muscle microdialysis of the vastus lateralis. In some probes, we infused either α-fluoromethylhistidine hydrochloride (α-FMH), a potent inhibitor of histidine decarboxylase, or histamine H₁/H₂ receptor blockers. We also measured interstitial tryptase concentrations, a biomarker of mast cell degranulation. Compared with pre-exercise, histamine was increased after exercise by 4.2 ± 1.8 ng ml^-1 (P < 0.05), but not when α-FMH was administered (-0.3 ± 1.3 ng ml^-1, P = 0.9). Likewise, local blood flow after exercise was reduced to pre-exercise levels by both α-FMH and H₁/H₂ blockade. In addition, tryptase was elevated during exercise by 6.8 ± 1.1 ng ml^-1 (P < 0.05). Taken together, these data suggest that interstitial histamine in skeletal muscle increases with exercise and results from both de novo formation and mast cell degranulation. This suggests that exercise produces an anaphylactoid signal which affects recovery, and may influence skeletal muscle blood flow during exercise.

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The Effect of Irradiation on Akt Signaling in Atrophying Skeletal Muscle

Muscle irradiation (IRR) exposure can accompany unloading during spaceflight or cancer treatment, and this has been shown to be sufficient by itself to induce skeletal muscle signaling associated with a remodeling response. While protein kinase B/Akt has an established role in the regulation of muscle growth and metabolism, there is a limited understanding of how Akt signaling in unloaded skeletal muscle is affected by IRR. Therefore, we examined the combined effects of acute IRR and short-term unloading on muscle Akt signaling. Female C57BL/6 mice were subjected to load bearing or hindlimb suspension (HS) for 5 days (N=6/group). A single, unilateral hindlimb IRR dose (0.5 Gy X-ray) was administered on day 3. Gastrocnemius muscle protein expression was examined. HS decreased Akt^T308 phosphorylation, while HS+IRR increased AktT308 phosphorylation above baseline. HS reduced Akt^S473 phosphorylation, which was rescued by HS+IRR. Interestingly, IRR alone increased AktS⁴⁷³, but not AktT308, phosphorylation. HS decreased mTORC1 signaling, and this suppression was not altered by IRR. Both IRR and HS increased MuRF-1 expression, while Atrogin-1 expression was not affected by either condition. These results demonstrate IRR alone or when combined with HS can differential affect Akt phosphorylation, but IRR did not disrupt suppressed mTORC1 signaling by HS. Collectively, these findings highlight that a single IRR dose is sufficient to disrupt the regulation of Akt signaling in atrophying skeletal muscle.

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A Combined Anesthesia Technique for Intubation in a Pediatric Patient with Difficult Airway

2016-08-25T20-57-27Z
Source: Case Study and Case Report
Semih Başkan, Dilşen Örnek, Özlem Saçan, Oya Kılcı, Onur Karaca, Mustafa Baydar.
Difficult airway management techniques in adults often cannot be applied to children. Therefore, specific pediatric algorithms have been developed. The case is here reported of the use of a combination of techniques on a pediatric patient suffering from an extremely restricted mouth opening. A fiberoptic bronchoscope assisted nasotracheal intubation was performed with topical anesthesia and an ultrasound-guided bilateral superior laryngeal nerve block under continuous sedation.


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Inside EMS Podcast: EMS education, funding and management in this week's news

Download this podcast on iTunes, SoundCloud or via RSS feed

In this week's episode of Inside EMS, co-hosts Chris Cebollero and Kelly Grayson discuss the importance of community paramedicine, EMS education and the "fire vs EMS" debate through this week's top news. After a Conn. city considers adding paramedic units to a fire station, Cebollero and Grayson discuss how the firefighter union disapproved of the possbility. The two discuss how leaders need to adapt and take on an educative role while working with the workforce of today.

A recent Nevada law allowing community paramedicine to be covered under Medicaid reimbursements, prompting the question of whether federal funding for such services will soon follow.

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What can EMS learn from 100 years of the National Park Service?

Yellowstone, Yosemite, Glacier and the Grand Canyon are among the crown jewels of America that are under the stewardship of the National Park Service. Since August 25, 1916 the staff and volunteers of the federal agency have protected 412 national parks, monuments, battlefields, military parks, historical parks, historic sites, lakeshores, seashores, recreation areas, scenic rivers and trails and the White House.

Last week I visited several parks and monuments in South Dakota and Wyoming. During my hikes and explorations I contemplated the NPS 100-year anniversary and the lessons EMS leaders and providers can draw from the agency as it looks forward to its second century.

1. Uniformity from park to park
Park rangers have a distinct uniform, regardless of their work location or position in the NPS. Park visitors can quickly identify a ranger by the gray shirt, green pants and tan hat with a band. All park staff wear an NPS patch on their left shoulder.

EMS provider uniforms vary widely in color, styling and formality. Our uniforms are sometimes indistinguishable from law enforcement, often carry more fire department branding or try to carry over the trim of hospital scrubs or lab coats.

NPS vehicles are white with a single green stripe. NPS fire vehicles have a red stripe. Vehicle branding and specifications, likely easing purchasing across the NPS, is consistent.

2. A variety of services is available for visitors with different needs and wants
The NPS offers a multitude of services to meet the needs and interests of visitors. Front-country driving routes, scenic overlooks and interpretive programs cater to the majority of visitors looking to have a short-duration, low intensity experience. A smaller group of visitors can journey deep into the backcountry and wilderness of the larger parks. Devils Tower in Wyoming, the first national monument, offers visitors scenic views, ranger-led programs, overnight camping, hiking trails and rock climbing.

EMS, through programs like community paramedicine, is just beginning to explore how it might cater its expertise and service offerings to the people they served. For most agencies it is no longer enough to simply be a 911 response agency. EMS, in the second half of its first century, will interact with its customers through a combination of short patient contacts, ongoing community outreach programs and long-term connections with high-frequency utilizers.

3. Predictable, transparent fees are charged for access and experiences
The NPS charges an entrance fee for some of its properties and then visitors pay additional fees for experiences like overnight camping at the Badlands National Park or an interpretive tour of the Jewel Cave. In addition visitors can make donations to parks and a percentage of gift shop receipts are returned to the park. The fee system, though it varies from park to park, is expected, predictable and transparent to park visitors.

When a patient asks, "What will this ambulance ride cost"" the best answer is usually, "It depends." EMS fees depend on insurance coverage, level of service provided and local practices for billing. The specific cost, before providing care is rarely predictable or transparent.

4. Paid staff, volunteers and contractors work together as a team
The NPS provides services to visitors with 22,000 professional staff and 221,000 volunteers. The paid staff likely have specialized training and are considering the NPS as a career. Volunteers, often with unique expertise, are able to supplement the paid staff, support the different needs of the park and contribute in areas aligned with their interests. There are likely some parks with high numbers of professional staff and only a handful of volunteers. As well as some parks that are highly reliant on volunteers.

Is the 10 volunteers to one paid staff a comparable ratio for combination EMS departments to consider" The high participation of volunteers in the NPS might point to opportunities for public EMS agencies with all paid staff to integrate community-minded volunteers into non-clinical areas of operations.

The NPS also shifts some of the visitor experience and care to concessions operators. Hotels, restaurants, retail stores and recreational tours are often the domain of contactors working inside the park and within the regulations set by the NPS. The use of contractors is familiar to EMS agencies that contract certain types of calls, such as non-emergent transfers to private providers. Patient billing, staff hiring, education and fleet maintenance are other areas to consider contracting to a concession operator.

5. Career advancement and mobility
NPS professionals are able to, and often expected, to move between parks to advance their careers. Their knowledge, skills and abilities are transferable throughout the system. We met an interpretive ranger and educator at Devils Tower who was at his fourth park, including previous stints at Everglades National Park and Shenandoah National Park. He expects to be at Devils Tower for several years before moving to his next assignment.

Local protocol approval processes and licenses, based on state-specific scope of practice documents, make it difficult for paramedics to move between systems within a state and nearly impossible to move to services in different states. The Recognition of EMS Personnel Licensure Interstate Project is model legislation for States to make it easier for EMS providers licensed in one state to practice in other states. Making it easier for EMS professionals to move between organizations, including transition from the military to civilian EMS, is essential to the future of EMS.

Have you worked in a National Park as a paramedic or EMT" Tell us about your experience in the comments. What are other lessons for EMS from the NPS" Find Your Park to join in the NPS celebration.

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This is your profession. Make of what you will.

I recently had the honor and privilege of addressing a number of paramedic school commencement exercises. While it is always a privilege to speak about EMS to my peers, I am particularly honored by these opportunities, because I was asked to speak not based upon a proposal I had submitted on a particular topic, but because of who I am, and my place in the EMS profession. It's a tall order to fill, particularly because David Givot has already done it so well, but this is my answer.

**********

Congratulations, you've finished the marathon that is paramedic school. You've memorized your drug dosages, you've learned complex anatomy and physiology, and the pathophysiology of dozens of diseases. You've survived the crucible of pharmacodynamics and pharmacokinetics, and been baptized in acid-base balance and the nuances of the electron transport system. You've practiced megacodes and intubation until you can do them in your sleep.

And right now, if your teachers have done their jobs right, you're brimming with confidence, tempered with the sober realization of the responsibility that will soon be in your hands. You're ready to go out and save some lives.

But none of you, really, know what's in store for you. Even I don't know, and your teachers don't know.

For the duration of your course, they've struggled with the daunting task of educating the paramedics of the future, without actually knowing what the paramedic of the future will be. Medicine is changing so fast, none of us can predict what form EMS will take — and what will be your role in it — in 10 or 20 years. What we do know is that it will be different than it is now.

So what I will tell you here today has nothing to do with medicine.

I'm going to talk about the truths that will serve you well over a long career, no matter what form that career will take. Even when technology and the forces of health care finance have radically transformed the face of your profession, there will still be patients, there will still be practitioners, and there will still be peers.

And your relationships with each of them will be what make the difference between your life's calling and paramedicine being just another job.

Choose your mentors wisely
In the coming months, you're going to learn how to apply the lessons of the classroom to practice on the street, and people with more time on an ambulance than you will have differing ideas of how to do that. I want you to choose your mentors well, because age does not necessarily convey experience, and experience does not necessarily convey wisdom.

The paramedics with twenty years of experience are far outnumbered by the paramedics with one year of experience repeated twenty times, for whom the only lessons learned were how to dodge calls, and the location of all the burger joints that give EMS discounts.

You'll know the real EMS professionals not only by their clinical acumen, but by how they treat people. They're the people with superior knowledge and skills, who have also discovered that a kind word and holding a hand are great therapy, too.

Clinical knowledge and technical skill don't make you a great paramedic, they merely make you a competent one. You can't take pride in those things. They're what you owe to each and every patient.

The best thing you can give to your patients, the gift that distinguishes a great paramedic from a good one, is your compassion. Your patients are never going to understand or appreciate your mad intubation skills, or your encyclopedic knowledge of cardiology. They're going to notice — and remember — how nice you were.

Never stop learning
I want you to become lifelong learners. Roughly half of what you learned in class — paramedic school, nursing school or medical school — is wrong. The problem is, no one knows which half.

The only way you will ever discover what information was valid and what was not, is by constantly trying to learn new things. If you spend just 15 minutes a week reading current EMS and emergency medicine research, you will be among the top 10 percent of your profession. If, five years from now, you are still approaching patient care in the same way you do now, you will have fallen far behind.  

Do the small things well
I want you to understand that the little things matter. As Aristotle said, "We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."

A supervisor once told me, "If you show up to work on time with your uniform pressed and your boots shined, turn in billable paperwork on time, wash your rig inside and out every shift, and don't get any patient complaints … you can retire here, without ever having been a good paramedic."

And he's absolutely right. You can spend twenty years doing just enough to get by, being comfortably anonymous and drawing a paycheck, and EMS will never be more than just a job to you.

What's more, you can climb the career ladder into management with the same strategy. Management is filled with people who were great employees and mediocre medics. And a great many of them are poor leaders, as well.

Your standards should always be higher than your employer's.

"If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures, sweep streets like Beethoven composed music, sweep streets like Leontyne Price sings before the Metropolitan Opera. Sweep streets like Shakespeare wrote poetry. Sweep streets so well that all the hosts of heaven and earth will have to pause and say: Here lived a great street sweeper who swept his job well."
- Martin Luther King, Jr.

There is no such thing as a call that is beneath you. Even a routine BLS transfer affords you the opportunity to enrich your life by connecting with another human being. Pay attention to little details, both in the care you provide, and the way you treat people, and you may one day become that rare creature, the great manager who was also a great paramedic.

Never doubt your impact
Many of you will go to work at agencies where the culture is the polar opposite of the admonitions I'm giving you today. You'll feel outnumbered by apathetic or burned out co-workers, people whose commitment to our profession extends no farther than their next patient and their next paycheck.

But I want you to remember one thing: one person can make a difference.

A lone, mad monk named Martin Luther sparked the Protestant Revolution. Jonas Salk's vaccine ended the scourge of polio. Five hundred seventy-six Florida voters decided the 2000 Presidential election.

Less than three percent of colonists took up arms in the American Revolution. They were outnumbered four-to-one by their own countrymen, yet they still managed to throw off the yoke of the most powerful nation in the world.

All it takes is a few committed people too angry to accept the status quo, too naive to realize that meaningful change is impossible, and too stubborn to quit. Be a Three Percenter for EMS, and we can shape the future of this profession ourselves.

In closing, I urge all of you to become stewards of emergency medical services. Live the example of your wise mentors. Pass on that culture of compassionate professionalism and learning to the next generation. Constantly question dogma. Call out unprofessionalism and misbehavior when you see it, and don't let unethical acts hide behind a false notion of brotherhood.

This is your profession. Make of it what you will.

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Stroke Rehabilitation Assessment of Movement Measure

Link to instrument: STREAM

Acronym:

STREAM

Purpose:

• The STREAM was designed for use by physical therapists to provide a quantitative evaluation of motor functioning for stroke patients. The STREAM was specifically designed to be easy to administer in a clinical setting.
  

Description:

The STREAM is composed of 30 items distributed across 3 domains:

• Upper-limb movements (scored on a 3-point ordinal scale
• Lower-limb movements (scored on a 3-point ordinal scale)
• Basic mobility items (scored on a 4-point ordinal scale)

Scoring the STREAM:

• Total of 20 points for each of the limb sub-scales (40 points total)
• Total of 30 points for the mobility subscale
• Scores can be transformed, allowing for items that can't be scored
• Subscales are converted to a percentage, even though the scores are not interval based. This is done to allow for occasional items that cannot be scored.  Total scores are calculated using the average of the 3 subscale scores
• Instructions for score transformation can be found in the instruments manual

Area of Assessment: Coordination, Functional Mobility, Range of Motion

Body Part: Upper Extremity, Lower Extremity

ICF Domain: Body Function, Activity

Domain: Motor

Assessment Type: Performance Measure

Length of Test: 06 to 30 Minutes

Time to Administer:

15 minutes

Number of Items: 30

Equipment Required:

None

Training Required:

None

Type of training required: No Training

Cost: Free

Actual Cost:

Free

Age Range: Adult: 18-64 years, Elderly adult: 65+

Administration Mode: Paper/Pencil

Diagnosis: Stroke

Populations Tested:

• Stroke

Standard Error of Measurement (SEM):

Chronic Stroke: (Chen et al, 2007; n = 50; mean age = 60.9 (12.8) years; median time between stroke and assessment = 24 months, mean Barthel Index (BI) scores = 15.9 (5.3) points)

• Standard Error of Measurement (SEM) = 1.5 points

Minimal Detectable Change (MDC):

Chronic Stroke: (Chen et al, 2007)

• Smallest Real Difference (SRD) = 4.2 points

Acute Stroke: (Hsueh et al, 2008; n = 50 mean age = 61.9 (11.7) years; onset to admission 18.6 (11.7) days; stay in rehab = 22.3 (5.7) days)

• STREAM Smallest Real Difference:
  Measure	ICC	95% CI	SRD (SRD%)
  STREAM
  UE-STREAM	.97	0.96-0.98	2.8 (14.0)
  LE-STREAM	.98	0.96-0.99	2.5 (12.6)
  Motor-STREAM	.98	0.97-0.99	3.9 (9.9)
  S-STREAM
  UE-S-STREAM	.95	0.92-0.97	11.6 (11.6)
  LE-S-STREAM	.97	0.95-0.98	9.1 (9.1)
  Motor-S-STREAM	.97	0.95-0.98	17.4 (8.7)
  FM
  UE-FM	.98	0.96-0.99	7.2 (10.9)
  LE-FM	.95	0.91-0.97	3.8 (11.3)
  Motor-FM	.98	0.97-0.99	8.4 (8.4)
  S-FM
  UE-S-FM	.93	0.89-0.96	12.2 (12.2)
  LE-S-FM	.96	0.93-0.97	8.6 (8.6)
  Motor-S-FM	.96	0.94-0.98	16.0 (8.0)
  STREAM = Motor Scale of Stroke Rehabilitation Assessment of Movement S-STREAM = Simplified Motor Scale of STREAM SRD = smallest real difference FM = Fugl-Meyer Motor Scale S-FM = Simplified Fugl-Meyer Motor Scale UE = Upper Extremity LE = Lower Extremity

Minimally Clinically Important Difference (MCID):

Stroke: (Hsieh et al, 2008; n = 81 stroke patients who were recruited from Departments of Physical Medicine and Rehabilitation of three hospital in Taiwan; mean age = 55.9 (13.3) years; mean MMSE score = 25.8 (2.8) years; mean STREAM baseline score = 10.27 (7.6) for upper extremity, 9.6 (6.7) for lower extremity, and 16.1 (7.6) for mobility)

• MCID for upper-extremity subscale (n = 42) = 2.2
• MCID for lower-extremity subscale (n = 38) = 1.9
• MCID for mobility subscale (n = 43) = 4.8

Cut-Off Scores:

Not Established

Normative Data:

Acute Stroke: (Ahmed et al, 2003; n = 63; mean age = 67 (14) years; assessed within a week of stroke, then again at 4 weeks and 3 months)

STREAM Norms Over Time with Comparisons:
Instrument		Intial		5 week		3 months
Name	Domain	Mean (SD)	Median	Mean (SD)	Median	Mean (SD)	Median
STREAM	Total Score	75 (26.7)	86	86 (19.1)	94	89 (18.0)	97
	UE subscale	73 (33.3)	90	85 (26.2)	100	88 (24.0)	100
	LE subscale	75 (28.9)	85	86 (22.3)	95	90 (19.0)	100
	Mobility subscale	74 (25.9)	83	88 (16.4)	97	91 (15.0)	97
Barthel Index	Total	72 (27.9)	85	86 (20.4)	100	92 (14.0)	100
Gait speed (m/s)	Total	0.55 (0.38)	0.58	0.82 (0.43)	0.90	0.85 (0.36)	0.93
STREAM = Stroke Rehabilitation Assessment of Movement UE = Upper Extremity LE = Lower Extremity

Test-retest Reliability:

Chronic Stroke: (Chen et al, 2007, n = 50, 7 days between assessments)

 

Test re-test data for the Mobility subscale of the STREAM
First Session Mean (SD)	17.9 (7.2)
Second Session Mean (SD)	17.8 (7.6)
Mean d (SD)	0.1 (2.1)
ICC (95% CI)	0.96 (0.93 to 0.98)*
SEM	1.5
SRD	4.2
*Excellent
d = difference of score between the 2 test sessions ICC = intraclass correlation coefficient CI = confidence interval SEM = standard error of measurement SRD = smallest real difference

 

 

Interrater/Intrarater Reliability:

Chronic Stroke: (Daley et al, 1999; n = 20; mean age = 66.7 (10.7) years; mean time between stroke onset and assessment = 104.5 (42.7) days)

 

Interrater and Intrarater Reliability:
Sub scale	Direct Observation (Interrater Agreement)	Videotaped Assessments (Intrarater Agreement)
Upper-extremity subscale	.994	.963
Lower-extremity subscale	.993	.999
Basic mobility subscale	.982	.999
Total scores on STREAM	.995	.999
GCC = generalizability correlation coefficient Reliability coefficients of .95 or better are recommended

Internal Consistency:

Chronic Stroke: (Daley et al, 1999)

• Internal Consistency (Cronbach's alpha):
  • Excellent: Mobility subscale = .965
  • Excellent: Limb subscales = .979
  • Excellent: overall STREAM scores = .984

Criterion Validity (Predictive/Concurrent):

Acute Stroke: (Ahmed et al, 2003)

 

STREAM Predictive and Concurrent Validity Correlations:
Stream	Time	Box and Block (Affected UE)	Box and Block (Unaffected UE)	Barthel	Balance	TUG	Gait
Total	Initial	.73	.36	.78	.75	.80	.74
	5 weeks	.77	.37	.71	.68	.64	.62
	3 months	.78	.44	.75	.65	.57	.73
UE	Initial	.78	.31	.67	.57	.69	.56
	5 weeks	.79	.36	.66	.61	.49	.53
	3 months	.76	.31	.67	.53	.60	.64
LE	Initial	.53	.40	.71	.73	.75	.74
	5 weeks	.64	.29	.59	.55	.59	.55
	3 months	.70	.30	.63	.55	.51	.65
Mobility	Initial	.66	.55	.84	.88	.85	.83
	5 weeks	.69	.40	.75	.71	.57	.65
	3 months	.66	.40	.82	.78	.62	.76

Construct Validity (Convergent/Discriminant):

Acute Stroke: (Hsueh et al, 2003, n = 59; mean age 64.2 (11.5) years; assessed within 14 days of stroke onset, Taiwanese sample)

 

Convergent Validity and Predictive Validity of the STREAM at 4 Time Points
Days	n	Convergent Validity* (p)	Predictive Validity† (p)
14	57	0.80	0.54
30	54	0.87	0.67
90	44	0.82	0.81
180	43	0.76	--
*Relationships between the STREAM and the BI at 4 time points. †Relationships between the STREAM and the BI at 3 time points (14, 30, and 90 days) after stroke.

 

 

Content Validity:

Items from the initial STREAM were reviewed by two panels of experts made up to 20 physical therapists. Feedback from these experts were used to refine the measure.

Face Validity:

Not statistically assessed

Floor/Ceiling Effects:

Acute Stroke: (Hsueh et al, 2008)

 

STREAM Floor and Ceiling Effects at Admission and Discharge
	At Admission, n (%)		t Discharge, n (%)
	Floor	Ceiling	Floor	Ceiling
UE-STREAM	13 (26.0)	10 (20.0)	4 (8.0)	20 (40.0)
LE-STREAM	10 (20.0)	2 (4.0)	1 (2.0)	12 (24.0)
Motor-STREAM	9 (18.0)	1 (2.0)	1 (2.0)	10 (20.0)
S-STREAM	2 (4.0)	0 (0.0)	0 (0.0)	6 (12.0)
UE = Upper Extremity LE = Lower Extremity STREAM = Motor Scale of Stroke Rehabilitation Assessment of Movement S-STREAM = Simplified Motor Scale of STREAM

 

Acute Stroke: (Hsueh et al, 2003)

 

STREAM Floor and Ceiling Effects at 4 Time Points
Days after Stroke	Floor n (%)	Ceiling n (%)
14 (n = 57)	0 (0)	0 (0)
30 (n = 54)	0 (0)	2 (3.7)
90 (n = 44)	0 (0)	6 (13.6)
180 (n = 43	0 (0)	7 (16.3)

Responsiveness:

Acute Stroke: (Higgins et al, 2005; n = 55; mean age = 66 (15), assessed at 5 weeks after onset)

 

Standard Response Means (SRM) for STREAM:
Sub-scale	SRM	95% Confidence Interval
STREAM Total	0.98	0.74 − 1.17
STREAM (upper limb)	0.75	0.56 − 0.93
STREAM (lower limb)	0.63	0.36 − 0.86

 

Acute Stroke: (Hsueh et al, 2008; assessed at admission and within 48 hours of discharge; mean time in rehabilitation = 22.3 (5.7) days)

 

STREAM Responsiveness:
Scale	Change score (SD)	Strength	Effect Size d	SRM
STREAM
UE-STREAM	3.3 (4.2)	small	0.38	0.78
LE-STREAM	3.3 (3.9)	small	0.44	0.84
Motor-STREAM	6.5 (6.9)	small	0.45	0.95
S-STREAM
UE-S-STREAM	14.5 (12.2)	small	0.49	1.19
LE-S-STREAM	14.7 (12.9)	medium	0.54	1.14
Motor-S-STREAM	29.1 (23.2)	medium	0.53	1.26
FM
UE-FM	8.4 (8.5)	small	0.34	1.00
LE-FM	4.3 (5.2)	small	0.41	0.83
Motor-FM	12.7 (11.0)	small	0.38	1.16
S-FM
UE-S-FM	14.6 (14.4)	small	0.47	1.00
LE-S-FM	14.9 (17.9)	medium	0.51	0.83
Motor-S-FM	29.4 (29.7)	medium	0.51	0.99
STREAM = Motor Scale of Stroke Rehabilitation Assessment of Movement S-STREAM = Simplified Motor Scale of STREAM FM = Fugl-Meyer Motor Scale UE = Upper Extremity LE = Lower Extremity S-FM = Simplified Fugl-Meyer Motor Scale SRM = Standardized Response Mean

 

Acute Stroke: (Hsueh et al, 2003)

 

Responsiveness of the STREAM at Different Stages of Recovery
Days	n	SRM	Wilcoxon z
14–30	51	1.17	6.02*
30–90	43	0.95	4.95*
90–180	43	0.40	2.23†
14–90	43	1.61	5.72*
14–180	43	1.65	5.57*
*P < 0.001; †P < 0.05

Considerations:

 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography:

Ahmed, S., Mayo, N. E., et al. (2003). "The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation." Phys Ther 83(7): 617-630. Find it on PubMed

Chen, H. M., Hsieh, C. L., et al. (2007). "The test-retest reliability of 2 mobility performance tests in patients with chronic stroke." Neurorehabil Neural Repair 21(4): 347-352. Find it on PubMed

Daley, K., Mayo, N., et al. (1999). "Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure." Phys Ther 79(1): 8-19; quiz 20-13. Find it on PubMed

Higgins, J., Mayo, N. E., et al. (2005). "Upper-limb function and recovery in the acute phase poststroke." J Rehabil Res Dev 42(1): 65-76. Find it on PubMed

Hsieh, Y. W., Wang, C. H., et al. (2008). "Estimating the minimal clinically important difference of the Stroke Rehabilitation Assessment of Movement measure." Neurorehabil Neural Repair 22(6): 723-727. Find it on PubMed

Hsueh, I. P., Hsu, M. J., et al. (2008). "Psychometric comparisons of 2 versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke Rehabilitation Assessment of Movement." Neurorehabil Neural Repair 22(6): 737-744. Find it on PubMed

Hsueh, I. P., Wang, C. H., et al. (2003). "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 34(7): 1741-1745. Find it on PubMed 

Year published: 1986

Instrument in PDF Format: Yes

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Fatigue Severity Scale

Link to instrument: Measure available at Manchester Osteopathic (other languages available below)

Acronym:

FSS

Purpose:

The 9-item scale which measures the severity of fatigue and its effect on a person's activities and lifestyle in patients with a variety of disorders.

Description:

• A 9 item questionnaire with questions related to how fatigue interferes with certain activities and rates its severity.
• The items are scored on a 7 point scale with 1 = strongly disagree and 7= strongly agree.
• The minimum score = 9 and maximum score possible = 63. Higher the score = greater fatigue severity.
• Another way of scoring: mean of all the scores with minimum score being 1 and maximum score being 7.
• Self report scale.

Area of Assessment: Activities of Daily Living, Life Participation, Sleep

Body Part: Not Applicable

ICF Domain: Activity, Participation

Domain: General Health

Assessment Type: Patient Reported Outcomes

Length of Test: 05 Minutes or Less

Time to Administer:

Less than 5 minutes

Number of Items: 9 Items; Lerdal (2011) found that items 1 and 2 in the FSS-9 should not be used in a mean score because the FSS-7 shows better validity and reliability and is likely more sensitive for measuring change in fatigue

Equipment Required:

• Pen

Training Required:

No training required

Type of training required: No Training

Cost: Free

Actual Cost:

No cost for administering the scale.

Administration Mode: Paper/Pencil

Diagnosis: Fibromyalgia, Geriatrics, Multiple Sclerosis, Parkinson's Disease, Stroke

Populations Tested:

• Cancer
• Chronic Hepatitis C (Rosa et al 2014)
• Congenital Myopathy (Werlauff et al, 2014)
• Elderly Population
• Fibromyalgia
• Lyme's Disease
• Multiple Sclerosis
• Obesity (Imperllizzeri et al, 2013)
• Parkinson's Disease
• Depression
• Post Polio Patients
• Rheumatoid Arthritis
• Stroke
• Spinal Muscular Atrophy Type II (Werlauff et al, 2014)
• Systemic Lupus Erythematosus

Standard Error of Measurement (SEM):

Multiple Sclerosis: (Learmonth et al, 2013; Mean age 49.2 (9); Disease duration (years) mean 11.8 (8.2))

• The SEM for the FSS was 0.7 points (mean = 5.1 points), indicating that a change of less than 0.7 points may be due to measurement error.

Obesity: (Impellizzeri et al, 2013; n=220, mean age=47 (15))

• The agreement as measured using the SEM was 0.43 (0.36 to 0.54) corresponding to 13% (11 to 17%).

Minimal Detectable Change (MDC):

Multiple Sclerosis: (Learmonth et al, 2013)

• The MDC provides an indication of clinically important change and is based on the SEM. The FSS had the smallest estimates of clinically important change; however, results indicated that a change in FSS score of 1.9 points (38% of the overall mean score) would be necessary to reflect a clinically important change.
• The CV for the FSS indicated that a change in score of 10.3% or less may be expected over six months and therefore, this level of change or less could be interpreted as no change in fatigue.
• Researchers and clinicians should be aware that a small change in FSS scores might be due to measurement error rather than a clinically relevant change.

Obesity: (Impellizzeri et al, 2013)

• The MDC was 1.2 points (37%). Cronbach's alpha was 0.94 and 0.93 at baseline and post-intervention, respectively.

Post-poliomyelitis Syndrome: (Koopman et al, 2014; n = 61, mean age = 59 (10) years, mean time post onset of PPS = 14.2 (11.5) years)

• The smallest detectable change for FSS (range 1-7) was 1.55 or 28.7%, which represents the percentage of the means of the FSS and CIS20-F. The authors found this SDC to be high and therefore insufficiently sensitive to detect changes beyond measurement error in single individuals. However, much smaller changes can be detected at the group level.

Minimally Clinically Important Difference (MCID):

Not Established

Cut-Off Scores:

Multiple Sclerosis and Systemic Lupus Erthymatosus:

(Krupp et al, 1989; n = 74, mean age = 40.2 years)

• The cut-off score is 36 where a score > 36 may indicate severe fatigue or need for further evaluation.

Normative Data:

Healthy Population:

(Grace et al, 2006; n = 16, mean age = 69.94 years)

• Mean (SD) FSS scores for healthy individuals; 2.3 (0.7)

Parkinson's Disease:

(Hagell et al, 2006; n = 118, mean age = 63.9(9.6) years, mean time post PD = 8.4 (5.7) years)

• Mean SD (FSS) score for PD patients; 3.9 (1.6), range 2.6-5.2

(Winward et al; n = 37; H&Y Stages 0 - 4; mean age = 64.1(8.17)

• Mean FSS Score = 4.08 (1.46); FSS Scored 0 - 7

(Fereshtehnejad et al, 2013; n = 90, mean age = 62.0 (10.7) years, mean duration of disease = 6.0 (4.8) years)

• Mean FSS Score = 4.4 (2.0), range 1-7

Epilepsy: (Hernandez-Ronquiloa et al, 2011)

PWE (patients with epilepsy) mean age = 36.5 (16.8)
PMS (patients with different neurological problems) mean age = 40.2 (10 )
HV (healthy volunteers) mean age = 39.6 (11.5)

• Healthy (HV) (n=34), Mean fatigue 2.6 (1.1)
• Epilepsy (PWE) (n=67), Mean fatigue 4.2 (1.5)
• MS (PMS) (n = 30), Mean fatigue 4.8 (1.4)
• Migraine (PMS) (n = 19), Mean fatigue 4.4 (1.9)
• Radiculopathy (PMS) (n = 7), Mean fatigue 4.5 (0.9)

Post-poliomyelitis Syndrome: (Koopman et al, 2014; n = 61, mean age = 59 (10) years, mean time post onset of PPS = 14.2 (11.5) years)

• Mean FSS Score = 5.3 (1.3), range 1-7

Test-retest Reliability:

Parkinson's Disease:

(Valderramas et al, 2012; n = 30, mean age = 62 (11) years, mean time post- PD = 7.6 (6.5) years)

• The evaluation of the FSS-BR (Fatigue Severity Scale-Brazilian-Portuguese version) suggests an excellent Test-retest reliability (ICC = 0.91)

Post-Poliomyelitis Syndrome:

(Koopman et al, 2014; n = 61, mean age = 59 (10) years, mean time post-onset of PPS = 14.2 (11.5) years)

• ICC (95% CI) = 0.80 Excellent

Chronic Neck Pain:

(Takasaki & Treleaven, 2013; n = 26, mean age = 35.4 (12.1) years, mean symptom duration = 36.6 (26.4).

• Test-retest reliability was examined using quadratic-weighted kappa (>0.4) and was considered adequate.

Chronic Hepatitis C:

(Rosa et al, 2014; n = 386, 462, mean age = 48.9(10.36), 44(11.81) years)

• ICC = 0.74, 0.86 Excellent test-retest reliability.

Congenital Myopathy:

(Werlauff et al, 2013, n=71, mean age 34.2 (14.4)

• Adequate test-retest reliability (0.72)

Obesity:

(Impellizzeri et al, 2013; n=220, mean age=47 (15)

• ICC = 0.89 (0.82 to 0.94) Excellent

Multiple Sclerosis:

(Learmonth et. al., 2013; n=86, mean age=49.2(9), disease duration 11.8 (8.2).

• Moderate: ICC = 0.751 over six months

Interrater/Intrarater Reliability:

Epilepsy:

(Hernandez-Ronquilloa et al, 2011)

• The intra-observer reliability for the FSS in PWE (patients with epilepsy) was 0.85

Internal Consistency:

Parkinson's Disease:

(Hagell et al, 2006)

• Excellent internal consistency (Cronbach's alpha = 0.94)

(Grace et al, 2006)

• Excellent split half reliability (Cronbach's alpha = 0.86 and 0.91)
• For 8 out of the 9 items, Adequate-Excellent (0.44-0.78) correlation was observed.
• For item 2, Poor (0.27) correlation was seen.

Post-Poliomyelitis Syndrome:

(Koopman et al, 2014) — Acceptable internal consistency (Cronbach's alpha = 0.90)

Chronic Neck Pain:

(Takasaki & Treleaven, 2013)—Good internal consistency (Cronbach's alpha = 0.81 ≤ α ≤ 0.89)

Chronic Hepatitis C:

(Rosa et al, 2014)—Excellent internal consistency (Cronbach's alpha = 0.96, 0.96 across two studies)

Congenital Myopathy:

(Werlauff et al, 2013)—Excellent internal consistency (Cronbach's alpha = 0.89), IRC ranged from 0.80 to 0.30, item 1 has weakest correlation

Spinal Muscular Atrophy Type II:

(Werlauff et al, 2013)—Excellent internal consistency (Cronbach's alpha = 0.92)

• IRC weak in item 1 (0.49) and item 2 (0.69)
• Excellent internal consistency amongst three factors
• Cronbach's alpha = 0.84 for physical status questions
• Cronbach's alpha = 0.94 for cognitive status questions
• Cronbach's alpha = 0.80 for psychosocial function status questions

Criterion Validity (Predictive/Concurrent):

Stroke: (Lerdal & Kottorp, 2011) Cronbach's alpha for the FSS-9 was 0.86 (adequate) at baseline while the alpha in the FSS-7 varied between 0.87 and 0.93 at four measurement times, supporting item reliability in the FSS-7. At baseline (n=119): 0.87; adequate 6 months (n=106): 0.92; excellent 12 months (n=104): 0.93; excellent 18 months (n=99): 0.92; excellent "Analyses of the concurrent validity of the FSS-7 showed a moderate to high relationship with SF-36-vitality and a moderate relationship with the one-item perceived energy item" (p. 1263).

Chronic Hepatitis C: (Rosa et al, 2014; PILLAR: n=386, mean age 44.0(11.81); ASPIRE: n=462, mean age 48.9(10.36)) Excellent correlation of concurrent validity (PILLAR: r= -0.63, ASPIRE: -0.66) between the total FSS score and with EQ-5D VAS PILLAR represented treatment-naïve patients while ASPIRE represented treatment-experienced patients with Chronic Hepatitis C infection.

Construct Validity (Convergent/Discriminant):

Convergent Validity:

Parkinson's Disease:

• Excellent (r = -0.77) negative correlation with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale (Hagell et al, 2006).
• Excellent (r = 0.62) correlation with Nottingham Health Profile (NHP-EN) scale (Hagell et al, 2006).
• Excellent (r = 0.84) correlation with Parkinson's Fatigue (PFS) scale (Grace et al, 2006).
• Poor-adequate (r = 0.22-0.47) correlation with Parkinson's Disease Questionnaire-39 (PDQ-39) scale (Herlofson et al, 2003; n = 66, mean age = 70.8 (9.9) years, time since PD = 70.2 (56.1) months).
• Adequate (r = 0.37) correlation with MOS-SF-36 scale (Herlofson et al, 2003).
• Poor (r = 0.19) correlation with Hamilton Depression Rating (HAM-D) scale (Garber CE & Friedman JH, 2003; n = 37)
• Excellent (r = 0.80) correlation with Fatigue rating Scale (Grace et al, 2006)
• Poor-adequate (r = 0.22-0.47) correlation with Parkinson's Disease Questionnaire-39 (PDQ-39) scale (Herlofson et al, 2003; n = 66, mean age = 70.8 (9.9) years, time since PD = 70.2 (56.1) months)
• Excellent (r = 0.93) correlation of FSS-BR with PDQ-39 (Valderramas et al, 2012)
• Excellent (r = 0.75) correlation of FSS-BR with Beck Depression Inventory (Valderramas et al, 2012)
• Adequate (r = 0.40) correlation of FSS-BR with Hoehn & Yahr scale (Valderramas et al, 2012)
• Adequate (r = 0.45) correlation of the FSS-BR with UPDRS (Valderramas et al, 2012)
• Adequate (r = 0.37) correlation with MOS-SF-36 scale (Herlofson et al, 2003)
• Poor (r = 0.19) correlation with Hamilton Depression Rating (HAM-D) scale (Garber CE & Friedman JH, 2003; n = 37)
• Excellent (r = 0.80) correlation with Fatigue rating Scale (Grace et al, 2006)
• Poor (r = -0.184) correlation of FSS with 6 minute walk test (Garber CE & Friedman JH, 2003)

Multiple Sclerosis:

Learmonth et al, 2013 n=82

• Excellent (r = 0.754) correlation of FSS with MFIS
• Adequate (r = 0.532) correlation of FSS with PDDS
• Adequate (r = 0.350) correlation of FSS with HADS (anxiety)
• Adequate (r = 0.456) correlation of FSS with HADS (depression)
• Adequate (r = 0.466) correlation of FSS with SF-MPQ (sensory)
• Adequate (r = 0.569) correlation of FSS with SF-MPQ (affective)
• Adequate (r = 0. 0.491) correlation of FSS with PSQI
• Excellent (r = 0.628) correlation of FSS with MSWS-12
• Adequate (r = −0.405) correlation of FSS with 6 MW
• Poor (r = −0.263) correlation of FSS with SDMT

(Téllez et al, 2005)—Excellent (r=0.68, p

(Ghajarzadeh et al, 2012)

Excellent (r=0.69, p

Obesity:

(Impellizzeri et al, 2013; n=220, mean age=47 (15)—At baseline:

• Adequate (r = 0.58; 95% CI 0.48 to 0.66) correlations were found between FSS and POMS Fatigue score
• Adequate (r = −0.53; 0.43 to 0.62) FSS and POMS Vigor was significantly negative and moderate large
• Adequate (r = 0.41, 0.29 to 0.51) The correlation between the change scores in FSS and POMS-Fatigue was positive and moderate
• Poor (r = −0.26, 0.13 to 0.38) POMS-Vigor the correlation was negative and small.
• Adequate (r = 0.52, 0.42 to 0.61) Moderate-large correlations were also found between FSS and ORWELL97
• Poor (r = 0.29, 0.16 to 0.41).small moderate correlation was found between change scores of the two questionnaires.
• Poor (r = 0.15, 0.02 to 0.28) The correlation between FSS and BMI was significant but small, however, when adjusted for age the correlation increased to r = 0.25 (0.12 )

Chronic Neck Pain:

(Takasaki & Treleaven, 2013)—Excellent (0.63 ≤ r ≤ 0.78) correlation of FSS-7 with the Fatigue Impact Scale, Adequate (r = 0.42) correlation of FSS-7 with the Visual Analog Fatigue Scale.

Content Validity:

Not Established

Face Validity:

Not Established

Floor/Ceiling Effects:

Parkinson's Disease:

(Hagell et al, 2006)

• The Floor/Ceiling effects were adequate (2.5%) for a sample of PD patients.

Post-poliomyelinits Syndrome:

(Koopman et al, 2014)—Both questionnaires had adequate floor and ceiling effects, with less than 15% of the post-polio patients demonstrating highest and lowest possible scores.

Chronic Hepatitis C:

(Rosa et al, 2014)—Floor / Ceiling effects were adequate (Floor: 4.9% (PILLAR) and 8% (ASPIRE); Ceiling 1.2% (PILLAR) and 2.7% (ASPIRE).

Obesity:

(Impellizzeri et al, 2013; n=220, mean age=47 (15)—Taking into account the MDC, the floor and ceiling effects post-intervention were 5%. The floor and ceiling effects were lower than the 15% cut-off value considered acceptable.

Responsiveness:

Parkinson's Disease:

Responsiveness to Pharmocological Intervention Mendoca et al, 2007; n = 17 treatment arm, receiving methyphenidate; mean age = 62.2(10), mean H&Y Stage = 2.58(0.5); n = 19 placebo arm, mean age = 66.3(7.6), mean H&Y Stage = 2.38(0.3)

• Those persons in the treatment arm had a significant (p < 0.04) reduction in FSS Score by 6.5 points (from FSS = 43.8 at baseline); Cohen's d = 0.79
• Smaller reductions in the placebo group did not reach levels of significance Response to Exercise Intervention: Winward et al, 2010; H&Y 0-4. n = 20 exercise group, mean age = 63.4(6.7); n = 19 control group, mean age = 64.9(9.6)
• No significant difference in score reduction between exercise and control group at 12 weeks.

Chronic Hepatitis C:

(Rosa et al, 2014)—The FSS showed responsiveness, however, neither PILLAR nor ASPIRE achieved statistical significance (p

Obesity:

(Impellizzeri et al, 2013; n=220, mean age=47 (15)—Significant moderate changes were found for all the instruments and BMI after the three-week intervention. The internal responsiveness of FSS was comparable to the ORWELL97.

Considerations:

Parkinson's Disease:

• At this point no studies report psychometrics in a sample of patients in H&Y Stage 5 and only one study includes pts in H&Y Stage 4
• In a study examining the effects of exercise on fatigue in persons with PD (H&Y Stages 0-4), no significant changes were observed in FSS scores, questioning its responsiveness to change in an exercise intervention.
• The FSS can be used to distinguish between fatigued and non-fatigued people with PD. (Hagell et al, 2006)
• The scale has been studied and evaluated for psychometrics in multiple sclerosis patients. Limited psychometric evaluation has been done in PD population. Further, research on FSS should be performed for patients with PD
• The FSS is widely used as it is concise and easy to administer. But it is a little vague as it is subjective in nature & does not provide a precise definition of fatigue
• It can be used as a good screening tool as it can easily distinguish between fatigued and non-fatigued people. Therefore, it is important that the FSS is adequately researched in PD population

Fatigue Severity Scale translations:

French:
http://ift.tt/2bZqIY7

German:
http://ift.tt/2brAIqa

Norwegian:
http://ift.tt/2brAIqa

Spanish (p4):
http://ift.tt/2bZqK2d

Turkish:
http://ift.tt/2brAIqa

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography:

Fereshtehnejad, S., Hadizadeh, H., Farhadi, F., Shahidi, G. A., Delbari, A., & Lökk, J. (2013). Reliability and validity of the persian version of the fatigue severity scale in idiopathic parkinson's disease patients. Parkinson's Disease, 2013, 935429. Find it on PubMed

Garber, C. E. and Friedman, J. H. (2003). "Effects of fatigue on physical activity and function in patients with Parkinson's disease." Neurology 60(7): 1119-1124. Find it on PubMed

Ghajarzadeh. M., Rozita Jalilian, Ghazaleh Eskandari, Mohammad Ali Sahraian, & Amir Reza Azimi. 2012. Validity and reliability of Persian version of Modified Fatigue Impact Scale (MFIS) questionnaire in Iranian patients with multiple sclerosis. Disability and Rehabilitation, 35(18): 1509-1512. Find it on PubMed

Grace, J., Mendelsohn, A., et al. (2007). "A comparison of fatigue measures in Parkinson's disease." Parkinsonism Relat Disord 13(7): 443-445. Find it on PubMed

Hagell, P., Hoglund, A., et al. (2006). "Measuring fatigue in Parkinson's disease: a psychometric study of two brief generic fatigue questionnaires." J Pain Symptom Manage 32(5): 420-432. Find it on PubMed

Herlofson, K. and Larsen, J. P. (2003). "The influence of fatigue on health-related quality of life in patients with Parkinson's disease." Acta Neurol Scand 107(1): 1-6. Find it on PubMed

Hernandez-Ronquillo, L., Moien-Afshari, F., Knox, K., Britz, J., Tellez-Zenteno, J. F. (2011). How to measure fatigue in epilepsy? The validation of three scales for clinical use. Epilepsy Research. Volume 95, Issues 1–2, , 119–129 Find it on PubMed

Impellizzeri, F. M., Agosti, F., De Col, A., & Sartorio, A. (2013). Psychometric properties of the Fatigue Severity Scale in obese patients. Health and Quality of Life Outcomes 2013, 11:32. Find it on PubMed

Koopman, F. S., Brehm, M. A., Heerkens, Y. F., Nollet, F., & Beelen, A. (2014). Measuring fatigue in polio survivors: Content comparison and reliability of the fatigue severity scale and the checklist individual strength. Journal of Rehabilitation Medicine, 46(8), 761. Find it on PubMed

Krupp, L. B., LaRocca, N. G., et al. (1989). "The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus." Arch Neurol 46(10): 1121-1123. Find it on PubMed

Learmonth,Y.C., D. Dlugonski, Pilutti, L.A., Sandroff, B.M., Klaren, R., & Motl R.W. (2013). Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale. Journal of the Neurological Sciences 331, 102–107. Find it on PubMed

Lerdal, A., & Kottorp, A. (2011). Psychometric properties of the fatigue severity Scale—Rasch analyses of individual responses in a norwegian stroke cohort. International Journal of Nursing Studies, 48(10), 1258-1265.Find it on PubMed

Rosa, K., Fu, M., Giles, L., Cerri, K., Peeters, M., Bubb, J., & Scott, J. (2014). Validation of the Fatigue Severity Scale in chronic hepatitis C. Health and Quality of Life Outcomes. 12(90).Find it on PubMed

Takasaki, H., & Treleaven, J. (2013). Construct validity and test-retest reliability of the fatigue severity scale in people with chronic neck pain. Archives of Physical Medicine and Rehabilitation, 94(7), 1328-1334.Find it on PubMed

Téllez, N., Río, J., Tintoré, M., Nos, C., Galán, I., & Montalban, X. (2005). Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS?. Multiple Sclerosis. 11: 198-202.Find it on PubMed

Valderramas, S., Feres, A. C., et al. (2012). "Reliability and validity study of a Brazilian-Portuguese version of the fatigue severity scale in Parkinson's disease patients." Arq Neuropsiquiatr 70(7): 497-500. Find it on PubMed

Werlauff, U., Hojberg, A., Firla-Holme, R., Steffenson, B.F., & Vissing, J. (2014). Fatigue in patients with spinal muscular atrophy type II and congenital myopathies: evaluation of the fatigue severity scale. Quality of Life Research. 23: 1479-1488Find it on PubMed

Instrument in PDF Format: Yes

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Clinical and electrodiagnostic characteristics of nitrous oxide-induced neuropathy in Taiwan

Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Han-Tao Li, Chun-Che Chu, Kuo-Hsuan Chang, Ming-Feng Liao, Hong-Shiu Chang, Hung-Chou Kuo, Rong-Kuo Lyu
ObjectiveNitrous oxide-induced neuropathy is toxic neuropathy occasionally encountered in Taiwanese neurological clinics. Only several case reports described their electrodiagnostic features. We used a case-control design to investigate the detailed electrodiagnostic characteristics and possible factors relating to severe nerve injury.MethodsWe retrospectively reviewed 33 patients with nitrous oxide-induced neuropathy over a 10-year period and reported their demographic data, spinal cord MRI, laboratory examinations and nerve conduction studies. 56 healthy controls' nerve conduction studies were collected for comparison analysis.ResultsWe noted significant motor and sensory amplitudes reduction, conduction velocities slowing, and latencies prolongation in most tested nerves compared to the controls. Similar nerve conduction study characteristics with prominent lower limbs' motor and sensory amplitudes reduction was observed in patient groups with or without abnormal vitamin B12 and/or homocysteine levels. Among those with lower limbs' motor or sensory amplitudes reduction <20% of the lower limit of normal, higher homocysteine levels were detected.ConclusionsSevere impairments of the lower limbs' sensory and motor amplitudes were frequently noted in patients with nitrous oxide exposure. Nitrous oxide exposure itself is an important factor for the development of neuropathy.SignificanceOur study contributes to the understanding of electrodiagnostic features underlying the nitrous oxide-induced neuropathy.



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Mo. EMS department paints new ambulances to match local sheriff, university colors

BUCHANAN COUNTY, Mo. — There's a new EMS department in town, and you'll know it when you see their ambulances.

Buchanan County EMS made some recent additions to their aging fleet, and chose a black and gold striping to match the colors of the local Sheriff's Department and state University.

"A group of employees worked to change the look because we are a new service," said Wally Patrick, Executive Director of Buchanan County EMS. "We wanted to be associated with the community."

The trucks were custom-built to meet the department's "dream ambulance" specifications.

Besides the striking color scheme, NewsPressNow reports that the new ambulances exceed federal safety guidelines. 

The department has plans to replace fleet vehicles after six years of use, but the transition will take some time. Each of the four new trucks cost more than $200,000 apiece.

"We want to make sure we can provide everything the county needs and one of our goals is to provide more service at community activities," Patrick said.

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