Research Report Abstracts - Gesundheit

eS342
ditions of the forearm lasting 15 minutes (cold pack and
cryomanchet) and one control condition. The control condition
was included to evaluate any fatigue or practice effects
during the repeated functional performance. In experiment 2,
the whole arm was cooled down for 15 minutes using multiple
coldpacks. 22 patients were tested 4 times (pre, post
0 minute, post 25 minutes and post 50 minutes) to evaluate
the effects of cooling. The tests were hand grip force, unilateral
tasks of the TEMPA, Fahn’s tremor rating scale (FTRS),
Nine Hole Peg test, Visual Analogue Scale and the Patient’s
Global Impression of Change. The skin temperature of the
shoulder, elbow and wrist was also measured.
Analysis: One and two-way ANOVA’s were applied to investigate
the effects of cooling in the different groups. Post hoc
tests were used where appropriate.
Results: Cooling the forearm with a cold pack or a cryomanchet
significantly reduced the FTRS, the performance
on the NHPT and 3/4 items of the TEMPA. Results of the control
condition showed no systematic influence of fatigue or
practice. Cooling the whole arm the FTRS and reduced time
needed to execute 2/4 items of the TEMPA. Most patients
judged their performance after cooling as much better. All
these effects occurred immediately after cooling and lasted
up to 25 minutes. Forearm cooling with a cryomanchet and
whole arm cooling had greater effect on part A of the FTRS
than cooling with a coldpack or the forearm only, respectively.
Other effects were similar across cooling modalities,
although it must be noted that patients in experiment showed
more tremor than those in experiment 1.
Conclusions: Cooling the upper limb lead to a clinical noticeable
effect on tremor severity and the functional performance,
pronounced during the first half hour after cooling. Although
not extensively demonstrated with the results, whole arm
cooling seems preferred especially for patients with severe
tremor as any improvement is experienced as useful by them.
Implications: Peripheral cooling of the whole arm leads
to temporary functional benefits in persons with intention
tremor due to MS.
Keywords: Tremor; Cooling; Multiple sclerosis
Funding acknowledgements: Fund for Scientific Research
– Flanders.
Ethics approval: Ethics committee of the University Hospitals
of Leuven, and National MS Center Melsbroek, Belgium.
Research Report Poster Display
Number: RR-PO-203-27-Wed Wednesday 22 June 12:00
RAI: Exhibit Halls2&3
BEST PRACTICE OF MICROCREDITS SCHEME
FOR PHYSICALLY DISABLED PERSONS IN
HERAT, AFGHANISTAN
Fiasse J.
I.C.R.C, Assistance/Orthopaedic, Geneva, Switzerland
Purpose: The objective of this article is to analyse until
2008 the results and impact of the microcredit scheme of
the International Committee of the Red Cross (ICRC) physical
rehabilitation center in Herat, Afghanistan and discuss
it at the light of the standards of Velema and mechanisms of
exclusions described by Simanowitz.
Relevance: In order to reach the millennium development
goals, microfinance and more specifically microcredits has
been promoted for the development, particularly for the
disabled population. However, research has shown that Persons
With Disabilities (PWD) continue to be excluded from
socioeconomic interventions like microcredits. Therefore
finding way to allow PWD to contribute to the family welfare
by their activity is a step towards alleviation of poverty.
In this context, in 1997, the Physical Rehabilitation Centre
(PRC) of the ICRC started to implement a comprehensive
approach in the rehabilitation of the physically disabled:
aside from the functional rehabilitation, there is a socioeconomic
programme. This socioeconomic programme provides
microcredit services for patients treated within the centre.
Unlike many micocredits projects for P.W.D., physiotherapists
in Herat are involved in order to choose an appropriate
income generating activity and participate to the follow up.
Therefore it is interesting to analyse this type of programme
according to what expert consider as standards for success.
Participants: The microcredit beneficiaries of the programme
until end of 2008: 328 physical disabled persons.
Methods: The programme is described according to the standards
of Johan P. Velema. we used a descriptive method
to analyse retrospectively the data. The data comes from
the socioeconomic department of the centre. Statistics are
presented and discussed at the light of the mechanisms of
exclusions described by Simanowitz in the scientific literature.
Analysis: The programme fullfill the standards. In 2008,
Internal effectiveness (repayment rate) is 70% while the
external effectiveness is 26.3%. The impact 6 months after
completing the loan is 65%.
Results: Following the mechanism of exclusions of
Simanowitz, we could observe in Herat that: self exclusion
was minimised, exclusion by others is still a challenge as
some beneficiaries are in competitive disadvantage in the
market due to social exclusion. Exclusion by staff exists only
for paraplegics as there is a trend to prioritise the sustainability
instead of accessibility. Exclusion by design is totally
avoided.