Objective To evaluate the effectiveness and safety of Botulinum toxin-A (BTX-A) injection into detrusor to treat neurogenic detrusor overactivity in patients with spinal cord injury (SCI).Methods A total of 78 patients with SCI were treated with transurethral injection of BTX-A (300 IU dissolved in 15 ml of saline) into 30 different points of detrusor with 15 ml in every patients. Urodynamic parameters and voiding diary were assessed at baseline and 3 weeks and 3 months after the injections. Adverse events were recorded after the injection if present.Results After the first injection, 78 patients showed that the mean frequencies of incontinence decreased from 13.5 to 2.7 times per day, the mean volume of intermittent catheterization (IC) increased from 131 ml to 389 ml per time, the mean volume of incontinence decreased from 1 690 ml to 281 ml per day, the mean getting effect time was 7.6 days. 10 patients received second injection at 8.9 months after first injection, the results showed that the mean frequencies of incontinence decreased from 9.7 to 3.7 times per day, the mean IC volume increased from 108 ml to 387 ml. 6 patients received third injection at 5.8 months after second injection, the results showed that the mean frequencies of incontinence decreased from 9.2 to 3.9 times per day, the mean IC volume increased from 116 ml to 364 ml. No side effects were observed during the follow-up.Conclusion BTX-A injection into detrusor to treat neurogenic detrusor overactivity in patients with SCI seems to be an effective, safe and miniinvasive solution.

The goals of videofluoroscopy are visualization of oropharyngeal swallow physiology in the lateral and anterior/posterior plane, visualization of symptoms of swallowing disorders and assessment of efficacy of various selected treatment strategies.Analyzing videofluoroscopic evaluation results can provide the foundation for treatment planning. The session will include: Overview of normal anatomy and physiology, X-ray landmarks of structures involved in oropharyngeal swallowing, videofluorographic view of normal swallow physiology, identification of symptoms and disorders representing swallowing problems, and overview of treatment planning.

Objective To improve communication between patients with communication disorders and their health care providers. Methods A communication training session and a communication toolkit for health care workers in long-term care facilities (L-TCFs) were used before. A control group and experimental group were used to assess the effectiveness of the communication training and a toolkit. Results and Conclusion There was little benefit to the training and toolkit. However, anecdotal observations showed there were some benefits, especially with the increased use of amplifiers for patients with hearing impairment. In addition, the L-TCF is inherent with structural obstacles to successful communication that need to be taken into account when interpreting the results. More research is needed in this area.

Autism is a perplexing developmental disorder that presents itself in a variety of behavioral disorders. Research indicates that through early intervention and appropriate treatment these behaviors can be improved. This article reviews and critiques several of the current treatment programs for children with autism. These include Applied Behavioral Analysis (ABA), TEACCH,Sign Language, Facilitated Communication, Piture Exchange Comminication System (PECS), Object Exchange, Auditory Integration Therapy (AIT), and augmentative communication. When appropriate, the treatments were reviewed for their abilities to increase attention, imitation and initiation, social interaction and intentional communication, language development, and emotional regulation. The article, hopefully, provides parents and professionals a clearer choice as to what treatment is most appropriate for which child and when to use them.

In this article, I will discuss disability issues as a second and a half generation American of Chinese descent who has worked with persons with disabilities, has taught rehabilitation counseling as well as having been a rehabilitation psychologist for more than 35 years in the U.S. and Australia. I am pleased to be able to share some of my thoughts and experiences in this article that is a bit less formal than what you may expect in a professional journal. Though I hope that what I share will provoke some thinking and action from those who read these words.

The article is intended to introduce the readers to the concept and background of Web accessibility in the United States. I will first discuss different definitions of Web accessibility. The beneficiaries of accessible Web or the sufferers from inaccessible Web will be discussed based on the type of disability. The importance of Web accessibility will be introduced from the perspectives of ethical, demographic, legal, and financial importance. Web accessibility related standards and legislations will be discussed in great detail. Previous research on evaluating Web accessibility will be presented. Lastly, a system for automated Web accessibility transformation will be introduced as an alternative approach for enhancing Web accessibility.

Despite years of interventions in the United States, substance abuse continues to be a major national problem in our society. For individuals affected, it can constitute a major disability and a decrease in quality of life. Current American societal expectations are that individuals who identify they are involved in substance abuse will go to treatment, eventually recover, get off public assistance straightaway, and return to work. Most rehabilitation professionals also maintain the same expectations. The reality is that efforts of prevention do not appear to diminish the number of people with substance abuse. Traditional treatment appears to have minimal, if any, influence upon the cessation of substance abuse, and traditional vocational rehabilitation practices appear unsuited for the unique problems and types of symptoms experienced by substance abusers. Creative, yet sound, alternatives that combine effective treatment strategies and non-traditional vocational rehabilitation methods need to be explored and tested for effectiveness, and applied.

Objective To compare the features of cerebral palsy with pachygyria or periventricular leukomalacia (PVL). Methods 15 children with pachygyria and 35 children with PVL were included. Their diagnosed age, clinical subtype, complications, Gross Motor Func-tion Classification System (GMFCS) were compared. Results The diagnosed age was significantly younger (P<0.001), the GMFCS was lower (P<0.05), the incidence rate of epilepsy was higher (P<0.05), and the intelligence was significantly lower (P<0.001) in the pachygyria group than in the PVL group. Conclusion Cerebral palsy children with pachygyria develope worse than that with PVL, as well as their prog-nosis.

Objective To compare the clinical effects of palpation, ultrasound and electromyography (EMG) guided injection of botuli-num toxin type A (BTX-A) on spastic equinovarus in stroke patients. Methods Stroke patients with equinovarus were randomly assigned to palpation-guided group (n=19), ultrasound-guided group (n=21) and EMG-guided group (n=19). All of the patients received injection of BTX-A 300 U in gastrocnemius, soleus and tibialis posterior, guided in their own ways. They were measured with modified Ashworth Scale (MAS), Physician Rating Scale (PRS), speed of gait, passive range of motion (PROM) of ankle dorsiflexion and eversion before and 2 weeks, 4 weeks, 8 weeks, and 12 weeks after injection. Results Compared with the baseline, all the indexes significantly improved after in-jection in all the groups (P<0.05). Compared with the EMG-guided group, the ultrasound-guided group improved significantly MAS at 4 weeks, PROM of ankle eversion at 4 and 12 weeks (P=0.046, P=0.008, P=0.038). Compared with the palpation-guided group, the ultra-sound-guided group improved significantly in MAS (P=0.015), PRS (P=0.01), PROM of ankle dorsiflexion and eversion (P=0.003, P=0.011) at 4 weeks, in MAS (P=0.002) and PROM of ankle dorsiflexion (P=0.022) at 8 weeks, in MAS (P=0.011) and PROM of ankle ever-sion (P=0.018) at 12 weeks. Compared with the palpation-guided group, the EMG-guided group improved significantly in PRS at 4weeks, PROM of ankle dorsiflexion at 4 and 8 weeks (P=0.048, P=0.08, P=0.026). There was no significantly difference in the variations with the time among 3 groups. Conclusion The correction of equinovarus in stroke patients can be obtained by BTX-A injection with any type of guidance technique. Ultrasound-guided technique is considered a valid alternative, which has a slight advantage over EMG-guided tech-nique. Both the EMG-and ultrasound-guided techniques obtained superior results to palpation-guided technique.

Cerebral ischemia tolerance was induced by exercise preconditioning, which protected the brain from injury. The detailed mechanism of exercise preconditioning protecting cerebral ischemia injury was complicated, which involving the regulation of multiple tar-get point and multi-path, such as inhibiting cell apoptosis, promoting angiogenesis in the brain, inhibiting the excessive activation of glutam-ic acid as well as the regulation of inflammation. More mechanisms were still unknown.