Computed tomography (CT) was used to explore if changes in muscle cross-sectional area and quality after anterior cruciate ligament (ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16-54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus-gracilis (STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right-leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft.

The authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful daily occupations. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 and 66 years participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a 6-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and healthrelated factors indicate that important progress was made. These findings support the use of the ELR intervention and suggest that larger randomized clinical trials are needed.

The purpose was to investigate whether deviations in gait parameters or muscular activity patterns can be detected in the injured and healthy leg of chronic ACL-deficient subjects. Sixteen medium-level active chronic ACL-deficient patients classified as "copers" (injury duration: 12-240 months, age 17-52 years) and 15 healthy subjects (age 20-33 years) walked at self-selected speed along a 10-m runway with a level force-plate. Gait specific data, ground reaction forces, knee and ankle angles, and EMG were documented. Knee laxity was increased and the functional scores (Lysholm, KOOS) decreased in the ACL- deficient subjects, whereas the Tegner activity level score was normal. Gait speed, stride length and stance time did not differ between ACL-deficient subjects and controls. Ground reaction forces (magnitude and times), as well as knee and ankle angles at selected points during stance and swing phases were normal in the ACL-deficient subjects compared to controls. The total duration of m. tibialis anterior (TA) activity was longer in ACL-deficient subjects than in controls (ACL-deficient injured leg vs. controls, P < 0.05). In addition, the onset of lateral gastrocnemius (LG) muscle activity occurred earlier in ACL-deficient patients (P < 0.03), resulting in a TA-LG cocontraction in the ACL-deficient but not in the control group. In conclusion, chronic, medium-level active ACL-deficient patients showed abnormalities in muscular activity patterns during gait compared to control subjects, whereas there were no detectable changes in ground reaction forces and 3D kinematic data. As the aberrant muscular activity pattern may be of importance for an even gait, it is proposed that EMG recordings may give additional information in the evaluation and rehabilitation of gait when the ACL is absent.

The outcome of six children in this study confirms that early haematopoietic stem cell transplantation in mucopolysaccharidosis type I, Hurler syndrome, preserves an affected child's mental ability. Consequently, it is essential that clinical recognition and early diagnosis take place, providing an additional challenge to paediatricians treating this condition.

A client-centred approach could be taken further if clients are engaged in productive discussions about challenging these 'progressive tensions'. Awareness of the meaning of home also emerged as central.