ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was undertaken to determine muscle strength of trunk flexion-extension in hemiplegic patients after stroke compared with that of normal controls. The design consisted of a nonrandomized control trial in a secondary care setting (a rehabilitation unit at a hospital facility). The subjects included 25 post-stroke male hemiplegic patients and 25 male healthy controls. The maximal peak torques of trunk flexion-extension at angular velocities of 0° (isometric contraction), 60°, 120°, and 150°/s were measured by using an isokinetic dynamometer (Cybex Trunk Extension-Flexion Unit, Cybex, Ronkonkoma, NY). Peak torque of trunk flexion and extension in hemiplegic patients was significantly smaller than that of healthy controls (P< 0.05), except isometric trunk flexion(P> 0.05). The weakness of trunk flexion-extension muscles in hemiplegic patients might be accounted for by the bilateral innervation from the motor cortex, the insufficient use of high threshold motor units, and disuse atrophy.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

There is no nerve conduction study for the thoracodorsal nerve in the literature. A conduction study for this nerve is described. Thirty healthy adults (16 males) with a mean age of 41.5 ± 10.6(range, 22-63) years were studied. The thoracodorsal nerve was stimulated at axilla and Erb's point with recording over the latissimus dorsi. The latency was 1.9 ± 0.4 (range, 1.2-2.7) ms and 3.6 ± 0.4 (range, 2.8-4.5) ms for the axillary and Erb's stimulations, respectively. The amplitude of the compound muscle action potential was 4.1 ± 1.8 mv on the right and 3.9 ± 1.4 mv on the left. The compound muscle action potential ratio was 0.8 ± 0.12 (range, 0.55-0.99). This study may be useful to evaluate the integrity of the thoracodorsal nerve and to assist in the diagnosis and prognosis of brachial plexus injury.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Our aim was to study the association of lower limb strength with maximum walking speed in disabled older women and to try to detect the reserve capacity threshold for maximum walking speed and the minimum strength required for walking at a speed of 1.22 m · s−1, which is required in crossing signaled intersections. The data are from the baseline of Women's Health and Aging Study, a population-based study on causes and course of disability. Altogether, 1,002 disabled women participated in the tests, which took place at their homes. Maximum isometric hip flexion and knee extension forces were measured on both sides using a handheld dynamometer. For analytic purposes, knee extension torque/body mass ratio (KET/BM) was calculated. Maximum walking speed was measured with a stopwatch during a 4-m walk. KET/BM had a significant effect on walking speed after controlling for number of chronic conditions, balance, use of walking aid, joint pain, age, and body height and mass. A total of 42.3% of the variation in maximum walking speed was explained by these variables. The cumulative percentage distribution of KET/BM of those able to attain a maximum walking speed of 1.22 m· s−1(n= 148) was flat to the level of 1.1 N · m · kg−1, after which it turned upward, indicating that the probability of attaining 1.22 m · s−1started to increase after that level. By using segmented linear regression analysis, 2.3 N · m · kg−1was found to be the cutoff point beyond which an increase in KET/BM did not correspond to an increase in maximum walking speed. Muscle strength was positively but not linearly associated with maximum walking speed. Strength testing may help to identify people close to functional thresholds and, thus, at risk of impaired walking, who would benefit most from strengthening exercises.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Since the last report, two additional objective structured clinical examinations (PGY-2, PGY-3, and PGY-4, as well as incoming PGY-2) have been administered. As a result, our curriculum has been modified to strengthen physical examination skills, including specific workshops. Interrater reliability of evaluators has been tested for the first time to verify reliability, and refinements have been made in the standardized checklist grading system. The interrater grading of history-taking had good reliability (0.73-0.96), as did neurological and spine physical examination (0.84-0.88). The interrater grading reliability of small and large joint examination was more problematic (0.46-0.62) because of examiners' inability to have full visibility, evaluator's fatigue, and confusing evaluation scoring descriptions. We now use a two-point grading scale (correct or incorrect) for history but continue a three-point scale (correct, partially correct, or incorrect) for physical examination. The examination schedule is being modified to add more encounters, give time for trainee feedback, and further refinement of grading expectations for a more efficient and reliable scoring system.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Decision makers at the federal and state level are considering, and some states have enacted, a reduction in total United States residency positions, a shift in emphasis from specialist to generalist training, a need for programs to join together in training consortia to determine local residency position allocation strategy, a reduction in funding of international medical graduates, and a reduction in funding beyond the first certificate or a total of five years. A 5-page, 24-item questionnaire was sent to all physiatry residency training directors. The objective was to discern a descriptive database of physiatry training programs and how their institutions might respond to cuts in graduate medical education funding. Fifty-eight (73%) of the questionnaires were returned. Most training directors believe that their primary mission is to train general physiatrists and, to a much lesser extent, to train subspecialty or research fellows. Directors were asked how they might handle reductions in house staff such as using physician extenders, shifting clinical workload to faculty, hiring additional faculty, and funding physiatry residents from practice plans and endowments. Physiatry has had little experience (29%; 17/58) with voluntary graduate medical education consortiums, but most (67%; 34/58) seem to feel that if a consortium system is mandated, they would favor a local or regional over a national body because they do not believe the specialty has a strong enough national stature. The major barriers to a consortium for graduate medical education allocation were governance, academic, fiscal, bureaucratic, and competition.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Low bone mass, functional impairment, low muscle strength, and postural instability are predictors of the risk of fracture in an elderly person. The purpose of this study was to investigate the functional impact of an unvarying long-term exercise program to be carried out at home. The exercises had been shown to delay bone loss in an elderly population. At the Department of Physical Medicine and Rehabilitation, University of Vienna, postmenopausal women who had been stratified into exercise or control groups 5 to 10 yr ago were called in for a follow-up examination. Frequency of training, habits, and pain causing disability in activities of daily living were recorded. Walking velocity, muscle strength, and postural stability were measured. Functional assessment, blood analysis, and x-rays of the spine were performed additionally. One hundred twenty-four women aged 68.3± 6.8 yr (mean ± SD) underwent a follow-up investigation at the outpatient clinic. After 7.7 ± 1.1 yr the compliance of the training group was still 36%. Self-chosen gait velocity was slightly higher in the regular exercisers than in the controls. No intergroup differences were found for pain induced disability, muscle strength, body sway, and fracture rate. The pain disability index was significantly associated with corrected self-chosen gait velocity. The results suggest that an unvarying home-based exercise program may support general agility but does not yield enough force to improve muscle strength and postural stability in healthy, nondisabled, postmenopausal women who start exercising at the age of 60 yr. Further studies are needed to define more appropriate exercise programs for a comprehensive improvement of functional outcome in a population at high risk for osteoporosis.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID