ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW: Functional MRI evidence of cortical reorganization in upper-limb stroke hemiparesis treated with constraint-induced movement therapy.Am J Phys Med Rehabil2001;80:4–12.ObjectiveThe purpose of this pilot study was to test constraint-induced movement therapy for chronic upper-limb stroke hemiparesis and to investigate the neural correlates of recovery with functional magnetic resonance imaging (MRI) in two subjects. Both subjects had been discharged from traditional therapy because no further improvement was anticipated.DesignConstraint-induced movement therapy consisted of 6 hr of daily upper-limb training for 2 wk; a restrictive mitt was worn on the nonparetic limb during waking hours. Functional MRI was performed on a 1.5-T MRI with echo-planar imaging; at the same time, the subjects attempted sequential finger-tapping.ResultsCompared with baseline, performance time improved an average of 24% immediately after training and also continued to improve up to 33% 3 mo after training. Lift, grip strength, and Motor Activity Log scores likewise improved. Initially, on functional MRI, subject 1 activated scattered regions in the ipsilateral posterior parietal and occipital cortices. Subject 2 showed almost no areas of significant activation. After training, subject 1 showed activity bordering the lesion, bilateral activation in the association motor cortices, and ipsilateral activation in the primary motor cortex. Subject 2 showed activation near the lesion site.ConclusionConstraint-induced movement therapy produced significant functional improvement and resulted in plasticity as demonstrated by functional MRI.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare manual muscle test with hand-held dynamometer measurements of knee extension strength. A secondary analysis of measurements (n= 256 knees) from 128 acute rehabilitation patients was performed.DesignKnee extensor muscle testing was conducted according to the technique of Hislop and Montgomery; 0 to 5 grades were converted to an expanded 0 to 12 scale. Dynamometry was used to measure the isometric knee extension force with ‘gravity eliminated.‘ResultsManual muscle test and dynamometer measures were highly correlated (r= 0.768;P< 0.001); the correlation was higher when the quadratic nature of the relationship was taken into account (R= 0.887;P< 0.001). Although the dynamometer forces that were associated with different manual muscle test grades differed overall (F = 67.736;P< 0.001), the forces associated with some of the higher grades did not differ statistically.ConclusionsThese findings reinforce the convergent construct validity of the manual muscle test and dynamometry measurements but challenge the discriminant construct validity of manual muscle testing. An alternative manual muscle testing grading scheme is suggested that provides for discriminant validity and retains convergent validity.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Sato Y, Kuno H, Kaji M, Tsuru T, Saruwatari N, Oizumi K: Serum &bgr;2-microglobulin reflects increased bone resorption in immobilized stroke patients.Am J Phys Med Rehabil2001;80:19–24.ObjectiveThe so-called bone-derived growth factor, &bgr;2-microglobulin, has a regulatory function in bone metabolism by stimulating osteoclast activity. We undertook this study because osteoclast activity is known to be enhanced in patients with immobilized stroke, suggesting that their &bgr;2-microglobulin concentrations may be increased.DesignWe studied 79 patients with acute stroke hemiplegia, including 36 men and 43 postmenopausal women ranging in age between 51 and 70 yr.ResultsThe mean Barthel Index was 43 and 42 for men and women, respectively. The serum &bgr;2-microglobulin concentration was increased in male and female patients, compared with the findings of 44 age-matched control subjects, and the serum concentration of pyridinoline cross-linked carboxyterminal telopeptide of type 1 collagen was also increased in male and female patients, compared with the findings of the control subjects. Serum concentrations of pyridinoline cross-linked carboxyterminal telopeptide of type 1 collagen correlated negatively with Barthel Index scores in both genders, indicating increased bone resorption caused by immobilization in these patients. Linear regression analysis revealed a positive correlation between &bgr;2-microglobulin and pyridinoline cross-linked carboxyterminal telopeptide of type 1 collagen in both genders.ConclusionsThese findings suggest that &bgr;2-microglobulin reflects osteoclastic activity in response to stroke-induced immobilization in both genders. &bgr;2-microglobulin is a useful indicator of bone resorption in patients with immobilized stroke.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Sadeghi H, Allard P, Duhaime M: Muscle power compensatory mechanisms in below-knee amputee gait.Am J Phys Med Rehabil2001;80:25–32.ObjectiveThis three-dimensional and bilateral gait study on five below-knee amputees was undertaken to demonstrate the following: (1) how hip muscle powers can compensate for the lack of ankle function on the amputated side; and (2) how these compensatory mechanisms can influence muscle power activities in the sound limb.DesignGait data were assessed by an eight-camera high-speed video system synchronized to two force plates. The three-dimensional mechanical muscle powers were calculated at the joints of the lower limbs. Significant differences between each limb were determined using the Student’sttest for paired data withP< 0.05.ResultsIn the absence of ankle plantar flexor power, hip extensors and flexors as well as hip external rotators became the major power generators, whereas hip abductors and adductors and knee extensors muscle powers became the main source of absorption. For the sound limb, increased hip extensor activity was observed, accompanied by less hip abduction-adduction activity.ConclusionsPerturbations in below-knee amputee gait affected the hip muscle powers on the amputated side in all three planes, although the hip frontal plane balance was modified in the sound limb.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveSpastic paretic stiff-legged gait, defined as reduced knee flexion in swing, has previously been attributed solely to spastic quadriceps activity. In earlier work, the authors suggested that reduced knee flexion in swing can be attributed to other indirect factors, such as poor hip flexion and abnormal foot-ankle function during gait. The present study was undertaken to determine whether toe-walking, which often occurs in conjunction with stiff-legged gait, in and of itself, might explain some of the reduced knee flexion in swing.DesignAn analysis was performed of three-dimensional kinematic data collected from able-bodied subjects while walking on their toesvs.normal heel-toe walking.ResultsPeak knee flexion was reduced significantly compared with normal heel-toe walking (42.2 ± 8.9 degrees toe-walkingvs.59.2 ± 5.7 degrees heel-toe walking;P< 0.00001).ConclusionsThis finding, which occurred when controlling for walking speed, may be clinically relevant for patients who have both a toe-walking and a stiff-legged gait pattern. Some of the reduced knee flexion in swing may be merely a consequence of toe-walking, rather than a result of other causes, such as intrinsic spasticity or abnormal muscle firing about the knee.

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:2001

数据来源: OVID