We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity.

Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity

Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic alkalosis: Bartter and Gitelman syndromes.

Purpose To investigate the phenotype of fetal and adult human limbal cells cultured on human amniotic membrane and the ability of cultured adult human limbal cells to repair limbal stem cell deficiency in a rabbit model. Methods Human adult and fetal limbal cells were isolated and cultured either on plastic plates or on human amniotic membrane. Connexin43, p63, and keratins 3 and 12 (K3 and K12) were detected by immunofluorescence and RT-PCR. Limbal stem cell deficiency was established in rabbits using chemical ablation and mechanical debridement. Cultured adult human limbal cells were transplanted onto rabbit corneas one month after injury, then fixed and imbedded in paraffin forty days later. Immunofluorescent staining of human-nuclear antigen, p63, K3, and connexin43 identified human-specific cells, progenitor cells, and differentiated corneal epithelial cells, respectively. Results Adult and fetal cultured limbal cells appeared similar in morphology. RT-PCR results showed that cells cultured from the human adult and fetal limbal area expressed both p63 and K12, whereas cells from central adult epithelium expressed K12 only. Immunofluorescent staining showed that more cells were p63 positive when cultured on human amniotic membrane than on plastic. Double staining for p63 and connexin43 showed some p63-positive cells co-expressing connexin43. After transplantation of adult human limbal cells cultured on human amniotic membrane, injured rabbit corneas were completely reconstructed exhibiting epithelial integrity, improved corneal clarity, and little or no neovascularization. The majority of repopulated epithelial cells expressed anti-human nuclear antibody. Cells expressing p63 occurred throughout the new epithelium. Conclusions During healing, expression of p63 is not limited to epithelial stem cells but may also mark transient amplifying progenitor cells. Culture on human amniotic membrane suppresses differentiation of limbal epithelial cells and promotes the proliferation of p63 expressing cells. Amniotic membrane-cultured human limbal cells fully reconstructed rabbit corneas having limbal stem cell deficiency, with human cells providing most of the cells of the new epithelium. Expression p63 is distributed throughout the reconstructed tissue.

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Functional reconstruction of rabbit corneal epithelium by human limbal cells cultured on amniotic membrane.

The present double-blind study examined the effects of methylphenidate, cognitive therapy, and their combination in attention deficit-disordered (ADD) children. Four treatment groups were compared on measures of attentional deployment and cognitive style, tests of academic achievement, and behavioral rating scales. In contrast to a previous study conducted in this laboratory, children in this study were not receiving medication during post-testing. Results were interpreted to suggest that measurable effects of stimulant medication dissipate rapidly upon discontinuation of pharmacotherapy. The combination of methylphenidate and cognitive therapy was not found to be any more efficacious than either of the treatments studied alone. Discussion suggests that medication status at follow-up is an essential feature of research design.

Methylphenidate and cognitive therapy with ADD children: a methodological reconsideration.

The purpose of this retrospective investigation was to determine whether a relationship exists between static strength deficits in the shoulder medial (internal) rotator and elbow flexor muscles and spasticity in these muscles or their antagonists. We reviewed the records of the first 50 stroke patients with hemiparesis who met the entry criteria for the study and who were admitted over a four-month period of time. Static muscle strength was measured by hand-held dynamometry. Spasticity was graded on the Ashworth scale. Kendall's tau correlations were calculated between static muscle strength deficits and spasticity. Static strength deficits of the shoulder medial rotator and elbow flexor muscles were correlated (p less than .01) with the agonist muscles' spasticity, but not with the antagonist muscles' spasticity. Muscle group spasticity and strength deficits, therefore, appear to be covarying manifestations of cerebrovascular accidents. Clinicians, thus, may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.

Relationship between static muscle strength deficits and spasticity in stroke patients with hemiparesis

In clinical research, "samples" are studied in order to get ideas about the characteristics of the larger populations from which the samples are taken. Population characteristics are called parameters (the population mean and standard deviation are examples). Parametric statistical methods are those that require estimates of parameters and assumptions about the source populations. Familiar examples of parametric methods are the t test, analysis of variance, and Pearson's correlation coefficient. Nonparametric (NP) methods do not require estimates of population parameters. These methods are sometimes called "distribution-free" because the samples of interest can be evaluated without concern for the shape (distribution) of the values in the populations providing the samples. NP methods also are called "ranking" or "ordering" tests, because the relative size or order of the observations may be evaluated, rather than requiring actual measurements. More than 30% of the research reports that appeared between July 1982 and June 1983, in four pediatric journals, employed at least one nonparametric method. The commonly used tests were chi-square, the Fisher exact test, and various "ranking" methods. An alphabetical list of common nonparametric tests is presented, with brief comments about each. Tables are presented, arranged by types of observations, so that the nature of the data guides the user to the method that might be used.

Gregory F. Hayden

Papers

Nonparametric Methods Clinical Applications