Showing papers in "Scandinavian Journal of Rehabilitation Medicine in 1977"

Oxygen uptake and cardiac output in graded arm exercise in paraplegics with low level spinal lesions.

Abstract: Oxygen uptake (V32), heart rate (fH) and cardiac output (Q, CO2-rebreathing method) were measured in 8 paraplegics with complete low level (Th6-Th12) lesions and in 1 paraplegic with a Th2 lesion during graded exercise performed on an arm ergometer. The submaximal work rates taxed about 50, 70 and 90% of the estimated functional capacity of the subjects. A linear relationship between the work rate and VO2 were assessed in the three tests. The increase of Q with increasing VO2 was accomplished by a considerable increase in fH accompanied by a slight increase in stroke volume (SV, calculated). Markedly low values of Q were found in 6 of the 9 subjects. The resulting high arterial-mixed venous blood oxygen content differences (calculated) as well as the high blood lactate concentrations (3.5-4.5 mM/l at 20-30 W and 8-11 mM/l after maximal exertion) indicate that the blood flow in the arm muscles was not adequate.

Voluminometric estimation of the degree of lymphedema and its therapy by pneumatic compression.

Abstract: The degree of lymphedema of an arm after surgical treatment of breast cancer is usually estimated by the measurement of arm circumference. In this study, the calculation was based on the volume of the arm in order to improve the estimation. The method of measuring the arm volume adopted for these experiments has been tested for precision. Measurements have been made of the decrease of volume due to treatment by lymph pulsator in edematic and healthy arms. A comparison taken between these experiments has allowed for better estimation of the efficiency of lymph pulsator treatment.

FGP assessment of postural disorders during the process of rehabilitation.

Abstract: Application of the newly developed footground pressure pattern (F.G.P.) method to a number of cranio-cerebral injured patients (C.C.I.) as well as to hemiplegics and normal subjects is made. The postural disorders in standing are assessed through modifications of the F.G.P. and different stages of the rehabilitation process may be followed up. Special parameters of the standing posture, which characterize its disorders, are presented; a diagonal pressure pattern is described. The visual qualitative analysis of the pressure pattern may also be directly useful in the physiotherapy treatment.

Back symptoms and psychological perception of work. A study among nursing aides in a geriatric hospital.

Abstract: Back symptoms and psychological perception of work : A study among nursing aides' in a geriatric hospital

Improvement of gait following functional electrical stimulation. I. Investigations on changes in voluntary strength and proprioceptive reflexes.

Abstract: Patients with central spastic paresis and equipped with peroneal stimulators sometimes experience an improvement in their gait, even when the stimulator has been switched off. The object of the present investigation was to reach a better understanding of the mechanisms operating in such cases. 7 patients were investigated on repeated occasions. It was found that some of these patients got a clear increase in isometric strength of foot dorsiflexion following 10 min of peroneal stimulation. In other cases the increase was only slight. There was an inverse relation between the increase and the strength before stimulation. The increase of strength was due, at least partly, to an increased ability to activate the foot dorsiflectors, since there was a simultaneous increase in the EMG from the anterior tibial muscle. Evidence was also obtained suggesting that the increase in strength involved not only foot dorsiflexion but also plantarflexion of the foot end extension of the knee. Following peroneal stimulation there was also a decrease of the achilles reflex and in some cases possibly also the patellar reflex. There was an inverse relation between the decrease in the achilles reflex and its strength before stimulation. It is probable that the changes in voluntary strength and reflex activity reflect conditions which can be of importance in explaining the gait improvement which is sometimes observed in patients equippped with peroneal stimulators.

The effect of electrical stimulation on the experimentally denervated rat muscle.

Abstract: The m. quadriceps of white rats was electrically stimulated after nerve crush and after nerve section. Electrically stimulated muscles showed fewer central nuclei and a greater number of necrotic single fibres. The demonstration of motor endplates could not give a reliable indication of the onset of reinnervation. The various results show the importance of the trophic influence of the nerve and raise the suspicion that electrical stimulation has a retarding effect on the atrophy but also on regeneration of the fibres. After 7 weeks the unstimulated muscles show a greater degree of regeneration than the stimulated ones.

Lean and fat component of the human thigh. The effects of immobilization in plaster and subsequent physical training.

Abstract: Changes in thigh components were investigated with the one-legged inactivity- and training-model using 22 young healthy male soccer players, who for 4-5 weeks had one leg immobilized in a cast. They were investigated before and after the cast period and after 4 weeks' physical training of the inactivated leg. Immobilization induced a significant increase in the subcutaneous thickness and a significant decrease in the circumference of the thigh (p less than 0.01). The calculated lean thigh volume was reduced from 4.93 1 to 4.10 1 (p less than 0.01), whereas the calculated fat thigh volume (1.5 1) was unchanged. The changes reversed after four weeks of progressive dynamic training, but did not reach the pre-immobilized values. Body weight decreased from 73.4 kg to 70.8 kg (p less than 0.01) during the immobilization period and was regained after the training period. The fat fraction of the body was unchanged. It is concluded that the loss in total thigh volume during inactivation in a cast is due to waste of the muscle tissue, and further that this loss is partly concealed by an unchanged fat thigh volume.

Grip function of the healthy hand in a standardized hand function test. A study of the Rancho Los Amigos test.

Abstract: In an experimental study 30 healthy subjects performed the tests of prehensile function in the Rancho Los Amigos test. The subjects were allowed a free choice of grip instead of those prescribed when the test is used for clinical purposes. The hand-grips were filmed and registered by means of a descriptive code system and the results were subjected to automatic data processing. The results showed that healthy subjects performing the RLA test used a stereo-typed grip pattern as a consequence of the uniform purpose of the hand-grips. Comparison with the results from a standardized meal study in the same subjects showed that functional assessment of a patient with a test of this type is not directly applicable to integrated daily activities, as several of the hand-grips most frequent in daily activities were rarely used. Comparison with types of grip prescribed for clinical use of the test showed that normal subjects often did not spontaneously handle the objects in the manner intended by the test.

Standardization of kinematic gait measurements and automatic pathological gait pattern diagnostics.

Abstract: The estimation of patients gait in the field of rehabilitation is the starting point for an appropirate therapy decision and convenient prosthesis or orthosis choice. The measurement and estimation of human locomotion is increasingly being transferred to every day clinical use. In recent times many systems are intended for kinematic gait parameters measurements: stroboscopic photography, movie camera, TV picture analysis, TV signal analysis, chronocyclographical measurement, polarised light goniometer, the "Selspot" system, parallelgram goniometers, exoskeleton goniometers. In the paper the role of the computer in gait measurements is also determined. The problems of the choice of parameters to be measured, unique reference coordinate systems and normal gait pattern are encountered in this work. Finally two versions of pathological gait pattern estimation are described: clinical gait analysis and mathematical quantitative gait analysis. A combination of both methods provides an efficient, compact automatic pathological gait pattern diagnostics.

Reflex dystrophy. Resting blood flow and muscle temperatures as diagnostic criteria.

Abstract: Fifty-one patients were examined following an injury of the upper extremity. Clinically, 25 patients were estimated as having reflex dystrophy, while the rest was categorized as either having a possible reflex dystrophy or acted as controls. Temperature and blood flow measurements were carried out on both extremities of the patients. The temperature of the brachioradial muscle and resting blood flow of the same segment of the forearm gave highly significant elevated values on the reflex dystrophic arms as compared with the healthy side, while the control patients revealed no such differences. Combination of these two parameters proved to give a specificity and sensitivity that high that they can be recommended as a diagnostic tool. A quantitative measurement and exact diagnosis make controlled trials on this group of patients easier in the future.

The grip pattern of the healthy hand during eating.

Abstract: Thirty subjects with healthy hands have been studied in standardized meal experiments comprising serving, eating and drinking. The activities were filmed and the grips classified by means of a descriptive code system and analysed by automatic data processing. The investigation has resulted in new information about the grip pattern of the normal hand as well as detailed data on fingers and parts of fingers used. The study demonstrates the value of analysing hand function with reference to integrated activities.

Somatosensory cerebral evoked potentials in diagnosing brachial plexus injuries.

Abstract: Seven patients, 5 months up to 7 years after closed injury of the brachial plexus, were stimulated in the wrist, elbow and axilla of the extremity affected in order to invistigate average somatosensory cerebral evoked potentials (SCEP). Avulsion of most of the roots C5-Thl from the spinal cord could be objectively proved. All available clinical, contrast X-ray, and electrophysiological methods were used as well as surgical approach in the supraclavicular region or laminectomy. Sensation was objectivized by the galvanic skin reflex. Sensory nerve action potentials (NAP) were registered from the ulnar, median, radial nerves. Absence of SCEP in normal NAP helped to localize injury at the preganglionic dorsal root level. Absence of both SCEP and NAP, as seen in one case only, was of no use in the localization. Reduced SCEPs were found in most cases (with or without NAP), with prolonged latency. SCEP can be induced by even a small part of the preserved dorsal roots, e.g. part of a single one, as actually found. The presence of reduced SCEP then does not rule out avulsion of other spinal roots. SCEP from the axilla and upper arm medial side can be conducted--not along the plexus root pathway, but along the intercostobrachia nerve (Th2-3), which normally supplies that skin region.

Homonymous hemianopsia and rehabilitation in fifteen cases of C.C.I.

Abstract: Fifteen cases of severe cranio-cerebral injuries (C.C.I.) with hemianopsia and rehabilitation problems are presented. The correlation between the side of the hemianopsia, dexterity, visual motor organization, intellectual functions and rehabilitation outcome are discussed.

Post-traumatic syringomyelia. Review of the literature and two new autopsy cases.

Abstract: Two cases of post-traumatic syringomyelia studied macro- and microscopically are reported and compared with three previous autopsy cases described in the literature reviewed. The histological findings suggest that the pathogenesis may be explained by a pressure gradient in a small primary cavity. Although syringomyelia is a rare complication of traumatic spinal cord lesions, it is important to draw attention to the condition because it may be improved by surgical intervention.

Sensory feedback therapy in patients with brain insult.

Abstract: Brain insults, regardless of etiology, may disrupt the CNS servosystems concerned with patterned voluntary movements and result in disorders of such movement. To aid functional recovery, we applied in these patients oscilloscopic display of digitally integrated EMG, monitored from malfunctioning primary movers, during attempted execution of movement (sensory feedback therapy). Such display provided the patient with an immediate and continuous visual feedback loop reflecting the events underlying the movement and occuring in the monitored muscle (force, displacement and rate). This information is essential for motor control of patterned voluntary movement. Coupled with auditory reward for optimal performance, such feedback also assumed reinforcing qualities and motivated the patient to execute voluntary movements with progressive improvement. Sixty patients with longstanding CNS insult, resulting in motor impairment, were treated and followed for periods of four months to four years. One half of these patients learned and retained voluntary movements that significantly improved their functional capabilities. Temporary substitution of feedback information about fundamental events in dysfunctional muscles can apparently be of lasting value in treatment of some patients with brain insult.

Verbal learning in aphasic and non-aphasic patients with severe head injuries.

Abstract: The performances of two groups of patients, one aphasic and one non-aphasic, with severe head injuries, and a control group were compared on tests of: auditory-verbal memory span, rote learning, learning of unrelated words, concrete and abstract, and substance recall. The non-aphasics scored significantly lower than the controls in all tests but substance recall (immediate) and the aphasics did so in all tests. The aphasics were significantly worse on rote learning and learning of unrelated words than patients without aphasia.

Vocational and functional assessment of clients reopened for service.

Abstract: Former clients (107) of the Massachusetts Rehabilitation Commission were evaluated to determine the reasons for their return to the Commission a second time. Clients returned to obtain physical restoration services, employment or training such as in a vocational school or college. Clients were given a vocational interview (the Goldberg Scale) and the Tufts Programmed Functional Assessment, embracing the Barthel and PULSES Profile. Work status at follow up was significantly predicted by the Goldberg Scale and the PULSES Profile. A significant number returned to work after receiving services a second time.

The biomechanical influence of traction on the cervical spine.

Abstract: The effects exerted on the cervical spine by a traction of 150 N was studied by means of an improved radiographic technique. The technique is presented together with results from a study including fifteen test subjects with and without clinical symptoms of neck pain. In a minority of discs a widening not exceeding 1 mm was seen. This widening was not correlated to presence of roentgen signs indicating degenerative disease of the disc nor to clinical symptomatology.

Tests of auditory perception in the assessment and management of patients with cerebral cranial injury.

Abstract: Special listening tests have been applied to patients with cerebral cranial injury to determine whether such tests of auditory performance will provide functional evidence of lesions which are difficult to examine physically. There have been many reports in the literature on the apparent relationship between lesions affecting portions of the central auditory nervous system and results on tests of auditory perception for speech which is either distorted in some way or presented in competing arrangements to the two ears. The premise is that these tests require integrative function of the brain while reducing the effects of conditions of the peripheral organ of hearing and of basic language functions such as symbolization and memorization. Much of the previous literature has been concerned with infiltrative lesions, such as tumors. Our rehabilitation facility serves a number of patients whose lesions are the result of injuries rather than growths or vascular accidents. The present study was undertaken, therefore, to explore the contribution of information derived from such test procedures to diagnosis and to the planning of individual programs of rehabilitation. Preliminary findings are presented for a series of patients with cerebral cranial injury.

Changes in occupation after coronary arteriography.

Abstract: This study, involving 266 white males evaluates the effect of angiographically determined mild coronary artery impairment upon occupational status. Questionnaires filled out at the time of coronary arteriography and about 13 months later showed that in the interim 65% of the patients stayed in the same occupational status, 31% changed occupational status, and 4% retired. In both younger (less than or equal to 55 years) and older men (greater than 55 years) the proportion of retirees increased after angiography. Of those who remained employed, 19% changed to jobs with higher physical demands while 11% took jobs with lower physical demands. The decision to change the job did not seem to be affected by age or the presence of angina pectoris. Comparison of this patient population with U.S. national average has shown that the presence or awareness of coronary artery disease is associated with measured increase in occupational mobility, regardless of the severity of the disease. Our findings suggest that changes in occupational status after determination of mild coronary artery disease are motivated by psychological rather than physiological factors.

The effects of message speed on auditory comprehension in patients with cerebral cranial injury.

Abstract: A brief preliminary report is presented on the effects of varying the speed of a spoken message on the performance of motor tasks by patients with cerebral cranial injury. The token test for aphasia was recorded at three different speech time compression/expansion ratios, then presented under sound field (loudspeaker) conditions to three groups of subjects, one of normal young adults as a control, the second of patients with cerebral cranial injury without evidence of aphasia, and the third containing CCI patients with aphasia. Results are reported for speech speed increases (compression) of 25% and 50% and for a speed decrease (expansion) of 35%.