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Biomedical subjects

A Delitto

Publications and source records attributed to A Delitto.

At least 19 recordsLinked to original sources
PubMed1992

A study of discomfort with electrical stimulation.

The primary purpose of this study was to investigate the influence of personality variables and contractile forces on magnitude estimates of pain unpleasantness and pain intensity during varying levels of neuromuscular electrical stimulation (NMES). Thirty volunteers, according to their scores on a preferred coping-style questionnaire, were assigned to one of two groups, one designated "monitors" (information seekers) and the other designated "blunters" (information avoiders). All subjects were administered varying levels of two types of NMES, one causing both afferent stimulation and muscle contraction and one causing only afferent stimulation. Subjects judged the intensity and unpleasantness of each current type using magnitude estimation. Data were analyzed using a 2 x 2 x 2 x 3 (coping style x current type x pain descriptor x current level) analysis of variance. The results indicated that the rate of increase of magnitude estimates for unpleasantness and pain intensity that corresponded to increases in current were dependent on (1) the preferred coping style of the subject, (2) whether the stimulus caused a muscle contraction, and (3) whether the subject was judging the intensity or the unpleasantness of the applied stimulus. Behavioral styles appear to affect how subjects characterize the discomfort associated with NMES, and involuntary muscle contractions contribute to the discomfort felt from NMES. These results suggest that interventions tailored to a preferred coping style may increase a subject's level of tolerance to NMES and thus provide a more beneficial treatment.

Adaptation, Psychological↗
PubMed1991

Reliability of isokinetic measurements of trunk muscle performance.

The purpose of this investigation was to assess the reliability of isokinetic trunk muscle performance. Sixty-one volunteers participated (29 men, 32 women; age range, 20-60 years). All subjects were without low-back symptoms at the time of testing. All testing was performed with the subject initially standing, using speeds of 60, 120, and 180 degrees per second. Ten repetitions of flexion and extension were performed reciprocally at each speed, with a 3-minute rest period between speeds. Test-retest intervals were 1 and 3 weeks from the initial test. Peak torque-to-body-weight ratios, extension-to-flexion ratios, and average work per repetition were calculated for each speed for flexion and extension. Data were analyzed with analysis of variance, intraclass correlation coefficients, and Pearson correlation coefficients. Intraclass correlation coefficient values ranged from .74 to .88 for measurements derived from peak torque, and from .88-.93 for measurements derived from work (with the exception of .69 for men at 180 degrees/sec). Standard error of measurements ranged from 8 to 32 ft-lb, with a tendency to increase with increasing speeds. It was concluded that, when using this protocol, isokinetic measurements of muscle function offer the clinician sensitive and reliable measurements of trunk muscle performance and that incorporating increased practice with women and longer rest periods with men may further decrease error associated with these isokinetic trunk strength measurements.

Adult↗
PubMed1990

Isokinetic dynamometry.

Quantitative muscle performance assessments require standardized protocols and logical explication of raw scores, regardless of technique used. A very expensive dynamometer is not a substitute for competent personnel carrying out strength assessments, and well-thought-out interpretations of the data.

Adult↗
PubMed1990

Two theories of muscle strength augmentation using percutaneous electrical stimulation.

Electrical stimulation of muscle is a commonly used, well-substantiated strategy that physical therapists use to augment strength in patients with muscle weakness. Two distinctly different theories of strength augmentation using percutaneous muscle stimulation are presented. The first theory proposes that augmentation of muscle strength with electrically elicited muscle contractions occurs in a similar manner to augmentation of muscle strength with voluntary exercise. Electrically elicited muscle contractions of relatively high intensity with low numbers of repetitions strengthen muscle proportionally to the external load on the muscle in a manner that is equivalent to voluntary contraction. The second theory proposes that augmentation of muscle strength using percutaneous stimulation is fundamentally different from augmentation of strength with voluntary exercise. This theory uses the physiological differences between electrically elicited and voluntary contractions, such as the reversal of motor unit recruitment order, as a basis for argument. Both theories are partially substantiated using published literature. Strategies for testing both theories are also presented.

Electric Stimulation Therapy↗
PubMed1990

Type II fiber activation with electrical stimulation: a preliminary report.

Electrical stimulation to augment or maintain muscle performance has been well documented. The purpose of this preliminary report is to present the results of a single-case study conducted to determine the order of activation of skeletal muscle fibers as a result of electrical stimulation. The subject's quadriceps femoris muscles were electrically stimulated at 80% of maximal isometric torque. Pre-stimulation and immediate post-stimulation muscle biopsy samples were obtained, and a modification of the glucogen-depletion method was used to determine activation of muscle fibers. The pre-stimulation muscle biopsy sample demonstrated uniform periodic acid-Schiff (PAS)-positive staining in all fiber types, whereas the post-stimulation muscle biopsy sample showed glycogen depletion of type II muscle fibers. The most PAS-negative muscle fibers were type IIa skeletal muscle fibers. The results of this single-case study provide evidence that electrical stimulation, as described, selectively activates type II skeletal muscle fibers. The implication of this finding is that, in many chronic diseases, type II fibers are selectively and preferentially affected. Electrical stimulation may be a clinically viable technique to use in patients with type II fiber involvement.

Adult↗
PubMed1990

Association between direction of lateral lumbar shift, movement tests, and side of symptoms in patients with low back pain syndrome.

The purpose of this study was to determine the relationship between direction of lateral lumbar shift (LLS) and 1) the occurrence of symptoms during the side-bending movement test and 2) the location of symptoms in patients with low back pain syndrome (LBS). Twenty-four patients with LBS (17 male, 7 female) with an observable LLS were studied. Side-bending movement tests were performed bilaterally, and the results were recorded as positive if symptoms occurred during the movement. The location of symptoms (right side or left side) was obtained from the patient history. Use of the chi-square statistic revealed a statistically significant relationship between the direction of the LLS and the direction of the positive side-bending movement test. Seventeen tests (71%) were positive to the contralateral side of the LLS, and 5 (21%) were positive to the ipsilateral side. Two tests (8%) were negative in both directions. There was no significant relationship between the side of symptoms and the direction of the LLS. The determination of presence and direction of an LLS is necessary in certain physical therapy management approaches. Pain or restricted side-bending movement has been used to confirm the presence of an LLS. This study confirms the clinical usefulness of the side-bending movement test for determining the presence and direction of an LLS.

Adult↗
PubMed1990

Muscle stimulators.

Explore the source record for details and available documents.

Electric Stimulation↗
PubMed1989

Electrical stimulation of quadriceps femoris in an elite weight lifter: a single subject experiment.

The response to treatment of high intensity neuromuscular electrical stimulation (NMES) to both quadriceps femoris muscles as an adjunct to ongoing weight training was evaluated using a single subject experimental design. For an elite weight lifter weekly maximal measurements of snatch (S), clean and jerk (CJ), and front squat (SQ) were obtained over 4 months during which the subject weight trained daily for 3 h. The 1st month, baseline data were collected. After baseline measurements, a 1-month period of high-intensity NMES was added to the subject's weight training. NMES was then withdrawn for 1 month and administered once more for 2 weeks. Three quadriceps femoris muscle biopsies were taken, two during the initial baseline period and one just before the end of the first stimulation period. The results showed a significant and clear relationship between performance gains and NMES administration and withdrawal. Steep gains for S, CJ, and SQ were seen after 2 weeks of stimulation, with front squat showing a 20-kg increase within the 1st week of both stimulation periods. Muscle biopsy showed an increased type I fiber area, decreased type IIa and IIb fiber area, and an increase of type II fibers after NMES. The results of this study support the use of high-dose NMES as an adjunct to weight training in elite lifters.

Adult↗
PubMed1989

Reliability of a diabetic foot evaluation.

The purpose of this study was to establish the interrater and intrarater reliability of various ankle and foot measures common to a diabetic evaluation. Bilateral biomechanical, sensory, and wound-size measurements were obtained in 31 subjects with diabetes mellitus. Twenty-five subjects were retested by the initial examiner to determine intratester reliability, and all subjects were retested by another examiner to determine intertester reliability. Both examiners participated in an extensive training period prior to the initiation of this study to minimize variability between and within measurers. Intraclass correlation coefficients for interrater and intrarater measurements ranged from .58 to .89 and from .74 to .99, respectively. The results of this study indicate that ankle and foot measurements common to a diabetic evaluation can be taken reliably between testers. We believe extensive examiner training in these clinically relevant measures can improve reliability between testers.

Adult↗
PubMed1989

Peak torque-to-body weight ratios in the trunk: a critical analysis.

The purpose of this study was to document the relationships between body weight and isokinetic extension and flexion peak torque produced by the trunk musculature. Using a dynamometer, we collected isokinetic measurements during trunk flexion and extension at speeds of 60 degrees and 120 degrees/sec on 61 healthy subjects (29 men, 32 women; 20-60 years old) while standing. Extension and flexion peak torque measurements were calculated for each subject at each speed. Male and female subjects' data were analyzed separately. Each subject's body weight was paired with peak torque at each speed, and Pearson product-moment correlation coefficients (r) were calculated. The correlation coefficients ranged from .27 to .39 for extension and from .66 to .70 for flexion, establishing a positive linear relationship between body weight and each of the isokinetic measurements. Body weight accounted for very small proportions of the variance (as low as 7%-15% in extension isokinetic measurements). In attempting to use a client's body weight to predict isokinetic peak torque measurements, the clinician should be aware that a great deal of unaccounted for variance exists. We recommend that clinicians use other variables (eg, activity level, age) in addition to body weight to control for individual differences among healthy subjects when measuring isokinetic trunk extension muscle performance.

Adult↗
PubMed1989

Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus.

The purpose of this study was to determine whether differences in sensation, ankle dorsiflexion (DF), and subtalar joint (STJ) motion exist between 1) diabetic patients with a history of plantar ulcer (DMW Group), 2) diabetic patients without a history of plantar ulcer (DMWO Group), and 3) a nondiabetic control group (NDC Group). There were 23, 23, and 24 subjects in the respective groups. The mean age for each group was 58, 63, and 60 years, respectively. The mean DF for each group was 2, 5, and 7 degrees, respectively, and the mean STJ motion was 26, 31, and 35 degrees, respectively. Mode values for sensation with Semmes-Weinstein monofilaments were 6.10, 5.07, and 4.17. The results indicate the DMW Group had significantly less sensation, DF, and STJ motion than the NDC Group (p less than .05). In the DWM Group, the ulceration was seen more often on the side with least motion. Limited DF and STJ motion may restrict the foot's ability to absorb shock and transverse rotation, contributing to the pathogenesis of plantar ulceration in the insensitive foot. Although these results demonstrate an association, not a causative relationship, we believe diabetic patients should be screened routinely for insensitivity and limited joint mobility at the feet and appropriate preventive measures should be taken.

Adolescent↗
PubMed1989

On developing expert-based decision-support systems in physical therapy: the NIOSH low back atlas.

We have described the process of the initial development of an expert-based decision-support system for the management of patients with low back syndrome. Important considerations for developing decision-support systems are reviewed, both generally and specifically. The term "expert" is dissected and discussed. Our work so far involved congregation of a number of experts and compilation of a testing protocol. We are now refining the system for specific populations and purposes.

Back Pain↗
PubMed1989

Subjective measures and clinical decision making.

I have attempted to use Feinstein's model of clinimetric indexes and his criteria as a focus for further development of measures that in physical therapy are currently considered "soft" or "subjective". I feel this development will enhance the body of knowledge by objectifying a portion of clinical assessment (eg, the patient's complaints, "subjective" portion of the POMR's SOAP format) that is in tremendous need of quantification. By making these "soft" data "hard," I feel we will enhance the decision-making power of clinicians.

Diagnostic Techniques and Procedures↗
PubMed1989

Total contact casting in treatment of diabetic plantar ulcers. Controlled clinical trial.

This study compared the treatment of total contact casting (TCC) with traditional dressing treatment (TDT) in the management of diabetic plantar ulcers. Forty patients with diabetes mellitus and a plantar ulcer but with no gross infection, osteomyelitis, or gangrene were randomly assigned to the TCC group (n = 21) or TDT group (n = 19). Age, sex, ratio of insulin-dependent diabetes mellitus to non-insulin-dependent diabetes mellitus, duration of diabetes mellitus, vascular status, size and duration of ulcer, and sensation were not significantly different between groups (P greater than .05). In the experimental group, TCC was applied on the initial visit, and subjects were instructed to limit ambulation to approximately 33% of their usual activity. Subjects in the control group were prescribed dressing changes and accommodative footwear and were instructed to avoid bearing weight on the involved extremity. Ulcers were considered healed if they showed complete skin closure with no drainage. Ulcers were considered not healed if they showed no decrease in size by 6 wk or if infection developed that required hospitalization. In the TCC group, 19 of 21 ulcers healed in 42 +/- 29 days; in the TDT group, 6 of 19 ulcers healed in 65 +/- 29 days. Significantly more ulcers healed (chi 2 = 12.4, P less than .05) and fewer infections developed (chi 2 = 4.1, P less than .05) in the TCC group. We conclude TCC is a successful method of treating diabetic plantar ulcers but requires careful application, close follow-up, and patient compliance with scheduled appointments to minimize complications.

Casts, Surgical↗
PubMed1989

Rehabilitation of the athlete with a knee injury.

Rehabilitation of the athlete with an injured knee is covered. The focus of this article is on identifying, measuring, and treating disorders commonly associated with an injured knee. If available, literature is reviewed that supports approaches suggested. If literature is not available, the authors attempt to justify suggested protocols with logic based on sound biological principles.

Athletic Injuries↗
PubMed1988

Electrically elicited co-contraction of thigh musculature after anterior cruciate ligament surgery. A description and single-case experiment.

The purpose of this article is to describe a method for strengthening the quadriceps femoris muscle in a patient after anterior cruciate ligament (ACL) surgery. The method incorporates electrically elicited co-contraction of the quadriceps femoris and hamstring muscles. A single-case experimental design based on a split-middle (ABAB) technique was used to assess the effects of the systematic administration and withdrawal of electrical stimulation with respect to changes in knee isometric extension and flexion torque and circumferential measurements of the thigh in a patient six weeks after ACL reconstruction. Results show increases in extension and flexion torque and thigh circumferential measurements that are associated with both stimulation (treatment) phases in addition to a maintenance effect demonstrated during the withdrawal phase. In this patient, the technique appears to be effective in increasing muscle strength and circumferential measurements, particularly quadriceps femoris muscle torque. Implications and suggestions for future research are included.

Adult↗
PubMed1988

Electrical stimulation versus voluntary exercise in strengthening thigh musculature after anterior cruciate ligament surgery.

Twenty patients who had undergone anterior cruciate ligament reconstructive surgery were placed randomly and independently in an Electrical Stimulation Group (n = 10) or Voluntary Exercise Group (n = 10) to compare the effectiveness of these two muscle-strengthening protocols. Patients in both groups used simultaneous contraction of quadriceps femoris and hamstring muscles during a training regimen that consisted of either voluntary exercise or electrical stimulation trials five days a week for a three-week period within the first six postoperative weeks. After patients completed the training regimen, bilateral maximal isometric measurements of gravity-corrected knee extension and flexion torque were obtained for both groups and percentages were calculated. Results showed that patients in the Electrical Stimulation Group finished the three-week training regimen with higher percentages of both extension and flexion torque when compared with patients in the Voluntary Exercise Group (extension: t = 4.35, p less than .05; flexion; t = 6.64, p less than .05). These results indicate that patients in an electrical stimulation regimen can achieve higher individual thigh musculature strength gains than patients in a voluntary exercise regimen when simultaneous contraction of thigh muscles is prescribed during an early phase of postoperative rehabilitation.

Adult↗