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Biomedical subjects

B J deLateur

Publications and source records attributed to B J deLateur.

At least 19 recordsLinked to original sources
PubMed1999

Exercise: effects on physical functional performance in independent older adults.

BACKGROUND: Age-related loss in physiologic capacities contributes to the decline in physical function in the elderly population. Despite the beneficial effects of exercise interventions on maximal physiologic capacity measures, the functional benefits have not been shown in independently living older adults. The objective of this study was to evaluate exercise in independent older adults for significant and meaningful improvements in physical function, not detected by commonly used measures of physical function. METHODS: In a randomized controlled study, 49 independently living men and women were assigned to either a nonexercise control group (Control; n = 26) or an exercise training group (Exercise; n = 23). Participants (age = 76+/-4) in good general health were recruited from retirement communities or apartments. The combined endurance and strength training was performed at 75% to 80% intensity; the groups met 3 times/week for 6 months of supervised sessions. Outcome measures included physical capacity, health status, and physical function using a newly developed performance test--the Continuous Scale-Physical Functional Performance test (CS-PFP). RESULTS: Compared to the Control group, the Exercise group showed significant increases in maximal oxygen consumption (11%) and muscle strength (33%). No significant differences were found between groups for changes in the Sickness Impact Profile, SF-36 scales, or the 6-minute walk. However, the CS-PFP score improved significantly in the Exercise group (14%, effect size 0.80). CONCLUSIONS: Independent older adults gain meaningful functional benefits from several months of exercise training. The public health importance of physical activity may relate not just to its role in preventing decline, but also to its role in enhancing physical function.

Activities of Daily Living↗
PubMed1996

Continuous-scale physical functional performance in healthy older adults: a validation study.

OBJECTIVE: The continuous-scale physical functional performance test (CS-PFP) is an original instrument designed to provide a comprehensive, in-depth measure of physical function that reflects abilities in several separate physical domains. It is based on a concept of physical function as the integration of physiological capacity, physical performance, and psychosocial factors. SETTING: The test was administered under standard conditions in a hospital facility with a neighborhood setting. The CS-PFP consists of a battery of 15 everyday tasks, ranging from easy to demanding, that sample the physical domains of upper and lower body strength, upper body flexibility, balance and coordination, and endurance. Participants are told to work safely but at maximal effort, and physical functional performance was measured as weight, time, or distance. Scores were standardized and scaled 0 to 12. The test yields a total score and separate physical domain scores. DESIGN: The CS-PFP was evaluated using 148 older adults-78 community dwellers, 31 long-term care facility residents living independently, and 39 residents with some dependence. MAIN OUTCOME MEASURES: Maximal physical performance assessment included measures of maximal oxygen consumption (VO2max), isokinetic strength, range of motion, gait, and balance. Psychosocial factors were measured as self-defined health status using the Sickness Impact Profile (SIP), self-perceived function using the Health Survey (SF36), and Instrumental Activities of Daily Living (IADL). RESULTS: IADL scores were not significantly different among the groups. Test-retest correlations ranged from .84 to .97 and inter-rater reliability from .92 to .99 for the CS-PFP total and 5 domains. Internal consistency was high (Cronbach's alpha, .74 to .97). Both total and individual domain CS-PFP scores were significantly different for the three groups of study participants, increasing with higher levels of independence, supporting construct validity. CS-PFP domain scores were significantly correlated with measures of maximal physical performance (VO2max, strength, etc) and with physical but not emotional aspects of self-perceived function. CONCLUSION: The CS-PFP is a valid, reliable measure of physical function, applicable to a wide range of functional levels, and having minimal floor and ceiling effect. The total and physical domains may be used to evaluate, discriminate, and predict physical functional performance for both research and clinical purposes.

Activities of Daily Living↗
PubMed1993

Patient-oriented functional outcome after unilateral lower extremity fracture.

To determine patient-perceived functional outcome after lower extremity fracture (LEF), a prospective, follow-up study of patients managed at three level I trauma centers was conducted. Patients with unilateral LEF involving the acetabulum and distally were eligible for the study. A total of 444 patients were enrolled. Of these, 363 (82%) were interviewed at 6 months postdischarge. Study patients were predominantly young (mean age 34 years), white (72%) men (71%) who had been working preinjury (78%). Their injuries resulted primarily from motor vehicle crashes (73%); 30% had more than one fracture to the same extremity. Functional status was measured using the Sickness Impact Profile (SIP), a well-validated, general health status instrument. Mean 6-month SIP scores were significantly worse (higher) than those based on preinjury activities (9.8 vs. 2.5) (p < 0.01). Overall disability levels were moderate compared with other health conditions. Analysis of the 12 subscores comprising the SIP indicated particularly high scores in ambulation (16.2 postdischarge vs. 1.1 preinjury), sleep/rest (13.1 vs. 5.1), household management (14.5 vs. 2.6), recreation (17.6 vs. 4.2), emotional well-being (9.9 vs. 2.1), and most significantly work (33.2 vs. 8.8). Of those working preinjury, only 49% had returned by 6 months. SIP scores were highest for persons with three or more fractures to the same extremity and for fracture patterns typical of high-energy forces.

Activities of Daily Living↗
PubMed1993

Physical impairment and functional outcomes six months after severe lower extremity fractures.

To determine functional outcomes after lower extremity fracture (LEF), a prospective follow-up study of patients admitted to three level I trauma centers for treatment of unilateral LEFs was conducted. In this paper we describe outcomes at 6 months after discharge from the initial hospitalization and examine the relationship between impairment and disability. A total of 444 patients met the entry criteria for the study. Of these 376 (85%) were successfully located and interviewed at 6 months; 302 (68%) returned to the trauma center at 6 months for a clinical assessment by a physical therapist. Study patients were predominantly young (mean age = 32.4), white (72%) men (70%) who were working before the injury (77%). The fractures resulted primarily from motor vehicle crashes (71%); mean hospital LOS was 12 days. Disability was measured using the Sickness Impact Profile (SIP), a well validated patient assessment of health status. The overall SIP score averaged for all patients was 10.2, denoting a moderate level of dysfunction or disability. Analysis of the 12 subscores that constitute the SIP indicate particularly high scores for ambulation (16.7 postdischarge vs. 1.2 preinjury), sleep and rest (14.0 vs. 5.1), emotional behavior (10.5 vs. 2.2), home management (15.1 vs. 2.6), recreation and pastimes (19.0 vs. 4.4), and most notably, work (33.2 vs. 8.3). Further analysis of the subgroup of patients working before the injury shows that 48% had returned to work at 6 months. Correlations between lower extremity impairment (range of motion, muscle strength, and pain) and the ambulation subscore of the SIP were high. However, correlations between impairment and more global areas of activity such as home management, work, and recreation were considerably lower. These results suggest that other factors, over and above the extent of physical impairment, significantly influence broader disability outcomes such as return to work. Further research is needed to define these factors so that effective interventions after acute care can be identified and appropriately targeted.

Activities of Daily Living↗
PubMed1993

Comprehensive analysis of energy storing prosthetic feet: Flex Foot and Seattle Foot Versus Standard SACH foot.

This study compared the mechanical and biomechanical functions, metabolic demand, and shock absorption of two dynamic elastic response (DER) prosthetic foot designs with the SACH foot. Nine individuals who had undergone unilateral below knee amputation were studied. Mechanical properties of the feet were related to gait biomechanics. Forefoot compliance is greatest for the Flex Foot and least for the SACH foot, hence, Flex Foot demonstrates (1) the longest midstance phase, (2) the greatest ankle angle range, and (3) greater forward movement of the center of pressure. There was some evidence that the DER feet produced a better push-off. However, neither the self-selected walking speed nor the metabolic rate or efficiency over a spectrum of walking speeds (73 to 120m/min) and running speeds (140 to 200m/min) was significantly different. Because no energy savings resulted for the DER feet, the release of stored energy in the flexible feet may not occur at the proper time to assist in ambulation as a result of the natural frequency of oscillation.

Adult↗
PubMed1993

Influence of cryotherapy on spasticity at the human ankle.

The application of cryotherapy to temporarily reduce spasticity is a widespread clinical practice. A method of quantifying spasticity, based on viscoelastic stiffness measurements at the ankle, was applied to objectively determine the efficacy of cryotherapy in reducing spasticity of the calf. Baseline, cryotherapy and one-hour postcryotherapy measurements of spasticity were performed in 25 subjects with clinical signs of spasticity secondary to traumatic brain injury, spinal cord injury, and stroke. A statistically significant reduction in spasticity occurred during cryotherapy. Postcryotherapy results were equivocal, although there was a tendency for diminished spasticity relative to the baseline measurement. Two subjects showed a clear aggravation of spasticity following cryotherapy, thus leading to the conclusion that dichotomous results are possible.

Adolescent↗
PubMed1992

Concentric versus combined concentric-eccentric isokinetic training programs: effect on peak torque of human quadriceps femoris muscle.

To determine the effects of isokinetic resistance training of the quadriceps, 25 male volunteers were randomly assigned to five training groups: Concentric Slow (CS), Concentric Fast (CF), Concentric-Eccentric Slow (MS), Concentric-Eccentric Fast (MF), and Control (C). In training, subjects performed 20 contractions of each quadriceps using either 60 degrees/sec or 180 degrees/sec, for both sides, five days per week for 12 weeks. Testing consisted of measurement of peak torque, at intervals of 60 degrees/sec across a spectrum of velocities ranging from plus to minus 240 degrees/sec, at 0, 4, 8, and 12 weeks. Repeated MANOVA using planned comparisons showed that all trained subjects made significant peak torque gains (p < .05), but that the gains made by MS and MF were greater. These findings suggest that the addition of an eccentric training component to a concentric isokinetic training program may allow greater peak torque gains regardless of the velocity.

Adult↗
PubMed1990

Spasticity in spinal cord injured persons: quantitative effects of baclofen and placebo treatments.

Spasticity commonly occurs after a spinal cord injury and is characterized by increased resistance to passive movement of peripheral joints. This study examined the effect of an antispasticity medication on stiffness from the myotatic reflex response generated by passive sinusoidal ankle motion. A repeated measures, multiple base-line, single-subject, double-blind design was employed. The independent variable was spasticity medication treatment, where the levels were 40 mg/day and 80 mg/day of baclofen v placebo treatment. Viscous and elastic stiffness measurements were taken at the ankle joint during a placebo base-line phase and during treatment with baclofen for five adult males with traumatic spinal cord injuries. Ankle sinusoidal oscillation frequencies were from 3 to 12 Hz during test sessions. Mean viscous and elastic stiffness scores for all frequencies were calculated for each phase of the study. Randomization tests of mean changes in stiffness measurements between each treatment phase of the study failed to provide any convincing evidence of a significant treatment effect for reduction of spasticity in the traumatic spinal cord injured subjects studied. Further testing is needed to exclude potential confounding factors before this conclusion can be confirmed. The results suggest that baclofen is not a universal treatment of choice for all individuals with spasticity resulting from traumatic spinal cord injury.

Adult↗
PubMed1990

Quantitative evaluation of sway as an indicator of functional balance in post-traumatic brain injury.

The test of sway, using different conditions of stance with measurements of the average radial deviation of the center of pressure and its path length of sway per unit of time, has been shown to be a useful clinical tool in determining balance problems in traumatic brain injury (TBI) patients. Normative values were established to determine if an individual patient's sway values fell within the normal range (mean +/- 2SD). The tests have shown good test-retest reliability for TBI patients. In addition, it has been shown that the sensitivity of the test is sufficient to identify changes in patients' performances as their clinical conditions change. It has been demonstrated that the different stance conditions of the battery of tests become progressively more difficult to perform (from comfortable stance, eyes open and eyes closed, through narrow stance, eyes open and eyes closed, to tandem stance with right or left foot forward, eyes open and eyes closed). By using these subtests, it is easy to distinguish between the performances of able-bodied patients and TBI patients with very mild balance problems. The validity of the measure has been documented by correlating the sway performance with clinical functional performance tests. The test performance also correlates with the patient's own assessment of his or her gait difficulties. The limited data available suggest that the test of sway relates difficulties in static balance to the frequency of falls. Finally, subtests permit identification of specific problems in maintaining balance as a basis for therapeutic intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Physiatric therapeutics. 1. Physiatric evaluation.

This self-directed learning module highlights advances in physiatric evaluation. It is part of the chapter on physiatric therapeutics for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section discusses goniometry, muscle strength testing, and functional and disability evaluation.

Biomechanical Phenomena↗
PubMed1990

Physiatric therapeutics. 2. Therapeutic heat and cold, electrotherapy, and therapeutic exercise.

This self-directed learning module highlights the general concepts and advances in therapeutic heat and cold, electrotherapy, and therapeutic exercise. This article is part of the chapter on physiatric therapeutics for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Special advances include lasers in medicine and the description of the appropriate type of exercise for weight control.

Cold Temperature↗
PubMed1990

Physiatric therapeutics. 3. Traction, manipulation, and massage.

This self-directed learning module highlights advances in this topic area. It is part of the chapter on physiatric therapeutics for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section discusses physiologic effects of, and indications and contraindications for, traction, manipulation, and massage. Advances covered in this section include hypotheses of pain relief in manipulation.

Humans↗
PubMed1989

Spasticity: quantitative measurements as a basis for assessing effectiveness of therapeutic intervention.

Spasticity, a common problem in upper motor neuron lesions, frequently results in uncontrolled involuntary motion that interferes with function. A quantifiable method related to the mechanical output of the muscle is needed to test and improve therapeutic intervention. A sinusoidal displacement of 5 degrees was used to measure elastic and viscous stiffness around the ankle at frequencies from 3 to 12Hz. To isolate viscoelastic response, the influences of inertia and equipment drag were eliminated. Test-retest correlation values were 0.953 for elastic and 0.992 for viscous stiffness. The elastic stiffness in 13 spastic subjects under nerve block was significantly higher than that of 13 healthy subjects (p less than or equal to 0.05), indicating early changes associated with contracture. Elastic and viscous response is expressed by the total stiffness vector containing both components, the Nyquist diagram. This diagram's pathlength from 3 to 12Hz was calculated and showed high test-retest reliability in healthy subjects. The median pathlength value for the spastic group was 98 Newton-meters/radian (N-m/rad) and, for the normal group, 24N-m/rad, a statistically significant difference (p less than or equal to 0.0001). A mathematical model of the spastic response shows that the Nyquist diagram's pathlength relates to reflex loop gain and is independent of the shift in passive properties. The model predicts a shift in passive properties during spastic responses relative to responses measured during nerve block. Thus, subtraction of passive responses measured during nerve block may not isolate the remaining reflex response, but the pathlength measure relating to the reflex response gain was unaffected, allowing evaluation of therapeutic intervention effectiveness.

Adult↗
PubMed1987

Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses.

Hemiparetic gait is characterized by slow speed and poorly coordinated movements. Because the values of gait parameters vary with changes in speed, the slow speed that is typical of hemiparetic gait necessitates applying controls for the influence of speed when comparing hemiparetic and able-bodied persons. Gait kinetics and kinematics were measured in seven hemiparetic and seven able-bodied adults to compare their gait patterns at similar speeds and to assess the effectiveness of ankle-foot orthoses which were double-stopped in 5 degrees of dorsiflexion or 5 degrees of plantarflexion. Hemiparetic persons ambulating without the orthoses had a shorter step length, longer duration stance, and shorter duration swing than normal. They displayed greater than normal flexion of the affected hip during midstance, which, by putting the center of mass farther in front of the knee, may explain the increased knee extension moment due to vertical force. Affected hip adduction during single support was less in hemiparetic persons than in able-bodied persons, indicating a decreased lateral shift to the paretic side. During the swing phase, the affected limbs of hemiparetic persons were in less knee flexion and less dorsiflexion than normal, necessitating circumduction to achieve toe clearance. Ankle-foot orthoses increased walking speed to normalize heelstrike duration through use of an optimally adjusted plantarflexion stop. An improperly adjusted orthosis may produce an exaggerated knee flexion moment resulting in knee instability.

Aged↗
PubMed1984

Local muscle blood flow and temperature responses to 915MHz diathermy as simultaneously measured and numerically predicted.

The therapeutic benefits of diathermy are tied to the relationship thought to exist between tissue temperature and augmented blood flow (BF). To further define this relationship, simultaneous measurements of thigh muscle blood flow (MBF) and temperature have been made in 15 human subjects during 915MHz, direct-contact microwave diathermy (MWD) with simultaneous skin cooling. Tissue temperatures were measured invasively by special thermistor probes designed to minimize MW-induced artifacts, and the local rates of MBF were measured by monitoring the radioactive washout of injected Xenon133 (Xe133). The experimental results have shown that the initial MBF response is characterized by a "critical temperature" behavior such that rapid increases in MBF occur for tissues above approximately 42C when diathermy power is sufficient. A proportionality between tissue temperature and MBF has not been found. To provide more useful descriptions of the temperature fields and diathermic BF responses, two-dimensional numerical thermal simulations of six of the subjects' treatments were constructed and recorded. An average peak simulated MBF of 48ml/min-100g was found for these subjects, a level in excess of previous estimates for maximum perfusion during diathermy.

Body Temperature↗