Biomedical subjects
Publications and source records attributed to D G Becker.
In our society, we take for granted the ability to travel with few restrictions. For most travelers, the major factor that limits travel is cost. However, for a significant number of Americans, the phrase "freedom to travel" is meaningless. These are the physically handicapped, a group with special needs that has long been denied what every American assumes to be a natural right.
The purpose of this study was to determine the position and size of flotation devices that permit deep-water exercise with the exerciser's thoracolumbar spine in a vertical position and without restriction of movement of the arms and legs. The buoyant force of the flotation device had to be at least 94.0 N to allow the exerciser to be suspended in water with the head above water. The position of the flotation devices had considerable influence on the thoracolumbar angle. When the large pad with a buoyant force of 55.0 N covered the lower abdominal wall and the small pad with a buoyant force at 39.0 N was located over the lower back, the exerciser's thoracolumbar spine assumed an almost vertical position. Anterior placement of the flotation devices resulted in marked extension of the thoracolumbar spine. Conversely, posterior placement of the buoyant devices resulted in flexion of the thoracolumbar spine. On the basis of these results, an ideal flotation device for deep-water exercise can now be developed.
The purposes of this report were to describe a successful treatment of a burn injury in a patient with multiple sclerosis as well as to outline specific aspects of therapy that contributed to minimizing the risk of complications in this challenging patient. Multiple sclerosis is the leading cause of neurologic morbidity and death among young adults. It is an inflammatory disease of the central nervous system that involves the autonomic and somatic components and is characterized by a primary destruction of myelin. The demyelinated nerves exhibit an increased temperature sensitivity that accounts for the adverse effects of elevated core temperature on the neurologic signs and symptoms of this disease. Because burn injury, infection, and vigorous exercise elicit an elevation of core temperature with an accompanying deterioration in neurologic function, lowering the elevated core body temperature is mandatory. The dysautonomias of multiple sclerosis may be as devastating as their somatic counterparts and may have life-threatening implications. In recent years, advances in our understanding of the pathophysiology of central nervous system dysfunction have enabled physicians to improve dramatically the management of symptoms in multiple sclerosis without significantly altering the progressive long-term course of the disease.
Current surgical treatment of the frontal sinus disease include external approaches to obliterate or ablate the sinus and both external and transnasal methods to restore drainage into the nasal cavity. The original Lothrop procedure resects the medial frontal sinus floor, superior nasal septum, and intersinus septum, creating a large frontonasal communication. However, as described, the external approach used in this procedure often allowed medial collapse of soft tissue and the stenosis of the nasofrontal communication. This report further relates our experience with the modified transnasal endoscopic Lothrop procedure using suction drills for cases in which frontal recess exploration had failed to relieve obstruction of the frontal sinus. We present an update of the University of Virginia experience in performing the modified Lothrop procedure in 20 patients from 10/93 to 4/95. Our findings over the follow-up period (average 12 months) have verified that this procedure is effective, with a 95% patency rate for the surgically enlarged frontal sinus ostium. When compared to osteoplastic flap with fat obliteration, the modified transnasal Lothrop procedure offers the advantages of a less invasive procedure with a shorter and usually no hospitalization, less morbidity, and the increased ability to evaluate post-operatively for recurrent disease. A patient charge analysis was also performed comparing patients undergoing frontal sinus obliteration during the same time period, revealing an additional benefit of decreased patient costs for the modified transnasal Lothrop procedure. None of our patients experienced complications, and all showed significant improvement, if not complete resolution of their symptoms. Although this procedure has produced favorable results, it should be noted that this procedure is technically demanding and will require further long term follow-up to verify its efficacy and proper role in the spectrum of surgical approaches for the treatment of chronic sinusitis.
The major objectives of water treatment of hydrotherapy pools are to disinfect the water and to balance the water appropriately. A variety of disinfectant systems utilizing either halogens, ozone, or metals have been implemented in hydrotherapy pools. Regardless of the disinfectant system employed, continual and appropriate monitoring of the system is mandatory to prevent infection. Water balancing refers to the control of the water mineral concentration so that the water does not damage the pool. Five major factors that influence water balance are pH, total alkalinity, calcium hardness, total dissolved solids, and temperature. The extent to which these five factors affect water balance can be computed by the Langelier saturation index.
Several hydrotherapy pools have been designed specifically for a variety of aquatic exercise. Aqua-Ark positions the exerciser in the center of the pool for deep-water exercise. Aqua-Trex is a shallow underwater treadmill system for water walking or jogging. Swim-Ex generates an adjustable laminar flow that permits swimming without turning. Musculoskeletal conditioning can be accomplished in the above-ground Arjo shallow-water exercise pool. A hydrotherapy pool also can be custom designed for musculoskeletal conditioning in its shallow part and cardiovascular conditioning in a deeper portion of the pool. Regardless of the type of exercise, there is general agreement that the specific exercise conducted in water requires significantly more energy expenditure than when the same exercise is performed on land.
Jogging and running in deep water (greater than or equal to 7 feet) appears to be a more efficient and safer means of aerobic exercise than jogging and running on land. Consequently, a variety of flotation devices have been developed to facilitate this deep-water exercise. A comprehensive evaluation of these devices revealed distinct performance limitations that interfered with this exercise. On the basis of the results of these studies, a new, improved flotation device has been conceptualized for individuals participating in deep-water exercise.
Our evaluation of hydrofitness devices for strengthening arm muscles has revealed several important determinants of their performance. Most importantly, the device's frontal projection should be in the shape of a paddle whose surface area can be varied to meet the individual exerciser's needs. Its weight should be light to minimize the inertial forces encountered in charging the velocity of paddle movement. Its handle should have a relatively large circumference without digital profiling. These optimal performance parameters have been recently incorporated into a new hydrofitness device that will be commercially available for aquatic exercise programs for strengthening upper extremity muscles.