The initial patient encounter: a re-creation through audio- and videotapes.
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Biomedical subjects
Publications and source records attributed to D R McNeal.
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An implantable RF-powered dual channel stimulator was designed for hip stabilization. The approach included: small size, low power consumption, external powering, adjustable output current stimulus, dual channel operation an hermetic sealed electronic packaging. Thick film hybrid circuit techniques were used. The circuit and RF powering scheme were designed for low power operation with compromise to allow for linear and lateral displacements between the transmitting and receiving antenna. The output stimuli are biphasic negative going current pulses of 175 microseconds duration and 0-5 mA amplitude. Hermeticity is provided by enclosure of the electronics in a flat pack and subsequent epoxy coating of the implant assembly.
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The carry-over effect of gait-synchronized stimulation of the peroneal nerve on voluntary dorsiflexion of the paretic foot was evaluated in hemiplegic patients. The influence of providing audiovisual feedback of performance on voluntary control was also evaluated. Each patient received three test sessions separated at least one week apart. In each session, measurement of isometric torque from voluntary effort was repeated four times: before, and at 0, 30 and 60 minutes after a 20-minute walk period. Session 2 involved both peroneal stimulation during walking and performance feedback during voluntary efforts. Session 1 had stimulation only. Session 3 had feedback only. The results were inconsistent among the patients. Where increase of voluntary dorsiflexion was obtained, it was more a consequence of performance feedback than peroneal stimulation. General problems of using isometric torque produced by voluntary dorsiflexion as a measure of the carry-over effect are discussed.
A study was made of the effectiveness of two dental health education programs in an elementary school in Flint, Michigan. Following stratification by grades, random assignments of students were made by classrooms to either the Toothkeeper group or a "Traditional" group. No control groups were employed. Separate in-service training workshops were attended by the classroom teachers according to the education program to which they had been randomly assigned. An intensive 16-week program was conducted by the classroom teachers following the guidelines of the two programs. Dental examinations which included an assessment of plaque and gingivitis scores were conducted on all participants at baseline, at the end of 16 weeks, and at the conclusion of the school year, some seven months after the initiation of the program. Only minimal reductions in plaque scores were observed with either program and little comparative difference was found in the two programs at the end of the evaluation period. The Toothkeeper group experienced a somewhat greater reduction in plaque scores than the "Traditional" group during the intensive 16-week phase of the study, but these scores worsened from this time to the end of the school year. Gingivitis scores demonstrated more improvement than the reductions in plaque scores would indicate and may be related to the confounding factor of large numbers of children receiving dental treatment, especially prophylaxes during the course of this study. Differences in reductions in gingivitis between the two programs were not meaningful clinically.
The effects of electric stimulation on nerve conduction velocity of the peroneal nerve via surgically implanted electrodes was evaluated in a group of nine hemiplegic patients. After a mean duration of 25 months nerve conduction velocity averaged 47.3 meters/sec in the uninvolved and 46.1 meters/sec in the stimulated (paretic) extremity. In a control group of ten hemiplegic subjects who did not receive stimulation, nerve conduction velocity averaged 43.1 meters/sec in the hemiplegic leg, and 41.3 meters/sec in the uninvolved leg. These differences were not statistically significant. Maximum dorsiflexion strength was increased in all patients following chronic stimulation.
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