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Biomedical subjects

F Biering-Sørensen

Publications and source records attributed to F Biering-Sørensen.

At least 19 recordsLinked to original sources
PubMed2003

Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury.

The purpose of the present study was to investigate the pathophysiological role of reciprocal facilitation between antagonistic motoneuron pools in spasticity. The soleus H-reflex was conditioned by prior stimulation of the peroneal nerve in 15 healthy subjects, six hemiplegic patients and 11 spinal cord injured (SCI) patients. The hemiplegic patients were tested from soon after the onset of hemiplegia and up to 2 years later. Whereas stimulation of the peroneal nerve produced short-latency inhibition of the soleus H-reflex in healthy subjects, it produced facilitation in spastic SCI and hemiplegic patients. This facilitation was demonstrated to have a low threshold compatible with activation of group I afferents and was most likely mediated by an oligosynaptic (reciprocal) excitatory pathway. The facilitation appeared in parallel with the development of hyperactive Achilles tendon reflexes, which was the only clinical finding that could be correlated positively with the facilitation. It is suggested that the appearance of reciprocal excitation plays a role in the pathophysiology of spasticity.

Achilles Tendon↗
PubMed2001

Role of the sympathoadrenergic system in adipose tissue metabolism during exercise in humans.

1. The relative roles of sympathetic nerve activity and circulating catecholamines for adipose tissue lipolysis during exercise are not known. 2. Seven paraplegic spinal cord injured (SCI, injury level T3-T5) and seven healthy control subjects were studied by microdialysis and (133)xenon washout in clavicular (Cl) and in umbilical (Um) (sympathetically decentralized in SCI) subcutaneous adipose tissue during 1 h of arm cycling exercise at approximately 60 % of the peak rate of oxygen uptake. 3. During exercise, adipose tissue blood flow (ATBF) and interstitial glycerol, lactate and noradrenaline concentrations increased significantly in both groups. Plasma catecholamine levels increased significantly less with exercise in SCI than in healthy subjects. The exercise-induced increase in interstitial glycerol concentration in subcutaneous adipose tissue was significantly lower in SCI compared with healthy subjects (SCI: 25 +/- 12 % (Cl), 36 +/- 20 % (Um); healthy: 60 +/- 17 % (Cl), 147 +/- 45 % (Um)) and the increase in ATBF was significantly lower (Cl) or similar (Um) in SCI compared with healthy subjects (SCI: 1.2 +/- 0.3 ml (100 g)(-1) min(-1) (Cl), 1.0 +/- 0.3 ml (100 g)(-1) min(-1) (Um); healthy: 2.8 +/- 0.7 ml (100 g)(-1) min(-1) (Cl), 0.6 +/- 0.3 ml (100 g)(-1) min(-1) (Um)). Accordingly, in both adipose tissues lipolysis increased less in SCI compared with healthy subjects, indicating that circulating catecholamines are important for the exercise-induced increase in subcutaneous adipose tissue lipolysis. In SCI subjects, the exercise-induced increase in subcutaneous adipose tissue lipolysis was not lower in decentralized than in sympathetically innervated adipose tissue. During exercise the interstitial noradrenaline and adrenaline concentrations were lower in SCI compared with healthy subjects (P < 0.05) and always lower than arterial plasma catecholamine concentrations (P < 0.05). 4. It is concluded that circulating catecholamines are important for the exercise-induced increase in subcutaneous adipose tissue lipolysis while sympathetic nerve activity is not.

3-Hydroxybutyric Acid↗
PubMed2001

Signals from skin mechanoreceptors used in control of a hand grasp neuroprosthesis.

We used signals from tactile mechanoreceptors in the skin of the index finger, recorded with an implanted cuff electrode, to automatically control grasp force in a hand grasp neuroprosthesis. Phasic events in the recorded nerve signal, related to mechanical events on the skin, were used to adjust electrical stimulation of hand muscles without any prior knowledge about muscle strength and properties of a held object. A simulated eating task was used to evaluate the hand grasp neuroprosthesis. When using the neuroprosthesis with feedback from natural sensors, the average grasp force could be reduced in comparison to not using feedback. Reducing grasp force is considered a major factor to decrease muscle fatigue, allowing a prolonged use of the hand grasp neuroprosthesis.

Adult↗
PubMed2001

[Use of outcome measures in physical medicine/rheumatological rehabilitation. Results of a questionnaire study].

BACKGROUND: As part of the EU-project ProESOR (Project for the European Standardisation of Outcome Measurement in Rehabilitation), a survey was undertaken to investigate the use of Outcome Measures (OM) within rehabilitation across Europe. This paper presents some of the Danish results of this survey. AIM: Evaluate the extent of use of OMs in rehabilitation. MATERIAL: All 37 Rheumatology/Physical Medicine and Rehabilitation departments and institutions in Denmark. METHOD: A questionnaire was mailed to the institutions. This included questions about the institution and its personnel, and nine diagnostic groups: Low back pain, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke, traumatic brain injury, hip and knee replacement, and lower limb amputees, with estimation of the number of patients treated and the extent of use of OMs. RESULTS: The majority of the departments treated more than 200 in- and out-patients per year. Patients with low back pain and rheumatoid arthritis were the largest patient groups, followed by patients with hip and knee replacement and stroke. OMs were most frequently used with rheumatoid arthritis and, to a lesser extent, patients with low back pain. Although many departments used one or more OM, several did not use any at all. For each diagnostic group more OMs were used if the patient was treated in a department specialised for patients with the particular diagnosis. More OMs were used with patients who tended to have longer inpatient stays. CONCLUSION: There is little consensus regarding which OMs should be used. We recommend that this challenge be taken up.

Cerebrovascular Disorders↗
PubMed2001

Muscle enzyme adaptation to training and tapering-off in spinal-cord-injured humans.

The activity of muscle metabolic enzymes depends on the amount and type of physical training. We examined muscle enzyme adaptation to prolonged training followed by a period of lowered activity in spinal-cord-injured individuals (SCI). Ten SCI [mean age 35 (SEM 2) years, mean body mass 78 (SEM 4) kg, mean time post-injury 12 (SEM 2) years and range of lesion C5-T4] were given 12 months of functional electrical stimulation of an upright cycling motion for 30 min a day, three times a week, followed by 6 months of training once a week. Activities of glycolytic (hexokinase HK, lactate dehydrogenase LDH) and oxidative (citrate synthase CS, 3-hydroxyacyl-CoA dehydrogenase HAD) enzymes were determined in biopsies of the vastus lateralis muscle taken at 0, 3, 6, 12, and 18 months of training. The degree of sympathoadrenergic activity was evaluated from arterial concentrations of catecholamines in response to acute exercise. Training three times a week induced increases (P < 0.05) in HK (150%), LDH (40%), CS (100%), and HAD (70%) activities that reached a plateau after 3 months. Peak oxygen uptake and power output during exercise by electrical stimulation rose continuously over the first 12 months. After reducing the amount of training by two-thirds, HK, LDH and CS activities remained elevated above basal levels (P < 0.05), whereas HAD, power output and maximal oxygen uptake returned to pretraining levels (P > 0.05). It is concluded that most improvements in glycolytic and mitochondrial oxidative enzyme activities induced by long-term training can be maintained in spinal-cord-injured individuals despite a marked reduction in training frequency unrelated to performance or to the degree of sympathoadrenergic impairment.

Adaptation, Physiological↗
PubMed2001

Reproducibility and validity of a questionnaire filled in by spinal cord lesioned individuals before regular follow-up.

OBJECTIVE: To speed up and focus (biennial) check-ups of out-patients with spinal cord lesions by means of a brief mail questionnaire concerning specific impairments as well as general life conditions. METHOD: A trial 69-item questionnaire was filled in twice, at home and on arrival for check-up, and, for a third time, by the physician during the consultation. Out of 115 check-ups, 107 and 105 could be included in a reproducibility and validity assessment respectively. RESULTS: Excellent agreement between the first two completions ('reproducibility') and between the markings made at home and those made by the physician ('validity') was obtained for the majority of the items. Those items not performing satisfactorily, not least those relating to defecation, were scrutinised. CONCLUSION: After revision, the questionnaire can serve the above mentioned purposes in a cost-effective and clinically satisfying manner. Further benefits are envisaged by computerised longitudinal monitoring of the patients' answers. Finally, we have pointed towards weak items/questions in our questionnaire, and we hope this can be of help to others who want to use similar questionnaires in their daily practice.

Activities of Daily Living↗
PubMed2001

Sleep disturbances in the spinal cord injured: an epidemiological questionnaire investigation, including a normal population.

STUDY DESIGN: Epidemiological review. OBJECTIVE: To evaluate sleep disturbances in the spinal cord injured. SETTING: The Clinic for Para- and Tetraplegia, Hornbaek/Copenhagen, Copenhagen University hospital, Denmark. METHODS: All patients admitted with traumatic SCI during the 20-year period 1968-1987 were reviewed. The normal population consisted of 339, 222 men and 117 women. These groups were asked to fill in the self-administered Nordic Sleep Questionnaire (NSQ) containing 21 questions. Questions were added regarding employment, smoking, alcohol, coffee or tea consumption, height and weight. The questionnaire for SCI individuals included questions about bladder emptying method, mobility, and spasms. For the SCI population age at injury, cause of injury, neurological level, and functional class were retrieved. RESULTS: Four hundred and eight SCI individuals, 331 men and 77 women, answered the NSQ corresponding to a response rate of 83.8%. Forty-seven per cent had a cervical cord lesion and about half of the population had a complete motor lesion. In comparison with the normal population the SCI individuals had greater difficulty in falling asleep, described more frequent awakenings, slept subjectively less well, were more often prescribed sleeping pills, slept more hours, took more and longer naps, and snored more and for more years. In particular, spasms, pain, paraesthesia, and troubles with voiding were claimed to be part of the sleep problems. CONCLUSION: In spite of the same average age and a higher body mass index in the normal than the SCI population, the SCI individuals showed significantly more sleep problems than the normal population.

Adolescent↗
PubMed2001

Sexual function in spinal cord lesioned men.

STUDY DESIGN: Review of literature. OBJECTIVE: To review the physical aspects related to penile erection, ejaculatory dysfunction, semen characteristics, and techniques for enhancement of fertility in spinal cord lesioned (SCL) men. SETTING: Worldwide: individuals with traumatic as well as non-traumatic SCL. RESULTS: Recommendations for management of erectile dysfunction in SCL men: If it is possible to obtain a satisfactory erection but of insufficient duration, then try to use a venous constrictor band to find out if this is sufficient to maintain the erection. Otherwise we recommend Sildenafil. If Sildenafil is not satisfactory then use intracavernous injection with prostaglandin E(1) (some SCL men may prefer cutaneous or intraurethral application). We discourage the implantation of penile prosthesis for the sole purpose of erection. Recommendations for management of ejaculatory dysfunction in SCL men: Penile vibratory stimulation (PVS) to induce ejaculation is recommended as first treatment choice. If PVS fails, SCL men should be referred for electroejaculation (EEJ). Semen characteristics: Impaired semen profiles with low motility rates are seen in the majority of SCL men. Recently reported data gives evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCL. It is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen profiles in men with chronic SCL. Fertility: Home insemination with semen obtained by PVS and introduced intravaginally in order to achieve successful pregnancies may be an option for some SCL men and their partners. The majority of SCL men will further enhance their fertility potential when using either PVS or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.

Alprostadil↗
PubMed2001

The use of outcome measures in physical medicine and rehabilitation within Europe.

The aim of the study was to survey the use of outcome measures in rehabilitation within Europe. It was envisaged that this would provide the basis for further studies on the cross-cultural validity of outcome measures. A postal questionnaire was distributed in November 1998 to 866 units providing rehabilitation. In total, 418 questionnaires were returned, corresponding to a response rate of 48%. These 418 centres treated an estimated 113,000 patients annually, undertaking 360,000 assessments. The survey focused on nine diagnostic groups: hip and knee replacement, low back pain, lower limb amputees, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke and traumatic brain injury. It identified a relatively small number of dominant outcome assessments for each diagnostic group and some variation in the preference for measures across regions. A large number of measures, however, are being used in one or a small number of locations and with relatively few patients. For rehabilitation of orthopaedic patients the majority of assessments undertaken are at the impairment level. For patients with neurological disorders the emphasis is mostly upon measures of disability.

Amputees↗
PubMed2001

Insulin action and long-term electrically induced training in individuals with spinal cord injuries.

PURPOSE: Individuals with spinal cord injuries (SCI) have an increased prevalence of insulin resistance and type 2 diabetes mellitus. In able-bodied individuals, training with large muscle groups increases insulin sensitivity and may prevent type 2 diabetes mellitus. However, individuals with SCI cannot voluntarily recruit major muscle groups, but by functional electrical stimulation (FES) they can now perform ergometer bicycle training. METHODS: Ten subjects with SCI (35 +/- 2 yr (mean +/- SE), 73 +/- 5 kg, level of lesion C6--Th4, time since injury: 12 +/- 2 yr) performed 1 yr of FES cycling (30 min x d(-1), 3 d x wk(-1) (intensive training)). Seven subjects continued 6 months with reduced training (1 d x wk(-1) (reduced training)). A sequential, hyperinsulinemic (50 mU x min(-1) x m(-2) (step 1) and 480 mU x min(-1) x m(-2) (step 2)), euglycemic clamp, an oral glucose tolerance test (OGTT), and determination of GLUT 4 transporter protein in muscle biopsies were performed before and after training. RESULTS: Insulin-stimulated glucose uptake rates increased after intensive training (from 4.9 +/- 0.5 mg x min(-1) x kg(-1) to 6.2 +/- 0.6 mg x min(-1) x kg(-1) (P < 0.008) (step 1) and from 9.0 +/- 0.8 mg x min(-1) x kg(-1) to 10.6 +/- 0.8 mg x min(-1) x kg(-1) (P = 0.103) (step 2)). With the reduction in training, insulin sensitivity decreased to a similar level as before training (P > 0.05). GLUT 4 increased by 105% after intense training and decreased again with the training reduction. The subjects had impaired glucose tolerance before and after training, and neither glucose tolerance nor insulin responses to OGTT were significantly altered by training. CONCLUSIONS: Electrically induced bicycle training, performed three times per week increases insulin sensitivity and GLUT 4 content in skeletal muscle in subjects with SCI. A reduction in training to once per week is not sufficient to maintain these effects. FES training may have a role in the prevention of the insulin resistance syndrome in persons with SCI.

Adult↗
PubMed2001

Urinary tract infections in patients with spinal cord lesions: treatment and prevention.

Even though the mortality due to urinary tract complications has decreased dramatically during the last decades in individuals with spinal cord lesions (SCL), urinary tract infections (UTI) still cause significant morbidity in this population. Complicated UTI are caused by a much wider variety of organisms in individuals with SCL than in the general population and are often polymicrobial. Escherichia coli, Pseudomonas spp., Klebsiella spp., Proteus spp., Serratia spp., Providencia spp., enterococci, and staphylococci are the most frequently isolated bacteria in urine specimens taken from individuals with SCL. There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterisation during the rehabilitation phase has been shown to lower the rate of UTI, and virtually eliminate many of the complications associated with indwelling catheters. Persons with SCL should only be treated for bacteriuria if they have symptoms. Generally, it is advisable to use antibacterial agents with little or no impact on the normal flora. Single agent therapy - in accordance with antimicrobial susceptibility test - is preferred. We advise extending treatment to at least 5 days, and in those with reinfection or relapsing UTI, at least 7 to 14 days, depending on the severity of the infection. The diagnosis of structural and/or functional risk factors is essential in order to plan an optimal treatment for UTI in individuals with SCL, which should include treatment of simultaneously occurring predisposing factors. The treatment of structural risk factors follows general urological principles, aiming for sufficient outlet from the bladder with minimal residual urine and low pressure voiding. For prevention of UTI, general cleanliness and local hygiene should be encouraged. If the patient has a reinfection or relapsing symptomatic UTI, it is important to check for inadequately treated infection and complications, which need special attention, in particular residual urine and urinary stones. No reliable evidence exists of the effectiveness of cranberry juice and other cranberry products. Prophylactic antibacterials should only be used in patients with recurrent UTI where no underlying cause can be found and managed, and in particular if the upper urinary tract is dilated. Antibacterials should not be used for the prevention of UTI in individuals with SCL and indwelling catheters. However, the use of prophylactic antibacterials for individuals with SCL using intermittent catheterisation or other methods of bladder emptying is controversial.

Anti-Bacterial Agents↗
PubMed2000

[Improved function of the hand in persons with tetraplegia using electric stimulation via implanted electrodes].

Functional Electrical Stimulation (FES) is a controlled use of electrical stimulation of muscle contractions to obtain function. FES is utilised today in the treatment of spinal cord injured individuals for diaphragmatic pacing, bladder and bowel management, ejaculation, walking and hand function, as well as conditioning. We present The Freehand System, which consists of implanted electrodes to arm and hand muscles. This system has now been implanted in the first two Nordic tetraplegics. Candidates are tetraplegics with C5-6 lesions. After implantation it may take 6-8 months before the tetraplegic person can expect to use The Freehand System completely in daily life. The tetraplegic individual can choose between two grasps. The Freehand System can for some few very physically disabled tetraplegics be a good aid to increase their level of activities of daily living and independence. Continued development in the coming years may broaden the indications with benefit for more individuals.

Activities of Daily Living↗