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Biomedical subjects

F J Kottke

Publications and source records attributed to F J Kottke.

At least 19 recordsLinked to original sources
PubMed1988

The development of physiatry before 1950.

The early development of physiatry as a specialty must be credited to a small group of men who were literally giants in the roles they played in the evolution of physiatry and of the American Academy of PM&R. Of those very early leaders, John S. Coulter, Frank H. Krusen, William Bierman, and Richard Kovacs stand out for their inspirational and conceptual leadership regarding the potentials of physiatry. The field will forever be indebted to Walter J. Zeiter for his administrative and executive abilities. Howard A. Rusk earned the approbation "Father of Rehabilitation Medicine" when he first demonstrated that rehabilitation of the ill and injured made it possible to restore meaning to life and at the same time reduce the duration and costs of disability. Finally, it is important that we appreciate the role George C. Deaver played as the progenitor, or perhaps "Grandfather" of physical medicine and rehabilitation. Although he was not an organization man--and in fact appears to have shunned them--he was the first physiatrist to use all the available tools of PM&R to rehabilitate the spinal cord injured, the patients with cerebral palsy, with the muscular dystrophies, with multiple sclerosis, and rheumatoid arthritis. At a time when these patients were being rejected and discarded as permanently disabled, Deaver was accepting them and patiently working with them to achieve the best possible outcomes through rehabilitation. And now, on to the 1950s. . .

History, 20th Century↗
PubMed1983

Strategies for recruiting medical students to physical medicine and rehabilitation.

Estimations that the incidence of need for health care among the chronically ill exceeds the need for acute episodic health care in the rest of the population indicate a misdirection of the focus of medical education. Estimates indicate not enough psychiatrists will be trained under the present program to meet the existing demands. Unless there can be some material increase in the number of psychiatrists trained, it appears that there will be extensive disability persisting because of lack of rehabilitation. Failure to expose medical students to rehabilitation, the lack of role models to demonstrate how a psychiatrist practices, and the less dramatic progress which occurs in rehabilitation all decrease the attractiveness of rehabilitation medicine for the medical student. The objective of this study was to develop suggestions for strategies to attract and recruit medical students into physical medicine and rehabilitation. The Regional Advisory Council of the Research and Training Center #2 at the University of Minnesota was asked to brainstorm as a group such suggestions. As a result 37 suggestions were generated which were grouped under 5 headings: A. Whom to recruit; B. Methods; C. Time and Place; D. Impediments; E. Advantages of a career in PM & R. Suggestions in each of the categories were then prioritized.

Career Choice↗
PubMed1982

Philosophic considerations of quality of life for the disabled.

All of us are concerned not only about the length of our lives but also about having meaningful lives. The quality of living rather than longevity is the significant consideration. For all of us a certain level of physical and material well-being, safety, and health is necessary as the basis for a satisfying life. However, that level is only the physical foundation on which we build the meaningful relationships, the social interaction, and the personal participation that provide the same fulfillment that is the epitome of quality of life. The disabled patient has a greater problem in achieving a satisfactory quality of life. He has lost, or possibly never had, the physical capacity for the necessary responses to establish and maintain the relationships, interactions, and participation that healthy persons have. As a consequence he is dependent upon the rehabilitation team to provide assistance and services to make it possible for him to achieve his optimal level of performance as the basis for the quality of his life.

Persons with Disabilities↗
PubMed1981

Muscle formation in Ehlers-Danlos syndrome.

Ehlers-Danlos Syndrome (EDS) is a familial connective tissue disorder characterized by marked joint hypermobility, skin hyperdistensibility and fragility. To determine the influence of connective tissue hyperdistensibility on muscle function, a young woman with classic EDS underwent extensive muscle function testing which included a controlled strengthening exercise program. Quantitative muscle strength testing revealed generalized muscle weakness characteristic of this disease. The strength-length relationship curve for quadriceps was shifted, implying an increased series elastic component of muscle. No inherent muscle abnormality was evident from electromyography and serum enzyme evaluation. Unusual fluctuation in maximal isometric strength output curves was found in all tested groups. A functional proprioceptive deficit was demonstrated and found correctable with training and visual compensation. Reduced joint proprioception, plus the tendency for minor subluxations from daily activities, resulted in a learned motor pattern that emphasized short jerky motions rather than sustained precise muscular contractions. From these findings, muscle function in EDS was hypothesized to be affected by connective tissue distensibility.

Adult↗
PubMed1981

Muscular strength as an index of response to therapy in childhood dermatomyositis.

Dermatomyositis, an inflammatory disease of unknown etiology, causes diffuse symmetrical weakness and atrophy, muscular pain and tenderness, induration of muscles, and the tendency to develop contractures. The disease may follow a prolonged course which can best be managed with steroids and regulation of physical activity if there is an objective criterion for determining the extent of clinical involvement. In 6 children with dermatomyositis, quantitative muscular strength was compared with clinical evaluation of the state of the disease, serum enzyme levels, and other laboratory measures of systemic inflammation. Quantitative evaluation of ankle plantar flexor strength by the method of Beasley or handgrip force by the method of Mundale indicated that muscular strength provided a better criterion for the clinical status of the patient than any of the other laboratory tests studied. In dermatomyositis, the inflammation is equally great in distal and proximal muscles when tested quantitatively. These tests, when used together with enzyme levels and clinical evaluation, permit more effective management of dermatomyositis in children.

Adolescent↗
PubMed1980

From reflex to skill: the training of coordination.

All motor activity is based on inherent reflexes and on modification of those reflexes by higher centers. The reflex patterns are developed as the result of the neuronal connections and remain consistent rather than showing variability. It is only the extent of spread of excitation through the entire distribution of the reflex pathway that changes with intensity of stimulation byt the reflex pathway remains constant. Control of reflex activity by the pyramidal system precedes and is the basis for the development of the automatic engrams of coordination. However, precise control can be exerted through the pyramidal system only when the patient is related, the effort is low, and attention is directed to the single activity being attempted. An engram is formed only by repetition of the precise pattern of that engram. In the repetition of a precise pattern the inhibition of muscles which should not be in the pattern is as important as the excitation of the muscles which participate in the pattern. Thousands of repetitions are required to begin to form an engram and millions of repetitions are necessary to perfect it. Coordination is developed in proportion to the number of repetitions of an engram practiced just below the maximal level of ability to perform. The performance of our strongest, fastest, and most complex motor patterns is a function of the extrapyramidal system.

Adult↗
PubMed1979

Cardiac output and contractility indices: establishing a standard in response to low-to-moderate level exercise in healthy men.

Measurement by impedance cardiography (ZCG) of cardiac output and contractility indices during exercise is a recent addition to exercise testing of the cardiac patient. To provide a needed standard of normal responses to exercise at integrals of resting oxygen consumption (METS), 10 healthy men were tested. Basal oxygen consumption (1MET) under standardized conditions was measured by mass spectrometry. Over several days the subjects were exercised on a treadmill at 2METS through 6METS with monitoring of heart rate, electrocardiogram, oxygen consumption per minute (VO2) and ZCG. The exercise routine was then repeated to look for test-retest effect. Values closely approximating presently accepted basal oxygen consumptions were achieved under these standardized but practical conditions. Cardiac output during sitting, fully supported rest was slightly higher than that at 2METS on treadmill owing to higher stroke volume. From 2METS through 6METS the curvilinear mean heart rate and stroke volume were mirror images, producing a linear increase in mean cardiac output which at 6METS was 145% of basal and 160% of the 2MET value, while the contractility index increased to 217% of basal. Comparison of the 2 trials revealed no significant test-retest effect.

Adult↗
PubMed1978

Stroke rehabilitation: a reconsideration of some common attitudes.

Some common, yet erroneous, attitudes and perceptions about stroke still persist. These warrant reconsideration: (1) benefits of stroke rehabilitation (including validity of its basis, life expectancy, adequacy in nursing homes, outcome prediction, cost benefits, and vocational outcome); (2) gait training (including evaluation methods, gait patterns, hand supports, sensory deficits, and types of braces); (3) effects of training on regaining balance; (4) spasticity (as a negative factor, enhancement by spring-action brace, benefit of inhibition training, and importance of antispasmotic drugs); (5) danger of early activity; (6) depression; (7) effects on patients' sexuality; (8) effects of communication impairments on learning abilities as well as effectiveness of speech therapy; (9) application of neurphysiological principles (regarding decreasing synaptic resistance, applications of principles from cerebral palsy training, and benefits of training for percept-concept-motor function deficits); and (10) research including reliability of past reports and paucity of facilities for new research.

Attitude↗
PubMed1978

Research trends in physical medicine and rehabilitation.

Titles and abstracts of the 700 papers presented in the scientific sessions of the American Congress of Rehabilitation Medicine and American Academy of Physical Medicine and Rehabilitation from 1972 to 1976 were reviewed. There were 81 papers in 1972, 123 in 1973, 131 in 1974, 158 in 1975 and 207 in 1976. Two hundred thirty-seven (34%) of the papers were presented by 11 Research and Training Centers and 463 papers (66%) were presented by other institutions. One hundred fifteen papers were related to spinal cord injury, 84 to electromyography, 57 to stroke, 51 to muscle histology, physiology and chemistry, 49 to orthotics and 43 to urologic problems. Only six papers were related to cerebral palsy, only one to myelodysplasia, 4 to burns, 8 to cancer, 13 to human sexuality and 10 to prosthetics. It is believed that appropriate funding of research and an emphasis on the neglected subjects through seminars and courses may provoke the curiosity of the research and encourage him to do research in important areas other than the few which are currently most popular.

Physical and Rehabilitation Medicine↗
PubMed1978

Stroke rehabilitation: evaluation of its quality by assessing patient outcomes.

A modified version of an outcome-oriented quality-assurance system was used to assess the care received by patients, aged 21 to 60 years, with completed stroke, who had participated for at least three weeks in a rehabilitation program. Care for 110 patients was evaluated by comparing actual results with a set of standards for outcomes produced by practicing rehabilitation professionals using small-group estimation techniques. Outcomes were better than estimated, standards having indicated that 29% of patients should be capable of self-care, while actually 43% were. When 50 of the 110 outcomes were individually investigated; only 5% of the total study population were probably not functioning at an optimal level, and 3% more might reach optimal functioning if existing follow-up procedures were extended and made more routine. Since only an estimated 3 to 6 cases per year would be affected, the cost of instituting such care would not be justified. Participants concluded that assessment of outcomes justified continuation on the existing processes for stroke rehabilitation.

Adult↗
PubMed1978

The training of coordination.

The training of coordination is generally considered a volitional activity, during which, by trial and perception of results, an individual selects the muscular activity resulting in the desired performance. This concept of volitionally directed complex coordination of multiple muscles with speed, skill, and strength does not stand the test of thorough evaluation. Attention is limited to 1 activity at a time, with the ability to shift attention not more frequently than 3 times per second. Only under special conditions can activity be limited to specific muscles during an untrained contraction without cocontraction of other muscles. However, with repeated practice of the desired activity, a pattern of performance is developed which can be carried out rapidly and forcefully without activation of other muscles. At that time, the consciousness is no longer directing the components of the activity but merely starting, maintaining, and stopping the performance. The development of these patterns, or engrams, by practice develops the capacity to automatically inhibit muscles that do not contribute to the performance of the desired pattern. The capacity for inhibition results in coordinated activation of the muscles contributing to the performance desired. Investigation of the development of coordination in many types of normal activities, as well as in neuromuscularly impaired patients, shows that engrams develop progressively by slow, precise practice of simple patterns, combined as they develop into more and more complex patterns, until the final skill is attained.

Attention↗
PubMed1977

Stroke rehabilitation: maintenance of achieved gains.

Gains made during rehabilitation following stroke were maintained or improved by the majority of rehabilitants when assessed 2 to 12 years later. Five measures of rehabilitative activity studied were self care, mobility, amount of time spent at the rehabilitant's major daily activity, vocational status, and over-all rehabilitative status. Independent variables that correlated positively with these rehabilitative functions were living at home, rather than in a nursing home, and the rehabilitant's having an accepting, rather than non-accepting, attitude about his present status. The functional levels of rehabilitation are maintained as well through education of the rehabilitant and his family as through the use of public health nursing and community resources. The interviewed rehabilitants in this study maintained the gains in function achieved during stroke rehabilitation throughout the long survival time, averaging seven to eight years; and functional loss, when it did occur, was usually secondary to a superimposed health problem. This study shows that the gains in the level of functioning achieved during stroke rehabilitation presist in long-surviving stroke patients and that the quality of life is enhanced from the perspectives of the patient and his family.

Activities of Daily Living↗
PubMed1975

Renal function in patients with spinal cord injury: the eighth year of a ten-year continuing study.

In the eighth year of a continuing study of renal function in patients with spinal cord injury, 78 percent had good function, 13 percent mild deterioration, 4 percent moderate deterioration and 5 percent severe deterioration of kidney function. No single factor was shown to be a dominant cause of decreased function. The factors most frequently associated with renal deterioration were vesicoureteral reflux, renal calculi, recurrent pyelonephritis as demonstrated by calyceal blunting, and recurrent decubitus ulcers, the latter usually in combination with other factors. Most of these factors could be prevented by good medical supervision and meticulous self-care.

Bacteriuria↗
PubMed1975

Reflex patters initiated by the secondary sensory fiber endings of muscle spindles: a proposal.

Muscle spindles have two kinds of sensory fibers, each with stretch-sensitive endings on the nuclear bag muscle fibers and the nuclear chain muscle fibers within the spindle. The stretch reflex responses initiated by the primary sensory fibers have been well defines. There are other stretch reflexes of poorly defined origin and distribution. Clinical studies on spastic patients indicate that these stretch reflexes show regional responses or regional synergies. Stretch of flexor muscles of proximal joints of an extremity causes slowly recruiting, prolonged, reflex flexion in that extremity, in the contralateral extremity and also in the ipsilateral extremity, producing the crossed extension-flexion reflex and long spinal reflex. Likewise, stretch of extensor muscles of the proximal joints initiates a similar extension reflex in the same distribution. Stretch of the distal flexors of an extremity reflexly spreads flexion through that extremity. Stretch of the distal extensors of an extremity spreads extension throughout that extremity. These reflexes can be abolished by intramuscular neurolysis with phenol. They have long internuncial pathways and involve both alpha and gamma motoneurons. The demonstration that these reflex patterns are initiated by stretch of the muscle and show characteristics similar to those shown in physiological studies by the secondary sensory spindle reflexes suggests that they are initiated by stretch of the endings of the secondary sensory fibers of muscle spindles.

Humans↗