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Biomedical subjects

G L Gottlieb

Publications and source records attributed to G L Gottlieb.

At least 55 records · Page 3Linked to original sources
PubMed1991

Gender differences in age effect on brain atrophy measured by magnetic resonance imaging.

A prospective sample of 69 healthy adults, age range 18-80 years, was studied with magnetic resonance imaging scans (T2 weighted, 5 mm thick) of the entire cranium. Volumes were obtained by a segmentation algorithm that uses proton density and T2 pixel values to correct field inhomogeneities ("shading"). Average (+/- SD) brain volume, excluding cerebellum, was 1090.91 ml (+/- 114.30; range, 822.19-1363.66), and cerebrospinal fluid (CSF) volume was 127.91 ml (+/- 57.62; range, 34.00-297.02). Brain volume was higher (by 5 ml) in the right hemisphere (P less than 0.0001). Men (n = 34) had 91 ml higher brain and 20 ml higher CSF volume than women (n = 35). Age was negatively correlated with brain volume [r(67) = -0.32, P less than 0.01] and positively correlated with CSF volume (r = 0.74, P less than 0.0001). The slope of the regression line with age for CSF was steeper for men than women (P = 0.03). This difference in slopes was significant for sulcal (P less than 0.0001), but not ventricular, CSF. The greatest amount of atrophy in elderly men was in the left hemisphere, whereas in women age effects were symmetric. The findings may point to neuroanatomic substrates of hemispheric specialization and gender differences in age-related changes in brain function. They suggest that women are less vulnerable to age-related changes in mental abilities, whereas men are particularly susceptible to aging effects on left hemispheric functions.

Adult↗
PubMed1991

Relativistic effects in single-joint voluntary movements.

We assume that there is an upper limit for the rate of change of controlled variables in the motor control system. Superposition of two single-joint motor programs can lead to a distortion of their simple algebraic summation similar to relativistic Lorenz transformations. Experiments were carried out with the subjects performing fast oscillatory elbow movements on the background of a smooth elbow flexion. Changes in the period of oscillations during the smooth movement were used as index of time transformations. Statistically 5%-7% changes in the period were observed for each of the subjects corresponding to the predictions of the model.

Humans↗
PubMed1991

Reconstruction of shifting elbow joint compliant characteristics during fast and slow movements.

The purpose of this study was to experimentally investigate the applicability of the equilibrium-point hypothesis to the dynamics of single-joint movements. Subjects were trained to perform relatively slow (movement time 600-1000 ms) or fast (movement time 200-300 ms) single-joint elbow flexion movements against a constant extending torque bias. They were instructed to reproduce the same time pattern of central motor command for a series of movements when the external torque could slowly and unpredictably increase, decrease, or remain constant. For fast movements, the total muscle torque was calculated as a sum of external and inertial components. Analysis of the data allowed reconstruction of the elbow joint compliant characteristics at different times during execution of the learned motor command. "Virtual" trajectories of the movements, representing time-varying changes in a central control parameter, were reconstructed and compared with the "actual" trajectories. For slow movements, the actual trajectories lagged behind the virtual ones. There were no consistent changes in the joint stiffness during slow movements. Similar analysis of experiments without voluntary movements demonstrated a lack of changes in the central parameters, supporting the assumption that the subjects were able to keep the same central motor command in spite of externally imposed unexpected torque perturbations. For the fast movements, the virtual trajectories were N-shaped, and the joint stiffness demonstrated a considerable increase near the middle of the movement. These findings contradict an hypothesis of monotonic joint compliant characteristic translation at a nearly constant rate during such movements.

Adult↗
PubMed1991

Delirium in the medically ill elderly: operationalizing the DSM-III criteria.

This prospective study determined the incidence and prevalence of delirium in 235 consecutive subjects over age 70 admitted to a general medicine hospital service. The DSM-III criteria for delirium were operationalized. Using accepted screening procedures, patients were referred for evaluation by a psychiatrist who determined whether delirium was present by applying explicit operational definitions to each of the DSM-III criteria. Data on presence and severity of each of the DSM-III symptoms were recorded. Analysis of these data indicates that the DSM-III criteria describe a discrete, recognizable syndrome. However, some of the symptoms are more specific than others in identifying the syndrome in this population.

Aged↗
PubMed1991

An equilibrium-point model for fast, single-joint movement: I. Emergence of strategy-dependent EMG patterns.

We describe a model for the regulation of fast, single-joint movements, based on the equilibrium-point hypothesis. Limb movement follows constant rate shifts of independently regulated neuromuscular variables. The independently regulated variables are tentatively identified as thresholds of a length sensitive reflex for each of the participating muscles. We use the model to predict EMG patterns associated with changes in the conditions of movement execution, specifically, changes in movement times, velocities, amplitudes, and moments of limb inertia. The approach provides a theoretical neural framework for the dual-strategy hypothesis, which considers certain movements to be results of one of two basic, speed-sensitive or speed-insensitive strategies. This model is advanced as an alternative to pattern-imposing models based on explicit regulation of timing and amplitudes of signals that are explicitly manifest in the EMG patterns.

Journal Article↗
PubMed1991

An equilibrium-point model for fast, single-joint movement: II. Similarity of single-joint isometric and isotonic descending commands.

The model for isotonic movements introduced in the preceding article in this issue is used to account for isometric contractions. Isotonic movements and isometric contractions are analyzed as consequences of one motor program acting under different peripheral conditions. Differences in isotonic and isometric EMG patterns are analyzed theoretically. Computer simulation of the EMG patterns was performed both with and without the inclusion of possible effects of reciprocal inhibition. A series of experiments was performed to test the model. The subjects made fast isotonic movements that were unexpectedly blocked at the very beginning in some of the trials. The observed differences in the EMG patterns between blocked and unblocked trials corresponded to the model's predictions. The results suggest that these differences are due to the action of a tonic stretch reflex rather than to preprogrammed reactions. The experimental and simulation findings, and also the data from the literature, are discussed in the framework of the model and the dual-strategy hypothesis. They support the hypothesis that the motor control system uses one of a few standardized subprograms, specifying a small number of parameters to match a specific task.

Journal Article↗
PubMed1990

Sleep disorders and their management. Special considerations in the elderly.

Complaints of insomnia and disordered sleep are pervasive among the elderly, and reduced total sleep time and changes in sleep architecture are considered to be normal in the aging process. Additionally, numerous medical and psychiatric disorders that are highly prevalent in the geriatric population are known to affect sleep adversely. Epidemiologic data indicate that at least 5 million older adults suffer severe disorders of sleep and that most people with severe insomnia receive no treatment for this troubling symptom. However, although the elderly comprise only about 12 percent of the American population, between 35 and 40 percent of all prescriptions for sedative hypnotics are written for people over the age of 60. Moreover, approximately 23 percent of Americans over age 85 reside in long-term care facilities, and institutionalization is an important risk factor for disordered sleep and for sedative hypnotic prescription. Consequently, the evaluation of any sedative hypnotic agent must include substantial assessment of efficacy, safety, and tolerance in geriatric patients.

Aged↗
PubMed1990

Compliant characteristics of single joints: preservation of equifinality with phasic reactions.

Electromyograms (EMGs) of elbow flexors and extensors, elbow joint angle and torque were recorded in healthy subjects in the "do not react voluntarily" paradigm. Random loading and unloading torque perturbations of different rise times (Tr) were applied. Perturbations with Tr less than 300 ms evoke a phasic increase (in case of loading) or decrease (in case of unloading) in the flexor EMGs. The shortest EMG latency of about 30 ms was observed with very rapid perturbations (Tr less or equal to 20 ms). Smooth torque changes (Tr of 500-800 ms) were not accompanied by noticeable phasic reactions. Two types of the compliant characteristics were recorded: those with a zone of relatively high stiffness at the starting point ("S-shaped" curves) and those with a relatively constant stiffness. The presence or absence of the S-shape does not depend on Tr and therefore, does not seem to depend on phasic reflex or triggered reactions. In some of the subjects who were tested twice with an intervals of 2 months, the form of the compliant characteristics changed. This finding suggests that presence or absence of the S-shape can depend upon the subject's ability to follow the "do not react voluntarily" instruction. The invariance of the compliant characteristics in the presence or absence of reflex reactions can be regarded as an example of equifinality in a case of transient perturbations generated within the motor control system.

Adult↗
PubMed1990

Using DSM-III criteria to diagnose delirium in elderly general medical patients.

Studies of delirium in general medical populations have used criteria for delirium different from current DSM-III or DSM-IIIR criteria of the American Psychiatric Association, or have used DSM-III or DSM-IIIR criteria without operationalizing the components of these criteria. Therefore this prospective study was conducted to establish an approach to operationalizing DSM-III criteria and to determine the incidence and prevalence of delirium. Two hundred thirty-five consecutive subjects age 70 and over admitted to general medicine underwent daily standardized screening. Patients with low scores on screening tests or clinical evidence suggestive of any psychiatric disorder and controls were seen by a psychiatrist, who determined whether delirium was present by applying explicit operational definitions to each component of the DSM-III criteria for delirium. We conclude that the syndrome of delirium as defined by the American Psychiatric Association is prevalent on admission among elderly on general medical services, but the number of cases developing in the hospital is much less than often stated in the literature.

Aged↗
PubMed1990

Organizing principles for single joint movements. III. Speed-insensitive strategy as a default.

1. Human subjects made discrete elbow flexions in a horizontal plane over different distances, from a stationary initial position to a visually defined stationary target 9 degrees wide. We measured joint angle, acceleration, and electromyograms (EMGs) from two agonist and two antagonist muscles. 2. Subjects made movements over four different distances following one of four different instructions. The first instructed the subject simply to choose a comfortable speed. The other three explicitly emphasized either speed, accuracy, or maintenance of the "same" speed over different distances. These instructions produced a wide range of movement velocities. 3. The initial rises of the acceleration (and therefore of the inertial torque), as well as the initial slope of the agonist EMG, were all invariant over changes in the target distance for any single instruction but were all sensitive to the given instruction. 4. Our results demonstrate that the speed-insensitive strategy is a standard or default pattern for performing movements that may be carried out for different instructions over a wide range of speeds. A uniform intensity of excitation pulse is not a byproduct of moving at maximal speed. Submaximal intensities are associated with submaximal speeds and are a selected feature of the pattern of movement control.

Acceleration↗
PubMed1990

Organizing principles for single-joint movements. IV. Implications for isometric contractions.

1. Normal human subjects made isometric pulse and step contractions about the elbow to visually defined target torques of different amplitudes and at different rates. We measured joint torque and electromyograms (EMG) from two agonist and two antagonist muscles. 2. When the task specification requires that the subject explicitly alter the rate at which torque is increased, the rates of rise of the agonist and antagonist EMG bursts covary with the rate of rise of the torque. For pulses of torque the duration of motoneuron excitation varies with the duration of the task-defined contractile event. 3. When a subject is asked to generate torques of different amplitudes without specifying a time interval, torque amplitude is positively correlated with how long, and therefore how high, the EMG rose. Subjects usually proportionately covary the strength of the agonist and antagonist contractions but are not constrained to do so. Some subjects use a strategy of varying the antagonist inversely with the agonist contraction. 4. We extend the organizing principles for the control of movement about a single joint to the control of isometric torque. These rules state that control of torque about a single joint is exercised by one of two strategies: the speed-sensitive strategy modulates the rate at which contraction rises by varying the intensity of motoneuron-pool excitation. The speed-insensitive strategy varies the duration over which contraction rises but does not change the rate. These two respective patterns of torque emerge from pulse-height and pulse-width modulation of motoneuron-pool excitation. 5. The rules defining speed-sensitive and speed-insensitive strategies for movements are broadened for isometric contractions because of the wider range of torque patterns that we observe under these conditions. We propose a step-excitation component for prolonged isometric step contractions and slowly rising ramp patterns of excitation for contractions that develop over several hundreds of milliseconds. 6. The choice of strategies is based on task-specific torque requirements. The same two strategies that control torque to produce movement apply to the control of isometric torque. Unlike movements, however, isometric tasks are more often controlled by a blending of the two patterns. Possible reasons for this are discussed.

Electromyography↗
PubMed1990

Effects of intrathecal baclofen on voluntary motor control in spastic paresis.

Intrathecal baclofen injections were given to six patients with long-standing spastic paresis resistant to any nondestructive treatment, including oral baclofen. Attempts by the patients at voluntary muscle activation before intrathecal administration of baclofen led to considerable uncontrolled coactivation of antagonist and distant muscles. After the injection, dramatic suppression of the spastic signs was accompanied by more selective voluntary muscle activation. Tonic coactivation of the antagonists and distant muscle groups during voluntary contractions was decreased while the agonist level on electromyography (EMG) was not affected (three cases) or only slightly reduced (three cases). Furthermore, in one patient with sufficient residual motor control function, there was a considerable increase in the speed of fast isotonic movements, accompanied by the emergence of the ability to generate phasic muscle bursts on EMG that were characteristic of normal motor patterns. The results suggest that baclofen exerts different effects upon reflex pathways and descending motor pathways. This therapy appears to be a promising way for improving residual motor control in patients with increased muscle tone and/or reflexes.

Baclofen↗
PubMed1990

Reflex responses to ankle perturbations during electrical stimulation of muscle: 1. Measurement techniques and preliminary examples.

Electrical stimulation of muscle has been proposed as a technique to restore function to paralyzed muscles. But, from a control stand-point, little is known about how such artificial activation interacts with the still intact spinal reflex loops. We have developed instrumentation to measure and compare ankle compliance and muscle EMG activity when the ankle is subjected to perturbations in torque or angular position from bias positions that are achieved volitionally or via electrical muscle stimulation. We deliver precise torque or position perturbations (step, ramp, sinusoidal, random) to the ankle via a pivoting footplate driven by a computer-controlled torque motor. Angular displacement, torque, acceleration, and 2 to 4 channels of electromyographic (EMG) data are collected on analog (VHS) tape and simultaneously digitized and stored. Torque or position biases to normal ankle equilibrium position are applied volitionally (for the neurologically intact) or via electrical stimulation of the Gastroc/Soleus or the Tibialis Anterior muscle (for either the neurologically intact or spinal cord injured). A special stimulator/recording amplifier permits the recording of EMG signals from the muscle being stimulated. An overview of the features and response characteristics of the perturbation system and a comparison from preliminary studies of responses at different biases achieved volitionally versus those achieved by stimulation are presented.

Ankle Joint↗
PubMed1989

Short-term effects of intrathecal baclofen in spasticity.

Six patients with long-lasting spasticity resistant to different drug therapies including oral baclofen received a bolus injection of lumbar intrathecal baclofen. Electromyographic (EMG) reactions of leg muscles (soleus, tibialis anterior, quadriceps, and hamstrings) to standard stimuli and during attempts at voluntary activation were recorded before the drug injection and up to 3 h after the injection. Responses to joint movements, H-reflexes, ankle clonus, and defensive reactions were noticeably suppressed within 30-45 min after the injection and had practically disappeared after 2 h. Ankle clonus was seen only in patients with H-reflexes, and clonus disappeared when the reflex responses to the n. tibialis stimuli were absent. A decrease in clonus EMG burst amplitudes was accompanied by a decrease in the clonus frequency. These observations favor the autooscillation hypothesis of clonus. Baclofen injection led to improvement in selective voluntary activation of leg muscles in patients with residual motor control. These results suggest that execution of voluntary motor commands in the patients suffered from functionally abnormal spinal circuitry rather than from changes in the descending motor commands. Intrathecal baclofen appears to be an effective way of eliminating increased muscle tone and spasms which can allow for voluntary motor function when it is present.

Administration, Oral↗
PubMed1989

Health services research in nursing homes: a systematic review of three clinical geriatric journals.

This article presents the results of a systematic review of five years of health services research found in nursing home studies published in three major geriatric journals. This review indicates that very little services research has been undertaken in nursing home settings. The small amount of quantitative, empirical research that has been published has suffered from research design, method, and analytic shortcomings. Nursing home research in at least one federal agency has experienced worse than average funding and disapproval rates. The implications of this review are discussed, and recommendations are made for advancing this important area of study.

Aged↗
PubMed1989

Organizing principles for single-joint movements. I. A speed-insensitive strategy.

1. Normal human subjects made discrete elbow flexions and extensions in the horizontal plane from a stationary initial position to visually defined targets at different distances with a constant inertial load or made flexions to a visually defined target with different inertial loads. We measured joint angle, acceleration, and electromyograms (EMGs) from two agonist and two antagonist muscles. 2. Subjects were instructed to move their limbs accurately but quickly to the targets. Movements of greater distances or lesser loads were performed at higher velocities. 3. Peak inertial torque, acceleration and velocity, movement time, and integrated, rectified EMG were all highly correlated with the task variables, distance and inertial load. We show that peak inertial torque can be used as a linking variable that is almost sufficient to explain all correlations between the tasks, the EMG, and movement kinematics. 4. The rate at which subjects initially developed torque to accelerate their movements was invariant over changes in the value of either task variable. The rising phase of the agonist EMG was also independent of the distance or load moved. 5. Two components were distinguished in the antagonist EMG. The first had a relatively constant latency and amplitude. It terminated on the onset of the second and larger component at a latency that was delayed as both distance and load increased. 6. The integrated, rectified antagonist EMG was proportional to inertial load and peak decelerating torque for changes in inertial load. When target distance varied, proportionality between peak decelerating torque and antagonist EMG could be found if correction was made for the effects of muscle length on the torque-EMG relationship. 7. We propose organizing principles for the control of single-joint human movements in which tasks are performed by one of two strategies. These are called speed-insensitive and speed-sensitive strategies. 8. A model is described in which movements made under a speed-insensitive strategy are executed by controlling the duration and the relative timing of amplitude invariant patterns of activation to the spinal motoneuron pools.

Elbow Joint↗
PubMed1989

Organizing principles for single-joint movements. II. A speed-sensitive strategy.

1. Normal human subjects made discrete flexions of the elbow over a fixed distance in the horizontal plane from a stationary initial position to a visually defined target. We measured joint angle, acceleration, and electromyograms (EMGs) from two agonist and two antagonist muscles. 2. Changes in movement speed were elicited either by explicit instruction to the subject or by adjusting the target width. Instructions always required accurately stopping in the target zone. 3. Peak inertial torques and accelerations, movement times, and integrated EMGs were all highly correlated with speed. We show that inertial torque can be used as a linking variable that is almost sufficient to explain all correlations between the task, the EMG, and movement kinematics. 4. When subjects perform tasks that require control of movement speed, they adjust the rate at which torque is developed by the muscles. This rate is modulated by the way in which the muscles are activated. The rate at which joint torque develops is correlated with the rate at which the agonist EMG rises as well as with integrated EMG. 5. The antagonist EMG shows two components. The latency of the first is 30-50 ms and independent of movement dynamics. The latency of the second component is proportional to movement time. The rate of rise and area of both components scale with torque. 6. We propose organizing principles for the control of single-joint movements in which tasks are performed by one of two strategies. These are called speed-insensitive and speed-sensitive strategies. 7. A model is proposed in which movements made under a speed-sensitive strategy are executed by controlling the intensity of an excitation pulse delivered to the motoneuron pool. The effect is to regulate the rate at which joint torque, and consequently acceleration, increases. 8. Movements of variable distance, speed, accuracy, and load are shown to be controlled by one of two consistent sets of rules for muscle activation. These rules apply to the control of both the agonist and antagonist muscles. Rules of activation lead to distinguishable patterns of EMG and torque development. All observable changes in movement kinematics are explained as deterministic consequences of these effects.

Elbow Joint↗