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Biomedical subjects

M B O'Neil

Publications and source records attributed to M B O'Neil.

11 recordsLinked to original sources
PubMed1994

A randomized trial of physical rehabilitation for very frail nursing home residents.

BACKGROUND: Past studies suggest multidisciplinary interventions that include physical therapy (PT) can improve function of nursing home residents. This trial specifically evaluates effects of PT for frail long-stay nursing home residents. DESIGN: Randomized, controlled trial. SETTING: One academic nursing home and eight community nursing homes. PATIENTS: A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months. INTERVENTIONS: Patients were randomized to individually tailored one-on-one PT sessions or friendly visits (FVs) three times a week for 4 months. Physical therapy included range-of-motion, strength, balance, transfer, and mobility exercises. MAIN OUTCOME MEASURES: Performance-based physical function assessed by the Physical Disability Index; self-perceived health status assessed with the Sickness Impact Profile; observer-reported activities of daily living; and falls. RESULTS: Eighty-nine percent and 92% of PT and FV sessions, respectively, were attended; 5% and 9% of subjects dropped out in the PT group and FV group, respectively. Compared with the FV group, the PT group experienced no significant improvements in overall Physical Disability Index, Sickness Impact Profile, or activities of daily living scores. A 15.5% improvement in the mobility subscale of the Physical Disability Index was seen (95% confidence interval [CI], 6.4% to 24.7%); no benefits in range-of-motion, strength, or balance subscales were found. Compared with the FV group, the PT group used assistive devices for bed mobility tasks less often (P = .06) and were less likely to use assistive devices and wheelchairs for locomotion (P < .005). There were 79 falls in the PT group vs 60 falls in the FV group (P = .11). Charge for the 4-month PT program was $1220 per subject (95% CI, $412 to $1832). CONCLUSION: This standardized physical therapy program provided modest mobility benefits for very frail long-stay nursing home residents with physical disability due to multiple comorbid conditions.

Activities of Daily Living↗
PubMed1993

The dynamic clamp: artificial conductances in biological neurons.

The dynamic clamp is a novel method that uses computer simulation to introduce conductances into biological neurons. This method can be used to study the role of various conductances in shaping the activity of single neurons, or neurons within networks. The dynamic clamp can also be used to form circuits from previously unconnected neurons. This approach makes computer simulation an interactive experimental tool, and will be useful in many applications where the role of synaptic strengths and intrinsic properties in neuronal and network dynamics is of interest.

Animals↗
PubMed1993

Development and validation of a physical performance instrument for the functionally impaired elderly: the Physical Disability Index (PDI).

Article describes development of the Physical Disability Index (PDI), an observer-administered, performance-based instrument measuring physical disability in frail-elderly persons without severe cognitive impairment. Sixty-five items in four subscales encompassing Range of Motion (ROM), Strength (STR), Balance (BAL), and Mobility (MOB) were measured. Subjects were randomly selected frail nursing home residents (N = 103) with a Folstein Mini-Mental State Exam (MMSE) score of > or = 11. Using correlation matrices, cluster analysis, and regression techniques, the scale was reduced to 54 items. All individual item values were standardized and aggregated into subscale and summary PDI scores, each with a range of 0-100. Test-retest and interrater reliability were evaluated. Discriminant and convergent validity were established using MMSE, Physical Self-Maintenance Scale (PSMS), and Sickness Impact Profile-Physical Dimension (SIP-PD). PDI is a performance-based instrument that appears to discriminate among frail individuals with differing levels of physical function. Further testing is warranted in other populations of frail-elderly persons to ascertain its applicability and generalizability.

Activities of Daily Living↗
PubMed1993

Dynamic clamp: computer-generated conductances in real neurons.

1. We describe a new method, the dynamic clamp, that uses a computer as an interactive tool to introduce simulated voltage and ligand mediated conductances into real neurons. 2. We simulate a gamma-aminobutyric acid (GABA) response of a cultured stomatogastric ganglion neuron to illustrate that the dynamic clamp effectively introduces a conductance into the target neuron. 3. To demonstrate an artificial voltage-dependent conductance, we simulate the action of a voltage-dependent proctolin response on a neuron in the intact stomatogastric ganglion. We show that shifts in the activation curve and the maximal conductance of the response produce different effects on the target neuron. 4. The dynamic clamp is used to construct reciprocal inhibitory synapses between two stomatogastric ganglion neurons that are not coupled naturally, illustrating that this method can be used to form new networks at will.

Animals↗
PubMed1992

Physical therapy assessment and treatment protocol for nursing home residents.

This article describes a standard protocol for assessing physical function in elderly nursing home residents. Major physical dimensions that are measured with the protocol include range of motion, muscle force, muscle reflex activity, sensation, soft tissue status, balance/coordination, and posture. A practical, functionally prioritized treatment model based on the assessment is also presented. The standardized assessment and treatment plan may be useful to the physical therapist in (1) planning and prioritizing treatment, (2) identifying when goals have been met, (3) recognizing when there is a need for treatment plan modification, and (4) educating physical therapy students in applying problem-solving skills in their treatment sessions.

Activities of Daily Living↗
PubMed1986

The innervation of the pyloric region of the crab, Cancer borealis: homologous muscles in decapod species are differently innervated.

The muscles of the pyloric region of the stomach of the crab, Cancer borealis, are innervated by motorneurons found in the stomatogastric ganglion (STG). Electrophysiological recording and stimulating techniques were used to study the detailed pattern of innervation of the pyloric region muscles. Although there are two Pyloric Dilator (PD) motorneurons in lobsters, previous work reported four PD motorneurons in the crab STG (Dando et al. 1974; Hermann 1979a, b). We now find that only two of the crab PD neurons innervate muscles homologous to those innervated by the PD neurons in the lobster, Panulirus interruptus. The remaining two PD neurons innervate muscles that are innervated by pyloric (PY) neurons in P. interruptus. The innervation patterns of the Lateral Pyloric (LP), Ventricular Dilator (VD), Inferior Cardiac (IC), and PY neurons were also determined and compared with those previously reported in lobsters. Responses of the muscles of the pyloric region to the neurotransmitters, acetylcholine (ACh) and glutamate, were determined by application of exogenous cholinergic agonists and glutamate. The effect of the cholinergic antagonist, curare, on the amplitude of the excitatory junctional potentials (EJPs) evoked by stimulation of the pyloric motor nerves was measured. These experiments suggest that the differences in innervation pattern of the pyloric muscles seen in crab and lobsters are also associated with a change in the neurotransmitter active on these muscles. Possible implications of these findings for phylogenetic relations of decapod crustaceans and for the evolution of neural circuits are discussed.

Acetylcholine↗
PubMed1986

A GABA-activated chloride-conductance not blocked by picrotoxin on spiny lobster neuromuscular preparations.

Conductance increases to gamma-aminobutyric acid (GABA) were recorded in the gm6b and opener muscle of the spiny lobsters, Panulirus interruptus and P. argus. GABA-evoked responses were insensitive to picrotoxin at concentrations as high as 5 X 10(-5) M. Some blockade by picrotoxin was observed at higher concentrations. In normal physiological saline, the reversal potential of the Panulirus GABA-induced response was near the resting potential. The reversal potential was unaffected by reductions in sodium and calcium. Reduction of chloride by 50% resulted in a greater than 10 mV shift in the reversal potential of the GABA-induced response. Muscimol was able to mimic the action of GABA while baclofen was without effect. Bicuculline was a weak blocker. Avermectin B1a irreversibly increased the chloride permeability of the gm6b membrane. This conductance increase was blocked by picrotoxin over a range of concentrations similar to those required for blockade of the GABA-induced response. GABA-induced responses of the gm6b muscle of Homarus americanus were blocked almost completely by picrotoxin 10(-6) M. Sensitivity to picrotoxin is not invariably associated with GABA-activated chloride-mediated conductance increases. It is suggested that alteration in the binding-site for picrotoxin on the GABA-activated chloride-ion channel does not change other functional characteristics of the GABA-induced response.

Action Potentials↗
PubMed1981

Spontaneous heterograft aortic valve failure.

Glutaraldehyde-treated porcine aortic valve prostheses have been in clinical use for ten years. The long-term durability of these valves remains unknown although they have functioned well in most large clinical series for more than five years. At the present time, several manufacturers produce bioprostheses mounted on flexible stents. This report concerns the failure of an Edwards porcine xenograft in the aortic position 15 months following implantation. At reoperation, the right and left coronary leaflets of the explanted valve were torn from the aortic wall. The loss of wall integrity suggests that during the process of mounting the xenograft on the flexible stent, the aortic walls of the bioprosthesis may have been thinned beyond a critical point of maintenance of wall strength. The pathological and clinical findings of similar cases are reviewed.

Aortic Valve Stenosis↗
PubMed1979

Cardial myxomas: a clinical diagnostic challenge.

Our experience consists of seven intracardiac myxomas in five patients seen over an 8 year period. It includes one patient who had three primary tumors, each anatomically distinct, occurring at 4 year intervals. The initial clinical presentation included embolic phenomena, unexplained neurologic symptoms, hemodynamic obstruction, and vague systemic illness. Preoperative diagnosis was confirmed by echocardiography or angiocardiography in all cases. At operation, only two of seven tumors were found to arise from the vicinity of the fossa ovalis; the other five arose from the atrial wall or ventricular septum. Wide resection of the tumors constituted the key to successful treatment. All patients have done well for periods of follow-up ranging from 6 months to 8 years. Awareness of cardiac myxoma is the key to diagnosis; treatment should be uniformly successful in all instances once the proper diagnosis has been made. Although recurrences are rare, all patients must be followed up closely for the development of new tumors, and a thorough investigation of all chambers must be conducted in patients with suspected recurrence.

Adolescent↗
PubMed1977

Periappendicitis: Clinical reality or pathologic curiosity?

The data from a retrospective study of 224 patients with preoperative diagnosis of acute appendicitis are presented. Periappendicitis was subsequently diagnosed in 5.4 per cent of these patients. More than half of these patients with periappendicitis had other intraabdominal disease demonstrable at operation. The remaining patientw with periappendicitis were followed for two years, and long-term complications were not observed. It is concluded that periappendicitis does not represent an unrecognized nonappendiceal process that requires special management.

Acute Disease↗