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Biomedical subjects

S S Fitts

Publications and source records attributed to S S Fitts.

9 recordsLinked to original sources
PubMed1999

Exercise coaching and rehabilitation counseling improve quality of life for predialysis and dialysis patients.

Advances in medical treatment have improved the rehabilitation potential of predialysis (P) and dialysis (D) patients, but deficits remain in their physical and vocational functioning. We studied 18 P (expected to begin dialysis in 6-12 months) and 18 D patients (on dialysis 1-5 years) for 1 year. Exercise coaching and rehabilitation counseling were provided at no cost for the first 6 months to half of each patient group (rehabilitation group = R); the other half were assigned randomly to controls (C). No R services were provided during 6 months of follow-up. PR walked further in 6 min at 6 months (+3.9 m) and 12 months (+4.1 m) than initially (p < 0.01). Hematocrit increased in R (p < 0.05), but not in C. Symptom scores were stable in D, worsened 21% in PC, and improved 15% in PR. Sickness impact profile scores were better in PR than PC at 6 months (p < 0.05) and 12 months (NS). Comorbidity correlated with symptoms (r = +0.34, p < 0.05), self-rated affect (r = -0.35, p < 0.05), and self-rated Karnofsky index of disability (r = -0.37, p < 0.05), but not with physician-rated affect or physician-rated Karnofsky index of disability. Thus, quality of life was stable or improved in PR, but declined in PC; PR benefited more than DR. Rehabilitation services are more beneficial before than after patients stabilize on dialysis, and quality of life monitoring should continue indefinitely.

Adolescent↗
PubMed1992

Techniques to improve function of the arm and hand in chronic hemiplegia.

We evaluated functional improvement in the upper limb of chronic (more than six months' duration) stroke patients who received one of two electrical stimulation treatments, conventional treatment, or no treatment. Twenty-two right-handed patients were assigned to one of four groups studied for 12 months posttreatment. Subjects received (1) EMG-initiated electrical stimulation of wrist extensors (EMG-stim), (2) low-intensity electrical stimulation of wrist extensors combined with voluntary contractions (B/B), (3) proprioceptive neuromuscular facilitation (PNF) exercises, or (4) no treatment. Subjects were treated for three months. Before treatment, upon completion of treatment, and three and nine months after treatment, subjects were evaluated by the Fugl-Meyer (FM) poststroke motor recovery test and by grip strength. Subjects also attempted three Jebsen-Taylor hand function tests and a finger tapping test at the same evaluation sessions, but many were unable to complete these tests. During the course of treatment, FM scores of subjects receiving PNF improved 18%, B/B improved 25%, and EMG-stim improved 42%. The aggregate FM improvement of the treated groups was significant from pretreatment to posttreatment, and the improvement was maintained at three-month and nine-month followups (all p less than .005). The treated subjects' improvement in grip strength was also maintained at both followups (p less than .10). In contrast, the control group showed no significant change in FM scores or grip strength. The four treated subjects who were able to perform the hand function tests and finger tapping at all four evaluations also improved on these tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Laterality of performance in fingertapping rate and grip strength by hemisphere of stroke and gender.

To determine whether individuals with unilateral cerebrovascular accident (CVA) have different motor abilities depending on hemisphere of lesion, we tested fingertapping rate (TAP) and grip strength (GRIP) in 20 right-handed right (R) and left (L) chronic CVA survivors and 19 right-handed age- and gender-matched controls. GRIP and TAP tests are common measures of motor function selected to distinguish rapid repetitive vs sustained performance. As expected, performance was significantly worse for contralateral-to-lesion arms than for control arms (p less than .001). Ipsilateral-to-lesion performance confirmed predictions of lateralized motor disabilities: R-GRIP in R-CVA survivors was inferior to R-GRIP in controls (p less than .05); L-TAP in L-CVA survivors was inferior to L-TAP in controls (p less than .01). In addition, male CVA survivors had the enhanced abilities predicted in the converse tests: R-TAP in R-CVA men was superior to R-TAP in controls (p less than .10); L-GRIP in L-CVA men was superior to L-GRIP in controls (p less than .01). It was concluded that individuals move differently depending on hemisphere of stroke, and some implications for the poststroke motor rehabilitation program were discussed.

Aged↗
PubMed1989

Quantification of gaps in the EMG interference pattern in chronic hemiparesis.

This study presents a quantification of the impersistence in the EMG interference pattern (IP) produced during maximal effort by patients with chronic hemiparesis. Monopolar needles were used to record from the flexor carpi radialis (FCR) and extensor carpi radialis longus (ECR) muscles of both the paretic and non-paretic sides of 19 patients with a history of unilateral CVA and 10 healthy control subjects during maximal voluntary isometric wrist flexion or extension. We found more gaps in the IP and fewer total seconds of EMG activity in paretic than in non-paretic or control forearm muscles. The number of gaps was similar in paretic FCR and ECR, but the reduced active time in paretic ECR indicates proportionally more gaps per second of EMG activity. This method provides quantitative measures of both the lapses (gaps in the IP during maximal effort and the inability to sustain EMG activity (total seconds) during long contractions. The latter measure is sufficiently sensitive to distinguish the greater impairment of a paretic wrist extensor than a paretic wrist flexor muscle, and both may prove to be valuable for future comparisons of the severity of paresis and the progress of recovery. These results represent the first quantitative confirmation of previous qualitative descriptions of impersistent recruitment.

Aged↗
PubMed1988

Recruitment and termination of electromyographic activity in the hemiparetic forearm.

Motor unit control measured by timed recruitment and termination of intramuscular electromyographic (EMG) activity provides muscle-specific quantification of deficits of the arm in chronic hemiparesis. Latencies to recruitment and termination of EMG activity of flexor carpi radialis and extensor carpi radialis longus were recorded from nine stroke patients and five age- and sex-matched control subjects, in response to buzzer signals, during maximal isometric wrist flexion and extension. Both agonist and antagonist recruitment times were slower in paretic than in control forearms (p less than .01). Termination of EMG activity occurred earlier in paretic forearms, primarily because of inability to maintain a prolonged muscular contraction. The effects of the variable lengths of testing trials reinforced these conclusions. The paretic extensor carpi radialis longus showed the greatest impairment with a very long latency to contract, and frequent failure to maintain a contraction. This study presents a new method of quantifying a common clinical problem in rehabilitation medicine.

Aged↗
PubMed1988

Co-contraction in the hemiparetic forearm: quantitative EMG evaluation.

Co-contraction of antagonist muscles is a recognized clinical phenomenon in patients surviving a cerebrovascular accident. Yet, discrepancies persist in the literature as to whether or not antagonist electromyographic activity is increased in hemiparesis. We have developed a technique to obtain simultaneous counts of motor unit activity in a wrist flexor and extensor muscle using monopolar needle electromyography. Stable stroke patients and age/sex matched control subjects were tested during maximal voluntary isometric wrist flexion and extension. Fewer agonist events (p less than 0.05) and more antagonist events (p less than 0.10) were counted in paretic than in control muscles. A co-contraction ratio of antagonist activity to total (agonist and antagonist) activity was much greater for patients than controls (p less than 0.01). We conclude that both agonist recruitment and antagonist inhibition are impaired in the hemiparetic arm.

Aged↗
PubMedDate not supplied

Six-minute walk by people with chronic renal failure. Assessment of effort by perceived exertion.

The ability to exercise among 20 people with chronic renal failure was assessed on three tests by measuring the distance walked in 6 min, heart rate change from pre-exercise to postexercise and perceived exertion. Test 1 was conducted to minimize practice effects. Ten participants received exercise coaching for 3 mo between Tests 2 and 3, and 10 individuals were in a control group. Distance walked was highly correlated on the three tests; heart rate change and perceived exertion were only slightly less consistent. Three people changed their perceived exertion by more than one point between Tests 2 and 3, and these changes obscured differences between the exercise and control groups. Exclusion of data for those who changed by more than one point equalized perceived exertion changes in the two groups and revealed a significant (P < 0.05) increase in distance in the exercise group (+21.8 m) but not in the control group (+1.5 m). The study demonstrates that, although perceived exertion ratings are intended for use in incremental exercise testing, they are also valuable for assessing consistency v change in the effort of individual participants in single-intensity testing, such as a self-paced walk.

Adult↗
PubMedDate not supplied

Body cooling may not improve somatosensory pathway function in multiple sclerosis.

We tested the hypothesis that reducing core body temperature in subjects with multiple sclerosis (MS) improves the cortical somatosensory evoked potential (SEP) response. Twenty subjects with definite MS were compared with 20 subjects without neurologic symptoms or disease. SEPs were recorded with stimulation of the tibial and median nerves unilaterally at 3.1 and 6.1 Hz. The procedure was repeated after a cooking vest and hat reduced core body temperature by an average of 0.46 +/- 0.28 degrees C. No appreciable change in latency or amplitude of the SEP responses occurred in either the control or MS group with cooling. Although the amplitude of the cortical SEP response was less at the 6.1 Hz rate than at 3.1 Hz, there were no statistically significant differences between the MS and control groups or between stimulation rates with cooling. We conclude that, although some reports suggest symptomatic improvements during cooling in subjects with MS, this improvement may not be associated with changes in the SEP.

Adult↗