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Biomedical subjects

Shirley A Sahrmann

Publications and source records attributed to Shirley A Sahrmann.

16 recordsLinked to original sources
PubMed2006

Upper extremity muscle activation during recovery of reaching in subjects with post-stroke hemiparesis.

OBJECTIVE: To investigate upper extremity muscle activation and recovery during the first few months after stroke. METHODS: Subjects with hemiparesis following stroke were studied performing a reaching task at an acute time point (mean=9 days post-stroke) and then again at a subacute time point (mean=109 days post-stroke). We recorded kinematics and electromyographic activity of six upper extremity muscles. RESULTS: At the acute time point, the hemiparetic group had delayed muscle onsets, lower modulation ratios, and higher relative levels of muscle activation (%MVIC) during reaching than controls. From the acute to the subacute time points, improvements were noted in all three variables. By the subacute phase, muscle onsets were similar to controls, while modulation ratios remained lower than controls and %MVIC showed a trend toward being greater in the hemiparetic group. Changes in muscle activation were differentially related to changes in reaching performance. CONCLUSIONS: Our data show that improvements in muscle timing and decreases in the relative level of volitional activation may underlie improved reaching performance in the early months after stroke. SIGNIFICANCE: Given that stroke is one of the leading causes of persistent physical disability, it is important to understand how the ability to activate muscles changes during the early phases of recovery after injury.

Adult↗
PubMed2006

Relationships between sensorimotor impairments and reaching deficits in acute hemiparesis.

OBJECTIVE: To determine the relationships between sensorimotor impairments and upper extremity reaching performance during the acute phase of stroke and to determine which, if any, measures of sensorimotor impairment can predict variance in reaching performance during this phase. METHODS: Sensorimotor impairments of upper extremity (UE) strength, active range of motion, isolated movement control, light touch sensation, joint position sense, spasticity, and shoulder pain were evaluated in a group of 46 individuals with acute hemiparesis (mean time since insult = 9.2 days). Subjects performed a reaching task to a target placed on their affected side. Three-dimensional kinematic analyses were used to assess reaching speed, accuracy, and efficiency. Forward stepwise multiple linear regression analyses were used to determine which impairment was the best predictor of variance in reaching performance. RESULTS: Measures of UE strength predicted the largest proportion of variance in the speed, accuracy, and efficiency of forward reaching. Isolated movement control, somatosensory deficits, and elbow spasticity predicted smaller amounts of variance in reaching performance. CONCLUSIONS: The authors' data show that deficits in strength appear to be the most influential sensorimotor impairment associated with limited reaching performance in subjects with acute hemiparesis.

Adult↗
PubMed2006

Recovery of grasp versus reach in people with hemiparesis poststroke.

BACKGROUND AND OBJECTIVE: The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp. METHODS: Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement: speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations. RESULTS: The authors' results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accuracy were greater in the reach than the grasp acutely, and these deficits lessened such that by the 90-day time point, the relative accuracy of the 2 movements was the same. In contrast, deficits in efficiency were greater in the grasp than the reach acutely, and grasp efficiency did not recover. The majority of recovery in reaching and grasping occurred by the 90-day time point, with little change occurring between the 90-day and 1-year time points. CONCLUSIONS: The authors hypothesize that, in chronic hemiparesis, purposeful movements requiring distal control may be more impaired than purposeful movements requiring proximal control, not because of the initial lesion, but because, over the course of recovery, spared components of the descending motor systems may be able to compensate for the accuracy deficits in reaching (proximal control) but not the efficiency deficits in grasping (distal muscular control).

Adaptation, Physiological↗
PubMed2006

Trunk rotation-related impairments in people with low back pain who participated in 2 different types of leisure activities: a secondary analysis.

STUDY DESIGN: Cross-sectional, secondary analysis. OBJECTIVES: To examine whether there were differences in the numbers and types of impairments on examination between 2 groups of people with low back pain (LBP), those who participated in symmetric leisure activities and those who participated in asymmetric leisure activities. BACKGROUND: It has been proposed that people who repeatedly perform an activity that involves trunk movements and alignments in the same direction will develop strategies that are generalized to many activities. The repeated use of these strategies is proposed to contribute to impairments identifiable on examination and to LBP. METHODS AND MEASURES: Forty males and 40 females (mean +/- SD age, 41.4 +/- 13.9 years) with LBP who reported participation in either a symmetric or an asymmetric leisure activity participated in a standardized examination. Responses from 10 trunk-rotation-related impairment tests were analyzed using the Mann-Whitney U and chi-square statistics. RESULTS: Thirty people participated in asymmetric leisure activities and 50 people participated in symmetric leisure activities. The total number of rotation-related impairments was different for the 2 groups (U = 1112, P < .01). The asymmetric group displayed more total rotation-related impairments (median, 4.0; range, 7) than the symmetric group (median, 2.0; range, 6). A greater percentage of the asymmetric group displayed more impairments on 5 out of 10 individual tests, as compared to the symmetric group ( < or = .05 for all comparisons). CONCLUSIONS: Our results provide preliminary data to suggest that trunk-rotation-related impairments, identified on examination, may be related to the general type of movements and alignments used repeatedly by patients with LBP.

Adolescent↗
PubMed2005

Gender differences in pattern of hip and lumbopelvic rotation in people with low back pain.

BACKGROUND: Findings from previous studies suggest gender may affect the pattern of hip and lumbopelvic motion during a multi-segmental movement. To date, no studies have examined movement patterns and low back pain symptom behavior during hip lateral rotation. METHODS: Forty-six people (27 males and 19 females) with low back pain were examined. Three-dimensional kinematic data and low back pain symptoms were recorded during active hip lateral rotation. Percent of maximum lumbopelvic rotation was calculated for each 10% increment of maximum active hip lateral rotation. FINDINGS: Men exhibited a greater percent of maximum lumbopelvic rotation (mean 49.3, SD 13.3) during the first 60% of hip lateral rotation than women (mean 36.2, SD 16.4) (P < 0.01). Nineteen (70.4%) of the men and seven (36.8%) of the women had pain with the hip lateral rotation test (P = 0.02). INTERPRETATION: Men exhibited more lumbopelvic rotation in the early part of hip lateral rotation than women, and hip lateral rotation was more likely to be associated with symptoms in men than women. Greater lumbopelvic motion, earlier in hip lateral rotation, may make men more vulnerable to low back pain associated with hip lateral rotation. Factors that contribute to these gender differences should be investigated further.

Adult↗
PubMed2005

Deficits in grasp versus reach during acute hemiparesis.

We studied how acute hemiparesis affects the ability to perform purposeful movements of proximal versus distal upper extremity segments. Given the gradient of corticospinal input to the spinal motoneuron pools, we postulated that movement performance requiring distal segment control (grasping) should be more impaired than movement performance requiring proximal segment control (reaching) in people with hemiparesis. We tested subjects with acute hemiparesis and control subjects performing reach and reach-to-grasp movements. Three characteristics of movement performance were quantified for each movement: speed, accuracy, and efficiency. For the reach, we calculated peak wrist velocity, endpoint error, and reach path ratio. For the grasp, we calculated peak aperture rate, aperture at touch, and aperture path ratio. To evaluate the relative deficits in reaching versus grasping, performance measures were converted to z-scores using control group means and standard deviations. For both the movements, movement times were longer and performance was more variable in the hemiparetic group compared to the control group. Hemiparetic z-scores indicated that relative deficits in movement speed were small in the two movements, with deficits in grasp being slightly greater than deficits in reach. Relative deficits in accuracy showed a trend for being larger in the reach compared to the grasp, but this difference did not reach statistical significance. In contrast, relative deficits in efficiency were larger in the grasp compared to the reach, with reaching efficiency near the range of normal performance. When considering data across all three movement characteristics, the ability to perform a purposeful movement with the distal segments was not clearly more disrupted than the ability to perform a purposeful movement with the proximal segments in people with acute hemiparesis.

Acute Disease↗
PubMed2005

A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To describe an intervention approach consisting of a specific active-exercise program and modification of postural alignment for an individual with cervicogenic headache. BACKGROUND: The patient was a 46-year-old male with a 7-year history of cervicogenic headache. He reported constant symptoms with an average intensity of 5/10 on a visual analogue scale where 0 indicated no pain and 10 the worst pain imaginable. Average pain intensity in the week prior to the initial evaluation was 3/10 secondary to trigger point injections. The patient's headache symptoms worsened with activities that involved use of his arms and prolonged sitting. METHODS AND MEASURES: The patient was treated 7 times over a 3-month period. Impairments of alignment, muscle function, and movement of the cervical, scapulothoracic, and lumbar regions were identified. Outcome measurements included headache frequency, intensity, and the Neck Disability Index (NDI) questionnaire. Intervention included modification of alignment and movement during active cervical and upper extremity movements. The patient also received functional instructions focused on diminishing the effect of the weight of the upper extremities on the cervical spine. RESULTS: The patient reported a decrease in headache frequency and intensity (1 headache in 3 weeks, intensity 1/10) and a decrease in his NDI score from 31 (severe disability) to 11 (mild disability). The patient also demonstrated improvement in upper cervical joint mobility, cervical range of motion, scapular alignment, and scapulothoracic muscle strength. CONCLUSION: Interventions that included modification of alignment in the cervical, scapulothoracic, and lumbar region, along with instruction in a specific active-exercise program to address movement impairments in these 3 regions, appeared to have been successful in relieving headaches and improving function in this patient.

Abdominal Muscles↗
PubMed2005

Classification, intervention, and outcomes for a person with lumbar rotation with flexion syndrome.

BACKGROUND AND PURPOSE: The purpose of this case report is to describe the classification, intervention, and outcomes for a patient with lumbar rotation with flexion syndrome. CASE DESCRIPTION: The patient was a 22-year-old man with a medical diagnosis of low back strain. Impairments in lumbar flexion and right rotation and lateral bending were identified. Daily activities and positions associated with these actions were associated with increased low back pain (LBP). Instruction focused on modifying lumbar rotation and flexion movements and alignments in daily activities. Exercises to address the direction-specific impairments were prescribed. OUTCOMES: The patient participated in 4 visits and completed a questionnaire 1 year after intervention. The patient reported a decrease in symptoms, disability, and frequency of recurrences. DISCUSSION: Repetition of specific strategies (alignment and movement) during activities may result in specific impairments that contribute to LBP. Modification of the strategies and exercises to change contributing factors are proposed to help alleviate symptoms, disability, and recurrences.

Activities of Daily Living↗
PubMed2004

Differences in measurements of lumbar curvature related to gender and low back pain.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To test the assumption that postural alignment and gender have a bearing on the specific type of low back pain (LBP) a person manifests. BACKGROUND: Measurements of static sagittal lumbar curvature are used by clinicians in the management of patients with LBP, but no investigator has reported differences in curvature related to specific categories of LBP. METHODS AND MEASURES: We used a computer-interfaced, 3-D, electromechanical digitizer to derive curvature angles for the region of the spine between T12-L1 and S2. Trained clinicians examined the subjects and determined their LBP diagnoses. We used t tests to examine differences in curvature between women and men, those with and those without LBP, and those in 4 different categories of LBP. We used chi2 to examine the relationship between gender and LBP category. RESULTS: Lumbar curvature angle (lordosis) was 13.2 degrees larger for women than for men (t = 6.74; P<.01). There was no difference in lumbar curvature between people with undifferentiated LBP and people without LBP. There were differences in lumbar curvature between people in various categories of LBP, for example, subjects in the lumbar-rotation-with-extension category had 8.4 degrees more lumbar curvature than subjects in the lumbar-rotation-with-flexion category (t = 2.16; P<.05). Based on the frequency distributions, there was a significant relationship between gender and LBP category (chi2 = 10.19; P<.01). CONCLUSIONS: Measurements of lumbar curvature should be expected to differ between men and women and may be related to different types of low back pain.

Adult↗
PubMed2003

The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report.

OBJECTIVE: To examine the effect on symptoms of modifying patient-preferred movements and alignments of the lumbar spine during patient examination. DESIGN: Repeated-measures study in which patients with low back pain (LBP) participated in a standardized examination that included tests of symptoms with various movements and positions. SETTING: Six university-affiliated outpatient physical therapy clinics and the local community. PARTICIPANTS: Five trained physical therapists examined a total of 185 patients (102 women, 83 men; mean age, 41.89+/-13.29 y) with LBP. The majority of patients had multiepisode, chronic LBP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The examination included tests of symptoms with various alignments and movements in several different positions. Seven tests were designated as primary tests. Tests that increased symptoms were followed immediately by a secondary test in which (1) patient-preferred lumbar spine movement was modified or (2) the lumbar spine was positioned in a neutral alignment. Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test. Three responses were possible: symptoms increased, remained the same, or decreased. RESULTS: Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests. Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests. The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests. CONCLUSIONS: Modifying the symptom-provoking movements and alignments of the spine during symptom testing resulted in a decrease in symptoms for the majority of patients. Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities.

Adult↗
PubMed2003

Movement system impairment-based categories for low back pain: stage 1 validation.

STUDY DESIGN: Cross-sectional study of patients with mechanical low back pain (MLBP). OBJECTIVE: To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP. BACKGROUND: A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed. METHODS AND MEASURES: A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure. RESULTS: Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements. CONCLUSION: Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.

Adult↗
PubMed2002

Preservation of directly stimulated muscle strength in hemiplegia due to stroke.

BACKGROUND: Hemiplegia, or hemiparesis, severe impairment of purposeful activation of striated musculature, is the most conspicuous and often most disabling symptom of acute cerebrovascular lesions. Spontaneous improvement of voluntary strength may extend over many months. OBJECTIVE: In this archetypical upper motor neuron syndrome we wish to ascertain the degree of functional impairment due to direct contractile impairment of the affected striated musculature. DESIGN: Maximal tetanic muscle contraction was elicited by electrical stimulation applied directly to the tibialis anterior of the paretic and nonparetic limbs. Maximal forces of the normal limbs were compared with the afflicted limbs both early and late after vascular lesions of the pyramidal tract. Maximal voluntary force of foot dorsiflexion in the same limbs was also determined. Similar measurements were made in healthy control participants. SETTING: Acute hospital, rehabilitation, and outpatient units of a clinical research center. PATIENTS: Patients with unilateral stroke were studied a few or many weeks after the ictus. MAIN OUTCOME MEASURES: Comparison was made between contraction strengths induced by maximal tetanic electrical stimulation of the dysfunctional and contralateral unaffected muscles. Maximal voluntary strength of the foot dorsiflexion forces was also measured. RESULTS: Compared with the range of electrically evoked contractile force of tibialis anterior between the limbs of healthy participants, the directly elicited force in stroke-impaired tibialis anterior was not significantly impaired. CONCLUSIONS: Modes of exercise therapy focused primarily on direct strengthening of striated musculature, as in resistive exercise training, are strategically questionable. Whether other approaches may be more effective remains to be proved. The central disability of the upper motor neuron syndrome is failure of rapid coordinated adjustment of graded high-frequency motoneuron firing in purposeful complex synergies.

Acute Disease↗
PubMedDate not supplied

Classification, treatment and outcomes of a patient with lumbar extension syndrome.

The purpose of the current report is to describe the classification, treatment, and outcomes of a patient with lumbar extension syndrome. The patient was a 40-year-old female with an 18-month history of mechanical low back pain (LBP). The patient reported a history of daily, intermittent pain (mean intensity of 9/10) that limited her ability to sit, stand, walk, and sleep, as well as perform work-related activities. Symptom-provoking movement and alignment impairments associated with the direction of lumbar extension were identified and modification of these impairments consistently resulted in a decrease in pain. Treatment was provided in 3 sessions over a 2-month period. Priority of treatment was to train the patient to restrict lumbar extension-related alignments and movements during symptom-provoking functional activities. Exercises to address the extension-related impairments also were prescribed. The primary change in outcome was a decrease in the mean intensity (2 months: 2/10; 6 months: 1/10) and frequency of pain (2 months: decreased pain with standing and walking; 6 months: additional decrease with sitting, standing and walking). She also reported a decreased duration and number of LBP episodes. Classification directed treatment resulted in improvement in short and long term impairment and functional-level outcomes.

Adult↗
PubMedDate not supplied

Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke.

This study explored relationships between upper-limb (UL) functional limitations and self-reported disability in stroke patients with relatively pure motor hemiparesis who were enrolled in an acute rehabilitation treatment trial. All participants were enrolled in the VECTORS (Very Early Constraint Treatment for Recovery from Stroke) study. VECTORS is a single-center pilot clinical trial of early application of constraint-induced movement therapy (CIMT). All 39 subjects who completed 90 days of VECTORS were included in this analysis. Trained study personnel who were blinded to the treatment type performed all evaluations. Data in this article examine relationships between assessments performed 90 days after stroke. Functional limitation measures included the Action Research Arm (ARA) test and Wolf Motor Function Test (WMFT), and self-reported disability measures included the Functional Independence Measure (FIM) and Motor Activity Log (MAL) (by telephone). Mean plus or minus standard deviation time from stroke onset to randomization was 9.4 plus or minus 4.3 days, and median time to follow-up was 99 days (range 68-178). Subjects with perfect or near-perfect scores on the ARA test or WMFT reported residual disability on the FIM and MAL. Quality of movement on the WMFT (functional ability score) was not strongly associated with self-reported frequency, and speed of movement on the WMFT (timed score) was not associated with self-reported frequency (MAL amount of use). In this early UL intervention trial, we found that perceived disability measures captured information that was not assessed by functional limitation and impairment scales. Our results indicate that excellent motor recovery as measured by functional limitation and impairment scales did not equal restoration of everyday productive UL use and speed of task completion did not translate to actual use. Our results confirm the need for a measurement strategy that is sensitive to change, assesses a broad performance range, and detects meaningful clinical improvements in early rehabilitation intervention trials.

Activities of Daily Living↗