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Biomedical subjects

T W Findley

Publications and source records attributed to T W Findley.

At least 19 recordsLinked to original sources
PubMed1992

Physiological analysis of motor reorganization following lower limb amputation.

It is now known that amputation results in reorganization of central motor pathways, but the mechanism for the changes is unclear. One possibility is alteration of the excitability of the alpha motoneurons. We studied motor reorganization and excitability of alpha motoneurons to Ia input in 6 subjects with unilateral lower limb amputation. A Cadwell MES-10 stimulator was used to deliver transcranial magnetic stimuli through a circular coil centered on the sagittal axis 4 cm anterior to Cz and through an 8-shaped coil positioned over scalp locations 1 cm apart along the coronal axis. Surface EMG was recorded bilaterally from quadriceps femoris, the first muscle immediately proximal to the site of amputation. Excitability of the spinal alpha motoneuron pool to Ia afferents was assessed by determining the ratio of the maximal H reflex to the maximal M response (H/M ratio) elicited in the quadriceps femoris. Stimuli of equal intensity delivered to optimal scalp positions recruited a larger percentage of the alpha motoneuron pool in muscles ipsilateral to the stump than in those contralateral to the stump (P less than 0.01). Mean onset latencies of motor evoked potentials were shorter in ipsilateral muscles than in contralateral muscles (P less than 0.01). Muscles ipsilateral to the stump showed a trend toward activation from a larger number of scalp positions than those contralateral to the stump (P = 0.06). There was no difference in the quadriceps H/M ratios (7.2% ipsilateral vs. 10.9% contralateral). The absence of changes in the excitability of the alpha motoneuron pool in the presence of motor reorganization targeting muscles proximal to the stump suggests that reorganization occurs proximal to the alpha motoneuron level.

Adult↗
PubMed1991

Elements of academic productivity: a comparison of PM&R units versus other clinical science units.

In early 1989, the Research Committee of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) established a subcommittee to develop methods to monitor academic progress in physical medicine and rehabilitation (PM&R) units in the US. To develop an indirect baseline of academic productivity in PM&R, the rates and types of publications by PM&R researchers were assessed in eight peer review medical journals. The journals selected consisted of all issues of the following (published in calendar years 1987 to 1989): Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Physical Therapy, Archives of Neurology, Pain, Stroke, Paraplegia, and Arthritis & Rheumatism. The sampling frame consisted of 3,553 journal articles. Affiliation with a PM&R unit or other clinical science unit (other unit), extramural funding sources, and type of manuscript (eg, case report or scientific investigation) were identified and coded. Sixteen percent of all articles were authored by members of PM&R units. The prevalence of scientific reports written by other unit authors (71%) was comparable to that written by PM&R authors (67%) (chi 2[3] = 5.54; p less than .20). There was a greater prevalence of funding by the US Department of Education of studies written by PM&R authors (10%) than of studies written by members of other units (2%) (chi 2[1] = 79.4; p less than .0001). Reports authored by members of other units had a greater prevalence rate of funding from all other sources--federal and private (47% vs 33%; chi 2[1] = 41.2; p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Authorship↗
PubMed1991

Motor reorganization after upper limb amputation in man. A study with focal magnetic stimulation.

To evaluate reorganization in motor pathways following amputation, we studied motor evoked potentials (MEPs) to transcranial magnetic stimulation in 7 patients with unilateral upper limb amputations, a patient with congenital absence of a hand, and 10 normal subjects. Electromyographic recordings were made from biceps and deltoid muscles immediately proximal to the stump and the same contralateral muscles. Magnetic stimulation was delivered by a Cadwell MES-10 magnetic stimulator through a 'figure eight' magnetic coil over scalp positions separated by 1-2.5 cm. Maximal M responses were elicited by peripheral nerve stimulation at Erb's point. The amplitude of MEPs was expressed both as absolute values and as a percentage of maximal responses to peripheral nerve stimulation. Threshold for activation of muscles ipsilateral and contralateral to the stump and the region of excitable scalp positions were also determined in 7 patients. Magnetic scalp stimulation induced a sensation of movement in the missing hand or fingers in the patients with acquired amputation, but failed to do so in the patient with congenital absence of a limb. It evoked larger MEPs, recruited a larger percentage of the motoneuron pool, and elicited MEPs at lower intensities of stimulation in muscles ipsilateral to the stump than in contralateral muscles. Muscles ipsilateral to the stump could be activated from a larger area than those contralateral to the stump. These results are compatible with cortical or spinal reorganization in adult human motor pathways targeting muscles proximal to the stump after amputations.

Adult↗
PubMed1991

Research in physical medicine and rehabilitation. XII. Measurement tools with application to brain injury.

There are basic principles and techniques of measurement that are relevant across biomedical disciplines. The purpose of this article is to explain some of the most important of these for medical rehabilitation, to illustrate how to use them to choose assessment instruments and to describe the nature of measurement in medical rehabilitation by examples in brain injury rehabilitation. Reliability is basic to any scientific measure. Validity, the ultimate criterion, is closely associated with the purpose of the measure. Content validity, criterion validity and construct validity are explained. Sensitivity to rehabilitative interventions and significance in patients' real lives (ecological validity) are emphasized. Measures of functional outcomes (disability) may show improvement after rehabilitation even when impairment measures do not. An extensive but selected list of measures of coma, global status, disabilities, communicative and cognitive impairments, and handicaps is presented, and their main uses are illustrated. Examples illustrate how to choose measures to study comprehensive program-level outcomes, to study learning-based interventions and to develop a general purpose database. Although there are many measures of activities of daily living and mobility, little published evidence of reliability and validity could be found even for some well-known scales. Ecologically valid and sensitive outcome measures are especially needed. Studies of the clinical utility of measures were also scarce. Many of these gaps can be spanned by clinical researchers with limited resources. Physical medicine and rehabilitation will benefit from formal studies of the reliabilities and validities of both its old and its new measurement instruments and by increased sophistication in choice of measures.

Brain Injuries↗
PubMed1991

Malpractice in physical medicine and rehabilitation. A review and analysis of existing data.

Malpractice issues are a concern for physiatrists, but little information specific to the field is readily available. Medical, legal and economic literature provide profiles of physicians involved in malpractice claims and the types of clinical situations in which suits are brought in general but no specifics on physiatry before 1973. Nine malpractice studies were examined to characterize malpractice claims in the field. The physiatrist's risk relative to other specialties could be studied specifically in three studies of 197,230 claims reported from 182 liability carriers. The number of claims brought was one-third of that predicted relative to the size of the specialty. The number of paid claims was one-fourth of that predicted, and the total dollar indemnity was one-fifth of that predicted. The average indemnity per claim rose 770% over a decade, from $12,000 in 1978 to $92,000 by 1988. Dollar losses were significantly lower than expected compared with other specialties classified by insurance carriers to be of similar risk such as neurology, pediatrics and general/family practice and one specialty considered to be very low, dermatology. Losses for physiatry were more similar to that of the very low risk category specialties such as psychiatry and pathology. One-fourth of successful claims resulting in one-third of the total dollar losses were associated with physical therapy. Cases involving femoral fracture comprised 14% of paid claims accounting for 34% of the total losses. Conditions of the vertebral column accounted for 35% of monetary losses and medication error accounted for 14% of monetary losses. The claim incidence was very low as one study of 71,130 claims identified none against physiatrists, with no more than 110 claims in any single study.

Insurance, Liability↗
PubMed1990

Research in physical medicine and rehabilitation. VII. The role of the principal investigator.

The roles and responsibilities of the principal investigator of a research project are described to allow the young researcher to make an intelligent decision regarding which role to take in a research project. Guidelines are given about which tasks may be delegated and how to do this. These tasks include formulation of the question, project design, obtaining funding, project startup and ongoing management, data analysis and publication. Particular attention is paid to design/analysis and publication, since these determine authorship on biomedical research articles.

Humans↗
PubMed1990

Research in physical medicine and rehabilitation. VIII. Preliminary data analysis.

This paper describes important aspects of preliminary data analysis to be taken after data are checked for clerical entry errors and before the primary statistical analysis is performed. These include description and graphic display of each variable, recoding categorical data, transforming continuous data into another continuous variable and recoding continuous to categorical data. Missing values and outlying data points are identified and several techniques are recommended to minimize mistakes in variable recoding. Related variables measured with different units may be combined by using the z transformation and converted back to one of the original units for ease of interpretation. Finally, both categorical and continuous variables are checked for reliability by using kappa or the intraclass R.

Data Collection↗
PubMed1990

Research in physical medicine and rehabilitation. IX. Primary data analysis.

The primary statistical analysis is approached from the standpoint of what is required to publish in medical research journals. Descriptive and bivariate statistics cover the majority of medical research articles now published. Statistical guidelines for review of manuscripts are used to develop guidelines for analysis, including specifying the objective, the source of subjects and response rate, differences detectable with the expected sample size, appropriateness of statistics for one and two variables, method of presentation of results and conclusions and calculation of confidence intervals. Common mistakes to avoid include use of standard error of the mean instead of standard deviation, use of standard deviation with skewed data, failure to describe the statistical test used, multiple comparisons and failure to use special forms of t test and chi 2.

Cerebrovascular Disorders↗
PubMed1990

Research in physical medicine and rehabilitation X. Information resources.

Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles.

Humans↗
PubMed1990

Research in physical medicine and rehabilitation. XI. Research training: setting the stage for lifelong learning.

This is the summary article in our research series. We have attempted to provide useful information for persons at all levels of research training, from the student to the clinician with a collaborative but not active role, to the new clinical researcher, to the experienced faculty member. But there is much more to be learned than can be presented in a short series of articles. From this series, you should be able to make a reasoned choice about what role in research you would like to take, and seek to maintain or upgrade your research skills to accomplish that. The previous articles, exercises and references presented will guide you in independent study. The focus of this article is to help you choose an environment in which you can continue to learn and develop. Although the "ideal" place as described here may never exist, no institution is totally devoid of research possibilities and you can use this article to help seek or develop local resources you may not have considered. By extracting questions and clues from people around you, you stimulate them to "think research" even if a formal program is absent; at the least, you can ally yourself with a nearby institution which has researchers in other clinical specialties or areas of basic science. Each organization is obviously different, having different strengths and resources. It is up to each chairperson to decide what proportion of limited resources should be invested in research. Once this decision is made, it is the initiative of the individual faculty members that will make a productive department.

Education, Medical, Continuing↗
PubMed1989

Research in physical medicine and rehabilitation. I. How to ask the question.

A predictable pattern in research efforts is seen in 28 academic centers in physical medicine and rehabilitation. They consist of at least one technician and one small research room (220 square feet), with an additional small room (280 square feet), and 1/4 technician for every MD or PhD in the department (r = 0.72). Persons who are not active researchers with external funding must first define the research question in order to develop fundable research proposals. Clinical research is a process that starts from the clinical situation, leads to formulation and answering of the question, and eventually results in integration back into clinical practice. There are many reasons for posing a clinical research question and each results in a different type of question. Asking the right question is the most important part of research, as how the problem is stated determines what data is to be collected, the analysis to be done, and what kind of conclusions can be drawn. A strong research study addresses questions that are clearly spelled out and leads to conclusions that are within the limits of the experimental design and the availability, reliability, and validity of the data. Complex design and analysis do not make a study better if the question itself is not well formulated. It is not as important to know how to answer the question as it is to know how to ask the question. If the initial question is incomplete or incorrect, the rest of the research is at best irrelevant.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

Research in physical medicine and rehabilitation. IV. Some practical designs in applied research.

The randomized controlled trial is often difficult, impractical or unethical in the clinical setting. Specific types of experimental design are examined for application and ease of interpretation of results, with particular focus on the generalization and demonstration of cause and effect. Examples are given of relatively easy changes that greatly strengthen the design and several recently published studies are used as illustrative examples.

Brain Injuries↗
PubMed1989

Research in physical medicine and rehabilitation. V. Data entry and early exploratory data analysis.

The process of data entry and initial analysis to locate data errors is described. Basic terms are defined and a simple method of entering data by using word processing software is illustrated. Data checking is done by using visual check of the raw data. Statistical programs are then used to locate possible data errors by finding data points (outliers) that are very different from the average. Special graphic output of statistical programs, scatterplots and box and whisker plots can be used to further locate questionable data. Examples of data entry forms and annotated step by step data cleaning with the use of inexpensive programs for personal computers are presented.

Computers↗
PubMed1989

Research in physical medicine and rehabilitation. VI. Research project management.

This article on research project management is written primarily for the researcher who has started a project, has collected data on a few subjects and has now realized that the project is more involved than anticipated. Although discussion of the many different styles of management is beyond the scope of this article, it addresses some common problems faced by the researcher, including finding subjects, obtaining project approval from the institutional review board, identifying and training staff, establishing a work plan, pilot testing, recording data, identifying problems, using computer software for project management and budgeting. Specific examples and exercises are included.

Documentation↗
PubMed1989

Research in physical medicine and rehabilitation. III. The chart review or how to use clinical data for exploratory retrospective studies.

This article guides the design and execution of a small research project using existing clinical data. The most important point in experimental design is to identify potential difficulties and limitations before you start by 1) review of published studies, 2) use of your clinical experience and 3) review of individual case records. Some of these can be addressed by changes in the study design, but some are inherent in the data and methods we are forced to use. The choice of study design may be based primarily on the quality of the clinical data and available resources for additional data collection. The level of measurement (nominal, ordinal, interval or ratio) of your data must first be determined as it limits the descriptive and statistical techniques you can use. After you decide how many variables to include, a rough guess of sample size will help you select your charts for review. Actual review of three charts will further pinpoint any difficulties and will allow you to revise your study and make an accurate estimate of time to completion. Given the long time span of most projects, accurate record keeping is essential.

Data Collection↗
PubMed1989

Research in physical medicine and rehabilitation. II. The conceptual review of the literature or how to read more articles than you ever want to see in your entire life.

The purpose of the literature review is to place your research question in the context of the existing scientific literature. This article will help you to develop an overall conceptual framework to allow you to sort through the mass of published material in a focused way. The conceptual review differs from the individual article review in that it is guided by your understanding of the basic issues rather than by your knowledge of research methodology. The goal of this paper is to help you develop a conceptual framework starting from your clinical knowledge. A specific search strategy is presented to help you determine which articles are highly relevant to your topic and to locate all of these published within the past 5 years. Articles are classified into three types: those that are obviously highly relevant, other less relevant articles and articles that are potentially relevant. Guidelines are given on how to start looking, when to stop looking, how to organize the articles you find so that you can review them in a reasonable amount of time and how to read in depth the most pertinent ones you find.

Abstracting and Indexing↗
PubMed1988

Ambulation in the adolescent with spina bifida. II. Oxygen cost of mobility.

This study was designed to determine the energy cost (measured as oxygen use) of walking and wheelchair propulsion in children aged 10 to 15 with myelomeningocele of thoracic to sacral levels, and to determine whether energy cost of mobility could be estimated from clinical measures. Oxygen consumption (measured with open circuit spirometry) and heart rate were measured during treadmill walking by 21 children, wheelchair use by eight children, and, for five children, in both modes. Speeds ranged from 27 to 134 m/min, with slopes up to 15%. Energy consumption for walking was linearly related to speed, slope, heart rate, and body weight (r = .90, p less than .001); for wheelchair propulsion, energy consumption was a linear function of speed, slope, and body weight (r = .90, p less than .001). The same linear function applied for all disabled children; maximum walk/run speed over a 30 m distance correlated highly with both maximal oxygen consumption (r = .87) and speed using 70% of VO2max (r = .82). For both wheelchair use and walking, the relative energy consumption (percentage of VO2max) was highly correlated with heart rate alone (r = .93), and the absolute level of energy consumption was highly correlated with heart rate and maximum walk/run speed (r = .89). Simple clinical measures of maximum ambulatory velocity and heart rate allow accurate prediction (r = .89) of energy consumption in all children with myelomeningocele, regardless of neurologic and functional level.

Adolescent↗