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Biomedical subjects

V Maynard

Publications and source records attributed to V Maynard.

8 recordsLinked to original sources
PubMed2005

The effects of isotonic and isokinetic muscle stretch on the excitability of the spinal alpha motor neurones in patients with muscle spasticity.

To examine the effect of isotonic (with and without weight bearing) and isokinetic muscle stretch on the excitability of the spinal alpha motor neurones (alphaMN) in patients with spasticity and to establish whether this effect is maintained for at least 24 h after the intervention. A single 20-min session of isotonic muscle stretch (with or without weight bearing) or isokinetic stretch was delivered to the ankle plantar flexors in patients with post-stroke lower limb spasticity and healthy control subjects. The effect of these types of muscle stretch on the excitability of alphaMN was assessed by measuring the latency of the Hoffmann reflex (H-reflex) and the ratio of the amplitude of the maximum H-reflex (H(max)) to that of the maximum action motor potential of the soleus muscle (M(max)). Sixty-six hemiplegic stroke patients and 21 healthy control subjects were recruited and completed the trial. The H(max):M(max) ratio was significantly higher in patients with spasticity than in healthy control subjects. However, there were no statistically significant differences in the H-reflex latency or the change in H(max):M(max) ratio between the baseline values and those recorded immediately after the therapy intervention or 24 h later for each type of muscle stretch. Similarly, there were no significant differences in these variables between the interventions. In the present study neither isotonic muscle stretch (with or without weight bearing) or isokinetic stretch had a statistically significant effect on the excitability of the alphaMN in patients with muscle spasticity. This suggests that the previously reported reduction in spasticity after muscle stretch is because of mechanisms other than the direct effect on alphaMN. However, the lack of a demonstrable benefit of treatment may be due the fact that we examined the effects of a single, rather than repeated treatment cycles.

Aged↗
PubMed2005

Comparison of the impact of a single session of isokinetic or isotonic muscle stretch on gait in patients with spastic hemiparesis.

OBJECTIVE: To establish if isokinetic and isotonic muscle stretch (with or without weight-bearing) of the ankle plantar flexors improves gait in hemiplegic patients. A further aim was to compare the effectiveness of these treatment methods. DESIGN: A randomized, parallel group prospective study. SETTING: A stroke rehabilitation unit. SUBJECTS: Ambulatory hemiparetic stroke patients with mild to moderately severe muscle hypertonia of the lower limb and a group of healthy control subjects. INTERVENTION: Subjects were randomized to receive a single 20-min session of isokinetic muscle stretch or isotonic muscle stretch with or without weight-bearing. OUTCOME MEASURES: Selected kinematic, kinetic and spatio-temporal gait parameters were measured at baseline, immediately after the muscle stretch and 24 h later. RESULTS: Sixty-six patients and 21 healthy control subjects were recruited and completed the study. There were statistically significant differences between the patient groups and the healthy subjects on most of the gait parameters studied. However, the differences between the patient groups or between the three measurements over time for each type of muscle stretch did not reach statistical significance. CONCLUSIONS: A single session of isokinetic or isotonic muscle stretch (with or without weight-bearing) of the ankle plantar flexors has no clinically observable effect on the gait of hemiplegic stroke patients.

Aged↗
PubMed2003

Intra-rater and inter-rater reliability of gait measurements with CODA mpx30 motion analysis system.

Variations between measurements of clinical outcomes sometimes result from observer errors and are not due to the therapeutic intervention. For the correct interpretation of clinical data it is, therefore, important to ascertain the reliability of the measurement methods used. In the present study we evaluated the test-retest and between observer reliability of gait measurements with the Cartesian Optoelectronic Dynamic Anthropometer (CODA mpx30) motion analysis system. Our findings suggest a better intra-rater and inter-rater reliability of kinetic than kinematic data. Disagreements between the investigators were most marked for the kinematic data, especially the hip angle, and disagreements were least for the spatio-temporal gait parameters. The poor reproducibility of kinematic variables may be due to problems with the accurate placement of markers on the surface anatomical landmarks.

Adult↗
PubMed2003

Safety and outcome after fludarabine-thiotepa-TBI conditioning for allogeneic transplantation: a prospective study of 30 patients with hematologic malignancies.

Fludarabine, thiotepa and total body irradiation (TBI) has been used as conditioning in haplo-identical transplantation. We studied this conditioning regimen in adults undergoing matched sibling transplantation and alternative donor transplantation. A total of 30 consecutive patients underwent matched related, haplo-identical related or matched unrelated donor transplantation with fludarabine, thiotepa and TBI conditioning. All but four had advanced hematologic malignancies. For haplo-identical transplant, ATG was added to the regimen. All patients received peripheral blood stem cells; these were T-cell depleted for 2-antigen or 3-antigen mismatched related transplantation. Additional graft-versus-host disease prophylaxis consisted of tacrolimus and mini-methotrexate. One recipient of haplo-identical transplant failed to engraft; all other evaluable patients had prompt engraftment. Four patients died of regimen-related toxicity. In all, 14 additional patients died of regimen-related causes including four from failure to thrive with persistent thrombocytopenia and four from delayed pulmonary toxicity. Six patients relapsed. Progression-free survival at 12 months was 47% (90% CI: 25-69%) for recipients of HLA-identical sibling transplants and 30% (90% CI: 14-46%) for all patients. Five of six long-term survivors have extensive chronic GVHD. As a result of the delayed complications and a relatively high recurrence rate, we abandoned this regimen.

Adolescent↗
PubMed2003

Regimen-related toxicity after fludarabine-melphalan conditioning: a prospective study of 31 patients with hematologic malignancies.

A total of 31 consecutive patients with hematologic malignancies who were considered poor candidates for TBI underwent allogeneic stem cell transplantation after conditioning with fludarabine and melphalan. A total of 25 matched sibling recipients received fludarabine 25 mg/m(2) x 5 days and melphalan 70 mg/m(2) x 2 days. For unrelated and haploidentical donor recipients, fludarabine was increased to 30 mg/m(2) and ATG 30 mg/kg x 4 days was added. Graft-versus-host disease prophylaxis consisted of tacrolimus and mini methotrexate. All patients engrafted. Regimen-related toxicity was considerable and included mainly renal, hepatic and mucosal toxicity. There were seven regimen-related-deaths including two VOD, two pulmonary, one renal, one cardiac and one mucosal toxicity. One case of fatal pulmonary toxicity death could be attributed to pre-existing pulmonary damage. Progression-free survival at 12 months was 44% (90% CI: 30-58%) for recipients of HLA-identical sibling transplants and 33% (90% CI: 21-45%) for all patients. In conclusion, the fludarabine-melphalan regimen leads to consistent engraftment. The regimen-related toxicity is considerable and cannot be explained solely by patient selection. Cardiac toxicity is emerging as a unique toxicity of this regimen. Despite toxicity, fludarabine-melphalan has considerable activity and leads to durable remission in a proportion of patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Effect of positioning on respiratory synchrony in non-ventilated pre-term infants.

BACKGROUND AND PURPOSE: Body position can play an important role in an infant's recovery from respiratory disease, but few studies have accounted for sleep state which is known to have a direct influence on the control of respiratory muscles as well as on metabolic and circulatory changes. The purpose of this study was to examine the influence of body position on respiratory function in pre-term infants whilst accounting for sleep state. METHOD: Thoraco-abdominal motion was assessed using respiratory inductance plethysmography (RIP) to provide measures of relative rib cage (RC) and abdominal (AB) movement in ten non-ventilated pre-term infants. Continuous measurements of oxygen saturation (SaO2), pulse and heart rate (HR), were made and sleep state was recorded using behavioural criteria and electro-oculogram (EOG) measurements. RESULTS: The results showed a significant increase in HR in supine, but no significant difference in SaO2 as a function of position, compared to the prone position where a significant reduction was found in thoraco-abdominal asynchrony for both groups and a reduction in variability in both HR and SaO2. Intra-subject variability of thoraco-abdominal motion as a function of position demonstrated no significant difference on return to supine or on return to prone, illustrating good repeatability of measures. CONCLUSIONS: Prone positioning of pre-term infants recovering from respiratory disease may improve respiratory function. As measured, the improvement in respiratory synchrony in prone position brings pre-term infants' breathing pattern into line with that expected in term infants.

Cross-Over Studies↗
PubMed2000

Development and implementation of the MTutor on-line tutorial system for diploma level research students.

This study describes the development, implementation and evaluation of MTutor, a web-based tutorial system, which was developed for students undertaking a diploma level research module. The aim of the study was to evaluate the feasibility of using a problem solving approach through an on-line system, to provide additional academic support for health care students undertaking a research module. The extent to which students found it a useful approach and resource for reinforcing learning and for developing their computer and information technology skills was also evaluated. The tutorial was developed around a single researchable problem related to communication skills and nurse-patient interactions. It was based on an experimental design and consisted of four sub-problems supported by a variety of text-based resources relevant to the sub-problems. A series of multiple-choice questions accompanied each sub-problem and an evaluation questionnaire at the end of the tutorial was used to obtain formal feedback on the system. The evaluation questionnaire revealed that students found the system to be easy to use and that the on-line resources provided sufficient information with which to answer the tutorial problems. Students felt that the tutorial reinforced the taught sessions in the module and that working through the problems enhanced their understanding of research design. Further piloting of the system is planned to obtain feedback from an additional cohort of students as well as lecturers teaching the diploma level research module.

Computer-Assisted Instruction↗