Biomedical subjects

W J Mysiw

Publications and source records attributed to W J Mysiw.

18 recordsLinked to original sources

PubMed1994

Catecholamine response to exercise and training in individuals with spinal cord injury.

It is unknown whether the catecholamine (CAT) response to acute exercise and prolonged training in humans with spinal cord injury (SCI) is similar to that of neurologically intact man. Plasma samples were collected from seven subjects with chronic SCI (level of injury C5-T7) at rest and during voluntary arm-crank ergometry (ACE) before and after 6 months of training with functional electrical stimulation cycle ergometry (FES-CE). Similar plasma collections were made during one FES-CE exercise training session after 6 months of training. Norepinephrine (NE) and epinephrine (EPI) were measured by HPLC. After FES-CE training, resting NE decreased 37% (950 +/- 150 vs 1510 +/- 350 pmol.l-1 pretraining); resting EPI decreased 80% (54 +/- 10 vs 163 +/- 32 pmol.l-1 pretraining) (P < 0.05 by paired t-tests). No significant changes were observed in group means after training for the CAT response to submaximal ACE; however, five of seven subjects exhibited greater increments in plasma NE with ACE after FES-CE training. Acute FES-CE exercise elicited a 55-844% increase in NE, and a 35-350% increase in EPI above resting values with power outputs eliciting heart rates of 90-146 bpm. These data provide evidence for a systemic CAT response in subjects with SCI during acute FES-CE and reduced resting CAT following 6 months of training with FES-CE.

Adult↗

PubMed1993

Heterotopic ossification. The utility of osteocalcin in diagnosis and management.

The status of 12 patients after severe traumatic brain injury was investigated to determine the clinical significance of serum osteocalcin levels during the active phase of neurogenic heterotopic ossification. The diagnosis of heterotopic ossification was confirmed on the basis of radiologic findings. The mean interval between the initial injury and diagnosis of heterotopic ossification was 29 weeks. At the time of diagnosis, serum osteocalcin and total alkaline phosphatase levels were determined along with 24-hour urinary calcium and hydroxyproline excretion. The mean serum osteocalcin level was normal at 4.3 ng/ml (normal range 1.6-6.6 ng/ml) in contrast to the elevated mean values for serum alkaline phosphatase (mean = 173 units/liter; normal range 0-105 units/liter) and urinary hydroxyproline concentration (mean = 39.6 mg/24 h; normal range 7-25 mg/24 hr). Only 17% of the subjects demonstrated an elevated serum osteocalcin level, whereas 58% of the patients had an elevated serum alkaline phosphatase level. Urinary calcium excretion and hydroxyproline excretion were elevated in 33% and 70% of subjects, respectively. These data did not reveal a significant correlation between serum osteocalcin and serum alkaline phosphatase, urinary calcium excretion or urinary hydroxyproline at the time of diagnosis or in serial measurements. Therefore, serum osteocalcin is not a valuable adjunct in confirming the diagnosis of neurogenic heterotopic ossification once the diagnosis has been suggested on the basis of clinical findings and it does not appear to play a role in assessing the maturation of heterotopic ossification.

Adolescent↗

PubMed1992

Academic productivity in physical medicine and rehabilitation.

Academic productivity of faculty members in physical medicine and rehabilitation (PM&R) was evaluated retrospectively by using the numbers of scientific publications as a measurement instrument. This study was completed by examining ten medical peer-reviewed journals that regularly included original articles in the specialty area of PM&R during the years 1988 through 1990. The number of articles was weighted according to the specific journal's impact on the Science Citation Index. Academic productivity of physiatric departments showed wide variation. Ten units published at least 20 articles during the 3-yr period. Eight departments achieved a ratio of at least one article per faculty member based on reports from the Association of American Medical Colleges. Further study will be needed to assess the factors underlying these wide variations in departments' productivity.

Abstracting and Indexing↗

PubMed1990

F response characteristics in type I diabetes mellitus.

Ulnar and tibial F response parameters were characterized in 17 healthy controls and 26 subjects with type I diabetes mellitus meeting or exceeding criteria for mild diabetic peripheral neuropathy. The presence of mild diabetic peripheral neuropathy was determined by utilizing conventional nerve conduction studies, the neuropathy symptoms score and a neurologic examination. Ulnar and tibial nerve F response latency, amplitude, duration, chronodispersion and persistence were then compared between populations. The relationship between tibial F response persistence and minimal F response latency was assessed in both populations. In addition, the relationship between tibial F response persistence and tibial nerve conduction velocity and tibial nerve compound action potential characteristics (e.g., latency, amplitude and duration) was assessed in the diabetic population. The results indicate that ulnar F response latency and chronodispersion failed to differentiate the subject and control populations; however, significantly decreased ulnar F response amplitude and duration were noted in the diabetic population. In the tibial nerve, the F response persistence was significantly decreased in the diabetic population but persistence did not correlate with compound muscle action potential latency, amplitude, duration or nerve conduction velocity. Finally, the tibial F response latency, amplitude, duration and chronodispersion failed to differentiate the control and diabetic populations.

Adult↗

PubMed1990

First lumbrical latency and amplitude. Control values and findings in carpal tunnel syndrome.

It has been suggested that the nerve fibers to the first and second lumbrical muscles are relatively spared in patients with carpal tunnel syndrome compared with the fibers to the abductor pollicis brevis. Latencies and amplitudes of the first lumbrical and the abductor pollicis brevis (APB) muscles were compared with both wrist stimulation and midpalmar stimulation. The lumbrical latency at 12 cm and the APB at 8 cm were found to be similar at less than 4.3 ms. Amplitudes to the lumbrical were 0.6-8 mV compared with 4-13.6 mV for the APB. Three patients who had an abnormal sensory study, yet normal motor values to the APB, were found to have abnormal lumbrical latencies. This is an additional technique that could be useful for individuals suspected of carpal tunnel syndrome who have normal latencies and amplitudes to the APB.

Adult↗

PubMed1989

Prospective cognitive assessment of stroke patients before inpatient rehabilitation. The relationship of the Neurobehavioral Cognitive Status Examination to functional improvement.

Prospective studies establish cognitive status as an important determinant of post-stroke rehabilitation success. The Neurobehavioral Cognitive Status Examination (NCSE) briefly assesses cognition in the ability areas of language, constructions, memory, calculation and reasoning. The NCSE, as well as the commonly used Mini-Mental State Examination and Albert's Test, were administered to 38 stroke patients before inpatient rehabilitation to determine the extent to which they predict rehabilitation outcome. Rehabilitation outcome was measured as the difference between initial and discharge Barthel Index score. The NCSE was shown to be a more sensitive indicator of impairment than the Mini-Mental State Examination and Albert's Test, especially in subsections of orientation and memory (X2 = 8.690, df = 1, P less than 0.005; X2 = 13.348, df = 1, P less than 0.001, respectively). Stepwise multiple regression revealed that attention, calculations and judgement were in association the best predictors of improvement in the Barthel Index scores. Therefore, the NCSE provides both a rapid and sensitive measure of cognitive function and it appears to predict functional status change as a result of inpatient stroke rehabilitation.

Aged↗

PubMed1989

Abnormal cortisol dynamics after traumatic brain injury. Lack of utility in predicting agitation or therapeutic response to tricyclic antidepressants.

A period of significant agitation affects up to 30% of patients after traumatic brain injury. The severity and persistence of this agitation may be such as to require pharmacologic methods as part of the treatment plan. To define which subgroup of patients develop severe agitation warranting intervention and to utilize the information to predict therapeutic responsiveness to tricyclic antidepressants (TCA), we examined cortisol dynamics in 35 traumatically brain-injured (TBI) patients 2-10 months post-TBI. Fasting hypercortisolemia (cortisol greater than 20 micrograms/dl) and/or an absent diurnal variation (1600:0800 cortisol greater than 0.5) was noted in more than 70% of TBI subjects. These abnormalities in cortisol dynamics were not predictive of severe agitation (chi 2 = 0, df = 1, P = 0.99 for hypercortisolemia; chi 2 = 0.163, df = 1, P = 0.7 for absent diurnal variation) and did not differ significantly between TCA responders and nonresponders. The cortisol response to dexamethasone suppression was abnormal (postdexamethasone cortisol value at 0800 and 1600 greater than 5 micrograms/dl) in 34 of 35 subjects and was also not predictive of the presence of agitation. The 0800 cortisol was lower in TCA nonresponders in comparison with TCA responders (8.3 +/- 5 v 17.2 +/- 9). In summary, severe TBI warranting inpatient rehabilitation results in hypothalamic-pituitary-adrenal dysfunction. The extent of these abnormalities renders the assessment of cortisol secretion of limited value in making clinical judgments concerning the development of post-traumatic agitation or the management of that agitation by tricyclic therapy.

Adolescent↗

PubMed1989

Orientation Group Monitoring System: an indicator for reversible impairments in cognition during posttraumatic amnesia.

During posttraumatic amnesia (PTA), confusion, attention deficits, impaired memory, disorientation, and inability to process external stimuli often preclude accurate assessment of subtle neurologic changes. The Orientation Group Monitoring System (OGMS) has proven to be a simple, useful strategy for assessing cognitive status. Retrospective analysis of weekly aggregate OGMS scores indicated that a decline in performance of 0.23 or greater is clinically significant. Over a one-year period, 27 patients demonstrated significant decrements in OGMS performance, and in 93% of these instances, the decrease was attributable to a medical problem. Adverse effects of medication was the most common etiology of decreased performance (n = 13). Overwhelmingly, the decline in the OGMS score was the first indication of impaired cognition. This monitoring device is therefore useful as an indicator during PTA of declining cognitive function, warranting further medical evaluation.

Adult↗

PubMed1988

Amitriptyline for post-traumatic agitation.

Agitated behavior is exhibited in up to 30% of patients recovering from a traumatic brain injury. Past treatment protocols have included proactive behavioral management and major tranquilizers. We now report the use of amitriptyline for control of agitation. For a period of over 2 years, 43 male and 15 female patients with a "recent" severe brain injury were admitted for inpatient rehabilitation and subjected to traditional structured programming for treatment of post-traumatic amnesia (PTA). In 20 patients, 18 men and 2 women, where agitation persisted sufficiently to impede rehabilitation despite initiation of structure, amitriptyline was instituted. These patients were of a comparable age (29.4 years for the agitated group versus 25.6 years for the nonagitated group), but the agitated patients had a lower median Rancho Los Amigos Hospital Level of Cognitive Functioning in a comparison to nonagitated patients (V versus VI). All patients were monitored for cognitive performance by the Orientation Group Monitoring System, and a daily account of frequency, severity and type of agitation was recorded. Within 7 days of initiation of therapy, 12 of 17 patients within PTA had dramatic decrease in agitation (5/5 patients at Rancho IV; 4/8 at Rancho V; 3/4 at Rancho VI). Two of the three patients at Rancho VII had agitation that was unresponsive to amitriptyline. The amitriptyline-responsive patients were maintained on the drug through PTA, and the Orientation Group Monitoring System scale demonstrated no impedance in cognitive recovery. Thus, amitriptyline appears most useful as an adjunct for treatment of nondirected agitation; it also has a role in reducing the severity of the directed agitation that is seen during but not after PTA.

Adolescent↗

PubMed1988

Electrophysiologic study of the anterior interosseous nerve.

Nerve conduction studies of the anterior interosseous nerve were performed on 26 healthy subjects (6 women and 20 men, aged 24 to 63 years). The compound muscle action potential from the pronator quadratus muscle was obtained by using surface electrodes placed over the dorsal aspect of the distal forearm and median nerve stimulation at the elbow. The latency of the evoked potential was determined over distances that ranged from 17.5-28 cm from the elbow to the pronator quadratus muscle; this resulted in latencies of 3.5 ms (+/- 0.4) and 3.6 ms (+/- 0.4) for the left and right extremities, respectively, with a side-to-side difference of 0.1 ms (+/- 0.1). The amplitude of the potentials recorded was 3.1 mV (+/- 0.8); a difference in amplitude of 11.4% (+/- 7.7%) between extremities was seen. Although duration measurements were obtained, the frequent presence of biomodal peaks made interpretation difficult. This bimodal pattern was felt to represent either two heads of the pronator quadratus or another muscle innervated by the anterior interosseous nerve. The technique in the present study is easy to perform, allows better assessment of the compound muscle action potentials obtained and provides for side-to-side comparisons of latency and amplitude. This technique aids the electromyographer in evaluation of suspected cases of injury to the anterior interosseous nerve, particularly in unilateral cases.

Adult↗

PubMed1988

Agitation following traumatic head injury: equivocal evidence for a discrete stage of cognitive recovery.

Agitation and confusion appear to be associated in the early period of recovery from traumatic head injury. Eighteen severely head-injured patients were assessed during acute rehabilitation for both the extent of agitation and level of cognitive functioning. Agitation was measured by the Agitated Behavior Scale developed by Corrigan. Simultaneous independent measurements of cognitive functioning were obtained from the Orientation Group Monitoring System and Mini-Mental State. Agitation was significantly correlated with both measures of cognitive functioning, indicating that as cognition improved, agitation diminished. Agitation was partitioned into high and low levels, and cognitive functioning was partitioned into low, middle, and high levels for each of the two measures of cognitive functioning. Chi-square analysis of the distribution of agitation and cognition indicated significant differentiation, with high agitation prevalent in low levels of cognition, and low agitation prevalent in high levels of cognition. Patients in the middle level of cognition were equally likely to demonstrate high and low agitation. Further descriptive analysis indicated that improvement from low levels of cognition preceded improved agitation, and improved agitation preceded clearing from posttraumatic amnesia. These results provide equivocal support for the long-held clinical observation that a period of pronounced confusion and agitation represents a discrete stage of recovery from traumatic head injury.

Adolescent↗

PubMedDate not supplied

Effect of stimulus parameters on characteristics of the F-response in normal subjects.

The F-response is a valuable tool for evaluating the functional integrity of proximal nerve segments. Although many studies have focused on the various F-response characteristics observed (e.g., latency, amplitude, duration, persistence, etc.), few have examined the significance of stimulus parameters on the resultant F-response. In this study, we examined the F-responses obtained in 25 healthy subjects when using various stimulus parameters. The stimulus parameters used were: 1) 0.5 Hz, 25% supramaximal intensity at 0.05 ms duration; 2) 0.5 Hz, 25% supramaximal intensity at 0.1 ms duration; 3) 0.5 Hz, 25% supramaximal intensity at 0.2 ms duration; 4) 0.5 Hz, 50% supramaximal intensity at 0.1 ms duration; 5) 3.0 Hz, 25% supramaximal intensity at 0.1 ms duration. No significant differences in F-response latency, amplitude, duration or persistence were seen when duration or intensity of stimuli was altered. However, changing stimulus frequency resulted in a significant decrease in latency and a significant increase in persistence and amplitude. Care should be taken in controlling for stimulus frequency to enhance the reproducibility of F-response determinations.

Adult↗

PubMedDate not supplied

Vocational evaluation of traumatic brain injury patients using the functional assessment inventory.

Impaired work capacity is one of the most common residual impairments encountered after either a severe or moderate traumatic brain injury (TBI), yet no instrument is available for screening TBI victims regarding their readiness to participate in more comprehensive vocational planning and evaluation. In the study reported here, the Functional Assessment Inventory (FAI) was administered to 76 subjects who suffered a moderate or severe TBI and the results obtained were compared to the Rancho Los Amigos Hospital Levels of Cognitive Functioning, the Mini-Mental State and the Glasgow Outcome Scale for sensitivity in discerning vocational readiness. The results obtained indicated that the FAI composite score has the greatest discriminating power in screening the vocational readiness of this population, followed by the Glasgow Outcome Scale. In addition, the FAI cluster scores demonstrated reasonable discriminative ability, which may prove useful in directing ongoing remediation.

Adolescent↗

PubMedDate not supplied

Relationship of new-onset systemic hypertension and normal pressure hydrocephalus.

Communicating normal pressure hydrocephalus (NPH) is an important remote complication of traumatic brain injury (TBI). The diagnosis of this hydrocephalus depends largely on clinical signs and symptoms, including cognitive deterioration, gait changes and incontinence. However, many of these signs are also seen during post-traumatic amnesia, making early recognition of this syndrome difficult. A case study of one man post-TBI, who presented with new-onset hypertension as a sign of NPH, prompted a retrospective chart review of all patients admitted over a 2-year period with a diagnosis of NPH. Ninety per cent of patients had one or more of the classic triad of NPH and 25% of patients had symptoms suggestive of raised intracranial pressure (unexplained nausea, headache and visual disturbance). Mean systolic and diastolic blood pressures among the 20 subjects for six consecutive days pre-operatively compared with those for days 8-14 and 15-21 post-operatively showed no significant differences; a subgroup of five patients (25%), however, demonstrated a significant change in blood pressure temporally related to shunting. We suggest that demonstration of new-onset systemic hypertension may also be a clinical sign suggestive of NPH useful in the evaluation of the TBI patient.

Adolescent↗

PubMedDate not supplied

The ataxic subgroup: a discrete outcome after traumatic brain injury.

We have observed five individuals who appear to represent a unique subgroup of patients with traumatic brain injury (TBI). Because of the prominence of severe ataxia, this group has been labelled the 'ataxic subgroup'. These individuals are distinguished by both clinical course and outcome, including severe ataxia, prolonged coma and prolonged post-traumatic amnesia (PTA). They distinguish themselves from other severely impaired TBI patients in that they spend a relatively longer length of time prior to the establishment of volition, but progress rapidly through the period of confusion. We hypothesized that this group is unique in that they have suffered Grade III diffuse axonal injury (DAI) with no or minimal complications due to other primary or secondary brain damage. In order to investigate these hypotheses, a retrospective file review of a selected group of 72 patients was undertaken to determine the specificity and sensitivity of two diagnostic criteria. The existence of severe Grade III DAI without other primary or secondary brain damage was presumed if severe ataxia was present in conjunction with normal CT scans. Results of this review indicated that 33% of the population demonstrated severe ataxia, although only 11% also had normal CT scans. These dual criteria were neither adequately sensitive nor specific to define the five patients who comprised the 'ataxic subgroup'. When rate of clearing the confused period of PTA was added to the diagnostic criteria, specificity improved. Although this attempt to define this subgroup empirically was not entirely successful, further attempts to delineate this group are important in that prognosis for clearing PTA is good despite early indicators of poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Fever of unknown origin following traumatic brain injury.

Fever is a common complication of a traumatic brain injury, occurring during both the acute-care phase and the rehabilitation phase of recovery. The aetiology of fever in this population may remain obscure because of the presence of cognitive confusion associated with post-traumatic amnesia interfering with history taking and the difficult physical examination. We present a case where recovery from a traumatic brain injury was complicated by a fever of unknown origin that proved to be secondary to lateral sinus thrombophlebitis. This case emphasises the importance of a thorough knowledge of the differential diagnosis for fever that is unique to the traumatic brain injury population.

Adult↗

PubMedDate not supplied

Agitation, cognition and attention during post-traumatic amnesia.

During the early phases of recovery from traumatic head injury, the level of functional cognition and the presence of agitation in patients appear to co-vary. However, it has been observed that there appears to be some temporal disassociation in the recovery of cognition and agitation. The purpose of this study was to investigate the degree to which attention accounts for the co-variation previously observed. Over a 1-year period, 130 patient-weeks of independent monitoring of cognition, agitation and attention were obtained from 20 head-injured patients in the acute phase of recovery. Weekly scores for measures of cognition, agitation and attention were each found to share approximately 50% of the variance when paired with one of the other two. When attention was extracted, only 7% of the variation in cognition was accounted for by agitation, and 40% of the variance could not be accounted for by either agitation or attention. These results support previous findings that cognition and agitation co-vary with most of the co-variance due to the effect of attention on each. Concomitantly, these results allow that significant portions of the variance in cognition and agitation may be temporally dissociated during the acute phases of recovery from traumatic head injury.

Adolescent↗

PubMedDate not supplied

Hyponatremia-associated cognitive impairment in traumatic brain injury.

The case of a traumatic brain injury (TBI) patient with dramatic cognitive deterioration in the absence of medical aetiology other than simultaneous decline in serum sodium led to an investigation of the association between declines in sodium levels and cognitive status. In a population of 50 persons undergoing TBI rehabilitation, 12 (24%) had relative (3 mEq/L) decreases in serum sodium while five (10%) experienced absolute hyponatremia (136 mEq/L). Correlation with cognitive status was significant when the absolute hyponatremia group was compared with those whose sodium levels remained above 136 mEq/L. A case-matched study of the relative hyponatremia group yielded no significant association between sodium-level decreases and cognitive status. These data support previous conclusions indicating wide variation in individual responses to changes in serum sodium. The threshold for significant effects of hyponatremia may be higher in patients with TBI than in populations studied previously.

Bicycling↗