Biomedical subjects

Zeevi Dvir

Publications and source records attributed to Zeevi Dvir.

17 recordsLinked to original sources

PubMed2006

Balance performance in adult epilepsy patients.

PURPOSE: To evaluate the magnitude of subclinical balance dysfunction in adult epilepsy patients and to assess the relative contribution of different variables to balance impairment. METHODS: Balance performance was evaluated by computerized dynamic platform posturography (CDPP) in 25 adult patients following a generalized tonic-clonic seizure (GTCS) and in 11 healthy subjects. RESULTS: The GTCS was a breakthrough seizure in 20 patients with epilepsy and a first seizure in 5. Seven of the patients had localization-related epilepsy and 13 had generalized epilepsy. Mean epilepsy duration was 6.6 years. Nineteen of the patients were treated with antiepileptic drugs (AEDs), 16 on monotherapy and three on polytherapy. Brain CT scan and EEG abnormalities were found in 7 and 14 patients, respectively. None of the patients had clinical signs of balance dysfunction. Postural function, measured by Sway Index (SI), was worse in the patients compared to controls. A lower SI was found in patients who did not receive AEDs, had one or two seizures, had a disease duration of less than a year and had a generalized epilepsy. CONCLUSIONS: Although the study group was small and heterogeneous and only a small number of parameters have reached statistical significance, it seems that posturography can be helpful in the evaluation of postural stability in adult patients with epilepsy.

Adolescent↗

PubMed2006

Rehabilitation vs drug therapy for urge urinary incontinence: short-term outcome.

The objective of this study was to compare the short-term effectiveness of rehabilitation treatment with a standard drug treatment for urge urinary incontinence (UUI). The study design includes parallel clinical trial in an outpatient urogynecologic clinic setting. The subjects were 44 women who suffered from UUI and who were systematically assigned to a rehabilitation group (REH) (N=24) or a medication group (MED) (N=20). The intervention for REH was consisted of five visits during a 3-month period of pelvic floor muscle training and behavioral training, whereas for MED was extended release oxybutynin at 5 mg/day, for 3 months. The urinary symptoms considered were frequency of voiding per day and night (freq/day and freq/night), number of incontinent episodes per week based on a bladder diary, and data based on the Incontinence Quality of Life Instrument (I-QoL). In the within-group comparison, both groups had improved significantly over time with respect to urinary symptoms and I-QoL (p<0.01). In addition, there was a significant group-time interaction effect on freq/day. While REH improved during the 3-month follow-up period, the MED group deteriorated to mean baseline value (p<0.01). A significant negative association was found between the urinary symptoms and the I-QoL at the end of follow-up (r (p)=-0.35 to -0.62, p<0.05). Three months after the intervention, both groups maintained the achievements of the intervention period. In addition, the REH group demonstrated additional improvement in mean freq/day while the condition of MED patients deteriorated to baseline values.

Aged↗

PubMed2006

Cervical motion in patients with chronic disorders of the cervical spine: a reproducibility study.

STUDY DESIGN: Test-retest of cervical motion in patients with chronic disorders of the cervical spine. OBJECTIVES: To determine the reproducibility of cervical motion and examine the feasibility of its representation by a single parameter. SUMMARY OF BACKGROUND DATA: Reproducibility of cervical motion findings has been largely limited to normal subjects, leaving a conspicuous void regarding the measurement error in clinical groups. METHODS: There were 2 groups of 25 chronic patients with whiplash and degenerative changes of the cervical spine tested twice (4-7 days). Head movement was measured along the 6 directions, as well as during rotation out of flexion and extension (cervical degenerative changes only). RESULTS: Compared to normal subjects, both groups had a 25% to 35% reduction in cervical motion. High intraclass correlation coefficients (ICCs) (range 0.8-0.92) were derived for all directions. The ICCs for rotation out of flexion and extension were low. The relative standard error of measurement ranged from 15% to 28% for all directions, whereas the corresponding scores of the total cervical motion excursion were 10.6 (cervical degenerative changes) and 13.6% (whiplash). CONCLUSIONS: Judged by the ICCs cervical motion, findings were reproducible. However, in view of the measurement error as well as the homogenous reductions, total cervical range of motion should be considered a suitable parameter for interpretation of cervical motion limitations in these patients.

Adult↗

PubMed2006

Performance of cervical motion in chronic whiplash patients and healthy subjects: the case of atypical patients.

STUDY DESIGN: A comparative study of cervical motion performance in chronic whiplash (CW) patients and healthy subjects. OBJECTIVES: To examine the efficiency of total cervical range of motion (TCROM), which consists of the combined score of all six primary movements and their mean coefficient of variation (MCV), in differentiating CW patients from healthy subjects as well as typical from atypical patients. Additionally to explore in the patients possible relationships between their cervical motion profile and functional and personality traits. SUMMARY OF BACKGROUND DATA: Previous studies revealed that cervical motion was an efficient discriminator between healthy and CW patients. However, none of these studies provided either guidelines regarding cutoff scores or insight as to what should be considered typical compared with atypical patient with respect to cervical motion performance. METHODS: Cervical motion was measured in 75 healthy subjects and 101 CW patients in each of the six primary movements. In addition, patients filled the functional neck disability index (NDI) and personality symptom check list (SCL-R-90) questionnaire. RESULTS: Total CROM was significantly lower and the MCV was significantly higher in patients compared with healthy subjects. Age and gender affected TCROM significantly in both groups while MCV remained unaffected, respectively. Atypical patients were identified by having a TCROM < 58 degrees and or MCV > 22%, both scores corresponding to 2 SDs below and above group means, respectively. These benchmarks resulted in classifying as atypical 6% of the CW group who also scored drastically higher in the NDI and SCL-R-90 questioners. CONCLUSIONS: Using MCV and TCROM adds new insight regarding what should be considered as atypical cervical motion profile in CW patients. Several aspects of this complex clinical entity are discussed.

Adult↗

PubMed2006

The influence of early cycling training on balance in stroke patients at the subacute stage. Results of a preliminary trial.

OBJECTIVE: To investigate the effect of early cycling training on balance and motor abilities of stroke patients in their subacute stage. DESIGN: Randomized clinical trial. SETTING: Inpatient rehabilitation. SUBJECTS: Twenty-four patients who had had a first stroke were randomly assigned to a cycling training group (N=10) or to a control (N=14) group. INTERVENTION: All subjects received their usual rehabilitation programme; the cycling training group received in addition a daily session of leg cycle ergometer, lasting three weeks. Both groups were followed for six weeks. MAIN OUTCOME MEASUREMENTS: Balance was assessed using the Postural Assessment Scale for Stroke Patients (PASS) and the standing balance test. The motor function of the lower extremity was also assessed by the Fugl-Meyer Assessment (FMA). RESULTS: In the within-group comparison, both the exercise group and the control group had improved significantly (P < 0.01) with time with respect to PASS total (exercise group 18.7 +/- 2.8 to 31.1 +/- 2.2, control group 18.1 +/- 3.2 to 26.4 +/- 3.8) and PASS subscores, as well as the FMA score (exercise group 17.2 +/- 7.5 to 29.1 +/- 5.9, control group 16.6 +/- 6.4 to 22.1 +/- 6.8). In addition there was a significant group-time interaction effect, with exercise group patients demonstrating better performance in both the total PASS score and PASS subscores and FMA score relative to the control patients (P < 0.01). CONCLUSIONS: These preliminary findings suggest that stroke patients in the subacute stage can improve their motor and balance abilities after an early short duration of cycling training.

Aged↗

PubMed2006

Cervical radiofrequency neurotomy in patients with chronic whiplash: a study of multiple outcome measures.

OBJECT: Cervical radiofrequency neurotomy (CRFN) is used in the treatment of patients with chronic pain and disability due to whiplash injury. Confirmation of its efficiency has, however, been based solely on pain and psychological distress factors. The aim of the present study was to extend the assessment of CRFN efficacy by adding other outcome measures to shed light on neuromotor-functional-psychological interactions by undertaking comparison of pre- and 1-year postintervention data. METHODS: Forty patients with chronic whiplash injury-associated disorders were evaluated prior to and at two separate sessions after CRFN. The evaluation included Neck Disability Index, cervical range of motion, isometric cervical muscle strength, cervical pressure pain threshold, Symptom Check List-90-Revised, and subjective Self-Report of Improvement (SRI). The authors found that the CRFN had a significantly positive effect on all measured parameters. A case-by-case analysis revealed improvement in 70% of the patients at the final follow-up examination. Using stringent cutoff values, between 30 and 60% of the patients experienced measurable improvement. Evaluation of SRI results indicated that more than 80% of the patients were satisfied with the procedure. CONCLUSIONS: Approximately 1 year after intervention, CRFN was associated with an acceptable rate of success, as reflected by objective and subjective outcome measures.

Activities of Daily Living↗

PubMed2005

Spectral EMG changes in vastus medialis muscle following short range of motion isokinetic training.

This study was aimed at exploring the carryover effect of short range of motion (RoM) isokinetic conditioning on vastus medialis (VM) motor unit recruitment (MUR) across the full RoM. Fifty-five women were randomly assigned to one of four groups: G1 (n = 14) and G2 (n = 14) trained concentrically at 30 and 90 degrees /s, respectively whereas G3 (n = 13) and G4 (n = 14) trained similarly but using the eccentric mode. All 4 groups trained within 30-60 degrees of knee flexion. The training protocol consisted of 4 sets of 10 maximal repetitions, 3 times a week for 6 weeks. sEMG was recorded from the VM for analysis of mean frequency of the EMG power spectrum prior to the training period and 2 days after its termination. The EMG assessments took place during dynamic contractions within 3 angular RoM's: 85-60 degrees (R1), 60-30 degrees (R2) and 30-5 degrees (R3). In addition MUR was evaluated during isometric contractions at 10 degrees , 45 degrees and 80 degrees . Significant increases were observed in the MUR at R1, R2, and R3 during dynamic contractions as well as in all 3 angles during isometric contractions. These findings applied equally regardless of the mode of contraction and motion speed during training. The fact that MUR increased significantly within untrained RoM's may point out to the potential benefits of short RoM conditioning, particularly in those cases where, during specific phases of rehabilitation, a wider RoM may be contraindicative.

Adaptation, Physiological↗

PubMed2005

Cervical muscles weakness in chronic whiplash patients.

BACKGROUND: Isometric cervical strength has been used for assessing the severity of cervical spine pathologies. However there is a conspicuous dearth of information relating to cervical strength data in patients suffering from chronic whiplash. Therefore the objective of this study was to compare absolute and ratio-based isometric cervical strength scores in chronic whiplash patients with reported corresponding scores in healthy subjects. METHODS: Isometric cervical strength was measured in the directions of flexion, extension, right and left lateral flexion in 97 patients, 51 women and 46 men, using a wall-mounted dynamometer. FINDINGS: Compared to published values of normal subjects, whiplash patients suffered sharp reductions of about 90% in both genders and in all directions. The consistency of the isometric cervical strength scores as indicated by the mean coefficient of variation was relatively low, 17% and 20% in men and women respectively. The flexion/extension strength ratio ranged 0.8--0.9, slightly higher than the reported range for normal subjects. This ratio was highly correlated (r=0.91, P=0.01) with the mean coefficient of variation in a subgroup of 9 patients. INTERPRETATION: In the absence of an obvious reason such as sever atrophy or grossly dysfunctional neurological control the indicated weakness of the cervical muscles may be associated with learned pain avoidance behavior which is typical among this group of patients.

Adult↗

PubMed2004

Simulated pain and cervical motion in patients with chronic disorders of the cervical spine.

The primary objective of the present study was to determine how simulated severe cervical pain affects cervical motion in patients suffering from two distinct chronic cervical disorders: whiplash (n=25) and degenerative changes (n=25). The second objective was to derive an index that would allow the differentiation of maximal from submaximal performances of cervical range of motion. Patients first performed maximal movement of the head (maximal effort) in each of the six primary directions and then repeated the test as if they were suffering from a much more intense level of pain (submaximal effort). All measurements were repeated within four to seven days. In both groups, there was significant compression of cervical motion during the submaximal effort. This compression was also highly stable on a test-retest basis. In both groups, a significantly higher average coefficient of variation was associated with the imagined pain and it was significantly different between the two clinical groups. In the whiplash group, a logistic regression model allowed the derivation of coefficient of variation-based cutoff scores that might, at selected levels of probability and an individual level, identify chronic whiplash patients who intentionally magnify their motion restriction using pain as a cue. However, the relatively small and very stable compression of cervical motion under pain simulation supports the view that the likelihood that chronic whiplash patients are magnifying their restriction of cervical range of motion using pain as a cue is very low.

Adult↗

PubMed2004

Transferability of strength gains from limited to full range of motion.

PURPOSE: This study was aimed at exploring the transferability of short range of motion (RoM) isokinetic conditioning on quadriceps performance inside and outside the trained range. METHODS: Fifty-five women were randomly assigned to one of four groups: G1 (N = 14) and G2 (N = 14) trained concentrically at 30 and 90degrees x s(-1), respectively, whereas G3 (N = 13) and G4 (N = 14) trained similarly but using the eccentric mode. All four groups trained within 30-60degrees of knee flexion. The training paradigm consisted of 4 sets of 10 maximal repetitions, 3x wk(-1) for a total period of 6 wk. Before the training period and 2 d after its termination, the isokinetic work output (Wisk) was assessed within three angular RoM: 85-60degrees (R1), 60-30degrees (R2), and 30-5degrees (R3). Isometric peak extension moment (PM) and rate of force development (RFD) were evaluated at 10degrees, 45degrees and 80degrees. RESULTS: Significant increases were observed in the isometric output (at all three angles), Wisk (in R1 and R2), and the RFD (45degrees). The PM increased significantly more in G3 and G4 compared with G1 and G2, evidencing specificity of contraction mode. CONCLUSION: These findings point out to the potential benefits of short RoM conditioning, particularly in those cases where, during specific phases of rehabilitation, a wider RoM may be contraindicative.

Adult↗

PubMed2003

The effects of protocol and test situation on maximal vs. submaximal cervical motion: medicolegal implications.

The objectives of this study were to examine the influence of the measurement protocol on the range and consistency of cervical motion (CM) in maximal vs. feigned limitation of CM, to explore some cognitive aspects of the feigning performance and to assess the effect of imagined pain vs. financial gain as a stimulus for the submaximal performance. The directions of flexion, extension, right and left rotation and right and left lateral flexion were measured in 26 normal subjects. Four protocols were compared: performance of CM with eyes open vs. eyes closed and testing at either a repetitive (within direction) or random (among directions) order. In each direction three measurements were recorded. Subjects were initially asked to move the head maximally, they were then presented with a vignette describing a fictitious accident involving the neck and were told to feign CM limitation in order to achieve unlawful compensation. In the third part, subjects were instructed to limit CM due to an imagined severe pain applying the repetitive order-eyes open paradigm only. Maximal CM paradigms were associated with significantly larger range ( p=0.0000) and higher consistency ( p=0.0000) compared the feigning paradigms. The eyes open-repetitive order protocol best separated between maximal and feigned performance. It was also indicated that the majority of subjects used the sensation of tension in the neck region as a cue for feigning while attempting to be as consistent as possible. Compared to feigning motivated by financial gain, limitation due to imagined pain resulted in significantly greater CM reductions and lesser consistency. The findings suggest that while feigning of motion impairment is probably based on somato-sensory input, the preferred CM testing protocol should consist of within direction repetitive movements with eyes open.

Adult↗

PubMed2003

Trunk extension effort in patients with chronic low back dysfunction.

STUDY DESIGN: Single-session measurement was performed. OBJECTIVE: To measure trunk extension strength and assess trunk extension effort in patients with chronic low back dysfunction using a novel test protocol and the DEC parameter. SUMMARY OF BACKGROUND DATA: In normal subjects, the DEC parameter effectively and reproducibly differentiates between maximal effort and feigned weakness of the trunk extensors, but its applicability to patients with chronic low back dysfunction has not yet been explored. METHODS: Isokinetic trunk extension strength was measured in 44 patients with chronic low back dysfunction (22 women and 22 men) who were not involved in litigation process. Tests were conducted using a range of motion of 20 degrees, angular velocities of 10 degrees and 40 degrees per second, and an isometric preactivation force of 50 N. The average strength at these velocities served for calculation of the DEC score, which is the difference between the eccentric and concentric strength ratios at these velocities. RESULTS: The strength scores resembled the characteristic physiologic moment-angular velocity relation, and were much reduced, as compared with the scores of normal subjects. The DEC scores for 39 patients (89%) were less than the cutoff value, which in normal subjects differentiates maximal effort (below cutoff) from feigned weakness (above cutoff) at tolerance limits of 99%. This figure was slightly lower (84%) at a corresponding 95% level. A principal finding in the false-positive cases was a particularly low concentric strength at 40 degrees per second. CONCLUSIONS: This study indicates that under the current protocol, the large majority of patients perform at a maximal level of effort.

Abdomen↗

PubMed2002

The effect of measurement protocol on active cervical motion in healthy subjects.

BACKGROUND AND PURPOSE: Although the assessment of cervical motion is routinely performed in clinical practice, no standard protocol for this procedure has ever been established formally. The specific aim of the present study was to select from four different measurement protocols the one which was most stable in terms of reproducibility and was appropriate for clinical and/or medicolegal applications. METHOD: A repeated measurement, test-retest of cervical motion study design using an ultrasound-based system for three-dimensional (3D) motion analysis; cervical range of motion was measured along the six primary directions: flexion; extension; right and left rotation; and right and left lateral flexion, in 20 healthy subjects who were tested twice over a period of lasting from one to four weeks. 'Protocol A' (reciprocal--intermittent testing) consisted of moving the head along a given primary direction, return to the neutral position, a pause and then motion to the opposite primary direction and return to neutral position. These movements were repeated three times. 'Protocol B' (reciprocal--continuous testing) was identical to Protocol A, but without the pause between the primary directions. 'Protocol C' consisted of three repetitions of the same primary direction with a break between two consecutive primary directions. Three sets of six randomly ordered primary directions constituted 'Protocol D'. RESULTS: Protocol D was associated with a significantly smaller range of motion and with the least intra-test reproducibility, as indicated by the coefficient of variation. The differences between the other protocols were largely negligible. CONCLUSION: In routine clinical practice, either of protocols A, B or C may be applied.

Adult↗

PubMed2002

Identification of feigned shoulder flexion weakness in normal subjects.

OBJECTIVE: The purpose of this study was to compare the effect of three related test protocols on the power of a specific index relating to the difference between the eccentric to concentric strength ratios (DEC) to identify feigned shoulder flexion effort. DESIGN: Seventeen normal subjects were instructed to exert maximal concentric and eccentric shoulder flexion effort and then to feign weakness, pretending the presence of a shoulder injury. RESULTS: For both range of motions (ROMs), the DEC scores in the feigned effort were significantly greater than their maximal counterparts. A case by case analysis revealed that the DEC correctly identified 100% of the feigned efforts when derived from the 40 and 160 degrees/sec combination. CONCLUSIONS: The findings indicate that the DEC retains its efficiency even under very short muscle length variation as long as adequate velocity gradients are applied. Consequently, maximality of effort may be tested outside compromised ROMs, particularly where pain or instability denies the performance of a standard full ROM protocol.

Adult↗

PubMed2002

Clinical application of the DEC variables in assessing maximality of muscular effort: report of 34 patients.

OBJECTIVE: To examine maximality of muscular effort in patients with expected muscle strength deficiency using acceptance-rejection cutoff values derived from isokinetic testing of maximal and feigned effort in normal subjects. DESIGN: A retrospective study of 34 patients with orthopedic, rheumatic, or neurologic disorders for which financial compensation was sought. RESULTS: The relevant scores in all patients save one were less than the respective cutoff values that in normal subjects differentiate maximal effort (below cutoff) from feigned weakness (above cutoff) at a 95% level of confidence. CONCLUSIONS: If normal subjects-based cutoff values are accepted as benchmarks for validation of muscle strength deficiency claims, this study indicates that subject to a given protocol, patients performed at a maximal level of effort.

Adolescent↗

PubMed1997

The measurement of isokinetic fingers flexion strength.

OBJECTIVE: To investigate the feasibility of using isokinetic dynamometry for measuring the dynamic strength of the fingers flexors. SUBJECTS: Sixteen healthy women aged 19-52. DESIGN: Flexion strength was measured isometrically using a Jamar dynamometer and isokinetically using a special attachment which was harnessed to a KinCom 125 dynamometer. In the series comprising the dynamic measurements, the elements of contraction mode (concentric vs eccentric), test velocity (low, medium and high) and isometric preactivation bias (low vs high) were incorporated. RESULTS: Dynamic strength parameters manifested expected physiological relationships both within their own frame of reference and with respect to the static measures. CONCLUSION: Based on various facets of validity it is suggested that isokinetic dynamometry offers a valid venue for measuring fingers flexion strength. Furthermore, this study allows a selection of test parameters for the standardization of this measurement.

Journal Article↗

PubMedDate not supplied

Reproducibility indices applied to cervical pressure pain threshold measurements in healthy subjects.

OBJECTIVES: To apply various statistical indices for reproducibility analysis of pressure pain threshold measurements and to derive a preferred pressure pain threshold measurement protocol based on these indices. METHODS: The pressure pain threshold of 3 pairs of right and left homologous cervical region sites were measured in 20 healthy subjects (10 women, 10 men) using a hand-held pressure algometer. Measurements took place on 2 occasions (test 1 and test 2) separated by a mean interval of 1 week. On each testing session, the site-related pressure pain thresholds were measured 3 times each according to 2 different protocols. Protocol A consisted of a repetitive order, namely 3 consecutive measurements at each site before proceeding to the next, whereas protocol B consisted of an alternate order in which 3 consecutive rounds of all individually tested sites took place. For test 1, protocol A was followed by protocol B with an hour interval. For test 2, the reverse order took place. RESULTS: The findings revealed no significant differences between the two protocols and indicated a significant rise (P < 0.0001) in the absolute scores from test 1 to test 2 in both protocols. Absolute values (mean +/-SD) derived from the entire sample of pressure pain threshold sites ranged from 140 +/- 60 to 198.7 +/- 95 kPa (1.60 +/- 0.6 to 1.99 +/- 0.95 kg/cm, respectively). No significant gender or side differences were noted. Pearson r as well as the intraclass correlation coefficient revealed good to excellent reproducibility for both protocols and for all sites measured: r = 0.79-0.94 and intraclass correlation coefficient(3,3) = 0.85-0.96, respectively. To define site-specific cutoff values indicating change at the 95% confidence level, 1.96*SEM was calculated, and its values ranged from 31.6 to 58.2 kPa, which correspond to 16.8% to 32.8% of the absolute mean values. In addition, the limits of agreement, which depict the individual test-retest differences relative to their mean, indicated a heteroscedastic trend. DISCUSSION: The two protocols yielded very similar results. However, on the grounds of patient's comfort and compliance as well as facility of application, protocol B stands out as the more preferred between the two.

Abstracting and Indexing↗