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PubMed1988

Muscle strength following anaesthesia with atracurium and pancuronium.

Postoperative recovery from muscle weakness was investigated by handgrip strength after general anaesthesia using short- and long-acting muscle relaxants. Handgrip strength was measured on four occasions, preoperatively, before and after premedication, and postoperatively, both as soon as the patient could sustain a five-second headlift and one hour later. Twenty patients received either atracurium 0.6 mg/kg or pancuronium 0.1 mg/kg as part of a general anaesthetic technique with neostigmine reversal. Compared with their initial preoperative hand strengths, the two relaxant groups showed only an insignificant decrease in grip strength to 92% after premedication. Postoperatively when a five-second headlift was achieved, the patients in both groups were weak. The group given atracurium had a mean of 60% of their initial grip strength and those given pancuronium had a mean of 44%. This difference in strength was statistically significant from the initial level and from each other. However, there was no difference between the groups in the time interval from administering reversal to achieving a sustained headlift. One hour later in both groups grip strength was much better, within 80% of that seen after premedication in most patients, and no significant difference in grip strength was seen between the groups. This study demonstrates that patients who receive relaxant anaesthesia have substantial muscle weakness in the recovery phase. When neostigmine reversal is used, pancuronium appears to have a similar return of voluntary muscle power to that seen with atracurium. The marked difference in elimination kinetics of these two relaxants seems to be of little importance when neostigmine reversal is used.

Adult↗
PubMed1999

Is the coefficient of variation a valid measure for detecting sincerity of effort of grip strength?

The wide use of the coefficient of variation in detecting sincerity of effort is puzzling since existing research findings regarding its effectiveness are contradictory. The lack of empirical support in the literature raises the question of whether or not the coefficient of variation is a valid measure for detecting sincerity of effort. Many clinicians, especially those who use a computer software to calculate the coefficient of variation, may not understand how the coefficient of variation is derived and what it is based on. The coefficient of variation is a measure of relative variability and would be used correctly only if the average and the standard deviation of grip strength trials increased proportionally. This case study, however, demonstrated that the average and standard deviation of grip strength are independent. Thus, the coefficient of variation is not a valid measure of sincerity of effort. In addition, this study indicated that the coefficient of variation may be inflated in individuals after carpal tunnel release surgery. The author, therefore, cautions clinicians against the use of the coefficient of variation as a measure of sincerity of effort especially in injured individuals with compromised hand strength.

Journal Article↗
PubMedDate not supplied

Nurses' ability to achieve hyperinflation and hyperoxygenation with a manual resuscitation bag during endotracheal suctioning.

OBJECTIVE: To examine nurses' ability to deliver 1.5 times the ventilated tidal volume at 100% FIO2 with a manual resuscitation bag during endotracheal suctioning. DESIGN: Prospective, descriptive. SETTING: Six adult critical care units in a large university-affiliated medical center. SUBJECTS: One hundred nurses randomly selected from the six adult intensive care units. OUTCOME MEASURES: Nurses' manual resuscitation bag delivery of tidal volume and oxygen, as well as bagging rate, number of breaths delivered, and number of suction catheter passes performed. Patients' heart rate, mean arterial pressure, and arterial oxygen saturation. RESULTS: The mean FIO2 delivered was 0.71 (range 0.24 to 0.97). Oxygen liter flow and nurses' delivered minute ventilation predicted 24% of the variance in FIO2 delivered. Mean bagging rate was 31 compressions per minute. The mean volume per breath delivered was 626 cc, which resulted in achievement of 57% of the standard (1128 cc). Volume achieved was related to patient lung compliance, but not related to nurses' experience, unit of employment, hand strength, or size. CONCLUSIONS: Nurses observed were unable to meet the standard for volume or oxygen delivery. However this did not affect the patient's heart rate, mean arterial pressure, or SaO2.

Adult↗
PubMed2005

Factors related to oral hygiene in persons with scleroderma.

OBJECTIVES: The purpose of this study was to assess potential risk factors for the development of poor oral hygiene and increased dental caries in individuals with scleroderma. METHODS: Twenty-two subjects with scleroderma participated in this study. All subjects were examined with the Patient Hygiene Performance (PHP) Index, which assesses the extent of plaque and debris over a tooth surface. In addition, oral aperature, xerostomia and dominant upper extremity strength, motion, skin thickness, and dexterity were measured. RESULTS: None of the subjects had good or excellent hygiene. Fifteen subjects had fair oral hygiene and seven subjects had poor oral hygiene as measured by the PHP Index. Significant differences were seen between these two groups for oral aperture, percentage of teeth with caries, skin thickness, dexterity and finger flexion. Dexterity and joint motion correlated significantly with the number of decayed surfaces and number of caries. Oral aperture correlated with the PHP Index and the number of dental caries. CONCLUSIONS: Subjects with poor oral hygiene required more time to complete manual dexterity task and had decreased hand strength and joint motion. Moreover, these same subjects had more contractures, scars, ulcers, and higher skin scores (more disease activity) than subjects in the fair hygiene group. In addition to frequent dental exam and routine cleaning, dental personnel may want to consider exercises to increase oral aperature and investigate toothbrush and dental floss selection used by persons with scleroderma.

Dental Caries↗
PubMed1989

Trapeziometacarpal abnormalities in Ehlers-Danlos syndrome.

We studied 24 patients with Ehlers-Danlos syndrome with particular attention to the thumb and the trapeziometacarpal joint. The 11 males and 13 females had a mean age of 15.9 years. Symptomatic complaints included pinch, grip and twisting weakness; measurements showed dominant hand strength deficits of 71% for tip pinch, 55% for palmar pinch, 46% for key pinch, and 70% for grip. All finger joint ranges of motion were increased. Sixty-six percent of all the patients had trapeziometacarpal subluxation; 29% had dislocation. Sixteen percent had radiographic evidence of arthritis. Early occupational therapy evaluation and education can help these patients better understand and adapt to their limitations.

Adolescent↗
PubMed2003

Outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health.

This article is a brief review of the outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health. Several tools currently exist to quantify outcome in hand surgery at the impairment level (eg, mobility, hand strength, cutaneous sensation, dexterity). According to the World Health Organization's paradigm, however, activity limitations and participation restrictions are also clinically relevant. The authors have recently built a measure of an upper limb-impaired individual's ability to manage manual activities in daily life. Participation and quality of life are difficult outcomes to measure because they are multidimensional and depend on such factors as functional abilities, general physical health, financial security, and stability of the social and familial environment.

Activities of Daily Living↗
PubMed2006

[Development of a rating scale for self-efficacy of physical activity in frail elderly people].

AIM: The purpose of the present study was to 1) development the scale of the self-efficacy of physical activity in frail elderly people (SEPAF), 2) investigate the relationship of physical functions and instrumental activity of daily living (IADL). METHODS: The study included 187 community-dwelling elderly people. Subject's SEPAF (walking, stair-climbing, lifting a weight), physical functions (usual gait speed, maximum gait speed, knee extension muscle strength, hand grip) and IADL according to the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence) were measured. The reliability of this scale was examined using Cronbach's alpha, and test-retest correlation. The criterion-related validity and the construct validity were evaluated relatively using physical functions and factor analysis. The score was compared between young-old and old-old and gender. The correlation between SEPAF and TMIG Index of Competence was examined. RESULTS: Cronbach's a showing internal consistency for these scales were 0.78-0.82. The score showed significant differences in gender and age group. There were significant relationships between SEPAF and physical functions, and the TMIG Index of Competence. CONCLUSION: The SEPAF was shown to be highly reliable. Few scale for frail elderly people exist, and it is useful to assess the self-efficacy of physical activities in frail and community-dwelling elderly people.

Activities of Daily Living↗
PubMed2001

Patient-controlled interscalene analgesia with ropivacaine 0.2% versus bupivacaine 0.15% after major open shoulder surgery: the effects on hand motor function.

UNLABELLED: We compared the effects of patient-controlled interscalene analgesia with ropivacaine 0.2% and patient-controlled interscalene analgesia (PCIA) with bupivacaine 0.15% on hand grip strength after major open shoulder surgery. Sixty patients scheduled for elective major shoulder surgery were prospectively randomized to receive in a double-blinded fashion either ropivacaine or bupivacaine through an interscalene catheter. Before surgery, all patients received an interscalene block (ISB) with either 40 mL of 0.6% ropivacaine or 40 mL of 0.5% bupivacaine. Six h after ISB, the patients received a continuous infusion of either 0.2% ropivacaine or 0.15% bupivacaine for 48 h. In both groups, the PCIA infusion rate was 5 mL/h plus a bolus of 4 mL with a lockout time of 20 min. Strength in the hand was assessed preoperatively, 24 h, and 48 h after ISB and 6 h after stopping the infusion of local anesthetic. The presence of paresthesia in the fingers was checked. Pain relief was assessed using a visual analog scale; side effects were noted, and the patients rated their satisfaction 54 h after the block. A significant decrease of strength in the hand was observed in the Bupivacaine group 24, 48, and 54 h after ISB (P < 0.05). Paresthesia was more frequently reported in the Bupivacaine group for the second and third fingers 48 h after ISB (P < 0.05) and in the first three fingers 6 h after discontinuation of the local anesthetic infusion (P: < 0.05). The pain score was similar in the two groups at all times, and patient satisfaction was comparable between the two groups. We conclude that the use of the PCIA technique with ropivacaine 0.2% or bupivacaine 0.15% provides a similar pain relief after major shoulder surgery. However, ropivacaine 0.2% is associated with better preservation of strength in the hand and less paresthesia in the fingers. IMPLICATIONS: We compared the patient-controlled interscalene analgesia technique with ropivacaine 0.2% and bupivacaine 0.15% after major open shoulder surgery. For similar pain control ropivacaine is associated with better preservation of strength in the hand and less paresthesia in the fingers.

Adolescent↗
PubMed1984

Family resemblance for neuromuscular performance in a Kansas Mennonite community.

Familial phenotypic resemblance for six quantitative neuromuscular performance traits is analyzed by path analysis using data from the Mennonite community of Goessel, Kansas. Of the six traits only one, dominant hand strength, shows no evidence of parent-offspring transmission (t2 = 0.001) and only one, trunk flexibility, shows evidence of a high degree of transmissibility (t2 = 0.662). The four remaining traits display low to moderate levels of transmissibility (t2 = 0.073 to t2 = 0.245). A substantial residual sibling resemblance due to shared environmental effects is seen for all six traits. It is suggested that the high heritabilities found for many of these traits by other methods result from the inability of these methods to account for the shared nongenetic effects.

Adolescent↗
PubMed1995

Sexual orientation and performance on sexually dimorphic motor tasks.

Performance of homosexual and heterosexual men and women on two motor tasks which reliably demonstrate sex differences in opposite directions was examined. A Throw-to-Target Task and the Purdue Pegboard were administered to undergraduate students matched for age and program of study. A two-way ANOVA (Sex x Sexual Orientation) of the Throw data showed a significant interaction, F(1, 90) = 16.22, p < or = 0.001, and a trend for an effect of sex, F(1, 90) = 3.72, p < 0.06. Heterosexual men outperformed heterosexual women, whereas gay men threw less accurately and lesbians tended to throw more accurately than their heterosexual counterparts. Differences in sports history or hand strength did not account for these effects. Analysis of the Pegboard scores found no interaction or main effect of sexual orientation, but the effect of sex was significant, F(1,63) = 7.01, p < or = 0.02. Regardless of sexual orientation, women outperformed men and this difference remained significant even when a measure of finger size was partialed out. This study provides new evidence suggesting an association between sexual orientation and motor-performance profiles. As with cognitive tasks, the motor-performance profiles of homosexuals are composites of some male-typical and some female-typical abilities. To the extent that sociological factors have been controlled, the study suggests that both sexual orientation and motor/cognitive predispositions may have early biological contributions.

Adult↗
PubMed2004

Assessing task "burden" of daily activities requiring upper body function among women following breast cancer treatment.

GOALS OF WORK: To determine which individual or groups of "upper-body" daily tasks are considered most burdensome to women following breast cancer treatment, and to assess whether certain patient or treatment characteristics influence task burden. PATIENTS AND METHODS: A convenience sample of breast cancer survivors (n =619) completed a self-administered questionnaire regarding 48 daily tasks requiring upper-body function. Women were asked to rate how frequent and physically demanding each task was using a five-point Likert scale, and the product of task frequency and physical demand determined overall task burden. Tasks were ranked to identify the most burdensome individual tasks, while a factor analysis was performed to define independent constructs (groupings) among the tasks. Multiple linear regression models were fitted to consider the independent influences on task groups of various participant characteristics. MAIN RESULTS: Factor analysis identified seven distinct task groups and the individual tasks considered most burdensome fell in five of these groups, specifically whole body, flexibility, carrying/upper-body strength, hand and weighted flexion tasks. Having lymphoedema or poor fitness was associated with upper-body disability involving all seven task groups, whereas other patient and treatment characteristics were related only to certain types of activities. CONCLUSIONS: Breast cancer survivors report difficulty with a range of upper-body tasks, particularly if they also have lymphoedema or poor fitness. Using all or some of the tasks within the reported constructs in a questionnaire format, or the functional requirements of the most burdensome tasks to develop more objective and quantitative measures, would provide a solid base for the measurement of upper-body function in women with breast cancer.

Activities of Daily Living↗
PubMed2003

Risk factors for osteoporosis in men.

We evaluated the risk factors for osteoporosis in men. The subjects of this study consisted of 686 healthy middle-aged (40-59 years) men who had undergone bone mineral density (BMD) measurement and medical examination, including physical strength. BMD of L2-4 was measured at the anterior-posterior position, using dual X-ray absorptiometry. Physical investigations, such as height, weight, and physical strength, were carried out on the examination day. Details of tobacco and alcohol consumption, exercise, and food intake were described on a questionnaire completed by the subjects. Sixty-five (9.5%) of the 686 subjects had a BMD less than 2.5 SD below the peak bone mass (PBM), 182 (26.5%) had a BMD between 1 SD and 2.5 SD below the PBM; and 439 (64.0%) had a BMD no less than 1 SD below the PBM. Body mass index (BMI) and leg strength were significant positive determinants of BMD, and smoking was a significant negative determinant on multiple regression analysis, with a coefficient of determination of 9.5%. Calcium intake, exercise, and alcohol consumption were not significant determinants of BMD. These results suggest that poor lifestyle behaviors (i.e., smoking) accelerate the reduction of bone density.

Absorptiometry, Photon↗
PubMed2004

Sex differences in common Marmosets (Callithrix jacchus) in response to an unfamiliar food task.

There is a growing body of information on sex differences in callitrichid behaviour that includes the animals' performance in food tasks. For example, both reproductive and non-reproductive adult females have been found to be more successful than adult males in solving food tasks. In this study ten adult male and ten adult female common marmosets (Callithrix jacchus), housed individually, were tested with an unfamiliar task that involved the extraction of an embedded food. The task was to open a plastic canister that contained a raisin; the open end was covered with parchment paper. Each marmoset was given 15 trials in three blocks of 5 consecutive days. We measured the latency for each animal to open the lid and get the raisin--by one of five strategies that spontaneously emerged. The females learned the task faster and more efficiently than males; all the females opened the canister on day 1, for instance, in contrast to seven of the males on the same day. Females also progressively decreased the time that they took to open the tube. The final latency on day 15, for instance, was significantly shorter for the females. These results are consistent with relevant literature for callitrichids and cannot be accounted for in terms of differences in mental abilities, strength, hand morphology, or energy requirements. Further investigation is necessary to clarify the reasons for these differences.

Animals↗
PubMed1987

Dichotic listening performance and writing posture in right- and left-handers.

Right-handers and left-handers with the inverted (IN) and noninverted (NI) writing posture were tested on a dichotic consonant-vowel listening task and on two motor tasks (hand strength and speed of tapping). The results failed to show the differences between IN and NI right-handers reported by S. M. Tapley and M. P. Bryden (1983, Neuropsychologia, 21, 129-138) and there were no significant handedness x writing posture x ear interactions. A significant interaction between dichotic listening performance and writing posture was found; NI right-handers and IN left-handers had more correct responses and fewer intrusions than IN right-handers and NI left-handers. Left-handers and right-handers were found to have a right ear advantage (REA) in the dichotic listening task but left-handers had relatively smaller left/right differences in all of the performance measures. Sample characteristics suggest that there are more IN male right-handers than IN female right-handers.

Adult↗
PubMed2006

The first Belgian hand transplantation--37 month term results.

The first Belgian hand transplant was a 22 year-old man with a traumatic amputation of his dominant hand at the junction of the middle and distal thirds of the forearm. The donor and recipient had three HLA mismatches. The cross-match was negative. The total ischaemic time was slightly over 6 hours. Immunosuppression included antithymocyte globulins at induction and tacrolimus, mycophenolate mofetil and prednisolone as induction and maintenance therapy. There has been no episode of rejection. The only significant complications, except for transient hyperglycaemia, were psychological. At 37 months post-transplantation, the patient has fully incorporated his transplant into his self-image and is back at work. He has good sensibility (two-point discrimination of 6mm at the thumb and index finger pulps), acceptable wrist and finger motion with functioning intrinsic muscles. According to Chen's criteria, the result is good to excellent.

Adult↗
PubMed2002

Exercise training for African Americans with disabilities residing in difficult social environments.

OBJECTIVE: To examine the feasibility, efficacy, and safety of a structured 12-week exercise training program for a predominantly African-American group of adults with multiple health conditions who reside in difficult social environments. METHODS: A total of 37 females and 7 males (mean age, 54.1 years) participated in an exercise training regimen 3 days per week for 60 minutes per day (cardiovascular, 30 minutes; strength, 20 minutes; and flexibility, 10 minutes). Outcome measures included peak VO(2) (mL min(-1), mL kg(-1) min(-1)); upper and lower body strength (strength); hand-grip strength (GS); body weight (BW); total skin folds (TS); waist-to-hip ratio (WHR); hamstring/low-back flexibility (HLBF); and shoulder flexibility (SF). RESULTS: Compared to the control group, the exercise group showed significant gains in peak VO(2) (p < 0.01); strength (p < 0.01); and body composition (TS, p < 0.01). There was no significant difference between the exercise and control groups on BW, WHR, HLBF, and GS. Of a total 1116 exercise sessions (31 experimental participants x 36 sessions), 87% of the sessions were attended. CONCLUSIONS: A structured exercise-training program can provide substantial improvement in strength and cardiovascular fitness in low-income, sedentary adults with multiple chronic conditions and/or risk factors for chronic conditions. Future research should explore simple home-based and community-based physical activity interventions that provide ongoing support for increasing and maintaining physical activity participation in this cohort.

Black or African American↗
PubMed2006

Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: a prospective, randomized, double-blind comparison between levobupivacaine 0.25%, and ropivacaine 0.25% or 0.4%.

BACKGROUND AND OBJECTIVES: To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery. METHODS: Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment. RESULTS: No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups. CONCLUSION: When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.

Adolescent↗