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PubMed2004

Correction of sagittal plane spinal deformities with unit rod instrumentation in children with cerebral palsy.

BACKGROUND: To our knowledge, there have been no previous studies addressing the indications for and the results of treatment of patients with cerebral palsy and concomitant kyphosis or lordosis without scoliosis. The purpose of the present study was to identify the indications for and the results of treatment of patients with cerebral palsy who have a spinal curve deformity solely in the sagittal plane. METHODS: We conducted a retrospective review of the data on all patients with cerebral palsy who had a sagittal plane spinal deformity but no coronal plane deformity, had undergone posterior spinal fusion with unit rod instrumentation at our institution, and had been followed for at least two years. Medical records and radiographs were reviewed for symptoms, type and magnitude of deformity, age at surgery, duration of surgery, nutritional status, complications, and concomitant medical problems. RESULTS: Twenty-four patients--ten boys and fourteen girls--were identified. Eight patients had a hyperlordotic deformity, fourteen had a hyperkyphotic deformity, and two exhibited both. Surgical indications included severe seating problems that could not be rectified with wheelchair modifications (eighteen patients), severe back pain (four patients), superior mesenteric artery syndrome that was refractory to conservative treatment (two patients), and a hyperlordotic deformity with a loss of bowel and bladder control (one patient). It was found that specific technical concerns had to be addressed when the unit rod instrumentation was used. The mean preoperative hyperkyphotic curve of 93.8 degrees was corrected to a mean of 35.8 degrees postoperatively and was a mean of 34.8 degrees at the last visit. The mean preoperative hyperlordotic curve of 91.8 degrees was corrected to a mean of 43.6 degrees postoperatively and was a mean of 48.6 degrees at the last visit. All patients with seating problems and back pain had improvement or resolution of the problem after the surgery. The superior mesenteric artery syndromes, losses of bowel and bladder function, and malnutrition all resolved completely after the surgery. CONCLUSIONS: Patients with cerebral palsy and a severe sagittal plane deformity (> or = 70 degrees ) can be treated successfully with posterior spinal fusion with use of unit rod instrumentation. Indications for treatment include loss of sitting ability or balance, back pain, loss of bowel or bladder function, and superior mesenteric artery syndrome that is unresponsive to medical management.

Cerebral Palsy↗
PubMed1997

Effects on archery performance of manipulating metamotivational state and felt arousal.

This study investigated the effect of the four different combinations of metamotivational state and felt arousal level (telic-low, paratelic-low, telic-high, paratelic-high) on archery performance. Skilled, average, and novice archers (n = 28) were voluntary subjects, randomly divided into 2 groups, balanced for ability. Each group performed 2 out of the 4 experimental conditions. In this reversal theory-based field experiment, telic and paratelic metamotivational states and arousal level were manipulated prior to archery performance. The hypothesis that archery performance would be superior under telic-low arousal conditions was rejected, but evidence pointed to the possible importance of hedonic tone in performance. Post boc analysis showed differences between combined high (telic-low, paratelic-high) and combined low (telic-low, paratelic-high) hedonic-tone groups which fell short of significance. This observation is taken as justification for further exploration of the relationship between hedonic tone and sports performance.

Adolescent↗
PubMed1996

Can the patient be the focus of managed care?

If the question were simply put: "What is it that succeeds or fails to meet patients' needs in managed care?" Dr. John M Ludden would have a short answer. "It depends. Success depends on whether you are talking about individuals or about populations of patients. And it depends on whether you are talking about meeting patients' needs or their desires. It depends on whether you're talking about well patients or sick patients, young patients or older patients, new patients or established patients, rich patients or poor patients. And it depends on your ability to balance each of these qualities." This article explores how to translate high-quality care for a population to high-quality care for individuals.

Health Maintenance Organizations↗
PubMed2000

Distribution of nociceptin/orphanin FQ precursor protein and receptor in brain and spinal cord: a study using in situ hybridization and X-gal histochemistry in receptor-deficient mice.

Nociceptin/orphanin FQ (N/OFQ) is an opioid-like heptadecapeptide agonist for the opioid receptor homolog, N/OFQ receptor. To explore the precise distribution of the peptide-receptor system, the authors examined the brain and spinal cord from receptor-deficient mice bearing the targeted mutation (morc(m1)), a lacZ insertional mutation in the N/OFQ receptor gene. Precursor protein N/OFQ (preproN/OFQ) mRNA was detected by using in situ hybridization, and the N/OFQ receptor was detected by using X-gal histochemistry. The N/OFQ receptor reflected by lacZ expression was observed at high levels in the dentate gyrus, lateral septum, subparafascicular thalamic nucleus, medial preoptic area, median preoptic nucleus, ventromedial preoptic nucleus, anterior hypothalamic area, paraventricular hypothalamic nucleus, ventromedial hypothalamic nucleus, auditory brainstem nuclei, pontine dorsal tegmentum, and nucleus of the solitary tract. In situ detection of the N/OFQ receptor mRNA by digoxigenin-labeled riboprobes coupled with tyramide signal amplification in normal and wild-type mice resulted in the regional distribution paralleling the lacZ expression in these regions. PreproN/OFQ mRNA was expressed at high levels in the subparafascicular thalamic nucleus, central gray, central tegmental field, auditory brainstem nuclei, caudal spinal trigeminal nucleus, and spinal dorsal horn. Furthermore, variable levels of expression of the peptide and receptor were seen in distinct sites of the brain and spinal cord. These data indicate a correspondence of the peptide and the receptor in local distribution at limbic, hypothalamic, and brainstem sites. Together with concurrent physiologic and behavioral studies in mutant mice, the results suggest functional roles for the N/OFQ system, including the central regulation of learning and memory, hearing ability, water balance, food intake, and blood pressure.

Animals↗
PubMed2001

[Development of gait in childhood: a systematic gait analysis].

To study the normal gait development in childhood, we performed a systematic gait analysis on 37 normal children (20 boys and 17 girls) aged between two and six years. The gait cycle, single support phase, ratio of stride length to body height, plantiflexor angles of the feet and propelling force increased with age, whereas the ratio of gait width to stride length and dorsiflexor angles of the feet decreased. The knee-flexion waves, heel-strikes were found in all subjects. From two to six years of age, balance-holding ability and feet plantiflexor forces developed, resulting in more efficient locomotion. The pattern of the lower limb movements on gait is considered to mature during the first three years of life.

Child↗
PubMed2001

What you don't know about making decisions.

Most executives think of decision making as a singular event that occurs at a particular point in time. In reality, though, decision making is a process fraught with power plays, politics, personal nuances, and institutional history. Leaders who recognize this make far better decisions than those who persevere in the fantasy that decisions are events they alone control. That said, some decision-making processes are far more effective than others. Most often, participants use an advocacy process, possibly the least productive way to get things done. They view decision making as a contest, arguing passionately for their preferred solutions, presenting information selectively, withholding relevant conflicting data so they can make a convincing case, and standing firm against opposition. Much more powerful is an inquiry process, in which people consider a variety of options and work together to discover the best solution. Moving from advocacy to inquiry requires careful attention to three critical factors: fostering constructive, rather than personal, conflict; making sure everyone knows that their viewpoints are given serious consideration even if they are not ultimately accepted; and knowing when to bring deliberations to a close. The authors discuss in detail strategies for moving from an advocacy to an inquiry process, as well as for fostering productive conflict, true consideration, and timely closure. And they offer a framework for assessing the effectiveness of your process while you're still in the middle of it. Decision making is a job that lies at the very heart of leadership and one that requires a genius for balance: the ability to embrace the divergence that may characterize early discussions and to forge the unity needed for effective implementation.

Administrative Personnel↗
PubMed1986

Neurotoxicity in rats following subchronic amiodarone treatment.

Rats were treated with amiodarone (20 mg/kg/day) up to 6 weeks and the neurotoxicity was assessed by determining changes in motor coordination, pain-threshold and rectal temperature every week during treatment. Body weight gain was decreased during amiodarone treatment and it was significant at and after 5 weeks. Food intake and water consumption were significantly reduced during treatment. After the first week of treatment with amiodarone, rats showed decreased ability to balance on horizontal rods. In the hot plate test (paw-lick), the amiodarone treated rats showed increased pain-thresholds throughout the treatment. Hypothermia was significant only at 6 weeks. These results show that amiodarone causes toxicity in rats and this model might be useful for further studies. Decreased motor-coordination, and increased pain-responding times may indicate development of peripheral neuropathy in addition to muscle weakness.

Amiodarone↗
PubMed1984

Genetic influences on the central nervous system depressant and membrane-disordering actions of ethanol and sodium valproate.

The effects of the two central nervous system (CNS) depressant drugs ethanol and sodium valproate were compared using two pairs of mouse lines that had been selected from a heterogeneous stock for differential sensitivity to ethanol. The LS/SS lines differ in sensitivity to ethanol-induced sedation, and the WSP/WSR lines differ in the severity of their withdrawal convulsions after chronic ethanol treatment. We used these lines to test the hypothesis that ethanol and valproate act by the same mechanism. CNS depressant action was assessed by determining the brain drug concentration at which the mice lost their ability to balance on a stationary wooden dowel. LS mice were about twice as sensitive as SS mice to valproate-induced ataxia, in agreement with their reported relative sensitivity to ethanol. The WSR and WSP mice did not differ significantly in sensitivity to ethanol or valproate in this test. The intrinsic order and sensitivity to disordering of synaptosomal plasma membranes prepared from the four lines were measured using fluorescence polarization with the probe 1,6-diphenyl-1,3,5-hexatriene and EPR spectroscopy with 5-doxylstearic acid. No differences in the intrinsic membrane order of the four lines were detected with either technique. The sensitivities of the membranes from the four lines to ethanol- or valproate-induced disordering were not significantly different when measured by fluorescence polarization, but EPR spectroscopy revealed line differences in disordering sensitivity that correlated with the relative sensitivity of the four lines to the CNS depressant action of these drugs. These studies show that genetic factors modulate sensitivity to ethanol and valproate in a similar manner both in vivo and in vitro, suggesting that these drugs act by the same membrane-disordering mechanism.

Animals↗
PubMed1982

Rapidly developing functional tolerance to ethanol is accompanied by increased erythrocyte cholesterol in mice.

We investigated the time course for development of functional tolerance to the ataxic effects of ethanol in four genetically distinct mouse populations. Two inbred-strains (C57BL/6J and DBA/2J) and two lines of mice (long-sleep and short-sleep) selectively bred for differences in acute ethanol sensitivity were used. Mice were injected i.p. with ethanol in doses that produced ataxia and were tested repeatedly for their ability to balance on a wooden rod. When they regained their balance at threshold, brain ethanol levels were measured in some mice and booster injections of ethanol were administered to the remaining animals. This sequence was repeated for five injections, delivering a total of 6 g/kg of ethanol to the final group of animals. Functional tolerance developed in all four populations of mice as evidence by threshold brain ethanol levels that were significantly higher after two or three successive injections than after one injection. The magnitude of tolerance was not increased by practice on the dowel. To investigate whether alterations in membrane lipid composition accompanied this rapid development of tolerance, we used erythrocytes as a model system and measured the cholesterol and phospholipid content of their membranes. The erythrocyte membranes from ethanol-tolerant mice of each population contained more cholesterol than those from controls. The erythrocyte membrane phospholipid content of ethanol-tolerant animals changed only slightly in two populations.

Animals↗
PubMed1993

Spatial orientation and posture during and following weightlessness: human experiments on Spacelab Life Sciences 1.

The 4 payload crew members of the Spacelab Life Sciences 9-day space flight in 1991 were subjected to limited vestibular testing in flight as well as pre and post flight. Major differences in individual "perceptual style" appeared in their reaction to the visual-vestibular stimuli in the rotating dome experiment, and especially in the extent to which nondirectional tactile cues served to anchor the subjective vertical and body postural reactions. The ability of subjects to point to remembered target positions was degraded in space, which produced a tendency to point low in some subjects in flight. The eye movements and subjective response to sudden stops and head pitching following continuous spinning (dumping) were measured both in space and on the ground. Although subjective duration of inflight rotation for the dumping tests was shorter than that for the preflight tests, the postrotatory nystagmus, with or without head pitch, was lengthened in time constant relative to preflight. Ground tests, in addition to the flight experiments, investigated the changes following weightlessness in subjective and oculomotor reactions to whole body tilt, the ability to balance with eyes open and closed; leg muscles strength and stamina as related to posture; visual field dependence; and the perceptual and oculomotor reactions to horizontal linear acceleration. Several of these tests, as well as post-flight measures of motion sickness susceptibility, revealed subtle evidence of neurovestibular alterations that lasted a week or more following the 10-day orbital exposure.

Adaptation, Physiological↗
PubMed1993

Repeated social stress during pregnancy impairs neuromotor development of the primate infant.

Neuromotor responses were assessed in 90 infant squirrel monkeys born from normal and stressed pregnancies. Repeated psychological disturbance during pregnancy, evoked by disruption of the pregnant female's social relationships, significantly altered the performance of the young infant on a standardized battery of neuromotor tests. As compared with infants from undisturbed pregnancies, infants from chronically stressed pregnancies had poorer motor abilities, impaired balance reactions, and reduced postrotary nystagmus. They also had shorter attention spans and looking episodes during the administration of orientation items. In contrast, when only a single stressful period was imposed during midgestation, infants were not significantly different from control subjects. These findings indicate that sustained stress across pregnancy can have deleterious effects on fetal development, but a short period of stress, at least when restricted to midgestation, does not appear to adversely affect neuromotor responses of the young primate infant.

Animals↗
PubMed1993

Losartan prevents salt-induced hypertension in reduced renal mass rats.

A reduction in functioning renal mass through surgical ablation leads to the development of hypertension and chronic renal failure in rats. Reduced renal mass (RRM) hypertension is more severe and develops more quickly if rats are on high salt intake. It has previously been shown that hypertension in these rats can be prevented by treatment with angiotensin-converting enzyme inhibitors. The current experiment examined the effect of losartan, an angiotensin II antagonist, on blood pressure in RRM and intact rats after a 3-fold increase in salt intake. It was found that chronic treatment with i.v. losartan (3 mg/kg/day) completely prevented sodium-induced hypertension in the RRM rats, whereas neither increased salt intake nor losartan treatment affected blood pressure in the intact rats. The antihypertensive effect of losartan was associated with an apparent renoprotective effect in RRM rats (blood urea nitrogen concentration rose in untreated animals, but remained stable in treated animals), but was not accompanied by chronic changes in water or sodium balance. The ability of losartan to prevent RRM hypertension suggests that angiotensin II is necessary for the development of this model of hypertension.

Angiotensin II↗
PubMed1998

Cancer-related fatigue: clinical practice issues.

The purpose of this paper is to review current nursing literature and practice in cancer-related fatigue and to provide a suggested plan of treatment. Cancer-related fatigue is one of the most common and challenging symptom-management problems. The successful treatment of fatigue depends on the clinician's understanding of the symptom's continuum within the cancer experience, its etiologies, assessment strategies, and research-based interventions. Clinical outcomes are measured by the patient's ability to balance energy expenditure and restoration. By applying this knowledge to clinical practice, oncology nurses can have a profound impact on the patient's quality of life.

Energy Metabolism↗
PubMed2004

Neuronal bases of perceptual learning revealed by a synaptic balance scheme.

Our ability to perceive external sensory stimuli improves as we experience the same stimulus repeatedly. This perceptual enhancement, called perceptual learning, has been demonstrated for various sensory systems, such as vision, audition, and somatosensation. I investigated the contribution of lateral excitatory and inhibitory synaptic balance to perceptual learning. I constructed a simple associative neural network model in which sensory features were expressed by the activities of specific cell assemblies. Each neuron is sensitive to a specific sensory feature, and the neurons belonging to the same cell assembly are sensitive to the same feature. During perceptual learning processes, the network was presented repeatedly with a stimulus that was composed of a sensory feature and noise, and the lateral excitatory and inhibitory synaptic connection strengths between neurons were modified according to a pulse-timing-based Hebbian rule. Perceptual learning enhanced the cognitive performance of the network, increasing the signal-to-noise ratio of neuronal activity. I suggest here that the alteration of the synaptic balance may be essential for perceptual learning, especially when the brain tries to adopt the most suitable strategy--signal enhancement, noise reduction, or both--for a given perceptual task.

Action Potentials↗
PubMed2001

A note on the effects of forward and rear-facing orientations on movement of horses during transport.

Several studies have attempted to determine the effects of orientation on a horse's ability to maintain balance during transportation. The results have often been contradictory because of differences in trailer design and lack of simultaneous comparisons. In this study, three replications of two forward-facing and two rear-facing horses were transported at the same time over a standardized course to allow for simultaneous comparisons. Each animal's total forward and backward motion during transport was calculated to estimate the effect of orientation on the horses' ability to maintain balance. The course consisted of four laps around a 3.6-km rectangular course, each lap reversing direction, totaling 14.4km. To mimic realistic travel, the course had artificial bumps, three turns (90 degrees, 45 degrees, and 135 degrees ), five straight-aways, and a hard stop at the end of each lap. Four horses were transported over the course in 3.7mx2.4m stalls mounted in-line on a 16-m long commercial straight-deck trailer (16 wheels). At the end of the first run (four laps), the orientation of each horse, two forward and two rear-facing, was reversed for a second run. Twelve horses were transported in each of the two orientations. Movement was recorded using video cameras positioned perpendicular to the horse's side. Movement while forward-facing ranged from 4.75 to 34.48m, averaging 12.95m; when rear-facing, movement ranged from 8.13 to 35.21m, averaging 16.99m, and was not statistically influenced by orientation (P=0.1219) due to high variation. Certain horses did demonstrate a superior ability to maintain balance in a particular orientation. Thus individual characteristics and other factors may play a larger role than orientation alone in the ability of horses to maintain balance during transport.

Journal Article↗
PubMed2000

Measures of postural stability are not predictors of recovery from large postural disturbances in healthy older adults.

OBJECTIVES: To determine, in healthy older adults, the relationship between postural steadiness, stability limits, and the ability to recover balance from three postural disturbances requiring anteriorly directed stepping responses. DESIGN: Analysis of multiple motor tasks in a cross-sectional sample of healthy older adults. SETTING: A biomechanics research laboratory. PARTICIPANTS: Fifty women and 29 men aged 65 or older, all healthy, living in the community, participated in this study. Subjects were examined by a geriatrician to identify the presence of exclusionary factors. MEASUREMENTS: Anterior-posterior and medial-lateral excursion distances of the center of pressure during quiet standing (postural steadiness), static leaning (static stability limits), and dynamic swaying (dynamic stability limits) were determined from ground reaction forces measured by a strain gauge forceplate. Within the same group of subjects, the maximum angle of forward lean from which a subject could recover with a single step, the ability to recover balance in response to an accelerated support surface, and the ability to recover balance after being tripped were determined. RESULTS: Recovery from the three types of postural disturbances were found to be statistically independent. The postural steadiness and the stability limit variables were only weakly correlated. Postural steadiness and stability limits were not related to the maximum recoverable angle of lean. The average medial-lateral center of pressure speed during the postural steadiness test was significantly slower for those who failed to recover after tripping than for the subjects who recovered successfully. However, a logistic regression model failed to achieve statistical significance, suggesting that the difference may not be functionally important. The anterior-posterior static stability limits were significantly larger for subjects who recovered successfully than for those who failed to recover during the accelerated support surface test. Although logistic regression suggested that a reduced anterior-posterior stability limit represents a risk factor for failure to recover during this task, only nine of 28 failures could be properly classified, thus diminishing the functional importance of this finding. CONCLUSIONS: Because recovery following postural disturbances could not generally be predicted from measures of postural stability, these findings suggest that these measures of postural stability are of limited utility in identifying potential anteriorly directed fallers in healthy older adults.

Aged↗
PubMed2000

Quinolinic acid released from polymeric brain implants causes behavioral and neuroanatomical alterations in a rodent model of Huntington's disease.

Quinolinic acid (QA) is an N-methyl-d-aspartate agonist that has been shown to produce neurotoxic effects that mimic certain neurodegenerative diseases when administered to laboratory animals. Intrastriatal injections of QA in rats have been used extensively to produce some of the neuropathological and behavioral deficits that are analogous to Huntington's disease (HD). However, acute intrastriatal injections of QA produce symptoms that are not analogous to the progressive nature of HD. Thus far, models using chronic administration of QA that produce HD-like behavioral and neuroanatomical changes have necessitated the use of a relatively bulky and fragile microdialytic pump apparatus. The present study tested an alternative way of chronically administering QA. Specifically, this study tested whether gradual release of QA from ethylene vinylacetate (EVA) polymers could produce symptoms analogous to HD. Rats received either no implants or bilateral intrastriatal implants of polymers with or without QA. Subsequent tests for spontaneous motor activity (SMA), grip strength, balance, and learning ability in a radial-arm-water-maze task revealed QA-induced impairments in balance and learning ability, but did not affect grip strength or SMA. Histological analysis revealed QA-induced enlargement of lateral ventricles, striatal atrophy, and striatal neuronal loss, with relative sparing of NADPH-diaphorase-positive neurons. These results suggest that QA released from polymers can produce behavioral and neuropathological profiles analogous to early stages of HD and that EVA polymers offer a useful means of chronically delivering QA in rodent models of neurodegeneration.

Animals↗