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PubMed1992

Differences in developmental movement patterns used by active versus sedentary middle-aged adults coming from a supine position to erect stance.

The purpose of this study was twofold: (1) to further validate categories for the movement pattern of supine to standing in adults and (2) to evaluate the influence physical activity might have on the movement patterns used for rising. Seventy-two adults, between 30 and 39 years of age (mean = 34.1, SD = 2.8), performed the rising task while being videotaped. Subjects were divided into three groups by self-reports of level of physical activity (daily to rarely). Individual videotaped trials were classified using the previously described categories. Comparisons among the activity-level groups revealed that more active subjects demonstrated more developmentally advanced movement patterns in the righting task, consistent with earlier research on older adults. Results suggest that lifestyle patterns of regular, moderate physical activity may influence how a person performs the basic righting task of coming from a supine to a standing position. This investigation also provided additional support for the use of developmental sequences for the movement pattern of supine to standing.

Adolescent↗
PubMed2002

Physiologic studies on swaddling: an ancient child care practice, which may promote the supine position for infant sleep.

OBJECTIVE: The calming effects of swaddling may help infants accept back sleeping and so reduce the risk of sudden infant death syndrome. We hypothesized that swaddling, with minimal leg restraint, would be accepted by postneonatal infants with minimal respiratory effects. STUDY DESIGN: Postneonatal infants (n = 37)were studied for the introduction of swaddling. Four infants were studied by using traditional swaddling techniques. Swaddle tightness was increased in 13 infants, simulating traditional swaddles. Respiratory variables-respiratory rate, tidal volume, oxygen saturation, heart rate, sigh rate, and "grunting"-were measured. RESULTS: Hips were flexed and abducted in the swaddle. The majority of infants accepted swaddling while supine, including 78% of infants who slept prone at home. Acceptance decreased with increasing age. With increased swaddle pressure, respiratory rate increased during quiet sleep (P <.05). In rapid eye movement sleep, a slight effect on heart rate was observed (P <.05). Other variables did not change. CONCLUSIONS: Older infants including usual prone sleepers generally accept a form of swaddling that has minimal respiratory effects. The reintroduction of swaddling, without restricting hip movement or chest wall excursion, combined with supine sleeping, may promote further sudden infant death syndrome reduction.

Bedding and Linens↗
PubMed2003

Postural adjustments in preterm infants at 4 and 6 months post-term during voluntary reaching in supine position.

Gradually it is getting clear that motor development - in particular balance control - in so-called "low-risk" preterm infants often differs from that in full-term infants. However, little is known on the etiology and pathophysiology of these problems. The aim of this study was to evaluate postural behavior during reaching by means of kinetic and kinematic measurements. Preterm infants (n = 32) without cerebral palsy were investigated longitudinally at the corrected ages of 4 and 6 mo. Thirteen age-matched full-term infants served as controls. Cognitive and motor development were assessed by means of the quality of General Movements (GMs) at 4 mo and Bayley scales at 6 and 12 mo. The infants were lying supine on a forceplate reaching for a toy and the kinetics of the total body's Center of Pressure (COP) was measured in cranial-caudal and medial-lateral direction. The analysis focused on COP displacement, Vmax and oscillatory changes of the COP displacement during reaching. The kinematic analysis of reaching focused on movement units, Vmax and a compound kinematic variable reflecting the quality of reaching. The results showed that preterm infants showed a remarkable "still" postural behavior, which differed significantly from the mobile COP behavior of the full-term infants. More "still" postural behavior at 6 mo was associated with a better quality of reaching movements and with normal GMs at 4 mo. We concluded that "still" postural behavior is an adequate postural strategy of preterm infants. But it might be that this postural behavior is an indicator of later dysfunction.

Biomechanical Phenomena↗
PubMed1998

Set-up error in supine-positioned patients immobilized with two different modalities during conformal radiotherapy of prostate cancer.

BACKGROUND: Conformal radiotherapy requires reduced margins around the clinical target volume (CTV) with respect to traditional radiotherapy techniques. Therefore, high set-up accuracy and reproducibility are mandatory. PURPOSE: To investigate the effectiveness of two different immobilization techniques during conformal radiotherapy of prostate cancer with small fields. MATERIALS AND METHODS: 52 patients with prostate cancer were treated by conformal three- or four-field techniques with radical or adjuvant intent between November 1996 and March 1998. In total, 539 portal images were collected on a weekly basis for at least the first 4 weeks of the treatment on lateral and anterior 18 MV X-ray fields. The average number of sessions monitored per patient was 5.7 (range 4-10). All patients were immobilized with an alpha-cradle system; 25 of them were immobilized at the pelvis level (group A) and the remaining 27 patients were immobilized in the legs (group B). The shifts with respect to the simulation condition were assessed by measuring the distances between the same bony landmarks and the field edges. The global distributions of cranio-caudal (CC), posterior-anterior (PA) and left-right (LR) shifts were considered; for each patient random and systematic error components were assessed by following the procedure suggested by Bijhold et al. (Bijhold J, Lebesque JV, Hart AAM, Vijlbrief RE. Maximising set-up accuracy using portal images as applied to a conformal boost technique for prostatic cancer. Radiother. Oncol. 1992;24:261-271). For each patient the average isocentre (3D) shift was assessed as the quadratic sum of the average shifts in the three directions. RESULTS: Group B showed a better accuracy and reproducibility than group A for PA shifts (2.6 versus 4.4 mm, 1 SD), LR shifts (2.4 versus 3.6 mm, 1 SD) and CC shifts (2.7 versus 3.3 mm, 1 SD). Furthermore, group B showed a rate of large PA shifts (>5 mm) equal to 4.4% with respect to the 21.6% of group A (P<0.0001). This value was also better than the corresponding value found in a previously investigated group of 21 non-immobilized patients (Italia C, Fiorino C, Ciocca M, et al. Quality control by portal film analysis of the conformal radiotherapy of prostate cancer: comparison between two different institutions and treatment techniques (abstract). Radiother. Oncol. 1997;43(Suppl. 2):S16, 16.8%, P = 0.001). For both groups there was no clear prevalence of one component (systematic or random) with respect to the other. The average isocentre shifts (averaged on all patients) were 3.0 mm (+/-1.4 mm, 1 SD) for group B and 5.0 mm (+/-2.8 mm, 1 SD) for group A against a value of 4.4 mm (+/-2.4 mm, 1 SD) for the previously investigated non-immobilized patient group. CONCLUSIONS: Immobilization of the legs with an alpha-cradle system seems to improve both the accuracy and reproducibility of the positioning of patients treated for prostate cancer with respect to alpha-cradle pelvic-abdomen immobilization. Based on these data, we decided to use the legs immobilization system and to reduce the margin around the CTV (from 10 to 8 mm) in the PA direction.

Humans↗
PubMed1995

Early results of percutaneous iliosacral screws placed with the patient in the supine position.

The operative management of pelvic ring fractures and dislocations is difficult. Posterior pelvic ring disruptions are often associated with severe soft-tissue injuries and high infection rates. Percutaneous iliosacral screw fixation of the posterior pelvis has become popular with improved fluoroscopic imaging techniques. The percutaneous iliosacral screw technique after closed reduction of the posterior pelvic disruption minimally violates the soft-tissue envelope and should diminish both the operative blood loss and infection rate. The early results and complications are documented in our first 68 patients.

Adolescent↗
PubMed1999

The sleep supine position has a major effect on optimal nasal continuous positive airway pressure : relationship with rapid eye movements and non-rapid eye movements sleep, body mass index, respiratory disturbance index, and age.

STUDY OBJECTIVES: To evaluate the impact of sleep position on optimal nasal continuous positive airway pressure (nCPAP [op-nCPAP]) in obstructive sleep apnea (OSA) patients and to investigate how rapid eye movements (REM) and Non-REM (NREM) sleep, body mass index (BMI), respiratory disturbance index (RDI), and age are related to this effect. DESIGN: Retrospective analysis. SETTING: Sleep Disorders Unit at Loewenstein Hospital Rehabilitation Center. PATIENTS: Eighty-three consecutive adult OSA patients who underwent a complete nCPAP titration. From this group, 60 patients who spent at least 30 min in both the supine (Sup) and lateral (Lat) positions and 46 patients who had data on both positions during REM and NREM sleep were included in the analysis. RESULTS: In most OSA patients (52; 86.7%), the recommended op-nCPAP was obtained when the patients slept in the Sup posture. The mean op-nCPAP was significantly higher in the Sup posture (10.00 +/- 2.20 cm H(2)O) than it was in the Lat posture (7.61 +/- 2.69 cm H(2)O). The op-nCPAP was significantly higher in the Sup position than it was in the Lat position in both REM and NREM sleep, as well as in the severe BMI group (BMI >/= 30) and in the less obese group (BMI < 30). Similarly, in the severe (RDI >/= 40) and less severe groups (RDI < 40), as well as in both age groups (< and > 60 years of age), the op-nCPAP was significantly higher in the Sup posture than it was in the Lat posture. Irrespective of the four parameters mentioned, the actual differences in op-nCPAP between the two body postures were almost identical, ranging between 2.31 and 2.66 cm H(2)O. CONCLUSIONS: For most OSA patients, the op-nCPAP level is significantly higher in the Sup position than it is in the Lat position. This is true for REM and NREM sleep, for obese and nonobese patients, for patients with different degrees of severity, and for young and old OSA patients. Since the op-nCPAP was highest in the Sup posture during REM sleep, no nCPAP titration should be considered complete without the patient having slept in the Sup posture during REM sleep.

Adult↗
PubMed1997

Clinical application of cardiac output during ramp exercise calculated using the Fick equation--comparison with the 2-stage bicycle ergometer exercise protocol in the supine position.

The purpose of this study was to clarify whether the direct Fick method is applicable to the measurement of cardiac output (Q) during ramp exercise. Twelve patients with chronic health failure underwent both a ramp exercise test and a steady-state exercise test. Oxygen intake (VO2), arterial oxygen saturation and mixed venous oxygen saturation were continuously measured using a pulse oximeter and a fiberoptic catheter, and the arteriovenous oxygen difference (a-v O2 diff) and Q were calculated. Both VO2 and a-v O2 diff were significantly lower in the ramp protocol than in the steady-state protocol when they were compared at the same workload. However, the VO2 vs Q relationship and the VO2 vs a-v O2 diff relationship were very similar in the 2 protocols. The difference between Q measured during steady-state exercise and Q calculated at the matched VO2 during ramp exercise was small (3.7 +/- 7.0% and 5.6 +/- 6.6%). The results indicate that, clinically, Q measured by the direct Fick method with simultaneous measurement of VO2 and a-v O2 diff during ramp exercise is a good substitute for the true Q measured by the steady-state protocol. We conclude that Fick Q is applicable to ramp exercise.

Adult↗
PubMed1998

Airway protection in sleeping infants in response to pharyngeal fluid stimulation in the supine position.

This study was designed to evaluate upper airway protective mechanisms in response to pharyngeal fluid stimulation in healthy term and preterm infants at term equivalent age. Five term and seven preterm infants were studied and the following recorded: sleep state, cardiorespiratory function, and swallowing. Infusions of 0.9% saline and sterile water of volumes of 0.04, 0.2, and 0.35 mL were made during active (AS) and quiet sleep (QS). The effect of these variables on apnea (> or = 2 and > or = 5 s), swallowing, and arousal was examined. After pharyngeal infusion, apnea of > or = 2 and > or = 5 s did not change from spontaneous rates for both term and preterm infants. The most common response to pharyngeal infusion was swallowing. In AS, swallowing occurred after 65 and 73% and in QS after 40 and 64% of infusions in term and preterm infants, respectively. Swallowing was volume-related and occurred significantly more often in term infants after larger infusions of 0.35 and 0.2 mL (83 and 67%) compared with the 0.04 mL (19%) and after 0.2 mL compared with 0.04 mL for preterm infants (94 and 44%). At 0.2 mL, this was significantly higher in preterm compared with term infants (p < 0.01) and was the only significant difference between these infants. In response to pharyngeal fluid stimulation, airway defense in both full-term and preterm infants is maintained primarily by swallowing with no evidence of apnea.

Deglutition↗
PubMed1998

Age-related differences in movement patterns used by toddlers to rise from a supine position to erect stance.

BACKGROUND AND PURPOSE: Rising from the floor to a standing position is an important milestone in the development of children. The purposes of this study were (1) to describe the movement patterns (MPs) toddlers use when rising to a standing position, (2) to determine whether toddlers' MPs differ with age, and (3) to investigate whether MPs that are proposed to occur earliest in the development of this task predominate in toddlers. SUBJECTS AND METHODS: Sixty children aged 15 to 47 months were videotaped performing at least six trials of rising. Data were reduced by classifying movements of the upper extremity (UE), axial region (AX), and lower extremity (LE) into categorical descriptions of the action of these body regions. The incidence of each UE, AX, and LE movement pattern was determined for each 10-month age interval and compared across age groups. RESULTS: Two previously unidentified MPs were described for LE action. The youngest children demonstrated the highest incidence of MPs that have been predicted by other researchers to occur early in development. CONCLUSION AND DISCUSSION: In general, toddlers' UE and AX movements were described using previously developed MP categories. Age differences were found among toddlers in the performance of the rising task. Movement patterns of the UE and AX that have been thought to occur earliest in the developmental sequence for this task predominated in this young group.

Aging↗
PubMed1999

Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study.

OBJECTIVE: There is controversy in the literature on the effects of anticholinergic drugs on gastroesophageal reflux. Our aim was to study more extensively the effects of an oral anticholinergic drug on esophageal motility and gastroesophageal reflux in normal ambulant subjects under different circumstances: upright, supine, fed, and fasted state. METHODS: Fifteen healthy subjects (seven men, eight women), mean age 34 yr (range, 22-61 yr) underwent randomized placebo-controlled 16-h evening and overnight ambulatory esophageal motility/pH study. After a 3-day loading dose of either oral dicyclomine (Dic) 20 mg four times daily or placebo (Pla), an ambulatory esophageal motility/pH study was performed while taking medication or placebo. Each study was analyzed for meal, first and second h postprandial, upright and supine periods, and first 2 h supine after bedtime snack. RESULTS: The mean number of reflux episodes decreased with dicyclomine during the first h postprandial (Dic, 1.9 vs Pla, 2.5; p < 0.05). During the first 2 h supine, mean number of reflux episodes increased with dicyclomine (Dic, 1.4 vs Pla, 0.8; p < 0.09), as did mean percent time pH < 4 (Dic, 2.6 vs Pla, 0.5; p < 0.04), with an increase in clearance time (Dic, 0.9 vs Pla, 0.3; p < 0.05; in min). Mean peristaltic amplitude decreased with dicyclomine during the 2nd h postprandial (Dic, 48.8 vs Pla, 56.3; p < 0.04). CONCLUSIONS: Oral dicyclomine caused a decrease in early postprandial upright reflux episodes, but also significantly increased the percent time pH < 4 during the first two h supine. Therefore, its effects are dependent on body position and fasted or fed state. Our results justify additional studies with oral anticholinergic agents in patients with gastroesophageal reflux disease.

Administration, Oral↗
PubMed2002

Spirometry in the supine position improves the detection of diaphragmatic weakness in patients with amyotrophic lateral sclerosis.

STUDY OBJECTIVES: To determine which respiratory function tests best predicted diaphragmatic strength in patients with amyotrophic lateral sclerosis. PATIENTS AND METHODS: Patients referred for pulmonary evaluation were included (n = 25) if they underwent measurement of transdiaphragmatic pressure (Pdi) and one or more of the following on the same day: upright FVC, supine FVC, upright FEV(1), supine FEV(1), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and PaCO(2). Abdominal paradox and use of accessory muscles were also assessed. Bivariate analyses were performed using simple linear regression. Sensitivity and specificity of the potential predictors to detect an abnormal Pdi (< 70 cm H(2)O) were calculated. SETTING: Pulmonary function laboratory of an academic medical center. RESULTS: Upright FVC, FEV(1), and MEP were all significantly correlated with Pdi, while MIP and PaCO(2) were not. Supine FVC was the most highly correlated predictor of Pdi (R(2) = 0.76). A cutoff of supine FVC that was < 75% predicted was 100% sensitive and specific for predicting an abnormally low Pdi. Accessory muscle use and abdominal paradox were both significantly associated with Pdi, and the presence of accessory muscle use had a sensitivity of 84% and a specificity of 100% for detecting a low Pdi. CONCLUSIONS: Our findings suggest that supine FVC is an excellent and simple test of diaphragmatic weakness.

Adult↗