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At least 361 records · Page 20Linked to original sources

PubMed2007

Changes in shoulder muscle size and activity following treatment for breast cancer.

BACKGROUND: Morbidity of the shoulder after breast cancer is a well-known phenomenon. MRI studies have shown muscle morbidity in cervical cancer and prostate cancer. In breast cancer clinical observations and patient reports include muscle morbidity in a number of muscles acting at the shoulder. Several of these muscles lie in the field of surgery and radiotherapy. Timed interaction between muscles that stabilise the shoulder and those acting as prime movers is essential to achieve a smooth scapulohumeral rthythm during functional elevation of the arm. METHOD: CROSS-SECTIONAL STUDY: Seventy-four women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). EMG activity of four muscles was recorded during scaption on the affected and unaffected side. Muscle cross sectional area and signal intensity was determined from MRI scans. The association between EMG and covariates was determined using multiple linear regression techniques. RESULTS: Three of the 4 muscles on the affected side demonstrated significantly less EMG activity, particularly when lowering the arm. Upper trapezius demonstrated the greatest loss in activity. Decreased activity in both upper trapezius and rhomboid were significantly associated with an increase in SPADI score and increased time since surgery. Pectoralis major and minor were significantly smaller on the affected side. CONCLUSION: Muscles affected in the long term are the muscles associated with pain and disability yet are not in the direct field of surgery or radiotherapy. Primary muscle shortening and secondary loss of muscle activity may be producing a movement disorder similar to the 'Dropped Shoulder Syndrome'. Exercise programmes should aim not only for range of movement but also for posture correction and education of potential long-term effects.

Aged↗

PubMed2003

Primary repair of the collateral ligament of the proximal interphalangeal joint using a suture anchor.

Ten out of 12 complete ruptures of the collateral ligament of the proximal interphalangeal joint were repaired primarily using a suture anchor. Active finger exercise was started gently by taping the injured finger to adjacent one one week postoperatively. All patients returned to their original occupation or sports activities within seven weeks of operation. No patients complained of pain on the involved finger at rest or during movement. There was no instability of the proximal interphalangeal joint on manual lateral stress test postoperatively.

Adolescent↗

PubMed1997

A new technique for measuring lumbar segmental motion in vivo. Method, accuracy, and preliminary results.

STUDY DESIGN: A direct method for three-dimensional in vivo spine kinematic studies was developed and used to measure segmental motion patterns in healthy subjects. OBJECTIVES: To validate the new method, and to study the L3-L4 segmental motion patterns for complex dynamic movements. SUMMARY OF BACKGROUND DATA: Conventional two-dimensional and three-dimensional radiographic methods have been used in the past to study spine kinematics. Few studies provided a direct approach to study segmental kinematics. No dynamic recordings of three-dimensional segmental motion patterns have been reported previously. METHODS: In 16 healthy men, Kirschner wires were inserted in the spinous processes of L3 and L4. Electromagnetic tracking sensors were attached to the pins. Motion data recorded during ranging exercises were used with biplanar radiographs to calculate L3-L4 segmental motion patterns. Errors resulting from pin deformation and the dynamic accuracy of the tracking system were investigated thoroughly. RESULTS: The average range of motion for flexion-extension was 16.9 degrees, for one side lateral bending 6.3 degrees and for one side axial rotation 1.1 degrees. Large intersubject variation was found in flexion-extension with values ranging from 7.1 to 29.9 degrees. Coupled motion patterns were found to be consistent among subjects in active lateral bending and inconsistent for active axial rotation. CONCLUSIONS: This new method offers dynamic recording capabilities and a measurement error comparable with stereo radiographic methods. Repetitive ranging experiments are highly reproducible. The range of motion for axial rotation seems overestimated in previous cadaveric studies. Coupling patterns show large variations between individuals.

Electromagnetic Phenomena↗

PubMed1980

Clinical electrophysiology in myasthenia gravis.

Effective diagnostic methods are of great importance in order to recognise myasthenic patients among those with muscle fatigability. Intracellular recordings are useful for research work within the field and for detailed description of the motor end-plate's physiology in the individual case. The method is not used for the routine diagnosis of myasthenia gravis. The decrement of the electrical muscle response with nerve stimulation is the most commonly used method. The diagnostic yield is higher in proximal muscles, in warmed muscles, after exercise, and after ischaemia. A significant number of patients may be undiagnosed with this technique. The mechanical response with nerve stimulation shows the same type of decrement but also an abnormal response to long stimulation. The diagnostic value of this is under dispute. Single fibre ENG needs more patient cooperation than do these tests. The diagnostic yield is significantly higher. Some patients considered to have myasthenia gravis do not show any abnormalities with this technique, particularly those with the pure ocular form. Conventional EMG is not useful for the diagnosis of myasthenia, but may be indicated in these patients when concurrent nerve or muscle disease is in question. Tests for eye movement fatique have not proved useful. Stapedius reflex fatigability is demonstrated in about the same proportion of patients as have positive SFEMG findings. The technique is not uncomfortable for the patient and requires minimal cooperation. The general usefulness must be assessed by further routine use. Even with the advent of immunological tests, neurophysiological investigations are indispensable in helping establish the diagnosis of myasthenia gravis. Discrepancies between the results comparing electrophysiological and immunological tests may indicate that myasthenia gravis is a heterogenous entity within which subgroups may be identified.

Computers↗

PubMed2003

Measurement of surgical dexterity using motion analysis of simple bench tasks.

The possibility of using quantitative motion analysis for objective assessment of simple surgical dexterity is investigated using the Imperial College Surgical Assessment Device (ICSAD) with qualitative analysis undertaken by inspection. Bench-top knot tying and suturing skills were performed and examined for the ability to discriminate between surgeons of varying experience. These exercises were found to discriminate significantly between junior and senior surgeons in terms of both time taken and the number of movements required. The relation between time and motion was found to be variable depending on what skill was being undertaken: simple suturing, suturing at depth, or knot tying (1.71 vs. 1.86 vs. 2.36; p = 0.002 for 1 vs. 2; p < 0.001 for others). When the number of movements in a minute (standardized movements per minute) were considered, both groups were found to work at a similar rate, depending on the task, implying that the more experienced surgeon is more economical, performing the same exercise with fewer moves rather than with higher speed. Motion analysis exhibits face and construct validity and is a reliable assessment of simple surgical dexterity. Its use for objective assessment of dexterity and competence should be encouraged.

Clinical Competence↗

PubMed2001

Assessment of free-living physical activity in humans: an overview of currently available and proposed new measures.

The number of physical activity measures and indexes used in the human literature is large and may result in some difficulty for the average investigator to choose the most appropriate measure. Accordingly, this review is intended to provide information on the utility and limitations of the various measures. Its primary focus is the objective assessment of free-living physical activity in humans based on physiological and biomechanical methods. The physical activity measures have been classified into three categories: Measures based on energy expenditure or oxygen uptake, such as activity energy expenditure, activity-related time equivalent, physical activity level, physical activity ratio, metabolic equivalent, and a new index of potential interest, daytime physical activity level. Measures based on heart rate monitoring, such as net heart rate, physical activity ratio heart rate, physical activity level heart rate, activity-related time equivalent, and daytime physical activity level heart rate. Measures based on whole-body accelerometry (counts/U time). Quantification of the velocity and duration of displacement in outdoor conditions by satellites using the Differential Global Positioning System may constitute a surrogate for physical activity, because walking is the primary activity of man in free-living conditions. A general outline of the measures and indexes described above is presented in tabular form, along with their respective definition, usual applications, advantages, and shortcomings. A practical example is given with typical values in obese and non-obese subjects. The various factors to be considered in the selection of physical activity methods include experimental goals, sample size, budget, cultural and social/environmental factors, physical burden for the subject, and statistical factors, such as accuracy and precision. It is concluded that no single current technique is able to quantify all aspects of physical activity under free-living conditions, requiring the use of complementary methods. In the future, physical activity sensors, which are of low-cost, small-sized, and convenient for subjects, investigators, and clinicians, are needed to reliably monitor, during extended periods in free-living situations, small changes in movements and grade as well as duration and intensity of typical physical activities.

Acceleration↗

PubMed1975

Primary mobilization after secondary flexor tendon surgery.

The value of immediate postoperative mobilization after secondary repair was studied in 63 patients with 93 flexor tendons. With grafts, an essential requirement is strong fixation. Distally, the graft was carried through a canal drilled from the distal phalanx to the upper side of the nail. Proximally, Pulvertaft's technique was used. The initial aftercare was very important, and required 3 weeks stay in hospital. Mobilization was started on the first postoperative day. The operating surgeon himself supervised the daily exercise for 3 weeks, after which the patient was discharged. The end-results show that, despite what has been alleged by the critics of primary mobilization, the graft is capable of development and grows stronger with this treatment.

Adolescent↗

PubMed1994

Simultaneous 31P NMR spectroscopy and EMG in exercising and recovering human skeletal muscle: technical aspects.

The bioenergetics of human skeletal muscle can be studied by 31P NMR spectroscopy (31P-MRS) and by surface electromyography (SEMG). Simultaneous 31P-MRS and SEMG permit accurate and noninvasive studies of the correlation between metabolic and electrical changes in exercising and recovering human skeletal muscle, a relationship that is still poorly understood. This study describes the optimization of skeletal muscle 31P-MRS in a whole-body magnet, involving surface coil design, utilization of adiabatic radio frequency pulses and advanced time-domain fitting, to the technical design of SEMG. A nonmagnetic ergometer was used for ankle dorsiflexions that activated only the anterior tibial muscle as verified by post exercise imaging. The coil design and the adiabatic sech/tanh pulse improved sensitivity by 45% and 56% respectively, compared with standard techniques. Simultaneous electromyographic recordings did not deteriorate the NMR spectra. The VARPRO time domain fitting routine was very suitable for estimating 31P muscle spectra. With these methods it was possible to accurately estimate parameters describing metabolic and electrical changes during rest, exercise and the entire recovery period with a 20-s time resolution on a standard 1.5 T whole-body NMR scanner.

Ankle Joint↗

PubMed1980

Physical demands during folk dancing.

This investigation was undertaken to evaluate the aerobic demands during one of the most popular and demanding Swedish folk dances the "hambo". Six men and six women, ranging in age from 22 to 32, participated. Their physical work capacity was investigated on a bicycle ergometer and a treadmill, using two to three submaximal and one maximal loads. All subjects were moderately well-trained and their average maximal oxygen uptake on the treadmill were 2.5 and 3.7 l/min (42.8 and 53.2 ml/kg . min-1) for women and men, respectively. When dancing the "hambo" the heart rate was telemetered, and the Douglas bag technique was used for measurements of pulmonary ventilation and oxygen uptake. The physical demand during "hambo" dancing was high in all subjects. Oxygen uptake was 38.5 and 37.3 ml/kg . min-1 and heart rate 179 and 172 in women and men, respectively. Women used 90% and men 70% of their maximal aerobic power obtained on the treadmill. The pulmonary ventilation and respiratory quotient of the female subjects were lower when dancing as compared to running, possibly because of voluntary restriction of the movements of the thoracic cage. Some popular Scandinavian folk dances are performed at a speed and with an activity pattern resembling the "hambo", while others are performed at a slower pace. The exercise intensity used in "hambo" is more than sufficient to induce training effects in the average individual provided that the dancing is performed at the frequency and for length of time usually recommended for physical training. For older or less fit people dances with a slow pace can be used for training purposes.

Adult↗

PubMed2006

Radiotherapy of mobile tumors.

In this overview, we discuss some major issues related to the management of mobile tumors and gating in radiotherapy. For most types of organ motion, there are both interfraction and intrafraction components. For respiratory motion, the magnitudes of these 2 components can be comparable and therefore both should be handled carefully. The motion artifacts in computed tomography (CT) simulation are discussed and the 4-dimensional CT scan technique is recommended for treatment simulation of patients with mobile tumors. There are various methods for handling organ motion in treatment delivery. Caution should be exercised when using patient-specific motion information for treatment planning because motion characteristics may vary from the treatment simulation time to the treatment delivery sessions. Respiratory gating is potentially accurate, easy to implement, and may be widely adopted in clinical practice in the near future, if existing technical problems can be resolved.

Humans↗

PubMed2003

Pre-operative screening: criteria for referring to anaesthetists.

Nurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questions to be tested was followed by a modified, two-round Delphi questionnaire to determine the level of agreement by anaesthetists. There was agreement for referring patients who gave a positive response to questions that query: restricted exercise tolerance; previous anaesthetic problems; family history of anaesthetic problem; pathology affecting neck movement; angina; arrhythmia; heart failure; asthma; epilepsy; insulin-dependent diabetes mellitus; liver disease and unspecified kidney disease. There was equivocal agreement on questions that report a myocardial infarction over one year ago, cerebrovascular accident, non insulin-dependent diabetes mellitus and thyroid disease. Nurses should use these criteria during pre-operative assessment to decide the timing of evaluation by an anaesthetist.

Anesthesiology↗

PubMed1995

A working cardiac valve phantom for radiographic assessment of prosthetic heart valves.

RATIONALE AND OBJECTIVES: A working valve phantom (WVP) that both exercises the valve occluder and simulates movements of the mitral annulus is described. It was designed to develop a method for radiographic detection of a single broken leg of the two-legged Björk-Shiley convexo-concave (C/C) heart valve outlet strut. METHODS: The WVP consists of a pneumatically driven left ventricular assist device immersed in 22 cm of water. Left ventricular assist device annulus movements are generated by systolic turgor and diastolic relaxation of the aortic outflow graft within limits set by the holding fixture design. RESULTS: WVP images were comparable in attenuation, valve motion, and diagnostic sensitivity to clinical C/C valve images and were effective in assessing leaflet excursions in another valve model. Techniques developed in the WVP have proved successful in the clinical detection of C/C valves that have a single broken leg but that show normal function in all other tests. CONCLUSION: The WVP can be a useful tool for developing refined radiographic assessments of prosthetic heart valves.

Heart Valve Prosthesis↗

PubMedDate not supplied

Propulsion technique in hand rim wheelchair ambulation.

Six male subjects took part in a pilot study on a stationary wheelchair ergometer. They propelled the ergometer at a speed of 0.55, 0.83, 1.11 and 1.39 m/s. The speed increased every 3 min. Inertia and friction force were adjusted proportional to body weight. Every third minute 750 samples of the torque and velocity signals were digitized at a sampling rate of 100 Hz. From the signals mean external power output (Pmean), peak power (Ppeak), mean torque (Mmean) and peak torque (Mpeak), work/cycle, 'time-to-peak torque' (TTP), cycle duration (CT), push time (PT) and recovery time (RT) were determined in relation to mean velocity (speed). For the mean velocity range studied, analysis of variance (P less than 0.05) revealed significant increments in Ppeak, Mpeak, Pmean, Mmean and work/cycle with increasing mean velocity, whereas CT and PT showed a significant decrease. TTP showed a decrease with speed which, however, was not statistically significant. The RT showed no significant variation as well. Our previous research into propulsion techniques mainly focused on movement frequency and timing and was conducted during wheelchair ambulation on a motor driven treadmill. Despite considerable interindividual variation in terms of movement pattern, current and previous studies showed similar trends in the timing pattern (cycle, push, recovery duration) with respect to speed. Theoretical considerations regarding variations in peak torque and work/cycle with respect to velocity are supported by the current results. Both torque and work/cycle are important technique parameters and of relevance in speed regulation. The data also suggest that wheelchair ambulation can be validly simulated and studied with the special purpose wheelchair ergometer.(ABSTRACT TRUNCATED AT 250 WORDS)

Ergonomics↗

PubMed1983

Conceptual model of an approach to the sensorimotor treatment of the head-injured client.

The complexity of problems encountered with head trauma clients is vast and inconsistent. This article presents a conceptual model that provides structure, yet flexibility, in addressing any aspect of these problems. Emphasis is placed on the importance of sensorimotor integration as it pertains to normal movement or response patterns. Justification of treatment techniques is addressed by suggesting the use of a classification system to categorize methods of treatment according to the specific or multiple sensory modality facilitated when applying those techniques. The clinician's understanding of applied neuroanatomy and physiology serves as the substrate for developing a flexible rationale for use of sensory input to facilitate desired response patterns. The need for a problem-oriented approach is emphasized. The approach stressed understanding of the general clinical problems and their sequential nature, evaluation, goal setting, and treatment planning.

Brain Injuries↗

PubMed1996

[Effects of pulmonary rehabilitation on vital capacity in patients with chronic pulmonary emphysema].

To evaluate the effects of pulmonary rehabilitation on pulmonary function, 15 patients with chronic pulmonary emphysema underwent pulmonary rehabilitation for six weeks as inpatients. Pulmonary rehabilitation consisted of relaxation techniques, breathing retraining, thoracic massage, physical exercise, and walking. In 8 of the 15 patients vital capacity increased by more than 200 ml (over 10%), and in 7 of the 15 patients the load of maximal exercise increased by more than 5 watts (over 10%). Increases in vital capacity were not associated with increases in maximal exercise load. The percent change in vital capacity associated with pulmonary rehabilitation correlated significantly with the percent change in tidal volume and the percent change in expiratory minute ventilation at the maximal load. The percent change in tidal volume at the maximal load correlated significantly with the percent change in maximum oxygen uptake. We attribute the increase in vital capacity to an improvement in thoracic cage movement. These findings suggest that pulmonary rehabilitation can increase vital capacity in some patients with chronic pulmonary emphysema, and that such an increase is not directly connected to increases in exercise capacity.

Aged↗

PubMed2002

Acute effects of stretching on the neuromechanical properties of the triceps surae muscle complex.

Previous research has shown that an acute bout of passive muscle stretching can diminish performance in certain movements where success is a function of maximal force and/or power output. Two possible mechanisms that might account for such findings are a change in active musculotendinous stiffness and a depression of muscle activation. To investigate the likelihood of these two mechanisms contributing to a post-stretch reduction in performance, we examined the acute effects of stretching on the active stiffness and muscle activation of the triceps surae muscle group during maximal single-joint jumps with movement restricted to the ankle joint. Ten males performed both static (SJ) and countermovement (CMJ) jumps before and after passively stretching the triceps surae. Electrical activity of the triceps surae during each jump was determined by integrating electromyographic recordings (IEMG) over the course of the movement. Triceps surae musculotendinous stiffness was calculated before and after stretching using a technique developed by Cavagna (1970). Following stretching, a significant decrease [mean (SD) 7.4 (1.9)%; P<0.05] in jump height for the CMJ occurred, but for the SJ, no significant ( P>0.05) change in jump height was found. A small but significant decrease [2.8 (1.24)%; P<0.05] in stiffness was noted, but the magnitude of this change was probably not sufficient for it to have been a major factor underlying the decline in CMJ performance. Paradoxically, after stretching, the SJ exhibited a significant ( P<0.05) decrease in IEMG, but the IEMG for the CMJ remained unchanged ( P>0.05). It appears that an acute bout of stretching can impact negatively upon the performance of a single-joint CMJ, but it is unlikely that the mechanism responsible is a depression of muscle activation or a change in musculotendinous stiffness.

Achilles Tendon↗

PubMed2006

Physical fitness assessment: an update.

The American College of Sports Medicine (ACSM) gives the following definition of health-related physical fitness: Physical fitness is defined as a set of attributes that people have or achieve that relates to the ability to perform physical activity. It is also characterized by (1) an ability to perform daily activities with vigor, and (2) a demonstration of traits and capacities that are associated with a low risk of premature development of hypokinetic diseases (e.g., those associated with physical inactivity). Information from an individual's health and medical records can be combined with information from physical fitness assessment to meet the specific health goals and rehabilitative needs of that individual. Attaining adequate informed consent from participants prior to exercise testing is mandatory because of ethical and legal considerations.A physical fitness assessment includes measures of body composition, cardiorespiratory endurance, muscular fitness, and musculoskeletal flexibility. The three common techniques for assessing body composition are hydrostatic weighing, and skinfold measurements, and anthropometric measurements. Cardiorespiratory endurance is a crucial component of physical fitness assessment because of its strong correlation with health and health risks. Maximal oxygen uptake (VO2max) is the traditionally accepted criterion for measuring cardiorespiratory endurance. Although maximal-effort tests must be used to measure VO2max, submaximal exercise can be used to estimate this value. Muscular fitness has historically been used to describe an individual's integrated status of muscular strength and muscular endurance. An individual's muscular strength is specific to a particular muscle or muscle group and refers to the maximal force (N or kg) that the muscle or muscle group can generate. Dynamic strength can be assessed by measuring the movement of an individual's body against an external load. Isokinetic testing may be performed by assessing the muscle tension generated throughout a range of motion at a constant angular velocity. The ability of a muscle group to perform repeated contractions over a specific period of time that is sufficient to cause fatigue is termed muscular endurance. Musculoskeletal flexibility evaluations focus on the joints and associated structures, ligaments, and muscles that cross the joints. The sit-and-reach test and the behind-the-back reach test satisfy many of the criteria for physical assessment of musculoskeletal flexibility. A physical fitness assessment must be integrated into all activities of daily living, as well as the physician's examination, to assess and promote health.

Anthropometry↗

PubMed1996

Importance of the right ventricle in valvular heart disease.

The importance of the right ventricle as a determinant of clinical symptoms, exercise capacity, peri-operative survival and postoperative outcome has been underestimated for a long time. Right ventricular ejection fraction has been used as a measure of right ventricular function but has been found to be dependent on loading conditions, ventricular interaction as well as on myocardial structure. Altered left ventricular function in patients with valvular disease influences right ventricular performance mainly by changes in afterload but also by ventricular interaction. Right ventricular function and regional wall motion can be determined with right ventricular angiography, radionuclide ventriculography, two-dimensional echocardiography or magnetic resonance imaging. However, the complex structure of the right ventricle and its pronounced translational movements render quantification difficult. True regional wall motion analysis is, however, possible with myocardial tagging based on magnetic resonance techniques. With this technique a baso-apical shear motion of the right ventricle was observed which was enhanced in patients with aortic stenosis.

Aortic Valve↗