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Functional effectiveness of a myo-electric prosthesis compared with a functional split-hook prosthesis: a single subject experiment.

The functional effectiveness of a myo-electric prosthesis with sensory feedback compared with that of a split-hook is described. Thirty independent observations were made on a single subject with a right below-elbow amputation wearing the myo-electric prosthesis and the split-hook prosthesis. Using a first order autoregressive model for making inferences about the two sets of data, the split-hook was found to be functionally better (p less than 0.001) than the myo-electric prosthesis. Functional effectiveness was defined operationally as scores on the Minnesota Rate of Manipulation Placing Test and the Smith Test of Hand Function. No predictions are made regarding the use of either prosthesis for other amputees. However clinical evidence suggested suitability of the myo-electric prosthesis with sensory feedback for some other functional tasks.

Adult↗

Functional assessment in partial hospitalization: clinical and administrative applications and implications after one year's utilization of the Framingham Functional Assessment Scale.

This paper presents the use of functional assessment as one response to the growing need for objective measures of outcome in psychiatric treatment. The Framingham Functional Assessment Scale was developed in 1979 as a functional assessment measure to form the basis of a client-oriented cost-outcome system for Medicaid reimbursement in Massachusetts. Clinical and administrative findings from 1 year's utilization of the scale are presented. Level of functioning (LOF) scores in a sample of 45 clients are analyzed to determine the amount of LOF change that occurred during the course of an intensive, 13-week, day-treatment program. Trends and patterns of LOF change are described. Utilization of functional assessment input/outcome data in administrative decision making is discussed, in light of increasing economic constraints in mental-health programs and concomitant demands for service accountability.

Analysis of Variance↗

Comparing pupil function with visual function in patients with Leber's hereditary optic neuropathy.

PURPOSE: To compare pupil function with visual function in patients with Leber's hereditary optic neuropathy (LHON) and age-matched normal control subjects. METHODS: Visual function was assessed by measuring the perceptual thresholds at five central locations in the visual field using automated static perimetry. Pupil function was assessed by recording the pupil responses to a standard intensity light stimulus (size equivalent to a Goldmann V target) presented at the same five locations in the visual field. The extent of the pupil afferent defect in LHON patients was quantified by establishing the relationship between stimulus intensity and the size of the pupil response in normal subjects and then interpolating the equivalent luminance deficit in LHON patients from the size of their pupil responses. RESULTS: At all five locations tested, the pupil responses were significantly reduced in amplitude, and the perceptual thresholds were significantly raised in LHON patients compared with normal control subjects. A nonparametric analysis of perceptual and pupil responses to perithreshold stimuli showed that a stimulus that was not perceived was three times more likely to be followed by a pupil response in a LHON patient than in a normal subject (P < 0.001). A quantitative comparison showed that the visual deficits exceeded the pupil deficits by on average 7.5 dB at all tested locations. CONCLUSIONS: Although both visual and pupil function are abnormal in LHON, there appears to be relative sparing of the pupil afferent fibers.

Adult↗

Lateralization of cortical function in swallowing: a functional MR imaging study.

BACKGROUND AND PURPOSE: While functional MR imaging and other techniques have contributed to our knowledge of functional brain localization, these methods have not been extensively applied to the complex and incompletely understood task of swallowing. We used functional MR imaging to investigate motor cortex activity during swallowing in healthy human adults. METHODS: Eight subjects were imaged on a 1.5-T MR system using blood oxygen level-dependent contrast mechanisms. Subjects performed three swallowing tasks and a finger-tapping task. Areas of activation in the cortex and subcortical areas were tabulated, and a laterality index, defined as LI = [sigmas left - sigmas right]/[sigmas left + sigmas right] x 100, was computed for the three tasks. RESULTS: Activation was observed in the primary motor and sensory cortices, motor processing and association areas, and subcortical sites. This activity was dominant for one hemisphere with left hemispheric dominance more prevalent among the subjects. Right hemispheric dominance, however, showed stronger lateralization than the left hemisphere. CONCLUSION: Our data indicate that specific sites in the motor cortex and other cortical and subcortical areas are activated with swallowing tasks and that hemispheric dominance is a feature of swallowing under these conditions. In addition, we demonstrate the utility of functional MR imaging in the study of the cortical representation of swallowing and suggest a role for functional MR imaging in the diagnosis of dysphagia of cerebral origin.

Adult↗

Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning.

OBJECTIVE: Development of a scale to assess patients' social functioning, the Personal and Social Performance scale (PSP). METHOD: PSP has been developed through focus groups and reliability studies on the basis of the social functioning component of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS). The last reliability study was carried out by 39 workers with different professional roles on a sample of 61 psychiatric patients admitted to the rehabilitation unit. Each patient was rated independently on the scale by the two workers who knew them best. RESULTS: The PSP is a 100-point single-item rating scale, subdivided into 10 equal intervals. The ratings are based mainly on the assessment of patient's functioning in four main areas: 1) socially useful activities; 2) personal and social relationships; 3) self-care; and 4) disturbing and aggressive behaviours. Operational criteria to rate the levels of disabilities have been defined for the above-mentioned areas. Excellent inter-rater reliability was also obtained in less educated workers. CONCLUSION: Compared to SOFAS, PSP has better face validity and psychometric properties. It was found to be an acceptable, quick and valid measure of patients' personal and social functioning.

Adult↗

Mapping functionally related regions of brain with functional connectivity MR imaging.

BACKGROUND AND PURPOSE: In subjects who are performing no prescribed cognitive task, functional connectivity mapped with MR imaging (fcMRI) shows regions with synchronous fluctuations of cerebral blood flow. When specific tasks are performed, functional MR imaging (fMRI) can map locations in which regional cerebral blood flow increases synchronously with the performance of the task. We tested the hypothesis that fcMRI maps, based on the synchrony of low-frequency blood flow fluctuations, identify brain regions that show activation on fMRI maps of sensorimotor, visual, language, and auditory tasks. METHODS: In four volunteers, task-activation fMRI and functional connectivity (resting-state) fcMRI data were acquired. A small region of interest (in an area that showed maximal task activation) was chosen, and the correlation coefficient of the corresponding resting-state signal with the signal of all other voxels in the resting data set was calculated. The correlation coefficient was decomposed into frequency components and its distribution determined for each fcMRI map. The fcMRI maps were compared with the fMRI maps. RESULTS: For each task, fcMRI maps based on one to four seed voxel(s) produced clusters of voxels in regions of eloquent cortex. For each fMRI map a closely corresponding fcMRI map was obtained. The frequencies that predominated in the cross-correlation coefficients for the functionally related regions were below 0.1 Hz. CONCLUSION: Functionally related brain regions can be identified by means of their synchronous slow fluctuations in signal intensity. Such blood flow synchrony can be detected in sensorimotor areas, expressive and receptive language regions, and the visual cortex by fcMRI. Regions identified by the slow synchronous fluctuations are similar to those activated by motor, language, or visual tasks.

Adult↗

Early use of cyclic TPN prevents further deterioration of liver functions for the TPN patients with impaired liver function.

BACKGROUND/AIMS: Impaired liver function is frequently found in patients who need prolonged total parenteral nutrition. Cyclic total parenteral nutrition can minimize the adverse effects of long-term total parenteral nutrition, such as hepatic complication. The adequate timing to shift to use cyclic total parenteral nutrition for patients with impaired liver function may prevent further hepatic dysfunction. METHODOLOGY: A prospective study of 65 patients who need total parenteral nutrition and have impaired liver functions was performed. Cyclic total parenteral nutrition was used in different groups of patients, when their total bilirubin levels were just over 5 mg%, 10 mg%, or 20 mg% during the course of total parenteral nutrition. The patients of control groups received straight non-cyclic total parenteral nutrition. All the patients had stable vital signs without major stress, such as sepsis or acute bleeding. Ten patients (A2) in Group A were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 5 mg%; the other 10 patients (A1) continued the non-cyclic total parenteral nutrition. Eleven patients (B2) in Group B were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 10 mg%; the other 11 patients (B1) continued the non-cyclic total parenteral nutrition. Ten patients (C2) in Group C were shifted to cyclic total parenteral nutrition when their total bilirubin was just over 20 mg%; the other 13 patients (C1) continued the non-cyclic total parenteral nutrition. The average energy intake among 3 groups had no difference. Their liver functions were examined each week for 2 weeks. RESULTS: The results showed that the patients with non-cyclic total parenteral nutrition had significant increase of direct-total bilirubin and alkaline phosphatase (P < 0.05) in Group A and significant decrease of albumin accompanied with increase of GOT, GPT, direct/total bilirubin (P < 0.05) in Group B. The patients either using cyclic or non-cyclic total parenteral nutrition showed significant decrease of albumin and increase of direct/total bilirubin (P < 0.05) in Group C. CONCLUSIONS: We conclude that the early use of cyclic total parenteral nutrition may prevent deterioration of liver function for the patients with jaundice and need prolonged total parenteral nutrition.

Adolescent↗

Form or function? Part 2. Objective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy.

BACKGROUND: Treatment-related factors that influence quality of life (QOL) for women who are diagnosed with breast carcinoma require study. This study was designed to examine the convergent validity of objective and subjective indices of cosmetic and functional status after patients undergo breast-conserving treatment (BCT) and to test the relations of the objective indicators with QOL. METHODS: Women (n = 54 patients) who had received BCT and radiotherapy for Stage 0-II disease for whom the diagnosis duration ranged from 9 months to 18 years completed assessments of background information, perceived cosmetic and functional outcomes, and QOL. They also were administered a clinical breast examination, including objective ratings of arm edema and breast cosmesis. The patients were a subsample from the study reported by the authors in an accompanying article that is presented in this issue. RESULTS: The findings revealed positive cosmetic and functional treatment outcomes, such that 82% of patients had no or minimal arm edema, and 70% of patients evidenced good or excellent cosmetic results. Convergent validity was demonstrated for the objective and subjective assessments of cosmetic and functional treatment outcomes. In addition, women who had more arm edema reported poorer QOL with regard to depressive symptoms (P < 0.05) and fear of disease recurrence (P < 0.05). CONCLUSIONS: The findings from this study and those reported in the accompanying article reveal that functional treatment outcomes, such as arm edema and breast specific pain, are important correlates of QOL even many years after patients undergo BCT and radiotherapy. Both subjective and objective indicators of treatment outcomes are useful predictors of QOL.

Breast Neoplasms↗

Functional food ingredients against colorectal cancer. An example project integrating functional genomics, nutrition and health.

Functional Food Ingredients Against Colorectal Cancer is one of the first European Union funded Research Projects at the cross-road of functional genomics [comprising transcriptomics, the measurement of the expression of all messengers RNA (mRNAs) and proteomics, the measurement of expression/state of all proteins], nutrition and human health. The goal of Functional Food Ingredients Against Colorectal Cancer is to develop a colon epithelial cell line-based screening assay for nutrients with presumed anti-colorectal carcinogenic properties. Genes involved in colon carcinogenesis are identified at the RNA and protein level, using a variety of methods (subtractive hybridisation, DNA microarray, proteomics) in combination with models for colorectal cancer development (human biopsies, rat model for colorectal carcinogenesis, colorectal cancer epithelial cell lines). Secondly, colorectal cancer epithelial cell lines are selected, in terms of their capacity to undergo gene/protein expression changes representing different phases in the colorectal carcinogenesis. Thirdly, these cell lines are used to determine the effects of nutrients with presumed anti-carcinogenic properties (e.g. resveratrol, flavonoids) on functional genomics-derived endpoints. Once validated against the effects of these nutrients in in vivo animal models and classical biomarkers for colorectal carcinogenesis, these cell line models combined with functional genomics represent useful tools to study colorectal carcinogenesis and screen for nutrients with anti-carcinogenic properties.

Animals↗

[Risk functions and expected spike density functions for neurons in the cat cochlear nucleus].

The temporal properties of spontaneous and (or) evoked discharges of 157 neurons localized in dorsal cochlear nucleus of anaesthetized cats have been studied. Tone bursts were presented at stimulus best frequency in a free field from the side of ipsilateral ear. About half of cells were characterized by paused or build-up types of the discharge. For all such units a long lasting post-spike decrease in excitability could be seen from the analysis of hazard functions of spontaneous and evoked activity. As a result, the time dependence of conditional probability of the first crossing of the threshold (under condition of an absence of previous response spikes) or expecting probability function (EPF) were over the usual peristimulus histograms. Units with chopper discharges usually did not demonstrate alternative peaks in EPF. We interpreted this fact as evidence that chopper discharge pattern is a result of strong post spike decrease in excitability. Such pattern doesn't demonstrate an existence of real periodicity of the unit. In primary-like units the hazard functions demonstrated only minor after-spike decrease of excitability, and the EPFs were similar to the initial part of peristimulus histograms. Type II units (presumably inhibitory cells) were characterized by non-monotonous hazard functions and by a tendency to burst response patterns. In some cells, we observed a tendency to existence of real intrinsic oscillations both in the EPFs and hazard functions.

Acoustic Stimulation↗

[Erectile function and urinary function].

In recent years, with the great advance in neuro-urophysiological concept, the evaluation and limitations of clinical investigation for sexual (erection) function and bladder (urinary) function are continuously changing, so they should be correctly recognized at the time of actual interpretation. The common problems on these functional tests are standardization of terminology and of methodology, and difference of individual sensitivity. From a viewpoint of respective evaluation and limitations, AVSS, NPT, papaverine test, BCR for erectile function tests and CM, UFM, EMG, complex urodynamics for urinary function tests are reviewed.

Autonomic Nervous System Diseases↗

Functional assessment of elderly patients after percutaneous aortic balloon valvuloplasty: New York Heart Association classification versus functional status questionnaire.

Monitoring functional status in patients with cardiac disease has traditionally been done by using the New York Heart Association (NYHA) classification system. For various reasons, we found the NYHA system difficult to apply to elderly patients. We proposed that the functional status questionnaire (FSQ), which measures the ability to perform tasks, would more accurately assess the functional status of the elderly. In a study in 37 patients with a mean age of 76 years, who had aortic stenosis, we measured FSQ and NYHA scores at baseline, 1 month and 3 months. The difference in questionnaires was evident by the 3-month measurement. Individual patients were better evaluated by the FSQ. Six patients had an FSQ score of less than 72 (suggesting severe functional impairment) at 3 months but only two patients gave symptoms scored as NYHA class III or IV (cardiac disability). Five of six patients had a recurrent cardiac event subsequent to the 3-month follow-up. Changes in functional performance preceded symptomatic deterioration that was reflected only by the FSQ scores. The FSQ system more reliably predicted outcome than the NYHA system and appears to be a more useful tool in the evaluation of elderly patients with cardiac disease.

Activities of Daily Living↗

[Pathogenesis of functional retardation of physical and sexual development in adolescents. Status of somatotropic and gonadotropic function].

A study of somatotropic and gonadotropic functions in male adolescents with functional retardation of physical and sexual development has shown an important role of the deficiency of gonadotropins, especially FSH, in the pathogenesis of this condition. LH secretion in retarded physical development (RPD) is lowered to a lesser degree and positively correlates with testosterone deficiency. The feedback in the hypothalamohypophyseogonadal function in RPD is less frequently affected and to a lesser degree than gonadotropic functions. Of the tested methods (tests with TRH, L-DOPA and bromocriptine) STH reserves are better revealed with L-DOPA and TRH tests, gonadotropic reserves, especially LH,--with TRH and bromocriptine tests. The stimulating TRH effect on the growth hormone is indicative of the versatility and nonspecificity of its action on the pituitary gland in functional developmental disorders.

Adolescent↗

The graft-versus-host reaction and immune function. IV. B cell functional defect associated with a depletion of splenic colony-forming units in marrow of graft-versus-host-reactive mice.

Studies were conducted to determine whether a functional B cell defect occurred in the bone marrow of mice experiencing a GVH reaction (GVHBM). GVH reactions were induced in AxCBA F1 adult mice by an injection of A strain lymphoid cells. The GVH reaction was confirmed by immunosuppression and thymus histology. At various intervals after GVH induction, GVHBM was tested for its ability to restore B cell function in adult thymectomized irradiated mice reconstituted with normal thymocytes. GVHBM cells obtained seven days after GVH induction restored but slightly the plaque forming cell (PFC) response to sheep erythrocytes and the mitogen response to lipopolysaccharide (LPS). GVHBM cells obtained 10 days or later failed to reconstitute the PFC or LPS responses. GVHBM cells suppressed neither the T or B cell function of normal spleen cells nor the LPS mitogen response of normal bone marrow cells. In addition, the splenic colony-forming units (CFU-s) in GVHBM were slightly decreased by day 10 after GVH induction and markedly depressed by day 22 after GVH induction. These results suggest that the GVH reaction may affect two different events in B cell differentiation. The early decrease in functional B cells that occurs before there is any change in the CFU-s population suggests a direct effect on B cell production, whereas the later absence of functional B cells could be due to the marked decline in stem cell production (CFU-s).

Animals↗

Obesity and thyroid function. 3. Relationship between some indicators of thyroid function and the energy metabolism of striated muscle in obese women.

1. In a group of 23 obese women the relations between some indicators of thyroid function (thyroxine-binding globuline--T4BG, triiodothyronine-binding globuline--T3BG, Achilles tendon reflex--ART) on the one hand and activities of enzymes of the energy metabolism (hexokinase--HK, triose phosphate dehydrogenase--TPDH, lactate dehydrogenase--LDH, glycerol-3-phosphate dehydrogenase--GPDH, citrate synthease--CS, malate dehydrogenase--MDH, hydroxyacyl--COA dehydrogenase) in the quadriceps femoris muscle on the other hand were investigated. 2. Correlations were found between T4BG and TPDH, LDH and GPDH activities, between T3BG and TPDH and GPDH activities and between the value of the Achilles tendon reflex and TPDH activity. Functionally these enzymes activities are associated with glycolysis and hydrogen transport from cytoplasmatic NADH2. No correlations were found between enzymes of the aerobic metabolism incl. enzymes of fatty acid oxidation and indicators of thyroid function. 3. The results indicate a relationship between thyroid function and enzymes involved in glycolysis and hydrogen transport from cytoplasmatic NADH2. They do not suggest, however, the unequivocal conclusion that in obese women with reduced thyroid function there is a generally reduced energy supplying metabolism in skeletal muscle.

Achilles Tendon↗

Functional analysis of human T cell subsets defined by monoclonal antibodies. VI. Distinct and opposing immunoregulatory functions within the OKT8+ population.

In the present study, we investigated the immunoregulatory potential of OKT8+ cells after in vitro activation. Initial studies had demonstrated that the T cell marker OKT4 identifies T cell sets containing helper cells, whereas OKT8 reacts with the suppressor and cytotoxic T cell effectors. More detailed analysis of the OKT4+ subset, however, demonstrated that there is functional heterogeneity in the OKT4+ population. The evidence for this heterogeneity arose from studies on (1) the relative radiosensitivities of the distinct immunoregulatory functions of cells contained within this set, and, (2) the effects of the state of activation of this population on immune function. For example, OKT4+ cells included radiosensitive helper cells, radioresistant helper cells, and radiosensitive inducers of suppressor cells. Furthermore, after activation, the OKT4+ population also contained cells capable of suppressing B cell differentiation. Since activation of the OKT4+ population results in the emergence of cells with counterbalancing immunoregulatory properties, it was of interest to determine whether the state of activation of the OKT8+ population influences the immunoregulatory potential of this subset. In the experiments reported here E+ cells were cultured with pokeweed mitogen (PWM) for 60-70 h and then thoroughly depleted of OKT4+ cells, leaving OKT8+ cells. The ability of the PWM-activated OKT8+ cells (first culture) to exert suppressive activity was determined by adding graded numbers of these cells to fresh autologous OKT4+ cells and B cells. The cell mixtures were cultured in the presence of PWM for 5 days and then assayed for plaque-forming-cell (PFC) activity by the reverse hemolytic plaque assay. Our studies demonstrate that activation of OKT8+ cells results in the emergence of cells with apparently counterbalancing immunoregulatory properties. Activated nonirradiated OKT8+ cells consistently suppressed B cell immunoglobulin production. However, the immunoregulatory function mediated by irradiated activated OKT8+ cells is highly dependent on the magnitude of the helper activity obtained with fresh OKT4+ cells. Thus, irradiated activated OKT8+ cells suppressed the generation of PFC only when the level of helper activity was optimal. However, when the level of help was not optimal, no suppressor activity was observed; rather, under these conditions, irradiated activated OKT8+ cells amplify the PFC response. We would emphasize that the amplification function of irradiated OKT8+ cells depends strictly on the presence of fresh OKT4+ cells. Irradiated activated OKT8+ cells alone are not helper cells, since addition of these cells to B cells thoroughly dep

Antibodies, Monoclonal↗

Terbutaline serum concentrations related to different lung function parameters and beta-receptor function.

In eight asthmatic and six normal subjects serum terbutaline concentrations were correlated with changes in FEV1, MEF50%, Gaw, sGaw, and plasma cAMP concentrations after administration of 0.5 mg terbutaline subcutaneously, 5 mg orally, and an oral placebo. In asthmatics and normals the changes in serum terbutaline levels and plasma cAMP levels were closely correlated and in the same range. No change in lung function parameters was registered in normals, whereas in asthmatics a significant improvement was shown. In asthmatics all lung function parameters closely parallelled the changes in serum terbutaline concentrations and cAMP plasma concentrations, the FEV1 being the least variable lung function parameter. The maximal effect in FEV1 occurred 30-60 min after the subcutaneous dose and 2-4 h after the oral dose. The FEV1 improvement showed a linear relationship with the serum terbutaline concentration between 1.6 and 6 ng/ml. In contrast with theophyllines and anticholinergics, serum terbutaline concentrations showed a very low interindividual variance. Nevertheless it appeared that prediction of a certain improvement in lung function was not possible on the basis of the serum concentration. Since changes in plasma cAMP values after terbutaline therapy were similar in normals and asthmatics, the lung function improvement in the asthmatics suggests that if a beta-adrenergic defect exists, this must be mainly situated in the lung tissue.

Adult↗

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 2: postoperative functional and anatomical evaluation of ruptures of the rotator cuff].

PURPOSE OF THE STUDY: The authors examined the anatomic condition and the function of the rotator cuff obtained after an average period of four years following surgical repair in a series of 100 full thickness rotator cuff tears. The aim was to assess the validity of Constant's scoring method and to analyse risk factors and the frequency of recurrent tears. MATERIAL AND METHODS: The series comprised 98 patients, 62 men and 36 women whose average age was 56 years. It included 69 tears of less than 2 cm in size (39 cases) or between 2 to 4 cm (3 cases) of the supra-spinatus, 22 tears of the supra- and infraspinatus measuring between 2 to 4 cm, and 9 massive tears. The tendon of the long head of the biceps was pathological in 1/3 of cases. All 98 patients were operated on by the same surgeon using the same repair technique, and all followed ambulatory rehabilitation along the same principles of self-rehabilitation applied pre operatively. In each patient function was assessed using Constant's scoring method, and the condition of the repaired cuff was determined by ultrasonography at the time of clinical follow-up. The average follow-up period was 4 years (2 to 6 years). RESULTS: Ultrasonography revealed intact cuffs in 65 per cent, thinned cuffs in 11 per cent and recurrent full thickness tears in 24 per cent of cases. The risk of recurrent tear increased with the extent of the tear to be repaired (57 per cent), in older patient (25 per cent) and with a higher level of post-surgical occupational use (18 per cent). A drop in the post-operative Constant score had a predictive value for a full thickness recurrent defect. DISCUSSION: Constant's scoring method appears to be a reliable, reproducible method for analysing functional results following surgical repair of full thickness cuff tears and to reflect the anatomic condition of the repaired cuff. At clinical follow-up, the anatomic condition of the cuff is more determinant of final functional results than initial tear size. CONCLUSIONS: Assessment of functional results must be complemented by anatomic examination using ultrasonography in order to specify the size of any possible recurrent defect and to detect thinning of the cuff which cannot be identified by Constant's score. Analysis of the risk factors for recurrent tear led the authors to question the necessity of repairing massive tears in older patients and pointed to the valuable advantages of reinforcing fragile cuffs during initial repair especially in very active patients.

Adult↗