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PubMed2003

Use of videotape to assess mobility in a controlled randomized crossover trial of physiotherapy in chronic multiple sclerosis.

OBJECTIVES: To determine to what degree assessment of mobility based on comparison of videotape recordings before and after courses of physiotherapy in patients with chronic multiple sclerosis (MS) is reliable, correlates with 'live' assessments and indicates benefit. DESIGN: Prospective data collection within a randomized crossover controlled trial of physiotherapy at home, as an outpatient, or 'no therapy' in 40 patients. SETTING: Hospital outpatients: outpatient and home physiotherapy. OUTCOMES: Mobility change based on a comparison of short video recordings before and after each treatment period was scored independently by two physiotherapists blinded to therapy type and other measures of outcome. Scores were compared with changes in the Rivermead Mobility Index (RMI) and other indices assessed by a physiotherapist in the patient's home. RESULTS: The two video observers agreed substantially on patient outcome. Changes in walking based on video correlated with RMI for home treatment (r = 0.41, p = 0.008) but not for hospital or no treatment periods (r = 0.14 and 0.15): video changes correlated with the 'live' assessor's global change score inconsistently ('no therapy' r = 0.48, p = 0.002, hospital r = 0.30, p = 0.06 and home r = 0.17, p = 0.30 treatment periods). Based on video data alone, improved mobility was evident following home therapy for only one observer but not for the other or the averaged scores of both. CONCLUSION: There was substantial agreement between two observers deciding on change in mobility based on independent blinded evaluation of short video sequences. However the correlations of these with 'live' assessments were variable. Physiotherapy had a less clear benefit on mobility based on video analysis alone compared with 'live' assessments. The study highlights the need for more objective measures of habitual mobility over longer periods.

Adult↗

PubMed2000

Selection of mobile phase in high-performance liquid chromatographic determination for medicines.

A convenient method was developed to select mobile phase to separate drugs commonly used in clinical therapy, using high-performance liquid chromatography (HPLC). The separation conditions determined by this method were similar for each compound. Two kinds of mobile phase, a mixture of acetonitrile-phosphate buffers, pH 4.2 and 2.5, was used and the composition of mobile phase used for a drug in HPLC analysis was systematically determined as follows: (1) the retention time of a drug was measured under the gradient condition, (2) this retention time value was applied to the regression equation which was determined from the retention time values of p-hydroxybenzoate derivatives under the gradient condition and the concentration of acetonitrile in mobile phase, giving about 5 min of retention time, (3) percentage of acetonitrile in the isocratic condition was calculated from this regression equation and a target drug was eluted with the mobile phase consisting of the calculated concentration of acetonitrile. According to the proposed method, the composition of mobile phase, with which retention time value was between 4 to 8 min in the isocratic condition, was examined for 75 drugs clinically used. Seventy-two of the 75 drugs were analyzed well in the mobile phase, their composition was calculated by the regression equation, and the peak shape of each compound was observed to be sharp. Using this method, the time required for not only the setting of HPLC conditions but also the analysis will be shortened.

Buffers↗

PubMed1997

[Slow Ca2+ (RAMIC) mobilization operated by postsynaptic neuronal nicotinic receptor regulates synaptic function at the mouse neuromuscular junction].

We have found that non-contractile slow Ca2+ mobilization (RAMIC; Receptor-Activity Modulating Intracellular Ca2+) is generated by motor nerve stimulation with anti-cholinesterase at the skeletal muscle, and desensitizes muscle nicotinic receptor (nAChR). To confirm this Ca2+ mobilization without anti-cholinesterase, acetylcholine (ACh) was locally applied by N2-gas pressure onto endplate region at the mouse phrenic nerve-diaphragm muscle preparation. ACh (0.1-3 mM, 20 microliters) elicited bi-phasic elevation of [Ca2+]i (fast and slow Ca2+ mobilization measured as Ca(2+)-aequorin luminescence) in muscle cells. The peak amplitude of slow Ca2+ mobilization (not accompanied by contraction) was increased by ACh concentration-dependently, whereas that of fast component (accompanied by contraction) reached a maximum response at a lower concentration of ACh. The slow Ca2+ mobilization was blocked by lower concentrations of competitive nAChR antagonists which did not affect the fast Ca2+ transients. Moreover, the slow Ca2+ signal was selectively depressed by a neuronal nAChR antagonist methyllycaconitine. Neither Ca2+ channel blockers nor a Na+ channel blocker tetrodotoxin prevented the generation of the slow Ca2+ mobilization. These results suggest that RAMIC is mobilized through postsynaptic neuronal nAChR subtype to desensitize muscle nAChR at the neuromuscular junction.

Acetylcholine↗

PubMed2004

Changes in mobility of children with cerebral palsy over time and across environmental settings.

This study examined changes in mobility methods of children with cerebral palsy (CP) over time and across environmental settings. Sixty-two children with CP, ages 6-14 years and classified as levels II-IV on the Gross Motor Function Classification System, were randomly selected from a larger data base and followed for three to four years. On each of several assessments, parents completed a questionnaire on their child's usual mobility methods in the home, school, and outdoors/community settings. During the first assessment interval, mobility methods increased to methods requiring more gross motor control. During the second assessment interval, mobility methods were unchanged or decreased to methods requiring less gross motor control. Changes within the child and within the environment are hypothesized to occur and to impact changes in mobility methods. Screening at regular intervals is recommended to monitor changes in mobility. Interventions to enhance mobility may be indicated during periods of change in the child or exposure to new environments.

Adolescent↗

PubMed2005

Mobile thrombi of the right heart in pulmonary embolism: delayed disappearance after thrombolytic treatment.

BACKGROUND AND OBJECTIVE: In patients presenting with pulmonary embolism (PE), echocardiography, in some cases, reveals mobile clots in right heart (RH) cavities. How these clots evolve after treatment, in particular after thrombolytic treatment (TT), is unknown. We sought to determine the outcome of these mobile clots in the RH during TT. METHODS AND RESULTS: Of a series of 343 patients who had been hospitalized for PE in our department, echocardiography performed on hospital admittance showed a mobile clot in the RH in 18 patients (mobile clot incidence, 5.2%). This subgroup of 18 patients presented with a more severe form of PE than the 325 patients without mobile clots in the RH. In our series, 16 patients were treated with thrombolytic agents. Close echocardiography monitoring showed the outcomes of these mobile clots during and after TT. In 50% of cases, the clot disappeared rapidly in < 2 h after the end of TT. In 50% of the remaining cases, the clot disappeared later, half within 12 h following the completion of TT, and the other half within 24 h. All patients were alive on day 30 without any clinical sequellae. CONCLUSION: In these particular forms of PE with mobile clots in the RH, the short time lag required to disperse the clot after TT makes it imperative to delay any decision about new aggressive therapy.

Echocardiography↗

PubMed2000

Immunologic profiles of effector cells and peripheral blood stem cells mobilized with different hematopoietic growth factors.

BACKGROUND: Peripheral blood stem cells (PBSC) have become the preferred source of stem cells for autologous transplantation because of the technical advantage and the shorter time to engraftment. Mobilization of CD34(+) cells into the peripheral blood can be achieved by the administration of G-CSF or GM-CSF, or both, alone or in combination with chemotherapy. G-CSF and GM-CSF differ somewhat in the number and composition of CD34(+) cells and effector cells mobilized to the peripheral blood. However, the molecular mechanism underlying the release and engraftment of CD34(+) cells is poorly understood. PURPOSE: The purpose of this review is to give a recent update on the type and immunological properties of effector cells and CD34(+) cells mobilized by the different growth factors with emphasis on A) mobilization of T cells, natural killer cells, and dendritic cells; B) coexpression of adhesion molecules such as VLA-4 and L-selectin in mobilized PBSC collection, and C) coexpression of CXCR4-the receptor for the stromal-derived differentiation factor 1-with latest information shedding light on the molecular mechanism underlying the release and subsequent engraftment of CD34(+) cells. CONCLUSIONS: A) The reported suppression of T cell and NK cell functions in PBSC apheresis collections in patients primed with G-CSF or GM-CSF is controversial and may merely reflect low effector cell activity before mobilization. B) A decrease in the expression of adhesion molecules such as VLA-4 and L-selectin is a necessary requirement for the release of CD34(+) cells to the peripheral blood. C) A decrease in the expression of CXCR4 is a necessary requirement for the release of CD34(+) cells to the peripheral blood and correlates with mobilization success.

Animals↗

PubMed2003

Use of matrix metalloproteinase (MMP)-9 knockout mice demonstrates that MMP-9 activity is not absolutely required for G-CSF or Flt-3 ligand-induced hematopoietic progenitor cell mobilization or engraftment.

Recombinant growth factors (GFs) are used to mobilize hematopoietic stem cells (HSCs) for autologous and allogeneic transplantation; however, little is known about the mechanism(s) critical to this process. Increased levels of serum matrix metalloproteinase (MMP)-9 are detected during mobilization by G-CSF in humans or interleukin (IL)-8 in primates and mice, suggesting a role for this molecule in mobilization. Further, antibodies to MMP-9 block IL-8-induced mobilization. To investigate the role of MMP-9, we compared G-CSF and Flt-3 ligand (Flt-3L)-induced mobilization in wild-type (WT) and MMP-9 knockout (KO) mice. The absence of MMP-9 in the KO mice was confirmed by zymography, which also revealed that serum MMP-9 levels were elevated in WT mice following G-CSF administration. We report that MMP-9 KO mice did not have impaired G-CSF- or Flt-3L-induced hematopoietic progenitor mobilization, suggesting that MMP-9 is not an absolute requirement for this process. In addition, MMPs produced by HSCs have been demonstrated to be important for their transmigration; however, we demonstrate that the engraftment of MMP-9-deficient bone marrow HSCs was not impaired in sublethally irradiated WT recipients. We conclude that while MMP-9 may play an important role in GF-induced hematopoietic progenitor mobilization and engraftment in WT animals, compensatory upregulation of enzymes with a similar activity profile to MMP-9 may obscure the impact of MMP-9 deficiency in the KO model.

Animals↗

PubMedDate not supplied

Overarching principles and salient findings for inclusion in guidelines for power mobility use within residential care facilities.

Although power mobility has many potential benefits for users, power mobility incidents and accidents are a serious concern. To date, little research has explored power mobility safety, and no gold standard exists to determine whether the user is a safe driver. As a possible alternative to a facility unilaterally imposing regulations on power mobility users, we conducted a research project in which power mobility users and other stakeholders used the Delphi method to develop guidelines for power mobility use within a residential facility setting. This article presents the overarching principles for power mobility use and noteworthy items from the safety guidelines that participants developed. These findings highlight the safety issues that are encountered in residential care settings and suggest some strategies to deal with them.

Aged↗

PubMed2004

Comparison of anterior-posterior-glide and rotating-platform low contact stress mobile-bearing total knee arthroplasties.

BACKGROUND: The anterior-posterior-glide Low Contact Stress mobile-bearing knee prosthesis was developed to approximate the natural kinematics of the knee more closely than the rotating-platform Low Contact Stress mobile-bearing knee prosthesis does. The purpose of the present study was to compare the results associated with these two prostheses in patients managed with simultaneous bilateral total knee replacement. METHODS: One hundred and ninety patients received an anterior-posterior-glide Low Contact Stress mobile-bearing prosthesis in one knee and a rotating-platform Low Contact Stress mobile-bearing prosthesis in the contralateral knee. The mean age of the patients at the time of the index procedure was sixty-four years. Eleven patients were men, and 179 patients were women. The mean duration of follow-up was 6.4 years (range, five to seven years). The patients were followed clinically and radiographically with use of the knee-rating systems of the Knee Society and the Hospital for Special Surgery. RESULTS: The mean postoperative Hospital for Special Surgery knee score was 89.4 points for the knees treated with the anterior-posterior-glide mobile-bearing prosthesis and 88.6 points for those treated with the rotating-platform mobile-bearing prosthesis. Three knees in each group had a poor result. Two knees in each group had persistent moderate pain. One knee with an anterior-posterior-glide prosthesis had permanent tibial and deep peroneal nerve palsies, and one knee with a rotating-platform prosthesis had a permanent deep peroneal nerve palsy. No knee had aseptic loosening, revision, measurable wear of the tibial or patellar polyethylene bearing, or osteolysis. CONCLUSIONS: After a minimum duration of follow-up of five years, the results associated with the anterior-posterior-glide and rotating-platform Low Contact Stress mobile-bearing total knee replacements were favorable and comparable.

Arthroplasty, Replacement, Knee↗

PubMed1998

The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome.

Primary shoulder impingement syndrome is a common shoulder problem which, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after nine treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.

Female↗

PubMed2001

Nutrient mobilization from body tissues as influenced by litter size in lactating sows.

Twenty-eight primiparous sows were used to study nutrient mobilization among body tissues as influenced by litter size in lactating sows. Litter size was set to 6, 7, 8, 9, 10, 11, or 12 pigs within 48 h postpartum by cross-fostering. Four sows were allotted to each litter size group. Sows had 11.5 +/- 1.3 Mcal of ME and 39.3 +/- 4.4 g of lysine per day and were killed on d 20.6 +/- 1.1 of lactation. Liver, gastrointestinal tract (GIT, composed of the empty stomach, empty small and large intestines, cecum and rectum), reproductive tract, and other organs (excluding liver, GIT, reproductive tract, and mammary gland) were separated from the carcass. Gastrointestinal tracts were manually stripped of contents and flushed with water to remove digesta. Hot carcasses were split longitudinally at the midline after removing mammary glands and internal organs. Individual organs and carcasses were weighed then ground for chemical analysis. Dry matter, crude protein, fat, and ash contents were measured. As litter size increased, protein mobilization was linearly increased (P < 0.05) in carcass, GIT, and reproductive tract. Protein mobilization in liver was quadratically affected by litter size (P < 0.05). Fat mobilization was not affected by litter size. The amount of protein mobilized from carcass, GIT, liver, and reproductive tract in sows increased by 641 g as litter size increased by one pig from 6 to 12 pigs after a 21-d lactation. Carcass contributed the largest amount of protein (600 g for an additional pig) among body tissues, whereas the reproductive tract contributed the highest percentage (26%) of its protein among body tissues. Protein efficiency from milk to litter weight gain was 72% as litter size increased during a 21-d lactation. In feeding lactating sows, effect of litter size on nutrient mobilization from various tissues should be considered for minimizing the excess tissue mobilization during lactation.

Animal Nutritional Physiological Phenomena↗

PubMed1995

Pre and post-amputation mobility of trans-tibial amputees: correlation to medical problems, age and mortality.

This retrospective study compares pre and post-amputation mobility and the influence of age and associated medical problems. Data from the charts of 120 male patients who underwent unilateral trans-tibial (below-knee) amputation at the Dallas Veteran's Administration Hospital between June, 1983 and October, 1991, were collected and analyzed. Mobility was assessed with a six level scale developed by Volpicelli et al. (1983). The presence of cardiac disease, pulmonary disease (COPD), peripheral vascular disease (PVD), diabetes mellitus, degenerative joint disease, blindness, cerebral vascular accident (CVA), and age are correlated with changes in mobility after amputation. Older patients had more medical problems and lower post-amputation scores Individual medical problems did not influence mobility scores, but the presence of COPD and PVD lowered pre-amputation mobility scores. Cardiac disease and diabetes mellitus influenced post-amputation mobility scores by lowering them, either together or individually. Regardless of age, however, patients with more medical problems were poor ambulators. The cause of amputation per se did not influence mobility scores.

Activities of Daily Living↗

PubMed1978

Measuring relative electrophoretic mobilities of mutant hemoglobins and globin chains.

A system of calculating relative mobilities of mutant hemoglobins and globin chains in four methods of zone electrophoresis is described. In electrophoresis on cellulose acetate, TEB buffer, pH 8.5, mobilities are calculated as ratios of the mobility of simultaneously analyzed Hb C. In electrophoresis on citrate agar, pH 6.0, anodic mobilities are also related to Hb C, cathodic ones to Hb F. In globin electrophoresis in urea 2-mercaptoethanol buffers, pH 6.0 and 8.9, mobilities of the mutant globin chains are calculated in relation to the mobilities of normal alpha and beta chains. These calculations provide objective comparisons of mobilities of hemoglobins, including those analyzed at different times. The combined data permit recognition of many mutant hemoglobins.

Blood Protein Electrophoresis↗

PubMed1997

Does family support buffer the impact of specific chronic diseases on mobility in community-dwelling elderly?

The present study explores whether different structural (presence of partner and children) and functional (amounts of instrumental and emotional support provided by partner and children) family characteristics buffer the influence of chronic diseases on physical functioning. Logistic regression analyses were performed in a population-based sample of 2830 community-dwelling elderly people with chronic diseases as independent variable, and mobility difficulties as dependent variable, for separate strata of family characteristics. The presence of buffer effects was ascertained by comparing the associations between disease variables and mobility difficulties across the strata of family characteristics, using the odds ratios and 95% confidence intervals. Living together with a partner appears to buffer the association between the presence of one chronic disease and mobility difficulties, but no such effect is present among subjects with more than one disease. Regarding specific chronic diseases, partner presence has a beneficial influence only on the association between stroke and mobility difficulties, regardless of whether the partner provides little or much support. For patients with chronic non-specific lung disease (asthma, chronic bronchitis or pulmonary emphysema), a small amount of instrumental support (help with daily chores in and around the house) received from the partner is associated with a higher risk for mobility difficulties, compared to patients who receive a large amount of instrumental support and to patients who are not living with a partner. Neither the presence of children, nor the amounts of support received from them, influences associations between specific chronic diseases and mobility difficulties. The present study provides limited evidence supporting a buffer effect of family characteristics on the association between chronic diseases and mobility. Only in elderly people with a relatively low burden of disease does family support mitigate the adverse effects of disease on physical functioning.

Activities of Daily Living↗

PubMed2000

Sulfated glycans induce rapid hematopoietic progenitor cell mobilization: evidence for selectin-dependent and independent mechanisms.

The adhesive mechanisms leading to the mobilization of hematopoietic progenitor cells (HPCs) from the bone marrow into the blood are poorly understood. We report on a role for selectins and fucoidan in progenitor mobilization. Baseline levels of circulating HPCs are increased in endothelial selectin-deficient (P/E-/-) mice. Similar levels are observed when E-selectin null (E-/-) mice are treated with anti-P-selectin antibody or with fucoidan (which inhibits P- and L-selectin function). In particular, administration of 2 doses of fucoidan (25 mg/kg) over 6 hours produces profound mobilization of progenitors in wild-type mice and the response is greatly enhanced in E-/- and P/E-/- mice. Competitive reconstitution experiments reveal that fucoidan also elicits long-term (more than 6 months) repopulating stem cells. Mobilization assays using chimeric mice harboring L-selectin-deficient progenitors and wild-type progenitors expressing the green fluorescence protein suggest that L-selectin expression is not required but confers an advantage for fucoidan-induced mobilization. Sulfation is critical as desulfated fucoidan is ineffective. In addition, sulphogalactosylceramide (sulfatide) but not heparin can induce HPC mobilization. Our results indicate that administration of sulfated glycans, especially with concurrent inhibition of E-selectin function, represents a powerful novel method for rapid mobilization of long-term-repopulating stem cells. These findings may help elucidate the mechanisms of HPC trafficking during development and adult life.

Animals↗

PubMed2002

Validation of a remote monitoring system for the elderly: application to mobility measurements.

The aim of this paper is to introduce a smart tool for the assessment of the mobility of patient with motor disorders and to evaluate its performance through some initial experiments. These experiments are based on a system which is composed of sensors connected to a Personal Computer (PC) using data acquisition cards and a communication network. The PC includes a data acquisition and processing software. This system has been installed in a patient's housing (a bedroom and a washroom) in a long-stay setting. Pre-established travel and activity (going to bed, getting up, visiting the washroom em leader ) patterns of patient in the housing including their duration have been defined by physicians for the experiments. A volunteer participated in the experiments and the results of his mobility obtained by the data processing software were compared with his real mobility. An agreement was found between the proposed assessment system and the experiments, thereby validating functioning of the whole system. Then, the system has been used to monitor a patient over a period of 39 nights. Again there is a good agreement between the characteristics derived from the system and the findings of the caring staff in charge of the patient's routine night monitoring. Data collected during 24 consecutive hours have been used to identify and characterise the patient's whole day mobility. This study paves the way for a new assessment system of the mobility of patient thus allowing the follow up of patients suffering from dementia and to study their significant mobility changes over time by introducing an indicator of mobility which can be used to assess their motor behavioural disorders.

Aged↗

PubMed2003

Mobility of wheelchair users: a proposed performance assessment framework.

PURPOSE: Few standardized outcome measures used in the clinical assessment of wheelchair user performance assess or document all the factors that influence mobility. This article presents a conceptual framework that suggests a more all-encompassing view of wheelchair mobility performance assessment. METHOD: After determining, through a survey of the literature, which factors influence wheelchair mobility, a conceptual framework was proposed. Outcome measures of wheelchair mobility were then surveyed. An analysis of these assessment tools allowed factors to be determined that were considered in the clinical assessment of wheelchair mobility performance. A comparison of these led to observations being drawn, which could allow the development of a valid and reliable standardized outcome measure to be used in clinics. RESULTS AND CONCLUSION: Future improvements to the clinical assessment of wheelchair mobility performance should focus on developing an assessment tool considering all categories of factors influencing wheelchair mobility. These categories are the user's profile, the wheelchair, the environment, the daily activities and social roles and the assessment and training received. A controlled-environment outcome measure using a standardized obstacle course with fundamental situations would allow rehabilitation therapists to evaluate clients for the selection of a wheelchair and to document their progress during training. This tool should make it possible to extrapolate the results and thereby apply them to daily activities and social roles.

Activities of Daily Living↗

PubMed2005

The relative kicking frequency of infants born full-term and preterm during learning and short-term and long-term memory periods of the mobile paradigm.

BACKGROUND AND PURPOSE: Infants born preterm differ in their spontaneous kicking, as well as their learning and memory abilities in the mobile paradigm, compared with infants born full-term. In the mobile paradigm, a supine infant's ankle is tethered to a mobile so that leg kicks cause a proportional amount of mobile movement. The purpose of this study was to investigate the relative kicking frequency of the tethered (right) and nontethered (left) legs in these 2 groups of infants. SUBJECTS: Ten infants born full-term and 10 infants born preterm (<33 weeks gestational age, <2,500 g) and 10 comparison infants participated in the study. METHODS: The relative kicking frequencies of the tethered and nontethered legs were analyzed during learning and short-term and long-term memory periods of the mobile paradigm. RESULTS: Infants born full-term showed an increase in the relative kicking frequency of the tethered leg during the learning period and the short-term memory period but not for the long-term memory period. Infants born preterm did not show a change in kicking pattern for learning or memory periods, and consistently kicked both legs in relatively equal amounts. DISCUSSION AND CONCLUSION: Infants born full-term adapted their baseline kicking frequencies in a task-specific manner to move the mobile and then retained this adaptation for the short-term memory period. In contrast, infants born preterm showed no adaptation, suggesting a lack of purposeful leg control. This lack of control may reflect a general decrease in the ability of infants born preterm to use their limb movements to interact with their environment. As such, the mobile paradigm may be clinically useful in the early assessment and intervention of infants born preterm and at risk for future impairment.

Analysis of Variance↗