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Results for “Physical Functional Performance”

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PubMed1999

[Diagnosis and treatment of heart failure within the community].

Congestive heart failure causes substantial morbidity and mortality. Symptoms and physical findings can help in diagnosis, but have limited sensitivity and specificity. Objective measurement of ventricular function is essential in virtually all patients in whom heart failure is suspected; reversible causes of heart failure must be sought. Out-patient management includes education and counseling, emphasis on and assessment of compliance with diet, and pharmacological treatment. Angiotensin-converting enzyme inhibitors are the mainstay of treatment but are underused, and maximal doses are not given, apparently because of concern about side-effects. Diuretics should be administered only as needed to manage fluid overload. Calcium channel blockers are relatively contraindicated in patients with impaired ventricular function. Patient follow-up should be guided by results of the medical history and physical examination. Routine serial testing of ventricular function and exercise performance is discouraged.

Counseling↗

PubMedDate not supplied

Hearing in the elderly: a population study.

An epidemiological study comparing speech audiometry with self-assessed hearing disability and an analysis of other factors influencing the quality of life was conducted. In the Veneto region (Italy), a representative sample of 2700 independently living individuals of 65 years of age and older was selected for the study. All participants were administered a comprehensive questionnaire and a brief examination at their home, including a general physical examination, speech audiometry, Sanders' Speech Disability test, part I and III, Mini Mental State Examination, CES-D scale for depression, visual acuity, self-reported diseases and physical function. Auditory function was worst in the older individuals: auditory performance was within acceptable limits up to the 75-79 age group, while it rapidly deteriorates in the older groups. This trend is consistent with self-reported auditory disability (Sanders' test). A detailed analysis of the type of errors made in the speech audiometry was conducted for each subject. Speech audiometry is a good indicator of real hearing difficulties faced by the elderly, and it might be preferred to pure-tone audiometry, since hearing deficits with age are not always limited to an increased detection threshold, but include other aspects of hearing such as distortion of sounds, comprehension of speech and noise discrimination.

Age Distribution↗

PubMed1991

Clinical-physiologic correlations in acute asthma of childhood.

Seventy-one patients who presented to the emergency room with acute asthma were evaluated to determine the relationship between common clinical signs and spirometric and transcutaneous arterial oxygen saturation (SaO2) measurements. Prior to treatment, a physical examination was performed, a clinical score assigned, and pulmonary function and SaO2 were measured. Although forced expiratory volume in 1 second (FEV1) and SaO2 had strong correlation with the overall clinical score (r2 = .47, .49 respectively), many patients with low clinical scores and apparent mild clinical disease had low FEV1 values (as low as 20% predicted). Of the individual components of the clinical score (ie, heart rate, respiratory rate, pulsus paradoxus, accessory muscle use, dyspnea, and wheezing), the degree of accessory muscle use correlated most closely with lung function followed by the degree of dyspnea and wheezing. Similarly, the degree of accessory muscle use correlated most closely with SaO2 followed by dyspnea and respiratory rate. Significant correlation (r2 = .59) was found between SaO2 and FEV1, although the range of SaO2 value for a given FEV1 was wide and some patients with low FEV1 values had normal SaO2 values. These results show that although clinically apparent severe disease and hypoxemia were always associated with low FEV1, their absence does not exclude the presence of airflow obstruction. It is concluded that for the optimal evaluation of acute asthma in children in the emergency room, clinical evaluation should be used in conjunction with objective laboratory measurements.

Acute Disease↗

PubMed1990

[Clinico-functional criteria of work capacity and the characteristics of professional rehabilitation of patients with stenocardia].

Proceeding from the experience gained in the medical examination of persistent working ability loss, which was based on the results of bicycle ergometric studies in 383 patients with stable angina, the authors developed clinicofunctional criteria allowing the practitioner to establish the degree of physical working capacity limitation (poor, satisfactory, good). The validity of the criteria was confirmed by coronary angiographic evidence and long-term observation results. Over 3 years of the follow-up, 28% of the patients who had been group II invalids and 7% of the Group III died among those recorded by the medical-and-labour examination commission that used the criteria described above. All the individuals who had been regarded as being able to work survived. The occupational activities adequate to the fitness of patients with angina promote the development of adaptive mechanisms, mobilize the functional reserve of the blood circulatory apparatus, enhance their physical performance. It has been concluded that the efficacy of the medical-and-labour examination in angina is determined by an accurate assessment of its severity and closely associated with the application of bicycle ergometry.

Adult↗

PubMedDate not supplied

[The importance of the transfer factor test in the diagnosis of pulmonary emphysema].

Physical examination, X-ray and lung function studies were performed in a group of 29 patients with chronic obstructive lung diseases. According to the diffusing capacity, patients were divided into two subgroups: one with normal and the other with decreased lung transfer-factor. Comparing the parameters of pulmonary function significantly more severe obstructive ventilatory insufficiency and greater lung hyperinflation were found in the subgroup of patients with decreased diffusing capacity. In this subgroup the collapsing type of flow-volume loop and X-ray signs of emphysema were present more frequently than in patients with normal lung diffusing capacity.

Bronchitis↗

PubMed1988

[Rational diagnosis in phlebologic practice].

Venous diseases are of extraordinary sociomedical and socioeconomic relevance. They are a daily problem in general practice and require careful diagnostic clarification and exact definition with regard to differential diagnosis. In the diagnosis of important venous diseases Doppler sonography must always be carried out after the case history has been taken and a physical examination has been performed. It allows a relatively fast, functionally orientated and differentiated assessment of all venous diseases of the lower and upper extremities and does not involve any risk. At present, it cannot be replaced by any other method either in general or in clinical practice, and also serves as an indication for phlebography for example. Duplex sonography can supplement Doppler ultrasonography significantly, but this examination is still very expensive. There are fundamental sources of error in photoplethysmography and this technique has considerable limitations. It never can replace Doppler ultrasonography. Its only well-founded application - besides a general determination of a more pronounced venous transport disturbance - is to test the haemodynamic effect of eliminating important venous insufficiency points as preparation for invasive forms of therapy. The kind of examination shown here offers the best prerequisites for rational diagnosis in phlebological practice.

Humans↗

PubMedDate not supplied

[Effect of sports participation on the physical aging process].

Ageing is determined by the laws of nature. But pace and course of ageing processes depend to a certain degree on environmental factors and particularly on the way of life. The individual maintains with advancing age an adaptability to physically shaping stimuli. The effects of regular physical activity can be assessed in elderly persons as beneficial modifications in bodily structure and function. On the other hand ageing and lack of physical performance capacity demonstrate numerous analogies. The manifestation of a number of (mostly chronic) diseases is promoted by ageing and by hypokinesia. The adaptive consequences of an adequate activity of the largest organ of the body, the musculature, are in a phenomenological contrast to essential processes of ageing. A good state of exercise-induced adaptation is an effective component in prophylaxis and in establishing a relatively low biological age.

Adult↗

PubMed1988

The construction of a simultaneous functional order in nervous systems. IV. The influence of physical constraints on the resulting functional order.

The signal activity in a neural net will be constrained both by its physical structure and by environmental constraints. By monitoring its signal activity a neural system can build up a simultaneous functional order that encodes these constraints. We have previously (Part I) presented two models that construct a simultaneous functional order in a collection of neural elements using either signal-covariances or signal-coincides. In this paper we present the results of simulation experiments that were performed to study the influence of the physical constraints of a neural system on the simultaneous functional order produced by both models. In the simulation experiments we used a one-dimensional detector array. We delineate the physical constraints such an array has to satisfy in order to induce a functional order relation that allows an isomorphism with a geometrical order. We show that for an appropriate choice of the system parameters both models can produce a simultaneous functional order with sufficient internal coherence to allow isomorphisms with a triangulation. In this case the dimensionality and the coherence of the detector array are objectively available to the system itself.

Environment↗

PubMed2002

Integration of bilateral whisker stimuli in rats: role of the whisker barrel cortices.

Recently, we demonstrated that neural responses within the whisker region of the primary somatosensory cortex (SIw) of rats are profoundly influenced by the spatiotemporal attributes of ipsilateral, as well as contralateral, whisker stimuli. As inactivation of one SIw eliminates in the intact SIw both ipsilaterally evoked responses and the influence of ipsilateral stimulation on contralaterally evoked activity, we proposed that interhemispheric interactions between the SIws may be important for integrating bilateral whisker information. To test whether rats can recognize the bilateral nature of a whisker stimulus, we developed a tactile discrimination task that required rats to conjointly determine distances to a left and a right discriminandum as equidistant or non-equidistant using only their facial whiskers. All rats trained in this task achieved performance levels indicative of an ability to integrate bilateral whisker information. Testing during unilateral, as well as bilateral, inactivation of the SIws indicated that rats rely on both SIws for detecting the bilateral nature of a whisker stimulus. Rats were unable to perform the task without both sets of whiskers, a fact that indicates that the whiskers (and not other modalities) were used to perform this task. The findings presented here indicate that rats can solve a task that requires the conjoint detection of left and right whisker-mediated distance information and implicate the SIws as central to this ability.

Animals↗

PubMed2005

Attention, psychomotor functions and age.

Nutrition might play an important role to ameliorate or to buffer age-related declines in attention and psychomotor functions. The assessment of nutritional effects in aged subjects has to take into account that attention and psychomotor functions can be subdivided in different functions that are differentially affected by age. This paper gives an overview of changes in different facets of attention and psychomotor functions beyond fifty as well as assessment methods for attention and psychomotor performance. It also provides a review of models to explain the pattern of changes with increasing age, and discusses the problems of high performance variance and of age related confounding variables like health status. Two different approaches are discussed that analyse a performance profile and an experimentally oriented functional microanalysis of changes in performance with respect to the effects of nutrition on attention and psychomotor functions. Addressed are examples of missing age-related deficits or even age-related superiority. Caffeine and Ginseng are considered as examples to enhance performance in older persons. Results are in accordance with data on the positive role of physical fitness for mental performance in older persons. Performance of older persons can well be enhanced by functional food components or nutritional supplementation. The effects are comparable to the effects obtained in younger groups, while there is only weak evidence for specific compensatory effects in aged persons. Finally the role of nutrition for the processes of healthy aging is discussed.

Aged↗

PubMed1994

Rehabilitation of walking with electromyographic biofeedback in foot-drop after stroke.

BACKGROUND AND PURPOSE: Alterations of gait cycle and foot-drop on the paretic limb are characteristic of stroke patients. Electromyographic biofeedback treatment has been used in rehabilitation of walking, but results are controversial. We performed gait analysis to evaluate the efficacy of electromyographic biofeedback compared with physical therapy. METHODS: Sixteen patients with ischemic stroke were enrolled in the study. The experimental group (4 men, 4 women) received electromyographic biofeedback treatment together with physical therapy. The control group (5 men, 3 women) was treated with physical therapy only. Clinical and functional evaluations before and after treatment were performed using Canadian Neurological, Adams, Ashworth, Basmajian, and Barthel Index scales. Computerized gait analysis was performed in all patients. RESULTS: Electromyographic biofeedback patients showed significantly increased scores on the Adams scale (P < .05) and Basmajian scale (P < .01). Gait analysis in this group showed a recovery of foot-drop in the swing phase (P < .02) after training. CONCLUSIONS: Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia.

Adult↗

PubMed1985

Cardiovascular disorders. Diagnostic and therapeutic implications for the podiatric medical practice.

The cardiovascular system has multiple implications in the podiatric patient. The examination should begin with a complete and careful history. The physical examination should be thorough. Noninvasive evaluation should be performed as indicated with both a static and functional component. Cardiac disease should be investigated in all patients with a history or physical findings consistent with this disorder, such as blue toe syndrome, palpitations, or chest pain.

Blood Pressure↗

PubMed2003

Non-dominant leg training improves the bilateral motor performance of soccer players.

The aim of this experiment was to evaluate bilateral motor performance effects from training the non-dominant leg of competitive soccer players. The subjects were 39 soccer players, 15-20 years of age, performance-matched and randomly divided into a training group (n = 18) and a control group (n = 21) both belonging to the same team. Both groups were tested by using two standardised foot-tapping tests and three soccer-specific tests. The training intervention consisted of the experimental group participating in all parts of their soccer training except full play, using the non-dominant leg for 8 weeks. Statistical analyses for the soccer-specific tests revealed that the experimental group improved significantly as compared to the control group from the pre-test to the post-test period in their use of the trained non-dominant leg. Somewhat unexpectedly, the experimental group also improved significantly in the tests, which made use of the dominant side. The standardised foot-tapping tests revealed similar results. The results might be explained by improved generalised motor programmes, or from a Dynamic Systems Approach, indicating that the actual training relates to the handling of all the information available to the subject in the situation, and that the body self-organises the motor performance.

Adolescent↗

PubMed1983

Physical work capacity and lung function in competitive swimmers.

Competitive swimmers require a high aerobic capacity to support the sustained performance of severe exercise. Maximal oxygen uptake values and blood lactate concentrations were measured in ten male and fifteen female swimmers from the Scottish National and Youth Squads 1981-82. Lung function tests were also performed to determine pulmonary efficiency. The results of these studies were compared with other investigations of international competitive swimmers and indicate a high level of fitness among Scottish national swimmers.

Adolescent↗

PubMed2002

Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial.

OBJECTIVES: Although deficits in skeletal muscle strength, gait, balance, and oxygen uptake are potentially reversible causes of frailty, the efficacy of exercise in reversing frailty in community-dwelling older adults has not been proven. The aim of this study was to determine the effects of intensive exercise training (ET) on measures of physical frailty in older community-dwelling men and women. DESIGN: Randomized controlled trial. SETTING: Medical school research center. PARTICIPANTS: One hundred fifteen sedentary men and women (mean age +/- standard deviation = 83 +/- 4) with mild to moderate physical frailty, as defined by two of the following three criteria: Modified Physical Performance Test (modified PPT) score between 18 and 32, peak oxygen uptake (VO2 peak) between 10 and 18 mL/kg/min, and self-report of difficulty or assistance with one basic activity of daily living (ADL), or two instrumental ADLs. INTERVENTION: Participants were randomly assigned to a control group that performed a 9-month low-intensity home exercise program (control) or an exercise-training program (ET). The control intervention primarily consisted of flexibility exercises. ET began with 3 months of flexibility, light-resistance, and balance training. During the next 3 months, resistance training was added, and, during the next 3 months, endurance training was added. MEASUREMENTS: Modified PPT score, VO2 peak, performance of ADLs as measured by the Older Americans Resources and Services instrument, and the Functional Status Questionnaire (FSQ). RESULTS: ET resulted in significantly greater improvements than home exercise in three of the four primary outcome measures. Adjusted 95% confidence bounds on the magnitude of improvement in the ET group compared with the control group were 1.0 to 5.2 points for the modified PPT score, 0.9 to 3.6 mL/kg/min for VO2 peak, and 1.6 to 4.9 points for the FSQ score. CONCLUSIONS: Our results show that intensive ET can improve measures of physical function and preclinical disability in older adults who have impairments in physical performance and oxygen uptake and are not taking hormone replacement therapy better than a low-intensity home exercise program.

Activities of Daily Living↗

PubMed2004

Inflammatory markers and physical performance in older persons: the InCHIANTI study.

BACKGROUND: Some studies have proposed chronic inflammation as an underlying biological mechanism responsible for physical function decline in elderly people. The aim of this study is to evaluate the relationship between several inflammatory markers and physical performance in an older population. METHODS: This study is part of the "Invecchiare in Chianti" (InCHIANTI) study, a prospective population-based study of older people, aimed at identifying risk factors for late-life disability. The study sample consisted of 1020 participants aged 65 years and older living in the Chianti area of Italy. Physical performance was assessed using walking speed, the chair-stand test, and the standing balance test. Hand-grip strength was assessed using a hand-held dynamometer. Serum levels of C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), IL-10, IL-1beta, IL-6sR, and IL-1RA were determined. Linear regression analyses were used to assess the multivariate relationship of inflammatory marker levels with physical performance, scored as a continuous variable from 0 to 3, and hand-grip strength after adjustment for demographics, chronic conditions, medication use, and other biological variables. RESULTS: CRP, IL-6, and IL1RA were significantly correlated with physical performance (r=-0.162, r=-0.251, and r=-0.127, respectively). Significant correlations with hand-grip strength were found for CRP and IL-6 (r=-0.081 and r=-0.089, respectively). After adjustment for covariates, high levels of IL-6 and IL-1RA continued to be strongly associated with worse physical performance (p<.001 and p=0.004, respectively). High levels of CRP (p<.001) and IL-6 (p<.001) were associated with low hand-grip strength. Mean adjusted physical performance scores ranged from 2.21 in the CRP<0.59 mg/dl group to 2.07 in the CRP>0.60 mg/dl group (p for trend=.004), and from 2.25 in the lowest IL-6 quartile to 2.08 in the highest IL-6 quartile (p for trend<.001). This trend was also reflected in mean adjusted hand-grip strength, with a range from 28.8 kg for the CRP<0.59 mg/dl group to 26.0 kg for the CRP>0.60 mg/dl group (p for trend=.001), and from 27.4 kg for the lowest IL-6 quartile to 25.1 kg for the highest IL-6 quartile (p for trend=.001). CONCLUSIONS: Inflammation, measured as high levels of IL-6, CRP, and IL-1RA, is significantly associated with poor physical performance and muscle strength in older persons. These data also support the biological face validity of physical performance measures. The assessment of inflammatory markers may represent a useful screening test and perhaps a potential target of intervention.

Aged↗

PubMed2002

Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing.

OBJECTIVE: To evaluate, in terms of function and mobility, the predictive value of commonly adopted anthropometric 'definitions' used in the nutritional assessment of older adults, in a cohort of older Australians. DESIGN: Prospective cohort study - Australian Longitudinal Study of Ageing (ALSA). SETTING: Adelaide, South Australia (1992-1994). SUBJECTS: Data were analysed from 1272 non-institutionalised (685 males, 587 females) older adults > or =70 years old in South Australia. Seven 'definitions' commonly used in the anthropometric assessment of both under- and overnutrition (including four using body mass index (BMI), waist-to-hip ratio, waist circumference and percentage weight change) were evaluated at baseline, for their ability to predict functional and mobility limitation assessed (by self-report questionnaire) at two years follow-up. All questionnaires were administered and anthropometry performed by trained investigators. The associations between the definitions and decline in mobility and physical function were evaluated over two years using multiple logistic regression. RESULTS: A BMI >85th percentile or >30 kg m-2 or a waist circumference of >102 cm in males and >88 cm in females increased risk of functional and mobility limitations. Over two years, a loss of 10% body weight significantly increased the risk of functional and mobility limitations. CONCLUSION: Maintaining weight within older adults, irrespective of initial body weight, may be important in preventing functional and mobility limitations. Excessive weight is associated with an increased risk of limitation in function and mobility, both key components of health-related quality of life.

Aged↗

PubMed2006

Incorporating injured employee outcomes into physical and occupational therapists' practice: a controlled trial of the Worker-Based Outcomes Assessment System.

BACKGROUND: Work related musculoskeletal disorders (WRMSDs) remain costly. The Worker-Based Outcomes Assessment System (WBOAS) is an injury treatment improvement tool. Its purpose is to increase treatment effectiveness and decrease the cost of care delivered in Occupational Health Service clinics. METHODS: The study used a non-randomized (parallel cohort) control trial design to test the effects on injured employee outcomes of augmenting the standard care delivered by physical and occupational therapists (PT/OTs) with the WBOAS. The WBOAS works by putting patient-reported functional health status, pain symptom, and work role performance outcomes data into the hands of PT/OTs and their patients. Test clinic therapists were trained to incorporate WBOAS trends data into standard practice. Control clinic therapists delivered standard care alone. RESULTS: WBOAS-augmented PT/OT care did improve (p< or =.05) physical functioning and new injury/re-injury avoidance and, on these same dimensions, cost-adjusted outcome. It did not improve (p>.05) mental health or pain symptoms or return-to-work or stay-at-work success nor, on these same dimensions, cost-adjusted outcome. CONCLUSION: Training PT/OTs to incorporate patient-reported health status, pain symptom, and work role performance outcomes trends data into standard practice does appear to improve treatment effectiveness and cost on some (e.g. physical functioning) but not other (e.g. mental health, pain symptoms) outcomes.

Adult↗