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PubMed2005

The effect of auditory experience on speech perception, localization, and functional performance of children who use a cochlear implant and a hearing aid in opposite ears.

This study was aimed at determining the effect of auditory experience on binaural benefits from using a cochlear implant and a hearing aid in opposite ears. Eighteen children were evaluated using tests of speech perception, horizontal localization, and functional performance when they used either a cochlear implant alone (CI) or a cochlear implant with a hearing aid (CIHA). Eight were experienced CIHA users, whereas ten had not worn a hearing aid in the non-implanted ear for up to eight years prior to participation. All children were fitted with a hearing aid in the non-implanted ear using the NAL-RP prescription, and the hearing aids were fine-tuned individually using a paired-comparisons procedure and a loudness balancing test. Evaluation results indicated that performance for all measures was significantly better with CIHA than with CI for both groups of children. We conclude that children who receive a unilateral cochlear implant should be encouraged to wear a hearing aid in the opposite ear where there is usable residual hearing.

Acoustic Stimulation↗

PubMedDate not supplied

The functional performance of elderly urban African-American women who return home to live alone after medical rehabilitation.

OBJECTIVE: Elderly women who live alone are at increased risk for loss of independence. Hospitalization, in particular, often marks the transition from independent living to institutional care. The purpose of this study was to examine the relationship of rehabilitation admission to the subsequent function of elderly women and their ability to return to live-alone status. METHOD: The women in the study (N = 138) were admitted to a geriatric rehabilitation unit at a large urban medical center between September 1997 and September 1998. The findings reported here pertain to the subset of African-American women (n = 122), the majority of the sample. Data were collected using several standardized assessments, including the Functional Independence Measure (FIM). RESULTS: The FIM motor scores improved significantly for the total sample between admission and discharge, and the mean FIM motor score for the group that subsequently attained live-alone status was significantly higher than the non-live-alone group at 3 months and 6 months postdischarge. The participants who returned to live alone also reported significantly greater independence than did their non-live-alone counterparts across a variety of activities of daily living and instrumental activities of daily living skills. CONCLUSION: These data suggest that rehabilitation is associated with improved functional outcomes, and higher functional performance is related to live-alone status.

Activities of Daily Living↗

PubMed2000

Biocompatibility and functional performance of a polyethylene glycol acid-grafted cellulosic membrane for hemodialysis.

In order to improve the biochemical reactivity of the cellulose polymer, which is mainly attributed to the presence of surface hydroxyl groups, derivatized cellulosic membranes have been engineered replacing or masking some or all of the hydroxyl groups in the manufacturing process of the membrane. The present study was set up to analyze both biocompatibility and functional performance of two different derivatized cellulosic membranes (cellulose diacetate; polyethylene glycol, PEG, acid-grafted cellulose) as compared to a synthetic membrane (polymethylmethacrylate, PMMA). Cellulose diacetate is prepared by substituting hydroxyl groups with acetyl groups; PEG cellulose is obtained by grafting PEG chains onto the cellulosic polymer with a smaller amount of substitution than cellulose diacetate. While the three dialyzers provided similar urea and creatinine removal, the dialyzer containing cellulose diacetate showed a reduced ability to remove 32-microglobulin compared to that containing PEG cellulose or PMMA. A transient reduction in leukocyte count was observed for both derivatized cellulosic membranes. The neutrophil and monocyte counts throughout the entire dialysis session showed a closer parallelism with the cellular expression of the adhesive receptor CD 15s (sialyl-Lewis x molecule) than with CD11b/CD18 expression. Platelet activation, as indicated by the percentage of cells expressing the activation markers CD62P (P-selectin) and CD63 (gp53), occurred with all membranes at 15 min of dialysis and also with PMMA at 30 min. An increased formation of platelet-neutrophil and platelet-monocyte coaggregates was found at 15 and 30 min during dialysis with cellulose diacetate and PMMA but not with PEG cellulose. Generally in concomitance with the increase in platelet-neutrophil coaggregates, an increased hydrogen peroxide production by neutrophils occurred. Our results indicate that derivatizing cellulose may represent a useful approach to improve the biocompatibility of the cellulose polymer, though some homeostatic reactions remain activated. Our results also indicate that there may be a great variability in the biocompatibility profile of derivatize cellulosic membranes which most likely stem from the different type of structural modification rather than from the degree of hydroxyl group replacement.

Aged↗

PubMed2003

Maximal voluntary and functional performance levels needed for independence in adults aged 65 to 97 years.

BACKGROUND AND PURPOSE: Age-related loss of muscle mass and cardiovascular endurance can lead to impairments in muscle force production and cardiac function that, in turn, limit performance in activities essential to everyday living. The purposes of this study were: (1) to identify the "breakpoint" or threshold of maximal voluntary performance and performance in ordinary daily function and (2) to evaluate the predictive validity of the threshold to identify the ability to live independently without self-reported functional limitation. SUBJECTS AND METHODS: Men and women (N=192; mean age=76 years, SD=7, range=65-97) were recruited from single-family community dwellings or retirement communities with multiple levels of care. Physical function was measured with the Continuous-Scale Physical Functional Performance Test (CS-PFP). Maximal voluntary performance measures included peak oxygen consumption (VO(2peak)) and isokinetic knee extensor torque (KET). Segmented linear regression models of the CS-PFP on the physical performance measures were used to determine the threshold values and their confidence intervals. A logistic regression model was used to evaluate the ability of the CS-PFP scores to identify those living independently and to further illustrate the concepts of threshold and physical reserve. RESULTS: Threshold values identified for VO(2peak) (20 mL x kg(-1) x min(-1)) and KET (2.5 N x m/[kg x m(-1)]) were associated with an average of CS-PFP score of 57 units. The threshold accurately predicted individuals reporting functional limitations. DISCUSSION AND CONCLUSION: The thresholds provide a mechanism for easily estimating an individual's physical reserve, predicting dependency in living status, and providing unbiased guidance for intervention in late-life independence.

Activities of Daily Living↗

PubMed2003

Spastic velocity threshold constrains functional performance in cerebral palsy.

OBJECTIVES: To evaluate a quantitative, velocity-based assessment of spasticity in the quadriceps and hamstrings muscles of children with cerebral palsy (CP) and to show the effects of spasticity in constraining knee velocities during fast gait. DESIGN: A quantitative comparison of neuromuscular and biomechanical performance in patients with CP and controls without CP. SETTING: Movement analysis laboratory within a university clinical referral center. PARTICIPANTS: A convenience sample of 18 ambulatory patients with CP and 11 control subjects without CP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spastic threshold velocity recorded from electromyographic response during passive isovelocity knee movement was compared with knee angular velocity during fast walking, Gross Motor Function Measure (GMFM) scores, and Ashworth Scale score. RESULTS: Patients with measurable spasticity showed slower peak knee angular velocity during walking than patients without spasticity (P<.005). A significant correlation existed between spastic threshold velocity and peak knee angular velocity during fast walking (r=.85, P<.001). Spastic threshold velocity correlated significantly with GMFM (r=.58, P<.05) but not with Ashworth score. CONCLUSIONS: The velocity dependency of spasticity can be measured by electromyograph and dynamometer to determine spastic threshold velocity. Spastic threshold velocity correlated with limitations in joint angular velocity during walking and functional performance.

Adolescent↗

PubMed2003

Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs.

Understanding total knee replacement mechanics and their influence on patient mobility requires accurate analysis of knee joint kinematics and traditional full body kinematics and kinetics. Three-dimensional fluoroscopic and gait analysis techniques were carried out on patients with either mobile bearing or posterior stabilized knee prostheses during stair ascent. Statistically significant correlation was found between knee flexion at foot strike and the position of the mid-condylar contact points, and between maximum knee adduction moment and corresponding lateral trunk tilt. A more complete and powerful assessment of the functional performances of different TKR designs can be performed in-vivo by combining gait and fluoroscopic analyses.

Aged↗

PubMed2005

HO-1 induction in the guinea-pig stomach: protection of smooth muscle functional performance during cobalt-induced oxidative stress.

Distribution and enzymatic activity of haem oxygenase (HO) was investigated in the stomach of healthy guinea pigs or animals subjected to in vivo cobalt-induced oxidative stress. The physiological role of HO-1 and HO-2 isoenzymes in fundic and antral area of the stomach was assessed by studying the action of HO substrate--hemin--on ionic currents of single smooth muscle cells. The data obtained suggest that HO-1 induction might serve in the guinea-pig stomach as genetically determined defense mechanism aimed to combat toxic stress-related pathology in order to preserve the functional performance of the organ.

Animals↗

PubMed1992

Cellulose-based haemodialysis membranes: biocompatibility and functional performance compared.

Regenerated cellulose membranes are widely used in the treatment of renal failure. The presence of hydroxyl (OH) groups on the membrane surface plays an important role in initiating complement activation and also influences thrombogenicity. The OH groups may be masked or reduced by alteration of the manufacturing process of the membrane. We have undertaken a clinical study of four cellulose-based membranes (Cuprophan, Hemophan, cellulose acetate, and cellulose triacetate) in which the hydroxyl groups of the membrane have been replaced and the magnitude of replacement has varied from less than 1% to greater than 80%, to assess the role that these modifications play in functional performance, biocompatibility (neutropenia, leukocyte activation, anaphylatoxin generation, and hypoxaemia). Our findings indicate that there does not appear to be a straightforward correlation between the numbers of hydroxyl groups replaced and modification of biocompatibility, suggesting that not all hydroxyl groups behave in a similar way.

Cellulose↗

PubMed2004

Covariance PET patterns in early Alzheimer's disease and subjects with cognitive impairment but no dementia: utility in group discrimination and correlations with functional performance.

Although multivariate analytic techniques might identify diagnostic patterns that are not captured by univariate methods, they have rarely been used to study the neural correlates of Alzheimer's disease (AD) or cognitive impairment. Nonquantitative H2(15)O PET scans were acquired during rest in 17 probable AD subjects selected for mild severity [mean-modified Mini Mental Status Examination (mMMS) 46/57; SD 5.1], 16 control subjects (mMMS 54; SD 2.5) and 23 subjects with minimal to mild cognitive impairment but no dementia (mMMS 53; SD 2.8). Expert clinical reading had low success in discriminating AD and controls. There were no significant mean flow differences among groups in traditional univariate SPM Noxel-wise analyses or region of interest (ROI) analyses. A covariance pattern was identified whose mean expression was significantly higher in the AD as compared to controls (P = 0.03; sensitivity 76-94%; specificity 63-81%). Sites of increased concomitant flow included insula, cuneus, pulvinar, lingual, fusiform, superior occipital and parahippocampal gyri, whereas decreased concomitant flow was found in cingulate, inferior parietal lobule, middle and inferior frontal, supramarginal and precentral gyri. The covariance analysis-derived pattern was then prospectively applied to the cognitively impaired subjects: as compared to subjects with Clinical Dementia Rating (CDR) = 0, subjects with CDR = 0.5 had significantly higher mean covariance pattern expression (P = 0.009). Expression of this pattern correlated inversely with Selective Reminding Test total recall (r = -0.401, P = 0.002), delayed recall (r = -0.351, P = 0.008) and mMMS scores (r = -0.401, P = 0.002) in all three groups combined. We conclude that patients with AD may differentially express resting cerebral blood flow covariance patterns even at very early disease stages. Significant alterations in expression of resting flow covariance patterns occur even for subjects with cognitive impairment. Expression of covariance patterns correlates with cognitive and functional performance measures, holding promise for meaningful associations with underlying biopathological processes.

Aged↗

PubMed2003

Comprehensive isokinetic knee measurements and quadriceps tendon evaluations in footballers for assessing functional performance.

OBJECTIVES: To ascertain whether detailed isokinetic knee muscle testing reflects the results of other functional measurements in footballers and to look for any correlations between quadriceps tendon thickness and knee strength. METHODS: Ultrasonographic evaluation of the quadriceps tendon (Hitachi EUB-405), isokinetic knee testing (Biodex System 3), and sprint measurements using telemetric photoelectric cells (Chronometre Prosport ESC TX02) were carried out on 29 elite footballers. Jumping capacity was evaluated using Bosco's jumping mat (Ergojump). Anaerobic fitness was assessed by auricular capillary blood lactate measurements (YSI Model 1500 Sport Lactate Analyzer). RESULTS: Quadriceps tendon thickness correlated positively with jumping and sprint measurements and negatively with extensor and flexor strength. However, these correlations did not reach statistical significance. There were significant correlations between knee extensor strength at 60 degrees /s and jumping or sprint measurements and between the extension acceleration values of both knees during isokinetic tests at 240 degrees /s and the sprint measurements. No significant correlation was found between the fatigue ratio values of both knees at 240 degrees /s and the calculated fatigue ratios from the sprint measurements. CONCLUSIONS: Apart from a few variables which correlated with the performance tests, the isokinetic studies did not fully predict the various functional measurements. Neither was there any relation between the quadriceps tendon measurements and the knee strength values nor with the functional performance.

Adolescent↗

PubMed1996

Recombinant human erythropoietin: effect on the functional performance of anemic orthopedic patients.

OBJECTIVE: To determine whether rapid correction of anemia improves the functional and cognitive performance of postoperative orthopedic patients. DESIGN: A randomized, double-blind, placebo-controlled clinical trial. SETTING: A rehabilitation institute. PATIENTS: Persons having orthopedic surgery at least 2 weeks previously, and a hemoglobin concentration < 10g/dL. INTERVENTIONS: Recombinant human erythropoietin (rH-EPO) or the EPO vehicle for up to 8 weeks. All patients received ferrous sulfate. MEASUREMENTS: Blood counts were performed at weekly intervals, and functional and cognitive tests at baseline and weeks 4 and 8. RESULTS: In patients receiving vehicle only, hemoglobin levels increased from a mean of 9.0 at baseline to 11.0 at 4 weeks and 11.7 at 8 weeks; corresponding values for rH-EPO were 8.8 (p = NS), 12.6 (p = .02), and 13.5 (p = .01). However, functional improvement in dressing, toileting, and mobility was similar between groups, and the results of neuropsychological tests showed no trends favoring rH-EPO. CONCLUSIONS: Although hemoglobin increases more rapidly in anemic orthopedic patients treated with rH-EPO, equally rapid functional improvement occurs in those who receive only iron therapy.

Activities of Daily Living↗

PubMed2005

Functions performed by level of practice of registered dietitian members of the diabetes care and education dietetic practice group.

The purpose of this study was to examine current professional practices of registered dietitians (RDs) in the Diabetes Care and Education dietetic practice group (DPG), analyzed by levels of practice: entry-level, specialty-practice, or advanced-level. The results of the Diabetes Care and Education DPG 2002-2003 membership survey were used for this study. The study was limited to RD members of the Diabetes Care and Education DPG who completed the membership survey in its entirety. Frequency distributions, chi2, Fisher exact test, and cluster analysis were performed with a prior alpha set at .10. Sixty-one (5.0%) RDs were functioning as an entry-level practitioner, 851 (69.1%) were functioning as a specialty-practice practitioner, and 320 (25.1%) as an advanced-level practitioner. Significantly more advanced-level practitioners were performing more tasks compared with entry-level practitioners. Entry-level RDs performed a mean of 2.4 functions, specialty-practice practitioners performed 7.7, and advanced-level practitioners performed 11.6 functions. The results of this survey further delineated that RDs function at various levels of practice and that credentials for RDs increased as level of practice advanced.

Chi-Square Distribution↗

PubMed1999

Association between executive attention and physical functional performance in community-dwelling older women.

OBJECTIVES: Executive functions supervise the contents of working memory, where information from long-term memory is integrated with information in the immediate present. This study examined whether executive attentional abilities were uniquely associated with the performance of complex, instrumental activities of daily living (IADLs) in cognitively intact and physically high-functioning older women. METHODS: Participants were 406 community-residing, older women aged 70-80 years in the Women's Health and Aging Study (WHAS) II, screened to be physically high functioning and cognitively intact using the Mini-Mental State Exam. Hierarchical regression models, adjusted for demographic and disease variables, were used to evaluate the association of cognitive domains, including executive attention, memory, psychomotor speed, and spatial ability with summary measures of IADL (e.g., looking up and dialing a telephone number) and mobility-based ADL (e.g., walking 4 meters) function. RESULTS: Tests of executive attention were associated with performance on IADLs (6.6%) and, to a lesser degree, mobility-based ADLs (1%), adjusting for demographic and disease variables. In particular, the mental flexibility component of the Trail Making Test accounted for the majority of attentional variance in IADL performance. Older age, lower education, and African American race were also associated with poorer physical test performances. DISCUSSION: Executive difficulties in flexibly planning and initiating a course of action were selectively associated with slower performance of higher-order IADL tests, relative to other domains of cognition, in a high-functioning, community-based older cohort. These results suggest that executive functions may be important in mediating the onset and progression of physical functional declines.

Activities of Daily Living↗

PubMedDate not supplied

How do American stroke risk functions perform in a Western European population?

OBJECTIVES: We evaluated the predictive performance of the stroke risk functions from the Framingham and the Cardiovascular Health Study in a population-based study in The Netherlands. METHODS: We assessed how well the functions could estimate the number of strokes in the Rotterdam Study, and how well they could discriminate between high- and low-risk persons. RESULTS: Both functions predicted the number of stroke cases reasonably well, except in persons with a predicted 5-year risk higher than 5%, where they overestimated the risk. The area under the receiver operator characteristic curve was 0.75 (95% confidence interval, 0.71-0.78) for both functions. CONCLUSIONS: Stroke risk functions developed in US populations predict the number of strokes reasonably well in elderly Western European persons at low or modest risk for stroke. The functions can be a useful tool to discriminate between persons at high or low risk for stroke.

Aged↗

PubMed1999

Nitecapone inhibits myeloperoxidase in vitro and enhances functional performance after 8 h of ischemia in experimental heart transplantation.

Nitecapone (NC) has been shown to have beneficial effects on the functional recovery of rat hearts in Langendorff-preparation. The present study was executed to evaluate the effect of NC on preservation of grafts in heart transplantation and the role of NC in the inhibition of granulocyte infiltration. Donor hearts were perfused and stored at +4 degrees C for 8 h in either Ringer solution in the control-group (C-group, n = 26) or in NC (50 microM) added Ringer solution (NC-group, n = 18). The heterotopic heart transplantation was performed. The rats in both groups were killed at either 10 min or 60 min after release of the aortic clamp and tissue samples were obtained for antioxidative capacity, myeloperoxidase activity, and lipid peroxidation measurements. In vitro studies were performed using sodium azide or nitecapone to inhibit myeloperoxidase (MPO) activity of isolated human leukocytes. A total of 61% of the grafts began to beat in the NC-group, compared to 46% in the control group. Using an arbitrary scale of functional performance, only 33% (4/12) of the grafts were classified as well functioning in the control group, compared to 82% (9/11) in the NC-group (P<0.05). MPO activity was equal in both groups after 10 min but significantly lower after 60 min in the NC-group as compared to the control group (P<0.05). In vitro studies demonstrated that NC inhibits 50% of purified MPO activity at a concentration of 10 microM. NC did not significantly affect lipid peroxidation or the preservation of endogenous antioxidants. Since NC inhibited myeloperoxidase both in vitro and in vivo, it seems that the positive effects of NC on graft preservation may be mediated via the inhibition of granulocyte infiltration.

Animals↗

PubMed1999

Exercise: effects on physical functional performance in independent older adults.

BACKGROUND: Age-related loss in physiologic capacities contributes to the decline in physical function in the elderly population. Despite the beneficial effects of exercise interventions on maximal physiologic capacity measures, the functional benefits have not been shown in independently living older adults. The objective of this study was to evaluate exercise in independent older adults for significant and meaningful improvements in physical function, not detected by commonly used measures of physical function. METHODS: In a randomized controlled study, 49 independently living men and women were assigned to either a nonexercise control group (Control; n = 26) or an exercise training group (Exercise; n = 23). Participants (age = 76+/-4) in good general health were recruited from retirement communities or apartments. The combined endurance and strength training was performed at 75% to 80% intensity; the groups met 3 times/week for 6 months of supervised sessions. Outcome measures included physical capacity, health status, and physical function using a newly developed performance test--the Continuous Scale-Physical Functional Performance test (CS-PFP). RESULTS: Compared to the Control group, the Exercise group showed significant increases in maximal oxygen consumption (11%) and muscle strength (33%). No significant differences were found between groups for changes in the Sickness Impact Profile, SF-36 scales, or the 6-minute walk. However, the CS-PFP score improved significantly in the Exercise group (14%, effect size 0.80). CONCLUSIONS: Independent older adults gain meaningful functional benefits from several months of exercise training. The public health importance of physical activity may relate not just to its role in preventing decline, but also to its role in enhancing physical function.

Activities of Daily Living↗

PubMed2005

Disability and walking capacity in patients with lumbar spinal stenosis: association with sensorimotor function, balance, and functional performance.

STUDY DESIGN: One-group, prospective, cross-sectional study. OBJECTIVES: To determine how sensorimotor function, balance, and physical performance are associated with disability and walking capacity in patients with lumbar spinal stenosis. BACKGROUND: Disability and limited walking capacity are often reported by patients with lumbar spinal stenosis. Identification of associated factors could provide information for future investigations leading to better prevention and intervention strategies. METHODS AND MEASURES: Fifty patients with lumbar spinal stenosis answered questions regarding symptom intensity, disability, and walking capacity. Muscle strength and vibration sense were assessed to represent sensorimotor function. Balance ability was measured by single-leg stance time and basic physical performance was tested by the up-and-go (UG) test. Regression analyses, entering demographics and symptom intensity as control variables, and sensory, strength, balance, and physical performance as additional independent variables, were conducted separately for disability and walking capacity. RESULTS: Symptom intensity, vibration sense at the big toe, and UG test time were significantly correlated with disability. The final regression model showed that the control variables explained 20% of the variance, while vibration sense and UG test time explained an additional 20% of the variance. Walking capacity was significantly correlated with vibration sense at the big toe and UG test time. No significant regression model emerged for walking capacity. CONCLUSIONS: A moderate amount of variance in disability could be explained by sensory function at the big toe and physical performance. These factors should be considered in future research.

Aged↗

PubMed1989

Hash function performance on different biological databases.

Open hashing is used to demonstrate the effectiveness of several hashing functions for the uniform distribution of biological records. The three types of database tested include (1) genetic nomenclature, mutation sites and strain names, (2) surnames extracted from literature files and (3) a set of 1000 numeric ASCII strings. Several hash functions (hashpjw, hashcrc and hashquad) showed considerable versatility on all data sets examined while two hash functions, hashsum and hashsmc, performed poorly, on the same databases.

Clinical Laboratory Information Systems↗