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Representational plasticity in cortical area 3b paralleling tactual-motor skill acquisition in adult monkeys.

The representations of the surfaces of the hand in the primary somatosensory cortical field, area 3b, were reconstructed in detail in seven owl monkeys and two squirrel monkeys trained to pick up food pellets from five wells of different sizes. From an early clumsy performance in which several to many retrieval attempts were required for each successful pellet retrieval, the monkeys exhibited a gradual improvement in digital dexterity as shown by significant decreases in mean numbers of grasp attempts/successful retrieval and corresponding standard deviations (e.g. 5.8 +/- 4.5 and 4.8 +/- 3.1 respectively, for the smallest well) between the first and last training sessions. All monkeys commonly used alternative, specific retrieval strategies involving various combinations of digits for significant time epochs before developing a highly successful strategy, which, once achieved, was rapidly stereotyped. For example, the numbers of digit combinations used during the first five versus the last five training sessions decreased from 3.3 +/- 0.7 to 1.8 +/- 0.6 for the smallest well. In both owl and squirrel monkeys, as the behavior came to be stereotyped, monkeys reliably engaged limited surfaces of the glabrous tips of two digits (in eight monkeys), or of three digits (in one monkey) in the palpation and manipulation of these small pellets for their location, capture, and transportation to the mouth. In cortical area 3b, the magnification of representation of these differentially engaged glabrous fingertip surfaces was nearly 2x larger than for the corresponding surfaces of other hand digits, or for the contralateral cortical representations of the same digit surfaces on the opposite hand. In parallel, cutaneous receptive field for area 3b neurons representing crucial digital tip surfaces were less than half as large as were those representing the corresponding surfaces of control digits. Receptive field overlaps were smaller on the trained fingertips than on control fingers. Moreover, the proportion of small overlaps was greater for the trained digits (76 +/- 7%) than for the other digits of the same hand (49 +/- 5.4%). There was still a simple, single--but apparently topologically expanded--representation of these differentially engaged skin surfaces in these monkeys. Thus, with very limited manual exercise over a total period of a few hours of practice at a skill played out in brief daily sessions over a several week long training period, the representations of skin surfaces providing information crucial for successfully performing a small-object retrieval behavior appeared to be substantially remodeled in the most 'primary' of the SI somatosensory cortical fields, cortical area 3b. By that remodeling, behaviorally important skin surfaces were represented in a much finer representational grain than normal. Some implications of these findings for motor skill acquisition are discussed.

Animals↗

Behavioral and psychosocial predictors of physical performance: MacArthur studies of successful aging.

BACKGROUND: Performance-based measures of physical performance are examined for an older cohort of relatively high-functioning men and women. The influences of baseline behavioral, social, and psychological characteristics on patterns of change in performance over 2.5 years are examined. METHODS: A cohort of relatively high-functioning men and women, aged 70-79, identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline assessments included physical performance, sociodemographic characteristics, health status, and behavioral, social, and psychological characteristics. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. RESULTS: Linear regression models were used to identify significant behavioral, social, and psychological predictors of better performance at follow-up, controlling for known sociodemographic and health status predictors. Significant, independent associations with better performance were found for participation in moderate and/or strenuous exercise activity and greater frequency of emotional support from social networks, particularly among those reporting low frequency of instrumental support. These effects remained significant independent of incident health conditions during follow-up. None of the psychological characteristics was a significant predictor. CONCLUSIONS: Maintenance of better physical performance within a high-functioning cohort is influenced by prior exercise behavior and social network emotional support. Observed patterns of both decline and improvement in performance suggest that older age is not uniformly associated with declines. Predictors of better performance identified here may offer potential for effective interventions to promote more successful aging.

Aged↗

The aging hand.

Hand function decreases with age in both men and women, especially after the age of 65 years. A review is presented of anatomical and physiological changes in the aging hand. The age-related changes in prehension patterns (grip and pinch strength) and hand dexterity in the elderly population are considered. Deterioration in hand function in the elderly population is, to a large degree, secondary to age-related degenerative changes in the musculoskeletal, vascular, and nervous systems. Deterioration of hand function in elderly adults is a combination of local structural changes (joints, muscle, tendon, bone, nerve and receptors, blood supply, skin, and fingernails) and more distant changes in neural control. These age-related changes are often accompanied by underlying pathological conditions (osteoporosis, osteoarthritis, rheumatic arthritis, and Parkinson's disease) that are common in the elderly population. Assessment of hand function and prehension patterns is needed in order to determine specific treatment approaches.

Activities of Daily Living↗

Patterns of motor impairement in normal aging, mild cognitive decline, and early Alzheimer's disease.

In order to determine the relationship between cognitive dysfunction and motor behavior in older adults, 41 cognitively normal elderly (NL), 25 cases exhibiting mild cognitive impairment (MI), and 25 patients with mild Alzheimer's disease (AD) were examined using a broad array to motor/psychomotor and cognitive tests. Relative to the NL group, MI individuals (at risk for future decline to AD) performed worse on tasks involving fine and complex motor function (e.g., tracking and manual dexterity). AD patients also exhibited motor dysfunction on tasks assessing relatively more rudimentary motor control. Motor tasks were able to distinguish NL vs MI and NL vs mild AD individuals as effectively as cognitive tests of memory and language. These results indicate that motor impairment is an important aspect of cognitive decline in older adults. Motor/psychomotor assessments may be comparably sensitive to traditional tests of cognitive function in identifying persons affected by the earliest stages of AD pathology.

Age Factors↗

Relations of age and personality dimensions to cognitive ability factors.

The relation between three cognitive ability factors - Information Processing Ability (IPA), Manual Dexterity (MD), and Pattern Analysis Capability (PAC) - and three personality dimensions - Anxiety, Extraversion, and Openness to Experience - were examined in three age groups. Subjects were 969 male volunteers ranging in age from 25 to 82. Subjects high in anixety scored lower on all three cognitive factors; subjects open to experience scored higher on IPA and PAC; and introverted subjects scored higher on PAC. Most of these effects remained when the education and socio-economic status were held constant in covariance analyses. Older subjects performed less well than younger ones on MD and PAC, but not on IPA. While personality has some influence on cognitive performance, the declines with age in performance on some cognitive tasks are not mediated by personality.

Adult↗

Rhythmic vs homeostatic influences on mood, activation, and performance in young and old men.

Nine healthy old (80+ years) men were compared with nine healthy young (20-30 years) men in a protocol that required 36 hours of continuous wakeful bedrest. Body temperature rhythm measurement confirmed that the old had as robust an endogenous circadian (approximately 24 hours) rhythm generation mechanism as the young. However, in measures of affect, activation, visual search speed, verbal reasoning speed, manual dexterity, and vigilance hit rate, the old showed a linear decline over the 36 hours of the vigil, with little of the superimposed 24-hour rhythmicity that was apparent in the young. Thus, separate from the endogenous rhythm generation processes, there appeared to be some attenuation with advanced age, which led to the relative absence of rhythmic expression in these mood and performance variables. Such attenuation might contribute to some of the sleep and performance problems reported by elderly adults.

Adult↗

Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging.

BACKGROUND: Performance-based measures of physical performance were examined for an older cohort of relatively high-functioning men and women. Relationships between baseline physical performance and sociodemographic and health status characteristics were also examined. Three-year pattern changes in performance are described, and sociodemographic and health status predictors of change are investigated. METHODS: A cohort of relatively high-functioning men and women, aged 70-79, was identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline in-home assessments included tests of physical performance and measurement of sociodemographic characteristics and health status. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. RESULTS: Better physical performance at baseline was more common among males, Whites, those reporting higher income and education, and those with fewer chronic conditions. In linear regression models, declines in performance were predicted by older age, lower income, higher education, relative weight and blood pressure, lower peak expiratory flow, prevalent diabetes and incident health conditions and hospitalizations during follow-up. Improvements in performance were also observed; the only significant association was with race (i.e., being Black). CONCLUSIONS: Declines in physical performance within a high-functioning cohort are predictable from sociodemographic and health status characteristics. The patterns of both decline and improvement in performance observed in this cohort suggest that older age is not uniformly associated with declines, indicating the potential for effective interventions to promote more successful aging.

Activities of Daily Living↗

Satisfaction with quality and access to health care among people with disabling conditions.

OBJECTIVE: To compare satisfaction with health care between persons with and without disabling conditions. DESIGN: Responses to 1996 Medicare Current Beneficiary Survey. SETTING: Nationally representative of the United States population. STUDY PARTICIPANTS: Community-dwelling Medicare beneficiaries, older and younger than 65 years (n = 16 403). MAIN OUTCOME MEASURE: Adjusted odds of being dissatisfied or very dissatisfied with five general quality measures and five access-to-care measures by five disabling conditions (blind or low vision, deaf or hard of hearing, difficulty walking, difficulty reaching, manual dexterity difficulties). Multivariable logistic regressions on dissatisfaction adjusted for age group, sex, disabling condition, race, ethnicity, urban versus rural residence, education, household income < $25 000 versus > or = $25 000, having a usual source of care, proxy respondent, and managed care. RESULTS: Of an estimated 33.58 million non-institutionalized Medicare beneficiaries, 64.1% (estimated 21.51 million) reported at least one disabling condition. Among younger beneficiaries, 10.4% with any major disability were dissatisfied with their care overall, as were 4.6% without disabilities. Nevertheless, persons with disabilities generally had significantly higher adjusted odds of dissatisfaction. For elderly persons with any major disability, the adjusted odds ratios (95% confidence interval) of dissatisfaction were: 3.2 (2.4-4.3) for overall quality; 3.2 (2.2-4.6) for access to specialists; 4.4 (3.1-6.4) for follow-up; and 4.2 (3.1-5.7) for ease of getting to doctors. Elderly managed care enrollees were less satisfied with access to specialists, but more satisfied with costs. CONCLUSION: The quality domains generating the greatest dissatisfaction were anticipated, given the nature of disabling conditions. Improving these areas requires attention inside and outside the health care system. Redesigning practice settings and procedures, and changing payment policies offer the only solutions to some problems.

Adolescent↗

The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial.

OBJECTIVES: The purpose of this study is to determine whether a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling could improve behavioural change, physical fitness, physiological condition and health-related quality of life of sedentary haemodialysis patients in The Netherlands. METHODS: Ninety-six haemodialysis patients of the Groningen Dialysis Center were randomized into an exercise group (n = 53) and a control group (n = 43). The exercise programme consists of cycling during dialysis together with a pre-dialysis strength training programme lasting 12 weeks. The intensity of the exercise programme is condition level 12-16 according to the rate of perceived exertion (RPE). Motivational interviewing techniques were used for exercise counselling. Before and after the intervention, both groups were tested on behavioural change and physical fitness components such as reaction time, manual dexterity, lower extremity muscle strength and VO2 peak. Physiological conditions such as weight, blood pressure, haemoglobin and haematocrit values, cholesterol and Kt/V were obtained from the medical records. Health-related quality of life assessment included RAND-36 scores, symptoms and depression. RESULTS: A group x time analysis with MANOVA (repeated measures) demonstrates that participation in a low-to-moderate intensity exercise programme linked with exercise counselling yields a significant increase in behavioural change, reaction time, lower extremity muscle strength, Kt/V and three components of quality of life, and no significant effects in the control group. CONCLUSION: Participating in a low-to-moderate intensity pre-conditioning exercise programme showed beneficial effects on behavioural change, physical fitness, physiological conditions and health-related quality of life.

Adult↗

Upper limb disability in HAVS cases--how does it relate to the neurosensory or vascular elements of HAVS?

AIMS: Hand-arm vibration syndrome (HAVS) consists of vascular, neurosensory and musculoskeletal components, characterized by symptoms that include Raynaud's phenomenon, tingling and numbness in the hands. However, there has been little published data on the effects of HAVS on the capability to carry out normal daily tasks. We have investigated the application of the widely-used disability, arm, shoulder and hand (DASH) disability questionnaire that reflects functionality problems in the upper extremities, as well as symptoms, in a HAVS cohort. METHODS: The cohort consisted of 118 males who, as a part of their health surveillance, had been referred for further assessment and Stockholm workshop staging. This process involved medical interview, physical examination and quantitative tests covering neurosensory function, manual dexterity and handgrip strength. RESULTS: The relationship between DASH outcome metric and a combination of quantitative tests reflecting a range of abnormalities found in HAVS, supports the validity of this questionnaire in HAVS studies. The data suggest that HAVS cases have a greater level of upper extremity disability compared with a general population. The study confirms that disability in HAVS is very largely related to sensorineural Stockholm workshop staging, rather than vascular staging. Any influence of vibration-induced Raynaud's phenomenon on upper extremity disability is related to the frequency of blanching attacks rather than their extent across the digits. CONCLUSION: This study strengthens the importance of identifying and preventing the exacerbation of the neurosenory component of HAVS, that unlike the blanching attacks of the vascular component does not have such an obvious pathognomic signal.

Adult↗

Hand-arm vibration syndrome in South African gold miners.

BACKGROUND: Hand-arm vibration syndrome (HAVS) is associated with the use of hand-held vibrating tools. Affected workers may experience symptoms of tingling, numbness, loss of grip strength and pain. Loss of dexterity may impair everyday activities, and potentially increase the risk of occupational accidents. Although high vibration levels (up to 31 m/s(2)) have been measured in association with rock drills, HAVS has not been scientifically evaluated in the South African mining industry. AIMS: The aim of this study was to determine the prevalence and severity of HAVS in South African gold miners, and to identify the tools responsible. METHODS: A cross-sectional study was conducted in a single South African gold-mine. Participants were randomly selected from mineworkers returning from annual leave, comprising 156 subjects with occupational exposure to vibration, and 140 workers with no exposure. Miners who consented to participate underwent a clinical HAVS assessment following the UK Health and Safety Laboratory protocol. RESULTS: The prevalence of HAVS in vibration-exposed gold miners was 15%, with a mean latent period of 5.6 years. Among the non-exposed comparison group, 5% had signs and symptoms indistinguishable from HAVS. This difference was statistically significant (P < 0.05). All the cases of HAVS gave a history of exposure to rock drills. CONCLUSIONS: The study has diagnosed the first cases of HAVS in the South African mining industry. The prevalence of HAVS was lower than expected, and possible explanations for this may include a survivor population, and lack of vascular symptom reporting due to warm-ambient temperatures.

Adult↗

Decrements in neurobehavioral performance associated with mixed exposure to organic and inorganic lead.

In 1990, 222 current employees of a chemical facility in the eastern United States that manufactured tetraethyl lead were administered a neurobehavioral test battery, tests of olfactory function and peripheral vibration threshold, and questionnaires that assessed neuropsychiatric symptoms. A cumulative variable of exposure to inorganic and organic lead was derived from 12 years of personal industrial hygiene sampling data and an occupational history interview that assessed work in each of 29 exposure zones in the lead area. The range of assigned exposure intensities in these 29 zones was 4-119 micrograms/m3 for organic lead and 1-56 micrograms/m3 for inorganic lead. Cumulative lead exposure and exposure duration were defined as categorical variables (four groups) in multiple linear regression models. The adjusted mean differences in neurobehavioral test scores were estimated by comparing the average scores of the moderate, high, and highest exposure groups with the low exposure (reference) group. After adjustment for premorbid intellectual ability, age, race, and alcohol consumption, neurobehavioral test scores were poorer as measures of both cumulative lead exposure and exposure duration increased; many of the associations evidenced dose-response relations. Associations were observed in most cognitive and functional domains tested, but were most common in two domains: manual dexterity and verbal memory/learning. On the affected neuropsychologic measures, the groups with the highest exposure averaged scores 5-22% lower than those of the reference groups. Overall, the data revealed generally consistent and coherent associations between two measures of lead exposure and poorer neurobehavioral test performance.

Adult↗

Echocardiographic evaluation of the dimensions and systolic properties of the left ventricle in freshman athletes during physical training.

The purpose of the study was to evaluate the early anatomic and functional changes of the left ventricles in junior freshman non-professional athletes just beginning specific regular training programs for 6 different types of sport. Forty-nine males (mean age 20 +/- 6 years) and 9 sedentary controls were studied by means of sequential M-mode echocardiograms, before and after a 10 to 12 week training period: 13 athletes started bicycle-riding (aerobic category), 6 sprint (anaerobic category), 6 weight-lifting (strength category), 13 soccer (mixed category), 11 rifle-shooting (manual dexterity category). Resting heart rate, blood pressure, left ventricular diameter (LVID), left ventricular posterior wall and interventricular septum thickness (LVPWT, IVST), left ventricular mass (LVMI), relative wall thickness (h/r ratio) and fractional shortening (FS%) of the LVID, cardiac index (CI) and stroke volume (SV) were comparable in all groups initially. After the training period, the cyclists, the sprinters and the soccer-players showed an increased LVID, LVMI and FS%. The cyclists and the soccer players also showed a decreased h/r ratio. The weight-lifters showed a slight increase of their LVMI, with an increased h/r ratio. We have, thus, documented that even after a relatively short non-strenuous training period, specific anatomical and functional changes occurred in the hearts of young athletes practising sports for recreational purposes, according to the type of sport.

Adolescent↗

Performance of retarded children, with and without Down syndrome, on the Bruininks Oseretsky Test of Motor Proficiency.

The purpose of this study was to examine the gross motor and fine motor abilities of children with mental retardation using the Bruininks Oseretsky Test of Motor Proficiency. We compared the motor skills of 24 mentally retarded children, 12 with Down syndrome and 12 without Down syndrome. The children ranged in chronological age from 7.6 years to 11 years and were of comparable mental age. Within each group, there were no significant sex differences nor were there differences between the two groups in motor performance for the male subjects. The female subjects with Down syndrome, however, scored significantly lower than female subjects without Down syndrome on running speed, strength, visual motor ability, speed, and dexterity and fine motor composite scores. As a group, the children with Down syndrome scored significantly lower than the children without Down syndrome in the areas of running speed, balance, strength, and visual motor control. The gross motor and fine motor skill composite scores were also significantly lower for the children with Down syndrome than for the children without Down syndrome.

Child↗

Computerized system for quantitative measurement of sensorimotor aspects of human performance.

The purpose of this article is to describe an integrated system for measuring selected aspects of human sensorimotor performance. The system consists of a computerized test battery, a database, and multiple software packages to present results for different applications. The system includes measures classified into major functional categories including sensation, range of motion, isometric muscle strength, anthropometric features, speed, reactions, muscle tone, coordination, body stability, and manual dexterity. A microcomputer is used to coordinate basic measurements obtained from a series of short-duration tests. Raw data are recorded in physical units (eg, degrees, milliseconds). A database currently consisting of over 2,000 data records of normal sensorimotor performance has been collected, permitting immediate comparison of patient data to a group of age- and sex-matched norms. This system permits an objective, reliable, and standardized method for measuring selected aspects of sensorimotor performance essential for physical therapists to quantify individual patient performance, document disability, justify reimbursement, screen employees and athletes, and demonstrate efficacy of treatment.

Activities of Daily Living↗

Evaluating the hand: issues in reliability and validity.

Evaluation of hand function is a qualitative and quantitative process. This article provides a review of several quantitative tests and measures used to evaluate range of motion, edema, muscle performance, sensation, dexterity, and physical capacity. The validity and reliability of these instruments are emphasized. Some of the hand assessments reviewed are in the early developmental phase with further refinements yet to come. This article demonstrates the continued need to provide support for the validity and reliability of hand-assessment instrumentation. Regardless of the statistical support provided, however, the authors believe that hand therapy will remain an art as well as a science.

Edema↗

Objective evaluation of hand function in scleroderma patients to assess effectiveness of physical therapy.

A system was developed to evaluate the hand function of patients with scleroderma objectively in terms of joint contracture, range of movement, dexterity, strength, and skin compliance. Twelve patients with progressive systemic sclerosis were evaluated using this technique to determine the effectiveness of classic physical therapy methods. A statistically significant improvement in hand function was found after a single physical therapy treatment. This conservative mode of treatment may contribute to improved hand function in patients with scleroderma.

Biomechanical Phenomena↗

Economics of anesthetic practice.

Anesthesiologists, like all other specialists, need to examine carefully their clinical practices so that excessive costs and waste can be reduced without compromising patient care or safety. While costs of drugs used for anesthesia constitute only a small fraction of total health care cost, they are highly visible costs which are easy for administrators to scrutinize. Although cost savings in an individual case may be small, the total savings may be impressive because of the large volume of cases performed. In a recent analysis of strategies to decrease PACU costs, Dexter and Tinker found that anesthesiologists have "little control over PACU economics via the choice of anesthetic drugs". Greater savings could be achieved by timing the arrival of patients into the PACU to reduce the peak requirement of nursing personnel. Hospital and operating room management would be better served by concentrating on these simple measures to improve efficiency rather than forcing anesthesiologists to base drug usage on acquisition costs. Even in countries that have nationalized health services, salaries make up the largest part of the costs, and the expenses in delaying an operation by 30 min exceeds the costs of a 2 h propofol infusion. It is becoming increasingly apparent that attempts at better scheduling of cases, more efficient processing of patients in the PACU to optimize admission rates, and reduced wastage of anesthetic and surgical supplies lead to greater savings than reducing anesthetic-related drug costs. Nevertheless, it is still important for anesthesiologists to participate in the ongoing effort to reduce medical costs without affecting the quality of patient care. Quality care and fiscally sound decision-making are not necessarily mutually exclusive. Simple, effective cost containment measures that all anesthesiologists can practice include using low fresh gas flow rates with inhalation agents and opening sterile packages and drug ampules only if the contents will be used. The choice of an anesthetic agent for routine use depends not only on its demonstrated efficacy and side effect profile, but also on economic factors. It is important to perform careful pharmacoeconomic evaluations of these newer drugs, including assessing all associated costs and benefits for subsets of patients undergoing different types of surgical procedures. These evaluations should also include input from patients regarding their personal preferences. Excessive emphasis on the acquisition costs of drugs may lead to blanket bans on the use of new drugs because of their higher costs rather than permitting physicians to individualize therapy according to their clinical experience and the perceived needs of a given patient. Institutional and individual variations in clinical practices, their associated costs and outcomes may alter conclusions about acceptability and economic evaluation of a particular drug or technique. The information in this review can be used to provide a rational basis for incorporating cost considerations into the decision-making process regarding the drugs, devices and techniques used in anesthesiology.

Anesthesiology↗