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Biomedical subjects

A Delitto

Publications and source records attributed to A Delitto.

At least 37 records · Page 2Linked to original sources
PubMed1994

Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Electrical stimulation has been shown to be effective in aiding the recovery of quadriceps femoris muscle force production after anterior cruciate ligament reconstruction. The actual dosage of stimulation (training intensity) has not been well described. The purpose of this investigation was to establish a dose-response curve for electrical stimulation regimens designed to improve quadriceps femoris muscle recovery in patients after anterior cruciate ligament reconstruction. SUBJECTS AND METHODS: We analyzed data from a subsample (n = 52) of patients receiving electrical stimulation (N = 110) who were involved in a large, multicenter randomized clinical trial investigating treatment strategies designed to enhance quadriceps femoris muscle recovery. Fifty-two subjects (40 male, 12 female), with an age range of 15 to 43 years (mean = 25, SD = 7), participated in 4 weeks of quadriceps femoris muscle training using either portable, battery-powered home stimulators or console stimulators designed for clinical use. Training intensities were monitored by logging the electrically elicited knee extension torque and expressing this torque as a percentage of the uninvolved quadriceps femoris muscles' maximal voluntary contraction force. After the 4 weeks of training, isometric muscle torque was assessed and a dose-response curve was generated. The relationship between training intensity and quadriceps femoris muscle torque was assessed with Pearson Product-Moment Correlation Coefficients. RESULTS: A significant, linear correlation was found between training intensity and quadriceps femoris muscle torque. Subjects training with console, clinical generators trained at higher intensities than those training with portable, battery-operated generators; such training resulted in higher quadriceps femoris muscle torque. CONCLUSION AND DISCUSSION: These results support the use of high-intensity electrical stimulation and do not support the use of low-intensity or battery-powered stimulators when the goal is recovery of quadriceps femoris muscle force production in the early phases of rehabilitation after anterior cruciate ligament surgery. [Snyder-Mackler L, Delitto A, Stralka SW, Bailey SL. Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction.

Adolescent↗
PubMed1994

Quadriceps femoris muscle resistance to fatigue using an electrically elicited fatigue test following intense endurance exercise training.

BACKGROUND AND PURPOSE: Electrical stimulation has been used to assess skeletal muscle resistance to fatigue. The purpose of this study was to test the hypothesis that 12 weeks of intense endurance exercise training on a bicycle ergometer would reduce the percentage of decline in quadriceps femoris muscle torque during an electrically elicited fatigue test. SUBJECTS AND METHODS: Eleven nondisabled subjects performed 12 weeks of high-intensity endurance exercise training, and 6 subjects served as controls and did not exercise. Two electrically elicited fatigue tests, one with and one without prior voluntary fatiguing exercise, were administered to each subject before and after the 12-week training period. RESULTS: The percentage of decline in peak torque of the quadriceps femoris muscle over 50 electrically elicited muscle contractions did not change as a result of endurance exercise training, despite significant improvements in maximal oxygen consumption and quadriceps femoris muscle endurance. The recovery of maximal isometric torque immediately after exhausting voluntary exercise followed by electrical stimulation was significantly greater after 12 weeks of intense exercise training. CONCLUSION AND DISCUSSION: The percentage of decline in peak torque during an electrically elicited fatigue test does not detect improvements in quadriceps femoris muscle endurance induced by endurance exercise training. The percentage of initial torque recovered immediately after fatiguing exercise, however, is improved by endurance training. [Sinacore Dr, Jacobson RB, Delitto A. Quadriceps femoris muscle resistance to fatigue using an electrically elicited fatigue test following intense endurance exercise training.

Adult↗
PubMed1994

Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome.

BACKGROUND AND PURPOSE: The relative effectiveness of an extension program and a manipulation program with flexion and extension exercises was examined in patients with low back syndrome. SUBJECTS: Forty-nine patients with less than a 3-month history of low back pain were seen at physical therapy clinics in western Pennsylvania, southern Mississippi, and eastern Missouri during a 6-month period. Twenty-seven of the 49 patients were classified a priori into a treatment-oriented category of extension/mobilization and were then randomly assigned to participate in an extension program or a program of manipulation followed by hand-heel rocks (flexion and extension). Two patients dropped out of the study (1 patient returned to work, and the other patient was unable to comply with the treatment schedule), and 1 patient was eliminated from the study because of magnified illness behavior. The remaining 24 patients (15 male, 9 female; mean age = 44 years, SD = 15, range = 14-73) were assigned randomly and equally to the two groups. Eight physical therapists participated in the study. METHODS: A randomized clinical trial comparing the two regimens was conducted for a 1-week period. Outcome was assessed using an Oswestry Low Back Pain Questionnaire initially (before treatment) and at 3 and 5 days posttreatment, and data were analyzed using a 2 x 3 (group x time) analysis of variance. RESULTS: A significant interaction of the group and time variables was demonstrated, indicating that the rate of positive response was greater in the manipulation/hand-heel rock group than in the extension group. CONCLUSION AND DISCUSSION: In this category of patients with low back pain, the use of manipulation as an adjunct to an ongoing exercise program appears to be warranted.

Acute Disease↗
PubMed1994

Recovery from a 1-minute bout of fatiguing exercise: characteristics, reliability, and responsiveness.

BACKGROUND AND PURPOSE: The purposes of this study were (1) to describe the characteristics of recovery of peak torque after a 1-minute bout of isokinetic exercise of the quadriceps femoris muscle, (2) to determine the short-term reliability of the recovery of peak torque, and (3) to determine whether the recovery of peak torque more closely associates with maximal endurance exercise capacity than does the decline in peak torque at the end of the fatigue test. SUBJECTS: Thirty-three nondisabled subjects, ranging in age from 23 to 34 years (X = 27, SD = 3.4), participated in the reliability portion (phase 1) of the study. A different group of 21 nondisabled subjects, ranging in age from 21 to 47 years (X = 27.5, SD = 5.2), participated in the correlational portion (phase 2) of the study. METHODS: The short-term reliability of percentage of decline in peak torque and recovery of peak torque was assessed in phase 1. Each subject performed two quadriceps femoris muscle fatigue tests (test-retest) on an isokinetic dynamometer. In phase 2, each subject performed a single fatigue test and a test of maximal oxygen uptake (VO2max) to examine the relationships between VO2max and percentage of decline in peak torque at the end of the fatigue test and recovery of peak torque. RESULTS: Intraclass correlation coefficient values at every 30-second interval during recovery were acceptable (ICC = .67-.87), indicating recovery of peak torque is a consistent measure of quadriceps femoris muscle performance. A high negative correlation (r = -.84) was found between the percentage of decline at 30 seconds of recovery and VO2max, but a lower negative correlation (r = -.48) was found between the percentage of decline in torque at the end of the fatigue test and VO2max. CONCLUSION AND DISCUSSION: These results suggest recovery of peak torque is a reliable measure of muscle performance and closely associates with maximal aerobic exercise capacity.

Adult↗
PubMed1994

Are measures of function and disability important in low back care?

Currently, disablement due to low back syndrome (LBS) inflicts an extremely high cost to society, with yearly direct and indirect costs estimated in the billions of dollars. Patients with LBS often present a challenge for physical therapists trained in the evaluation of the physical nature of LBS. The psychosocial nature of a patient's complaint and the use of measures obtained from evaluation to guide patient management sometimes require interaction in a multidisciplinary environment. In this article, LBS will be discussed within the frameworks of Nagi's disablement pathway and an illness model described by Waddell. Both models suggest that to adequately treat LBS requires evaluation of the impairment, functional limitations, and disability using tools with adequate measurement characteristics. This article will focus on impairments and patient self-reports of quality of life and will discuss the relationship between impairments, functional limitations, and disability in LBS. Standardized quality of life measures are easily administered in everyday clinical settings and capture the patient's perceptions of the functional limitations and disability seen with LBS. Common self-reports are reviewed, and potential barriers to their use are discussed. Lacking an identifiable disease process in the majority of cases of LBS leaves most clinicians to deal with the impairments, functional limitations, and resultant disability. Physical therapists should, therefore, measure and gauge changes in all of these dimensions. To accomplish this, physical therapists must be willing to evaluate the dimensions of functional limitations and disabilities using tools that allow adherence to the same measurement standards (eg, reliability and validity) as those used to evaluate physical impairments.

Disability Evaluation↗
PubMed1993

Evidence for use of an extension-mobilization category in acute low back syndrome: a prescriptive validation pilot study.

BACKGROUND AND PURPOSE: The prescriptive validity of a treatment-oriented extension-mobilization category for patients with low back syndrome (LBS) was examined. SUBJECTS: Of a total of 39 patients with LBS referred for physical therapy, 24 patients (14 male, 10 female), aged 14 to 50 years (means = 31.3, SD = 11.6), were classified as having signs and symptoms indicating treatment with an extension-mobilization approach. The remaining subjects were dismissed from the study. Patients in the extension-mobilization category were randomly assigned to either an experimental (treatment) group (n = 14) or a comparison group (n = 10). METHODS: The experimental and comparison group subjects were treated with either mobilization and extension (a treatment matched to the category) or a flexion exercise regimen (an unmatched treatment). Outcome was assessed with a modified Oswestry Low Back Pain Questionnaire administered initially and at 3 and 5 days after initiation of treatment. Data were analyzed with a 2 x 3 (treatment group x treatment period) analysis of variance. RESULTS: The subjects' rate of improvement, as indicated by the Oswestry questionnaire scores, was dependent on the treatment group to which they were assigned. Subjects treated with extension and mobilization positively responded at a faster rate than did those treated with a flexion-oriented program. CONCLUSION AND DISCUSSION: This study illustrates that a priori classification of selected patients with LBS into a treatment category of extension and mobilization and subsequently treating the patients accordingly with specified interventions can be an effective approach to conservative management of selected patients.

Acute Disease↗
PubMed1993

Effect of total contact cast immobilization on subtalar and talocrural joint motion in patients with diabetes mellitus.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the effect of total contact casting (TCC) on dorsiflexion at the talocrural joint (TCJ) and motion (inversion/eversion) at the subtalar joint (STJ). SUBJECTS: Thirty-seven patients (29 men, 8 women), ranging in age from 32 to 79 years (mean = 54, SD = 11), with diabetes mellitus and a unilateral plantar ulceration participated in the study. METHODS: The subjects were measured with a goniometer for dorsiflexion and STJ range of motion (ROM). The ROMs for each subject's casted and noncasted legs were compared before and after treatment with TCC for neuropathic plantar ulcers by use of a 2 x 2 repeated-measures analysis of variance design. RESULTS: Mean time of immobilization in TCC (healing time) was 42 days (SD = 43, range = 8-119). The results indicated (1) ROM was unchanged at the STJ, but dorsiflexion decreased slightly (1 degree) on both the casted and noncasted sides following the last cast removal, and (2) ROM was less on the ulcerated side prior to casting compared with the nonulcerated side. CONCLUSION AND DISCUSSION: We believe the beneficial effects (healing of wounds) outweigh the minimal detrimental effects (decreased dorsiflexion) of treatment with TCC.

Adult↗
PubMed1993

A comparison of two different methods to treat hip pain in runners.

Little or no research has been performed on the physical therapy treatment of hip pain. The purpose of this study was to compare two different treatments for hip pain. Twenty runners who had primary hip pain and sacroiliac joint dysfunction, without evidence of arthritic changes, were randomly assigned to two groups. One group received a mobilization technique to the involved hip, while the other was treated with a manipulative technique known to affect sacroiliac joint dysfunction. The subjects were evaluated by using a pain questionnaire and the Faber test to determine the response of the hip joint to treatment. Data were analyzed with the Mann-Whitney U statistic for perceived pain response and with the Chi-square statistic with Yates correction for the Faber test. Results showed a significant difference in perceived pain response, as well as reproduction of pain with the Faber test, between the two groups. The results suggest that a manipulative technique designed to reduce sacroiliac joint dysfunction is an effective method to reduce hip pain. Physical therapists should evaluate the sacroiliac joint in patients with hip pain.

Adolescent↗
PubMed1992

A study of discomfort with electrical stimulation.

The primary purpose of this study was to investigate the influence of personality variables and contractile forces on magnitude estimates of pain unpleasantness and pain intensity during varying levels of neuromuscular electrical stimulation (NMES). Thirty volunteers, according to their scores on a preferred coping-style questionnaire, were assigned to one of two groups, one designated "monitors" (information seekers) and the other designated "blunters" (information avoiders). All subjects were administered varying levels of two types of NMES, one causing both afferent stimulation and muscle contraction and one causing only afferent stimulation. Subjects judged the intensity and unpleasantness of each current type using magnitude estimation. Data were analyzed using a 2 x 2 x 2 x 3 (coping style x current type x pain descriptor x current level) analysis of variance. The results indicated that the rate of increase of magnitude estimates for unpleasantness and pain intensity that corresponded to increases in current were dependent on (1) the preferred coping style of the subject, (2) whether the stimulus caused a muscle contraction, and (3) whether the subject was judging the intensity or the unpleasantness of the applied stimulus. Behavioral styles appear to affect how subjects characterize the discomfort associated with NMES, and involuntary muscle contractions contribute to the discomfort felt from NMES. These results suggest that interventions tailored to a preferred coping style may increase a subject's level of tolerance to NMES and thus provide a more beneficial treatment.

Adaptation, Psychological↗
PubMed1991

Reliability of isokinetic measurements of trunk muscle performance.

The purpose of this investigation was to assess the reliability of isokinetic trunk muscle performance. Sixty-one volunteers participated (29 men, 32 women; age range, 20-60 years). All subjects were without low-back symptoms at the time of testing. All testing was performed with the subject initially standing, using speeds of 60, 120, and 180 degrees per second. Ten repetitions of flexion and extension were performed reciprocally at each speed, with a 3-minute rest period between speeds. Test-retest intervals were 1 and 3 weeks from the initial test. Peak torque-to-body-weight ratios, extension-to-flexion ratios, and average work per repetition were calculated for each speed for flexion and extension. Data were analyzed with analysis of variance, intraclass correlation coefficients, and Pearson correlation coefficients. Intraclass correlation coefficient values ranged from .74 to .88 for measurements derived from peak torque, and from .88-.93 for measurements derived from work (with the exception of .69 for men at 180 degrees/sec). Standard error of measurements ranged from 8 to 32 ft-lb, with a tendency to increase with increasing speeds. It was concluded that, when using this protocol, isokinetic measurements of muscle function offer the clinician sensitive and reliable measurements of trunk muscle performance and that incorporating increased practice with women and longer rest periods with men may further decrease error associated with these isokinetic trunk strength measurements.

Adult↗
PubMed1990

Isokinetic dynamometry.

Quantitative muscle performance assessments require standardized protocols and logical explication of raw scores, regardless of technique used. A very expensive dynamometer is not a substitute for competent personnel carrying out strength assessments, and well-thought-out interpretations of the data.

Adult↗
PubMed1990

Two theories of muscle strength augmentation using percutaneous electrical stimulation.

Electrical stimulation of muscle is a commonly used, well-substantiated strategy that physical therapists use to augment strength in patients with muscle weakness. Two distinctly different theories of strength augmentation using percutaneous muscle stimulation are presented. The first theory proposes that augmentation of muscle strength with electrically elicited muscle contractions occurs in a similar manner to augmentation of muscle strength with voluntary exercise. Electrically elicited muscle contractions of relatively high intensity with low numbers of repetitions strengthen muscle proportionally to the external load on the muscle in a manner that is equivalent to voluntary contraction. The second theory proposes that augmentation of muscle strength using percutaneous stimulation is fundamentally different from augmentation of strength with voluntary exercise. This theory uses the physiological differences between electrically elicited and voluntary contractions, such as the reversal of motor unit recruitment order, as a basis for argument. Both theories are partially substantiated using published literature. Strategies for testing both theories are also presented.

Electric Stimulation Therapy↗
PubMed1990

Type II fiber activation with electrical stimulation: a preliminary report.

Electrical stimulation to augment or maintain muscle performance has been well documented. The purpose of this preliminary report is to present the results of a single-case study conducted to determine the order of activation of skeletal muscle fibers as a result of electrical stimulation. The subject's quadriceps femoris muscles were electrically stimulated at 80% of maximal isometric torque. Pre-stimulation and immediate post-stimulation muscle biopsy samples were obtained, and a modification of the glucogen-depletion method was used to determine activation of muscle fibers. The pre-stimulation muscle biopsy sample demonstrated uniform periodic acid-Schiff (PAS)-positive staining in all fiber types, whereas the post-stimulation muscle biopsy sample showed glycogen depletion of type II muscle fibers. The most PAS-negative muscle fibers were type IIa skeletal muscle fibers. The results of this single-case study provide evidence that electrical stimulation, as described, selectively activates type II skeletal muscle fibers. The implication of this finding is that, in many chronic diseases, type II fibers are selectively and preferentially affected. Electrical stimulation may be a clinically viable technique to use in patients with type II fiber involvement.

Adult↗
PubMed1990

Association between direction of lateral lumbar shift, movement tests, and side of symptoms in patients with low back pain syndrome.

The purpose of this study was to determine the relationship between direction of lateral lumbar shift (LLS) and 1) the occurrence of symptoms during the side-bending movement test and 2) the location of symptoms in patients with low back pain syndrome (LBS). Twenty-four patients with LBS (17 male, 7 female) with an observable LLS were studied. Side-bending movement tests were performed bilaterally, and the results were recorded as positive if symptoms occurred during the movement. The location of symptoms (right side or left side) was obtained from the patient history. Use of the chi-square statistic revealed a statistically significant relationship between the direction of the LLS and the direction of the positive side-bending movement test. Seventeen tests (71%) were positive to the contralateral side of the LLS, and 5 (21%) were positive to the ipsilateral side. Two tests (8%) were negative in both directions. There was no significant relationship between the side of symptoms and the direction of the LLS. The determination of presence and direction of an LLS is necessary in certain physical therapy management approaches. Pain or restricted side-bending movement has been used to confirm the presence of an LLS. This study confirms the clinical usefulness of the side-bending movement test for determining the presence and direction of an LLS.

Adult↗
PubMed1990

Muscle stimulators.

Explore the source record for details and available documents.

Electric Stimulation↗
PubMed1989

Electrical stimulation of quadriceps femoris in an elite weight lifter: a single subject experiment.

The response to treatment of high intensity neuromuscular electrical stimulation (NMES) to both quadriceps femoris muscles as an adjunct to ongoing weight training was evaluated using a single subject experimental design. For an elite weight lifter weekly maximal measurements of snatch (S), clean and jerk (CJ), and front squat (SQ) were obtained over 4 months during which the subject weight trained daily for 3 h. The 1st month, baseline data were collected. After baseline measurements, a 1-month period of high-intensity NMES was added to the subject's weight training. NMES was then withdrawn for 1 month and administered once more for 2 weeks. Three quadriceps femoris muscle biopsies were taken, two during the initial baseline period and one just before the end of the first stimulation period. The results showed a significant and clear relationship between performance gains and NMES administration and withdrawal. Steep gains for S, CJ, and SQ were seen after 2 weeks of stimulation, with front squat showing a 20-kg increase within the 1st week of both stimulation periods. Muscle biopsy showed an increased type I fiber area, decreased type IIa and IIb fiber area, and an increase of type II fibers after NMES. The results of this study support the use of high-dose NMES as an adjunct to weight training in elite lifters.

Adult↗
PubMed1989

Reliability of a diabetic foot evaluation.

The purpose of this study was to establish the interrater and intrarater reliability of various ankle and foot measures common to a diabetic evaluation. Bilateral biomechanical, sensory, and wound-size measurements were obtained in 31 subjects with diabetes mellitus. Twenty-five subjects were retested by the initial examiner to determine intratester reliability, and all subjects were retested by another examiner to determine intertester reliability. Both examiners participated in an extensive training period prior to the initiation of this study to minimize variability between and within measurers. Intraclass correlation coefficients for interrater and intrarater measurements ranged from .58 to .89 and from .74 to .99, respectively. The results of this study indicate that ankle and foot measurements common to a diabetic evaluation can be taken reliably between testers. We believe extensive examiner training in these clinically relevant measures can improve reliability between testers.

Adult↗