Biomedical subjects

A Delitto

Publications and source records attributed to A Delitto.

52 records · Page 3Linked to original sources

PubMed1989

Peak torque-to-body weight ratios in the trunk: a critical analysis.

The purpose of this study was to document the relationships between body weight and isokinetic extension and flexion peak torque produced by the trunk musculature. Using a dynamometer, we collected isokinetic measurements during trunk flexion and extension at speeds of 60 degrees and 120 degrees/sec on 61 healthy subjects (29 men, 32 women; 20-60 years old) while standing. Extension and flexion peak torque measurements were calculated for each subject at each speed. Male and female subjects' data were analyzed separately. Each subject's body weight was paired with peak torque at each speed, and Pearson product-moment correlation coefficients (r) were calculated. The correlation coefficients ranged from .27 to .39 for extension and from .66 to .70 for flexion, establishing a positive linear relationship between body weight and each of the isokinetic measurements. Body weight accounted for very small proportions of the variance (as low as 7%-15% in extension isokinetic measurements). In attempting to use a client's body weight to predict isokinetic peak torque measurements, the clinician should be aware that a great deal of unaccounted for variance exists. We recommend that clinicians use other variables (eg, activity level, age) in addition to body weight to control for individual differences among healthy subjects when measuring isokinetic trunk extension muscle performance.

Adult↗

PubMed1989

Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus.

The purpose of this study was to determine whether differences in sensation, ankle dorsiflexion (DF), and subtalar joint (STJ) motion exist between 1) diabetic patients with a history of plantar ulcer (DMW Group), 2) diabetic patients without a history of plantar ulcer (DMWO Group), and 3) a nondiabetic control group (NDC Group). There were 23, 23, and 24 subjects in the respective groups. The mean age for each group was 58, 63, and 60 years, respectively. The mean DF for each group was 2, 5, and 7 degrees, respectively, and the mean STJ motion was 26, 31, and 35 degrees, respectively. Mode values for sensation with Semmes-Weinstein monofilaments were 6.10, 5.07, and 4.17. The results indicate the DMW Group had significantly less sensation, DF, and STJ motion than the NDC Group (p less than .05). In the DWM Group, the ulceration was seen more often on the side with least motion. Limited DF and STJ motion may restrict the foot's ability to absorb shock and transverse rotation, contributing to the pathogenesis of plantar ulceration in the insensitive foot. Although these results demonstrate an association, not a causative relationship, we believe diabetic patients should be screened routinely for insensitivity and limited joint mobility at the feet and appropriate preventive measures should be taken.

Adolescent↗

PubMed1989

On developing expert-based decision-support systems in physical therapy: the NIOSH low back atlas.

We have described the process of the initial development of an expert-based decision-support system for the management of patients with low back syndrome. Important considerations for developing decision-support systems are reviewed, both generally and specifically. The term "expert" is dissected and discussed. Our work so far involved congregation of a number of experts and compilation of a testing protocol. We are now refining the system for specific populations and purposes.

Back Pain↗

PubMed1989

Subjective measures and clinical decision making.

I have attempted to use Feinstein's model of clinimetric indexes and his criteria as a focus for further development of measures that in physical therapy are currently considered "soft" or "subjective". I feel this development will enhance the body of knowledge by objectifying a portion of clinical assessment (eg, the patient's complaints, "subjective" portion of the POMR's SOAP format) that is in tremendous need of quantification. By making these "soft" data "hard," I feel we will enhance the decision-making power of clinicians.

Diagnostic Techniques and Procedures↗

PubMed1989

Total contact casting in treatment of diabetic plantar ulcers. Controlled clinical trial.

This study compared the treatment of total contact casting (TCC) with traditional dressing treatment (TDT) in the management of diabetic plantar ulcers. Forty patients with diabetes mellitus and a plantar ulcer but with no gross infection, osteomyelitis, or gangrene were randomly assigned to the TCC group (n = 21) or TDT group (n = 19). Age, sex, ratio of insulin-dependent diabetes mellitus to non-insulin-dependent diabetes mellitus, duration of diabetes mellitus, vascular status, size and duration of ulcer, and sensation were not significantly different between groups (P greater than .05). In the experimental group, TCC was applied on the initial visit, and subjects were instructed to limit ambulation to approximately 33% of their usual activity. Subjects in the control group were prescribed dressing changes and accommodative footwear and were instructed to avoid bearing weight on the involved extremity. Ulcers were considered healed if they showed complete skin closure with no drainage. Ulcers were considered not healed if they showed no decrease in size by 6 wk or if infection developed that required hospitalization. In the TCC group, 19 of 21 ulcers healed in 42 +/- 29 days; in the TDT group, 6 of 19 ulcers healed in 65 +/- 29 days. Significantly more ulcers healed (chi 2 = 12.4, P less than .05) and fewer infections developed (chi 2 = 4.1, P less than .05) in the TCC group. We conclude TCC is a successful method of treating diabetic plantar ulcers but requires careful application, close follow-up, and patient compliance with scheduled appointments to minimize complications.

Casts, Surgical↗

PubMed1989

Rehabilitation of the athlete with a knee injury.

Rehabilitation of the athlete with an injured knee is covered. The focus of this article is on identifying, measuring, and treating disorders commonly associated with an injured knee. If available, literature is reviewed that supports approaches suggested. If literature is not available, the authors attempt to justify suggested protocols with logic based on sound biological principles.

Athletic Injuries↗

PubMed1988

Electrically elicited co-contraction of thigh musculature after anterior cruciate ligament surgery. A description and single-case experiment.

The purpose of this article is to describe a method for strengthening the quadriceps femoris muscle in a patient after anterior cruciate ligament (ACL) surgery. The method incorporates electrically elicited co-contraction of the quadriceps femoris and hamstring muscles. A single-case experimental design based on a split-middle (ABAB) technique was used to assess the effects of the systematic administration and withdrawal of electrical stimulation with respect to changes in knee isometric extension and flexion torque and circumferential measurements of the thigh in a patient six weeks after ACL reconstruction. Results show increases in extension and flexion torque and thigh circumferential measurements that are associated with both stimulation (treatment) phases in addition to a maintenance effect demonstrated during the withdrawal phase. In this patient, the technique appears to be effective in increasing muscle strength and circumferential measurements, particularly quadriceps femoris muscle torque. Implications and suggestions for future research are included.

Adult↗

PubMed1988

Electrical stimulation versus voluntary exercise in strengthening thigh musculature after anterior cruciate ligament surgery.

Twenty patients who had undergone anterior cruciate ligament reconstructive surgery were placed randomly and independently in an Electrical Stimulation Group (n = 10) or Voluntary Exercise Group (n = 10) to compare the effectiveness of these two muscle-strengthening protocols. Patients in both groups used simultaneous contraction of quadriceps femoris and hamstring muscles during a training regimen that consisted of either voluntary exercise or electrical stimulation trials five days a week for a three-week period within the first six postoperative weeks. After patients completed the training regimen, bilateral maximal isometric measurements of gravity-corrected knee extension and flexion torque were obtained for both groups and percentages were calculated. Results showed that patients in the Electrical Stimulation Group finished the three-week training regimen with higher percentages of both extension and flexion torque when compared with patients in the Voluntary Exercise Group (extension: t = 4.35, p less than .05; flexion; t = 6.64, p less than .05). These results indicate that patients in an electrical stimulation regimen can achieve higher individual thigh musculature strength gains than patients in a voluntary exercise regimen when simultaneous contraction of thigh muscles is prescribed during an early phase of postoperative rehabilitation.

Adult↗

PubMed1988

Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low back pain. An experimental study.

The purposes of this study were to 1) propose a method to detect sacroiliac joint dysfunction (SIJD), 2) test the interrater reliability of the method on a group of patients with low back pain (LBP), and 3) document changes in innominate tilt after manipulation of the sacroiliac joint. Criteria for SIJD were established by the authors. Twenty-six patients with unilateral LBP were examined independently for presence of SIJD by two examiners. Interrater agreement for presence or absence of SIJD was found to be excellent (Cohen's Kappa = .88). Twenty of the patients who met the criteria for SIJD were randomly assigned to an Experimental Group (n = 10) or a Control Group (n = 10). The left and right innominate bones of these 20 patients were measured for tilt before and after the intervention period. The sacroiliac joint of the patients in the Experimental Group was manipulated during the intervention period, whereas the patients in the Control Group received no treatment. Data were analyzed using a mixed three-factor analysis of variance. The data analysis revealed that the manipulation procedure resulted not only in an altered innominate tilt of the same side but also in an equal and opposite tilt of the opposite side (F = 67.07; df = 1.18; p less than .05). The results indicate that SIJD can be identified reliably in patients with LBP and that a manipulative procedure purported to be specific to the sacroiliac joint changes innominate tilt bilaterally and in opposite directions.

Adolescent↗

PubMed1987

Electrically elicited fatigue test of the quadriceps femoris muscle. Description and reliability.

The purposes of this study were to develop an electrically elicited fatigue test (EEFT) that uses electrically elicited isometric muscle contractions and to examine the reliability of this test on a group of healthy individuals. Fifteen subjects were tested on two occasions, one week apart. The subjects were seated and the left leg secured to an isokinetic dynamometer with the knee positioned at 45 degrees of flexion. Maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle was obtained and resultant knee extension torque was recorded. The quadriceps femoris muscle then was stimulated 50 times at the current level that elicited a knee extension torque level equal to 60% of that obtained during the MVIC. Percentages of decline in torque were calculated. Test-retest reliability indexes were calculated for the means of contractions 21 to 25 (r = .82, ICC = .83) and for contractions 46 to 50 (r = .92, ICC = .82). The EEFT was found to be reliable and may provide a clinically applicable means of measuring peripheral muscle fatigue.

Adult↗

PubMed1986

Comparative comfort of three waveforms used in electrically eliciting quadriceps femoris muscle contractions.

The purpose of this study was to compare the relative comfort levels of electrical stimulation having different waveforms, but otherwise identical current characteristics, delivered percutaneously to normal quadriceps femoris muscles contracting at the same intensity level. The quadriceps femoris muscles of 20 healthy subjects were stimulated to a torque level 60% of that obtained in a maximal voluntary isometric contraction, using pulsed current with a carrier frequency of 2,500 Hz, at 50 pulses per second of 10-msec pulse duration. Three different waveforms were used: sinusoidal, sawtooth (triangular), and square. The relative comfort level of each electrically elicited contraction for each waveform was determined for each subject using a 20-cm-long visual analog scale. The results showed that no one waveform was most comfortable (least uncomfortable) and the difference was significant in what the subjects perceived to be the most comfortable contraction, regardless of waveform (p less than .01). These results indicate that a subject's perception of discomfort changes as the waveform of stimulation varies and that individual preferences exist for different waveforms. Selection of the most comfortable waveform could prove beneficial when the intensity of muscle stimulation is increased.

Electric Stimulation↗

PubMed1986

Hamstring muscle strain treated by mobilizing the sacroiliac joint.

The purpose of this study was to compare the effectiveness of two types of treatment of hamstring muscle strains. Twenty patients with hamstring muscle strains were assigned randomly to an Experimental Group (n = 10) or a Control Group (n = 10). Peak torque production of the quadriceps femoris and hamstring muscles and hamstring muscle length were measured before and after treatment. The hamstring muscles of the Experimental and Control groups were treated with moist heat followed by passive stretching. The Experimental Group also received manipulation of the sacroiliac joint. The change in hamstring muscle peak torque was significantly greater for the Experimental Group than for the Control Group (p less than .005). No significant differences existed between the two groups in either quadriceps femoris muscle peak torque or hamstring muscle length. The results of this study suggest a relationship between sacroiliac joint dysfunction and hamstring muscle strain.

Adolescent↗

PubMed1985

Selective criteria for successful long-term prosthetic use.

The purpose of this study was to identify criteria contributing to successful long-term prosthetic use in patients with an amputation secondary to vascular disease. All elderly patients with a unilateral below-knee amputation or an above-knee amputation, secondary to vascular disease, seen in our clinic between 1977 and 1982 were included in this telephone survey. Of those contacted, 37 of 38 below-knee amputees (BKAs) and 7 of 18 above-knee amputees (AKAs) still wore their prostheses at least part of every day (success). We used a two-tailed chi-square to compare the success of the BKAs with the success of the AKAs. The BKAs were successful more often (X2 = 24.81, df = 1, p less than .001). All AKAs also were characterized according to age, time from prescription, obesity, ambulatory status, strength, range of motion, sex, general compliance, and medical problems after prosthetic prescription. Of these criteria, only compliance and medical problems after prescription showed a significant difference between successful and nonsuccessful long-term AKA prosthetic users (X2 = 5.76, df = 1, p less than .05 for each criterion). As the demands of quality assurance and diagnostic related groupings increase, these results can assist the physical therapy clinician in setting realistic goals for the geriatric amputee and help predict if the patient will be a successful prosthetic user.

Aged↗

PubMed1983

Muscle function in rheumatic disease patients treated with corticosteroids.

Clinical and experimental data indicate that long-term corticosteroid use leads to atrophy of the type 2 muscle fibers. The purpose of this study was to characterize and quantify the nature of muscle function in rheumatic disease patients who have been on long-term corticosteroid therapy. Quadriceps function (i.e., peak torque and power) in 19 patients (11 with rheumatoid arthritis, five with systemic lupus erythematosis, and 3 other) and 11 age- and activity-matched normal controls was measured with an isokinetic dynamometer (Cybex II), during four constant velocity movements. Power was significantly lower for the patients at all speeds. At the higher speeds the patients' deficit in power production increased as indicated by a difference in the slopes of power-velocity regression lines. Measures of peak torque could not be consistently used to differentiate the groups. Patients with rheumatic diseases receiving corticosteroids have a decreased ability to generate muscle power. The method described allows for quantification of these deficits in a clinical setting.

Adrenal Cortex Hormones↗

PubMed1983

Electromyographic, peak torque, and power relationships during isokinetic movement.

The use of isokinetic measurements for research and clinical practice becomes more meaningful when it can be demonstrated that subjects being tested at multiple velocities are making similar efforts and when the relationships between various biomechanical measures are understood. The purpose of this study was to examine 1) integrated electromyographic activity per second of the quadriceps femoris muscle at four isokinetic speeds (30, 60, 90, and 120 degrees/sec) and 2) the relationship of power to peak torque at each speed. Two groups were tested: "normals" (healthy subjects) and patients undergoing long-term steroid therapy for rheumatic diseases. The integrated electromyographic activity per second did not vary significantly across speeds, indicating that subjects in each group made equivalent efforts at all four speeds. At each speed, for each group, high correlations were found between peak torque and power. Population-specific and speed-specific linear regression equations were calculated that allowed for predictions of power from the more easily obtained clinical measure of peak torque.

Adult↗

PubMed1983

Effect of damp on isokinetic measurements.

Meaningful use of isokinetic data requires understanding potential sources of variation and error. The purpose of this study was to examine one possible source of variation: the effect of recorder damp settings on Cybex II torque tracings. The effect of damp settings 0 through 4 at speeds of 30 degrees/sec and 75 degrees/sec was assessed by dropping loads of 13.65 kg and 36.85 kg attached to a lever arm of 30.5 cm on a Cybex II. The effect of damp settings at 180 degrees/sec was examined with the same weights at damp settings 2 and 4. Increasing damp resulted in 1) a decrease in amplitude of the entire torque curve and a decreased measurement of peak torque and 2) a shift of the torque curve to the right (later in time). The data underscore the need to record and to report the damp settings used during isokinetic testing.

Electronics, Medical↗