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Biomedical subjects

B M Gans

Publications and source records attributed to B M Gans.

17 recordsLinked to original sources
PubMed1992

Functional outcome in children with traumatic brain injury. Agreement between clinical judgment and the functional independence measure.

As improvements in the delivery of trauma care have increased survival from injury, it has become essential to assess the resulting morbidity to plan for medical and psychosocial services, particularly for children whose needs may be wide and long term. This paper focuses on the assessment of disability of 598 children, age 8 to 19 yr, hospitalized for traumatic brain injury with or without injury to other body regions, exclusive of spinal cord injury. The disability was measured at discharge from acute care in nine areas of functional activities and a recovery time assigned by a clinician. For the study, children were divided into three groups: those whose recovery was expected in less than 7 months (Group A: n = 463), in 7 to 24 months (Group B: n = 66) and in greater than 2 yr (Group C: n = 69). The clinician's expectation of recovery time significantly (P less than 0.01) reflected the injury severity as measured by the Glasgow Coma Scale and the Injury Severity Score. By the Glasgow Coma Scale, 16.4% were comatose on admission in Group A, 51.5% in Group B and 58% in Group C. The Injury Severity Score was significantly different with 25.5% severely injured in Group A, 68.2% in Group B and 84% in Group C. At discharge, 15% in Group A had four or more areas of impairments, 61% in Group B and 84% in Group C. The Functional Independence Measure confirmed the clinician's assessment of compromise with significantly (P less than 0.01) different average values of 110, 80 and 58 for Groups A, B and C, respectively.

Accidents, Traffic↗
PubMed1991

Children with traumatic head injury: morbidity and postacute treatment.

The purpose of this paper was to describe pediatric head trauma and the factors that affect the extent, characteristics, and postacute service needs of functional limitations resulting from head trauma. Data are presented on 4,870 children who survived head injuries and who were enrolled in the National Pediatric Trauma Registry during 1985 to 1988. The sample excluded 349 children who died and 151 children who had impairments before injury. More than 50% of the surviving children sustained extracranial injury in addition to head injury, and this occurrence was related to age and mechanism of injury. Although 78% of the children were discharged from acute care without obvious impairments, 787 had one to three impairments, and 286 had four or more impairments. Discharge to rehabilitation or extended care facilities depended on the number and type of resulting impairments.

Activities of Daily Living↗
PubMed1991

Rehabilitation of severely injured children.

Injury is the leading cause of death and disability in childhood. Ideal systems of care integrate comprehensive management of acutely injured children with rehabilitation. We review the nature of childhood injury, its disabling consequences, and the best ways to manage the care of children with serious injuries.

Child↗
PubMed1991

Tufts assessment of motor performance: an empirical approach to identifying motor performance categories.

The Tufts Assessment of Motor Performance (TAMP) is a criterion-referenced test that measures motor performance capabilities of basic self-care skills, mobility and physical aspects of communication. Discrete motor performance tasks were identified within each of the 32 items. The purpose of this paper is to report the results of an empirical method of determining the factor structure underlying the motor performance tasks of the TAMP. Initially, motor performance tasks were categorized into a priori groupings based on previous literature and clinical judgment. The TAMP was administered to 206 children and adults (age range 6 to 86 years) with physical disabilities. Diagnoses included a variety of musculoskeletal and neurologic disorders. A principal-factor analysis was used to organize and cluster the item tasks into appropriate common factors. Seven factors were identified that accounted for 70.6% of the total variance for the assistance dimension; similar results were obtained for other measurement dimensions of the TAMP. The defined factor structure has patterns of similarity to the motor performance variables as defined by clinical judgment; however, the tasks were organized into factors that were more functionally oriented than expected. The results provide a framework for which the motor performance tasks of the TAMP might be organized into scales that identify essential performance constructs for rehabilitation. The results permit examination of the nature and clinical importance of these common motor performance factors for clinical evaluation and the description of functional disability.

Adolescent↗
PubMed1990

Utilization of inpatient rehabilitation services among traumatically injured children discharged from pediatric trauma centers.

This paper investigates factors that predict whether or not children treated at pediatric trauma centers are discharged to inpatient rehabilitation. Variables pertaining to functional impairments, injury severity and institutional factors explained over 45% of the variance in discharge disposition. It appears that a good deal of rationality pervades the decision as to whether patients are discharged to home or to rehabilitation. The extent of functional impairments and the severity of injury are closely related to these discharge decisions, as one would expect in a well-functioning discharge planning system. However, there are indications that discharge decisions are also affected by factors that ideally should be external to the decision process. Chief among these is whether or not the trauma center has an onsite rehabilitation unit. Patients treated at trauma centers that have onsite rehabilitation units are significantly more likely to be discharged to rehabilitation than patients treated at trauma centers without onsite rehabilitation.

Adolescent↗
PubMed1989

National Pediatric Trauma Registry.

The National Pediatric Trauma Registry (NPTR) is a multi-institutional database designed to compile information concerning all aspects of pediatric trauma care. The registry is designed and operated in a manner that maximizes data accuracy and provides this information to all participating investigators. The growth of the database has allowed the NPTR to provide the first accurate epidemiologic description of pediatric trauma as a national disease, as well as to develop national norms for pediatric trauma care. The registry presently contains 10,177 patients, and is undergoing revisions (phase II) to allow a more focused evaluation of various aspects of the clinical care and rehabilitation of the pediatric trauma patient.

Child↗
PubMed1988

Description and interobserver reliability of the Tufts Assessment of Motor Performance.

This paper describes the conceptual basis for the development of a new clinical evaluation instrument, the Tufts Assessment of Motor Performance (TAMP). The TAMP is a 32-item, diagnosis-independent, criterion-referenced test that samples physical performance items in the areas of mobility, activities of daily living and physical aspects of communication. The administrative and scoring criteria of the TAMP are presented, and the multiple measurement dimensions are described. The documentation of patient status and progress, as described in the functional and performance profiles, is outlined. The paper also reports initial interobserver reliability on the intraitem tasks and the summary indexes of the two profiles. Forty individuals (20 adults and 20 children) with neurologic and musculoskeletal disorders comprised the reliability sample. Kappa and intraclass correlations were used to estimate the reliability of three independent raters on individual tasks and aggregate scores, respectively. Task reliability for the assistance and approach measurement dimensions were generally higher than for the more qualitative pattern and proficiency dimensions. Yet over 90% of all the tasks had acceptable reliability, while all the summary indexes had high interobserver reliability. Determination of interobserver reliability data is the initial phase of defining the most appropriate and technically valuable items, and will serve as a basis for item revision and reduction to enhance the clinical utility of the test.

Activities of Daily Living↗
PubMed1988

The Pediatric Trauma Score as a predictor of injury severity: an objective assessment.

The ability of the Pediatric Trauma Score (P.T.S.) to predict injury severity and mortality was evaluated by analysis of its relationship with the Injury Severity Score (I.S.S.) of 615 children entered into the National Pediatric Trauma Registry (N.P.T.R.). Mean age was 8.2 years and mortality was 3.5%. Mean I.S.S. of survivors was 8.1 in comparison to 59.7 for nonsurvivors. Linear regression coefficient determined from analysis of these variables produced a slope of -3.7 with a statistically significant correlation of P.T.S. to I.S.S. (p less than 0.001; r2 = 0.89). Analysis of the mortality for each cohort of patients with the same P.T.S. identified three categories of mortality potential. Children whose P.T.S. was greater than 8 had a 0% mortality. Children whose P.T.S. was between 0 and 8 had an increasing mortality related to their decreasing P.T.S. (r2 = 0.86), and children whose P.T.S. was below 0 had 100% mortality. This study documents the direct linear relationship between P.T.S. and injury severity, and confirms the P.T.S. as an effective predictor of both severity of injury and potential for mortality.

Child↗
PubMed1988

Modified WAIS-R for patients with speech and/or hand dysfunction.

A feasibility study showed that the research edition of the modified WAIS-R for patients with speech and/or hand dysfunction has promise. Four Verbal Scale subtests and three Performance subtests of the modified WAIS-R were correlated with the standard version. The Verbal IQs of an experimental group (n = 16 severely physically handicapped) and Performance IQs of a control group (n = 32 able-bodied adults) on the two versions were not significantly different. In a comparison study of nonretarded patients with severe cerebral palsy (n = 14) or with spinal cord injury (n = 14), the spinal cord group's mean Verbal IQs and Performance IQs on the modified WAIS-R were significantly higher than those of the severe cerebral palsy group, but the difference was relatively larger for Performance IQs than Verbal IQs. Acquisition of motor dysfunction early in development (severe cerebral palsy) compared to later in development (spinal cord injury) may constrain nonverbal intelligence more than verbal intelligence.

Adolescent↗
PubMed1987

Rehabilitation engineering technology and the arthritis patient.

Patients with arthritis and related disorders experience major limitations in their abilities to do work in the environment. The selective and appropriate use of technical aids and new forms of advanced technology can resolve dysfunctions of mobility, self-care, and manipulation of objects in the environment. This paper reviews the state of the art of various technologies for the disabled and points out specific applications and limitations to the patient with arthritis.

Activities of Daily Living↗
PubMed1981

M-response quantification: a technique.

Median nerve responses in 13 patients and 9 normal subjects were evaluated using surface bipolar stimulation. The M response from surface electrodes placed upon the thenar eminence was recorded on a fiberoptic chart recorder and simultaneously subjected to true electronic integration. Comparison between the integrated M response and the M index (the product of the M response peak-to-peak amplitude and total duration) revealed a highly correlated linear regression. This linear relationship was present when stimulating both at the wrist (r2 = 0.96) and the antecubital fossa (r2 = 0.95). Statistically significant differences were observed between the integrated M response of 5 normal adult men and men with carpal tunnel syndrome (n 3, p less than 0.01) or anterior horn cell or neuropathic processes (n 4, p less than 0.001). Differences of borderline significance were noted between normal women (n = 4) and women with carpal tunnel syndrome (n 4, p less than 0.05) or anterior horn cell or neuropathic processes (n 2, p less than 0.01). There was no correlation between the integrated M response and the distal latency in patients with carpal tunnel syndrome. It is concluded that the M index is a highly reliable method of quantifying the M response as an approximation of integration in median nerve studies, but that this measurement holds little relationship with the presence of the distal neuropathic processes studied.

Adult↗
PubMed1979

Below-knee orthosis: a wrap-around design for ankle-foot control.

Control of foot and ankle positions with orthotic appliances is generally more difficult to accomplish in children with spastic than flaccid paralytic disorders. Our new design for a custom molded plastic ankle-foot orthosis has proven superior to other designs in most applications. The appliance is vacuum molded from very thin polypropylene plastic and innerfaced with a foam material (Aliplast). The limb is enclosed completely in plastic with an anterior opening secured by several Velcro straps. Although the material is soft and pliable, the circumferential support provides remarkably rigid control of the limb. The orthosis has been successfully applied to children with polio, meningomyelocele and all forms of spastic and athetoid cerebral palsy. In addition to superior limb control, another advantage appears to be reflex inhibition of abnormal motor tone in may spastic patients. Patients have preferred this orthosis to those previously worn probably due to greater comfort. The limitation of adjustability of dorsiflexion can be compensated by heel or sole shoe lifts. Excessive heat created by the "wrap-around" design can be reduced by a thin cotton sock extended above the orthosis.

Adult↗
PubMed1977

Pain perception in clinical electromyography.

In a prospective study of 93 electromyographic examinations including those of 42 men and 51 women, various factors relating to the experience were correlated with pain levels. Patients were asked to record their pain levels, and electromyographers were asked to record their perception of the patients' levels of pain on a scale of 0 to 4. It was found that the pain reported was not related to length of wait or of examination, number of surface areas studied, whether the findings on examination were normal or abnormal, the age of the patient, time of day, the electromyographic findings or the characteristics of the examiner. The data suggested that nerve conduction velocity studies are more uncomfortable for patients than needle electromyographic studies. The only other statistically significant factor appeared to be the patient's sex. All of the patients who reported no pain were male while 86% of the patients reporting maximum pain were females. The electromyographer's evaluation of the patient's pain perception was accurate in 84% of the cases.

Adult↗
PubMed1975

Voluntary skeletal muscles: a unifying theory on the relationship of their electrical and mechanical activities.

Experiments designed to examine the relationship between electrical and mechanical events in voluntarily contracting human muscle were performed. Experiments reported in the literature, as well as our own, were categorized according to technique into one of four types: (1) isometric-isotonic, (2) isometric-anisotonic,(3) anisometric-isotonic or (4) anisometric-anisotonic. A general relationship between the absolute value of the surface electromyogram (the absolute value of E and the force (F) generated by the contraction is proposed. This is the integral of the absolute value of E dt = k-1integralF dx i-2integralF dt, where k-1 and k-2 are constants. In the isometric-isotonic condition, this equation reduces to a linear relation between the average electromyogram and the force of contraction. A quadratic relation exists in the isometric-anisotonic, constantly increasing contraction, between the integrated electromyogram and the force of contraction. Also, this equation predicts linear relations for anisometric-isotonic contractions, and quadratic relations for an accelerated rate of contraction, between the average electromyogram and force of contraction. Both the data reported in the literature and our data provide confirmatory evidence for the unifying theory offered in this paper.

Adult↗