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Biomedical subjects

H Alaranta

Publications and source records attributed to H Alaranta.

At least 37 records · Page 2Linked to original sources
PubMed1996

Psychomotor speed and postural control in chronic low back pain patients A controlled follow-up study.

STUDY DESIGN: Psychomotor speed (reaction time) and postural control (center point of force velocity) among healthy control volunteers and patients with chronic low back pain (LBP) were studied at the beginning of an active, functional, restoration back rehabilitation program and 5 months after the program. OBJECTIVES: To study cross-sectionally reaction times and center points of force velocity among control volunteers and patients with low back pain, and to evaluate the effects of the restoration on these measures of motor function in a follow-up examination. SUMMARY OF BACKGROUND DATA: Deficits of motor skills and of coordination have been reported in association with musculoskeletal disorders, but one can only speculate about an association between proprioceptive dysfunction and low back disorders on the basis of the currently available data. METHODS: Sixty-one healthy control volunteers and 99 patients with low back pain-68 of these patients experienced moderate pain; 31 experienced severe pain-participated in the study. Reaction times for upper and lower limbs were tested with a system based on a microcomputer. Postural stability was measured with a vertical force platform. RESULTS: A consistent trend was found in which patients with low back pain had reaction times slower than these of control volunteers. Man with severe low back pain had significantly longer hand reaction times than men in the control group (P = 0.03). Women with severe low back pain also had poorer postural control than women with moderate low back pain (P = 0.02) and women in the control group (P = 0.04). Functional restoration seemed to have an effect on reaction times. The restoration was considered successful if the condition of a patient with a disability that had resulted from low back pain improved during the follow-up examination and unsuccessful if the disability worsened. Patients who experienced these results were identified in groups called "good" and "poor," respectively. Among men, the reaction times improved in the control group and "good" groups, but they became slower in the "poor" group. The difference between "good" and "poor" groups was significant (P = 0.008). Women in the "good" group achieved the most improved reaction times, and the difference between these women and the control women almost reached significance (P = 0.076). CONCLUSION: The results indicate that patients with chronic low back pain have impaired psychomotor speed and, among women, impaired postural control. Psychomotor speed improved during an active, functional, restoration back rehabilitation program.

Adult↗
PubMed1996

Sequelae in the abdominal wall after pedicled or free TRAM flap surgery.

Twenty-seven free transverse rectus abdominis musculocutaneous (TRAM) and 16 pedicled TRAM flap breast reconstruction patients were studied for 7 to 41 months (mean, 23 months) postoperatively to compare abdominal sequelae after these two operations. The patient groups were demographically similar; mean age was 47 years in both groups. Subjective grading of the results was similar in both groups. The incidence of minor lower abdominal bulges was higher (44%, 7/16) in the pedicled group than in the free TRAM flap group (4%, 1/27). No hernias were found. Delayed healing of the abdominal scar occurred in 3 free TRAM flap and 1 pedicled TRAM flap patients. Two free TRAM flap (8%) and 7 pedicled TRAM (44%) flap patients had minor edge necrosis of the breast. Trunk strength was tested using an isokinetic device (Lido Multi Joint II), and peak torque for flexion (mean, 111 Nm +/- 25 Nm in the free TRAM flap group and 123 Nm +/- 28 Nm in the pedicled TRAM flap group) and extension (mean, 144 Nm +/- 38 Nm and 167 Nm +/- 45 Nm) were measured. No statistical differences occurred between these groups. Sit-up performance was tested and graded from 1 to 6. Both groups performed equally (4.8 and 4.8) and within normal values for this age group. Ultrasonography of the rectus muscles revealed that in the free TRAM flap group, the rectus muscle of the operated side was significantly thinner (cranial segment 6.8 mm vs. 7.8 mm, p < 0.05), thus the harvesting of a segment of muscle below the umbilicus seems to disturb the quality of the entire muscle. The mean size of the muscular defect in the free TRAM flap group was 4.3 x 6.1 cm. In this study no differences in patient satisfaction or trunk strength could be found between free and pedicled TRAM flap patients.

Abdominal Muscles↗
PubMed1996

Isokinetic performance capacity of trunk muscles. Part I: The effect of repetition on measurement of isokinetic performance capacity of trunk muscles among healthy controls and two different groups of low-back pain patients.

The aim of this investigation was to assess the reproducibility of the isokinetic trunk muscle performance measurement among patients with different degrees of low-back pain. Twenty-two healthy volunteers, 20 patients with mild and 18 patients with severe low-back pain participated in isokinetic measurements. Lidoback isokinetic dynamometer was used. The measurements were performed with the subjects standing, using velocities of 60, 90 and 120 degrees/second. Five repetitions were performed at each velocity. All subjects were tested three times with a 1-week interval between the tests. Peak torque, average peak torque, coefficient of variation, total work done and peak torque to body weight ratio were calculated for each velocity for both flexion and extension. The results showed that in every measurement peak torque, average peak torque, peak torque to body weight ratio and total work done correlated with each other very strongly both in flexion and extension (r > or = 0.9). The average peak torques increased in further measurements. The change had a strong correlation with the severity of the back problem, which was evaluated by means of the Oswestry disability index. The critical value was found to be 20% in the Oswestry index: values above this meant big changes between measurements and values below this meant small changes between measurements.

Adult↗
PubMed1996

Isokinetic performance capacity of trunk muscles. Part II: Coefficient of variation in isokinetic measurement in maximal effort and in submaximal effort.

It has been claimed that with the aid of isokinetic trunk strength measuring devices it is possible to distinguish true muscular weakness from submaximal effort in the test. This proposition is based on the presumption that in the isokinetic trunk strength test identical performances can only be reproduced by maximal effort. The purpose of this study was to investigate whether it is possible to distinguish maximal effort from submaximal with the aid of the coefficient of variation (CV) in an isokinetic trunk muscle strength test. The study group included 35 (21 male and 14 female) subjects of whom 12 were healthy, 10 had a mild low-back pain and 13 had a more severe chronic low-back pain. The subjects performed five consecutive bendings both with maximal (100%) and submaximal (50%) efforts at a speed of 90 degrees/second. In maximal effort only healthy subjects reached an average level of CV close to 10% both in extension and in flexion. In the chronic low-back pain group the average CV was close to 20%. The difference in CV was statistically significant (p < 0.05-0.02) between the healthy and the chronic low-back pain subjects. In the submaximal effort all health groups had a CV of approximately 20% or more and no significant differences were found. The group of slightly variable measurements (CV = 11-20%) was remarkably large in both the maximal and submaximal effort. The results suggest that an effort with a CV of 11-20% cannot be classified as definitely submaximal or maximal. When the CV is less than 10% the effort can be fairly certainly classified as maximal.

Back↗
PubMed1995

Effect of intensive training on the isokinetic strength and structure of lumbar muscles in patients with chronic low back pain.

STUDY DESIGN: This study investigated the effects of the intensive physical rehabilitation program on the trunk and knee extensor muscles in patients with chronic low back pain. At baseline and after 3 months, strength was measured and muscle biopsies were taken. OBJECTIVES: To evaluate the effects of strength exercises on the structure of back muscles. SUMMARY OF BACKGROUND DATA: Rehabilitation designed for chronic low back pain patients improves trunk muscle strength, mobility of the spine, and the patients' functional capacity. The effects of such programs on the structure of back muscles have not been reported previously. METHODS: Thirty patients with chronic low back pain volunteered to participate in the study. Biopsies were taken from the multifidus and vastus lateralis muscles. The sizes of Types 1 and 2 muscle fibers were measured. The peak-torques of isokinetic trunk and knee extension were determined at two different angular velocities. RESULTS: Strength increased by 19-22% (P < 0.05) in trunk extension and by 7-11% (P < 0.05) in knee extension. Type 1 fibers maintained their pre-exercise size. The size of Type 2 muscle fibers in men increased by 11% (P < 0.05) in the multifidus and by 8% (P < 0.05) in the vastus lateralis. In women, the corresponding increases were 11% (P = 0.16) and 11% (P < 0.05). The correlation between the size of Type 2 muscle fibers in the multifidus and the strength of trunk extension improved, especially in men at follow-up. CONCLUSIONS: The results of the present study suggest that training with maximal or submaximal effort may reverse the selective atrophy of Type 2 fibers in the multifidus muscles in men. Intensive training also can significantly increase the trunk extension strength in women, but women may need a longer training period than men to achieve significant structural changes in their back muscles.

Adult↗
PubMed1995

Severe sciatica: a 13-year follow-up of 342 patients.

This study involved 342 patients hospitalized because of severe, persistent sciatica suggestive of a lumbar intervertebral disc herniation. After standard clinical evaluation, EMG and myelography, 220 patients underwent lumbar discectomy. The remaining 122 patients were treated conservatively. Follow-up examinations were arranged after 1, 5 and 13 years. The study focused on the rehabilitation outcome in general and differences in outcome between the two treatment groups. Several indicators showed a rather poor outcome for sciatica patients during the 13-year follow-up period. In the operated group 16% had been re-operated because of lumbar disc herniation. True recurrence of herniation (same level and side) occurred in 8%. In the conservatively treated group 14% had undergone spinal surgery. Nearly 70% of the patients still reported sciatica. Self-assessed levels of low back pain were "no change/worse" for 19% in the operated group and for 44% in the conservatively treated group. In both the study groups, nearly 40% of the subjects had retired on disability pensions.

Activities of Daily Living↗
PubMed1995

Good muscle performance does not compensate instability symptoms in chronic anterior cruciate ligament deficiency.

A total of 167 patients with documented anterior cruciate ligament deficiency was examined preoperatively with laxity and isokinetic muscle strength measurements. Functional evaluation with Lysholm knee and Tegner activity level scores were done. Antero-posterior (AP) knee laxity correlated negatively with Tegner activity level (NS), and insignificantly with Lysholm knee score. A marginal correlation was found between the Lysholm score and muscle strength. Patients were divided into four groups depending on whether their AP laxity was greater or less than 20 mm and whether their quadriceps strength was greater or less than 85% of their control knee. No difference in the Lysholm or Tegner scores between the groups was observed. As a conclusion it seems that even a relatively good muscle performance does not compensate severe instability symptoms.

Adolescent↗
PubMed1995

Static back endurance and the risk of low-back pain.

Spinal physical capacity and in particular static back endurance were studied for their prediction of first-time experience of low-back pain. Of a total of 126 persons who were free from back complaints at entry, 33 developed low-back pain during a follow-up of 1 year. The static back endurance test was found to be the only physical capacity measurement that indicated an increased risk of low-back pain. Adjusted for age, sex, and occupation, the odds ratio of a new low-back pain in those with poor performance was 3.4 (95% confidence interval, 1.2-10.0) compared to those with medium or good performance. RELEVANCE--:The simple static back endurance test might have value in health examinations because of its strong predictive value of future low-back pain.

Journal Article↗
PubMed1995

Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms.

OBJECTIVES: To investigate if autonomic nervous system function, reflected in cardiovascular variables, among patients with neck-shoulder symptoms (tension neck group (T)) differed from that in a symptom free control group (C), and to establish its relation with pain and psychological stress. METHODS: Twelve women with tension neck and nine controls in secretarial jobs were studied. They underwent an orthostatic test, deep breathing test, Valsalva manoeuvre, isometric handgrip test, and muscular endurance test. Pain was measured using visual analogue scales, and psychological stress by the Modified Somatic Perception Questionnaire (MSPQ). Plasma endothelin-1 (ET-1) was measured using high pressure liquid chromatography and radioimmunoassay. RESULTS: Signs of psychological stress were significantly (p < 0.001) more common in group T than in group C. Mean resting heart rate in group T (77.8 (SE 2.9) beats/min; range 64-100) was significantly greater than that in group C (63.8 (3.1) beats/min; range 52-80) (p < 0.01). In the orthostatic test, the overall changes in R-R intervals during the first 40 heart beats after standing up and during seven minutes of testing differed significantly between the groups (p < 0.001, < 0.05, respectively). The increase in diastolic blood pressure in the three minute isometric handgrip test was significantly less in group T (19.4 (3.5) mm Hg; range -5 to 35) than in group C (30 (3.4) mm Hg; range 15-50) (p < 0.05). The MSPQ score in the study group (n = 21) correlated positively with resting heart rate (r = 0.462, p < 0.05) and negatively with increase in diastolic blood pressure (r = -0.514, p < 0.05). Plasma concentrations of ET-1 did not differ between the groups. CONCLUSION: Increased sympathetic activity was found among patients having neck-shoulder symptoms. Local mechanisms may have influenced the cardiovascular changes observed during isometric testing in these patients.

Adult↗
PubMed1995

Lower limb amputees in Southern Finland.

The purpose of this study was to look at the current epidemiological trends of lower limb amputees in 1992 in the area of Southern Finland with 1.2 million inhabitants. Similar data was collected earlier in 1984-85 and 1989. The amputation incidence was found to be 27.4 per 100,000 inhabitants. The trans-tibial/trans-femoral ratio was 0.78. The percentage of prosthetic fitting among patients undergoing unilateral trans-tibial amputation was 68% and the corresponding figure among the trans-femoral patients was 35%. The epidemiological data showed an improvement on that found 8 years earlier although the overall age structure is shifting upwards.

Adult↗
PubMed1994

Isokinetic and non-dynamometric tests in low back pain patients related to pain and disability index.

STUDY DESIGN: This study compared isokinetic and non-dynamometric tests for their correlation with subjective low back pain symptoms. METHODS: A total of 185 patients with chronic low back pain were examined. RESULTS: The repetitive arch-up and sit-up tests correlated significantly with pain and disability (Million index) both in men and women (r ranged from -0.39 to -0.46; P < 0.001). In women, the isokinetic trunk flexion and extension tests and the non-dynamometric tests correlated equally well with the Million index. In men, the isokinetic flexion and extension tests had weaker correlations. Overall, the isokinetic lifting tests showed lower correlations than did the isokinetic trunk extension tests. In the isokinetic flexion and extension tests, fast testing speeds (120 degrees/sec and 150 degrees/sec) correlated somewhat better with the subjective symptoms than did the lowest speed (30 degrees/sec). CONCLUSIONS: The non-dynamometric tests are still useful in clinical practice in spite of the development of more accurate muscle strength evaluation methods.

Adult↗
PubMed1994

Intensive physical and psychosocial training program for patients with chronic low back pain. A controlled clinical trial.

STUDY DESIGN: The authors conducted a controlled clinical trial with 1-year follow-up to define the effectiveness of an intensive physical and psychosocial training program on patients with low back pain. SUMMARY OF BACKGROUND DATA: The intervention group included 152 patients (mean age 40.5 yr, Million index 45.1/100), and the reference group included 141 patients (mean age 40.4 yr, Million-index 44.5/100). METHODS: The progressive intervention program consisted of intensive physical training and psychosocial activation. The outcomes were physical and psychosocial measures, the pain and disability index (Million), sick leaves, and occupational handicap. RESULTS: The intervention was more efficient with respect to physical measures and pain and disability index. There were only mild or no differences in changes between the study groups in psychologic variables, sick leaves, or retirement. CONCLUSIONS: The intervention program could improve physical disability, but to improve occupational handicap, activities of the whole society (social legislation, labor market policy) are needed.

Absenteeism↗
PubMed1994

Anthropometric measurements and the incidence of low back pain in a cohort of pubertal children.

STUDY DESIGN: The authors studied the anthropometric measurements to predict low back pain (LBP) in a cohort of growing adolescents. SUMMARY OF BACKGROUND DATA: The cohort consisted of all the fourth-grade school children of the western school district of Helsinki, Finland, in the spring of 1986. They were examined annually from the mean age of 11.8 to 13.8 years. METHODS: The forward bending test, measurements of total arm length, pelvic equilibrium, and spinal pantographs were carried out by the same physiatrist. A standardized pain questionnaire presented at the final examination obtained the history of LBP. Of the original cohort of 1060 children, those 859 (408 girls and 451 boys) who participated in all the examinations and had not had LBP until the age of 12.8 years were included in this study. RESULTS: The 1-year (from 12.8 to 13.8 years) incidence of LBP was 18.4% in girls and 16.9% in boys. Trunk asymmetry measured by the forward bending test and sitting height were significant determinants of the incidence of LBP. In the whole cohort, the odds ratio (OR) of trunk asymmetry adjusted for all the other risk determinants was 1.19 and its confidence interval (CI) was 1.00-1.39 per one standard deviation increase of the trunk hump. In the multivariate analysis comprising both sexes, OR per one standard deviation increase of sitting height was 1.24, (95% CI 1.03-1.46). In boys, standing height (OR 1.40, 95% CI 1.13-1.65, per one standard deviation) and sitting height (OR 1.35, 95% CI 1.09-1.63, per one standard deviation) were positively associated with the risk of LBP. These associations were not significant in girls. CONCLUSIONS: Sitting height and trunk asymmetry may contribute to LBP in pubertal children. The role of anthropometric characteristics seems, however, modest.

Adolescent↗
PubMed1994

Long-term results of primary scalenotomy in the treatment of thoracic outlet syndrome.

A total of 107 patients with thoracic outlet syndrome were reviewed an average of 4.1 years (range 2-11 years) after primary scalenotomy. The sample included 86 women and 21 men, and the mean age at surgery was 41.9 years (range 16-59 years). The three most disturbing pre-operative symptoms were pain at rest (87%), numbness (66%) and lack of power (55%). The post-operative success rate diminished from 71% 1 month after operation to 63% at follow-up. The retirement frequency increased from 6% up to 33% during the follow-up time. It was highest among factory workers at 60%. Of the patients older than 45 years at surgery, 68% were retired at follow-up. The importance of careful selection for operation is emphasized, and also the need to consider vocational rehabilitation before resorting to surgical treatment of thoracic outlet syndrome. We recommend surgical treatment for this disabling disorder, especially for younger patients with clear evidence of thoracic outlet syndrome who are engaged in occupations demanding little repetitive work. The best results have occurred in this group.

Adolescent↗
PubMed1994

Subjective benefits of energy storing prostheses.

The energy storing (ES) prosthesis has been used in the Prosthetic Foundation's workshop since 1987. Subjective responses from 168 amputees (141 trans-tibial and 27 trans-femoral) fitted with the ES prosthesis were analysed. Ratings were generally favourable in comparison with those for conventional prostheses. The most pronounced advantages of the new prosthesis as shown by the ratings were in walking uphill or swift walking. The younger amputees had more benefit than the older ones. High body weight decreased the benefit of the ES prosthesis. The ES prosthesis does not seem to provide any major advantage for the less active amputee whose movements are mainly indoors.

Adult↗