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Biomedical subjects

L Sykes

Publications and source records attributed to L Sykes.

18 recordsLinked to original sources
PubMed2003

Agreement between physiotherapists on quality of movement rated via videotape.

BACKGROUND: Although achieving quality of movement after stroke is an important aim of physiotherapy it is rarely measured objectively or described explicitly. OBJECTIVE: To test whether physiotherapists agree on a composite measure of quality of movement. SETTING; A movement analysis laboratory SUBJECTS: Ten stroke patients and 10 healthy age-matched volunteers. DESIGN: Prospective correlational. PROCEDURE: All subjects were videofilmed performing three trials of six standardized functional tasks. Two videotapes were made, each with a different randomized order of appearance of the trials. Ten senior physiotherapists independently rated the videotapes twice using a 100-mm visual analogue scale. ANALYSIS: Analysis of variance models were fitted to transformed data. Estimates of components of variance were calculated and presented as a percentage of the total variance for differences, within subjects (intra-subject), between raters (inter-rater) and within raters (intra-rater). An acceptable percentage was set at less than 10%. RESULTS: The percentage of intra-subject variance ranged from 1% (pick up box and walking) to 9% (step on block). The percentage of inter-rater variance ranged from 18% (pick up pencil) to 38% (sit to stand). The percentage of intra-rater variance was less than 1% for all tasks. CONCLUSIONS: Although physiotherapists disagreed with each other on quality of movement they were more consistent in their own scoring.

Aged↗
PubMed2003

A comparison of knee kinematic characteristics of stroke patients and age-matched healthy volunteers.

OBJECTIVE: To investigate which knee kinematic characteristics show the greatest differences between stroke patients with minimal residual disability and age-matched healthy volunteers as a first step towards the development of a sensitive, objective measure of performance of movement for use in the clinical setting. DESIGN: A comparative study. SETTING: A movement analysis laboratory. SUBJECTS: Ten patients between 6 and 12 months post stroke aged between 65 and 74 years and 10 age-matched healthy volunteers. All patients had made a good recovery and were able to complete all of the functional tasks. INTERVENTIONS: Each subject had reflective markers placed on anatomical landmarks and was filmed performing three movement tasks: sit-to-stand, walking, and step on block. MAIN OUTCOME MEASURES: Knee kinematic characteristics involving timing, joint angle and angular velocity at key points during each task. RESULTS: Significant differences were found between patients and volunteers for only some of the timing and joint angle characteristics but for all angular velocity characteristics for which the mean differences ranged from 31.85 degrees/s for sit-to-stand (p = 0.013) to 82.5 degrees/s (p = 0.014) for the swing phase of gait. CONCLUSIONS: These preliminary findings suggest that angular velocity of the knee during functional tasks might have potential as a sensitive, objective measure of performance of movement after stroke for patients with minimal residual disability.

Aged↗
PubMed2000

The unreliability of clinical measures of muscle tone: implications for stroke therapy.

BACKGROUND: the central tenet of the neurofacilitatory approach to stroke therapy is that muscle tone needs to be normal before normal movement can occur. A reliable clinical measure of the full spectrum of muscle tone is needed to test: (i) the purported relationship between muscle tone, other motor impairments and disability, and (ii) the effectiveness of stroke therapy to restore movement. AIM: the purpose of the study was to test the inter-rater reliability of clinical categorization of muscle tone (spastic/normal/flaccid) and also a visual analogue scale with anchor points of 'lowest tone possible' (score 0) and 'highest tone possible' (score 100). METHODS: four independent raters assessed tone of elbow flexors and knee extensors of 14 stroke rehabilitation inpatients using the categorical scale. Six independent raters assessed tone of elbow flexors and knee extensors of 25 chronic stroke patients and two healthy volunteers using the visual analogue scale. All assessment orders were randomized. RESULTS: both scales were unreliable, with K coefficients for the categorical scale ranging from -0.046 to 0.56 for the categorical scale, and intra-class correlation coefficients for the visual analogue scale of 0.595 for elbow flexors and 0.451 for knee extensors. Assessment order effects for the visual analogue scale were non-significant for elbow flexors (P= 0.545) and knee extensors (P= 0.911). CONCLUSIONS: these results, and those of earlier studies, suggest that clinical measures of muscle tone are consistently unreliable. Systematic investigation of the therapy rationale for planning and evaluating treatment is required before relevant clinical measures can be developed.

Humans↗
PubMed1999

A feeding adaptation by an infant with a cleft palate.

One of the primary problems in the management and care of infants born with cleft palates is that of achieving an adequate seal of the cleft to allow proper swallowing to take place. This article describes an interesting case in which a 14-month-old baby, who had received no surgical or prosthodontic treatment for her cleft palate, had developed her own 'obturation' mechanism to enable her to swallow efficiently.

Bottle Feeding↗
PubMed1996

Scar traction appliance for a patient with microstomia: a clinical report.

This clinical report illustrates how an active traction appliance was made for a patient with severe microstomia by attaching custom-made lip retractors to an orthodontic headgear. A steady, light tensile force was imparted to the lips with the elastic bands between the retractors and the headgear.

Child, Preschool↗
PubMed1996

Energy expenditure of walking for adult patients with spinal cord lesions using the reciprocating gait orthosis and functional electrical stimulation.

A major factor influencing compliance with walking orthoses following spinal cord damage, is the energy requirement associated with them. We compared ambulatory energy expenditure in subjects using the reciprocating gait orthosis (RGO) with and without functional electrical stimulation (FES) of the thigh muscles at self selected walking speeds. Five adult subjects (median age 34 years, range 24-37) with spinal cord lesions ranging from C2 (incomplete) to T6 volunteered to participate in this study. All subjects were successful RGO users (median use 5.7 years, range 4.1-7.3). Walking speed (m/s), ambulatory energy consumption (J/kg/s) and energy cost (J/kg/m) were derived from oxygen uptake determined using the Douglas bag technique. We anticipated that subjects walking with FES would either: (a) walk at the same speed but reduce their energy cost or (b) increase their walking speed for the same (or less) energy cost. Walking speed and energy cost remained unchanged in one subject. One subject increased his walking speed by 14.0% and increased his energy consumption by 8.4%. His energy cost remained unchanged. Three subjects increased their walking speeds (by 12.4, 12.7 and 6.8%), energy consumption (by 25.9, 20.4 and 18.4% respectively) and energy cost (by 11.6, 6.8 and 10.5% respectively). We did not find a substantial benefit, in terms of energy expenditure, from the hybrid system when walking continuously for 5 min. We suggest that the hybrid system may be of greater benefit during prolonged walking, although other limitations, inherent in the RGO itself, may prevent an increase in compliance. Repetition of walking speed tests supported the reliability of our results. Tests on comparably aged, able-bodied subjects showed that an increase in energy cost of up to 5.8% was within the biological variability of the subject and the error of the methodology.

Adult↗
PubMed1996

Objective measurement of use of the reciprocating gait orthosis (RGO) and the electrically augmented RGO in adult patients with spinal cord lesions.

The purpose of the study was to measure objectively the home use of the reciprocating gait orthosis (RGO) and the electrically augmented (hybrid) RGO. It was hypothesised that RGO use would increase following provision of functional electrical stimulation (FES). Five adult subjects participated in the study with spinal cord lesions ranging from C2 (incomplete) to T6. Selection criteria included active RGO use and suitability for electrical stimulation. Home RGO use was measured for up to 18 months by determining the mean number of steps taken per week. During this time patients were supplied with the hybrid system. Three alternatives for the measurement of steps taken were investigated: a commercial digital pedometer, a magnetically actuated counter and a heel contact switch linked to an electronic counter. The latter was found to be the most reliable system and was used for all measurements. Additional information on RGO use was acquired using three patient diaries administered throughout the study and before and after the provision of the hybrid system. Testing of the original hypothesis was complicated by problems in finding a reliable measurement tool and difficulties with data collection. However, the results showed that overall use of the RGO, whether with or without stimulation, is low. Statistical analysis of the step counter results was not realistic. No statistically significant change in RGO use was found between the patient diaries. The study suggests that the addition of electrical stimulation does not increase RGO use. The study highlights the problem of objectively measuring orthotic use in the home.

Adult↗
PubMed1995

The reciprocating gait orthosis: long-term usage patterns.

OBJECTIVE: To investigate the frequency of nonusage of the reciprocating gait orthosis (RGO) in 85 patients supplied between 1986 and 1993. Reasons for nonusage and usage patterns were examined. DESIGN: Nonusage was determined from patient records and clinical knowledge. Patients were surveyed using a detailed questionnaire to produce information on usage patterns. SETTING: All patients had been treated as hospital outpatients. PATIENTS: Most patients had congenital or acquired spinal cord lesions. Postal questionnaires were sent to 81 patients 5 to 55 years of age (mean 20.4 years). Thirty-five patients replied. RESULTS: At a mean follow-up of 5.4 years, 71% of patients were classified as nonusers. Of the 35 respondents to the questionnaire (mean follow-up 5.5 years, range 4 to 7 years), 20 patients were nonusers. Median usage was 27 months in patients under age 18 and 24 months in adult patients. Significant differences were observed between nonusers and users in the areas of perception of the RGO as a functional tool, independence, and reliability and between the adult and the under 18 groups in the areas of weekly usage, function, independence, and reliability. CONCLUSION: The high level of nonusage of the RGO has implications for prescription practice. Identifying reasons for nonusage and acknowledging differences in use between age groups will help in patient assessment.

Activities of Daily Living↗
PubMed1992

Epidemiologic changes in gunshot wounds in Washington, DC, 1983-1990.

The purpose of this study was to examine temporal patterns in gunshot wound admission rates and wound profiles from 1983 through 1990 at a level I trauma center in Washington, DC. Data on trauma admissions were collected at the time of admission. Records were reviewed to identify patients admitted for gunshot wounds from assaults. Data on the number and location of entrance gunshot wounds, survival, complications, length of stay in the intensive care unit, and total inpatient days were recorded. Admissions due to gunshot wounds grew at an exponential rate beginning in 1987 and reached a level from 1989 through 1990 three times higher than the preepidemic rate. The mean number of entrance gunshot wounds per patient grew from 1.44 before the epidemic to 2.04 from 1988 through 1990. Multiple thoracic wounds became relatively more common from 1988 through 1990. This increase was partially responsible for reversing a downward trend in patient mortality. Temporal changes in admission rates and wound profiles were consistent with the city's epidemic of drug-related violence and with a shift in weaponry toward high-capacity, semiautomatic handguns.

Adult↗
PubMed1978

Sensitivity of urine-grown cells of Providencia stuartii to antiseptics.

Urine-grown cultures of 23 clinical isolates of Gram-negative bacteria having a range of minimum inhibitory concentration values for chorhexidine were challenged with various concentrations of this antiseptic. The results suggest that cells of Providencia stuartii, in particular, exhibit a considerable degree of resistance to chlorhexidine under these conditions, concentrations of up to 10 000--20 000 microgram/ml of urine being necessary to produce complete loss of viability of such cultures. Of the other two antiseptics tested, phenoxyethanol proved to be the more effective, the recommended use concentration of 2% v/v producing reductions in viable counts of greater than six logarithms in all the strains examined. It is suggested that phenoxyethanol may be a suitable alternative to the cationic agents for use in antiseptic policies for bladder management of urinary tract infections with Providencia stuartii.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Accidental hypothermia with cardiac arrest: recovery following rewarming by cardiopulmonary bypass.

A 22-year-old man eventually had a good neurologic recovery following prolonged coma after extracorporeal rewarming from profound hypothermia (24 degrees C) due to exposure. The patient was in full arrest for 60 minutes prior to institution of cardiopulmonary bypass (CPB). Total bypass time was 50 minutes. Cardiopulmonary bypass is the current rewarming method of choice for severe hypothermia associated with a persistent nonperfusing cardiac rhythm. CPB provides the most rapid core rewarming with the additional benefit of circulatory support during the period of cardiac instability.

Adult↗
PubMedDate not supplied

Outcome measures for the study of activities of daily living in vascular dementia.

Decline in functional abilities is a major component of the dementia syndrome. The definition of dementia in the International Classification of Diseases (10th rev.) requires a cognitive impairment sufficient to impair personal activities of daily living (ADL). The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) also requires cognitive deficits sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from a higher level of functioning. However, the term disability is more appropriate than impairment to describe a loss in activities, as opposed to a loss of elementary functions, and is consistent with World Health Organization definitions of impairment, disability, and handicap. There is no doubt that ADL outcomes are required in therapeutic drug studies on vascular dementia, and there is a good rationale and some evidence for the use of ADL scales developed for therapeutic research in Alzheimer disease, favoring scales devoid of items sensitive to physical disabilities. Similarly, ADL-related clinical milestones could be used for longer-term studies aiming predominantly at slowing progression of disease in both early and later stages of dementia. Slower decline in ADL and delay in reaching ADL-related clinical milestones should be considered as valid outcomes by regulatory bodies in the process of dementia drug approval.

Activities of Daily Living↗
PubMedDate not supplied

The effect of long-term thyroxine on bone mineral density and serum cholesterol.

The effect of thyrotrophin suppression on bone mineral density (BMD) and serum cholesterol concentration was assessed in 31 treated hypothyroid women. Measurements of the BMD of the lumbar spine and femoral neck were repeated in seven of those with the lowest value after an average period of 22.7 months. Final cholesterol concentrations were compared with values before thyroxine was started. The dose of thyroxine was based on clinical assessment, serum triiodothyronine concentrations kept within the normal range, and thyrotrophin values within the normal range or suppressed. The patients had taken thyroxine replacement for a mean of 12.7 years. Two-thirds (21 subjects) had suppressed thyrotrophin concentrations, and it was normal in one-third (10). Fifteen subjects had a past history of thyrotoxicosis. BMD and cholesterol concentrations were compared between those with suppressed and normal thyrotrophin concentrations and between those with and without a past history of thyrotoxicosis. No patient had a pathological fracture. One had a Z value for the femoral neck of -1.6, denoting early but definite osteoporosis, and five had borderline osteoporosis with Z values for one or other site between -1.1 and -1.5. None of the seven with the lowest BMDs had any significant change when measurements were repeated. The difference in Z values between subjects with suppressed and normal thyrotrophin concentrations was not significant for either the lumbar spine (p = 0.68) or the femoral neck (p = 0.28). A past history of thyrotoxicosis had a greater effect on BMD for both sites than thyrotrophin suppression, but again the difference between those with and without a past history of thyrotoxicosis was significant neither for the lumbar spine (p = 0.18) nor for the femoral neck (p = 0.34). The combination of thyrotrophin suppression and a past history of thyrotoxicosis also failed significantly to reduce the BMD of the lumbar spine (p = 0.38) or femoral neck (p = 0.30) in comparison with those who had neither thyrotrophin suppression nor a past history of thyrotoxicosis. The mean fall in serum cholesterol concentration was 2.1 mmol/l (SD 1.78) (p = 0.001) in those with a suppressed thyrotrophin concentration taking a mean daily dose of thyroxine of 171 micrograms (SD: 34.7), compared with a fall of 0.89 mmol/l (SD: 1.04) (p = 0.065) in those whose thyrotrophin concentration was not suppressed on a mean daily thyroxine dose of 140 micrograms (SD: 50). No patient had atrial fibrillation or cardiographic evidence of coronary artery disease (CAD). The serum cholesterol concentration should play at least as important a part in influencing the dose of thyroxine as a fear of osteoporosis. Fractures are not a feature in the natural history of treated hypothyroidism, whereas CAD is a common cause of death in these patients.

Bone Density↗