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Biomedical subjects

M E Brandstater

Publications and source records attributed to M E Brandstater.

At least 19 recordsLinked to original sources
PubMed2001

Painless electrodiagnostic current perception threshold and pain tolerance threshold values in CRPS subjects and healthy controls: a multicenter study.

The purpose of this study is to evaluate both painless and painful sensory transmission in patients with Complex Regional Pain Syndrome (CRPS) using the automated electrodiagnostic sensory Nerve Conduction Threshold (sNCT) test. This test generates reliable, painless Current Perception Threshold (CPT) and atraumatic Pain Tolerance Threshold (PTT) measures. Standardized CPT and PTT measures using constant alternating current sinusoid waveform stimulus at 3 different frequencies 5 Hz, 250 Hz, and 2 kHz (Neurometer CPT/C Neurotron, Inc. Baltimore, MD) were obtained from CRPS subjects at a distal phalange of the affected extremity and at an ipsilateral asymptomatic control site. Matched sites were tested on healthy subjects. Detection sensitivities for an abnormal PTT and CPT test were calculated based on specificity of 90% as determined from data obtained from healthy controls. A Spearman rank correlation was used to test for a significant association between presence of allodynia and an abnormal PTT or CPT at any frequency tested. Thirty-six CRPS subjects and 57 healthy controls were tested. The highest detection sensitivity of the PTT test from symptomatic test sites was 63% for the finger and 71% for the toe. PTT abnormalities were also detected, to a lesser degree, at the asymptomatic control site (41% finger control site, 16% toe control site). The highest CPT detection sensitivity at the symptomatic site was 37% for the finger site and 53% for the toe site. CPT abnormalities were also detected at the asymptomatic control site (29% finger control site, 37% toe control site). Eighty-six percent of the CRPS subjects had either a PTT or CPT abnormality at any frequency at the symptomatic site. There was a significant correlation between presence of allodynia and presence of an abnormal CPT and PTT, respectively (P < .01). The correlation coefficient was lower for CPT than for PTT, ie, 0.34 versus 0.6 for the finger and 0.48 versus 0.67 for the toe, respectively. In studied CRPS patients an abnormal PTT was detected with higher sensitivity than an abnormal CPT. Assessing PTT may become a useful electrodiagnostic quantitative sensory test for diagnosing and following the course of neuropathic pain conditions.

Journal Article↗
PubMed1999

Motor unit number estimate-based rates of progression of ALS predict patient survival.

We have examined, as predictors of survival in patients with amyotrophic lateral sclerosis (ALS), linear estimates of rates of disease progression (LEP), based on motor unit number estimates (MUNE). Motor unit number estimates of thenar, hypothenar, and extensor digitorum brevis muscles (according to the manual method of McComas), isometric grip and foot dorsiflexion (FD) strength, and forced vital capacity (FVC) were available in 34 patients. Linear estimates of rates of disease progression were derived. Probability of survival was calculated using the Kaplan-Meier method. Motor unit number estimates, LEP based on MUNE, and demographic characteristics were tested as risk factors within the Cox Proportional Hazards Model, using regression techniques. Individually, all MUNE-based LEP were highly significant (P < 0.00005); bulbar onset attained modest significance (P = 0.044). Secondary analysis showed MUNE-based LEP were more significant than regionally concordant function-based LEP. Linear estimates of rates of disease progression based on MUNE may thus predict survival of patients with ALS better than LEP based on function.

Adult↗
PubMed1998

Immobilization hypercalcemia in incomplete paraplegia: successful treatment with pamidronate.

Immobilization hypercalcemia (IH) occurs in adolescent patients with high-level complete tetraplegia, but it has not been reported in patients with incomplete paraplegia. We describe two adolescent patients with low-level incomplete paraplegia who developed IH during comprehensive rehabilitation. Conventional therapies with hydration, diuresis, and calcitonin were not effective. Finally, a single-dose infusion of pamidronate, an amino-bisphosphonate, completely resolved the hypercalcemia. Although it has a pharmacologic profile similar to etidronate, pamidronate is more potent, being effective in a single dose, has fewer adverse effects, and has a longer action than etidronate. These features make pamidronate more suitable for the treatment of severe IH in rehabilitation settings. It is reasonable to consider immobilization as the cause of hypercalcemia in low-level incomplete paraplegic patients who have other contributing factors.

Adolescent↗
PubMed1995

Physical medicine and rehabilitation.

An important priority has been the development of quantitative methods for measuring the disability status of patients undergoing rehabilitation. Intramuscular injection of botulinum toxin is an effective new therapy for spasticity due to a number of causes.

Humans↗
PubMed1995

Influence of breathing technique on arterial blood pressure during heavy weight lifting.

Arterial hypertension occurring during heavy resistance exercise may be a risk factor for stroke in healthy young adults. Any training method that ameliorates the pressor effect of exercise should reduce the risk of stroke. The objective of this study was to observe the influence of breathing technique on arterial blood pressure (BP) generated during heavy, dynamic weight lifting. BP was recorded in 10 male athletes by radial artery catheterization. Each subject then performed double-leg press sets at 85% and 100% of maximum. Each exercise was performed twice, once with closed glottis Valsalva, and then with slow exhalation during concentric contraction. The mean BP at 100% maximum with Valsalva was 311/284. The highest pressure recorded in an individual was 370/360. With slow exhalation, the mean BP was 198/175 when the same 100% maximum was lifted (p < .005). A reduced pressor response was also noted at 85% maximal lifting with slow exhalation. Arterial hypertension produced during heavy weight lifting with Valsalva is extreme and may be dramatically reduced when the exercise is performed with an open glottis (without Valsalva). It is concluded that heavy resistance exercise is safer when performed while the subject breathes with an open glottis.

Adult↗
PubMed1994

Efficacy of three measures to relieve pressure in seated persons with spinal cord injury.

This study compares three methods of pressure relief in seated spinal cord injured patients. One method consists of tipping the wheelchair back to 35 degrees, the second, tipping the wheelchair back to 65 degrees, and the third, leaning the subject forward with chest toward thighs. We evaluated dynamic pressure changes in each position using a new pressure mapping system. The greatest pressure relief over the ischial tuberosities was seen in the forward-leaning position. Significant pressure relief was shown in the 65 degrees backward tip. Only a minimal drop in ischial pressure was observed with a backward tip of 35 degrees indicating that the 35 degrees backward-tip position probably provides little protection against ischial skin breakdown.

Adult↗
PubMed1991

Rehabilitation in brain disorders. 3. Intervention strategies.

This self-directed learning module highlights advances in the principles of management of brain disorders. It is part of the chapter on rehabilitation in brain disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The chapter is composed of four articles, and each builds on principles established in the others. This article covers rehabilitation philosophy, management of cognitive remediation, and behavioral management, with attention to communication disorders, social factors, vocational/educational/avocational issues, treatment of motor deficits, dysphagia, sensory dysfunction, sexual dysfunction, and substance abuse. Advances that are covered in this section include pharmacologic and rehabilitative interventions for acute, chronic, and progressive brain injuries and diseases. The learner is directed to articles 1, 2, and 4 in this chapter for supporting information.

Brain Diseases↗
PubMed1991

Rehabilitation in brain disorders. 4. Specific disorders.

This self-directed learning module highlights important aspects of medical rehabilitation of patients with brain disorders. The specific disorders reviewed in this module are traumatic brain injury, stroke, multiple sclerosis, Parkinson's disease, and other degenerative disorders. This module is a section of the chapter on rehabilitation of brain disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The chapter is composed of four articles, and each builds on principles established in the others. Emphasis is given in this section on key elements of current medical practice, including epidemiology, pathophysiology, prognosis, and outcome. Neurologic assessment and management is highlighted for coma, amnesia, cranial nerve and late intracranial complications, postacute management, and postconcussive syndromes. The learner is directed to articles 1, 2, and 3 in this chapter for supporting information.

Brain Diseases↗
PubMed1987

Running endurance in 27-h-fasted humans.

Nine male marathon runners were exercised to exhaustion to determine the effects of a 27-h fast on endurance performance. Each subject completed two exercise tests at the same treadmill speed (set at 70% maximal O2 uptake), one following a 27-h fast and one 3 h after a preexercise meal, in random order. Fasting caused a 44.7 +/- 5.8% (SE) decrease in endurance performance (P less than 0.01). Blood, muscle, psychological, and ventilatory data were examined to determine the cause of the decreased performance. Fasting caused significant increases in O2 uptake (9.3 +/- 2.0%), heart rate (8.4 +/- 2.4%), and rating of perceived exertion, ventilation, and psychological fatigue, evident within the first 60 min of exercise. There were no differences in plasma glucose or epinephrine levels. Muscle glycogen degraded at the same rate (0.482 +/- 0.146 vs. 0.470 +/- 0.281 mumol.g-1.min-1 in the nonfasted and fasted tests, respectively) despite lower respiratory exchange ratio and elevated free fatty acid levels, which may partially explain the elevated O2 uptake. Lactate, insulin, and norepinephrine were all increased in the fasted test (P less than 0.05). The increase in norepinephrine (r = 0.79, P less than 0.01), the diameter of type I muscle fibers (r = 0.70, P less than 0.05), and ending insulin levels (r = -0.88, P less than 0.01) were correlated with endurance time in the fasted state. Fatigue in endurance running for 27-h fasted humans appears to be related to a combination of physiological, psychological, metabolic, and hormonal changes.

Adult↗
PubMed1987

Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs.

This was a controlled study of the efficacy of two forms of therapy on upper limb functions of hemiparetic patients--one heavily behavioral and the other based on Bobath therapeutic exercises. It arose from an earlier pilot study comparing EMG biofeedback with physical therapy from which it was concluded that both the elapsed time since the acute stroke and the severity of residual disability were particularly important factors. Of 29 patients included and randomly assigned to one or the other heavily systematized therapies, 18 were classified as having early-severe and 11 as late-mild conditions. Multiple function tests by a "blinded" special technician in another location revealed that overall both forms of therapy obtained worthwhile clinical and statistical improvement, which was maintained at nine-month recheck testing; but there was no statistically significant superiority of one therapy over the other under the very specific circumstances of the research design. Ease of delivering care and other socioeconomic considerations become important factors in choosing either or both of these methods.

Adult↗
PubMed1983

Hemiplegic gait: analysis of temporal variables.

The objective of this study was to determine key quantitative variables in hemiplegic gait, and to correlate them with clinical abnormality, eg, degree of motor recovery. In 23 hemiplegic patients, clinical and locomotion laboratory assessments gave the following results. Two temporal gait variables, walking speed and symmetry of the swing/phase, showed a good correlation with the stage of motor recovery. Patients with greater degrees of motor recovery walked faster and more symmetrically than those with less motor recovery. None of the other temporal variables analyzed showed a significant relationship with the stage of motor recovery.

Adult↗