Bladder retraining device for handicapped persons.
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Biomedical subjects
Publications and source records attributed to M Sinaki.
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In blind persons, perception from the remaining sensory mechanisms is of utmost importance in maintaining contact with their surrounds. Absence of visual input in bilateral hand amputees would render the use of prosthetic devices unsuccessful. Krukenberg's kineplasty, which transforms the forearm stump into a forceps and provides retention of tactile, pain, temperature, and proprioceptive inputs, can increase the patient's functional abilities substantially. In the case reported, a 12-year-old boy who became blind and a bilateral hand amputee as a result of an explosion had significantly improved functional ability, independence, and life-style after this procedure. Active physical and occupational therapy and muscle re-education, begun two to three weeks after the Krukenberg procedure, were very important in aiding the patient to achieve independent function.
Forth-seven patients with symptomatic back pain secondary to spondylolisthesis who were not surgical candidates were instructed in a treatment program that included flexion or extension or combined flexion-extension exercises. At follow-up, symptomatic changes were correlated with the type of exercise program. Patients treated with flexion-type exercises were less likely to require use of back supports, require job modification, or limit their activities because of pain. Although surgical treatment of spondylolisthesis has been outlined in current literature, conservative programs have not been well defined. Factors aggravating pain and a specific program for pain reduction are discussed.
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Rehabilitation techniques for the management of patients with amyotrophic lateral sclerosis are aimed at maintaining the patients at their optimum functional levels for as long as possible and at preventing complications secondary to disuse of muscles and immobilization. A functional staging of patients is proposed which is helpful in categorizing them in reference to the type of rehabilitative techniques required and the kinds of assistive devices needed.
The clinical picture in and efficacy of physical treatment for pelvic floor myalgia were reviewed. The medical records of patients having a diagnosis of pyriformis syndrome, coccygodynia, levator ani spasm syndrome, proctalgia fugax, or rectal pain who had been seen at the Mayo Clinic and treated in the Department of Physical Medicine and Rehabilitation from 1970 through 1975 were retrieved. Adequate information and follow-up were available for 94 patients. Seventy-eight patients were women and 16 were men, whose ages ranged from 26 to 72 years. All patients had tenderness of the pelvic floor muscles on rectal examination. The most common associated findings were poor posture, deconditioned abdominal muscles, and generalized muscle attachment tenderness. The most effective therapeutic regimen was a combination of rectal diathermy, Thiele's massage, and relaxation exercises. Of the 94 patients, 30 had complete resolution of their symptoms, 19 had marked improvement, 17 had moderate improvement, and 14 had mild improvement. Only 14 patients had no change and 1 patient was worse after treatment.
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Aging and osteoporosis have been associated with skeletal changes. Back extensor strengthening exercises are highly recommended for management of back pain, especially back pain related to osteoporosis. To our knowledge, the correlation of thoracic kyphosis, lumbar lordosis, and sacral inclination with back extensor strength, physical activity, and bone mineral density has not been critically studied in healthy, active, estrogen-deficient women. In a study of 65 such women (ages 48-65 yr), back extensor strength, bone mineral density, and physical activity score were evaluated and measured. These factors were then correlated with radiographic factors: (1) vertebral body ratios (anterior/posterior height) calculated for each vertebra from T-4 through L-5; (2) kyphosis index determined by adding the anterior heights of each vertebral body, T-4 through T-12, and then dividing the total by the corresponding sum of the posterior heights of each vertebral body; (3) thoracic kyphosis; (4) lumbar lordosis; and (5) sacral inclination. Back extensor strength had a significant negative correlation with thoracic kyphosis (r = -0.30, P = 0.019) and a positive correlation with lumbar lordosis (r = 0.26, P = 0.048) and sacral inclination (r = 0.34, P = 0.009). However, bone mineral density and physical activity score did not show any significant correlations with the radiographic factors. The results indicate that the stronger the back extensor, the smaller the thoracic kyphosis and the larger the lumbar lordosis and sacral inclination. We conclude that back extensor strength is an important determinant of posture in healthy women. However, prescribing back extensor strengthening exercises alone may also increase lumbar lordosis, which is not desirable.
Physical activity in children is important, both for its direct benefits and for establishing potentially lasting future behaviors. Understanding the development of back strength in children is also important, because decreased back strength is associated with low back pain in adults. We hypothesized the following: (1) a substantial percentage of children do not participate in adequate physical activity; (2) the development of back strength corresponds to the development of strength of appendicular muscles; (3) there is a positive relationship between physical activity and back strength. The study included 53 boys and 43 girls, aged 10 to 19 yr, who had undergone isometric strength testing 4 yr previously. From responses to a questionnaire, each child's level of physical and sedentary activity was calculated. Isometric back flexion and extension were measured with the same method used 4 yr previously. Statistical analyses were performed, including quadratic regressions to estimate the rate of increase in strength, height, and weight. The following results were found: (1) during the month before testing, 21 children participated in physical activity for less than 30 min/day; (2) the level of physical activity was significantly associated with back flexion and back extension (P = 0.03 for both); (3) the peak rate of increase in back strength occurred approximately 1 yr after the peak rate of increase in height. We conclude the following: (1) measures should be taken to increase the involvement of children in athletic activities; 2) physical activity may be important in the development of back strength; (3) the pattern of back strength development seems to be the same as that for development of muscles of the appendicular skeleton.
We proposed that there are significant correlations between muscle strength and bone mineral density in premenopausal women and that these correlations are site-specific. To test this hypothesis, we examined the relationships among site-specific bone mineral density, physical activity, and muscle strength in a group of 96 healthy premenopausal Caucasian women. Bone mineral density was measured at the lumbar spine and at three sites in the proximal femur (trochanter, femoral neck, and Ward's triangle) with dual-energy x-ray absorptiometry and at the mid-radius with single-photon absorptiometry. The muscle strength of hip and spinal muscle groups was determined with a strain gauge isodynamometer, and grip strength was measured with the JAMAR dynamometer. The strength of shoulder girdle muscle groups was evaluated with the use of free weights. Physical activity was determined by surveying the subjects and by using a standardized scale. Data analysis revealed significant linear correlations of muscle strength with bone mineral density at the mid-radius (r = 0.31; P = 0.002) and at the hip (r = 0.26; P = 0.01). Grip strength was significantly correlated with bone mineral density of both the spine and the femur (r = 0.24, r = 0.34; P < 0.05 for both). Back extensor strength correlated with bone mineral density of the hip (Ward's triangle; r = 0.23; P = 0.023). However, there was no significant positive correlation between the strength of the spinal flexor or extensor muscles and the site-related bone mass (lumbar spine). Only one of the three components of the physical activity score (job) positively correlated with vertebral bone mineral density (r = 0.21; P = 0.04). Physical activity negatively correlated with age (r = 0.24; P = 0.02). We conclude that in premenopausal women, the effect of muscle strength on bone mass is more systemic than site-specific. A positive correlation between vertebral bone mass and components of physical activity demonstrates that even job-related physical activity is an important factor in maintaining adequate bone mass.