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Biomedical subjects

S L Wolf

Publications and source records attributed to S L Wolf.

At least 19 recordsLinked to original sources

Iron uptake by Escherichia coli cultured with antibodies from cows immunized with high-affinity ferric receptors.

The synergistic effects of immunoglobulin G (IgG) from cows vaccinated with ferric citrate receptor (FecA) and IgG from cows vaccinated with ferric enterobactin receptor (FepA) were measured in an in vitro iron uptake assay. Serum was isolated and pooled within treatment from five cows each vaccinated with FepA or FecA or not vaccinated. Immunoglobulin G was isolated by ammonium sulfate precipitation and protein G affinity chromatography. Six Escherichia coli isolates from bovine intramammary infections were cultured in an iron-depleted medium to induce high-affinity iron acquisition systems and, in iron-depleted conditions, to specifically induce the expression of FecA. The bacterial cells were mixed with either 3 or 6 mg/mL of purified IgG and 55Fe. The radioactivity of 55Fe taken up by the bacterial cells was measured by a liquid scintillation counter after 5-, 10-, and 15-min incubations at 37 degrees C. The combination of anti-FecA IgG and anti-FepA IgG reduced 55Fe uptake compared with either anti-FecA or anti-FepA alone. Iron uptake was reduced more by anti-FecA IgG than by anti-FepA IgG when the ferric citrate system was induced. Reduction of iron uptake did not differ between anti-FepA alone and anti-FecA alone when citrate was absent from the medium.

Animals↗

A study design to investigate the effect of intense Tai Chi in reducing falls among older adults transitioning to frailty.

This paper describes the study design, methodological considerations, and baseline characteristics of a clinical trial to determine if intense (48 weeks, twice per week) Tai Chi practice can reduce the frequency of falls among older adults transitioning to frailty compared to a wellness education program. Twenty facilities will be stratified on socioeconomic status and facility type and randomly assigned to one of the two interventions. Secondary outcome measurements include variables related to function, behavior, and the biomechanics of movement. This study is unique because it represents an effort to offer a novel physical intervention to a large sample of transitional frail adults, a population that has received few formal exercise interventions. In addition to bringing the interventions into facilities, a 1-year follow-up is also included to assess rates of change in outcome measurements.

Accidental Falls↗

From tibialis anterior to Tai Chi: biofeedback and beyond.

This keynote presentation highlights events that have contributed to scientific explorations of one research clinician. Steve Wolf traces his scientific roots to early studies in single motor unit control under the guidance of his primary mentor, John Basmajian, MD. This work led to subsequent studies on the role of EMG feedback in predicting successful outcomes in upper extremity use and in ambulatory capabilities among patients with chronic stroke. These findings are contrasted to further efforts to condition entire reflexes rather than individual muscles through use of operant-conditioning paradigms. The findings from applications of EMG biofeedback to stroke patients became the basis for minimal motor criteria in the treatment of the impaired upper extremities of patients with chronic stroke, using "forced use" or "constraint-induced movement therapy." Last, investigations into center of pressure feedback using computerized balance machines resulted in a series of experiments that ultimately led to the finding that Tai Chi as an exercise form for older adults can have a substantially favorable effect in delaying the onset of fall events.

Biofeedback, Psychology↗

Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty.

OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity-related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC). DESIGN: Baseline cross-sectional analysis in a prospective cohort intervention study. SETTING: Twenty independent senior living facilities in Atlanta. PARTICIPANTS: Seventeen male and 270 female subjects (n = 287), age 70 and older (mean +/- standard deviation, 80.9 +/- 6.2), with Mini-Mental State Examination score > or = 24, transitioning to frailty, ambulatory (with or without assistive device), medically stable, and having fallen in the past year. MEASUREMENTS: Activity-related fear of falling was evaluated with the FES and ABC Scale. Because of the comparable data derived from each scale, associations with functional measures-related analyses were expressed using the latter. Depression was measured by Center for Epidemiological Studies Depression Scale. Functional measurements included timed 360 degrees turn, functional reach test, timed 10-meter walk test, single limb stands, picking up an object, and three chair stands. RESULTS: No statistically significant association was found between activity-related fear of falling and age. For the proposed activities, about half (ABC, 48.1%; FES, 50.1%) of the subjects were concerned about falling or showed lack of confidence in controlling their balance. A statistically significant inverse correlation was found between FES and ABC (r = -0.65; P < .001). African-American subjects showed more activity-related fear of falling than did Caucasians (odds ratio (OR): 2.7 for ABC; 2.1 for FES). Fearful individuals were more likely to be depressed and more likely to report the use of a walking aid than were nonfearful individuals. Fear of falling was significantly correlated to all of the functional measurements (P < .05). In a multivariable logistic regression model, depression, using a walking-aid, slow gait speed, and being an African-American were directly related to being more fearful of falling. CONCLUSIONS: Activity-related fear of falling was present in almost half of this sample of older adults transitioning to frailty. The significant association of activity-related fear of falling with demographic, functional, and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity-related fear of falling in this population.

Accidental Falls↗

Modified emory functional ambulation profile: an outcome measure for the rehabilitation of poststroke gait dysfunction.

BACKGROUND AND PURPOSE: The modified Emory Functional Ambulation Profile (mEFAP) is an easily administered test that measures the time to ambulate through 5 common environmental terrains with or without an assistive device or manual assistance. The mEFAP was evaluated for its interrater reliability, test-retest reliability, concurrent validity, and sensitivity to change during outpatient rehabilitation for poststroke gait dysfunction. METHODS: Twenty-six poststroke patients were followed up prospectively in a rehabilitation day-treatment program. The mEFAP, Berg Balance Test (BBT), and 7-item mobility subsection of the Functional Independence Measure + Functional Assessment Measure (FAMm) were completed at admission and discharge. RESULTS: mEFAP interrater reliability (intraclass coefficient [ICC] 0.999) and test-retest reliability (ICC 0.998) were high. The BBT demonstrated high interrater (ICC 0.992) but poor test-retest (ICC 0.605) reliability. Initial and final scores comparing the mEFAP with the BBT (r=-0.735, r=-0.703) and the mEFAP with the FAMm (r=0.685, r=-0.775) were strongly correlated. Improvement on the mEFAP correlated with improved BBT performance (r=-0.524). There was no correlation between overall change observed on the FAMm and change on the mEFAP (r=-0.145). Total mEFAP and all mEFAP subtask scores improved over time (P:<0.0001). CONCLUSIONS: The mEFAP is a reliable gait-assessment tool for patients with stroke and is sensitive to change in ambulation speed.

Adult↗

Assessing Wolf motor function test as outcome measure for research in patients after stroke.

BACKGROUND AND PURPOSE: The Wolf Motor Function Test (WMFT) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements. This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population. METHODS: Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment. Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment (FMA) on 2 occasions (12 to 16 days apart), with scoring performed independently by 2 random raters. RESULTS: The WMFT and FMA demonstrated agreement (P<0.0001) between raters at each session. WMFT scores for the dominant and nondominant extremities of individuals without impairment were different (P</=0.05) from the more and less affected extremities of subjects after stroke. The FMA score for the more affected extremity of subjects after stroke was different (P</=0.05) from the dominant and nondominant extremities. However, the FMA score for the less affected upper extremity of individuals after stroke was not different (P>0.05) from the dominant and nondominant extremities of individuals without impairment. The WMFT and FMA scores were related (P<0.02) for the more affected extremity in individuals after stroke. CONCLUSIONS: The interrater reliability, construct validity, and criterion validity of the WMFT, as used in these subject samples, are supported.

Adult↗

Doing it with mirrors: a case study of a novel approach to neurorehabilitation.

Arm amputees can experience the perception of movement of a phantom limb while looking at a mirror reflection of the moving, intact arm superimposed on the perceived phantom. Such use of a mirror to provide illusory visual feedback of movement can be useful in rehabilitation of hemiparetic patients. In this case report, we describe the successful application of "mirror therapy" to the post-stroke rehabilitation of a patient with poor functional use of an upper extremity, due mainly to somatosensory deficits. Mirror therapy facilitated employment of a motor copy strategy (bimanual movements) and later progression to "forced use" of the affected arm. The end result was increased functional use of the affected upper limb.

Arm↗

An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke.

BACKGROUND AND PURPOSE: The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a "learned nonuse phenomenon." CASE DESCRIPTION: The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). OUTCOMES: For the Wolf Motor Function Test, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both "how well" and "how much" the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. DISCUSSION: Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.

Arm↗

Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile.

BACKGROUND AND PURPOSE: The Emory Functional Ambulation Profile (E-FAP) measures time to walk in different environments and accounts for use of assistive devices. This study assessed the reliability and validity of walking time measurements using these components. SUBJECTS: Twenty-eight subjects who had strokes and 28 subjects without impairment were recruited. METHODS: The E-FAP, Berg Balance Test, Functional Reach Test, and Timed 10-Meter Walk Test were administered in random order during a single data collection session. RESULTS: Interrater reliability for the total E-FAP was > or = .997. Subjects without impairment performed better on all 4 tests than did subjects who had strokes. Increased times on the E-FAP correlated with poor performance on the Berg Balance Test and slow gait speeds on the Timed 10-Meter Walk Test in the subjects who had strokes. The E-FAP scores and the Functional Reach Test scores were not correlated. CONCLUSION AND DISCUSSION: The E-FAP can be administered easily and inexpensively. Because the E-FAP scores differentiated subject groups and correlated with known measures of function, the E-FAP may be a clinically useful measure of ambulation.

Adult↗

Organization of responses in human lateral gastrocnemius muscle to specified body perturbations.

There is mounting evidence that human muscles have discrete partitions. In an effort to accurately assess how the control to each of the three heads (designated as A-C) of the lateral gastrocnemius (LG) muscle might be organized, we performed exploratory studies in five subjects each of whom was provided 30 random angular and linear perturbations while standing on a balance platform in each of three experiments. The responses from each LG head were recorded with strategically-placed fine-wire electrodes and, after correction for variation in distance to each recording site, latency to activation and the sequence of recruitment for each LG head were determined. Within individual subjects, the same LG head was first recruited. The C-head was recruited first during linear perturbations between subjects and across sessions, but the overall recruitment pattern was different between subjects. The fact that a consistent, selective response was seen during dynamic linear but not angular perturbations suggests that a more consistent strategy of inter-partition response may be engaged for the former perturbation. This behaviour may be caused by use of the LG C-head to assist the medial gastrocnemius to control ankle plantar flexion and pronation during the shearing forces generated with linear translations. Further exploration into the relationship between selective activation of muscle partitions in the presence of defined movement conditions appears justified.

Adolescent↗

Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach.

For many centuries Tai Chi has been a martial art form, practiced primarily in Oriental cultures. For the past 300 years this movement approach has been used as an exercise form, practiced by millions of Chinese elderly people. To date, virtually no information exists about the therapeutic elements of this intriguing movement sequence. This article provides a historical review of existing documentation of reputed Tai Chi benefits. The 108 "forms" of Tai Chi Chuan are reduced to 10 composite forms for ease of application of these forms to older individuals within a reasonable time frame. An effort is set forth to identify the potential therapeutic elements within these forms.

Age Factors↗

Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group.

OBJECTIVE: To conduct an in-depth examination of the environmental and behavioral circumstances associated with falls and near-falls experienced by elderly individuals and to evaluate the usefulness of reenactment as a method for studying falls. DESIGN: Observational and self-report data of incidents were obtained through a reenactment procedure. Environmental characteristics were documented with physical measurements, visual inspection, and photography. SETTING: Incidents occurred inside participants' homes, and reenactments were conducted at incident sites. PARTICIPANTS: Subjects were 15 community-dwelling, relatively healthy individuals, age 70 to 81 years. MAIN OUTCOME MEASURES: Incidents were analyzed to determine patterns of interaction of individuals' personal characteristics, environmental use behaviors, and environmental characteristics. RESULTS: Seven patterns were identified: collisions in the dark, failing to avoid temporary hazards, preoccupation with temporary conditions, frictional variations between shoes and floor coverings, excessive environmental demands, habitual environmental use, and inappropriate environmental use. CONCLUSIONS: There is a dynamic interaction between environmental conditions and behavior involving use of the environment and its implications for falls in older people. Although some incidents involved familiar environmental and behavioral risk factors, less familiar factors also were critical contributors to the incidents. Successful elimination of these factors is likely to be closely related to an individual's perception that an environmental or environmental use problem is correctable, motivation to undertake changes in the environment, and a desire to integrate changes into daily activities.

Accidental Falls↗

Self-report benefits of Tai Chi practice by older adults.

Older persons who are willing to begin exercise programs are often not willing to continue them. At the Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) site, individuals aged 70+ were randomized to Tai Chi (TC), individualized balance training (BT), and exercise control education (ED) groups for 15 weeks. In a follow-up assessment 4 months post-intervention, 130 subjects responded to exit interview questions asking about perceived benefits of participation. Both TC and BT subjects reported increased confidence in balance and movement, but only TC subjects reported that their daily activities and their overall life had been affected; many of these subjects had changed their normal physical activity to incorporate ongoing TC practice. The data suggest that when mental as well as physical control is perceived to be enhanced, with a generalized sense of improvement in overall well-being, older persons' motivation to continue exercising also increases.

Activities of Daily Living↗

The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques.

BACKGROUND AND PURPOSE: This study explored whether two exercise programs would affect the ability to minimize postural sway of 72 relatively inactive, older subjects who participated in the Atlanta FICSIT trial. SUBJECTS: Subjects were randomly assigned to (1) a computerized balance training group, (2) a tai chi group, or (3) an educational group serving as a control for exercise. Each group consisted of 24 members. METHODS: All subjects were evaluated under four postural conditions before, immediately after, and 4 months following their respective interventions, each of which was given over 15 weeks. RESULTS: Platform balance measures revealed greater stability after training among subjects in the balance training group but little change in stability among subjects in the tai chi and educational group. Subjects in the tai chi group were less afraid of falling after training compared with subjects in other groups with similar covariates. CONCLUSION AND DISCUSSION: Unlike computerized balance training, tai chi does not improve measures of postural stability. Because tai chi delayed onset to first or multiple falls in older individuals, this effect does not appear to be associated with measures of enhanced postural stability. Tai chi may gain its success, in part, from promoting confidence without reducing sway rather than primarily facilitating a reduction in sway-based measures.

Accidental Falls↗

Morphological analysis of the human tibialis anterior and medial gastrocnemius muscles.

The morphology and nerve innervation patterns of eight tibialis anterior (TA) and medial gastrocnemius (MG) muscles from human cadavers were examined. TA has three distinct partitions, two of which lie posteriorly. The anterior aspect of the muscle has one partition (head A) whose fibers are oriented longitudinally. The posterior partitions possess fibers that course longitudinally (B head) and obliquely (C head). The posterior longitudinal fibers and the anterior longitudinal fibers are divided by an aponeurosis that is continuous with the tendon of insertion. The proximal muscle fibers insert into this aponeurosis and the distal fibers insert into the tendon. The MG is a unipennate muscle. Both TA and MG muscles show variations in innervation patterns among specimens. In light of these findings, partitioning of TA may be based on its architecture.

Cell Size↗

Electrokinesiologic measurement of trunk sagittal mobility and lumbar erector spinae muscle activity.

Additional studies to determine intratester reliability of electrokinesiologic (EK) measures related to trunk movement and low back muscle activity are needed. EMG activity and EK records of repetitive movements at both natural and maximal speeds were computer sampled and quantified among 22 nonimpaired subjects. Significant differences were observed between group means at different speeds and trials for both kinematic and EMG measures. Predictably, maximal speed testing resulted in higher levels of EMG activity when compared to natural speed testing. Intratester reliability of measures was high at both speeds. Range of motion data correlated well between two trials for both natural and maximal speed movements, ranging from 0.81 to 0.97. Correlation of speed of movement measures ranged from 0.41 to 0.76. These data suggest that computer-analyzed EMG activity and EK signals are reliable assessment tools for trunk mobility. The application of this procedure to persons with low back pain to acquire EMG activity and mobility data appears justified.

Adolescent↗