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Biomedical subjects

S L Wolf

Publications and source records attributed to S L Wolf.

At least 73 records · Page 4Linked to original sources
PubMed1987

Malpractice litigation for uninformed consent. Implications for physical therapists.

Although physicians generally are expected to secure their patients' informed consent to medical treatment, an emerging body of legal opinion holds that in certain situations nurses and allied health care professionals may be found similarly responsible. Failure of a health care provider to protect a patient's right of informed consent might result in a lawsuit alleging that serious harm was sustained needlessly because the patient plaintiff was not informed of certain significant risks of or consequences that resulted from treatment. As a professional group that puts patients at risk of harm during treatment, physical therapists need to know about their legal duty to facilitate a patient's awareness of and consent to treatment. This article discusses the nature of that duty and how a patient plaintiff might try to prove negligence against a physical therapist who allegedly fails to secure a valid statement of informed consent. The article also provides recommendations so that physical therapists might protect themselves from malpractice suits alleging "uninformed" consent.

Humans↗
PubMed1985

Applications of transcutaneous electrical nerve stimulation in the management of patients with pain. State-of-the-art update.

Numerous publications devoted to the topic of transcutaneous electrical nerve stimulation (TENS) have appeared since the presentation of a special issue of Physical Therapy (December, 1978). This update article addresses contemporary information on efficacy, mode of application, treatment outcomes, and neurophysiological mechanisms relevant to this modality. Investigators have become far more specific when presenting this information in the current literature on treating acute pain conditions with TENS than they were in the literature for the 1978 special issue. Improvement has been made in providing specific details to enable replication of TENS stimulating characteristics among patients with chronic pain; yet several clinical researchers still fail to evaluate treatment outcomes adequately. Perhaps the greatest advances in our understanding of TENS involve the recent development of mechanisms that might account for how different types of TENS work. Suggestions for predicting patient responses to TENS and for avenues of future inquiry are offered.

Electric Stimulation Therapy↗
PubMed1984

Assessing the reliability of measurements from the Krusen limb load monitor to analyze temporal and loading characteristics of normal gait.

This study assessed the reliability of measurements made by four physical therapists on healthy subject gait data recorded from the Krusen limb load monitor. The five components of step (stance time, time up, time to second peak, and force at the first and second peaks) were analyzed. Six components contributing to gait (ambulation time; velocity; cadence; average swing phase duration, left lower extremity; average swing phase duration, right lower extremity; and ratio of unilateral weight bearing, right lower extremity to left lower extremity) were also analyzed. Intraclass correlation coefficients for the five step components and the gait measures of ambulation time, velocity, and cadence showed high measurement reliability. The other measures of gait showed low intraclass correlation coefficients. The limb load monitor can, therefore, be used by clinicians to measure the five step components and three gait measures (ambulation time, velocity, and cadence) with high measurement reliability.

Adult↗
PubMed1983

Electromyographic biofeedback applications to the hemiplegic patient. Changes in upper extremity neuromuscular and functional status.

The effect of a specific EMG biofeedback treatment protocol on quantified changes in neuromuscular measures and functional activities was examined among the upper extremities of 22 chronic stroke patients who each received 60 feedback training sessions. These data were compared with changes measured from a Control Group of 9 (no treatment) patients. Those patients receiving feedback training showed significant improvements in numerous neuromuscular measures but not in functional measures. When the Experimental Group was subdivided into two groups (hand, n = 5; no hand, n = 17) on the basis of acquiring a specific hand function, significant pretreatment differences in neuromuscular status emerged. Based upon these pretreatment differences and outcome measures, characteristics possibly predictive of beneficial outcomes from EMG biofeedback training were exposed. Chronic stroke patients who gained maximal functional benefits from the biofeedback intervention initially had greater active range of motion at all major upper extremity joints and comparatively less hyperactivity within typically "spastic" muscles. Electromyographic biofeedback can lead to substantial improvements among select chronic stroke patients and can be of considerable functional benefit to others.

Adult↗
PubMed1983

Electromyographic biofeedback applications to the hemiplegic patient. Changes in lower extremity neuromuscular and functional status.

The efficacy of EMG biofeedback in improving neuromuscular and functional measures of involved lower extremities in an Experimental Group of chronic stroke patients (n = 7) was examined. Differences in pretreatment-posttreatment measures of the Experimental Group were compared with those of groups of chronic stroke patients receiving no treatment (n = 6), biofeedback treatment of the involved upper extremity only (n = 16), and general relaxation training (n = 8). All examinations were performed in a blind fashion. The Experimental Group showed significant improvement in active range of motion at the knee and ankle that appeared to result from increases in EMG output to muscles governing these movements. Experimental patients did not improve substantially in walking speed over different terrains but did require significantly fewer or less complex assistive devices to walk. Limitations in the design and implementation of this study are provided, and suggestions for future investigation are offered.

Adult↗
PubMed1983

Electromyographic biofeedback applications to stroke patients. A critical review.

This article critically reviews publications on EMG biofeedback applications to stroke patients. The state of the art on specificity of treatment effects, consistency across training procedures, measurement techniques, outcome assessments, transfer of treatment effect, and mechanism of action is discussed. Although EMG biofeedback may augment movement capabilities, at least as well as exercise regimens, data relating neuromuscular changes to function are limited. The deficiencies in our current knowledge about this application to stroke patients are identified, and suggestions for items requiring future clarification are delineated.

Age Factors↗
PubMed1982

The motor unit. Anatomy and physiology.

The physiological and anatomical properties of mammalian motor units are discussed, and the results of human and animal studies are compared. A physiological organization of motor units based on the mechanical properties of their associated muscle units is examined. It is concluded that such an organizing principle has broad universal application in both animal and human studies. An anatomical organization of muscle units by their association with their physiological properties and the histochemical profile of their muscle fibers is also considered. The anatomical organizing principle also has broad-ranging applicability. The organization of muscle units according to muscle architecture and innervation patterns is described and its potential applicability to considerations of muscle structure and function is discussed. It is concluded that a number of gaps in our knowledge of muscle unit organization have been identified, especially among human studies, but the potential to fill these gaps rapidly is great.

Action Potentials↗
PubMed1982

Use of the Krusen Limb Load Monitor to quantify temporal and loading measurements of gait.

The purposes of this investigation were to determine whether the temporal and force measurements from the Krusen Limb Load Monitor produced clinically reliable data and to begin identifying the factors that determine the monitor's reliability. Temporal and loading measurements were made from the output of the Krusen Limb Load Monitor and compared to values obtained from a calibrated force platform. Such comparisons were made for 30 steps taken by two subjects on three separate occasions and from the same two subjects plus a third subject for 100 consecutive steps. For most measures, mean values from the limb-load monitor were significantly different from those recorded from the force platform. From a clinical perceptive, however, the range of measures was narrow for the 95 percent confidence level of the observed differences for the temporal components of stance between the limb-load monitor and force platform, with the narrowest range of measures related to the appropriateness of "fit" of the limb-load monitor force plate within the shoe. The loading components of stance showed a relatively wide 95 percent confidence interval that appeared unrelated to fit. Thus, given a "good fitting" force plate insert, the therapist can make clinically meaningful measurements of the temporal components of the stance phase of gait using the limb-load monitor.

Biomechanical Phenomena↗
PubMed1981

Evaluation of electromyographic biofeedback as an adjunct to therapeutic exercise in treating the lower extremities of hemiplegic patients.

The following controlled, preliminary investigation was designed to determine whether electromyographic biofeedback, in conjunction with therapeutic exercise, could influence the reacquisition of functional lower extremity movements in chronic hemiplegic patients. Both the control (standardized therapeutic exercise regimen) and experimental (therapeutic exercise regimen combined with electromyographic biofeedback) groups improved in ankle active range of motion; only the experimental group significantly shortened its timed ambulation over a carpeted surface. One patient in the experimental group who was given 12 additional training sessions showed further gains in knee and ankle joint angle measurements during walking. The apparent potential for rehabilitation of chronic hemiplegic patients and the benefits afforded to physical therapists from a standardized therapeutic exercise protocol are discussed.

Biofeedback, Psychology↗
PubMed1981

Effect of forced use of the upper extremity of a hemiplegic patient on changes in function. A single-case design.

This study was designed to examine the effect of forced use of the affected upper extremity of a hemiplegic patient on the quantity, quality, and efficiency of functional behaviors. The patient was a woman with right hemiplegia of 18 months' duration. The study was divided into three one-week phases: an initial base-line, and experimental, and a second base-line phase. Base-line scores of frequency, quality, and time were recorded for completion of functional tasks. During the experimental phase, the patient's intact upper extremity was restrained. The efficiency and quality of movement scores did not reflect changes related to the period of restraint; however, the frequency of purposeful behaviors and the patient's functional use of her affected extremity increased during the experimental phase. The relationship of forced use to recovery of function in hemiplegia remains uncertain.

Arm↗
PubMed1980

Treating chronic low back pain. EMG biofeedback training during movement.

Fifteen sessions of EMG biofeedback training to low back musculature were completed by a patient with chronic low back pain during a five-week interval. The training was provided while standing, during trunk movements, and for movement patterns which exacerbated pain. Specific joint ranges of motion and pain ratings were recorded at each session. A minitrainer worn by the patient in his occupational setting was used to reinforce training. Joint ranges of motion increased over time while variability in integrated EMG was reduced. Subjective pain ratings declined after 11 of 17 sessions and remained "very low" throughout a follow-up period. The patient substantially decreased intake of prescription drugs. Fifteen weeks after the first treatment session, the patient was still able to minimize variability in EMG activity for specific body positioning.

Adult↗
PubMed1980

EMG biofeedback in stroke: a 1-year follow-up on the effect of patient characteristics.

Outcomes from emg biofeedback training to 28 upper and 26 lower extremities among 34 patients who were hemiplegic were reassessed at varying intervals and at 1-year after completion of feedback sessions. Examinations took into account both neuromuscular measures of muscle activity and total limb function. There was virtually no deterioration in performance among the 19 upper and 20 lower extremities in which the outcome had previously been graded as "success" or "moderate." Therefore, age, sex, affected side, duration of injury or previous rehabilitation, or the presence of proprioceptive involvement are unrelated to a 1-year retention of improved function. Since patients continued to function within the limits of clinical improvement achieved during biofeedback training, it was concluded that sensory-motor integrative processes had been learned.

Aged↗
PubMed1979

Procedures for EMG biofeedback training in involved upper extremities of hemiplegic patients.

This article presents practical information about using electromyographic biofeedback to train specific muscle groups in the involved upper extermity of hemiplegic patients. Our approach is first to reduce hyperactivity in spastic musculature and then to increase activity levels in weak muscles. Electrode placements and a sequence of training procedures for muscles whose functions are most commonly impaired following stroke are described.

Arm↗