Biomedical subjects

T W Findley

Publications and source records attributed to T W Findley.

At least 19 recordsLinked to original sources

PubMed1999

A simple biofeedback digital data collection instrument to control ventilation during autonomic investigations.

Autonomic evaluation using the heart rate spectrum is sensitive to changes in breathing parameters, but few studies using this technique have controlled both the rate and depth of breathing. Fewer still have also measured or controlled inspiration and expiration times, or end-tidal carbon dioxide. This study describes the development of a digital instrument that can be used to alter tidal volume, ventilation rate and the time of inspiration and expiration with paced breathing visual templates displayed on a computer monitor. The digital instrument runs during data acquisition and displays the ventilatory signal from the subject superimposed on the paced breathing templates. Thus, adjustment of ventilatory parameters is achieved by matching the actual breathing signal to the target template. By regulating the ventilation rate and the tidal volume, end-tidal carbon dioxide could be increased or decreased in small increments. This instrument provided ventilatory control to investigate the effects on the heart rate spectrum of breathing depth, ventilation rate, end-tidal carbon dioxide and the time of expiration.

Biofeedback, Psychology↗

PubMed1999

Use of noninvasive electroacupuncture for the treatment of HIV-related peripheral neuropathy: a pilot study.

OBJECTIVES: The main objective of this study was to test the hypothesis that low-voltage non-invasive electroacupuncture will improve the condition of neuropathic human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. DESIGN: A prospective study using HIV/AIDS patients who had antiretroviral drug-induced neuropathy. Eleven patients were enrolled, but complete data was obtained from only 7. Non-invasive skin electrodes were placed on leg acupuncture points BL60, ST36, K1, LIV3, and low-voltage current passed for 20 minutes every day for 30 days. Patients were assessed preintervention and postintervention with MOS-HIV 30-item instrument questionnaire and tibial H-reflex was similarly recorded from the right calf muscle. RESULTS: There was improvement in the condition of all 7 patients. They felt much better and reported feelings of increased physical strength. Outcomes on MOS-HIV 30-item instrument showed significant overall improvement in functional activities (pre 33+/-10, post 38.4+/-9.6, p = 0.02 MANOVA). This was confirmed by postintervention H-reflex parameters; H-max and direct muscle response (M-response) amplitudes were potentiated in relation to pretreatment values (H-max: pre = 1.19+/-1.2, post = 2.68+/-1.9, p<0.05; M-response: pre = 0.93+/-1.1, post = 2.34+/-1.8, p<0.05); M-response latency decreased in relation to pretreatment value (pre = 9.7+/-1.8, post = 7.8+/-1.9, p<0.01). CONCLUSION: The results support the hypothesis that low-voltage electroacupuncture will improve the condition of the neuropathic HIV/AIDS patient.

Acupuncture Therapy↗

PubMed1997

A useful method for measuring daily physical activity by a three-direction monitor.

The purpose of this study was to investigate whether a three-direction accelerometer is useful for measuring daily physical activity. Physical activity, being an important part of human behavior, may be related to various aspects of health and disease. In this study, the relationship between the intensity of each action and the three-direction accelerometer (Actigraph) output was compared in 10 healthy subjects under free-living conditions. Subjects wore the Actigraph on their non-dominant wrist and filled out a physical activity check list (self-report) throughout the daytime. Daily physical activities were classified into six categories according to different intensities. The differences of the Actigraph output among each of the six categories were significant by the Kruskal-Wallis analysis (p = 0.001). The Actigraph output appeared to correlate highly with the intensity of actions by the Spearman Rank test (r = 0.95, p < 0.05). The Actigraph output was over-estimated while the subjects were typing, driving and being a passenger in a motor vehicle. The Actigraph was shown to be a useful and convenient device for measuring daily physical activity.

Acceleration↗

PubMed1997

Bioelectrical impedance changes in regional extracellular fluid alterations.

The purpose of this study was to determine whether changes in bioelectrical impedance (BI) can reveal regional extracellular fluid (ECF) alterations. ECF changes were induced by holding various arm positions for ten minutes, and they were evaluated through the measurement of BI in eight normal adult subjects. A low frequency current (100 Hz, 0.50 mA) was applied using an electromyography machine through two current electrodes, and the voltage signals were recorded by two amplitude electrodes. The corresponding BI was calculated by Ohm's law, resistance = voltage/current (R = V/I). There was no significant difference between BI and time interval, but between BI and arm position (two-way ANOVA with replicate, p = 0.954, p < 0.001). BI has a negative correlation with wrist circumference. These results show that this experimental method can be used as reflection of ECF changes and that both position and wrist circumference are major factors for BI in the upper extremity.

Adult↗

PubMed1996

Randomized, double blind, controlled placebo-phase in trial of low dose phenelzine in the chronic fatigue syndrome.

Because of the striking similarity of the clinical manifestations produced by use of the drug reserpine and seen in patients with the chronic fatigue syndrome (CFS), we theorized that CFS was a disorder of reduced central sympathetic drive. Because of the pharmacology of control of this central sympathetic system, we further postulated that CFS symptoms would respond quickly to low dose treatment with a monamine oxidase inhibitor. To test these hypotheses, we designed a randomized, double blind placebo controlled study using phenelzine. No patient in the trial had a diagnosis of lifetime or current psychiatric disorder and none had depressed mood in the range of clinically depressed patients on a paper and pencil test of depression. Patients in the placebo group received placebo for 6 weeks while those in the drug treatment group were treated in three 2-week segments-placebo, 15 mg phenelzine every other day, and then 15 mg daily. This treatment regimen produced a significant pattern of improvement compared to worsening in 20 self report vehicles of CFS symptoms, illness severity, mood or functional status. Thus the data support our hypothesis of reduced sympathetic drive, although an alternative hypothesis of pain alleviation is also possible. The study design also allowed us to evaluate patients for a placebo effect: no evidence for this was found, suggesting that CFS is not an illness due to patients' being overly suggestible.

Adult↗

PubMed1996

Voluntary contraction shortens peripheral conduction time in response to transcranial magnetic stimulation of the brain.

We investigated the effects of voluntary contraction on peripheral conduction time in response to transcranial magnetic stimulation (TMS) of the brain in 10 normal subjects. We obtained surface recordings of compound muscle action potentials (CMAP) from the abductor digiti minimi muscle (ADM) and nerve action potentials (NAP) from the ulnar nerve, at rest and during contraction (10% of maximal voluntary contraction) in response to TMS delivered at 100% output using a coil shaped like a figure 8. The distance between the two recording electrodes was 10 cm. The distal latency in response to TMS was calculated by subtracting the NAP latency from the CMAP latency. Distal latency was also measured by recording ADM responses to supramaximal electrical stimulation (ES) 10 cm proximal to the recording electrode. TMS-induced distal latency was significantly shorter during voluntary contraction than at rest (P < 0.0001). There was no significant difference between TMS-induced distal latency during contraction and ES-induced distal latency. TMS-induced distal latencies at rest and during contraction were correlated with the ES-induced distal latencies (r2 = 0.468, P = 0.028 and r2 = 0.769, P = 0.0009, respectively). Our results showed that the peripheral conduction time in response to TMS was related to the activity of the target muscle and to the fastest conduction velocity of the target nerve. Voluntary contraction reduced the peripheral conduction time in response to TMS.

Adult↗

PubMed1993

Sexual activities, desire, and satisfaction in males pre- and post-spinal cord injury.

Thirty-eight spinal cord injured (SCI) males (median age = 26) completed an 80-item multiple choice questionnaire (median 37 months postinjury) which assessed sexual functioning pre- and post-spinal cord injury in four areas: (i) sexual activities and preferences, (ii) sexual abilities, (iii) sexual desire, arousal, and satisfaction, and, (iv) sexual adjustment. Frequency of sexual activity decreased following SCI with a reduction in intercourse and increased interest in alternative sexual activities. Of complete quadriplegic subjects 38% reported the ability to have an orgasm accompanied by ejaculation underscoring the need for physiological studies. Partner's desire for sex as perceived by the SCI individual was correlated with frequency of sex and numbers of sexual partners postinjury. Subject's perceptions of their own and partner's sexual desire decreased following SCI. Sexual satisfaction decreased postinjury and was positively correlated with both the patients' and their partners' interest in penile-vaginal intercourse. Of the subjects, 27% reported sexual adjustment difficulties and 74% relationship difficulties but only 22% received counseling. Results indicate the importance of the availability and desire of a sexual partner in the sexual activities and satisfaction of the SCI individual. SCI patient and staff sexual education and counseling continue to be strong needs.

Adolescent↗

PubMed1993

Physical medicine and rehabilitation. Trends in academic productivity.

Numerous authorities have emphasized the need for expanding the quantity and quality of physical medicine and rehabilitation (PM&R) research and academic productivity. Thus far, however, attempts to evaluate academic productivity have involved the manual sampling of relevant specialty journals. This approach greatly underestimates productivity. By conducting a computer-facilitated search for PM&R-related publications and then contacting the most academically prolific PM&R departments to verify the computer-generated data, it was found that computer search strategies more accurately estimate PM&R academic productivity. PM&R publication activity increased by 15% in the United States and 46% internationally over the period 1988 to 1990. At least 76% of the United States residency programs in PM&R had scientific publications over this period. With ever increasing emphasis placed on academic productivity, the trend of increasing productivity can only be expected to continue in the future.

Academic Medical Centers↗

PubMed1992

Physiological analysis of motor reorganization following lower limb amputation.

It is now known that amputation results in reorganization of central motor pathways, but the mechanism for the changes is unclear. One possibility is alteration of the excitability of the alpha motoneurons. We studied motor reorganization and excitability of alpha motoneurons to Ia input in 6 subjects with unilateral lower limb amputation. A Cadwell MES-10 stimulator was used to deliver transcranial magnetic stimuli through a circular coil centered on the sagittal axis 4 cm anterior to Cz and through an 8-shaped coil positioned over scalp locations 1 cm apart along the coronal axis. Surface EMG was recorded bilaterally from quadriceps femoris, the first muscle immediately proximal to the site of amputation. Excitability of the spinal alpha motoneuron pool to Ia afferents was assessed by determining the ratio of the maximal H reflex to the maximal M response (H/M ratio) elicited in the quadriceps femoris. Stimuli of equal intensity delivered to optimal scalp positions recruited a larger percentage of the alpha motoneuron pool in muscles ipsilateral to the stump than in those contralateral to the stump (P less than 0.01). Mean onset latencies of motor evoked potentials were shorter in ipsilateral muscles than in contralateral muscles (P less than 0.01). Muscles ipsilateral to the stump showed a trend toward activation from a larger number of scalp positions than those contralateral to the stump (P = 0.06). There was no difference in the quadriceps H/M ratios (7.2% ipsilateral vs. 10.9% contralateral). The absence of changes in the excitability of the alpha motoneuron pool in the presence of motor reorganization targeting muscles proximal to the stump suggests that reorganization occurs proximal to the alpha motoneuron level.

Adult↗

PubMed1991

Elements of academic productivity: a comparison of PM&R units versus other clinical science units.

In early 1989, the Research Committee of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) established a subcommittee to develop methods to monitor academic progress in physical medicine and rehabilitation (PM&R) units in the US. To develop an indirect baseline of academic productivity in PM&R, the rates and types of publications by PM&R researchers were assessed in eight peer review medical journals. The journals selected consisted of all issues of the following (published in calendar years 1987 to 1989): Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Physical Therapy, Archives of Neurology, Pain, Stroke, Paraplegia, and Arthritis & Rheumatism. The sampling frame consisted of 3,553 journal articles. Affiliation with a PM&R unit or other clinical science unit (other unit), extramural funding sources, and type of manuscript (eg, case report or scientific investigation) were identified and coded. Sixteen percent of all articles were authored by members of PM&R units. The prevalence of scientific reports written by other unit authors (71%) was comparable to that written by PM&R authors (67%) (chi 2[3] = 5.54; p less than .20). There was a greater prevalence of funding by the US Department of Education of studies written by PM&R authors (10%) than of studies written by members of other units (2%) (chi 2[1] = 79.4; p less than .0001). Reports authored by members of other units had a greater prevalence rate of funding from all other sources--federal and private (47% vs 33%; chi 2[1] = 41.2; p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Authorship↗

PubMed1991

Motor reorganization after upper limb amputation in man. A study with focal magnetic stimulation.

To evaluate reorganization in motor pathways following amputation, we studied motor evoked potentials (MEPs) to transcranial magnetic stimulation in 7 patients with unilateral upper limb amputations, a patient with congenital absence of a hand, and 10 normal subjects. Electromyographic recordings were made from biceps and deltoid muscles immediately proximal to the stump and the same contralateral muscles. Magnetic stimulation was delivered by a Cadwell MES-10 magnetic stimulator through a 'figure eight' magnetic coil over scalp positions separated by 1-2.5 cm. Maximal M responses were elicited by peripheral nerve stimulation at Erb's point. The amplitude of MEPs was expressed both as absolute values and as a percentage of maximal responses to peripheral nerve stimulation. Threshold for activation of muscles ipsilateral and contralateral to the stump and the region of excitable scalp positions were also determined in 7 patients. Magnetic scalp stimulation induced a sensation of movement in the missing hand or fingers in the patients with acquired amputation, but failed to do so in the patient with congenital absence of a limb. It evoked larger MEPs, recruited a larger percentage of the motoneuron pool, and elicited MEPs at lower intensities of stimulation in muscles ipsilateral to the stump than in contralateral muscles. Muscles ipsilateral to the stump could be activated from a larger area than those contralateral to the stump. These results are compatible with cortical or spinal reorganization in adult human motor pathways targeting muscles proximal to the stump after amputations.

Adult↗

PubMed1991

Research in physical medicine and rehabilitation. XII. Measurement tools with application to brain injury.

There are basic principles and techniques of measurement that are relevant across biomedical disciplines. The purpose of this article is to explain some of the most important of these for medical rehabilitation, to illustrate how to use them to choose assessment instruments and to describe the nature of measurement in medical rehabilitation by examples in brain injury rehabilitation. Reliability is basic to any scientific measure. Validity, the ultimate criterion, is closely associated with the purpose of the measure. Content validity, criterion validity and construct validity are explained. Sensitivity to rehabilitative interventions and significance in patients' real lives (ecological validity) are emphasized. Measures of functional outcomes (disability) may show improvement after rehabilitation even when impairment measures do not. An extensive but selected list of measures of coma, global status, disabilities, communicative and cognitive impairments, and handicaps is presented, and their main uses are illustrated. Examples illustrate how to choose measures to study comprehensive program-level outcomes, to study learning-based interventions and to develop a general purpose database. Although there are many measures of activities of daily living and mobility, little published evidence of reliability and validity could be found even for some well-known scales. Ecologically valid and sensitive outcome measures are especially needed. Studies of the clinical utility of measures were also scarce. Many of these gaps can be spanned by clinical researchers with limited resources. Physical medicine and rehabilitation will benefit from formal studies of the reliabilities and validities of both its old and its new measurement instruments and by increased sophistication in choice of measures.

Brain Injuries↗

PubMed1991

Malpractice in physical medicine and rehabilitation. A review and analysis of existing data.

Malpractice issues are a concern for physiatrists, but little information specific to the field is readily available. Medical, legal and economic literature provide profiles of physicians involved in malpractice claims and the types of clinical situations in which suits are brought in general but no specifics on physiatry before 1973. Nine malpractice studies were examined to characterize malpractice claims in the field. The physiatrist's risk relative to other specialties could be studied specifically in three studies of 197,230 claims reported from 182 liability carriers. The number of claims brought was one-third of that predicted relative to the size of the specialty. The number of paid claims was one-fourth of that predicted, and the total dollar indemnity was one-fifth of that predicted. The average indemnity per claim rose 770% over a decade, from $12,000 in 1978 to $92,000 by 1988. Dollar losses were significantly lower than expected compared with other specialties classified by insurance carriers to be of similar risk such as neurology, pediatrics and general/family practice and one specialty considered to be very low, dermatology. Losses for physiatry were more similar to that of the very low risk category specialties such as psychiatry and pathology. One-fourth of successful claims resulting in one-third of the total dollar losses were associated with physical therapy. Cases involving femoral fracture comprised 14% of paid claims accounting for 34% of the total losses. Conditions of the vertebral column accounted for 35% of monetary losses and medication error accounted for 14% of monetary losses. The claim incidence was very low as one study of 71,130 claims identified none against physiatrists, with no more than 110 claims in any single study.

Insurance, Liability↗

PubMed1990

Research in physical medicine and rehabilitation. VII. The role of the principal investigator.

The roles and responsibilities of the principal investigator of a research project are described to allow the young researcher to make an intelligent decision regarding which role to take in a research project. Guidelines are given about which tasks may be delegated and how to do this. These tasks include formulation of the question, project design, obtaining funding, project startup and ongoing management, data analysis and publication. Particular attention is paid to design/analysis and publication, since these determine authorship on biomedical research articles.

Humans↗

PubMed1990

Research in physical medicine and rehabilitation. VIII. Preliminary data analysis.

This paper describes important aspects of preliminary data analysis to be taken after data are checked for clerical entry errors and before the primary statistical analysis is performed. These include description and graphic display of each variable, recoding categorical data, transforming continuous data into another continuous variable and recoding continuous to categorical data. Missing values and outlying data points are identified and several techniques are recommended to minimize mistakes in variable recoding. Related variables measured with different units may be combined by using the z transformation and converted back to one of the original units for ease of interpretation. Finally, both categorical and continuous variables are checked for reliability by using kappa or the intraclass R.

Data Collection↗

PubMed1990

Research in physical medicine and rehabilitation. IX. Primary data analysis.

The primary statistical analysis is approached from the standpoint of what is required to publish in medical research journals. Descriptive and bivariate statistics cover the majority of medical research articles now published. Statistical guidelines for review of manuscripts are used to develop guidelines for analysis, including specifying the objective, the source of subjects and response rate, differences detectable with the expected sample size, appropriateness of statistics for one and two variables, method of presentation of results and conclusions and calculation of confidence intervals. Common mistakes to avoid include use of standard error of the mean instead of standard deviation, use of standard deviation with skewed data, failure to describe the statistical test used, multiple comparisons and failure to use special forms of t test and chi 2.

Cerebrovascular Disorders↗

PubMed1990

Research in physical medicine and rehabilitation X. Information resources.

Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles.

Humans↗

PubMed1990

Research in physical medicine and rehabilitation. XI. Research training: setting the stage for lifelong learning.

This is the summary article in our research series. We have attempted to provide useful information for persons at all levels of research training, from the student to the clinician with a collaborative but not active role, to the new clinical researcher, to the experienced faculty member. But there is much more to be learned than can be presented in a short series of articles. From this series, you should be able to make a reasoned choice about what role in research you would like to take, and seek to maintain or upgrade your research skills to accomplish that. The previous articles, exercises and references presented will guide you in independent study. The focus of this article is to help you choose an environment in which you can continue to learn and develop. Although the "ideal" place as described here may never exist, no institution is totally devoid of research possibilities and you can use this article to help seek or develop local resources you may not have considered. By extracting questions and clues from people around you, you stimulate them to "think research" even if a formal program is absent; at the least, you can ally yourself with a nearby institution which has researchers in other clinical specialties or areas of basic science. Each organization is obviously different, having different strengths and resources. It is up to each chairperson to decide what proportion of limited resources should be invested in research. Once this decision is made, it is the initiative of the individual faculty members that will make a productive department.

Education, Medical, Continuing↗