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T W Findley

Publications and source records attributed to T W Findley.

At least 37 records · Page 2Linked to original sources
PubMed1989

Research in physical medicine and rehabilitation. I. How to ask the question.

A predictable pattern in research efforts is seen in 28 academic centers in physical medicine and rehabilitation. They consist of at least one technician and one small research room (220 square feet), with an additional small room (280 square feet), and 1/4 technician for every MD or PhD in the department (r = 0.72). Persons who are not active researchers with external funding must first define the research question in order to develop fundable research proposals. Clinical research is a process that starts from the clinical situation, leads to formulation and answering of the question, and eventually results in integration back into clinical practice. There are many reasons for posing a clinical research question and each results in a different type of question. Asking the right question is the most important part of research, as how the problem is stated determines what data is to be collected, the analysis to be done, and what kind of conclusions can be drawn. A strong research study addresses questions that are clearly spelled out and leads to conclusions that are within the limits of the experimental design and the availability, reliability, and validity of the data. Complex design and analysis do not make a study better if the question itself is not well formulated. It is not as important to know how to answer the question as it is to know how to ask the question. If the initial question is incomplete or incorrect, the rest of the research is at best irrelevant.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

Research in physical medicine and rehabilitation. IV. Some practical designs in applied research.

The randomized controlled trial is often difficult, impractical or unethical in the clinical setting. Specific types of experimental design are examined for application and ease of interpretation of results, with particular focus on the generalization and demonstration of cause and effect. Examples are given of relatively easy changes that greatly strengthen the design and several recently published studies are used as illustrative examples.

Brain Injuries↗
PubMed1989

Research in physical medicine and rehabilitation. V. Data entry and early exploratory data analysis.

The process of data entry and initial analysis to locate data errors is described. Basic terms are defined and a simple method of entering data by using word processing software is illustrated. Data checking is done by using visual check of the raw data. Statistical programs are then used to locate possible data errors by finding data points (outliers) that are very different from the average. Special graphic output of statistical programs, scatterplots and box and whisker plots can be used to further locate questionable data. Examples of data entry forms and annotated step by step data cleaning with the use of inexpensive programs for personal computers are presented.

Computers↗
PubMed1989

Research in physical medicine and rehabilitation. VI. Research project management.

This article on research project management is written primarily for the researcher who has started a project, has collected data on a few subjects and has now realized that the project is more involved than anticipated. Although discussion of the many different styles of management is beyond the scope of this article, it addresses some common problems faced by the researcher, including finding subjects, obtaining project approval from the institutional review board, identifying and training staff, establishing a work plan, pilot testing, recording data, identifying problems, using computer software for project management and budgeting. Specific examples and exercises are included.

Documentation↗
PubMed1989

Research in physical medicine and rehabilitation. III. The chart review or how to use clinical data for exploratory retrospective studies.

This article guides the design and execution of a small research project using existing clinical data. The most important point in experimental design is to identify potential difficulties and limitations before you start by 1) review of published studies, 2) use of your clinical experience and 3) review of individual case records. Some of these can be addressed by changes in the study design, but some are inherent in the data and methods we are forced to use. The choice of study design may be based primarily on the quality of the clinical data and available resources for additional data collection. The level of measurement (nominal, ordinal, interval or ratio) of your data must first be determined as it limits the descriptive and statistical techniques you can use. After you decide how many variables to include, a rough guess of sample size will help you select your charts for review. Actual review of three charts will further pinpoint any difficulties and will allow you to revise your study and make an accurate estimate of time to completion. Given the long time span of most projects, accurate record keeping is essential.

Data Collection↗
PubMed1989

Research in physical medicine and rehabilitation. II. The conceptual review of the literature or how to read more articles than you ever want to see in your entire life.

The purpose of the literature review is to place your research question in the context of the existing scientific literature. This article will help you to develop an overall conceptual framework to allow you to sort through the mass of published material in a focused way. The conceptual review differs from the individual article review in that it is guided by your understanding of the basic issues rather than by your knowledge of research methodology. The goal of this paper is to help you develop a conceptual framework starting from your clinical knowledge. A specific search strategy is presented to help you determine which articles are highly relevant to your topic and to locate all of these published within the past 5 years. Articles are classified into three types: those that are obviously highly relevant, other less relevant articles and articles that are potentially relevant. Guidelines are given on how to start looking, when to stop looking, how to organize the articles you find so that you can review them in a reasonable amount of time and how to read in depth the most pertinent ones you find.

Abstracting and Indexing↗
PubMed1988

Ambulation in the adolescent with spina bifida. II. Oxygen cost of mobility.

This study was designed to determine the energy cost (measured as oxygen use) of walking and wheelchair propulsion in children aged 10 to 15 with myelomeningocele of thoracic to sacral levels, and to determine whether energy cost of mobility could be estimated from clinical measures. Oxygen consumption (measured with open circuit spirometry) and heart rate were measured during treadmill walking by 21 children, wheelchair use by eight children, and, for five children, in both modes. Speeds ranged from 27 to 134 m/min, with slopes up to 15%. Energy consumption for walking was linearly related to speed, slope, heart rate, and body weight (r = .90, p less than .001); for wheelchair propulsion, energy consumption was a linear function of speed, slope, and body weight (r = .90, p less than .001). The same linear function applied for all disabled children; maximum walk/run speed over a 30 m distance correlated highly with both maximal oxygen consumption (r = .87) and speed using 70% of VO2max (r = .82). For both wheelchair use and walking, the relative energy consumption (percentage of VO2max) was highly correlated with heart rate alone (r = .93), and the absolute level of energy consumption was highly correlated with heart rate and maximum walk/run speed (r = .89). Simple clinical measures of maximum ambulatory velocity and heart rate allow accurate prediction (r = .89) of energy consumption in all children with myelomeningocele, regardless of neurologic and functional level.

Adolescent↗
PubMed1987

Atlantoaxial instability in Down syndrome: roentgenographic, neurologic, and somatosensory evoked potential studies.

To identify patients with Down syndrome and asymptomatic atlantoaxial instability who are at increased risk for developing neurologic symptoms, we studied 27 patients with this skeletal disorder and compared them with an age- and sex-matched group of 27 patients with Down syndrome without atlantoaxial instability. A third group of six patients had symptomatic atlantoaxial instability. The mean atlanto-dens intervals and the mean spinal canal widths among the three groups were significantly different. There were no significant differences in mean composite neurologic scores and somatosensory evoked responses between patients in the asymptomatic group and those in the control group. However, when a subsample of patients with high and low latencies (greater than 1 SD below and above the mean) was formed and comparisons were made with roentgenographic findings, there was a high correspondence between somatosensory evoked potential latencies and atlanto-dens interval measurements. We conclude that no single assessment technique, but a combined approach using roentgenographic, CT scan, neurologic, and neurophysiologic investigations, will provide information of the risk status of patients with Down syndrome and atlantoaxial instability.

Adolescent↗
PubMed1987

Isometric exercise for an individual with hemophilic arthropathy.

Several authors have described nonsurgical rehabilitative techniques for individuals with hemophilia who have single or recurrent hemarthroses. The effects of these low intensity exercise programs are not stated clearly in the literature. In this single-case experimental study, we investigated the effects of a training program of isometric exercise of at least two thirds of maximum voluntary contraction on the knee joint and surrounding muscles of a patient with hemophilia. A 12-year-old subject with severe factor-VIII deficiency and chronic knee arthroses was seen for baseline measurements, three weeks of treatment, and follow-up baseline measurements. The isometric exercise program safely increased right hamstring and quadriceps femoris muscle group strength 40% to 70% without adversely affecting knee range of motion, circumference, or skin temperature and without causing bleeding or discomfort. The use of isometric exercise programs during rehabilitation and maintenance is a promising treatment component for the total care of the individual with hemophilia.

Child↗
PubMed1987

Rehabilitation needs in the 1990s. Effects of an aging population.

The number of physically disabled persons has risen in the past few decades. Acute rehabilitation will continue to increase in importance as a result of the disease and age structure of the population, as well as current hospital reimbursement practices. This project quantifies the continued rise to be expected into the 1990s on the basis of increasing age of the population, using census and hospital discharge data for the state of Rhode Island, which has a population of almost 1 million and is well suited to demographic studies. Although Rhode Island's population is expected to increase by only 3% between 1980 and 1990, a 20% increase is expected for persons over age 65. Age-specific national disability rates applied to these projections show an increase of 7% in persons with activity limitations, with those over age 65 constituting 58% of those with limitations. The most severely disabled, those requiring inpatient rehabilitation, are increasing even more. Estimates of inpatient rehabilitation for the recently disabled person show an increase of 15% by methods developed here based on acute hospitalization data.

Adolescent↗
PubMed1987

Ambulation in the adolescent with myelomeningocele. I: Early childhood predictors.

Birth records identified 192 children with myelomeningocele born in Minnesota in the years 1966-1970. In 1981 current ambulation, neurologic level, and early motor achievement were determined in 77 of the surviving 80 children by chart review and questionnaire. Of these 77, 20 were not walking at all, one was walking only in therapy, and the remaining 56 were community ambulators (16 of these occasionally used wheelchairs). The actual distance walked daily varied from 100 to 5,000 meters in this group, with 19 of these community ambulators never walking as far as around a block. Five children never walked, 16 had stopped walking by 1981, and another six, although still walking, were doing less than they had previously. In 20 of the 22 who showed a decrease in total walking between the ages of ten and 15, the beginning of the decline was associated with a period of immobilization, demonstrating the potentially adverse effects of immobilization in these children. The ability to walk outdoors independently and to use a wheelchair by age seven predicted ambulation as an adolescent correctly for 87% of the children. In contrast, neurologic level predicted adolescent mobility correctly for only 71%.

Adolescent↗
PubMed1987

Physical activity capacity in children with myelomeningocele.

Thirty-three children (10 to 15 years of age) with myelomeningocele were studied to determine isometric muscle strength of hip and knee extension, range of hip and knee extension, usual and maximal ambulatory velocities, maximal aerobic capacity, and the energy cost (oxygen uptake) of ambulation versus wheelchair usage in subjects who both walked and wheeled. Subjects were placed into one of four groups depending on their level of motor function (those with motor levels at L2 and above, L3-4, L5 to sacral, and without motor deficit). Maximal ambulatory velocity correlated with strength of the hip extensor (r = 0.85) and knee extensor (r = 0.81) muscles. All variables were found highly dependent upon the level of motor function. Subjects with the greatest deficits had the most significant impairments and vice versa. It was found, however, that subjects without motor deficit had impairments in the usual speed of ambulation (9%), maximal running velocity (20%), and VO2 max (13%). These deficits were due to the measured strength deficits in these subjects as compared to normal values. This finding underscores the importance of quantitative assessment of muscle strength as significant deficits in strength can be missed with manual muscle testing. In those subjects who walked and wheeled, wheeling was found much more energy efficient. Wheeling at 4.8 km/hr was 11% more efficient than walking at 33% that velocity.

Adolescent↗
PubMed1983

Wrist subluxation in juvenile rheumatoid arthritis: pathophysiology and management.

Management principles in juvenile rheumatoid arthritis provide for long-term follow-up throughout all phases of disease activity, including apparent remission. Treatment is based on the stage of disease and anatomy and kinesiology of the joints. Palmar subluxation of the wrist requires proximal support by splints for prevention and correction. Small sphygmomanometer bags have been incorporated into splints for home stretching with demonstrated improvement in bony alignment.

Arthritis, Juvenile↗