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PubMed1995

Preconditioning by brief ischaemic episodes in the isolated rat heart assessed by 31P NMR spectroscopy: dissociation between metabolic and functional recovery?

31P NMR spectroscopy was used to investigate whether improved functional recovery in ischaemic preconditioning was due to improved metabolic recovery in isolated rat hearts. The preconditioning stimulus was global ischaemia of 1 or 4 min followed by 12 min of reperfusion (Langendorff mode). The hearts were then subjected to a main ischaemic period of 16 min and 40 min of reperfusion. Functional and metabolic recoveries of hearts were compared to a control group subjected only to the main ischaemia. Preconditioning improved recovery of contractile function during the final reperfusion. Thus left ventricular developed pressure (LVDP) and heart rate (HR) product after 40 min of reperfusion recovered to 56, 67 and 68% in the control group, 1 min group and 4 min group, respectively. However, the metabolic recovery was comparable in all groups. CrP and ATP recovered to levels of 67-78% (CrP) and 35-41% (ATP), and pH to a level of 7.13-7.15 (not different from baseline values) at the end of the final reperfusion. We conclude that the improved functional recovery in preconditioning is not due to a higher level of high energy phosphates or less acidosis during the final reperfusion.

Adenosine Triphosphate↗
PubMed1999

The effect of legal representation on functional recovery of the hand in injured workers following carpal tunnel release.

A group of 225 patients who underwent surgical release for carpal tunnel syndrome, considered causally related to their jobs, were compared on the basis of one variable: representation by an attorney. Postoperative functional recovery measurements for the represented and the unrepresented workers were reviewed. There is no difference in the functional recovery rates or final functional values in these two groups of workers. We concluded that an attorney representing an injured worker did not influence the functional recovery of the hand in these patients, nor did it affect the medical decision-making process.

Adult↗
PubMed2001

Functional recovery and regeneration of descending tracts in rats after spinal cord transection in infancy.

STUDY DESIGN: The functional recovery of rats that underwent spinal cord transection in infancy was evaluated by multimodal examination (functional tests, electrophysiologic evaluation, tract-tracing) to determine the basis for the recovery. OBJECTIVES: To determine whether the hind limb function in rats that underwent spinal cord transection in infancy is regained completely, which descending tracts regenerate after the transection, and whether the functional recovery is correlated with axonal reconnection. SUMMARY OF BACKGROUND DATA: It is widely accepted that a newborn rat recovers its hind limb function after spinal cord transection even without any specific treatments. This functional recovery might be attributed to possible regeneration of some descending pathways, although there is a counterargument that well-trained spinal cord reflexes may bring about functional compensation. METHODS: The thoracic spinal cord of infant rats was completely transected at Th10 when they were 2 weeks of age. Multimodal functional tests and electrophysiologic studies were performed 5 weeks later. Some recovered rats (i.e., those able to walk after the transection) underwent spinal cord retransection, with subsequent reevaluation of locomotion and muscle-evoked potentials. At 6 weeks after the initial transection, tract-tracing studies were performed in some animals. RESULTS: A motor performance score detected the functional differences between the control and the recovered rats. Muscle-evoked potentials of hind limbs after electrical stimulation to the brain were recorded in some of the recovered rats, but never in the unrecovered rats. Moreover, the muscle-evoked potentials of the recovered rats disappeared after spinal cord retransection that resulted in loss of voluntary movement. Morphologic studies in two rats provided evidence that reconnection of rubrospinal, vestibulospinal, and reticulospinal tracts had occurred, whereas corticospinal regeneration was not detected. CONCLUSIONS: It can be concluded that the hind limb function of rats that underwent spinal cord transection in infancy was partially regained; that axonal regeneration of the rubrospinal, vestibulospinal, or reticulospinal tracts was demonstrated, whereas the reconnection of the corticospinal tract was not observed; and that the axonal regeneration of these tracts is involved in the functional recovery.

Animals↗
PubMed2006

Circulating insulin-like growth factor I and functional recovery from spinal cord injury under enriched housing conditions.

Voluntary locomotor training as induced by enriched housing of rats stimulates recovery of locomotion after spinal cord injury (SCI). Generally it is thought that spinal neural networks of motor- and interneurons located in the ventral and intermediate laminae within the lumbar intumescence of the spinal cord, also referred to as central pattern generators (CPGs), are the 'producers of locomotion' and play a pivotal role in the amelioration of locomotor deficits after SCI. It has been suggested that locomotor training provides locomotor-specific sensory feedback into the CPGs, which stimulates remodeling of central nervous system pathways, including motor systems. Several molecules have been proposed to potentiate this process but the underlying mechanisms are not yet known. To understand these mechanisms, we studied the role of insulin-like growth factor (IGF) I in functional recovery from SCI under normal and enriched environment (EE) housing conditions. In a first experiment, we discovered that subcutaneous administration of IGF-I resulted in better locomotor recovery following SCI. In a second experiment, detailed analysis of the observed functional recovery induced by EE revealed full recovery of hindlimb coordination and stability of gait. This EE-dependent functional recovery was attenuated by alterations in the pre-synaptic bouton density within the ventral gray matter of the lumbar intumescence or CPG area. Neutralization of circulating IGF-I significantly blocked the effectiveness of EE housing on functional recovery and diminished the EE-induced alterations in pre-synaptic bouton density within the CPG area. These results support the use of IGF-I as a possible therapeutic aid in early rehabilitation after SCI.

Animals↗
PubMed1999

Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery.

OBJECTIVE: To examine the relation between the initial microvascular perfusion pattern, as assessed by intracoronary myocardial contrast echocardiography (MCE), immediately after restoration of TIMI (thrombolysis in myocardial infarction) (TIMI) grade 3 flow during acute myocardial infarction, and the extent and timing of functional recovery in the area at risk. SETTING: Referral centre for interventional cardiology. METHODS: Intracoronary MCE was performed 15 minutes after TIMI grade 3 recanalisation of the infarct artery in 25 patients. Segmental myocardial contrast patterns were graded semiquantitatively (0, none; 0.5, heterogeneous; 1, homogeneous). Functional recovery was assessed by echocardiography on days 9 and 42. RESULTS: Among 174 myocardial segments in the area at risk, wall motion recovery on day 9 was observed in 40% of MCE grade 1 segments but there was no significant recovery in grade 0 or 0.5 segments. On day 42, recovery had occurred in 56% of MCE grade 1 segments (p < 0. 0001 v MCE grade 0 and 0.5; p = 0.0001 v MCE grade 1 on day 9), and 22% of MCE grade 0.5 segments (p = 0.02 v MCE grade 0; p = 0.0005 v MCE grade 0.5 on day 9); MCE grade 0 segments did not recover. Negative predictive value in predicting recovery by contrast enhancement was 95% and 89% by days 9 and 42, respectively. CONCLUSIONS: Contractile recovery occurs earliest in well reperfused segments. Up to one quarter of segments with heterogeneous contrast enhancement show wall motion recovery within the first six weeks. Myocardial perfusion after recanalisation in acute myocardial infarction, even if heterogeneous, is a prerequisite for postischaemic functional recovery. Thus preservation of acute myocardial perfusion is associated with more complete and early functional recovery.

Adult↗
PubMed2001

Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses.

We studied the relationship between the neuroendocrine and inflammatory responses to hip arthroplasty and functional recovery in 102 patients undergoing elective arthroplasty for osteoarthritis. Blood samples were collected for up to 7 days after surgery and analysed for concentrations of norepinephrine, epinephrine, cortisol, interleukin-6 and C-reactive protein. The primary outcome measures were milestones in hospital, times to walk 10 and 25 m, pain on discharge from hospital, and function 1 and 6 months after surgery. Walking distances in hospital were significantly delayed in patients with greater interleukin 6 and C-reactive protein concentrations, but few neuroendocrine measures had significant correlations with functional recovery in hospital. Multivariate analysis showed that the interleukin 6 concentration on day 1 was the unique predictor of time to walk 10 and 25 m, and that the day 2 concentration of C-reactive protein was the unique predictor of pain on discharge from hospital. No significant correlations were found between the inflammatory and neuroendocrine variables and recovery at 1 and 6 months. We conclude that the inflammatory response affects immediate functional recovery after hip arthroplasty.

Adult↗
PubMed2004

Survival, regeneration and functional recovery of motoneurons in adult rats by reimplantation of ventral root following spinal root avulsion.

We investigated the functional recovery of motoneurons after reimplanting an avulsed ventral root in a rat model of traction injury. The eighth cervical root (C8) was avulsed by controlled traction and immediately reimplanted to the spinal cord. Spinal nerves from neighbouring segments (C5, C6, C7 and T1) were ligated and cut. After 12 or 20 weeks, the survival, regeneration and functional recovery of spinal motoneurons were evaluated by Nissl staining, retrograde labelling of motoneurons, NOS histochemistry, histological examination of muscle and nerve-muscle junction, electromyography and behavioural observation. In the control animals, about 14% or 11% of spinal motoneurons survived 12 or 20 weeks postinjury, respectively. By contrast, in animals with ventral root reimplantation, 62% and 55% of motoneurons survived at 12 or 20 weeks postinjury, respectively. Retrograde labelling and histological examination indicated that about 90% of the surviving motoneurons in the C8 segment regenerated axons into the reimplanted ventral root. Staining the muscles with silver and cholinesterase revealed new motor endplates in the reinnervated muscle. Functionally significant electromyographic responses in flexor digitorum superficialis and flexor carpi radialis were observed in experimental animals; however, the average latency of the motor action potentials was greater than normal control. The grasping test showed functional recovery of finger flexors and median nerve. In conclusion, our results indicate that spinal motoneurons can regenerate axons through reimplanted roots and reinnervate muscles to recover partial function.

Animals↗
PubMed2005

Serum levels of 25-hydroxyvitamin D and functional recovery after hip fracture.

OBJECTIVE: To evaluate the association between serum levels of 25-hydroxyvitamin D (25[OH]D(3)) and functional recovery after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: A total of 350 white hip-fracture patients consecutively admitted to a rehabilitation hospital. Thirty-five patients were excluded because their hip fracture was caused by major trauma or cancer affecting the bone or they could not complete rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients underwent 25(OH)D(3) assessment at a mean +/- standard deviation of 21.3+/-8.1 days after the hip fracture. Functional recovery was evaluated by using Barthel Index scores. RESULTS: Low levels of 25(OH)D(3) were found (median, 6.9 ng/mL). By using the Spearman rank correlation test, a significant positive correlation was observed between serum 25(OH)D(3) and Barthel Index score assessed on admission (rho=.218, P <.001) and discharge (rho=.198, P <.001), but not with the change in Barthel Index score attributable to rehabilitation. Linear multiple regression showed that the association between 25(OH)D(3) and Barthel Index score was independent of 11 confounding variables: age, sex, hip-fracture type, pressure ulcers, cognitive impairment, neurologic impairment, infections, time between fracture occurrence and 25(OH)D(3) evaluation, comorbidity, surgical procedure type, and previous hip fractures. CONCLUSIONS: In the study population, serum 25(OH)D(3) was an independent predictor of functional recovery assessed by Barthel Index score after hip fracture but not of the change in the functional score resulting from rehabilitation.

Aged↗
PubMed2003

Ischemic preconditioning: infarct size is a more reliable endpoint than functional recovery.

The search for the mechanism of preconditioning-induced cardioprotection has been hampered by controversial results obtained by workers using different animal species, experimental models, protocols and endpoints. The aim of this study was to evaluate the role of the perfusion model (retrograde vs working), the infarct size and severity of ischaemia (regional vs global) as well as the endpoint (functional recovery vs infarct size) in preconditioning. The isolated perfused rat heart was preconditioned by 3 x 5 min global ischaemia, followed by different periods of regional or global ischaemia and reperfusion. Ischaemic preconditioning of working hearts resulted in increased functional recovery after 25-35 min global ischaemia, while retrogradely perfused hearts showed no significant improvement (except after 30 min global ischaemia). In addition, the percentage reduction in functional performance during reperfusion observed in the latter group was significantly less than in working hearts. Hearts were also subjected to regional ischaemia, perfused in either retrograde or working mode and infarct size determined. Regionally ischaemic working as well as retrogradely perfused hearts when preconditioned showed a significant increase in functional recovery after 35 min ischaemia only. In contrast to global ischaemia, the percentage recovery in mechanical performance of regionally ischaemic hearts was not affected by the mode of perfusion. Preconditioning of working hearts caused a significant reduction in infarct size after both 30 and 35 min ischaemia. However, preconditioned retrogradely perfused hearts showed a significant decline in infarct size after 35 min regional ischaemia only. In conclusion, the effect of the perfusion mode on functional recovery is dependent on the size and severity of ischaemia. It also affects the ischaemic time at which infarct size reduction by prior preconditioning occurs in the retrogradely perfused heart.

Animals↗
PubMed1979

Functional recovery from cancer surgery: estimation of expectations.

Level of expected functional recovery from colostomy, laryngectomy and mastectomy was established by the Delphi technique. One hundred fifteen cancer rehabilitation experts responded to 2 rounds of questionnaires and provided their judgments regarding degrees and timing of recovery in 14 functional, physical and psychological areas. Feedback of first round judgments was provided in the second round and 85% agreement was set as the standard for consensus. The mastectomy patient is expected to have the quickest recovery with former level of functioning reached in most areas by 3 months postdischarge. The colostomy patient is expected to be functioning normally in most areas by 6 months postdischarge. The laryngectomy patient is expected to be functioning normally in most areas by 12 months postdischarge. Some functions were judged to have the same rate of recovery for all 3 patient types; for example, the experts agreed that for the 55-year-old patients described in the case abstracts, sexual activities would not reach the preoperative frequency until 12 months postdischarge.

Breast Neoplasms↗
PubMed2005

The effect of intra-aortic balloon counterpulsation on left ventricular functional recovery early after acute myocardial infarction: a randomized experimental magnetic resonance imaging study.

AIMS: We sought to determine whether intra-aortic balloon pump (IABP) counterpulsation improves the recovery of left ventricular (LV) systolic function after reperfused acute myocardial infarction (AMI). METHODS AND RESULTS: Fourteen dogs underwent 90-min coronary artery occlusion followed by reperfusion. Seven animals were randomized to IABP counterpulsation immediately after reperfusion. Tagged, cine, and contrast-enhanced magnetic resonance imaging were used for regional and global LV functional assessment and MI characterization, respectively. Image acquisition was performed at 1 h, 6 h, and 24 h after reperfusion, during which the IABP device was paused. Animals randomized to IABP demonstrated an earlier improvement of LV ejection fraction when compared with controls (25+/-3 vs. 25+/-2% at 1 h, P=0.91; 36+/-3 vs. 26+/-2% at 6 h, P=0.015; and 38+/-3 vs. 35+/-1% at 24 h, P=0.34). Regional functional analyses revealed the same behaviour among non-infarcted risk regions, i.e., earlier circumferential systolic strain improvement in the IABP group than in controls (-5.4+/-0.4 vs. -5.3+/-0.5% at 1 h, P=0.86; -12.1+/-1.0 vs. -6.0+/-0.4% at 6 h, P<0.001; and -13.9+/-1.1% vs. -12.8+/-0.6% at 24 h, P=0.40). Importantly, however, the degree of LV functional recovery 24 h after reperfusion was similar whether IABP counterpulsation was used or not. CONCLUSION: IABP counterpulsation accelerates but does not significantly improve the recovery of LV systolic function after reperfused AMI.

Animals↗
PubMed2002

Femur bone mineral density is independently associated with functional recovery after hip fracture in elderly women.

OBJECTIVE: To evaluate the association between femur bone mineral density (BMD) and functional recovery after hip fracture. DESIGN: Cross-sectional study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: A total of 233 of 263 white women with hip fracture consecutively admitted to a rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients underwent BMD assessment by dual-energy x-ray absorptiometry (DXA) at the proximal femur (5 sites) on admission. Functional recovery was evaluated by using Barthel Index scores. RESULTS: A positive correlation was found between BMD and Barthel Index scores assessed on both admission and discharge (r range,.16-.24, depending on the site of BMD measurement). Linear multiple regression showed that the association between BMD and Barthel Index score was independent of 10 confounding variables: age, body mass index, fracture type, pressure ulcers, cognitive impairment, neurologic diseases, total lymphocyte count as a nutritional index, time between fracture occurrence and DXA assessment, comorbidity, and surgical procedure. Conversely, no significant associations were found between BMD and the change in Barthel Index score attributable to rehabilitation. CONCLUSIONS: In the study population, femur BMD was an independent predictor of the functional recovery assessed by Barthel Index score after hip fracture, but not of the change in the functional score resulting from rehabilitation.

Absorptiometry, Photon↗
PubMed1985

Flush solution 2, a new concept for one-to-three-day hypothermic renal storage preservation. Functional recovery after preservation in Euro-Collins, Collins' C2, hypertonic citrate, and F.2 solution.

Experiments were performed on the quality of renal functional recovery after 24, 48, or 72-hr hypothermic storage preservation of canine kidneys in Euro-Collins solution (EC), Collins' solution C2, hypertonic citrate solutions (HC, HC-D2O), or our new flush solution 2 (F.2). Clearance tests (inulin, paraaminohippuric acid, and creatinine) and resorption rates for sodium, potassium, and glucose indicated a high superiority in the early functional recovery of F.2-preserved kidneys after all preservation periods tested. The excellent function after preservation in F.2 contrasted especially with the poor or even absent function after 72-hr preservation in HC and HC-D2O or EC. Thus F.2--a hyperosmolar solution containing sucrose with a balanced Na-K relation on the basis of "heavy water" (D2O)--is especially suitable for preservation up to 72 hr if cyclosporine is used for immunosuppression in the recipient. The recipient can be supplied with an organ with immediate good functional recovery because cyclosporine banishes the higher risk for rejection of these well-functioning organs; simultaneously, the possibility for continuous functional supervision allows avoidance of nephrotoxic side effects from the immunosuppressant.

Animals↗
PubMed2006

Seizure heralding functional recovery in a patient with apallic syndrome: A case report with retrospective-prospective observation.

BACKGROUND: It has been suggested that there exists a close relationship between seizure discharges and functional recovery from brain injury, and that paroxysmal bombardment in late seizures may herald functional recovery or may "kick-start" recovery. CASE REPORT: We report the case of a 52-year-old patient who, following a subarachnoid hemorrhage and multiple surgeries, experienced discernible apallic syndrome of long duration. His hospitalization is well documented. The patient underwent protracted, intense rehabilitation, but he remained in this prolonged state of loss of consciousness and behavioral passivity until he experienced a series of periodic seizures. Widespread improvement in his cognitive and functional abilities coincided closely with the seizure activity. The literature on this topic is reviewed. CONCLUSION: This case confirms the close relationship between seizure discharges and functional recovery reported in preclinical literature.

Humans↗
PubMed2001

Quantification of functional recovery following rat sciatic nerve transection.

Functional recovery following experimental nerve injury has been notoriously difficult to quantify precisely. The current gold standard in the rat sciatic nerve model involves analysis of footprints of the recovering animal, and computation of the sciatic function index (SFI). We performed transection injuries and measured recovery both by walking track analysis and by a newer, simpler, more quantitative test of motor recovery, the extensor postural thrust (EPT). We demonstrate a high correlation between both testing modalities and suggest a role for EPT measurements as an easier, more consistent measure of motor recovery following experimental rat sciatic nerve transection.

Animals↗
PubMed1994

Fumarate-enriched blood cardioplegia results in complete functional recovery of immature myocardium.

Amino acid enrichment of cardioplegic solutions has been shown to improve both the metabolic and functional recovery of ischemic myocardium. However, because of the marked systemic vasodilatation involved, use of amino acid enrichment is limited to the periods of induction and reperfusion. Fumarate is a Krebs' cycle intermediate whose conversion to succinate is responsible for the generation of adenosone triphosphate and the oxidation of the reduced form of nicotinamide-adenine nucleotide which is the pathway by which aspartate exerts its effect. Fumarate may also function as a free-radical scavenger and is involved in calcium transport. To determine if fumarate-enriched blood cardioplegia would improve the functional recovery of the neonatal heart, 14 neonatal piglet hearts were isolated and placed on a blood-perfused working heart circuit. After the baseline functional and metabolic assessment was done, cold ischemic arrest was initiated with either standard blood cardioplegic solution (group I; N = 7) or fumarate-enriched (13 mmol/L) blood cardioplegic solution (group II; N = 7). Cardioplegic solution was given at a pressure of 40 mm Hg every 20 minutes for 2 hours, and topical hypothermia was used. Sixty minutes after warm whole blood reperfusion, the functional recovery at left atrial pressures of 3, 6, 9, and 12 mm Hg was 70%, 66%, 66%, and 65%, respectively, in group I, versus 102%, 106%, 105%, and 109%, respectively, in group II (p < 0.05). The tissue creatinine phosphate levels after reperfusion were significantly higher in group II hearts (15.0 +/- 1.2 mumol/g dry heart tissue) than in group I hearts (9.2 +/- 1.9 mumol/g dry heart tissue), although the adenosine triphosphate levels were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1996

Long-term functional recovery from age-induced spatial memory impairments by nerve growth factor gene transfer to the rat basal forebrain.

Nerve growth factor (NGF) stimulates functional recovery from cognitive impairments associated with aging, either when administered as a purified protein or by means of gene transfer to the basal forebrain. Because gene transfer procedures need to be tested in long-term experimental paradigms to assess their in vivo efficiency, we have used ex vivo experimental gene therapy to provide local delivery of NGF to the aged rat brain over a period of 2.5 months by transplanting immortalized central nervous system-derived neural stem cells genetically engineered to secrete NGF. By grafting them at two independent locations in the basal forebrain, medial septum and nucleus basalis magnocellularis, we show that functional recovery as assessed in the Morris water maze can be achieved by neurotrophic stimulation of any of these cholinergic cell groups. Moreover, the cholinergic neurons in the grafted regions showed a hypertrophic response resulting in a reversal of the age-associated atrophy seen in the learning-impaired aged control rats. Long-term expression of the transgene lead to an increased NGF tissue content (as determined by NGF-ELISA) in the transplanted regions up to at least 10 weeks after grafting. We conclude that the gene transfer procedure used here is efficient to provide the brain with a long-lasting local supply of exogenous NGF, induces long-term functional recovery of cognitive functions, and that independent trophic stimulation of the medial septum or nucleus basalis magnocellularis has similar consequences at the behavioral level.

Aging↗
PubMed1994

Enhancement of functional recovery following a crush lesion to the rat sciatic nerve by exposure to pulsed electromagnetic fields.

Previous studies showed that exposure to pulsed electromagnetic fields (PEMF) produced a 22% increase in the axonal regeneration rate during the first 6 days after crush injury in the rat sciatic nerve. We used the same injury model to assess the effect on functional recovery. The animals were treated with whole body exposure to PEMF (0.3 mT, repetition rate 2 Hz) for 4 h/day during Days 1-5 while held in plastic restrainers. Functional recovery was serially assessed up to Postinjury Day 43 using recently described video imaging of the 1-5 toe spread and the gait-stance duration. Footprint analysis was also used with calculation of a sciatic function index. Those animals treated with PEMF had improved functional recovery, as compared to sham controls, using the tests for video 1-5 toe spread and gait-stance duration (P = 0.001 and P = 0.081, respectively). This effect was found throughout the 43-day recovery period. No effect was found using the sciatic function index. This study confirms that functional recovery after nerve crush lesion is accelerated by PEMF and has broad implications for the clinical use of these fields in the management of nerve injuries.

Animals↗