The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke

OBJECTIVE: To compare body weight-supported exercise on a gait trainer with walking exercise overground. DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-five ambulatory patients with chronic stroke. INTERVENTIONS: Patients were randomized to 3 groups: (1) gait trainer exercise with functional electric stimulation (GTstim), (2) gait trainer exercise without stimulation (GT), and (3) walking overground (WALK). All patients practiced gait for 15 sessions during 3 weeks (each session, 20 min), and they received additional physiotherapy 55 minutes daily. MAIN OUTCOME MEASURES: Ten-meter walk test (10MWT), six-minute walk test (6MWT), lower-limb spasticity and muscle force, postural sway tests, Modified Motor Assessment Scale (MMAS), and FIM instrument scores were recorded before, during, and after the rehabilitation and at 6 months follow-up. RESULTS: The mean walking distance using the gait trainer was 6900+/-1200 m in the GTstim group and 6500+/-1700 m in GT group. In the WALK group, the distance was 4800+/-2800 m, which was less than the walking distance obtained in the GTstim group (P=.027). The body-weight support was individually reduced from 30% to 9% of the body weight over the course of the program. In the pooled 45 patients, the 10MWT (P<.001), 6MWT (P<.001), MMAS (P<.001), dynamic balance test time (P<.001), and test trip (P=.005) scores improved; however, no differences were found between the groups. CONCLUSIONS: Both the body weight-supported training and walking exercise training programs resulted in faster gait after the intensive rehabilitation program. Patients' motor performance remained improved at the follow-up.     

Women's perceptions of caesarean birth: a Roy international study

The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.     

Short latency somatosensory evoked potentials during active hand movements

This study was designed to investigate the effect of active movement on spinal and cortical evoked responses. During voluntary hand movements the cervical and cortical short latency somatosensory evoked potentials (SEP) elicited by stimulation of the median nerve at the wrist were studied in nine healthy subjects. The latencies of the SEPs were not affected by active movements whereas the peak to peak amplitudes of the main cervical (N13-P15) and the main cortical (N20-P25) deflections were significantly reduced. The cortical subcomponents (N16 and N17), probably reflecting thalamic and thalamocortical activity, were not significantly affected by movements. The amplitude reductions in the cervical and cortical recordings might be related to proprioceptive feedback from the muscle afferents.     

Surgical Complications Associated with Arterial Catheterization

Objectives. Atherosclerosis is a systemic disease affecting several vessels of the body. Coronary artery patients requiring bypass surgery have increased prevalence of carotid artery atherosclerosis which is known to increase operative risk in coronary artery bypass surgery (CABG). Radial artery is often screened for grafting purposes preoperatively. Our aim was to find out whether atherosclerotic changes in forearm vessels are correlated and could reveal risk to carotid artery disease. Design. Eighty-five patients planned for elective CABG were examined with ultrasonography preoperatively. Biplane ultrasonographic scanning was performed on forearm arteries and both carotid arteries. Results. Eleven patients had pathologic changes in the wall of forearm vessels. Carotid artery disease was found on 19 patients. Forearm vessel pathology was found to have correlation to carotid artery disease. When forearm arteries show atherosclerotic pathology the risk of having carotid disease is at least five-fold, in subgroups even higher. Conclusions. Forearm arterial pathology is correlated to carotid artery disease. When forearm vessel pathology is evident in preoperative examination, scanning of the carotid vessels should be considered.     

How first-time mothers cope with child care while still in the maternity ward

The aim of the study was to ascertain those factors that are related to the way first-time mothers assess themselves to be coping with child care when leaving the maternity hospital. The study is part of a wider longitudinal project that follows-up first-time mothers' growth into motherhood for a period of 8 months after the birth. Data collection was done using a questionnaire distributed between January and May 1995. The sample comprised 271 first time mothers. The mothers completed the questionnaire on average on the fifth day after childbirth. A stepwise regression analysis was applied. The mothers who assessed themselves to be coping better with child care were those who went home feeling rested and in a good frame of mind and who had positive experience of child care in the maternity ward. The more functional support the mother perceived herself to receive from members of her social network the better she assessed herself to be coping with child care. Those mothers who had previous experience of taking care of infants also assessed themselves to be coping better with child care. On the basis of the research findings it may be stated that the first-time mother needs support from both nursing professionals and close relatives in order to trust their own abilities to cope better with child care during early motherhood.     

Influence of physical activity on vertebral strength during late adolescence

Background contextReduced vertebral strength is a clear risk factor for vertebral fractures. Men and women with vertebral fractures often have reduced vertebral size and bone mineral density (BMD). Vertebral strength is controlled by both genetic and developmental factors. Malnutrition and low levels of physical activity are commonly considered to result in reduced bone size during growth. Several studies have also demonstrated the general relationship between BMD and physical activity in the appendicular skeleton.PurposeIn this study, we wanted to clarify the role of physical activity on vertebral bodies. Vertebral dimensions appear to generally be less pliant than long bones when lifetime changes occur. We wanted to explore the association between physical activity during late adolescence and vertebral strength parameters such as cross-sectional size and BMD.Study designThe association between physical activity and vertebral strength was explored by measuring vertebral strength parameters and defining the level of physical activity during adolescence.Patient sampleThe study population consisted of 6,928 males and females who, at 15 to 16 and 19 years of age, responded to a mailed questionnaire inquiring about their physical activity. A total of 558 individuals at the mean age of 21 years underwent magnetic resonance imaging (MRI) scans.MethodsWe measured the dimensions of the fourth lumbar vertebra from the MRI scans of the Northern Finland Birth Cohort 1986 and performed T2* relaxation time mapping, reflective of BMD. Vertebral strength was based on these two parameters. We analyzed the association of physical activity on vertebral strength using the analysis of variance.Results and conclusionsWe observed no association between the level of physical activity during late adolescence and vertebral strength at 21 years.     

Distinct effects of calorie restriction on adipose tissue cytokine and angiogenesis profiles in obese and lean mice

ABSTRACT: BACKGROUND: Obesity associates with low-grade inflammation and adipose tissue remodeling. Using sensitive high-throughput protein arrays we here investigated adipose tissue cytokine and angiogenesis-related protein profiles from obese and lean mice, and in particular, the influence of calorie restriction (CR). METHODS: Tissue samples from visceral fat were harvested from obese mice fed with a high-fat diet (60% of energy), lean controls receiving low-fat control diet as well as from obese and lean mice kept under CR (energy intake 70% of ad libitum intake) for 50 days. Protein profiles were analyzed using mouse cytokine and angiogenesis protein array kits. RESULTS: In obese and lean mice, CR was associated with 11.3% and 15.6% reductions in body weight, as well as with 4.0% and 4.6% reductions in body fat percentage, respectively. Obesity induced adipose tissue cytokine expressions, the most highly upregulated cytokines being IL-1ra, IL-2, IL-16, MCP-1, MIG, RANTES, C5a, sICAM-1 and TIMP-1. CR increased sICAM-1 and TIMP-1 expression both in obese and lean mice. Overall, CR showed distinct effects on cytokine expressions; in obese mice CR largely decreased but in lean mice increased adipose tissue cytokine expressions. Obesity was also associated with increased expressions of angiogenesis-related proteins, in particular, angiogenin, endoglin, endostatin, endothelin-1, IGFBP-3, leptin, MMP-3, PAI-1, TIMP-4, CXCL16, platelet factor 4, DPPIV and coagulation factor III. CR increased endoglin, endostatin and platelet factor 4 expressions, and decreased IGFBP-3, NOV, MMP-9, CXCL16 and osteopontin expressions both in obese and lean mice. Interestingly, in obese mice, CR decreased leptin and TIMP-4 expressions, whereas in lean mice their expressions were increased. CR decreased MMP-3 and PAI-1 only in obese mice, whereas CR decreased FGF acidic, FGF basic and coagulation factor III, and increased angiogenin and DPPIV expression only in lean mice. CONCLUSIONS: CR exerts distinct effects on adipocyte cytokine and angiogenesis profiles in obese and lean mice. Our study also underscores the importance of angiogenesis-related proteins and cytokines in adipose tissue remodeling and development of obesity.