Safety Issues in Functional Capacity Evaluation: Findings From a Trial of a New Approach for Evaluating Clients With Chronic Back Pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.     

Histologic and histomorphometric analysis of three types of dental implants following 18 months of occlusal loading: a preliminary study in baboons

The purpose of this study was to determine the percentage of 'bone area' (BA) and 'bone-to-implant contact' (BIC) of dental implants with different designs and surface modifications after functional loading. Three types of dental implants with fixed partial dentures were placed in the posterior jaws of adult baboons (commercially pure titanium (CpTi) screws, grit-blasted acid-etched (GBAE) screws, and titanium plasma-sprayed (TPS) cylinders), three of the same design per quadrant. After 18 months of functional loading, all implants investigated were successfully integrated in the jawbone and histologic and histomorphometric analyses were carried out. Statistical evaluation was performed with a mixed model with data given as least-square means and standard errors of the mean (SEM). Histologically, direct BIC without connective tissue interposed between implant surfaces and peri-implant bone was seen. Analysis of BA within 1 mm around implants showed significant differences between CpTi (50.5%) and TPS (39.7%) (+/-2.72 SEM; P<0.01) in the maxilla. To account for the different implant designs, absolute BIC was calculated. Significant differences were found between CpTi (23.9 mm) and TPS (15.1 mm) and between GBAE (27.2 mm) and TPS (15.1 mm) (+/-1.05 SEM; P<0.01) in the maxilla and between GBAE (26.5 mm) and TPS (19.6 mm) (+/-1.42 SEM; P<0.01) in the mandible. Overall, the data indicate that, in the maxilla, screw-shaped implants showed more absolute BIC than cylindrical implants, which had less maxillary than mandibular absolute BIC after 18 months of functional loading.     

Rizatriptan 10-mg wafer versus usual nontriptan therapy for migraine: analysis of return to function and patient preference

BACKGROUND: More than half of patients with migraine suffer moderate to severe functional disability during migraine attacks. OBJECTIVE: To compare effects on functional disability at 2 hours after treating a migraine with rizatriptan 10-mg wafer versus usual nontriptan therapy for triptan-na?ve patients with migraine. DESIGN: Open-label, prospective, two-attack study conducted at 111 neurology clinics. METHODS: Adult patients with migraine treated two migraine attacks, the first with their usual nontriptan therapy (nonsteroidal anti-inflammatory drugs, 57%; analgesics, 27%; or ergot derivatives, 16%) and the second with rizatriptan 10-mg wafer. Patients recorded pain intensity and functional disability at the start, and functional disability at 2 hours, as well as the time of return to normal function. RESULTS: A total of 1353 patients, 76% of them female, completed the study and were considered evaluable. During first and second migraine attacks, 55% and 63% of patients, respectively, reported severe disability or requiring bed rest. At 2 hours after treatment, the likelihood of experiencing any disability was more than five times greater after usual nontriptan therapy than after rizatriptan (odds ratio, 5.68; 95% confidence interval (CI), 4.66 to 6.94; P < .001). Rizatriptan was twice as likely to return patients to normal function than usual nontriptan therapy after adjusting for confounding factors (adjusted hazard ratio, 2.08; 95% CI, 1.92 to 2.25; P < .001). Assessed over all time points up to 6 hours, the speed of return to normal function was 52% faster after rizatriptan therapy (P < .001). Significantly more patients preferred rizatriptan than usual nontriptan therapy (78.8% vs. 21.2%; P < .001). The most common reasons cited for preference for rizatriptan were faster relief of headache pain and faster return to normal function. CONCLUSIONS: Patients in this study were more likely to experience a return to normal function at 2 hours after receiving rizatriptan than after their usual nontriptan therapy for migraine. The results of this study, using patient-oriented, clinically relevant endpoints such as functional disability and preference, will help to guide practitioners in making recommendations for acute migraine treatment.     

Functional hyperemia is reduced in skeletal muscle of aged rats

OBJECTIVE: To test the hypothesis that active hyperemia is reduced in skeletal muscle of old rats due to a decreased bioavailability of prostanoids, which in turn is due to increased oxidative stress. METHODS: The microvasculature of the spinotrapezius muscle of 3-, 12-, and 24-month male Sprague-Dawley rats was examined using in vivo videomicroscopy. Arteriolar diameter and centerline red cell velocity were measured in resting and contracting muscle. The effect of prostanoids was examined using indomethacin (10 microM), and passive resting arteriolar diameters were determined using adenosine (100 microM). Lipid peroxidation was assessed ex vivo by measuring tissue levels of malondialdehyde. RESULTS: Arteriolar diameters and blood flow in resting muscle did not differ among the age groups, but increases in diameter and flow during muscle contraction in young rats were greater than in the two older age groups. Indomethacin did not affect resting arteriolar diameters and blood flow in 3- and 12-month rats, but significantly decreased both parameters in 24-month rats. Indomethacin had no effect on arteriolar diameter and blood flow responses during muscle contraction in any age group. Passive resting diameters of arterioles were significantly smaller in 12- and 24-month rats than in 3-month rats. Tissue levels of TBARS were not different among the three age groups. CONCLUSIONS: Arteriolar tone and blood flow in resting skeletal muscle of rats is not altered with age, whereas the increases in these variables that normally accompany muscle contraction are markedly impaired during aging. Neither cyclooxygenase metabolites nor lipid peroxidation appear to be involved in this impairment.     

Functional Scoring of the Binocular Field

A new method for evaluating the total (BINOCULAR) field is based on FUNCTION instead of on anatomy. According to the author's theory of relative values, certain areas of the field are functionally more important than others in human activity. The new system imitates nature by plotting the total field binocularly instead of combining the two conventional monocular fields. Scoring is then done by a new binocular grid—a relative value scale, weighted exactly like its monocular prototype to favor the functionally more valuable parts of the field. The new method also led to the discovery of “binocular enhancement” that produces scores more realistic than formerly possible. Especially useful to ophthalmic consultants for evaluating visual capability or disability in industry, law and government (workers compensation, motor vehicle, social security, aviation, military), the new scale works accurately and rapidly with most existing perimeters, manual or automated.     

A supramodal limbic-paralimbic-neocortical network supports goal-directed stimulus processing

Limited processing resources are allocated preferentially to events that are relevant for behavior. Research using the novelty "oddball" paradigm suggests that a widespread network of limbic, paralimbic, and association areas supports the goal-directed processing of task-relevant target events. In that paradigm, greater activity in diverse brain areas is elicited by rare task-relevant events that require a subsequent motor response than by rare task-irrelevant novel events that require no response. Both stimulus infrequency (unexpectedness) and novelty, however, may contribute to the pattern of activity observed using that paradigm. The goal of the present study was to examine the supramodal neural activity elicited by regularly occurring, equiprobable, and non-novel stimuli that differed in the subsequent behavior they prescribed. We employed event-related functional magnetic resonance imaging (fMRI) during auditory and visual versions of a Go/NoGo task. Participants made a motor response to the designated "Go" (target) stimulus, and no motor response to the equiprobable "NoGo" (nontarget) stimulus. We hypothesized that task-relevant Go events would elicit relatively greater hemodynamic activity than would NoGo events throughout a network of limbic, paralimbic, and association areas. Indeed, Go events elicited greater activity than did NoGo events in the amygdala-hippocampus, paralimbic cortex at the anterior superior temporal sulcus, insula, posterior orbitofrontal cortex, and anterior and posterior cingulate cortex, as well as in heteromodal association areas located at the temporoparietal junction, anterior intraparietal sulcus and precuneus, and premotor cortex. Paralimbic cortex offers an important site for the convergence of motivational/goal-directed influences from limbic cortex with stimulus processing and response selection mediated within the frontoparietal areas.     

Visual evoked potentials may be recorded simultaneously with fMRI scanning: A validation study

Integrating electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) data may help to optimize anatomical and temporal resolution in the investigation of cortical function. Successful removal of fMRI scanning artifacts from continuous EEG in simultaneous recordings has been reported. We assessed the feasibility of recording reliable visual evoked potentials (VEPs) during fMRI scanning using available artifact removing procedures. EEG during administration of visual stimuli was recorded using MRI-compatible 32-channel equipment in nine normal subjects (mean age, 23.9 +/- 2.5 years), with and without fMRI acquisition. fMRI scanning and cardioballistographic artifacts were removed after subtraction of averaged artifact waveforms. Consistency between VEPs waveforms and of P1 and N1 peak latencies and amplitudes in the two conditions was assessed. Good correlation was found between VEP waveforms (Pearson's correlation coefficient: r(P) between 0.76-0.94 across subjects; P < 0.0001) and between latency or amplitude of P1 and N1 peaks (latencies: r = 0.7, P < 0.035; amplitudes: r > 0.65, P < 0.05; Spearman rank correlation coefficient) in the two recording conditions. No significant differences were found between P1 and N1 parameters in the two conditions (Wilcoxon signed rank test). Consistent VEP waveforms, latencies, and amplitudes with and without fMRI scanning indicate that reliable VEPs may be obtained simultaneously with fMRI recording. This possibility might be helpful by shortening recording times and reducing variability from learning, habituation, and fatigue phenomena from separate recordings for the integration of event-related EEG and fMRI data.     

Visual evoked potentials recovered from fMRI scan periods

Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) may allow functional imaging of the brain at high temporal and spatial resolution. Artifacts generated in the EEG signal during MR acquisition, however, continue to pose a major challenge. Due to these artifacts, an interleaved modus has often been used for "evoked potential" experiments, i.e., only EEG signals recorded between MRI scan periods were assessed. An obvious disadvantage of this approach is the loss of a portion of the EEG information, which might be relevant for the specific scientific issue. In this study, continuous, simultaneous EEG-fMRI measurements were carried out. Visual evoked potentials (VEPs) could be reconstructed reliably from periods during MR scanning and in between successive scans. No significant differences between both VEPs were detected. This indicates sufficient artifact removal as well as physiological correspondence of VEPs in both periods. Simultaneous continuous VEP-fMRI recordings are thus shown to be feasible.     

Function of striatum beyond inhibition and execution of motor responses

We used functional magnetic resonance imaging (fMRI) to study the role of the striatum in inhibitory motor control. Subjects had to refrain from responding to designated items (STOP trials) within a similar series of motor stimuli. Striatal activation was increased significantly compared to that when responding to all targets within a series of motor stimuli, indicating that the striatum is more active when inhibitory motor control over responses is required. The likelihood of a STOP trial was varied parametrically by varying the number of GO trials before a STOP trial. We could thus measure the effect of expecting a STOP trial on the fMRI response in the striatum. We show for the first time in humans that the striatum becomes more active when the likelihood of inhibiting a planned motor response increases. Our findings suggest that the striatum is critically involved in inhibitory motor control, most likely by controlling the execution of planned motor responses.     

Cortical, thalamic, and hypothalamic responses to cooling and warming the skin in awake humans: a positron-emission tomography study

Thermoregulatory mechanisms are remarkably efficient, ensuring minimal temperature variation within the core of the human body under physiological conditions. Diverse afferent and efferent neural pathways contribute to the monitoring of core and skin temperature, generation of heat, and control of thermal exchange with the external environment. We have investigated the cortical, thalamic, and hypothalamic responses to cooling and warming by using positron-emission tomography activation imaging of subjects clad in a water-perfused suit, which enabled rapid change of their skin-surface temperature. Human brain regions that respond to changes in skin temperature have been identified in the somatosensory cortex, insula, anterior cingulate, thalamus, and hypothalamus, with evidence that the hypothalamic response codes for the direction of temperature change. We conclude that signals from thermosensors in the skin providing crucial afferent information to the brain are integrated with signals from central thermosensors, resulting in thermoregulatory responses that maintain core temperature within a remarkably narrow range.