Partial Rehabilitation Research Articles

Gait adaptations before and after anterior cruciate ligament reconstruction surgery.

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

What is the science of the soul ? A case study in the evolution of late medieval natural philosophy

This paper aims at a partial rehabilitation of E. A. Moody's characterization of the 14th century as an age of rising empiricism, specifically by contrasting the conception of the natural science of psychology found in the writings of a prominent 13th-century philosopher (Thomas Aquinas) with those of two 14th-century philosophers (John Buridan and Nicole Oresme). What emerges is that if the meaning of empiricism can be disengaged from modern and contemporary paradigms, and understood more broadly in terms of a cluster of epistemic doctrines concerned with the methodology of knowing, it characterizes very appropriately some of the differences between the ways in which late-medieval thinkers both understood and practised the science of psychology. In particular, whereas Aquinas thinks psychology is about reasoning demonstratively to the real nature of the soul from its evident operations (thereby assimilating psychology to metaphysics), Buridan and Oresme, both of whom doubt whether real animate natures can be known empirically, focus on giving detailed accounts of those operations themselves (thereby assimilating psychology to physics).

Noninformative Bayesian testing and neutral Bayes factors

In contrast with usual point estimation settings, there is no well-defined notion of noninformative Bayesian, procedures for tests of two-sided hypotheses. In this paper, we examine the behavior of the answers associated with the (point estimation) Jeffreys priors and show that, in some cases, they coincide numerically with the classical p-values. This partial equivalence between noninformative and classical answers is also exhibited with neutral Bayes factors. This new evaluation, which determines the cut-off point between acceptance and rejection of the null hypothesis, actually leads to a procedure similar to the (so-called) Jeffreys answere and thus supports the use of a noninformative improper prior. This interpretation thus brings a partial rehabilitation of some p-values as noninformative answers.

Treating Substance Abuse in the Multidisabled

Issues related to the rehabilitation of individuals with a disability who simultaneously present with a substance abuse disorder are reviewed. Causal factors resulting in treatment failures or limited or partial rehabilitation are examined. Disabilities are discussed in general but particular emphasis is placed on physical impairments. It is essential that helping professionals need to be aware of the special needs and problems of multidisabled individuals. Areas in which additional research is needed are proposed.

Comparison of Two Methods for Calculating Percent Body Weight on a Tilt Table

Physical therapists commonly treat patients when knowledge of percent weight bearing is desirable during functional lower extremity exercise. The purpose of this study was to compare two methods for calculating percent body weight at different angles of inclination on a tilt table. Twenty healthy subjects were weighed on a spring scale in standing and on a tilt table at 5 degrees increments between 0 and 90 degrees of tilt. Percent body weight at each angle was compared to a value predicted from a trigonometric equation. Predicted values were significantly greater than measured values at all angles greater than 10 degrees of tilt. Predicted overestimation ranged from 2.8 to 14.2%. Compared to the trigonometric method, physical therapists can more easily and accurately determine percent body weight on a tilt table using a scale if total body weight is known. Partial weight-bearing rehabilitation could be performed on the tilt table by varying the degree of inclination, allowing functional lower extremity exercise for patients with weight-bearing restrictions. Guidelines could be established following a variety of injuries and orthopaedic procedures incorporating functional lower extremity exercises at varying percentages of body weight.

Home parenteral and enteral nutrition in cancer patients.

The clinical outcomes of 2968 patients with active cancer receiving home nutrition support are described. Of these patients 1672 were receiving home parenteral nutrition and 1296 were receiving home enteral nutrition. The outcomes of these active cancer patients are compared to those of 123 radiation enteritis ("cured" cancer) and 480 Crohn's disease patients receiving home parenteral nutrition and 918 noncancer dysphagic patients receiving home enteral nutrition. This longitudinal clinical information was reported to the North American Home Parenteral and Enteral Nutrition Patient Registry between 1985 and 1990. Evidence indicates that the number of home parenteral and enteral nutrition patients has increased nationally by about 25% each year between 1989 and 1990. In a subsample of 37 home nutrition support programs that have consistently reported their data to the registry since 1985, more than 90% of their program growth was accounted for by new patients with active cancer. This is now the largest single diagnosis of patients starting home parenteral and enteral nutrition. The mean survival time of cancer patients is 6 months after starting home parenteral and enteral nutrition, but 25% live beyond a year and 20% resume full oral nutrition. Although most active cancer patients experience only partial rehabilitation, for those patients with longer survival, rehabilitation is more complete. The outcome is relatively better for children and for patients whose neoplasm is leukemia, lymphoma, small bowel, or liver. In comparison, 96% of home parenteral nutrition Crohn's patients, 80% of home parenteral nutrition radiation enteritis patients, and 60% of home enteral nutrition noncancer dysphagic patients survive at least 1 year. Adult active cancer home parenteral and enteral nutrition patients do not have a greater incidence of therapy-related readmissions than other patient groups, however, their overall rehospitalization rate is much more frequent. This article discusses factors that may have contributed to this growth in home nutrition support in active cancer patients. It attempts to clarify where this therapy is clearly justified and where more information is needed. It emphasizes some of the special issues that need to be addressed in treating these vulnerable patients.

A Partial Rehabilitation of the Principle of Collective Punishment

Most, if not all, high school graduates have experienced the following event at some stage of their academic careers. Their teacher wishes to leave the classroom but is fearful about the noise level that will ensue after he or she departs, and so issues the following stern warning to the class: I shall be out of the classroom for a few minutes and during my absence, I want to be able to hear a pin drop from down the hall. If I hear so much as a peep coming from this classroom, everyone will have to remain for detention after class.

Collective Punishment: Criminological Assessment: A Reply to Lipnowski's “A Partial Rehabilitation of the Principle of Collective Punishment”

One of the former members of the U.S. Sentencing Commission was an economist who proposed the following reasoning during a conference on sentencing held in Ottawa in 1988. Since there was no doubt that doubling all fares for air travel would result, at least momentarily, in fewer customers using air transportation, it was presumed to follow at least as clearly that noticeably increasing the punishment for crime would result in fewer persons willing to engage in crime. What the economist had overlooked was that the probability that you would have to pay for your plane ticket at the increased rate is very high; actually, you cannot fly unless you have bought a ticket. In contrast, the probability that a criminal will be caught and suffer the consequences of his or her behavior is perceived to be rather low in the case of most criminals, and with regard to certain crimes, such as break and enter, is actually quite low. Hence, increasing criminal punishments will not deter criminals as automatically as raising the cost of air travel will deter potential customers.

Pre- and post-transplant assessment of liver function in paediatric liver transplantation.

The pre-operative risk of paediatric liver transplantation candidates (n = 41) was assessed in a prospective study by means of clinical symptoms, conventional static and liver blood flow dependent dynamic liver function tests. Nine patients died during the 365-day waiting period. The data were subjected as covariates to a survival analysis in the Cox proportional hazards model. There was a significant relationship between the results of mono-ethylglycinexylidide (MEGX) formation and ICG test and the 365-day survival rate. In the stepwise analysis, none of the remaining parameters improved the predictive ability when added to the dynamic liver function test results. The assessment of post-transplantation liver function was studied in 27 patients during the first 28 postoperative-day period. In addition, liver function was studied in a cross-sectional study 1-7 years after successful liver transplantation in children with complete or partial rehabilitation. In the early postoperative period severe organ damage was indicated by both static and dynamic liver function tests. In the later course after transplantation no deterioration of liver function measured with MEGX formation was to be observed. These findings demonstrate the usefulness of dynamic liver function tests in the pre- and post-transplant assessment of liver function.

Rehabilitation of the Paralyzed Face

Rehabilitation for facial paralysis is a highly individualized task that relies on a complex set of physical, physiologic, social, and emotional factors. A wide range of surgical techniques exist for establishing partial rehabilitation of facial expression and motion. The facial surgeon must analyze these factors and work with the patient in a realistic approach to the problem.

Wealth, Poverty and Politics.

Problems of majority voting An economic analysis of political choice Entry barriers in politics The general irrelevance of the general impossibility theorem Social cost and government action The social cost of reducing social cost Why so much stability? The short way with dissenters A simple algebraic logrolling model Income testing and dissenters: A theoretical model A partial rehabilitation of the public interest theory How to do well while doing good

The Improving Utility of Renal Transplantation in the Management of End-Stage Renal Disease

The results achieved by treating patients with end-stage renal failure with allotransplantation have improved dramatically since the 1950s when immunosuppression was induced by total body irradiation and there was a lack of HLA typing. Although long-term hemodialysis offers prolonged survival and partial rehabilitation for many individuals with end-stage renal disease, the technique is inconvenient and time consuming. Patients are restricted by necessary proximity to the machine, dietary limitations, potential failure of access sites, and complications of various organ systems. Despite the availability of dialysis and the federal funds to partially pay for treatment, long-term dialysis still remains a costly process for the individual in need of care. During the same period when dialysis techniques improved and became widely available, transplantation of the human kidney became an established and justified treatment for some patients with end-stage renal disease. Those with successful kidney allografts may achieve remarkable recovery and are often able to return to normal lives. One of the more striking improvements in the results of renal transplantation in recent years had been the decline in morbidity and mortality. Mortality by the end of the first year after transplantation during which time most deaths occur, is currently less than 5 percent in a number of major medical units. In part, this decline represents a change in philosophy by transplant teams, who now tend to decrease immunosuppression and sacrifice the kidney rather than the patient in instances of inexorable rejection. In addition, declining mortality is directly attributable to improved methods of preventing, discovering, and treating patients with potential or real infections. More recently, in some centers, the rate of successful engraftment has shown gratifying improvement due to refinements in tissue typing, improved cross matching, new immunosuppressive therapies, and pretransplant conditioning with blood products. These recent improvements are the primary focus of this review. Unfortunately, until very recently, rates of functional survival of allografts have not been satisfactory.

Intractable ascites treated with peritoneovenous shunts (LeVeen). A 24- to 64-month follow-up of results in 52 alcoholic cirrhotics.

Peritoneovenous shunts (LeVeen) were placed in 52 patients with intractable ascites due to alcoholic cirrhosis between March 1975 and June 1978. The ascites was defined as intractable if it persisted despite at least six weeks of in-hospital medical management. Only 4.5% of such patients seen during this interval met this criterion by failing to respond to intensive drug and diet therapy. Eight (15%) died five to 60 days postoperatively; six of these did not undergo diuresis. Hepatic encephalopathy and sepsis were important contributing factors. There were 21 late deaths (mean survival, 16 months), primarily related to complications characteristic of this group of cirrhotics: upper gastrointestinal hemorrhage and infection. Twenty-three patients were alive by June 25, 1980, with mean survival of 46 months. Four patients operated on five or more years ago survive without ascites. An accurately placed LeVeen shunt dramatically relieves intractable ascites with improvement in renal function, nutrition, and general health. The operation enables at least partial rehabilitation so that ambulatory care becomes feasible for many of these chronically and seriously disabled patients.

Effects of an Essential Fatty Acid Deficiency, Pair-Feeding and Level of Dietary Corn Oil on the Hypothalamic-Pituitary-Gonadal Axis and Other Physiological Parameters in the Male Chicken

Two studies were conducted to observe the effects of an essential fatty acid (EFA) deficiency, added dietary corn oil and pair-feeding on growth, reproduction and other physiological parameters in the mature cockerel. A purified, linoleic acid (LA)-deficient diet (0.01% LA), or additions of 5% (3.01% LA) or 15% (9.04% LA) corn oil, were fed ad libitum from hatching through 24 weeks of age. Reductions in growth, feed consumption, and comb, and testes size, incomplete spermatogenesis, increased tissue eicosatrienoic acid (20: 3 omega 9) and changes in weights of selected internal organs were observed in deficient cockerels. Total pituitary gonadotropic activity was measured by two bioassay procedures and blood luteinizing hormone was measured by radioimmunoassay. By maturity both of these parameters were significantly reduced in deficient chickens. When these chickens were fed diets with 5% or 15% corn oil under pair-feeding or ad libitum conditions from 20 to 24 weeks, the reduced growth, comb and testes size and gonadotropin metabolism appeared to be caused by depressions in appetite and energy intake rather than EFA per se. The degenerate testicular histology of the 20-week old deficient cockerels, while responding fully to the ad libitum intake of the diets containing corn oil, showed only partial rehabilitation of spermatogenesis when diets with either 5% or 15% corn oil were pair-fed. In general, increasing the level of dietary fat from 5% to 15% did not cause many physiological changes.

Metabolic and hormonal responses to a protein-glucose meal in normal infants and in marasmus and marasmic kwashiorkor.

Blood sugar and plasma free fatty acids (FFA), immunoreactive insulin (IRI), and growth hormone (GH) responses to a protein-glucose meal were determined in normal infants and those with marasmus and marasmic kwashiorkor. Among the normal subjects, fasting blood sugar (BS), peak BS and IRI, and the IRI/BS ratio tended to decrease as age increased. Peak IRI was at least 13muU/ml above fasting in 21 of 24 infants. Fasting GH levels were high 38.5 +/- 13.6 (SD) and 26.3 +/- 14.0 ng/ml, in the two youngest groups (under 1 year) and were comparable with those of the late newborn period. They were slightly lower, 20.8 +/- 22.1, in those 12.5-18.5 months of age. Suppressions of FFA and subsequent rebounds were in close temporal relation to BS and IRI peaks and lows, but not the GH levels. GH was promptly suppressed by the meal, and in most infants secondary elevations were seen. Untreated marasmic infants had normal or low BS, correspondingly normal or low IRI, markedly elevated FFA (1,821 +/- 588 muEq/liter), and GH levels comparable with those of the control subjects. There was some delay in BS elevation and disappearance and poor insulin release after the meal, with only two of nine having elevations of at least 13 muU /ml The BS elevations and IRI responses, however, were adequate to block FFA release. GH levels were poorly suppressed by the meal but some infants had further elevations, possibly in response to protein. After partial rehabilitation, fasting BS and FFA and BS elevations after the meal were normal. A slight improvement in insulin release was apparent. Fasting GH levels and responses to the meal were normal. Fasting, minimally treated children with marasmic kwashiorkor (MK) had normal or low BS, normal or low IRI, normal FFA, and probably normal GH levels. There was considerable delay in BS elevation, moderately delayed glucose disappearance, and very poor or unmeasurable insulin release after the test meal; FFA and GH were poorly suppressed. After partial rehabilitation, fasting BS was normal, FFA levels were (630 +/- 163 muEq/l), IRI was still low, BS elevations and disappearance improved. IRI responses modestly improved, and GH responses were normal.

Free catecholamine excretion in the urine in normal infants and in those with marasmus or kwashiorkor

Free catecholamine (epinephrine + norepinephrine) excretions of normal male infants 2.1-3.2, 4.5-10.6, and 12.5-18.5 months of age, respectively, and of infants and children with marasmus or marasmic kwashiorkor were measured on three consecutive days after admission and after partial rehabilitation. In normal infants, particularly the older ones, the first day's excretion was higher than that of the next two days, probably in response to the stress of the procedures. There was an increase with age, but on a surface area basis, the differences were not significant, the three age groups excreting 15.1 plus or minus 10.2, 23.8 plus or minus 20.9, and 24.7 plus or minus 14.3 mug/m-2/day, respectively. Excretions of marasmic infants on admission were not significantly different from those of the control children. Higher mean values were due to elevated excretions of infants with severe infection. After partial rehabilitation, excretions were similar to those of control subjects. In children with marasmic kwashiorkor excretions were no different from those of control infants, except in severely infected children. Admission values revealed more day-to-day variation than recovery values or than those of normal and marasmic infants, in whom subject to subject variation was more marked.

The Mystery of Iniquity: Kuzmin's “Temnye ulitsy rozhdaiut temnye mysli”

There can be little doubt that the name Mikhail Alekseevich Kuzmin (1872–1936) would be near the top of any list of important twentieth-century Russian writers neglected both in and outside their homeland. Even though he was regarded as an original and major poet by writers as diverse as Briusov, Blok, Gumilev, Khlebnikov, Mayakovsky, Tsvetaeva, and Pasternak, Kuzmin still awaits rehabilitation in the Soviet Union and rediscovery in the West. There are some signs of a partial rehabilitation in Soviet Russia today, but the chances for a full rehabilitation—a major publication of his works—are slight. Obstacles to a Western rediscovery exist as well. Clichés die hard and perhaps no harder than in literary history. Kuzmin himself must share part of the blame for the major one. By writing the article “On Beautiful Clarity” he unwittingly gave critics and literary historians the tag for comments on his verse. That the article is about prose and that Kuzmin chose not to republish it in his one volume of collected essays is ignored.

The Rise, Fall, and Resurrection of M. N. Pokrovsky

Evaluating the career and scholarship of Mikhail Nikolaevitch Pokrovsky, the onetime dean of Soviet historians, has confronted Soviet historiography with many problems. Lavishly exalted in the 1920s, calumnied in the 1930s, unmentioned throughout the 1940s, Pokrovsky has undergone a partial rehabilitation in the post-Stalin years. Pokrovsky's early career, like that of many of the leading figures of the October Revolution, followed a tortuous path to Marxism-Leninism. In 1904 Pokrovsky contributed a series of articles to Pravda, a largely Menshevik literary monthly (1904-1907), whose editor, Alexander Bogdanov, held views opposed to the then current Bolshevik party line.1 A year later Pokrovsky participated in the Trotskyite journal Borba and continued to associate with the renegade Trotsky through 1912.2 His collaboration with these publications and the lectures he delivered on revolutionary history at Capri and Bologna, rival establishments of the official Bolshevik school at Longjumneau, provided ammunition for those who later sought to vilify his reputation.3 These critics would also remember that ill 1918 Pokrovsky, who was a delegate at the negotiations with the Germans, sided with the left communist opposition to the harsh peace of Brest-Litovsk.

Gingivectomy and crown preparation in occluso-rehabilitation

M OST PATIENTS REQUIRING complete or partial rehabilitation of the mouth present themselves with disturbed and, in many instances, badly broken down periodontal structures. These patients have gone through stages of missing and drifting teeth which have changed the occlusion drastically. The centric, protrusive, and lateral occlusal positions have become accommodated to a malfunctioning set of teeth, and their replacements, both fixed and removable, are constructed to these incorrect positions. In many of these patients, the breakdown of the periodontium proceeds until the end result is an edentulous mouth. In rehabilitating these badly broken down mouths, it is very effective to make preliminary preparations of the teeth for veneers for a quadrant or a half of the mouth during each visit. After the bulk of the crown is prepared, and during the same visit, gingivectomy is performed where it is indicated. It is possible to obtain a simple approach to the proximal pockets after the preparations are started. If there should be an infrabony pocket on the proximal surface and an indication for the surgery of this area, the opportunity for completely cleaning out the area is vastly improv.ed and, in many instances, there may be a visible approach to the pocket. Even if there are narrow tortuous pockets, the technical problem of instrumentation is simplified. From the patient’s point of view, a gingivectomy done during the prosthetic phase is also an improvement. There is excellent local anesthesia. The patient does not require more office visits than the time necessary to complete his prosthesis, and there is no duplication of effort. From the dentist’s point of view, after the gingivectomy is completed, temporary splints can be constructed so that centric occlusion is obtained, and the proper protrusive and lateral components of occlusion are developed. This begins the treatment phase for the periodontium immediately, and it is an excellent test to determine the future maintenance of any questionable teeth. If the periodontium responds within a reasonable time (one to three months), then questionable tooth or teeth may be utilized as abutments if they have been so indicated in the treatment plan. If, after a fair test, there is a negative response, the best approach is extraction of the questionable teeth, and an alternate plan must be accepted. The time of healing with the above procedure is at least equal to that of a gingivectomy performed prior to the crown preparation. The clinical result is also equally favorable, and patients have not shown any unusual discomfort during or after the combined operations. A rehabilitation can be completed with a similar end result in a much shorter time in this way than by doing it separately.

Significance of the Military in Post-War Japan

Military elements in Japan reached their all-time nadir in August I945. For some years thereafter they continued in the doldrums, but, beginning in ig5o, the new rearmament policy of the Occupation and the general Reverse Course policy in Japan produced a climate that encouraged some of the former professional military to engage once more in organized activity. Not only could many of them join the new armed forces, but they were able to participate with a certain degree of success in national elections and also to form various ex-officer and ex-servicemen's associations. It should, however, be emphasized that although the position of the former professional military has greatly improved since the years immediately following the war, the militarists themselves have, so far at least, failed in all their attempts to influence the Japanese Government in its defence plans: they have not had the slightest eflect on the actual evolution of the Self-Defence Forces, which have developed quietly and almost without deviation along the lines laid down by the American Military Assistance Group towards the target of a very modest degree of rearmament. The following article, which examines some of the more significant aspects of the partial rehabilitation of the military in post-war Japan, is based on one chapter of a book on post-war Japan being prepared by the writer under the auspices of the Royal Institute of International Agfairs, London. The sections included here are concerned mainly with interpretation, rather than with a factual account.