Reliability and normative values of the Wheelchair Propulsion Test: A preliminary investigation.

BACKGROUND: Normative data for the equivalent of gait speed via the Wheelchair Propulsion Test (WPT) do not exist for wheelchair users. OBJECTIVE: The purposes of the current study were to: 1) determine the reliability of the WPT, 2) propose and compare normative values for the WPT for young adult males and females utilizing three different propulsion techniques, and 3) compare how different wheelchair types affect performance on the WPT. METHODS: 50 young adults (25 of each sex) performed the WPT using three different propulsion techniques in three different types of wheelchairs. Participants were asked to propel a wheelchair over 10 m at a comfortable speed. Time and number of pushes were recorded for three trials for each propulsion technique in each type of wheelchair. RESULTS: All of the ICC(2,2) values were >0.83 for speed and number of pushes. Normative values for speed, number of pushes, push frequency and effectiveness categorized by propulsion technique, sex and wheelchair type were developed. CONCLUSIONS: Preliminary normative values have been established for young adults performing the WPT. This study highlights the need to maintain consistency of the wheelchair type and propulsion technique between trials in order for the WPT to be reliable.

Immunocytochemical localization of opsin, visual arrestin, myosin III, and calmodulin in Limulus lateral eye retinular cells and ventral photoreceptors.

The photoreceptors of the horseshoe crab Limulus polyphemus are classical preparations for studies of the photoresponse and its modulation by circadian clocks. An extensive literature details their physiology and ultrastructure, but relatively little is known about their biochemical organization largely because of a lack of antibodies specific for Limulus photoreceptor proteins. We developed antibodies directed against Limulus opsin, visual arrestin, and myosin III, and we have used them to examine the distributions of these proteins in the Limulus visual system. We also used a commercial antibody to examine the distribution of calmodulin in Limulus photoreceptors. Fixed frozen sections of lateral eye were examined with conventional fluorescence microscopy; ventral photoreceptors were studied with confocal microscopy. Opsin, visual arrestin, myosin III, and calmodulin are all concentrated at the photosensitive rhabdomeral membrane, which is consistent with their participation in the photoresponse. Opsin and visual arrestin, but not myosin III or calmodulin, are also concentrated in extra-rhabdomeral vesicles thought to contain internalized rhabdomeral membrane. In addition, visual arrestin and myosin III were found widely distributed in the cytosol of photoreceptors, suggesting that they have functions in addition to their roles in phototransduction. Our results both clarify and raise new questions about the functions of opsin, visual arrestin, myosin III, and calmodulin in photoreceptors and set the stage for future studies of the impact of light and clock signals on the structure and function of photoreceptors.

Discharge function and length of stay for patients with stroke are predicted by lower extremity muscle force on admission to rehabilitation.

OBJECTIVE: We sought to determine the relative value of lower extremity muscle strength as a predictor of discharge function and length of stay of patients with stroke. METHODS: We studied 72 patients undergoing inpatient rehabilitation after a stroke and documented their outcome using length of stay and function [as measured by the Functional Independence Measure (FIM) at discharge]. RESULTS: Knee-extension force and the total force of four lower extremity muscle actions (hip flexion, knee extension, knee flexion, and ankle dorsiflexion) were correlated significantly with discharge FIM and length of stay. The correlations involving the actions of the weaker side were higher. Admission FIM was also correlated significantly with discharge FIM and length of stay. Previous stroke and age were correlated significantly with discharge FIM but not length of stay. The set of variables offering the best explanation of discharge FIM (R = 0.867) was admission FIM, admission FIM squared, age, and total force of the weaker side. The set of variables offering the best explanation of length of stay (R = 0.812) was knee-extension force of the weaker side squared, admission FIM, admission FIM squared, and age. CONCLUSIONS: Lower extremity muscle force of the weaker side on admission has value as a predictor of function at discharge and length of stay for patients with stroke admitted to inpatient rehabilitation. Muscle force, therefore, is a reasonable target of measurement and treatment. Knowledge of muscle force on admission can assist clinicians, patients, families, and others to anticipate patient outcomes after rehabilitation.

Distribution of muscle strength impairments following stroke.

OBJECTIVE: The purpose of this study was to quantify the distribution of strength impairments soon after stroke. We were specifically interested in differences in impairments between proximal and distal actions, flexion and extension actions, and upper and lower limb actions. DESIGN: We conducted a retrospective chart review of strength scores of patients with acute stroke. SETTING: Inpatient rehabilitation unit. SUBJECTS: Forty-eight patients with a primary diagnosis of stroke underwent initial testing on admission; 31 of the same patients underwent final testing prior to discharge. MAIN OUTCOME MEASURES: The strength of eight muscle actions was assessed bilaterally using hand-held dynamometry. Force measurements obtained were expressed in newtons and as a percentage of normal. RESULTS: Strength was impaired bilaterally but more so on the side contralateral to the brain lesion. Distal muscle actions were less impaired than proximal muscle actions on the stronger side. Extension actions were less impaired than flexion actions bilaterally but primarily in the upper limbs. Upper limb actions were less impaired than lower limb actions only on the stronger side. CONCLUSIONS: With a few exceptions, our results do not support common clinical assumptions regarding the distribution of strength impairments following stroke.

Visual arrestin in Limulus is phosphorylated at multiple sites in the light and in the dark.

Arrestins participate in the termination of phototransduction in both vertebrates and invertebrates. However, the visual arrestins of invertebrates and vertebrates differ significantly from one another in that the invertebrate visual arrestins become phosphorylated rapidly in response to light while those in the photoreceptors of vertebrates do not. In an effort to understand the functional relevance of arrestin phosphorylation, we examined this process in the photoreceptors of the horseshoe crab Limulus polyphemus. We report that Limulus visual arrestin can be phosphorylated at three sites near its C-terminus and show that arrestin molecules phosphorylated on one, two, and three sites are normally present in both light- and dark-adapted photoreceptors. Light adaptation increases the amount of arrestin phosphorylated at three sites.

Standards for judgments of unilateral impairments in muscle strength.

A secondary analysis of a data base of isometric strength measures from 136 asymptomatic adults (50-79 years) was conducted to estimate the normal difference between dominant and nondominant side strengths. Measures of strength obtained by hand-held dynamometry from 13 muscle actions were expressed as a ratio, dominant side strength:nondominant side strength. The ratios indicated that the dominant side was stronger on average but that the normal range of differences between sides could reach 23.2 to 40.2%, depending on the action. The findings do not provide much support for the convention of using a 10% difference in strength between sides to designate impairment.

A myosin III from Limulus eyes is a clock-regulated phosphoprotein.

The lateral eyes of the horseshoe crab Limulus polyphemus undergo dramatic daily changes in structure and function that lead to enhanced retinal sensitivity and responsiveness to light at night. These changes are controlled by a circadian neural input that alters photoreceptor and pigment cell shape, pigment migration, and phototransduction. Clock input to the eyes also regulates photomechanical movements within photoreceptors, including membrane shedding. The biochemical mechanisms underlying these diverse effects of the clock on the retina are unknown, but a major biochemical consequence of activating clock input to the eyes is a rise in the concentration of cAMP in photoreceptors and the phosphorylation of a 122 kDa visual system-specific protein. We have cloned and sequenced cDNA encoding the clock-regulated 122 kDa phosphoprotein and show here that it is a new member of the myosin III family. We report that Limulus myosin III is similar to other unconventional myosins in that it binds to calmodulin in the absence of Ca2+; it is novel in that it is phosphorylated within its myosin globular head, probably by cAMP-dependent protein kinase. The protein is present throughout the photoreceptor, including the region occupied by the photosensitive rhabdom. We propose that the phosphorylation of Limulus myosin III is involved in one or more of the structural and functional changes that occur in Limulus eyes in response to clock input.

Relationships between impairments in strength of limb muscle actions following stroke.

To examine the relationships between impairments in limb muscle strength soon after stroke, a secondary analysis of a data base of 48 patients with stroke was undertaken. Measurements of isometric muscle strength obtained bilaterally from eight muscle actions and recorded in the data base were retrieved for analysis. Most of the strength measures correlated significantly with one another. The measures of muscle strength showed high internal consistency in each limb, on each side, and over-all. Principal components analysis and cluster analysis indicated that the closest relationships were between muscle actions of the upper limb contralateral to the stroke (the "paretic" side), limb muscle actions of the side ipsilateral to the stroke (the "nonparetic" side), and muscle actions of the lower limbs. These findings may reflect the organization of the central nervous system following stroke.

A community-based nursing approach to the prevention of otitis media.

Otitis media (OM), a disease of the middle ear, is one of the most common diseases of childhood. Although the medical and surgical treatment of the disease by physicians is covered at length in the literature, information about the role of nurses in dealing with OM is scant. The purpose of this article is to propose a community-based nursing prevention plan for OM based on what is known about its prevalence and pathogenesis.

Calcium/calmodulin-dependent protein kinase II and arrestin phosphorylation in Limulus eyes.

In rhabdomeral photoreceptors, light stimulates the phosphorylation of arrestin, a protein critical for quenching the photoresponse, by activating a calcium/calmodulin-dependent protein kinase (CaM PK). Here we present biochemical evidence that a CaM PK that phosphorylates arrestin in Limulus eyes is structurally similar to mammalian CaM PK II. In addition, cDNAs encoding proteins homologous to mammalian and Drosophila CaM PK II in the catalytic and regulatory domains were cloned and sequenced from a Limulus lateral eye cDNA library. The Limulus sequences are unique, however, in that they lack most of the association domain. The proteins encoded by these sequences may phosphorylate arrestin.

Normative values for isometric muscle force measurements obtained with hand-held dynamometers.

BACKGROUND AND PURPOSE: The extent of a patient's impairment can be established by comparing measurements of that patient's performance with normative values obtained from apparently unimpaired individuals. Only a few studies have described normative values for muscle strength measured by hand-held dynamometry. The purpose of this study of older adults, therefore, was to obtain normative values of maximum voluntary isometric force using hand-held dynamometers. SUBJECTS: One hundred fifty-six asymptomatic adults (77 men, 70 women) participated in this study. The subjects' mean age was 64.4 years (SD=8.3, range=50-79). The male subjects' mean age was 64.5 years (SD=8.4, range=50-79), and the female subjects' mean age was 64.3 years (SD=8.2, range=50-79). METHODS: Gender, age, dominant side, height, weight, and activity level were recorded. Eight upper-extremity movements (shoulder flexion, extension, abduction, and medial and lateral rotation; elbow flexion and extension; and wrist extension) and five lower-extremity movements (hip flexion and abduction, knee flexion and extension, and ankle dorsiflexion) were resisted by one of three experienced testers using a strain-gauge hand-held dynamometer. RESULTS: Gender, age, and weight were identified as independent predictors of force for all muscle actions on both the dominant and nondominant sides. These variables were used, therefore, to create regression equations and normative values for the force of each muscle action. CONCLUSION AND DISCUSSION: The reference values provided may allow clinicians who follow the described testing protocol to estimate the severity of force-generating impairments in patients aged 50 to 79 years.

Mutagenicity of particulate emissions from the M16 rifle: variation with particle size.

Emissions generated by firing the M16 rifle with the propellant WC844 in a combustion chamber designed to simulate conditions of actual use were tested for mutagenic activity in the Salmonella/Ames assay. Dimethyl sulfoxide extracts of emissions collected from either the breech or muzzle end of the rifle were mutagenic in three strains of Salmonella (TA1537, TA1538, and TA98) both in the presence and absence of metabolic activation systems (S9). The extracts were negative in strains TA100 and TA102. Aerosols generated by firing the M16 rifle were fractionated according to aerodynamic diameter. Submicrometer particles were far more mutagenic than particles with aerodynamic diameters between 1 and 15 microns. The mutagens associated with the smaller particles were more active in the presence of S9, while extracts of larger particles were as active, or more active, in the absence of S9. Heavier particles, which settled rapidly out of the airstream, were not mutagenic.

Mutagenicity of glyceryl trinitrate (nitroglycerin) in Salmonella typhimurium.

The recent finding that the clinical nitrovasodilator, glyceryl trinitrate (GTN), is mutagenic in Salmonella typhimurium strain TA1535 has been examined in closer detail, with emphasis on its mechanism of action. GTN increased the number of His+ revertants to a maximum of 4 times over background at a GTN dose of 5 mumol/plate. Hamster liver S9 depressed the toxicity of high GTN doses and increased the maximum number of revertants to 5 times over background at 10 mumol/plate. GTN did not cause significant reversion in any of the six other S. typhimurium strains tested (TA1975, TA102, TA1538, TA100, TA100NR, YG1026), although signs of toxicity were observed. Therefore, the mutagenicity of GTN was manifest only in the repair-deficient (uvrB and lacking in pKM101) strain which is responsive to single base changes. Oligonucleotide probe hybridization of TA1535 revertants showed that virtually all of the GTN-induced mutants contained C-->T transitions in either the first or second base of the hisG46 (CCC) target codon, with a preference for the latter. A similar mutational spectrum was seen previously with a complex of spermine and nitric oxide (NO) which releases nitric oxide. This suggests that NO, which can be derived from GTN via metabolic reduction, may be responsible for GTN's mutagenic action. The known NO scavenger oxymyoglobin did not substantially alter the dose response of GTN, indicating that extracellular NO was not mediating reversion. The data are consistent with the hypothesis that intracellular nitric oxide is responsible for the observed mutations.

DNA deaminating ability and genotoxicity of nitric oxide and its progenitors.

Nitric oxide (NO), a multifaceted bioregulatory agent and an environmental pollutant, can also cause genomic alterations. In vitro, NO deaminated deoxynucleosides, deoxynucleotides, and intact DNA at physiological pH. That similar DNA damage can also occur in vivo was tested by treating Salmonella typhimurium strain TA1535 with three NO-releasing compounds, including nitroglycerin. All proved mutagenic. Observed DNA sequence changes were greater than 99% C----T transitions in the hisG46 (CCC) target codon, consistent with a cytosine-deamination mechanism. Because exposure to endogenously and exogenously produced NO is extensive, this mechanism may contribute to the incidence of deamination-related genetic disease and cancer.

Central projections of Limulus photoreceptor cells revealed by a photoreceptor-specific monoclonal antibody.

Studies of lateral, median, and ventral eyes of the chelicerate arthropod Limulus polyphemus (the common American horseshoe crab) are providing important basic information about mechanisms for information processing in the peripheral visual system and for the modulation of visual responses by light and circadian rhythms. The processing of visual information in Limulus brain is less well understood in part because the specific central projections of the various classes of visual neurons are not known. This study describes a mouse monoclonal antibody, 3C6A3, which binds to Limulus photoreceptor cell bodies, their axons, and terminals, but not to any other cell type in the central nervous system. This antibody, and intracellular injection of biocytin, are used to demonstrate the central projections of each type of photoreceptor. Our main conclusions are that: 1) the photoreceptors (retinular cells) of the lateral eye project only to the lamina; 2) the photoreceptors of the lateral rudimentary eye project to both the lamina and medulla; 3) the photoreceptors of the median ocellus project only to the ocellar ganglion; and 4) the photoreceptors of the rudimentary median (endoparietal) eye project to the ocellar ganglion and also into the optic tract. These results, along with previous studies, allow us to infer the projections of the secondary cells. The eccentric cells of the lateral eye project to the lamina, medulla, optic tract, and ocellar ganglion. The arhabdomeral cells of the median ocellus project through the ocellar ganglion and to optic tract to the medulla.

1,3-Dialkyltriazenes: reactive intermediates and DNA alkylation.

The reactions of calf thymus (ct) DNA with 1,3-dimethyltriazene (DMT), N-methyl-N-nitrosourea (MNU), 1,3-diethyltriazene (DET), N-ethyl-N-nitrosourea (ENU), and 1-ethyl-3-methyltriazene (MET) were studied as a function of concentration of the alkylating agents, of various buffers, and of ionic strength. The amount of alkylation at the 7- and O6-positions of guanine increased linearly with dose over a 10-fold concentration range. The slopes of the DMT and MNU curves were identical as were those of DET and ENU. These data suggest that both types of compounds alkylate DNA via a similar intermediate, presumably the corresponding alkanediazonium ion. MET methylates and ethylates DNA, the amount of each product being a function of the competitive formation of the two diazonium ions possible from MET. The MET product ratios could be reproduced by an appropriate mixture of DET and DMT. The alkylation of DNA by DMT and by MET is very sensitive to ionic strength, to the nature of the buffer, and to the identity of the salt used to balance ionic strength. In general, the reaction is favored by low ionic strength, by amine rather than oxy acid buffers, and by doubly charged inert anions. The alkylation of DNA is inversely proportional to the logarithm of the ionic strength over a wide range. The mutagenic activity of triazenes in Salmonella typhimurium is correlated very well with the ability of the triazenes to form adducts, particularly O6-guanine adducts.(ABSTRACT TRUNCATED AT 250 WORDS)

Histamine: a putative afferent neurotransmitter in Limulus eyes.

Histamine has been proposed as a photoreceptor neurotransmitter in two major groups of arthropods, the insects and the crustacea. In this study biochemical and immunocytochemical approaches were used to examine the synthesis, endogenous content, and cellular distribution of histamine in the visual system of the horseshoe crab Limulus polyphemus, an ancient chelicerate arthropod. Studies with this animal have been critical to our understanding of the basic processes of vision. High-voltage paper electrophoresis was used to assay for histamine synthesis in Limulus tissues incubated with radiolabeled histidine; histamine synthesis was detected in the lateral, median, and ventral eyes and optic nerves and in the visual centers in the brain. Endogenous histamine, assayed as its orthophthalaldehyde derivative by high-performance liquid chromatography and electrochemical detection, was also detected in these tissues. Immunocytochemical analyses, with an antiserum directed against a protein conjugate of histamine, revealed histamine-like immunoreactivity in the somata of photoreceptors in each of the eyes and in the regions of the brain where the photoreceptors terminate. Histamine-like immunoreactivity was also intense in the cell bodies and axon collaterals of eccentric cells in the lateral eye and in eccentric cell projections in the brain. These results show that histamine is a major biogenic amine in the Limulus visual system, and they suggest that this amine is involved in transmitting visual information from the eyes to the brain and in lateral inhibition, a fundamental mechanism for processing visual information in the lateral eye.

Aerial oxidation of hydrazines to nitrosamines.

When 1,1-dimethylhydrazine and N-aminopiperidine were deliberately exposed to air substantial amounts of the corresponding carcinogenic nitrosamines were formed. Unoxidized samples of 1,1-dimethylhydrazine were not mutagenic while oxidized samples (which contained much higher levels of nitrosamines) were mutagenic. Both unoxidized and oxidized samples of N-aminopiperidine were mutagenic.

Shoulder subluxation and pain in stroke patients.

Twenty-four patients with stroke were studied (a) to determine the interrater reliability of a clinical measurement of shoulder subluxation, (b) to confirm the interrater reliability of the Ritchie Articular Index (Bohannon & LeFort, 1986) for measuring shoulder pain, (c) to establish the relationship between the Ritchie index scores and shoulder lateral rotation range of motion measured at the point of pain (SROMP), and (d) to determine the relationship between shoulder subluxation and shoulder pain. The agreement between the two examiners' (the authors) measurements of subluxation was "almost perfect" (Landis & Koch, 1977, p. 165). The agreement between the two examiners' Ritchie index measurements was "substantial" (Landis & Koch, 1977, p. 165). The Ritchie index and SROMP measurements correlated significantly. Neither the Ritchie index nor the SROMP measurements correlated significantly with subluxation. Although the measurements used in this study were reliable, they did not support the association of shoulder subluxation with shoulder pain in stroke patients. Clinicians wishing to reduce shoulder pain in stroke patients should direct their treatment accordingly.