The training of coordination.

The training of coordination is generally considered a volitional activity, during which, by trial and perception of results, an individual selects the muscular activity resulting in the desired performance. This concept of volitionally directed complex coordination of multiple muscles with speed, skill, and strength does not stand the test of thorough evaluation. Attention is limited to 1 activity at a time, with the ability to shift attention not more frequently than 3 times per second. Only under special conditions can activity be limited to specific muscles during an untrained contraction without cocontraction of other muscles. However, with repeated practice of the desired activity, a pattern of performance is developed which can be carried out rapidly and forcefully without activation of other muscles. At that time, the consciousness is no longer directing the components of the activity but merely starting, maintaining, and stopping the performance. The development of these patterns, or engrams, by practice develops the capacity to automatically inhibit muscles that do not contribute to the performance of the desired pattern. The capacity for inhibition results in coordinated activation of the muscles contributing to the performance desired. Investigation of the development of coordination in many types of normal activities, as well as in neuromuscularly impaired patients, shows that engrams develop progressively by slow, precise practice of simple patterns, combined as they develop into more and more complex patterns, until the final skill is attained.

Research trends in physical medicine and rehabilitation.

Titles and abstracts of the 700 papers presented in the scientific sessions of the American Congress of Rehabilitation Medicine and American Academy of Physical Medicine and Rehabilitation from 1972 to 1976 were reviewed. There were 81 papers in 1972, 123 in 1973, 131 in 1974, 158 in 1975 and 207 in 1976. Two hundred thirty-seven (34%) of the papers were presented by 11 Research and Training Centers and 463 papers (66%) were presented by other institutions. One hundred fifteen papers were related to spinal cord injury, 84 to electromyography, 57 to stroke, 51 to muscle histology, physiology and chemistry, 49 to orthotics and 43 to urologic problems. Only six papers were related to cerebral palsy, only one to myelodysplasia, 4 to burns, 8 to cancer, 13 to human sexuality and 10 to prosthetics. It is believed that appropriate funding of research and an emphasis on the neglected subjects through seminars and courses may provoke the curiosity of the research and encourage him to do research in important areas other than the few which are currently most popular.

Lactate dehydrogenase isoenzyme levels in collagen disease.

Serum lactate dehydrogenase (LDH) isoenzymes were determined in 27 patients with collagen disease and 88 normal subjects. The mean value for LDH-3 isoenzyme was 20.4 +/- 3% in normal controls, 31.47 +/- 8.9% in patients with collagen disease who showed activity of the disease, and 20 +/- 3.74% in patients in complete remission. Six patients who had positive rheumatoid factor showed higher LDH-3 levels. There was also some correlation between the activity of the disease and serum LDH-3 level in patients with connective tissue disorders.