Effects of unilateral brain damage on contralateral and ipsilateral upper extremity function in hemiplegia.

This article describes the long-term effects of unilateral penetrating hemispheric lesions on contralateral and ipsilateral upper extremity motor performance and functional outcome. Activities-of-daily-living skill and gross motor performance contralateral to the lesions were compared among 32 left-sided and 19 right-sided hemiplegic subjects using analysis of variance and chi-square techniques. Ipsilateral to the damaged hemisphere, fine motor tasks of simple visual motor reaction time, grip and pinch strength, finger tapping, and Purdue Pegboard performance were tested. Analysis of covariance compared each ipsilateral task to performance in the corresponding hand of 70 matched controls. Results indicate similar long-term functional ADL outcome in right and left hemisphere-damaged subjects, despite more severe contralateral functional motor deficits following lesions of the left hemisphere. Right hemisphere lesions led to ipsilateral decrements in reaction time, and lesions of either hemisphere diminished grip or pinch strength, finger tapping, and pegboard performance ipsilaterally. These results demonstrate that unilateral brain damage involving the motor areas of either hemisphere has detrimental effects on ipsilateral upper extremity motor function. Findings are discussed and related to the concept that the left hemisphere is specialized or has greater neuronal representation for bilateral motor processes. Physical therapists involved in the treatment of patients with hemiplegia should be aware that motor functions of the ipsilateral, nonparetic upper extremity may also be affected adversely by unilateral brain lesions.

Cardiopulmonary functioning in adolescent patients with mild idiopathic scoliosis.

This study measured the physical work capacity of adolescent subjects with idiopathic scoliosis to determine whether cardiopulmonary restrictions begin to occur in the early stages of the condition. Nineteen adolescents (four males, 15 females) between the ages of 10 and 17 years (means = 13.4), with idiopathic thoracic scoliosis, served as subjects. The mean scoliotic curve was 21.5 degrees. Each subject had his/her height, weight, and percent body fat (Lange caliper) recorded. Resting vital capacity and forced expiratory volume were evaluated using standardized clinical spirometry techniques. Work capacity was measured via a continuous graded incremental exercise tolerance test, using a treadmill. A running protocol was used. Heart rate was continuously monitored by an ECG, and a Beckman Metabolic Cart analyzed ventilation (VE), breathing rate (f), and oxygen uptake (VO2) every minute. Twelve of the subjects had vital capacity measures that were one or more standard deviations below normal and also had VO2max scores below 40ml/kg/min. Subjects with curves of 25 degrees or higher had a mean VO2max of 32.6ml/kg/min, while subjects with curves of less than 25 degrees had a mean VO2max of 42.6ml/kg/min. It appears that some pulmonary limitations begin even in mild curves. Curves greater than 25 degrees also appear to affect work capacity.

Physical work capacity in adolescent patients with mild idiopathic scoliosis.

The purpose of this study was to investigate the physical work capacity of adolescent patients with mild idiopathic scoliosis (less than 60 degrees). Fourteen subjects, who were being treated with a Milwaukee brace, were given a progressive exercise stress test. Ventilatory volume, frequency of breathing, end-tidal PCO2, heart rate, and blood pressure were continuously monitored and oxygen consumption (VO2) was computed for each work load. Results indicated that the majority of subjects were 1 to 4 standard deviations above the mean for nonhandicapped peers in expired ventilation, and all of the subjects were 2 standard deviations or more below the mean for their nonhandicapped peers in VO2max. The low work capacity was similar to that reported in individuals with much larger curves. Reduced work capacity was not apparently limited by maximal attainable ventilation or ventilatory pattern (frequency). Reduced aerobic fitness cannot be ruled out.