RESUMO
Chronic pain patients (101) were assigned ratings of impairment and disability and were assessed for organic pathology and pain behavior through comprehensive testing procedures. As predicted, higher ratings of impairment and disability were significantly associated with higher levels of both physical pathology and pain behaviors. These results indicate that conditioning and pathologic processes significantly influence impairment and disability ratings. Many patients showed higher disability than impairment ratings, which suggests the possibility of gainful employment in less demanding jobs. However, the current disability system rewards sickness and dysfunction and discourages patients from resuming work.
Assuntos
Avaliação da Deficiência , Dor/psicologia , Adulto , Terapia Comportamental , Doença Crônica/psicologia , Feminino , Humanos , Masculino , Modelos Biológicos , Dor/reabilitaçãoRESUMO
There is a need for a simple, quickly applied tool which can correlate performance of the handicapped individual with that of the able-bodied worker and be easily utilized by nontechnical personnel. Efforts at both the Cerebral Palsy Center and the Rehabilitation Center in Atlanta demonstrated that the third generation of Methods-Time-Measurement (MTM-3) satisfies these criteria. As every motion involved in an operation is detailed and a corresponding time value applied, the over-all result reflects a normal rate of accomplishment more accurately than the usual methods and is especially useful in bidding jobs for the workshop. MTM-3 also has a place in the evaluation section to verify or correct existing standards on bench-type work samples and to develop more meaningful time distribution charts relating to a specific population at a center. In studies of disabled individuals, MTM-3 yields a more accurate determination of the actual degree of disability than the American Medical Association's existing estimated percentages in regard to motor skills.
Assuntos
Pessoas com Deficiência , Oficinas de Trabalho Protegido , Análise e Desempenho de Tarefas , Estudos de Tempo e Movimento , Humanos , Reabilitação VocacionalAssuntos
Hormônio do Crescimento/metabolismo , Distrofias Musculares/metabolismo , Distrofia Miotônica/metabolismo , Adolescente , Adulto , Peso Corporal/efeitos dos fármacos , Criança , Dieta , Relação Dose-Resposta a Droga , Eletrocardiografia , Feminino , Hormônio do Crescimento/administração & dosagem , Hormônio do Crescimento/farmacologia , Coração/efeitos dos fármacos , Bloqueio Cardíaco/complicações , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Distrofias Musculares/genética , Distrofia Miotônica/complicações , Nitrogênio/metabolismo , Fósforo/metabolismo , Potássio/metabolismo , Pulso Arterial/efeitos dos fármacos , Sódio/metabolismoAssuntos
Atetose/tratamento farmacológico , Paralisia Cerebral/tratamento farmacológico , Hidantoínas/uso terapêutico , Relaxantes Musculares Centrais/uso terapêutico , Atividades Cotidianas , Administração Oral , Adolescente , Adulto , Criança , Ensaios Clínicos como Assunto , Dantroleno/administração & dosagem , Dantroleno/uso terapêutico , Tolerância a Medicamentos , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Placebos , Sódio/administração & dosagem , Sódio/uso terapêuticoAssuntos
Hidantoínas/uso terapêutico , Relaxantes Musculares Centrais/uso terapêutico , Espasmo/tratamento farmacológico , Atividades Cotidianas , Adolescente , Adulto , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Paralisia Cerebral/tratamento farmacológico , Criança , Ensaios Clínicos como Assunto , Dantroleno/administração & dosagem , Dantroleno/efeitos adversos , Dantroleno/uso terapêutico , Dantroleno/toxicidade , Diazepam/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Esclerose Múltipla/tratamento farmacológico , Fatores de TempoAssuntos
Dietilestilbestrol/farmacologia , Hormônio do Crescimento/farmacologia , Distrofias Musculares/genética , Adolescente , Estatura , Peso Corporal/efeitos dos fármacos , Criança , Creatina Quinase/sangue , Dietilestilbestrol/administração & dosagem , Dietilestilbestrol/uso terapêutico , Hormônio do Crescimento/administração & dosagem , Hormônio do Crescimento/metabolismo , Hormônio do Crescimento/uso terapêutico , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Músculos/fisiopatologia , Distrofias Musculares/diagnóstico , Distrofias Musculares/tratamento farmacológico , Distrofias Musculares/enzimologia , Distrofias Musculares/metabolismo , Distrofias Musculares/fisiopatologia , Nitrogênio/metabolismo , Fósforo/metabolismo , Potássio/metabolismo , Sódio/metabolismo , Fatores de TempoAssuntos
Hormônio do Crescimento/uso terapêutico , Distrofia Miotônica/tratamento farmacológico , Fatores Etários , Contagem de Células Sanguíneas , Peso Corporal , Eletrocardiografia , Eletroencefalografia , Eletromiografia , Estudos de Avaliação como Assunto , Hormônio do Crescimento/administração & dosagem , Frequência Cardíaca , Hematócrito , Hemoglobinometria , Humanos , Masculino , Distrofia Miotônica/metabolismo , Nitrogênio/metabolismo , Fósforo/metabolismo , Potássio/metabolismo , Sódio/metabolismoAssuntos
Hormônio do Crescimento/farmacologia , Distrofias Musculares/metabolismo , Adulto , Arginina/farmacologia , Peso Corporal/efeitos dos fármacos , Feminino , Hormônio do Crescimento/metabolismo , Humanos , Insulina/farmacologia , Masculino , Pessoa de Meia-Idade , Músculos/efeitos dos fármacos , Nitrogênio/metabolismo , Fósforo/metabolismo , Hipófise/efeitos dos fármacos , Hipófise/metabolismo , Potássio/metabolismo , Sódio/metabolismoRESUMO
Metabolic balance studies were conducted in seven boys with Duchenne-type muscular dystrophy, and in six normal boys of similar age, during a 12 day control period and during a 12 day period of treatment with human growth hormone (HGH) at the following doses: 0.0168, 0.0532, and 0.168 U/kg body weight (BW)((3/4)) per day (doses A, B, and C, respectively). In five of the six normals, dose C caused positive balances in N, P, Na, and K; doses B and A had anabolic effects in two and one normal subjects, respectively. In six of the seven Duchenne cases, dose C caused negative balances of N and K, and sometimes of P. Negative balances were produced in three of the Duchenne subjects by dose B, and in one by dose A. None of the dystrophy cases exhibited an anabolic response to any dosage of HGH tested. The release of endogenous HGH in response to insulin, after 2 days' pretreatment with diethylstilbestrol, was similar in both groups of subjects. In the course of these tests, a marked anabolic effect of diethylstilbestrol in the Duchenne patients was apparent. Therefore metabolic balance studies were repeated, in both Duchenne and normal cases, during a 12 day control period and during 12 days of treatment with diethylstilbestrol (0.106 mg/kg BW((3/4)) per day). In three of the normal children, diethylstilbestrol had no effect on the elemental balances; in two cases, a retention of Na was observed. In all seven Duchenne cases, diethylstilbestrol caused positive balances in N, P, Na, and K. Ethinyl estradiol (0.0106 mg/kg BW((3/4)) per day) produced positive N, P, Na, and K balances in all three Duchenne cases tested with this agent. The data show that exogenous HGH causes a catabolic effect in boys with Duchenne dystrophy. These patients are hyperresponsive to the anabolic effect of diethylstilbestrol. The latter phenomenon may reflect the inhibitory effect of estrogen upon the peripheral actions of these boys' endogenous HGH.
Assuntos
Anabolizantes , Dietilestilbestrol/uso terapêutico , Etinilestradiol/uso terapêutico , Hormônio do Crescimento/uso terapêutico , Distrofias Musculares/metabolismo , Adolescente , Amônia/urina , Peso Corporal/efeitos dos fármacos , Criança , Pré-Escolar , Creatina Quinase/sangue , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Distrofias Musculares/tratamento farmacológico , Nitrogênio/metabolismo , Fósforo/metabolismo , Potássio/metabolismo , Sódio/metabolismo , Ureia/urinaAssuntos
Doenças do Sistema Nervoso Central/fisiopatologia , Destreza Motora , Paralisia Cerebral/tratamento farmacológico , Paralisia Cerebral/fisiopatologia , Di-Hidroxifenilalanina/uso terapêutico , Hemiplegia/fisiopatologia , Humanos , Métodos , Relaxantes Musculares Centrais/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Fatores de TempoRESUMO
The effect of human growth hormone (HGH) on the N, P, Na, and K balance, and on the body weight (BW) of three groups of subjects was measured. In group I were nine cases (age 6-69) with HGH deficiency; in group II, eight cases (age 9-79) with normal endogenous HGH; in group III, four cases with myotonic dystrophy (age 45-51). After a 7 day control period, the hormone was administered for 7 days. Each subject was tested with three doses of HGH: dose A, 0.0168 U/kg BW(3/4) per day; dose B, 0.0532 U/kg BW(3/4) per day; dose C, 0.168 U/kg BW(3/4) per day. In group I, the responsiveness to HGH declined with age. Two subjects aged 6 yr responded to all three doses of HGH with positive balances in N, P, Na, and K and increases in BW. At ages 15-17, responses were obtained only to doses B and C in three cases, and only to dose C in two cases. Two subjects, aged 42 and 69, responded only to dose C. Not only did the threshold dose increase with age in group I, but the magnitude of the responses declined with age as well.Patients of group II were less responsive to all doses of HGH than were patients of group I at comparable age. None responded to dose A or dose B. All responded to dose C, but the increments in balances and in BW stimulated by this dose were only one-third to one-half as great as in HGH-deficient subjects of similar age. Three patients of group III responded to all three doses of HGH, and one responded to doses B and C. The responses were similar in magnitude to those in the 6-yr old HGH-deficient children, and greater than those in all other subjects studied. These data show that responsiveness to exogenous HGH rises with deficiency of endogenous HGH, and that individuals with myotonic dystrophy are hyperresponsive to exogenous HGH.