[Changes in acetylcholine level and its related enzyme activities in rat brain following focal ischemia].

At 1 to 4 weeks following middle cerebral artery occlusion in Wistar rats, levels of acetylcholine, which is neuro-transmitter, were measured. In the hippocampus, which plays an important role in memory, levels of acetylcholine in the ischemic group could not be detected the significant difference compared with those in the sham-operated group. But in the anterior cortex and the caudate-putamen, levels of acetylcholine in the ischemic group were recognized the significant difference compared with those in the sham operated group. Moreover activities of choline acetyltransferase, which is the synthetic enzyme of acetylcholine, and activities of acetylcholinesterase, which is the degradative enzyme of acetylcholine, were measured in the anterior cortex which was recognized decrease of the acetylcholine level and the hippocampus which could not be detected the difference of the acetylcholine level. Activities of both enzymes in the hippocampus could not be recognized the significant difference between the ischemic group and the normal group. But in the anterior cortex activities of both enzymes in the ischemic group were significantly decreased compared with those in the normal group. These results suggest that these decreases in the ischemic group were due to damage of injection of cholinergic neuron from Meynert nucleus (basal nucleus of Meynert) to anterior cortex.

Progressive isoinertial lifting evaluation. I. A standardized protocol and normative database.

Dynamic tests of trunk strength and lifting capacity have become more popular in recent years, offering certain advantages over static isometric tests in measuring patient progress in functional restoration programs for spinal disorders. However, equipment for performing such tests is expensive to buy, complex to run, and requires technical expertise and clinical volume unavailable in most physician offices. In this study, a new dynamic test known as Progressive Isoinertial Lifting Evaluation (PILE) is described, which draws upon prior psychophysical and isoinertial methods. An industrial sample of 61 male and 31 female incumbent workers were tested using the PILE, and a variety of anthropometric normalizing factors were evaluated. The isolation of an "Adjusted Weight" (AW) normalizing factor is documented, after which normative data are presented for male and female workers utilizing lumbar (0-30 inches) and cervical (30-54 inches) dynamic protocols.

Progressive isoinertial lifting evaluation. II. A comparison with isokinetic lifting in a disabled chronic low-back pain industrial population.

The Progressive Isoinertial Lifting Evaluation (PILE), as described in Part I of this series of articles, is a simplified test combining psychophysical and isoinertial protocols to provide an unconstrained lifting assessment. In the second part of this study, 100 chronically disabled low-back pain patients (57 men and 43 women) were studied at two points: 1) at initial evaluation, when referred for possible entry into a comprehensive Functional Restoration treatment program; and 2) at the conclusion of the treatment (an average 7 weeks later). Results of simultaneous lumbar PILE and Cybex Liftask (Lumex, Ronkonkoma, NY) tests are presented, showing that patients may frequently double or triple initial lifting capacity after undergoing the functional restoration training program, achieving lifting levels at or above normal for incumbent industrial workers. Overall, results demonstrate that the PILE test can be an effective baseline screening test for lifting capacity under certain circumstances. Although several drawbacks affecting the PILE as an isolated test are discussed, its usefulness as part of a battery of physical capacity tests making up a quantitative functional evaluation is clearly demonstrated. Finally, the potential use of PILE as a safe, inexpensive, simple, and relevant screening test for frequent lifting capacity in worker selection is discussed.

A prospective two-year study of functional restoration in industrial low back injury. An objective assessment procedure.

One hundred sixteen consecutive patients entered a functional restoration treatment program for chronic low back pain and were compared with 72 patients not treated. A two-year follow-up survey reached more than 85% of both groups; its findings were compared with earlier results of a five-month and one-year follow-up. Analysis demonstrated that 87% of the treatment group was actively working after two years, as compared with only 41% of the nontreatment comparison group. Moreover, about twice as many of the comparison group patients had additional spine surgery relative to the treatment group. The comparison group continued with an approximately five times higher rate of patient visits to health professionals in the second year as the treatment group. Also, treatment group reinjury rates were no higher than those expected in the general population, while nontreatment subjects had a higher incidence of reinjury. Finally, a small treatment "dropout" group did poorest of all, with results in almost all areas even worse than those of the comparison group patients.

Quantification of lumbar function. Part 4: Isometric and isokinetic lifting simulation in normal subjects and low-back dysfunction patients.

The present study collected the first normative data on a new dynamic isokinetic lifting device and compared a normal subject sample (n = 65) with a chronic low-back pain patient sample (n = 68) on this device. In addition, a comparison was made between isometric lifting measures collected for these controls and patients, and a normative industrial sample used in an earlier isometric testing protocol. Results demonstrated significant differences between controls and patients on all measures. An unanticipated finding was the greater lifting capacity levels of the present normal sample relative to those reported in the earlier isometric testing. These findings demonstrate that dynamic lifting simulation offers an important new tool for medical and industrial assessment, and conservative medical management.

Objective assessment of spine function following industrial injury. A prospective study with comparison group and one-year follow-up.

Objective functional capacity measurement techniques were used to guide a treatment program for a group of 66 chronic back pain patients. These patients were compared with a group of 38 chronic patients who were not administered the treatment program. Outcome data were collected by telephone survey at an average 1 year follow-up. In addition, functional capacity measures were collected for treatment group patients on admission and follow-up evaluations. Results demonstrated that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients. These changes were also accompanied by positive changes in psychologic measures. In addition, at 1 year follow-up, the treatment group had approximately twice the rate of patients who returned to work, relative to the comparison group. Additional surgery rates were comparable for both groups (6% in the treatment and 7% in the comparison group), but the frequency of additional health-care professional visits was substantially higher in the comparison group. The findings suggest that quantitative functional capacity measures can give objective evidence of patient physical abilities and degree of effort and can significantly guide the clinician in administering an effective treatment program.