1. The relationship between joint damage, quadriceps weakness and arthrogenic muscle inhibition was investigated in eight patients who had sustained extensive traumatic knee injury. Isometric and isokinetic quadriceps and hamstring voluntary strength, and quadriceps arthrogenic muscle inhibition during isometric contractions, were measured before and after 4 weeks (approximately 100 h) of intensive rehabilitation. 2. Compared with the uninjured leg, before rehabilitation the injured leg had larger amounts of quadriceps arthrogenic muscle inhibition (P < 0.025), quadriceps (P < 0.0001) and hamstring (P < 0.0001) weakness and severe functional joint instability. There was a negative correlation between the amount of arthrogenic muscle inhibition and quadriceps voluntary contraction force (P < 0.025). 3. After rehabilitation in the injured leg there were small hamstring strength increases (P < 0.05-0.025), but no overall significant quadricep strength increase. Arthrogenic muscle inhibition was statistically unchanged. Severe functional joint instability was still reported by all patients. 4. Previous studies have shown that minimal joint damage evokes relatively less arthrogenic muscle inhibition that does not impede rehabilitation. These data indicate that greater joint damage is associated with greater arthrogenic muscle inhibition, quadriceps weakness and joint instability. Furthermore, intensive rehabilitation had little affect on either quadriceps arthrogenic muscle inhibition or atrophy.
The report of the meeting was edited by Bo Klasson and Derek Jones. The report has just been published and the following Workshop Declaration was compiled from the reports of the discussions that took place during the workshop. Workshop DeclarationProstheses and orthoses are part of the range of assistive technology available to people with disabilities that access rehabilitation services. This document concentrates on the quality issues relating to the provision of prostheses and orthoses and any related care and clinical services.Users of prostheses or orthoses require access to services that first establish, and then provide for, their individual needs. Provision should be responsive and shaped by user views. Any provided device (devices) must not only meet a user's current need, but do so in a manner that allows for the ongoing management of quality.The organisation providing such services must possess certain general characteristics in order to provide appropriate services, and to ensure a climate in which to properly conduct a quality assessment and improvement program. These characteristics can be grouped into four general categories: clinical services, clinical provision, education and training, and measurement of performance and evaluation. In the following sections these four general characteristics and their sub-components are identified 1.Clinical Services 1.1 The ultimate objective of the process is to satisfy the functional, psychological and medical requirements or needs of the individual. The process takes into account his/her overall condition and the 18
The effects of conformational changes in purified canine von Willebrand's factor (VWF) were investigated to explore the relationship between its factor VIII-related antigen (VIII:AG) and ristocetin cofactor (RCoF) properties and the factor VIII-coagulant (VIII:C) binding site(s). Binding of VIII:C from canine von Willebrand's disease (VWD) plasma by VWF was used to measure the combining reaction of these proteins. The VWF was denatured to varying degrees by exposure to temperature and pH extremes, low ionic strength, and 6 M urea. Various treatments resulted in three types of change: elimination of RCoF, VIIIR:Ag, and VIII:C binding, removal of RCoF activity alone; or elimination of RCoF and retarded elution of VIII:Ag and VIII:C. As long as VIIIR:Ag reactivity was maintained, binding of VIII:C could be demonstrated; but in the absence of VIIIR:Ag, neither RCoF activity nor VIII:C binding remained. These results suggest that VIII:C binding and RCoF sites are separate on VWF and that interaction between VIII:C and VWF is possible even after significant structural changes occur in VWF. Furthermore, RCoF is more vulnerable to denaturation than the antigenic site. The spectrum of conformational changes that affect the properties of VWF may parallel the various recognized subtypes of VWD.
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