Recent evidence indicates that muscle ischemia and activation of the muscle chemoreflex are the principal stimuli to sympathetic nerve activity (SNA) during isometric exercise. We postulated that physical training would decrease muscle chemoreflex stimulation during isometric exercise and thereby attenuate the SNA response to exercise. We investigated the effects of 6 wk of unilateral handgrip endurance training on the responses to isometric handgrip (IHG: 33% of maximal voluntary contraction maintained for 2 min). In eight normal subjects the right arm underwent exercise training and the left arm sham training. We measured muscle SNA (peroneal nerve), heart rate, and blood pressure during IHG before vs. after endurance training (right arm) and sham training (left arm). Maximum work to fatigue (an index of training efficacy) was increased by 1,146% in the endurance-trained arm and by only 40% in the sham-trained arm. During isometric exercise of the right arm, SNA increased by 111 +/- 27% (SE) before training and by only 38 +/- 9% after training (P less than 0.05). Endurance training did not significantly affect the heart rate and blood pressure responses to IHG. We also measured the SNA response to 2 min of forearm ischemia after IHG in five subjects. Endurance training also attenuated the SNA response to postexercise forearm ischemia (P = 0.057). Sham training did not significantly affect the SNA responses to IHG or forearm ischemia. We conclude that endurance training decreases muscle chemoreflex stimulation during isometric exercise and thereby attenuates the sympathetic nerve response to IHG.

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Clinical practice databases are frequently used to assess outcomes in various medical specialties. Formulating a computerized physical therapy medical record requires standardization of clinical assessments among the users. The purpose of this article is to describe an acute care physical therapy database system that emphasizes high-quality measures of function. The logic underlying the development of a physical therapy computerized medical record is described. Selected uses of the database are demonstrated by projects that assess data quality, generate clinical hypotheses, manage clinical data, develop clinical measures, and generate pilot data on patient variability. Patients seen in physical therapy for total joint replacement, pain, and decreased ambulation were studied to demonstrate some of the present capabilities of the database. Clinical practice databases contribute to the overall research mission, provided the data are of high quality. The use of databases in conjunction with randomized clinical trials may serve an important role in determining effective physical therapy interventions to reduce disability.

The purpose of this study was to determine if patients with hemispheric brain lesions and subsequent paresis demonstrated a correlation between the perception of joint position sense and the ability to combine component parts of the limb synergies. Twenty-one adult patients with 6-week to 87-month histories of unilateral, hemispheric, paralytic brain lesions were evaluated by each of two tests. The first test evaluated the subject's ability to combine components of the limb synergies. A pilot investigation was performed which established the reliability of the testing instruments. The correlation between the perception of joint position sense and synergy test results, .83, was significant at p less than .01. Implications for therapeutic management of the patient with hemiplegia are discussed.