Vladimir Janda, MD, DSc: tribute to a master of rehabilitation.

The purpose of this presentation is to pay tribute to the life's work of Professor Vladimir Janda, a key figure in the 20th Century rehabilitation movement. An accomplished neurologist, he founded the rehabilitation department at Charles University Hospital in Prague, Czechoslovakia. He was one of the seminal members of the Prague school of manual medicine and rehabilitation that expanded its influence throughout Central and Eastern Europe.

Use of the Halstead Category Test as a cognitive predictor of functional recovery in the hemiplegic upper limb: a cross-validation study.

Current motor learning theory suggests that recovery in the hemiplegic upper limb partially depends on the client's cognitive ability to maximize sensory feedback in order to activate appropriate efferent motor pathways. Study 1 investigated the use of the Category Test as a predictor of functional recovery. Initial scores on the Upper Extremity Function Test and the Category Test explained 81% of the variance of the discharge Upper Extremity Function score (N = 29).

The third therapeutic revolution: behavioral medicine.

Behavioral medicine--and one of its progenitors, biofeedback--are expanding as the Third Therapeutic Revolution, supplementing surgery and pharmacology in treating human illnesses. Parallel development of nonscience-based therapies is a part of the same revolution. Labeling their positive results as "placebo effects" hides a greater truth: faith and trust play an enormous role in therapy.

Agonist and antagonist activity during voluntary upper-limb movement in patients with stroke.

Forty-four patients with hemiplegia following stroke and 10 nondisabled subjects were studied to examine the contributions inadequate motor unit recruitment and co-contraction attributable to impaired antagonist inhibition play in the movement disorder of the hemiplegic arm. Electromyographic data were recorded from agonist and antagonist muscles while subjects attempted six specified tasks. Data from subjects who could complete the tasks were compared with those who could not complete the tasks.

Electromyography of pronators and supinators in great apes.

We obtained electromyographic recordings from the supinator, biceps brachii, pronator quadratus, and pronator teres muscles of a chimpanzee and a gorilla and from the supinator, pronator quadratus, and biceps brachii muscles of an orangutan as they stood and walked quadrupedally on horizontal and inclined surfaces, engaged in suspensory behavior, reached overhead, and manipulated a variety of foods and artifacts. In Pan troglodytes and Pan gorilla, as in Homo sapiens, the supinator muscle is the prime supinator, with the biceps brachii muscle serving to augment speed or force of supination. Primary of the pronator quadratus muscle over the pronator teres muscle during pronation is less clear in the African apes than in humans.

Special considerations for research with pharmacologic agents.

As physical medicine and rehabilitation becomes more and more complicated, the medical rehabilitation research teams are often bewildered by the sweeping changes occurring in the application of therapeutic drugs for rehabilitation. Society, through the instrument of governmental regulations, dictates that all new treatments must be efficacious before "release."

Acute back pain and spasm. A controlled multicenter trial of combined analgesic and antispasm agents.

A double-blind, 18-center, balanced trial of diflunisal vs. cyclobenzaprine HCl vs. these two drugs combined vs.

Therapeutic exercise in the management of rheumatic diseases.

In spite of the wide use of therapeutic exercise in the management of musculoskeletal diseases such as chronic arthritis, there are few controlled studies that establish its effectiveness. Only active contraction can increase muscle strength. Exercises in the horizontal plane or of limbs supported by the buoyancy of water can be carried out with relative ease by people with weak muscles or painful joints.

Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs.

This was a controlled study of the efficacy of two forms of therapy on upper limb functions of hemiparetic patients--one heavily behavioral and the other based on Bobath therapeutic exercises. It arose from an earlier pilot study comparing EMG biofeedback with physical therapy from which it was concluded that both the elapsed time since the acute stroke and the severity of residual disability were particularly important factors. Of 29 patients included and randomly assigned to one or the other heavily systematized therapies, 18 were classified as having early-severe and 11 as late-mild conditions.

Muscle relaxants in multiple sclerosis.

Spasticity is an important cause of physical impediment in multiple sclerosis. Only drug therapy offers useful (but not universal) relief. Dantrolene sodium and/or baclofen are the drugs of choice, being both effective and clinically suitable in over half of cases when carefully titrated and monitored.

Ketazolam once daily for spasticity: double-blind cross-over study.

This double-blind cross-over study of 14 severely spastic inpatients with chronic multiple sclerosis reveals that once-daily doses of ketazolam, a new drug, are effective in reducing spasticity in a significant proportion of patients without significant side-effects. Added to the similar findings of an earlier double-blind controlled study of divided doses, the results suggest that this special feature of ketazolam provides a unique flexibility that may be exploited in individual cases.

Electrodiagnostic model for motor unit action potential (MUAP) generation.

The paper presents the development of inverse analysis of EMG, in terms of a Linear Prediction Coding (LPC) model and its parametric simulation of recorded single motor-unit action potential, for electrodiagnosis of neuromuscular disorders due to motor neuron degeneration, regeneration after lesion, myopathy, etc.

Ketazolam treatment for spasticity: double-blind study of a new drug.

A minor tranquilizer, ketazolam, was tested in a double-blind, randomized, crossover study of 50 patients for its effects in neurologic spasticity. The drug was compared with diazepam (widely accepted as an effective antispasticity agent) and a placebo. The patients with spasticity were almost all cases of multiple sclerosis (24) or stroke (24).

Reflex cervical muscle spasm: treatment by diazepam, phenobarbital or placebo.

This double-blind study of the effects of diazepam on painful cervical muscle spasms compared with those of phenobarbital and an inert placebo employed clinical, electrogoniometric and electromyographic recording methods for evaluation and computer analysis. The clinical results were equivocal but the technological recordings revealed a statistically significant greater desirable effect of diazepam compared to the other 2 treatments which would be expected to have only minor nonspecific effects.

EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study.

Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years; only 4% to 5% of patients regain arm function during or after the active rehabilitation phase. This pilot study included 37 patients randomly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback (experimental group) or a standard exercise physical therapy program of like duration and intensity (control group). Both groups showed clinically significant improvements that exceeded previously reported experience.