Pseudotachometer for mobile metabolic analyzer

Metabolic analyzer determines a patient's walking or ambulation speed and simultaneously measures his metabolic parameters. Analyzer is designed to move at some preselected human ambulation speed. During test, patient is connected to system and follows analyzer closely while his metabolic data is being monitored

Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naive or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naive group (p <0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naive group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. (C) 2015 The Authors. Published by Elsevier B.V

Development of a Step Counting Algorithm Using the Ambulatory Tibia Load Analysis System for Tibia Fracture Patients

Introduction: Ambulation can be used to monitor the healing of lower extremity fractures. However, the ambulatory behavior of tibia fracture patients remains unknown due to an inability to continuously quantify ambulation outside of the clinic. The goal of this study was to design and validate an algorithm to assess ambulation in tibia fracture patients using the ambulatory tibial load analysis system during recovery, outside of the clinic. Methods Data were collected from a cyclic tester, 14 healthy volunteers performing a 2-min walk test on the treadmill, and 10 tibia fracture patients who wore the ambulatory tibial load analysis system during recovery. Results The algorithm accurately detected 2000/2000 steps from simulated ambulatory data. (see full text for full abstract

Open field modifications needed to measure, in the mouse, exploration- driven ambulation and fear of open space.

The open field test is used to assess ambulation and anxiety; one way to assess anxiety is to compare ambulation in the center with ambulation in the periphery: the more anxious is the mouse, the less it moves in the center. The results of this report cast doubts on the generality of that rule, because they show that ambulation, both in the center and in the periphery, depends on the mouse strain and on the size of the open field; specifically, in a brightly lit open-field of moderate size (38 x 31 x 25 cm), ambulation in the center reflects anxiety in Balb/c mice, but not in C57Bl/6 mice. Yet, a large open-field (100 x 100 x 30 cm), receiving approximately the same amount of light as in the mouse room, allows assessment of anxiety and exploration-driven ambulation in both strains of mice. To do that, the author of this report proposes (i) to express ambulation in normalized scores (i.e., ambulation per surface unit) to verify that ambulation in the periphery is higher than ambulation in the center, (ii) to use an open field sufficiently large so that mice of any strain ambulate more in the periphery than in the center, and (iii) to measure ambulation in concentric strips of the open field and plot ambulation against the distance of the strips from the wall: it is proposed that the intercept of the line reflects explorationdriven ambulation whereas the slope reflects fear of leaving the wall

Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery.

ObjectiveThis retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery.MethodsAdults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery.ResultsA total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p=0.02) and estimated blood loss over 500 mL (OR, 3.67; p=0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p=0.02) and operative time (OR, 1.005; p=0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p=0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p=0.04) and higher intraoperative blood loss (OR, 1.0007; p=0.03).ConclusionPreoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery

The 6-minute walk test and other endpoints in Duchenne muscular dystrophy: longitudinal natural history observations over 48 weeks from a multicenter study.

IntroductionDuchenne muscular dystrophy (DMD) subjects ≥5 years with nonsense mutations were followed for 48 weeks in a multicenter, randomized, double-blind, placebo-controlled trial of ataluren. Placebo arm data (N = 57) provided insight into the natural history of the 6-minute walk test (6MWT) and other endpoints.MethodsEvaluations performed every 6 weeks included the 6-minute walk distance (6MWD), timed function tests (TFTs), and quantitative strength using hand-held myometry.ResultsBaseline age (≥7 years), 6MWD, and selected TFT performance are strong predictors of decline in ambulation (Δ6MWD) and time to 10% worsening in 6MWD. A baseline 6MWD of &lt;350 meters was associated with greater functional decline, and loss of ambulation was only seen in those with baseline 6MWD &lt;325 meters. Only 1 of 42 (2.3%) subjects able to stand from supine lost ambulation.ConclusionFindings confirm the clinical meaningfulness of the 6MWD as the most accepted primary clinical endpoint in ambulatory DMD trials

Effect of Tilt Sensor versus Heel Loading on Neuroprosthesis Stimulation Reliability and Timing for Individuals Post-Stroke during Level and Non- Level Treadmill Walking

Study background: Non-level walking may adversely affect stimulation of neuroprostheses as initial programming is performed during level walking. The objectives of this study were to assess stimulation reliability of tilt and heel sensor-based neuroprosthesis stimulation during level and non-level walking, examine stimulation initiation and termination timing during level and non-level walking, and determine whether heel or tilt sensor-based stimulation control is more robust for non-level ambulation. Methods: Eight post-stroke individuals with drop foot who were able to actively ambulate within the community were selected for participation. Each subject acclimated to the neuroprosthesis and walked on a treadmill randomly positioned in inclined, level and declined orientations. The primary measures of interest were stimulation reliability and timing. Results: Statistically significant differences in tilt, but not heel, sensor-based stimulation reliability were observed between level and non-level walking trials. Tilt sensor-based stimulation initiation occurred significantly closer to swing as the treadmill processed from declined to inclined orientations. No statistically significant differences in stimulation reliability or timing were observed between theoretical heel versus clinical tilt sensor-based stimulation control. Discussion and conclusions: Tilt sensor-based stimulation reliability may be adversely affected by non-level walking. Differences in stimulation initiation timing with tilt sensor-based control during non-level walking may be advantageous as stimulation initiation closer to swing during inclined ambulation may allow for greater ankle plantar flexion to assist with forward progression. Despite a lack of significant differences in stimulation reliability or timing between sensors, theoretical heel sensor-based stimulation control exhibited more consistent stimulation timing with less variability than for tilt sensor-based stimulation during non-level ambulation

Beneficial effects of childhood selective dorsal rhizotomy in adulthood

Background: Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP) for over three decades. However, little is known about the outcomes of childhood SDR in adults.  Objectives: 1) To study the effects of childhood SDR on the quality of life and ambulatory function in adult life. 2) To determine late side effects of SDR in adults.   Methods: Adults (> 17.9 years) who underwent SDR in childhood (2 - 17.9 years) between 1987 and 2013 were surveyed in 2015. Patients completed a survey, including questions on demographic information, quality of life, health, surgical outcomes, motor function, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, work status, and side effects of SDR.  Results: In our study population of 294 patients (18.0 - 37.4 years), patients received SDR during the ages of 2.0 - 17.9 years and were followed up 2.2 to 28.3 years after surgery. Eighty-four percent had spastic diplegia, 12% had spastic quadriplegia, and 4% had spastic triplegia. The majority (88%) of patients reported improved post-SDR quality of life and 1% considered the surgery detrimental. Most (83%) would recommend the procedure to others and 3% would not. However, patients who would not recommend SDR to others ambulated with a walker or were not ambulatory at all prior to SDR. The majority (83%) of patients improved (30%) or remained stable (53%) in ambulation. Twenty-nine percent of patients reported pain, mostly in the back and lower limbs, with a mean pain level of 4.4 ± 2.4 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in small areas of the lower limbs was reported by 8% of patients, though this did not affect daily life. Scoliosis was diagnosed in 28%, with 40% of these patients pursuing treatment. Whether scoliosis was related to SDR is not clear, though scoliosis is known to occur in patients with CP and also in the general population. Only 4% of patients underwent spinal fusion.  Orthopedic surgeries were pursued by 59% of patients. The most common orthopedic surgeries were hamstring lengthenings (31%), Achilles tendon lengthenings (18%), adductor lengthenings (16%), and derotational osteotomies (16%). Twenty-four percent of all patients later underwent hip surgery and 8% had surgeries on their knees.  Conclusion: Results of this study indicate that the beneficial effects of childhood SDR extend to adulthood quality of life and ambulatory function without late side effects of surgery