Introduction: Increasing and maintaining physical activity in special populations

Exercise Physiology in Special Populations covers the prevalent health conditions that are either linked to an inactive lifestyle or whose effects can be ameliorated by increasing physical activity and physical fitness. The book explores physiological aspects of obesity and diabetes before moving on to cardiac disease, lung disease, arthritis and back pain, ageing and older people, bone health, the female participant, neurological and neuromuscular disorders, and spinal chord injury. The author team includes many of the UK?s leading researchers and exercise science and rehabilitation practitioners that specialise in each of the topic areas

Impact on the biomechanics of overground gait of using an ‘Echelon’ hydraulic ankle–foot device in unilateral trans-tibial and trans-femoral amputees

YesIf a prosthetic foot creates resistance to forwards shank rotation as it deforms during loading, it will exert a braking effect on centre of mass progression. The present study determines whether the centre of mass braking effect exerted by an amputee's habitual rigid ‘ankle’ foot was reduced when they switched to using an ‘Echelon’ hydraulic ankle–foot device. Nineteen lower limb amputees (eight trans-femoral, eleven trans-tibial) walked overground using their habitual dynamic-response foot with rigid ‘ankle’ or ‘Echelon’ hydraulic ankle–foot device. Analysis determined changes in how the centre of mass was transferred onto and above the prosthetic-foot, freely chosen walking speed, and spatio-temporal parameters of gait. When using the hydraulic device both groups had a smoother/more rapid progression of the centre of pressure beneath the prosthetic hindfoot (p ≤ 0.001), and a smaller reduction in centre of mass velocity during prosthetic-stance (p < 0.001). As a result freely chosen walking speed was higher in both groups when using the device (p ≤ 0.005). In both groups stance and swing times and cadence were unaffected by foot condition whereas step length tended (p < 0.07) to increase bilaterally when using the hydraulic device. Effect size differences between foot types were comparable across groups. Use of a hydraulic ankle–foot device reduced the foot's braking effect for both amputee groups. Findings suggest that attenuation of the braking effect from the foot in early stance may be more important to prosthetic-foot function than its ability to return energy in late stance

Walking speed related joint kinetic alterations in trans-tibial amputees: impact of hydraulic 'ankle' damping

YesPassive prosthetic devices are set up to provide optimal function at customary walking speed and thus may function less effectively at other speeds. This partly explains why joint kinetic adaptations become more apparent in lower-limb amputees when walking at speeds other than customary. The present study determined whether a trans-tibial prosthesis incorporating a dynamic-response foot that was attached to the shank via an articulating hydraulic device (hyA-F) lessened speed-related adaptations in joint kinetics compared to when the foot was attached via a rigid, non-articulating attachment (rigF). Eight active unilateral trans-tibial amputees completed walking trials at their customary walking speed, and at speeds they deemed to be slow-comfortable and fast-comfortable whilst using each type of foot attachment. Moments and powers at the distal end of the prosthetic shank and at the intact joints of both limbs were compared between attachment conditions. There was no change in the amount of intact-limb ankle work across speed or attachment conditions. As speed level increased there was an increase on both limbs in the amount of hip and knee joint work done, and increases on the prosthetic side were greater when using the hyA-F. However, because all walking speed levels were higher when using the hyA-F, the intact-limb ankle and combined joints work per meter travelled were significantly lower; particularly so at the customary speed level. This was the case despite the hyA-F dissipating more energy during stance. In addition, the amount of eccentric work done per meter travelled became increased at the residual knee when using the hyA-F, with increases again greatest at customary speed. Findings indicate that a trans-tibial prosthesis incorporating a dynamic-response foot reduced speed-related changes in compensatory intact-limb joint kinetics when the foot was attached via an articulating hydraulic device compared to rigid attachment. As differences between attachment conditions were greatest at customary speed, findings indicate a hydraulic ankle-foot device is most effectual at the speed it is set-up for

Which prosthetic foot to prescribe? Biomechanical differences found during a single session comparison of different foot types hold true one year later

YesIntroduction: Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to ‘try out’ a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to patient related factors which can change from day-to-day and can thus make device comparisons unreliable. To determine whether a device’s mechanical function consistently has a more meaningful impact on gait than patient-related factors, the present study undertook quantitative gait analyses of a trans-tibial amputee walking using two different foot-ankle devices on two occasions over a year apart. If the observed differences present between devices, established using quantitative gait analysis, were in the same direction and of similar magnitude on each of the two occasions, this would indicate that device-related factors were more important than patient-related factors. Methods: One adult male with a unilateral trans-tibial amputation completed repeated walking trials using two different prosthetic foot devices on two separate occasions, 14 months apart. Walking speed and sagittal plane joint kinematics and kinetics for both limbs were assessed on each occasion. Clinically meaningful differences in these biomechanical outcome variables were defined as those with an effect size difference (d) between prosthetic conditions of at least 0.4 (i.e. ‘medium’ effect size). Results: Eight variables namely, walking speed, prosthetic ‘ankle’ peak plantar- and dorsi- flexion and peak positive power, and residual knee loading response flexion, peak stance-phase extension and flexion moments and peak negative power, displayed clinically meaningful differences (d > 0.4) between foot devices during the first session. All eight of these showed similar effect size differences during the second session despite the participant being heavier and older. Conclusions: Findings suggest that a prosthetic device’s mechanical function consistently has a more meaningful impact on gait than patient-related factors. These findings support the current clinical practice of making decisions regarding prosthetic prescription for an individual, based on a single session evaluation of their gait using two different devices. However, to confirm this conclusion, a case series using the same approach as the present study could be undertaken

The effects of laterality on obstacle crossing performance in unilateral trans-tibial amputees

yesBackground Unilateral trans-tibial amputees have bilaterally reduced toe clearance, and an increased risk of foot contact, while crossing obstacles compared to the able-bodied. While the able-bodied tend to lead with a ‘preferred’ limb it is equivocal whether amputees prefer to lead with the intact or prosthetic limb. This study determined the effects of laterality, compared to side of amputation, on amputees' obstacle crossing performance. To help understand why laterality could affect performance we also assessed knee proprioception for both limbs. Methods Foot placement and toe clearance parameters were recorded while nine amputees crossed obstacles of varying heights leading with both their intact and prosthetic limbs. Joint-position sense was also assessed. Participants self-reported which limb was their preferred (dominant) limb. Findings There were no significant differences in foot placements or toe clearance variability across lead-limb conditions. There were no significant differences in toe clearance between intact and prosthetic lead-limbs (p = 0.28) but toe clearance was significantly higher when amputees led with their preferred compared to non-preferred limb (p = 0.025). There was no difference in joint-position sense between the intact and residual knees (p = 0.34) but joint-position sense tended to be more accurate for the preferred, compared to non-preferred limb (p = 0.08). Interpretation Findings suggest that, despite the mechanical constraints imposed by use of a prosthesis, laterality may be as important in lower-limb amputees as it is in the able bodied. This suggests that amputees should be encouraged to cross obstacles leading with their preferred limb.Engineering and Physical Sciences Research Counci

Corporate performance reporting: relevance lost, relevance regained?

Increasingly, an organization’s success is a function of its ability to effectively manage non-financial assets and intangible value creating activities. This paper examines the calls for and preliminary experimentation with non-financial performance measures aimed at restoring relevance to the corporate reporting process

Stair-specific algorithms for identification of touch-down and foot-off when descending or ascending a non-instrumented staircase.

yesThe present study introduces four event detection algorithms for defining touch-down and foot-off during stair descent and stair ascent using segmental kinematics. For stair descent, vertical velocity minima of the whole body center-of-mass was used to define touch-down, and foot-off was defined as the instant of trail limb peak knee flexion. For stair ascent, vertical velocity local minima of the lead-limb toe was used to define touch-down, and foot-off was defined as the local maxima in vertical displacement between the toe and pelvis. The performance of these algorithms was determined as the agreement in timings of kinematically derived events to those defined kinetically (ground reaction forces). Data were recorded while 17 young and 15 older adults completed stair descent and ascent trials over a four-step instrumented staircase. Trials were repeated for three stair riser height conditions (85 mm, 170 mm, and 255 mm). Kinematically derived touch-down and foot-off events showed good agreement (small 95% limits of agreement) with kinetically derived events for both young and older adults, across all riser heights, and for both ascent and descent. In addition, agreement metrics were better than those returned using existing kinematically derived event detection algorithms developed for overground gait. These results indicate that touch-down and foot-off during stair ascent and descent of non-instrumented staircases can be determined with acceptable precision using segmental kinematic data

Managing Birds and Controlling Aircraft in the Kennedy Airport–Jamaica Bay Wildlife Refuge Complex: The Need for Hard Data and Soft Opinions

During the 1980s, the exponential growth of laughing gull (Larus atricilla) colonies, from 15 to about 7600 nests in 1990, in the Jamaica Bay Wildlife Refuge and a correlated increase in the bird-strike rate at nearby John F. Kennedy International Airport (New York City) led to a controversy between wildlife and airport managers over the elimination of the colonies. In this paper, we review data to evaluate if: (1) the colonies have increased the level of risk to the flying public; (2) on-colony population control would reduce the presence of gulls, and subsequently bird strikes, at the airport; and (3) all on-airport management alternatives have been adequately implemented. Since 1979, most (2987, 87%) of the 3444 bird strikes (number of aircraft struck) were actually bird carcasses found near runways (cause of death unknown but assumed to be bird strikes by definition). Of the 457 pilot-reported strikes (mean = 23 ± 6 aircraft/yr, N= 20 years), 78 (17%) involved laughing gulls. Since a gull-shooting program was initiated on airport property in 1991, over 50,000 adult laughing gulls have been killed and the number of reported bird strikes involving laughing gulls has declined from 6.9 ± 2.9 (1983–1990) to 2.6 ± 1.3 (1991–1998) aircraft/yr; nongull reported bird strikes, however, have more than doubled (6.4 ± 2.6, 1983–1990; 14.9 ± 5.1, 1991–1998). We found no evidence to indicate that on-colony management would yield a reduction of bird strikes at Kennedy Airport. Dietary and mark–recapture studies suggest that 60%–90% of the laughing gulls collected on-airport were either failed breeders and/or nonbreeding birds. We argue that the Jamaica Bay laughing gull colonies, the only ones in New York State, should not be managed at least until all on-airport management alternatives have been properly implemented and demonstrated to be ineffective at reducing bird strikes, including habitat alterations and increasing the capability of the bird control unit to eliminate bird flocks on-airport using nonlethal bird dispersal techniques. Because the gull-shooting program may be resulting in a nonsustainable regional population of laughing gulls (\u3e30% decline), we also recommend that attempts be made to initiate an experimental colony elsewhere on Long Island to determine if colony relocation is a feasible management option