Uphill and downhill walking in unilateral lower limb amputees

Objective: To study adjustment strategies in unilateral amputees in uphill and downhill walking. Design: observational cohort study. Subjects: Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects. Methods: In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured. Results: In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee Groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body. Conclusion: Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability. (c) 2007 Elsevier B.V. All fights reserved

Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

BACKGROUND: Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments. AIM OF THE STUDY: To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis. METHODS: We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members). RESULTS: The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood. DISCUSSION: In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance. CONCLUSION: We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family

Effect of flat insoles with different shore A values on posture stability in diabetic neuropathy

The objective of the study was to determine whether insoles with a low Shore A value (15 degrees) as prescribed for patients with a diabetic neuropathy have a negative effect on posture stability because these insoles may reduce somatosensory input under the feet. It was conducted in the Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands The study was observational and conducted on 30 diabetic patients (aged 37 - 82 years) with a neuropathy. Posture stability (body sway) was assessed in a shoe without insole, on a flat insole with a low Shore A value (15 degrees) and on a flat insole with a higher Shore A value (30 degrees). These assessments were done under four different conditions: (1) eyes open, no dual-task, (2) eyes closed, no dual-task, (3) eyes open, dual-task (mental arithmetic) and (4) eyes closed, dual-task. Additionally 10 healthy controls (aged 27-51 years) were assessed similarly. A significantly higher root-mean-square (rms) value of the anterior-posterior velocity, V-y, was found in patients compared with controls (3.4 cm/s vs. 1.2 cm/s, p < 0.05). Also a significant difference in rms value of the anterior-posterior velocity, V-Y, was found between eyes open and eyes closed (1.9 cm/s vs. 2.7 cm/s, p < 0.05). No significant effects were found for insoles or dual tasks for the total group. In diabetic patients no significant effect was found of insoles on posture stability. The effect of closed eyes on posture stability was significantly larger for diabetic patients compared to controls. It was found that prescribing insoles with a low Shore A value (15 degrees), compared to insoles with a higher Shore A value (30 degrees) has no significant negative effect on posture stability in patients with a diabetic neuropathy

Musculoskeletal modeling of human lower limb during normal walking, one-legged forward hopping and side jumping:Comparison of measured EMG and predicted muscle activity patterns

Item does not contain fulltextThis study focused on comparing muscle activities predicted by the Musculoskeletal Modeling System with EMG from ten healthy subjects who performed normal walking, one-legged forward hopping and side jumping. Eight EMG electrodes measured the activity of eight right leg muscles. Specific thresholds per muscle were applied on the EMG prior comparison. These thresholds were determined by equalizing the duration of EMG to AMS muscle activity. Three graph variables, number of onsets, offsets and hills were used to quantify the level of agreement by using Cohens kappa analysis. The Pearson correlation coefficient was also calculated as a result comparison. Overall, visual inspection showed comparable activity patterns. However, when quantifying them some differences became apparent. The mean level of agreement of all tests was <0.20, meaning poor agreement. Pearson correlation showed better agreement compared to kappa analysis. In general, a more prescribed motion like FH and SJ showed a better agreement than NW. This explorative study shows that there are distinct differences between the model and EMG pattern. Those differences can be attributed to inevitable modeling limitation within the AMS framework like miscalculating the knee net moment, absence of co-contraction, simplified knee joint. Moreover, the delay between EMG and AMS has a clear effect on the comparison and this delay is obviously missing in the model. Despite those differences, this study can serve as a baseline measurement allowing progress in scientific work in order to reduce uncertainties with the aim to generate more reliable and robust musculoskeletal models in a valid manner

No difference in gait between posterior cruciate retention and the posterior stabilized design after total knee arthroplasty

In the present study, knee joint kinematics (e.g. knee flexion/extension) and kinetics (e.g. knee flexion moments) are assessed after total knee arthroplasty (TKA) between patients implanted with either a unilateral posterior stabilized (PS) and a posterior cruciate-retaining (PCR) design. It was hypothesized that maximum knee flexion during the loading response of the stance phase is greater in patients implanted with a PS design than in patients with a PCR design. Secondarily, it was hypothesized that patients with a PS design show decreased knee flexion moments during loading, compared with patients implanted with a PCR design. This study examined two groups of TKA patients: one group (n = 12) with a PS design in which the posterior cruciate ligament (PCL) was sacrificed and the other (n = 9) with a PCR design. Gait analysis was used in level walking before and 6-9 months after surgery, to assess knee joint kinematics and kinetics during the loading response of the stance phase. No significant differences in maximum knee flexion between the two groups were found during the loading response of the stance phase. No significant differences in knee flexion moments were found either. Although in both groups knee flexion moments increased postoperatively, this was not statistically significant. In the contralateral (nonimplanted) knees, all mean knee flexion moments decreased postoperatively for both groups, yet this was not significant. The present gait analysis study showed no differences in kinematics and kinetics between the PS and the PCR TKP design. This might suggest that surgeons do not necessarily need to substitute the PCL by a PS design during TKA. Prospective comparative study, Level II