Gait Characteristics, Range of Motion, and Spasticity Changes in Response to Massage in a Person with Incomplete Spinal Cord Injury: Case Report

Purpose: Our study set out to measure the effect of a specific routine of massage on gait characteristics, range of motion, and spasticity in a person with incomplete spinal cord injury. Methods: This descriptive, pre–post case study, conducted at the outpatient program of a rehabilitation facility, used neuromuscular techniques in massage for a 42-year-old man with incomplete chronic C5 spinal cord injury. The massage was applied to the iliopsoas, triceps surae, and hamstring muscle groups for 3 consecutive days. Main Outcome Measures: Pre- and post-intervention testing included standard goniometric measurement of joint range of motion in the lower extremities, spasticity evaluation using the modified Ashworth scale, and evaluation of gait characteristics using GAITRite Walkway (CIR Systems, Havertown, PA, USA) pressure mapping for ambulation time, cadence, velocity, stride length, base of support, and single- and double-limb support. Results: After the therapeutic intervention, the following gait changes were demonstrated: increase in velocity and cadence of gait, decrease in ambulation time, increase in stride length, and improvements in the percentages of the swing and stance phases of the gait cycle. Conclusions: Specific application of massage therapy influenced gait speed, stride length, and swing and stance phase percentages in one person with incomplete spinal cord injury. Further study is warranted to determine the extent to which massage may affect musculoskeletal and neural impairments that limit gait in people with incomplete spinal cord injury, and the method or routine whose application will yield the most benefit

Solving modal equations of motion with initial conditions using MSC/NASTRAN DMAP. Part 1: Implementing exact mode superposition

Within the MSC/NASTRAN DMAP (Direct Matrix Abstraction Program) module TRD1, solving physical (coupled) or modal (uncoupled) transient equations of motion is performed using the Newmark-Beta or mode superposition algorithms, respectively. For equations of motion with initial conditions, only the Newmark-Beta integration routine has been available in MSC/NASTRAN solution sequences for solving physical systems and in custom DMAP sequences or alters for solving modal systems. In some cases, one difficulty with using the Newmark-Beta method is that the process of selecting suitable integration time steps for obtaining acceptable results is lengthy. In addition, when very small step sizes are required, a large amount of time can be spent integrating the equations of motion. For certain aerospace applications, a significant time savings can be realized when the equations of motion are solved using an exact integration routine instead of the Newmark-Beta numerical algorithm. In order to solve modal equations of motion with initial conditions and take advantage of efficiencies gained when using uncoupled solution algorithms (like that within TRD1), an exact mode superposition method using MSC/NASTRAN DMAP has been developed and successfully implemented as an enhancement to an existing coupled loads methodology at the NASA Lewis Research Center

Efficacy of Two Common Methods of Application of Residual Insecticide for Controlling the Asian Tiger Mosquito, Aedes albopictus (Skuse), in Urban Areas

After its first introduction in the 1980's the Asian tiger mosquito, Aedes albopictus (Skuse), has spread throughout Southern Europe. Ae. albopictus is considered an epidemiologically important vector for the transmission of many viral pathogens such as the yellow fever virus, dengue fever and Chikungunya fever, as well as several filarial nematodes such as Dirofilaria immitis or D. repens. It is therefore crucial to develop measures to reduce the risks of disease transmission by controlling the vector populations. The aim of the study was to compare the efficacy of two application techniques (mist vs. stretcher sprayer) and two insecticides (Etox based on the nonester pyrethroid Etofenprox vs. Microsin based on the pyrethroid type II Cypermetrin) in controlling adult tiger mosquito populations in highly populated areas. To test the effect of the two treatments pre- and post-treatment human landing rate counts were conducted for two years. After one day from the treatment we observed a 100% population decrease in mosquito abundance with both application methods and both insecticides. However, seven and 14 days after the application the stretcher sprayer showed larger population reductions than the mist sprayer. No effect of insecticide type after one day and 14 days was found, while Etox caused slightly higher population reduction than Microsin after seven days. Emergency measures to locally reduce the vector populations should adopt adulticide treatments using stretcher sprayers. However, more research is still needed to evaluate the potential negative effects of adulticide applications on non-target organisms

Gross Motor Outcomes After Dynamic Weight-Bearing in 2 Children With Trunk Hypotonia: A Case Series

NTRODUCTION: Children with trunk hypotonia may have limited ability to maintain an upright weight-bearing position, resulting in decreased postural control and a delay in achieving gross motor milestones. PURPOSE: The purpose of this case series is to report the effect of a home-based dynamic standing program on postural control and gross motor activity in 2 children with trunk hypotonia. DESCRIPTIONS: Child 1 (aged 24 months, Gross Motor Function Classification Scale Level IV) and Child 2 (aged 21 months, Gross Motor Function Classification Scale Level V) participated in a standing program using the Upsee harness at home 3 days per week for 12 weeks. OUTCOMES: Both children improved their gross motor function, and Child 1 demonstrated improved trunk control in sitting. WHAT THIS CASE ADDS: The use of the Upsee harness was an effective intervention for these children with trunk hypotonia to achieve weight-bearing and improve gross motor abilities

Relationship between Movement Quality, Functional Ambulation Status, and Spatiotemporal Gait Parameters in Children with Myelomeningocele.

Aims: We investigated relationships among the Pediatric Neuromuscular Recovery Scale (Peds NRS), modified Hoffer Scale, and spatiotemporal gait parameters in children with myelomeningocele (MMC). Methods: 21 children with MMC, age 5.3 years (SD = 2.6), were assessed by three clinicians using the Peds NRS and modified Hoffer Scale. In eight children, gait parameters were also measured. Results: The Peds NRS summary score demonstrated good correlation with modified Hoffer Scale score (r = -0.64, p = 0.002) that accounted for 41% of variation in summary score. Six Peds NRS seated/standing items exhibited good relationships with modified Hoffer Scale (r = -0.51 to -0.70, p≤ 0.023), and the sit-to-stand item demonstrated an excellent relationship (r = -0.85, ps = 0.81 to 0.88, p≤ 0.014), and swing and stance time (both Rs = -0.83 to -0.90, p≤ 0.01). Two Peds NRS standing items and modified Hoffer Scale score demonstrated good correlations with velocity (Rs = 0.71, p= 0.047; Rs = -0.73, p= 0.04, respectively). Conclusions: Our findings suggest that children with MMC who exhibit greater movement quality and trunk control are likely to be functional ambulators with more optimal spatiotemporal gait parameters

Upsee Daisy! Gross Motor Outcomes after Dynamic Weight Bearing in Two Children with Truncal Hypotonia: A Case Series

PURPOSE: The purpose of this case series was to report the impact of a home-based dynamic standing program on postural control and gross motor activity in two children with truncal hypotonia. BACKGROUNDS/SIGNIFICANCE: Poor postural control associated with central hypotonia limits a child’s ability to interact with the environment, delaying attainment of developmental milestones such as sitting, crawling, standing and walking. Participation in social interactions with peers and caregivers may be restricted resulting in a decreased quality of life. Supported standing programs are commonly used to ameliorate impairments and optimize function in children with poor postural control. Increased social interactions, as well as reduced burden of care have all been associated with supported standing programs. The Upsee is an orthotic standing and walking device which is worn by the child and parent. As the adult stands, moves, and walks the child is encouraged to stand, move, and step. Functional tasks and participation activities are encouraged while the child is in the Upsee. There are no reports of the effectiveness of the Upsee as a dynamic standing program. Because of its simple design and ease of use, the Upsee can be readily added to a home program to increase standing and weight shifting in children. SUBJECTS: Child 1 was a 24-month-old boy born at 37 weeks gestation and diagnosed at birth with a rare form of chromosome 3 deletion and agenesis of the corpus callosum. His Gross Motor Function Classification System (GMFCS) classification was Level IV. Child 2 was a 21-month-old boy born at 39 weeks gestation. Prior to birth, his mother experienced decreased fetal movement. A cesarean section was performed and the baby was found to have a true umbilical cord knot, causing hypoxic ischemic encephalopathy. He was diagnosed with Cerebral Palsy (CP) at 12 months of age. His GMFCS classification was Level V. Both children displayed truncal hypotonicity with significant gross motor delays for their ages. They both had cognitive ability to follow simple commands, but no verbal communication skills. The children had excellent family support and parents of both children expressed an overall goal for improvement with functional independence. METHODS AND MATERIALS: Each child participated in 12 weeks of a home-based program that included upright dynamic weight bearing using the Upsee device. The harness system was adjusted by a physical therapist during the first assessment period to provide appropriate anatomical alignment and positioning for the children to bear weight through their lower extremities. The families were educated in the correct use of the device, and followed a protocol that included up to 30 minutes of weight bearing per day, 3 to 5 days a week. The parents were educated on dynamic weight bearing to facilitate muscle activation in the trunk and legs while using the Upsee. Families were asked to keep a journal of the amount of time spent in the device and activities performed by their child. ANALYSES: The Segmental Assessment of Trunk Control (SATCo) and the Gross Motor Function Measure (GMFM- 66) identified changes in gross motor function and trunk control. Pre- and post-intervention scores were compared. RESULTS: Final scores revealed that both children improved gross motor function, and Child 1 demonstrated improved trunk control in sitting. Child 1 improved his SATCo score from 11/20 to 20/20 and GMFM-66 score from 35 to 42. Child 2 initially scored 0/20 on the SATCo outcome measure, which did not change. His GMFM-66 score improved from 16 to 21. By the end of the study period, both children were able to take steps independently with a gait trainer. This new ability expanded opportunities for physical therapy goals and interventions for both children. CONCLUSIONS: Children with truncal hypotonia can participate in, and benefit from, a dynamic standing program using the Upsee. We speculate that this program may be effective in improving the gross motor abilities of children with severely impaired postural control. Of the two children, Child 1 demonstrated more improvement in gross motor function and trunk control. One possible reason for this is that Child 2 presented with increased extensor tone of his four extremities, which increased when he became excited or when attempting to focus on an activity at hand and constrained his movement activity. Also, Child 2 spent less time overall in the Upsee, never progressing beyond 15 minutes of weight bearing per session. Future research is needed to further explore the necessary dosage of an upright dynamic weight bearing program for children with impaired postural control. Studies with a more homogenous and larger sample are needed to conduct a randomized controlled trial design comparing the use of the Upsee to a traditional standing frame. Future studies should also aim to capture changes across the full ICF-CY model, including activities and participation. The findings from this case series support the use of the Upsee as a new home-based upright dynamic weight bearing program for children with impaired postural control

“Anything Goes”: Regulating the Conduct of Money-Bundling Broadway Co-Producers

This Note will analyze industry concerns relating to the practice of granting above-the-title producer credit to individuals solely for contributing or bundling a share of a production’s capitalization, specifically by asking whether money-bundling Broadway co-producers are acting as unregistered broker-dealers in violation of applicable Security Exchange Commission (“SEC”) registration requirements. In Section I of this Note, I provide a history of Broadway producing models, so as to understand how today’s dominant model developed. In Section II, I unpack that model by describing the structure of theatrical investment vehicles and identifying the different types of Broadway producers. In Sections III and IV, I outline the applicable provisions of the Securities Act of 1933 (the “Securities Act”) and the Securities Exchange Act of 1934 (the “Exchange Act”), and in Section V, I apply the SEC’s four-factor “broker-dealer” test to the conduct of money-bundling Broadway co-producers, thereby isolating industry practices that might trigger registration requirements. Finally, in Sections VI through VII, I identify the potential consequences of using unregistered brokers and develop a list of recommendations that production companies can follow to avoid violating SEC registration requirements

Oltre lo sprawl? Ambizioni, successi e problemi irrisolti

Urban settlements are critical today, not only in demographic, economic and cultural terms, but also for their environmental impact. A sustainable land management is therefore a fundamental requirement. Urban sprawl has long been described as settlement model that is unsustainable from all the points of view, but its growth has been virtually unchallenged for decades. Many regions have recently become aware of the problem however, and they are trying to tackle this challenge. This book tries to focus on this challenge and it moves from the following research questions: which outcomes have been obtained against sprawl? Which difficulties emerged? Who and why is against these policies? Which are the "unwanted effects" of these policies? The book is focused on the US trends, where the problem emerged first. Portland, Denver and Minneapolis are considered: three metropolitan regions in different parts of the country but with similar dimensions, characteristics and policies. The conditions that made some outcomes possible are highlighted (the ability to network institutions at multiple levels and to foster the participation of local actors in the land management process), as well as some critical issues and unsolved problems (the exponential growth of real estate costs, the opposition of a part of the local community, the persistence of segregation and inequality forms)

“Oltre lo spettacolo”: prove ed errori di riqualificazione alla Bolognina

In this article, two cases of urban redevelopment in Bologna are considered: the Nuova Sede Unica city hall headquarter and the Officine Minganti shopping mall. Both of them are results of projects for new centralities in Bolognina, a former working-class neighborhood, with the help of “spectacular” architecture, design and marketing elements. Many problems occurred; some of them have been solved while others are still ongoing, especially for Officine Minganti. The article is based on bibliographic analysis, consultation of administrative documents, consultation of websites, interviews with key informants, and direct observation of these settlements.In quest’articolo si considerano due casi di riqualificazione urbana a Bologna: la Nuova Sede Unica del Comune ed il centro commerciale Officine Minganti. Entrambi nascono dal progetto di costituire nuove centralità nella Bolognina, ex quartiere operaio, ricorrendo anche ad elementi architettonici e di marketing che richiamano la dimensione della spettacolarizzazione. Entrambi hanno mostrato molte problematiche, alcune delle quali risolte ed altre tuttora in corso, soprattutto per le Officine Minganti. L’articolo si basa su: analisi bibliografica, consultazione di documenti amministrativi, consultazione di siti web, interviste a testimoni privilegiati e osservazione diretta dei due insediamenti