Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reactions vs knee reactions

Study Design: Comparative analysis\ud Background: Calculations of lower limbs kinetics are limited by floor-mounted force-plates.\ud Objectives: Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer).\ud Methods: Kinematics, ground reactions and knee reactions were collected using a motion analysis system, two force-plates and a multi-axial transducer mounted below the socket, respectively.\ud Results: The inverse dynamics using ground reactions under-estimated the peaks of hip energy generation and absorption occurring at 63 % and 76 % of the gait cycle (GC) by 28 % and 54 %, respectively. This method over-estimated a phase of negative work at the hip (from 37 %GC to 56 %GC) by 24%. It under-estimated the phases of positive (from 57 %GC to 72 %GC) and negative (from 73 %GC to 98 %GC) work at the hip by 11 % and 58%, respectively.\ud Conclusions: A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without issues of foot placement on force-plates

A taxonomy to assess the interaction between nurses and children:Development and reliability

Aims and objectives The aim of this study was to develop a valid and reliable instrument to assess the nurse-child interaction during medical or nursing interventions. Background Communication is an important competency for the professional practice of nurses and physicians. The nurse-patient relationship is fundamental for high-quality care. It has been suggested that if nurses have more skills to interact with children, care will be less distressing and less painful for the children. Design A qualitative observational psychometric study; the GRRAS checklist was used. Methods In-depth video-analyses, taxonomy development (19 videos) and testing it is psychometric properties (10 videos). Three observers micro-analysed video recordings of experienced nurses changing children's wound dressing in a specialised Burn Centre. Results The nurse-child interaction taxonomy (NCIT) was developed to observe and score the interactional behaviour between nurse and child. The taxonomy has three main patterns: being considerate, attuning oneself, and procedural interventions, subdivided in eight dimensions. These dimensions contain 16 elements that can be observed and scored on a 7-point scale. Intra-rater, inter-rater reliability and agreement were good. Conclusions This study shows that interaction between nurses and children can be assessed reliably with the NCIT by an experienced observer or alternatively, scoring by two observers is recommended. Relevance to clinical practice The development of the taxonomy is an important step to find evidence for the best way for nurses to interact with children during nursing interventions or medical events and as such, ultimately, contributes to providing the best care possible

Predictability of exercise capacity following pediatric burns:a preliminary investigation

Purpose: Describe the course of exercise capacity in pediatric burn patients during the initial 6 months after hospital discharge, and examine whether its recovery can be predicted from burn characteristics, sociodemographic characteristics, and/or prior assessment. Materials and methods: Exercise capacity was assessed at discharge, and 6 weeks, 3 months, and 6 months after discharge using the Steep Ramp Test (SRT). Results: Twenty-four pediatric patients with burns affecting 0.1-34% of total body surface area were included. At group level, exercise capacity was low at discharge and did not reach healthy reference values within 6 months, despite significant improvement over time. At individual level, the course of exercise capacity varied widely. Six months after discharge, 48% of participants scored more than one standard deviation below healthy age- and sex-specific reference values. SRT outcomes at 6 weeks and 3 months were the best predictors of exercise capacity 6 months after discharge, explaining, respectively, 76% and 93% of variance. Conclusions: Forty-eight percent of participants did not achieve healthy reference values of exercise capacity and were therefore considered "at risk" for diminished functioning. Our preliminary conclusion that early assessment of exercise capacity with the SRT can timely identify those patients, needs to be strengthened by further research. IMPLICATIONS FOR REHABILITATION Pediatric burns can be considered as a chronic medical condition because of the lifelong consequences. Exercise capacity is reduced following- even minor -pediatric burns. Recovery patterns vary widely: some pediatric burn patients achieve healthy levels of exercise capacity without specific intervention, while others do not. The Steep Ramp Test can be used to assess exercise capacity, identifying those "at risk" for adverse outcomes at an early stage. Patients "at risk" should be encouraged to play sports and adopt an active lifestyle

Virtual prototyping of a semi-active transfemoral prosthetic leg

This article presents a virtual prototyping study of a semi-active lower limb prosthesis to improve the functionality of an amputee during prosthesis–environment interaction for level ground walking. Articulated ankle–foot prosthesis and a single-axis semi-active prosthetic knee with active and passive operating modes were considered. Data for level ground walking were collected using a photogrammetric method in order to develop a base-line simulation model and with the hip kinematics input to verify the proposed design. The simulated results show that the semi-active lower limb prosthesis is able to move efficiently in passive mode, and the activation time of the knee actuator can be reduced by approximately 50%. Therefore, this semi-active system has the potential to reduce the energy consumption of the actuators required during level ground walking and requires less compensation from the amputee due to lower deviation of the vertical excursion of body centre of mass

Development of a value-based healthcare burns core set for adult burn care

Background: Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients. Methods: A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item ‘important’. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set. Results: Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards. Conclusion: A VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.</p

Simulating polarized Galactic synchrotron emission at all frequencies, the Hammurabi code

We present a publicly available code called Hammurabi for generating mock polarized observations of Galactic synchrotron emission for telescopes like LOFAR, SKA, Planck and WMAP, based on model inputs for the Galactic magnetic field (GMF), the cosmic-ray density distribution and the thermal electron density. We also present mock UHECR deflection measure (UDM) maps based on model inputs for the GMF. In future, when UHECR sources are identified, this will allow us to define UDM as a GMF probe in a similar way as polarized radio sources permit us to define rotation measures. To demonstrate the code's abilities mock observations are compared to real data as a means to constrain the input parameters of our simulations with a focus on large-scale magnetic field properties. As expected, attempts at trying to model the synchrotron, UHECR deflection and RM input parameters, show that any additional observational data set greatly increases the constraints on the models. The hammurabi code addresses this by allowing to perform simulations of several different data sets simultaneously, providing the means for a more reliable constraint of the magnetized inter-stellar-medium.Comment: Submitted to A&A (Numerical methods and codes section

The reliability of determining effort level of lifting and carrying in a functional capacity evaluation

Objectives: To establish inter- and intra-rater reliability of observations in a functional capacity evaluation. Background: Functional capacity evaluations are used to assess a person's functional capacity as it relates to work. Lifting and carrying are important aspects of a functional capacity evaluation. An evaluator determines the patient's levels of effort through standardized observations. Questions remain with regards to the reliability of these observations. Methods: Four healthy subjects were videotaped while performing two lifts and four carries with progressive loads. The videotape was scrambled randomly and viewed twice by 3 physical therapists and 2 occupational therapists. The evaluators determined the amount of effort it required (light, medium, heavy, and maximum). The inter- and intra-rater reliability of the observations was expressed by means of percentage agreement. Results: Inter-rater reliability ranged 87-96%, intra-rater reliability ranged 93-97%. Conclusion: The results indicate that by means of standardized observations, therapists can reliably determine effort level during lifting and carrying in healthy subjects, and thus affirm the findings of other studies of similar design.</p

Perceptual skills of children with developmental coordination disorder

The aim of this study was to investigate whether children with a Developmental Coordination Disorder (DCD) experience problems in the processing of visual, proprioceptive or tactile information. Different aspects of visual perception were tested with the Developmental Test of Visual Perception (DTVP-2), tactile perception was assessed with the Tactual Performance Test (TPT), and a manual pointing task was employed to measure the ability to use visual and proprioceptive information in goal-directed movements. Nineteen children with DCD and nineteen age and sex-matched controls participated in this study. Differences between groups were most pronounced in the subtests measuring visual-motor integration of the DTVP-2, and in two subtests measuring visual perception (visual closure and position in space). On average the children with DCD performed slightly below the norm for tactile perception, with only three children failing the norm. On the manual pointing task, children with DCD made inconsistent responses towards the targets in all three conditions (visual, visual-proprioceptive and proprioceptive condition). No significant differences between groups were found for absolute error. Inspection of the individual data revealed that only two children failed on the majority of perceptual tasks in the three modalities. Across tasks, no consistent pattern of deficits appeared, illustrating the heterogeneity of the problems of children with DCD