Reliabilität der statischen Posturografie bei älteren Personen

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Hintergrund und Zielsetzung: Die statische Posturografie ist eine Messmethode für die Bewegungen des Körperdruckpunktes. Mit ihr werden beispielsweise ältere sturzgefährdete Patienten untersucht. Ob die statische Posturografie ein reliables Messinstrument bei älteren Menschen ist, konnte bisher nicht endgültig geklärt werden. Mit der vorliegenden Arbeit sollte die intraindividuelle Reliabilität der statischen Posturografie bei älteren Senioren geprüft werden. Probanden und Methode: Die intraindividuelle Reliabilität von 11 Messparametern der statischen Posturografie wurde bei 30 älteren Senioren untersucht. Messparameter waren: die Durchschnittsgeschwindigkeit der Druckpunktbewegung in mm/s, die Länge der Druckpunktbewegung in mm, die Schwankungsfläche in mm2, die Amplituden der Druckpunktbewegung, die Oszillationsachse in Grad und die Neigungswinkel der Patienten in Grad. Die drei Messungen fanden am selben Tag im Abstand von zwei Minuten statt. Sie wurden in vier verschiedenen Testpositionen durchgeführt: normaler Stand und Nahstand, jeweils mit offenen und geschlossenen Augen. Die statistische Analyse erfolgte mit Intra-Klassen-Korrelationskoeffizienten. Ergebnisse: Sechs der getesteten Parameter sind sehr gut reliabel, mit einem Korrelationskoeffizienten von jeweils >0,9. Diese sechs Parameter sind: die Durchschnittsgeschwindigkeit der Bewegung des Körperdruckpunktes in mm/s im Nahstand, die Schwankungsfläche in mm2 (im Nahstand mit geschlossenen Augen), die Länge der Druckpunktbewegung in mm (gesamt und in beiden Ebenen) im Normalstand und im Nahstand sowie der Neigungswinkel des Patienten in Grad in der Sagittalebene, im Normalstand und im Nahstand. Von den vier Testpositionen ist die Position „Nahstand mit geschlossenen Augen“ am besten geeignet, um reliable Werte zu erhalten. Schlussfolgerung: Sechs der getesteten Parameter können zur Verwendung in Folgestudien empfohlen werden. Als Testposition eignet sich die Position „Nahstand mit geschlossenen Augen“. Das vorhandene Messprotokoll liefert reliable Messergebnisse. Ob die verwendeten Parameter zur Diagnostik von Gang- und Balancestörungen geeignet sind, muss in einer Folgestudie geklärt werden

Reliabilität der statischen Posturografie bei älteren Personen

Zusammenfassung: Hintergrund und Zielsetzung: Die statische Posturografie ist eine Messmethode für die Bewegungen des Körperdruckpunktes. Mit ihr werden beispielsweise ältere sturzgefährdete Patienten untersucht. Ob die statische Posturografie ein reliables Messinstrument bei älteren Menschen ist, konnte bisher nicht endgültig geklärt werden. Mit der vorliegenden Arbeit sollte die intraindividuelle Reliabilität der statischen Posturografie bei älteren Senioren geprüft werden. Probanden und Methode: Die intraindividuelle Reliabilität von 11Messparametern der statischen Posturografie wurde bei 30 älteren Senioren untersucht. Messparameter waren: die Durchschnittsgeschwindigkeit der Druckpunktbewegung in mm/s, die Länge der Druckpunktbewegung in mm, die Schwankungsfläche in mm2, die Amplituden der Druckpunktbewegung, die Oszillationsachse in Grad und die Neigungswinkel der Patienten in Grad. Die drei Messungen fanden am selben Tag im Abstand von zwei Minuten statt. Sie wurden in vier verschiedenen Testpositionen durchgeführt: normaler Stand und Nahstand, jeweils mit offenen und geschlossenen Augen. Die statistische Analyse erfolgte mit Intra-Klassen-Korrelationskoeffizienten. Ergebnisse: Sechs der getesteten Parameter sind sehr gut reliabel, mit einem Korrelationskoeffizienten von jeweils >0,9. Diese sechs Parameter sind: die Durchschnittsgeschwindigkeit der Bewegung des Körperdruckpunktes in mm/s im Nahstand, die Schwankungsfläche in mm2 (im Nahstand mit geschlossenen Augen), die Länge der Druckpunktbewegung in mm (gesamt und in beiden Ebenen) im Normalstand und im Nahstand sowie der Neigungswinkel des Patienten in Grad in der Sagittalebene, im Normalstand und im Nahstand. Von den vier Testpositionen ist die Position "Nahstand mit geschlossenen Augen" am besten geeignet, um reliable Werte zu erhalten. Schlussfolgerung: Sechs der getesteten Parameter können zur Verwendung in Folgestudien empfohlen werden. Als Testposition eignet sich die Position "Nahstand mit geschlossenen Augen". Das vorhandene Messprotokoll liefert reliable Messergebnisse. Ob die verwendeten Parameter zur Diagnostik von Gang- und Balancestörungen geeignet sind, muss in einer Folgestudie geklärt werde

Reliability analysis of time series force plate data of community dwelling older adults

Frequency-based analysis of body sway has been used to distinguish between healthy young, healthy elderly adults and elderly adults with Huntingtons disease. Our aim was to assess the reliability of spectral-based outcomes of the centre of pressure (CoP) kinematics in order to determine if these outcomes could be tested for their capability to distinguish between elderly fallers and non-fallers in a future study. We have studied balance for 30 community dwelling healthy older adults 60 years or older. Four test conditions were used. Three successive trials were performed for each condition. CoP kinematics were estimated with a force platform with three strain gauges set in a triangular position. The frequency content of these signals was estimated. Intrasession correlation coefficients (ICC's) were then calculated for all test conditions. The reliability of the selected parameters varied between low and high (ICC 0.652-0.939). The ICC's for the narrow stance tests were higher compared to tests with normal standing conditions (0.771-0.94) to (0.652-0.865). The highest value was obtained in the high frequency band (0.939). These measures should be viewed with caution when screening geriatric patients because their reliability cannot always be assumed

Decrease in the expression of the type 1 PTH/PTHrP receptor (PTH1R) on chondrocytes in animals with osteoarthritis

<p>Abstract</p> <p>Background</p> <p>To evaluate the expression of the type 1 PTH/PTHrP receptor (PTH1R) on chondrocytes from hyaline cartilage over the course of osteoarthritis (OA).</p> <p>Methods</p> <p>In 12 NZW rabbits, the anterior cruciate ligament (ACL) was resected to create anterior instability of the knee. In 12 control rabbits, only a sham operation, without resection of the ACL, was performed. Four animals from each group were killed at 3, 6, and 12 weeks. After opening the knee joint, OA was macroscopically graded and hyaline cartilage of the load-bearing area was evaluated histologically according to the Mankin scale and by immunostaining for PTH1R.</p> <p>Results</p> <p>There was a positive linear correlation between the time after surgery and the macroscopic and histologic OA scores. The scores in the control group were constant over the time course. Immunostaining showed significantly less expression of PTH1R in the experimental compared to the control group after 6 (P < 0.05) and 12 weeks (P < 0.01). In the experimental group, a negative linear correlation between PTH1R expression and macroscopic and histologic grades was found.</p> <p>Conclusions</p> <p>The results show an in vivo decrease in the expression of PTH1R on chondrocytes over the time course of OA. Further studies are needed to evaluate whether new treatment approaches could evolve from this knowledge.</p

Gait analysis of fixed bearing and mobile bearing total knee prostheses during walking: Do mobile bearings offer functional advantages?

Background - Limited previous findings have detailed biomechanical advantages following implantation with mobile bearing (MB) prostheses after total knee replacement (TKR) surgery during walking. The aim of this study was to compare three dimensional spatiotemporal, kinematic, and kinetic parameters during walking to examine whether MBs offer functional advantages over fixed bearing (FB) designs. Methods - Sixteen patients undergoing primary unilateral TKR surgery were randomised to receive either a FB (n = 8) or MB (n = 8) total knee prosthesis. Eight age and gender matched controls underwent the same protocol on one occasion. A 12 camera Vicon system integrated with four force plates was used. Patients were tested pre-surgery and nine months post-surgery. Results - No significant differences between FB and MB groups were found at any time point in the spatiotemporal parameters. The MB group was found to have a significantly reduced frontal plane knee range of motion (ROM) at pre-surgery than the FB group (FB = 14.92 ± 4.02°; MB = 8.87 ± 4.82°), with the difference not observed post-surgery. No further significant kinematic or kinetic differences were observed between FB and MB groups. Fixed bearing and MB groups both displayed spatiotemporal, kinematic, and kinetic differences when compared to controls. Fixed bearing and MB groups differed from controls in six and five parameters at nine months post-surgery, respectively. Conclusions - No functional advantages were found in knees implanted with MB prostheses during walking, with both groups indicative of similar differences when compared to normal knee biomechanics following prosthesis implantation

Damages of the tibial post in constrained total knee prostheses in the early postoperative course – a scanning electron microscopic study of polyethylene inlays

<p>Abstract</p> <p>Background</p> <p>Investigation of the risk of fracture of the polyethylene (PE) inlay in constrained total knee prostheses.</p> <p>Methods</p> <p>Three unused and seven polyethylene inlays that had been implanted in a patient's knee for an average of 25.4 months (min 1.1 months, max 50.2 months) were investigated using scanning electron microscopy (SEM). All inlays were of the same type and size (Genesis II constrained, Smith & Nephew). The PE surface at the transition from the plateau to the post was analyzed.</p> <p>Results</p> <p>The unused inlays had fissure-free surfaces. All inlays that had been implanted in a patient's knee already had distinct fissures at the front and backside of the post.</p> <p>Conclusion</p> <p>The fissures of the transition from the plateau to the post indicated a loading-induced irreversible mechanical deformation and possibly cause the fracture of the inlay.</p

Evaluation of subsidence, chondrocyte survival and graft incorporation following autologous osteochondral transplantation

Contains fulltext : 95878.pdf (publisher's version ) (Open Access)PURPOSE: The aim of this study was to evaluate subsidence tendency, surface congruency, chondrocyte survival and plug incorporation after osteochondral transplantation in an animal model. The potential benefit of precise seating of the transplanted osteochondral plug on the recipient subchondral host bone ('bottoming') on these parameters was assessed in particular. METHODS: In 18 goats, two osteochondral autografts were harvested from the trochlea of the ipsilateral knee joint and inserted press-fit in a standardized articular cartilage defect in the medial femoral condyle. In half of the goats, the transplanted plugs were matched exactly to the depth of the recipient hole (bottomed plugs; n = 9), whereas in the other half of the goats, a gap of 2 mm was left between the plugs and the recipient bottom (unbottomed plugs; n = 9). After 6 weeks, all transplants were evaluated on gross morphology, subsidence, histology, and chondrocyte vitality. RESULTS: The macroscopic morphology scored significantly higher for surface congruency in bottomed plugs as compared to unbottomed reconstructions (P = 0.04). However, no differences in histological subsidence scoring between bottomed and unbottomed plugs were found. The transplanted articular cartilage of both bottomed and unbottomed plugs was vital. Only at the edges some matrix destaining, chondrocyte death and cluster formation was observed. At the subchondral bone level, active remodeling occurred, whereas integration at the cartilaginous surface of the osteochondral plugs failed to occur. Subchondral cysts were found in both groups. CONCLUSIONS: In this animal model, subsidence tendency was significantly lower after 'bottomed' versus 'unbottomed' osteochondral transplants on gross appearance, whereas for histological scoring no significant differences were encountered. Since the clinical outcome may be negatively influenced by subsidence, the use of 'bottomed' grafts is recommended for osteochondral transplantation in patients