Ground reaction force patterns during gait in patients with lower limb lymphedema

Although gait problems have been reported in patients with lower limb lymphedema (LLL), the gait pattern (GP) changes have not been documented yet. However, it is possible that patients with LLL show abnormal GP that can be related to biomechanical complications related to osteoarthritis or falls affecting the quality of life. Ground reaction force analysis during gait allows objective assessment of the patients and it can be used to plan a rehabilitation approach. Objective: To analyze the GRF during gait in patients LLL. Methods: An experimental descriptive study was realized with twenty-three LLL patients, both unilateral and bilateral and classified as moderate and severe, participated in the experiments. The patients walked on a force plate while the three ground reaction force (GRF) components, vertical, mediolateral (M-L) and anteroposterior (A-P), under their feet were recorded and analyzed. Results: In the patients with unilateral lymphedema, either moderate or severe, the vertical GRF components of the affected limb were similar to the sound one and also resembling those found in healthy adults. The M-L GRF was smaller in the non-affected side. In patients with bilateral lymphedema gait speed was significantly slower. More interestingly, the vertical GRF pattern was flat, not showing the typical 2-peak shape. Finally, the large M-L forces found suggest gait stability problems. Conclusions: The patients showed abnormal GRF patterns, including compensation with the non-affected leg. The GRF variability was higher in the patients with severe unilateral lymphedema. Bilateral lymphedema results in lower A-P forces. Stance phase duration was longer in patients with bilateral and severe lymphedem

Podoconiosis in Ethiopia. A pilot study to improve the management of Lymphedema.

Podoconiosis is a non-infectious cause of lymphedema, frequent in Africa. The aim of this study is to implement the management of lymphedema secondary to podoconiosis in a rural hospital in Southern Ethiopia. A call for donation of compression garments was made in Spain, to give any used and retired garment among lymphedema patients. The working plan was to train the staff in the lymphatic system, the causes of lymphedema, prevention strategies, skin care, intensive treatment and maintenance at long-term, Decongestive lymphatic treatment of the patients affected from podoconiosis and the adaptation of the donated garments for maintenance phase. Fifteen patients were treated with 10 sessions of Decongestive Lymphatic Therapy (DLT) consisting of Manual Lymphatic Drainage and multilayer bandages. The Percentage of Volume Reduction was 11.3% (95%CI: 8.8-13.9). Fifty percent of the patients showed an increase of the volume of lymphedema as they did not comply with the compression treatment. This pilot study has had good results in helping lymphedema management in Southern Ethiopia. The donation of used garments by chronic patients can be a feasible and effective step to improving the maintenance phase of patients with lymphedema in places with limited resources

Analysis of the human interaction with a wearable lower-limb exoskeleton

The design of a wearable robotic exoskeleton needs to consider the interaction, either physical or cognitive, between the human user and the robotic device. This paper presents a method to analyse the interaction between the human user and a unilateral, wearable lower-limb exoskeleton. The lower-limb exoskeleton function was to compensate for muscle weakness around the knee joint. It is shown that the cognitive interaction is bidirectional; on the one hand, the robot gathered information from the sensors in order to detect human actions, such as the gait phases, but the subjects also modified their gait patterns to obtain the desired responses from the exoskeleton. The results of the two-phase evaluation of learning with healthy subjects and experiments with a patient case are presented, regarding the analysis of the interaction, assessed in terms of kinematics, kinetics and/or muscle recruitment. Human-driven response of the exoskeleton after training revealed the improvements in the use of the device, while particular modifications of motion patterns were observed in healthy subjects. Also, endurance (mechanical) tests provided criteria to perform experiments with one post-polio patient. The results with the post-polio patient demonstrate the feasibility of providing gait compensation by means of the presented wearable exoskeleton, designed with a testing procedure that involves the human users to assess the human-robot interaction

Modelo transteórico de mudança de comportamentos na promoção da actividade física nas grávidas

Determinar se o Modelo Transteórico de Mudança de Comportamento (MTMC) é eficaz na promoção da actividade física (AF) nas grávidas. O grupo experimental (GE) participou no projecto “Mães em Movimento” baseado no MTMC. Aplicou-se o Questionário de AF para Gestantes, Escala de Estados de Mudança, Behavioural Regulation in Exercise Questionnaire e Questionário de Conhecimentos. Na 2ª avaliação, no GE, todas as grávidas referiram praticar AF. A motivação intrínseca e os conhecimentos aumentaram. O MTMC revelou-se um modelo eficaz na promoção da AF em grávidas.To determine whether the Transtheoretical Model of Behavior Change (TTM) is effective in promoting physical activity (PA) in pregnant women. The experimental group (EG), participated in the "Moms in Motion" based on the TTM. It was applied the Pregnancy Physical Activity Questionnaire, Stages of Change Questionnaire, Behavioral Regulation in Exercise Questionnaire and Skills Questionnaire. In the 2nd evaluation, in EG, all women reported practicing PA. The intrinsic motivation and knowledge increased. The TTM revealed to be an effective model in promoting PA habits in pregnant women

Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology

Background: In the evaluation of upper limb impairment post stroke there remains a gap between detailed kinematic analyses with expensive motion capturing systems and common clinical assessment tests. In particular, although many clinical tests evaluate the performance of functional tasks, metrics to characterise upper limb kinematics are generally not applicable to such tasks and very limited in scope. This paper reports on a novel, user-friendly methodology that allows for the assessment of both signal magnitude and timing variability in upper limb movement trajectories during functional task performance. In order to demonstrate the technique, we report on a study in which the variability in timing and signal magnitude of data collected during the performance of two functional tasks is compared between a group of subjects with stroke and a group of individually matched control subjects. Methods: We employ dynamic time warping for curve registration to quantify two aspects of movement variability: 1) variability of the timing of the accelerometer signals' characteristics and 2) variability of the signals' magnitude. Six stroke patients and six matched controls performed several trials of a unilateral ('drinking') and a bilateral ('moving a plate') functional task on two different days, approximately 1 month apart. Group differences for the two variability metrics were investigated on both days. Results: For 'drinking from a glass' significant group differences were obtained on both days for the timing variability of the acceleration signals' characteristics (p = 0.002 and p = 0.008 for test and retest, respectively); all stroke patients showed increased signal timing variability as compared to their corresponding control subject. 'Moving a plate' provided less distinct group differences. Conclusion: This initial application establishes that movement variability metrics, as determined by our methodology, appear different in stroke patients as compared to matched controls during unilateral task performance ('drinking'). Use of a user-friendly, inexpensive accelerometer makes this methodology feasible for routine clinical evaluations. We are encouraged to perform larger studies to further investigate the metrics' usefulness when quantifying levels of impairment

Gait kinematic analysis in patients with a mild form of central cord syndrome

<p>Abstract</p> <p>Background</p> <p>Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). Independent ambulation was achieved in 87-97% in young patients with CCS but no gait analysis studies have been reported before in such pathology. The aim of this study was to analyze the gait characteristics of subjects with CCS and to compare the findings with a healthy age, sex and anthropomorphically matched control group (CG), walking both at a self-selected speed and at the same speed.</p> <p>Methods</p> <p>Twelve CCS patients and a CG of twenty subjects were analyzed. Kinematic data were obtained using a three-dimensional motion analysis system with two scanner units. The CG were asked to walk at two different speeds, at a self-selected speed and at a slower one, similar to the mean gait speed previously registered in the CCS patient group. Temporal, spatial variables and kinematic variables (maximum and minimum lower limb joint angles throughout the gait cycle in each plane, along with the gait cycle instants of occurrence and the joint range of motion - ROM) were compared between the two groups walking at similar speeds.</p> <p>Results</p> <p>The kinematic parameters were compared when both groups walked at a similar speed, given that there was a significant difference in the self-selected speeds (p < 0.05). Hip abduction and knee flexion at initial contact, as well as minimal knee flexion at stance, were larger in the CCS group (p < 0.05). However, the range of knee and ankle motion in the sagittal plane was greater in the CG group (p < 0.05). The maximal ankle plantar-flexion values in stance phase and at toe off were larger in the CG (p < 0.05).</p> <p>Conclusions</p> <p>The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support. The findings of this study help to improve the understanding how CCS affects gait changes in the lower limbs.</p