Kinesiological study of the push-up motion in spinal cord injury patients: involving measurement of hand pressure applied to a force plate.

We studied the pressure exerted by hands during push-ups in 21 paraplegic and 2 tetraplegic patients employing 4 different hand positions. In the fingers-spread position, the initial force exerted was a vertical force (Fz), followed by a medio-lateral force (Fy) and then an antero-posterior force (Fx). In the other 3 positions, the order of force type exertion was Fz, Fx, and then Fy. All subjects with neurological injury levels above T4 and subjects between T5 and T10 without spinal instrumentation could not push themselves up in the fingers-spread position. The fact that Fy is initiated before Fx in the fingers-spread position indicates that lateral balancing of the trunk is critical in this position, thus explaining why subjects without spinal instrumentation with neurological injury at a level higher than T10 could not control their spinal columns while performing push-ups. In contrast, antero-posterior balancing takes priority in the other hand positions. We believe that spinal instrumentation helps balance the trunk in the lateral direction, converting the thoracic spine into a rigid body in subjects with neurological injury at levels above T10. </p

Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury.

Pressure distribution patterns of the seating interface on the multi-cell air cushion (ROHO High Profile) of 36 adults with spinal cord injury (SCI) (Neurological level Th3 -L1) were measured at different air pressure levels by a pressure mat measurement system. Stress distribution relative to the inflated air pressure in the air cushion on the patients' wheelchairs was analyzed to determine the appropriate inflated air pressure of the cushion for patients. The maximum pressure points in all subjects were at the areas of the ischial tuberosities (82 to 347 mmHg). The optimal reduction in interface pressure at the ischial tuberosities was obtained just before bottoming out. The cushion air pressure at that point was between 17 and 42 mmHg, and correlated well to body weight (r = 0.495, P = 0.0021). In contrast, the maximum pressure levels did not correlate to body weight or the Body Mass Index (BMI). Pressure at the ischial area could be reduced, but not eliminated, by adjusting the air pressure. The maximum pressure levels seemed to be related to the shape of the buttocks, especially the amount of soft tissue, and exceeded the defined threshold for pressure ulcers (&#62; 80 g/cm2).</p

Kinesiological Study of Push-up Motion Using a Three-Dimensional Floor Reaction on a Force Plate

To find an effective way to handle wheelchairs, 3-dimensional floor reactions of the hand and angular deviation of the elbow and wrist joints during push-up motion were studied in 10 healthy men. The push-up was carried out using 3 hand positions (fist, finger and palm) and a push-up device. In all hand positions, anteroposterior force (Fx) and the mediolateral force (Fy) appeared after the vertical force (Fz). The end point of Fx and Fy was observed before that of Fz. Among the 4 different hand positions, Fx and Fy appeared first in the palm, followed by the finger and fist positions, and lastly in the push-up devices. The results indicate that the more unstable pushing-up the body is, the earlier and longer Fx and Fy are. Thus, Fx and Fy are considered to be good indicators of body balance during the push-up motion. The elbow joint showed a hyperextended position only when using the palm position in the maintenance phase. The wrist joint showed palmar flexion only when using the fist position.</p

Evaluation of wheelchair cushions by means of pressure distribution mapping.

We studied the seated buttock pressure distribution in six paraplegic patients by means of computerized pressure mapping. They were all male and their age ranged from 18 to 48 years old. Their level of paralysis varied from Th5 to L1. Five kinds of wheelchair cushions were studied: an air cushion, a contour cushion, a polyurethane foam cushion, a Cubicushion (which is made of polyurethane foams) and a silicone gel cushion. A tactile sensor consisting of 2064 matrices was used for measuring the buttock pressure distribution and the data was analyzed on a personal computer. Peak pressures measured for each cushion were as follows (in descending order): the Cubicushion, the polyurethane foam cushion, the contour cushion, the silicone gel cushion, and the air cushion. The areas of total contact measured for each cushion were as follows (in descending order): the air cushion, the silicone gel cushion, the polyurethane foam cushion, the contour cushion and the Cubicushion. Based on these findings, we conclude that the most advantageous cushion is the air cushion or the silicone gel cushion. Likewise, we conclude that the Cubicushion is not practical for pressure sore prevention.</p

Gait analysis of slope walking: a study on step length, stride width, time factors and deviation in the center of pressure.

Determination was made of step length, stride width, time factors and deviation in the center of pressure during up- and downslope walking in 17 healthy men between the ages of 19 and 34 using a force plate. Slope inclinations were set at 3, 6, 9 and 12 degrees. At 12 degrees, walking speed, the product of step length and cadence, decreased significantly (p less than 0.01) in both up- and downslope walking. The most conspicuous phenomenon in upslope walking was in cadence. The steeper the slope, the smaller was the cadence. The most conspicuous phenomenon in downslope walking was in step length. The steeper the slope, the shorter was the step length.</p

Survey of above knee (A/K) prostheses currently used in the Chugoku-Shikoku district of Japan

To determine the extent to which recent advances in biomechanical technology have been implemented and to evaluate these new technologies, 84 unilateral above knee (A/K) amputees and their prostheses were surveyed in the Chugoku-Shikoku district of Japan, especially in regard to the types, sockets and components of A/K prostheses currently in use. Background factors such as age and sex of the A/K amputees and the period after amputation were also surveyed. Of the 84 amputees surveyed, 74 (88.1%) were over 40 years old and 40 (47.6%) were over 60 years old. There were 10 women (11.9%) and 74 men (88.1%). The period after amputation was under 25 years in 58 (69.0%) cases. Regarding the type of A/K prostheses, one-third of the prostheses was of the exoskeletal type and two-thirds were of the endoskeletal type. Although the endoskeletal type is becoming more popular recently, elderly A/K amputees tend to use the exoskeletal type. Thirty-one (36.9%) had plug-fit sockets which are preferable for those who follow the Japanese practice of sitting on the floor, especially for elderly amputees. Thirty-seven (44.0%) had a lock-knee, 27 (73.0%) of which were used by amputees over 60 years old. Seventy-three (86.9%) had a single-axis ankle which is generally considered to be the most stable ankle. Thus, the most common combination of prosthetic components for elderly A/K amputees was the plug-fit socket, lock-knee joint and single-axis ankle.</p

Stump problems in traumatic amputation.

Stump problems in amputations resulting from employment related injuries were investigated in 397 cases in the Chugoku and Shikoku districts of Japan between 1987 and 1991. Ninety-seven patients (24%) had stump problems which interfered the prosthetic fitting. Stump problems of the upper extremity were seen in about 9% (17 amputees), two thirds of which were skin troubles. Stump problems of the lower extremity were seen in about 37% (80 amputees). Certain complaints were associated with specific methods of amputation; abnormal keratosis in Syme's amputation, equinus deformity in Chopart's amputation, reduced muscle power in above the knee (A/K) amputation and joint dysfunction in below the knee (B/K) amputation. Adequate prosthetic fitting was achieved by the modification of the socket and alignment in almost all amputees with stump problems. In only two cases, Chopart's amputation required subsequent Syme's amputation due to equinus deformity with abnormal keratosis. In almost every case, stump problems are avoidable by means of surgeons' deliberate evaluation of the affected limb and adequate choice of the amputation level.</p

Autonomic Dysreflexia during a Bowel Program in Patients with Cervical Spinal Cord Injury.

The purpose of the present study was to investigate the relationship between bowel maneuvers and autonomic dysreflexia (AD) in patients with cervical spinal cord injuries (CSCI). Fifteen consecutive, clinically stable patients with CSCI participated. We evaluated changes in blood pressure (BP), pulse rate (PR) and classic symptoms of AD before, during and after a bowel program involving the manual removal of stool in lateral recumbency. The insertion of rectal medication induced a significant increase in systolic BP, which persisted during additional digital rectal stimulation. Furthermore, the manual removal of stool induced AD, with maximal increases of systolic BP (169.1(+-)19.5 mmHg, mean(+-)SD). However, the insertion of a finger into the anus after the end of stool flow did not cause a further increase in systolic BP. Systolic BP recovered to pre-program values within 5 min after defecation. Our study demonstrated that the combined effects of rectal and/or anal sphincter distension and uninhibited rectal contraction in response to the manual removal of stool might induce AD. We recommend avoiding, if at all possible, the manual removal of stool in order to prevent AD in patients with CSCI

A risk stratification model based on four novel biomarkers predicts prognosis for patients with renal cell carcinoma.

Background:Accurate prediction of the prognosis of RCC using a single biomarker is challenging due to the genetic heterogeneity of the disease. However, it is essential to develop an accurate system to allow better patient selection for optimal treatment strategies. ARL4C, ECT2, SOD2, and STEAP3 are novel molecular biomarkers identified in earlier studies as survival-related genes by comprehensive analyses of 43 primary RCC tissues and RCC cell lines.Methods:To develop a prognostic model based on these multiple biomarkers, the expression of four biomarkers ARL4C, ECT2, SOD2, and STEAP3 in primary RCC tissue were semi-quantitatively investigated by immunohistochemical analysis in an independent cohort of 97 patients who underwent nephrectomy, and the clinical significance of these biomarkers were analyzed by survival analysis using Kaplan-Meier curves. The prognostic model was constructed by calculation of the contribution score to prognosis of each biomarker on Cox regression analysis, and its prognostic performance was validated.Results:Patients whose tumors had high expression of the individual biomarkers had shorter cancer-specific survival (CSS) from the time of primary nephrectomy. The prognostic model based on four biomarkers segregated the patients into a high- and low-risk scored group according to defined cut-off value. This approach was more robust in predicting CSS compared to each single biomarker alone in the total of 97 patients with RCC. Especially in the 36 metastatic RCC patients, our prognostic model could more accurately predict early events within 2 years of diagnosis of metastasis. In addition, high risk-scored patients with particular strong SOD2 expression had a much worse prognosis in 25 patients with metastatic RCC who were treated with molecular targeting agents.Conclusions:Our findings indicate that a prognostic model based on four novel biomarkers provides valuable data for prediction of clinical prognosis and useful information for considering the follow-up conditions and therapeutic strategies for patients with primary and metastatic RCC