Does gait analysis change clinical decision-making in poststroke patients? Results from a pragmatic prospective observational study

BACKGROUND

Gait analysis (GA) was demonstrated to change presurgical planning and improve gait outcomes in children with Cerebral Palsy. GA is often used also to assess walking capability of poststroke subjects, although its influence in the clinical management of these patients has not yet been established.

OBJECTIVE

To assess the impact of GA on clinical decision-making in adult chronic poststroke patients.

DESIGN

Pragmatic prospective observational study.

SETTING

Rehabilitation hospital, both outpatients and inpatients.

POPULATION

Forty-nine patients (age: 53.3±14.5 years) who had had a cerebrovascular accident 35.2±26.4 months before and were referred to the gait analysis service.

METHODS

Recommendations of therapeutic treatments before and after the analysis of GA data were compared, together with the confidence level of recommendations on a 10-point scale. Frequency of changes of post-GA vs pre-GA recommendations were computed for each recommendation type: surgery, botulinum toxin (BT), orthotic management and physiotherapy.

RESULTS

Based on the analysis of GA data, 71% of poststroke subjects had their treatment planning changed in some components. Indeed, 73% of patients with indications for surgery had their surgical planning changed; 81%, 37% and 32% had, respectively, their BT, orthotic and physiotherapy planning changed. Confidence level of recommendations increased significantly after GA, in both the whole group of patients (from 6.7±1.4 to 8.7±0.6, P<0.01) and the subgroup whose recommendations had not changed (7.0±1.5 vs. 8.8±0.4, P<0.01).

CONCLUSION

GA significantly influences the therapeutic planning and reinforces decision-making for chronic poststroke patients. Further work should be done to better translate GA results into indications for specific physiotherapy.

CLINICAL REHABILITATION IMPACT

The use of GA as a tool to better define the rehabilitation planning in post-stroke patients should be fostered, particularly when surgery or botulinum toxin are considered and/or the prescription of orthoses is hypothesised.

Substitution pattern elucidation of hydroxypropyl Pinus pinaster (Ait.) bark polyflavonoid derivatives by ESI(-)-MS/MS

The structure of condensed tannins (CTs) from Pinus pinaster bark extract and their hydroxypropylated derivatives with four degrees of substitution (DS 1, 2, 3 and 4) has been characterized for the first time using negative-ion mode electrospray ionization tandem mass spectrometry (ESI(-)-MS/MS). The results showed that P. pinaster bark CTs possess structural homogeneity in terms of monomeric units (C(15), catechin). The oligomer sizes were detected to be dimers to heptamers. The derivatives showed typical phenyl-propyl ether mass fragmentation by substituent elimination (58 amu) and inherent C(15) flavonoid fissions. The relative abundance of the product ions revealed a preferential triple, tetra-/penta- and octa- hydroxypropylation substitution pattern in the monomer, dimer and trimer derivatives, respectively. A defined order of -OH reactivity towards propylene oxide was established by means of multistage experiments (A-ring ≥ B-ring > C-ring). A high structural heterogeneity of the modified oligomers was detected.

Latest progresses in the preparation of tannin-based cellular solids

Tannins are non toxic, cheap and abundant polyphenolic oligomers extracted from tree barks. They can be easily used for preparing thermoset resins that are natural at the 70–95% level, depending on the cases. From these resins, highly porous monoliths can be obtained by different techniques such as classical physical or chemical foaming, mixed physical/chemical foaming, by less-conventional methods such as emulsion-templating and stabilisation and hardening of either aerated emulsions or liquid foams. The resultant materials are not only interesting per se, but are also key precursors of novel cellular carbons having a broad range of applications. The present paper briefly reviews the latest advances for producing tannin-based cellular materials and their related characteristics and properties.

Kinetics of the hydrothermal treatment of tannin for producing carbonaceous microspheres

Aqueous solutions of condensed tannins were submitted to hydrothermal carbonization (HTC) in a stainless steel autoclave, and the kinetics of hydrothermal carbon formation was investigated by changing several parameters: amount of tannin (0.5; 1.0; 1.5; 2.0 g in 16 mL of water), HTC temperature (130, 160, 180 and 200°C) and reaction times (from 1 to 720 h). The morphology and the structure of the tannin-based hydrothermal carbons were studied by TEM, krypton adsorption at -196°C and helium pycnometry. These materials presented agglomerated spherical particles, having surface areas ranging from 0.6 to 10.0 m(2) g(-1). The chemical composition of the hydrothermal carbons was found to be constant and independent of reaction time. HTC kinetics of tannin were determined and shown to correspond to first-order reaction. Temperature-dependent measurements led to an activation energy of 91 kJ mol(-1) for hydrothermal conversion of tannin into carbonaceous microspheres separable by centrifugation.

The influence of forest management systems on the environmental impacts for Douglas-fir production in France

The environmental wood profile, all over its life cycle, is a subject of interest for industries within the forest sector. Douglas-fir is a wood species with multiple applications and high productivity. In Europe, France is the country with the largest area dedicated to the cultivation of this tree species. This study aims to quantify the Douglas-fir forestry environmental impacts under different management practices performed in France. This study presents detailed life cycle inventories of both intensive and extensive scenarios, including all the processes from site preparation to logging activities. The results showed that stand establishment operations, tending and logging were the main stages responsible for the environmental impacts in both scenarios. The requirement of numerous thinning steps prior to the final cutting, which require machines with large fuel consumption, also had a negative influence. The logging stage, which includes the final cutting and the corresponding forwarding and loading onto trucks, also accounted for a significant contribution to all the categories. When the environmental results were compared with other life cycle studies on pine, eucalyptus and spruce, similar trends were identified in spite of the different management practices (low or high intensive scenarios), system boundaries and forest systems intensity (frequency of activities) considered.

Systematic studies of tannin-formaldehyde aerogels: preparation and properties

Gelation of tannin-formaldehyde (TF) solutions was systematically investigated by changing pH and concentration of TF resin in water. In this way we constructed the TF phase diagram, from which chemical hydrogels could be described, and also synthesized thermoreversible tannin-based hydrogels. Conditions of non-gelation were also determined. Hydrogels were dried in supercritical CO₂, leading to a broad range of TF aerogels. The latter were investigated for volume shrinkage, total porosity, micro-, meso- and macropore volumes, Brunauer-Emmett-Teller (BET) surface area, microscopic texture, mechanical and thermal properties. All these properties are discussed in relation to each other, leading to an accurate and self-consistent description of these bioresource-based highly porous materials. The conditions for obtaining the highest BET surface area or mesopore volume were determined and explained in relation to the preparation conditions. The highest BET surface area, 880 m² g^-1, is remarkably high for organic aerogels derived from a natural resource.

Bimodal activated carbons derived from resorcinol-formaldehyde cryogels

Resorcinol-formaldehyde cryogels prepared at different dilution ratios have been activated with phosphoric acid at 450 °C and compared with their carbonaceous counterparts obtained by pyrolysis at 900 °C. Whereas the latter were, as expected, highly mesoporous carbons, the former cryogels had very different pore textures. Highly diluted cryogels allowed preparation of microporous materials with high surface areas, but activation of initially dense cryogels led to almost non-porous carbons, with much lower surface areas than those obtained by pyrolysis. The optimal acid concentration for activation, corresponding to stoichiometry between molecules of acid and hydroxyl groups, was 2 M l-1, and the acid-cryogel contact time also had an optimal value. Such optimization allowed us to achieve surface areas and micropore volumes among the highest ever obtained by activation with H3PO4, close to 2200 m2 g-1 and 0.7 cm3 g-1, respectively. Activation of diluted cryogels with a lower acid concentration of 1.2 M l-1 led to authentic bimodal activated carbons, having a surface area as high as 1780 m2 g-1 and 0.6 cm3 g-1 of microporous volume easily accessible through a widely developed macroporosity.

Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals

STUDY DESIGN

Between-groups design with repeated measures.

OBJECTIVE

To quantify spastic hypertonia in spinal cord-injured (SCI) individuals.

SETTING

Rehabilitative Center, Italy.

SUBJECTS

29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls.

METHODS

According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS=1, 1+) and SCI-2 (MAS=2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 30°, 60°, 90° and 120° s(-1). We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles.

RESULTS

At the speed of 120° s(-1) all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) = 8.89, P < 0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 90° and 120° s(-1). Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work.

CONCLUSIONS

The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.

Tannin-based rigid foams: a survey of chemical and physical properties

Tannin-based rigid foams, prepared from 95% natural material, are suggested for replacing synthetic phenol-formaldehyde foams in various applications. For that purpose, a few physical properties were measured and reported here: resistance to fire and chemicals, absorption of various liquids, permeability, thermal conductivity and mechanical (compressive and tensile) strength. Modifying the composition through the use of boric and/or phosphoric acid allowed substantial increase of fire resistance. The materials were also found to present good resistance to strong acid and bases, and to solvents. High affinity for water, but limited one for organic liquids, was also evidenced. Finally, slightly anisotropic mechanical properties were measured. The materials present a brittle behaviour, whether tested in compression or traction; nevertheless, their strengths, as well as their thermal conductivities, are fully comparable with those of their phenolic counterparts. We show that such materials of vegetable origins can compete with synthetic ones for most of traditional applications.

X-ray microtomography studies of tannin-derived organic and carbon foams

Tannin-based rigid foams of different bulk densities and their carbonized counterparts were investigated for the first time by X-ray microtomography. This method allowed acquisition of three-dimensional pictures of such highly porous materials. Through mathematical treatment of the images, extremely useful physical characteristics such as porosity, fraction of open cells, connectivity, tortuosity, and pore-size distribution were determined as a function of the foam's density. The obtained information was compared with independent data derived from pycnometry measurements and scanning electron microscope image analysis. The agreement was shown to be acceptable in the limit of the accuracy of the laboratory microtomograph (4 microm). Moreover, recalculating properties like permeability were shown to be quite possible based on the results of standard microtomography data.

The cardiovascular profile of soccer referees: an echocardiographic study

Background

During a soccer game, the cardiovascular system is severely taxed The referees must be alert and their level of fitness must be such that fatigue will not impair their decision-making. Referee's peak overall performance is usually after 40 when the performance starts to decline. We evaluated the morphological and functional cardiac profile of professional soccer referees.

Materials and methods

We submitted to a clinical and echocardiographic exam a group of 120 professional soccer referees aged 25 – 45 years, including the first division of the Italian Championship, matched with 120 soccer players, including élite soccer players. Data were compared using an unpaired Student's t test. Statistical significance was with p < 0.05.

Results

Right ventricle dimensions (22.2 ± 3.8 vs 25.9 ± 2.4 mm) and Left Ventricular Mass Index (LVMi) (100.5 ± 45.2 vs 105.4 ± 17.3) were significantly greater in referees than in active soccer players. Left atrium dimensions (33.7 ± 8.9 vs 36.2 ± 3.1 mm), aortic root (29.7 ± 7.9 vs 32.1 ± 3 mm) and LVMi (115.1 ± 16.7 vs 134.1 ± 19.9 g/m²) were significantly greater in élite soccer players than in first-division referees.

Conclusion

Our investigation shows that right ventricle is greater in referees than in soccer players. The differences (left atrium, aortic root and LVMi) between first division referees and élite soccer players may derive from the different training workloads.