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Dittmar JM, Mitchell PD, Cessford C, Inskip SA, Robb JE. Fancy shoes and painful feet: Hallux valgus and fracture risk in medieval Cambridge, England. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 35:90-100. [PMID: 34120868 PMCID: PMC8631459 DOI: 10.1016/j.ijpp.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Hallux valgus, the lateral deviation of the great toe, can result in poor balance, impaired mobility and is an independent risk factor for falls. This research aims to compare the prevalence of hallux valgus in subpopulations of medieval Cambridge, England, and to examine the relationship between hallux valgus and fractures to examine the impact of impaired mobility and poor balance caused by this condition. MATERIALS 177 adult individuals from four cemeteries located in Cambridge, England. METHODS Human remains were macroscopically and radiographically assessed. RESULTS Hallux valgus was identified in 18 % of individuals and was significantly more common during the 14th-15th centuries than the 11th-13th centuries. The highest prevalence was observed in the friary (43 %), followed by the Hospital (23 %), the rurban parish cemetery (10 %), and the rural parish cemetery (3%). Fractures from falls were significantly more common in those with hallux valgus than those without. CONCLUSION The increased prevalence of hallux valgus identified in individuals from the 14th to 15th centuries coincided with the adoption of new footwear with pointed toes. Those that adopted this fashion trend appear to have been more likely to develop balance and mobility problems that resulted in an increased risk of falls. SIGNIFICANCE This is the first study to explore the relationship between foot problems and functional ability by studying hallux valgus in archaeological assemblages. LIMITATIONS Falls are complex and determining the mechanism of injury in human skeletal remains is not always possible. FURTHER RESEARCH Fracture prevalence rates may have been affected by biological factors and underlying pathological conditions.
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Affiliation(s)
- Jenna M Dittmar
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; Department of Archaeology, University of Aberdeen, Aberdeen, UK.
| | - Piers D Mitchell
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Craig Cessford
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; Cambridge Archaeological Unit, Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Sarah A Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; School of Archaeology and Ancient History, University of Leicester, Leicester, UK
| | - John E Robb
- Department of Archaeology, University of Cambridge, Cambridge, UK
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Betsinger TK, DeWitte SN. Toward a bioarchaeology of urbanization: Demography, health, and behavior in cities in the past. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175 Suppl 72:79-118. [PMID: 33619721 DOI: 10.1002/ajpa.24249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/11/2022]
Abstract
Urbanization is one of the most important settlement shifts in human history and has been the focus of research within bioarchaeology for decades. However, there have been limited attempts to synthesize the results of these studies in order to gain a broader perspective on whether or how urbanization affects the biology, demography, and behavior of humans, and how these potential effects are embodied in the human skeleton. This paper outlines how bioarchaeology is well-suited to examine urbanization in the past, and we provide an overview and examples of three main ways in which urbanization is studied in bioarchaeological research: comparison of (often contemporaneous) urban and rural sites, synchronic studies of the variation that exists within and between urban sites, and investigations of changes that occur within urban sites over time. Studies of urbanization, both within bioarchaeology and in other fields of study, face a number of limitations, including a lack of a consensus regarding what urban and urbanization mean, the assumed dichotomous nature of urban versus rural settlements, the supposition that urbanization is universally bad for people, and the assumption (at least in practice) of homogeneity within urban and rural populations. Bioarchaeologists can address these limitations by utilizing a wide array of data and methods, and the studies described here collectively demonstrate the complex, nuanced, and highly variable effects of urbanization.
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Affiliation(s)
| | - Sharon N DeWitte
- Department of Anthropology, University of South Carolina, Columbia, South Carolina, USA
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Dittmar JM, Mitchell PD, Cessford C, Inskip SA, Robb JE. Medieval injuries: Skeletal trauma as an indicator of past living conditions and hazard risk in Cambridge, England. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:626-645. [PMID: 33496027 PMCID: PMC8629122 DOI: 10.1002/ajpa.24225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022]
Abstract
Objective To explore how medieval living conditions, occupation, and an individual's role within society impacted their risk of skeletal trauma. Materials The skeletal remains of 314 individuals from medieval Cambridge that were buried in the parish cemetery of All Saints by the Castle (n = 84), the Augustinian friary (n = 75), and the cemetery of the Hospital of St John the Evangelist (n = 155) were analyzed. Methods Macroscopic examination and plain radiographs were used to classify fracture type. The causative mechanisms and forces applied to a bone were inferred based on fracture morphology. Results The skeletal trauma observed represents accidental injuries, likely sustained through occupational or everyday activities, and violence. The highest prevalence rate was observed on the individuals buried at All Saints by the Castle (44%, n = 37/84), and the lowest was seen at the Hospital of St John (27%, n = 42/155). Fractures were more prevalent in males (40%, n = 57/143) than females (26%, n = 25/95). Conclusions Skeletal trauma was highest in All Saints parish burial ground, indicating that the poor, whether working urban or rurally, had the highest risk of injury. The pattern and types of fractures observed suggests that males experienced more severe traumatic events than females. However, females that were routinely involved in manual labor were also at increased risk of injury. Significance This article enhances our understanding of how traumatic injuries differed by age, sex, and burial locations in the medieval period. Further research Additional comparative studies in different geographical regions are needed to determine how representative these findings are.
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Affiliation(s)
- Jenna M Dittmar
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK
| | - Piers D Mitchell
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Craig Cessford
- Department of Archaeology, University of Cambridge, Cambridge, UK.,Cambridge Archaeological Unit, Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Sarah A Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK
| | - John E Robb
- Department of Archaeology, University of Cambridge, Cambridge, UK
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Tucker K, Berezina N, Reinhold S, Kalmykov A, Belinskiy A, Gresky J. An accident at work? Traumatic lesions in the skeleton of a 4th millennium BCE "wagon driver" from Sharakhalsun, Russia. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:256-273. [PMID: 28615110 DOI: 10.1016/j.jchb.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
The study of ante-mortem trauma is a popular and important aspect of palaeopathological analysis. The majority of publications focus on a particular assemblage, skeletal element or type of fracture, with case studies of single individuals with multiple/unusual traumata being much rarer in the literature. This paper presents the case of an adult male from the Bronze Age site of Sharakhalsun, Russia, buried, uniquely, in a sitting position on a fully assembled wagon, who displayed evidence for multiple healed ante-mortem fractures of the cranium, axial and appendicular skeleton. The mechanisms and likely etiologies of the fractures are presented, with reference to modern and 19th century clinical literature, and possible interpretations suggested: that the individual was involved in a severe accident involving a wagon or draft animals, or both, a number of years before his death. The suggestion is also made that the unique burial position of the individual was a form of commemoration by the community of the survival and recovery of the individual from such a serious incident.
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Affiliation(s)
- K Tucker
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany.
| | - N Berezina
- Research Institute and Museum of Anthropology, Moscow State University, 123001 Moscow, Russia
| | - S Reinhold
- Eurasia Department, German Archaeological Institute, 14195 Berlin, Germany
| | | | | | - J Gresky
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany
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Rowbotham SK, Blau S. Skeletal fractures resulting from fatal falls: A review of the literature. Forensic Sci Int 2016; 266:582.e1-582.e15. [PMID: 27264682 DOI: 10.1016/j.forsciint.2016.04.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 02/11/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
To investigate what is currently known about skeletal blunt force trauma (BFT) resulting from falls, and how valuable that research is in contributing to forensic anthropology investigations and interpretations of circumstances of death, a comprehensive review of forensic anthropology, forensic pathology and clinical medicine literature was performed. Forensic anthropology literature identified that establishing the type of fall from the analysis of BFT is difficult given the uniqueness of each fall event, the complexities involved with identify BFT and, in particular, the limited available research documenting fracture patterning and morphologies. Comparatively, skeletal BFT resulting from fatal falls is well documented in the forensic pathology and clinical medicine literature. These disciplines cover a wide range of fall types (free falls, falls in juveniles, specific fractures produced from falls, falls down staircases, falls resulting in impalements, and 'other' fall types), provide details on how the nature of the fall influences the skeletal fracturing, and documents the anatomical regions susceptible to fracturing. Whilst these contributions may assist forensic anthropologists, they provide limited details of fracture patterns and morphologies and thus further research investigating the details of skeletal BFT resulting from fatal falls is required.
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Affiliation(s)
| | - Soren Blau
- Victorian Institute of Forensic Medicine/Department of Forensic Medicine, Monash University, Australia
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Kim DK, Kim MJ, Kim YS, Oh CS, Lee SS, Lim SB, Ki HC, Shin DH. Long bone fractures identified in the Joseon Dynasty human skeletons of Korea. Anat Cell Biol 2013; 46:203-9. [PMID: 24179696 PMCID: PMC3811853 DOI: 10.5115/acb.2013.46.3.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/20/2013] [Accepted: 05/02/2013] [Indexed: 11/28/2022] Open
Abstract
Fracture is one of the pathological signs most frequently encountered in archaeologically obtained bones. To expand the paleopathological knowledge on traumatic injuries, it is desirable to secure data on long bone fractures from as wide a geographic and temporal range as possible. We present, for the first time, evidence of long bone fractures in a 16th-18th century Joseon skeletal series (n=96). In this study, we found 3 Colles' fractures of the radius in 2 individual cases. The pattern of fractures was unique. Although previous reports show that the ulna is broken more often than the radius, ulnar fracture associated with fending off a blunt attack was rare in our series (1/7 cases). Transverse fractures, typically caused by intentional violence, were also very rare (1/7 cases) in this study. These results may reflect the relatively tranquil lives of the Joseon people in 16th-18th century Korea. We also found post-fracture complications such as deformations, bone length shortening, and osteomyelitis. The present study would be of interest to medical scientists in related fields because it is one of the few studies conducted on long bone fractures among pre-modern societies in East Asian countries, thus far.
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Affiliation(s)
- Deog Kyeom Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
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Gasperetti MA, Sheridan SG. Cry Havoc: Interpersonal Violence at Early Bronze Age Bab edh-Dhra’. AMERICAN ANTHROPOLOGIST 2013. [DOI: 10.1111/aman.12024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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CURATE FRANCISCO, ASSIS SANDRA, LOPES CÉLIA, SILVA ANAMARIA. Hip fractures in the Portuguese archaeological record. ANTHROPOL SCI 2011. [DOI: 10.1537/ase.100211] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- FRANCISCO CURATE
- Research Centre for Anthropology and Health, University of Coimbra, Coimbra
| | - SANDRA ASSIS
- Research Centre for Anthropology and Health, University of Coimbra, Coimbra
| | - CÉLIA LOPES
- Research Centre for Anthropology and Health, University of Coimbra, Coimbra
| | - ANA MARIA SILVA
- Research Centre for Anthropology and Health, University of Coimbra, Coimbra
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Scott RM, Buckley HR. Biocultural interpretations of trauma in two prehistoric Pacific Island populations from Papua New Guinea and the Solomon Islands. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2010; 142:509-18. [DOI: 10.1002/ajpa.21250] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Robbins G, Tripathy VM, Misra VN, Mohanty RK, Shinde VS, Gray KM, Schug MD. Ancient skeletal evidence for leprosy in India (2000 B.C.). PLoS One 2009; 4:e5669. [PMID: 19479078 PMCID: PMC2682583 DOI: 10.1371/journal.pone.0005669] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 04/25/2009] [Indexed: 11/27/2022] Open
Abstract
Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects almost 250,000 people worldwide. The timing of first infection, geographic origin, and pattern of transmission of the disease are still under investigation. Comparative genomics research has suggested M. leprae evolved either in East Africa or South Asia during the Late Pleistocene before spreading to Europe and the rest of the World. The earliest widely accepted evidence for leprosy is in Asian texts dated to 600 B.C. Methodology/Principal Findings We report an analysis of pathological conditions in skeletal remains from the second millennium B.C. in India. A middle aged adult male skeleton demonstrates pathological changes in the rhinomaxillary region, degenerative joint disease, infectious involvement of the tibia (periostitis), and injury to the peripheral skeleton. The presence and patterning of lesions was subject to a process of differential diagnosis for leprosy including treponemal disease, leishmaniasis, tuberculosis, osteomyelitis, and non-specific infection. Conclusions/Significance Results indicate that lepromatous leprosy was present in India by 2000 B.C. This evidence represents the oldest documented skeletal evidence for the disease. Our results indicate that Vedic burial traditions in cases of leprosy were present in northwest India prior to the first millennium B.C. Our results also support translations of early Vedic scriptures as the first textual reference to leprosy. The presence of leprosy in skeletal material dated to the post-urban phase of the Indus Age suggests that if M. leprae evolved in Africa, the disease migrated to India before the Late Holocene, possibly during the third millennium B.C. at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt. This evidence should be impetus to look for additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of the disease.
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Affiliation(s)
- Gwen Robbins
- Department of Anthropology, Appalachian State University, Boone, North Carolina, United States of America.
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Steadman DW, Adams BJ, Konigsberg LW. Statistical basis for positive identification in forensic anthropology. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2006; 131:15-26. [PMID: 16485302 DOI: 10.1002/ajpa.20393] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Forensic scientists are often expected to present the likelihood of DNA identifications in US courts based on comparative population data, yet forensic anthropologists tend not to quantify the strength of an osteological identification. Because forensic anthropologists are trained first and foremost as physical anthropologists, they emphasize estimation problems at the expense of evidentiary problems, but this approach must be reexamined. In this paper, the statistical bases for presenting osteological and dental evidence are outlined, using a forensic case as a motivating example. A brief overview of Bayesian statistics is provided, and methods to calculate likelihood ratios for five aspects of the biological profile are demonstrated. This paper emphasizes the definition of appropriate reference samples and of the "population at large," and points out the conceptual differences between them. Several databases are introduced for both reference information and to characterize the "population at large," and new data are compiled to calculate the frequency of specific characters, such as age or fractures, within the "population at large." Despite small individual likelihood ratios for age, sex, and stature in the case example, the power of this approach is that, assuming each likelihood ratio is independent, the product rule can be applied. In this particular example, it is over three million times more likely to obtain the observed osteological and dental data if the identification is correct than if the identification is incorrect. This likelihood ratio is a convincing statistic that can support the forensic anthropologist's opinion on personal identity in court.
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Affiliation(s)
- Dawnie Wolfe Steadman
- Department of Anthropology, Binghamton University, SUNY, Binghamton, New York 13902, USA.
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Djurić MP, Roberts CA, Rakocević ZB, Djonić DD, Lesić AR. Fractures in late medieval skeletal populations from Serbia. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2006; 130:167-78. [PMID: 16365855 DOI: 10.1002/ajpa.20270] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Bone fractures were analyzed from skeletal remains of 861 adult individuals from six cemeteries dating to the Late Medieval period in Serbia. Results of the study were compared to other cemetery populations (635 individual skeletons) of the same date and region in an attempt to understand fracture patterns. The association of types of fractures and their prevalence with sex, age at death, cemetery site, and information deriving from historical sources are discussed. Results showed that the long bone fracture frequency was 0.7%, and the majority of the fractures were the result of direct force. This rate is similar to some studies of contemporary British skeletal samples. However, it is much lower than for some other Old World sites. Cranial vault fractures had a rate of 6.7%, and of the facial skeleton, 1.3%; the frontal bone was the most affected of bones of the cranial vault. Injuries were more common on the upper extremities (0.8%) compared to the lower (0.6%). However, the fibula was the most fractured bone (2.8%), followed by the ulna (2.4%). This pattern is similar to three of six Late Medieval urban sites in Britain. These findings suggest that this rural community was exposed to a low risk of trauma, probably related mostly to accidents sustained during farming, and rarely to interpersonal violence.
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Affiliation(s)
- Marija P Djurić
- Laboratory of Anthropology, Department of Anatomy, Medical Faculty, University of Belgrade,11000 Belgrade, Serbia.
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Mays SA. Age-related cortical bone loss in women from a 3rd–4th century AD population from England. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2006; 129:518-28. [PMID: 16342260 DOI: 10.1002/ajpa.20365] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Age-dependent cortical bone loss in adult females from a skeletal assemblage from 3rd-4th century AD England was studied using metacarpal radiogrammetry. Results showed reduced peak cortical bone thickness compared with modern subjects, and the magnitude of cortical bone loss in older females compared with their younger counterparts was greater than that documented for a modern reference population. An elevated prevalence of fractures classically associated with osteoporosis was also observed in the over-50-year cohort. The severity of osteoporosis in this group is difficult to explain in terms of extraneous factors relating to 3rd-4th century lifestyles. Given the important genetic component in osteoporosis, the results may indicate some inherent susceptibility in this particular population to the disease, and ways in which this possibility might be further explored are suggested.
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Affiliation(s)
- S A Mays
- Ancient Monuments Laboratory, English Heritage Centre for Archaeology, Eastney, Portsmouth PO4 9LD, UK.
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Richardson J. Optimizing Gait in Peripheral Neuropathy. NEUROLOGICAL DISEASE AND THERAPY 2005. [DOI: 10.1201/b14109-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Richardson JK, Thies SB, DeMott TK, Ashton-Miller JA. Interventions improve gait regularity in patients with peripheral neuropathy while walking on an irregular surface under low light. J Am Geriatr Soc 2004; 52:510-5. [PMID: 15066064 DOI: 10.1111/j.1532-5415.2004.52155.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine which, if any, of three inexpensive interventions improve gait regularity in patients with peripheral neuropathy (PN) while walking on an irregular surface under low-light conditions. DESIGN Observational. SETTING University of Michigan Biomechanics Research Laboratory. PARTICIPANTS Forty-two patients with PN (20 women), mean age+/-standard deviation=64.5+/-9.7. INTERVENTIONS A straight cane, touch of a vertical surface, or semirigid ankle orthoses. MEASUREMENTS Step-width variability and range, step-time variability, and speed. RESULTS Subjects demonstrated significantly less step-width variability (mean=41.0+/-1.5, 36.9+/-1.6, 37.2+/-1.3, and 35.9+/-1.5 mm for baseline, cane, orthoses, and vertical surface, respectively; P<.0001) and range (182.7+/-7.4, 163.7+/-8.3, 164.3+/-7.4, 154.3+/-6.9 mm for baseline, cane, orthoses and vertical surface, respectively; P=.0006) with each of the interventions than under baseline conditions. Step-time variability significantly decreased with use of the orthoses and vertical surface but not the cane (P=.0001). Use of a cane, but not orthoses or vertical surface, was associated with decreased speed (0.79+/-0.03, 0.73+/-0.03, 0.79+/-0.03, 0.80+/-0.03 m/s for baseline, cane, orthoses, and vertical surface, respectively; P=.0001). CONCLUSION Older patients with PN demonstrate improved spatial and temporal measures of gait regularity with the use of a cane, ankle orthoses, or touch of a vertical surface while walking under challenging conditions. The decreased speed and stigma associated with the cane and uncertain availability of a vertical surface suggest that the ankle orthoses may be the most practical intervention.
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Affiliation(s)
- James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Ittrich H, Kleibscheidel C, Nizze H. [Paleopathological skeleton findings. Macroscopical and radiographical studies of 364 individuals from a medieval graveyard]. DER PATHOLOGE 2004; 25:147-54. [PMID: 15011001 DOI: 10.1007/s00292-004-0683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Paleopathological examinations can give an idea of diseases and living conditions in ancient populations. An archaeological collection of 364 late medieval/early modern skeletons from the thirteenth to eighteenth centuries, excavated from a church cemetery in the Rostock town center, was examined palaeopathologically. The type and frequency of certain diseases within this north German urban population are described. The majority of the skeletons were from adults with a remarkably low percentage of children. Skeletal malformations (e.g. gap formations of the spinal column) were not abnormally represented. With the exception of single individuals, metabolic disorders or unusual infectious diseases could not be diagnosed. Degenerative diseases often found at the joints and the spinal column showed substantially lower prevalences in comparison with reference rural populations. Individual cases of benign and rare malignant neoplasms could be documented. Traumatic injuries as well as dental pathological changes were rare. In summary it can be concluded that the individuals buried here belonged to a better social class within the medieval population of Rostock.
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Affiliation(s)
- H Ittrich
- Institut für Pathologie, Universität Rostock, Rostock, Germany.
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Abstract
OBJECTIVES To identify clinical factors associated with falls by older persons with polyneuropathy (PN). DESIGN A cross-sectional study of 82 subjects aged 50 to 85 with clinical and electrodiagnostic evidence of PN. SETTING Electrodiagnostic and biomechanical research laboratories. PARTICIPANTS Patients referred to the electrodiagnostic laboratory. MEASUREMENTS History and physical examination, including semiquantitative methods of peripheral nerve function, and clinical balance testing. Falls were defined by retrospective self-report over a 2-year period. RESULTS Forty (48.8%), 28 (34.1%), and 18 (22.0%) subjects reported a history of at least one fall, multiple falls, and injurious falls, respectively. Factors associated with single and multiple falls were similar, so only results for multiple and injurious falls are reported. Bivariate analysis showed that an increased body mass index (BMI) and more severe PN (as determined by the Michigan Diabetes Neuropathy Score) were associated with both fall categories. Men reporting falls also demonstrated a decreased unipedal stance time. Age, sex, nerve conduction study parameters, Romberg testing, medications, and comorbidities were not consistently associated with either fall category. Logistic regression demonstrated that multiple and injurious falls were associated with an increased BMI and more severe PN, controlling for age, sex, medications, and comorbidities (pseudo R2 = 0.458 and 0.484, respectively). CONCLUSIONS Although previous work has demonstrated that all older persons with PN are at increased risk for falls, patients with increased BMI and more severe PN are at particularly high risk and should be targeted for intervention.
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Affiliation(s)
- James K Richardson
- University of Michigan Medical Center, Department of Physical Medicine and Rehabilitation, Ann Arbor, Michigan 48109, USA.
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Rothschild BM, Rothschild C. Skeletal Manifestations of Leprosy: Analysis of 137 Patients from Different Clinical Settings in the Pre- and Postmodern Treatment Eras. J Clin Rheumatol 2001; 7:228-37. [PMID: 17039140 DOI: 10.1097/00124743-200108000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study was conducted to further characterize the nature of leprosy-related bone alterations, to develop a hypothesis of their pathophysiology, and to define the impact of treatment on bone damage. Radiographs of 60 patients under care at the Carville, Louisiana leprosy hospital were compared with 50 from the early (before availability of effective treatment) part of this century and with 27 from the Toronto (Ontario, Canada) leprosy clinic. Two-thirds of lesions were so severe that distal digital tufts had been lost to whittling, resorption, or fragmentation. Fifty percent were felt to be pathognomonic for the changes of leprosy. Resorption, fragmentation, and malaligned fractures are highly suggestive of leprosy, while diaphyseal whittling appears specific when medullary sclerosis or wavy diaphyseal borders are present. Medicinal intervention appeared to be of limited benefit for bone damage; perhaps greater attention to joint/bone protection (as recommended in diabetes management) will prove helpful. Environmental adjustment to minimize injury risk and daily limb examination for injury are recommended.
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Affiliation(s)
- B M Rothschild
- Department of Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, OH 44512, USA.
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Affiliation(s)
- A M Klioze
- Department of Medicine and Division of Dermatology, University of Florida College of Medicine, Gainesville, FL , USA
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