The role of knee immobilizers in cancer patients with femoral neuropathy

Opportunities for rehabilitation of patients with radiation fibrosis syndrome

This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders that can result as late effects of radiation treatment. Although radiation therapy is often an effective method of killing cancer cells, it can also damage nearby blood vessels that nourish the skin, ligaments, tendons, muscles, nerves, bones and lungs. This can result in a progressive condition called radiation fibrosis syndrome (RFS). It is generally a late complication of radiotherapy which may manifest clinically years after treatment. Radiation-induced damage can include "myelo-radiculo-plexo-neuro-myopathy," causing muscle weakness and dysfunction and contributing to neuromuscular injury. RFS is a serious and lifelong disorder which, nevertheless, may often be decremented when identified and rehabilitated early enough. This medical treatment should be a complex procedure consisting of education, physical therapy, occupational therapy, orthotics as well as medications.

Reducing costly falls of total knee replacement patients

The objective of this study was to determine whether the use of a knee immobilizer brace reduces patient falls associated with the recent use of femoral nerve blocks for pain control after total knee arthroplasty (TKA). The authors conducted a retrospective study to investigate fall rates before and after the introduction of an immobilizer brace. The demographics of patients and total cost of care were examined. Of the 600 TKA patients who did not receive a knee immobilizer, 22 (3.7%) experienced a fall. In contrast, of the 502 patients who received knee immobilizers, only 8 patients (1.6%) fell. This difference achieves statistical significance (P = .04). Given the considerable costs associated with hospital falls and the significant reduction of these falls related to knee immobilizer use shown in this study, the authors recommend that knee immobilizers be given to TKA patients as standard practice.

Using induced accelerations to understand knee stability during gait of individuals with muscle weakness

The purpose of this case series was to quantify the effectiveness of different compensatory strategies used by individuals with muscle weakness to produce knee extension during the stance phase gait. Subjects were three males with less than anti-gravity strength in the quadriceps femoris and a variable pattern of weakness elsewhere in the lower extremity. They walked independently at a self-selected speed without assistive devices. Gait analysis of the pelvis and bilateral lower extremity segments was performed with a six-camera, two force platform motion capture system. Joint angles and net internal moments were computed from the motion data. Induced acceleration analysis was performed to quantify the relative ability of each lower extremity joint moment and gravity to produce knee angular acceleration. Results showed that a variety of adaptive strategies both within and across limbs can control knee position during gait. One subject generated knee extension almost exclusively via the hip extensor moment. Another relied less on the hip extensor moment (39%) and more on the ankle plantar flexor moment (61%) to create knee extension. The third subject used the ipsilateral hip extensor moment (24%) and the contralateral ankle plantar flexor moment (67%) to assist knee extension. The strategy selected by each subject likely was influenced by both their total pattern of impairments and the effectiveness of the available compensations. This case series demonstrates how an induced acceleration analysis can augment a traditional gait analysis to expand and enhance our understanding of compensatory movement control strategies.