Effect of facial burns on the nasal mucosa

In this study the nasal mucosa of patients who had recently sustained facial burns was examined endoscopically. The saccharin clearance test was performed as a measure of nasal mucociliary transport. All the patients had singed nasal hairs, but none had inflammatory changes extending beyond the nasal valve. In only one patient was the saccharin clearance prolonged beyond 20 min, and only one patient developed nasal obstruction postburn. This study shows that the nasal mucosa is resistant to damage when the face is burned, suggesting the nose is an efficient heat exchanger, and the nasal mucosa should preserve its capacity to absorb drugs.

The diagnosis of flat foot in the child

The term flat foot is surrounded by confusion and there is little to help the clinician to identify cases which require treatment and to avoid treating many children unnecessarily. Research for 25 years has been aimed at elucidating this problem by identifying and evaluating a series of signs and tests. These tests allow the recognition of the abnormal foot as early as possible, when efficient treatment is likely to be most effective. The results indicate that evaluation of the flat foot should be based on a combination of signs, with most emphasis on the result of the great toe extension test.

Clinical gait assessment: a personal view

Some problems of the establishment and management of a clinical gait assessment laboratory are explored. It is suggested that the term 'gait analysis' should be restricted to data gathering and that the term 'gait assessment' be used for the integration of this information with that from other sources for the purpose of clinical decision-making. Particular problems derive from the fact that gait analysis measures the effects of combined causes and compensatory activities of the body. The identification of causes requires, therefore, an initial theory which has to be tested by some interference with the system and this repeated as this proves necessary. This may be facilitated by a computer-aided decision program. The overall implications are that the whole body needs to be studied by a wide range of devices in a situation where the contribution of the clinician in regard to time more nearly matches that of the bioengineer than is customary.

A clinical review of the orthotic treatment of myelomeningocele patients

High myelomeningocele lesions do not preclude an acceptable level of functional walking provided that an integrated programme of surgical treatment and bracing is adopted. Clinical analysis of 100 patients with myelomeningocele shows that the development of the "swivel walker" and "hip guidance orthosis" has been associated with an improved level of function. Over 30 per cent of patients with thoracic lesions and 68 per cent of those with lumbar lesions achieved independent walking. For this reason the criteria used at present by paediatricians to govern the selection of infants for non-active treatment may require reconsideration.

The dynamics of walking using the hip guidance orthosis (hgo) with crutches

The variation of ground reaction forces with time for a complete hgo gait cycle using crutches has been synthesized from video recordings and force platform data. This has led to an understanding of the dynamics of hgo ambulation. The results show that when a patient used the orthosis the crutches provide a subtle control mechanism taking maximum advantage of forward momentum and produce small propulsive forces when needed to make up energy losses.

Clinical evaluation of spina bifida patients using hip guidance orthosis

A hip guidance orthosis has been designed to provide the highest potential level of ambulation for the child with myelomeningocele. It permits low energy-cost ambulation at a reasonable speed, and independent transfer from chair to walking and vice versa. It also enables some patients to ascend or descend steps of up to 150mm, as well as gradients of up to one in 10. A review of 27 patients who had used the orthosis for periods of between six and 45 months was undertaken in order to establish the degree of benefit. 17 patients had no power in hips or below, the rest having some power in one or both hips. 17 patients had dorsal lesions and the remainder had lumbar lesions. Using Hoffer's (1973) classification, 13 patients had improved ambulation when using the hip guidance orthosis, and most of the remainder showed some measurable improvement in ambulation. 14 patients were tested for speed of ambulation and heart rate before and after use of the orthosis, and the mean increase in speed was 87.3 per cent, with a mean decrease in heart rate of 10bpm--a clear improvement in efficiency. The results indicate that the hip guidance orthosis can provide low-energy ambulation for spina bifida patients with dorsal and high lumbar lesions in a form acceptable both to patients and parents.

A comparison of efficiency of three types of crutches using oxygen consumption

Because the axillary crutch can cause axillary artery thrombosis and crutch palsy, the elbow crutch is more frequently used. Canadian crutches combine features of both the axilla and elbow crutches. A previous study examined any advantages in terms of energy cost using heart rate. The present study re-evaluates the energy cost by using the measurement of oxygen consumption. The study further suggests that the Canadian crutches have advantages in terms of energy cost.

Clinical decision making with the aid of ambulatory monitoring of heart rate

Routine assessment of heavily handicapped patients by means of speed and heart rate has been carried out in ORLAU over the past four years. The methodology and the apparatus have been described by Davies (1977) and Stallard et al (1978), who also indicated its value in terms of research. Gradually the technique has been assimilated as a routine clinical assessment procedure, and a number of cases in which it has positively influenced treatment are described in order to illustrate its benefits. The simplicity of the methodology and portable nature of the equipment enable physiotherapists to carry out many assessments in schools, greatly minimising disruption for the patient and maximising the effectiveness of the procedure. Analysis of the types of assessment which had been conducted showed that they could be divided into six categories: Learning time for a new orthosis; Relative value of a new orthosis; The need for operative procedures; The value of operative procedures; Indication of areas requiring further investigation; Confirmation of clinical opinion. When used in conjunction with the other assessment techniques available in ORLAU, monitoring speed and heart rate become a powerful tool for routine evaluation of patients.

One leg swing through gait using two crutches. An analysis of the ground reaction forces and gait phases

Using a Force Plate the gait cycle for one leg swing-through gait of ten normal subjects on Canadian crutches was monitored, and a composite diagram of forces on the lower limb and both crutches was produced. In addition the relationship of the stance and swing phase for both the lower limb and crutches was studied and the percentage of these phases and their overlap included on the composite diagram. The average maximum vertical ground reaction to the leg was 1.32 body weight, 16 per cent higher than that reported for normal walking. The horizontal force on the lower limb in the direction of walking was 0.35 body weight, compared to 0.15 for normal walking. Vertical ground reaction to crutches was on average 0.54 body weight on the side of the landing leg and 0.51 on the contralateral side. Horizontal ground reaction on the crutches at right angles to the direction of ambulation was 0.09 body weight on the right and 0.08 on the left. The results were considered to indicate caution in the prescription of one leg swing-through gait in subjects with diseased bone and joints in the lower limb.

A comparison of axillary, elbow and Canadian crutches

Crutches can be used by patients with injuries to the lower extremities in order to perform 'swing-through' gait. Because axillary crutches have been associated with axillary artery thrombosis and crutch palsy, they have to a large extent been superseded by elbow crutches. Canadian crutches combine many of the features of axillary and elbow crutches, and a study of the three types suggests that they have advantages in terms of energy cost.

The Orlau swivel walker

A new design of swivel walker for the severely disabled is described which has advantages over previous types. Increased rigidity improves the confidence of apprehensive patients, greater strength gives better reliability for those with good ambulation function and a novel construction gives more opportunity for independent transfer into and out of the orthosis, besides easing the burden of those caring for users of swivel walkers.

Assessment of orthoses by means of speed and heart rate

Energy expenditure is an important parameter in the assessment of gait and orthotic treatment of heavily handicapped patients, since any orthosis which increases the effort required is likely to be discarded with consequently disturbing implications. Heart rate has been shown to be a reliable monitor of energy expenditure and is convenient because ECG can be telemetered by a miniature radio transmitter. Using a transmitter causes minimal interference with the patient, but care must be employed to obtain ECG signals free of artefact from subjects who are exercising. Means of reducing artefact are discussed, as are ways in which heart rate monitoring by radio telemetry is being used in the routine assessment of orthotic treatment of paediatric patients and the development of new orthotic devices.

Restraint in the treatment of a bowed tibia associated with neurofibromatosis

A 20-year follow-up in no way suggests that an active programme of treatment could have improved this patient's function and clearly it could have resulted in much worse cosmesis.

A twenty-one-year review of a case of congenital indifference to pain

A boy aged three with indifference to pain was followed up until his death from amyloid disease some twenty-one years later. A full necropsy was done and the neuropathology suggested a sensory neuropathy.

A TWENTY-ONE-YEAR REVIEW OF A CASE OF CONGENITAL INDIFFERENCE TO PAIN

A boy aged three with indifference to pain was followed up until his death from amyloid disease some twenty-one years later. A full necropsy was done and the neuropathology suggested a sensory neuropathy.