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Sinitski E, Baddour N, Gholizadeh H, Besemann M, Dudek N, Lemaire E. Cross slope gait biomechanics for individuals with and without a unilateral transtibial amputation. Clin Biomech (Bristol, Avon) 2022; 98:105734. [PMID: 35964385 DOI: 10.1016/j.clinbiomech.2022.105734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This research was conducted to better understand compensatory strategies during cross-slope walking for adults with and without a unilateral transtibial amputation. METHODS Fourteen individuals with unilateral transtibial amputation and 14 individuals with no lower limb amputation participated in this study. Motion and force data were captured while participants walked on a treadmill in a virtual reality environment for level and ± 5° cross slopes. Temporal-spatial parameters, kinematics (ankle, knee, hip, pelvis, trunk), and ground reaction forces were examined. FINDINGS Compared to level, participants had similar step width but slightly longer steps for top-cross-slope and slightly shorter steps for bottom-cross-slope. Top-cross-slope required a more flexed limb with ankle eversion, and bottom-cross-slope required a more extended limb with ankle inversion. Participants had similar lateral pelvis and trunk motion for all walking conditions, but slightly more anterior trunk lean for top cross-slope with more anterior trunk lean observed for individuals with a lower limb amputation than without lower limb amputation. Participants with a lower limb amputation compensated for limited prosthetic ankle-foot dorsiflexion on the top-cross-slope by increasing prosthetic side hip flexion, reducing intact ankle/knee flexion, and increasing intact push-off force. INTERPRETATION Gait adaptations during cross-slope walking were primarily in the lower extremities and were largely similar for those with and without a transtibial amputation. The information presented in this paper provides a better understanding of gait strategies adopted during cross-slope walking and can guide researchers and industry in prosthetic development.
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Affiliation(s)
| | - Natalie Baddour
- Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - Hossein Gholizadeh
- Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada
| | | | - Nancy Dudek
- Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Canada
| | - Edward Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Canada
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D'Arcy RCN, Sandhu JK, Marshall S, Besemann M. Mitigating Long-Term COVID-19 Consequences on Brain Health. Front Neurol 2021; 12:630986. [PMID: 34646224 PMCID: PMC8502890 DOI: 10.3389/fneur.2021.630986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is increasingly being linked to brain health impacts. The emerging situation is consistent with evidence of immunological injury to the brain, which has been described as a resulting "brain fog." The situation need not be medicalized but rather clinically managed in terms of improving resilience for an over-stressed nervous system. Pre-existing comparisons include managing post-concussion syndromes and/or brain fog. The objective evaluation of changes in cognitive functioning will be an important clinical starting point, which is being accelerated through pandemic digital health innovations. Pre-morbid brain health can significantly optimize risk factors and existing clinical frameworks provide useful guidance in managing over-stressed COVID-19 nervous systems.
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Affiliation(s)
- Ryan C N D'Arcy
- Centre for Neurology Studies, HealthTech Connex, Vancouver, BC, Canada.,Faculty of Applied Sciences, Simon Fraser University, Vancouver, BC, Canada.,DM Centre for Brain Health (Radiology), University of British Columbia, Vancouver, BC, Canada
| | - Jagdeep K Sandhu
- Human Health Therapeutics Research Centre, National Research Council Canada, Ottawa, ON, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Shawn Marshall
- Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | - Markus Besemann
- Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada.,Rehabilitation Medicine, Canadian Forces Health Services, Ottawa, ON, Canada
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3
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Thompson JM, Heber A, Zacharias R, Besemann M, Gupta G, Hapidou E, Buckley N, Lamoureux D, Begley K. Out of the shadows: Chronic pain in Canadian Armed Forces veterans - Proceedings of a workshop at the 2019 Forum of the Canadian Institute for Military and Veteran Health Research. Can J Pain 2020; 4:199-204. [PMID: 33987498 PMCID: PMC7951166 DOI: 10.1080/24740527.2020.1796479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022]
Abstract
This commentary summarizes proceedings of a workshop on chronic pain in military personnel and veterans (released personnel) at the Annual Forum of the Canadian Institute for Military and Veteran Health Research in Gatineau and Ottawa on October 22, 2019. The extent and impact of chronic pain among Canadian Armed Forces (CAF) veterans and their families is significant and has been underappreciated, largely due to limited disclosure by serving and veteran military personnel, stemming from a fear of stigmatization. Living with pain is seen as a fact of life in military cultures, something to be endured and not discussed. Though progress is being made in reducing the stigma of mental illness, the discourse on chronic pain remains censored. This workshop's goal was to bring the discussion of chronic pain out of the shadows in the search for ways to help veterans and active service personnel living with chronic pain. Many points of view were brought forward at this first national Canadian multidisciplinary gathering of researchers, veterans with lived experience, clinicians, and policymakers. A CAF member described his lived experience with constant chronic pain. Clinicians described aspects of chronic pain in military personnel and veterans whom they treat in their clinics. Dr. Ramesh Zacharias described the new Chronic Pain Center of Excellence for Canadian Veterans that will be established with funding from Veterans Affairs Canada. Dr. Norman Buckley highlighted collaboration with the existing Chronic Pain Network funded by the Canadian Institute for Health Research. Audience members identified a diverse variety of issues.
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Affiliation(s)
- James M. Thompson
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
- Canadian Institute for Military and Veteran Health Research, Kingston, Ontario, Canada
| | - Alexandra Heber
- Veterans Affairs Canada, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramesh Zacharias
- Department of Anesthesia, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Pain Clinic, Hamilton, Ontario, Canada
| | - Markus Besemann
- Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Gaurav Gupta
- Allan Edwards Pain Management Unit, McGill University, Montreal, Ontario, Canada
| | - Eleni Hapidou
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Ontario, Canada
| | - Norm Buckley
- Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, Kingston, Ontario, Canada
| | | | - Kimberly Begley
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
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4
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Robinson-Freeman KE, Collins KL, Garber B, Terblanche R, Risling M, Vermetten E, Besemann M, Mistlin A, Tsao JW. A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI. Front Neurol 2020; 11:836. [PMID: 32982907 PMCID: PMC7477387 DOI: 10.3389/fneur.2020.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.
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Affiliation(s)
| | - Kassondra L Collins
- Department of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bryan Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Ronel Terblanche
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Marten Risling
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Eric Vermetten
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Markus Besemann
- Physical Medicine and Rehabilitation, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Alan Mistlin
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, Children's Foundation Research Institute, Memphis, TN, United States
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Minerbi A, Besemann M, Kari T, Gentile C, Gupta G. Comparing the Efficiency of Software-Based Speech Recognition Versus Traditional Telephone Transcription in an Outpatient Physical Medicine and Rehabilitation Practice. Mil Med 2020; 185:e1183-e1186. [PMID: 32627823 DOI: 10.1093/milmed/usz374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Speech recognition (SR) uses computerized word recognition software that automatically transcribes spoken words to written text. Some studies indicate that SR may improve efficiency of electronic charting as well as associated cost and turnaround time1,2, but it remains unclear in the literature whether SR is superior to traditional transcription (TT). This study compared the impact of report generation efficiency of SR to TT at the Canadian Armed Forces Health Services Centre. MATERIALS AND METHODS Dragon Medical Dictation™ SR software and traditional telephone dictation TT were used for two prespecified clinical days per week. In order to adjust for note length, total transcription efficacy was calculated as follows: word count/[dictation time + correction time]. The means and standard deviations were then separately calculated for TT visits and for SR visits. Differences in transcription efficacy and in visit measures, including patient demographics, visit duration, number of issues raised during the visit, and interventions performed, were compared using ANOVA, with the significance level set to 0.05. RESULTS A total of 340 consecutive visits were analyzed; 198 were dictated over the phone using TT and 142 were transcribed using SR software. Dictation efficacy was significantly higher (p < 0.0001) for TT as compared to SR, while turnaround times were shorter for SR (0.12 versus 4.75 days). CONCLUSIONS In light of these results, the Canadian Forces Health Services Centre in Ottawa has returned to use of TT because the relative inefficiency of report generation was deemed to have a greater impact on clinical care when compared to slower dictation turnaround time.
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Affiliation(s)
- Amir Minerbi
- Alan Edwards Pain Management Unit, Canada.,McGill University Health Centre, Canada
| | | | | | - Christina Gentile
- Alan Edwards Pain Management Unit, Canada.,McGill University Health Centre, Canada
| | - Gaurav Gupta
- Alan Edwards Pain Management Unit, Canada.,McGill University Health Centre, Canada.,Canadian Forces Health Services Centre, Ottawa, Canada
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Sinitski EH, Lemaire ED, Baddour N, Besemann M, Dudek N, Hebert JS. Maintaining stable transtibial amputee gait on level and simulated uneven conditions in a virtual environment. Disabil Rehabil Assist Technol 2019; 16:40-48. [DOI: 10.1080/17483107.2019.1629186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Emily H. Sinitski
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Department of Mechanical Engineering, Ottawa, Canada
| | - Edward D. Lemaire
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - Natalie Baddour
- University of Ottawa, Department of Mechanical Engineering, Ottawa, Canada
| | | | - Nancy Dudek
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - Jacqueline S. Hebert
- University of Alberta, Faculty of Medicine, Edmonton, Canada
- Glenrose Rehabilitation Hospital, Edmonton, Canada
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Besemann M, Hebert J, Thompson JM, Cooper RA, Gupta G, Brémault-Phillips S, Dentry SJ. Reflections on recovery, rehabilitation and reintegration of injured service members and veterans from a bio-psychosocial-spiritual
perspective. Can J Surg 2019; 61:S219-S231. [PMID: 30418009 DOI: 10.1503/cjs.015318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Medical interventions regarding trauma resuscitation have increased survivorship to levels not previously attained. Multiple examples from recent conflicts illustrate the potential return to high-level function of severely injured service members following medical and rehabilitative interventions. This review addresses the goals of rehabilitation, distills hard-won lessons of the last decade of military trauma and rehabilitation, and recommends the use of a bio-psychosocial-spiritual approach to care that can be applied at all tiers of the health care system. Questions on enabling participation in meaningful life activities include the following: Why do some patients do well and others do not? What elements contribute to positive outcomes? What factors relate to suboptimal results? Lessons learned revolve around the importance of considering the physical, psychosocial and spiritual aspects of a person’s well-being; empowering patients by fostering self-efficacy; and helping patients find meaning in life events and set high-level goals. A bio-psychosocial-spiritual model from the rehabilitation medicine literature — the Canadian Model of Occupational Performance and Engagement — is proposed as a guide to the provision of person-centred care and the maximization of a person’s functioning posttrauma.
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Affiliation(s)
- Markus Besemann
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
| | - Jacqueline Hebert
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
| | - James M. Thompson
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
| | - Rory A. Cooper
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
| | - Gaurav Gupta
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
| | - Suzette Brémault-Phillips
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
| | - Sarah J. Dentry
- From the Canadian Forces Health Services (Besemann); the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alta. (Hebert); Veterans Affairs Canada, Charlottetown, PEI (Thompson); the US Department of Veterans Affairs, University of Pittsburgh, and UPMC Health System (Cooper); McGill University, Montreal, Que. (Gupta); the Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta. (Brémault-Phillips); and the College of Medical Rehabilitation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Dentry)
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Sturk JA, Lemaire ED, Sinitski E, Dudek NL, Besemann M, Hebert JS, Baddour N. Gait differences between K3 and K4 persons with transfemoral amputation across level and non-level walking conditions. Prosthet Orthot Int 2018; 42:626-635. [PMID: 30044178 DOI: 10.1177/0309364618785724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: A transfemoral amputee's functional level can be classified from K-level 0 (lowest) to K-level 4 (highest). Knowledge of the biomechanical differences between K3 and K4 transfemoral amputation could help inform clinical professionals and researchers in amputee care and gait assessment. OBJECTIVES: Explore gait differences between K3- and K4-level transfemoral amputation across different surface conditions. STUDY DESIGN: Cross-sectional study. METHODS: Four K3 and six K4 transfemoral amputation and 10 matched able-bodied individuals walked in a virtual environment with simulated level and non-level surfaces on a self-paced treadmill. Stability measures included medial-lateral margin of stability, step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, root-mean-square of medial-lateral trunk acceleration). RESULTS: K3 walked slower than K4 with wider steps, greater root-mean-square of medial-lateral trunk acceleration, and greater medial-lateral margin of stability standard deviations, indicating their stability was further challenged. K3 participants had greater asymmetry in double support time and trunk acceleration root-mean-square in the medial-lateral direction, but similar asymmetry overall. K3 participants had larger differences from AB and in more parameters than K4, although K4 differed from AB in trunk acceleration root-mean-square in the medial-lateral direction, walking speed, and double support time standard deviations. CONCLUSION: The findings improve our understanding of K3 and K4 transfemoral amputation gait on slopes and simulated uneven surfaces. CLINICAL RELEVANCE High performing and community ambulatory transfemoral amputees cannot match the ambulatory abilities of ablebodied individuals. Understanding gait differences between these groups under conditions that challenge balance is required to develop rehabilitation protocols and prosthetic componentry targeted at improving transfemoral amputee gait and overall mobility in their chosen environment.
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Affiliation(s)
- James A Sturk
- 1 Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward D Lemaire
- 1 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,2 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emily Sinitski
- 1 Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nancy L Dudek
- 2 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Markus Besemann
- 3 Canadian Forces Health Services Centre Ottawa, Ottawa, ON, Canada
| | - Jacqueline S Hebert
- 4 University of Alberta, Edmonton, AB, Canada.,5 Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Natalie Baddour
- 6 Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
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Elgueta MF, Wang NN, Gupta G, Besemann M. Case Report: Unilateral Paresis of the Abdominal Wall with Associated Thoraco-Lumbar Pain. US Army Med Dep J 2018:74-75. [PMID: 30623402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Sturk JA, Lemaire ED, Sinitski EH, Dudek NL, Besemann M, Hebert JS, Baddour N. Maintaining stable transfemoral amputee gait on level, sloped and simulated uneven conditions in a virtual environment. Disabil Rehabil Assist Technol 2017; 14:226-235. [DOI: 10.1080/17483107.2017.1420250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- James A. Sturk
- Centre for Rehab Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Edward D. Lemaire
- Centre for Rehab Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Emily H. Sinitski
- Centre for Rehab Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nancy L. Dudek
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Markus Besemann
- Department of Rehabilitation, Canadian Forces Health Services, Ottawa, Canada
| | - Jacqueline S. Hebert
- Alberta Health Services, Glenrose Rehabilitation Hospital, Edmonton, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
| | - Natalie Baddour
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
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11
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Gupta G, Jarzem P, Meredith S, Radhakrishna M, Besemann M, Elgueta MF, Charghi R, Chankowsky J. Antibiotics in the treatment of patients with lower back pain associated with Modic changes: a case series. US Army Med Dep J 2017:1-9. [PMID: 29214613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To determine the clinical effect of antibiotic treatment for patients with low back pain and Modic 1 changes. METHODS This is a retrospective case series of patients treated at the Canadian Forces Health Services Centre in Ottawa and the McGill University Health Centre. Where available, pain, functional, and imaging outcomes in 11 patients treated between 2013 and 2015 were analyzed to determine effect of antibiotic treatment for patients with low back pain and associated Modic 1 changes on magnetic resonance imaging. RESULTS Conservatively, only 3 of 11 patients met the criteria for improvement for pain and/or function. While a larger proportion improved in the long term, outcomes were not thought to be temporally attributable to antibiotic treatment, as in most cases, ongoing therapy, medications, and/or injections were required. There did not appear to be a correlation between clinical improvement and associated end plate volume involvement for Modic changes. CONCLUSION Antibiotics for the treatment of low back pain in the context of Modic changes on MRI did not generally provide significant improvement in pain and function for patients in this small cohort. Despite early excitement regarding this treatment, further research is required.
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Affiliation(s)
- Gaurav Gupta
- Canadian Forces Health Services Centre-Ottawa; Department of Anesthesia, Montreal General Hospital
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12
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Gupta G, Radhakrishna M, Tamblyn I, Tran DQ, Besemann M, Thonnagith A, Elgueta MF, Robitaille ME, Finlayson RJ. A randomized comparison between neurostimulation and ultrasound-guided lateral femoral cutaneous nerve block. US Army Med Dep J 2017:33-38. [PMID: 28853117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND This prospective, randomized trial compared neurostimulation (NS) and ultrasound (US) guided lateral femoral cutaneous nerve (LFCN) block. We hypothesized that US would result in a shorter total anesthesia-related time (sum of performance and onset times). METHODS Twenty-one volunteers were enrolled. The right lower limb was randomized to an NS- or US-guided LFCN block. The alternate technique was employed for the left lower limb. With NS, paresthesias were sought in the lateral thigh at a stimulatory threshold of 0.6 mA (pulse width=0.3 ms; frequency=2 Hz) or lower. With US, local anesthetic was deposited under the inguinal ligament, ventral to the iliopsoas muscle. In both groups, 5 mL of lidocaine 2% were used to anesthetize the nerve. During the procedure of the block, the performance time and number of needle passes were recorded. Subsequently, a blinded observer assessed sensory block in the lateral thigh every minute until 20 minutes. Success was defined as loss of pinprick sensation at a point midway between the anterior superior iliac spine and the lateral knee line. The blinded observer also assessed the areas of sensory block in the anterior, medial, lateral, and posterior aspects of the thigh and mapped this distribution onto a corresponding grid. RESULTS Both modalities provided comparable success rates (76.2%-95.2%), performance times (162.1 to 231.3 seconds), onset times (300.0 to 307.5 seconds) and total anesthesia related-times (480.1 to 554.0 seconds). However US required fewer needle passes (3.2±2.9 vs 9.5±12.2; P=.009). There were no intergroup differences in terms of the distribution of the anesthetized cutaneous areas. However considerable variability was encountered between individuals and between the 2 sides of a same subject. The most common areas of sensory loss included the central lateral two-eighths anteriorly and the central antero-inferior three-eighths laterally. CONCLUSION Ultrasound guidance and NS provide similar success rates and total anesthesia-related times for LFCN block. The territory of the LFCN displays wide inter- and intra-individual variability.
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Affiliation(s)
- Gaurav Gupta
- Department of Anesthesia, Montreal General Hospital
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Vincent C, Belleville G, Gagnon DH, Dumont F, Auger E, Lavoie V, Besemann M, Champagne N, Lessart G. Effectiveness of Service Dogs for Veterans with PTSD: Preliminary Outcomes. Stud Health Technol Inform 2017; 242:130-136. [PMID: 28873789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Limited scientific evidence on the effectiveness of psychiatric service dogs used by Veterans with post-traumatic stress disorder (PTSD) is available. This study investigated their short-term effectiveness among 15 Canadian veterans who received a first psychiatric service dog. Preliminary results suggest potential beneficial effects at 3 months on the psychiatric symptoms.
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Affiliation(s)
- Claude Vincent
- Université Laval, Department of Rehabilitation. Quebec City, Canada
| | | | - Dany H Gagnon
- Université de Montréal, School of Rehabilitation, Montreal, Canada
| | - Frédéric Dumont
- Centre of Interdisciplinary Research in Rehabilitation and Social Integration
| | - Edouard Auger
- Operational Stress Injury Clinic of the Quebec's CHU
| | - Vicky Lavoie
- Operational Stress Injury Clinic of the Quebec's CHU
| | - Markus Besemann
- Rehabilitation Medicine, Department of National Defence, Ottawa, Canada
| | | | - Geneviève Lessart
- Centre of Interdisciplinary Research in Rehabilitation and Social Integration
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Reid L, Thomson P, Besemann M, Dudek N. Going places: Does the two-minute walk test predict the six-minute walk test in lower extremity amputees? J Rehabil Med 2016; 47:256-61. [PMID: 25588644 DOI: 10.2340/16501977-1916] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Assessing a patient's ability to walk the distance required for community ambulation (at least 300 m) is important in amputee rehabilitation. During the 2-min walk test, most amputees cannot walk 300 m. Thus, the 6-min walk test may be preferred, but it has not been fully validated in this population. This study examined the convergent and discriminative validity of the 6-min walk test and assessed whether the 2-min test could predict the results of the 6-min test. METHODS A total of 86 patients with unilateral or bilateral amputations at the Syme, transtibial, knee disarticulation or transfemoral level completed the 6-min walk test, 2-min walk test, Timed Up and Go test, Locomotor Capabilities Index version 5, Houghton Scale of Prosthetic Use, and Activity-Specific Balance Confidence scale. RESULTS The 6-min walk test correlated with the other tests (R = 0.57-0.95), demonstrating convergent validity. It demonstrated discriminative validity with respect to age, aetiology of amputation, and K-level (p < 0.0001). The 2-min walk test was highly predictive of the 6-min walk test distance (R2 = 0.91). CONCLUSION The 6-min walk test is a valid measure of amputee ambulation. However, the results suggest that it may not be necessary, since the 2-min walk test strongly predicts the 6-min walk test. Clinicians could therefore save time by using the shorter test.
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Affiliation(s)
- Lauren Reid
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Ottawa, K1H 8M2 Ottawa, Canada.
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15
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Sinitski EH, Herbert-Copley AG, Lemaire ED, Doyle SS, Besemann M, Dudek NL. Center of pressure and total force analyses for amputees walking with a backpack load over four surfaces. Appl Ergon 2016; 52:169-176. [PMID: 26360208 DOI: 10.1016/j.apergo.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 05/13/2015] [Accepted: 07/10/2015] [Indexed: 06/05/2023]
Abstract
Understanding how load carriage affects walking is important for people with a lower extremity amputation who may use different strategies to accommodate to the additional weight. Nine unilateral traumatic transtibial amputees (K4-level) walked over four surfaces (level-ground, uneven ground, incline, decline) with and without a 24.5 kg backpack. Center of pressure (COP) and total force were analyzed from F-Scan insole pressure sensor data. COP parameters were greater on the intact limb than on the prosthetic limb, which was likely a compensation for the loss of ankle control. Double support time (DST) was greater when walking with a backpack. Although longer DST is often considered a strategy to enhance stability and/or reduce loading forces, changes in DST were only moderately correlated with changes in peak force. High functioning transtibial amputees were able to accommodate to a standard backpack load and to maintain COP progression, even when walking over different surfaces.
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Affiliation(s)
- Emily H Sinitski
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | | | - Edward D Lemaire
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada; University of Ottawa, Faculty of Medicine, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada
| | - Sean S Doyle
- University of Ottawa, School of Human Kinetics, 125 University Private, Ottawa, ON K1N 6N5, Canada
| | - Markus Besemann
- Canadian Forces Health Services Group, 1745 Alta Vista Drive, Ottawa ON, K1A 0K6, Canada
| | - Nancy L Dudek
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada; University of Ottawa, Faculty of Medicine, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada
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16
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Doyle SS, Lemaire ED, Besemann M, Dudek NL. Changes to transtibial amputee gait with a weighted backpack on multiple surfaces. Clin Biomech (Bristol, Avon) 2015; 30:1119-24. [PMID: 26476601 DOI: 10.1016/j.clinbiomech.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 05/21/2015] [Accepted: 08/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Modern prosthetic technology and rehabilitation practices have enabled people with lower extremity amputations to participate in almost all occupations and physical activities. Carrying backpack loads can be an essential component for many of these jobs and activities; however, amputee gait with backpack loads is poorly understood. This knowledge gap must be addressed in order to further improve an individual's quality of living through changes in rehabilitation programs and prosthesis development. METHODS Ten male, unilateral, K4-level (ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels), transtibial amputees completed ten walking trials at a self-selected pace on simulated uneven ground, ramp ascent, and ramp descent. Five trials were with a 24.5 kg backpack load and five trials without. Temporal-spatial parameters and kinematic peak values for the ankle, knee, hip, pelvis, and trunk were collected and analyzed for differences between backpack conditions. FINDINGS Each surface had novel findings not found on the other surfaces. However differences in temporal-spatial parameters were congruent with the literature on able bodied individuals. Pelvis and trunk angular velocities decreased with the backpack. Hip flexion on both limbs increased during weight acceptance while wearing the backpack, a common adaptation seen in able-bodied individuals on level ground. INTERPRETATION A 24.5 kg backpack load can be accommodated by transtibial amputees at the K4 functional level. Future studies on load carriage and gait training programs should include incline and descent due to the increased difficulty. Rehabilitation programs should verify hip and knee flexor strength and work to reduce intact limb reliance.
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Affiliation(s)
- Sean S Doyle
- University of Ottawa, School of Human Kinetics, Canada.
| | - Edward D Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Canada; University of Ottawa, Faculty of Medicine, Canada.
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Sinitski EH, Lemaire ED, Baddour N, Besemann M, Dudek NL, Hebert JS. Fixed and self-paced treadmill walking for able-bodied and transtibial amputees in a multi-terrain virtual environment. Gait Posture 2015; 41:568-73. [PMID: 25661003 DOI: 10.1016/j.gaitpost.2014.12.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 02/02/2023]
Abstract
A self-paced treadmill automatically adjusts speed in real-time to match the user's walking speed, potentially enabling more natural gait than fixed-speed treadmills. This research examined walking speed changes for able-bodied and transtibial amputee populations on a self-paced treadmill in a multi-terrain virtual environment and examined gait differences between fixed and self-paced treadmill speed conditions. Twelve able-bodied (AB) individuals and 12 individuals with unilateral transtibial amputation (TT) walked in a park-like virtual environment with level, slopes, and simulated uneven terrain scenarios. Temporal-spatial and range-of-motion parameters were analyzed. Within the self-paced condition, all participants significantly varied walking speed (p<0.001) across different walking activities. Compared to level walking, participants reduced speed for uphill and hilly activities (p<0.001). TT also reduced speed downhill (p<0.001). Generally, differences in temporal-spatial and range-of-motion parameters between fixed and self-paced speed conditions were no longer significantly different with a speed covariate. However, for uphill walking, both groups decreased stride length during self-paced trials, and increased stride length during fixed-speed trials to maintain the constant speed (p<0.01). The results from this study demonstrated self-paced treadmill mode is important for virtual reality systems with multiple movement scenarios in order to elicit more natural gait across various terrain. Fixed-speed treadmills may induce gait compensations to maintain the fixed speed.
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Affiliation(s)
- Emily H Sinitski
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada; University of Ottawa, Department of Mechanical Engineering, 161 Louis Pasteur, Ottawa, ON K1N 6N5, Canada.
| | - Edward D Lemaire
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada; University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Natalie Baddour
- University of Ottawa, Department of Mechanical Engineering, 161 Louis Pasteur, Ottawa, ON K1N 6N5, Canada
| | - Markus Besemann
- Canadian Forces Health Services, 1745 Alta Vista Drive, Ottawa, ON K1A 0K6, Canada
| | - Nancy L Dudek
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Jacqueline S Hebert
- Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, AB T5G 0B7, Canada; University of Alberta, 116 Street and 85 Avenue, Edmonton, AB T6G 2R3, Canada
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Thompson JM, Pranger T, Sweet J, VanTil L, McColl MA, Besemann M, Shubaly C, Pedlar D. Disability correlates in Canadian Armed Forces Regular Force Veterans. Disabil Rehabil 2014; 37:884-91. [PMID: 25203768 DOI: 10.3109/09638288.2014.947441] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study was undertaken to inform disability mitigation for military veterans by identifying personal, environmental, and health factors associated with activity limitations. METHOD A sample of 3154 Canadian Armed Forces Regular Force Veterans who were released during 1998-2007 participated in the 2010 Survey on Transition to Civilian Life. Associations between personal and environmental factors, health conditions and activity limitations were explored using ordinal logistic regression. RESULTS The prevalence of activity reduction in life domains was higher than the Canadian general population (49% versus 21%), as was needing assistance with at least one activity of daily living (17% versus 5%). Prior to adjusting for health conditions, disability odds were elevated for increased age, females, non-degree post-secondary graduation, low income, junior non-commissioned members, deployment, low social support, low mastery, high life stress, and weak sense of community belonging. Reduced odds were found for private/recruit ranks. Disability odds were highest for chronic pain (10.9), any mental health condition (2.7), and musculoskeletal conditions (2.6), and there was a synergistic additive effect of physical and mental health co-occurrence. CONCLUSIONS Disability, measured as activity limitation, was associated with a range of personal and environmental factors and health conditions, indicating multifactorial and multidisciplinary approaches to disability mitigation.
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Affiliation(s)
- James M Thompson
- Veterans Affairs Canada , Charlottetown, Prince Edward Island , Canada
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Gupta G, Radhakrishna M, Etheridge P, Besemann M, Finlayson RJ. Radiofrequency denervation of the hip joint for pain management: case report and literature review. US Army Med Dep J 2014:41-51. [PMID: 24706242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A 55-year-old male presented with severe pain and functional limitations as a result of left hip osteoarthritis. He had failed multiple treatments while waiting for a hip arthroplasty, including physical therapy, medications, and various intra-articular injections. Thermal radiofrequency lesioning of the obturator and femoral articular branches to the hip joint was offered in the interim. OBJECTIVES To our knowledge, this is the first report to describe an inferior-lateral approach for lesioning the obturator branch, the clinical application of successive lesions to increase denervation area, and outcomes in a patient receiving a second treatment with previously good results. METHODS To discuss relevant and technical factors for this specific case, we reviewed previous literature on hip joint radiofrequency and critically evaluated previous anatomic studies in the context of radiofrequency. RESULTS The first treatment provided significant benefit for a period of 6 months. A second treatment was employed providing only mild to moderate benefit until his joint replacement surgery 4 months later. Literature review revealed studies of low quality secondary to small sample sizes, patient selection methodology, inclusion of patients with heterogenous etiologies for pain, variable needle placement techniques, and lack of measurement of functional outcomes. LIMITATIONS Case report and low quality studies in existing literature. CONCLUSIONS Hip joint radiofrequency denervation is a promising avenue for adjunctive treatment of hip pain. Further cadaveric studies are required to clarify a multitude of technical parameters. Once these are well defined, future clinical studies should consider pain, functional, and economic outcomes in their design.
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Affiliation(s)
- Gaurav Gupta
- Alan Edwards Pain Management Unit, Dept of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada
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Doyle SS, Lemaire ED, Besemann M, Dudek NL. Changes to level ground transtibial amputee gait with a weighted backpack. Clin Biomech (Bristol, Avon) 2014; 29:149-54. [PMID: 24355702 DOI: 10.1016/j.clinbiomech.2013.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/05/2013] [Accepted: 11/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many occupations and hobbies require the use of a weighted pack. To date there has been limited backpack gait studies performed on the amputee population. It is important that we address this knowledge gap in order to further improve individual's quality of living through changes in rehabilitation, and prosthesis development. METHODS The study population was ten male, unilateral, traumatic, K4-level (ability for prosthetic ambulation with high impact, stress, or energy levels), transtibial amputees. Ten walking trials were collected on level ground; five with a 24.5 kg backpack and five without a backpack. Temporal-spatial parameters and kinematic and kinetic peak values for the ankle, knee, hip, pelvis, and trunk were collected and analyzed for significant differences. FINDINGS Temporal-spatial parameters incurred changes that were congruent with the literature on able bodied individuals. Pelvis speeds and range of motion decreased with the pack. Knee flexion during weight acceptance increased, and was supported on the intact limb by increased eccentric knee power during weight acceptance. Hip flexion on both limbs also increased during weight acceptance while wearing the backpack. INTERPRETATION The backpack load can be accommodated by people at a K4 functional level for level ground walking. At the prosthetic limb, greater deformation was found at the foot-ankle and further increases in pack weight and higher impact tasks (i.e., jogging) could lead to decreased performance for some prosthetic feet. Gait training programs should focus on removing any gait asymmetries and increasing the strength of both the hip and knee flexors.
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Affiliation(s)
- Sean S Doyle
- University of Ottawa, School of Human Kinetics, Canada; Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Canada.
| | - Edward D Lemaire
- Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Canada; University of Ottawa, Faculty of Medicine, Canada
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Abstract
As a consequence of Canada's involvement in the war in Afghanistan, many members of the Canadian Forces have experienced debilitating injuries. Despite the Canadian Forces Health Services (CFHS) having outstanding relationships with many civilian care providers for the rehabilitation of injured soldiers, it became apparent early on that the high-level goals and aspirations of these returning soldiers were sometimes beyond the capability of these centres to facilitate. From this reality grew the need to develop a Physical Rehabilitation Program within the CFHS. This article describes the lessons learned since the creation of the program and outlines the future vision in terms of unique challenges and opportunities. The primary purpose of this article is to describe a hybrid model of civilian-military rehabilitation for injured soldiers and discuss the benefits and challenges of such a model of care.
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Affiliation(s)
- Markus Besemann
- Canadian Forces Health Services, 1745 Alta Vista Dr., Ottawa, Ontario.
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