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Choi M, Kim HC, Youn I, Lee SJ, Lee JH. Use of functional magnetic resonance imaging to identify cortical loci for lower limb movements and their efficacy for individuals after stroke. J Neuroeng Rehabil 2024; 21:58. [PMID: 38627779 PMCID: PMC11020805 DOI: 10.1186/s12984-024-01319-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Identification of cortical loci for lower limb movements for stroke rehabilitation is crucial for better rehabilitation outcomes via noninvasive brain stimulation by targeting the fine-grained cortical loci of the movements. However, identification of the cortical loci for lower limb movements using functional MRI (fMRI) is challenging due to head motion and difficulty in isolating different types of movement. Therefore, we developed a custom-made MR-compatible footplate and leg cushion to identify the cortical loci for lower limb movements and conducted multivariate analysis on the fMRI data. We evaluated the validity of the identified loci using both fMRI and behavioral data, obtained from healthy participants as well as individuals after stroke. METHODS We recruited 33 healthy participants who performed four different lower limb movements (ankle dorsiflexion, ankle rotation, knee extension, and toe flexion) using our custom-built equipment while fMRI data were acquired. A subgroup of these participants (Dataset 1; n = 21) was used to identify the cortical loci associated with each lower limb movement in the paracentral lobule (PCL) using multivoxel pattern analysis and representational similarity analysis. The identified cortical loci were then evaluated using the remaining healthy participants (Dataset 2; n = 11), for whom the laterality index (LI) was calculated for each lower limb movement using the cortical loci identified for the left and right lower limbs. In addition, we acquired a dataset from 15 individuals with chronic stroke for regression analysis using the LI and the Fugl-Meyer Assessment (FMA) scale. RESULTS The cortical loci associated with the lower limb movements were hierarchically organized in the medial wall of the PCL following the cortical homunculus. The LI was clearer using the identified cortical loci than using the PCL. The healthy participants (mean ± standard deviation: 0.12 ± 0.30; range: - 0.63 to 0.91) exhibited a higher contralateral LI than the individuals after stroke (0.07 ± 0.47; - 0.83 to 0.97). The corresponding LI scores for individuals after stroke showed a significant positive correlation with the FMA scale for paretic side movement in ankle dorsiflexion (R2 = 0.33, p = 0.025) and toe flexion (R2 = 0.37, p = 0.016). CONCLUSIONS The cortical loci associated with lower limb movements in the PCL identified in healthy participants were validated using independent groups of healthy participants and individuals after stroke. Our findings suggest that these cortical loci may be beneficial for the neurorehabilitation of lower limb movement in individuals after stroke, such as in developing effective rehabilitation interventions guided by the LI scores obtained for neuronal activations calculated from the identified cortical loci across the paretic and non-paretic sides of the brain.
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Affiliation(s)
- Minseok Choi
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Hyun-Chul Kim
- Department of Artificial Intelligence, Kyungpook National University, Daegu, South Korea
| | - Inchan Youn
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, South Korea
| | - Song Joo Lee
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, South Korea.
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea.
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea.
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Boston, Massachusetts, USA.
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Tapanya W, Sangkarit N, Manoy P, Konsanit S. Modified Squat Test for Predicting Knee Muscle Strength in Older Adults. Ann Geriatr Med Res 2024:agmr.24.0005. [PMID: 38584428 DOI: 10.4235/agmr.24.0005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024] Open
Abstract
Background Methods for evaluating the strength of the knee extensor muscles play a vital role in determining the functionality of the lower limbs and monitoring any alterations that occur over time in older individuals. This study assessed the validity of the modified squat test (MST) in predicting knee extensor muscle strength in older adults. Methods This study included a total of 110 older adults. We collected demographic information such as sex, age, body weight, height, and thigh circumference. Muscle strength was assessed by measuring the maximum voluntary isometric contraction (MVIC) of the knee extensors, and by performing the MST (5 and 10 repetitions) and single-leg standing balance test. Stepwise multiple linear regression analysis was used to investigate multiple factors impacting the prediction of knee extensor strength. Results Factors such as age, sex, thigh circumference, performance on the single-leg standing eye-open (SSEO) task, and the time required to complete the 10 MST repetitions together explained 77.8% of the variation in knee extensor muscle strength among older adults. We further developed a predictive equation to calculate strength as follows: strength = 36.78 - 0.24 (age) + 6.16 (sex) + 0.19 (Thigh circumference) + 0.05 (SSEO) - 0.54 (Time required to complete 10 MST repetitions) ± 5.51 kg. Conclusion The 10-repetition MST is an invaluable instrument for establishing an equation to accurately predict lower limb muscle strength.
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Affiliation(s)
- Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Noppharath Sangkarit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Pacharee Manoy
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Saisunee Konsanit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
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Marty-Diloy T, Rougereau G, Mary P, Vialle R, Fitoussi F, Pietton R, Langlais T. Induced-membrane technique for lower limb reconstruction after malignant bone tumour resection in paediatric patients: Complication and re-operation rates. Orthop Traumatol Surg Res 2024:103875. [PMID: 38556207 DOI: 10.1016/j.otsr.2024.103875] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND The objective of this study was to assess the complication and re-operation rates, evaluate the risk of non-union, and describe the functional outcomes at last follow-up in children and adolescents after lower-limb malignant tumour resection and reconstruction using the induced-membrane technique. HYPOTHESIS Weight-bearing resumption 6 weeks after the second stage of the induced-membrane procedure promotes bone healing. MATERIAL AND METHODS The study included 13 patients (9 with osteosarcoma, 3 with Ewing's sarcomas, and 1 with alveolar sarcoma) managed between 2000 and 2020 by oncological femoral or tibial resection followed, at a distance from adjuvant chemotherapy, by reconstruction using the induced-membrane technique. Non-union was the primary outcome measure and the MusculoSkeletal Tumor Society (MSTS) lower-limb functional score was the secondary outcome measure. Mean follow-up was 6.1 years (range, 2.0-12.7). At last follow-up, mean age was 18.1 years (range, 11.0-26.0) and the mean MSTS score was 66.6% (37.0-93.0%). RESULTS After the second reconstruction stage, 8 complications developed in 6 patients (46%). Either a complication or limb-length inequality required 12 re-operations in 8 patients (61.5%). Non-union occurred after reconstruction in 5 (38.5%) patients. Early resumption of 50% weight-bearing 6 weeks after reconstruction was associated with bone healing (p=0.02). CONCLUSION The non-union rate was 38.5%. Partial, 50% weight-bearing with two elbow crutches and an orthosis, if allowed by construct stability, may promote bone healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Thibault Marty-Diloy
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Pierre Mary
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Vialle
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculo-squelettiques, université de la Sorbonne, Paris, France
| | - Franck Fitoussi
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Pietton
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Tristan Langlais
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département d'orthopédie pédiatrique, hôpital des enfants, Purpan, université de Toulouse, Toulouse, France.
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Woodhead A, Rainer C, Hill J, Murphy CP, North JS, Kidgell D, Tallent J. Corticospinal and spinal responses following a single session of lower limb motor skill and resistance training. Eur J Appl Physiol 2024:10.1007/s00421-024-05464-9. [PMID: 38532177 DOI: 10.1007/s00421-024-05464-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
Prior studies suggest resistance exercise as a potential form of motor learning due to task-specific corticospinal responses observed in single sessions of motor skill and resistance training. While existing literature primarily focuses on upper limb muscles, revealing a task-dependent nature in eliciting corticospinal responses, our aim was to investigate such responses after a single session of lower limb motor skill and resistance training. Twelve participants engaged in a visuomotor force tracking task, self-paced knee extensions, and a control task. Corticospinal, spinal, and neuromuscular responses were measured using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). Assessments occurred at baseline, immediately post, and at 30-min intervals over two hours. Force steadiness significantly improved in the visuomotor task (P < 0.001). Significant fixed-effects emerged between conditions for corticospinal excitability, corticospinal inhibition, and spinal excitability (all P < 0.001). Lower limb motor skill training resulted in a greater corticospinal excitability compared to resistance training (mean difference [MD] = 35%, P < 0.001) and control (MD; 37%, P < 0.001). Motor skill training resulted in a lower corticospinal inhibition compared to control (MD; - 10%, P < 0.001) and resistance training (MD; - 9%, P < 0.001). Spinal excitability was lower following motor skill training compared to control (MD; - 28%, P < 0.001). No significant fixed effect of Time or Time*Condition interactions were observed. Our findings highlight task-dependent corticospinal responses in lower limb motor skill training, offering insights for neurorehabilitation program design.
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Affiliation(s)
- Alex Woodhead
- Faculty of Sport, Technology and Health Sciences, St. Mary's University, Twickenham, Middlesex, TW1 4SX, UK.
| | - Christopher Rainer
- Faculty of Sport, Technology and Health Sciences, St. Mary's University, Twickenham, Middlesex, TW1 4SX, UK
| | - Jessica Hill
- Faculty of Sport, Technology and Health Sciences, St. Mary's University, Twickenham, Middlesex, TW1 4SX, UK
| | - Colm P Murphy
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jamie S North
- Faculty of Sport, Technology and Health Sciences, St. Mary's University, Twickenham, Middlesex, TW1 4SX, UK
| | - Dawson Kidgell
- Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, 3199, Australia
| | - Jamie Tallent
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
- Monash Exercise Neuroplasticity Research Unit, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, 3199, Australia
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Hsu YY, Nguyen TT, Chou YJ, Ho CL. Effects of exercise on lower limb lymphedema in gynecologic cancer: A systematic review and meta-analysis. Eur J Oncol Nurs 2024; 70:102550. [PMID: 38554614 DOI: 10.1016/j.ejon.2024.102550] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE A systematic review investigated the effectiveness of physical activity in alleviating lower limb lymphedema among patients with gynecological cancer after surgery. METHODS A systematic review of randomized controlled trials and quasi-experimental designs was conducted. Six databases, Cinahl, Cochrane, Embase, Medline, Scopus, and Web of Science, were searched for relevant publications from inception to October 2022 and updated in January 2024. RevMan software was used to perform meta-analysis using a random-effects model. RESULTS Seven studies (5 randomized controlled trials) containing 261 subjects were synthesized. The risk of bias was low in the included studies. The exercise interventions for lower limb lymphedema included active, aerobic, aquatic, and weight-lifting exercises. Meta-analyses showed that active exercise had no effect on lymphedema symptoms of limb volume, pain, and heaviness. However, the effectiveness of exercise on limb volume had subthreshold borderline significance in 2 studies (standardized mean difference = 0.43, 95% confidence interval - 0.01, 0.88; I2 = 0%, p = 0.06). Three studies found that lymphedema symptoms were significantly improved after exercise interventions. The adherence rate of the exercise was 77-100%, with the only complication being cellulitis. CONCLUSIONS Although the meta-analysis does not reveal a significant effect, the systematic review study demonstrated that exercise is feasible, safe, and has a clinical effect on alleviating lymphedema-related symptoms of women following gynecological cancer surgery.
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Affiliation(s)
- Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Tram Tb Nguyen
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; Medical Simulation Center, Duy Tan University, Viet Nam
| | | | - Chien-Liang Ho
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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Alyousef YS, Johnston V, Smith MD. Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: A cross-sectional survey of Australian Physiotherapists. Musculoskelet Sci Pract 2024; 71:102942. [PMID: 38507868 DOI: 10.1016/j.msksp.2024.102942] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Lower limb osteoarthritis (OA) is a leading cause of disability and can affect an individual's ability to work. OBJECTIVES To explore Australian physiotherapists' use of work-related interventions in managing patients with lower limb OA, and identify current management practices. METHODS Physiotherapists with at least two years of experience treating patients with lower limb OA were invited to complete an online survey to understand how physiotherapists manage patients with lower limb OA, specifically regarding interventions related to work. RESULTS A total of 132 physiotherapists completed the survey. In free text responses, only 1.5% and 2.3% of physiotherapists nominated work-related items in their key components of treatment or educational topics discussed with patients with lower limb OA, respectively. From a range of work-related activities presented, over half of physiotherapists indicated they regularly/always provided education about the benefits of remaining in work (63.5%) and advice on managing symptoms at work (57.4%). Less than 10% of physiotherapists regularly/always used a validated scale to identify barriers for work (9.6%), discussed absences from work (9.6%), conducted a workplace assessment (4.4%), and discussed submitting workers' compensation claims (2.6%). Exercise and patient education were the most frequently nominated physiotherapy treatments in free text (96.2% and 86.3%, respectively) and fixed response (99.2% and 93.9%, respectively) questions. CONCLUSION Many physiotherapists do not address work-related activities in their management of patients with lower limb OA. In light of work-related challenges commonly experienced by individuals with lower limb OA, this is an important aspect of management of this condition.
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Affiliation(s)
- Yousef S Alyousef
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia; Majmaah University, College of Applied Medical Sciences, Al Majma'ah, Saudi Arabia
| | - Venerina Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia; University of Southern Queensland, School of Health and Medical Sciences, Ipswich, QLD, Australia
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia.
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Mahdi S, Stoner R, Wyatt J, De'Ath H, Perkins Z. Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis. Injury 2024; 55:111495. [PMID: 38490051 DOI: 10.1016/j.injury.2024.111495] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Globally, severe lower limb injuries (SLLIs) are the predominant cause of long-term injury related disability and poor functional outcomes. Chronic pain is a major source of this morbidity, but the magnitude of the contribution is not clearly understood. The aim of this systematic review and meta-analysis was to determine the prevalence of chronic pain following SLLIs in civilian and military patients. METHOD This systematic review was prospectively registered with The International Prospective Register of Systematic Reviews (PROSPERO) with study ID CRD42022313615. A systematic literature search (Medline, Embase, Ovid, and Web of Science) was performed to identify original studies that reported chronic pain outcomes for adults who underwent surgical treatment for SLLIs in a civilian or military setting. Risk of bias in included studies was assessed using the ROBINS-E tool, and quality assessment was reported at study level using the Newcastle-Ottawa Scale, and at outcome-level using the GRADE framework. Absolute (proportional) and relative (odds ratio) outcome measures were calculated and pooled using a random effects model. RESULTS Forty-three studies reporting the outcomes of 5601 patients were included. Estimated overall prevalence of pain was 63 % (CI 55-70 %). The prevalence of chronic pain in amputees (64 % (CI 55-73 %)) was similar to those who underwent limb salvage (56 % (CI 44-67 %)). The prevalence of chronic pain in civilian populations was 70 % (CI 63-77 %) compared to military populations (51 % (CI 35-66 %)). In amputees, the prevalence of residual limb pain was similar to phantom limb pain (OR 1.06 [0.64-1.78], p = 0.81, I2 = 92 %). CONCLUSION Most people who sustain a SLLI will suffer from chronic pain. Healthcare systems must continue to research interventions that can reduce the incidence and severity of long-term pain and ensure adequate resources are allocated for this common and debilitating complication.
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Affiliation(s)
- Shareef Mahdi
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
| | - Rebecca Stoner
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | | | - Henry De'Ath
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Zane Perkins
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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S Oliveira S, G L Bandeira W, M Lopes L, R M Lima R, C Cavalcante J. Incidence of the tensor of the vastus intermedius: A cadaveric study. Morphologie 2024; 108:100609. [PMID: 37897940 DOI: 10.1016/j.morpho.2023.100609] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION The quadriceps femoris muscle is present in the anterior region of the thigh and is classically described as a muscle with four heads: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. A few years ago, a "fifth head" was described and named the tensor of the vastus intermedius (TVI). The TVI belly is in line with the belly of the vastus lateralis, and its aponeurosis imposes considerable tension on the vastus intermedius, medializing its action, to play a significant role in knee extension. OBJECTIVE To perform a study of the TVI incidence in a Brazilian population and describe its variations. MATERIAL AND METHODS We dissected lower limbs from cadavers previously fixed in 10% formaldehyde, belonging to the Laboratory of Anatomy of the Department of Morphology of the Biosciences Center of the Federal University of Rio Grande do Norte. RESULTS Eighty-one lower limbs were analyzed with only 33 (40.74%) of them presenting TVI. All four types of TVI described by the literature were present in our sample with the following distribution: type 1 with 15.15%; type 2 with 9.1%; type 3 with 33.33%; type 4 with 42.42%. DISCUSSION Although the literature points to the TVI as a normal belly of the quadriceps, making it a "quinticeps", our analysis points to the TVI as a variation and probably a matter of regionality. However, the presence of TVI is not a rare case and cannot be disregarded, which makes this study important for anatomists, physiotherapists, physicians, and surgeons.
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Affiliation(s)
- S S Oliveira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - W G L Bandeira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L M Lopes
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - R R M Lima
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - J C Cavalcante
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Hague A, Platford B, Rehman SU, Howes AJ, Brackley P. Multi-nodal basin drainage in lower limb melanoma. JPRAS Open 2024; 39:71-74. [PMID: 38111715 PMCID: PMC10726213 DOI: 10.1016/j.jpra.2023.11.009] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Lymph node status is an important factor that influences outcomes in melanoma. Whilst certain anatomical areas have multiple-nodal basin drainage, limb melanomas are thought to have more predictable lymphatic drainage patterns, with lower limb melanomas reliably draining to the corresponding ipsilateral inguinal lymph node basin with occasional popliteal drainage. Here we share our unique experience of a patient with a lower limb melanoma demonstrating sentinel lymph nodes, and subsequent metastatic spread, in both the ipsilateral and contralateral inguinal lymph node basins, highlighting an important learning point with respect to our clinical examination of melanoma patients.
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Affiliation(s)
- Adam Hague
- Department of Plastic Surgery, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Bethany Platford
- Department of Plastic Surgery, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Saif Ur Rehman
- Department of Plastic Surgery, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Andrea J. Howes
- Department of Plastic Surgery, Whiston Hospital, Prescot, L35 5DR, United Kingdom
| | - Philip Brackley
- Department of Plastic Surgery, Whiston Hospital, Prescot, L35 5DR, United Kingdom
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He Y, Zhang Q, Ma TT, Liang YH, Guo RR, Li XS, Liu QJ, Feng TY. Effect of repetitive transcranial magnetic stimulation-assisted training on lower limb motor function in children with hemiplegic cerebral palsy. BMC Pediatr 2024; 24:136. [PMID: 38383331 PMCID: PMC10882917 DOI: 10.1186/s12887-024-04605-5] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To explore the effect of repetitive transcranial magnetic stimulation (rTMS)-assisted training on lower limb motor function in children with hemiplegic cerebral palsy (HCP). METHOD Thirty-one children with HCP who met the inclusion criteria were selected and randomly divided into a control group (n = 16) and an experimental group (n = 15). The control group received routine rehabilitation treatment for 30 min each time, twice a day, 5 days a week for 4 weeks. Based on the control group, the experimental group received rTMS for 20 min each time, once a day, 5 days a week for 4 weeks. The outcome measures included a 10-metre walk test (10MWT), a 6-minute walk distance (6MWD) test, D- and E-zone gross motor function measurements (GMFM), the symmetry ratio of the step length and stance time and the muscle tone of the triceps surae and the hamstrings (evaluated according to the modified Ashworth scale), which were obtained in both groups of children before and after treatment. RESULTS After training, the 10MWT (P < 0.05), 6MWD (P < 0.01), GMFM (P < 0.001) and the symmetry ratio of the step length and stance time of the two groups were significantly improved (P < 0.05), there was more of an improvement in the experimental group compared with the control group. There was no significant change in the muscle tone of the hamstrings between the two groups before and after treatment (P > 0.05). After treatment, the muscle tone of the triceps surae in the experimental group was significantly reduced (P < 0.05), but there was no significant change in the control group (P > 0.05). CONCLUSION Repetitive TMS-assisted training can improve lower limb motor function in children with HCP.
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Affiliation(s)
- Yan He
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Qi Zhang
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China.
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China.
| | - Ting-Ting Ma
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Yan-Hua Liang
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Rong-Rong Guo
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
| | - Xiao-Song Li
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Qian-Jin Liu
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
| | - Tian-Yang Feng
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
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11
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Tian TF, Mo FH, Su HY, Huang C, Zhao H, Liu J, Shang B, Li K, Qiu JL. Investigation on vehicle occupant dummy applicability for under-foot impact loading conditions. Chin J Traumatol 2024:S1008-1275(24)00008-7. [PMID: 38637177 DOI: 10.1016/j.cjtee.2024.02.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Under-foot impact loadings can cause serious lower limb injuries in many activities, such as automobile collisions and underbody explosions to military vehicles. The present study aims to compare the biomechanical responses of the mainstream vehicle occupant dummies with the human body lower limb model and analyze their robustness and applicability for assessing lower limb injury risk in under-foot impact loading environments. METHODS The Hybrid III model, the test device for human occupant restraint (THOR) model, and a hybrid human body model with the human active lower limb model were adopted for under-foot impact analysis regarding different impact velocities and initial lower limb postures. RESULTS The results show that the 2 dummy models have larger peak tibial axial force and higher sensitivity to the impact velocities and initial postures than the human lower limb model. In particular, the Hybrid III dummy model presented extremely larger peak tibial axial forces than the human lower limb model. In the case of minimal difference in tibial axial force, Hybrid III's tibial axial force (7.5 kN) is still 312.5% that of human active lower limb's (2.4 kN). Even with closer peak tibial axial force values, the biomechanical response curve shapes of the THOR model show significant differences from the human lower limb model. CONCLUSION Based on the present results, the Hybrid III dummy cannot be used to evaluate the lower limb injury risk in under-foot loading environments. In contrast, potential improvement in ankle biofidelity and related soft tissues of the THOR dummy can be implemented in the future for better applicability.
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Affiliation(s)
- Teng-Fei Tian
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Fu-Hao Mo
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Hao-Yang Su
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Can Huang
- State Key Laboratory of Advanced Design and Manufacture for Vehicle Body, Hunan University, Changsha, 410082, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jun Liu
- Chonging Zhongzheng Judicial Expert Center, Chongqing, 400020, China
| | - Bo Shang
- NIO Limited Liability Company, Shanghai, 200050, China
| | - Kui Li
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China; Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics, Chongqing, 400042, China.
| | - Jin-Long Qiu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics, Chongqing, 400042, China.
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12
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Abbas RL, Cooreman D, Sultan HA, Nayal ME, Saab IM, Khatib AE, Kawam AE, Melhat AME. Effect of Adding Virtual Reality Training to Traditional Exercise Program on Pain, Mental Status and Psychological Status in Unilateral Traumatic Lower Limb Amputees: A Randomized Controlled Trial. Games Health J 2024. [PMID: 38324006 DOI: 10.1089/g4h.2023.0164] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background: Lower limb amputation is an emotionally devastating condition that causes a complete change in the quality of life, may lead to phantom limb pain in most of the cases, and puts the individual in a high risk of developing psychological disorders. The objective of this study is to evaluate the consequence of adding virtual reality (VR) to a traditional exercise program on pain, mental status, and psychological status in traumatic unilateral lower limb amputees (LLAs). Methods: Thirty-two traumatic LLAs were randomly assigned into two equal groups in this randomized control trial. Participants did accomplish a postfitting exercise program at least 6 months before enrolment; the control group (CG) underwent a traditional rehabilitation program, and experimental group (EG) had the same program, in addition to VR training. Data were collected before and after 6 weeks of intervention using visual analog scale (VAS) for pain, Beck's depression inventory (BDI) for depression, and 12-item short form survey for mental health summary (MHS) and physical health summary (PHS). Results: Thirty-two amputees (29 males and 3 females) were included with mean age in CGs and EG (27.6 ± 4) and (27.6 ± 7.6) years, respectively. Postintervention, the VAS score was significantly reduced only in EG (P = 0.003). Both groups showed significant improvement in BDI, MHS, and PHS (P < 0.05). However, the EG showed a superior significance in BDI and MHS scores (P < 0.05). There was no significance between groups in PHS score. Conclusion: Adding VR to conventional training is beneficial in decreasing pain and in improving depression and MHS of traumatic unilateral LLAs.
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Affiliation(s)
- Rami L Abbas
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Didier Cooreman
- Physical Rehabilitation Program, International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Hala Al Sultan
- Physical Rehabilitation Program, International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Mayssah El Nayal
- College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Ibtissam M Saab
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ayman El Khatib
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Aseel El Kawam
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Ahmed M El Melhat
- Department of Physical Therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
- Department of Physical Therapy for Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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13
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Maderbacher G, Baier C, Meyer M, Holzapfel D, Pagano S, Grifka J, Greimel F. [Navigation and robotics-current status and future implications]. Orthopadie (Heidelb) 2024; 53:107-116. [PMID: 38294695 PMCID: PMC10844471 DOI: 10.1007/s00132-023-04468-1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Both navigation systems and robotics enable greater precision in the implantation of an artificial knee joint. However, they do not improve clinical outcomes. We hypothesized that although implantation of a total knee arthroplasty results in reconstruction of the alignment in the coronal plane, the variable rotational tibial and variable translational femoral and tibial component positioning lead to a change in the remaining alignment parameters of the lower extremity. However, these parameters could be determined using a navigation system or robot and could represent future implications for these systems. METHODS The kinematics and the position between femur and tibia before and after implantation of a total knee arthroplasty were determined using a navigation system in nine healthy knee joints of Thiel-fixed whole-body cadavers. RESULTS After arthroplasty, there was no change in the natural coronal alignment. In extension and the early degrees of flexion, the rotational position of the femur relative to the tibia was altered. This also led to a change in the positioning of the medial and lateral epicondyle in relation to the tibia; while both epicondyles were positioned more laterally in relation to the tibia after arthroplasty, the lateral epicondyle was significantly more lateral in relation to the tibia up to 20° of flexion. DISCUSSION Following arthroplasty of a knee joint using the established technique, a good reconstruction of the coronal alignment was achieved with simultaneous changes in the alignment in both the rotational and translational directions between the femur and tibia. Using navigation as well as robotics, we would be able to quantify all alignment parameters and could achieve an alignment of the components or a reconstruction of the overall alignment in all six degrees of freedom. We might also be able to achieve a clinical advantage or increase the service life even further.
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Affiliation(s)
- Günther Maderbacher
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Clemens Baier
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Matthias Meyer
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Dominik Holzapfel
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Stefano Pagano
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Joachim Grifka
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Felix Greimel
- Orthopädische Klinik, Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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14
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Yim GH, Pikturnaite J, Harry L, Clement R, Pope-Jones S, Emam A, Marsden N. Enhanced recovery for acute open lower limb fracture 'fix and flap'. Injury 2024; 55:111234. [PMID: 38029681 DOI: 10.1016/j.injury.2023.111234] [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: 05/09/2023] [Revised: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Enhanced recovery (ER) aims to achieve earlier recovery, reduced hospital length of stay (LoS) whilst improving outcomes. Our ER protocol for acute lower-limb open fracture (ALLOFs) includes dangling at day 3 and mobilising fully weight-bearing from day 5. Our aims were to evaluate the outcomes of ALLOFs using our ER protocol for limb salvage, LoS following 'fix & flap', return to theatre, rate of successful flap salvage, flap failure and deep infection rates. METHODS An observational study of a prospectively maintained lower limb flap database from September 2020 to January 2023 was undertaken. Search criteria encompassed patients with a Gustilo IIIB/C injury and a free flap reconstruction. Exclusions were for local/perforator flaps, soft tissue injury only, fracture related/prosthetic joint infections, or chronic osteomyelitis cases. RESULTS 161 patients were available for analysis, 126 male (78 %) and 35 female (22 %) with a median age of 40 years (12-79, interquartile range 30.0). 81 % of cases were high-energy injuries. For all patients, the median time to definitive fixation and soft tissue coverage from injury was 4 days (0-30, interquartile range 2). 18 cases (11.2 %) required return to theatre for flap exploration; 11 cases were successfully salvaged (61 %). Nine free flaps failed (5.4 %). The median total LoS from admission was 10 days (6 to 46, interquartile range 5), with a median LoS following definitive fixation and soft tissue coverage of 7 days (4 to 20, interquartile range 3). The median follow-up period was 18 months (12 to 38.2, interquartile range 9), with a deep infection rate of 6.5 %. CONCLUSION In isolated ALLOFs, our ER protocol is safe and effective in shortening the LoS. Our outcomes sit comfortably within acceptable ranges of contemporary literature for return to theatre, flap salvage/failure and deep infection. Our ER protocol actively involves our allied health professional colleagues early to facilitate discharge.
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Affiliation(s)
- Guang Hua Yim
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Jurga Pikturnaite
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Lorraine Harry
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Rhys Clement
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Orthopaedic department, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom
| | - Sophie Pope-Jones
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Ahmed Emam
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Nicholas Marsden
- The Welsh Centre for Burns & Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston SA6 6NL, Swansea, United Kingdom; Major Trauma Centre, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom.
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15
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Bing F, Zhang G, Wang Y, Zhang M. Effects of workload and saddle height on muscle activation of the lower limb during cycling. Biomed Eng Online 2024; 23:6. [PMID: 38229090 DOI: 10.1186/s12938-024-01199-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Cycling workload is an essential factor in practical cycling training. Saddle height is the most studied topic in bike fitting, but the results are controversial. This study aims to investigate the effects of workload and saddle height on the activation level and coordination of the lower limb muscles during cycling. METHODS Eighteen healthy male participants with recreational cycling experience performed 15 × 2-min constant cadence cycling at five saddle heights of 95%, 97%, 100%, 103%, and 105% of greater trochanter height (GTH) and three cycling workloads of 25%, 50%, and 75% of functional threshold power (FTP). The EMG signals of the rectus femoris (RF), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (MG) of the right lower limb were collected throughout the experiment. RESULTS Greater muscle activation was observed for the RF and BF at a higher cycling workload, whereas no differences were observed for the TA and MG. The MG showed intensified muscle activation as the saddle height increased. The mean and maximum amplitudes of the EMG signals of the MG increased by 56.24% and 57.24% at the 25% FTP workload, 102.71% and 126.95% at the 50% FTP workload, and 84.27% and 53.81% at the 75% FTP workload, respectively, when the saddle height increased from 95 to 100% of the GTH. The muscle activation level of the RF was minimal at 100% GTH saddle height. The onset and offset timing revealed few significant differences across cycling conditions. CONCLUSIONS Muscle activation of the RF and BF was affected by cycling workload, while that of the MG was affected by saddle height. The 100% GTH is probably the appropriate saddle height for most cyclists. There was little statistical difference in muscle activation duration, which might be related to the small workload.
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Affiliation(s)
- Fangbo Bing
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Guoxin Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518057, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China.
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong SAR, 999077, China.
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518057, China.
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16
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Molitor SL, Neptune RR. Lower-limb joint quasi-stiffness in the frontal and sagittal planes during walking at different step widths. J Biomech 2024; 162:111897. [PMID: 38103312 DOI: 10.1016/j.jbiomech.2023.111897] [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] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Quasi-stiffness describes the intersegmental joint moment-angle relationship throughout the progression of a task. Previous work has explored sagittal-plane ankle quasi-stiffness and its application for the development of powered lower-limb assistive devices. However, frontal-plane quasi-stiffness remains largely unexplored but has important implications for the development of exoskeletons since clinical populations often walk with wider steps and rely on frontal-plane balance recovery strategies at the hip and ankle. This study aimed to characterize frontal-plane hip and ankle quasi-stiffness during walking and determine how step width affects quasi-stiffness in both the frontal and sagittal planes. Kinematic and kinetic data were collected and quasi-stiffness values computed for healthy young adults (n = 15) during treadmill walking across a range of step widths. We identified specific subphases of the gait cycle that exhibit linear and quadratic frontal-plane quasi-stiffness approximations for the hip and ankle, respectively. In addition, we found that at wider step widths, sagittal-plane ankle quasi-stiffness increased during early stance (∼12-35% gait cycle), sagittal-plane hip quasi-stiffness decreased in late stance (∼40-55% gait cycle) and frontal-plane hip quasi-stiffness decreased during terminal stance (∼48-65% gait cycle). These results provide a framework for further exploration of frontal-plane quasi-stiffness, lend insight into how quasi-stiffness may relate to balance control at various step widths, and motivate the development of stiffness-modulating assistive devices to improve balance related outcomes.
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Affiliation(s)
- Stephanie L Molitor
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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17
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Devi M. Exploring research trends and focal points in the application of transcranial magnetic stimulation for enhancing motor function in post-stroke patients: A bibliometric and content analytical approach. Injury 2023; 54:111116. [PMID: 37880033 DOI: 10.1016/j.injury.2023.111116] [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: 08/19/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Motor impairment is a significant health concern among post-stroke patients. Transcranial magnetic stimulation (TMS) is considered as an emerging rehabilitation therapy for various neurological conditions, and the effects of excitatory TMS on post-stroke have received much attention in past decade. However, the future hotspots and content analysis on the growth trends have not been studied. This bibliometric and content analysis aimed to study the global developmental history and current status of TMS for motor function of post-stroke from January 2004 to July 2023. METHODS Literature published on Scopus database from January 2004 to July 2023 were searched. Extracted data was analysed using the R studio and VOS viewer for author's publication, institutions, sources, keyword co-occurrence and world network analysis. Keyword cluster analysis, co-citation analysis for references and content analysis were also performed. We screened top 10 most cited or collaborative areas for publications, institutions and sources in the field of TMS associated with motor function of post-stroke. RESULTS In this study, a comprehensive analysis of 267 publications was conducted, revealing a substantial surge in research output throughout 2022. China emerged as the leading contributor, with 409 publications, followed by the United States with 211 publications. Notably, Harvard Medical School stood out as one of the most prolific institutions, accounting for 34 publications (13.12 %). Among researchers, Abo M garnered the highest publication count, with 9 articles (14.5 %). The Word cloud showed that motor function, repetitive transcranial magnetic stimulation (rTMS) and upper limb have been the focus of recent attention. Burst keywords on thematic evolution and topic trend shows that quality of life scale, network parameters, cognition, lower limb motor function are the future trends. CONCLUSION This bibliometric study describes that TMS has shown promising results in improving motor function of upper extremity in stroke patients, the long-term effects and durability of these improvements are still being investigated. Future research might focus on understanding the optimal duration and frequency of TMS sessions for sustained motor recovery and exploring strategies to maintain gains achieved through TMS over extended periods of time. Future studies can investigate the changes in the lower limb motor function.
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Affiliation(s)
- Manju Devi
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001, India.
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18
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Mollaelahi F, Shahali S. The Effect of Modified Buerger-Allen Exercises on Lower Extremities Edema in Late Pregnancy: Randomized Clinical Trial. J Obstet Gynaecol India 2023; 73:488-495. [PMID: 38205103 PMCID: PMC10774471 DOI: 10.1007/s13224-023-01850-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 01/12/2024] Open
Abstract
Background Lower limbs edema is one of the common problems in late pregnancy. This study aimed to determine the effect of modified Berger-Allen exercises on lower limb swelling in late pregnancy. Materials and Methods This randomized clinical trial was conducted on 105 pregnant women suffering from lower limbs edema. Samples were randomly placed in three groups: modified Buerger-Allen exercises for five days, modified Buerger-Allen exercises for ten days, and the control group. Foot circumferences and volume and pain were measured before and after the study. Results There was a significant difference between the average of right and left ankle circumference, right and left heel circumference, right and left foot circumference, left foot volume and pain score after the 5-day intervention group (p < 0.05). In the 10-day intervention group, there was a significant difference in all averages of ankles, heels, foot circumference and volume, and pain score 10 days after the intervention, compared to before the intervention (p < 0.05). Conclusion Performing innovative modified Buerger-Allen exercises in pregnant women with lower limbs edema may reduce their pain and swelling. It can also reduce the leg areas in pregnant women with lower limb edema in late pregnancy. Trial registration Approval number from Iranian Registry of Clinical Trials: IRCT20200713048096N1 (Registration date: 2020-11-12).
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Affiliation(s)
- Fatemeh Mollaelahi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, PO Box: 14115-111, Tehran, Iran
| | - Shadab Shahali
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, PO Box: 14115-111, Tehran, Iran
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19
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Mansi MK, Chockalingam N, Chatzistergos PE. An exploration of the mechanistic link between the enhanced paper grip test and the risk of falling. Foot (Edinb) 2023; 57:102059. [PMID: 37926054 DOI: 10.1016/j.foot.2023.102059] [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: 09/26/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
The enhanced paper grip test (EPGT) offers an easy-to-use measure of hallux plantar-flexion strength that does not need expensive specialised equipment. Literature suggests that it could be a useful screening tool to assess the risk of falling in older people. However, research on a specific mechanistic link to the risk of falling is lacking. It is hypothesised here that muscle weakening (assessed by the EPGT) is indicative of impaired ability to recover balance after a slip or a trip. To get an initial assessment of validity of the above hypothesis, the EPGT is compared against an established lab-based measure of lower-limb strength that is capable of assessing a person's ability to recover balance after a slip or a trip: maximum isometric leg press push-off force (leg press force). A gender-balanced sample of twenty people (median age=34 y) was recruited. Two different but equaly valid techniques of administering the EPGT were included regarding whether the participants' ankle was supported by the examiner or not. Results for the two EPGT techniques differed susbtantialy but they were both significantly associated with leg press force and therefore linked to better ability to maintain balance after a slip or a trip. The "ankle not held" EPGT technique was more strongly correlated to leg press force (r(18) = 0.652, p = 0.002) than the "ankle held" (r(18) = 0.623, p = 0.003) and appears to be the more favourable technique to administer the EPGT. These findings offer new insight on a potential mechanistic link between the EPGT and the risk of falling and support its optimal use in future research involving older people.
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Affiliation(s)
- Mahmoud K Mansi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK.
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20
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Tseng YT, Tsai CL, Chen FC. Motion sense sensitivity of the ankle is abnormal and correlated with motor performance in children with and without a probable developmental coordination disorder. Hum Mov Sci 2023; 92:103157. [PMID: 37956544 DOI: 10.1016/j.humov.2023.103157] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/26/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
This study systematically examined ankle motion sense sensitivity and its relation to motor functions in children with and without a probable developmental coordination disorder (pDCD). Seventy-two children aged 10-11 years were recruited, including thirty-six children with pDCD and 36 age- and sex-matched typically developing (TD) children. Children placed their dominant foot on a passive ankle motion apparatus that induced plantar flexion of the ankle under nine constant velocities ranging between 0.15 and 1.35°/s. The adjusted movement detection time (ADT) to passive ankle motion was obtained to measure ankle motion sense sensitivity. The results showed that, in comparison to that in the TD group, ankle ADT was significantly increased by 22-59% for the range of velocities in the pDCD group. A correlation analysis showed that mean ADTs were significantly correlated with the manual dexterity (r = -0.33, p = 0.005) and balance (r = -0.24, p = 0.046) scores on the Movement Assessment Battery for Children (MABC-2) in the combined group. Similar correlations were found between the ADTs and the manual dexterity (r = -0.37, p = 0.028) and total motor (r = -0.34, p = 0.047) scores in the TD group. This study documents that ankle motion sense sensitivity to passive foot motion is reduced and is likely to contribute to poor motor performance in children with and without pDCD.
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Affiliation(s)
- Yu-Ting Tseng
- Department of Kinesiology, National Tsing Hua University, Hsinchu City, Taiwan; Research Center for Education and Mind Sciences, National Tsing Hua University, Hsinchu City, Taiwan.
| | - Chia-Liang Tsai
- Institutes of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan City, Taiwan
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, Kaohsiung City, Taiwan
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21
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Alyousef YS, Ross MH, Johnston V, Smith MD. Experiences of Working with Lower Limb Osteoarthritis: A Qualitative Study. J Occup Rehabil 2023:10.1007/s10926-023-10158-8. [PMID: 37995059 DOI: 10.1007/s10926-023-10158-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Pain and disability associated with lower limb osteoarthritis (OA) may contribute to difficulties at work. This study aimed to understand the perspectives of workers with lower limb OA on difficulties, concerns, and coping strategies used at work. METHODS Twenty-two individuals with lower limb OA who were working in paid employment participated in semi-structured interviews. Data were qualitatively analyzed using an inductive thematic approach. Codes were identified and refined through review of interview transcripts and discussion with the research team. RESULTS Six themes were identified in relation to experiences working with lower limb OA. Themes were as follows: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three themes were identified relating to strategies to manage at work: adjustments at work help manage pain and avoid exacerbations; regular strategies to manage pain; and healthcare professionals are consulted, but usually not specifically for work. CONCLUSIONS Workers with lower limb OA experience physical and emotional difficulties at work that can impact work performance. Workers are concerned about longevity and job security and use a range of strategies to manage symptoms and remain at work. Employers, employees, and healthcare professionals may need to work together to create workplace accommodations to help workers with lower limb OA confidently remain in work.
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Affiliation(s)
- Yousef S Alyousef
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
- College of Applied Medical Sciences, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Megan H Ross
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Michelle D Smith
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia.
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22
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Manewell SM, Rao P, Haneman K, Zheng M, Charaf H, Menz HB, Sherrington C, Paul SS. Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review. J Foot Ankle Res 2023; 16:81. [PMID: 37986004 PMCID: PMC10659051 DOI: 10.1186/s13047-023-00679-z] [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: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Foot and lower limb health complications are common among patients undergoing dialysis; but a summary of prevention and management evidence is not available. The aim of this scoping review was to summarise study characteristics and the nature of results regarding strategies to prevent and manage peripheral arterial disease (PAD), foot ulceration, amputation, associated infection and associated hospital admission in adults undergoing dialysis. METHODS MEDLINE, Embase, CINAHL and AMED databases were searched for longitudinal experimental and observational studies. Eligible studies included adults undergoing dialysis (≥10 dialysis patients, with separate results or ≥ 75% of the cohort). Any interventions relating to PAD, foot ulceration, amputation, associated infection, and associated hospital admission were included. RESULTS The review included 212 studies, of which 199 were observational (94%) and 13 were experimental (6%). Sixteen studies (8%) addressed the prevention of foot and lower limb health complications, 43 (20%) addressed management, and 153 (72%) addressed both. The main intervention type in each study was surgery (n = 159, 75%), care from one or more health professionals (n = 13, 6%), screening by a health professional (n = 10, 5%), medication (n = 9, 4%) and rehabilitation (n = 5, 2%). No studies were identified where exercise, offloading or education were the main intervention. Results for PAD were reported in 137 (65%) studies, foot ulceration in 54 (25%), amputation in 171 (81%), infection in 7 (3%), and admission in 26 studies (12%). Results for more than one foot or lower limb outcome were reported in 141 studies (67%), with each study reporting on average two outcomes. Results varied and spanned positive, negative, and neutral outcomes following intervention. CONCLUSIONS Identified studies frequently aimed to both prevent and manage foot and lower limb health complications. A variety of interventions were identified and studies often reported results for more than one foot or lower limb health outcome. Findings from this review can be used to guide future research, with a goal to support improved patient outcomes.
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Affiliation(s)
- Sarah M Manewell
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia.
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia.
| | - Purnima Rao
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Keren Haneman
- Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Minjia Zheng
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia
| | - Hady Charaf
- Faculty of Podiatric Medicine, School of Health Sciences, Western Sydney University, NSW, Campbelltown, Australia
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney/Sydney Local Health District, NSW, Camperdown, Australia
| | - Serene S Paul
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia
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Messori M, Touloupakis G, Gilli A, Theodorakis E, Pozzi P, Ghirardelli S, Antonini G. The risk of infection in open distal tibial fracture: the DANGER score. Eur J Orthop Surg Traumatol 2023; 33:2965-2970. [PMID: 36917286 DOI: 10.1007/s00590-023-03517-x] [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] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/02/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Open fractures of the distal tibia can be functionally devastating, and they remain one of the most challenging injuries treated by trauma surgeons usually burdened with a high rate of complications, including surgical site infections (SSI). Our aim is to analyze the most significant risk factors of SSI and propose a new scoring system-called the DANGER scale-potentially able to predict reliably and quantify the infection risk in distal tibia open fractures. METHODS We identified six variables summarized in the acronym DANGER where D stands for Diabetes, A for Antibiotic, N for Nature of trauma (high- or low-energy trauma), G represents Grade of fracture following the AO/OTA classification, E indicates Exposure of the fracture according to the Gustilo-Anderson classification, and R represents Relative risk of patient, including use of tobacco, alcoholism, and psychiatric disorders. Therefore, total score ranged from 1 to 14, with a lower score indicating less risk to develop SSI. RESULTS A total of 103 patients with open distal tibial fractures were enrolled, 12 patients (11.6%) developed SSI. Regarding DANGER score, a rating of 8.2 was calculated in SSI group and 4.8 in non-SSI group. Based on Fisher's test, diabetes (odds = 31.8 p < 0.05), grade of articular involvement (p < 0.05), severity of open fracture (p < 0.05), and dangerous behavior such as use of tobacco, alcoholism, and psychiatric disorders (p < 0.05) were significantly correlated with infection. Significant difference between total DANGER scores in SSI and non-SSI groups was found (p < 0.001). ROC curve was calculated founding a potential threshold of 7.5 (p < 0.001). CONCLUSION Based on the above well-accepted risk factors, DANGER scale represents an advantageous and practical tool in order to readily estimate the risk of surgical site infection of open distal tibial fractures.
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Affiliation(s)
- Matteo Messori
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
- University of Milan, 20122, Milan, Italy.
| | - Georgios Touloupakis
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
- University of Milan, 20122, Milan, Italy
| | - Antonio Gilli
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
- University of Milan, 20122, Milan, Italy
| | - Emmanouil Theodorakis
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
- University of Milan, 20122, Milan, Italy
| | - Pierrenzo Pozzi
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
- University of Milan, 20122, Milan, Italy
| | - Stefano Ghirardelli
- Women's College Hospital, University Toronto Orthopedic Sports Medicine, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Guido Antonini
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy
- University of Milan, 20122, Milan, Italy
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Kakavas G, Giannakopoulos I, Tsiokanos A, Potoupnis M, Tsaklis PV. The Effect of Ball Heading and Subclinical Concussion On the Neuromuscular Control Of The Lower Limb: A Systematic Review. Int J Sports Phys Ther 2023; 18:1054-1064. [PMID: 37795323 PMCID: PMC10547093 DOI: 10.26603/001c.87922] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Soccer is unique among sports because it is the only sport that involves purposeful use of the head to control, pass, or shoot the ball. Over the previous five years, a relationship between lower extremity (LE) injury and sports related concussion (SRC) has been established in various sporting populations. Athletes at the high school, collegiate, and professional levels have demonstrated a greater risk for sustaining a LE injury post SRC. The purpose of this systematic review was to examine the relationship of the SRC with the incidence of LE injuries. Methods Ten databases were searched with the following keywords: Lower limb, ball heading, neuromuscular control, concussion, MEDLINE, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), EMBASE, and Scopus. The search was limited to English-language and peer-reviewed publications, until 15/12/2022. The PEDro scale was used for the assessment of the risk of bias among the included studies. All included papers were qualitatively analyzed. Results A total of 834 studies were identified and 10 articles (four concussion-MSK biomechanics, six concussion-MSK injury) were included in the qualitative analyses. Included papers ranged from low to high quality. Due to the heterogeneous nature of the included study designs, quantitative meta-analysis was unable to be performed. All four of the included concussion-MSK biomechanics studies demonstrated, to some degree, that worse cognitive performance was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. Among the six injury related studies, two investigations failed to determine group differences in cognitive performance between subsequently injured and non-injured athletes. Conclusion More research is needed to better understand the relationship of SRC and lower extremity injuries and the extent to which they are related to concussions and/or repetitive neurotrauma after ball heading sustained in soccer. Level of Evidence 2.
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Affiliation(s)
- Georgios Kakavas
- Fysiotek Spine and Sports Lab Athens, Greece
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
| | - Ioannis Giannakopoulos
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
| | - Athanasios Tsiokanos
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
| | | | - Panagiotis V Tsaklis
- Department of Physical Education and Sport Science, University of Thessaly, ErgoMech- Lab, Greece
- Department of Molecular Medicine and Surgery, Growth and Metabolism, Karolinska Institute, Sweden
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25
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Vitti LFR, Hanasilo CEH, Silva CM, Etchebehere M. Muscle strength and psychometric properties of the health-related quality of life in patients with soft tissue sarcoma resection in the thigh. Clinics (Sao Paulo) 2023; 78:100283. [PMID: 37783169 PMCID: PMC10562151 DOI: 10.1016/j.clinsp.2023.100283] [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: 02/22/2023] [Revised: 08/13/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. METHODS Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). RESULTS There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). CONCLUSIONS The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.
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Affiliation(s)
- Liza Furlan Ranzani Vitti
- Department of Orthopaedics and Traumatology, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil
| | - Carlos Eduardo Hideo Hanasilo
- Department of Orthopaedics and Traumatology, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil
| | - Cleide Moreira Silva
- Research Committee, Statistical Service, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil
| | - Mauricio Etchebehere
- Department of Orthopaedics and Traumatology, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil.
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Alyousef YS, Johnston V, Smith MD. Work-related outcomes in individuals with and without lower limb osteoarthritis: an online survey. BMC Public Health 2023; 23:1885. [PMID: 37773119 PMCID: PMC10540324 DOI: 10.1186/s12889-023-16723-3] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE While osteoarthritis (OA) affects people who are still participating in the workforce, there is limited data about the impact of OA on work. The aim of this study was to compare work participation in individuals with and without lower limb OA. METHODS This cross-sectional study included workers with (n = 124) and without (n = 106) lower limb OA. Work participation was assessed as work status (full/part time work), work ability (Work Ability Index (WAI)), absenteeism and presenteeism (World Health Organization's Health and Work Performance Questionnaire (WHO-HPQ)), and perceived difficulties meeting work demands (Work Role Functioning Questionnaire (WRFQ)). The data were analyzed using an analysis of covariance with age, body mass index and physical job demands included as covariates. RESULTS Work ability was poorer (p < 0.001) and loss of work performance (p < 0.001) was higher among workers with OA than healthy controls. There was no statistical difference in absenteeism or overall ability to meet work demands between participants with and without lower limb OA. However, workers with lower limb OA had more difficulty with work scheduling demands (p = 0.05) and physical demands (p = 0.003) than healthy workers. CONCLUSION Lower limb OA was associated with poorer work ability, loss of work performance and difficulty in meeting physical and work scheduling demands. Health professionals and employers should consider these challenges when managing individuals with lower limb OA and supporting them to remain in the workforce.
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Affiliation(s)
- Yousef S Alyousef
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Venerina Johnston
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
| | - Michelle D Smith
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia.
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Piñero-Madrona A, Cerezuela-Fuentes P, Ruiz-Merino G, Martínez-Barba E, Ortiz-Reina S, Martínez-Ortiz MJ, López-Ávila A, Frías-Iniesta JF, Viney A, Cabezas-Herrera J. Lower limb cutaneous melanoma surgery: location matters. Arch Dermatol Res 2023; 315:1971-1978. [PMID: 36862181 PMCID: PMC10366258 DOI: 10.1007/s00403-023-02571-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/21/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
The anatomical location of cutaneous melanoma is a relevant independent prognostic factor in melanoma. The aim of the study is to know the prognosis of lower limb cutaneous melanoma related to their location within the limb, regardless of the histological type, and if there are any other influencing variables. A real-world data observational study was developed. The lesions were divided depending on the location of the melanoma (thigh, leg and foot). Bivariate and multivariate analysis were performed, and melanoma-specific survival and disease-free survival rates were calculated. When these analysis were done, the results showed that, in melanomas of the lower limb, location on the foot presented a lower melanoma-specific survival rate compared to more proximal locations, and only the anatomical location presents statistical significance to discriminate cases with a higher mortality risk and a lower disease-free survival rate among distal melanomas (mainly on the foot). In conclusion, this study confirms that a more distal location of lower limb cutaneous melanoma is a relevant prognostic factor.Trial registration number NCT04625491 retrospectively registered.
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Affiliation(s)
- Antonio Piñero-Madrona
- Surgery Department, Hospital Clínico Universitario "Virgen de la Arrixaca", School of Medicine, University of Murcia, Campus de Ciencias de la Salud. Edificio Departamental, Office 4.27, 30120, Murcia, Spain.
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain.
| | - Pablo Cerezuela-Fuentes
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Medical Oncology Department, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
| | - Guadalupe Ruiz-Merino
- Biostatistics Department, Fundación para la Formación e Investigación Sanitaria de la Región de Murcia, Murcia, Spain
| | - Enrique Martínez-Barba
- Pathology Department, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
| | | | | | - Angel López-Ávila
- Dermatology Department, Complejo Hospitalario de Cartagena, Cartagena, Spain
| | - José F Frías-Iniesta
- Dermatology Department, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
| | - Alice Viney
- Pharmacy Department, Complejo Hospitalario de Cartagena, Cartagena, Spain
| | - Juan Cabezas-Herrera
- Research Department, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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Radler C. [External fixation for the correction of complex deformities : From the classic Ilizarov ring fixator to modern software-driven hexapod fixators]. Orthopadie (Heidelb) 2023; 52:710-718. [PMID: 37522930 DOI: 10.1007/s00132-023-04419-w] [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] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
The history and development of circular fixation is closely aligned with the history of limb lengthening. Gavriil A. Ilizarov not only developed his circular fixator, but he also was the first to research and publish on distraction osteogenesis. Progress and dissemination of the method was initially based on individual pioneers; a standardized nomenclature and annual courses led to a wider dissemination. The introduction of the Taylor spatial frame in 1997 was a game changer. Although various groups had already developed Hexapod-fixators, it was the TSF that hit the market and achieved market presence. After the patent for TSF expired, many companies developed hexapod fixators with various modifications. A new version of the TSF, the Smart TSF, which included an intuitive planning software, was introduced in Baltimore in 2021. The introduction of intramedullary lengthening nails at the beginning of the 2000s and the wide dissemination starting approximately 2013 rendered external fixation obsolete for certain indications. However, ring fixators are still the method of choice for complex reconstruction of deformity in traumatology, as well as in pediatric orthopedics in the presence of open growth plates.
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Affiliation(s)
- Christof Radler
- Abteilung für Kinderorthopädie und Fußchirurgie, Orthopädisches Spital Speising GmbH, Speisinger Str. 109, 1130, Wien, Österreich.
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Chen YN, Wu YN, Yang BS. The neuromuscular control for lower limb exoskeleton- a 50-year perspective. J Biomech 2023; 158:111738. [PMID: 37562276 DOI: 10.1016/j.jbiomech.2023.111738] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Historically, impaired lower limb function has resulted in heavy health burden and large economic loss in society. Although experts from various fields have put large amounts of effort into overcoming this challenge, there is still not a single standard treatment that can completely restore the lost limb function. During the past half century, with the advancing understanding of human biomechanics and engineering technologies, exoskeletons have achieved certain degrees of success in assisting and rehabilitating patients with loss of limb function, and therefore has been spotlighted in both the medical and engineering fields. In this article, we review the development milestones of lower limb exoskeletons as well as the neuromuscular interactions between the device and wearer throughout the past 50 years. Fifty years ago, the lower-limb exoskeletons just started to be devised. We review several prototypes and present their designs in terms of structure, sensor and control systems. Subsequently, we introduce the development milestones of modern lower limb exoskeletons and discuss the pros and cons of these differentiated devices. In addition, we summarize current important neuromuscular control systems and sensors; and discuss current evidence demonstrating how the exoskeletons may affect neuromuscular control of wearers. In conclusion, based on our review, we point out the possible future direction of combining multiple current technologies to build lower limb exoskeletons that can serve multiple aims.
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Affiliation(s)
- Yu-Ning Chen
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Taiwan
| | - Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, MA, USA; The New England Robotics Validation and Experimentation Center, University of Massachusetts Lowell, MA, USA
| | - Bing-Shiang Yang
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Taiwan; Biomechanics and Medical Application Laboratory, National Yang Ming Chiao Tung University; Mechanical and Mechatronics Systems Research Laboratories, Industrial Technology Research Institute, Taiwan; Taiwanese Society of Biomechanics, Taiwan.
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Wang AWT, Chhina H, Cooper AP. Multimodal Analgesia for Paediatric Patients Undergoing Lower Limb Reconstruction with External Fixators: A Prospective Case Series of Post-operative Pain and Functional Goals. Strategies Trauma Limb Reconstr 2023; 18:140-147. [PMID: 38404562 PMCID: PMC10891349 DOI: 10.5005/jp-journals-10080-1601] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 12/12/2023] [Indexed: 02/27/2024] Open
Abstract
Aim Limb reconstruction with external fixators requires appropriate pain management to promote effective analgesia and healing while minimising adverse events of the analgesic technique used. The objective of this prospective case series was to evaluate a multimodal analgesia regimen designed to reduce opioid requirements and hence reduce the opioid-related side effect profile. Materials and methods A prospective cohort of patients undergoing lower limb reconstruction surgery (LRS) were managed through an evidence-informed multimodal analgesia guideline (MMAG), including acetaminophen, pregabalin, dexmedetomidine, IV lidocaine, and opioids. Outcome measures included intraoperative and post-operative opioid administration, post-operative pain scores, time to achieve mobilisation milestones, and post-operative complications. Surveys were conducted to obtain patient reported experiences. Results 26 patients were included in this prospective case series. 110.59 (84.29, 162.13) (median, interquartile range) µg/kg/hr intraoperative IV morphine equivalent opioids were administered. In the first 48 hours post-operatively, patients received 11.49 (6.41, 19.35) µg/kg/hr of IV morphine equivalent dose. Median level of pain (0-10) in the first 48 post-operative hours was 2 (1, 2). Patients achieved mobilisation. And 19/20 patients surveyed reported 'yes' to having effective pain management; 17/20 patients had no unwanted side effects associated with analgesia medications. There were no cases of compartment syndrome. Conclusion This multimodal analgesia regime applied to patients undergoing lower LRS with external fixators demonstrates the feasibility of this analgesic regimen which revealed effective pain control, early mobilisation, with minimal side effects, but warrants further study. Clinical significance This study provides valuable evidence that this standardised multimodal anaesthesia and analgesia regimen is feasible, offers adequate post-operative comfort and encourages early mobilization while minimising opioid use and adverse events in a paediatric LRS population at our institution. How to cite this article Wang AWT, Chhina H, Cooper A. Multimodal Analgesia for Paediatric Patients Undergoing Lower Limb Reconstruction with External Fixators: A Prospective Case Series of Post-operative Pain and Functional Goals. Strategies Trauma Limb Reconstr 2023;18(3):140-147.
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Affiliation(s)
- Alice Wei Ting Wang
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Harpreet Chhina
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia; Department of Orthopaedic Surgery, BC Children's Hospital Vancouver, Canada
| | - Anthony P Cooper
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia; Department of Orthopaedic Surgery, BC Children's Hospital Vancouver, Canada
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Pérez F, Rubia ADL, Cañadas E, Lorenzo-Calvo J, Marquina M, García-Sánchez C. Musculoskeletal injury prevalence in professional padel players. A retrospective study of the 2021 season. Phys Ther Sport 2023; 63:9-16. [PMID: 37413954 DOI: 10.1016/j.ptsp.2023.06.003] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To investigate the influence of the gender, ranking and playing position on the musculoskeletal injuries in professional padel players. DESIGN An epidemiological, observational, descriptive, retrospective cross-sectional study. PARTICIPANTS 44 injuries were reported by 36 players (20 men/16 women) who participated in the World Padel Tour 2021. SETTING Online questionnaire. MAIN OUTCOME MEASURE Descriptive statistics and injury prevalence were calculated. Spearman/Pearson correlations between sample characteristics and injury variables were calculated. The chi-square test was used to analyse the association between injury and descriptive variables. A Mann-Whitney U test was performed to compare the group differences with regard to days of absence. RESULTS The results showed different injury prevalence (x1000 matches) in male (10.50) and female players (15.10). A higher injury incidence in top-ranked players, both in male (44.40%) and female (58.33%) was identified, but the low-ranked players reported more severe injuries (>28 days) (p < 0.05). Top-ranked players suffered more muscle injuries (p < 0.01) and low-ranked players suffered more tendon injuries (p < 0.01). Gender, ranking and playing position did not influence the days of absence (p > 0.05). CONCLUSIONS This study confirms that gender and ranking position had an impact on the injury prevalence in professional padel players.
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Affiliation(s)
- Fernando Pérez
- Deporte y Entrenamiento Research Group, Departamento de Deportes, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040, Madrid, Spain
| | - Alfonso de la Rubia
- Deporte y Entrenamiento Research Group, Departamento de Deportes, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040, Madrid, Spain
| | - Enrique Cañadas
- Deporte y Entrenamiento Research Group, Departamento de Deportes, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040, Madrid, Spain
| | - Jorge Lorenzo-Calvo
- Deporte y Entrenamiento Research Group, Departamento de Deportes, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040, Madrid, Spain
| | - Moisés Marquina
- Deporte y Entrenamiento Research Group, Departamento de Deportes, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040, Madrid, Spain
| | - Carlos García-Sánchez
- Deporte y Entrenamiento Research Group, Departamento de Deportes, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, C/Martín Fierro 7, 28040, Madrid, Spain.
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Liu W, Chen J. The efficacy of exoskeleton robotic training on ambulation recovery in patients with spinal cord injury: A meta-analysis. J Spinal Cord Med 2023:1-10. [PMID: 37534920 DOI: 10.1080/10790268.2023.2214482] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To discuss the efficacy of exoskeleton robotic training on ambulation recovery in patients with spinal cord injury (SCI). METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched systematically from their inception to April 2022 for studies on exoskeleton robotic training in patients with SCI. The language was restricted to English. The retrieved studies were screened to select eligible clinical trials. Meta-analysis was performed using Review Manager 5.4. RESULTS Eleven randomized clinical trials (RCTs) involving 456 participants were included in the meta-analysis. The results of the meta-analysis showed that exoskeleton robotic training was more effective in improving FIM [SMD = 0.58, 95%CI = (0.07, 1.10), P = 0.03], LEMS [MD = 4.64, 95%CI = (3.58, 5.70), P<0.05], MAS [MD = 0.76, 95%CI = (0.48, 1.03), P<0.05] and BBS [MD = -3.11, 95%CI = (-12.59, 6.36), P<0.05] in patients with SCI, compared to conventional gait training(CGT). Subgroup analysis showed that the exoskeleton robotic could significantly improve the walking endurance and walking speed of patients with a duration of injury within 6 months. The sensitivity of inverted funnel plot analysis is low, suggesting that the analysis results of this study are relatively stable. CONCLUSION Exoskeleton robotic training improves ambulation in patients with SCI, especially for patients with a course of injury within six months.
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Affiliation(s)
- Wentan Liu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, People's Republic of China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053 Hangzhou, Zhejiang, People's Republic of China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013 Hangzhou, Zhejiang, People's Republic of China
- Neurorehabilitation Department, Zhejiang Rehabilitation Medical Center, 310053 Hangzhou, Zhejiang, People's Republic of China
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Colyn W, Vanbecelaere L, Bruckers L, Scheys L, Bellemans J. The effect of weight-bearing positions on coronal lower limb alignment: A systematic review. Knee 2023; 43:51-61. [PMID: 37271072 DOI: 10.1016/j.knee.2023.05.004] [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: 06/25/2022] [Revised: 03/30/2023] [Accepted: 05/06/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The coronal alignment of the lower limb is generally accepted as a major determinant of surgical outcome in total knee arthroplasty (TKA). To achieve the ideal post-operative alignment, surgeons need to be aware of the influence that weight-bearing positions have on the final knee alignment. Therefore, this review aims to define the effect of varying weight-bearing positions on the coronal alignment of the lower limb. We hypothesized that a coronal alignment deformity increases with loading. METHODS The PubMed, Medline and google scholar databases were searched systematically in June 2022. Only studies which compared coronal alignment with a standardized radiographic protocol in the single leg, double leg and supine positions were included. To obtain pooled estimates of the effect of different weight-bearing positions, random-effect analysis were fitted using SAS. RESULTS Compared to the supine position, double leg weight-bearing positions were found to be associated with a more pronounced varus deformity (mean difference in HKA is 1,76° (95% CI 1,32: 2,21), p < 0.0001)). The mean difference in HKA between double leg and single leg weight-bearing conditions was 1.43° (95% CI (-0,042;2,90), p = 0.0528). CONCLUSION The overall knee alignment was found to be influenced by the weight-bearing position. An average difference of 1.76° in HKA-angle was found between a double leg-stance and supine position, tending to increased varus in the former weight-bearing position. It is therefore possible that the deformity could increase by 1.76° if knee surgeons only follow a pre-op planning based on double-leg stance full length radiographs.
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Affiliation(s)
- William Colyn
- Dept. of Orthopedic Surgery, AZ Turnhout, Turnhout, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Ziekenhuis Oost-Limburg, Dept. Future Health, Genk, Belgium.
| | - Lukas Vanbecelaere
- Dept. of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Lennart Scheys
- Dept. of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johan Bellemans
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Dept. of Orthopedic Surgery, ZOL Genk, Genk, Belgium; GRIT Belgian Sports Clinic, Leuven, Belgium
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Asséré YAGRA, Kaba L, Assi-Dje Bi Dje V, Akpro LR. [Elephantiasis of the lower limb: Treatment of seven cases using the modified Charles technique]. ANN CHIR PLAST ESTH 2023; 68:354-360. [PMID: 35927107 DOI: 10.1016/j.anplas.2022.06.010] [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] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Lymphedema is an obstructive dysfunction of the lymphatic system characterised by an inability of the lymphatic system to eliminate excess lymphatic load. It can be congenital or secondary. Untreated, it progresses in three stages, the final stage being elephantiasis. We report a short series of 7 cases of elephantiasis of the lower limb treated with the Charles technique. Our aim was to describe the results of the surgical treatment. METHOD This was a retrospective descriptive and analytical study from January 2010 to December 2020. Patients with at least one lower limb elephantiasis of any aetiology of any age and gender who underwent excisional surgery with a complete medical record containing clinical and therapeutic data were included. RESULTS During the study period, we received 710 patients with a prevalence of elephantiasis of 1.69%. The mean age was 43.3±14.5years with a male predominance. No etiology or co-morbidity factors (diabetes, hypertension, VRS) were found. In our mini-series, the average time between the two procedures was 34.3±9.6days. The mean time to healing was 82.3±15.1days. All patients healed with two excellent results. CONCLUSION excisional surgery with two-stage repair combined with compression therapy gave satisfactory results.
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Affiliation(s)
- Y A G R A Asséré
- Service de chirurgie réparatrice, plastique et de la main de l'Institut Raoul Follereau Adzopé, Cote d'Ivoire.
| | - L Kaba
- Service de chirurgie réparatrice, plastique et de la main de l'Institut Raoul Follereau Adzopé, Cote d'Ivoire.
| | - V Assi-Dje Bi Dje
- Service de chirurgie plastique, de la main et brulologie du CHU de Treichville, Abidjan.
| | - L R Akpro
- Service de traumatologie-orthopédie et chirurgie réparatrice du CHU de Bouaké.
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Nascimento MB, Vilarinho LG, Lobato DFM, Dionisio VC. Role of gluteus maximus and medius activation in the lower limb biomechanical control during functional single-leg Tasks: A systematic review. Knee 2023; 43:163-175. [PMID: 37422984 DOI: 10.1016/j.knee.2023.05.005] [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: 02/06/2023] [Revised: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Single-leg (SL) tasks are included as assessment and intervention strategies in several dysfunctions due to the inherent motor control requirement. The recruitment of gluteus maximus (GMAX) and medius (GMED) muscles is essential for proper biomechanical control of the knee and hip joints. The study aims to identify the role of gluteal activation in the biomechanical control of the lower limb during SL tasks. METHODS This is a systematic review with searches performed in Pubmed, CINAHL, MEDLINE, Web of Science, and Sportdiscus databases. Cross-sectional studies carried out with asymptomatic individuals were selected, containing hip and knee kinematic and kinetic outcomes assessed through 3D or 2D movement analysis and EMG activity of GMED and GMAX muscles. Two independent reviewers performed the procedures to select the studies, determine the methodological quality and extract the data. RESULTS The initial search resulted in 391 studies, and after the assessment procedures, 11 studies were included. Lower GMAX activation was associated with greater hip internal rotation (HIR) excursion and greater HIR moment, and lower GMED activation was associated with greater hip adduction (HAD)/knee abduction (KAB) excursions and greater KAB moment during single-leg squat (SLS). CONCLUSIONS The SL tasks showed a relevant association between the gluteal EMG and other biomechanical outcomes, mainly the SLS task. Interpretation must be cautious, as most studies present high and moderate methodological quality, especially on kinetic data.
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Affiliation(s)
- Matheus Batista Nascimento
- Federal University of Uberlândia - UFU, Faculty of Physical Education and Physiotherapy- FAEFI, Uberlândia, Minas Gerais, Brazil.
| | - Lucas Gois Vilarinho
- Federal University of Uberlândia - UFU, Faculty of Physical Education and Physiotherapy- FAEFI, Uberlândia, Minas Gerais, Brazil
| | | | - Valdeci Carlos Dionisio
- Federal University of Uberlândia - UFU, Faculty of Physical Education and Physiotherapy- FAEFI, Uberlândia, Minas Gerais, Brazil
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Song K, Hullfish TJ, Scattone Silva R, Silbernagel KG, Baxter JR. Markerless motion capture estimates of lower extremity kinematics and kinetics are comparable to marker-based across 8 movements. J Biomech 2023; 157:111751. [PMID: 37552921 PMCID: PMC10494994 DOI: 10.1016/j.jbiomech.2023.111751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/23/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
Motion analysis is essential for assessing in-vivo human biomechanics. Marker-based motion capture is the standard to analyze human motion, but the inherent inaccuracy and practical challenges limit its utility in large-scale and real-world applications. Markerless motion capture has shown promise to overcome these practical barriers. However, its fidelity in quantifying joint kinematics and kinetics has not been verified across multiple common human movements. In this study, we concurrently captured marker-based and markerless motion data on 10 healthy study participants performing 8 daily living and exercise movements. We calculated the correlation (Rxy) and root-mean-square difference (RMSD) between markerless and marker-based estimates of ankle dorsi-plantarflexion, knee flexion, and three-dimensional hip kinematics (angles) and kinetics (moments) during each movement. Estimates from markerless motion capture matched closely with marker-based in ankle and knee joint angles (Rxy ≥ 0.877, RMSD ≤ 5.9°) and moments (Rxy ≥ 0.934, RMSD ≤ 2.66 % height × weight). High outcome comparability means the practical benefits of markerless motion capture can simplify experiments and facilitate large-scale analyses. Hip angles and moments demonstrated more differences between the two systems (RMSD: 6.7-15.9° and up to 7.15 % height × weight), especially during rapid movements such as running. Markerless motion capture appears to improve the accuracy of hip-related measures, yet more research is needed for validation. We encourage the biomechanics community to continue verifying, validating, and establishing best practices for markerless motion capture, which holds exciting potential to advance collaborative biomechanical research and expand real-world assessments needed for clinical translation.
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Affiliation(s)
- Ke Song
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Todd J Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Rodrigo Scattone Silva
- Department of Physical Therapy, University of Delaware, Newark, DE, USA; Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Josh R Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Heitzmann DWW, Block J, Trinler U, Wolf SI, Alimusaj M. [Motion analysis in lower limb exoprosthetics-possibilities and limitations]. Orthopadie (Heidelb) 2023:10.1007/s00132-023-04408-z. [PMID: 37458809 DOI: 10.1007/s00132-023-04408-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Gait analysis is of high relevance in prosthetics as it is an essential part of the fitting process. The documentation of movement by means of videos and instrumented methods is becoming increasingly important in prosthetics as benefits of a complex prosthesis can best be shown by structured observation. PROCEDURE A movement analysis should always be preceded by an anamnesis and clinical examination in order to detect functional limitations of the examined person and thus to establish correlations to gait deviations. Additionally, the orthopaedic aid should be evaluated as well. In addition to walking on level ground, walking on everyday obstacles such as stairs and ramps is also of interest when observing people using prosthetic limbs. Functional tests can be used to determine the functional status more comprehensively. An instrumental-3D gait analysis is indicated for specific questions, especially regarding kinetic parameters.
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Affiliation(s)
- Daniel Walter Werner Heitzmann
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
| | - Julia Block
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Sebastian I Wolf
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Merkur Alimusaj
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
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Cassidy RP, Lunt KM, Coppack RJ, Bennett AN, Bilzon JLJ, Mcguigan MP, Egginton N, Sellon E, Day J, Ladlow P. ADAPTations to low load blood flow restriction exercise versus conventional heavier load resistance exercise in UK military personnel with persistent knee pain: protocol for the ADAPT study, a multi-centre randomized controlled trial. BMC Musculoskelet Disord 2023; 24:580. [PMID: 37461024 DOI: 10.1186/s12891-023-06693-3] [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: 02/22/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Muscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual's one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to 'conventional' heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain. METHODS This is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18-55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study. DISCUSSION LL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI. TRIAL REGISTRATION ClinicalTrials.org reference number, NCT05719922.
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Affiliation(s)
- Robyn P Cassidy
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Kieran M Lunt
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Russell J Coppack
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James L J Bilzon
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Natalie Egginton
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK
| | - Edward Sellon
- Royal Centre for Defence Medicine (RCDM), Birmingham, UK
- Radiology Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Jo Day
- Radiology Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK.
- Department for Health, University of Bath, Bath, UK.
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Dong X, Zhang X, Yu X, Meng X, Zhang K, Chen X, Guo L, Wang Z. Investigating Risk Factors and Magnetic Resonance Imaging (MRI)-Based Grading of Subchondral Incomplete Fracture (SIF) of Medial Femoral Condyle. Curr Med Imaging 2023:CMIR-EPUB-132746. [PMID: 37403399 DOI: 10.2174/1573405620666230704092752] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Subchondral insufficiency fractures (SIF) of the knee joint are prevalent in osteoporosis patients over the age of 55. Early diagnosis of SIF fracture of the medial femoral condyle is crucial for delaying disease progression, early therapy, and potential disease reversal. Magnetic resonance imaging (MRI) is useful in detecting SIF, which is often undetectable on initial radiographs. This study aimed at developing a grading system for subchondral insufficiency fractures (SIF) based on MRI to predict outcomes and evaluate risk factors. METHODS In this study, MRI was used to examine SIF risk variables in the medial condyle of the femur to help clinicians diagnose, treat, and delay the condition. A total of 386 patients with SIF from 2019 to 2021 were retrospectively analyzed and divided into 106 patients in the disease group and 280 patients in the control group according to whether they had SIF. The lesion site, meniscus, ligament, and other parameters were evaluated and compared. At the same time, a grading system was introduced to stratify and statistically analyze the size of the lesion area, the degree of bone marrow edema (BME), meniscus tears, and other parameters in the patients. RESULTS Most SIF were low-grade (LG) fractures, and the predictors of LG and high-grade (HG) fractures included heel tear (P =0.031), degree of medial malleolus degeneration (P < 0.001), advanced age (P < 0.001), and lesion size (P < 0.001). The prognostic factors that showed significant differences between the two groups included age (P =0.027), gender (P =0.005), side (P =0.005), medial tibial plateau injury (P < 0.0001), femoral medullary bone marrow edema (P < 0.0001), medial tibial plateau bone marrow edema (P < 0.0001), meniscus body partial injury (P =0.016), heel tear (P =0.001), anterior cruciate ligament injury (P =0.002), and medial collateral ligament injury (P < 0.0001). CONCLUSION This current study proposed an MRI-based grading system for inferior condylar fractures of the femur, in which HG inferior condylar fractures are associated with severe medial malleolus degeneration, advanced age, lesion size (correlation), and meniscus heel tears.
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Affiliation(s)
- Xiaoman Dong
- Department of Radiology,Tianjin Hospital,No. 406 Jiefang South Road, Hexi District,Tianjin 300211 China
| | - Xiaoguang Zhang
- Department of Radiology,Tianjin Hospital,No. 406 Jiefang South Road, Hexi District,Tianjin 300211 China
| | - Xiaokun Yu
- Department of Radiology,The Fifth Central Hospital of Tianjin, No.41 Zhejiang Road, Binhai New District, Tianjin 300450 China
| | - Xianghong Meng
- Department of Radiology,Tianjin Hospital,No. 406 Jiefang South Road, Hexi District,Tianjin 300211 China
| | - Kaihui Zhang
- Department of Minimally Invasive Spine Surgery,Tianjin Hospital,No. 406 Jiefang South Road, Hexi District,Tianjin 300211 China
| | - Xiao Chen
- Department of Sports Injury and Arthroscopy, Tianjin Hospital, No. 406 Jiefang South Road, Hexi District ,Tianjin 300211, China
| | - Lin Guo
- Department of Radiology,Tianjin Hospital,No. 406 Jiefang South Road, Hexi District,Tianjin 300211 China
| | - Zhi Wang
- Department of Radiology,Tianjin Hospital,No. 406 Jiefang South Road, Hexi District,Tianjin 300211 China
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Walsh JA, Bos S, McAndrew DJ, Stapley PJ. Can eccentric cycling be used to treat patellar tendinopathy? Br J Sports Med 2023; 57:832-833. [PMID: 36963806 DOI: 10.1136/bjsports-2022-106498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Affiliation(s)
- Joel A Walsh
- Faculty of Science, Medicine and Health, University of Wollongong School of Medical Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| | - Sophie Bos
- Independent Occupational Therapy, University of Wollongong-Innovation Campus, North Wollongong, New South Wales, Australia
| | - Darryl J McAndrew
- Faculty of Science, Medicine and Health, University of Wollongong Graduate School of Medicine, Wollongong, New South Wales, Australia
| | - Paul J Stapley
- Faculty of Science, Medicine and Health, University of Wollongong School of Medical Indigenous and Health Sciences, Wollongong, New South Wales, Australia
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Berner JE, Ali SR, Will PA, Tejos R, Nanchahal J, Jain A. Standardising the management of open extremity fractures: a scoping review of national guidelines. Eur J Orthop Surg Traumatol 2023; 33:1463-1471. [PMID: 35819519 PMCID: PMC10276057 DOI: 10.1007/s00590-022-03324-w] [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] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Open extremity fractures can be life-changing events. Clinical guidelines on the management of these injuries aim to standardise the care of patients by presenting evidence-based recommendations. We performed a scoping systematic review to identify all national clinical practice guidelines published to date. MATERIALS AND METHODS A PRISMA-compliant scoping systematic review was designed to identify all national or federal guidelines for the management of open fractures, with no limitations for language or publication date. EMBASE and MEDLINE database were searched. Article screening and full-text review was performed in a blinded fashion in parallel by two authors. RESULTS Following elimination of duplicates, 376 individual publications were identified and reviewed. In total, 12 clinical guidelines were identified, authored by groups in the UK, USA, the Netherlands, Finland, and Malawi. Two of these focused exclusively on antibiotic prophylaxis and one on combat-related injuries, with the remaining nine presented wide-scope recommendations with significant content overlap. DISCUSSION Clinical practice guidelines serve clinicians in providing evidence-based and cost-effective care. We only identified one open fractures guideline developed in a low- or middle-income country, from Malawi. Even though the development of these guidelines can be time and resource intensive, the benefits may outweigh the costs by standardising the care offered to patients in different healthcare settings. International collaboration may be an alternative for adapting guidelines to match local resources and healthcare systems for use across national borders.
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Affiliation(s)
- Juan Enrique Berner
- Kellogg College, University of Oxford, Oxford, UK.
- Plastic Surgery Department, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd., E1 1FR, London, UK.
| | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Patrick A Will
- BG Klinik Ludwigshafen, Ludwigshafen Am Rhein, Germany
- Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Rodrigo Tejos
- Sección de Cirugía Plástica y Reconstructiva. Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abhilash Jain
- Imperial College Healthcare NHS Trust, London, UK
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Rauer T, Friedl E, Gamble JG, Zelle BA, Pape HC, Pfeifer R. Long-term analysis of chronic pain associated with lower extremity injuries. Arch Orthop Trauma Surg 2023; 143:4149-4154. [PMID: 36454306 PMCID: PMC10293374 DOI: 10.1007/s00402-022-04717-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The main objective of this study is to examine chronic pain and limping in relation to lower extremity and pelvic fracture location in addition to fracture combinations if multiple fractures are present on the same leg that have not been previously reported. We hypothesize that fracture pattern and location of lower extremity and pelvis fractures of multiple injured patients influence their long-term pain outcome. MATERIALS AND METHODS Retrospective cohort study. Patients with treated multiple lower limb and pelvic fractures at a level 1 trauma center and followed up for at least 10 years postinjury were assessed. Lower leg pain subdivided into persistent, load-dependent and intermittent pain, as well as limping were recorded by using self-administered patient questionnaires and standardized physical examinations performed by a trauma surgeon. Descriptive statistics were used to present comparative measurements between groups. RESULTS Fifty-seven percent of patients (n = 301) showed chronic lower limb pain 10 years postinjury. Ten percent of all patients with chronic pain displayed persistent pain, and here the most common fracture combination was tibial shaft fractures in combination with femoral shaft or proximal tibial fractures (13%). One hundred fifty-one patients reported load-dependent pain, with the most common fracture combinations being fractures of the foot in combination with femoral shaft fractures or distal tibial fractures (11%). One hundred twenty patients reported intermittent pain, with the most common fracture combinations involving the shaft of the tibia with either the femoral shaft or distal tibia (9%). Two hundred fifteen patients showed a persistent limp, and here the most common fractures were fractures of the femoral shaft (19%), tibial shaft (17%), and pelvis (15%). CONCLUSIONS In multiple injured patients with lower extremity injuries, the combination of fractures and their location are critical factors in long-term outcome. Patients with chronic persistent or load-dependent pain often had underlying femoral shaft fractures in combination with joint fractures.
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Affiliation(s)
- Thomas Rauer
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland.
| | - Eva Friedl
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
| | | | - Boris A Zelle
- Department of Orthopedics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
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Guízar-Sánchez C, Hernández-Díaz C, Guízar-Sánchez D, Meza-Sánchez AV, Torres-Serrano A, Camacho Cruz ME, Ventura-Ríos L. Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy. BMC Musculoskelet Disord 2023; 24:512. [PMID: 37349815 DOI: 10.1186/s12891-023-06610-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison. OBJECTIVE A retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers. SETTING Paediatric Rehabilitation Hospital in Mexico City, from August to November 2018. PARTICIPANTS 21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls). CHARACTERISTICALLY DATA Sociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips. RESULTS All children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus. CONCLUSION Though possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.
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Affiliation(s)
- Claudia Guízar-Sánchez
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | | | - Diana Guízar-Sánchez
- Physiology Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, México, Av. Universidad 3004, Col. Copilco Universidad, Alcaldía Coyoacán, Cd. Universitaria.
| | - Ana Victoria Meza-Sánchez
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán., Ciudad de México, México
| | - Alejandra Torres-Serrano
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - María Elena Camacho Cruz
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - Lucio Ventura-Ríos
- Rheumatology Department, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, México
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DelMastro HM, Simaitis LB, Gromisch ES, Gomes K, Ruiz JA. Establishment of regression-based normative isometric strength values for major lower limb muscle groups in persons with multiple sclerosis. Mult Scler Relat Disord 2023; 75:104772. [PMID: 37247487 DOI: 10.1016/j.msard.2023.104772] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Limb weakness is a major impairment that affects mobility in persons with multiple sclerosis (PwMS). Specifically, lower limb (LL) weakness can greatly affect gait and balance, while increasing fall risk and decreasing quality of life. Numerous studies have compared LL strength of PwMS to healthy controls, however none have objectively measured strength in all major LL joints (hip, knee, and ankle) in a large number of PwMS. Additionally, while discrete normative values exist for knee extensors in PwMS, there has yet to be regression-based normative isometric strength values for all major LL muscle groups. Therefore, this study aimed to develop gender-specific regression-based normative prediction equations, with 95% confidence intervals, for maximal isometric peak torque of major LL muscles in PwMS. A secondary aim was to characterize the prevalence of LL weakness in PwMS, defined as ≥ 2 SD below values reported for healthy individuals. METHODS A convenience sample of 175 (women: n = 135) PwMS participated in a prospective, cross-sectional study where isometric peak torque of hip flexors, extensors, and abductors, knee flexors and extensors, and ankle plantarflexors and dorsiflexors were measured using the Biodex System 4 Pro-Dynamometer®. Demographics (age, height, and weight) and disease characteristics (disease duration and disability) were collected. Performances were separated for each muscle group into strongest limb and weakest limb. For each gender, regression-based equations were generated for the LL muscle groups by limb with age, height, weight, disability, and disease duration as the covariates. Descriptive statistics were used to examine the frequency of LL weakness by gender and disability level. For comparison purposes, age-stratified (<30, 30-39, 40-49, 50-59, 60-69, >70 years) and disability-stratified (mild, moderate, and severe ambulant) discrete peak torque values were also generated for each gender. RESULTS Regression-based normative data are presented for men and women, accounting for age, height, weight, disability, and disease duration. Men were significantly stronger (P < 0.001) than women for all LL, with the men's models accounting for a greater percent of muscle strength variation than women's models for all muscle groups, except for hip extension. Disability was inversely related to strength in all of the models. LL weakness was prevalent in hip flexion (m: 47.5%; w: 63.0%) and extension (m: 92.5%; w: 88.1%), knee extension (m: 30.0%; w: 33.3%) and flexion (m: 25.0%; w: 34.8%), and ankle plantarflexion (m: 15.0%; w: 10.4%) and dorsiflexion (m: 100.0%; w: 96.3%). PwMS with mild disability had a high prevalence of ankle dorsiflexion (94.9-100.0%) and hip extension (81.4-90.0%) weakness. CONCLUSIONS This study is the first to provide regression-based normative data of bilateral strength in all major LL muscle groups and clinically useful prevalence data on the occurrence of weakness in these muscles. Of note, PwMS had a high prevalence of ankle dorsiflexion and hip extension weakness even when they were only mildly disabled. These findings can help guide the direction of future interventions and treatments to improve muscle function in PwMS.
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Affiliation(s)
- Heather M DelMastro
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States.
| | - Laura B Simaitis
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
| | - Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, United States
| | - Kayla Gomes
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Rehabilitation Medicine, Department of Veterans Affairs, 555 Willard Avenue, Newington, CT, 06111 United States
| | - Jennifer A Ruiz
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, United States; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, United States
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Wood JM, Morton SM, Kim HE. A reliable and efficient adaptive Bayesian method to assess static lower limb position sense. J Neurosci Methods 2023; 392:109875. [PMID: 37150304 DOI: 10.1016/j.jneumeth.2023.109875] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Lower limb proprioception is critical for maintaining stability during gait and may impact how individuals modify their movements in response to changes in the environment and body state, a process termed "sensorimotor adaptation". However, the connection between lower limb proprioception and sensorimotor adaptation during human gait has not been established. We suspect this gap is due in part to the lack of reliable, efficient methods to assess global lower limb proprioception in an ecologically valid context. NEW METHOD We assessed static lower limb proprioception using an alternative forced choice task, administered twice to determine test-retest reliability. Participants stood on a dual-belt treadmill which passively moved one limb to stimulus locations selected by a Bayesian adaptive algorithm. At the stimulus locations, participants judged relative foot positions and the algorithm estimated the point of subjective equality (PSE) and the uncertainty of lower limb proprioception. RESULTS Using the Bland-Altman method, combined with Bayesian statistics, we found that both the PSE and uncertainty estimates had good reliability. COMPARISON WITH EXISTING METHOD(S) Current methods assessing static lower limb proprioception do so within a single joint, in non-weight bearing positions, and rely heavily on memory. One exception assessed static lower limb proprioception in standing but did not measure reliability and contained confounds impacting participants' judgments, which we experimentally controlled here. CONCLUSIONS This efficient and reliable method assessing lower limb proprioception will aid future mechanistic understanding of locomotor adaptation and serve as a useful tool for basic and clinical researchers studying balance and falls.
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Affiliation(s)
- Jonathan M Wood
- Department of Physical Therapy, University of Delaware, Newark, DE 19711, United States; Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE 19711, United States.
| | - Susanne M Morton
- Department of Physical Therapy, University of Delaware, Newark, DE 19711, United States; Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE 19711, United States
| | - Hyosub E Kim
- Department of Physical Therapy, University of Delaware, Newark, DE 19711, United States; Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE 19711, United States; Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States; School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Sung PS, Park MS. Delayed response in rectus abdominis muscle following a step perturbation in subjects with and without recurrent low back pain. Eur Spine J 2023; 32:1842-1849. [PMID: 36939887 DOI: 10.1007/s00586-023-07639-y] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Delayed trunk and lower limb muscle activation is associated with balance loss and fall injuries in subjects with recurrent low back pain (LBP). PURPOSE This study was conducted to compare differences in the onset of muscle contractions of the trunk and lower limb muscles following a treadmill-induced step perturbation between subjects with and without LBP. METHODS Eighty-three right limb dominant individuals (43 subjects with LBP and 40 control subjects) were exposed to the perturbation (0.31 m/s velocity for 0.2 m). The electromyography (EMG) reaction times were analyzed during the first step following the perturbation. The EMG electrodes were placed on both sides of the trunk and lower limbs, including the rectus abdominis (RA), erector spinae (ES), tibialis anterior (TA), and gastrocnemius (GA) muscles. RESULTS The group x muscle interaction was statistically significant (F = 9.44, p = 0.003). The TA muscle activation was significantly delayed compared to the RA, ES, and GA. There was a significant interaction on side x muscle (F = 4.14, p = 0.04). The RA muscles were significantly delayed on the non-dominant (t = - 3.35, p = 0.001) and dominant (t = - 2.53, p = 0.01) sides in the LBP group. CONCLUSION The LBP group demonstrated a delayed reaction time on the RA muscles, which indicated poor trunk control relative to the lower limbs. The delayed bilateral RA muscle might indicate possible coordination problems relative to the ES and lower limb muscles, which may lead to potential fall hazards.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN, 46953, USA.
| | - Moon Soo Park
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, 7, Keunjaebong-Gil, Hwaseong-Si, Gyeonggi-Do, 18450, Republic of Korea
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Barnard L, Karimian S, Foster P, Shankar VK. Blunt Vascular Trauma in the Lower Extremity at a Major Trauma Centre: Salvage Rate and Complications. Strategies Trauma Limb Reconstr 2023; 18:87-93. [PMID: 37942434 PMCID: PMC10628618 DOI: 10.5005/jp-journals-10080-1588] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/23/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Blunt trauma of the lower limb with vascular injury can cause devastating outcomes, including loss of limb and even loss of life. The primary aim of this study was to determine the limb salvage rate of patients sustaining such injuries when treated at Leeds General Infirmary (LGI) since becoming a Major Trauma Centre (MTC). The secondary aim was to establish patient complications. Methods A retrospective analysis found that from 2013 to 2018, 30 patients, comprising of 32 injured limbs, were treated for blunt trauma to the lower limb associated with vascular injury. Results Twenty-four patients were male and six were female. Their mean ages were 32 and 49, respectively. Three limbs were deemed unsalvageable and underwent primary amputation; of the remaining 29 potentially salvageable limbs, 27 (93%) were saved. Median ischaemic times for both amputees and salvaged limbs were under 6 hours. Of the 32 limbs, 27 (84%) were salvaged. All amputees had a MESS score ≥ 7, although not all patients with MESS ≥ 7 required amputation. Eleven limbs had prophylactic fasciotomies, three limbs developed compartment syndrome - all successfully treated and three contracted deep infections - one of which necessitated amputation. All but one patient survived their injuries and were discharged from the hospital. Conclusion Attempted salvage of 27/29 (93%) limbs was successful and all but one patient survived these injuries when treated at an MTC. MESS scoring and ischaemic time are useful but not sole predictors of limb salvage. Complication rates are low but may be significant for their future implications. How to cite this article Barnard L, Karimian S, Foster P, et al. Blunt Vascular Trauma in the Lower Extremity at a Major Trauma Centre: Salvage Rate and Complications. Strategies Trauma Limb Reconstr 2023;18(2):87-93.
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Affiliation(s)
- Liam Barnard
- Leeds School of Medicine, Worsley Building, University of Leeds, Woodhouse, Leeds, United Kingdom
| | - Sina Karimian
- Leeds School of Medicine, Worsley Building, University of Leeds, Woodhouse, Leeds, United Kingdom
| | - Patrick Foster
- Department of Trauma and Orthopaedics, Leeds Vascular Institute, Leeds General Infirmary, Leeds, United Kingdom
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Shakeel M, Jiyad Z, Grant M, Cook MG, Oudit D, Green AC. Melanoma predilection for the lower limbs of women compared with men. Arch Dermatol Res 2023; 315:633-636. [PMID: 36104631 DOI: 10.1007/s00403-022-02375-7] [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] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/02/2022]
Abstract
The lower limb is a common site for melanoma in women, but the reason for this is not fully understood. To investigate this phenomenon in more detail, we assessed the specific subsites of primary melanoma occurring on the lower limbs of females compared with males across age groups. In a records-based study at an oncology hospital in north-west of England, among an unselected sample of patients with primary invasive melanoma treated between 2002-2015, information was collected on patient age at diagnosis, sex, and co-morbidities, and the tumor thickness and anatomical subsite (thigh, lower leg, foot for lower limb). Of a total sample of 1,522 patients, 316 (227, 72% female) had lower limb melanoma. The most common subsite was lower leg (142 cases with F:M ratio =3.74), followed by thigh (55 cases with F:M = 1.83) and feet (30 cases with F:M = 1.15). At ages <40 years the odds of thigh to foot melanoma was 20 times higher in females than in males (OR 20.0, 95% CI 2.6-152.6) and 7.5 times higher on the lower limb (OR 7.5, 95% CI 1.1-49.2). For ages 40+ years, the odds of females developing thigh melanoma compared to foot melanoma was similar in males versus females (OR 0.8), while the corresponding odds of lower leg melanoma in females versus males remained significantly increased at ages 40-59 and 60+ (OR 4.2 and 2.8 respectively). Our study demonstrates the female predilection for lower limb melanoma persists over most but not all subsites.However, there is heterogeneity in the female to male occurence of lower limb melanoma across subsites and at different ages, which may be linked to relative influence of genetic and environmental risk factors.
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Affiliation(s)
- M Shakeel
- Northern Care Alliance NHS Group, Mayo Building, Salford Royal, Stott Lane, Salford, M6 8HD, UK
| | - Z Jiyad
- Department of Dermatology, St George's Hospital, London, UK
| | - M Grant
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield, SK10 4TG, Cheshire, UK
| | - M G Cook
- Department of Dermatology, St George's Hospital, London, UK
- Department of Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
- Division of Clinical Medicine, University of Surrey, Guildford, UK
- Member of EORTC Melanoma Group, Brussels, Belgium
| | - D Oudit
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, UK
| | - A C Green
- Department of Dermatology, St George's Hospital, London, UK.
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
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Queeno SR, Reiser PJ, Orr CM, Capellini TD, Sterner KN, O'Neill MC. Human and African ape myosin heavy chain content and the evolution of hominin skeletal muscle. Comp Biochem Physiol A Mol Integr Physiol 2023;:111415. [PMID: 36931425 DOI: 10.1016/j.cbpa.2023.111415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
Humans are unique among terrestrial mammals in our manner of walking and running, reflecting 7 to 8 Ma of musculoskeletal evolution since diverging with the genus Pan. One component of this is a shift in our skeletal muscle biology towards a predominance of myosin heavy chain (MyHC) I isoforms (i.e. slow fibers) across our pelvis and lower limbs, which distinguishes us from chimpanzees. Here, new MyHC data from 35 pelvis and hind limb muscles of a Western gorilla (Gorilla gorilla) are presented. These data are combined with a similar chimpanzee dataset to assess the MyHC I content of humans in comparison to African apes (chimpanzees and gorillas) and other terrestrial mammals. The responsiveness of human skeletal muscle to behavioral interventions is also compared to the human-African ape differential. Humans are distinct from African apes and among a small group of terrestrial mammals whose pelvis and hind/lower limb muscle is slow fiber dominant, on average. Behavioral interventions, including immobilization, bed rest, spaceflight and exercise, can induce modest decreases and increases in human MyHC I content (i.e. -9.3% to 2.3%, n = 2033 subjects), but these shifts are much smaller than the mean human-African ape differential (i.e. 31%). Taken together, these results indicate muscle fiber content is likely an evolvable trait under selection in the hominin lineage. As such, we highlight potential targets of selection in the genome (e.g. regions that regulate MyHC content) that may play an important role in hominin skeletal muscle evolution.
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Gu L, Jiang J, Han H, Gan JQ, Wang H. Recognition of unilateral lower limb movement based on EEG signals with ERP-PCA analysis. Neurosci Lett 2023; 800:137133. [PMID: 36801241 DOI: 10.1016/j.neulet.2023.137133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
It has been confirmed that motor imagery (MI) and motor execution (ME) share a subset of mechanisms underlying motor cognition. In contrast to the well-studied laterality of upper limb movement, the laterality hypothesis of lower limb movement also exists, but it needs to be characterized by further investigation. This study used electroencephalographic (EEG) recordings of 27 subjects to compare the effects of bilateral lower limb movement in the MI and ME paradigms. Event-related potential (ERP) recorded was decomposed into meaningful and useful representatives of the electrophysiological components, such as N100 and P300. Principal components analysis (PCA) was used to trace the characteristics of ERP components temporally and spatially, respectively. The hypothesis of this study is that the functional opposition of unilateral lower limbs of MI and ME should be reflected in the different alterations of the spatial distribution of lateralized activity. Meanwhile, the significant ERP-PCA components of the EEG signals as identifiable feature sets were applied with support vector machine to identify left and right lower limb movement tasks. The average classification accuracy over all subjects is up to 61.85% for MI and 62.94% for ME. The proportion of subjects with significant results are 51.85% for MI and 59.26% for ME, respectively. Therefore, a potential new classification model for lower limb movement can be applied on brain computer interface (BCI) systems in the future.
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Affiliation(s)
- Lingyun Gu
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, Jiangsu, PR China
| | - Jiuchuan Jiang
- School of Information Engineering, Nanjing University of Finance and Economics, Nanjing 210003, Jiangsu, PR China
| | - Hongfang Han
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, Jiangsu, PR China
| | - John Q Gan
- School of Computer Science and Electronic Engineering, University of Essex, Colchester CO4 3SQ, UK
| | - Haixian Wang
- Key Laboratory of Child Development and Learning Science of Ministry of Education, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, Jiangsu, PR China.
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