Effects of different tools and working height on physical workload in vertical cleaning tasks applying ambient control techniques

This study aimed to investigate the effects of different tools and working heights on physical workloads in vertical cleaning tasks. Thirty healthy adults were recruited to use a rag and a long-handle tool (LHT) to simulate cleaning operations on the Wii Fit board surfaces of 3 different heights, respectively. Participants used a lower 50th percentile force but were required to spend a longer time to finish the task while using an LHT than using a rag. The tool preferences were the main factors considered for efficiency and personal subjective workload and physiological load. 76.6% of the participants preferred to use the LHT instead of the rag at a high task height, but 70% preferred to use the rag when working at a medium task height. For low workload cleaning tasks on vertical surfaces, employers should provide cleaners with different handle lengths tools to choose from to reduce the cleaner's workload.

Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study

BACKGROUND

Ankylosing spondylitis (AS) is an inflammatory autoimmune disorder that manifested with sacroiliitis at its early stage and developed extensive inflammation with syndesmophytes of the lumbar, thoracic and cervical spines at its later stage. In the present study, we characterized the trunk isometric strength in patients with AS with different disease severity, defined by the radiological images.

METHODS

In a cross-sectional study conducted in a university-affiliated hospital, thirty-eight male AS patients (23 in the early AS group whose radiological findings showed no syndesmophyte, Modified Stoke Ankylosing Spinal Score (m-SASSS <3); and 15 in the syndesmophyte group, m-SASSS ≥24), and 22 healthy controls were recruited. All subjects received assessments of maximum isometric strength of trunk flexor and extensor muscles at a variety of trunk postures measured by an isokinetic device.

RESULTS

Under all examined trunk postures, the syndesmophyte AS patient group had the lowest isometric trunk muscle strength among the three groups. The flexion/extension ratio, defined by the ratio between isometric trunk flexor and extensor strengths, was highest among the three groups.

CONCLUSIONS

Trunk muscle strength significantly decreases in patients with syndesmophyte AS. The decrease of trunk muscle is inhomogeneous, which is more profound in extensor than in flexor muscles.

The effects of total contact insole with forefoot medial posting on rearfoot movement and foot pressure distributions in patients with flexible flatfoot

The purpose of this study is to evaluate the therapeutic effect of total contact insole with forefoot medial posting (TCIFMP) orthosis in patients with flexible flatfoot. The TCIFMP insole was custom- mode, made from semi-rigid plastazote and PPT. Using the gait analysis and the plantar-pressure measure systems, we investigate rearfoot motion and plantar pressure redistribution in these patients. The results of this study showed that the excessive valgus movement of the rearfoot can be reduced significantly by the TCIFMP insole in these patients. Besides, there were significant decreases in the peak pressure under the toe, lateral metatarsal, lateral foot and heel areas. Therefore, we suggested that the TCIFMP insole is an effective orthotic device for rearfoot motion control, plantar pressure reduction and re-distribution in patients with flexible flatfoot.

Effect of shoe heel height and total-contact insert on muscle loading and foot stability while walking

BACKGROUND

Women wearing high-heeled shoes often complain of foot instability and low-back pain. Previous studies have demonstrated that using total-contact inserts (TCIs) in running shoes reduces impact on leg muscles and alters rearfoot motion. This study investigated how shoe heel height and use of TCIs in high-heeled shoes affect the wearer's rearfoot complex, muscle loading, and subjective comfort.

METHODS

Fifteen inexperienced high heel wearers walked under 6 test conditions formed by the cross-matching of shoe insert (with and without TCI) and heel height (1.0, 5.1, and 7.6 cm) at a speed of 1.3 m/s. The measures of interest were rearfoot kinematics; muscle activities by electromyography (EMG) of the tibialis anterior (TA), medial gastrocnemius (MG), quadriceps (QUA), hamstrings (HAM), and erector spinae (ES); and subjective comfort rating by visual analogue scale for each test condition.

RESULTS

The statistical results showed that elevated heel height significantly increased plantar flexion (P < .001) and inversion (P < .01) at heel strike, prolonged TA-MG co-contraction (P < .001) and QUA activation period (P < .001), and increased root mean square (RMS) EMG in all measured muscles (TA, MG, QUA, ES: P < .001; HAM: P < .01). The use of TCIs reduced the rearfoot inversion angle (P < .01) and RMS EMG in both QUA and ES muscles (P < .01) and increased comfort rating (P < .001).

CONCLUSIONS

These findings suggest that wearing high-heeled shoes adversely affects muscle control and reduces loads in QUA and ES muscles.

CLINICAL RELEVANCE

The use of a TCI may improve comfort rating and foot stability.

Knee muscle strength at varying angular velocities and associations with gross motor function in ambulatory children with cerebral palsy

The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n=17) or level II (n=16) according to Gross Motor Function Classification System (GMFCS) levels. All children underwent curl-up test and isokinetic tests of the knee extensor and flexor muscle. Children with CP underwent the gross motor function assessments, including the Gross Motor Function Measure (GMFM-66) and the gross motor subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The hamstring-quadriceps ratio (HQ ratio) was calculated as 100%×(isokinetic peak torque of hamstring (knee flexor)/isokinetic peak torque of quadriceps (knee extensor)). Children with GMFCS level II had lower BOTMP and GMFM-66 scores, curl-up scores, HQ ratio, and knee muscle strength, especially knee flexor, compared to those with GMFCS level I. The regression analysis showed that knee flexor torques at 60 and 90°/s are mainly related to balance (r(2)=0.167, p=0.011) and strength (r(2)=0.243, p=0.002) while knee flexor torques at 120°/s mainly contribute to running speed and agility (r(2)=0.372, p<0.001). These findings suggest that children with CP had knee strength deficits, especially knee flexor. Postural muscle (knee flexor) strength dominated gross motor function than antigravity muscle strength (knee extensor). The knee flexor strength at different angular velocities was associated with various gross motor tasks. The HQ ratio may be used as a potential biomarker to probe the therapeutic effectiveness for muscle strengthening in these children. These data may allow clinician for formulating effective muscle strengthening strategies for these children.

Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study

OBJECTIVE

To determine the effect of therapist-based constraint-induced therapy at home on motor performance, daily function and reaching control for children with cerebral palsy.

DESIGN

A single-blinded, randomized controlled trial.

SUBJECTS

Forty-seven children (23 boys; 24 girls) with unilateral cerebral palsy, aged 6-12 years, were randomized to constraint-induced therapy (n = 24) or traditional rehabilitation (n = 23).

INTERVENTIONS

Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained. Traditional rehabilitation involved functional unilateral and bilateral arm training. Both groups received individualized therapist-based interventions at home for 3.5-4 hours/day, two days a week for four weeks.

MAIN MEASURES

Motor performance and daily function were measured by the Peabody Developmental Motor Scale, Second Edition and the Pediatric Motor Activity Log. Reaching control was assessed by the kinematics of reaction time, movement time, movement unit and peak velocity.

RESULTS

There were larger effects in favour of constraint-induced therapy on motor performance, daily function, and some aspects of reaching control compared with traditional rehabilitation. Children receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale, Second Edition - Grasping (pretest mean ± SD, 39.9 ± 3.1; posttest, 44.1 ± 2.8; P < 0.001), Pediatric Motor Activity Log (pretest, 1.8 ± 0.3; posttest, 2.5 ± 0.3; P < 0.001) and shorter reaction time, normalized movement time (P < 0.001) and higher peak velocity (P = 0.004) of reaching movement.

CONCLUSIONS

Constraint-induced therapy induced better grasping performance, daily function, and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation.

Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy

This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n=13) or a control group (n=15). Outcome measures, including gross motor function of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and muscle strength (isokinetic torque of knee extensor and flexor muscle), were administered before and immediately after the 12-week intervention. Analysis of covariance (ANCOVA) at post-treatment showed that, compared to the control group, the hVCT group had significantly higher isokinetic torque in the knee extensor and flexor muscles at 60°/s and 120°/s angular velocities (p<0.05). At post-treatment, the hVCT group also showed greater isokinetic strength improvement in the knee flexor than in the knee extensor at 60°/s (knee flexor: 41%; knee extensor: 19%) and at 120°/s (knee flexor: 36%; knee extensor: 30%). However, the BOTMP scores at post-treatment did not differ between the two groups. Although the proposed 12-week hVCT protocol does not improve gross motor function, it enhances knee muscle strength in children with CP. The protocol obtains larger gains in the knee flexor than in the knee extensor at different angular velocities. The study findings will help clinicians to provide more effective and efficient strategies for muscle strength training in children with CP.

GAIT ANALYSIS THROUGH FOOT PATTERN RECOGNITION FOR CHILDREN WITH CEREBRAL PALSY

In this study, we simplified the analysis of kinetic gait data using pattern recognition. Gait patterns were studied in 42 spastic children with cerebral palsy (age range: 3 to 17 years old), and 24 age- and sex-matched children. Gait analysis was performed using the DynoGraphy (CDG) system (Infortronic, Holland). The foot enrollment and the role of the heel or forefoot were assessed to form the gaitline. The bipedal phase was examined using a cyclogram, which is a cyclic characteristic formed by the changing position of the application point of the resultant normal force on a vertical supporting horizontal plane during motion. Based on the pattern recognition, the gait patterns of the subjects could be classified into 4 different patterns in both the gaitline and the cyclogram. The classification of the gait was parallel to the clinical evaluation of cerebral palsy obtained based on Minear's classification of daily activity (p<0.05). The correlation between the gaitline and cyclogram was also highly significant (p<0.05). The results of this study suggest that an automated pattern recognition program might provide an additional method for comprehensive gait evaluation in children with cerebral palsy.

Speech-associated labiomandibular movement in Mandarin-speaking children with quadriplegic cerebral palsy: a kinematic study

The purpose of this study was to investigate the speech-associated labiomandibular movement during articulation production in Mandarin-speaking children with spastic quadriplegic (SQ) cerebral palsy (CP). Twelve children with SQ CP (aged 7-11 years) and 12 age-matched healthy children as controls were enrolled for the study. All children underwent analysis of percentage of consonants correct (PCC) and kinematic analysis of speech tasks using the Vicon Motion 370 system. Kinematic parameters included utterance duration, displacement and velocity of the lip and jaw, coefficient of variation (CV) of lip utterance duration, and spatial and temporal coupling of labiomandibular movement of speech produced in mono-syllable (MS) and poly-syllable (PS) tasks. Children with CP showed lower temporal coupling (MS, p = 0.015; PS, p = 0.007), but not spatial coupling, of labiomandibular movement than healthy children. Children with CP had greater CVs (MS, p = 0.003; PS, p = 0.010) and the peak opening displacement and velocity of lower lip and jaw (p < 0.05) and lower PCC (p < 0.001) than healthy children. Children with SQ CP displayed labiomandibular coupling movement impairment, especially in the aspect of temporal coupling. These children also had high temporal oromotor variability and needed to make more effort to coordinate the labiomandibular movement for speech production.

The effect of thickness on the texture and magnetic properties of single-layered FePt films by rapid thermal annealing

The single-layered FePt films with thickness in the range of 5 to 50 nm are deposited directly on Si(100) substrate without underlayer, then post annealed at 700 degrees C by rapid thermal annealing (RTA) technique. As the film thickness of FePt is over 20 nm, the L1(0) FePt(111) preferred orientation is presented and tended to in-plane magnetic anisotropy. However, the L1(0) FePt(001) texture is obtained and exhibited perpendicular magnetic anisotropy as the film thickness is decreased to 10 nm. Its perpendicular coercivity (Hc(perpendicular)), saturation magnetization (Ms) and perpendicular squareness (S(perpendicular)) are 14.8 kOe, 795 emu/cm3 and 0.79, respectively. On the other hand, both the grain size and domain size of FePt film decrease with decreasing the film thickness of FePt. The grain size for 10-nm FePt film is as small as 9.7 nm with domain size of 123 nm, which reveal its significant potential as perpendicular magnetic recording media for ultra high-density recording.

Perceived job stress and health complaints at a bank call center: comparison between inbound and outbound services

This study investigated how perceived job stress and health status differ, as well as the relationships to inbound (incoming calls) versus outbound (outgoing calls) calling activities, for call center workers in a bank in Taiwan. The sample bank employed 289 call center workers at the time of the survey, ranging in age from 19 to 54 yr old. Data were obtained on individual factors, health complaints, perceived level job stress, and major job stressors. Overall, 33.5% of outbound operators and 27.1% of inbound operators reported frequently or always experiencing high stress at work, however, the differences between inbound and outbound operators were insignificant. "Having to deal with difficult customers" was the most frequent job stressor for all workers. Musculoskeletal discomfort, eye strain, and hoarse or sore throat were the most prevalent complaints among call center workers. The relationship between perceived job stress and health complaints indicated that workers who perceived higher job stress had significantly increased risk of multiple health problems, including eye strain, tinnitus, hoarse or sore throat, chronic cough with phlegm, chest tightness, irritable stomach or peptic ulcers, and musculoskeletal discomfort (with odds ratios ranging from 2.13 to 8.24). These analytical results suggest that perceived job stress in the call center profoundly affected worker health. This study identified main types of job stressors requiring further investigation.

Acoustic study in Mandarin-speaking children: developmental changes in vowel production

BACKGROUND

Acoustic analysis had been well incorporated into clinical evaluation and management of children with speech disorders for many years. The aim of this study is to investigate developmental changes in vowel production in Mandarin-speaking children using acoustic study analysis.

METHODS

A total of 22 children from 5-12 years old were analyzed in this study. Each child read a list of speech materials consisting of 6 dissyllabic words in Mandarin phonemes and the speech samples were recorded. The digitized acoustic recordings were submitted for acoustic analysis. The acoustic parameters in this study include the first and second formant frequencies (F1 and F2) of /a/, /i/ and /u/ and the vowel space. We used the Wilcoxon rank sum test and Spearman's rho correlation test for statistical analysis.

RESULTS

The F1 values of the vowel /i/ were significantly lower in boys than those in girls (p = 0.013) by Wilcoxon ranksum test. The F1 value of the vowel /i/ was negatively correlated with children's age (rho = -0.601, p = 0.003) and their body height (rho = 0.478 p = 0.045). The F1 values of the other two vowels (/u/ and /a/), the F2 values of all three vowels and the vowel space had no association with age and gender.

CONCLUSIONS

F1 acoustic parameters have developmental and gender changes in vowel production in Mandarin-speaking children. The data in this study provide references for acoustic assessment of Mandarin-speaking children.

Application of a novel integrated pointing device apparatus for children with cerebral palsy

BACKGROUND

To improve the computer operation of children suffering from cerebral palsy (CP) with severe disabilities, more flexible pointing devices are required. This study investigates the effectiveness of a newly developed Integrated Pointing Device Apparatus (IPDA) that can integrate numerous commercial pointing devices.

METHODS

We enrolled 27 children with quadriplegic CP and 15 healthy children. All children were required to perform three specific mouse operation tasks. Children with CP were classified into two groups based on hand operation: one hand (group A) and both hands (group B). The efficiency of children with CP in each mouse operation task was expressed as a percentage of that for normal children (% NL).

RESULTS

Group A operated a standard mouse with their dominant hand; group B had to use both hands to operate a mouse via IPDA. Group A demonstrated better efficiency of continuous-clicking tasks than group B (p < 0.05). Group B had a similar level of efficiency in the target-acquisition task (30% NL) and drag-and-drop task (20% NL) as that of group A, although group B could not operate a standard mouse with one hand. All children in group A were spastic quadriplegia, while 30% of children in group B were spastic-athetoid (p < 0.05). All children in group B were at level 3 of the gross motor functional classification system (GMFCS) but only 57% of children in group A were at level 3 (p < 0.05).

CONCLUSION

The IPDA can help some children with CP, who cannot utilize a commercial mouse alone, to achieve acceptable operational efficiency. The operation methods for children with CP were determined by their underlying motor control.

Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking

BACKGROUND

The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF).

METHODS

Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done.

RESULTS

The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait.

CONCLUSIONS

These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.

Motor control in patients with incomplete spinal cord injuries and various voluntary movement capabilities

BACKGROUND

In this study, we attempted to verify the hypothesis that further improvements in volitional movement of patients with a spinal cord injury would diminish and ultimately suppress the segmental responses, while enhancing the supraspinal inhibitory influence.

METHODS

Eleven patients with an incomplete spinal cord injury and partial preservation of motor function (ASIS grades C and D) were recruited. Their lower limbs were evaluated using polyelectromyography (PEMG) during voluntary movements, reinforcement maneuvers, tonic vibratory reflex, passive stretch reflex, irradiation of the passive stretch reflex (PSRirrad), and plantar reflex suppression.

RESULTS

The reinforcement maneuver response, tonic vibratory response, passive stretch reflex, and PSRirrad were most active in limbs with partially preserved volitional movement, but for which patients were still incapable of lifting their heel off the examination table. In contrast, plantar reflex suppression was strongest in limbs with partially preserved volitional movement, for which patients were capable of lifting the heel off the examination table.

CONCLUSIONS

Supraspinal inhibitory effects were most active in those limbs which were capable of lifting the heel off the examination table, compared to limbs with partially preserved volitional activity but without visible movement or which were incapable of lifting the heel off the examination table. The capability for volitional activity paralleled the supraspinal inhibitory effects.

Improvement of Muscle Strength in Osteoarthritic Knee Patients After Intraarticular Knee Injection of Hyaluronan

OBJECTIVE

The objective of this study was to investigate whether the knee concentric and eccentric muscle strengths can be improved in patients with bilateral knee osteoarthritis after intraarticular hyaluronan injections.

DESIGN

A total of 25 patients with bilateral knee osteoarthritis and with a radiographic Ahlbäck grading scale of I or II participated in this study. One session of intraarticular knee injection of hyaluronan was given to both knees (weekly intraarticular knee hyaluronan injections for a total of 5 wks). Knee concentric and eccentric muscle strengths were recorded between 10 and 90 degrees of knee flexion. The recordings were done on two angular velocities, 80 and 240 degrees/sec. This study took place in a tertiary medical center with a gait laboratory and a KIN-COM isokinetic dynamometer.

RESULTS

An increase in concentric and eccentric muscle strength adjusted for body weight (P < 0.01) was observed in both knees, ranging between 5.1% and 27.7%.

CONCLUSION

The decreased knee muscle contraction strength (concentric and eccentric) can be improved in knee osteoarthritis patients with an Ahlbäck grading scale of I or II after five weekly intraarticular knee injections of hyaluronan.

Foot contact pattern analysis in hemiplegic stroke patients: An implication for neurologic status determination11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To investigate the feasibility of using a foot contact pattern to predict neurologic recovery and the effect of ambulation training in hemiplegic stroke patients.

DESIGN

Case-comparison study.

SETTING

Gait laboratory in a tertiary care center.

PARTICIPANTS

Sixty-five functionally ambulant hemiplegic stroke patients, and 30 healthy subjects serving as the control group.

INTERVENTIONS

Gait analyses were performed by using the conventional gait analysis system (6 cameras) and the portable Computer DynoGraphy (CDG) system. Main outcome measures Walking velocity, step length, and cadence were measured from the conventional gait analysis system. Cyclogram, gaitline, and ground reaction force (GRF) patterns were recorded with the CDG system.

RESULTS

Velocity, cadence, and step length increased in higher Brunnstrom stages (P<.01). Negative correlation was noted between the Brunnstrom stages and the foot contact patterns (P<.01). Lower cyclogram, GRF, and gaitline patterns were expected in subjects with higher Brunnstrom stages. There were high prediction probabilities between cyclogram, gaitline, and GRF patterns.

CONCLUSIONS

Foot contact pattern can be a simple and reliable indicator of hemiplegic gait in stroke patients. It is closely related to patient's neurologic status and is correlated with parameters obtained from conventional gait analysis systems. Pathologic presentations are noted in both the affected and unaffected limbs, suggesting that rehabilitation programs should be implemented on both sides.

Leg muscle activation patterns of sit-to-stand movement in stroke patients

OBJECTIVE

To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers.

DESIGN

Subjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared.

RESULTS

The mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated.

CONCLUSIONS

Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.

Gait Performance with Compensatory Adaptations in Stroke Patients with Different Degrees of Motor Recovery

OBJECTIVE

Gait patterns vary among stroke patients. This study attempted to discover gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery.

DESIGN

Data were gathered from 35 stroke patients and 15 healthy subjects. Gait performance and motor recovery were assessed 6 mos after stroke. Stroke patients further were divided into poor and good groups. The walking velocity was correlated with Brunnström's stages, and the temporal stride and motion variables of the two groups were compared.

RESULTS

Walking velocity was positively correlated with the Brunnström's stages of the proximal lower limb. The poor group displayed slower walking velocity and shorter single-support time compared with the good group. Both groups displayed low maximum excursion of hip extension and ankle plantarflexion during the stance phase and low maximum excursion of hip and knee flexion and ankle dorsiflexion during the swing phase. Moreover, both groups displayed excessive pelvic tilts during the stance and swing phases. However, the poor group displayed different pelvic motion and timing sequences to each peak joint angle from normal subjects and the good group. Peak hip and knee angles of the affected limb during the stance phase occurred almost simultaneously in this group.

CONCLUSIONS

Selective control of the proximal lower limb may be the main determinant of walking velocity. The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.

Correlation of polyelectromyographic patterns and clinical motor manifestations in children with cerebral palsy

OBJECTIVE

We investigated the correlation between movement patterns, measured by polyelectromyography (PEMG), and clinical motor manifestations in children with cerebral palsy.

DESIGN

Subjects included 53 children with spastic cerebral palsy (diplegic [n = 43] and quadriplegic [n = 10] groups) and 18 normal children. All children underwent PEMG assessments, recorded from pairs of flexor/extensor muscles during voluntary movement. We correlated PEMG patterns with clinical motor assessments, including muscle tone, range of motion, and ambulatory and functional capacities in the children with cerebral palsy.

RESULTS

Children with cerebral palsy exhibited four distinct PEMG patterns, ranging from partial reciprocal to complete synchrony. Lower PEMG pattern scores were significantly associated with better ambulatory (rho = 0.88, P < 0.01) and functional (rho = 0.78, P < 0.01) capacities. PEMG patterns also had weakly positive relationships with muscle tone (rho > 0.33, P < 0.01) and range of motion of both lower limbs (rho > 0.31, P < 0.01). Most children of spastic diplegia with PEMG patterns II and III had independent ambulatory capacities and mild limitation of functional capacity, whereas most children with pattern of IV and V had no ambulatory abilities and no independent functional capacities (P < 0.01).

CONCLUSIONS

These findings suggest that PEMG patterns correlate with clinical motor deficits and may allow us to plan treatment strategies based on underlying motor control in cerebral palsy.

Improvement of gait by using orthotic insoles in patients with heel injury who received reconstructive flap operations

OBJECTIVE

To investigate the effect of orthotic insoles in heel injury patients who received reconstructive flap operations.

DESIGN

Motion analysis and force platform data were collected in able-bodied subjects and patients with heel injuries during walking without and with the use of the total contact insole. Gait kinetics were collected for the hip, knee, and ankle joints and then compared with Student's t tests.

RESULTS

Walking velocity and step length were decreased (P < 0.014 and P < 0.005) for patients not wearing the total contact insole. The affected limbs had longer double-support duration (14.8% of gait cycle, P < 0.037) and shorter single-support duration (34.5% of gait cycle, P < 0.045). Less hip power generation was noted for the affected limbs during both initial contact and preswing phases, 0.17 +/- 0.10 N-m/kg-m and 0.45 +/- 0.20 N-m/kg-m, as compared with that of the able-bodied subjects, 0.36 +/- 0.08 N-m/kg-m and 0.89 +/- 0.22 N-m/kg-m, respectively. Decreased ankle power generation was noted for the affected limbs (1.08 +/- 0.38 N-m/kg-m) during preswing phase as compared with the able-bodied subjects (2.24 +/- 0.33 N-m/kg-m). After fitting of the total contact insole, the affected limbs recovered to a gait pattern similar to that of the able-bodied subjects (P < 0.05).

CONCLUSION

Asymmetry of gait pattern after heel injury resulted in altered gait kinetics. Gait symmetry could be recovered in these patients as the total contact insole provides weight acceptance, shock absorption, and cushioning effect for the reconstructed heels.

Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study

OBJECTIVES

To evaluate the electromyographic activities of vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles in open and closed kinetic chain exercises in subjects with patellofemoral pain syndrome (PFPS).

DESIGN

Case-controlled study.

SETTING

Rehabilitation science center in a tertiary medical center.

PARTICIPANTS

Ten patients with bilateral knee pain diagnosed with PFPS and 10 healthy volunteers.

INTERVENTIONS

Subjects performed open kinetic chain exercise on an isokinetic dynamometer and closed kinetic chain exercise by squat-to-stand and stand-to-squat tasks. Surface electromyography was done for the VMO and VL muscles.

MAIN OUTCOME MEASURES

VMO/VL ratios were calculated after normalization of muscle activities.

RESULTS

The VMO/VL ratios of PFPS subjects were significantly lower than were those of unimpaired subjects during knee isokinetic closed kinetic chain exercises (p = .047). However, there was no statistical difference in VMO/VL ratio between subjects with and without PFPS during closed kinetic chain exercises (p = .623). Maximum VMO/VL ratio was obtained at 60 degrees knee flexion in closed kinetic chain exercise.

CONCLUSION

In closed kinetic chain exercises, more selective VMO activation can be obtained at 60 degrees knee flexion. Maximal VMO/VL ratio was observed at this knee flexion angle, and muscle contraction intensity was also greatest.

Motor control assessment for rhizotomy in cerebral palsy

OBJECTIVE

To apply motor control assessment for selection of appropriate spastic cerebral palsy children to receive selective posterior rhizotomy (SPR).

DESIGN

Forty children with spastic cerebral palsy (3-16 yr) were divided into three groups: "independent ambulator," "dependent ambulator," and "nonambulator." Another 18 healthy children were selected as the control group. Both motor control (tested by using polyelectromyography (PEMG)) and clinical ambulatory capability were assessed within 1 mo before SPR and 12 mo after. PEMG patterns were classified into seven patterns according to electromyographic activities during hip/knee flexion and extension. Gait patterns, which were analyzed by computer DynoGraphy, were classified into four patterns for children with ambulatory capability.

RESULTS

PEMG and gait patterns were correlated with ambulatory ability. PEMG patterns 2-3 could predict independent ambulatory ability, whereas patterns 6-7 will interfere with ambulatory ability. PEMG patterns showed significant improvement after SPR in the ambulatory groups (P < 0.05), whereas they did not improve in the nonambulator group. Children with cerebral palsy with co-contraction of proximal/distal muscles had better results after SPR, whereas those with diffuse co-contraction or reduced electromyography activities had poor results.

CONCLUSIONS

PEMG patterns may allow the physician to select the appropriate children with spastic cerebral palsy to receive SPR with good results.

Balance evaluation in hemiplegic stroke patients

BACKGROUND

Decreased equilibrium in standing and walking is a common problem associated with hemiplegic stroke patients. Stroke patients with balance problems are prone to falls. In addition to spatial recognition, the appropriate pattern of muscle activity to preserve balance depends on sensory and motor processes. Previous reports have mentioned that the right posterior parietal cortex seems to be predominantly involved in spatial integration. We therefore wanted to conduct a study to quantify and compare the balance control between right hemispheric stroke and left hemispheric stroke patients.

METHODS

Thirty hemiplegic stroke patients (14 right, 16 left) and 15 age-matched healthy subjects were included in this study. The objective measurement of the basic components of balance control was performed using the SMART Balance Master. The motor status of the hemiplegic limbs was evaluated by Brunnstrom staging. The functional outcome of the stroke patients was evaluated by the functional independence measure (FIM).

RESULTS

The balance function of stroke patients was significantly worse as compared to that of the healthy subjects especially in dynamic stability. However, different from the other reports, our right hemispheric stroke patients had better balance function than our left hemispheric patients. The locomotion and mobility scores of the FIM were also better in the right hemispheric stroke patients.

CONCLUSION

This result suggested that the motor function of the healthy limbs of stroke patients may play an important role in their balance function. The results of this study may provide a guide for prescribing a more efficient rehabilitation program for stroke patients.

Effects of silicon-insole socks on pressure distribution and shear force of the foot

BACKGROUND

Many problems of the foot are due to abnormal plantar pressure and shear force, but until now shear force could not be accurately measured. Different methods can be used to reduce foot pressure, such as foot orthosis or shoe modification. The purposes of our study were to propose a method for measuring the maximum shear force of the foot and also to investigate the effect of silicone-insole socks in reducing the peak plantar pressure and shear stress of the foot.

METHODS

Twenty-two healthy subjects were included in this study, each subject underwent 2 kinds of experiments to study the peak plantar pressure, the horizontal shear reaction force, and the maximum shear force under 3 conditions: barefoot, wearing 100% cotton socks, and wearing silicone-insole socks.

RESULTS

Our results showed a significant decrease in midfoot peak plantar pressure while walking, and a decrease in horizontal shear reaction force and maximum shear force while wearing cotton socks and silicone-insole socks in walking and pulling. Silicone-insole socks were more significant in decreasing horizontal shear reaction force than cotton socks.

CONCLUSION

Silicone-insole socks are better than cotton socks in reducing horizontal shear reaction forces and their friction coefficients. Because only normal subjects have been tested, further study is required to prove the efficacy of silicone-insole socks on different kinds of foot pathology.

[Studies on longevity tea]

This paper reports the preparation, physical and chemical identification and content determination of Longevity Tea. The preparation process is advanced, the content determination is simple and accurate and thus can be taken as standards for the quality control of Longevity Tea.

Isolation of vindoline from Catharanthus roseus by supercritical fluid extraction

Vindoline was extracted from the leaves of Catharanthus roseus over the ranges of 35-70 degrees C and 100-300 bar using supercritical carbon dioxide with and without the addition of 3 wt % ethanol as a cosolvent. The vindoline contents in the extracts were determined by HPLC and identified by LC/MS. The remarkable highest vindoline concentration, 58 wt %, was obtained at the lowest temperature, 35 degrees C, and the highest pressure, 300 bar, of this study. The use of a cosolvent only slightly improved the extraction yields or selectivities at some experimental conditions.

Improved high-performance liquid chromatographic assay of erythromycin in pharmaceutical solid dosage forms

A reversed-phase high-performance liquid chromatography method for the assay of erythromycins in pharmaceutical preparations is described. Detailed experimental procedures and results are given. The major erythromycins are well separated, very good recoveries were obtained and detection limits for erythromycins B and C were estimated.

Characteristics of equilibrium reaction of zolazepam

The equilibrium reaction of zolazepam, a pyrazolodiazepinone, was studied and analyzed using the approach used previously for other pyrazolodiazepinone derivatives. The intrinsic ring closure equilibrium constant for this reaction was approximately 100 times larger than that observed for pyrazolodiazepinones studied previously. This study illustrates that the diazepinone ring can dominate in equilibrium mixtures formed at pH values far below the pKa of the corresponding form.

Stability-indicating assay for vidarabine

A physicochemical procedure for the analysis of vidarabine in aqueous parenteral formulations was needed to assure potency and to define stability. Concurrent with the development of this method, its decomposition products and route in aqueous solution were determined. A quantitative procedure was developed to determine intact drug in the presence of decomposition products, and the results obtained were validated by microbial assay. Spectral (UV and polarimetric) and TLC evidence indicated that, in aqueous solution, hydrolysis without racemization occurs, yielding adenine and arabinose. The sensitivity of the method to decomposition is improved by ion-exchange separation of adenine and drug before UV measurement. Analysis of partially decomposed solutions of the drug by both ion-exchange and microbiological methods gave comparable results.

Equilibrium reaction of pyrazolodiazepinones in aqueous solution

This study of the behavior of some pyrazolodiazepinones in aqueous solution at near ambient temperature indicated that they form stable equilibrium mixtures consisting of ring and opened forms. Under isothermal conditions, mixtures are produced whose composition is dependent on pH and may vary from that corresponding to essentially complete ring opening to complete closure. Ring closure equilibrium constants were calculated, and the influence of methyl substitution was determined. Substitution of a methyl group for an amido hydrogen in the open form results in a fivefold increase in this constant. Methylation of the terminal amino group, however, did not cause a corresponding increase and may not significantly affect equilibrium.