Development of low-cost and personalized external silicone breast prosthesis produced by additive manufacturing for women who have undergone mastectomy: A pilot study.

BACKGROUND: The aim of this study was to develop a low-cost and personalized method for external breast prosthesis production. METHODS: The projected light method was used for the acquisition of the 3D geometry of the left breast of a healthy 29-year-old woman, 69 kg and 1.69 m. The 3D modeling software Blender was used to make the prosthesis model and mold with adjustments to the model's mesh, such as smoothing, assigning thickness, and creating the walls of the prosthesis mold. Two counter-molds were created. The pieces were manufactured on the 3D printer Stella Lite 3 using polylactic acid filament. Finally, the silicone was pigmented, and the mold was filled. FINDINGS: Prototype 1 of the prosthesis was produced using a mold without a counter-mold, which resulted in a prosthesis of 495 g, considered heavy compared to traditional prostheses for the same breast size. To solve this issue, a counter-mold with pins was used to produce prototype 2 with a mass of 393 g, 20.6% lighter than prototype 1. Prototype 3 was made with a central-volume counter-mold and presented a mass of 355 g, a reduction of 28.3% compared to prototype 1. The definitive breast prosthesis was made with the pin counter-mold with a different silicone. It has nipple and areola pigmentation and a mass of 294 g, 25.2% lighter than prototype 2. INTERPRETATION: The results suggest that the projected light method and additive manufacturing are potential tools for developing external breast prostheses, which may improve the health conditions and quality of life of mastectomized women.

Multifactorial Assessment of Older Adults Able and Unable to Recover Balance During a Laboratory-induced Trip.

BACKGROUND: Older adults are prone to falls, and identifying fallers and non-fallers from a set of fall-related variables is essential while establishing effective preventive programs. AIMS: This study aimed to analyze if a set of parameters (i.e., strength, functional status, dynamic balance, gait, and obesity-related anthropometric measures) differ between older adults able and unable to recover from an induced trip. OBJECTIVE: To analyze predictors among older adults able and unable to identify fallers and nonfallers. METHODS: Thirty healthy old adults were tripped once during the mid-swing phase of the gait. The trip outcome was used as a criterion to assign participants to a recovery (REC; n=21; 71.2±5.7 years; 70.9±12.8 kg; 1.60±0.09 m) or a non-recovery group (NREC; n=9; 69.4±6.8 years; 85.7±11.8 kg; 1.59±0.08 m). The spatiotemporal gait parameters, functional mobility, dynamic balance, and isokinetic muscular function were measured. RESULTS: The NREC presented larger BMI (33.6±2.7 vs. 27.5±3.4 kg.m-2; p<0.05); greater time for the initiation phase on the voluntary step execution test (197.0±27.9 vs. 171.7±31.3s; p<0.05); lower plantarflexor (0.41±0.15 vs. 0.59±0.18 N.m; p<0.05), dorsiflexor (0.18±0.05 vs. 0.24±0.07 N.m; p<0.05), knee extensor (1.03±0.28 vs. 1.33±0.24 N.m; p<0.05) and knee flexor peak torques (0.50±0.15 vs. 0.64±0.13 N.m; p<0.05); and greater time up and go (8.0±0.8 vs. 7.4±0.7 s). CONCLUSION: The results showed that it is possible to identify fall risk components based on several fall-related parameters using a laboratory-induced trip as the outcome variable.

Immediate Effects of Acupuncture on Force and Delayed Onset of Muscle Soreness.

Background: The ability to produce force is critical to several daily activities. Strategies to reduce delayed onsent muscle soreness (DOMS) and restore force-generating properties that occur in response to training and impair physical performance have been proposed. Acupuncture has been proposed to accelerate recovery and optimize muscle functioning. It was to determine the effects of acupuncture on DOMS and on the muscle force production capacity. Methods: Thirty physically active volunteers (26.3 ± 3.1 years old, 1.70 ± 0.08 m, 66.5 ± 12.6 kg) were allocated in a control (CG; n = 10), placebo (PG; n = 10), and acupuncture (AG; n = 10) groups. The groups were subjected to an exercise protocol to induce DOMS and were assessed for muscle force, threshold, and rate of perceived pain and activation of the biceps brachialis muscle before (PRE) and 20 minutes after (POST) a single acupuncture session using a mixed model analysis. Results: The threshold and rate of perceived pain were reduced in the AG (P < 0.05) but remained unchanged in the other groups (P > 0.05). Muscle activation also showed larger changes in the AG in comparison with the other groups (P < 0.05). No changes in the ability to produce force were found after acupuncture in any groups (P > 0.05). Conclusions: Acupuncture may reduce discomfort and improve muscle activation but was not effective to promote force improvement and/or restore the force-generating properties. It may be speculated that muscle disruption may have played a role and did not allow participants to restore their muscular performance. Rebec Number; RBR-8bh5k7 (www.ensaiosclinicos.gov.br/rg/RBR-8bh5k7); Clinical Trial Registry (UTN No.: U1111-1234-9553).

Muscle function, physical function, and gait in older women with and without knee osteoarthritis

Abstract Aim: To compare muscle function of knee extensors, gait parameters, and physical function in older women with and without knee osteoarthritis (KOA) and to associate these parameters to the KOA incidence in this population. Methods: Sixteen older women with KOA (66.9 ± 5.5 years; 74.9 ± 10.0 kg; 157.9 ± 0.9 cm; 30.2 ± 5.0 kg/m2) and fourteen healthy counterparts (control group: CG; 68.8 ± 5.8 years; 68.9 ± 10.5 kg; 158 ± 0.06 cm; 27.4 ± 4.0 kg/m2) participated in this study. Muscle function, physical function, and gait parameters were evaluated in both groups. The Western Ontario and McMaster Index (WOMAC) questionnaire was answered only by the KOA group. A correlation was performed to verify if KOA incidence was associated with muscle function, physical function, and gait parameters. Results: KOA group showed lower peak torque at 60°/s (30%; p = 0.003) and 180°/s (37%; p < 0.001), greater acceleration time at 60°/s (382%; p < 0.001), lower cadence (12.2%; p = 0.002), slower gait speed (19.5%; p < 0.001) and greater stride time (12.5%; p = 0.001) than CG group. However, there was no difference between groups in physical function (p < 0.0045). The KOA incidence presented a negative correlation with peak torque (rho = −0.602; p < 0.001), cadence (rho = −0.533; p = 0.002), gait speed (rho = −0.633; p < 0.001), stride length (rho = −0.517; p = 0.003) and a positive correlation with stride time (rho = 0.533; p = 0.002) and acceleration time (rho = 0.655; p < 0.001). Conclusion: Our findings suggest that knee osteoarthritis may impair the function of the knee extensors muscles and gait parameters. An association between the ability to produce force rapidly and gait speed with the KOA incidence in older women was also observed.

Multicomponent Training Program with High-Speed Movement Execution of Ankle Muscles Reduces Risk of Falls in Older Adults.

The purpose of this study was to investigate the effects of multicomponent training program, designed to improve the torque around the ankle joint performing high-speed movement execution, on healthy older adults. Participants were balanced by torque around the ankle joint and randomly allocated to either exercise (n = 12, 69.7 ± 4.8 years, 74.6 ± 16.8 kg, 1.63 ± 0.10 m) or control group (CG) (n = 14, 70.86 ± 6.48 years; 73.5 ± 13.4 kg, 1.56 ± 0.05 m). The exercise group (EG) performed a multicomponent training of resistance, agility, and coordination exercises, focusing on the plantar flexor muscles during 12 weeks (3 days per week). Outcome measures were torque (plantar flexion and extension), reactive capacity (Step test), and functional mobility (gait and timed up and go [TUG] test). The training program was induced to increase peak torque of extensor muscles around the ankle joint to EG (Δ = 50%; d = 1.59) compared to the CG. Such improvement was converted to reactive capacity improvements considering the decrease in the execution time of the Swing phase and in the Total time of the Step test (Δ = 19%; d = 0.93, Δ = 14%; d = 1.02, respectively). Gains in functional mobility were verified by the increase of the walking speed (Δ = 15%; d = 1.37) and by the smaller time of execution of TUG test (Δ = 17%; d = 1.73) in the EG. Therefore, the multicomponent training was effective to reduce or to reverse muscular age-related declines, which are associated with functional capacity and reduction of fall risk in older adults.

Variability and reliability of gait kinematic parameters after controlled tripping in older adults: a preliminary study / Variabilidade e confiabilidade dos parâmetros cinemáticos da marcha de idosos após um tropeço controlado: estudo preliminar

ABSTRACT Approximately 21% of the falls in older adults occur due to tripping, while walking. There is a paucity of information regarding the gait variability and reliability when a tripping is induced in different days mainly with elderly. It was aimed to analyze the variability and the reliability (intra- and inter-day) of spatiotemporal gait parameters and joint angles after controlled tripping in older adults. Eight healthy older women participated. The trip was induced during the early-mid swing phase on the transposing segment and the kinematic data was obtained from trials. The variability and reliability of spatiotemporal gait parameters and joint angles during the gait cycle were checked through the coefficient of variation (CV), the intraclass coefficient correlation (ICC) and the standard error of measurement (SEM). The variability of spatiotemporal and intra- and inter-day angular parameters was low for most variables, except for plantar flexion. The SEM was low for all parameters. Intra-day reliability was moderate to high for the spatiotemporal and angular parameters. Inter-day reliability was considered low to moderate for all parameters. The variables did not differ between instants and days. Experimental procedures demonstrate that the walking pattern did not change, but should be considered with caution in studies that include intervention, particularly for angular parameters during gait.

RESUMO Aproximadamente 21% das quedas em idosos ocorrem como consequência de tropeços ao caminhar. Há uma escassez de informações referentes à variabilidade e à confiabilidade dos parâmetros cinemáticos da marcha em diferentes dias de avaliação, sobretudo com idosos. Buscou-se analisar a variabilidade e a confiabilidade (intra e inter-dia) dos parâmetros espaço-temporais e angulares da marcha de idosos, após a indução de tropeço controlado. Oito idosas participaram do estudo. O tropeço foi induzido durante o início da fase de balanço da marcha. Foram analisados os dados cinemáticos das tentativas de marcha. A variabilidade e confiabilidade dos parâmetros espaço-temporais da marcha foram verificados através do coeficiente de variação (CV), do coeficiente de correlação intraclasse (ICC) e do erro padrão de medida (SEM). A variabilidade dos parâmetros espaço-temporais e angulares intra e inter-dia foi baixa para a maioria das variáveis, à exceção da flexão plantar. O SEM foi baixo para todos os parâmetros. A confiabilidade intra-dia foi moderada a alta para os parâmetros espaço-temporais e angulares; A confiabilidade inter-dia foi baixa a moderada para todos os parâmetros. As variáveis não diferiram entre instantes e dias. Apesar do padrão de marcha não ter alterado deve ser analisado com cautela em estudos que incluam intervenção, particularmente para os parâmetros angulares.

Torque and Muscle Activation Impairment Along With Insulin Resistance Are Associated With Falls in Women With Fibromyalgia.

Góes, SM, Stefanello, JMF, Homann, D, Lodovico, A, Hubley-Kozey, CL, and Rodacki, ALF. Torque and muscle activation impairment along with insulin resistance are associated with falls in women with fibromyalgia. J Strength Cond Res 30(11): 3155-3164, 2016-Fibromyalgia (FM) is a chronic pain condition associated with reduced muscle strength, which can lead to functional incapacity and higher risk of falls. The purpose of the study was to compare maximal ankle joint torque, muscle activation, and metabolic changes between women with and without FM. In addition, the relationship between those aspects and retrospectively reported falls in women with FM was determined. Twenty-nine middle-aged women with FM and 30 controls were recruited. Fall history, pain intensity, and pain threshold were assessed. Plasma glucose levels and insulin resistance (IR) were determined. Peak torque and rate of torque development (RTD) were calculated, and muscle activation was assessed from maximum isometric voluntary ankle dorsiflexion and plantar flexion contractions. In addition, voluntary muscle activation failure of the anterior tibialis muscle during maximal dorsiflexion was calculated. When compared to controls, women with FM reported higher number of retrospectively reported falls, exhibited higher IR, showed reduced plantar flexion and dorsiflexion RTD, had lower plantar flexion peak torque, and demonstrated more antagonist coactivation and higher muscle activation failure (p ≤ 0.05). Higher muscle activation failure was explained by glucose level and pain intensity (adj R = 0.28; p ≤ 0.05). Reduced plantar flexion and dorsiflexion peak torque explained 80% of retrospectively reported falls variance; also, high antagonist coactivation (odds ratio [OR] = 1.6; p ≤ 0.05) and high IR (OR = 1.8; p ≤ 0.05) increased the chance of falls in the FM group. A combination of metabolic factors and muscle function increased the odds of retrospectively reporting a fall in FM. Both aspects may be considered in interventions designed for reducing falls in this population.

Strength and Power Training Effects on Lower Limb Force, Functional Capacity, and Static and Dynamic Balance in Older Female Adults.

It has been proposed that muscle power is more effective to prevent falls than muscle force production capacity, as rapid reactions are required to allow the postural control. This study aimed to compare the effects of strength and power training on lower limb force, functional capacity, and static and dynamic balance in older female adults. Thirty-seven volunteered healthy women had been allocated into the strength-training group (n = 14; 69 ± 7.3 years, 155 ± 5.6 cm, 72 ± 9.7 kg), the power-training group (n = 12; 67 ± 7.4 years, 153 ± 5.5 cm, 67.2 ± 7 kg), and control group (n = 11; 65 ± 3.1 years, 154 ± 5.6 cm, 70.9 ± 3 kg). After 12 weeks of training, the strength-training and power-training groups increased significantly maximum dynamic strength (29% and 27%), isometric strength (26% and 37%), and step total time (13% and 14%, dynamic balance), respectively. However, only the power-training group increased the rate of torque development (55%) and the functional capacity in 30-second chair stand (22%) and in time up and go tests (-10%). Empirically, power training may reduce the risk of injuries due to lower loads compared to strength training, and consequently, the physical effort demand during the training session is lower. Therefore, power training should be recommended as attractive training stimuli to improve lower limb force, functional capacity, and postural control of older female adults.

Effect of an Eight-Week Ballroom Dancing Program on Muscle Architecture in Older Adults Females.

Aging is related to a progressive remodeling of the neuromuscular system, which includes muscle mass, strength, and power reductions. This study investigated the effect of an eight-week dance program on fascicle pennation angle, fascicle length, and thickness of the vastus lateralis (VL), tibialis anterior (TA), biceps femoris (BF), and gastrocnemius medialis (GM) muscles using ultrasound images. Thirty-four healthy older women were randomly assigned to either a dancing (DG: n = 19, 69.1 ± 6.5 years, 72.5 ± 11.7 kg) or control group (CG: n = 15, 71.5 ± 7.4 years, 70.9 ± 9.3 kg). After training, the DG showed greater (p < .05) thickness for VL (16%), TA (17%), BF (19%), and GM (15%); pennation angle for VL (21%), TA (23%), BF (21%), and GM (17%); and fascicle length for VL (11%), TA (12%), BF (10%), and GM (10%). These findings suggest that dance training was effective to change the lower limb muscle architecture in older female adults.

Kinetic analysis of floor-to-stair transition gait of elderly with different functional levels / Analise cinetica da marcha de idosos com diferentes niveis de funcionalidade na transicao entre o terreno plano e a escada

Climbing stairs represents a difficult and dangerous task for the elderly, and its performance depends on the functional ability level of the subject. The aim of this study was to compare the kinetic parameters of the floor-to-stair transition gait of elderly with different levels of functionality. The sample comprised 34 subjects, divided into two groups through Cluster techniques according to the results of functional tests (Timed Up & Go and sit-to-stand test), with G1 being the group with lower functionality (n=13, 72.61 ± 0.28 years) and G2 the group with greater functionality (n=21, 69.14 ± 4.96 years). Ground reaction force (GRF) data was captured with one AMTI force plate at a frequency of 1000 Hz, placed over the first step of a stairs with 4 steps (17.5 cm high x 29 cm wide and 31° slope). Descriptive statistics and Mann-Whitney test were used for data analysis (p≤0.05). G2 presented higher vertical GRF and lower support time in the ascending phase (p≤0.05). There were practically no differences in GRF values between groups in the descending phase. Based on these findings, we concluded that GRFs are influenced by subject's functional ability level and can influence the risk of falls during stair ascent.

Transpor escadas representa uma tarefa difícil e perigosa para os idosos e apresenta alto risco de quedas. O nível de funcionalidade do idoso é um fator determinante para sua independência e segurança na transposição de terrenos. Assim, o objetivo deste estudo foi comparar os parâmetros cinéticos da marcha de idosos com diferentes níveis de funcionalidade na transição entre o terreno plano e a escada na subida e na descida. Participaram do estudo 34 idosos, divididos em dois grupos pela técnica de Cluster de acordo com os resultados obtidos nos testes funcionais aplicados (Timed Up & Go e Teste de sentar e levantar), sendo o G1 o grupo com menor funcionalidade (n=13, 72.61 ± 0.28 anos) e o G2 o grupo com maior funcionalidade (n=21, 69.14 ± 4.96 anos). A captura de dados de força de reação do solo (FRS) foi feita através de uma plataforma de força AMTI a 1000 Hz, acoplada no primeiro degrau de uma escada com 4 degraus (17,5 cm altura x 29 cm largura e 31° de inclinação). Para análise dos resultados, utilizaram-se a estatística descritiva e o teste de Mann-Whitney (p≤0.05). Na subida, maiores forças verticais e menor tempo de apoio foram encontrados no G2 (p≤0.05). Os grupos praticamente não revelaram diferenças nas aplicações de força no solo na descida da escada. Baseado nos resultados encontrados, é possível concluir que as FRS são influenciadas pelo nível de funcionalidade do idoso na subida da escada.

Wheelchair rugby improves pulmonary function in people with tetraplegia after 1 year of training.

This study investigated the effects of 1 year of regular wheelchair rugby training on the pulmonary function of subjects with tetraplegia. A total of 15 male subjects with tetraplegia participated in this study and were divided into an experimental group of rugby players (n = 8) and a control group (n = 7) of sedentary tetraplegic subjects. Both groups underwent spirometry, and the experimental group was tested before and after participating of a regular 1-year program of wheelchair rugby training. At the beginning of the training program, all the subjects presented reduced pulmonary function compared with predicted values (p < 0.05) for healthy subjects. There were a significant increase in forced vital capacity (FVC), forced expired volume after 1 second (FEV1), and maximal voluntary ventilation (MVV, p < 0.05) values after 1 year of regular wheelchair rugby training. The regression analysis between total training time and spirometric variables FVC (r = 0.97, p < 0.0001) and MVV (r = 0.58, p = 0.02) revealed that the players with longer training time had higher pulmonary function values. This study showed that regular wheelchair rugby training can improve the pulmonary function of subjects with spinal cord injuries.

A novel video-based method using projected light to measure trunk volumes during respiration.

This paper proposes and evaluates an innovative video-based method for measuring the trunk volume during respiration, using projected light and surface reconstruction. The method consists of the following main steps: (a) to project a grid of circular light markers on the anterior and posterior human body trunk surface during breathing, (b) to register the subject's trunk surface using two pairs of pre-calibrated digital video cameras, (c) to segment the video stream and track the projected markers using pre-processing techniques, morphological operators and detection algorithms, (d) to label the corresponding markers in the video sequences registered by each pair of stereo cameras, (e) to reconstruct the 3-D coordinates of all markers, (f) to reconstruct the surfaces from the unordered cloud of points using the Power Crust method and (g) to calculate the trunk volume in function of time using the divergence theorem. The evaluation of the method was based on two experiments. (1) Comparison of the volume of a trunk model (mannequin) by immersion and using the proposed optical method. (2) Analysis of the applicability of the method for measuring a subject's trunk volume during a vital capacity respiratory manoeuvre. The results showed that the method was able to automatically measure more than 2000 projected points per image and to provide a very detailed representation of the subject's trunk. The relative accuracy of the volume measurement was estimated to be better than 3%. The analysis of the experiments revealed that signals coherent with the respiratory cycles could be identified through this method. In conclusion, the method based on light projection and surface reconstruction provides an accurate, non-invasive and useful means to calculate human trunk volumes during breathing.