Mobility device use in people with Parkinson's disease: A 3-year follow-up study.

OBJECTIVES: This study aimed to investigate how the use and perceived unmet need of mobility devices (MD) in people with Parkinson's disease (PD) evolve over a 3-year period. METHODS: The study reports baseline assessments (n = 255) and comparisons for participants with complete data at baseline and the 3-year follow-up (n = 165). Structured questions addressed the use and perceived unmet need of various MDs indoor and outdoor (eg, canes, wheeled walkers, and manual and powered wheelchairs). McNemar tests were used to investigate differences over time. RESULTS: In the total sample at baseline, 30% and 52% of the participants reported using MDs indoors and outdoors, respectively. Among those with complete data also at the 3-year follow-up, the proportion of participants using MDs increased significantly (P < .001) from 22% to 40% for indoors and from 48% to 66% for outdoors, with transition of MD toward more assistive potential (ie, wheeled walker and manual wheelchair). Wheeled walkers were the most commonly used MD indoors as well as outdoors on both occasions. Among the users of multiple MDs, the most common combination was cane and wheeled walker on both occasions. The proportion of participants who reported a perceived unmet need of MDs was 5% at baseline, whereas it was 21%, 3 years later. CONCLUSIONS: The use and perceived unmet need of MDs in people with PD increase over time. There is a need for addressing MDs at clinical follow-ups of people with PD, with continuous attention in primary health care and municipality contexts.

Walking Aids for Enabling Activity and Participation: A Systematic Review.

In this systematic literature review, we examined whether and how walking aids (i.e., canes, crutches, walkers, and rollators) enable activity and participation among adults with physical disabilities. Medline, Embase, all EBM reviews, PsychInfo, CINAHL, and Web of Science databases were used to identify studies published since 2008. Quantitative and qualitative designs were included. Data regarding participants, assistive device use, outcome measures, and domains of participation were extracted. Two reviewers independently rated the level of evidence and methodological quality of the studies. Outcomes were categorized per types of walking aids and activity and participation domains. Thirteen studies were included. Two studies involved canes, four pertained to rollators, and seven dealt with multiple types of walking aids. Mobility was the most frequently examined domain of activity and participation. Both negative and positive results were found. Negative outcomes were linked to the physical characteristics of the device, the use, environment, and personal reluctance. When incorporated in daily life, walking aids were found to enable several domains of activity and participation. Whether walking aids facilitate activity and participation may depend on the user's ability to overcome obstacles and integrate them in daily life. More high-quality research is needed to draw conclusions about their effectiveness.

Primary surgical repair of acute Achilles tendon rupture: comparative results of three surgical techniques.

PURPOSE: To determine which of the three surgical techniques for acute unilateral complete rupture of Achilles tendons in use at the University Clinical Centre Maribor gives the best short-term functional results. METHODS: In the retrospective analysis of the results of 3 surgical techniques, 262 patients of which 244 (93.1%) were men (mean age 41.6 ± 10.0 years, range 21.5-83.0 years) operated on during the period from 2000 to 2008 were included. Group A (open technique with fascial augmentation) included 42 (16%) patients, group B (original modification of percutaneous suturing according to Cretnik and Kosanovic) included 159 (60.7%) patients, and group C (original percutaneous fixation with two embracing and crossed loops according to Kruscic) included 61 (23.3%) patients. The rehabilitation protocol for group C included use of individually manufactured closed ankle functional orthosis, which replaced the plaster cast after 2 weeks of immobilization and permits early ankle range-of-motion exercising and full weight bearing. The functional outcome and incidence of postsurgical complications were analysed from medical records covering the period of 6 months. RESULTS: Patients from group C achieved the best functional results in the shortest time. The duration of immobilization (5.3 ± 0.1 weeks) and use of crutches (5.3 ± 0.5 weeks) were the shortest. The ability to rise up on toes on the affected leg, to walk on toes and heels, and duration of restriction of physical activities including sports were shorter than in the other two groups (p < 0.001 for all variables). Two reruptures were experienced in group B, one in group C, and none in group A. CONCLUSIONS: Good functional results and a relatively small number of postsurgical complications advocate the use of percutaneous suturing techniques. The best and fastest functional recovery was attained in the group treated with the original technique of percutaneous fixation with two embracing and crossed thread loops according to Kruscic.

Upper extremity inverse dynamics model for crutch-assisted gait assessment.

Current inverse dynamics models of the upper extremity (UE) are limited for the measurement of Lofstrand crutch-assisted gait. The objective of this study is to develop, validate, and demonstrate a three-dimensional (3-D) UE motion assessment system to quantify crutch-assisted gait in children. We propose a novel 3-D dynamic model of the UEs and crutches for quantification of joint motions, forces, and moments during Lofstrand crutch-assisted gait. The model is composed of the upper body (i.e., thorax, upper arms, forearms, and hands) and Lofstrand crutches to determine joint dynamics of the thorax, shoulders, elbows, wrists, and crutches. The model was evaluated and applied to a pediatric subject with myelomeningocele (MM) to demonstrate its effectiveness in the characterization of crutch gait during multiple walking patterns. The model quantified UE dynamics during reciprocal and swing-through crutch-assisted gait patterns. Joint motions and forces were greater during swing-through gait than reciprocal gait. The model is suitable for further application to pediatric crutch-user populations. This study has potential for improving the understanding of the biomechanics of crutch-assisted gait and may impact clinical intervention strategies and therapeutic planning of ambulation.

Load-relief of walking AIDS on osseointegrated fixation: instrument for evidence-based practice.

Clinicians are currently in demand of tools enabling individual assessment during their daily practice of load-relief of walking aids. The first aim of this article is to describe a portable kinetic system that could be used to measure directly the true load applied on the residuum during assisted walking. The second aim is to present the information that can be derived from the raw loading data. The third aim is to provide an example for a participant. One active transfemoral amputee fitted with an osseointegrated fixation was asked to walk in straight level line with no aid, one stick, one and two elbow crutches on a 20 m walkway. The load-relief was measured using a six-channel transducer and recorded using a data logger. The overall loading was decreased by 2% using one stick, 5% using one crutch and by 10% using two crutches. This study presents a method that can be used by clinicians facing the challenge of prescribing and assessing walking aids to restore the locomotion of lower limb amputees in the framework of an evidence-based practice.

Outcomes of individuals with transfemoral and contralateral transtibial amputation due to dysvascular etiologies.

OBJECTIVE: To evaluate the functional outcome of individuals with transfemoral and contralateral transtibial amputations secondary to peripheral vascular disease. METHODS: A retrospective chart review followed by phone interview. The primary outcome measures were the discharge 2-minute walk test, Frenchay Activities Index, and the Houghton Scale. RESULTS: There were 31 dysvascular individuals identified to have a combination of transfemoral/transtibial (TF/TT) amputation admitted to our institution for rehabilitation from February 1998 to June 2007. The mortality at follow up was 68%. There were eight surviving amputees. The average 2-minute walk test score was 31.9 m at the time of discharge from our inpatient program. Of these, the average Frenchay Activities Index was 15.3. The average Houghton Scale score for use of the transtibial prosthesis alone was 2.1. The average Houghton Scale score for use of both prostheses was 1.5. Comparisons between groups based on initial amputation level revealed a significant difference of being fitted with a transfemoral prosthesis. Those whom initially had a TT amputation were less likely to ultimately be fitted with a TF prosthesis (X(2) (1,n=31) = 4.76, p < 0.05). CONCLUSION: The overall functional outcome of individuals with a combination of TF/TT amputation due to dysvascular causes is poor. These individuals have a low level of ambulation, activity, and prosthetic use.

[Frequency of biceps tendon tenosynovitis from crutches: a sonographical observation]. / Häufigkeit einer Bizepssehnentenosynovitis bei Gehhilfenverwendung : Eine sonographische Beobachtung.

A total of 138 patients using elbow crutches after endoprothetic joint replacement of the hip or knee were examined for effusion of the biceps tendon sheath using ultrasound sonography. A surprisingly high number of patients showed liquid effusion around the long biceps tendon area (69 patients, 50%). Tenosynovitis was associated with a liquid effusion of the glenohumeral joint in only 5 cases, whereas isolated tenovaginitis was seen in the large majority of the cases. This leads to the hypothesis that axial-mediated stress is the pathogenetic mechanism and causes a functional impingement as a result of high positioning of the caput humeri by the use of crutches. Further investigations are necessary to find out why the inflammation is limited to the anterior recessus region (Sulcus intertubercularis) of the glenohumeral joint.

Assessing functional mobility in survivors of lower-extremity sarcoma: reliability and validity of a new assessment tool.

BACKGROUND: Reliability and validity of a new tool, Functional Mobility Assessment (FMA), were examined in patients with lower-extremity sarcoma. FMA requires the patients to physically perform the functional mobility measures, unlike patient self-report or clinician administered measures. PROCEDURE: A sample of 114 subjects participated, 20 healthy volunteers and 94 patients with lower-extremity sarcoma after amputation, limb-sparing, or rotationplasty surgery. Reliability of the FMA was examined by three raters testing 20 healthy volunteers and 23 subjects with lower-extremity sarcoma. Concurrent validity was examined using data from 94 subjects with lower-extremity sarcoma who completed the FMA, Musculoskeletal Tumor Society (MSTS), Short-Form 36 (SF-36v2), and Toronto Extremity Salvage Scale (TESS) scores. Construct validity was measured by the ability of the FMA to discriminate between subjects with and without functional mobility deficits. RESULTS: FMA demonstrated excellent reliability (ICC [2,1] >or=0.97). Moderate correlations were found between FMA and SF-36v2 (r = 0.60, P < 0.01), FMA and MSTS (r = 0.68, P < 0.01), and FMA and TESS (r = 0.62, P < 0.01). The patients with lower-extremity sarcoma scored lower on the FMA as compared to healthy controls (P < 0.01). CONCLUSION: The FMA is a reliable and valid functional outcome measure for patients with lower-extremity sarcoma. This study supports the ability of the FMA to discriminate between patients with varying functional abilities and supports the need to include measures of objective functional mobility in examination of patients with lower-extremity sarcoma.

Upper-limb pain in long-term poliomyelitis.

BACKGROUND: Late functional deterioration is common in long-term poliomyelitis patients. While upper-limb pain in individual functional regions is common, its overall prevalence and pattern in long-term poliomyelitis is poorly documented. AIM: To assess the nature of upper-limb pain in these patients and examine its association with dependence on mobility aids (and therefore upper limb 'overuse'). DESIGN: Questionnaire-based survey of patients attending a specialist unit. METHODS: Questionnaires were sent to 139 patients with known long-term poliomyelitis (mean 49.8 years post polio), attending the Lane Fox Unit out-patient clinic at St Thomas' Hospital between January 1998 and December 1998. There were questions on the nature of the patient's acute illness, limb involvement at initial infection ('polio-affected' limbs), the site and onset of upper-limb pain, hand dominance, previous injuries and surgery, and the use of mobility aids. Limbs that had sustained an injury or undergone surgery, at or preceding onset of upper-limb pain, were excluded from analysis. RESULTS: Among 103 valid replies, the prevalence of upper limb pain was 64%. Mobility aids were used by 74%, and were associated with an increased risk of upper-limb pain, while 'polio-affected' limbs were at reduced risk. DISCUSSION: These data support 'overuse' due to greater mobility aid dependence as a cause of increasing upper-limb pain in long-term poliomyelitis.

Canes, crutches and home care services: the interplay of human and technological assistance.

This brief reports the results of a study investigating the efficacy of canes, crutches, walkers, and wheelchairs for people who need assistance with everyday activities and asks the question, does low assistive technology replace human help for people with disabilities? Study results show that canes and crutches are low cost, versatile aids that can partially substitute for human assistance by reducing the overall number of hours of care required. They can also reduce out-of-pocket expenses for supportive services. Walkers and wheelchairs, on the other hand, appear to supplement, rather than substitute for, human assistance. The brief concludes by recommending that greater use of canes and crutches be actively encouraged to increase the independence of people who need help with daily activities.

Mobility of persons after traumatic lower limb amputation.

The objective of this study was to determine the influence of time span since amputation on mobility of persons experiencing traumatic lower limb amputation. A special questionnaire was sent to such persons and responses were analysed statistically. The subjects comprised 223 persons after traumatic lower limb amputation, residents of Slovenia. We discovered that 186 (74.2%) are using their prosthesis for more than 7 hours per day, 109 (52.2%) are able to walk outdoors without crutches, and 129 (57.8%) climb more than 20 stairs per day. In addition, those who are walking without crutches, walking longer distances, still cycling and driving a care are, on average, 5-10 years younger than the others. However, around one-third of persons who were young at the time of amputation face limitations of mobility later in life. A total of 76 (35.3%) are able to walk only up to 500 m out of doors, 38 (18.2%) can walk only with a pair of crutches, 62 (29.7%) need a cane or one crutch, and 37 (16.6%) cannot climb stairs. We conclude that successful fitting and usage of a prosthesis by persons after lower limb amputation promotes independent walking and mobility in everyday life. The level of independence achieved is related to time span since amputation.