Using Wavelet Analysis of Blood Flow Oscillations to Investigate Differences in Skin Blood Flow Regulations Between the Upper and Lower Limbs.

BACKGROUND: The objective of this study was to investigate the differences in skin blood flow regulations between the upper and lower limbs in healthy adults using wavelet analysis of skin blood oscillations. To the best of our knowledge, this is the first study investigating the dominant skin blood flow control of the upper and lower limbs in healthy adults. METHODS: Skin blood flow of the forearm and leg was simultaneously measured by laser Doppler flowmetry (LDF) in 17 healthy adults. Skin blood flow oscillations were analyzed using wavelet analysis to assess the dominant control among the metabolic endothelial (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), myogenic (0.05-0.15 Hz), respiratory (0.15-0.4 Hz), and cardiac (0.4-2 Hz) origins. RESULTS: Skin blood flow in the leg (11.13 ± 4.90 perfusion unit) was significantly higher than in the forearm (6.90 ± 2.50 perfusion unit, p < 0.001). The metabolic endothelial control is more dominant in the forearm (1.19 ±0.51 au) compared to the leg (0.73 ± 0.41 au, p < 0.01). The myogenic control is more dominant in the leg (1.18 ± 0.28 au) compared to the forearm (0.96±0.18 au, p < 0.05). CONCLUSION: Through wavelet analysis of skin blood flow oscillations, the results indicate that metabolic endothelial control is more dominant in the forearm (upper limbs) and myogenic control is more dominant in the leg (lower limbs).

Adaptive Changes in Longitudinal Arch During Long-distance Running.

This study investigates the biomechanical adaptations of the longitudinal arch (LA) in long-distance runners, focusing on changes in stiffness, angle, and moment during a 60-minute run. Twenty runners participated in this experiment, and were asked to run at a speed of 2.7 m·s-1 for 60 minutes. The kinematic and kinetic data collected at five-minute intervals during running were calculated, including the stiffness of LA in the loading phase (k load ) and the stiffness of LA in the unloading phase (k unload ), the maximum LA moment (M max ), the range of LA angle change (∆θ range ), and the maximum LA angle change (∆θ max ). Foot morphology was also scanned before and after running. Variations of kinematic and kinetic data were analyzed throughout the running activity, as well as variations of foot morphology pre- and post-run. Results showed that there was a significant decrease in k load (p<0.001), coupled with increases in ∆θ range (p=0.002) and ∆θ max (p<0.001), during the first 15 minutes of running, which was followed by a period of mechanical stability. No differences were found in k unload and M max throughout the running process and the foot morphology remained unchanged after running. These results highlight a critical adaptation phase that may be pivotal for improving running economy and performance.

Comparison of Isometric and Dynamic Bridging Exercises on Low Back Muscle Oxygenation.

Bridging exercises are commonly performed by people with low back pain (LBP). However, the effect of the contraction mode in a bridging exercise on the hemodynamics of the low back muscle has not been investigated in people with and without LBP. The objective of this study was to assess the effect of the mode of bridging exercise on oxygenation of the low back muscle. A near-infrared spectroscopy was used to measure hemodynamic responses of the erector spinae between isometric and dynamic bridging exercises in 16 healthy participants. The results demonstrated that during exercise, the isometric bridging exercise significantly decreased oxyhemoglobin and deoxy-hemoglobin compared to the dynamic bridging exercise (oxyhemoglobin, t=- 3.109, p=0.007, Cohen's d=0.68 and deoxy-hemoglobin, t=- 2.193, P=0.046, Cohen's d=0.60). The results also demonstrated that after exercise, the dynamic bridging exercise induced a significantly higher oxygenation response (oxygenation, t=- 2.178, P=0.048, Cohen's d=0.43). This study indicates that the dynamic bridging exercise is more effective in improving oxygenation of low back muscles.

Texture differences of microchambers and macrochambers in heel pads between the elderly with and without diabetes.

OBJECTIVE: This study aims to use the texture analysis of ultrasound images to distinguish the features of microchambers (a superficial thinner layer) and macrochambers (a deep thicker layer) in heel pads between the elderly with and without diabetes, so as to preliminarily explore whether texture analysis can identify the potential injury characteristics of deep tissue under the influence of diabetes before the obvious injury signs can be detected in clinical management. METHODS: Ultrasound images were obtained from the right heel (dominant leg) of eleven elderly people with diabetes (DM group) and eleven elderly people without diabetes (Non-DM group). The TekScan system was used to measure the peak plantar pressure (PPP) of each participant. Six gray-level co-occurrence matrix (GLCM) features including contrast, correlation, dissimilarity, energy, entropy, homogeneity were used to quantify texture changes in microchambers and macrochambers of heel pads. RESULTS: Significant differences in GLCM features (correlation, energy and entropy) of macrochambers were found between the two groups, while no significant differences in all GLCM features of microchambers were found between the two groups. No significant differences in PPP and tissue thickness in the heel region were observed between the two groups. CONCLUSIONS: In the elderly with diabetes who showed no significant differences in PPP and plantar tissue thickness compared to those without diabetes, several texture features of ultrasound images were found to be significantly different. Our finding indicates that texture features (correlation, energy and entropy) of macrochambers could be used for early detection of soft tissue damage associated with diabetes.

Effects of alternating pressure patterns on sacral skin blood flow responses in people with spinal cord injury.

Alternating pressure support surface (APSS) is a common support surface for treating pressure injury in individuals with spinal cord injury (SCI). However, conflicting results on the effectiveness of APSS have been reported and may be associated with inappropriate configurations of APSS. The objectives of this study were to compare the different pressure amplitudes (75/5 mmHg [alternating between 75 and 5 mmHg] vs. 65/15 mmHg) and cycle periods (5 min [4 cycles] vs. 2.5 min [8 cycles]) of alternating pressure on sacral skin blood flow responses in 10 individuals with SCI. Sacral skin blood flow during and after loading of four alternating pressure protocols was assessed using laser Doppler flowmetry and was normalised to the value before loading (10-min baseline, 20-min loading and 10-min recovery). The results demonstrated that during the high-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (0.3658 ± 0.0688 for 75/5 mmHg and 0.1702 ± 0.0389 for 65/15 mmHg, p < 0.05); and during the low-pressure phase, there was a significant difference between the 75/5 and 65/15 mmHg protocols (1.7184 ± 0.262 for 75/5 mmHg and 0.5916 ± 0.1378 for 65/15 mmHg, p < 0.05). There were no differences between cycle periods in skin blood flow responses. No adverse events were reported. Our finding indicates that the pressure amplitude of alternating pressure is a significant factor affecting sacral skin blood flow responses. An appropriate configuration of alternating pressure is needed to effectively increase skin blood flow and tissue viability in individuals with SCI.

Application of Multiscale Sample Entropy in Assessing Effects of Exercise Training on Skin Blood Flow Oscillations in People with Spinal Cord Injury.

Spinal cord injury (SCI) causes a disruption of autonomic nervous regulation to the cardiovascular system, leading to various cardiovascular and microvascular diseases. Exercise training is an effective intervention for reducing risk for microvascular diseases in healthy people. However, the effectiveness of exercise training on improving microvascular function in people with SCI is largely unknown. The purpose of this study was to compare blood flow oscillations in people with spinal cord injury and different physical activity levels to determine if such a lifestyle might influence skin blood flow. A total of 37 participants were recruited for this study, including 12 athletes with SCI (ASCI), 9 participants with SCI and a sedentary lifestyle (SSCI), and 16 healthy able-bodied controls (AB). Sacral skin blood flow (SBF) in response to local heating at 42 °C for 50 min was measured using laser Doppler flowmetry. The degree of the regularity of blood flow oscillations (BFOs) was quantified using a multiscale entropy approach. The results showed that BFO was significantly more irregular in ASCI and AB compared to SSCI during the maximal vasodilation period. Our results also demonstrate that the difference in the regularity of BFOs between original SBF signal and phase-randomized surrogate time series was larger in ASCI and AB compared to SSCI. Our findings indicate that SCI causes a loss of complexity of BFOs and exercise training may improve complexity in people with SCI. This study demonstrates that multiscale entropy is a sensitive method for detecting differences between different categories of people with SCI and might be able to detect effects of exercise training related to skin blood flow.

Effects of walking speeds and durations on the plantar pressure gradient and pressure gradient angle.

BACKGROUND: Walking exercise has been demonstrated to improve health in people with diabetes. However, it is largely unknown the influences of various walking intensities such as walking speeds and durations on dynamic plantar pressure distributions in non-diabetics and diabetics. Traditional methods ignoring time-series changes of plantar pressure patterns may not fully capture the effect of walking intensities on plantar tissues. The purpose of this study was to investigate the effect of various walking intensities on the dynamic plantar pressure distributions. In this study, we introduced the peak pressure gradient (PPG) and its dynamic patterns defined as the pressure gradient angle (PGA) to quantify dynamic changes of plantar pressure distributions during walking at various intensities. METHODS: Twelve healthy participants (5 males and 7 females) were recruited in this study. The demographic data were: age, 27.1 ± 5.8 years; height, 1.7 ± 0.1 m; and weight, 63.5 ± 13.5 kg (mean ± standard deviation). An insole plantar pressure measurement system was used to measure plantar pressures during walking at three walking speeds (slow walking 1.8 mph, brisk walking 3.6 mph, and slow running 5.4 mph) for two durations (10 and 20 min). The gradient at a location is defined as the unique vector field in the two-dimensional Cartesian coordinate system with a Euclidean metric. PGA was calculated by quantifying the directional variation of the instantaneous peak gradient vector during stance phase of walking. PPG and PGA were calculated in the plantar regions of the first toe, first metatarsal head, second metatarsal head, and heel at higher risk for foot ulcers. Two-way ANOVA with Fisher's post-hoc analysis was used to examine the speed and duration factors on PPG and PGA. RESULTS: The results showed that the walking speeds significantly affect PPG (P < 0.05) and PGA (P < 0.05), and the walking durations does not. No interaction between the walking duration and speed was observed. PPG in the first toe region after 5.4 mph for either 10 or 20 min was significantly higher than 1.8 mph. Meanwhile, after 3.6 mph for 20 min, PPG in the heel region was significantly higher than 1.8 mph. Results also indicate that PGA in the forefoot region after 3.6 mph for 20 min was significantly narrower than 1.8 mph. CONCLUSIONS: Our findings indicate that people may walk at a slow speed at 1.8 mph for reducing PPG and preventing PGA concentrated over a small area compared to brisk walking at 3.6 mph and slow running at 5.4 mph.

A Deep Learning Method for Foot Progression Angle Detection in Plantar Pressure Images.

Foot progression angle (FPA) analysis is one of the core methods to detect gait pathologies as basic information to prevent foot injury from excessive in-toeing and out-toeing. Deep learning-based object detection can assist in measuring the FPA through plantar pressure images. This study aims to establish a precision model for determining the FPA. The precision detection of FPA can provide information with in-toeing, out-toeing, and rearfoot kinematics to evaluate the effect of physical therapy programs on knee pain and knee osteoarthritis. We analyzed a total of 1424 plantar images with three different You Only Look Once (YOLO) networks: YOLO v3, v4, and v5x, to obtain a suitable model for FPA detection. YOLOv4 showed higher performance of the profile-box, with average precision in the left foot of 100.00% and the right foot of 99.78%, respectively. Besides, in detecting the foot angle-box, the ground-truth has similar results with YOLOv4 (5.58 ± 0.10° vs. 5.86 ± 0.09°, p = 0.013). In contrast, there was a significant difference in FPA between ground-truth vs. YOLOv3 (5.58 ± 0.10° vs. 6.07 ± 0.06°, p < 0.001), and ground-truth vs. YOLOv5x (5.58 ± 0.10° vs. 6.75 ± 0.06°, p < 0.001). This result implies that deep learning with YOLOv4 can enhance the detection of FPA.

Effect of intermittent pneumatic compression with different inflation pressures on the distal microvascular responses of the foot in people with type 2 diabetes mellitus.

Intermittent pneumatic compression (IPC) is commonly used to improve peripheral circulation of the lower extremity. However, its therapeutic dosage for people with type 2 diabetes mellitus (DM) at risk for ulcers is not well established. This study explored the effect of IPC with different inflation pressures on the distal microvascular responses of the foot in people with type 2 DM. Twenty-four subjects with and without DM were recruited. Three IPC protocols with inflation pressures of 60, 90, and 120 mmHg were applied to the foot. The foot skin blood flow (SBF) responses were measured by laser Doppler flowmetry during and after IPC interventions. Results show that all three IPC interventions significantly increased foot SBF of IPC stage in healthy subjects, but only 90 and 120 mmHg IPC significantly improved SBF in diabetic subjects. IPC with 90 and 120 mmHg showed a greater effect than 60 mmHg in both groups, but 120 mmHg IPC was more effective for diabetic subjects. This study demonstrates that 90 and 120 mmHg are effective dosages of IPC for improving blood flow in healthy people, and 120 mmHg IPC may be more suitable for people with type 2 DM.

Using laser Doppler flowmetry with wavelet analysis to study skin blood flow regulations after cupping therapy.

BACKGROUND: The purpose of this study was to use laser Doppler flowmetry (LDF) with wavelet analysis to investigate skin blood flow control mechanisms in response to various intensities of cupping therapy. To the best of our knowledge, this is the first study to assess skin blood flow control mechanism in response to cupping therapy using wavelet analysis of laser Doppler blood flow oscillations. MATERIALS AND METHODS: Twelve healthy participants were recruited for this repeated-measures study. Three different intensities of cupping therapy were applied using 3 cup sizes at 35, 40, and 45 mm (in diameter) with 300 mm Hg negative pressure for 5 minutes. LDF was used to measure skin blood flow (SBF) on the triceps before and after cupping therapy. Wavelet analysis was used to analyze the blood flow oscillations (BFO) to assess blood flow control mechanisms. RESULTS: The wavelet amplitudes of metabolic and cardiac controls after cupping therapy were higher than those before cupping therapy. For the metabolic control, the 45-mm cupping protocol (1.65 ± 0.09) was significantly higher than the 40-mm cupping protocol (1.40 ± 0.10, P < .05) and the 35-mm cupping protocol (1.35 ± 0.12, P < .05). No differences were showed in the cardiac control among the 35-mm (1.61 ± 0.20), 40-mm (1.64 ± 0.24), and 45-mm (1.27 ± 0.25) cupping protocols. CONCLUSION: The metabolic and cardiac controls significantly contributed to the increase in SBF after cupping therapy. Different intensities of cupping therapy caused different responses within the metabolic control and not the cardiac control.

Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions.

BACKGROUND: Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns. METHODS: A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated. RESULTS: Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016). CONCLUSIONS: This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

The effects of different accumulated pressure-time integral stimuli on plantar blood flow in people with diabetes mellitus.

BACKGROUND: Exercise, especially weight-bearing exercise (e.g. walking), may affect plantar tissue viability due to prolonged repetitive high vertical and high shear pressure stimulus on the plantar tissue, and further induce development of diabetic foot ulcers (DFUs). This study aimed to investigate the effects of different accumulated pressure-time integral (APTI) stimuli induced by walking on plantar skin blood flow (SBF) responses in people with diabetes mellitus (DM). METHODS: A repeated measures design was used in this study. Two walking protocols (low APTI (73,000 kPa·s) and high APTI (73,000 × 1.5 kPa·s)) were randomly assigned to ten people with DM and twenty people without DM. The ratio of SBF measured by laser Doppler flowmetry after walking to that before (normalized SBF) was used to express the SBF responses. RESULTS: After low APTI, plantar SBF of people with DM showed a similar response to people without DM (P = 0.91). However, after high APTI, people with DM had a significantly lower plantar SBF compared to people without DM (P < 0.05). In people with DM, plantar SBF in the first 2 min after both APTI stimuli significantly decreased compared to plantar SBF before walking (P < 0.05). CONCLUSIONS: People with DM had a normal SBF response after low APTI walking but had an impaired SBF response after high APTI walking, which suggests that they should avoid weight-bearing physical activity with intensity more than 73,000 kPa·s and should rest for more than 2 min after weight-bearing physical activity to allow a full vasodilatory response to reduce risk of DFUs.

Estimation of Various Walking Intensities Based on Wearable Plantar Pressure Sensors Using Artificial Neural Networks.

Walking has been demonstrated to improve health in people with diabetes and peripheral arterial disease. However, continuous walking can produce repeated stress on the plantar foot and cause a high risk of foot ulcers. In addition, a higher walking intensity (i.e., including different speeds and durations) will increase the risk. Therefore, quantifying the walking intensity is essential for rehabilitation interventions to indicate suitable walking exercise. This study proposed a machine learning model to classify the walking speed and duration using plantar region pressure images. A wearable plantar pressure measurement system was used to measure plantar pressures during walking. An Artificial Neural Network (ANN) was adopted to develop a model for walking intensity classification using different plantar region pressure images, including the first toe (T1), the first metatarsal head (M1), the second metatarsal head (M2), and the heel (HL). The classification consisted of three walking speeds (i.e., slow at 0.8 m/s, moderate at 1.6 m/s, and fast at 2.4 m/s) and two walking durations (i.e., 10 min and 20 min). Of the 12 participants, 10 participants (720 images) were randomly selected to train the classification model, and 2 participants (144 images) were utilized to evaluate the model performance. Experimental evaluation indicated that the ANN model effectively classified different walking speeds and durations based on the plantar region pressure images. Each plantar region pressure image (i.e., T1, M1, M2, and HL) generates different accuracies of the classification model. Higher performance was achieved when classifying walking speeds (0.8 m/s, 1.6 m/s, and 2.4 m/s) and 10 min walking duration in the T1 region, evidenced by an F1-score of 0.94. The dataset T1 could be an essential variable in machine learning to classify the walking intensity at different speeds and durations.

Effects of Muscle Fatigue and Recovery on Complexity of Surface Electromyography of Biceps Brachii.

This study aimed to investigate the degree of regularity of surface electromyography (sEMG) signals during muscle fatigue during dynamic contractions and muscle recovery after cupping therapy. To the best of our knowledge, this is the first study assessing both muscle fatigue and muscle recovery using a nonlinear method. Twelve healthy participants were recruited to perform biceps curls at 75% of the 10 repetitions maximum under four conditions: immediately and 24 h after cupping therapy (-300 mmHg pressure), as well as after sham control (no negative pressure). Cupping therapy or sham control was assigned to each participant according to a pre-determined counter-balanced order and applied to the participant's biceps brachii for 5 min. The degree of regularity of the sEMG signal during the first, second, and last 10 repetitions (Reps) of biceps curls was quantified using a modified sample entropy (Ems) algorithm. When exercise was performed immediately or 24 h after sham control, Ems of the sEMG signal showed a significant decrease from the first to second 10 Reps; when exercise was performed immediately after cupping therapy, Ems also showed a significant decrease from the first to second 10 Reps but its relative change was significantly smaller compared to the condition of exercise immediately after sham control. When exercise was performed 24 h after cupping therapy, Ems did not show a significant decrease, while its relative change was significantly smaller compared to the condition of exercise 24 h after sham control. These results indicated that the degree of regularity of sEMG signals quantified by Ems is capable of assessing muscle fatigue and the effect of cupping therapy. Moreover, this measure seems to be more sensitive to muscle fatigue and could yield more consistent results compared to the traditional linear measures.

Using Bidimensional Multiscale Entropy Analysis of Ultrasound Images to Assess the Effect of Various Walking Intensities on Plantar Soft Tissues.

Walking performance is usually assessed by linear analysis of walking outcome measures. However, human movements consist of both linear and nonlinear complexity components. The purpose of this study was to use bidimensional multiscale entropy analysis of ultrasound images to evaluate the effects of various walking intensities on plantar soft tissues. Twelve participants were recruited to perform six walking protocols, consisting of three speeds (slow at 1.8 mph, moderate at 3.6 mph, and fast at 5.4 mph) for two durations (10 and 20 min). A B-mode ultrasound was used to assess plantar soft tissues before and after six walking protocols. Bidimensional multiscale entropy (MSE2D) and the Complexity Index (CI) were used to quantify the changes in irregularity of the ultrasound images of the plantar soft tissues. The results showed that the CI of ultrasound images after 20 min walking increased when compared to before walking (CI4: 0.39 vs. 0.35; CI5: 0.48 vs. 0.43, p < 0.05). When comparing 20 and 10 min walking protocols at 3.6 mph, the CI was higher after 20 min walking than after 10 min walking (CI4: 0.39 vs. 0.36, p < 0.05; and CI5: 0.48 vs. 0.44, p < 0.05). This is the first study to use bidimensional multiscale entropy analysis of ultrasound images to assess plantar soft tissues after various walking intensities.

Effects of walking speeds and durations on plantar skin blood flow responses.

BACKGROUND: Various walking speeds and durations in daily life cause different levels of ischemia of plantar tissues. It is unclear what walking speeds and durations significantly affect plantar tissue viability and risks for foot ulcers in non-diabetics and diabetics. OBJECTIVE: The aim of this study was to establish the normal response of plantar skin blood flow to different speeds and durations of walking exercise in non-diabetics that would be needed to quantify impaired responses in diabetics. METHOD: Laser Doppler flowmetry was used to measure plantar skin blood flow of the first metatarsal head in 12 non-diabetics. A 3 × 2 factorial design, including 3 speeds (slow at 3 km/h, moderate at 6 km/h, and fast at 9 km/h) and 2 durations (10 and 20 min), was used in this study. Skin blood flow after walking was expressed as a ratio of skin blood flow before walking. The 3 × 2 two-way analysis of variance (ANOVA) with repeated measures was used to examine the main effects of speeds and durations and their interaction. RESULT: The walking speed significantly affected skin blood flow responses (p < 0.01). Walking at 9 km/h significantly increased plantar skin blood flow (5.71 ±â€¯1.89) compared to walking at 6 km/h (2.1 ±â€¯0.29) and 3 km/h (1.16 ±â€¯0.14), especially at 20-minute walking duration (p < 0.01). The walking duration showed a trend of significance on affecting skin blood flow responses (p = 0.06). There was no significant interaction between walking speeds and durations (p > 0.05). CONCLUSIONS: Our results provide the first evidence that walking speeds affect plantar skin blood flow and a fast walking speed (9 km/h) significantly increases plantar skin blood flow compared to moderate (6 km/h) and slow (3 km/h) walking speeds.

The effects of local cooling rates on perfusion of sacral skin under externally applied pressure in people with spinal cord injury: an exploratory study.

STUDY DESIGN: Experimental before-after design. OBJECTIVES: The objectives of this study were to explore the effects of local cooling rates on perfusion of sacral skin under externally applied pressure in people with spinal cord injury (SCI). SETTING: Research laboratory. METHODS: Seventeen participants, including seven wheelchair users with SCI and ten able-bodied (AB) controls. Each participant underwent seven protocols, including pressure (60 mmHg) with local cooling (∆t = -10 °C) for 20 min at three cooling rates (-0.5, -4, -10 °C/min), pressure with local cooling for 40 min, pressure with local heating (∆t = +10 °C), local cooling without pressure, and pressure without temperature changes. Each protocol included a 10-min baseline, a 20-min (or 40-min) loading period and a 20-min recovery. A compound sensor head consisting of laser Doppler and heating and cooling probes was used to measure sacral skin blood flow and temperature in the prone position. Blood flow responses were characterized by peak blood flow, recovery time, and total blood flow in the recovery period. RESULTS: The results demonstrated that the cooling rate at -10 °C/min resulted in smaller skin blood flow response compared with -0.5 °C/min (p < 0.05) but were not significantly different to the cooling rate at -4 °C/min. There was a significant difference in the recovery time between the 20-min cooling compared with the 40-min cooling for the SCI group (p < 0.05). CONCLUSIONS: Our findings provide initial evidence that local cooling rates affect skin blood flow responses under externally applied pressure in people with SCI.

Effects of cycle periods and pressure amplitudes of alternating pressure on sacral skin blood flow responses.

BACKGROUND: There are no guidelines on selecting alternating pressure (AP) configurations on increasing sacral skin blood flow (SBF). AIM: The specific aims were to compare different cycle periods and pressure amplitudes of AP on sacral SBF responses in healthy people to establish the efficacy and safety of the protocols. METHODS: Two studies were tested, including the cycle period study (8 2.5-min vs 4 5-min protocols) and the pressure amplitude study (75/5 vs 65/15 mmHg protocols). Sacral SBF was measured using laser Doppler flowmetry (LDF) in 20 participants. AP loads were randomly applied using an indenter through the rigid LDF probe. Each protocol included a 10-min baseline, 20-min AP and 10-min recovery periods. A 30-min washout period was provided. The SBF response was normalized to the baseline SBF of each condition of each participant. RESULTS: For the cycle period study, the 4 5-min cycle protocol partially restored more SBF than the 8 2.5-min cycle protocol at the low-pressure phase (0.87 ± 0.04 vs 0.71 ± 0.03, p < 0.05) and at the high-pressure phase (0.25 ± 0.03 vs 0.19 ± 0.03, p < 0.05). For the pressure amplitude study, the 75/5 mmHg protocol partially restored more sacral SBF than the 65/15 mmHg protocol at the low-pressure phase (0.87 ± 0.1 vs 0.25 ± 0.03, p < 0.05) but not at the high-pressure phase (0.23 ± 0.02 vs 0.21 ± 0.02, non-significant). CONCLUSION: This study demonstrated that 1) a cycle period of 5 min was better than 2.5 min and 2) a pressure amplitude of 75/5 mmHg was better than 65/15 mmHg. The finding provides insights for selecting the AP configurations for increasing SBF.

Emerging technologies for the prevention and management of diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are one of the most serious complications of diabetes mellitus (DM). Although research has improved understanding of DFU etiology, an effective clinical prevention and management of DFUs remains undetermined. Knowledge of recent technologies may enable clinicians and researchers to provide appropriate interventions to prevent and treat DFUs. This paper discusses how diabetes causes peripheral neuropathy and peripheral arterial diseases, which contribute to increased risk of DFUs. Then, emerging technologies that could be used to quantify risks of DFUs are discussed, including laser Doppler flowmetry for assessing plantar tissue viability, infrared thermography for early detection of plantar tissue inflammation, plantar pressure and pressure gradient system for identification of specific site at risk for DFUs, and ultrasound indentation tests (elastography) to quantify plantar tissue mechanical property. This paper also reviews how physical activity reduces risks of DFUs and how technology promotes adherence of physical activity. The clinician should encourage people with DM to exercise (brisk walking) at least 150 min per week and assess their exercise log along with the blood glucose log for providing individualized exercise prescription. Last, rehabilitation interventions such as off-loading devices, thermotherapy and electrotherapy are discussed. Although the exact etiology of DFUs is unclear, the emerging technologies discussed in this paper would enable clinicians to closely monitor the change of risk of DFUs and provide timely intervention. An integrated approach using all these emerging technologies should be promoted and may lead to a better outcome of preventing and managing DFUs.

Effect of Different Local Vibration Frequencies on the Multiscale Regularity of Plantar Skin Blood Flow.

Local vibration has shown promise in improving skin blood flow (SBF). However, there is no consensus on the selection of the best vibration frequency. An important reason may be that previous studies utilized time- and frequency-domain parameters to characterize vibration-induced SBF responses. These parameters are unable to characterize the structural features of the SBF response to local vibrations, thus contributing to the inconsistent findings seen in vibration research. The objective of this study was to provide evidence that nonlinear dynamics of SBF responses would be an important aspect for assessing the effect of local vibration on SBF. Local vibrations at 100 Hz, 35 Hz, and 0 Hz (sham vibration) with an amplitude of 1 mm were randomly applied to the right first metatarsal head of 12 healthy participants for 10 min. SBF at the same site was measured for 10 min before and after local vibration. The degree of regularity of SBF was quantified using a multiscale sample entropy algorithm. The results showed that 100 Hz vibration significantly increased multiscale regularity of SBF but 35 Hz and 0 Hz (sham vibration) did not. The significant increase of regularity of SBF after 100 Hz vibration was mainly attributed to increased regularity of SBF oscillations within the frequency interval at 0.0095-0.15 Hz. These findings support the use of multiscale regularity to assess effectiveness of local vibration on improving skin blood flow.