Wheelchair users' satisfaction after provision using the WHO 8-step guidelines: A pilot study.

BACKGROUND: Wheelchairs are vital for the successful rehabilitation and inclusion of people with mobility disabilities; 10% of the population with disabilities needs a wheelchair, but only 15% have access to an adequate one. Not user-configured wheelchairs may lead to postural deformities and pressure ulcers, thus negatively impact user satisfaction, wheelchair skills, and quality of life. OBJECTIVE: To assess the impact of the 8-step "Guidelines on the provision of manual wheelchairs in less-resourced settings" from the World Health Organization (WHO) on user satisfaction, wheelchair skills, and quality of life of Mexican manual wheelchair users. METHODS: 12 wheelchair users with spinal cord injury that received rehabilitation were recruited. Volunteers were provided a wheelchair and cushion following the WHO 8-step guidelines. Assessment of QUEST, WHOQOL-Bref, and WST-Q was performed at the beginning of the study and 12 months later. RESULTS: Significant improvement was observed in terms of satisfaction (QUEST; P = 0.009) after receiving the wheelchair and the foam cushion (QUEST; P = 0.004). WHOQol-Bref did not denote significant differences. For the dimensions assessed by the WST-Q scores, a significant 10.9% improvement was observed in both, capacity (P = 0.022) and performance (P = 0.009). CONCLUSIONS: The application of the WHO 8-step guidelines for wheelchair provision may contribute to increase user satisfaction regarding the wheelchair and cushion devices as well as the prescription process as determined by the QUEST. According to the WST-Q, functional capacity and mobility may also be improved by following the 8-step guidelines.

Effect of whole-body vibration training on transcutaneous oxygen levels of the foot in patients with type 2 diabetes: A randomized controlled trial.

Whole body vibration (WBV) has been suggested as improving skin and blood flow. This study aimed to determine the effect of exposure to WBV on levels of partial transcutaneous oxygen pressure (TcPO2) in the foot of patients with type 2 diabetes (T2D) within the metabolic control goals. A block randomized, open, two-arm, parallel and controlled clinical trial was conducted. Participants recruited from the Center of Comprehensive Care for the Patient with Diabetes were assessed at the National Institute of Rehabilitation, Mexico City. Control group underwent multidisciplinary care for T2D; experimental group, in addition to the comprehensive diabetes care, was exposed to WBV through an exercise program, attending three times a week for a period of 3 months. TcPO2 was measured in the feet of the participants at baseline and after 12 weeks. A sample of 50 volunteers with recently-diagnosed T2D and similar baseline characteristics (demographic, cardiovascular risk, presence of diabetic polyneuropathy, and indicators of glycemic control and TcPO2) was recruited. The experimental group (n = 27) showed a mean value of 47.7 ± 6.1 mmHg in TcPO2, significantly higher (p = 0.028) than the 44.3 ± 7.5 mmHg of control group (n = 23), at the end of intervention. In conclusion, exposure to WBV promoted an increase and a significant 3 mmHg difference in the foot TcPO2 levels between those subjects with T2D that underwent the 12-week exercise program and those not exposed to the treatment.

Comparing Machine Learning Methods to Improve Fall Risk Detection in Elderly with Osteoporosis from Balance Data.

Falls are a multifactorial cause of injuries for older people. Subjects with osteoporosis are particularly vulnerable to falls. We study the performance of different computational methods to identify people with osteoporosis who experience a fall by analysing balance parameters. Balance parameters, from eyes open and closed posturographic studies, and prospective registration of falls were obtained from a sample of 126 community-dwelling older women with osteoporosis (age 74.3 ± 6.3) using World Health Organization Questionnaire for the study of falls during a follow-up of 2.5 years. We analyzed model performance to determine falls of every developed model and to validate the relevance of the selected parameter sets. The principal findings of this research were (1) models built using oversampling methods with either IBk (KNN) or Random Forest classifier can be considered good options for a predictive clinical test and (2) feature selection for minority class (FSMC) method selected previously unnoticed balance parameters, which implies that intelligent computing methods can extract useful information with attributes which otherwise are disregarded by experts. Finally, the results obtained suggest that Random Forest classifier using the oversampling method to balance the data independent of the set of variables used got the best overall performance in measures of sensitivity (>0.71), specificity (>0.18), positive predictive value (PPV >0.74), and negative predictive value (NPV >0.66) independent of the set of variables used. Although the IBk classifier was built with oversampling data considering information from both eyes opened and closed, using all variables got the best performance (sensitivity >0.81, specificity >0.19, PPV = 0.97, and NPV = 0.66).

Efecto de la vibración mecánica sobre los niveles de oxígeno transcutáneo medidos en el pie de pacientes con diabetes mellitus tipo 2 / Effect of mechanical vibration on transcutaneous oxygen levels in the feet of type 2 diabetes mellitus patients

Antecedentes y objetivo: Las afecciones del pie en pacientes con diabetes mellitus (DM) generan morbilidad y discapacidad. La vibración mecánica favorece la perfusión sanguínea en la extremidad inferior, facilitando el aporte de nutrimentos y oxígeno. Valores de oximetría transcutánea (TcPO2) > 40 mmHg se asocian al buen pronóstico de resolución de úlceras en el pie. El objetivo de este trabajo ha sido determinar si un programa de terapia vibratoria favorece parámetros de interés relacionados con complicaciones asociadas al síndrome del pie diabético. Pacientes y métodos: Cincuenta y cuatro pacientes con DM participaron en un programa de ejercicios sobre plataforma de vibración (12 semanas). Se determinó el control glucémico (HbA1c), la sensibilidad y la TcPO2 del pie. Se realizaron valoraciones al inicio y después del programa. Resultados: No se observaron cambios significativos en la HbA1c (p = 0,442) ni en la sensibilidad (p = 0,07). La TcPO2 registró un incremento medio significativo de 7 mmHg (p < 0,0001; tamaño del efecto: d = 0,53). Conclusiones: La vibración mecánica puede favorecer el incremento de la TcPO2, lo que podría ser útil para la prevención o tratamiento de complicaciones asociadas a una perfusión sanguínea alterada en el pie diabético (AU)

Background and objective: Foot conditions in patients with diabetes mellitus (DM) are major causes of morbidity and disability. Whole body vibration may promote blood circulation in the lower limbs, hence facilitating perfusion and promoting the supply of nutrients and oxygen to comprised tissues. Transcutaneous oxygen levels (TcPO2) > 40 mmHg in cases of diabetic foot syndrome are associated with a good prognosis in the resolution of ulcers. The objective of this study was to determine whether whole body vibration favors some parameters of interest related to complications associated with the diabetic foot syndrome. Patients and methods: Fifty-four patients with DM were included in a 12-week exercise program based on whole body vibration. Glycemic control was determined on the basis of the patients’ levels of glycated hemoglobin (HbA1c); sensitivity and TcPO2 levels of each foot were also recorded. Assessments were performed prior to initiating the whole body vibration program and at the end of it. Results: No significant changes were observed in the patients’ HbA1c (P = .442) levels or sensitivity (P = .07). A significant 7 mmHg increase (P < .0001; effect size: d = 0.53) was observed in the concentration of TcPO2. Conclusions: Whole body vibration may increase TcPO2 levels with useful implications for the prevention or management of complications associated with restricted blood perfusion in the diabetic foot syndrome (AU)

Effect of mechanical vibration on transcutaneous oxygen levels in the feet of type 2 diabetes mellitus patients. / Efecto de la vibración mecánica sobre los niveles de oxígeno transcutáneo medidos en el pie de pacientes con diabetes mellitus tipo 2.

BACKGROUND AND OBJECTIVE: Foot conditions in patients with diabetes mellitus (DM) are major causes of morbidity and disability. Whole body vibration may promote blood circulation in the lower limbs, hence facilitating perfusion and promoting the supply of nutrients and oxygen to comprised tissues. Transcutaneous oxygen levels (TcPO2)>40mmHg in cases of diabetic foot syndrome are associated with a good prognosis in the resolution of ulcers. The objective of this study was to determine whether whole body vibration favors some parameters of interest related to complications associated with the diabetic foot syndrome. PATIENTS AND METHODS: Fifty-four patients with DM were included in a 12-week exercise program based on whole body vibration. Glycemic control was determined on the basis of the patients' levels of glycated hemoglobin (HbA1c); sensitivity and TcPO2 levels of each foot were also recorded. Assessments were performed prior to initiating the whole body vibration program and at the end of it. RESULTS: No significant changes were observed in the patients' HbA1c (P=.442) levels or sensitivity (P=.07). A significant 7mmHg increase (P<.0001; effect size: d=0.53) was observed in the concentration of TcPO2. CONCLUSIONS: Whole body vibration may increase TcPO2 levels with useful implications for the prevention or management of complications associated with restricted blood perfusion in the diabetic foot syndrome.

[Familiarization to treadmill walking in unimpaired Parkinson's disease patients]. / Familiarización de la marcha en banda sinfin de individuos con enfermedad de Parkinson.

Familiarization to treadmill walking in unimpaired Parkinson's disease (PD) patients is assessed, across multiple treadmill walking sessions. Thirteen PD subjects were enrolled into the study (Eight were in a moderate stage of the disease, and 5 in an advanced stage). PD subjects attended a progressive program consisting of 12 sessions of 20 min. Walking speed, cadence, step length and coefficient of variation were assessed. ANOVA test were used to evaluate progression of disease and time influence over familiarization. PD Subjects baseline characteristics did not differ significantly between both groups and typical dependencies over progression of disease and velocity were found for cadence, step length and coefficient of variation. However, we showed that some PD subjects may require longer familiarization times and that familiarization is an adaptation process which involves parameters as velocity, cadence and gait stability. A better definition of familiarization to treadmill is needed since some parameters such as step length does not change significantly while others such as cadence, coefficient of variation and intraclass correlation coefficient does. Therefore familiarization to treadmill walking should remain on measures of velocity, cadence, reliability and variability. However, a bigger sample size is needed in order to improve the results of the present study.

Evidence-based design and development of a VR-based treadmill system for gait research and rehabilitation of patients with Parkinson's disease.

Virtual reality (VR) in neurorehabilitation allows to reduce patient's risk and allows him to learn on a faster way. Up to now VR has been used in patients with Parkinson disease (PD) as a research tool and none of the developed systems are used in clinical practice. The goal of this project is to develop a VR-based system for gait therapy, and gait research of patients with PD designed based on published evidence. The developed system uses a digital camera to measure spatiotemporal gait parameters. The software was developed in C#, using Open-Source libraries that facilitates VR programming. The system has potential uses in clinical and research settings.

A dynamic Bayesian network for estimating the risk of falls from real gait data.

Pathological and age-related changes may affect an individual's gait, in turn raising the risk of falls. In elderly, falls are common and may eventuate in severe injuries, long-term disabilities, and even death. Thus, there is interest in estimating the risk of falls from gait analysis. Estimation of the risk of falls requires consideration of the longitudinal evolution of different variables derived from human gait. Bayesian networks are probabilistic models which graphically express dependencies among variables. Dynamic Bayesian networks (DBNs) are a type of BN adequate for modeling the dynamics of the statistical dependencies in a set of variables. In this work, a DBN model incorporates gait derived variables to predict the risk of falls in elderly within 6 months subsequent to gait assessment. Two DBNs were developed; the first (DBN1; expert-guided) was built using gait variables identified by domain experts, whereas the second (DBN2; strictly computational) was constructed utilizing gait variables picked out by a feature selection algorithm. The effectiveness of the second model to predict falls in the 6 months following assessment is 72.22%. These results are encouraging and supply evidence regarding the usefulness of dynamic probabilistic models in the prediction of falls from pathological gait.

Temporal and spatial gait parameters analysis in non-pathological Mexican children.

OBJECTIVE: To examine temporal and spatial gait parameters in Mexican healthy pediatric subjects to describe normal values which could serve as reference data to eventually compare pathological patterns of the Mexican infant gait. MATERIALS AND METHODS: Descriptive study that analyzed the gait of 120 children (61 boys and 59 girls) between the ages of 6 and 13 years old. Modifying factors (age, gender, and footwear) were recorded and its impact over temporal and spatial gait parameters was assessed. The data was stratified according to the modifying factors. A GAITRite System was used for recording the gait data. RESULTS: Significant differences were noted for the following factors: age and the use of footwear. As the individual advances in age, a decrease in number of steps, normalized velocity, velocity, cadence, normalized cadence, normalized step and stride length was observed. In contrast, step and stride length increased. Use of footwear increased velocity (normalized and non-normalized), normalized cadence, step and stride length (normalized and non-normalized), and percentage of stance GC phase; cadence and swing GC percentage diminished. Gender stratification showed no significant differences in any temporal and spatial gait parameters. There were also found significant differences with those reported for normal adult and pediatric gait in the literature. CONCLUSION: Age and footwear modified gait pattern in the studied sample, while gender apparently did not exert any influence on it.

Placa-tornillo deslizante utilizada para el tratamiento de las fracturas intertrocantéreas. Estudio mécanico comparativo de tres distintas fabricaciones / Sliding screw and plating for treatment of intertrochanteric fractures. Comparative trial of three different trading marks of fabrication

En este estudio se determina la resistencia mecánica de tres distintos modelos de placastornillo deslizante que se emplean en la cirugía ortopédica para el tratamiento de las fracturas intertrocantéreas. Dos de ellas son de importación y una de fabricación nacional. Dichos implantes son ensayados a flexión estática siguiendo los parámetros establecidos en la norma ASTM F 384-73, tanto para el montaje de los implantes, como para la realización de las pruebas mismas. Los resultados obtenidos se comparan con trabajos previos de la literatura internacional, los cuales relacionan las cargas fisiológicas encontradas para la cadera, con la resistencia de los implantes ensayados. Se concluye que a pesar de mostrar una marca de implante una resistencia mecánica adecuada para emplearse aún para el tratamiento de las fracturas intertrocantéreas inestables. Por otra parte, los resultados muestran un elevado grado de variabilidad en el comportamiento mecánico de la placa-tornillo de origen nacional, lo cual es indicio de un deficiente control de calidad, mientras que los implantes de importación mostraron un menor grado de variabilidad