Minimum toe clearance and tripping probability in people with unilateral transtibial amputation walking on ramps with different prosthetic designs.

BACKGROUND: Minimum Toe Clearance (MTC) is defined as the minimum vertical distance between the lowest point under the front part of the foot and the ground, during mid-swing. Low values of MTC and walking on inclines are both related to higher probability of tripping and falling in lower limb amputees. New prosthetic designs aim at improving MTC, especially on ramps, however the real effect on MTC still needs investigation. The objective of this study was then to evaluate the effect of different prosthetic designs on MTC in inclined walking. METHODS: Thirteen transtibial amputees walked on a ramp using three different prostheses: non articulating ankle (NAA), articulating hydraulic ankle (AHA), and articulating hydraulic ankle with microprocessor (AHA-MP). Median MTC, coefficient of variation (CV), and tripping probability (TP) for obstacles of 10 and 15 mm were compared across ankle type in ascent and descent. FINDINGS: When using AHA-MP, larger MTC median values for ascending (P ≤ 0.001, W = 0.58) and descending the ramp (P = 0.003, W = 0.47) were found in the prosthetic limb. Also significantly lower CV was found on the prosthetic limb for both types of AHA feet when compared to NAA for descending the ramp (P = 0.014, W = 0.45). AHA-MP showed the lowest TP for the prosthetic leg in three conditions evaluated. On the sound limb results showed the median MTC was significantly larger (P = 0.009, W = 0.43) and CV significantly lower (P = 0.005, W = 0.41) when using an AHA in ascent. INTERPRETATION: Both AHA prosthetic designs help reduce the risk of tripping of the prosthetic limb by increasing the median MTC, lowering its variability and reducing TP for both legs when ascending and descending the ramp. For most of the conditions, AHA-MP showed the lowest TP values. Findings suggest that AHA prostheses, especially AHA-MP could reduce the risk of tripping on ramps in amputees.

Procedure to diagnose onychomycosis through changes in emissivity on infrared images.

A noninvasive, quick, reliable, and relatively cheap procedure for the diagnosis of onychomycosis is put forward. It is known that a nail may show an abnormal appearance, although only 50% of all the nails having such an appearance may owe it to the presence of onychomycosis; hence, adequate diagnosis of nail disease is needed for appropriate prescription of medication and treatment of the nail. In order to contribute to the process of improvement in the diagnosis, a procedure based on the analysis of medium-range infrared images is presented in which it is possible to observe energy changes mostly due to the changes in emissivity of the nail. As a nail is more affected by onychomycosis, such changes become more intense. Also, it was found that a nail without onychomycosis has a lower temperature than toe skin, but has a higher emission of energy. Fifty percent of the ailments that may a cause a fingernail or toenail to have an abnormal appearance are not considered in the present work.

Lateralizing value of ictal dorsiflexion of the great toe in refractory partial epilepsy.

INTRODUCTION: A case of ictal dorsiflexion of the great toe was reported two years ago in a patient with insular cortex seizures. Since that publication, series of patients with the sign have not been reported. OBJECTIVES: The aims of the present study were to describe the frequency of the ictal sign and to evaluate positive predictive value (PPV) to lateralize the epileptogenic zone. METHODS: We retrospectively analyzed archived seizures of all patients who were consecutively evaluated at two tertiary centers for epilepsy surgery. All patients underwent a standard presurgical evaluation. We evaluated the dorsiflexion latency and, also, examined whether dorsiflexion of the great toe appeared when ictal electrographic activity remained focal or generalized. RESULTS: Ictal dorsiflexion of the great toe was seen in only 15 (9.1%) out of 165 patients and in 25 (9.2%) of 272 seizures. The seizure localized to the temporal lobe in 22 (88%) out of 25 seizures. More than 50% of these seizures were associated with hippocampal sclerosis. Ictal dorsiflexion of the great toe was contralateral to the epileptogenic zone in 72% of the patients. In 7 out of 25, the seizures had a short latency period. In 6 out of these 7 seizures, the sign was contralateral to the epileptogenic zone (VPP = 85.7). CONCLUSION: This ictal motor sign is not infrequent in refractory partial epilepsy and has a high positive predictive value.

Ictal extension (dorsiflexion) of the toes in a patient with temporal lobe epilepsy: a new ictal lateralizing sign.

Neurologists have analyzed the clinical behaviors that occur during seizures for many years. Several ictal behaviors have been defined in temporal lobe epilepsy (TLE). Ictal behaviors are especially important in the evaluation of candidates for epilepsy surgery. We propose a new ictal lateralizing sign originating from the nondominant hemisphere: extension (dorsiflexion) of the toes (Babinski's, Chaddock's, and Moniz' signs). Our patient is a 16-year-old woman. Her epileptogenic foci were localized to the right neocortical temporal region after noninvasive presurgical investigations. Cranial MRI revealed a right insular lesion compatible with focal cortical dysplasia or cortical tumor. We observed progressive movement of the left leg and, when the patient touched the lateral aspect of the foot to the bed, dorsiflexion of the great toe (Babinski's sign). In other seizures, the patient started a progressive movement of the left leg, rubbing the external border of the left foot on the bed and provoking dorsiflexion of the great toe (Chaddock's sign). The Brissaud reflex component was also observed when the movement was accompanied by internal rotation of the leg and recruitment of the tensor fascia lata, making dorsiflexion more likely to be a reflex response and not voluntary. We also observed forceful passive plantar flexion at the ankle in association with dorsiflexion of the great toe (Moniz' sign). All of these signs were contralateral to ictal seizure onset and to the cerebral epileptogenic lesion. These signs may occur as a result of ictal activation of a specific brain region in this hemisphere.