A study on the effectiveness of training in the operation of an electric mobility aid in severely mentally and physically handicapped children.

Hideshima Y, Asami T, Ichiba M, Matsuo K, Murata T. A study on the effectiveness of training in the operation of an electric mobility aid in severely mentally and physically handicapped children. Jpn J Compr Rehabil Sci 2024; 15: 8-16. Purpose: We examined whether operation training for children with severe mental and physical disabilities using recently developed electric mobility aids improves their skills in operating such aids and their daily activities. By doing so, we aimed to clarify the effectiveness of electric mobility aid operation training for children with severe mental and physical disabilities. Method: Operation training and normal training using an electric mobility aid were conducted for 42 school-aged children with severe mental and physical disabilities, aged 8-18 years old. The trainee children were randomly assigned to two groups: 21 to the intervention group to receive operation training and 21 to the control group to receive general training. The intervention lasted 20 minutes/training session, with three sessions/week over a period of eight weeks. The Powered Mobility Program (PMP) and Pediatric Evaluation of Disability Inventory (PEDI) were used for pre- and post-intervention assessments, and SPSS was used for two-way analysis of variance (ANOVA). Results: PMP scaled scores significantly increased (p = 0.001) in both groups, but there was no interaction effect. The PEDI scaled scores did not significantly increase in either of the two groups. Discussion: The effects of the intervention and use of the electric mobility aid on the operating skills of children with severe mental and physical disabilities were explicitly demonstrated. Future long-term studies are required to clarify the effects of training in the operation of electric mobility aids on the subsequent development of severely physically and mentally handicapped children.

Inferior Vena Cava Compression as a Novel Maneuver to Detect Patent Foramen Ovale: A Transesophageal Echocardiographic Study.

BACKGROUND: The Valsalva maneuver, the most sensitive test for patent foramen ovale (PFO) detection, is difficult during transesophageal echocardiography (TEE), especially after sedation. The aim of this study was to compare PFO detection effectiveness between inferior vena cava (IVC) compression and the Valsalva maneuver. METHODS: A total of 293 patients with paroxysmal atrial fibrillation undergoing TEE before initial atrial fibrillation ablation were prospectively enrolled. Agitated saline was injected in 290 patients under three conditions: Valsalva maneuver under conscious sedation, at rest, and IVC compression under deep sedation. Three patients with newly diagnosed atrial septal defects on TEE were excluded. The IVC compression maneuver consisted of manual compression 5 cm to the right of the epigastric region and depressed the abdominal wall by 5 cm for 30 sec and compression release immediately before right atrial opacification with microbubbles by agitated intravenous saline. RESULTS: The overall PFO detection rate was better with IVC compression (57 PFOs [19.7%]) than at rest (15 patients [5.2%]) (P < .0001) or with the Valsalva maneuver (37 patients [12.8%]) (P = .024). There were no significant differences in PFO detection between IVC compression and the Valsalva maneuver (IVC compression, 43 patients [22.5%]; Valsalva maneuver, 35 patients [18.3%]; P = .31), even in patients who could perform the Valsalva maneuver effectively (n = 191). CONCLUSIONS: IVC compression is feasible and effective for detecting PFO and is not inferior to the Valsalva maneuver. In particular, IVC compression could be an alternative diagnostic method for PFO using TEE when the Valsalva maneuver cannot be performed under deep sedation.

Effects of Wheelchair Seat-height Settings on Alternating Lower Limb Propulsion With Both Legs.

This study investigated the effects of seat-height settings of wheelchairs with alternating propulsion with both legs. Seven healthy individuals with no orthopedic disease participated. Flexion angles at initial contact (FA-IC) of each joint, range of motion during propulsion period (ROM-PP), and ground reaction force (GRF) were measured using a three dimensional motion capture system and force plates, and compared with different seat-height settings. Statistically significant relationships were found between seat-height and speed, stride length, knee FA-IC, ankle FA-IC, hip ROM-PP, vertical ground reaction force (VGRF), and anterior posterior ground reaction force (APGRF). Speed, hip ROM-PP, VGRF and APGRF increased as the seat-height was lowered. This effect diminished when the seat-height was set below -40 mm. VGRF increased as the seat-height was lowered. The results suggest that the seat-height effect can be attributed to hip ROM-PP; therefore, optimal foot propulsion cannot be achieved when the seat height is set either too high or too low. Efficient foot propulsion of the wheelchair can be achieved by setting the seat height to lower leg length according to a combination of physical characteristics, such as the user's physical functions, leg muscles, and range of motion.

The effect of different positions on lower limbs skin perfusion pressure.

We have encountered situations of patients with critical limb ischemia accompanied by pain at rest and necrosis, who hang their legs down from the bed during sleep. This lower limb position is known to be a natural position, which reduces pain in the lower extremity induced by ischemia. However, the effect of this position on blood flow of the lower extremity is poorly understood. We studied whether measurements of skin perfusion pressure (SPP) changes by leg position and the difference between healthy adults and patients with critical limb ischemia. The subjects of this study were 10 healthy adults and 11 patients with critical limb ischemia. Patients with critical limb ischemia, including both dorsum of foot and plantar of foot, having SPP of lower limbs of less than 40 mmHg (supine position) were the object of this study. SPP was measured on four positions (supine position, lower limbs elevation position, sitting position, and reclining bed elevation of 20(°) position). In sitting position, both the number of healthy adults and critical patients show significant increases in SPP compared with the other three positions. These results suggest that sitting position is effective to keep good blood stream of lower limbs not only in healthy adults but also in patients with critical limb ischemia. However, an appropriate leg position should not have lower limbs hang downwards for long periods time because edema is caused by the fall in venous return in lower limbs, and the wound healing is prolonged. Our clinical research could be more useful in the future, particularly in developing countries, for surgeons managing wounds in leg and foot and preserving ischemic limbs.

Sonocatalytic degradation of methylene blue with TiO2 pellets in water.

A series of experiments were carried out to study the degradation of methylene blue by the irradiation of ultrasound onto TiO(2) in aqueous solution. A statistically significant decrease in the concentration of methylene blue was observed after 60 min irradiation. While the reduction was 22% of the initial concentration without H(2)O(2), addition of H(2)O(2) significantly enhanced the degradation of methylene blue for the TiO(2) containing system (85% reduction of the initial concentration). The addition of H(2)O(2) had no effect on the methylene blue degradation when the system contained Al(2)O(3). The degradation ratio of methylene blue was dependent on the amount of TiO(2) and also the specific surface area of TiO(2) in the solution. The effects of radical scavenging agents on the degradation of methylene blue were also investigated for the system with TiO(2). It was found that the radical scavenging agents dimethyl sulfoxide (DMSO), methanol, and mannitol suppressed the degradation, with DMSO being the most effective. The effect of pH on the degradation of methylene blue was further investigated. An U-shaped change in the concentration of methylene blue in the presence of TiO(2) was observed along with the change in pH values (pH 3-12), and the highest degradation ratio was observed at around pH 7. In conclusion, ultrasound irradiation of TiO(2) in aqueous solution resulted in significant generation of hydroxyl radicals, and this process may have potential for the treatment of organic dyes in wastewater.

Dental rehabilitation using an implant-supported overdenture after repair of a fracture in a severely resorbed edentulous mandible: a case report.

Treatment of mandibular fracture in senior citizens with severely resorbed edentulous mandibles is extremely difficult. Such treatment must achieve successful osteosynthesis and restore functional mastication. A severely resorbed (Class V) mandible was successfully reconstructed with an autogenous bone graft on the inferior border of the mandible and a titanium mesh plate after a failed attempt to fix the fracture. After the placement of endosseous implants in the mandible, the patient was rehabilitated with an overdenture to restore masticatory function.

Immunohistochemical study of syndecan-1 down-regulation and the expression of p53 protein or Ki-67 antigen in oral leukoplakia with or without epithelial dysplasia.

BACKGROUND: Leukoplakia is an oral pre-cancerous lesion that sometimes develops into squamous cell carcinoma. Therefore, leukoplakia with epithelial dysplasia is useful for studying carcinogenesis at the cellular level. The purpose of this study was to evaluate a potential association between the loss of syndecan-1 expression and the expression of p53 protein and Ki-67 antigen, and to identify reliable markers for predicting malignant changes in oral leukoplakia with epithelial dysplasia. METHODS: Changes in the expression of syndecan-1, p53, and Ki-67 were examined immunohistochemically in 43 cases of oral leukoplakia with or without epithelial dysplasia. The subjects were categorized as: none, 13 cases; mild dysplasia, 5 cases; moderate dysplasia, 17 cases; and severe dysplasia, 8 cases. The expression of these molecules in normal oral epithelia (22 cases) was also investigated. RESULTS: Strong syndecan-1 expression was observed on the surface of keratinocytes in normal epithelium. Immunopositivity was lost gradually as the extent of epithelial dysplasia increased. In normal epithelium, p53 and Ki-67 appeared mainly in the basal cell layer, while they were more widely distributed in leukoplakia. Specifically, significant changes were observed in the labeling index of p53 and Ki-67 in leukoplakia as epithelial dysplasia progressed from mild to moderate or severe. CONCLUSION: Our results reveal that overexpression of p53 protein and Ki-67 antigen, and down-regulation of syndecan-1 expression in the lower part of the epithelium, are associated with dysplastic changes. Therefore, the down-regulation of syndecan-1 expression may be the most important reliable marker for dysplastic changes.