Kinetic Gait Parameters in Unilateral Lower Limb Amputations and Normal Gait in Able-Bodied: Reference Values for Clinical Application.

Unilateral lower limb amputations usually present with asymmetric interlimb gait patterns, in the long term leading to secondary physical conditions and carrying the risk of low physical activity and impairment of general health. To assess prosthetic fittings and rehabilitation measures, reference values for asymmetries as well as the most significant gait parameters are required. Kinetic gait data of 865 patients with unilateral lower limb amputations (hip and knee disarticulations, transfemoral, transtibial and foot amputations) and 216 able-bodied participants were quantitatively assessed by instrumented gait analyses. Characteristic spatiotemporal (stance time, walking speed, step length and width) and ground reaction force parameters (weight-acceptance and push-off peak) were contrasted to normal gait. All spatiotemporal and ground reaction force parameters differed significantly from normal gait with the largest differences in transfemoral amputations. These also differed between amputation levels and showed age-dependencies. The stance time and push-off peak difference were identified as the most discriminative parameters with the highest diagnostic specificity and sensitivity. The present results mark the first step to establishing universal reference values for gait parameters by means of which the quality and suitability of a prosthetic fitting and the rehabilitation progress can be assessed, and are generalizable for all adults with unilateral lower limb amputations in terms of level walking.

Impact of innovations on future energy supply - chemical enhanced oil recovery (CEOR).

The International Energy Agency (IEA) expects an increase of global energy demand by one-third during next 20 years together with a change in the global energy mix. A key-influencing factor is a strong expected increase in oil and gas production in the United States driven by 'new' technologies such as hydraulic fracturing. Chemical enhanced oil recovery (CEOR) is another strong growing technology with the potential of a step change innovation, which will help to secure future oil supply by turning resources into reserves. While conventional production methods give access to on average only one-third of original oil in place, the use of surfactants and polymers allows for recovery of up to another third of this oil. In the case of polymer flooding with poly acrylamide, the number of full field implementations has increased in recent years. In the meantime new polymers have been developed to cover previously unmet needs - such polymers can be applied in fields of high salinity and high temperature. Use of surfactants is in an earlier stage, but pilot tests show promising results.

Comparison of conventional therapies for dentin hypersensitivity versus medical hypnosis.

This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS.

Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy.

OBJECTIVE: To assess the inter-rater and intra-rater reliability and validity of the original and a modified Medical Research Council scale for testing muscle strength in radial palsy. DESIGN: Prospective, randomized validation study. PATIENTS: Thirty-one patients with peripheral paresis of radial innervated forearm muscles were included. METHODS: Wrist extension, finger extension and grip strength were evaluated by manual muscle testing. Dynamometric measurement of grip strength was performed. Pair-wise weighted kappa coefficients were calculated to determine inter-rater and intra-rater reliability. The 2 scores were compared using the signed-rank test. Spearman's correlation coefficients of the maximal relative force measurements with the median (over-raters) Medical Research Council and modified Medical Research Council scores were calculated to determine validity. RESULTS: Inter-rater agreement of the Medical Research Council scale (finger extension: 0.77; wrist extension: 0.78; grip strength: 0.78) and the modified Medical Research Council scale (finger extension: 0.81; wrist extension: 0.78; grip strength: 0.81) as well as intra-rater agreement of the Medical Research Council scale (finger extension: 0.86; wrist extension: 0.82; grip strength: 0.84) and the modified Medical Research Council scale (finger extension: 0.84, wrist extension: 0.81; grip strength: 0.88) showed almost perfect agreement. Spearman's correlation coefficients of the maximal relative force measurements with the median Medical Research Council and modified Medical Research Council score were both 0.78. CONCLUSION: Medical Research Council and modified Medical Research Council scales are measurements with substantial inter-rater and intra-rater reliability in evaluating forearm muscles.

[Aerobic endurance training for cancer patients]. / Aerobes Ausdauertraining für Krebspatienten.

With the increase in the number of patients who survive cancer, there is a growing need to attend to the physical and emotional effects of cancer and oncological treatment. Reduced physical performance, fatigue, nausea, weight gain, psychological distress, changes in body image, dependency, and reduced quality of life are some of the short- and long-term sequelae of cancer. We describe data from the literature about firstly the effects of aerobic exercise as an additive treatment for cancer patients, and about the feasibility of aerobic exercise secondly during oncological treatment, and thirdly in patients suffering from terminal cancer. The data from the literature support that exercise as an additive treatment may help to attenuate the physical limitations caused by cancer and oncological treatment and there by contribute to rehabilitation and quality of life of cancer patients. Feasibility of aerobic exercise has been demonstrated also for patients suffering from advanced cancer. Aerobic exercise has been shown to provide benefits to cancer patients. It enables these patients to recover their physical function and to return to an active lifestyle. Aerobic exercise seems to be an effective possibility to reduce sequelae of cancer and to increase quality of life.

Functional and biochemical properties of chronically stimulated human skeletal muscle.

The present study was undertaken to investigate in a randomized controlled trial the effects of chronic (10 weeks, 4 h per day, 7 days per week) low-frequency (15 Hz) stimulation (CLFS) of the knee extensor and hamstring muscles of both legs in healthy volunteers via surface electrodes. A control group (n=10) underwent the same treatment (sham stimulation) as the CLFS-treated group (n=10), except that stimulation intensity was kept at a level which did not evoke contractions. Biopsy samples were taken before the onset and after cessation of stimulation from the right vastus lateralis muscle of all subjects. The biopsy samples were analyzed for changes in myosin heavy chain (MHC) isoforms and activities of citrate synthase (CS) and glyceraldehyde phosphate dehydrogenase (GAPDH) as markers of aerobic-oxidative and anaerobic pathways of energy metabolism, respectively. In addition, functional properties, i.e., oxygen consumption (VO(2)) and work capacity, were assessed. Sham stimulation did not affect the functional properties and had no detectable effect on MHC isoform and enzyme activity patterns. Conversely, CLFS induced changes in the MHC isoform pattern in the fast-to-slow direction with an approximately 20% decrease in the relative concentration of MHCIId/x (from 28% to 22%) and an approximately 10% increase in the relative concentration of MHCI (from 30% to 34%). In addition, CLFS led to a approximately 9% increase in the activity of CS concomitant with an approximatley 7% decrease in the activity of GAPDH. This increase in aerobic-oxidative capacity was accompanied by improved work capacity and VO(2) at the anaerobic threshold by 26% and 20%, respectively.

Pulsed magnetic field therapy for osteoarthritis of the knee--a double-blind sham-controlled trial.

BACKGROUND AND METHODS: Pulsed magnetic field therapy is frequently used to treat the symptoms of osteoarthritis, although its efficacy has not been proven. We conducted a randomized, double-blind comparison of pulsed magnetic field and sham therapy in patients with symptomatic osteoarthritis of the knee. Patients were assigned to receive 84 sessions, each with a duration of 30 minutes, of either pulsed magnetic field or sham treatment. Patients administered the treatment on their own at home, twice a day for six weeks. RESULTS: According to a sample size estimation, 36 consecutive patients were enrolled. 34 patients completed the study, two of whom had to be excluded from the statistical analysis, as they had not applied the PMF sufficiently. Thus, 15 verum and 17 sham-treated patients were enrolled in the statistical analysis. After six weeks of treatment the WOMAC Osteoarthritis Index was reduced in the pulsed magnetic field-group from 84.1 (+/- 45.1) to 49.7 (+/- 31.6), and from 73.7 (+/- 43.3) to 66.9 (+/- 52.9) in the sham-treated group (p = 0.03). The following secondary parameters improved in the pulsed magnetic field group more than they did in the sham group: gait speed at fast walking [+6.0 meters per minute (1.6 to 10.4) vs. -3.2 (-8.5 to 2.2)], stride length at fast walking [+6.9 cm (0.2 to 13.7) vs. -2.9 (-8.8 to 2.9)], and acceleration time in the isokinetic dynamometry strength tests [-7.0% (-15.2 to 1.3) vs. 10.1% (-0.3 to 20.6)]. CONCLUSION: In patients with symptomatic osteoarthritis of the knee, PMF treatment can reduce impairment in activities of daily life and improve knee function.