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1.
Clin Chim Acta ; 495: 507-511, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152696

RESUMO

BACKGROUND: The pneumatic tube system (PTS) is widely established in clinical laboratories. We aimed to evaluate the impacts of PTS on high-sensitivity cardiac troponin T (hs-cTnT) assays. METHODS: The hemolysis distribution of hs-cTnT PTS specimens from emergency department (ED) were determined by hemolysis index (HI). Grouped samples from 15 healthy volunteers were delivered to the laboratory via manual delivery (MD) or PTS. Interference studies were conducted to access the influence of different hemolysis degrees on hs-cTnT assays. RESULTS: 7.26% PTS specimens from ED were hemolyzed in clinic. Compared with MD samples, we found highly elevated free plasma hemoglobin (Hb) in PTS samples. Hs-cTnT was interfered negatively with free Hb (R = -0.625, P < .001), and it was also validated in interference studies (R ≥ -0.820, all P ≤ .001). Clinically significant bias occurred in each hs-cTnT concentration at 100 mg/dl free Hb (Bias≥ - 13.85%, all P < .05). Moreover, bias of hs-cTnT assays at 50 mg/dl free Hb was approaching 10%, especially at 30 ng/l hs-cTnT concentration (Bias: -11.72%, P < .001). CONCLUSIONS: PTS could increase the frequency of specimen hemolysis which might cause false decrease in hs-cTnT assays. Hence, clinicians should be aware of the increased measurement bias in hs-cTnT from hemolyzed PTS samples with free Hb ≥50 mg/dl.


Assuntos
Análise Química do Sangue/instrumentação , Limite de Detecção , Miocárdio/metabolismo , Troponina T/sangue , Reações Falso-Negativas , Feminino , Voluntários Saudáveis , Humanos , Masculino , Troponina T/metabolismo , Adulto Jovem
2.
Environ Pollut ; 245: 764-770, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30502706

RESUMO

A nationwide survey, including 75 sludge samples and 18 wastewater samples taken from different wastewater treatment plants (WWTPs) from 23 cities, was carried out to investigate the occurrence and composition profiles of polycyclic aromatic hydrocarbons (PAHs) in China. In total, the concentrations of ∑16PAHs in sludge ranged from 565 to 280,000 ng/g (mean: 9340 ng/g) which was at a moderate level in the world. The composition profiles of PAHs were characterized by 3- and 4-ring PAHs in textile dyeing sludge and 4- and 5-ring PAHs in domestic sludge. Significant variations in regional distribution of PAHs were observed. Both the principal components analysis and diagnostic ratios revealed that vehicle exhaust, coal and natural gas combustion were the main sources of PAHs in China. The estimated concentrations of PAHs were 3820 ng/L and 1120 ng/L in influents and effluents of the WWTPs, respectively. The high toxic equivalent quantity (TEQ) values of PAHs are ascribed to the high PAH levels. Risk quotient values (RQs) in sludge indicated that there was low potential risk to soil ecosystem after sludge had been applied one year except for indeno [1,2,3-cd]pyrene (IcdP) detected in Huaibei, Anhui province.


Assuntos
Monitoramento Ambiental , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Químicos da Água/análise , China , Cidades , Carvão Mineral/análise , Pirenos , Medição de Risco , Esgotos/análise , Solo , Águas Residuárias/análise
3.
Front Neurol ; 9: 863, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30416478

RESUMO

We investigated the muscle alterations related to spasticity in stroke quantitatively using a portable manual spasticity evaluator. Methods: Quantitative neuro-mechanical evaluations under controlled passive elbow stretches in stroke survivors and healthy controls were performed in a research laboratory of a rehabilitation hospital. Twelve stroke survivors and nine healthy controls participated in the study. Spasticity and catch angle were evaluated at 90°/s and 270°/s with the velocities controlled through real-time audiovisual feedback. The elbow range of motion (ROM), stiffness, and energy loss were determined at a slow velocity of 30°/s. Four-dimensional measures including joint position, torque, velocity and torque change rate were analyzed jointly to determine the catch angle. Results: The catch angle was dependent on the stretch velocity and occurred significantly later with increasing velocity (p < 0.001), indicating position dependence of spasticity. The higher resistance felt by the examiner at the higher velocity was also due to more extreme joint position (joint angle) since the spastic joint was moved significantly further to a stiffer elbow position with the higher velocity. Stroke survivors showed smaller ROM (p < 0.001), higher stiffness (p < 0.001), and larger energy loss (p = 0.005). Compared to the controls, stroke survivors showed increased reflex excitability with higher reflex-mediated torque (p < 0.001) and at higher velocities (p = 0.02). Conclusion: Velocity dependence of spasticity is partially due to joint angle position dependence with the joint moved further (to a stiffer position where higher resistance was felt) at a higher velocity. The "4-dimensional characterization" including the joint angle, velocity, torque, and torque change rate provides a systematic tool to characterize catch angle and spasticity quantitatively.

4.
J Phys Ther Sci ; 30(8): 1069-1072, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30154602

RESUMO

[Purpose] To examine muscular demands during self-propelled treadmill walking to provide a potential option for fitness training. [Participants and Methods] Eleven healthy college students were recruited. Participants walked under three conditions: over-ground walking at a self-selected speed, treadmill walking at a self-selected speed, and treadmill walking at a speed comparable to that of over-ground walking. Step lengths and lower extremity muscle activations were recorded while participants walked under the three conditions. [Results] Step lengths were significantly shorter when participants walked on a self-propelled treadmill than when walking over-ground. The spatiotemporal and muscle activations of the gaits varied among the different walking conditions. Muscular demands at the moment of heel-strike were higher around the hip and knee when walking on the self-propelled treadmill than when walking over-ground. [Conclusion] During heel-strike, the lower extremity extensors were activated more on the self-propelled treadmill with an incline, especially at faster speeds, than during over-ground walking. A low-cost, self-propelled treadmill may be a modality for training specific muscles.

5.
Environ Sci Pollut Res Int ; 25(1): 541-551, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29047061

RESUMO

To estimate the pollution of As and Pb in the Songhua River which flows through the major rice-producing regions in China, the present study investigated the level and release of As and Pb in surficial sediments which collected from nine sites in Songhua River (M1-M9). The concentration of As and Pb was ranged as follows: As = 3.104~15.01 µg/g, Pb = 20.10~37.42 µg/g; the average concentration: As = 6.466 ± 3.077 µg/g, Pb = 28.88 ± 5.077 µg/g. By analysis vertically, the average concentration of As was 5.166 ± 1.496 µg/g in the upstream, 5.815 ± 1.793 µg/g in the midstream, and 9.716 ± 4.977 µg/g in the downstream. The average concentration of Pb was 27.83 ± 4.552 µg/g in the upstream, 28.66 ± 6.333 µg/g in the midstream, and 30.99 ± 4.837 µg/g in the downstream. It indicated that the concentration of As and Pb increased gradually from upstream to downstream. As existed mainly as insoluble state and Pb existed mainly as sulfide and organic combining state in surficial sediments, and the species of As and Pb could transform with the change of the circumstance. The release of quantity of As was higher than Pb. The pH of 6 was not conducive to the release of As and Pb. When the temperature was 35 and 6 °C, the release of As and Pb in surficial sediments were restrained, respectively. Fumaric acid and citric acid played an important role in promoting the release of As, but not conducive to Pb. Furthermore, the reasonable aeration rate was beneficial to the release process of As and Pb in surficial sediment. By kinetic analysis, the Elovich equation (Ct = 84.931-8.952lnt) could be used to describe the dynamic process of the release of As in a relatively short time. The Elovich equation (C t  = 2.724 + 1.3724lnt) and double constant rate equation (lnC T  = 1.4646 + 0.1522lnT) could well describe the dynamics process of the release of Pb.


Assuntos
Arsênico/análise , Monitoramento Ambiental , Sedimentos Geológicos/química , Chumbo/análise , Rios/química , Poluentes Químicos da Água/análise , China , Cinética
6.
IEEE Int Conf Rehabil Robot ; 2017: 1233-1238, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28813990

RESUMO

This paper presents the iterative development of an artificially intelligent system to promote home-based neurorehabilitation. Although proper, structured practice of rehabilitation exercises at home is the key to successful recovery of motor functions, there is no home-program out there which can monitor a patient's exercise-related activities and provide corrective feedback in real time. To this end, we designed a Learning from Demonstration (LfD) based home-rehabilitation framework that combines advanced robot learning algorithms with commercially available wearable technologies. The proposed system uses exercise-related motion information and electromyography signals (EMG) of a patient to train a Markov Decision Process (MDP). The trained MDP model can enable an agent to serve as a coach for a patient. On a system level, this is the first initiative, to the best of our knowledge, to employ LfD in an health-care application to enable lay users to program an intelligent system. From a rehabilitation research perspective, this is a completely novel initiative to employ machine learning to provide interactive corrective feedback to a patient in home settings.


Assuntos
Inteligência Artificial , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Adolescente , Adulto , Algoritmos , Eletromiografia/instrumentação , Terapia por Exercício/instrumentação , Retroalimentação , Feminino , Humanos , Robótica , Realidade Virtual , Adulto Jovem
7.
IEEE Trans Neural Syst Rehabil Eng ; 25(6): 589-596, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27337720

RESUMO

Ankle movement training is important in motor recovery post stroke and early intervention is critical to stroke rehabilitation. However, acute stroke survivors receive motor rehabilitation in only a small fraction of time, partly due to the lack of effective devices and protocols suitable for early in-bed rehabilitation. Considering the first few months post stroke is critical in stroke recovery, there is a strong need to start motor rehabilitation early, mobilize the ankle, and conduct movement therapy. This study seeks to address the need and deliver intensive passive and active movement training in acute stroke using a wearable ankle robotic device. Isometric torque generation mode under real-time feedback is used to guide patients in motor relearning. In the passive stretching mode, the wearable robotic device stretches the ankle throughout its range of motion to the extreme dorsiflexion forcefully and safely. In the active movement training mode, a patient is guided and motivated to actively participate in movement training through game playing. Clinical testing of the wearable robotic device on 10 acute stroke survivors over 12 sessions of feedback-facilitated isometric torque generation, and passive and active movement training indicated that the early in-bed rehabilitation could have facilitated neuroplasticity and helped improve motor control ability.


Assuntos
Articulação do Tornozelo , Biorretroalimentação Psicológica/instrumentação , Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Terapia Passiva Contínua de Movimento/instrumentação , Robótica/instrumentação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Biorretroalimentação Psicológica/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Monitorização Ambulatorial/instrumentação , Reprodutibilidade dos Testes , Robótica/métodos , Sensibilidade e Especificidade , Terapia Assistida por Computador/instrumentação , Terapia Assistida por Computador/métodos , Jogos de Vídeo
8.
J Orthop Sports Phys Ther ; 46(9): 775-83, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27494057

RESUMO

Study Design Controlled laboratory study. Background Recurrent ankle sprains associated with chronic ankle instability (CAI) occur not only in challenging sports but also in daily walking. Understanding whether and how CAI alters feedback and feedforward controls during walking may be important for developing interventions for CAI prevention or treatment. Objective To understand whether CAI is associated with changes in feedback and feedforward control when individuals with CAI are subjected to experimental perturbation during walking. Methods Twelve subjects with CAI and 12 control subjects walked on a treadmill while adapting to external loading that generated inversion perturbation at the ankle joint. Ankle kinematics around heel contact during and after the adaptation were compared between the 2 groups. Results Both healthy and CAI groups showed an increase in eversion around heel contact in early adaptation to the external loading. However, the CAI group adapted back toward the baseline, while the healthy controls showed further increase in eversion in late adaptation. When the external loading was removed in the postadaptation period, healthy controls showed an aftereffect consisting of an increase in eversion around heel contact, but the CAI group showed no aftereffect. Conclusion The results provide preliminary evidence that CAI may alter individuals' feedback and feedforward control during walking. J Orthop Sports Phys Ther 2016;46(9):775-783. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6403.


Assuntos
Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Teste de Esforço/métodos , Calcanhar/fisiologia , Instabilidade Articular/fisiopatologia , Caminhada/fisiologia , Adaptação Fisiológica , Adulto , Estudos de Casos e Controles , Retroalimentação , Feminino , Humanos , Masculino , Adulto Jovem
9.
Arch Phys Med Rehabil ; 97(8): 1237-43, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26903143

RESUMO

OBJECTIVE: To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. DESIGN: A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. SETTING: Home versus laboratory within a research hospital. PARTICIPANTS: Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups. Children in home-based and laboratory-based groups were 8.7±2.8 (n=23) and 10.7±6.0 (n=18) years old, respectively. INTERVENTIONS: Six-week combined passive stretching and active movement intervention of impaired ankle in a laboratory or home environment using a portable rehabilitation robot. MAIN OUTCOME MEASURES: Active dorsiflexion range of motion (as the primary outcome), mobility (6-minute walk test and timed Up and Go test), balance (Pediatric Balance Scale), Selective Motor Control Assessment of the Lower Extremity, Modified Ashworth Scale (MAS) for spasticity, passive range of motion (PROM), strength, and joint stiffness. RESULTS: Significant improvements were found for the home-based group in all biomechanical outcome measures except for PROM and all clinical outcome measures except the MAS. The laboratory-based group also showed significant improvements in all the biomechanical outcome measures and all clinical outcome measures except the MAS. There were no significant differences in the outcome measures between the 2 groups. CONCLUSIONS: These findings suggest that the translation of repetitive, goal-directed, biofeedback training through motivating games from the laboratory to the home environment is feasible. The benefits of home-based robot-guided therapy were similar to those of laboratory-based robot-guided therapy.


Assuntos
Tornozelo/fisiopatologia , Paralisia Cerebral/reabilitação , Serviços de Assistência Domiciliar , Modalidades de Fisioterapia , Robótica , Adolescente , Criança , Feminino , Humanos , Masculino , Limitação da Mobilidade , Força Muscular , Amplitude de Movimento Articular , Índice de Gravidade de Doença
10.
J Biomech ; 49(5): 797-801, 2016 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-26897646

RESUMO

Muscle fiber tension and sarcomere length play critical roles in regulating muscle functions and adaptations under pathological conditions. However, methods are lacking to quantify these two variables simultaneously in vivo. A novel force microscope was developed with the unique capabilities of estimating muscle fiber tension and acquiring sarcomere images simultaneously in vivo. The force microscope consisting of a custom microscopic imaging system and a force sensor was used to quantify in vivo sarcomere length, muscle fiber tension and stress of the tibialis cranialis muscle at plantar-flexed and dorsi-flexed positions from 11 rat hind limbs. Results showed that sarcomere images and fiber tension could be measured together in vivo with significantly higher muscle fiber tension and stress and longer sarcomere length at the plantar-flexed position when compared to their counterparts at the dorsi-flexed position. The fiber tension estimated using the force microscope had close agreement with the direct measurements of the fiber tension. The present force microscope with simultaneous characterizations of fiber tension and sarcomere imaging provides us a useful in vivo tool to investigate the roles of muscle tension in regulating sarcomere and muscle fiber functions under physiological and pathological conditions.


Assuntos
Fibras Musculares Esqueléticas/fisiologia , Sarcômeros/fisiologia , Animais , Masculino , Microscopia , Ratos Sprague-Dawley
11.
J Phys Ther Sci ; 27(9): 2783-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26504293

RESUMO

[Purpose] This study was performed to examine the relationship between physical performance and muscle properties during police cadet training. The study's hypothesis was that improved physical performance brought about by training, would in turn cause a reduction in muscle flexibility. [Subjects and Methods] Fifty-nine police cadets were included in this study. Standard fitness tests and quantitative assessments of muscular biomechanical properties were conducted before, during and after the 20-week cadet training. [Results] General fitness had improved at the end of the police cadet training. There was no significant decrease in muscle flexibility as measured by the Sit-and-Reach test. However, muscle compliance of the non-dominant leg measured by the relaxation coefficient had decreased at the end of the police cadet training. [Conclusion] The increased sit-and-reach distance could be due in part to strengthening of the abdominal muscles. On the other hand, the biomechanical test, which was specific to muscle extensibility, showed a reduction in the relaxation coefficient of the non-dominant leg. Our data suggests that changes in muscle compliance as a result of lower extremity training should be considered. This data may be useful in the design of a training protocol that prevents the potential injuries caused by reduced muscle flexibility.

12.
IEEE Trans Neural Syst Rehabil Eng ; 21(3): 490-9, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23096119

RESUMO

Arm impairments in patients post stroke involve the shoulder, elbow and wrist simultaneously. It is not very clear how patients develop spasticity and reduced range of motion (ROM) at the multiple joints and the abnormal couplings among the multiple joints and the multiple degrees-of-freedom (DOF) during passive movement. It is also not clear how they lose independent control of individual joints/DOFs and coordination among the joints/DOFs during voluntary movement. An upper limb exoskeleton robot, the IntelliArm, which can control the shoulder, elbow, and wrist, was developed, aiming to support clinicians and patients with the following integrated capabilities: 1) quantitative, objective, and comprehensive multi-joint neuromechanical pre-evaluation capabilities aiding multi-joint/DOF diagnosis for individual patients; 2) strenuous and safe passive stretching of hypertonic/deformed arm for loosening up muscles/joints based on the robot-aided diagnosis; 3) (assistive/resistive) active reaching training after passive stretching for regaining/improving motor control ability; and 4) quantitative, objective, and comprehensive neuromechanical outcome evaluation at the level of individual joints/DOFs, multiple joints, and whole arm. Feasibility of the integrated capabilities was demonstrated through experiments with stroke survivors and healthy subjects.


Assuntos
Diagnóstico por Computador/instrumentação , Terapia Passiva Contínua de Movimento/instrumentação , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/reabilitação , Aparelhos Ortopédicos , Robótica/instrumentação , Terapia Assistida por Computador/instrumentação , Braço , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Sistemas Homem-Máquina , Resultado do Tratamento
13.
Stroke ; 43(10): 2757-63, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22829546

RESUMO

BACKGROUND AND PURPOSE: The pattern of antenatal brain injury varies with gestational age at the time of insult. Deep brain nuclei are often injured at older gestational ages. Having previously shown postnatal hypertonia after preterm fetal rabbit hypoxia-ischemia, the objective of this study was to investigate the causal relationship between the dynamic regional pattern of brain injury on MRI and the evolution of muscle tone in the near-term rabbit fetus. METHODS: Serial MRI was performed on New Zealand white rabbit fetuses to determine equipotency of fetal hypoxia-ischemia during uterine ischemia comparing 29 days gestation (E29, 92% gestation) with E22 and E25. E29 postnatal kits at 4, 24, and 72 hours after hypoxia-ischemia underwent T2- and diffusion-weighted imaging. Quantitative assessments of tone were made serially using a torque apparatus in addition to clinical assessments. RESULTS: Based on the brain apparent diffusion coefficient, 32 minutes of uterine ischemia was selected for E29 fetuses. At E30, 58% of the survivors manifested hind limb hypotonia. By E32, 71% of the hypotonic kits developed dystonic hypertonia. Marked and persistent apparent diffusion coefficient reduction in the basal ganglia, thalamus, and brain stem was predictive of these motor deficits. CONCLUSIONS: MRI observation of deep brain injury 6 to 24 hours after near-term hypoxia-ischemia predicts dystonic hypertonia postnatally. Torque-displacement measurements indicate that motor deficits in rabbits progressed from initial hypotonia to hypertonia, similar to human cerebral palsy, but in a compressed timeframe. The presence of deep brain injury and quantitative shift from hypo- to hypertonia may identify patients at risk for developing cerebral palsy.


Assuntos
Lesões Encefálicas/etiologia , Lesões Encefálicas/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Hipóxia Fetal/complicações , Hipóxia-Isquemia Encefálica/complicações , Hipertonia Muscular/fisiopatologia , Hipotonia Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Animais , Lesões Encefálicas/fisiopatologia , Paralisia Cerebral/epidemiologia , Feminino , Feto/fisiopatologia , Idade Gestacional , Modelos Animais , Tono Muscular/fisiologia , Valor Preditivo dos Testes , Gravidez , Coelhos , Fatores de Risco , Fatores de Tempo
14.
J Rehabil Res Dev ; 48(4): 473-81, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21674395

RESUMO

Spasticity and contracture are major sources of disability in people with neurological impairments that have been evaluated using various instruments: the Modified Ashworth Scale, tendon reflex scale, pendulum test, mechanical perturbations, and passive joint range of motion (ROM). These measures generally are either convenient to use in clinics but not quantitative or they are quantitative but difficult to use conveniently in clinics. We have developed a manual spasticity evaluator (MSE) to evaluate spasticity/contracture quantitatively and conveniently, with ankle ROM and stiffness measured at a controlled low velocity and joint resistance and Tardieu catch angle measured at several higher velocities. We found that the Tardieu catch angle was linearly related to the velocity, indicating that increased resistance at higher velocities was felt at further stiffer positions and, thus, that the velocity dependence of spasticity may also be position-dependent. This finding indicates the need to control velocity in spasticity evaluation, which is achieved with the MSE. Quantitative measurements of spasticity, stiffness, and ROM can lead to more accurate characterizations of pathological conditions and outcome evaluations of interventions, potentially contributing to better healthcare services for patients with neurological disorders such as cerebral palsy, spinal cord injury, traumatic brain injury, and stroke.


Assuntos
Tornozelo , Paralisia Cerebral/reabilitação , Adolescente , Adulto , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Equipamentos e Provisões , Humanos , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Amplitude de Movimento Articular , Adulto Jovem
15.
J Appl Physiol (1985) ; 111(2): 435-42, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21596920

RESUMO

Biomechanical properties of calf muscles and Achilles tendon may be altered considerably in children with cerebral palsy (CP), contributing to childhood disability. It is unclear how muscle fascicles and tendon respond to rehabilitation and contribute to improvement of ankle-joint properties. Biomechanical properties of the calf muscle fascicles of both gastrocnemius medialis (GM) and soleus (SOL), including the fascicle length and pennation angle in seven children with CP, were evaluated using ultrasonography combined with biomechanical measurements before and after a 6-wk treatment of passive-stretching and active-movement training. The passive force contributions from the GM and SOL muscles were separated using flexed and extended knee positions, and fascicular stiffness was calculated based on the fascicular force-length relation. Biomechanical properties of the Achilles tendon, including resting length, cross-sectional area, and stiffness, were also evaluated. The 6-wk training induced elongation of muscle fascicles (SOL: 8%, P = 0.018; GM: 3%, P = 0.018), reduced pennation angle (SOL: 10%, P = 0.028; GM: 5%, P = 0.028), reduced fascicular stiffness (SOL: 17%, P = 0.128; GM: 21%, P = 0.018), decreased tendon length (6%, P = 0.018), increased Achilles tendon stiffness (32%, P = 0.018), and increased Young's modulus (20%, P = 0.018). In vivo characterizations of calf muscles and Achilles tendon mechanical properties help us better understand treatment-induced changes of calf muscle-tendon and facilitate development of more effective treatments.


Assuntos
Tendão do Calcâneo/fisiologia , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/reabilitação , Técnicas de Exercício e de Movimento , Perna (Membro)/fisiologia , Exercícios de Alongamento Muscular , Músculo Esquelético/fisiologia , Tendão do Calcâneo/diagnóstico por imagem , Adolescente , Tornozelo/fisiologia , Fenômenos Biomecânicos , Paralisia Cerebral/diagnóstico por imagem , Criança , Pré-Escolar , Módulo de Elasticidade , Feminino , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Ultrassonografia
16.
Neurorehabil Neural Repair ; 25(4): 378-85, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21343525

RESUMO

BACKGROUND: Ankle impairments are closely associated with functional limitations in children with cerebral palsy (CP). Passive stretching is often used to increase the range of motion (ROM) of the impaired ankle. Improving motor control is also a focus of physical therapy. However, convenient and effective ways to control passive stretching and motivate active movement training with quantitative outcomes are lacking. OBJECTIVE: To investigate the efficacy of combined passive stretching and active movement training with motivating games using a portable rehabilitation robot. METHODS: Twelve children with mild to moderate spastic CP participated in robotic rehabilitation 3 times per week for 6 weeks. Each session consisted of 20 minutes of passive stretching followed by 30 minutes of active movement training and ended with 10 minutes of passive stretching. Passive ROM (PROM), active ROM (AROM), dorsiflexor and plantarflexor muscle strength, Selective Control Assessment of the Lower Extremity, and functional outcome measures (Pediatric Balance Scale, 6-minute walk, and Timed Up-and-Go) were evaluated before and after the 6-week intervention. RESULTS: Significant increases were observed in dorsiflexion PROM (P = .002), AROM (P = .02), and dorsiflexor muscle strength (P = .001). Spasticity of the ankle musculature was significantly reduced (P = .01). Selective motor control improved significantly (P = .005). Functionally, participants showed significantly improved balance (P = .0025) and increased walking distance within 6 minutes (P = .025). CONCLUSIONS: Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP. They demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.


Assuntos
Paralisia Cerebral/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Perna (Membro)/fisiopatologia , Espasticidade Muscular/reabilitação , Modalidades de Fisioterapia/instrumentação , Robótica/instrumentação , Adolescente , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Perna (Membro)/inervação , Masculino , Espasticidade Muscular/etiologia , Robótica/métodos
17.
J Shoulder Elbow Surg ; 20(1): 33-8, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21051243

RESUMO

HYPOTHESIS: The biomechanical effects of placing a portal through the subscapularis tendon have not been studied. Our hypothesis is that placing a portal through the subscapularis tendon will affect the strain properties of the tendon. MATERIALS AND METHODS: Eight shoulders from deceased donors were dissected to expose the subscapularis musculotendinous unit. The subscapularis muscle was isolated, the arm was locked at neutral (0° abduction, 0° flexion/extension, 0° external rotation/internal rotation), and 3 cables were sutured to the subscapularis musculotendinous junction. Each cable was connected to a static weight. Three differential variable reluctance transducers (DVRTs) from Microstrain were sutured into the subscapularis tendon-superior, inferior, and in line with the proposed 5 o'clock portal. The musculotendinous unit was loaded along its line of action with 3, 9, and then 15 kg. Strain at each DVRT was measured in the native subscapularis tendon at each load level. The same strain measurement was taken after placing and removing a 5-mm suture anchor through the 5 o'clock portal and in the tendon after placing and removing an 8-mm cannula. RESULTS: Penetrating the subscapularis tendon with either a 5-mm suture anchor or an 8-mm cannula does not produce any statistically significant change in strain compared with the native tendon. CONCLUSION: Placing an anchor, or even an 8-mm cannulated portal, does not significantly alter the strain properties of the subscapularis tendon. This lack of effect on the strain characteristics of the subscapularis does not preclude the possibility of clinical effects.


Assuntos
Artroscopia , Articulação do Ombro/cirurgia , Âncoras de Sutura , Tendões/fisiologia , Tendões/cirurgia , Cateteres , Humanos , Técnicas In Vitro , Luxação do Ombro/cirurgia , Estresse Mecânico
18.
Conf Proc IEEE Eng Med Biol Soc ; 2010: 1986-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21096789

RESUMO

Current work demonstrates a new method and a new device for simultaneous in vivo measurements of sarcomere imaging and fiber tension. Sarcomere, a building block of muscles, plays a critical role in muscle contraction. In the pathological conditions, the biomechanical properties of sarcomere and muscle fibers may be altered significantly. We developed a novel methodology by combining the optical image capture system with force measurement which allowed us to investigate the muscle cell properties in vivo under monitored/controlled tension. The methodology was validated in an in vivo rat model as well as using an in vitro corroboration setup. The in vivo evaluation provides us a powerful tool to investigate pathological changes of fibers/sarcomeres and help determine proper treatment.


Assuntos
Músculos/patologia , Sarcômeros/patologia , Algoritmos , Animais , Fenômenos Biomecânicos , Engenharia Biomédica/métodos , Masculino , Modelos Estatísticos , Contração Muscular , Fibras Musculares Esqueléticas/patologia , Ratos , Ratos Sprague-Dawley , Processamento de Sinais Assistido por Computador
19.
Conf Proc IEEE Eng Med Biol Soc ; 2010: 4481-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21095776

RESUMO

The current study introduces a novel rehabilitation robot for treatment of impaired ankle in children with cerebral palsy (CP). The treatment consisted of passive stretching under intelligent control and active movement training with motivating game-playing using the portable robot. After 18 sessions of training (3 sessions/week for 6 weeks), we found significant improvement in 12 children with CP in terms of improved passive and active ranges of motion, selective motor control and mobility functions. The positive outcomes of this study along with the improvements in motor control and functional activities suggest that robotic rehabilitation provides a useful and convenient option of treatment in clinic or patient home for more accessible and frequent rehabilitation.


Assuntos
Paralisia Cerebral/reabilitação , Artropatias/reabilitação , Terapia Passiva Contínua de Movimento/instrumentação , Robótica/instrumentação , Terapia Assistida por Computador/instrumentação , Jogos de Vídeo , Articulação do Tornozelo , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Artropatias/etiologia , Resultado do Tratamento
20.
Dev Med Child Neurol ; 52(6): 563-9, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20132137

RESUMO

AIM: To evaluate spasticity under controlled velocities and torques in children with cerebral palsy (CP) using a manual spasticity evaluator. METHOD: The study involved 10 children with spastic CP (six males, four females; mean age 10 y 1 mo, SD 2 y 9 mo, range 7-16 y; one with quadriplegia, six with right hemiplegia, three with left hemiplegia; Gross Motor Function Classification System levels I [n=2], II [n=3], III [n=2], IV [n=2], and V [n=1]; Manual Ability Classification System levels II [n=5], III [n=4], and V [n=1]) and 10 typically developing participants (four males, six females; mean age 10 y 3 mo, SD 2 y 7 mo, range 7-15 y). Spasticity and catch angle were evaluated using joint position, resistance torque, and torque rate at velocities of 90 degrees, 180 degrees, and 270 degrees per second, controlled using real-time audio-visual feedback. Biomechanically, elbow range of motion (ROM), stiffness, and energy loss were determined during slow movement (30 degrees/s) and under controlled terminal torque. RESULTS: Compared with typically developing children, children with CP showed higher reflex-mediated torque (p<0.001) and the torque increased more rapidly with increasing velocity (p<0.001). Catch angle was dependent on velocity and occurred later with increasing velocity (p=0.005). Children with CP showed smaller ROM (p<0.05), greater stiffness (p<0.001), and more energy loss (p=0.003). INTERPRETATION: Spasticity with velocity dependence may also be position-dependent. The delayed catch angle at higher velocities indicates that the greater resistance felt by the examiner at higher velocities was also due to position change, because the joint was moved further to a stiffer position at higher velocities.


Assuntos
Braço/fisiopatologia , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Destreza Motora , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Adolescente , Fenômenos Biomecânicos , Paralisia Cerebral/complicações , Criança , Avaliação da Deficiência , Eletromiografia , Feminino , Lateralidade Funcional , Humanos , Masculino , Destreza Motora/fisiologia , Espasticidade Muscular/complicações , Músculo Esquelético/fisiopatologia , Desempenho Psicomotor/fisiologia , Quadriplegia/complicações , Quadriplegia/diagnóstico , Quadriplegia/fisiopatologia , Reflexo/fisiologia , Reprodutibilidade dos Testes , Análise e Desempenho de Tarefas
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