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1.
Acta Orthop ; 95: 86-91, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38305435

RESUMO

BACKGROUND AND PURPOSE: Re-amputation after lower extremity amputation is frequent. The primary aim of our study was to investigate cumulative re-amputation risk after transtibial amputation (TTA), knee disarticulation (KD), and transfemoral amputation (TFA) and secondarily to investigate time to re-amputation, and risk factors. METHODS: This observational cohort study was based on data from the Danish Nationwide Health registers. The population included first-time major lower extremity amputations (MLEA) performed in patients ≥ 50 years between 2010 and 2021. Both left and right sided MLEA from the same patient were included as index procedures. RESULTS: 11,743 index MLEAs on 10,052 patients were included. The overall cumulative risks for re-amputation were 29% (95% confidence interval [CI] 27-30), 30% (CI 26-35), and 11% (CI 10-12) for TTA, KD, and TFA, respectively. 58% of re-amputations were performed within 30 days after index MLEA. Risk factors for re-amputation within 30 days were dyslipidemia (hazard ratio [HR] 1.2, CI 1.0-1.3), renal insufficiency (HR 1.2, CI 1.1-1.4), and prior vascular surgery (HR 1.3, CI 1.2-1.5). CONCLUSION: The risk of re-amputation was more than twice as high after TTA (29%) and KD (30%) compared with TFA (11%). Most re-amputations were conducted within 30 days of the index MLEA. Dyslipidemia, renal insufficiency, and prior vascular surgery were associated with higher risk of re-amputation.


Assuntos
Dislipidemias , Insuficiência Renal , Humanos , Pessoa de Meia-Idade , Amputação Cirúrgica , Estudos de Coortes , Dinamarca/epidemiologia , Extremidade Inferior/cirurgia , Fatores de Risco
2.
Sci Rep ; 14(1): 3082, 2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38321081

RESUMO

Post-stroke gait disorders involve altered lower limb kinematics. Recently, the endpoint of the lower limb has been used as a control variable to understand gait kinematics better. In a cross-sectional study of sixty-seven post-stroke patients, the limb extension angle and effective limb length during gait were used as input variables with a mixed Gaussian model-based probabilistic clustering approach to identify five distinct clusters. Each cluster had unique characteristics related to motor paralysis, spasticity, balance ability, and gait strategy. Cluster 1 exhibited high limb extension angle and length values, indicating increased spasticity. Cluster 2 had moderate extension angles and high limb lengths, indicating increased spasticity and reduced balance ability. Cluster 3 had low limb extension angles and high limb length, indicating reduced balance ability, more severe motor paralysis, and increased spasticity. Cluster 4 demonstrated high extension angles and short limb lengths, with a gait strategy that prioritized stride length in the component of gait speed. Cluster 5 had moderate extension angles and short limb lengths, with a gait strategy that prioritized cadence in the component of gait speed. These findings provide valuable insights into post-stroke gait impairment and can guide the development of personalized and effective rehabilitation strategies.


Assuntos
Transtornos dos Movimentos , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Fenômenos Biomecânicos , Estudos Transversais , Marcha , Extremidade Inferior , Espasticidade Muscular , Paralisia
3.
Sci Rep ; 14(1): 2899, 2024 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-38316811

RESUMO

Lower extremity open revascularization is a treatment option for peripheral artery disease that carries significant peri-operative risks; however, outcome prediction tools remain limited. Using machine learning (ML), we developed automated algorithms that predict 30-day outcomes following lower extremity open revascularization. The National Surgical Quality Improvement Program targeted vascular database was used to identify patients who underwent lower extremity open revascularization for chronic atherosclerotic disease between 2011 and 2021. Input features included 37 pre-operative demographic/clinical variables. The primary outcome was 30-day major adverse limb event (MALE; composite of untreated loss of patency, major reintervention, or major amputation) or death. Our data were split into training (70%) and test (30%) sets. Using tenfold cross-validation, we trained 6 ML models. Overall, 24,309 patients were included. The primary outcome of 30-day MALE or death occurred in 2349 (9.3%) patients. Our best performing prediction model was XGBoost, achieving an area under the receiver operating characteristic curve (95% CI) of 0.93 (0.92-0.94). The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.08. Our ML algorithm has potential for important utility in guiding risk mitigation strategies for patients being considered for lower extremity open revascularization to improve outcomes.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Humanos , Procedimentos Endovasculares/efeitos adversos , Salvamento de Membro , Resultado do Tratamento , Fatores de Risco , Isquemia/etiologia , Doença Arterial Periférica/cirurgia , Doença Arterial Periférica/etiologia , Extremidade Inferior/cirurgia , Extremidade Inferior/irrigação sanguínea , Aprendizado de Máquina , Estudos Retrospectivos
4.
Sci Rep ; 14(1): 3061, 2024 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321169

RESUMO

This study investigated the associations of sarcopenic obesity (SO) with muscle strength and physical performance in sufficiently active older adults. Data from 72 older sarcopenic obese adults classified as sufficiently active were analyzed. Participants were categorized into four groups based on sex and SO status. Muscle strength/physical performance tests were compared using independent sample t-tests. Multiple linear regression and binary logistic regression were performed to examine the associations between SO and muscle strength and physical performance, adjusting for confounding variables. Only handgrip strength showed differences between SO groups, regardless of sex (p < 0.05). SO negatively explained the variability of handgrip strength (p < 0.05). An increase in handgrip strength values was associated with a decrease in the chances of older adults being classified as SO (p < 0.05). The findings suggest that even with SO, sufficiently active older adults did not present a significant reduction in muscle strength in the lower limbs and physical performance.


Assuntos
Sarcopenia , Humanos , Idoso , Sarcopenia/complicações , Estudos Transversais , Força da Mão/fisiologia , Força Muscular/fisiologia , Obesidade/complicações , Extremidade Inferior , Desempenho Físico Funcional
5.
Int J Rehabil Res ; 47(1): 41-45, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38323889

RESUMO

Facioscapulohumeral muscular dystrophy (FSHD) is a common form of adult muscular dystrophy often resulting also in cardiorespiratory deconditioning and weakness of the lower limbs. Although previous studies examined outcomes of interventions aimed at improving either cardiorespiratory fitness or muscle strength, the potential benefits of a rehabilitation program targeting both remain unexplored. Thus, the aim of this study was to evaluate changes following participation in a rehabilitation program combining aerobic and strength exercises. We conducted a retrospective analysis of 10 subjects with FSHD who participated in our rehabilitation program during 2018 and 2019. Each of the 20 sessions consisted of aerobic training on a cycloergometer and a moderate lower limb strength exercises on an isokinetic machine in combination with conventional therapy. The primary outcomes were walking speed, aerobic performance and isokinetic strength of the knee extensors and flexors. The secondary outcomes were fatigue, insomnia. VO2max and walking speed increased significantly by 2.125 ml·kg-1·min-1 [95% confidence interval (CI): 0.75-3.62, P = 0.022] and 0.28 m/s (95% CI: 0.16-0.4, P = 0.002), respectively. The effect size was small for V02max (Hedge's g, 0.44; 95% CI: -0.5 to 1.37) and large for walking speed (Hedge's g, 0.99; 95% CI: 0.06-1.92). The knee flexor strength significantly increased at rehabilitation discharge (repeated measures analysis of variance P = 0.004). Positive changes in fatigue and insomnia were also observed. Our preliminary results provide evidence that a relatively short course of a comprehensive rehabilitation program targeting both cardiorespiratory fitness and knee muscle strength can be beneficial for people with FSHD, which warrants further prospective studies.


Assuntos
Terapia por Exercício , Distrofia Muscular Facioescapuloumeral , Treinamento de Força , Adulto , Humanos , Fadiga , Extremidade Inferior , Distrofia Muscular Facioescapuloumeral/reabilitação , Estudos Prospectivos , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono , Caminhada
6.
Artigo em Inglês | MEDLINE | ID: mdl-38323927

RESUMO

INTRODUCTION: The relative citation ratio (RCR), a novel bibliometric tool supported by the National Institute of Health, provides a standardized approach to evaluate research productivity and impact across different fields. This study aims to evaluate RCR of fellowship-trained foot and ankle orthopaedic surgeons to analyze the influence of various surgeon demographics. METHODS: Fellow names listed on the American Orthopaedic Foot and Ankle Society website were extracted from the year 2008 to 2009 to the year 2022 to 2023. Demographic information for each fellow was collected including sex, degree type, and academic title. The iCite database developed by the National Institute of Health was used to obtain total publications, mean RCR, weighted RCR, and change in RCR after fellowship graduation for each fellow. Univariate and multivariate analysis was conducted to predict these four parameters based on sex, degree type, academic position, and career longevity. RESULTS: Of the 820 fellows, 674 (82%) were male. Most fellows (n = 587, 71%) did not go on to hold academic positions. Multivariate analysis revealed that male sex (ß = 2.32, P < 0.001), holding an academic position (ß = 6.44, P < 0.001), holding a PhD (ß = 22.96, P < 0.001), and a shorter length time since graduation (ß = -0.50, P < 0.001) were independent predictors of number of total publications. Holding a DO degree was an independent predictor of decreased mean RCR (ß = 0.39, P = 0.039). Finally, multivariate analysis revealed that male sex (ß = 4.05, P = 0.003), a career in academics (ß = 4.61, P < 0.001), and a shorter time since graduation (ß = -0.45, P = 0.001) were associated with a larger weighted RCR. DISCUSSION: The findings highlight the importance of addressing gender disparities and promoting research opportunities across different programs. Moreover, academic institutions should provide adequate support and mentorship to early-career foot and ankle-trained orthopaedic surgeons to foster sustained research productivity.


Assuntos
Tornozelo , Ortopedia , Masculino , Feminino , Humanos , Bolsas de Estudo , Extremidade Inferior , Bibliometria
7.
Sci Rep ; 14(1): 2861, 2024 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-38311615

RESUMO

Accurately predicting prognosis subcutaneous leiomyosarcoma (LMS) is crucial for guiding treatment decisions in patients. The objective of this study was to develop prediction models for cancer-specific survival (CSS) in patients with subcutaneous LMS. The collected cases of diagnosed subcutaneous LMS were randomly divided into a training cohort and a validation cohort at a 6:4 ratio based on tumor location and histological code. The X-tile program was utilized to determine the optimal cutoff points for age index. Univariate and Cox multivariate regression analyses were conducted to identify independent risk factors for subcutaneous LMS patients. Nomograms were constructed to predict CSS, and their performance was assessed using C-index and calibration plots. Additionally, a decision tree model was established using recursive partitioning analysis to determine the total score for CSS prediction in subcutaneous LMS patients based on the nomogram model. A total of 1793 patients with subcutaneous LMS were found. X-tile software divides all patients into ≤ 61 years old, 61-82 years old, and ≥ 82 years old. The most important anatomical sites were the limbs (including the upper and lower limbs, 48.0%). Only 6.2% of patients received chemotherapy, while 44% had a history of radiotherapy and 92.9% underwent surgery. The independent risk factors for patients with subcutaneous LMS were age, summary stage, grade, and surgery. CSS was significantly decreased in patients with distant metastases, which showed the highest independent risk predictor (HR 4.325, 95% CI 3.010-6.214, p < 0.001). The nomogram prediction model of LMS was constructed based on four risk factors. The C-index for this model was 0.802 [95% CI 0.781-0.823] and 0.798 [95% CI 0.768-0.829]. The training cohort's 3-, 5-, and 10-year AUCs for CSS in patients with subcutaneous LMS were 0.833, 0.830, and 0.859, and the validation cohort's AUC for predicting CSS rate were 0.849, 0.830, and 0.803, respectively. Recursive segmentation analysis divided patients into 4 risk subgroups according to the total score in the nomogram, including low-risk group < 145, intermediate-low-risk group ≥ 145 < 176, intermediate-high-risk group ≥ 176 < 196, and high-risk group ≥ 196; The probability of the four risk subgroups is 9.1%, 34%, 49%, and 79% respectively. In this retrospective study, a novel nomogram or corresponding risk classification system for patients with subcutaneous LMS were developed, which may assist clinicians in identifying high-risk patients and in guiding the clinical decision.


Assuntos
Compostos de Anilina , Leiomiossarcoma , Nomogramas , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Extremidade Inferior , Programa de SEER , Prognóstico
8.
Tex Heart Inst J ; 51(1)2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38321790

RESUMO

BACKGROUND: Peripheral arterial disease and related lower extremity wounds are prominent causes of amputation. Revascularization may reduce amputation rates or the amputation margin more distally in patients with peripheral arterial disease who have wounds resulting from critical limb ischemia. This study examined the association of risk factors and intervention types with amputation rates in patients with critical lower extremity arterial disease. METHODS: A total of 211 patients who underwent peripheral intervention because of foot wound were followed up for 12 months after the intervention. All patients had lower extremity wounds resulting from peripheral arterial disease. The effects of treatment approaches were compared in patients who underwent and did not undergo amputation. RESULTS: Revascularization of the anterior tibial artery reduced the amputation rate by 6.52 times compared with occlusion. Posterior tibial artery revascularization reduced the amputation rate by 49.95 times. CONCLUSION: In this study of percutaneous intervention methods for prevention of amputation, the most effective option was revascularization of the posterior tibial artery and anterior tibial artery. Considering these results, treatment of critical peripheral arterial disease can be cost-effective and efficient and may shorten procedure time.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Humanos , Resultado do Tratamento , Salvamento de Membro , Cicatrização , Extremidade Inferior/irrigação sanguínea , Amputação Cirúrgica , Fatores de Risco , Isquemia/terapia , Estudos Retrospectivos
9.
Front Endocrinol (Lausanne) ; 15: 1334414, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38318295

RESUMO

Background: Diabetic foot ulcers constitute a substantial healthcare burden on a global scale and present challenges in achieving healing. Our objective was to assess the efficacy of modified tibial cortex transverse transport surgery in managing refractory diabetic foot ulcers. Methods: We retrospectively analyzed clinical data from 98 patients suffering from diabetic foot ulcers classified as Wagner grade ≥II who were admitted to our medical facility between January 2020 and June 2022. All the patients were treated by modified tibial cortex transverse transport surgery, wherein the osteotomy scope was reduced to two rectangular bone windows measuring 1.5cm × 1.5cm each. Record the patient's general information and ulcer healing time; ulcer area, ankle-brachial index, WIFi classification, and visual analogue scale before and 3 months following the surgical intervention. Results: The average duration of diabetes of 98 patients with diabetic foot ulcer was 20.22 ± 8.02 years, 52 patients had more than one toe gangrene on admission. The postoperative wound healing rate was 95.83% and the average healing time was 53.18 ± 20.18 days. The patients showed significant improvement in ankle-brachial index, WIFi classification, and visual analogue scale at 3 months postoperatively compared to preoperatively, with statistically significant differences (P< 0.05). Eight patients experienced complications, and the incidence of complications was 8.16%. Throughout the follow-up period, there were no instances of ulcer recurrence noted. Conclusion: Modified tibial cortex transverse transport surgery demonstrates effectiveness in the management of diabetic foot ulcers by enhancing lower limb microcirculation and facilitating the process of wound healing.


Assuntos
Diabetes Mellitus , Pé Diabético , Humanos , Pé Diabético/cirurgia , Estudos Retrospectivos , Tíbia/cirurgia , Extremidade Inferior , Cicatrização
10.
PeerJ ; 12: e16821, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38313026

RESUMO

The force a muscle generates is dependent on muscle structure, in which fibre length, pennation angle and tendon slack length all influence force production. Muscles are not preserved in the fossil record and these parameters must be estimated when constructing a musculoskeletal model. Here, we test the capability of digitally reconstructed muscles of the Australopithecus afarensis model (specimen AL 288-1) to maintain an upright, single-support limb posture. Our aim was to ascertain the influence that different architectural estimation methods have on muscle specialisation and on the subsequent inferences that can be extrapolated about limb function. Parameters were estimated for 36 muscles in the pelvis and lower limb and seven different musculoskeletal models of AL 288-1 were produced. These parameters represented either a 'static' Hill-type muscle model (n = 4 variants) which only incorporated force, or instead a 'dynamic' Hill-type muscle model with an elastic tendon and fibres that could vary force-length-velocity properties (n = 3 variants). Each muscle's fibre length, pennation angle, tendon slack length and maximal isometric force were calculated based upon different input variables. Static (inverse) simulations were computed in which the vertical and mediolateral ground reaction forces (GRF) were incrementally increased until limb collapse (simulation failure). All AL 288-1 variants produced somewhat similar simulated muscle activation patterns, but the maximum vertical GRF that could be exerted on a single limb was not consistent between models. Three of the four static-muscle models were unable to support >1.8 times body weight and produced models that under-performed. The dynamic-muscle models were stronger. Comparative results with a human model imply that similar muscle group activations between species are needed to sustain single-limb support at maximally applied GRFs in terms of the simplified static simulations (e.g., same walking pose) used here. This approach demonstrated the range of outputs that can be generated for a model of an extinct individual. Despite mostly comparable outputs, the models diverged mostly in terms of strength.


Assuntos
Músculo Esquelético , Tendões , Humanos , Músculo Esquelético/fisiologia , Tendões/fisiologia , Extremidade Inferior , Caminhada , Pelve
11.
PLoS One ; 19(2): e0296340, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38300954

RESUMO

OBJECTIVES: Spasticity is an incurable chronic condition, and patients with spasticity frequently experience symptoms such as muscle stiffness, restricted mobility, fatigue, spasms, and pain. The study objective was to assess the cost-effectiveness of abobotulinumtoxinA plus best supportive care compared with best supportive care alone for the early treatment of adult lower limb spasticity following an acute event (e.g. stroke or traumatic brain injury), from an Australian payer perspective. METHODS: Using clinical data from published pivotal trials, an economic model based on a Markov model was developed to capture changes in treatment costs, healthcare resource use costs, functional outcomes, and health-related quality of life over a lifetime horizon. Scenario analyses and a probabilistic sensitivity analysis were conducted to explore the uncertainty in the model parameters and assumptions used in the base case. RESULTS: AbobotulinumtoxinA plus best supportive care was cost-effective versus best supportive care, yielding an incremental cost-effectiveness ratio of $35,721 per quality-adjusted life year gained. Sensitivity analyses confirm the robustness of the base case, with most results remaining below the commonly acceptable cost-effectiveness willingness-to-pay threshold of $75,000 per quality-adjusted life year for cost-effectiveness in Australia. Inputs and assumptions that produced the top four highest incremental cost-effectiveness ratios include the application of different health resource utilisation source, short time horizon, unweighted regression analyses to determine regression probabilities, and no stopping rule. AbobotulinumtoxinA plus best supportive care has a 74% probability of being cost-effective compared with best supportive care alone at the willingness to pay threshold. CONCLUSION: AbobotulinumtoxinA plus best supportive care treatment is cost-effective in Australia for the management of adult lower limb spasticity in patients treated within 2 years of an acute event.


Assuntos
Toxinas Botulínicas Tipo A , Extremidade Inferior , Qualidade de Vida , Adulto , Humanos , Análise Custo-Benefício , Austrália , Anos de Vida Ajustados por Qualidade de Vida
12.
J Drugs Dermatol ; 23(2): 61-66, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38306139

RESUMO

INTRODUCTION: Chronic venous insufficiency (CVI) may lead to sustained elevated pressure (aka venous hypertension) in the dermal venous microcirculation. Risk factors include advanced age, obesity, female gender, pregnancy, and prolonged standing. CVI in the lower extremities may lead to cutaneous changes such as xerosis and venous leg dermatitis (VLD). This review explores skin barrier restoration using skincare for xerosis and VLD.    Methods: Prior to the meeting, a structured literature search yielded information on fourteen draft statements. During the meeting, a multi-disciplinary group of experts adopted five statements on xerosis and VLD supported by the literature and the authors’ clinical expertise.   Results: VLD and associated xerosis is a common condition requiring more attention from healthcare providers. Compression therapy is the standard CVI and should be combined with good-quality skincare to enhance adherence to treatment. Maintaining an intact skin barrier by preventing and treating xerosis using gentle cleansers and ceramide-containing moisturizers may improve the skin sequelae of CVI. Skincare is frequently lacking or overlooked as part of the treatment of patients with CVI and VLD. This skin treatment is an unmet need that can be addressed with ceramides-containing pH balanced cleansers and moisturizers. CONCLUSION: Compression therapy is the mainstay of treatment for CVI and VLD. Quality skincare can improve treatment adherence and the efficacy of compression therapy. Using a skincare agent may reduce friction and help patients avoid skin trauma while putting on compression garments. A ceramide-containing moisturizer sustained significant improvements in skin moisturization for 24 hours and may offer synergistic benefits together with compression treatment.  J Drugs Dermatol. 2024;23(2):61-66.     doi:10.36849/JDD.7588.


Assuntos
Ceramidas , Dermatite , Insuficiência Venosa , Humanos , Ceramidas/uso terapêutico , Consenso , Perna (Membro) , Extremidade Inferior , Insuficiência Venosa/complicações , Insuficiência Venosa/terapia
13.
PLoS One ; 19(2): e0297074, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38306360

RESUMO

BACKGROUND AND PURPOSE: Motor deficits of the ipsilateral lower limb could occur after stroke and may be associated with walking performance. This study aimed to determine whether the accuracy and movement path of targeted movement in the ipsilateral lower limb would be impaired in the chronic stage of stroke and whether this impairment would contribution to gait. METHODS: Twenty adults with chronic stroke and 20 age-matched controls went through Mini Mental Status Examination (MMSE), and a series of sensorimotor tests. The targeted movement tasks were to place the big toe ipsilateral to the lesion at an external visual target (EXT) or a proprioceptive target (PRO, contralateral big toe) with eyes open (EO) or closed (EC) in a seated position. A motion analysis system was used to obtain the data for the calculation of error distance, deviation from a straight path, and peak toe-height during the targeted movement tasks and gait velocity, step length, step width and step length symmetry of the lower limb ipsilateral to the brain lesion during walking. RESULTS: The stroke group had significantly lower MMSE and poorer visual acuity on the ipsilateral side, but did not differ in age or other sensorimotor functions when compared to the controls. For the targeted movement performance, only the deviation in PRO-EC showed significant between-group differences (p = 0.02). Toe-height in both EXT-EO and in PRO-EO was a significant predictor of step length (R2 = 0.294, p = 0.026) and step length symmetry (R2 = 0.359, p = 0.014), respectively. DISCUSSION AND CONCLUSIONS: The performance of ipsilateral lower limb targeted movement could be impaired after stroke and was associated with step length and its symmetry. The training of ipsilateral targeted movement with unseen proprioceptive target may be considered in stroke rehabilitation.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Humanos , Acidente Vascular Cerebral/complicações , Marcha , Extremidade Inferior , Caminhada
14.
BMC Pediatr ; 24(1): 136, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38383331

RESUMO

OBJECTIVE: To explore the effect of repetitive transcranial magnetic stimulation (rTMS)-assisted training on lower limb motor function in children with hemiplegic cerebral palsy (HCP). METHOD: Thirty-one children with HCP who met the inclusion criteria were selected and randomly divided into a control group (n = 16) and an experimental group (n = 15). The control group received routine rehabilitation treatment for 30 min each time, twice a day, 5 days a week for 4 weeks. Based on the control group, the experimental group received rTMS for 20 min each time, once a day, 5 days a week for 4 weeks. The outcome measures included a 10-metre walk test (10MWT), a 6-minute walk distance (6MWD) test, D- and E-zone gross motor function measurements (GMFM), the symmetry ratio of the step length and stance time and the muscle tone of the triceps surae and the hamstrings (evaluated according to the modified Ashworth scale), which were obtained in both groups of children before and after treatment. RESULTS: After training, the 10MWT (P < 0.05), 6MWD (P < 0.01), GMFM (P < 0.001) and the symmetry ratio of the step length and stance time of the two groups were significantly improved (P < 0.05), there was more of an improvement in the experimental group compared with the control group. There was no significant change in the muscle tone of the hamstrings between the two groups before and after treatment (P > 0.05). After treatment, the muscle tone of the triceps surae in the experimental group was significantly reduced (P < 0.05), but there was no significant change in the control group (P > 0.05). CONCLUSION: Repetitive TMS-assisted training can improve lower limb motor function in children with HCP.


Assuntos
Paralisia Cerebral , Estimulação Magnética Transcraniana , Criança , Humanos , Hemiplegia/etiologia , Caminhada , Extremidade Inferior
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 38(2): 234-239, 2024 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-38385238

RESUMO

Objective: To improve the clinical utility of the plantaris tendon mainly by summarizing its anatomical characteristics, biomechanical properties, harvesting methods, and its applications in ligament reconstruction. Methods: The relevant literature from domestic and international databases regarding the anatomical and biomechanical characteristics of the plantaris tendon and its applications in ligament reconstruction was comprehensively reviewed and systematically summarized. Results: The plantaris tendons have an absence. The majority of plantaris tendon forms a fan-shape on the anterior and medial sides of the Achilles tendon and terminates at the calcaneal tuberosity. There are significant differences in biomechanical parameters between plantaris tendon with different numbers of strands, and multi strand plantaris tendon have significant advantages over single strand tendon. The plantaris tendon can be harvested through proximal and distal approaches, and it is necessary to ensure that there are no obvious anatomical variations or adhesions in the surrounding area before harvesting. The plantaris tendon is commonly utilized in ligament reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture, with satisfactory effectiveness. There is limited research on the use of plantar tendon in the reconstruction of upper limb and knee joint ligaments. Conclusion: The plantaris tendon is relatively superficial, easy to be harvested, and has less impact on local function. The plantaris tendon is commonly utilized in ligaments reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture. The study on the plantaris tendon for upper limbs and knee joints ligament reconstruction is rarely and require further research.


Assuntos
Tendão do Calcâneo , Traumatismos do Tornozelo , Traumatismos dos Tendões , Humanos , Músculo Esquelético , Tendão do Calcâneo/cirurgia , , Extremidade Inferior , Ligamentos Articulares/cirurgia , Traumatismos do Tornozelo/cirurgia , Traumatismos dos Tendões/cirurgia
16.
Artigo em Inglês | MEDLINE | ID: mdl-38335075

RESUMO

In this study, a minimal setup for the ankle joint kinematics estimation is proposed relying only on proximal information of the lower-limb, i.e. thigh muscles activity and joint kinematics. To this purpose, myoelectric activity of Rectus Femoris (RF), Biceps Femoris (BF), and Vastus Medialis (VM) were recorded by surface electromyography (sEMG) from six healthy subjects during unconstrained walking task. For each subject, the angular kinematics of hip and ankle joints were synchronously recorded with sEMG signal for a total of 288 gait cycles. Two feature sets were extracted from sEMG signals, i.e. time domain (TD) and wavelet (WT) and compared to have a compromise between the reliability and computational capacity, they were used for feeding three regression models, i.e. Artificial Neural Networks, Random Forest, and Least Squares - Support Vector Machine (LS-SVM). BF together with LS-SVM provided the best ankle angle estimation in both TD and WT domains (RMSE < 5.6 deg). The inclusion of Hip joint trajectory significantly enhanced the regression performances of the model (RMSE < 4.5 deg). Results showed the feasibility of estimating the ankle trajectory using only proximal and limited information from the lower limb which would maximize a potential transfemoral amputee user's comfortability while facing the challenge of having a small amount of information thus requiring robust data-driven models. These findings represent a significant step towards the development of a minimal setup useful for the control design of ankle active prosthetics and rehabilitative solutions.


Assuntos
Articulação do Tornozelo , Caminhada , Humanos , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Reprodutibilidade dos Testes , Caminhada/fisiologia , Extremidade Inferior , Músculo Esquelético/fisiologia , Marcha/fisiologia , Eletromiografia/métodos , Articulação do Joelho
17.
Artigo em Inglês | MEDLINE | ID: mdl-38345960

RESUMO

The prediction of gait motion intention is essential for achieving intuitive control of assistive devices and diagnosing gait disorders. To reduce the cost associated with using multimodal signals and signal processing, we proposed a novel method that integrates machine learning with musculoskeletal modelling techniques for the prediction of time-series joint angles, using only kinematic signals. Additionally, we hypothesised that a stacked long short-term memory (LSTM) neural network architecture can perform the task without relying on any ahead-of-motion features typically provided by electromyography signals. Optical cameras and inertial measurement unit (IMU) sensors were used to track level gait kinematics. Joint angles were modelled using the musculoskeletal model. The optimal LSTM architecture in fulfilling the prediction task was determined. Joint angle predictions were performed for joints on the sagittal plane, benefiting from joint angle modelling using signals from optical cameras and IMU sensors. Our proposed method predicted the upcoming joint angles in the prediction time of 10 ms, with an averaged root mean square error of 5.3° and a coefficient of determination of 0.81. Moreover, in support of our hypothesis, the recurrent stacked LSTM network demonstrated its ability to predict intended motion accurately and efficiently in gait, outperforming two other neural network architectures: a feedforward MLP and a hybrid LSTM-MLP. The method paves the way for the development of a cost-effective, single-modal control system for assistive devices in gait rehabilitation.


Assuntos
Intenção , Memória de Curto Prazo , Humanos , Marcha , Redes Neurais de Computação , Extremidade Inferior , Fenômenos Biomecânicos
18.
Sci Rep ; 14(1): 3840, 2024 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-38360820

RESUMO

Despite the common focus of gait in rehabilitation, there are few tools that allow quantitatively characterizing gait in the clinic. We recently described an algorithm, trained on a large dataset from our clinical gait analysis laboratory, which produces accurate cycle-by-cycle estimates of spatiotemporal gait parameters including step timing and walking velocity. Here, we demonstrate this system generalizes well to clinical care with a validation study on prosthetic users seen in therapy and outpatient clinics. Specifically, estimated walking velocity was similar to annotated 10-m walking velocities, and cadence and foot contact times closely mirrored our wearable sensor measurements. Additionally, we found that a 2D keypoint detector pretrained on largely able-bodied individuals struggles to localize prosthetic joints, particularly for those individuals with more proximal or bilateral amputations, but after training a prosthetic-specific joint detector video-based gait analysis also works on these individuals. Further work is required to validate the other outputs from our algorithm including sagittal plane joint angles and step length. Code for the gait transformer and the trained weights are available at https://github.com/peabody124/GaitTransformer .


Assuntos
Membros Artificiais , Análise da Marcha , Humanos , Marcha , Caminhada , Extremidade Inferior , Fenômenos Biomecânicos
19.
Sci Rep ; 14(1): 3956, 2024 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-38368453

RESUMO

This study provides a detailed description of growing pains in young Danish children as standardized diagnostic criteria are needed to avoid misclassifications of other musculoskeletal diagnoses. The study is nested in a cohort study of Danish preschool children. At baseline, parents completed a questionnaire with sociodemographic information. During the study, the parents received a text message every two weeks inquiring about musculoskeletal pain in the child. If pain was reported, a telephone interview about pain characteristics was conducted. The present study includes data from 2016 to 2019 with 777 children, aged 3-6 years of age at baseline. The prevalence of growing pains was 24-43%, depending on the definition. The pain occurred most frequently 1-3 times per week and most commonly in the lower legs, could be unilateral or bilateral and was usually without consequences. The prevalence increased with age, and there were no consistent associations with socio-economic factors. We suggest using Evan's criteria with the addition of unilateral pain as standard diagnostic criteria in the future. We found no relation to periods of rapid growth and suggest that the term is a misnomer. Etiology and long-term courses of pain need to be explored in future studies.


Assuntos
Dor Musculoesquelética , Humanos , Pré-Escolar , Criança , Estudos de Coortes , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/epidemiologia , Extremidade Inferior , Prevalência , Dinamarca/epidemiologia
20.
Artigo em Russo | MEDLINE | ID: mdl-38372738

RESUMO

Dynamically developing sphere of physical and rehabilitative medicine raises an important issue on implementation of technologies with proven effectiveness to recover neuromuscular, skeletal and movement-related functions, activity and partipation of traumatological patients into rehabilitation practice. The aim of this review is the consistent information analysis and synthesis of evidence-based researches of current effective methods in the context of medical rehabilitation after endoprosthesis of lower limbs' major joints, as well as the provision of structured information that helps to influence on decision-making for doctors of physical and rehabilitative medicine and other professionals who take part in multidisciplinary interaction.


Assuntos
Medicina Física e Reabilitação , Médicos , Humanos , Extremidade Inferior/cirurgia , Movimento , Próteses e Implantes
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