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1.
Bone Joint J ; 102-B(4): 434-441, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228078

RESUMO

AIMS: There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. METHODS: A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints. RESULTS: The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321). CONCLUSION: At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434-441.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Período Pós-Operatório , Desenho de Prótese , Falha de Prótese/etiologia , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença
2.
Am J Phys Med Rehabil ; 99(4): 330-337, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32195716

RESUMO

OBJECTIVE: The aims of the study were to investigate the kinetic effects of sit-to-stand training in various foot positions on the coronal plane in patients with strokes and to suggest appropriate exercises. DESIGN: Thirty-six poststroke subjects participated in this study. The subjects performed three sit-to-stand trials in the following foot positions: (a) symmetric foot positioning (symmetric), (b) affected foot placed to the side (asymmetric 1), and (c) and less affected foot placed to the side (asymmetric 2). They were asked to perform sit-to-stand training at a spontaneous velocity and remain standing for 5 secs, whereas the vertical ground reaction force was measured using force platforms. The activation of lower limb muscles was evaluated using surface electromyography, and the peak and mean vertical ground reaction force and weight-bearing symmetry ratio were evaluated using force platforms. RESULTS: Our results showed significant increases in the muscle activation, peak and mean vertical ground reaction force, and weight-bearing symmetry ratio of the lower limbs using the asymmetric 2 strategy (P < 0.05). CONCLUSIONS: Our results suggest that sit-to-stand training with the less affected foot placed to the side by the width of the subject's foot may be the most beneficial in the rehabilitation of patients with hemiparetic stroke.


Assuntos
Hemiplegia/reabilitação , Posicionamento do Paciente/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Eletromiografia , Feminino , Pé/fisiopatologia , Hemiplegia/etiologia , Hemiplegia/fisiopatologia , Humanos , Cinética , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Postura , Acidente Vascular Cerebral/complicações , Suporte de Carga
3.
Medicine (Baltimore) ; 99(12): e19374, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195933

RESUMO

To explore the relationship of glycemic variability with lower extremity arterial disease (LEAD) and diabetic peripheral neuropathy (DPN).Seventy-eight patients with type 2 diabetes were enrolled. All patients underwent 72-hour dynamic blood glucose monitoring and obtained mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), standard deviation of blood glucose (SD), largest amplitude of glycemic excursion (LAGE), mean blood glucose (MBG), T≥10.0 (percentage of time for blood glucose levels ≥10.0 mmol/L), T≤3.9 (percentage of time for blood glucose levels ≤3.9 mmol/L), and other glycemic variability parameters. In the meanwhile, in order to explore the correlation of glycemic variability parameters with ankle-brachial index (ABI), vibration perception threshold (VPT), and current perception threshold (CPT), all patients underwent quantitative diabetic foot screening, including ABI for quantitative assessment of lower extremity arterial lesions and VPT and CPT for quantitative assessment of peripheral neuropathy.Patients were divided into abnormal CPT group (n = 21) and normal CPT group (n = 57) according to the CPT values. Compared with the normal CPT group, abnormal CPT group showed significantly higher levels of HbA1c, longer duration of diabetes, and higher levels of T≤3.9 (P < .05). However, there was no significant difference of MAGE, SD, LAGE, MODD, and other glycemic variability parameters between abnormal CPT group and normal CPT group (P > .05). Pearson correlation analysis or Spearman correlation analysis showed that ABI negatively correlated with MBG, T≥10.0, SD, LAGE, and MAGE (P < .05), but no correlation of ABI with T≤3.9 and MODD (P > .05) was shown. VPT showed a positive correlation with T≥10.0 (P < .05), but no correlation with other glycemic variability parameters (P > .05). There was no correlation between the other CPT values and the glycemic variability parameters (P > .05), except that the left and right 250 Hz CPT values were positively correlated with T≤3.9 (P > .05).The higher the blood glucose levels, the severer the degree of LEAD and DPN lesions; the higher the incidence of hypoglycemia, the severer the degree of DPN lesions; the greater the fluctuation of blood glucose, the severer the degree of LEAD lesions. However, the glycemic variability was not significantly correlated with DPN.


Assuntos
Índice Tornozelo-Braço , Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Neuropatias Diabéticas/epidemiologia , Doença Arterial Periférica/epidemiologia , Vibração , Adulto , Idoso , Estudos Transversais , Pé Diabético/epidemiologia , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
4.
Sports Health ; 12(3): 296-303, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994970

RESUMO

BACKGROUND: Because of the complex and multifaceted nature of running injuries, a multifactorial approach when investigating running injuries is required. HYPOTHESIS: Compared with uninjured runners, injured runners would exhibit different running biomechanics, display more fatigue changes, and would run a greater weekly running volume; more injured runners would also report having a previous injury. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: At commencement of the study, data were collected on demographics, anthropometrics, training history, previous injury history, and center-of-mass accelerations during a long-distance overground run. Participants completed weekly training diaries and were monitored for 1 year for an injury. RESULTS: A total of 76 runners completed the study, with 39 (22 male; 17 female) reporting an injury. Compared with male uninjured runners, male injured runners were heavier and ran a greater weekly distance. Male runners (injured and uninjured) exhibited increases in mediolateral center-of-mass accelerations during the run. Compared with female uninjured runners, female injured runners were heavier, ran with longer flight times and lower step frequencies, and more of them had reported an injury in the previous year and had increased speed training in the weeks prior to injury. Over 60% of male injured runners and over 50% of female injured runners had increased their weekly running distance by >30% between consecutive weeks at least once in the 4 weeks prior to injury. CONCLUSION: Factors that may be related to injury for male runners include being heavier, running a greater weekly distance, and exhibiting fatigue changes in mediolateral center-of-mass accelerations. Factors that may be related to injury for female runners include being heavier, having an injury in the previous year, running with longer flight times and lower step frequencies, and increasing speed training prior to injury. Increases in weekly running distance in 1 consecutive week (particularly >30%) needs to be monitored in training, and this along with the other factors found may have contributed to injury development. CLINICAL RELEVANCE: This study found that multiple factors are related to running injuries and that some factors are sex specific. The findings can aid in injury prevention and management.


Assuntos
Transtornos Traumáticos Cumulativos/fisiopatologia , Extremidade Inferior/lesões , Corrida/lesões , Aceleração , Adulto , Fenômenos Biomecânicos , Transtornos Traumáticos Cumulativos/etiologia , Transtornos Traumáticos Cumulativos/prevenção & controle , Feminino , Seguimentos , Marcha/fisiologia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fadiga Muscular/fisiologia , Condicionamento Físico Humano , Postura/fisiologia , Estudos Prospectivos , Fatores de Risco , Corrida/fisiologia , Fatores Sexuais
5.
J Nurs Care Qual ; 35(1): 45-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31464845

RESUMO

BACKGROUND: Care variation is associated with poor quality outcomes. Clinical practice guideline implementation is one method to decrease care variation and improve outcomes. Enhanced Recovery After Surgery (ERAS) is a clinical pathway encompassing best practices across the surgical patient care continuum. LOCAL PROBLEM: The lower extremity bypass (LEB) population had high length of stay (LOS), readmissions, and surgical site infections. METHODS: A comprehensive and systematic project management process was utilized to implement the ERAS pathway in the LEB population with the help of an interdisciplinary team. INTERVENTIONS: Clinical practice guidelines were created to integrate ERAS elements into the LEB population care continuum. Patient education was revised or created to ensure standardized information was communicated to patients from consultation through discharge and early follow-up. RESULTS: Preliminary data show 4.57 mean LOS (n = 21) compared with the prior year's mean of 6.81 (n = 53). CONCLUSION: ERAS pathway introduction to the LEB population is suggestive of improved outcomes based on preliminary data.


Assuntos
Recuperação Pós-Cirúrgica Melhorada/normas , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Resultado do Tratamento , Alabama , Humanos , Tempo de Internação/estatística & dados numéricos , Extremidade Inferior/fisiopatologia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
6.
Gait Posture ; 75: 85-92, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31627119

RESUMO

BACKGROUND: Patients with recurrent clubfoot may seek intervention to address impairments that impact gait function. An understanding of these impairments and associated gait issues will provide valuable information about ongoing treatment requirements. RESEARCH QUESTION: The purpose of this study was to describe the prevalence of impairments and associated gait deviations in children with recurrent clubfoot and to evaluate whether these findings differ depending on unilateral or bilateral presentation. METHODS: Eighty-four affected feet (42 unilateral, 21 bilateral) were retrospectively reviewed. History, clinical exam, and gait data were collected. Statistical analysis included evaluations of associations between clinical exam and gait parameters and differences among patients with unilateral versus bilateral clubfoot and a database of healthy controls. RESULTS: The average age was 7.5 ±â€¯3.3 years for unilateral and 7.0 ±â€¯2.8 years for bilateral patients. Patients presented with limited passive ankle dorsiflexion (unilateral/bilateral:67%/57%), limited ankle plantar flexion strength (unilateral/bilateral:53%/55%), metatarsus adductus (unilateral/bilateral:86%/83%) and internal foot-thigh angles (unilateral/bilateral:83%/82%), while only a subset presented with internal bi-malleolar axis angles (unilateral/bilateral:36%/45%). The most common gait deviations were internal foot progression (unilateral/bilateral:76%/73%), external hip rotation (unilateral/bilateral:66%/69%), reduced peak ankle plantar flexion moments (unilateral/bilateral:84%/83%), and reduced peak ankle power generation (unilateral/bilateral:67%/74%). Passive dorsiflexion was significantly correlated with peak dorsiflexion during stance and swing in both groups. Patients with unilateral compared to bilateral clubfoot showed decreased peak dorsiflexion and an associated knee flexor moment. SIGNIFICANCE: Patients with recurrent clubfoot show gait deviations at the ankle that can be explained by joint level impairment and compensations at the knee, hip and pelvis. Patients with unilateral clubfoot typically show decreased dorsiflexion range of motion and associated greater gait impacts and compensations than bilateral clubfoot. Understanding the relationships between impairments and gait function and the implications of unilateral versus bilateral clubfoot will help improve prognostic ability and optimize future treatment outcomes.


Assuntos
Tomada de Decisão Clínica/métodos , Pé Torto Equinovaro/fisiopatologia , Análise da Marcha , Extremidade Inferior/fisiopatologia , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Pé Torto Equinovaro/diagnóstico , Pé Torto Equinovaro/cirurgia , Feminino , Marcha , Humanos , Cinética , Masculino , Amplitude de Movimento Articular , Recidiva , Estudos Retrospectivos
7.
Clin Podiatr Med Surg ; 37(1): 1-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735261

RESUMO

In trying to explain the myriad of foot deformities and symptoms that have slow onset and/or are considered to be overuse syndromes, clinicians have been trying to develop quantitative examinations to describe the cause of the patient's problems and to better individualize treatment modalities. This type of examination is called a biomechanical examination. This article discusses some of the more common portions of a biomechanical examination of the foot and lower extremity. It will also point out some ways that the information from a biomechanical examination can be applied in clinically treating patients.


Assuntos
Deformidades do Pé/terapia , Extremidade Inferior/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Deformidades do Pé/diagnóstico , Deformidades do Pé/etiologia , Humanos , Exame Físico
8.
Clin Podiatr Med Surg ; 37(1): 53-60, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735269

RESUMO

Lower extremity biomechanics is the cornerstone of podiatric medicine and surgery. The foot and ankle act as the interface between the ground and proximal segments, mediating internal and external moments Although the medial longitudinal arch has been widely researched, the details of the lateral longitudinal arch are less extensively delineated. The purpose of this review is to analyze the biomechanics of the lateral column as it relates to lower extremity biomechanics and function.


Assuntos
Articulações do Pé/fisiopatologia , Extremidade Inferior/fisiopatologia , Fenômenos Biomecânicos , Humanos
9.
Medicine (Baltimore) ; 98(50): e18286, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852105

RESUMO

RATIONALE: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs). PATIENT CONCERNS: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. DIAGNOSIS: The patient was tetraplegia with incomplete SCI at C3-C4. INTERVENTIONS: The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes. OUTCOMES: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO2 tests. LESSIONS: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.


Assuntos
Vértebras Cervicais/lesões , Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Extremidade Inferior/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Velocidade de Caminhada/fisiologia , Caminhada/fisiologia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/fisiopatologia
10.
NeuroRehabilitation ; 45(4): 493-499, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868698

RESUMO

BACKGROUND: Disturbed lower limb coordination is thought to limit gait ability in patients with stroke. However, the relationship of lower limb coordination with gait kinematics and physical function has not yet been clarified. OBJECTIVE: The purpose of the study was to clarify the gait kinematic and physical function variables that most affect intralimb coordination by using the continuous relative phase (CRP) between the thigh and shank. METHODS: Fifteen participants with stroke were enrolled in this study. Kinematic and kinetic measurements were recorded during gait at preferred speeds. CRP was defined as the difference between the thigh and shank phase angles. RESULTS: Stepwise analysis revealed that non-paretic CRP during the propulsive phase was a determinant of gait speed. The paretic knee extension and flexion angles were determinants of the CRP during the propulsive phase in the non-paretic limb. Stepwise analysis showed that the paretic knee extension angle was a determinant of the CRP during the propulsive phase in the paretic limb. Stepwise analysis revealed that the paretic knee extensor muscle strength was a determinant of the CRP during the propulsive phase in both limbs. CONCLUSIONS: Our study indicates that improvement in knee movement during the stance phase may improve coordination.


Assuntos
Acidente Vascular Cerebral/fisiopatologia , Velocidade de Caminhada , Fenômenos Biomecânicos , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/fisiopatologia , Amplitude de Movimento Articular
11.
Braz J Med Biol Res ; 52(12): e8786, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778439

RESUMO

Exercise-based training decreases hospitalizations in heart failure patients but such patients have exercise intolerance. The objectives of the study were to evaluate the effect of 12 weeks of Tai Chi exercise and lower limb muscles' functional electrical stimulation in older chronic heart failure adults. A total of 1,084 older adults with chronic systolic heart failure were included in a non-randomized clinical trial (n=271 per group). The control group did not receive any kind of intervention, one group received functional electrical stimulation of lower limb muscles (FES group), another group practiced Tai Chi exercise (TCE group), and another received functional electrical stimulation of lower limb muscles and practiced Tai Chi exercise (FES & TCE group). Quality of life and cardiorespiratory functions of all patients were evaluated. Compared to the control group, only FES group had increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score (P<0.0001, q=9.06), only the TCE group had decreased heart rate (P<0.0001, q=5.72), and decreased peak oxygen consumption was reported in the TCE group (P<0.0001, q=9.15) and FES & TCE group (P<0.0001, q=10.69). FES of lower limb muscles and Tai Chi exercise can recover the quality of life and cardiorespiratory functions of older chronic heart failure adults (trial registration: Research Registry 4474, January 1, 2015).


Assuntos
Terapia por Estimulação Elétrica/métodos , Insuficiência Cardíaca Sistólica/reabilitação , Extremidade Inferior/fisiopatologia , Músculo Esquelético/fisiopatologia , Tai Ji/métodos , Idoso , Doença Crônica , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Qualidade de Vida , Resultado do Tratamento
12.
Hum Mov Sci ; 68: 102522, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31707313

RESUMO

Individuals with stroke often present functional impairment and gait alteration. Among different aspects, intralimb coordination of these individuals is one of the key points that should be considered before implementing any gait intervention protocol. The purpose of this study was to investigate the effects of stroke on intralimb gait coordination of the lower limbs using a vector coding technique. Twenty-five individuals with stroke and 18 non-disabled individuals (control), between 46 and 71 years old, participated in this study. A computerized analysis system registered data from reflective markers placed on specific body landmarks to define thigh, shank, and foot of both body sides, as participants walked at self-selected comfortable speed. Coordination modes, such as in-phase, anti-phase, proximal-segment-phase, and distal-segment-phase, and variability of thigh-shank, and shank-foot were analyzed for the paretic, non-paretic and control limbs during the stance and swing periods, and the entire gait cycle using the vector coding technique. During the stance period, individuals with stroke presented higher frequency of thigh-phase and lower frequency of shank-phase for the thigh-shank coupling and higher frequency of shank-phase for the shank-foot coupling compared to non-disabled controls, indicating that the proximal segment of each pair leads the movement. During the swing period, the paretic limb presented higher frequency for in-phase than non-paretic and control limbs for the thigh-shank coupling. Adaptations in the non-paretic limb were observed in the swing period, with higher frequency than paretic and control limbs in the thigh-phase for the thigh-shank coupling, and higher frequency than the paretic limb in the foot-phase for the shank-foot coupling. No differences in coordination variability were found between paretic, non-paretic, and control limbs. The vector coding technique constitutes a useful tool for identifying gait alterations in intralimb coordination of individuals with stroke. Our coordination results demonstrate a shift from distal to more proximal control during the stance phase in both legs for the individuals with stroke and an inability to decouple segment coordination during the swing phase in the paretic limb. The results indicate that it is more suitable to consider the stance and swing periods separately instead of considering the entire gait cycle to investigate intralimb gait coordination of individuals with stroke.


Assuntos
Marcha/fisiologia , Extremidade Inferior/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Fenômenos Biomecânicos/fisiologia , Estudos de Casos e Controles , Feminino , Pé/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Desempenho Psicomotor/fisiologia , Acidente Vascular Cerebral/complicações , Coxa da Perna/fisiopatologia , Caminhada/fisiologia
13.
J Sports Sci ; 37(23): 2744-2750, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31608831

RESUMO

In this study, we aimed to clarify the characteristics of neuromuscular function, kinetics, and kinematics of the lower extremity during sprinting in track and field athletes with a history of strain injury. Ten male college sprinters with a history of unilateral hamstring injury performed maximum effort sprint on an athletic track. The electromyographic (EMG) activity of the long head of the biceps femoris (BFlh) and gluteus maximus (Gmax) muscles and three-dimensional kinematic data were recorded. Bilateral comparisons were performed for the EMG activities, pelvic anterior tilt angle, hip and knee joint angles and torques, and the musculotendon length of BFlh. The activity of BFlh in the previously injured limb was significantly lower than that in the uninjured limb during the late-swing phase of sprinting (p < 0.05). However, the EMG activity of Gmax was not significantly different between the previously injured and uninjured limbs. Furthermore, during the late-swing phase, a significantly more flexed knee angle (p < 0.05) and a decrease in BFlh muscle length (p < 0.05) were noted in the injured limb. It was concluded that previously injured hamstring muscles demonstrate functional deficits during the late swing phase of sprinting in comparison with the uninjured contralateral muscles.


Assuntos
Músculos Isquiossurais/lesões , Músculos Isquiossurais/fisiopatologia , Extremidade Inferior/fisiopatologia , Entorses e Distensões/fisiopatologia , Atletismo/lesões , Atletismo/fisiologia , Fenômenos Biomecânicos , Eletromiografia , Humanos , Cinética , Extremidade Inferior/fisiologia , Masculino , Músculo Esquelético/fisiopatologia , Adulto Jovem
14.
Gait Posture ; 74: 250-254, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31590046

RESUMO

INTRODUCTION: Simulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether subjects with reduced hip ROM (Stiff hip) or hip flexor weakness (Weak hip) exhibit ankle compensations during walking and investigate redistribution of power in the lower extremity joints. METHODS: Retrospective gait data were reviewed (IRB-approved hip registry). Preoperative kinematic/kinetic walking data were collected in patients with: adolescent hip dysplasia (AHD), femoral acetabular impingement (FAI), and Legg-Calvé Perthes disease (Perthes). AHD patients with significantly weak hip flexors on their affected side were included (Weak hip group). The Gait Profile Score (GPS) was calculated on the affected side of the FAI and Perthes groups to identify patients who had a Stiff hip. Patients who had undergone a hip arthrodesis (Fusion) were also included (Stiff hip group). Ankle kinematics/kinetics were compared to healthy participants (Control). The total positive work of sagittal plane hip, knee and ankle power were compared along with the distribution of power. RESULTS: Patients in the Weak/Stiff hip groups did not walk with greater ankle plantarflexion, peak push-off power or positive ankle work on their affected sides compared to Control. Ankle work contribution (percentage of total positive work) on the affected or unaffected sides was greater in the Perthes and Hip Fusion patients compared to Control. Significant gait abnormalities on the unaffected side were observed. CONCLUSIONS: Patients with a weak or stiff hip did exhibit altered ankle mechanics during walking. Greater percent ankle work contribution appeared to correspond with hip stiffness. In patients with hip pathology the redistribution of power among the lower extremity joints can highlight the importance of preserving ankle function.


Assuntos
Articulação do Tornozelo/fisiologia , Impacto Femoroacetabular/fisiopatologia , Marcha/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Caminhada/fisiologia , Adulto Jovem
15.
Khirurgiia (Mosk) ; (10): 43-49, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626238

RESUMO

OBJECTIVE: To analyze the effectiveness of complex therapy of necrotizing infection using the original method of stimulation of angiogenesis in patients with chronic arterial insufficiency of the lower extremities. MATERIAL AND METHODS: In 53 patients, operations were performed using the proposed technologies for stimulation of angiogenesis. A control group consisting of 56 patients was formed to compare the results of treatment. They had standard vascular therapy for the correction of ischemia. Morphological studies of the muscles of the lower extremities included assessment of capillary bed density and spatial orientation of the capillaries before and after treatment. Computed angiography of the lower extremities followed by calculation of perfusion index was performed to assess changes in the microvasculature. Clinical evaluation of the results was carried out using R. Rutherford scale. RESULTS: Revascularization resulted significant augmentation of capillary bed density and the number of functioning capillaries in muscular tissue. This was accompanied by increased perfusion index and TcPO2 values. The effect of treatment is observed in 12-14 days after surgery and persists for a long time. The best outcomes are found in patients with ischemia grade IIb-III. Incidence of lower limb amputations was more than 2 times lower in the main group compared with the control group. CONCLUSION: Combined stimulation of angiogenesis including mechanical tunneling of the muscles of the affected limb and administration of platelet rich plasma is effective procedure. This method does not require complex equipment and may be used in the treatment of patients with complications of chronic lower limb ischemia and contraindicated direct arterial reconstruction.


Assuntos
Arteriopatias Oclusivas/cirurgia , Capilares/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Necrose/cirurgia , Neovascularização Fisiológica , Arteriopatias Oclusivas/fisiopatologia , Capilares/fisiopatologia , Humanos , /terapia , Isquemia/fisiopatologia , Isquemia/cirurgia , Extremidade Inferior/fisiopatologia , Microvasos/fisiopatologia , Microvasos/cirurgia , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Necrose/etiologia , Necrose/fisiopatologia , Plasma Rico em Plaquetas/fisiologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(39): e17261, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574840

RESUMO

BACKGROUND: This study aims to systematically explore the effectiveness of neuromuscular electrical stimulation (NMES) combined with rehabilitation training (RT) for the treatment of post-stroke limb spasticity (PSLS). METHODS: We will search Cochrane Library, MEDILINE, EMBASE, CINAHL, AMED, PsycINFO, WOS, Scopus, OpenGrey, and 4 Chinese databases from inception to the present without language restrictions. We will only consider randomized controlled trial on assessing the effectiveness and safety of NMES combined with RT for the treatment of PSLS. All included randomized controlled trials will be assessed using Cochrane risk of bias tool. Two researchers will independently perform study selection, risk of bias assessment, and data extraction, respectively. Any disagreements will be solved by a third researcher through discussion. RESULTS: Primary outcome is limb spasticity status. Secondary outcomes comprise of limb function, quality of life, and adverse events. CONCLUSION: This study will summarize the latest evidence of NMES combined with RT for the treatment of patients with PSLS. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138900.


Assuntos
Terapia por Estimulação Elétrica/métodos , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Humanos , Extremidade Inferior/fisiopatologia , Espasticidade Muscular/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Acidente Vascular Cerebral/fisiopatologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Extremidade Superior/fisiopatologia
17.
Eklem Hastalik Cerrahisi ; 30(3): 217-23, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650917

RESUMO

OBJECTIVES: This study aims to compare patients treated with single event multilevel surgery (SEMS) and multiple surgical events (MSE) for disorders of the lower extremities due to cerebral palsy (CP). PATIENTS AND METHODS: The study included 130 patients (74 males, 56 females; mean age 7.7±4 years; range, 4 to 13 years) who were retrospectively staged preoperatively and at the final follow-up with the Gross Motor Function Classification System (GMFCS). The patients were divided into two groups as group 1 (MSE) and group 2 (SEMS). Gross Motor Function Measure-88 (GMFM-88) was used as evaluation criteria and visual analog scale was used to measure family satisfaction. RESULTS: In the final follow-up, group 2 had better GMFM-88 D and E scores (p=0.037 and p=0.045, respectively). Similarly, family satisfaction was better in group 2 (p=0.047). There was a difference between preoperative and final follow-up GMFCS stages (I, II, III) of all patients (21÷53÷56 and 53÷49÷28; respectively, p<0.001). A total of 3.8 (range, 2-7) operations were performed per child. CONCLUSION: In this study, SEMS contributed significantly to movement, posture and independence of children with CP compared to MSE. Single event multilevel surgery also increased family satisfaction.


Assuntos
Paralisia Cerebral/cirurgia , Contratura/cirurgia , Extremidade Inferior/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Contratura/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Escala Visual Analógica
18.
Clin Interv Aging ; 14: 1399-1405, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496667

RESUMO

Purpose: The purpose of this study was to evaluate the association between the early stages of lumbar spinal stenosis (LSS) and the risk of locomotive syndrome, as well as its effect upon muscle strength of the back, upper extremities, and lower extremities. Patients and methods: LSS was diagnosed with a self-administered, self-reported history questionnaire. Participants (n=113) who agreed to be tested by the diagnostic support tool for LSS underwent three risk tests for locomotive syndrome: a stand-up test, a two-step test, and a 25-question Geriatric Locomotive Function Scale (GLFS-25), as well as measurements of the strength of their grip, back extensor, hip flexor, and knee extensor muscles. Results: Twenty-three participants were diagnosed with LSS by the questionnaire. Results of the stand-up test in the LSS group were significantly worse than those in the no-LSS group (P=0.003). The results of the two-step test and the total score on the GLFS-25 in the LSS group were significantly worse than those in the no-LSS group (P=0.002 and P<0.0001, respectively). The stages of locomotive syndrome assessed by the stand-up test, two-step test, and the GLFS-25 were significantly worse in the LSS group than in the no-LSS group (P=0.0004, P=0.0007, and P<0.0001, respectively). Hip flexor and knee extensor strength, but not grip and back extensor strength, in the LSS group were significantly lower than that in the no-LSS group. Conclusions: LSS diagnosed using the self-reported support tool worsened the stage of locomotive syndrome in older people. Furthermore, participants with LSS had significant lower extremity weakness.


Assuntos
Extremidade Inferior/fisiopatologia , Limitação da Mobilidade , Debilidade Muscular/etiologia , Estenose Espinal/complicações , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Estenose Espinal/diagnóstico , Inquéritos e Questionários , Síndrome
19.
Medicine (Baltimore) ; 98(37): e17103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517841

RESUMO

BACKGROUND: To assess whether the ultrasound (US) is a reliable approach in detecting lower-limb deep-vein thrombosis (DVT) in patients without symptoms of DVT. METHODS: The research team performed a systematic search in PubMed, Ovid, Cochrane, and Web of Science without language or date restrictions. Full-text reports on prospective diagnostic studies involve the detection of lower-limb proximal and distal DVT in patients without symptoms of DVT using US and venography. A meta-analysis was performed using Meta-DiSc (version 1.4), providing the pooled sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios of the detection accuracy of US. There were 4 different classes of subgroup analysis-the class of patients stratified by location of US exam (proximal, distal, whole leg), the class stratified by technique (color/doppler, compression, both modalities), the class stratified by kind of surgery (orthopedic, otherwise hospitalized) and the class stratified by era of publishing (1980s, 1990s, 2000s). The study quality and the risk of bias were evaluated using QUADAS-2, with heterogeneity was assessed and quantified by the Q score and I statistics, respectively. RESULTS: The meta-analysis included 26 articles containing 41 individual studies with a total of 3951 patients without symptoms of DVT. Using venography as the gold standard, US for proximal DVT had a pooled sensitivity of 59% (95% confidence interval (CI) = 51%-66%) and a pooled specificity of 98% (95% CI = 97%-98%), US for distal DVT had a poor sensitivity of 43% (95% CI = 38%-48%) and a pooled specificity of 95% (95% CI = 94%-96%), US for whole-leg DVT had a pooled sensitivity of 59% (95% CI = 54%-64%) and a pooled specificity of 95% (95% CI = 94%-96%), US for post-major orthopedic surgery patients had a pooled sensitivity of 52% (95% CI = 49%-55%), and US for other types of patients had a pooled sensitivity of 58% (95% CI = 43%-72%). Pure compression technique for DVT had a poor sensitivity of 43% (95% CI = 39%-48%), pure color/doppler technique for DVT had a pooled sensitivity of 58% (95% CI = 53%-63%), compression and color/doppler technique for DVT had a pooled sensitivity of 61% (95% CI = 48%-74%). CONCLUSION: US could be a useful tool for diagnosing DVT, but it has a lower positive rate and a higher false negative rate. The rate of missed diagnosis of lower-limb DVT by US amounts to 50% or so in the patients without symptoms of DVT. The negative results do not preclude the possibility of DVT and if appropriate heightened surveillance and continued monitoring or try a more accurate inspection method is warranted. The whole leg evaluation and color/doppler technique should be the preferred approach.


Assuntos
Diagnóstico Tardio , Extremidade Inferior/irrigação sanguínea , Ultrassonografia/normas , Trombose Venosa/diagnóstico , Humanos , Extremidade Inferior/fisiopatologia , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Trombose Venosa/epidemiologia
20.
J Med Case Rep ; 13(1): 293, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522686

RESUMO

BACKGROUND: A hip joint ganglion is a rare cause of lower-extremity swelling. CASE PRESENTATION: We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. CONCLUSIONS: Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.


Assuntos
Acetábulo/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Edema/fisiopatologia , Veia Femoral/fisiopatologia , Cistos Glanglionares/fisiopatologia , Veia Ilíaca/fisiopatologia , Idoso de 80 Anos ou mais , Constrição Patológica/diagnóstico por imagem , Feminino , Veia Femoral/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
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