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1.
Clin Podiatr Med Surg ; 39(1): 15-35, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809793

RESUMO

The neurologic causes of foot and leg dysfunction are reviewed. Disorders causing foot and ankle pain, weakness, or other sensorimotor disturbances often cause difficulty with ambulation and prompt patients to seek medical evaluation. Physical signs and symptoms along with targeted diagnostic testing are needed to come to the correct diagnosis and treatment plan. An overview of peripheral nerve, muscle, and central nervous system disorders affecting the foot and leg are discussed.


Assuntos
Doença de Charcot-Marie-Tooth , Doenças do Sistema Nervoso , Tornozelo , Articulação do Tornozelo , Humanos
2.
Clin Podiatr Med Surg ; 39(1): 37-55, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809794

RESUMO

Children with cerebral palsy (CP) are at a high risk of developing foot and ankle deformities that can impact function, brace/shoe fit, and seating. The 3 commonly observed foot and ankle segmental malalignment patterns include equinus, planovalgus, and equinovarus. Assessment of foot deformities is multifaceted, requiring the collection and integration of data from a combination of sources that include the clinical history, standardized physical examination, observational and quantitative gait analysis, GMFCS classification, and radiographic findings. Surgical procedures are determined by identifying all segmental malalignments and assessing the contribution of dynamic or flexible soft-tissue imbalance, fixed soft-tissue imbalance, and skeletal deformities.


Assuntos
Paralisia Cerebral , Pé Torto Equinovaro , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Paralisia Cerebral/complicações , Criança , Marcha , Humanos , Exame Físico
3.
Appl Ergon ; 98: 103593, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34600306

RESUMO

Exoskeletons have the potential to assist users and augment physical ability. To achieve these goals across users, individual variation in muscle activation patterns when using an exoskeleton need to be evaluated. This study examined individual muscle activation patterns during walking with a powered ankle exoskeleton. 60% of the participants were observed to reduce medial gastrocnemius activation with exoskeleton powered and increase with the exoskeleton unpowered during stance. 80% of the participants showed a significant increase in tibialis anterior activation upon power addition, with inconsistent changes upon power removal during swing. 60% of the participants that were able to adapt to the system, did not de-adapt after 5 min. Muscle activity patterns differ between individuals in response to the exoskeleton power state, and affected the antagonist muscle behavior during this early adaptation. It is important to understand these different individual behaviors to inform the design of exoskeleton controllers and training protocols.


Assuntos
Exoesqueleto Energizado , Robótica , Tornozelo , Articulação do Tornozelo , Fenômenos Biomecânicos , Eletromiografia , Marcha , Humanos , Músculo Esquelético , Caminhada
4.
Acta Orthop Traumatol Turc ; 55(5): 435-438, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34730531

RESUMO

OBJECTIVE: The aim of this study was to determine the clinical usefulness of the Ottawa Ankle Rules (OAR) in overweight and obese patients compared to the general population. METHODS: In this prospective cross-sectional study, 935 adult patients (453 female, 482 male; mean age = 57.2 ± 20.9) admitted to the emergency department following an acute ankle injury (<3 days) secondary to low energy-trauma were included. All the patients were examined based on a standardized protocol, including age, Body-Mass Index (BMI), OAR, and presence of ankle fracture. As accuracy indicators, sensitivity, specificity, positive and negative predictive values of OAR were calculated. RESULTS: Of all patients, 790 (84.5%) were normal weighted, 107 (11.5%) were overweight, and 38 (4%) were obese. While OAR was negative in 58.8% of patients, 41.2% of patients met OAR. The sensitivity of OAR in the normal weighted population was significantly higher than obese and overweight groups (P < 0.01). The specificity of OAR in the normal weighted population was significantly lower than overweight and obese groups (P < 0.01). The accuracy of OAR in the overweight group was 82.7% and significantly higher compared with the normal weighted population (62.8%) (P < 0.01). CONCLUSION: We do not recommend OAR as a screening tool to be used safely in patients with higher BMI because of its lower sensitivity in this population. In this specific patient population, these rules should be implemented carefully, and radiography should be evaluated meticulously not to miss a fracture. LEVEL OF EVIDENCE: Level IV, Cross Sectional Study.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Fraturas Ósseas , Adulto , Idoso , Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Estudos Prospectivos , Sensibilidade e Especificidade
5.
Sensors (Basel) ; 21(21)2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34770421

RESUMO

The purpose of this retrospective study was to quantify the three-dimensional knee and ankle joint kinematics and kinetics during walking in young participants with different degrees of obesity and to identify the associated effects by stratifying the obese participants according to their BMI. Thirty-two young obese individuals (mean age 30.32 years) and 16 normal-weight age-matched individuals were tested using 3D gait analysis. Analysis of kinematic and kinetic data revealed significant differences in mechanics at knee and ankle joints in all the evaluated planes of movement. Compared to the healthy-weight participants, obese adults demonstrated less knee flexion, greater knee ab-adduction angle during the entire gait cycle and abnormalities at the knee flex-extension moment. At the ankle joint, reduced range of motion was observed together with a lower peak of ankle plantarflexor moment and power during terminal stance. These results provide insight into a potential pathway by which obesity predisposes a healthy adult for increased risk of osteoarthritis.


Assuntos
Articulação do Tornozelo , Caminhada , Adulto , Tornozelo , Fenômenos Biomecânicos , Marcha , Humanos , Articulação do Joelho , Obesidade , Amplitude de Movimento Articular , Estudos Retrospectivos
6.
Sensors (Basel) ; 21(21)2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34770611

RESUMO

This preliminary investigation studied the effects of concurrent and terminal visual feedback during a standing balance task on ankle co-contraction, which was accomplished via surface electromyography of an agonist-antagonist muscle pair (medial gastrocnemius and tibialis anterior muscles). Two complementary mathematical definitions of co-contraction indices captured changes in ankle muscle recruitment and modulation strategies. Nineteen healthy older adults received both feedback types in a randomized order. Following an analysis of co-contraction index reliability as a function of surface electromyography normalization technique, linear mixed-effects regression analyses revealed participants learned or utilized different ankle co-contraction recruitment (i.e., relative muscle pair activity magnitudes) and modulation (i.e., absolute muscle pair activity magnitudes) strategies depending on feedback type and following the cessation of feedback use. Ankle co-contraction modulation increased when concurrent feedback was used and significantly decreased when concurrent feedback was removed. Ankle co-contraction recruitment and modulation did not significantly change when terminal feedback was used or when it was removed. Neither ankle co-contraction recruitment nor modulation was significantly different when concurrent feedback was used compared to when terminal feedback was used. The changes in ankle co-contraction recruitment and modulation were significantly different when concurrent feedback was removed as compared to when terminal feedback was removed. Finally, this study found a significant interaction between feedback type, removal of feedback, and order of use of feedback type. These results have implications for the design of balance training technologies using visual feedback.


Assuntos
Tornozelo , Retroalimentação Sensorial , Idoso , Envelhecimento , Eletromiografia , Humanos , Contração Muscular , Músculo Esquelético , Equilíbrio Postural , Reprodutibilidade dos Testes
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(11): 1467-1471, 2021 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-34779175

RESUMO

Objective: To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries (SIEA) for repairing the large soft tissue defects on the foot and ankle. Methods: The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females; the age ranged from 25 to 62 years, with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases, cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels, tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement (the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm, with an average of 6.0 cm; the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. Results: One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair; the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. Conclusion: The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adulto , Tornozelo/cirurgia , Artérias Epigástricas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
8.
Medicine (Baltimore) ; 100(41): e27526, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731144

RESUMO

BACKGROUND: The effect of platelet-rich plasma (PRP) on patients with acute Achilles tendon rupture is still controversial. The purpose of this systematic review is to assess the efficacy of PRP injections treating acute Achilles tendon rupture. METHODS: A comprehensive electronic literature search was performed in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant studies that were published prior to April 29, 2021. Randomized controlled trials evaluating the efficacy of PRP injections in treating patients with acute Achilles tendon rupture were included. Statistical analyses were conducted using RevMan software. RESULTS: Five randomized controlled trials were included in this systematic review. The results of the meta-analysis showed that PRP has positive effects on ankle dorsiflexion angle, dorsal extension strength of the ankle, and calf circumference compared with that in controls. However, the current evidence failed to show that PRP effectively improves ankle plantar flexion angle, plantar flexion strength of the ankle, and pain. CONCLUSIONS: PRP injections for the treatment of acute Achilles tendon rupture significantly improved ankle dorsiflexion angle, dorsal extension strength of the ankle, and calf circumference compared with that in controls. Additional studies with larger sample sizes, more rigorous designs and standardized protocols are needed to draw more reliable and accurate conclusions.


Assuntos
Tendão do Calcâneo/patologia , Plasma Rico em Plaquetas/fisiologia , Ruptura/diagnóstico , Ruptura/terapia , Tendão do Calcâneo/lesões , Doença Aguda , Adulto , Tornozelo/fisiologia , Estudos de Casos e Controles , Feminino , Humanos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Plasma Rico em Plaquetas/química , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular/fisiologia , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/patologia , Resultado do Tratamento
9.
Foot Ankle Clin ; 26(4): 941-954, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752245

RESUMO

Complex tarsal coalition includes extensive talocalcaneal coalition, double or triple coalition, coalition with severe hindfoot deformities, or coalition with a ball-and-socket ankle deformity. Careful preoperative physical examination including diagnostic injection is important in treatment planning. Both radiographic examination and computed tomographic scan that involve not only the foot but also the ankle are necessary to analyze the location and size of the coalitions, determining the presence of arthritis in the involved or adjacent joints, and if there are any deformities including a ball-and-socket ankle, which is frequently associated with complex tarsal coalitions.


Assuntos
Ossos do Tarso , Coalizão Tarsal , Tornozelo , Articulação do Tornozelo , Criança , Humanos , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Coalizão Tarsal/diagnóstico por imagem , Coalizão Tarsal/cirurgia , Tomografia Computadorizada por Raios X
10.
Trials ; 22(1): 770, 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736490

RESUMO

BACKGROUND: Insomnia is very common in current society, and patients are often accompanied by a certain degree of anxiety, depression, etc. Recent studies have found that the hypothalamic-pituitary-adrenal (HPA) axis excitement-inhibition state is an important indicator of sleep quality. Wrist-ankle acupuncture (WAA) is safe and effective for insomnia. Based on WAA theory, the acupressure wrist-ankle straps are portable WAA point compression straps that can treat diseases by automatically applying pressure to the treatment location and being operated by patients themselves. We design this trial to evaluate the clinical effect of the acupressure wrist-ankle strap in the treatment of mild insomnia patients with anxiety disorders. METHODS/DESIGN: This trial is a parallel-design, patients-assessor blinded, randomized, sham-controlled. In total, 114 patients diagnosed with mild insomnia and anxiety disorders will be randomly assigned into two groups, the acupressure wrist-ankle strap group or the non-acupressure wrist-ankle strap group; they will receive treatments for eight weeks with five sessions each week. Rating scales, sleep monitors, and laboratory tests will be used to observe the clinical effect. From the perspective of the circadian secretion of peripheral blood-related hormones in the hypothalamic-pituitary-adrenal (HPA) axis, the possible mechanism of acupressure wrist-ankle straps for treating insomnia is studied. DISCUSSION: The results of this study will confirm the efficacy of acupressure wrist-ankle strap in treating mild insomnia patients with anxiety disorder and whether its mechanism is related to the HPA axis. The acupressure wrist-ankle strap may become a pure physical, no side effect treatment of mild insomnia. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000039352 . Registered on 24 October 2020.


Assuntos
Acupressão , Distúrbios do Início e da Manutenção do Sono , Tornozelo , Transtornos de Ansiedade , Humanos , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Ensaios Clínicos Controlados Aleatórios como Assunto , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento , Punho
11.
Acta Chir Orthop Traumatol Cech ; 88(4 Suppl): 42-49, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34593100

RESUMO

This guide to ultrasound imaging of the ankle and foot describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on joint effusion detection, plantar fasciitis, Achilles tendinopathy, and ligamentous injuries around the ankle. Key words: tendons, ankle joint, tendinopathy, Achilles tendon, fasciitis, plantar, anterior talofibular ligament, musculoskeletal, protocol, ultrasound.


Assuntos
Tendão do Calcâneo , Tendinopatia , Tendão do Calcâneo/diagnóstico por imagem , Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Humanos , Ultrassonografia
12.
J Pak Med Assoc ; 71(Suppl 5)(8): S26-S31, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34634011

RESUMO

OBJECTIVE: A retrospective cohort study was performed at a UK major trauma centre to identify whether timing of surgical fixation of closed unstable ankle fracture affected the rate of major wound complications. Methods: Consecutive cases of unstable ankle fractures treated with open reduction internal fixation (ORIF) between March 2014 to December 2016 were included in this retrospective cohort study. Data were collected from 2018 onwards allowing a minimum follow-up of 2 years. Patients under the age of 18, polytrauma, open fractures and those requiring external fixation were excluded. Timing of ORIF were categorised into early (within 24 hours of injury) and delayed (after 24 hours of injury). Primary outcome was major soft tissue complications (defined as deep wound infections or wound breakdown that required further surgery). Secondary outcomes included fixation failure, and symptomatic metal work requiring removal. RESULTS: A total of 235 consecutive cases were included. There were 108(46%) patients in the early fixation group, and 127(54%) patients in the delayed fixation group. Seven major wound complications were identified. Five of which were in the early group, and 2 in the late group. There was no statistically significant difference in the major wound complication rates between the early and delayed surgery groups (p = 1.000). CONCLUSIONS: No significant difference was observed in the rate of major soft tissue complications between early and delayed fixation for isolated unstable ankle fractures.


Assuntos
Fraturas do Tornozelo , Tornozelo , Fraturas do Tornozelo/epidemiologia , Fraturas do Tornozelo/cirurgia , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Centros de Traumatologia , Reino Unido/epidemiologia
13.
Zhonghua Yi Xue Za Zhi ; 101(37): 2934-2939, 2021 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-34638185

RESUMO

Chronic ankle instability is a chronic sports injury disease characterized by recurrent sprains, feeling of instability, pain, swelling and other symptoms after an initial sprain. Research on the pathological mechanism of chronic ankle instability still cannot explain the diversity of symptoms. In the past, the surgical indications for chronic ankle instability only emphasized mechanical joint laxity. However, most patients with chronic symptoms after a lateral ankle sprain may not have a typical complaint of mechanical instability. More patients presented with persistent pain or functional instability as the chief complaint. Surgical treatment also has a certain effect on the symptoms of functional instability, but the surgical indications of functional instability are mainly based on subjective symptoms. At present, there is a lack of objective indicators for surgery, which is still controversial. Further in-depth research on the mechanism of chronic ankle instability is needed to guide the formulation of diagnosis and treatment strategies.


Assuntos
Traumatismos do Tornozelo , Instabilidade Articular , Entorses e Distensões , Tornozelo , Articulação do Tornozelo , Humanos
14.
Zhonghua Yi Xue Za Zhi ; 101(37): 2975-2981, 2021 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-34638187

RESUMO

Objective: To investigate the outcomes and factors influencing postoperative return-to-sport of patients with chronic ankle instability (CAI) underwent all-inside arthroscopic lateral collateral ligament repair. Methods: Patients with CAI treated at Huashan Hospital of Fudan University from January 2017 to August 2019 were retrospectively recruited. Preoperative and postoperative Tegner and Karlsson scores were evaluated and compared, and a multivariate Cox regression model was applied to explore factors influencing postoperative return to desired sports postoperatively. Results: A total of 81 patients with CAI treated by all-inside arthroscopic lateral collateral ligament repair were assessed, including 44 males and 37 females with a mean age of (32.7±9.9) years. Karlsson scores (M(Q1, Q3)) increased from 55.0 (40.0,65.0) preoperatively to 90.0 (85.0,95.0) postoperatively (P<0.01), while Tegner scores increased from 3.0 (1.0,4.0) preoperatively to 5.0 (4.0,6.0) postoperatively (P<0.01). Sixty patients returned to their desired sports with a median return-to-sport time of 9.0 months. Multivariate Cox regression analysis showed that higher age (HR=0.95, 95%CI: 0.92-0.99, P<0.01) and lower preinjury activity levels (HR=1.43, 95%CI: 1.10-1.85, P<0.01) were independent factors affecting postoperative return-to-sport. The one-year postoperative return-to-sport cutoff scores were 37 years old and a Tegner score of 4, respectively. Conclusions: The all-inside arthroscopic lateral collateral ligament repair procedure can achieve good short-term outcomes for patients with CAI, permitting a high incidence of postoperative return-to-sport. Higher age and lower pre-injury activity levels are independent factors hindering postoperative return-to-sport.


Assuntos
Ligamentos Laterais do Tornozelo , Volta ao Esporte , Adulto , Tornozelo , Articulação do Tornozelo/cirurgia , Feminino , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Estudos Retrospectivos , Adulto Jovem
15.
Sensors (Basel) ; 21(19)2021 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-34640750

RESUMO

Brain-computer interface (BCI) remains an emerging tool that seeks to improve the patient interaction with the therapeutic mechanisms and to generate neuroplasticity progressively through neuromotor abilities. Motor imagery (MI) analysis is the most used paradigm based on the motor cortex's electrical activity to detect movement intention. It has been shown that motor imagery mental practice with movement-associated stimuli may offer an effective strategy to facilitate motor recovery in brain injury patients. In this sense, this study aims to present the BCI associated with visual and haptic stimuli to facilitate MI generation and control the T-FLEX ankle exoskeleton. To achieve this, five post-stroke patients (55-63 years) were subjected to three different strategies using T-FLEX: stationary therapy (ST) without motor imagination, motor imagination with visual stimulation (MIV), and motor imagination with visual-haptic inducement (MIVH). The quantitative characterization of both BCI stimuli strategies was made through the motor imagery accuracy rate, the electroencephalographic (EEG) analysis during the MI active periods, the statistical analysis, and a subjective patient's perception. The preliminary results demonstrated the viability of the BCI-controlled ankle exoskeleton system with the beta rebound, in terms of patient's performance during MI active periods and satisfaction outcomes. Accuracy differences employing haptic stimulus were detected with an average of 68% compared with the 50.7% over only visual stimulus. However, the power spectral density (PSD) did not present changes in prominent activation of the MI band but presented significant variations in terms of laterality. In this way, visual and haptic stimuli improved the subject's MI accuracy but did not generate differential brain activity over the affected hemisphere. Hence, long-term sessions with a more extensive sample and a more robust algorithm should be carried out to evaluate the impact of the proposed system on neuronal and motor evolution after stroke.


Assuntos
Interfaces Cérebro-Computador , Exoesqueleto Energizado , Acidente Vascular Cerebral , Tornozelo , Humanos , Sobreviventes
16.
Sensors (Basel) ; 21(19)2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34640952

RESUMO

A position sensing glove called SmartScan, which creates a 3D virtual model of a real object, is presented. The data from the glove is processed by a volume minimization algorithm to validate the position sensor data. This allows only data from the object's surface to be retained. The data validation algorithm allows the user to progressively improve an image by repeatedly moving their hand over the object. In addition, the user can choose their own balance between feature resolution and invalid data rejection. The SmartScan glove is tested on a foot model and is shown to be robust against motion artifacts, having a mean accuracy of 2.9 mm (compared to a 3D model generated from optical imaging) without calibration.


Assuntos
Órtoses do Pé , Algoritmos , Tornozelo , Articulação do Tornozelo , Amplitude de Movimento Articular
18.
J Prim Health Care ; 13(2): 165-170, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34620298

RESUMO

INTRODUCTION Peripheral arterial disease is an increasingly prevalent chronic illness globally. The Ankle Brachial Pressure Index (ABPI) is a well-established, simple, relatively quick and non-invasive assessment useful in diagnosing and quantifying peripheral arterial disease. ABPIs may be currently underutilised in general practice. AIM To explore perspectives of health professionals on the role of the ABPI. METHODS One-to-one interviews were conducted with health professionals using snowball sampling. Questions centred around interviewees' education on, experience with and view on the usefulness of the ABPI in general practice. Interviews were recorded and used for thematic analysis. RESULTS Participants consisted of 13 health-care professionals: nine general practitioners, two vascular surgeons and two allied health professionals. Most general practitioners interviewed identified benefits of ABPIs use in primary care, including aiding peripheral arterial disease diagnostics, management, referral and triage. No general practitioners stated they had ever had formal training in undertaking ABPIs. Two of the nine general practitioners stated regular ABPI use in their practice. Participants who did not use ABPIs identified practical barriers to its use in general practice, including cost of equipment, length of time needed and perceived low patient need to justify cost. All interviewees agreed that there was a role for ABPI use in the community if barriers were overcome. DISCUSSION There was consensus among general practitioners that ABPI use is beneficial. Many general practitioners named similar practical barriers to more common use of ABPIs in general practice. They saw a role for ABPIs in primary care, although it may be more practical as a tool for specialised individual clinicians to use for communities, given practical barriers of cost, time and perceived low patient need. Formal training could be considered, as none of the interviewed general practitioners had ever had any.


Assuntos
Tornozelo , Medicina Geral , Hospitais , Humanos , Percepção , Atenção Primária à Saúde
19.
Indian Heart J ; 73(5): 650-652, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34627587

RESUMO

This study aimed to evaluate the clinical implication of the brachial-ankle pulse wave velocity (baPWV) for endovascular treatment (EVT). Eighty-four patients who underwent EVT for aortoiliac and femoropopliteal artery were included. In these patients, 36 (43 %) had an ABI improvement above 0.9 a day after EVT. The baPWV in patients who received re-EVT afterwards was significantly higher than that of patients who did not. The area under the receiver operating characteristic curve for the baPWV for predicting re-EVT was 0.788. The optimal cut-off values of the baPWV for re-EVT, specificity, and sensitivity were 2220 cm/s, 93.1 %, and 57.1 %, respectively.


Assuntos
Índice Tornozelo-Braço , Análise de Onda de Pulso , Tornozelo , Artéria Braquial , Humanos , Curva ROC
20.
J Neuroeng Rehabil ; 18(1): 152, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663372

RESUMO

BACKGROUND: Autonomous exoskeletons will need to be useful at a variety of walking speeds, but it is unclear how optimal hip-knee-ankle exoskeleton assistance should change with speed. Biological joint moments tend to increase with speed, and in some cases, optimized ankle exoskeleton torques follow a similar trend. Ideal hip-knee-ankle exoskeleton torque may also increase with speed. The purpose of this study was to characterize the relationship between walking speed, optimal hip-knee-ankle exoskeleton assistance, and the benefits to metabolic energy cost. METHODS: We optimized hip-knee-ankle exoskeleton assistance to reduce metabolic cost for three able-bodied participants walking at 1.0 m/s, 1.25 m/s and 1.5 m/s. We measured metabolic cost, muscle activity, exoskeleton assistance and kinematics. We performed Friedman's tests to analyze trends across walking speeds and paired t-tests to determine if changes from the unassisted conditions to the assisted conditions were significant. RESULTS: Exoskeleton assistance reduced the metabolic cost of walking compared to wearing the exoskeleton with no torque applied by 26%, 47% and 50% at 1.0, 1.25 and 1.5 m/s, respectively. For all three participants, optimized exoskeleton ankle torque was the smallest for slow walking, while hip and knee torque changed slightly with speed in ways that varied across participants. Total applied positive power increased with speed for all three participants, largely due to increased joint velocities, which consistently increased with speed. CONCLUSIONS: Exoskeleton assistance is effective at a range of speeds and is most effective at medium and fast walking speeds. Exoskeleton assistance was less effective for slow walking, which may explain the limited success in reducing metabolic cost for patient populations through exoskeleton assistance. Exoskeleton designers may have more success when targeting activities and groups with faster walking speeds. Speed-related changes in optimized exoskeleton assistance varied by participant, indicating either the benefit of participant-specific tuning or that a wide variety of torque profiles are similarly effective.


Assuntos
Exoesqueleto Energizado , Velocidade de Caminhada , Tornozelo , Articulação do Tornozelo , Fenômenos Biomecânicos , Marcha , Humanos , Caminhada
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