Rembrandt's 'Beggar with a wooden leg' and other comparable prints.

PubMed

ten Kate, J J; Jennekens, F G I; Vos-Niël, J M E

2009-02-01

Rembrandt's etching of a beggar with a wooden leg is notable because the two lower limbs of the presumed beggar are present and not deformed. Using the facilities of four specialised Dutch art institutes, we carried out a systematic investigation to find other etchings and engravings of subjects with artificial legs supporting non-amputated limbs, from the period 1500 to 1700 AD. We discovered 28 prints produced by at least 18 artists. Several offered clues to a disorder of a knee, the lower leg or the foot. All individuals were adult males, suggesting the probability of traumatic lesions. We conclude that in this period artificial legs were not only used in the case of absence of part of a lower limb, but also for other reasons, notably disorders of the knee, lower leg or foot. They may also have been used to attract compassion.

The prevalence of symptoms of Post-Traumatic Stress Disorder among soldiers with amputation of a limb or spinal injury: a report from a rehabilitation centre in Sri Lanka.

PubMed

Abeyasinghe, N L; de Zoysa, P; Bandara, K M K C; Bartholameuz, N A; Bandara, J M U J

2012-01-01

Post-Traumatic Stress Disorder has been identified as one of the most commonly occurring mental illnesses in combatants. This study was conducted to determine the prevalence of Post-Traumatic Stress Disorder among soldiers who had undergone amputation of a lower or an upper limb or sustained a spinal cord injury in the battlefield, and to compare the prevalence among these categories. The research presented seeks to increase the awareness of this condition among those treating war casualties so that appropriate treatment choices could be made to address them. The study was carried out in 2009 at a rehabilitation centre for combatants of war. Data were collected from 96 male army veterans between the ages of 18-49 years using a pre-tested self-administered questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, the Impact of Event Scale and the PTSD symptom scale. Soldiers with injuries sustained at least four weeks prior to the study were selected by a convenience sampling technique. Soldiers with multiple injuries, head injuries or those diagnosed with psychiatric disorders were excluded. The results revealed that 41.7% of the study population was compatible with the diagnosis of Post-Traumatic Stress Disorder. Within the three groups, 42.5% of the lower limb amputees, 33.3% of the upper limb amputees and 45.7% of the participants with spinal cord injury had symptoms compatible with Post-Traumatic Stress Disorder. There was no difference between the prevalence among the different injury categories considered. This study highlights the need to pay more attention in providing psychological care as a part of the overall health management of injured combatants. Early preparation of soldiers for stressors of war and screening for and proper management of Post-Traumatic Stress Disorder will improve the overall outcome of rehabilitation.

[The importance of upper limb diseases in occupational medicine].

PubMed

Riva, Matteo Marco; Santini, Marisa; Mosconi, Giovanni

2013-01-01

In this work the authors analyse the results of the clinical evaluation of patients affected by suspected work related musculo-skeletal disorders (WMSDs), observed throughout 2008-2009 in the specific ambulatory of Occupational Medicine Division of Ospedali Riuaniti di Bergamo. The aim is to illustrate the epidemiological relevance of upper limb (UL) WMSDs. We observed 430 patients (mean age 46,9 years, DS 9,3; mean working seniority 29 years, DS 10,4), investigating 600 disorders in diferent musculoskeletal segments. Most of the patients (66%) got to the division for a clinical consultation requested by general practitioners, 29,8% by occupational physicians, 4,2% by national insurance for occupational injuries and diseases (INAIL). Most of the patients (38,4%) were employed in construction industry. Among the 600 disorders investigated, 34,5% was at lumbar spine, 74,5% was at upper limb. The clinical diagnosis was already clear at the first consultation for 81,6% of subjects with low back pain and for 56,5% of patients with upper limb disorders; for the others was necessary to prescribe some instrumental exams or specialistic (neurologic, physiatric, orthopaedic) medical examination. We concluded for a diagnosis of WMSDs in 48,3% of the 600 cases: the percentage is 50,2% if we consider only disorders at lumbar spine and 52,5% among disorders at upper limb. The most frequent reason of refusing occupational aetiology, in the cases of low back pain, was the concomitant presence of other diseases at the segment; on the contrary, for the cases of upper limb disorders, was the lack of correlation between type of disease and professional exposure. All physicians demonstrate a high attention about upper limb disorders, topical subject of great epidemiological interest. General practitioners and occupational physicians have to take more advantage of diagnostic support and clinical evaluations offered by Occupational Medicine Divisions an Universities about WMSDs. In consideration of the dificulties to diagnose upper limb disorders and proving correlation with professional exposure is useful to promote specific courses for general practitioners and occupational physicians.

Work-Related Upper Limb Disorders: A Case Report

PubMed Central

Stoyneva, Zlatka Borisova; Dermendjiev, Svetlan; Dermendjiev, Tihomir; Dobrev, Hristo

2015-01-01

In this study the complex interrelationship between physical factors, job stress, lifestyle and genetic factors on symptoms of work-related musculoskeletal disorders of the upper limbs is demonstrated by a case report and discussion of the literature. A 58 year old woman with long lasting complaints of the upper limbs with increasing intensity and duration, generalisation, combined with skin thickness, Raynaud’s phenomenon, joint disorders, arterial and pulmonary hypertension, metabolic lipid dysfunctions is presented. Occupational history proves continuous duration of service at a job with occupational physical static load with numerous repetitive monotonous systematic motions of fingers and hands as a weaver of Persian rugs followed by work at an automated loom and variable labour activities. Though the complaints dated since the time she was a manual weaver, the manifestations of generalized joint degenerative changes, system sclerosis with Raynaud’s phenomenon with similar upper extremities signs and symptoms discount upper limbs musculoskeletal disorder as caused only or mainly by occupational risk factors. The main principles and criteria for occupational diagnosis of musculoskeletal upper limb disorders and legislative requirements for their reglamentation are discussed. PMID:27275213

Limb Amputations in Fixed Dystonia: A Form of Body Integrity Identity Disorder?

PubMed Central

Edwards, Mark J; Alonso-Canovas, Araceli; Schrag, Arnette; Bloem, Bastiaan R; Thompson, Philip D; Bhatia, Kailash

2011-01-01

Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases, combined with recent data regarding disorders of mental rotation in patients with fixed dystonia, as well as previous data regarding body integrity identity disorder and amputations sought by patients with chronic regional pain syndrome, raise the possibility that patients with fixed dystonia might have a deficit in body schema that predisposes them to developing fixed dystonia and drives some to seek amputation. The outcome of amputation in fixed dystonia is invariably unfavorable. © 2011 Movement Disorder Society PMID:21484872

Limb amputations in fixed dystonia: a form of body integrity identity disorder?

PubMed

Edwards, Mark J; Alonso-Canovas, Araceli; Schrag, Arnette; Bloem, Bastiaan R; Thompson, Philip D; Bhatia, Kailash

2011-07-01

Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases, combined with recent data regarding disorders of mental rotation in patients with fixed dystonia, as well as previous data regarding body integrity identity disorder and amputations sought by patients with chronic regional pain syndrome, raise the possibility that patients with fixed dystonia might have a deficit in body schema that predisposes them to developing fixed dystonia and drives some to seek amputation. The outcome of amputation in fixed dystonia is invariably unfavorable. Copyright © 2011 Movement Disorder Society.

Disappearance of "phantom limb" and amputated arm usage during dreaming in REM sleep behaviour disorder.

PubMed

Vetrugno, Roberto; Arnulf, Isabelle; Montagna, Pasquale

2009-01-01

Limb amputation is followed, in approximately 90% of patients, by "phantom limb" sensations during wakefulness. When amputated patients dream, however, the phantom limb may be present all the time, part of the time, intermittently or not at all. Such dreaming experiences in amputees have usually been obtained only retrospectively in the morning and, moreover, dreaming is normally associated with muscular atonia so the motor counterpart of the phantom limb experience cannot be observed directly. REM sleep behaviour disorder (RBD), in which muscle atonia is absent during REM sleep and patients act out their dreams, allows a more direct analysis of the "phantom limb" phenomena and their modifications during sleep.

Lower Limb Function in Elderly Korean Adults Is Related to Cognitive Function.

PubMed

Kim, A-Sol; Ko, Hae-Jin

2018-05-01

Patients with cognitive impairment have decreased lower limb function. Therefore, we aimed to investigate the relationship between lower limb function and cognitive disorders to determine whether lower limb function can be screened to identify cognitive decline. Using Korean National Health Insurance Service-National Sample Cohort database data, we assessed the cognitive and lower limb functioning of 66-year-olds who underwent national health screening between 2010 and 2014. Cognitive function was assessed via a questionnaire. Timed Up-and-Go (TUG) and one-leg-standing (OLS) tests were performed to evaluate lower limb function. Associations between cognitive and lower limb functions were analyzed, and optimal cut-off points for these tests to screen for cognitive decline, were determined. Cognitive function was significantly correlated with TUG interval ( r = 0.414, p < 0.001) and OLS duration ( r = −0.237, p < 0.001). Optimal cut-off points for screening cognitive disorders were >11 s and ≤12 s for TUG interval and OLS duration, respectively. Among 66-year-olds who underwent national health screening, a significant correlation between lower limb and cognitive function was demonstrated. The TUG and OLS tests are useful screening tools for cognitive disorders in elderly patients. A large-scale prospective cohort study should be conducted to investigate the causal relationship between cognitive and lower limb function.

Hard work never hurt anyone: or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb.

PubMed

Walker-Bone, K; Cooper, C

2005-10-01

Pain in the neck and upper limb is common and contributes considerably to absence from work due to sickness. Evidence suggest that prolonged abnormal posture and repetition contribute to such conditions. Psychosocial risk factors may also play a part in the aetiology of upper limb disorders.

Disorders of Upper Limb Movements in Ataxia-Telangiectasia

PubMed Central

Shaikh, Aasef G.; Zee, David S.; Mandir, Allen S.; Lederman, Howard M.; Crawford, Thomas O.

2013-01-01

Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task), while arms were outstretched (postural task), and at rest. Almost all ataxia-telangiectasia subjects (79/80) had abnormal involuntary movements, such as rhythmic oscillations (tremor), slow drifts (dystonia or athetosis), and isolated rapid movements (dystonic jerks or myoclonus). All patients with involuntary movements had both kinetic and postural tremor, while 48 (61%) also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia. PMID:23826191

Disorders of Upper Limb Movements in Ataxia-Telangiectasia.

PubMed

Shaikh, Aasef G; Zee, David S; Mandir, Allen S; Lederman, Howard M; Crawford, Thomas O

2013-01-01

Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task), while arms were outstretched (postural task), and at rest. Almost all ataxia-telangiectasia subjects (79/80) had abnormal involuntary movements, such as rhythmic oscillations (tremor), slow drifts (dystonia or athetosis), and isolated rapid movements (dystonic jerks or myoclonus). All patients with involuntary movements had both kinetic and postural tremor, while 48 (61%) also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia.

[Repetitive movement of the upper limbs: results of exposure evaluation and clinical investigation during jar packaging of preserved vegetables].

PubMed

Panzone, I; Carra, G; Melosi, A; Rappazzo, G; Innocenti, A

1996-01-01

In order to assess the prevalence of work-related musculo-skeletal disorders of the upper limbs, a total population of 29 female workers in an industrial vegetable preserving plant were examined. The average age of the workers was 41.3 years (SD = 9.2), and their average length of service was 16.7 years (SD = 7.2). Only 20% of the workers were anamnestically negative, whilst 80% had one or more disorders attributable to repetitive trauma of the upper limbs. The disorders showed no prevalence for the right side, a finding in line with the risk analysis which indicated that both limbs were equally used. The results of the risk analysis and clinical assessment confirm that high-frequency actions, combined with improper posture and a shortage of suitable recovery times, play a causal role in determining the onset of the disorders studied.

Reduced benzodiazepine sensitivity in patients with panic disorder: comparison with patients with obsessive-compulsive disorder and normal subjects.

PubMed

Roy-Byrne, P; Wingerson, D K; Radant, A; Greenblatt, D J; Cowley, D S

1996-11-01

The authors sought to replicate their previous finding of reduced response to diazepam in patients with panic disorder, to test whether this effect was specific for panic disorder, and to determine whether this reduced response was merely an artifact of resistance to sedation from anxiety-related overarousal. The effects of four increasing intravenous doses of diazepam on saccadic eye movement velocity and accuracy (the latter being a saccadic variable that is unaffected by sedation), short-term memory, and self- and observer-rated sedation were assessed in 18 patients with panic disorder, 15 patients with obsessive-compulsive disorder, and 14 normal comparison subjects. The ratios of effect to blood level areas under the curve for both ascending and descending limbs of the effect/blood level curves were compared for each variable. Patients with panic disorder showed significantly less diazepam effect on saccadic velocity and accuracy for the ascending limb of the blood level curve than comparison subjects. Patients with obsessive-compulsive disorder showed similar differences from comparison subjects but only for saccadic velocity. There were no group differences in diazepam effects on memory and sedation. Patients with panic disorder are less sensitive than comparison subjects to diazepam. Although this difference is not an artifact of resistance to sedation, it may not be specific for panic disorder but rather may reflect a more nonspecific aspect of anxiety disorders.

Selected sleep disorders: restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy.

PubMed

Erman, Milton K

2006-12-01

Sleep disorders, including restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy, are prevalent medical conditions, likely to be seen by practicing psychiatrists. Awareness of these conditions and their presentations, pathophysiology, and treatment allows psychiatrists to treat these conditions where appropriate, to minimize complications and health consequences associated with delayed diagnosis, and to reduce the burden of disease that these conditions may place on patients already experiencing primary psychiatric disorders.

Diagnostic Value of Isolated Mentalis Versus Mentalis Plus Upper Limb Electromyography in Idiopathic REM Sleep Behavior Disorder Patients Eventually Developing a Neurodegenerative Syndrome.

PubMed

Fernández-Arcos, Ana; Iranzo, Alex; Serradell, Mónica; Gaig, Carles; Guaita, Marc; Salamero, Manel; Santamaria, Joan

2017-04-01

To compare two electromyographic (EMG) montages, isolated mentalis muscle versus mentalis in combination with upper limb muscles in the baseline diagnostic video-polysomnography (V-PSG) of patients with idiopathic REM sleep behaviors disorder (IRBD) who eventually were diagnosed with a clinically defined neurodegenerative syndrome. Forty-nine patients were included. At baseline, diagnosis of RBD was based on a typical history of dream enactment behaviors plus V-PSG showing REM sleep with qualitative increased EMG activity and/or abnormal behaviors. Quantification of EMG activity (tonic, phasic and "any") in the mentalis and upper limb muscles (biceps brachii-BB, n = 36 or flexor digitorum superficialis-FDS, n = 13) was performed manually and compared with published cut-offs. Nine (18.4%) patients had either tonic or phasic EMG below the cut-offs for the isolated mentalis and four of them (11.1 %) also had values below the cut-off for the mentalis combined with BB. All 13 patients recorded with the FDS were above the mentalis combined with FDS cut-off. For the diagnosis of IRBD, sensitivity of isolated mentalis was 81.6% and of the combination of mentalis plus upper limb muscles was 91.8% (p = .03). Audiovisual analysis showed abnormal REM sleep behaviors in all nine patients with values below the cut-offs. Quantification of EMG activity in the upper limbs combined with the mentalis increases the ability to diagnose IRBD when compared with the isolated measurement of the mentalis. Detection of typical abnormal behaviors during REM sleep with audiovisual analysis is essential for the diagnosis of IRBD in patients with EMG values below the published cut-offs. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Proximal weakness of lower limbs as the sole presentation of hyperthyroidism: report of one case.

PubMed

Chen, Chu-Chin; Chiu, Pao-Chin; Shih, Chen-Houng; Hsieh, Kai-Sheng

2005-01-01

Most children with acute or chronic flaccid limb weakness have a disorder of motor unit. However, it is very important to exclude cerebral or other upper motor neuron disorders before we approach such patients as pure muscle disorders. In general, neuropathy results in distal limb weakness, myopathy manifests with proximal weakness. There are exceptions, however. Accurate diagnosis in this wide array of disorders is dependent on a careful clinical assessment followed by the appropriate investigations. Here we report a 14-year-old girl who presented with progressive difficulty in rising up from the floor for one month. Neurological examination revealed an obese, clumsy but clear girl with stable vital signs. The muscle power of neck and upper limbs was normal. There was positive Gower sign, but the toe and heel gaits were acceptable. The initial blood work and motor/sensory nerve conduction velocity were unremarkable. Further study for thyroid function showed a hyperthyroid state. The proximal myopathy recovered soon after medical treatment. There were no other symptoms, and signs indicating hyperthyroidism and proximal myopathy of lower limbs was the isolated clinical feature. Hyperthyroid myopathy is common in hyperthyroidism, but is unusual as the sole presenting symptom.

Stiff person case misdiagnosed as conversion disorder: A case report

PubMed Central

Razmeh, Saeed; Habibi, Amir Hasan; Sina, Farzad; Alizadeh, Elham; Eslami, Monireh

2017-01-01

Background: Stiff person syndrome (SPS) is a rare neurological disease resulting in stiffness and spasm of muscles. It initially affects the axial muscles and then spread to limb muscles. Emotional stress exacerbated the symptoms and signs of the disease. The pathophysiology of the disease is caused by the decreased level of the glutamic acid decarboxylase (GAD) activity due to an autoantibody against GAD that decreases the level of gamma-aminobutyric acid (GABA). In this paper, we present a case of atypical presentation of SPS with lower limb stiffness misdiagnosed as conversion disorder. Case presentation: We report a patient with atypical presentation of SPS with lower limb stiffness and gait disorder misdiagnosed as conversion disorder for a year. Her antithyroid peroxidase antibody (anti-TPO Ab) level was 75 IU (normal value: 0–34 IU). Intravenous immunoglobulin (IVIG) was administered (2gr/kg, 5 days) for the patient that showed significant improvement in the follow-up visit. Conclusion: It is essential that in any patient with bizarre gait disorder and suspicious to conversion disorder due to the reversibility of symptoms, SPS and other movement disorder should be considered. PMID:29201327

Stiff person case misdiagnosed as conversion disorder: A case report.

PubMed

Razmeh, Saeed; Habibi, Amir Hasan; Sina, Farzad; Alizadeh, Elham; Eslami, Monireh

2017-01-01

Stiff person syndrome (SPS) is a rare neurological disease resulting in stiffness and spasm of muscles. It initially affects the axial muscles and then spread to limb muscles. Emotional stress exacerbated the symptoms and signs of the disease. The pathophysiology of the disease is caused by the decreased level of the glutamic acid decarboxylase (GAD) activity due to an autoantibody against GAD that decreases the level of gamma-aminobutyric acid (GABA). In this paper, we present a case of atypical presentation of SPS with lower limb stiffness misdiagnosed as conversion disorder. We report a patient with atypical presentation of SPS with lower limb stiffness and gait disorder misdiagnosed as conversion disorder for a year. Her antithyroid peroxidase antibody (anti-TPO Ab) level was 75 IU (normal value: 0-34 IU). Intravenous immunoglobulin (IVIG) was administered (2gr/kg, 5 days) for the patient that showed significant improvement in the follow-up visit. It is essential that in any patient with bizarre gait disorder and suspicious to conversion disorder due to the reversibility of symptoms, SPS and other movement disorder should be considered.

Assisting people with attention deficit hyperactivity disorder by actively reducing limb hyperactive behavior with a gyration air mouse through a controlled environmental stimulation.

PubMed

Shih, Ching-Hsiang

2011-01-01

The latest researches have adopted software technology turning the gyration air mouse into a high performance limb movement detector, and have assessed whether two persons with multiple disabilities would be able to control an environmental stimulation using limb movement. This study extends gyration air mouse functionality by actively reducing limb hyperactive behavior to assess whether two persons with attention deficit hyperactivity disorder (ADHD) would be able to actively reduce their limb hyperactive behavior by controlling their favorite stimulation on/off using a gyration air mouse with a newly developed actively limb hyperactive behavior reducing program (ALHBRP). The study was performed according to an ABAB design, in which A represented the baseline and B represented intervention phases. Data showed that both participants significantly increased their time duration of maintaining a static limb posture (TDMSLP) to activate the control system in order to produce environmental stimulation during the intervention phases. Practical and developmental implications of the findings are discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Audio-Visual Stimulation in Conjunction with Functional Electrical Stimulation to Address Upper Limb and Lower Limb Movement Disorder.

PubMed

Kumar, Deepesh; Verma, Sunny; Bhattacharya, Sutapa; Lahiri, Uttama

2016-06-13

Neurological disorders often manifest themselves in the form of movement deficit on the part of the patient. Conventional rehabilitation often used to address these deficits, though powerful are often monotonous in nature. Adequate audio-visual stimulation can prove to be motivational. In the research presented here we indicate the applicability of audio-visual stimulation to rehabilitation exercises to address at least some of the movement deficits for upper and lower limbs. Added to the audio-visual stimulation, we also use Functional Electrical Stimulation (FES). In our presented research we also show the applicability of FES in conjunction with audio-visual stimulation delivered through VR-based platform for grasping skills of patients with movement disorder.

Assisting children with Attention Deficit Hyperactivity Disorder actively reduces limb hyperactive behavior with a Nintendo Wii Remote Controller through controlling environmental stimulation.

PubMed

Shih, Ching-Hsiang; Yeh, Jui-Chi; Shih, Ching-Tien; Chang, Man-Ling

2011-01-01

The latest studies have adopted software technology which turns the Wii Remote Controller into a high-performance limb action detector, we assessed whether two persons with multiple disabilities would be able to control an environmental stimulus through limb action. This study extends the functionality of the Wii Remote Controller to the correction of limb hyperactive behavior to assess whether two children with Attention Deficit Hyperactivity Disorder (ADHD) would be able to actively reduce their limb hyperactive behavior through controlling their favorite stimuli by turning them on/off using a Wii Remote Controller. An ABAB design, in which A represented the baseline and B represented intervention phases, was adopted in this study. Result showed that both participants significantly increased their time duration of maintaining a static limb posture (TDMSLP) to activate the control system in order to produce environmental stimulation in the intervention phases. Practical and developmental implications of the findings are discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Wheelchair propulsion kinematics in beginners and expert users: influence of wheelchair settings.

PubMed

Gorce, P; Louis, N

2012-01-01

Biomechanical studies have linked the handrim wheelchair propulsion with a prevalence of upper limb musculoskeletal disorders. The purpose of this study was to examine the influence of the wheelchair settings on upper limb kinematics during wheelchair propulsion. Recordings were made under various wheelchair configuration conditions to understand the effect of wheelchair settings on kinematics parameters such shoulder, elbow and wrist angles. Ten experts and ten beginners' subjects propelled an experimental wheelchair on a roller ergometer system at a comfortable speed. Twelve wheelchair configurations were tested. Kinematics were recorded for each configuration. Based on the hand position relatively to the handrim, the main kinematic parameters of wheelchair propulsion were investigated on the whole propulsion cycle and a key event such as handrim contact and release. Compared to the beginner subjects, all the experts' subjects generally present higher joint amplitude and propulsion speeds. Seat height and antero-posterior axle position influence usage of the hand-rim, timing parameters and configurations of upper limb joints. Results seem to confirm that low and backward seat position allow a greater efficiency. Nevertheless, according that proximity of joint limit is a well known factor of musculoskeletal disorders, our results let us think that too low and backward seat position, increasing joints positions and amplitudes, could increase the risk of upper limb injuries in relation with manual wheelchair propulsion. Kinematic differences highlight that future studies on wheelchair propulsion should only be done with impaired experienced subjects. Furthermore, this study provides indications on how wheelchair settings can be used for upper limb injury prevention. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Upper-limb work-related musculoskeletal disorders (UL-WMSDs) and latency of effect].

PubMed

Nicoletti, S; Battevi, N

2008-01-01

Trends in work-related upper limb musculoskeletal disorders appear to be in constant increase in industrialized countries. In Europe claims and compensation for these disorders have significantly increased. The aim of this study was to investigate the temporal relationship between the beginning of occupational exposure to repetitive movements and exertions of upper limbs, assessed through the OCRA index, and the manifestation of the disorders. Clinical and questionnaire information about 557 cases of UL-WMSDs in the upholstered furniture industry were analyzed in order to investigate the mean latency period of the disorders and to verify to what extent different levels of exposure influence the latency time. The latency of UL-WMSDs is influenced by the level of exposure to risk, measured by means of the OCRA index. Shorter latency times were found for wrist/hand tendonitis, with a mean latency time of 5.4 years and with a greater sensitivity to the level of exposure assessed with the OCRA index value. This might support a sort of predictive value with reference to other UL-WMSDs with longer latency. Probably a latency period of 12 years may be suggested as the cut-off limit to assess a causal relationship between tendon or canalicular WMISDs and occupational exposure to repetitive movements and exertions of upper limbs.

Review of applicability of existing functional status measures to the study of workers with musculoskeletal disorders of the neck and upper limb.

PubMed

Stock, S R; Cole, D C; Tugwell, P; Streiner, D

1996-06-01

Both epidemiologic studies of the factors that contribute to the development of work-related musculoskeletal disorders of the neck and upper limb and intervention studies that test the effectiveness of workplace ergonomic and organizational changes are needed to provide empiric evidence for preventive strategies. This study reviews the relevance and comprehensiveness of existing functional status instruments for epidemiologic studies of work-related neck and upper limb disorders. Twelve domains were identified as the major areas of life affected by workers' neck and upper extremity disorder(s): work, household and family responsibilities, self-care, transportation/driving, sexual activity, sleep, social activities, recreational activities, mood, self-esteem, financial effects, and iatrogenic effects of assessments and treatment. Fifty-two functional status instruments were identified. Of these, 21 met the specified criteria as potentially relevant and were rated on the 3-point scale for relevance and comprehensiveness for each domain. None of the instruments covered all 12 domains adequately.

Increased polyamines as protective disease modifiers in congenital muscular dystrophy.

PubMed

Kemaladewi, D U; Benjamin, J S; Hyatt, E; Ivakine, E A; Cohn, R D

2018-06-01

Most Mendelian disorders, including neuromuscular disorders, display extensive clinical heterogeneity that cannot be solely explained by primary genetic mutations. This phenotypic variability is largely attributed to the presence of disease modifiers, which can exacerbate or lessen the severity and progression of the disease. LAMA2-deficient congenital muscular dystrophy (LAMA2-CMD) is a fatal degenerative muscle disease resulting from mutations in the LAMA2 gene encoding Laminin-α2. Progressive muscle weakness is predominantly observed in the lower limbs in LAMA2-CMD patients, whereas upper limbs muscles are significantly less affected. However, very little is known about the molecular mechanism underlying differential pathophysiology between specific muscle groups. Here, we demonstrate that the triceps muscles of the dy2j/dy2j mouse model of LAMA2-CMD demonstrate very mild myopathic findings compared with the tibialis anterior (TA) muscles that undergo severe atrophy and fibrosis, suggesting a protective mechanism in the upper limbs of these mice. Comparative gene expression analysis reveals that S-Adenosylmethionine decarboxylase (Amd1) and Spermine oxidase (Smox), two components of polyamine pathway metabolism, are downregulated in the TA but not in the triceps of dy2j/dy2j mice. As a consequence, the level of polyamine metabolites is significantly lower in the TA than triceps. Normalization of either Amd1 or Smox expression in dy2j/dy2j TA ameliorates muscle fibrosis, reduces overactive profibrotic TGF-β pathway and leads to improved locomotion. In summary, we demonstrate that a deregulated polyamine metabolism is a characteristic feature of severely affected lower limb muscles in LAMA2-CMD. Targeted modulation of this pathway represents a novel therapeutic avenue for this devastating disease.

[Socioeconomic position and duration of disability benefit due to work-related musculoskeletal disorders].

PubMed

Souza, Norma Suely Souto; Santana, Vilma Sousa

2012-02-01

This study estimated the effect of socioeconomic position on the duration of disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs. A cohort study including 563 insured workers from the city of Salvador, Bahia, Brazil, registered in the General Social Security System and who received temporary disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs, was performed in 2008 using data from the National Social Security Institute. The results show that among union member workers with high psychosocial demands at work, those with low socioeconomic status are almost twice as likely to receive benefit for a shorter period of time compared to those with a higher socioeconomic position (RR = 1.89; 95%CI: 1.25-2.87). These results reveal an inequitable situation or unnecessary use of insurance for workers with a higher socioeconomic position. Future research aimed at elucidating the differences in the use of benefits are needed so that social insurance system managers may take the appropriate steps to resolve this issue.

Clinical and theoretical parallels between desire for limb amputation and gender identity disorder.

PubMed

Lawrence, Anne A

2006-06-01

Desire for amputation of a healthy limb has usually been regarded as a paraphilia (apotemnophilia), but some researchers propose that it may be a disorder of identity, similar to Gender Identity Disorder (GID) or transsexualism. Similarities between the desire for limb amputation and nonhomosexual male-to-female (MtF) transsexualism include profound dissatisfaction with embodiment, related paraphilias from which the conditions plausibly derive (apotemnophilia and autogynephilia), sexual arousal from simulation of the sought-after status (pretending to be an amputee and transvestism), attraction to persons with the same body type one wants to acquire, and an elevated prevalence of other paraphilic interests. K. Freund and R. Blanchard (1993) proposed that nonhomosexual MtF transsexualism represents an erotic target location error, in which men whose preferred erotic targets are women also eroticize their own feminized bodies. Desire for limb amputation may also reflect an erotic target location error, occurring in combination with an unusual erotic target preference for amputees. This model predicts that persons who desire limb amputation would almost always be attracted to amputees and would display an increased prevalence of gender identity problems, both of which have been observed. Persons who desire limb amputation and nonhomosexual MtF transsexuals often assert that their motives for wanting to change their bodies reflect issues of identity rather than sexuality, but because erotic/romantic orientations contribute significantly to identity, such distinctions may not be meaningful. Experience with nonhomosexual MtF transsexualism suggests possible directions for research and treatment for persons who desire limb amputation.

Apotemnophilia or body integrity identity disorder: a case report review.

PubMed

Bou Khalil, Rami; Richa, Sami

2012-12-01

Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. In this report, we review the available case reports in the literature in order to enhance psychiatrists' and physicians' comprehension of this disorder. A search for the case reports available via MEDLINE was done since the first case report published by Money et al in 1977 till May 2011, using the following terms: apotemnophilia, self-demand amputation, body integrity identity disorder, and BIID. In all, 14 case reports were found relevant to our search. The desire to amputate one's healthy limb seems to be related to a major disturbance in the person's perception of one's own identity, where limb amputation can relieve temporarily the patient's feeling of distress without necessarily and uniformly adjusting the patient's own identity misperception. More investigations are needed in this domain in order to develop noninvasive treatment strategies that approach this aspect of the patient's distress within a globalist perspective. In addition, the health professionals' awareness regarding this disorder is required to ensure professional management of patients' suffering.

Further heterogeneity within lethal neonatal short-limbed dwarfism: the platyspondylic types.

PubMed

Horton, W A; Rimoin, D L; Hollister, D W; Lachman, R S

1979-05-01

Twelve infants, initially considered to have thanatophoric dysplasia, were studied by a combined radiographic-histochemical-biochemical approach. Three distinct forms of platyspondylic lethal neonatal short-limbed dwarfism could be distinguished: (1) Thanatophoric type, (2) Torrance type, and (3) San Diego type. The latter two disorders had similar radiographic abnormalities that were clearly different from those of typical thanatophoric dysplasia. All three disorders had clearly different condroosseous histopathologic abnormalities. Preliminary biochemical studies have revealed different electrophorectic abnormalities in solubilized type II collagen chains of cartilage in each of these three disorders.

No Proprioceptive Deficits in Autism despite Movement-Related Sensory and Execution Impairments

ERIC Educational Resources Information Center

Fuentes, Christina T.; Mostofsky, Stewart H.; Bastian, Amy J.

2011-01-01

Autism spectrum disorder (ASD) often involves sensory and motor problems, yet the proprioceptive sense of limb position has not been directly assessed. We used three tasks to assess proprioception in adolescents with ASD who had motor and sensory perceptual abnormalities, and compared them to age- and IQ-matched controls. Results showed no group…

The relationship between buccofacial and limb apraxia.

PubMed

Raade, A S; Rothi, L J; Heilman, K M

1991-07-01

There are at least two possible models depicting the relationship between buccofacial and limb apraxia. First, apraxia can be viewed as a unitary motor disorder which transcends the output modalities of both buccofacial and limb output. A high degree of similarity between the two types of apraxia would support this model. Alternatively, the relationship between buccofacial and limb apraxia may not include a unitary mechanism. The presence of quantitative and qualitative differences between buccofacial and limb performance would support this nonunitary model. The results of the present study support the nonunitary model.

Body integrity identity disorder (BIID)--is the amputation of healthy limbs ethically justified?

PubMed

Müller, Sabine

2009-01-01

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.

Improvements in Limb Kinetic Apraxia by Repetition of a Newly Designed Facilitation Exercise in a Patient with Corticobasal Degeneration

ERIC Educational Resources Information Center

Kawahira, Kazumi; Noma, Tomokazu; Iiyama, Junichi; Etoh, Seiji; Ogata, Atsuko; Shimodozono, Megumi

2009-01-01

Corticobasal degeneration is a progressive neurological disorder characterized by a combination of parkinsonism and cortical dysfunction such as limb kinetic apraxia, alien limb phenomenon, and dementia. To study the effect of repetitive facilitation exercise (RFE) in a patient with corticobasal degeneration, we used a newly designed facilitation…

Mental disorder in limb reconstruction: Prevalence, associations and impact on work disability.

PubMed

Rayner, L; Simpson, A; Matcham, F; Shetty, S; Lahoti, O; Groom, G; Hotopf, M

2016-10-01

This cross-sectional survey aimed to assess the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and drug and alcohol dependence in a limb reconstruction population and examine associations with demographic and functional variables. As part of routine clinical care, data were collected from 566 patients attending a tertiary referral centre for limb reconstruction between April 2012 and February 2016. Depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and drug dependence were measured using standardised self-report screening tools. 173 patients (30.6% CI 26.7-34.4) screened positive for at least one of the mental disorders assessed. 110 (19.4% CI 16.2-22.7) met criteria for probable major depression; 112 (19.9% CI 16.6-23.2) patients met criteria for probable generalised anxiety disorder; and 41 (7.6% CI 5.3-9.8) patients met criteria for probable PTSD. The prevalence of probable alcohol dependence and probable drug dependence was 1.6% (CI 0.6-2.7) and 4.5% (CI 2.7-6.3), respectively. Patients who screened positive for depression, anxiety and PTSD reported significantly higher levels of pain, fatigue, and functional impairment. Depression and anxiety were independently associated with work disability after adjustment for covariates (OR 1.98 (CI 1.08-3.62) and OR 1.83 (CI 1.04-3.23), respectively). The high prevalence and adverse associations of probable mental disorder in limb reconstruction attest to the need for routine psychological assessment and support. Integrated screening and management of mental disorder in this population may have a positive impact on patients' emotional, physical and occupational rehabilitation. A randomised controlled trial is needed to test this hypothesis. Copyright © 2016 Elsevier Inc. All rights reserved.

Associations of sleep disturbance with ADHD: implications for treatment.

PubMed

Hvolby, Allan

2015-03-01

Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also 'paradoxically' calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.

A tailored workplace exercise program for women at risk for neck and upper limb musculoskeletal disorders: a randomized controlled trial.

PubMed

Rasotto, Chiara; Bergamin, Marco; Sieverdes, John C; Gobbo, Stefano; Alberton, Cristine L; Neunhaeuserer, Daniel; Maso, Stefano; Zaccaria, Marco; Ermolao, Andrea

2015-02-01

The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain. Sixty female subjects were randomly assigned to an intervention group or a control group. The IG was administered of a 6-month, twice-a-week, tailored exercise program, whereas the CG received no intervention. The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures. In addition, reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength. This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders, showing clinically meaningful reductions of pain symptoms and disability on upper limb and neck regions.

Effects of Partial Vibration on Morphological Changes in Bone and Surrounding Muscle of Rats Under Microgravity Condition: Comparative Study by Gender

NASA Astrophysics Data System (ADS)

Park, Ji Hyung; Seo, Dong-Hyun; Cho, Seungkwan; Kim, Seo-Hyun; Eom, Sinae; Kim, Han Sung

2015-09-01

Musculoskeletal disorders during and after spaceflight are considered as a serious health issue. In space, weight-bearing exercise recognized as the main countermeasure to bone loss, since many anti-resorptive medications have not yet been approved for spaceflight or have been unsuccessful in their limited application. We need to investigate a complementary or alternative way to prevent bone loss and muscle atrophy resulting from microgravity condition. Partial vibration was chosen because it is one of the most feasible ways to adopt safely and effectively. Moreover, although the influence of hind-limb suspension has been studied in both male and female rodents, only rarely are both genders evaluated in the same study. Thus, to further extend our knowledge, the present study performed comparative analysis between genders. A total of 36 12-week-old male and female Sprague-Dawley rats were used and were randomly assigned to control (CON), hind-limb suspension without vibration stimulus (HS), and hind-limb suspension with vibration stimulus (HV) groups. Hind-limb suspension has led to increasing the rate of bone loss and muscle atrophy regardless of gender. The rates of bone loss in male group obviously increased than that of female group. All structural parameters were showed significant difference between HS and HV ( p < 0.05) in male group whereas there are no significant differences in female group. In female, the muscle volume with treatment of partial vibration stimulus significantly increased which compared with that of hind-limb suspension ( p < 0.05) whereas there are no significant differences in male group. Thus partial vibration could prevent bone loss of tibia in males and muscle atrophy in females induced by hind-limb suspension. In other words, partial vibration has positive effects on damaged musculoskeletal tissues that differ based on gender.

Assisting People with Attention Deficit Hyperactivity Disorder by Actively Reducing Limb Hyperactive Behavior with a Gyration Air Mouse through a Controlled Environmental Stimulation

ERIC Educational Resources Information Center

Shih, Ching-Hsiang

2011-01-01

The latest researches have adopted software technology turning the gyration air mouse into a high performance limb movement detector, and have assessed whether two persons with multiple disabilities would be able to control an environmental stimulation using limb movement. This study extends gyration air mouse functionality by actively reducing…

Assisting Children with Attention Deficit Hyperactivity Disorder Actively Reduces Limb Hyperactive Behavior with a Nintendo Wii Remote Controller through Controlling Environmental Stimulation

ERIC Educational Resources Information Center

Shih, Ching-Hsiang; Yeh, Jui-Chi; Shih, Ching-Tien; Chang, Man-Ling

2011-01-01

The latest studies have adopted software technology which turns the Wii Remote Controller into a high-performance limb action detector, we assessed whether two persons with multiple disabilities would be able to control an environmental stimulus through limb action. This study extends the functionality of the Wii Remote Controller to the…

Characteristics of antigravity spontaneous movements in preterm infants up to 3 months of corrected age.

PubMed

Miyagishima, Saori; Asaka, Tadayoshi; Kamatsuka, Kaori; Kozuka, Naoki; Kobayashi, Masaki; Igarashi, Risa; Hori, Tsukasa; Yoto, Yuko; Tsutsumi, Hiroyuki

2016-08-01

We investigated whether spontaneous antigravity limbs movements in very low birth weight preterm infants were insufficient compared to those in term infants. The relationship between the quality of general movements (GMs) and antigravity limbs movements was also examined. Preterm infants with very low birth weight without central nervous system disorders nor severe respiration disorders, and healthy term infants were recruited. The infants were set in a supine position. The distance between both hands and between both feet, and the height of both hands and feet from the floor were recorded at 1-3 corrected months for preterm infants, and at 1-3 months for term infants by a 3D motion capture system. The measurements were adjusted for body proportions. GMs in preterm and term infants were assessed similarly. Thirteen preterm and 15 term infants completed the study. In preterm infants, the distance between both hands and between both feet were longer, and the height of both hands and feet were lower than those in term infants in all measurements. In term infants, the height of both hands and feet increased as they developed, but no change was observed in preterm infants. In preterm infants with abnormal GMs, the distance between both hands was longer, and the height of both hands and feet was lower than that in those with normal GMs. There were no such differences between preterm infants with normal GMs and term infants with normal GMs. Antigravity limbs movements in preterm infants within the first 3 month of corrected age were insufficient compared with those in term infants. Furthermore, no improvement with development was observed in preterm infants. In addition, preterm infants with abnormal GMs showed worse antigravity limbs movements than preterm and term infants with normal GMs. The preterm infants with normal GMs could behave similar to the full term infants. Copyright © 2016 Elsevier Inc. All rights reserved.

Amputees by choice: body integrity identity disorder and the ethics of amputation.

PubMed

Bayne, Tim; Levy, Neil

2005-01-01

Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.

Use of microcirculatory parameters to evaluate clinical treatments of chronic venous disorder (CVD).

PubMed

Lascasas-Porto, Carmen Lucia; Milhomens, Ana Letícia M; Virgini-Magalhães, Carlos Eduardo; Fernandes, Fabiano F A; Sicuro, Fernando L; Bouskela, Eliete

2008-05-01

To evaluate changes on cutaneous microangiopathy in chronic venous disorder (CVD) after use of Cirkan [venotonic drug containing Ruscus aculeatus (plant extract), hesperidine methylchalcone (flavonoid) and vitamin C], elastic compression stockings (ECS) or no treatment for four weeks. Fifty-five female patients (85 legs), 25 to 57 years, with at least one limb classified as C2,s or C2,3,s (CEAP classification), were allocated consecutively, according to entrance order, in these three groups. Ten healthy women age-matched were also investigated. Using orthogonal polarization spectral technique (noninvasive method), measurements of functional capillary density (FCD, number of capillaries with flowing red blood cells/mm(2)), capillary morphology (CM, % of abnormal capillaries/mm(2)) and diameters (mum) of dermal papilla (DDP), capillary bulk (DCB) and capillary limb (CD) were obtained on the medial perimalleolar region and later analyzed using CapImage software. CVD patients showed significant changes on CD and CM compared to healthy subjects in agreement with our previous findings (J Vasc Surg 43:1037-1044, 2006). On Cirkan-treated patients, after 4 weeks, CD decreased on both limbs and CM improved on the left one, suggesting an amelioration of the chronic venous hypertension. No significant changes could be detected on other patient groups. These results confirm the existence of microcirculatory dysfunction in early stages of CVD, probably due to post-capillary hypertension, and further support the venotonic action of Cirkan.

The effects of soy isoflavone on bone density in north region of climacteric Chinese women

PubMed Central

Chi, Xiao-Xing; Zhang, Tao

2013-01-01

Only a few investigations were based on limb bone density. This study evaluated the efficacy of soy isoflavone in the treatment of the principal menopausal disorders, limb bone density and the role of pathway. The research protocol involved the random subdivision of the enrolled sample into two groups of 40 women, who were to receive treatment for 6 months with isoflavone (90 mg/day) and with placebo. All of the patients were asked to fill in a questionnaire concerning their complaints. BMD of the radius and tibia were measured using quantitative ultrasound. Bone metabolism indexes calcium, phosphorus and alkaline phosphatase (ALP) were examined regularly. Serum cytokines interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) examined by ELISA. The results of the score of Kupperman table showed that the isoflavone can lead to a significant reduction in some of the disorders. Compared with placebo, the tibia bone density in isoflavone group increased obviously against the base value before trail. Isoflavone led to a stronger descent of the concentration of ALP and a decrease of IL-6 and TNF-α level than placebo. For climacteric women, soy isoflavone in the dose of 90 mg/day could improve some menopausal syndromes and was effective on increasing limb bone density, which maybe had the relationship with the levels of IL-6, TNF-α and ALP in serum. PMID:24062607

Higher limb asymmetry in deceased human fetuses and infants with aneuploidy

PubMed Central

Bots, Jessica; ten Broek, Clara M. A.; Belien, Jeroen A. M.; Bugiani, Marianna; Galis, Frietson; Van Dongen, Stefan

2014-01-01

Aneuploidies cause gene-dosage imbalances that presumably result in a generalized decreased developmental homeostasis, which is expected to be detectable through an increase in fluctuating asymmetry (FA) of bilateral symmetric traits. However, support for the link between aneuploidy and FA is currently limited and no comparisons among different aneuploidies have been made. Here, we study FA in deceased human fetuses and infants from a 20-year hospital collection. Mean FA of limb bones was compared among groups of aneuploidies with different prenatal and postnatal survival chances and two reference groups (normal karyogram or no congenital anomalies). Limb asymmetry was 1.5 times higher for aneuploid cases with generally very short life expectancies (trisomy 13, trisomy 18, monosomy X, triploidy) than for trisomy 21 patients and both reference groups with higher life expectancies. Thus, FA levels are highest in groups for which developmental disturbances have been highest. Our results show a significant relationship between fluctuating asymmetry, human genetic disorders and severity of the associated abnormalities. PMID:24424506

Enhancer elements upstream of the SHOX gene are active in the developing limb.

PubMed

Durand, Claudia; Bangs, Fiona; Signolet, Jason; Decker, Eva; Tickle, Cheryll; Rappold, Gudrun

2010-05-01

Léri-Weill Dyschondrosteosis (LWD) is a dominant skeletal disorder characterized by short stature and distinct bone anomalies. SHOX gene mutations and deletions of regulatory elements downstream of SHOX resulting in haploinsufficiency have been found in patients with LWD. SHOX encodes a homeodomain transcription factor and is known to be expressed in the developing limb. We have now analyzed the regulatory significance of the region upstream of the SHOX gene. By comparative genomic analyses, we identified several conserved non-coding elements, which subsequently were tested in an in ovo enhancer assay in both chicken limb bud and cornea, where SHOX is also expressed. In this assay, we found three enhancers to be active in the developing chicken limb, but none were functional in the developing cornea. A screening of 60 LWD patients with an intact SHOX coding and downstream region did not yield any deletion of the upstream enhancer region. Thus, we speculate that SHOX upstream deletions occur at a lower frequency because of the structural organization of this genomic region and/or that SHOX upstream deletions may cause a phenotype that differs from the one observed in LWD.

Enhancer elements upstream of the SHOX gene are active in the developing limb

PubMed Central

Durand, Claudia; Bangs, Fiona; Signolet, Jason; Decker, Eva; Tickle, Cheryll; Rappold, Gudrun

2010-01-01

Léri-Weill Dyschondrosteosis (LWD) is a dominant skeletal disorder characterized by short stature and distinct bone anomalies. SHOX gene mutations and deletions of regulatory elements downstream of SHOX resulting in haploinsufficiency have been found in patients with LWD. SHOX encodes a homeodomain transcription factor and is known to be expressed in the developing limb. We have now analyzed the regulatory significance of the region upstream of the SHOX gene. By comparative genomic analyses, we identified several conserved non-coding elements, which subsequently were tested in an in ovo enhancer assay in both chicken limb bud and cornea, where SHOX is also expressed. In this assay, we found three enhancers to be active in the developing chicken limb, but none were functional in the developing cornea. A screening of 60 LWD patients with an intact SHOX coding and downstream region did not yield any deletion of the upstream enhancer region. Thus, we speculate that SHOX upstream deletions occur at a lower frequency because of the structural organization of this genomic region and/or that SHOX upstream deletions may cause a phenotype that differs from the one observed in LWD. PMID:19997128

Chronic hypobaric hypoxia increases isolated rat fast-twitch and slow-twitch limb muscle force and fatigue.

PubMed

El-Khoury, R; Bradford, A; O'Halloran, K D

2012-01-01

Chronic hypoxia alters respiratory muscle force and fatigue, effects that could be attributed to hypoxia and/or increased activation due to hyperventilation. We hypothesized that chronic hypoxia is associated with phenotypic change in non-respiratory muscles and therefore we tested the hypothesis that chronic hypobaric hypoxia increases limb muscle force and fatigue. Adult male Wistar rats were exposed to normoxia or hypobaric hypoxia (PB=450 mm Hg) for 6 weeks. At the end of the treatment period, soleus (SOL) and extensor digitorum longus (EDL) muscles were removed under pentobarbitone anaesthesia and strips were mounted for isometric force determination in Krebs solution in standard water-jacketed organ baths at 25 °C. Isometric twitch and tetanic force, contractile kinetics, force-frequency relationship and fatigue characteristics were determined in response to electrical field stimulation. Chronic hypoxia increased specific force in SOL and EDL compared to age-matched normoxic controls. Furthermore, chronic hypoxia decreased endurance in both limb muscles. We conclude that hypoxia elicits functional plasticity in limb muscles perhaps due to oxidative stress. Our results may have implications for respiratory disorders that are characterized by prolonged hypoxia such as chronic obstructive pulmonary disease (COPD).

Periodic Limb Movements During Sleep Mimicking REM Sleep Behavior Disorder: A New Form of Periodic Limb Movement Disorder.

PubMed

Gaig, Carles; Iranzo, Alex; Pujol, Montserrat; Perez, Hernando; Santamaria, Joan

2017-03-01

To describe a group of patients referred because of abnormal sleep behaviors that were suggestive of rapid eye movement (REM) sleep behavior disorder (RBD) in whom video-polysomnography ruled out RBD and showed the reported behaviors associated with vigorous periodic limb movements during sleep (PLMS). Clinical history and video-polysomnography review of patients identified during routine visits in a sleep center. Patients were 15 men and 2 women with a median age of 66 (range: 48-77) years. Reported sleep behaviors were kicking (n = 17), punching (n = 16), gesticulating (n = 8), falling out of bed (n = 5), assaulting the bed partner (n = 2), talking (n = 15), and shouting (n = 10). Behaviors resulted in injuries in 3 bed partners and 1 patient. Twelve (70.6%) patients were not aware of displaying abnormal sleep behaviors that were only noticed by their bed partners. Ten (58.8%) patients recalled unpleasant dreams such as being attacked or chased. Video-polysomnography showed (1) frequent and vigorous stereotyped PLMS involving the lower limbs, upper limbs, and trunk (median PLMS index 61.2; median PLMS index in NREM sleep 61.9; during REM sleep only 8 patients had PLMS and their median PLMS index in REM sleep was 39.5); (2) abnormal behaviors (e.g., punching, groaning) during some of the arousals that immediately followed PLMS in NREM sleep; and (3) ruled out RBD and other sleep disorders such as obstructive sleep apnea. Dopaminergic agents were prescribed in 14 out of the 17 patients and resulted in improvement of abnormal sleep behaviors and unpleasant dreams in all of them. After dopaminergic treatment, follow-up video-polysomnography in 7 patients showed a decrease in the median PLMS index from baseline (108.9 vs. 19.2, p = .002) and absence of abnormal behaviors during the arousals. Abnormal sleep behaviors and unpleasant dreams simulating RBD symptomatology may occur in patients with severe PLMS. In these cases, video-polysomnography ruled out RBD and identified prominent PLMS followed by arousals containing abnormal behaviors. Our cases represent an objectively documented subtype of periodic limb movement disorder causing abnormal sleep behaviors. © Sleep Research Society 2016. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012.

PubMed

Stocks, S Jill; McNamee, Roseanne; van der Molen, Henk F; Paris, Christophe; Urban, Pavel; Campo, Giuseppe; Sauni, Riitta; Martínez Jarreta, Begoña; Valenty, Madeleine; Godderis, Lode; Miedinger, David; Jacquetin, Pascal; Gravseth, Hans M; Bonneterre, Vincent; Telle-Lamberton, Maylis; Bensefa-Colas, Lynda; Faye, Serge; Mylle, Godewina; Wannag, Axel; Samant, Yogindra; Pal, Teake; Scholz-Odermatt, Stefan; Papale, Adriano; Schouteden, Martijn; Colosio, Claudio; Mattioli, Stefano; Agius, Raymond

2015-04-01

The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Upper limb work-related musculoskeletal disorders (UL-WMSDs) in a large factory of the upholstered furniture industry: risk management].

PubMed

Nicoletti, S; Castoro, V; Iacobellis, M; Loizzo, N; Monopoli, L

2008-01-01

The industrial production of upholstered furniture exposes workers to significant risk of occupational disorders due to ergonomics-related problems, such as repetitive strain and movements of the upper limb, manual load lifting, prolonged static postures. This paper describes the main measures taken by the biggest company in the "sofa sector" in southern Italy in order to solve such problems in the years 1996-2004. the classic instruments of ergonomics were used such as risk assessment, medical surveillance, training and information programmes, technological reorganization of the manufacturing process and of single working tasks. The accident rate (number of accidents per million working hours) which showed an increasing trend in the previous years, rose from a value of 31 in 1996 to 51 in the years 1999-2000 (with a percentage of accidents related to load lifting in the range 25-35%). At the same time the incidence rate of work-related upper limb musculoskeletal disorders (UL-WMSDs) in the population of workers (which had increased in the meantime from 2500 to 3500 employees) reached nearly 5% in 2001, with peaks of 8-9% in the work tasks with higher exposure. Accident rates progressively fell in the following three years until a value of 20 was reached in 2004 and 2005, while the mean incidence rate of WMSDs reached a value of nearly 1%. The data need to be compared with the trends in the other companies of the sector in the same period, with an average incidence rate of WMSDs around 2% and a generally increasing trend. Ergonomic interventions not only concur in the management and control of negative events for workers health but also in achieving advantages in terms of lower costs and greater productivity.

Motor skills in Czech children with attention-deficit/hyperactivity disorder and their neurotypical counterparts.

PubMed

Scharoun, S M; Bryden, P J; Otipkova, Z; Musalek, M; Lejcarova, A

2013-11-01

Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed neurobehavioural disorder. Characterized by recurring problems with impulsiveness and inattention in combination with hyperactivity, motor impairments have also been well documented in the literature. The aim of this study was to compare the fine and gross motor skills of male and female children with ADHD and their neurotypical counterparts within seven skill assessments. This included three fine motor tasks: (1) spiral tracing, (2) dot filling, (3) tweezers and beads; and four gross motor tasks: (1) twistbox, (2) foot tapping, (3) small plate finger tapping, and (4) large plate finger tapping. It was hypothesized that children with ADHD would display poorer motor skills in comparison to neurotypical controls in both fine and gross motor assessments. However, statistically significant differences between the groups only emerged in four of the seven tasks (spiral tracing, dot filling, tweezers and beads and foot tapping). In line with previous findings, the complexity underlying upper limb tasks solidified the divide in performance between children with ADHD and their neurotypical counterparts. In light of similar research, impairments in lower limb motor skill were also observed. Future research is required to further delineate trends in motor difficulties in ADHD, while further investigating the underlying mechanisms of impairment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Work-related posttraumatic upper limb disorder. A case report.

PubMed

Capodaglio, P; Nigrelli, M P; Malaguti, S; Panigazzi, M; Pierobon, A

1999-01-01

In this paper we describe a patient with mor-sensory loss in the right forearm and hand, which persisted more than 2 years after work-related crush trauma of the left hand. Radiographic and electromyographic investigations, somatosensory evoked potentials, CT scans of the encephalus as well as the Minnesota Multiphasic Personality Inventory and the Roarschach test have been performed. On the basis of these investigations, we think this represents a case of conversion disorder with somatic features. Included is a brief overview of other psychological illness with physical findings involving the upper limb.

Research Priorities in Limb and Task-Specific Dystonias.

PubMed

Pirio Richardson, Sarah; Altenmüller, Eckart; Alter, Katharine; Alterman, Ron L; Chen, Robert; Frucht, Steven; Furuya, Shinichi; Jankovic, Joseph; Jinnah, H A; Kimberley, Teresa J; Lungu, Codrin; Perlmutter, Joel S; Prudente, Cecília N; Hallett, Mark

2017-01-01

Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer's cramp, runner's dystonia, or musician's dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants.

Research Priorities in Limb and Task-Specific Dystonias

PubMed Central

Pirio Richardson, Sarah; Altenmüller, Eckart; Alter, Katharine; Alterman, Ron L.; Chen, Robert; Frucht, Steven; Furuya, Shinichi; Jankovic, Joseph; Jinnah, H. A.; Kimberley, Teresa J.; Lungu, Codrin; Perlmutter, Joel S.; Prudente, Cecília N.; Hallett, Mark

2017-01-01

Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants. PMID:28515706

Young People's Computer Use: Implications for Health Education

ERIC Educational Resources Information Center

Alexander, Leslie M.; Currie, Candace

2004-01-01

Increasing numbers of young people use Information and Communication Technology (ICT) for education, work and leisure activities. Research on ICT and Upper Limb Disorders (ULDs) in adults has shown that functional impairment, pain and discomfort in the upper limbs, neck and shoulder increases with frequency and duration of exposure to computer…

Response to narrow-band UVB--vitiligo-melasma versus vitiligo: a comparative study.

PubMed

Sharma, Parikshit; Pai, Harsha S; Pai, Ganesh S; Kuruvila, Maria; Kolar, Reshma

2011-04-01

Vitiligo is the most common depigmentary disorder of the skin and hair, resulting from selective destruction of melanocytes. Melasma, a hyperpigmentary disorder, presents as irregular, brown, macular hypermelanosis. A small subset of vitiligo patients paradoxically also have melasma. To evaluate and compare the response to narrow-band UVB in a group of patients with vitiligo, and another group of patients with vitiligo and coexisting melasma (vitiligo-melasma). Patients in both groups were treated with narrow-band UVB and a comparison of the zonal repigmentation was made at 4, 8, and 12 weeks after the initiation of therapy. At the end of 12 weeks, 86% of patients in the vitiligo-melasma group attained ≥75% pigmentation on the face, whereas this was achieved in only 12.5% of patients in the vitiligo group. Over the limbs, 73% of patients in the vitiligo-melasma group attained 75% or more pigmentation at the end of 12 weeks compared with only 9% in the vitiligo group. On the trunk, only 20% of vitiligo-melasma patients showed ≥75% pigmentation at 12 weeks compared with 63% of patients in the vitiligo group. Patients having both vitiligo and melasma have a significantly better prognosis for repigmentation on the face and limbs with narrow-band UVB compared with patients with vitiligo alone; the vitiligo-melasma patients achieve repigmentation much earlier and also attain a greater level of repigmentation. Unexpectedly, for truncal lesions, patients with vitiligo alone responded better than those with both conditions. Although the vitiligo-melasma group with truncal lesions started repigmenting earlier, the final pigmentation was more extensive in the vitiligo group.

Parkinsonian syndromes presenting with circadian rhythm sleep disorder- advanced sleep-phase type.

PubMed

Shukla, Garima; Kaul, Bhavna; Gupta, Anupama; Goyal, Vinay; Behari, Madhuri

2015-01-01

Circadian rhythm sleep disorder-advanced sleep-phase type is a relatively uncommon disorder, mostly seen among the elderly population. Impaired circadian rhythms have been reported in neurodegenerative conditions; however, there are no reports of any circadian rhythm sleep disorder among patients with Parkinsonian syndromes. We report two patients who presented with this circadian rhythm disorder, and were then diagnosed with a Parkinsonian syndrome. The cases. A 65-year-old retired man presented with history of abrupt change in sleep schedules, sleeping around 6.30-7 p.m. and waking up around 3-4 a.m. for the last 2 months. On detailed examination, the patient was observed to have symmetrical bradykinesia and cogwheel rigidity of limbs. A diagnosis of multiple system atrophy was made, supported by MRI findings and evidence of autonomic dysfunction. Symptoms of change in sleep-wake cycles resolved over the next 1 year, while the patient was treated with dopaminergic therapy. A 47-year-old man, who was being evaluated for presurgical investigation for refractory temporal lobe epilepsy, presented with complaints suggestive of dysarthria, bradykinesia of limbs and frequent falls for 5 months. Simultaneously, he began to sleep around 7 p.m. and wake up at about 2-3 a.m. Examination revealed severe axial rigidity, restricted vertical gaze and bradykinesia of limbs. A diagnosis of progressive supranuclear palsy was made. This is the first report of Parkinson's plus syndromes presenting with a circadian rhythm sleep disorder-advanced sleep-phase type. More prospective assessment for circadian sleep disorders may introduce useful insights into similar associations. Copyright 2015, NMJI.

Hang Them High: A Hands-Free Technique for Upper Extremity Limb Holding During Surgical Preparation.

PubMed

Aneja, Arun; Leung, Patrick; Marquez-Lara, Alejandro

Lifting and holding upper and lower limbs during the "prep and drape" portion of certain orthopaedic procedures exert strong forces on the holder and may lead to musculoskeletal disorders. To address these challenges during upper extremity procedures, this article describes a hand-free elevation and traction technique of the upper limbs during preoperative skin preparation with the use of items readily available within the operating room (OR). This technique is particularly useful for heavy or fractured limbs that may impose a physical challenge to lift and maintain in a stable position. Implementation of this technique reduces the risk to nurses, OR personnel, and caregivers of developing work-related musculoskeletal injuries while lifting and holding limbs in the orthopaedic OR.

[Aging at work and musculoskeletal disorders].

PubMed

Occhipinti, E; Colombini, D

2000-01-01

By means of a critical review of the international literature and of their own published experiences, the Authors discuss the influence of the "age" factor on work related musculoskeletal disorders of the spine and upper limbs. Regarding the spine, the lumbosacral spine in particular, there is evidence (both in relation to pathways and from epidemiological data) of the influence of age in determining a progressive increase in the occurrence of spondyloarthropathy with clear radiological signs. For upper limb disorders the influence of the "age" factor is still under debate and in any case does not seem of great importance. As far prevention is concerned for elderly workers subject to fixed postures and repetitive movements of the upper limbs it seems sufficient, to adopt the general measures used for the whole working population. However, specific measures should be adopted for elderly workers exposed to manual material handling (MMH). These consist in using reference values for the recommended weight that are lower than those adopted for younger workers (aged 18-45 years) and in implementing specific programs of active health surveillance.

Playing-related disabling musculoskeletal disorders in young and adult classical piano students.

PubMed

Bruno, S; Lorusso, A; L'Abbate, N

2008-07-01

To determine the prevalence of instrument-related musculoskeletal problems in classical piano students and investigate piano-specific risk factors. A specially developed four parts questionnaire was administered to classical piano students of two Apulian conservatories, in southern Italy. A cross-sectional design was used. Prevalences of playing related musculoskeletal disorders (MSDs) were calculated and cases were compared with non-cases. A total of 195 out of the 224 piano students responded (87%). Among 195 responders, 75 (38.4%) were considered affected according to the pre-established criteria. Disabling MSDs showed similar prevalence rates for neck (29.3%), thoracic spine (21.3%) and upper limbs (from 20.0 to 30.4%) in the affected group. Univariate analyses showed statistical differences concerning mean age, number of hours per week spent playing, more than 60 min of continuative playing without breaks, lack of sport practice and acceptability of "No pain, no gain" criterion in students with music-related pain compared with pianists not affected. Statistical correlation was found only between upper limbs diseases in pianists and hand sizes. No correlation with the model of piano played was found in the affected group. The multivariate analyses performed by logistic regression confirmed the independent correlation of the risk factors age, lack of sport practice and acceptability of "No pain, no gain" criterion. Our study showed MSDs to be a common problem among classical piano students. With variance in several studies reported, older students appeared to be more frequently affected by disabling MSDs and no difference in the prevalence rate of the disorders was found in females.

The Comparisons of Cerebral Hemodynamics Induced by Obstructive Sleep Apnea with Arousal and Periodic Limb Movement with Arousal: A Pilot NIRS Study

PubMed Central

Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Qi, Ming; Khatami, Ramin

2016-01-01

Obstructive sleep apnea syndrome (OSA) and restless legs syndrome (RLS) with periodic limb movement during sleep (PLMS) are two sleep disorders characterized by repetitive respiratory or movement events associated with cortical arousals. We compared the cerebral hemodynamic changes linked to periodic apneas/hypopneas with arousals (AHA) in four OSA-patients with periodic limb movements (PLMA) with arousals in four patients with RLS-PLMS using near-infrared spectroscopy (NIRS). AHA induced homogenous pattern of periodic fluctuations in oxygenated (HbO2) and deoxygenated (HHb) hemoglobin, i.e., the decrease of HbO2 was accompanied by an increase of HHb during the respiratory event and resolved to reverse pattern when cortical arousal started. Blood volume (BV) showed the same pattern as HHb but with relative smaller amplitude in most of the AHA events.These changing patterns were significant as Wilcoxon signed-rank tests gave p < 0.001 when comparing the area under the curve of these hemodynamic parameters to zero. By contrast, in PLMA limb movements induced periodic increments in HbO2 and BV (Wilcoxon signed-rank tests, p < 0.001), but HHb changed more heterogeneously even during the events coming from the same patient. Heart rate (HR) also showed different patterns between AHA and PLMA. It significantly decreased during the respiratory event (Wilcoxon signed-rank test, p < 0.001) and then increased after the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001); while in PLMA HR first increased preceding the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001) and then decreased. The results of this preliminary study show that both AHA and PLMA induce changes in cerebral hemodynamics. The occurrence of cortical arousal is accompanied by increased HR in both events, but by different BV changes (i.e., decreased/increased BV in AHA/PLMA, respectively). HR changes may partially account for the increased cerebral hemodynamics during PLMA; whereas in AHA probable vasodilatation mediated by hypoxia/hypercapnia is more crucial for the post-arousal hemodynamics. The differences between changes of cerebral hemodynamics and HR may indicate different pathological mechanisms behind these two sleep disorder events. PMID:27630539

The Comparisons of Cerebral Hemodynamics Induced by Obstructive Sleep Apnea with Arousal and Periodic Limb Movement with Arousal: A Pilot NIRS Study.

PubMed

Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Qi, Ming; Khatami, Ramin

2016-01-01

Obstructive sleep apnea syndrome (OSA) and restless legs syndrome (RLS) with periodic limb movement during sleep (PLMS) are two sleep disorders characterized by repetitive respiratory or movement events associated with cortical arousals. We compared the cerebral hemodynamic changes linked to periodic apneas/hypopneas with arousals (AHA) in four OSA-patients with periodic limb movements (PLMA) with arousals in four patients with RLS-PLMS using near-infrared spectroscopy (NIRS). AHA induced homogenous pattern of periodic fluctuations in oxygenated (HbO2) and deoxygenated (HHb) hemoglobin, i.e., the decrease of HbO2 was accompanied by an increase of HHb during the respiratory event and resolved to reverse pattern when cortical arousal started. Blood volume (BV) showed the same pattern as HHb but with relative smaller amplitude in most of the AHA events.These changing patterns were significant as Wilcoxon signed-rank tests gave p < 0.001 when comparing the area under the curve of these hemodynamic parameters to zero. By contrast, in PLMA limb movements induced periodic increments in HbO2 and BV (Wilcoxon signed-rank tests, p < 0.001), but HHb changed more heterogeneously even during the events coming from the same patient. Heart rate (HR) also showed different patterns between AHA and PLMA. It significantly decreased during the respiratory event (Wilcoxon signed-rank test, p < 0.001) and then increased after the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001); while in PLMA HR first increased preceding the occurrence of cortical arousal (Wilcoxon signed-rank test, p < 0.001) and then decreased. The results of this preliminary study show that both AHA and PLMA induce changes in cerebral hemodynamics. The occurrence of cortical arousal is accompanied by increased HR in both events, but by different BV changes (i.e., decreased/increased BV in AHA/PLMA, respectively). HR changes may partially account for the increased cerebral hemodynamics during PLMA; whereas in AHA probable vasodilatation mediated by hypoxia/hypercapnia is more crucial for the post-arousal hemodynamics. The differences between changes of cerebral hemodynamics and HR may indicate different pathological mechanisms behind these two sleep disorder events.

[Musculo-skeletal disorders of the upper limb in the "new tables of professional diseases in industry and agriculture"].

PubMed

Clemente, M

2008-01-01

The author, after an analysis of the statistical data on work-related diseases reported to the INAIL and listed on the Annual Report 2007, examines the main highlights of the "new tables of professional diseases in industry and agriculture" published in the Ministerial Decree of July 21st, 2008 (GU n.169, 21-7-2008), also relating to the introduction of musculo-skeletal disorders of the upper limb due to bio-mechanical strain into the list of professional diseases to which the legal presumption of origin is applicable.

Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS)

MedlinePlus

... Professional Version Sleep Disorders Overview of Sleep Snoring Insomnia and Excessive Daytime Sleepiness (EDS) Circadian Rhythm Sleep ... pressure when a person stands (orthostatic hypotension), and insomnia. Benzodiazepines: These drugs (such as clonazepam ) cause drowsiness, ...

Mutations in WNT7A cause a range of limb malformations, including Fuhrmann syndrome and Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome.

PubMed

Woods, C G; Stricker, S; Seemann, P; Stern, R; Cox, J; Sherridan, E; Roberts, E; Springell, K; Scott, S; Karbani, G; Sharif, S M; Toomes, C; Bond, J; Kumar, D; Al-Gazali, L; Mundlos, S

2006-08-01

Fuhrmann syndrome and the Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome are considered to be distinct limb-malformation disorders characterized by various degrees of limb aplasia/hypoplasia and joint dysplasia in humans. In families with these syndromes, we found homozygous missense mutations in the dorsoventral-patterning gene WNT7A and confirmed their functional significance in retroviral-mediated transfection of chicken mesenchyme cell cultures and developing limbs. The results suggest that a partial loss of WNT7A function causes Fuhrmann syndrome (and a phenotype similar to mouse Wnt7a knockout), whereas the more-severe limb truncation phenotypes observed in Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome result from null mutations (and cause a phenotype similar to mouse Shh knockout). These findings illustrate the specific and conserved importance of WNT7A in multiple aspects of vertebrate limb development.

Mutations in WNT7A Cause a Range of Limb Malformations, Including Fuhrmann Syndrome and Al-Awadi/Raas-Rothschild/Schinzel Phocomelia Syndrome

PubMed Central

Woods, C. G.; Stricker, S.; Seemann, P.; Stern, R.; Cox, J.; Sherridan, E.; Roberts, E.; Springell, K.; Scott, S.; Karbani, G.; Sharif, S. M.; Toomes, C.; Bond, J.; Kumar, D.; Al-Gazali, L.; Mundlos, S.

2006-01-01

Fuhrmann syndrome and the Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome are considered to be distinct limb-malformation disorders characterized by various degrees of limb aplasia/hypoplasia and joint dysplasia in humans. In families with these syndromes, we found homozygous missense mutations in the dorsoventral-patterning gene WNT7A and confirmed their functional significance in retroviral-mediated transfection of chicken mesenchyme cell cultures and developing limbs. The results suggest that a partial loss of WNT7A function causes Fuhrmann syndrome (and a phenotype similar to mouse Wnt7a knockout), whereas the more-severe limb truncation phenotypes observed in Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome result from null mutations (and cause a phenotype similar to mouse Shh knockout). These findings illustrate the specific and conserved importance of WNT7A in multiple aspects of vertebrate limb development. PMID:16826533

Proprioceptive Rehabilitation of Upper Limb Dysfunction in Movement Disorders: A Clinical Perspective

PubMed Central

Abbruzzese, Giovanni; Trompetto, Carlo; Mori, Laura; Pelosin, Elisa

2014-01-01

Movement disorders (MDs) are frequently associated with sensory abnormalities. In particular, proprioceptive deficits have been largely documented in both hypokinetic (Parkinson’s disease) and hyperkinetic conditions (dystonia), suggesting a possible role in their pathophysiology. Proprioceptive feedback is a fundamental component of sensorimotor integration allowing effective planning and execution of voluntary movements. Rehabilitation has become an essential element in the management of patients with MDs, and there is a strong rationale to include proprioceptive training in rehabilitation protocols focused on mobility problems of the upper limbs. Proprioceptive training is aimed at improving the integration of proprioceptive signals using “task-intrinsic” or “augmented feedback.” This perspective article reviews the available evidence on the effects of proprioceptive stimulation in improving upper limb mobility in patients with MDs and highlights the emerging innovative approaches targeted to maximizing the benefits of exercise by means of enhanced proprioception. PMID:25505402

Five early accounts of phantom limb in context: Paré, Descartes, Lemos, Bell, and Mitchell.

PubMed

Finger, Stanley; Hustwit, Meredith P

2003-03-01

PHANTOM LIMB WAS described long before American physician and surgeon Silas Weir Mitchell coined the term and drew attention to the disorder in the 1860s. The early descriptions of Ambroise Paré, René Descartes, Aaron Lemos, Charles Bell, and then Mitchell of this strange consequence of amputation are presented in historical and cultural context. These five men described phantom limbs for various reasons. They also differed when it came to explaining and dealing with these illusory sensations. The rich history of phantom limbs can begin to be appreciated by viewing the contributions of these individuals in perspective and by realizing that their writings represent only a fraction of what was published about phantom limbs more than 130 years ago.

Alterations of white matter integrity in adults with major depressive disorder: a magnetic resonance imaging study

PubMed Central

Zou, Ke; Huang, Xiaoqi; Li, Tao; Gong, Qiyong; Li, Zhe; Ou-yang, Luo; Deng, Wei; Chen, Qin; Li, Chunxiao; Ding, Yi; Sun, Xueli

2008-01-01

Objective The purpose of our study was to investigate alterations of white matter integrity in adults with major depressive disorder (MDD) using magnetic resonance imaging (MRI). Methods We performed diffusion tensor imaging with a 3T MRI scanner on 45 patients with major depression and 45 healthy controls matched for age, sex and education. Using a voxel-based analysis, we measured the fractional anisotropy (FA), and we investigated the differences between the patient and control groups. We examined the correlations between the microstructure abnormalities of white matter and symptom severity, age of illness onset and cumulative illness duration, respectively. Results We found a significant decrease in FA in the left hemisphere, including the anterior limb of the internal capsule and the inferior parietal portion of the superior longitudinal fasciculus, in patients with MDD compared with healthy controls. Diffusion tensor imaging measures in the left anterior limb of the internal capsule were negatively related to the severity of depressive symptoms, even after we controlled for age and sex. Conclusion Our findings provide new evidence of microstructural changes of white matter in non–late-onset adult depression. Our results complement those observed in late-life depression and support the hypothesis that the disruption of cortical– subcortical circuit integrity may be involved in the etiology of major depressive disorder. PMID:18982175

Classification of Posture in Poststroke Upper Limb Spasticity: A Potential Decision Tool for Botulinum Toxin A Treatment?

ERIC Educational Resources Information Center

Hefter, Harald; Jost, Wolfgang H.; Reissig, Andrea; Zakine, Benjamin; Bakheit, Abdel Magid; Wissel, Jorg

2012-01-01

A significant percentage of patients suffering from a stroke involving motor-relevant central nervous system regions will develop a spastic movement disorder. Hyperactivity of different muscle combinations forces the limbs affected into abnormal postures or movement patterns. As muscular hyperactivity can effectively and safely be treated with…

Coexistence of 9p Deletion Syndrome and Autism Spectrum Disorder

ERIC Educational Resources Information Center

Günes, Serkan; Ekinci, Özalp; Ekinci, Nuran; Toros, Fevziye

2017-01-01

Deletion or duplication of the short arm of chromosome 9 may lead to a variety of clinical conditions including craniofacial and limb abnormalities, skeletal malformations, mental retardation, and autism spectrum disorder. Here, we present a case report of 5-year-old boy with 9p deletion syndrome and autism spectrum disorder.

Deep brain stimulation of the anterior limb of the internal capsule for treatment of therapy-refractory obsessive compulsive disorder (OCD): a case study highlighting neurocognitive and psychiatric changes.

PubMed

Choudhury, Tabina K; Davidson, Joyce E; Viswanathan, Ashwin; Strutt, Adriana M

2017-04-01

Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by repeated, unwanted thoughts and behaviors. Individuals with this condition often experience significant emotional distress secondary to their symptoms. Additionally, impairments in attention/concentration, processing speed, and executive functions are typically observed. The exact pathology of OCD remains unknown; consequently, it can be difficult to treat patients with severe symptomatology. Deep brain stimulation (DBS) may be a viable treatment option for individuals who do not respond to medication and/or cognitive behavioral therapy. The following case discusses DBS of the anterior limb of the internal capsule for a patient with severe, therapy-refractory OCD, including pre- to postoperative neurocognitive and psychiatric changes.

Marrow-isolated adult multilineage inducible cells embedded within a biologically-inspired construct promote recovery in a mouse model of peripheral vascular disease.

PubMed

Grau-Monge, Cristina; Delcroix, Gaëtan J-R; Bonnin-Marquez, Andrea; Valdes, Mike; Awadallah, Ead Lewis Mazen; Quevedo, Daniel F; Armour, Maxime R; Montero, Ramon B; Schiller, Paul C; Andreopoulos, Fotios M; D'Ippolito, Gianluca

2017-02-17

Peripheral vascular disease is one of the major vascular complications in individuals suffering from diabetes and in the elderly that is associated with significant burden in terms of morbidity and mortality. Stem cell therapy is being tested as an attractive alternative to traditional surgery to prevent and treat this disorder. The goal of this study was to enhance the protective and reparative potential of marrow-isolated adult multilineage inducible (MIAMI) cells by incorporating them within a bio-inspired construct (BIC) made of two layers of gelatin B electrospun nanofibers. We hypothesized that the BIC would enhance MIAMI cell survival and engraftment, ultimately leading to a better functional recovery of the injured limb in our mouse model of critical limb ischemia compared to MIAMI cells used alone. Our study demonstrated that MIAMI cell-seeded BIC resulted in a wide range of positive outcomes with an almost full recovery of blood flow in the injured limb, thereby limiting the extent of ischemia and necrosis. Functional recovery was also the greatest when MIAMI cells were combined with BICs, compared to MIAMI cells alone or BICs in the absence of cells. Histology was performed 28 days after grafting the animals to explore the mechanisms at the source of these positive outcomes. We observed that our critical limb ischemia model induces an extensive loss of muscular fibers that are replaced by intermuscular adipose tissue (IMAT), together with a highly disorganized vascular structure. The use of MIAMI cells-seeded BIC prevented IMAT infiltration with some clear evidence of muscular fibers regeneration.

MIAMI cells embedded within a biologically-inspired construct promote recovery in a mouse model of peripheral vascular disease

PubMed Central

Grau-Monge, Cristina; Delcroix, Gaëtan J.-R; Bonnin-Marquez, Andrea; Valdes, Mike; Awadallah, Ead Lewis Mazen; Quevedo, Daniel F.; Armour, Maxime R.; Montero, Ramon B.; Schiller, Paul C.; Andreopoulos, Fotios M.; D’Ippolito, Gianluca

2017-01-01

Peripheral vascular disease is one of the major vascular complications in individuals suffering from diabetes and in the elderly that is associated with significant burden in terms of morbidity and mortality. Stem cell therapy is being tested as an attractive alternative to traditional surgery to prevent and treat this disorder. The goal of this study was to enhance the protective and reparative potential of marrow-isolated adult multilineage inducible (MIAMI) cells by incorporating them within a bio-inspired construct (BIC) made of 2 layers of gelatin B electrospun nanofibers. We hypothesized that the BIC would enhance MIAMI cell survival and engraftment, ultimately leading to a better functional recovery of the injured limb in our mouse model of critical limb ischemia compared to MIAMI cells used alone. Our study demonstrated that MIAMI cell-seeded BIC resulted in a wide range of positive outcomes with an almost full recovery of blood flow in the injured limb, thereby limiting the extent of ischemia and necrosis. Functional recovery was also the greatest when MIAMI cells were combined with BICs, compared to MIAMI cells alone or BICs in the absence of cells. Histology was performed 28 days after grafting the animals to explore the mechanisms at the source of these positive outcomes. We observed that our critical limb ischemia model induces an extensive loss of muscular fibers that are replaced by intermuscular adipose tissue (IMAT), together with a highly disorganized vascular structure. The use of MIAMI cells-seeded BIC prevented IMAT infiltration with some clear evidence of muscular fibers regeneration. PMID:28211362

Realization of Intelligent Measurement and Control System for Limb Rehabilitation Based on PLC and Touch Screen

NASA Astrophysics Data System (ADS)

Liu, Xiangquan

According to the treatment needs of patients with limb movement disorder, on the basis of the limb rehabilitative training prototype, function of measure and control system are analyzed, design of system hardware and software is completed. The touch screen which is adopt as host computer and man-machine interaction window is responsible for sending commands and training information display; The PLC which is adopt as slave computer is responsible for receiving control command from touch screen, collecting the sensor data, regulating torque and speed of motor by analog output according to the different training mode, realizing ultimately active and passive training for limb rehabilitation therapy.

Limb myokymia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Albers, J.W.; Allen, A.A.; Bastron, J.A.

Thirty-eight patients with myokymic discharges localized to limb muscles on needle electromyography had various neurologic lesions, both acute and chronic. Of the 38 patients, 27 had had previous radiation therapy and the clinical diagnosis of radiation-induced plexopathy, myelopathy, or both. For the remaining 11 patients, the diagnoses included multiple sclerosis, inflammatory polyradiculoneuropathy, ischemic neuropathy, inflammatory myopathy, and chronic disorders of the spinal cord and peripheral nerves. The clinical presentations and results of local ischemia, peripheral nerve block, and percutaneous stimulation suggest that most limb myokymic discharges arise focally at the site of a chronic peripheral nerve lesion.

Proteus syndrome: A rare cause of gigantic limb.

PubMed

Chakrabarti, Nandini; Chattopadhyay, Chandan; Bhuban, Majhi; Pal, Salil Kumar

2014-04-01

A congenital disorder with variable manifestations, including partial gigantism of the hands and feet with hypertrophy of soles, nevi, hemihypertrophy, gynecomastia, macrocephaly and other skull abnormalities, and abdominal lipomatosis. The cause is unknown, although a genetic origin, generally of autosomal-dominant transmission, has been conjectured. Symptoms can be treated, but there is no known cure. We present the case of a young male with grotesque overgrowth of the right lower limb, splenomegaly and multiple nevi. Angiography revealed venous malformation within the limb. The findings are in conformity to the criteria for the Proteus syndrome.

Workplace management of upper limb disorders: a systematic review.

PubMed

Dick, F D; Graveling, R A; Munro, W; Walker-Bone, K

2011-01-01

Upper limb pain is common among working-aged adults and a frequent cause of absenteeism. To systematically review the evidence for workplace interventions in four common upper limb disorders. Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology. 1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis. Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.

[Variable magnetic fields in the treatment of tics disorders - preliminary results].

PubMed

Pasek, Jarosław; Jędrzejewska, Anna; Jagodziński, Leszek; Obuchowicz, Anna; Flak, Maria; Sieroń, Aleksander

Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk. The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated. After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents. The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.

[Variable magnetic fields in the treatment of tics disorders - preliminary results].

PubMed

Pasek, Jarosław; Jędrzejewska, Anna; Jagodziński, Leszek; Obuchowicz, Anna; Flak, Maria; Sieroń, Aleksander

2016-01-01

Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk. The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated. After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents. The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.

[Body integrity identity disorder, relief after amputation].

PubMed

Blom, R M; Braam, A W; de Boer-Kreeft, N; Sonnen, M P A M

2014-01-01

Body integrity identity disorder (BIID) is a rare condition in which a person, for no apparent physical reason, is tormented by the experience that a body-part, such as a limb, does not really belong to the body. Patients experience an intense desire for the limb to be amputated (a 'desire' formerly referred to as 'apotemnophilia'). We report on a 58-year-old male patient with BIID who froze one of his legs so that he could amputate it himself. A surgeon ultimately intervened and amputated the leg professionally. The patient was extremely relieved and was still experiencing relief at a follow-up three years later.

[May physicians amputate a healthy limb?].

PubMed

Denys, Damiaan

2014-01-01

A recent article in the Dutch Journal of Medicine describes two cases of patients with body integrity identity disorder (BIID), a disorder in which patients might resort to self-amputation in order to create the body they wish for. The authors wonder if medical professionals should provide elective amputations in BIID patients in order to prevent them from harm and death. The amputation of a healthy limb in BIID in a medical context is currently under discussion. Doctors struggle to proceed to elective amputation of a healthy body part in BIID. An analogy with gender dysphoria or euthanasia might shed a different light on this dilemma.

Musculoskeletal disorders among workers in plastic manufacturing plants.

PubMed

Fernandes, Rita de Cássia Pereira; Assunção, Ada Avila; Silvany Neto, Annibal Muniz; Carvalho, Fernando Martins

2010-03-01

Epidemiological studies have indicated an association between musculoskeletal disorders (MSDs) and physical work demands. Psychosocial work demands have also been identified as possible risk factors, but findings have been inconsistent. To evaluate factors associated with upper back, neck and upper limb MSD among workers from 14 plastic manufacturing companies located in the city of Salvador, Brazil. A cross-sectional study design was used to survey a stratified proportional random sample of 577 workers. Data were collected by questionnaire interviews. Factor analysis was carried out on 11 physical demands variables. Psychosocial work demands were measured by demand, control and social support questions. The role of socio-demographic factors, lifestyle and household tasks was also examined. Multiple logistic regression was used to identify factors related to upper back, neck and upper limb MSDs. Results from multiple logistic regression showed that distal upper limb MSDs were related to manual handling, work repetitiveness, psychosocial demands, job dissatisfaction, and gender. Neck, shoulder or upper back MSDs were related to manual handling, work repetitiveness, psychosocial demands, job dissatisfaction, and physical unfitness. Reducing the prevalence of musculoskeletal disorders requires: improving the work environment, reducing biomechanical risk factors, and replanning work organization. Programs must also be aware of gender specificities related to MSDs.

Impaired anatomical connectivity and related executive functions: differentiating vulnerability and disease marker in bipolar disorder.

PubMed

Linke, Julia; King, Andrea V; Poupon, Cyril; Hennerici, Michael G; Gass, Achim; Wessa, Michèle

2013-12-15

Bipolar 1 disorder (BD1) has been associated with impaired set shifting, increased risk taking, and impaired integrity of frontolimbic white matter. However, it remains unknown to what extent these findings are related to each other and whether these abnormalities represent risk factors or consequences of the illness. We addressed the first question by comparing 19 patients with BD1 and 19 healthy control subjects (sample 1) with diffusion tensor imaging, the Intra-Extra Dimensional Set Shift Task, and the Cambridge Gambling Task. The second question we approached by applying the same protocol to 22 healthy first-degree relatives of patients with BD1 and 22 persons without a family history of mental disorders (sample 2). In comparison with their control groups, BD1 patients and healthy first-degree relatives of patients with BD1 showed significantly reduced fractional anisotropy (FA) in the right anterior limb of the internal capsule and right uncinate fasciculus. White matter integrity in corpus callosum was reduced in BD1 patients only. In addition, reduced FA in anterior limb of the internal capsule correlated significantly with an increased number of errors during set shifting and increased risk taking and reduced FA in uncinate fasciculus correlated significantly with increased risk taking. Similar white matter alterations in BD1 patients and healthy relatives of BD1 patients are associated with comparable behavioral abnormalities. Further, results indicate that altered frontolimbic and frontothalamic connectivity and corresponding behavioral abnormalities might be a trait and vulnerability marker of BD1, whereas interhemispheric connectivity appears to be a disease marker. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Clinical efficacy and safety of a new 1000-mg suspension versus twice-daily 500-mg tablets of MPFF in patients with symptomatic chronic venous disorders: a randomized controlled trial.

PubMed

Carpentier, Patrick; van Bellen, Bonno; Karetova, Debora; Hanafiah, Harunarashid; Enriquez-Vega, Elizabeth; Kirienko, Alexander; Dzupina, Andrej; Sabovic, Miso; Reina Gutierrez, Lourdes; Subwongcharoen, Somboom; Tüzün, Hasan; Maggioli, Arnaud

2017-10-01

Chronic venous disorders (CVD) is estimated to affect 30% to 50% of women and 10% to 30% of men. The most widely prescribed treatment for CVD worldwide is micronized purified flavonoid fraction 500 mg (MPFF). The aim of this clinical trial was to develop a new once daily 1000-mg oral suspension of MPFF. In an international, randomized, double-blind, parallel-group study, symptomatic individuals classified CEAP C0s to C4s were randomized in either treatment arm and treated for 8 weeks. Lower limb symptoms (discomfort, pain and heaviness) were assessed using Visual Analog Scales (VAS), and quality of life (QoL) was measured with the CIVIQ-20 Questionnaire. A total of 1139 patients were included in the study. Both MPFF treatment regimens were well tolerated and associated with a significant reduction in lower limb symptoms. A non-inferiority of MPFF 1000-mg oral suspension once daily compared to MPFF 500-mg tablet twice daily (P<0.0001) was found for lower limb discomfort (-3.33 cm for MPFF 1000 mg and -3.37 cm for MPFF 500 mg), leg pain (-3.27 cm for MPFF 1000 mg and -3.31 cm for MPFF 500 mg) and leg heaviness (-3.41 cm for MPFF 1000 mg and -3.46 cm for MPFF 500 mg). The patients' QoL was improved by about 20 points on the CIVIQ scale in both groups (19.33 points for MPFF 1000 mg and 20.28 points for MPFF 500 mg). MPFF 1000-mg oral suspension and MPFF 500-mg tablets treatments were associated with similar reductions in lower limb symptoms and QoL improvement. The new once daily MPFF1000-mg oral suspension has a similar safety profile to two tablets of MPFF 500 mg, with the advantage of one daily intake, potentially associated with improved patient adherence and easier CVD management.

Comparison of transtibial amputee and non-amputee biomechanics during a common turning task.

PubMed

Segal, Ava D; Orendurff, Michael S; Czerniecki, Joseph M; Schoen, Jason; Klute, Glenn K

2011-01-01

The biomechanics of amputee turning gait has been minimally studied, in spite of its integral relationship with the more complex gait required for household or community ambulation. This study compares the biomechanics of unilateral transtibial amputees and non-amputees completing a common turning task. Full body gait analysis was completed for subjects walking at comparable self-selected speeds around a 1m radius circular path. Peak internal and external rotation moments of the hip, knee and ankle, mediolateral ground reaction impulse (ML GRI), peak effective limb length, and stride length were compared across conditions (non-amputee, amputee prosthetic limb, amputee sound limb). Amputees showed decreased internal rotation moments at the prosthetic limb hip and knee compared to non-amputees, perhaps as a protective mechanism to minimize stress on the residual limb. There was also an increase in amputee sound limb hip external rotation moment in early stance compared to non-amputees, which may be a compensation for the decrease in prosthetic limb internal rotation moment during late stance of the prior step. ML GRI was decreased for the amputee inside limb compared to non-amputee, possibly to minimize the body's acceleration in the direction of the turn. Amputees also exhibited a shorter inside limb stride length compared to non-amputees. Both decreased ML GRI and stride length indicate a COM that is more centered over the base of support, which may minimize the risk of falling. Finally, a longer effective limb length was found for the amputee inside limb turning, possibly due to excessive trunk shift. Published by Elsevier B.V.

[Desire for amputation in body integrity identity disorder].

PubMed

Blom, Rianne M; Hennekam, Raoul C M

2014-01-01

Body integrity identity disorder (BIID) is a rare neuropsychiatric disorder in which patients experience a mismatch between the real and experienced body from childhood. BIID results in a strong desire to amputate or paralyse one or more limbs. We describe two BIID patients. A 40-year-old healthy male suffered daily from his desire for amputation, and therefore made a request for amputation at our academic medical centre. A 61-year-old male proceeded to self-amputation to create the body he had wished for, thereby curing himself from BIID. To date, no treatment has been found for BIID. Therefore patients often proceed to self-amputation, which could lead to serious and even dangerous complications. These case histories suggest that elective amputation may be a treatment for BIID. Many doctors, however, will question the admissibility of amputation of a healthy limb.

Bartsocas-papas syndrome: unusual findings in the first reported egyptian family.

PubMed

Abdalla, E M; Morsy, H

2011-01-01

Bartsocas-Papas syndrome (BPS) is an autosomal recessive syndrome with severe craniofacial, limb, and genital abnormalities. As of 2011, 24 published cases and families were registered in the Orphanet Report Series. Compared to other disorders characterized by pterygia, the condition is usually more severe and often lethal: most affected patients die in utero or shortly after birth. We report the first Egyptian family with Bartsocas-Papas syndrome comprising three cases; our proband who was a female infant with severe craniofacial and limb anomalies typical of Bartsocas-Papas syndrome, a similarly affected female fetus which died in utero at the 7th gestational month, and a 16-year-old mentally retarded uncle who presented with some of the typical features of Bartsocas-Papas syndrome, including syndactyly, thumb hypoplasia, and microphthalmia. This male patient actually did not present with pterygia, however, we find his clinical description noteworthy.

Body ownership: When feeling and knowing diverge.

PubMed

Romano, Daniele; Sedda, Anna; Brugger, Peter; Bottini, Gabriella

2015-07-01

Individuals with the peculiar disturbance of 'overcompleteness' experience an intense desire to amputate one of their healthy limbs, describing a sense of disownership for it (Body Integrity Identity Disorder - BIID). This condition is similar to somatoparaphrenia, the acquired delusion that one's own limb belongs to someone else. In ten individuals with BIID, we measured skin conductance response to noxious stimuli, delivered to the accepted and non-accepted limb, touching the body part or simulating the contact (stimuli approach the body without contacting it), hypothesizing that these individuals have responses like somatoparaphrenic patients, who previously showed reduced pain anticipation, when the threat was directed to the disowned limb. We found reduced anticipatory response to stimuli approaching, but not contacting, the unwanted limb. Conversely, stimuli contacting the non-accepted body-part, induced stronger SCR than those contacting the healthy parts, suggesting that feeling of ownership is critically related to a proper processing of incoming threats. Copyright © 2015. Published by Elsevier Inc.

A Comparison of Four Year Health Outcomes following Combat Amputation and Limb Salvage

DTIC Science & Technology

2017-01-25

without amputation (limb salvage, n = 107). Patient medi- cal records were analyzed for four years postinjury. After adjusting for group differences...likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four ...between the patient groups over time. Longitudinal results (repeated measures). Repeated measure analyses were conducted for four years postinjury

Kinect-based virtual rehabilitation and evaluation system for upper limb disorders: A case study.

PubMed

Ding, W L; Zheng, Y Z; Su, Y P; Li, X L

2018-04-19

To help patients with disabilities of the arm and shoulder recover the accuracy and stability of movements, a novel and simple virtual rehabilitation and evaluation system called the Kine-VRES system was developed using Microsoft Kinect. First, several movements and virtual tasks were designed to increase the coordination, control and speed of the arm movements. The movements of the patients were then captured using the Kinect sensor, and kinematics-based interaction and real-time feedback were integrated into the system to enhance the motivation and self-confidence of the patient. Finally, a quantitative evaluation method of upper limb movements was provided using the recorded kinematics during hand-to-hand movement. A preliminary study of this rehabilitation system indicates that the shoulder movements of two participants with ataxia became smoother after three weeks of training (one hour per day). This case study demonstrated the effectiveness of the designed system, which could be promising for the rehabilitation of patients with upper limb disorders.

An Investigation of Upper Limb Motor Function in High Functioning Autism and Asperger's Disorder Using a Repetitive Fitts' Aiming Task

ERIC Educational Resources Information Center

Papadopoulos, Nicole; McGinley, Jennifer; Tonge, Bruce J.; Bradshaw, John L.; Saunders, Kerryn; Rinehart, Nicole J.

2012-01-01

There is now a growing body of research examining movement difficulties in children diagnosed with high functioning autism (HFA) and Asperger's disorder (AD). Despite this, few studies have investigated the kinematic components of movement that may be disrupted in children diagnosed with these disorders. The current study investigated rapid aiming…

Influence of Total Knee Arthroplasty on Gait Mechanics of the Replaced and Non-Replaced Limb During Stair Negotiation.

PubMed

Standifird, Tyler W; Saxton, Arnold M; Coe, Dawn P; Cates, Harold E; Reinbolt, Jeffrey A; Zhang, Songning

2016-01-01

This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints. Copyright © 2016 Elsevier Inc. All rights reserved.

Duplications of BHLHA9 are associated with ectrodactyly and tibia hemimelia inherited in non-Mendelian fashion.

PubMed

Klopocki, Eva; Lohan, Silke; Doelken, Sandra C; Stricker, Sigmar; Ockeloen, Charlotte W; Soares Thiele de Aguiar, Renata; Lezirovitz, Karina; Mingroni Netto, Regina Celia; Jamsheer, Aleksander; Shah, Hitesh; Kurth, Ingo; Habenicht, Rolf; Warman, Matthew; Devriendt, Koenraad; Kordass, Ulrike; Hempel, Maja; Rajab, Anna; Mäkitie, Outi; Naveed, Mohammed; Radhakrishna, Uppala; Antonarakis, Stylianos E; Horn, Denise; Mundlos, Stefan

2012-02-01

Split-hand/foot malformation (SHFM)-also known as ectrodactyly-is a congenital disorder characterised by severe malformations of the distal limbs affecting the central rays of hands and/or feet. A distinct entity termed SHFLD presents with SHFM and long bone deficiency. Mouse models suggest that a defect of the central apical ectodermal ridge leads to the phenotype. Although six different loci/mutations (SHFM1-6) have been associated with SHFM, the underlying cause in a large number of cases is still unresolved. High resolution array comparative genomic hybridisation (CGH) was performed in patients with SHFLD to detect copy number changes. Candidate genes were further evaluated for expression and function during limb development by whole mount in situ hybridisation and morpholino knock-down experiments. Array CGH showed microduplications on chromosome 17p13.3, a locus previously associated with SHFLD. Detailed analysis of 17 families revealed that this copy number variation serves as a susceptibility factor for a highly variable phenotype with reduced penetrance, particularly in females. Compared to other known causes for SHFLD 17p duplications appear to be the most frequent cause of SHFLD. A ~11.8 kb minimal critical region was identified encompassing a single gene, BHLHA9, a putative basic loop helix transcription factor. Whole mount in situ hybridisation showed expression restricted to the limb bud mesenchyme underlying the apical ectodermal ridge in mouse and zebrafish embryos. Knock down of bhlha9 in zebrafish resulted in shortening of the pectoral fins. Genomic duplications encompassing BHLHA9 are associated with SHFLD and non-Mendelian inheritance characterised by a high degree of non-penetrance with sex bias. Knock-down of bhlha9 in zebrafish causes severe reduction defects of the pectoral fin, indicating a role for this gene in limb development.

Peripheral post-ischemic vascular repair is impaired in a murine model of Alzheimer's disease.

PubMed

Merkulova-Rainon, Tatyana; Mantsounga, Chris S; Broquères-You, Dong; Pinto, Cristina; Vilar, José; Cifuentes, Diana; Bonnin, Philippe; Kubis, Nathalie; Henrion, Daniel; Silvestre, Jean-Sébastien; Lévy, Bernard I

2018-03-07

The pathophysiology of sporadic Alzheimer's disease (AD) remains uncertain. Along with brain amyloid-β (Aβ) deposits and neurofibrillary tangles, cerebrovascular dysfunction is increasingly recognized as fundamental to the pathogenesis of AD. Using an experimental model of limb ischemia in transgenic APPPS1 mice, a model of AD (AD mice), we showed that microvascular impairment also extends to the peripheral vasculature in AD. At D70 following femoral ligation, we evidenced a significant decrease in cutaneous blood flow (- 29%, P < 0.001), collateral recruitment (- 24%, P < 0.001), capillary density (- 22%; P < 0.01) and arteriole density (- 28%; P < 0.05) in hind limbs of AD mice compared to control WT littermates. The reactivity of large arteries was not affected in AD mice, as confirmed by unaltered size, and vasoactive responses to pharmacological stimuli of the femoral artery. We identified blood as the only source of Aβ in the hind limb; thus, circulating Aβ is likely responsible for the impairment of peripheral vasculature repair mechanisms. The levels of the majority of pro-angiogenic mediators were not significantly modified in AD mice compared to WT mice, except for TGF-β1 and PlGF-2, both of which are involved in vessel stabilization and decreased in AD mice (P = 0.025 and 0.019, respectively). Importantly, endothelin-1 levels were significantly increased, while those of nitric oxide were decreased in the hind limb of AD mice (P < 0.05). Our results suggest that vascular dysfunction is a systemic disorder in AD mice. Assessment of peripheral vascular function may therefore provide additional tools for early diagnosis and management of AD.

Deficiency in Mental Rotation of Upper and Lower-Limbs in Patients With Multiple Sclerosis and Its Relation With Cognitive Functions.

PubMed

Azin, Mahdieh; Zangiabadi, Nasser; Moghadas Tabrizi, Yousef; Iranmanesh, Farhad; Baneshi, Mohammad Reza

2016-08-01

Mental rotation is a cognitive motor process which was impaired in different neurologic disorders. We investigated whether there were deficits in response pattern, reaction time and response accuracy rate of mental rotation in multiple sclerosis (MS) patients compared to healthy subjects and whether cognitive dysfunctions in MS patients were correlated with mental rotation deficits. Moreover, we showed whether there was a difference between upper and lower-limbs mental rotation in MS patients. Thirty-five MS patients and 25 healthy subjects performed hand mental rotation (HMR) and foot mental rotation (FMR) tasks. Visual information processing speed, spatial learning and memory ability, and visuospatial processing were assessed by Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and Judgment of Line Orientation Test (JLO) respectively in MS patients. Reaction time for both hand and foot stimuli increased, and response accuracy rate for hand stimuli decreased in MS patients compared to healthy subjects, but response pattern of mental rotation in MS patients persisted. Similar to healthy subjects, MS patients performed upper-limbs mental rotation more easily than a lower-limbs mental rotation with more speed and response accuracy rate. Reaction time and response accuracy rate were correlated with the mentioned cognitive functions. MS patients made use of the correct response pattern for problem solving of increasing orientation from upright stimuli. Reaction time and response accuracy rate altered in these patients and this alteration might occur along with impairment in motor planning. Subjects' better responding to hand stimuli was due to more familiarity with hand stimuli. The correlation of mental rotation ability with cognitive functions indicates the possible role of cognitive functions in mental rotation.

A low-cost rapid upper limb assessment method in manual assembly line based on somatosensory interaction technology

NASA Astrophysics Data System (ADS)

Jiang, Shengqian; Liu, Peng; Fu, Danni; Xue, Yiming; Luo, Wentao; Wang, Mingjie

2017-04-01

As an effective survey method of upper limb disorder, rapid upper limb assessment (RULA) has a wide application in industry period. However, it is very difficult to rapidly evaluate operator's postures in real complex work place. In this paper, a real-time RULA method is proposed to accurately assess the potential risk of operator's postures based on the somatosensory data collected from Kinect sensor, which is a line of motion sensing input devices by Microsoft. First, the static position information of each bone point is collected to obtain the effective angles of body parts based on the calculating methods based on joints angles. Second, a whole RULA score of body is obtained to assess the risk level of current posture in real time. Third, those RULA scores are compared with the results provided by a group of ergonomic practitionerswho were asked to observe the same static postures. All the experiments were carried out in an ergonomic lab. The results show that the proposed method can detect operator's postures more accurately. What's more, this method is applied in a real-time condition which can improve the evaluating efficiency.

Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation.

PubMed

Rink, Cameron L; Wernke, Matthew M; Powell, Heather M; Tornero, Mark; Gnyawali, Surya C; Schroeder, Ryan M; Kim, Jayne Y; Denune, Jeffrey A; Albury, Alexander W; Gordillo, Gayle M; Colvin, James M; Sen, Chandan K

2017-07-01

Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial ( n  = 5) and transfemoral ( n  = 5) amputation were compared to able-limb controls ( n  = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.

Hypersomnia.

PubMed

Dauvilliers, Yves; Buguet, Alain

2005-01-01

Hypersomnia, a complaint of excessive daytime sleep or sleepiness, affects 4% to 6% of the population, with an impact on the everyday life of the patient Methodological tools to explore sleep and wakefulness (interview, questionnaires, sleep diary, polysomnography, Multiple Sleep Latency Test, Maintenance of Wakefulness Test) and psychomotor tests (for example, psychomotor vigilance task and Oxford Sleep Resistance or Osler Test) help distinguish between the causes of hypersomnia. In this article, the causes of hypersomnia are detailed following the conventional classification of hypersomnic syndromes: narcolepsy, idiopathic hypersomnia, recurrent hypersomnia, insufficient sleep syndrome, medication- and toxin-dependent sleepiness, hypersomnia associated with psychiatric disorders, hypersomnia associated with neurological disorders, posttraumatic hypersomnia, infection (with a special emphasis on the differences between bacterial and viral diseases compared with parasitic diseases, such as sleeping sickness) and hypersomnia, hypersomnia associated with metabolic or endocrine diseases, breathing-related sleep disorders and sleep apnea syndromes, and periodic limb movements in sleep.

Hypersomnia

PubMed Central

Dauvilliers, Yves; Buguet, Alain

2005-01-01

Hypersomnia, a complaint of excessive daytime sleep or sleepiness, affects 4% to 6% of the population, with an impact on the everyday life of the patient Methodological tools to explore sleep and wakefulness (interview, questionnaires, sleep diary, polysomnography Multiple Sleep Latency Test, Maintenance of Wakefulness Test) and psy-chomotor tests (for example, psychomotor vigilance task and Oxford Sleep Resistance or Osier Test) help distinguish between the causes of hypersomnia. In this article, the causes of hypersomnia are detailed following the conventional classification of hypersomnic syndromes: narcolepsy, idiopathic hypersomnia, recurrent hypersomnia, insufficient sleep syndrome, medication- and toxin-dependent sleepiness, hypersomnia associated with psychiatric disorders, hypersomnia associated with neurological disorders, posttraumatic hypersomnia, infection (with a special emphasis on the differences between bacterial and viral diseases compared with parasitic diseases, such as sleeping sickness) and hypersomnia, hypersomnia associated with metabolic or endocrine diseases, breathing-related sleep disorders and sleep apnea syndromes, and periodic limb movements in sleep. PMID:16416710

Sleep disorders and the prevalence of asymptomatic nocturnal acid and non-acid reflux.

PubMed

Herdman, Christine; Marzio, Dina Halegoua-De; Shah, Paurush; Denuna-Rivera, Susie; Doghramji, Karl; Cohen, Sidney; Dimarino, Anthony J

2013-01-01

Nocturnal acid reflux is associated with symptomatic and asymptomatic sleep arousals, leading to fragmented sleep. The frequency and influence of acid reflux in patients with various forms of insomnia has not been reported. The aim of this study was to quantify nocturnal acid and nonacid reflux in patients with primary sleep disorders as previously diagnosed by polysomnography. THIRTY ONE SUBJECTS WERE STUDIED: (A) 9 subjects with a polysomnographically diagnosed sleep disorder (1 with restless legs syndrome, 4 with narcolepsy, 4 with periodic limb movement disorder); (B) 12 subjects with primary insomnia (PI) and unrevealing polysomnography; and (C) 10 controls without disturbed sleep. All subjects underwent a physical examination and 24 h transnasal pH and impedance monitoring to detect acid and non-acid reflux. The 21 subjects with fragmented sleep due to a primary sleep disorder had significantly more recumbent acid exposure (>1.2% of time) as compared with control subjects (33% versus 0%). When fragmented sleep subjects were divided into two groups, 17% of PI subjects and 55% of subjects with a diagnosed sleep disorder had significant recumbent acid exposure (P=0.009). Likewise, the median recumbent nonacid events were increased in the sleep disordered group (P=0.011). This study indicates that patients with primary sleep disorders have prominent nocturnal acid reflux without symptoms of daytime acid reflux. Acid reflux is most prominent in patients with polysomnographic findings of disturbed sleep as compared to patients with PI; while non acid reflux is increased minimally in these patients.

[Body Integrity Identity Disorder (BIID): interrogation of patients and theories for explanation].

PubMed

Kasten, E

2009-01-01

Apotemnophilia, Amputee Identity Disorder or Body Integrity Identity Disorder (BIID) is the intensive feeling that the body will be "more complete" after amputation of a limb. The article disputes the question of matching personality characteristics of these subjects and asks for motives. Based on reports of nine individuals, triggering experiences are referred. In contrast to other children, often these subjects were fascinated by the sight of a handicapped person. In the article is investigated, whether the concerned limb showed more affections. Described is typical pretending behavior. Parallels to body dysmorphic disorder (BDD), fetishism, or delusions are investigated. These were minor, in most cases the wish was fixated on a specific limb, the subjects were aware of the abnormity of their desire and quarreled with the pros and cons. Sexual motives were found in one third. Some of the interviewed persons were in medical or psychological therapy; this did not let the desire disappear. In several BIID sufferers the wish for amputation changed, e. g. from the left to the right leg. This finding is not in accordance with the brain-dysfunction-theory. These people rather have an ideal of a "perfect" body minus one arm or leg. Most admire the beauty of a stump, and see amputees as "heroes" who still master their life in spite of their handicap. BIID is not a homogenous disturbance, one should separate three axes: 1. Strength of neuronal dysfunction, 2. Psychic components (e. g. secondary morbid gain) and 3. Intensity of sexual interests.

Mobile-bearing medial unicompartmental knee arthroplasty restores limb alignment comparable to that of the unaffected contralateral limb

PubMed Central

Mullaji, Arun B; Shah, Siddharth; Shetty, Gautam M

2017-01-01

Background and purpose — Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. We investigated whether restoration of natural soft tissue tension would result in a lower limb alignment similar to that of the contralateral unaffected lower limb after mobile-bearing medial UKA. Patients and methods — In this retrospective study, hip-knee-ankle (HKA) angle, position of the weight-bearing axis (WBA), and knee joint line obliquity (KJLO) after mobile-bearing medial UKA was compared with that of the unaffected (clinically and radiologically) contralateral lower limb in 123 patients. Results — Postoperatively, HKA angle was restored to within ±3° of the contralateral lower limb in 87% of the patients and the WBA passed within ±1 Kennedy and White’s tibial zone of the unaffected contralateral lower limb in 95% of the patients. The mean KJLO in the operated limbs was not significantly different from that in the unaffected lower limbs (p = 0.07) and the KJLO in the operated limb was restored to within ±3° of that in the contralateral lower limb in 96% of the patients. Interpretation — Lower limb alignment and knee joint line obliquity after mobile-bearing medial UKA were comparable to that of the unaffected contralateral limb in most patients. Comparison with the contralateral unaffected lower limb is a reliable method for evaluation and validation of limb mechanical alignment after mobile-bearing medial UKA. PMID:27794622

Coping with Musculoskeletal Pain: Implications for Office Workers

ERIC Educational Resources Information Center

Oztug, Ozhan; Cowie, Helen

2011-01-01

The aim of the present research was to understand how office workers cope with back, neck and upper limb musculoskeletal disorders at work (and their implications for work). A small (N = 120) questionnaire survey collected information about potential participants' background and history of musculoskeletal disorders. These data were used to inform…

Successful treatment of pain in melorheostosis with zoledronate, with improvement on bone scintigraphy.

PubMed

Slimani, Samy; Nezzar, Adlen; Makhloufi, Hachemi

2013-06-21

Melorheostosis is a very rare sclerosing bone disorder that involves frequently one limb. It may be asymptomatic, but pain and limb deformity may occur and can be very debilitating. Different reports have indicated efficacy of bisphosphonates (pamidronate and etidronate) on symptoms. We report an adult patient with a very painful melorheostosis, who  improved after treatment with zoledronate, either on symptoms or on bone scans.

A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

PubMed Central

Walker, Jay; Bhatnagar, Vibha; Richard, Erin; Sechriest, V. Franklin; Galarneau, Michael

2017-01-01

Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107). Patient medical records were analyzed for four years postinjury. After adjusting for group differences, early amputation was generally associated with a lower or similar prevalence for adverse physical and psychological diagnoses (e.g., pain, osteoarthritis, posttraumatic stress disorder) versus late amputation and/or limb salvage. By contrast, early amputation was associated with an increased likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four years postinjury, particularly in the second year. The different clinical outcomes among combat extremity injured patients treated with early amputation, late amputation, or limb salvage highlight their different healthcare requirements. These findings can inform and optimize the specific treatment pathways that address the physical and psychological healthcare needs of such patients over time. PMID:28122002

[Prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs) in workers of the upholstered furniture industry].

PubMed

Nicoletti, S; Carino, M; Di Leone, G; Trani, G; Carella, F; Rubino, G; Leone, E; Popolizio, R; Colafiglio, S; Ambrosi, L

2008-01-01

The upholstered furniture industry, the so-called "triangle of the sofa industry", is a geographic area of national and strategic economic importance in southern Italy. The single tasks are carried out mostly manually, with the characteristics of a handicraft approach. The aim of the survey was to assess the prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs) in 30 factories of the sofa industry located in a large geographic area of the Puglia and Basilicata Regions. In the period 1 January-31 December 2003 a network of occupational physicians investigated a population of 5.477 subjects (exposed n=3481, controls n=1996, M=3865, F=1612) in 30 different factories of the area. More than 60 percent of the total workforce studied was employed in large-sized companies (>500 employees). The following work tasks were considered: filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. Case-definition was assessed through standardized procedures: symptoms by questionnaire plus physical and laboratory/imaging findings. Cumulative prevalence rates of UL-WMSDs as at 31 December 2003 reached values of up to 30% in high risk groups. Prevalence rates showed good correlation with the concise OCRA index used for assessment of exposure to repetitive strain and movements of the upper limb. The most frequently occurring disorders were tendon-related cysts and wrist tendonitis. Shoulder disorders were more frequent in male and female leather-cutting operators. This survey showed a significantly high prevalence of UL-WMSDs in sofa industry workers. It did not seem to be confirmed in this study that there was a greater female susceptibility to UL-WMSDs with the exception of carpal tunnel syndrome: gender difference seems to be less relevant at increasing levels of occupational exposure to repetitive movements and exertion of the upper limbs.

Sleep and psychiatry

PubMed Central

Abad, Vivien C.; Guilleminault, Christian

2005-01-01

Psychiatric disorders constitute 15.4% of the disease burden in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including post-traumatic stress disorder), substance abuse disorders, eating disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insomnia, hypersomnia, nocturnal panic, sleep paralysis, hypnagogic hallucinations, restless legs/periodic limb movements of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are summarized. PMID:16416705

Secondary dystonia in a botulinum toxin clinic: clinical characteristics, neuroanatomical substrate and comparison with idiopathic dystonia.

PubMed

Strader, Scott; Rodnitzky, Robert L; Gonzalez-Alegre, Pedro

2011-12-01

The analysis of patients with secondary dystonia has been valuable to explore the anatomical, pharmacological and physiological bases of this disorder. The goal of this study is to compare the clinical characteristics of patients with primary and secondary dystonia and analyze the neuroanatomical bases of a subgroup of patients with lesion-induced dystonia. We identified patients evaluated in our Botulinum Toxin Clinic from 1/2000 to 7/2009 with an ICD code for "dystonia". Medical records of all subjects were reviewed, recording demographic, clinical, therapeutic and neuroimaging data. A total of 230 patients were included in the study. Idiopathic/primary dystonia was diagnosed in 162 and secondary dystonia in 58, while in 10 the etiology was uncertain. We found a female predominance (2.4:1 and 1.9:1 for primary and secondary dystonia, respectively). The cervical region was most commonly affected in primary dystonia and the limbs in secondary cases. The age at presentation was higher in primary (54.4 ± 14.1) than secondary (49 ± 17.9) dystonia. Among patients with secondary dystonia, a focal lesion was the presumed etiology in 32, with localizing diagnostic studies available in 16. The most common lesions were strokes involving the corticospinal pathway. All of those patients exhibited limb dystonia, except one with cervical dystonia following a thalamic infarct. In conclusion, primary and secondary dystonias are more prevalent in women, suggesting a sex-related predisposition to the development of this movement disorder. Lesion-induced dystonia most frequently involves the limbs and is caused by lesions in the cerebral cortex and subcortical white matter. Copyright © 2011 Elsevier Ltd. All rights reserved.

Exoskeleton robots for upper-limb rehabilitation: state of the art and future prospects.

PubMed

Lo, Ho Shing; Xie, Sheng Quan

2012-04-01

Current health services are struggling to provide optimal rehabilitation therapy to victims of stroke. This has motivated researchers to explore the use of robotic devices to provide rehabilitation therapy for strokepatients. This paper reviews the recent progress of upper limb exoskeleton robots for rehabilitation treatment of patients with neuromuscular disorders. Firstly, a brief introduction to rehabilitation robots will be given along with examples of existing commercial devices. The advancements in upper limb exoskeleton technology and the fundamental challenges in developing these devices are described. Potential areas for future research are discussed. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

PREVENTION AND MANAGEMENT OF LIMB CONTRACTURES IN NEUROMUSCULAR DISEASES

PubMed Central

Skalsky, Andrew J.; McDonald, Craig M.

2012-01-01

Synopsis Limb contractures are a common impairment in neuromuscular diseases (NMD). They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living (ADL), and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures in comparison to neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve ROM in NMD in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from the contractures. PMID:22938881

[Antegrade diastolic blood flow and classic reflux in varicose dilatation of the intersaphenous vein].

PubMed

Shaidakov, E V; Rosukhovsky, D A; Grigoryan, A G; Bulatov, V L; Ilyukhin, E A

2016-01-01

In the intersaphenous vein (ISV) there may take place the so-called "antegrade" or "paradoxical" reflux. This type of blood flow is revealed in a series of patients during muscular diastole and is a link of the pathogenesis of varicose disease, but has, as distinct from the "classical" reflux, an antegrade direction. An incompetent saphenopopliteal junction (SPJ) is a source of the antegrade diastolic blood flow (ADBF) through the ISV. Descriptions of possible variants of impaired blood flow through the ISV are fragmentary and their interpretations are controversial. Prevalence and pathogenesis of these disorders impairments have not yet been studied. A cross-sectional study: over 4 years three centres examined a total of 1,413 patients diagnosed with class C2-C6 varicose veins according the CEAP classification. All patients underwent ultrasound duplex scanning of lower limb veins. The ADBF was determined as a unidirectional antegrade blood flow with the duration of not more than 0.5 second, observed after the crus was relived of compression (in the diastole). Of the patients included into the study who had no varicose veins on the contralateral extremity with the ISV being spotted we sequentially selected 40 subjects including them into the Study Group for the analysis of blood flow and the diameter of the ISV in health. Impairments of blood flow in the ISV were revealed in 61 (4.8%) of 1,265 extremities included into the study: the "classical" reflux in 9 (14.8%) limbs, ADBF was revealed in 37 (60.7%) limbs, a combination of the "classical" blood flow and ADBF - in 15 (24.6%) limbs. Hence, the patients were subdivided into three groups. Studying the nature of blood flow through the ISV in the control group on 40 lower limbs revealed no blood flow disorders. The mean ISV diameter amounted to 1.68 mm (ME=1 mm). The ISV diameter was considerably higher in all studied groups as compared with the control one (p<0.0001). The diameter of the ISV in its proximal portion averagely amounted to 4.48 mm (SD 1.337 mm, SE 0.171 mm). The diameter in the distal portion amounted to 5.39 mm (SD 1.725 mm, SE 0.221 mm).

The effects of laterality on obstacle crossing performance in unilateral trans-tibial amputees.

PubMed

De Asha, Alan R; Buckley, John G

2015-05-01

Unilateral trans-tibial amputees have bilaterally reduced toe clearance, and an increased risk of foot contact, while crossing obstacles compared to the able-bodied. While the able-bodied tend to lead with a 'preferred' limb it is equivocal whether amputees prefer to lead with the intact or prosthetic limb. This study determined the effects of laterality, compared to side of amputation, on amputees' obstacle crossing performance. To help understand why laterality could affect performance we also assessed knee proprioception for both limbs. Foot placement and toe clearance parameters were recorded while nine amputees crossed obstacles of varying heights leading with both their intact and prosthetic limbs. Joint-position sense was also assessed. Participants self-reported which limb was their preferred (dominant) limb. There were no significant differences in foot placements or toe clearance variability across lead-limb conditions. There were no significant differences in toe clearance between intact and prosthetic lead-limbs (p=0.28) but toe clearance was significantly higher when amputees led with their preferred compared to non-preferred limb (p=0.025). There was no difference in joint-position sense between the intact and residual knees (p=0.34) but joint-position sense tended to be more accurate for the preferred, compared to non-preferred limb (p=0.08). Findings suggest that, despite the mechanical constraints imposed by use of a prosthesis, laterality may be as important in lower-limb amputees as it is in the able bodied. This suggests that amputees should be encouraged to cross obstacles leading with their preferred limb. Copyright © 2015. Published by Elsevier Ltd.

Dietary glutamine supplementation enhances endothelial progenitor cell mobilization in streptozotocin-induced diabetic mice subjected to limb ischemia.

PubMed

Su, Shiau-Tsz; Yeh, Chiu-Li; Hou, Yu-Chen; Pai, Man-Hui; Yeh, Sung-Ling

2017-02-01

Diabetes is a metabolic disorder with increased risk of vascular diseases. Tissue ischemia may occur with diabetic vascular complications. Bone marrow-derived endothelial progenitor cells (EPCs) constitute a reparative response to ischemic injury. This study investigated the effects of oral glutamine (GLN) supplementation on circulating EPC mobilization and expression of tissue EPC-releasing markers in diabetic mice subjected to limb ischemia. Diabetes was induced by a daily intraperitoneal injection of streptozotocin for 5 days. Diabetic mice were divided into 2 nonischemic groups and 6 ischemic groups. One of the nonischemic and 3 ischemic groups were fed the control diet, while the remaining 4 groups received diets with identical components except that part of the casein was replaced by GLN. The respective diets were fed to the mice for 3 weeks, and then the nonischemic mice were sacrificed. Unilateral hindlimb ischemia was created in the ischemic groups, and mice were sacrificed at 1, 7 or 21 days after ischemia. Their blood and ischemic muscle tissues were collected for further analyses. Results showed that plasma matrix metallopeptidase (MMP)-9 and the circulating EPC percentage increased after limb ischemia in a diabetic condition. Compared to groups without GLN, GLN supplementation up-regulated plasma stromal cell-derived factor (SDF)-1 and muscle MMP-9, SDF-1, hypoxia-inducible factor-1 and vascular endothelial growth factor gene expression. The CD31-immunoreactive intensities were also higher in the ischemic limb. These findings suggest that GLN supplementation enhanced circulating EPC mobilization that may promote endothelium repair at ischemic tissue in diabetic mice subjected to limb ischemia. Copyright © 2016 Elsevier Inc. All rights reserved.

Biomechanical Analysis of Abdominal Injury in Tennis Serves. A Case Report

PubMed Central

Tubez, François; Forthomme, Bénédicte; Croisier, Jean-Louis; Cordonnier, Caroline; Brüls, Olivier; Denoël, Vincent; Berwart, Gilles; Joris, Maurice; Grosdent, Stéphanie; Schwartz, Cédric

2015-01-01

The serve is an important stroke in any high level tennis game. A well-mastered serve is a substantial advantage for players. However, because of its repeatability and its intensity, this stroke is potentially deleterious for upper limbs, lower limbs and trunk. The trunk is a vital link in the production and transfer of energy from the lower limbs to the upper limbs; therefore, kinematic disorder could be a potential source of risk for trunk injury in tennis. This research studies the case of a professional tennis player who has suffered from a medical tear on the left rectus abdominis muscle after tennis serve. The goal of the study is to understand whether the injury could be explained by an inappropriate technique. For this purpose, we analyzed in three dimensions the kinematic and kinetic aspects of the serve. We also performed isokinetic tests of the player’s knees. We then compared the player to five other professional players as reference. We observed a possible deficit of energy transfer because of an important anterior pelvis tilt. Some compensation made by the player during the serve could be a possible higher abdominal contraction and a larger shoulder external rotation. These particularities could induce an abdominal overwork that could explain the first injury and may provoke further injuries. Key points In the proximal-distal sequence, energy is transmitted from lower limbs to upper limps via trunk. The 3D analysis tool is an indispensable test for an objective evaluation of the kinematic in the tennis serve. Multiple evaluations techniques are useful for fuller comprehension of the kinematics and contribute to the awareness of the player’s staff concerning pathologies and performance. PMID:25983591

Functional roles of lower-limb joint moments while walking in water.

PubMed

Miyoshi, Tasuku; Shirota, Takashi; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Akai, Masami

2005-02-01

To clarify the functional roles of lower-limb joint moments and their contribution to support and propulsion tasks while walking in water compared with that on land. Sixteen healthy, young subjects walked on land and in water at several different speeds with and without additional loads. Walking in water is a major rehabilitation therapy for patients with orthopedic disorders. However, the functional role of lower-limb joint moments while walking in water is still unclear. Kinematics, electromyographic activities in biceps femoris and gluteus maximums, and ground reaction forces were measured under the following conditions: walking on land and in water at a self-determined pace, slow walking on land, and fast walking in water with or without additional loads (8 kg). The hip, knee, and ankle joint moments were calculated by inverse dynamics. The contribution of the walking speed increased the hip extension moment, and the additional weight increased the ankle plantar flexion and knee extension moment. The major functional role was different in each lower-limb joint muscle. That of the muscle group in the ankle is to support the body against gravity, and that of the muscle group involved in hip extension is to contribute to propulsion. In addition, walking in water not only reduced the joint moments but also completely changed the inter-joint coordination. It is of value for clinicians to be aware that the greater the viscosity of water produces a greater load on the hip joint when fast walking in water.

Mild Myopathy Is Associated with COMP but Not MATN3 Mutations in Mouse Models of Genetic Skeletal Diseases

PubMed Central

Piróg, Katarzyna A.; Katakura, Yoshihisa; Mironov, Aleksandr; Briggs, Michael D.

2013-01-01

Pseudoachondroplasia (PSACH) and multiple epiphyseal dysplasia (MED) are skeletal disorders resulting from mutations in COMP, matrilin-3 or collagen IX and are characterised by short-limbed dwarfism and premature osteoarthritis. Interestingly, recent reports suggest patients can also manifest with muscle weakness. Here we present a detailed analysis of two mouse models of the PSACH/MED disease spectrum; ΔD469 T3-COMP (PSACH) and V194D matrilin-3 (MED). In grip test experiments T3-COMP mice were weaker than wild-type littermates, whereas V194D mice behaved as controls, confirming that short-limbed dwarfism alone does not contribute to PSACH/MED-related muscle weakness. Muscles from T3-COMP mice showed an increase in centronuclear fibers at the myotendinous junction. T3-COMP tendons became more lax in cyclic testing and showed thicker collagen fibers when compared with wild-type tissue; matrilin-3 mutant tissues were indistinguishable from controls. This comprehensive study of the myopathy associated with PSACH/MED mutations enables a better understanding of the disease progression, confirms that it is genotype specific and that the limb weakness originates from muscle and tendon pathology rather than short-limbed dwarfism itself. Since some patients are primarily diagnosed with neuromuscular symptoms, this study will facilitate better awareness of the differential diagnoses that might be associated with the PSACH/MED spectrum and subsequent care of PSACH/MED patients. PMID:24312420

Successful treatment of pain in melorheostosis with zoledronate, with improvement on bone scintigraphy

PubMed Central

Slimani, Samy; Nezzar, Adlen; Makhloufi, Hachemi

2013-01-01

Melorheostosis is a very rare sclerosing bone disorder that involves frequently one limb. It may be asymptomatic, but pain and limb deformity may occur and can be very debilitating. Different reports have indicated efficacy of bisphosphonates (pamidronate and etidronate) on symptoms. We report an adult patient with a very painful melorheostosis, who  improved after treatment with zoledronate, either on symptoms or on bone scans. PMID:23813581

Hard work never hurt anyone--or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb.

PubMed

Walker-Bone, K; Cooper, C

2005-08-01

Pain in the neck and upper limb is common and contributes greatly to absence due to sickness. Evidence is accumulating that factors such as prolonged abnormal posture and repetition contribute to these conditions. Psychosocial factors may also play a part and the relative importance of these is not yet known. Primary and secondary prevention trials are needed.

[The esthetics of lower limb prosthesis].

PubMed

Gardrat, Franck

2015-01-01

The amputation, which is upper or lower limb, entails important consequences and often traumatic into subject amputee from a physical, psychological, interpersonal and social point of view. It acts on the body image unleashing different psychological disorders and alterations in the social and professional reality. The aesthetic prosthesis can be considered a good support to help the person regain a new body image of themselves, facilitating the process of physical rehabilitation and social integration.

Body integrity identity disorder: from a psychological to a neurological syndrome.

PubMed

Sedda, Anna

2011-12-01

Body Integrity Identity Disorder (BIID) is a condition in which individuals experience an intense desire for amputation of an healthy limb. Recently, McGeoch and colleagues provided the first direct evidence that this syndrome may be neurological rather than psychological in its origin. However, before including BIID in body ownership disorders, several concerns should be clarified, exploring other components of body representation and not only somatosensory perception.

Working conditions at hospital food service and the development of venous disease of lower limbs.

PubMed

da Luz, Clarissa Medeiros; da Costa Proença, Rossana Pacheco; de Salazar, Begoña Rodriguez Ortiz; do Nascimento Galego, Gilberto

2013-12-01

The present study assesses some factors that may influence the development of lower limb venous disease in workers of a hospital food service unit. An Ergonomic analysis of work was carried out at a hospital located in the south of Brazil. As for data collection, the following were used: interviews and body mass index assessment; specific clinical examination to diagnose venous disease, water displacement volumetry of the lower limbs. The activities performed at the workplace were followed by direct observation with image registration, use of pedometers, stopwatches, decibel meter, and digital thermo-hygrometer. It was observed different degrees of venous disease in 78% of the cases investigated. The volumetric variation of the lower limbs was 5.13%, showing the presence of edema. Working in hospital food service is associated with circulatory disorders of lower limbs, such as edema and venous disease. The following risk factors were identified: standing activities at work during a long period of time, high temperature, and humidity and carrying heavy weights.

Surgical trauma induces overgrowth in lower limb gigantism: regulation with use of rapamycin is promising.

PubMed

Pinto, Rohan Sebastian; Harrison, William David; Graham, Kenneth; Nayagam, Durai

2018-01-04

We describe an unclassified overgrowth syndrome characterised by unregulated growth of dermal fibroblasts in the lower limbs of a 35-year-old woman. A PIK3CA gene mutation resulted in lower limb gigantism. Below the waist, she weighed 117 kg with each leg measuring over 100 cm in circumference. Her total adiposity was 50% accounted for by her legs mainly. Liposuction and surgical debulking were performed to reduce the size of the limbs but had exacerbated the overgrowth in her lower limbs. Systemic sepsis from an infected foot ulcer necessitated treatment by an above-knee amputation. Postoperatively, the stump increased in size by 19 kg. A trial of rapamycin to reverse the growth of the stump has shown promise. We discuss the clinical and genetic features of this previously unclassified disorder and the orthopaedic considerations involved. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The influence of age, gender and education on the performance of healthy individuals on a battery for assessing limb apraxia

PubMed Central

Mantovani-Nagaoka, Joana; Ortiz, Karin Zazo

2016-01-01

ABSTRACT Introduction: Apraxia is defined as a disorder of learned skilled movements, in the absence of elementary motor or sensory deficits and general cognitive impairment, such as inattention to commands, object-recognition deficits or poor oral comprehension. Limb apraxia has long been a challenge for clinical assessment and understanding and covers a wide spectrum of disorders, all involving motor cognition and the inability to perform previously learned actions. Demographic variables such as gender, age, and education can influence the performance of individuals on different neuropsychological tests. Objective: The present study aimed to evaluate the performance of healthy subjects on a limb apraxia battery and to determine the influence of gender, age, and education on the praxis skills assessed. Methods: Forty-four subjects underwent a limb apraxia battery, which was composed of numerous subtests for assessing both the semantic aspects of gestural production as well as motor performance itself. The tasks encompassed lexical-semantic aspects related to gestural production and motor activity in response to verbal commands and imitation. Results: We observed no gender effects on any of the subtests. Only the subtest involving visual recognition of transitive gestures showed a correlation between performance and age. However, we observed that education level influenced subject performance for all sub tests involving motor actions, and for most of these, moderate correlations were observed between education level and performance of the praxis tasks. Conclusion: We conclude that the education level of participants can have an important influence on the outcome of limb apraxia tests. PMID:29213460

PERIODIC LIMB MOVEMENTS AND RESTLESS LEGS SYNDROME IN CHILDREN WITH A HISTORY OF PREMATURITY

PubMed Central

Cielo, Christopher M.; DelRosso, Lourdes M.; Tapia, Ignacio E.; Biggs, Sarah N.; Nixon, Gillian M.; Meltzer, Lisa J.; Traylor, Joel; Kim, Ji Young; Marcus, Carole L.

2017-01-01

Introduction Little is known about which children are at increased risk for restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Polysomnographic data from the Caffeine for Apnea of Prematurity-Sleep (CAPS) study showed a high prevalence of elevated periodic limb movement index in a cohort of ex-preterm children, but the clinical importance of this finding, such as association with RLS, is unknown. We hypothesized that ex-preterm children would have a high prevalence of RLS and PLMD. Methods Ex-preterm children enrolled in CAPS, now aged 5-12 years, completed home polysomnography and standardized questionnaires. A diagnosis of RLS or PLMD was established by participants meeting the International Classification of Sleep Disorders, 3rd edition criteria based on questionnaires and polysomnograms. Clinically available serum ferritin levels were assessed. Results 167 participants underwent polysomnography and completed all questionnaires. The overall prevalence of RLS was 14/167 (8.4%). An additional 13 subjects (7.8%) were found to have PLMD. Of the 26 participants who had >5 periodic limb movements/hour, 7 (26.9%) had RLS and 13 (50%) had PLMD. Serum ferritin levels were <50 mcg/L (range 11 to 38.4) for all 8 participants referred for testing. Conclusions Children with a history of prematurity have a high prevalence of RLS, particularly those with elevated periodic limb movements. Iron deficiency likely contributes to RLS and PLMD symptoms in this population. Clinicians evaluating ex-preterm children with sleep disturbances should evaluate for RLS and PLMD. Further studies including serum ferritin evaluation are needed to confirm these findings. PMID:28215268

The influence of age, gender and education on the performance of healthy individuals on a battery for assessing limb apraxia.

PubMed

Mantovani-Nagaoka, Joana; Ortiz, Karin Zazo

2016-01-01

Apraxia is defined as a disorder of learned skilled movements, in the absence of elementary motor or sensory deficits and general cognitive impairment, such as inattention to commands, object-recognition deficits or poor oral comprehension. Limb apraxia has long been a challenge for clinical assessment and understanding and covers a wide spectrum of disorders, all involving motor cognition and the inability to perform previously learned actions. Demographic variables such as gender, age, and education can influence the performance of individuals on different neuropsychological tests. The present study aimed to evaluate the performance of healthy subjects on a limb apraxia battery and to determine the influence of gender, age, and education on the praxis skills assessed. Forty-four subjects underwent a limb apraxia battery, which was composed of numerous subtests for assessing both the semantic aspects of gestural production as well as motor performance itself. The tasks encompassed lexical-semantic aspects related to gestural production and motor activity in response to verbal commands and imitation. We observed no gender effects on any of the subtests. Only the subtest involving visual recognition of transitive gestures showed a correlation between performance and age. However, we observed that education level influenced subject performance for all sub tests involving motor actions, and for most of these, moderate correlations were observed between education level and performance of the praxis tasks. We conclude that the education level of participants can have an important influence on the outcome of limb apraxia tests.

Is Atherectomy the Best First-Line Therapy for Limb Salvage in Patients With Critical Limb Ischemia?

PubMed Central

Loor, Gabriel; Skelly, Christopher L.; Wahlgren, Carl-Magnus; Bassiouny, Hisham S.; Piano, Giancarlo; Shaalan, Wael

2010-01-01

Objective To determine the efficacy of atherectomy for limb salvage compared with open bypass in patients with critical limb ischemia. Methods Ninety-nine consecutive bypass and atherectomy procedures performed for critical limb ischemia between January 2003 and October 2006 were reviewed. Results A total of 99 cases involving TASC C (n = 43, 44%) and D (n = 56, 56%) lesions were treated with surgical bypass in 59 patients and atherectomy in 33 patients. Bypass and atherectomy achieved similar 1-year primary patency (64% vs 63%; P = .2). However, the 1-year limb salvage rate was greater in the bypass group (87% vs 69%; P = .004). In the tissue loss subgroup, there was a greater limb salvage rate for bypass patients versus atherectomy (79% vs 60%; P = .04). Conclusions Patients with critical limb ischemia may do better with open bypass compared with atherectomy as first-line therapy for limb salvage. PMID:19640919

Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy.

PubMed

Scott, Stephen H; Dukelow, Sean P

2011-01-01

Robotic technologies have profoundly affected the identification of fundamental properties of brain function. This success is attributable to robots being able to control the position of or forces applied to limbs, and their inherent ability to easily, objectively, and reliably quantify sensorimotor behavior. Our general hypothesis is that these same attributes make robotic technologies ideal for clinically assessing sensory, motor, and cognitive impairments in stroke and other neurological disorders. Further, they provide opportunities for novel therapeutic strategies. The present opinionated review describes how robotic technologies combined with virtual/augmented reality systems can support a broad range of behavioral tasks to objectively quantify brain function. This information could potentially be used to provide more accurate diagnostic and prognostic information than is available from current clinical assessment techniques. The review also highlights the potential benefits of robots to provide upper-limb therapy. Although the capital cost of these technologies is substantial, it pales in comparison with the potential cost reductions to the overall healthcare system that improved assessment and therapeutic interventions offer.

Ergonomic Training Reduces Musculoskeletal Disorders among Office Workers: Results from the 6-Month Follow-Up

PubMed Central

Mahmud, Norashikin; Kenny, Dianna Theadora; Md Zein, Raemy; Hassan, Siti Nurani

2011-01-01

Background: Musculoskeletal disorders are commonly reported among computer users. This study explored whether these disorders can be reduced by the provision of ergonomics education. Methods: A cluster randomised controlled trial was conducted in which 3 units were randomised for intervention and received training, and 3 units were given a leaflet. The effect of intervention on workstation habits, musculoskeletal disorders, days and episodes of sick leave, and psychological well-being were assessed. Results: A significant improvement in workstation habits was found, and the differences remained significant at the follow-up time point for keyboard, mouse, chair, and desk use. The largest reduction in the percentage of musculoskeletal disorders was in the neck region (−42.2%, 95% CI −60.0 to −24.4). After adjusting for baseline values, significant differences were found at the follow-up time point in the neck, right shoulder, right and left upper limbs, lower back, and right and left lower limbs. No significant differences were found for the days and episodes of sick leave or the psychological well-being among workers after the intervention. Conclusion: Consistent reductions were observed for all musculoskeletal disorders at the follow-up time point, although the difference was not statistically significant for the upper back. The improvements in the musculoskeletal disorders did not translate into fewer days lost from work or improved psychological well-being. PMID:22135582

The Differential Effect of Arm Movements during Gait on the Forward Acceleration of the Centre of Mass in Children with Cerebral Palsy and Typically Developing Children.

PubMed

Meyns, Pieter; Molenaers, Guy; Duysens, Jacques; Jonkers, Ilse

2017-01-01

Background: We aimed to study the contribution of upper limb movements to propulsion during walking in typically developing (TD) children ( n = 5) and children with hemiplegic and diplegic cerebral palsy (CP; n = 5 and n = 4, respectively). Methods: Using integrated three-dimensional motion capture data and a scaled generic musculoskeletal model that included upper limbs, we generated torque driven simulations of gait in OpenSim. Induced acceleration analyses were then used to determine the contributions of the individual actuators located at the relevant degrees of freedoms of the upper and lower limb joints to the forward acceleration of the COM at each time point of the gait simulation. The mean values of the contribution of the actuators of upper limbs, lower limbs, and gravity in different phases of the gait cycle were compared between the three groups. Findings: The results indicated a limited contribution of the upper limb actuators to COM forward acceleration compared to the contribution of lower limbs and gravity, in the three groups. In diplegic CP, the contribution of the upper limbs seemed larger compared to TD during the preswing and swing phases of gait. In hemiplegic CP, the unaffected arm seemed to contribute more to COM deceleration during (pre)swing, while the affected side contributed to COM acceleration. Interpretation: These findings suggest that in the presence of lower limb dysfunction, the contribution of the upper limbs to forward propulsion is altered, although they remain negligible compared to the lower limbs and gravity.

Severe Craniofacial Involvement due to Amniotic Band Sequence.

PubMed

Becerra-Solano, Luis Eduardo; Castañeda-Cisneros, Gema; Corona-Rivera, Jorge Roman; Díaz-Rodríguez, Manuel; Figuera, Luis Eduardo; López-Muñoz, Eunice; Nastasi-Catanese, José Antonio; Toscano-Flores, José Jesús; Ramírez-Dueñas, María de Lourdes; García-Ortíz, José Elias

2018-02-01

Disruptive amniotic band sequence (DABS) is a sporadic, non-familial disorder with unclear etiology. Diagnosis is based on clinical features because there is currently no reliable laboratory diagnostic tests. We describe six cases of DABS with severe craniofacial deformations, three with and three without classical constrictive limb deformation. The craniofacial deformities were delimited by peripheral sharply demarcated scarring. When a sharply demarcated linear disruptive craniofacial lesion is observed, DABS should be considered despite the absence of constrictive limb scarring.

Marfan syndrome (image)

MedlinePlus

Marfan syndrome is a disorder of connective tissue which causes skeletal defects typically recognized in a tall, lanky person. A person with Marfan syndrome may exhibit long limbs and spider-like fingers, ...

[Difficulties in the diagnosis in the case of subacute paraplegia in a woman with Addison-Biermer disease].

PubMed

Szupień, Elzbieta; Ositek, Bozena; Pniewski, Jarosław

2004-01-01

The following paper presents a case of presently rare serious and non-typical subacutely progressing neurological complications in Addison-Biermer disease in a period before the diagnosis, and effective treatment with vitamin B12 in the advanced process of the nervous system impairment. The patient was a 52-year-old woman with the following (increasingly severe) symptoms occurring over a period of 5 weeks, after an earlier non-related operation: paresis of lower limbs (up to paraplegia), slight paresis of upper limbs, sphincters disorder, numbness and the loss of sensation in the upper and lower limbs, and finally mental deterioration. The woman was admitted to a neurological clinic with the suspected Guillain-Bare syndrome. After an interview and medical examination, with the help of some additional tests and resulting clinical picture, it was diagnosed as the Addison-Biermer disorder. A typical treatment was started with vitamin B12 injections, with a neurological improvement within a week, and further gradual improvement over the following 5 weeks of treatment in the clinic (improvement in the strength, sensation in the limbs, functionality of the sphincters, and normalization of the cognitive functions). After 2 months of continuous pharmacological treatment and physical rehabilitation, the patient started to walk with the help of a walker, and after further 2 months, she was able to walk on her own with a crutch.

Upper-limb tremor suppression with a 7DOF exoskeleton power-assist robot.

PubMed

Kiguchi, Kazuo; Hayashi, Yoshiaki

2013-01-01

A tremor which is one of the involuntary motions is somewhat rhythmic motion that may occur in various body parts. Although there are several kinds of the tremor, an essential tremor is the most common tremor disorder of the arm. The essential tremor is a disorder of unknown cause, and it is common in the elderly. The essential tremor interferes with a patient's daily living activity, because it may occur during a voluntary motion. If a patient of an essential tremor uses an EMG-based controlled power-assist robot, the robot might misunderstand the user's motion intention because of the effect of the essential tremor. In that case, upper-limb power-assist robots must carry out tremor suppression as well as power-assist, since a person performs various precise tasks with certain tools by the upper-limb in daily living. Therefore, it is important to suppress the tremor at the hand and grasped tool. However, in the case of the tremor suppression control method which suppressed the vibrations of the hand and the tip of the tool, vibration of other part such as elbow might occur. In this paper, the tremor suppression control method for upper-limb power-assist robot is proposed. In the proposed method, the vibration of the elbow is suppressed in addition to the hand and the tip of the tool. The validity of the proposed method was verified by the experiments.

Children with congenital limb deficiency in Norway: issues related to school life and health-related quality of life. A cross-sectional study.

PubMed

Johansen, Heidi; Dammann, Brede; Øinæs Andersen, Liv; Andresen, Inger-Lise

2016-09-01

To describe clinical features, issues related to school life and health-related quality of life (HRQOL) for children with congenital limb deficiency (CLD) and compare these children to Norwegian school children on HRQOL. Cross-sectional study. In 2010, a postal questionnaire, designed for this study and the Paediatric Quality of Life Inventory (PedsQL), was sent to 154 eligible parents of children with CLD, aged 6-18 years and registered at TRS National Resource Centre for Rare Disorders in Norway. Response rate 44% (n = 67), median age 11 years, 42% were girls. Of the total group, 46 had unilateral upper limb deficiency (UULD) and 21 had multiple/lower limb deficiency (MLD/LLD). The most common UULD was below-elbow deficiency, of these, 65% used grip-improving devices, and 35% used prostheses. Children with UULD-reported PedsQL score similar to Norwegian schoolchildren (NSC). The MLD/LLD group was heterogeneous; most had below-elbow/knee deficiency. In this group, PedsQL scores were reduced for physical and social functioning compared with NSC. Compared with children with UULD, more children with MLD/LLD were restricted in participation because of pain and fewer participated in physical education with peers. Most children with CLD participated with their peers and managed well in everyday life. Children with MLD/LLD seemed to have more challenges than children with UULD. Approximately one-third of all the children had assistive devices and/or practical assistance in school. Implications for Rehabilitation Most children with upper-limb deficiency (UULD) in Norway manage well in everyday life and have HRQOL equal to other Norwegian children. Many choose grip-improving devices instead of prostheses. Their preferences should be respected and taken into account as the need for new assistive devices arise. For children with pronounced disabilities, access to, and use of, assistive devices, adaptions and practical assistance may be important for participation. Cooperation with the child and the parents is necessary to find useful measures. Physical education and practical subjects may provide special challenges, both for children and their teachers. Children themselves often find good solutions and the tasks should be planned ahead in cooperation with them.

Validity of the modified RULA for computer workers and reliability of one observation compared to six.

PubMed

Levanon, Yafa; Lerman, Yehuda; Gefen, Amit; Ratzon, Navah Z

2014-01-01

Awkward body posture while typing is associated with musculoskeletal disorders (MSDs). Valid rapid assessment of computer workers' body posture is essential for the prevention of MSD among this large population. This study aimed to examine the validity of the modified rapid upper limb assessment (mRULA) which adjusted the rapid upper limb assessment (RULA) for computer workers. Moreover, this study examines whether one observation during a working day is sufficient or more observations are needed. A total of 29 right-handed computer workers were recruited. RULA and mRULA were conducted. The observations were then repeated six times at one-hour intervals. A significant moderate correlation (r = 0.6 and r = 0.7 for mouse and keyboard, respectively) was found between the assessments. No significant differences were found between one observation and six observations per working day. The mRULA was found to be valid for the assessment of computer workers, and one observation was sufficient to assess the work-related risk factor.

[Musculoskeletal disorders in piano students of a conservatory].

PubMed

Bruno, S; Lorusso, A; Caputo, F; Pranzo, S; L'Abbate, N

2006-01-01

A four parts questionnaire administered to piano students of Conservatory "T. Schipa" of Lecce, southern Italy, was used to determine the prevalence of instrument-related problems. Among 121 responders, 48 (39.6%) were considered affected according to pre-established criteria. Univariate analyses showed statistical differences for mean age, number of hours spent playing per week, interval without breaks, lack of sport practice and acceptability of "No pain, no gain" criteria in students with music-related pains compared with not affected pianists. No association with hand site was found in pianists with only upper limbs diseases. The multivariate analyses performed by logistic regression confirmed the independent association for the risk factors age, lack of sport practice and acceptability of "No pain, no gain" criteria. Differently from several studies older students were more frequently affected and no difference in the prevalence rate was found in females. Findings suggest a probable causal contribution of fixed postures in the development of PRMDs in pianists in addition to repetitive movements of upper limbs.

Increased white matter metabolic rates in autism spectrum disorder and schizophrenia.

PubMed

Mitelman, Serge A; Buchsbaum, Monte S; Young, Derek S; Haznedar, M Mehmet; Hollander, Eric; Shihabuddin, Lina; Hazlett, Erin A; Bralet, Marie-Cecile

2017-11-22

Both autism spectrum disorder (ASD) and schizophrenia are often characterized as disorders of white matter integrity. Multimodal investigations have reported elevated metabolic rates, cerebral perfusion and basal activity in various white matter regions in schizophrenia, but none of these functions has previously been studied in ASD. We used 18 fluorodeoxyglucose positron emission tomography to compare white matter metabolic rates in subjects with ASD (n = 25) to those with schizophrenia (n = 41) and healthy controls (n = 55) across a wide range of stereotaxically placed regions-of-interest. Both subjects with ASD and schizophrenia showed increased metabolic rates across the white matter regions assessed, including internal capsule, corpus callosum, and white matter in the frontal and temporal lobes. These increases were more pronounced, more widespread and more asymmetrical in subjects with ASD than in those with schizophrenia. The highest metabolic increases in both disorders were seen in the prefrontal white matter and anterior limb of the internal capsule. Compared to normal controls, differences in gray matter metabolism were less prominent and differences in adjacent white matter metabolism were more prominent in subjects with ASD than in those with schizophrenia. Autism spectrum disorder and schizophrenia are associated with heightened metabolic activity throughout the white matter. Unlike in the gray matter, the vector of white matter metabolic abnormalities appears to be similar in ASD and schizophrenia, may reflect inefficient functional connectivity with compensatory hypermetabolism, and may be a common feature of neurodevelopmental disorders.

Xenomelia: a social neuroscience view of altered bodily self-consciousness.

PubMed

Brugger, Peter; Lenggenhager, Bigna; Giummarra, Melita J

2013-01-01

Xenomelia, the "foreign limb syndrome," is characterized by the non-acceptance of one or more of one's own extremities and the resulting desire for elective limb amputation or paralysis. Formerly labeled "body integrity identity disorder" (BIID), the condition was originally considered a psychological or psychiatric disorder, but a brain-centered Zeitgeist and a rapidly growing interest in the neural underpinnings of bodily self-consciousness has shifted the focus toward dysfunctional central nervous system circuits. The present article outlays both mind-based and brain-based views highlighting their shortcomings. We propose that full insight into what should be conceived a "xenomelia spectrum disorder" will require interpretation of individual symptomatology in a social context. A proper social neuroscience of xenomelia respects the functional neuroanatomy of corporeal awareness, but also acknowledges the brain's plasticity in response to an individual's history, which is lived against a cultural background. This integrated view of xenomelia will promote the subfield of consciousness research concerned with the unity of body and self.

Insight into an Autism Spectrum Disorder

ERIC Educational Resources Information Center

Birch, Jen

2006-01-01

In this article, the author shares some insights on the characteristics of a person with Asperger's syndrome, a condition on the higher-functioning end of autism spectrum disorders (ASD). Born in 1955, the author was raised in rural South Auckland. As a baby, she propelled herself around the floor on her stomach, using her limbs as flippers,…

Differences in ergonomic and workstation factors between computer office workers with and without reported musculoskeletal pain.

PubMed

Rodrigues, Mirela Sant'Ana; Leite, Raquel Descie Veraldi; Lelis, Cheila Maira; Chaves, Thaís Cristina

2017-01-01

Some studies have suggested a causal relationship between computer work and the development of musculoskeletal disorders. However, studies considering the use of specific tools to assess workplace ergonomics and psychosocial factors in computer office workers with and without reported musculoskeletal pain are scarce. The aim of this study was to compare the ergonomic, physical, and psychosocial factors in computer office workers with and without reported musculoskeletal pain (MSP). Thirty-five computer office workers (aged 18-55 years) participated in the study. The following evaluations were completed: Rapid Upper Limb Assessment (RULA), Rapid Office Strain Assessment (ROSA), and Maastricht Upper Extremity Questionnaire revised Brazilian Portuguese version (MUEQ-Br revised). Student t-tests were used to make comparisons between groups. The computer office workers were divided into two groups: workers with reported MSP (WMSP, n = 17) and workers without positive report (WOMSP, n = 18). Those in the WMSP group showed significantly greater mean values in the total ROSA score (WMSP: 6.71 [CI95% :6.20-7.21] and WOMSP: 5.88 [CI95% :5.37-6.39], p = 0.01). The WMSP group also showed higher scores in the chair section of the ROSA, workstation of MUEQ-Br revised, and in the upper limb RULA score. The chair height and armrest sections from ROSA showed the higher mean values in workers WMSP compared to workers WOMSP. A positive moderate correlation was observed between ROSA and RULA total scores (R = 0.63, p < 0.001). Our results demonstrated that computer office workers who reported MSP had worse ergonomics indexes for chair workstation and worse physical risk related to upper limb (RULA upper limb section) than workers without pain. However, there were no observed differences in workers with and without MSP regarding work-related psychosocial factors. The results suggest that inadequate workstation conditions, specifically the chair height, arm and back rest, are linked to improper upper limb postures and that these factors are contributing to MSP in computer office workers.

Upper-limb motor and sensory function in patients with hip fracture: Comparison with community-dwelling older adults.

PubMed

Hayashi, Hiroyuki; Nakashima, Daiki; Matsuoka, Hiroka; Iwai, Midori; Nakamura, Shugo; Kubo, Ayumi; Tomiyama, Naoki

2017-11-06

Upper-limb function is important in patients with hip fracture so they can perform activities of daily living and participate in leisure activities. Upper-limb function of these patients, however, has not been thoroughly investigated. The aim of this study was to evaluate the upper-limb motor and sensory functions in patients with hip fracture by comparing these functions with those of community-dwelling older adults (control group). We compared the results of motor and sensory function tests of upper-limb function - range of motion, strength, sensibility, finger dexterity, comprehensive hand function - between patients with hip fracture (n= 32) and the control group (n= 32). Patients with hip fracture had significantly reduced grip strength, pinch strength, finger dexterity, and comprehensive hand function compared with the control group. Most upper-limb functions are impaired in the patients with hip fracture. Thus, upper-limb function of patients with hip fracture should be considered during treatment.

[Clinical relevance of periodic limb movements during sleep in obstructive sleep apnea patients].

PubMed

Iriarte, J; Alegre, M; Irimia, P; Urriza, J; Artieda, J

The periodic limb movements disorder (PLMD) is frequently associated with the obstructive sleep apnea syndrome (OSAS), but the prevalence and clinical relevance of this association have not been studied in detail. The objectives were to make a prospective study on the prevalence of PLMD in patients with OSAS, and correlate this association with clinical and respiratory parameters. Forty-two patients diagnosed with OSAS, without clinical suspicion of PLMD, underwent a polysomnographic study. Clinical symptoms and signs were evaluated with an structured questionnaire, and respiratory parameters were obtained from the nocturnal study. Periodic limb movements were found in 10 patients (24%). There were no differences in clinical parameters between both groups (with and without periodical limb movements). However, respiratory parameters were significantly worse in patients without PLMD. PLMD is very frequent in patients with OSAS, and can contribute to worsen clinical signs and symptoms in these patients independently from respiratory parameters.

Influence of maturation on instep kick biomechanics in female soccer athletes.

PubMed

Lyle, Mark A; Sigward, Susan M; Tsai, Liang-Ching; Pollard, Christine D; Powers, Christopher M

2011-10-01

The purpose of this study was to compare kicking biomechanics between young female soccer players at two different stages of physical maturation and to identify biomechanical predictors of peak foot velocity. Swing and stance limb kinematics and kinetics were recorded from 20 female soccer players (10 prepubertal, 10 postpubertal) while kicking a soccer ball using an angled two-step approach. Peak foot velocity as well as hip and knee kinematics and kinetics were compared between groups using independent-samples t-tests. Pearson correlation coefficients and stepwise multiple regression were used to identify predictors of peak foot velocity. Peak foot velocity and the peak swing limb net hip flexor moment was significantly greater in the postpubertal group when compared with the prepubertal group (13.4 vs 11.6 m·s(-1), P = 0.003; 1.22 vs 1.07 N·m·kg(-1)·m(-1), P = 0.03). Peak stance limb hip and knee extensor moments were not different between groups. Although the peak swing limb hip and knee flexion angles were similar between groups, the postpubertal group demonstrated significantly less peak stance limb hip and knee flexion angles when compared with the prepubertal group (P < 0.001 and P = 0.045). Using a linear regression model, swing limb peak hip flexor moment and peak swing limb hip extension range of motion combined to explain 65% of the variance in peak foot velocity. Despite a difference in stance limb kinematics, similar swing limb kinematics between groups indicates that the prepubertal female athletes kicked with a mature swing limb kick pattern. The ability to generate a large hip flexor moment of the swing limb seems to be an important factor for improving kicking performance in young female soccer players.

An integrative review of health-related quality of life in patients with critical limb ischaemia.

PubMed

Monaro, Susan; West, Sandra; Gullick, Janice

2017-10-01

To examine the domains and the domain-specific characteristics within a peripheral arterial disease health-related quality of life framework for their usefulness in defining critical limb ischaemia health-related quality of life. Critical Limb Ischaemia presents a highly individualised set of personal and health circumstances. Treatment options include conservative management, revascularisation or amputation. However, the links between treatment decisions and quality of life require further investigation. The framework for this integrative review was the peripheral arterial disease-specific health-related quality of life domains identified by Treat-Jacobson et al. The literature expanded and refined Treat-Jacobson's framework by modifying the characteristics to better describe health-related quality of life in critical limb ischaemia. Given that critical limb ischaemia is a highly individualised situation with powerful health-related quality of life implications, further research focusing on patient and family-centred decision-making relating to therapeutic options and advanced care planning is required. A critical limb ischaemia-specific, health-related quality of life tool is required to capture both the unique characteristics of this disorder, and the outcomes for active or conservative care among this complex group of patients. © 2016 John Wiley & Sons Ltd.

Comparison of risk assessment procedures used in OCRA and ULRA methods

PubMed Central

Roman-Liu, Danuta; Groborz, Anna; Tokarski, Tomasz

2013-01-01

The aim of this study was to analyse the convergence of two methods by comparing exposure and the assessed risk of developing musculoskeletal disorders at 18 repetitive task workstations. The already established occupational repetitive actions (OCRA) and the recently developed upper limb risk assessment (ULRA) produce correlated results (R = 0.84, p = 0.0001). A discussion of the factors that influence the values of the OCRA index and ULRA's repetitive task indicator shows that both similarities and differences in the results produced by the two methods can arise from the concepts that underlie them. The assessment procedure and mathematical calculations that the basic parameters are subjected to are crucial to the results of risk assessment. The way the basic parameters are defined influences the assessment of exposure and risk assessment to a lesser degree. The analysis also proved that not always do great differences in load indicator values result in differences in risk zones. Practitioner Summary: We focused on comparing methods that, even though based on different concepts, serve the same purpose. The results proved that different methods with different assumptions can produce similar assessment of upper limb load; sharp criteria in risk assessment are not the best solution. PMID:24041375

Primordial Dwarfism

MedlinePlus

... Topics Gait & Motion Analysis Genetic Disorders Limb Length Discrepancy Orthopedics Orthotics Primordial Dwarfism Locations & Doctors About Primordial ... Sign-In » Patient-Family Resources Insurance We Accept Pay My Bill Financial Assistance Medical Records Support Services ...

[Interrelationship between lower limb varicosity, the grade of connective tissue dysplasia and atrial fibrillation in patients with coronary artery disease].

PubMed

Forster, O V; Tsarev, O A; Shvarts, Iu G

2006-01-01

To determine interrelationship between lower limb varicosity, the clinical grade of non-differentiated dysplasia of the connective tissue and atrial fibrillation in patients with coronary artery disease (CAD). Altogether 156 coronary patients were examined. Persistent atrial fibrillation was present in 58 and chronic in 38 patients. The reference group comprised 60 patients without evident rhythm disorders in persons suffering from CAD. Markers of connective tissue dysplasia () were revealed on the part of the skeleton, joints skin and visceral organs. Lower limb varicosity was recorded as well. The number of the stigmas in the study groups was different. So, in the patient group without rhythm disorders, the mean number of the stigmas was equal to 3, which is a variant of normal. In the groups with persistent and constant AF, this indicator was equal to 4.7 and 5.2 respectively (p<0.05). The number of patients with evident signs of CID (the number of stigmas 5) was greater in the groups with AP than among patients with normal rhythm. Varicosity was recorded in 41% of both group patients. It is to be noted that in the group with normal rhythm, lower limb varicosity was encountered in 22.1% of cases whereas in the group with AF, in 58.4% of cases with persistent AF and in 41% of cases with constant AF. The mean number of stigmas in the group without varicosity accounted for 3.6 and in patients with varicosity - for 5 (P<0.05). When coronary artery disease is coupled with atrial fibrilation there is a direct close correlation between the signs of connective tissue dysplasia and lower limb varicosity. In patients with persistent AF lower limb varicosity occurs more frequently than in CAD patients with normal rhythm.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Lower Limb Functional Index.

PubMed

Duruturk, Neslihan; Tonga, Eda; Gabel, Charles Philip; Acar, Manolya; Tekindal, Agah

2015-07-26

This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. The LLFI was translated into Turkish and cross-culturally adapted with a double forward-backward protocol that determined face and content validity. Individuals (n = 120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson's r), internal consistency (Cronbachs α) and test-retest reliability (intraclass correlation coefficient - ICC 2.1 ). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC 90 ), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. The psychometric characteristics showed strong criterion validity (r = 0.74-0.76), high internal consistency (α = 0.82) and high test-retest reability (ICC 2.1  = 0.97). The SEM of 3.2% gave an MDC 90  = 5.8%. The factor structure was uni-dimensional. Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population. Implications for Rehabilitation Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life. Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care. The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

Low typing endurance in keyboard workers with work-related upper limb disorder

PubMed Central

Povlsen, Bo

2011-01-01

Objective To compare results of typing endurance and pain before and after a standardized functional test. Design A standardized previously published typing test on a standard QWERTY keyboard. Setting An outpatient hospital environment. Participants Sixty-one keyboard and mouse operating patients with WRULD and six normal controls. Main outcome measure Pain severity before and after the test, typing endurance and speed were recorded. Results Thirty-two patients could not complete the test before pain reached VAS 5 and this group only typed a mean of 11 minutes. The control group and the remaining group of 29 patients completed the test. Two-tailed student T test was used for evaluation. The endurance was significantly shorter in the patient group that could not complete the test (P < 0.00001) and the pain levels were also higher in this group both before (P = 0.01) and after the test (P = 0.0003). Both patient groups had more pain in the right than the left hand, both before and after typing. Conclusions Low typing endurance correlates statistically with more resting pain in keyboard and mouse operators with work-related upper limb disorder and statistically more pain after a standardized typing test. As the right hands had higher pain levels, typing alone may not be the cause of the pain as the left hand on a QWERTY keyboard does relative more keystrokes than the right hand. PMID:21637395

Developmental origin of limb size variation in lizards.

PubMed

Andrews, Robin M; Skewes, Sable A

2017-05-01

In many respects, reptile hatchlings are fully functional, albeit miniature, adults. This means that the adult morphology must emerge during embryonic development. This insight emphasizes the connection between the mechanisms that generate phenotypic variation during embryonic development and the action of selection on post-hatching individuals. To determine when species-specific differences in limb and tail lengths emerge during embryonic development, we compared allometric patterns of early limb growth of four distantly related species of lizards. The major questions addressed were whether early embryonic limb and tail growth is characterized by the gradual (continuous allometry) or by the abrupt emergence (transpositional allometry) of size differences among species. Our observations supported transpositional allometry of both limbs and tails. Species-specific differences in limb and tail length were exhibited when limb and tail buds first protruded from the body wall. Genes known to be associated with early limb development of tetrapods are obvious targets for studies on the genetic mechanisms that determine interspecific differences in relative limb length. Broadly comparative studies of gene regulation would facilitate understanding of the mechanisms underlying adaptive variation in limb size, including limb reduction and loss, of squamate reptiles. © 2017 Wiley Periodicals, Inc.

Genetics Home Reference: congenital contractural arachnodactyly

MedlinePlus

... 9 Related Information How are genetic conditions and genes named? Additional Information & Resources MedlinePlus (5 links) Encyclopedia: Arachnodactyly Encyclopedia: Contracture Deformity Encyclopedia: Skeletal Limb Abnormalities Health Topic: Connective Tissue Disorders Health ...

[Ulnar nerve tunnel syndrome of the elbow and an occupational disorder. Analysis of socio-professional and physical parameters].

PubMed

Pellieux, S; Fouquet, B; Lasfargues, G

2001-05-01

The ulnar nerve tunnel syndrome at the elbow is the second frequently tunnel syndrome, registered as an occupational disorder. The musculoskeletal troubles of the upper limb are now a public health challenge. These disorders allow manifold risk factors related to the work state, extrinsic to the patient, and related to individual factors, or intrinsic. In the same venture, 25 patients with a UNTS, declared as an occupational disorder, have been compared to 48 individuals (T). Intrinsic (physical and psychological) and extrinsic parameters have been evaluated by a questionnaire, physical examination completed by an investigation in the venture. The Nottingham Health Profile was performed by all the individuals. All the cases of UNTS were observed after an increase of the production and a change in the work organization. Only 50% of the declared UNTS have a typical topography of the pain. No UNTS patient had neurological objective motor and sensitive deficit. 52% of the UNTS patients had diffused physical disorders comparatively to 17% of the T population. Stress events were observed more frequently in the UNTS population than in the T population: in the living area, in respectively 96% and 52% of the cases, at the work place in 12% and 2%. 50% of the UNTS population was distress comparatively to 17% of the T population. The NHP score was significantly higher in the UNTS population than the T population. These data confirm the mutual influences of individual factors, physical and psychological, and of workplace factors in the occurrence of painful disorders related to an occupational activity. The therapeutic approach of these patients must be done with a physical, psychological and social evaluation.

Experimental evaluation of rigor mortis. III. Comparative study of the evolution of rigor mortis in different sized muscle groups in rats.

PubMed

Krompecher, T; Fryc, O

1978-01-01

The use of new methods and an appropriate apparatus has allowed us to make successive measurements of rigor mortis and a study of its evolution in the rat. By a comparative examination on the front and hind limbs, we have determined the following: (1) The muscular mass of the hind limbs is 2.89 times greater than that of the front limbs. (2) In the initial phase rigor mortis is more pronounced in the front limbs. (3) The front and hind limbs reach maximum rigor mortis at the same time and this state is maintained for 2 hours. (4) Resolution of rigor mortis is accelerated in the front limbs during the initial phase, but both front and hind limbs reach complete resolution at the same time.

Hereditary motor and sensory neuropathy-russe: new autosomal recessive neuropathy in Balkan Gypsies.

PubMed

Thomas, P K; Kalaydjieva, L; Youl, B; Rogers, T; Angelicheva, D; King, R H; Guergueltcheva, V; Colomer, J; Lupu, C; Corches, A; Popa, G; Merlini, L; Shmarov, A; Muddle, J R; Nourallah, M; Tournev, I

2001-10-01

A novel peripheral neuropathy of autosomal recessive inheritance has been identified in Balkan Gypsies and termed hereditary motor and sensory neuropathy-Russe (HMSN-R). We investigated 21 affected individuals from 10 families. Distal lower limb weakness began between the ages of 8 and 16 years, upper limb involvement beginning between 10 and 43 years, with an average of 22 years. This progressive disorder led to severe weakness of the lower limbs, generalized in the oldest subject (aged 57 years), and marked distal upper limb weakness. Prominent distal sensory loss involved all modalities, resulting in neuropathic joint degeneration in two instances. All patients showed foot deformity, and most showed hand deformity. Motor nerve conduction velocity was moderately reduced in the upper limbs but unobtainable in the legs. Sensory nerve action potentials were absent. There was loss of larger myelinated nerve fibers and profuse regenerative activity in the sural nerve. HMSN-R is a new form of autosomal recessive inherited HMSN caused by a single founder mutation in a 1 Mb interval on chromosome 10q.

The functional anatomy of suggested limb paralysis.

PubMed

Deeley, Quinton; Oakley, David A; Toone, Brian; Bell, Vaughan; Walsh, Eamonn; Marquand, Andre F; Giampietro, Vincent; Brammer, Michael J; Williams, Steven C R; Mehta, Mitul A; Halligan, Peter W

2013-02-01

Suggestions of limb paralysis in highly hypnotically suggestible subjects have been employed to successfully model conversion disorders, revealing similar patterns of brain activation associated with attempted movement of the affected limb. However, previous studies differ with regard to the executive regions involved during involuntary inhibition of the affected limb. This difference may have arisen as previous studies did not control for differences in hypnosis depth between conditions and/or include subjective measures to explore the experience of suggested paralysis. In the current study we employed functional magnetic resonance imaging (fMRI) to examine the functional anatomy of left and right upper limb movements in eight healthy subjects selected for high hypnotic suggestibility during (i) hypnosis (NORMAL) and (ii) attempted movement following additional left upper limb paralysis suggestions (PARALYSIS). Contrast of left upper limb motor function during NORMAL relative to PARALYSIS conditions revealed greater activation of contralateral M1/S1 and ipsilateral cerebellum, consistent with the engagement of these regions in the completion of movements. By contrast, two significant observations were noted in PARALYSIS relative to NORMAL conditions. In conjunction with reports of attempts to move the paralysed limb, greater supplementary motor area (SMA) activation was observed, a finding consistent with the role of SMA in motor intention and planning. The anterior cingulate cortex (ACC, BA 24) was also significantly more active in PARALYSIS relative to NORMAL conditions - suggesting that ACC (BA 24) may be implicated in involuntary, as well as voluntary inhibition of prepotent motor responses. Copyright © 2012 Elsevier Ltd. All rights reserved.

Growth characteristics of fibroblasts isolated from the trunk and distal aspect of the limb of horses and ponies.

PubMed

Miller, C B; Wilson, D A; Keegan, K G; Kreeger, J M; Adelstein, E H; Ganjam, V K

2000-01-01

To determine if there is a difference in in vitro growth of fibroblasts isolated from the trunk and distal aspect of the limb of horses and ponies. To determine the effects of a corticosteroid and monokine on in vitro growth of fibroblasts isolated from the trunk and distal aspect of the limb of horses and ponies. Growth of fibroblasts from tissues harvested from the trunk and limb were compared from horse and pony samples grown in control media and control media with triamcinolone or monokine added. Dermal and subcutaneous tissue from 22 horses and 17 ponies of various ages and breeds. Fibroblast growth was assessed by tritiated thymidine uptake using standard cell culture techniques. The effect of a monokine or triamcinolone plus control media were compared with control media for fibroblast growth. Fibroblast growth from tissues isolated from the horse limb was significantly less than growth from the horse trunk and the limb and trunk of ponies. Monokine was more effective than triamcinolone in suppressing fibroblast growth from tissues isolated from the trunk and limb in both horses and ponies. There are growth differences in fibroblasts isolated from the limb of horses compared with those isolated from the trunk and from the limb and trunk of ponies. The difference in fibroblast growth from tissues isolated from the trunk and limb of horses and ponies may provide evidence for the difference reported in the healing characteristics of limb wounds in horses and ponies. Influencing fibroblast growth may provide a key to controlling the development of exuberant granulation tissue in horses and ponies.

The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder.

PubMed

Hung, Ching-I; Liu, Chia-Yih; Chen, Ching-Yen; Yang, Ching-Hui; Wang, Shuu-Jiun

2014-11-10

No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.

Classical test theory and Rasch analysis validation of the Upper Limb Functional Index in subjects with upper limb musculoskeletal disorders.

PubMed

Bravini, Elisabetta; Franchignoni, Franco; Giordano, Andrea; Sartorio, Francesco; Ferriero, Giorgio; Vercelli, Stefano; Foti, Calogero

2015-01-01

To perform a comprehensive analysis of the psychometric properties and dimensionality of the Upper Limb Functional Index (ULFI) using both classical test theory and Rasch analysis (RA). Prospective, single-group observational design. Freestanding rehabilitation center. Convenience sample of Italian-speaking subjects with upper limb musculoskeletal disorders (N=174). Not applicable. The Italian version of the ULFI. Data were analyzed using parallel analysis, exploratory factor analysis, and RA for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices. Parallel analysis revealed 2 factors explaining 32.5% and 10.7% of the response variance. RA confirmed the failure of the unidimensionality assumption, and 6 items out of the 25 misfitted the Rasch model. When the analysis was rerun excluding the misfitting items, the scale showed acceptable fit values, loading meaningfully to a single factor. Item separation reliability and person separation reliability were .98 and .89, respectively. Cronbach alpha was .92. RA revealed weakness of the scale concerning dimensionality and internal construct validity. However, a set of 19 ULFI items defined through the statistical process demonstrated a unidimensional structure, good psychometric properties, and clinical meaningfulness. These findings represent a useful starting point for further analyses of the tool (based on modern psychometric approaches and confirmatory factor analysis) in larger samples, including different patient populations and nationalities. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Optimizing Positioning for In-Office Otology Procedures.

PubMed

Govil, Nandini; DeMayo, William M; Hirsch, Barry E; McCall, Andrew A

2017-01-01

Objective Surgeons often report musculoskeletal discomfort in relation to their practice, but few understand optimal ergonomic positioning. This study aims to determine which patient position-sitting versus supine-is ergonomically optimal for performing otologic procedures. Study Design Observational study. Setting Outpatient otolaryngology clinic setting in a tertiary care facility. Subjects and Methods We observed 3 neurotologists performing a standardized simulated cerumen debridement procedure on volunteers in 2 positions: sitting and supine. The Rapid Upper Limb Assessment (RULA)-a validated tool that calculates stress placed on the upper limb during a task-was used to evaluate ergonomic positioning. Scores on this instrument range from 1 to 7, with a score of 1 to 2 indicating negligible risk of developing posture-related injury. The risk of musculoskeletal disorders increases as the RULA score increases. Results In nearly every trial, RULA scores were lower when the simulated patient was placed in the supine position. When examined as a group, the median RULA scores were 5 with the patient sitting and 3 with the patient in the supine position ( P < .0001). When the RULA scores of the 3 neurotologists were examined individually, each had a statistically significant decrease in score with the patient in the supine position. Conclusion This study indicates that patient position may contribute to ergonomic stress placed on the otolaryngologist's upper limb during in-office otologic procedures. Otolaryngologists should consider performing otologic procedures with the patient in the supine position to decrease their own risk of developing upper-limb musculoskeletal disorders.

Comparison of 2-limb versus 3-limb electrodiagnostic studies in the evaluation of chronic inflammatory demyelinating polyneuropathy.

PubMed

Vo, Mary L; Hanineva, Aneliya; Chin, Russell L; Carey, Bridget T; Latov, Norman; Langsdorf, Jennifer A

2015-04-01

European Federation of Neurological Societies/Peripheral Nerve Society electrodiagnostic (EDx) criteria for the definite diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) require the presence of demyelinating findings (DF) in at least 2 nerves. Data are lacking, however, regarding the optimal number of nerves to test. We retrospectively reviewed EDx data from 53 patients with CIDP and compared the number of DF found on 2- and 3-limb testing. A median of 3 (range 2-5) DF were found on 2-limb testing compared with 5 (range 4-7) DF when 3 limbs were evaluated. Two-limb EDx studies were sufficient to diagnose definite CIDP in 92.3% of typical, 84.2% of asymmetric, and 66.7% of distal phenotypes. Testing a third limb increased diagnostic certainty in 11 patients (20.8%) to definite CIDP. Three-limb testing may increase diagnostic sensitivity of definite CIDP, especially in patients with atypical phenotypes. Larger prospective studies are needed to better assess the benefit of performing 3-limb EDx studies. © 2014 Wiley Periodicals, Inc.

Factors associated with non-return to work in the severely injured victims 3 years after a road accident: A prospective study.

PubMed

Pélissier, C; Fort, E; Fontana, L; Charbotel, B; Hours, M

2017-09-01

Road accidents may impact victims' physical and/or mental health and socio-occupational life, particularly the capacity to return to work. The purpose of our study is to assess modifiable medical and socio-occupational factors of non-return to work in the severely injured 3 years after a road accident. Among1,168 road accidents casualties in the Rhône administrative Département of France followed for five years, 141 of the 222 severely injured (Maximal Abbreviated Injury Scale ≥ 3) aged more than 16 years who were in work at the time of the accident, reported whether they had returned to work in the 3 years following the accident. The subgroups of those who had (n=113) and had not returned to work (n=28) were compared for socio-occupational (gender, age, educational level, marital status, socio-occupational group) accident-related medical factors (type of road user, type of journey, responsibility in the accident, initial care) and post-accident medical factors (pain intensity, post-traumatic stress disorder, physical sequelae, quality of life) by using standardized tools. Severity of initial head, face and lower-limb injury, intense persistent pain, post-traumatic stress disorder, poor self-assessed quality of life and health status at 3 years were associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head and lower-limb injury, intense persistent pain at 3 years and post-traumatic stress disorder were significantly associated with non-return to work 3 years following severe road-accident injury. Post-traumatic stress disorder and chronic pain were essential modifiable medical determinants of non-return to work in the severely injured after a road accident: early adapted management could promote return to work in the severely injured. Improve early adapted treatment of pain and PTSD in the rehabilitation team should help the severely injured return to work following a road accident. Copyright © 2017 Elsevier Ltd. All rights reserved.

Normal sensorimotor plasticity in complex regional pain syndrome with fixed posture of the hand.

PubMed

Morgante, Francesca; Naro, Antonino; Terranova, Carmen; Russo, Margherita; Rizzo, Vincenzo; Risitano, Giovanni; Girlanda, Paolo; Quartarone, Angelo

2017-01-01

Movement disorders associated with complex regional pain syndrome type I have been a subject of controversy over the last 10 years regarding their nature and pathophysiology, with an intense debate about the functional (psychogenic) nature of this disorder. The aim of this study was to test sensorimotor plasticity and cortical excitability in patients with complex regional pain syndrome type I who developed a fixed posture of the hand. Ten patients with complex regional pain syndrome type I in the right upper limb and a fixed posture of the hand (disease duration less than 24 months) and 10 age-matched healthy subjects were enrolled. The following parameters of corticospinal excitability were recorded from the abductor pollicis brevis muscle of both hands by transcranial magnetic stimulation: resting and active motor thresholds, short-interval intracortical inhibition and facilitation, cortical silent period, and short- and long-latency afferent inhibition. Sensorimotor plasticity was tested using the paired associative stimulation protocol. Short-interval intracortical inhibition and long-latency afferent inhibition were reduced only in the affected right hand of patients compared with control subjects. Sensorimotor plasticity was comparable to normal subjects, with a preserved topographic specificity. Our data support the view that motor disorder in complex regional pain syndrome type I is not associated with abnormal sensorimotor plasticity, and it shares pathophysiological abnormalities with functional (psychogenic) dystonia rather than with idiopathic dystonia. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

Study of biomechanical overload in urban gardeners of Barcelona: application of analytical models for risk exposure evaluation in annual working cycle.

PubMed

Alvarez-Casado, Enrique; Hernandez-Soto, Aquiles; Tello, Sandoval; Gual, Rosa

2012-01-01

Occupational musculoskeletal disorders in the upper limbs and its consequences on the impact and prevalence in the work force are subject of many investigations in almost all the production fields. However, the exposure to this kind of risk factor on urban gardeners has not been well studied so far. The kind of plant varieties used in the parks, the tools that they use, as much as the necessary actions for the maintenance of the park, have an impact on the biomechanical overload of the upper limbs. Additionally, the analysis of the exposure to the biomechanical overload on upper limbs in gardening work is a complex task, mainly because it is an activity highly variable and of annual cycle. For this reason an analytical model for risk exposure evaluation is necessary. During this research the work activity of 29 gardeners in 3 urban parks of Barcelona has been analyzed. Each park has a specific acting plan, in relation with the quantity and the typology of vegetal species, its classification and the season of the year. Work and observation and video recording sessions on-site were conducted. The video-graphic registration was done on workers without any prior musculoskeletal disorder and with a minimum labour experience of 5 years. Moreover, the analysis of saturation time, considered as the relation of the repetitive working hours in reference with the hours of effective work was done. Using the registered tasks on video, the biomechanical overload on upper limbs applying the OCRA Checklist method was analyzed. A methodological procedure to analyze the risk exposure in annual working cycle has been proposed. The results that we got allow us to get information that can help in the assignment of the tasks and in the training of staff, as well as in the recommendations of the urban landscape's design. All these aspects have the goal to decrease the risk to develop work-related musculoskeletal disorders.

Quantitative gait analysis in parkin disease: Possible role of dystonia.

PubMed

Castagna, Anna; Frittoli, Serena; Ferrarin, Maurizio; Del Sorbo, Francesca; Romito, Luigi M; Elia, Antonio E; Albanese, Alberto

2016-11-01

Parkin disease (PARK2, OMIM 602544) is an autosomal-recessive early-onset parkinsonism characterized by an early occurrence of lower limb dystonia. The aim of this study was to analyze spatiotemporal, kinematic, and kinetic gait parameters in patients with parkin disease in the OFF and ON conditions compared to healthy age-matched controls. Fifteen patients with parkin disease and 15 healthy age-matched controls were studied in a gait analysis laboratory with an integrated optoelectronic system. Spatiotemporal, kinematic, and kinetic gait parameters at a self-selected speed were recorded in the OFF and ON conditions. A jerk index was computed to quantify the possible reduction of smoothness of joint movements. Compared to controls, parkin patients had, either in the OFF or in the ON conditions, significant reduction of walking velocity, increased step width, and decreased percentage of double support. Kinematic analysis in both conditions showed: increased ankle dorsiflexion and knee flexion at the initial contact; maximal flexion and increased range of motion in mid stance; increased hip flexion and max extension in stance at pelvis; and increased mean tilt antiversion. Kinetics showed increased hip and knee power generation in stance in either condition. The jerk index was increased at all joints both in OFF and ON. There were no correlations between individual gait parameters and clinical ratings. Parkin patients have an abnormal gait pattern that does not vary between the OFF and the ON conditions. Variations recorded with instrumented analysis are more evident for kinematic than kinetic parameters at lower limbs. Severity of dystonia does not correlate with any individual kinematic parameter. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

Validity of Nordic-style questionnaires in the surveillance of upper-limb work-related musculoskeletal disorders

PubMed Central

Descatha, Alexis; Roquelaure, Yves; Chastang, Jean-François; Evanoff, Bradley; Melchior, Maria; Mariot, Camille; Ha, Catherine; Imbernon, Ellen; Goldberg, Marcel; Leclerc, Annette

2007-01-01

Objectives The study aimed to compare results of the standardized Nordic-style questionnaire to those of a clinical examination in two large surveys on upper-limb work-related musculoskeletal disorders (UWMSD). Methods The “Repetitive task” survey based on 1757 workers in 1993–1994 and 598 workers in 1996–1997 aimed at studying UWMSD risk factors in a population exposed to repetitive work. The “Pays de la Loire” survey, based on 2685 workers in 2002–2003, was part of a population-wide surveillance system. In both surveys, each worker completed a Nordic-style questionnaire and underwent a standardized clinical examination. Presence of at least one UWMSD was compared, with evaluation of sensitivity, specificity, and kappa value, considering clinical examination as the reference method. In the second survey, a score based on a numeric scale for severity of symptoms at the time of examination was evaluated in the same way (plus ROC curves). Results Agreement between questionnaire and examination was different in the two surveys: from kappa=0.22 [0.19–0.23] in the “Pays de la Loire” survey to 0.77 [0.74–0.80] in 1993–1994 in the “Repetitive task” survey. Sensitivity was excellent in all situations (from 82.3% to 100%). Specificity was variable, from 51.1% in the “Pays de la Loire” survey to 82.4% for score ≥ 2 based on the severity of symptoms in the survey. Conclusion Nordic-style questionnaires exploring symptoms in the past year can be considered as useful tools for surveillance of UWMSD, especially if they include numerical scales on symptom severity. Physical examination remains essential for a medical or clinical diagnosis assessment. PMID:17353966

Gain-of-function mutation of a voltage-gated sodium channel NaV1.7 associated with peripheral pain and impaired limb development.

PubMed

Tanaka, Brian S; Nguyen, Phuong T; Zhou, Eray Yihui; Yang, Yong; Yarov-Yarovoy, Vladimir; Dib-Hajj, Sulayman D; Waxman, Stephen G

2017-06-02

Dominant mutations in voltage-gated sodium channel Na V 1.7 cause inherited erythromelalgia, a debilitating pain disorder characterized by severe burning pain and redness of the distal extremities. Na V 1.7 is preferentially expressed within peripheral sensory and sympathetic neurons. Here, we describe a novel Na V 1.7 mutation in an 11-year-old male with underdevelopment of the limbs, recurrent attacks of burning pain with erythema, and swelling in his feet and hands. Frequency and duration of the episodes gradually increased with age, and relief by cooling became less effective. The patient's sister had short stature and reported similar complaints of erythema and burning pain, but with less intensity. Genetic analysis revealed a novel missense mutation in Na V 1.7 (2567G>C; p.Gly856Arg) in both siblings. The G856R mutation, located within the DII/S4-S5 linker of the channel, substitutes a highly conserved non-polar glycine by a positively charged arginine. Voltage-clamp analysis of G856R currents revealed that the mutation hyperpolarized (-11.2 mV) voltage dependence of activation and slowed deactivation but did not affect fast inactivation, compared with wild-type channels. A mutation of Gly-856 to aspartic acid was previously found in a family with limb pain and limb underdevelopment, and its functional assessment showed hyperpolarized activation, depolarized fast inactivation, and increased ramp current. Structural modeling using the Rosetta computational modeling suite provided structural clues to the divergent effects of the substitution of Gly-856 by arginine and aspartic acid. Although the proexcitatory changes in gating properties of G856R contribute to the pathophysiology of inherited erythromelalgia, the link to limb underdevelopment is not well understood. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

The risk of musculoskeletal disorders for workers due to repetitive movements during tomato harvesting.

PubMed

Cecchini, M; Colantoni, A; Massantini, R; Monarca, D

2010-04-01

Tomatoes are the most common crop in Italy. The production cycle requires operations in the field and factory that can cause musculoskeletal disorders due to the repetitive movements of the upper limbs of the workers employed in the sorting phase. This research aims to evaluate these risks using the OCRA (occupational repetitive actions) index method This method is based firstly on the calculation of a maximum number of recommended actions, related to the way the operation is performed, and secondly on a comparison of the number of actions effectively carried out by the upper limb with the recommended calculated value. The results of the risk evaluation for workers who manually sort tomatoes during harvest showed a risk for the workers, with an exposure index greater than 20; the OCRA index defines an index higher than 3.5 as unacceptable. The present trend of replacing manual sorting onboard a vehicle with optical sorters seems to be appropriate to reduce the risk of work-related musculoskeletal disorders (WMSDs) and is supported from both a financial point of view and as a quality control measure.

Diagnosing soft tissue rheumatic disorders of the upper limb in epidemiological studies of vibration-exposed populations

PubMed Central

Palmer, Keith T

2013-01-01

Objectives To investigate approaches adopted to diagnose soft tissue rheumatic disorders of the upper limb (ULDs) in vibration-exposed populations and in other settings, and to compare their methodological qualities. Methods Systematic searches were made of the Medline, Embase, and CINAHL electronic bibliographic databases, and of various supplementary sources (textbooks, reviews, conference and workshop proceedings, personal files). For vibration-exposed populations, qualifying papers were scored in terms of the provenance of their measuring instruments (adequacy of documentation, standardisation, reliability, criterion-related and content validity). Similar criteria were applied to general proposals for whole diagnostic schemes, and evidence was collated on the test-retest reliability of symptom histories and clinical signs. Results In total, 23 relevant reports were identified concerning vibration-exposed populations - 21 involving symptoms and 9 involving examination/diagnosis. Most of the instruments employed scored poorly in terms of methodological quality. The search also identified, from the wider literature, more than a dozen schemes directed at classifying ULDs, and 18 studies of test-retest reliability of symptoms and physical signs in the upper limb. Findings support the use of the standardised Nordic questionnaire for symptom inquiry and suggest that a range of physical signs can be elicited with reasonable between-observer agreement. Four classification schemes rated well in terms of content validity. One of these had excellent documentation, and one had been tested for repeatability, agreement with an external reference standard, and utility in distinguishing groups that differed in disability, prognosis and associated risk factors. Conclusions Hitherto, most studies of ULDs in vibration-exposed populations have used custom-specified diagnostic methods, poorly documented, and non-stringent in terms of standardisation and supporting evidence of reliability and/or validity. The broader literature contains several question sets and procedures that improve upon this, and offer scope in vibration-exposed populations to diagnose ULDs more systematically. PMID:17909839

[Rehabilitation evaluation on post-stroke abnormal movement pattern prevented and treated with acupuncture and rehabilitation].

PubMed

Zhang, Hui-min; Tang, Qiang

2011-06-01

To explore the impacts of acupuncture and rehabilitation on post-stroke abnormal patterns of limb movement and evaluate them via rehabilitation method. Ninety cases of post-stroke movement disorder were randomly divided into an acupuncture-rehabilitation group, a body acupuncture group and a medication group, 30 cases in each group. In medication group, the conventional medication in neurological department was administered. In acupuncture-rehabilitation group and body acupuncture group, on the basis of the therapy as medication group, scalp acupuncture (such as parietal area and anterior parietal area, etc.), rehabilitation training and traditional body acupuncture [such as Jianyu (LI 15) and Fengshi (GB 31),etc.] were supplemented. The continuous electric stimulation was applied in body acupuncture group. The treatment lasted for 8 weeks. The assessment of clinical efficacy, Fugl-Meyer score, Modified Ashworth scale (MAS), range of motion (ROM) and shoulder pain score were taken as observation indices for rehabilitation evaluation before and after treatment in each group. The effective rate was 93.1% (27/29) in acupuncture-rehabilitation group, which was superior to 66.7% (20/30) in body acupuncture group and 57.1% (16/28) in control group (both P<0.01) separately. After treatment, Fugl-Meyer score, MAS, ROM of the lower limbs and shoulder joint and shoulder pain score (except medication group) were all remarkably improved as compared with those before treatment in each group (all P<0.01). The improvements in Fugl-Meyer score, MAS, ROM of the upper limbs and shoulder pain score in acupuncture-rehabilitation group were significantly superior to those in body acupuncture group and medication group (P<0.05, P<0.01). Acupuncture and rehabilitation therapy and traditional body acupuncture remarkably improve in post-stroke movement disorder. But acupuncture and rehabilitation therapy is apparently superior to traditional body acupuncture. This therapy can effectively prevent and treat post-stroke abnormal patterns and it is greatly significant in the improvement of survival quality for the patients.

Diagnosis abnormalities of limb movement in disorders of the nervous system

NASA Astrophysics Data System (ADS)

Tymchik, Gregory S.; Skytsiouk, Volodymyr I.; Klotchko, Tatiana R.; Bezsmertna, Halyna; Wójcik, Waldemar; Luganskaya, Saule; Orazbekov, Zhassulan; Iskakova, Aigul

2017-08-01

The paper deals with important issues of diagnosis early signs of diseases of the nervous system, including Parkinson's disease and other specific diseases. Small quantities of violation trajectory of spatial movement of the extremities of human disease at the primary level as the most appropriate features are studied. In modern medical practice is very actual the control the emergence of diseases of the nervous system, including Parkinson's disease. In work a model limbs with six rotational kinematic pairs for diagnosis of early signs of diseases of the nervous system is considered. subject.

Vibration therapy of the plantar fascia improves spasticity of the lower limbs of a patient with fetal-type Minamata disease in the chronic stage.

PubMed

Usuki, Fusako; Tohyama, Satsuki

2011-10-11

The authors present a novel treatment for spasticity using a hand-held vibration massager. A fetal-type Minamata disease patient showing spasticity of lower limbs had direct application of vibratory stimuli to the right plantar fascia and to the left hamstring. After the treatment for 1 year, the Modified Ashworth Scale (MAS) of the lower limbs was improved from three (right > left) to two (right < left). After then, direct application of the same method with the left plantar fascia improved the MAS of the left lower limb to two (right = left). The increased deep tendon reflexes had diminished and markedly positive Babinski's sign had also decreased to slightly positive on both sides. This method is so simple that patients can treat themselves at home. The authors think that direct application of vibratory stimuli to the plantar fascia is valuable to patients with neurologic disorders, particularly those who cannot receive more invasive treatments.

Vibration therapy of the plantar fascia improves spasticity of the lower limbs of a patient with fetal-type Minamata disease in the chronic stage

PubMed Central

Usuki, Fusako; Tohyama, Satsuki

2011-01-01

The authors present a novel treatment for spasticity using a hand-held vibration massager. A fetal-type Minamata disease patient showing spasticity of lower limbs had direct application of vibratory stimuli to the right plantar fascia and to the left hamstring. After the treatment for 1 year, the Modified Ashworth Scale (MAS) of the lower limbs was improved from three (right > left) to two (right < left). After then, direct application of the same method with the left plantar fascia improved the MAS of the left lower limb to two (right = left). The increased deep tendon reflexes had diminished and markedly positive Babinski’s sign had also decreased to slightly positive on both sides. This method is so simple that patients can treat themselves at home. The authors think that direct application of vibratory stimuli to the plantar fascia is valuable to patients with neurologic disorders, particularly those who cannot receive more invasive treatments. PMID:22675016

Methylphenidate-induced acute orofacial and extremity dyskinesia.

PubMed

Yilmaz, Ayse Esra; Donmez, Ahsen; Orun, Emel; Tas, Tugba; Isik, Bunyamin; Sonmez, Fatma Mujgan

2013-06-01

Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. Orofacial dyskinesia appeared 5 hours after methylphenidate administration, persisted for 10 hours, and had completely resolved within 2 days. Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors' knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug-receptor interactions via different mechanisms.

Lower limb strength in sports-active transtibial amputees.

PubMed

Nolan, Lee

2009-09-01

The aim of this study was to compare hip strength in sports-active transtibial (TT) amputees, sedentary TT amputees and sports-active non-amputees. Three 'active' (exercising recreationally at least three times per week) TT amputees, four 'inactive' or sedentary TT amputees and nine 'active' able-bodied persons (AB) underwent concentric and eccentric hip flexion and extension strength testing on both limbs on an isokinetic dynamometer at 60 and 120 degrees /s. Little strength asymmetry was noted between the limbs of the active TT amputees (8% and 14% at 60 and 120 degrees /s, respectively), their residual limb being slightly stronger. Inactive TT amputees demonstrated up to 49% strength asymmetry, their intact limb being the stronger. Active TT amputees demonstrated greater peak hip torques (Nm/kg) for all conditions and speeds compared to inactive TT amputees. Peak hip torques (Nm/kg), were greater in the active TT amputees' residual limb compared to AB. While inactive TT amputees and AB had similar flexion/extension ratios, active TT amputees exhibited a lower ratio indicating overdeveloped hip extensors with respect to their hip flexors. It is not known whether this is due to the demands of sport or exercise with a prosthetic limb, or remaining residual thigh atrophy.

Local dynamic stability of lower extremity joints in lower limb amputees during slope walking.

PubMed

Chen, Jin-Ling; Gu, Dong-Yun

2013-01-01

Lower limb amputees have a higher fall risk during slope walking compared with non-amputees. However, studies on amputees' slope walking were not well addressed. The aim of this study was to identify the difference of slope walking between amputees and non-amputees. Lyapunov exponents λS was used to estimate the local dynamic stability of 7 transtibial amputees' and 7 controls' lower extremity joint kinematics during uphill and downhill walking. Compared with the controls, amputees exhibited significantly lower λS in hip (P=0.04) and ankle (P=0.01) joints of the sound limb, and hip joints (P=0.01) of the prosthetic limb during uphill walking, while they exhibited significantly lower λS in knee (P=0.02) and ankle (P=0.03) joints of the sound limb, and hip joints (P=0.03) of the prosthetic limb during downhill walking. Compared with amputees level walking, they exhibited significantly lower λS in ankle joints of the sound limb during both uphill (P=0.01) and downhill walking (P=0.01). We hypothesized that the better local dynamic stability of amputees was caused by compensation strategy during slope walking.

Achondroplasia: Really rhizomelic?

PubMed

Shelmerdine, Susan Cheng; Brittain, Helen; Arthurs, Owen J; Calder, Alistair D

2016-08-01

Achondroplasia is the most common form of short limb dwarfism in humans. The shortening of the limb lengths in achondroplasia is widely described as "rhizomelic." While this appearance may be convincing clinically, the description is not necessarily true or helpful radiologically. The aims of this study, were therefore, to determine whether rhizomelic shortening is a true feature of achondroplasia at diagnosis in infancy. Humeral, radial, femoral, and tibial diaphyseal lengths were recorded by two independent observers from 22 skeletal surveys of infants with achondroplasia and compared with 150 normal age-matched control subjects. Upper and lower limb bone length ratios (radial/humeral and tibial/femoral lengths, respectively) in both groups were compared using an unpaired t-test. Mean upper limb length ratios were statistically higher within the achondroplasia group at 0.87 ± 0.04 (n = 22, mean age 70 ± 94 days) compared to normal controls at 0.79 ± 0.02 (n = 150, mean age 113 days ± 88 days; P < 0.0001). Lower limb length ratios were not significantly different between groups (0.84 ± 0.04 vs. 0.83 ± 0.02, P = 0.46). There was good inter-observer agreement of limb length measurements, with an average measurement difference of 0.1 ± 1.4 mm. In conclusion, infants with achondroplasia demonstrate statistically significant rhizomelic shortening within the upper limbs, but not lower limbs at diagnosis, compared to normal controls. The term "rhizomelic shortening" in relation to achondroplasia should be reserved when describing upper limb proportions. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Hip Strength in Patients with Quadriceps Strength Deficits after ACL Reconstruction.

PubMed

Bell, David R; Trigsted, Stephanie M; Post, Eric G; Walden, Courtney E

2016-10-01

Quadriceps strength deficits persist for years after anterior cruciate ligament (ACL) reconstruction, and patients with these deficits often shift torque demands away from the knee extensors to the hip during functional tasks. However, it is not clear how quadriceps strength deficits may affect hip strength. Therefore, the purpose of this study was to investigate differences in lower extremity strength in individuals with ACL reconstruction with differing levels of quadriceps strength asymmetry. Isometric strength was recorded bilaterally in 135 participants (73 control and 62 with unilateral ACL reconstruction, time from surgery = 30.9 ± 17.6 months) from the knee extensors and flexors, hip extensors and abductors, and hip internal and external rotator muscle groups. Symmetry indices (limb symmetry index (LSI)) were created based on quadriceps strength, and subjects with ACL reconstruction were subdivided (high quadriceps (LSI ≥ 90%), n = 37; low quadriceps (LSI < 85%), n = 18). Individual group (control vs high quadriceps vs low quadriceps) by limb (reconstructed/nondominant vs healthy/dominant) repeated-measures ANOVA was used to compare strength (%BW) for each of the six joint motions of interest (knee extensors/flexors, hip abductors/extensors/external, and internal rotators) while controlling for time from surgery. An interaction was observed for quadriceps strength (P < 0.001), and the reconstructed limb in the low quadriceps group was weaker than all other limbs. A main effect for group was observed with the low quadriceps group having greater hip extension (P = 0.007) strength in both limbs compared with the other groups. Knee flexion strength was weaker in the reconstructed limb of the high quadriceps group (P = 0.047) compared with all other groups and limbs. Individuals with ACL reconstruction and involved limb quadriceps weakness have greater hip extension strength in both limbs compared with patients with bilateral strength symmetry and controls.

Models of sarcopenia: Short review.

PubMed

Palus, S; Springer, J I; Doehner, W; von Haehling, S; Anker, M; Anker, S D; Springer, J

2017-07-01

Approximately 40-50% of the population over 80years of age suffers from sarcopenia making this condition a major geriatric clinical disorder and a key challenge to healthy aging. The hallmark symptom of sarcopenia is the loss of muscle mass and strength without the loss of overall body weight. Sarcopenic patients are likely to have worse clinical outcomes and higher mortality compared to healthy individuals. This review will focus on animal models designed to study sarcopenia including hind-limb unloading, de-nervation, and immobilization by using casts or wire strategies, as well as using aged rodents. Currently there are no registered treatments for sarcopenia. Most sarcopenic individuals show signs of physical frailty, which leads to increases the prevalence of balance disorders, falls, fractures and pain. Therefore, is it essential to develop and use relevant animal models to further the research on sarcopenia therapy? Copyright © 2017 Elsevier B.V. All rights reserved.

Computational fluid dynamics evaluation of the cross-limb stent graft configuration for endovascular aneurysm repair.

PubMed

Shek, Tina L T; Tse, Leonard W; Nabovati, Aydin; Amon, Cristina H

2012-12-01

The technique of crossing the limbs of bifurcated modular stent grafts for endovascular aneurysm repair (EVAR) is often employed in the face of splayed aortic bifurcations to facilitate cannulation and prevent device kinking. However, little has been reported about the implications of cross-limb EVAR, especially in comparison to conventional EVAR. Previous computational fluid dynamics studies of conventional EVAR grafts have mostly utilized simplified planar stent graft geometries. We herein examined the differences between conventional and cross-limb EVAR by comparing their hemodynamic flow fields (i.e., in the "direct" and "cross" configurations, respectively). We also added a "planar" configuration, which is commonly found in the literature, to identify how well this configuration compares to out-of-plane stent graft configurations from a hemodynamic perspective. A representative patient's cross-limb stent graft geometry was segmented using computed tomography imaging in Mimics software. The cross-limb graft geometry was used to build its direct and planar counterparts in SolidWorks. Physiologic velocity and mass flow boundary conditions and blood properties were implemented for steady-state and pulsatile transient simulations in ANSYS CFX. Displacement forces, wall shear stress (WSS), and oscillatory shear index (OSI) were all comparable between the direct and cross configurations, whereas the planar geometry yielded very different predictions of hemodynamics compared to the out-of-plane stent graft configurations, particularly for displacement forces. This single-patient study suggests that the short-term hemodynamics involved in crossing the limbs is as safe as conventional EVAR. Higher helicity and improved WSS distribution of the cross-limb configuration suggest improved flow-related thrombosis resistance in the short term. However, there may be long-term fatigue implications to stent graft use in the cross configuration when compared to the direct configuration.

Genetics Home Reference: CAV3-related distal myopathy

MedlinePlus

... can cause other caveolinopathies including limb-girdle muscular dystrophy , rippling muscle disease , isolated hyperCKemia , and a heart disorder called ... links) GeneReview: Caveolinopathies MedlinePlus Encyclopedia: Electromyography MedlinePlus Encyclopedia: Muscle ... Care Surgery and Rehabilitation Related ...

Novel DDR2 mutation identified by whole exome sequencing in a Moroccan patient with spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type.

PubMed

Mansouri, Maria; Kayserili, Hülya; Elalaoui, Siham Chafai; Nishimura, Gen; Iida, Aritoshi; Lyahyai, Jaber; Miyake, Noriko; Matsumoto, Naomichi; Sefiani, Abdelaziz; Ikegawa, Shiro

2016-02-01

Spondylo-meta-epiphyseal dysplasia (SMED), short limb-abnormal calcification type (SMED, SL-AC), is a very rare autosomal recessive disorder with various skeletal changes characterized by premature calcification leading to severe disproportionate short stature. Twenty-two patients have been reported until now, but only five mutations (four missense and one splice-site) in the conserved sequence encoding the tyrosine kinase domain of the DDR2 gene has been identified. We report here a novel DDR2 missense mutation, c.370C > T (p.Arg124Trp) in a Moroccan girl with SMED, SL-AC, identified by whole exome sequencing. Our study has expanded the mutational spectrum of this rare disease and it has shown that exome sequencing is a powerful and cost-effective tool for the diagnosis of clinically heterogeneous disorders such as SMED. © 2015 Wiley Periodicals, Inc.

Angular Deformities of the Lower Limb in Children

PubMed Central

Espandar, Ramin; Mortazavi, Seyed Mohammad-Javad; Baghdadi, Taghi

2010-01-01

Angular deformities of the lower limbs are common during childhood. In most cases this represents a variation in the normal growth pattern and is an entirely benign condition. Presence of symmetrical deformities and absence of symptoms, joint stiffness, systemic disorders or syndromes indicates a benign condition with excellent long-term outcome. In contrast, deformities which are asymmetrical and associated with pain, joint stiffness, systemic disorders or syndromes may indicate a serious underlying cause and require treatment. Little is known about the relationship between sport participation and body adaptations during growth. Intense soccer participation increases the degree of genu varum in males from the age of 16. Since, according to some investigations, genu varum predisposes individuals to more injuries, efforts to reduce the development of genu varum in soccer players are warranted. In this article major topics of angular deformities of the knees in pediatric population are practically reviewed. PMID:22375192

Nerve and muscle involvement in mitochondrial disorders: an electrophysiological study.

PubMed

Mancuso, Michelangelo; Piazza, Selina; Volpi, Leda; Orsucci, Daniele; Calsolaro, Valeria; Caldarazzo Ienco, Elena; Carlesi, Cecilia; Rocchi, Anna; Petrozzi, Lucia; Calabrese, Rosanna; Siciliano, Gabriele

2012-04-01

Involvement of the peripheral nervous system in mitochondrial disorders (MD) has been previously reported. However, the exact prevalence of peripheral neuropathy and/or myopathy in MD is still unclear. In order to evaluate the prevalence of neuropathy and myopathy in MD, we performed sensory and motor nerve conduction studies (NCS) and concentric needle electromyography (EMG) in 44 unselected MD patients. NCS were abnormal in 36.4% of cases, and were consistent with a sensori-motor axonal multineuropathy (multifocal neuropathy), mainly affecting the lower limbs. EMG evidence of myopathy was present in 54.5% of patients, again mainly affecting the lower limbs. Nerve and muscle involvement was frequently subclinical. Peripheral nerve and muscle involvement is common in MD patients. Our study supports the variability of the clinical expression of MD. Further studies are needed to better understand the molecular basis underlying the phenotypic variability among MD patients.

The influence of hip strength on lower-limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women.

PubMed

Smith, Jo Armour; Popovich, John M; Kulig, Kornelia

2014-07-01

Cross-sectional laboratory study. To compare peak lower-limb, pelvis, and trunk kinematics and interjoint and intersegmental coordination in women with strong and weak hip muscle performance. Persons with lower extremity musculoskeletal disorders often demonstrate a combination of weak hip musculature and altered kinematics during weight-bearing dynamic tasks. However, the association between hip strength and kinematics independent of pathology or pain is unclear. Peak hip extensor and abductor torques were measured in 150 healthy young women. Of these, 10 fit the criteria for the strong group and 9 for the weak group, representing those with the strongest and weakest hip musculature, respectively, of the 150 screened individuals. Kinematics of the hip, knee, pelvis, and trunk were measured during the stance phases of walking and rate-controlled hopping. Hip/knee and pelvis/trunk coordination were calculated using the vector coding technique. There were no group differences in peak hip, knee, or pelvis kinematics. Participants in the weak group demonstrated greater trunk lateral bend toward the stance limb during hopping (P = .002, effect size [d] = 1.88). In the transverse plane, those in the weak group utilized less inphase coordination between the hip and the knee during walking (P = .036, d = 1.45) and more antiphase coordination between the hip and knee during hopping (P = .03, d = 1.47). In the absence of pain or pathology, poor hip muscle performance does not affect peak hip or knee joint kinematics in young women, but is associated with significantly different lower-limb and trunk/pelvis coordination during weight-bearing dynamic tasks. J Orthop Sports Phys Ther 2014;44(7):525-531. Epub 10 May 2014. doi:10.2519/jospt.2014.5028.

Myasthenia Gravis: Unusual Presentations and Diagnostic Pitfalls.

PubMed

Rodolico, Carmelo; Parisi, Daniela; Portaro, Simona; Biasini, Fiammetta; Sinicropi, Stefano; Ciranni, Annamaria; Toscano, Antonio; Messina, Sonia; Musumeci, Olimpia; Vita, Giuseppe; Girlanda, Paolo

2016-08-30

Myasthenia gravis (MG) is an autoimmune disorder presenting with fluctuating, fatigable muscle weakness. Initial symptoms classically involve ocular and proximal limb muscles. Rarely, MG may onset with unusual features, so it can be misdiagnosed with other neuromuscular diseases. To describe unusual and atypical presentations of MG in a large cohort of patients, considering and discussing diagnostic difficulties and pitfalls. We report on 21 out of 508 MG patients, coming to our department in the last 27 years and presenting with atypical or unusual features. The diagnosis was achieved performing a careful clinical examination, a proper neurophysiological assessment, the neostigmine test, the AChR and MuSK antibodies assay and chest CT-scan. Patients with atypical/unusual MG onset were the 4.4% of all MG patients population. We describe seven different clinical categories: asymmetric distal upper limbs weakness, foot drop, isolated triceps brachii weakness and foot drop, post exertional axial weakness with dropped head, acute facial dyplegia, limb-girdle MG and MG with sudden lower limbs weakness and recurrent falls. Atypical and unusual presentations may increase the risk to misdiagnose or delay MG diagnosis. Isolated limb-girdle presentation is the most frequent atypical form in our series.

Progressive joint limitations as the first alarming signs in a boy with short - limbed dwarfism: A case report.

PubMed

Al Kaissi, Ali; Klaushofer, Klaus; Grill, Franz

2008-08-19

Contracture is a condition of abnormal shortening or shrinkage of a muscle, and or a tendon often with persistent flexion or distortion at a joint. Careful documentation of the kind of contractures encountered in different paediatric disorders is important in distinguishing a specific subtype. Achondroplasia has been considered as the most common short-limbed dwarfism syndrome, but there are a variety of other syndromes within this category, and other types of limb shortening. We report on a 5-year-old boy of Austrian origin who manifests progressive joint limitations in connection with a dysplastic form of short-limbed dwarfism namely chondrodysplasia punctata-tibial-metacarpal-type. Progressive joint limitations of maximal intensity over the hip, and the ankle joints were the main presenting features. Osteochondrodysplasias involve abnormal bone or cartilage growth leading to skeletal maldevelopment, often short-limbed dwarfism. Diagnosis is by physical examination, radiographic documentation, and, in some cases, genetic testing. In patients with chondrodysplasia punctata, early life radiographic examination is fundamental, since resolution of the punctate calcifications leaving abnormal epiphyses and flared and irregular metaphyses after age one to three years seems to be characteristic.

Progressive joint limitations as the first alarming signs in a boy with short – limbed dwarfism: A case report

PubMed Central

Al Kaissi, Ali; Klaushofer, Klaus; Grill, Franz

2008-01-01

Introduction Contracture is a condition of abnormal shortening or shrinkage of a muscle, and or a tendon often with persistent flexion or distortion at a joint. Careful documentation of the kind of contractures encountered in different paediatric disorders is important in distinguishing a specific subtype. Achondroplasia has been considered as the most common short-limbed dwarfism syndrome, but there are a variety of other syndromes within this category, and other types of limb shortening. Case presentation We report on a 5-year-old boy of Austrian origin who manifests progressive joint limitations in connection with a dysplastic form of short-limbed dwarfism namely chondrodysplasia punctata-tibial-metacarpal-type. Progressive joint limitations of maximal intensity over the hip, and the ankle joints were the main presenting features. Conclusion Osteochondrodysplasias involve abnormal bone or cartilage growth leading to skeletal maldevelopment, often short-limbed dwarfism. Diagnosis is by physical examination, radiographic documentation, and, in some cases, genetic testing. In patients with chondrodysplasia punctata, early life radiographic examination is fundamental, since resolution of the punctate calcifications leaving abnormal epiphyses and flared and irregular metaphyses after age one to three years seems to be characteristic. PMID:18713450

Exome sequencing identifies a DNAJB6 mutation in a family with dominantly-inherited limb-girdle muscular dystrophy.

PubMed

Couthouis, Julien; Raphael, Alya R; Siskind, Carly; Findlay, Andrew R; Buenrostro, Jason D; Greenleaf, William J; Vogel, Hannes; Day, John W; Flanigan, Kevin M; Gitler, Aaron D

2014-05-01

Limb-girdle muscular dystrophy primarily affects the muscles of the hips and shoulders (the "limb-girdle" muscles), although it is a heterogeneous disorder that can present with varying symptoms. There is currently no cure. We sought to identify the genetic basis of limb-girdle muscular dystrophy type 1 in an American family of Northern European descent using exome sequencing. Exome sequencing was performed on DNA samples from two affected siblings and one unaffected sibling and resulted in the identification of eleven candidate mutations that co-segregated with the disease. Notably, this list included a previously reported mutation in DNAJB6, p.Phe89Ile, which was recently identified as a cause of limb-girdle muscular dystrophy type 1D. Additional family members were Sanger sequenced and the mutation in DNAJB6 was only found in affected individuals. Subsequent haplotype analysis indicated that this DNAJB6 p.Phe89Ile mutation likely arose independently of the previously reported mutation. Since other published mutations are located close by in the G/F domain of DNAJB6, this suggests that the area may represent a mutational hotspot. Exome sequencing provided an unbiased and effective method for identifying the genetic etiology of limb-girdle muscular dystrophy type 1 in a previously genetically uncharacterized family. This work further confirms the causative role of DNAJB6 mutations in limb-girdle muscular dystrophy type 1D. Copyright © 2014 Elsevier B.V. All rights reserved.

Neuromuscular Strain Increases Symptom Intensity in Chronic Fatigue Syndrome

PubMed Central

Rowe, Peter C.; Fontaine, Kevin R.; Lauver, Megan; Jasion, Samantha E.; Marden, Colleen L.; Moni, Malini; Thompson, Carol B.; Violand, Richard L.

2016-01-01

Chronic fatigue syndrome (CFS) is a complex, multisystem disorder that can be disabling. CFS symptoms can be provoked by increased physical or cognitive activity, and by orthostatic stress. In preliminary work, we noted that CFS symptoms also could be provoked by application of longitudinal neural and soft tissue strain to the limbs and spine of affected individuals. In this study we measured the responses to a straight leg raise neuromuscular strain maneuver in individuals with CFS and healthy controls. We randomly assigned 60 individuals with CFS and 20 healthy controls to either a 15 minute period of passive supine straight leg raise (true neuromuscular strain) or a sham straight leg raise. The primary outcome measure was the symptom intensity difference between the scores during and 24 hours after the study maneuver compared to baseline. Fatigue, body pain, lightheadedness, concentration difficulties, and headache scores were measured individually on a 0–10 scale, and summed to create a composite symptom score. Compared to individuals with CFS in the sham strain group, those with CFS in the true strain group reported significantly increased body pain (P = 0.04) and concentration difficulties (P = 0.02) as well as increased composite symptom scores (all P = 0.03) during the maneuver. After 24 hours, the symptom intensity differences were significantly greater for the CFS true strain group for the individual symptom of lightheadedness (P = 0.001) and for the composite symptom score (P = 0.005). During and 24 hours after the exposure to the true strain maneuver, those with CFS had significantly higher individual and composite symptom intensity changes compared to the healthy controls. We conclude that a longitudinal strain applied to the nerves and soft tissues of the lower limb is capable of increasing symptom intensity in individuals with CFS for up to 24 hours. These findings support our preliminary observations that increased mechanical sensitivity may be a contributor to the provocation of symptoms in this disorder. PMID:27428358

Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system.

PubMed

Abdulhasan, Zahraa M; Scally, Andy J; Buckley, John G

2018-05-30

Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its 'ramp-descent' mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Possible factors influencing the duration of hospital stay in patients with psychiatric disorders attempting suicide by jumping.

PubMed

Omi, Tsubasa; Ito, Hiroshi; Riku, Keisen; Kanai, Koji; Takada, Hiromune; Fujimi, Satoshi; Matsunaga, Hidenori; Ohi, Kazutaka

2017-03-20

Patients with psychiatric disorders have a high rate of suicide. The present study investigated factors influencing hospital stays for Japanese patients with psychiatric disorders attempting suicide by jumping. We diagnosed all suicide attempts (n = 113) by jumping based on the International Classification of Diseases 10th Revision (ICD-10) and investigated the mean hospital stays of patients with each diagnosis based on the ICD-10 code. We then analyzed differences in the demographic and clinical characteristics between the diagnostic groups to identify factors influencing the duration of hospital stay. Patients diagnosed with schizophrenia (F2 code) were the most frequent (32.7%) of all diagnoses; therefore, we divided the diagnostic groups into schizophrenia group (n = 37) and other psychiatric diagnoses group (n = 76). The patients with schizophrenia showed a significantly longer hospital stay (125.7 ± 63.9 days) compared with the patients with other psychiatric diagnoses (83.6 ± 63.2) (β ± SE = 42.1 ± 12.7, p = 0.0013), whereas there was no difference in the jump height between the two groups (the average was the 3rd to 4th floor; p > 0.05). The number of injured parts, particularly lower-limb fractures, was significantly higher (p = 0.017) in patients with schizophrenia than in patients with other psychiatric diagnoses. The duration of psychiatric treatment in patients with schizophrenia were significantly longer (z = 3.4, p = 0.001) than in patients with other psychiatric diagnoses. Our findings indicate that the number of injuries and the body parts injured in patients with schizophrenia are associated with a longer duration of hospital stay following a suicide attempt by jumping. The current use of antipsychotics and a longer duration of taking antipsychotics might contribute to the risk of bone fracture via hyperprolactinemia. Further cognitive impairment in patients with schizophrenia might prevent rehabilitation for the management of lower-limb fractures. From these results, we suggest that clinicians should monitor the level of prolactin and cognitive function in patients with schizophrenia in future studies on managing of lower-limb fractures.

Sleep-related movement disorders.

PubMed

Merlino, Giovanni; Gigli, Gian Luigi

2012-06-01

Several movement disorders may occur during nocturnal rest disrupting sleep. A part of these complaints is characterized by relatively simple, non-purposeful and usually stereotyped movements. The last version of the International Classification of Sleep Disorders includes these clinical conditions (i.e. restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, sleep-related bruxism and sleep-related rhythmic movement disorder) under the category entitled sleep-related movement disorders. Moreover, apparently physiological movements (e.g. alternating leg muscle activation and excessive hypnic fragmentary myoclonus) can show a high frequency and severity impairing sleep quality. Clinical and, in specific cases, neurophysiological assessments are required to detect the presence of nocturnal movement complaints. Patients reporting poor sleep due to these abnormal movements should undergo non-pharmacological or pharmacological treatments.

Is typing speed proportional to the severity of pain in keyboard workers with work-related upper limb disorder

PubMed Central

Povlsen, Bo

2012-01-01

Objectives To investigate if typing speed is proportional to the severity of pain in keyboard workers with work-related upper limb disorder (WRULD). Design Standardized functional typing test with participants scoring pain before and after typing; calculation of typing speed. Participants Fifty-nine patients and six controls. Setting Tertiary hospital centre for hand and upper limb pain. Main outcome measures Pain (VAS 0–10) and calculation of typing speed as words per minute. Results Three subgroups of patients were found based on their typing speed: fast, slow and intermediate. Two-tailed student T-test with P level at 0.05 was used for evaluation. The typing speeds were significantly different between all three patient groups (P < 0.05). The typing speed was significantly faster in the fastest patient group than in the control group (P = 0.04) and the slow and middle groups (P = < 0.0001). The pain before typing was highest in the ‘slow’ group, in both hands but this difference was not statistically significant. Conclusion Typing speed is not proportional to the severity of pain in keyboard workers with WRULD. Patients with statistically significant slower or faster typing speeds do not have statistically different levels of pain. PMID:22299070

[Epidemiology of illnesses and musculoskeletal disorders in grocery stores and catering].

PubMed

Bonzini, Matteo; Battevi, Natale; Stucchi, Giulia; Vitelli, Nora

2014-01-01

Large scale retail industry and catering industry are characterized by the widespread presence of several risk factors of work-related musculoskeletal disorders (WMSD): repetitive movements, incongruous postures and manual handling tasks. We reviewed current epidemiological evidence related to musculoskeletal disorders within these two sectors, distinguishing between symptoms and clinically documented disorders. In retail industry cashier is the most investigated figure, regarding upper limbs disorders as a consequence of repetitive tasks. In the catering sector there are few studies, mostly focused only on the job as a cook. The majority of studies showed a high prevalence of WMSD and, to a lesser extent, a high frequency ofmusculoskeletal alterations; suggesting the presence of a not negligible risk. These findings, however, are affected by a number of methodological limitations: they derive from cross-sectional studies, are based on voluntary self-selected workers, are focused on not unequivocally defined health outcomes, and are usually lacking a proper comparison. with the prevalence in less exposed/reference working groups. In order to achieve an effective control of the workers' risk, it is therefore necessary to design and conduct prospective studies that compare the risk of developing disorders and/or diseases in workers exposed to different levels of biomechanical load. It appears essential to involve occupational physicians in active health surveillance programs in order to identify critical areas and to develop effective preventive measures.

Active prospective control is required for effective sensorimotor learning.

PubMed

Snapp-Childs, Winona; Casserly, Elizabeth; Mon-Williams, Mark; Bingham, Geoffrey P

2013-01-01

Passive modeling of movements is often used in movement therapy to overcome disabilities caused by stroke or other disorders (e.g. Developmental Coordination Disorder or Cerebral Palsy). Either a therapist or, recently, a specially designed robot moves or guides the limb passively through the movement to be trained. In contrast, action theory has long suggested that effective skill acquisition requires movements to be actively generated. Is this true? In view of the former, we explicitly tested the latter. Previously, a method was developed that allows children with Developmental Coordination Disorder to produce effective movements actively, so as to improve manual performance to match that of typically developing children. In the current study, we tested practice using such active movements as compared to practice using passive movement. The passive movement employed, namely haptic tracking, provided a strong test of the comparison, one that showed that the mere inaction of the muscles is not the problem. Instead, lack of prospective control was. The result was no effective learning with passive movement while active practice with prospective control yielded significant improvements in performance.

Knee Joint Loading during Single-Leg Forward Hopping.

PubMed

Krupenevich, Rebecca L; Pruziner, Alison L; Miller, Ross H

2017-02-01

Increased or abnormal loading on the intact limb is thought to contribute to the relatively high risk of knee osteoarthritis in this limb for individuals with unilateral lower limb loss. This theory has been assessed previously by studying walking, but knee joint loading during walking is often similar between individuals with and without limb loss, prompting assessment of other movements that may place unusual loads on the knee. One such movement, hopping, is a form of locomotion that individuals with unilateral lower limb loss may situationally use instead of walking, but the mechanical effects of hopping on the intact limb are unknown. Compare knee joint kinetics of healthy adults during single-leg forward hopping compared to walking, a more traditional form of locomotion. Twenty-four healthy adults walked and hopped at self-selected speeds of 1.5 and 2.3 m·s, respectively. Joint moments were calculated using inverse dynamics. A paired Student's t-test was utilized to compare peak, impulse, and loading rate (LR) of knee adduction moment (KAM), and peak knee flexion moment (KFM) between walking and hopping. Peak KFM and KAM LR were greater during hopping compared to walking (peak KFM: 20.73% vs 5.51% body weight (BW) × height (Ht), P < 0.001; KAM LR: 0.47 vs. 0.33 BW·Ht·s, P = 0.01). Kinetic measures affecting knee joint loading are greater in hopping compared to walking. It may be advisable to limit single-leg forward hopping in the limb loss population until it is known if these loads increase knee osteoarthritis risk.

A newborn with unilateral limb enlargement.

PubMed

Sharma, Shanel; Maino, Anna P F; Husain, Shad M; Adams, Gill G W

2012-03-01

On routine neonatal examination, a newborn term male was noted to have unilateral enlargement of the right lower limb, loose thickened red skin over the palm and widening of all the fingers on the right hand. His body was pinker and warmer on the right side compared with the left and he had a right undescended testicle and hypoplastic scrotum. Radiological examination of the lower limbs demonstrated the enlargement of the soft tissue of the right lower limb compared to the left (Fig. 1). Therefore, the diagnosis was unclear from this constellation of findings and an ophthalmic assessment was requested.

Longitudinal patient-reported mobility assessment in fibrodysplasia ossificans progressiva (FOP).

PubMed

Kaplan, Frederick S; Al Mukaddam, Mona; Pignolo, Robert J

2018-04-01

Fibrodysplasia ossificans progressiva (FOP) is a rare, disabling genetic disorder characterized by episodic soft tissue swelling (flare-ups) that leads to progressive heterotopic ossification and restricted joint mobility. Here we present the first longitudinal patient-reported mobility assessment (PRMA) in FOP based on a simple evaluation tool. At initial presentation and follow-up (1-11year span; median: 6 year span), 64 patients (36 females; 28 males) with classic FOP completed a questionnaire designed to rapidly assess mobility at 15 sites (three axial; six upper limb, and six lower limb). In order to validate this instrument, twenty-one of 64 patients (33%) underwent a cumulative analogue joint involvement scale (CAJIS) evaluation by two physicians within six months of their second self-assessment. We found that: 1) mobility changes were episodic and regional, occurring first in the neck and trunk, followed by the upper limbs and finally the lower limbs; 2) interval improvements in mobility did occur, most notably in the lower limbs (18%), and less so in the upper limbs (12%) and trunk (3%), and 3) patient-reported mobility assessments correlate highly (R 2 =0.81) with physician-reported CAJIS evaluations. This is the first longitudinal PRMA in FOP and provides a simple and valid tool that can be used in the design and evaluation of clinical trials in this progressively disabling disease. Copyright © 2017 Elsevier Inc. All rights reserved.

Rehabilitative Soft Exoskeleton for Rodents.

PubMed

Florez, Juan Manuel; Shah, Manan; Moraud, Eduardo Martin; Wurth, Sophie; Baud, Laetitia; Von Zitzewitz, Joachim; van den Brand, Rubia; Micera, Silvestro; Courtine, Gregoire; Paik, Jamie

2017-02-01

Robotic exoskeletons provide programmable, consistent and controllable active therapeutic assistance to patients with neurological disorders. Here we introduce a prototype and preliminary experimental evaluation of a rehabilitative gait exoskeleton that enables compliant yet effective manipulation of the fragile limbs of rats. To assist the displacements of the lower limbs without impeding natural gait movements, we designed and fabricated soft pneumatic actuators (SPAs). The exoskeleton integrates two customizable SPAs that are attached to a limb. This configuration enables a 1 N force load, a range of motion exceeding 80 mm in the major axis, and speed of actuation reaching two gait cycles/s. Preliminary experiments in rats with spinal cord injury validated the basic features of the exoskeleton. We propose strategies to improve the performance of the robot and discuss the potential of SPAs for the design of other wearable interfaces.

Use of Lower-Limb Robotics to Enhance Practice and Participation in Individuals With Neurological Conditions.

PubMed

Jayaraman, Arun; Burt, Sheila; Rymer, William Zev

2017-07-01

To review lower-limb technology currently available for people with neurological disorders, such as spinal cord injury, stroke, or other conditions. We focus on 3 emerging technologies: treadmill-based training devices, exoskeletons, and other wearable robots. Efficacy for these devices remains unclear, although preliminary data indicate that specific patient populations may benefit from robotic training used with more traditional physical therapy. Potential benefits include improved lower-limb function and a more typical gait trajectory. Use of these devices is limited by insufficient data, cost, and in some cases size of the machine. However, robotic technology is likely to become more prevalent as these machines are enhanced and able to produce targeted physical rehabilitation. Therapists should be aware of these technologies as they continue to advance but understand the limitations and challenges posed with therapeutic/mobility robots.

Efferent limb of gastrojejunostomy obstruction by a whole okra phytobezoar: Case report and brief review

PubMed Central

Zin, Thant; Maw, Myat; Pai, Dinker Ramananda; Paijan, Rosaini Binti; Kyi, Myo

2012-01-01

A phytobezoar is one of the intraluminal causes of gastric outlet obstruction, especially in patients with previous gastric surgery and/or gastric motility disorders. Before the proton pump inhibitor era, vagotomy, pyloroplasty, gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients. One of the sequelae of gastrojejunostomy is phytobezoar formation. However, a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars. We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site. This phytobezoar which consisted of a whole piece of okra (lady finger vegetable) was successfully removed by endoscopic snare. To the best of our knowledge, this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature. PMID:22624073

Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index-10 as a measure of functional recovery post burn injury: a cross-sectional repeated measures study design.

PubMed

Ryland, Margaret E; Grisbrook, Tiffany L; Wood, Fiona M; Phillips, Michael; Edgar, Dale W

2016-01-01

Lower limb burns can significantly delay recovery of function. Measuring lower limb functional outcomes is challenging in the unique burn patient population and necessitates the use of reliable and valid tools. The aims of this study were to examine the test-retest reliability, sensitivity, and internal consistency of Sections 1 and 3 of the Lower Limb Functional Index-10 (LLFI-10) questionnaire for measuring functional ability in patients with lower limb burns over time. Twenty-nine adult patients who had sustained a lower limb burn injury in the previous 12 months completed the test-retest procedure of the study. In addition, the minimal detectable change (MDC) was calculated for Section 1 and 3 of the LLFI-10. Section 1 is focused on the activity limitations experienced by patients with a lower limb disorder whereas Section 3 involves patients indicating their current percentage of pre-injury duties. Section 1 of the LLFI-10 demonstrated excellent test-retest reliability (intra-class correlation coefficient (ICC) 0.98, 95 % CI 0.96-0.99) whilst Section 3 demonstrated high test-retest reliability (ICC 0.88, 95 % CI 0.79-0.94). MDC scores for Sections 1 and 3 were 1.27 points and 30.22 %, respectively. Internal consistency was demonstrated with a significant negative association (r s  = -0.83) between Sections 1 and 3 of the LLFI-10 (p < 0.001). This study demonstrates that Section 1 and 3 of the LLFI-10 are reliable for measuring functional ability in patients who have sustained lower limb burns in the previous 12 months, and furthermore, Section 1 is sensitive to changes in patient function over time.

The CDKL5 disorder is an independent clinical entity associated with early-onset encephalopathy.

PubMed

Fehr, Stephanie; Wilson, Meredith; Downs, Jenny; Williams, Simon; Murgia, Alessandra; Sartori, Stefano; Vecchi, Marilena; Ho, Gladys; Polli, Roberta; Psoni, Stavroula; Bao, Xinhua; de Klerk, Nick; Leonard, Helen; Christodoulou, John

2013-03-01

The clinical understanding of the CDKL5 disorder remains limited, with most information being derived from small patient groups seen at individual centres. This study uses a large international data collection to describe the clinical profile of the CDKL5 disorder and compare with Rett syndrome (RTT). Information on individuals with cyclin-dependent kinase-like 5 (CDKL5) mutations (n=86) and females with MECP2 mutations (n=920) was sourced from the InterRett database. Available photographs of CDKL5 patients were examined for dysmorphic features. The proportion of CDKL5 patients meeting the recent Neul criteria for atypical RTT was determined. Logistic regression and time-to-event analyses were used to compare the occurrence of Rett-like features in those with MECP2 and CDKL5 mutations. Most individuals with CDKL5 mutations had severe developmental delay from birth, seizure onset before the age of 3 months and similar non-dysmorphic features. Less than one-quarter met the criteria for early-onset seizure variant RTT. Seizures and sleep disturbances were more common than in those with MECP2 mutations whereas features of regression and spinal curvature were less common. The CDKL5 disorder presents with a distinct clinical profile and a subtle facial, limb and hand phenotype that may assist in differentiation from other early-onset encephalopathies. Although mutations in the CDKL5 gene have been described in association with the early-onset variant of RTT, in our study the majority did not meet these criteria. Therefore, the CDKL5 disorder should be considered separate to RTT, rather than another variant.

The CDKL5 disorder is an independent clinical entity associated with early-onset encephalopathy

PubMed Central

Fehr, Stephanie; Wilson, Meredith; Downs, Jenny; Williams, Simon; Murgia, Alessandra; Sartori, Stefano; Vecchi, Marilena; Ho, Gladys; Polli, Roberta; Psoni, Stavroula; Bao, Xinhua; de Klerk, Nick; Leonard, Helen; Christodoulou, John

2013-01-01

The clinical understanding of the CDKL5 disorder remains limited, with most information being derived from small patient groups seen at individual centres. This study uses a large international data collection to describe the clinical profile of the CDKL5 disorder and compare with Rett syndrome (RTT). Information on individuals with cyclin-dependent kinase-like 5 (CDKL5) mutations (n=86) and females with MECP2 mutations (n=920) was sourced from the InterRett database. Available photographs of CDKL5 patients were examined for dysmorphic features. The proportion of CDKL5 patients meeting the recent Neul criteria for atypical RTT was determined. Logistic regression and time-to-event analyses were used to compare the occurrence of Rett-like features in those with MECP2 and CDKL5 mutations. Most individuals with CDKL5 mutations had severe developmental delay from birth, seizure onset before the age of 3 months and similar non-dysmorphic features. Less than one-quarter met the criteria for early-onset seizure variant RTT. Seizures and sleep disturbances were more common than in those with MECP2 mutations whereas features of regression and spinal curvature were less common. The CDKL5 disorder presents with a distinct clinical profile and a subtle facial, limb and hand phenotype that may assist in differentiation from other early-onset encephalopathies. Although mutations in the CDKL5 gene have been described in association with the early-onset variant of RTT, in our study the majority did not meet these criteria. Therefore, the CDKL5 disorder should be considered separate to RTT, rather than another variant. PMID:22872100

Axial bone-socket displacement for persons with a traumatic transtibial amputation: The effect of elevated vacuum suspension at progressive body-weight loads.

PubMed

Darter, Benjamin J; Sinitski, Kirill; Wilken, Jason M

2016-10-01

Elevated vacuum suspension systems use a pump to draw air from the socket with the intent of reducing bone-socket motion as compared to passive suction systems. However, it remains unknown if elevated vacuum suspension systems decrease limb displacement uniformly during transitions from unloaded to full-body-weight support. To compare limb-socket motion between elevated vacuum and passive suction suspension sockets using a controlled loading paradigm. Comparative analysis. Persons with transtibial amputation were assessed while wearing either an elevated vacuum or passive suction suspension socket. Digital video fluoroscopy was used to measure axial bone-socket motion while the limb was loaded in 20% body-weight increments. An analysis of variance model was used to compare between suspension types. Total axial displacement (0%-100% body weight) was significantly lower using the elevated vacuum (vacuum: 1.3 cm, passive suction: 1.8 cm; p < 0.0001). Total displacement decreased primarily due to decreased motion during initial loading (0%-20%; p < 0.0001). Other body-weight intervals were not significantly different between systems. Elevated vacuum suspension reduced axial limb-socket motion by maintaining position of the limb within the socket during unloaded conditions. Elevated vacuum provided no meaningful improvement in limb-socket motion past initial loading. Excessive bone-socket motion contributes to poor residual limb health. Our results suggest elevated vacuum suspensions can reduce this axial displacement. Visual assessment of the images suggests that this occurs through the reduction or elimination of the air pocket between the liner and socket wall while the limb is unloaded. © The International Society for Prosthetics and Orthotics 2015.

A cross sectional study of the prevalence, risk factors and population attributable fractions for limb and body lesions in lactating sows on commercial farms in England

PubMed Central

KilBride, Amy L; Gillman, Claire E; Green, Laura E

2009-01-01

Background Lesions on sows' limbs and bodies are an abnormality that might impact on their welfare. The prevalence of and risks for limb and body lesions on lactating sows on commercial English pig farms were investigated using direct observation of the sows and their housing. Results The prevalence of lesions on the limbs and body were 93% (260/279) and 20% (57/288) respectively. The prevalence of limb and body lesions was significantly lower in outdoor-housed sows compared with indoor-housed sows. Indoor-housed sows had an increased risk of wounds (OR 6.8), calluses (OR 8.8) and capped hock (OR 3.8) on their limbs when housed on fully slatted floors compared with solid concrete floors. In addition, there was an increased risk of bursitis (OR 2.7), capped hock (OR 2.3) and shoulder lesions (OR 4.8) in sows that were unwilling to rise to their feet. There was a decreased risk of shoulder lesions (OR 0.3) and lesions elsewhere on the body (OR 0.2) in sows with more than 20 cm between their tail and the back of the crate compared with sows with less than 10 cm. Conclusion The sample of outdoor housed sows in this study had the lowest prevalence of limb and body lesions. In lactating sows housed indoors there was a general trend for an increased risk of limb and body lesions in sows housed on slatted floors compared with those housed on solid concrete floors with bedding. Sows that were less responsive to human presence and sows that had the least space to move within their crates had an additional increased risk of lesions. PMID:19703273

Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk.

PubMed

Jodoin, Marianne; Rouleau, Dominique M; Charlebois-Plante, Camille; Benoit, Benoit; Leduc, Stéphane; Laflamme, G-Yves; Gosselin, Nadia; Larson-Dupuis, Camille; De Beaumont, Louis

2016-08-01

This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI. Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; p<0.0001). Patients suffering from an upper limb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008). Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI. Copyright © 2016 Elsevier Ltd. All rights reserved.

EFFECTS OF RETINOIC ACID AND ULTRAVIOLET RADIATION ON LIMB DEVELOPMENT IN ANURANS

EPA Science Inventory

Several recent studies suggest that the prevalence of limb abnormalities in North American anurans is elevated compared to historical records. These obsrvations have caused concern that environmental conditions are responsible for the increase through perturbation of normal limb ...

Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury.

PubMed

Wellsandt, Elizabeth; Failla, Mathew J; Snyder-Mackler, Lynn

2017-05-01

Study Design Prospective cohort. Background The high risk of second anterior cruciate ligament (ACL) injuries after return to sport highlights the importance of return-to-sport decision making. Objective return-to-sport criteria frequently use limb symmetry indexes (LSIs) to quantify quadriceps strength and hop scores. Whether using the uninvolved limb in LSIs is optimal is unknown. Objectives To evaluate the uninvolved limb as a reference standard for LSIs utilized in return-to-sport testing and its relationship with second ACL injury rates. Methods Seventy athletes completed quadriceps strength and 4 single-leg hop tests before anterior cruciate ligament reconstruction (ACLR) and 6 months after ACLR. Limb symmetry indexes for each test compared involved-limb measures at 6 months to uninvolved-limb measures at 6 months. Estimated preinjury capacity (EPIC) levels for each test compared involved-limb measures at 6 months to uninvolved-limb measures before ACLR. Second ACL injuries were tracked for a minimum follow-up of 2 years after ACLR. Results Forty (57.1%) patients achieved 90% LSIs for quadriceps strength and all hop tests. Only 20 (28.6%) patients met 90% EPIC levels (comparing the involved limb at 6 months after ACLR to the uninvolved limb before ACLR) for quadriceps strength and all hop tests. Twenty-four (34.3%) patients who achieved 90% LSIs for all measures 6 months after ACLR did not achieve 90% EPIC levels for all measures. Estimated preinjury capacity levels were more sensitive than LSIs in predicting second ACL injuries (LSIs, 0.273; 95% confidence interval [CI]: 0.010, 0.566 and EPIC, 0.818; 95% CI: 0.523, 0.949). Conclusion Limb symmetry indexes frequently overestimate knee function after ACLR and may be related to second ACL injury risk. These findings raise concern about whether the variable ACL return-to-sport criteria utilized in current clinical practice are stringent enough to achieve safe and successful return to sport. Level of Evidence Prognosis, 2b. J Orthop Sports Phys Ther 2017;47(5):334-338. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7285.

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients.

PubMed

Luque-Moreno, C; Oliva-Pascual-Vaca, A; Kiper, P; Rodríguez-Blanco, C; Agostini, M; Turolla, A

2016-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

A new view of “dream enactment” in REM sleep behavior disorder

PubMed Central

Blumberg, Mark S.; Plumeau, Alan M.

2015-01-01

SUMMARY REM sleep behavior disorder (RBD) is a disorder in which patients exhibit increased muscle tone and exaggerated myoclonic twitching during REM sleep. In addition, violent movements of the limbs, and complex behaviors that can sometimes appear to involve the enactment of dreams, are associated with RBD. These behaviors are widely thought to result from a dysfunction involving atonia-producing neural circuitry in the brainstem, thereby unmasking cortically generated dreams. Here we scrutinize the assumptions that led to this interpretation of RBD. In particular, we challenge the assumption that motor cortex produces twitches during REM sleep, thus calling into question the related assumption that motor cortex is primarily responsible for all of the pathological movements of RBD. Moreover, motor cortex is not even necessary to produce complex behavior; for example, stimulation of some brainstem structures can produce defensive and aggressive behaviors in rats and monkeys that are striking similar to those reported in human patients with RBD. Accordingly, we suggest an interpretation of RBD that focuses increased attention on the brainstem as a source of the pathological movements and that considers sensory feedback from moving limbs as an important influence on the content of dream mentation. PMID:26802823

Estimation of ultrasound reference values for the lower limb peripheral nerves in adults: A cross-sectional study.

PubMed

Bedewi, Mohamed Abdelmohsen; Abodonya, Ahmed; Kotb, Mamdouh; Kamal, Sanaa; Mahmoud, Gehan; Aldossari, Khaled; Alqabbani, Abdullah; Swify, Sherine

2018-03-01

The objective of this study is to estimate the reference values for the lower limb peripheral nerves in adults.The demographics and physical characteristics of 69 adult healthy volunteers were evaluated and recorded. The estimated reference values and their correlations with the age, weight, height, body mass index (BMI) were evaluated.The cross sectional area reference values were obtained at 5 predetermined sites for 3 important lower limb peripheral nerves. Our CSA values correlated significantly with age, weight, and BMI. The normal reference values for each nerve were as follows: Tibial nerve at the popliteal fossa 19 mm ± 6.9, tibial nerve at the level of the medial malleolus 12.7 mm ± 4.5, common peroneal nerve at the popliteal fossa 9.5 mm ± 4, common peroneal nerve fibular head 8.9 mm ± 3.2, sural nerve 3.5 mm ± 1.4.The reference values for the lower limb peripheral nerves were identified. These values could be used for future management of peripheral nerve disorders.

The effect of electrical muscle stimulation on the prevention of disuse muscle atrophy in patients with consciousness disturbance in the intensive care unit.

PubMed

Hirose, Tomoya; Shiozaki, Tadahiko; Shimizu, Kentaro; Mouri, Tomoyoshi; Noguchi, Kazuo; Ohnishi, Mitsuo; Shimazu, Takeshi

2013-08-01

Disuse atrophy of the lower limbs of patients with consciousness disturbance has often been recognized as "an unavoidable consequence," such that the mechanism was not investigated diligently. In this study, we examined the preventive effects of electrical muscle stimulation (EMS) against disuse atrophy of the lower limbs in patients in coma after stroke or traumatic brain injury in the intensive care unit. We evaluated changes in cross-sectional area of lower limb muscles weekly with computed tomography in 6 control group patients and 9 EMS group patients. Electrical muscle stimulation was performed daily from day 7 after admission. We evaluated the anterior thigh muscle compartment, posterior thigh muscle compartment, anterior leg muscle compartment, and posterior leg muscle compartment. In the control group, the decrease in cross-sectional area progressed in all compartments every week (P < .0001). Cross-sectional areas of all compartments at day 14 were significantly decreased in the control group compared with those in the EMS group at day 7 (P < .001). We were able to limit the rate of muscle atrophy as measured in the cross-sectional areas to within 4% during the period of EMS (days 7-42) in 5 patients. The difference between the control and the EMS groups was statistically significant (P < .001). Electrical muscle stimulation is effective in the prevention of disuse muscle atrophy in patients with consciousness disorder. Copyright © 2013 Elsevier Inc. All rights reserved.

Propulsive forces of mudskipper fins and salamander limbs during terrestrial locomotion: implications for the invasion of land.

PubMed

Kawano, Sandy M; Blob, Richard W

2013-08-01

The invasion of land was a pivotal event in vertebrate evolution that was associated with major appendicular modifications. Although fossils indicate that the evolution of fundamentally limb-like appendages likely occurred in aquatic environments, the functional consequences of using early digited limbs, rather than fins, for terrestrial propulsion have had little empirical investigation. Paleontological and experimental analyses both have led to the proposal of an early origin of "hind limb-driven" locomotion among tetrapods or their ancestors. However, the retention of a pectoral appendage that had already developed terrestrial adaptations has been proposed for some taxa, and few data are available from extant functional models that can provide a foundation for evaluating the relative contributions of pectoral and pelvic appendages to terrestrial support among early stem tetrapods. To examine these aspects of vertebrate locomotor evolution during the invasion of land, we measured three-dimensional ground reaction forces (GRFs) produced by isolated pectoral fins of mudskipper fishes (Periophthalmus barbarus) during terrestrial crutching, and compared these to isolated walking footfalls by the forelimbs and hind limbs of tiger salamanders (Ambystoma tigrinum), a species with subequally-sized limbs that facilitate comparisons to early tetrapods. Pectoral appendages of salamanders and mudskippers exhibited numerous differences in GRFs. Compared with salamander forelimbs, isolated fins of mudskippers bear lower vertical magnitudes of GRFs (as a proportion of body weight), and had GRFs that were oriented more medially. Comparing the salamanders' forelimbs and hind limbs, although the peak net GRF occurs later in stance for the forelimb, both limbs experience nearly identical mediolateral and vertical components of GRF, suggesting comparable contributions to support. Thus, forelimbs could also have played a significant locomotor role among basal tetrapods that had limbs of sub-equal size. However, the salamander hind limb and mudskipper pectoral fin had a greater acceleratory role than did the salamander forelimb. Together, data from these extant taxa help to clarify how structural change may have influenced locomotor function through the evolutionary invasion of land by vertebrates.

Evaluating optimal superficial limb perfusion at different angles using non-invasive micro-lightguide spectrophotometry.

PubMed

Darmanin, Geraldine; Jaggard, Matthew; Hettiaratchy, Shehan; Nanchahal, Jagdeep; Jain, Abhilash

2013-06-01

It is common practice to elevate the limbs postoperatively to reduce oedema and hence optimise perfusion and facilitate rehabilitation. However, elevation may be counterproductive as it reduces the mean perfusion pressure. There are no clear data on the optimal position of the limbs even in normal subjects. The optimal position of limbs was investigated in 25 healthy subjects using a non-invasive micro-lightguide spectrophotometry system "O2C", which indirectly measures skin and superficial tissue perfusion through blood flow, oxygen saturation and relative haemoglobin concentration. We found a reduction in skin and superficial tissue blood flow of 17% (p=0.0001) on arm elevation (180° shoulder flexion) as compared to heart level and an increase in skin and superficial tissue blood flow of 25% (p=0.02) on forearm elevation of 45°. Lower limb skin and superficial tissue blood flow decreased by 15% (p=0.004) on elevation to 47 cm and by 70% on dependency (p=0.0001) compared to heart level. However, on elevation of the lower limb there was also a 28% reduction in superficial venous pooling (p=0.0001) compared to heart level. In the normal limb, the position for optimal superficial perfusion of the upper limb is with the arm placed at heart level and forearm at 45°. In the lower limb the optimal position for superficial perfusion would be at heart level. However, some degree of elevation may be useful if there is an element of venous congestion. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Genetics Home Reference: congenital hemidysplasia with ichthyosiform erythroderma and limb defects

MedlinePlus

... lesions. Arch Dermatol. 2006 Mar;142(3):348-51. Citation on PubMed Herman GE. Disorders of cholesterol ... Genet A. 2003 Oct 15;122A(3):246-51. Citation on PubMed Kaminska-Winciorek G, Brzezinska-Wcisło ...

Characterizing the effects of amplitude, frequency and limb position on vibration induced movement illusions: Implications in sensory-motor rehabilitation.

PubMed

Schofield, Jonathon S; Dawson, Michael R; Carey, Jason P; Hebert, Jacqueline S

2015-01-01

Strategic vibration of musculotendinous regions of a limb elicits illusionary sensations of movement. As a rehabilitation technique, this 'kinesthetic illusion' has demonstrated beneficial results for numerous sensory-motor disorders. However, literature shows little consistency in the vibration parameters or body positioning used, and their effects have yet to be comprehensively investigated. To characterize the effects of the vibration amplitude, frequency, and limb position on the kinesthetic illusion. Movement illusions were induced in 12 participants' biceps and triceps. The effect of amplitude (0.1 to 0.5 mm), frequency (70 to 110 Hz), and two limb positions were quantified on the strength of illusion (SOI), range of motion (ROM) and velocity. Amplitude significantly affected the illusionary SOI, ROM and velocity in the biceps and triceps (p< 0.05). Increasing amplitude resulted in an increase of all three output variables. Limb position showed an effect on illusionary velocity in the biceps as well as ROM and velocity in the triceps (p< 0.05). Frequency demonstrated no statistical effect. Amplitude demonstrated the most profound impact on the kinesthetic illusion in the experimental ranges tested. This work may help guide clinicians and researchers in selecting appropriate vibratory parameters and body positions to consistently elicit and manipulate the kinesthetic illusion.

Functional specialisation of pelvic limb anatomy in horses (Equus caballus)

PubMed Central

Payne, RC; Hutchinson, JR; Robilliard, JJ; Smith, NC; Wilson, AM

2005-01-01

We provide quantitative anatomical data on the muscle–tendon units of the equine pelvic limb. Specifically, we recorded muscle mass, fascicle length, pennation angle, tendon mass and tendon rest length. Physiological cross sectional area was then determined and maximum isometric force estimated. There was proximal-to-distal reduction in muscle volume and fascicle length. Proximal limb tendons were few and, where present, were relatively short. By contrast, distal limb tendons were numerous and long in comparison to mean muscle fascicle length, increasing potential for elastic energy storage. When compared with published data on thoracic limb muscles, proximal pelvic limb muscles were larger in volume and had shorter fascicles. Distal limb muscle architecture was similar in thoracic and pelvic limbs with the exception of flexor digitorum lateralis (lateral head of the deep digital flexor), the architecture of which was similar to that of the pelvic and thoracic limb superficial digital flexors, suggesting a functional similarity. PMID:15960766

Diagnosis and treatment of sleep disorders: a brief review for clinicians

PubMed Central

Abad, Vivien C.; Guilleminault, Christian

2003-01-01

Sleep disorders encompass a wide spectrum of diseases with significant individual health consequences and high economic costs to society. To facilitate the diagnosis and treatment of sleep disorders, this review provides a framework using the International Classification of Sleep Disorders, Primary and secondary insomnia are differentiated, and pharmacological and nonpharmacological treatments are discussed. Common circadian rhythm disorders are described in conjunction with interventions, including chronotherapy and light therapy. The diagnosis and treatment of restless legs syndrome/periodic limb movement disorder is addressed. Attention is focused on obstructive sleep apnea and upper airway resistance syndrome, and their treatment. The constellation of symptoms and findings in narcolepsy are reviewed together with diagnostic testing and therapy, Parasomnias, including sleep terrors, somnambulism, and rapid eye movement (REM) behavior sleep disorders are described, together with associated laboratory testing results and treatment. PMID:22033666

Upper limb contributions to frontal plane balance control in rollator-assisted walking.

PubMed

Tung, James Y; Gage, William H; Poupart, Pascal; McIlroy, William E

2014-01-01

While assisting with balance is a primary reason for rollator use, few studies have examined how the upper limbs are used for balance. This study examines upper limb contributions to balance control during rollator-assisted walking. We hypothesized that there would be an increased upper limb contribution, measured by mean vertical loading (Fz) and variation in frontal plane center-of-pressure (COPhigh), when walking balance is challenged/impaired. Experiment 1 compared straight-line and beam-walking in young adults (n = 11). As hypothesized, Fz and COPhighincreased in beam-walking compared to baseline (mean Fz: 13.7 vs. 9.1% body weight (BW), p < 0.001, RMS COPhigh: 1.35 vs. 1.07 cm, p < 0.001). Experiment 2 compared older adults who regularly use rollators (RU, n = 10) to older adult controls (CTL, n = 10). The predicted higher upper limb contribution in the RU group was not supported. However, when individuals were grouped by balance impairment, those with the lowest Berg Balance scores (< 45) demonstrated greater speed-adjusted COPhigh than those with higher scores (p = 0.013). Furthermore, greater COPhigh and Fz were correlated to greater reduction in step width, supporting the role of upper limb contributions to frontal plane balance. This work will guide studies assessing reliance on rollators by providing a basis for measurement of upper limb balance contributions.

ENGINEERING APPLICATION AND ECONOMICS OF LIMB (LIMESTONE INJECTION/MULTISTAGE BURNERS)

EPA Science Inventory

The paper describes the use of an EPA LIMB cost model, in conjunction with cost and performance models for flue gas desulfurization (FGD), to compare these two technologies under similar premises. (NOTE: The performance goals of LIMB, EPA's acronym for Limestone Injection/Multist...

Periodic limb movements and restless legs syndrome in children with a history of prematurity.

PubMed

Cielo, Christopher M; DelRosso, Lourdes M; Tapia, Ignacio E; Biggs, Sarah N; Nixon, Gillian M; Meltzer, Lisa J; Traylor, Joel; Kim, Ji Young; Marcus, Carole L

2017-02-01

Little is known about the pediatric population at an increased risk of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Polysomnographic data from the Caffeine for Apnea of Prematurity-Sleep (CAPS) study showed a high prevalence of elevated periodic limb movement index (PLMI) in a cohort of ex-preterm children, but the clinical importance of this finding, such as association with RLS, is unknown. We hypothesized that ex-preterm children would have a high prevalence of RLS and PLMD. Ex-preterm children enrolled in CAPS, now aged 5-12 years, completed home polysomnography (PSG) and standardized questionnaires. A diagnosis of RLS or PLMD was established by participants meeting the International Classification of Sleep Disorders, 3rd edition, criteria based on questionnaires and polysomnograms. The clinically available serum ferritin levels were assessed. In total, 167 participants underwent polysomnography and completed all questionnaires. The overall prevalence of RLS was 14/167 (8.4%). An additional 13 subjects (7.8%) were found to have PLMD. Of the 26 participants who had PLMI > 5/h, seven (26.9%) had RLS and 13 (50%) had PLMD. The serum ferritin levels were <50 mcg/L (range -38.4) for all eight participants referred for testing. Children with a history of prematurity have a high prevalence of RLS, particularly those with elevated periodic limb movements. Iron deficiency likely contributes to RLS and PLMD symptoms in this population. Clinicians evaluating ex-preterm children with sleep disturbances should evaluate for RLS and PLMD. Further studies including serum ferritin evaluation are required to confirm these findings. Copyright © 2016 Elsevier B.V. All rights reserved.

Primary Intestinal Lymphangiectasia Manifested as Unusual Edemas and Effusions: A Case Report.

PubMed

Wang, Xuefeng; Jin, Hong; Wu, Weilu

2016-03-01

Primary intestinal lymphangiectasia (PIL) is a rare disorder of unknown etiology characterized by diffuse or localized dilation and eventual rupture of the enteric lymphatic vessels in mucosa, submucosa, and/or subserosa. Lymph, rich in all kinds of proteins and lymphocytes, leaks into the gastrointestinal tract via the affected lymphatic vessels causing hypoproteinemia and lymphopenia. The main symptom is variable degrees of pitting edemas of bilateral lower limbs. But edemas of any other parts of body, and mild serous effusions may also occur sometimes. PIL occurs in conjunction with a right hemifacial edema, a right upper limb lymphedema, asymmetric bilateral calves edemas, and a unilateral massive pleural effusion seems never to be reported before. In addition, increased enteric protein loss that may cause severe hypoproteinemia usually get overlooked, and the lymphatic system disorders always put the diagnoses in a dilemma.We described a case of a 17-year-old Chinese girl with a history of gradually progressive swellings of right-sided face, right upper limb, and bilateral calves since 3 to 4 months of age. A right-sided massive pleural effusion, a moderate pericardial effusion, and a mild ascites have been proved unchanged by a series of computerized tomography (CT) scans since 5 years ago. The diagnosis of PIL was finally confirmed by severe hypoproteinemia, endoscopic changes, and histology of jejunum biopsy. Further lymphoscintigraphy and lymphangiography also identified lymph leakage in her bowel and several abnormal lymphatic vessels. A high-protein, low-fat diet supplemented with medium-chain triglycerides (MCT) showed some benefit.This case suggested that PIL was a rare but important etiology of hypoproteinemia, effusions, and edemas. PIL, effusions, and lymphedema can be the features of multisegmental generalized lymphatic dysplasia. In addition, both lymphoscintigraphy and intranodal lymphangiography could be considered when lymphatic system disorders are suspected.

Primary Intestinal Lymphangiectasia Manifested as Unusual Edemas and Effusions

PubMed Central

Wang, Xuefeng; Jin, Hong; Wu, Weilu

2016-01-01

Abstract Primary intestinal lymphangiectasia (PIL) is a rare disorder of unknown etiology characterized by diffuse or localized dilation and eventual rupture of the enteric lymphatic vessels in mucosa, submucosa, and/or subserosa. Lymph, rich in all kinds of proteins and lymphocytes, leaks into the gastrointestinal tract via the affected lymphatic vessels causing hypoproteinemia and lymphopenia. The main symptom is variable degrees of pitting edemas of bilateral lower limbs. But edemas of any other parts of body, and mild serous effusions may also occur sometimes. PIL occurs in conjunction with a right hemifacial edema, a right upper limb lymphedema, asymmetric bilateral calves edemas, and a unilateral massive pleural effusion seems never to be reported before. In addition, increased enteric protein loss that may cause severe hypoproteinemia usually get overlooked, and the lymphatic system disorders always put the diagnoses in a dilemma. We described a case of a 17-year-old Chinese girl with a history of gradually progressive swellings of right-sided face, right upper limb, and bilateral calves since 3 to 4 months of age. A right-sided massive pleural effusion, a moderate pericardial effusion, and a mild ascites have been proved unchanged by a series of computerized tomography (CT) scans since 5 years ago. The diagnosis of PIL was finally confirmed by severe hypoproteinemia, endoscopic changes, and histology of jejunum biopsy. Further lymphoscintigraphy and lymphangiography also identified lymph leakage in her bowel and several abnormal lymphatic vessels. A high-protein, low-fat diet supplemented with medium-chain triglycerides (MCT) showed some benefit. This case suggested that PIL was a rare but important etiology of hypoproteinemia, effusions, and edemas. PIL, effusions, and lymphedema can be the features of multisegmental generalized lymphatic dysplasia. In addition, both lymphoscintigraphy and intranodal lymphangiography could be considered when lymphatic system disorders are suspected. PMID:26962779

On the use of information theory for detecting upper limb motor dysfunction: An application to Parkinson’s disease

NASA Astrophysics Data System (ADS)

de Oliveira, M. Elias; Menegaldo, L. L.; Lucarelli, P.; Andrade, B. L. B.; Büchler, P.

2011-11-01

Parkinson’s disease (PD) is a chronic neurodegenerative disorder characterized by a selective loss of dopaminergic neurons in the substantia nigra, decreased striatal dopamine levels, and consequent extrapyramidal motor dysfunctions. Several potential early diagnostic markers of PD have been proposed. Since they have not been validated in presymptomatic PD, the diagnosis and monitoring of the disease is based on subjective clinical assessment of cognitive and motor symptoms. In this study, we investigated interjoint coordination synergies in the upper limb of healthy and parkinsonian subjects during the performance of unconstrained linear-periodic movements in a horizontal plane using the mutual information (MI). We found that the MI is a sensitive metric in detecting upper limb motor dysfunction, thus suggesting that this method might be applicable to quantitatively evaluating the effects of the antiparkinsonian medication and to monitor the disease progression.

A novel missense mutation, p.(R102W) in WNT7A causes Al-Awadi Raas-Rothschild syndrome in a fetus.

PubMed

Mutlu, Mehmet Burak; Cetinkaya, Arda; Koc, Nermin; Ceylaner, Gulay; Erguner, Bekir; Aydın, Hatip; Karaman, Selin; Demirci, Oya; Goksu, Kamber; Karaman, Ali

2016-11-01

Al-Awadi-Raas-Rothschild syndrome (AARRS) is a rare autosomal recessive disorder which consists of severe malformations of the upper and lower limbs, abnormal genitalia and underdeveloped pelvis. Here, we present a fetus with severe limbs defects, including bilateral humeroradial synostosis, bilateral oligodactyly in hands, underdeveloped pelvis, short femora and tibiae, absence of fibulae, severely small feet, and absence of uterus. An autosomal recessively inherited novel mutation in WNT7A found in the fetus, c.304C > T, affects an evolutionarily well-conserved amino acid, causing the p.(R102W) missense change at protein level. The findings presented in this fetus are compatible with diagnosis of AARRS, expanding the mutational spectrum of limb malformations arising from defects in WNT7A. Crown Copyright © 2016. Published by Elsevier Masson SAS. All rights reserved.

Calculating regional tissue volume for hyperthermic isolated limb perfusion: Four methods compared.

PubMed

Cecchin, D; Negri, A; Frigo, A C; Bui, F; Zucchetta, P; Bodanza, V; Gregianin, M; Campana, L G; Rossi, C R; Rastrelli, M

2016-12-01

Hyperthermic isolated limb perfusion (HILP) can be performed as an alternative to amputation for soft tissue sarcomas and melanomas of the extremities. Melphalan and tumor necrosis factor-alpha are used at a dosage that depends on the volume of the limb. Regional tissue volume is traditionally measured for the purposes of HILP using water displacement volumetry (WDV). Although this technique is considered the gold standard, it is time-consuming and complicated to implement, especially in obese and elderly patients. The aim of the present study was to compare the different methods described in the literature for calculating regional tissue volume in the HILP setting, and to validate an open source software. We reviewed the charts of 22 patients (11 males and 11 females) who had non-disseminated melanoma with in-transit metastases or sarcoma of the lower limb. We calculated the volume of the limb using four different methods: WDV, tape measurements and segmentation of computed tomography images using Osirix and Oncentra Masterplan softwares. The overall comparison provided a concordance correlation coefficient (CCC) of 0.92 for the calculations of whole limb volume. In particular, when Osirix was compared with Oncentra (validated for volume measures and used in radiotherapy), the concordance was near-perfect for the calculation of the whole limb volume (CCC = 0.99). With methods based on CT the user can choose a reliable plane for segmentation purposes. CT-based methods also provides the opportunity to separate the whole limb volume into defined tissue volumes (cortical bone, fat and water). Copyright © 2016 Elsevier Ltd. All rights reserved.

Body image and self-esteem in lower-limb amputees.

PubMed

Holzer, Lukas A; Sevelda, Florian; Fraberger, Georg; Bluder, Olivia; Kickinger, Wolfgang; Holzer, Gerold

2014-01-01

Limb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL). 298 patients (149 uni- or bilateral lower-limb amputees and 149 controls) were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) scale and the SF-36 Health Survey (QoL). ANOVA and student's t-test were used for statistical analysis. Unilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (p<0.001) and a lower score in the RSE compared to controls (21.63±4.72 vs. 21.46±5.86). However, differences were not statistically significant (p = 0.36). Patients with phantom pain sensation had a significantly reduced RSE (p = 0.01). The SF-36 health survey was significantly lower in patients with lower-limb amputation compared to controls (42.17±14.47 vs. 64.05±12.39) (p<0.001). This study showed that lower-limb amputations significantly influence patients' body image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation.

Familial pterygium syndrome.

PubMed

Stoll, C; Levy, J M; Kehr, P; Roth, M P

1980-11-01

Two sisters affected with the same disorder are described. They had webbing of the neck, the antecubital fossae and the popliteal regions, together with flexion deformities of the limb joints and anomalies of the vertebrae. Eight other cases are known. The condition is inherited in an autosomal recessive mode.

[Domestic external fixator application in the treatment of limb deformities: 7 289 cases application report].

PubMed

Qin, S H; Guo, B F; Zheng, X J; Jiao, S F; Xia, H T; Peng, A M; Pan, Q; Zang, J C; Wang, Z J

2017-09-01

Objective: To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs. Methods: A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on. Results: All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on. Conclusions: The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical, economical, adjustable, universal and portable. The domestic external fixator could meet the clinical demand for fixation of the osteotomy end of the limbs, the correction of the deformity, the repair of the defects and the limb lengthening.

Chronic pain associated with upper-limb loss.

PubMed

Hanley, Marisol A; Ehde, Dawn M; Jensen, Mark; Czerniecki, Joseph; Smith, Douglas G; Robinson, Lawrence R

2009-09-01

To describe the prevalence, intensity, and functional impact of the following types of pain associated with upper-limb loss: phantom limb, residual limb, back, neck, and nonamputated-limb pain. Cross-sectional survey; 104 respondents with upper-limb loss at least 6 months postamputation completed measures of pain intensity, interference, disability, and health-related quality-of-life. Nearly all (90%) of the respondents reported pain, with 76% reporting more than one pain type. Phantom-limb pain and residual-limb pain were the most prevalent (79% and 71%, respectively), followed by back (52%), neck (43%), and nonamputated-limb pain (33%). Although nonamputated-limb pain was least prevalent, it was reported to cause the highest levels of interference and pain-related disability days. Self-reported quality-of-life was significantly lower for individuals with each type of pain compared with those without any pain. Age, time since amputation, and cause of amputation were not associated with pain. In addition to pain in the phantom and residual limb, back, neck, and nonamputated-limb pain are also common after upper-limb loss. All of these pain types are associated with significant disability and activity interference for some individuals, suggesting that assessment of multiple pain types in persons with upper-limb amputation may be important.

Predictors of return to work with upper limb disorders.

PubMed

Moshe, S; Izhaki, R; Chodick, G; Segal, N; Yagev, Y; Finestone, A S; Juven, Y

2015-10-01

Return to work (RTW) is a key goal in the proper management of upper limb disorders (ULDs). ULDs stem from diverse medical aetiologies and numerous variables can affect RTW. The abundance of factors, their complex interactions and the diversity of human behaviour make it difficult to pinpoint those at risk of not returning to work (NRTW) and to intervene effectively. To weigh various clinical, functional and occupational parameters that influence RTW in ULD sufferers and to identify significant predictors. A retrospective analysis of workers with ULD referred to an occupational health clinic and further examined by an occupational therapist. Functional assessment included objective and subject ive [Disability of the Arm, Shoulder and Hand (DASH) score] parameters. Quantification of work requirements was based on definitions from the Dictionary of Occupational Titles web site. RTW status was confirmed by a follow-up telephone questionnaire. Among the 52 subjects, the RTW rate was 42%. The DASH score for the RTW group was 27 compared with 56 in the NRTW group (P < 0.001). In multivariate analyses, only the DASH score was found to be a significant independent predictor of RTW (P < 0.05). Physicians and rehabilitation staff should regard a high DASH score as a warning sign when assessing RTW prospects in ULD cases. It may be advisable to focus on workers with a large discrepancy between high DASH scores and low objective disability and to concentrate efforts appropriately. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Xenomelia: a new right parietal lobe syndrome.

PubMed

McGeoch, Paul D; Brang, David; Song, Tao; Lee, Roland R; Huang, Mingxiong; Ramachandran, V S

2011-12-01

Damage to the right parietal lobe has long been associated with various disorders of body image. The authors have recently suggested that an unusual behavioural condition in which otherwise rational individuals desire the amputation of a healthy limb might also arise from right parietal dysfunction. Four subjects who desired the amputation of healthy legs (two right, one left and one, at first, bilateral and then left only) were recruited and underwent magnetoencephalography (MEG) scans during tactile stimulation of sites above and below the desired amputation line. Regions of interest (ROIs) in each hemisphere (superior parietal lobule (SPL), inferior parietal lobule, S1, M1, insula, premotor cortex and precuneus) were defined using FreeSurfer software. Analysis of average MEG activity across the 40-140 ms post-stimulation timeframe was carried out using an unpaired t test. This revealed significantly reduced activation only in the right SPL ROI for the subjects' affected legs when compared with both subjects' unaffected legs and that of controls. The right SPL is a cortical area that appears ideally placed to unify disparate sensory inputs to create a coherent sense of having a body. The authors propose that inadequate activation of the right SPL leads to the unnatural situation in which the sufferers can feel the limb in question being touched without it actually incorporating into their body image, with a resulting desire for amputation. The authors introduce the term 'xenomelia' as a more appropriate name than apotemnophilia or body integrity identity disorder, for what appears to be an unrecognised right parietal lobe syndrome.

Measures of central hyperexcitability in chronic whiplash associated disorder--a systematic review and meta-analysis.

PubMed

Stone, Andrew M; Vicenzino, Bill; Lim, Edwin C W; Sterling, Michele

2013-04-01

To synthesise the evidence for central hyperexcitability in Chronic WAD (whiplash associated disorders) with meta-analysis, and review test protocols. Chronic WAD was compared to healthy controls. Studies were eligible if they used measures of central hyperexcitability with standardised procedure. Meta-analyses (where possible) were conducted. The search yielded 27 trials of good quality and 13 were suitable for meta-analyses. Individuals with chronic WAD showed heightened sensitivity to the following tests (p < 0.05): Pressure Pain Thresholds at Head/Neck/Upper Thoracic area (H/N/UT) (SMD (Standardised mean differences) -1.36, 95% CI (confidence intervals) -1.89 to -0.82), Upper Limb (UL) (-1.33, 95% CI -2.50 to -0.16), Lower Limb (LL) (-1.01, 95% CI -1.70 to -0.33), flexor withdrawal (-0.73, 95% CI -1.11 to -0.35), Cold Pain Threshold at H/N/UT (0.91, 95% CI 0.66-1.17) and UL (0.66, 95% CI 0.37-0.94), Heat Pain Threshold at H/N/UT (-0.58, 95% CI -0.88 to -0.28), Electrocutaneous Stimulation at H/N/UT (-1.04, 95% CI -1.63 to -0.45) and LL (-0.85, 95% CI -1.67 to -0.03), and elbow extension with the Brachial Plexus Provocation Test (SMD -0.55, 95% CI -0.76 to -0.35). There is compelling evidence for central hyperexcitability in chronic WAD. This should be considered in the management of chronic WAD. Copyright © 2012 Elsevier Ltd. All rights reserved.

Arm and neck pain in ultrasonographers.

PubMed

Claes, Frank; Berger, Jan; Stassijns, Gaëtane

2015-03-01

The aim of this study was to evaluate the prevalence of upper-body-quadrant pain among ultrasonographers and to evaluate the association between individual ergonomics, musculoskeletal disorders, and occurrence of neck pain. A hundred and ten (N = 110) Belgian and Dutch male and female hospital ultrasonographers were consecutively enrolled in the study. Data on work-related ergonomic and musculoskeletal disorders were collected with an electronic inquiry, including questions regarding ergonomics (position of the screen, high-low table, and ergonomic chair), symptoms (neck pain, upper-limb pain), and work-related factors (consecutive working hours a day, average working hours a week). Subjects with the screen on their left had significantly more neck pain (odds ratio [OR] = 3.6, p = .0286). Depending on the workspace, high-low tables increased the chance of developing neck pain (OR = 12.9, p = .0246). A screen at eye level caused less neck pain (OR = .22, p = .0610). Employees with a fixed working space were less susceptible to arm pain (OR = 0.13, p = .0058). The prevalence of arm pain was significantly higher for the vascular department compared to radiology, urology, and gynecology departments (OR = 9.2, p = .0278). Regarding prevention of upper-limb pain in ultrasonograph, more attention should be paid to the work environment and more specialty to the ultrasound workstation layout. Primary ergonomic prevention could provide a painless work situation for the ultrasonographer. Further research on the ergonomic conditions of ultrasonography is necessary to develop ergonomic solutions in the work environment that will help to alleviate neck and arm pain. © 2014, Human Factors and Ergonomics Society.

Polysomnographic Findings and Clinical Correlates in Huntington Disease: A Cross-Sectional Cohort Study

PubMed Central

Piano, Carla; Losurdo, Anna; Della Marca, Giacomo; Solito, Marcella; Calandra-Buonaura, Giovanna; Provini, Federica; Bentivoglio, Anna Rita; Cortelli, Pietro

2015-01-01

Study Objectives: To evaluate the sleep pattern and the motor activity during sleep in a cohort of patients affected by Huntington disease (HD). Design: Cross-sectional cohort study. Setting: Sleep laboratory. Patients: Thirty HD patients, 16 women and 14 men (mean age 57.3 ± 12.2 y); 30 matched healthy controls (mean age 56.5 ± 11.8 y). Interventions: Subjective sleep evaluation: Epworth Sleepiness Scale (ESS); Berlin's Questionnaire, interview for restless legs syndrome (RLS), questionnaire for REM sleep behavior disorder (RBD). Clinical evaluation: disease duration, clinical severity (unified Huntington disease motor rating scale [UHDMRS]), genetic tests. Laboratory-based full-night attended video-polysomnography (V-PSG). Measurements and Results: The duration of the disease was 9.4 ± 4.4 y, UHMDRS score was 55.5 ± 23.4, CAG repeats were 44.3 ± 4.1. Body mass index was 21.9 ± 4.0 kg/m2. No patients or caregivers reported poor sleep quality. Two patients reported symptoms of RLS. Eight patients had an ESS score ≥ 9. Eight patients had high risk of obstructive sleep apnea. At the RBD questionnaire, two patients had a pathological score. HD patients, compared to controls, showed shorter sleep, reduced sleep efficiency index, and increased arousals and awakenings. Four patients presented with sleep disordered breathing (SDB). Periodic limb movements (PLMs) during wake and sleep were observed in all patients. No episode of RBD was observed in the V-PSG recordings, and no patients showed rapid eye movement (REM) sleep without atonia. The disease duration correlated with ESS score (P < 0.02). UHMDRS correlated positively with the ESS score (P < 0.005), and negatively with the percentage of REM sleep. Conclusions: Patients with Huntington disease showed a severe sleep disruption and a high prevalence of periodic limb movements, but no evidence of sleep disordered breathing or REM sleep behavior disorder. Citation: Piano C, Losurdo A, Della Marca G, Solito M, Calandra-Buonaura G, Provini F, Bentivoglio AR, Cortelli P. Polysomnographic findings and clinical correlates in Huntington disease: a cross-sectional cohort study. SLEEP 2015;38(9):1489–1495. PMID:25845698

Reasonable classical concepts in human lower limb anatomy from the viewpoint of the primitive persistent sciatic artery and twisting human lower limb.

PubMed

Kawashima, Tomokazu; Sasaki, Hiroshi

2010-11-01

The main aim of this review is (1) to introduce the two previous studies we published human lower limb anatomy based on the conventional macroscopic anatomical [corrected] criteria with hazardous recognition of this description, (2) to activate the discussion whether the limb homology exists, and (3) to contribute to future study filling the gap between the gross anatomy and embryology. One of the topics we discussed was the human persistent sciatic artery. To date, numerous human cases of persistent sciatic artery have been reported in which the anomalous artery was present in the posterior compartment of the thigh alongside the sciatic nerve. As one of the important criteria for assessing the human primitive sciatic artery, its ventral arterial position with respect to the sciatic nerve is reasonable based on the initial positional relationship between ventral arterial and dorsal nervous systems and comparative anatomical findings. We also discuss ways of considering the topography of muscles of the lower limb and their innervations compared to those of the upper limb. We propose a schema of the complex anatomical characteristics of the lower limb based on the vertebrate body plan. According to this reasonable schema, the twisted anatomy of the lower limb can be understood more easily. These two main ideas discussed in this paper will be useful for further understanding of the anatomy of the lower limb and as a first step for future. We hope that the future study in lower limb will be further developed by both viewpoints of the classical gross anatomy and recent embryology.

Are ovine fenugreek (Trigonella foenum-graecum) staggers and kangaroo gait of lactating ewes two clinically and pathologically similar nervous disorders?

PubMed

Bourke, Ca

2009-03-01

Fenugreek staggers has occurred in sheep in Victoria, as both an acute and a chronic syndrome. Signs included quadraparesis, a high stepping fore limb gait and a 'bunny-hopping' hind limb gait. Changes consistent with acute oedema were found in the brain and spinal cord of acute cases, and Wallerian degeneration in the peripheral nerves of chronic cases. Kangaroo gait occurred in ewes in New South Wales, and the clinical signs and microscopic changes were remarkably similar to those of fenugreek staggers. Although the diet associated with each is different the causal agent may be the same.

Kinematics Analysis of Dominant and Non-Dominant Lower Limb during Knee Strike among MuayThai Beginners

NASA Astrophysics Data System (ADS)

Chinnasee, Chamnan; Nadzalan, Ali Md; Ikhwan Mohamad, Nur; Sazili, Abdul Hafiz Ahmad; Hemapandha, Witthaya; Azizuddin Khan, Thariq Khan; Pimjan, Luckhana; Tan, Kevin

2018-05-01

This study was conducted to determine and compare the kinematics of knee strike in MuayThai between dominant and non-dominant lower limb. Ten MuayThai beginners (mean age = 20 ± 1 years old) with less than one week experiences in MuayThai training were recruited and were asked to perform three trials of knee strikes for each leg (dominant and non-dominant). Joint angles and angular velocity of the movement were assessed for each trial. Repeated measure multivariate analyses of variances (MANOVA) were performed to compare the kinematics data between the dominant and non-dominant lower limb. Results showed no significant differences existed in all the joint kinematics examined between dominant and non-dominant lower limb. As the conclusion, MuayThai beginners demonstrated no differences of joint kinematics during knee strike between dominant and non-dominant lower limb.

Caspase inhibition supports proper gene expression in ex vivo mouse limb cultures.

PubMed

De Valck, D; Luyten, F P

2001-10-01

We standardized conditions for ex vivo mouse limb culture to study cartilage maturation and joint formation. We compared 12.5 d.p.c. mouse forelimbs that were cultured either mounted or freely rotating for up to 72 h. Limb outgrowth progressed ex vivo at a variable rate as compared to its development in vivo, spanning approximately 48 h. Although cartilage maturation and joint formation developed grossly normal, aberrant expression of skeletal marker genes was seen. Interestingly, no regression of the interdigital webs took place in mounted cultures, in contrast to limited webbing under freely rotating conditions. Caspase inhibition, by addition of zVAD-fmk to the culture medium of freely rotating limbs, supported proper gene expression associated with skeletal development, and prevented interdigital web regression. Taken together, a freely rotating ex vivo culture for mouse limb outgrowth that is combined with caspase inhibition provides a good model to study cartilage maturation and joint formation.

Mental health and satisfaction with life among upper limb amputees: a Norwegian population-based survey comparing adult acquired major upper limb amputees with a control group.

PubMed

Østlie, Kristin; Magnus, Per; Skjeldal, Ola H; Garfelt, Beate; Tambs, Kristian

2011-01-01

To assess how upper limb amputation affects mental health and life satisfaction. Cross-sectional study comparing the mental health and perceived satisfaction with life among adult acquired major upper limb amputees in Norway with a control group drawn from the Norwegian general population. The scales used were the Satisfaction With Life Scale (SWLS) and the Hopkins Symptom Check List 25-item (SCL-25). The groups were compared using multiple linear regression analyses. The amputees scored significantly lower on life satisfaction than the control group. A tendency to poorer mental health in the amputee group was observed, but there was no clear evidence of such a difference. The amputation effect on life satisfaction seemed to be mediated mainly by changes in occupational status and by the occurrence of short- or long-term complications related to the amputation. Our findings imply that rehabilitation of upper limb amputees should emphasise facilitating return to work as well as the prevention of short- and long-term complications, and that this will be of importance not only for the amputees' physical function, but for the maintenance of acceptable life satisfaction. Further studies on the effect of upper limb amputation on mental health are recommended.

Wheeled mobility: factors influencing mobility and assistive technology in veterans and servicemembers with major traumatic limb loss from Vietnam war and OIF/OEF conflicts.

PubMed

Laferrier, Justin Z; McFarland, Lynne V; Boninger, Michael L; Cooper, Rory A; Reiber, Gayle E

2010-01-01

Returning wounded veterans and servicemembers to their highest level of function following traumatic injury is a priority of the Departments of Defense and Veterans Affairs. We surveyed 245 veterans from the Vietnam war and 226 servicemembers and veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) conflicts with at least one major traumatic lower-limb loss to determine their use of mobility assistive technology (AT) and patterns of limb abandonment. Prosthetic device use without wheelchair use is found in 50.5% of Vietnam and 42.8% of OIF/OEF groups. Prostheses and supplementary wheelchairs are used by Vietnam (32%) and OIF/OEF (53%) groups (p < 0.01). Exclusive wheelchair use is more frequent in the Vietnam group (18%) than in the OIF/OEF group (4.0%, p < 0.01). In Vietnam participants, multivariate analysis found that multiple-limb loss (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] 5.5-38.5), bilateral lower-limb loss (AOR = 12.7; 95% CI 6.2-26.1), and number of comorbidities (AOR = 1.3; 95% CI 1.2-1.5) are associated with increased likelihood of wheelchair use. In OIF/OEF participants, bilateral lower-limb loss (AOR = 29.8; 95% CI 11.0-80.7), multiple-limb loss (AOR = 16.3; 95% CI 3.1-85.3), cumulative trauma disorder (AOR = 2.4; 95% CI 1.2-4.9), and number of combat injuries (AOR = 1.4; 95% CI 1.2-1.7) are associated with wheelchair use. Combined use of different types of mobility ATs promotes improved rehabilitation and ability to function.

Neuromuscular dysfunction that may predict ACL injury risk: a case report.

PubMed

Saunders, Natalie; McLean, Scott G; Fox, Aaron S; Otago, Leonie

2014-06-01

This case report examined the neuromuscular function of a competitive female netball player six days prior to an incident where she sustained an acute anterior cruciate ligament injury during normal sports activity. Electromyography was used to examine activation onsets of four lower limb muscles (rectus femoris, biceps femoris, medial hamstrings and gluteus medius) relative to initial contact (IC) during netball-specific landings of varying complexity. The results of the injured participant were compared to the remaining participants in the study (n=8), and the injured participant's injured limb was compared to the contralateral limb. The injured participant was the only player to record delayed pre-injury muscle onsets after IC for all muscles tested in the injured limb, while her non-injured limb was comparable to the other participants tested. Furthermore, delayed muscle onset after IC occurred more frequently as landing complexity increased. This case report suggests that delayed muscle activity onset after IC during landing may be an important risk factor for ACL injury. Copyright © 2014 Elsevier B.V. All rights reserved.

Comparative genomic analysis of the false killer whale (Pseudorca crassidens) LMBR1 locus.

PubMed

Kim, Dae-Won; Choi, Sang-Haeng; Kim, Ryong Nam; Kim, Sun-Hong; Paik, Sang-Gi; Nam, Seong-Hyeuk; Kim, Dong-Wook; Kim, Aeri; Kang, Aram; Park, Hong-Seog

2010-09-01

The sequencing and comparative genomic analysis of LMBR1 loci in mammals or other species, including human, would be very important in understanding evolutionary genetic changes underlying the evolution of limb development. In this regard, comparative genomic annotation of the false killer whale LMBR1 locus could shed new light on the evolution of limb development. We sequenced two false killer whale BAC clones, corresponding to 156 kb and 144 kb, respectively, harboring the tightly linked RNF32, LMBR1, and NOM1 genes. Our annotation of the false killer whale LMBR1 gene showed that it consists of 17 exons (1473 bp), in contrast to 18 exons (1596 bp) in human, and it displays 93.1% and 95.6% nucleotide and amino acid sequence similarity, respectively, compared with the human gene. In particular, we discovered that exon 10, deleted in the false killer whale LMBR1 gene, is present only in primates, and this fact strongly implies that exon 10 might be crucial in determining primate-specific limb development. ZRS and TFBS sequences have been well conserved across 11 species, suggesting that these regions could be involved in an important function of limb development and limb patterning. The neighboring gene RNF32 showed several lineage-conserved exons, such as exons 2 through 9 conserved in eutherian mammals, exons 3 through 9 conserved in mammals, and exons 5 through 9 conserved in vertebrates. The other neighboring gene, NOM1, had undergone a substitution (ATG→GTA) at the start codon, giving rise to a 36 bp shorter N-terminal sequence compared with the human sequence. Our comparative analysis of the false killer whale LMBR1 genomic locus provides important clues regarding the genetic regions that may play crucial roles in limb development and patterning.

Analysis of gait symmetry during over-ground walking in children with autism spectrum disorder.

PubMed

Eggleston, Jeffrey D; Harry, John R; Hickman, Robbin A; Dufek, Janet S

2017-06-01

Gait symmetry is utilized as an indicator of neurologic function. Healthy gait often exhibits minimal asymmetries, while pathological gait exhibits exaggerated asymmetries. The purpose of this study was to examine symmetry of mechanical gait parameters during over-ground walking in children with Autism Spectrum Disorder (ASD). Kinematic and kinetic data were obtained from 10 children (aged 5-12 years) with ASD. The Model Statistic procedure (α=0.05) was used to compare gait related parameters between limbs. Analysis revealed children with ASD exhibit significant lower extremity joint position and ground reaction force asymmetries throughout the gait cycle. The observed asymmetries were unique for each subject. These data do not support previous research relative to gait symmetry in children with ASD. Many individuals with ASD do not receive physical therapy interventions, however, precision medicine based interventions emphasizing lower extremity asymmetries may improve gait function and improve performance during activities of daily living. Copyright © 2017 Elsevier B.V. All rights reserved.

Sex-specific gait adaptations prior to and up to six months after ACL reconstruction

PubMed Central

Stasi, Stephanie L. Di; Hartigan, Erin H.; Snyder-Mackler, Lynn

2015-01-01

STUDY DESIGN Controlled longitudinal laboratory study. OBJECTIVES Compare sagittal plane gait mechanics of men and women before and up to 6 months after anterior cruciate ligament reconstruction (ACLR). BACKGROUND Aberrant gait patterns are ubiquitous after anterior cruciate ligament (ACL) rupture and persist after ACLR despite skilled physical therapy. Sex influences post-operative function and second ACL injury risk, but its influence on gait adaptations after injury have not been investigated. METHODS Sagittal plane knee and hip joint excursions during midstance and internal knee and hip extension moments at peak knee flexion were collected on 12 women and 27 men using 3-dimensional gait analysis before (Screen) and after pre-operative physical therapy (Pre-sx), and 6 months after ACLR (6mo). Repeated measures analysis of variance models were used to determine whether limb asymmetries changed differently over time in men and women. RESULTS Significant time x limb x sex interactions were identified for hip and knee excursions and internal knee extension moments (P≤.007). Both sexes demonstrated smaller knee excursions on the involved compared to the uninvolved knee at each time point (P≤.007), but only women demonstrated a decrease in the involved knee excursion from pre-sx to 6mo (P=.03). Women also demonstrated smaller hip excursions (P<.001) and internal knee extension moments (P=.005) on the involved limb compared to the uninvolved limb at 6mo. Men demonstrated smaller hip excursions and knee moments on the involved limb compared to the uninvolved limb (main effects, P<.001). CONCLUSION The persistence of limb asymmetries in men and women 6 months after ACLR indicates that current rehabilitation efforts are inadequate for some individuals following ACLR. PMID:25627155

Sensorimotor adaptation of speech in Parkinson's disease.

PubMed

Mollaei, Fatemeh; Shiller, Douglas M; Gracco, Vincent L

2013-10-01

The basal ganglia are involved in establishing motor plans for a wide range of behaviors. Parkinson's disease (PD) is a manifestation of basal ganglia dysfunction associated with a deficit in sensorimotor integration and difficulty in acquiring new motor sequences, thereby affecting motor learning. Previous studies of sensorimotor integration and sensorimotor adaptation in PD have focused on limb movements using visual and force-field alterations. Here, we report the results from a sensorimotor adaptation experiment investigating the ability of PD patients to make speech motor adjustments to a constant and predictable auditory feedback manipulation. Participants produced speech while their auditory feedback was altered and maintained in a manner consistent with a change in tongue position. The degree of adaptation was associated with the severity of motor symptoms. The patients with PD exhibited adaptation to the induced sensory error; however, the degree of adaptation was reduced compared with healthy, age-matched control participants. The reduced capacity to adapt to a change in auditory feedback is consistent with reduced gain in the sensorimotor system for speech and with previous studies demonstrating limitations in the adaptation of limb movements after changes in visual feedback among patients with PD. © 2013 Movement Disorder Society.

Can a novel smartphone application detect periodic limb movements?

PubMed

Bhopi, Rashmi; Nagy, David; Erichsen, Daniel

2012-01-01

Periodic limb movements (PLMs) are repetitive, stereotypical and unconscious movements, typically of the legs, that occur in sleep and are associated with several sleep disorders. The gold standard for detecting PLMs is overnight electromyography which, although highly sensitive and specific, is time and labour consuming. The current generation of smart phones is equipped with tri-axial accelerometers that record movement. To develop a smart phone application that can detect PLMs remotely. A leg movement sensing application (LMSA) was programmed in iOS 5x and incorporated into an iPhone 4S (Apple INC.). A healthy adult male subject underwent simultaneous EMG and LMSA measurements of voluntary stereotypical leg movements. The mean number of leg movements recorded by EMG and by the LMSA was compared. A total of 403 leg movements were scored by EMG of which the LMSA recorded 392 (97%). There was no statistical difference in mean number of leg movements recorded between the two modalities (p = 0.3). These preliminary results indicate that a smart phone application is able to accurately detect leg movements outside of the hospital environment and may be a useful tool for screening and follow up of patients with PLMs.

Copy number analysis of NIPBL in a cohort of 510 patients reveals rare copy number variants and a mosaic deletion.

PubMed

Cheng, Yu-Wei; Tan, Christopher A; Minor, Agata; Arndt, Kelly; Wysinger, Latrice; Grange, Dorothy K; Kozel, Beth A; Robin, Nathaniel H; Waggoner, Darrel; Fitzpatrick, Carrie; Das, Soma; Del Gaudio, Daniela

2014-03-01

Cornelia de Lange syndrome (CdLS) is a genetically heterogeneous disorder characterized by growth retardation, intellectual disability, upper limb abnormalities, hirsutism, and characteristic facial features. In this study we explored the occurrence of intragenic NIPBL copy number variations (CNVs) in a cohort of 510 NIPBL sequence-negative patients with suspected CdLS. Copy number analysis was performed by custom exon-targeted oligonucleotide array-comparative genomic hybridization and/or MLPA. Whole-genome SNP array was used to further characterize rearrangements extending beyond the NIPBL gene. We identified NIPBL CNVs in 13 patients (2.5%) including one intragenic duplication and a deletion in mosaic state. Breakpoint sequences in two patients provided further evidence of a microhomology-mediated replicative mechanism as a potential predominant contributor to CNVs in NIPBL. Patients for whom clinical information was available share classical CdLS features including craniofacial and limb defects. Our experience in studying the frequency of NIBPL CNVs in the largest series of patients to date widens the mutational spectrum of NIPBL and emphasizes the clinical utility of performing NIPBL deletion/duplication analysis in patients with CdLS.

Mapping pathological phenotypes in a mouse model of CDKL5 disorder.

PubMed

Amendola, Elena; Zhan, Yang; Mattucci, Camilla; Castroflorio, Enrico; Calcagno, Eleonora; Fuchs, Claudia; Lonetti, Giuseppina; Silingardi, Davide; Vyssotski, Alexei L; Farley, Dominika; Ciani, Elisabetta; Pizzorusso, Tommaso; Giustetto, Maurizio; Gross, Cornelius T

2014-01-01

Mutations in cyclin-dependent kinase-like 5 (CDKL5) cause early-onset epileptic encephalopathy, a neurodevelopmental disorder with similarities to Rett Syndrome. Here we describe the physiological, molecular, and behavioral phenotyping of a Cdkl5 conditional knockout mouse model of CDKL5 disorder. Behavioral analysis of constitutive Cdkl5 knockout mice revealed key features of the human disorder, including limb clasping, hypoactivity, and abnormal eye tracking. Anatomical, physiological, and molecular analysis of the knockout uncovered potential pathological substrates of the disorder, including reduced dendritic arborization of cortical neurons, abnormal electroencephalograph (EEG) responses to convulsant treatment, decreased visual evoked responses (VEPs), and alterations in the Akt/rpS6 signaling pathway. Selective knockout of Cdkl5 in excitatory and inhibitory forebrain neurons allowed us to map the behavioral features of the disorder to separable cell-types. These findings identify physiological and molecular deficits in specific forebrain neuron populations as possible pathological substrates in CDKL5 disorder.

Autosomal recessive type II hereditary motor and sensory neuropathy with acrodystrophy.

PubMed

Thomas, P K; Claus, D; King, R H

1999-02-01

A family is described with presumed autosomal recessive inheritance in which three siblings developed a progressive neuropathy that combined limb weakness and severe distal sensory loss leading to prominent mutilating changes. Electrophysiological and nerve biopsy findings indicated an axonopathy. The disorder is therefore classifiable as type II hereditary motor and sensory neuropathy (HMSN II). The clinical features differ from those reported in previously described cases of autosomal recessive HMSN II. This disorder may therefore represent a new variant.

Sparing of extraocular muscle in aging and muscular dystrophies: A myogenic precursor cell hypothesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kallestad, Kristen M.; Hebert, Sadie L.; McDonald, Abby A.

2011-04-01

The extraocular muscles (EOM) are spared from pathology in aging and many forms of muscular dystrophy. Despite many studies, this sparing remains an enigma. The EOM have a distinct embryonic lineage compared to somite-derived muscles, and we have shown that they continuously remodel throughout life, maintaining a population of activated satellite cells even in aging. These data suggested the hypothesis that there is a population of myogenic precursor cells (mpcs) in EOM that is different from those in limb, with either elevated numbers of stem cells and/or mpcs with superior proliferative capacity compared to mpcs in limb. Using flow cytometry,more » EOM and limb muscle mononuclear cells were compared, and a number of differences were seen. Using two different cell isolation methods, EOM have significantly more mpcs per mg muscle than limb skeletal muscle. One specific subpopulation significantly increased in EOM compared to limb was positive for CD34 and negative for Sca-1, M-cadherin, CD31, and CD45. We named these the EOMCD34 cells. Similar percentages of EOMCD34 cells were present in both newborn EOM and limb muscle. They were retained in aged EOM, whereas the population decreased significantly in adult limb muscle and were extremely scarce in aged limb muscle. Most importantly, the percentage of EOMCD34 cells was elevated in the EOM from both the mdx and the mdx/utrophin{sup -/-} (DKO) mouse models of DMD and extremely scarce in the limb muscles of these mice. In vitro, the EOMCD34 cells had myogenic potential, forming myotubes in differentiation media. After determining a media better able to induce proliferation in these cells, a fusion index was calculated. The cells isolated from EOM had a 40% higher fusion index compared to the same cells isolated from limb muscle. The EOMCD34 cells were resistant to both oxidative stress and mechanical injury. These data support our hypothesis that the EOM may be spared in aging and in muscular dystrophies due to a subpopulation of mpcs, the EOMCD34 cells, that are retained in significantly higher percentages in normal, mdx and DKO mice EOM, appear to be resistant to elevated levels of oxidative stress and toxins, and actively proliferate throughout life. Current studies are focused on further defining the EOMCD34 cell subtype molecularly, with the hopes that this may shed light on a cell type with potential therapeutic use in patients with sarcopenia, cachexia, or muscular dystrophy.« less

Systemic Lupus Erythematosus and Sjögren's Syndrome Complicated by Conversion Disorder: a Case Report.

PubMed

Nakamura, Misa; Tanaka, Seiji; Inoue, Tadashi; Maeda, Yasuto; Okumiya, Kiyohito; Esaki, Takuya; Shimomura, G O; Masunaga, Kenji; Nagamitsu, Shinichiro; Yamashita, Yushiro

2018-05-21

Conversion disorder (CD) is sometimes accompanied by motor and sensory impairments, such as muscle weakness, paralysis, sensory hypersensitivity, and sensory loss. Sjögren's syndrome (SS) complicates 5-10% of cases of systemic lupus erythematosus (SLE). Patients with SS or SLE present with various neurological symptoms and psychiatric manifestations. When neurological symptoms are present, it is important to distinguish whether the symptoms are caused by a neurological or a mental disorder because the former requires early intensive intervention, such as methylprednisolone pulse therapy (MPT), whereas psychotherapy or antidepressant drugs are recommended for mental disorders. We noticed SS- and SLE-like symptoms just after a diagnosis of idiopathic thrombocytopenic purpura in a 14-year-old girl. At approximately the same time, paralysis started in her lower limbs and subsequently spread to her upper limbs. An examination for neurological symptoms revealed no abnormalities. Because of the conversion reaction between her neurological symptoms and her disease state, CD was suspected as the etiology of her physical symptoms. Nevertheless, because of the progressive nature of the neurological symptoms, MPT was initiated with concurrent administration of intravenous immunoglobulin, but it failed to achieve a good outcome. The patient's symptoms eventually improved after she underwent psychotherapy treatment for a few months. Because early diagnosis of the cause of neurological symptoms accompanying SS and SLE is difficult, it may be necessary to combine the two lines of treatment in the early stages. However, when a mental disorder is suspected, psychotherapy should be started early to minimize the use of unnecessary neurological treatment.

Major amputation of lower extremity: prognostic value of positive bone biopsy cultures.

PubMed

Vaznaisiene, D; Beltrand, E; Laiskonis, A P; Yazdanpanah, Y; Migaud, H; Senneville, E

2013-02-01

To assess the correlation between culture results of section's osseous slice biopsy (SOB) and the distal infected site responsible for the amputation performed concomitantly during major amputation of lower extremity. The influence of a positive culture of SOB on the patients' outcome was also evaluated. We conducted a retrospective study of medical charts of patients who underwent SOB during major amputation of lower extremity at our institution from 2000 to 2009. Fifty-seven patients (42 males/15 females, mean age 52.16years) who undergone major limb amputation (47 below knee and ten above knee) were included. The initial medical conditions of the investigated patients were: trauma (n=32), infection (n=13), trophic disorders (n=10) and tumor (n=2). The major cause of amputation was an uncontrolled infection, accouting for 64.9% of the cases (37/57) (foot=5, ankle=8, leg=24), the remaining 20 patients had trophic disorders of lower limb. Twenty-one (36.8%) from 57 biopsies were sterile, 12 (21.1%) doubtful and 24 (42.1%) positive. Thirty-one (54.4%) patients had an antibiotic-free interval before limb amputation. Independently of the bacterial species, 69.6% of the microorganisms identified from SOB were found in the distal infected site. Patients with positive SOB had a significantly longer interval between the decision to amputate the patient and the surgical procedure (200.2 vs. 70.1days; P<0.03) and a shorter total duration of antibiotic therapy before amputation than patients with negative SOB (3.68 vs. 6.08months; P<0.03). The delay for complete healing was significantly higher in patients with a positive SOB compared with those with a negative SOB (3.57 vs. 2.48months; P<0.03). Our results suggest that the infection may extend from the distal site to the level of amputation in a large proportion of cases and that the delay with which the amputation is performed after the decision has been taken may play a role in this event. Study level IV: retrospective observationnal study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Retrospective exploration of risk factors for L5 radiculopathy following lumbar floating fusion surgery.

PubMed

Orita, Sumihisa; Yamagata, Masatsune; Ikeda, Yoshikazu; Nakajima, Fumitake; Aoki, Yasuchika; Nakamura, Junichi; Takahashi, Kazuhisa; Suzuki, Takane; Ohtori, Seiji

2015-10-17

Lumbar floating fusion occasionally causes postoperative adjacent segment disorder (ASD) at lumbosacral level, causing L5 spinal nerve disorder by L5-S1 foraminal stenosis. The disorder is considered to be one of the major outcomes of L5-S1 ASD, which has not been evaluated yet. The present study aimed to evaluate the incidence and risk factors of postoperative L5 spinal nerve disorder after lumbar interbody fusion extending to the L5 vertebra. We evaluated 125 patients with a diagnosis of spondylolisthesis who underwent floating fusion surgery with transforaminal lumbar interbody fusion with average postoperative period of 25.2 months. The patients were regarded as symptomatic with postoperative L5 spinal nerve disorder such as radicular pain/numbness in the lower limbs and/or motor dysfunction. We estimated and compared the wedging angle (frontal view) and height (lateral view) of the lumbosacral junction in pre- and postoperative plain X-ray images and the foraminal ratio (ratio of the narrower foraminal diameter to the wider diameter in the craniocaudal direction) in the preoperative magnetic resonance image. Risk factors for the incidence of L5 spinal nerve disorder were explored using multivariate logistic regression. Eight of the 125 patients (6.4%) were categorized as symptomatic, an average of 13.3 months after surgery. The wedging angle was significantly higher, and the foraminal ratio was significantly decreased in the symptomatic group (both P < 0.05) compared to the asymptomatic group. Multivariate logistic regression analysis of possible risk factors revealed that the wedging angle, foraminal ratio, and multileveled fusion were statistically significant. Higher wedging angle and lower foraminal ratio in the lumbosacral junction were significantly predictive for the incidence of L5 nerve root disorder as well as multiple-leveled fusion. These findings indicate that lumbosacral fixation should be considered for patients with these risk factors even if they have few symptoms from the L5-S1 junction.

The role of early development in mammalian limb diversification: a descriptive comparison of early limb development between the Natal long-fingered bat (Miniopterus natalensis) and the mouse (Mus musculus).

PubMed

Hockman, Dorit; Mason, Mandy K; Jacobs, David S; Illing, Nicola

2009-04-01

Comparative embryology expands our understanding of unique limb structures, such as that found in bats. Bat forelimb digits 2 to 5 are differentially elongated and joined by webbing, while the hindlimb digits are of similar length in many species. We compare limb development between the mouse and the Natal long-fingered bat, Miniopterus natalensis, to pinpoint the stage at which their limbs begin to differ. The bat forelimb differs from the mouse at Carollia stage (CS) 14 with the appearance of the wing membrane primordia. This difference is enhanced at CS 15 with the posterior expansion of the hand plate. The bat hindlimb begins to differ from the mouse between CS 15 and 16 when the foot plate undergoes a proximal expansion resulting in digit primordia of very similar length. Our findings support recent gene expression studies, which reveal a role for early patterning in the development of the bat limb. Copyright 2009 Wiley-Liss, Inc.

Position Sense in Chronic Pain: Separating Peripheral and Central Mechanisms in Proprioception in Unilateral Limb Pain.

PubMed

Tsay, Anthony J; Giummarra, Melita J

2016-07-01

Awareness of limb position is derived primarily from muscle spindles and higher-order body representations. Although chronic pain appears to be associated with motor and proprioceptive disturbances, it is not clear if this is due to disturbances in position sense, muscle spindle function, or central representations of the body. This study examined position sense errors, as an indicator of spindle function, in participants with unilateral chronic limb pain. The sample included 15 individuals with upper limb pain, 15 with lower limb pain, and 15 sex- and age-matched pain-free control participants. A 2-limb forearm matching task in blindfolded participants, and a single-limb pointer task, with the reference limb hidden from view, was used to assess forearm position sense. Position sense was determined after muscle contraction or stretch, intended to induce a high or low spindle activity in the painful and nonpainful limbs, respectively. Unilateral upper and lower limb chronic pain groups produced position errors comparable with healthy control participants for position matching and pointer tasks. The results indicate that the painful and nonpainful limb are involved in limb-matching. Lateralized pain, whether in the arm or leg, does not influence forearm position sense. Painful and nonpainful limbs are involved in bilateral limb-matching. Muscle spindle function appears to be preserved in the presence of chronic pain. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Paralyzed by desire: a new type of body integrity identity disorder.

PubMed

Giummarra, Melita J; Bradshaw, John L; Hilti, Leonie M; Nicholls, Michael E R; Brugger, Peter

2012-03-01

Body incongruity in body integrity identity disorder (BIID) manifests in the desire to have a healthy limb amputated. We describe a variant of the disorder: the desire to become paralyzed (paralysis-BIID). Sixteen otherwise healthy participants, recruited through Internet-based forums, websites, or word of mouth, completed questionnaires about details of their desire and accompanying symptoms. Onset of the desire for paralysis typically preceded puberty. All participants indicated a specific level for desired spinal cord injury. All participants simulated paralysis through mental imagery or physical pretending, and 9 (56%) reported erotic interest in paraplegia and/or disability. Our key new finding was that 37.5% of paralysis-BIID participants were women, compared with 4.4% women in a sample of 68 individuals with amputation-BIID. BIID reflects a disunity between self and body, usually with a prominent sexual component. Sex-related differences are emerging: unlike men, a higher proportion of women desire paralysis than desire amputation, and, while men typically seek unilateral amputation, women typically seek bilateral amputation. We propose that these sex-related differences in BIID manifestation may relate to sex differences in cerebral lateralization, or to disruption of representation and/or processing of body-related information in right-hemisphere frontoparietal networks.

A Robot Hand Testbed Designed for Enhancing Embodiment and Functional Neurorehabilitation of Body Schema in Subjects with Upper Limb Impairment or Loss

PubMed Central

Hellman, Randall B.; Chang, Eric; Tanner, Justin; Helms Tillery, Stephen I.; Santos, Veronica J.

2015-01-01

Many upper limb amputees experience an incessant, post-amputation “phantom limb pain” and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech “rubber hand” illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the “BairClaw” presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger–object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden. PMID:25745391

A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss.

PubMed

Hellman, Randall B; Chang, Eric; Tanner, Justin; Helms Tillery, Stephen I; Santos, Veronica J

2015-01-01

Many upper limb amputees experience an incessant, post-amputation "phantom limb pain" and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech "rubber hand" illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the "BairClaw" presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden.

Characterizing the effects of amplitude, frequency and limb position on vibration induced movement illusions: Implications in sensory-motor rehabilitation

PubMed Central

Schofield, Jonathon S.; Dawson, Michael R.; Carey, Jason P.; Hebert, Jacqueline S.

2015-01-01

BACKGROUND Strategic vibration of musculotendinous regions of a limb elicits illusionary sensations of movement. As a rehabilitation technique, this ‘kinesthetic illusion’ has demonstrated beneficial results for numerous sensory-motor disorders. However, literature shows little consistency in the vibration parameters or body positioning used, and their effects have yet to be comprehensively investigated. OBJECTIVE To characterize the effects of the vibration amplitude, frequency, and limb position on the kinesthetic illusion. METHODS Movement illusions were induced in 12 participants’ biceps and triceps. The effect of amplitude (0.1 to 0.5 mm), frequency (70 to 110 Hz), and two limb positions were quantified on the strength of illusion (SOI), range of motion (ROM) and velocity. RESULTS Amplitude significantly affected the illusionary SOI, ROM and velocity in the biceps and triceps (p < 0.05). Increasing amplitude resulted in an increase of all three output variables. Limb position showed an effect on illusionary velocity in the biceps as well as ROM and velocity in the triceps (p < 0.05). Frequency demonstrated no statistical effect. CONCLUSIONS Amplitude demonstrated the most profound impact on the kinesthetic illusion in the experimental ranges tested. This work may help guide clinicians and researchers in selecting appropriate vibratory parameters and body positions to consistently elicit and manipulate the kinesthetic illusion. PMID:25425585

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

PubMed Central

Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

2016-01-01

Abstract The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery. We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey. At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group. In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate. PMID:27537579

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

PubMed

Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

2016-08-01

The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.

Agency over Phantom Limb Enhanced by Short-Term Mirror Therapy

PubMed Central

Imaizumi, Shu; Asai, Tomohisa; Koyama, Shinichi

2017-01-01

Most amputees experience phantom limb, whereby they feel that the amputated limb is still present. In some cases, these experiences include pain that can be alleviated by “mirror therapy.” Mirror therapy consists of superimposing a mirrored image of the moving intact limb onto the phantom limb. This therapy provides a closed loop between the motor command to the amputated limb and its predicted visual feedback. This loop is also involved in the sense of agency, a feeling of controlling one’s own body. However, it is unclear how mirror therapy is related to the sense of agency over a phantom limb. Using mirror therapy, we investigated phantom limb pain and the senses of agency and ownership (i.e., a feeling of having one’s own body) of the phantom limb. Nine upper-limb amputees, five of whom reported recent phantom limb pain, underwent a single 15-min trial of mirror therapy. Before and after the trial, the participants completed a questionnaire regarding agency, ownership, and pain related to their phantom limb. They reported that the sense of agency over the phantom limb increased following the mirror therapy trial, while the ownership slightly increased but not as much as did the agency. The reported pain did not change; that is, it was comparably mild before and after the trial. These results suggest that short-term mirror therapy can, at least transiently, selectively enhance the sense of agency over a phantom limb, but may not alleviate phantom limb pain. PMID:29046630

Agency over Phantom Limb Enhanced by Short-Term Mirror Therapy.

PubMed

Imaizumi, Shu; Asai, Tomohisa; Koyama, Shinichi

2017-01-01

Most amputees experience phantom limb, whereby they feel that the amputated limb is still present. In some cases, these experiences include pain that can be alleviated by "mirror therapy." Mirror therapy consists of superimposing a mirrored image of the moving intact limb onto the phantom limb. This therapy provides a closed loop between the motor command to the amputated limb and its predicted visual feedback. This loop is also involved in the sense of agency, a feeling of controlling one's own body. However, it is unclear how mirror therapy is related to the sense of agency over a phantom limb. Using mirror therapy, we investigated phantom limb pain and the senses of agency and ownership (i.e., a feeling of having one's own body) of the phantom limb. Nine upper-limb amputees, five of whom reported recent phantom limb pain, underwent a single 15-min trial of mirror therapy. Before and after the trial, the participants completed a questionnaire regarding agency, ownership, and pain related to their phantom limb. They reported that the sense of agency over the phantom limb increased following the mirror therapy trial, while the ownership slightly increased but not as much as did the agency. The reported pain did not change; that is, it was comparably mild before and after the trial. These results suggest that short-term mirror therapy can, at least transiently, selectively enhance the sense of agency over a phantom limb, but may not alleviate phantom limb pain.

Role of diabetes in heart rhythm disorders

PubMed Central

Koektuerk, Buelent; Aksoy, Murat; Horlitz, Marc; Bozdag-Turan, Ilkay; Turan, Ramazan Goekmen

2016-01-01

The incidence of diabetes mellitus (DM) is increasing rapidly. DM is the leading cause of cardiovascular diseases, which can lead to varied cardiovascular complications by aggravated atherosclerosis in large arteries and coronary atherosclerosis, thereby grows the risk for macro and microangiopathy such as myocardial infarction, stroke, limb loss and retinopathy. Moreover diabetes is one of the strongest and independent risk factor for cardiovascular morbidity and mortality, which is associated frequently with rhythm disorders such as atrial fibrillation (AF) and ventricular arrhythmias (VA). The present article provides a concise overview of the association between DM and rhythm disorders such as AF and VA with underlying pathophysiological mechanisms. PMID:26862372

Clinical effects of leg length discrepancy through ground and joint reaction force responses: A review

NASA Astrophysics Data System (ADS)

Zabri, S. W. K. Ali; Basaruddin, K. S.; Salleh, A. F.; Rusli, W. M. R.; Daud, R.

2017-09-01

Leg length discrepancy (LLD) is caused either due to functional disorder or shortening of bone structure. This disorder could contribute to the significant effects on body weight distribution and lumbar scoliosis at the certain extend. Ground reaction force and joint reaction force are the parameters that can be used to analyze the responses in weight distribution and kinetics changes on the body joints, respectively. Hence, the purpose of this paper is to review the studies that focus on the clinical effects of LLD to the lower limb and spine through ground and joint reaction force responses that could lead to the orthopedics disorder.

Fundamental Principles of Tremor Propagation in the Upper Limb.

PubMed

Davidson, Andrew D; Charles, Steven K

2017-04-01

Although tremor is the most common movement disorder, there exist few effective tremor-suppressing devices, in part because the characteristics of tremor throughout the upper limb are unknown. To clarify, optimally suppressing tremor requires a knowledge of the mechanical origin, propagation, and distribution of tremor throughout the upper limb. Here we present the first systematic investigation of how tremor propagates between the shoulder, elbow, forearm, and wrist. We simulated tremor propagation using a linear, time-invariant, lumped-parameter model relating joint torques and the resulting joint displacements. The model focused on the seven main degrees of freedom from the shoulder to the wrist and included coupled joint inertia, damping, and stiffness. We deliberately implemented a simple model to focus first on the most basic effects. Simulating tremorogenic joint torque as a sinusoidal input, we used the model to establish fundamental principles describing how input parameters (torque location and frequency) and joint impedance (inertia, damping, and stiffness) affect tremor propagation. We expect that the methods and principles presented here will serve as the groundwork for future refining studies to understand the origin, propagation, and distribution of tremor throughout the upper limb in order to enable the future development of optimal tremor-suppressing devices.

Fundamental Principles of Tremor Propagation in the Upper Limb

PubMed Central

Davidson, Andrew D.; Charles, Steven K.

2017-01-01

Although tremor is the most common movement disorder, there exist few effective tremor-suppressing devices, in part because the characteristics of tremor throughout the upper limb are unknown. To clarify, optimally suppressing tremor requires a knowledge of the mechanical origin, propagation, and distribution of tremor throughout the upper limb. Here we present the first systematic investigation of how tremor propagates between the shoulder, elbow, forearm, and wrist. We simulated tremor propagation using a linear, time-invariant, lumped-parameter model relating joint torques and the resulting joint displacements. The model focused on the seven main degrees of freedom from the shoulder to the wrist and included coupled joint inertia, damping, and stiffness. We deliberately implemented a simple model to focus first on the most basic effects. Simulating tremorogenic joint torque as a sinusoidal input, we used the model to establish fundamental principles describing how input parameters (torque location and frequency) and joint impedance (inertia, damping, and stiffness) affect tremor propagation. We expect that the methods and principles presented here will serve as the groundwork for future refining studies to understand the origin, propagation, and distribution of tremor throughout the upper limb in order to enable the future development of optimal tremor-suppressing devices. PMID:27957608

Upper limb robotics applied to neurorehabilitation: An overview of clinical practice.

PubMed

Duret, Christophe; Mazzoleni, Stefano

2017-01-01

During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind their use for the assessment and treatment of common neurological disorders. Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke.

Applications of Shape Memory Alloys for Neurology and Neuromuscular Rehabilitation

PubMed Central

Pittaccio, Simone; Garavaglia, Lorenzo; Ceriotti, Carlo; Passaretti, Francesca

2015-01-01

Shape memory alloys (SMAs) are a very promising class of metallic materials that display interesting nonlinear properties, such as pseudoelasticity (PE), shape memory effect (SME) and damping capacity, due to high mechanical hysteresis and internal friction. Our group has applied SMA in the field of neuromuscular rehabilitation, designing some new devices based on the mentioned SMA properties: in particular, a new type of orthosis for spastic limb repositioning, which allows residual voluntary movement of the impaired limb and has no predetermined final target position, but follows and supports muscular elongation in a dynamic and compliant way. Considering patients in the sub-acute phase after a neurological lesion, and possibly bedridden, the paper presents a mobiliser for the ankle joint, which is designed exploiting the SME to provide passive exercise to the paretic lower limb. Two different SMA-based applications in the field of neuroscience are then presented, a guide and a limb mobiliser specially designed to be compatible with diagnostic instrumentations that impose rigid constraints in terms of electromagnetic compatibility and noise distortion. Finally, the paper discusses possible uses of these materials in the treatment of movement disorders, such as dystonia or hyperkinesia, where their dynamic characteristics can be advantageous. PMID:26023790

Chronic Stimulation-Induced Changes in the Rodent Thyroarytenoid Muscle

ERIC Educational Resources Information Center

McMullen, Colleen A.; Butterfield, Timothy A.; Dietrich, Maria; Andreatta, Richard D.; Andrade, Francisco H.; Fry, Lisa; Stemple, Joseph C.

2011-01-01

Purpose: Therapies for certain voice disorders purport principles of skeletal muscle rehabilitation to increase muscle mass, strength, and endurance. However, applicability of limb muscle rehabilitation to the laryngeal muscles has not been tested. In this study, the authors examined the feasibility of the rat thyroarytenoid muscle to remodel as a…

Phenotypic and immunohistochemical characterization of sarcoglycanopathies

PubMed Central

Ferreira, Ana F. B.; Carvalho, Mary S.; Resende, Maria Bernadete D.; Wakamatsu, Alda; Reed, Umbertina Conti; Marie, Suely Kazue Nagahashi

2011-01-01

INTRODUCTION: Limb-girdle muscular dystrophy presents with heterogeneous clinical and molecular features. The primary characteristic of this disorder is proximal muscular weakness with variable age of onset, speed of progression, and intensity of symptoms. Sarcoglycanopathies, which are a subgroup of the limb-girdle muscular dystrophies, are caused by mutations in sarcoglycan genes. Mutations in these genes cause secondary deficiencies in other proteins, due to the instability of the dystrophin-glycoprotein complex. Therefore, determining the etiology of a given sarcoglycanopathy requires costly and occasionally inaccessible molecular methods. OBJECTIVE: The aim of this study was to identify phenotypic differences among limb-girdle muscular dystrophy patients who were grouped according to the immunohistochemical phenotypes for the four sarcoglycans. METHODS: To identify phenotypic differences among patients with different types of sarcoglycanopathies, a questionnaire was used and the muscle strength and range of motion of nine joints in 45 patients recruited from the Department of Neurology – HC-FMUSP (Clinics Hospital of the Faculty of Medicine of the University of São Paulo) were evaluated. The findings obtained from these analyses were compared with the results of the immunohistochemical findings. RESULTS: The patients were divided into the following groups based on the immunohistochemical findings: α-sarcoglycanopathies (16 patients), β-sarcoglycanopathies (1 patient), γ-sarcoglycanopathies (5 patients), and non-sarcoglycanopathies (23 patients). The muscle strength analysis revealed significant differences for both upper and lower limb muscles, particularly the shoulder and hip muscles, as expected. No pattern of joint contractures was found among the four groups analyzed, even within the same family. However, a high frequency of tiptoe gait was observed in patients with α-sarcoglycanopathies, while calf pseudo-hypertrophy was most common in patients with non-sarcoglycanopathies. The α-sarcoglycanopathy patients presented with more severe muscle weakness than did γ-sarcoglycanopathy patients. CONCLUSION: The clinical differences observed in this study, which were associated with the immunohistochemical findings, may help to prioritize the mutational investigation of sarcoglycan genes. PMID:22012042

Temporal response of canine flexor tendon to limb suspension

PubMed Central

Thoreson, Andrew R.; Cha, Stephen S.; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C.

2010-01-01

Tendon disuse, or stress deprivation, frequently accompanies clinical disorders and treatments, yet the metabolism of tendons subject to stress deprivation has rarely been investigated systematically. The effects of stress deprivation on canine flexor tendon were investigated in this study. One adult canine forepaw was suspended for 21 or 42 days. Control forepaws were collected from dogs that had no intervention on their limbs and paws. The expression of collagen I and III was not significantly altered in the tendons disused for 21 days but was significantly decreased at 42 days (P < 0.03). The expression of collagen II, aggrecan, decorin, and fibronectin was significantly decreased in the tendons in the suspended limbs at 21 days (P < 0.002) and further reduced at 42 days. With stress deprivation, the expression of matrix metalloproteinase 2 (MMP2) was significantly increased (P < 0.004) at 21 and 42 days. The expression of MMP3 was significantly decreased at 21 and 42 days (P < 0.03). The expression of MMP13 was not altered with stress deprivation at 21 and 42 days. The expression of MMP14 was significantly increased at 21 days (P = 0.0015) and returned to the control level at 42 days. Tissue inhibitor of metalloproteinase 1 (TIMP1) expression was decreased after the limbs were suspended for 42 days (P = 0.0043), but not 21 days. However, TIMP2 expression was not significantly different from control at 21 or 42 days. Furthermore, the cross-sectional area of the stress-deprived tendons at 42 days was decreased compared with the control group (P < 0.01). The intervention method in this study did not result in any alteration of stiffness of the tendon. Our study demonstrated that stress deprivation decreases the anabolic process and increases the catabolic process of extracellular matrix in flexor tendon. PMID:20947711

A Biomechanical Investigation of A Single-Limb Squat: Implications for Lower Extremity Rehabilitation Exercise

PubMed Central

Richards, Jim; Thewlis, Dominic; Selfe, James; Cunningham, Andrew; Hayes, Colin

2008-01-01

Context: Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used. Objective: To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60° of knee flexion while performing a single-limb squat at different decline angles. Design: Participants acted as their own controls in a repeated-measures design. Patients or Other Participants: We recruited 10 participants who had no pain, injury, or neurologic disorder. Intervention(s): Participants performed single-limb squats at different decline angles. Main Outcome Measure(s): Angle-specific knee and ankle moments were calculated at 60° of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60° of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat. Results: An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P  =  .001), but EMG activity in the gastrocnemius increased between 16° and 24° (P  =  .018). Conclusions: As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24° decline angle compared with the 16° decline angle. This indicates that decline squats at an angle greater than 16° may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee. PMID:18833310

Cost-effectiveness of postural exercise therapy versus physiotherapy in computer screen-workers with early non-specific work-related upper limb disorders (WRULD); a randomized controlled trial.

PubMed

van Eijsden, Marjon D; Gerhards, Sylvia A; de Bie, Rob A; Severens, Johan L

2009-11-17

Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders (WRULD). To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints, both from health care and societal perspective. Prospective randomized trial including cost-effectiveness analysis; one year follow-up. Eighty-eight screen-workers with early non-specific WRULD; six drop-outs. A ten week postural exercise program versus regular physiotherapy. Effectiveness measures: Pain: visual analogous scale (VAS), self-perceived WRULD (yes/no). Functional outcome: Disabilities of Arm, Shoulder and Hand- Dutch Language Version (DASH-DLV). Quality of life outcome: EQ-5D.Economic measures: health care costs including patient and family costs and productivity costs resulting in societal costs. Cost-effectiveness measures: health care costs and societal costs related to the effectiveness measures. OUTCOME MEASURES were assessed at baseline; three, six and twelve months after baseline. At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs. No significant differences between the groups concerning effectiveness at one year follow-up were found. Effectiveness scores slightly improved over time. After one year 55% of participants were free of complaints. After one year the postural exercise group had higher mean total health care costs, but lower productivity costs compared to the physiotherapy group. Mean societal costs after one year (therefore) were in favor of postural exercise therapy [- euro622; 95% CI -2087; +590)]. After one year, only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs, postural exercise therapy had a probability of over 80% to be cost-effective over a wide range of cost-effectiveness ceiling ratios; however based on a marginal QALY-difference of 0.1 over a 12 month time frame. Although our trial failed to find significant differences in VAS, QALYs and ICERs based on VAS and QALYs at one-year follow-up, CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy; however further research is required. ISRCTN 15872455.

Recovery of peripheral muscle function from fatiguing exercise and daily physical activity level in patients with multiple sclerosis: a case-control study.

PubMed

Ickmans, Kelly; Simoens, Fauve; Nijs, Jo; Kos, Daphne; Cras, Patrick; Willekens, Barbara; Meeus, Mira

2014-07-01

Delayed recovery of muscle function following exercise has been demonstrated in the lower limbs of patients with multiple sclerosis (MS). However, studies examining this in the upper limbs are currently lacking. This study compared physical activity level (PAL) and recovery of upper limb muscle function following exercise between MS patients and healthy inactive controls. Furthermore, the relationship between PAL and muscle recovery was examined. PAL of 19 MS patients and 32 controls was measured using an accelerometer for 7 consecutive days. Afterwards, recovery of muscle function was assessed by performing a fatiguing upper limb exercise test with subsequent recovery measures. Muscle recovery of the upper limb muscles was similar in both groups. Average activity counts were significantly lower in MS patients than in the control group. MS patients spent significantly more time being sedentary and less time on activities of moderate intensity compared with the control group. No significant correlation between PAL and recovery of muscle function was found in MS patients. Recovery of upper limb muscle function following exercise is normal in MS patients. MS patients are less physically active than healthy inactive controls. PAL and recovery of upper limb muscle function appear unrelated in MS patients. Copyright © 2014 Elsevier B.V. All rights reserved.

A Noncoding Expansion in EIF4A3 Causes Richieri-Costa-Pereira Syndrome, a Craniofacial Disorder Associated with Limb Defects

PubMed Central

Favaro, Francine P.; Alvizi, Lucas; Zechi-Ceide, Roseli M.; Bertola, Debora; Felix, Temis M.; de Souza, Josiane; Raskin, Salmo; Twigg, Stephen R.F.; Weiner, Andrea M.J.; Armas, Pablo; Margarit, Ezequiel; Calcaterra, Nora B.; Andersen, Gregers R.; McGowan, Simon J.; Wilkie, Andrew O.M.; Richieri-Costa, Antonio; de Almeida, Maria L.G.; Passos-Bueno, Maria Rita

2014-01-01

Richieri-Costa-Pereira syndrome is an autosomal-recessive acrofacial dysostosis characterized by mandibular median cleft associated with other craniofacial anomalies and severe limb defects. Learning and language disabilities are also prevalent. We mapped the mutated gene to a 122 kb region at 17q25.3 through identity-by-descent analysis in 17 genealogies. Sequencing strategies identified an expansion of a region with several repeats of 18- or 20-nucleotide motifs in the 5′ untranslated region (5′ UTR) of EIF4A3, which contained from 14 to 16 repeats in the affected individuals and from 3 to 12 repeats in 520 healthy individuals. A missense substitution of a highly conserved residue likely to affect the interaction of eIF4AIII with the UPF3B subunit of the exon junction complex in trans with an expanded allele was found in an unrelated individual with an atypical presentation, thus expanding mutational mechanisms and phenotypic diversity of RCPS. EIF4A3 transcript abundance was reduced in both white blood cells and mesenchymal cells of RCPS-affected individuals as compared to controls. Notably, targeting the orthologous eif4a3 in zebrafish led to underdevelopment of several craniofacial cartilage and bone structures, in agreement with the craniofacial alterations seen in RCPS. Our data thus suggest that RCPS is caused by mutations in EIF4A3 and show that EIF4A3, a gene involved in RNA metabolism, plays a role in mandible, laryngeal, and limb morphogenesis. PMID:24360810

Intralimb and Interlimb Cutaneous Reflexes during Locomotion in the Intact Cat.

PubMed

Hurteau, Marie-France; Thibaudier, Yann; Dambreville, Charline; Danner, Simon M; Rybak, Ilya A; Frigon, Alain

2018-04-25

When the foot contacts an obstacle during locomotion, cutaneous inputs activate spinal circuits to ensure dynamic balance and forward progression. In quadrupeds, this requires coordinated reflex responses between the four limbs. Here, we investigated the patterns and phasic modulation of cutaneous reflexes in forelimb and hindlimb muscles evoked by inputs from all four limbs. Five female cats were implanted to record muscle activity and to stimulate the superficial peroneal and superficial radial nerves during locomotion. Stimulating these nerves evoked short-, mid-, and longer-latency excitatory and/or inhibitory responses in all four limbs that were phase-dependent. The largest responses were generally observed during the peak activity of the muscle. Cutaneous reflexes during mid-swing were consistent with flexion of the homonymous limb and accompanied by modification of the stance phases of the other three limbs, by coactivating flexors and extensors and/or by delaying push-off. Cutaneous reflexes during mid-stance were consistent with stabilizing the homonymous limb by delaying and then facilitating its push-off and modifying the support phases of the homolateral and diagonal limbs, characterized by coactivating flexors and extensors, reinforcing extensor activity and/or delaying push-off. The shortest latencies of homolateral and diagonal responses were consistent with fast-conducting disynaptic or trisynaptic pathways. Descending homolateral and diagonal pathways from the forelimbs to the hindlimbs had a higher probability of eliciting responses compared with ascending pathways from the hindlimbs to the forelimbs. Thus, in quadrupeds, intralimb and interlimb reflexes activated by cutaneous inputs ensure dynamic coordination of the four limbs, producing a whole-body response. SIGNIFICANCE STATEMENT The skin contains receptors that, when activated, send inputs to spinal circuits, signaling a perturbation. Rapid responses, or reflexes, in muscles of the contacted limb and opposite homologous limb help maintain balance and forward progression. Here, we investigated reflexes during quadrupedal locomotion in the cat by electrically stimulating cutaneous nerves in each of the four limbs. Functionally, responses appear to modify the trajectory or stabilize the movement of the stimulated limb while modifying the support phase of the other limbs. Reflexes between limbs are mediated by fast-conducting pathways that involve excitatory and inhibitory circuits controlling each limb. The comparatively stronger descending pathways from cervical to lumbar circuits controlling the forelimbs and hindlimbs, respectively, could serve a protective function. Copyright © 2018 the authors 0270-6474/18/384104-19$15.00/0.

Failure to activate the in-hospital emergency team: causes and outcomes.

PubMed

Barbosa, Vera; Gomes, Ernestina; Vaz, Senio; Azevedo, Gustavo; Fernandes, Gonçalo; Ferreira, Amélia; Araujo, Rui

2016-01-01

To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure. A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05. Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters. The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations.

Gender differences in limited duty time for lower limb injury.

PubMed

Holsteen, K K; Choi, Y S; Bedno, S A; Nelson, D A; Kurina, L M

2018-02-16

Among active-duty military personnel, lower limb musculoskeletal injuries and related conditions (injuries) frequently arise as unintended consequences of physical training. These injuries are particularly common among women. The practical impact of such injuries on temporary military occupational disability has not been estimated with precision on a large scale. To determine the proportion of service time compromised by limited duty days attributable to lower limb injuries, characterize the time affected by these limitations in terms of specific lower limb region and compare the limited duty time between male and female soldiers. Administrative data and individual limited duty assignments (profiles) were obtained for active-duty US Army personnel who served in 2014. Lower limb injury-related profiles were used to calculate the percent of person-time requiring duty limitations by gender and body region. The study group was 568 753 soldiers of whom 14% were women. Nearly 13% of service days for active-duty US Army soldiers required limited duty for lower limb injuries during 2014. Knee injuries were responsible for 45% of those days. Within integrated military occupations, female soldiers experienced 27-57% more time on limited duty for lower limb injuries compared with men. The substantial amount of limited duty for lower limb musculoskeletal injuries among soldiers highlights the need for improvement in training-related injury screening, prevention and timely treatment with particular attention to knee injuries. The excessive impact of lower limb injuries on female soldiers' occupational functions should be a surveillance priority in the current environment of expanding gender-integrated training. Published by Oxford University Press on behalf of The Society of Occupational Medicine 2017.

Three novel serum biomarkers, miR-1, miR-133a, and miR-206 for Limb-girdle muscular dystrophy, Facioscapulohumeral muscular dystrophy, and Becker muscular dystrophy.

PubMed

Matsuzaka, Yasunari; Kishi, Soichiro; Aoki, Yoshitsugu; Komaki, Hirofumi; Oya, Yasushi; Takeda, Shin-Ichi; Hashido, Kazuo

2014-11-01

Muscular dystrophies are a clinically and genetically heterogeneous group of inherited myogenic disorders. In clinical tests for these diseases, creatine kinase (CK) is generally used as diagnostic blood-based biomarker. However, because CK levels can be altered by various other factors, such as vigorous exercise, etc., false positive is observed. Therefore, three microRNAs (miRNAs), miR-1, miR-133a, and miR-206, were previously reported as alternative biomarkers for duchenne muscular dystrophy (DMD). However, no alternative biomarkers have been established for the other muscular dystrophies. We, therefore, evaluated whether these miR-1, miR-133a, and miR-206 can be used as powerful biomarkers using the serum from muscular dystrophy patients including DMD, myotonic dystrophy 1 (DM1), limb-girdle muscular dystrophy (LGMD), facioscapulohumeral muscular dystrophy (FSHD), becker muscular dystrophy (BMD), and distal myopathy with rimmed vacuoles (DMRV) by qualitative polymerase chain reaction (PCR) amplification assay. Statistical analysis indicated that all these miRNA levels in serum represented no significant differences between all muscle disorders examined in this study and controls by Bonferroni correction. However, some of these indicated significant differences without correction for testing multiple diseases (P < 0.05). The median values of miR-1 levels in the serum of patients with LGMD, FSHD, and BMD were approximately 5.5, 3.3 and 1.7 compared to that in controls, 0.68, respectively. Similarly, those of miR-133a and miR-206 levels in the serum of BMD patients were about 2.5 and 2.1 compared to those in controls, 1.03 and 1.32, respectively. Taken together, our data demonstrate that levels of miR-1, miR-133a, and miR-206 in serum of BMD and miR-1 in sera of LGMD and FSHD patients showed no significant differences compared with those of controls by Bonferroni correction. However, the results might need increase in sample sizes to evaluate these three miRNAs as variable biomarkers.

Hop Distance Symmetry Does Not Indicate Normal Landing Biomechanics in Adolescent Athletes With Recent Anterior Cruciate Ligament Reconstruction.

PubMed

Wren, Tishya A L; Mueske, Nicole M; Brophy, Christopher H; Pace, J Lee; Katzel, Mia J; Edison, Bianca R; VandenBerg, Curtis D; Zaslow, Tracy L

2018-03-30

Study Design Retrospective cohort. Background Return to sport (RTS) protocols after anterior cruciate ligament reconstruction (ACLR) often include assessment of hop distance symmetry. However, it is unclear if movement deficits are present regardless of hop symmetry. Objectives To assess biomechanics and symmetry of adolescent athletes following ACLR during a single leg hop for distance. Methods Forty-six patients with ACLR (5-12 months post-surgery; 27 female; age 15.6, SD 1.7 years) were classified as asymmetric (operative limb hop distance <90% of non-operative limb; n=17) or symmetric (n=29). Lower extremity biomechanics were compared among operative and contralateral limbs and 24 symmetric controls (12 female; age 14.7, SD 1.5 years) using ANOVA. Results Compared to controls, asymmetric patients hopped a shorter distance on their operative limb (P<0.001), while symmetric patients hopped an intermediate distance on both sides (P≥0.12). During landing, operative limbs, regardless of hop distance, exhibited lower knee flexion moments compared to controls and the contralateral side (P≤0.04) with lower knee energy absorption than the contralateral side (P≤0.006). During take-off, both symmetric and asymmetric patients had less hip extension and smaller ankle range of motion on the operative side compared with controls (P≤0.05). Asymmetric patients also had lower hip range of motion on the operative, compared with the contralateral, side (P=0.001). Conclusion Both symmetric and asymmetric patients offloaded the operative knee; symmetric patients achieved symmetry in part by hopping a shorter distance on the contralateral side. Therefore, hop distance symmetry may not be an adequate test of single limb function and RTS readiness. Level of Evidence 2b. J Orthop Sports Phys Ther, Epub 30 Mar 2018. doi:10.2519/jospt.2018.7817.

Combined therapy for critical limb ischaemia: Biomimetic PLGA microcarriers potentiates the pro-angiogenic effect of adipose tissue stromal vascular fraction cells.

PubMed

Hoareau, Laurence; Fouchet, Florian; Planesse, Cynthia; Mirbeau, Sophie; Sindji, Laurence; Delay, Emmanuel; Roche, Régis; Montero-Menei, Claudia N; Festy, Franck

2018-06-01

We propose a regenerative solution in the treatment of critical limb ischaemia (CLI). Poly-lactic/glycolic acid microcarriers were prepared and coated with laminin to be sterilized through γ-irradiation of 25 kGy at low temperature. Stromal vascular fraction (SVF) cells were extracted through enzymatic digestion of adipose tissue. Streptozotocin-induced diabetic mice underwent arteriotomy and received an administration of SVF cells combined or not with biomimetic microcarriers. Functional evaluation of the ischaemic limb was then reported, and tissue reperfusion was evaluated through fluorescence molecular tomography. Microcarriers were stable and functional after γ-irradiation until at least 12 months of storage. Mice that received an injection of SVF cells in the ischaemic limb have 22% of supplementary blood supply within this limb 7 days after surgery compared with vehicle, whereas no difference was observed at Day 14. With the combined therapy, the improvement of blood flow is significantly higher compared with vehicle, of about 31% at Day 7 and of about 11% at Day 14. Injection of SVF cells induces a significant 27% decrease of necrosis compared with vehicle. This effect is more important when SVF cells were mixed with biomimetic microcarriers: -37% compared with control. Although SVF cells injection leads to a non-significant 22% proprioception recovery, the combined therapy induces a significant recovery of about 27% compared with vehicle. We show that the combination of SVF cells from adipose tissue with laminin-coated poly-lactic/glycolic acid microcarriers is efficient for critical limb ischaemia therapy in a diabetic mouse model. Copyright © 2018 John Wiley & Sons, Ltd.

Lower Limb Interjoint Postural Coordination One Year after First-Time Lateral Ankle Sprain.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Patterson, Matthew R; Delahunt, Eamonn

2015-11-01

Longitudinal analyses of participants with a history of lateral ankle sprain are lacking. This investigation combined measures of lower limb interjoint coordination and stabilometry to evaluate static unipedal stance with the eyes open (condition 1) and closed (condition 2) in a group of participants with chronic ankle instability (CAI) compared to lateral ankle sprain "copers" (both recruited 12 months after sustaining an acute first-time lateral ankle sprain) and a group of noninjured controls. Twenty-eight participants with CAI, 42 lateral ankle sprain "copers," and 20 noninjured controls completed three 20-s single-limb stance trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb three-dimensional kinematic data for similarity to establish patterns of interjoint coordination. The fractal dimension of the stance limb center of pressure path was also calculated. Between-group analyses revealed that participants with CAI displayed notable increases in ankle-hip linked coordination compared with both lateral ankle sprain "copers" (-0.52 (1.05) vs 0.28 (0.9), P = 0.007) and controls (-0.52 (1.05) vs 0.63 (0.64), P = 0.006) in condition 1 and compared with controls only (0.62 (1.92) vs 0.1 (1.0) P = 0.002) in condition 2. Participants with CAI also exhibited a decrease in the fractal dimension of the center-of-pressure path during condition 2 compared with both controls and lateral ankle sprain "copers." Participants with CAI present with a hip-dominant strategy of eyes-open and eyes-closed static unipedal stance. This coincided with reduced complexity of the stance limb center of pressure path in the eyes-closed condition.

The association between restorative pre-clinical activities and musculoskeletal disorders.

PubMed

Corrocher, P A; Presoto, C D; Campos, J A D B; Garcia, P P N S

2014-08-01

To evaluate the risk of development of musculoskeletal disorders in the upper limbs of undergraduate dentistry students during the execution of pre-clinical laboratory activities based on gender, type of dental procedure and area of the mouth under treatment. Male and female undergraduate students in the second year of the Araraquara Dental School, UNESP, were enrolled in this study. Digital photographs were obtained whilst the subjects performed laboratory activities. The working postures adopted by each student were evaluated using the Rapid Upper Limb Assessment (RULA). The photos were analysed by a calibrated researcher (k = 0.89), and a final risk score was attributed to each analysed procedure (n = 354). Descriptive statistical analyses were performed, and the associations of interest were analysed by the chi-square test (P = 0.05). During most of the laboratory procedures performed, the risk of developing musculoskeletal disorders was high (64.7%; - IC95% : 59.7-69.7%), with no significant association between the RULA final score and gender (χ(2)  = 1.100; P = 0.577), type of dental procedure (χ(2)  = 5.447, P = 0.244) and mouth area treated (χ(2) =4.150; P = 0.126). The risk of developing musculoskeletal disorders was high in undergraduate dentistry students; this risk was not related to gender, type of dental procedure and region of the mouth being treated. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Determinants of midterm functional outcomes, wound healing, and resources used in a hospital-based limb preservation program.

PubMed

Ramanan, Bala; Ahmed, Ayman; Wu, Bian; Causey, Marlin W; Gasper, Warren J; Vartanian, Shant M; Reyzelman, Alexander M; Hiramoto, Jade S; Conte, Michael S

2017-12-01

The objective of this study was to assess midterm functional status, wound healing, and in-hospital resource use among a prospective cohort of patients treated in a tertiary hospital, multidisciplinary Center for Limb Preservation. Data were prospectively gathered on all consecutive admissions to the Center for Limb Preservation from July 2013 to October 2014 with follow-up data collection through January 2016. Limbs were staged using the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification scheme at the time of hospital admission. Patients with nonatherosclerotic vascular disorders, acute limb ischemia, and trauma were excluded. The cohort included 128 patients with 157 threatened limbs; 8 limbs with unstageable disease were excluded. Mean age (±standard deviation [SD]) was 66 (±13) years, and median follow-up duration (interquartile range) was 395 (80-635) days. Fifty percent (n = 64/128) of patients were readmitted at least once, with a readmission rate of 20% within 30 days of the index admission. Mean total number of admissions per patient (±SD) was 1.9 ± 1.2, with mean (±SD) cumulative length of stay (cLOS) of 17.1 (±17.9) days. During follow-up, 25% of limbs required a vascular reintervention, and 45% developed recurrent wounds. There was no difference in the rate of readmission, vascular reintervention, or wound recurrence by initial WIfI stage (P > .05). At the end of the study period, 23 (26%) were alive and nonambulatory; in 20%, functional status was missing. On both univariate and multivariate analysis, end-stage renal disease and prior functional status predicted ability to ambulate independently (P < .05). WIfI stage was associated with major amputation (P = .01) and cLOS (P = .002) but not with time to wound healing. Direct hospital (inpatient) cost per limb saved was significantly higher in stage 4 patients (P < .05 for all time periods). WIfI stage was associated with cumulative in-hospital costs at 1 year and for the overall follow-up period. Among a population of patients admitted to a tertiary hospital limb preservation service, WIfI stage was predictive of midterm freedom from amputation, cLOS, and hospital costs but not of ambulatory functional status, time to wound healing, or wound recurrence. Patients presenting with limb-threatening conditions require significant inpatient care, have a high frequency of repeated hospitalizations, and are at significant risk for recurrent wounds and leg symptoms at later times. Stage 4 patients require the most intensive care and have the highest initial and aggregate hospital costs per limb saved. However, limb salvage can be achieved in these patients with a dedicated multidisciplinary team approach. Published by Elsevier Inc.

Cutaneous sensitivity in unilateral trans-tibial amputees

PubMed Central

Templeton, Cale A.; Strzalkowski, Nicholas D. J.; Galvin, Patti

2018-01-01

Aim To examine tactile sensitivity in the leg and foot sole of below-knee amputees (diabetic n = 3, traumatic n = 1), and healthy control subjects (n = 4), and examine the association between sensation and balance. Method Vibration perception threshold (VPT; 3, 40, 250Hz) and monofilaments (MF) were used to examine vibration and light touch sensitivity on the intact limb, residual limb, and homologous locations on controls. A functional reach test was performed to assess functional balance. Results Tactile sensitivity was lower for diabetic amputee subjects compared to age matched controls for both VPT and MF; which was expected due to presence of diabetic peripheral neuropathy. In contrast, the traumatic amputee participant showed increased sensitivity for VPT at 40Hz and 250Hz vibration in both the intact and residual limbs compared to controls. Amputees with lower tactile sensitivity had shorter reach distances compared to those with higher sensitivity. Conclusion Changes in tactile sensitivity in the residual limb of trans-tibial amputees may have implications for the interaction between the amputee and the prosthetic device. The decreased skin sensitivity observed in the residual limb of subjects with diabetes is of concern as changes in skin sensitivity may be important in 1) identification/prevention of excessive pressure and 2) for functional stability. Interestingly, we saw increased residual limb skin sensitivity in the individual with the traumatic amputation. Although not measured directly in the present study, this increase in tactile sensitivity may be related to cortical reorganisation, which is known to occur following amputation, and would support similar findings observed in upper limb amputees. PMID:29856766

Correlation of ankle eversion to inversion strength ratio and static balance in dominant and non-dominant limbs of basketball players.

PubMed

Dabadghav, Rachana

2016-04-01

To compare ankle eversion to inversion strength ratio (E/I R) and static balance control between the dominant and non-dominant limbs of basketball players and to correlate ankle E/I R and static balance control in the dominant and non-dominant limbs of basketball players. Twenty-one healthy basketball players in the age-group of 18-25 years participated in this study. Isokinetic ankle eversion and inversion muscle strength was assessed at 30°/s and 120°/s in both dominant and non-dominant limbs using the Biodex isokinetic dynamometer. Similarly balance was assessed on a force platform with eyes open and eyes closed in both dominant and non-dominant limbs. Repeated measure ANOVA for strength measurement, found that there was significant main effect of speed, P=0.001 (P<0.05). However, there was no significant main effect in the sides P=0.099 (P<0.05).There was significant main effect of sides with respect to balance. Balance was affected more in non-dominant limb P=0.000 as compared to dominant limb. However, there was not much of a significant difference with eyes open and eyes closed position. The E/I ratio was >1.0 at the angular velocity of 120°/s increasing the chances of ankle injuries in basketball players. There was no correlation between ankle strength and balance in both dominant and non-dominant limbs.

A comparative study of single-leg ground reaction forces in running lizards.

PubMed

McElroy, Eric J; Wilson, Robbie; Biknevicius, Audrone R; Reilly, Stephen M

2014-03-01

The role of different limbs in supporting and propelling the body has been studied in many species with animals appearing to have either similarity in limb function or differential limb function. Differential hindlimb versus forelimb function has been proposed as a general feature of running with a sprawling posture and as benefiting sprawled postured animals by enhancing maneuvering and minimizing joint moments. Yet only a few species have been studied and thus the generality of differential limb function in running animals with sprawled postures is unknown. We measured the limb lengths of seven species of lizard and their single-limb three-dimensional ground reaction forces during high-speed running. We found that all species relied on the hindlimb for producing accelerative forces. Braking forces were forelimb dominated in four species and equally distributed between limbs in the other three. Vertical forces were dominated by the hindlimb in three species and equally distributed between the forelimb and hindlimb in the other four. Medial forces were dominated by the hindlimb in four species and equally distributed in the other three, with all Iguanians exhibiting hindlimb-biased medial forces. Relative hindlimb to forelimb length of each species was related to variation in hindlimb versus forelimb medial forces; species with relatively longer hindlimbs compared with forelimbs exhibited medial forces that were more biased towards the hindlimbs. These results suggest that the function of individual limbs in lizards varies across species with only a single general pattern (hindlimb-dominated accelerative force) being present.

Sit-To-Stand Biomechanics Before and After Total Hip Arthroplasty

PubMed Central

Abujaber, Sumayeh B.; Marmon, Adam R.; Pozzi, Federico; Rubano, James J.; Zeni, Joseph A.

2015-01-01

The purpose of this study was to evaluate changes in movement patterns during a sit-to-stand (STS) task before and after total hip arthroplasty (THA), and to compare biomechanical outcomes after THA to a control group. Forty-five subjects who underwent THA and twenty-three healthy control subjects participated in three-dimensional motion analysis. Pre-operatively, subjects exhibited inter-limb movement asymmetries with lower vertical ground reaction force (VGRF) and smaller moments on the operated limb. Although there were significant improvements in movement symmetry 3 months after THA, patients continued to demonstrate lower VGRF and smaller moments on the operated limb compared to non-operated and to control limbs. Future studies should identify the contributions of physical impairments and the influence of surgical approach on STS biomechanics. PMID:26117068

Effects of a leaf spring structured midsole on joint mechanics and lower limb muscle forces in running

PubMed Central

Wunsch, Tobias; Alexander, Nathalie; Kröll, Josef; Stöggl, Thomas; Schwameder, Hermann

2017-01-01

To enhance running performance in heel-toe running, a leaf spring structured midsole shoe (LEAF) has recently been introduced. The purpose of this study was to investigate the effect of a LEAF compared to a standard foam midsole shoe (FOAM) on joint mechanics and lower limb muscle forces in overground running. Nine male long-distance heel strike runners ran on an indoor track at 3.0 ± 0.2 m/s with LEAF and FOAM shoes. Running kinematics and kinetics were recorded during the stance phase. Absorbed and generated energy (negative and positive work) of the hip, knee and ankle joint as well as muscle forces of selected lower limb muscles were determined using a musculoskeletal model. A significant reduction in energy absorption at the hip joint as well as energy generation at the ankle joint was found for LEAF compared to FOAM. The mean lower limb muscle forces of the m. soleus, m. gastrocnemius lateralis and m. gastrocnemius medialis were significantly reduced for LEAF compared to FOAM. Furthermore, m. biceps femoris showed a trend of reduction in running with LEAF. The remaining lower limb muscles analyzed (m. gluteus maximus, m. rectus femoris, m. vastus medialis, m. vastus lateralis, m. tibialis anterior) did not reveal significant differences between the shoe conditions. The findings of this study indicate that LEAF positively influenced the energy balance in running by reducing lower limb muscle forces compared to FOAM. In this way, LEAF could contribute to an overall increased running performance in heel-toe running. PMID:28234946

Effects of a leaf spring structured midsole on joint mechanics and lower limb muscle forces in running.

PubMed

Wunsch, Tobias; Alexander, Nathalie; Kröll, Josef; Stöggl, Thomas; Schwameder, Hermann

2017-01-01

To enhance running performance in heel-toe running, a leaf spring structured midsole shoe (LEAF) has recently been introduced. The purpose of this study was to investigate the effect of a LEAF compared to a standard foam midsole shoe (FOAM) on joint mechanics and lower limb muscle forces in overground running. Nine male long-distance heel strike runners ran on an indoor track at 3.0 ± 0.2 m/s with LEAF and FOAM shoes. Running kinematics and kinetics were recorded during the stance phase. Absorbed and generated energy (negative and positive work) of the hip, knee and ankle joint as well as muscle forces of selected lower limb muscles were determined using a musculoskeletal model. A significant reduction in energy absorption at the hip joint as well as energy generation at the ankle joint was found for LEAF compared to FOAM. The mean lower limb muscle forces of the m. soleus, m. gastrocnemius lateralis and m. gastrocnemius medialis were significantly reduced for LEAF compared to FOAM. Furthermore, m. biceps femoris showed a trend of reduction in running with LEAF. The remaining lower limb muscles analyzed (m. gluteus maximus, m. rectus femoris, m. vastus medialis, m. vastus lateralis, m. tibialis anterior) did not reveal significant differences between the shoe conditions. The findings of this study indicate that LEAF positively influenced the energy balance in running by reducing lower limb muscle forces compared to FOAM. In this way, LEAF could contribute to an overall increased running performance in heel-toe running.

Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED.

PubMed

Bolandparvaz, Shahram; Moharamzadeh, Payman; Jamali, Kazem; Pouraghaei, Mahboob; Fadaie, Maryam; Sefidbakht, Sepideh; Shahsavari, Kavous

2013-11-01

Long bone fractures are currently diagnosed using radiography, but radiography has some disadvantages (radiation and being time consuming). The present study compared the diagnostic accuracy of bedside ultrasound and radiography in multiple trauma patients at the emergency department (ED). The study assessed 80 injured patients with multiple trauma from February 2011 to July 2012. The patients were older than 18 years and triaged to the cardiopulmonary resuscitation ward of the ED. Bedside ultrasound and radiography were conducted for them. The findings were separately and blindly assessed by 2 radiologists. Sensitivity, specificity, the positive and negative predictive value, and κ coefficient were measured to assess the accuracy and validity of ultrasound as compared with radiography. The sensitivity of ultrasound for diagnosis of limb bone fractures was not high enough and ranged between 55% and 75% depending on the fracture site. The specificity of this diagnostic method had an acceptable range of 62% to 84%. Ultrasound negative prediction value was higher than other indices under study and ranged between 73% and 83%, but its positive prediction value varied between 33.3% and 71%. The κ coefficient for diagnosis of long bone fractures of upper limb (κ = 0.58) and upper limb joints (κ = 0.47) and long bones of lower limb (κ = 0.52) was within the medium range. However, the value for diagnosing fractures of lower limb joints (κ = 0.47) was relatively low. Bedside ultrasound is not a reliable method for diagnosing fractures of upper and lower limb bones compared with radiography. © 2013 Elsevier Inc. All rights reserved.

Apotemnophilia, body integrity identity disorder or xenomelia? Psychiatric and neurologic etiologies face each other.

PubMed

Sedda, Anna; Bottini, Gabriella

2014-01-01

This review summarizes the available studies of a rare condition in which individuals seek the amputation of a healthy limb or desire to be paraplegic. Since 1977, case reports and group studies have been produced, trying to understand the cause of this unusual desire. The main etiological hypotheses are presented, from the psychological/psychiatric to the most recent neurologic explanation. The paradigms adopted and the clinical features are compared across studies and analyzed in detail. Finally, future directions and ethical implications are discussed. A proposal is made to adopt a multidisciplinary approach that comprises state-of-the-art technologies and a variety of theoretical models, including both body representation and psychological and sexual components.

In situ saphenous vein bypass for limb salvage.

PubMed

Sarcina, A; Carlesi, R; Bellosta, R; Agrifoglio, G

1993-02-01

A total of 130 infrapopliteal in situ saphenous vein bypasses were performed in 128 patients between January 1980 and June 1991. The indication for surgery was critical ischaemia with impending limb loss in 121 patients; seven suffered from severe claudication. The distal anastomosis was to the popliteal artery below the knee in 60 cases (46.2%) and in 70 (53.8%) to the tibioperoneal arteries. The results, in terms of secondary patency and limb salvage rates, of the first 68 procedures (1980-1985) and subsequent 62 (1986-June 1991) were compared. In the first period, a secondary patency rate of 42.6% and a limb salvage rate of 67.0% were obtained, compared with 71.3 and 80.8% respectively in the second. These differences are significant for patency (P < 0.005) and limb salvage (P < 0.01). These results show that the in situ technique can give acceptable results but a learning period with a high percentage of early failures is to be expected.

Quantitative rest activity in ambulatory monitoring as a physiological marker of restless legs syndrome: a controlled study.

PubMed

Tuisku, Katinka; Holi, Matti Mikael; Wahlbeck, Kristian; Ahlgren, Aulikki Johanna; Lauerma, Hannu

2003-04-01

An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS-related motor symptoms and normal motor activity. Nocturnal lower-limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS. Copyright 2002 Movement Disorder Society

Imaging features of macrodystrophia lipomatosa: an unusual cause of a brawny arm

PubMed Central

Dhanasekaran, Jagadeesan; Reddy, Ajit Kumar; Sarawagi, Radha; Lakshmanan, Prakash Manikka

2014-01-01

Macrodystrophia lipomatosa (MDL), a rare non-hereditary congenital disorder of localised gigantism, is characterised by progressive proliferation of all mesenchymal elements, with a disproportionate increase in fibroadipose tissue. We report a case of a 19-year-old man who presented with a history of painless enlargement of the left upper limb since childhood, which was gradually increasing in size and predominantly involving the radial aspect of the upper limb with relative sparing of the ulnar aspect. The patient was imaged with X-ray and MRI. Imaging and clinical features were classical of MDL. The patient underwent stage 1 reduction plasty of the left forearm; preoperative and histopathological findings confirmed the preoperative diagnosis. PMID:25406225

Management of work-relevant upper limb disorders: a review.

PubMed

Burton, A Kim; Kendall, Nicholas A S; Pearce, Brian G; Birrell, Lisa N; Bainbridge, L Christopher

2009-01-01

Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management. To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate. Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses. Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be on side and acting in a coordinated fashion; this requires engaging employers and workers to participate. The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift.

[Manufacture of upholstered furniture and work-related upper limb musculoskeletal disorders: an industrial sector prevention project].

PubMed

Di Leone, G; Carino, M; Nicoletti, S; Trani, G; Ambrosi, L

2008-01-01

In cooperation with the IRCCS Fondazione Maugeri and the IRCCS Fondazione Ospedale Maggiore Policlinico - EPM-CEMOC, of Milan, the Local Health Unit in Bari, Italy carried out a research project, sponsored partly by the Italian Ministry of Health, on upper limb work-related musculoskeletal disorders (UL-WMSDs) in a specific manufacturing sector, the upholstered furniture industry. This "sofa district" is widely represented with approximately 14,000 workers and 500 factories over a wide geographic area of southern Italy. Advanced technology in the manufacturing process is combined with workers performing intensive arm-hand tasks. The aim of the study included: a) assessment of exposure to repetitive strain and movements of the upper limb in a representative sample of the factories using the OCRA method, b) analysis of the annual prevalence and incidence rates, c) definition of possible improvement via ergonomic solutions in the various factories. Via a network of occupational physicians a total of more than 6000 subjects were examined over a 5-year period. Case-definition was assessed through standardized procedures. A detailed description of the manufacturing process of the upholstered furniture industry and of the characteristics of the working population is provided Exposed groups at risk were:filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. Data collected in private companies of different size in this extensive industrial "sofa area" emphasize the importance of prevention through adequate ergonomic solutions and the need to improve training programmes covering the whole area.

Predictors for the development of post-thrombotic syndrome in patients with primary lower limb deep venous thrombosis: A case-control study.

PubMed

Siddiqui, Nadeem A; Sophie, Ziad; Zafar, Farhan; Soares, Delvene; Naz, Iram

2017-02-01

Introduction Post-thrombotic syndrome is a common and debilitating sequelae of lower limb deep venous thrombosis. Very little awareness is present about the risk factors and about the diagnosis, prevention, and treatment of this condition. Objective The objective of this study is to identify the predictors of post-thrombotic syndrome after lower limb deep venous thrombosis. Materials and methods A case-control study was conducted on all adult patients who were admitted with lower limb deep venous thrombosis at our institution from January 2005 to June 2012. These patients were scheduled for a research clinic visit, which included informed consent, data collection, and physical examination. Patients found to have post-thrombotic syndrome served as cases and those without post-thrombotic syndrome served as controls. Villalta scoring system was used to diagnose the post-thrombotic syndrome and then to assess the severity of the condition in both the groups. Cox regression risk factor analysis was performed to identify the predictors of post-thrombotic syndrome. Results Out of the 125 patients examined, 49 were found to have post-thrombotic syndrome. Risk factors found to be significant were body mass index of more than 35 kg/m 2 ( n = 13, p = 0.003), history of immobilization ( n = 19, p = 0.003), one or more hypercoagable disorders ( n = 32, p = 0.02), iliofemoral deep venous thrombosis ( n = 18, p = 0.001), complete obstruction on ultrasound ( n = 26, p = 0.016), unstable range of international normalized ratio ( n = 23, p = 0.041) and non-compliance for the use of compressions stockings ( n = 14, p = 0.001). On multivariate analysis, one or more hypercoagable disorder, iliofemoral deep venous thrombosis, and non-compliance to the use of compression stockings were found to be independent risk factors for the development of post-thrombotic syndrome. Conclusion One or more hypercoagable disorders, iliofemoral deep venous thrombosis and non-compliance to the use of compression stockings were independent predictors of post-thrombotic syndrome after deep venous thrombosis. These findings will help prognosticate and prevent development of PTS in similar patient populations.

Characterizing differential poststroke corticomotor drive to the dorsi- and plantarflexor muscles during resting and volitional muscle activation.

PubMed

Palmer, Jacqueline A; Zarzycki, Ryan; Morton, Susanne M; Kesar, Trisha M; Binder-Macleod, Stuart A

2017-04-01

Imbalance of corticomotor excitability between the paretic and nonparetic limbs has been associated with the extent of upper extremity motor recovery poststroke, is greatly influenced by specific testing conditions such as the presence or absence of volitional muscle activation, and may vary across muscle groups. However, despite its clinical importance, poststroke corticomotor drive to lower extremity muscles has not been thoroughly investigated. Additionally, whereas conventional gait rehabilitation strategies for stroke survivors focus on paretic limb foot drop and dorsiflexion impairments, most contemporary literature has indicated that paretic limb propulsion and plantarflexion impairments are the most significant limiters to poststroke walking function. The purpose of this study was to compare corticomotor excitability of the dorsi- and plantarflexor muscles during resting and active conditions in individuals with good and poor poststroke walking recovery and in neurologically intact controls. We found that plantarflexor muscles showed reduced corticomotor symmetry between paretic and nonparetic limbs compared with dorsiflexor muscles in individuals with poor poststroke walking recovery during active muscle contraction but not during rest. Reduced plantarflexor corticomotor symmetry during active muscle contraction was a result of reduced corticomotor drive to the paretic muscles and enhanced corticomotor drive to the nonparetic muscles compared with the neurologically intact controls. These results demonstrate that atypical corticomotor drive exists in both the paretic and nonparetic lower limbs and implicate greater severity of corticomotor impairments to plantarflexor vs. dorsiflexor muscles during muscle activation in stroke survivors with poor walking recovery. NEW & NOTEWORTHY The present study observed that lower-limb corticomotor asymmetry resulted from both reduced paretic and enhanced nonparetic limb corticomotor excitability compared with neurologically intact controls. The most asymmetrical corticomotor drive was observed in the plantarflexor muscles of individuals with poor poststroke walking recovery. This suggests that neural function of dorsi- and plantarflexor muscles in both paretic and nonparetic limbs may play a role in poststroke walking function, which may have important implications when developing targeted poststroke rehabilitation programs to improve walking ability. Copyright © 2017 the American Physiological Society.

Hip joint torques during the golf swing of young and senior healthy males.

PubMed

Foxworth, Judy L; Millar, Audrey L; Long, Benjamin L; Way, Michael; Vellucci, Matthew W; Vogler, Joshua D

2013-09-01

Descriptive, laboratory study. To compare the 3-D hip torques during a golf swing between young and senior healthy male amateur golfers. The secondary purpose was to compare the 3-D hip joint torques between the trail leg and lead leg. The generation of hip torques from the hip musculature is an important aspect of the golf swing. Golf is a very popular activity, and estimates of hip torques during the golf swing have not been reported. Twenty healthy male golfers were divided into a young group (mean ± SD age, 25.1 ± 3.1 years) and a senior group (age, 56.9 ± 4.7 years). All subjects completed 10 golf swings using their personal driver. A motion capture system and force plates were used to obtain kinematic and kinetic data. Inverse dynamic analyses were used to calculate 3-D hip joint torques of the trail and lead limbs. Two-way analyses of covariance (group by leg), with club-head velocity as a covariate, were used to compare peak hip torques between groups and limbs. Trail-limb hip external rotator torque was significantly greater in the younger group compared to the senior group, and greater in the trail leg versus the lead leg. When adjusting for club-head velocity, young and senior healthy male amateur golfers generated comparable hip torques during a golf swing, with the exception of the trail-limb hip external rotator torque. The largest hip torque found was the trail-limb hip extensor torque.

Does a balance deficit persist in Australian Football players with previous lower limb ligament injury?

PubMed

Hrysomallis, C; McLaughlin, P; Goodman, C

2005-03-01

A history of lower limb ligament injury is a commonly-cited risk factor for another similar injury. During the acute phase of injury, there is a balancing skill deficit in the injured limb. It has been unclear as to whether this deficit persists in the medium-to-long term for previously injured Australian footballers, contributing to the risk of re-injury. This study compared the balance ability of footballers with and without previous lower limb ligament injury and, for previously injured players, the balance ability of the previously injured limb to the opposite uninjured limb. A total of 216 players from 6 teams from the Australian Football League were tested. The balance task comprised stepping on to a foam mat on top of a force plate and maintaining one-legged balance. The subjects were divided into 4 groups based on their injury history: all ankle injuries to only one limb, recent ankle injuries to only one limb (within the last 12 months), knee ligament injury only to one limb, and no previous ankle or knee ligament injury. Statistical analysis revealed that there was no significant difference between the balance scores of any of the previously injured players and those with no previous lower limb ligament injury. There was no significant difference between the balance score of the previously injured limb with the opposite uninjured limb. It appears that a balance deficit does not persist in Australian Football players with previous lower limb ligament injury.

Long-term outcome of dogs treated with ulnar rollover transposition for limb-sparing of distal radial osteosarcoma: 27 limbs in 26 dogs.

PubMed

Séguin, Bernard; O'Donnell, Matthew D; Walsh, Peter J; Selmic, Laura E

2017-10-01

To determine outcomes in dogs with distal radial osteosarcoma treated with ulnar rollover transposition (URT) limb-sparing surgery including: viability of the ulnar graft, complications, subjective limb function, disease-free interval (DFI), and survival time (ST). Retrospective case series. Twenty-six client-owned dogs with distal radial osteosarcoma and no involvement of the ulna. Data of dogs treated with URT were collected at the time of surgery and retrospectively from medical records and by contacting owners and referring veterinarians. URT technique was performed on 27 limbs in 26 dogs. The ulnar graft was determined to be viable in 17 limbs, nonviable in 3, and unknown in 7. Complications occurred in 20 limbs. Infection was diagnosed in 12 limbs. Biomechanical complications occurred in 15 and local recurrence in 2 limbs. Limb function graded by veterinarians or owners was poor in 2 limbs, fair in 4, good in 14, excellent in 3, and unknown in 4. Median DFI was 245 days and median ST was 277 days. The URT technique maintained the viability of the ulnar graft. The complication rate was high but limb function appeared acceptable. Although sufficient length of the distal aspect of the ulna must be preserved to perform this technique, local recurrence was not increased compared to other limb-sparing techniques when cases were appropriately selected. © 2017 The American College of Veterinary Surgeons.

Treatment of Sleep Disorders after Traumatic Brain Injury

PubMed Central

Castriotta, Richard J.; Atanasov, Strahil; Wilde, Mark C.; Masel, Brent E.; Lai, Jenny M.; Kuna, Samuel T.

2009-01-01

Study Objectives: Determine whether treatment of sleep disorders identified in brain injured adults would result in resolution of those sleep disorders and improvement of symptoms and daytime function. Methods: Prospective evaluation of unselected traumatic brain injury patients with nocturnal polysomnography (NPSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS), and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ) before and after treatment with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA), modafinil (200 mg) for narcolepsy and posttraumatic hypersomnia (PTH), or pramipexole (0.375 mg) for periodic limb movements in sleep (PLMS). Setting: Three academic medical centers. Participants: Fifty-seven (57) adults ≥ 3 months post traumatic brain injury (TBI). Measurements And Results: Abnormal sleep studies were found in 22 subjects (39%), of whom 13 (23%) had OSA, 2 (3%) had PTH, 3 (5%) had narcolepsy, 4 (7%) had PLMS, and 12 had objective excessive daytime sleepiness with MSLT score < 10 minutes. Apneas, hypopneas, and snoring were eliminated by CPAP in OSA subjects, but there was no significant change in MSLT scores. Periodic limb movements were eliminated with pramipexole. One of 3 narcolepsy subjects and 1 of 2 PTH subjects had resolution of hypersomnia with modafinil. There was no significant change in FOSQ, POMS, or PVT results after treatment. Conclusions: Treatment of sleep disorders after TBI may result in polysomnographic resolution without change in sleepiness or neuropsychological function. Citation: Castriotta RJ; Atanasov S; Wilde MC; Masel BE; Lai JM; Kuna ST. Treatment of sleep disorders after traumatic brain injury. J Clin Sleep Med 2009;5(2):137-144. PMID:19968047

Working postures of dental students: ergonomic analysis using the Ovako Working Analysis System and rapid upper limb assessment.

PubMed

Petromilli Nordi Sasso Garcia, Patrícia; Polli, Gabriela Scatimburgo; Campos, Juliana Alvares Duarte Bonini

2013-01-01

As dentistry is a profession that demands a manipulative precision of hand movements, musculoskeletal disorders are among the most common occupational diseases. This study estimated the risk of musculoskeletal disorders developing in dental students using the Ovako Working Analysis System (OWAS) and Rapid Upper Limb Assessment (RULA) methods, and estimated the diagnostic agreement between the 2 methods. Students (n = 75), enrolled in the final undergraduate year at the Araraquara School of Dentistry--UNESP--were studied. Photographs were taken of students while performing diverse clinical procedures (n = 283) using a digital camera, which were assessed using OWAS and RULA. A risk score was attributed following each procedure performed by the student. The prevalence of the risk of musculoskeletal disorders was estimated per point and for a 95% CI. To assess the agreement between the 2 methods, Kappa statistics with linear weighting were used. The level of significance adopted was 5%. There was a high prevalence of the mean score for risk of musculoskeletal disorders in the dental students evaluated according to the OWAS method (p = 97.88%; 95% CI: 96.20-99.56%), and a high prevalence of the high score (p = 40.6; 95% CI: 34.9-46.4%) and extremely high risk (p = 59.4%; 95% CI: 53.6-65.1%) according to RULA method Null agreement was verified (k = 0) in the risk di agnosis of the tested methods. The risk of musculoskeletal disorders in dental students estimated by the OWAS method was medium, whereas the same risk by the RULA method was extremely high. There was no diagnostic agreement between the OWAS and RULA methods.

MRI correlates of alien leg-like phenomenon in corticobasal degeneration.

PubMed

Hu, William T; Josephs, Keith A; Ahlskog, J Eric; Shin, Cheolsu; Boeve, Bradley F; Witte, Robert J

2005-07-01

We describe the clinical and neuroradiologic correlates in two patients with the clinical picture of CBD and alien leg phenomena. The MRI brain scan in both had unique focal abnormalities in the corresponding leg area of the homunculus that may be the substrate for the alien limb features. Copyright 2005 Movement Disorder Society.

Design and Development of VR Learning Environments for Children with ASD

ERIC Educational Resources Information Center

Cai, Yiyu; Chiew, Ruby; Nay, Zin Tun; Indhumathi, Chandrasekaran; Huang, Lihui

2017-01-01

Basic social interaction and executing certain tasks can be difficult for children with autism spectrum disorder (ASD). The symptoms of such behaviour include inappropriate gestures, body language and facial expressions, lack of interest in certain tasks, cognitive disability in coordination of limbs, and a difficulty in comprehending tasks'…

Dynamics of Self-Injurious Behaviors.

ERIC Educational Resources Information Center

Newell, Karl M.; Sprague, Robert L.; Pain, Matthew T.; Deutsch, Katherine M.; Meinhold, Patricia

1999-01-01

Self-injurious behavior was examined in a case study of head-banging by an 8-year-old girl with profound mental retardation and an autistic disorder. Trajectories of arm movements and impact forces were determined from dynamic analysis of videotapes. Cycle-to-cycle consistency in the qualitative dynamics of the limb motions and impact forces…

Moral Injury, Soul Repair, and Creating a Place for Grace

ERIC Educational Resources Information Center

Antal, Chris J.; Winings, Kathy

2015-01-01

Our returning veterans face many challenges from loss of limb and physical disabilities to posttraumatic stress disorder, depression, substance abuse, homelessness, family problems, and unemployment. The greater challenge, though, for returning veterans is the injury to their soul due to the war and violence they have experienced. Our challenge is…

Isolated limb perfusion for the management limb threatening soft tissue sarcomas: The role of histological type on clinical outcomes.

PubMed

Rastrelli, M; Mocellin, S; Stramare, R; Brunello, A; Maruzzo, M; Basso, U; Scarzello, G; Buzzaccarini, M S; Pilati, P; Saadeh, L M; Del Fiore, S P; Tosi, A; Montesco, C; Campana, L G; Tropea, S; Rossi, C R

2017-02-01

Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes. This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution. The following endpoints were evaluated: tumor response (assessed by radiological imaging and histology), limb sparing rate, local progression-free survival (LPFS) and overall survival (OS). On average, overall (complete + partial) tumor response was significantly greater in patients affected with liposarcoma as compared to those with other histotypes (radiological response rate: 38/41, 92.7% vs 66/84, 78.6%, P-value: 0.048; mean histological necrosis: 83.6% vs 52.9%, P < 0.0001). Limb sparing rate was also higher among patients with liposarcoma as compared to other histotypes (39/41, 95.1% vs 62/84, 73.8%, P-value: 0.005). As regards survival, LPFS was similar across tumor types, whereas OS resulted significantly worse in patients with limb leiomyosarcoma (log-rank P-value: 0.009). HILP is a very effective treatment modality for limb threatening STS. In our series, liposarcoma appears to be the histological type most sensitive to HILP in terms of tumor response and thus limb sparing, which might help clinicians in the patient selection process. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Tool development to assess the work related neck and upper limb musculoskeletal disorders among female garment workers in Sri-Lanka.

PubMed

Amarasinghe, Nirmalie Champika; De AlwisSenevirathne, Rohini

2016-10-17

Musculoskeletal disorders (MSDs) have been identified as a predisposing factor for lesser productivity, but no validated tool has been developed to assess them in the Sri- Lankan context. To develop a validated tool to assess the neck and upper limb MSDs. It comprises three components: item selections, item reduction using principal component analysis, and validation. A tentative self-administrated questionnaire was developed, translated, and pre-tested. Four important domains - neck, shoulder, elbow and wrist - were identified through principal component analysis. Prevalence of any MSDs was 38.1% and prevalence of neck, shoulder, elbow and wrist MSDs are 12.85%, 13.71%, 12%, 13.71% respectively. Content and criterion validity of the tool was assessed. Separate ROC curves were produced and sensitivity and specificity of neck (83.1%, 71.7%), shoulder (97.6%, 91.9%), elbow (98.2%, 87.2%), and wrist (97.6%, 94.9%) was determined. Cronbach's Alpha and correlation coefficient was above 0.7. The tool has high sensitivity, specificity, internal consistency, and test re-test reliability.

Cable-driven elastic parallel humanoid head with face tracking for Autism Spectrum Disorder interventions.

PubMed

Su, Hao; Dickstein-Fischer, Laurie; Harrington, Kevin; Fu, Qiushi; Lu, Weina; Huang, Haibo; Cole, Gregory; Fischer, Gregory S

2010-01-01

This paper presents the development of new prismatic actuation approach and its application in human-safe humanoid head design. To reduce actuator output impedance and mitigate unexpected external shock, the prismatic actuation method uses cables to drive a piston with preloaded spring. By leveraging the advantages of parallel manipulator and cable-driven mechanism, the developed neck has a parallel manipulator embodiment with two cable-driven limbs embedded with preloaded springs and one passive limb. The eye mechanism is adapted for low-cost webcam with succinct "ball-in-socket" structure. Based on human head anatomy and biomimetics, the neck has 3 degree of freedom (DOF) motion: pan, tilt and one decoupled roll while each eye has independent pan and synchronous tilt motion (3 DOF eyes). A Kalman filter based face tracking algorithm is implemented to interact with the human. This neck and eye structure is translatable to other human-safe humanoid robots. The robot's appearance reflects a non-threatening image of a penguin, which can be translated into a possible therapeutic intervention for children with Autism Spectrum Disorders.

Longitudinal outcomes after tibioperoneal angioplasty alone compared to tibial stenting and atherectomy for critical limb ischemia.

PubMed

Reynolds, Shaun; Galiñanes, Edgar Luis; Dombrovskiy, Viktor Y; Vogel, Todd R

2013-10-01

There are limited data available evaluating longitudinal outcomes after tibioperoneal angioplasty (TA) alone compared to adjunctive tibial procedures including stenting and atherectomy. Using the Centers for Medicare & Medicaid Services inpatient claims (2005-2007), patients evaluated TA only, TA plus stent placement (TA + S), and TA plus atherectomy (TA + A). A total of 2080 patients with critical limb ischemia underwent percutaneous tibioperoneal intervention for the indication of ulceration. Procedures included TA (56.3%), TA + S (16.2%), and TA + A (27.5%). Rates of amputation were not statistically different between the groups at 30, 90, and 365 days after the intervention. Mean total hospital charges were TA ($35,867), TA + A ($41,698; P = .0004), and TA + S ($51,040; P < .0001). Patients undergoing TA alone compared to concomitant stenting or atherectomy for ulceration demonstrated no improvement in limb salvage. Future analysis of adjunctive tibioperoneal interventions is essential to temper cost, as they fail to improve long-term limb salvage.

Robotic set-up to quantify hand-eye behavior in motor execution and learning of children with autism spectrum disorder.

PubMed

Casellato, Claudia; Gandolla, Marta; Crippa, Alessandro; Pedrocchi, Alessandra

2017-07-01

Autism spectrum disorder (ASD) is a multifaceted neurodevelopmental disorder characterized by a persistence of social and communication impairment, and restricted and repetitive behaviors. However, motor disorders have also been described, but not objectively assessed. Most studies showed inefficient eye-hand coordination and motor learning in children with ASD; in other experiments, mechanisms of acquisition of internal models in self-generated movements appeared to be normal in autism. In this framework, we have developed a robotic protocol, recording gaze and hand data during upper limb tasks, in which a haptic pen-like handle is moved along specific trajectories displayed on the screen. The protocol includes trials of reaching under a perturbing force field and catching moving targets, with or without visual availability of the whole path. We acquired 16 typically-developing scholar-age children and one child with ASD as a case study. Speed-accuracy tradeoff, motor performance, and gaze-hand spatial coordination have been evaluated. Compared to typically developing peers, in the force field sequence, the child with ASD showed an intact but delayed learning, and more variable gazehand patterns. In the catching trials, he showed less efficient movements, but an intact capability of exploiting the available a-priori plan. The proposed protocol represents a powerful tool, easily tunable, for quantitative (longitudinal) assessment, and for subject-tailored training in ASD.

Electromyography-based analysis of human upper limbs during 45-day head-down bed-rest

NASA Astrophysics Data System (ADS)

Fu, Anshuang; Wang, Chunhui; Qi, Hongzhi; Li, Fan; Wang, Zheng; He, Feng; Zhou, Peng; Chen, Shanguang; Ming, Dong

2016-03-01

Muscle deconditioning occurs in response to simulated or actual microgravity. In spaceflight, astronauts become monkey-like for mainly using their upper limbs to control the operating system and to complete corresponding tasks. The changes of upper limbs' athletic ability will directly affect astronauts' working performance. This study investigated the variation trend of surface electromyography (sEMG) during prolonged simulated microgravity. Eight healthy males participating in this study performed strict 45-day head-down bed-rest (HDBR). On the 5th day of pre-HDBR, and the 15th, the 30th and the 45th days of HDBR, the subjects performed maximum pushing task and maximum pulling task, and sEMG was collected from upper limbs synchronously. Each subject's maximum volunteer contractions of both the tasks during these days were compared, showing no significant change. However, changes were detected by sEMG-based analysis. It was found that integrated EMG, root mean square, mean frequency, fuzzy entropy of deltoid, and fuzzy entropy of triceps brachii changed significantly when comparing pre-HDBR with HDBR. The variation trend showed a recovery tendency after significant decline, which is inconsistent with the monotonic variation of lower limbs that was proved by previous research. These findings suggest that EMG changes in upper limbs during prolonged simulated microgravity, but has different variation trend from lower limbs.

EFFICACY of P188 ON LAPINE MENISCUS PRESERVATION FOLLOWING BLUNT TRAUMA

PubMed Central

Coatney, Garrett A.; Abraham, Adam C.; Fischenich, Kristine M.; Button, Keith D.; Haut, Roger C.; Haut Donahue, Tammy L.

2015-01-01

Traumatic injury to the knee leads to the development of posttraumatic osteoarthritis. The objective of this study was to characterize the effects of a single intra-articular injection of a non-ionic surfactant, Poloxamer 188 (P188), in preservation of meniscal tissue following trauma through maintenance of meniscal glycosaminoglycan (GAG) content and mechanical properties. Flemish Giant rabbits were subjected to a closed knee joint, traumatic compressive impact with the joint constrained to prevent anterior tibial translation. The contralateral limb served as an un-impacted control. Six animals (treated) received an injection of P188 in phosphate buffered saline (PBS) post trauma, and another six animals (sham) received a single injection of PBS to the impacted limb. Histological analyses for GAG was determined 6 weeks post trauma, and functional outcomes were assessed using stress relaxation micro-indentation. The impacted limbs of the sham group demonstrated a significant decrease in meniscal GAG coverage compared to non-impacted limbs (p < 0.05). GAG coverage of the impacted P188 treated limbs was not significantly different than contralateral non-impacted limbs in all regions except the medial anterior (p < 0.05). No significant changes were documented in mechanics for either the sham or treated groups compared to their respective control limbs. This suggests that a single intra-articular injection of P188 shows promise in prevention of trauma induced GAG loss. PMID:25846264

The Effect of Sliding Humeral Osteotomy (SHO) on Frontal Plane Thoracic Limb Alignment: An Ex Vivo Canine Cadaveric Study.

PubMed

Breiteneicher, Adam H; Norby, Bo; Schulz, Kurt S; Kerwin, Sharon C; Hulse, Don A; Fox, Derek B; Saunders, W Brian

2016-11-01

To determine the effect of sliding humeral osteotomy (SHO) on frontal plane thoracic limb alignment in standing and recumbent limb positions. Canine cadaveric study. Canine thoracic limbs (n=15 limb pairs). Limbs acquired from healthy Labrador Retrievers euthanatized for reasons unrelated to this study were mounted in a limb press and aligned in a standing position followed by axial loading at 30% body weight. Frontal plane radiography was performed in standing and recumbent positions pre- and post-SHO. In the standing position, lateralization of the foot was measured pre- and post-SHO using a textured grid secured to the limb press base plate. Twelve thoracic limb alignment values (mean ± SD and 95% CI) were determined using the center of rotation of angulation (CORA) method were compared using linear mixed models to determine if significant differences existed between limb alignment values pre- or post-SHO, controlling for dog, limb, and limb position. Six of 12 standing or recumbent alignment values were significantly different pre- and post-SHO. SHO resulted in decreased mechanical lateral distal humeral angle and movement of the mechanical humeral radio-ulnar angle, radio-ulnar metacarpal angle, thoracic humeral angle, and elbow mechanical axis deviation toward coaxial limb alignment. In the standing position, the foot underwent significant lateralization post-SHO. SHO resulted in significant alteration in frontal plane thoracic limb alignment. Additional studies are necessary to determine if the changes reported using our ex vivo model occur following SHO in vivo. © Copyright 2016 by The American College of Veterinary Surgeons.

Development of Evaluation Methods for Lower Limb Function between Aged and Young Using Principal Component Analysis

NASA Astrophysics Data System (ADS)

Nomoto, Yohei; Yamashita, Kazuhiko; Ohya, Tetsuya; Koyama, Hironori; Kawasumi, Masashi

There is the increasing concern of the society to prevent the fall of the aged. The improvement in aged people's the muscular strength of the lower-limb, postural control and walking ability are important for quality of life and fall prevention. The aim of this study was to develop multiple evaluation methods in order to advise for improvement and maintenance of lower limb function between aged and young. The subjects were 16 healthy young volunteers (mean ± S.D: 19.9 ± 0.6 years) and 10 healthy aged volunteers (mean ± S.D: 80.6 ± 6.1 years). Measurement items related to lower limb function were selected from the items which we have ever used. Selected measurement items of function of lower are distance of extroversion of the toe, angle of flexion of the toe, maximum width of step, knee elevation, moving distance of greater trochanter, walking balance, toe-gap force and rotation range of ankle joint. Measurement items summarized by the principal component analysis into lower ability evaluation methods including walking ability and muscle strength of lower limb and flexibility of ankle. The young group demonstrated the factor of 1.6 greater the assessment score of walking ability compared with the aged group. The young group demonstrated the factor of 1.4 greater the assessment score of muscle strength of lower limb compared with the aged group. The young group demonstrated the factor of 1.2 greater the assessment score of flexibility of ankle compared with the aged group. The results suggested that it was possible to assess the lower limb function of aged and young numerically and to advise on their foot function.

Intra-articular decorin influences the fibrosis genetic expression profile in a rabbit model of joint contracture.

PubMed

Abdel, M P; Morrey, M E; Barlow, J D; Grill, D E; Kolbert, C P; An, K N; Steinmann, S P; Morrey, B F; Sanchez-Sotelo, J

2014-01-01

The goal of this study was to determine whether intra-articular administration of the potentially anti-fibrotic agent decorin influences the expression of genes involved in the fibrotic cascade, and ultimately leads to less contracture, in an animal model. A total of 18 rabbits underwent an operation on their right knees to form contractures. Six limbs in group 1 received four intra-articular injections of decorin; six limbs in group 2 received four intra-articular injections of bovine serum albumin (BSA) over eight days; six limbs in group 3 received no injections. The contracted limbs of rabbits in group 1 were biomechanically and genetically compared with the contracted limbs of rabbits in groups 2 and 3, with the use of a calibrated joint measuring device and custom microarray, respectively. There was no statistical difference in the flexion contracture angles between those limbs that received intra-articular decorin versus those that received intra-articular BSA (66° vs 69°; p = 0.41). Likewise, there was no statistical difference between those limbs that received intra-articular decorin versus those who had no injection (66° vs 72°; p = 0.27). When compared with BSA, decorin led to a statistically significant increase in the mRNA expression of 12 genes (p < 0.01). In addition, there was a statistical change in the mRNA expression of three genes, when compared with those without injection. In this model, when administered intra-articularly at eight weeks, 2 mg of decorin had no significant effect on joint contractures. However, our genetic analysis revealed a significant alteration in several fibrotic genes. Cite this article: Bone Joint Res 2014;3:82-8.

Antagonists to TRPV1, ASICs and P2X have a potential role to prevent the triggering of regional bone metabolic disorder and pain-like behavior in tail-suspended mice.

PubMed

Hanaka, Megumi; Iba, Kousuke; Dohke, Takayuki; Kanaya, Kumiko; Okazaki, Shunichiro; Yamashita, Toshihiko

2018-05-01

Our recent studies demonstrated that regional bone loss in the unloaded hind limbs of tail-suspended mice triggered pain-like behaviors due to the acidic environment in the bone induced by osteoclast activation. The aims of the present study were to examine whether TRPV1, ASIC and P2X (known as nociceptors) are expressed in bone, and whether the antagonists to those receptors affect the expression of osteoblast and osteoclast regulators, and prevent the triggering of not only pain-like behaviors but also high bone turnover conditions in tail-suspension model mice. The hind limb-unloaded mice were subjected to tail suspension with the hind limbs elevated for 14days. The effects of the TRPV1, ASIC3, P2X2/3 antagonists on pain-like behaviors as assessed by the von Frey test, paw flick test and spontaneous pain scale; the expressions of TRPV1, ASICs, and P2X2 in the bone; and the effects of those antagonists on osteoblast and osteoclast regulators were examined. In addition, we evaluated the preventive effect of continuous treatment with a TRPV1 antagonist on the trigger for pain-like behavior and bone loss in tail-suspended mice. Pain-like behaviors were significantly improved by the treatment with TRPV1, ASIC, P2X antagonists; TRPV1, ASICs and P2X were expressed in the bone tissues; and the antagonists to these receptors down-regulated the expression of osteoblast and osteoclast regulators in tail-suspended mice. In addition, continuous treatment with a TRPV1 antagonist during tail-suspension prevented the induction of pain-like behaviors and regional bone loss in the unloaded hind limbs. We, therefore, believe that those receptor antagonists have a potential role in preventing the triggering of skeletal pain with associated regional bone metabolic disorder. Copyright © 2018 Elsevier Inc. All rights reserved.

Selection and application of familiar and novel tools in patients with left and right hemispheric stroke: Psychometrics and normative data.

PubMed

Buchmann, Ilka; Randerath, Jennifer

2017-09-01

Frequently left brain damage (LBD) leads to limb apraxia, a disorder that can affect tool-use. Despite its impact on daily life, classical tests examining the pantomime of tool-use and imitation of gestures are seldom applied in clinical practice. The study's aim was to present a diagnostic approach which appears more strongly related to actions in daily life in order to sensitize applicants and patients about the relevance of the disorder before patients are discharged. Two tests were introduced that evaluate actual tool selection and tool-object-application: the Novel Tools (NTT) and the Familiar Tools (FTT) Test (parts of the DILA-S: Diagnostic Instrument for Limb Apraxia - Short Version). Normative data in healthy subjects (N = 82) was collected. Then the tests were applied in stroke patients with unilateral left brain damage (LBD: N = 33), a control right brain damage group (RBD: N = 20) as well as healthy age and gender matched controls (CL: N = 28, and CR, N = 18). The tests showed appropriate interrater-reliability and internal consistency as well as concurrent and divergent validity. To examine criterion validity based on the well-known left lateralization of limb apraxia, group comparisons were run. As expected, the LBD group demonstrated a high prevalence of tool-use apraxia (NTT: 36.4%, FTT: 48.5%) ranging from mild to severe impairment and scored worse than their control group (CL). A few RBD patients did demonstrate impairments in tool-use (NTT: 15%, FTT: 15%). On a group level they did not differ from their healthy controls (CR). Further, it was demonstrated that the selection and application of familiar and novel tools can be impaired selectively. Our study results suggest that real tool-use tests evaluating tool selection and tool application should be considered for standard diagnosis of limb apraxia in left as well as right brain damaged patients. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Skin temperature during cutaneous wound healing in an equine model of cutaneous fibroproliferative disorder: kinetics and anatomic-site differences.

PubMed

Celeste, Christophe J; Deschesne, Karine; Riley, Christopher B; Theoret, Christine L

2013-02-01

To map skin temperature kinetics, and by extension skin blood flow throughout normal or abnormal repair of full-thickness cutaneous wounds created on the horse body and limb, using infrared thermography. Experimental. Standardbreds (n = 6), aged 3-4 years. Three cutaneous wounds were created on the dorsolateral surface of each metacarpus and on the lateral thoracic wall. Thoracic skin wounds and those on 1 randomly chosen forelimb healed by second intention without a bandage, whereas contralateral limb wounds were bandaged to induce formation of exuberant granulation tissue (EGT). Thermal data were collected from all planned wound sites before the surgical procedure (baseline), and at 24, 48, 96 hours, 1, 2, and 4 weeks after wounding. Data were analyzed using repeated measures ANOVA and a priori contrasts submitted to Bonferroni sequential correction. Level of significance was P < .05. Cutaneous wound temperature (CWT) increased temporally from preoperative period to week 1 postwounding, independently of anatomic location (P < .0001). CWT of limb wounds was significantly less than that of body wounds throughout healing (P < .01). CWT of limb wounds managed with bandages and developing EGT was significantly less than that of unbandaged limb wounds, which did not develop EGT (P ≤ .01). CWT varied with anatomic location and throughout healing. CWT of wounds developing EGT was significantly less than that of wounds without EGT. © Copyright 2012 by The American College of Veterinary Surgeons.

Application of Comparative Functional Genomics to Identify Regeneration-Specific Genes

DTIC Science & Technology

2014-08-25

The first objective will extend an ongoing study of the transcriptional basis of limb regeneration in the Mexican axolotl (Ambystoma mexicanum) to...Army Research Office P.O. Box 12211 Research Triangle Park, NC 27709-2211 Limb Regeneration, Transcriptome, Salamander, Axolotl REPORT...transcriptional basis of limb regeneration in the Mexican axolotl (Ambystoma mexicanum) to three additional salamander species (A. tigrinum, A. maculatum, and

Electromyographic Analysis of the Lower Limb Muscles in Low- and High-Handicap Golfers

ERIC Educational Resources Information Center

Marta, Sérgio; Silva, Luís; Vaz, João R.; Castro, Maria António; Reinaldo, Gustavo; Pezarat-Correia, Pedro

2016-01-01

Purpose: The aim of this study was to compare the electromyographic patterns of the lower limb muscles during a golf swing performed by low- and high-handicap golfers. Method: Ten golfers (5 low- and 5 high-handicap) performed 8 swings using a 7-iron. Surface electromyography (EMG) was recorded for the following lower limb muscles on both sides:…

Age-related changes in spatiotemporal characteristics of gait accompany ongoing lower limb linear growth in late childhood and early adolescence.

PubMed

Froehle, Andrew W; Nahhas, Ramzi W; Sherwood, Richard J; Duren, Dana L

2013-05-01

Walking gait is generally held to reach maturity, including walking at adult-like velocities, by 7-8 years of age. Lower limb length, however, is a major determinant of gait, and continues to increase until 13-15 years of age. This study used a sample from the Fels Longitudinal Study (ages 8-30 years) to test the hypothesis that walking with adult-like velocity on immature lower limbs results in the retention of immature gait characteristics during late childhood and early adolescence. There was no relationship between walking velocity and age in this sample, whereas the lower limb continued to grow, reaching maturity at 13.2 years in females and 15.6 years in males. Piecewise linear mixed models regression analysis revealed significant age-related trends in normalized cadence, initial double support time, single support time, base of support, and normalized step length in both sexes. Each trend reached its own, variable-specific age at maturity, after which the gait variables' relationships with age reached plateaus and did not differ significantly from zero. Offsets in ages at maturity occurred among the gait variables, and between the gait variables and lower limb length. The sexes also differed in their patterns of maturation. Generally, however, immature walkers of both sexes took more frequent and relatively longer steps than did mature walkers. These results support the hypothesis that maturational changes in gait accompany ongoing lower limb growth, with implications for diagnosing, preventing, and treating movement-related disorders and injuries during late childhood and early adolescence. Copyright © 2012 Elsevier B.V. All rights reserved.

Limb-kinetic apraxia affects activities of daily living in Parkinson’s disease: a multi-center study

PubMed Central

Foki, T.; Vanbellingen, T.; Lungu, C.; Pirker, W.; Bohlhalter, S.; Nyffeler, T.; Kraemmer, J.; Haubenberger, D.; Fischmeister, F. Ph. S.; Auff, E.; Hallett, M.; Beisteiner, R.

2017-01-01

Background and purpose Impaired dexterity (fine hand movements) is often present in Parkinson’s disease (PD), even at early to moderate disease stages. It has a detrimental impact on activities of daily living (ADL) such as buttoning, contributing to reduced quality of life. Limb-kinetic apraxia, a loss of the ability to make precise, independent but coordinated finger and hand movements, may contribute to impaired dexterity even more than bradykinesia per se. However, the impact of limb-kinetic apraxia on ADL remains controversial. Our aim was to identify the strongest predictor of buttoning and unbuttoning in PD. It was hypothesized that coin rotation (a surrogate of limb-kinetic apraxia) represents the most important determinant. Methods Sixty-four right-handed, early to moderate PD patients were recruited from three movement disorder centers (Hoehn and Yahr stages 1–3). Buttoning, unbuttoning and coin rotation (right and left hand) represented the target tasks. Motor impairment was assessed according to the Unified Parkinson’s Disease Rating Scale. Results Multiple linear regression analysis showed that coin rotation with the right hand was the only significant predictor of buttoning (P < 0.001) and unbuttoning (P = 0.002). Notably, measures of bradykinesia or overall motor impairment did not represent significant predictors. Conclusions Constituting the novel key finding, limb-kinetic apraxia seems to be particularly relevant for ADL requiring dexterity skills in PD, even at early to moderate disease stages. Our results prompt research into the pathophysiological background and therapeutic options to treat limb-kinetic apraxia. The simple coin rotation test provides valuable information about ADL-related dexterity skills. PMID:27132653

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy.

PubMed

Zielinski, Ingar Marie; Steenbergen, Bert; Baas, C Marjolein; Aarts, Pauline; Jongsma, Marijtje L A

2016-01-11

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.

Assessing the role of dopamine in limb and cranial-oromotor control in a rat model of Parkinson’s disease

PubMed Central

Kane, Jacqueline R.; Ciucci, Michelle R.; Jacobs, Amber N.; Tews, Nathan; Russell, John A.; Ahrens, Allison M.; Ma, Sean T.; Britt, Joshua M.; Cormack, Lawrence K.; Schallert, Timothy

2012-01-01

Parkinson’s disease (PD) is a neurodegenerative disorder primarily characterized by sensorimotor dysfunction. The neuropathology of PD includes a loss of dopamine (DA) neurons of the nigrostriatal pathway. Classic signs of the disease include rigidity, bradykinesia, and postural instability. However, as many as 90% of patients also experience significant deficits in speech, swallowing (including mastication), and respiratory control. Oromotor deficits such as these are underappreciated, frequently emerging during the early, often hemi-Parkinson, stage of the disease. In this paper, we review tests commonly used in our labs to model early and hemi-Parkinson deficits in rodents. We have recently expanded our tests to include sensitive models of oromotor deficits. This paper discusses the most commonly used tests in our lab to model both limb and oromotor deficits, including tests of forelimb-use asymmetry, postural instability, vibrissae-evoked forelimb placing, single limb akinesia, dry pasta handling, sunflower seed shelling, and acoustic analyses of ultrasonic vocalizations and pasta biting strength. In particular, we lay new groundwork for developing methods for measuring abnormalities in the acoustic patterns during eating that indicate decreased biting strength and irregular intervals between bites in the hemi-Parkinson rat. Similar to limb motor deficits, oromotor deficits, at least to some degree, appear to be modulated by nigrostriatal DA. Finally, we briefly review the literature on targeted motor rehabilitation effects in PD models. Learning outcomes Readers will: (a) understand how a unilateral lesion to the nigrostriatal pathway affects limb use, (b) understand how a unilateral lesion to the nigrostriatal pathway affects oromotor function, and (c) gain an understanding of how limb motor deficits and oromotor deficits appear to involve dopamine and are modulated by training. PMID:21820129

Cardiac cycle-synchronized electrical muscle stimulator for lower limb training with the potential to reduce the heart's pumping workload

PubMed Central

Matsuse, Hiroo; Akimoto, Ryuji; Kamiya, Shiro; Moritani, Toshio; Sasaki, Motoki; Ishizaki, Yuta; Ohtsuka, Masanori; Nakayoshi, Takaharu; Ueno, Takafumi; Shiba, Naoto; Fukumoto, Yoshihiro

2017-01-01

Background The lower limb muscle may play an important role in decreasing the heart’s pumping workload. Aging and inactivity cause atrophy and weakness of the muscle, leading to a loss of the heart-assisting role. An electrical lower limb muscle stimulator can prevent atrophy and weakness more effectively than conventional resistance training; however, it has been reported to increase the heart’s pumping workload in some situations. Therefore, more effective tools should be developed. Methods We newly developed a cardiac cycle-synchronized electrical lower limb muscle stimulator by combining a commercially available electrocardiogram monitor and belt electrode skeletal muscle electrical stimulator, making it possible to achieve strong and wide but not painful muscle contractions. Then, we tested the stimulator in 11 healthy volunteers to determine whether the special equipment enabled lower limb muscle training without harming the hemodynamics using plethysmography and a percutaneous cardiac output analyzer. Results In 9 of 11 subjects, the stimulator generated diastolic augmentation waves on the dicrotic notches and end-diastolic pressure reduction waves on the plethysmogram waveforms of the brachial artery, showing analogous waveforms in the intra-aortic balloon pumping heart-assisting therapy. The heart rate, stroke volume, and cardiac output significantly increased during the stimulation. There was no change in the systolic or diastolic blood pressure during the stimulation. Conclusion Cardiac cycle-synchronized electrical muscle stimulation for the lower limbs may enable muscle training without harmfully influencing the hemodynamics and with a potential to reduce the heart’s pumping workload, suggesting a promising tool for effectively treating both locomotor and cardiovascular disorders. PMID:29117189

A biomechanical comparison in the lower limb and lumbar spine between a hit and drag flick in field hockey.

PubMed

Ng, Leo; Rosalie, Simon M; Sherry, Dorianne; Loh, Wei Bing; Sjurseth, Andreas M; Iyengar, Shrikant; Wild, Catherine Y

2018-03-01

Research has revealed that field hockey drag flickers have greater odds of hip and lumbar injuries compared to non-drag flickers (DF). This study aimed to compare the biomechanics of a field hockey hit and a specialised field hockey drag flick. Eighteen male and seven female specialised hockey DF performed a hit and a drag flick in a motion analysis laboratory with an 18-camera three-dimensional motion analysis system and a calibrated multichannel force platform to examine differences in lower limb and lumbar kinematics and kinetics. Results revealed that drag flicks were performed with more of a forward lunge on the left lower limb resulting in significantly greater left ankle dorsiflexion, knee, hip and lumbar flexion (Ps<0.001) compared to a hit. Drag flicks were also performed with significantly greater lateral flexion (P < 0.002) and rotation of the lumbar spine (P < 0.006) compared to a hit. Differences in kinematics lead to greater shear, compression and tensile forces in multiple left lower limb and lumbar joints in the drag flick compared to the hit (P < 0.05). The biomechanical differences in drag flicks compared to a hit may have ramifications with respect to injury in field hockey drag flickers.

Mapping Pathological Phenotypes in a Mouse Model of CDKL5 Disorder

PubMed Central

Amendola, Elena; Zhan, Yang; Mattucci, Camilla; Castroflorio, Enrico; Calcagno, Eleonora; Fuchs, Claudia; Lonetti, Giuseppina; Silingardi, Davide; Vyssotski, Alexei L.; Farley, Dominika; Ciani, Elisabetta; Pizzorusso, Tommaso; Giustetto, Maurizio; Gross, Cornelius T.

2014-01-01

Mutations in cyclin-dependent kinase-like 5 (CDKL5) cause early-onset epileptic encephalopathy, a neurodevelopmental disorder with similarities to Rett Syndrome. Here we describe the physiological, molecular, and behavioral phenotyping of a Cdkl5 conditional knockout mouse model of CDKL5 disorder. Behavioral analysis of constitutive Cdkl5 knockout mice revealed key features of the human disorder, including limb clasping, hypoactivity, and abnormal eye tracking. Anatomical, physiological, and molecular analysis of the knockout uncovered potential pathological substrates of the disorder, including reduced dendritic arborization of cortical neurons, abnormal electroencephalograph (EEG) responses to convulsant treatment, decreased visual evoked responses (VEPs), and alterations in the Akt/rpS6 signaling pathway. Selective knockout of Cdkl5 in excitatory and inhibitory forebrain neurons allowed us to map the behavioral features of the disorder to separable cell-types. These findings identify physiological and molecular deficits in specific forebrain neuron populations as possible pathological substrates in CDKL5 disorder. PMID:24838000

A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees.

PubMed

Allami, Mostafa; Mousavi, Batool; Masoumi, Mehdi; Modirian, Ehsan; Shojaei, Hadi; Mirsalimi, Fatemeh; Hosseini, Maryam; Pirouzi, Pirouz

2016-01-01

Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. The most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %). The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

Body proportions in ancient Andeans from high and low altitudes.

PubMed

Weinstein, Karen J

2005-11-01

Living human populations from high altitudes in the Andes exhibit relatively short limbs compared with neighboring groups from lower elevations as adaptations to cold climates characteristic of high-altitude environments. This study compares relative limb lengths and proportions in pre-Contact human skeletons from different altitudes to test whether ecogeographic variation also existed in Andean prehistory. Maximum lengths of the humerus, radius, femur, and tibia, and femoral head breadth are measured in sex-specific groups of adult human skeletons (N = 346) from the central (n = 80) and the south-central (n = 123) Andean coasts, the Atacama Desert at 2,500 m (n = 102), and the southern Peruvian highlands at 2,000-3,800 m (n = 41). To test whether limb lengths vary with altitude, comparisons are made of intralimb proportions, limb lengths against body mass estimates derived from published equations, limb lengths against the geometric mean of all measurements, and principal component analysis. Intralimb proportions do not statistically differ between coastal groups and those from the Atacama Desert, whereas intralimb proportions are significantly shorter in the Peruvian highland sample. Overall body size and limb lengths relative to body size vary along an altitudinal gradient, with larger individuals from coastal environments and smaller individuals with relatively longer limbs for their size from higher elevations. Ecogeographic variation in relation to climate explains the variation in intralimb proportions, and dietary variation may explain the altitudinal cline in body size and limb lengths relative to body size. The potential effects of gene flow on variation in body proportions in Andean prehistory are also explored. Copyright 2005 Wiley-Liss, Inc

Quantifying frontal plane knee motion during single limb squats: reliability and validity of 2-dimensional measures.

PubMed

Gwynne, Craig R; Curran, Sarah A

2014-12-01

Clinical assessment of lower limb kinematics during dynamic tasks may identify individuals who demonstrate abnormal movement patterns that may lead to etiology of exacerbation of knee conditions such as patellofemoral joint (PFJt) pain. The purpose of this study was to determine the reliability, validity and associated measurement error of a clinically appropriate two-dimensional (2-D) procedure of quantifying frontal plane knee alignment during single limb squats. Nine female and nine male recreationally active subjects with no history of PFJt pain had frontal plane limb alignment assessed using three-dimensional (3-D) motion analysis and digital video cameras (2-D analysis) while performing single limb squats. The association between 2-D and 3-D measures was quantified using Pearson's product correlation coefficients. Intraclass correlation coefficients (ICCs) were determined for within- and between-session reliability of 2-D data and standard error of measurement (SEM) was used to establish measurement error. Frontal plane limb alignment assessed with 2-D analysis demonstrated good correlation compared with 3-D methods (r = 0.64 to 0.78, p < 0.001). Within-session (0.86) and between-session ICCs (0.74) demonstrated good reliability for 2-D measures and SEM scores ranged from 2° to 4°. 2-D measures have good consistency and may provide a valid measure of lower limb alignment when compared to existing 3-D methods. Assessment of lower limb kinematics using 2-D methods may be an accurate and clinically useful alternative to 3-D motion analysis when identifying individuals who demonstrate abnormal movement patterns associated with PFJt pain. 2b.

Detection of Genes Regulated by Lmx1b During Limb Dorsalization

PubMed Central

Feenstra, Jennifer M.; Kanaya, Kohei; Pira, Charmaine U; Hoffman, Sarah E.; Eppey, Richard J.; Oberg, Kerby C.

2012-01-01

Lmx1b is a homeodomain transcription factor that regulates dorsal identity during limb development. Lmx1b knockout (KO) mice develop distal ventral-ventral limbs. Although induction of Lmx1b is linked to Wnt7a expression in the dorsal limb ectoderm, the downstream targets of Lmx1b that accomplish limb dorsalization are unknown. To identify genes targeted by Lmx1b, we compared gene arrays from Lmx1b KO and wildtype mouse limbs during limb dorsalization, i.e., 11.5, 12.5, and 13.5 days post coitum. We identified 54 target genes differentially expressed in all three stages. Several skeletal targets, including Emx2, Matrilin1 and Matrilin4, demonstrated a loss of scapular expression in the Lmx1b KO mice, supporting a role for Lmx1b in scapula development. Furthermore, the relative abundance of extracellular matrix-related soft tissue targets regulated by Lmx1b, such as collagens and proteoglycans, suggests a mechanism which includes changes in the extracellular matrix composition to accomplish limb dorsalization. Our study provides the most comprehensive characterization of genes regulated by Lmx1b during limb development to-date and provides targets for further investigation. PMID:22417325

Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial.

PubMed

Rink, Cameron; Wernke, Matthew M; Powell, Heather M; Gynawali, Surya; Schroeder, Ryan M; Kim, Jayne Y; Denune, Jeffrey A; Gordillo, Gayle M; Colvin, James M; Sen, Chandan K

2016-01-01

A growing number of clinical trials and case reports support qualitative claims that use of an elevated vacuum suspension (EVS) prosthesis improves residual-limb health on the basis of self-reported questionnaires, clinical outcomes scales, and wound closure studies. Here, we report first efforts to quantitatively assess residual-limb circulation in response to EVS. Residual-limb skin health and perfusion of people with lower-limb amputation (N = 10) were assessed during a randomized crossover study comparing EVS with nonelevated vacuum suspension (control) over a 32 wk period using noninvasive probes (transepidermal water loss, laser speckle imaging, transcutaneous oxygen measurement) and functional hyperspectral imaging approaches. Regardless of the suspension system, prosthesis donning decreased perfusion in the residual limb under resting conditions. After 16 wk of use, EVS improved residual-limb oxygenation during treadmill walking. Likewise, prosthesis-induced reactive hyperemia was attenuated with EVS following 16 wk of use. Skin barrier function was preserved with EVS but disrupted after control socket use. Taken together, outcomes suggest chronic EVS use improves perfusion and preserves skin barrier function in people with lower-limb amputation. ClinicalTrials.gov; "Evaluation of limb health associated with a prosthetic vacuum socket system": NCT01839123; https://clinicaltrials.gov/ct2/show/NCT01839123?term=NCT01839123&rank=1.

ATHLETE: A Limbed Vehicle for Solar System Exploration

NASA Technical Reports Server (NTRS)

Wilcox, Brian H.

2012-01-01

As part of the Human-Robot Systems project funded by NASA, the Jet Propulsion Laboratory has developed a vehicle called ATHLETE: the All-Terrain Hex-Limbed Extra-Terrestrial Explorer. Each vehicle is based on six wheels at the ends of six multi-degree-of-freedom limbs. Because each limb has enough degrees of freedom for use as a general-purpose leg, the wheels can be locked and used as feet to walk out of excessively soft or other extreme terrain. Since the vehicle has this alternative mode of traversing through or at least out of extreme terrain, the wheels and wheel actuators can be sized for nominal terrain. There are substantial mass savings in the wheel and wheel actuators associated with designing for nominal instead of extreme terrain. These mass savings are comparable-to or larger-than the extra mass associated with the articulated limbs. As a result, the entire mobility system, including wheels and limbs, can be about 25% lighter than a conventional mobility chassis. A side benefit of this approach is that each limb has sufficient degrees-of-freedom to use as a general-purpose manipulator (hence the name "limb" instead of "leg"). Our prototype ATHLETE vehicles have quick-disconnect tool adapters on the limbs that allow tools to be drawn out of a "tool belt" and maneuvered by the limb.

Impact of long-term corticosteroid therapy on the distribution pattern of lower limb atherosclerosis.

PubMed

Willenberg, T; Diehm, N; Zwahlen, M; Kalka, C; Do, D-D; Gretener, S; Ortmann, J; Baumgartner, I

2010-04-01

Ectopic calcification and mediacalcinosis can be promoted by corticosteroid use. Aim of the present investigation is to describe macrovascular disease features in patients with long-term corticosteroid therapy and symptomatic lower limb peripheral arterial occlusive disease (PAD). A consecutive series of 2783 patients undergoing clinical and angiographic work-up of PAD were screened for long-term (>5 years) corticosteroid use (group A). Comparison was performed to a randomly selected age-, sex- and risk factor-matched PAD control cohort from the same series without corticosteroid use (group B). Patients with diabetes mellitus or severe renal failure were excluded. Arterial calcification was evaluated by qualitative assessment on radiographic images. Severity of atherosclerotic lesions was analysed from angiographic images using a semi-quantitative score (Bollinger score). In general, 12 patients (5 males, mean age 78.5 +/- 9.0 years) with 15 ischaemic limbs qualified to be enrolled in group A and were compared to 23 matching control patients (6 2 males, mean age 79.5 +/- 6 years) with 32 ischaemic limbs. Incompressibility of ankle arteries determined by measurement of the ankle-brachial index was seen in 12 limbs (80%) in group A compared to 3 limbs (9%) in group B (p = 0.0009). No significant difference was found comparing group A and B for segmental calcification, whereas comparison of the atherosclerotic burden using the angiographic severity score showed a significantly higher score at the infragenicular arterial level in group A (p = 0.001). Findings suggest that the long-term corticosteroid therapy is associated with a distally accentuated, calcifying peripheral atherosclerosis inducing arterial incompressibility. This occlusion pattern is comparable to patients with renal failure or diabetes. Further research is required to support our observations.

Post-amputation pain is associated with the recall of an impaired body representation in dreams-results from a nation-wide survey on limb amputees.

PubMed

Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

2015-01-01

The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person's well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model.

Post-Amputation Pain Is Associated with the Recall of an Impaired Body Representation in Dreams—Results from a Nation-Wide Survey on Limb Amputees

PubMed Central

Bekrater-Bodmann, Robin; Schredl, Michael; Diers, Martin; Reinhard, Iris; Foell, Jens; Trojan, Jörg; Fuchs, Xaver; Flor, Herta

2015-01-01

The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person’s well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model. PMID:25742626

Movement patterns of limb coordination in infant rolling.

PubMed

Kobayashi, Yoshio; Watanabe, Hama; Taga, Gentaro

2016-12-01

Infants must perform dynamic whole-body movements to initiate rolling, a key motor skill. However, little is known regarding limb coordination and postural control in infant rolling. To address this lack of knowledge, we examined movement patterns and limb coordination during rolling in younger infants (aged 5-7 months) that had just begun to roll and in older infants (aged 8-10 months) with greater rolling experience. Due to anticipated difficulty in obtaining measurements over the second half of the rolling sequence, we limited our analysis to the first half. Ipsilateral and contralateral limbs were identified on the basis of rolling direction and were classified as either a stationary limb used for postural stability or a moving limb used for controlled movement. We classified the observed movement patterns by identifying the number of stationary limbs and the serial order of combinational limb movement patterns. Notably, older infants performed more movement patterns that involved a lower number of stationary limbs than younger infants. Despite the wide range of possible movement patterns, a small group of basic patterns dominated in both age groups. Our results suggest that the fundamental structure of limb coordination during rolling in the early acquisition stages remains unchanged until at least 8-10 months of age. However, compared to younger infants, older infants exhibited a greater ability to select an effective rotational movement by positioning themselves with fewer stationary limbs and performing faster limb movements.

Movement quality of conventional prostheses and the DEKA Arm during everyday tasks

PubMed Central

Cowley, Jeffrey; Resnik, Linda; Wilken, Jason; Walters, Lisa Smurr; Gates, Deanna

2017-01-01

Background Conventional prosthetic devices fail to restore the function and characteristic movement quality of the upper limb. The DEKA Arm is a new, advanced prosthesis featuring a compound, powered wrist and multiple grip configurations. Objectives The purpose of this study was to determine if the DEKA Arm improved the movement quality of upper limb prosthesis users compared to conventional prostheses. Study design Case series. Methods Three people with transradial amputation completed tasks of daily life with their conventional prosthesis and with the DEKA Arm. A total of 10 healthy controls completed the same tasks. The trajectory of the wrist joint center was analyzed to determine how different prostheses affected movement duration, speed, smoothness, and curvature compared to patients’ own intact limbs and controls. Results Movement quality decreased with the DEKA Arm for two participants, and increased for the third. Prosthesis users made slower, less smooth, more curved movements with the prosthetic limb compared to the intact limb and controls, particularly when grasping and manipulating objects. Conclusion The effects of one month of training with the DEKA Arm on movement quality varied with participants’ skill and experience with conventional prostheses. Future studies should examine changes in movement quality after long-term use of advanced prostheses. PMID:26932980

A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015.

PubMed

Chahine, Lama M; Amara, Amy W; Videnovic, Aleksandar

2017-10-01

Sleep disorders are among the most common non-motor manifestations in Parkinson's disease (PD) and have a significant negative impact on quality of life. While sleep disorders in PD share most characteristics with those that occur in the general population, there are several considerations specific to this patient population regarding diagnosis, management, and implications. The available research on these disorders is expanding rapidly, but many questions remain unanswered. We thus conducted a systematic review of the literature published from 2005 to 2015 on the following disorders of sleep and wakefulness in PD: REM sleep behavior disorder, insomnia, nocturia, restless legs syndrome and periodic limb movements, sleep disordered breathing, excessive daytime sleepiness, and circadian rhythm disorders. We discuss the epidemiology, etiology, clinical implications, associated features, evaluation measures, and management of these disorders. The influence on sleep of medications used in the treatment of motor and non-motor symptoms of PD is detailed. Additionally, we suggest areas in need of further research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Stance-phase force on the opposite limb dictates swing-phase afferent presynaptic inhibition during locomotion

PubMed Central

Hayes, Heather Brant; Chang, Young-Hui

2012-01-01

Presynaptic inhibition is a powerful mechanism for selectively and dynamically gating sensory inputs entering the spinal cord. We investigated how hindlimb mechanics influence presynaptic inhibition during locomotion using pioneering approaches in an in vitro spinal cord–hindlimb preparation. We recorded lumbar dorsal root potentials to measure primary afferent depolarization-mediated presynaptic inhibition and compared their dependence on hindlimb endpoint forces, motor output, and joint kinematics. We found that stance-phase force on the opposite limb, particularly at toe contact, strongly influenced the magnitude and timing of afferent presynaptic inhibition in the swinging limb. Presynaptic inhibition increased in proportion to opposite limb force, as well as locomotor frequency. This form of presynaptic inhibition binds the sensorimotor states of the two limbs, adjusting sensory inflow to the swing limb based on forces generated by the stance limb. Functionally, it may serve to adjust swing-phase sensory transmission based on locomotor task, speed, and step-to-step environmental perturbations. PMID:22442562

[Prevention of recurrent varicose veins after surgery caused by phenomenon of neovascularization].

PubMed

Kas'ian, D A; Gutsu, E V; Ivanov, V A; Kuliuk, V S; Dontsu, I I

2010-01-01

The aim of study was to evaluate the effectiveness of surgical "barrier techniques" in prevention of phenomenon of inguinal neovascularization in patients with varicose veins of lower limbs. There were 68 patients (80 limbs) treated with flush ligation of saphenofemoral junction, stripping of great saphenous vein and avulsion of varicosities. Patients were divided in three groups: I (no "barrier techniques")--40 limbs; II (anatomical barrier)--20 limbs and III (synthetic barrier)--20 limbs. Duplex ultrasound was performed at interval of 24 months postoperatively. Signs of neovascularization were found more frequently in group I--22.5% of limbs vs 7.5% of limbs in patients with utilization of "barrier techniques". There were types B1, B2a and B2b of neovascularization only, according to Fischer classification. We conclude that use of a "barrier techniques", either anatomic or synthetic, is associated with a decreased incidence of neovascularization at the level of the saphenofemoral junction compared with a control group.

[Muskuloskeletal disorders in construction industry: hospital cases].

PubMed

Santini, M; Riva, M M; Mosconi, G

2012-01-01

The authors analyse 493 hospital cases in 356 workers from the construction industry, came to observation for musculoskeletal disorders (average age 48, 2 years, SD 9; work seniority 32, 2 years, SD 9, 7; work seniority in construction industry 27, 3 years, SD 12, 4). The evaluation was required in 305 subjects (85.7% of the sample) to investigate one or more suspected WMDS; in 51 subjects (14.3% of the sample) to express an opinion on fitness to work or residual work capacity. Investigations led to diagnosis of 479 musculoskeletal disorders; the districts most affected are spine and upper limb. 64.7% of the musculoskeletal disorders was evaluated to be work-related, the percentage rises to 68% when considering only cases sent for evaluation of suspected WMDS. The most frequent reasons to exclude relation between the musculoskeletal disorders and work were an high age at diagnosis, presence of comorbidity or outcome of trauma, a disease mismatch exposure.

Upper limb function in Duchenne muscular dystrophy: 24 month longitudinal data.

PubMed

Pane, Marika; Coratti, Giorgia; Brogna, Claudia; Mazzone, Elena Stacy; Mayhew, Anna; Fanelli, Lavinia; Messina, Sonia; D'Amico, Adele; Catteruccia, Michela; Scutifero, Marianna; Frosini, Silvia; Lanzillotta, Valentina; Colia, Giulia; Cavallaro, Filippo; Rolle, Enrica; De Sanctis, Roberto; Forcina, Nicola; Petillo, Roberta; Barp, Andrea; Gardani, Alice; Pini, Antonella; Monaco, Giulia; D'Angelo, Maria Grazia; Zanin, Riccardo; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Ricci, Federica; Pegoraro, Elena; Bello, Luca; Berardinelli, Angela; Battini, Roberta; Sansone, Valeria; Albamonte, Emilio; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

2018-01-01

The aim of the study was to establish 24 month changes in upper limb function using a revised version of the performance of upper limb test (PUL 2.0) in a large cohort of ambulant and non-ambulant boys with Duchenne muscular dystrophy and to identify possible trajectories of progression. Of the 187 patients studied, 87 were ambulant (age range: 7-15.8 years), and 90 non-ambulant (age range: 9.08-24.78). The total scores changed significantly over time (p<0.001). Non-ambulant patients had lower total scores at baseline (mean 19.7) when compared to the ambulant ones (mean 38.4). They also had also a bigger decrease in total scores over 24 months compared to the ambulant boys (4.36 vs 2.07 points). Multivariate model analysis showed that the Performance of Upper Limb changes reflected the entry level and ambulation status, that were independently associated to the slope of Performance of Upper Limb changes. This information will be of help both in clinical practice and at the time of designing clinical trials.

Identification of temporal pathomechanical factors during the tennis serve.

PubMed

Martin, Caroline; Kulpa, Richard; Ropars, Mickaël; Delamarche, Paul; Bideau, Benoit

2013-11-01

The purpose of this study was twofold: (a) to measure the effects of temporal parameters on both ball velocity and upper limb joint kinetics to identify pathomechanical factors during the tennis serve and (b) to validate these pathomechanical factors by comparing injured and noninjured players. The serves of expert tennis players were recorded with an optoelectronic motion capture system. These experts were then followed during two seasons to identify overuse injuries of the upper limb. Correlation coefficients assessed the relationships between temporal parameters, ball velocity, and peaks of upper limb joint kinetics to identify pathomechanical factors. Temporal parameters and ball velocity were compared between injured and noninjured groups. Temporal pathomechanical factors were identified. The timings of peak angular velocities of pelvis longitudinal rotation, upper torso longitudinal rotation, trunk sagittal rotation, and trunk transverse rotation and the duration between instants of shoulder horizontal adduction and external rotation were significantly related to upper limb joint kinetics and ball velocity. Injured players demonstrated later timings of trunk rotations, improper differences in time between instants of shoulder horizontal adduction and external rotation, lower ball velocities, and higher joint kinetics. The findings of this study imply that improper temporal mechanics during the tennis serve can decrease ball velocity, increase upper limb joint kinetics, and thus possibly increase overuse injuries of the upper limb.

Crouch gait can be an effective form of forced-use/no constraint exercise for the paretic lower limb in stroke.

PubMed

Tesio, Luigi; Rota, Viviana; Malloggi, Chiara; Brugliera, Luigia; Catino, Luigi

2017-09-01

In hemiplegic gait the paretic lower limb provides less muscle power and shows a briefer stance compared with the unaffected limb. Yet, a longer stance and a higher power can be obtained from the paretic lower limb if gait speed is increased. This supports the existence of a 'learned non-use' phenomenon, similar to that underlying some asymmetric impairments of the motion of the eyes and of the upper limbs. Crouch gait (CG) (bent-hip bent-knee, about 30° minimum knee flexion) might be an effective form of 'forced-use' treatment of the paretic lower limb. It is not known whether it also stimulates a more symmetric muscle power output. Gait analysis on a force treadmill was carried out in 12 healthy adults and seven hemiplegic patients (1-127 months after stroke, median: 1.6). Speed was imposed at 0.3 m/s. Step length and single and double stance times, sagittal joint rotations, peak positive power, and work in extension of the hip, knee, and ankle (plantar flexion), and surface electromyography (sEMG) area from extensor muscles during the generation of power were measured on either side during both erect and crouch walking. Significance was set at P less than 0.05; corrections for multiplicity were applied. Patients, compared with healthy controls, adopted in both gait modalities and on both sides a shorter step length (61-84%) as well as a shorter stance (76-90%) and swing (63-83%) time. As a rule, they also provided a higher muscular work (median: 137%, range: 77-250%) paralleled by a greater sEMG area (median: 174%, range: 75-185%). In erect gait, the generation of peak extensor power across hip, knee, and ankle joints was in general lower (83-90%) from the paretic limb and higher (98-165%) from the unaffected limb compared with control values. In CG, peak power generation across the three lower limb joints was invariably higher in hemiparetic patients: 107-177% from the paretic limb and 114-231% from the unaffected limb. When gait shifted from erect to crouch, only for hemiplegic patients, at the hip, the paretic/unaffected ratio increased significantly. For peak power, work, sEMG area, and joint rotation, the paretic/unaffected ratio increased from 55 to 85%, 56 to 72%, 68 to 91%, and 67 to 93%, respectively. CG appears to be an effective form of forced-use exercise eliciting more power and work from the paretic lower limb muscles sustained by a greater neural drive. It also seems effective in forcing a more symmetric power and work from the hip extensor muscles, but neither from the knee nor the ankle.

Head stereotypies in STXBP1 encephalopathy.

PubMed

Kim, Young Ok; Korff, Christian M; Villaluz, Mel Michel G; Suls, Arvid; Weckhuysen, Sarah; De Jonghe, Peter; Scheffer, Ingrid E

2013-08-01

STXBP1 encephalopathy is associated with a range of movement disorders. We observed head stereotypies in three patients. These comprised a slow (<1Hz), high-amplitude, horizontal, 'figure-of-eight' pattern, beginning at age 4-6 years and resulting in neck muscle hypertrophy, in two males; a faster (2-3Hz), side-to-side, 'no' movement, starting at the age of 9 years 6 months was observed in one female. Upper limb and truncal stereotypies and vocalization occurred intermittently with the head movements. The stereotypies increased with excitement but settled with concentration and sleep. Head and upper limb stereotypies are valuable clinical clues to the diagnosis of STXBP1 encephalopathy in patients with profound impairments. © 2013 Mac Keith Press.

Imaging features of macrodystrophia lipomatosa: an unusual cause of a brawny arm.

PubMed

Dhanasekaran, Jagadeesan; Reddy, Ajit Kumar; Sarawagi, Radha; Lakshmanan, Prakash Manikka

2014-11-18

Macrodystrophia lipomatosa (MDL), a rare non-hereditary congenital disorder of localised gigantism, is characterised by progressive proliferation of all mesenchymal elements, with a disproportionate increase in fibroadipose tissue. We report a case of a 19-year-old man who presented with a history of painless enlargement of the left upper limb since childhood, which was gradually increasing in size and predominantly involving the radial aspect of the upper limb with relative sparing of the ulnar aspect. The patient was imaged with X-ray and MRI. Imaging and clinical features were classical of MDL. The patient underwent stage 1 reduction plasty of the left forearm; preoperative and histopathological findings confirmed the preoperative diagnosis. 2014 BMJ Publishing Group Ltd.

Anatomical Network Comparison of Human Upper and Lower, Newborn and Adult, and Normal and Abnormal Limbs, with Notes on Development, Pathology and Limb Serial Homology vs. Homoplasy

PubMed Central

Diogo, Rui; Esteve-Altava, Borja; Smith, Christopher; Boughner, Julia C.; Rasskin-Gutman, Diego

2015-01-01

How do the various anatomical parts (modules) of the animal body evolve into very different integrated forms (integration) yet still function properly without decreasing the individual’s survival? This long-standing question remains unanswered for multiple reasons, including lack of consensus about conceptual definitions and approaches, as well as a reasonable bias toward the study of hard tissues over soft tissues. A major difficulty concerns the non-trivial technical hurdles of addressing this problem, specifically the lack of quantitative tools to quantify and compare variation across multiple disparate anatomical parts and tissue types. In this paper we apply for the first time a powerful new quantitative tool, Anatomical Network Analysis (AnNA), to examine and compare in detail the musculoskeletal modularity and integration of normal and abnormal human upper and lower limbs. In contrast to other morphological methods, the strength of AnNA is that it allows efficient and direct empirical comparisons among body parts with even vastly different architectures (e.g. upper and lower limbs) and diverse or complex tissue composition (e.g. bones, cartilages and muscles), by quantifying the spatial organization of these parts—their topological patterns relative to each other—using tools borrowed from network theory. Our results reveal similarities between the skeletal networks of the normal newborn/adult upper limb vs. lower limb, with exception to the shoulder vs. pelvis. However, when muscles are included, the overall musculoskeletal network organization of the upper limb is strikingly different from that of the lower limb, particularly that of the more proximal structures of each limb. Importantly, the obtained data provide further evidence to be added to the vast amount of paleontological, gross anatomical, developmental, molecular and embryological data recently obtained that contradicts the long-standing dogma that the upper and lower limbs are serial homologues. In addition, the AnNA of the limbs of a trisomy 18 human fetus strongly supports Pere Alberch's ill-named "logic of monsters" hypothesis, and contradicts the commonly accepted idea that birth defects often lead to lower integration (i.e. more parcellation) of anatomical structures. PMID:26452269

Anatomical Network Comparison of Human Upper and Lower, Newborn and Adult, and Normal and Abnormal Limbs, with Notes on Development, Pathology and Limb Serial Homology vs. Homoplasy.

PubMed

Diogo, Rui; Esteve-Altava, Borja; Smith, Christopher; Boughner, Julia C; Rasskin-Gutman, Diego

2015-01-01

How do the various anatomical parts (modules) of the animal body evolve into very different integrated forms (integration) yet still function properly without decreasing the individual's survival? This long-standing question remains unanswered for multiple reasons, including lack of consensus about conceptual definitions and approaches, as well as a reasonable bias toward the study of hard tissues over soft tissues. A major difficulty concerns the non-trivial technical hurdles of addressing this problem, specifically the lack of quantitative tools to quantify and compare variation across multiple disparate anatomical parts and tissue types. In this paper we apply for the first time a powerful new quantitative tool, Anatomical Network Analysis (AnNA), to examine and compare in detail the musculoskeletal modularity and integration of normal and abnormal human upper and lower limbs. In contrast to other morphological methods, the strength of AnNA is that it allows efficient and direct empirical comparisons among body parts with even vastly different architectures (e.g. upper and lower limbs) and diverse or complex tissue composition (e.g. bones, cartilages and muscles), by quantifying the spatial organization of these parts-their topological patterns relative to each other-using tools borrowed from network theory. Our results reveal similarities between the skeletal networks of the normal newborn/adult upper limb vs. lower limb, with exception to the shoulder vs. pelvis. However, when muscles are included, the overall musculoskeletal network organization of the upper limb is strikingly different from that of the lower limb, particularly that of the more proximal structures of each limb. Importantly, the obtained data provide further evidence to be added to the vast amount of paleontological, gross anatomical, developmental, molecular and embryological data recently obtained that contradicts the long-standing dogma that the upper and lower limbs are serial homologues. In addition, the AnNA of the limbs of a trisomy 18 human fetus strongly supports Pere Alberch's ill-named "logic of monsters" hypothesis, and contradicts the commonly accepted idea that birth defects often lead to lower integration (i.e. more parcellation) of anatomical structures.

Gene Expression Profiling in Limb-Girdle Muscular Dystrophy 2A

PubMed Central

Sáenz, Amets; Azpitarte, Margarita; Armañanzas, Rubén; Leturcq, France; Alzualde, Ainhoa; Inza, Iñaki; García-Bragado, Federico; De la Herran, Gaspar; Corcuera, Julián; Cabello, Ana; Navarro, Carmen; De la Torre, Carolina; Gallardo, Eduard; Illa, Isabel; de Munain, Adolfo López

2008-01-01

Limb-girdle muscular dystrophy type 2A (LGMD2A) is a recessive genetic disorder caused by mutations in calpain 3 (CAPN3). Calpain 3 plays different roles in muscular cells, but little is known about its functions or in vivo substrates. The aim of this study was to identify the genes showing an altered expression in LGMD2A patients and the possible pathways they are implicated in. Ten muscle samples from LGMD2A patients with in which molecular diagnosis was ascertained were investigated using array technology to analyze gene expression profiling as compared to ten normal muscle samples. Upregulated genes were mostly those related to extracellular matrix (different collagens), cell adhesion (fibronectin), muscle development (myosins and melusin) and signal transduction. It is therefore suggested that different proteins located or participating in the costameric region are implicated in processes regulated by calpain 3 during skeletal muscle development. Genes participating in the ubiquitin proteasome degradation pathway were found to be deregulated in LGMD2A patients, suggesting that regulation of this pathway may be under the control of calpain 3 activity. As frizzled-related protein (FRZB) is upregulated in LGMD2A muscle samples, it could be hypothesized that β-catenin regulation is also altered at the Wnt signaling pathway, leading to an incorrect myogenesis. Conversely, expression of most transcription factor genes was downregulated (MYC, FOS and EGR1). Finally, the upregulation of IL-32 and immunoglobulin genes may induce the eosinophil chemoattraction explaining the inflammatory findings observed in presymptomatic stages. The obtained results try to shed some light on identification of novel therapeutic targets for limb-girdle muscular dystrophies. PMID:19015733

A systematic review: the influence of real time feedback on wheelchair propulsion biomechanics.

PubMed

Symonds, Andrew; Barbareschi, Giulia; Taylor, Stephen; Holloway, Catherine

2018-01-01

Clinical guidelines recommend that, in order to minimize upper limb injury risk, wheelchair users adopt a semi-circular pattern with a slow cadence and a large push arc. To examine whether real time feedback can be used to influence manual wheelchair propulsion biomechanics. Clinical trials and case series comparing the use of real time feedback against no feedback were included. A general review was performed and methodological quality assessed by two independent practitioners using the Downs and Black checklist. The review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Six papers met the inclusion criteria. Selected studies involved 123 participants and analysed the effect of visual and, in one case, haptic feedback. Across the studies it was shown that participants were able to achieve significant changes in propulsion biomechanics, when provided with real time feedback. However, the effect of targeting a single propulsion variable might lead to unwanted alterations in other parameters. Methodological assessment identified weaknesses in external validity. Visual feedback could be used to consistently increase push arc and decrease push rate, and may be the best focus for feedback training. Further investigation is required to assess such intervention during outdoor propulsion. Implications for Rehabilitation Upper limb pain and injuries are common secondary disorders that negatively affect wheelchair users' physical activity and quality of life. Clinical guidelines suggest that manual wheelchair users should aim to propel with a semi-circular pattern with low a push rate and large push arc in the range in order to minimise upper limbs' loading. Real time visual and haptic feedback are effective tools for improving propulsion biomechanics in both complete novices and experienced manual wheelchair users.

A noncoding expansion in EIF4A3 causes Richieri-Costa-Pereira syndrome, a craniofacial disorder associated with limb defects.

PubMed

Favaro, Francine P; Alvizi, Lucas; Zechi-Ceide, Roseli M; Bertola, Debora; Felix, Temis M; de Souza, Josiane; Raskin, Salmo; Twigg, Stephen R F; Weiner, Andrea M J; Armas, Pablo; Margarit, Ezequiel; Calcaterra, Nora B; Andersen, Gregers R; McGowan, Simon J; Wilkie, Andrew O M; Richieri-Costa, Antonio; de Almeida, Maria L G; Passos-Bueno, Maria Rita

2014-01-02

Richieri-Costa-Pereira syndrome is an autosomal-recessive acrofacial dysostosis characterized by mandibular median cleft associated with other craniofacial anomalies and severe limb defects. Learning and language disabilities are also prevalent. We mapped the mutated gene to a 122 kb region at 17q25.3 through identity-by-descent analysis in 17 genealogies. Sequencing strategies identified an expansion of a region with several repeats of 18- or 20-nucleotide motifs in the 5' untranslated region (5' UTR) of EIF4A3, which contained from 14 to 16 repeats in the affected individuals and from 3 to 12 repeats in 520 healthy individuals. A missense substitution of a highly conserved residue likely to affect the interaction of eIF4AIII with the UPF3B subunit of the exon junction complex in trans with an expanded allele was found in an unrelated individual with an atypical presentation, thus expanding mutational mechanisms and phenotypic diversity of RCPS. EIF4A3 transcript abundance was reduced in both white blood cells and mesenchymal cells of RCPS-affected individuals as compared to controls. Notably, targeting the orthologous eif4a3 in zebrafish led to underdevelopment of several craniofacial cartilage and bone structures, in agreement with the craniofacial alterations seen in RCPS. Our data thus suggest that RCPS is caused by mutations in EIF4A3 and show that EIF4A3, a gene involved in RNA metabolism, plays a role in mandible, laryngeal, and limb morphogenesis. Copyright © 2014 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Identification of a Recurrent Microdeletion at 17q23.1q23.2 Flanked by Segmental Duplications Associated with Heart Defects and Limb Abnormalities

PubMed Central

Ballif, Blake C.; Theisen, Aaron; Rosenfeld, Jill A.; Traylor, Ryan N.; Gastier-Foster, Julie; Thrush, Devon Lamb; Astbury, Caroline; Bartholomew, Dennis; McBride, Kim L.; Pyatt, Robert E.; Shane, Kate; Smith, Wendy E.; Banks, Valerie; Gallentine, William B.; Brock, Pamela; Rudd, M. Katharine; Adam, Margaret P.; Keene, Julia A.; Phillips, John A.; Pfotenhauer, Jean P.; Gowans, Gordon C.; Stankiewicz, Pawel; Bejjani, Bassem A.; Shaffer, Lisa G.

2010-01-01

Segmental duplications, which comprise ∼5%–10% of the human genome, are known to mediate medically relevant deletions, duplications, and inversions through nonallelic homologous recombination (NAHR) and have been suggested to be hot spots in chromosome evolution and human genomic instability. We report seven individuals with microdeletions at 17q23.1q23.2, identified by microarray-based comparative genomic hybridization (aCGH). Six of the seven deletions are ∼2.2 Mb in size and flanked by large segmental duplications of >98% sequence identity and in the same orientation. One of the deletions is ∼2.8 Mb in size and is flanked on the distal side by a segmental duplication, whereas the proximal breakpoint falls between segmental duplications. These characteristics suggest that NAHR mediated six out of seven of these rearrangements. These individuals have common features, including mild to moderate developmental delay (particularly speech delay), microcephaly, postnatal growth retardation, heart defects, and hand, foot, and limb abnormalities. Although all individuals had at least mild dysmorphic facial features, there was no characteristic constellation of features that would elicit clinical suspicion of a specific disorder. The identification of common clinical features suggests that microdeletions at 17q23.1q23.2 constitute a novel syndrome. Furthermore, the inclusion in the minimal deletion region of TBX2 and TBX4, transcription factors belonging to a family of genes implicated in a variety of developmental pathways including those of heart and limb, suggests that these genes may play an important role in the phenotype of this emerging syndrome. PMID:20206336

Upper extremity prosthesis user perspectives on unmet needs and innovative technology.

PubMed

Benz, Heather L; Jia Yao; Rose, Laura; Olgac, Okan; Kreutz, Karen; Saha, Anindita; Civillico, Eugene F

2016-08-01

The needs of individuals with upper limb amputation and congenital limb difference are not being fully met by current prostheses, as evidenced by prosthesis rejection, non-wear, and user reports of pain and challenging activities. Emerging technologies such as dexterous sensorized robotic limbs, osseointegrated prostheses, implantable EMG electrodes, and electrical stimulation for sensory feedback have the potential to address unmet needs, but pose additional risks. We plan to assess upper limb prosthesis user needs and perspectives on these new benefits and risks using an extensive quantitative survey. In preparation for this survey, we report here on qualitative interviews with seven individuals with upper limb amputation or congenital limb difference. Unstructured text was mined using topic modeling and the results compared with identified themes. A more complete understanding of how novel technologies could address real user concerns will inform implementation of new technologies and regulatory decision-making.

Upper Extremity Prosthesis User Perspectives on Unmet Needs and Innovative Technology

PubMed Central

Benz, Heather L.; Yao, Jia; Rose, Laura; Olgac, Okan; Kreutz, Karen; Saha, Anindita; Civillico, Eugene F.

2017-01-01

The needs of individuals with upper limb amputation and congenital limb difference are not being fully met by current prostheses, as evidenced by prosthesis rejection, non-wear, and user reports of pain and challenging activities. Emerging technologies such as dexterous sensorized robotic limbs, osseointegrated prostheses, implantable EMG electrodes, and electrical stimulation for sensory feedback have the potential to address unmet needs, but pose additional risks. We plan to assess upper limb prosthesis user needs and perspectives on these new benefits and risks using an extensive quantitative survey. In preparation for this survey, we report here on qualitative interviews with seven individuals with upper limb amputation or congenital limb difference. Unstructured text was mined using topic modeling and the results compared with identified themes. A more complete understanding of how novel technologies could address real user concerns will inform implementation of new technologies and regulatory decision-making. PMID:28268333

Use of Machine Learning to Identify Children with Autism and Their Motor Abnormalities

ERIC Educational Resources Information Center

Crippa, Alessandro; Salvatore, Christian; Perego, Paolo; Forti, Sara; Nobile, Maria; Molteni, Massimo; Castiglioni, Isabella

2015-01-01

In the present work, we have undertaken a proof-of-concept study to determine whether a simple upper-limb movement could be useful to accurately classify low-functioning children with autism spectrum disorder (ASD) aged 2-4. To answer this question, we developed a supervised machine-learning method to correctly discriminate 15 preschool children…

Teaching with Twitter: Not for the Faint of Heart

ERIC Educational Resources Information Center

Young, Jeffrey R.

2010-01-01

Asking 250 students to post questions on Twitter during a class doesn't risk life or limb. But it can cause ego damage if students get disorderly online. Opening up a Twitter-powered channel in class--which professors at other universities are experimenting with as well--alters classroom power dynamics and signals to students that they're in…

Assessing the Role of Dopamine in Limb and Cranial-Oromotor Control in a Rat Model of Parkinson's Disease

ERIC Educational Resources Information Center

Kane, Jacqueline R.; Ciucci, Michelle R.; Jacobs, Amber N.; Tews, Nathan; Russell, John A.; Ahrens, Allison M.; Ma, Sean T.; Britt, Joshua M.; Cormack, Lawrence K.; Schallert, Timothy

2011-01-01

Parkinson's disease (PD) is a neurodegenerative disorder primarily characterized by sensorimotor dysfunction. The neuropathology of PD includes a loss of dopamine (DA) neurons of the nigrostriatal pathway. Classic signs of the disease include rigidity, bradykinesia, and postural instability. However, as many as 90% of patients also experience…

An Update on the Conceptual-Production Systems Model of Apraxia: Evidence from Stroke

ERIC Educational Resources Information Center

Stamenova, Vessela; Black, Sandra E.; Roy, Eric A.

2012-01-01

Limb apraxia is a neurological disorder characterized by an inability to pantomime and/or imitate gestures. It is more commonly observed after left hemisphere damage (LHD), but has also been reported after right hemisphere damage (RHD). The Conceptual-Production Systems model (Roy, 1996) suggests that three systems are involved in the control of…

Multiscale entropy analysis of electroencephalography during sleep in patients with Parkinson disease.

PubMed

Chung, Chen-Chih; Kang, Jiunn-Horng; Yuan, Rey-Yue; Wu, Dean; Chen, Chih-Chung; Chi, Nai-Fang; Chen, Po-Chih; Hu, Chaur-Jong

2013-07-01

Sleep disorders are frequently seen in patients with Parkinson disease (PD), including rapid eye movement (REM) behavior disorder and periodic limb movement disorder. However, knowledge about changes in non-REM sleep in patients with PD is limited. This study explored the characteristics of electroencephalography (EEG) during sleep in patients with PD and non-PD controls. We further conducted multiscale entropy (MSE) analysis to evaluate and compare the complexity of sleep EEG for the 2 groups. There were 9 patients with PD (Hoehn-Yahr stage 1 or 2) and 11 non-PD controls. All participants underwent standard whole-night polysomnography (PSG), which included 23 channels, 6 of which were for EEG. The raw data of the EEG were extracted and subjected to MSE analysis. Patients with PD had a longer sleep onset time and a higher spontaneous EEG arousal index. Sleep stage-specific increased MSE was observed in patients with PD during non-REM sleep. The difference was more marked and significant at higher time scale factors (TSFs). In conclusion, increased biosignal complexity, as revealed by MSE analysis, was found in patients with PD during non-REM sleep at high TSFs. This finding might reflect a compensatory mechanism for early defects in neuronal network control machinery in PD.

Alterations in white matter volume and its correlation with clinical characteristics in patients with generalized anxiety disorder.

PubMed

Moon, Chung-Man; Jeong, Gwang-Woo

2015-11-01

Only a few morphological studies have focused on changes in white matter (WM) volume in patients with generalized anxiety disorder (GAD). We evaluated alterations in WM volume and its correlation with symptom severity and duration of illness in adults with GAD. The 44 subjects were comprised of 22 patients with GAD (13 males and nine females) diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and 22 age-matched healthy controls (13 males and nine females). High-resolution magnetic resonance imaging (MRI) data were processed by voxel-based morphometry (VBM) analysis based on diffeomorphic anatomical registration using the exponentiated Lie algebra (DARTEL) algorithm in SPM8. Patients with GAD showed significantly reduced WM volume, particularly in the dorsolateral prefrontal cortex (DLPFC), anterior limb of the internal capsule (ALIC), and midbrain. In addition, DLPFC volume was negatively correlated with GAD-7 score and illness duration. ALIC volume was negatively correlated with GAD-7 score. Female patients had significantly less orbitofrontal cortex volume compared to that in male patients. The findings demonstrate localized changes in WM volume associated with cognitive and emotional dysfunction in patients with GAD. The finding will be helpful for understanding the neuropathology in patients with GAD.

Electrical stimulation of acupoint combinations against deep venous thrombosis in elderly bedridden patients after major surgery.

PubMed

Hou, Lili; Chen, Cuiping; Xu, Lei; Yin, Peihao; Peng, Wen

2013-04-01

To compare the effects of electrical stimulation of different acupoint combinations among postoperative bedridden elderly patients on hemorheology and deep venous blood flow velocity and investigate the.role of electrical stimulation against deep vein thrombosis (DVT). From November 2010 to October 2011, a total of 160 elderly bedridden patients after major surgery were divided into the conventional care group, invigorating and promoting Qi group, blood-activating and damp-eliminating group, and acupoint-combination stimulation group. Whole blood viscosity, plasma viscosity, D-dimer levels, lower limb skin temperature, lower limb circumference, and flow velocities of the external iliac vein, femoral vein, popliteal vein, and deep calf veins in all patients were documented and compared among the four groups. Whole blood viscosity, plasma viscosity, D-dimer levels, and lower limb circumference were significantly reduced in the blood-activating and damp-eliminating group compared with the conventional care group (P < 0.05) and were almost equal to those in the acupoint-combination stimulation group (P > 0.05). Lower limb venous flow velocities were accelerated in the invigorating and promoting Qi group compared with the other groups, excluding the acupoint-combination stimulation group (P < 0.05). Hemorheological indices in postoperative bedridden elderly patients were improved after combined electrical stimulation at Yinlingquan (SP 9) and Sanyinjiao (SP 6). Combined electrical stimulation at Zusanli (ST 36) and Taichong (LR 3), on the other hand, accelerated lower limb venous flow.

The Roberts syndrome/SC phocomelia spectrum--a case report of an adult with review of the literature.

PubMed

Goh, Elaine Suk-Ying; Li, Chumei; Horsburgh, Sheri; Kasai, Yumi; Kolomietz, Elena; Morel, Chantal France

2010-02-01

Roberts syndrome (RBS) (OMIM #268300) is a rare autosomal recessive disorder characterized by tetraphocomelia (symmetrical limb reduction), craniofacial anomalies, growth retardation, mental retardation, cardiac and renal abnormalities. The syndrome is caused by mutations in the ESCO2 (establishment of cohesion 1 homolog 2) (Entrez 609353) gene, which is located at 8p21.1, and encodes a protein essential in establishing sister chromatid cohesion during S phase. SC phocomelia (SC) (OMIM #269000), has less severe symmetric limb reduction, flexion contractures of various joints, minor facial anomalies, growth retardation and occasionally, mental retardation. These two syndromes can be considered part of a spectrum, with RBS at the most severe range in which severely affected infants may be stillborn or die in the post-natal period, while individuals with SC phocomelia represent the milder end of the spectrum and typically survive to adulthood. In both presentations, karyotype investigations characteristically reveal premature centromere separation (PCS), otherwise known as heterochromatin repulsion or puffing. There is little literature about the follow-up of adults with the spectrum of RBS/SC phocomelia or their recommended management. We report on an adult presentation of RBS/SC phocomelia spectrum disorder with a history of major cardiac malformation in childhood, normal limbs on physical examination, mild facial anomalies, mild learning difficulties, and PCS. Molecular studies of ESCO2 have confirmed the diagnosis. A literature review, focussing on adult manifestations of this condition and a discussion of follow-up guidelines are presented. Copyright 2010 Wiley-Liss, Inc.

Force Plate Gait Analysis in Doberman Pinschers with and without Cervical Spondylomyelopathy

PubMed Central

Foss, K.; da Costa, R.C.; Rajala-Shultz, P.J.; Allen, M.J.

2014-01-01

Background The most accepted means of evaluating the response of a patient with cervical spondylomyelopathy (CSM) to treatment is subjective and based on the owner and clinician's perception of the gait. Objective To establish and compare kinetic parameters based on force plate gait analysis between normal and CSM-affected Dobermans. Animals Nineteen Doberman Pinschers: 10 clinically normal and 9 with CSM. Methods Force plate analysis was prospectively performed in all dogs. At least 4 runs of ipsilateral limbs were collected from each dog. Eight force platform parameters were evaluated, including peak vertical force (PVF) and peak vertical impulse (PVI), peak mediolateral force (PMLF) and peak mediolateral impulse, peak braking force and peak braking impulse, and peak propulsive force (PPF) and peak propulsive impulse. In addition, the coefficient of variation (CV) for each limb was calculated for each parameter. Data analysis was performed by a repeated measures approach. Results PMLF (P = .0062), PVI (P = .0225), and PPF (P = .0408) were found to be lower in CSM-affected dogs compared with normal dogs. Analysis by CV as the outcome indicated more variability in PVF in CSM-affected dogs (P = 0.0045). The largest difference in the CV of PVF was seen in the thoracic limbs of affected dogs when compared with the thoracic limbs of normal dogs (P = 0.0019). Conclusions and Clinical Importance The CV of PVF in all 4 limbs, especially the thoracic limbs, distinguished clinically normal Dobermans from those with CSM. Other kinetic parameters less reliably distinguished CSM-affected from clinically normal Dobermans. PMID:23278957

A Comparison of Angular Values of the Pelvic Limb with Normal and Medial Patellar Luxation Stifles in Chihuahua Dogs Using Radiography and Computed Tomography.

PubMed

Phetkaew, Thitaporn; Kalpravidh, Marissak; Penchome, Rampaipat; Wangdee, Chalika

2018-02-01

 This article aimed to determine and compare the angular values of the pelvic limb in normal and medial patellar luxation (MPL) stifles in Chihuahuas using radiography and computed tomographic (CT) scan, to identify the relationship between pelvic limb angles and severity of MPL. In addition, radiographic and CT images were compared to determine the more suitable method of limb deformity assessment.  Sixty hindlimbs of Chihuahuas were divided into normal and grade 1, 2, 3 and 4 MPL groups. The pelvic limb angles in frontal and sagittal planes were evaluated on radiography and CT scan. Femoral and tibial torsion angles (FTA and TTA) were evaluated only by CT scan. All angles were compared among normal and MPL stifles and between radiography and CT scan.  Based on the CT scan, the mechanical lateral distal femoral angle (mLDFA), anatomical caudal proximal femoral angle (aCdPFA), and TTA were related to the severity of MPL. The mLDFA and TTA were significantly increased ( p  < 0.05) in grade 4 MPL, while the aCdPFA was significantly decreased in grade 2, 3 and 4 MPL groups. There were significant differences of many angles between radiography and CT scan.  The angles related to MPL in Chihuahuas are aLDFA, mLDFA, aCdPFA and TTA. Radiography had some limitations for evaluating pelvic limb angles. The caudocranial radiograph is recommended for the assessment of the distal femoral angles, while the craniocaudal radiograph is for the tibial angles. Schattauer GmbH Stuttgart.

Kinematic adaptations to tripedal locomotion in dogs.

PubMed

Goldner, B; Fuchs, A; Nolte, I; Schilling, N

2015-05-01

Limb amputation often represents the only treatment option for canine patients with certain diseases or injuries of the appendicular system. Previous studies have investigated adaptations to tripedal locomotion in dogs but there is a lack of understanding of biomechanical compensatory mechanisms. This study evaluated the kinematic differences between quadrupedal and tripedal locomotion in nine healthy dogs running on a treadmill. The loss of the right pelvic limb was simulated using an Ehmer sling. Kinematic gait analysis included spatio-temporal comparisons of limb, joint and segment angles of the remaining pelvic and both thoracic limbs. The following key parameters were compared between quadrupedal and tripedal conditions: angles at touch-down and lift-off, minimum and maximum joint angles, plus range of motion. Significant differences in angular excursion were identified in several joints of each limb during both stance and swing phases. The most pronounced differences concerned the remaining pelvic limb, followed by the contralateral thoracic limb and, to a lesser degree, the ipsilateral thoracic limb. The thoracic limbs were, in general, more retracted, consistent with pelvic limb unloading and previous observations of bodyweight re-distribution in amputees. Proximal limb segments showed more distinct changes than distal ones. Particularly, the persistently greater anteversion of the pelvis probably affects the axial system. Overall, tripedal locomotion requires concerted kinematic adjustments of both the appendicular and axial systems, and consequently preventive, therapeutic and rehabilitative care of canine amputees should involve the whole musculoskeletal apparatus. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reliability of lower limb alignment measures using an established landmark-based method with a customized computer software program

PubMed Central

Sled, Elizabeth A.; Sheehy, Lisa M.; Felson, David T.; Costigan, Patrick A.; Lam, Miu; Cooke, T. Derek V.

2010-01-01

The objective of the study was to evaluate the reliability of frontal plane lower limb alignment measures using a landmark-based method by (1) comparing inter- and intra-reader reliability between measurements of alignment obtained manually with those using a computer program, and (2) determining inter- and intra-reader reliability of computer-assisted alignment measures from full-limb radiographs. An established method for measuring alignment was used, involving selection of 10 femoral and tibial bone landmarks. 1) To compare manual and computer methods, we used digital images and matching paper copies of five alignment patterns simulating healthy and malaligned limbs drawn using AutoCAD. Seven readers were trained in each system. Paper copies were measured manually and repeat measurements were performed daily for 3 days, followed by a similar routine with the digital images using the computer. 2) To examine the reliability of computer-assisted measures from full-limb radiographs, 100 images (200 limbs) were selected as a random sample from 1,500 full-limb digital radiographs which were part of the Multicenter Osteoarthritis (MOST) Study. Three trained readers used the software program to measure alignment twice from the batch of 100 images, with two or more weeks between batch handling. Manual and computer measures of alignment showed excellent agreement (intraclass correlations [ICCs] 0.977 – 0.999 for computer analysis; 0.820 – 0.995 for manual measures). The computer program applied to full-limb radiographs produced alignment measurements with high inter- and intra-reader reliability (ICCs 0.839 – 0.998). In conclusion, alignment measures using a bone landmark-based approach and a computer program were highly reliable between multiple readers. PMID:19882339

Resisted side-stepping: the effect of posture on hip abductor muscle activation

PubMed Central

Berry, Justin W.; Lee, Theresa S.; Foley, Hanna D.; Lewis, Cara L.

2016-01-01

Study Design Controlled laboratory study, repeated-measures design. Objectives To compare hip abductor muscle activity and hip and knee joint kinematics in the moving limb to the stance limb during resisted side-stepping and also to determine if muscle activity was affected by the posture (upright standing versus squat) used to perform the exercise. Background Hip abductor weakness has been associated with a variety of lower extremity injuries. Resisted side-stepping is often used as an exercise to increase strength and endurance of the hip abductors. Exercise prescription would benefit from knowing the relative muscle activity level generated in each limb and for different postures during the side-stepping exercise. Methods Twenty-four healthy adults participated in this study. Kinematics and surface electromyographic (EMG) data from the gluteus maximus, gluteus medius, and tensor fascia lata (TFL) were collected as participants performed side-stepping with a resistive band around the ankle while maintaining each of 2 postures: 1) upright standing and 2) squat. Results Mean normalized EMG signal amplitude of the gluteus maximus, gluteus medius, and TFL was higher in the stance limb than the moving limb (P≤.001). Gluteal muscle activity was higher, while TFL muscle activity was lower, in the squat posture compared to the upright standing posture (P<.001). Hip abduction excursion was greater in the stance limb than in the moving limb (P<.001). Conclusions The 3 hip abductor muscles respond differently to the posture variations of side-stepping exercise in healthy individuals. When prescribing resisted side-stepping exercises, therapists should consider the differences in hip abductor activation across limbs and variations in trunk posture. PMID:26161629

Functional anatomy and muscle moment arms of the thoracic limb of an elite sprinting athlete: the racing greyhound (Canis familiaris)

PubMed Central

Williams, S B; Wilson, A M; Daynes, J; Peckham, K; Payne, R C

2008-01-01

We provide quantitative muscle–tendon architecture and geometry data for the racing greyhound thoracic limb. Muscle mass, belly length, fascicle lengths, pennation angles and moment arms were measured, as were tendon masses and lengths. Maximum isometric force and maximum power were estimated for muscles, and maximum stress and strain were estimated for tendons. Results are compared with other fast quadrupedal runners, and to previously published data in mixed-breed dogs. The implications of the functional adaptations of the greyhound thoracic limb for sprinting performance are discussed. The thoracic limb was found to benefit from a similar proportion of locomotor muscle mass to the pelvic limb, suggesting that it may be used to some extent in propulsion, or alternatively that stabilisation is very important in this animal. Extrinsic muscles, especially latissimus dorsi and pectoralis profundus, were predicted to be powerful and important for generating net positive work during accelerations. Proximal biarticular muscles show specialisation toward preventing collapse of the shoulder and elbow joints to enable strut-like limb function, or some form of dynamic control. Distal muscles did not appear specialised for elastic energy storage, a functional difference to pelvic limb muscles, and the equivalents in horse thoracic limbs. The greyhound thoracic limb appears to possess substantial differences from both that of more ‘sub-maximal specialist’ quadrupeds, and from the greyhound pelvic limb. PMID:19034998

Functional anatomy and muscle moment arms of the thoracic limb of an elite sprinting athlete: the racing greyhound (Canis familiaris).

PubMed

Williams, S B; Wilson, A M; Daynes, J; Peckham, K; Payne, R C

2008-10-01

We provide quantitative muscle-tendon architecture and geometry data for the racing greyhound thoracic limb. Muscle mass, belly length, fascicle lengths, pennation angles and moment arms were measured, as were tendon masses and lengths. Maximum isometric force and maximum power were estimated for muscles, and maximum stress and strain were estimated for tendons. Results are compared with other fast quadrupedal runners, and to previously published data in mixed-breed dogs. The implications of the functional adaptations of the greyhound thoracic limb for sprinting performance are discussed. The thoracic limb was found to benefit from a similar proportion of locomotor muscle mass to the pelvic limb, suggesting that it may be used to some extent in propulsion, or alternatively that stabilisation is very important in this animal. Extrinsic muscles, especially latissimus dorsi and pectoralis profundus, were predicted to be powerful and important for generating net positive work during accelerations. Proximal biarticular muscles show specialisation toward preventing collapse of the shoulder and elbow joints to enable strut-like limb function, or some form of dynamic control. Distal muscles did not appear specialised for elastic energy storage, a functional difference to pelvic limb muscles, and the equivalents in horse thoracic limbs. The greyhound thoracic limb appears to possess substantial differences from both that of more 'sub-maximal specialist' quadrupeds, and from the greyhound pelvic limb.

Transcriptomic insights into the genetic basis of mammalian limb diversity.

PubMed

Maier, Jennifer A; Rivas-Astroza, Marcelo; Deng, Jenny; Dowling, Anna; Oboikovitz, Paige; Cao, Xiaoyi; Behringer, Richard R; Cretekos, Chris J; Rasweiler, John J; Zhong, Sheng; Sears, Karen E

2017-03-23

From bat wings to whale flippers, limb diversification has been crucial to the evolutionary success of mammals. We performed the first transcriptome-wide study of limb development in multiple species to explore the hypothesis that mammalian limb diversification has proceeded through the differential expression of conserved shared genes, rather than by major changes to limb patterning. Specifically, we investigated the manner in which the expression of shared genes has evolved within and among mammalian species. We assembled and compared transcriptomes of bat, mouse, opossum, and pig fore- and hind limbs at the ridge, bud, and paddle stages of development. Results suggest that gene expression patterns exhibit larger variation among species during later than earlier stages of limb development, while within species results are more mixed. Consistent with the former, results also suggest that genes expressed at later developmental stages tend to have a younger evolutionary age than genes expressed at earlier stages. A suite of key limb-patterning genes was identified as being differentially expressed among the homologous limbs of all species. However, only a small subset of shared genes is differentially expressed in the fore- and hind limbs of all examined species. Similarly, a small subset of shared genes is differentially expressed within the fore- and hind limb of a single species and among the forelimbs of different species. Taken together, results of this study do not support the existence of a phylotypic period of limb development ending at chondrogenesis, but do support the hypothesis that the hierarchical nature of development translates into increasing variation among species as development progresses.

Comparison of lower limb muscle activation with ballet movements (releve and demi-plie) and general movements (heel rise and squat) in healthy adults.

PubMed

Kim, Min-Ju; Kim, Joong-Hwi

2016-01-01

[Purpose] The aim of this study was to demonstrate therapeutic grounds for rehabilitation exercise approach by comparing and analyzing muscular activities of Ballet movements: the releve movement (RM) and the demi-plie movement (DM). [Methods] Four types of movements such as RM vs. heel rise (HM) and DM vs. squat movement (SM) were randomized and applied in 30 healthy male and female individuals while measuring 10-s lower limb muscular activities (gluteus maximus [GMa], gluteus medius [GMe], rectus femoris [RF], adductor longus [AL], medial gastrocnemius [MG], and lateral gastrocnemius [LG]) by using surface electromyography (EMG). [Results] Significant differences were found in GMa, GMe, AL and MG activities for DM and in all of the six muscles for RM, in particular when the two groups were compared (RM vs HM and DM vs SM). [Conclusion] The RM and DM have a greater effect on lower limb muscular force activities compared to HM and SM and could be recommended as clinical therapeutic exercises for lower limb muscle enhancement.

Comparison of lower limb muscle activation with ballet movements (releve and demi-plie) and general movements (heel rise and squat) in healthy adults

PubMed Central

Kim, Min-Ju; Kim, Joong-Hwi

2016-01-01

[Purpose] The aim of this study was to demonstrate therapeutic grounds for rehabilitation exercise approach by comparing and analyzing muscular activities of Ballet movements: the releve movement (RM) and the demi-plie movement (DM). [Methods] Four types of movements such as RM vs. heel rise (HM) and DM vs. squat movement (SM) were randomized and applied in 30 healthy male and female individuals while measuring 10-s lower limb muscular activities (gluteus maximus [GMa], gluteus medius [GMe], rectus femoris [RF], adductor longus [AL], medial gastrocnemius [MG], and lateral gastrocnemius [LG]) by using surface electromyography (EMG). [Results] Significant differences were found in GMa, GMe, AL and MG activities for DM and in all of the six muscles for RM, in particular when the two groups were compared (RM vs HM and DM vs SM). [Conclusion] The RM and DM have a greater effect on lower limb muscular force activities compared to HM and SM and could be recommended as clinical therapeutic exercises for lower limb muscle enhancement. PMID:26957762

Timed activity performance in persons with upper limb amputation: A preliminary study.

PubMed

Resnik, Linda; Borgia, Mathew; Acluche, Frantzy

55 subjects with upper limb amputation were administered the T-MAP twice within one week. To develop a timed measure of activity performance for persons with upper limb amputation (T-MAP); examine the measure's internal consistency, test-retest reliability and validity; and compare scores by prosthesis use. Measures of activity performance for persons with upper limb amputation are needed The time required to perform daily activities is a meaningful metric that implication for participation in life roles. Internal consistency and test-retest reliability were evaluated. Construct validity was examined by comparing scores by amputation level. Exploratory analyses compared sub-group scores, and examined correlations with other measures. Scale alpha was 0.77, ICC was 0.93. Timed scores differed by amputation level. Subjects using a prosthesis took longer to perform all tasks. T-MAP was not correlated with other measures of dexterity or activity, but was correlated with pain for non-prosthesis users. The timed scale had adequate internal consistency and excellent test-retest reliability. Analyses support reliability and construct validity of the T-MAP. 2c "outcomes" research. Published by Elsevier Inc.

Detection of genes regulated by Lmx1b during limb dorsalization.

PubMed

Feenstra, Jennifer M; Kanaya, Kohei; Pira, Charmaine U; Hoffman, Sarah E; Eppey, Richard J; Oberg, Kerby C

2012-05-01

Lmx1b is a homeodomain transcription factor that regulates dorsal identity during limb development. Lmx1b knockout (KO) mice develop distal ventral-ventral limbs. Although induction of Lmx1b is linked to Wnt7a expression in the dorsal limb ectoderm, the downstream targets of Lmx1b that accomplish limb dorsalization are unknown. To identify genes targeted by Lmx1b, we compared gene arrays from Lmx1b KO and wild type mouse limbs during limb dorsalization, i.e., 11.5, 12.5, and 13.5 days post coitum. We identified 54 target genes that were differentially expressed in all three stages. Several skeletal targets, including Emx2, Matrilin1 and Matrilin4, demonstrated a loss of scapular expression in the Lmx1b KO mice, supporting a role for Lmx1b in scapula development. Furthermore, the relative abundance of extracellular matrix-related soft tissue targets regulated by Lmx1b, such as collagens and proteoglycans, suggests a mechanism that includes changes in the extracellular matrix composition to accomplish limb dorsalization. Our study provides the most comprehensive characterization of genes regulated by Lmx1b during limb development to-date and provides targets for further investigation. © 2012 The Authors. Development, Growth & Differentiation © 2012 Japanese Society of Developmental Biologists.

Bilateral electromyogram response latency following platform perturbation in unilateral transtibial prosthesis users: influence of weight distribution and limb position.

PubMed

Rusaw, David; Hagberg, Kerstin; Nolan, Lee; Ramstrand, Nerrolyn

2013-01-01

Appropriate muscular response following an external perturbation is essential in preventing falls. Transtibial prosthesis users lack a foot-ankle complex and associated sensorimotor structures on the side with the prosthesis. The effect of this lack on rapid responses of the lower limb to external surface perturbations is unknown. The aim of the present study was to compare electromyogram (EMG) response latencies of otherwise healthy, unilateral, transtibial prosthesis users (n = 23, mean +/- standard deviation [SD] age = 48 +/- 14 yr) and a matched control group (n = 23, mean +/- SD age = 48 +/- 13 yr) following sudden support-surface rotations in the pitch plane (toes-up and toes-down). Perturbations were elicited in various weight-bearing and limb-perturbed conditions. The results indicated that transtibial prosthesis users have delayed responses of multiple muscles of the lower limb following perturbation, both in the intact and residual limbs. Weight-bearing had no influence on the response latency in the residual limb, but did on the intact limb. Which limb received the perturbation was found to influence the muscular response, with the intact limb showing a significantly delayed response when the perturbation was received only on the side with a prosthesis. These delayed responses may represent an increased risk of falling for individuals who use transtibial prostheses.

Periodic limb movements during sleep in stroke/TIA: Prevalence, course, and cardiovascular burden.

PubMed

Manconi, Mauro; Fanfulla, Francesco; Ferri, Raffaele; Miano, Silvia; Haba-Rubio, Josè; Heinzer, Raphael; Horvath, Thomas; Proserpio, Paola; Young, Peter; Moschovitis, Giorgio; Seiler, Andrea; Cereda, Carlo; Nobili, Lino; Wiest, Roland; Ott, Sebastian R; Bassetti, Claudio L

2018-05-08

To define the prevalence, time course, and associated factors of periodic limb movements during sleep (PLMS) in patients with ischemic stroke or TIA. Patients enrolled in the prospective Sleep-Disordered Breathing in Transient Ischemia Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy (SAS-CARE) study underwent a double polysomnographic investigation in the acute and chronic phases after stroke/TIA, together with a MRI brain scan and a 24-hour blood pressure evaluation. The prevalence of PLMS in patients was compared with that in a matched sample of randomly selected healthy controls from the HypnoLaus cohort. One hundred sixty-nine recordings were performed in the acute phase and 191 after 3 months (210 recordings were obtained from the same 105 patients in both phases) and were compared to those of 162 controls. The mean number of PLMS per hour and the percentage of participants with a PLMS index >10 and >15 per hour were similar between patients and controls. PLMS remained stable from the acute to the chronic phase after stroke. Factors positively associated with PLMS were age, body mass index, and history of hypertension. Blood pressure over 24 hours and the burden of cerebrovascular damage were similar between the groups with PLMS and without PLMS. PLMS are equally frequent in patients with stroke/TIA and the general population. The absence of higher blood pressure values and of a greater vascular brain damage found in patients with PLMS compared to those without PLMS might be due to a greater use of antihypertensive medication among patients with PLMS, which corresponds to a higher prevalence of previous diagnosis of hypertension in these patients. © 2018 American Academy of Neurology.

Complex Regional Pain Syndrome Type I Affects Brain Structure in Prefrontal and Motor Cortex

PubMed Central

Pleger, Burkhard; Draganski, Bogdan; Schwenkreis, Peter; Lenz, Melanie; Nicolas, Volkmar; Maier, Christoph; Tegenthoff, Martin

2014-01-01

The complex regional pain syndrome (CRPS) is a rare but debilitating pain disorder that mostly occurs after injuries to the upper limb. A number of studies indicated altered brain function in CRPS, whereas possible influences on brain structure remain poorly investigated. We acquired structural magnetic resonance imaging data from CRPS type I patients and applied voxel-by-voxel statistics to compare white and gray matter brain segments of CRPS patients with matched controls. Patients and controls were statistically compared in two different ways: First, we applied a 2-sample ttest to compare whole brain white and gray matter structure between patients and controls. Second, we aimed to assess structural alterations specifically of the primary somatosensory (S1) and motor cortex (M1) contralateral to the CRPS affected side. To this end, MRI scans of patients with left-sided CRPS (and matched controls) were horizontally flipped before preprocessing and region-of-interest-based group comparison. The unpaired ttest of the “non-flipped” data revealed that CRPS patients presented increased gray matter density in the dorsomedial prefrontal cortex. The same test applied to the “flipped” data showed further increases in gray matter density, not in the S1, but in the M1 contralateral to the CRPS-affected limb which were inversely related to decreased white matter density of the internal capsule within the ipsilateral brain hemisphere. The gray-white matter interaction between motor cortex and internal capsule suggests compensatory mechanisms within the central motor system possibly due to motor dysfunction. Altered gray matter structure in dorsomedial prefrontal cortex may occur in response to emotional processes such as pain-related suffering or elevated analgesic top-down control. PMID:24416397

The Effect of Prosthetic Socket Interface Design on Socket Comfort, Residual Limb Health, and Function for the Transfemoral Amputee

DTIC Science & Technology

2017-10-01

significantly lower trim lines, without ischial containment compared with a traditional interface. However, these alternative designs could compromise...overall function compared to the standard of care interface design . Therefore the focus of this clinical trial is to determine if the DS and Sub-I...alternative interface designs will improve socket comfort, residual limb health and function compared to the standard of care IRC interface design . 15

Back and neck pain disability and upper limb symptoms of home healthcare workers: A case-control study from Northern Italy.

PubMed

Riccò, Matteo; Pezzetti, Federica; Signorelli, Carlo

2017-03-30

Work-related musculoskeletal disorders (MSD) are quite frequent in healthcare workers (HCWs), but data about MSD in home-based healthcare workers (HHWs) are lacking. In this study we describe the prevalence of MSD among Italian HHWs. A case-control study was carried out among 300 random-selected female HCWs, the sample comprising 100 HHWs, 100 HCWs with a low exposure to patient handling (MAPO - Movimentazione e Assistenza Pazienti Ospedalizzati - Movement and Assistance of Hospital Patients index 0-5) and 100 HCWs with high exposure to patient handling (MAPO index ≥ 5.01). As a negative control group, 200 visual display unit workers were also randomly selected. Musculoskeletal disorder cases were collected using a standardized case definition. A multivariate logistic regression analysis was performed comparing the MSD prevalence in the 4 groups. The overall prevalence of MSD was 17% in the reference group and 28.3% for HCWs. HHWs and HCWs with MAPO index ≥ 5.01 had similar prevalence of neck pain (9% and 11%, respectively), whereas lumbosacral pain prevalence was higher in the HHWs group (31%), with similar results in residential HCWs groups (21% in MAPO index 0-5 group and 25% in MAPO index ≥ 5.01 group). HCWs of group MAPO index ≥ 5.01 and HHWs showed the higher prevalence of upper limb complaints, with a prevalence of 20% and 10%, respectively. In multivariate regression analysis, prevalence of MSD complaints was quite similar in HHWs (adjusted odds ratio (OR_adj) = 2.335, 95% confidence interval (CI): 1.318-4.138) and in HCWs of the group MAPO ≥ 5.01 (OR_adj = 2.729, 95% CI: 1.552-4.797). The prevalence of MSD in the examined HCWs was relatively high, with HHWs appearing as a particularly high-risk group for lumbosacral back pain. In higher exposed HCWs, upper-limb symptoms were particularly frequent, probably reflecting the different tasks required to manage residential and homebased patients. In conclusion, this study reaffirms the high prevalence of MSD in HHWs, seemly similar to high-risk residential groups. Int J Occup Med Environ Health 2017;30(2):291-304. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Fibromyalgia syndrome: considerations for dental hygienists.

PubMed

Walters, Amber; Tolle, Susan L; McCombs, Gayle M

2015-04-01

Fibromyalgia syndrome (FMS) is a neurosensory disorder characterized by widespread musculoskeletal pain. Typically persistent fatigue, depression, limb stiffness, non-refreshing sleep and cognitive deficiencies are also experienced. Oral symptoms and pain are common, requiring adaptations in patient management strategies and treatment interventions. Appropriate dental hygiene care of patients suffering with this disorder is contingent upon an understanding of disease epidemiology, pathophysiology, clinical characteristics, oral signs and symptoms, as well as treatment approaches. With this information dental hygienists will be better prepared to provide appropriate and effective treatment to patients with FMS. Copyright © 2015 The American Dental Hygienists’ Association.

Treatment with acetazolamide of brain-stem and spinal paroxysmal disturbances in multiple sclerosis.

PubMed Central

Voiculescu, V; Pruskauer-Apostol, B; Alecu, C

1975-01-01

Nine cases of multiple sclerosis with paroxysmal disorders were treated with acetazolamide. In most cases a brain-stem origin of the seizures was suggested by their particular pattern: crossed syndromes (facial spasm associated with contralateral weakness of the arm and leg, paroxysmal paraesthesiae in one side of the face and weakness of the contralateral leg), paroxysmal dysarthria, and ataxia. One patient with a Brown-Sequard syndrome complained of paroxysmal paraesthesiae in the lower limbs, for which a spinal origin was admitted. In all patients the paroxysmal disorders were promptly suppressed or markedly reduced by acetazolamide. PMID:1151400

[Contemporary approach to evaluation of sensory disorders in polyneuropathy due to vibration].

PubMed

Nepershina, C P; Lagutina, G N; Kuzmina, L P; Skrypnik, O V; Ryabininal, S N; Lagutina, A P

2016-08-01

Recently, the studies search possibilities to visualize and objectify sensory disorders in polyneuropathy caused by vibration. Special attention is paid on studies of injuried structures responsible for temperature and pain sensitivity. Examination covered 92 patients with vibration disease, aged 34 to 73 years. Methods used are: pallesthesiometry, quantitative sensory tests, questionnaires and s 'cales of pain (visual analog scale (VAS) of pain, Pain-Detect, MPQ DN-, HADS). Correlation was found between.temperature, pain thresholds and VAS and pallesthesiometry parameters. The obtained results analysis indicates formation distal polyneuropathy syndrome of upper limbs with concomitant pain during vibration disease.

Customization of biliopancreatic limb length to modulate and sustain antidiabetic effect of gastric bypass surgery.

PubMed

Pal, A; Rhoads, D B; Tavakkoli, A

2018-02-01

Although Roux-en-Y Gastric Bypass (RYGB) remains the most effective treatment for obesity and type 2 diabetes (T2D), many patients fail to achieve remission, or relapse. Increasing intestinal limb lengths of RYGB may improve outcomes, but the mechanistic basis for this remains unclear. We hypothesize biliopancreatic (BP) limb length modulates the antidiabetic effect of RYGB. Rats underwent RYGB with a 20-cm (RYGB-20cm) or 40-cm (RYGB-40cm) BP limb and were compared with control animals. After 2 and 4 wk, portal and systemic blood was sampled during intestinal glucose infusion. Portosystemic gradient was used to calculate intestinal glucose utilization (G util ), absorption (G absorp ), and hormone secretion. Intestinal morphology and gene expression were assessed. At 2 wk, G absorp progressively decreased with increasing BP limb length; this pattern persisted at 4 wk. G util increased ≈70% in both RYGB-20cm and -40cm groups at 2 wk. At 4 wk, G util progressively increased with limb length. Furthermore, Roux limb weight, and expression of hexokinase and preproglucagon, exhibited a similar progressive increase. At 4 wk, glucagon-like peptide-1 and -2 levels were higher after RYGB-40cm, with associated increased secretion. We conclude that BP limb length modulates multiple antidiabetic mechanisms, analogous to the dose-response relationship of a drug. Early postoperatively, a longer BP limb reduces G absorp . Later, G util , Roux limb hypertrophy, hormone secretion, and hormone levels are increased with longer BP limb. Sustained high incretin levels may prevent weight regain and T2D relapse. These data provide the basis for customizing BP limb length according to patient characteristics and desired metabolic effect. NEW & NOTEWORTHY Biliopancreatic limb length in gastric bypass modulates multiple antidiabetic mechanisms, analogous to the dose-response relationship of a drug. With a longer biliopancreatic limb, Roux limb hypertrophy, increased glucose utilization, reduced glucose absorption, and sustained high incretin levels may prevent weight regain and diabetes relapse.

A comparison of hemisphere-specific training pattern in Inter-limb Learning Transfer (ILT) for stroke patients with hemiparesis.

PubMed

Yoo, In-gyu; Jung, Min-ye; Yoo, Eun-young; Park, Ji-hyuk; Kang, Dae-hyuk; Lee, Jin

2014-01-01

Stroke patients have major problems with impaired upper-extremity function. Unfortunately, many patients do not experience a full recovery from movement deficits in the upper extremities. The purpose of this study was to compare the effectiveness of inter-limb learning transfer (ILT) to the contralateral upper limb after both hemisphere-specific and -unspecific ipsilateral upper limb training for stroke patients with hemiparesis. Twenty-four stroke patients with hemiparesis participated. The hemisphere-specific training group performed reaching movements in a customized training setting in which non-dominant limb training participants began from a single starting location and proceeded to one of three target locations (1S3T condition); the dominant limb training participants started from one of three starting locations and proceeded to a single target location (3S1T condition). The hemisphere-unspecific training group performed these movements starting under reverse-start and target conditions. The non-dominant to dominant limb transfer, the hemisphere-specific training group performance time decreased significantly as compared with the pre-training session (p < 0.05). Also, the isolation contraction ratio was decreased significantly from that of the pre-training session in the biceps brachii muscles and increased significantly in the upper trapezius muscles (p < 0.05). And, dominant to non-dominant limb transfer in the hemisphere-specific training group significantly increased RMS amplitudes from the pre-training session in the biceps brachii and triceps muscles (p < 0.05). Also, the isolation contraction ratio was increased significantly from that of the pre-training session in the biceps brachii muscles and decreased significantly in the upper trapezius muscles (p < 0.05). However, the hemisphere-unspecific training group showed no significant differences in inter-limb learning transfer (ILT). The transfer of hemisphere-specific training from one arm to the other had a more positive influence on functional recovery than did hemisphere-unspecific training for patients with stroke and hemiparesis.

Epidemiologic data of trauma-related lower limb amputees: A single center 10-year experience.

PubMed

Yaşar, Evren; Tok, Fatih; Kesikburun, Serdar; Ada, A Mustafa; Kelle, Bayram; Göktepe, A Salim; Yazıcıoğlu, Kamil; Tan, A Kenan

2017-02-01

The aim of this study is three fold: 1) to introduce epidemiologic data of patients with trauma-related amputations as a 10-year experience of a rehabitation center; 2) to determine comorbidities and secondary conditions of lower limb loss; 3) to determine the rehospitalization reasons for lower limb amputee patients. This retrospective study was conducted in a tertiary rehabilitation center in Turkey. Clinical and demographic data of amputees including sex, age, employment status, time since amputation, time after amputation to first hospitalization, length of hospitalization, how many times the patient was hospitalized, reason for hospitalization, stump complications, comorbid conditions, amputation level and K classifacation were documented. Three hundred ninetynine patients with a mean age of 23,48±6,04 (4-74) years were included in this study. Mean duration after amputation was 119,71±68,86months. Patients were 3,43±2,53 times hospitalized. Landmine explosion was the most common etiology of amputation with 370 patients (92.7%). Below knee amputation was the most common amputation level with 230 (50,77%) amputations. 399 patients were hospitalized 1369 times and the most common hospitalization reason were stump complications (356 times, 26,00%). Spur formation (202 times) was the most common stump complications. Pyscologic disorders were the most common comorbidity with 68 patient (37,56%). Patients with traumatic limb amputations are likely to experience several complications and comorbidities. Prevention of secondary conditions affecting those living with the loss of a limb is an important part of amputee rehabilitation and may prevent rehospitalization. Copyright © 2016 Elsevier Ltd. All rights reserved.

A case of boomerang dysplasia with a novel causative mutation in filamin B: identification of typical imaging findings on ultrasonography and 3D-CT imaging.

PubMed

Tsutsumi, Seiji; Maekawa, Ayako; Obata, Miyuki; Morgan, Timothy; Robertson, Stephen P; Kurachi, Hirohisa

2012-01-01

Boomerang dysplasia is a rare lethal osteochondrodysplasia characterized by disorganized mineralization of the skeleton, leading to complete nonossification of some limb bones and vertebral elements, and a boomerang-like aspect to some of the long tubular bones. Like many short-limbed skeletal dysplasias with accompanying thoracic hypoplasia, the potential lethality of the phenotype can be difficult to ascertain prenatally. We report a case of boomerang dysplasia prenatally diagnosed by use of ultrasonography and 3D-CT imaging, and identified a novel mutation in the gene encoding the cytoskeletal protein filamin B (FLNB) postmortem. Findings that aided the radiological diagnosis of this condition in utero included absent ossification of two out of three long bones in each limb and elements of the vertebrae and a boomerang-like shape to the ulnae. The identified mutation is the third described for this disorder and is predicted to lead to amino acid substitution in the actin-binding domain of the filamin B molecule. Copyright © 2012 S. Karger AG, Basel.

Alterations in knee kinematics after partial medial meniscectomy are activity dependent.

PubMed

Edd, Shannon N; Netravali, Nathan A; Favre, Julien; Giori, Nicholas J; Andriacchi, Thomas P

2015-06-01

Alterations in knee kinematics after partial meniscectomy have been linked to the increased risk of osteoarthritis in this population. Understanding differences in kinematics during static versus dynamic activities of increased demand can provide important information regarding the possible underlying mechanisms of these alterations. Differences in the following 2 kinematics measures will increase with activity demand: (1) the offset toward external tibial rotation for the meniscectomized limb compared with the contralateral limb during stance and (2) the difference in knee flexion angle at initial foot contact between the meniscectomized and contralateral limbs. Controlled laboratory study. This study compared side-to-side differences in knee flexion and rotation angles during static and dynamic activities. Thirteen patients (2 female) were tested in a motion capture laboratory at 6 ± 2 months after unilateral, arthroscopic, partial medial meniscectomy during a static reference pose and during 3 dynamic activities: walking, stair ascent, and stair descent. The meniscectomized limb demonstrated more external tibial rotation compared with the contralateral limb during dynamic activities, and there was a trend that this offset increased with activity demand (repeated-measures analysis of variance [ANOVA] for activity, P = .07; mean limb difference: static pose, -0.1° ± 3.3°, P = .5; walking, 1.2° ± 3.8°, P = .1; stair ascent, 2.0° ± 3.2°, P = .02; stair descent, 3.0° ± 3.5°, P = .005). Similarly, the meniscectomized knee was more flexed at initial contact than the contralateral limb during dynamic activities (repeated-measures ANOVA for activity P = .006; mean limb difference: reference pose, 1.0° ± 2.5°, P = .09; walking, 2.0° ± 3.9°, P = .05; stair ascent, 5.9° ± 5.3°, P = .009; stair descent, 3.5° ± 4.0°, P = .004). These results suggest both a structural element and a potential muscular element for the differences in kinematics after partial medial meniscectomy and highlight the importance of challenging the knee with activities of increased demands to detect differences in kinematics from the contralateral limb. With further investigation, these findings could help guide clinical rehabilitation of patients with torn meniscus tissue, especially in the context of the patients' increased risk of joint degeneration. © 2015 The Author(s).

Recovery of decreased bone mineral mass after lower-limb fractures in adolescents.

PubMed

Ceroni, Dimitri; Martin, Xavier E; Delhumeau, Cécile; Farpour-Lambert, Nathalie J; De Coulon, Geraldo; Dubois-Ferrière, Victor; Rizzoli, René

2013-06-05

Loss of bone mineral mass, muscle atrophy, and functional limitations are predictable consequences of immobilization and subsequent weight-bearing restriction due to leg or ankle fractures. The aim of this study was to prospectively determine whether decreased bone mineral mass following lower-limb fractures recovers at follow-up durations of six and eighteen months in adolescents. In the present study, we included fifty adolescents who underwent cast immobilization for a leg or ankle fracture. Dual x-ray absorptiometry scans of four different sites (total hip, femoral neck, entire lower limb, and calcaneus) were performed at the time of the fracture, at cast removal, and at follow-ups of six and eighteen months. Patients with fractures were paired with healthy controls according to sex, age, and ethnicity. Dual x-ray absorptiometry values were compared between groups and between injured and non-injured legs in adolescents with fractures. Among those with fractures, lower-limb bone mineral variables were significantly lower at the injured side compared with the non-injured side at cast removal, with differences ranging from 6.2% to 31.7% (p < 0.0001). Similarly, injured adolescents had significantly lower bone mineral values at the level of the injured lower limb compared with healthy controls (p < 0.0001). At the six-month follow-up, there were still significant residual differences between injured and non-injured legs in adolescents with fractures (p < 0.0001). However, a significant residual difference between healthy controls and injured adolescents was present only for femoral neck bone mineral density (p = 0.011). At the eighteen-month follow-up, no significant difference was observed at any lower-limb site. Bone mineral loss following a fracture of the lower limb in adolescents is highly significant and affects the lower limb both proximal to and distal to the fracture site. In contrast to observations in adults, a rapid bone mass reversal occurs with full bone recovery by eighteen months. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

The body electric: a long view of electrical therapy for functional neurological disorders.

PubMed

McWhirter, Laura; Carson, Alan; Stone, Jon

2015-04-01

The use of electricity in medical treatment has always been technology-driven, rather than aetiology-driven; as new techniques have appeared, clinicians have quickly looked to try them in the treatment of all sorts of conditions where existing treatment options are limited. Functional disorders--as identified anachronistically in our analysis--have been key contenders for emerging electrical treatments: with Leyden jars, with galvanic and electromagnetic machines, and more recently with TMS and TENS. Parallels can be drawn with the history of electrical treatments for migraine and headache (Koehler and Boes, 2010). Regardless of the mode of delivery of electricity, stimulating a limb to produce movement has repeatedly been found to aid and assist recovery in functional motor disorders. This may also be true of non-electrical methods: we have found benefits using both therapeutic sedation and explanatory demonstration of a positive Hoover's sign as therapeutic methods of demonstrating normal movement in functionally weak limbs (Stone et al., 2014). Each surge in enthusiasm for new electrical treatments has been followed by questions about the nature of the disorder and validity of the treatment response. Physicians have tended to attribute therapeutic success initially to powerful biological or even metaphysical effects, but with time and experience these explanations have been replaced by views that the treatment works through suggestion and placebo. Discomfort with these conclusions has in the past discouraged ongoing development of electrical treatments, even if the end result for patients has been encouraging. In Edwards's Bayesian model, functional motor and sensory symptoms are hypothesized to arise when 'pathologically precise prior beliefs' mediated by attentional processes cause experience of symptoms via a hierarchy of false inferences (Edwards, 2012). It can be argued that use of TMS or peripheral stimulation to produce movement of a functionally weak limb has the specific potential to modulate pathological expectations. To reject these treatments as no more than placebo may mean missing an unusual opportunity to manipulate key elements in the mechanism of the disorder. However, changes to these 'priors' may also be dependent upon patient expectations, and as we see through history, this may only happen if the patient believes there is an actual neuromodulatory effect. This may give rise to significant ethical issues in that the treatment may well directly benefit patients but only if they are (mis)informed that there is an underlying biological rationale. We conclude that modern trials of TMS in functional disorders are part of a repeating cycle of experimentation recurring since the mid-18th century. We suspect that emerging technology, including transcranial direct current stimulation, will follow a similar pattern of experimentation, speculation and marginalization. We suggest that considering our modern efforts in a historical context could aid our ability to further expand and maintain our use of electrical therapies that have proven helpful in the past for patients with functional disorders.

Graft type for femoro-popliteal bypass surgery.

PubMed

Ambler, Graeme K; Twine, Christopher P

2018-02-11

Femoro-popliteal bypass is implemented to save limbs that might otherwise require amputation, in patients with ischaemic rest pain or tissue loss; and to improve walking distance in patients with severe life-limiting claudication. Contemporary practice involves grafts using autologous vein, polytetrafluoroethylene (PTFE) or Dacron as a bypass conduit. This is the second update of a Cochrane review first published in 1999 and last updated in 2010. To assess the effects of bypass graft type in the treatment of stenosis or occlusion of the femoro-popliteal arterial segment, for above- and below-knee femoro-popliteal bypass grafts. For this update, the Cochrane Vascular Information Specialist searched the Vascular Specialised Register (13 March 2017) and CENTRAL (2017, Issue 2). Trial registries were also searched. We included randomised trials comparing at least two different types of femoro-popliteal grafts for arterial reconstruction in patients with femoro-popliteal ischaemia. Randomised controlled trials comparing bypass grafting to angioplasty or to other interventions were not included. Both review authors (GKA and CPT) independently screened studies, extracted data, assessed trials for risk of bias and graded the quality of the evidence using GRADE criteria. We included nineteen randomised controlled trials, with a total of 3123 patients (2547 above-knee, 576 below-knee bypass surgery). In total, nine graft types were compared (autologous vein, polytetrafluoroethylene (PTFE) with and without vein cuff, human umbilical vein (HUV), polyurethane (PUR), Dacron and heparin bonded Dacron (HBD); FUSION BIOLINE and Dacron with external support). Studies differed in which graft types they compared and follow-up ranged from six months to 10 years.Above-knee bypassFor above-knee bypass, there was moderate-quality evidence that autologous vein grafts improve primary patency compared to prosthetic grafts by 60 months (Peto odds ratio (OR) 0.47, 95% confidence interval (CI) 0.28 to 0.80; 3 studies, 269 limbs; P = 0.005). We found low-quality evidence to suggest that this benefit translated to improved secondary patency by 60 months (Peto OR 0.41, 95% CI 0.22 to 0.74; 2 studies, 176 limbs; P = 0.003).We found no clear difference between Dacron and PTFE graft types for primary patency by 60 months (Peto OR 1.67, 95% CI 0.96 to 2.90; 2 studies, 247 limbs; low-quality evidence). We found low-quality evidence that Dacron grafts improved secondary patency over PTFE by 24 months (Peto OR 1.54, 95% CI 1.04 to 2.28; 2 studies, 528 limbs; P = 0.03), an effect which continued to 60 months in the single trial reporting this timepoint (Peto OR 2.43, 95% CI 1.31 to 4.53; 167 limbs; P = 0.005).Externally supported prosthetic grafts had inferior primary patency at 24 months when compared to unsupported prosthetic grafts (Peto OR 2.08, 95% CI 1.29 to 3.35; 2 studies, 270 limbs; P = 0.003). Secondary patency was similarly affected in the single trial reporting this outcome (Peto OR 2.25, 95% CI 1.24 to 4.07; 236 limbs; P = 0.008). No data were available for 60 months follow-up.HUV showed benefits in primary patency over PTFE at 24 months (Peto OR 4.80, 95% CI 1.76 to 13.06; 82 limbs; P = 0.002). This benefit was still seen at 60 months (Peto OR 3.75, 95% CI 1.46 to 9.62; 69 limbs; P = 0.006), but this was only compared in one trial. Results were similar for secondary patency at 24 months (Peto OR 4.01, 95% CI 1.44 to 11.17; 93 limbs) and at 60 months (Peto OR 3.87, 95% CI 1.65 to 9.05; 93 limbs).We found HBD to be superior to PTFE for primary patency at 60 months for above-knee bypass, but these results were based on a single trial (Peto OR 0.38, 95% CI 0.20 to 0.72; 146 limbs; very low-quality evidence). There was no difference in primary patency between HBD and HUV for above-knee bypass in the one small study which reported this outcome.We found only one small trial studying PUR and it showed very poor primary and secondary patency rates which were inferior to Dacron at all time points.Below-knee bypassFor bypass below the knee, we found no graft type to be superior to any other in terms of primary patency, though one trial showed improved secondary patency of HUV over PTFE at all time points to 24 months (Peto OR 3.40, 95% CI 1.45 to 7.97; 88 limbs; P = 0.005).One study compared PTFE alone to PTFE with vein cuff; very low-quality evidence indicates no effect to either primary or secondary patency at 24 months (Peto OR 1.08, 95% CI 0.58 to 2.01; 182 limbs; 2 studies; P = 0.80 and Peto OR 1.22, 95% CI 0.67 to 2.23; 181 limbs; 2 studies; P = 0.51 respectively)Limited data were available for limb survival, and those studies reporting on this outcome showed no clear difference between graft types for this outcome. Antiplatelet and anticoagulant protocols varied extensively between trials, and in some cases within trials.The overall quality of the evidence ranged from very low to moderate. Issues which affected the quality of the evidence included differences in the design of the trials, and differences in the types of grafts they compared. These differences meant we were often only able to combine and analyse small numbers of participants and this resulted in uncertainty over the true effects of the graft type used. There was moderate-quality evidence of improved long-term (60 months) primary patency for autologous vein grafts when compared to prosthetic materials for above-knee bypasses. In the long term (two to five years) there was low-quality evidence that Dacron confers a small secondary patency benefit over PTFE for above-knee bypass. Only very low-quality data exist on below-knee bypasses, so we are uncertain which graft type is best. Further randomised data are needed to ascertain whether this information translates into an improvement in limb survival.

Upper limb joint muscle/tendon injury and anthropometric adaptations in French competitive tennis players.

PubMed

Rogowski, Isabelle; Creveaux, Thomas; Genevois, Cyril; Klouche, Shahnaz; Rahme, Michel; Hardy, Philippe

2016-01-01

The purpose of this study was to examine the relationship between the upper limb anthropometric dimensions and a history of dominant upper limb injury in tennis players. Dominant and non-dominant wrist, forearm, elbow and arm circumferences, along with a history of dominant upper limb injuries, were assessed in 147 male and female players, assigned to four groups based on location of injury: wrist (n = 9), elbow (n = 25), shoulder (n = 14) and healthy players (n = 99). From anthropometric dimensions, bilateral differences in circumferences and in proportions were calculated. The wrist group presented a significant bilateral difference in arm circumference, and asymmetrical bilateral proportions between wrist and forearm, as well as between elbow and arm, compared to the healthy group (6.6 ± 3.1% vs. 4.9 ± 4.0%, P < 0.01; -3.6 ± 3.0% vs. -0.9 ± 2.9%, P < 0.05; and -2.2 ± 2.2% vs. 0.1 ± 3.4%, P < 0.05, respectively). The elbow group displayed asymmetrical bilateral proportions between forearm and arm compared to the healthy group (-0.4 ± 4.3% vs. 1.5 ± 4.0%, P < 0.01). The shoulder group showed significant bilateral difference in elbow circumference, and asymmetrical bilateral proportions between forearm and elbow when compared to the healthy group (5.8 ± 4.7% vs. 3.1 ± 4.8%, P < 0.05 and -1.7 ± 4.5% vs. 1.4 ± 4.3%, P < 0.01, respectively). These findings suggest that players with a history of injury at the upper limb joint present altered dominant upper limb proportions in comparison with the non-dominant side, and such asymmetrical proportions would appear to be specific to the location of injury. Further studies are needed to confirm the link between location of tennis injury and asymmetry in upper limb proportions using high-tech measurements in symptomatic tennis players.

A three-dimensional electronic report of a venous echo color Doppler of the lower limbs: MEVeC®

PubMed Central

Galeandro, Aldo Innocente; Scicchitano, Pietro; Zito, Annapaola; Galeandro, Cristina; Gesualdo, Michele; Ciciarello, Francesco; Cecere, Annagrazia; Marzullo, Andrea; Contursi, Vincenzo; Annicchiarico, Annamaria; Ciccone, Marco Matteo

2014-01-01

Background The reports of ultrasound evaluation of lower limb veins are difficult to understand by general practitioners (GPs) and physicians who are not specialized. We developed software for a three-dimensional (3D) electronic report of venous hemodynamic mapping (MEVeC®) in order to represent lower limb venous vasculature in a 3D way. The aim of the study is to compare the novel 3D report with the standard report. Methods Thirty subjects (medical students and GPs) evaluated a standard report and a novel 3D report of the lower limb veins of a prespecified patient. The cases were randomly and blindly taken from an archive of 100 cases. GPs and students answered a questionnaire made up of 13 questions that were structured in order to investigate the readability and comprehension of the two reports. A score ranging from 0 to 10 (0= not understandable; 10= full comprehension) was attributed to each report for each question according to the readability of the venous scheme proposed. Results The scores from each question of the questionnaire were compared. The 3D report (MEVeC®) obtained higher scores than those from the evaluation of the standard report (P<0.0001). Each question revealed the superiority of the 3D report (MEVeC®) as compared with the standard report of the ultrasound evaluation of lower limbs. When dividing the scores according to percentiles, the 3D report (MEVeC®) still continued to show more readability than the standard report in a statistically significant way (P<0.0001). Conclusion The new 3D report (MEVeC®) concerning ultrasound evaluation of lower limb veins is more reproducible than the standard report when evaluated by medical physicians not specialized in the evaluation of the vein tree of lower limbs. PMID:25214793

Evaluation of rotator cuff muscle strength in healthy individuals

PubMed Central

Cortez, Paulo José Oliveira; Tomazini, José Elias

2015-01-01

OBJECTIVE: To compare the strength generated by the rotator muscles of the shoulder joint between the right upper limb and left upper limb among healthy individuals. METHODS: To evaluate the muscle strength of upper limbs from isometric contractions in the horizontal direction (rotation) an isometric dynamometer was used, equipped with transducers, signal conditioning, a data acquisition board, and finally, a computer. Study participants were 22 male military subjects, aged between 18 and 19 years old, body mass between 57.7 and 93.0 kg (71.8 ± 9.45 kg) and height between 1.67 and 1.90 m (1.75 ± 0.06 m), healthy and without clinical diseases or any type of orthopedic injury in the muscle skeletal system. RESULTS: The internal rotation in the right upper limb (RUL) was higher than the average strength of internal rotation in the left upper limb (LUL) (p = 0.723). The external rotation strength in RUL was lower than the average strength of external rotation in the LUL (p=0.788). No statistical difference was observed by comparing the strength values of all isometric strength tests. CONCLUSION: For the sample and methodology used to assess muscle strength, there was no statistical difference between the strength generated by the muscles of the rotator cuff of the right and left upper limbs. Experimental Study. PMID:26207091

On VI /lambda equals 1032 A/ profiles in and above an active region prominence, compared to quiet sun center and limb profiles

NASA Astrophysics Data System (ADS)

Vial, J. C.; Lemaire, P.; Artzner, G.; Gouttebroze, P.

1980-11-01

O VI (λ = 1032 Å) profiles have been measured in and above a filament at the limb, previously analyzed in H I, Mg II, Ca II resonance lines (Vial et al., 1979). They are compared to profiles measured at the quiet Sun center and at the quiet Sun limb. Absolute intensities are found to be about 1.55 times larger than above the quiet limb at the same height (3"); at the top of the prominence (15" above the limb) one finds a maximum blue shift and a minimum line width. The inferred non-thermal velocity (29 km s-1) is about the same as in cooler lines while the approaching line-of-sight velocity (8 km s-1) is lower than in Ca II lines. The O VI profile recorded 30" above the limb outside the filament is wider (FWHM 0.33 Å). It can be interpreted as a coronal emission of 0 VI ions with a temperature of about 106 K, and a non-thermal velocity (NTV) of 49 km s-1. This NTV is twice the NTV of quiet Sun center O VI profiles. Lower NTV require higher temperatures and densities (as suggested by K-coronameter measurements). Computed emission measures for this high temperature regime agree with determinations from disk intensities of EUV lines.

Role of Color Flow Ultrasound in Detection of Deep Venous Thrombosis

ERIC Educational Resources Information Center

Mohammed, Shelan Hakeem; AL-Najjar, Salwa A.

2016-01-01

Background: Deep vein thrombosis (DVT) of lower limbs is one of the most causes for the majority of death caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and squeal of…

The bodily self and its disorders: neurological, psychological and social aspects.

PubMed

Brugger, Peter; Lenggenhager, Bigna

2014-12-01

The experience of ourselves as an embodied agent with a first-person perspective is referred to as 'bodily self'. We present a selective overview of relevant clinical and experimental studies. Sharing multisensory body space with others can be observed in patients with structurally altered bodies (amputations, congenital absence of limbs), with altered functionality after hemiplegia, such as denial of limb ownership (somatoparaphrenia) and with alterations in bodily self-consciousness on the level of the entire body (e.g. in autoscopic phenomena). In healthy participants, the mechanisms underpinning body ownership and observer perspective are empirically investigated by multisensory stimulation paradigms to alter the bodily self. The resulting illusions have promoted the understanding of complex disturbances of the bodily self, such as out-of-body experiences. We discuss the role of interoception in differentiating between self and others and review current advances in the study of body integrity identity disorder, a condition shaped as much by neurological as by social-psychological factors. We advocate a social neuroscience approach to the bodily self that takes into account the interactions between body, mind and society and might help close the divide between neurology and psychiatry.

Upper limb performance and the structuring of joint movement in teenagers with cerebral palsy: the reciprocal role of task demands and action capabilities.

PubMed

Figueiredo, Priscilla Rezende Pereira; Silva, Paula Lanna; Avelar, Bruna Silva; da Fonseca, Sérgio Teixeira; Bootsma, Reinoud J; Mancini, Marisa Cotta

2015-04-01

Individuals with unilateral cerebral palsy (CP) demonstrate reduced performance in upper limb tasks compared to typically developing (TD) peers. We examined whether task conditions modify differences between teenagers with and without CP during a reciprocal aiming task. Twenty teenagers (nine CP and 11 TD) moved a pointer between two targets as fast as possible without missing a target. Task conditions were manipulated by changing the targets' size, by modifying the inertial properties of the pointer and by varying the upper limb used to perform the task (preferred/non-affected and non-preferred/affected upper limbs). While compared to TD peers, CP teenagers exhibited lower performance (longer movement times). Such differences were attenuated when the task was performed with the preferred upper limb and when accuracy requirements were less stringent. CP teenagers were not differentially affected by the pointer inertia manipulation. Task conditions not only affected performance but also joint kinematics. CP teenagers revealed less movement at the elbow and more movement at the shoulder when performing the task with their less skilled upper limb. However, both CP and TD teenagers demonstrated a larger contribution of trunk movement when facing more challenging task conditions. The overall pattern of results indicated that the joint kinematics employed by individuals with unilateral CP constituted adaptive responses to task requirements. Thus, the explanation of the effects of unilateral CP on upper limb behavior needs to go beyond a context-indifferent manifestation of the brain injury to include the interaction between task demands and action capabilities.

A quick and effective method of limb preparation with health, safety and efficiency benefits.

PubMed

Naderi, N; Maw, K; Thomas, M; Boyce, D E; Shokrollahi, K

2012-03-01

Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed 'static' posture for several minutes. This is hazardous to theatre staff. Furthermore, 'painting' the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the 'sterile bag' preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists. We monitored the duration of PLP in 20 patients using the 'sterile bag' technique compared to 20 patients using a conventional 'painting' method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery. The mean duration of the 'sterile bag' PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken. The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.

Subcutaneous Crotaline Fab antivenom for the treatment of rattlesnake envenomation in a porcine model.

PubMed

Offerman, Steven R; Barry, J David; Richardson, William H; Tong, Tri; Tanen, Dave; Bush, Sean P; Clark, Richard F

2009-01-01

This study was designed to investigate whether the local, subcutaneous injection of Crotaline Fab antivenom (CroFab) at the rattlesnake envenomation site would result in less extremity edema when compared to intravenous (i.v.) antivenom infusion alone. This is a randomized, three-arm laboratory experiment using a porcine model. Each animal was anesthetized, intubated, and maintained on mechanical ventilation. About 6 mg/kg of Crotalus atrox venom was injected subcutaneously at the hock of the right hind leg. Animals were then randomized to immediately receive subcutaneous and i.v. antivenom (SC/IV), i.v. antivenom only, or saline control. SC/IV animals received two vials of CroFab subcutaneously at the envenomation site and two vials intravenously. IV animals received four vials of CroFab intravenously. Limb edema was tracked by serial circumference and volumetric measurements over an 8-h period. Limb circumference was measured at four pre-determined locations hourly. Limb volume was measured by a water displacement method at baseline, 4, and 8 h. Twenty-six animals were randomized to the three treatment groups. The SC/IV and IV arms included nine animals each. Two animals in the SC/IV group died suddenly during the study, leaving seven animals for data analysis. There were eight controls. Increasing limb edema was observed in all groups. No differences were detected in limb circumferences or limb volumes between control and either treatment arms. In this porcine model of crotaline envenomation, no differences in limb edema were found between animals treated with SC/IV or IV CroFab when compared to saline controls.

Energy flow analysis during the tennis serve: comparison between injured and noninjured tennis players.

PubMed

Martin, Caroline; Bideau, Benoit; Bideau, Nicolas; Nicolas, Guillaume; Delamarche, Paul; Kulpa, Richard

2014-11-01

Energy flow has been hypothesized to be one of the most critical biomechanical concepts related to tennis performance and overuse injuries. However, the relationships among energy flow during the tennis serve, ball velocity, and overuse injuries have not been assessed. To investigate the relationships among the quality and magnitude of energy flow, the ball velocity, and the peaks of upper limb joint kinetics and to compare the energy flow during the serve between injured and noninjured tennis players. Case-control study; Level of evidence, 3. The serves of expert tennis players were recorded with an optoelectronic motion capture system. The forces and torques of the upper limb joints were calculated from the motion captures by use of inverse dynamics. The amount of mechanical energy generated, absorbed, and transferred was determined by use of a joint power analysis. Then the players were followed during 2 seasons to identify upper limb overuse injuries with a questionnaire. Finally, players were classified into 2 groups according to the questionnaire results: injured or noninjured. Ball velocity increased and upper limb joint kinetics decreased with the quality of energy flow from the trunk to the hand + racket segment. Injured players showed a lower quality of energy flow through the upper limb kinetic chain, a lower ball velocity, and higher rates of energy absorbed by the shoulder and elbow compared with noninjured players. The findings of this study imply that improper energy flow during the tennis serve can decrease ball velocity, increase upper limb joint kinetics, and thus increase overuse injuries of the upper limb joints. © 2014 The Author(s).

Crouch gait can be an effective form of forced-use/no constraint exercise for the paretic lower limb in stroke

PubMed Central

Rota, Viviana; Malloggi, Chiara; Brugliera, Luigia; Catino, Luigi

2017-01-01

In hemiplegic gait the paretic lower limb provides less muscle power and shows a briefer stance compared with the unaffected limb. Yet, a longer stance and a higher power can be obtained from the paretic lower limb if gait speed is increased. This supports the existence of a ‘learned non-use’ phenomenon, similar to that underlying some asymmetric impairments of the motion of the eyes and of the upper limbs. Crouch gait (CG) (bent-hip bent-knee, about 30° minimum knee flexion) might be an effective form of ‘forced-use’ treatment of the paretic lower limb. It is not known whether it also stimulates a more symmetric muscle power output. Gait analysis on a force treadmill was carried out in 12 healthy adults and seven hemiplegic patients (1–127 months after stroke, median: 1.6). Speed was imposed at 0.3 m/s. Step length and single and double stance times, sagittal joint rotations, peak positive power, and work in extension of the hip, knee, and ankle (plantar flexion), and surface electromyography (sEMG) area from extensor muscles during the generation of power were measured on either side during both erect and crouch walking. Significance was set at P less than 0.05; corrections for multiplicity were applied. Patients, compared with healthy controls, adopted in both gait modalities and on both sides a shorter step length (61–84%) as well as a shorter stance (76–90%) and swing (63–83%) time. As a rule, they also provided a higher muscular work (median: 137%, range: 77–250%) paralleled by a greater sEMG area (median: 174%, range: 75–185%). In erect gait, the generation of peak extensor power across hip, knee, and ankle joints was in general lower (83–90%) from the paretic limb and higher (98–165%) from the unaffected limb compared with control values. In CG, peak power generation across the three lower limb joints was invariably higher in hemiparetic patients: 107–177% from the paretic limb and 114–231% from the unaffected limb. When gait shifted from erect to crouch, only for hemiplegic patients, at the hip, the paretic/unaffected ratio increased significantly. For peak power, work, sEMG area, and joint rotation, the paretic/unaffected ratio increased from 55 to 85%, 56 to 72%, 68 to 91%, and 67 to 93%, respectively. CG appears to be an effective form of forced-use exercise eliciting more power and work from the paretic lower limb muscles sustained by a greater neural drive. It also seems effective in forcing a more symmetric power and work from the hip extensor muscles, but neither from the knee nor the ankle. PMID:28574860

Comparative anatomy and muscle architecture of selected hind limb muscles in the Quarter Horse and Arab.

PubMed

Crook, T C; Cruickshank, S E; McGowan, C M; Stubbs, N; Wakeling, J M; Wilson, A M; Payne, R C

2008-02-01

The Quarter Horse (bred for acceleration) and the Arab (bred for endurance) are situated at either end of the equine athletic spectrum. Studies into the form and function of the leg muscles in human sprint and endurance runners have demonstrated that differences exist in their muscle architecture. It is not known whether similar differences exist in the horse. Six Quarter Horse and six Arab fresh hind limb cadavers were dissected to gain information on the muscle mass and architecture of the following muscles: gluteus medius; biceps femoris; semitendinosus; vastus lateralis; gastrocnemius; tibialis cranialis and extensor digitorum longus. Specifically, muscle mass, fascicle length and pennation angle were quantified and physiological cross-sectional area (PCSA) and maximum isometric force were estimated. The hind limb muscles of the Quarter Horse were of a significantly greater mass, but had similar fascicle lengths and pennation angles when compared with those of the Arab; this resulted in the Quarter Horse hind limb muscles having greater PCSAs and hence greater isometric force potential. This study suggests that Quarter Horses as a breed inherently possess large strong hind limb muscles, with the potential to accelerate their body mass more rapidly than those of the Arab.

Abnormal landing strategies after ACL reconstruction.

PubMed

Gokeler, A; Hof, A L; Arnold, M P; Dijkstra, P U; Postema, K; Otten, E

2010-02-01

The objective was to analyze muscle activity and movement patterns during landing of a single leg hop for distance after anterior cruciate ligament (ACL) reconstruction. Nine (six males, three females) ACL-reconstructed patients 6 months after surgery and 11 (eight males, three females) healthy control subjects performed the hop task. Electromyographic signals from lower limb muscles were analyzed to determine onset time before landing. Biomechanical data were collected using an Optotrak Motion Analysis System and force plate. Matlab was used to calculate kinetics and joint kinematics. Side-to-side differences in ACL-reconstructed patients and healthy subjects as well as differences between the patients and control group were analyzed. In ACL-reconstructed limbs, significantly earlier onset times were found for all muscles, except vastus medialis, compared with the uninvolved side. The involved limbs had significantly reduced knee flexion during the take-off and increased plantarflexion at initial contact. The knee extension moment was significantly lower in the involved limb. In the control group, significantly earlier onset times were found for the semitendinosus, vastus lateralis and medial gastrocnemius of the non-dominant side compared with the dominant side. Muscle onset times are earlier and movement patterns are altered in the involved limb 6 months after ACL reconstruction.

Electromyographic Analysis of the Lower Limb Muscles in Low- and High-Handicap Golfers.

PubMed

Marta, Sérgio; Silva, Luís; Vaz, João R; Castro, Maria António; Reinaldo, Gustavo; Pezarat-Correia, Pedro

2016-09-01

The aim of this study was to compare the electromyographic patterns of the lower limb muscles during a golf swing performed by low- and high-handicap golfers. Ten golfers (5 low- and 5 high-handicap) performed 8 swings using a 7-iron. Surface electromyography (EMG) was recorded for the following lower limb muscles on both sides: biceps femoris, semitendinosus, gluteus maximus, vastus medialis and lateralis, rectus femoris, tibialis anterior, peroneus longus, and gastrocnemius medialis and lateralis. The golf-swing phases were determined by 3-dimensional high-speed video analysis. Compared with the high-handicap golfers, the low-handicap golfers performed the forward swing with a shorter duration of the swing phases, with the exception of the late follow-through, where they exhibited longer duration. Considering the EMG patterns, the low-handicap golfers showed a tendency for the studied muscles to reach an activation peak earlier and presented statistically significant higher muscle activity in some of the lower limb muscles, mainly from the left side. Differences between low- and high-handicap golfers were found in the average duration of swing phases and in the activation level of the lower limbs, with more evidence on muscles from the left side.

Limb versus speech motor control: a conceptual review.

PubMed

Grimme, Britta; Fuchs, Susanne; Perrier, Pascal; Schöner, Gregor

2011-01-01

This paper presents a comparative conceptual review of speech and limb motor control. Speech is essentially cognitive in nature and constrained by the rules of language, while limb movement is often oriented to physical objects. We discuss the issue of intrinsic vs. extrinsic variables underlying the representations of motor goals as well as whether motor goals specify terminal postures or entire trajectories. Timing and coordination is recognized as an area of strong interchange between the two domains. Although coordination among different motor acts within a sequence and coarticulation are central to speech motor control, they have received only limited attention in manipulatory movements. The biomechanics of speech production is characterized by the presence of soft tissue, a variable number of degrees of freedom, and the challenges of high rates of production, while limb movements deal more typically with inertial constraints from manipulated objects. This comparative review thus leads us to identify many strands of thinking that are shared across the two domains, but also points us to issues on which approaches in the two domains differ. We conclude that conceptual interchange between the fields of limb and speech motor control has been useful in the past and promises continued benefit.

The effects of body proportions on thermoregulation: an experimental assessment of Allen's rule.

PubMed

Tilkens, Michael J; Wall-Scheffler, Cara; Weaver, Timothy D; Steudel-Numbers, Karen

2007-09-01

Numerous studies have discussed the influence of thermoregulation on hominin body shape concluding, in accordance with Allen's rule, that the presence of relatively short limbs on both extant as well as extinct hominin populations offers an advantage for survival in cold climates by reducing the limb's surface area to volume ratio. Moreover, it has been suggested that shortening the distal limb segment compared to the proximal limb segment may play a larger role in thermoregulation due to a greater relative surface area of the shank. If longer limbs result in greater heat dissipation, we should see higher resting metabolic rates (RMR) in longer-limbed individuals when temperature conditions fall, since the resting rate will need to replace the lost heat. We collected resting oxygen consumption on volunteer human subjects to assess the correlation between RMR and lower limb length in human subjects, as well as to reexamine the prediction that shortening the distal segment would have a larger effect on heat loss and, thus, RMR than the shortening of the proximal segment. Total lower limb length exhibits a statistically significant relationship with resting metabolic rate (p<0.001; R(2)=0.794). While this supports the hypothesis that as limb length increases, resting metabolic rate increases, it also appears that thigh length, rather than the length of the shank, drives this relationship. The results of the present study confirm the widely-held expectation of Allen's rule, that short limbs reduce the metabolic cost of maintaining body temperature, while long limbs result in greater heat dissipation regardless of the effect of mass. The present results suggest that the shorter limbs of Neandertals, despite being energetically disadvantageous while walking, would indeed have been advantageous for thermoregulation.

Postural control strategies during single limb stance following acute lateral ankle sprain.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2014-06-01

Single-limb stance is maintained via the integration of visual, vestibular and somatosensory afferents. Musculoskeletal injury challenges the somatosensory system to reweight distorted sensory afferents. This investigation supplements kinetic analysis of eyes-open and eyes-closed single-limb stance tasks with a kinematic profile of lower limb postural orientation in an acute lateral ankle sprain group to assess the adaptive capacity of the sensorimotor system to injury. Sixty-six participants with first-time acute lateral ankle sprain completed a 20-second eyes-open single-limb stance task on their injured and non-injured limbs (task 1). Twenty-three of these participants successfully completed the same 20-second single-limb stance task with their eyes closed (task 2). A non-injured control group of 19 participants completed task 1, with 16 completing task 2. 3-dimensional kinematics of the hip, knee and ankle joints, as well as associated fractal dimension of the center-of-pressure path were determined for each limb during these tasks. Between trial analyses revealed significant differences in stance limb kinematics and fractal dimension of the center-of-pressure path for task 2 only. The control group bilaterally assumed a position of greater hip flexion compared to injured participants on their side-matched "involved"(7.41 [6.1°] vs 1.44 [4.8]°; η(2)=.34) and "uninvolved" (9.59 [8.5°] vs 2.16 [5.6°]; η(2)=.31) limbs, with a greater fractal dimension of the center-of-pressure path (involved limb=1.39 [0.16°] vs 1.25 [0.14°]; uninvolved limb=1.37 [0.21°] vs 1.23 [0.14°]). Bilateral impairment in postural control strategies present following a first time acute lateral ankle sprain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Objective assessment of the compensatory effect of clinical hind limb lameness in horses: 37 cases (2011-2014).

PubMed

Maliye, Sylvia; Marshall, John F

2016-10-15

OBJECTIVE To characterize and describe the compensatory load redistribution that results from unilateral hind limb lameness in horses. DESIGN Retrospective case series. ANIMALS 37 client-owned horses. PROCEDURES Medical records were reviewed to identify horses with unilateral hind limb lameness that responded positively (by objective assessment) to diagnostic local anesthesia during lameness evaluation and that were evaluated before and after diagnostic local anesthesia with an inertial sensor-based lameness diagnosis system. Horses were grouped as having hind limb lameness only, hind limb and ipsilateral forelimb lameness, or hind limb and contralateral forelimb lameness. Measures of head and pelvic movement asymmetry before (baseline) and after diagnostic local anesthesia were compared. The effect of group on baseline pelvic movement asymmetry variables was analyzed statistically. RESULTS Maximum pelvic height significantly decreased from the baseline value after diagnostic local anesthesia in each of the 3 lameness groups and in all horses combined. Minimum pelvic height significantly decreased after the procedure in all groups except the hind limb and contralateral forelimb lameness group. Head movement asymmetry was significantly decreased after diagnostic local anesthesia for horses with hind limb and ipsilateral forelimb lameness and for all horses combined, but not for those with hind limb lameness only or those with hind limb and contralateral forelimb lameness. CONCLUSIONS AND CLINICAL RELEVANCE Results supported that hind limb lameness can cause compensatory load redistribution evidenced as ipsilateral forelimb lameness. In this population of horses, contralateral forelimb lameness was not compensatory and likely reflected true lameness. Further studies are needed to investigate the source of the contralateral forelimb lameness in such horses.

Assessment of radial torsion using computed tomography in dogs with and without antebrachial limb deformity.

PubMed

Kroner, Kevin; Cooley, Katie; Hoey, Seamus; Hetzel, Scott J; Bleedorn, Jason A

2017-01-01

To evaluate the reliability of radial torsion assessment in dogs using computed tomography (CT). Cadaveric and retrospective observational clinical study. Thoracic limbs (n = 40) from bilateral normal cadaveric canine specimens (10 pairs) and unilateral antebrachial angular limb deformity (ALD) dogs (10 uniapical and 10 biapical deformities). Limbs were evaluated using CT. Frontal, sagittal, and axial plane (torsion) values were obtained using published guidelines and compared between groups and limbs. Radial torsion reliability was assessed among 3 observers using intraclass correlation coefficients (ICC). The mean (±SD) radial torsion of normal dogs was 3.6° ± 6.4° and contained a significant right to left limb variation of 2.6°. Mean radial torsion in uniapical ALD limbs (3.6° ± 18.7°) was not significantly different from biapical ALD limbs (8.9° ± 17.9°). There was a wide range of torsion values in normal and ALD limbs. The interobserver reliability was excellent (ICC > 0.8) for normal dogs, good (0.73) for uniapical, and excellent (0.89) for biapical ALD limbs. The intraobserver reliability was excellent (>0.8) for all groups. There was a small side-to-side variation of radial torsion in normal dogs. With directed training, torsion assessment using CT is reliable in dogs with and without antebrachial bone deformity. © 2016 The American College of Veterinary Surgeons.

Whole-exome sequencing identified a homozygous FNBP4 mutation in a family with a condition similar to microphthalmia with limb anomalies.

PubMed

Kondo, Yukiko; Koshimizu, Eriko; Megarbane, Andre; Hamanoue, Haruka; Okada, Ippei; Nishiyama, Kiyomi; Kodera, Hirofumi; Miyatake, Satoko; Tsurusaki, Yoshinori; Nakashima, Mitsuko; Doi, Hiroshi; Miyake, Noriko; Saitsu, Hirotomo; Matsumoto, Naomichi

2013-07-01

Microphthalmia with limb anomalies (MLA), also known as Waardenburg anophthalmia syndrome or ophthalmoacromelic syndrome, is a rare autosomal recessive disorder. Recently, we and others successfully identified SMOC1 as the causative gene for MLA. However, there are several MLA families without SMOC1 abnormality, suggesting locus heterogeneity in MLA. We aimed to identify a pathogenic mutation in one Lebanese family having an MLA-like condition without SMOC1 mutation by whole-exome sequencing (WES) combined with homozygosity mapping. A c.683C>T (p.Thr228Met) in FNBP4 was found as a primary candidate, drawing the attention that FNBP4 and SMOC1 may potentially modulate BMP signaling. Copyright © 2013 Wiley Periodicals, Inc.

[A year's review of the treatment of lymphedema of the extremities with the Lymphapress (preliminary note)].

PubMed

Gruffaz, J

1981-01-01

Lymphoedema of the limbs constitutes a chronic disorder. Its form may vary but its treatment is now well-established and medical and surgical therapies have been perfected. We have tried out the Lymphapress as a replacement of Van der Molen's treatment used successfully since 1968. After a brief anatomopathological resume based on Foldi's theory, we recall the various therapeutic indications and the observation of a patient with lymphoedema of the limbs following surgery and Cobalt for seminoma, which we treated using the Lymphapress. The results are analysed. 17 patients were treated between April and June 1979. The method of treatment is not detailed here. This technique does not dispense with secondary compression; it replaces the "piping" used by Van der Molen in major lymphoedema.

Progress on gene therapy, cell therapy, and pharmacological strategies toward the treatment of oculopharyngeal muscular dystrophy.

PubMed

Harish, Pradeep; Malerba, Alberto; Dickson, George; Bachtarzi, Houria

2015-05-01

Oculopharyngeal muscular dystrophy (OPMD) is a muscle-specific, late-onset degenerative disorder whereby muscles of the eyes (causing ptosis), throat (leading to dysphagia), and limbs (causing proximal limb weakness) are mostly affected. The disease is characterized by a mutation in the poly(A)-binding protein nuclear-1 (PABPN1) gene, resulting in a short GCG expansion in the polyalanine tract of PABPN1 protein. Accumulation of filamentous intranuclear inclusions in affected skeletal muscle cells constitutes the pathological hallmark of OPMD. This review highlights the current translational research advances in the treatment of OPMD. In vitro and in vivo disease models are described. Conventional and experimental therapeutic approaches are discussed with emphasis on novel molecular therapies including the use of intrabodies, gene therapy, and myoblast transfer therapy.

A novel homozygous Arg222Trp missense mutation in WNT7A in two sisters with severe Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome.

PubMed

Kantaputra, Piranit N; Mundlos, Stefan; Sripathomsawat, Warissara

2010-11-01

Al-Awadi/Raas-Rothschild/Schinzel phocomelia (AARRS) syndrome, a rare autosomal recessive disorder, comprises malformations of upper and lower limbs with severely hypoplastic pelvis and abnormal genitalia. Mutations in WNT7A have been reported as cause of the syndrome. We report on two sisters in a Thai family with short and malformed long bones, absent fibulae, flexion contracture of digits, and a/hypoplastic nails. Fusion between severely malformed femora and slender tibiae has never been reported in patients with WNT7A mutations. Lower limbs were more severely malformed than the upper ones and the pelvis was also severely affected. Multiple fusions of long bones and of the femoral heads to the acetabula were evident. A novel homozygous missense mutation in coding exon 4 of the WNT7A was detected in both affected daughters (c.664C > T) leading to an amino acid exchange from arginine to tryptophan (p.Arg222Trp; R222W). The phenotype is likely to result from an abnormality of all three signaling centers in the developing limb resulting in ventralization with a loss of dorsal structures (aplasia/hypoplasia of nails) a loss of anterior-posterior identity (single distal bones in lower limb without polarity) and an outgrowth defect resulting in distal truncations. © 2010 Wiley-Liss, Inc.

Whorled hairless nevus of the scalp, linear hyperpigmentation, and telangiectatic nevi of the lower limbs: a novel variant of the "phacomatosis complex".

PubMed

Castori, Marco; Scarciolla, Oronzo; Morlino, Silvia; Manente, Liborio; Biscaglia, Assunta; Fragasso, Alberto; Grammatico, Paola

2012-02-01

The term "phacomatosis" refers to a growing number of sporadic genetic skin disorders characterized by the combination of two or more different nevi and possibly resulting from non-allelic twin spotting. While phacomatosis pigmentovascularis (PPV) and pigmentokeratotica represent the most common patterns, some patients do not fit with either condition and are temporarily classified as unique phenotypes. We report on an 8-year-old boy with striking right hemihypoplasia, resulting in limb asymmetry and fixed dislocation of right hip. Skin on the affected side showed three distinct nevi: (i) A whorled, hairless nevus of the scalp in close proximity with (ii) epidermal hyperpigmentation following lines of Blaschko on the neck and right upper limb, and (iii) multiple telangiectatic nevi of the right lower limb and hemiscrotum. Didymosis atricho-melanotica was proposed for the combination of adjacent patchy congenital alopecia and linear hyperpigmentation, while phacomatosis atricho-pigmento-vascularis appears to define the entire cutaneous phenotype, thus implying the involvement of three neighboring loci influencing the development of distinct constituents of the skin. Given the striking asymmetry of the observed phenotype, the effect of mosaicism (either genomic or functional) for a mutation in a single gene with pleiotropic action and influenced by the lateralization pattern of early development cannot be excluded. Copyright © 2012 Wiley Periodicals, Inc.

Measurement properties of a new wireless electrogoniometer for quantifying spasticity during the pendulum test in ARSACS patients.

PubMed

Bui, Hung Tien; Gagnon, Cynthia; Audet, Olivier; Mathieu, Jean; Leone, Mario

2017-04-15

Autosomal recessive spastic ataxia of Charlevoix/Saguenay (ARSACS) is a neuromuscular disorder that induces spasticity in lower limbs. The Wartenberg pendulum test is a classical method of assessing lower limb spasticity based on the dynamics of the pendular leg motion. However, in its original form, this test only provides subjective results and do not allow accurate assessment of spasticity. Thirteen ARSACS patients were assessed using a new wireless electrogoniometer to measure spasticity by quantifying oscillation amplitudes and relaxation indices during the Wartenburg pendulum test. The validity of the instrument was evaluated by comparing its measurements to a known precise goniometer whereas discriminant validity was evaluated by comparing healthy participants and ARSACS patients. Reliability was measured using intraclass correlation (ICC) between pendulum test scores obtained at different moments in time. Data from different tests show that the proposed device is accurate (standard error of measurement of 0.0005°), discriminates healthy and ARSACS patients (most variables have p=0.00) and provides repeatable results (significant ICC usually higher than 0.64 and p<0.05). The proposed tool allows the clinician to analyze pendulum oscillation amplitudes and ratios and thus, provide an index of spasticity for the patients affected by ARSACS. This is important as the original procedure is only evaluated visually and the progression cannot be detected until the condition changes drastically. Thus, the system proposed meets the requirements of being useful, precise and user-friendly in the evaluation of patients in a research as well as a clinical environment. Copyright © 2017 Elsevier B.V. All rights reserved.

Body schema and corporeal self-recognition in the alien hand syndrome.

PubMed

Olgiati, Elena; Maravita, Angelo; Spandri, Viviana; Casati, Roberta; Ferraro, Francesco; Tedesco, Lucia; Agostoni, Elio Clemente; Bolognini, Nadia

2017-07-01

The alien hand syndrome (AHS) is a rare neuropsychological disorder characterized by involuntary, yet purposeful, hand movements. Patients with the AHS typically complain about a loss of agency associated with a feeling of estrangement for actions performed by the affected limb. The present study explores the integrity of the body representation in AHS, focusing on 2 main processes: multisensory integration and visual self-recognition of body parts. Three patients affected by AHS following a right-hemisphere stroke, with clinical symptoms akin to the posterior variant of AHS, were tested and their performance was compared with that of 18 age-matched healthy controls. AHS patients and controls underwent 2 experimental tasks: a same-different visual matching task for body postures, which assessed the ability of using your own body schema for encoding others' body postural changes (Experiment 1), and an explicit self-hand recognition task, which assessed the ability to visually recognize your own hands (Experiment 2). As compared to controls, all AHS patients were unable to access a reliable multisensory representation of their alien hand and use it for decoding others' postural changes; however, they could rely on an efficient multisensory representation of their intact (ipsilesional) hand. Two AHS patients also presented with a specific impairment in the visual self-recognition of their alien hand, but normal recognition of their intact hand. This evidence suggests that the AHS following a right-hemisphere stroke may involve a disruption of the multisensory representation of the alien limb; instead, self-hand recognition mechanisms may be spared. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Effect of Ankle Positioning During Hamstring Stretches for Improving Straight Leg Hip Flexion Motion.

PubMed

Laudner, Kevin G; Benjamin, Peter J; Selkow, Noelle M

2016-03-01

To compare the effects of stretching the hamstrings with the ankle in either a plantar-flexed (PF) or dorsiflexed (DF) position for improving straight leg hip flexion range of motion (ROM) over a 4-week period. Randomized, single-blinded, pretest, posttest design. Athletic training facility. Each limb of 34 asymptomatic individuals (15 males, 19 females) was randomly assigned to one of the 3 groups. Twenty-four limbs received hamstring stretches with the ankle in DF, 24 limbs received hamstring stretches with the ankle in PF, and 20 limbs received no stretch (control). Ankle position (PF, DF) during hamstring stretching. We measured pretest and posttest passive straight leg hip flexion ROM with the test ankle in a neutral position. For the intervention groups, the test limb was passively stretched with the ankle held in end range DF or PF for their respective group. Each stretch was held for 30 seconds for a total of 3 applications. Two treatment sessions were completed per week for a total of 4 weeks. The control limbs received no stretching during the 4-week period. We conducted 1-way analyses of covariance to determine significant changes in ROM between groups (P < 0.05). There was no significant difference between treatment groups (P = 0.90), but a significant difference was found for both the PF (P = 0.04) and DF (P = 0.01) groups when compared with the control group. Our findings indicate that both stretching the hamstrings in either PF or DF improve straight leg hip ROM compared with a control group. The results of this study should be considered by clinicians when determining the optimal stretching techniques aimed at increasing hamstring length.

ITRAQ-based quantitative proteomic analysis of Cynops orientalis limb regeneration.

PubMed

Tang, Jie; Yu, Yuan; Zheng, Hanxue; Yin, Lu; Sun, Mei; Wang, Wenjun; Cui, Jihong; Liu, Wenguang; Xie, Xin; Chen, Fulin

2017-09-22

Salamanders regenerate their limbs after amputation. However, the molecular mechanism of this unique regeneration remains unclear. In this study, isobaric tags for relative and absolute quantification (iTRAQ) coupled with liquid chromatography tandem mass spectrometry (LC-MS/MS) was employed to quantitatively identify differentially expressed proteins in regenerating limbs 3, 7, 14, 30 and 42 days post amputation (dpa). Of 2636 proteins detected in total, 253 proteins were differentially expressed during different regeneration stages. Among these proteins, Asporin, Cadherin-13, Keratin, Collagen alpha-1(XI) and Titin were down-regulated. CAPG, Coronin-1A, AnnexinA1, Cathepsin B were up-regulated compared with the control. The identified proteins were further analyzed to obtain information about their expression patterns and functions in limb regeneration. Functional analysis indicated that the differentially expressed proteins were associated with wound healing, immune response, cellular process, metabolism and binding. This work indicated that significant proteome alternations occurred during salamander limb regeneration. The results may provide fundamental knowledge to understand the mechanism of limb regeneration.

Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial.

PubMed

Jeon, Hye Joo; Hwang, Byong Yong

2018-02-01

[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the paretic lower limb. The BTG completed strength training in the paretic and non-paretic lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results] In both groups, the lower limb strengthening exercise for balance and walking significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke patients.

Limb darkening effect on transit light curves of HAT-P-32b

NASA Astrophysics Data System (ADS)

ćuha, H.; Erdem, A.

2018-02-01

The transit light curve of a transiting exoplanet offers us an opportunity to measure the fractional radius, semi-major axis and orbital inclination of the star-planet system. Precision of those parameters is strongly affected by limb darkening of the host star. In this study, we examine the limb darkening effect on the transit light curves of HAT-P-32b. The transit light curves of HAT-P-32b were observed on three nights at TUBITAK National Observatory with a 100-cm aperture telescope in Bessel R and V filters. The light curves were solved using jktebop code. Linear, square root, logarithmic and quadratic limb darkening laws were taken into account during the analysis. The derived limb darkening coefficients from our observations were then compared with theoretical values given in the literature. We conclude that more sensitive data, such as space based photometric observations, are needed in order to determine the limb darkening coefficients accurately.

Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial

PubMed Central

Jeon, Hye Joo; Hwang, Byong Yong

2018-01-01

[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the paretic lower limb. The BTG completed strength training in the paretic and non-paretic lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results] In both groups, the lower limb strengthening exercise for balance and walking significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke patients. PMID:29545693

Using upper limb kinematics to assess cognitive deficits in people living with both HIV and stroke.

PubMed

Bui, Kevin D; Rai, Roshan; Johnson, Michelle J

2017-07-01

In this study, we aim to explore ways to objectively assess cognitive deficits in the stroke and HIV/stroke populations, where cognitive and motor impairments can be hard to separate. Using an upper limb rehabilitation robot called the Haptic TheraDrive, we collect performance error scores and motor learning data on the impaired and unimpaired limb during a trajectory tracking task. We compare these data to clinical cognitive scores. The preliminary results suggest a possible relationship between unimpaired upper limb performance error and visuospatial/executive function cognitive domains, but more work needs to be done to further investigate this. The potential of using robot-assisted technologies to measure unimpaired limb kinematics as a tool to assess cognitive deficits would be useful to inform more effective rehabilitation strategies for HIV, stroke, and HIV/stroke populations.

Musculoskeletal disorders in physically active conscripts: a one-year follow-up study in the Finnish Defence Forces

PubMed Central

Taanila, Henri; Suni, Jaana; Pihlajamäki, Harri; Mattila, Ville M; Ohrankämmen, Olli; Vuorinen, Petteri; Parkkari, Jari

2009-01-01

Background Musculoskeletal disorders (MSDs) are an important cause for morbidity in military service. They result in disabilities needing long-term rehabilitation and functional impairment leading to premature discharge from military service. The purpose of the study was to investigate the incidence and nature of MSDs in Finnish conscripts. Methods Two successive arrivals of 18–28-yr-old male conscripts (N = 955, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Results During the 12-month study period there were 437 outpatient clinic visits in 955 persons. The occurrence rate was 33% during 6-month service while the event-based incidence was 3.3 per 1000 person-days. Occurrence peaked in summer months. The most common types of MSDs were low back pain (LBP, 20%), lower limb overuse injuries (16%) and sprains or strains (13%). Disorders mostly occurred in combat training in combat gear (40%) and during marching on foot or bicycle (28%). Overuse-related MSDs were more prevalent (66%) than traumatic ones (34%). One-third (34%) of the MSDs were recurrent and 66% were new ones. Disorders of the back and the knee were most frequently recurrent conditions (44% for both). Fractures, knee ligament ruptures, dislocations and muscle strains accounted for the highest number of service days lost. Twenty-four (2.5%) out of 955 conscripts were prematurely discharged due to MSDs. Conclusion Preventive measures during military service should be targeted at decreasing low back pain and lower limb overuse injuries, because these inflict the largest burden of MSDs and tend to have a chronic nature. PMID:19624829

Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1-A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration.

PubMed

Lemeunier, Nadège; da Silva-Oolup, S; Chow, N; Southerst, D; Carroll, L; Wong, J J; Shearer, H; Mastragostino, P; Cox, J; Côté, E; Murnaghan, K; Sutton, D; Côté, P

2017-09-01

To determine the reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. We also searched the literature to identify studies on the reliability and validity of Doppler velocimetry for the evaluation of cervical arteries. Two independent reviewers screened and critically appraised studies. We conducted a best evidence synthesis of low risk of bias studies and ranked the phases of investigations using the classification proposed by Sackett and Haynes. We screened 9022 articles and critically appraised 8 studies; all 8 studies had low risk of bias (three reliability and five validity Phase II-III studies). Preliminary evidence suggests that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joints. The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling's and the upper limb neurodynamic tests. No evidence was found for doppler velocimetry. Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension-rotation test, neurological examination, Spurling's and the upper limb neurodynamic tests.

Recovery of physical activity levels in adolescents after lower limb fractures: a longitudinal, accelerometry-based activity monitor study.

PubMed

Ceroni, Dimitri; Martin, Xavier; Lamah, Léopold; Delhumeau, Cécile; Farpour-Lambert, Nathalie; De Coulon, Geraldo; Ferrière, Victor Dubois

2012-07-25

In adolescents, loss of bone mineral mass usually occurs during phases of reduced physical activity (PA), such as when an injured extremity spends several weeks in a cast. We recorded the PA of adolescents with lower limb fractures during the cast immobilization, at 6 and at 18 months after the fracture, and we compared these values with those of healthy controls. Fifty adolescents with a first episode of limb fracture and a control group of 50 healthy cases were recruited for the study through an advertisement placed at the University Children's Hospital of Geneva, Switzerland. PA was assessed during cast immobilization and at 6- and 18-month follow-up by accelerometer measurement (Actigraph(®) 7164, MTI, Fort Walton Beach, FL, USA). Patients and their healthy peers were matched for gender and age. Time spent in PA at each level of intensity was determined for each participant and expressed in minutes and as a percentage of total valid time. From the 50 initial teenagers with fractures, 44 sustained functional evaluations at 6 months follow-up, whereas only 38 patients were studied at 18 months. The total PA count (total number of counts/min) was lower in patients with lower limb fractures (-62.4%) compared with healthy controls (p<0.0001) during cast immobilization. Similarly, time spent in moderate-to-vigorous PA was lower by 76.6% (p<0.0001), and vigorous PA was reduced by 84.4% (p<0.0001) in patients with cast immobilization for lower limb injuries compared to healthy controls values. At 6 and 18 months after the fracture, the mean PA level of injured adolescents was comparable to those of healthy teenagers (-2.3%, and -1.8%, respectively).Importantly, we observed that time spent in vigorous PA, which reflects high-intensity forces beneficial to skeletal health, returned to similar values between both groups from the six month follow-up in adolescents who sustained a fracture. However, a definitive reduction in time spent in moderate PA was observed among patients with a lower limb fracture at 18 months, when comparing with healthy controls values (p = 0.0174). As cast immobilization and reduced PA are known to induce bone mineral loss, this study provides important information to quantify the decrease of skeletal loading in adolescents with limb fractures. The results of this study demonstrate that the amount of skeletal loading returns to normal values in adolescents with lower limb fractures after bone healing and is probably linked to an overall better pattern of functional recovery among this age group. When comparing both populations of adolescents, a definitive decrease in time spent in moderate-to-vigorous PA was observed among patients with a lower limb fracture at 18 months and may suggest a modification of lifestyle. The high rate of missing data (26.5%) due to above all non compliance with monitor wearing among teenagers complicates the data analysis, and requires a more cautious interpretation of the results. Future studies using accelerometer to monitor PA in adolescents should therefore include strategies for improving the rate of adherence and minimizing the ratio of missing data.

Insomnia with Objective Short Sleep Duration: the Most Biologically Severe Phenotype of the Disorder

PubMed Central

Vgontzas, Alexandros N.; Fernandez-Mendoza, Julio; Liao, Duanping; Bixler, Edward O.

2013-01-01

Summary Until recently, the association of chronic insomnia with significant medical morbidity was not established and its diagnosis was based solely on subjective complaints. We present evidence that insomnia with objective short sleep duration is the most biologically severe phenotype of the disorder, as it is associated with cognitive-emotional and cortical arousal, activation of both limbs of the stress system, and a higher risk for hypertension, impaired heart rate variability, diabetes, neurocognitive impairment, and mortality. Also, it appears that objective short sleep duration is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of activation of both limbs of the stress system or medical complications. Furthermore, the first phenotype is associated with unremitting course, whereas the latter is more likely to remit. We propose that short sleep duration in insomnia is a reliable marker of the biological severity and medical impact of the disorder. Objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment of insomnia patients in a clinician’s office setting. We speculate that insomnia with objective short sleep duration has primarily biological roots and may respond better to biological treatments, whereas insomnia with objective normal sleep duration has primarily psychological roots and may respond better to psychological interventions alone. PMID:23419741

Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder.

PubMed

Vgontzas, Alexandros N; Fernandez-Mendoza, Julio; Liao, Duanping; Bixler, Edward O

2013-08-01

Until recently, the association of chronic insomnia with significant medical morbidity was not established and its diagnosis was based solely on subjective complaints. We present evidence that insomnia with objective short sleep duration is the most biologically severe phenotype of the disorder, as it is associated with cognitive-emotional and cortical arousal, activation of both limbs of the stress system, and a higher risk for hypertension, impaired heart rate variability, diabetes, neurocognitive impairment, and mortality. Also, it appears that objective short sleep duration is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of activation of both limbs of the stress system or medical complications. Furthermore, the first phenotype is associated with unremitting course, whereas the latter is more likely to remit. We propose that short sleep duration in insomnia is a reliable marker of the biological severity and medical impact of the disorder. Objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment of insomnia patients in a clinician's office setting. We speculate that insomnia with objective short sleep duration has primarily biological roots and may respond better to biological treatments, whereas insomnia with objective normal sleep duration has primarily psychological roots and may respond better to psychological interventions alone. Copyright © 2012 Elsevier Ltd. All rights reserved.

Central timing deficits in subtypes of primary speech disorders.

PubMed

Peter, Beate; Stoel-Gammon, Carol

2008-03-01

Childhood apraxia of speech (CAS) is a proposed speech disorder subtype that interferes with motor planning and/or programming, affecting prosody in many cases. Pilot data (Peter & Stoel-Gammon, 2005) were consistent with the notion that deficits in timing accuracy in speech and music-related tasks may be associated with CAS. This study replicated and expanded earlier findings. Eleven children with speech disorders and age-and gender-matched controls participated in non-word imitation, clapped rhythm imitation, and paced repetitive tapping tasks. Results suggest a central timing deficit, expressed in both the oral and the limb modality, and observable in two different types of timing measures, overall rhythmic structures and small-scale durations. Associations among timing measures were strongest in the participants with speech disorders, who also showed lower timing accuracy than the controls in all measures. The number of observed CAS characteristics was associated with timing deficits.

A better way of fitting clips? A comparative study with respect to physical workload.

PubMed

Gaudez, Clarisse; Wild, Pascal; Aublet-Cuvelier, Agnès

2015-11-01

The clip fitting task is a frequently encountered assembly operation in the car industry. It can cause upper limb pain. During task laboratory simulations, upper limb muscular activity and external force were compared for 4 clip fitting methods: with the bare hand, with an unpowered tool commonly used at a company and with unpowered and powered prototype tools. None of the 4 fitting methods studied induced a lower overall workload than the other three. Muscle activity was lower at the dominant limb when using the unpowered tools and at the non-dominant limb with the bare hand or with the powered tool. Fitting clips with the bare hand required a higher external force than fitting with the three tools. Evaluation of physical workload was different depending on whether external force or muscle activity results were considered. Measuring external force only, as recommended in several standards, is insufficient for evaluating physical workload. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Neurotrophic regulation of epidermal dedifferentiation during wound healing and limb regeneration in the axolotl (Ambystoma mexicanum).

PubMed

Satoh, A; Graham, G M C; Bryant, S V; Gardiner, D M

2008-07-15

Adult urodeles (salamanders) are unique in their ability to regenerate complex organs perfectly. The recently developed Accessory Limb Model (ALM) in the axolotl provides an opportunity to identify and characterize the essential signaling events that control the early steps in limb regeneration. The ALM demonstrates that limb regeneration progresses in a stepwise fashion that is dependent on signals from the wound epidermis, nerves and dermal fibroblasts from opposite sides of the limb. When all the signals are present, a limb is formed de novo. The ALM thus provides an opportunity to identify and characterize the signaling pathways that control blastema morphogenesis and limb regeneration. In the present study, we have utilized the ALM to identity the buttonhead-like zinc-finger transcription factor, Sp9, as being involved in the formation of the regeneration epithelium. Sp9 expression is induced in basal keratinocytes of the apical blastema epithelium in a pattern that is comparable to its expression in developing limb buds, and it thus is an important marker for dedifferentiation of the epidermis. Induction of Sp9 expression is nerve-dependent, and we have identified KGF as an endogenous nerve factor that induces expression of Sp9 in the regeneration epithelium.

Design of a 6-DOF upper limb rehabilitation exoskeleton with parallel actuated joints.

PubMed

Chen, Yanyan; Li, Ge; Zhu, Yanhe; Zhao, Jie; Cai, Hegao

2014-01-01

In this paper, a 6-DOF wearable upper limb exoskeleton with parallel actuated joints which perfectly mimics human motions is proposed. The upper limb exoskeleton assists the movement of physically weak people. Compared with the existing upper limb exoskeletons which are mostly designed using a serial structure with large movement space but small stiffness and poor wearable ability, a prototype for motion assistance based on human anatomy structure has been developed in our design. Moreover, the design adopts balls instead of bearings to save space, which simplifies the structure and reduces the cost of the mechanism. The proposed design also employs deceleration processes to ensure that the transmission ratio of each joint is coincident.

More on the Liang Bua finds and modern human cretins.

PubMed

Oxnard, Charles; Obendorf, Peter J; Kefford, Ben J; Dennison, John

2012-12-01

Brown (2012: LB1 and LB6 Homo floresiensis are not modern human (Homo sapiens) cretins, Journal of Human Evolution) makes errors of fact, omission and interpretation. Brown's comments refer, among others, to (1) delayed growth and development indicated by unfused epiphyses, (2) postcranial limb proportions: limbs to trunk, between limbs, and within limbs, (3) postcranial bone torsions and angles, (4) postcranial robusticity, real and apparent, (5) skull features, and (6) cretinism on Flores. In each of these areas, much information about cretins is incorrect and much information (Oxnard et al., 2010) comparing the Liang Bua remains with cretins is ignored. Copyright © 2012 Elsevier GmbH. All rights reserved.

Comparative Anatomy of the Hind Limb Vessels of the Bearded Capuchins (Sapajus libidinosus) with Apes, Baboons, and Cebus capucinus: With Comments on the Vessels' Role in Bipedalism

PubMed Central

Aversi-Ferreira, Roqueline A. G. M. F.; de Abreu, Tainá; Pfrimer, Gabriel A.; Silva, Sylla F.; Ziermann, Janine M.; Carneiro-e-Silva, Frederico O.; Tomaz, Carlos; Tavares, Maria Clotilde H.; Maior, Rafael S.; Aversi-Ferreira, Tales A.

2013-01-01

Capuchin monkeys are known to exhibit sporadic bipedalism while performing specific tasks, such as cracking nuts. The bipedal posture and locomotion cause an increase in the metabolic cost and therefore increased blood supply to lower limbs is necessary. Here, we present a detailed anatomical description of the capuchin arteries and veins of the pelvic limb of Sapajus libidinosus in comparison with other primates. The arterial pattern of the bearded capuchin hind limb is more similar to other quadrupedal Cebus species. Similarities were also found to the pattern observed in the quadruped Papio, which is probably due to a comparable pelvis and the presence of the tail. Sapajus' traits show fewer similarities when compared to great apes and modern humans. Moreover, the bearded capuchin showed unique patterns for the femoral and the short saphenous veins. Although this species switches easily from quadrupedal to bipedal postures, our results indicate that the bearded capuchin has no specific or differential features that support extended bipedal posture and locomotion. Thus, the explanation for the behavioral differences found among capuchin genera probably includes other aspects of their physiology. PMID:24396829

Comparative anatomy of the hind limb vessels of the bearded capuchins (Sapajus libidinosus) with apes, baboons, and Cebus capucinus: with comments on the vessels' role in bipedalism.

PubMed

Aversi-Ferreira, Roqueline A G M F; de Abreu, Tainá; Pfrimer, Gabriel A; Silva, Sylla F; Ziermann, Janine M; Carneiro-E-Silva, Frederico O; Tomaz, Carlos; Tavares, Maria Clotilde H; Maior, Rafael S; Aversi-Ferreira, Tales A

2013-01-01

Capuchin monkeys are known to exhibit sporadic bipedalism while performing specific tasks, such as cracking nuts. The bipedal posture and locomotion cause an increase in the metabolic cost and therefore increased blood supply to lower limbs is necessary. Here, we present a detailed anatomical description of the capuchin arteries and veins of the pelvic limb of Sapajus libidinosus in comparison with other primates. The arterial pattern of the bearded capuchin hind limb is more similar to other quadrupedal Cebus species. Similarities were also found to the pattern observed in the quadruped Papio, which is probably due to a comparable pelvis and the presence of the tail. Sapajus' traits show fewer similarities when compared to great apes and modern humans. Moreover, the bearded capuchin showed unique patterns for the femoral and the short saphenous veins. Although this species switches easily from quadrupedal to bipedal postures, our results indicate that the bearded capuchin has no specific or differential features that support extended bipedal posture and locomotion. Thus, the explanation for the behavioral differences found among capuchin genera probably includes other aspects of their physiology.

Hemodynamic changes in the brachial artery induced by acupuncture stimulation on the lower limbs: a single-blind randomized controlled trial.

PubMed

Watanabe, Masashi; Takayama, Shin; Hirano, Atsushi; Seki, Takashi; Yaegashi, Nobuo

2012-01-01

Acupuncture is commonly performed at acupoints. No comparisons of quantitative physiological alterations in the brachial artery (BA) induced by the stimulation of different acupoints in the lower limbs have been performed in humans. Therefore, we investigated changes in blood flow volume (BFV) in the BA as an indicator of the physiological effects induced by stimulation at 3 points. Seventy-five healthy participants aged 33 ± 9 years (mean ± SD) were enrolled and randomly assigned to 3 groups; they received stimulation at 3 different points located on the lower limbs: ST36, LR3, and a non-acupoint. Stimulation was performed bilaterally with manual rotation of the needles. Using ultrasonography, BFV was measured continuously from rest to 180 seconds after stimulation. LR3 stimulation significantly increased BFV compared to that before needle insertion. Meanwhile, stimulation at ST36 and the non-acupoint significantly decreased BFV compared to that before needle insertion. Stimulation at LR3 elicited a significant increase in BFV compared to that at ST36 and the non-acupoint. The results suggest that the stimulation of different points on the lower limbs causes distinct physiological effects on BFV in the BA.

Randomized controlled comparative study on effect of training to improve lower limb motor paralysis in convalescent patients with post-stroke hemiplegia

PubMed Central

Kawakami, Kenji; Miyasaka, Hiroyuki; Nonoyama, Sayaka; Hayashi, Kazuya; Tonogai, Yusuke; Tanino, Genichi; Wada, Yosuke; Narukawa, Akihisa; Okuyama, Yuko; Tomita, Yutaka; Sonoda, Shigeru

2015-01-01

[Purpose] The motor paralysis-improving effect on the hemiplegic lower limb was compared among mirror therapy, integrated volitional-control electrical stimulation, therapeutic electrical stimulation, repetitive facilitative exercises, and the standard training method in post-stroke hemiplegia patients. [Subjects and Methods] Eighty one stroke patients admitted to a convalescent rehabilitation ward were randomly allocated to the above 5 treatment groups. Each patient performed functional training of the paralytic lower limb for 20 minutes a day for 4 weeks, and changes in the lower limb function were investigated using the Stroke Impairment Assessment Set. [Results] The hip and knee joint functions did not significantly improve in the standard training control group, but significant improvements were observed after 4 weeks in the other intervention groups. Significant improvement was noted in the ankle joint function in all groups. [Conclusion] Although the results were influenced by spontaneous recovery and the standard training in the control group, the hip and knee joints were more markedly improved by the interventions in the other 4 groups of patients with moderate paralysis, compared to the control group. PMID:26504331

Comparison of adaptive neuro-fuzzy inference system (ANFIS) and Gaussian processes for machine learning (GPML) algorithms for the prediction of skin temperature in lower limb prostheses.

PubMed

Mathur, Neha; Glesk, Ivan; Buis, Arjan

2016-10-01

Monitoring of the interface temperature at skin level in lower-limb prosthesis is notoriously complicated. This is due to the flexible nature of the interface liners used impeding the required consistent positioning of the temperature sensors during donning and doffing. Predicting the in-socket residual limb temperature by monitoring the temperature between socket and liner rather than skin and liner could be an important step in alleviating complaints on increased temperature and perspiration in prosthetic sockets. In this work, we propose to implement an adaptive neuro fuzzy inference strategy (ANFIS) to predict the in-socket residual limb temperature. ANFIS belongs to the family of fused neuro fuzzy system in which the fuzzy system is incorporated in a framework which is adaptive in nature. The proposed method is compared to our earlier work using Gaussian processes for machine learning. By comparing the predicted and actual data, results indicate that both the modeling techniques have comparable performance metrics and can be efficiently used for non-invasive temperature monitoring. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

A Heart-Hand Syndrome Gene: Tfap2b Plays a Critical Role in the Development and Remodeling of Mouse Ductus Arteriosus and Limb Patterning

PubMed Central

Zhao, Feng; Bosserhoff, Anja-Katrin; Buettner, Reinhard; Moser, Markus

2011-01-01

Background Patent ductus arteriosus (PDA) is one of the most common forms of congenital heart disease. Mutations in transcription factor TFAP2B cause Char syndrome, a human disorder characterized by PDA, facial dysmorphysm and hand anomalies. Animal research data are needed to understand the mechanisms. The aim of our study was to elucidate the pathogenesis of Char syndrome at the molecular level. Methodology/Principal Findings Gene expression of Tfap2b during mouse development was studied, and newborns of Tfap2b-deficient mice were examined to identify phenotypes. Gel shift assays had been carried out to search for Tfap2 downstream genes. Promoters of candidate genes were cloned into a reporter construct and used to demonstrate their regulation by Tfap2b in cell transfection. In situ hybridizations showed that the murine transcription factor Tfap2b was expressed during the entire development of mouse ductus arteriosus. Histological examination of ductus arteriosus from Tfap2b knockout mice 6 hours after birth revealed that they were not closed. Consequently, the lungs of Tfap2b −/− mice demonstrated progressive congestion of the pulmonary capillaries, which was postulated to result secondarily from PDA. In addition, Tfap2b was expressed in the limb buds, particularly in the posterior limb field during development. Lack of Tfap2b resulted in bilateral postaxial accessory digits. Further study indicated that expressions of bone morphogenetic protein (Bmp) genes, which are reported to be involved in the limb patterning and ductal development, were altered in limb buds of Tfap2b-deficient embryos, due to direct control of Bmp2 and Bmp4 promoter activity by Tfap2b. Conclusions/Significance Tfap2b plays important roles in the development of mouse ductus arteriosus and limb patterning. Loss of Tfap2b results in altered Bmp expression that may cause the heart-limb defects observed in Tfap2b mouse mutants and Char syndrome patients. The Tfap2b knockout mouse may add to the very limited available animal models of PDA. PMID:21829553

Sleep disturbances in children with attention-deficit/hyperactivity disorder

PubMed Central

Spruyt, Karen; Gozal, David

2011-01-01

In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities. PMID:21469929

Sleep disorders in Parkinson's disease: a narrative review of the literature.

PubMed

Raggi, Alberto; Bella, Rita; Pennisi, Giovanni; Neri, Walter; Ferri, Raffaele

2013-01-01

Parkinson's disease (PD) is classically considered to be a motor system affliction; however, also non-motor alterations, including sleep disorders, are important features of the disease. The aim of this review is to provide data on sleep disturbances in PD in the following grouping: difficulty initiating sleep, frequent night-time awakening and sleep fragmentation, nocturia, restless legs syndrome/periodic limb movements, sleep breathing disorders, drug induced symptoms, parasomnias associated with rapid eye movements (REM) sleep, sleep attacks, reduced sleep efficiency and excessive daytime sleepiness. Research has characterized some of these disturbances as typical examples of dissociated states of wakefulness and sleep that are admixtures or incomplete declarations of wakefulness, REM sleep, and non-REM (NREM) sleep. Moreover, sleep disorders may precede the typical motor system impairment of PD and their ability to predict disease has important implications for development of neuroprotective treatment; in particular, REM sleep behavior disorder may herald any other clinical manifestation of PD by more than 10 years.

Altered distribution of ATG9A and accumulation of axonal aggregates in neurons from a mouse model of AP-4 deficiency syndrome

PubMed Central

De Pace, Raffaella; Damme, Markus; Mattera, Rafael; Jarnik, Michal; Hoffmann, Victoria; Morris, H. Douglas; Han, Tae-Un; Mancini, Grazia M. S.; Buonanno, Andrés

2018-01-01

The hereditary spastic paraplegias (HSP) are a clinically and genetically heterogeneous group of disorders characterized by progressive lower limb spasticity. Mutations in subunits of the heterotetrameric (ε-β4-μ4-σ4) adaptor protein 4 (AP-4) complex cause an autosomal recessive form of complicated HSP referred to as “AP-4 deficiency syndrome”. In addition to lower limb spasticity, this syndrome features intellectual disability, microcephaly, seizures, thin corpus callosum and upper limb spasticity. The pathogenetic mechanism, however, remains poorly understood. Here we report the characterization of a knockout (KO) mouse for the AP4E1 gene encoding the ε subunit of AP-4. We find that AP-4 ε KO mice exhibit a range of neurological phenotypes, including hindlimb clasping, decreased motor coordination and weak grip strength. In addition, AP-4 ε KO mice display a thin corpus callosum and axonal swellings in various areas of the brain and spinal cord. Immunohistochemical analyses show that the transmembrane autophagy-related protein 9A (ATG9A) is more concentrated in the trans-Golgi network (TGN) and depleted from the peripheral cytoplasm both in skin fibroblasts from patients with mutations in the μ4 subunit of AP-4 and in various neuronal types in AP-4 ε KO mice. ATG9A mislocalization is associated with increased tendency to accumulate mutant huntingtin (HTT) aggregates in the axons of AP-4 ε KO neurons. These findings indicate that the AP-4 ε KO mouse is a suitable animal model for AP-4 deficiency syndrome, and that defective mobilization of ATG9A from the TGN and impaired autophagic degradation of protein aggregates might contribute to neuroaxonal dystrophy in this disorder. PMID:29698489

A Reevaluation of X-Irradiation Induced Phocomelia and Proximodistal Limb Patterning

PubMed Central

Galloway, Jenna L.; Delgado, Irene; Ros, Maria A.; Tabin, Clifford J.

2009-01-01

Phocomelia is a devastating, rare congenital limb malformation in which the long bones are shorter than normal, with the upper portion of the limb being most severely affected. In extreme cases, the hands or fingers are attached directly to the shoulder and the most proximal elements (those closest to the shoulder) are entirely missing. This disorder, previously known in both autosomal recessive and sporadic forms, showed a dramatic increase in incidence in the early 1960’s due to the tragic toxicological effects of the drug thalidomide, which had been prescribed as a mild sedative1, 2. This human birth defect is mimicked in developing chick limb buds exposed to X-irradiation3-5. Both X-irradiation5 and thalidomide-induced phocomelia5, 6 have been interpreted as patterning defects in the context of the Progress Zone Model, which states that a cell’s proximodistal (PD) identity is determined by the length of time spent in a distal limb region termed the “Progress Zone” 7. Indeed, studies of X-irradiation induced phocomelia have served as one of the two major experimental lines of evidence supporting the validity of the Progress Zone Model. Here, using a combination of molecular analysis and lineage tracing, we show that X-irradiation-induced phocomelia is fundamentally not a patterning defect, but rather results from a time-dependent loss of skeletal progenitors. As skeletal condensation proceeds from the shoulder to fingers (in a proximal to distal direction), the proximal elements are differentially affected in limb buds exposed to radiation at early stages. This conclusion changes the framework for considering the effect of thalidomide and other forms of phocomelia, suggesting the possibility that the etiology lies not in a defect in the patterning process, but rather in progenitor cell survival and differentiation. Moreover, molecular evidence that PD patterning is unaffected following X-irradiation does not support the predictions of the Progress Zone Model. PMID:19553938

A reevaluation of X-irradiation-induced phocomelia and proximodistal limb patterning.

PubMed

Galloway, Jenna L; Delgado, Irene; Ros, Maria A; Tabin, Clifford J

2009-07-16

Phocomelia is a devastating, rare congenital limb malformation in which the long bones are shorter than normal, with the upper portion of the limb being most severely affected. In extreme cases, the hands or fingers are attached directly to the shoulder and the most proximal elements (those closest to the shoulder) are entirely missing. This disorder, previously known in both autosomal recessive and sporadic forms, showed a marked increase in incidence in the early 1960s due to the tragic toxicological effects of the drug thalidomide, which had been prescribed as a mild sedative. This human birth defect is mimicked in developing chick limb buds exposed to X-irradiation. Both X-irradiation and thalidomide-induced phocomelia have been interpreted as patterning defects in the context of the progress zone model, which states that a cell's proximodistal identity is determined by the length of time spent in a distal limb region termed the 'progress zone'. Indeed, studies of X-irradiation-induced phocomelia have served as one of the two major experimental lines of evidence supporting the validity of the progress zone model. Here, using a combination of molecular analysis and lineage tracing in chick, we show that X-irradiation-induced phocomelia is fundamentally not a patterning defect, but rather results from a time-dependent loss of skeletal progenitors. Because skeletal condensation proceeds from the shoulder to fingers (in a proximal to distal direction), the proximal elements are differentially affected in limb buds exposed to radiation at early stages. This conclusion changes the framework for considering the effect of thalidomide and other forms of phocomelia, suggesting the possibility that the aetiology lies not in a defect in the patterning process, but rather in progenitor cell survival and differentiation. Moreover, molecular evidence that proximodistal patterning is unaffected after X-irradiation does not support the predictions of the progress zone model.

Towards Efficient Decoding of Multiple Classes of Motor Imagery Limb Movements Based on EEG Spectral and Time Domain Descriptors.

PubMed

Samuel, Oluwarotimi Williams; Geng, Yanjuan; Li, Xiangxin; Li, Guanglin

2017-10-28

To control multiple degrees of freedom (MDoF) upper limb prostheses, pattern recognition (PR) of electromyogram (EMG) signals has been successfully applied. This technique requires amputees to provide sufficient EMG signals to decode their limb movement intentions (LMIs). However, amputees with neuromuscular disorder/high level amputation often cannot provide sufficient EMG control signals, and thus the applicability of the EMG-PR technique is limited especially to this category of amputees. As an alternative approach, electroencephalograph (EEG) signals recorded non-invasively from the brain have been utilized to decode the LMIs of humans. However, most of the existing EEG based limb movement decoding methods primarily focus on identifying limited classes of upper limb movements. In addition, investigation on EEG feature extraction methods for the decoding of multiple classes of LMIs has rarely been considered. Therefore, 32 EEG feature extraction methods (including 12 spectral domain descriptors (SDDs) and 20 time domain descriptors (TDDs)) were used to decode multiple classes of motor imagery patterns associated with different upper limb movements based on 64-channel EEG recordings. From the obtained experimental results, the best individual TDD achieved an accuracy of 67.05 ± 3.12% as against 87.03 ± 2.26% for the best SDD. By applying a linear feature combination technique, an optimal set of combined TDDs recorded an average accuracy of 90.68% while that of the SDDs achieved an accuracy of 99.55% which were significantly higher than those of the individual TDD and SDD at p < 0.05. Our findings suggest that optimal feature set combination would yield a relatively high decoding accuracy that may improve the clinical robustness of MDoF neuroprosthesis. The study was approved by the ethics committee of Institutional Review Board of Shenzhen Institutes of Advanced Technology, and the reference number is SIAT-IRB-150515-H0077.

Tissue dielectric constant and circumference measurement in the follow-up of treatment-related changes in lower-limb lymphedema.

PubMed

Tugral, Alper; Viren, Tuomas; Bakar, Yesim

2018-02-01

Lymphedema of lower limbs is a chronic condition that requires life-long management. Therapeutic effect of complex decongestive physiotherapy (CDP) is most often followed by circumference measurements (CM). However, the CM measurements are not specific to interstitial tissue fluid and have problems in sensitivity and objectivity. The aim of present study was to evaluate the therapeutic effect of CDP with a new tissue water specific measurement technique, in patients with lower limb lymphedema (LLL). A total of 17 patients with unilateral LLL (11 primary, 6 secondary lymphedema) were recruited in this study. CDP was applied for 5 days a week for 4 weeks. CM measurement of both limbs was performed at nine sites along limb by tape measure. Percentage skin water content (PWC) of thigh, calf and ankle was measured in affected lymphedema limb and contralateral limb with MoistureMeterD Compact (MMDC) device. Inter-limb PWC ratio was calculated by dividing affected side's PWC value with PWC of contralateral limb. Patients were asked to fullfill the Lymph Quality of Life Questionnaire. Significant reduction of circumference after CDP was detected at all nine measurement sites along lower limb (P<0.01). PWC measurements showed a significant decrease of skin tissue water at thigh, calf and ankle measurement sites after CDP (P<0.001). Inter-limb PWC ratios demonstrated significant reduction of edema between affected and contraletral limbs post-treatment (P<0.003). CDP also increased the quality of life (P=0.006). CM and PWC measurements reflected a positive effect of CDP in patients with LLL. Both absolute PWC values and inter-limb PWC ratios were meaningful tools to follow the effect of therapautic intervention. Compared with CM measurements the TDC technique offered easier, quicker, objective and more practical measurements for routine assessments of LLL.

Myasthenia Gravis: A Review

PubMed Central

Jayam Trouth, Annapurni; Dabi, Alok; Solieman, Noha; Kurukumbi, Mohankumar; Kalyanam, Janaki

2012-01-01

Acquired myasthenia gravis is a relatively uncommon disorder, with prevalence rates that have increased to about 20 per 100,000 in the US population. This autoimmune disease is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. In about two-thirds of the patients, the involvement of extrinsic ocular muscle presents as the initial symptom, usually progressing to involve other bulbar muscles and limb musculature, resulting in generalized myasthenia gravis. Although the cause of the disorder is unknown, the role of circulating antibodies directed against the nicotinic acetylcholine receptor in its pathogenesis is well established. As this disorder is highly treatable, prompt recognition is crucial. During the past decade, significant progress has been made in our understanding of the disease, leading to new treatment modalities and a significant reduction in morbidity and mortality. PMID:23193443

[An update on myasthenia gravis].

PubMed

Martínez Torre, S; Gómez Molinero, I; Martínez Girón, R

2018-03-16

Myasthenia gravis is one of the most common disorders that affect neuromuscular transmission. It is currently one of the most understood and characterised autoimmune disorders Its typical symptoms are fluctuating weakness and fatigue that affects a combination of ocular muscles, bulbar functions, as well as limb and respiratory muscles, which are due to an immune attack against the postsynaptic membrane of the neuromuscular junction. The diagnosis of myasthenia gravis is based on clinical and serological test. It is a disease that can be effectively controlled with the current therapeutic lines, even achieving a complete remission. An update of this interesting disorder is now presented. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

2D AND 3D KINEMATICS DURING LATERAL STEP-DOWN TESTING IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

PubMed

Mostaed, Maria F; Werner, David M; Barrios, Joaquin A

2018-02-01

The lateral step-down test is an established clinical evaluation tool to assess quality of movement in patients with knee disorders. However, this test has not been investigated in individuals after anterior cruciate ligament reconstruction (ACLR) in association with quantitative 3D motion analysis. The purpose of this study was to determine the strength of association between visually-assessed quality of movement during the lateral step-down test and 3D lower limb kinematics in patients with history of ACLR. A second purpose was to compare kinematics between subgroups based on the presence or absence of faulty alignments during the task. The final purpose was to compare visually-assessed quality of movement scores between box heights during lateral step-down testing. Twenty subjects at least one year status post-ACLR (18 females, age of 24.5 ± 4.6 years and body mass index of 23.4 ± 2.3 kg/m 2 ) performed the lateral step-down test unilaterally on the surgical limb atop four and six inch boxes. A board-certified orthopedic physical therapist scored overall quality of movement during the lateral step-down test using established criteria during 2D video playback. Lower limb kinematics were simultaneously collected using 3D motion capture. An alpha level of 0.05 was used for all statistical treatments. Overall 2D quality of movement score significantly correlated (r =0.47-0.57) with 3D hip adduction and hip internal rotation across box heights. Across box heights, the presence of faulty pelvic alignment differentiated a subgroup exhibiting less peak knee flexion, and the presence of faulty knee alignment differentiated a subgroup exhibiting greater peak hip adduction. The six inch box elicited worse quality of movement compared to the four inch box. These results suggest that visually-assessed quality of movement is associated with several kinematic variables after ACLR. 2D movement deviations at the pelvis appear to consistently relate to less knee flexion, and 2D deviations at the knee appear to suggest greater hip adduction. Generally, poorer quality of movement was observed for the six inch box height. Clinically, these data suggest that interventions targeting hip abductor and knee extensor strength and neuromuscular control may be useful in the presence of poor quality of movement during lateral step-down testing. 2b.

Fanconi anemia in brothers initially diagnosed with VACTERL association with hydrocephalus, and subsequently with Baller-Gerold syndrome

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rossbach, H.C.; Granan, N.H.; Rossi, A.R.

1996-01-02

Two brothers with presumed Baller-Gerold syndrome, one of whom was previously diagnosed with the association of vertebral, cardiac, renal, limb anomalies, anal atresia, tracheo-esophageal fistula (VACTERL) association with hydrocephalus, were evaluated for chromosome breakage because of severe thrombo cytopenia in one of them. Spontaneous and clastogen-induced breakage was markedly increased in both patients as compared to control individuals. Clinical manifestations and chromosome breakage, consistent with Fanconi anemia, in patients with a prior diagnosis of either Baller-Gerold syndrome, reported earlier in one other patient, or with VACTERL association with hydrocephalus, recently reported in 3 patients, underline the clinical heterogeneity of Fanconimore » anemia and raise the question of whether these syndromes are distinct disorders or phenotypic variations of the same disease. 12 refs., 3 figs., 1 tab.« less

Acute limb heating improves macro- and microvascular dilator function in the leg of aged humans.

PubMed

Romero, Steven A; Gagnon, Daniel; Adams, Amy N; Cramer, Matthew N; Kouda, Ken; Crandall, Craig G

2017-01-01

Local heating of an extremity increases blood flow and vascular shear stress throughout the arterial tree. Local heating acutely improves macrovascular dilator function in the upper limbs of young healthy adults through a shear stress-dependent mechanism but has no such effect in the lower limbs of this age group. The effect of acute limb heating on dilator function within the atherosclerotic prone vasculature of the lower limbs of aged adults is unknown. Therefore, the purpose of this study was to test the hypothesis that acute lower limb heating improves macro- and microvascular dilator function within the leg vasculature of aged adults. Nine young and nine aged adults immersed their lower limbs at a depth of ~33 cm into a heated (~42°C) circulated water bath for 45 min. Before and 30 min after heating, macro (flow-mediated dilation)- and microvascular (reactive hyperemia) dilator functions were assessed in the lower limb, following 5 min of arterial occlusion, via Doppler ultrasound. Compared with preheat, macrovascular dilator function was unchanged following heating in young adults (P = 0.6) but was improved in aged adults (P = 0.04). Similarly, microvascular dilator function, as assessed by peak reactive hyperemia, was unchanged following heating in young adults (P = 0.1) but was improved in aged adults (P < 0.01). Taken together, these data suggest that acute lower limb heating improves both macro- and microvascular dilator function in an age dependent manner. We demonstrate that lower limb heating acutely improves macro- and microvascular dilator function within the atherosclerotic prone vasculature of the leg in aged adults. These findings provide evidence for a potential therapeutic use of chronic lower limb heating to improve vascular health in primary aging and various disease conditions. Copyright © 2017 the American Physiological Society.

A comparison of upper limb amputees and patients with upper limb injuries using the Disability of the Arm, Shoulder and Hand (DASH).

PubMed

Davidson, Judith

To use the Disability of the Arm Shoulder and Hand (DASH) scale to measure the disability of patients with upper limb amputation(s) and to compare these to other upper limb injuries. All 274 patients over the age of 18 years presenting to Prince Henry Hospital in Sydney over a 4-year time frame were given the DASH assessment tool and asked to complete it under supervision of the Occupational Therapist. Patients with brachial plexus injuries, Complex Regional Pain Syndrome and bilateral upper limb amputations demonstrated significantly higher levels of disability to patients with unilateral upper limb amputations. Partial hand amputees reported a higher level of disability than major unilateral upper limb amputees. For the 48 patients who completed pre- and post-treatment assessments, there was a significant improvement in their health status. Further research is required to understand the factors that affect a patient's perceptions of their disability. Perhaps the definitive nature of an amputation and the immediate involvement of highly skilled health professionals serve to assist patients to accept their injury and therefore minimizes the level of disability.

Comparative Transcriptional Profiling of the Axolotl Limb Identifies a Tripartite Regeneration-Specific Gene Program

PubMed Central

Knapp, Dunja; Schulz, Herbert; Rascon, Cynthia Alexander; Volkmer, Michael; Scholz, Juliane; Nacu, Eugen; Le, Mu; Novozhilov, Sergey; Tazaki, Akira; Protze, Stephanie; Jacob, Tina; Hubner, Norbert; Habermann, Bianca; Tanaka, Elly M.

2013-01-01

Understanding how the limb blastema is established after the initial wound healing response is an important aspect of regeneration research. Here we performed parallel expression profile time courses of healing lateral wounds versus amputated limbs in axolotl. This comparison between wound healing and regeneration allowed us to identify amputation-specific genes. By clustering the expression profiles of these samples, we could detect three distinguishable phases of gene expression – early wound healing followed by a transition-phase leading to establishment of the limb development program, which correspond to the three phases of limb regeneration that had been defined by morphological criteria. By focusing on the transition-phase, we identified 93 strictly amputation-associated genes many of which are implicated in oxidative-stress response, chromatin modification, epithelial development or limb development. We further classified the genes based on whether they were or were not significantly expressed in the developing limb bud. The specific localization of 53 selected candidates within the blastema was investigated by in situ hybridization. In summary, we identified a set of genes that are expressed specifically during regeneration and are therefore, likely candidates for the regulation of blastema formation. PMID:23658691

Upper and lower limb functionality: are these compromised in obese children?

PubMed

Riddiford-Harland, Diane L; Steele, Julie R; Baur, Louise A

2006-01-01

The aim of this study was to investigate the effects of obesity on upper and lower limb functional strength and power in children, and to determine whether the ability to perform the daily activity of rising from a chair was compromised in obese children. It was hypothesised that obese children would display less upper and lower limb functionality compared to their non-obese counterparts. Upper and lower limb strength and power of 43 obese children (aged 8.4 +/- 0.5 y, BMI 24.1 +/- 2.3 kg/m(-2)) and 43 non-obese controls (aged 8.4 +/- 0.5 y, BMI 16.9 +/- 0.4 kg/m(-2)) were assessed using age-appropriate field-based tests: arm push/pull ability; basketball throw; vertical jump (VJ), and standing long jump (SLJ) performance. Functional lower limb strength was assessed for 13 obese and 13 non-obese children by quantifying their chair rising ability. Although obese children displayed significantly greater upper limb push (9.3 +/- 2.3 kg) and pull strength (9.6 +/- 3.0 kg) than their non-obese peers (push: 8.8 +/- 2.2 kg; pull: 8.8 +/- 2.3 kg; p < or = 0.05), their VJ (22.1 +/- 4.3 cm) and SLJ (94.6 +/- 12.8 cm) performance was significantly impaired relative to the non-obese children (VJ: 24.7 +/- 4.0 cm; SLJ: 101.7 +/- 14.0 cm; p < or = 0.05). Obese children spent significantly more time during all transfer phases of the chair rising task, compared to the non-obese children. Lower limb functionality in young obese children is impeded when they move their greater body mass against gravity.

THE CHROMOSPHERIC SOLAR LIMB BRIGHTENING AT RADIO, MILLIMETER, SUB-MILLIMETER, AND INFRARED WAVELENGTHS

DOE Office of Scientific and Technical Information (OSTI.GOV)

De la Luz, V.

2016-07-10

Observations of the emission at radio, millimeter, sub-millimeter, and infrared wavelengths in the center of the solar disk validate the autoconsistence of semi-empirical models of the chromosphere. Theoretically, these models must reproduce the emission at the solar limb. In this work, we tested both the VALC and C7 semi-empirical models by computing their emission spectrum in the frequency range from 2 GHz to 10 THz at solar limb altitudes. We calculate the Sun's theoretical radii as well as their limb brightening. Non-local thermodynamic equilibrium was computed for hydrogen, electron density, and H{sup −}. In order to solve the radiative transfermore » equation, a three-dimensional (3D) geometry was employed to determine the ray paths, and Bremsstrahlung, H{sup −}, and inverse Bremsstrahlung opacity sources were integrated in the optical depth. We compared the computed solar radii with high-resolution observations at the limb obtained by Clark. We found that there are differences between the observed and computed solar radii of 12,000 km at 20 GHz, 5000 km at 100 GHz, and 1000 km at 3 THz for both semi-empirical models. A difference of 8000 km in the solar radii was found when comparing our results against the heights obtained from H α observations of spicules-off at the solar limb. We conclude that the solar radii cannot be reproduced by VALC and C7 semi-empirical models at radio—infrared wavelengths. Therefore, the structures in the high chromosphere provide a better measurement of the solar radii and their limb brightening as shown in previous investigations.« less

Thromboembolic Complications after Zenith{sup ®} Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Urlings, T. A. J., E-mail: t-urlings@hotmail.com; Vries, A. C. de, E-mail: a.de.vries@mchaaglanden.nl; Mol van Otterloo, J. C. A. de, E-mail: a.de.molvanotterloo@mchaaglanden.nl

2015-06-15

PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith{sup ®} Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographicmore » images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute.« less

Substantive hemodynamic and thermal strain upon completing lower-limb hot-water immersion; comparisons with treadmill running.

PubMed

Thomas, Kate N; van Rij, André M; Lucas, Samuel J E; Gray, Andrew R; Cotter, James D

2016-01-01

Exercise induces arterial flow patterns that promote functional and structural adaptations, improving functional capacity and reducing cardiovascular risk. While heat is produced by exercise, local and whole-body passive heating have recently been shown to generate favorable flow profiles and associated vascular adaptations in the upper limb. Flow responses to acute heating in the lower limbs have not yet been assessed, or directly compared to exercise, and other cardiovascular effects of lower-limb heating have not been fully characterized. Lower-limb heating by hot-water immersion (30 min at 42°C, to the waist) was compared to matched-duration treadmill running (65-75% age-predicted heart rate maximum) in 10 healthy, young adult volunteers. Superficial femoral artery shear rate assessed immediately upon completion was increased to a greater extent following immersion (mean ± SD: immersion +252 ± 137% vs. exercise +155 ± 69%, interaction: p = 0.032), while superficial femoral artery flow-mediated dilation was unchanged in either intervention. Immersion increased heart rate to a lower peak than during exercise (immersion +38 ± 3 beats·min -1 vs. exercise +87 ± 3 beats·min -1 , interaction: p < 0.001), whereas only immersion reduced mean arterial pressure after exposure (-8 ± 3 mmHg, p = 0.012). Core temperature increased twice as much during immersion as exercise (+1.3 ± 0.4°C vs. +0.6 ± 0.4°C, p < 0.001). These data indicate that acute lower-limb hot-water immersion has potential to induce favorable shear stress patterns and cardiovascular responses within vessels prone to atherosclerosis. Whether repetition of lower-limb heating has long-term beneficial effects in such vasculature remains unexplored.

The cross education of strength and skill following unilateral strength training in the upper and lower limbs.

PubMed

Green, Lara A; Gabriel, David A

2018-04-18

Cross education is the strength gain or skill improvement transferred to the contralateral limb following unilateral training or practice. The present study examined the transfer of both strength and skill following a strength training program. Forty participants (20M, 20F) completed a 6-week unilateral training program of dominant wrist flexion or dorsiflexion. Strength, force variability, and muscle activity were assessed pre-training, post-training, and following 6-weeks of detraining (retention). Analyses of covariance compared the experimental limb (trained or untrained) to the control (dominant or non-dominant). There were no sex differences in the training response. Cross education of strength at post-training was 6% (p<0.01) in the untrained arm and 13% (p<0.01) in the untrained leg. Contralateral strength continued to increase following detraining to 15% in the arm (p<0.01) and 14% in the leg (p<0.01). There was no difference in strength gains between upper and lower limbs (p>0.05). Cross education of skill (force variability) demonstrated greater improvements in the untrained limbs compared to the control limbs during contractions performed without concurrent feedback. Significant increases in V-wave amplitude (p=0.02) and central activation (p<0.01) were highly correlated with contralateral strength gains. There was no change in agonist amplitude or motor unit firing rates in the untrained limbs (p>0.05). The neuromuscular mechanisms mirrored the force increases at post-training and retention supporting central drive adaptations of cross education. The continued strength increases at retention identified the presence of motor learning in cross education, as confirmed by force variability.

Ontogenetic scaling of fore limb and hind limb joint posture and limb bone cross-sectional geometry in vervets and baboons.

PubMed

Burgess, M Loring; Schmitt, Daniel; Zeininger, Angel; McFarlin, Shannon C; Zihlman, Adrienne L; Polk, John D; Ruff, Christopher B

2016-09-01

Previous studies suggest that the postures habitually adopted by an animal influence the mechanical loading of its long bones. Relatively extended limb postures in larger animals should preferentially reduce anteroposterior (A-P) relative to mediolateral (M-L) bending of the limb bones and therefore decrease A-P/M-L rigidity. We test this hypothesis by examining growth-related changes in limb bone structure in two primate taxa that differ in ontogenetic patterns of joint posture. Knee and elbow angles of adult and immature vervets (Chlorocebus aethiops, n = 16) were compared to published data for baboons (Papio hamadryas ursinus, n = 33, Patel et al., ). Ontogenetic changes in ratios of A-P/M-L bending rigidity in the femur and humerus were compared in skeletal samples (C. aethiops, n = 28; P. cynocephalus, n = 39). Size changes were assessed with linear regression, and age group differences tested with ANOVA. Only the knee of baboons shows significant postural change, becoming more extended with age and mass. A-P/M-L bending rigidity of the femur decreases during ontogeny in immature and adult female baboons only. Trends in the humerus are less marked. Adult male baboons have higher A-P/M-L bending rigidity of the femur than females. The hypothesized relationship between more extended joints and reduced A-P/M-L bending rigidity is supported by our results for immature and adult female baboon hind limbs, and the lack of significant age changes in either parameter in forelimbs and vervets. Adult males of both species depart from general ontogenetic trends, possibly due to socially mediated behavioral differences between sexes. Am J Phys Anthropol 161:72-83, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Hamstring Strength and Morphology Progression after Return to Sport from Injury

PubMed Central

Sanfilippo, Jennifer; Silder, Amy; Sherry, Marc A; Tuite, Michael J; Heiderscheit, Bryan C

2012-01-01

Hamstring strain re-injury rates can reach 30% within the initial two weeks following return to sport (RTS). Incomplete recovery of strength may be a contributing factor. However, relative strength of the injured and unaffected limbs at RTS is currently unknown. PURPOSE: Characterize hamstring strength and morphology at the time of RTS and six months later. METHODS: Twenty-five athletes that experienced an acute hamstring strain injury participated, following completion of a controlled rehabilitation program. Bilateral isokinetic strength testing and magnetic resonance imaging (MRI) were performed at RTS and 6-months later. Strength (knee flexion peak torque, work, angle of peak torque) and MRI (muscle and tendon volumes) measures were compared between limbs and over time using repeated measures ANOVA. RESULTS: The injured limb showed a peak torque deficit of 9.6% compared to the uninjured limb at RTS (60°/s, p<0.001), but not 6-months following. The knee flexion angle of peak torque decreased over time for both limbs (60°/s, p<0.001). MRI revealed that 20.4% of the muscle cross-sectional area showed signs of edema at RTS with full resolution by the 6-month follow-up. Tendon volume of the injured limb tended to increase over time (p=0.108), while muscle volume decreased 4–5% in both limbs (p<0.001). CONCLUSION: Residual edema and deficits in isokinetic knee flexion strength were present at RTS, but resolved during the subsequent six months. This occurred despite MRI evidence of scar tissue formation (increased tendon volume) and muscle atrophy, suggesting that neuromuscular factors may contribute to the return of strength. PMID:23059864

Outcomes of the Bobath concept on upper limb recovery following stroke.

PubMed

Luke, Carolyn; Dodd, Karen J; Brock, Kim

2004-12-01

To determine the effectiveness of the Bobath concept at reducing upper limb impairments, activity limitations and participation restrictions after stroke. Electronic databases were searched to identify relevant trials published between 1966 and 2003. Two reviewers independently assessed articles for the following inclusion criteria: population of adults with upper limb disability after stroke; stated use of the Bobath concept aimed at improving upper limb disability in isolation from other approaches; outcomes reflecting changes in upper limb impairment, activity limitation or participation restriction. Of the 688 articles initially identified, eight met the inclusion criteria. Five were randomized controlled trials, one used a single-group crossover design and two were single-case design studies. Five studies measured impairments including shoulder pain, tone, muscle strength and motor control. The Bobath concept was found to reduce shoulder pain better than cryotherapy, and to reduce tone compared to no intervention and compared to proprioceptive neuromuscular facilitation (PNF). However, no difference was detected for changes in tone between the Bobath concept and a functional approach. Differences did not reach significance for measures of muscle strength and motor control. Six studies measured activity limitations, none of these found the Bobath concept was superior to other therapy approaches. Two studies measured changes in participation restriction and both found equivocal results. Comparisons of the Bobath concept with other approaches do not demonstrate superiority of one approach over the other at improving upper limb impairment, activity or participation. However, study limitations relating to methodological quality, the outcome measures used and contextual factors investigated limit the ability to draw conclusions. Future research should use sensitive upper limb measures, trained Bobath therapists and homogeneous samples to identify the influence of patient factors on the response to therapy approaches.

Elective amputation of a "healthy limb".

PubMed

Blom, Rianne M; Guglielmi, Valeria; Denys, Damiaan

2016-10-01

Patients with body integrity identity disorder (BIID) experience a strong desire for amputation from very early on. BIID patients are often dismissed when they share their wish for amputation with surgeons. Consequently, patients resort to self-amputation, including complications and sometimes death. BIID patients are not psychotic and are mentally competent to oversee the consequences of an elective amputation. The authors offer arguments in favor of elective amputation.

Ectopic Fgf signaling induces the intercalary response in developing chicken limb buds.

PubMed

Makanae, Aki; Satoh, Akira

2018-01-01

Intercalary pattern formation is an important regulatory step in amphibian limb regeneration. Amphibian limb regeneration is composed of multiple steps, including wounding, blastema formation, and intercalary pattern formation. Attempts have been made to transfer insights from regeneration-competent animals to regeneration-incompetent animalsat each step in the regeneration process. In the present study, we focused on the intercalary mechanism in chick limb buds. In amphibian limb regeneration, a proximodistal axis is organized as soon as a regenerating blastema is induced. Intermediate structures are subsequently induced (intercalated) between the established proximal and distal identities. Intercalary tissues are derived from proximal tissues. Fgf signaling mediates the intercalary response in amphibian limb regeneration. We attempted to transfer insights into intercalary regeneration from amphibian models to the chick limb bud. The zeugopodial part was dissected out, and the distal and proximal parts were conjunct at st. 24. Delivering ectopic Fgf2 + Fgf8 between the distal and proximal parts resulted in induction of zeugopodial elements. Examination of HoxA11 expression, apoptosis, and cell proliferation provides insights to compare with those in the intercalary mechanism of amphibian limb regeneration. Furthermore, the cellular contribution was investigated in both the chicken intercalary response and that of axolotl limb regeneration. We developed new insights into cellular contribution in amphibian intercalary regeneration, and found consistency between axolotl and chicken intercalary responses. Our findings demonstrate that the same principal of limb regeneration functions between regeneration-competent and -incompetent animals. In this context, we propose the feasibility of the induction of the regeneration response in amniotes.

The innocent bystander. Doxylamine/dicyclomine/pyridoxine and congenital limb defects.

PubMed

McCredie, J; Kricker, A; Elliott, J; Forrest, J

1984-04-28

The antinausea drug combination, doxylamine/dicyclomine/pyridoxine (Debendox or Bendectin [US] ), has been withdrawn from the market because of litigation based upon charges that it causes congenital limb defects. To investigate this allegation, the pregnancy histories of mothers of 155 limb-deficient children, born between 1970 and 1981, have been compared with those of mothers of 273 matched normal controls. There was no significant difference between the pregnancy histories of mothers of case children and those of mothers of control children in respect of reported frequency of morning sickness, the use of doxylamine/dicyclomine/pyridoxine, the date of commencement of its intake, the duration of intake, or its dose. The relative risk of limb deficiency in children of mothers exposed to this drug is estimated to be 1.1 with confidence limits of 0.8-1.5. No risk of congenital limb defects was found to be associated with the use of this drug.

Analysis of the intermediate size proteoglycans from the developing chick limb buds.

PubMed

Vasan, N

1982-08-01

Limb-bud proteoglycans are heterogeneous molecules which vary in their chemical and physical properties with development. This report describes proteoglycan intermediates (PG-I) that predominate in stage-34 limbs, and compares them with proteoglycan aggregates (PG-A) in stage-38 limbs. We analysed proteoglycans and their components extracted with guanidinium chloride by subjecting them to density gradient centrifugation, molecular sieve chromatography, electrophoretic separation, and selective enzymatic degradation. PG-I and PG-A have similar chondroitin sulphate composition, amino sugars, chondroitin sulphate side-chain length, glycoprotein link factors, and hyaluronic acid binding capacity, and both cross react with antisera prepared against cartilage-specific chick sternal proteoglycans. However, PG-I has lower molecular weight, lower buoyant density, and fewer chondroitin sulphate side chains on the protein core. The PG-I in the developing limb can be considered a mixture of smaller aggregates and cartilage-specific large monomers in which the former predominate.

The relationship of gross upper and lower limb motor competence to measures of health and fitness in adolescents aged 13-14 years.

PubMed

Weedon, Benjamin David; Liu, Francesca; Mahmoud, Wala; Metz, Renske; Beunder, Kyle; Delextrat, Anne; Morris, Martyn G; Esser, Patrick; Collett, Johnny; Meaney, Andy; Howells, Ken; Dawes, Helen

2018-01-01

Motor competence (MC) is an important factor in the development of health and fitness in adolescence. This cross-sectional study aims to explore the distribution of MC across school students aged 13-14 years old and the extent of the relationship of MC to measures of health and fitness across genders. A total of 718 participants were tested from three different schools in the UK, 311 girls and 407 boys (aged 13-14 years), pairwise deletion for correlation variables reduced this to 555 (245 girls, 310 boys). Assessments consisted of body mass index, aerobic capacity, anaerobic power, and upper limb and lower limb MC. The distribution of MC and the strength of the relationships between MC and health/fitness measures were explored. Girls performed lower for MC and health/fitness measures compared with boys. Both measures of MC showed a normal distribution and a significant linear relationship of MC to all health and fitness measures for boys, girls and combined genders. A stronger relationship was reported for upper limb MC and aerobic capacity when compared with lower limb MC and aerobic capacity in boys (t=-2.21, degrees of freedom=307, P=0.03, 95% CI -0.253 to -0.011). Normally distributed measures of upper and lower limb MC are linearly related to health and fitness measures in adolescents in a UK sample. NCT02517333.

Neuroimaging Insights into the Pathophysiology of Sleep Disorders

PubMed Central

Desseilles, Martin; Dang-Vu, Thanh; Schabus, Manuel; Sterpenich, Virginie; Maquet, Pierre; Schwartz, Sophie

2008-01-01

Neuroimaging methods can be used to investigate whether sleep disorders are associated with specific changes in brain structure or regional activity. However, it is still unclear how these new data might improve our understanding of the pathophysiology underlying adult sleep disorders. Here we review functional brain imaging findings in major intrinsic sleep disorders (i.e., idiopathic insomnia, narcolepsy, and obstructive sleep apnea) and in abnormal motor behavior during sleep (i.e., periodic limb movement disorder and REM sleep behavior disorder). The studies reviewed include neuroanatomical assessments (voxel-based morphometry, magnetic resonance spectroscopy), metabolic/functional investigations (positron emission tomography, single photon emission computed tomography, functional magnetic resonance imaging), and ligand marker measurements. Based on the current state of the research, we suggest that brain imaging is a useful approach to assess the structural and functional correlates of sleep impairments as well as better understand the cerebral consequences of various therapeutic approaches. Modern neuroimaging techniques therefore provide a valuable tool to gain insight into possible pathophysiological mechanisms of sleep disorders in adult humans. Citation: Desseilles M; Dang-Vu TD; Schabus M; Sterpenich V; Maquet P; Schwartz S. Neuroimaging insights into the pathophysiology of sleep disorders. SLEEP 2008;31(6):777–794. PMID:18548822

Relationship between the practice of physical activity and quality of movement in adolescents: a screening tool using self-organizing maps.

PubMed

Herrero-Herrero, María; García-Massó, Xavier; Martínez-Corralo, Carlos; Prades-Piñón, Josep; Sanchis-Alfonso, Vicente

2017-09-01

The aim of this study was to determine whether the most physically active adolescents have better lower limb control. 31 high school students (12 males and 19 females) participated in this study. The Anterior Knee Pain Scale was used to find any cases of knee pain. Only subjects with high scores were selected, to exclude those with knee pain or lower limb injuries. Single Leg Squat and Tuck Jump Assessment were used to evaluate movements with two cameras in a two-dimensional assessment. The IPAQ Questionnaire was used to score the physical activity and to classify it into MET total, MET moderate activity, MET vigorous activity and MET walking. These scores were related to knee angle at landing, age and body mass index by self-organizing maps analysis. The subjects were classified into 4 clusters and the descriptive statistics of the different clusters were determined to find any differences. The subjects in cluster 3 were classified as those with the highest risk factors of suffering lower limb musculoskeletal disorders or knee pain, even though injuries do not only depend on quality of movement. Physical activity was not related to healthy movements during jump and single leg squat. Physical activity alone cannot be an indicator of good quality lower limb movement, as the knee valgus angle plays a determining role, as it could also depend on neuromuscular control and anatomical characteristics. The analytical method described in the study could be used by physical education teachers to detect potential risk factors for musculoskeletal problems in the lower limbs, especially in the knees.

Adults with congenital limb deficiency in Norway: demographic and clinical features, pain and the use of health care and welfare services. A cross-sectional study.

PubMed

Johansen, Heidi; Østlie, Kristin; Andersen, Liv Øinæs; Rand-Hendriksen, Svend

2015-01-01

To describe an adult population with congenital limb deficiency (CLD) recruited through the National Resource Centre for Rare Disorders (TRS) in Norway: (1) demographic factors, (2) clinical features, (3) pain and (4) use of health care and welfare services. Cross-sectional study. In 2012, a postal questionnaire was sent to 186 eligible persons with CLD, age 20 years and older. Ninety-seven respondents, median-age 39 years (range: 20-82); 71% were women. The population was divided into two subgroups: (1) unilateral upper-limb deficiency (UULD) n = 77, (2) multiple and/or lower-limb deficiency (MLD/LLD). About 40% worked full-time, 18% received disability pensions and 64% reported chronic pain, mostly bilateral pain. Grip-improving devices were used more often than prostheses; 23% were previous prosthesis users. Use of health care and welfare services are described. No significant differences were found between the subgroups regarding pain or employment status. Persons with CLD reported increased prevalence of chronic pain, mostly bilateral, and increased prevalence of early retirement. A greater focus on the benefits of the use of assistive devices, the consequences of overuse and vocational guidance may moderate pain and prevent early retirement. Further studies of more representative samples should be conducted to confirm our findings. Most adults with congenital limb deficiency (CLD) live ordinary lives and experience normal life events. However, several report chronic pain and retire before normal retirement age. In spite of free and accessible prosthetic services, a large fraction chooses not to use prosthesis, more use grip-improving devices for specific activities. These preferences should be acknowledged by rehabilitation specialists. Focus on individually adapted environments, more information about the consequences of overuse, and vocational guidance may moderate pain and prevent early retirement.

PubMed

Salerno, Silvana

2018-02-01

In Italy and in Europe occupational diseases (OD) claims are growing among women, and international studies show women's lower compensation rate. Analysis of occupational diseases compensation rate among "Italian" women (country of birth: Italy) and "immigrant" women (country of birth: not Italy) focusing on biomechanical overload of the upper limb, the most common OD in Italy. INAIL (Italian National Institute for Insurance against Accidents at Work) statistical data (2010-2013) on ascertained OD in Industry-Services (I-S) were analyzed by gender and country of birth with particular attention to biomechanical overload of the upper limb and to occupational diseases not included in the official OD list. A significantly lower compensation rate was found among women (Italy: 39% females vs 43% males; not Italy: 32.5% females vs 36% males). Women's lower success rate was also found for biomechanical overload of the upper limb (Italy: 73% females vs 76% males; not Italy: 64% females vs 70% males), including carpal tunnel syndrome (Italy: 72% females vs 74% males; not Italy: 62% females vs 64% males) and supraspinatus muscle tendinitis (Italy: 71% females vs 79% males; not Italy: 62.5% females vs 72.5% males). Women's claims were more frequent for OD not in the official list (Italy: 53% females vs 51% males; not Italy: 54% females vs 53% males) and had a lower rate of recognition and compensation (Italy: 13% females vs 19% males; not Italy 10% females vs 14% males). Since 2010 women compensation rate has shown a reduction after the initial amelioration in 2008 when biomechanical overload of the upper limb was included in the official list of OD. An overall lower compensation rate among "Italian" and "immigrant" women was found for biomechanical overload disorders of the upper limb and for not officially recognized occupational diseases. Good gender-oriented preventive practices should be promoted.

Residual Limb Hyperhidrosis and RimabotulinumtoxinB: A Randomized Placebo-Controlled Study.

PubMed

Pasquina, Paul F; Perry, Briana N; Alphonso, Aimee L; Finn, Sacha; Fitzpatrick, Kevin F; Tsao, Jack W

2016-05-01

To investigate the use of rimabotulinumtoxinB (BoNT/B [Myobloc]) compared with placebo in treating hyperhidrosis in the residual limbs of individuals with amputation. Randomized, double-blind, placebo-controlled pilot study. Military medical center. Male participants (N=9) with 11 major amputations of the lower limbs and who complained of excessive sweating in their residual limbs were enrolled in the study between September 24, 2008 to October 28, 2011. Participants' lower limbs were randomly assigned to receive injections of either BoNT/B (n=7) or placebo (n=4). BoNT/B. The primary efficacy variable was a minimum of 50% reduction in sweat production 4 weeks after the injection as measured via gravimetric sweat analysis after 10 minutes of physical exertion. Secondary analyses were performed on prosthetic function and pain. All volunteers (100%; 7) in the BoNT/B group achieved a minimum of 50% reduction in sweat production as compared with only 50% (2) in the placebo group. The percent reduction was significantly greater for the BoNT/B group than for the placebo group (-72.7%±15.7% vs -32.7%±39.2%; P<.05). Although both groups subjectively self-reported significant sweat reduction and improved prosthetic function (P<.05 for both), objective gravimetric sweat analyses significantly decreased only for the BoNT/B group (2.3±2.3g vs 0.7±1.1g; P<.05). Neither group reported a change in phantom limb pain or residual limb pain (P>.05 for both). BoNT/B successfully reduces sweat production in individuals with residual limb hyperhidrosis, but does not affect pain. No differences were found in perceived effect on prosthetic use between BoNT/B and placebo groups. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Hox gene expression in the specialized limbs of the Iberian mole (Talpa occidentalis).

PubMed

Bickelmann, Constanze; van der Vos, Wessel; de Bakker, Merijn A G; Jiménez, Rafael; Maas, Saskia; Sánchez-Villagra, Marcelo R

2017-01-01

Fossorial talpid moles use their limbs predominantly for digging, which explains their highly specialized anatomy. The humerus is particularly short and dorsoventrally rotated, with broadened distal and proximal parts where muscles attach and which facilitate powerful abductive movements. The radius and ulna are exceptionally robust and short. The ulna has an expanded olecranon process. The femur is generalized, but the fused tibia-fibula complex is short and robust. To understand the developmental bases of these specializations, we studied expression patterns of four 5' Hox genes in the fossorial Iberian mole (Talpa occidentalis). These genes are known to play major roles in patterning the developing limb skeleton in the mouse, with which comparisons were made (Mus musculus, C57BL/6Jico strain). We find that HoxA9 expression is spatially expanded in the developing stylopodial area in the mole forelimb, compared to the less specialized mouse forelimb and mole hind limb. HoxD9 expression does not extend into the thoracic body wall in the mole forelimb in contrast to the mouse, and is also reduced in the presumptive zeugopodium in mole forelimb, compared to mouse. Expression of HoxD11 is upregulated in the mole in the postaxial area of the hind limb zeugopod, compared to the mouse. On the other hand, HoxD13 is downregulated in the postaxial zeugopodial area in the forelimb of the mole, compared to the mouse. The differences in the expression patterns of these 5' Hox genes between Talpa and Mus are an indication of the developmental changes going hand in hand with anatomical digging adaptations in the mole adult. © 2016 Wiley Periodicals, Inc.

Acute alcohol effects on set-shifting and its moderation by baseline individual differences: a latent variable analysis.

PubMed

Korucuoglu, Ozlem; Sher, Kenneth J; Wood, Phillip K; Saults, John Scott; Altamirano, Lee; Miyake, Akira; Bartholow, Bruce D

2017-03-01

To compare the acute effects of alcohol on set-shifting task performance (relative to sober baseline performance) during ascending and descending limb breath alcohol concentration (BrAC), as well as possible moderation of these effects by baseline individual differences. Shifting performance was tested during an initial baseline and a subsequent drinking session, during which participants were assigned randomly to one of three beverage conditions (alcohol, placebo or control) and one of two BrAC limb conditions [ascending and descending (A/D) or descending-only (D-only)]. A human experimental laboratory on the University of Missouri campus in Columbia, MO, USA. A total of 222 moderate-drinking adults (ages 21-30 years) recruited from Columbia, MO and tested between 2010 and 2013. The outcome measure was performance on set-shifting tasks under the different beverage and limb conditions. Shifting performance assessed at baseline was a key moderator. Although performance improved across sessions, this improvement was reduced in the alcohol compared with no-alcohol groups (post-drink latent mean comparison across groups, all Ps ≤ 0.05), and this effect was more pronounced in individuals with lower pre-drink performance (comparison of pre- to post-drink path coefficients across groups, all Ps ≤ 0.05). In the alcohol group, performance was better on descending compared with ascending limb (P ≤ 0.001), but descending limb performance did not differ across the A/D and D-only groups. Practising tasks before drinking moderates the acute effects of alcohol on the ability to switch between tasks. Greater impairment in shifting ability on descending compared with ascending breath alcohol concentration is not related to task practice. © 2016 Society for the Study of Addiction.