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Sample records for lower-extremity swelling mimicking

  1. Deep venous thrombosis as a cause of stump swelling in two lower extremity amputee patients.

    PubMed

    Chong, D K; Panju, A

    1993-09-01

    Two patients who were initially treated for an infection as a cause for their swollen stump were subsequently found to have deep venous thrombosis. The diagnosis was made noninvasively by compressive ultrasound (CU) scanning. DVT should be considered in the different diagnosis of stump swelling in the otherwise stable, post-rehabilitated lower extremity amputee patient.

  2. Heterotopic bone formation (myositis ossificans) and lower-extremity swelling mimicking deep-venous disease

    SciTech Connect

    Orzel, J.A.; Rudd, T.G.; Nelp, W.B.

    1984-10-01

    A quadriplegic patient with a swollen leg was suspected of having deep-venous thrombosis, and was studied with radionuclide venography (RNV) and contrast venography. Focal narrowing of the femoral vein, seen on RNV, was due to extrinsic compression. Although soft-tissue radiographs were normal, Tc-99m diphosphonate imaging established the diagnosis of early heterotopic bone formation (myositis ossificans), which was responsible for the venous compression. Clinically this inflammatory process can mimic deep-venous thrombosis, and should be considered in evaluating patients at risk for both heterotopic bone formation and deep-venous thrombosis.

  3. Myoparasitism mimicking parotid swelling: a rare presentation of cysticercosis

    PubMed Central

    Tewari, Sandeep; Singh, Saumya; Jaiswal, Vaibhav; Mishra, Anand Kumar

    2014-01-01

    Muscular infestation with larval stage of Taenia solium is a well-recognised entity but cysticercosis of the head and neck region is a rarity. We present a case of 35-year-old young man with diffuse swelling of 3.5×4 cm in the parotid region on the right side of the face with signs of inflammation. Diagnosis was established on high-resolution ultrasonography which revealed it to be of parasitic origin. The patient was managed with antihelminthic pharmacotherapy and improved within a month. Thus cysticercosis should be considered in the differential diagnosis of subcutaneous swellings of the head and neck region, especially in endemic zones and it must be investigated well with appropriate imaging modalities so that inadvertent surgery can be avoided. PMID:24842360

  4. Lower extremity orthoses.

    PubMed

    Bogucki, Artur

    2002-01-31

    This article presents the medical indications and contemporary technical capabilities in orthotic management of lower extremity. The classification included typical orthoses as well as devices that today constitute an integral part of modern therapeutic procedures are presented. Therapeutic success is conditioned by professional team-work of the physician, the therapist, the orthotic technician and the patient. PMID:17679908

  5. Lower extremity prostheses.

    PubMed

    Bogucki, A

    2001-01-01

    This article discusses the technical and medical difficulties involved in the proper fitting of prostheses on the lower extremity. The factors determining the success of a prosthesis include the quality of the stump, the skill of prosthesis socket fabrication, and the proper ordering of components, as well as rehabilitation supervised by experts and professional care for the amputee. PMID:17984917

  6. A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis.

    PubMed

    Akgun, C

    2012-01-01

    Henoch-Schönlein purpura, is one of the most common types of multisystemic vasculitis seen in childhood. The major clinical manifestations are cutaneous purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. Isolated central nervous system vasculitis, seizures, coma and hemorrhage, Guillan--Barré syndrome, ataxia and central and peripheral neuropathy, ocular involvement, orchitis, epididymitis or testicular torsion are medical or surgical complications. In this study, we report a 7-year-old boy with scrotal swelling mimicking testicular torsion with ultrasonographic and clinical findings that the typical clinical features of Henoch-Schönlein purpura including rashes and arthritis were developed after one week of surgery (Ref. 15).

  7. Muscles of the Lower Extremity

    MedlinePlus

    ... Home » Cancer Registration & Surveillance Modules » Anatomy & Physiology » Muscular System » Muscle Groups » Lower Extremity Cancer Registration & Surveillance Modules Anatomy & Physiology Intro to the Human Body Body Functions & Life Process Anatomical Terminology Review Quiz ...

  8. Swelling

    MedlinePlus

    ... syndrome Poor nutrition Pregnancy Thyroid disease Too little albumin in the blood (hypoalbuminemia) Too much salt or ... the swelling. Tests that may be done include: Albumin blood test Blood electrolyte levels Echocardiography ECG Kidney ...

  9. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis.

    PubMed

    Abou Al-Shaar, Hussam; AbouAl-Shaar, Iyad; Al-Kawi, Mohammed Z

    2015-10-01

    Acute infarction of the cervical segment of the spinal cord is extremely uncommon. Patients may present with signs and symptoms mimicking that of acute myelitis. On imaging, both conditions may present as a hyperintense area on T-2 weighted MRI. History of sudden onset is essential in establishing the diagnosis. We report a case of cervical spinal cord infarction in a 40-year-old man who was diagnosed with acute transverse myelitis, and was treated with high dose intravenous corticosteroids followed by 5 sessions of plasma exchange. An MRI of the spine revealed abnormal high T2 signal intensity extending from the C2 to C7 level involving the anterior two-thirds of the cord with more central involvement. The findings were consistent with anterior spinal artery territory cervical cord infarction.

  10. The MR appearance of volume overload in the lower extremities

    NASA Technical Reports Server (NTRS)

    Meler, J. D.; Solomon, M. A.; Steele, J. R.; Yancy, C. W. Jr; Parkey, R. W.; Fleckenstein, J. L.; Blomqvist, C. G. (Principal Investigator)

    1997-01-01

    PURPOSE: Our goal was to describe the MR findings of volume overload (VO) in the lower extremities. METHOD: Fifteen individuals were studied, including eight healthy controls and seven patients with VO (four cardiac, three renal). MR evaluation included various SE techniques. Edema detection, localization, and symmetry were assessed subjectively. Relaxation time estimates were also made of the subcutaneous tissue, marrow, and three muscles. RESULTS: Subcutaneous tissue was markedly edematous in seven of seven patients and asymmetric in four of seven, whereas marrow was normal in all patients. Muscle edema was mild and asymmetric in six and two of seven patients, respectively. Perifascial fluid collections were identified in six of seven patients. CONCLUSION: Subcutaneous tissue edema is the dominant feature of VO in the lower extremities. Perifascial fluid is common but does not necessarily distribute symmetrically. Muscle edema is relatively mild. These findings should aid in identifying VO as the potential cause of swelling in patients with swollen legs.

  11. Prevention of Lower Extremity Injuries in Basketball

    PubMed Central

    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

    2015-01-01

    Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P < 0.001) and ankle sprains (OR, 0.45; 95% CI, 0.29-0.69; P < 0.001), yet not ACL ruptures (OR, 1.09; 95% CI, 0.36-3.29; P = 0.87) in basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. PMID

  12. Lower extremity muscle activation during baseball pitching.

    PubMed

    Campbell, Brian M; Stodden, David F; Nixon, Megan K

    2010-04-01

    The purpose of this study was to investigate muscle activation levels of select lower extremity muscles during the pitching motion. Bilateral surface electromyography data on 5 lower extremity muscles (biceps femoris, rectus femoris, gluteus maximus, vastus medialis, and gastrocnemius) were collected on 11 highly skilled baseball pitchers and compared with individual maximal voluntary isometric contraction (MVIC) data. The pitching motion was divided into 4 distinct phases: phase 1, initiation of pitching motion to maximum stride leg knee height; phase 2, maximum stride leg knee height to stride foot contact (SFC); phase 3, SFC to ball release; and phase 4, ball release to 0.5 seconds after ball release (follow-through). Results indicated that trail leg musculature elicited moderate to high activity levels during phases 2 and 3 (38-172% of MVIC). Muscle activity levels of the stride leg were moderate to high during phases 2-4 (23-170% of MVIC). These data indicate a high demand for lower extremity strength and endurance. Specifically, coaches should incorporate unilateral and bilateral lower extremity exercises for strength improvement or maintenance and to facilitate dynamic stabilization of the lower extremities during the pitching motion.

  13. Overuse lower extremity injuries in sports.

    PubMed

    Fullem, Brian W

    2015-04-01

    When athletes train harder the risk of injury increases, and there are several common overuse injuries to the lower extremity. Three of the most common lower extremity overuse injuries in sports are discussed including the diagnosis and treatments: medial tibal stress syndrome, iliotibial band syndrome, and stress fractures. The charge of sports medicine professionals is to identify and treat the cause of the injuries and not just treat the symptoms. Symptomatology is an excellent guide to healing and often the patient leads the physician to the proper diagnosis through an investigation of the athlete's training program, past injury history, dietary habits, choice of footwear, and training surface. PMID:25804713

  14. Exertional compartment syndromes of the lower extremity.

    PubMed

    Schepsis, A A; Lynch, G

    1996-03-01

    Compartment syndromes may be acute or chronic secondary to exertion or exercise. The chronic or exertional type most commonly involves the lower extremity, particularly the anterior compartment of the lower leg, and is the subject of this review. Rarely, an exertional compartment syndrome may become acute. The diagnosis is based on history, physical examination, and compartment pressure measurements. The differential diagnosis of exertional leg pain includes stress fractures, stress reaction, periostitis, claudication, popliteal artery entrapment, and peripheral nerve entrapment. Unusual causes, such as a ganglion of the proximal tibiofibular joint causing an anterior compartment syndrome, have recently been reported.

  15. Lower extremity kinematics of athletics curve sprinting.

    PubMed

    Alt, Tobias; Heinrich, Kai; Funken, Johannes; Potthast, Wolfgang

    2015-01-01

    Curve running requires the generation of centripetal force altering the movement pattern in comparison to the straight path run. The question arises which kinematic modulations emerge while bend sprinting at high velocities. It has been suggested that during curve sprints the legs fulfil different functions. A three-dimensional motion analysis (16 high-speed cameras) was conducted to compare the segmental kinematics of the lower extremity during the stance phases of linear and curve sprints (radius: 36.5 m) of six sprinters of national competitive level. Peak joint angles substantially differed in the frontal and transversal plane whereas sagittal plane kinematics remained unchanged. During the prolonged left stance phase (left: 107.5 ms, right: 95.7 ms, straight: 104.4 ms) the maximum values of ankle eversion (left: 12.7°, right: 2.6°, straight: 6.6°), hip adduction (left: 13.8°, right: 5.5°, straight: 8.8°) and hip external rotation (left: 21.6°, right: 12.9°, straight: 16.7°) were significantly higher. The inside leg seemed to stabilise the movement in the frontal plane (eversion-adduction strategy) whereas the outside leg provided and controlled the motion in the horizontal plane (rotation strategy). These results extend the principal understanding of the effects of curve sprinting on lower extremity kinematics. This helps to increase the understanding of nonlinear human bipedal locomotion, which in turn might lead to improvements in athletic performance and injury prevention. PMID:25495196

  16. Augmented amputations of the lower extremity.

    PubMed

    Mohler, D G; Kessler, J I; Earp, B E

    2000-02-01

    Ten patients who had amputations of a lower extremity for high-grade sarcomas underwent bone augmentation with either allograft or autograft between 1988 and 1996. There were eight transfemoral amputations and two transtibial amputations. The transferred segments consisted of one proximal tibia and six distal tibia autografts, two allografts, one autograft talar dome and first metatarsal, and one with a patellar cap of a supracondylar amputation. The average length of followup was 54 months. There were no nonunions of any of the grafts. There were three wound problems requiring additional operations. One autograft resorbed, and one autograft had a late infection. There was one local recurrence. Augmentation to provide length resulted in a 42% increase in bone length in those performed purely for length. All patients were able to use standard prostheses. Functional outcome was appropriate to the amputation level. Half of the patients avoided more proximal levels of amputation because of the ability to augment the osteotomy. The use of nonvascularized structural autografts or allografts is a simple procedure that can produce a superior residual limb in patients undergoing amputation. Its use should be considered in patients for whom traditional amputation techniques will result in poor function, difficulty in fitting a prosthesis, or greater than necessary anatomic loss. PMID:10693566

  17. Lower extremity stress fractures in the military.

    PubMed

    Jacobs, Jeremy M; Cameron, Kenneth L; Bojescul, John A

    2014-10-01

    Stress fractures of the lower extremities are common among the military population and, more specifically, military recruits who partake in basic training. Both intrinsic and extrinsic factors play a role in the development of these injuries, and it is important to identify those individuals at risk early in their military careers. Some of these factors are modifiable, so they may become preventable injuries. It is important to reiterate that one stress fracture places the soldier at risk for future stress fractures; but the first injury should not be reason enough for separation from the military, as literature would support no long-term deficits from properly treated stress fractures. Early in the process, radiographic analysis is typically normal; continued pain may warrant advanced imaging, such as scintigraphy or MRI. Most stress fractures that are caught early are amendable to nonoperative management consisting of a period of immobilization and NWB followed by progressive rehabilitation to preinjury levels. Complete or displaced fractures may require operative intervention as do tension-sided FNSF. Improving dietary and preaccession physical fitness levels may play a role in reducing the incidence of stress fractures in the active-duty military population. It is important to keep in mind when evaluating soldiers and athletes who present with activity-related pain that stress fractures are not uncommon and should be given significant consideration.

  18. Lower extremity corrective reactions to slip events.

    PubMed

    Cham, R; Redfern, M S

    2001-11-01

    A significant number of injuries in the workplace is attributed to slips and falls. Biomechanical responses to actual slip events determine whether the outcome of a slip will be recovery or a fall. The goal of this study was to examine lower extremity joint moments and postural adjustments for experimental evidence of corrective strategies evoked during slipping in an attempt to prevent falling. Sixteen subjects walked onto a possibly oily vinyl tile floor, while ground reaction forces and body motion were recorded at 350 Hz. The onset of corrective reactions by the body in an attempt to recover from slips became evident at about 25% of stance and continued until about 45% into stance, i.e. on average between 190 and 350 ms after heel contact. These reactions included increased flexion moment at the knee and extensor activity at the hip. The ankle, on the other hand, acted as a passive joint (no net moment) during fall trials. Joint kinematics showed increased knee flexion and forward rotation of the shank in an attempt to bring the foot back towards the body. Once again, the ankle kinematics appeared to play a less dominant role (compared to the knee) in recovery attempts. This study indicates that humans generate corrective reactions to slips that are different than previously reported responses to standing perturbations translating the supporting surface. PMID:11672718

  19. Lower extremity kinetics in tap dance.

    PubMed

    Mayers, Lester; Bronner, Shaw; Agraharasamakulam, Sujani; Ojofeitimi, Sheyi

    2010-01-01

    Tap dance is a unique performing art utilizing the lower extremities as percussion instruments. In a previous study these authors reported decreased injury prevalence among tap dancers compared to other dance and sports participants. No biomechanical analyses of tap dance exist to explain this finding. The purpose of the current pilot study was to provide a preliminary overview of normative peak kinetic and kinematic data, based on the hypothesis that tap dance generates relatively low ground reaction forces and joint forces and moments. Six professional tap dancers performed four common tap dance sequences that produced data captured by the use of a force platform and a five-camera motion analysis system. The mean vertical ground reaction force for all sequences was found to be 2.06+/-0.55 BW. Mean peak sagittal, frontal, and transverse plane joint moments (hip, knee, and ankle) ranged from 0.07 to 2.62 N.m/kg. These small ground reaction forces and joint forces and moments support our hypothesis, and may explain the relatively low injury incidence in tap dancers. Nevertheless, the analysis is highly complex, and other factors remain to be studied and clarified.

  20. Diabetes, Peripheral Neuropathy, and Lower Extremity Function

    PubMed Central

    Chiles, Nancy S.; Phillips, Caroline L.; Volpato, Stefano; Bandinelli, Stefania; Ferrucci, Luigi; Guralnik, Jack M.; Patel, Kushang V.

    2014-01-01

    Objective Diabetes among older adults causes many complications, including decreased lower extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 and older from the InCHIANTI Study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0-12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cut-points of PNF tests were used to create a neuropathy score from 0-5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion 12.8% (n=126) of participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β= −0.99; p< 0.01), decreased walking speed (β= −0.1m/s; p< 0.01), decreased nerve conduction velocity (β= −1.7m/s; p< 0.01), and increased neuropathy (β= 0.25; p< 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. PMID:24120281

  1. Adaptive prosthetics for the lower extremity.

    PubMed

    Carroll, K

    2001-06-01

    The potential for lifestyle recovery is tremendous for most lower extremity amputees. The amazing and ever-expanding array of adaptive prosthetics can help make the devastating loss of amputation more bearable for patients, their families, and their health care team. The new amputee, in a state of shock and grief, does not know what his or her prosthetic options are. It is crucial that the surgeon is knowledgeable about what the patient can have and what the patient needs to ask for. Dana Bowman stated: Ideally, the new amputee should say to their doctor, "I'd like my leg to be lightweight, flexible, durable, comfortable. I want to do sports or I want to ride bikes with my kids." Whatever it is they like to do. I was told I would never be able to wear two dynamic feet and that my sky diving days were over. I said, "Well how do you know? Can't I try?" It took years to find out what I could have and then to find people to help me get it. The prosthetic prescription the physician writes is the patient's gateway to the kind of prosthetics that will enable him or her to pursue the activities of their life. Often, new amputees end up with the bare minimum prosthesis, which can cause problems with comfort and mobility. A poorly designed or badly fitting prosthesis is as disabling as the actual amputation. When the surgeon can help the amputee and his or her family understand what kind of prosthetic choices are available, it establishes an optimistic outlook that is highly beneficial to the entire recovery process physically and mentally. "When I lost my leg, if someone would have told me that I could at least try to run again, that would have meant a lot," said Brian Frasure. "Getting that positive mental attitude is every bit as important as having good medical and prosthetic care." By asking probing questions about the patient's preamputation lifestyle and postamputation goals, the physician can write a prescription for truly adaptive prosthetics. The surgeon should

  2. Imaging of lower extremity trauma from Boston Marathon bombing.

    PubMed

    Konwinski, Ryan R; Singh, Ajay; Soto, Jorge

    2016-10-01

    The goal of this study is to describe the imaging features of lower extremity blast injuries in patients encountered in the radiology departments from the Boston Marathon bombings. A total of 115 patients presented to four acute care hospitals on April 15, 2013, 43 of whom presented with lower extremity injuries and were included in this study. The imaging findings of primary, secondary, tertiary, and quaternary blast injuries were evaluated. Forty-one of 43 patients sustained secondary blast injuries to the lower extremities with 31 patients (70 %) having retained shrapnel, seven patients (16 %) having soft tissue lacerations without retained shrapnel, and ten patients (23 %) having lower extremity amputation (7 % double amputees). Eight of these patients (20 %) had lower extremity fractures, and five patients (12 %) had vascular injuries. Two of the 43 patients (5 %) had only tertiary injuries, and five of 43 patients (12 %) were noted to have lower extremity burns, consistent with quaternary blast injury. No primary blast injury occurred in the lower extremities. A vast majority of lower extremity injuries were from secondary blast injury, most commonly from retained shrapnel in 70 % of patients and 23 % of patients sustaining lower extremity amputation. Retained shrapnel in the lower extremity was most commonly ball bearings and pressure cooker fragments, and most injuries affected the leg, followed by the thigh and foot. PMID:27272899

  3. Imaging of lower extremity trauma from Boston Marathon bombing.

    PubMed

    Konwinski, Ryan R; Singh, Ajay; Soto, Jorge

    2016-10-01

    The goal of this study is to describe the imaging features of lower extremity blast injuries in patients encountered in the radiology departments from the Boston Marathon bombings. A total of 115 patients presented to four acute care hospitals on April 15, 2013, 43 of whom presented with lower extremity injuries and were included in this study. The imaging findings of primary, secondary, tertiary, and quaternary blast injuries were evaluated. Forty-one of 43 patients sustained secondary blast injuries to the lower extremities with 31 patients (70 %) having retained shrapnel, seven patients (16 %) having soft tissue lacerations without retained shrapnel, and ten patients (23 %) having lower extremity amputation (7 % double amputees). Eight of these patients (20 %) had lower extremity fractures, and five patients (12 %) had vascular injuries. Two of the 43 patients (5 %) had only tertiary injuries, and five of 43 patients (12 %) were noted to have lower extremity burns, consistent with quaternary blast injury. No primary blast injury occurred in the lower extremities. A vast majority of lower extremity injuries were from secondary blast injury, most commonly from retained shrapnel in 70 % of patients and 23 % of patients sustaining lower extremity amputation. Retained shrapnel in the lower extremity was most commonly ball bearings and pressure cooker fragments, and most injuries affected the leg, followed by the thigh and foot.

  4. [Ultrasound examination for lower extremity deep vein thrombosis].

    PubMed

    Toyota, Kosaku

    2014-09-01

    Surgery is known to be a major risk factor of vein thrombosis. Progression from lower extremity deep vein thrombosis (DVT) to pulmonary embolism can lead to catastrophic outcome, although the incidence ratio is low. The ability to rule in or rule out DVT is becoming essential for anesthesiologists. Non-invasive technique of ultrasonography is a sensitive and specific tool for the assessment of lower extremity DVT. This article introduces the basics and practical methods of ultrasound examination for lower extremity DVT.

  5. Current thinking about acute compartment syndrome of the lower extremity.

    PubMed

    Shadgan, Babak; Menon, Matthew; Sanders, David; Berry, Gregg; Martin, Claude; Duffy, Paul; Stephen, David; O'Brien, Peter J

    2010-10-01

    Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity.

  6. Lower extremity reconstruction with the anterolateral thigh flap.

    PubMed

    Nosrati, Naveed; Chao, Albert H; Chang, David W; Yu, Peirong

    2012-05-01

    The versatility and location of the anterolateral thigh (ALT) flap make it well suited for lower extremity reconstruction. The purpose of this study was to evaluate surgical and functional outcomes by specific anatomic regions in the lower extremity to better define the role of the ALT flap in lower extremity reconstruction. A retrospective review of patients undergoing lower extremity reconstruction with an ALT flap between July 2002 and December 2010 was performed. Total 46 patients underwent lower extremity reconstruction with an ALT flap, of whom 29 (63%) had a pedicled flap and 17 (37%) a microvascular free flap. Defects were located in the hip/buttocks (n = 8), groin (n = 13), thigh (n = 8), knee (n = 5), leg (n = 6), and foot/ankle (n = 6). The mean postoperative follow-up was 4 months. Total flap loss occurred in two patients (4%). There were 11 recipient site complications (24%). The most common complication was recipient site seroma, which occurred in five patients (11%), all of whom had hip/buttock or groin defects. Overall, 38 patients (83%) returned to their preoperative functional status. The ALT flap is an effective method of lower extremity reconstruction. It can be performed as a pedicled or free flap, with good surgical and functional outcomes. PMID:22399252

  7. Step frequency and lower extremity loading during running.

    PubMed

    Hobara, H; Sato, T; Sakaguchi, M; Sato, T; Nakazawa, K

    2012-04-01

    The purpose of the present study was to ascertain whether increase in step frequency at a given velocity during running reduces the lower extremity loading variables, which is associated with tibial stress fracture in runner. We hypothesized that the lower extremity loading variables at a given speed would be minimized at around +15% f step. 10 male subjects were asked to run at 2.5 m/s on a treadmill-mounted force platform. 5 step frequencies were controlled using a metronome: the preferred, below preferred (-15 and -30%) and above preferred (+15 and +30%). From the vertical ground reaction force, we measured following lower extremity loading variables; vertical impact peak (VIP), vertical instantaneous loading rate (VILR) and vertical average loading rate (VALR). We found that there were significant differences in lower extremity loading variables among 5 step frequency conditions. Furthermore, quadratic regression analyses revealed that the minimum loading variable frequencies were 17.25, 17.55, and 18.07% of preferred step frequency for VIP, VILR and VIAR, respectively. Thus, adopting a step frequency greater than one's preferred may be practical in reducing the risk of developing a tibial stress fracture by decreasing lower extremity loading variables. PMID:22383130

  8. Doppler ultrasonography in lower extremity peripheral arterial disease.

    PubMed

    Verim, Samet; Taşçı, Ilker

    2013-04-01

    Systemic atherosclerosis is a condition which progresses with age, decreases quality of life, and life expectancy. Lower extremity peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis in the elderly. These individuals have a 2 to 4 fold higher risk of coronary heart disease and stroke. In addition, systemic atherosclerosis causes overall functional disability including restricted lower extremity movements. When used alone for diagnostic purposes, claudication is an unreliable sign of PAD in all age groups especially the elderly. Moreover, claudication is difficult to define due to the advancing age and degenerative changes in lumbar and peripheral joints. Doppler ultrasonography (US) is an easily available and noninvasive means of arterial visualization in the lower extremities. In this review, supporting evidence for the use of Doppler US in the diagnosis of PAD will be discussed. Past and present recommendations regarding Doppler US in the current PAD guidelines will be overviewed.

  9. A primer on lower extremity outcome measurement instruments.

    PubMed Central

    Saltzman, C. L.; Mueller, C.; Zwior-Maron, K.; Hoffman, R. D.

    1998-01-01

    Tracing the roots of lower extremity outcome scales is an interesting and somewhat bemusing journey. A large number of different grading methods can be found with limited reliability and/or validity testing. The usefulness of these instruments in the assessment of patient outcomes after lower extremity interventions is worrisome. This article focuses on the most commonly used scales and demonstrates an alarming and incestuous pattern of cross-validation with moderate to weak associations between potentially unreliable and crudely validated original instruments. PMID:9807715

  10. Scintigraphic demonstration of lower extremity periostitis secondary to venous insufficiency

    SciTech Connect

    Gensburg, R.S.; Kawashima, A.; Sandler, C.M.

    1988-07-01

    The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of (/sup 67/Ga)citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

  11. Staff Radiation Doses to the Lower Extremities in Interventional Radiology

    SciTech Connect

    Shortt, C. P.; Al-Hashimi, H.; Malone, L.; Lee, M. J.

    2007-11-15

    The purpose of this study was to investigate the radiation doses to the lower extremities in interventional radiology suites and evaluate the benefit of installation of protective lead shielding. After an alarmingly increased dose to the lower extremity in a preliminary study, nine interventional radiologists wore thermoluminescent dosimeters (TLDs) just above the ankle, over a 4-week period. Two different interventional suites were used with Siemens undercouch fluoroscopy systems. A range of procedures was carried out including angiography, embolization, venous access, drainages, and biopsies. A second identical 4-week study was then performed after the installation of a 0.25-mm lead curtain on the working side of each interventional table. Equivalent doses for all nine radiologists were calculated. One radiologist exceeded the monthly dose limit for a Category B worker (12.5 mSv) for both lower extremities before lead shield placement but not afterward. The averages of both lower extremities showed a statistically significant dose reduction of 64% (p < 0.004) after shield placement. The left lower extremity received a higher dose than the right, 6.49 vs. 4.57 mSv, an increase by a factor of 1.42. Interventional radiology is here to stay but the benefits of interventional radiology should never distract us from the important issue of radiation protection. All possible measures should be taken to optimize working conditions for staff. This study showed a significant lower limb extremity dose reduction with the use of a protective lead curtain. This curtain should be used routinely on all C-arm interventional radiologic equipment.

  12. Adolescent baseball pitching technique: lower extremity biomechanical analysis.

    PubMed

    Milewski, Matthew D; Õunpuu, Sylvia; Solomito, Matthew; Westwell, Melany; Nissen, Carl W

    2012-11-01

    Documentation of the lower extremity motion patterns of adolescent pitchers is an important part of understanding the pitching motion and the implication of lower extremity technique on upper extremity loads, injury and performance. The purpose of this study was to take the initial step in this process by documenting the biomechanics of the lower extremities during the pitching cycle in adolescent pitchers and to compare these findings with the published data for older pitchers. Three-dimensional motion analysis using a comprehensive lower extremity model was used to evaluate the fast ball pitch technique in adolescent pitchers. Thirty-two pitchers with a mean age of 12.4 years (range 10.5-14.7 years) and at least 2 years of experience were included in this study. The pitchers showed a mean of 49 ± 12° of knee flexion of the lead leg at foot contact. They tended to maintain this position through ball release, and then extended their knee during the follow through phase (ball release to maximal internal glenohumeral rotation). The lead leg hip rapidly progressed into adduction and flexion during the arm cocking phase with a range of motion of 40 ± 10° adduction and 30 ± 13° flexion. The lead hip mean peak adduction velocity was 434 ± 83°/s and flexion velocity was 456 ± 156°/s. Simultaneously, the trailing leg hip rapidly extended approaching to a mean peak extension of -8 ± 5° at 39% of the pitch cycle, which is close to passive range of motion constraints. Peak hip abduction of the trailing leg at foot contact was -31 ± 12°, which also approached passive range of motion constraints. Differences and similarities were also noted between the adolescent lower extremity kinematics and adult pitchers; however, a more comprehensive analysis using similar methods is needed for a complete comparison. PMID:22660979

  13. Adolescent baseball pitching technique: lower extremity biomechanical analysis.

    PubMed

    Milewski, Matthew D; Õunpuu, Sylvia; Solomito, Matthew; Westwell, Melany; Nissen, Carl W

    2012-11-01

    Documentation of the lower extremity motion patterns of adolescent pitchers is an important part of understanding the pitching motion and the implication of lower extremity technique on upper extremity loads, injury and performance. The purpose of this study was to take the initial step in this process by documenting the biomechanics of the lower extremities during the pitching cycle in adolescent pitchers and to compare these findings with the published data for older pitchers. Three-dimensional motion analysis using a comprehensive lower extremity model was used to evaluate the fast ball pitch technique in adolescent pitchers. Thirty-two pitchers with a mean age of 12.4 years (range 10.5-14.7 years) and at least 2 years of experience were included in this study. The pitchers showed a mean of 49 ± 12° of knee flexion of the lead leg at foot contact. They tended to maintain this position through ball release, and then extended their knee during the follow through phase (ball release to maximal internal glenohumeral rotation). The lead leg hip rapidly progressed into adduction and flexion during the arm cocking phase with a range of motion of 40 ± 10° adduction and 30 ± 13° flexion. The lead hip mean peak adduction velocity was 434 ± 83°/s and flexion velocity was 456 ± 156°/s. Simultaneously, the trailing leg hip rapidly extended approaching to a mean peak extension of -8 ± 5° at 39% of the pitch cycle, which is close to passive range of motion constraints. Peak hip abduction of the trailing leg at foot contact was -31 ± 12°, which also approached passive range of motion constraints. Differences and similarities were also noted between the adolescent lower extremity kinematics and adult pitchers; however, a more comprehensive analysis using similar methods is needed for a complete comparison.

  14. Vascular impairment and free tissue transfer in the lower extremity.

    PubMed

    Vlastou, C; Earle, A S; Soucacos, P N

    1994-06-01

    Fourteen patients with arteriosclerotic peripheral vascular disease and extensive tissue defects of the lower extremity, underwent microsurgical reconstruction using free tissue ("free flap") transfer. It was possible to provide coverage in ten of these patients. Analysis of this small series showed that only six of these ten patients were able to resume unassisted ambulation. The authors discuss technical aspects of microsurgical reconstruction in this unfavorable group of patients. Analysis of this small series suggest that: (1) inadequate patient motivation, and (2) inability to form granulation tissue in the soft tissue defect, either before or after a vascular reconstructive procedure, are both strong contraindications to microvascular free flap reconstruction in patients with arteriosclerotic peripheral vascular insufficiency of the lower extremity.

  15. Anticipatory Effects on Lower Extremity Neuromechanics During a Cutting Task

    PubMed Central

    Meinerz, Carolyn M.; Malloy, Philip; Geiser, Christopher F.; Kipp, Kristof

    2015-01-01

    Context  Continued research into the mechanism of noncontact anterior cruciate ligament injury helps to improve clinical interventions and injury-prevention strategies. A better understanding of the effects of anticipation on landing neuromechanics may benefit training interventions. Objective  To determine the effects of anticipation on lower extremity neuromechanics during a single-legged land-and-cut task. Design  Controlled laboratory study. Setting  University biomechanics laboratory. Participants  Eighteen female National Collegiate Athletic Association Division I collegiate soccer players (age = 19.7 ± 0.8 years, height = 167.3 ± 6.0 cm, mass = 66.1 ± 2.1 kg). Intervention(s)  Participants performed a single-legged land-and-cut task under anticipated and unanticipated conditions. Main Outcome Measure(s)  Three-dimensional initial contact angles, peak joint angles, and peak internal joint moments and peak vertical ground reaction forces and sagittal-plane energy absorption of the 3 lower extremity joints; muscle activation of selected hip- and knee-joint muscles. Results  Unanticipated cuts resulted in less knee flexion at initial contact and greater ankle toe-in displacement. Unanticipated cuts were also characterized by greater internal hip-abductor and external-rotator moments and smaller internal knee-extensor and external-rotator moments. Muscle-activation profiles during unanticipated cuts were associated with greater activation of the gluteus maximus during the precontact and landing phases. Conclusions  Performing a cutting task under unanticipated conditions changed lower extremity neuromechanics compared with anticipated conditions. Most of the observed changes in lower extremity neuromechanics indicated the adoption of a hip-focused strategy during the unanticipated condition. PMID:26285089

  16. Lower extremity finite element model for crash simulation

    SciTech Connect

    Schauer, D.A.; Perfect, S.A.

    1996-03-01

    A lower extremity model has been developed to study occupant injury mechanisms of the major bones and ligamentous soft tissues resulting from vehicle collisions. The model is based on anatomically correct digitized bone surfaces of the pelvis, femur, patella and the tibia. Many muscles, tendons and ligaments were incrementally added to the basic bone model. We have simulated two types of occupant loading that occur in a crash environment using a non-linear large deformation finite element code. The modeling approach assumed that the leg was passive during its response to the excitation, that is, no active muscular contraction and therefore no active change in limb stiffness. The approach recognized that the most important contributions of the muscles to the lower extremity response are their ability to define and modify the impedance of the limb. When nonlinear material behavior in a component of the leg model was deemed important to response, a nonlinear constitutive model was incorporated. The accuracy of these assumptions can be verified only through a review of analysis results and careful comparison with test data. As currently defined, the model meets the objective for which it was created. Much work remains to be done, both from modeling and analysis perspectives, before the model can be considered complete. The model implements a modeling philosophy that can accurately capture both kinematic and kinetic response of the lower limb. We have demonstrated that the lower extremity model is a valuable tool for understanding the injury processes and mechanisms. We are now in a position to extend the computer simulation to investigate the clinical fracture patterns observed in actual crashes. Additional experience with this model will enable us to make a statement on what measures are needed to significantly reduce lower extremity injuries in vehicle crashes. 6 refs.

  17. Arterial Injuries Associated with Blunt Fractures in the Lower Extremity.

    PubMed

    Coleman, Jamie J; Tavoosi, Saharnaz; Zarzaur, Ben L; Brewer, Brian L; Rozycki, Grace S; Feliciano, David V

    2016-09-01

    Problems related to the combination of an arterial injury and a blunt fracture in the lower extremity are well known-delayed diagnosis, damaged soft tissue, and high amputation rate. The actual incidence of this injury pattern is, however, unknown. The purposes of this study were to determine the current incidence of named arterial injuries in patients with blunt fractures in the lower extremities and assess potential associated risk factors. This was a 7-year (2007-2013) retrospective review of patients ≥18 years with blunt lower extremity fractures at a Level I trauma center. Fracture location and concomitant arterial injury were determined and patients stratified by age, gender, and injury velocity. Low injury velocity was defined as falls or assaults, whereas an injury secondary to a motorized vehicle was defined as high velocity. A total of 4413 patients (mean age 52.2 years, 54.3% male, mean Injury Severity Score 13.1) were identified. Forty-six patients (1.04%) had arterial injuries (20.4% common femoral, 8.2% superficial femoral, 44.9% popliteal, and 26.5% shank). After stratifying by age and injury velocity, younger age was associated with a significantly higher rate of vascular injury. For high-velocity injuries, there was no difference based on age. In conclusion, the prevalence of arterial injury after blunt lower extremity fractures is 1.04 per cent in our study. A significant paradoxical relationship exists between age and associated arterial injuries in patients with low-velocity injuries. If these data are confirmed in future studies, a low index of suspicion in patients >55 years after falls is appropriate. PMID:27670570

  18. Lower extremity injuries at the New York City Marathon.

    PubMed

    Caselli, M A; Longobardi, S J

    1997-01-01

    The purpose of this study was to determine the type and frequency of lower extremity running injuries incurred by athletes participating in the New York City Marathon. A survey was conducted of 265 athletes presenting to medical stations for podiatric care during the 1994 New York City Marathon. The results of the survey indicated that the most common injuries occurring in marathon runners were corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia. An inverse relationship was observed between the number of miles trained per week and the number of injuries. These findings are consistent with long-term studies of running injuries.

  19. Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials.

    PubMed

    Stout, N; Partsch, H; Szolnoky, G; Forner-Cordero, I; Mosti, G; Mortimer, P; Flour, M; Damstra, R; Piller, N; Geyer, M J; Benigni, J-P; Moffat, C; Cornu-Thenard, A; Schingale, F; Clark, M; Chauveau, M

    2012-08-01

    Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

  20. Low-impact trauma causing acute compartment syndrome of the lower extremities.

    PubMed

    Aliano, Kristen; Gulati, Salil; Stavrides, Steve; Davenport, Thomas; Hines, George

    2013-05-01

    Compartment syndrome usually occurs in the muscles of an extremity as a consequence of trauma or reperfusion. However, it can also occur from minor injuries with resulting hematoma.We reviewed the charts of 5 individuals who presented to the emergency department after minimal or no known trauma and were ultimately diagnosed with acute compartment syndrome. None sustained fractures, and 2 had documented muscle tears. All patients were found to have hematomas in the affected compartment at the time of surgery. Low-impact trauma can cause acute compartment syndrome in the lower extremities. These cases could be the result of muscle hemorrhage and subsequent hematoma formation, rather than muscle swelling itself. Anticoagulation therapy can increase the risk of hemorrhage.

  1. Lower Extremity Malalignments and Anterior Cruciate Ligament Injury History

    PubMed Central

    Hertel, Jay; Dorfman, Jennifer H.; Braham, Rebecca A.

    2004-01-01

    To identify if lower extremity malalignments were associated with increased propensity of a history of anterior cruciate ligament (ACL) ruptures in males and females using a case control design. Twenty subjects (10 males, 10 females) had a history of ACL injury and twenty (10 males, 10 females) had no history of ACL injury. Subjects were assessed for navicular drop, quadriceps angle, pelvic tilt, hip internal and external rotation range of motion, and true and apparent leg length discrepancies. Statistical analysis was performed to identify differences in these measures in regard to injury history and gender, and to identify if any of these measures were predictive of ACL injury history. Increased navicular drop and anterior pelvic tilt were found to be statistically significant predictors of ACL injury history regardless of gender. Limbs that had previously suffered ACL ruptures were found to have increased navicular drop and anterior pelvic tilt compared to uninjured limbs. Based on the results of this retrospective study, the lower extremity malalignments examined do not appear to predispose females to tearing their ACLs more than males. Key Points Hyperpronation and greater anterior pelvic tilt were the two malalignments most associated with history of ACL injury. Females had larger quadriceps angles than males, but this measure was not significantly related to ACL injury history. Not all structural differences between genders help explain the increased risk of ACL injuries in female athletes. PMID:24624006

  2. Lower-extremity amputation with immediate postoperative prosthetic placement.

    PubMed

    Folsom, D; King, T; Rubin, J R

    1992-10-01

    To study the efficacy of an immediate postoperative prosthesis (IPOP) program, a retrospective review of 167 major lower-extremity amputations was performed. Patient enrollment in the IPOP program was based on the individual's potential for rehabilitation and participation in an aggressive postoperative physical therapy regimen, as determined by the surgeon, prosthetist, physical therapist, and social worker. Indications for amputation were intractable infection and/or severe unreconstructable arterial insufficiency. Sixty-five patients underwent 69 amputations with IPOP (59 below knee; 10 above knee). Successful program completion was defined as independent ambulation and occurred in 86% of those patients enrolled. The average interval from amputation to ambulation was 15.2 days for the below-knee amputees and 9.3 days for the above-knee amputees. Failure to complete the program occurred in 14% of patients and was due to noncompliance, stump infection, stump trauma, and death. The results of this review support the use of IPOP after major lower-extremity amputation. PMID:1415937

  3. Wound size measurement of lower extremity ulcers using segmentation algorithms

    NASA Astrophysics Data System (ADS)

    Dadkhah, Arash; Pang, Xing; Solis, Elizabeth; Fang, Ruogu; Godavarty, Anuradha

    2016-03-01

    Lower extremity ulcers are one of the most common complications that not only affect many people around the world but also have huge impact on economy since a large amount of resources are spent for treatment and prevention of the diseases. Clinical studies have shown that reduction in the wound size of 40% within 4 weeks is an acceptable progress in the healing process. Quantification of the wound size plays a crucial role in assessing the extent of healing and determining the treatment process. To date, wound healing is visually inspected and the wound size is measured from surface images. The extent of wound healing internally may vary from the surface. A near-infrared (NIR) optical imaging approach has been developed for non-contact imaging of wounds internally and differentiating healing from non-healing wounds. Herein, quantitative wound size measurements from NIR and white light images are estimated using a graph cuts and region growing image segmentation algorithms. The extent of the wound healing from NIR imaging of lower extremity ulcers in diabetic subjects are quantified and compared across NIR and white light images. NIR imaging and wound size measurements can play a significant role in potentially predicting the extent of internal healing, thus allowing better treatment plans when implemented for periodic imaging in future.

  4. [Prophylaxis, diagnosis and conservative treatment of chronic lower extremities ischaemia].

    PubMed

    Ruszkiewicz, Cezary B

    2005-01-01

    The most frequent cause underlying the chronic lower extremities ischaemia is atheromatosis. As the basic symptom of the disease, intermittent claudication exerts essential impact upon the state of patient's health as it causes the limitation or the loss of the ability of unassisted walking and, effectively, also the deterioration of the quality of his or her life. The discovery of the etiopathogenesis of atheromatosis and correct assessment of risk factors involved are the elementary conditions of proper administering of pharmacological treatment as well as the basis for adequate planning of necessary prophylactic steps. In such cases, the diagnostic process ought to involve obtaining data from the patient's medical history and his or her physical examination, as well as determining his or her ankle-brachial index (ABI) and information derived from ultrasonographic examination performed at non-invasive diagnostics laboratory. The resultant treatment ought to focus on the improvement of the patient's functional efficiency. Before the necessity of surgical treatment is considered it is recommended to determine a plan for conservative treatment. Adequate diagnosis combined with an early commencement of conservative treatment in the cases of chronic lower extremities ischaemia frequently prove effective in arresting the development of the disease and, consequently, render invasive treatment unnecessary--thus resulting in the improvement of patient's quality of life.

  5. Joint swelling

    MedlinePlus

    Swelling of a joint ... Joint swelling may occur along with joint pain . The swelling may cause the joint to appear larger or abnormally shaped. Joint swelling can cause pain or stiffness. After an ...

  6. Lower extremity deep vein thrombosis after heavy exertion.

    PubMed

    Tak, Sandeep; Tak, Shubhanjali

    2013-01-01

    A young woman leading a sedentary life, travelled on foot for a distance of 25 km in a day. The following day she noticed pain and swelling of left foot and left leg. She got no relief with analgesics and her orthopaedic evaluation was normal. Her clinical examination was normal except for local swelling, oedema and tender calf. Her haematological and biochemical examination was normal except for mild elevation of creatine phosphokinase. A Doppler ultrasound revealed the thrombosis of anterior tibial vein and popliteal vein.

  7. Stenting for Peripheral Artery Disease of the Lower Extremities

    PubMed Central

    2010-01-01

    Executive Summary Background Objective In January 2010, the Medical Advisory Secretariat received an application from University Health Network to provide an evidentiary platform on stenting as a treatment management for peripheral artery disease. The purpose of this health technology assessment is to examine the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities. Clinical Need: Condition and Target Population Peripheral artery disease (PAD) is a progressive disease occurring as a result of plaque accumulation (atherosclerosis) in the arterial system that carries blood to the extremities (arms and legs) as well as vital organs. The vessels that are most affected by PAD are the arteries of the lower extremities, the aorta, the visceral arterial branches, the carotid arteries and the arteries of the upper limbs. In the lower extremities, PAD affects three major arterial segments i) aortic-iliac, ii) femoro-popliteal (FP) and iii) infra-popliteal (primarily tibial) arteries. The disease is commonly classified clinically as asymptomatic claudication, rest pain and critical ischemia. Although the prevalence of PAD in Canada is not known, it is estimated that 800,000 Canadians have PAD. The 2007 Trans Atlantic Intersociety Consensus (TASC) II Working Group for the Management of Peripheral Disease estimated that the prevalence of PAD in Europe and North America to be 27 million, of whom 88,000 are hospitalizations involving lower extremities. A higher prevalence of PAD among elderly individuals has been reported to range from 12% to 29%. The National Health and Nutrition Examination Survey (NHANES) estimated that the prevalence of PAD is 14.5% among individuals 70 years of age and over. Modifiable and non-modifiable risk factors associated with PAD include advanced age, male gender, family history, smoking, diabetes, hypertension and hyperlipidemia. PAD is a strong predictor of myocardial infarction (MI

  8. Contemporary evaluation and management of lower extremity peripheral artery disease.

    PubMed

    Foley, T Raymond; Armstrong, Ehrin J; Waldo, Stephen W

    2016-09-15

    Peripheral artery disease (PAD) includes atherosclerosis of the aorta and lower extremities. Affecting a large segment of the population, PAD is associated with impaired functional capacity and reduced quality of life as well as an increased risk of stroke, myocardial infarction and cardiovascular death. The evaluation of PAD begins with the physical examination, incorporating non-invasive testing such as ankle-brachial indices to confirm the diagnosis. Therapeutic interventions are aimed at alleviating symptoms while preserving limb integrity and reducing overall cardiovascular risk. With this in mind, risk factor modification with exercise and medical therapy are the mainstays of treatment for many patients with PAD. Persistent symptoms or non-healing wounds should prompt more aggressive therapies with endovascular or surgical revascularisation. The following manuscript provides a comprehensive review on the contemporary evaluation and management of PAD.

  9. INCORPORATING KETTLEBELLS INTO A LOWER EXTREMITY SPORTS REHABILITATION PROGRAM

    PubMed Central

    En Gilpin, Hui; Brunette, Meredith; Meira, Erik P.

    2010-01-01

    The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury. PMID:21655384

  10. [Surgical treatment of lower extremity peripheral nerve injuries].

    PubMed

    Kaiser, Radek

    2016-01-01

    Peripheral nerve injuries of the lower extremities are not frequent. The most common are traction injury of the peroneal nerve at the knee level or iatrogenic trauma of the pelvic nerves during abdominal surgery. Civil sharp injuries are rare.Indications for surgical revision follow the general rules of nerve surgery. Sharp injury should be treated as soon as possible, ideally within 72 hours. Closed lesions are indicated for surgery if a complete denervation remains unchanged three months after the injury. Best results can be achieved within six months from the injury. Irritations caused by bone fragments or scarring or by iatrogenic injury (clamps, cement, screws, etc.) may be revised later. However, the most important is early clinical examination in a specialized neurosurgical department. PMID:27256143

  11. Bilaterally Symmetrical Lower Extremity Compartment Syndrome following Massive Transfusion.

    PubMed

    Karaoren, Gulsah; Bakan, Nurten; Tomruk, Senay Goksu; Topaç, Zelin; Kurtulmuş, Tuhan; Irkören, Saime

    2016-01-01

    Compartment syndrome is a serious condition characterized by raised intracompartmental pressure, which develops following trauma. Well leg compartment syndrome (WLCS) is a term reserved for compartment syndrome in a nontraumatic setting, usually resulting from prolonged lithotomy position during surgery. In literature, 8 cases have been reported regarding well leg compartment syndrome in a supine position and bilateral symmetrical involvement was observed in only 2 cases. In WLCS etiology, lengthy surgery, lengthy hypotension, and extremity malpositioning have been held responsible but one of the factors with a role in the etiology may have been the tissue oedema and impaired microcirculation formed from the effect of vasoactive mediators expressed into the circulation associated with the massive blood transfusion. The case is presented here regarding symmetrical lower extremity compartment syndrome after surgery in which massive transfusion was made for gross haemorrhage from an abdominal injury. In conclusion, blood transfusion applied at the required time is life-saving but potential risks must always be considered.

  12. Development of HIFU Treatment for Lower Extremity Varicose Veins

    NASA Astrophysics Data System (ADS)

    Senoo, Naohiko; Ushijima, Hiroyuki; Suzuki, Jun; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2011-09-01

    High-intensity focused ultrasound (HIFU) has recently been developed as a noninvasive therapeutic method. In our study, a novel noninvasive therapy with HIFU was proposed for occlusion of lower extremity varicose veins. The temperature increase caused by HIFU is used to occlude varicose veins. Occluded veins became fibrotic, resulting in complete recovery. Our final goal is the medical application of HIFU treatment for varicose veins. In this study, we attempted to occlude the veins of rabbits. Prior to venous occlusion experiments, the area heated by HIFU was investigated using bovine serum albumin (BSA) gel, which denatures at >70 °C. The results indicate that the size of the heated area mainly depends on intensity at the focal point and the exposure time. A tendency was also seen for the heated area to extend toward the transducer with increasing exposure time. In animal experiments, skin burns during HIFU exposure represented a critical problem. We therefore examined the safe range of HIFU intensities in abdominal exposure experiments before conducting venous occlusion experiments. The ultrasound frequency was 1.7 MHz. Intensity at the focal point was 900 W/cm2, and the exposure time was 20 s. Rabbits underwent chemical depilation and echo gel was applied to the exposed skin to fill the boundary gap. Target veins were compressed during HIFU exposure to avoid thermal dissipation, and hyaluronan water solution was injected between the veins and skin to maintain the distance between the skin and veins at ≥5 mm. Veins were then exposed to HIFU and occluded. The capability of HIFU treatment to occlude lower extremity varicose veins was verified by the present study.

  13. Lower Extremity Muscle Activity During a Women's Overhand Lacrosse Shot.

    PubMed

    Millard, Brianna M; Mercer, John A

    2014-06-28

    The purpose of this study was to describe lower extremity muscle activity during the lacrosse shot. Participants (n=5 females, age 22±2 years, body height 162.6±15.2 cm, body mass 63.7±23.6 kg) were free from injury and had at least one year of lacrosse experience. The lead leg was instrumented with electromyography (EMG) leads to measure muscle activity of the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (GA). Participants completed five trials of a warm-up speed shot (Slow) and a game speed shot (Fast). Video analysis was used to identify the discrete events defining specific movement phases. Full-wave rectified data were averaged per muscle per phase (Crank Back Minor, Crank Back Major, Stick Acceleration, Stick Deceleration). Average EMG per muscle was analyzed using a 4 (Phase) × 2 (Speed) ANOVA. BF was greater during Fast vs. Slow for all phases (p<0.05), while TA was not influenced by either Phase or Speed (p>0.05). RF and GA were each influenced by the interaction of Phase and Speed (p<0.05) with GA being greater during Fast vs. Slow shots during all phases and RF greater during Crank Back Minor and Major as well as Stick Deceleration (p<0.05) but only tended to be greater during Stick Acceleration (p=0.076) for Fast vs. Slow. The greater muscle activity (BF, RF, GA) during Fast vs. Slow shots may have been related to a faster approach speed and/or need to create a stiff lower extremity to allow for faster upper extremity movements. PMID:25114727

  14. Dominant spinal muscular atrophy with lower extremity predominance

    PubMed Central

    Harms, M.B.; Allred, P.; Gardner, R.; Fernandes Filho, J.A.; Florence, J.; Pestronk, A.; Al-Lozi, M.; Baloh, R.H.

    2010-01-01

    Objective: Spinal muscular atrophies (SMAs) are hereditary disorders characterized by weakness from degeneration of spinal motor neurons. Although most SMA cases with proximal weakness are recessively inherited, rare families with dominant inheritance have been reported. We aimed to clinically, pathologically, and genetically characterize a large North American family with an autosomal dominant proximal SMA. Methods: Affected family members underwent clinical and electrophysiologic evaluation. Twenty family members were genotyped on high-density genome-wide SNP arrays and linkage analysis was performed. Results: Ten affected individuals (ages 7–58 years) showed prominent quadriceps atrophy, moderate to severe weakness of quadriceps and hip abductors, and milder degrees of weakness in other leg muscles. Upper extremity strength and sensation was normal. Leg weakness was evident from early childhood and was static or very slowly progressive. Electrophysiology and muscle biopsies were consistent with chronic denervation. SNP-based linkage analysis showed a maximum 2-point lod score of 5.10 (θ = 0.00) at rs17679127 on 14q32. A disease-associated haplotype spanning from 114 cM to the 14q telomere was identified. A single recombination narrowed the minimal genomic interval to Chr14: 100,220,765–106,368,585. No segregating copy number variations were found within the disease interval. Conclusions: We describe a family with an early onset, autosomal dominant, proximal SMA with a distinctive phenotype: symptoms are limited to the legs and there is notable selectivity for the quadriceps. We demonstrate linkage to a 6.1-Mb interval on 14q32 and propose calling this disorder spinal muscular atrophy–lower extremity, dominant. GLOSSARY lod = logarithm of the odds; SMA = spinal muscular atrophy; SMA-LED = spinal muscular atrophy–lower extremity, dominant; SNP = single-nucleotide polymorphism. PMID:20697106

  15. Robot-aided assessment of lower extremity functions: a review.

    PubMed

    Maggioni, Serena; Melendez-Calderon, Alejandro; van Asseldonk, Edwin; Klamroth-Marganska, Verena; Lünenburger, Lars; Riener, Robert; van der Kooij, Herman

    2016-01-01

    The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice. PMID:27485106

  16. A rare case of bilateral lower extremity edema due to low dose gabapentin therapy in a young male patient.

    PubMed

    Kahlon, Arunpreet; Gnanabakthan, Naveen; Dhillon, Amrita; Subedi, Dinesh

    2015-09-01

    46 year old male with past medical history of schizoaffective disorder and chronic lower back pain, was admitted for management of worsening depression and anxiety. He was started on gabapentin, 300mg twice daily for his back pain and anxiety symptoms. His only other medication was hydrocodone. Over next few days, he started developing worsening bilateral lower extremity edema. He did not have any cardiovascular related symptoms. Physical exam was only significant for 3+ pitting edema with all laboratory values and imaging being unremarkable. Gabapentin was discontinued and his lower extremity swelling improved over subsequent days. Incidence of pedal edema with gabapentin use is approximately 7 to 7.5% with all studies being in elderly patients receiving doses above 1200 mg/day. This case illustrates that lower doses of gabapentin can also cause this adverse effect. It is important to recognize this adverse effect because gabapentin is used in conditions like diabetic neuropathy, which is associated with multiple co-morbidities that can give rise to bilateral leg swelling. Presence of gabapentin induced leg swelling can thus confound the clinical picture.

  17. A rare case of bilateral lower extremity edema due to low dose gabapentin therapy in a young male patient.

    PubMed

    Kahlon, Arunpreet; Gnanabakthan, Naveen; Dhillon, Amrita; Subedi, Dinesh

    2015-09-01

    46 year old male with past medical history of schizoaffective disorder and chronic lower back pain, was admitted for management of worsening depression and anxiety. He was started on gabapentin, 300mg twice daily for his back pain and anxiety symptoms. His only other medication was hydrocodone. Over next few days, he started developing worsening bilateral lower extremity edema. He did not have any cardiovascular related symptoms. Physical exam was only significant for 3+ pitting edema with all laboratory values and imaging being unremarkable. Gabapentin was discontinued and his lower extremity swelling improved over subsequent days. Incidence of pedal edema with gabapentin use is approximately 7 to 7.5% with all studies being in elderly patients receiving doses above 1200 mg/day. This case illustrates that lower doses of gabapentin can also cause this adverse effect. It is important to recognize this adverse effect because gabapentin is used in conditions like diabetic neuropathy, which is associated with multiple co-morbidities that can give rise to bilateral leg swelling. Presence of gabapentin induced leg swelling can thus confound the clinical picture. PMID:26692738

  18. Lower Extremity Overuse Conditions Affecting Figure Skaters During Daily Training

    PubMed Central

    Campanelli, Valentina; Piscitelli, Francesco; Verardi, Luciano; Maillard, Pauline; Sbarbati, Andrea

    2015-01-01

    Background Most ice figure skaters train and compete with ongoing issues in the lower extremities, which are often overlooked by the skaters and considered injuries only when they prevent the athletes from skating. Although not severe, these conditions impair the quality of daily training and compromise the skaters’ state of mind and performances. Purpose (1) To determine the point prevalence of the ongoing lower extremity overuse conditions in a population of ice figure skaters of all ages and levels and (2) to identify the risk factors contributing to the development of the most common ongoing conditions. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 95 skaters of all ages and skating levels were evaluated in a single examination in the middle of the competitive season. Data collection consisted of a questionnaire, clinical examination, and measurement of the skaters’ characteristics and the equipment used. Results Retrocalcaneal bursitis was the most common problem, affecting at least 1 foot in 34% of the skaters evaluated, followed by posterior heel skin calluses and superficial calcaneal bursitis, which affected 29% and 28% of skaters, respectively. The prevalence of the majority of these conditions was 10% to 32% higher in elite skaters than in nonelite skaters. Higher boot–foot length difference was associated with greater risk of superficial calcaneal bursitis in the landing foot of elite skaters, while higher body weight and greater in-skate ankle flexibility were associated with the development of retrocalcaneal bursitis in nonelite skaters. Only 30 skaters (32%) wore the appropriate boot size, while 57 skaters (51%) could not dorsiflex their ankles properly while wearing skates. Conclusion The heel represents a major area of concern for the high prevalence of calcaneal bursitis and calluses in proximity of the Achilles tendon, suggesting that improvements on the boot heel cup design should take priority. The

  19. Rehabilitation for patients with paraplegia and lower extremity amputation

    PubMed Central

    Wang, Fangyong; Hong, Yi

    2015-01-01

    [Purpose] To study the characteristics and treatment strategy for patients with paraplegia and lower extremity amputation. [Subjects] Six cases were selected from among the patients admitted to the China Rehabilitation Research Center from 1991 to 2014. The criteria for the six cases were spinal cord injury with amputation immediately or in a short time (1 week) after the trauma. [Methods] General information, clinical diagnosis, treatment, rehabilitation and other data were analyzed. [Results] All the six cases were injured by high energy or complex energy accidents: two cases by falls after high voltage electric shock, one by an oil pipeline explosion, one by the impact of a falling tower crane and received high energy traffic accident injuries (one was hit by a train, and the other was hit by a truck at high speed). All the six cases had thoracic and lumbar vertebral injuries and complete paraplegia. Amputation stump infection occurred in four cases. After comprehensive rehabilitation treatment, patients’ functional independence measure (FIM) scores improved significantly, but American Spinal Injury Association (ASIA) scores and ASIA Impairment Scale (AIS) grades showed no significant improvement. [Conclusion] When formulating the clinical treatment and rehabilitation for spinal cord injury with amputation patients, simultaneous consideration of the characteristics of the spinal cord injury and amputation is needed to develop an individualized strategy. For spinal cord injury with limb amputation patients, prostheses should allow the improvement of patients’ self-care ability. PMID:26644641

  20. Lower Extremity Joint Moments During Carrying Tasks in Children

    PubMed Central

    Stevermer, Catherine A.; Miller, Ross H.; Edwards, W. Brent; Schwab, Charles V.

    2015-01-01

    Farm youth often carry loads that are proportionally large and/or heavy, and field measurements have determined that these tasks are equivalent to industrial jobs with high injury risks. The purpose of this study was to determine the effects of age, load amount, and load symmetry on lower extremity joint moments during carrying tasks. Three age groups (8–10 years, 12–14 years, adults), three load amounts (0%, 10%, 20% BW), and three load symmetry levels (unilateral large bucket, unilateral small bucket, bilateral small buckets) were tested. Inverse dynamics was used to determine maximum ankle, knee, and hip joint moments. Ankle dorsiflexion, ankle inversion, ankle eversion, knee adduction, and hip extension moments were significantly higher in 8–10 and 12–14 year olds. Ankle plantar flexion, ankle inversion, knee extension, and hip extension moments were significantly increased at 10% and 20% BW loads. Knee and hip adduction moments were significantly increased at 10% and 20% BW loads when carrying a unilateral large bucket. Of particular concern are increased ankle inversion and eversion moments for children, along with increased knee and hip adduction moments for heavy, asymmetrical carrying tasks. Carrying loads bilaterally instead of unilaterally avoided increases in knee and hip adduction moments with increased load amount. PMID:21975284

  1. Rehabilitation for patients with paraplegia and lower extremity amputation.

    PubMed

    Wang, Fangyong; Hong, Yi

    2015-10-01

    [Purpose] To study the characteristics and treatment strategy for patients with paraplegia and lower extremity amputation. [Subjects] Six cases were selected from among the patients admitted to the China Rehabilitation Research Center from 1991 to 2014. The criteria for the six cases were spinal cord injury with amputation immediately or in a short time (1 week) after the trauma. [Methods] General information, clinical diagnosis, treatment, rehabilitation and other data were analyzed. [Results] All the six cases were injured by high energy or complex energy accidents: two cases by falls after high voltage electric shock, one by an oil pipeline explosion, one by the impact of a falling tower crane and received high energy traffic accident injuries (one was hit by a train, and the other was hit by a truck at high speed). All the six cases had thoracic and lumbar vertebral injuries and complete paraplegia. Amputation stump infection occurred in four cases. After comprehensive rehabilitation treatment, patients' functional independence measure (FIM) scores improved significantly, but American Spinal Injury Association (ASIA) scores and ASIA Impairment Scale (AIS) grades showed no significant improvement. [Conclusion] When formulating the clinical treatment and rehabilitation for spinal cord injury with amputation patients, simultaneous consideration of the characteristics of the spinal cord injury and amputation is needed to develop an individualized strategy. For spinal cord injury with limb amputation patients, prostheses should allow the improvement of patients' self-care ability.

  2. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    PubMed Central

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  3. Calf pump activity influencing venous hemodynamics in the lower extremity.

    PubMed

    Recek, Cestmir

    2013-03-01

    Calf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of the previous pathological situation; this chain of events has been called hemodynamic paradox. PMID:24436580

  4. Bilaterally Symmetrical Lower Extremity Compartment Syndrome following Massive Transfusion

    PubMed Central

    Karaoren, Gulsah; Bakan, Nurten; Tomruk, Senay Goksu; Topaç, Zelin; Kurtulmuş, Tuhan; Irkören, Saime

    2016-01-01

    Compartment syndrome is a serious condition characterized by raised intracompartmental pressure, which develops following trauma. Well leg compartment syndrome (WLCS) is a term reserved for compartment syndrome in a nontraumatic setting, usually resulting from prolonged lithotomy position during surgery. In literature, 8 cases have been reported regarding well leg compartment syndrome in a supine position and bilateral symmetrical involvement was observed in only 2 cases. In WLCS etiology, lengthy surgery, lengthy hypotension, and extremity malpositioning have been held responsible but one of the factors with a role in the etiology may have been the tissue oedema and impaired microcirculation formed from the effect of vasoactive mediators expressed into the circulation associated with the massive blood transfusion. The case is presented here regarding symmetrical lower extremity compartment syndrome after surgery in which massive transfusion was made for gross haemorrhage from an abdominal injury. In conclusion, blood transfusion applied at the required time is life-saving but potential risks must always be considered. PMID:26885421

  5. Lower-extremity ground reaction forces in collegiate baseball pitchers.

    PubMed

    Guido, John A; Werner, Sherry L

    2012-07-01

    The purpose of this study was to investigate ground reaction forces (GRF) in collegiate baseball pitchers and their relationship to pitching mechanics. Fourteen healthy collegiate baseball pitchers participated in this study. High-speed video and force plate data were collected for fastballs from each pitcher. The average ball speed was 35 ± 3 m/sec (78 ± 7 mph). Peak GRFs of 245 ± 20% body weight (BW) were generated in an anterior or braking direction to control descent. Horizontal GRFs tended to occur in a laterally directed fashion, reaching a peak of 45 ± 63% BW. The maximum vertical GRF averaged 202 ± 43% BW approximately 45 milliseconds after stride foot contact. A correlation between braking force and ball velocity was evident. Because of the downward inclination and rotation of the pitching motion, in addition to volume, shear forces may occur in the musculoskeletal tissues of the stride limb leading to many of the lower-extremity injuries seen in this athletic population. PMID:22344047

  6. Lower-extremity ground reaction forces in collegiate baseball pitchers.

    PubMed

    Guido, John A; Werner, Sherry L

    2012-07-01

    The purpose of this study was to investigate ground reaction forces (GRF) in collegiate baseball pitchers and their relationship to pitching mechanics. Fourteen healthy collegiate baseball pitchers participated in this study. High-speed video and force plate data were collected for fastballs from each pitcher. The average ball speed was 35 ± 3 m/sec (78 ± 7 mph). Peak GRFs of 245 ± 20% body weight (BW) were generated in an anterior or braking direction to control descent. Horizontal GRFs tended to occur in a laterally directed fashion, reaching a peak of 45 ± 63% BW. The maximum vertical GRF averaged 202 ± 43% BW approximately 45 milliseconds after stride foot contact. A correlation between braking force and ball velocity was evident. Because of the downward inclination and rotation of the pitching motion, in addition to volume, shear forces may occur in the musculoskeletal tissues of the stride limb leading to many of the lower-extremity injuries seen in this athletic population.

  7. Mortality following lower extremity amputation in minorities with diabetes mellitus.

    PubMed

    Lavery, L A; van Houtum, W H; Armstrong, D G; Harkless, L B; Ashry, H R; Walker, S C

    1997-07-01

    The aim of this study was to identify the age adjusted and level specific mortality rate in African-Americans, Hispanics and non-Hispanic whites (NHW) during the perioperative period following a lower extremity amputation. We identified amputation data obtained from the Office of Statewide Planning and Development in California for 1991 from ICD-9-CM codes 84.11-84.18 and diabetes mellitus from any 250 related code. Amputations were categorized as foot (84.11-84.12), leg (84.13-84.16) or thigh (84.17-84.18). Death was coded under discharge status. Age adjusted and level specific mortality rates per 1000 amputees were calculated for each race/ethnic group. The age adjusted mortality was highest for African-Americans (41.39) compared to Hispanics (19.69) and NHW's (34.98). Mortality was consistently more frequent for proximal amputations. We conclude that mortality rates for persons with diabetes hospitalized for an amputation varied by race, gender and level of amputation. Higher prevalence or severity of risk factors may explain the excess mortality observed in African-Americans.

  8. Combined Lymphedema and Capillary Malformation of the Lower Extremity

    PubMed Central

    Maclellan, Reid A.; Chaudry, Gulraiz

    2016-01-01

    Background: Primary lymphedema and capillary malformation are independent vascular malformations that can cause overgrowth of the lower extremity. We report a series of patients who had both types of malformations affecting the same leg. The condition is unique but may be confused with other types of vascular malformation overgrowth conditions (eg, Klippel–Trenaunay and Parkes Weber). Methods: Our Vascular Anomalies Center and Lymphedema Program databases were searched for patients with both capillary malformation and lymphedema. Diagnosis of lymphedema–capillary malformation was made by history, physical examination, and imaging studies. Because lymphedema–capillary malformation has phenotypical overlap with other conditions, only patients who had imaging confirming their diagnosis were included in the analysis. Clinical and radiological features, morbidity, and treatment were recorded. Results: Eight patients (4 females and 4 males) had confirmed lymphedema–capillary malformation. Referring diagnosis was Klippel–Trenaunay syndrome (n = 4), diffuse capillary malformation with overgrowth (n = 3), or lymphatic malformation (n = 1). The condition was unilateral (n = 6) or bilateral (n = 2). Morbidity included infection (n = 6), difficulty fitting clothes (n = 6), bleeding or leaking vesicles (n = 5), leg length discrepancy (n = 4), and difficulty ambulating (n = 3). All patients were managed with compression regimens. Operative management was liposuction (n = 3), treatment of phlebectatic veins (n = 3), staged skin/subcutaneous excision (n = 1), and/or epiphysiodesis (n = 1). Conclusions: Lymphedema and capillary malformation can occur together in the same extremity. Both conditions independently cause limb overgrowth primarily because of subcutaneous adipose deposition. Compression garments and suction-assisted lipectomy can improve the condition. Lymphedema–capillary malformation should not be confused with other vascular malformation overgrowth

  9. Regional intensity of vascular care and lower extremity amputation rates

    PubMed Central

    Goodney, Philip P.; Holman, Kerianne; Henke, Peter K.; Travis, Lori L.; Dimick, Justin B.; Stukel, Therese A.; Fisher, Elliott. S.; Birkmeyer, John D.

    2013-01-01

    Objective To examine the relationship between the intensity of vascular care and population-based rate of major lower extremity amputation (above-or below-knee) from vascular disease. Background Because patient-level differences do not fully explain the variation in amputation rate across the United States, we hypothesized that variation in intensity of vascular care may also affect regional rates of amputation. Methods Intensity of vascular care was defined as the proportion of Medicare patients who underwent any vascular procedure in the year prior to amputation, calculated at the regional level (2003–2006), using the 306 hospital referral regions in the Dartmouth Atlas of Healthcare. We examined relationship between intensity of vascular care and major amputation rate, at the regional level, between 2007–2009. Results Amputation rates varied widely by region, from 1 to 27 per 10,000 Medicare patients. Compared to regions in the lowest quintile of amputation rate, patients in the highest quintile were commonly African American (50% versus 13%) and diabetic (38% versus 31%). Intensity of vascular care also varied across regions: fewer than 35% of patients underwent revascularization in the lowest quintile of intensity, while nearly 60% of patients underwent revascularization in the highest quintile. Overall, there was an inverse correlation between intensity of vascular care and amputation rate ranging from R= −0.36 for outpatient diagnostic and therapeutic procedures, to R= −0.87 for inpatient surgical revascularizations. In analyses adjusting for patient characteristics and socioeconomic status, patients in high vascular care regions were significantly less likely to undergo amputation without an antecedent attempt at revascularization (OR 0.37, 95% CI 0.34–0.37, p<0.001). Conclusions The intensity of vascular care provided to patients at risk for amputation varies, and regions with the most intensive vascular care have the lowest amputation rate

  10. Erythema nodosum of non-lower extremity sites - a histopathologic reappraisal.

    PubMed

    Perez-Chua, T; Miller, D D; Mahalingam, M

    2014-11-19

    We recently saw a 51 year--old female with a tender, erythematous nodule on the left elbow and histopathology consistent with Erythema nodosum (EN). A subsequent literature review of EN in non--lower extremity (LE) sites identified only three reports, with minimal histopathology, prompting the current study. We identified nine EN cases on non--LE sites over a 14--year period. Histopathology typical of EN observed included septal panniculitis, fibrosis and edema, a mixed septal inflammatory infiltrate with and spillover into adjacent lobules and Miescher's radial granulomas. Atypical features observed included a mixed (septal and lobular) panniculitis, leukocytoclastic vasculitis, changes in septal small vessels (lymphocytic cuffing of septal venules, endothelial swelling), lipomembranous cystic change and asteroid bodies. To the best of our knowledge, this is the first study to detail the histopathologic findings of EN on non--LE sites. Similar to that noted in classical EN in the LE, findings from the current study indicate that EN in non--LE sites display typical as well as atypical features. Limitations include retrospective design and the unspecified duration of biopsied lesions relative to clinical presentation. PMID:25407105

  11. Acute compartment syndrome in lower extremity musculoskeletal trauma.

    PubMed

    Olson, Steven A; Glasgow, Robert R

    2005-11-01

    Acute compartment syndrome is a potentially devastating condition in which the pressure within an osseofascial compartment rises to a level that decreases the perfusion gradient across tissue capillary beds, leading to cellular anoxia, muscle ischemia, and death. A variety of injuries and medical conditions may initiate acute compartment syndrome, including fractures, contusions, bleeding disorders, burns, trauma, postischemic swelling, and gunshot wounds. Diagnosis is primarily clinical, supplemented by compartment pressure measurements. Certain anesthetic techniques, such as nerve blocks and other forms of regional and epidural anesthesia, reportedly contribute to a delay in diagnosis. Basic science data suggest that the ischemic threshold of normal muscle is reached when pressure within the compartment is elevated to 20 mm Hg below the diastolic pressure or 30 mm Hg below the mean arterial blood pressure. On diagnosis of impending or true compartment syndrome, immediate measures must be taken. Complete fasciotomy of all compartments involved is required to reliably normalize compartment pressures and restore perfusion to the affected tissues. Recognizing compartment syndromes requires having and maintaining a high index of suspicion, performing serial examinations in patients at risk, and carefully documenting changes over time.

  12. Changes in Lower Extremity Biomechanics Due to a Short-Term Fatigue Protocol

    PubMed Central

    Cortes, Nelson; Greska, Eric; Kollock, Roger; Ambegaonkar, Jatin; Onate, James A.

    2013-01-01

    Context: Noncontact anterior cruciate ligament injury has been reported to occur during the later stages of a game when fatigue is most likely present. Few researchers have focused on progressive changes in lower extremity biomechanics that occur throughout fatiguing. Objective: To evaluate the effects of a sequential fatigue protocol on lower extremity biomechanics during a sidestep-cutting task (SS). Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: Eighteen uninjured female collegiate soccer players (age = 19.2 ± 0.9 years, height = 1.66 ± 0.5 m, mass = 61.6 ± 5.1 kg) volunteered. Intervention(s): The independent variable was fatigue level, with 3 levels (prefatigue, 50% fatigue, and 100% fatigue). Using 3-dimensional motion capture, we assessed lower extremity biomechanics during the SS. Participants alternated between a fatigue protocol that solicited different muscle groups and mimicked actual sport situations and unanticipated SS trials. The process was repeated until fatigue was attained. Main Outcome Measure(s): Dependent variables were hip- and knee-flexion and abduction angles and internal moments measured at initial contact and peak stance and defined as measures obtained between 0% and 50% of stance phase. Results: Knee-flexion angle decreased from prefatigue (−17° ± 5°) to 50% fatigue (−16° ± 6°) and to 100% fatigue (−14° ± 4°) (F2,34 = 5.112, P = .004). Knee flexion at peak stance increased from prefatigue (−52.9° ± 5.6°) to 50% fatigue (−56.1° ± 7.2°) but decreased from 50% to 100% fatigue (−50.5° ± 7.1°) (F2,34 = 8.282, P = 001). Knee-adduction moment at peak stance increased from prefatigue (0.49 ± 0.23 Nm/kgm) to 50% fatigue (0.55 ± 0.25 Nm/kgm) but decreased from 50% to 100% fatigue (0.37 ± 0.24) (F2,34 = 3.755, P = 03). Hip-flexion angle increased from prefatigue (45.4° ± 10.9°) to 50% fatigue (46.2° ± 11.2°) but decreased from 50% to 100% fatigue (40.9° ± 11.3

  13. Outcomes of lower extremity injuries sustained during Operation Iraqi Freedom and Operation Enduring Freedom.

    PubMed

    Spear, Marcia

    2009-01-01

    Lower extremity war injuries are complex because of changes in weaponry and ballistics. Outcomes of a functional lower extremity depend on early transport, early debridement and washout, and advanced surgical techniques such as microvascular procedures. The purpose of this article is to present evidence on the outcomes of lower extremity complex injuries and provide evidence-based factors that contribute to these outcomes. PMID:19752681

  14. Lower Extremity Fracture Reduction: Tips, Tricks, and Techniques So That You Leave the Operating Room Satisfied.

    PubMed

    Mir, Hassan R; Boulton, Christina L; Russell, George V; Archdeacon, Michael

    2016-01-01

    It can be challenging for surgeons to obtain proper alignment and to create stable constructs for the maintenance of many lower extremity fractures until union is achieved. Whether lower extremity fractures are treated with plates and screws or intramedullary nails, there are numerous pearls that may help surgeons deal with these difficult injuries. Various intraoperative techniques can be used for lower extremity fracture reduction and stabilization. The use of several reduction tools, tips, and tricks may facilitate the care of lower extremity fractures and, subsequently, improve patient outcomes. PMID:27049180

  15. The Effects of Load Carriage and Muscle Fatigue on Lower-Extremity Joint Mechanics

    ERIC Educational Resources Information Center

    Wang, He; Frame, Jeff; Ozimek, Elicia; Leib, Daniel; Dugan, Eric L.

    2013-01-01

    Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. Purpose: To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. Method: Eighteen men performed the following tasks: unloaded…

  16. Deep venous thrombosis and pulmonary embolism following cast immobilization of the lower extremity.

    PubMed

    Nesheiwat, F; Sergi, A R

    1996-01-01

    It is generally accepted that venous thrombosis in the lower extremity predisposes to pulmonary embolism. A case of pulmonary embolism after cast immobilization of the lower extremity, as well as a review of thromboembolic disease is presented. A high level of vigilance and close follow-up of even simple cast treatment is necessary to avoid this complication.

  17. Lower-extremity overuse injury and use of foot orthotic devices in women's basketball.

    PubMed

    Jenkins, Walter L; Raedeke, Susanne G

    2006-01-01

    One hundred thirty-two female basketball players were observed for lower-extremity overuse injury between 1993 and 2004. Athletes studied between 1993 and 1996 did not receive foot orthotic devices and composed the control group. The treatment group comprised athletes studied between 1996 and 2004. Athletes in the treatment group were given a foot orthotic device before participation in basketball. Data analysis included lower-extremity overuse injury rates and the effect of foot orthotic devices on lower-extremity overuse injury rates by means of an incidence density ratio. The control group had a lower-extremity overuse injury rate of 5.37 per 1,000 exposures, and the treatment group had a rate of 6.44 per 1,000 exposures. The incidence density ratio was not significant (P = .44). This study rejects the concept that foot orthotic devices may assist in prevention of lower-extremity overuse injury in female basketball players.

  18. The effect of cushioning insoles on back and lower extremity pain in an industrial setting.

    PubMed

    Jefferson, John R

    2013-10-01

    The purpose of this study was to examine the relationship between low back pain and lower extremity pain in a group of factory workers and determine the effect of cushioning insoles on low back pain and lower extremity pain. Data were gathered via questionnaire from 306 employees of an aircraft engine assembly factory. A subset of 40 workers who had reported significant levels of back or lower extremity pain were sampled for four consecutive 12-hour shifts wearing their normal footwear and then a week later for four consecutive shifts wearing cushioning insoles. High levels of low back pain and lower extremity pain were reported by workers on the plant floor, but low back pain was poorly correlated to lower extremity pain (r = 0.371). The effect of insoles on the subset of 40 workers was to lower low back pain by 38%, foot pain by 37%, and knee pain by 38% (p < .001). The reduction in low back pain, however, was not correlated to the reduction in lower extremity pain; workers reporting a decrease in low back pain differed from those reporting less lower extremity pain.

  19. Difficulty with daily activities involving the lower extremities in people with systemic sclerosis.

    PubMed

    Poole, Janet L; Brandenstein, Jane

    2016-02-01

    The purpose of this study was to examine the extent of lower extremity impairments in motion and strength in people with systemic sclerosis and the relationships of the impairments to limitations in activities of daily living primarily involving the lower extremities. Participants were 69 persons with SSc who received evaluations of lower extremity joint motion (Keitel function test), strength (timed-stands test), and basic mobility (timed up and go test) and completed a demographic questionnaire regarding symptoms in the lower extremities. Activity limitations were measured by the Rheumatoid and Arthritis Outcome Score (RAOS) which examines functional ability, pain, and quality of life. The participants had difficulty with items requiring external rotation of the hips and lower extremity strength. There were moderate correlations between the impairment measures of joint motion, strength, mobility, and activity limitations. Fair correlations were found between the skin scores and the RAOS sections except for pain. The results of this study show that lower extremity involvement is present in persons with SSc. The findings, regarding strength, mobility, and joint motion are related to the ability to perform everyday activities involving the lower extremities, suggest that these areas should be targeted for intervention in persons with SSc.

  20. Pathology Image Of the Month: Rapidly Progressive Hemorrhagic Cellulitis of Bilateral Lower Extremities with Subsequent Septic Shock and Death.

    PubMed

    Connor, Ellen E; Jackson, Nicole R; McGoey, Robin R

    2016-01-01

    A 51-year-old man presented to a community based emergency department with bilateral lower extremity swelling that began four days prior and that had evolved into recent blister formation on the left lower extremity. Medical history was significant only for hypertension and a recent self-described episode of "food poisoning" five days earlier characterized by diarrhea, nausea, and vomiting that quickly resolved. Physical exam revealed marked bilateral lower extremity edema and an ecchymotic rash below the knee. In addition to the rash, there were large flaccid bullae on the left leg, mostly intact but some notable for draining of scanty serosanguinous fluid. The patient was tachycardic with a rate of 114 bpm and initial labs showed thrombocytopenia (platelets 56 x 103/uL [140-440 x 103/uL]), hypoglycemia (15mg/dl [70-105mg/dl]), an elevated creatinine (2.7mg/dL [0.7- 1.25mg/dL]), and aspartate aminotransferase (AST 156U/L [5- 34U/L]). Two sets of blood cultures were drawn, broad spectrum antibiotics including doxycycline were empirically initiated and then he was subsequently transported to a tertiary care hospital for escalation of care. Within hours of presentation to the tertiary care facility, the rash appeared progressively hemorrhagic and bullous, lactic acidosis and coagulopathy developed and hemodynamic instability and septic shock necessitated endotracheal intubation and vasopressors. He was taken to the operating room for skin debridement but was emergently converted to bilateral above the knee lower extremity amputations due to the extent of the soft tissue necrosis. The patient remained intubated and in critical condition following surgery and the ecchymotic rash reappeared at the amputation sites. A newly developed ecchymotic rash with bullae formation was noted on the right upper extremity forearm. At that time, the clinicians were notified that four out of four blood culture bottles from admission were rapidly growing a microorganism. The family

  1. Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers

    PubMed Central

    Karukunchit, Usa; Puntumetakul, Rungthip; Swangnetr, Manida; Boucaut, Rose

    2015-01-01

    Background Rice farming activities involve prolonged manual work and human–machine interaction. Prolonged farming risk-exposure may result in lower limb malalignment. This malalignment may increase the risk of lower extremity injury and physical disabilities. However, the prevalence and factors associated with lower extremity malalignment have not yet been reported. This study aimed to investigate the prevalence and risk factors of lower extremity malalignment among rice farmers. Methods A cross-sectional survey was conducted with 249 rice farmers. Lower extremity alignment assessment included: pelvic tilt angle, limb length equality, femoral torsion, quadriceps (Q) angle, tibiofemoral angle, genu recurvatum, rearfoot angle, and medial longitudinal arch angle. Descriptive statistics were used to analyze participant characteristics and prevalence of lower extremity malalignment. Logistic regression analysis was used to identify risk factors. Results The highest prevalence of lower extremity malalignment was foot pronation (36.14%), followed by the abnormal Q angle (34.94%), tibiofemoral angle (31.73%), pelvic tilt angle (30.52%), femoral antetorsion (28.11%), limb length inequality (22.49%), tibial torsion (21.29%), and genu recurvatum (11.24%). In females, the risk factors were abnormal Q angle, tibiofemoral angle, and genu recurvatum. Being overweight was a risk factor for abnormal pelvic tilt angle, Q angle, and tibiofemoral angle. Age was a risk factor for limb length inequality. Years of farming were a major risk factor for abnormal Q angle, tibiofemoral angle, and foot malalignment. Conclusion Prevalence of lower extremity malalignment was reported in this study. Female sex, being overweight, and years of farming were major risk factors for lower extremity malalignment. Lower extremity screening should assist in the identification of foot and knee malalignment in rice farmers. This may then lead to early prevention of musculoskeletal disorders arising from

  2. Overuse injuries of the lower extremity: shin splints, iliotibial band friction syndrome, and exertional compartment syndromes.

    PubMed

    Jones, D C; James, S L

    1987-04-01

    The authors' discussion of overuse injuries of the lower extremity encompasses shin splints, iliotibial band friction syndrome, and exertional compartment syndromes. Etiology, diagnosis, and treatment are considered for each disorder.

  3. [Phlebography in chronic venous insufficiency of the lower extremities. Technic and value of different tests].

    PubMed

    Genevois, A; Bolot, J E; Michel, C

    1988-01-01

    Remainder of the various phlebographic procedures in chronic venous insufficiency of the lower extremities: peripheral phlebography, popliteal phlebography, femoral phlebography, varicography. The techniques and the informations they provide are presented for each one of these examinations. PMID:3043478

  4. The causes of lower-extremity deep venous thrombosis in the children with cranial diseases

    PubMed Central

    Wang, Yan; Liu, Wei; Jia, Ge; Li, Na; Jia, Yulong

    2015-01-01

    In order to investigate the prevalence of lower-extremity deep venous thrombosis (DVT) and to explore its possible reasons in children patients who received neurosurgery operation. Clinical data of 4958 cases children patients with lower-extremity DVT and without the thrombosis after the neurosurgery operation from 2010 January to 2014 December in department of neurosurgery of Tian Tan hospital were collected and analyzed. 18 cases children were diagnosed with lower-extremity DVT. All of them had invasive operation of lower-extremity deep venous catheterization. The mainly primary diseases of thrombosis children were craniopharyngioma. They have longer operation time compared with those without thrombosis (P<0.05). Therefore, the causes of DVT in neurosurgical children involve not only deep venous catheter-related but also neurological primary disease and operation time. PMID:26885175

  5. [Phlebography in chronic venous insufficiency of the lower extremities. Technic and value of different tests].

    PubMed

    Genevois, A; Bolot, J E; Michel, C

    1988-01-01

    Remainder of the various phlebographic procedures in chronic venous insufficiency of the lower extremities: peripheral phlebography, popliteal phlebography, femoral phlebography, varicography. The techniques and the informations they provide are presented for each one of these examinations.

  6. Decoding movement intent of patient with multiple sclerosis for the powered lower extremity exoskeleton.

    PubMed

    Zhang, Fan; Huang, He

    2013-01-01

    This study aims to recognize movement intent of patients with multiple sclerosis (MS) by decoding neuromuscular control signals fused with mechanical measurements as a method of powered lower extremity exoskeleton control. Surface electromyographic (EMG) signals recorded from the lower extremity muscles, ground reaction forces measured from beneath both feet, and kinematics from both thigh segments of a single MS patient were used to identify three activities (level-ground walking, sitting, and standing). Our study showed that during activity performance clear modulation of muscle activity in the lower extremities was observed for the MS patient, whose Kurtzke Expanded Disability Status Scale (EDSS) was 6. The designed intent recognition algorithm can accurately classify the subject's intended movements with 98.73% accuracy in static states and correctly predict the activity transitions about 100 to 130 ms before the actual transitions were made. These promising results indicate the potential of designed intent recognition interface for volitional control of powered lower extremity exoskeletons. PMID:24110847

  7. Risk factors for lower extremity injury: a review of the literature

    PubMed Central

    Murphy, D; Connolly, D; Beynnon, B

    2003-01-01

    Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine addtional risk factors for lower extremity injury. PMID:12547739

  8. An update around the evidence base for the lower extremity ultrasound regional block technique

    PubMed Central

    Fanelli, Andrea; Ghisi, Daniela; Melotti, Rita Maria

    2016-01-01

    Ultrasound guidance currently represents the gold standard for regional anesthesia. In particular for lower extremity blocks, despite the heterogeneity and the lack of large randomized controlled trials, current literature shows a modest improvement in block onset and quality compared with other localization techniques. This review aims to present the most recent findings on the application of ultrasound guidance for each single lower extremity approach. PMID:26918177

  9. Measurements of HIFU-induced Lesions in BSA Gel Phantoms for HIFU Treatment of Varicose Veins of Lower Extremity

    NASA Astrophysics Data System (ADS)

    Ushijima, Hiroyuki; Senoo, Naohiko; Suzuki, Jun; Ichiyanagi, Mitsuhisa; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2011-09-01

    HIFU treatment has been developed for various diseases because of its minimal invasiveness, and we are now developing a HIFU treatment for varicose veins of the lower extremity. Previous studies have succeeded in occluding rabbit's veins with HIFU, but the success rate was low (about 10%). Failures were mainly caused by skin burns. When the heating lesion comes close to skin, the absorbed ultrasound energy may cause skin burns. Therefore, it is necessary to study the relationships between HIFU lesions and skin burns to improve the success rate. To visualize heating lesions from HIFU, we used tissue-mimicking BSA gel phantoms. We tried various concentrations of BSA in gels, and determined 14% BSA as the most suitable for phantoms for experiments. The attenuation coefficient of the gel was 0.73 dB/cm, and the denaturation temperature was 70 °C. We put the BSA gel phantom in a water tank in which the temperature was kept at 39 °C, and used HIFU exposures at various intensities and irradiation times. After irradiation, we measured the sizes and positions of HIFU-induced lesions, and the results indicate that the sizes of lesion become larger when the intensitiy rises or irradiation time becomes longer. Furthermore, when the intensity rises and irradiation time becomes longer, the heating lesions move closer to upper surface of the gel, which means skin easily gets burned. Thus we have investigated relationships between HIFU parameters and heated lesions that can be used for further research into HIFU treatment of varicose veins of the lower extremity.

  10. Scrotal swelling

    MedlinePlus

    ... determine whether you need any tests. Your health care provider may prescribe antibiotics and pain medications, or recommend surgery. A scrotal ultrasound may be done to find where the swelling is occurring.

  11. Lower extremity work is associated with club head velocity during the golf swing in experienced golfers.

    PubMed

    McNally, M P; Yontz, N; Chaudhari, A M

    2014-08-01

    While the golf swing is a complex whole body movement requiring coordination of all joints to achieve maximum ball velocity, the kinetic contribution of the lower extremities to club head velocity has not been quantified, despite the perception that the legs are a primary source of power during the swing. Mechanical power at the hips, knees, and ankles was estimated during the downswing phase of a full swing with a driver using a passive optical motion capture system and 2 force plates for adult males across a range of age and self-reported skill levels. Total work by the lower extremities was calculated by integrating the powers of all 6 joints over the downswing. Regression analyses showed that total lower extremity work was a strong predictor of club head velocity (R=0.63). Secondary analyses showed different relationships to club head velocity in lead and trail leg lower extremity joints, but none of these were as predictive of club head velocity as the total work performed by the lower extremities. These results provide quantitative evidence that the lower body's kinetic contribution may be an important factor in achieving greater club head velocity, contributing to greater driving distance and overall golf performance. PMID:24577856

  12. Lower extremity work is associated with club head velocity during the golf swing in experienced golfers.

    PubMed

    McNally, M P; Yontz, N; Chaudhari, A M

    2014-08-01

    While the golf swing is a complex whole body movement requiring coordination of all joints to achieve maximum ball velocity, the kinetic contribution of the lower extremities to club head velocity has not been quantified, despite the perception that the legs are a primary source of power during the swing. Mechanical power at the hips, knees, and ankles was estimated during the downswing phase of a full swing with a driver using a passive optical motion capture system and 2 force plates for adult males across a range of age and self-reported skill levels. Total work by the lower extremities was calculated by integrating the powers of all 6 joints over the downswing. Regression analyses showed that total lower extremity work was a strong predictor of club head velocity (R=0.63). Secondary analyses showed different relationships to club head velocity in lead and trail leg lower extremity joints, but none of these were as predictive of club head velocity as the total work performed by the lower extremities. These results provide quantitative evidence that the lower body's kinetic contribution may be an important factor in achieving greater club head velocity, contributing to greater driving distance and overall golf performance.

  13. Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis.

    PubMed

    Carlson, Russell M; Smith, Nicholas C; Dux, Katherine; Stuck, Rodney M

    2014-04-01

    Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast-derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review.

  14. New Surgical Drapes for Observation of the Lower Extremities during Abdominal Aortic Repair

    PubMed Central

    2010-01-01

    Objective: For the early diagnosis and therapy of peripheral thromboembolism (TE) as a complication of abdominal aortic repair (AAR), we developed and evaluated the usefulness of surgical drapes that permit observation of the lower extremities during AAR. Materials and Methods: Between January 2007 and June 2009, the handling, durability, and usefulness of new surgical drapes were evaluated during AAR in 157 patients with abdominal aortic aneurysms and 9 patients with peripheral arterial disease. The drapes are manufactured by Hogy Medical Co. Ltd. and made of a water-repellent, spun lace, non-woven fabric, including a transparent polyethylene film that covers the patients' legs. This transparent film enables inspection and palpation of the lower extremities during surgery for early diagnosis and therapy of peripheral TE. Results: As a peripheral complication, 1 patient had right lower extremity TE. This was diagnosed immediately after anastomosis, thrombectomy was performed, and the remaining clinical course was uneventful. In all patients, the drapes permitted observation of the lower extremities , and the dorsal arteries were palpable. There were no problems with durability. Conclusions: New surgical drapes permit observation of the lower extremities during AAR for early diagnosis and treatment of peripheral TE. PMID:23555399

  15. Effect of Lower Extremity Stretching Exercises on Balance in Geriatric Population

    PubMed Central

    Reddy, Ravi Shankar; Alahmari, Khalid A

    2016-01-01

    Background and Objective The purpose of this study was to find “Effect of lower extremity stretching exercises on balance in the geriatric population. Method 60 subjects (30 male and 30 female) participated in the study. The subjects underwent 10 weeks of lower limb stretching exercise program. Pre and post 10 weeks stretching exercise program, the subjects were assessed for balance, using single limb stance time in seconds and berg balance score. These outcome measures were analyzed. Results Pre and post lower extremity stretching on balance was analyzed using paired t test. Of 60 subjects 50 subjects completed the stretching exercise program. Paired sample t test analysis showed a significant improvement in single limb stance time (eyes open and eyes closed) (p<0.001) and berg balance score (p<0.001). Conclusion Lower extremity stretching exercises enhances balance in the geriatric population and thereby reduction in the number of falls.

  16. Effect of Lower Extremity Stretching Exercises on Balance in Geriatric Population

    PubMed Central

    Reddy, Ravi Shankar; Alahmari, Khalid A

    2016-01-01

    Background and Objective The purpose of this study was to find “Effect of lower extremity stretching exercises on balance in the geriatric population. Method 60 subjects (30 male and 30 female) participated in the study. The subjects underwent 10 weeks of lower limb stretching exercise program. Pre and post 10 weeks stretching exercise program, the subjects were assessed for balance, using single limb stance time in seconds and berg balance score. These outcome measures were analyzed. Results Pre and post lower extremity stretching on balance was analyzed using paired t test. Of 60 subjects 50 subjects completed the stretching exercise program. Paired sample t test analysis showed a significant improvement in single limb stance time (eyes open and eyes closed) (p<0.001) and berg balance score (p<0.001). Conclusion Lower extremity stretching exercises enhances balance in the geriatric population and thereby reduction in the number of falls. PMID:27610062

  17. Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

    PubMed Central

    Patel, Manesh R.; Conte, Michael S.; Cutlip, Donald E.; Dib, Nabil; Geraghty, Patrick; Gray, William; Hiatt, William R.; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R.; Jones, W. Schuyler; Kawahara, Masayuki; Lookstein, Robert A.; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W.; Povsic, Thomas J.; Rosenfield, Kenneth; Rundback, John; Shamoun, Fadi; Tcheng, James; Tsai, Thomas T.; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N.; White, Christopher J.; Yokoi, Hiroyoshi; Krucoff, Mitchell W.

    2016-01-01

    The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease. PMID:25744011

  18. Medical devices; physical medicine devices; classification of the powered lower extremity exoskeleton; republication. Final order; republication.

    PubMed

    2015-05-01

    The Food and Drug Administration (FDA or the Agency) is republishing in its entirety a final order entitled ``Medical Devices; Physical Medicine Devices; Classification of the Powered Lower Extremity Exoskeleton'' that published in the Federal Register on February 24, 2015. FDA is republishing to correct an inadvertent omission of information. FDA is classifying the powered lower extremity exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered lower extremity exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. PMID:25985478

  19. Medical devices; physical medicine devices; classification of the powered lower extremity exoskeleton; republication. Final order; republication.

    PubMed

    2015-05-01

    The Food and Drug Administration (FDA or the Agency) is republishing in its entirety a final order entitled ``Medical Devices; Physical Medicine Devices; Classification of the Powered Lower Extremity Exoskeleton'' that published in the Federal Register on February 24, 2015. FDA is republishing to correct an inadvertent omission of information. FDA is classifying the powered lower extremity exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered lower extremity exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  20. Outpatient or short-stay skin grafting with early ambulation for lower-extremity burns.

    PubMed

    Dean, S; Press, B

    1990-08-01

    Lower-extremity burns and skin grafts to these wounds have traditionally required extended hospitalization. We have used early tangential excision of the burn wounds and application of an Unna boot to fresh skin grafts in an attempt to shorten the hospitalization for such patients. Over a six-month period, 9 patients were treated with Unna boots to fresh skin grafts on the lower extremity. The average hospital stay was 0.9 days (range, 0 to 3 days). Graft take was 85% to 100%; no regrafting was required. Ambulation was begun 24 hours postoperatively. The technique described is a safe, effective, and inexpensive alternative to prolonged immobilization and hospitalization in patients with lower-extremity skin grafts.

  1. Lower Extremity Fatigue, Sex, and Landing Performance in a Population With Recurrent Low Back Pain

    PubMed Central

    Haddas, Ram; James, C. Roger; Hooper, Troy L.

    2015-01-01

    Context: Low back pain and lower extremity injuries affect athletes of all ages. Previous authors have linked a history of low back pain with lower extremity injuries. Fatigue is a risk factor for lower extremity injuries, some of which are known to affect female athletes more often than their male counterparts. Objective: To determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force during landing in people with recurrent low back pain (LBP). Design: Cross-sectional study. Setting: A clinical biomechanics laboratory. Patients or Other Participants: Thirty-three young adults with recurrent LBP but without current symptoms. Intervention(s): Fatigue was induced using a submaximal free-weight squat protocol with 15% body weight until task failure was achieved. Main Outcome Measure(s): Three-dimensional knee motion, knee and ankle moments, ground reaction force, and trunk and lower extremity muscle-activity measurements were collected during 0.30-m drop vertical-jump landings. Results: Fatigue altered landing mechanics, with differences in landing performance between sexes. Women tended to have greater knee-flexion angle at initial contact, greater maximum knee internal-rotation angle, greater maximum knee-flexion moment, smaller knee-adduction moment, smaller ankle-inversion moment, smaller ground reaction force impact, and earlier multifidus activation. In men and women, fatigue produced a smaller knee-abduction angle at initial contact, greater maximum knee-flexion moment, and delays in semitendinosus, multifidus, gluteus maximus, and rectus femoris activation. Conclusions: Our results provide evidence that during a fatigued 0.30-m landing sequence, women who suffered from recurrent LBP landed differently than did men with recurrent LBP, which may increase women's exposure to biomechanical factors that can contribute to lower extremity injury. PMID:25322344

  2. Lower extremity control and dynamics during backward angular impulse generation in forward translating tasks.

    PubMed

    Mathiyakom, W; McNitt-Gray, J L; Wilcox, R

    2006-01-01

    Observation of complex whole body movements suggests that the nervous system coordinates multiple operational subsystems using some type of hierarchical control. When comparing two forward translating tasks performed with and without backward angular impulse, we have learned that both trunk-leg coordination and reaction force-time characteristics are significantly different between tasks. This led us to hypothesize that differences in trunk-leg coordination and reaction force generation would induce between-task differences in the control of the lower extremity joints during impulse generation phase of the tasks. Eight highly skilled performers executed a series of forward jumps with and without backward rotation (reverse somersault and reverse timer, respectively). Sagittal plane kinematics, reaction forces, and electromyograms of lower extremity muscles were acquired during the take-off phase of both tasks. Lower extremity joint kinetics were calculated using inverse dynamics. The results demonstrated between-task differences in the relative angles between the lower extremity segments and the net joint forces/reaction force and the joint angular velocity profiles. Significantly less knee extensor net joint moments and net joint moment work and greater hip extensor net joint moments and net joint moment work were observed during the push interval of the reverse somersault as compared to the reverse timer. Between-task differences in lower extremity joint kinetics were regulated by selectively activating the bi-articular muscles crossing the knee and hip. These results indicate that between-task differences in the control of the center of mass relative to the reaction force alters control and dynamics of the multijoint lower extremity subsystem. PMID:15878165

  3. Soccer-Specific Warm-Up and Lower Extremity Injury Rates in Collegiate Male Soccer Players

    PubMed Central

    Grooms, Dustin R.; Palmer, Thomas; Onate, James A.; Myer, Gregory D.; Grindstaff, Terry

    2013-01-01

    Context: A number of comprehensive injury-prevention programs have demonstrated injury risk-reduction effects but have had limited adoption across athletic settings. This may be due to program noncompliance, minimal exercise supervision, lack of exercise progression, and sport specificity. A soccer-specific program described as the F-MARC 11+ was developed by an expert group in association with the Federation Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC) to require minimal equipment and implementation as part of regular soccer training. The F-MARC 11+ has been shown to reduce injury risk in youth female soccer players but has not been evaluated in an American male collegiate population. Objective: To investigate the effects of a soccer-specific warm-up program (F-MARC 11+) on lower extremity injury incidence in male collegiate soccer players. Design: Cohort study. Setting: One American collegiate soccer team followed for 2 seasons. Patients or Other Participants: Forty-one male collegiate athletes aged 18–25 years. Intervention(s): The F-MARC 11+ program is a comprehensive warm-up program targeting muscular strength, body kinesthetic awareness, and neuromuscular control during static and dynamic movements. Training sessions and program progression were monitored by a certified athletic trainer. Main Outcome Measure(s): Lower extremity injury risk and time lost to lower extremity injury. Results: The injury rate in the referent season was 8.1 injuries per 1000 exposures with 291 days lost and 2.2 injuries per 1000 exposures and 52 days lost in the intervention season. The intervention season had reductions in the relative risk (RR) of lower extremity injury of 72% (RR = 0.28, 95% confidence interval = 0.09, 0.85) and time lost to lower extremity injury (P < .01). Conclusions: This F-MARC 11+ program reduced overall risk and severity of lower extremity injury compared with controls in collegiate-aged male soccer

  4. Lateral Approach to the Popliteal Artery for Free Tissue Transfer to the Lower Extremity

    PubMed Central

    Sinkin, Jeremy C.; Rudolph, Megan; Akbari, Cameron

    2016-01-01

    Summary: Free tissue transfer to the proximal leg and knee requires appropriate recipient vessel selection. The popliteal vessels have historically been unpopular choices, due to their remote location often necessitating vein grafts, and need for prone positioning. In this report, we describe a lateral approach to the above-knee popliteal vessels, which was utilized for 2 cases of free tissue transfer to the lower extremity. Neither prone positioning nor vein grafts were needed. The lateral approach to the above-knee popliteal vessels and their branches is a viable option for the otherwise recipient vessel-depleted lower extremity. PMID:27200237

  5. Effects of prosthetic limb prescription on 3-year mortality among lower extremity veteran amputees

    PubMed Central

    Kurichi, Jibby E.; Kwong, Pui; Vogel, W. Bruce; Xie, Dawei; Ripley, Diane Cowper; Bates, Barbara E.

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and three-year mortality post-surgery among veterans with lower extremity amputation. We conducted a retrospective observational study that included 4,578 veterans hospitalized for lower extremity amputation and discharged in Fiscal Years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3-year anniversary of the surgical date. There were 1,300 (28.4%) veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation. About 46% (n=2086) died within three-years of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 years of the surgical anniversary. After adjustment, veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than veterans without a prescription with a hazard ratio of 0.68 (95% CI, 0.60-0.77). Findings demonstrated that veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation were less likely to die within three years of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics. PMID:26348602

  6. Musculoskeletal rehabilitation and sports medicine. 3. Knee and lower extremity injuries.

    PubMed

    Ellen, M I; Young, J L; Sarni, J L

    1999-05-01

    This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of knee and lower extremity injuries that commonly occur during athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.

  7. [Orthovoltage roentgenotherapy in the treatment of lymphorrhea after reconstructive operations on the lower extremities arteries].

    PubMed

    Buga, D A; Ermolaev, E V; Miagkov, A P; Titarenko, S G; Kapustin, I P; Danilenko, A I

    2012-09-01

    After performance of 728 reconstructive-restoration operations on the lower extremities arteries in 58 (7.9%) patients a lymphorrhea from the wound have had occurred. While roentgenotherapy application for postoperative lymphorrhea treatment in 67% patients a good result was achieved. The number of the ray therapy procedures was determined in accordance with the clinical effect obtained.

  8. The impact of lower extremity mass and inertia manipulation on sprint kinematics.

    PubMed

    Bennett, John P; Sayers, Mark G L; Burkett, Brendan J

    2009-12-01

    Resistance sprint training is a sprint-specific training protocol commonly employed by athletes and coaches to enhance sprint performance. This research quantified the impact of lower extremity mass and inertia manipulation on key temporal and kinematic variables associated with sprint performance. A 3-dimensional analysis of 40 m sprinting was conducted on 8 elite sprinters under normal conditions and resisted sprint training. Results of the study showed that lower extremity additional mass training (at 10% individual segment weight) led to a significant reduction in sprint time for both the 10-m to 20-m and the 30-m to 40-m splits and the total 40 m measure. The stride velocity throughout the 20-m to 30-m phase of the sprint trials was also shown to be significantly reduced in the lower extremity mass and inertia manipulation condition. Importantly, no significant differences were observed across the remaining spatiotemporal variables of stride length, stride frequency, total stride time, and ground contact time. For coaches and athletes, the addition of specific lower extremity mass could improve the athlete's sprint performance without any measured effect on the technique of highly trained elite sprinters. PMID:19855307

  9. Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events.

    PubMed

    McKay, Brian J; Bir, Cynthia A

    2009-11-01

    Anti-vehicular (AV) landmines and improvised explosive devices (IED) have accounted for more than half of the United States military hostile casualties and wounded in Operation Iraqi Freedom (OIF) (Department of Defense Personnel & Procurement Statistics, 2009). The lower extremity is the predominantly injured body region following an AV mine or IED blast accounting for 26 percent of all combat injuries in OIF (Owens et al., 2007). Detonations occurring under the vehicle transmit high amplitude and short duration axial loads onto the foot-ankle-tibia region of the occupant causing injuries to the lower leg. The current effort was initiated to develop lower extremity injury criteria for occupants involved in underbelly blast impacts. Eighteen lower extremity post mortem human specimens (PMHS) were instrumented with an implantable load cell and strain gages and impacted at one of three incrementally severe AV axial loading conditions. Twelve of the 18 PMHS specimens sustained fractures of the calcaneus, talus, fibula and/or tibia. The initiation of skeletal injury was precisely detected by strain gages and corresponded with local peak axial tibia force. Survival analysis identified peak axial tibia force and impactor velocity as the two best predictors of incapacitating injury. A tibia axial force of 5,931 N and impactor velocity of 10.8 m/s corresponds with a 50 percent risk of an incapacitating injury. The criteria may be utilized to predict the probability of lower extremity incapacitating injury in underbelly blast impacts.

  10. Lower extremity power training in elderly subjects with moderate mobility limitations: A randomized controlled trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fifty-seven community-dwelling older adults were randomized to either high-velocity high-power training (POW), slow-velocity progressive resistance training (STR) or a control group of lower extremity stretching (CON). Training was performed three times per week for 12 weeks and subjects completed t...

  11. Effects of Arm Ergometry Exercise on the Reaction, Movement and Response Times of the Lower Extremities.

    ERIC Educational Resources Information Center

    Israel, Richard G.

    A study determined the effects of fatigue produced in the upper extremities on the reaction time, movement time, and response time of the lower extremities in 30 male subjects, 19-25 years old. Each subject participated in a 10 trial practice session one day prior to the experiment and immediately preceding the pre-test. The pre-test consisted of…

  12. [EXPERIENCE OF SEVERE CHRONIC VENOUS INSUFFICIENCY OF THE LOWER EXTREMITIES TREATMENT].

    PubMed

    Ponomarenko, A V

    2015-06-01

    The results of treatment of 246 patients on different forms of chronic venous insufficiency of the lower extremities were presented. The leading diagnostic criterion when choosing tactics consider patients ultrasound duplex scanning with color mapping. Patients in the presence of large ulcers basic treatment is autodermoplasty. The complex treatment include pharmacotherapy, the use of elastic compression hosiery.

  13. Incidence of deep vein thrombosis in erysipelas or cellulitis of the lower extremities.

    PubMed

    Mortazavi, Mohammadreza; Samiee, Mitra M; Spencer, Frederick A

    2013-03-01

    The incidence of deep vein thrombosis (DVT) in patients with erysipelas and cellulitis of the lower extremities is unknown. As such, the indication and efficacy of prophylactic anticoagulation for prevention of DVT in these patients is unclear. The main goal of this review is to provide an estimate of the incidence of DVT in erysipelas and cellulitis based on existing literature. A comprehensive search of the electronic sources: MEDLINE, EMBASE, CINAHL, LILAC and Cochrane without any language limitation was performed from 1950 to April 2011 for articles focused on the occurrence of DVT in cellulitis or erysipelas of the lower extremities. The selected studies were divided into two groups according to presence or absence of systematic investigation for DVT. Those studies in which the patients received prophylactic or therapeutic anticoagulants before a diagnosis of DVT were excluded. The reported incidence rate of DVT in patients with erysipelas or cellulitis of the lower extremities is highly variable, ranging from 0 to 15%. In this review, the overall incidence rates of DVT in studies with and without systematic investigation for thromboembolism were 2.72% (95% CI: 1.71-3.75%) and 0.68% (95% CI: 0.27-1.07%), respectively. Given the low reported overall incidence of DVT, neither routine prophylactic anticoagulation nor systematic paraclinical investigation for DVT is indicated in low risk patients with erysipelas or cellulitis of the lower extremities. DVT should still be considered in patients with high pretest probability or other thromboembolic risk factors.

  14. Lower extremity amputations in diabetic Mexican American elders: incidence, prevalence and correlates.

    PubMed

    Otiniano, Max E; Du, Xianglin; Ottenbacher, Kenneth; Black, Sandra A; Markides, Kyriakos S

    2003-01-01

    This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.

  15. Lower Extremity Muscle Mass Predicts Functional Performance in Mobility-Limited Elders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objectives This study examined the influence of lower extremity body composition and muscle strength on the severity of mobility-disability in community-dwelling older adults. Methods Fifty-seven older males and females (age 74.2 +/- 7 yrs; BMI 28.9 +/- 6 kg/m2) underwent an objective assessment ...

  16. Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients

    PubMed Central

    Kim, Eun-Kyung; Lee, Dong-Kyu; Kim, Young-Mi

    2015-01-01

    [Purpose] This study investigated the effect of aquatic proprioceptive neuromuscular facilitation (PNF) patterns in the lower extremity on balance and activities of daily living (ADL) in stroke patients. [Subjects] Twenty poststroke participants were randomly assigned to an experimental group (n = 10) or a control group (n = 10). The experimental group performed lower extremity patterns in an aquatic environment, and the control group performed lower extremity patterns on the ground. Both exercises were conducted for 30 minutes/day, 5 days/week for 6 weeks. Balance was measured with the Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), Functional Reach Test (FRT), and One Leg Stand Test (OLST). Activities of daily living were measured with the Functional Independence Measure (FIM). A paired t-test was used to measure pre- and post-experiment differences, and an independent t-test was used to measure between-group differences. [Results] The experimental and control groups showed significant differences for all pre- and post-experiment variables. In the between-group comparison, the experimental group was significantly difference from the control group. [Conclusion] These results indicate that performing aquatic proprioceptive neuromuscular facilitation patterns in the lower extremity enhances balance and ADL in stroke patients. PMID:25642076

  17. The effects of a lateral in-flight perturbation on lower extremity biomechanics during drop landings.

    PubMed

    Yom, Jae P; Simpson, Kathy J; Arnett, Scott W; Brown, Cathleen N

    2014-10-01

    One potential ACL injury situation is due to contact with another person or object during the flight phase, thereby causing the person to land improperly. Conversely, athletes often have flight-phase collisions but do land safely. Therefore, to better understand ACL injury causation and methods by which people typically land safely, the purpose of this study was to determine the effects of an in-flight perturbation on the lower extremity biomechanics displayed by females during typical drop landings. Seventeen collegiate female recreational athletes performed baseline landings, followed by either unexpected laterally-directed perturbation or sham (nonperturbation) drop landings. We compared baseline and perturbation trials using paired-samples t tests (P < .05) and 95% confidence intervals for lower-extremity joint kinematics and kinetics and GRF. The results demonstrated that perturbation landings compared with baseline landings exhibited more extended joint positions of the lower extremity at initial contact; and, during landing, greater magnitudes for knee abduction and hip adduction displacements; peak magnitudes of vertical and medial GRF; and maximum moments of ankle extensors, knee extensors, and adductor and hip adductors. We conclude that a lateral in-flight perturbation leads to abnormal GRF and angular motions and joint moments of the lower extremity.

  18. Lower extremity control and dynamics during backward angular impulse generation in backward translating tasks.

    PubMed

    Mathiyakom, W; McNitt-Gray, J L; Wilcox, R

    2006-03-01

    Observation of complex whole-body movements suggests that the nervous system coordinates multiple operational subsystems using some type of hierarchical control. When comparing two backward translating tasks performed with and without backward angular impulse, we have learned that task-specific modifications in trunk-leg coordination contribute to the regulation of total-body center of mass (CoM) position relative to the reaction force (RF). In this study, we hypothesized that task-specific differences in trunk-leg coordination would affect the control of the lower extremity joints during the impulse-generation phase of the tasks. Eight highly skilled performers executed a series of backward translating jumps with and without backward rotation (back somersault and back timer, respectively). Sagittal plane kinematics, RFs and electromyograms of lower extremity muscles were acquired during the take-off phase of both tasks. Lower extremity joint kinetics was calculated using inverse dynamics. The results indicate that between-task differences in the relative angles between the lower extremity segments and the net joint forces/RF contributed to significant reductions in knee-extensor net joint moments and increases in hip-extensor net joint moments during the push interval of the back somersault as compared to the back timer. Between-task differences in backward trunk angular velocity also contributed to the re-distribution of work done by the lower extremity net joint moments. Between-task differences in lower extremity joint kinetics were associated with synergistic activation of the bi-articular muscles crossing the knee and hip. These results indicated that task-specific control of CoM relative to the RF in order to regulate the backward angular-impulse-involved modification in the control and dynamics of the knee and hip joints. These results indicate that between-task differences in the control objectives at the total-body level (position of CoM relative to the

  19. A functional agility short-term fatigue protocol changes lower extremity mechanics

    PubMed Central

    Cortes, Nelson; Quammen, David; Lucci, Shawn; Greska, Eric; Onate, James

    2012-01-01

    The purpose of this study was to evaluate the effects of a functional agility fatigue protocol on lower extremity biomechanics between two unanticipated tasks (stop-jump and sidestep). The subjects consisted of fifteen female collegiate soccer athletes (19 ± 0.7 years, 1.67 ± 0.1 m, 61.7 ± 8 kg) free of lower extremity injury. Participants performed five trials of stop-jump and sidestep tasks. A functional short-term agility protocol was performed, and immediately following participants repeated the unanticipated running tasks. Lower extremity kinematic and kinetic values were obtained pre and post fatigue. Repeated measures analyses of variance were conducted for each dependent variable with an alpha level set at 0.05. Knee position post-fatigue had increased knee internal rotation (11.4 ± 7.5° vs. 7.9 ± 6.5° p = 0.011) than pre-fatigue, and a decreased knee flexion angle (−36.6 ± 6.2° vs.−40.0 ± 6.3°, p = 0.003), as well as hip position post-fatigue had decreased hip flexion angle (35.5 ± 8.7° vs. 43.2 ± 9.5°, p = 0.002). A quick functional fatigue protocol altered lower extremity mechanics of Division I collegiate soccer athletes during landing tasks. Proper mechanics should be emphasized from the beginning of practice/game to aid in potentially minimizing the effects of fatigue in lower extremity mechanics. PMID:22424559

  20. Classifying Lower Extremity Muscle Fatigue during Walking using Machine Learning and Inertial Sensors

    PubMed Central

    Zhang, Jian; Lockhart, Thurmon E.; Soangra, Rahul

    2013-01-01

    Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as Support Vector Machines (SVM) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and kinetic gait patterns of 17 participants (29±11 years) were recorded and analyzed in normal and fatigued state of walking. Lower extremities were fatigued by performance of a squatting exercise until the participants reached 60% of their baseline maximal voluntary exertion level. Feature selection methods were used to classify fatigue and no-fatigue conditions based on temporal and frequency information of the signals. Additionally, influences of three different kernel schemes (i.e., linear, polynomial, and radial basis function) were investigated for SVM classification. The results indicated that lower extremity muscle fatigue condition influenced gait and loading responses. In terms of the SVM classification results, an accuracy of 96% was reached in distinguishing the two gait patterns (fatigue and no-fatigue) within the same subject using the kinematic, time and frequency domain features. It is also found that linear kernel and RBF kernel were equally good to identify intra-individual fatigue characteristics. These results suggest that intra-subject fatigue classification using gait patterns from an inertial sensor holds considerable potential in identifying “at-risk” gait due to muscle fatigue. PMID:24081829

  1. Reliability and Validity of a Partial Weight Bearing Measure of Lower Extremity Performance

    PubMed Central

    Haines, Michelle; O'Rand, Denise; Levy, Susan

    2009-01-01

    Background Methods of measuring lower extremity function is limited for those with partial weight bearing (PWB) status in early phases of a lower extremity rehabilitation program. Objectives The purpose of this study was to measure intra-rater reliability of two lower extremity PWB performance measures using an incline exercise apparatus and to evaluate the concurrent validity and responsiveness to change of these two measures. Methods Thirty-seven adult patients with lower extremity injuries were measured on two PWB measures (PWB20 and PWB30) of lower extremity performance as well as several common measures of LE function. After initial testing, subjects were asked to return for retesting, following four to six weeks of rehabilitation intervention. Reliability of the data from the measures was tested using intraclass correlation coefficients (ICC); validity was based on bivariate correlations of the measures. The minimal detectable change (MDC) value and limb symmetry index (LSI) were used to study the responsiveness of the PWB measures. Results The ICC for the PWB20 and PWB30 were 0.95 and 0.98, respectively. The bivariate correlations of the PWB20 with stair climbing and walking speed were greater than those of the PWB30. Correlations ranged from r = 0.49 to 0.72 between the PWB measures and the functional measures. For most patients, their change in score between initial testing and follow-up exceeded the MDC; the LSI improved for all patients. Conclusion Using the incline apparatus yielded reliable PWB data. In addition, performance on the PWB measures correlated fairly well with common measures of function. PMID:21509110

  2. Classifying lower extremity muscle fatigue during walking using machine learning and inertial sensors.

    PubMed

    Zhang, Jian; Lockhart, Thurmon E; Soangra, Rahul

    2014-03-01

    Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as support vector machines (SVMs) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and kinetic gait patterns of 17 participants (29 ± 11 years) were recorded and analyzed in normal and fatigued state of walking. Lower extremities were fatigued by performance of a squatting exercise until the participants reached 60% of their baseline maximal voluntary exertion level. Feature selection methods were used to classify fatigue and no-fatigue conditions based on temporal and frequency information of the signals. Additionally, influences of three different kernel schemes (i.e., linear, polynomial, and radial basis function) were investigated for SVM classification. The results indicated that lower extremity muscle fatigue condition influenced gait and loading responses. In terms of the SVM classification results, an accuracy of 96% was reached in distinguishing the two gait patterns (fatigue and no-fatigue) within the same subject using the kinematic, time and frequency domain features. It is also found that linear kernel and RBF kernel were equally good to identify intra-individual fatigue characteristics. These results suggest that intra-subject fatigue classification using gait patterns from an inertial sensor holds considerable potential in identifying "at-risk" gait due to muscle fatigue. PMID:24081829

  3. Alignment control exercise changes lower extremity movement during stop movements in female basketball players.

    PubMed

    Kato, Shigeyuki; Urabe, Yukio; Kawamura, Kenji

    2008-08-01

    This study was intended to evaluate a short-term intervention designed to improve the lower extremity alignment with neutral position during stop movements of female basketball players when performing a quick-stop jump shot. In this study, 20 healthy female college basketball players (mean age 20.5 years) participated. The authors monitored two groups for 4 weeks: one which trained (n=10) and one which did not train (n=10). The exercise program emphasized the neutral position of lower extremities for dynamic alignment control; the players avoided the valgus position with their knees. Kinematics analysis with a lower extremity angle in the stop action was performed using three digital video cameras and analyzed using software. Following the intervention exercise program, each subject was re-evaluated at two and four weeks to determine changes in movement patterns during the "sink shot" task. Two-way analysis of variance models were used to determine differences at pre-intervention, at mid-term, and post-intervention. After the 2-week intervention, the trained athletes group made basketball shots with greater change of the lower extremity motion pattern during the stop action than did non-trained athletes (p<0.05). However, no significant differences were found between other data of the 2-week and 4-week intervention groups. Results of this study show that two weeks of training can improve the dynamic alignment control of the lower extremities, as measured using the alignment angle of the coronal plane and the torsion angle of horizontal plane during a stop action.

  4. Prevalence of exclusive lower extremity metastases at 18F-NaF PET/CT*

    PubMed Central

    Ordones, Monique Beraldo; Valadares, Agnes Araujo; Duarte, Paulo Schiavom; Sado, Heitor Naoki; Lima, Marcos Santos; Carvalho, Giovanna; Sapienza, Marcelo Tatit; Buchpiguel, Carlos Alberto

    2015-01-01

    Objective To evaluate the prevalence of exclusive lower extremity metastases, specifically in the femur and below the knee, observed at 18F-NaF PET/CT. Materials and Methods One thousand consecutive PET/CT studies were retrospectively evaluated for the presence of exclusive uptake in lower extremities suggesting metastatic involvement. The presumptive diagnoses based on such uptakes were subsequently obtained by evaluation of other imaging studies. Results No exclusive uptake suggestive of metastasis below the femur was observed in the present series. Exclusive uptake was observed in the proximal femur with a presumptive diagnosis of metastasis in two patients. Conclusion The prevalence of exclusive metastasis below the femur is low and scanning from head to knees is appropriate in most cases. PMID:26185339

  5. EMG analysis of the lower extremities during pitching in high-school baseball.

    PubMed

    Yamanouchi, T

    1998-01-01

    I evaluated the contractions of the muscles of the lower extremities during baseball pitching using video imaging and simultaneous surface EMG. The subjects were 10 members of a high school baseball club and, for contrast, 10 students without any baseball club experience. I divided their pitching movements into two phases determined with respect to the landing of the non-pivot leg. The EMG signal intensities over the 2 seconds prior to landing, and over the 2 seconds after landing, were then integrated to give an EMG value to each phase. I then computed this value as the % MMT. The abductor and adductor of the hip muscles of both lower extremities in the players were strongly contracted, especially the adductor. This finding was consistent with the observation that pitching tends to lead to adductor muscle disorders. Strengthening the adductor and its antagonist abductor can therefore directly influence the capability for pitching, and can reduce the risk for the adductor disorders. PMID:9658746

  6. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

    PubMed Central

    Kahanov, Leamor; Eberman, Lindsey E; Games, Kenneth E; Wasik, Mitch

    2015-01-01

    Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence. PMID:25848327

  7. Lower Extremity Radicular Pain Caused by Entrapped Sigmoid Colon Between L5 and S1 Vertebrae

    PubMed Central

    Ko, Sanghyung; Park, Noh Kyoung; Cho, Kyoung Jin; Baek, Jung Hyun; Lim, Jeong-Wook; Choi, Dongjin

    2015-01-01

    Intestinal entrapment between two vertebral bodies is very rare. In all previous cases, it occurred by major trauma. However, the bowel entrapment between two vertebral bodies without trauma has never been reported, not to mention as the cause of lower extremity radicular pain. We describe the case of an 82-year-old female patient with right lower extremity radicular pain without recent trauma history. The patient was diagnosed sigmoid colon entrapment between the L5 and S1 vertebrae by lumbar spinal computerized tomography and magnetic resonance imaging, and showed improvement in radicular pain after manual reduction of interpositioned colon during surgery. Intestinal entrapment between two vertebrae without trauma is caused by degenerative and vacuum changes of the intervertebral disc combined with the anterior longitudinal ligament injury. PMID:26619145

  8. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

    PubMed Central

    Sista, Akhilesh K.; Vedantham, Suresh; Kaufman, John A.

    2015-01-01

    The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article. © RSNA, 2015 PMID:26101920

  9. Hip Arthroscopy in Patients With Lower-Extremity Amputations: Patient Positioning and Traction Technique.

    PubMed

    McCabe, Michael P; Davila, Jeffrey

    2015-12-01

    Improved battlefield survival rates have resulted in a significant number of young active patients with lower-extremity amputations. Because of the increased demands placed on their hips, patients with amputations may be more susceptible to the sequelae of hip pathology and femoroacetabular impingement. Arthroscopic management of hip pathology may be successfully performed in patients with ipsilateral, contralateral, or bilateral lower-extremity amputations. We describe our experience in this unique patient population. A technique for secure patient positioning that provides sufficient countertraction in the case of contralateral amputation is described, as is the use of skeletal traction with a temporary external fixator for joint distraction in patients with ipsilateral amputations. Considerations specific to patients with high transfemoral amputations are discussed as well. PMID:27284510

  10. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

    PubMed Central

    Min, Seung-Kee; Kim, Young Hwan; Joh, Jin Hyun; Kang, Jin Mo; Park, Ui Jun; Kim, Hyung-Kee; Chang, Jeong-Hwan; Park, Sang Jun; Kim, Jang Yong; Bae, Jae Ik; Choi, Sun Young; Kim, Chang Won; Park, Sung Il; Yim, Nam Yeol; Jeon, Yong Sun; Yoon, Hyun-Ki; Park, Ki Hyuk

    2016-01-01

    Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.

  11. Exercise testing and training in patients with peripheral vascular disease and lower extremity amputation.

    PubMed

    Priebe, M; Davidoff, G; Lampman, R M

    1991-05-01

    Patients with peripheral vascular disease have a high risk of coronary artery disease. The risk is even greater when the peripheral vascular disease leads to lower extremity amputation. Exercise testing using lower extremity exercise has been the "gold standard" for screening for coronary artery disease, but many patients with peripheral vascular disease and those with amputations have difficulty doing this type of exercise. Arm exercise ergometry has been shown to be a safe and effective alternative for the detection of coronary artery disease in patients who cannot do leg exercise. This test has also been used to determine safe exercise levels and may be able to predict the ultimate level of prosthetic use in amputees. Exercise training with arm ergometry also improves cardiovascular efficiency and upper body strength in poorly conditioned patients. Studies are needed to appreciate fully the role of exercise testing and training in the recovery of these patients after amputation. PMID:1866958

  12. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

    PubMed Central

    Min, Seung-Kee; Kim, Young Hwan; Joh, Jin Hyun; Kang, Jin Mo; Park, Ui Jun; Kim, Hyung-Kee; Chang, Jeong-Hwan; Park, Sang Jun; Kim, Jang Yong; Bae, Jae Ik; Choi, Sun Young; Kim, Chang Won; Park, Sung Il; Yim, Nam Yeol; Jeon, Yong Sun; Yoon, Hyun-Ki; Park, Ki Hyuk

    2016-01-01

    Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care. PMID:27699156

  13. EMG analysis of the lower extremities during pitching in high-school baseball.

    PubMed

    Yamanouchi, T

    1998-01-01

    I evaluated the contractions of the muscles of the lower extremities during baseball pitching using video imaging and simultaneous surface EMG. The subjects were 10 members of a high school baseball club and, for contrast, 10 students without any baseball club experience. I divided their pitching movements into two phases determined with respect to the landing of the non-pivot leg. The EMG signal intensities over the 2 seconds prior to landing, and over the 2 seconds after landing, were then integrated to give an EMG value to each phase. I then computed this value as the % MMT. The abductor and adductor of the hip muscles of both lower extremities in the players were strongly contracted, especially the adductor. This finding was consistent with the observation that pitching tends to lead to adductor muscle disorders. Strengthening the adductor and its antagonist abductor can therefore directly influence the capability for pitching, and can reduce the risk for the adductor disorders.

  14. Pelvic and lower extremity injuries in Homer's Iliad: a review of the literature.

    PubMed

    Galanakos, Spyridon P; Bot, Arjan G J; Macheras, George A

    2015-01-01

    The Iliad, composed approximately in the middle of the eighth century bc, constitutes the leading and oldest known example of heroic epic. The Homeric epic presents the conflicts that took place during the last year of the 10-year lasting Trojan War, offering a realistic description of battle wounds. We studied the text of The Iliad in ancient Greek and in the translations in modern Greek and English and searched for all recorded injuries to the pelvis and lower extremities. A total of 16 traumatic injuries of pelvis and lower extremities were described, including 7 fatal wounds, while in 9 cases, the outcome was unknown.The Iliad remains the oldest record of Greek medicine and a unique source of surgical history. To study the vividly reported events is a great experience, particularly for a surgeon.

  15. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review

    PubMed Central

    van Gent, R N; Siem, D; van Middelkoop, M; van Os, A G; Bierma‐Zeinstra, S M A; Koes, B W

    2007-01-01

    The purpose of this study was to present a systematic overview of published reports on the incidence and associated potential risk factors of lower extremity running injuries in long distance runners. An electronic database search was conducted using the PubMed–Medline database. Two observers independently assessed the quality of the studies and a best evidence synthesis was used to summarise the results. The incidence of lower extremity running injuries ranged from 19.4% to 79.3%. The predominant site of these injuries was the knee. There was strong evidence that a long training distance per week in male runners and a history of previous injuries were risk factors for injuries, and that an increase in training distance per week was a protective factor for knee injuries. PMID:17473005

  16. A new method of training for the lower extremity using unloading.

    PubMed

    Kelsey, D D; Tyson, E

    1994-04-01

    Rehabilitation of the patient with lower extremity dysfunction is frequently limited to open kinetic chain exercise due to pain and weakness in weight-bearing positions. Although hydrotherapy has been used in the past as a method of reducing body weight forces, task-specific training is not possible due to the resistance offered by water and the inability to regulate load. This clinical commentary describes a new form of lower extremity rehabilitation through the use of Unloading, a controlled reduction in body weight during task-specific activities. Two case reports of professional basketball players with foot injuries are presented in order to describe this method of therapy, which, in the authors' opinion, has the potential for broad applications in physical rehabilitation and deserves further research.

  17. Effect of Variable Lower Extremity Immobilization Devices on Emergency Brake Response Driving Outcomes.

    PubMed

    Sansosti, Laura E; Rocha, Zinnia M; Lawrence, Matthew W; Meyr, Andrew J

    2016-01-01

    The effect of lower extremity pathologic features and surgical intervention on automobile driving function has been a topic of contemporary interest in the orthopedic medical literature. The objective of the present case-control investigation was to assess 3 driving outcomes (i.e., mean emergency brake response time, frequency of abnormally delayed brake responses, and frequency of inaccurate brake responses) in a group of participants with 3 variable footwear conditions (i.e., regular shoe gear, surgical shoe, and walking boot). The driving performances of 25 participants without active right-sided lower extremity pathology were evaluated using a computerized driving simulator. Both the surgical shoe (0.611 versus 0.575 second; p < .001) and the walking boot (0.736 versus 0.575 second; p < .001) demonstrated slower mean brake response times compared with the control shoe gear. Both the surgical shoe (18.5% versus 2.5%; p < .001) and the walking boot (55.5% versus 2.5%; p < .001) demonstrated more frequent abnormally delayed brake responses compared with the control shoe gear. The walking boot (18.0% versus 2.0%; p < .001) demonstrated more frequent inaccurate brake responses compared with the control shoe gear. However, the surgical shoe (4.0% versus 2.0%; p = .3808) did not demonstrate a difference compared with the control shoe gear. The results of the present investigation provide physicians working with the lower extremity with a better understanding on how to assess the risk and appropriately advise their patients who have been prescribed lower extremity immobilization devices with respect to the safe operation of an automobile. PMID:27445123

  18. Bilateral lower extremity hyperkeratotic plaques: a case report of ichthyosis vulgaris.

    PubMed

    Leight, Hayley; Zinn, Zachary; Jalali, Omid

    2015-01-01

    Here, we report a case of a middle-aged woman presenting with severe, long-standing, hyperkeratotic plaques of the lower extremities unrelieved by over-the-counter medications. Initial history and clinical findings were suggestive of an inherited ichthyosis. Ichthyoses are genetic disorders characterized by dry scaly skin and altered skin-barrier function. A diagnosis of ichthyosis vulgaris was confirmed by histopathology. Etiology, prevalence, and treatment options are discussed.

  19. Bilateral lower extremity hyperkeratotic plaques: a case report of ichthyosis vulgaris

    PubMed Central

    Leight, Hayley; Zinn, Zachary; Jalali, Omid

    2015-01-01

    Here, we report a case of a middle-aged woman presenting with severe, long-standing, hyperkeratotic plaques of the lower extremities unrelieved by over-the-counter medications. Initial history and clinical findings were suggestive of an inherited ichthyosis. Ichthyoses are genetic disorders characterized by dry scaly skin and altered skin-barrier function. A diagnosis of ichthyosis vulgaris was confirmed by histopathology. Etiology, prevalence, and treatment options are discussed. PMID:26396540

  20. THE RELATIONSHIP BETWEEN LOWER EXTREMITY CLOSED KINETIC CHAIN STRENGTH & SAGITTAL PLANE LANDING KINEMATICS IN FEMALE ATHLETES

    PubMed Central

    Kivlan, Ben; Scibek, Jason S.

    2011-01-01

    Background: Female athletes continue to injure their anterior cruciate ligaments at a greater rate than males in comparable sports. During landing activities, females exhibit several different kinematic and kinetic traits when compared to their male counterparts including decreased knee flexion angles as well as decreased lower extremity (LE) strength. While open kinetic chain strength measures have not been related to landing kinematics, given the closer replication of movement patterns that occur during closed kinetic chain (CKC) activity, it is possible that lower extremity strength if measured in this fashion will be related to landing kinematics. Purpose: To determine if unilateral isometric CKC lower extremity (LE) strength was related to sagittal plane tibiofemoral kinematics during a single leg landing task in competitive female athletes. We hypothesized females who demonstrated lesser CKC LE strength would exhibit decreased sagittal plane angles during landing. Methods: 20 competitive female athletes (age = 16.0 ± 1.8 yrs; height = 166.5 ± 8.3 cm; weight = 59.7 ± 10.2 kg) completed CKC LE strength testing followed by 5 unilateral drop landings on the dominant LE during one test session at an outpatient physical therapy clinic. Closed kinetic chain LE strength was measured on a computerized leg press with an integrated load cell while sagittal plane tibiofemoral kinematics were quantified with an electrogoniometer. Results: No significant relationships between absolute or normalized isometric CKC strength and sagittal plane landing kinematics were identified. Conclusions: Closed kinetic chain lower extremity isometric strength tested at 25 degrees of knee flexion is not related to sagittal plane landing kinematics in adolescent competitive female athletes. Levels of Evidence: Analytic, Observational PMID:21655453

  1. Application of Advanced Magnetic Resonance Imaging Techniques in Evaluation of the Lower Extremity

    PubMed Central

    Braun, Hillary J.; Dragoo, Jason L.; Hargreaves, Brian A.; Levenston, Marc E.; Gold, Garry E.

    2012-01-01

    Synopsis This article reviews current magnetic resonance imaging techniques for imaging the lower extremity, focusing on imaging of the knee, ankle, and hip joints. Recent advancements in MRI include imaging at 7 Tesla, using multiple receiver channels, T2* imaging, and metal suppression techniques, allowing more detailed visualization of complex anatomy, evaluation of morphological changes within articular cartilage, and imaging around orthopedic hardware. PMID:23622097

  2. Lower Extremity Arterial Calcification as a Predictor of Coronary Atherosclerosis in Patients with Peripheral Arterial Disease

    PubMed Central

    Shin, Hwa Seon; Jung Park, Mi; Nyeo Jeon, Kyung; Min Cho, Jae; Soo Bae, Kyung; Seob Choi, Dae; Boem Na, Jae; Cheol Choi, Ho; Young Choi, Hye; Eun Kim, Ji; Bueum Cho, Soo; Eun Park, Sung

    2016-01-01

    Background Until now, there has been no study on the relationship between the calcification of the lower extremity arteries and significant coronary arterial disease (CAD). Objectives To evaluate whether lower extremity calcium scores (LECS) are associated with CAD and whether this can predict multivessel-CAD in patients with peripheral arterial disease (PAD). Patients and Methods We retrospectively enrolled 103 PAD patients without cardiac symptoms or known CAD. All patients underwent cardiac computed tomography (CT) and lower extremity CT within 1 month and were categorized as nonsignificant CAD, single-CAD, or multivessel-CAD. The coronary calcium scores (CCS) were quantitatively measured according to the Agatston method and LECS were semi-quantitatively measured according to the presence of lower extremity calcification in the segment. The extent of CAD was evaluated according to the presence of ≥ 50% luminal diameter stenosis in the segment of CAD. Results LECS in multivessel-CAD were significantly higher than those in nonsignificant CAD (10.0 ± 5.8 versus 4.0 ± 3.1, P < 0.001). LECS significantly correlated with CCS (r = 0.831, P < 0.001) and the extent of CAD (r = 0.631, P < 0.001). Multivariate regression analysis demonstrated LECS and log-transformed CCS were independent predictors for multivessel-CAD. In receiver operating characteristic curve analysis, the diagnostic performance of LECS was 0.807 (95% confidence interval = 0.724-0.891, P < 0.001) for predicting multivessel-CAD. Conclusion Peripheral arterial calcification is significantly correlated with CAD extent in patients with PAD. Peripheral arterial calcification can be a useful marker for predicting multivessel-CAD. PMID:27703657

  3. Lower extremity lipedema, upper extremity lipodystrophy and severe calcinosis complicating juvenile dermatomyositis.

    PubMed

    Pavlov-Dolijanovic, Slavica R; Vujasinovic Stupar, Nada Z; Gavrilov, Nikola; Seric, Srdjan

    2014-11-01

    Juvenile dermatomyositis (JDM) is a rare but complex and potentially life-threatening autoimmune disease of childhood. Significant proportions of patients have residual weakness, muscle atrophy, joint contractures, and calcinosis. Recently, new clinical findings, such as lipodystrophy accompanied with increased fat deposition in certain areas, have been reported. So far, it is not known whether the redistribution of body fat may be the type of lipedema of lower extremity. We describe a 39-year-old woman who was diagnosed with JDM at the age of 7. Later she developed symmetrical lipodystrophy of upper extremities and symmetrical lipedema of lower extremities (making 2 and 58.3 % of total body fat mass, respectively), with multiple calcified nodules in the subcutaneous tissues. These nodules gradually increased in size despite therapy. Capillaroscopy findings showed scleroderma-like abnormalities. ANA and anti-U1RNP antibodies were positive. Similar cases with simultaneous occurrence of the lipedema of lower extremities, lipodystrophy of upper extremities, and severe calcinosis complicating JDM have not been published so far. We showed that the calcinosis and lipodystrophy were associated with short duration of active disease. Also, we display case that raises the question whether it is possible overlapping autoimmune diseases revealed during follow-up.

  4. Whole Body Vibration Immediately Decreases Lower Extremity Loading During the Drop Jump.

    PubMed

    Chen, Zong-Rong; Peng, Hsien-Te; Siao, Sheng-Wun; Hou, Yan-Ting; Wang, Li-I

    2016-09-01

    Chen, Z-R, Peng, H-T, Siao, S-W, Hou, Y-T, and Wang, L-I. Whole body vibration immediately decreases lower extremity loading during the drop jump. J Strength Cond Res 30(9): 2476-2481, 2016-The purpose of this study was to evaluate the acute effect of whole body vibration (WBV) on lower extremity loading during the drop jump (DJ). Fifteen male collegiate physical education students randomly completed 3 experimental sessions on 3 separate days with 4 days interval between sessions (performing 3 trials of DJ from 30-, 40-, and 50-cm drop heights before WBV and 4 minutes after WBV). Eight cameras and 2 force platforms were used to record kinematic and kinetic data, respectively. Peak impact force and loading rate significantly decreased after WBV during DJ from 40 and 50 cm. Knee angular displacements significantly increased after WBV during DJ from 30, 40, and 50 cm. Whole body vibration may help immediately reduce lower extremity loading. PMID:26849793

  5. Physical therapy management of primary lymphedema in the lower extremities: A case report.

    PubMed

    Greene, Revenda; Fowler, Rhonda

    2010-01-01

    Lymphedema is the tissue fluid accumulation that arises as a consequence of impaired lymphatic drainage. Lymphedema can result from either congenital (primary) or acquired (secondary) anomalies. Primary lymphedema affects 1-2 million people in the United States. Women are more affected by this disorder than men. The management of lymphedema by physical therapists usually includes a combination of skin care, external pressure, isotonic exercise, and massage. This case report describes the course of treatment for a 24-year-old female with stages 2 and 3 primary lymphedema. The goals of physical therapy intervention were as follows: 1) to reduce total limb girth circumference for both lower extremities; 2) to improve skin texture; 3) to promote independence with skin care to reduce the risk of infection; and 4) to facilitate independence with self-management. Following intervention, the patient met and exceeded all goals to decrease limb circumference. She had minimal fibrosis in the lower extremities, and she exhibited no signs and/or symptoms of infection. Decongestive lymphedema therapy was effective in treating this patient with primary lymphedema of the lower extremities. Continuous maintenance is required to ensure that the patient's limb size continues to reduce. PMID:20067355

  6. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia.

    PubMed

    McDermott, Mary McGrae

    2015-04-24

    Lower extremity peripheral artery disease (PAD) is frequently underdiagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of patients with PAD report no exertional leg symptoms and ≈45% to 50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline are common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle, including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared with people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of patients with PAD, including in those who are asymptomatic or who have exertional leg symptoms other than claudication.

  7. Correlation between Intrinsic Patellofemoral Pain Syndrome in Young Adults and Lower Extremity Biomechanics

    PubMed Central

    Kwon, Ohjeoung; Yun, Mijung; Lee, Wanhee

    2014-01-01

    [Purpose] The purpose of this study was to evaluate the correlation between intrinsic patellofemoral pain syndrome (PFPS) in young adults and lower extremity biomechanics. [Subjects] This experiment was carried out with sixty (24 men and 32 women), who are normal university students as subjects. [Methods] All subjects underwent 3 clinical evaluations. For distinguishing the intrinsic PFPS from controls, we used the Modified Functional Index Questionnaire (MFIQ), Clarke’s test and the Eccentric step test. Based on the results of the tests, subjects who were classified as positive for 2 more tests were allocated to the bilateral or unilateral intrinsic PFPS group (n=14), and the others were allocated to the control group (n=42). These two groups were tested for hamstring tightness, foot overpronation, and static Q-angle and dynamic Q-angle. These are the four lower extremity biomechanic, cited as risk factors of patellofemoral pain syndrome. [Results] The over pronation, static Q-angle and the dynamic Q-angle were not significantly different between the two groups. However, the hamstring tightness of the PFPS group was significantly greater than that of the controls. [Conclusion] We examined individuals for intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. We found a strong correlation between intrinsic PFPS and hamstring tightness. PMID:25140074

  8. Effect of in-hospital physical activity on cardiovascular prognosis in lower extremity bypass for claudication

    PubMed Central

    Matsuo, Tomohiro; Sakaguchi, Taichi; Ishida, Atsuhisa; Yuguchi, Satoshi; Saito, Kazuya; Nakajima, Masaharu; Ujikawa, Takuya; Morisawa, Tomoyuki; Chikazawa, Genta; Takahashi, Tetsuya

    2015-01-01

    [Purpose] This study aimed to evaluate the effect of in-hospital physical activity on patient prognosis after lower extremity bypass surgery for peripheral arterial disease. [Subjects and Methods] A total of 13 patients (16 limbs; 11 males and 2 females; mean age [standard deviation], 72.8 [5.9] years) who underwent lower extremity bypass surgery for Fontaine stage 2 peripheral arterial disease were included in this study and assigned to either an active group (n = 6) to perform increased physical activity after surgery or an inactive group (n = 7) to perform decreased physical activity after surgery. Daily in-hospital physical activity levels were measured continuously with a triaxial accelerometer. The occurrence of adverse cardiovascular events within a 2 year follow-up period was compared between groups. [Results] At discharge, the patients in the active group were able to walk more steps daily than those in the inactive group. The incidence of adverse events was 16.7% in the active group and 71.4% in the inactive group. [Conclusion] A higher in-hospital physical activity level was associated with a better long-term prognosis after lower extremity bypass surgery in patients with peripheral arterial disease. PMID:26180335

  9. Effect of commercially available pantyhose on venous return in the lower extremity.

    PubMed

    Godin, M S; Rice, J C; Kerstein, M D

    1987-06-01

    Although compression stockings have long been recognized as a physiologically significant tool for the promotion of venous return from the lower extremity, the role of nonprescription, commercially available support hose has not been assessed in this regard. The present study involved 100 consecutive women with no known prior history of vascular disease, who responded to an advertisement for free evaluation of the venous status of their legs. The subjects, all of whom wore commercial support hose routinely, were screened for the presence of venous disease by means of Doppler ultrasonography, phleborheography, and a detailed history focusing on risk factors and unrecognized symptoms of venous disease. Photoplethysmography (PPG) was then used to evaluate the efficiency of venous return from the lower extremity with and without the support hose in place. Worsening of PPG results occurred in 43% of the women with commercial stockings in place, whereas 23% improved and 34% showed no change. Women 50 years of age and older had a somewhat higher tendency toward poorer PPG results while wearing the support hose. Furthermore, measurements in women who showed evidence of venous disease by an abnormality in one or more of the screening tests were significantly different from the overall group (p = 0.025): 61% exhibited worsening of PPG results when wearing stockings, only 14% showed improvement, and 25% were unchanged. These results suggest that the use of a commercial support hose may be particularly deleterious to older women and is contraindicated in those with evidence of venous disease in the lower extremity. PMID:3295307

  10. LOWER EXTREMITY FUNCTIONAL TESTS AND RISK OF INJURY IN DIVISION III COLLEGIATE ATHLETES

    PubMed Central

    Heiderscheit, Bryan C.; Manske, Robert C.; Niemuth, Paul E.; Rauh, Mitchell J.

    2013-01-01

    Purpose/Background: Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single‐leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time‐loss sports‐related low back or lower extremity injury. Methods: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. Results: Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time‐loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side‐to‐side asymmetry between SLH distances had a 4‐fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3‐fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. Conclusions: The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. Clinical Relevance: The single‐leg hop for

  11. Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

    PubMed Central

    Lollo, Loreto; Grabinsky, Andreas

    2016-01-01

    Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients

  12. A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

    PubMed

    Bowerman, Erin Anne; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth

    2015-06-01

    The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers. PMID:26045395

  13. A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

    PubMed

    Bowerman, Erin Anne; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth

    2015-06-01

    The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

  14. The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis

    PubMed Central

    Khademvatani, Kamal; Seyyed-Mohammadzad, Mir Hossein; Akbari, Mohammad; Rezaei, Yousef; Eskandari, Ramin; Rostamzadeh, Alireza

    2014-01-01

    Background Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). Methods In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. Results The participants’ mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, P=0.001 and OR 0.51, 95% CI 0.26–1.00, P=0.049, respectively). Conclusion Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D. PMID:24971035

  15. Acute enhancement of lower-extremity dynamic strength and flexibility with whole-body vibration.

    PubMed

    Jacobs, Patrick L; Burns, Patricia

    2009-01-01

    The purpose of this investigation was to examine the acute effects of whole-body vibration (WBV) on muscular strength, flexibility, and heart rate (HR). Twenty adults (10 men, 10 women) untrained to WBV participated in the study. All subjects completed assessment of lower-extremity isokinetic torque, flexibility, and HR immediately before and after 6 minutes of WBV and 6 minutes of leg cycling ergometry (CYL), in randomized order. During WBV, subjects stood upright on a vibration platform for a total of 6 minutes. Vibration frequency was gradually increased during the first minute to a frequency of 26 Hz, which was maintained for the remaining 5 minutes. During CYL, power output was gradually increased to 50 W during the first minute and maintained at that power output for the remaining 5 minutes. Lower-extremity flexibility was determined using the sit-and-reach box test. Peak and average isokinetic torque of knee extension and flexion were measured by means of a motor-driven dynamometer with velocity fixed at 120 degrees .s. Change scores for the outcome measures were compared between treatments using Student's paired t-tests. Analysis revealed significantly greater HR acceleration with CYL (24.7 bpm) than after WBV (15.8 bpm). The increase of sit-and-reach scores after WBV (4.7 cm) was statistically greater (p < 0.05) than after CYL (0.8 cm). After WBV, increases in peak and average isokinetic torque of knee extension, 7.7% and 9.6%, were statistically greater than after CYL (p < 0.05). Average torque of knee flexion also increased more with WBV (+7.8%) than with CYL (-1.5%) (p < 0.05). The findings of this study indicate that short-term WBV standing elicits acute enhancements of lower-extremity muscular torque and flexibility, suggesting the application of this technology as a preparatory activity before more intense exercise.

  16. Nerve conduction velocities in the lower extremities among patients with vibration syndrome.

    PubMed

    Hirata, M; Sakakibara, H; Yamada, S; Hashiguchi, T; Toibana, N; Koshiyama, H

    1995-01-01

    In order to clarify the effect of vibration syndrome (VS) on the peripheral nervous system (PNS) in the lower extremities, 59 patients with VS (age 58.5 +/- 5.1 years) and 49 age-matched controls (age 57.0 +/- 5.1 years) were examined for sensory nerve conduction velocities (SCV) in the sural nerve (SSCV) and the medial plantar nerve (PSCV) in the summer of 1993 and 1994. They had not been suffering from diseases and injuries which might have affected the SCV in the lower extremities. These patients were divided into two subgroups, one with past vibration exposure to chainsaw (N = 22) and the other with past vibration exposure to rock drills and other tools (N = 37). SCVs corrected by skin temperature were subjected to statistical analysis. In PSCV a significant reduction among all patients (40.8 +/- 4.24 m/s, p < 0.01) including two subgroups (chainsaw, 39.7 +/- 4.7 m/s, p < 0.01; rock drill and others, 41.0 +/- 4.6 m/s, p < 0.01) was observed compared with those of the controls (43.2 +/- 4.31 m/s), but there was no significant reduction in SSCV. Significantly more subjects with PSCV below the standard of PSCV (ten percentile value of those of the controls) were observed among all patients (17/59, 28.8%, p < 0.05) including two subgroups (chainsaw, 7/22, 31.8%, p < 0.05; rock drill and others, 10/37, 27.0%, p < 0.05) than in the controls (4/49, 8.2%). These findings suggested that VS affected the PNS function in the lower extremities and that its mechanism was considered to mediate a circulatory disturbance, and to differ from SCV reduction in the finger.

  17. Autologous Fat Grafting in Severe Lower Extremity Asymmetries: Report of Four Cases

    PubMed Central

    2015-01-01

    Background: Lower extremity asymmetries are challenging problems in plastic and aesthetic surgery practice. Regardless of their origin, atrophies and asymmetries can be extremely varied and difficult to solve with simple techniques. Objectives:  The author reports his experience in the treatment of four patients suffering from severe lower extremity atrophy and asymmetry of different etiologies with autologous fat grafting. Methods: A total of four cases are presented. Patient selection was based on the severity of atrophy and asymmetry. Two patients were treated with two sessions of simple fat grafting and two patients with one session of cell-enriched fat grafting. The end point in each session was determined by tension/blanching of soft tissues. All patients were followed up for at least 12 months after the last session. During the postoperative follow-up, variables, such as objective volume improvement, objective girth loss, return to daily activities, and patient satisfaction, were analyzed. Results: The initial analysis of postoperative results showed a good patient satisfaction rate with no relevant complications and an early return to daily activities. Estimated mean volume improvement for simple fat grafting cases was estimated as 44% after two treatments. Mean volume improvement in cell-enriched fat grafting cases was estimated as 25% after only one treatment. Conclusions: Autologous fat grafting is a safe, effective, and reliable technique to perform aesthetic and reconstructive reshaping of a lower extremity in cases of atrophy or severe asymmetry. Depending on the preoperative soft tissue compliance, cell-assisted fat grafting will play an important role in reducing the number of sessions to perform. PMID:26824005

  18. Early versus delayed amputation in the setting of severe lower extremity trauma.

    PubMed

    Williams, Zachary F; Bools, Lindsay M; Adams, Ashley; Clancy, Thomas V; Hope, William W

    2015-06-01

    Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1, 2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

  19. Prevalence of Vitamin D Deficiency in Korean Children Presenting with Nonspecific Lower-Extremity Pain

    PubMed Central

    Park, Min Jung; Lee, Juyeob; Lee, Jun Ku

    2015-01-01

    Purpose Although interest in the role played by vitamin D in bone health is increasing, little is known about the role of this vitamin in musculoskeletal pain in children. This study aimed to assess the prevalence of vitamin D deficiency in children presenting with nonspecific lower extremity pains. Materials and Methods From 2011 to 2012, 183 children underwent evaluation for nonspecific lower-extremity pains. Patients with valid causes, such as fractures or transient synovitis, were excluded, as were those with underlying medical conditions, such as cerebral palsy and metabolic disease. Ultimately, 140 patients met the inclusion criteria. Levels of serum 25-hydroxy vitamin D [25-(OH)D], the ideal indicator of vitamin D status, were measured in these children. Results Eighty-seven boys (62.1%) and 53 girls (37.9%) were included. The mean age at presentation was 5.2 years (range, 2-15). Serum 25-(OH)D levels were <10 ng/mL in 5.7% of patients, 10 to <20 ng/mL in 51.4%, 20 to <30 ng/mL in 37.9%, and ≥30 ng/mL in only 5.0%. Most patients visited the hospital in the winter (41.4%) (summer, 12.9%), and serum 25-(OH)D levels were also lowest in the winter (17.2±5.5 ng/mL). Conclusion This study found a high prevalence of vitamin D deficiency or insufficiency in Korean children with nonspecific lower-extremity pains, indicating a positive association between vitamin D deficiency and growing pains. More attention should be directed toward vitamin D and its role in the optimization of bone health. PMID:26256984

  20. Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management

    PubMed Central

    Topal, Aşkın Ender; Eren, Mehmet Nesimi; Celik, Yusuf

    2010-01-01

    Purpose: Limb loss following lower extremity arterial injury is not uncommon and has serious implications on the patient’s life and functionality. This retrospective study was performed to analyze the results of lower extremity arterial injuries and to identify the risk factors associated with amputation. Methods: Between 2002 and 2009, retrospectively collected data on 140 patients with 173 lower extremity arterial injuries were analyzed. Results: There were 133 males (95%) and 7 females (5%). The mechanism of injuries was gunshot wounds in 56.4% of cases, stab wounds in 30%, and blunt trauma in 13.4%. Associated injuries included vein injury in 45% of cases, nerve injury in 16.4%, and bone fracture in 31.4%. The most frequently injured artery was superficial femoral artery (31.2%). More than 1 artery was injured in 18.6% of patients. Surgery was carried out, with a limb salvage rate of 90.4% and a survival of 97.1%. Amputation was performed in 75% of patients in whom only 1 artery was repaired, although all crural arteries were injured. Multivariate logistic regression analysis showed that significant risk factors of outcome were below-knee multiple arterial injuries (odds ratio [OR] 6.62, P < 0.001), associated 2-bone fractures (OR 2.71, P = 0.003), development of compartment syndrome (OR 1.94, P = 0.042), and great soft tissue disruption (OR 1.74, P = 0.010). Conclusions: Limb loss may be decreased by performing prophylactic fasciotomy more often and by repairing at least 2 crural arteries. PMID:21191430

  1. Embolosclerotherapy by the Transvenous Approach for Lower Extremity Arteriovenous Malformation in Cowden Syndrome: A Case Report

    PubMed Central

    Kishino, Mitsuhiro; Nakadate, Masashi; Kudo, Toshifumi; Inoue, Yoshinori; Tateishi, Ukihide

    2016-01-01

    A 69-year-old female with Cowden syndrome presented with pain at rest in the right leg. Arteriovenous malformations (AVMs) of the right lower extremity were detected by computed tomography and magnetic resonance imaging. Angiography indicated arteriolovenous fistulae, which were initially treated using a transarterial approach with minimal therapeutic effect. In contrast, excellent outcomes were achieved with a transvenous approach using coil embolization and liquid sclerotherapy for the venous component of the nidus. At 15 months after embolosclerotherapy, no angiographic evidence of AVM recurrence was noted. Embolosclerotherapy by the transvenous approach for AVM in Cowden syndrome was a useful therapeutic strategy for arteriolovenous fistulae. PMID:27087878

  2. Sports nuclear medicine. Bone imaging for lower extremity pain in athletes

    SciTech Connect

    Brill, D.R.

    1983-03-01

    Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes.

  3. Treatment of lower extremity oedema by subcutaneous drainage in a home hospice patient.

    PubMed

    Rodgers, Susan; Birkholz, Lorri; Hebert, Randy

    2013-04-29

    Lower extremity oedema is common in patients with advanced illness and can normally be managed with oral diuretics and elevation of the involved extremities. The management of oedema can be more complicated in home hospice patients, however. They tend to be more frail and are often less able to tolerate usual interventions. We present a case of a home hospice patient with severe oedema treated by creating subcutaneous tracts in his legs to allow drainage of excess interstitial fluid. The procedure was very successful in improving the patient's quality of life.

  4. Severe myalgia of the lower extremities as the first clinical feature of meningococcal purpura fulminans.

    PubMed

    de Souza, Alexandre Leite; Sztajnbok, Jaques; Salgado, Maristela Marques; Romano, Carla C; Alkmin, Maria das Graças Adelino; Duarte, Alberto J S; Seguro, Antonio Carlos

    2007-10-01

    In patients with meningococcal infection, devastating presentations, such as purpura fulminans, which can progress to extensive tissue necrosis of the limbs and digits, have a significant social impact. The case presented herein illustrates such a phenomenon in a patient who developed bilateral necrosis of the lower extremities as a result of infection with Neisseria meningitis. We emphasize that severe myalgia was the first clinical manifestation of meningococcal purpura fulminans in our case. However, myalgia has typically been overlooked and undervalued as an early clinical feature of meningococcal sepsis. Early recognition and prompt initial antibiotic therapy continue to be the cornerstones of the successful management of this dramatic disease, reducing morbidity and mortality.

  5. [Phlebosclerosing therapy after operative intervention for chronic venous insufficiency of the lower extremities].

    PubMed

    Shamsadinskiĭ, A A; Shamsadinskaia, T A

    2009-02-01

    To the Center of angiology and microsurgery have been submitted 75 patients seeking for the cosmetic result of their treatment improvement, to whom operative interventions for the lower extremities varicosities were performed previously. The sclerosing procedures for the dilated venous tributaries, reticular veins and teleangiectasiae was conducted, complete elimination of a "heavy feet" syndrome was noted together with reduction of the symptoms severity. The phlebosclerosing method permits to achieve good clinical, aesthetic results, to improve the quality of life and social activity of the patients.

  6. Endovascular repair of spontaneous infrarenal aortic dissection presenting as severe lower extremity ischaemia.

    PubMed

    Adam, D J; Roy-Choudhury, S; Bradbury, A W

    2007-12-01

    We report a 90-year old man who presented with severe lower extremity ischaemia due to spontaneous dissection of a non-aneurysmal infrarenal abdominal aorta. The aortic lesion was treated using an aorto-uni-iliac stent-graft with contralateral common iliac artery occlusion and femoro-femoral cross-over bypass. The patient underwent digital amputation and debridement of the foot four weeks post-operatively. At 12 months follow-up, he remains symptom-free with an excluded dissection, patent reconstruction and healed foot.

  7. Actions of Two Bi-Articular Muscles of the Lower Extremity: A Review

    PubMed Central

    Landin, Dennis; Thompson, Melissa; Reid, Meghan

    2016-01-01

    The extremities of the human body contain several bi-articular muscles. The actions produced by muscles at the joints they cross are greatly influenced by joint moment arms and muscle length. These factors are dynamic and subject to change as joint angles are altered. Therefore, to more completely understand the actions of such muscles, the angles of both joints must be manipulated. This report reviews investigations, which have explored the actions of two bi-articular muscles of the lower extremities (gastrocnemius and rectus femoris) as the joints they cross are moved into various combinations of angles. The findings have both clinical and physical performance ramifications. PMID:27298656

  8. Comparison of Lower Extremity Kinematics and Hip Muscle Activation During Rehabilitation Tasks Between Sexes

    PubMed Central

    Dwyer, Maureen K.; Boudreau, Samantha N.; Mattacola, Carl G.; Uhl, Timothy L.; Lattermann, Christian

    2010-01-01

    Abstract Context: Closed kinetic chain exercises are an integral part of rehabilitation programs after lower extremity injury. Sex differences in lower extremity kinematics have been reported during landing and cutting; however, less is known about sex differences in movement patterns and activation of the hip musculature during common lower extremity rehabilitation exercises. Objective: To determine whether lower extremity kinematics and muscle activation levels differ between sexes during closed kinetic chain rehabilitation exercises. Design: Cross-sectional with 1 between-subjects factor (sex) and 1 within-subjects factor (exercise). Setting: Research laboratory. Patients or Other Participants: Participants included 21 women (age  =  23 ± 5.8 years, height  =  167.6 ± 5.1 cm, mass  =  63.7 ± 5.9 kg) and 21 men (age  =  23 ± 4.0 years, height  =  181.4 ± 7.4 cm, mass  =  85.6 ± 16.5 kg). Intervention(s): In 1 testing session, participants performed 3 trials each of single-leg squat, lunge, and step-up-and-over exercises. Main Outcome Measure(s): We recorded the peak joint angles (degrees) of knee flexion and valgus and hip flexion, extension, adduction, and external rotation for each exercise. We also recorded the electromyographic activity of the gluteus maximus, rectus femoris, adductor longus, and bilateral gluteus medius muscles for the concentric and eccentric phases of each exercise. Results: Peak knee flexion angles were smaller and peak hip extension angles were larger for women than for men across all tasks. Peak hip flexion angles during the single-leg squat were smaller for women than for men. Mean root-mean-square amplitudes for the gluteus maximus and rectus femoris muscles in both the concentric and eccentric phases of the 3 exercises were greater for women than for men. Conclusions: Sex differences were observed in sagittal-plane movement patterns during the rehabilitation exercises. Because of the sex differences

  9. Lower Extremity Tissue Defect Caused by Mobile Phone Charger Explosion: A Case Report.

    PubMed

    Duran, Arif; Ocak, Tarık; Tekelioglu, Umit Yasar; Karabekmez, Furkan Erol; Cetin, Ayse

    2014-06-01

    As the usage of cell phones is markedly increasing worldwide, accidental injuries and even lethal damages caused by cellular phone explosions have been reported lately. Although, cell phone charger explosion related scalding and tissue loss is extremely rare, they generally cause severe damage to tissues and cause severe complications, ending up in hospitalization. We are presenting a case of 9-year old female patient who was admitted to our emergency service due to a phone charger explosion that resulted in a lower extremity tissue defect.

  10. Acute compartment syndrome of the lower extremity secondary to noncontact injury.

    PubMed

    Moyer, R A; Boden, B P; Marchetto, P A; Kleinbart, F; Kelly, J D

    1993-01-01

    We retrospectively reviewed the cases of three patients with injuries similar to the mechanism of an ankle sprain which resulted in compartment syndrome of the lower extremity. All three patients presented with sharp, proximal, anterolateral pain in the leg after an indirect, twisting injury. None of the injuries involved direct contact. Two of the three athletes initially presented to local hospitals, where the injury was misdiagnosed as an ankle sprain. The mechanism appears to be a muscle strain or tear with resultant hemorrhage in the compartment. All three patients returned to high-level athletics after prolonged recovery periods.

  11. Lower extremity mechanics during marching at three different cadences for 60 minutes.

    PubMed

    Seay, Joseph F; Frykman, Peter N; Sauer, Shane G; Gutekunst, David J

    2014-02-01

    During group marches, soldiers must walk in step with one another at the same imposed cadence. The literature suggests that shorter trainees may be more susceptible to injury due to overstriding that can occur when taller recruits dictate marching cadence. This study assessed the effects of fixed cadence simulated marching at cadences above and below preferred step rate (PSR) on lower extremity joint mechanics in individuals who were unaccustomed to marching. During three separate visits, 13 volunteers walked with a 20 kg load on a force-sensing treadmill at self-selected PSR, PSR+15% (shorter strides), and PSR-15% (longer strides) at 1.3 m/s for 60 min. Two-way RM ANOVAs (cadence by time) were performed during the stance phase. Ranges of motion and anteroposterior ground reaction force increased significantly as cadence decreased (P < .03). Knee extension moment increased slightly when step rate decreased from PSR+15% (shortest strides, 0.85 ± 0.2 N m/kg) to PSR (0.87 ± 0.3 N m/kg, 3% increase); however, this increase was substantially greater (20% increase) when cadence was decreased from PSR to PSR-15% (longest strides, 1.09 ± 0.3 N m/kg). Our results indicate that overstriding during fixed-cadence marching is a factor that can substantially increase mechanical stress on lower extremity joints.

  12. Treatment of lower-extremity long-bone fractures in active, nonambulatory, wheelchair-bound patients.

    PubMed

    Sugi, Michelle T; Davidovitch, Roy; Montero, Nicole; Nobel, Tamar; Egol, Kenneth A

    2012-09-01

    A retrospective review of surgically treated lower-extremity long-bone fractures in wheelchair-bound patients was conducted. Between October 2000 and July 2009, eleven lower-extremity fractures in 9 wheelchair-bound patients underwent surgical fixation. The Short Musculoskeletal Function Assessment, Short Form, and Spinal Cord Injury Quality of Life questionnaires were used to assess functional outcome. Mechanism of injury for all patients was a low-energy fall that occurred while transferring. Four patients who sustained a distal femur fracture, 1 patient who sustained a distal femur fracture and a subsequent proximal tibia fracture, and 1 patient who sustained a proximal third tibia shaft fracture underwent open reduction and internal fixation with plates and screws. Three patients with 4 midshaft tibia fractures underwent intramedullary nailing. At last follow-up, all 9 patients had returned to their baseline preoperative function. Quality of life was significantly higher (P<.01) than the Spinal Cord Injury Quality of Life questionnaire's reference score. Self-reported visual analog scale pain scores improved significantly from time of fracture to last follow-up (P=.02). All fractures achieved complete union, and no complications were reported. This study's findings demonstrate that operative treatment in active, wheelchair-bound patients can provide an improved quality of life postinjury and a rapid return to activities.

  13. Lower-extremity ground reaction forces in youth windmill softball pitchers.

    PubMed

    Guido, John A; Werner, Sherry L; Meister, Keith

    2009-09-01

    Ground reaction forces are important in pitching given that the only external contact a pitcher has is between the foot and the ground. Windmill softball pitchers are routinely seen clinically for injuries to the lower extremities, and lower-extremity kinetics have not been well studied. The purpose of this study was to investigate the relationships between ground reaction forces and throwing mechanics in youth windmill pitchers and to provide a scientific basis for the improvement of preventive and rehabilitative protocols. Fifty-three youth softball pitchers were tested in an indoor facility. High-speed video and force plate data were collected for fastballs from each pitcher. Average ball speed was 25 m/sec. Peak vertical ground reaction force averaged 139 % body weight (BW), peak anterior force averaged 24 %BW, and the medially directed component of the ground reaction force averaged 42 %BW. Loading rates to peak force in all 3 directions were high. Preventive and rehabilitative protocols for windmill softball pitchers can begin to be improved on the basis of knowledge of the magnitudes and times to peak forces under the stride foot.

  14. Morphological and functional relationships with ultrasound measured muscle thickness of the lower extremity: a brief review.

    PubMed

    Abe, Takashi; Loenneke, Jeremy P; Thiebaud, Robert S

    2015-08-01

    Ultrasound is a potential method for assessing muscle size of the extremity and trunk. In a large muscle, however, a single image from portable ultrasound measures only muscle thickness (MT), not anatomical muscle cross-sectional area (CSA) or muscle volume (MV). Thus, it is important to know whether MT is related to anatomical CSA and MV in an individual muscle of the extremity and trunk. In this review, we summarize previously published articles in the lower extremity demonstrating the relationships between ultrasound MT and muscle CSA or MV as measured by magnetic resonance imaging and computed tomography scans. The relationship between MT and isometric and isokinetic joint performance is also reviewed. A linear relationship is observed between MT and muscle CSA or MV in the quadriceps, adductor, tibialis anterior, and triceps surae muscles. Intrarater correlation coefficients range from 0.90 to 0.99, except for one study. It would appear that anterior upper-thigh MT, mid-thigh MT and posterior thigh MT are the best predictors for evaluating adductor, quadriceps, and hamstrings muscle size, respectively. Despite a limited number of studies, anterior as well as posterior lower leg MT appear to reflect muscle CSA and MV of the lower leg muscles. Based on previous studies, ultrasound measured anterior thigh MT may be a valuable predictor of knee extension strength. Nevertheless, more studies are needed to clarify the relationship between lower extremity function and MT. PMID:27433253

  15. Post Mortem Human Surrogate Injury Response of the Pelvis and Lower Extremities to Simulated Underbody Blast.

    PubMed

    Bailey, Ann M; Christopher, John J; Brozoski, Frederick; Salzar, Robert S

    2015-08-01

    Military vehicle underbody blast (UBB) is the cause of many serious injuries in theatre today; however, the effects of these chaotic events on the human body are not well understood. The purpose of this research was to replicate both UBB loading conditions and investigate occupant response in a controlled laboratory setting. In addition to better understanding the response of the human to high rate vertical loading, this test series also aimed to identify high rate injury thresholds. Ten whole body post mortem human surrogate (PMHS) tests were completed using the University of Virginia's ODYSSEY simulated blast rig under a range of loading conditions. Seat pan accelerations ranged from 291 to 738 g's over 3 ms of positive phase duration, and foot pan accelerations from 234 to 858 g's over 3 ms of positive phase duration. Post-test computed tomography (CT) scans and necropsies were performed to determine injuries, and revealed a combination of pelvic, lumbar, thoracic, and lower extremity injuries. The research in this paper discusses pelvis and lower extremity injuries under high rate vertical loads.

  16. Immediate effects of kinematic taping on lower extremity muscle tone and stiffness in flexible flat feet

    PubMed Central

    Wang, Joong-San; Um, Gi-Mai; Choi, Jung-Hyun

    2016-01-01

    [Purpose] This study aimed to examine the immediate effects of kinematic taping on the tone and stiffness in the leg muscles of subjects with flexible flat feet. [Subjects and Methods] A total of 30 subjects, 15 in the kinematic taping and 15 in the sham taping group, were administered respective taping interventions. Subsequently, the foot pressure and the tone and stiffness in the tibialis anterior, rectus femoris, medial gastrocnemius, and the long head of the biceps femoris muscles of both the lower extremities were measured. [Results] The foot pressure of the dominant leg significantly decreased in the kinematic taping group. The muscle tone and stiffness in the rectus femoris muscle of the dominant and non-dominant leg, tibialis anterior muscle of the dominant leg, medial gastrocnemius muscle of the non-dominant leg, and the stiffness in the dominant leg significantly decreased. The muscle tone and stiffness generally increased in the sham taping group. However, no significant difference was observed between the 2 groups. [Conclusion] This study demonstrated that kinematic taping on flexible flat feet had positive effects of immediately reducing the abnormally increased foot pressure and the tone and stiffness in the lower extremity muscles. PMID:27190479

  17. Quality of life issues in patients with diabetes and lower extremity ulcers: patients and care givers.

    PubMed

    Brod, M

    1998-05-01

    The impact of lower extremity ulcers on the quality of life (QoL) of patients with diabetes and their care givers was assessed in a series of focus groups. Fourteen patients with diabetes and lower extremity ulcers and 11 care givers participated in the focus groups. Semi-structured discussions identified the issues relating to four broad QoL domains and subdomains: social (daily, leisure, family and social life), psychological (emotional health and positive consequences), physical (physical health and treatment impact) and economic (employment and finances). The patients and care givers experienced a negative impact on all domains of QoL because of the limitations in mobility caused by the ulcer which required an adaptation to a different lifestyle. A reduction in social activities, increased family tensions, lost time from work and a negative impact on general health were experienced by both groups. It is necessary to separate the impact of the ulcer from the general condition of diabetes on both patients' and care givers' QoL. The results from this disease-specific focus will allow for an improved clinical understanding with targeted interventions and contribute to the development of a disease-specific instrument to understand and measure QoL better in these individuals.

  18. Lower-Extremity Amputation Risk After Charcot Arthropathy and Diabetic Foot Ulcer

    PubMed Central

    Sohn, Min-Woong; Stuck, Rodney M.; Pinzur, Michael; Lee, Todd A.; Budiman-Mak, Elly

    2010-01-01

    OBJECTIVE To compare risks of lower-extremity amputation between patients with Charcot arthropathy and those with diabetic foot ulcers. RESEARCH DESIGN AND METHODS A retrospective cohort of patients with incident Charcot arthropathy or diabetic foot ulcers in 2003 was followed for 5 years for any major and minor amputations in the lower extremities. RESULTS After a mean follow-up of 37 ± 20 and 43 ± 18 months, the Charcot and ulcer groups had 4.1 and 4.7 amputations per 100 person-years, respectively. Among patients <65 years old at the end of follow-up, amputation risk relative to patients with Charcot alone was 7 times higher for patients with ulcer alone and 12 times higher for patients with Charcot and ulcer. CONCLUSIONS Charcot arthropathy by itself does not pose a serious amputation risk, but ulcer complication multiplicatively increases the risk. Early surgical intervention for Charcot patients in the absence of deformity or ulceration may not be advisable. PMID:19825822

  19. Inverse dynamic analysis of the lower extremities during nordic walking, walking, and running.

    PubMed

    Stief, Felix; Kleindienst, Frank I; Wiemeyer, Josef; Wedel, Florian; Campe, Sebastian; Krabbe, Berthold

    2008-11-01

    Compared with walking (W), Nordic walking (NW) exhibits greater cardiopulmonary and cardiovascular benefits. Some authors conjecture that compared with W or running (R), NW imposes smaller mechanical loads on the musculoskeletal system. The purpose of the current study was to quantify any differences in joint loading of the lower extremities among NW, W, and R. Fifteen experienced adults participated. Kinematic and force measurements were combined using an inverse dynamics approach to yield joint moments. The results showed no biomechanical benefit of NW. Instead, NW involved greater knee joint loading just after heel strike compared with W. This was due to the longer steps and the higher sole angle during the first part of the stance phase. The sagittal and frontal plane moments were smaller for NW compared with R, but in the transverse plane, the ankle moments were greater in NW than in W or R. Based on these results, NW is not recommended as an exercise for persons who seek to reduce biomechanical loading of the lower extremities.

  20. Experimal study of young male drivers' responses to vehicle collision using EMG of lower extremity.

    PubMed

    Gao, Zhenhai; Li, Chuzhao; Hu, Hongyu; Zhao, Hui; Chen, Chaoyang; Yu, Huili

    2015-01-01

    A driver's response to a front-coming vehicle collision consists of braking reaction time and braking behavior. The purpose was to investigate drivers' responses at different speeds, relative distances, and particularly the behavior on the accelerator at the collision moment. Twelve young men participated in driving simulator tests. Vehicle parameters and electromyograms (EMGs) of the drivers' tibialis anterior muscles were recorded and responses were analyzed. The drivers' braking reaction time windows were divided into pre-motor time, muscle activation time, accelerator release time, and movement time. By comparing the reaction times and collision times, braking behaviors were investigated. It was found that movement times (r = -0.281) decreased with speed. Pre-motor times (r = 0.326) and muscle activation times (r = 0.281) increased with relative distance. At the collision moment, the probability of the driver's lower extremity being on the accelerator, in the air, and on the brake pedal was 7.4%, 18.9%, and 73.7%, respectively. With higher speeds and smaller distances, the lower extremity was more likely to be in the air or even on the accelerator in different muscle activation states. The driver will collide in normal driving postures which muscles are not or not fully activated in very urgent situation. PMID:26406050

  1. Lower-extremity muscle atrophy and fat infiltration after chronic spinal cord injury

    PubMed Central

    Moore, C.D.; Craven, B.C.; Thabane, L.; Laing, A.C.; Frank-Wilson, A.W.; Kontulainen, S.A.; Papaioannou, A.; Adachi, J. D.; Giangregorio, L.M.

    2016-01-01

    Background Atrophy and fatty-infiltration of lower-extremity muscle after spinal cord injury (SCI) predisposes individuals to metabolic disease and related mortality. Objectives To determine the magnitude of atrophy and fatty-infiltration of lower-extremity muscles and related factors in a group of individuals with chronic SCI and diverse impairment. Methods Muscle cross-sectional area and density were calculated from peripheral quantitative computed tomography scans of the 66% site of the calf of 70 participants with chronic SCI [50 male, mean age 49 (standard deviation 12) years, C2-T12, AIS A-D] and matched controls. Regression models for muscle area and density were formed using 16 potential correlates selected a priori. Results Participants with motor-complete SCI had ≈32% lower muscle area, and ≈43% lower muscle density values relative to controls. Participants with motor-incomplete SCI had muscle area and density values that were both ≈14% lower than controls. Body mass (+), tetraplegia (+), motor function (+), spasticity (+), vigorous physical activity (+), wheelchair use (−), age (−), and waist circumference (−) were associated with muscle size and/or density in best-fit regression models. Conclusions There are modifiable factors related to muscle size, body composition, and activity level that may offer therapeutic targets for preserving metabolic health after chronic SCI. PMID:25730650

  2. Effects of a Static Stretching Program on the Incidence of Lower Extremity Musculotendinous Strains

    PubMed Central

    Cross, Kevin M.; Worrell, Ted W.

    1999-01-01

    Objective: Musculotendinous strains are among the most prevalent injuries for which health care professionals provide treatment and rehabilitation interventions. Flexibility has been identified as one of the primary etiologic factors associated with musculotendinous strains, but limited research exists on the effect of a preventive stretching program on musculotendinous strains. Therefore, the purpose of our study was to compare the number of musculotendinous strains for the hamstrings, quadriceps, hip adductors, and gastrocnemius-soleus muscle groups before and after the incorporation of a static stretching program for each muscle group. Design and Setting: We analyzed the incidence of musculotendinous strains among the players of a Division III collegiate football team between 1994 and 1995. All variables were consistent between the 2 seasons except for the incorporation of a lower extremity stretching program in 1995. Subjects: One hundred and ninety-five Division III college football players. Measurements: We calculated the number of musculotendinous strains that required a minimum absence of 1 day from practices or games in 1994 and 1995. Results: A x² analysis revealed a significant reduction in the number of lower extremity musculotendinous strains in 1995 as opposed to 1994. Conclusions: Our statistical analysis indicates an association between the incorporation of a static stretching program and a decreased incidence of musculotendinous strains in Division III college football players. PMID:16558540

  3. Effect of rain boot shaft length on lower extremity muscle activity during treadmill walking

    PubMed Central

    Kim, Young-Hwan; Yoo, Kyung-Tae

    2016-01-01

    [Purpose] This study aimed to determine the extent of lower extremity muscle activity before and after walking based on rain boot shaft length. [Subjects and Methods] The subjects, 12 young and healthy females, were divided into three groups based on rain boot shaft length (long, middle, and short). They walked on a treadmill for 30 minutes. Activity of the rectus femoris, vastus lateralis, semitendinosus, tibialis anterior, peroneus longus, and gastrocnemius was measured using electromyography before and after walking. Two-way repeated measures analysis of variance was performed to compare the muscle activities of each group. [Results] There were no significant differences in terms of the interactive effects between group and time for all muscles, the main effects of group, or the main effects of time. [Conclusion] The results of this study may indicate that movement of the lower extremities was not significantly limited by friction force based on the characteristics of the boot material or the circumference of the boot shaft. Thus, it may be helpful instead to consider the material of the sole or the weight of the boots when choosing which rain boots to wear. PMID:27799685

  4. Balance control in lower extremity amputees during quiet standing: a systematic review.

    PubMed

    Ku, Pei Xuan; Abu Osman, Noor Azuan; Wan Abas, Wan Abu Bakar

    2014-02-01

    Postural control has been widely evaluated for the normal population and different groups over the past 20 years. Numerous studies have investigated postural control in quiet standing posture among amputees. However, a comprehensive analysis is lacking on the possible contributing factors to balance. The present systematic review highlights the current findings on variables that contribute to balance instability for lower extremity amputees. The search strategy was performed on PubMed, Web of Science, Medline, Scopus, and CINAHL and then followed by additional manual searching via reference lists in the reviewed articles. The quality of the articles was evaluated using a methodological quality assessment tool. This review included and evaluated a total of 23 full-text articles. Despite the inconsistencies in the methodological design of the studies, all articles scored above the acceptable level in terms of quality. A majority of the studies revealed that lower extremity amputees have increased postural sway in the standing posture. Asymmetry in body weight, which is mainly distributed in the non-amputated leg, was described. Aside from the centre of pressure in postural control, sensory inputs may be a related topic for investigation in view of evidence on their contribution, particularly visual input. Other balance-related factors, such as stump length and patients' confidence level, were also neglected. Further research requires examination on the potential factors that affect postural control as the information of standing postural is still limited. PMID:24331296

  5. Effects of physical characteristics and residence style on alignment of lower extremity

    PubMed Central

    Lee, Jangwon; Park, Hye-Sang

    2016-01-01

    This research was performed to identify the incidence of deformity of lower extremity and to identify the relationship of the incidence between the deformities. Once the incidences and relationship are found, next purpose was to find the effects of physical characteristics and residence styles on the development of lower extremity deformities. One hundred fifteen males and 108 females participated in this study. Data collecting was performed by questionnaire and visual postural evaluation. The incidence of genu varus was significantly high in standing-up life style compared to sitting-on life style (chi-square=8.28; P=0.004). However, the incidences of heel varus (chi-square=13.223; P=0.004) and femoral torsion (chi-square=19.347; P<0.0001) were significantly high in sitting-on life style than standing-up life style. The incidences of genu varus (chi-square=24.18; P<0.0001), heel varus (chi-square= 15.412; P<0.0001), and tibial torsion (chi-square=6.285; P<0.012) were significantly high in sitting-on life style compared to standing-up life style (P<0.05). The odd ratio result for sitting-on life style against standing-up life style showed 6.6 times significantly high relationship in femoral torsion (95% confidence range, 1.64–26.47) in men. PMID:27162772

  6. Effects of shoe type on lower extremity muscle activity during treadmill walking

    PubMed Central

    Kim, Mi-Kyoung; Kim, Young-Hwan; Yoo, Kyung-Tae

    2015-01-01

    [Purpose] The purpose of this study was to analyze the effects of different shoe types on lower extremity muscle activity in healthy young women by using electromyography. [Subjects and Methods] Fifteen healthy young women in their 20s were included in this single-group repeated measures study. The subjects were divided into three groups: Converse sneakers, rain boots, and combat boots. The subjects walked on a treadmill at 4 km/h for 30 min, during which six muscles were examined using electromyography: the rectus femoris, vastus medialis, semimembranosus, tibialis anterior, peroneus longus, and medial head of the gastrocnemius. Between switching shoe types, a 24-h rest period was instated to prevent the fatigue effect from treadmill walking. [Results] One-way analysis of variance used to compare electromyography results among the three groups showed that the main effect of group differed significantly for the vastus medialis. Vastus medialis activity was higher in the rain boots group than the Converse sneakers group, and it was higher in the combat boots group than rain boots group. [Conclusion] Shoe type affects lower extremity muscle activity. Our findings may help individuals choose the ideal shoes for daily walking. PMID:26834363

  7. Post Mortem Human Surrogate Injury Response of the Pelvis and Lower Extremities to Simulated Underbody Blast.

    PubMed

    Bailey, Ann M; Christopher, John J; Brozoski, Frederick; Salzar, Robert S

    2015-08-01

    Military vehicle underbody blast (UBB) is the cause of many serious injuries in theatre today; however, the effects of these chaotic events on the human body are not well understood. The purpose of this research was to replicate both UBB loading conditions and investigate occupant response in a controlled laboratory setting. In addition to better understanding the response of the human to high rate vertical loading, this test series also aimed to identify high rate injury thresholds. Ten whole body post mortem human surrogate (PMHS) tests were completed using the University of Virginia's ODYSSEY simulated blast rig under a range of loading conditions. Seat pan accelerations ranged from 291 to 738 g's over 3 ms of positive phase duration, and foot pan accelerations from 234 to 858 g's over 3 ms of positive phase duration. Post-test computed tomography (CT) scans and necropsies were performed to determine injuries, and revealed a combination of pelvic, lumbar, thoracic, and lower extremity injuries. The research in this paper discusses pelvis and lower extremity injuries under high rate vertical loads. PMID:25503737

  8. Changes in muscle strength, endurance, and reaction of the lower extremities with Tai Chi intervention.

    PubMed

    Li, Jing Xian; Xu, Dong Qing; Hong, Youlian

    2009-05-29

    This study examines the effects of a 16-week Tai Chi (TC) training program on the muscle strength, endurance, and reaction time of the lower extremities of elderly people. A total of 40 elderly individuals (aged 60 years) completed the study. They were divided into two groups: the TC group (11 men and 11 women) underwent a supervised TC exercise program for 16 weeks, while the control group (9 men and 9 women) received general education for a comparable time period. Pre- and post-intervention measurements were conducted. An isokinetic dynamometer was used to measure the maximum concentric strength and dynamic endurance of the knee flexors and the extensors, and the maximum concentric strength of the ankle plantarflexors and dorsiflexors. The neuromuscular response of the rectus femoris, semitendinosus, gastrocnemius, and anterior tibialis muscles was measured by the onset latency to sudden perturbations using an electromyography system. After 16 weeks, the TC group showed a 19.9% increase in muscle strength of the knee flexors (p<.000) that was significantly greater than that in the control group (p=.046). There was also a significant decrease in semitendinosus muscle latency (6.6%, p=.014) that was significantly shorter than that in the control group (p=.042). No significant training effects were found in other measures. These results suggest that improving biomechanical characteristics of lower extremity muscles may need longer TC intervention for elderly people.

  9. Patellar chondropathy and apicitis, and muscle imbalances of the lower extremities in competitive sports.

    PubMed

    Sommer, H M

    1988-06-01

    The jumping motion of 15 competitive basketball and volleyball players was tested until exhaustion in a cinematographic study. A stereotyped motion pattern was recognisable. The knee joint shows an evasive movement into a valgus and internal rotation position during the acceleration phase before take-off. Furthermore, the knee shows a brief stabilisation in overextension at heel strike. An imbalance of the muscles which stabilise the pelvis and the lower extremities can be regularly found in these athletes and could be a possible cause for this jump motion. It leads to a shortening of the hip flexors and adductors and of the knee extensors with the final evasive action of the knee joint. Though the anatomical condition of the joint is not directly observed, such a motion pattern must be the cause of additional shear forces and peak loads in the area of the patellofemoral joint and of the apex patellae. Clinical experience shows that an active correction of the evasive motion can be achieved by systematic physiotherapy. It ensures muscular balance of the pelvic region and lower extremities and thus lasting good results.

  10. Lower Extremity Passive Range of Motion in Community-Ambulating Stroke Survivors

    PubMed Central

    Schindler-Ivens, Sheila; Desimone, Davalyn; Grubich, Sarah; Kelley, Carolyn; Sanghvi, Namita; Brown, David A.

    2014-01-01

    Background Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length. Methods Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANGmax), torque required to achieve ANGmax (Tmax), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs. Results Contrary to our expectations, between-group differences in ANGmax were observed only during hip extension in which ANGmax was greater bilaterally in people post-stroke compared to control subjects (P ≤ 0.05; stroke = 13 degrees, able-bodied = −1 degree). Tmax, but not K, was also significantly higher during passive hip extension in paretic and nonparetic limbs compared to control limbs (P ≤ 0.05; stroke = 40 Nm, able-bodied = 29 Nm). Compared to the control group, Tmax was increased during hip flexion in the paretic and nonparetic limbs of post-stroke subjects (P

  11. Ankle Dorsiflexion Among Healthy Men With Different Qualities of Lower Extremity Movement

    PubMed Central

    Rabin, Alon; Kozol, Zvi; Spitzer, Elad; Finestone, Aharon

    2014-01-01

    Context: Lower extremity movement patterns have been implicated as a risk factor for various knee disorders. Ankle-dorsiflexion (DF) range of motion (ROM) has previously been associated with a faulty movement pattern among healthy female participants. Objective: To determine the association between ankle DF ROM and the quality of lower extremity movement during the lateral step-down test among healthy male participants. Design: Cross-sectional study. Setting: Training facility of the Israel Defense Forces. Patients or Other Participants: Fifty-five healthy male Israeli military recruits (age = 19.7 ± 1.1 years, height = 175.4 ± 6.4 cm, mass = 72.0 ± 7.6 kg). Intervention(s): Dorsiflexion ROM was measured in weight-bearing and non–weight-bearing conditions using a fluid-filled inclinometer and a universal goniometer, respectively. Lower extremity movement pattern was assessed visually using the lateral step-down test and classified categorically as good or moderate. All measurements were performed bilaterally. Main Outcome Measure(s): Weight-bearing and non–weight-bearing DF ROM were more limited among participants with moderate quality of movement than in those with good quality of movement on the dominant side (P = .01 and P = .02 for weight-bearing and non–weight-bearing DF, respectively). Non–weight-bearing DF demonstrated a trend toward a decreased range among participants with moderate compared with participants with good quality of movement on the nondominant side (P = .03 [adjusted P = .025]). Weight-bearing DF was not different between participants with good and moderate movement patterns on the nondominant side (P = .10). Weight-bearing and non–weight-bearing ankle DF ROM correlated significantly with the quality of movement on both sides (P < .01 and P < .05 on the dominant and nondominant side, respectively). Conclusions: Ankle DF ROM was associated with quality of movement among healthy male participants. The association seemed weaker in

  12. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis

    PubMed Central

    Wang, W. J.; Liu, F.; Zhu, Y.W.; Sun, M.H.; Qiu, Y.

    2016-01-01

    Objectives Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Methods Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples t-tests or chi-squared test. Results Patients with severe KOA showed significant backward femoral inclination (FI), hip flexion, forward spinal inclination, and higher prevalence of global imbalance (27.1% versus 3.4%, p < 0.001) compared with controls. In addition, patients with FI of 10° (n = 23) showed reduced lumbar lordosis and significant forward spinal inclination compared with controls, whereas those with FI > 10° (n = 36) presented with significant pelvic anteversion and hip flexion. A total of 39 patients with KOA (66.1%) suffered from LBP. There was no significant difference in sagittal alignment between KOA patients with and without LBP. Conclusions The sagittal alignment of spine-pelvis-lower extremity axis was significantly influenced by severe KOA. The lumbar spine served as the primary source of compensation, while hip flexion and pelvic anteversion increased for further compensation. Changes in sagittal alignment may not be involved in the pathogenesis of LBP in this patient population. Cite this article: W. J. Wang, F. Liu

  13. Influence of Lower Extremity Muscle Size and Quality on Stair-Climb Performance in Career Firefighters.

    PubMed

    Kleinberg, Craig R; Ryan, Eric D; Tweedell, Andrew J; Barnette, Timothy J; Wagoner, Chad W

    2016-06-01

    Kleinberg, CR, Ryan, ED, Tweedell, AJ, Barnette, TJ, and Wagoner, CW. Influence of lower extremity muscle size and quality on stair-climb performance in career firefighters. J Strength Cond Res 30(6): 1613-1618, 2016-The purpose of this study was to examine the influence of lower extremity muscular size and quality on stair-climb performance (SCP) in career firefighters. Forty-six male career firefighters (age = 37.0 ± 7.2 years; stature = 180.2 ± 6.9 cm; body mass = 108.0 ± 19.8 kg) volunteered for this study. Panoramic ultrasound images of the vastus lateralis and rectus femoris were obtained to determine cross-sectional area (CSA) and echo intensity (EI) of each muscle. The CSA of each muscle was then summed together and normalized to body mass (CSA/BM [QCSA]). Additionally, EI was averaged across both muscles (QEI). Participants then performed a timed and weighted SCP assessment where they ascended and descended 26 stairs 4 times as quickly as possible while wearing a weighted vest (22.73 kg) to simulate the weight of their self-contained breathing apparatus and turnout gear. Bivariate correlations and stepwise regression analyses were used to examine the relationships among variables and the relative contributions of QCSA and QEI to SCP. Partial correlations were used to examine the relationship between QCSA and SCP and QEI and SCP while controlling for age and body mass index (BMI). The results indicated that QCSA and QEI were significantly related to SCP before (r = -0.492, p = 0.001; r = 0.363, p = 0.013, respectively) and after accounting for age and BMI (r = -0.324, p = 0.032; r = 0.413, p = 0.005, respectively). Both QCSA and QEI contributed significantly to the prediction of SCP (r = 0.560, p < 0.001). These findings indicate that lower extremity muscle size and quality are important contributors to critical firefighting tasks, which have been shown to be improved with resistance training.

  14. Risk Factors and Indications for Readmission Following Lower Extremity Amputation in the ACS-NSQIP

    PubMed Central

    Curran, Thomas; Zhang, Jennifer Q.; Lo, Ruby C.; Fokkema, Margriet; McCallum, John C.; Buck, Dominique; Darling, Jeremy; Schermerhorn, Marc L.

    2014-01-01

    BACKGROUND Postoperative readmission, recently identified as a marker of hospital quality in the Affordable Care Act, is associated with increased morbidity, mortality and healthcare costs, yet data on readmission following lower extremity amputation is limited. We evaluated risk factors for readmission and post-discharge adverse events following lower extremity amputation in the ACS-NSQIP. STUDY DESIGN All patients undergoing transmetatarsal (TMA), below-knee (BKA) or above-knee amputation (AKA) in the 2011 – 2012 NSQIP were identified. Independent pre-discharge predictors of 30-day readmission were determined using multivariable logistic regression. Readmission indication and re-interventions, available in the 2012 NSQIP only, were also evaluated. RESULTS We identified 5,732 patients undergoing amputation (TMA: 12%; BKA: 51%; AKA: 37%). Readmission rate was 18%. Post-discharge mortality rate was 5% (TMA: 2%; BKA: 3%; AKA: 8%; p<.001). Overall complication rate was 43% (In-hospital: 32%; Post-discharge: 11%). Reoperation was for wound related complication or additional amputation in 79% of cases. Independent predictors of readmission included chronic nursing home residence (OR: 1.3; 95% CI: 1.0–1.7), non-elective surgery (OR: 1.4; 95% CI: 1.1–1.7), prior revascularization/amputation (OR: 1.4; 95% CI: 1.1–1.7), preoperative congestive heart failure (OR: 1.7; 95% CI: 1.2–2.4), and preoperative dialysis (OR: 1.5; 95% CI: 1.2–1.9). Guillotine amputation (OR: .6; 95%CI: .4–.9) and non-home discharge (OR: .7; 95%CI: .6–1.0) were protective of readmission. Wound related complications accounted for 49% of readmissions. CONCLUSIONS Post discharge morbidity, mortality and readmission are common following lower extremity amputation. Closer follow up of high risk patients, optimization of medical comorbidities and aggressive management of wound infection may play a role in decreasing readmission and post discharge adverse events. PMID:24985536

  15. Role for Lower Extremity Interstitial Fluid Volume Changes in the Development of Orthostasis after Simulated Microgravity

    NASA Technical Reports Server (NTRS)

    Platts, Steven H.; Summers, Richard L.; Martin, David S.; Meck, Janice V.; Coleman, Thomas G.

    2007-01-01

    Reentry orthostasis after exposure to the conditions of spaceflight is a persistent problem among astronauts. In a previous study, a computer model systems analysis was used to examine the physiologic mechanisms involved in this phenomenon. In this analysis, it was determined that an augmented capacitance of lower extremity veins due to a fluid volume contracture of the surrounding interstitial spaces during spaceflight results in an increase in sequestered blood volume upon standing and appears to be the initiating mechanism responsible for reentry orthostasis. In this study, we attempt to validate the central premise of this hypothesis using a ground-based spaceflight analog. 10 healthy subjects were placed at bed rest in a 6 head down tilt position for 60 days of bed rest. The impact of adaptations in interstitial fluid volume and venous capacitance in the lower extremities were then observed during a standard tilt test protocol performed before and after the confinement period. The interstitial thickness superficial to the calcaneous immediately below the lateral malleolus was measured using ultrasound with a 17-5 MHz linear array transducer. Measurements of the changes in anterior tibial vein diameter during tilt were obtained by similar methods. The measurements were taken while the subjects were supine and then during upright tilt (80') for thirty minutes, or until the subject had signs of presyncope. Additional measurements of the superficial left tibia interstitial thickness and stroke volume by standard echocardiographic methods were also recorded. In addition, calf compliance was measured over a pressure range of 10-60 mmHg, using plethysmography, in a subset of these subjects (n = 5). There was a average of 6% diminution in the size of the lower extremity interstitial space as compared to measurements acquired prior to bed rest. This contracture of the interstitial space coincided with a subsequent relative increase in the percentage change in tibial

  16. Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk.

    PubMed

    Dingenen, Bart; Malfait, Bart; Nijs, Stefaan; Peers, Koen H E; Vereecken, Styn; Verschueren, Sabine M P; Janssens, Luc; Staes, Filip F

    2016-08-01

    Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016

  17. Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome

    PubMed Central

    Seyahi, Emire; Cakmak, Osman Serdal; Tutar, Burcin; Arslan, Caner; Dikici, Atilla Suleyman; Sut, Necdet; Kantarci, Fatih; Tuzun, Hasan; Melikoglu, Melike; Yazici, Hasan

    2015-01-01

    Abstract Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes. All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed. Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS. Lower-extremity vein

  18. Foot, leg, and ankle swelling

    MedlinePlus

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Painless swelling may affect both legs and may include the calves or ... of gravity makes the swelling most noticeable in the lower ...

  19. Age-Related Differences in Muscle Shear Moduli in the Lower Extremity.

    PubMed

    Akagi, Ryota; Yamashita, Yota; Ueyasu, Yuta

    2015-11-01

    This study investigated the age-related differences in shear moduli of the rectus femoris muscle (RF), the lateral head of the gastrocnemius muscle (LG) and the soleus muscle (SOL) using shear wave ultrasound elastography. Thirty-one young individuals and 49 elderly individuals volunteered for this study. The shear modulus of RF was determined at 50% of the thigh length, and those of LG and SOL were determined at 30% of the lower leg length. RF and LG shear moduli were significantly higher in young individuals than in elderly individuals, but there was no age-related difference in SOL shear modulus. From the standpoint of an index reflecting muscle mechanical properties, it is suggested that the lower muscle shear moduli of RF and LG are the reason for the decreased explosive muscle strength in the lower extremity and the increased risk of falls for elderly individuals.

  20. Effective management of major lower extremity wounds using an acellular regenerative tissue matrix: a pilot study.

    PubMed

    Brigido, Stephen A; Boc, Steven F; Lopez, Ramon C

    2004-01-01

    Wound healing is a significant problem in orthopedics. Graftjacket tissue matrix (Wright Medical Technology, Inc, Arlington, Tenn), a novel acellular regenerative tissue matrix, has been designed to aid wound closure. A prospective, randomized study was initiated to determine the efficacy of this tissue product in wound repair compared with conventional treatment. Lower extremity wounds are refractile to healing in patients with diabetes mellitus. Therefore, researchers used diabetic foot ulcers to evaluate the efficacy of GraftJacket tissue matrix in wound repair. Only a single administration of the tissue matrix was required. After 1 month of treatment, preliminary results demonstrate that this novel tissue matrix promotes faster healing at a statistically significant rate over conventional treatment. Because wounds in this series of patients are deep and circulation around the wound is poor, the preliminary results suggest that this tissue matrix will be applicable to other types of orthopedic wounds.

  1. MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity.

    PubMed

    Magerkurth, Olaf; Girish, Gandikota; Jacobson, Jon A; Kim, Sung Moon; Brigido, Monica K; Dong, Qian; Jamadar, David A

    2015-01-01

    MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

  2. MR Imaging Appearances of Soft Tissue Flaps Following Reconstructive Surgery of the Lower Extremity

    PubMed Central

    Girish, Gandikota; Jacobson, Jon A; Kim, Sung Moon; Brigido, Monica K; Dong, Qian; Jamadar, David A

    2015-01-01

    MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence. PMID:25598685

  3. The first successful lower extremity transplantation: 6-year follow-up and implications for cortical plasticity.

    PubMed

    Fattah, A; Cypel, T; Donner, E J; Wang, F; Alman, B A; Zuker, R M

    2011-12-01

    Vascularized composite allotransplantation as a viable reconstructive option is gaining recognition and new cases are being reported with increasing frequency including hand, face and laryngeal transplantation. However, only one successful complete lower limb transplantation has been reported to date, in which a functioning limb from one ischiopagus twin with a lethal cardiac anomaly was transplanted to the other. Six years later, the patient is mobilizing well and engaging in sporting activities with her peers in a mainstream school. Clinical evaluation of motor and sensory modalities demonstrated a good functional result. Quality of life was assessed using the short form-36 health survey and lower extremity functional scale disclosing a high level of social and physical capacity. Functional magnetic resonance imaging was performed and showed cortical integration of the limb; the implications of cortical plasticity and vascularized composite allotransplantation for the correction of congenital limb anomalies are presented. PMID:21991888

  4. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment

    PubMed Central

    Pedersen, M.E; DaCambra, M.P; Jibri, Z; Dhillon, S; Jen, H; Jomha, N.M

    2015-01-01

    Chondral and osteochondral fractures of the lower extremities are important injuries because they can cause pain and dysfunction and often lead to osteoarthritis. These injuries can be misdiagnosed initially which may impact on the healing potential and result in poor long-term outcome. This comprehensive review focuses on current pitfalls in diagnosing acute osteochondral lesions, potential investigative techniques to minimize diagnostic errors as well as surgical treatment options. Acute osteochondral fractures are frequently missed and can be identified more accurately with specific imaging techniques. A number of different methods can be used to fix these fractures but attention to early diagnosis is required to limit progression to osteoarthritis. These fractures are common with joint injuries and early diagnosis and treatment should lead to improved long term outcomes. PMID:26587063

  5. [A MIDDLE-TERM RESULTS OF ENDOVENOUS LASER ABLATION FOR VARICOSE DISEASE OF THE LOWER EXTREMITIES].

    PubMed

    Osmanov, R R

    2016-02-01

    Abstract The results of endovascular laser ablation (EVLA) under ultrasonographic control in treatment of the lower extremities varicose disease (LEVD) in 189 patients (214 extremities) were analyzed. There was established, that for the trustworthy information obtaining the ultrasonographic duplex angioscanning conduction is necessary. The fibrous involution of a big subcutaneous vein trunk was achieved in (97.7 ± 1.0)% observations, in (1.9 ± 0.9)%--while the clinical signs absence--there were revealed the echo-signs of a reflux recurrence--the "ultrasonographic recurrence", and in one observation--a clinical recurrence of LEVD. In (5.1 ± 1.5)% observations in fibrous involution of the segments treated the signs of venous insufficiency in earlier competent parts were revealed--the disease progress registered. The recurrence rate and the pain syndrome severity did not depend on the treated veins diameter. High security of EVLA was established while the complications analyzing. PMID:27244920

  6. Surgical management of a dermal lymphatic malformation of the lower extremity

    PubMed Central

    Schneider, Lisa F; Chen, Constance M; Zurada, Joanna M; Walther, Robert; Grant, Robert T

    2008-01-01

    Dermal lymphatic malformations are rare congenital hamartomas of superficial lymphatics characterized by high recurrence rates after excision. The standard therapy for a single lesion is surgical excision with wide margins, which reduces recurrence but can have a potentially unacceptable aesthetic outcome. A case of a 24-year-old woman with a 6 cm × 5 cm dermal lymphatic malformation on her right thigh, diagnosed by clinical history, physical examination, magnetic resonance imaging and pathological findings, is reported. The patient underwent wide local excision with split-thickness skin grafting. After pathological examination revealed negative margins, the patient underwent tissue expander placement and excision of the skin graft with primary closure. The lesion did not recur, and the patient achieved a satisfactory aesthetic result. The present case represents the first report of the use of tissue expanders to treat dermal lymphatic malformations in the lower extremity and demonstrates a safe, staged approach to successful treatment. PMID:19949506

  7. [The use of gravitation overloading in the treatment of obliterative atherosclerosis of lower extremity arteries].

    PubMed

    Galkin, R A; Kotel'nikov, G P; Makarov, I V; Oparin, A N

    2003-01-01

    The article sums up results of treatment of 152 patients with obliterating atherosclerosis of the lower extremity arteries which were exposed to 2-3 G gravitation overloading made in a centrifuge of a short radius in direction head--pelvis. The gravitation overloading in the regimen followed were not found to have negative effects of central hemodynamics. Peripheral circulation was noted to considerably improve which is confirmed: 1) by clinical data showing 2-5 times longer distance of painless walking; 2) by the data of ultrasound dopplerography manifested as larger volume rate of blood flow and regional perfusion index; 3) by thermographic explorations evidencing the recovery of the thermoprophile of the legs and feet. Thus, the application of gravitation overloading is a new effective method of conservative treatment of patients with the pathology in question.

  8. [Transtibial amputation of the lower extremity in patients with ischemic foot contracture].

    PubMed

    Liabakh, A P; Mikhnevych, O E; Dolhopolov, O V

    2014-07-01

    The results of operative treatment of 8 patients was analyzed, in whom the lower extremity amputation on the upper third of the shin was performed for severe stage of the ischemic foot contacture. Operative interventions is expedient to perform in a specialized stationary, were exists possibility of further prosthesis. It is necessary to perform the extremity amputation in a residual period of the foot ischemic contracture, when operations for restoration of the sole sensitivity are nonperspective as well as in presence of severe trophic disorders on the sole and the shin, but without purulent--necrotic signs. Confirmed data of clinic--instrumental investigations for chronic course of the ischemic process constitutes an absolute indication for operation.

  9. New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

    PubMed Central

    Damiano, Diane L.; Alter, Katharine E.; Chambers, Henry

    2010-01-01

    Synopsis Cerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life. PMID:19643348

  10. Lateral compartment syndrome of the lower extremity in a recreational athlete: a case report.

    PubMed

    Taxter, Alysha J; Konstantakos, Emmanuel K; Ames, Donald W

    2008-10-01

    There are a limited number of reported cases of acute-onset isolated lateral compartment syndrome. We report a case of a 28-year-old recreational athlete who was erroneously diagnosed as having a muscle strain of his right lower extremity and discharged home. The patient over the course of the next day developed increasing leg pain and returned to the same emergency department where measurement of the peroneal compartment was 122 mm Hg. The patient had an emergent fasciotomy of the peroneal compartment of the right leg. The remainder of his hospital course was unremarkable. Although not commonly encountered, lateral compartment syndrome is important to consider in all patients who present with increasing pain out of proportion to injury and a tense swollen compartment after physical activity.

  11. Newly Developed Urinary Retention and Motor Weakness of Lower Extremities in a Postherpetic Neuralgia Patient

    PubMed Central

    Lee, Mi Hyun; Song, Jang Ho; Lee, Doo Ik; Ahn, Hyun Soo; Park, Ji Woong

    2013-01-01

    During the early stage of postherpetic neuralgia, an epidural block on the affected segment is helpful in controlling pain and preventing progression to a chronic state. The main neurologic complication following an epidural block is cord compression symptom due to an epidural hematoma. When neurologic complications arise from an epidural block for the treatment of postherpetic neuralgia, it is important to determine whether the complications are due to the procedure or due to the herpes zoster itself. We report a case of a patient who was diagnosed with herpes zoster myelitis during treatment for postherpetic neuralgia. The patient complained of motor weakness in the lower extremities after receiving a thoracic epidural block six times. Although initially, we believed that the complications were due to the epidural block, it was ultimately determined to be from the herpes zoster myelitis. PMID:23342213

  12. The Effect of Manipulating Subject Mass on Lower Extremity Torque Patterns During Locomotion

    NASA Technical Reports Server (NTRS)

    DeWitt, John K.; Cromwell, Ronita L.; Hagan, R. Donald

    2007-01-01

    During locomotion, humans adapt their motor patterns to maintain coordination despite changing conditions (Reisman et al., 2005). Bernstein (1967) proposed that in addition to the present state of a given joint, other factors, including limb inertia and velocity, must be taken into account to allow proper motion to occur. During locomotion with added mass counterbalanced using vertical suspension to maintain body weight, vertical ground reaction forces (GRF's) increase during walking but decrease during running, suggesting that adaptation may be velocity-specific (De Witt et al., 2006). It is not known, however, how lower extremity joint torques adapt to changes in inertial forces. The purpose of this investigation was to examine the effects of increasing body mass while maintaining body weight upon lower-limb joint torque during walking and running. We hypothesized that adaptations in joint torque patterns would occur with the addition of body mass.

  13. Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery

    PubMed Central

    Li, Ye; Guan, Xiang-Hong; Wang, Rui; Li, Bin; Ning, Bo; Su, Wei; Sun, Tao; Li, Hong-Yan

    2016-01-01

    Background The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. Material/Methods We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. Results On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). Conclusions Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery. PMID:27600467

  14. Effect of Reduced Stiffness Dance Flooring on Lower Extremity Joint Angular Trajectories During a Ballet Jump.

    PubMed

    Hackney, James; Brummel, Sara; Newman, Mary; Scott, Shannon; Reinagel, Matthew; Smith, Jennifer

    2015-09-01

    We carried out a study to investigate how low stiffness flooring may help prevent overuse injuries of the lower extremity in dancers. It was hypothesized that performing a ballet jump (sauté) on a reduced stiffness dance floor would decrease maximum joint flexion angles and negative angular velocities at the hips, knees, or ankles compared to performing the same jump on a harder floor. The participants were 15 young adult female dancers (age range 18 to 28, mean = 20.89 ± 2.93 years) with at least 5 years of continuous ballet experience and without history of serious lower body injury, surgery, or recent pain. They performed sautés on a (low stiffness) Harlequin ® WoodSpring Floor and on a vinyl-covered hardwood on concrete floor. Maximum joint flexion angles and negative velocities at bilateral hips, knees, and ankles were measured with the "Ariel Performance Analysis System" (APAS). Paired one-tailed t-tests yielded significant decreases in maximum knee angle (average decrease = 3.4° ± 4.2°, p = 0.026) and angular negative velocity of the ankles (average decrease = 18.7°/sec ± 27.9°/sec, p = 0.009) with low stiffness flooring. If the knee angle is less acute, then the length of the external knee flexion moment arm will also be shorter and result in a smaller external knee flexion moment, given an equal landing force. Also, high velocities of eccentric muscle contraction, which are necessary to control negative angular velocity of the ankle joint, are associated with higher risk of musculotendinous injury. Hence, our findings indicate that reduced floor stiffness may indeed help decrease the likelihood of lower extremity injuries. PMID:26349504

  15. Lower Extremity Muscle Activation and Kinematics of Catchers When Throwing Using Various Squatting and Throwing Postures.

    PubMed

    Peng, Yi-Chien; Lo, Kuo-Cheng; Wang, Lin-Hwa

    2015-09-01

    This study investigated the differences in joint motions and muscle activities of the lower extremities involved in various squatting postures. The motion capture system with thirty-one reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the quadriceps, biceps femoris, tibialis anterior, and gastrocnemius muscles of the pivot and stride leg. The joint extension and flexion in wide squatting are greater than in general squatting (p = 0.005). Knee joint extension and flexion in general squatting are significantly greater than in wide squatting (p = 0.001). The adduction and abduction of the hip joint in stride passing are significantly greater than in step squatting (p = 0.000). Furthermore, the adduction and abduction of the knee joint in stride passing are also significantly greater than in step squatting (p = 0.000). When stride passing is performed, the muscle activation of the hamstring of the pivot foot in general squatting is significantly greater than in wide squatting (p < 0.05), and this difference continues to the stride period. Most catchers use a general or wide squatting width, exclusive of a narrow one. Therefore, the training design for strengthening the lower extremity muscles should consider the appropriateness of the common squat width to enhance squat-up performance. For lower limb muscle activation, wide squatting requires more active gastrocnemius and tibialis anterior muscles. Baseball players should extend the knee angle of the pivot foot before catching the ball. Key pointsCommon squatting width can enhance squat-up performance through strengthening lower body muscle.Wide squatting width might improve lower body muscle activation, leading to more effective communication between the brain and the muscle group. The benefit might be improved coordination of lower body muscle.Common and wide squatting width might be cycled through training to enhance the strengthen and

  16. Effect of Reduced Stiffness Dance Flooring on Lower Extremity Joint Angular Trajectories During a Ballet Jump.

    PubMed

    Hackney, James; Brummel, Sara; Newman, Mary; Scott, Shannon; Reinagel, Matthew; Smith, Jennifer

    2015-09-01

    We carried out a study to investigate how low stiffness flooring may help prevent overuse injuries of the lower extremity in dancers. It was hypothesized that performing a ballet jump (sauté) on a reduced stiffness dance floor would decrease maximum joint flexion angles and negative angular velocities at the hips, knees, or ankles compared to performing the same jump on a harder floor. The participants were 15 young adult female dancers (age range 18 to 28, mean = 20.89 ± 2.93 years) with at least 5 years of continuous ballet experience and without history of serious lower body injury, surgery, or recent pain. They performed sautés on a (low stiffness) Harlequin ® WoodSpring Floor and on a vinyl-covered hardwood on concrete floor. Maximum joint flexion angles and negative velocities at bilateral hips, knees, and ankles were measured with the "Ariel Performance Analysis System" (APAS). Paired one-tailed t-tests yielded significant decreases in maximum knee angle (average decrease = 3.4° ± 4.2°, p = 0.026) and angular negative velocity of the ankles (average decrease = 18.7°/sec ± 27.9°/sec, p = 0.009) with low stiffness flooring. If the knee angle is less acute, then the length of the external knee flexion moment arm will also be shorter and result in a smaller external knee flexion moment, given an equal landing force. Also, high velocities of eccentric muscle contraction, which are necessary to control negative angular velocity of the ankle joint, are associated with higher risk of musculotendinous injury. Hence, our findings indicate that reduced floor stiffness may indeed help decrease the likelihood of lower extremity injuries.

  17. Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients.

    PubMed

    Wanivenhaus, Florian; Mauler, Flavien; Stelzer, Teresa; Tschopp, Alois; Böni, Thomas; Berli, Martin C

    2016-01-01

    This article reports the revision rate and possible risk factors for lower extremity amputations in patients with diabetes mellitus or peripheral arterial disease (PAD). Data were collected from 421 patients with diabetes mellitus or PAD who underwent amputations of the lower extremity at the authors' institution from 2002 to 2012. There was a 25.2% overall revision rate. Mean time from amputation to revision was 244 days (range, 2-2590 days). Patients with diabetes mellitus had a significantly higher rate of revision to a more proximal level compared with patients without diabetes mellitus (type 1: odds ratio [OR]=3.73; 95% confidence interval [CI], 1.21-11.52; P=.022; and type 2: OR=2.3; 95% CI, 1.07-4.95; P=.033). A significant increase in revision rates was observed from Fontaine stage 0 to IV (stage 0: 17.9%; stage IV, 34.7%; P=.03). Risk factors for revision were diabetic nephropathy (OR=2.26; 95% CI, 1.4-3.63; P=.001) and polyneuropathy (OR=1.68; 95% CI, 1.03-2.73; P=.037). Patients who underwent revision amputation had a significantly younger mean age than patients who did not undergo revision amputation (65.23 years [range, 40-92 years] vs 68.52 years [range, 32-96 years]; P=.013). Anticipated amputation in this patient population requires a multidisciplinary approach with optimization of the patient's health. In the authors' clinical practice, the determination of the appropriate amputation level is performed individually for each patient, considering the risk factors identified in this study and the patient's expected mobilization potential, social background, and acceptance of a more proximal primary amputation level.

  18. Lower Extremity Muscle Activity During a Women’s Overhand Lacrosse Shot

    PubMed Central

    Millard, Brianna M.; Mercer, John A.

    2014-01-01

    The purpose of this study was to describe lower extremity muscle activity during the lacrosse shot. Participants (n=5 females, age 22±2 years, body height 162.6±15.2 cm, body mass 63.7±23.6 kg) were free from injury and had at least one year of lacrosse experience. The lead leg was instrumented with electromyography (EMG) leads to measure muscle activity of the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (GA). Participants completed five trials of a warm-up speed shot (Slow) and a game speed shot (Fast). Video analysis was used to identify the discrete events defining specific movement phases. Full-wave rectified data were averaged per muscle per phase (Crank Back Minor, Crank Back Major, Stick Acceleration, Stick Deceleration). Average EMG per muscle was analyzed using a 4 (Phase) × 2 (Speed) ANOVA. BF was greater during Fast vs. Slow for all phases (p<0.05), while TA was not influenced by either Phase or Speed (p>0.05). RF and GA were each influenced by the interaction of Phase and Speed (p<0.05) with GA being greater during Fast vs. Slow shots during all phases and RF greater during Crank Back Minor and Major as well as Stick Deceleration (p<0.05) but only tended to be greater during Stick Acceleration (p=0.076) for Fast vs. Slow. The greater muscle activity (BF, RF, GA) during Fast vs. Slow shots may have been related to a faster approach speed and/or need to create a stiff lower extremity to allow for faster upper extremity movements. PMID:25114727

  19. Lower Extremity Ischemia, Calf Skeletal Muscle Characteristics, and Functional Impairment in Peripheral Arterial Disease

    PubMed Central

    McDermott, Mary M.; Hoff, Frederick; Ferrucci, Luigi; Pearce, William H.; Guralnik, Jack M.; Tian, Lu; Liu, Kiang; Schneider, Joseph R.; Sharma, Leena; Tan, Jin; Criqui, Michael H.

    2009-01-01

    OBJECTIVES To determine whether lower ankle brachial index (ABI) levels are associated with lower calf skeletal muscle area and higher calf muscle percentage fat in persons with and without lower extremity peripheral arterial disease (PAD). DESIGN Cross-sectional. SETTING Three Chicago-area medical centers. PARTICIPANTS Four hundred thirty-nine persons with PAD (ABI<0.90) and 265 without PAD (ABI 0.90–1.30). MEASUREMENTS Calf muscle cross-sectional area and the percentage of fat in calf muscle were measured using computed tomography at 66.7% of the distance between the distal and proximal tibia. Physical activity was measured using an accelerometer. Functional measures included the 6-minute walk, 4-meter walking speed, and the Short Physical Performance Battery (SPPB). RESULTS Adjusting for age, sex, race, comorbidities, and other potential confounders, lower ABI values were associated with lower calf muscle area (ABI<0.50, 5,193 mm2; ABI 0.50–0.90, 5,536 mm2; ABI 0.91–1.30, 5,941 mm2; P for trend <.001). These significant associations remained after additional adjustment for physical activity. In participants with PAD, lower calf muscle area in the leg with higher ABI was associated with significantly poorer performance in usual- and fast-paced 4-meter walking speed and on the SPPB, adjusting for ABI, physical activity, percentage fat in calf muscle, muscle area in the leg with lower ABI, and other confounders (P<.05 for all comparisons). CONCLUSION These data support the hypothesis that lower extremity ischemia has a direct adverse effect on calf skeletal muscle area. This association may mediate previously established relationships between PAD and functional impairment. PMID:17341243

  20. Trunk and Lower Extremity Kinematics During Stair Descent in Women With or Without Patellofemoral Pain

    PubMed Central

    Schwane, Brandi G.; Goerger, Benjamin M.; Goto, Shiho; Blackburn, J. Troy; Aguilar, Alain J.; Padua, Darin A.

    2015-01-01

    Context There is limited evidence indicating the contribution of trunk kinematics to patellofemoral pain (PFP). A better understanding of the interaction between trunk and lower extremity kinematics in this population may provide new avenues for interventions to treat PFP. Objective To compare trunk and lower extremity kinematics between participants with PFP and healthy controls during a stair-descent task. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants Twenty women with PFP (age = 22.2 ± 3.1 years, height = 164.5 ± 9.2 cm, mass = 63.5 ± 13.6 kg) and 20 healthy women (age = 21.0 ± 2.6 years, height = 164.5 ± 7.1 cm, mass = 63.8 ± 12.7 kg). Intervention(s) Kinematics were recorded as participants performed stair descent at a controlled velocity. Main Outcome Measure(s) Three-dimensional joint displacement of the trunk, hip, and knee during the stance phase of stair descent for the affected leg was measured using a 7-camera infrared optical motion-capture system. Pretest and posttest pain were assessed using a visual analogue scale. Kinematic differences between groups were determined using independent-samples t tests. A 2 × 2 mixed-model analysis of variance (group = PFP, control; time = pretest, posttest) was used to compare knee pain. Results We observed greater knee internal-rotation displacement for the PFP group (12.8° ± 7.2°) as compared with the control group (8.9° ± 4.4°). No other between-groups differences were observed for the trunk, hip, or other knee variables. Conclusions We observed no difference in trunk kinematics between groups but did note differences in knee internal-rotation displacement. These findings contribute to the current knowledge of altered movement in those with PFP and provide direction for exercise interventions. PMID:25898109

  1. Lower Extremity Muscle Activation and Kinematics of Catchers When Throwing Using Various Squatting and Throwing Postures.

    PubMed

    Peng, Yi-Chien; Lo, Kuo-Cheng; Wang, Lin-Hwa

    2015-09-01

    This study investigated the differences in joint motions and muscle activities of the lower extremities involved in various squatting postures. The motion capture system with thirty-one reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the quadriceps, biceps femoris, tibialis anterior, and gastrocnemius muscles of the pivot and stride leg. The joint extension and flexion in wide squatting are greater than in general squatting (p = 0.005). Knee joint extension and flexion in general squatting are significantly greater than in wide squatting (p = 0.001). The adduction and abduction of the hip joint in stride passing are significantly greater than in step squatting (p = 0.000). Furthermore, the adduction and abduction of the knee joint in stride passing are also significantly greater than in step squatting (p = 0.000). When stride passing is performed, the muscle activation of the hamstring of the pivot foot in general squatting is significantly greater than in wide squatting (p < 0.05), and this difference continues to the stride period. Most catchers use a general or wide squatting width, exclusive of a narrow one. Therefore, the training design for strengthening the lower extremity muscles should consider the appropriateness of the common squat width to enhance squat-up performance. For lower limb muscle activation, wide squatting requires more active gastrocnemius and tibialis anterior muscles. Baseball players should extend the knee angle of the pivot foot before catching the ball. Key pointsCommon squatting width can enhance squat-up performance through strengthening lower body muscle.Wide squatting width might improve lower body muscle activation, leading to more effective communication between the brain and the muscle group. The benefit might be improved coordination of lower body muscle.Common and wide squatting width might be cycled through training to enhance the strengthen and

  2. Lower Extremity Muscle Activation and Kinematics of Catchers When Throwing Using Various Squatting and Throwing Postures

    PubMed Central

    Peng, Yi-Chien; Lo, Kuo-Cheng; Wang, Lin-Hwa

    2015-01-01

    This study investigated the differences in joint motions and muscle activities of the lower extremities involved in various squatting postures. The motion capture system with thirty-one reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the quadriceps, biceps femoris, tibialis anterior, and gastrocnemius muscles of the pivot and stride leg. The joint extension and flexion in wide squatting are greater than in general squatting (p = 0.005). Knee joint extension and flexion in general squatting are significantly greater than in wide squatting (p = 0.001). The adduction and abduction of the hip joint in stride passing are significantly greater than in step squatting (p = 0.000). Furthermore, the adduction and abduction of the knee joint in stride passing are also significantly greater than in step squatting (p = 0.000). When stride passing is performed, the muscle activation of the hamstring of the pivot foot in general squatting is significantly greater than in wide squatting (p < 0.05), and this difference continues to the stride period. Most catchers use a general or wide squatting width, exclusive of a narrow one. Therefore, the training design for strengthening the lower extremity muscles should consider the appropriateness of the common squat width to enhance squat-up performance. For lower limb muscle activation, wide squatting requires more active gastrocnemius and tibialis anterior muscles. Baseball players should extend the knee angle of the pivot foot before catching the ball. Key points Common squatting width can enhance squat-up performance through strengthening lower body muscle. Wide squatting width might improve lower body muscle activation, leading to more effective communication between the brain and the muscle group. The benefit might be improved coordination of lower body muscle. Common and wide squatting width might be cycled through training to enhance the strengthen and

  3. Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery.

    PubMed

    Li, Ye; Guan, Xiang-Hong; Wang, Rui; Li, Bin; Ning, Bo; Su, Wei; Sun, Tao; Li, Hong-Yan

    2016-01-01

    BACKGROUND The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. MATERIAL AND METHODS We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. RESULTS On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). CONCLUSIONS Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery. PMID:27600467

  4. Lower Extremity Neuromuscular Control Immediately After Fatiguing Hip-Abduction Exercise

    PubMed Central

    McMullen, Kelly L.; Cosby, Nicole L.; Hertel, Jay; Ingersoll, Christopher D.; Hart, Joseph M.

    2011-01-01

    Context: Fatigue of the gluteus medius (GMed) muscle might be associated with decreases in postural control due to insufficient pelvic stabilization. Men and women might have different muscular recruitment patterns in response to GMed fatigue. Objective: To compare postural control and quality of movement between men and women after a fatiguing hip-abduction exercise. Design: Descriptive laboratory study. Setting: Controlled laboratory. Patients or Other Participants: Eighteen men (age = 22 ± 3.64 years, height = 183.37 ± 8.30 cm, mass = 87.02 ±12.53 kg) and 18 women (age = 22 ± 3.14, height = 167.65 ± 5.80 cm, mass = 66.64 ± 10.49 kg) with no history of low back or lower extremity injury participated in our study. Intervention(s): Participants followed a fatiguing protocol that involved a side-lying hip-abduction exercise performed until a 15% shift in electromyographic median frequency of the GMed was reached. Main Outcome Measure(s): Baseline and postfatigue measurements of single-leg static balance, dynamic balance, and quality of movement assessed with center-of-pressure measurements, the Star Excursion Balance Test, and lateral step-down test, respectively, were recorded for the dominant lower extremity (as identified by the participant). Results: We observed no differences in balance deficits between sexes (P > .05); however, we found main effects for time with all of our postfatigue outcome measures (P ≤ .05). Conclusions: Our findings suggest that postural control and quality of movement were affected negatively after a GMed-fatiguing exercise. At similar levels of local muscle fatigue, men and women had similar measurements of postural control. PMID:22488185

  5. The effect of virtual reality-based eccentric training on lower extremity muscle activation and balance in stroke patients.

    PubMed

    Park, Seung Kyu; Yang, Dae Jung; Uhm, Yo Han; Heo, Jae Won; Kim, Je Ho

    2016-07-01

    [Purpose] The purpose of this study was to examine the effect of virtual reality-based eccentric training on lower extremity muscle activity and balance in stroke patients. [Subjects and Methods] Thirty stroke patients participated, with 15 patients allotted to each of two eccentric training groups: one using a slow velocity (group I) and one using a fast velocity (group II). The virtual reality-based eccentric training was performed by the patients for 30 minutes once a day, 5 days a week, for 8 weeks using an Eccentron system. Surface electromyography was used to measure the lower extremity muscle activity, while a BioRescue was used to measure balancing ability. [Results] A significant difference in lower extremity muscle activation and balance ability was observed in group I compared with group II. [Conclusion] This study showed that virtual reality-based eccentric training using a slow velocity is effective for improving lower extremity muscle activity and balance in stroke patients. PMID:27512263

  6. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

    PubMed Central

    Ford, Kevin R; Nguyen, Anh-Dung; Dischiavi, Steven L; Hegedus, Eric J; Zuk, Emma F; Taylor, Jeffrey B

    2015-01-01

    Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions. PMID:26346471

  7. The effect of virtual reality-based eccentric training on lower extremity muscle activation and balance in stroke patients

    PubMed Central

    Park, Seung Kyu; Yang, Dae Jung; Uhm, Yo Han; Heo, Jae Won; Kim, Je Ho

    2016-01-01

    [Purpose] The purpose of this study was to examine the effect of virtual reality-based eccentric training on lower extremity muscle activity and balance in stroke patients. [Subjects and Methods] Thirty stroke patients participated, with 15 patients allotted to each of two eccentric training groups: one using a slow velocity (group I) and one using a fast velocity (group II). The virtual reality-based eccentric training was performed by the patients for 30 minutes once a day, 5 days a week, for 8 weeks using an Eccentron system. Surface electromyography was used to measure the lower extremity muscle activity, while a BioRescue was used to measure balancing ability. [Results] A significant difference in lower extremity muscle activation and balance ability was observed in group I compared with group II. [Conclusion] This study showed that virtual reality-based eccentric training using a slow velocity is effective for improving lower extremity muscle activity and balance in stroke patients. PMID:27512263

  8. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

    PubMed Central

    Toursavadkohi, Shahab; Kakkos, Stavros K.; Rubinfeld, Ilan; Shepard, Alexander

    2016-01-01

    Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA) repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics. In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR) (11 Zenith, 8 Excluder, and 1 Medtronic) and 18 patients with open repair (OR) (16 bifurcated grafts, 2 tube grafts). Pre- and postoperative ankle-brachial indices (ABIs) and toe-brachial indices (TBIs) were measured preoperatively and on postoperative day (POD) 1 and 5. Demographics and preoperative ABIs/TBIs were identical in EVAR (0.97/0.63) and OR (0.96/0.63) patients (p = 0.21). There was a significant decrease in ABIs/TBIs following both EVAR (0.83/0.52, p = 0.01) and OR (0.73/0.39, p = 0.003) on POD #1, although this decrease was greater following OR than EVAR (p = 0.002). This difference largely resolved by POD #5 (p = 0.41). In the OR group, TBIs in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs. 0.61, p = 0.03). In the EVAR group, there was also a difference in TBIs between the main body insertion side and the contralateral side (0.50 vs. 0.59, p = 0.02). Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR, suggesting that microembolization plays a major role in this deterioration. The derangement following OR is more profound than after EVAR on POD #1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g., the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively) may play a role. PMID

  9. Stiffness and ultimate load of osseointegrated prosthesis fixations in the upper and lower extremity

    PubMed Central

    2013-01-01

    Background Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall. We therefore investigated the bending stiffness and ultimate bending moment of such devices implanted in human and synthetic bones. Methods Eight human specimens and 16 synthetic models of the proximal femora were implanted with lower extremity prostheses and eight human specimens and six synthetic humeri were implanted with upper extremity prostheses. They were dissected according to typical amputation levels and underwent loading in a material testing machine in a four-point bending setup. Bending stiffness, ultimate bending moment and fracture modes were determined in a load to failure experiment. Additionally, axial pull-out was performed on eight synthetic specimens of the lower extremity. Results Maximum bending moment of the synthetic femora was 160.6±27.5 Nm, the flexural rigidity of the synthetic femora was 189.0±22.6 Nm2. Maximum bending moment of the human femora was 100.4±38.5 Nm, and the flexural rigidity was 137.8±29.4 Nm2. The maximum bending moment of the six synthetic humeri was 104.9±19.0 Nm, and the flexural rigidity was 63.7±3.6 Nm2. For the human humeri the maximum bending moment was 36.7±11.0 Nm, and the flexural rigidity at was 43.7±10.5 Nm2. The maximum pull-out force for the eight synthetic femora was 3571±919 N. Conclusion Significant differences were found between human and synthetic specimens of the lower and upper extremity regarding maximum bending moment, bending displacement and flexural rigidity. The results of this study are relevant with respect to previous finding regarding the load at the interfaces of osseointegrated prosthesis

  10. Development and control of a lower extremity assistive device (LEAD) for gait rehabilitation.

    PubMed

    Shen, Bingquan; Li, Jinfu; Bai, Fengjun; Chew, Chee-Meng

    2013-06-01

    This research developed a wearable lower extremity assistive device intended to aid stroke patient during rehabilitation. The device specifically aims to assist the patient in sit-to-stand, stand-to-sit, and level-walking tasks in order to promote active gait rehabilitation exercises. The device adopts an anthropomorphic structure with hip and knee joint actuated in sagittal plane. A finite state machine strategy was proposed to control the device. At different states, appropriate assist torque is added to each joint. EMG signals are used to assess the assist performance. Tests on an able-bodied subject show that the device could successfully detect and transit between states. In sit-to-stand tasks, the integrated EMG (iEMG) of the Vastus Medialis for standing up with 11 Nm of assistance torque were found to be significantly less (P = 0.00187) than the iEMG of without assistance for standing up which indicate reduced muscle effort with the device assistance. Results show the device could potentially assist stroke patient in similar tasks.

  11. Differences in lower-extremity muscular activation during walking between healthy older and young adults

    PubMed Central

    Schmitz, Anne; Silder, Amy; Heiderscheit, Bryan; Mahoney, Jane; Thelen, Darryl G.

    2013-01-01

    Previous studies have identified differences in gait kinetics between healthy older and young adults. However, the underlying factors that cause these changes are not well understood. The objective of this study was to assess the effects of age and speed on the activation of lower-extremity muscles during human walking. We recorded electromyography (EMG) signals of the soleus, gastrocnemius, biceps femoris, medial hamstrings, tibialis anterior, vastus lateralis, and rectus femoris as healthy young and older adults walked over ground at slow, preferred and fast walking speeds. Nineteen healthy older adults (age, 73 ± 5 years) and 18 healthy young adults (age, 26 ± 3 years) participated. Rectified EMG signals were normalized to mean activities over a gait cycle at the preferred speed, allowing for an assessment of how the activity was distributed over the gait cycle and modulated with speed. Compared to the young adults, the older adults exhibited greater activation of the tibialis anterior and soleus during mid-stance at all walking speeds and greater activation of the vastus lateralis and medial hamstrings during loading and mid-stance at the fast walking speed, suggesting increased coactivation across the ankle and knee. In addition, older adults depend less on soleus muscle activation to push off at faster walking speeds. We conclude that age-related changes in neuromuscular activity reflect a strategy of stiffening the limb during single support and likely contribute to reduced push off power at fast walking speeds. PMID:19081734

  12. Influences of trunk flexion on mechanical energy flow in the lower extremities during gait

    PubMed Central

    Takeda, Takuya; Anan, Masaya; Takahashi, Makoto; Ogata, Yuta; Tanimoto, Kenji; Shinkoda, Koichi

    2016-01-01

    [Purpose] The time-series waveforms of mechanical energy generation, absorption, and transfer through the joints indicate how movements are produced and controlled. Previous studies have used these waveforms to evaluate and describe the efficiency of human movements. The purpose of this study was to examine the influence of trunk flexion on mechanical energy flow in the lower extremities during gait. [Subjects and Methods] The subjects were 8 healthy young males (mean age, 21.8 ± 1.3 years, mean height, 170.5 ± 6.8 cm, and mean weight, 60.2 ± 6.8 kg). Subjects walked at a self-selected gait speed under 2 conditions: normal gait (condition N), and gait with trunk flexion formed with a brace to simulate spinal curvature (condition TF). The data collected from initial contact to the mid-stance of gait was analyzed. [Results] There were no significant differences between the 2 conditions in the mechanical energy flow in the knee joint and negative mechanical work in the knee joint. However, the positive mechanical work of the knee joint under condition TF was significantly less than that under condition N. [Conclusion] Trunk flexion led to knee flexion in a standing posture. Thus, a strategy of moving of center of mass upward by knee extension using less mechanical energy was selected during gait in the trunk flexed posture. PMID:27313351

  13. Influences of trunk flexion on mechanical energy flow in the lower extremities during gait.

    PubMed

    Takeda, Takuya; Anan, Masaya; Takahashi, Makoto; Ogata, Yuta; Tanimoto, Kenji; Shinkoda, Koichi

    2016-05-01

    [Purpose] The time-series waveforms of mechanical energy generation, absorption, and transfer through the joints indicate how movements are produced and controlled. Previous studies have used these waveforms to evaluate and describe the efficiency of human movements. The purpose of this study was to examine the influence of trunk flexion on mechanical energy flow in the lower extremities during gait. [Subjects and Methods] The subjects were 8 healthy young males (mean age, 21.8 ± 1.3 years, mean height, 170.5 ± 6.8 cm, and mean weight, 60.2 ± 6.8 kg). Subjects walked at a self-selected gait speed under 2 conditions: normal gait (condition N), and gait with trunk flexion formed with a brace to simulate spinal curvature (condition TF). The data collected from initial contact to the mid-stance of gait was analyzed. [Results] There were no significant differences between the 2 conditions in the mechanical energy flow in the knee joint and negative mechanical work in the knee joint. However, the positive mechanical work of the knee joint under condition TF was significantly less than that under condition N. [Conclusion] Trunk flexion led to knee flexion in a standing posture. Thus, a strategy of moving of center of mass upward by knee extension using less mechanical energy was selected during gait in the trunk flexed posture.

  14. Postoperative sciatic and femoral or saphenous nerve blockade for lower extremity surgery in anesthetized adults

    PubMed Central

    Lollo, Loreto; Bhananker, Sanjay; Stogicza, Agnes

    2015-01-01

    Background: Guidelines warn of increased risks of injury when placing regional nerve blocks in the anesthetized adult but complications occurred in patients that received neither sedation nor local anesthetic. This restriction of nerve block administration places vulnerable categories of patients at risk of severe opioid induced side effects. Patient and operative technical factors can preclude use of preoperative regional anesthesia. The purpose of this study was to assess complications following sciatic popliteal and femoral or saphenous nerve blockade administered to anesthetized adult patients following foot and ankle surgery. Materials and Methods: Postoperative patients administered general anesthesia received popliteal sciatic nerve blockade and either femoral or saphenous nerve blockade if operative procedures included medial incisions. Nerve blocks were placed with nerve stimulator or ultrasound guidance. A continuous nerve catheter was inserted if hospital admission was over 24 hours. Opioid analgesic supplementation was administered for inadequate pain relief. Postoperative pain scores and total analgesic requirements for 24 hours were recorded. Nerve block related complications were monitored for during the hospital admission and at follow up surgical clinic evaluation. Results: 190 anesthetized adult patients were administered 357 nerve blocks. No major nerve injury or deficit was reported. One patient had numbness in the toes not ascribed to a specific nerve of the lower extremity. Perioperative opioid dose differences were noted between male and female and between opioid naïve and tolerant patients. PMID:26807391

  15. Effect of initial projectile speed on contamination distribution in a lower extremity surrogate "wound track".

    PubMed

    Krebsbach, Meaghen A; Muci-Küchler, Karim Heinz; Hinz, Brandon J

    2012-05-01

    This article presents an experimental study that examines the relationship between initial projectile speed and bacterial distribution along a wound track due to surface contamination. A ballistic gelatin cylinder was used as a lower extremity surrogate, and surface contamination was simulated using circular filter paper moistened with a solution containing Escherichia coli strain K-12 that was previously transformed to express green fluorescent protein and be resistant to ampicillin. An 11.43-mm caliber round-nose lead projectile was shot through the contaminated area and into the extremity surrogate at firing velocities ranging from 61 to 199 m/s. The "wound track" was extracted and cut into 10 evenly spaced slices. Then, the permanent cavity was removed from each slice using a biopsy punch, liquefied, and grown on selective agar containing ampicillin. Direct and normalized bacterial colony counts and normalized extents of area covered by bacteria colonies were used to compare the differences between distribution trends corresponding to different projectile speeds. The results obtained showed that, for the cases considered, an increase in projectile speed resulted in a significant shift in the percentage of contamination from the "wound" entrance region to the "wound" exit region. PMID:22645885

  16. Validity of the lower extremity functional movement screen in patients with chronic ankle instability

    PubMed Central

    Choi, Ho-Suk; Shin, Won-Seob

    2015-01-01

    [Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI. PMID:26180349

  17. Blast effect on the lower extremities and its mitigation: a computational study.

    PubMed

    Dong, Liqiang; Zhu, Feng; Jin, Xin; Suresh, Mahi; Jiang, Binhui; Sevagan, Gopinath; Cai, Yun; Li, Guangyao; Yang, King H

    2013-12-01

    A series of computational studies were performed to investigate the response of the lower extremities of mounted soldiers under landmine detonation. A numerical human body model newly developed at Wayne State University was used to simulate two types of experimental studies and the model predictions were validated against test data in terms of the tibia axial force as well as bone fracture pattern. Based on the validated model, the minimum axial force causing tibia facture was found. Then a series of parametric studies was conducted to determine the critical velocity (peak velocity of the floor plate) causing tibia fracture at different upper/lower leg angles. In addition, to limit the load transmission through the vehicular floor, two types of energy absorbing materials, namely IMPAXX(®) foam and aluminum alloy honeycomb, were selected for floor matting. Their performances in terms of blast effect mitigation were compared using the validated numerical model, and it has been found that honeycomb is a more efficient material for blast injury prevention under the loading conditions studied. PMID:23973770

  18. The influence of physical activity, body composition, and lower extremity strength on walking ability.

    PubMed

    Marques, Elisa; Carvalho, Joana; Pizarro, Andreia; Wanderlay, Flávia; Mota, Jorge

    2011-10-01

    We examined the relationship among objective measures of body composition, lower extremity strength, physical activity, and walking performance and determined whether this interaction differed according to walking ability. Participants were 126 adults ages 60-91 yr. Stepwise multiple regression analysis showed that the 30-s chair stand test (30sCST), appendicular lean mass index (aLMI), body mass index, and age were independent contributors to walking performance, explaining 44.3% of the variance. For slower walkers, appendicular fat mass index (aFMI), moderate to vigorous physical activity (MVPA), 30sCST, and aLMI (r2 = .49, p < .001) largely explained variance in walking performance. For faster walkers, aFMI and aLMI explained 31.4% (p < .001) of the variance. These data suggest that both fat and lean mass are associated with walking performance in higher- and lower-functioning older adults, whereas MPVA and muscle strength influence walking ability only among lower-functioning older adults. PMID:22113093

  19. Effect of sprung (suspended) floor on lower extremity stiffness during a force-returning ballet jump.

    PubMed

    Hackney, James; Brummel, Sara; Becker, Dana; Selbo, Aubrey; Koons, Sandra; Stewart, Meredith

    2011-12-01

    Our objective in this study was to compare stiffness of bilateral lower extremities (LEs) in ballet dancers performing sauté on a low-stiffness "sprung floor" to that during the same movement on a high-stiffness floor (wood on concrete). LE stiffness was calculated as the ratio of vertical ground reaction force (in kN) to compression of the lower limb (in meters). Seven female dancers were measured for five repetitions each at the point of maximum leg compression while performing sauté on both of the surfaces, such that 43 ms of data were represented for each trial. The stiffness of bilateral LEs at the point of maximum compression was higher by a mean difference score of 2.48 ± 2.20 kN/m on the low-stiffness floor compared to a high-stiffness floor. Paired t-test analysis of the difference scores yielded a one-tailed probability of 0.012. This effect was seen in six out of seven participants (one participant showed no difference between floor conditions). The finding of increased stiffness of the LEs in the sprung floor condition suggests that some of the force of landing the jump was absorbed by the surface, and therefore did not need to be absorbed by the participants' LEs themselves. This in turn implies that a sprung dance floor may help to prevent dance-related injuries.

  20. Blast effect on the lower extremities and its mitigation: a computational study.

    PubMed

    Dong, Liqiang; Zhu, Feng; Jin, Xin; Suresh, Mahi; Jiang, Binhui; Sevagan, Gopinath; Cai, Yun; Li, Guangyao; Yang, King H

    2013-12-01

    A series of computational studies were performed to investigate the response of the lower extremities of mounted soldiers under landmine detonation. A numerical human body model newly developed at Wayne State University was used to simulate two types of experimental studies and the model predictions were validated against test data in terms of the tibia axial force as well as bone fracture pattern. Based on the validated model, the minimum axial force causing tibia facture was found. Then a series of parametric studies was conducted to determine the critical velocity (peak velocity of the floor plate) causing tibia fracture at different upper/lower leg angles. In addition, to limit the load transmission through the vehicular floor, two types of energy absorbing materials, namely IMPAXX(®) foam and aluminum alloy honeycomb, were selected for floor matting. Their performances in terms of blast effect mitigation were compared using the validated numerical model, and it has been found that honeycomb is a more efficient material for blast injury prevention under the loading conditions studied.

  1. Lower extremity muscle activity during deep-water running on self-determined pace.

    PubMed

    Kaneda, Koichi; Wakabayashi, Hitoshi; Sato, Daisuke; Uekusa, Tamotsu; Nomura, Takeo

    2008-12-01

    Although deep-water running (DWR) is often used to obtain the benefits of aerobic fitness and to reduce vertical component stress, its attendant muscle stress remains unclear. The present study investigated lower extremity muscle activity and during DWR compared to that during land walking (LW) and water walking (WW). Surface electromyography was used to evaluate muscle activity in nine healthy adults during each exercise at self-determined slow, moderate, and fast paces. The duration of swing phase, ankle, knee and hip joint angle, and each joint range of motion (ROM) also investigated. Results show that the percentages of maximal voluntary contraction (%MVC) of the soleus and medial gastrocnemius were lower during DWR than during LW or WW in the backward swing phase. The %MVC of the rectus femoris was higher during WW and DWR than during LW; that of the vastus lateralis was lower during WW and DWR than during LW in the forward swing phase. In the biceps femoris, the %MVC was higher during DWR than during LW or WW in the forward and backward swing phase. Every pace showed a similar trend. These results suggest that DWR can stimulate the hip joint flexor or extensor muscles.

  2. Association between Lower Extremity Performance and Health-Related Quality of Life in Elderly Mexican Americans

    PubMed Central

    Bindawas, Saad M.; Al Snih, Soham; Ottenbacher, Allison J.; Graham, James; Protas, Elizabeth E.; Markides, Kyriakos S.; Ottenbacher, Kenneth J.

    2015-01-01

    Objective To examine the longitudinal association between levels of lower extremity performance (LEP) and health-related quality of life (HRQoL) in older Mexican Americans aged 72 years or older participating in the Hispanic Established Population for the Epidemiological Study of the Elderly (2000-2006). Method LEP was measured in 621 non-institutionalized participants with the Short Physical Performance Battery (SPPB). Participants were divided into high (SPPB score 10-12), intermediate (SPPB score 7-9), and low (SPPB score 0-6) groups based on LEP. HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS). Results Participants in the high LEP group had slower rates of decline in the PCS, and those in the intermediate LEP group had slower rates of decline in the MCS score over time. Discussion Increased LEP was associated with slower rates of decline in physical and mental HRQoL in older Mexican Americans. PMID:25804900

  3. Mechanical axis of the lower extremity determined by a new digital photographic method.

    PubMed

    Simonsen, Ole Højgaard; Thomsen, Hanne; Skou, Søren Thorgaard; Andersen, Mikkel Meyer

    2013-08-01

    Assessment of the mechanical axis is routine during the examination of patients with lower extremity pain. Long-leg radiographic examination is the gold standard for exact measurement, but it is associated with a significant radiation dose. An alternative method to examine the mechanical axis has been warranted. This article validates a newly developed computerized photograph method to calculate the mechanical axis using a digital photograph. The location of the center of the femoral head was calculated using ink marks on both superior iliac spines. Twenty-five patients (10 women and 15 men) had both legs examined using the photographic method and long-leg radiography examination. The digital photograph method was found to be highly reliable. The interobserver absolute mean difference was 0.99°±0.85°, and the intraobserver absolute mean difference (day-to-day variation) was 1.04°±0.81°. The mechanical axis determined by the 2 methods was highly correlated (R=0.943). The long-leg radiography method was within an average of ±1.88° of the photographic method, with a 95% probability. The photographic method appears to be an effective alternative to conventional long-leg radiography. The photographic method seems convenient in the routine examination of patients with leg pain and children with suspected axial deformity and for follow-up after treatment for malalignment. Calculation coefficients for children and a possible racial difference remain to be studied.

  4. Outcomes of lengthening short lower-extremity amputation stumps with planar fixators.

    PubMed

    Bowen, Richard E; Struble, Steven G; Setoguchi, Yoshio; Watts, Hugh G

    2005-01-01

    Patients with short lower-extremity amputation stumps exhibit poor prosthetic fit and inefficient gait. Often they are fit at the next-higher prosthetic level, increasing energy consumption. This study aimed to characterize the risk/benefit ratio of stump lengthening with planar external fixators. All patients lengthened for functionally short amputation stumps were reviewed. Outcome measures included changes in prosthetic use, soft tissue problems, qualitative gait analysis, and surgical complications. Patients averaged 15.1 years of age at surgery, with 4.1 years of follow-up. The average lengthening index was 9.2 mm/mo. Femoral lengthenings obtained more length (8.7 vs. 6.9 cm). After treatment, prosthetic skin-related complications decreased and qualitative gait parameters improved. Most (85%) wore a standard prosthesis for their amputation level after surgery, whereas none could before. There were 1.4 complications per patient, all successfully surgically treated. Lengthening is time-consuming and associated with frequent complications but results in improved gait and energy consumption.

  5. MR Angiography of the Lower Extremities with a Moving-Bed Infusion-Tracking Technique

    SciTech Connect

    Klein, W.M.; Schlejen, P.M.; Eikelboom, B.C.; Graaf, Y. van der; Mali, W.P.T.M.

    2003-02-15

    Purpose: To assess the value of MR angiography (MRA) with automatic table movement in a consecutive series of patients with peripheral arterial disease. Methods: Seventy-two patients underwent both conventional angiography (CA) and MRA for peripheral arterial occlusive disease. Both techniques were scored in a masked way. Consensus scoring for CA was compared with MRA scoring per observer. If there was a discrepancy in scoring of asegment on MRA and CA, the images were reviewed and a consensus arrived at. Results: Observer A found 7.4% and observer B found 6.5% of the segments could not be analyzed on MRA. Observer A scored 11.4% dissimilar on MRA and CA, observer B 15.2%. In the aortoiliacarteries, this was mainly caused by stents and overestimation of stenoses; in the crural arteries it resulted from underestimation of the stenoses on MRA. Overall sensitivity and specificity for the aortoiliac, femoropopliteal and crural vessels were respectively 90% and 91%, 90% and 96%, 59% and 96% for observer A, and 85% and 91%, 84% and 89%, 68% and 85% for observer B. Conclusion: Although MRA of the lower extremities is a promising technique, improvements still need to be made. In particular, MRA below the knee is suboptimal for clinical use.

  6. Lower Extremity Joint Angle Tracking with Wireless Ultrasonic Sensors during a Squat Exercise.

    PubMed

    Qi, Yongbin; Soh, Cheong Boon; Gunawan, Erry; Low, Kay-Soon; Thomas, Rijil

    2015-01-01

    This paper presents an unrestrained measurement system based on a wearable wireless ultrasonic sensor network to track the lower extremity joint and trunk kinematics during a squat exercise with only one ultrasonic sensor attached to the trunk. The system consists of an ultrasound transmitter (mobile) and multiple receivers (anchors) whose positions are known. The proposed system measures the horizontal and vertical displacement, together with known joint constraints, to estimate joint flexion/extension angles using an inverse kinematic model based on the damped least-squares technique. The performance of the proposed ultrasonic measurement system was validated against a camera-based tracking system on eight healthy subjects performing a planar squat exercise. Joint angles estimated from the ultrasonic system showed a root mean square error (RMSE) of 2.85° ± 0.57° with the reference system. Statistical analysis indicated great agreements between these two systems with a Pearson's correlation coefficient (PCC) value larger than 0.99 for all joint angles' estimation. These results show that the proposed ultrasonic measurement system is useful for applications, such as rehabilitation and sports. PMID:25915589

  7. Imaging features of soft tissue epithelioid angiosarcoma in the lower extremity: A case report

    PubMed Central

    LV, LULU; XU, PENG; SHI, YIBING; HAO, JINGMING; HU, CHUNAI; ZHAO, BAOZHONG

    2016-01-01

    Epithelioid angiosarcomas are extremely rare malignant tumors formed from endothelial cells. The majority of studies reporting these tumors have been concerned with the clinical and pathological aspects, with limited reporting of radiological diagnosis. The aim of the present study was to provide a reference to improve understanding of diagnosis, treatment choice and prognosis assessment of epithelioid angiosarcoma. The current study reports the case of a 44-year-old woman with epithelioid angiosarcoma located in the deep soft tissue of the lower extremities. Physical examination of the right thigh revealed a palpable hard mass and movement was clearly restricted and painful. X-ray, computed tomography (CT) scans and magnetic resonance imaging (MRI) were used to evaluate the imaging features of the tumor. Using X-ray and CT scanning, an inhomogenous tumor with osteolytic osseous destruction was observed. MRI revealed that the bordering skeletal muscles were infiltrated. The patient was treated with palliative surgery and chemotherapy, but succumbed to disease 1 year later. PMID:27123135

  8. Lower Extremity Joint Angle Tracking with Wireless Ultrasonic Sensors during a Squat Exercise

    PubMed Central

    Qi, Yongbin; Soh, Cheong Boon; Gunawan, Erry; Low, Kay-Soon; Thomas, Rijil

    2015-01-01

    This paper presents an unrestrained measurement system based on a wearable wireless ultrasonic sensor network to track the lower extremity joint and trunk kinematics during a squat exercise with only one ultrasonic sensor attached to the trunk. The system consists of an ultrasound transmitter (mobile) and multiple receivers (anchors) whose positions are known. The proposed system measures the horizontal and vertical displacement, together with known joint constraints, to estimate joint flexion/extension angles using an inverse kinematic model based on the damped least-squares technique. The performance of the proposed ultrasonic measurement system was validated against a camera-based tracking system on eight healthy subjects performing a planar squat exercise. Joint angles estimated from the ultrasonic system showed a root mean square error (RMSE) of 2.85° ± 0.57° with the reference system. Statistical analysis indicated great agreements between these two systems with a Pearson's correlation coefficient (PCC) value larger than 0.99 for all joint angles' estimation. These results show that the proposed ultrasonic measurement system is useful for applications, such as rehabilitation and sports. PMID:25915589

  9. Gender differences in the variability of lower extremity kinematics during treadmill locomotion.

    PubMed

    Barrett, Rod; Noordegraaf, Maarten Vonk; Morrison, Steven

    2008-01-01

    The authors examined whether there were gender differences in the variability of basic gait parameters (stride length, stride time) and 3-dimensional (3D) rotations of the hip, knee, and ankle joints during treadmill locomotion of 18 men and 15 women at 4 different gait speeds (walking at 5 km/hr, running at 8, 10, and 12 km/hr). The authors used 2-way analyses of variance to assess the data. No gender differences in the mean values or variability of basic gait parameters were detected. However, the women exhibited lower variability than did the men for 6 individual joint rotations: (a) transverse plane rotations of the ankle joint at 8, 10, and 12 km/hr, (b) transverse plane rotations of the hip and knee joints at 12 km/hr, and (c) sagittal plane rotations of the ankle joint at 12 km/hr. When collapsed across all 3D lower extremity rotations, the data showed that the women had lower variability than did the men at 12 km/hr. Reduced variability may result in more localized mechanical stress on anatomical structures and could therefore be a risk factor for injury in women at high gait speeds. The results also suggested that gender differences in variability may not be consistent across different levels of the motor system. PMID:18316297

  10. Gender-based analysis of perioperative outcomes associated with lower extremity bypass.

    PubMed

    Jain, Ashish K; Velazquez-Ramirez, Gabriela; Goodney, Philip P; Edwards, Matthew S; Corriere, Matthew A

    2011-07-01

    We analyzed gender-based differences in preoperative factors, procedural characteristics, and 30-day outcomes after lower extremity bypass (LEB). LEB procedures were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File. Groupwise comparisons of preoperative and procedural variables were made using chi square, t tests, and nonparametric methods; gender influences on mortality, systemic, and surgical site complications were evaluated using logistic regression. Women (4,107 of 11,011 [37.3%]) were older and had greater prevalence of hypertension, diabetes, chronic obstructive pulmonary disease, rest pain, dialysis, previous stroke, open/infected wound, and dependent functional status (P < 0.01 for all comparisons). Women more commonly underwent emergent and extra-anatomic procedures but had lower rates of venous conduit or tibial level outflow use. Univariable associations between female gender and risk of 30-day mortality, systemic, and surgical site complications were identified; only the association with surgical site complications remained significant in multivariable modeling (OR, 1.8; 95% CI, 1.6 to 2.1; P < 0.0001). Gender-based differences in demographic, comorbidity, and procedural factors may contribute to disparities in perioperative outcomes associated with LEB. Female gender may be associated with increased risk for surgical site complications, but 30-day mortality and systemic complication rates in women may reflect effects of confounding factors rather than gender-specific influence. PMID:21944345

  11. Lower extremity mechanics of iliotibial band syndrome during an exhaustive run.

    PubMed

    Miller, Ross H; Lowry, Jennifer L; Meardon, Stacey A; Gillette, Jason C

    2007-09-01

    Injury patterns in distance running may be related to kinematic adjustments induced by fatigue. The goal was to measure changes in lower extremity mechanics during an exhaustive run in individuals with and without a history of iliotibial band syndrome (ITBS). Sixteen recreational runners ran to voluntary exhaustion on a treadmill at a self-selected pace. Eight runners had a history of ITBS. Twenty-three reflective marker positions were recorded by an eight-camera 120 Hz motion capture system. Joint angles during stance phase were exported to a musculoskeletal model (SIMM) with the iliotibial band (ITB) modeled as a passive structure to estimate strain in the ITB. For ITBS runners, at the end of the run: (1) knee flexion at heel-strike was higher than control (20.6 degrees versus 15.3 degrees, p=0.01); (2) the number of knees with predicted ITB impingment upon the lateral femoral epicondyle increased from 6 to 11. Strain in the ITB was higher in the ITBS runners throughout all of stance. Maximum foot adduction in the ITBS runners was higher versus control at the start of the run (p=0.003). Maximum foot inversion (p=0.03) and maximum knee internal rotation velocity (p=0.02) were higher versus control at the end of the run. In conclusion, ITB mechanics appear to be related to changes in knee flexion at heel-strike and internal rotation of the leg. These observations may suggest kinematic discriminators for clinical assessment.

  12. The effects of age and type of carrying task on lower extremity kinematics

    PubMed Central

    Gillette, Jason C.; Stevermer, Catherine A.; Miller, Ross H.; Meardon, Stacey A.; Schwab, Charles V.

    2009-01-01

    The purpose of this study was to determine the effects of age, load amount, and load symmetry on lower extremity kinematics during carrying tasks. Forty-two participants in four age groups (8-10 years, 12-14 years, 15-17 years, and adults) carried loads of 0%, 10%, and 20% body weight (BW) in large or small buckets unilaterally and bilaterally. Reflective markers were tracked to determine total joint ROM and maximum joint angles during the stance phase of walking. Maximum hip extension, hip adduction, and hip internal rotation angles were significantly greater for each of the child/adolescent age groups as compared to adults. In addition, maximum hip internal rotation angles significantly increased when carrying a 20% BW load. The observation that the 8-10 year old age group carried the lightest absolute loads and still displayed the highest maximum hip internal rotation angles suggests a particular necessity in setting carrying guidelines for the youngest children. PMID:20191410

  13. Effect of foot orthoses on lower extremity kinetics during running: a systematic literature review

    PubMed Central

    McMillan, Andrew; Payne, Craig

    2008-01-01

    Background Throughout the period of one year, approximately 50% of recreational runners will sustain an injury that disrupts their training regimen. Foot orthoses have been shown to be clinically effective in the prevention and treatment of several running-related conditions, yet the physical effect of this intervention during running remains poorly understood. The aim of this literature review was therefore to evaluate the effect of foot orthoses on lower extremity forces and pressure (kinetics) during running. Methods A systematic search of electronic databases including Medline (1966-present), CINAHL, SportDiscus, and The Cochrane Library occurred on 7 May 2008. Eligible articles were selected according to pre-determined criteria. Methodological quality was evaluated by use of the Quality Index as described by Downs & Black, followed by critical analysis according to outcome variables. Results The most widely reported kinetic outcomes were loading rate and impact force, however the effect of foot orthoses on these variables remains unclear. In contrast, current evidence suggests that a reduction in the rearfoot inversion moment is the most consistent kinetic effect of foot orthoses during running. Conclusion The findings of this review demonstrate systematic effects that may inform the direction of future research, as further evidence is required to define the mechanism of action of foot orthoses during running. Continuation of research in this field will enable targeting of design parameters towards biomechanical variables that are supported by evidence, and may lead to advancements in clinical efficacy. PMID:19014705

  14. Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

    PubMed Central

    Simpson, Brad G; Simon, Corey B

    2014-01-01

    A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain. PMID:24976753

  15. Non traumatic lower extremity amputations in younger patients: an 11-year retrospective study.

    PubMed

    Chin, Jessica W S; Teague, Laura; McLaren, Ann-Marie; Mahoney, James L

    2013-02-01

    The purpose of this study was to assess morbidity and mortality in patients undergoing non traumatic lower extremity amputations ≤65 years to identify the specific needs of these younger patients. A retrospective study was conducted to determine the demographics, comorbidity and mortality with below-knee amputations and above-knee amputations from 1998 to 2008. A total of 203 amputations were performed on 176 patients who were ≤65 years. Major comorbidities and associated physical findings were peripheral vascular disease, diabetes, pain, gangrene, hypertension, ulcer, local wound infection and hypercholesterolemia. Compared to patients who were not deceased post-amputation, those deceased had a higher prevalence of diabetes, renal failure, coronary artery disease (CAD) and sepsis. Significant predictors of mortality were renal failure (hazard ratio [HR] = 4·19; 95% CI 1·96-8·93), CAD (HR = 3·33; 95% CI 1·42-7·81) and amputation site (above-knee) (HR = 3·26; 95% CI 1·51-7·04). This study showed that younger patients may benefit from an interdisciplinary approach in treating local foot ulcers aggressively and optimising their cardiovascular, renal and diabetic risk factors.

  16. Perioperative complications of orthopedic surgery for lower extremity in patients with cerebral palsy.

    PubMed

    Lee, Seung Yeol; Sohn, Hye-Min; Chung, Chin Youb; Do, Sang-Hwan; Lee, Kyoung Min; Kwon, Soon-Sun; Sung, Ki Hyuk; Lee, Sun Hyung; Park, Moon Seok

    2015-04-01

    Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

  17. A real-time fatigue monitoring and analysis system for lower extremity muscles with cycling movement.

    PubMed

    Chen, Szi-Wen; Liaw, Jiunn-Woei; Chan, Hsiao-Lung; Chang, Ya-Ju; Ku, Chia-Hao

    2014-01-01

    A real-time muscle fatigue monitoring system was developed to quantitatively detect the muscle fatigue of subjects during cycling movement, where a fatigue progression measure (FPM) was built-in. During the cycling movement, the electromyogram (EMG) signals of the vastus lateralis and gastrocnemius muscles in one leg as well as cycling speed are synchronously measured in a real-time fashion. In addition, the heart rate (HR) and the Borg rating of perceived exertion scale value are recorded per minute. Using the EMG signals, the electrical activity and median frequency (MF) are calculated per cycle. Moreover, the updated FPM, based on the percentage of reduced MF counts during cycling movement, is calculated to measure the onset time and the progressive process of muscle fatigue. To demonstrate the performance of our system, five young healthy subjects were recruited. Each subject was asked to maintain a fixed speed of 60 RPM, as best he/she could, under a constant load during the pedaling. When the speed reached 20 RPM or the HR reached the maximal training HR, the experiment was then terminated immediately. The experimental results show that the proposed system may provide an on-line fatigue monitoring and analysis for the lower extremity muscles during cycling movement. PMID:25014101

  18. Precision and accuracy of 3D lower extremity residua measurement systems

    NASA Astrophysics Data System (ADS)

    Commean, Paul K.; Smith, Kirk E.; Vannier, Michael W.; Hildebolt, Charles F.; Pilgram, Thomas K.

    1996-04-01

    Accurate and reproducible geometric measurement of lower extremity residua is required for custom prosthetic socket design. We compared spiral x-ray computed tomography (SXCT) and 3D optical surface scanning (OSS) with caliper measurements and evaluated the precision and accuracy of each system. Spiral volumetric CT scanned surface and subsurface information was used to make external and internal measurements, and finite element models (FEMs). SXCT and OSS were used to measure lower limb residuum geometry of 13 below knee (BK) adult amputees. Six markers were placed on each subject's BK residuum and corresponding plaster casts and distance measurements were taken to determine precision and accuracy for each system. Solid models were created from spiral CT scan data sets with the prosthesis in situ under different loads using p-version finite element analysis (FEA). Tissue properties of the residuum were estimated iteratively and compared with values taken from the biomechanics literature. The OSS and SXCT measurements were precise within 1% in vivo and 0.5% on plaster casts, and accuracy was within 3.5% in vivo and 1% on plaster casts compared with caliper measures. Three-dimensional optical surface and SXCT imaging systems are feasible for capturing the comprehensive 3D surface geometry of BK residua, and provide distance measurements statistically equivalent to calipers. In addition, SXCT can readily distinguish internal soft tissue and bony structure of the residuum. FEM can be applied to determine tissue material properties interactively using inverse methods.

  19. Lower extremity static and dynamic relationships with rearfoot motion in gait.

    PubMed

    Knutzen, K M; Price, A

    1994-04-01

    Twenty nonsymptomatic subjects were assessed while walking at a photoelectronically monitored place (2 +/- 0.1 m.s-1) using high speed cinematography (200 Hz) to record the rearfoot motion in the frontal plane, and electrogoniometry (100 Hz) to measure joint kinematics in the lower extremity. The foot type of the subjects was determined statically by using a podiascope and digitization techniques. The results demonstrated that no foot type variables contributed significantly to the variance in either rearfoot angle at foot strike or maximum rearfoot angle (p > 0.05). Regression equations were developed using kinematic variables: rearfoot angle at foot strike = 3.81 + (0.06*time to hip internal rotation) - (0.46*tibia internal rotation) + (0.14*plantarflexion); (R = 0.87, SE = 1.23 degrees); maximum rearfoot angle = 4.02 + (0.52*hip internal rotation) - (0.11*time to hip internal rotation); (R = 0.66, SE = 2.07 degrees). This study identifies hip joint movements as being the most significant contributors to prediction of rearfoot angles produced during walking. PMID:8201551

  20. Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly

    PubMed Central

    Sloan, Frank A; Feinglos, Mark N; Grossman, Daniel S

    2010-01-01

    Objective To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)-related lower extremity amputation. Data Sources Medicare 5 percent sample claims, 1991–2007. Study Design Individuals with DM-related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation. Data Collection Individuals were stratified based on disease severity, Stage 1—neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2—cellutis, charcot foot; Stage 3—ulcer; Stage 4—osteomyelitis, gangrene. Principal Findings Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals. Conclusions Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care. PMID:20722748

  1. Lower Extremity Strength and Active Range of Motion in College Baseball Pitchers: A Comparison between Stance Leg and Kick Leg.

    PubMed

    Tippett, S R

    1986-01-01

    The role of the lower extremities and torso is vital in the pitching mechanism. However, a review of the literature reveals information primarily dealing with the upper extremity's role in throwing. This pilot study was conducted to: 1) determine selected lower extremity strength and range of motion measurements in sixteen college baseball pitchers, and 2) compare measurements in the stance leg to the kick leg. When preseason profiling is not possible, clinical norms for those treating college pitchers can be valuable in proper rehabilitation of the lower extremity. Also, by determining trends in lower extremity strength and motion when comparing kick (plant) leg to stance (drive) leg, a better understanding of lower extremity kinematics in the pitching act can be appreciated. Statistically significant differences were found in the active range of motion in plantarflexion, hip internal rotation, and hip extension of the stance leg, as well as hip flexion of the kick leg. lsokinetic evaluations at slow and fast speeds revealed significant differences in the strength of ankle dorsiflexors and hip flexors at slow speeds of the kick leg. Strength of the hamstrings on the kick leg was significant at fast speeds as was strength of the hip external rotators on the stance leg. J Orthop Sports Phys Ther 1986;8(1):10-14.

  2. Tissue mass ratios and the reporting of distal lower extremity injuries in varsity athletes at a Canadian University.

    PubMed

    Burkhart, Timothy A; Schinkel-Ivy, Alison; Andrews, David M

    2013-01-01

    The purpose of this preliminary investigation was to determine the relative role of the distal lower extremity tissue masses of varsity athletes in predicting distal lower extremity injury sustained during a competitive season. One hundred male and female varsity athletes (basketball, volleyball, soccer, cross country) completed a questionnaire on general health, physiological, and psychosocial variables, during each sport's respective training camp. A series of anthropometric measurements were used as inputs to distal lower extremity tissue mass prediction equations to calculate lean mass, fat mass, bone mineral content and wobbling mass (lean mass + fat mass) and tissue mass ratios. Athletes were monitored throughout their respective seasons and were instructed to report any distal lower extremity injuries to a certified athletic therapist who was responsible for assessing and confirming the reports. Logistic regression analyses were performed to determine which variables significantly predicted distal lower extremity injury. Mean leg fat mass:bone mass (OR = 1.6, CI = 1.0 - 2.5), and competition surface (rubber OR = 8.5, CI = 1.5 - 47.7; artificial turf OR = 4.0, CI = 0.77 - 22.9) were identified as significant predictors of injury. Overall, tibia bone injuries were significantly associated with the ratio of fat mass:bone mineral content and the surface on which the athletes compete.

  3. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot.

    PubMed

    Rubio, José Antonio; Aragón-Sánchez, Javier; Jiménez, Sara; Guadalix, Gregorio; Albarracín, Agustín; Salido, Carmen; Sanz-Moreno, José; Ruiz-Grande, Fernando; Gil-Fournier, Nuria; Álvarez, Julia

    2014-03-01

    We analyzed the incidence of lower extremity amputations (LEAs) in the 3rd Health Care Area of Madrid before and after the March 2008 introduction of a multidisciplinary team for managing diabetic foot disease. We compared the amputation rates in people with and without diabetes during 2 periods: before (2001-2007) and after (2008-2011) the introduction of a Multidisciplinary Diabetic Foot Unit (MDFU). We also analyzed the trend of the amputation rates by joinpoint regression analysis and measured the annual percentage change (APC). During the study period, 514 nontraumatic LEAs were performed, 374 (73%) in people with diabetes and 140 (27%) in people without the disease. The incidence of LEAs showed a significant reduction in major amputations in people with diabetes, from 6.1 per 100 000 per year (95% confidence interval [CI] = 4.9 to 7.2), in the 2001 to 2007 period, to 4.0 per 100 000 per year (95% CI = 2.6 to 5.5) in the 2008 to 2011 period (P = .020). There were no changes in incidence of minor or total amputations in the diabetic population or in amputations in the nondiabetic population during the study period. Joinpoint regression analysis showed a significant reduction in the incidence of major LEAs in diabetic population with an APC of -6.6% (95% CI = -10.2 to -2.8; P = .003), but there were no other significant changes. This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the incidence of major amputations in patients with diabetes.

  4. Lower Extremity Kinematic Profile of Gait of Patients After Ankle Fracture: A Case-Control Study.

    PubMed

    Elbaz, Avi; Mor, Amit; Segal, Ganit; Bar, Dana; Monda, Maureen K; Kish, Benjamin; Nyska, Meir; Palmanovich, Ezequiel

    2016-01-01

    The present study examined the differences in the lower extremity gait kinematic profile of patients recovering from ankle fracture compared with healthy controls. In addition, we inquired whether the profile would differ among fracture severity groups. A total of 48 patients participated in the present prospective, case-control study. The gait of 24 patients recovering from an ankle fracture injury and 24 healthy matched controls was examined using an inertial measurement unit sensor system. The following gait parameters were evaluated: knee range of motion (ROM) during the swing phase, maximum knee flexion angle during stance, thigh and calf ROM, and stride duration. Statistically significant differences were found between the ankle fracture group and the control group for all parameters. The patients with ankle fracture had a lower knee ROM during swing phase compared with the control group (mean ± standard deviation 43.0° ± 15.5° compared with 66.7° ± 5.1°, respectively; p < .001). The maximum knee flexion angle during stance was lower in the patients with ankle fracture than in the control group (mean ± standard deviation 10.5° ± 6.1° compared with 21.2° ± 4.5°, respectively; p < .001). Patients with ankle fracture also had lower gait cycle thigh and calf ROM angles (p < .001) and a longer stride duration (p < .001) compared with the control group. No statistically significant differences were found among the severity groups. These results suggest that the gait kinematic characteristics vary between healthy people and patients recovering from an ankle fracture injury during the short-term period after injury. PMID:27267411

  5. Gender differences of lower extremity amputation risk in patients with diabetic foot: a meta-analysis.

    PubMed

    Tang, Zhu-Qi; Chen, Hong-Lin; Zhao, Fang-Fang

    2014-09-01

    In this meta-analysis, we aim to evaluate gender differences of lower extremity amputation risk in patients with diabetic foot. Systematic computerized searches of PubMed and Web of Knowledge were performed. The pooled odds ratio (OR) and 95% confidence interval (CI) for amputation risk were calculated. Twenty studies with 15 385 case (present amputation) and 438 760 control (absent amputation) patients were included in the meta-analysis. The pooled crude OR was 1.676 (95% CI 1.307-2.149; Z = 4.07, P = .000). In the retrospective study subgroup, the pooled OR was 1.708 (95% CI = 1.235-2.363; Z = 3.24, P = .001); in the prospective study subgroup, the pooled OR was 1.478 (95% CI = 1.189-1.838; Z = 3.51, P = .000). The pooled adjusted OR was 1.439 (95% CI = 1.238-1.671; Z = 4.76, P = .000). In retrospective study subgroup, the pooled OR was 1.440 (95% CI = 1.208-1.717; Z = 4.07, P = .000); in prospective study subgroup, the pooled OR was 1.478 (95% CI = 1.080-2.024; Z = 2.44, P = .015). No significant publication bias was found. Sensitivity analyses by omitting a heterogeneity study showed the results were robust. In conclusion, our meta-analysis indicates that men with diabetic foot have about one half increased amputation risk than women with diabetic foot. Men with diabetes should receive more complete follow-up and more adequate health education.

  6. Simultaneous Magnetic Resonance Angiography and Perfusion (MRAP) Measurement: Initial Application in Lower Extremity Skeletal Muscle

    PubMed Central

    Wright, Katherine L.; Seiberlich, Nicole; Jesberger, John A.; Nakamoto, Dean A.; Muzic, Raymond F.; Griswold, Mark A.; Gulani, Vikas

    2012-01-01

    Purpose To obtain a simultaneous 3D MR Angiography and Perfusion (MRAP) using a single acquisition, and to demonstrate MRAP in the lower extremities. A time-resolved contrast-enhanced exam is utilized in MRAP to simultaneously acquire a contrast-enhanced MR angiography (MRA) and dynamic contrast-enhanced (DCE) perfusion, which currently requires separate acquisitions and thus two contrast doses. MRAP can be used to assess large and small vessels in vascular pathologies such as peripheral arterial disease. Materials and Methods MRAP was performed on ten volunteers following unilateral plantar flexion exercise (one leg exercised and one rested) on two separate days. Data were acquired after administration of a single dose of contrast agent using an optimized sampling strategy, parallel imaging, and partial-Fourier acquisition to obtain a high spatial resolution, 3D-MRAP frame every four seconds. Two radiologists assessed MRAs for image quality, a signal-to-noise ratio (SNR) analysis was performed, and pharmacokinetic modeling yielded perfusion (Ktrans). Results MRA images had high SNR and radiologist-assessed diagnostic quality. Mean Ktrans±standard error were 0.136±0.009, 0.146±0.012, and 0.191±0.012 min−1 in the resting tibialis anterior, gastrocnemius, and soleus, respectively, which significantly increased with exercise to 0.291±0.018, 0.270±0.019, and 0.338±0.022 min−1. Bland-Altman analysis showed good repeatability. Conclusion MRAP provides simultaneous high-resolution MRA and quantitative DCE exams to assess large and small vessels with a single contrast dose. Application in skeletal muscle shows quantitative, repeatable perfusion measurements, and the ability to measure physiological differences. PMID:23389970

  7. Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis

    PubMed Central

    Shi, Wan-Yin; Wang, Li-Wei; Wang, Shao-Juan; Yin, Xin-Dao; Gu, Jian-Ping

    2016-01-01

    Abstract This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT). The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations. Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram. Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system. PMID:26986113

  8. Spectral Clustering for Unsupervised Segmentation of Lower Extremity Wound Beds Using Optical Images.

    PubMed

    Dhane, Dhiraj Manohar; Krishna, Vishal; Achar, Arun; Bar, Chittaranjan; Sanyal, Kunal; Chakraborty, Chandan

    2016-09-01

    Chronic lower extremity wound is a complicated disease condition of localized injury to skin and its tissues which have plagued many elders worldwide. The ulcer assessment and management is expensive and is burden on health establishment. Currently accurate wound evaluation remains a tedious task as it rely on visual inspection. This paper propose a new method for wound-area detection, using images digitally captured by a hand-held, optical camera. The strategy proposed involves spectral approach for clustering, based on the affinity matrix. The spectral clustering (SC) involves construction of similarity matrix of Laplacian based on Ng-Jorden-Weiss algorithm. Starting with a quadratic method, wound photographs were pre-processed for color homogenization. The first-order statistics filter was then applied to extract spurious regions. The filter was selected based on the performance, evaluated on four quality metrics. Then, the spectral method was used on the filtered images for effective segmentation. The segmented regions were post-processed using morphological operators. The performance of spectral segmentation was confirmed by ground-truth pictures labeled by dermatologists. The SC results were additionally compared with the results of k-means and Fuzzy C-Means (FCM) clustering algorithms. The SC approach on a set of 105 images, effectively delineated targeted wound beds yielding a segmentation accuracy of 86.73 %, positive predictive values of 91.80 %, and a sensitivity of 89.54 %. This approach shows the robustness of tool for ulcer perimeter measurement and healing progression. The article elucidates its potential to be incorporated in patient facing medical systems targeting a rapid clinical assistance. PMID:27520612

  9. Muscle activation patterns of the upper and lower extremity during the windmill softball pitch.

    PubMed

    Oliver, Gretchen D; Plummer, Hillary A; Keeley, David W

    2011-06-01

    Fast-pitch softball has become an increasingly popular sport for female athletes. There has been little research examining the windmill softball pitch in the literature. The purpose of this study was to describe the muscle activation patterns of 3 upper extremity muscles (biceps, triceps, and rhomboids [scapular stabilizers]) and 2 lower extremity muscles (gluteus maximus and medius) during the 5 phases of the windmill softball pitch. Data describing muscle activation were collected on 7 postpubescent softball pitchers (age 17.7 ± 2.6 years; height 169 ± 5.4 cm; mass 69.1 ± 5.4 kg). Surface electromyographic data were collected using a Myopac Jr 10-channel amplifier (RUN Technologies Scientific Systems, Laguna Hills, CA, USA) synchronized with The MotionMonitor™ motion capture system (Innovative Sports Training Inc, Chicago IL, USA) and presented as a percent of maximum voluntary isometric contraction. Gluteus maximus activity reached (196.3% maximum voluntary isometric contraction [MVIC]), whereas gluteus medius activity was consistent during the single leg support of phase 3 (101.2% MVIC). Biceps brachii activity was greatest during phase 4 of the pitching motion. Triceps brachii activation was consistently >150% MVIC throughout the entire pitching motion, whereas the scapular stabilizers were most active during phase 2 (170.1% MVIC). The results of this study indicate the extent to which muscles are activated during the windmill softball pitch, and this knowledge can lead to the development of proper preventative and rehabilitative muscle strengthening programs. In addition, clinicians will be able to incorporate strengthening exercises that mimic the timing of maximal muscle activation most used during the windmill pitching phases.

  10. Temperature Changes in Deep Muscles of Humans During Upper and Lower Extremity Exercise

    PubMed Central

    Wirth, Valerie J.; Van Lunen, Bonnie L.; Mistry, Dilaawar; Saliba, Ethan; McCue, Frank C.

    1998-01-01

    Objective: To examine the effect of 15 minutes of upper and lower extremity exercise on raising intramuscular temperature in the triceps surae to 39 ° C to 45 ° C (the therapeutic range). Design and Setting: Intramuscular temperature was measured 5 cm deep in the triceps surae using a 23-gauge thermistor needle microprobe connected to a monitor. Each subject was tested under 3 conditions: 15 minutes of rest, 15 minutes of jogging on a treadmill, and 15 minutes of handpedaling an upper-body ergometer. Exercise bouts were performed at 70% of each subject's maximum heart rate. Subjects: Six males, either sedentary or recreational athletes (age = 21.3 ± 2.9 years; ht = 176.8 ± 6.0 cm; wt = 72.7 ± 11.6 kg; resting heart rate = 57.8 ± 6.74 bpm; target heart rate = 156.5 ± 3.0 bpm), volunteered to participate in this experiment. Measurements: Intramuscular temperature was measured at a depth of 5 cm before and after each test condition. Results: Data analyses consisted of analyses of variance with repeated measures and a Tukey post hoc test (P < .05). The results showed a significant temperature increase over baseline after exercise on the treadmill (2.2 ° C ± 0.63 ° C); however, it did not yield temperature increases ≥ 39 ° C. No significant temperature change occurred after exercise on the upper-body ergometer (-0.45 ° C ± 0.80 ° C). Conclusions: Active exercise increased intramuscular temperature in working muscles but did not affect intramuscular temperature in nonworking muscles. In addition, 15 minutes of jogging on a treadmill at 70% of maximum heart rate was not sufficient to raise intramuscular temperature to 39 ° C to 45 ° C. ImagesFigure 1.Figure 2. PMID:16558512

  11. Deep Vein Thrombosis in the Lower Extremities in Comatose Elderly Patients with Acute Neurological Diseases

    PubMed Central

    Tomita, Yusuke; Murakami, Hideki; Nakane, Makoto

    2016-01-01

    Purpose Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients. Materials and Methods Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was ≤11 and who was older than ≥60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed. Results DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis. Conclusion Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding. PMID:26847291

  12. Lower extremity neuromuscular recovery following anterior cruciate ligament reconstruction; a 2-week case study.

    PubMed

    Nyland, J; Cook, C; Keen, J; Caborn, David N M

    2003-01-01

    The lower extremity neuromuscular recovery of a 31-year-old male physical therapy student during the initial 2-weeks following anterior cruciate ligament reconstruction was evaluated by measuring involved side vastus medialis (VM), gluteus maximus (GMAX) and gastrocnemius (GASTROC) electromyographic (EMG) signals (1000 Hz), plantar forces (50 Hz), and knee pain as the subject performed a series of volitional, maximal effort unilateral, isometric leg presses (6 sec) in a modified continuous passive motion device. Data were standardized to pre-operative values and graphically plotted for split middle technique, celeration line assessment. From 1-8 hours post-surgery, EMG amplitudes and plantar forces decreased, pain increased, and plantar force location shifted toward the forefoot. From 9-12 hours post-surgery, EMG amplitudes and plantar forces increased and pain decreased. By 24 hours post-surgery, pain decreased to pre-operative levels. From 24-72 hours post-surgery, EMG amplitudes and plantar forces increased. From 1-2 weeks post-surgery, EMG amplitudes and plantar forces increased. From 9 hours-2 weeks post-surgery, plantar force location shifted toward the pre-operative location. Sequential increases were observed for GMAX, GASTROC, and VM EMG amplitudes. By 2 weeks post-surgery, plantar forces and VM EMG amplitudes remained reduced. Reduced plantar forces and VM EMG amplitude at 2 weeks post-surgery suggest a need for greater focus on restoring VM function before attempting closed kinetic chain exercises that require the full shock absorption capabilities of the quadriceps femoris muscle group.

  13. Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis.

    PubMed

    Shi, Wan-Yin; Wang, Li-Wei; Wang, Shao-Juan; Yin, Xin-Dao; Gu, Jian-Ping

    2016-03-01

    This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT). The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations. Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram. Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system.

  14. Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis.

    PubMed

    Shi, Wan-Yin; Wang, Li-Wei; Wang, Shao-Juan; Yin, Xin-Dao; Gu, Jian-Ping

    2016-03-01

    This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT). The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations. Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram. Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system. PMID:26986113

  15. Lower extremity peak force and gait kinematics in individuals with inclusion body myositis

    PubMed Central

    Davenport, Todd E.; Benson, Kimberly; Baker, Stephanie; Gracey, Christopher; Rakocevic, Goran; McElroy, Beverly; Dalakas, Marinos; Shrader, Joseph A.; Harris-Love, Michael O.

    2015-01-01

    Objective To determine the relationship between peak isometric muscle force and temporal characteristics of gait in individuals with sporadic inclusion body myositis (s-IBM). Patients and Methods An observational study of 42 individuals with s-IBM (12 female; age: 61.6 ±7.3 years [mean ±standard deviation]; disease duration 8.9 ±4.3 years) was conducted at a Federal hospital. Peak isometric force measurements for lower extremity (LE) muscle groups were obtained using quantitative muscle testing. Temporal characteristics of gait during habitual and fast walking conditions were measured using a portable gait analysis system. Results All observed muscle force values were significantly lower than predicted values (p <.001). During habitual walking, subjects’ gait speed and cadence were < 83% of normative literature values. During the fast walking, total gait cycle time was 133% of normal, while gait speed and cadence were 58% and 78%, respectively, of normative literature values. Scaled LE peak muscle forces showed significant moderate correlations with the temporal gait variables. Weaker subjects demonstrated greater limitations in gait speed and cadence compared to stronger subjects (p <.05). Peak isometric force of the knee flexors and ankle plantar flexors, but not knee extensors, were significantly correlated with most temporal features of habitual gait. Conclusions Muscle weakness associated with s-IBM disease activity may contribute to diminished gait kinematics. Temporal features of gait are not substantially influenced by knee extensor weakness alone, as the knee flexors and ankle plantar flexors play a compensatory role in maintaining the walking ability of individuals with s-IBM. PMID:25201017

  16. Trends in diabetes-related lower extremities amputations in Romania-A five year nationwide evaluation.

    PubMed

    Veresiu, Ioan Andrei; Iancu, Silvia Stefania; Bondor, Cosmina

    2015-08-01

    The aim of the study was to perform a nationwide evaluation of the frequency, incidence and trends of diabetes-related LEA (lower extremities amputations) in Romania. We have retrospectively analysed DRG data (ICD 10 AM codes) from all hospitals in the country, over a 5 year period (2006-2010). Knowing the shortcomings of this approach, we have assumed that our study can serve as a platform for future comparisons. The total number of non-traumatic diabetes related LEA procedures was 24,312, they were performed in 16,873 patients with diabetes, 22.55% with type 1 diabetes, 70.26 with type 2 diabetes and 7.19% with non-specified diabetes at discharge. The total number of hospital admissions for these patients was 46,985. During the five years of the study there was an increase in the absolute number of major amputations (above the ankle), as well as of minor amputations. The rate of amputations decreased in type 1 diabetes, from baseline (2006): -8.15% in 2007, -25.83% in 2008, -23.43% in 2009, -27.71% in 2010, whereas it increased in type 2 diabetes in the respective years: 16.96%, 60.75%, 66.91%, and 104.64%, due to an increase in minor amputations and mainly in elderly people. Male: female amputations rate was 2:1 in type 1 diabetes patients and 2.4:1 in type 2 diabetes patients. This study, the first of its kind in the Romanian population, offers a starting point for future comparisons and identifies a target for preventive measures.

  17. Effect of landing stiffness on joint kinetics and energetics in the lower extremity.

    PubMed

    Devita, P; Skelly, W A

    1992-01-01

    Ground reaction forces (GRF), joint positions, joint moments, and muscle powers in the lower extremity were compared between soft and stiff landings from a vertical fall of 59 cm. Soft and stiff landings had less than and greater than 90 degrees of knee flexion after floor contact. Ten trials of sagittal plane film and GRF data, sampled at 100 and 1000 Hz, were obtained from each of eight female athletes and two landing conditions. Inverse dynamics were performed on these data to obtain the moments and powers during descent (free fall) and floor contact phases. Angular impulse and work values were calculated from these curves, and the conditions were compared with a correlated t-test. Soft and stiff landings averaged 117 and 77 degrees of knee flexion. Larger hip extensor (0.010 vs 0.019 N.m.s.kg-1; P less than 0.01) and knee flexor (-0.010 vs -0.013 N.m.s.kg-1; P less than 0.01) moments were observed during descent in the stiff landing, which produced a more erect body posture and a flexed knee position at impact. The shapes of the GRF, moment, and power curves were identical between landings. The stiff landing had larger GRFs, but only the ankle plantarflexors produced a larger moment (0.185 vs 0.232 N.m.s.kg-1; P less than 0.01) in this condition. The hip and knee muscles absorbed more energy in the soft landing (hip, -0.60 vs -0.39 W.kg-1; P less than 0.01; knee, -0.89 vs -0.61 W.kg-1; P less than 0.01), while the ankle muscles absorbed more in the stiff landing (-0.88 vs -1.00 W.kg-1; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes.

    PubMed

    Myer, Gregory D; Ford, Kevin R; Palumbo, Joseph P; Hewett, Timothy E

    2005-02-01

    The purpose of this study was to examine the effects of a comprehensive neuromuscular training program on measures of performance and lower-extremity movement biomechanics in female athletes. The hypothesis was that significant improvements in measures of performance would be demonstrated concomitant with improved biomechanical measures related to anterior cruciate ligament injury risk. Forty-one female basketball, soccer, and volleyball players (age, 15.3 +/- 0.9 years; weight, 64.8 +/- 9.96 kg; height, 171.2 +/- 7.21 cm) underwent 6 weeks of training that included 4 main components (plyometric and movement, core strengthening and balance, resistance training, and speed training). Twelve age-, height-, and weight-matched controls underwent the same testing protocol twice 6 weeks apart. Trained athletes demonstrated increased predicted 1 repetition maximum squat (92%) and bench press (20%). Right and left single-leg hop distance increased 10.39 cm and 8.53 cm, respectively, and vertical jump also increased from 39.9 +/- 0.9 cm to 43.2 +/- 1.1 cm with training. Speed in a 9.1-m sprint improved from 1.80 +/- 0.02 seconds to 1.73 +/- 0.01 seconds. Pre- and posttest 3-dimensional motion analysis demonstrated increased knee flexion-extension range of motion during the landing phase of a vertical jump (right, 71.9 +/- 1.4 degrees to 76.9 +/- 1.4 degrees ; left, 71.3 +/- 1.5 degrees to 77.3 +/- 1.4 degrees ). Training decreased knee valgus (28%) and varus (38%) torques. Control subjects did not demonstrate significant alterations during the 6-week interval. The results of this study support the hypothesis that the combination of multiple-injury prevention-training components into a comprehensive program improves measures of performance and movement biomechanics.

  19. Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC).

    PubMed

    Patel, Manesh R; Conte, Michael S; Cutlip, Donald E; Dib, Nabil; Geraghty, Patrick; Gray, William; Hiatt, William R; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R; Jones, W Schuyler; Kawahara, Masayuki; Lookstein, Robert A; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W; Povsic, Thomas J; Rosenfield, Kenneth; Rundback, John; Shamoun, Fadi; Tcheng, James; Tsai, Thomas T; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N; White, Christopher J; Yokoi, Hiroyoshi; Krucoff, Mitchell W

    2015-03-10

    The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease.

  20. Psychometric Properties of the Lower Extremity Subscale of the Fugl-Myer Assessment for Community-dwelling Hemiplegic Stroke Patients.

    PubMed

    Park, Eun Young; Choi, Yoo Im

    2014-11-01

    [Purpose] The purpose of this study was to investigate the psychometric properties of the lower extremity subscale of the Fugl-Meyer Assessment lower extremity (FMA-LE) for community-dwelling hemiplegic stroke patients. [Subjects] The participants were 140 community-dwelling hemiplegic stroke patients. [Methods] To determine the psychometric properties of the FMA-LE, we examined construct validity, response characteristics, item discrimination, and internal consistency. [Results] Factor analysis of the FMA-LE revealed that the first factor explained 61.73% of the variance and provided evidence of unidimensionality. The FMA-LE did not show ceiling or floor effects; Cronbach's α was 0.935 (95% CI: 0.919-0.950). [Conclusion] Because the FMA-LE seems to be both valid and reliable, we conclude that it is appropriate for the measurement of the lower extremity motor impairment of community-dwelling hemiplegic stroke patients.

  1. A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high?

    PubMed

    Nelson, Jonas A; Fischer, John P; Brazio, Philip S; Kovach, Stephen J; Rosson, Gedge D; Rad, Ariel N

    2013-10-01

    Soft tissue coverage in the distal lower extremity remains a significant challenge. While free flaps are often utilized for larger defects, local perforator-based propeller flaps may be ideal for smaller wounds requiring coverage. Propeller flaps can provide excellent form and function for both traumatic and atraumatic defects with minimal donor site morbidity but can have concerning rates of flap loss. We reviewed the literature, identifying 21 studies presenting 310 propeller flaps for distal lower extremity reconstruction. Total flap necrosis was noted in 5.5% of flaps, with partial necrosis in 11.6%. While these flaps do enable transfer of local, healthy tissue to the defect site without the need for a microsurgical anastomosis, this rate of flap loss is concerning and appropriate patient selection is crucial. This review provides a brief history and overview of the clinical application and research into distal lower extremity perforator propeller flaps to place this technique into a clinical context.

  2. The Role of Limb Torque, Muscle Action and Proprioception During Closed Kinetic Chain Rehabilitation of The Lower Extremity

    PubMed Central

    Bunton, Edwin E.; Pitney, William A.; Cappaert, Thomas A.; Kane, Alexander W.

    1993-01-01

    This paper defines the differences between open and closed kinetic chain exercise and explains the role of limb torque, muscle action, and proprioception during rehabilitation of the lower extremity. Closed kinetic chain rehabilitation is shown to decrease shear forces, increase proprioception, and increase muscle group coordination through examples of progressive exercises. The authors conclude that closed kinetic chain rehabilitation is an economical, efficient, and effective means of rehabilitation, with the ultimate goal of enhancing proprioception, thus gaining lower extremity joint stability. ImagesFig 9a-b.Fig 1.Fig 2.Fig 3a-b.Fig 4a-b.Fig 5.Fig 6.Fig 7.Fig 8. PMID:16558197

  3. Lower Extremity Biomechanical Relationships with Different Speeds in Traditional, Minimalist, and Barefoot Footwear

    PubMed Central

    Fredericks, William; Swank, Seth; Teisberg, Madeline; Hampton, Bethany; Ridpath, Lance; Hanna, Jandy B.

    2015-01-01

    Minimalist running footwear has grown increasingly popular. Prior studies that have compared lower extremity biomechanics in minimalist running to traditional running conditions are largely limited to a single running velocity. This study compares the effects of running at various speeds on foot strike pattern, stride length, knee angles and ankle angles in traditional, barefoot, and minimalist running conditions. Twenty-six recreational runners (19-46 years of age) ran on a treadmill at a range of speeds (2.5-4.0 m·sec-1). Subjects ran with four different footwear conditions: personal, standard, and minimalist shoes and barefoot. 3D coordinates from video data were collected. The relationships between speed, knee and ankle angles at foot strike and toe-off, relative step length, and footwear conditions were evaluated by ANCOVA, with speed as the co-variate. Distribution of non-rearfoot strike was compared across shod conditions with paired t-tests. Non-rearfoot strike distribution was not significantly affected by speed, but was different between shod conditions (p < 0.05). Footwear condition and speed significantly affected ankle angle at touchdown, independent of one another (F [3,71] = 10.28, p < 0.001), with barefoot and minimalist running exhibiting greater plantarflexion at foot strike. When controlling for foot strike style, barefoot and minimalist runners exhibited greater plantarflexion than other conditions (p < 0.05). Ankle angle at lift-off and relative step length exhibited a significant interaction between speed and shod condition. Knee angles had a significant relationship with speed, but not with footwear. There is a clear influence of footwear, but not speed, on foot strike pattern. Additionally, speed and footwear predict ankle angles (greater plantarflexion at foot strike) and may have implications for minimalist runners and their risk of injury. Long-term studies utilizing various speeds and habituation times are needed. Key points Foot strike

  4. LOWER EXTREMITY HYPERMOBILITY, BUT NOT CORE MUSCLE ENDURANCE INFLUENCES BALANCE IN FEMALE COLLEGIATE DANCERS

    PubMed Central

    Cortes, Nelson; Caswell, Shane V.; Ambegaonkar, Gautam P.; Wyon, Matthew

    2016-01-01

    Background Dance is a physically demanding activity, with almost 70% of all injuries in dancers occurring in the lower extremity (LE). Prior researchers report that muscle function (e.g. muscle endurance) and anatomical factors (e.g. hypermobility) affect physical performance (e.g. balance) and can subsequently influence LE injury risk. Specifically, lesser core muscle endurance, balance deficits, and greater hypermobility are related to increased LE injury risk. However, the potentials interrelationships among these factors in dancers remain unclear. Purpose The purposes of this study were to examine the relationships among core muscle endurance, balance, and LE hypermobility, and determine the relative contributions of core muscle endurance and LE hypermobility as predictors of balance in female collegiate dancers. Study Design Cross-sectional Methods Core muscle endurance was evaluated using the combined average anterior, left, and right lateral plank test time scores(s). LE hypermobility was measured using the LE-specific Beighton hypermobility measure, defining hypermobility if both legs had greater than 10 ° knee hyperextension. Balance was measured via the composite anterior, posterolateral, and posteromedial Star Excursion Balance Test (SEBT) reach distances (normalized to leg length) in 15 female healthy collegiate dancers (18.3 + 0.5yrs, 165.5 + 6.9cm, 63.7 + 12.1kg). Point-biserial-correlation-coefficients examined relationships and a linear regression examined whether core endurance and hypermobility predicted balance (p<.05). Results LE hypermobility (Yes; n = 3, No; n = 12) and balance (87.2 + 8.3% leg length) were positively correlated r(14)=.67, (p=.01). However, core endurance (103.9 + 50.6 s) and balance were not correlated r(14)=.32, (p=.26). LE hypermobility status predicted 36.9% of the variance in balance scores (p=.01). Conclusion LE hypermobility, but not core muscle endurance may be related to balance in female

  5. Fast gaze reorientations by combined movements of the eye, head, trunk and lower extremities.

    PubMed

    Anastasopoulos, Dimitri; Naushahi, J; Sklavos, Sokratis; Bronstein, Adolfo M

    2015-05-01

    Large reorientations of the line of sight, involving combined rotations of the eyes, head, trunk and lower extremities, are executed either as fast single-step or as slow multiple-step gaze transfers. In order to obtain more insight into the mechanisms of gaze and multisegmental movement control, we have investigated time-optimal gaze shifts (i.e. with the instruction to move as fast as possible) during voluntary whole-body rotations to remembered targets up to 180° eccentricity performed by standing healthy humans in darkness. Fast, accurate, single-step movement patterns occurred in approximately 70 % of trials, i.e. considerably more frequently than in previous studies with the instruction to turn at freely chosen speed (30 %). Head-in-space velocity in these cases was significantly higher than during multiple-step transfers and displayed a conspicuously regular bell-shaped profile, increasing smoothly to a peak and then decreasing slowly until realignment with the target. Head-in-space acceleration was on average not different during reorientations to the different target eccentricities. In contrast, head-in-space velocity increased with target eccentricity due to the longer duration of the acceleration phase implemented during trials to more distant targets. Eye saccade amplitude approached the eye-in-orbit mechanical limit and was unrelated to eye/head velocity, duration or target eccentricity. Overall, the combined movement was stereotyped such that the first two principal components accounted for data variance almost up to gaze shift end, suggesting that the three mechanical degrees of freedom under consideration (eye-in-orbit, head-on-trunk and trunk-in-space) are on average reduced to two kinematic degrees of freedom (i.e. eye, head-in-space). Synchronous EMG activity in the anterior tibial and gastrocnemius muscles preceded the onset of eye rotation. Since the magnitude and timing of peak head-in-space velocity were scaled with target eccentricity and

  6. [Efficacy of oral drug Thrombovasim® in therapy of lower extremity deep vein thromboses].

    PubMed

    Mishenina, S V; Madonov, P G; Kinsht, D N; Émedova, T A; Zotov, S P; Ufimtsev, M S; Leont'ev, S G

    2016-01-01

    Within the framework of the multicenter randomized placebo-controlled double-blind clinical trial "VETTER-1" the authors carried out assessment of therapeutic efficacy and safety of oral drug Thrombovasim® possessing a thrombolytic effect in comprehensive treatment of lower-extremity deep vein thrombosis (LEDVT). The clinical study comprised a total of 154 patients. All patients received standard therapy accepted in LEDVT. The patients were subdivided into 4 groups. Patients from the three study groups received Thrombovasim® at a daily dose of 1,600, 3,200, and 4,800 IU. The control group patients were given placebo. Efficacy was assessed by the results of ultrasound duplex scanning first performed before treatment commenced and then after it terminated. The relative frequency of positive dynamics according to the findings of instrumental methods of study in patients taking Thrombovasim® amounted to 0.728 and in the group of patients receiving placebo to 0.585, p=0.0031. Comparing the degree of blood flow normalization in the zone of the compromised blood flow revealed a pronounced dose-dependent effect: in patients taking the drug at a daily dose of 1,600 IU, the relative frequency of positive dynamics amounted to 0.707 corresponding to an increase in therapeutic efficacy by 21%, for a dose of 3,200 IU these parameters amounted to 0.0257 and 24% and for 4,800 IU - 0.747 and 28%, respectively. In patients taking Thrombovasim® there were no cases of negative dynamics observed. Of the patients taking Thrombovasim®, none developed undesirable or severe adverse events. Inclusion of Thrombovasim® into the composition of comprehensive therapy for LEDVT increases efficacy of treatment at the expense of a spontaneous thrombolytic effect. The most effective dose amounted to 4,800 IU daily. Thrombovasim® turned out to be an efficient and safe agent in treatment of venous thromboses. PMID:27626255

  7. A Refined Prediction Model for Core and Lower Extremity Sprains and Strains Among Collegiate Football Players

    PubMed Central

    Wilkerson, Gary B.; Colston, Marisa A.

    2015-01-01

    Context Researchers have identified high exposure to game conditions, low back dysfunction, and poor endurance of the core musculature as strong predictors for the occurrence of sprains and strains among collegiate football players. Objective To refine a previously developed injury-prediction model through analysis of 3 consecutive seasons of data. Design Cohort study. Setting National Collegiate Athletic Association Division I Football Championship Subdivision football program. Patients or Other Participants For 3 consecutive years, all 152 team members (age = 19.7 ± 1.5 years, height = 1.84 ± 0.08 m, mass = 101.08 ± 19.28 kg) presented for a mandatory physical examination on the day before initiation of preseason practice sessions. Main Outcome Measure(s) Associations between preseason measurements and the subsequent occurrence of a core or lower extremity sprain or strain were established for 256 player-seasons of data. We used receiver operating characteristic analysis to identify optimal cut points for dichotomous categorizations of cases as high risk or low risk. Both logistic regression and Cox regression analyses were used to identify a multivariable injury-prediction model with optimal discriminatory power. Results Exceptionally good discrimination between injured and uninjured cases was found for a 3-factor prediction model that included equal to or greater than 1 game as a starter, Oswestry Disability Index score equal to or greater than 4, and poor wall-sit–hold performance. The existence of at least 2 of the 3 risk factors demonstrated 56% sensitivity, 80% specificity, an odds ratio of 5.28 (90% confidence interval = 3.31, 8.44), and a hazard ratio of 2.97 (90% confidence interval = 2.14, 4.12). Conclusions High exposure to game conditions was the dominant injury risk factor for collegiate football players, but a surprisingly mild degree of low back dysfunction and poor core-muscle endurance appeared to be important modifiable risk factors that

  8. Knee and ankle strength and lower extremity power in adolescent female ballet dancers.

    PubMed

    Kenne, Ellinor; Unnithan, Viswanath B

    2008-01-01

    The aims of this study were twofold: (1) to compare the strength of four muscle groups of the lower limb (quadriceps [Q], hamstrings [H], plantar flexors [PF], and dorsiflexors [DF]) between female adolescent ballet dancers (BALs) and basketball players (BBs) over three angular velocities (30 degrees, 60 degrees and 90 degrees/sec) and two types of contraction (eccentric and concentric); and (2) to compare peak and mean power between the BALs and BBs. Eleven BALs (age: 15.8 +/- 1.2 years; stature: 163.9 +/- 6.2 cm; body mass: 56.3 +/- 5.7 kg; Tanner stage 4: N=10, stage 5: N=1) and ten BBs (age: 15.8 +/- 1.0 years; stature: 172.5 +/- 5.8 cm; body mass: 63.2 +/- 10.0 kg; Tanner stage 4: N=7, stage 5: N=3) volunteered to participate. Each participant performed one habituation session and one testing session on a Biodex isokinetic dynamometer to determine peak torque. Three angular velocities (30 degrees, 60 degrees and 90 degrees/sec) were used for each muscle group. To determine absolute and relative peak and mean power, participants performed a 30 second anaerobic Wingate test on a cycle ergometer. There were no significant differences in peak torque for Q, H, PF, and DF between the groups. Basketball players produced greater absolute peak power [569.7 +/- 82.2 vs. 454.6 +/- 79.3 W (p < .05)], relative peak power [9.1 +/- 1.3 vs. 8.1 +/- 1.0 W/kg body mass (p < .05)], absolute mean power [428.4 +/- 53.9 vs. 333.7 +/- 68.2 W (p < .05)] and relative mean power [6.83 +/- 0.7 vs. 5.9 +/- 0.7 W/kg (p < .05)] than BALs. Ballet dancers and BBs had similar isokinetically measured lower extremity muscular strength, but BALs generated lower levels of peak power and mean power compared to BBs.

  9. Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital

    PubMed Central

    Sundar, Gaurav; Keshava, Shyamkumar N; Moses, Vinu; Chiramel, George K; Ahmed, Munawwar; Mammen, Suraj; Aggarwal, Sunil; Stephen, Edwin

    2016-01-01

    Background: Lower extremity deep vein thrombosis (DVT) is a common illness with an annual incidence of 1 per 1000 adults. The major long-term complication of DVT is post-thrombotic syndrome (PTS) which occurs in up to 60% of patients within 2 years of an episode of DVT. Aims: We aim to evaluate the outcomes of catheter-directed treatment (CDT) for symptomatic acute or subacute lower extremity DVT. Materials and Methods: A retrospective 12-year study was conducted on the outcomes of CDT on 54 consecutive patients who presented with acute or subacute lower extremity DVT to our hospital. Statistical Analysis: Descriptive summary statistics and the Chi-square test were used to measure the outcomes of CDT. Results: Grade 3 thrombolysis was achieved in 25 (46.3%) patients, grade 2 thrombolysis in 25 (46.3%) patients, and grade 1 thrombolysis in 4 (7.4%) patients. Significant recanalization (grade 2 or 3 thrombolysis) was possible in 50 (92.6%) patients. There was no statistically significant difference in the percentage of significant recanalization that could be achieved between patients who underwent CDT before and after 10 days. There was no significant difference between the thrombolysis achieved between urokinase and r-tPA. PTS was seen in 33% of the patients. Major complications were seen in 5.5% of the patients. Conclusion: CDT is a safe and effective therapeutic technique in patients with acute and subacute lower extremity DVT, if appropriate patient selection is made. PMID:27081228

  10. Relationship of fatigued run and rapid stop to ground reaction forces, lower extremity kinematics, and muscle activation.

    PubMed

    Nyland, J A; Shapiro, R; Stine, R L; Horn, T S; Ireland, M L

    1994-09-01

    Fatigue may be related to lower extremity injury. The effect of lower extremity fatigue on ground reaction force production, lower extremity kinematics, and muscle activation during the landing phase of a run and rapid stop was investigated. Subjects were 19 female, Division 1 collegiate basketball and volleyball players (mean age = 20.8 +/- 1.8 years, mean weight = 71.7 +/- 6.9 kg, mean height = 174 +/- 5 cm). Dominant leg ground reaction and muscle activation data were sampled at 2,000 Hz. Lower extremity kinematic data were sampled at 200 Hz, and three-dimensional analysis was performed. Knee extensor/flexor muscle activation tended to be delayed during fatigue (p < or = .08). Maximum knee flexion tended to occur earlier during fatigue (p < or = .09). Step-wise multiple regression suggested that the knee may be the primary site of force attenuation following fatigue. During fatigue, biodynamical compensations in the mechanical properties of the knee extensor musculature, as evidenced by differences in knee kinematics and muscle activation times, may occur to enhance knee stability.

  11. Classification of Lower Extremity Movement Patterns Based on Visual Assessment: Reliability and Correlation With 2-Dimensional Video Analysis

    PubMed Central

    Harris-Hayes, Marcie; Steger-May, Karen; Koh, Christine; Royer, Nat K.; Graci, Valentina; Salsich, Gretchen B.

    2014-01-01

    Context: Abnormal movement patterns have been implicated in lower extremity injury. Reliable, valid, and easily implemented assessment methods are needed to examine existing musculoskeletal disorders and investigate predictive factors for lower extremity injury. Objective: To determine the reliability of experienced and novice testers in making visual assessments of lower extremity movement patterns and to characterize the construct validity of the visual assessments. Design: Cross-sectional study. Setting: University athletic department and research laboratory. Patients or Other Participants: Convenience sample of 30 undergraduate and graduate students who regularly participate in athletics (age = 19.3 ± 4.5 years). Testers were 2 experienced physical therapists and 1 novice postdoctoral fellow (nonclinician). Main Outcome Measure(s): We took videos of 30 athletes performing the single-legged squat. Three testers observed the videos on 2 occasions and classified the lower extremity movement as dynamic valgus, no change, or dynamic varus. The classification was based on the estimated change in frontal-plane projection angle (FPPA) of the knee from single-legged stance to maximum single-legged squat depth. The actual FPPA change was measured quantitatively. We used percentage agreement and weighted κ to examine tester reliability and to determine construct validity of the visual assessment. Results: The κ values for intratester and intertester reliability ranged from 0.75 to 0.90, indicating substantial to excellent reliability. Percentage agreement between the visual assessment and the quantitative FPPA change category was 90%, with a κ value of 0.85. Conclusions: Visual assessments were made reliably by experienced and novice testers. Additionally, movement-pattern categories based on visual assessments were in excellent agreement with objective methods to measure FPPA change. Therefore, visual assessments can be used in the clinic to assess movement patterns

  12. Orthopedic Surgeons and Physical Therapists Differ in Assessment of Need for Physical Therapy After Traumatic Lower-Extremity Injury

    PubMed Central

    MacKenzie, Ellen J.; Castillo, Renan C.; Bosse, Michael J.

    2009-01-01

    Background Lower-extremity injuries constitute the leading cause of trauma hospitalizations among people under the age of 65 years. Rehabilitation has the potential to favorably influence the outcomes associated with traumatic lower-extremity injuries. Objectives The objectives of this study were to explore variability in surgeon and physical therapist assessments of the need for physical therapy in patients with traumatic lower-extremity injuries and to determine the factors associated with assessments of need. Design This study was a retrospective cohort investigation. Methods Participants were 395 patients treated by reconstruction in the Lower-Extremity Assessment Project. They were evaluated at 8 level I trauma centers at 3, 6, and 12 months after hospitalization by an orthopedic surgeon and a physical therapist to determine the need for physical therapy. Analyses included multilevel logistic regression. Results Chi-square analyses showed that surgeon and therapist assessments of need differed statistically across trauma centers. Surgeons were more likely to assess a need for therapy at 3 months when participants had low work self-efficacy, impaired knee flexion range of motion (ROM), and weight-bearing limitations and at 6 and 12 months when participants had impaired knee flexion ROM and weight-bearing and balance limitations. Therapists were more likely to assess a need for therapy at 3 months when participants had moderate to severe pain and at 6 and 12 months when participants had low work self-efficacy, pain, impaired knee flexion ROM, and balance limitations. Conclusions The results revealed variability in assessments of the need for physical therapy at the provider and trauma center levels. Differences in provider assessments highlight the need for communication and further investigation into the outcomes and timing of physical therapy for the treatment of traumatic lower-extremity injuries. PMID:19875460

  13. Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary.

    PubMed

    Crawford, Penny Ellen; Fields-Varnado, Myra

    2013-01-01

    This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline.

  14. Acute Motor Weakness of Opposite Lower Extremity after Percutaneous Epidural Neuroplasty

    PubMed Central

    Lim, Yong Seok; Park, Cheon Hee; Wee, Sang Woo; Sin, Sung Sik; Kim, Joon

    2015-01-01

    Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication. PMID:25852837

  15. The influence of a foot orthotic on lower extremity transverse plane kinematics in collegiate female athletes with pes planus.

    PubMed

    Christopher, R Carcia; Drouin, Joshua M; Houglum, Peggy A

    2006-01-01

    Non-contact anterior cruciate ligament (ACL) injuries in female athletes remain prevalent. Athletes with excessive foot pronation have been identified to be at greater risk for non-contact ACL injury. Excessive foot pronation has been linked to increased medial tibial rotation. Increased medial tibial rotation heightens ACL strain and has been observed at or near the time of ACL injury. Foot orthotics have been shown to decrease medial tibial rotation during walking and running tasks. The effect of a foot orthotic on activities that simulate a non-contact ACL injury mechanism (i.e. landing) however is unknown. Therefore, the objective of this study was to determine whether a foot orthotic was capable of altering transverse plane lower extremity kinematics in female athletes during landing. Twenty uninjured collegiate female athletes participating in the sports of basketball, soccer or volleyball with pes planus volunteered. Utilizing a repeated measures counterbalanced design, subjects completed two landing tasks with and without a foot orthotic using standardized footwear. The prefabricated orthotic had a rigid shell and a 6 extrinsic rear-foot varus post. Dependent measures included initial contact angle, peak angle, excursion and time to peak angle for both the tibia and femur. Statistical analysis suggested that the selected foot orthosis had little influence over lower extremity transverse plane kinematics. Several factors including: the limitation of a static measure to predict dynamic movement, inter-subject variability and the physical characteristics of the orthotic device likely account for the results. Future research should examine the influence of different types of foot orthotics not only on lower extremity kinematics but also tibiofemoral kinetics. Key PointsLower extremity transverse plane kinematics in female athletes during a landing task exhibit substantial variability.A rigid prefabricated foot orthotic does not significantly alter transverse

  16. Morphing of geometric composites via residual swelling.

    PubMed

    Pezzulla, Matteo; Shillig, Steven A; Nardinocchi, Paola; Holmes, Douglas P

    2015-08-01

    Understanding and controlling the shape of thin, soft objects has been the focus of significant research efforts among physicists, biologists, and engineers in the last decade. These studies aim to utilize advanced materials in novel, adaptive ways such as fabricating smart actuators or mimicking living tissues. Here, we present the controlled growth-like morphing of 2D sheets into 3D shapes by preparing geometric composite structures that deform by residual swelling. The morphing of these geometric composites is dictated by both swelling and geometry, with diffusion controlling the swelling-induced actuation, and geometric confinement dictating the structure's deformed shape. Building on a simple mechanical analog, we present an analytical model that quantitatively describes how the Gaussian and mean curvatures of a thin disk are affected by the interplay among geometry, mechanics, and swelling. This model is in excellent agreement with our experiments and numerics. We show that the dynamics of residual swelling is dictated by a competition between two characteristic diffusive length scales governed by geometry. Our results provide the first 2D analog of Timoshenko's classical formula for the thermal bending of bimetallic beams - our generalization explains how the Gaussian curvature of a 2D geometric composite is affected by geometry and elasticity. The understanding conferred by these results suggests that the controlled shaping of geometric composites may provide a simple complement to traditional manufacturing techniques. PMID:26076671

  17. [The theory of lymphangion and current approaches to the pathogenesis, diagnosis and treatment of lymphedema of the lower extremities].

    PubMed

    Bubnova, N A; Borisova, R P; Borisov, A V

    2003-01-01

    The paper describes the results of examination carried out by the Sankt-Peterburg school of lymphologists, pertaining to the structure, physiological properties and function of lymphangions responsible for active lymph transport. The problems of the pathogenesis, diagnosis and treatment of lymphedema of the lower extremities used in clinical practice are reviewed from the standpoint of the new theory. The data obtained as a result of the clinico-morphofunctional studies allowed to delineate the stages of lymphedema as dependent on the degree of lymphocytic structure and function integrity. Based on the aforesaid the new approaches to the diagnosis and selection of the treatment methods for lymphedema of the lower extremities have been formulated. PMID:12811377

  18. [Application of multimodal anesthesia/analgesia in complex of anesthesiological support of reconstructive operations, performed on the lower extremity arteries].

    PubMed

    Homon, M L

    2014-09-01

    Anesthesiological support of 47 patients, while performing reconstructive operations on the lower extremities arteries in presence of the third level of operative risk (according to ASA), was analyzed; of them in 24 - a spinal anesthesia was applied, in 23 - a reduced spino-epidural anesthesia. Application of a spino-epidural anesthesia/analgesia with reduction of the dose of a spinal component and usage of analgesia instead of anesthesia secures lesser intraoperative oscillations of hemodynamic indices in comparison with such while performing spinal anesthesia, as well as better antinociceptive protection, is also characterized by small toxic impact on the patient, demands application of a sedative and the infusion therapy of lesser volume. While performing a potentially complex and durable reconstructive operations on the lower extremities arteries a wide application of the method depicted is recommended.

  19. Validation of a full body finite element model (THUMS) for running-type impacts to the lower extremity.

    PubMed

    Schinkel-Ivy, Alison; Altenhof, William J; Andrews, David M

    2014-01-01

    The purpose of this study was to determine whether modifying an existing, highly biofidelic full body finite element model [total human model for safety (THUMS)] would produce valid amplitude and temporal shock wave characteristics as it travels proximally through the lower extremity. Modifying an existing model may be more feasible than developing a new model, in terms of cost, labour and expertise. The THUMS shoe was modified to more closely simulate the material properties of a heel pad. Relative errors in force and acceleration data from experimental human pendulum impacts and simulated THUMS impacts were 22% and 54%, respectively, across the time history studied. The THUMS peak acceleration was attenuated by 57.5% and took 19.7 ms to travel proximally along the lower extremity. Although refinements may be necessary to improve force and acceleration timing, the modified THUMS represented, to a certain extent, shock wave propagation and attenuation demonstrated by living humans under controlled impact conditions. PMID:22519546

  20. [Renal infarction and acute arterial obstruction of the lower extremity encountered after surgery for primary lung cancer].

    PubMed

    Tamaki, Masafumi; Miura, Kazumasa; Norimura, Shoko; Kenzaki, Koichirou; Yosizawa, Kiyoshi

    2013-02-01

    The patient was 68-year-old who underwent left upper lobectomy and lymph node dissection. On the 4th postoperative day, he developed vomiting and lumbar pain. On 5th postoperative day, he complained of pain, sensory paralysis and cold sensation of the right lower extremity. Computed tomography(CT)examination revealed left renal infarction and acute arterial obstruction of the right common iliac artery. Emergency thrombectomy of the right lower extremity was performed. Postoperatively, he received anticoagulant therapy and was able to leave the hospital on the 20th postoperative day. Attention should be paid to the infarction of abdominal organs when developing abdominal symptoms after lung cancer surgery in elderly patients.

  1. Associations between lower extremity muscle mass and metabolic parameters related to obesity in Japanese obese patients with type 2 diabetes.

    PubMed

    Hamasaki, Hidetaka; Kawashima, Yu; Adachi, Hiroki; Moriyama, Sumie; Katsuyama, Hisayuki; Sako, Akahito; Yanai, Hidekatsu

    2015-01-01

    Background. Age-related loss of muscle mass (sarcopenia) increases the incidence of obesity in the elderly by reducing physical activity. This sarcopenic obesity may become self-perpetuating, increasing the risks for metabolic syndrome, disability, and mortality. We investigated the associations of two sarcopenic indices, the ratio of lower extremity muscle mass to body weight (L/W ratio) and the ratio of lower extremity muscle mass to upper extremity muscle mass (L/U ratio), with metabolic parameters related to obesity in patients with type 2 diabetes and obesity. Methods. Of 148 inpatients with type 2 diabetes treated between October 2013 and April 2014, we recruited 26 with obesity but no physical disability. Daily physical activity was measured by a triaxial accelerometer during a period of hospitalization, and which was also evaluated by our previously reported non-exercise activity thermogenesis questionnaire. We measured body composition by bioelectrical impedance and investigated the correlations of L/W and L/U ratios with body weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), visceral fat area, subcutaneous fat area, serum lipid profile, and daily physical activity. Results. The L/W ratio was significantly and negatively correlated with BMI, WC, WHR, body fat mass, body fat percentage, subcutaneous fat area, and serum free fatty acid concentration, was positively correlated with daily physical activity: the locomotive non-exercise activity thermogenesis score, but was not correlated with visceral fat area. The L/U ratio was significantly and positively correlated with serum high-density lipoprotein cholesterol. Conclusions. High L/W and L/U ratios, indicative of relatively preserved lower extremity muscle mass, were predictive of improved metabolic parameters related to obesity. Preserved muscle fitness in obesity, especially of the lower extremities, may prevent sarcopenic obesity and lower associated risks for metabolic

  2. Moderate-intensity physical activity is independently associated with lower-extremity muscle power in older women.

    PubMed

    Straight, Chad R; Brady, Anne O; Evans, Ellen M

    2016-01-01

    Skeletal muscle power is a salient determinant of physical function in older adults, but its relationship with habitual physical activity has not been well-characterized. The aim of this study was to examine the association between moderate-intensity physical activity and lower-extremity muscle power in community-dwelling older women. Older women (n = 96, mean age = 73.9 ± 5.6 years, mean body mass index = 26.5 ± 4.7 kg/m(2)) underwent assessments for body composition via dual-energy X-ray absorptiometry and lower-extremity muscle power (watts) using the Nottingham power rig. The Community Health Activities Model Program for Seniors questionnaire was used to estimate weekly caloric expenditure in moderate-intensity physical activity (kcals/wk). Linear regression indicated that moderate-intensity physical activity was independently related to muscle power (standardized β = 0.20, p = .03), and this relationship remained following adjustment for covariates. Analysis of covariance revealed that women in the highest tertile of volume of physical activity had significantly greater muscle power than those with the lowest volume (199.0 vs. 170.7 watts, p < .05). Moderate-intensity physical activity was independently associated with lower-extremity muscle power in older women. Future intervention trials should determine if increasing habitual physical activity is associated with improvements in lower-extremity muscle power in older women.

  3. Hip External Rotator Strength Is Associated With Better Dynamic Control of the Lower Extremity During Landing Tasks.

    PubMed

    Malloy, Philip J; Morgan, Alexander M; Meinerz, Carolyn M; Geiser, Christopher F; Kipp, Kristof

    2016-01-01

    The purpose of this study was to determine the association between hip strength and lower extremity kinematics and kinetics during unanticipated single-leg landing and cutting tasks in collegiate female soccer players. Twenty-three National Collegiate Athletic Association division I female soccer players were recruited for strength testing and biomechanical analysis. Maximal isometric hip abduction and external rotation strength were measured using a hand-held dynamometer and expressed as muscle torque (force × femoral length) and normalized to body weight. Three-dimensional lower extremity kinematics and kinetics were assessed with motion analysis and force plates, and an inverse dynamics approach was used to calculate net internal joint moments that were normalized to body weight. Greater hip external rotator strength was significantly associated with greater peak hip external rotation moments (r = 0.47; p = 0.021), greater peak knee internal rotation moments (r = 0.41; p = 0.048), greater hip frontal plane excursion (r = 0.49; p = 0.017), and less knee transverse plane excursion (r = -0.56; p = 0.004) during unanticipated single-leg landing and cutting tasks. In addition, a statistical trend was detected between hip external rotator strength and peak hip frontal plane moments (r = 0.39; p = 0.06). The results suggest that females with greater hip external rotator strength demonstrate better dynamic control of the lower extremity during unanticipated single-leg landing and cutting tasks and provide further support for the link between hip strength and lower extremity landing mechanics. PMID:26110347

  4. Evaluation of the effects of homologous platelet gel on healing lower extremity wounds in patients with diabetes.

    PubMed

    Shan, Gui-Qiu; Zhang, Ya-Ni; Ma, Jing; Li, Yan-Hui; Zuo, Da-Ming; Qiu, Jin-Lang; Cheng, Biao; Chen, Zheng-Liang

    2013-03-01

    The treatment of chronic diabetic wounds remains complicated, despite new insight into the cellular and molecular basis of wound healing and cutaneous regeneration. A growing body of clinical trials has shown that platelet release has a notable effectiveness on refractory ulcer healing. However, patients with chronic diabetic ulcers usually have poor general health, and the large-volume blood absence required to produce autologous platelet-rich plasma often causes adverse effects. To overcome the limitation, the homologous platelet gel (PG) from healthy donor was used for the treatment of chronic diabetic lower extremity wound in the study. We show here that homologous derived platelets significantly enhanced EVC304 cell and HaCaT cell proliferation and homologous PG was capable of prompting cell migration. Twenty-one patients with refractory diabetic lower extremity ulcers, who had no response to conventional treatments, were treated in this study. Our data indicated that homologous PG was effective for the enhancement and acceleration of diabetic lower extremity wounds healing. We propose that homologous PG appeared to enhance vascularization and epithelialization, which might induce a quicker healing process and and encourage controlled studies in future.

  5. Effect of vibration on muscle strength imbalance in lower extremity using multi-control whole body vibration platform.

    PubMed

    Yu, Chang Ho; Seo, Shin Bae; Kang, Seung Rok; Kim, Kyung; Kwon, Tae Kyu

    2015-01-01

    This study shows the improvement of muscle activity and muscle strength imbalance in the lower extremities through independent exercise loads in vibration platform. Twenty females of age 20 participated in this study. The subjects were divided into WBV group, with more than 10% of muscle strength imbalance between left and right the lower extremities, and control group, with less than 10% of muscle strength imbalance between left and right the lower extremities. As the prior experiment showed, different exercise postures provide different muscular activities. As a result, the highest muscular activity was found to be in the low squat posture. Therefore, the LS posture was selected for the exercise in this experiment. Vibration intensities were applied to dominant muscle and non-dominant muscle, and the vibration frequency was fixed at 25Hz for the WBV group. The control group was asked to perform the same exercise as the WBV group, without stimulated vibration. This exercise was conducted for a total of 4 weeks. As a result, the WBV group which showed an average deviation of 16% before the experiment, tended to decrease approximately to 5%. In this study, vibration exercise using load deviation is shown to be effective in improving the muscle strength imbalance.

  6. Relationship between Lower Extremity Tightness and Star Excursion Balance Test Performance in Junior High School Baseball Players.

    PubMed

    Endo, Yasuhiro; Sakamoto, Masaaki

    2014-05-01

    [Purpose] The purpose of this study was to examine the relationship between lower extremity tightness and lower extremity balance, measured by the Star Excursion Balance Test (SEBT), in junior high school baseball players. [Subjects] Thirty-three male students belonging to baseball clubs in 2 junior high schools participated in this study. [Methods] For the SEBT, we chose to examine the anterior (ANT), posterior (POS), lateral (LAT), and medial (MED) directions. Regarding muscle tightness measurement, the angle of each joint of the bilateral iliopsoas, quadriceps, hamstring, gastrocnemius, hip internal rotator, and hip external rotator was measured. [Results] The ANT direction of the SEBT was significantly negatively correlated with gastrocnemius tightness. The MED direction of the SEBT was significantly positively correlated with hip internal rotator tightness and hamstrings tightness and significantly negatively correlated with gastrocnemius tightness. The LAT direction of the SEBT was significantly negatively correlated with iliopsoas tightness and gastrocnemius tightness. [Conclusion] Since the rate of upper extremity injury is high in these subjects and this could be due to tightness and instability of the lower extremity from a kinetic viewpoint, the SEBT could be used as a standard evaluation test when examining upper extremity injuries in young baseball players.

  7. The Influence of an Unstable Surface on Trunk and Lower Extremity Muscle Activities during Variable Bridging Exercises

    PubMed Central

    Kim, Jung-hyun; Kim, Young; Chung, Yijung

    2014-01-01

    [Purpose] The aim of this study was to investigate the influence of an unstable surface on trunk and lower extremity muscle activities during various types of bridging exercises. [Subjects] Thirty healthy female adults voluntarily participated in this study. [Methods] All subjects were asked to perform 3 different bridging exercises (bridging exercise, single leg lift bridging exercise, single leg cross bridging exercise) with and without an unstable surface. The trunk and lower extremity muscle activities were measured by using surface electromyography during bridging exercise. [Results] During the bridging exercise (BE), single leg lift bridging exercise (LBE), and single leg cross bridging exercise (CBE), the muscle activities of the external oblique muscle (EO), erector spinae (ES), and biceps femoris (BF) were significantly higher on an unstable surface than on a stable surface. The muscle activities of the EO on both sides, contralateral BF, and ipsilateral ES were significantly higher during LBE than during BE and CBE. [Conclusion] Use of an unstable surface increases muscle activity of the trunk and lower extremities, and single leg lift bridging exercise increases the muscle activity of the EO on both sides, ipsilateral ES, and contralateral BF. PMID:24764625

  8. Twenty‐eight‐joint counts invalidate the DAS28 remission definition owing to the omission of the lower extremity joints: a comparison with the original DAS remission

    PubMed Central

    Landewé, R; van der Heijde, D; van der Linden, S; Boers, M

    2006-01-01

    Objective To compare 28 joint disease activity score (DAS28) remission with comprehensive joint count DAS remission in rheumatoid arthritis. Methods 620 actually measured paired observations of DAS28 and DAS were analysed in 155 patients. Discordant observations (either DAS or DAS28 below remission cut off level: 1.6 for DAS and 2.6 for DAS28) and concordant observations (both DAS and DAS28 below their remission cut off level) were analysed separately. Results 91 of 620 paired DAS observations (15%) were discordant; 87 (in 53 patients) comprised observations in which the DAS28 remission criterion, but not the DAS remission criterion, was met. The reverse was found in only four observations, which were therefore omitted. With the original DAS as standard, DAS28 sensitivity was 95% and specificity 84%. Probability plots showed a swollen joint count >0 in 75% of discordant pairs v 48% of concordant pairs. The same was found for total joint count (TJC >0 in 90% v 40%; median TJC, 0 v 6) and patient global assessment, but not for ESR. Individual joint analysis showed that 51% of discordant v 18% of concordant observations (p<0.0005) had involvement of lower extremity joints that are not included in the DAS28. Conclusions DAS remission is more conservative than DAS28 remission. Activity (tenderness and swelling) in joints not included in the reduced joint counts (ankles, feet) mainly account for the discrepancy between the two assessments. DAS28 remission at a cut off level of 2.6 has insufficient construct validity and should be used with caution in clinical practice and clinical trials. PMID:16219709

  9. Use of a pedicled fillet foot flap for knee preservation in severe lower extremity trauma: A case report and literature review

    PubMed Central

    Jensson, David; Audolfsson, Thorir; Mani, Maria; Rodriguez-Lorenzo, Andres

    2015-01-01

    We report the sequential use of a pedicled fillet foot flap in a clinical case of complex bilateral lower extremity trauma to achieve stable wound closure, maximizing length preservation and gait rehabilitation. In addition, we perform a literature review of the use of fillet foot flaps in lower extremity trauma. PMID:27252976

  10. Methodological report: dynamic field tests used in an NFL combine setting to identify lower-extremity functional asymmetries.

    PubMed

    Hickey, Kathryn C; Quatman, Carmen E; Myer, Gregory D; Ford, Kevin R; Brosky, Joseph A; Hewett, Timothy E

    2009-12-01

    Side-to-side differences in lower-extremity biomechanics may be predictive of increased risk of lower-extremity injuries in athletes. The purpose of this report is to provide field testing methodology for tests designed to isolate lower-extremity asymmetry and to demonstrate the potential for these tests to provide reliable measures. Six athletes (3 females, 3 males) were tested on 2 consecutive days for activities incorporated into a replicated National Football League (NFL) combine setting. Vertical hop power (VHP) and jump height were measured on a portable force platform as athletes performed maximum effort hops for 10 seconds. The modified agility T-test (MAT) incorporates two 90-degree single-leg cuts during the trial and was measured as total time for completion. Intraclass correlations (within ICC [3,k], between ICC [3,1]) were calculated. The VHP test had good to excellent within-session reliability for peak power of both the right (ICC = 0.942) and left (ICC = 0.895) sides. Jump height showed excellent within-session reliability for both the right (ICC = 0.963) and left (ICC = 0.940) sides. The between-session reliability for peak power between jumps was good for the right (ICC = 0.748) and left (ICC = 0.834) sides. Jump height showed good to excellent between-session reliability on the right (ICC = 0.794) and left (ICC = 0.909) sides. The MAT also showed good reliability between days (ICC = 0.825).The results indicate that the VHP test provides reliable assessment of both within- and between-session jump height and power production. The MAT also provides good reliability between testing days. Both the VHP and the MAT may be useful for clinicians to identify the presence of lower-limb asymmetry and potential injury risk factors in athletic populations.

  11. The Effects of Tai Chi Chuan Combined with Vibration Training on Balance Control and Lower Extremity Muscle Power

    PubMed Central

    Chung, Pao-Hung; Lin, Guan-Lun; Liu, Chiang; Chuang, Long-Ren; Shiang, Tzyy-Yuang

    2013-01-01

    The aim of this study was to determine whether performing Tai Chi Chuan on a customized vibration platform could enhance balance control and lower extremity muscle power more efficiently than Tai Chi Chuan alone in an untrained young population. Forty-eight healthy young adults were randomly assigned to the following three groups: a Tai Chi Chuan combined with vibration training group (TCV), a Tai Chi Chuan group (TCC) or a control group. The TCV group underwent 30 minutes of a reformed Tai Chi Chuan program on a customized vibration platform (32 Hz, 1 mm) three times a week for eight weeks, whereas the TCC group was trained without vibration stimuli. A force platform was used to measure the moving area of a static single leg stance and the heights of two consecutive countermovement jumps. The activation of the knee extensor and flexor was also measured synchronously by surface electromyography in all tests. The results showed that the moving area in the TCV group was significantly decreased by 15.3%. The second jump height in the TCV group was significantly increased by 8.14%, and the activation of the knee extensor/flexor was significantly decreased in the first jump. In conclusion, Tai Chi Chuan combined with vibration training can more efficiently improve balance control, and the positive training effect on the lower extremity muscle power induced by vibration stimuli still remains significant because there is no cross-interaction between the two different types of training methods. Key points Eight weeks of Tai Chi Chuan combined with vibration training can more efficiently improve balance control for an untrained young population. The positive training effect on the lower extremity muscle power induced by vibration stimuli during Tai Chi Chuan movements still remains significant because of SSC mechanism. Combining Tai Chi Chuan with vibration training is more efficient and does not decrease the overall training effects due to a cross-interaction of each other

  12. The effects of tai chi chuan combined with vibration training on balance control and lower extremity muscle power.

    PubMed

    Chung, Pao-Hung; Lin, Guan-Lun; Liu, Chiang; Chuang, Long-Ren; Shiang, Tzyy-Yuang

    2013-01-01

    The aim of this study was to determine whether performing Tai Chi Chuan on a customized vibration platform could enhance balance control and lower extremity muscle power more efficiently than Tai Chi Chuan alone in an untrained young population. Forty-eight healthy young adults were randomly assigned to the following three groups: a Tai Chi Chuan combined with vibration training group (TCV), a Tai Chi Chuan group (TCC) or a control group. The TCV group underwent 30 minutes of a reformed Tai Chi Chuan program on a customized vibration platform (32 Hz, 1 mm) three times a week for eight weeks, whereas the TCC group was trained without vibration stimuli. A force platform was used to measure the moving area of a static single leg stance and the heights of two consecutive countermovement jumps. The activation of the knee extensor and flexor was also measured synchronously by surface electromyography in all tests. The results showed that the moving area in the TCV group was significantly decreased by 15.3%. The second jump height in the TCV group was significantly increased by 8.14%, and the activation of the knee extensor/flexor was significantly decreased in the first jump. In conclusion, Tai Chi Chuan combined with vibration training can more efficiently improve balance control, and the positive training effect on the lower extremity muscle power induced by vibration stimuli still remains significant because there is no cross-interaction between the two different types of training methods. Key pointsEight weeks of Tai Chi Chuan combined with vibration training can more efficiently improve balance control for an untrained young population.The positive training effect on the lower extremity muscle power induced by vibration stimuli during Tai Chi Chuan movements still remains significant because of SSC mechanism.Combining Tai Chi Chuan with vibration training is more efficient and does not decrease the overall training effects due to a cross-interaction of each other.

  13. Functional Foot Symmetry and Its Relation to Lower Extremity Physical Performance in Older Adults: The Framingham Foot Study

    PubMed Central

    Riskowski, J.L.; Hagedorn, TJ; Dufour, AB; Hannan, MT

    2012-01-01

    Background While many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures. Methods Members of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function. Results Individuals with faster gait speed displayed greater foot function asymmetry; individuals with −3.0% to −9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced. Conclusions While this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging. PMID:22560642

  14. TLEM 2.0 - a comprehensive musculoskeletal geometry dataset for subject-specific modeling of lower extremity.

    PubMed

    Carbone, V; Fluit, R; Pellikaan, P; van der Krogt, M M; Janssen, D; Damsgaard, M; Vigneron, L; Feilkas, T; Koopman, H F J M; Verdonschot, N

    2015-03-18

    When analyzing complex biomechanical problems such as predicting the effects of orthopedic surgery, subject-specific musculoskeletal models are essential to achieve reliable predictions. The aim of this paper is to present the Twente Lower Extremity Model 2.0, a new comprehensive dataset of the musculoskeletal geometry of the lower extremity, which is based on medical imaging data and dissection performed on the right lower extremity of a fresh male cadaver. Bone, muscle and subcutaneous fat (including skin) volumes were segmented from computed tomography and magnetic resonance images scans. Inertial parameters were estimated from the image-based segmented volumes. A complete cadaver dissection was performed, in which bony landmarks, attachments sites and lines-of-action of 55 muscle actuators and 12 ligaments, bony wrapping surfaces, and joint geometry were measured. The obtained musculoskeletal geometry dataset was finally implemented in the AnyBody Modeling System (AnyBody Technology A/S, Aalborg, Denmark), resulting in a model consisting of 12 segments, 11 joints and 21 degrees of freedom, and including 166 muscle-tendon elements for each leg. The new TLEM 2.0 dataset was purposely built to be easily combined with novel image-based scaling techniques, such as bone surface morphing, muscle volume registration and muscle-tendon path identification, in order to obtain subject-specific musculoskeletal models in a quick and accurate way. The complete dataset, including CT and MRI scans and segmented volume and surfaces, is made available at http://www.utwente.nl/ctw/bw/research/projects/TLEMsafe for the biomechanical community, in order to accelerate the development and adoption of subject-specific models on large scale. TLEM 2.0 is freely shared for non-commercial use only, under acceptance of the TLEMsafe Research License Agreement.

  15. Does Eccentric Exercise Reduce Pain and Improve Strength in Physically Active Adults With Symptomatic Lower Extremity Tendinosis? A Systematic Review

    PubMed Central

    Wasielewski, Noah J; Kotsko, Kevin M

    2007-01-01

    Objective: To critically review evidence for the effectiveness of eccentric exercise to treat lower extremity tendinoses. Data Sources: Databases used to locate randomized controlled trials (RCTs) included PubMed (1980–2006), CINAHL (1982–2006), Web of Science (1995–2006), SPORT Discus (1980–2006), Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration Database. Key words included tendon, tendonitis, tendinosis, tendinopathy, exercise, eccentric, rehabilitation, and therapy. Study Selection: The criteria for trial selection were (1) the literature was written in English, (2) the research design was an RCT, (3) the study participants were adults with a clinical diagnosis of tendinosis, (4) the outcome measures included pain or strength, and (5) eccentric exercise was used to treat lower extremity tendinosis. Data Extraction: Specific data were abstracted from the RCTs, including eccentric exercise protocol, adjunctive treatments, concurrent physical activity, and treatment outcome. Data Synthesis: The calculated post hoc statistical power of the selected studies (n = 11) was low, and the average methodologic score was 5.3/10 based on PEDro criteria. Eccentric exercise was compared with no treatment (n = 1), concentric exercise (n = 5), an alternative eccentric exercise protocol (n = 1), stretching (n = 2), night splinting (n = 1), and physical agents (n = 1). In most trials, tendinosis-related pain was reduced with eccentric exercise over time, but only in 3 studies did eccentric exercise decrease pain relative to the control treatment. Similarly, the RCTs demonstrated that strength-related measures improved over time, but none revealed significant differences relative to the control treatment. Based on the best evidence available, it appears that eccentric exercise may reduce pain and improve strength in lower extremity tendinoses, but whether eccentric exercise is more effective than other forms of therapeutic exercise for the resolution

  16. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    SciTech Connect

    Ganguli, Suvranu Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil; Grabowski, Eric F.; Wicky, Stephan

    2012-10-15

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  17. Cutaneous lymphoid hyperplasia mimicking cutaneous lymphoma in a hyperthyroid cat.

    PubMed

    Snead, Elisabeth; Kerr, Moira; Macdonald, Valerie

    2013-10-01

    A 12-year-old neutered male domestic shorthair cat presented for chronic, localized, swelling and crusting of the left upper lip, weight loss, sporadic vomiting, and focal alopecia between the scapulae was diagnosed with hyperthyroidism and regional eosinophilic lymphadenitis. Treatment with methimazole exacerbated an underlying hypersensitivity disorder leading to marked generalized lymphadenopathy that histologically mimicked lymphoma.

  18. Cutaneous lymphoid hyperplasia mimicking cutaneous lymphoma in a hyperthyroid cat

    PubMed Central

    Snead, Elisabeth; Kerr, Moira; MacDonald, Valerie

    2013-01-01

    A 12-year-old neutered male domestic shorthair cat presented for chronic, localized, swelling and crusting of the left upper lip, weight loss, sporadic vomiting, and focal alopecia between the scapulae was diagnosed with hyperthyroidism and regional eosinophilic lymphadenitis. Treatment with methimazole exacerbated an underlying hypersensitivity disorder leading to marked generalized lymphadenopathy that histologically mimicked lymphoma. PMID:24155419

  19. Fixed-site high-frequency transcutaneous electrical nerve stimulation for treatment of chronic low back and lower extremity pain

    PubMed Central

    Gozani, Shai N

    2016-01-01

    Objective The objective of this study was to determine if fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) is effective in treating chronic low back and lower extremity pain. Background Transcutaneous electrical nerve stimulation is widely used for treatment of chronic pain. General-purpose transcutaneous electrical nerve stimulation devices are designed for stimulation anywhere on the body and often cannot be used while the user is active or sleeping. FS-TENS devices are designed for placement at a pre-determined location, which enables development of a wearable device for use over extended time periods. Methods Study participants with chronic low back and/or lower extremity pain self-administered an FS-TENS device for 60 days. Baseline, 30-, and 60-day follow-up data were obtained through an online questionnaire. The primary outcome measure was the patient global impression of change. Pain intensity and interference were assessed using the Brief Pain Inventory. Changes in use of concomitant pain medications were evaluated with a single-item global self-rating. Results One hundred and thirty participants were enrolled, with 88 completing the 60-day follow-up questionnaire. Most participants (73.9%) were 50 years of age or older. At baseline, low back pain was identified by 85.3%, lower extremity pain by 71.6%, and upper extremity pain by 62.5%. Participants reported widespread pain, at baseline, with a mean of 3.4 (standard deviation 1.1) pain sites. At the 60-day follow-up, 80.7% of participants reported that their chronic pain had improved and they were classified as responders. Baseline characteristics did not differentiate non-responders from responders. There were numerical trends toward reduced pain interference with walking ability and sleep, and greater pain relief in responders. There was a large difference in use of concomitant pain medications, with 80.3% of responders reporting a reduction compared to 11.8% of non

  20. Use of Intra-Arterial Chemotherapy and Embolization Before Limb Salvage Surgery for Osteosarcoma of the Lower Extremity

    SciTech Connect

    Zhang Huojun Yang Jijin Lu Jianping; Lai Chaojen; Sheng Jin; Li Yuxiao; Hao Qiang; Zhang Shunmin; Gupta, Sanjay

    2009-07-15

    We report our experience with the use of intra-arterial chemotherapy and embolization before limb salvage surgery in patients with osteosarcoma of the lower extremity. We evaluated the effect of this procedure on the degree of tumor necrosis and on the amount of blood loss during surgery. We reviewed the medical records of all patients who received intra-arterial chemotherapy and embolization before undergoing limb salvage surgery for osteosarcoma of the lower extremity at our institution between January 2003 and April 2008. Patient demographic, tumor characteristics, treatment details, postembolization complications, and surgical and pathological findings were recorded for each patient. We evaluated the operative time, estimated blood loss (EBL), and volume of blood transfusion during surgery and in the postoperative period in all patients in the study group. The same parameters were recorded for 65 other patients with lower extremity osteosarcoma who underwent limb salvage operation at our institution without undergoing preoperative intervention. The study included 47 patients (25 males and 22 females). Angiography showed that the tumors were hypervascular. Intra-arterial chemotherapy and embolization were performed successfully, resulting in a substantial reduction or complete disappearance of tumor stain in all patients. No major complications were encountered. At the time of surgery, performed 3-7 days after embolization, a fibrous edematous band around the tumor was observed in 43 of the 47 patients, facilitating surgery. The goal of limb salvage was achieved successfully in all cases. Percentage tumor necrosis induced by treatment ranged from 70.2% to 94.2% (average, 82.9%). EBL during surgery, EBL from drains in the postoperative period, total EBL, and transfusion volumes were significantly lower in the 47 study patients compared to the 65 patients who underwent surgery without preoperative treatment with intra-arterial chemotherapy and embolization. The

  1. [Transplantation of adipose tissue multipotent stromal cells in the treatment of chronic ischemia of the lower extremities].

    PubMed

    Saliutin, R V; Palianytsia, S S; Sirman, V M; Panchenko, L A; Komarova, L S

    2014-07-01

    The expediency of the stromal cells application, obtained from adipose tissue, was determined in a frame of preclinical investigations conduction, concerning experimental works on laboratory rats, in whom the extremity ischemia was simulated. Histologic and immunohistochemical changes were studied in muscular tissue after transplantation of multipotent stromal cells of own adipose tissue in patients, suffering ischemia of the lower extremity. Reduction of severity of the myofibrills ischemic damage, rapid activation of the muscles regenerative power, accurate stimulation of the angiogenesis processes in 3 mo after transplantation of the cells were demonstrated. PMID:25252413

  2. Shales and swelling soils

    NASA Astrophysics Data System (ADS)

    Franklin, J. A.; Dimillio, A. F.; Strohm, W. E., Jr.; Vandre, B. C.; Anderson, L. R.

    The thirteen (13) papers in this report deal with the following areas: a shale rating system and tentative applications to shale performance; technical guidelines for the design and construction of shale embankments; stability of waste shale embankments; dynamic response of raw and stabilized Oklahoma shales; laboratory studies of the stabilization of nondurable shales; swelling shale and collapsing soil; development of a laboratory compaction degradation test for shales; soil section approach for evaluation of swelling potential soil moisture properties of subgrade soils; volume changes in compacted clays and shales on saturation; characterization of expansive soils; pavement roughness on expansive clays; and deep vertical fabric moisture barriers in swelling soils.

  3. Mimickers of lumbar radiculopathy.

    PubMed

    Grimm, Bennett Douglas; Blessinger, Brian Joseph; Darden, Bruce Vaiden; Brigham, Craig D; Kneisl, Jeffrey S; Laxer, Eric B

    2015-01-01

    Orthopaedic surgeons frequently treat patients who report pain that radiates from the back into the lower extremity. Although the most common etiology is either a herniated disk or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy, resulting in differences in the clinical presentation and the workup. Therefore, the clinician must be able to distinguish the signs and symptoms of lumbar radiculopathy from pathologies that may have a similar presentation. Being cognizant of these other possible conditions enables the physician to consider a breadth of alternative diagnoses when a patient presents with radiating lower extremity pain. PMID:25538126

  4. Mimickers of lumbar radiculopathy.

    PubMed

    Grimm, Bennett Douglas; Blessinger, Brian Joseph; Darden, Bruce Vaiden; Brigham, Craig D; Kneisl, Jeffrey S; Laxer, Eric B

    2015-01-01

    Orthopaedic surgeons frequently treat patients who report pain that radiates from the back into the lower extremity. Although the most common etiology is either a herniated disk or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy, resulting in differences in the clinical presentation and the workup. Therefore, the clinician must be able to distinguish the signs and symptoms of lumbar radiculopathy from pathologies that may have a similar presentation. Being cognizant of these other possible conditions enables the physician to consider a breadth of alternative diagnoses when a patient presents with radiating lower extremity pain.

  5. Analysis of walking variability through simultaneous evaluation of the head, lumbar, and lower-extremity acceleration in healthy youth.

    PubMed

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-06-01

    [Purpose] The purpose of this study was to clarify whether walking speed affects acceleration variability of the head, lumbar, and lower extremity by simultaneously evaluating of acceleration. [Subjects and Methods] Twenty young individuals recruited from among the staff at Kurashiki Heisei Hospital participated in this study. Eight accelerometers were used to measure the head, lumbar and lower extremity accelerations. The participants were instructed to walk at five walking speeds prescribed by a metronome. Acceleration variability was assessed by a cross-correlation analysis normalized using z-transform in order to evaluate stride-to-stride variability. [Results] Vertical acceleration variability was the smallest in all body parts, and walking speed effect had laterality. Antero-posterior acceleration variability was significantly associated with walking speed at sites other than the head. Medio-lateral acceleration variability of the bilateral hip alone was smaller than the antero-posterior variability. [Conclusion] The findings of this study suggest that the effect of walking speed changes on the stride-to-stride acceleration variability was individual for each body parts, and differs among directions.

  6. Analysis of walking variability through simultaneous evaluation of the head, lumbar, and lower-extremity acceleration in healthy youth

    PubMed Central

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-01-01

    [Purpose] The purpose of this study was to clarify whether walking speed affects acceleration variability of the head, lumbar, and lower extremity by simultaneously evaluating of acceleration. [Subjects and Methods] Twenty young individuals recruited from among the staff at Kurashiki Heisei Hospital participated in this study. Eight accelerometers were used to measure the head, lumbar and lower extremity accelerations. The participants were instructed to walk at five walking speeds prescribed by a metronome. Acceleration variability was assessed by a cross-correlation analysis normalized using z-transform in order to evaluate stride-to-stride variability. [Results] Vertical acceleration variability was the smallest in all body parts, and walking speed effect had laterality. Antero-posterior acceleration variability was significantly associated with walking speed at sites other than the head. Medio-lateral acceleration variability of the bilateral hip alone was smaller than the antero-posterior variability. [Conclusion] The findings of this study suggest that the effect of walking speed changes on the stride-to-stride acceleration variability was individual for each body parts, and differs among directions. PMID:27390419

  7. Analysis of walking variability through simultaneous evaluation of the head, lumbar, and lower-extremity acceleration in healthy youth.

    PubMed

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-06-01

    [Purpose] The purpose of this study was to clarify whether walking speed affects acceleration variability of the head, lumbar, and lower extremity by simultaneously evaluating of acceleration. [Subjects and Methods] Twenty young individuals recruited from among the staff at Kurashiki Heisei Hospital participated in this study. Eight accelerometers were used to measure the head, lumbar and lower extremity accelerations. The participants were instructed to walk at five walking speeds prescribed by a metronome. Acceleration variability was assessed by a cross-correlation analysis normalized using z-transform in order to evaluate stride-to-stride variability. [Results] Vertical acceleration variability was the smallest in all body parts, and walking speed effect had laterality. Antero-posterior acceleration variability was significantly associated with walking speed at sites other than the head. Medio-lateral acceleration variability of the bilateral hip alone was smaller than the antero-posterior variability. [Conclusion] The findings of this study suggest that the effect of walking speed changes on the stride-to-stride acceleration variability was individual for each body parts, and differs among directions. PMID:27390419

  8. A Multiple Degree of Freedom Lower Extremity Isometric Device to Simultaneously Quantify Hip, Knee, and Ankle Torques.

    PubMed

    Sánchez, Natalia; Acosta, Ana Maria; Stienen, Arno H A; Dewald, Julius P A

    2015-09-01

    Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee, or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee, and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee, and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation, and validation of a multiple degree of freedom, lower extremity isometric device (the MultiLEIT) that accurately quantifies simultaneous torques at the hip, knee, and ankle. The system was mechanically validated and then implemented with two healthy control individuals and two post-stroke individuals to test usability and patient acceptance. Data indicated different joint torque coupling strategies used by both healthy individuals. In contrast, data showed the same torque coupling patterns in both post-stroke individuals, comparable to those described in the clinic. Successful implementation of the MultiLEIT can contribute to the understanding of the underlying mechanisms responsible for abnormal movement patterns and aid in the design of therapeutic interventions.

  9. The role of leukodepletion in limiting ischemia/reperfusion damage in the heart, lung and lower extremity.

    PubMed

    Allen, Bradley S

    2002-05-01

    This article describes the experimental infrastructure and subsequent clinical application of a comprehensive reperfusion strategy to limit the injury following ischemia, resulting in an improvement in post operative organ function. In particular, it examines the role of luekodepletion in minimizing damage and improving functional outcome in the heart, lung and lower extremity. During cardiothoracic procedures, various organs can be subjected to temporary ischemia, particularly the heart (cardioplegic arrest), lung (transplant), and lower extremity (femoral canulation, IABP). The background of ischemia/reperfusion injury is discussed as it applies to each of these 3 organs, as well as findings that ischemia followed by reperfusion results in a similar injury in each organ. Data are then presented to demonstrate that a comprehensive reperfusion strategy, utilizing a modified substrate-enriched blood reperfusate delivered at a low pressure can limit this injury, and that adding white blood cell filtration significantly improves the efficacy of this approach. These principles have now been used in a series of patients undergoing various surgical procedures with excellent results. Application of these concepts may significantly improve the outcome in patients undergoing procedures which subject these organs to temporary ischemia. PMID:12009081

  10. Dynamic Frequency Analyses of Lower Extremity Muscles during Sit-To-Stand Motion for the Patients with Knee Osteoarthritis

    PubMed Central

    Suzuki, Kentaro; Yagi, Masahide

    2016-01-01

    Objective Muscle activities during the sit-to-stand motion (STS) are characterized by coordinated movements between hip extensors and knee extensors. However, previous reports regarding the STS and lower extremity muscle activities have focused on some quantitative assessment, but little qualitative research. This study aimed to examine the muscle activities of the lower extremity both quantitatively and qualitatively. Methods Study participants included 13 patients with knee osteoarthritis (knee OA) and 11 age-matched asymptomatic controls. The task was STS from a chair with a height-adjustable seat. EMG activities were acquired using surface electromyogram. The root mean square signals normalized as a percentage of maximum voluntary isometric contraction values (RMS%MVC) and the mean power frequency (MPF) were calculated. Results During STS, knee OA patients had increased RMS%MVC of the vastus medialis and raised MPF of the rectus femoris before buttocks-off. Conclusion These findings suggest that STS of knee OA patients not only increased relative muscle activity of the vastus medialis, but also enlisted the rectus femoris in knee extension to improve muscle contraction force by activating more type II fibers to accomplish buttocks-off. PMID:26807578

  11. The Effect of Backpack Load on Muscle Activities of the Trunk and Lower Extremities and Plantar Foot Pressure in Flatfoot

    PubMed Central

    Son, Hohee

    2013-01-01

    [Purpose] The purpose of this study was to investigate the changes in muscle activation of the trunk and lower extremities and plantar foot pressure due to backpack loads of 0, 10, 15, and 20% of body weight during level walking in individuals with flatfoot. [Methods] Fourteen young flatfoot subjects and 12 normal foot subjects participated in this study. In each session, the subjects were assigned to carry a backpack load, and there were four level walking modes: (1) unloaded walking (0%), (2) 10% body weight (BW) load, (3) 15% BW load, and (4) 20% BW load. Trunk and lower extremity muscle activities were recorded by surface EMG, and contact area and plantar foot pressure were determined using a RS scan system. [Results] The erector spinae, vastus medialis, tibialis anterior and gastrocnemius muscle activities, but not the rectus femoris and rectus abdominis muscle activities of flatfoot subjects significantly and progressively increased as load increased in flatfoot subjects. Contact area and pressure of the lateral and medial heel zones were significantly increased too. [Conclusion] Based on this data, the weight of a backpack could influence muscle activation and plantar foot pressure in flatfoot. PMID:24396193

  12. Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

    SciTech Connect

    Yamagami, Takuji Kato, Takeharu; Iida, Shigeharu; Hirota, Tatsuya; Nishimura, Tsunehiko

    2005-05-15

    Purpose. To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity. Methods. We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology. Results. Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 {+-} 8.3 days (mean {+-} SD, range 4-37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment. Conclusion. The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary.

  13. A Multiple Degree of Freedom Lower Extremity Isometric Device to Simultaneously Quantify Hip, Knee and Ankle Torques

    PubMed Central

    Sánchez, Natalia; Acosta, Ana Maria; Stienen, Arno H.A.

    2015-01-01

    Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation and validation of a multiple degree of freedom, lower extremity isometric device (the MultiLEIT) that accurately quantifies simultaneous torques at the hip, knee and ankle. The system was mechanically validated and then implemented with two healthy control individuals and two post-stroke individuals to test usability and patient acceptance. Data indicated different joint torque coupling strategies used by both healthy individuals. In contrast, data showed the same torque coupling patterns in both post-stroke individuals, comparable to those described in the clinic. Successful implementation of the MultiLEIT can contribute to the understanding of the underlying mechanisms responsible for abnormal movement patterns and aid in the design of therapeutic interventions. PMID:25163064

  14. Differences in distal lower extremity tissue masses and mass ratios exist in athletes of sports involving repetitive impacts.

    PubMed

    Schinkel-Ivy, Alison; Burkhart, Timothy A; Andrews, David M

    2014-01-01

    This study aimed to examine the effects of sex and sport on the tissue composition of the distal lower extremity of varsity athletes, in sports that involve repetitive-impact loading patterns. Fat mass, lean mass, bone mineral content and wobbling mass were predicted for the leg and leg + foot segments of varsity basketball, cross-country, soccer and volleyball athletes. The absolute masses were normalised to body mass, and also expressed relative to each other as ratios. Females and males differed on most normalised tissue masses and ratios by 11-101%. Characteristic differences were found in the normalised tissue masses across sports, with the lowest and highest values displayed by cross-country and volleyball (female)/basketball (male) athletes, respectively. Conversely, cross-country athletes had the highest wobbling mass:bone mineral content and lean mass:bone mineral content ratios for females by 10% and 16%, respectively. The differences between sports may be explained in part by different impact loading patterns characteristic of each sport. Tissue mass ratio differences between sports may suggest that the ratios of soft to rigid tissues are optimised by the body in response to typical loading patterns, and may therefore be useful in investigations of distal lower extremity injury mechanisms in athletes.

  15. Comparison of joint angles and electromyographic activity of the lower extremities during standing with wearing standard and revised high-heeled shoes: A pilot study.

    PubMed

    Bae, Young-Hyeon; Ko, Mansoo; Lee, Suk Min

    2016-04-29

    Revised high-heeled shoes (HHSs) were designed to improve the shortcomings of standard HHSs. This study was conducted to compare revised and standard HHSs with regard to joint angles and electromyographic (EMG) activity of the lower extremities during standing. The participants were five healthy young women. Data regarding joint angles and EMG activity of the lower extremities were obtained under three conditions: barefoot, when wearing revised HHSs, and when wearing standard HHSs. Lower extremity joint angles in the three dimensional plane were confirmed using a VICON motion capture system. EMG activity of the lower extremities was measured using active bipolar surface EMG. Kruskal-Wallis one-way analysis of variance by rank applied to analyze differences during three standing conditions. Compared with the barefoot condition, the standard HHSs condition was more different than the revised HHSs condition with regard to lower extremity joint angles during standing. EMG activity of the lower extremities was different for the revised HHSs condition, but the differences among the three conditions were not significant. Wearing revised HHSs may positively impact joint angles and EMG activity of the lower extremities by improving body alignment while standing. PMID:27163313

  16. Chondromyxoid fibroma of the frontal bone mimicking meningioma.

    PubMed

    Wang, Hao; Shu, Hansheng; Tian, Xuping; Zhang, Hui; Zhang, Qiujian; Guo, Liemei

    2015-03-01

    Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor that usually arises from lower-extremity long-bone metaphyses, with approximately 5.4% of all CMFs presenting in the craniofacial bones. Chondromyxoid fibroma of the frontal bone is exceedingly rare, with only a few cases reported. Herein, we report another case of CMF arising from the frontal bone mimicking meningioma. We suggest that histopathologic examination is of vital importance for the diagnosis of CMF; complete surgical resection is the best treatment option for frontal CMF.

  17. Chondromyxoid fibroma of the frontal bone mimicking meningioma.

    PubMed

    Wang, Hao; Shu, Hansheng; Tian, Xuping; Zhang, Hui; Zhang, Qiujian; Guo, Liemei

    2015-03-01

    Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor that usually arises from lower-extremity long-bone metaphyses, with approximately 5.4% of all CMFs presenting in the craniofacial bones. Chondromyxoid fibroma of the frontal bone is exceedingly rare, with only a few cases reported. Herein, we report another case of CMF arising from the frontal bone mimicking meningioma. We suggest that histopathologic examination is of vital importance for the diagnosis of CMF; complete surgical resection is the best treatment option for frontal CMF. PMID:25748938

  18. Lower Extremity Radiography

    MedlinePlus

    ... images of the toes, feet, ankles, lower leg, knee, upper leg or hip. These types of examinations are performed to detect conditions such as fractures, soft tissue damage and arthritis. A physician will ...

  19. The reliability of the modified lower extremity functional scale among adults living with HIV on antiretroviral therapy, in Rwanda, Africa

    PubMed Central

    Tumusiime, D.K.; Stewart, A.; Venter, F.W.D.; Musenge, E.

    2014-01-01

    Abstract Peripheral neuropathy (PN) is common among people living with HIV (PLHIV) on antiretroviral therapy (ART), and affects their daily functional ability and quality of life. Lower extremity functional ability, which is most commonly compromised in patients with PN, has not been clearly evaluated in an African setting, with regard to functional limitations. The lower extremity functional scale (LEFS) was originally developed and validated among elderly people in the USA, where the environment and activities of daily life are very different from those in Rwanda. The purpose of this study was to adapt and establish the reliability of LEFS, among adults living with HIV on ART, in a Rwandan environment. The study translated LEFS from English to Kinyarwanda, the local language spoken in Rwanda, the LEFS was then modified accordingly, and tested for test-retest reliability among 50 adult PLHIV on ART. An average Spearman rank order correlation coefficient, ρ ≥ 0.7, was considered optimal for reliability. Prior to the modification of the LEFS and in the initial testing of the translated LEFS, none of the activities was strongly correlated (ρ ≥ 0.8); most of the activities (90%, 18/20) were moderately correlated (ρ ≥ 0.5) and 10% (2/20) were weakly correlated (ρ ≤ 0.5). The ρ of most of the functional activities improved after modification by an expert group to ρ ≥ 0.7, establishing reliability and validity of LEFS among PLHIV on ART with lower extremity functional limitations, in this environment. In conclusion, this study demonstrated the importance of modifying and establishing test – retest reliability of tools derived from developed world contexts to local conditions in developing countries, such as in Rwanda. The modified LEFS in this study can be used in Rwanda by clinicians, specifically at ART clinics to screen and identify people with functional limitations at an early stage of the limitations, for treatment

  20. The effect of limb crossing and limb congruency on multisensory integration in peripersonal space for the upper and lower extremities.

    PubMed

    van Elk, Michiel; Forget, Joachim; Blanke, Olaf

    2013-06-01

    The present study investigated how multisensory integration in peripersonal space is modulated by limb posture (i.e. whether the limbs are crossed or uncrossed) and limb congruency (i.e. whether the observed body part matches the actual position of one's limb). This was done separately for the upper limbs (Experiment 1) and the lower limbs (Experiment 2). The crossmodal congruency task was used to measure peripersonal space integration for the hands and the feet. It was found that the peripersonal space representation for the hands but not for the feet is dynamically updated based on both limb posture and limb congruency. Together these findings show how dynamic cues from vision, proprioception, and touch are integrated in peripersonal limb space and highlight fundamental differences in the way in which peripersonal space is represented for the upper and lower extremity. PMID:23579198

  1. Extensive muscle necrosis and infection following treatment of a lower extremity vascular malformation with Sotradecol and absolute ethanol.

    PubMed

    Zochowski, Christopher G; Salgado, Christopher J; Jamali, Amir A

    2010-07-01

    Venous malformations are a subset of low-flow vascular malformations. These are usually present at birth and grow commensurate with the child. The treatment of low-flow vascular malformations has been studied extensively. Many interventions have been devised to benefit this patient population in regard to the pain, ulcerations, infections, cosmetic concerns, and overall bulk associated with these malformations. Treatment can begin with compression garments. Another treatment is sclerotherapy. This can be done as a stand-alone treatment or as an adjunct to surgical excision. Percutaneous sclerosis of venous malformations has an efficacy of between 74 and 90% in relieving symptoms. We present a case of percutaneous sclerotherapy with Sotradecol and ethanol into an extensive lower extremity venous malformation in the setting of orthopedic megaprosthesis. We feel that this led to extensive soft tissue necrosis and infection of the limb and created a precipitous situation.

  2. Treatment of lower extremity injuries due to antipersonnel mines: blast resuscitation and victim assistance team experiences in Cambodia.

    PubMed

    Parr, Reagan R; Providence, Bertram C; Burkhalter, William E; Smith, Allan C

    2003-07-01

    The two teams comprising the fiscal year 2001 Blast Resuscitation and Victim Assistance mission had the opportunity to learn from and practice mine injury treatment principles with experienced local and international war surgeons in Cambodia. Treatment principles were modifications of International Committee of the Red Cross recommendations. A total of 14 acute lower extremity mine injuries were treated. Surgery generally consisted of an open amputation or thorough irrigation and debridement using equipment readily available in any U.S. military field hospital. The surgical techniques will be described in detail. Delayed primary closure occurred 5 days later followed by prosthesis fitting (for amputees) in an International Committee of the Red Cross facility 12 weeks later. Other options and techniques will be discussed with an emphasis on applicability to U.S. military field surgery. PMID:12901462

  3. A comparison of diabetic smokers and non-smokers who undergo lower extremity amputation: a retrospective review of 112 patients

    PubMed Central

    Anderson, J. Joseph; Boone, Joshua; Hansen, Myron; Spencer, Loren; Fowler, Zflan

    2012-01-01

    Background A diabetic foot or lower extremity amputation may be exacerbated by or related to the smoking habits and history of the patient. Patients and methods Of the 112 diabetic patients in this retrospective study, 46 were non-smokers and 66 were smokers. The smokers were further categorized into patients who: 1) did not cease smoking; 2) ceased in the immediate post-operative period but resumed within 3 months; and 3) ceased up to and at the 3-month post-operative period. The patients were also divided by their amputation level of forefoot, midfoot/rearfoot, and proximal leg. Results Smoking diabetic patients underwent more amputations, as well as more proximal amputations than those who did not smoke. The higher amount of smoking in pack years followed an increasing trend of more proximal amputations as well. Conclusion Neither the amputation level nor the amputation itself was enough motivation for the patients to participate in smoking cessation. PMID:23082237

  4. [Case report: Infestation of lower extremities by Phthirus pubis, Linnaeus 1758 after contact with second-hand furniture].

    PubMed

    Akdemir, Cihangir; Demirci, Mustafa; Mıstanoğlu, Duru

    2011-01-01

    This case has been filed as a 21-year old male patient who was diagnosed with P. pubis present in his tibial hair. The agent was not found in body parts of the patient other than both lower extremities. The infestation is thought to stem from using second-hand furniture which had been bought the day before the case developed; as other possible ways of infection such as transmission through the rest of the residents of the house were ruled out in our medical investigation. It is understood that second-hand furniture pieces such as mattresses, quilts, carpets, and sofas might be a source of infection of P. pubis including tibial hair areas. The conclusion is that, in infested people or those who are exposed to such a risk, this possibility should be taken into account.

  5. A study of the effects of prolonged simulated microgravity on the musculature of the lower extremities in man - An introduction

    NASA Technical Reports Server (NTRS)

    Buchanan, Paul; Convertino, Victor A.

    1989-01-01

    The experimental approach and the protocol are described for a study designed to investigate the effect of prolonged microgravity (simulated by a continuous exposure of subjects to 30-d-long 6-deg headdown tilt) on the musculature of the lower extremities in humans. The objectives of this study are as follows: (1) to determine changes in the functional characteristics of knee joint flexor and extensor muscle group; (2) to examine changes in the histochemical, biochemical, electron microscopic, and computed tomographic characteristics of skeletal muscle; (3) to determine if functional characteristics of skeletal muscle would be normalized four weeks after the bedrest; and (4) to compare these results to those of spaceflight. Percutaneous muscle biopsy, computed tomography, anthropometry, and in vivo muscle strength measurements are to be used to assess mechanical, structural, and metabolic characteristics of skeletal muscle.

  6. The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults.

    PubMed

    Warren, Meghan; Ganley, Kathleen J; Pohl, Patricia S

    2016-12-01

    Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001-2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5-6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation.

  7. Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review.

    PubMed

    Ward, Rachel E; Caserotti, Paolo; Cauley, Jane A; Boudreau, Robert M; Goodpaster, Bret H; Vinik, Aaron I; Newman, Anne B; Strotmeyer, Elsa S

    2016-08-01

    The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (≥65 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those

  8. Effects of the lower extremities muscle activation during muscular strength training on an unstable platform with magneto-rheological dampers

    NASA Astrophysics Data System (ADS)

    Piao, YongJun; Choi, YounJung; Kim, JungJa; Kwan, TaeKyu; Kim, Nam-Gyun

    2009-03-01

    Adequate postural balance depends on the spatial and temporal integration of vestibular, visual, and somatosensory information. Especially, the musculoskeletal function (range of joint, flexibility of spine, muscular strength) is essential in maintaining the postural balance. Muscular strength training methods include the use of commercialized devices and repeatable resistance training tools (rubber band, ball, etc). These training systems cost high price and can't control of intensity. Thus we suggest a new training system which can adjust training intensity and indicate the center of pressure of a subject while the training was passively controlled by applying controlled electric current to the Magneto- Rheological damper. And we performed experimental studies on the muscular activities in the lower extremities during maintaining, moving and pushing exercises on an unstable platform with Magneto rheological dampers. A subject executed the maintaining, moving and pushing exercises which were displayed in a monitor. The electromyographic signals of the eight muscles in lower extremities were recorded and analyzed in the time and frequency domain: the muscles of interest were rectus femoris, biceps femoris, tensor fasciae latae, vastus lateralis, vastus medialis, gastrocnemius, tibialis anterior, and soleus. The experimental results showed the difference of muscular activities at the four moving exercises and the nine maintaining exercises. The rate of the increase in the muscular activities was affected by the condition of the unstable platform with MR dampers for the maintaining and moving exercises. The experimental results suggested the choice of different maintaining and moving exercises could selectively train different muscles with varying intensity. Furthermore, the findings also suggested the training using this system can improve the ability of postural balance.

  9. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration.

    PubMed

    Rankin, Timothy M; Miller, John D; Gruessner, Angelika C; Nickerson, D Scott

    2015-07-01

    The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States.

  10. The Effects of Wearing High Heels while Pressing a Car Accelerator Pedal on Lower Extremity Muscle Activation.

    PubMed

    Jung, Jaemin; Lee, Sang-Yeol

    2014-11-01

    [Purpose] The purpose of this study was to determine the effects of wearing high heels while driving on lower extremity muscle activation. [Subjects] The subjects of this experimental study were 14 healthy women in their 20s who normally wear shoes with high heels. [Methods] The subjects were asked to place their shoes on an accelerator pedal with the heel touching the floor and then asked to press the pedal with as much pressure as possible for 3 seconds before removing their feet from the pedal. A total of 3 measurements were taken for each heel height (flat, 5 cm, 7 cm), and the heel height was randomly selected. [Results] The levels of muscle activity, indicated as the percentage of reference voluntary contraction, for gastrocnemius muscle in the flat, 5 cm, and 7 cm shoes were 180.8±61.8%, 285.4±122.3%, and 366.2±193.7%, respectively, and there were significant differences between groups. Those for the soleus muscle were 477.3±209.2%, 718.8±380.5%, and 882.4±509.9%, and there were significant differences between groups. [Conclusion] To summarize the results of this study, it was found that female drivers require greater lower extremity muscle activation when wearing high heels than when wearing low heels. Furthermore, instability and muscle fatigue of the ankle joint, which results from wearing high heels on a daily basis, could also occur while driving.

  11. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration

    PubMed Central

    Rankin, Timothy M.; Miller, John D.; Gruessner, Angelika C.; Nickerson, D. Scott

    2015-01-01

    The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States. PMID:26055081

  12. Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review.

    PubMed

    Ward, Rachel E; Caserotti, Paolo; Cauley, Jane A; Boudreau, Robert M; Goodpaster, Bret H; Vinik, Aaron I; Newman, Anne B; Strotmeyer, Elsa S

    2016-08-01

    The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (≥65 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those

  13. A Comparison of Stride Length and Lower Extremity Kinematics during Barefoot and Shod Running in Well Trained Distance Runners

    PubMed Central

    Francis, Peter; Ledingham, James; Clarke, Sarah; Collins, DJ; Jakeman, Philip

    2016-01-01

    Stride length, hip, knee and ankle angles were compared during barefoot and shod running on a treadmill at two speeds. Nine well-trained (1500m time: 3min:59.80s ± 14.7 s) male (22 ±3 years; 73 ±9 kg; 1.79 ±0.4 m) middle distance (800 m – 5,000 m) runners performed 2 minutes of running at 3.05 m·s-1 and 4.72 m·s-1 on an treadmill. This approach allowed continuous measurement of lower extremity kinematic data and calculation of stride length. Statistical analysis using a 2X2 factorial ANOVA revealed speed to have a main effect on stride length and hip angle and footwear to have a main effect on hip angle. There was a significant speed*footwear interaction for knee and ankle angles. Compared to shod running at the lower speed (3.05 m·s-1), well trained runners have greater hip, knee and ankle angles when running barefoot. Runners undertake a high volume (~75%) of training at lower intensities and therefore knowledge of how barefoot running alters running kinematics at low and high speeds may be useful to the runner. Key points Barefoot and shod kinematics are examined in competitive track runners with a mean 1500m personal best of 3:59:80. Previous literature has not investigated competitive track runners. Compared to amateur runners, competitive track runners demonstrate a smaller reduction in stride length during barefoot running at ~3 m·s-1. There is no difference in stride length or lower extremity kinematics when running at 4.72 m·s-1. Given that competitive runners spend a large (~75%) amount of time training at lower speeds, interventions which favourably alter running kinematics may be advantageous for the prevention of injury. PMID:27803620

  14. The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults.

    PubMed

    Warren, Meghan; Ganley, Kathleen J; Pohl, Patricia S

    2016-12-01

    Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001-2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5-6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation. PMID:27413675

  15. HIV/AIDS and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement.

    PubMed

    Saber, A A; Aboolian, A; LaRaja, R D; Baron, H; Hanna, K

    2001-07-01

    Many aspects of acquired immunodeficiency syndrome (AIDS) have been described in detail in the literature. However, there have been very few articles on the phenomenon of deep vein thrombosis (DVT) in the lower extremities of human immunodeficiency virus (HIV)/AIDS patients. The objective of this communication is to record the incidence of DVT in HIV/AIDS patients and the risks for development of embolic events and to emphasize the need for prevention and for the vigorous treatment of this complication. We conducted a retrospective review of HIV/AIDS-infected patients with DVT admitted to Mount Sinai School of Medicine/Cabrini Hospital in New York during the last 5 years. Analysis includes demographic data; risk factors for HIV/AIDS infection; associated medical problems; recent surgery; and laboratory findings including CD4 counts, platelet counts, prothrombin times, partial thromboplastin times, and plasma albumin levels; and image studies. From January 1995 to January 2000 4752 HIV/AIDS-infected patients were admitted. Of those admitted to the hospital 45 (0.95%) were found to have DVT. There were 36 males and nine females (mean age 43 years). Of the 45 patients 38 had infectious complications and 13 developed a malignancy. The distribution of the thromboses were the femoral vein in 23 patients, the popliteal vein in 20 patients, and the iliofemoral system in 2 patients. Twelve patients had recurrent DVT and three patients developed a pulmonary embolism. HIV/AIDS infection is a considerable risk for development of DVT in the lower extremity. Statistically DVT in HIV/AIDS is approximately 10 times greater than in the general population. Emphasis upon prevention and vigorous treatment of DVT is recommended.

  16. Testing and Modeling the Responses of Hybrid III Crash-Dummy Lower Extremity under High-speed Vertical Loading.

    PubMed

    Zhu, Feng; Dong, Liqiang; Jin, Xin; Jiang, Binhui; Kalra, Anil; Shen, Ming; Yang, King H

    2015-11-01

    Anthropometric test devices (ATDs), such as the Hybrid III crash-test dummy, have been used to simulate lowerextremity responses to military personnel subjected to loading conditions from anti-vehicular (AV) landmine blasts. Numerical simulations [e.g., finite element (FE) analysis] of such high-speed vertical loading on ATD parts require accurate material parameters that are dependent on strain rate. This study presents a combined experimental and computational study to calibrate the rate-dependent properties of three materials on the lower extremities of the Hybrid III dummy. The three materials are heelpad foam, foot skin, and lower-leg flesh, and each has properties that can affect simulation results of forces and moments transferred to the lower extremities. Specifically, the behavior of the heel-pad foam was directly calibrated through standard compression tests, and the properties of the foot skin and lower-leg flesh were calibrated based on an optimization procedure in which the material parameters were adjusted for best fit between the calculated force-deflection responses and least squares of the experimental data. The material models updated with strain-rate effects were then integrated into an ATD full-body FE model (FEM), which was used to simulate vertical impulsive loading responses at different speeds. Results of validations using this model demonstrated basic replication of experimentally obtained response patterns of the tibia. The bending moments matched those calculated from the experimental data 25-40% more accurately than those obtained from the original model, and axial forces were 60-90% more accurate. However, neither the original nor the modified models well captured whole-body response patterns, and further improvements are required. As a generalized approach, the optimization method presented in this paper can be applied to characterize material constants for a wide range of materials. PMID:26660755

  17. A research on the effects of practicing Baduanjin on the lower extremities by using sEMG

    NASA Astrophysics Data System (ADS)

    Jin, Li; Li, Ran; Chen, Jing; Tian, Ye

    2015-03-01

    The purpose of this study was to evaluate the effects of practicing Baduanjin exercises on the lower extremities of subjects, using electromyography analysis, and values of IEMG were calculated. [Subjects] Forty, healthy adults were randomly assigned as subjects to two groups: SG (Study Group, n=20) who received twelve weeks of Baduanjin training, and CG (Control Group, n=20), who received no training. [Methods] A sixteen-channel sEMG system (ME6000, Mega Electronics Ltd., Kuopio, Finland) was selected to record and measure activity changes in two muscles (vastus medialis and vastus lateralis). [Results] After twelve-week of Baduanjin training, the results of this study showed that the SG group had significant increases in values of IEMG in second, fifth and seventh section of the Baduanjin exercises. In second section, the values of IEMG had increased for 56.95% in vastus lateralis (p < 0.05) and for 40.04% in vastus medialis (p < 0.05). In fifth section, the values of IEMG had increased for 37.61% in vastus lateralis (p < 0.05) and for 33.83% in vastus medialis (p < 0.05). In seventh section, the increasement of IEMG values was 47.19% in vastus lateralis (p < 0.05) and 49.31% in vastus medialis (p < 0.05). [Conclusion] This study indicated that performing twelve-week of Baduanjin training can significantly increase the strength and the physical function of the lower extremities among healthy adults. With no adverse events from exercise were reported during the training procedure, the safety and low intensity of Baduanjin exercise was also proved, it could be widely taken as an appropriate no-risk treatment exercise for healthy adults.

  18. Is thrombophilia a major risk factor for deep vein thrombosis of the lower extremities among Lebanese patients?

    PubMed Central

    Kreidy, R; Irani-Hakime, N

    2009-01-01

    Aim Factor V Leiden (R506Q) mutation is the most commonly observed inherited genetic abnormality related to vein thrombosis. Lebanon has one of the highest frequencies of this mutation in the world with a prevalence of 14.4% in the general population. The aim of this study is to define risk factors including inherited genetic abnormalities among Lebanese patients with lower extremity deep vein thrombosis. We report the clinical outcome of patients with thrombophilia. Methods From January 1998 to January 2008, 162 patients (61 males and 101 females) were diagnosed with lower extremity deep vein thrombosis. Mean age was 61 years (range: 21 to 95 years). Results The most frequent risk factors for vein thrombosis were surgery, advanced age, obesity, and cancer. Twenty-five patients had thrombophilia, 16 patients had factor V Leiden (R506Q) mutation, and seven patients had MTHFR C677T mutation. Ninety-two percent of patients screened for thrombophilia were positive. Screening was requested in young patients (16), patients with recurrent (11), spontaneous (8), and extensive (5) venous thrombosis, familial history (5), pregnancy (4), estroprogestative treatment (3), and air travel (1). Nine patients had one, 11 patients had two, and five had three of these conditions. Follow-up (6 to 120 months) of these 25 patients treated with antivitamin K did not reveal recurrences or complications related to venous thromboembolism. Conclusion Factor V Leiden mutation followed by MTHFR mutation are the most commonly observed genetic abnormalities in these series. Defining risk factors and screening for thrombophilia when indicated reduce recurrence rate and complications. Recommendations for thrombophilia screening will be proposed. PMID:19688103

  19. Lower-extremity strength profiles and gender-based classification of basketball players ages 9-22 years.

    PubMed

    Buchanan, Patricia A; Vardaxis, Vassilios G

    2009-03-01

    Despite an increase in women sports participants and recognition of gender differences in injury patterns (e.g., knee), few normative strength data exist beyond hamstrings and quadriceps measures. This study had 2 purposes: to assess the lower-extremity strength of women (W) and men (M) basketball players who were 9-22 years old, and to determine which strength measures most correctly classify the gender of 12- to 22-year-old athletes. Fifty basketball players (26 W, 24 M) without ligamentous or meniscal injury performed concentric isokinetic testing of bilateral hip, knee, and ankle musculature. We identified maximal peak torques for the hip (flexors, extensors, abductors, adductors), knee (flexors and extensors), and ankle (plantar flexors and dorsiflexors), and we formed periarticular (hip, knee, and ankle), antigravity, and total leg strength composite measures. We calculated mean and 95% confidence intervals. With body mass-height normalization, most age and gender differences were small. Mean values were typically higher for older vs. younger players and for men vs. women players. Mean values were often lower for girls 12-13 years vs. those 9-10 years. In the age group of 16-22 years, men had stronger knee flexors, hip flexors, plantar flexors, and total leg strength than women. Men who were 16-22 years old had stronger knee flexors and hip flexors than did younger men and women players. Based on discriminant function, knee strength measures did not adequately classify gender. Instead, total leg strength measures had correct gender classifications of 74 and 69% (jackknifed) with significant multivariate tests (p = 0.025). For researchers and practitioners, these results support strength assessment and training of the whole lower extremity, not just knee musculature. Limited strength differences between girls 9-10 years old and those 12-13 years old suggest that the peripubertal period is an important time to target strength development.

  20. Simultaneous toe-to-hand transfer and lower extremity amputations for severe upper and lower limb defects: the use of spare parts.

    PubMed

    Chang, J; Jones, N F

    2002-06-01

    From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery.

  1. Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

    SciTech Connect

    Oguzkurt, Levent Ozkan, Ugur; Tercan, Fahri; Koc, Zafer

    2007-04-15

    We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

  2. Intermittent facial swelling

    PubMed Central

    Pope, Charlie; Gopala Pillai, Suresh Kumar

    2014-01-01

    Intermittent facial swelling is an unusual presentation in the emergency department. The differential diagnosis may range from a variety of causes. Most common differential diagnosis is angio-oedema. However, more serious presentations such as superior venacaval obstruction must not be ignored. This case report presents a patient who was investigated in the hospital for 2 weeks (2 admissions) with intermittent facial swelling. He presented to the emergency department (3rd admission) and was diagnosed to have superior venacaval obstruction secondary to metastatic bronchogenic carcinoma. He underwent emergency endovascular stenting; however, he died within a few weeks. PMID:25326556

  3. Salvage procedures in lower-extremity trauma in a child with hereditary motor and sensory neuropathy type I: a case report

    PubMed Central

    2012-01-01

    Introduction Fractures of the lower extremity are a common type of childhood injury and many can be treated without surgery. Dislocated and open fractures are an indication for fracture stabilization via either intramedullary nailing or, in the case of complicated fractures, external fixation. But if complications are likely because of diseases and disabilities (for example, a neuropathy) that can complicate the post-operative procedure and rehabilitation, what options does one have? Case presentation We report a nine-year-old Caucasian girl who had hereditary motor and sensory neuropathy type I and who was admitted with a grade I open tibia fracture after a fall from a small height. Plain radiographs showed a dislocated tibia and fibula fracture. An open reduction with internal fixation with a compression plate osteosynthesis was performed, and soft tissue debridement combined with an external fixateur was undertaken. Three months later, she was re-admitted with localized swelling and signs of a local soft tissue infection in the middle of her tibia. Plain radiographs showed a non-union of the tibia fracture, and microbiological analysis confirmed a wound infection with cefuroxime-sensitive Staphylococcus aureus. Because of the non-union, the osteosynthesis was replaced with an Ilizarov external fixateur, and appropriate antibiotic therapy was initiated. Four months after the initial accident, the fracture was consolidated and we removed the external fixateur. Conclusions If there is a pre-existing neuropathy and if disease makes it difficult for a child to follow all post-operative instructions, salvage procedures should be kept in mind in case of complications. There are multiple therapeutic options, including osteosynthesis, intramedullary nailing systems, cast therapy, or an external fixateur like the Ilizarov or Taylor spatial frame system. The initial use of an external fixateur such as an Ilizarov or Taylor spatial frame in patients with pre

  4. Hotspot swells revisited

    NASA Astrophysics Data System (ADS)

    King, Scott D.; Adam, Claudia

    2014-10-01

    The first attempts to quantify the width and height of hotspot swells were made more than 30 years ago. Since that time, topography, ocean-floor age, and sediment thickness datasets have improved considerably. Swell heights and widths have been used to estimate the heat flow from the core-mantle boundary, constrain numerical models of plumes, and as an indicator of the origin of hotspots. In this paper, we repeat the analysis of swell geometry and buoyancy flux for 54 hotspots, including the 37 considered by Sleep (1990) and the 49 considered by Courtillot et al. (2003), using the latest and most accurate data. We are able to calculate swell geometry for a number of hotspots that Sleep was only able to estimate by comparison with other swells. We find that in spite of the increased resolution in global bathymetry models there is significant uncertainty in our calculation of buoyancy fluxes due to differences in our measurement of the swells’ width and height, the integration method (volume integration or cross-sectional area), and the variations of the plate velocities between HS2-Nuvel1a (Gripp and Gordon, 1990) and HS3-Nuvel1a (Gripp and Gordon, 2002). We also note that the buoyancy flux for Pacific hotspots is in general larger than for Eurasian, North American, African and Antarctic hotspots. Considering that buoyancy flux is linearly related to plate velocity, we speculate that either the calculation of buoyancy flux using plate velocity over-estimates the actual vertical flow of material from the deep mantle or that convection in the Pacific hemisphere is more vigorous than the Atlantic hemisphere.

  5. Pelvic Rotation and Lower Extremity Motion with Two Different Front Foot Directions in the Tennis Backhand Groundstroke

    PubMed Central

    Iwamoto, Sayumi; Fukubayashi, Toru; Hume, Patria

    2013-01-01

    When a tennis player steps forward to hit a backhand groundstroke in closed stance, modifying the direction of the front foot relative to the net may reduce the risk of ankle injury and increase performance. This study evaluated the relationship between pelvic rotation and lower extremity movement during the backhand groundstroke when players stepped with toes parallel to the net (Level) or with toes pointed towards the net (Net). High school competitive tennis players (eleven males and seven females, 16.8 ± 0.8 years, all right- handed) performed tennis court tests comprising five maximum speed directional runs to the court intersection line to hit an imaginary ball with forehand or backhand swings. The final backhand groundstroke for each player at the backcourt baseline was analyzed. Pelvic rotation and lower extremity motion were quantified using 3D video analysis from frontal and sagittal plane camera views reconstructed to 3D using DLT methods. Plantar flexion of ankle and supination of the front foot were displayed for both Net and Level groups during the late phase of the front foot step. The timings of the peak pelvis rotational velocity and peak pelvis rotational acceleration showed different pattern for Net and Level groups. The peak timing of the pelvis rotational velocity of the Level group occurred during the late phase of the step, suggesting an increase in the risk of inversion ankle sprain and a decrease in stroke power compared to the Net group. Key Points Regarding the movement of the forefoot, the Net group and the Level group showed a pattern of supination-pronation-supination during the front stepping foot contact phase (FSFCP). However, the Level group showed only supination of various degrees during FSFCP. For the Net group, the maximum angular velocity of pelvis occurred in the early phase of FSFCP before impact; however, for the Level group, the maximum angular velocity of pelvis occurred in the latter phase of FSFCP after impact. The

  6. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults

    PubMed Central

    Alnahdi, Ali H; Alderaa, Asma A; Aldali, Ali Z; Alsobayel, Hana

    2015-01-01

    [Purpose] This study aimed to establish gender-specific reference values for the Y Balance Test (YBT) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in healthy young adults in Saudi Arabia, and to examine gender differences in the YBT and LEFS-Ar values. [Subjects and Methods] Healthy young adults (31 females, 30 males) completed the YBT and LEFS-Ar in 1 test session. Descriptive statistical analysis (mean, standard deviation, 95% confidence interval) was used to compute the YBT and LEFS-Ar reference values. Independent t-tests were used to examine gender differences in the YBT and LEFS-Ar values. [Results] Gender-specific reference values were obtained for the right, left, dominant, and non-dominant leg as well as for the average performance of both the legs. males showed greater YBT normalized reach distances than females did in the anterior, posteromedial, and posterolateral directions; furthermore, males showed higher YBT composite scores than females did. However, the LEFS-Ar values did not differ between males and females. [Conclusion] Gender-specific reference values were obtained for the YBT and LEFS-Ar in healthy young adults in Saudi Arabia. males performed better than females did in the YBT. However, no gender differences were noted in LEFS-Ar. PMID:26834380

  7. Validation of the Microsoft Kinect® camera system for measurement of lower extremity jump landing and squatting kinematics.

    PubMed

    Eltoukhy, Moataz; Kelly, Adam; Kim, Chang-Young; Jun, Hyung-Pil; Campbell, Richard; Kuenze, Christopher

    2016-01-01

    Cost effective, quantifiable assessment of lower extremity movement represents potential improvement over standard tools for evaluation of injury risk. Ten healthy participants completed three trials of a drop jump, overhead squat, and single leg squat task. Peak hip and knee kinematics were assessed using an 8 camera BTS Smart 7000DX motion analysis system and the Microsoft Kinect® camera system. The agreement and consistency between both uncorrected and correct Kinect kinematic variables and the BTS camera system were assessed using interclass correlations coefficients. Peak sagittal plane kinematics measured using the Microsoft Kinect® camera system explained a significant amount of variance [Range(hip) = 43.5-62.8%; Range(knee) = 67.5-89.6%] in peak kinematics measured using the BTS camera system. Across tasks, peak knee flexion angle and peak hip flexion were found to be consistent and in agreement when the Microsoft Kinect® camera system was directly compared to the BTS camera system but these values were improved following application of a corrective factor. The Microsoft Kinect® may not be an appropriate surrogate for traditional motion analysis technology, but it may have potential applications as a real-time feedback tool in pathological or high injury risk populations.

  8. A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods

    PubMed Central

    Luque-Moreno, Carlos; Ferragut-Garcías, Alejandro; Rodríguez-Blanco, Cleofás; Heredia-Rizo, Alberto Marcos; Oliva-Pascual-Vaca, Jesús; Kiper, Pawel; Oliva-Pascual-Vaca, Ángel

    2015-01-01

    Objective. To develop a systematic review of the literature, to describe the different virtual reality (VR) interventions and interactive videogames applied to the lower extremity (LE) of stroke patients, and to analyse the results according to the most frequently used outcome measures. Material and Methods. An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane) was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait) were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria. Results. The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention. Conclusions. Although evidence is limited, it suggests that VR intervention (more than 10 sessions) in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and conventional physiotherapy, was used. Flexible software seems to adapt better to patients' requirements, allowing more specific and individual treatments. PMID:26539480

  9. Use of a Dehydrated Amniotic Membrane Allograft on Lower Extremity Ulcers in Patients with Challenging Wounds: A Retrospective Case Series.

    PubMed

    Lintzeris, Dimitrios; Yarrow, Kari; Johnson, Laura; White, Amber; Hampton, Amanda; Strickland, Andy; Albert, Kristy; Cook, Arlene

    2015-10-01

    Lower extremity ulcers in patients with diabetes mellitus may take a long time to heal despite the use of advanced topical therapies. A retrospective review of cases was conducted to assess the use of a dehydrated amniotic membrane allograft (DAMA) in a convenience sample of 9 wounds in 8 patients (5 men, 3 women, average age 62 years [range 31-81 years]) with diabetes mellitus and/or vascular disease. Wound data and patient characteristics were abstracted from medical records. Descriptive statistics were used to summarize the data. In 5 of 9 wounds, DAMA was applied after a failure to demonstrate a 50% reduction in area after 4 weeks of treatment with advanced wound care, offloading, and compression as indicated. In 4 wounds, DAMA was applied 2-4 weeks after presentation because of concerns about existing patient risk factors for nonhealing. Wounds were present for an average of 11 weeks (range 1-35 weeks) before application of DAMA. Mean baseline wound area and volume were 3.11 cm2 (± 3.73) and 0.55 cm3 (± 0.58), respectively. All wounds healed in an average of 5.7 (± 2.9) weeks (range: 1-9 weeks) after a mean of 2.7 applications (± 1.7) (range 1-5 applications). No adverse events occurred. These observations suggest prospective, randomized, controlled clinical studies to compare the use of DAMA to other topical treatment modalities are warranted.

  10. The effect of hip abductor exercise on muscle strength and trunk stability after an injury of the lower extremities

    PubMed Central

    Kak, Hwang-Bo; Park, Sun-Ja; Park, Byun-Joon

    2016-01-01

    [Purpose] The gluteus medius, a hip abductor, controls femoral movement and stabilizes the pelvis during lower extremity mobilization. [Subjects] This study enrolled 24 subjects into control and experimental groups. [Methods] This randomized controlled study included patients who underwent arthroscopy after meniscus injury and started a rehabilitative exercise program 8 weeks after surgery. Subjects were divided into the experimental gluteus medius resistance exercise group (n=12) and the control group (n=12). The study investigated muscle strength and balance of the flexors, extensors, and abductors of the knee for 8 weeks. [Results] Strengths of knee extensors in patients who underwent rehabilitative exercise for 8 weeks were measured. Strength of the knee extensors of the experimental and control groups increased by 40% and 31%, respectively; strength of the hip flexors of the experimental and control groups increased by 31% and 18%, respectively. Strength of the hip joint muscles showed a 40% increase in the experimental group and a 14% increase in the control group. However, there was a significant difference (18%) in muscle strength of the hip abductors between the groups. Measurements of trunk lateral flexion showed a difference within a group, but no intergroup difference was found. [Conclusion] This study investigated the effect of hip abductor exercise on muscular strength and trunk stability in patients with a meniscus injury. PMID:27134387

  11. Validation of the Microsoft Kinect® camera system for measurement of lower extremity jump landing and squatting kinematics.

    PubMed

    Eltoukhy, Moataz; Kelly, Adam; Kim, Chang-Young; Jun, Hyung-Pil; Campbell, Richard; Kuenze, Christopher

    2016-01-01

    Cost effective, quantifiable assessment of lower extremity movement represents potential improvement over standard tools for evaluation of injury risk. Ten healthy participants completed three trials of a drop jump, overhead squat, and single leg squat task. Peak hip and knee kinematics were assessed using an 8 camera BTS Smart 7000DX motion analysis system and the Microsoft Kinect® camera system. The agreement and consistency between both uncorrected and correct Kinect kinematic variables and the BTS camera system were assessed using interclass correlations coefficients. Peak sagittal plane kinematics measured using the Microsoft Kinect® camera system explained a significant amount of variance [Range(hip) = 43.5-62.8%; Range(knee) = 67.5-89.6%] in peak kinematics measured using the BTS camera system. Across tasks, peak knee flexion angle and peak hip flexion were found to be consistent and in agreement when the Microsoft Kinect® camera system was directly compared to the BTS camera system but these values were improved following application of a corrective factor. The Microsoft Kinect® may not be an appropriate surrogate for traditional motion analysis technology, but it may have potential applications as a real-time feedback tool in pathological or high injury risk populations. PMID:26835547

  12. Force-displacement differences in the lower extremities of young healthy adults between drop jumps and drop landings.

    PubMed

    Hackney, James M; Clay, Rachel L; James, Meredith

    2016-10-01

    We measured ground reaction force and lower extremity shortening in ten healthy, young adults in order to compare five trials of drop jumps to drop landings. Our dependent variable was the percentage of displacement (shortening) between the markers on the ASIS and second metatarsal heads on each LE, relative to the maximum shortening (100% displacement) for that trial at the point of greatest ground reaction force. We defined this as "percent displacement at maximum force" (%dFmax). The sample mean %dFmax was 0.73%±0.14% for the drop jumps, and 0.47%±0.09% for the drop landings. The mean within-subject difference score was 0.26%±0.20%. Two-tailed paired t test comparing %dFmax between the drop jump and drop landing yielded P=0.002. For all participants in this study, the %dFmax was greater in drop jumps than in drop landings. This indicates that in drop jumps, the point of maximum force and of maximum shortening was nearly simultaneous, compared to drop landings, where the point of maximum shortening followed that of maximum force by a greater proportion. This difference in force to displacement behavior is explained by linear spring behavior in drop jumps, and linear damping behavior in drop landings. PMID:27344129

  13. Autologous transplantation of peripheral blood stem cells as an effective therapeutic approach for severe arteriosclerosis obliterans of lower extremities.

    PubMed

    Huang, Ping Ping; Li, Shan Zhu; Han, Ming Zhe; Xiao, Zhi Jian; Yang, Ren Chi; Qiu, Lu Gui; Han, Zhong Chao

    2004-03-01

    Treatment of severe arteriosclerosis obliterans of lower extremities (ASOLE) remains a clinical challenge. To develop a more effective approach, we evaluated the clinical efficacy of autologous transplantation of mobilized peripheral blood stem cells (PBSCs) in 5 patients with ASOLE. The patients received recombinant human granulocyte colony-stimulating factor (rhG-CSF, 600 micro g/day) for 5 consecutive days. On day 5, PBSCs were collected, sorted from blood circulation of patients, and then intramuscularly injected into their ischemic lower limbs. A significant improvement of clinical manifestations including severe pain, skin temperature and ulcer, was observed, without obvious adverse effect. The patient's limb was successfully saved. Satisfactory remission was obtained 3 months after transplantation as shown by significant improvement in ankle-brachial pressure index (ABI), blood flow in personal vascular laboratory (PVL), laser Doppler blood perfusion, and the angio-graphic scores. Our data suggest for the first time that autologous transplantation of mobilized PBSCs provides a practical, safe, and effective method of treatment for lower limb ischemia.

  14. Factors Associated with Total Inpatient Costs and Length of Stay among Veterans with Lower Extremity Amputation during the Surgical Hospitalization

    PubMed Central

    Kurichi, Jibby E.; Vogel, W. Bruce; Kwong, Pui L.; Xie, Dawei; Bates, Barbara E.; Stineman, Margaret G.

    2013-01-01

    Objective To identify patient- and facility-level factors associated with total inpatient costs and length of stay (LOS) among veterans with lower extremity amputation. Design Patient data for 1,536 veterans were compiled from 9 databases from the Veterans Health Administration between October 1, 2002, and September 30, 2003. Linear mixed models were used to identify factors associated with the natural logarithm of total inpatient costs and LOS. Results Statistically significant factors associated with both higher total inpatient costs and longer LOS included admission by transfer from another hospital, systemic sepsis, arrhythmias, chronic blood loss anemia, fluid and electrolyte disorders, weight loss, specialized inpatient rehabilitation, and larger hospital bed sizes. Device infection, coagulopathy, solid tumor without metastasis, CARF accreditation, and Medicare Wage Index were only associated with higher total inpatient costs. Factors only associated with longer LOS included older age, not being married, previous amputation complication, congestive heart failure, deficiency anemias, and paralysis. Conclusions Most drivers of total inpatient costs were similar to those that increased LOS with a few exceptions. These findings may have implications for projecting future health care costs, and thus could be important in efforts to reducing costs, understanding LOS, and refining payment and budgeting policies. PMID:23117271

  15. Wireless wearable range-of-motion sensor system for upper and lower extremity joints: a validation study.

    PubMed

    Kumar, Yogaprakash; Yen, Shih-Cheng; Tay, Arthur; Lee, Wangwei; Gao, Fan; Zhao, Ziyi; Li, Jingze; Hon, Benjamin; Tian-Ma Xu, Tim; Cheong, Angela; Koh, Karen; Ng, Yee-Sien; Chew, Effie; Koh, Gerald

    2015-02-01

    Range-of-motion (ROM) assessment is a critical assessment tool during the rehabilitation process. The conventional approach uses the goniometer which remains the most reliable instrument but it is usually time-consuming and subject to both intra- and inter-therapist measurement errors. An automated wireless wearable sensor system for the measurement of ROM has previously been developed by the current authors. Presented is the correlation and accuracy of the automated wireless wearable sensor system against a goniometer in measuring ROM in the major joints of upper (UEs) and lower extremities (LEs) in 19 healthy subjects and 20 newly disabled inpatients through intra (same) subject comparison of ROM assessments between the sensor system against goniometer measurements by physical therapists. In healthy subjects, ROM measurements using the new sensor system were highly correlated with goniometry, with 95% of differences < 20° and 10° for most movements in major joints of UE and LE, respectively. Among inpatients undergoing rehabilitation, ROM measurements using the new sensor system were also highly correlated with goniometry, with 95% of the differences being < 20° and 25° for most movements in the major joints of UE and LE, respectively.

  16. A comparative study of the electromyographic activities of lower extremity muscles during level walking and Pedalo riding

    PubMed Central

    Lee, DongGeon; Kim, YouJeong; Yun, JiHyeon; Jung, MiHye; Lee, GyuChang

    2016-01-01

    [Purpose] To analyze the electromyographic (EMG) activities of several lower extremity muscles during ground walking and pedaling using the Pedalo Reha-Bar device. [Subjects and Methods] Fifteen healthy adults aged 20–29 year participated in this study. The subjects’ surface EMG signals while walking and Pedalo Reha-Bar riding were recorded. The subjects performed 20 steps on flat ground and 20 cycles on the Pedalo Reha-Bar. During the tasks, EMG signals of the rectus femoris, biceps femoris, tibialis anterior, soleus, and gastrocnemius within a 20-second period were recorded. The mean EMG signals within the 10 seconds from 6 to 15 seconds were used for the data analysis. [Results] There was a significant increase in the bilateral use of the rectus femoris and a significant decrease in the use of the left tibialis anterior and left soleus in pedaling using the Pedalo Reha-Bar device compared to ground walking. [Conclusion] Level walking and the Pedalo Reha-Bar riding utilize different types of muscles activities. These results suggest that Pedalo Reha-Bar riding may be used for neuromuscular activation, especially of the rectus femoris. PMID:27313354

  17. Wireless wearable range-of-motion sensor system for upper and lower extremity joints: a validation study

    PubMed Central

    Kumar, Yogaprakash; Yen, Shih-Cheng; Lee, Wangwei; Gao, Fan; Zhao, Ziyi; Li, Jingze; Hon, Benjamin; Tian-Ma Xu, Tim; Cheong, Angela; Koh, Karen; Ng, Yee-Sien; Chew, Effie; Koh, Gerald

    2015-01-01

    Range-of-motion (ROM) assessment is a critical assessment tool during the rehabilitation process. The conventional approach uses the goniometer which remains the most reliable instrument but it is usually time-consuming and subject to both intra- and inter-therapist measurement errors. An automated wireless wearable sensor system for the measurement of ROM has previously been developed by the current authors. Presented is the correlation and accuracy of the automated wireless wearable sensor system against a goniometer in measuring ROM in the major joints of upper (UEs) and lower extremities (LEs) in 19 healthy subjects and 20 newly disabled inpatients through intra (same) subject comparison of ROM assessments between the sensor system against goniometer measurements by physical therapists. In healthy subjects, ROM measurements using the new sensor system were highly correlated with goniometry, with 95% of differences < 20° and 10° for most movements in major joints of UE and LE, respectively. Among inpatients undergoing rehabilitation, ROM measurements using the new sensor system were also highly correlated with goniometry, with 95% of the differences being < 20° and 25° for most movements in the major joints of UE and LE, respectively. PMID:26609398

  18. Do lower-extremity joint dynamics change when stair negotiation is initiated with a self-selected comfortable gait speed?

    PubMed

    Vallabhajosula, Srikant; Yentes, Jennifer M; Momcilovic, Mira; Blanke, Daniel J; Stergiou, Nicholas

    2012-02-01

    Previous research on the biomechanics of stair negotiation has ignored the effect of the approaching speed. We examined if initiating stair ascent with a comfortable self-selected speed can affect the lower-extremity joint moments and powers as compared to initiating stair ascent directly in front of the stairs. Healthy young adults ascended a custom-built staircase instrumented with force platforms. Kinematics and kinetics data were collected simultaneously for two conditions: starting from farther away and starting in front of the stairs and analyzed at the first and second ipsilateral steps. Results showed that for the first step, participants produced greater peak knee extensor moment, peak hip extensor and flexor moments and peak hip positive power while starting from farther away. Also, for both the conditions combined, participants generated lesser peak ankle plantiflexor, greater peak knee flexor moment, lesser peak ankle negative power and greater peak hip negative power while encountering the first step. These results identify the importance of the starting position in experiments dealing with biomechanics of stair negotiation. Further, these findings have important implications for studying stair ascent characteristics of other populations such as older adults.

  19. The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion.

    PubMed

    Almonroeder, Thomas G; Benson, Lauren C; O'Connor, Kristian M

    2016-09-01

    Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253. PMID:27494054

  20. Age-related differences in muscle control of the lower extremity for support and propulsion during walking

    PubMed Central

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-01-01

    [Purpose] This study examined age-related differences in muscle control for support and propulsion during walking in both males and females in order to develop optimal exercise regimens for muscle control. [Subjects and Methods] Twenty elderly people and 20 young people participated in this study. Coordinates of anatomical landmarks and ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Muscle forces during walking were estimated using OpenSim. Muscle modules were obtained by using non-negative matrix factorization analysis. A two-way analysis of covariance was performed to examine the difference between the elderly and the young in muscle weightings using walking speed as a covariate. The similarities in activation timing profiles between the elderly and the young were analyzed by cross-correlation analysis in males and females. [Results] In the elderly, there was a change in the coordination of muscles around the ankle, and muscles of the lower extremity exhibited co-contraction in late stance. Timing and shape of these modules were similar between elderly and young people. [Conclusion] Our results suggested that age-related alteration of muscle control was associated with support and propulsion during walking. PMID:27134360

  1. RETURN TO PLAY PROGRESSION FOR RUGBY FOLLOWING INJURY TO THE LOWER EXTREMITY: A CLINICAL COMMENTARY AND REVIEW OF THE LITERATURE

    PubMed Central

    Davis, Chelseana C.

    2016-01-01

    Background & Purpose Rugby requires unique demands from its players. Those involved in rehabilitation and care of these athletes must possess an understanding of both the game and various positions. There have been numerous reports focusing on the physiological demands and biomechanical analyses of various components of gameplay, but no specific progression has been developed to assist clinicians assessing the readiness to return of a player after injury. The purpose of this clinical commentary is to outline testing components, general gameplay guidelines, movement progressions, and sport and position-specific progressions related to rugby gameplay following a lower extremity injury. Description of Topic This commentary provides a recommended progression for clinical use for use in a return to rugby program. It includes metabolic considerations, advanced strengthening exercises, agility exercises, and incorporation of drills specific to the sport of rugby that may be performed with the clinician or with assistance from team members. This progression also includes testing parameters for each phase and guidance for clinicians regarding the ability to gauge readiness to return to sport. Discussion It is essential that an athlete returning to the sport of rugby undertake a guided, graduated return to sport progression to ensure safety and to decrease the risk of re-injury. This proposed return to sport progression outlines key parameters for both the sport as a whole and for various specific positions. Level of Evidence Level 5 – Clinical Commentary, Review of Literature PMID:27104062

  2. Analyzing Longitudinal Data with Multilevel Models: An Example with Individuals Living with Lower Extremity Intra-articular Fractures

    PubMed Central

    Kwok, Oi-Man; Underhill, Andrea T.; Berry, Jack W.; Luo, Wen; Elliott, Timothy R.; Yoon, Myeongsun

    2008-01-01

    The use and quality of longitudinal research designs has increased over the past two decades, and new approaches for analyzing longitudinal data, including multi-level modeling (MLM) and latent growth modeling (LGM), have been developed. The purpose of this paper is to demonstrate the use of MLM and its advantages in analyzing longitudinal data. Data from a sample of individuals with intra-articular fractures of the lower extremity from the University of Alabama at Birmingham’s Injury Control Research Center is analyzed using both SAS PROC MIXED and SPSS MIXED. We start our presentation with a discussion of data preparation for MLM analyses. We then provide example analyses of different growth models, including a simple linear growth model and a model with a time-invariant covariate, with interpretation for all the parameters in the models. More complicated growth models with different between- and within-individual covariance structures and nonlinear models are discussed. Finally, information related to MLM analysis such as online resources is provided at the end of the paper. PMID:19649151

  3. Relation between cycling exercise capacity, fiber-type composition, and lower extremity muscle strength and muscle endurance.

    PubMed

    Segerström, Asa B; Holmbäck, Anna M; Hansson, Ola; Elgzyri, Targ; Eriksson, Karl-Fredrik; Ringsberg, Karin; Groop, Leif; Wollmer, Per; Thorsson, Ola

    2011-01-01

    The aim of the study was to determine the relation between peak oxygen uptake V(O2)peak), peak work rate (WRpeak), fiber-type composition, and lower extremity strength and endurance during a maximal incremental cycle test. Thirty-nine healthy sedentary men, aged 30-46, participated in the study. Subjects performed a maximal incremental cycle test and isokinetic knee extension (KE) and flexion (KF) strength and endurance tests at velocities of 60 and 180° · s(-1). Muscle biopsies were taken from m. vastus lateralis and analyzed for fiber-type composition. A significant correlation existed between KE strength and V(O2)peak and WRpeak. Also, KF endurance correlated significantly to V(O2)peak and WRpeak. The KE endurance correlated significantly to WRpeak (rp = 0.32, p < 0.05) and almost significantly to V(O2)peak (rp = 0.28, p = 0.06). Stepwise multiple regression analyses showed that KE strength, KF endurance, and the percentage of type I fibers could explain up to 40% of the variation in V(O2) and WRpeak. The performance of sedentary subjects in a maximal incremental cycle test is highly affected by knee muscle strength and endurance. Fiber-type composition also contributes but to a smaller extent.

  4. A systematic review of model-based economic evaluations of diagnostic and therapeutic strategies for lower extremity artery disease.

    PubMed

    Vaidya, Anil; Joore, Manuela A; ten Cate-Hoek, Arina J; Kleinegris, Marie-Claire; ten Cate, Hugo; Severens, Johan L

    2014-01-01

    Lower extremity artery disease (LEAD) is a sign of wide spread atherosclerosis also affecting coronary, cerebral and renal arteries and is associated with increased risk of cardiovascular events. Many economic evaluations have been published for LEAD due to its clinical, social and economic importance. The aim of this systematic review was to assess modelling methods used in published economic evaluations in the field of LEAD. Our review appraised and compared the general characteristics, model structure and methodological quality of published models. Electronic databases MEDLINE and EMBASE were searched until February 2013 via OVID interface. Cochrane database of systematic reviews, Health Technology Assessment database hosted by National Institute for Health research and National Health Services Economic Evaluation Database (NHSEED) were also searched. The methodological quality of the included studies was assessed by using the Philips' checklist. Sixteen model-based economic evaluations were identified and included. Eleven models compared therapeutic health technologies; three models compared diagnostic tests and two models compared a combination of diagnostic and therapeutic options for LEAD. Results of this systematic review revealed an acceptable to low methodological quality of the included studies. Methodological diversity and insufficient information posed a challenge for valid comparison of the included studies. In conclusion, there is a need for transparent, methodologically comparable and scientifically credible model-based economic evaluations in the field of LEAD. Future modelling studies should include clinically and economically important cardiovascular outcomes to reflect the wider impact of LEAD on individual patients and on the society.

  5. 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD): An Executive Summary.

    PubMed

    Bonham, Phyllis A; Flemister, Bonny G; Droste, Linda R; Johnson, Jan J; Kelechi, Teresa; Ratliff, Catherine R; Varnado, Myra F

    2016-01-01

    The purpose of this article is to provide a summary of the recommendations from the 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD), published by the Wound, Ostomy and Continence Nurses Society (WOCN). This article provides an overview of the process used to update and develop the guideline, and specific recommendations from the guideline for assessment, referral for further evaluation, interventions (ie, debridement, dressings, infection, antibiotics, nutrition, pain management, compression issues, medications, surgical options, and adjunctive therapies), and patient education and risk-reduction strategies. The LEAD guideline is a resource for physicians, nurses, therapists, and other healthcare professionals who work with adults who have/or are at risk for wounds due to LEAD. The full text of the published guideline, which includes the available evidence supporting the recommendations and a complete reference list, is available from the WOCN Society, 1120 Rt. 73, Suite 200, Mount Laurel, NJ, 08054; Web site: www.wocn.org. Refer to the Supplemental Digital Content (Supplement Digital Content 1, http://links.lww.com/JWOCN/A31) associated with this article for the complete reference list for the guideline. The guideline has been accepted for publication by the National Guideline Clearinghouse (www.guideline.gov/). PMID:26649551

  6. Age-related differences in muscle control of the lower extremity for support and propulsion during walking.

    PubMed

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-03-01

    [Purpose] This study examined age-related differences in muscle control for support and propulsion during walking in both males and females in order to develop optimal exercise regimens for muscle control. [Subjects and Methods] Twenty elderly people and 20 young people participated in this study. Coordinates of anatomical landmarks and ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Muscle forces during walking were estimated using OpenSim. Muscle modules were obtained by using non-negative matrix factorization analysis. A two-way analysis of covariance was performed to examine the difference between the elderly and the young in muscle weightings using walking speed as a covariate. The similarities in activation timing profiles between the elderly and the young were analyzed by cross-correlation analysis in males and females. [Results] In the elderly, there was a change in the coordination of muscles around the ankle, and muscles of the lower extremity exhibited co-contraction in late stance. Timing and shape of these modules were similar between elderly and young people. [Conclusion] Our results suggested that age-related alteration of muscle control was associated with support and propulsion during walking.

  7. Design and evaluation of a quasi-passive knee exoskeleton for investigation of motor adaptation in lower extremity joints.

    PubMed

    Shamaei, Kamran; Cenciarini, Massimo; Adams, Albert A; Gregorczyk, Karen N; Schiffman, Jeffrey M; Dollar, Aaron M

    2014-06-01

    In this study, we describe the mechanical design and control scheme of a quasi-passive knee exoskeleton intended to investigate the biomechanical behavior of the knee joint during interaction with externally applied impedances. As the human knee behaves much like a linear spring during the stance phase of normal walking gait, the exoskeleton implements a spring across the knee in the weight acceptance (WA) phase of the gait while allowing free motion throughout the rest of the gait cycle, accomplished via an electromechanical clutch. The stiffness of the device is able to be varied by swapping springs, and the timing of engagement/disengagement changed to accommodate different loading profiles. After describing the design and control, we validate the mechanical performance and reliability of the exoskeleton through cyclic testing on a mechanical knee simulator. We then describe a preliminary experiment on three healthy adults to evaluate the functionality of the device on both left and right legs. The kinetic and kinematic analyses of these subjects show that the exoskeleton assistance can partially/fully replace the function of the knee joint and obtain nearly invariant moment and angle profiles for the hip and ankle joints, and the overall knee joint and exoskeleton complex under the applied moments of the exoskeleton versus the control condition, implying that the subjects undergo a considerable amount of motor adaptation in their lower extremities to the exoskeletal impedances, and encouraging more in-depth future experiments with the device.

  8. Muscle activation and knee biomechanics during squatting and lunging after lower extremity fatigue in healthy young women.

    PubMed

    Longpré, Heather S; Acker, Stacey M; Maly, Monica R

    2015-02-01

    Muscle activations and knee joint loads were compared during squatting and lunging before and after lower extremity neuromuscular fatigue. Electromyographic activations of the rectus femoris, vastus lateralis and biceps femoris, and the external knee adduction and flexion moments were collected on 25 healthy women (mean age 23.5 years, BMI of 23.7 kg/m(2)) during squatting and lunging. Participants were fatigued through sets of 50 isotonic knee extensions and flexions, with resistance set at 50% of the peak torque achieved during a maximum voluntary isometric contraction. Fatigue was defined as a decrease in peak isometric knee extension or flexion torque ≥25% from baseline. Co-activation indices were calculated between rectus femoris and biceps femoris; and between vastus lateralis and biceps femoris. Fatigue decreased peak isometric extension and flexion torques (p<0.05), mean vastus lateralis activation during squatting and lunging (p<0.05), and knee adduction and flexion moments during lunging (p<0.05). Quadriceps activations were greater during lunging than squatting (p<0.05). Thus, fatigue altered the recruitment strategy of the quadriceps during squatting and lunging. Lunging challenges quadriceps activation more than squatting in healthy, young women.

  9. Factors Associated With Late Specialized Rehabilitation among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

    PubMed Central

    Kurichi, Jibby E.; Xie, Dawei; Kwong, Pui L.; Bates, Barbara E.; Vogel, W. Bruce; Stineman, Margaret G.

    2011-01-01

    Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units. PMID:21389847

  10. The effect of lateral banking on the kinematics and kinetics of the lower extremity during lateral cutting movements.

    PubMed

    Wannop, John W; Graf, Eveline S; Stefanyshyn, Darren J

    2014-02-01

    There are many aspects of cutting movements that can limit performance, however, the implementation of lateral banking may reduce some of these limitations. Banking could provide a protective mechanism, placing the foot and ankle in orientations that keep them out of dangerous positions. This study sought to determine the effect of two banking angles on the kinematics and kinetics of the lower extremity during two athletic maneuvers. Kinematic and kinetic data were collected on 10 recreational athletes performing v-cuts and side shuffle movements on different banked surfaces (0°, 10°, 20°). Each sample surface was rigidly attached to the force platform. Joint moments were calculated and compared between conditions using a repeated measures ANOVA. Banking had a pronounced effect on the ankle joint. As banking increased, the amount of joint loading in the transverse and frontal planes decreased likely leading to a reduction in injury risk. Also an increase in knee joint loading in the frontal plane was seen during the 20° bank during the v-cut. Conversely loading in the sagittal plane at the ankle joint increased with banking and coupled with a reorientation of the ground reaction vector may facilitate a performance increase. The current study indicates that the 10° bank may be the optimal bank, in that it decreases ankle joint loading, as well as increases specific performance variables while not increasing frontal plane knee joint loading. If banking could be incorporated in footwear it may be able to provide a protective mechanism for athletes.

  11. Lower Extremity Muscle Thickness During 30-Day 6 degrees Head-Down Bed Rest with Isotonic and Isokinetic Exercise Training

    NASA Technical Reports Server (NTRS)

    Ellis, S.; Kirby, L. C.; Greenleaf, J. E.

    1993-01-01

    Muscle thickness was measured in 19 Bed-Rested (BR) men (32-42 year) subjected to IsoTonic (ITE, cycle orgometer) and IsoKi- netic (IKE, torque orgometer) lower extremity exercise training, and NO Exercise (NOE) training. Thickness was measured with ultrasonography in anterior thigh-Rectus Femoris (RF) and Vastus Intermadius (VI), and combined posterior log-soleus, flexor ballucis longus, and tibialis posterior (S + FHL +TP) - muscles. Compared with ambulatory control values, thickness of the (S + FHL + TP) decreased by 90%-12% (p less than 0.05) In all three test groups. The (RF) thickness was unchanged in the two exercise groups, but decreased by 10% (p less than 0.05) in the NOE. The (VI) thickness was unchanged In the ITE group, but decreased by 12%-l6% (p less than 0.05) in the IKE and NOE groups. Thus, intensive, alternating, isotonic cycle ergometer exercise training is as effective as intensive, intermittent, isokinetic exercise training for maintaining thicknesses of rectus femoris and vastus lntermedius anterior thigh muscles, but not posterior log muscles, during prolonged BR deconditioning.

  12. Catheter-Directed Thrombolysis with Percutaneous Rheolytic Thrombectomy Versus Thrombolysis Alone in Upper and Lower Extremity Deep Vein Thrombosis

    SciTech Connect

    Kim, Hyun S. Patra, Ajanta; Paxton, Ben E.; Khan, Jawad; Streiff, Michael B.

    2006-12-15

    Purpose. To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT). Methods. A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT. Results. Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 {+-} 27.1 hr compared with 26.3 {+-} 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 {+-} 5.3 million units compared with 2.7 {+-} 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT. Conclusion. Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.

  13. Correlation between the selective control assessment of lower extremity and pediatric balance scale scores in children with spastic cerebral palsy

    PubMed Central

    Lim, Hyoungwon

    2015-01-01

    [Purpose] The purpose of this study was to investigate the correlation between the Selective Control Assessment of Lower Extremity (SCALE) and Pediatric Balance Scales (PBS) in children with spastic cerebral palsy and further to test whether the SCALE is a valid tool to predict the PBS. [Subjects and Methods] A cross-sectional study was conducted to evaluate the SCALE and PBS in 23 children (9 females, 14 males, GMFCS level I–III) with spastic cerebral palsy. [Results] Both the SCALE and PBS scores for children with spastic hemiplegia were significantly higher than those for children with spastic diplegia. The scores for SCALE items were low for distal parts. The PBS items that were difficult for the participants to perform were items 8, 9, 10, and 14 with the highest difficulty experienced for item 8 followed by items 9, 10, and 14. The correlation coefficient (0.797) between the SCALE and PBS scores was statistically significant. The correlations between each SCALE item and the PBS scores were also statistically significant. SCALE items were significantly correlated with two PBS dimensions (standing and postural change). [Conclusion] In SCALE assessment, more severe deficits were observed in the distal parts. Standing and postural changes in the PBS method were difficult for the participants to perform. The two tests, that is, the SCALE and PBS, were highly correlated. Therefore, the SCALE is useful to prediction of PBS outcomes and is also applicable as a prognostic indicator for treatment planning. PMID:26834323

  14. Effects of Juvenile Idiopathic Arthritis on Kinematics and Kinetics of the Lower Extremities Call for Consequences in Physical Activities Recommendations

    PubMed Central

    Hartmann, M.; Kreuzpointner, F.; Haefner, R.; Michels, H.; Schwirtz, A.; Haas, J. P.

    2010-01-01

    Juvenile idiopathic arthritis (JIA) patients (n = 36) with symmetrical polyarticular joint involvement of the lower extremities and healthy controls (n = 20) were compared concerning differences in kinematic, kinetic, and spatio-temporal parameters with 3D gait analysis. The aims of this study were to quantify the differences in gait between JIA patients and healthy controls and to provide data for more detailed sport activities recommendations. JIA-patients showed reduced walking speed and step length, strongly anterior tilted pelvis, reduced maximum hip extension, reduced knee extension during single support phase and reduced plantar flexion in push off. Additionally the roll-off procedure of the foot was slightly decelerated. The reduced push off motion in the ankle was confirmed by lower peaks in ankle moment and power. The gait of JIA-patients can be explained as a crouch-like gait with hyperflexion in hip and knee joints and less plantar flexion in the ankle. A preventive mobility workout would be recommendable to reduce these restrictions in the future. Advisable are sports with emphasis on extension in hip, knee, and ankle plantar flexion. PMID:20862334

  15. Force-displacement differences in the lower extremities of young healthy adults between drop jumps and drop landings.

    PubMed

    Hackney, James M; Clay, Rachel L; James, Meredith

    2016-10-01

    We measured ground reaction force and lower extremity shortening in ten healthy, young adults in order to compare five trials of drop jumps to drop landings. Our dependent variable was the percentage of displacement (shortening) between the markers on the ASIS and second metatarsal heads on each LE, relative to the maximum shortening (100% displacement) for that trial at the point of greatest ground reaction force. We defined this as "percent displacement at maximum force" (%dFmax). The sample mean %dFmax was 0.73%±0.14% for the drop jumps, and 0.47%±0.09% for the drop landings. The mean within-subject difference score was 0.26%±0.20%. Two-tailed paired t test comparing %dFmax between the drop jump and drop landing yielded P=0.002. For all participants in this study, the %dFmax was greater in drop jumps than in drop landings. This indicates that in drop jumps, the point of maximum force and of maximum shortening was nearly simultaneous, compared to drop landings, where the point of maximum shortening followed that of maximum force by a greater proportion. This difference in force to displacement behavior is explained by linear spring behavior in drop jumps, and linear damping behavior in drop landings.

  16. Hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) for children with cerebral palsy.

    PubMed

    Bleyenheuft, Yannick; Gordon, Andrew M

    2014-11-01

    Hand-arm bimanual intensive therapy and constrained-induced movement therapy have shown evidence of effectiveness in improvement of upper extremity use in children with unilateral spastic cerebral palsy (CP). The effectiveness of interventions that are based on intensive practice of activities that combine UE and LE functions has not been reported. We propose that bimanual UE activities that simultaneously require trunk and LE postural adaptations uniquely address motor control limitations of children with unilateral spastic CP. The aim of this perspective is to present such an approach Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE). HABIT-ILE is unique in selection of tasks and activities that require simultaneous control and coordination of UE and LE movements. It is a motor-learning-based approach using problem solving and highly structured practice. During the intervention, activities and tasks are progressively graded toward more complex bimanual coordination for the UE and increasing demands of the LE. HABIT-ILE is provided in small groups for 90 hr using a camp model. Future research (randomized controlled trial) is needed to determine the effectiveness of HABIT-ILE. PMID:25271469

  17. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults.

    PubMed

    Alnahdi, Ali H; Alderaa, Asma A; Aldali, Ali Z; Alsobayel, Hana

    2015-12-01

    [Purpose] This study aimed to establish gender-specific reference values for the Y Balance Test (YBT) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in healthy young adults in Saudi Arabia, and to examine gender differences in the YBT and LEFS-Ar values. [Subjects and Methods] Healthy young adults (31 females, 30 males) completed the YBT and LEFS-Ar in 1 test session. Descriptive statistical analysis (mean, standard deviation, 95% confidence interval) was used to compute the YBT and LEFS-Ar reference values. Independent t-tests were used to examine gender differences in the YBT and LEFS-Ar values. [Results] Gender-specific reference values were obtained for the right, left, dominant, and non-dominant leg as well as for the average performance of both the legs. males showed greater YBT normalized reach distances than females did in the anterior, posteromedial, and posterolateral directions; furthermore, males showed higher YBT composite scores than females did. However, the LEFS-Ar values did not differ between males and females. [Conclusion] Gender-specific reference values were obtained for the YBT and LEFS-Ar in healthy young adults in Saudi Arabia. males performed better than females did in the YBT. However, no gender differences were noted in LEFS-Ar. PMID:26834380

  18. The effect of hip abductor exercise on muscle strength and trunk stability after an injury of the lower extremities.

    PubMed

    Kak, Hwang-Bo; Park, Sun-Ja; Park, Byun-Joon

    2016-03-01

    [Purpose] The gluteus medius, a hip abductor, controls femoral movement and stabilizes the pelvis during lower extremity mobilization. [Subjects] This study enrolled 24 subjects into control and experimental groups. [Methods] This randomized controlled study included patients who underwent arthroscopy after meniscus injury and started a rehabilitative exercise program 8 weeks after surgery. Subjects were divided into the experimental gluteus medius resistance exercise group (n=12) and the control group (n=12). The study investigated muscle strength and balance of the flexors, extensors, and abductors of the knee for 8 weeks. [Results] Strengths of knee extensors in patients who underwent rehabilitative exercise for 8 weeks were measured. Strength of the knee extensors of the experimental and control groups increased by 40% and 31%, respectively; strength of the hip flexors of the experimental and control groups increased by 31% and 18%, respectively. Strength of the hip joint muscles showed a 40% increase in the experimental group and a 14% increase in the control group. However, there was a significant difference (18%) in muscle strength of the hip abductors between the groups. Measurements of trunk lateral flexion showed a difference within a group, but no intergroup difference was found. [Conclusion] This study investigated the effect of hip abductor exercise on muscular strength and trunk stability in patients with a meniscus injury.

  19. Effect of gender on lower extremity kinematics during rapid direction changes: an integrated analysis of three sports movements.

    PubMed

    McLean, S G; Walker, K B; van den Bogert, A J

    2005-12-01

    Anterior cruciate ligament (ACL) injury is a common sports injury, particularly in females. Gender differences in knee kinematics have been observed for specific movements, but there is limited information on how these findings relate to other joints and other movements. Here we present an integrated analysis of hip, knee and ankle kinematics across three movements linked to non-contact ACL injury. It was hypothesised that there are gender differences in lower extremity kinematics, which are consistent across sports movements. Ten female and ten male NCAA basketball players had three-dimensional hip, knee and ankle kinematics quantified during the stance phase of sidestep, sidejump and shuttle-run tasks. For each joint angle, initial value at contact, peak value and between-trial variability was obtained and submitted to a two-way mixed design ANOVA (gender and movement), with movement condition treated as a repeated measure. Females had higher peak knee valgus and lower peak hip and knee flexion, with the same gender differences also existing at the beginning of stance (p<0.05). Peak valgus measures were highly correlated between movements, but not to static valgus alignment. Kinematic differences demonstrated by females for the sports movements studied, and in particular knee valgus, may explain their increased risk of ACL injury. These differences appear to stem largely from subject-specific neuromuscular mechanisms across movements, suggesting that prevention via neuromuscular training is possible.

  20. Contribution of the lower extremity joints to mechanical energy in running vertical jumps and running long jumps.

    PubMed

    Stefanyshyn, D J; Nigg, B M

    1998-02-01

    The energy contribution of the lower extremity joints to vertical jumping and long jumping from a standing position has previously been investigated. However, the resultant joint moment contributions to vertical and long jumps performed with a running approach are unknown. Also, the contribution of the metatarsophalangeal joint to these activities has not been investigated. The objective of this study was to determine the mechanical energy contributions of the hip, knee, ankle and metatarsophalangeal joints to running long jumps and running vertical jumps. A sagittal plane analysis was performed on five male university basketball players while performing running vertical jumps and four male long jumpers while performing running long jumps. The resultant joint moment and power patterns at the ankle, knee and hip were similar to those reported in the literature for standing jumps. It appears that the movement pattern of the jumps is not influenced by an increase in horizontal velocity before take-off. The metatarsophalangeal joint was a large energy absorber and generated only a minimal amount of energy at take-off. The ankle joint was the largest energy generator and absorber for both jumps; however, it played a smaller relative role during long jumping as the energy contribution of the hip increased.

  1. Mitosis is swell.

    PubMed

    Zatulovskiy, Evgeny; Skotheim, Jan M

    2015-11-23

    Cell volume and dry mass are typically correlated. However, in this issue, Zlotek-Zlotkiewicz et al. (2015. J. Cell Biol. http://dx.doi.org/10.1083/jcb.201505056) and Son et al. (2015. J. Cell Biol. http://dx.doi.org/10.1083/jcb.201505058) use new live-cell techniques to show that entry to mitosis coincides with rapid cell swelling, which is reversed before division.

  2. Mitosis is swell

    PubMed Central

    Zatulovskiy, Evgeny

    2015-01-01

    Cell volume and dry mass are typically correlated. However, in this issue, Zlotek-Zlotkiewicz et al. (2015. J. Cell Biol. http://dx.doi.org/10.1083/jcb.201505056) and Son et al. (2015. J. Cell Biol. http://dx.doi.org/10.1083/jcb.201505058) use new live-cell techniques to show that entry to mitosis coincides with rapid cell swelling, which is reversed before division. PMID:26598610

  3. Using the Star Excursion Balance Test to Assess Dynamic Postural-Control Deficits and Outcomes in Lower Extremity Injury: A Literature and Systematic Review

    PubMed Central

    Gribble, Phillip A.; Hertel, Jay; Plisky, Phil

    2012-01-01

    Context: A dynamic postural-control task that has gained notoriety in the clinical and research settings is the Star Excursion Balance Test (SEBT). Researchers have suggested that, with appropriate instruction and practice by the individual and normalization of the reaching distances, the SEBT can be used to provide objective measures to differentiate deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue, and it has the potential to predict lower extremity injury. However, no one has reviewed this body of literature to determine the usefulness of the SEBT in clinical applications. Objective: To provide a narrative review of the SEBT and its implementation and the known contributions to task performance and to systematically review the associated literature to address the SEBT's usefulness as a clinical tool for the quantification of dynamic postural-control deficits from lower extremity impairment. Data Sources: Databases used to locate peer-reviewed articles published from 1980 and 2010 included Derwent Innovations Index, BIOSIS Previews, Journal Citation Reports, and MEDLINE. Study Selection: The criteria for article selection were (1) The study was original research. (2) The study was written in English. (3) The SEBT was used as a measurement tool. Data Extraction: Specific data extracted from the articles included the ability of the SEBT to differentiate pathologic conditions of the lower extremity, the effects of external influences and interventions, and outcomes from exercise intervention and to predict lower extremity injury. Data Synthesis: More than a decade of research findings has established a comprehensive portfolio of validity for the SEBT, and it should be considered a highly representative, noninstrumented dynamic balance test for physically active individuals. The SEBT has been shown to be a reliable measure and has validity as a dynamic test to predict risk of lower extremity injury, to

  4. Relation of selective voluntary motor control of the lower extremity and extensor strength of the knee joint in children with spastic diplegia

    PubMed Central

    Kusumoto, Yasuaki; Takaki, Kenji; Matsuda, Tadamitsu; Nitta, Osamu

    2016-01-01

    [Purpose] The aim of this study was to investigate differences in selective voluntary motor control of the lower extremities by objective assessment and determine the relationship between selective voluntary motor control and knee extensor strength in children with spastic diplegia. [Subjects and Methods] Forty individuals who had spastic cerebral palsy, with Gross Motor Function Classification System levels ranging from I to III, were assessed using the Selective Control Assessment of the Lower Extremity and by testing the maximum knee extensor strength. The unaffected side was defined as the lower limb with the higher score, and the affected side was defined as the lower limb with the lower score. [Results] The Selective Control Assessment of the Lower Extremity score on the affected side had a lower average than that on the unaffected side. The scores showed a significant inverse correlation with the maximum knee extensor strength. [Conclusion] There was bilateral difference in the selective voluntary motor control of the lower extremities in children with spastic diplegia, and the selective voluntary motor control of the lower extremity was related to maximum knee extensor strength. PMID:27390436

  5. Relation of selective voluntary motor control of the lower extremity and extensor strength of the knee joint in children with spastic diplegia.

    PubMed

    Kusumoto, Yasuaki; Takaki, Kenji; Matsuda, Tadamitsu; Nitta, Osamu

    2016-06-01

    [Purpose] The aim of this study was to investigate differences in selective voluntary motor control of the lower extremities by objective assessment and determine the relationship between selective voluntary motor control and knee extensor strength in children with spastic diplegia. [Subjects and Methods] Forty individuals who had spastic cerebral palsy, with Gross Motor Function Classification System levels ranging from I to III, were assessed using the Selective Control Assessment of the Lower Extremity and by testing the maximum knee extensor strength. The unaffected side was defined as the lower limb with the higher score, and the affected side was defined as the lower limb with the lower score. [Results] The Selective Control Assessment of the Lower Extremity score on the affected side had a lower average than that on the unaffected side. The scores showed a significant inverse correlation with the maximum knee extensor strength. [Conclusion] There was bilateral difference in the selective voluntary motor control of the lower extremities in children with spastic diplegia, and the selective voluntary motor control of the lower extremity was related to maximum knee extensor strength.

  6. Effects of preemptive analgesia with celecoxib or acetaminophen on postoperative pain relief following lower extremity orthopedic surgery

    PubMed Central

    Kashefi, Parviz; Honarmand, Azim; Safavi, Mohammadreza

    2012-01-01

    Background: Efficacy of preemptive analgesia with nonsteroidal antiinflammatory drugs (NSAIDs) in comparison with acetaminophen is controversial. The present study evaluates the preemptive analgesia efficacy of celecoxib and acetaminophen in comparison with placebo for postoperative pain relief in patients who underwent orthopedic surgery under general anesthesia. Materials and Methods: Ninetypatients eligible for elective distal extremity surgery were categorized in three groups: group C includedpatients who received oral celecoxib 200 mg 2 h before surgery; group A included those who received oral acetaminophen 320 mg 2 h before surgery; and group P included those who received oral placebo 2 h before surgery. Pain scores were recorded at 4, 12, and 24 h after operation. Results: The pain scores 4 h after operation was significantly less in group C than in groups A and P (4.7±1.7 vs. 5±1.5 vs. 6.8±1.7, respectively, P = 0.015). No significant difference was noted in pain scores at 12 h (4.6±2, 4.9±1.9, 4.3±1.4 in group A, group C, group P, respectively P > 0.05) and 24 h (3.1±1.7, 3.0±1.4, 3.3±1.7 in group A, group C, group P, respectively, P > 0.05) after operation among the three groups. Conclusion: Using oral celecoxib 200 mg 2 h before operation is better thanusing oral acetaminophen 320 mg 2 h before the beginning of surgery for control of postoperative pain in patients who underwent lower extremity orthopedic surgery under general anesthesia. PMID:23459777

  7. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    PubMed Central

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael; Jensen, Pia S; Gebuhr, Peter

    2016-01-01

    Background and purpose Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25–0.91) and by 46% (HR =0.54, 95% CI: 0.35–0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise. PMID:27088484

  8. The effects of lower extremity muscle activation and passive range of motion on single leg squat performance.

    PubMed

    Mauntel, Timothy C; Begalle, Rebecca L; Cram, Tyler R; Frank, Barnett S; Hirth, Christopher J; Blackburn, Troy; Padua, Darin A

    2013-07-01

    Knee valgus is a potential risk factor for lower extremity (LE) injuries. Clinical movement screenings and passive range of motion (PROM) measurements may help identify neuromuscular patterns, which contribute to knee valgus. The purpose of this study was to compare LE muscle activation and PROM between subjects who display visual medial knee displacement (MKD) during a single leg squat (SLS) and those who do not. We hypothesized that muscular activation and PROM would differ between the groups. Forty physically active adults (20 controls, 20 MKDs) participated in this study. Subjects completed 10 LE PROM assessments and performed 5 SLS trials while electromyography (EMG) data were collected from 8 LE muscles. Three separate multivariate analysis of variance were used to identify group differences in EMG data, muscle coactivation, and PROM. Results during the SLS indicated hip coactivation ratios revealed smaller gluteus medius to hip adductor (GMed:Hip Add) (p = 0.028) and gluteus maximus to hip adductor (GMax:Hip Add) coactivation ratios (p = 0.007) compared with the control group. Also, the MKD group displayed significantly less passive ankle dorsiflexion with the knee extended (p = 0.047) and flexed (p = 0.034), and greater talar glide motion (p = 0.012). The findings of this study indicate that MKD during a SLS seems to be influenced by decreased coactivation of the gluteal to the hip adductor muscles and restricted dorsiflexion. Therefore, conditioning, rehabilitation, and injury prevention programs should focus on decreasing hip adductor activity, increasing hip abductor and external rotator activity, and increasing ankle dorsiflexion in hopes to decrease the incidence of these injuries. PMID:23096063

  9. Risk of lower extremity arterial disease in a cohort of workers occupationally exposed to ionizing radiation over a prolonged period.

    PubMed

    Azizova, Tamara V; Bannikova, Maria V; Grigorieva, Evgenia S; Bagaeva, Yaroslava P; Azizova, Elena V

    2016-05-01

    In this study the incidence risk of lower extremity arterial disease (LEAD; international classification of diseases version 9 code 440.2) was assessed in a cohort of workers occupationally exposed to radiation over a prolonged period. The study cohort includes 22,377 workers of the Mayak Production Association (25% of whom are females) first employed at one of the main facilities in 1948-1982 and followed up to the end of 2008. Dose estimates used in the study are provided by Mayak Worker Dosimetry System 2008. The mean total dose from external gamma-rays is 0.54 Gy for males and 0.44 Gy for females. The mean absorbed liver dose from internal alpha-radiation due to incorporated plutonium is 0.23 Gy in males and 0.44 Gy in females. Relative risks and excess relative risks per unit dose (ERR/Gy) are calculated based on maximum likelihood. A total of 943 cases of LEAD are registered in the study cohort during the follow-up of 512,801 person-years. A significant association of LEAD incidence with total dose from external gamma-rays (based on a linear model) was revealed, and the ERR/Gy is 0.27 (95% confidence interval (CI) 0.11; 0.48). It turned out that a linear-exponential model provides a better fit of the data (∆AIC = 9.957). Inclusion of an adjustment for internal alpha-radiation dose resulted in the reduction of the ERR/Gy to 0.19 (95% CI 0.05; 0.39), but the risk remains significant. No association of LEAD incidence with dose from internal alpha-radiation was found in the study worker cohort. It is concluded that this study provides evidence for an association of LEAD incidence with dose from external gamma-rays taking non-radiation factors into account. PMID:26994996

  10. Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower Extremity Joint Arthroplasty: A Prospective, Observational Cohort Study

    PubMed Central

    Brummett, Chad M.; Janda, Allison M.; Schueller, Christa M.; Tsodikov, Alex; Morris, Michelle; Williams, David A.; Clauw, Daniel J.

    2013-01-01

    Background Variance in pain following total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, we conducted a prospective, observational cohort study of patients undergoing lower extremity joint arthroplasty. Methods 519 patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to assessing factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions Using the survey criteria for fibromyalgia distinct phenotypic differences were found, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population. PMID:24343289

  11. Modeling of the blood flow in the lower extremities for dynamic diffuse optical tomography of peripheral artery disease

    NASA Astrophysics Data System (ADS)

    Marone, A.; Hoi, J. W.; Khalil, M. A.; Kim, H. K.; Shrikhande, G.; Dayal, R.; Hielscher, A. H.

    2015-07-01

    Peripheral Arterial Disease (PAD) is caused by a reduction of the internal diameters of the arteries in the upper or lower extremities mainly due to atherosclerosis. If not treated, its worsening may led to a complete occlusion, causing the death of the cells lacking proper blood supply, followed by gangrene that may require chirurgical amputation. We have recently performed a clinical study in which good sensitivities and specificities were achieved with dynamic diffuse optical tomography. To gain a better understanding of the physiological foundations of many of the observed effects, we started to develop a mathematical model for PAD. The model presented in this work is based on a multi-compartment Windkessel model, where the vasculature in the leg and foot is represented by resistors and capacitors, the blood pressure with a voltage drop, and the blood flow with a current. Unlike existing models, the dynamics induced by a thigh-pressure-cuff inflation and deflation during the measurements are taken into consideration. This is achieved by dynamically varying the resistances of the large veins and arteries. By including the effects of the thigh-pressure cuff, we were able to explain many of the effects observed during our dynamic DOT measurements, including the hemodynamics of oxy- and deoxy-hemoglobin concentration changes. The model was implemented in MATLAB and the simulations were normalized and compared with the blood perfusion obtained from healthy, PAD and diabetic patients. Our preliminary results show that in unhealthy patients the total system resistance is sensibly higher than in healthy patients.

  12. Risk of lower extremity arterial disease in a cohort of workers occupationally exposed to ionizing radiation over a prolonged period.

    PubMed

    Azizova, Tamara V; Bannikova, Maria V; Grigorieva, Evgenia S; Bagaeva, Yaroslava P; Azizova, Elena V

    2016-05-01

    In this study the incidence risk of lower extremity arterial disease (LEAD; international classification of diseases version 9 code 440.2) was assessed in a cohort of workers occupationally exposed to radiation over a prolonged period. The study cohort includes 22,377 workers of the Mayak Production Association (25% of whom are females) first employed at one of the main facilities in 1948-1982 and followed up to the end of 2008. Dose estimates used in the study are provided by Mayak Worker Dosimetry System 2008. The mean total dose from external gamma-rays is 0.54 Gy for males and 0.44 Gy for females. The mean absorbed liver dose from internal alpha-radiation due to incorporated plutonium is 0.23 Gy in males and 0.44 Gy in females. Relative risks and excess relative risks per unit dose (ERR/Gy) are calculated based on maximum likelihood. A total of 943 cases of LEAD are registered in the study cohort during the follow-up of 512,801 person-years. A significant association of LEAD incidence with total dose from external gamma-rays (based on a linear model) was revealed, and the ERR/Gy is 0.27 (95% confidence interval (CI) 0.11; 0.48). It turned out that a linear-exponential model provides a better fit of the data (∆AIC = 9.957). Inclusion of an adjustment for internal alpha-radiation dose resulted in the reduction of the ERR/Gy to 0.19 (95% CI 0.05; 0.39), but the risk remains significant. No association of LEAD incidence with dose from internal alpha-radiation was found in the study worker cohort. It is concluded that this study provides evidence for an association of LEAD incidence with dose from external gamma-rays taking non-radiation factors into account.

  13. Exoskeleton control for lower-extremity assistance based on adaptive frequency oscillators: adaptation of muscle activation and movement frequency.

    PubMed

    Aguirre-Ollinger, Gabriel

    2015-01-01

    In this article, we analyze a novel strategy for assisting the lower extremities based on adaptive frequency oscillators. Our aim is to use the control algorithm presented here as a building block for the control of powered lower-limb exoskeletons. The algorithm assists cyclic movements of the human extremities by synchronizing actuator torques with the estimated net torque exerted by the muscles. Synchronization is produced by a nonlinear dynamical system combining an adaptive frequency oscillator with a form of adaptive Fourier analysis. The system extracts, in real time, the fundamental frequency component of the net muscle torque acting on a specific joint. Said component, nearly sinusoidal in shape, is the basis for the assistive torque waveform delivered by the exoskeleton. The action of the exoskeleton can be interpreted as a virtual reduction in the mechanical impedance of the leg. We studied the ability of human subjects to adapt their muscle activation to the assistive torque. Ten subjects swung their extended leg while coupled to a stationary hip joint exoskeleton. The experiment yielded a significant decrease, with respect to unassisted movement, of the activation levels of an agonist/antagonist pair of muscles controlling the hip joint's motion, which suggests the exoskeleton control has potential for assisting human gait. A moderate increase in swing frequency was observed as well. We theorize that the increase in frequency can be explained by the impedance model of the assisted leg. Per this model, subjects adjust their swing frequency in order to control the amount of reduction in net muscle torque.

  14. Long-Term Clinical and Functional Outcomes After Treatment for Localized Ewing's Tumor of the Lower Extremity

    SciTech Connect

    Indelicato, Daniel J.; Keole, Sameer R. Shahlaee, Amir H.; Gibbs, Charles P.; Scarborough, Mark T.; Marcus, Robert B.

    2008-02-01

    Purpose: Retrospective review describing the 35-year University of Florida experience with Ewing's tumors of the lower extremity. Patients and Methods: Fifty-three patients were treated between 1971 and 2006. Thirty patients were treated with radiotherapy (RT) alone and 23 patients were treated with surgery {+-} RT. Larger tumors and tumors of the femur were treated more often with definitive RT. Median potential follow-up was 19.2 years. Functional outcome was assessed using the Toronto Extremity Salvage Score (TESS). Results: Before 1985, 24% of patients were treated with surgery; since then, the rate has increased to 61%. The 15-year actuarial overall survival (OS), cause-specific survival (CSS), freedom from relapse, and limb preservation rates were 68% vs. 47% (p = 0.21), 73% vs. 47% (p = 0.13), 73% vs. 40% (p = 0.03), and 43% vs. 40% (p = 0.52), respectively, for patients treated with surgery {+-} RT vs. RT alone. Excluding 8 patients who underwent amputation or rotationplasty, the 15-year actuarial local control rate was 100% for the surgery {+-} RT group and 68% for the definitive RT group (p = 0.03). The ranges of the TESS for surgery {+-} RT vs. RT alone were 70-100 (mean, 94) and 97-100 (mean, 99), respectively. Twenty-six percent (6/23) of patients had complications related to surgery requiring amputation or reoperation. Conclusions: Overall survival and CSS were not statistically compromised, but we observed an increased risk of relapse and local failure in patients treated with RT alone, thereby justifying a transition toward primary surgical management in suitable patients. However, despite an adverse risk profile, patients treated with RT alone had similar long-term amputation-free survival and demonstrated comparable functional outcomes. Poor results observed in Ewing's of the femur mandate innovative surgical and RT strategies.

  15. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation.

    PubMed

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael; Jensen, Pia S; Gebuhr, Peter

    2016-06-01

    Background and purpose - Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods - 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results - The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25-0.91) and by 46% (HR =0.54, 95% CI: 0.35-0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation - With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise.

  16. Exoskeleton control for lower-extremity assistance based on adaptive frequency oscillators: adaptation of muscle activation and movement frequency.

    PubMed

    Aguirre-Ollinger, Gabriel

    2015-01-01

    In this article, we analyze a novel strategy for assisting the lower extremities based on adaptive frequency oscillators. Our aim is to use the control algorithm presented here as a building block for the control of powered lower-limb exoskeletons. The algorithm assists cyclic movements of the human extremities by synchronizing actuator torques with the estimated net torque exerted by the muscles. Synchronization is produced by a nonlinear dynamical system combining an adaptive frequency oscillator with a form of adaptive Fourier analysis. The system extracts, in real time, the fundamental frequency component of the net muscle torque acting on a specific joint. Said component, nearly sinusoidal in shape, is the basis for the assistive torque waveform delivered by the exoskeleton. The action of the exoskeleton can be interpreted as a virtual reduction in the mechanical impedance of the leg. We studied the ability of human subjects to adapt their muscle activation to the assistive torque. Ten subjects swung their extended leg while coupled to a stationary hip joint exoskeleton. The experiment yielded a significant decrease, with respect to unassisted movement, of the activation levels of an agonist/antagonist pair of muscles controlling the hip joint's motion, which suggests the exoskeleton control has potential for assisting human gait. A moderate increase in swing frequency was observed as well. We theorize that the increase in frequency can be explained by the impedance model of the assisted leg. Per this model, subjects adjust their swing frequency in order to control the amount of reduction in net muscle torque. PMID:25655955

  17. Do Ergogenic Aids Alter Lower Extremity Joint Alignment During a Functional Movement Lunge Prior to and Following an Exercise Bout?

    PubMed Central

    Mills, Chris; Knight, James; Milligan, Gemma

    2015-01-01

    Ergogenic aids have been used to alter joint kinematics in an attempt to minimise injury risk, yet the effectiveness of these aids may be compromised following a bout of exercise. This preliminary study aimed to measure the effect of compression garments and Kinesio Tape® on lower extremity joint alignment prior to and following an exercise bout. Eight male athletes (age = 24.1 ± 3.0 years, body height = 177.4 ± 5.2 cm, body mass = 72.3 ± 7.2 kg) volunteered to participant in this study. Joint kinematics were recorded whilst all participants performed three rotational lunges, in three conditions (control, compression garment, Kinesio Tape®), prior to and following a 10 minute exercise bout. Frontal plane kinematics (lateral pelvic tilt, knee valgus, ankle inversion/eversion) were used to assess ergogenic aid effectiveness during the lunge. Participants exhibited no significant differences in joint kinematics between ergogenic aid conditions prior to the exercise bout. Following exercise the only significant difference occurred within the Kinesio Tape® condition where maximum knee valgus angle significantly increased from 6.5° prior to exercise, to 7.7° following the exercise bout. The results of this study suggest joint kinematics are not affected by the ergogenic aids in this study prior to an exercise bout. However, there is evidence to suggest that the application of Kinesio Tape® may allow an increase in knee valgus angle following a bout of exercise, yet, compression garments are effective at maintaining joint alignment following a bout of exercise. PMID:25964805

  18. Post-Exercise Phosphocreatine Recovery, an Index of Mitochondrial Oxidative Phosphorylation, is Reduced in Diabetic Patients With Lower Extremity Complications

    PubMed Central

    Tecilazich, Francesco; Dinh, Thanh; Lyons, Thomas E.; Guest, Julie; Villafuerte, Rose; Sampanis, Christos; Gnardellis, Charalambos; Zuo, Chun; Veves, Aristidis

    2013-01-01

    Objective To identify differences in the post-exercise phosphocreatine (PCr) recovery, an index of mitochondrial function, in diabetic patients with and without lower extremity complications. Research Methods and Design We enrolled healthy control subjects and three groups of T2DM patients: patients without complications, with peripheral neuropathy and both peripheral neuropathy and peripheral arterial disease. We employed Magnetic Resonance Spectroscopic (MRS) measurements to perform continuous measurements of phosphorous metabolites (PCr and Pi) during a 3-minute graded exercise at the level of the posterior calf muscles (gastrocnemius and soleus muscles). Micro- and macrovascular reactivity measurements were also performed. Results The resting Pi/PCr ratio and PCr at baseline and the maximum reached during exercise was similar in all groups. The post-exercise time required for recovery of Pi/PCr ratio and PCr levels to resting levels, an assessment of mitochondrial oxidative phosphorylation, was significantly higher in the diabetic patients with neuropathy and those with both neuropathy and PAD (p <0.01 for both measurements). These two groups had also higher levels of TNFα, (p<0.01) and G-CSF (p <0.05). Multiple regression analysis showed that only G-CSF, OPG and TNFα were significant contributing factors in the variation of the Pi/PCr ratio recovery time. No associations were observed between micro- and macrovascular reactivity measurements and Pi/Pcr ration or Pcr recovery time. Conclusions Mitochondrial oxidative phosphorylation is impaired only in T2DM patients with neuropathy whether PAD is present or not and is associated with the increased proinflammatory state that was observed in these groups. PMID:23465172

  19. Investigation of the Saturation Pulse Artifact in Non-Enhanced MR Angiography of the Lower Extremity Arteries at 7 Tesla

    PubMed Central

    Johst, Sören; Maderwald, Stefan; Fischer, Anja; Quick, Harald H.; Ladd, Mark E.; Orzada, Stephan

    2015-01-01

    When performing non-enhanced time-of-flight MR angiography of the lower extremity arteries at 7 T with cardiac triggering, the acquisition time is a crucial consideration. Therefore, in previous studies, saturation RF pulses were applied only every second TR. In the axial source images a slight artifact with an appearance similar to aliasing could be observed. The purpose of this study was to investigate the origin of this artifact. The reason for the artifact is supposed to be related to the two effective TRs during acquisition caused by the sparsely applied saturation RF pulse. Several sequence variants were simulated and implemented within the sequence source code to examine this hypothesis. An adaptation of the excitation flip angles for each TR as well as a correction factor for the k-space data was calculated. Additionally, a different ordering of the k-space data during acquisition was implemented as well as the combination of the latter with the k-space correction factor. The observations from the simulations were verified using both a static and a flow phantom and, finally, in a healthy volunteer using the same measurement setup as in previous volunteer and patient studies. Of all implemented techniques, only the reordering of the k-space was capable of suppressing the artifact almost completely at the cost of creating a ringing artifact. The phantom measurements showed the same results as the simulations and could thus confirm the hypothesis regarding the origin of the artifact. This was additionally verified in the healthy volunteer. The origin of the artifact could be confirmed to be the periodic signal variation caused by two effective TRs during acquisition. PMID:25785837

  20. Use of a fluorescence angiography system in assessment of lower extremity ulcers in patients with peripheral arterial disease: A review and a look forward.

    PubMed

    Samies, John H; Gehling, Marie; Serena, Thomas E; Yaakov, Raphael A

    2015-01-01

    The prevalence of chronic wounds is sharply rising throughout the world due to an aging population and increases in the incidence of obesity, diabetes, and cardiovascular diseases. People with diabetes, hypertension, and hyperlipidemia are at increased risk for developing peripheral arterial disease (PAD). PAD affects 8 to 12 million people over the age of 40 years in the United States and it is a major contributing factor to the development of lower extremity ulcers. Although a number of noninvasive diagnostic tests are available to detect PAD in lower extremities, they have several clinical limitations. In this review, current understanding of the pathophysiology of commonly seen lower extremity ulcers is described and vascular assessments typically used in practice are evaluated. In addition, application of the LUNA Fluorescence Angiography System (Novadaq, Bonita Springs, FL) for the screening and treatment of complex nonhealing wounds in patients with PAD is discussed. PMID:27113286

  1. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    PubMed Central

    Gopinathan, Nirmal Raj; Prakash, Mahesh; Saibaba, Balaji; Das, Ashim

    2016-01-01

    Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis. PMID:27413281

  2. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    PubMed

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures. PMID:26606762

  3. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    PubMed

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  4. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

    PubMed Central

    Pemayun, Tjokorda Gde Dalem; Naibaho, Ridho M.; Novitasari, Diana; Amin, Nurmilawati; Minuljo, Tania Tedjo

    2015-01-01

    Background Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods We performed a hospital-based, case–control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years), sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21. Results There were 47 case–control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12–134.31; p=0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44–48.88; p<0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74–17.91; p=0.004), and hypertension (OR 3.67, 95% CI 1.14–11.79; p=0.028) as the independent risk factors associated with subsequent LEA in DFU. Conclusions Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study. Good glycemic

  5. Triaxial modulation of the acceleration induced in the lower extremity during whole-body vibration training: a pilot study.

    PubMed

    Cook, David P; Mileva, Katya N; James, Darren C; Zaidell, Lisa N; Goss, Victor G; Bowtell, Joanna L

    2011-02-01

    The purpose of the present study was to quantify vibration transmissibility through the lower extremity during exercise on a whole-body vibration (WBV) platform. Six healthy adults completed 20 trials of 30-second static squat exercise at 30 or 40 degrees of knee flexion angle on a WBV platform working at combinations of 5 frequencies (VF: 20, 25, 30, 35, 40 Hz) and 2 amplitudes (VA: low, 1.5 mm or high, 3 mm). Accelerations induced by the platform were recorded simultaneously at the shank and the thigh using triaxial accelerometers positioned at the segmental center of mass. Root-mean-square (RMS) acceleration amplitude and transmission ratios between the platform and the leg segments were calculated and compared between the experimental conditions. An alpha level of 0.05 was set to establish significance. Shank vertical acceleration was greatest at the lower VF (p = 0.028), higher VA (p = 0.028), and deeper squat (p = 0.048). Thigh vertical acceleration was not affected by depth of squat (p = 0.25), but it was greatest at higher VA (p = 0.046) and lower VF (p = 0.028). Medial-lateral shank acceleration was greatest at higher VF and deeper squat (both p = 0.046) and at higher VA (p = 0.028). Medial-lateral thigh acceleration was positively related to both VF (p = 0.046) and VA (p = 0.028) but was not affected by knee angle (p = 0.46). Anterior-posterior shank acceleration was higher at deeper squat (p = 0.046) and at lower VF and higher VA (both p = 0.028). Anterior-posterior thigh acceleration was related positively to the VA (p = 0.028), inversely to the VF (p = 0.028), and not dependent on knee angle (p = 0.75). Identification of specific vibration parameters and posture, which underpin WBV training efficacy, will enable coaches and athletes to design WBV training programs to specifically target shank or thigh muscles for enhanced performance.

  6. High Prevalence of Lower Extremity Peripheral Artery Disease in Type 2 Diabetes Patients with Proliferative Diabetic Retinopathy

    PubMed Central

    Zhao, Dong; Yu, Cai-Guo; Xin, Zhong; Cao, Xi; Shi, Jing; Yang, Guang-Ran; Yuan, Ming-Xia; Yang, Jin-Kui

    2015-01-01

    Little is known about the relationship between lower extremity peripheral arterial disease (PAD) and proliferative diabetic retinopathy (PDR) in type 2 diabetes (T2D). Here, we explored the relationship between sight-threatening PDR and PAD. We screened for diabetic retinopathy (DR) and PAD in hospitalized patients with T2D. Patients with a diabetic duration of more than 10 years, HbA1c ≥7.5%, eGFR ≥60mL/min/1.73m2 and with PDR or with no diabetic retinopathy (NDR) were eligible for this cross-sectional study. Severities of DR were graded by digital retinal photographs according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. We assessed PAD by measuring Ankle Brachial Index (ABI), Toe Brachial Index (TBI) and Doppler ultrasound. Statistical analyses were performed using SPSS 17.0 software. Of the 1544 patients, 169 patients with extreme eye (57 PDR and 112 NDR) phenotypes met the inclusion criteria. Patients with PDR had a significantly higher proportion of low ABI (≤0.99) and high ABI (≥1.3) than patients with NDR (28.1% and 15.8% vs. 14.3% and 6.2% respectively, P<0.05). PDR patients also had lower TBI than NDR patients (0.56±0.09 vs. 0.61±0.08, P<0.01). The proportion of patients with abnormal duplex ultrasound was higher in PDR than in NDR (21.1% vs. 9.8%, P<0.001). This showed that PDR associated with PAD could be defined in multiple ways: abnormal ABI (≤0.9) (OR = 3.61, 95% CI: 1.15–11.26), abnormal TBI (OR = 2.84, 95% CI: 1.19–6.64), abnormal duplex (OR = 3.28, 95% CI: 1.00–10.71), and critical limb ischemia (OR = 5.52, 95% CI: 2.14–14.26). Moreover, PDR was a stronger independent correlation factor for PAD than a diabetic duration of 10 years. In conclusion, PAD is more common in PDR than in NDR. It implies that PDR and PAD are mostly concomitant in T2D. We should focus on screening PAD in patients with PDR in clinical practice. PMID:25822410

  7. Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score

    PubMed Central

    Hung, Man; Hon, Shirley D.; Cheng, Christine; Franklin, Jeremy D.; Aoki, Stephen K.; Anderson, Mike B.; Kapron, Ashley L.; Peters, Christopher L.; Pelt, Christopher E.

    2014-01-01

    Background: The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood. Purpose: To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index. Results: All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good. Conclusion: The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior

  8. COMPARISON OF TRUNK AND LOWER EXTREMITY MUSCLE ACTIVITY AMONG FOUR STATIONARY EQUIPMENT DEVICES: UPRIGHT BIKE, RECUMBENT BIKE, TREADMILL, AND ELLIPTIGO®

    PubMed Central

    Baker, Ryan; Gibson, Chris; Kearney, Andrew; Busemeyer, Tommy

    2016-01-01

    Background Stationary equipment devices are often used to improve fitness. The ElliptiGO® was recently developed that blends the elements of an elliptical trainer and bicycle, allowing reciprocal lower limb pedaling in an upright position. However, it is unknown whether the muscle activity used for the ElliptiGO® is similar to walking or cycling. To date, there is no information comparing muscle activity for exercise on the treadmill, stationary upright and recumbent bikes, and the ElliptiGO®. Purpose/Hypothesis The purpose of this study was to assess trunk and lower extremity muscle activity among treadmill walking, cycling (recumbent and upright) and the ElliptiGO® cycling. It was hypothesized that the ElliptiGO® and treadmill would elicit similar electromyographic muscle activity responses compared to the stationary bike and recumbent bike during an exercise session. Study Design Cohort, repeated measures Methods Twelve recreationally active volunteers participated in the study and were assigned a random order of exercise for each of the four devices (ElliptiGO®, stationary upright cycle ergometer, recumbent ergometer, and a treadmill). Two-dimensional video was used to monitor the start and stop of exercise and surface electromyography (SEMG) were used to assess muscle activity during two minutes of cycling or treadmill walking at 40-50% heart rate reserve (HRR). Eight muscles on the dominant limb were used for analysis: gluteus maximus (Gmax), gluteus medius (Gmed), biceps femoris (BF), lateral head of the gastrocnemius (LG), tibialis anterior (TA), rectus femoris (RF). Two trunk muscles were assessed on the same side; lumbar erector spinae at L3-4 level (LES) and rectus abdominus (RA). Maximal voluntary isometric contractions (MVIC) were determined for each muscle and SEMG data were expressed as %MVIC in order to normalize outputs. Results The %MVIC for RF during ElliptiGO® cycling was higher than recumbent cycling. The LG muscle activity was highest

  9. Longitudinal decline of lower extremity muscle power in healthy and mobility-limited older adults: influence of muscle mass, strength, composition, neuromuscular activation and single fiber contractile properties

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This longitudinal study examined the major physiological mechanisms that determine the age related loss of lower extremity muscle power in two distinct groups of older humans. We hypothesized that after ~3 years of follow-up, mobility-limited older adults (mean age: 77.2 +/- 4, n = 22, 12 females) w...

  10. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

    PubMed

    Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George

    2014-01-01

    Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population. PMID:24126108

  11. Relationship of lower extremity alignment during the wall squat and single-leg jump: assessment of single-leg landing using three-dimensional motion analysis

    PubMed Central

    Watanabe, Manabu; Matsumoto, Takaaki; Ono, Susumu; Koseki, Hirohisa; Watarai, Koji

    2016-01-01

    [Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury. PMID:27390393

  12. Managing Lower Extremity Muscle Tone and Function in Children with Cerebral Palsy via Eight-Week Repetitive Passive Knee Movement Intervention

    ERIC Educational Resources Information Center

    Cheng, Hsin-Yi Kathy; Ju, Yan-Ying; Chen, Chia-Ling; Chang, Ya-Ju; Wong, Alice May-Kuen

    2013-01-01

    This study used a repeated measures design to assess the effect of an eight-week repetitive passive movement (RPM) intervention on lower extremity muscle tone and function in children with cerebral palsy (CP). Eighteen children (aged 9.5 [plus or minus] 2.1 years) with spastic CP were randomly assigned to a knee RPM intervention condition of 3…

  13. Relationship of lower extremity alignment during the wall squat and single-leg jump: assessment of single-leg landing using three-dimensional motion analysis.

    PubMed

    Watanabe, Manabu; Matsumoto, Takaaki; Ono, Susumu; Koseki, Hirohisa; Watarai, Koji

    2016-06-01

    [Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury. PMID:27390393

  14. Co-Activity during Maximum Voluntary Contraction: A Study of Four Lower-Extremity Muscles in Children with and without Cerebral Palsy

    ERIC Educational Resources Information Center

    Tedroff, Kristina; Knutson, Loretta M.; Soderberg, Gary L.

    2008-01-01

    This study was designed to determine whether children with cerebral palsy (CP) showed more co-activity than comparison children in non-prime mover muscles with regard to the prime mover during maximum voluntary isometric contraction (MVIC) of four lower-extremity muscles. Fourteen children with spastic diplegic CP (10 males, four females; age…

  15. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

    PubMed

    Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George

    2014-01-01

    Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.

  16. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease

    PubMed Central

    Lo, Ruby C.; Bensley, Rodney P.; Dahlberg, Suzanne E.; Matyal, Robina; Hamdan, Allen D.; Wyers, Mark; Chaikof, Elliot L.; Schermerhorn, Marc L.

    2013-01-01

    Objective Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality. Methods We identified individuals with intermittent claudication and critical limb ischemia (CLI) using International Classification of Diseases, Ninth Revision codes in the Nationwide Inpatient Sample from 1998 to 2009. We compared presentation at time of intervention (intermittent claudication vs CLI), procedure (open surgery vs percutaneous transluminal angioplasty or stenting vs major amputation), and in-hospital mortality for men and women. Regional and ambulatory trends were evaluated by performing a separate analysis of the State Inpatient and Ambulatory Surgery Databases from four geographically diverse states: California, Florida, Maryland, and New Jersey. Results From the Nationwide Inpatient Sample, we identified 1,797,885 patients (56% male) with intermittent claudication (26%) and CLI (74%), who underwent 1,865,999 procedures (41% open surgery, 20% percutaneous transluminal angioplasty or stenting, and 24% amputation). Women were older at the time of intervention by 3.5 years on average and more likely to present with CLI (75.9% vs 72.3%; odds ratio [OR], 1.21; 95% confidence interval [CI], 1.21–1.23; P < .01). Women were more likely to undergo endovascular procedures for both intermittent claudication (47% vs 41%; OR, 1.27; 95% CI, 1.25–1.28; P < .01) and CLI (21% vs 19%; OR, 1.14; 95% CI, 1.13–1.15; P < .01). From 1998 to 2009, major amputations declined from 18 to 11 per 100,000 in men and 16 to 7 per 100,000 in women, predating an increase in total CLI revascularization procedures that was seen starting in 2005 for both men and women. In-hospital mortality was

  17. The Swelling of Olympic Gels

    NASA Astrophysics Data System (ADS)

    Lang, Michael; Fischer, Jakob; Werner, Marco; Sommer, Jens-Uwe

    2014-03-01

    The swelling equilibrium of Olympic gels is studied by Monte Carlo Simulations. We observe that gels consisting of flexible cyclic molecules of a higher degree of polymerization N show a smaller equilibrium swelling degree Q ~N - 0 . 28φ0- 0 . 72 for the same monomer volume fraction φ0 at network preparation. This observation is explained by a disinterpenetration process of overlapping non-concatenated polymers upon swelling. In the limit of a sufficiently large number of concatenations per cyclic molecule we expect that the equilibrium degree of swelling becomes proportional to φ0- 1 / 2 independent of N. Our results challenge current textbook models for the equilibrium degree of swelling of entangled polymer networks. Now at: Bio Systems Analysis Group, Jena Centre for Bioinformatics (JCB) and Department for Mathematics and Computer Sciences, Friedrich Schiller University of Jena, 07743 Jena, Germany.

  18. Effects of Low-Impact Dance on Blood Biochemistry, Bone Mineral Density, the Joint Range of Motion of Lower Extremities, Knee Extension Torque, and Fall in Females.

    PubMed

    Wu, Hui Ying; Tu, Jui Hung; Hsu, Chin Hsing; Tsao, Te Hung

    2016-01-01

    The effect of low-impact dance on blood metabolites, the joint range of motion (ROM) of the lower extremities, knee extension torque, bone mass density (BMD), the number of falls, and the confidence to perform daily activities (Modified Falls Efficacy Scale [MFES]) was examined in older sedentary women (age: 59 ± 4 years) before and after a 16-week intervention. Results showed that the average score for the MFES, some parameters of blood chemistry, and joint ROM were significantly improved after low-impact intervention. In addition to improvements in blood lipids and body fat percentages, the increases shown in the parameters regarding the lower extremities may contribute to confidence in performing common daily activities in older women, although the number of falls did not significantly differ between the two groups during the 16-week period.

  19. The effects of horseback riding simulator exercises on the muscle activity of the lower extremities according to changes in arm posture

    PubMed Central

    Park, Jungseo; Lee, Sangyong; Lee, Daehee

    2015-01-01

    [Purpose] This study aimed to determine the effects of horseback riding simulator exercise on the muscle activities of the lower extremities according to changes in arm posture. [Subjects] The subjects of this study were 30 normal adult males and females. [Methods] The horseback riding simulator exercise used a horseback riding simulator device; two arm postures were used, posture 1 (holding the handle of the device) and posture 2 (crossing both arms, with both hands on the shoulders). Electromyography was used to compare the muscle activities of the rectus femoris, biceps femoris, and hip adductors in the lower extremities. [Results] Posture 2 had significantly higher muscle activity than posture 1. [Conclusion] Posture 2, which entailed crossing both arms with both hands on the shoulders, was an effective intervention for improved muscle activity in the hip adductors. PMID:26504280

  20. Sixty-four-slice CT angiography to determine the three dimensional relationships of vascular and soft tissue wounds in lower extremity war time injuries.

    PubMed

    Smith, Jennifer M; Fox, Charles J; Brazaitis, Michael P; Via, Kathy; Garcia, Roman; Feuerstein, Irwin M

    2010-01-01

    This article analyzes the use and benefits of the 64-slice CT scanner in determining the 3D relationships of vascular and soft tissue wounds in lower extremity war time injuries. A brief overview of CT scanning is given as well as the techniques used to produce the images needed for diagnosis. The series follows two similar cases of war time injury patients at the Walter Reed Army Medical Center. The first case is a 30-year-old active duty male, who presented with multiple trauma from a motor vehicle accident because of an improvised explosive device (IED) blast, sustaining substantial lower extremity injuries. The second case is a 34-year-old active duty male, who presented with multiple trauma blast injuries. Both cases were of interest because the vasculature was found to be very close to the surface of the wound, which put the arteries at risk for rupture and for iatrogenic injury during repeated debridements.

  1. Ewing sarcoma mimicking a peripheral nerve sheath tumor.

    PubMed

    Mitchell, B D; Fox, B D; Viswanathan, A; Mitchell, A H; Powell, S Z; Cech, D A

    2010-10-01

    We describe the first patient with an extradural, extramedullary Ewing's sarcoma tumor mimicking a nerve sheath tumor with no overt evidence of metastasis. A 28-year-old woman with no past medical history presented with a progressive 3-year history of low back pain and right-sided lower extremity radiculopathy after having failed conservative therapies. MRI of the lumbar spine revealed a right-sided enhancing, dumbbell-shaped lesion at the right neural foramen appearing to originate from the L4 nerve root, suspicious for a peripheral nerve sheath tumor or schwannoma. The patient and findings are discussed in the context of the literature, including an update on the relatively recent diagnostic redesignation of the Ewing's sarcoma family tumors.

  2. Effect of Roy’s Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial

    PubMed Central

    Farsi, Zahra; Azarmi, Somayeh

    2016-01-01

    Background: Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy’s adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. Methods: In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy’s adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. Results: Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). Conclusion: The findings of this research indicated that the Roy’s adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy’s adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. Trial Registration Number: IRCT2014081118763N1 PMID:27218110

  3. Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke

    PubMed Central

    Goliwas, Magdalena; Kocur, Piotr; Furmaniuk, Lech; Majchrzycki, Marian; Wiernicka, Marzena; Lewandowski, Jacek

    2015-01-01

    [Purpose] To assess the effects of sensorimotor foot stimulation on the symmetry of weight distribution on the feet of patients in the chronic post-stroke phase. [Subjects and Methods] This study was a prospective, single blind, randomized controlled trial. In the study we examined patients with chronic stroke (post-stroke duration > 1 year). They were randomly allocated to the study group (n=8) or to the control group (n=12). Both groups completed a standard six-week rehabilitation programme. In the study group, the standard rehabilitation programme was supplemented with sensorimotor foot stimulation training. Each patient underwent two assessments of symmetry of weight distribution on the lower extremities with and without visual control, on a treadmill, with stabilometry measurements, and under static conditions. [Results] Only the study group demonstrated a significant increase in the weight placed on the leg directly affected by stroke, and a reduction in asymmetry of weight-bearing on the lower extremities. [Conclusion] Sensorimotor stimulation of the feet enhanced of weight bearing on the foot on the side of the body directly affected by stroke, and a decreased asymmetry of weight distribution on the lower extremities of patients in the chronic post-stroke phase. PMID:26504326

  4. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

    PubMed Central

    Mohan, Uthra; babu, S. Karthik; Kumar, K. Vijay; Suresh, B. V.; Misri, Z. K.; Chakrapani, M.

    2013-01-01

    Objective: To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke. Design: A randomized, sham-controlled, assessor blinded, pilot trial. Setting: Inpatient stroke rehabilitation unit. Subjects: First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled. Intervention: Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups. Outcome Measures: Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC). Results: Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11) and control group (N = 11). Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02). Significance was set at P < 0.05. Conclusion: Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility. PMID:24339596

  5. Effect of attending to a ball during a side-cut maneuver on lower extremity biomechanics in male and female athletes.

    PubMed

    Fedie, Rebecca; Carlstedt, Kristen; Willson, John D; Kernozek, Thomas W

    2010-09-01

    Many sports associated with anterior cruciate ligament (ACL) injury require athletes attend to a ball during participation. We investigated effects of attending to a ball on lower extremity mechanics during a side-cut maneuver and if these effects are consistent for males and females. Sagittal and frontal plane hip and knee kinematics and joint moments were measured during side-cut maneuvers in 19 male and 19 female National Collegiate Athletic Association division III basketball players. Participants also experienced two side-cut conditions that required attention to a ball. Our results did not indicate that the effect of attention varies with gender. However, during side-cut conditions while attending to a ball, internal knee adductor moment was 20% greater (p = 0.03) and peak knee flexion angle was 4 degrees larger (p < 0.01). Females demonstrated 5 degrees less hip flexion (p = 0.046), 12 degrees less knee flexion (p < 0.01), and 4 degrees more knee abduction (p = 0.026) at initial contact during all side-cut conditions than males. Attention to a ball may affect lower extremity mechanics relevant to ACL injury. The validity of laboratory studies of lower extremity mechanics for sports that include attention to a ball may be increased if participants are required to attend to a ball during the task.

  6. The association of meniscal status, lower extremity alignment, and body mass index with chondrosis at the time of revision Anterior Cruciate Ligament reconstruction

    PubMed Central

    Brophy, Robert H.; Haas, Amanda K.; Huston, Laura J.; Nwosu, Sam K.; Wright, Rick W.

    2015-01-01

    Background Knees undergoing revision ACL reconstruction (rACLR) have a high prevalence of articular cartilage lesions. Hypothesis The purpose of this study was to test the hypothesis that the prevalence of chondrosis at the time of rACLR is associated with meniscus status and lower extremity alignment. Study design Cross sectional study. Methods Data from the prospective Multicenter ACL Revision Study (MARS) cohort was reviewed to identify patients with pre-operative lower extremity alignment films. Lower extremity alignment was defined by the weight bearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weight bearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors in order to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. Results The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Average (SD) patient age was 26.9 (9.5) years with a BMI of 26.4 (4.6). The medial compartment had more chondrosis (Grade 2/3: 42%, Grade 4: 6.5%) than the lateral compartment (Grade 2/3: 26%, Grade 4: 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The average (SD) WBL was measured to be 0.43 (0.13). Medial compartment chondrosis was associated with BMI (p=0.025), alignment (p=0.002), and medial meniscus status (p=0.001). None of the knees with the WBL lateral to 0.625 had Grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (p=0.013) and lateral meniscus status (p<0.001). Subjects with ‘intact’ menisci were found to decrease their odds of having chondrosis by 64–84%. Conclusions The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Lower

  7. Pulse Waves in the Lower Extremities as a Diagnostic Tool of Peripheral Arterial Disease and Predictor of Mortality in Elderly Chinese.

    PubMed

    Sheng, Chang-Sheng; Li, Yan; Huang, Qi-Fang; Kang, Yuan-Yuan; Li, Fei-Ka; Wang, Ji-Guang

    2016-03-01

    Patients with peripheral arterial disease may have elongated upstroke time in pulse waves in the lower extremities. We investigated upstroke time as a diagnostic tool of peripheral arterial disease and predictor of mortality in an elderly (≥60 years) Chinese population. We recorded pulse waves at the left and right ankles by pneumoplethysmography and calculated the percentage of upstroke time per cardiac cycle. Diagnostic accuracy was compared with the conventional ankle-brachial index method (n=4055) and computed tomographic angiography (34 lower extremities in 17 subjects). Upstroke time per cardiac cycle at baseline (mean±SD, 16.4%±3.1%) was significantly (P<0.0001) associated with ankle-brachial index in men (n=1803; r=-0.44) and women (n=2252; r=-0.32) and had an overall sensitivity and specificity of 86% and 80%, respectively, for the diagnosis of peripheral arterial disease (upstroke time per cardiac cycle, ≥21.7%) in comparison with computed tomographic angiography. During 5.9 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 366 and 183 subjects, respectively. In adjusted Cox regression analyses, an upstroke time per cardiac cycle ≥21.7% (n=219; 5.4%) significantly (P<0.0001) predicted total and cardiovascular mortality. The corresponding hazard ratios were 1.98 (95% confidence interval, 1.48-2.65) and 2.29 (1.58-3.32), respectively, when compared with that of 2.10 (1.48-3.00) and 2.44 (1.57-3.79), respectively, associated with an ankle-brachial index of ≤0.90 (n=115; 2.8%). In conclusion, pulse waves in the lower extremities may behave as an accurate and ease of use diagnostic tool of peripheral arterial disease and predictor of mortality in the elderly.

  8. Chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life: a population-based cross-sectional study.

    PubMed

    Feddern, Marie-Louise; Jensen, Troels Staehelin; Laurberg, Søren

    2015-09-01

    The aim of this investigation was to examine the prevalence of and factors associated with chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life (QoL). This is a population-based cross-sectional study of chronic pain and QoL in patients treated for rectal cancer from 2001 to 2007. A modified version of the Brief Descriptive Danish Pain Questionnaire and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire were mailed to 1713 Danish patients. Informative answers were obtained from 1369 patients (80%). A total of 426 patients (31%) reported chronic pain in the pelvic area or lower extremities, 173 (41%) of whom had daily pain. Pain in other parts of the body was associated with the presence of pain in the pelvic region (odds ratio [OR] 4.81 [3.63-6.38], P < 0.001). Multivariate logistic regression analysis showed an association with chronic pain in female patients (OR 1.91 [1.51-2.43], P < 0.001) and in those who received radio(chemo)therapy (OR 1.31 [1.01-1.7], P = 0.041) or underwent abdominoperineal excision (OR 1.71 [1.19-2.44], P = 0.003), total mesorectal excision (OR 1.39 [1.01-1.90], P = 0.041), and Hartmann procedure (OR 1.72 [1.04-2.84], P = 0.33) compared with partial mesorectal excision. Ordinal regression analysis showed a strong association between all QoL subgroups and pelvic pain. Chronic pain in the pelvic region or lower extremities after rectal cancer treatment is a common but largely neglected problem that is associated with female gender, type of surgery, radio(chemo)therapy, and young age, all of which impact the patient's QoL.

  9. High spatial resolution time-resolved magnetic resonance angiography of lower extremity tumors at 3T: Comparison with computed tomography angiography.

    PubMed

    Wu, Gang; Jin, Teng; Li, Ting; Morelli, John; Li, Xiaoming

    2016-09-01

    The aim of this study was to compare diagnostic value of high spatial resolution time-resolved magnetic resonance angiography with interleaved stochastic trajectory (TWIST) using Gadobutrol to Computed tomography angiography (CTA) for preoperative evaluation of lower extremity tumors.This prospective study was approved by the institutional review board. Fifty consecutive patients (31 men, 19 women, age range 18-80 years, average age 42.7 years) with lower extremity tumors underwent TWIST magnetic resonance angiography (MRA) and CTA. Digital subtraction angiography was available for 8 patients. Image quality of MRA was compared with CTA by 2 radiologists according to a 4-point Likert scale. Arterial involvement by tumor was compared using kappa test between MRA and CTA. The ability to identify feeding arteries and arterio-venous fistulae (AVF) was compared using Wilcoxon signed rank test and McNemar test, respectively.Image quality of MRA and CTA was rated without a statistically significant difference (3.88 ± 0.37 vs. 3.97 ± 0.16, P = 0.135). Intramodality agreement was high for the identification of arterial invasion (kappa = 0.806 ± 0.073 for Reader 1, kappa = 0.805 ± 0.073 for Reader 2). Readers found AVF in 27 of 50 MRA cases and 14 of 50 CTA cases (P < 0.001). Mean feeding arteries identified with MRA were significantly more than that with CTA (2.08 ± 1.72 vs. 1.62 ± 1.52, P = .02).TWIST MRA is a reliable imaging modality for the assessment of lower extremity tumors. TWIST MRA is comparable to CTA for the identification of AVF and feeding arteries. PMID:27631262

  10. [Features of allele polymorphism of genes involved in homocysteine and folate metabolism in patients with atherosclerosis of the lower extremity arteries].

    PubMed

    Klenkova, N A; Kapustin, S I; Saltykova, N B; Shmeleva, V M; Blinov, M N

    2009-01-01

    Under study were features of allele polymorphism of genes of methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), methionine synthase (MS A 2756G), methionine synthase reductase (MTRR A66G) and methylenetetrahydrofolate dehydrogenase (MTHFD G1958A) in patients with atherosclerosis of the lower extremity arteries (ALEA). Patients with hyperhomocysteinemia (HHcy) had statistically significant increase of allele MTHFR 677T and MTRR 66GG as compared both with the control group and with the group of patients without HHcy. It suggests that polymorphism of genes involved in homocystein and folate metabolism might affect the risk of HHcy in patients with ALEA. PMID:20209990

  11. [Features of allele polymorphism of genes involved in homocysteine and folate metabolism in patients with atherosclerosis of the lower extremity arteries].

    PubMed

    Klenkova, N A; Kapustin, S I; Saltykova, N B; Shmeleva, V M; Blinov, M N

    2009-01-01

    Under study were features of allele polymorphism of genes of methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), methionine synthase (MS A 2756G), methionine synthase reductase (MTRR A66G) and methylenetetrahydrofolate dehydrogenase (MTHFD G1958A) in patients with atherosclerosis of the lower extremity arteries (ALEA). Patients with hyperhomocysteinemia (HHcy) had statistically significant increase of allele MTHFR 677T and MTRR 66GG as compared both with the control group and with the group of patients without HHcy. It suggests that polymorphism of genes involved in homocystein and folate metabolism might affect the risk of HHcy in patients with ALEA.

  12. The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study.

    PubMed

    Brigido, Stephen A

    2006-09-01

    A prospective, single-centre, randomized controlled study was performed to evaluate the effectiveness of Graftjacket, a human acellular regenerative tissue matrix as a treatment option for chronic non healing lower extremity wounds. Twenty-eight diabetic patients with full-thickness wounds that had been present for at least 6 weeks were treated with sharp debridement and randomized to a single application of Graftjacket tissue matrix plus mineral oil-soaked fluff compression dressing or to a control treatment of wound gel with gauze dressings. All patients were seen weekly. By week 16, 12 of 14 patients treated with Graftjacket tissue matrix demonstrated complete wound closure compared with 4 of 14 patients in the control group. Patients treated with Graftjacket tissue matrix showed a statistically significant higher percentage of wound healing with respect to wound area, and clinically significant differences in wound depth and wound volume. This comparison is not performed to demonstrate that the application of the Grafjacket is more effective than sharp debridement. This study is done to help assign a role to the use of Graftjacket matrix in lower extremity wound care.

  13. Observed Rates of Lower Extremity Stress Fractures After Implementation of the Army Physical Readiness Training Program at JBSA Fort Sam Houston.

    PubMed

    Chalupa, Robyn L; Aberle, Curtis; Johnson, Anthony E

    2016-01-01

    Millions of dollars are lost each year to the US military in medical discharges from injuries sustained in the initial training of recruits. Most medical discharges in recruits are related to musculoskeletal overuse injuries, including stress fractures. Any strategies that can reduce injury rates are also likely to reduce rates of medical discharge. This study evaluated the Army Physical Readiness Training (PRT) program which was established to provide a method of physical fitness training that would reduce the number of preventable injuries. We conducted a retrospective study to evaluate the number of lower extremity stress fractures that were diagnosed in the 6 months prior to and 6 months following the implementation of the PRT program. Electronic medical records were queried for specific diagnoses of stress fractures to the pelvis, femoral neck, femoral shaft, tibia, fibula, tarsals and metatarsals. The observed number of diagnoses in each time period were compared using the χ² method. Decrease was shown not only in the overall occurrence of stress fractures, but specifically in the occurrence of stress fractures of the femoral neck, femoral shaft, and tarsals. Our study was able to show a correlation between the PRT program and a decrease in the observed occurrence of lower extremity stress fractures.

  14. Remote ischaemic conditioning in the context of type 2 diabetes and neuropathy: the case for repeat application as a novel therapy for lower extremity ulceration.

    PubMed

    Epps, J A; Smart, N A

    2016-01-01

    An emerging treatment modality for reducing damage caused by ischaemia-reperfusion injury is ischaemic conditioning. This technique induces short periods of ischaemia that have been found to protect against a more significant ischaemic insult. Remote ischaemic conditioning (RIC) can be administered more conveniently and safely, by inflation of a pneumatic blood pressure cuff to a suprasystolic pressure on a limb. Protection is then transferred to a remote organ via humoral and neural pathways. The diabetic state is particularly vulnerable to ischaemia-reperfusion injury, and ischaemia is a significant cause of many diabetic complications, including the diabetic foot. Despite this, studies utilising ischaemic conditioning and RIC in type 2 diabetes have often been disappointing. A newer strategy, repeat RIC, involves the repeated application of short periods of limb ischaemia over days or weeks. It has been demonstrated that this improves endothelial function, skin microcirculation, and modulates the systemic inflammatory response. Repeat RIC was recently shown to be beneficial for healing in lower extremity diabetic ulcers. This article summarises the mechanisms of RIC, and the impact that type 2 diabetes may have upon these, with the role of neural mechanisms in the context of diabetic neuropathy a focus. Repeat RIC may show more promise than RIC in type 2 diabetes, and its potential mechanisms and applications will also be explored. Considering the high costs, rates of chronicity and serious complications resulting from diabetic lower extremity ulceration, repeat RIC has the potential to be an effective novel advanced therapy for this condition. PMID:27613524

  15. Effects of 8 weeks of military training on lower extremity and lower back clinical findings of young Iranian male recruits: A prospective case series

    PubMed Central

    Boroujeni, Amir Momeni; Yousefi, Elham; Moayednia, Amir; Tahririan, Mohammad Ali

    2014-01-01

    Background: In this prospective case series we have assessed the clinical effects of 8 weeks military training on the lower extremity of the recruits. Materials and Methods: Military recruits who met the eligibility criteria and gave informed consent were entered into the study. They were asked to fill out a self-reporting pain and functionality questionnaire before and after their training. They were also examined by a physician before and after their military training. The questionnaire and examination were concentrated on three blocs: lower back, knee, and foot. Results: Three-hundred and seventy-three study subjects were evaluated. The study showed that there is a significant difference in reporting lower back pain after the training compared to the rate of complaints prior to the training (P < 0.001), knee pain, and foot pain also increased significantly (P < 0.1 and P < 0.0001, respectively) The difference was most prominent in foot complaints. Physical examination also showed significant increase in lower extremity findings following the training (P < 0.05). Conclusion: Our study shows that there is a need for a new approach to military training of male recruits in Iran in order to minimize the adverse health effects. PMID:24600600

  16. Remote ischaemic conditioning in the context of type 2 diabetes and neuropathy: the case for repeat application as a novel therapy for lower extremity ulceration.

    PubMed

    Epps, J A; Smart, N A

    2016-01-01

    An emerging treatment modality for reducing damage caused by ischaemia-reperfusion injury is ischaemic conditioning. This technique induces short periods of ischaemia that have been found to protect against a more significant ischaemic insult. Remote ischaemic conditioning (RIC) can be administered more conveniently and safely, by inflation of a pneumatic blood pressure cuff to a suprasystolic pressure on a limb. Protection is then transferred to a remote organ via humoral and neural pathways. The diabetic state is particularly vulnerable to ischaemia-reperfusion injury, and ischaemia is a significant cause of many diabetic complications, including the diabetic foot. Despite this, studies utilising ischaemic conditioning and RIC in type 2 diabetes have often been disappointing. A newer strategy, repeat RIC, involves the repeated application of short periods of limb ischaemia over days or weeks. It has been demonstrated that this improves endothelial function, skin microcirculation, and modulates the systemic inflammatory response. Repeat RIC was recently shown to be beneficial for healing in lower extremity diabetic ulcers. This article summarises the mechanisms of RIC, and the impact that type 2 diabetes may have upon these, with the role of neural mechanisms in the context of diabetic neuropathy a focus. Repeat RIC may show more promise than RIC in type 2 diabetes, and its potential mechanisms and applications will also be explored. Considering the high costs, rates of chronicity and serious complications resulting from diabetic lower extremity ulceration, repeat RIC has the potential to be an effective novel advanced therapy for this condition.

  17. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke.

    PubMed

    Shea, Sarah; Moriello, Gabriele

    2014-07-01

    Pilates is a method that can potentially be used for stroke rehabilitation to address impairments in gait, balance, strength, and posture. The purpose of this case report was to document the feasibility of using Pilates and to describe outcomes of a 9-month program on lower extremity strength, balance, posture, gait, and quality of life in an individual with stroke. The participant was taught Pilates exercises up to two times per week for nine months in addition to traditional rehabilitation in the United States. Outcomes were assessed using the Berg Balance Scale (BBS), Stroke Impact Scale (SIS), GAITRite System(®), 5 repetition sit-to-stand test (STST), and flexicurve. Improvements were found in balance, lower extremity strength, and quality of life. Posture and gait speed remained the same. While these changes cannot be specifically attributed to the intervention, Pilates may have added to his overall rehabilitation program and with some modifications was feasible to use in someone with a stroke. PMID:25042304

  18. Different Sagittal Angles and Moments of Lower Extremity Joints during Single-leg Jump Landing among Various Directions in Basketball and Volleyball Athletes.

    PubMed

    Sinsurin, Komsak; Vachalathiti, Roongtiwa; Jalayondeja, Wattana; Limroongreungrat, Weerawat

    2013-09-01

    [Purpose] The purpose of this study was to assess the sagittal angles and moments of lower extremity joints during single-leg jump landing in various directions. [Subjects] Eighteen male athletes participated in the study. [Methods] Participants were asked to perform single-leg jump-landing tests in four directions. Angles and net joint moments of lower extremity joints in the sagittal plane were investigated during jump-landing tests from a 30-cm-high platform with a Vicon™ motion system. The data were analyzed with one-way repeated measures ANOVA. [Results] The results showed that knee joint flexion increased and hip joint flexion decreased at foot contact. In peak angle during landing, increasing ankle dorsiflexion and decreasing hip flexion were noted. In addition, an increase in ankle plantarflexor moment occurred. [Conclusion] Adjusting the dorsiflexion angle and plantarflexor moment during landing might be the dominant strategy of athletes responding to different directions of jump landing. Decreasing hip flexion during landing is associated with a stiff landing. Sport clinicians and athletes should focus on increasing knee and hip flexion angles, a soft landing technique, in diagonal and lateral directions to reduce risk of injury.

  19. Mimicking human texture classification

    NASA Astrophysics Data System (ADS)

    van Rikxoort, Eva M.; van den Broek, Egon L.; Schouten, Theo E.

    2005-03-01

    In an attempt to mimic human (colorful) texture classification by a clustering algorithm three lines of research have been encountered, in which as test set 180 texture images (both their color and gray-scale equivalent) were drawn from the OuTex and VisTex databases. First, a k-means algorithm was applied with three feature vectors, based on color/gray values, four texture features, and their combination. Second, 18 participants clustered the images using a newly developed card sorting program. The mutual agreement between the participants was 57% and 56% and between the algorithm and the participants it was 47% and 45%, for respectively color and gray-scale texture images. Third, in a benchmark, 30 participants judged the algorithms' clusters with gray-scale textures as more homogeneous then those with colored textures. However, a high interpersonal variability was present for both the color and the gray-scale clusters. So, despite the promising results, it is questionable whether average human texture classification can be mimicked (if it exists at all).

  20. Xanthomatous pleuritis mimicking mesothelioma.

    PubMed

    McGuire, Franklin R; Gourdin, Todd; Finley, James L; Downie, Gordon

    2009-01-01

    Recurrent non-malignant exudative effusions remain a diagnostic and potentially management dilemma. Fluid characteristics frequently narrow the differential but fail to offer a definitive diagnosis. Medical thoracoscopy is well tolerated and allows direct visualization and biopsy of pleural processes under conscious sedation. Rarely, macroscopic appearance and even histology may be misleading. We present a case of xanthomatous pleuritis that mimicked early mesothelioma. Our patient was a 69-year-old female with a large left pleural effusion. Her medical history was significant for a recent small pericardial effusion without cardiac dysfunction. Thoracentesis revealed a non-malignant exudative effusion. Thoracoscopy demonstrated two foci of raised soft plaques with petechial hemorrhage and adhesions. Preliminary evaluation suggested chronic inflammation admixed with proliferating spindle cells and necrosis. The immunohistochemical phenotype of the spindle cells favored a spindle and epithelioid cell neoplasm, mesothelioma. Because of discord between pathologists, we repeated the thoracoscopy through the existing chest tube/thoracoscopy site. We acquired more tissue for special stains and outside review. Following extensive immunohistochemistry, the diagnosis of xanthomatous pleuritis was made. Our patient quickly recovered with steroid therapy and is without recurrence 18 months later. This case demonstrates the utility and nuances of medical thoracoscopy in a perplexing case of xanthomatous pleuritis. PMID:18223309

  1. Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower-Extremity Muscle Strength of the Elderly: A Randomized Controlled Trial.

    PubMed

    Tseng, Shiuan-Yu; Lai, Chung-Liang; Chang, Kai-Ling; Hsu, Pi-Shan; Lee, Meng-Chih; Wang, Chun-Hou

    2016-02-01

    The purpose of this study was to investigate the influence of whole-body vibration (WBV) training without visual feedback on balance and lower-extremity muscle strength in the elderly.Elderly subjects who did not exercise regularly participated in this study. Subjects were randomly divided into a WBV with eyes open group, a visual feedback-deprived plus WBV (VFDWBV) group, and a control group (0 Hz, eyes open). WBV training was provided over a 3-month period, 3 times per week for 5 min each session. Balance performance was measured with the limits of stability test, and muscle strength was measured with an isokinetic dynamometer.A total of 45 elderly subjects with an average age of 69.22  ±  3.97 years, divided into a WBV group (n = 14), a VFDWBV group (n = 17), and a control group (n = 14), completed the trial. Statistically significant differences were found in the balance performance of the 3 groups at different time points (time × group interaction: F = 13.213, P < 0.001), and the VFDWBV group had more improvement in balance than the WBV and control groups. The strength of the knee extensor and flexor muscles had time × group interactions: F = 29.604, P < 0.001 and F = 4.684, P = 0.015, respectively; the VFDWBV group had more improvement on lower-extremity muscle strength than the WBV and control groups. The 6-month follow-up showed that the rates of hospital visits for medical services due to falls were 0% in the WBV group (0/14), 0% in the VFDWBV group (0/17), and 28.57% in the control group (4/14).Results showed that WBV training at 20  Hz without visual feedback can significantly improve the balance performance and lower-extremity muscle strength of the elderly. PMID:26844514

  2. [THE COMPARATIVE ANALYSIS RESULTS OF ENDOVASCULAR LASER COAGULATION AND A STANDARD PHLEBECTOMY IN THE TREATMENT OF CHRONIC DISEASES OF THE LOWER EXTREMITIES VEINS].

    PubMed

    Savolyuk, S I; Gorbovets, V S; Khodos, V A

    2016-03-01

    The results of treatment of 58 patients, suffering chronic diseases of the lower extremities veins, were analyzed. In 28 patients a vertical reflux was eliminated using endovascular laser coagulation, in 32 patients--a standard phlebectomy in accordance to Babcock method was performed. The complications rate was compared as well as the term of the patients' stationary treatment. After elimination of endovascular laser coag- ulation the complications rate and severity is significantly lesser, than after a standard phiebectomy. In accordance to the ultrasonographic duplex scanning data in 12 mo in one patient a partial recanalization of large subcutaneous vein was noted. A total fibrous transformation of the coagulated venous trunks was achieved in 95.24% of the patients. Duration of postoperative stationary treatment have had reduced from (4.8 ± 0.8) to (1.2 ± 0.1) days (p < 0.001). PMID:27514093

  3. [Interpretation and consideration of the Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities management of asymptomatic disease and claudication].

    PubMed

    Shen, Chenyang; Li, Weihao

    2016-02-01

    Atherosclerotic occlusive disease of the lower extremities (ASO-LE) has the third highest rate among systematic atherosclerosis obliterans, ranking after coronary heart disease and stoke, and the disease burden of ASO-LE has been continuously increasing. Invasive revascularizations, which is presented by endovascular therapy technique, has undergone a dramatic development in the past couples of decades. However, controversy concerned about the surgical management and operative indications has heated up in the meanwhile. Thus Society for Vascular Surgery (SVS) published the practice guidelines for ASO-LE with asymptomatic disease and claudication in March, 2015. At the first time the guideline definitely opposed the aggressive invasive revascularization for ASO-LE patients with asymptomatic disease or claudication under satisfied tolerance. Instead, it posed the extreme emphasis on the pharmacotherapy with risk reduction of atherosclerosis at the core and the exercise therapy with supervised or home-based exercise program at the core for ASO-LE patients with asymptomatic disease and claudication.

  4. Pharmacomechanical thrombectomy and catheter-directed thrombolysis of acute lower extremity deep venous thrombosis in a 9-year-old boy with inferior vena cava atresia.

    PubMed

    Hamidian Jahromi, Alireza; Coulter, Amy H; Bass, Patrick; Zhang, Wayne W; Tan, Tze-Woei

    2015-04-01

    Lower extremity deep venous thrombosis (DVT) is uncommon in the pediatric population, but it can be associated with severe symptoms and potential long-term morbidity secondary to post-thrombotic syndrome. Inferior vena cava (IVC) atresia can predispose a patient to the development of extremity DVT. There is no clear consensus on optimal management of extensive extremity DVT in pediatric patients, especially in patients with IVC anomalies. We report a case of iliofemoral DVT in a 9-year-old boy with IVC atresia and presumed protein S deficiency that was treated successfully using pharmacomechanical thrombectomy and catheter-directed thrombolysis. He was maintained on long-term anticoagulation and remained symptom free at 6 months' follow-up.

  5. The Efficacy of Femoral Block and Unilateral Spinal Anaesthesia on Analgesia, Haemodynamics and Mobilization in Patients undergoing Endovenous Ablation in the Lower Extremity

    PubMed Central

    Öztürk, Tülün; Çevikkalp, Eralp; Nizamoglu, Funda; Özbakkaloğlu, Alper; Topcu, İsmet

    2016-01-01

    Objective This study aimed to investigate the efficacy of femoral block and unilateral spinal anaesthesia on analgesia, haemodynamics and mobilization during endovenous ablation in patients with lower extremity venous insufficiency. Methods Forty patients of ASA physical status I and II, with ages ranging between 30 and 45 years, and who were scheduled for endovenous laser ablation for varicose veins were prospectively enrolled in this study. Patients were randomized into a unilateral spinal anaesthesia group (group HS, n=20) or a femoral block group (group F, n=20). Group HS received 7.5–10 mg of heavy bupivacaine for unilateral spinal anaesthesia, while group F received 100 mg prilocaine for femoral block with ultrasound guidance. The level of motor blockage (Bromage score), visual pain score, mean heart rate and mean arterial pressures were recorded at postoperative 0, 1, 2, 3d and 6 h, respectively. Results Perioperative visual pain score values in both groups were <4. None of the groups required an additional analgesic agent. Bromage scores were significantly lower in group F than in group HS during the postoperative period (p<0.01). Motor function returned to normal in all patients at 3 h in group F and at 6 h in group HS. Postoperative mean heart rate and arterial pressure did not differ between the groups (p>0.05). Conclusion In patients with lower extremity venous insufficiency who were undergoing endovenous laser ablation, an ultrasound-guided femoral block provided similar analgesia with that of unilateral spinal anaesthesia. In group F, the duration of anaesthesia and mobilization time was shorter. PMID:27366565

  6. A Prospective Cohort Study of the Effects of Lower Extremity Orthopaedic Surgery on Outcome Measures in Ambulatory Children With Cerebral Palsy

    PubMed Central

    Gorton, George Edwin; Abel, Mark F.; Oeffinger, Donna J.; Bagley, Anita; Rogers, Sarah P.; Damiano, Diane; Romness, Mark; Tylkowski, Chester

    2010-01-01

    Background Lower-extremity musculotendinous surgery is standard treatment for ambulatory children with deformities such as joint contractures and bony torsions resulting from cerebral palsy (CP). However, evidence of efficacy is limited to retrospective, uncontrolled studies with small sample sizes focusing on gait variables and clinical examination measures. The aim of this study was to prospectively examine whether lower-extremity musculotendinous surgery in ambulatory children with CP improves impairments and function measured by gait and clinical outcome tools beyond changes found in a concurrent matched control group. Methods Seventy-five children with spastic CP (Gross Motor Function Classification System levels I to III, age 4 to 18 y) that underwent surgery to improve gait were individually matched on the basis of sex, Gross Motor Function Classification System level, and CP subtype to a nonsurgical cohort, minimizing differences in age and Gross Motor Function Measure Dimension E. At baseline and at least 12 months after baseline or surgery, participants completed gait analysis and Gross Motor Function Measure, and parents completed outcome questionnaires. Mean changes at follow-up were compared using analysis of covariance adjusted for baseline differences. Results Surgery ranged from single-level soft tissue release to multilevel bony and/or soft tissue procedures. At follow-up, after correcting for baseline differences, Gillette Gait Index, Pediatric Outcomes Data Collection Instrument Expectations, and Pediatric Quality of Life Inventory (PedsQL) Physical Functioning improved significantly for the surgical group compared with the nonsurgical group, which showed minimal change. Conclusions On the basis of a matched concurrent data set, there was significant improvement in function after 1 year for a surgical group compared with a nonsurgical group as measured by the Gillette Gait Index, with few significant changes noted in outcome measures. Changes

  7. The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities

    PubMed Central

    Tekin, Ali Çağrı; Çabuk, Haluk; Dedeoğlu, Süleyman Semih; Saygılı, Mehmet Selçuk; Adaş, Müjdat; Esenyel, Cem Zeki; Büyükkurt, Cem Dinçay; Tonbul, Murat

    2016-01-01

    Aim: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. Materials and methods: The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure’s level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. Results: The mean age of the patients was 24.58 years (range, 5–51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6–31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1–6 cm). The mean duration of fixator application was 202.7 days (range, 104–300 days). The mean External Fixator Index was 98 days/cm (range, 42–265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10–14 days/cm). Conclusion: The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity. PMID:27163100

  8. [The application of the method of kinesio-taping technique for the combined non-pharmacological rehabilitation of the patients presenting with lymphedema of the lower extremities].

    PubMed

    Gerasimenko, M Yu; Knyazeva, T A; Apkhanova, T V; Kul'Chitskaya, D B

    2015-01-01

    Based on the innovative "kinesio-taping" technique proposed by the Japanese researcher Kenzo Kace, we have designed a new physiotherapeutic complex including the well-known physiotherapeutic methods of lymphatic drainage with intermittent pneumatic compression and underwater massage shower. The objective of our study was to evaluate the efficiency of the application of the "kinesio-taping" technique for the non-pharmacological rehabilitative treatment of the patients presenting with stage I-III lymphedema of the lower sextremities. The secondary objective was to evaluate the possibility of correction of endothelial dysfunction in the patients with lymphedema after the application of the "kinesio-taping" technique. The study included 30 patients with stage I-III lymphedema of the lower extremities randomized into two groups. Group 1 was comprised of 15 patients who were consistently treated by a combination of intermittent pneumatic compression, "akinesio-taping", and underwater massage shower. Group 2 contained 15 patients treated with the use of intermittent pneumatic compression and underwater massage shower. The results of study give evidence of positive changes in microcirculation of the patients comprising group 1 that suggest the improvement of endothelial function, vasodilation of precapillaries, enhancement of the blood flow in the microcirculatory system, and reduction of the influence of the ineffective shunting blood flow. The data obtained confirm the effectiveness of the new non-pharmacological rehabilitation complex that includes the innovative lymph-draining method of kinesio-taping, intermittent pneumatic compression and underwater massage shower for the treatment of patients with lymphedema of the lower extremities. The effectiveness of this complex is due to combined stimulation of the lymphatic and venous drainage systems and coupled to the stimulation of blood flow in the microcirculatory bed and the formation of a positive endothelial response

  9. A Multimodality Imaging Approach for Serial Assessment of Regional Changes in Lower Extremity Arteriogenesis and Tissue Perfusion in a Porcine Model of Peripheral Arterial Disease

    PubMed Central

    Stacy, Mitchel R.; Yu, Da Yu; Maxfield, Mark W.; Jaba, Irina M.; Jozwik, Bartosz P.; Zhuang, Zhen W.; Lin, Ben A.; Hawley, Christi L.; Caracciolo, Christopher M.; Pal, Prasanta; Tirziu, Daniela; Sampath, Smita; Sinusas, Albert J.

    2014-01-01

    Background A standard quantitative imaging approach to evaluate peripheral arterial disease (PAD) does not exist. Quantitative tools for evaluating arteriogenesis in vivo are not readily available and the feasibility of monitoring serial regional changes in lower extremity perfusion has not been examined. Methods and Results Serial changes in lower extremity arteriogenesis and muscle perfusion were evaluated following femoral artery occlusion in a porcine model using SPECT/CT imaging with post-mortem validation of in vivo findings using gamma counting, post-mortem imaging, and histological analysis. Hybrid thallium-201 (201Tl) SPECT/CT imaging was performed in pigs (n=8) at baseline, immediately post-occlusion, and at 1 and 4 weeks post-occlusion. CT imaging was used to identify muscle regions of interest in the ischemic (I) and non-ischemic (NI) hindlimbs for quantification of regional changes in CT defined arteriogenesis and quantification of 201Tl perfusion. Four weeks post-occlusion, post-mortem tissue 201Tl activity was measured by gamma counting and immunohistochemistry was performed to assess capillary density. Relative 201Tl retention (I/NI) was reduced immediately post-occlusion in distal and proximal muscles and remained lower in calf and gluteus muscles 4 weeks later. Analysis of CT angiography revealed collateralization at 4 weeks within proximal muscles (p<0.05). SPECT perfusion correlated with tissue gamma counting at 4 weeks (p=0.01). Increased capillary density was seen within the ischemic calf at 4 weeks (p=0.004). Conclusions 201Tl SPECT/CT imaging permits serial, regional quantification of arteriogenesis and resting tissue perfusion following limb ischemia. This approach may be effective for detection of disease and monitoring therapy in PAD. PMID:24170237

  10. Ultrasound assessment of the caliber of the arteries in the lower extremities in healthy persons – the dependency on age, sex and morphological parameters of the subjects

    PubMed Central

    Ustymowicz, Andrzej; Krysiuk, Kamil; Witkowski, Paweł; Zonenberg, Mateusz; Dobrzycki, Konrad; Łebkowska, Urszula

    2012-01-01

    Aim The aim of this paper was to evaluate the caliber of the following arteries in the lower extremities: the common femoral artery, superficial femoral artery, popliteal artery, posterior tibial artery and dorsalis pedis artery and to determine the relation of the calibers to age, sex and morphological parameters of the body such as weight, height and BMI of the subject. Material Two hundred and twenty-eight healthy persons aged 18–81 were examined (average ±SD; 43.1±16.71): 134 women aged 19–74 (43.2±15.63) and 94 men aged 18–81 (43±18.22). Methods The study was conducted with the use of a linear probe of 7.5 MHz frequency. The vascular caliber was assessed after the color map (color Doppler) was placed on a B-mode image. Results The average and standard deviation values for the calibers of examined vessels were determined. The calibers of all vessels examined in the group of men were statistically significantly larger than those in the group of women. No statistically significant differences between the calibers of the right and left sides were determined. The statistically significant correlations were specified between the age and the caliber of the examined vessels; positive for large femoral arteries and negative for the arteries of the crus and foot. Positive, statistically significant correlations between the caliber and the height, weight and BMI were also reported. Conclusions The reported calibers of the arteries in the lower extremities and their relation to age, sex and morphological parameters of the subjects enable the differentiation of the physiological remodeling of the vessels from the pathological processes in e.g. atherosclerosis or hypertension. PMID:26675343

  11. Swelling-resistant nuclear fuel

    DOEpatents

    Arsenlis, Athanasios; Satcher, Jr., Joe; Kucheyev, Sergei O.

    2011-12-27

    A nuclear fuel according to one embodiment includes an assembly of nuclear fuel particles; and continuous open channels defined between at least some of the nuclear fuel particles, wherein the channels are characterized as allowing fission gasses produced in an interior of the assembly to escape from the interior of the assembly to an exterior thereof without causing significant swelling of the assembly. Additional embodiments, including methods, are also presented.

  12. Managing Chemotherapy Side Effects: Swelling (Fluid Retention)

    MedlinePlus

    ... ancer I nstitute Managing Chemotherapy Side Effects Swelling (Fluid retention) “My hands and feet were swollen and ... at one time. Managing Chemotherapy Side Effects: Swelling (Fluid retention) Weigh yourself. l Weigh yourself at the ...

  13. SYNERESIS AND SWELLING OF GELATIN.

    PubMed

    Kunitz, M

    1928-11-20

    1. When solid blocks of isoelectric gelatin are placed in cold distilled water or dilute buffer of pH 4.7, only those of a gelatin content of more than 10 per cent swell, while those of a lower gelatin content not only do not swell but actually lose water. 2. The final quantity of water lost by blocks of dilute gelatin is the same whether the block is immersed in a large volume of water or whether syneresis has been initiated in the gel through mechanical forces such as shaking, pressure, etc., even in the absence of any outside liquid, thus showing that syneresis is identical with the process of negative swelling of dilute gels when placed in cold water, and may be used as a convenient term for it. 3. Acid- or alkali-containing gels give rise to greater syneresis than isoelectric gels, after the acid or alkali has been removed by dialysis. 4. Salt-containing gels show greater syneresis than salt-free gels of the same pH, after the salt has been washed away. 5. The acid and alkali and also the salt effect on syneresis of gels disappears at a gelatin concentration above 8 per cent. 6. The striking similarity in the behavior of gels with respect to syneresis and of gelatin solutions with respect to viscosity suggests the probability that both are due to the same mechanism, namely the mechanism of hydration of the micellae in gelatin by means of osmosis as brought about either by diffusible ions, as in the presence of acid or alkali, or by the soluble gelatin present in the micellae. The greater the pressures that caused swelling of the micellae while the gelatin was in the sol state, the greater is the loss of water from the gels when the pressures are removed. 7. A quantitative study of the loss of water by dilute gels of various gelatin content shows that the same laws which have been found by Northrop to hold for the swelling of gels of high concentrations apply also to the process of losing water by dilute gels, i.e. to the process of syneresis. The general

  14. Outcomes Following Low-Energy Civilian Gunshot Wound Trauma to the Lower Extremities: Results of a Standard Protocol at an Urban Trauma Center

    PubMed Central

    Abghari, Michelle; Monroy, Alexa; Schubl, Sebastian; Davidovitch, Roy; Egol, Kenneth

    2015-01-01

    Background Lower extremity injuries secondary to low-energy gunshot wounds are frequently seen in the civilian populations of urban areas. Although these wounds have fewer complications than high-energy gunshot injuries, the functional and psychological damage is still significant making appropriate timely orthopaedic treatment and follow-up imperative. Purpose The purpose of this study is to present our outcomes in the treatment of low-energy gunshot wounds in a civilian population at an urban, level one trauma center in patients treated by a standard protocol. Methods One hundred and thirty three patients who sustained 148 gunshot wound injuries were treated at our level one trauma center between January 1st, 2009 and October 1st, 2011. Following IRB approval, we extracted information from medical records regarding hospital course, length of stay and type of operative or non-operative treatment. If available, injury and post-operative radiographs were also reviewed. Patients were contacted by telephone to obtain Short Musculoskeletal Function Assessment (SMFA) surveys, pain on a scale of 0–10 and for the determination of any adverse events related to their shooting. Results There were 125 men (94.0%) and 8 women (6.0%) with an average age of 27.1 years (range 15.2–56.3). Seventy-six patients (57.1%) did not have any health insurance upon admission. The average length of stay in the hospital was 4.5 days (range 0.0–88.0). Fifty-one gun shots (34.5%) resulted in fractures of the lower extremities. Patients underwent a total of 95 lower extremity-related procedures during their hospitalization. Twenty-two patients (16.5%) experienced a complication related to their gunshot wounds. 38% of the cohort was available for long-term functional assessment At a mean 23.5 months (range 8–48) of follow up, patients reported mean Functional and Bothersome SMFA scores of 19.6 (SD 15.9) and 10.9 (SD 15.6) suggesting that these patients have poorer function scores than the

  15. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

    SciTech Connect

    Pak, Daniel; Vineberg, Karen A.; Griffith, Kent A.; Sabolch, Aaron; Chugh, Rashmi; Biermann, Janet Sybil; Feng, Mary

    2012-07-15

    Purpose: We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). Methods and Materials: We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V{sub d}) receiving specified doses ({>=}30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Results: Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 {+-} 8.9 Gy, V30 of 14.5 {+-} 2.3 cc, V45 of 11.8 {+-} 1.1 cc, and V60 of 7.2 {+-} 2.2 cc at the femoral neck compared with 22.9 {+-} 20.8 Gy, 4.8 {+-} 5.6 cc, 2.5 {+-} 3.9 cc, and 0.8 {+-} 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. Conclusions: These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients.

  16. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis

    PubMed Central

    Chen, I-Wen; Yang, Hui-Mei; Chiu, Cheng-Hsun; Yeh, Jiun-Ting; Huang, Chung-Huei; Huang, Yu-Yao

    2015-01-01

    Abstract Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF. We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis. Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625–203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968–205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002). In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA

  17. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis.

    PubMed

    Chen, I-Wen; Yang, Hui-Mei; Chiu, Cheng-Hsun; Yeh, Jiun-Ting; Huang, Chung-Huei; Huang, Yu-Yao

    2015-11-01

    Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF.We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis.Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625-203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968-205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002).In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA. PMID:26554804

  18. Efficacy of Preoperative Color Doppler Sonography of Lower Extremity Veins on Postoperative Outcomes in Candidates of Saphenectomy: A Randomized Clinical Trial

    PubMed Central

    Zarepur, Rouhollah; Kargar, Saeed; Hadadzadeh, Mehdi; Hatamizadeh, Nooshin; Zarepur, Ehsan; Forouzannia, Seyed Khalil; Faraji, Reza; Sarebanhassanabadi, Mohammadtaghi

    2016-01-01

    Background Doppler sonography is a type of sonography used for imaging the blood flow in the vessels and heart. This technique uses ultrasound waves with high frequency. In some patient candidates for venous graft, the identification of the suitable vein is not possible with clinical examination. Objective This study compared the effects of preoperative color Doppler sonography of lower extremity veins on the postoperative outcomes of saphenectomy. Methods This randomized clinical trial was conducted on 100 candidates of an off-pump coronary artery bypass graft (CABG) hospitalized in Afshar Hospital in Yazd in 2015. Patients were divided into two groups: 50 patients in the study group and 50 patients in the control group. Patients in the study group underwent color Doppler sonography of lower extremity veins using the Medison 8000 Live device. Patients in the control group were assessed preoperatively by routine venous examination without undergoing color Doppler sonography. The prepping and draping methods and also the preoperative antibiotics were the same for both groups. The patients were assessed for wound infection, edema, hematoma, and DVT 2 days, 1 week, and 1 month after surgery. Data were analyzed by SPSS version 16 using t-test, Chi-square, and Fisher’s exact test. Results The length of incision for saphenectomy was 29.20 ± 3.71 cm in the Doppler group and 28.98 ± 3.72 cm in the non-Doppler group with no significant difference between the two groups (p=0.768). The two groups were not significantly different with respect to age, gender, diabetes, hypertension, hyperlipidemia, smoking, and history of peripheral vessels disease, postoperative infection, postoperative organ edema, postoperative hematoma, and postoperative DVT. Conclusion Preoperative color Doppler sonography of the saphenous vein before saphenectomy has no effect on reducing the postoperative complications, and saphenectomy on the basis of intraoperative examination of the vein course by

  19. Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis

    PubMed Central

    Zasadzka, Ewa; Borowicz, Adrianna Maria; Roszak, Magdalena; Pawlaczyk, Mariola

    2015-01-01

    Background Falling in the elderly results in a significant number of admissions to hospitals and long-term care facilities, especially among patients with lower extremity osteoarthritis (OA). Objective The aim of the study was to assess the risk of falling in adults older than 60 years with OA using timed up and go (TUG) test. Materials and methods A total of 187 patients (aged >60 years) were enrolled in the study. The assessment included: basic activities of daily living (ADLs), lower extremity strength with the use of the 30-second chair stand test (30 CST), and assessment of the risk of falling (TUG test). Pain intensity was evaluated with the numeric rating scale (NRS). Results The TUG test results were significantly better in younger OA patients (aged 60–69 years), as compared with their older peers (aged 70–79 years; P<0.01) and the oldest group (aged >80 years; P<0.001). Also, the 30 CST results were significantly higher in younger OA patients (P<0.05). Subjects older than 80 years had a significantly worse ADL score (P<0.05 and P<0.001). Pain complaints were reported significantly more frequently by women than men (P<0.05). A correlation between age and the TUG test score (r=0.412; P<0.0004) as well as between the TUG test and the 30 CST scores (r=0.7368; P=0.000) was detected. In the group with the TUG test score of <13.5 seconds, the 30 CST (P<0.0001) and ADL (P<0.003) results were significantly better. A comparison of fallers vs nonfallers revealed that the number of falls was significantly higher in the group of subjects who scored ≥13.5 when compared to <13.5 (P=0.003). Fallers significantly more often reported pain (P<0.0001), whereas nonfallers had significantly better 30 CST results (P=0.0003). Conclusion Elderly population with OA is at an elevated risk of falling, which increases with progressing age, pain, and muscle weakness. It seems prudent to identify individuals at a high risk of falling and to propose an adequate treatment for them

  20. Comparison of measures of physiologic stress during treadmill exercise in a patient with 20% lower extremity burn injuries and healthy matched and nonmatched individuals.

    PubMed

    Wetzel, J L; Giuffrida, C; Petrazzi, A; Schlanser, J; McDowell-Montini, C; Pietrzyk, C; Landry, V L

    2000-01-01

    Patients with burn injuries are referred for rehabilitation within days after the injuries to encourage early ambulation and functional training. Many of these patients are hypermetabolic at rest. Metabolic demands of activity are added to the already hypermetabolic state and elevate total energy requirements and some physiologic measures. Reports on the physiologic stress imposed by therapeutic activities for patients with burn injuries are limited to low levels of metabolic demand (< or =2 metabolic equivalents [METS]). The degree of stress imposed by functional activities such as ambulation (3 METS) and stair climbing (5 METS) is not known for adults with burn injuries. The purpose of this study was to report the clinical measures of myocardial and physiologic stress in a patient with 20% lower extremity total body surface area burns during an exercise challenge equivalent to stair climbing. Physiologic measures were assessed before and during a treadmill activity (5 METS) for a 40-year-old obese man 3 weeks after he had lower extremity burn injuries. These measures were compared with mean values for 62 healthy counterparts and 6 healthy subjects matched for age, gender, and fitness level. Heart rate, systolic blood pressure, rate pressure product, and the rating of perceived exertion for the patient with burn injuries were higher at baseline and during exercise than the mean values for the 62 healthy individuals and the 6 matched subjects. The steady state exercise values for heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion at 6 minutes were 189 beats per minute, 190 mm Hg, 3591, and 17, respectively, for the patient with burn injuries and were 111.3 beats per minute, 149 mm Hg, 1680, and 11.7, respectively, for the 6 matched subjects. Ventilation during exercise also increased for the patient with burn injuries more than for the matched subjects (3/4 vs 1/4). Pain experienced by the patient with burn injuries

  1. Dirofilariasis Mimicking an Acute Scrotum.

    PubMed

    Bertozzi, Mirko; Rinaldi, Victoria Elisa; Prestipino, Marco; Giovenali, Paolo; Appignani, Antonino

    2015-10-01

    Human infections caused by Dirofilaria repens have been reported in many areas of the world. We describe a case of a 3-year-old child with an intrascrotal mass caused by D repens mimicking an acute scrotum. This represents the first case of scrotal dirofilariasis described in pediatric age with such an unusual presentation.

  2. Effects of an eight-week whole body vibration on lower extremity muscle tone and function in children with cerebral palsy.

    PubMed

    Cheng, Hsin-Yi Kathy; Yu, Yu-Chun; Wong, Alice May-Kuen; Tsai, Yung-Shen; Ju, Yan-Ying

    2015-03-01

    The aim of this study was to evaluate the effect of an eight-week whole body vibration (WBV) on lower extremity spasticity and ambulatory function in children with cerebral palsy with a complete crossover design. Sixteen participants aged 9.2 (2.1) years participated in this study. Half of the participants received a 10-min WBV, 3 times a week for 8 weeks. Then a 4-week washout period followed, after which they received a sham WBV 3 times a week for 8 weeks. The other half received the intervention in a reversed order. The participants were evaluated via variables measuring range-of-motion, muscle tone, and ambulatory function before, immediately after, 1 day after, and 3 days after each intervention. Repeated-measures analyses revealed significant beneficial effects on most variables expect the passive range-of-motion measurement. Significant correlations were found between timed up-and-go and relaxation index, and between timed up-and-go and six-minute walk test. The results suggested that an 8-week WBV intervention normalized muscle tone, improved active joint range and enhanced ambulatory performance in children with cerebral palsy for at least 3 days. These indicated that regular WBV can serve as an alternative, safe, and efficient treatment for these children in both clinical and home settings.

  3. Magnetic Resonance Imaging of Phosphocreatine and Determination of BOLD Kinetics in Lower Extremity Muscles using a Dual-Frequency Coil Array

    PubMed Central

    Brown, Ryan; Khegai, Oleksandr; Parasoglou, Prodromos

    2016-01-01

    Magnetic resonance imaging (MRI) pr