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Biomedical subjects

E Isakov

Publications and source records attributed to E Isakov.

35 records · Page 2Linked to original sources
PubMed1996

Influence of speed on gait parameters and on symmetry in trans-tibial amputees.

Normal gait is characterised by a high level of inter-leg symmetry of gait parameters. Therefore, efforts in rehabilitation of amputees are directed at the construction of a prosthesis which provides normal leg function and allows a more symmetrical gait. Analysis of the gait of trans-tibial amputees was performed when they were ambulating at their own freely selected speed and at a faster speed. The effect of speed on selected gait parameters in each leg was evaluated and the influence on symmetry established by comparing the inter-leg changes for each of the selected parameters. The faster gait trail affected significantly all temporal and distance parameters in both legs but not the level of symmetry between legs. At the faster speed, the hip angles at heel-strike and during swing and the knee angle during load response, in the normal leg, and the knee angle during swing in the amputated leg, all increased significantly. Speed of gait significantly affected symmetry between knee angles as reflected by the increased differences measured during load response (from 2.62 +/- 5.2 to 7.06 +/- 4.2 degrees) and during toe-off (from 1.80 +/- 7.4 to 9.50 +/- 9.1 degrees). Timing and sequence of selected gait events, as related to stride time, were not significantly affected by speed of gait. These results might contribute to a better understanding of gait characteristics in trans-tibial amputees and provide design guidance for prosthetic components.

Adult↗
PubMed1996

The use of Methenamine as an antiperspirant for amputees.

The socket of a prosthesis is a tightly closed container. Sweating inside the socket is annoying and may also irritate the skin over the stump or lead to local infection such as folliculitis. The most effective method of preventing sweating is by the use of astringent agents. Formaldehyde is a very strong astringent but is not pleasant to use and may cause skin irritation and systemic reactions. Methenamine, in water or when applied to the skin, decomposes to generate formaldehyde in small quantities which do not cause side effects. Methenamine was used on the stump of sixteen amputees. The trial was conducted as a double blind study using two different solutions market as solution A and as solution B. The effectiveness of the solutions as an antiperspirant was evaluated clinically by the subjects and the physician. Solution A containing Methenamine, was found significantly effective, both by the subjects and physician when compared with the solution B the blank one. The use of Methenamine as an antiperspirant is recommended in amputation stumps.

Administration, Topical↗
PubMed1995

Reflex sympathetic dystrophy of both patellae following burns.

This study describes a previously undescribed cause of reflex sympathetic dystrophy involving both patellae. This syndrome developed following burns inflicted over both knees in a male industrial worker. The report highlights physical examination findings, investigation results, socioeconomic and psychological evaluation, and rehabilitation treatments involved in patients suffering from reflex sympathetic dystrophy.

Bone and Bones↗
PubMed1993

Computer-controlled portable stimulator for paraplegic patients.

A six-channel lightweight, portable and computer-controlled stimulator for the functional activation of paraplegic patients is described. To enable programming of the various functions, the stimulator was designed to work in a remote-control mode hosted by an IBM PC or compatible computer, in addition to its normally used local mode. The stimulus parameters, including current intensity, stimulus frequency and pulse width, are individually adjustable and programmable for each channel. The power source is 12 V 500 m Ah-1, from 10 rechargeable nickel cadmium batteries, with a run time of 1.5 h for a load of 200 mA in four channels. Various training programmes for the activation of paraplegics in the sitting, standing and walking positions are described. The final design of the stimulator is based on experience gained from 25 patients, treated and evaluated during the course of development. Ongoing work including clinical, biomechanical and physiological studies is carried out to evaluate performance of the activated patients and to optimize stimulation.

Humans↗
PubMed1992

Ambulation using the reciprocating gait orthosis and functional electrical stimulation.

Until recently, rehabilitation engineering offered 2 different methods to improve daily living independence for spinal cord paralyzed subjects. One, the use of various orthotics and the other, the application of functional electrical stimulation. In the present work we chose to combine reciprocating gait orthosis (RGO) with functional electrical stimulation (FES) into one hybrid system. A detailed biomechanical and clinical instruction for the use of this system is given. Results obtained from application of the hybrid system on a complete T4 paraplegic patient demonstrate that the most significant contribution was the reduced invested energy cost required for stand-up and for ambulation.

Adult↗
PubMed1992

Reflex sympathetic dystrophy of the stump in below-knee amputees.

OBJECTIVE: To document the occurrence of reflex sympathetic dystrophy of the stump in two patients with below-knee amputation. DESIGN: A retrospective survey emphasising two clinical case reports. SETTING: Department of orthopaedic rehabilitation at a teaching rehabilitation hospital. PATIENTS: Lower limb amputees (n = 164) were accepted for prosthetic rehabilitation. Twenty-one amputees were regarded as rehabilitation failures; in two below-knee amputees intractable pain was the major problem. RESULTS: Clinical manifestations, radiological, and scintigraphic findings in the two amputees with intractable pain met the criteria for diagnosis of reflex sympathetic dystrophy. CONCLUSIONS: Reflex sympathetic dystrophy of the stump should be suspected in below-knee amputees whenever severe pain persists over a period of 3 to 4 months following amputation.

Amputation Stumps↗
PubMed1992

A Swedish knee-cage for stabilizing short below-knee stumps.

Stump length is an important factor in attaining successful prosthetic rehabilitation in below-knee (BK) amputees. Stability of the stump-prosthesis complex is impaired in the case of a stump shorter than 10 cm. Thus, fitting a prosthesis to a BK amputee with a stump which is very short often requires the use of different prosthetic techniques. In this work, the authors suggest the use of a Swedish knee-cage attached to a conventional patellar-tendon-bearing prosthesis as an alternative solution in the case of a short BK stump. Objective evaluation was performed by an analysis of gait and the foot-ground reaction forces. The results obtained indicate an improvement in all the measured parameters resulting from the modified stump-prosthesis complex.

Adult↗
PubMed1992

Standing sway and weight-bearing distribution in people with below-knee amputations.

Upright stability in humans has been found to decrease with age, certain diseases, or trauma. We investigated stability of standing in people with below-knee amputations (BKA) and in able-bodied controls. Body sway was evaluated during standing on a set of two Kistler force plates, first with eyes open and then with eyes closed. People with BKA were tested twice--first, one to two days after receiving their prostheses, and second, on completing their prosthetic rehabilitation. The results indicate that both able-bodied people and those with BKA sway more with their eyes closed. However, people with BKA are significantly less stable when they stand with either closed eyes or open eyes. We demonstrated that the differences between the groups studied are due to a proprioceptive deficit as a result of partial limb loss. We also found that there was a gradual process of compensation and adaptation, as some people with BKA sway less at the end of the rehabilitation period.

Adaptation, Physiological↗
PubMed1986

Biomechanical and physiological evaluation of FES-activated paraplegic patients.

Four paraplegic patients with traumatic upper motor neuron lesions at the spinal levels between D5 and D12 were activated by functional electrical stimulation (FES) and evaluated biomechanically and physiologically. After a training program aimed at strengthening the muscles of the lower legs, the patients were able to stand up, maintain the standing position, and walk for short distances while being supported. Biomechanical evaluation included weight bearing on the patients' own legs during standing as measured on a force platform and analysis of the time-distance parameters of the stride during walking as measured on a walkway. Physiological evaluation included heart rate and oxygen consumption at rest, when activated by FES in the sitting position, during standing, and during walking. The results obtained indicate that while significant standing and walking performances are achieved, the corresponding physical effort can reach relatively high levels requiring the support of anaerobic energy sources. The practical implications of these results are discussed.

Adult↗
PubMed1985

Energy expenditure and cardiac response in above-knee amputees while using prostheses with open and locked knee mechanisms.

The difference in physiological responses to ambulation effort, of above-knee (AK) amputees, using a prosthesis with open or locked knee mechanism was investigated at the Orthopaedic Rehabilitation Department of the Loewenstein Hospital. Of seventeen patients who were examined, fourteen were vascular patients over the age of fifty, and three were young traumatic amputees. Subjects performed an unrestrained walking test, using their prosthesis with an open-knee, and then with a locked knee joint mechanism. Heart rate and walking speed were measured, while oxygen consumption was evaluated only in the young patients. Results show that the use of a locked-knee joint resulted in a lower increase in heart rate in both groups. Comfortable walking velocity, as chosen by the subject himself, was higher with a locked-knee joint in the aged group and with an open-knee joint in the younger amputees. Oxygen consumption as measured for the younger patients was higher with an open-knee joint. In conclusion, a locked knee is recommended for the older amputees as it enables a higher walking velocity and lower effort. The preference of an open-knee in the young amputees is due to their better physical condition which enables a higher walking speed although energy expenditure and heart rate are higher.

Adult↗
PubMed1985

Energy cost and physiological reactions to effort during activation of paraplegics by functional electrical stimulation.

In this study, the aim was to evaluate the influence on the cardiopulmonary system of muscular contractions of the paralyzed limbs in paraplegia, activated by FES during treatment, and the energy cost of standing and walking while using FES as an orthotic aid. Three traumatic spastic paraplegics were selected for the measurements. At the end of a 6 month training program heart rate and oxygen consumption of the patients were evaluated as follows: at rest; following 30 minutes of FES in the sitting position; following 15 minutes of standing; and during ambulation. Lactic acid level during maximal effort was evaluated as well. The results indicated a low energy cost of FES in the sitting position and during usage of FES as an orthotic device for standing, confirming the beneficial effect of FES for spastic paraplegics. However, effort invested during ambulation by means of FES was found exhaustive and FES is therefore advisable for young subjects mainly.

Adult↗
PubMed1984

The diagnostic value of three common primitive reflexes.

Systematic attempts were made to elicit the snout, palmomental and corneomandibular reflexes in 50 young patients with prolonged traumatic coma, 50 elderly hemiplegics soon after their first cerebrovascular accident and in 100 normal age-matched controls. None was found significantly more frequently alone in brain-damaged patients than in age-matched controls. Only combinations of two or three reflexes showed diagnostic value in distinguishing between neurologically damaged patients and normal age-matched controls. Only the combination of all three was completely absent in the normal controls; this combination was found in 13% of the brain-damaged subjects.

Adult↗
PubMedDate not supplied

The control of genu recurvatum by combining the Swedish knee-cage and an ankle-foot brace.

Genu recurvatum is a consequence of a poor control over the knee joint due to muscle weakness, impaired tonus and deficit in joint proprioception. Uncontrolled locking of the knee during ambulation causes recurrent microtrauma which leads to degenerative changes and instability. Known methods to control hyperextension of the knee during ambulation often fail. We have used the Swedish knee-cage attached to ankle-foot brace in an attempt to improve control over the knee in three patients. Gait analysis was performed to evaluate the effectiveness of this combined orthosis. Quality of gait improved, as demonstrated by a decrease in stance time asymmetry in the order of 45%; stride increased by 29% and speed of ambulation increased by 72%.

Braces↗
PubMedDate not supplied

Self-injury resulting in amputation among vascular patients: a retrospective epidemiological study.

In the course of 24 months, 164 nontraumatic vascular amputees were accepted for prosthetic rehabilitation; 120 (73%) were diabetic and 44 (27%) non-diabetic. Subjects were divided into two groups, the first consisting of 114 with spontaneous foot infection or gangrene and the second of 50, of whom 44 were diabetic and six had peripheral arterial disease on its own. Sixty-five per cent of all amputees had fewer than nine years of formal education and 46% were in the low-income bracket, but no significant relationship was found between mechanism of self-injury and level of education and income. All patients in the second group were able to detail ways in which they had injured their feet. The relationship between the mechanism of self-injury and the presence of diabetes mellitus was found to be highly significant. By instructing in better self-care it may be possible to prevent or at least postpone amputation in these patients.

Aged↗
PubMedDate not supplied

Anatomic sites of foot lesions resulting in amputation among diabetics and non-diabetics.

OBJECTIVE: To identify and quantify the anatomic sites of foot lesions resulting in amputation among patients suffering from peripheral arterial disease with and without diabetes mellitus. DESIGN: A retrospective study. SETTING: Department of Orthopaedic Rehabilitation. PATIENTS: A total of 212 recent lower limb amputees with diabetes mellitus (158) or peripheral arterial disease only (54) admitted for prosthetic rehabilitation. RESULTS: In 62.2% of all amputees the site of lesion that led to amputation was located in the digits. A lesion under the metatarsal heads was reported in 8.0%, along the mid-foot and heel in 8.5%, on the dorsum of the foot in 3.3%, around the ankle joint and lower leg in 5.7%. Finally, 12.3% reported multiple lesions or were unable to recall the exact anatomic location. CONCLUSIONS: Most foot lesions resulting in amputation are located around the digits. These high-risk sites, therefore, need the patient's and the health care team's special attention. The patient should be trained in self foot examination and meticulous daily care, whereas the role of the health care team is in foot evaluation and provision of protective foot wear.

Adult↗