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Biomedical subjects

J H Patrick

Publications and source records attributed to J H Patrick.

At least 19 recordsLinked to original sources
PubMed1991

Isolated dorsal fracture-dislocation of the tarsal navicular.

Two cases of isolated fracture and dorsal dislocation of the tarsal navicular are reported. Analysis of the mechanism of injury is made, and it is suggested that the dislocation of the tarsal navicular does not occur without a fracture because of anatomical considerations. The necessity for accurate reduction and internal fixation to hold the fracture is emphasized which, when healed, maintains the reduction. The possibility of orthotic treatment for postfracture morbidity is mentioned. Late pain may occur due to degenerative disease affecting the navicular articulations.

Adult↗
PubMed1990

Variations of gait parameters in Duchenne muscular dystrophy.

The gait parameters (speed, stride length and cadence) of nine boys with Duchenne muscular dystrophy were compared with those of 21 normal boys in the same age range. Differences found were due to the altered ability to control their dynamic state and, to a lesser extent, physical limitations of joint range. This simple method of quantifying gait is proposed as a way in which progression or response to treatment in muscular dystrophy might be monitored. The information obtained may alert the clinician to the fact that the progressive muscle weakness and joint contractures have begun to cause compensatory mechanisms during walking to fail. It is also useful to obtain information on gait in clinical treatment trials as there are very few reliable methods for testing function in muscular dystrophy.

Adolescent↗
PubMed1990

Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis.

In an adult paraplegic walking with the ParaWalker, electrical stimulation of the stance-side gluteal muscles (gluteus maximus and medius) reduces the force applied through the crutches during the gait cycle. In this study, five posttrauma, fully rehabilitated, complete paraplegic adult men walked using their ParaWalkers both without and with electrical stimulation augmentation. Oxygen consumption and distance covered during the test period were monitored to derive speed (m s-1), energy cost (J kg-1 m-1), and energy consumption (J kg-1 s-1). With the ParaWalker-electrical stimulation "hybrid" orthosis, three subjects increased their walking speed (10.92%, 7.85%, and 9.27%) and two reduced it (4.49% and 9.36%). Energy cost was reduced in four subjects (6.47%, 7.93%, 6.92%, and 7.97%) but remained the same for the fifth. Energy consumption was reduced in four subjects (0.82%, 11.06%, 0.38%, and 10.28%) and increased in one subject (4.19%). Results were better than those in a previous study of paraplegic locomotion using functional electrical stimulation and long-leg braces. Although electrical stimulation augmentation yields only a small reduction in energy cost, its long-term physiologic effect could be significant in increasing the aerobic-anaerobic threshold of an individual via recruitment of large muscles like the gluteus maximus and medius, thereby increasing performance in a sustained activity like walking.

Adult↗
PubMed1989

A review of the fundamental design problems of providing ambulation for paraplegic patients.

Walking for paraplegics with complete mid-thoracic lesions is now becoming a clinically viable reality. However, much of the literature in this field overstates the achievements and masks the difficulties that patients may encounter. This paper highlights Independence, Energy Cost, Cosmesis, Reliability and Cost as the five areas of prime interest involved in the design compromise for any walking system and urges that all relevant information for any system should be readily available to prescribers. Currently available walking systems are briefly considered.

Costs and Cost Analysis↗
PubMed1989

Energy cost of paraplegic locomotion with the ORLAU ParaWalker.

Ten subjects with neurological lesion levels between T4 and T9 have been evaluated in the laboratory at ORLAU using their orthosis in its mechanical form alone (without FES assist). Initially the oxygen consumption at rest was measured. Then the patients were asked to walk (orthotic gait) at their preferred constant steady speed for a period of 5 minutes. Min. VO2 was measured during the exercise. From these readings the energy cost and consumption of the patients' gait was calculated. Our results show that the ParaWalker allows more efficient walking than do bilateral long leg braces and a paraplegic 3 point gait. It also shows that higher speeds with lower energy cost walking is possible with a different orthotic approach for high or mid thoracic lesion paraplegics. We believe that the energy demands to walk with the ParaWalker are within sustainable limits.

Adult↗
PubMed1987

Augmentation of the Oswestry Parawalker orthosis by means of surface electrical stimulation: gait analysis of three patients.

The Oswestry 'Parawalker' orthosis has been supplied to 15 adult thoracic level complete paraplegic patients enabling them to achieve a reciprocal gait with an inherent low energy demand. In order to further off-load the work demands on the upper limb girdle musculature during ambulation, three of these patients have undergone electrical stimulation of the gluteal muscles in stance phase. This was shown to increase the stability of the adduction and also provided forward propulsion by driving the stance-leg into extension. Bilateral stimulation of the quadriceps muscles has been shown to facilitate standing and sitting in the orthosis. Using a Kistler force platform, the crutch impulse can be seen to be reduced by as much as 36%. We speculate that this leads to a similar order of reduction in the work done by the upper limbs in these patients.

Adult↗
PubMed1986

Knee moments in Duchenne muscular dystrophy.

The gait of 7 boys with Duchenne muscular dystrophy (DMD) who could walk unaided and 21 normal boys was analysed by means of a video recording technique linked to a Kistler force plate. An electronic device was used to superimpose the patient's ground reaction vector on the video recording of their walking. This recording was analysed to obtain sequential values for the moments developed around the knee during the walking cycle. The equinus gait of boys with DMD is shown to be a necessary adaptation to keep the forces about proximal joints, particularly the knee, within limits controllable by weakened muscles. These findings explain the observation that elongation of the Achilles tendon to correct contracture at the ankle can have irrevocably damaging effects on gait.

Adaptation, Physiological↗
PubMed1986

Tibial tubercle advancement for anterior knee pain. A temporary or permanent solution.

In a prospective study of 29 consecutive cases of tibial tubercle advancement, the patients were assessed on the Larson knee chart preoperatively, three years postoperatively, and again after a minimum of six years (range, six to eight years; mean, 7.2 years). Only one patient was lost to follow-up evaluation. The overall results show that at three years, 65.5% of the knees were excellent or good, 13.8% were fair, and 20.7% were poor. By six years a significant change occurred in five knees. Four knees deteriorated, while one improved. The remainder maintained their three-year postoperative grade. The patients provide clinical evidence to support the biomechanical and morphological observations that form the basis of the Maquet principle. Two considerations influence the final result: surgical complications (three out of four cases with complications had a poor result) and the preoperative status (in patellofemoral osteoarthritis a preoperative Larson score of over 60 is necessary for a satisfactory outcome).

Adolescent↗
PubMed1985

Low energy cost reciprocal walking for the adult paraplegic.

The hip guidance orthosis which allows paraplegic children to walk reciprocally has been further developed for adult traumatic paraplegics. Since December 1981, 11 adult complete paraplegics have walked using this device, designated a 'Parawalker'. Our understanding of the mechanics of this form of ambulation and our early work with functional electrical stimulation leave us hopeful of achieving a realistic goal for these patients.

Adult↗
PubMed1984

Physiological cost index of walking for normal children and its use as an indicator of physical handicap.

Seventy-two normal children aged between three and 12 years were assessed to establish their walking function. Speed of walking and heart rate were monitored continuously, both barefoot and in shoes, over eight consecutive lengths of a 25m walkway. Since heart rate is affected by speed, the physiological cost index (PCI)--which combines the two parameters--was calculated for each child, both barefoot and in shoes. Speed tends to increase and walking heart rate to decrease with age. However, resting heart rate also decreases with age, so the PCI has the same range for all ages. The mean PCI in shoes was 0.4 and barefoot was 0.38. The PCI for children with pathological gait is appreciably greater than that for normal children, so the PCI is a valuable quantitative indicator of the level of handicap.

Child↗
PubMed1984

The technique of reciprocal walking using the hip guidance orthosis (hgo) with crutches.

An orthotic method of providing reciprocal walking for high thoracic levels of paralysis is detailed. The essential features of the hip guidance orthosis are described, as well as the basic muscle requirements for this form of walking (shoulder, arm and hand function plus Latissimus Dorsi). The walking sequence is described at each stage under the three main headings: mechanics, muscle action and hip guidance orthosis reaction--to build a complete picture of the walking process. The importance of considering the input made by the patient in addition to the purely mechanical orthotic contribution is illustrated.

Adult↗
PubMed1982

An examination of joint laxity in haemophilia.

An adolescent haemophiliac group (all less than 1 per cent Factor VIII) and a normal, similarly aged, 'control group' of boys were examined to measure joint laxity in an effort to identify a causative factor for bleeding. Definitive laxity was found in the thumb joints and in finger extension of haemophiliacs compared with normal boys. The haemophiliacs who were more lax-jointed showed no tendency towards an increased number of bleeds when they were followed for 100 days. Possible explanations for these phenomena are discussed.

Adolescent↗