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Biomedical subjects

J Perry

Publications and source records attributed to J Perry.

At least 127 records · Page 7Linked to original sources
PubMed1995

Perimalleolar tendon transfer to the os calcis for triceps surae insufficiency in patients with postpolio syndrome.

Twelve patients (14 feet) with the diagnosis of postpolio syndrome underwent patients-specific transfer of perimalleolar tendons to the os calcis for triceps surae insufficiency. One to 5 tendons were transferred, for a resulting mean muscle strength of Grade 3 at a mean followup of 2.7 years. At final followup, 7 patients were restudied with ankle plantar flexion torque measurements, range of motion, and gait analysis. Patients reported subjective improvements in endurance (86%), pain (90%), and ambulatory distance (50%). No progression of foot deformity was noted. Three of 5 patients became brace free. After tendon transfer, patients recorded increased ankle plantar flexion torque strength (80%) and an increase in 1 grade of muscle strength (29%). There was no significant change in gait velocity, stride length, or heeloff time between pre- and postoperative gait analysis. No tenodesis effect was observed. In conclusion, perimalleolar tendon transfers for triceps surae insufficiency in postpolio patients was effective in decreasing subjective complaints, arresting progressive foot deformity caused by muscle imbalance, and increasing plantar flexion strength, whereas the results of gait analysis failed to show significant improvement.

Adult↗
PubMed1995

Electromyograph analysis of the popliteus muscle in level and downhill walking.

It has been proposed that the popliteus muscle is a source of lateral knee pain, typically after downhill activities. Electromyography of the popliteus muscle was recorded in 9 normal subjects during level walking, downhill walking, and walking downhill wearing a 40-lb backpack (to simulate hiking). Popliteal muscle intensity during the midstance phase of walking downhill with weights increased significantly over that of level walking (30% versus 13%, respectively) (p < 0.05). There was a nonsignificant trend (p = 0.07) for a similar increase at terminal swing (51% versus 36%). Significantly greater knee flexion was recorded at loading response, midstance, and terminal stance (p < 0.01) during both downhill trials as compared with level walking. Initial contact position showed no differences. Velocities for downhill walking (72.9 m/min) and downhill walking with weights (71.1 m/min) were significantly less than those of level walking (83.9 m/min) (p < 0.01). Stride analysis showed no significant difference in stance phase duration or in initial double-limb support times between level walking and either downhill condition. These data suggest that increased popliteal muscle activity during midstance in downhill walking with weights is in response to weight bearing with an increased load on a flexed knee. Increased Electromyographic activity may be associated with overuse of the popliteus muscle.

Adult↗
PubMed1995

The effect of five prosthetic feet on the gait and loading of the sound limb in dysvascular below-knee amputees.

The purpose of this study was to determine the effects of prosthetic foot design on the vertical ground reaction forces experienced by the sound and amputated limbs in a group of persons with dysvascular below-knee amputations. Stride characteristics, joint motion, and ground reaction forces were recorded simultaneously during a self-selected free walking velocity in seven subjects wearing five different prosthetic feet (SACH, Flex-Foot, Carbon Copy II, Seattle, Quantum). Subjects used each foot for one month prior to testing. Results indicated that the sound limb was exposed to higher vertical ground reaction forces than normal despite a reduced walking velocity. Use of the Flex-Foot resulted in the lowest sound limb vertical forces, which appears to be related to its large arc of dorsiflexion motion. In addition, there was increased loading response knee flexion of the sound limb indicating an attempt by these subjects to modulate floor impact. These results suggest that the intact lower extremity is susceptible to excessive floor impact, and that prosthetic foot design can have an effect on the magnitude of the vertical forces experienced by the limb.

Aged↗
PubMed1994

Assessing the impact of the All-Wales Mental Handicap Strategy: a survey of four districts.

The All-Wales Mental Handicap Strategy (AWS) pledged government leadership and additional resources for the task of developing community based residential, domiciliary, respite, daycare and professional services for people with mental handicaps and their families throughout Wales. Ultimately, the authors of the AWS sought to affect for the better the extent to which people with mental handicaps experience typical community life. A large random sample of people with mental handicaps in four diverse districts was used to track changes in services received, professional input, involvement in individual planning, the number of community activities pursued, and the size and range of individuals' social networks across the middle 4 years of the AWS. The balance between private housing and service residence remained unchanged although, with the ageing of the cohort, there was a decrease in the proportion living with parents and an increase in those living independently or in another family situation. There was an increase in the availability of residential services in the form of ordinary housing and an associated contraction in large congregate care facilities. However, not all moves were towards more ordinary living. Some people moved from large statutory sector specialist facilities to other atypical forms of residence, as did some people from family homes. Family support services in the form of family aides and short-term care increased significantly, but indicators still suggest that an expansion of these services is merited. Day services diversified slightly, but without affecting the major role of the traditional centre. There was a decrease in the numbers receiving a fulltime service. Only a third of the sample received regular individual plan reviews of the services they received and the developmental goals set in their name. In general, individuals were involved in a greater number of community activities that brought them into contact with other citizens. However, such an increase has not led to significant changes in the size or composition of people's friendship networks. Overall, the changes in service provision and family and user experience have been in line with the direction set by the AWS. However, the degree of change still required before the new pattern of services envisaged by the AWS is substantially in existence, or the experience of people with mental handicaps conforms with the guiding principles which underpin it, is considerably greater than that achieved after 7 of its initial 10 years.

Adolescent↗
PubMed1994

Electromyographic analysis of knee rehabilitation exercises.

Many exercises are used to strengthen the knee muscles, yet limited studies that evaluate the exercises exist. The purpose of this study was to describe and compare the muscle firing patterns in five knee muscles during five rehabilitative exercises, which were presumed either to strengthen a specific muscle group or to elicit a cocontraction. During short-arc knee extension, the medial and lateral vasti were significantly more active during the last 15 degrees of extension than during other arcs (p < .05). The short-arc knee extension with hamstring cocontraction demonstrated significantly more activity in the rectus femoris, vastus medialis oblique, and vastus lateralis than the biceps femoris and semimembranosus in the final 15 degrees of extension (p < .05). With isometric knee cocontractions, no significant difference in muscle activity occurred in any of the arcs tested. During squatting, the rectus femoris, vastus medialis oblique, and vastus lateralis were significantly more active than the biceps femoris and semimembranosus during the descending, holding, and arising phases (p < .05). This information offers suggestions in selecting optimal knee rehabilitation exercises.

Adult↗
PubMed1994

Adaptations during the stance phase of gait for simulated flexion contractures at the knee.

Adaptations in the stance phase of gait to knee flexion contractures simulated by a knee-ankle-foot orthosis were studied in 20 healthy women (mean age: 25 +/- 3.6 years). Stride characteristics, joint postures, floor reactions, and indwelling electromyographic activity of the lower gluteus maximus, vastus lateralis, long head of the biceps femoris, and soleus muscles were measured during walking with the orthosis, with and without contracture simulation. Simulated knee flexion contracture resulted in decreased stride length and velocity and increased forefoot weight bearing and flexion posture in stance. Increases were also seen in magnitude and/or duration of flexion floor reaction torques and gluteus maximus, vastus lateralis, and soleus muscle activity. The addition of a restriction of plantar flexion resulted in a further decrease in velocity and stride length and a small increase in hip extension posture. These results show that knee flexion contractures, simulated in healthy subjects, cause a decrease in gait function with a simultaneous increase in muscular demand.

Adaptation, Physiological↗
PubMed1994

Isometric shoulder torque in subjects with spinal cord injury.

The etiology of shoulder pain in spinal cord injured (SCI) patients has been attributed to overuse, with dysfunction being more prevalent as the time since injury increases. Impingement syndrome, the most common diagnosis in this population, may be related to weakness of the rotator cuff and shoulder girdle musculature. Shoulder dysfunction is greater in subjects with SCI than in able-bodied patients; consequently, this study compares isometric strength of quadriplegic and paraplegic subjects to able-bodied controls. Peak isometric torque for internal rotation, external rotation, and scapular elevation was assessed using a Lido isokinetic dynamometer. The strength (torque) values of the quadriplegic group were significantly lower than the control group and paraplegic group for all motions tested (p < .0005). The only significant difference between the paraplegic and able-bodied groups was found with internal rotation (p < .0001). These results indicate that quadriplegic patients may be at greater risk for shoulder pathology because of both muscular limitation and increased functional demand.

Adult↗
PubMed1994

Influence of prosthetic foot design on sound limb loading in adults with unilateral below-knee amputations.

Altered gait patterns resulting from amputation has been implicated as a possible mechanism for early degenerative changes in the sound limb of unilateral amputees. The purpose of this study was to examine the ground reaction force characteristics and joint motion in this population. Ground reaction forces, joint motion, and stride characteristics of 10 traumatic below-knee amputees were analyzed while wearing five different prosthetic feet (SACH, Flex-foot, Carbon Copy II, Seattle, and Quantum). Subjects used each foot for 1 month prior to testing. Results indicated that the Flex-foot significantly reduced the initial peak of the vertical ground reaction force on the sound limb compared to all other feet tested (p < .0001). The SACH foot consistently produced the greatest ground reaction forces on the sound limb; however, this was not statistically significant. The effective factor of the Flex-foot appears to be minimization of the center of gravity elevation, which was accomplished through a significant increase in terminal stance dorsiflexion compared to the other feet tested (p < .0001).

Adult↗
PubMed1994

Surgical morbidity in the North Coast Health Region.

A comparison of morbidity following 20 selected surgical procedures was conducted in the North Coast Health Region of NSW in 1988. Morbidity rates between procedures, hospitals and hospital levels were compared and the effects of age, gender and the American Society of Anesthesiologists rating on morbidity were examined. The respective perceptions of doctors and patients regarding complications were also compared. The study gives conditional support to the continuation of a surgical programme in Level 3 hospitals in the North Coast Health Region.

Age Factors↗
PubMed1994

Below-knee amputee gait in stair ambulation. A comparison of stride characteristics using five different prosthetic feet.

The purpose of this study was to compare the stride characteristics provided by four of the new dynamic elastic response prosthetic feet and the SACH foot to determine if any of them provided an increased performance during stair ambulation. Ten traumatic below-knee amputees were studied; each of them tested all five prosthetic feet (Flex-Foot, Carbon Copy II, Seattle, Quantum, and SACH). Compression closing footswitches were used to calculate stride characteristics while ascending and descending a four-step staircase. The only significant difference between feet was found during the initial double-limb support (IDLS) phase of stair ascent, with the Flex-Foot providing a more symmetrical amputated:sound limb IDLS ratio compared with the SACH foot (1.03 versus 1.30). The increased IDLS time seen with the SACH foot reflects the inability to adequately advance the tibia and body weight over the prosthetic foot to achieve progression. This lack of progression and symmetrical gait pattern between limbs may be a function of the limited dorsiflexion range inherent with the SACH foot.

Amputation, Traumatic↗
PubMed1993

The Rancho EMG analyzer: a computerized system for gait analysis.

This paper describes a computer system which accurately defines the EMG patterns of the lower extremities during gait. Footswitches are used to identify the temporal relationships and determine the phases of the gait cycle. Fine wire electrodes, inserted in the desired muscles of the patient being tested, provide EMG signals for comparison with a normal database. The system is also usable with surface electrodes when an appropriate normal database for surface electrodes is incorporated. Descriptive qualifiers (such as 'premature onset', 'delayed cessation', 'no clinically significant EMG', 'continuous activity' etc.) are used to produce a clinically relevant printed (textual) report. The intensity filtered average (IFA) of the EMG is shown graphically with the representative profile of each stride. The IFAs for all muscles tested can be plotted together (up to six on a page) and the graphic representation of the 'raw' EMG can be produced. The methods of generating the normal database by creating time-adjusted mean profiles (TAMP) are enumerated. The clinical use of the system is discussed. A detailed analysis of 31 of the most recent patient tests for which the system was used provides an indication of its accuracy. For 86% of the 428 muscle tests examined, the EMG analyser was considered to have given the correct result as compared with a visual analysis of the raw EMG record by a trained expert. Recommendations for the use and future improvements of the EMG analyser are made.

Adolescent↗
PubMed1993

Computer-guided surgery for tachyarrhythmias in children: current results and expectations.

OBJECTIVES: The purpose of this report is to summarize our entire surgical experience in the treatment of tachyarrhythmias in children. We emphasize our application of a newer computerized mapping system for use in both the electrophysiology laboratory and the operating room to localize points of activation of the tachyarrhythmias. BACKGROUND: A retrospective review was undertaken to examine the results of operative procedures in 290 children undergoing surgical treatment for tachyarrhythmias from 1977 to the present. METHODS: Operative procedures were performed in 290 children and consisted of the following: surgical ablation of accessory pathways of the Kent bundle type (210 children); surgery with cryoablation for atrial ectopic tachycardia (35 children); surgical excision or cryoablation, or both, for ventricular tachycardia (26 children); cryoablation for the permanent form of junctional reciprocating tachycardia (15 children) and atrioventricular (AV) node reentrant tachycardia (4 children). RESULTS: The surgical cure rate for accessory pathway tachycardia in the era before computerized mapping was 80% (41 patients) in the period from 1977 to 1982 and 95% (86 patients) in the period from 1982 to 1988. This rate improved to 100% (83 patients) after the advent of the computerized mapping technique. These improved results are probably due to a combination of factors, including increasing experience in electrophysiologic mapping and surgery, and cannot be attributed to the computerized mapping system alone. Surgical cure or major improvement in symptoms was documented in 33 (94%) of 35 patients with atrial ectopic tachycardia. Surgical cure was accomplished in 25 (96%) of 26 patients with the complex form of ventricular tachycardia. In 19 patients with the permanent form of junctional reciprocating tachycardia and the more typical AV node reentrant tachycardia, the surgical cure rate was 100%. CONCLUSIONS: In all forms of supraventricular reentrant tachycardia that occur in children, preoperative computerized mapping techniques combined with intraoperative computerized mapping and surgical ablation can eliminate tachycardia at a success rate of close to 100%. Computerized mapping techniques are less accurate in patients with atrial ectopic tachycardia because of multiple foci and a broader surface area to be mapped. This experience demonstrates that excellent results can be achieved in the surgical treatment of tachyarrhythmias in children.

Child↗
PubMed1993

A nursing model in action: the University of British Columbia experience.

At the University of British Columbia (UBC) School of Nursing, a model building challenge in the early 1970s launched 2 decades of model development and application projects. In this paper, selected creative applications will illustrate the utility of a nursing model beyond its explicit direction for clinical practice decision-making. The UBC Model for Nursing had been applied as a basis for curriculum development and teaching strategies in a baccalaureate programme as well as a foundation for nursing administrative decisions in a variety of clinical agencies.

British Columbia↗
PubMed1993

The relationship of lower extremity strength and gait parameters in patients with post-polio syndrome.

Relationships between lower extremity strength and stride characteristics were studied in 24 patients with post-polio syndrome. Maximum isometric torques were measured in the ankle plantar flexors, hip and knee extensors, and hip abductors. Gait velocity, stride length, and cadence were recorded during free and fast walking. Step-wise regression analysis was performed to determine which muscle groups best predicted ambulatory function. Plantar flexion torque was the best predictor of velocity (r = .55 free walking and r = .76 fast) and cadence (r = .46 free and r = .58 fast). The combination of plantar flexion and hip abduction torques was the best predictor of fast stride length (r = .78). These findings emphasize the important role of the plantar flexor muscles in gait. Knee extension torque was the poorest predictor for each of the gait parameters. Several patients demonstrated gait deviations that minimized the penalty of quadriceps weakness. Without a contracture or an orthosis, however, no adequate substitution exists for weak plantar flexion.

Adult↗
PubMed1993

A computer algorithm for defining the group electromyographic profile from individual gait profiles.

A computer algorithm was developed to determine the group electromyographic (EMG) profile for the soleus muscle during free speed level walking. Subjects consisted of 50 adults (21 male, 29 female) with no history of musculoskeletal disease. EMG was recorded from the soleus muscle with wire electrodes, and was normalized by maximum muscle test. Two algorithms (time-adjusted mean profile (TAMP) and mean intensity profile (MIP)) were implemented to construct a group profile from identical individual EMG profiles. In addition, a grand ensemble average (GEAV) of the same individual data was performed. A high positive correlation (omega 2 > .995) was found between MIP and GEAV of EMG data. A control group was established based on mean timing and relative intensity of the individual EMG profiles. The MIP and GEAV were shown to have earlier onsets, later cessations, and extended EMG duration in comparison to control values. No significant differences were observed comparing TAMP and mean values for any measure.

Adult↗