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Biomedical subjects

J Stallard

Publications and source records attributed to J Stallard.

At least 37 records · Page 2Linked to original sources
PubMed1995

The use of the Orthotic Research and Locomotor Assessment Unit (ORLAU) ParaWalker by adult myelomeningocele patients: a seven year retrospective study--preliminary results.

There is a widely accepted perception that whereas many paediatric myelomeningocele patients use walking orthoses effectively, very few continue to ambulate in adult life. A seven-year retrospective review of 31 patients for whom the ORLAU ParaWalker (2) was prescribed in Oswestry showed that there was a 58% adult compliance rate. Of the 18 who continued walking the average age at supply was 11.28 years (range 5 to 24), average age at survey 22.61 yrs. (range 17 to 33) and the average period of use was 11.33 yrs. (range 3 to 16). These results compare surprisingly well with an ORLAU review of adult traumatic lesions who had a compliance rate of 63% and average follow-up of 2.87 years. The ORLAU ParaWalker has been shown to be an efficient form of walking and this is considered an important feature in ensuring that many adults can continue to take advantage of the proven therapeutic benefits of walking. Notwithstanding, the adult compliance rate shown in this study lends strength to the case for a vigorous and efficient walking programme in treating spina bifida children so as to promote the longer term health of the patient.

Adolescent↗
PubMed1995

The influence of orthosis stiffness on paraplegic ambulation and its implications for functional electrical stimulation (FES) walking systems.

This study examines the evidence which supports the importance of maintaining relative abduction for effective reciprocal walking in high level paraplegic patients. In comparisons of orthoses, where this can only be achieved mechanically, those with higher lateral rigidity consistently showed greater levels of walking efficiency. The influence on hybrid systems of functional electrical stimulation (FES) of the gluteal muscles, where the primary function is to maintain abduction, also showed reductions in overall energy cost, reductions in upper limb effort, or both. Examination of the effect of increasing lateral rigidity of a purely mechanical orthosis by 10% showed that significant energy cost reductions were achieved (30% reduction in Physiological Cost Index) for patients with thoracic lesions experienced in reciprocal walking. A review of FES research suggested that for the modern healthcare sector the cost effectiveness of purely mechanical systems make them an attractive means of routinely providing the functional and therapeutic benefits of walking for high level paraplegic patients. In the prevailing climate of strict budgetry control a case is made for concentrating more research resources on improving still further walking efficiency, and resolving the outstanding problems of functionality and cosmesis in such systems for reciprocal walking.

Electric Stimulation↗
PubMed1993

The case for lateral stiffness in walking orthoses for paraplegic patients.

The provision of walking for paraplegic patients has therapeutic benefits but must be at a low energy cost. Although claims have been made regarding the need for high lateral stiffness in any orthosis targeted at this group, much of the supporting evidence was confusing. This paper presents the theoretical reasoning behind this claim and reviews recent evidence that would appear to support it.

Biomechanical Phenomena↗
PubMed1992

The ORLAU VCG (variable centre of gravity) swivel walker for muscular dystrophy patients.

Swivel walkers are being increasingly used for muscular dystrophy patients in order to prolong the period of their ambulation. Existing designs did not address the special problems of accommodating such patients comfortably and providing the easier and more assured ambulation which their weakened condition requires. The ORLAU VCG (variable centre of gravity) swivel walker has been developed so that the walking mechanics can be adjusted independently of patient posture. Additional patient support features permit the patient to be secured in their chosen position of comfort prior to setting the ambulation mechanics. Patients using the device, which is now approved for supply by the Department of Health in England and Wales, have improved their walking performance and extended their period of walking.

Equipment Design↗
PubMed1990

The Edinburgh-ORLAU prosthetic system to provide reciprocal locomotion in children and adults with complete transverse lower limb deficiency.

A novel prosthetic system to provide reciprocal locomotion in children and adults with complete transverse lower limb deficiency is described. This is based on the hip joints from the ORLAU ParaWalker, a system with a proven record of success in the orthotic management of paraplegic patients. The fitting of the prototype system to an eight year old girl is described. This experience shows that the orthotic principles of the ParaWalker, which provides reciprocal locomotion for the paraplegic, is equally applicable to the prosthetic situation. Developments are therefore continuing to improve the design and to enable further fittings.

Artificial Limbs↗
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↗
PubMed1985

[Effect of nifedipine on arterial pressure and control of the cardiac reflex].

Nine patients with untreated essential hypertension (random blood pressure 173/109 +/- 14/7 mmHg) were studied before and after 16 weeks' treatment with oral nifedipine 10 mg three times a day. Direct continuous measurement of the systolic and diastolic blood pressures showed that both values were significantly reduced during the 24 hour period. Nifedipine did not change the variability of the blood pressure. There was no significant change in the heart rate after treatment with nifedipine. Long-term nifedipine induced an increase in blood flow in the forearm and decreased the vascular resistances which confirmed the vasodilator effects of the drug. The absolute responses of the blood pressure during postural changes, the hand grip test and cold pressor test were reduced but the treatment did not change the percentage increase in blood pressure during these tests. Long-term nifedipine therapy did not affect the plasma renin activity. The sensitivity and characteristics of the baroreflex response to intravenous phenylephrine were measured. After long-term nifedipine therapy we observed a normalisation of the sino-aortic baroreflex and an increase in its sensitivity. Normalisation of the blood pressure by nifedipine induced a significant reduction in the index of left ventricular mass.

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↗
PubMed1983

A clinical review of the orthotic treatment of myelomeningocele patients.

High myelomeningocele lesions do not preclude an acceptable level of functional walking provided that an integrated programme of surgical treatment and bracing is adopted. Clinical analysis of 100 patients with myelomeningocele shows that the development of the "swivel walker" and "hip guidance orthosis" has been associated with an improved level of function. Over 30 per cent of patients with thoracic lesions and 68 per cent of those with lumbar lesions achieved independent walking. For this reason the criteria used at present by paediatricians to govern the selection of infants for non-active treatment may require reconsideration.

Adolescent↗
PubMed1981

Clinical evaluation of spina bifida patients using hip guidance orthosis.

A hip guidance orthosis has been designed to provide the highest potential level of ambulation for the child with myelomeningocele. It permits low energy-cost ambulation at a reasonable speed, and independent transfer from chair to walking and vice versa. It also enables some patients to ascend or descend steps of up to 150mm, as well as gradients of up to one in 10. A review of 27 patients who had used the orthosis for periods of between six and 45 months was undertaken in order to establish the degree of benefit. 17 patients had no power in hips or below, the rest having some power in one or both hips. 17 patients had dorsal lesions and the remainder had lumbar lesions. Using Hoffer's (1973) classification, 13 patients had improved ambulation when using the hip guidance orthosis, and most of the remainder showed some measurable improvement in ambulation. 14 patients were tested for speed of ambulation and heart rate before and after use of the orthosis, and the mean increase in speed was 87.3 per cent, with a mean decrease in heart rate of 10bpm--a clear improvement in efficiency. The results indicate that the hip guidance orthosis can provide low-energy ambulation for spina bifida patients with dorsal and high lumbar lesions in a form acceptable both to patients and parents.

Adolescent↗
PubMed1981

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

The variation of ground reaction forces with time for a complete hgo gait cycle using crutches has been synthesized from video recordings and force platform data. This has led to an understanding of the dynamics of hgo ambulation. The results show that when a patient used the orthosis the crutches provide a subtle control mechanism taking maximum advantage of forward momentum and produce small propulsive forces when needed to make up energy losses.

Biomechanical Phenomena↗
PubMed1980

Clinical decision making with the aid of ambulatory monitoring of heart rate.

Routine assessment of heavily handicapped patients by means of speed and heart rate has been carried out in ORLAU over the past four years. The methodology and the apparatus have been described by Davies (1977) and Stallard et al (1978), who also indicated its value in terms of research. Gradually the technique has been assimilated as a routine clinical assessment procedure, and a number of cases in which it has positively influenced treatment are described in order to illustrate its benefits. The simplicity of the methodology and portable nature of the equipment enable physiotherapists to carry out many assessments in schools, greatly minimising disruption for the patient and maximising the effectiveness of the procedure. Analysis of the types of assessment which had been conducted showed that they could be divided into six categories: Learning time for a new orthosis; Relative value of a new orthosis; The need for operative procedures; The value of operative procedures; Indication of areas requiring further investigation; Confirmation of clinical opinion. When used in conjunction with the other assessment techniques available in ORLAU, monitoring speed and heart rate become a powerful tool for routine evaluation of patients.

Decision Making↗
PubMed1980

One leg swing through gait using two crutches. An analysis of the ground reaction forces and gait phases.

Using a Force Plate the gait cycle for one leg swing-through gait of ten normal subjects on Canadian crutches was monitored, and a composite diagram of forces on the lower limb and both crutches was produced. In addition the relationship of the stance and swing phase for both the lower limb and crutches was studied and the percentage of these phases and their overlap included on the composite diagram. The average maximum vertical ground reaction to the leg was 1.32 body weight, 16 per cent higher than that reported for normal walking. The horizontal force on the lower limb in the direction of walking was 0.35 body weight, compared to 0.15 for normal walking. Vertical ground reaction to crutches was on average 0.54 body weight on the side of the landing leg and 0.51 on the contralateral side. Horizontal ground reaction on the crutches at right angles to the direction of ambulation was 0.09 body weight on the right and 0.08 on the left. The results were considered to indicate caution in the prescription of one leg swing-through gait in subjects with diseased bone and joints in the lower limb.

Adult↗