Biomedical subjects

Joseph Czerniecki

Publications and source records attributed to Joseph Czerniecki.

4 recordsLinked to original sources

PubMed2006

Does having a computerized prosthetic knee influence cognitive performance during amputee walking?

OBJECTIVE: To compare objective cognitive performance and perception of cognitive burden during walking tasks using 2 different prosthetic knees: a computerized hydraulic knee (Otto Bock C-leg) and a noncomputerized hydraulic knee (Ossur Mauch SNS). DESIGN: Two-group crossover trial, with participants randomly assigned to order of prosthesis. Participants completed assessments under 2 conditions, a self-selected speed walk and a controlled speed walk, on 2 separate occasions (precrossover, postcrossover). SETTING: Veterans Health Administration hospital. PARTICIPANTS: Eight transfemoral amputees. INTERVENTION: Computerized versus noncomputerized prosthetic knee. MAIN OUTCOME MEASURES: Objective cognitive performance measures included verbal fluency (Controlled Oral Word Association Test, Category Test), attention and working memory (serial subtraction), and walking speed during cognitive tasks. Measures of perceived cognitive burden included subjective attentional requirements of walking and cognitive tasks and subjective general cognitive burden of prosthesis. RESULTS: There were no significant differences in objective cognitive performance on any task between prostheses, nor did walking speed vary by prosthesis during the free-speed walk. Participants reported that walking required less attention while wearing the C-leg and that the C-leg was less of a cognitive burden than the noncomputerized prosthesis. CONCLUSIONS: In nondemanding walking conditions with experienced amputees, participants reported that the more costly C-leg required less cognitive attention than the noncomputerized knee. However, this subjective experience did not translate to improved performance on neuropsychologic screening instruments or on walking speed. Noncomputerized prostheses may be adequate for a majority of amputees, and further research is needed to identify particular groups of amputees (ie, new amputees, amputees with complex physical or cognitive demands) who may benefit from computerized prostheses.

Adult↗

PubMed2004

The epidemiology of lower-extremity disease in veterans with diabetes.

OBJECTIVE: To describe the epidemiology of lower-extremity complications of diabetes in veterans who are users of the Department of Veterans Affairs (VA). RESEARCH DESIGN AND METHODS: Hospital discharge records for care provided in all VA hospitals in 1998 were obtained. All hospitalizations for lower-extremity ulceration, peripheral vascular procedures, and amputation were analyzed using frequency tables. A diabetes denominator was defined as a veteran with at least three ambulatory care visits with at least one diabetes diagnosis code. Age-specific and total age-adjusted rates of discharge with ulceration, vascular procedures, and amputation were calculated. RESULTS: Veterans with diabetes comprised over half of all hospitalizations for lower-extremity ulceration, one-third of all hospitalizations for peripheral vascular procedures, and two-thirds of all hospitalizations for amputation. The age-specific discharge rate per 1,000 diabetic persons for age 0-64 years, 65-74 years, and 75 years and older for ulceration were 28.4, 31.0, and 37.9; for vascular procedures, the rates were 3.5, 4.4, and 4.4; and for amputation, the rates were 7.3, 9.0, and 10.0, respectively. CONCLUSIONS: Veterans with diabetes comprise a significant proportion of hospitalizations for lower-extremity ulceration, peripheral vascular bypass, and amputation. Age-specific rates of diabetic amputation in veterans are lower than U.S. rates.

Adult↗

PubMed2002

Energy storage and return prostheses: does patient perception correlate with biomechanical analysis?

The development and prescription of energy storage and return prosthetic feet in favor of conventional feet is largely based upon prosthetist and amputee experience. Regretfully, the comparative biomechanical analysis of energy storage and return and conventional prosthetic feet is rarely a motivation to either the technical development or clinical prescription of such devices. The development and prescription of prosthetic feet without supportive scientific evidence is likely due to the conflicting or non-significant results often presented in the scientific literature. Despite the sizeable history of comparative prosthetic literature and continued analysis of prosthetic components, the link between clinical experience and scientific evidence remains largely unexplored.A review of the comparative analysis literature evaluating energy storage and return and conventional prosthetic feet is presented to illustrate consistencies between the perceptive assessments and the objective biomechanical data. Results suggest that while experimental methodologies may limit the statistical significance of objective gait analysis results, consistent trends in temporal, kinetic, and kinematic parameters correlate well with perceptive impressions of these feet. These correlations provide insight to subtle changes in gait parameters that are deemed neither clinically nor statistically significant, yet are perceived by amputees to affect their preference for and performance of prosthetic feet during locomotion. Acknowledging and targeting areas of perceptive significance will help researchers develop more structured protocols for energy storage and return prosthesis evaluation as well as provide clinicians with information needed to enhance the appropriateness of their clinical recommendations. Expanding test environments to measure activities of perceived improvement such as high-velocity motions, stair ascent/descent, and uneven ground locomotion will provide a more appropriate assessment of the conditions for which energy storage and return prosthetic feet were designed. Concentrating research to specific test populations by age or amputation etiologies can overcome statistical limitations imposed by small study samples. Finally, directing research toward the areas of gait adaptation, heel performance, and the temporal release of energy in energy storage and return feet may reinforce the selection and utilization of advanced prosthetic components. These enhancements to current biomechanical analyses may serve to reduce the boundaries of perceptive significance and provide clinicians, designers, and researchers with the supportive data needed to prescribe, design, and evaluate energy storage and return prosthetic feet.

Amputees↗

PubMedDate not supplied

Assessment of an electronic goniometer designed to measure equinus contracture.

To achieve more objective and repeatable measurements of equinus contracture, we developed the equinometer, a device that allows the measurement of ankle range of motion under controlled torque conditions. This study assessed its accuracy across different subjects and examiners. Two examiners used the equinometer to measure the angle of ankle dorsiflexion at 15 N x m torque on five subjects. Accounting for variation in measurements because of subjects, examiners, and placement of device, we used linear mixed-effects models. Accounting for the variation because of subject, different placements of the equinometer within each subject and the adjustment for the effects of examiner and trial sequence, the standard deviation was 0.94 degrees, 95% confidence interval (0.79 degrees, 1.13 degrees). An upper standard deviation of 1.36 degrees is felt to be acceptable for clinical investigation.

Ankle Joint↗