PubMed Health⌕ Search

Biomedical subjects

Malcolm H Granat

Publications and source records attributed to Malcolm H Granat.

6 recordsLinked to original sources
PubMed2005

Continuous monitoring of upper-limb activity in a free-living environment.

OBJECTIVE: To develop and evaluate a system for the objective measurement of upper-limb activity during a person's activities of daily living. DESIGN: Construct validation study. SETTING: Home and work environment. PARTICIPANTS: Ten able-bodied participants and 10 stroke patients. INTERVENTIONS: A novel activity monitor was developed for monitoring upper-limb activity. The Strathclyde Upper-Limb Activity Monitor (SULAM) gave a signal proportional to the vertical displacement of the wrist with respect to the shoulder. Participants wore the SULAM on both upper limbs for 8 hours while performing their normal daily activities. MAIN OUTCOME MEASURES: SULAM-derived variables quantified the total upper-limb activity and the range in which movement of the upper limb occurred. RESULTS: Data showed that the dominant arm of the able-bodied participants was 19% more active than the nondominant arm, whereas the unaffected arms of the group of stroke patients was used 3 to 6 times more than their affected arm. For all the variables, in both groups, there were significant differences between their upper limbs except for movement below midtrunk. There were also significant differences between groups for bimanual movement time ( P =.000) and composite movement time ( P =.000). CONCLUSIONS: The results suggest that the quantification of vertical position of the wrist with respect to the shoulder might reflect upper-limb activity. By using the SULAM, it is possible to monitor upper-limb activity over the course of a person's normal day, with minimal interference. This study provides preliminary evidence of the SULAM as a useful tool for objectively evaluating interventions aimed at improving upper-limb activity and function.

Activities of Daily Living↗
PubMed2005

Effect of functional electrical stimulation, applied during walking, on gait in spastic cerebral palsy.

This study investigated the effect of functional electrical stimulation (FES), applied during walking, on the gait of children with spastic cerebral palsy (CP). Eight children (five males, three females; mean age 13y 2mo, SD 2y 2m; range 8y 11mo to 17y 6mo) diagnosed with diplegic (n=6) or hemiplegic (n=2) spastic CP completed the study. All participants were ambulant. Core FES strategies based on common CP gait deviations were developed and tailored for each child. FES strategies for each child were evaluated in two separate test sessions. Effects of FES on gait were monitored with three-dimensional motion analysis. Within each test session each child's gait was assessed when walking without FES (phase A) and with FES (phase B). An A-B-A-B test sequence was employed allowing the effects of the withdrawal and reinstatement of FES to be assessed. All children performed 10 consecutive walks in each phase. Replication of this sequence on a separate day allowed the repeatability of the intervention to be evaluated. Outcome measures, including summary variables of kinematic data, temporal-spatial variables, and mode of initial contact, were predefined for each child and targets for clinical significance were set for these outcome measures. Comparisons were performed between these targets and the actual outcomes. Consistent clinically significant improvements were recorded for three children: one child showed some improvement that was statistically significant but not clinically significant. Results for one child were mixed. There was no change in the remaining three children. Gait analysis proved to be a useful tool in both developing and determining the effectiveness of FES strategies.

Adolescent↗
PubMed2004

Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: A pilot study.

OBJECTIVE: To study the application of partial weight-bearing (PWB) supported treadmill gait training augmented by functional electric stimulation (FES) in subjects with acute incomplete spinal cord injury (SCI). DESIGN: Before-after crossover trial with control (A) and intervention (B) periods. SETTING: Physiotherapy (PT) department of a spinal injuries unit in Scotland. PARTICIPANTS: Fourteen inpatients with acute incomplete SCI with American Spinal Injury Association class C or D injury. INTERVENTION: Training consisted of treadmill walking with PWB support augmented by FES. Subjects walked on the treadmill for up to 25 minutes a day, 5 days a week for 4 weeks. The intervention was compared with a 4-week control period in which standard PT was given. MAIN OUTCOME MEASURES: Overground walking endurance and speed, cadence, stride length, and observational gait analysis and walking speed, distance, and percentage PWB support on the treadmill. RESULTS: A greater increase in overground walking endurance was achieved after the intervention (AB group mean, 72.2m; confidence interval [CI], 39.8-104.6m; BA group mean, 63.8m; CI, -10.2 to 137.9m), as compared with after standard PT (AB group mean, 38.4m; CI, 1.8-75.0m; BA group mean, 60.1m; CI, 9.2-110.9m). A similar pattern was observed for overground walking speed. CONCLUSIONS: This pilot study indicated that PWB supported treadmill training with FES had a positive effect on overground gait parameters and could potentially accelerate gait training in subjects with incomplete SCI. A larger randomized trial is required to substantiate these findings.

Adult↗
PubMed2003

A knee and ankle flexing hybrid orthosis for paraplegic ambulation.

Limitations of mechanical walking orthoses for paraplegics are high energy consumption and upper limb loading. Flexing of the knee during swing phase has been used as a means of attempting to reduce these. It has been found that this has little effect because using knee flexion results in no change in the compensatory mechanisms required for swing foot clearance. This is because knee flexion can result in an increase in effective leg length, i.e. hip to toe distance. A combination of knee flexion and ankle dorsiflexion during swing phase is suggested as a means of reducing compensatory mechanisms. To examine this hypothesis, an orthosis incorporating knee and ankle flexion was constructed. The design used a novel mechanism to link the motion of the knee to that of the ankle, and also used functional electrical stimulation. Two spinal cord-injured subjects were trained to use the orthosis in two configurations. The first configuration used knee flexion and ankle dorsiflexion and the second configuration used knee flexion alone. Kinematic data were obtained to measure the compensatory mechanisms used during gait. The results showed that a combination of knee flexion and ankle dorsiflexion during swing phase resulted in a reduction in compensatory mechanisms when compared with knee flexion alone.

Activities of Daily Living↗
PubMed2002

A new method of using heart rate to represent energy expenditure: the Total Heart Beat Index.

OBJECTIVES: To develop a new method of representing energy expenditure using heart rate and to determine its reproducibility compared with the criterion standard of oxygen cost. DESIGN: Repeated-measures design. SETTING: University gait analysis laboratory and gymnasium at 2 spinal injury units. PARTICIPANTS: Twenty unimpaired adults and 17 subjects with spinal cord injury (SCI). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Heart rate and oxygen consumption were measured on 20 unimpaired adults walking under controlled steady-state and nonsteady-state conditions. New methods of estimating energy expenditure by using heart rate were compared with oxygen consumption, oxygen cost, and Physiological Cost Index (PCI). Nine subjects with SCI, walking with and without functional electric stimulation, were assessed to determine use of these new measures with this group. Sensitivity to change of the new measurement techniques was investigated in 10 subjects with SCI, comparing wheelchair pushing to walking. RESULTS: The Total Heart Beat Index (THBI) was developed as a new index, calculated by dividing the total heartbeats during activity by distance traveled. High repeatability was found under steady-state and nonsteady-state conditions (intraclass correlation coefficients,.893-.995). Sensitivity to change in activity level was also shown. CONCLUSIONS: The THBI is a simple parameter to calculate from continuous heart rate data and provides a reproducible alternative to gas analysis and the PCI.

Adult↗