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Biomedical subjects

Peter R Cavanagh

Publications and source records attributed to Peter R Cavanagh.

29 records · Page 2Linked to original sources

Assessment of the functional method of hip joint center location subject to reduced range of hip motion.

Motion analysis of the lower extremities usually requires determination of the location of the hip joint center. The results of several recent studies have suggested that kinematic and kinetic variables calculated from motion analysis data are highly sensitive to errors in hip joint center location. "Functional" methods in which the location of the hip joint center is determined from the relative motion of the thigh and pelvis, rather than from the locations of bony landmarks, are promising but may be ineffective when motion is limited. The aims of the present study were to determine whether the accuracy of the functional method is compromised in young and elderly subjects when limitations on hip motion are imposed and to investigate the possibility of locating the hip joint center using data collected during commonly studied motions (walking, sit-to-stand, stair ascent, stair descent) rather than using data from an ad hoc trial in which varied hip motions are performed. The results of the study suggested that functional methods would result in worst-case hip joint center location errors of 26mm (comparable to the average errors previously reported for joint center location based on bony landmarks) when available hip motion is substantially limited. Much larger errors ( approximately 70mm worst-case), however, resulted when hip joint centers were located from data collected during commonly performed motions, perhaps because these motions are, for the most part, restricted to the sagittal plane. It appears that the functional method can be successfully implemented when range of motion is limited but still requires collection of a special motion trial in which hip motion in both the sagittal and frontal planes is recorded.

Adult↗

Stair performance in people aged 75 and older.

OBJECTIVES: To examine specific behaviors used by older adults while ascending and descending stairs and to assess the relationships between confidence and stair performance. DESIGN: Cross-sectional. SETTING: Center for Locomotion Studies, The Pennsylvania State University. PARTICIPANTS: Sixteen male (mean age=82.7, range= 77-89) and 16 female (mean age=82.2, range=77-87) community-dwelling adults. MEASUREMENTS: A stair self-efficacy (SSE) test was created to assess individuals' confidence in their safety on stairs. Observational stair performance measures, measures of walking speed on stairs, and the total SSE score were examined for differences due to sex, and the relationships between SSE and specific stair behaviors were assessed. RESULTS: There was a significant relationship between SSE and the safety precautions taken during stair negotiation. Those with lower SSE were more likely to ascend and descend the stairs at a slower speed, use the handrail to a greater extent, and position themselves closer to the rail. The women had lower domain-specific SSE and tended to use the handrail to a greater extent than men even though there were no sex differences in self-reported functional ability or general falls and mobility confidence. A small group of subjects exhibited characteristics of instability, particularly during stair descent, yet most of this group had high SSE scores and failed to use the handrail. CONCLUSION: It appears that confidence related to stair negotiation plays a major role in determining risk-taking propensity during stair use in older adults.

Activities of Daily Living↗

Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity: a magnetic resonance imaging study.

OBJECTIVE: The aim of this study was to quantify the association between claw/hammer toe deformity and changes in submetatarsal head (sub-MTH) fat-pad geometry in diabetic neuropathic feet. RESEARCH DESIGN AND METHODS: Thirteen neuropathic diabetic subjects (mean age 56.2 years) with toe deformity, 13 age- and sex-matched neuropathic diabetic control subjects without deformity, and 13 age- and sex-matched healthy control subjects without deformity were examined. From high-resolution sagittal plane magnetic resonance images of the second and third ray of the foot, toe angle (a measure of deformity), sub-MTH fat-pad thickness, and subphalangeal fat-pad thickness were measured. The ratio of these thicknesses was used to indicate fat-pad displacement. RESULTS: Sub-MTH fat pads were significantly thinner (2.5 +/- 1.3 vs. 6.0 +/- 1.4 mm, P < 0.001) and subphalangeal fat pads significantly thicker (9.1 +/- 1.9 vs. 7.6 +/- 1.2 mm, P < 0.005) in the neuropathic group with deformity compared with neuropathic control subjects. As a result, thickness ratio was substantially smaller in the deformity group: 0.28 +/- 0.14 vs. 0.79 +/- 0.14 in neuropathic control subjects (P < 0.001). A significant correlation of 0.85 was present between toe angle and thickness ratio (P < 0.001). No significant differences were found between neuropathic and healthy control subjects. CONCLUSIONS: This study shows a distal displacement and subsequent thinning of the sub-MTH fat pads in neuropathic diabetic patients with toe deformity and suggests that, as a result, the capacity of the tissue in this region to reduce focal plantar pressure is severely compromised. This condition is likely to increase the risk of plantar ulceration in these patients.

Adipose Tissue↗

Locomotion in simulated zero gravity: ground reaction forces.

BACKGROUND: Exercise is likely to be an important countermeasure to bone demineralization, which remains a concern for astronauts during long-duration spaceflight. However, loads on the feet during exercise with 1 G equivalent gravity replacement are not known. The purpose of this study was to compare ground reaction forces (GRFs) during over-ground and simulated zero gravity (0 G) locomotion. HYPOTHESIS: It was hypothesized that sufficient gravity replacement loading could be applied to the subjects such that GRF profiles similar to those seen in 1 G would occur during locomotion in a zero-gravity locomotion simulator (ZLS). METHODS: GRFs were measured during overground walking and running, and during locomotion in two restraint harness designs in the ZLS with an initial loading of 1 body weight. Load cells measured the gravity replacement load (GRL) in the ZLS. Joint angles at the hip and knee were also measured by goniometers. RESULTS: Peak forces were greater in overground locomotion than in the ZLS; however, loading rates were greater in the ZLS running conditions than in overground running. The knee joint was more flexed at key times in the support phase during running in the ZLS compared with overground. CONCLUSIONS: Large loads and loading rates can be generated at the feet during simulated 0 G exercise although peak forces during running in the ZLS are less than overground running at the same speed. The refinement of the gravity replacement system to provide a constant 1 G load should be considered.

Adult↗

Ground reaction forces and frictional demands during stair descent: effects of age and illumination.

Stair descent is an inherently risky and demanding task that older adults often encounter in everyday life. It is believed that slip between the foot or shoe sole and the stair surface may play a role in stair related falls, however, there are no reports on slip resistance requirements for stair descent. The aim of this study was to determine the required coefficient of friction (RCOF) necessary for safe stair descent in 12 young and 12 older adults, under varied illuminance conditions. The RCOF during stair descent was found to be comparable in magnitude and time to that for overground walking, and thus, with adequate footwear and dry stair surfaces, friction does not appear to be a major determinant of stair safety. Illuminance level had little effect on the dependent variables quantified in this study. However, the older participants demonstrated safer strategies than the young during stair descent, as reflected by differences in the ground reaction forces and lower RCOF.

Activities of Daily Living↗

Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy.

The ulcerated foot in individuals with Charcot neuroarthropathy presents a complex problem when correction of the deformity is necessary but the presence of infection precludes the use of internal fixation. We reviewed 11 patients with midfoot Charcot neuroarthropathy, collapse, and ulceration who were at risk for amputation. These patients underwent operative debridement, corrective osteotomy, external skeletal fixation and culture-directed antibiotic therapy as a limb salvage procedure. Patients were transitioned from the external fixator (average 57 days) to total contact casting (average 131 days) and all subsequently progressed to therapeutic footwear in 12 to 49 months of follow-up (average 24 months), except one patient whose medical decline resulted in bedrest. We believe that when performed in properly selected patients, this procedure presents an alternative to amputation and, via corrective osteotomy, results in a shoe-able, functional foot that is potentially less prone to ulceration.

Adult↗

Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study.

OBJECTIVE: The objectives of this study were to compare intrinsic foot muscle cross-sectional area (CSA) in patients with diabetic polyneuropathy and nondiabetic control subjects and to examine the association between intrinsic muscle CSA and clawing/hammering of the toes in neuropathic feet. RESEARCH DESIGN AND METHODS: High-resolution T2-weighted fast spin-echo images and parametric T2 multiple spin-echo images were acquired using multiple spin-echo magnetic resonance imaging (MRI) of frontal plane sections of the metatarsal region of the foot in a sample of eight individuals with diabetic polyneuropathy and eight age- and sex-matched nonneuropathic nondiabetic control subjects. The configuration of joints of the second toe was obtained using a three-dimensional contact digitizer. RESULTS: Remarkable atrophy was found in all the intrinsic muscles of neuropathic subjects as compared with nondiabetic control subjects. Quantitative T2 analysis showed a 73% decrease in muscle tissue CSA distally in the neuropathic subjects. Muscle comprised only 8.3 +/- 2.9% (means +/- SD) of total foot CSA compared with 30.8 +/- 3.9% in control subjects. No significant differences were found between the groups in the metatarso-phalangeal and proximal and distal interphalangeal joint angles of the second ray. Moreover, clawing/hammering of the toes was found in only two of eight neuropathic subjects. CONCLUSIONS: Although sensory neuropathy is often emphasized in considerations of diabetic foot pathology, our results show that the consequences of motor neuropathy in the feet are profound in people with diabetes. This has implications for foot function and may play a significant role in postural instability. However, intrinsic muscle atrophy does not necessarily appear to imply toe deformity.

Adult↗

Locomotion in simulated microgravity: gravity replacement loads.

BACKGROUND: When an astronaut walks or runs on a treadmill in microgravity, a subject load device (SLD) is used to return him or her back to the treadmill belt. The gravity replacement load (GRL) in the SLD is transferred, via a harness, to the pelvis and/or the shoulders. This research compared comfort and ground reaction forces during treadmill running in a microgravity locomotion simulator at GRLs of 60%, 80%, and 100% of body weight (BW). Two harness designs (shoulder springs only (SSO) and waist and shoulder springs (WSS)) were used. HYPOTHESES: 1) The 100% BW gravity replacement load conditions would be comfortably tolerated and would result in larger ground reaction forces and loading rates than the lower load conditions, and 2) the WSS harness would be more comfortable than the SSO harness. METHODS: Using the Penn State Zero Gravity Locomotion Simulator (ZLS), 8 subjects ran at 2.0 m x s(-1) (4.5 mph) for 3 min at each GRL setting in each harness. Subjective ratings of harness comfort, ground reaction forces, and GRL data were collected during the final minute of exercise. RESULTS: The 100% BW loading conditions were comfortably tolerated (2.3 on a scale of 0-10), although discomfort increased as the GRL increased. There were no overall differences in perceived comfort between the two harnesses. The loading rates (27.1, 33.8, 39.1 BW x s(-1)) and the magnitudes of the first (1.0, 1.4, 1.6 BW) and second (1.3, 1.7, 1.9 BW) peaks of the ground reaction force increased with increasing levels (60, 80, 100% BW respectively) of GRL. CONCLUSIONS: Subjects were able to tolerate a GRL of 100% BW well. The magnitude of the ground reaction force peaks and the loading rate is directly related to the magnitude of the GRL.

Adult↗

Tibial flexural wave propagation in vivo: potential for bone stress injury risk assessment.

OBJECTIVE: To determine the reliability of tibial flexural wave propagation velocity (FWPV) and the effect of overlying soft-tissues on the result. DESIGN: The velocity of tibial flexural wave propagation was repeatedly measured in healthy subjects. BACKGROUND: The tibia is the most frequently stress-fractured bone of runners and in military training populations. Developing techniques to measure tibial bone strength and, thereby, fracture resistance may be useful in pre-participation examinations in order to identify at-risk individuals. One such method, tibial flexural wave propagation velocity (FWPV) has been reported to be a measure of tibial stiffness. METHODS: The tibial FWPV was measured 80 times per subject (10 trials X 2 setups/day X 4 days) in a sample of 25 young women. Two methods of calculating FWPV were used (Peak method time domain and Phase method frequency domain). Intraclass correlations (ICCs) were calculated. RESULTS: The results demonstrated that the peak method was more reliable then the phase method. The ICCs ranged from 0.81-0.96 for the peak method and from 0.59-0.89 for the phase method. The 95% confidence intervals demonstrated that the FWPV could discriminate between subjects with low, medium, or high velocity values with reasonable accuracy and confidence. The soft-tissue overlying the tibia was not significantly (p = 0.63) correlated with FWPV. CONCLUSION: In summary, it is possible to discriminate between varying levels of tibial FWPV. Furthermore, if FWPV is related to bone stress fracture resistance, then this method may be useful in determining stress fracture risk prior to intensive physical activity. RELEVANCE: The tibia is the most frequently stress-fractured bone of runners and in military training populations. This study explores the feasibility of tibial FWPV as a potential method to assess tibial stress fracture resistance.

Adult↗

Therapeutic footwear for people with diabetes.

In this review, the evidence for the role of footwear in causing, healing, and preventing foot ulceration in diabetic patients is discussed. The mechanisms of action of therapeutic footwear are elucidated, and an 'ideal' approach to footwear prescription is outlined. Finally, some future directions for 'intelligent' footwear are also presented.

Diabetic Foot↗