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Biomedical subjects

R K Ashley

Publications and source records attributed to R K Ashley.

14 recordsLinked to original sources
PubMed1992

Gait analysis in pediatric lower extremity amputees.

Walking function in 56 children with lower extremity amputations was assessed using a questionnaire and gait analysis. Children with prosthetic lower extremities can be very functional in society, often participating in sports. Limitations are proportional to the extent of the missing limbs. As a group, pediatric amputees walk more slowly than their normal peers with a slower cadence and a longer stride length. Pediatric amputees have higher heart rates when walking than normal children, but they seem willing to pay a higher physiologic price for ambulation.

Adolescent↗
PubMed1991

Derotational analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis.

Ten patients with idiopathic scoliosis were treated with posterior spinal fusion and Cotrel-Dubousset instrumentation. Computed tomographic scans and intraoperative photographs were used to evaluate the derotational effect of the Cotrel-Dubousset instrumentation. The frontal deformity was corrected from an average of 51 degrees to 15 degrees and the kyphosis from 9.5 degrees to 18 degrees. The amount of preoperative vertebral rotation was variable, however, and insignificant postoperative changes were documented in the majority of cases.

Adolescent↗
PubMed1990

Phasic relationships of the extrinsic muscles of the normal hand.

The objective of this investigation was to improve the interpretation of dynamic electromyogram studies of upper extremity musculature by providing normal reference data. Fine wire electrodes recorded electromyogram data from the extrinsic forearm and hand muscles of 10 normal adults. Simultaneous wrist and finger motions were recorded by goniometers with the electromyogram data. Subjects performed hand opening and closing while actively maintaining selected elbow, forearm, and wrist positions. Phasic muscle activity was identified in each position for individual subjects. Normal adult subjects use gravity and tenodesis effects in addition to active muscle contraction to achieve motor goals. Individual subjects used different muscles to accomplish the same motor task, but each subject was remarkably consistent in muscle assignment. These findings suggest that individuals employ "motor planning strategies" in hand function.

Adult↗
PubMed1989

Variations in the gait of normal children. A graph applicable to the documentation of abnormalities.

The goal of much orthopaedic treatment of children is to improve their walking. To document the quantitative characteristics of walking, we devised graphic displays of speed, cadence, stride length, and body height on the basis of 2,416 observations of 324 children walking over a range of speeds. The gait graph is an uncomplicated tool for the clinician to use in the documentation and evaluation of gait in children. It also provides the means to relate the walking abilities of patients to the standards for normal children.

Child↗
PubMed1987

Treatment of the congenital vertical talus: a retrospective review of 36 feet with long-term follow-up.

To ascertain whether one type of treatment of the congenital vertical talus was superior to others, we conducted a retrospective analysis of 36 congenital vertical tali in 21 patients whose average follow-up of 14 years was considered to be unusually lengthy. Ten patients (48%) had an underlying primary diagnosis, and 13 patients (62%) had at least one other secondary congenital abnormality. None of the surgical techniques produced significantly better results than any other one according to criteria involving shoewear, range of motion, and degree of pain. Subtalar and talotibial motion were frequently restricted, with or without prior arthrodesis. Pain generally was not an immediate or long-term problem. To maintain maximal foot mobility, we recommend a one-stage soft tissue correction alone in the child under 3 years of age. In older, untreated children or those in whom conservative treatments have failed, a subtalar or triple arthrodesis may be necessary.

Adolescent↗
PubMed1981

Congenital metacarpotalar syndrome.

Three children were presented having similar facies, musculoskeletal anomalies and a common ethnic background. All had dislocated hips, scoliosis, congenital vertical tali and hand deformities. There was a very small web space between the first and second metacarpals, extension deformities at the wrist, flexion deformities at the metacarpophalangeal joints, and at one or more proximal interphalangeal joints. In addition, 2 of the 3 youngsters had marked crowding of the teeth and a small maxillary arch. All laboratory studies were normal. The most alarming finding was the poor wound healing which averaged 48%. The wound complication rate at Shriner's Hospital in San Francisco during the identical period of time these children were treated ranged from 1.2% to 1.8%. It is believed that this represents a new syndrome, as similar cases could not be found in the literature. The orthopedist may treat these anomalies in the standard fashion but should keep in mind the propensity for poor wound healing in these patients. The common ethnic background was that of Spanish-American or Chicago families.

Abnormalities, Multiple↗
PubMed1980

Restoration of elbow flexion in arthrogryposis multiplex congenita.

In 15 patients with arthrogryposis multiplex congenita, 18 operations were performed to improve elbow function. These operations were for seven cases of pectoralis transfer, seven cases of anterior transfer of triceps, two cases of posterior elbow release, and two cases of Steindler flexoroplasty. Results were evaluated on two simple criteria: single-hand feeding and improved elbow joint motion. These criteria showed that the pectoralis transfer was the most effective procedure.

Arthrogryposis↗
PubMedDate not supplied

Effects of ankle-foot orthoses on the gait of children.

Gait analysis was performed on five normal children walking barefoot with bilateral double-upright ankle-foot orthoses (AFOs) and with plastic AFOs. When orthoses were worn, walking speed and cadence were reduced and quadriceps EMG timing was prolonged. Changes in lower extremity motions and torques were observed. The metal-and-leather AFOs impaired normal walking, more than the plastic orthoses. This study provides baseline information for evaluation of new orthotic designs and materials for children. In clinical practice, this information may be useful in selection of orthotic materials for some patients.

Ankle Joint↗
PubMedDate not supplied

Persistent brachial plexus birth palsies.

Sixty-six brachial plexus palsies in 64 patients were retrospectively reviewed at the San Francisco Unit of the Shriners Hospital system in a 15-year period from 1973 to 1988. All patients were referred with persistent brachial plexus palsies caused by birth trauma. The distribution of palsies at birth included 34 upper palsies, three lower palsies, and 29 mixed (or global) palsies. At final follow-up, the distribution of palsies had shifted and included 42 upper palsies, 6 lower palsies, and 14 mixed (or global) palsies. One patient had a persistent flail upper extremity. Many previously documented obstetrical risk factors were confirmed. Time to resolution or plateau averaged 4.5 months (range 3 weeks to 18 months). Only two palsies (one patient) resolved completely with time.

Birth Injuries↗
PubMedDate not supplied

Focal scleroderma in children: an orthopaedic perspective.

Focal scleroderma is a connective-tissue disorder manifested by fibrosis of the skin and subcutaneous tissues. Consequently, it may be associated with joint contractures, extremity deformity, and impairment of extremity function. It has a variable clinical course, with both remissions and recurrences. In resistant cases of extremity involvement, treatment considerations should include physical and occupational therapy, medical treatment, bracing, serial casting, and surgical intervention. We reviewed seven patients treated between 1960 and 1990 with significant joint contractures secondary to focal scleroderma. Serial casting was found to be useful for contractures about the wrist, knee, and ankle. Soft-tissue release was an effective treatment for contractures at the wrist, hip, and ankle. Knee disarticulation was performed on one patient with a severe knee-flexion contracture. Epiphysiodesis and femoral shortening osteotomy were effective treatments for leg-length equalization in a case of hemiatrophy.

Adolescent↗