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Miniplate fixation of high condylar fracture and postoperative exercise regimen.

The aim of this report is to present three cases of high condylar fracture treated with vertical ramus osteotomy, miniplate fixation of fractured condylar neck, and free grafting. The authors also introduce a simple and easy postoperative exercise regimen. A submandibular incision is made and the ascending ramus divided between the sigmoid notch and the angle of the mandible. After the fragment is removed, the dislocated head of the condyle is readily visible and can be retrieved. The reconstructed osteotomized ramus and condylar head can now be reinserted through the wound and plated. Intermaxillary fixation with arch bar is used. The length of the fixation period is about 14 days after surgery. At the end of this period, the bracket is applied to maxillary incisors, the occlusion becomes stable and reproducible, and then aggressive jaw-opening exercise begins. On postoperative day 21, elastics are applied 24 hours a day. They are placed lightly during the daytime to assist guiding protrusion of the mandible. The patient is instructed to protrude the mandible and to open the mouth simultaneously. The exercise is modified to lateral movement. After the bracket is removed on postoperative day 28, the patient exercises the chin laterally without any guiding elastic fixation for approximately 1 week. This regimen can be widely used in ostectomy-osteosynthesis cases.

Adolescent↗

Characteristics of energy metabolism in males with mental retardation.

To characterize the energy metabolism in individuals with mental retardation (MRs), we measured energy cost at several physical activity levels (basal, supine, sitting, standing, and walking at 30, 50 and 70 m/min), maximal oxygen consumption (Vo2max), and body composition in 23 male MRs and the same number of volunteer male controls. Both groups were individually matched for age, body height, and body weight. Energy cost was measured by the Douglas bag technique. The recently developed sulfur hexafluoride (SF6) dilution technique was employed for measuring body composition. In addition, 3-dimensional accelerometry was used for evaluating body movements, and plasma indices of macronutrients were also measured. The energy cost of MRs, when sitting, standing, and walking at 30 and 50 m/min, was significantly higher than that of controls (p < 0.05), while the basal and resting metabolic rates were similar in both groups. Vo2max was significantly lower (p < 0.05) in MRs than controls. Accelerometry demonstrated excessive movement by MRs, which may explain their higher energy cost of exercise. In contrast, no significant difference was observed in percent body fat or lean body mass. Concentrations of plasma total cholesterol, triacylglycerols and albumin were significantly lower in MRs as compared with the controls. Our findings suggest that MRs are burdened with an energy metabolism less economical than non-MRs. Limited physical activity in their daily life may be the cause. These characteristics of MRs' energy metabolism should be considered for planning their proper dietary schedules and physical activity programs.

Adolescent↗

Does taping influence electromyographic muscle activity in the scapular rotators in healthy shoulders?

Although taping techniques are commonly used in addition to exercise programmes in the rehabilitation of shoulder instability and secondary subacromial or internal impingement, few studies exist on the effect of taping on the muscle activity of the scapular rotators. The purpose of our study was to examine the influence of one particular tape on muscular activity in scapular muscles. Twenty healthy shoulders were examined with surface EMG recordings on the three parts of trapezius and serratus anterior muscle during dynamic full range of motion abduction and forward flexion. The movement direction, and tape and no-tape conditions were randomized. The statistical analyses with ANOVA repeated Measures (GLM model) showed significant differences among the means between the four muscles (P<0.05), two movement directions (P<0.05), applied resistance (P<0.01), and movement period (P<0.01). However, no significant difference was observed based on the application of tape. The results of our investigation revealed no significant influence of tape application on EMG activity in the scapular muscles in healthy subjects. Future research will be necessary to examine other parameters of neuromuscular control in order to determine possible proprioceptive changes in muscle recruitment with tape application.

Adult↗

An impedance cardiography system: a new design.

An IBM compatible impedance cardiac output monitoring prototype system has been developed for use at the bedside on patients in the ICU, CCU, ER, Cath. Lab, and OR, etc. This impedance cardiographic (ICG) system, whose operation is completely technician-free, provides a continuous display with digital results and four channel color waveforms on an Enhanced Graphics Display screen. The software is written in C language with several special segments in assembly code where speed is essential. In this prototype system, a real-time algorithm was introduced to modify the ensemble averaging technique so that it averages nonperiodic signals such as: ECG, dZ/dT, delta Z, etc. Also, a real-time algorithm was developed to adaptively detect R spikes from conventional ECG signals. A signal preprocessor was developed to process signals digitally before any further work is done. This procedure reduces muscle noise, 60 Hz interference, and ventilatory movement. A special digital filter was designed to cope with the cases in which pacemakers are used. A special algorithm was also developed to further reduce the ventilation artifacts so that a period of apnea is unnecessary during the performance of the measurements. An anatomically specified electrode configuration has been defined enabling precise and reproducible positioning of the electrodes--hopefully leading to electrode standardization. At the present time, this prototype system has been compared with standard hand calculation and correlated with the clinical "gold standard," the Swan-Ganz thermodilution cardiac output. Using 144 sets of data from 10 healthy volunteers, 4 critically ill patients, and 8 healthy exercising volunteers, calculations of cardiac output were made using our system and the standard hand calculation of stroke volume, based upon Kubicek's equation; there was a relatively high and stable correlation: r = 0.93, p less than 0.005 (healthy); r = 0.94, p less than 0.002 (ill), r = 0.95, p less than 0.002 (exercise). From 20 patients at two different hospitals all with Swan-Ganz catheters in their hearts, 65 correlation studies between our system and the standard thermodilution technique were performed; the results were encouraging in terms of accuracy and consistency (r1 = 0.84, p less than 0.01, n = 10 CCU patients), and (r2 = 0.93, p less than 0.01, n = ICU patients). These results along with a growing body of data from other investigators indicate that this noninvasive and technician-free system for measuring cardiac output could have a significant role in patient care.

Cardiography, Impedance↗

Anaerobic power output and propulsion technique in spinal cord injured subjects during wheelchair ergometry.

In order to investigate the influence of the level of the spinal cord injury (SCI) on anaerobic or short-term power production and propulsion technique, 23 male SCI subjects performed a 30-second sprint test on a stationary wheelchair ergometer. Kinematic parameters were studied both inter- and intra-individually. Subjects with a cervical lesion showed a lower mean power output (21.5 Watt, one-sided) than the other subjects; whereas, no differences were found between subjects with a thoracic or lumbar injury (46.9, 63.7, and 49.1 Watt, one-sided). Unexpectedly, no differences were found for the effectiveness of the force applied on the rim between subjects with a cervical injury and the other subjects. It is suggested that the high hand rim velocity reached by subjects with a lower injury cause coordination problems. Reduced arm functionality of subjects with a cervical lesion appeared to cause a higher inward directed force. Arm functionality and rim velocity may have a compensating effect with respect to the effectiveness of force. The kinematics of subjects with a cervical lesion differed strongly from subjects with a lower lesion. Propulsion technique appeared to be intra-individually consistent, which is reflected in the consistency of the force curves, the power output curves, and the movement patterns. Large inter-individual differences in propulsion technique were found. It is concluded that the large diversity in capacity of the SCI population should be taken into account with respect to guidelines and requirements for the environmental space of the SCI population.

Adult↗

Feasibility of gait training for acute stroke patients using FNS with implanted electrodes.

Following stroke, many patients do not regain a normal, safe gait pattern even after receiving conventional physical therapy. One promising technique is functional neuromuscular stimulation (FNS) with intramuscular (IM) electrodes (FNS-IM). Five subjects were admitted into the study at 3 weeks to 3 months following the stroke. For each subject, electrodes were placed intramuscularly at the motor point of up to seven lower extremity paretic muscles. Subjects were treated for 6 months, twice weekly with FNS-IM for exercise and gait training. The stimulator and software provided individualized stimulation patterns, with flexible stimulus parameters and activation timings of multiple muscles. Outcome measures were active joint movement, coordination (Fugl-Meyer scale), balance (Tinetti scale), gait (Tinetti scale), activities of daily living (functional independence measure), and therapist and subject satisfaction (survey instrument). Subjects tolerated well the placement of IM electrodes with no adverse effects, and subjects lost no conventional rehabilitation time. Therapists and subjects were satisfied with the FNS-IM system as a rehabilitation tool. Post treatment, subjects demonstrated improvements in impairment and disability in active joint movement, coordination, balance, gait and activities of daily living. Considered together with prior research for chronic stroke subjects, this research suggests that FNS-IM can be successfully and efficaciously utilized for gait training for those with acute stroke.

Acute Disease↗

Analysis and physics of laparoscopic intracorporeal square-knot tying.

Square knots are often used in open surgery to approximate tissue borders or tie off tubular structures like vessels or ducts. Three common methods are used for surgical square-knot tying: one-hand tying, two-hand tying, and the instrument-tying technique. Two types of suture placements are studied in both the open and laparoscopic surgical fields. The first called equal length has suture segment ends placed at equal distances from the tying site. The second called unequal length has one suture end further away from the tying site than the other. Laparoscopic intracorporeal square-knot tying maneuvers are analyzed herein. Mechanical analysis of square-knot tying movements reveals that regardless of location or method used in construction, all square knots consist of 2 half-knots. For study purposes, these sets of movements are identified in laparoscopy as maneuver A and maneuver B. Further breakout of these maneuvers reveals that they consist of 5 motions. This study reveals that 16 different ways exist to place a square knot by means of the laparoscopic intracorporeal technique. It is likely that difficulty mastering this essential skill is not just the result of poor instrumentation, improper port placement, or the limitations of a 2-dimensional video image. It may also be attributed to mixing up the different square-knot tying techniques during random practice exercises. This is possible if the surgeon is ignorant of the technical variations present in what most people consider a simple task.

Laparoscopy↗

Rehabilitation after burn injury.

Optimal rehabilitation of patients after burn injury requires the organised application of sound, recognised principles. The basic concerns are the prevention of loss of joint motion, loss of muscle mass, and the prevention of anatomical deformities. Important considerations are starting the rehabilitative programme as early as possible after injury and avoiding techniques which unduly immobilise the patient or parts of the body. The use of early active motion to the patient and all movable joints, along with appropriate positioning while at rest, is crucial to a successful programme. Passive exercising along with the use of restraints and splints are necessary in certain patients.

Burns↗

[Psychotherapy with expressive technics in psychotic patients].

In February 1984, it was decided to resort to non-verbal expressive techniques as a suitable way for doing group psychotherapy with psychotic patients. A corporal language technique was selected which comprised (a) sense-perception elements, (b) corporal expression, and (c) yoga, arranged in five-step sessions: space acknowledgment, deep-breathing exercise, palpation of an osteoarticular structure, motility test of the previously palpated zone, and expressive exercise. Such an experiment was carried out with a group of psychotic patients, another group with psychosomatic symptoms, and a third, changeable, heterogenous group, with, obviously, a control group. Observations were made of patients' behavior during sessions, and their clinical progress throughout. All patients showed good response to the movement proposals, and no emotional excesses were detected. It was clinically observed that, in all cases, sociability improved, and anxiety decreased--in this connection, medication could be cut down accordingly. As regards 2 schizophrenic female patients, biological therapy could be ruled out.

Adolescent↗

Physical activity assessment in children and adolescents.

Chronic disease risk factors, including a sedentary lifestyle, may be present even in young children, suggesting that early prevention programmes may be critical to reducing the rates of chronic disease. Accurate assessment of physical activity in children is necessary to identify current levels of activity and to assess the effectiveness of intervention programmes designed to increase physical activity. This article summarises the strengths and limitations of the methods used to evaluate physical activity in children and adolescents. MEDLINE searches and journal article citations were used to locate 59 articles that validated physical activity measurement methods in children and adolescents. Only those methods that were validated against a more stringent measure were included in the review. Based on the definition of physical activity as any bodily movement resulting in energy expenditure (EE), direct observation of the individual's movement should be used as the gold standard for physical activity research. The doubly labelled water technique and indirect calorimetry can also be considered criterion measures for physical activity research, because they measure EE, a physiologic consequence closely associated with physical activity. Devices such as heart rate monitors, pedometers and accelerometers have become increasingly popular as measurement tools for physical activity. These devices reduce the subjectivity inherent in survey methods and can be used with large groups of individuals. Heart rate monitoring is sufficiently valid to use in creating broad physical activity categories (e.g. highly active, somewhat active, sedentary) but lacks the specificity needed to estimate physical activity in individuals. Laboratory and field validations of pedometers and accelerometers yield relatively high correlations using oxygen consumption (r = 0.62 to 0.93) or direct observation (r = 0.80 to 0.97) as criterion measures, although, they may not be able to capture all physical activity. Physical activity has traditionally been measured with surveys and recall instruments. These techniques must be used cautiously in a paediatric population that has difficulty recalling such information. Still, some studies have reported 73.4% to 86.3% agreement between these instruments and direct observation. Future investigations of physical activity instruments should validate the novel instrument against a higher standard. Additional studies are needed to investigate the possibility of improving the accuracy of measurement by combining 2 or more techniques. The accurate measurement of physical activity is critical for determining current levels of physical activity, monitoring compliance with physical activity guidelines, understanding the dose-response relationship between physical activity and health and determining the effectiveness of intervention programmes designed to improve physical activity.

Adolescent↗

Pain arising in the posterior arch of the atlas.

Headache of cervical origin is by no means an adequate diagnosis. The exact mechanism has to be established for the case in question. A type of cervical headache which arises from the posteriorr arch of the atlas is described. The basic finding is tenderness of this structure on palpation; the technique of palpation is described. In a majority of cases movement restriction (blockage) between the occiput and the atlase is found. The headache as described by the patient is not characteristic, migrainous attacks being present in about one-third of the cases. A frequent feature is pain on retroflexion of the head. Treatment consists of manipulation of the blockage, and infiltration or needling of the posterior arch of the atlas if there is no blockage or if pain continues after the restoration of mobility. In the more complicated cases remedial exercise is indicated. Experience with 64 cases is described.

Atlanto-Occipital Joint↗

Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain.

STUDY DESIGN: A double-blind randomized crossover experimental study with repeated measures, including a no-treatment control condition. OBJECTIVE: To evaluate the initial effect of 2 mobilization with movement (MWM) treatment techniques performed in weight bearing and non-weight bearing on posterior talar glide and talocrural dorsiflexion in individuals with recurrent lateral ankle sprain. BACKGROUND: MWM treatment techniques are commonly used in the treatment of musculoskeletal pain, such as lateral ankle sprain. Recent evidence indicates that a lack of posterior talar glide and weight-bearing ankle dorsiflexion are common physical impairments in individuals with recurrent ankle sprains. MWM of the ankle joint involves the application of a combined posterior talar glide mobilization and active dorsiflexion movement. The recurrent ankle sprain injury and the MWM treatment techniques for the ankle seemingly provide an appropriate model to further evaluate the effects and mechanism(s) of action of the MWM treatment techniques in a way that they have not been tested to date. METHODS: Sixteen subjects (mean +/- SD age, 19.8 +/- 2.3 years) with a history of recurrent lateral ankle sprain and deficits in posterior talar glide (71%) and weight-bearing dorsiflexion (34%) were studied. A within-subjects study design was used to evaluate the effect of 2 independent variables: treatment conditions (weight-bearing MWM, non-weight-bearing MWM, and a no-treatment control group) and time (pretreatment and posttreatment) on the dependent variables of posterior talar glide and weight-bearing dorsiflexion. RESULTS: Both the weight-bearing and non-weight-bearing MWM treatment techniques significantly improved posterior talar glide by 55% and 50% of the preapplication deficit between affected and unaffected sides, respectively, which was significantly greater than that of the control group (P<.001). The weight-bearing and non-weight-bearing MWM treatment techniques improved weight-bearing dorsiflexion by 26% (P<.017), compared to 9% for the control condition. The change in posterior talar glide, expressed as a proportion of pretreatment deficit, was correlated to the change in weight-bearing dorsiflexion (r = .88, P<.001), but only after the weight-bearing MWM technique. CONCLUSION: This preliminary study demonstrated an initial ameliorative effect of MWM treatment techniques on posterior talar glide and dorsiflexion range of motion in individuals with recurrent lateral ankle sprain. These results suggest that this technique should be considered in rehabilitation programs following lateral ankle sprain. This study provides justification for follow-up research of the long-term effects of MWM on lateral ankle sprain and proposes further work be conducted on the posterior talar glide test.

Adult↗

Fetal surveillance.

The primary objective of fetal surveillance is to prevent antenatal fetal deaths, which still account for greater than one half of perinatal mortality. Several techniques for assessing fetal well-being are available to the practicing obstetrician, including fetal movement counting, nonstress testing, contraction stress testing, fetal biophysical assessment with real-time sonography, and Doppler ultrasonography for measuring umbilical and fetal blood flow. Despite several unanswered questions regarding fetal surveillance, identification of high-risk pregnancies allows appropriate fetal evaluation that can reduce intrauterine fetal death rates.

Exercise Test↗

[Clinical and neurophysiological characteristics of motor cortical responsiveness during prolonged cranial osteoplasty].

The data of global and stimulation poly-EMG were used to estimate the outcomes of multimodality treatment of sequelae of brain injury and stroke, which was based on the vasoactive effects of prolonged cranial osteoplasty. Thirteen patients (7 males and 6 females) aged 19 to 64 (mean 42 +/- 4) years who had signs of left- (n = 2) and right-sided (n = 11) spastic hemiparesis. Global and stimulation poly-EMG, which involved recording and analysis of resting and total EMG under the maximum voluntary tension, M-waves H-reflexes, transcranially evoked potentials. The muscles of the shoulder, forearm, hand, femur, leg, and foot were studied. The surgical procedure developed at the Russian Research Center "VTO" for stimulation of cerebral blood flow in combination with conventional conservative treatments (physiotherapy, therapeutical exercises, and adequate drug therapy) was shown to increase the transmission coefficient of an efferent signal in the motor cortex-spinal motor neurons-muscle system, which is clinically accompanied by improved coordination of simple and complex movements realized with the participation of the muscles of both the paretic and contralateral extremity. The ambiguous effects of the vasoactive factors of prolonged osteoplasty on the functions of unequally modal pathologically changed cerebral motor structures were noted. The findings may be considered as evidence for the low traumatic ability of the VTO's techniques for replacing posttraumatic defects of skull vault bones.

Adult↗

Recent advances in the treatment of low back pain.

There is at the present time an epidemic of low back pain in the industrialized countries. Although the exact origin of such pain is still unknown, there is increasing awareness that the outcome is usually favourable. Only some 10% of those suffering an acute episode of back pain are incapacitated for more than 6 weeks. The causes of long standing back pain are being identified in an increasing number of patients. They include anatomical and pathological disturbances in the motion segment as well as psychological, social and political causes. There are numerous factors which influence the pathophysiology of the motion segment. The degree of loading has been successfully measured and delineated for various postures and exercises, including those at work. The nutritional pathways to the disc have been established and the effect of various external factors measured. Movement is good for the disc and the importance of continuous passive motion for the healing of diseased or injured connective tissues is not established. Activation of large muscle groups increases the production of the body's pain reducing encephalins. Early diagnosis and early mobilisation of the patient should be of benefit, and long term bed rest and inactivity must be prevented. Fewer cases will need operation in the future. Improved imaging techniques and better methods of operation and fixation will help those few who have a definite pathological lesion amenable to surgery.

Animals↗

Influence of task complexity on mechanical efficiency and propulsion technique during learning of hand rim wheelchair propulsion.

OBJECTIVE: To investigate the consequence of task complexity on gross mechanical efficiency and propulsion technique during the learning process of hand rim wheelchair propulsion. METHODS: Three groups of unimpaired subjects (N=10 each) received a 3-week wheelchair practice period (3 week(-1), nine practice trials) with different levels of complexity, i.e. propelling a stationary wheelchair ergometer, wheelchair propulsion on a motor-driven treadmill or at a circular wheelchair track. During practice trials 1 and 9, gross mechanical efficiency and propulsion technique variables (work per cycle, cycle frequency, push and cycle time, effective force) were measured. RESULTS: Using multi-level regression analysis, no differences in the development over time in mechanical efficiency and propulsion technique could be discerned between the three conditions of task complexity. Only the percentage push time during the cycle decreased significantly more in the group that practiced on the ergometer compared to the treadmill-practice group. For all three groups a change over time was shown for cycle frequency, push time and cycle time. DISCUSSION: Under the current experimental conditions, task complexity does not have an influence on gross mechanical efficiency and propulsion technique during the learning process of wheelchair propulsion. The 3-week practice period had a favorable practice effect on timing regardless of the task complexity.

Adaptation, Physiological↗

Human movement analysis using stereophotogrammetry. Part 3. Soft tissue artifact assessment and compensation.

When using optoelectronic stereophotogrammetry, skin deformation and displacement causes marker movement with respect to the underlying bone. This movement represents an artifact, which affects the estimation of the skeletal system kinematics, and is regarded as the most critical source of error in human movement analysis. A comprehensive review of the state-of-the-art for assessment, minimization and compensation of the soft tissue artifact (STA) is provided. It has been shown that STA is greater than the instrumental error associated with stereophotogrammetry, has a frequency content similar to the actual bone movement, is task dependent and not reproducible among subjects and, of lower limb segments, is greatest at the thigh. It has been shown that in in vivo experiments only motion about the flexion/extension axis of the hip, knees and ankles can be determined reliably. Motion about other axes at those joints should be regarded with much more caution as this artifact produces spurious effects with magnitudes comparable to the amount of motion actually occurring in those joints. Techniques designed to minimize the contribution of and compensate for the effects of this artifact can be divided up into those which model the skin surface and those which include joint motion constraints. Despite the numerous solutions proposed, the objective of reliable estimation of 3D skeletal system kinematics using skin markers has not yet been satisfactorily achieved and greatly limits the contribution of human movement analysis to clinical practice and biomechanical research. For STA to be compensated for effectively, it is here suggested that either its subject-specific pattern is assessed by ad hoc exercises or it is characterized from a large series of measurements on different subject populations. Alternatively, inclusion of joint constraints into a more general STA minimization approach may provide an acceptable solution.

Adipose Tissue↗