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PubMed2006

An injectable, biodegradable hydrogel for trophic factor delivery enhances axonal rewiring and improves performance after spinal cord injury.

The failure of long descending pathways to regenerate after spinal cord injury (SCI) is generally attributed to inhibitory proteins associated with the glial scar and myelin, or to the loss of neurons' intrinsic capacity to grow, or both. Here, we describe the use of hydrogels as a novel way to deliver molecules that promote axon growth in the injured CNS of adult rats. This method utilizes an injectable liquid polymer solution that crosslinks into a biodegradable, water-swollen hydrogel when photoactivated under visible light. Neurotrophin-3 (NT-3), a trophic factor known to act on corticospinal tract (CST) projection neurons, was used as a prototypic pro-regenerative molecule. Hydrogel release properties were established in vitro to ensure long-term, sustained NT-3 release over a 2-week period; this avoided the need for multiple injections or minipump implantation. Hydrogel/NT-3-treated animals showed improved recovery in the open-field BBB test and in a horizontal ladder walk test compared to controls implanted with hydrogel alone. At the anatomical level, hydrogel/NT-3-treated animals showed far greater axon growth than controls in two major descending pathways for motor control, the CST and the raphespinal tract. In the case of the CST, much of the NT-3-induced growth represented collateral branching from undamaged ventral CST fibers. These studies demonstrate the effectiveness of hydrogel technology as a clinically feasible delivery system to promote regeneration and enhance functional outcome after spinal cord injury.

Animals↗

PubMed2006

Gender differences in health-related quality of life among the elderly: the role of objective functional capacity and chronic conditions.

Although worse Health-Related Quality of Life (HRQL) among women has been widely described, it remains unclear whether this is due to differential reporting patterns, or whether there is a real difference in health status. The objective of this study was to evaluate to what extent gender differences in HRQL among the elderly might be explained by differences in performance-based functional capacity and chronic conditions, using the conceptual model of health outcomes as proposed by Wilson and Cleary. Data are from a cross-sectional home survey of 872 surviving individuals from an elderly cohort representative of Barcelona's general population. Complete valid data for these analyses were obtained from 62% of the subjects (n = 544). The evaluation included the Nottingham Health Profile (NHP), a generic measure of HRQL; three performance-based functional capacity tests (balance, chair-stand, and walking tests); and a standardized list of self-reported chronic conditions. A series of multiple linear regression models were built with the total NHP score as the dependent variable, with gender, socio-demographic information, performance-based functional capacity and chronic conditions included sequentially, as independent variables. Women (65.4%) showed worse results than men on HRQL (mean of NHP total score 28.3 vs 16.7, p < 0.001) and functional capacity (mean of summary score 7.1 vs 8.3, p < 0.001). Functional capacity, arthritis, back pain, diabetes, and depression were significantly associated to the NHP total score in the final regression model, which explained 42% of the variance. Raw differences by gender in the total NHP score were 11.5 points (p < 0.001), but decreased to a non-significant 3.2 points (p = 0.18) after adjusting for all the other variables. In conclusion, our data suggest that worse reported HRQL in elderly women is mainly due to a higher prevalence of disability and chronic conditions.

Activities of Daily Living↗

PubMed2002

The Performance Enhancement Project: improving physical performance in older persons.

OBJECTIVE: To determine the effects of center-based exercise on physical performance in older persons at risk for decline in physical functioning. DESIGN: Randomized controlled trial. SETTING: Senior centers. PARTICIPANTS: A total of 155 community-dwelling persons, 78.7% women, ages 70 years and older (mean +/- standard deviation, 77.0+/-4.5y), with mobility impairments. INTERVENTION: Intervention volunteers (n=80) exercised at a center (endurance, strength, balance, flexibility) 3 times weekly, for months 1 to 6; once weekly, for months 7 to 12 with home exercise 2 sessions a week; and at home only, for months 13 to 18. Home control volunteers (n=75) were instructed in home endurance exercise. MAIN OUTCOME MEASURES: MacArthur battery, Physical Performance Test (PPT-8), and 6-Minute Walk Test (6MWT) at baseline and 3, 6, 12, and 18 months. RESULTS: MacArthur battery scores improved in intervention compared with home control at 3, 6, and 12 months (repeated-measures analysis of variance: group x time, P<.05) but not 18 months. PPT-8 and 6MWT did not improve. Intervention group assignment, younger age, and better baseline physical function and self-perceived health were independent predictors of long-term MacArthur battery score improvement. CONCLUSIONS: Compared with home control, center-based exercise improved gait, chair rise time, and balance over 1 year. Improvements were not sustained with transition to home exercise for months 13 to 18. Classes may be necessary to maintain improvements in older persons attending center-based exercise.

Activities of Daily Living↗

PubMed1999

Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease.

BACKGROUND: Methods of classifying chronic obstructive pulmonary disease (COPD) depend largely upon spirometric measurements but disability is only weakly related to measurements of lung function. With the increased use of pulmonary rehabilitation, a need has been identified for a simple and standardised method of categorising disability in COPD. This study examined the validity of the Medical Research Council (MRC) dyspnoea scale for this purpose. METHODS: One hundred patients with COPD were recruited from an outpatient pulmonary rehabilitation programme. Assessments included the MRC dyspnoea scale, spirometric tests, blood gas tensions, a shuttle walking test, and Borg scores for perceived breathlessness before and after exercise. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ). The Nottingham Extended Activities of Daily Living (EADL) score and Hospital Anxiety and Depression (HAD) score were also measured. RESULTS: Of the patients studied, 32 were classified as having MRC grade 3 dyspnoea, 34 MRC grade 4 dyspnoea, and 34 MRC grade 5 dyspnoea. Patients with MRC grades 1 and 2 dyspnoea were not included in the study. There was a significant association between MRC grade and shuttle distance, SGRQ and CRQ scores, mood state and EADL. Forced expiratory volume in one second (FEV1) was not associated with MRC grade. Multiple logistic regression showed that the determinants of disability appeared to vary with the level of disability. Between MRC grades 3 and 4 the significant covariates were exercise performance, SGRQ and depression score, whilst between grades 4 and 5 exercise performance and age were the major determinants. CONCLUSIONS: The MRC dyspnoea scale is a simple and valid method of categorising patients with COPD in terms of their disability that could be used to complement FEV1 in the classification of COPD severity.

Adult↗

PubMed2000

Form switching during human locomotion: traversing wedges in a single step.

We examined the neural control strategies used to accommodate discrete alterations in walking surface inclination. Normal subjects were tested walking on a level surface and on different wedges (10 degrees, 15 degrees, 20 degrees, and 30 degrees ) presented in the context of level walking. On a given trial, a subject walked on a level surface in approach to a wedge, took a single step on the wedge, and continued walking on an elevated level surface beyond the wedge. As wedge inclination increased, subjects linearly increased peak joint angles. Changes in timing of peak joint angles and electromyograms were not linear. Subjects used two distinct temporal strategies, or forms, to traverse the wedges. One form was used for walking on a level surface and on the 10 degrees wedge, another form for walking on the 20 degrees and 30 degrees wedges. In the level/10 degrees form, peak hip flexion occurred well before heel strike (HS) and peak dorsiflexion occurred in late stance. In the 20 degrees /30 degrees form, peak hip flexion was delayed by 12% of the stride cycle and peak dorsiflexion was reached 12% earlier. For the level/10 degrees form, onsets of the rectus femoris, gluteus maximus, and vastus lateralis muscles were well before HS and offset of the anterior tibialis was at HS. For the 20 degrees /30 degrees form, onsets of the rectus femoris, gluteus maximus, and vastus lateralis and offset of the anterior tibialis were all delayed by 12% of the stride cycle. Muscles shifted as a group, rather than individually, between the forms. Subjects traversing a 15 degrees wedge switched back and forth between the two forms in consecutive trials, suggesting the presence of a transition zone. Differences between the forms can be explained by the differing biomechanical constraints imposed by the wedges. Steeper wedges necessitate changes in limb orientation to accommodate the surface, altering limb orientation with respect to gravity and making it necessary to pull the body forward over the foot. The use of different forms of behavior is a common theme in neural control and represents an efficient means of coordinating and adapting movement to meet changing environmental demands. The forms of locomotion reported here are likely used on a regular basis in real-world settings.

Adult↗

PubMedDate not supplied

Muscle strength and mass of lower extremities in relation to functional abilities in elderly adults.

BACKGROUND: Functional and physiological declines in advancing age may be significant limiting factors in reduced physical activity. Sarcopenia of aging, as a normative process or disease, cannot entirely explain reduced physical activity in the elderly. OBJECTIVE: The purpose of the study was to investigate the relationship between muscle loss and reduction in functional abilities in elderly adults and also to determine whether an exercise program can improve functional performance and muscle quality. METHODS: Anthropometric measurements and sensorimotor testing were conducted on 28 volunteers (12 men and 16 women, 82.7 +/- 2.4 years of age) who were permanent residents in a skilled nursing facility. Twenty-nine elderly adults (79.3 +/- 3.5 years of age) served as a control, nonexercising group. Anthropometric measurements included: weight, height, body fat, and thigh circumference. The muscle strength was tested with a medical isokinetic system. We assessed two sensorimotor functions including a 'timed up-and-go' test and a 3-min distance walking test. The institutionalized participants undertook an exercise training program lasting 12 weeks. RESULTS: No significant changes were observed in thigh circumference, body weight, or percentage of body fat in either gender as a result of the exercise training. An improvement in muscle strength was noticed in 82% of the relatively younger group (79-83 years of age) under a slow voluntary contraction at 60 degrees /s (p < 0.05). Post-training results showed a significant improvement in performance in the two sensorimotor tests (p < 0.05). The correlation coefficients between muscle strength and functional ability were weak: r = 0.60 and r = 0. 57 for males and females, respectively. CONCLUSIONS: This study confirmed the positive effects of an exercise program on functional performance in older adults. The improvement in functional abilities did not correlate with muscle strength, body weight, or body fat.

Adipose Tissue↗

PubMed2007

Recommendations on the use of exercise testing in clinical practice.

Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest. For symptom-limited incremental exercise, CPET indices, such as peak O(2) uptake (V'O(2)), V'O(2) at lactate threshold, the slope of the ventilation-CO(2) output relationship and the presence of arterial O(2) desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable. In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) "When should an evaluation of exercise intolerance be sought?"; 2) "Which particular form of test should be asked for?"; and 3) "What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?"

Exercise Test↗

PubMed1996

Effects of repeated administration of zolpidem on sleep, diurnal and nocturnal respiratory function, vigilance, and physical performance in patients with COPD.

STUDY OBJECTIVE: To assess the effects of repeated 10-mg oral doses of zolpidem on diurnal and nocturnal respiratory function, as well as on diurnal vigilance and physical performance in COPD patients with disordered sleep. DESIGN: Prospective single-blind placebo-controlled clinical study. SETTING: Outpatients of a respiratory medicine department. PATIENTS AND METHODS: Patients with stable COPD were enrolled for 10 days (D0 to D10), ie, 9 consecutive nights (N1 to N9). They received placebo on N1 and N9 and zolpidem, 10 mg, from N2 to N8. MEASUREMENTS: The following parameters were measured: nocturnal polysomnographic recordings with respiratory signals and arterial blood gas values on retiring and awakening on N0, N1, N2, N8, and N9; subjective evaluation of the quality of sleep and of diurnal vigilance by visual analog scales every day from D0 to D10; pulmonary function test, central control of breathing, and walking test on D0 and D9; biological laboratory tests and theophylline level on D0 and D8. RESULTS: Ten COPD patients (PaO2 = 72.7 +/- 7.6 mm Hg; PaCO2 = 47.7 +/- 5.4 mm Hg; FEV1 = 0.84 +/- 0.3 L; FEV1/vital capacity = 42.5 +/- 12.3%), 56.8 +/- 8.3 years old, were studied. Compared with placebo, no significant change was found for the various sleep architecture parameters, except an increase in the duration of stage 2 during the D8/N8 night (p < 0.05). In contrast, the autoevaluation score for the quality of sleep was significantly improved during the D6/N6 night relative to that with placebo (p < 0.05), with no change in the other subjective criteria. No variable of the nocturnal respiratory parameters, pulmonary function test, central control of breathing, and physical performance was altered by zolpidem. Arterial blood gas values on awakening were not altered. Clinical and biological tolerance of zolpidem was correct with no significant variation of the theophylline level. CONCLUSION: This study shows that repeated 10-mg oral doses of zolpidem during 8 days does not impair nocturnal respiratory and sleep architecture parameters or diurnal pulmonary function tests, central control of breathing, and physical performances in patients with stable COPD.

Administration, Oral↗

PubMedDate not supplied

[Resynchronisation therapy in patients with heart failure: our results].

INTRODUCTION: Resynchronisation therapy with biventricular permanent pacing stimulation is one method of treating patients with systolic heart failure, with echocardiograph signs of ventricular asynchrony and a prolonged QRS of longer than 120 milliseconds. This method has been accepted in most medical centres around the world and was instigated in our Pacemaker Centre in December 2001, 3 months after FDA approval for human use. OBJECTIVE: The aim of the study was to present this new procedure and the results obtained from our own group of patients. METHOD: A multi-site, biventricular pacemaker, with a special electrode for left-half heart stimulation was implanted in the coronary sinus of 17 patients who had suffered systolic heart failure (12 male and 5 female, average age 59.9 years). For all of them, the duration of the QRS interval was longer than 120 ms, with left bundle branch morphology, and an ejection fraction below 30%. All the patients were NYHA class II or III. Prior to and after the implantation, a 12-channel ECG and ECHO were carried out, a 6-minute hall walk test was performed, additionally, the total walked distance on a flat surface was measured, the general condition of the patient was evaluated, the number of medications being taken was noted, as was the number of days of hospitalisation. RESULTS: The average time from diagnosis to implantation was 22 months, and the average post-operative follow-up was 14 months. Two of the patients died 10 and 7 months after the implantation, due to a new myocardial infarction and refractory heart failure. In addition, one patient did not show any improvement after the implantation of the multi-site pacemaker (there were three "non-responder" patients). All the other patients felt much better: decreased NYHA class for I - II class, increased left ventricle ejection fraction, reduced use of diuretics, increased 6-minute hall walk distance and general walk distance on a flat surface, and decreased number of days of hospitalisation. CONCLUSION: Resynchronisation heart failure therapy in the majority of patients with systolic left ventricular dysfunction and a prolonged QRS interval considerably improves cardiac function, in addition to reducing symptoms and hospital stays.

Electrocardiography↗

PubMed2005

[Muscular mechanisms of lowering of physical working capacity in chronic heart failure and action of beta-adrenoblockers].

Parameters of physical working capacity (symptom limited treadmill test with gas analysis, 6 min walk test and usual everyday activity), activity of muscular metaboreflex, efficacy of pulmonary ventilation, and heart rate variability were studied in 50 patients with postinfarction cardiosclerosis with chronic class I-III heart failure and 30 patients without heart failure. Patients with heart failure of all functional classes had lowered parameters of working capacity while metaboloreflex hyperactivation and diminished effectiveness of ventilation were found only in patients with clinical signs of chronic heart failure but not in those with symptomless left ventricular dysfunction. Therapy with metoprolol was associated with lowering of activity of metaboloreflex, augmented effectiveness of ventilation and heart rate variability, improvement of results of 6 min test and everyday activity without considerable changes of peak oxygen consumption.

Adrenergic beta-Antagonists↗

PubMed1976

[Objective results of lumbar sympathectomy. Statistical study, based on vascular function tests].

A series of 100 unselected patients who had undergone low lumbar sympathectomy were studied using vascular function tests (digital plethysmography, hyperaemia test, rheography, measurement of segmental pressures and dynamic tests, walking tolerance on a conveyor belt, Strandness test). Statistical study of the results obtained showed that, above all, isolated lesions of atherosclerotic origin gave excellent results. Increase in walking tolerance and circulatory flow (rheographic quotient) were the only statistically valid parameters. Prediction of the effects of lumbar sympathectomy by Hillestad's hyperaemia test was confirmed. There were many failures amongst the other cases (diffuse lesions, leg artery involvement, diabetic type lesions). Lumbar sympathectomy is hence justified only in the presence of femoral lesions and in association with reconstructive aorto-iliac surgery in all cases when the distal bed consists of the deep femoral only.

Aged↗

PubMed2001

Functional testing of elderly subjects after lower limb amputation.

The aim of the present study was to find out if it is possible to use the same functional tests for elderly subjects after lower limb amputation who live independently at their homes as for healthy ones. Will these tests discriminate among different problems in subjects with different levels and different causes of amputation and will they discriminate between active and sedentary subjects? The study examined 83 volunteers who lived independently at their homes (55 healthy sedentary, 17 after trans-tibial amputation, 11 after trans-femoral amputation). All subjects were aged 60 or older. All subjects after lower limb amputation were found to have significantly worse results in almost all tests in comparison with the healthy sedentary men. The subjects after transfemoral amputation needed significantly more time at the "up and go" test, walked a shorter distance in 9 minutes. and performed fewer stand-ups from a chair and fewer steps in two minutes than the subjects after trans-tibial amputation. The active subjects after lower limb amputation had better balance, were quicker at the "up and go" test and walked longer in a minute than the sedentary subjects after lower limb amputation. It can be concluded that this test battery can also be used to test subjects after lower limb amputation because it discriminates among different severity of problems in subjects with different level and cause of amputation as well as between active and sedentary ones.

Aged↗

PubMedDate not supplied

Oral amino acids in elderly subjects: effect on myocardial function and walking capacity.

BACKGROUND: With advancing age the risk of developing serious nutritional deficiencies increases, and disturbances to the actions of insulin and insulin-like growth factor, coupled with reduced protein/amino acid (AA) intake, impair protein synthesis in muscles. OBJECTIVE: To assess the effects of administering oral AAs on walking capacity and perceived walking impairment, isometric muscular strength, and myocardial function at rest and during isometric exercise. METHODS: One hundred elderly subjects (aged >65 years) with reduced physical activity were randomized to receive an oral AA mixture (12 g/day) or placebo for 3 months. At baseline and after 3 months of therapy we assessed physical capacity with the 6-min walk test, and perceived physical impairment with the walking impairment questionnaire (WIQ); we assessed maximal isometric muscular strength of the right hand with a handgrip dynamometer, and left ventricular ejection fraction (LVEF) using quantitative two-dimensional echocardiography at rest and during acute overload. RESULTS: Three months of AA treatment resulted in significant increases in 6-min walk distance (268.8 +/- 34.9 vs. 212 +/- 40 m, p < 0.001), WIQ scores (distance: 68.3 +/- 12 vs. 53 +/- 14.8%, p < 0.001; speed: 72.2 +/- 14.4 vs. 52.8 +/- 12%, p < 0.001; stairs: 98.2 +/- 24 vs. 72.4 +/- 22%, p < 0.001), and in maximal muscular isometric strength (20.2 +/- 2 vs. 14 +/- 2.8 kg, p < 0.001). Moreover, peak stress LVEF was higher during AA administration when compared to placebo administration (67 +/- 7 vs. 56 +/- 9%, p < 0.01). Left ventricular response to exercise normalized during AA administration in 24 out of 32 (75%) patients with abnormal LV response at baseline, whereas it remained unchanged in the placebo group. CONCLUSION: An oral AA supply such as that used in this study improves ambulatory capacity, maximal isometric muscle strength and myocardial ability to match an acute overload in elderly subjects without affecting the main metabolic parameters. These functional gains may translate into increased perceived walking capacity.

Administration, Oral↗

PubMed2005

Effects of home exercises on motor performance in patients with Parkinson's disease.

OBJECTIVE: To investigate the effect of home exercises on the motor performance of patients with Parkinson's disease. DESIGN: A prospective blinded study with allocation of patients into their groups by alternate weeks. SETTING: A University Hospital neurology and physiotherapy department. SUBJECTS: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinson's disease, classified as Hoehn and Yahr Grades I, II and III. INTERVENTIONS: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n = 15) were given a schedule of exercises to undertake at home; the others (n = 15) did not receive this instruction. MEASURES: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. RESULTS: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). CONCLUSIONS: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.

Aged↗

PubMed2003

Piribedil and bromocriptine in Parkinson's disease: a single-blind crossover study.

INTRODUCTION: Clinicians switch from one dopamine agonist to another for various reasons. However, each change may inadvertently result in certain potential risks such as decreased medication efficacy or new side-effects. OBJECTIVE: We evaluated the tolerability of a switch of bromocriptine to piribedil using two conversion ratios as a primary outcome measure, with motor function as a secondary outcome measure, in patients with mild to moderate Parkinson's disease (PD). METHODS: Twenty consecutive patients with mild to moderate PD (Hoehn and Yahr, stage II-III) on treatment with stable doses of bromocriptine and levodopa were randomized to two groups of 10 patients each, to receive piribedil based on 1:5 or 1:10 conversion ratios. Blinded evaluations were performed: 1) United Parkinson's Diseased Rating Scale (UPDRS) scores both in 'on' and 'off', 2) Open-ended interviews for adverse events, 3) Epworth Sleepiness Scale, 4) Purdue Pegboard assessment during 'on' and 'off', 5) Hand-arm movement test during 'on' and 'off', and 6) Walking test during 'on' and 'off'. RESULTS: Major adverse events included 'sleep attacks' in one patient and minor side-effects included giddiness, nausea, hallucinations, sleepiness and lethargy. However, these were mild and 19 (95%) of the 20 patients completed the study. There was a significant improvement in both the UPDRS 'off' total and motor scores at 1 month compared with baseline for the group on 1:10 ratio. The walking times during the 'off' state at 1 and 2 months were significantly better compared with baseline in the 1:5 group. There were otherwise no significant differences in the rating tests during both 'off' and 'on' states before and after the bromocriptine switch. CONCLUSIONS: We demonstrated that patients with mild to moderate PD who were on relatively low doses of bromocriptine can be safely switched to piribedil based on a conversion ratio of either 1:5 or 1:10. However, the higher conversion ratio has to be carried out with caution in patients with daytime somnolence.

Administration, Oral↗

PubMed1995

Simple indicators of physical working capacity.

Traditional methods used to estimate an individual's physical working capacity have at least one disadvantage in common, namely, the demand for expensive equipment such as cycle ergometers or treadmills. Consequently, the search for suitable tests performed in the field has been extensive. Most field tests do, however, require a maximal performance from the subject. The present investigation compared two special field tests, walking and running, both of a submaximal character, with (a) a treadmill run test and (b) a standardized cycle ergometer test. The comparisons were made to judge whether these field tests have the potential to replace or complement laboratory tests in certain situations, for example, when the purpose is to monitor training progress over time. Correlations were generally high and statistically significant within as well as between tests. Higher values were observed between field running and the laboratory tests than with field walking. This was true especially for the higher reference levels. Despite this, field walking may still be the best alternative for elderly persons or subjects recovering from injury, since the results indicate that walking, when performed intensely enough, gives a fairly good estimate of an individual's physical working capacity.

Adult↗

PubMed1997

A new concept of dynamic orthosis for paraplegia: the weight bearing control (WBC) orthosis.

A new concept of device, termed the weight-bearing control (WBC) orthosis, has been designed with three major needs in mind; a rigid frame that supports the user's body weight, a special hip joint device that reciprocally propels each leg forward, a gas powered foot device that varies the sole thickness of the device for foot/floor clearance, and control system of the orthosis. A paraplegic (T7 level complete paraplegia, sensory evoked potential silent, response to electro-stimulation on the cortical area of the brain also silent) who has tested this WBC orthosis has been able to walk without fatigue at a high speed for a greater distance than before. In walking tests of this WBC orthosis, he achieved a maximum walking speed of 34.1 m/min for a distance of 10 metres. The walking distance reached 521 m with an average walking speed of 21.2 m/min without rest on one small tank of CO2 liquid gas, measuring 10 cm in length and 3 cm in diameter.

Adult↗

PubMed1999

[Exercise tolerance of patients under nasal intermittent positive pressure ventilation (nIPPV)].

BACKGROUND: There are only a few papers concerning with exercise tolerance of patients under nasal intermittent positive pressure ventilation (nIPPV). PATIENTS AND METHOD: Therefore since 1996 we routinely checked exercise tolerance of our nIPPV-patients when admitted to the hospital. Till March 1997 we had carried out 1386-minute walking tests (6-min WT) in 111 patients. QUESTIONS: Is there an improvement of exercise tolerance in the course of nIPPV-therapy? Are hypoxemia or hypercapnia occurring during exercise-test? METHODS: The 6-min WT was performed after one practice walk. The patients got oxygen in case of a preexisting oxygen therapy or in case of an oxygen saturation below 85% before starting. Blood gas analyses were carried out before and after stopping the test. Oxygen saturation and heart rate were registered continuously. The distance walked was measured. Twenty-one patients were tested before introducing nIPPV therapy and 3 months after home mechanical ventilation (HMV). RESULTS: The average distance walked amounted only 283 +/- 82 m (norm in healthy persons: 800 m). pO2 decreased from 69 +/- 11 to 58 +/- 12 mm Hg, pCO2 increased from 47 +/- 8 to 49 +/- 8 mm Hg. Oxygen saturation (SaO2) fell from 92 +/- 5 to 80 +/- 10%, heart rate increased from 104 +/- 18 to 130 +/- 23 beats/min. The distance walked changed not significantly from 282 +/- 109 to 308 +/- 71 m. Six patients could be tested a 3rd time after 6 months HMV. The distance walked was 315 +/- 103 m (also no significant difference). CONCLUSIONS: Everyday activity can cause severe hypoxemia in nIPPV patients. Ambulatory oxygen therapy should be considered in each case. A significant improvement of exercise tolerance under nIPPV therapy is not yet proven. Our data only show a tendency towards an increase.

Exercise Tolerance↗