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PubMed2005

[The effect of controlled and uncontrolled dynamic lower extremity training in the rehabilitation of patients with chronic obstructive pulmonary disease].

UNLABELLED: Pulmonary rehabilitation has become a part of the integrated management of patients with chronic obstructive pulmonary disease (COPD). The lower extremity dynamic training has been proved to be the most effective element of the program. OBJECTIVE: Does the supervised training have more favorable effect in case of similar program? PATIENTS AND METHODS: In two groups: 54 patients, supervised (group K, n = 22) and not supervised (group NK, n = 32) by physiotherapists, chosen at random have been investigated. Both groups consisted of hospitalized patients of the same severity (forced expiratory volume in one second) [FEV1 (average +/- SD)]: K: 51.0 +/- 16.1 vs. NK: 51.9 +/- 15.6% pred). Group K performed physiotherapist-supervised cycling training in the Pulmonology Ambulance Unit 3-4 times a week for 45 minutes doing an 8-week period and group NK performed training in the form of cycling, stepping on stairs or dynamic walking at home with the same duration, weekly periodicity and time interval. RESULTS: After rehabilitation vital capacity (VC) (K: 3.0 +/- 0.8 vs. 3.3 +/- 0.7 l, p < 0.05), emphysema ratio (RV/TLC): K: 53.5 +/- 10.1 vs. 51.6 +/- 9.9, p < 0.05) in the supervised group, and alveolar volume (VA) in the not supervised group (NK: 4.3 +/- 0.9 vs. 4.7 +/- 0.9 l, p < 0.05) significantly improved. Improvement of exercise capacity was more effective in group K (K: 92.7 +/- 33.9 vs. 106.4 +/- 34.5 W, p < 0.001; NK: 95.8 +/- 36.7 vs. 99.9 +/- 35.1 W, p < 0.05). In both groups aerobic capacity (VO2: K: 1.2 +/- 0.4 vs. 1.3 +/- 0.4 l/min, p < 0.01, NK: 1.1 +/- 0.4 vs. 1.2 +/- 0.4 l/min, p < 0.01; VO2/kg: K: 16.1 +/- 5.5 vs. 17.5 +/- 5.8 ml/kg/mm, p < 0.01, NK: 16.2 +/- 5.3 vs. 16.7 +/- 4.8 ml/kg/ min, p < 0.01) and anaerobic threshold level [AT (pred VO2%)] (K: 36.6 +/- 9.8 vs. 42.8 +/- 10.2%, p < 0.001; NK: 40.8 +/- 12.0 vs. 44.6 + 11.6%, p < 0.001) significantly improved. Heart rate reserve: (K: 17.7 +/- 22.7 vs. 28.8 +/- 31.5 l/min, p < 0.01; NK: 20.4 +/- 21.2 vs. 25.0 +/- 21.6 l/min, p < 0.01) improved at the same level of exercise. The Borg scale of dyspnea (0-10): (K: 6.4 +/- 2.5 vs. 5.7 +/- 2.7, p < 0.05; NK: 7.5 +/- 1.8 vs. 6.9 +/- 2.2, p < 0.05) was reduced and quality of life score (0-24): K: 11.5 +/- 0.7 vs. 9.0 +/- 2.8, p < 0.005; NK: 11.6 +/- 2.3 vs. 7.0 +/- 1.9, p < 0.005) was improved. CONCLUSION: In both group dynamic lower extremity training caused improvement in exercise capacity. The favorable metabolic effect of training was shown by the change of anaerobic threshold resulting in less carbon dioxide production during analogous exercise. This reduction led to less ventilation reducing the work of breathing in supervised group. The more favorable adaptation taking place in the group supervised by physiotherapists might have resulted from the controlled higher intensity of the training.

Adult↗

PubMed2001

Sequelae after limb-sparing surgery with major vascular resection for tumor of the lower extremity.

PURPOSE: Limb-sparing procedures have recently replaced amputations as the treatment for tumors invading major vessels of the lower extremity. Major arteries must be reconstructed for limb salvage. The veins are not usually reconstructed. This study was undertaken to investigate the sequelae such as chronic venous disease after venous resection for tumors. METHODS: Ten patients who underwent limb-sparing surgery for a tumor of the lower extremity or retroperitoneum that required major vascular resection were studied. The median follow-up period was 48 months. After combined resection of a major artery and vein, arterial reconstruction was performed. The veins were not reconstructed. The resected veins included the inferior vena cava (n = 2), the external iliac and common femoral veins (n = 3), the superficial femoral vein (n = 3), and the popliteal vein (n = 2). The main outcome measures were clinical classification of chronic venous disease in 10 patients and air plethysmography in seven patients. RESULTS: Clinical classification was C(0A) in 6 patients, C(3A) in 1 patient, C(3S) in 2 patients, and C(4S) in 1 patient. Venous claudication with uncontrollable edema was observed in two patients with C(3S) disease. Pain and itching with inflammatory skin changes were observed in one patient with C(4S) disease. These three patients had undergone resection of the femoral vein, including the deep femoral vein along with proximal adductor muscles. Air plethysmography revealed that the ejection fraction was significantly lower and the residual volume fraction was significantly higher in the three patients with symptoms than in symptom-free patients. CONCLUSIONS: Significant chronic venous disease was observed in the patients who underwent combined resection of the femoral vein, the deep femoral vein, and the adductor muscles for a tumor.

Adult↗

PubMed1992

Aortic saddle embolus presenting with transient lower extremity paresthesia.

We report the case of a 58-year-old woman who developed acute onset of bilateral lower-extremity numbness and difficulty ambulating at home. On presentation to the emergency department, however, the patient's symptoms essentially had resolved. An aortic saddle embolus was suspected based on the patient's cardiac history and the absence of distal pulses in the lower extremities. This case illustrates that even with vague or resolving complaints, a high index of suspicion should be maintained for the diagnosis of aortic saddle embolus based on the patient's medical history and on physical examination.

Aorta, Abdominal↗

PubMed2004

Bone transport in the management of posttraumatic bone defects in the lower extremity.

BACKGROUND: The aim of this study was to evaluate the clinical and functional outcomes of traumatic bone defects of the lower extremity managed by internal bone transport using the Ilizarov technique. METHODS: We retrospectively reviewed 19 patients who underwent internal bone transport for traumatic bone defects in the lower extremity. Mean follow-up was 68.7 months (5.7 years). Eighteen cases were open: grade IIIA, 10 cases; grade IIIB, 4 cases; and grade IIIC, 4 cases. RESULTS: Clinical outcome was 2 excellent, 11 good, 4 fair, and 2 poor. Eighteen of 19 patients reported being satisfied. The results of the SF-36 Health Survey showed a significant difference between the population norm and the mean of the study group in Physical Functioning, Bodily Pain, and Role-Emotional. The mean length of time in external fixation for all patients was 13.8 months. The mean length of regenerate was 5.7 cm (range, 0.8-20.4 cm). The total number of complications was 39 (20 minor and 19 major). Major complications included two transtibial amputations and four fractures at the docking site. CONCLUSION: Although the number of complications was high, the patients in this study were satisfied to have their limbs preserved. The SF-36 Health Survey showed that patients suffer mainly from physical and emotional consequences after these major injuries. Their general, social, and mental health is usually not affected. Infection significantly increased the healing index. The limb should be protected for a long time, with careful evaluation to avoid fracture at the docking site after fixator removal.

Adult↗

PubMedDate not supplied

Efficacy of percutaneous angioplasty in lower extremity arterial occlusive disease.

One hundred and twenty four percutaneous transluminal angioplasties performed over a 5 year period for lower extremity arterial occlusive disease were reviewed to evaluate clinical efficacy and define parameters of success. Technical success was achieved in 82%, clinical success in 71%. The important predictive variables were severity of disease, anatomic site and length of diseased vessel segment. Best results (94% success rate) were obtained in the proximal single segment lesion with lesser initial disease as reflected by flow study, calf vessel runoff and claudication as the indication for treatment. The poorest results (33% success rate) were obtained in distal vessels with multisegmental disease where limb salvage was the indication for intervention. Stenosing or recently occluded bypass grafts were successfully dilated in 7 of 8 patients. With a complication rate of 3%, percutaneous angioplasty is clearly a highly effective treatment for lower extremity arterial insufficiency in the properly selected patient judged by immediate and relatively short term follow-up observations.

Aged↗

PubMed1980

Venous reconstruction by endvenectomy with temporary arteriovenous fistula for stasis syndrome of lower extremity: experimental and clinical studies.

Effect of the temporary arteriovenous fistula on venous reconstruction for stasis syndrome of the lower extremity was studied experimentally and clinically. The canine iliac vein was replaced with an autogenous vein graft in which the intimal surface was roughened by scrubbing with sponge. A temporary arteriovenous fistula which was closed surgically three or four weeks later was created between the femoral vessels. The patency rate for twenty-one grafts was 80.9 per cent for one to thirty-six weeks (mean 8 weeks), in contrast to complete failure in the control group in which no arteriovenous fistula was created. Adequate healing of the luminal surface of the grafts were experimentally demonstrated by light microscopic examination and en face silver staining of the endothel-like cells with the aid of patent arteriovenous fistula for three weeks. This procedure was clinically applied in four patients with stasis syndrome of the lower extremities. Good function of the reconstructed venous segments in three of four patients was observed for the last 3 to 8 years after the operations. A looping technique using 2-0 monfilament nylon around the fistula devised by us was very helpful to make easy the shunt closure later. Open endvenectomy with a temporary arteriovenous fistula is believed to be an acceptable approach for segmental chronic occlusive lesion in the iliac vein.

Adolescent↗

PubMed1998

Lower extremity muscle force measures and functional ambulation in patients with amyotrophic lateral sclerosis.

OBJECTIVE: To examine the relation between lower extremity muscle force production and functional ambulation in patients with amyotrophic lateral sclerosis (ALS). DESIGN: Retrospective analysis of data collected from 1979 to 1995. PATIENTS: Two hundred forty ALS patients referred to the New England Medical Center Neuromuscular Research Unit. MAIN OUTCOME MEASURES: Muscle force production during a maximum, voluntary isometric contraction of ankle dorsiflexors, knee flexors, knee extensors, hip flexors, and hip extensors was calculated as percent predicted maximal force (PPMF). Functional ambulation status was classified as unable, home, or community. RESULTS: The probability of community ambulation compared with home increased with progressively higher PPMF for all muscle groups. Subjects with knee flexion strength greater than 75% PPMF were 395 times more likely to ambulate in the community. Subjects with hip extension strength over 50% PPMF showed improved chance of ambulation at home. CONCLUSION: Lower extremity PPMF is a critical factor determining functional ambulation in patients with ALS. Knee flexors play an important role in community ambulation while the hip extensors are important for home ambulation.

Activities of Daily Living↗

PubMed2004

Reduction of leg pain and lower-extremity weakness for 1 year with Oxiplex/SP gel following laminectomy, laminotomy, and discectomy.

OBJECT: Although good surgical technique is effective in reducing postoperative epidural fibrosis, compression or tethering of the nerve root may cause recurrent radicular pain and physical impairment. The implantation of a bioresorbable gel on the dura may further decrease the amount of scar formation after surgery and thus improve the patient's ability to perform activities of daily living (ADL). This study is a 12-month evaluation of the safety and effectiveness of Oxiplex/SP Gel (FzioMed, Inc., San Luis Obispo, CA) in the reduction of pain and radiculopathy after lumbar discectomy. METHODS: A pilot randomized single-blind multicenter clinical trial was conducted to evaluate the performance of Oxiplex/SP Gel in patients who underwent surgery for unilateral herniation of the lumbar disc at L4-5 or L5-S1. Eighteen patients with severe leg pain and lower-extremity weakness (11 women and seven men) were randomly assigned intraoperatively to receive the gel at the conclusion of surgery (treatment group) or to undergo surgery alone (control group). Self-assessment questionnaires (Lumbar Spine Outcomes Questionnaire) to assess pain, symptoms, and ADL were completed preoperatively and at scheduled postoperative intervals (30 days, 90 days, 6 months, and 12 months). The authors examined the spine and lower extremities of patients scheduled for discectomy to assess neurological function and pain. Treated patients received sufficient Oxiplex/SP Gel (1-3 ml) to coat the nerve root and fill the epidural space. Postoperative clinical evaluations were performed at 30 and 90 days. Patients completed the self-assessment questionnaires at baseline and were contacted by telephone or mail for the completion of the postoperative self-assessment questionnaires. Surgical procedures were well tolerated; no device-related adverse events and no clinically significant laboratory results were reported. The 11 patients with severe leg pain and lower-extremity weakness who were treated with Oxiplex/SP Gel had a reduction in those symptoms at 30 days, 90 days, 6 months, and 12 months after discectomy, compared with the seven control patients who underwent surgery only. CONCLUSIONS: Oxiplex/SP Gel was easy to use and safe in patients who underwent unilateral discectomy. A greater benefit in clinical outcome measures was seen over the 12-month follow-up period in gel-treated patients.

Activities of Daily Living↗

PubMed2002

Diabetes-related lower extremity amputations in the community: a study based on hospital discharge diagnoses.

BACKGROUND AND AIM: To assess the validity of hospital discharge diagnoses (HDDs) as a means for the surveillance of diabetes-related lower extremity amputations on a population basis, and to compare the demographic and clinical characteristics of diabetic and non-diabetic amputees. METHODS AND RESULTS: All of the 1996 hospital discharge diagnoses reporting ICD-9-CM codes 84.10-84.19 were reviewed in the Campania Region, an area in Southern Italy with 5.7 million inhabitants. Diabetes was defined as any concomitant 250 ICD-9 code. The completeness of ascertainment and accuracy in reporting diabetes were validated in a sub-sample of cases by matching their HDDs with the register of buried limbs and the clinical records of the hospital. During the study period, 701 individuals underwent 738 amputations, 330 (47.1%) of whom had diabetes mentioned in their discharge diagnosis. All of the amputations reported in the buried limbs register were identified by the HDDs, whereas some minor amputations recorded in the HDDs were not reported in the registers. On the basis of the clinical charts, the diagnosis of diabetes was underreported by 10%. The proportion of females was significantly higher among the diabetic amputees (41% vs 35%), whereas the proportion of people aged less than 50 years was significantly lower (5% vs 13%) (p < 0.002). The duration of hospitalisation was similar for the diabetics and non-diabetics (23 +/- 20 vs 22 +/- 18 days). Minor amputations were significantly more frequent in the individuals with diabetes (38.8% vs 29.1%; p < 0.001), as was reamputation (7.2% vs 2.9%; p < 0.01). CONCLUSION: These findings confirm the markedly increased risk of amputation among diabetics and demonstrate that HDDs represent a suitable procedure for the surveillance of lower extremity amputations.

Adult↗

PubMed1997

The practical implications of recent trials comparing thrombolytic therapy with surgery for lower extremity ischemia.

UNLABELLED: Catheter-based thrombolysis for lower extremity ischemia is a well-accepted and frequently used technique. Three prospective randomized trials, Rochester, STILE, and TOPAS, which compared thrombolytic therapy with traditional surgical revascularization for lower limb ischemia, have recently been published. METHODS: These three trials are reviewed with the intent of assessing the relative of value of thrombolytic therapy and surgical revascularization for lower limb ischemia. RESULTS: As an initial therapy, thrombolysis reduces the magnitude of any subsequent surgical procedure in approximately 40% to 60% of patients. However, recurrent ischemia is frequent, and the subsequent need for surgical revascularization is common for any native artery occlusion or chronic (> 14 days) bypass graft occlusion. In the patient with an acute bypass graft occlusion, the incidence of recurrent ischemia is less and limb salvage at 1 year is enhanced when treated initially by thrombolysis. A possible survival benefit after thrombolysis was suggested in the Rochester trial and in the STILE trial for diabetics with femoral-popliteal occlusions. CONCLUSIONS: Surgical revascularization remains the optimal therapy for most patients with lower limb ischemia. However, thrombolysis as an initial therapy does reduce the magnitude of any subsequent surgical procedure and provides improved limb salvage for patients with acute bypass graft occlusions.

Arterial Occlusive Diseases↗

PubMed2003

Lower-extremity muscle forces measured by a hand-held dynamometer and the risk of falls among day-care users in Japan: using multinomial logistic regression analysis.

PURPOSE: To assess the relationship between the lower extremity muscle forces and risk of falls among the elderly who were using day-care services in the long-term care insurance system. METHOD: The study population comprised 96 women aged 69 - 91 years. At baseline, we assessed ADL, functional capacity, isometric muscle forces of knee extension and ankle dorsiflexion obtained with a hand-held dynamometer. After 1 year, we asked subjects about falls during the follow up period. RESULTS: In univariate analysis, only the knee extensor strength (p = 0.003) and ankle dorsiflexor strength (p = 0.02) differed significantly according to the fall status. After adjustment for age using multinomial logistic regression analysis, the weak quadriceps group was 7.50 times more likely than the strong group to fall once (p = 0.02), and 5.00 times more likely to fall twice or more (p = 0.02). The weakest ankle dorsiflexor group was 5.09 times more likely than the strongest group to fall twice or more (p = 0.05). CONCLUSIONS: Our results indicated that the forces of knee extensor and ankle dorsiflexor were strongly associated with falls among day-care users. Physiotherapy should focus on the lower-extremity muscle strength to prevent falls and deterioration of physical ability among elderly persons who are partially dependent and need support.

Accidental Falls↗

PubMed2004

Functional outcomes following trauma-related lower-extremity amputation.

BACKGROUND: The principal aims of this study were to examine functional outcomes following trauma-related lower-extremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-the-knee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, in addition to amputation level, that influence outcome, including the type of soft-tissue coverage, selected patient characteristics, and the technological sophistication of the prosthetic device. METHODS: A cohort of 161 patients who had undergone an above-the-ankle amputation at a trauma center within three months following the injury was followed prospectively at three, six, twelve, and twenty-four months after the injury. The Sickness Impact Profile, a self-reported measure of functional status, was used as the principal measure of outcome. Secondary outcomes included pain; degree of independence in transfers, walking, and climbing stairs; self-selected walking speed; and the physician's satisfaction with the clinical, functional, and cosmetic recovery of the limb. Longitudinal multivariate regression techniques were used to determine whether outcomes differed according to the level of amputation after we controlled for covariates. RESULTS: There was no significant difference in the scores on the Sickness Impact Profile between the patients treated with above-the-knee and those treated with below-the-knee amputation. However, patients with a below-the-knee amputation performed better than did patients with an above-the-knee amputation on the timed test for walking speed (p = 0.04). Patients with a through-the-knee amputation had worse regression-adjusted Sickness Impact Profile scores (p = 0.05) and slower self-selected walking speeds (p = 0.004) than did patients with either a below-the-knee or an above-the-knee amputation. Differences according to the level of amputation were most pronounced for physical function. In general, physicians were less satisfied with the clinical, cosmetic, and functional recovery of the patients with a through-the-knee amputation. Except for problems encountered with insufficient gastrocnemius coverage of the stump in many patients with a through-the-knee amputation, neither the soft-tissue coverage nor the technological sophistication of the prosthesis correlated with outcome. CONCLUSIONS: Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes.

Amputation, Surgical↗

PubMed1999

Electromyographic effects of foot orthotics on selected lower extremity muscles during running.

OBJECTIVE: To study the effects of foot orthotics on the mean electromyographic amplitude of proximal and distal lower extremity muscle groups during the first 50% of the stance phase during treadmill running. DESIGN: Repeated measures. SETTING: Subjects were recruited from the general community. PARTICIPANTS: Twelve recreational runners who were symptomatic for lower extremity pain. Clinical and radiographic findings confirmed the presence of structural malalignment of the foot. INTERVENTION: Semirigid orthotics were fabricated for each subject, and like footwear provided. MAIN OUTCOME MEASURES: Surface electromyogram activity from the tibialis anterior, medial gastrocnemius, vastus medialis, vastus lateralis, and biceps femoris was collected during treadmill running at self-selected speeds for orthotic and nonorthotic conditions. Root mean square values were averaged across 10 cycles, normalized to time and expressed as a percentage of the nonorthotic condition. RESULTS: Paired t test results showed statistically significant changes (p<.05) for the biceps femoris (-11.1%) and tibialis anterior (+37.5%) muscle groups during the orthotic condition. Electromyographic activity in the medial gastrocnemius, vastus medialis, and vastus lateralis with orthotic use was not significantly different from the nonorthotic condition. CONCLUSION: Although subjects' electromyographic responses to orthotic use were highly individualized, the findings of this study may enhance our understanding of muscle activity changes associated with positive outcomes from orthotic use.

Adult↗

PubMed1995

Rehabilitation management of the lower extremity in HIV disease.

The sequelae of human immunodeficiency virus (HIV) disease include a host of devastating conditions involving the lower extremity. These include rheumatologic dysfunction, Kaposi's sarcoma, peripheral neuropathies, and skin ulcers. Pain, weakness, and loss of range of motion caused by these conditions can lead to changes in gait pattern, loss of mobility and function, and limited quality of life. The role of the rehabilitation specialist in the care and treatment of HIV disease as it affects the lower extremity, and the treatment strategies, precautions, and suggestions will be discussed.

HIV Infections↗

PubMed1992

Bending moments in lower extremity bones for two standing postures.

The goal of this paper is to study how external gravitational forces stress the lower extremity bones and to ascertain and study how muscle activation compensates for the external load. For these purposes relatively accurate anatomical and biomechanical modelling is necessary. For a comparison of the calculated results to the naturally occurring muscular activity, seven-channel surface EMG activity was recorded. For simplicity a two-dimensional model was developed for the sagittal plane including 19 lower extremity muscles relevant to human standing and walking. In the calculation procedure of muscle forces an optimization procedure is also included. The results give rise to the expected assumption that muscle action is covered by two main requirements: first, to stabilize the joint actively (moment equilibrium) and, second, to compensate efficiently for bending moments produced by gravitational and external forces.

Biomechanical Phenomena↗

PubMed2005

Augmentation in lower extremity sonography for the detection of deep venous thrombosis.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of venous flow augmentation with duplex sonography in the evaluation of deep venous thrombus of the lower extremities. CONCLUSION: The augmentation component of the lower extremity sonogram rarely provides additional information in the diagnosis of deep venous thrombus. In our large series, no deep venous thromboses were discovered with augmentation. Factors such as the lack of usefulness and patient discomfort may justify removal of augmentation from the routine study. However, augmentation should still be applied as a diagnostic tool in difficult or uncertain cases.

Adolescent↗

PubMed1984

Lower extremity amputation for peripheral vascular disease. A low-risk operation.

Two hundred fifty-three consecutive major amputations of the lower extremity for peripheral vascular insufficiency were performed over a 3-year period. Operative mortality was 0.9 per cent for 113 below-knee and 2.8 per cent for 140 above-knee amputations. Although lower extremity amputation has a reputation for high mortality and morbidity, this is unwarranted; adherence to a protocol of aggressive medical management with timely surgical intervention allows a mortality that is appropriate to the age and general debility of this patient population.

Aged↗

PubMed1993

Lumbar spinal stenosis and lower extremity arthroplasty.

Because of their prevalence in elderly patients, the clinical symptoms of acquired lumbar spinal stenosis and degenerative joint disease of the lower extremity can often be present in the same patient. This study reports 14 patients who had diagnoses of both lower extremity degenerative disease and acquired lumbar spinal stenosis. Five of the 14 patients presented with concomitant symptoms, while 9 of 14 patients presented with clinical symptoms of spinal stenosis an average of 9.3 months following joint arthroplasty surgery. Comparison of the preoperative hip and knee scores between the concomitant and sequential groups demonstrated no differences. Seven of the nine patients in the sequential group required subsequent decompression for their spinal stenosis. Stenosis of the lumbar spine must be considered in patients who complain of continuing symptoms of neurogenic claudication in the postoperative period. In addition, these patients should be specifically counseled before their arthroplasty procedures that subsequent spinal surgery may be necessary.

Aged↗