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Sample records for system limb otic

  1. Ciprofloxacin and Dexamethasone Otic

    Science.gov (United States)

    Ciprofloxacin and dexamethasone otic is used to treat outer ear infections in adults and children and acute (suddenly occurring) middle ear ... in a class of medications called quinolone antibiotics. Dexamethasone is in a class of medications called corticosteroids. ...

  2. Analysis of FGF-dependent and FGF-independent pathways in otic placode induction.

    Directory of Open Access Journals (Sweden)

    Lu Yang

    Full Text Available The inner ear develops from a patch of thickened cranial ectoderm adjacent to the hindbrain called the otic placode. Studies in a number of vertebrate species suggest that the initial steps in induction of the otic placode are regulated by members of the Fibroblast Growth Factor (FGF family, and that inhibition of FGF signaling can prevent otic placode formation. To better understand the genetic pathways activated by FGF signaling during otic placode induction, we performed microarray experiments to estimate the proportion of chicken otic placode genes that can be up-regulated by the FGF pathway in a simple culture model of otic placode induction. Surprisingly, we find that FGF is only sufficient to induce about 15% of chick otic placode-specific genes in our experimental system. However, pharmacological blockade of the FGF pathway in cultured chick embryos showed that although FGF signaling was not sufficient to induce the majority of otic placode-specific genes, it was still necessary for their expression in vivo. These inhibitor experiments further suggest that the early steps in otic placode induction regulated by FGF signaling occur through the MAP kinase pathway. Although our work suggests that FGF signaling is necessary for otic placode induction, it demonstrates that other unidentified signaling pathways are required to co-operate with FGF signaling to induce the full otic placode program.

  3. Customizable Rehabilitation Lower Limb Exoskeleton System

    OpenAIRE

    Riaan Stopforth

    2012-01-01

    Disabled people require assistance with the motion of their lower limbs to improve rehabilitation. Exoskeletons used for lower limb rehabilitation are highly priced and are not affordable to the lowerincome sector of the population. This paper describes an exoskeleton lower limb system that was designed keeping in mind that the cost must be as low as possible. The forward kinematic system that is used must be a simplified model to decrease computational time, yet allow the exoskeleton to be a...

  4. Optic and otic side effects of molecular targeted therapies.

    Science.gov (United States)

    O'Leary, Colleen

    2014-08-01

    To discuss the optic and otic toxicities associated with molecular targeted therapies including description, presentation, grading, and management of these toxicities. PubMed, CINAHL, the Cochrane Library and nursing text books. Although targeted therapies often do not have the same systemic toxicities as chemotherapy, they have their own unique side effects. Optic and otic toxicities are seen with a variety of targeted therapies and, although these are not life-threatening toxicities, they do have the potential to severely impair a patient's quality of life. Baseline optic and otic assessments along with periodic assessments throughout treatment can lead to early recognition of problems with the eyes or ears. Recognition and treatment of these problems will help maintain the patient's quality of life. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Customizable Rehabilitation Lower Limb Exoskeleton System

    Directory of Open Access Journals (Sweden)

    Riaan Stopforth

    2012-10-01

    Full Text Available Disabled people require assistance with the motion of their lower limbs to improve rehabilitation. Exoskeletons used for lower limb rehabilitation are highly priced and are not affordable to the lowerincome sector of the population. This paper describes an exoskeleton lower limb system that was designed keeping in mind that the cost must be as low as possible. The forward kinematic system that is used must be a simplified model to decrease computational time, yet allow the exoskeleton to be adjustable according to the patient's leg dimensions.

  6. File list: ALL.Oth.50.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ALL.Oth.50.AllAg.Multipotent_otic_progenitor mm9 All antigens Others Multipotent otic progeni...ncedbc.jp/kyushu-u/mm9/assembled/ALL.Oth.50.AllAg.Multipotent_otic_progenitor.bed ...

  7. ATHLETE: A Limbed Vehicle for Solar System Exploration

    Science.gov (United States)

    Wilcox, Brian H.

    2012-01-01

    As part of the Human-Robot Systems project funded by NASA, the Jet Propulsion Laboratory has developed a vehicle called ATHLETE: the All-Terrain Hex-Limbed Extra-Terrestrial Explorer. Each vehicle is based on six wheels at the ends of six multi-degree-of-freedom limbs. Because each limb has enough degrees of freedom for use as a general-purpose leg, the wheels can be locked and used as feet to walk out of excessively soft or other extreme terrain. Since the vehicle has this alternative mode of traversing through or at least out of extreme terrain, the wheels and wheel actuators can be sized for nominal terrain. There are substantial mass savings in the wheel and wheel actuators associated with designing for nominal instead of extreme terrain. These mass savings are comparable-to or larger-than the extra mass associated with the articulated limbs. As a result, the entire mobility system, including wheels and limbs, can be about 25% lighter than a conventional mobility chassis. A side benefit of this approach is that each limb has sufficient degrees-of-freedom to use as a general-purpose manipulator (hence the name "limb" instead of "leg"). Our prototype ATHLETE vehicles have quick-disconnect tool adapters on the limbs that allow tools to be drawn out of a "tool belt" and maneuvered by the limb.

  8. Culture conditions have an impact on the maturation of traceable, transplantable mouse embryonic stem cell-derived otic progenitor cells.

    Science.gov (United States)

    Abboud, Nesrine; Fontbonne, Arnaud; Watabe, Isabelle; Tonetto, Alain; Brezun, Jean Michel; Feron, François; Zine, Azel

    2017-09-01

    The generation of replacement inner ear hair cells (HCs) remains a challenge and stem cell therapy holds the potential for developing therapeutic solutions to hearing and balance disorders. Recent developments have made significant strides in producing mouse otic progenitors using cell culture techniques to initiate HC differentiation. However, no consensus has been reached as to efficiency and therefore current methods remain unsatisfactory. In order to address these issues, we compare the generation of otic and HC progenitors from embryonic stem (ES) cells in two cell culture systems: suspension vs. adherent conditions. In the present study, an ES cell line derived from an Atoh1-green fluorescent protein (GFP) transgenic mouse was used to track the generation of otic progenitors, initial HCs and to compare these two differentiation systems. We used a two-step short-term differentiation method involving an induction period of 5 days during which ES cells were cultured in the presence of Wnt/transforming growth factor TGF-β inhibitors and insulin-like growth factor IGF-1 to suppress mesoderm and reinforce presumptive ectoderm and otic lineages. The generated embryoid bodies were then differentiated in medium containing basic fibroblast growth factor (bFGF) for an additional 5 days using either suspension or adherent culture methods. Upon completion of differentiation, quantitative polymerase chain reaction analysis and immunostaining monitored the expression of otic/HC progenitor lineage markers. The results indicate that cells differentiated in suspension cultures produced cells expressing otic progenitor/HC markers at a higher efficiency compared with the production of these cell types within adherent cultures. Furthermore, we demonstrated that a fraction of these cells can incorporate into ototoxin-injured mouse postnatal cochlea explants and express MYO7A after transplantation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons

  9. Evaluation of new suspension system for limb prosthetics.

    Science.gov (United States)

    Gholizadeh, Hossein; Abu Osman, Noor Azuan; Eshraghi, Arezoo; Ali, Sadeeq; Arifin, Nooranida; Wan Abas, Wan Abu Bakar

    2014-01-10

    Good prosthetic suspension system secures the residual limb inside the prosthetic socket and enables easy donning and doffing. This study aimed to introduce, evaluate and compare a newly designed prosthetic suspension system (HOLO) with the current suspension systems (suction, pin/lock and magnetic systems). All the suspension systems were tested (tensile testing machine) in terms of the degree of the shear strength and the patient's comfort. Nine transtibial amputees participated in this study. The patients were asked to use four different suspension systems. Afterwards, each participant completed a questionnaire for each system to evaluate their comfort. Furthermore, the systems were compared in terms of the cost. The maximum tensile load that the new system could bear was 490 N (SD, 5.5) before the system failed. Pin/lock, magnetic and suction suspension systems could tolerate loads of 580 N (SD, 8.5), 350.9 (SD, 7) and 310 N (SD, 8.4), respectively. Our subjects were satisfied with the new hook and loop system, particularly in terms of easy donning and doffing. Furthermore, the new system is considerably cheaper (35 times) than the current locking systems in the market. The new suspension system could successfully retain the prosthesis on the residual limb as a good alternative for lower limb amputees. In addition, the new system addresses some problems of the existing systems and is more cost effective than its counterparts.

  10. RA and FGF Signalling Are Required in the Zebrafish Otic Vesicle to Pattern and Maintain Ventral Otic Identities

    Science.gov (United States)

    Maier, Esther C.; Whitfield, Tanya T.

    2014-01-01

    During development of the zebrafish inner ear, regional patterning in the ventral half of the otic vesicle establishes zones of gene expression that correspond to neurogenic, sensory and non-neural cell fates. FGF and Retinoic acid (RA) signalling from surrounding tissues are known to have an early role in otic placode induction and otic axial patterning, but how external signalling cues are translated into intrinsic patterning during otic vesicle (OV) stages is not yet understood. FGF and RA signalling pathway members are expressed in and around the OV, suggesting important roles in later patterning or maintenance events. We have analysed the temporal requirement of FGF and RA signalling for otic development at stages after initial anteroposterior patterning has occurred. We show that high level FGF signalling acts to restrict sensory fates, whereas low levels favour sensory hair cell development; in addition, FGF is both required and sufficient to promote the expression of the non-neural marker otx1b in the OV. RA signalling has opposite roles: it promotes sensory fates, and restricts otx1b expression and the development of non-neural fates. This is surprisingly different from the earlier requirement for RA signalling in specification of non-neural fates via tbx1 expression, and highlights the shift in regulation that takes place between otic placode and vesicle stages in zebrafish. Both FGF and RA signalling are required for the development of the otic neurogenic domain and the generation of otic neuroblasts. In addition, our results indicate that FGF and RA signalling act in a feedback loop in the anterior OV, crucial for pattern refinement. PMID:25473832

  11. Skull mechanics and the evolutionary patterns of the otic notch closure in capitosaurs (Amphibia: Temnospondyli).

    Science.gov (United States)

    Fortuny, Josep; Marcé-Nogué, Jordi; Gil, Lluis; Galobart, Angel

    2012-07-01

    Capitosaurs were among the largest amphibians that have ever lived. Their members displayed an amphibious lifestyle. We provide new information on functional morphology data, using finite element analysis (FEA) which has palaeoecological implications for the group. Our analyses included 17 taxa using (2D) plate models to test four loading cases (bilateral, unilateral and lateral bitings and skull raising system simulation). Our results demonstrates that, when feeding, capitosaurs concentrated the stress at the circumorbital region of the capitosaur skull and cranial sutures probably played a key role in dissipating and absorbing the stress generated during biting. Basal members (as Wetlugasaurus) were probably less specialized forms, while during Middle- and Late Triassic the group radiated into different ecomorphotypes with closed otic notch forms (as Cyclotosaurus) resulting in the strongest skulls during biting. Previous interpretations discussed a trend from an open to closed otic notch associated with lateral repositioning of the tabular horns, but the analysis of the skull-raising system reveals that taxa exhibiting posteriorly directed tabular horns display similar results during skull raising to those of closed otic notch taxa. Our results suggest that various constraints besides otic notch morphology, such as the elongation of the tabular horns, snout length, skull width and position, and size of the orbits affect the function of the skull. On the light of our results, capitosaur skull showed a trend to reduce the stresses and deformation during biting. Capitosaurs could be considered crocodilian analogues as they were top-level predators in fluvial and brackish Triassic ecosystems. Copyright © 2012 Wiley Periodicals, Inc.

  12. Higgs-otic inflation and moduli stabilization

    Energy Technology Data Exchange (ETDEWEB)

    Bielleman, Sjoerd; Ibáñez, Luis E.; Pedro, Francisco G. [Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC,Universidad Autónoma de Madrid,Cantoblanco, 28049 Madrid (Spain); Valenzuela, Irene [Max-Planck-Institut fur Physik,Föhringer Ring 6, 80805 Munich (Germany); Institute for Theoretical Physics and Center for Extreme Matter and Emergent Phenomena, Utrecht University,Leuvenlaan 4, 3584 CE Utrecht (Netherlands); Wieck, Clemens [Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC,Universidad Autónoma de Madrid,Cantoblanco, 28049 Madrid (Spain)

    2017-02-14

    We study closed-string moduli stabilization in Higgs-otic inflation in Type IIB orientifold backgrounds with fluxes. In this setup large-field inflation is driven by the vacuum energy of mobile D7-branes. Imaginary selfdual (ISD) three-form fluxes in the background source a μ-term and the necessary monodromy for large field excursions while imaginary anti-selfdual (IASD) three-form fluxes are sourced by non-perturbative contributions to the superpotential necessary for moduli stabilization. We analyze Kähler moduli stabilization and backreaction on the inflaton potential in detail. Confirming results in the recent literature, we find that integrating out heavy Kähler moduli leads to a controlled flattening of the inflaton potential. We quantify the flux tuning necessary for stability even during large-field inflation. Moreover, we study the backreaction of supersymmetrically stabilized complex structure moduli and the axio-dilaton in the Kähler metric of the inflaton. Contrary to previous findings, this backreaction can be pushed far out in field space if a similar flux tuning as in the Kähler sector is possible. This allows for a trans-Planckian field range large enough to support inflation.

  13. File list: His.Oth.10.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available His.Oth.10.AllAg.Multipotent_otic_progenitor mm9 Histone Others Multipotent otic pr...ogenitor http://dbarchive.biosciencedbc.jp/kyushu-u/mm9/assembled/His.Oth.10.AllAg.Multipotent_otic_progenitor.bed ...

  14. File list: Unc.Oth.20.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  1. File list: Pol.Oth.10.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  6. File list: DNS.Oth.10.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  10. File list: Pol.Oth.20.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  11. File list: His.Oth.05.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  12. File list: His.Oth.50.AllAg.Multipotent_otic_progenitor [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  13. Study on possible control algorithms for lower limb rehabilitation system.

    Science.gov (United States)

    Kordasz, Marta; Kuczkowski, Krzysztof; Sauer, Piotr

    2011-01-01

    In this paper, one of the possibilities of introduction of variable stiffness in a rehabilitation manipulator for lower limbs, is described. Mechanical design and working principle of a proposed system are presented. The following control algorithms for manipulators with flexible joints are suggested: the position control and the active impedance control. The tracking performance is experimentally studied for sinusoidal and polynomial reference trajectories. Obtained results confirm that both control strategies are suitable for controlling a rehabilitation manipulator with changeable stiffness. © 2011 IEEE

  14. Definitive Management of Open Tibia Fractures Using Limb Reconstruction System.

    Science.gov (United States)

    Patil, Mahantesh Yellangouda; Gupta, Srinath Myadam; Kurupati, Sri Krishna Chaitanya; Agarwal, Saumya; Chandarana, Vishal

    2016-07-01

    Open fractures are treated as surgical emergency and early administration of intravenous antibiotic coupled with early irrigation and debridement decreases the infection rate dramatically. Limb Reconstruction System (LRS) is a unilateral rail system which consists of Shanz pins, rail rods and sliding clamps. It is specifically designed to enable the surgeon to perform simple and effective surgery as it offers rigid fixation of fracture fragments, allowing early weight bearing and reduces economic burden. To determine the efficacy of Limb Reconstruction System for treatment of compound tibia fractures. A prospective study was carried out where in 54 cases out of 412 compound tibia fractures having Modified Gustilo Anderson Type IIIA and IIIB with a mean age of 42±5 years were treated using LRS over a period of 26 months. Limb reconstruction system was used in acute docking mode or with corticotomy and bone transport was done depending upon the bone loss. The soft tissue condition was assessed and split thickness skin grafting and flap repairs were done as per the need. Clinical and radiological assessment was done at every follow-up. Bony and functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. Among 54 patients, bony results as per ASAMI score were excellent in 36, good in 14, fair in 2 and poor in 2 patients. Functional results were excellent in 43, good in 7, fair in 4 patients. The average fracture union time was 8 months. Post-surgery patient satisfaction was excellent since fixation allowed weight bearing immediately. Average hospital stay was 7 days and financial burden was reduced by 40% as compared to multi staged surgery. The average time of return to work was 20 days. LRS is an easy, simple and definitive surgical procedure that allows immediate full weight bearing walking. It reduces hospital stay, is cost effective with excellent patient compliance and can also be used for bone

  15. Modular externally-powered system for limb prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Seamone, W.; Hoshall, C.H.; Schmeisser, G.

    Many upper limb amputees especially those who have sustained high level amputations of injury to remaining portions of the body, are unable to use conventional prosthetic devices effectively. In an effort to help the more severely handicapped amputees and those who may for other reasons require capabilities that standard prostheses cannot provide, the Applied Physics Laboratory, in conjunction with the Johns Hopkins Medical Institutions, has developed a prosthetic system which is powered by rechargeable batteries. The amputee need supply only a control signal. This article describes the concept which is now being evaluated with the aid of amputee subjects, and discusses results obtained to data in field tests.

  16. Outcome of limb reconstruction system in open tibial diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Anand Ajmera

    2015-01-01

    Full Text Available Background: Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Materials and Methods: Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI criteria. Results: Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm. The mean duration of bone transport was 13 weeks (range 8-30 weeks with a mean time for LRS in place was 44 weeks (range 24-51 weeks. The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25, good in 12% (3/25 and fair in 4% (1/25 with union in all except 2 patients, which showed poor results (8% with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25, good in 8% (2/25, fair in 8% (2/25. Pin

  17. Assistive Control System for Upper Limb Rehabilitation Robot.

    Science.gov (United States)

    Chen, Sung-Hua; Lien, Wei-Ming; Wang, Wei-Wen; Lee, Guan-De; Hsu, Li-Chun; Lee, Kai-Wen; Lin, Sheng-Yen; Lin, Chia-Hsun; Fu, Li-Chen; Lai, Jin-Shin; Luh, Jer-Junn; Chen, Wen-Shiang

    2016-11-01

    This paper presents an assistive control system with a special kinematic structure of an upper limb rehabilitation robot embedded with force/torque sensors. A dynamic human model integrated with sensing torque is used to simulate human interaction under three rehabilitation modes: active mode, assistive mode, and passive mode. The hereby proposed rehabilitation robot, called NTUH-ARM, provides 7 degree-of- freedom (DOF) motion and runs subject to an inherent mapping between the 7 DOFs of the robot arm and the 4 DOFs of the human arm. The Lyapunov theory is used to analyze the stability of the proposed controller design. Clinical trials have been conducted with six patients, one of which acts as a control. The results of these experiments are positive and STREAM assessment by physical therapists also reveals promising results.

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    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  6. The intravestibular source of the vestibular aqueduct. II: its structure and function clarified by a developmental study of the intra-skeletal channels of the otic capsule.

    Science.gov (United States)

    Michaels, Leslie; Soucek, Sava; Linthicum, Fred

    2010-04-01

    A developmental histologic study of the otic capsule indicates that it grows a system of lamellar bone with abundant interconnecting intraosseous channels. These include the 'cartilage canals' in the cartilage model, the chondro-osseous and Haversian-like (Volkmann's) canals in the ossified otic capsule, the fissula ante fenestram, which seems to function as a lifelong manufacturer of the latter two channels, and the inner layer (vestibular arch) of the vestibular aqueduct, which is a complex series of Volkmann's canals and microcanals. Chemical changes, possibly produced by breakdown of cells within the channels, may provide a homeostatic environment for the functions of hearing and balance that take place in the endolymphatic fluid. We studied the development of the otic capsule to clarify the cellular appearances that we had previously described in the normal vestibular arch and the changes in that structure in Ménière's disease. Step sections from 84 temporal bones, including those from fetuses, children and adults from a variety of ages were examined histologically. Cartilage canals, bringing blood vessels and mesenchymal cells from perichondrium to the depths of the cartilage model to mediate ossification, are found early in fetal life and disappear when ossification is complete at about 24 weeks. The otic capsule is formed of chondro-osseous canals, which are composed of trabeculae of mineralized cartilage lacunae containing mesenchymal cells that undergo ossification (globuli ossei); also Volkmann's canals (like Haversian canals in long bones but multidirectional), which are produced from osteoblasts. The lumina of the latter frequently link up with chondro-osseous canals. Lamellar bone forms the background of the otic capsule. The fissula ante fenestram is present from early in the cartilage model and then throughout life. It appears to mediate bone production and the new formation of chondro-osseous channels and Volkmann's canals. The internal layer of

  7. A novel motion tracking system for evaluation of functional rehabilitation of the upper limbs.

    Science.gov (United States)

    Gil-Agudo, Angel; de Los Reyes-Guzmán, Ana; Dimbwadyo-Terrer, Iris; Peñasco-Martín, Benito; Bernal-Sahún, Alberto; López-Monteagudo, Patricia; Del Ama-Espinosa, Antonio; Pons, José Luis

    2013-07-05

    Upper limb function impairment is one of the most common sequelae of central nervous system injury, especially in stroke patients and when spinal cord injury produces tetraplegia. Conventional assessment methods cannot provide objective evaluation of patient performance and the tiveness of therapies. The most common assessment tools are based on rating scales, which are inefficient when measuring small changes and can yield subjective bias. In this study, we designed an inertial sensor-based monitoring system composed of five sensors to measure and analyze the complex movements of the upper limbs, which are common in activities of daily living. We developed a kinematic model with nine degrees of freedom to analyze upper limb and head movements in three dimensions. This system was then validated using a commercial optoelectronic system. These findings suggest that an inertial sensor-based motion tracking system can be used in patients who have upper limb impairment through data integration with a virtual reality-based neuroretation system.

  8. Realization of Intelligent Measurement and Control System for Limb Rehabilitation Based on PLC and Touch Screen

    Science.gov (United States)

    Liu, Xiangquan

    According to the treatment needs of patients with limb movement disorder, on the basis of the limb rehabilitative training prototype, function of measure and control system are analyzed, design of system hardware and software is completed. The touch screen which is adopt as host computer and man-machine interaction window is responsible for sending commands and training information display; The PLC which is adopt as slave computer is responsible for receiving control command from touch screen, collecting the sensor data, regulating torque and speed of motor by analog output according to the different training mode, realizing ultimately active and passive training for limb rehabilitation therapy.

  9. Peripheral nervous system origin of phantom limb pain.

    Science.gov (United States)

    Vaso, Apostol; Adahan, Haim-Moshe; Gjika, Artan; Zahaj, Skerdi; Zhurda, Tefik; Vyshka, Gentian; Devor, Marshall

    2014-07-01

    Nearly all amputees continue to feel their missing limb as if it still existed, and many experience chronic phantom limb pain (PLP). What is the origin of these sensations? There is currently a broad consensus among investigators that PLP is a top-down phenomenon, triggered by loss of sensory input and caused by maladaptive cortical plasticity. We tested the alternative hypothesis that PLP is primarily a bottom-up process, due not to the loss of input but rather to exaggerated input, generated ectopically in axotomized primary afferent neurons in the dorsal root ganglia (DRGs) that used to innervate the limb. In 31 amputees, the local anesthetic lidocaine was applied intrathecally and/or to the DRG surface (intraforaminal epidural block). This rapidly and reversibly extinguished PLP and also nonpainful phantom limb sensation (npPLS). Control injections were ineffective. For intraforaminal block, the effect was topographically appropriate. The suppression of PLP and npPLS could also be demonstrated using dilute lidocaine concentrations that are sufficient to suppress DRG ectopia but not to block the propagation of impulses generated further distally in the nerve. PLP is driven primarily by activity generated within the DRG. We recommend the DRG as a target for treatment of PLP and perhaps also other types of regional neuropathic pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  10. Performance of the efferent limb of a rapid response system

    DEFF Research Database (Denmark)

    Sørensen, Emilie M; Petersen, Asger

    2015-01-01

    AIM: To determine the distribution of outcomes following a medical emergency team (MET) call using a modified version of the multidisciplinary audit and evaluation of outcomes of rapid response (MAELOR) tool, and to evaluate its usefulness in monitoring the performance of the efferent limb...

  11. Ceruminal diffusion activities and ceruminolytic characteristics of otic preparations – an in-vitro study

    Science.gov (United States)

    2013-01-01

    Background An in-vitro setup was established in order to determine a) the diffusion activities of eight otic preparations (Aurizon®, Eas Otic®, Epi Otic®, Otifree®, Otomax®, Panolog®, Posatex®, Surolan®) through synthetic cerumen, and b) the ceruminolytic capacity and impregnation effects of these products. The main lipid classes of canine cerumen produced with moderate, non-purulent otitis externa were determined by thin layer chromatography and were subsequently used to produce a standardised synthetic cerumen (SCC). SCC was filled into capillary tubes, all of which were loaded with six commercially available multipurpose otic medications and two ear cleaners, each mixed with two markers in two experimental setups. These two marker compounds (Oil red O and marbofloxacin) were chosen, since they exhibit different physicochemical drug characteristics by which it is possible to determine and verify the diffusion activity of different types of liquids (i.e. the otic preparations). A synthetic cerumen described in the literature (JSL) was also used for comparison as its lipid composition was different to SCC. The diffusion activities of the otic preparations through both types of synthetic cerumen were studied over 24 hours. A second in-vitro experiment determined both the ceruminolytic activity and impregnation effect of the otic preparations by comparing the weight loss or weight gain after repeated incubation of JSL. Results Canine cerumen is mainly composed of triglycerides, sterol esters, fatty acid esters and squalene. The diffusion experiments showed a high diffusion efficacy along with a high impregnation effect for one test product. All the other products exhibited a lower diffusion activity with a mild to moderate impregnation effect. A mild ceruminolytic activity was observed for the two ear cleaners but not for any of the otic medications. Conclusions The present study demonstrates that there are significant differences in the diffusion

  12. Development and evaluation of new coupling system for lower limb prostheses with acoustic alarm system.

    Science.gov (United States)

    Eshraghi, Arezoo; Osman, Noor Azuan Abu; Gholizadeh, Hossein; Ahmadian, Jalil; Rahmati, Bizhan; Abas, Wan Abu Bakar Wan

    2013-01-01

    Individuals with lower limb amputation need a secure suspension system for their prosthetic devices. A new coupling system was developed that is capable of suspending the prosthesis. The system's safety is ensured through an acoustic alarm system. This article explains how the system works and provides an in vivo evaluation of the device with regard to pistoning during walking. The system was designed to be used with silicone liners and is based on the requirements of prosthetic suspension systems. Mechanical testing was performed using a universal testing machine. The pistoning during walking was measured using a motion analysis system. The new coupling device produced significantly less pistoning compared to a common suspension system (pin/lock). The safety alarm system would buzz if the suspension was going to fail. The new coupling system could securely suspend the prostheses in transtibial amputees and produced less vertical movement than the pin/lock system.

  13. A novel etiology for pneumolabyrinth after temporal bone fracture without otic capsule involvement.

    Science.gov (United States)

    Muelleman, Thomas J; Bhalla, Vidur; Staecker, Hinrich

    2017-01-01

    Pneumolabyrinth has been considered an indicator of otic capsule involvement in temporal bone fractures. We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth. Our patient experienced transient bilateral pneumolabyrinth after head trauma due to a motor vehicle collision. The patient was noted to have extensive pneumocephalus and a unilateral temporal bone fracture that spared the otic capsule. Initial computed tomography (CT) scans demonstrated air in the cochlea and both internal auditory canals. A high-resolution CT scan 6 hours later showed resolution of this air. Pneumolabyrinth may not be a sensitive indicator of otic capsule involvement in temporal bone fractures. In addition to middle ear sources, air in the labyrinth can also plausibly originate intrathecally, especially in the setting of pneumocephalus.

  14. AKT signaling mediates IGF-I survival actions on otic neural progenitors.

    Directory of Open Access Journals (Sweden)

    Maria R Aburto

    Full Text Available BACKGROUND: Otic neurons and sensory cells derive from common progenitors whose transition into mature cells requires the coordination of cell survival, proliferation and differentiation programmes. Neurotrophic support and survival of post-mitotic otic neurons have been intensively studied, but the bases underlying the regulation of programmed cell death in immature proliferative otic neuroblasts remains poorly understood. The protein kinase AKT acts as a node, playing a critical role in controlling cell survival and cell cycle progression. AKT is activated by trophic factors, including insulin-like growth factor I (IGF-I, through the generation of the lipidic second messenger phosphatidylinositol 3-phosphate by phosphatidylinositol 3-kinase (PI3K. Here we have investigated the role of IGF-dependent activation of the PI3K-AKT pathway in maintenance of otic neuroblasts. METHODOLOGY/PRINCIPAL FINDINGS: By using a combination of organotypic cultures of chicken (Gallus gallus otic vesicles and acoustic-vestibular ganglia, Western blotting, immunohistochemistry and in situ hybridization, we show that IGF-I-activation of AKT protects neural progenitors from programmed cell death. IGF-I maintains otic neuroblasts in an undifferentiated and proliferative state, which is characterised by the upregulation of the forkhead box M1 (FoxM1 transcription factor. By contrast, our results indicate that post-mitotic p27(Kip-positive neurons become IGF-I independent as they extend their neuronal processes. Neurons gradually reduce their expression of the Igf1r, while they increase that of the neurotrophin receptor, TrkC. CONCLUSIONS/SIGNIFICANCE: Proliferative otic neuroblasts are dependent on the activation of the PI3K-AKT pathway by IGF-I for survival during the otic neuronal progenitor phase of early inner ear development.

  15. Induction of the inner ear: stepwise specification of otic fate from multipotent progenitors.

    Science.gov (United States)

    Chen, Jingchen; Streit, Andrea

    2013-03-01

    Despite its complexity in the adult, during development the inner ear arises from a simple epithelium, the otic placode. Placode specification is a multistep process that involves the integration of various signalling pathways and downstream transcription factors in time and space. Here we review the molecular events that successively commit multipotent ectodermal precursors to the otic lineage. The first step in this hierarchy is the specification of sensory progenitor cells, which can contribute to all sensory placodes, followed by the induction of a common otic-epibranchial field and finally the establishment the otic territory. In recent years, some of the molecular components that control this process have been identified, and begin to reveal complex interactions. Future studies will need to unravel how this information is integrated and encoded in the genome. This will form the blueprint for stem cell differentiation towards otic fates and generate a predictive gene regulatory network that models the earliest steps of otic specification. Copyright © 2012 Elsevier B.V. All rights reserved.

  16. An Affordable Virtual Reality System for Treatment of Phantom Limb Pain

    DEFF Research Database (Denmark)

    Henriksen, Bartal; Nielsen, Ronni Nedergaard; Szabo, Laszlo

    2016-01-01

    This paper describes the implementation of an affordable phantom limb pain (PLP) home treatment system using virtual reality (VR) and a motion sensor to immerse the users in a virtual environment (VE). The work is inspired by mirror therapy (MT) which is used to treat patients with PLP. This proj......This paper describes the implementation of an affordable phantom limb pain (PLP) home treatment system using virtual reality (VR) and a motion sensor to immerse the users in a virtual environment (VE). The work is inspired by mirror therapy (MT) which is used to treat patients with PLP...

  17. MANAGEMENT OF INFECTED NON-UNION OF LONG BONES WITH LIMB RE-CONSTRUCTION SYSTEM

    Directory of Open Access Journals (Sweden)

    Girish Kumar

    2015-12-01

    Full Text Available BACKGROUND: CONTEXT: Infected nonunion of long bones are a great challenge to treating surgeons. Various factors such as devitalisation of bone, soft tissue scarring, deformity, limb length discrepancy, joint stiffness and secondary osteoporosis need to be addressed along with financial constraints and compliance in management of such situations to choose appropriate treatment. Limb reconstruction system provides single stage, easy to construct and less cumbersome option to the patient. PURPOSE To evaluate safety and efficacy of limb reconstruction system in management of infected nonunion of long bones. STUDY DESIGN/SETTING Retrospective study. METHODS Thirteen patients with infected nonunion of long bones (tibia-8 cases and femur-5 cases were operated using limb reconstruction system. There were 11 males and 2 females. The average age was 35 years (range 21-50 years. All cases had established nonunion for at least 6 months with evidence of infection. The infection was active in 8 patients and non-draining in 5 patients. Ilizarov study group ASAMI score was used for bone results and functional results. Complications assessed as per Paley classification. RESULTS The mean time for union was 9.8 months (7-12 months. The mean follow up after LRS removal was 35.2 months (range 24- 44 months. Two cases had angulation of about 8 degrees (femur and remaining cases did not have any angulation. Infection was eradicated in all cases. Functional outcome was excellent in five patients and eight good in patients. Bone outcome was excellent eleven patients and good in two patients. CONCLUSIONS Limb reconstruction system is a safe and effective tool for simultaneous correction of limb length discrepancy; achieve union and infection control in a single stage. It is easy to perform with reliable results and less complications.

  18. Monitoring system for isolated limb perfusion based on a portable gamma camera

    Energy Technology Data Exchange (ETDEWEB)

    Orero, A.; Muxi, A.; Rubi, S.; Duch, J. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); Vidal-Sicart, S.; Pons, F. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); Inst. d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Red Tematica de Investigacion Cooperativa en Cancer (RTICC), Barcelona (Spain); Roe, N. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); CIBER de Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona (Spain); Rull, R. [Servei de Cirurgia, Hospital Clinic, Barcelona (Spain); Pavon, N. [Inst. de Fisica Corpuscular, CSIC - UV, Valencia (Spain); Pavia, J. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); Inst. d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); CIBER de Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona (Spain)

    2009-07-01

    Background: The treatment of malignant melanoma or sarcomas on a limb using extremity perfusion with tumour necrosis factor (TNF-{alpha}) and melphalan can result in a high degree of systemic toxicity if there is any leakage from the isolated blood territory of the limb into the systemic vascular territory. Leakage is currently controlled by using radiotracers and heavy external probes in a procedure that requires continuous manual calculations. The aim of this work was to develop a light, easily transportable system to monitor limb perfusion leakage by controlling systemic blood pool radioactivity with a portable gamma camera adapted for intraoperative use as an external probe, and to initiate its application in the treatment of MM patients. Methods: A special collimator was built for maximal sensitivity. Software for acquisition and data processing in real time was developed. After testing the adequacy of the system, it was used to monitor limb perfusion leakage in 16 patients with malignant melanoma to be treated with perfusion of TNF-{alpha} and melphalan. Results: The field of view of the detector system was 13.8 cm, which is appropriate for the monitoring, since the area to be controlled was the precordial zone. The sensitivity of the system was 257 cps/MBq. When the percentage of leakage reaches 10% the associated absolute error is {+-}1%. After a mean follow-up period of 12 months, no patients have shown any significant or lasting side-effects. Partial or complete remission of lesions was seen in 9 out of 16 patients (56%) after HILP with TNF-{alpha} and melphalan. Conclusion: The detector system together with specially developed software provides a suitable automatic continuous monitoring system of any leakage that may occur during limb perfusion. This technique has been successfully implemented in patients for whom perfusion with TNF-{alpha} and melphalan has been indicated. (orig.)

  19. Endovascular treatment of a chronically occluded limb of endograft with combination TNK pharmacological and EKOS thrombolytic catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Stambo, Glenn W., E-mail: xraydoc2@yahoo.co [SDI Radiologists, Department of Vascular and Interventional Radiology, St. Joseph' s Hospital and Medical Center, 4516 N. Armenia Ave., Tamp, FL 33603 (United States); Gabriel, Yves [Department of Vascular Surgery, St Joseph' s Hospital and Medical Center, 4516 N. Armenia Ave., Tamp, FL 33603 (United States)

    2011-02-15

    Arterial occlusion is a common and sometimes devastating medical condition related to peripheral vascular and cardiovascular disease. These patients are at severe risk of limb loss and death. Those patients with embolic phenomena are at significantly higher mortality risk than those with thrombosis. Catheter directed therapies have been used routinely for restoration of perfusion to a limb removing the thrombosis or embolic material. Limb thrombosis following endovascular graft placement is a known complication occurring within the first year of the endograft. In many institutions, endovascular treatment of aortic limb occlusions has become the initial management for acute occlusions. We describe the endovascular treatment of a chronic occluded limb utilizing a combination of pharmacological and mechanical thrombolysis using the new ultrasound enhanced EKOS catheter system. Endovascular specialists should be aware that chronically occluded endograft limbs can be successfully treated in the endovascular suite with the EKOS system without requiring more invasive surgical therapies.

  20. A Virtual Reality System for Treatment of Phantom Limb Pain using Game Training and Motion Tracking

    DEFF Research Database (Denmark)

    Henriksen, Bartal; Nielsen, Ronni Nedergaard; Szabo, Laszlo

    2016-01-01

    This paper describes the implementation of a phantom limb pain (PLP) home-based system using virtual reality (VR) and a motion sensor to immerse the users in a virtual environment (VE). The work is inspired by mirror therapy (MT), which has been used to relieve PLP. The target patient group focuses...

  1. Development of an EMG-ACC-Based Upper Limb Rehabilitation Training System.

    Science.gov (United States)

    Ling Liu; Xiang Chen; Zhiyuan Lu; Shuai Cao; De Wu; Xu Zhang

    2017-03-01

    This paper focuses on the development of an upper limb rehabilitation training system designed for use by children with cerebral palsy (CP). It attempts to meet the requirements of in-home training by taking advantage of the combination of portable accelerometers (ACC) and surface electromyography (SEMG) sensors worn on the upper limb to capture functional movements. In the proposed system, the EMG-ACC acquisition device works essentially as wireless game controller, and three rehabilitation games were designed for improving upper limb motor function under a clinician's guidance. The games were developed on the Android platform based on a physical engine called Box2D. The results of a system performance test demonstrated that the developed games can respond to the upper limb actions within 210 ms. Positive questionnaire feedbacks from twenty CP subjects who participated in the game test verified both the feasibility and usability of the system. Results of a long-term game training conducted with three CP subjects demonstrated that CP patients could improve in their game performance through repetitive training, and persistent training was needed to improve and enhance the rehabilitation effect. According to our experimental results, the novel multi-feedback SEMG-ACC-based user interface improved the users' initiative and performance in rehabilitation training.

  2. Prevalence, size and distribution of microdamage in the human otic capsule

    DEFF Research Database (Denmark)

    Frisch, Thomas; Bloch, Sune Land; Sørensen, Mads Sølvsten

    2015-01-01

    CONCLUSIONS: Age-dependent microdamage (MDx) accumulates excessively in human perilabyrinthine bone, where the bone turnover is almost absent. This may have pathological implications for bone-specific disorders such as otosclerosis. The role of MDx accumulation is discussed from an osteodynamic...... perspective. OBJECTIVES: Bone remodelling is highly inhibited within the otic capsule compared with the rest of the skeleton. Consequently excessive accumulation of age-dependent capsular MDx is expected. This study describes the prevalence, size and topographical distribution of MDx in the human otic capsule...... constant with age. There was no statistically significant sex difference....

  3. NeXOS - The design, development and evaluation of a rehabilitation system for the lower limbs

    OpenAIRE

    BRADLEY, DAVID; Acosta-Marquez, C.; Hawley, Mark; Brownsell, Simon; Enderby, Pam; Mawson, S

    2009-01-01

    Recent years have seen the development of a number of automated and semi-automated systems to support physiotherapy and rehabilitation. These deploy a range of technologies from highly complex purpose built systems to approaches based around the use of industrial robots operating either individually or in combination for applications ranging from stroke rehabilitation to mobility enhancement. The NeXOS project set out to investigate an approach to the rehabilitation of the lower limbs in a wa...

  4. Restoring movement representation and alleviating phantom limb pain through short-term neurorehabilitation with a virtual reality system.

    Science.gov (United States)

    Osumi, M; Ichinose, A; Sumitani, M; Wake, N; Sano, Y; Yozu, A; Kumagaya, S; Kuniyoshi, Y; Morioka, S

    2017-01-01

    We developed a quantitative method to measure movement representations of a phantom upper limb using a bimanual circle-line coordination task (BCT). We investigated whether short-term neurorehabilitation with a virtual reality (VR) system would restore voluntary movement representations and alleviate phantom limb pain (PLP). Eight PLP patients were enrolled. In the BCT, they repeatedly drew vertical lines using the intact hand and intended to draw circles using the phantom limb. Drawing circles mentally using the phantom limb led to the emergence of an oval transfiguration of the vertical lines ('bimanual-coupling' effect). We quantitatively measured the degree of this bimanual-coupling effect as movement representations of the phantom limb before and immediately after short-term VR neurorehabilitation. This was achieved using an 11-point numerical rating scale (NRS) for PLP intensity and the Short-Form McGill Pain Questionnaire (SF-MPQ). During VR neurorehabilitation, patients wore a head-mounted display that showed a mirror-reversed computer graphic image of an intact arm (the virtual phantom limb). By intending to move both limbs simultaneously and similarly, the patients perceived voluntary execution of movement in their phantom limb. Short-term VR neurorehabilitation promptly restored voluntary movement representations in the BCT and alleviated PLP (NRS: p = 0.015; 39.1 ± 28.4% relief, SF-MPQ: p = 0.015; 61.5 ± 48.5% relief). Restoration of phantom limb movement representations and reduced PLP intensity were linearly correlated (p phantom limb and subsequently have a potent analgesic effect. There was no objective evidence that restoring movement representation by neurorehabilitation with virtual reality alleviated phantom limb pain. This study revealed quantitatively that restoring movement representation with virtual reality rehabilitation using a bimanual coordination task correlated with alleviation of phantom limb pain. © 2016 European Pain

  5. Upper limb training/assessment program using passive force controllable rehabilitation system.

    Science.gov (United States)

    Kikuchi, Takehito; Sato, Chihiro; Yamabe, Kazuki; Abe, Isao; Ohno, Tetsuya; Kugimiya, Shintaro; Inoue, Akio

    2017-07-01

    Upper limb rehabilitation training for Hemiplegie patients has been conducted mainly by human therapists. Training methods and conditions depend strongly on their experience because of the wide range of individual differences between patients. The force control and sensing functions of rehabilitation robots are expected to be used for the qualitative assessment of next-generation computational rehabilitation. In this study, we developed a simple exercise machine for upper limbs (SEMUL) using an electro-rheological fluid brake, as a safe brake-type robotic rehabilitation system. We also developed a new upper limb training/assessment program, called "WIPE," for the SEMUL. Furthermore, we conducted clinical tests on twelve subjects (six each for the SEMUL training and for general training). We adopted the ABA design methodology for the clinical research tests. The motor functions of upper limbs were assessed using five clinical scores: Fugl-Meyer Assessment (FMA), Brunnstrome recovery stage, Simple Test for Evaluating Hand Function (STEF), Stroke Impairment Assessment Set (SIAS), and Motor Activity Log. Improvements of the FMA, STEF, and SIAS in the SEMUL training groups were found to be higher than those in the general training groups.

  6. Acute Effect of Static Stretching on Lower Limb Movement Performance by Using STABL Virtual Reality System.

    Science.gov (United States)

    Ameer, Mariam A; Muaidi, Qassim I

    2017-07-17

    The effect of acute static stretch (ASS) on the lower limb RT has been recently questioned to decrease the risk of falling and injuries in situations requiring a rapid reaction, as in the cases of balance disturbance. The main purpose of this study was to detect the effect of ASS on the lower limb RT by using virtual reality device. Two Group Control Group design. Research laboratory. The control and experimental groups were formed randomly from sixty female university students. Each participant in the experimental group was tested before and after ASS for the quadriceps, hamstrings and planter flexor muscles, and compared with the control group with warming-up exercise only. The stretching program involved warming-up in the form of circular running inside the lab for 5 minutes followed by stretching of each muscle group thrice, to the limit of discomfort of 45 s, with resting period of 15s between stretches. The measurements included the RT of the dominant lower extremity by using the dynamic stability program, STABL Virtual Reality System (Model No. DIZ 2709, Motek Medical and Force Link Merged Co., Amsterdam). There was statistically significant reduction (F = 162, P= .00) in post-test RT between the two groups, and significant decrease in RT after stretching, in the experimental group (7.5%) (P= .00). ASS of the lower limb muscles tends to decrease the lower limb RT and improve movement performance.

  7. Motion planning of mobile multi-limb robotic systems subject to force and friction constraints

    Science.gov (United States)

    Madhani, Akhil; Dubowsky, Steven

    1992-01-01

    A method is presented to generate motions for a class of multilimb robotic systems enabling them to apply large static forces over large ranges of motion without saturating actuator effort limits, system-environment friction constraints, kinematic joint limits, or geometric workspace obstacles. The approach, termed the force-workspace (FW) approach, maps these constraints into the system C-space to form constraint obstacles using a recursive subdivision process. To generate motions along which actuator efforts can be specified without violating system constraints, paths are planned that avoid these constraint obstacles. The method permits the shape of the paths to be controlled using any configuration-dependent performance criterion. The FW approach was applied to a proposed three-limb planar climbing robot whose task is to climb upwards between two vertical walls by pushing outwards to generate frictional support. Motions were planned automatically within the system FW, enabling it to lift itself upwards using two limbs at a time, and a gait was planned to enable it to switch limbs and climb continuously.

  8. Development of rehabilitation training support system for occupational therapy of upper limb motor function

    Science.gov (United States)

    Morita, Yoshifumi; Hirose, Akinori; Uno, Takashi; Uchid, Masaki; Ukai, Hiroyuki; Matsui, Nobuyuki

    2007-12-01

    In this paper we propose a new rehabilitation training support system for upper limbs. The proposed system enables therapists to quantitatively evaluate the therapeutic effect of upper limb motor function during training, to easily change the load of resistance of training and to easily develop a new training program suitable for the subjects. For this purpose we develop control algorithms of training programs in the 3D force display robot. The 3D force display robot has parallel link mechanism with three motors. The control algorithm simulating sanding training is developed for the 3D force display robot. Moreover the teaching/training function algorithm is developed. It enables the therapists to easily make training trajectory suitable for subject's condition. The effectiveness of the developed control algorithms is verified by experiments.

  9. Synovial distribution of ?systemically? administered acetylsalicylic acid in the isolated perfused equine distal limb

    OpenAIRE

    Friebe, Maren; Schumacher, Stephan; Stahl, Jessica; Kietzmann, Manfred

    2013-01-01

    Background This study investigated synovial concentrations of acetylsalicylic acid (ASA) and its metabolite salicylic acid (SA) in the equine fetlock joint following systemic administration of ASA. Salicylates were chosen because SA is the only nonsteroidal anti-inflammatory drug for which threshold levels exist for plasma and urine in equine sports. To avoid animal experiments, the study was conducted using an ex vivo model of the isolated perfused equine distal limb in combination with plas...

  10. PCR amplification and DNA sequencing of Demodex injai from otic secretions of a dog.

    Science.gov (United States)

    Milosevic, Milivoj A; Frank, Linda A; Brahmbhatt, Rupal A; Kania, Stephen A

    2013-04-01

    The identification of Demodex mites from dogs is usually based on morphology and location. Mites with uncharacteristic features or from unusual locations, hosts or disease manifestations could represent new species not previously described; however, this is difficult to determine based on morphology alone. The goal of this study was to identify and confirm Demodex injai in association with otitis externa in a dog using PCR amplification and DNA sequencing. Otic samples were obtained from a beagle in which a long-bodied Demodex mite was identified. For comparison, Demodex mite samples were collected from a swab and scraping of the dorsal skin of a wire-haired fox terrier and an otic sample from a dog with generalized and otic demodicosis. To identify the Demodex mite, DNA was extracted, and 16S rRNA was amplified by PCR, sequenced and compared with Demodex sequences available in public databases and from separate samples morphologically diagnosed as D. injai and Demodex canis. PCR amplification of the long-bodied mite rRNA DNA obtained from otic samples was approximately 330 bp and was identical to that from the mite morphologically identified as D. injai obtained from the dorsal skin of a dog. Furthermore, the examined mite did not have any significant homology to any of the reported genes from Demodex spp. These results confirmed that the demodex mites in this case were D. injai. © 2013 The Authors. Veterinary Dermatology © 2013 ESVD and ACVD.

  11. A 10-year review of otic lichen planus: the Mayo Clinic experience.

    Science.gov (United States)

    Sartori-Valinotti, Julio C; Bruce, Alison J; Krotova Khan, Yulia; Beatty, Charles W

    2013-09-01

    Lichen planus is an autoimmune inflammatory dermatosis that typically affects the skin but can also involve the stratified squamous epithelium of the external auditory canals and tympanic membranes. Here we report our experience with the clinical presentation, diagnosis, and management of otic lichen planus. We retrospectively reviewed medical records from January 1, 2001, through May 31, 2011, of patients with a diagnosis of otic lichen planus. Nineteen cases were identified (mean age at diagnosis, 57 years; 15 women). The most common concerns were persistent otorrhea and hearing loss. Other symptoms included plugging, pruritus, tinnitus, pain, and bleeding. The mean symptom duration was 4.0 years (n = 13). Most patients responded well to topical tacrolimus within several months. One patient had a dramatic positive response to rituximab. Otic lichen planus can lead to persistent hearing loss and should be considered in the differential diagnosis of relentless otorrhea and external auditory canal stenosis. In our experience, topical tacrolimus is the best primary treatment, but alternative therapies could be instituted in severe cases. Early recognition of the nonspecific symptoms of otic lichen planus may lead to prompt treatment and avoidance of irreparable late sequelae.

  12. Determination of ototoxicity of common otic drops using isolated cochlear outer hair cells.

    Science.gov (United States)

    Jinn, T H; Kim, P D; Russell, P T; Church, C A; John, E O; Jung, T T

    2001-12-01

    Otic drops are commonly used not only for otitis externa, but also for otorrhea in the presence of tympanostomy tubes or tympanic membrane perforations. Many studies have demonstrated the ototoxicity of common otic preparations such as Cortisporin otic drops (Monarch Pharmaceuticals, Bristol, TN). The purpose of this study was to assess the relative ototoxicity of common otic preparations by direct exposure to isolated cochlear outer hair cells (OHCs). OHCs from adult chinchilla cochlea were exposed to standard bathing solution (control), acetic acid, Acetasol HC (Alpharma USPD Inc., Baltimore, MD), Gentacidin (CIBA Vision Ophthalmics, Atlanta, GA), and Tobradex (Alcon, Fort Worth, TX). The cells were observed using an inverted microscope, and the images were recorded in digital still-frame and video, and analyzed on the Image Pro-Plus 3.0 program (Media Cybernetics, Silver Spring, MD). As measured by time to cell death and change in morphology of OHCs, acetic acid with or without hydrocortisone was most toxic to OHCs. Cortisporin was more cytotoxic than gentamicin and Tobradex.

  13. Effects of common topical otic preparations on the morphology of isolated cochlear outer hair cells.

    Science.gov (United States)

    Russell, P T; Church, C A; Jinn, T H; Kim, D J; John, E O; Jung, T T

    2001-01-01

    Otic drops are commonly used not only for otitis externa but also for otorrhea in the presence of tympanostomy tube or tympanic membrane perforation. Many studies have demonstrated the ototoxicity of common otic preparations such as Cortisporin otic drops. Recent studies have suggested the use of fluoroquinolone antibiotic drops as an alternative owing to their excellent antimicrobial coverage and no ototoxic effect. The purpose of this study was to assess the relative ototoxicity of four common otic preparations by direct exposure to isolated cochlear outer hair cells (OHCs). OHCs from adult chinchilla cochlea were exposed to standard bathing solution (control), Cortisporin, Cipro HC, Ciloxan, and Floxin. The cells were observed using an inverted microscope, and the images recorded in digital still-frame and video, and analyzed on the Image Pro-Plus 3.0 program. As measured by time to cell death and change in morphology of OHCs, Cortisporin was most toxic to OHCs. Among the fluoroquinolone drops, Floxin was more toxic than Ciloxan or Cipro HC.

  14. 21 CFR 524.1044b - Gentamicin sulfate, betamethasone valerate otic solution.

    Science.gov (United States)

    2010-04-01

    ... solution. 524.1044b Section 524.1044b Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... NEW ANIMAL DRUGS § 524.1044b Gentamicin sulfate, betamethasone valerate otic solution. (a) Specifications. Each milliliter of solution contains gentamicin sulfate equivalent to 3 milligrams (mg...

  15. 21 CFR 524.981e - Fluocinolone acetonide, dimethyl sulfoxide otic solution.

    Science.gov (United States)

    2010-04-01

    ... solution. 524.981e Section 524.981e Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... NEW ANIMAL DRUGS § 524.981e Fluocinolone acetonide, dimethyl sulfoxide otic solution. (a) Specifications. Each milliliter of solution contains 0.01 percent of fluocinolone acetonide in 60 percent...

  16. 21 CFR 524.1484k - Neomycin sulfate, prednisolone, tetracaine, and squalane topical-otic suspension.

    Science.gov (United States)

    2010-04-01

    ... squalane topical-otic suspension. 524.1484k Section 524.1484k Food and Drugs FOOD AND DRUG ADMINISTRATION... TOPICAL DOSAGE FORM NEW ANIMAL DRUGS § 524.1484k Neomycin sulfate, prednisolone, tetracaine, and squalane..., and 0.25 milliliter squalane. (b) Sponsor. See 017030 in § 510.600(c) of this chapter. (c) Conditions...

  17. Diagnosis abnormalities of limb movement in disorders of the nervous system

    Science.gov (United States)

    Tymchik, Gregory S.; Skytsiouk, Volodymyr I.; Klotchko, Tatiana R.; Bezsmertna, Halyna; Wójcik, Waldemar; Luganskaya, Saule; Orazbekov, Zhassulan; Iskakova, Aigul

    2017-08-01

    The paper deals with important issues of diagnosis early signs of diseases of the nervous system, including Parkinson's disease and other specific diseases. Small quantities of violation trajectory of spatial movement of the extremities of human disease at the primary level as the most appropriate features are studied. In modern medical practice is very actual the control the emergence of diseases of the nervous system, including Parkinson's disease. In work a model limbs with six rotational kinematic pairs for diagnosis of early signs of diseases of the nervous system is considered. subject.

  18. Towards an IoT-based upper limb rehabilitation assessment system.

    Science.gov (United States)

    Yizhou Jiang; Yajie Qin; IkHwan Kim; Yuanyuan Wang

    2017-07-01

    Rehabilitation of stroke survivors has been increasing in importance in recent years with increase in the occurrence of stroke. However, current clinical classification assessment is time-consuming while the result is not accurate and varies across physicians. This paper introduces an IoT-based upper limb rehabilitation assessment system for stroke survivors based on wireless sensing sub-system, data cloud, computing cloud and software based on Android platform. The system can automatically perform objective assessment. It is designed for home rehabilitation as well as for the concept of graded rehabilitation therapy.

  19. Abnormal functioning of the thalamocortical system underlies the conscious awareness of the phantom limb phenomenon.

    Science.gov (United States)

    Romero-Romo, J I; Bauer, C C C; Pasaye, E H; Gutiérrez, R A; Favila, R; Barrios, F A

    2010-12-01

    Phantom limb (PL), a phenomenon experienced by most patients after amputation, has mostly served as a paradigm to study experiences that appear to be associated with neural plasticity within the CNS. However, the subjective nature of PL experiences has had no definitive means of reliable assessment other than using patients' direct reports, nor was there a way to study the neural mechanisms involved in the conscious awareness of this mental phenomenon. Here we obtained patients' indirect responses to PL experiences for an objective evaluation using functional magnetic resonance imaging (fMRI). Six control subjects and six lower limb (LL) amputees participated in a motor imagery task for both the intact and the particular phantom toes. While all subjects shared neural processing of distinctive regional cerebral activations during motor imagery of the intact toes (prefrontal (PF), supplementary motor area (SMA), primary motor cortex (M1), superior temporal gyrus (STG)), it was only during motor imagery of the amputated toes in amputees that we observed an increased blood oxygen level-dependent (BOLD) signal in the contralateral basal ganglia at the medial globus pallidus (MGP), substantia nigra (SN), and thalamus. This increased BOLD signal in the basal ganglia-thalamus-cortex pathway during imaginary movement of the phantom toes may reflect an abnormal open loop functioning of the thalamocortical system underlying the conscious awareness of the phantom phenomenon. We suggest that the reduction in afferent information contributes to and coalesces with the higher-level reorganization resulting in the subjective conscious awareness of the phantom limb.

  20. Update and validation of the Society for Vascular Surgery wound, ischemia, and foot infection threatened limb classification system.

    Science.gov (United States)

    Mills, Joseph L

    2014-03-01

    The diagnosis of critical limb ischemia, first defined in 1982, was intended to delineate a patient cohort with a threatened limb and at risk for amputation due to severe peripheral arterial disease. The influence of diabetes and its associated neuropathy on the pathogenesis-threatened limb was an excluded comorbidity, despite its known contribution to amputation risk. The Fontaine and Rutherford classifications of limb ischemia severity have also been used to predict amputation risk and the likelihood of tissue healing. The dramatic increase in the prevalence of diabetes mellitus and the expanding techniques of arterial revascularization has prompted modification of peripheral arterial disease classification schemes to improve outcomes analysis for patients with threatened limbs. The diabetic patient with foot ulceration and infection is at risk for limb loss, with abnormal arterial perfusion as only one determinant of outcome. The wound extent and severity of infection also impact the likelihood of limb loss. To better predict amputation risk, the Society for Vascular Surgery Lower Extremity Guidelines Committee developed a classification of the threatened lower extremity that reflects these important clinical considerations. Risk stratification is based on three major factors that impact amputation risk and clinical management: wound, ischemia, and foot infection. This classification scheme is relevant to the patient with critical limb ischemia because many are also diabetic. Implementation of the wound, ischemia, and foot infection classification system in critical limb ischemia patients is recommended and should assist the clinician in more meaningful analysis of outcomes for various forms of wound and arterial revascularizations procedures required in this challenging, patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Markov Jump Linear Systems-Based Position Estimation for Lower Limb Exoskeletons

    Directory of Open Access Journals (Sweden)

    Samuel L. Nogueira

    2014-01-01

    Full Text Available In this paper, we deal with Markov Jump Linear Systems-based filtering applied to robotic rehabilitation. The angular positions of an impedance-controlled exoskeleton, designed to help stroke and spinal cord injured patients during walking rehabilitation, are estimated. Standard position estimate approaches adopt Kalman filters (KF to improve the performance of inertial measurement units (IMUs based on individual link configurations. Consequently, for a multi-body system, like a lower limb exoskeleton, the inertial measurements of one link (e.g., the shank are not taken into account in other link position estimation (e.g., the foot. In this paper, we propose a collective modeling of all inertial sensors attached to the exoskeleton, combining them in a Markovian estimation model in order to get the best information from each sensor. In order to demonstrate the effectiveness of our approach, simulation results regarding a set of human footsteps, with four IMUs and three encoders attached to the lower limb exoskeleton, are presented. A comparative study between the Markovian estimation system and the standard one is performed considering a wide range of parametric uncertainties.

  2. Shape-memory alloy overload protection device for osseointegrated transfemoral implant prosthetic limb attachment system

    Science.gov (United States)

    Xu, Wei; Shao, Fei; Hughes, Steven

    2002-11-01

    The osseointegrated trans-femoral implant system provides a direct anchoring technique to attach prosthetic limb. This technique was first introduced PI Brenmark in Sweden. The UK had the first clinical trial in 1997 and currently has 6 active limb wearers. The success of this procedure has the potential for improved gait function and mobility, increased employability and significant long-term improvements in the quality of life for above knee amputees. However, the significant load involved in the trans-femoral implant system has caused permanent deformation and/or fractures of the implant abutment in several occasions. To protect the implant system, the implant abutment in particularly, an overloading protection device was introduced. The device uses mechanical mechanism to release torsion overload on the abutment. However, the bending overload protection remains unsolved. To solve the problem, a new overload protection device was developed. This device uses SMA component for bending overload protection. In this paper, the results of non-linear finite element modelling of the SMA and steel (AISI 1040) components were presented. Experiments were also carried out using steel components to assess the design which is based on the non-linear property of the materials.

  3. Hybrid robotic systems for upper limb rehabilitation after stroke: A review.

    Science.gov (United States)

    Resquín, Francisco; Cuesta Gómez, Alicia; Gonzalez-Vargas, Jose; Brunetti, Fernando; Torricelli, Diego; Molina Rueda, Francisco; Cano de la Cuerda, Roberto; Miangolarra, Juan Carlos; Pons, José Luis

    2016-11-01

    In recent years the combined use of functional electrical stimulation (FES) and robotic devices, called hybrid robotic rehabilitation systems, has emerged as a promising approach for rehabilitation of lower and upper limb motor functions. This paper presents a review of the state of the art of current hybrid robotic solutions for upper limb rehabilitation after stroke. For this aim, studies have been selected through a search using web databases: IEEE-Xplore, Scopus and PubMed. A total of 10 different hybrid robotic systems were identified, and they are presented in this paper. Selected systems are critically compared considering their technological components and aspects that form part of the hybrid robotic solution, the proposed control strategies that have been implemented, as well as the current technological challenges in this topic. Additionally, we will present and discuss the corresponding evidences on the effectiveness of these hybrid robotic therapies. The review also discusses the future trends in this field. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  4. Effect of an Otic Milbemycin Oxime Formulation on Tegastes acroporanus Infesting Corals.

    Science.gov (United States)

    Christie, Barrett L; Raines, Janis A

    2016-12-01

    The copepod Tegastes acroporanus is a notorious pest of captive corals in the genus Acropora. In recent years, infestations of T. acroporanus have become widespread among public aquaria and coral propagation facilities and have been largely controlled with the extra-label use of milbemycin oxime formulations (Carl 2008). Many of these drug formulations (which were intended for dogs) have been discontinued by their manufacturers in favor of multidrug products, many of which are unsuitable for corals, forcing experimentation with alternatives. This report provides the first data on populations of T. acroporanus treated with milbemycin oxime and documents the first known use of an otic solution, MilbeMite Otic (Novartis Animal Health U.S., Greensboro, North Carolina), against copepods on live corals. MilbeMite Otic was found to be soluble in seawater and successful at eradicating T. acroporanus in a large exhibit over the course of 6-h waterborne baths (n = 12) at 0.167 µg/L. The resident population of T. acroporanus was also quantified before each treatment to provide the first estimates of coral parasite burden in response to the application of a waterborne chemotherapeutic agent. Received November 19, 2015; accepted June 7, 2016 Published online October 24, 2016.

  5. Clinical features and radiological evaluation of otic capsule sparing temporal bone fractures.

    Science.gov (United States)

    Song, S W; Jun, B C; Kim, H

    2017-03-01

    To evaluate the clinical and radiological aspects of otic capsule sparing temporal bone fractures. Using medical records, 188 temporal bones of 173 patients with otic capsule sparing temporal bone fractures were evaluated. Otoscopic findings and symptoms, facial paralysis, and hearing loss were assessed. Using regional analysis, 7 fractures were classified as type I, 85 as type II, 169 as type III and 114 as type IV. Fourteen of the 17 facial paralysis cases improved to House-Brackmann grade II or lower at an average of 57.6 days after the initial evaluation. Thirty-one patients underwent initial and follow-up pure tone audiometry examinations. The air-bone gap closed significantly from 27.2 dB at an average of 21.8 days post-trauma to 19.6 dB at an average of 79.9 days post-trauma, without the need for surgical intervention. Initial conservative treatment for facial paralysis or conductive hearing loss is possible in otic capsule sparing fracture cases after careful evaluation of the patient.

  6. A Mobile Motion Analysis System Using Intertial Sensors for Analysis of Lower Limb Prosthetics

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, John Kyle P [ORNL; Ericson, Milton Nance [ORNL; Farquhar, Ethan [ORNL; Lind, Randall F [ORNL; Evans III, Boyd Mccutchen [ORNL

    2011-01-01

    Soldiers returning from the global war on terror requiring lower leg prosthetics generally have different concerns and requirements than the typical lower leg amputee. These subjects are usually young, wish to remain active and often desire to return to active military duty. As such, they demand higher performance from their prosthetics, but are at risk for chronic injury and joint conditions in their unaffected limb. Motion analysis is a valuable tool in assessing the performance of new and existing prosthetic technologies as well as the methods in fitting these devices to both maximize performance and minimize risk of injury for the individual soldier. We are developing a mobile, low-cost motion analysis system using inertial measurement units (IMUs) and two custom force sensors that detect ground reaction forces and moments on both the unaffected limb and prosthesis. IMUs were tested on a robot programmed to simulate human gait motion. An algorithm which uses a kinematic model of the robot and an extended Kalman filter (EKF) was used to convert the rates and accelerations from the gyro and accelerometer into joint angles. Compared to encoder data from the robot, which was considered the ground truth in this experiment, the inertial measurement system had a RMSE of <1.0 degree. Collecting kinematic and kinetic data without the restrictions and expense of a motion analysis lab could help researchers, designers and prosthetists advance prosthesis technology and customize devices for individuals. Ultimately, these improvements will result in better prosthetic performance for the military population.

  7. Limb regeneration.

    Science.gov (United States)

    Simon, András; Tanaka, Elly M

    2013-01-01

    Limb regeneration is observed in certain members of the animal phyla. Some animals keep this ability during their entire life while others lose it at some time during development. How do animals regenerate limbs? Is it possible to find unifying, conserved mechanisms of limb regeneration or have different species evolved distinct means of replacing a lost limb? How is limb regeneration similar or different to limb development? Studies on many organisms, including echinoderms, arthropods, and chordates have provided significant knowledge about limb regeneration. In this focus article, we concentrate on tetrapod limb regeneration as studied in three model amphibians: newts, axolotls, and frogs. We review recent progress on tissue interactions during limb regeneration, and place those findings into an evolutionary context. Copyright © 2012 Wiley Periodicals, Inc.

  8. A lower limb exoskeleton control system based on steady state visual evoked potentials

    Science.gov (United States)

    Kwak, No-Sang; Müller, Klaus-Robert; Lee, Seong-Whan

    2015-10-01

    Objective. We have developed an asynchronous brain-machine interface (BMI)-based lower limb exoskeleton control system based on steady-state visual evoked potentials (SSVEPs). Approach. By decoding electroencephalography signals in real-time, users are able to walk forward, turn right, turn left, sit, and stand while wearing the exoskeleton. SSVEP stimulation is implemented with a visual stimulation unit, consisting of five light emitting diodes fixed to the exoskeleton. A canonical correlation analysis (CCA) method for the extraction of frequency information associated with the SSVEP was used in combination with k-nearest neighbors. Main results. Overall, 11 healthy subjects participated in the experiment to evaluate performance. To achieve the best classification, CCA was first calibrated in an offline experiment. In the subsequent online experiment, our results exhibit accuracies of 91.3 ± 5.73%, a response time of 3.28 ± 1.82 s, an information transfer rate of 32.9 ± 9.13 bits/min, and a completion time of 1100 ± 154.92 s for the experimental parcour studied. Significance. The ability to achieve such high quality BMI control indicates that an SSVEP-based lower limb exoskeleton for gait assistance is becoming feasible.

  9. A Virtual Reality-Cycling Training System for Lower Limb Balance Improvement

    Directory of Open Access Journals (Sweden)

    Chieh Yin

    2016-01-01

    Full Text Available Stroke survivors might lose their walking and balancing abilities, but many studies pointed out that cycling is an effective means for lower limb rehabilitation. However, during cycle training, the unaffected limb tends to compensate for the affected one, which resulted in suboptimal rehabilitation. To address this issue, we present a Virtual Reality-Cycling Training System (VRCTS, which senses the cycling force and speed in real-time, analyzes the acquired data to produce feedback to patients with a controllable VR car in a VR rehabilitation program, and thus specifically trains the affected side. The aim of the study was to verify the functionality of the VRCTS and to verify the results from the ten stroke patients participants and to compare the result of Asymmetry Ratio Index (ARI between the experimental group and the control group, after their training, by using the bilateral pedal force and force plate to determine any training effect. The results showed that after the VRCTS training in bilateral pedal force it had improved by 0.22 (p=0.046 and in force plate the stand balance has also improved by 0.29 (p=0.031; thus both methods show the significant difference.

  10. A Virtual Reality-Cycling Training System for Lower Limb Balance Improvement

    Science.gov (United States)

    Yin, Chieh; Hsueh, Ya-Hsin; Yeh, Chun-Yu; Lo, Hsin-Chang; Lan, Yi-Ting

    2016-01-01

    Stroke survivors might lose their walking and balancing abilities, but many studies pointed out that cycling is an effective means for lower limb rehabilitation. However, during cycle training, the unaffected limb tends to compensate for the affected one, which resulted in suboptimal rehabilitation. To address this issue, we present a Virtual Reality-Cycling Training System (VRCTS), which senses the cycling force and speed in real-time, analyzes the acquired data to produce feedback to patients with a controllable VR car in a VR rehabilitation program, and thus specifically trains the affected side. The aim of the study was to verify the functionality of the VRCTS and to verify the results from the ten stroke patients participants and to compare the result of Asymmetry Ratio Index (ARI) between the experimental group and the control group, after their training, by using the bilateral pedal force and force plate to determine any training effect. The results showed that after the VRCTS training in bilateral pedal force it had improved by 0.22 (p = 0.046) and in force plate the stand balance has also improved by 0.29 (p = 0.031); thus both methods show the significant difference. PMID:27034953

  11. Development of Quasi-3DOF upper limb rehabilitation system using ER brake: PLEMO-P1

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, T; Fukushima, K; Furusho, J; Ozawa, T [Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871 (Japan)], E-mail: kikuchi@mech.eng.osaka-u.ac.jp

    2009-02-01

    In recent years, many researchers have studied the potential of using robotics technology to assist and quantify the motor functions for neuron-rehabilitation. Some kinds of haptic devices have been developed and evaluated its efficiency with clinical tests, for example, upper limb training for patients with spasticity after stroke. However, almost all the devices are active-type (motor-driven) haptic devices and they basically require high-cost safety system compared to passive-type (brake-based) devices. In this study, we developed a new practical haptic device 'PLEMO-P1'; this system adopted ER brakes as its force generators. In this paper, the mechanism of PLEMO-P1 and its software for a reaching rehabilitation are described.

  12. NEUREX: a tutorial expert system for the diagnosis of neurogenic diseases of the lower limbs.

    Science.gov (United States)

    Starita, A; Majidi, D; Giordano, A; Battaglia, M; Cioni, R

    1995-02-01

    Specialist tutors have to transfer two types of knowledge to doctors who are specialising in a particular clinic: public declarative knowledge, including facts, notions, principles in that particular field; and their own private procedural knowledge acquired in years of direct experience. Embodying this knowledge into an expert system means that this information can be shared more rapidly, and tutoring is easier. This paper presents a tutorial expert system for neurological clinics which can emulate the diagnostic process of an expert neurologist for neurogenic diseases of the lower limbs, assist users in planning the optimal sequence of NG and EMG tests, interpret the results of these tests, and help users to achieve the most suitable diagnosis.

  13. Impact testing of the residual limb: System response to changes in prosthetic stiffness.

    Science.gov (United States)

    Boutwell, Erin; Stine, Rebecca; Gard, Steven

    2016-01-01

    Currently, it is unknown whether changing prosthetic limb stiffness affects the total limb stiffness and influences the shock absorption of an individual with transtibial amputation. The hypotheses tested within this study are that a decrease in longitudinal prosthetic stiffness will produce (1) a reduced total limb stiffness, and (2) reduced magnitude of peak impact forces and increased time delay to peak force. Fourteen subjects with a transtibial amputation participated in this study. Prosthetic stiffness was modified by means of a shock-absorbing pylon that provides reduced longitudinal stiffness through compression of a helical spring within the pylon. A sudden loading evaluation device was built to examine changes in limb loading mechanics during a sudden impact event. No significant change was found in the peak force magnitude or timing of the peak force between prosthetic limb stiffness conditions. Total limb stiffness estimates ranged from 14.9 to 17.9 kN/m but were not significantly different between conditions. Thus, the prosthetic-side total limb stiffness was unaffected by changes in prosthetic limb stiffness. The insensitivity of the total limb stiffness to prosthetic stiffness may be explained by the mechanical characteristics (i.e., stiffness and damping) of the anatomical tissue within the residual limb.

  14. Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries

    NARCIS (Netherlands)

    Emad, Y.; Al-Sherbeni, H.; Ragab, Y.; Abo-El-Youn, I.; El-Shaarawy, N.; Nassar, D.Y.; Fathy, A.; Al-Hanafi, H.; Rasker, Johannes J.

    2014-01-01

    Objective To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration. Methods Twenty-two cases with systemic

  15. Skill transfer from symmetric and asymmetric bimanual training using a robotic system to single limb performance

    Directory of Open Access Journals (Sweden)

    Trlep Matic

    2012-07-01

    Full Text Available Abstract Background Humans are capable of fast adaptation to new unknown dynamics that affect their movements. Such motor learning is also believed to be an important part of motor rehabilitation. Bimanual training can improve post-stroke rehabilitation outcome and is associated with interlimb coordination between both limbs. Some studies indicate partial transfer of skills among limbs of healthy individuals. Another aspect of bimanual training is the (asymmetry of bimanual movements and how these affect motor learning and possibly post-stroke rehabilitation. Methods A novel bimanual 2-DOF robotic system was used for both bimanual and unimanual reaching movements. 35 young healthy adults participated in the study. They were divided into 5 test groups that performed movements under different conditions (bimanual or unimanual movements and symmetric or asymmetric bimanual arm loads. The subjects performed a simple tracking exercise with the bimanual system. The exercise was developed to stimulate motor learning by applying a velocity-dependent disturbance torque to the handlebar. Each subject performed 255 trials divided into three phases: baseline without disturbance torque, training phase with disturbance torque and evaluation phase with disturbance torque. Results Performance was assessed with the maximal values of rotation errors of the handlebar. After exposure to disturbance torque, the errors decreased for both unimanual and bimanual training. Errors in unimanual evaluation following the bimanual training phase were not significantly different from errors in unimanual evaluation following unimanual training. There was no difference in performance following symmetric or asymmetric training. Changing the arm force symmetry during bimanual movements from asymmetric to symmetric had little influence on performance. Conclusions Subjects could adapt to an unknown disturbance torque that was changing the dynamics of the movements. The learning

  16. The alien limb phenomenon.

    Science.gov (United States)

    Graff-Radford, Jonathan; Rubin, Mark N; Jones, David T; Aksamit, Allen J; Ahlskog, J Eric; Knopman, David S; Petersen, Ronald C; Boeve, Bradley F; Josephs, Keith A

    2013-07-01

    Alien limb phenomenon refers to involuntary motor activity of a limb in conjunction with the feeling of estrangement from that limb. Alien limb serves as a diagnostic feature of corticobasal syndrome. Our objective was to determine the differential diagnoses of alien limb and to determine the features in a large group of patients with the alien limb with different underlying etiologies. We searched the Mayo Clinic Medical Records Linkage system to identify patients with the diagnosis of alien limb seen between January 1, 1996, and July 11, 2011. One hundred and fifty patients with alien limb were identified. Twenty-two were followed in the Alzheimer's Disease Research Center. Etiologies of alien limb included corticobasal syndrome (n = 108), stroke (n = 14), Creutzfeldt Jakob disease (n = 9), hereditary diffuse leukoencephalopathy with spheroids (n = 5), tumor (n = 4), progressive multifocal leukoencephalopathy(n = 2), demyelinating disease (n = 2), progressive dementia not otherwise specified (n = 2), posterior reversible encephalopathy syndrome (n = 1), corpus callosotomy (n = 1), intracerebral hemorrhage (n = 1) and thalamic dementia (n = 1). Ten of 14 cerebrovascular cases were right hemisphere in origin. All cases involved the parietal lobe. Of the 44 patients with corticobasal syndrome from the Alzheimer's Disease Research Center cohort, 22 had alien limb, and 73 % had the alien limb affecting the left extremities. Left sided corticobasal syndrome was significantly associated with the presence of alien limb (p = 0.004). These findings support the notion that the alien limb phenomenon is partially related to damage underlying the parietal cortex, especially right parietal, disconnecting it from other cortical areas.

  17. An inclined plane system with microcontroller to determine limb motor function of laboratory animals.

    Science.gov (United States)

    Chang, Ming-Wen; Young, Ming-Shing; Lin, Mao-Tsun

    2008-02-15

    This study describes a high-accuracy inclined plane test system for quantitative measurement of the limb motor function of laboratory rats. The system is built around a microcontroller and uses a stepping motor to drive a ball screw, which changes the angle of the inclined plane. Any of the seven inclination speeds can be selected by the user. Two infrared (IR) LED/detector pairs function as interrupt sensors for objective determination of the moment that the rat loses its grip on the textured flooring of the starting area and slips down the plane. Inclination angle at the moment of IR interrupt (i.e. rat slip) is recorded. A liquid crystal display module shows the inclination speed and the inclination angle. The system can function as a stand alone device but a RS232 port allows connection to a personal computer (PC), so data can be sent directly to hard disk for storage and analysis. Experiments can be controlled by a local keypad or by the connected PC. Advantages of the presented system include easy operation, high accuracy, non-dependence on human observation for determination of slip angle, stand-alone capability, low cost and easy modification of the controlling software for different types of experiments. A fully functional prototype of the system is described. The prototype was used experimentally by a hospital group testing traumatic brain injury experiments, and some of their results are presented for system verification. It is found that the system is stable, accurate and easily used by investigators.

  18. Artificial Limbs

    Science.gov (United States)

    ... you are missing an arm or leg, an artificial limb can sometimes replace it. The device, which ... activities such as walking, eating, or dressing. Some artificial limbs let you function nearly as well as ...

  19. Control system design for electrical stimulation in upper limb rehabilitation modelling, identification and robust performance

    CERN Document Server

    Freeman, Chris

    2016-01-01

    This book presents a comprehensive framework for model-based electrical stimulation (ES) controller design, covering the whole process needed to develop a system for helping people with physical impairments perform functional upper limb tasks such as eating, grasping and manipulating objects. The book first demonstrates procedures for modelling and identifying biomechanical models of the response of ES, covering a wide variety of aspects including mechanical support structures, kinematics, electrode placement, tasks, and sensor locations. It then goes on to demonstrate how complex functional activities of daily living can be captured in the form of optimisation problems, and extends ES control design to address this case. It then lays out a design methodology, stability conditions, and robust performance criteria that enable control schemes to be developed systematically and transparently, ensuring that they can operate effectively in the presence of realistic modelling uncertainty, physiological variation an...

  20. Comparison of lower limb and trunk kinematics between markerless and marker-based motion capture systems.

    Science.gov (United States)

    Perrott, Margaret A; Pizzari, Tania; Cook, Jill; McClelland, Jodie A

    2017-02-01

    Three dimensional (3-D) motion capture systems are used by researchers and clinicians to analyze the kinematics of human movement. Traditional marker based systems are time consuming and limit the size of studies. Markerless 3-D systems are quicker to use but the differences between data captured in each system is unclear. To examine the relationship of kinematic data captured by marker based and markerless motion capture systems. Movement was assessed in two tests: a simple knee flexion test and single leg squat with a marker based protocol (Vicon) and a markerless protocol (Organic Motion). There was no significant difference between protocols in knee flexion angle (p=0.33). In single leg squat there was no significant difference in 9 of 13 clinically relevant joint angles in the change in angle from the start to the peak of squat. There were significant differences in the angle at the peak of the squat for 9 of 13 joint angles. This study provides evidence that a marker-based and a markerless protocol report similar ranges of change in angle from the start of a squat to peak squat in the pelvis and lower limb in single leg squat. Specific joint angles should not be compared between protocols. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Design and Implementation of a Mechanical Control System for the Scanning Microwave Limb Sounder

    Science.gov (United States)

    Bowden, William

    2011-01-01

    The Scanning Microwave Limb Sounder (SMLS) will use technological improvements in low noise mixers to provide precise data on the Earth's atmospheric composition with high spatial resolution. This project focuses on the design and implementation of a real time control system needed for airborne engineering tests of the SMLS. The system must coordinate the actuation of optical components using four motors with encoder readback, while collecting synchronized telemetric data from a GPS receiver and 3-axis gyrometric system. A graphical user interface for testing the control system was also designed using Python. Although the system could have been implemented with a FPGA-based setup, we chose to use a low cost processor development kit manufactured by XMOS. The XMOS architecture allows parallel execution of multiple tasks on separate threads-making it ideal for this application and is easily programmed using XC (a subset of C). The necessary communication interfaces were implemented in software, including Ethernet, with significant cost and time reduction compared to an FPGA-based approach. For these reasons, the XMOS technology is an attractive, cost effective, alternative to FPGA-based technologies for this design and similar rapid prototyping projects.

  2. Gait training assist system of a lower limb prosthetic visualizing muscle activation pattern using a color-depth sensor.

    Science.gov (United States)

    Ogata, Kunihiro; Mita, Tomoki; Tsuji, Toshiaki; Matsumoto, Yoshio

    2017-07-01

    Some unilateral lower-limb amputees load the intact limb more than the prosthetic limb. This can cause chronic pains, fatigue, lumbago, and joint diseases, including knee osteoarthritis. To avoid and counteract these symptoms it is necessary to improve their asymmetric gait. Increasing the function of the hip abductor muscle is important to maintaining symmetrical weight distribution. Therefore, the purpose of this study is to develop a training assist system, which estimates and visualizes an abductor muscle by using a color-depth sensor. To estimate the muscle activation, first, the floor reaction force is calculated using a simple dynamic model. Then, the hip torque is calculated using joint angles. The floor reaction force and, the muscle length are calculated based on a human musculoskeletal model. Muscle activity is estimated by these parameters. Evaluation experiments of this proposed method were performed on healthy persons and unilateral trans femoral amputees, and the effectiveness of this proposed algorithm has been confirmed.

  3. Clinical and brain imaging changes after upper-limb rehabilitation with a virtual reality tabletop system: A case study

    OpenAIRE

    Llorens Rodríguez, Roberto; Colomer, C.; Baldovi Felici, A.; Verdecho, I.

    2014-01-01

    Llorens Rodríguez, R.; Colomer, C.; Baldovi Felici, A.; Verdecho, I. (2014). Clinical and brain imaging changes after upper-limb rehabilitation with a virtual reality tabletop system: A case study. Brain Injury. 28(4):166-166. doi:10.3109/02699052.2014.892379. Senia 166 166 28 4

  4. [Remote intelligent Brunnstrom assessment system for upper limb rehabilitation for post-stroke based on extreme learning machine].

    Science.gov (United States)

    Wang, Yue; Yu, Lei; Fu, Jianming; Fang, Qiang

    2014-04-01

    In order to realize an individualized and specialized rehabilitation assessment of remoteness and intelligence, we set up a remote intelligent assessment system of upper limb movement function of post-stroke patients during rehabilitation. By using the remote rehabilitation training sensors and client data sampling software, we collected and uploaded the gesture data from a patient's forearm and upper arm during rehabilitation training to database of the server. Then a remote intelligent assessment system, which had been developed based on the extreme learning machine (ELM) algorithm and Brunnstrom stage assessment standard, was used to evaluate the gesture data. To evaluate the reliability of the proposed method, a group of 23 stroke patients, whose upper limb movement functions were in different recovery stages, and 4 healthy people, whose upper limb movement functions were normal, were recruited to finish the same training task. The results showed that, compared to that of the experienced rehabilitation expert who used the Brunnstrom stage standard table, the accuracy of the proposed remote Brunnstrom intelligent assessment system can reach a higher level, as 92.1%. The practical effects of surgery have proved that the proposed system could realize the intelligent assessment of upper limb movement function of post-stroke patients remotely, and it could also make the rehabilitation of the post-stroke patients at home or in a community care center possible.

  5. Synovial distribution of "systemically" administered acetylsalicylic acid in the isolated perfused equine distal limb.

    Science.gov (United States)

    Friebe, Maren; Schumacher, Stephan; Stahl, Jessica; Kietzmann, Manfred

    2013-03-26

    This study investigated synovial concentrations of acetylsalicylic acid (ASA) and its metabolite salicylic acid (SA) in the equine fetlock joint following systemic administration of ASA. Salicylates were chosen because SA is the only nonsteroidal anti-inflammatory drug for which threshold levels exist for plasma and urine in equine sports. To avoid animal experiments, the study was conducted using an ex vivo model of the isolated perfused equine distal limb in combination with plasma concentrations obtained from literature.Salicylate concentrations in the joint were determined using microdialysis and high performance liquid chromatography (HPLC). Any anti-inflammatory effect of synovial ASA concentrations was assessed using an ASA EC50 (half maximal effective concentration) determined in equine whole blood. The ASA concentration in the synovial fluid (n=6) reached a maximum of 4 μg/mL, the mean concentration over the entire perfusion period was 2 μg/mL. Maximum SA concentration was 17 μg/mL, the average was 14 μg/mL. ASA and SA concentration in the synovial fluid exceeded systemic concentrations 2 h and 3.5 h after "systemic" administration, respectively. ASA and SA accumulated in the in the synovial fluid of the ex vivo model despite decreasing systemic concentrations. This suggests a prolonged anti-inflammatory effect within the joint that remains to be further elucidated.

  6. On the biology of the bony otic capsule and the pathogenesis of otosclerosis

    DEFF Research Database (Denmark)

    Bloch, Sune Land

    2012-01-01

    , avoided or medically reversed as the pathogenesis remains unknown. Previously genetic research has failed to identify a specific otosclerosis-gene and earlier theories of virus infections, autoimmunity or association to generalized bone diseases have been unable to explain why otosclerosis only occurs...... in the bony otic capsule while the rest of the skeleton remains completely normal. Studies from the otopathological laboratory (RH) have revealed how the bone turnover rates increase centrifugally from a sub-normal 0.1% adjacent to the inner ear space towards a normal 10% per year at the capsular periphery...

  7. The developing lamprey ear closely resembles the zebrafish otic vesicle: otx1 expression can account for all major patterning differences.

    Science.gov (United States)

    Hammond, Katherine L; Whitfield, Tanya T

    2006-04-01

    The inner ear of adult agnathan vertebrates is relatively symmetric about the anteroposterior axis, with only two semicircular canals and a single sensory macula. This contrasts with the highly asymmetric gnathostome arrangement of three canals and several separate maculae. Symmetric ears can be obtained experimentally in gnathostomes in several ways, including by manipulation of zebrafish Hedgehog signalling, and it has been suggested that these phenotypes might represent an atavistic condition. We have found, however, that the symmetry of the adult lamprey inner ear is not reflected in its early development; the lamprey otic vesicle is highly asymmetric about the anteroposterior axis, both morphologically and molecularly, and bears a striking resemblance to the zebrafish otic vesicle. The single sensory macula originates as two foci of hair cells, and later shows regions of homology to the zebrafish utricular and saccular maculae. It is likely, therefore, that the last common ancestor of lampreys and gnathostomes already had well-defined otic anteroposterior asymmetries. Both lamprey and zebrafish otic vesicles express a target of Hedgehog signalling, patched, indicating that both are responsive to Hedgehog signalling. One significant distinction between agnathans and gnathostomes, however, is the acquisition of otic Otx1 expression in the gnathostome lineage. We show that Otx1 knockdown in zebrafish, as in Otx1(-/-) mice, gives rise to lamprey-like inner ears. The role of Otx1 in the gnathostome ear is therefore highly conserved; otic Otx1 expression is likely to account not only for the gain of a third semicircular canal and crista in gnathostomes, but also for the separation of the zones of the single macula into distinct regions.

  8. Requirements Elicitation and Prototyping of a Fully Immersive Virtual Reality Gaming System for Upper Limb Stroke Rehabilitation in Saudi Arabia

    OpenAIRE

    Maram AlMousa; Al-Khalifa, Hend S.; Hana AlSobayel

    2017-01-01

    Stroke rehabilitation plays an important role in recovering the lifestyle of stroke survivors. Although existing research proved the effectiveness and engagement of nonimmersive virtual reality- (VR-) based rehabilitation systems, limited research is available on the applicability of fully immersive VR-based rehabilitation systems. In this paper, we present the elicited requirements of a fully immersive VR-based rehabilitation system that will be designed for domestic upper limb stroke patien...

  9. Study on development of active-passive rehabilitation system for upper limbs: Hybrid-PLEMO

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, T; Jin, Y; Fukushima, K; Akai, H; Furusho, J [Department of Mechanical Engineering, Graduate School of Engineering, Osaka University, Osaka (Japan)], E-mail: kikuchi@mech.eng.osaka-u.ac.jp

    2009-02-01

    In recent years, many researchers have studied the potential of using robotics technology to assist and quantify the motor functions for neuron-rehabilitation. Some kinds of haptic devices have been developed and evaluated its efficiency with clinical tests, for example, upper limb training for patients with spasticity after stroke. Active-type (motor-driven) haptic devices can realize a lot of varieties of haptics. But they basically require high-cost safety system. On the other hand, passive-type (brake-based) haptic devices have inherent safety. However, the passive robot system has strong limitation on varieties of haptics. There are not sufficient evidences to clarify how the passive/active haptics effect to the rehabilitation of motor skills. In this paper, we developed an active-passive-switchable rehabilitation system with ER clutch/brake device named 'Hybrid-PLEMO' in order to address these problems. In this paper, basic structures and haptic control methods of the Hybrid-PLEMO are described.

  10. The development of an adaptive upper-limb stroke rehabilitation robotic system

    Directory of Open Access Journals (Sweden)

    Goetschalckx Robby

    2011-06-01

    Full Text Available Abstract Background Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. This paper presents an automated system for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The system uses a decision theoretic model (a partially observable Markov decision process, or POMDP as its primary engine for decision making. The POMDP allows the system to automatically modify exercise parameters to account for the specific needs and abilities of different individuals, and to use these parameters to take appropriate decisions about stroke rehabilitation exercises. Methods The performance of the system was evaluated by comparing the decisions made by the system with those of a human therapist. A single patient participant was paired up with a therapist participant for the duration of the study, for a total of six sessions. Each session was an hour long and occurred three times a week for two weeks. During each session, three steps were followed: (A after the system made a decision, the therapist either agreed or disagreed with the decision made; (B the researcher had the device execute the decision made by the therapist; (C the patient then performed the reaching exercise. These parts were repeated in the order of A-B-C until the end of the session. Qualitative and quantitative question were asked at the end of each session and at the completion of the study for both participants. Results Overall, the therapist agreed with the system decisions approximately 65% of the time. In general, the therapist thought the system decisions were believable and could envision this system being used in both a clinical and home setting. The patient was satisfied with the system and would use this system as his/her primary method of rehabilitation. Conclusions The data collected in this study can only be

  11. The development of an adaptive upper-limb stroke rehabilitation robotic system

    Science.gov (United States)

    2011-01-01

    Background Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. This paper presents an automated system for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The system uses a decision theoretic model (a partially observable Markov decision process, or POMDP) as its primary engine for decision making. The POMDP allows the system to automatically modify exercise parameters to account for the specific needs and abilities of different individuals, and to use these parameters to take appropriate decisions about stroke rehabilitation exercises. Methods The performance of the system was evaluated by comparing the decisions made by the system with those of a human therapist. A single patient participant was paired up with a therapist participant for the duration of the study, for a total of six sessions. Each session was an hour long and occurred three times a week for two weeks. During each session, three steps were followed: (A) after the system made a decision, the therapist either agreed or disagreed with the decision made; (B) the researcher had the device execute the decision made by the therapist; (C) the patient then performed the reaching exercise. These parts were repeated in the order of A-B-C until the end of the session. Qualitative and quantitative question were asked at the end of each session and at the completion of the study for both participants. Results Overall, the therapist agreed with the system decisions approximately 65% of the time. In general, the therapist thought the system decisions were believable and could envision this system being used in both a clinical and home setting. The patient was satisfied with the system and would use this system as his/her primary method of rehabilitation. Conclusions The data collected in this study can only be used to provide insight into

  12. Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain

    National Research Council Canada - National Science Library

    Preißler, Sandra; Dietrich, Caroline; Blume, Kathrin R; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams...

  13. Isolated limb perfusion

    Directory of Open Access Journals (Sweden)

    Sandra Kuhar

    2016-02-01

    Full Text Available Isolated limb perfusion is a surgical procedure that can be used to treat an advanced malignant melanoma and soft tissue sarcomas, it is also effective in treating in-transit metastases of melanoma and local metastases of soft tissue sarcomas. With perfusion of the affected limb with cytostatic agents it is possible to avoid amputation and mutilating operations that significantly reduced the function of the limb. Since the procedure is isolated on a limb, it can be perfused with much higher doses of cytotoxic drugs, systemic toxicity is thus reduced or prevented. The most common side effects are erythema and edema.Cytotoxic drugs, that are manly used, are melphalan and tumor necrosis factor alpha. Efficient also proved to be simultaneous hyperthermia of the affected limb.

  14. LIMB Demonstration Project Extension

    Energy Technology Data Exchange (ETDEWEB)

    1988-09-15

    The basic goal of the Limestone Injection Multistage Burner (LIMB) demonstration is to extend LIMB technology development to a full-scale application on a representative wall-fired utility boiler. The successful retrofit of LIMB to an existing boiler is expected to demonstrate that (a) reductions of 50 percent or greater in SO and NO emissions can be achieved at a fraction of the cost of add-on FGD systems, (b) boiler reliability, operability, and steam production can be maintained at levels existing prior to LIMB retrofit, and (c) technical difficulties attributable to LIMB operation, such as additional slagging and fouling, changes in ash disposal requirements, and an increased particulate load, can be resolved in a cost-effective manner. The primary fuel to be used will be an Ohio bituminous coal having a nominal sulfur content of 3 percent or greater.

  15. Plasticity in the visual system is associated with prosthesis use in phantom limb pain

    OpenAIRE

    Sandra ePreißler; Caroline eDietrich; Kathrin eBlume; Hofmann, Gunther O; Miltner, Wolfgang H. R.; Thomas eWeiss

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand.To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested th...

  16. Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain

    OpenAIRE

    Preißler, Sandra; Dietrich, Caroline; Blume, Kathrin R.; Hofmann, Gunther O; Miltner, Wolfgang H. R.; Weiss, Thomas

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested t...

  17. Bilateral lower limb gangrene and stroke as initial manifestations of systemic giant cell arteritis in an African-American.

    Science.gov (United States)

    Lie, J T; Tokugawa, D A

    1995-02-01

    Giant cell arteritis (GCA) is a systemic disease of the elderly that occurs infrequently in blacks and seldom has peripheral vascular disease and stroke as its presenting major complications. The occurrence of bilateral lower limb gangrene and a fatal stroke as manifestations of occult systemic GCA in an African-American is such a unique combination of rare occurrences that it warrants documentation in the literature.

  18. Exoskeleton Technology in Rehabilitation: Towards an EMG-Based Orthosis System for Upper Limb Neuromotor Rehabilitation

    Directory of Open Access Journals (Sweden)

    Luis Manuel Vaca Benitez

    2013-01-01

    Full Text Available The rehabilitation of patients should not only be limited to the first phases during intense hospital care but also support and therapy should be guaranteed in later stages, especially during daily life activities if the patient’s state requires this. However, aid should only be given to the patient if needed and as much as it is required. To allow this, automatic self-initiated movement support and patient-cooperative control strategies have to be developed and integrated into assistive systems. In this work, we first give an overview of different kinds of neuromuscular diseases, review different forms of therapy, and explain possible fields of rehabilitation and benefits of robotic aided rehabilitation. Next, the mechanical design and control scheme of an upper limb orthosis for rehabilitation are presented. Two control models for the orthosis are explained which compute the triggering function and the level of assistance provided by the device. As input to the model fused sensor data from the orthosis and physiology data in terms of electromyography (EMG signals are used.

  19. A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke.

    Science.gov (United States)

    Rong, Wei; Li, Waiming; Pang, Mankit; Hu, Junyan; Wei, Xijun; Yang, Bibo; Wai, Honwah; Zheng, Xiaoxiang; Hu, Xiaoling

    2017-04-26

    It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs. In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training. In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P robotic system could improve the muscular coordination at the elbow, wrist and fingers. ClinicalTrials.gov. NCT02117089 ; date of registration: April 10, 2014.

  20. Requirements Elicitation and Prototyping of a Fully Immersive Virtual Reality Gaming System for Upper Limb Stroke Rehabilitation in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Maram AlMousa

    2017-01-01

    Full Text Available Stroke rehabilitation plays an important role in recovering the lifestyle of stroke survivors. Although existing research proved the effectiveness and engagement of nonimmersive virtual reality- (VR- based rehabilitation systems, limited research is available on the applicability of fully immersive VR-based rehabilitation systems. In this paper, we present the elicited requirements of a fully immersive VR-based rehabilitation system that will be designed for domestic upper limb stroke patients; we will also provide an initial conceptual prototype of the proposed system.

  1. Computational evaluation of some lower limbs protective systems under explosive loading

    Directory of Open Access Journals (Sweden)

    Casas J.P.

    2012-08-01

    Full Text Available Different types of protective equipment for human lower limb, such as boots and gaiters, have been developed in order to reduce the injury caused by blast antipersonnel-mines. Damage is mainly studied by the energy transmitted to the extremity that has stepped on the mine; nonetheless, side effects that may affect adjacent limbs cannot be left aside. This study is divided into three stages due to the complexity in modeling the different phenomena related to the problem. The first stage is the study of the energy transmitted when a mine is activated. Different results are gathered according to the variation of parameters such as: deep of burial, standoff between ground and protective equipment, explosive mass, energy absorbing material placed between the ground and the protected limb, and computational issues like the distance of the boundary conditions and the discretization level. The second stage is the base and first approximation to the modeling and evaluation of lower limb behavior. It includes the interaction of the detonation products and a lower limb that is placed in a mechanical measuring device. The energy transferred to the mechanical device is correlated to the damage caused by the explosion products in an attempt to validate previously experimental data. Finally, in the third stage, the side effect on the lower contiguous leg is assessed: pressure and temperature measures are taken at different distances according to the human pace in order to evaluate the worst-case scenario. The first and third stages propose different material arrangements or configurations to reduce the energy transmitted to the mechanical device and to mitigate damage caused to the contiguous limb respectively. All the three stages are simulated using two-dimensional (2D hydrocode Ansys AUTODYN ® and material previously reported in literature.

  2. Measurement of upper limb ulcers in patients with systemic sclerosis: reproducibility and correlation with pain, function, and quality of life.

    Science.gov (United States)

    Toffolo, Sandra Regina; Furtado, Rita Nely Vilar; Klein, Adriana; Watanabe, Sandra; Andrade, Luis Eduardo Coelho; Natour, Jamil

    2008-01-01

    There are a large number of studies addressing the treatment and assessment of chronic ulcers. Despite the fact that ischemic ulcers are frequent and difficult to manage in cases of systemic sclerosis, there is minimal literature on assessment measures regarding these wounds or on their reproducibility. The aim of this study was to investigate intraobserver and interobserver reproducibility regarding ulcer dimension measurements in patients with systemic sclerosis. Correlations between pain, upper limb function, pinch strength, and quality of life were also determined. A prospective 11-week follow-up study was carried out to assess active upper limb ulcers. Ulcer diameter, ulcer area, and interobserver reproducibility were performed weekly. Quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey), upper limb function (disabilities of the arm, shoulder, and hand), pinch strength, pain, visual analog scale, and intraobserver reproducibility were assessed at baseline, 3, 7, and 11 weeks. Fifty-one active ulcers were recorded. Larger ulcer diameter, smaller ulcer diameter, and ulcer area demonstrated excellent intraobserver (r > .81, p .76, p ulcer dimension and visual analog scale scores for pain (r = .42; p or= .40; p ulcers were reproducible in patients with SSc and correlated to other variables of interest for these wounds.

  3. Biomechanical study of upper-limb exoskeleton for resistance training with three-dimensional motion analysis system.

    Science.gov (United States)

    Wu, Tzong-Ming; Chen, Dar-Zen

    2014-01-01

    The world's population is aging rapidly, particularly in developed countries. The trend toward prolonged life expectancy will increase the elderly population and thereby lead to an increase in occurrences of age-related health problems such as chronic disease. Healthcare services and home-based rehabilitation are in high demand, and the demand for professional physical therapy is imposing an increasing burden on the healthcare system. Rehabilitation training devices must keep pace with standards of care, be cost effective, and meet the home-based training requirements of today's rehabilitation trends. This article presents an experimental study of a novel spring-loaded upper-limb exoskeleton meant to enable a patient or nondisabled individual to move a limb at multiple joints in different planes for resistance training in a free and unconstrained environment. To assess the functionality of the design, we have measured its kinematic data while performing designated movements and adopted a motion-capture system to verify the function of our mechanism. The collected data and analysis of the kinematic and dynamic joint torques may not only verify our mechanism but also provide a profound understanding of the design requirements for an appropriate spring-loaded exoskeleton for upper-limb resistance training.

  4. Peripheral neuropathy may increase the risk for asymptomatic otic barotrauma during hyperbaric oxygen therapy: research report.

    Science.gov (United States)

    Mozdzanowski, Christopher; Perdrizet, George A

    2014-01-01

    Otic barotrauma (OBT) is an adverse event seen in patients receiving hyperbaric oxygen (HBO2) therapy. After encountering a case of painless tympanic perforation during HBO2 therapy of a diabetic patient with the diagnosis of neuropathic Wagner Grade III foot ulcer, we hypothesized that peripheral neuropathy of the lower extremity may be associated with an increased risk of asymptomatic OBT during HBO2 therapy. The medical records of all HBO2 patients during a one-year period of time were reviewed. Subjects were selected based on otoscopic documentation of OBT and divided into two groups based on the presence or absence of lower extremity peripheral neuropathy. Time to therapeutic compression, presence or absence of ear-related symptoms and modified Teed (mTeed) scores were compared between the two groups. A total of 38 patients with OBT, 18 neuropathic and 20 non-neuropathic, were identified. Asymptomatic OBT occurred more frequently in the neuropathic vs. non-neuropathic group (56% vs. 5%, p < 0.001). mTeed scores were significantly greater in the neuropathic vs. non-neuropathic group (mTeed 1, 30% vs. 61%; mTeed 2, 65% vs. 36%; mTeed 3, 4% vs. 3%; p = 0.032). Mean compression times were shorter in the neuropathic vs. non-neuropathic group (10. 5 +/- 1.8 vs. 14.4 +/- 3.3 minutes, p < 0.001). The presence of peripheral neuropathy of the lower extremity may be associated with a significantly greater incidence of asymptomatic otic barotrauma during HBO2 therapy.

  5. [Analysis of clinical medication rules in 48 398 patients with limb fractures based on hospital information system].

    Science.gov (United States)

    Jia, Cheng-Hui; Zhang, Yin; Xie, Yan-Ming; Wei, Xu; Yin, He; Feng, Bo; Zhuang, Yan

    2016-07-01

    To explore the clinical medication rules in the patients with limb fractures, and provide guidance for clinical practice. Data of 48 398 patients with limb fractures from 2001 to 2011 was extracted from the hospital information system(HIS) established by the institute of basic research in clinical medicine, China academy of Chinese medical sciences. The gender and age distribution of patients and clinical medication characteristics were described. Apriori algorithm was adopted to analyze the common drug combinations of Chinese medicine(CM) and western medicine(WM). The study results showed that the ratio of included males and females was 1.83∶1. There was a high peak of incidence for the patients from 18 to 44 years. Apriori algorithm showed that the usage of WM was more frequent than that of CM. The most commonly used CM was Lugua polypeptide and sodium aescinate injection. Blood-activating and stasis-resolving medicines, as well as tendons and bones-strengthening medicines were the commonly used CM types. In addition, WM antibiotics plus blood-activating and stasis-resolving CM, or antibiotics plus tendons and bones-strengthening CM was the most commonly used drug combination. Based on the analysis of available data, the prevalence of limb fracture was higher in men than in women; more in young and middle-aged patients; the common drug combination was antibiotics plus blood-activating and stasis-resolving CM, or antibiotics plus tendons and bones-strengthening CM. More prospective and high-quality clinical trials are necessary to evaluate the effect of CM or integrative medicine treatment for limb fracture in the future research. Copyright© by the Chinese Pharmaceutical Association.

  6. Upper-limb virtual rehabilitation for traumatic brain injury: a preliminary within-group evaluation of the elements system.

    Science.gov (United States)

    Mumford, Nick; Duckworth, Jonathan; Thomas, Patrick R; Shum, David; Williams, Gavin; Wilson, Peter H

    2012-01-01

    The aim of this study was to assess the efficacy of the Elements virtual reality (VR) system for rehabilitation of upper-limb function in patients with traumatic brain injury (TBI). Using a within-group design, patients were tested three times, each 4 weeks apart: Pre-intervention 1 and 2 and Post-intervention. During intervention, participants received 12 1-hour training sessions over 4 weeks in addition to their usual care. Five males and four females aged 18-48 years with severe TBI were recruited. The Elements system consisted of a 100-cm tabletop LCD, camera tracking system, tangible user interfaces (i.e. graspable objects of basic shape) and software. The system provided two modes of interaction with augmented feedback: goal-directed and exploratory. Upper-limb performance was assessed using system-rated measures (movement speed, accuracy and efficiency) and standardized tests. Planned comparisons revealed little change in performance over the pre-test period apart from an increase in movement speed. There were significant training effects, with large effect sizes on all measures except the nuts-and-bolts task. These preliminary findings support the results of an early case study of the Elements system, further demonstrating that VR training is a viable adjunct to conventional physical therapy in facilitating motor learning in patients with TBI.

  7. Assistive-as-Needed Strategy for Upper-Limb Robotic Systems: An Initial Survey

    Science.gov (United States)

    Khairuddin, I. M.; Sidek, S. N.; Yusof, H. Md; Baarath, K.; Majeed, A. P. P. A.

    2017-11-01

    Stroke is amongst the leading causes of deprivation of one’s ability in carrying out activities of daily living. It has been reported from literature that, the functional recovery of stroke patients are rather poor, unless frequent rehabilitative therapy is assumed on the affected limb. Recent trends of rehabilitation therapy have also shifted towards allowing more participation of the patient in the therapy session rather than simple passive treatments as it has been demonstrated to be non-trivial in promoting neural plasticity to expedite motor recovery process. Therefore, the employment of rehabilitation robotics is seen as a means of mitigating the limitations of conventional rehabilitation therapy. It enables unique methods for promoting patient engagement by providing patients assistance only as needed basis. This paper attempts on reviewing assist-as-needed control strategy applied on upper-limb robotic rehabilitation devices.

  8. Chronic lower limb wounds evoke systemic response of the lymphatic (immune system

    Directory of Open Access Journals (Sweden)

    W L Olszewski

    2012-01-01

    Full Text Available Wound healing should not be considered as a process limited only to the damaged tissues. It is always accompanied by an intensive local immune response and in advanced stages, the systemic lymphatic (immune structure. In this review we present evidence from our own studies as well as pertinent literature on the role of skin and subcutaneous tissue lymphatics at the wound site and of transport of antigens along with collecting afferent lymphatics to the lymph nodes. We also speculate the role of lymph nodes in raising cohorts of bacterial and own tissue antigen-specific lymphocytes and their participation in healing and not infrequently evoking uncontrolled chronic immune reaction causing a delay of healing. It is also speculated as to why there is a rapid response of lymph node cells to microbial antigens and tolerance to damaged-tissue-derived antigens occurs

  9. Complete coverage of phantom limb and stump pain with constant current SCS system: a case report and review of the literature.

    Science.gov (United States)

    Bunch, Jennifer R; Goldstein, Heidi V; Hurley, Robert W

    2015-01-01

    Spinal cord stimulator (SCS) technology has advanced over the past several years. However, our literature review revealed a lack of well-documented cases of successful treatment of phantom limb pain with percutaneous revision of previously placed systems. We present the case of a patient who suffered from debilitating bilateral lower extremity phantom limb pain despite having a SCS with a constant voltage system. We used fluoroscopy to successfully guide a percutaneous octapolar paddle lead to the right of the existing surgical paddle lead and a cylindrical quadrapolar lead in between. Finally, the older paddle lead was connected to an extension to make it compatible with the updated constant current system. The revised constant current SCS system provided bilateral coverage of the patient's pain, and at 1-year postoperative, the patient reported he had sustained coverage from his bilateral phantom limb pain. Our patient had complete coverage of his phantom limb pain after his previously placed SCS was changed from a constant voltage to a constant current system, and percutaneous leads were connected to his system. Adding percutaneous leads or switching generator types may benefit patients whose pain patterns have expanded since original SCS system placement. This case reports the complete coverage of phantom limb pain with a change from a constant voltage to a constant current SCS system and the addition of percutaneous leads to an existing SCS system. © 2014 World Institute of Pain.

  10. Exploring the bases for a mixed reality stroke rehabilitation system, Part II: Design of Interactive Feedback for upper limb rehabilitation

    Directory of Open Access Journals (Sweden)

    Duff Margaret

    2011-09-01

    Full Text Available Abstract Background Few existing interactive rehabilitation systems can effectively communicate multiple aspects of movement performance simultaneously, in a manner that appropriately adapts across various training scenarios. In order to address the need for such systems within stroke rehabilitation training, a unified approach for designing interactive systems for upper limb rehabilitation of stroke survivors has been developed and applied for the implementation of an Adaptive Mixed Reality Rehabilitation (AMRR System. Results The AMRR system provides computational evaluation and multimedia feedback for the upper limb rehabilitation of stroke survivors. A participant's movements are tracked by motion capture technology and evaluated by computational means. The resulting data are used to generate interactive media-based feedback that communicates to the participant detailed, intuitive evaluations of his performance. This article describes how the AMRR system's interactive feedback is designed to address specific movement challenges faced by stroke survivors. Multimedia examples are provided to illustrate each feedback component. Supportive data are provided for three participants of varying impairment levels to demonstrate the system's ability to train both targeted and integrated aspects of movement. Conclusions The AMRR system supports training of multiple movement aspects together or in isolation, within adaptable sequences, through cohesive feedback that is based on formalized compositional design principles. From preliminary analysis of the data, we infer that the system's ability to train multiple foci together or in isolation in adaptable sequences, utilizing appropriately designed feedback, can lead to functional improvement. The evaluation and feedback frameworks established within the AMRR system will be applied to the development of a novel home-based system to provide an engaging yet low-cost extension of training for longer periods

  11. Exploring the bases for a mixed reality stroke rehabilitation system, Part II: design of interactive feedback for upper limb rehabilitation.

    Science.gov (United States)

    Lehrer, Nicole; Chen, Yinpeng; Duff, Margaret; L Wolf, Steven; Rikakis, Thanassis

    2011-09-08

    Few existing interactive rehabilitation systems can effectively communicate multiple aspects of movement performance simultaneously, in a manner that appropriately adapts across various training scenarios. In order to address the need for such systems within stroke rehabilitation training, a unified approach for designing interactive systems for upper limb rehabilitation of stroke survivors has been developed and applied for the implementation of an Adaptive Mixed Reality Rehabilitation (AMRR) System. The AMRR system provides computational evaluation and multimedia feedback for the upper limb rehabilitation of stroke survivors. A participant's movements are tracked by motion capture technology and evaluated by computational means. The resulting data are used to generate interactive media-based feedback that communicates to the participant detailed, intuitive evaluations of his performance. This article describes how the AMRR system's interactive feedback is designed to address specific movement challenges faced by stroke survivors. Multimedia examples are provided to illustrate each feedback component. Supportive data are provided for three participants of varying impairment levels to demonstrate the system's ability to train both targeted and integrated aspects of movement. The AMRR system supports training of multiple movement aspects together or in isolation, within adaptable sequences, through cohesive feedback that is based on formalized compositional design principles. From preliminary analysis of the data, we infer that the system's ability to train multiple foci together or in isolation in adaptable sequences, utilizing appropriately designed feedback, can lead to functional improvement. The evaluation and feedback frameworks established within the AMRR system will be applied to the development of a novel home-based system to provide an engaging yet low-cost extension of training for longer periods of time.

  12. Limb myokymia

    Energy Technology Data Exchange (ETDEWEB)

    Albers, J.W.; Allen, A.A.; Bastron, J.A.; Daube, J.R.

    Thirty-eight patients with myokymic discharges localized to limb muscles on needle electromyography had various neurologic lesions, both acute and chronic. Of the 38 patients, 27 had had previous radiation therapy and the clinical diagnosis of radiation-induced plexopathy, myelopathy, or both. For the remaining 11 patients, the diagnoses included multiple sclerosis, inflammatory polyradiculoneuropathy, ischemic neuropathy, inflammatory myopathy, and chronic disorders of the spinal cord and peripheral nerves. The clinical presentations and results of local ischemia, peripheral nerve block, and percutaneous stimulation suggest that most limb myokymic discharges arise focally at the site of a chronic peripheral nerve lesion.

  13. Effectiveness of the Virtual Reality System Toyra on Upper Limb Function in People with Tetraplegia: A Pilot Randomized Clinical Trial.

    Science.gov (United States)

    Dimbwadyo-Terrer, I; Gil-Agudo, A; Segura-Fragoso, A; de los Reyes-Guzmán, A; Trincado-Alonso, F; Piazza, S; Polonio-López, B

    2016-01-01

    The aim of this study was to investigate the effects of a virtual reality program combined with conventional therapy in upper limb function in people with tetraplegia and to provide data about patients' satisfaction with the virtual reality system. Thirty-one people with subacute complete cervical tetraplegia participated in the study. Experimental group received 15 sessions with Toyra(®) virtual reality system for 5 weeks, 30 minutes/day, 3 days/week in addition to conventional therapy, while control group only received conventional therapy. All patients were assessed at baseline, after intervention, and at three-month follow-up with a battery of clinical, functional, and satisfaction scales. Control group showed significant improvements in the manual muscle test (p = 0,043, partial η (2) = 0,22) in the follow-up evaluation. Both groups demonstrated clinical, but nonsignificant, changes to their arm function in 4 of the 5 scales used. All patients showed a high level of satisfaction with the virtual reality system. This study showed that virtual reality added to conventional therapy produces similar results in upper limb function compared to only conventional therapy. Moreover, the gaming aspects incorporated in conventional rehabilitation appear to produce high motivation during execution of the assigned tasks. This trial is registered with EudraCT number 2015-002157-35.

  14. Effectiveness of the Virtual Reality System Toyra on Upper Limb Function in People with Tetraplegia: A Pilot Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    I. Dimbwadyo-Terrer

    2016-01-01

    Full Text Available The aim of this study was to investigate the effects of a virtual reality program combined with conventional therapy in upper limb function in people with tetraplegia and to provide data about patients’ satisfaction with the virtual reality system. Thirty-one people with subacute complete cervical tetraplegia participated in the study. Experimental group received 15 sessions with Toyra® virtual reality system for 5 weeks, 30 minutes/day, 3 days/week in addition to conventional therapy, while control group only received conventional therapy. All patients were assessed at baseline, after intervention, and at three-month follow-up with a battery of clinical, functional, and satisfaction scales. Control group showed significant improvements in the manual muscle test (p = 0,043, partial η2 = 0,22 in the follow-up evaluation. Both groups demonstrated clinical, but nonsignificant, changes to their arm function in 4 of the 5 scales used. All patients showed a high level of satisfaction with the virtual reality system. This study showed that virtual reality added to conventional therapy produces similar results in upper limb function compared to only conventional therapy. Moreover, the gaming aspects incorporated in conventional rehabilitation appear to produce high motivation during execution of the assigned tasks. This trial is registered with EudraCT number 2015-002157-35.

  15. Hybrid functional electrical stimulation orthosis system for the upper limb: effects on spasticity in chronic stable hemiplegia.

    Science.gov (United States)

    Weingarden, H P; Zeilig, G; Heruti, R; Shemesh, Y; Ohry, A; Dar, A; Katz, D; Nathan, R; Smith, A

    1998-01-01

    A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.

  16. Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain.

    Science.gov (United States)

    Preißler, Sandra; Dietrich, Caroline; Blume, Kathrin R; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested the association between the amount of use of the hand prosthesis and cortical volume plasticity. On the behavioral level, we found no relation between PLP and the amount of prosthesis use for the whole patient group. However, by subdividing the patient group into patients with strong PLP and those with low to medium PLP, stronger pain was significantly associated with less prosthesis use whereas the group with low PLP did not show such an association. Most plasticity of cortical volume was identified within the dorsal stream. The more the patients that suffered from strong PLP used their prosthesis, the smaller was the volume of their posterior parietal cortex. Our data indicate a relationship between prosthesis use and cortical plasticity of the visual stream. This plasticity might present a brain adaptation process to new movement and coordination patterns needed to guide an artificial hand.

  17. Plasticity in the Visual System is Associated with Prosthesis Use in Phantom Limb Pain

    Science.gov (United States)

    Preißler, Sandra; Dietrich, Caroline; Blume, Kathrin R.; Hofmann, Gunther O.; Miltner, Wolfgang H. R.; Weiss, Thomas

    2013-01-01

    The experience of strong phantom limb pain (PLP) in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand. To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested the association between the amount of use of the hand prosthesis and cortical volume plasticity. On the behavioral level, we found no relation between PLP and the amount of prosthesis use for the whole patient group. However, by subdividing the patient group into patients with strong PLP and those with low to medium PLP, stronger pain was significantly associated with less prosthesis use whereas the group with low PLP did not show such an association. Most plasticity of cortical volume was identified within the dorsal stream. The more the patients that suffered from strong PLP used their prosthesis, the smaller was the volume of their posterior parietal cortex. Our data indicate a relationship between prosthesis use and cortical plasticity of the visual stream. This plasticity might present a brain adaptation process to new movement and coordination patterns needed to guide an artificial hand. PMID:23805096

  18. Plasticity in the visual system is associated with prosthesis use in phantom limb pain

    Directory of Open Access Journals (Sweden)

    Sandra ePreißler

    2013-06-01

    Full Text Available The experience of strong phantom limb pain (PLP in arm amputees was previously shown to be associated with structural neural plasticity in parts of the cortex that belong to dorsal and ventral visual streams. It has been speculated that this plasticity results from the extensive use of a functional prosthesis which is associated with increased visual feedback to control the artificial hand.To test this hypothesis, we reanalyzed data of cortical volumes of 21 upper limb amputees and tested the association between the amount of use of the hand prosthesis and cortical volume plasticity.On the behavioral level, we found no relation between PLP and the amount of prosthesis use for the whole patient group. However, by subdividing the patient group into patients with strong PLP and those with low to medium PLP, stronger pain was significantly associated with less prosthesis use whereas the group with low PLP did not show such an association.Most plasticity of cortical volume was identified within the dorsal stream. The more the patients that suffered from strong PLP used their prosthesis, the smaller was the volume of their posterior parietal cortex.Our data indicate a relationship between prosthesis use and cortical plasticity of the visual stream. This plasticity might present a brain adaption process to new movement and coordination patterns needed to guide an artificial hand.

  19. Concordance between otic cytology and culture in diagnosis of external otitis canine by Malassezia spp

    Directory of Open Access Journals (Sweden)

    Adriana Pulido-Villamarín

    2015-09-01

    Full Text Available Objective. To determine the correlation between microbiological culture and otic cytology for diagnoses of external otitis by Malassezia in dogs. Materials and methods. 158 ear swabs of dogs with clinical diagnosis of external otitis were analyzed by cytology, mycological culture and metabolic tests. Results. Were obtained a positive results by cytology of 62% and 75.3% by culture. The 31.1% of isolates were identified as M. pachydermatis, 12.6% as M. furfur and 56.3% were classified as Malassezia spp., because was not possible to define the species. We found a positive concordance between cytology and culture for Malassezia spp., of 0.76 with a kappa index of 0.448 (95% CI 0.30 to 0.60 which represents a moderate strength of concordance between the two techniques, without regard the identified species. Conclusions. The use of a diagnostic test is not enough to establish the participation of Malassezia spp., as a causal disease agent.

  20. Postexercise cold water immersion modulates skeletal muscle PGC-1α mRNA expression in immersed and nonimmersed limbs: evidence of systemic regulation.

    Science.gov (United States)

    Allan, Robert; Sharples, Adam P; Close, Graeme L; Drust, Barry; Shepherd, Sam O; Dutton, John; Morton, James P; Gregson, Warren

    2017-08-01

    Mechanisms mediating postexercise cold-induced increases in PGC-1α gene expression in human skeletal muscle are yet to be fully elucidated but may involve local cooling effects on AMPK and p38 MAPK-related signaling and/or increased systemic β-adrenergic stimulation. Therefore, we aimed to examine whether postexercise cold water immersion enhancement of PGC-1α mRNA is mediated through local or systemic mechanisms. Ten subjects completed acute cycling (8 × 5 min at ~80% peak power output) followed by seated-rest (CON) or single-leg cold water immersion (CWI; 10 min, 8°C). Muscle biopsies were obtained preexercise, postexercise, and 3 h postexercise from a single limb in the CON condition but from both limbs in CWI [thereby providing tissue from a CWI and nonimmersed limb (NOT)]. Muscle temperature decreased up to 2 h postexercise following CWI (-5°C) in the immersed limb, with lesser changes observed in CON and NOT (-3°C, P cold induction of PGC-1α mRNA.NEW & NOTEWORTHY We report for the first time that postexercise cold water immersion of one limb also enhances PGC-1α expression in a contralateral, nonimmersed limb. We suggest that increased systemic β-adrenergic stimulation, and not localized cooling per se, exerts regulatory effects on local signaling cascades, thereby modulating PGC-1α expression. Therefore, these data have important implications for research designs that adopt contralateral, nonimmersed limbs as a control condition while also increasing our understanding of the potential mechanisms underpinning cold-mediated PGC-1α responses. Copyright © 2017 the American Physiological Society.

  1. A pilot study of post-total knee replacement gait rehabilitation using lower limbs robot-assisted training system.

    Science.gov (United States)

    Li, Jianhua; Wu, Tao; Xu, Zhisheng; Gu, Xudong

    2014-02-01

    The aim of this study was to explore the application value of the lower limbs robot-assisted training system for post-total knee replacement (TKR) gait rehabilitation. A total of 60 patients with osteoarthritis of the knee were equally randomized into the traditional and robot-assisted rehabilitation training groups within 1 week after TKR. All patients received 2-week training. Scores of hospital for special surgery (HSS), knee kinesthesia grades, knee proprioception grades, functional ambulation (FAC) scores, Berg balance scores, 10-m sitting-standing time, and 6-min walking distances were compared between the groups. The HSS score, Berg score, 10-m sitting-standing time, and 6-min walking distance of the robot-assisted training group were significantly higher than the control group (P 0.05). Lower limbs robot-assisted rehabilitation training improves post-TKR patients' knee proprioception and stability more effectively compared with the traditional method. It improves patients' gait and symptoms, increases their walking speed, and prolongs their walking distances, which benefit their return to family and society.

  2. Limb girdle muscular dystrophies

    DEFF Research Database (Denmark)

    Vissing, John

    2016-01-01

    PURPOSE OF REVIEW: The aim of the study was to describe the clinical spectrum of limb girdle muscular dystrophies (LGMDs), the pitfalls of the current classification system for LGMDs, and emerging therapies for these conditions. RECENT FINDINGS: Close to half of all LGMD subtypes have been...

  3. Technical Aspects and Validation of a New Biofeedback System for Measuring Lower Limb Loading in the Dynamic Situation

    Directory of Open Access Journals (Sweden)

    Marco Raaben

    2017-03-01

    Full Text Available Background: A variety of techniques for measuring lower limb loading exists, each with their own limitations. A new ambulatory biofeedback system was developed to overcome these limitations. In this study, we described the technical aspects and validated the accuracy of this system. Methods: A bench press was used to validate the system in the static situation. Ten healthy volunteers were measured by the new biofeedback system and a dual-belt instrumented treadmill to validate the system in the dynamic situation. Results: Bench press results showed that the sensor accurately measured peak loads up to 1000 N in the static situation. In the healthy volunteers, the load curves measured by the biofeedback system were similar to the treadmill. However, the peak loads and loading rates were lower in the biofeedback system in all participants at all speeds. Conclusions: Advanced sensor technologies used in the new biofeedback system resulted in highly accurate measurements in the static situation. The position of the sensor and the design of the biofeedback system should be optimized to improve results in the dynamic situation.

  4. Interface stress in socket/residual limb with transtibial prosthetic suspension systems during locomotion on slopes and stairs.

    Science.gov (United States)

    Eshraghi, Arezoo; Abu Osman, Noor Azuan; Gholizadeh, Hossien; Ali, Sadeeq; Abas, Wan Abu Bakar Wan

    2015-01-01

    This study aimed to compare the effects of different suspension methods on the interface stress inside the prosthetic sockets of transtibial amputees when negotiating ramps and stairs. Three transtibial prostheses, with a pin/lock system, a Seal-In system, and a magnetic suspension system, were created for the participants in a prospective study. Interface stress was measured as the peak pressure by using the F-socket transducers during stairs and ramp negotiation. Twelve individuals with transtibial amputation managed to complete the experiments. During the stair ascent and descent, the greatest peak pressure was observed in the prosthesis with the Seal-In system. The magnetic prosthetic suspension system caused significantly different peak pressure at the anterior proximal region compared with the pin/lock (P = 0.022) and Seal-In (P = 0.001) during the stair ascent. It was also observed during the stair descent and ramp negotiation. The prostheses exhibited varying pressure profiles during the stair and ramp ascent. The prostheses with the pin/lock and magnetic suspension systems exhibited lower peak pressures compared with the Seal-In system. The intrasystem pressure distribution at the anterior and posterior regions of the residual limb was fairly homogenous during the stair and ramp ascent and descent. Nevertheless, the intrasystem pressure mapping revealed a significant difference among the suspension types, particularly at the anterior and posterior sensor sites.

  5. Rehabilitation for hemiplegia using an upper limb training system based on a force direction.

    Science.gov (United States)

    Ogata, Kunihiro; Hirabayashi, Yuto; Kubota, Keisuke; Hasegawa, Yuri; Tsuji, Toshiaki

    2017-07-01

    Hemiplegia patients have complete paralysis of half their body, and encounter many challenges in living an independent life. Rehabilitation of the lower body is more important than that of the upper body for independent living; thus, recovering upper body functions of their paralyzed side is not enough. Rehabilitation robots may be used to assist training without therapists. In this study, a small portable rehabilitation robot was developed for use at home, and a new training method was proposed. This robot consists on an omni wheel mechanism and a force sensor, and is capable of deciding the motion based on the force value. Voluntary movement of a hemiplegia patient is recovered by the rehabilitation robot and proposed training method. Thus, verification experiments were performed using participants with hemiplegia. The CCI (Co-Contraction Index) from after training were smaller than ones of before training, thus the movement skills of the participants improved with respect to controlling force direction and magnitude. Moreover, manual function test (MFT) scores increased as reflected by improvements in the motor function of the upper limb using the proposed training method.

  6. Development of a neurotechnological system for relieving phantom limb pain using transverse intrafascicular electrodes (TIME).

    Science.gov (United States)

    Stieglitz, Thomas; Boretius, Tim; Navarro, Xavier; Badia, Jordi; Guiraud, David; Divoux, Jean-Louis; Micera, Silvestro; Rossini, Paolo Maria; Yoshida, Ken; Harreby, Kristian R; Kundu, Aritra; Jensen, Winnie

    2012-12-01

    Phantom limb pain (PLP) is a chronic condition that develops in the majority of amputees. The underlying mechanisms are not completely understood, and thus, no treatment is fully effective. Based on recent studies, we hypothesize that electrical stimulation of afferent nerves might alleviate PLP by giving sensory input to the patient if nerve fibers can be activated selectively. The critical component in this scheme is the implantable electrode structure. We present a review of a novel electrode concept to distribute highly selective electrode contacts over the complete cross section of a peripheral nerve to create a distributed activation of small nerve fiber ensembles at the fascicular level, the transverse intrafascicular multichannel nerve electrode (TIME). The acute and chronic implantations in a small animal model exhibited a good surface and structural biocompatibility as well as excellent selectivity. Implantation studies on large animal models that are closer to human nerve size and anatomical complexity have also been conducted. They proved implant stability and the ability to selectively activate nerve fascicles in a limited proximity to the implant. These encouraging results have opened the way forward for human clinical trials in amputees to investigate the effect of selective electrical stimulation on PLP.

  7. ArmAssist Robotic System versus Matched Conventional Therapy for Poststroke Upper Limb Rehabilitation: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Tijana J. Dimkić Tomić

    2017-01-01

    Full Text Available The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group (n=13 each. Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS and Barthel index (BI. The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 ± 9.4 versus 7.5 ± 5.5, p=0.002 and WMFT-FAS score (14.1 ± 7.9 versus 6.7 ± 7.8, p=0.025 after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 ± 24.8 versus 13.1 ± 10.7, p=0.292. There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke. The study has been registered at the ClinicalTrials.gov, ID: NCT02729649.

  8. Psychophysical correlates of phantom limb experience.

    Science.gov (United States)

    Katz, J

    1992-01-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intensity of any phantom limb sensation or pain they experienced. The results from both sessions showed that mean skin temperature was significantly lower at the stump than the contralateral limb in the groups with phantom limb pain and non-painful phantom limb sensations, but not among subjects with no phantom limb at all. In addition, stump skin conductance responses correlated significantly with the intensity of non-painful phantom limb paresthesiae but not other qualities of sensation or pain. Between-limb measures of pressure sensitivity were not significantly different in any group. The results suggest that the presence of a phantom limb, whether painful or painless, is related to the sympathetic-efferent outflow of cutaneous vasoconstrictor fibres in the stump and stump neuromas. The hypothesis of a sympathetic-efferent somatic-afferent mechanism involving both sudomotor and vasoconstrictor fibres is proposed to explain the relationship between stump skin conductance responses and non-painful phantom limb paresthesiae. It is suggested that increases in the intensity of phantom limb paresthesiae follow bursts of sympathetic activity due to neurotransmitter release onto apposing sprouts of large diameter primary afferents located in stump neuromas, and decreases correspond to periods of relative sympathetic inactivity. The results of the study agree with recent suggestions that phantom limb pain is not a unitary syndrome, but a symptom class with each class subserved by

  9. [Research and Development of A Kinect Based Virtual System for Upper Limb Rehabilitation].

    Science.gov (United States)

    Ding, Weili; Zheng, Yazhuo; Su, Yuping; Li, Xiaoli; Wei, Xiuli

    2015-06-01

    We developed a rehabilitation system by using the virtual reality technique and the Kinect in this paper. The system combines rehabilitation training with HMI and serious game organically, and provides a game and motion database to meet different patients' demands. Extended interface of game database is provided in two ways: personalized games can be developed by Virtools and Flash games which are suitable for patients' rehabilitation can be download from the Internet directly. In addition, the system provides patients with flexible interaction and easy control mode, and also presents real time data recording. An objective and subjective evaluation method is proposed to review the effectiveness of the rehabilitation training. According to the results of short questionnaires and the evaluation results of patients' rehabilitation training, the system compared with traditional rehabilitation can record and analyze the training data, which is useful to make rehabilitation plans. More entertainment and lower cost will increase patients' motivation, which helps to increase the rehabilitation effectiveness.

  10. Evaluation of a new low-dose biplanar system to assess lower-limb alignment in 3D: a phantom study.

    Science.gov (United States)

    Thelen, Philippe; Delin, Cyrille; Folinais, Dominique; Radier, Catherine

    2012-09-01

    Knee coronal alignment is routinely assessed on a full-length radiograph of the lower limbs. However, poor positioning of the knee during the procedure affects the accuracy of this kind of measurement, particularly in cases combining knee rotation and flexion. The purpose of this study was to assess the value of a three-dimensional assessment of the hip-knee-ankle (HKA) angle based on a biplanar radiographic system. A biplanar slot scanning system was used to take radiographs of three lower-limb synthetic models with similar frontal deviation (5° valgus) but different flexion angulations (0°, 9°, and 18°). Biplane acquisitions were done with lower-limb axial rotations ranging from 20° of internal rotation to 20° of external rotation on each of the lower limb models. Three independent observers performed standard 2D measurements of the HKA angle from each anteroposterior (AP) image and also modeled the lower limb in 3D for each biplane acquisition with dedicated software. The HKA angle was automatically calculated from the 3D models. The results of the 2D and 3D techniques were compared. Axial rotation provoked 2D HKA measurement errors up to, respectively, 1.4°, 4.7°, and 6.8° for the lower extremities with 0°, 9°, and 18° flexion, while it never affected the 3D HKA measurement for more than 1.5°. Interobserver errors were 0.7° (SD = 0.5°) for the 2D measurements and 0.6° (SD = 0.4°) for the 3D measurements. The 3D modeling allows for a more accurate evaluation of coronal alignment compared to 2D, eliminating bias due to wrong knee positioning.

  11. Impact of a terbinafine-florfenicol-betamethasone acetate otic gel on the quality of life of dogs with acute otitis externa and their owners.

    Science.gov (United States)

    Noli, Chiara; Sartori, Roberta; Cena, Tiziana

    2017-08-01

    Treatment of canine otitis externa with owner-administered products can be difficult. To evaluate otic treatment administered by a veterinarian on quality of life (QoL) of dogs with otitis externa and their owners, and on clinical and cytology parameters of otitis; compared to an owner-administered treatment. Fifty client-owned dogs randomly randomized into two groups and treated for 2 weeks. Veterinarians treated Group A dogs with a veterinary licensed otic gel on two occasions at a 1 week interval; owners treated Group B dogs once daily with a veterinary licensed otic drop based product along with twice weekly cleaning. Veterinarians evaluated otitis with the OTI-3 scale and semi-quantitative cytological examination on days 0, 7, 14 and 28. At each visit, owners assessed QoL with a validated questionnaire and pruritus with a Visual Analog Scale. Scores before and after treatment of each group, and differences between groups were analysed statistically. In both groups, all parameters improved significantly. There was a significantly higher improvement of QoL scores, for dogs and owners, in Group A, compared to Group B at all time points (P owner QoL on Day 28. There was no difference in improvement of OTI-3 between groups at any time point, whereas Group A cytology scores and pruritus improved significantly more by Day 7 (P = 0.0026 and P = 0.0294, respectively). A veterinarian-administered otic gel provided equivalent efficacy and higher QoL to dogs with otitis externa and their owners, compared to an owner-administered topical otic therapy. © 2017 The Authors. Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of the ESVD and the ACVD.

  12. Estimation of Individual Muscular Forces of the Lower Limb during Walking Using a Wearable Sensor System

    Directory of Open Access Journals (Sweden)

    Suin Kim

    2017-01-01

    Full Text Available Although various kinds of methodologies have been suggested to estimate individual muscular forces, many of them require a costly measurement system accompanied by complex preprocessing and postprocessing procedures. In this research, a simple wearable sensor system was developed, combined with the inverse dynamics-based static optimization method. The suggested method can be set up easily and can immediately convert motion information into muscular forces. The proposed sensor system consisted of the four inertial measurement units (IMUs and manually developed ground reaction force sensor to measure the joint angles and ground reaction forces, respectively. To verify performance, the measured data was compared with that of the camera-based motion capture system and a force plate. Based on the motion data, muscular efforts were estimated in the nine muscle groups in the lower extremity using the inverse dynamics-based static optimization. The estimated muscular forces were qualitatively analyzed in the perspective of gait functions and compared with the electromyography signal.

  13. Comparison radiation dose with upper and lower limbs of automated injection of contrast media with a bolus tracking system in pulmonary embolism MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Kweon, Dae Cheol [Shin Heung College University, Uijeongbu (Korea, Republic of); Dong, Kyung Rae [Gwangju Health College University, Gwangju (Korea, Republic of); Chung, Woon Kwan [Chosun University, Gwangju (Korea, Republic of); Jung, Jae Eun [Nambu University, Gwangju (Korea, Republic of); Ryu, Young Hwan [Seoul Medical Center, Seoul (Korea, Republic of)

    2009-12-15

    Bolus tracking system allows optimized enhancement of the organs and reduces the dose of contrast material. In a retrospective study we investigated the radiation dose of this method with the intention of optimizing enhancement during examination of the pulmonary embolism MDCT. The purpose of the study was to compare radiation dose (CTDIvol and DLP) of MDCT performed with bolus tracking system in the pulmonary embolism. In total, we examined 75 patients under pulmonary embolism conditions. All examinations were performed on a MDCT system using the bolus tracking system of blood from the upper body to the lower limbs of patient. This produces repetitive low-dose test images and measures the Hounsfield attenuation in a pre-selected region of interest. After exceeding a defined threshold, a diagnostic spiral CT examination was begun automatically. Compared with bolus tracking system, upper limb injected of contrast media resulted in reduction of the pulmonary embolism in the CTDIvol (81.1%) and DLP (82.1%). Bolus triggering allows optimized enhancement of the organs and reduces the dose of contrast material required compared with lower limbs administration.

  14. Mobile Gait Analysis System for Lower Limb Amputee High-Level Activity Rehabilitation

    Science.gov (United States)

    2012-09-01

    affordable over the past several years driven by the smart phone and videogame industries. For our application, the accelerometer needs to detect >6...devices and tools [31-36]. Otto Bock HealthCare is the world market leader in prosthetics and is an outstanding system provider of high-quality and...morae.asp). This software is designed for usability testing and market research. It can capture audio, video, and annotations made be the moderator. This

  15. Reliability of an Integrated Ultrasound and Stereophotogrammetric System for Lower Limb Anatomical Characterisation

    Directory of Open Access Journals (Sweden)

    Frederick Greatrex

    2017-01-01

    Full Text Available Background. Lower extremity analysis for preoperative total knee and hip arthroplasty routines can increase surgery success rate and hence reduce associated costs. Current tools are limited by being invasive, limited to supine analysis, or too expensive. This study aimed to propose and validate a device, OrthoPilot®, based on the combined use of a stereophotogrammetric and ultrasound system which can in vivo and noninvasively measure varus/valgus, flexion/extension, femur and tibia torsion, and femur and tibia lengths. Methods. A phantom was measured by four operators to determine the resolution of the system. Interoperator variability was measured on three operators who measured the above six variables on both legs of three subjects in standing and supine positions. Intraoperator variability was assessed on data from three repeats from 9 subjects (18 legs. Results. All 6 variables were reliably detected on a phantom, with a resolution of 1 mm and 0.5°. Inter- and intraoperator consistency was observed for varus/valgus, flexion/extension, and length measurements on the healthy subjects in standing and supine positions (all ICC > 0.93. For torsion measurements, there was a considerable variation. Conclusion. The proposed system, when used on healthy subjects, allowed reliable measurements of key parameters for preoperative procedures in both supine and standing positions. Accuracy testing and further validation on patient populations will be the next step toward its clinical adoption.

  16. The development of multi-model rehabilitation training system for lower limb sitting function

    Science.gov (United States)

    Wu, Jianfeng; Sun, Yue; Wu, Qun

    2017-04-01

    The multi-model rehabilitation training system was manufactured according to the demands of patients' practical training. Through the use of the patient's exercise physiology information, the ability of muscle force and movement efficiency of the patient were identified. Following with medical rehabilitation therapy, the training model, a combination of active and passive training, was proposed to enhance the training efficiency and rehabilitation effect. Furthermore, taking the sitting movement training as an example, the research theory was applied in knee rehabilitation training. The results of the research provid technical support and practical reference to the relevant training equipment designs and clinical applications.

  17. Characteristic analysis of the lower limb muscular strength training system applied with MR dampers.

    Science.gov (United States)

    Yu, Chang Ho; Piao, Young Jun; Kim, Kyung; Kwon, Tae Kyu

    2014-01-01

    A new training system that can adjust training intensity and indicate the center pressure of a subject was proposed by applying controlled electric current to the Magneto-Rheological damper. The experimental studying on the muscular activities were performed in lower extremities during maintaining and moving exercises, which were processed on an unstable platform with Magneto rheological dampers and recorded in a monitor. The electromyography (EMG) signals of the eight muscles in lower extremities were recorded and analyzed in certain time and frequency domain. Muscles researched in this paper were rectus femoris (RF), biceps femoris (BF), tensor fasciae latae (TFL), vastuslateralis (VL), vastusmedialis (VM), gastrocnemius (Ga), tibialis anterior (TA), and soleus (So). Differences of muscular activities during four moving exercises were studied in our experimental results. The rate of the increment of the muscular activities was affected by the condition of the unstable platform with MR dampers, which suggested the difference of moving exercises could selectively train each muscle with varying intensities. Furthermore, these findings also proposed that this training system can improve the ability of postural balance.

  18. Development of subliminal persuasion system to improve the upper limb posture in laparoscopic training: a preliminary study.

    Science.gov (United States)

    Zhang, Di; Sessa, Salvatore; Kong, Weisheng; Cosentino, Sarah; Magistro, Daniele; Ishii, Hiroyuki; Zecca, Massimiliano; Takanishi, Atsuo

    2015-11-01

    Current training for laparoscopy focuses only on the enhancement of manual skill and does not give advice on improving trainees' posture. However, a poor posture can result in increased static muscle loading, faster fatigue, and impaired psychomotor task performance. In this paper, the authors propose a method, named subliminal persuasion, which gives the trainee real-time advice for correcting the upper limb posture during laparoscopic training like the expert but leads to a lower increment in the workload. A 9-axis inertial measurement unit was used to compute the upper limb posture, and a Detection Reaction Time device was developed and used to measure the workload. A monitor displayed not only images from laparoscope, but also a visual stimulus, a transparent red cross superimposed to the laparoscopic images, when the trainee had incorrect upper limb posture. One group was exposed, when their posture was not correct during training, to a short (about 33 ms) subliminal visual stimulus. The control group instead was exposed to longer (about 660 ms) supraliminal visual stimuli. We found that subliminal visual stimulation is a valid method to improve trainees' upper limb posture during laparoscopic training. Moreover, the additional workload required for subconscious processing of subliminal visual stimuli is less than the one required for supraliminal visual stimuli, which is processed instead at the conscious level. We propose subliminal persuasion as a method to give subconscious real-time stimuli to improve upper limb posture during laparoscopic training. Its effectiveness and efficiency were confirmed against supraliminal stimuli transmitted at the conscious level: Subliminal persuasion improved upper limb posture of trainees, with a smaller increase on the overall workload.

  19. Comparison of adaptive neuro-fuzzy inference system (ANFIS) and Gaussian processes for machine learning (GPML) algorithms for the prediction of skin temperature in lower limb prostheses.

    Science.gov (United States)

    Mathur, Neha; Glesk, Ivan; Buis, Arjan

    2016-10-01

    Monitoring of the interface temperature at skin level in lower-limb prosthesis is notoriously complicated. This is due to the flexible nature of the interface liners used impeding the required consistent positioning of the temperature sensors during donning and doffing. Predicting the in-socket residual limb temperature by monitoring the temperature between socket and liner rather than skin and liner could be an important step in alleviating complaints on increased temperature and perspiration in prosthetic sockets. In this work, we propose to implement an adaptive neuro fuzzy inference strategy (ANFIS) to predict the in-socket residual limb temperature. ANFIS belongs to the family of fused neuro fuzzy system in which the fuzzy system is incorporated in a framework which is adaptive in nature. The proposed method is compared to our earlier work using Gaussian processes for machine learning. By comparing the predicted and actual data, results indicate that both the modeling techniques have comparable performance metrics and can be efficiently used for non-invasive temperature monitoring. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  20. Relation between systemic inflammatory markers, peripheral muscle mass, and strength in limb muscles in stable COPD patients

    Directory of Open Access Journals (Sweden)

    Ferrari R

    2015-08-01

    Full Text Available Renata Ferrari,1 Laura MO Caram,1 Marcia M Faganello,2 Fernanda F Sanchez,3 Suzana E Tanni,1 Irma Godoy1 1Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu, São Paulo, 2Paulista State University, Department of Physiotherapy and Occupational Therapy, Marilia, São Paulo, 3Federal University of Amazonas, Department of Physiotherapy, Manaus, Amazonas, Brazil Abstract: The aim of this study was to investigate the association between systemic inflammatory mediators and peripheral muscle mass and strength in COPD patients. Fifty-five patients (69% male; age: 64±9 years with mild/very severe COPD (defined as forced expiratory volume in the first second [FEV1] =54%±23% were evaluated. We evaluated serum concentrations of IL-8, CRP, and TNF-α. Peripheral muscle mass was evaluated by computerized tomography (CT; midthigh cross-sectional muscle area (MTCSA and midarm cross-sectional muscle area (MACSA were obtained. Quadriceps, triceps, and biceps strength were assessed through the determination of the one-repetition maximum. The multiple regression results, adjusted for age, sex, and FEV1%, showed positive significant association between MTCSA and leg extension (0.35 [0.16, 0.55]; P=0.001, between MACSA and triceps pulley (0.45 [0.31, 0.58]; P=0.001, and between MACSA and biceps curl (0.34 [0.22, 0.47]; P=0.001. Plasma TNF-α was negatively associated with leg extension (-3.09 [-5.99, -0.18]; P=0.04 and triceps pulley (-1.31 [-2.35, -0.28]; P=0.01, while plasma CRP presented negative association with biceps curl (-0.06 [-0.11, -0.01]; P=0.02. Our results showed negative association between peripheral muscle mass (evaluated by CT and muscle strength and that systemic inflammation has a negative influence in the strength of specific groups of muscles in individuals with stable COPD. This is the first study showing association between systemic inflammatory markers and strength in upper limb muscles. Keywords

  1. Safety and Effectiveness of Bone Marrow Cell Concentrate in the Treatment of Chronic Critical Limb Ischemia Utilizing a Rapid Point-of-Care System

    Directory of Open Access Journals (Sweden)

    Venkatesh Ponemone

    2017-01-01

    Full Text Available Critical limb ischemia (CLI is the end stage of lower extremity peripheral vascular disease (PVD in which severe obstruction of blood flow results in ischemic rest pain, ulcers and/or gangrene, and a significant risk of limb loss. This open-label, single-arm feasibility study evaluated the safety and therapeutic effectiveness of autologous bone marrow cell (aBMC concentrate in revascularization of CLI patients utilizing a rapid point-of-care device. Seventeen (17 no-option CLI patients with ischemic rest pain were enrolled in the study. Single dose of aBMC, prepared utilizing an intraoperative point-of-care device, the Res-Q™ 60 BMC system, was injected intramuscularly into the afflicted limb and patients were followed up at regular intervals for 12 months. A statistically significant improvement in Ankle Brachial Index (ABI, Transcutaneous Oxygen Pressure (TcPO2, mean rest pain and intermittent claudication pain scores, wound/ ulcer healing, and 6-minute walking distance was observed following aBMC treatment. Major amputation-free survival (mAFS rate and amputation-free rates (AFR at 12 months were 70.6% and 82.3%, respectively. In conclusion, aBMC injections were well tolerated with improved tissue perfusion, confirming the safety, feasibility, and preliminary effectiveness of aBMC treatment in CLI patients.

  2. A gait retraining system using augmented-reality to modify footprint parameters: Effects on lower-limb sagittal-plane kinematics.

    Science.gov (United States)

    Bennour, Sami; Ulrich, Baptiste; Legrand, Thomas; Jolles, Brigitte M; Favre, Julien

    2018-01-03

    Improving lower-limb flexion/extension angles during walking is important for the treatment of numerous pathologies. Currently, these gait retraining procedures are mostly qualitative, often based on visual assessment and oral instructions. This study aimed to propose an alternative method combining motion capture and display of target footprints on the floor. The second objectives were to determine the error in footprint modifications and the effects of footprint modifications on lower-limb flexion/extension angles. An augmented-reality system made of an optoelectronic motion capture device and video projectors displaying target footprints on the floor was designed. 10 young healthy subjects performed a series of 27 trials, consisting of increased and decreased amplitudes in stride length, step width and foot progression angle. 11 standard features were used to describe and compare lower-limb flexion/extension angles among footprint modifications. Subjects became accustomed to walk on target footprints in less than 10 min, with mean (± SD) precision of 0.020 ± 0.002 m in stride length, 0.022 ± 0.006 m in step width, and 2.7 ± 0.6° in progression angle. Modifying stride length had significant effects on 3/3 hip, 2/4 knee and 4/4 ankle features. Similarly, step width and progression angle modifications affected 2/3 and 1/3 hip, 2/4 and 1/4 knee as well as 3/4 and 2/4 ankle features, respectively. In conclusion, this study introduced an augmented-reality method allowing healthy subjects to modify their footprint parameters rapidly and precisely. Walking with modified footprints changed lower-limb sagittal-plane kinematics. Further research is needed to design rehabilitation protocols for specific pathologies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Limb lengthening in achondroplasia

    Directory of Open Access Journals (Sweden)

    Sanjay K Chilbule

    2016-01-01

    Full Text Available Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%, 9.9 cm (52.8% and 9.6 cm (77.9%, respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3 rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment. Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length carries significant risk and should be undertaken only after due

  4. Lower limb amputation for diabetic foot.

    Science.gov (United States)

    Ohsawa, S; Inamori, Y; Fukuda, K; Hirotuji, M

    2001-01-01

    We amputated 35 limbs of 27 patients with diabetic foot from March 1988 to March 1998. The mean age of the patients at the time of operation was 67 years, and the mean follow-up period was 27 months. Thirteen patients died in the period from 1 day to 39 months after the operation. All patients suffering from diabetic foot were referred to our department for surgical procedures after failure of conservative treatment conducted elsewhere. Their feet were classified into grade 2-3 in 18 limbs, grade 4-5 in 11 limbs, and gangrene of the lower leg and entire foot in 2 limbs, as classified by the Wagner system. Two patients had cellulitis of the foot and two other limbs had infectious gonarthritis. All patients had type 2 diabetes with poor blood sugar control, and 90% were treated by insulin. All patients suffered from diabetic neuropathy. Half of the patients were put on hemodialysis because of diabetic nephropathy. More than 60% of the patients suffered from arteriosclerosis obliterans. The amputation level of the limb was determined by skin thermography, but the patient's will was critical. The initial amputation levels were: débridement and synovectomy in 4 limbs, toe and digital ray in 15 limbs, transmetatarsal in 3 limbs, transtibial in 9 limbs, transfemoral amputations in 4 limbs. Upper level reamputation was conducted on 15 limbs. Logistic regression analysis revealed that lower temperature of the amputation site, being female, and being elderly were significant risk factors in reamputation. Skin thermography was one of the effective determinants of amputation level, in order to avoid reamputation.

  5. Prescription and repair rates of prosthetic limbs in the VA healthcare system: implications for national prosthetic parity.

    Science.gov (United States)

    Etter, Katherine; Borgia, Matthew; Resnik, Linda

    2014-05-22

    Abstract Purpose: To quantify prescription and repair rates of prosthetic limbs in the Department of Veterans Affairs (VA) and explore differences by level, type, and age. Methods: Veterans (N = 32 440) with an initial prosthetic prescription between 2000 and 2010 were classified by amputation level and type. Annual rates of prescription and repair were calculated using person-time and compared by group. Results: Veterans with upper limb amputation had lower annual prescription and repair rates (0.28 and 0.21) compared with those with lower limb amputation (0.40 and 0.56). Myoelectric devices users had higher prescription rates. However, body-powered users had higher repair rates. Prescription and repair rates for microprocessor knee joints were higher than for fluid and friction devices. Veterans under 65 had 0.07 and 0.16 higher rates of prescription and repair than those over 65 (p < 0.0001). Conclusions: Because the VA is unconstrained by co-pays or caps, data on prosthetic prescription and repair can be used to estimate rates that might occur if national prosthetic parity laws were adopted. Given the rates found, it is likely that annual costs would exceed the typical annual and/or lifetime caps in most insurance plans. In states without prosthetic parity laws, such costs likely limit access to needed devices. Implications for Rehabilitation For the almost 2 million people in the United States living with an amputation or congenital limb loss, purchasing and maintaining a prosthetic limb can be costly, with insurances often imposing annual or lifetime caps. Data on prosthetic purchasing and repair is limited and reliant on self-reported information. Because the VA is unconstrained by co-pays or caps, claims data on prosthetic prescription and repair can be used to estimate rates that might occur if national prosthetic parity laws were adopted. Given the rates found, it is likely that annual costs would exceed the typical annual and/or lifetime caps

  6. Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry.

    Science.gov (United States)

    Abtan, Jérémie; Bhatt, Deepak L; Elbez, Yedid; Sorbets, Emmanuel; Eagle, Kim; Reid, Christopher M; Baumgartner, Iris; Wu, David; Hanson, Mary E; Hannachi, Hakima; Singhal, Puneet K; Steg, Philippe Gabriel; Ducrocq, Gregory

    2017-09-01

    Patients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited. We analyzed baseline characteristics and 4-year follow-up of patients enrolled in the international REduction of Atherothrombosis for Continued Health (REACH) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%-5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates (P < 0.01) vs North America. Renal impairment (P < 0.01), congestive heart failure (P < 0.01), history of diabetes (P < 0.01), history of myocardial infarction (P = 0.01), vascular disease (single or poly, P < 0.01), and older age (P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk (P = 0.03). The limb ischemic event rate was 5.7% at 2 years. Four-year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality. © 2017 Wiley Periodicals, Inc.

  7. The Mouse Limb Anatomy Atlas: An interactive 3D tool for studying embryonic limb patterning

    OpenAIRE

    DeLaurier April; Burton Nicholas; Bennett Michael; Baldock Richard; Davidson Duncan; Mohun Timothy J; Logan Malcolm PO

    2008-01-01

    Abstract Background The developing mouse limb is widely used as a model system for studying tissue patterning. Despite this, few references are available that can be used for the correct identification of developing limb structures, such as muscles and tendons. Existing textual references consist of two-dimensional (2D) illustrations of the adult rat or mouse limb that can be difficult to apply when attempting to describe the complex three-dimensional (3D) relationship between tissues. Result...

  8. Solute Carrier Family 26 Member a2 (slc26a2 Regulates Otic Development and Hair Cell Survival in Zebrafish.

    Directory of Open Access Journals (Sweden)

    Fei Liu

    Full Text Available Hearing loss is one of the most prevalent human birth defects. Genetic factors contribute to the pathogenesis of deafness. It is estimated that one-third of deafness genes have already been identified. The current work is an attempt to find novel genes relevant to hearing loss using guilt-by-profiling and guilt-by-association bioinformatics analyses of approximately 80 known non-syndromic hereditary hearing loss (NSHL genes. Among the 300 newly identified candidate deafness genes, slc26a2 were selected for functional studies in zebrafish. The slc26a2 gene was knocked down using an antisense morpholino (MO, and significant defects were observed in otolith patterns, semicircular canal morphology, and lateral neuromast distributions in morphants. Loss-of-function defects are caused primarily by apoptosis, and morphants are insensitive to sound stimulation and imbalanced swimming behaviours. Morphant defects were found to be partially rescued by co-injection of human SLC26A2 mRNA. All the results suggest that bioinformatics is capable of predicting new deafness genes and this showed slc26a2 is to be a critical otic gene whose dysfunction may induce hearing impairment.

  9. Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Calderwood, C.J. [St John' s Hospital, Livingston and Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom)], E-mail: catherine.calderwood@luht.scot.nhs.uk; Jamieson, R. [Princess Royal Maternity Unit, Glasgow Royal Infirmary, Glasgow (United Kingdom); Greer, I.A. [Hull York Medical School, University of York, York (United Kingdom)

    2007-12-15

    Objective: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. Methods: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. Results: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. Conclusions: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population.

  10. Factors Leading to Improved Gait Function in Patients with Subacute or Chronic Central Nervous System Impairments Who Receive Functional Training with the Robot Suit Hybrid Assistive Limb.

    Science.gov (United States)

    Nishimura, Masahiko; Kobayashi, Shigetaka; Kinjo, Yuki; Hokama, Yohei; Sugawara, Kenichi; Tsuchida, Yukio; Tominaga, Daisuke; Ishiuchi, Shogo

    2017-12-01

    The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (rs = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (rs = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.

  11. Describing severe limb trauma.

    Science.gov (United States)

    Arnez, Z M; Tyler, M P; Khan, U

    1999-06-01

    Seventy-nine severe limb injuries were retrospectively reviewed to compare the AO/ASIF and the Gustillo classifications. Specifically, the suitability of these classifications with respect to prognosis and management of these cases was compared. A healed and stable wound was the ultimate outcome measure. Surrogate outcome measures used were: the time to healing; the number of anaesthetics until the wounds were healed; and the number of operations until the wounds were healed. Any change in lifestyle following the injury was also assessed. The primary healing rates of the AO/ASIF groups showed significant (P Gustillo system, the primary healing rates did not show any differences between the groups. Also, differences in the other outcome measures were most pronounced when using the AO/ASIF system. Importantly, changes in lifestyle correlated with the injury score when using the AO/ASIF system (P Gustillo system was not applicable in 100% of cases. A modified AO/ASIF scoring system is proposed which provides a good predictor of outcome.

  12. Three-dimensional reconstructions for asymptomatic and cerebral palsy children's lower limbs using a biplanar X-ray system: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Assi, Ayman, E-mail: ayman.assi@gmail.com [Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris (France); Laboratory of Biomechanics, Faculty of Medicine, University of Saint-Joseph, Beirut (Lebanon); Gait and Motion Analysis Lab, SESOBEL, Beirut (Lebanon); Chaibi, Yasmina, E-mail: yasmina.chaibi@gmail.com [Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris (France); Presedo, Ana, E-mail: a.presedo@gmail.com [Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris (France); Hôpital Robert Debré, Paris (France); Dubousset, Jean, E-mail: jean.dubousset@wanadoo.fr [Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris (France); Ghanem, Ismat, E-mail: ghanem.i@dm.net.lb [Laboratory of Biomechanics, Faculty of Medicine, University of Saint-Joseph, Beirut (Lebanon); Gait and Motion Analysis Lab, SESOBEL, Beirut (Lebanon); Hôpital Hôtel Dieu de France, Beirut (Lebanon); Skalli, Wafa, E-mail: wafa.skalli@ensam.eu [Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris (France)

    2013-12-01

    The aim of this study is to explore the feasibility of 3D subject-specific skeletal reconstructions of lower limb in children using stereoradiography, and to assess uncertainty of clinical and anatomical parameters for children with cerebral palsy and for healthy children. The stereoradiography technique, using the EOS{sup ®} system (Eos-imaging{sup ®}), is based on the acquisition of two simultaneous digital anteroposterior and lateral X-rays, from head to feet in standing position and at low radiation dose. This technique allows subject-specific skeletal 3D reconstructions. Five children with cerebral palsy (CP) and 5 typically developing children (TD) were included in the study. Two operators performed the lower limb reconstructions twice. Tridimensional reconstructions were feasible for children over the age of 5 years. The study of reproducibility of anatomical parameters defining skeletal alignment showed uncertainties under 3° for the neck shaft angle, the femoral mechanical angle, and for the femoral and tibial torsions. The maximum degree of uncertainty was obtained for the femoral tibial rotation (4° for healthy children and 3.5° for children with CP)

  13. Biomechanical evaluation of a novel Limb Prosthesis Osseointegrated Fixation System designed to combine the advantages of interference-fit and threaded solutions.

    Science.gov (United States)

    Prochor, Piotr; Piszczatowski, Szczepan; Sajewicz, Eugeniusz

    2016-01-01

    The study was aimed at biomechanical evaluation of a novel Limb Prosthesis Osseointegrated Fixation System (LPOFS) designed to combine the advantages of interference-fit and threaded solutions. Three cases, the LPOFS (designed), the OPRA (threaded) and the ITAP (interference-fit) implants were studied. Von-Mises stresses in bone patterns and maximal values generated while axial loading on an implant placed in bone and the force reaction values in contact elements while extracting an implant were analysed. Primary and fully osteointegrated connections were considered. The results obtained for primary connection indicate more effective anchoring of the OPRA, however the LPOFS provides more appropriate stress distribution (lower stress-shielding, no overloading) in bone. In the case of fully osteointegrated connection the LPOFSs kept the most favourable stress distribution in cortical bone which is the most important long-term feature of the implant usage and bone remodelling. Moreover, in fully bound connection its anchoring elements resist extracting attempts more than the ITAP and the OPRA. The results obtained allow us to conclude that in the case of features under study the LPOFS is a more functional solution to direct skeletal attachment of limb prosthesis than the referential implants during short and long-term use.

  14. A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke.

    Science.gov (United States)

    Stockley, Rachel C; O'Connor, Deborah A; Smith, Phil; Moss, Sylvia; Allsop, Lizzie; Edge, Wendy

    2017-01-01

    Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber) in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it. Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants' views about using the YouGrabber. Results. Twelve participants (6 females) with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2-1.25; p < 0.05) within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges. Conclusions. The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.

  15. A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke

    Directory of Open Access Journals (Sweden)

    Rachel C. Stockley

    2017-01-01

    Full Text Available Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it. Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants’ views about using the YouGrabber. Results. Twelve participants (6 females with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2–1.25; p<0.05 within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges. Conclusions. The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.

  16. Upper limb neurorehabilitation in patients with stroke using haptic device system: reciprocal bi-articular muscle activities reflect as a result of improved circle-drawing smoothness.

    Science.gov (United States)

    Miyoshi, Tasuku; Takahashi, Yoshiyuki; Lee, Hokyoo; Suzuki, Tadashi; Komeda, Takashi

    2010-01-01

    Muscular co-contraction resulted in corrected elbow and shoulder joint stiffness; however, this correction neither ameliorated endpoint oscillation nor assisted in the execution of smooth two-joint arm movements. We hypothesised that the reacquisition of smooth arm movements became synonymous with the restoration of time-domain reciprocal electromyographic (EMG) activities in biarticular arm muscles. The purpose of this study was to investigate whether or not the restored reciprocal EMG activities in biarticular arm muscles reflected improved smooth motor performance in patients with stroke after 10 days of two-joint arm-movement training. Three male patients with sub-acute stroke with left-arm paralysis performed circle-drawing tasks using a haptic device system for upper limb neuromuscular rehabilitation. After the training, the movement velocities and achievement periods increased with the enhancement of the reciprocal EMG activities in biarticular arm muscles, and there was less jerkness in movement after training for the same duration. Patients with stroke could achieve smooth motor performance with the restoration of the reciprocal EMG activities in biarticular arm muscles. Therefore, the reciprocal EMG activities in biarticular arm muscles in response to circle drawing would be an index for the progressive improvements of smooth motor functions in the upper limbs.

  17. [Quality standards for ultrasound assessment of the superficial venous system of the lower limbs. Report of the French Society for Vascular Medicine].

    Science.gov (United States)

    Auvert, J-F; Chleir, F; Coppé, G; Hamel-Desnos, C; Moraglia, L; Pichot, O

    2014-02-01

    The quality standards of the French Society for Vascular Medicine for the ultrasound assessment of the superficial venous system of the lower limbs are based on the two following requirements: technical know-how (mastering the use of ultrasound devices and the method of examination); medical know-how (ability to adapt the methods and scope of the examination to its clinical indications and purpose and to rationally analyze and interpret its results). To describe an optimal method of examination in relation to the clinical question and hypothesis; to achieve consistent practice, methods, glossary terminologies and reporting; to provide good practice reference points and to promote a high quality process. The three levels of examination. Their clinical indications and goals. The reference standard examination (level 2) and its variants according to clinical needs. The minimal content of the examination report, the letter to the referring physician (synthesis, conclusion and management suggestions) and iconography. Commented glossary (anatomy, hemodynamics, semiology). Technical basis. Ultrasound devices settings. We discuss of use of Duplex ultrasound for the assessment of the superficial veins of the lower limbs in vascular medicine practice. Copyright © 2014. Published by Elsevier Masson SAS.

  18. Moving a generalised limb : a simulation with consequences for theories on limb control

    NARCIS (Netherlands)

    Otten, E

    The movement control of articulated limbs in vertebrates has been explained in terms of equilibrium points and moving equilibrium points or virtual trajectories. These hypotheses state that the nervous system makes the control Of multi-segment limbs easier by simply planning in terms of these

  19. Upper Limb Exoskeleton

    NARCIS (Netherlands)

    Rusak, Z.; Luijten, J.; Kooijman, A.

    2015-01-01

    The present invention relates a wearable exoskeleton for a user having a torso with an upper limb to support motion of the said upper limb. The wearable exoskeleton comprises a first fixed frame mountable to the torso, an upper arm brace and a first group of actuators for moving the upper arm brace

  20. Activation of the human mirror neuron system during the observation of the manipulation of virtual tools in the absence of a visible effector limb.

    Science.gov (United States)

    Modroño, Cristián; Navarrete, Gorka; Rodríguez-Hernández, Antonio F; González-Mora, José L

    2013-10-25

    This work explores the mirror neuron system activity produced by the observation of virtual tool manipulations in the absence of a visible effector limb. Functional MRI data was obtained from healthy right-handed participants who manipulated a virtual paddle in the context of a digital game and watched replays of their actions. The results show how action observation produced extended bilateral activations in the parietofrontal mirror neuron system. At the same time, three regions in the left hemisphere (in the primary motor and the primary somatosensory cortex, the supplementary motor area and the dorsolateral prefrontal cortex) showed a reduced BOLD, possibly related with the prevention of inappropriate motor execution. These results can be of interest for researchers and developers working in the field of action observation neurorehabilitation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Pattern Formation in Vertebrate Limbs

    Science.gov (United States)

    1995-05-08

    embryological systems was sporadic. A resurgence of interest occurred in the 1960 ’ s. It was at this time that Wolpert presented his concept of positional...as are changes in receptors on the plasma membrane (Hood, Huang, & Dreyer, 1977) . 11 DEVELOPMENT AND PATTERNS IN THE EMBRYONIC CHICKEN LIMB The...Development i. Stages 1 to 6 The period of gestation for the chicken is 20 to 21 days and is divided into a series of stages identified by

  2. Influence of complementing a robotic upper limb rehabilitation system with video games on the engagement of the participants: a study focusing on muscle activities.

    Science.gov (United States)

    Li, Chong; Rusák, Zoltán; Horváth, Imre; Ji, Linhong

    2014-12-01

    Efficacious stroke rehabilitation depends not only on patients' medical treatment but also on their motivation and engagement during rehabilitation exercises. Although traditional rehabilitation exercises are often mundane, technology-assisted upper-limb robotic training can provide engaging and task-oriented training in a natural environment. The factors that influence engagement, however, are not fully understood. This paper therefore studies the relationship between engagement and muscle activities as well as the influencing factors of engagement. To this end, an experiment was conducted using a robotic upper limb rehabilitation system with healthy individuals in three training exercises: (a) a traditional exercise, which is typically used for training the grasping function, (b) a tracking exercise, currently used in robot-assisted stroke patient rehabilitation for fine motor movement, and (c) a video game exercise, which is a proliferating approach of robot-assisted rehabilitation enabling high-level active engagement of stroke patients. These exercises differ not only in the characteristics of the motion that they use but also in their method of triggering engagement. To measure the level of engagement, we used facial expressions, motion analysis of the arm movements, and electromyography. The results show that (a) the video game exercise could engage the participants for a longer period than the other two exercises, (b) the engagement level decreased when the participants became too familiar with the exercises, and (c) analysis of normalized root mean square in electromyographic data indicated that muscle activities were more intense when the participants are engaged. This study shows that several sub-factors on engagement, such as versatility of feedback, cognitive tasks, and competitiveness, may influence engagement more than the others. To maintain a high level of engagement, the rehabilitation system needs to be adaptive, providing different exercises to

  3. Sensorimotor incongruence alters limb perception and movement.

    Science.gov (United States)

    Osumi, Michihiro; Nobusako, Satoshi; Zama, Takuro; Taniguchi, Megumi; Shimada, Sotaro; Morioka, Shu

    2017-09-21

    Altered limb ownership or heaviness has been observed in patients with hemiplegia, chronic pain, and several other conditions. Although these sensations are thought to be caused by sensorimotor incongruence, few studies have systematically verified this relationship. In addition, it remains unclear whether these subjective sensations affect movement execution. In a psychophysical experiment, we systematically investigated the relationships between sensorimotor integration and subjective limb perception, such as sense of ownership/heaviness, and verified the relationship between subjective limb perception and movement execution. Thirty-nine healthy participants were enrolled, and a visual feedback delay system was used to systematically evoke sensorimotor incongruence. Participants periodically flexed and extended their wrist while seeing a delayed image of their hand under five delay conditions (0, 150, 250, 350, 600ms). During wrist movement, electromyography (EMG) activity in flexor carpi radialis (FCR) was recorded. Also, to analyze the change in muscle activity and movement speed, the values of integral and peak frequency were calculated. To record changes in the subjective limb perception of the altered limb ownership and heaviness, we used a 7-point Likert scale for each participant. We found that altered ownership and heaviness increased with increasing feedback delay. Also, muscle activity and movement speed decreased with visual feedback delay. There was no significant correlation between subjective altered limb perception (i.e., altered limb ownership and heaviness) and muscle activity or movement speed. We systematically demonstrated that limb ownership, heaviness, muscle activation and movement speed were altered by sensorimotor incongruence. However, our study did not reveal the relationships between these factors. These results indicate the existence of different mechanisms governing subjective limb perception and movement execution. In the future, we

  4. Incomplete endochondral ossification of the otic capsule, a variation in children: evaluation of its prevalence and extent in children with and without sensorineural hearing loss.

    Science.gov (United States)

    Sanverdi, S E; Ozgen, B; Dolgun, A; Sarac, S

    2015-01-01

    Endochondral ossification of the otic capsule is a process that continues postnatally; hence, incomplete endochondral ossification is seen as pericochlear hypoattenuation on temporal bone CT scans of children. We determined the prevalence and extent of this entity in a large series and assessed its relation to age and underlying sensorineural hearing loss. Initially, temporal bone CTs of 40 children with sensorineural hearing loss were retrospectively assessed and compared with those of a control group scanned for non-sensorineural hearing loss reasons to assess any difference in the prevalence or extent of incomplete endochondral ossification. Then the CT scans of 510 children (age range, 17 days to 17 years) were retrospectively reviewed, and any observed endochondral ossification areas were classified as mild, moderate, or extensive, according to their extent. Neither the presence nor degree of incomplete endochondral ossification had any significant correlation with the presence of sensorineural hearing loss (P = .08 and P = .1, respectively). Incomplete endochondral ossification was more frequently seen (62% of cases) than complete ossification. There was no statistically significant correlation between incomplete endochondral ossification and sex (P = .8), but an inverse correlation was found between the presence of incomplete endochondral ossification and increasing age (P ossification was the most frequent involvement pattern (44.4%). The pericochlear hypoattenuation in the otic capsule representing incomplete endochondral ossification is a normal finding in children and can be seen as a marked curvilinear hypoattenuation at younger ages in the absence of any clinical disorder. © 2015 by American Journal of Neuroradiology.

  5. Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

    Directory of Open Access Journals (Sweden)

    Bachmann Lucas M

    2009-01-01

    Full Text Available Abstract Background Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs and nerve palpation. Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made. Methods Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve. Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation. We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test. Results We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation. Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59. When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06. Conclusion This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to

  6. Upper Limb Exoskeleton

    OpenAIRE

    Rusak, Z.; Luijten, J.; Kooijman, A.

    2015-01-01

    The present invention relates a wearable exoskeleton for a user having a torso with an upper limb to support motion of the said upper limb. The wearable exoskeleton comprises a first fixed frame mountable to the torso, an upper arm brace and a first group of actuators for moving the upper arm brace relative to the first fixed frame. In an example the present invention is for use in post-stroke therapy.

  7. Infrared optoelectronic volumetry, the ideal way to measure limb volume.

    Science.gov (United States)

    Tierney, S; Aslam, M; Rennie, K; Grace, P

    1996-11-01

    The aim of the study was to compare a novel infrared optoelectronic system (Perometer) of limb volume measurement with water displacement and two indirect measurement techniques. A prospective experimental study. In 10 healthy male volunteers (20 limbs) we compared limb volume measurements obtained by water displacement, infrared perometry, the disc model method and the frustrum method. In a further 17 patients with swollen limbs due to lymphatic (9 limbs) or venous (11 limbs) disease, perometry was compared to the disc model method and the frustrum method only. In normal limbs, mean +/- S.D. limb volume using water displacement was 1802 +/- 268 ml. Perometer values agreed almost exactly (1809 +/- 262 ml, r = 0.97, variation +/- 7% by limits of agreement) but both the disc (1923 +/- 306 ml, r = 0.90, variation +/- 14%) and frustrum (1905 +/- 372 ml, r = 0.72, variation +/- 28%) methods significantly overestimated limb volumes (p perometry. Perometry is a novel, extremely accurate and easy method for assessing limb volume. It provides more accurate results than traditional indirect measurement of limb volume and potentially is a very useful clinical and research tool.

  8. The Effect of Otic Melanocyte Destruction on Auditory and Vestibular Function: a Study on Vitiligo Patients

    Directory of Open Access Journals (Sweden)

    Parvane Mahdi

    2016-03-01

    Full Text Available The hallmark of vitiligo is the disappearance of melanocytes from the skin. As a result, of melanocytes presence in the auditory and vestibular apparatus, the involvement of these systems in vitiligo which targets the melanocytes of the whole body is possible; suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem. A total of 21 patients with vitiligo were enrolled in this study. A group of 20 healthy subjects served as a control group. Pure tone audiometry (PTA, auditory brainstem responses (ABR and vestibular evoked myogenic potentials (VEMP were carried out in all participants. High frequency sensory neural hearing loss was seen in 8 (38.09% patients. ABR analysis revealed 10 (47.61% had an abnormal increase in latency of wave III, and 6 (28.57% had an abnormal prolongation of IPL I-III, however, regarding our VEMP findings, there were no recorded responses on left ear of 1 (4.76% patient and latency of p13 was prolonged in 5(23.80% patients. There was no correlation between ages, duration of disease, and any of the recorded parameters (P>0.05. In the present survey, we highlighted the auditory and vestibular involvement in vitiligo patients.

  9. Effect of lower limb rehabilitation robot on lower limb motor function of hemiplegic patients after stroke

    Directory of Open Access Journals (Sweden)

    Jian-liang LU

    2017-07-01

    Full Text Available Objective To observe the rehabilitation effect of lower limb rehabilitation robot training on the lower limb motor function of hemiplegic patients after stroke. Methods A total of 60 stroke patients (duration < 6 months accepted conventional rehabilitation training combined with body weight support treadmill training (BWSTT group, N = 30 or conventional rehabilitation training combined with lower limb rehabilitation robot training (Robot group, N = 30. Fugl - Meyer Assessment Scale for Lower Extremity (FMA-LE was used to evaluate lower limb motor function. Berg Balance Scale (BBS was used to evaluate balance function. Lower limb rehabilitation robot torque feedback system was used to evaluate lower limb muscle strength. All evaluations were performed before and after 8-week training.   Results Compared with before training, the FMA-LE score (P = 0.000, BBS score (P = 0.000, hemiplegic side of hip joint feedback torque value (HJTV, P = 0.000 and knee joint feedback torque value (KJTV, P = 0.000 were increased in both groups after 8-week training. Compared with BWSTT group, the hemiplegic side of HJTV (P = 0.000 and KJTV (P = 0.000 were increased in Robot group after 8-week training, while the FMA-LE score (P = 0.118 and BBS score (P = 0.159 had no statistically significant difference between 2 groups.  Conclusions The lower limb rehabilitation robot or body weight support treadmill training combined with conventional rehabilitation training could improve the lower limb motor function of hemiplegic patients after stroke. The lower limb rehabilitation robot training was better than body weight support treadmill training on the recovery of lower limb muscle strength. DOI: 10.3969/j.issn.1672-6731.2017.05.004  

  10. "Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems

    DEFF Research Database (Denmark)

    Devita, M.A.; Smith, G.B.; Adam, S.K.

    2010-01-01

    Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patie...

  11. "Identifying the hospitalised patient in crisis"--a consensus conference on the afferent limb of rapid response systems

    DEFF Research Database (Denmark)

    DeVita, Michael A; Smith, Gary B; Adam, Sheila K

    2010-01-01

    Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deteriora...

  12. TITLE: OTIC FOREIGN BODIES

    African Journals Online (AJOL)

    Dr. A.O.A. Ogunleye

    P M Eds. Clinical Otolaryngology. Oxford: Blackwell, 1979; 546 – 552. 6. Ijaduola GT, Okeowo PA, Foreign body in the ear and its importance: the Nigerian experience. Journal of Tropical Paediatrics. 1986; 32: 4 -6. 7. Das SK. Aetiological evaluation of foreign bodies in the ear and nose. J. Laryngol Otol. 1984; 98: 989-991.

  13. Limb salvage surgery

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

  14. The Mouse Limb Anatomy Atlas: An interactive 3D tool for studying embryonic limb patterning

    Directory of Open Access Journals (Sweden)

    DeLaurier April

    2008-09-01

    Full Text Available Abstract Background The developing mouse limb is widely used as a model system for studying tissue patterning. Despite this, few references are available that can be used for the correct identification of developing limb structures, such as muscles and tendons. Existing textual references consist of two-dimensional (2D illustrations of the adult rat or mouse limb that can be difficult to apply when attempting to describe the complex three-dimensional (3D relationship between tissues. Results To improve the resources available in the mouse model, we have generated a free, web-based, interactive reference of limb muscle, tendon, and skeletal structures at embryonic day (E 14.5 http://www.nimr.mrc.ac.uk/3dlimb/. The Atlas was generated using mouse forelimb and hindlimb specimens stained using immunohistochemistry to detect muscle and tendon. Limbs were scanned using Optical Projection Tomography (OPT, reconstructed to make 3D models and annotated using computer-assisted segmentation tools in Amira 3D Visualisation software. The annotated dataset is visualised using Java, JAtlasView software. Users click on the names of structures and view their shape, position and relationship with other structures within the 3D model and also in 2D virtual sections. Conclusion The Mouse Limb Anatomy Atlas provides a novel and valuable tool for researchers studying limb development and can be applied to a range of research areas, including the identification of abnormal limb patterning in transgenic lines and studies of models of congenital limb abnormalities. By using the Atlas for "virtual" dissection, this resource offers an alternative to animal dissection. The techniques we have developed and employed are also applicable to many other model systems and anatomical structures.

  15. Development of an Upper Limb Power Assist System Using Pneumatic Actuators for Farming Lift-up Motion

    Science.gov (United States)

    Yagi, Eiichi; Harada, Daisuke; Kobayashi, Masaaki

    A power assist system has lately attracted considerable attention to lifting-up an object without low back pain. We have been developing power assist systems with pneumatic actuators for the elbow and shoulder to farming support of lifting-up a bag of rice weighing 30kg. This paper describes the mechanism and control method of this power assist system. The pneumatic rotary actuator supports shoulder motion, and the air cylinder supports elbow motion. In this control method, the surface electromyogram(EMG) signals are used as input information of the controller. The joint support torques of human are calculated based on the antigravity term of necessary joint torques, which are estimated on the dynamics of a human approximated link model. The experimental results show the effectiveness of the proposed mechanism and control method of the power assist system.

  16. Costs of Real-Life Endovascular Treatment of Critical Limb Ischemia: Report from Poland-A European Union Country with a Low-Budget Health Care System.

    Science.gov (United States)

    Krzanowski, Marek; Drelicharz, Lukasz; Belowski, Andrzej; Partyka, Lukasz; Sumek-Brandys, Barbara; Ramakrishnan, Piravin Kumar; Nizankowski, Rafal

    2016-02-01

    To analyze the costs of inhospital, percutaneous treatment of patients with critical limb ischemia (CLI) carried out in Poland, a European Union country with a low-budget national health system. A retrospective analysis of prospectively collected data on all patients admitted to a tertiary care hospital for endovascular treatment of CLI over 1 year. A single, large volume, tertiary angiology center located in Southern Poland. CLI patients due to aortoiliac, femoropopliteal, or infrapopliteal arterial stenoses or occlusions with indications for first-line endovascular therapy or similar patients who refused open surgical procedure despite having primary indications for vascular surgery. Direct stenting using bare-metal stents was the primary mode of treatment for lesions located within the aortoiliac and femoropopliteal arterial segments. Plain old balloon angioplasty (POBA) was the second most commonly used technique. For below-the-knee arteries, POBA was the mainstay of treatment, which was occasionally supported by drug-eluting stent angioplasty. Directional atherectomy, scoring balloon angioplasty, or local fibrinolysis was used infrequently. Drug-eluting balloon percutaneous transluminal angioplasty was not used. The main outcome measures were the mean reimbursement of costs provided by the Polish National Health Fund (NHF) for inhospital treatment of patients for whom endovascular procedures were performed as initial treatment for CLI and the inhospital costs of endovascular treatment calculated by the caregiver in the 2 years since the first procedure. The average total number of days spent in hospital, amputation-free survival (AFS), overall survival (OS), and limb salvage rate (LSR) according to a life-table method were also calculated for the 2 years. In the first year, there were 496 endovascular and 15 surgical hospitalizations for revascularization procedures to treat 340 limbs in 327 patients, with a further 53 revascularization procedures in the

  17. A actividade dos GAPI e das OTIC: uma análise multivariada de processos de transferência de tecnologia

    OpenAIRE

    Carvalho, Rui Manuel Cartaxo Simões de

    2010-01-01

    Mestrado em Economia e Gestão de Ciência, Tecnologia e Inovação A presente dissertação incide sobre a actividade dos Gabinetes de Apoio à Promoção da Propriedade Industrial (GAPI) universitários e das Oficinas de Transferência de Tecnologia e Conhecimento (OTIC) académicas, no período de 2006 a 2008. Os dados tratados foram recolhidos do Inquérito de equipa do CEGE/ISEG no âmbito de um estudo1 efectuado no Verão de 2008, por solicitação da Oficina de Transferência de Tecnologia e de Conhec...

  18. Ipsilateral Scapular Cutaneous Anchor System: An alternative for the harness in body-powered upper-limb prostheses.

    Science.gov (United States)

    Hichert, Mona; Plettenburg, Dick H

    2017-03-01

    Body-powered prosthesis users frequently complain about the poor cosmesis and comfort of the traditional shoulder harness. The Ipsilateral Scapular Cutaneous Anchor System offers an alternative, but it remains unclear to what extent it affects the perception and control of cable operation forces compared to the traditional shoulder harness. To compare cable force perception and control with the figure-of-nine harness versus the Ipsilateral Scapular Cutaneous Anchor System and to investigate force perception and control at different force levels. Experimental trial. Ten male able-bodied subjects completed a cable force reproduction task at four force levels in the range of 10-40 N using the figure-of-nine harness and the Anchor System. Perception and control of cable operating forces were quantified by the force reproduction error and the force variability. In terms of force reproduction error and force variability, the subjects did not behave differently when using the two systems. The smallest force reproduction error and force variability were found at the smallest target force level of 10 N. The Anchor System performs no differently than the traditional figure-of-nine harness in terms of force perception and control, making it a viable alternative. Furthermore, users perceive and control low operation forces better than high forces. Clinical relevance The Ipsilateral Scapular Cutaneous Anchor System offers an alternative for the traditional harness in terms of cable operation force perception and control and should therefore be considered for clinical use. Low cable operation forces increase the perception and control abilities of users.

  19. Phantom limb pain

    Science.gov (United States)

    ... there Changes in the weather Stress Infection An artificial limb that does not fit properly Poor blood flow ... Move or exercise the remaining part of your arm or leg. If you are wearing your prosthesis, take it off. If you are not wearing ...

  20. Ipsilateral Scapular Cutaneous Anchor System : An alternative for the harness in body-powered upper-limb prostheses

    NARCIS (Netherlands)

    Hichert, M.; Plettenburg, D.H.

    2017-01-01

    Background: Body-powered prosthesis users frequently complain about the poor cosmesis and comfort of the traditional shoulder harness. The Ipsilateral Scapular Cutaneous Anchor System offers an alternative, but it remains unclear to what extent it affects the perception and control of cable

  1. Limb-Girdle Muscular Dystrophy (LGMD)

    Science.gov (United States)

    ... Blog Donate Search MDA.org Close Limb-Girdle Muscular Dystrophy (LGMD) Share print email share facebook twitter google plus linkedin Limb-Girdle Muscular Dystrophy (LGMD) What is limb-girdle muscular dystrophy? Limb- ...

  2. An investigation of fatigue phenomenon in the upper limb muscle due to short duration pulses in an FES system

    Science.gov (United States)

    Naeem, Jannatul; Wong Azman, Amelia; Khan, Sheroz; Mohd Mustafah, Yasir

    2013-12-01

    Functional Electrical Stimulation (FES) is a method of artificially stimulating muscles or nerves in order to result in contraction or relaxation of muscles. Many studies have shown that FES system has helped patients to live a better lives especially those who are suffering from physical mobility. Unfortunately, one of the main limitations of an FES system besides of its high cost is largely due to muscle fatigue. Muscle fatigue will affect the training duration which could delay patients' recovery rate. In this paper, we analyzed the occurrence of this fatigue phenomenon in terms of stimulator parameters such as amplitude, frequency, pulse width and pulse shape. The objective of this investigation is to identify other key features of the FES system parameters in order to prolong the training duration among patients. The experiment has been done on a healthy person for the duration of one minute and later the muscles response will be observed. Resultant muscle response is recorded as force using force resistive sensor. The experimental results show muscles will get fatigue at a different rate as the frequency increases. The experiment also shows that the duty cycle is reciprocal to the resultant force.

  3. Design and development of a telerehabilitation platform for patients with phantom limb pain

    NARCIS (Netherlands)

    Andreas Rothgangel; Susy Braun; Rob Smeets; Anna Beurskens

    2017-01-01

    Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately,

  4. Motor control over the phantom limb in above-elbow amputees and its relationship with phantom limb pain.

    Science.gov (United States)

    Gagné, M; Reilly, K T; Hétu, S; Mercier, C

    2009-08-04

    Recent evidence shows that the primary motor cortex continues to send motor commands when amputees execute phantom movements. These commands are retargeted toward the remaining stump muscles as a result of motor system reorganization. As amputation-induced reorganization in the primary motor cortex has been associated with phantom limb pain we hypothesized that the motor control of the phantom limb would differ between amputees with and without phantom limb pain. Eight above-elbow amputees with or without pain were included in the study. They were asked to produce cyclic movements with their phantom limb (hand, wrist, and elbow movements) while simultaneously reproducing the same movement with the intact limb. The time needed to complete a movement cycle and its amplitude were derived from the kinematics of the intact limb. Electromyographic (EMG) activity from different stump muscles and from the homologous muscles on the intact side was recorded. Different EMG patterns were recorded in the stump muscles depending on the movement produced, showing that different phantom movements are associated with distinct motor commands. Phantom limb pain was associated with some aspects of phantom limb motor control. The time needed to complete a full cycle of a phantom movement was systematically shorter in subjects without phantom limb pain. Also, the amount of EMG modulation recorded in a stump muscle during a phantom hand movement was positively correlated with the intensity of phantom limb pain. Since phantom hand movement-related EMG patterns in above-elbow stump muscles can be considered as a marker of motor system reorganization, this result indirectly supports the hypothesis that amputation-induced plasticity is associated with phantom limb pain severity. The discordance between the (amputated) hand motor command and the feedback from above-elbow muscles might partially explain why subjects exhibiting large EMG modulation during phantom hand movement have more phantom

  5. Lipid emulsion mitigates impaired pulmonary function induced by limb I/R in rats through attenuation of local cellular injury and the subsequent systemic inflammatory response/inflammation.

    Science.gov (United States)

    Xia, Fangfang; Xia, Yun; Chen, Sisi; Chen, Lulu; Zhu, Weijuan; Chen, Yuanqing; Papadimos, Thomas J; Xu, Xuzhong; Liu, Le

    2017-06-19

    Limb ischemia/reperfusion causes inflammation and elicits oxidative stress that may lead to local tissue damage and remote organ such as lung injury. This study investigates pulmonary function after limb ischemia/reperfusion and the protective effect of a lipid emulsion (Intralipid). Twenty-four rats were divided into three groups: sham operation group (group S), ischemia/reperfusion group (group IR), and lipid emulsion treatment group (group LE). limb ischemia/reperfusion was induced through occlusion of the infrarenal abdominal aorta for 3 h. The microvascular clamp was removed carefully and reperfusion was provided for 3 h. The mean arterial pressure in group LE was higher than group IR during the reperfusion period (P = 0.024). The heart rate of both group LE and IR are significantly higher than group S during the ischemia period(P emulsion (Intralipid) effectively reversed the damage. In summary, Intralipid administration resulted in several beneficial effects as compared to group IR, such as the pulmonary gas exchange and inflammatory. The ischemic/reperfusion injury of limb muscles with resultant inflammatory damage to lung tissue can be mitigated by administration of a lipid emulsion (Intralipid, 20%, 5 ml/kg). The mechanisms attenuating such a physiological may be attributed to reduction of the degree of limb injury through a decrease in the release of local inflammatory mediators, a reduction of lipid peroxidation, and a blunting of the subsequent remote inflammatory response.

  6. Environmental monitoring for the DOE coolside and LIMB demonstration extension projects

    Energy Technology Data Exchange (ETDEWEB)

    White, T.; Contos, L.; Adams, L. (Radian Corp., Research Triangle Park, NC (United States). Progress Center)

    1992-02-01

    The purpose of this document is to present environmental monitoring data collected during the US DOE Limestone Injection Multistage Burner (LIMB) Demonstration Project Extension. The objective of the LIMB program is to demonstrate the sulfur dioxide (SO{sub 2}) and nitrogen oxide (NO{sub x}) emission reduction capabilities of the LIMB system. The LIMB system is a retrofit technology to be used for existing coal-fired boilers equipped with electrostatic precipitators. (VC)

  7. Neck muscle fatigue alters upper limb proprioception.

    Science.gov (United States)

    Zabihhosseinian, Mahboobeh; Holmes, Michael W R; Murphy, Bernadette

    2015-05-01

    Limb proprioception is an awareness by the central nervous system (CNS) of the location of a limb in three-dimensional space and is essential for movement and postural control. The CNS uses the position of the head and neck when interpreting the position of the upper limb, and altered input from neck muscles may affect the sensory inputs to the CNS and consequently may impair the awareness of upper limb joint position. The purpose of this study was to determine whether fatigue of the cervical extensors muscles (CEM) using a submaximal fatigue protocol alters the ability to recreate a previously presented elbow angle with the head in a neutral position. Twelve healthy individuals participated. CEM activity was examined bilaterally using surface electromyography, and kinematics of the elbow joint was measured. The fatigue protocol included an isometric neck extension task at 70 % of maximum until failure. Joint position error increased following fatigue, demonstrating a significant main effect of time (F 2, 18 = 19.41, p ≤ 0.0001) for absolute error. No significant differences were found for variable error (F 2, 18 = 0.27, p = 0.76) or constant error (F 2, 18 = 1.16 of time, p ≤ 0.33). This study confirms that fatigue of the CEM can reduce the accuracy of elbow joint position matching. This suggests that altered afferent input from the neck subsequent to fatigue may impair upper limb proprioception.

  8. Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Serra, Raffaele; Risitano, Claudia; Giardina, Massimiliano; Acri, Ignazio Eduardo; Volpe, Pietro; David, Antonio

    2016-04-01

    Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Computation Modeling of Limb-bud Dysmorphogenesis: Predicting Cellular Dynamics and Key Events in Developmental Toxicity with a Multicellular Systems Model (FutureToxII)

    Science.gov (United States)

    Congenital limb malformations are among the most frequent malformation occurs in humans, with a frequency of about 1 in 500 to 1 in 1000 human live births. ToxCast is profiling the bioactivity of thousands of chemicals based on high-throughput (HTS) and computational methods that...

  10. The intravestibular source of the vestibular aqueduct. III: Osseous pathology of Ménière's disease, clarified by a developmental study of the intraskeletal channels of the otic capsule.

    Science.gov (United States)

    Michaels, Leslie; Soucek, Sava

    2010-07-01

    Review of the histopathological changes in the vestibular arch in Ménière's disease, after a study of development of the otic capsule, indicated a severe apoptotic loss of osteoblasts with consequent denudation of these cells from and damage to the osseous canal structure of the arch. To review previously reported histological findings in the inner layer of the vestibular aqueduct and its intravestibular source in Ménière's disease, using newer knowledge of otic capsule development. Temporal bone histological sections from the vestibular arch region of eight patients with Ménière's disease were reviewed in our London-based material. Minute granules suggesting apoptotic bodies were found in the arch in the majority of cases, giving support for the concept of an apoptotic loss of osteoblasts. Explanation for the previously described appearance of proliferation of atypical channels and of small, finely outlined empty areas in the bone was provided by the observation of denudation of osteoblasts from Volkmann's canals and microcanals. These canals had been recently described in a developmental study of the otic capsule. Dislocation of dead microcanals into blood vessels of Volkmann's canals was seen in two of the cases.

  11. Extensive swelling of the limb and systemic symptoms after a fourth dose of acellular pertussis containing vaccines in England in children aged 3-6years.

    Science.gov (United States)

    Southern, Jo; Waight, Pauline A; Andrews, Nick; Miller, Elizabeth

    2017-01-23

    Extensive limb swelling (ESL) after a booster dose of acellular pertussis (aP) containing vaccine can cause concern and has the potential to be confused with cellulitis. In the United Kingdom aP-containing vaccine was introduced for primary immunisation at 2, 3 and 4months of age in 2004, with the first cohorts eligible to receive a fourth dose in 2007 at school entry. We assessed the frequency of ESL (here defined as swelling >100mms diameter) in 973 children receiving a fourth dose of one of four aP vaccines given combined with inactivated polio, tetanus and either low dose diphtheria (TdaP/IPV) or high dose diphtheria (DTaP/IPV) vaccine; 2 of the 3 DTaP/IPV vaccines also contained Haemophilus influenza b conjugate vaccine (Hib). Post-vaccination symptoms and local reactions were recorded in 7-day diaries or by a telephone follow up if no diary was returned. Local swellings >50mm diameter were reported by 2.2% TdaP/IPV recipients compared with 6.6-11.1% of DTaP/IPV recipients; the corresponding proportions for redness >50mms was 7.0% for TdaP/IPV and 13.3-17.7% for DTaP/IPV recipients. Among the latter, the addition of Hib did not affect the frequency or size of local reactions. Pain at the injection site and systemic symptoms did not differ between the four vaccine groups. A history of atopy was not associated with development of local swelling or redness. A total of 13 children (1.3%) experienced an ESL, three after TdaP/IPV. ESLs resolved without systemic upset within a few days and were usually painless; medical advice was only sought for two children. Parents should be informed about the possible occurrence of an ESL with the pre-school aP-containing booster vaccine but can be reassured that it is a benign and transient condition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Limb immobilization and corticobasal syndrome.

    Science.gov (United States)

    Graff-Radford, Jonathan; Boeve, Bradley F; Drubach, Daniel A; Knopman, David S; Ahlskog, J Eric; Golden, Erin C; Drubach, Dina I; Petersen, Ronald C; Josephs, Keith A

    2012-12-01

    Recently, we evaluated two patients with corticobasal syndrome (CBS) who reported symptom onset after limb immobilization. Our objective was to investigate the association between trauma, immobilization and CBS. The charts of forty-four consecutive CBS patients seen in the Mayo Clinic Alzheimer Disease Research Center were reviewed with attention to trauma and limb immobilization. 10 CBS patients (23%) had immobilization or trauma on the most affected limb preceding the onset or acceleration of symptoms. The median age at onset was 61. Six patients manifested their first symptoms after immobilization from surgery or fracture with one after leg trauma. Four patients had pre-existing symptoms of limb dysfunction but significantly worsened after immobilization or surgery. 23 percent of patients had immobilization or trauma of the affected limb. This might have implications for management of CBS, for avoiding injury, limiting immobilization and increasing movement in the affected limb. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Sex Differences in Limb and Joint Stiffness in Recreational Runners

    Directory of Open Access Journals (Sweden)

    Sinclair Jonathan

    2015-09-01

    Full Text Available Purpose. Female runners are known to be at greater risk from chronic running injuries than age-matched males, although the exact mechanisms are often poorly understood. The aim of the current investigation was to determine if female recreational runners exhibit distinct limb and joint stiffness characteristics in relation to their male counterparts. Methods. Fourteen male and fourteen female runners ran over a force platform at 4.0 m · s-1. Lower limb kinematics were collected using an eight-camera optoelectric motion capture system operating at 250 Hz. Measures of limb and joint stiffness were calculated as a function of limb length and joint moments divided by the extent of limb and joint excursion. All stiffness and joint moment parameters were normalized to body mass. Sex differences in normalized limb and knee and ankle joint stiffness were examined statistically using independent samples t tests. Results. The results indicate that normalized limb (male = 0.18 ± 0.07, female = 0.37 ± 0.10 kN · kg · m-1 and knee stiffness (male = 5.59 ± 2.02, female = 7.34 ± 1.78 Nm · kg · rad-1 were significantly greater in female runners. Conclusions. On the basis that normalized knee and limb stiffness were shown to be significantly greater in female runners, the findings from the current investigation may provide further insight into the aetiology of the distinct injury patterns observed between sexes.

  14. Lower-Limb Rehabilitation Robot Design

    Science.gov (United States)

    Bouhabba, E. M.; Shafie, A. A.; Khan, M. R.; Ariffin, K.

    2013-12-01

    It is a general assumption that robotics will play an important role in therapy activities within rehabilitation treatment. In the last decade, the interest in the field has grown exponentially mainly due to the initial success of the early systems and the growing demand caused by increasing numbers of stroke patients and their associate rehabilitation costs. As a result, robot therapy systems have been developed worldwide for training of both the upper and lower extremities. This paper investigates and proposes a lower-limb rehabilitation robot that is used to help patients with lower-limb paralysis to improve and resume physical functions. The proposed rehabilitation robot features three rotary joints forced by electric motors providing linear motions. The paper covers mechanism design and optimization, kinematics analysis, trajectory planning, wearable sensors, and the control system design. The design and control system demonstrate that the proposed rehabilitation robot is safe and reliable with the effective design and better kinematic performance.

  15. Pharmacokinetics of Acetaminophen in Hind Limbs Unloaded Mice: A Model System Simulating the Effects of Low Gravity on Astronauts in Space

    Science.gov (United States)

    Peterson, Amanda; Risin, Semyon A.; Ramesh, Govindarajan T.; Dasgupta, Amitava; Risin, Diana

    2008-01-01

    The pharmacokinetics (PK) of medications administered to astronauts could be altered by the conditions in Space. Low gravity and free floating (and associated hemodynamic changes) could affect the absorption, distribution, metabolism and excretion of the drugs. Knowledge of these alterations is essential for adjusting the dosage and the regimen of drug administration in astronauts. Acquiring of such knowledge has inherent difficulties due to limited opportunities for experimenting in Space. One of the approaches is to use model systems that simulate some of the Space conditions on Earth. In this study we used hind limbs unloaded mice (HLU) to investigate the possible changes in PK of acetaminophen, a widely used analgesic with high probability of use by astronauts. The HLU is recognized as an appropriate model for simulating the effects of low gravity on hemodynamic parameters. Mice were tail suspended (n = 24) for 24-96 hours prior to introduction of acetaminophen (150 - 300 mg/kg). The drug (in aqueous solution containing 10% ethyl alcohol by volume) was given orally by a gavage procedure and after the administration of acetaminophen mice were additionally suspended for 30 min, 1 and 2 hours. Control mice (n = 24) received the same dose of acetaminophen and were kept freely all the time. Blood specimens were obtained either from retroorbital venous sinuses or from heart. Acetaminophen concentration was measured in plasma by the fluorescent polarization immunoassay and the AxSYM analyzer (Abbott Laboratories). In control mice peak acetaminophen concentration was achieved at 30 min. By 1 hour the concentration decreased to less than 50% of the peak level and at 2 hours the drug was almost undetectable in the serum. HLU for 24 hours significantly altered the acetaminophen pharmacokinetic: at 30 min the acetaminophen concentrations were significantly (both statistically and medically significant) lower than in control mice. The concentrations also reduced less

  16. Phantom limb pain after lower limb trauma: origins and treatments.

    Science.gov (United States)

    Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan

    2011-12-01

    Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of painful phantom sensations, that is, phantom limb pain, presents a challenge for practitioners and researchers and is often detrimental to the patient's quality of life. In addition to the use of conventional therapies for chronic pain disorders, recent years have seen the development of novel treatments for phantom limb pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom limb pain.

  17. Supernumerary phantom limb after stroke

    Science.gov (United States)

    Bakheit, A; Roundhill, S

    2005-01-01

    The perception of a phantom limb is commonly reported after amputations. However, only a few cases have been described after a stroke. This article presents a patient who reported a supernumerary phantom limb (pseudopolymelia) after spontaneous intracerebral haemorrhage and discusses the possible underlying mechanisms for this rare phenomenon. PMID:15749787

  18. Limb Salvage After Bone Cancer

    Science.gov (United States)

    ... usually done at least yearly. Life-long follow-up by an orthopedic surgeon is recommended. Promoting Health after Limb Salvage Physical and occupational therapy play an important role in successful rehabilitation after limb salvage surgery. Both passive and active ...

  19. Evaluation of Limb-Girdle Muscular Dystrophy

    Science.gov (United States)

    2014-03-06

    Becker Muscular Dystrophy; Limb-Girdle Muscular Dystrophy, Type 2A (Calpain-3 Deficiency); Limb-Girdle Muscular Dystrophy, Type 2B (Miyoshi Myopathy, Dysferlin Deficiency); Limb-Girdle Muscular Dystrophy, Type 2I (FKRP-deficiency)

  20. Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

    Science.gov (United States)

    Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

    2012-04-01

    The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Capturing the Perceived Phantom Limb through Virtual Reality

    Directory of Open Access Journals (Sweden)

    Christian Rogers

    2016-01-01

    Full Text Available Phantom limb is the sensation amputees may feel when the missing limb is still attached to the body and is still moving as it would if it still existed. Despite there being between 50 and 80% of amputees who report neuropathic pain, also known as phantom limb pain (PLP, there is still little understanding of why PLP occurs. There are no fully effective long-term treatments available. One of the struggles with PLP is the difficulty for amputees to describe the sensations of their phantom limbs. The sensations may be of a limb that is in a position that is impossible for a normal limb to attain. The goal of this project was to treat those with PLP by developing a system to communicate the sensations those with PLP were experiencing accurately and easily through various hand positions using a model arm with a user friendly interface. The system was developed with Maya 3D animation software, the Leap Motion input device, and the Unity game engine. The 3D modeled arm was designed to mimic the phantom sensation being able to go beyond normal joint extensions of regular arms. The purpose in doing so was to obtain a true 3D visualization of the phantom limb.

  2. [Phantom limb pain originates from dysfunction of the primary motor cortex].

    Science.gov (United States)

    Sumitani, Masahiko; Miyauchi, Satoru; Uematsu, Hironobu; Yozu, Arito; Otake, Yuko; Yamada, Yoshitsugu

    2010-11-01

    Accumulated knowledge indicates that phantom limb pain is a phenomenon of the central nervous system that is related to plastic changes at several levels of the nervous systems. Especially, reports using patients with neuropathic pain clearly indicate the sensorimotor cortex as underlying mechanisms of phantom limb and its pain. Here, we focus the notion that limb amputation or deafferentation results in plasticity of connections between the brain and the body, and that the cortical motor representation of the missing or deafferented limb seemingly disappears. Meanwhile, the sensory representation of the limb does not disappear and thereby patients feel phantom limbs. We propose that dissociation between motor and sensory representations in the primary motor cortex induces pathologic pain and reconcile of sensorimotor integration of the limb would alleviate pain, on the basis of our neurorehabilitation approaches and artificial neuromodulation strategies.

  3. Isolated limb perfusion with cytostatic drug leakage.

    Science.gov (United States)

    Zarazua, M; Paredes, P; Gahete-Santiago, F; Rull, R; Blasi, A; Balust, J

    2017-07-25

    Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Design and development of a telerehabilitation platform for patients with phantom limb pain : a user-centered approach

    NARCIS (Netherlands)

    Andreas Rothgangel; Susy Braun; Rob Smeets; Anna Beurskens

    2017-01-01

    Background: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately,

  5. Phantom limbs and neural plasticity.

    Science.gov (United States)

    Ramachandran, V S; Rogers-Ramachandran, D

    2000-03-01

    The study of phantom limbs has received tremendous impetus from recent studies linking changes in cortical topography with perceptual experience. Systematic psychophysical testing and functional imaging studies on patients with phantom limbs provide 2 unique opportunities. First, they allow us to demonstrate neural plasticity in the adult human brain. Second, by tracking perceptual changes (such as referred sensations) and changes in cortical topography in individual patients, we can begin to explore how the activity of sensory maps gives rise to conscious experience. Finally, phantom limbs also allow us to explore intersensory effects and the manner in which the brain constructs and updates a "body image" throughout life.

  6. Management of Major Limb Injuries

    Science.gov (United States)

    Langer, Vijay

    2014-01-01

    Management of major limb injuries is a daunting challenge, especially as many of these patients have severe associated injuries. In trying to save life, often the limb is sacrificed. The existing guidelines on managing such trauma are often confusing. There is scope to lay down such protocols along with the need for urgent transfer of such patients to a multispecialty center equipped to salvage life and limb for maximizing outcome. This review article comprehensively deals with the issue of managing such major injuries. PMID:24511296

  7. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Science.gov (United States)

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…

  8. Upper limb and eye movement coordination during reaching tasks in people with stroke.

    Science.gov (United States)

    Meadmore, Katie L; Exell, Timothy A; Burridge, Jane H; Hughes, Ann-Marie; Freeman, Christopher T; Benson, Valerie

    2017-06-09

    To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke. Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session. Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group. Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support. Implications for Rehabilitation Deficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks. Upper limb support can reduce deficits in hand-eye coordination. Stroke rehabilitation outcomes should consider motor and oculomotor performance.

  9. Physiotherapy after amputation of the limb

    OpenAIRE

    Pospíšil, Daniel

    2010-01-01

    In this bachelor thesis the author considers physiotherapy after amputation of the lower limb. The theoretical section describes the anatomy of the lower limb, a procedure for amputation of the lower limb, occupational theraoy and prosthesis. The author then goes on to discuss physiotherapy in relation to two case studies of patients who have had their lower limbs removed.

  10. Ethical issues in limb transplants.

    Science.gov (United States)

    Dickenson, D; Widdershoven, G

    2001-04-01

    On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self-evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We present two linked schemas for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost-benefit, or patient autonomy.

  11. Limb apraxia in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Rapaić Dragan

    2014-01-01

    Full Text Available Background/Aim. There are almost no studies on apraxia in people with multiple sclerosis. Although the white matter is damaged in MS, it is not the only location in which the pathological changes are present. Demyelinated lesions in the cortex have recently been recognized as important components of multiple sclerosis pathology. The aim of this study was to determine whether apraxia is present among people with MS, and the importance of demographic characteristics and impairment of functional systems at conceptualization and execution of movements. Methods. The experimental group consisted of 30 patients, mean age 51.34 ± 7.70 years. The patients in the experimental group were diagnosed with MS according to the McDonald criteria. The control group consisted of 30 healthy subjects, mean age 50.30 ± 10.47 years. For research purposes, we used the following instruments: Questionnaire for Collecting Demographic Data, Kurtzke Functional Systems Scores, Waterloo-Sunnybrook Apraxia Battery (WatAB. Execution of motion tasks that are a part of the Watwere incorporated in the System for the Observation and Analysis of Motor Behavior. Results. Our study showed that limb apraxia was common in people with MS. Apraxia was present during pantomime in 26.70% of the patients, and during the imitation of movements in 44.80% of the patients. Gender, age, education level, duration of disease and a form of MS did not determine the quality of conceptualization and execution of movements. The time elapsed from the last exacerbation was a determinant of quality of executed movements. Impairments of functional systems predicted impairments of movement execution. The expanded disability scale score correlated with the severity of apraxia. Conclusion. Our study confirm the presence of apraxia in MS. It is necessary to carry out further studies using functional magnetic resonance imaging, as well as the conduct longitudinal studies to determine the precise structure of

  12. Regenerative Engineering and Bionic Limbs.

    Science.gov (United States)

    James, Roshan; Laurencin, Cato T

    2015-03-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been made in technological, material and in prosthesis integration where researchers are now exploring artificial prosthesis that integrate with the residual tissues and function based on signal impulses received from the residual nerves. Efforts are focused on challenging experts in different disciplines to integrate ideas and technologies to allow for the regeneration of injured tissues, recording on tissue signals and feed-back to facilitate responsive movements and gradations of muscle force. A fully functional replacement and regenerative or integrated prosthesis will rely on interface of biological process with robotic systems to allow individual control of movement such as at the elbow, forearm, digits and thumb in the upper extremity. Regenerative engineering focused on the regeneration of complex tissue and organ systems will be realized by the cross-fertilization of advances over the past thirty years in the fields of tissue engineering, nanotechnology, stem cell science, and developmental biology. The convergence of toolboxes crated within each discipline will allow interdisciplinary teams from engineering, science, and medicine to realize new strategies, mergers of disparate technologies, such as biophysics, smart bionics, and the healing power of the mind. Tackling the clinical challenges, interfacing the biological process with bionic technologies, engineering biological control of the electronic systems, and feed-back will be the important goals in regenerative engineering over the next

  13. Functional Reorganization of the Primary Somatosensory Cortex of a Phantom Limb Pain Patient.

    Science.gov (United States)

    Zhao, Jia; Guo, Xiaoli; Xia, Xiaolei; Peng, Weiwei; Wang, Wuchao; Li, Shulin; Zhang, Ya; Hu, Li

    2016-07-01

    Functional reorganization of the somatosensory system was widely observed in phantom limb pain patients. Whereas some studies demonstrated that the primary somatosensory cortex (S1) of the amputated limb was engaged with the regions around it, others showed that phantom limb pain was associated with preserved structure and functional organization in the former brain region. However, according to the law of use and disuse, the sensitivity of S1 of the amputated limb to pain-related context should be enhanced due to the adaptation to the long-lasting phantom limb pain experience. Here, we collected neurophysiological data from a patient with 21-year phantom limb pain using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) techniques. EEG data showed that both laser-evoked potentials (LEPs) and tactile-evoked potentials (TEPs) were clearly presented only when radiant-heat laser pulses and electrical pulses were delivered to the shoulder of the healthy limb, but not of the amputated limb. This observation suggested the functional deficit of somatosensory pathways at the amputated side. FMRI data showed that significant larger brain activations by painful rather than non-painful stimuli in video clips were observed not only at visual-related brain areas and anterior/mid-cingulate cortex, but also at S1 contralateral to the amputated limb. This observation suggested the increased sensitivity of S1 of the amputated limb to the pain-related context. In addition, such increase of sensitivity was significantly larger if the context was associated with the amputated limb of the patient. In summary, our findings provided novel evidence for a possible neuroplasticity of S1 of the amputated limb: in an amputee with long-lasting phantom limb pain, the sensitivity of S1 to pain-related and amputated-limb-related context was greatly enhanced.

  14. The phantom limb in dreams.

    Science.gov (United States)

    Brugger, Peter

    2008-12-01

    Mulder and colleagues [Mulder, T., Hochstenbach, J., Dijkstra, P. U., Geertzen, J. H. B. (2008). Born to adapt, but not in your dreams. Consciousness and Cognition, 17, 1266-1271.] report that a majority of amputees continue to experience a normally-limbed body during their night dreams. They interprete this observation as a failure of the body schema to adapt to the new body shape. The present note does not question this interpretation, but points to the already existing literature on the phenomenology of the phantom limb in dreams. A summary of published investigations is complemented by a note on phantom phenomena in the dreams of paraplegic patients and persons born without a limb. Integration of the available data allows the recommendation for prospective studies to consider dream content in more detail. For instance, "adaptation" to the loss of a limb can also manifest itself by seeing oneself surrounded by amputees. Such projective types of anosognosia ("transitivism") in nocturnal dreams should also be experimentally induced in normally-limbed individuals, and some relevant techniques are mentioned.

  15. Research Priorities in Limb and Task-Specific Dystonias

    Directory of Open Access Journals (Sweden)

    Sarah Pirio Richardson

    2017-05-01

    Full Text Available Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including

  16. Persistence of secondary restless legs syndrome in a phantom limb caused by end-stage renal disease.

    Science.gov (United States)

    Nishida, Shingo; Hitsumoto, Akiko; Namba, Kazuyoshi; Usui, Akira; Inoue, Yuichi

    2013-01-01

    Our patient had secondary restless legs syndrome (RLS) in the left lower limb caused by end-stage renal disease (ESRD). Severe RLS symptoms persisted even after amputation of the affected limb. Considering that oral administration of a dopamine receptor agonist was effective in treating the RLS in the phantom limb in this case, dysfunction of the central dopaminergic system was thought to be involved in the phantom limb-RLS mechanism. The persistence of RLS symptoms even after amputation of the affected limb suggests that the area responsible for ESRD-related RLS symptoms exists at the spinal level or in the higher central nervous system.

  17. Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface

    OpenAIRE

    Huang, Stephanie; Ferris, Daniel P

    2012-01-01

    Abstract Background Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user’s nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. Methods We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocne...

  18. Lower-limb venous thrombosis

    African Journals Online (AJOL)

    307. Lower-limb venous thrombosis. July 2009 Vol.27 No.7 CME. Most DVTs arise in calf muscle veins, particularly within the gastrocnemius and soleus muscles (calf vein DVT). Many of these remain localised to the muscle and will not cause any clinical problem. If, however, the circumstances that initially caused the.

  19. Mechanisms of urodele limb regeneration

    Science.gov (United States)

    2017-01-01

    Abstract This review explores the historical and current state of our knowledge about urodele limb regeneration. Topics discussed are (1) blastema formation by the proteolytic histolysis of limb tissues to release resident stem cells and mononucleate cells that undergo dedifferentiation, cell cycle entry and accumulation under the apical epidermal cap. (2) The origin, phenotypic memory, and positional memory of blastema cells. (3) The role played by macrophages in the early events of regeneration. (4) The role of neural and AEC factors and interaction between blastema cells in mitosis and distalization. (5) Models of pattern formation based on the results of axial reversal experiments, experiments on the regeneration of half and double half limbs, and experiments using retinoic acid to alter positional identity of blastema cells. (6) Possible mechanisms of distalization during normal and intercalary regeneration. (7) Is pattern formation is a self‐organizing property of the blastema or dictated by chemical signals from adjacent tissues? (8) What is the future for regenerating a human limb? PMID:29299322

  20. Limb salvage in tibial hemimelia.

    Science.gov (United States)

    Eamsobhana, Perajit; Kaewpornsawan, Kamolporn

    2012-09-01

    To study the results of treatment of tibial hemimelia with limb salvage procedure in term of patient satisfaction, clinical results and complications. From 1993 to 2007 the authors treated six cases of tibial hemimelia with limb salvage procedures. Three legs of type Ia and four legs of type IV tibial hemimelia classified by Jones classification. The age at the operation ranged from 2 to 11 years. For type Ia cases, the Brown procedure,foot centralization and ilizarov lengthening of the fibula were used to correct limb length discrepancy. For type IV the foot centralization, soft tissue release and ilizarov lengthening were used to correct limb length discrepancy. The follow-up range from 4 to 10 years. In two patients with type Ia, one patient could bear weight without gait aids, the other walked with orthosis and axillary crutch because this patient had bilateral Ia type and knee instability with progressive flexion contracture due to weakness of the quadriceps muscle. All patients with type IV can walk independently without gait aids. Three patients were performed limb lengthening. One case was fibular lengthening following Brown procedure in Ia type. Two cases were tibial lengthening in type IV The mean lengthening was 5.1 cm. Mean lengthening index was 2.4. Satisfactory functional and cosmetic results were achieved in all patients with partial deficiency, whereas in patients with completely deficiency of the limbs, none of the 3 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture and persistent ligamentous instability. Nevertheless, in these 3 legs, all patients were ultimately able to withstand weight bearing. Patients and families were satisfied even though patients must have multiple surgery to correct deformities of the foot and the knee joint, as well as leg-length discrepancy and also a prolong treatment time. Limb salvage procedure in tibial

  1. Asteroid Ida - Limb at Closest Approach

    Science.gov (United States)

    1994-01-01

    The Galileo imaging system captured this picture of the limb of the asteroid 243 Ida about 46 seconds after its closest approach on August 28, 1993, from a range of only 2480 kilometers. It is the highest-resolution image of an asteroid's surface ever captured and shows detail at a scale of about 25 meters per pixel. This image is one frame of a mosaic of 15 frames shuttered near Galileo's closest approach to Ida. Since the exact location of Ida in space was not well-known prior to the Galileo flyby, this mosaic was estimated to have only about a 50 percent chance of capturing Ida. Fortunately, this single frame did successfully image a part of the sunlit side of Ida. The area seen in this frame shows some of the same territory seen in a slightly lower resolution full disk mosaic of Ida returned from the spacecraft in September, 1993, but from a different perspective. Prominent in this view is a 2 kilometer deep 'valley' seen in profile on the limb. This limb profile and the stereoscopic effect between this image and the full disk mosaic will permit detailed refinement of Ida's shape in this region. This high resolution view shows many small craters and some grooves on the surface of Ida, which give clues to understanding the history of this heavily impacted object. The Galileo project, whose primary mission is the exploration of the Jupiter system in 1995-97, is managed for NASA's Office of Space Science by the Jet Propulsion Laboratory.

  2. [Phantom limb pain: from physiopathology to prevention].

    Science.gov (United States)

    Roullet, S; Nouette-Gaulain, K; Brochet, B; Sztark, F

    2009-05-01

    First described in 1545, phantom limb pain is a frequent complication after limb amputation, described by 60 to 85% of amputees. Stump pain, phantom limb sensation and phantom limb pain are often combined. Physiopathology is complex and peripheral, medullar and cortical mechanisms are combined. Pharmacological preventive treatments as well as regional anaesthesia techniques have equivalent results. Such treatments must be investigated more precisely as postoperative rehabilitation of amputees mostly depends on pain relief.

  3. Movement analysis of upper limb during resistance training using general purpose robot arm "PA10"

    Science.gov (United States)

    Morita, Yoshifumi; Yamamoto, Takashi; Suzuki, Takahiro; Hirose, Akinori; Ukai, Hiroyuki; Matsui, Nobuyuki

    2005-12-01

    In this paper we perform movement analysis of an upper limb during resistance training. We selected sanding training, which is one type of resistance training for upper limbs widely performed in occupational therapy. Our final aims in the future are to quantitatively evaluate the therapeutic effect of upper limb motor function during training and to develop a new rehabilitation training support system. For these purposes, first of all we perform movement analysis using a conventional training tool. By measuring upper limb motion during the sanding training we perform feature abstraction. Next we perform movement analysis using the simulated sanding training system. This system is constructed using the general purpose robot arm "PA10". This system enables us to measure the force/torque exerted by subjects and to easily change the load of resistance. The control algorithm is based on impedance control. We found these features of the upper limb motion during the sanding training.

  4. Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography

    Energy Technology Data Exchange (ETDEWEB)

    Dietrich, Tobias J.; Pfirrmann, Christian W.A.; Pankalla, Katja; Buck, Florian M. [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Zurich (Switzerland); Schwab, Alexander [University of Zurich, Zurich (Switzerland); Orthopedic University Hospital Balgrist, Department of Finances, Zurich (Switzerland)

    2013-07-15

    To compare the radiation dose, workflow, patient comfort, and financial break-even of a standard digital radiography and a biplanar low-dose X-ray system. A standard digital radiography system (Ysio, Siemens Healthcare, Erlangen, Germany) was compared with a biplanar X-ray unit (EOS, EOS imaging, Paris, France) consisting of two X-ray tubes and slot-scanning detectors, arranged at an angle of 90 allowing simultaneous vertical biplanar linear scanning in the upright patient position. We compared data of standing full-length lower limb radiographs and whole spine radiographs of both X-ray systems. Dose-area product was significantly lower for radiographs of the biplanar X-ray system than for the standard digital radiography system (e.g. whole spine radiographs; standard digital radiography system: 392.2 {+-} 231.7 cGy*cm{sup 2} versus biplanar X-ray system: 158.4 {+-} 103.8 cGy*cm{sup 2}). The mean examination time was significantly shorter for biplanar radiographs compared with standard digital radiographs (e.g. whole spine radiographs: 449 s vs 248 s). Patients' comfort regarding noise was significantly higher for the standard digital radiography system. The financial break-even point was 2,602 radiographs/year for the standard digital radiography system compared with 4,077 radiographs/year for the biplanar X-ray unit. The biplanar X-ray unit reduces radiation exposure and increases subjective noise exposure to patients. The biplanar X-ray unit demands a higher number of examinations per year for the financial break-even point, despite the lower labour cost per examination due to the shorter examination time. (orig.)

  5. Homeomorphisms Between Limbs of the Mandelbrot Set

    DEFF Research Database (Denmark)

    Branner, Bodil; Fagella, Nuria

    1999-01-01

    Using a family of higher degree polynomials as a bridge, together with complex surgery techniques, we construct a homeomorphism between any two limbs of the Mandelbrot set of equal denominator. Induced by these homeomorphisms and complex conjugation, we obtain an involution between each limb...... of the limbs in the plane. As usual we plough in the dynamical planes and harvest in the parameter space....

  6. Radiogrammetric analysis of upper limb long bones

    Directory of Open Access Journals (Sweden)

    Stojanović Zlatan

    2011-01-01

    Full Text Available Radiogrammetry is radiological method of bone mineral density quantification. Besides giving an insight in diagnostics and evolution of metabolic bone disorders (osteoporosis, osteomalacia, osteitis deformans- Paget's disease, it can also explain some specific biomechanical characteristics of bone structures. The aim of this study is to evaluate the significance and perspectives of radiogrammetry as a scientific model for further inquiry of skeletal system. The work demonstrates mathematical parameters (Ca-Cortical area, CI- Cortical index, GI- Garn's index, ESI- Exton Smith's index of upper limb long bones (humerus, radius, ulna. Two standard radiological projections of bones were taken: antero-posterior (AP and latero-lateral (LL. Correlation with metacarpal and lower limb bones was also performed. The value of the cortical area of humerus is significantly higher comparing with the two other examined bones (Xmean 2,2443 cm2, p < 0.01. Radial bone has the highest values of the relational mathematical parameters, which implicates its higher strength by volumetric unit concerning humerus and ulna. Despite the development of contemporary osteometric procedures (ultrasound densitometry, dual X-ray absorptiometry, digital X-ray radiogrammetry, the classical radiogrammetry sustains its important role in diagnostics of metabolic bone disorders and it can be successfully used for biomechanical inquiry of skeletal system.

  7. Environmental monitoring for the DOE coolside and LIMB demonstration extension projects. Quarterly report for the period of February, March and April 1991

    Energy Technology Data Exchange (ETDEWEB)

    White, T.; Contos, L.; Adams, L. [Radian Corp., Research Triangle Park, NC (United States). Progress Center

    1992-02-01

    The purpose of this document is to present environmental monitoring data collected during the US DOE Limestone Injection Multistage Burner (LIMB) Demonstration Project Extension. The objective of the LIMB program is to demonstrate the sulfur dioxide (SO{sub 2}) and nitrogen oxide (NO{sub x}) emission reduction capabilities of the LIMB system. The LIMB system is a retrofit technology to be used for existing coal-fired boilers equipped with electrostatic precipitators. (VC)

  8. Reasonable classical concepts in human lower limb anatomy from the viewpoint of the primitive persistent sciatic artery and twisting human lower limb.

    Science.gov (United States)

    Kawashima, Tomokazu; Sasaki, Hiroshi

    2010-11-01

    The main aim of this review is (1) to introduce the two previous studies we published human lower limb anatomy based on the conventional macroscopic anatomical [corrected] criteria with hazardous recognition of this description, (2) to activate the discussion whether the limb homology exists, and (3) to contribute to future study filling the gap between the gross anatomy and embryology. One of the topics we discussed was the human persistent sciatic artery. To date, numerous human cases of persistent sciatic artery have been reported in which the anomalous artery was present in the posterior compartment of the thigh alongside the sciatic nerve. As one of the important criteria for assessing the human primitive sciatic artery, its ventral arterial position with respect to the sciatic nerve is reasonable based on the initial positional relationship between ventral arterial and dorsal nervous systems and comparative anatomical findings. We also discuss ways of considering the topography of muscles of the lower limb and their innervations compared to those of the upper limb. We propose a schema of the complex anatomical characteristics of the lower limb based on the vertebrate body plan. According to this reasonable schema, the twisted anatomy of the lower limb can be understood more easily. These two main ideas discussed in this paper will be useful for further understanding of the anatomy of the lower limb and as a first step for future. We hope that the future study in lower limb will be further developed by both viewpoints of the classical gross anatomy and recent embryology.

  9. Regeneration of limb joints in the axolotl (Ambystoma mexicanum.

    Directory of Open Access Journals (Sweden)

    Jangwoo Lee

    Full Text Available In spite of numerous investigations of regenerating salamander limbs, little attention has been paid to the details of how joints are reformed. An understanding of the process and mechanisms of joint regeneration in this model system for tetrapod limb regeneration would provide insights into developing novel therapies for inducing joint regeneration in humans. To this end, we have used the axolotl (Mexican Salamander model of limb regeneration to describe the morphology and the expression patterns of marker genes during joint regeneration in response to limb amputation. These data are consistent with the hypothesis that the mechanisms of joint formation whether it be development or regeneration are conserved. We also have determined that defects in the epiphyseal region of both forelimbs and hind limbs in the axolotl are regenerated only when the defect is small. As is the case with defects in the diaphysis, there is a critical size above which the endogenous regenerative response is not sufficient to regenerate the joint. This non-regenerative response in an animal that has the ability to regenerate perfectly provides the opportunity to screen for the signaling pathways to induce regeneration of articular cartilage and joints.

  10. Regeneration of Limb Joints in the Axolotl (Ambystoma mexicanum)

    Science.gov (United States)

    Lee, Jangwoo; Gardiner, David M.

    2012-01-01

    In spite of numerous investigations of regenerating salamander limbs, little attention has been paid to the details of how joints are reformed. An understanding of the process and mechanisms of joint regeneration in this model system for tetrapod limb regeneration would provide insights into developing novel therapies for inducing joint regeneration in humans. To this end, we have used the axolotl (Mexican Salamander) model of limb regeneration to describe the morphology and the expression patterns of marker genes during joint regeneration in response to limb amputation. These data are consistent with the hypothesis that the mechanisms of joint formation whether it be development or regeneration are conserved. We also have determined that defects in the epiphyseal region of both forelimbs and hind limbs in the axolotl are regenerated only when the defect is small. As is the case with defects in the diaphysis, there is a critical size above which the endogenous regenerative response is not sufficient to regenerate the joint. This non-regenerative response in an animal that has the ability to regenerate perfectly provides the opportunity to screen for the signaling pathways to induce regeneration of articular cartilage and joints. PMID:23185640

  11. Upper Limb Posture Estimation in Robotic and Virtual Reality-Based Rehabilitation

    Directory of Open Access Journals (Sweden)

    Camilo Cortés

    2014-01-01

    Full Text Available New motor rehabilitation therapies include virtual reality (VR and robotic technologies. In limb rehabilitation, limb posture is required to (1 provide a limb realistic representation in VR games and (2 assess the patient improvement. When exoskeleton devices are used in the therapy, the measurements of their joint angles cannot be directly used to represent the posture of the patient limb, since the human and exoskeleton kinematic models differ. In response to this shortcoming, we propose a method to estimate the posture of the human limb attached to the exoskeleton. We use the exoskeleton joint angles measurements and the constraints of the exoskeleton on the limb to estimate the human limb joints angles. This paper presents (a the mathematical formulation and solution to the problem, (b the implementation of the proposed solution on a commercial exoskeleton system for the upper limb rehabilitation, (c its integration into a rehabilitation VR game platform, and (d the quantitative assessment of the method during elbow and wrist analytic training. Results show that this method properly estimates the limb posture to (i animate avatars that represent the patient in VR games and (ii obtain kinematic data for the patient assessment during elbow and wrist analytic rehabilitation.

  12. Upper Limb Posture Estimation in Robotic and Virtual Reality-Based Rehabilitation

    Science.gov (United States)

    Cortés, Camilo; Ardanza, Aitor; Molina-Rueda, F.; Cuesta-Gómez, A.; Ruiz, Oscar E.

    2014-01-01

    New motor rehabilitation therapies include virtual reality (VR) and robotic technologies. In limb rehabilitation, limb posture is required to (1) provide a limb realistic representation in VR games and (2) assess the patient improvement. When exoskeleton devices are used in the therapy, the measurements of their joint angles cannot be directly used to represent the posture of the patient limb, since the human and exoskeleton kinematic models differ. In response to this shortcoming, we propose a method to estimate the posture of the human limb attached to the exoskeleton. We use the exoskeleton joint angles measurements and the constraints of the exoskeleton on the limb to estimate the human limb joints angles. This paper presents (a) the mathematical formulation and solution to the problem, (b) the implementation of the proposed solution on a commercial exoskeleton system for the upper limb rehabilitation, (c) its integration into a rehabilitation VR game platform, and (d) the quantitative assessment of the method during elbow and wrist analytic training. Results show that this method properly estimates the limb posture to (i) animate avatars that represent the patient in VR games and (ii) obtain kinematic data for the patient assessment during elbow and wrist analytic rehabilitation. PMID:25110698

  13. Computer-Based Clinical Instrumentation for Processing and Analysis of Electroneuromyographic Signals in the Upper Limb

    National Research Council Canada - National Science Library

    Nazeran, Homer

    2001-01-01

    ...) activity in the upper limb in humans, This system was designed around AMLAB analog modules and software objects called ICAMs, The system consists of a nerve stimulator block, a time domain EMG block...

  14. Transparent biocompatible sensor patches for touch sensitive prosthetic limbs

    KAUST Repository

    Nag, Anindya

    2016-12-26

    The paper presents the fabrication of transparent, flexible sensor patches developed using a casting technique with polydimethylsiloxane (PDMS) as substrate and a nanocomposite of carbon nanotubes (CNTs) and PDMS as interdigital electrodes. The electrodes act as strain sensitive capacitor. The prototypes were used as touch sensitive sensors attached to the limbs. Experiments results show the sensitivity of the patches towards tactile sensing. The results are very promising and can play a key role in the development of a cost efficient sensing system attached to prosthetic limbs.

  15. Major limb amputation in Ibadan.

    Science.gov (United States)

    Ogunlade, S O; Alonge, T O; Omololu, A B O; Gana, J Y; Salawu, S A

    2002-12-01

    A prospective study of patients who had major limb amputation at the University College Hospital Ibadan over a 5-year period is presented. One hundred and one major limb amputations were performed within this period (71 Males, 30 Females, M:F = 2.3:1). Trauma accounted for 48% of the cases followed by diabetes in 26%, soft tissue infection in 13% and tumours also in 13%. The major post-op complication was wound infection. In accordance with the findings in other centers, a higher proportion of the amputations (69%) were carried out in the lower limbs. Patient's refusal to accept amputation resulted in a delay in amputation in 49 patients. This delay (before surgery) ranged from 1 day to 150 days, with a mean of 15.49 (SD 9.V). From this study, we found that a reduction in vehicular accidents and increasing emphasis on efficient foot care (and glycaemic control) in the diabetic may significantly reduce the rate of amputations in our environment.

  16. Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial.

    Science.gov (United States)

    Schuster-Amft, Corina; Eng, Kynan; Lehmann, Isabelle; Schmid, Ludwig; Kobashi, Nagisa; Thaler, Irène; Verra, Martin L; Henneke, Andrea; Signer, Sandra; McCaskey, Michael; Kiper, Daniel

    2014-09-06

    In recent years, virtual reality has been introduced to neurorehabilitation, in particular with the intention of improving upper-limb training options and facilitating motor function recovery. The proposed study incorporates a quantitative part and a qualitative part, termed a mixed-methods approach: (1) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated, (2a) a qualitative investigation of patients' experiences and expectations of virtual reality training and (2b) a qualitative investigation of therapists' experiences using the virtual reality training system in the therapy setting. At three participating clinics, 60 patients at least 6 months after stroke onset will be randomly allocated to an experimental virtual reality group (EG) or to a control group that will receive conventional physiotherapy or occupational therapy (16 sessions, 45 minutes each, over the course of 4 weeks). Using custom data gloves, patients' finger and arm movements will be displayed in real time on a monitor, and they will move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during, and twice after the 4-week intervention. The primary outcome measure is the Box and Block Test. Secondary outcome measures are the Chedoke-McMaster Stroke Assessments (hand, arm and shoulder pain subscales), the Chedoke-McMaster Arm and Hand Activity Inventory, the Line Bisection Test, the Stroke Impact Scale, the MiniMentalState Examination and the Extended Barthel Index. Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients' expectations and experiences regarding the virtual reality training. Therapists' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational

  17. Limb distribution, motor impairment, and functional classification of cerebral palsy

    NARCIS (Netherlands)

    Gorter, J.A.; Rosenbaum, P.L.

    2004-01-01

    This study explored the relationships between the Gross Motor Function Classification System (GMFCS), limb distribution, and type of motor impairment. Data used were collected in the Ontario Motor Growth study, a longitudinal cohort study with a population-based sample of children with cerebral

  18. Limb trauma in a university teaching hospital setting

    Directory of Open Access Journals (Sweden)

    I C Nwagbara

    2011-01-01

    Conclusion Majority of the limb trauma cases were as a result of road traffic crashes; thus efforts should be directed at improving safety on our roads to reduce the burden of trauma on the health care system. There is also a need to create awareness in the community on the role of orthodox medicine in the management of fractures.

  19. Environmental monitoring for the DOE coolside and LIMB demonstration extension projects

    Energy Technology Data Exchange (ETDEWEB)

    White, T.; Contos, L.; Adams, L. (Radian Corp., Research Triangle Park, NC (United States))

    1992-03-01

    The purpose of this document is to present environmental monitoring data collected during the US Department of Energy Limestone Injection Multistage Burner (DOE LIMB) Demonstration Project Extension at the Ohio Edison Edgewater Generating Station in Lorain, Ohio. The DOE project is an extension of the US Environmental Protection Agency's (EPA's) original LIMB Demonstration. The program is operated nuclear DOE's Clean Coal Technology Program of emerging clean coal technologies'' under the categories of in boiler control of oxides of sulfur and nitrogen'' as well as post-combustion clean-up.'' The objective of the LIMB program is to demonstrate the sulfur dioxide (SO{sub 2}) and nitrogen oxide (NO{sub x}) emission reduction capabilities of the LIMB system. The LIMB system is a retrofit technology to be used for existing coal-fired boilers equipped with electrostatic precipitators (ESPs).

  20. Distal Limb Defects and Aplasia Cutis: Adams-Oliver Syndrome.

    Science.gov (United States)

    Renfree, Kevin J; Dell, Paul C

    2016-07-01

    Adams-Oliver syndrome is a rare congenital condition that should be considered in persons with terminal transverse limb deficiencies and scalp defects (aplasia cutis congenita). Broad phenotypic variability exists in this condition. In its more severe forms, Adams-Oliver syndrome can involve the cardiovascular system, central nervous system, gastrointestinal tract, and genitourinary system and should require prompt evaluation by appropriate subspecialists. Extremity involvement is typically bilateral and asymmetrical, with lower extremities involved more than upper extremities. Brachydactyly is the most common limb defect, and severity ranges from hypoplastic nails to complete absence of the distal limb. The syndrome has been described as resulting from autosomal dominant and recessive modes of inheritance, but most cases are sporadic. No gene has been identified. Although the exact pathogenic mechanism is unknown, a common hypothesis is that a vascular disturbance occurs in watershed areas, such as cranial vertex and limbs, during fetal development. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Differentiation of cartilaginous anlagen in entire embryonic mouse limbs cultured in a rotating bioreactor

    Science.gov (United States)

    Montufar-Solis, D.; Oakley, C. R.; Jefferson, Y.; Duke, P. J.

    2003-10-01

    Mechanisms involved in development of the embryonic limb have remained the same throughout eons of genetic and environmental evolution under Earth gravity (lg). During the spaceflight era it has been of interest to explore the ancient theory that form of the skeleton develops in response to gravity, and that changes in gravitational forces can change the developmental pattern of the limb. This has been shown in vivo and in vitro, allowing the hypergravity of centrifugation and microgravity of space to be used as tools to increase our knowledge of limb development. In recapitulations of spaceflight experiments, premetatarsals were cultured in suspension in a bioreactor, and found to be shorter and less differentiated than those cultured in standard culture dishes. This study only measured length of the metatarsals, and did not account for possible changes due to the skeletal elements having a more in vivo 3D shape while in suspension vs. flattened tissues compressed by their own weight. A culture system with an outcome closer to in vivo and that supports growth of younger limb buds than traditional systems will allow studies of early Hox gene expression, and contribute to the understanding of very early stages of development. The purpose of the current experiment was to determine if entire limb buds could be cultured in the bioreactor, and to compare the growth and differentiation with that of culturing in a culture dish system. Fore and hind limbs from E11-E13 ICR mouse embryos were cultured for six days, either in the bioreactor or in center-well organ culture dishes, fixed, and embedded for histology. E13 specimens grown in culture dishes were flat, while bioreactor culture specimens had a more in vivo-like 3D limb shape. Sections showed excellent cartilage differentiation in both culture systems, with more cell maturation, and hypertrophy in the specimens cultured in the bioreactor. Younger limb buds fused together during culture, so an additional set of El 1

  2. Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system following infrapopliteal endovascular interventions for critical limb ischemia

    NARCIS (Netherlands)

    J. Darling (Jeremy); J.C. McCallum (John C.); P.A. Soden (Peter A.); Meng, Y. (Yifan); Wyers, M.C. (Mark C.); Hamdan, A.D. (Allen D.); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

    2016-01-01

    textabstractObjective The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee has composed a new threatened lower extremity classification system that reflects the three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI).

  3. LIMB SALVAGE IN DIABETIC FOOT INFECTION

    OpenAIRE

    J. Ramanaiah; M. Pavani; N. Dinesh Kumar Reddy; Sai Subrahmanyam

    2017-01-01

    BACKGROUND Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. Limb salvage procedures may prevent eventual limb loss, the need of a major limb amputation, decrease total cost and may restore full ambulation earlier. MATERIALS ...

  4. Angular Limb Deformities: Growth Retardation.

    Science.gov (United States)

    McCarrel, Taralyn M

    2017-08-01

    Angular limb deformities are common in foals; however, the importance of the deformity and if treatment is required depend on the degree of deformity relative to normal conformation for stage of growth, the breed and discipline expectations, age, and response to conservative therapies. This article addresses the importance of the foal conformation examination to determine which foals need surgical intervention to correct an angular deformity and when. Techniques for surgical growth retardation include the transphyseal staple, screw and wire transphyseal bridge, and transphyseal screw. Appropriate timing for intervention for each location and complications associated with each procedure are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Endograft Limb Occlusion in EVAR

    DEFF Research Database (Denmark)

    Taudorf, M; Jensen, L P; Vogt, K C

    2014-01-01

    occlusions were recorded and compared with a defined control group. Three different indices were used to describe the tortuosity of the iliac vessels based on preoperative CTA: pelvic artery index of tortuosity (PAI), common iliac artery index of tortuosity (CAI), and a visual description of vessel......% at 3 years. Logistic regression showed that iliac artery tortuosity (DIS) (p = .001) and body mass index (p = .007) had a significant impact on graft patency. CONCLUSION: A tortuous vessel on the preoperative CTA is associated with an increased risk of limb occlusion after EVAR. Adjunctive stenting...

  6. A multi-step genetic algorithm model for ensuring cost-effectiveness and adequate water pressure in a trunk/limb mains pipe system

    OpenAIRE

    Bakri, Bambang; Arai, Yasuhiro; Inakazu, Toyono; Koizumi, Akira; Pallu, Saleh; Yoda, Hiroyasu

    2015-01-01

    - A water distribution network is the most expensive component of awater supply system; consequently, the overall planning, installation, and rehabilitation processes should be implemented accurately and carefully. The main issue that developing countries are facing is how to optimize the distribution network to meet increasing water demand. To tackle the issue, this paper proposes a new concept for rehabilitation and expansion of a water distribution network while ensuring cost-effectiven...

  7. Phantom lower limb as a perceptual marker of neural plasticity in the mature human brain.

    Science.gov (United States)

    Aglioti, S; Bonazzi, A; Cortese, F

    1994-03-22

    Three lower limb amputees, who reported phantom sensations, referred somatic stimuli delivered to skin regions proximal to the stump to select points on the phantom limb. Stimuli on the rectum and anus (e.g. during defecation) and on genital areas (e.g. during sexual intercourse) induced analogous, although less precise, mislocation to the phantom limb. Although the representation of the stump in the somatosensory pathway is lateral to that of the amputated lower limb, both anus and genitals are mapped medially to the areas formerly subserving the amputated lower limb. Therefore the mislocalization phenomenon can be considered as a perceptual landmark of new functional connections between the deprived areas and the adjacent ones, thus suggesting a dynamic neural remodelling in the mature nervous system, which was previously considered as a static entity.

  8. NEW THERAPEUTIC OPTIONS IN THE TREATMENT OF METASTATIC LIMB SARCOMAS: A CASE SERIES

    Directory of Open Access Journals (Sweden)

    Nicola Ratto

    2013-04-01

    Full Text Available Palliative procedures are those usually used in the treatment of metastatic limb sarcoma. However given the impressive results obtained with hyperthermic isolated limb perfusion (ILP, we tested the feasibility of isolated lung perfusion (ILuP, using the same regimen. Three patients with multiple metastases from limb sarcoma were included in this study. ILP was applied in one patient resulting in limb preservation. Patients underwent 90- minute ILuP, and subsequent metastasectomy. In all cases the procedure was completed without complications. No systemic toxicity developed. The only postoperative complication was one case of reversible interstitial and alveolar lung edema. The three patients are still alive and two of them were disease-free at a mean follow-up of 19 months. ILuP, with TNF and Melphaln, proved to be feasible and safe. This technique, in association with ILP, might improve long-term survival and quality of life in patients with multiple metastases from limb sarcoma.

  9. LIMB Demonstration Project Extension. Quarterly report no. 5, May, June and July 1988

    Energy Technology Data Exchange (ETDEWEB)

    1988-09-15

    The basic goal of the Limestone Injection Multistage Burner (LIMB) demonstration is to extend LIMB technology development to a full-scale application on a representative wall-fired utility boiler. The successful retrofit of LIMB to an existing boiler is expected to demonstrate that (a) reductions of 50 percent or greater in SO and NO emissions can be achieved at a fraction of the cost of add-on FGD systems, (b) boiler reliability, operability, and steam production can be maintained at levels existing prior to LIMB retrofit, and (c) technical difficulties attributable to LIMB operation, such as additional slagging and fouling, changes in ash disposal requirements, and an increased particulate load, can be resolved in a cost-effective manner. The primary fuel to be used will be an Ohio bituminous coal having a nominal sulfur content of 3 percent or greater.

  10. Upper limb swelling following mastectomy: lymphedema or not?

    Science.gov (United States)

    Armer, Jane

    2007-04-01

    Having experienced an excisional biopsy, sentinel lymph node biopsy, and mastectomy, BH is at lifetime risk of developing post-breast cancer lymphedema in the arm on the side where her breast cancer was treated. She has two additional risk factors, among those documented in the literature: history of an infection (specifically a systemic infection, significant in that it required hospitalization for intravenous antibiotics) in the postsurgery period, and a moderate increase in bilateral limb volume and weight (body mass index) over the months and years following the breast cancer diagnosis. Further, the patient-reported transient hand swelling on the affected side and gradual weight increase are cues indicating a need for patient vigilance and careful monitoring by the health-care team. Preventing future infections, managing weight at an optimal level, and preventing trauma or injury to the affected arm and chest are important self-management precautions to reduce risk of chronic lymphedema development. BH needs continued support in reviewing evidence-based risk-reduction guidelines and understanding ways to apply them to her lifestyle. In the absence of preoperative baseline or contralateral limb measurements (with circumferences or perometry or water displacement), assessment of limb change at a level identified as diagnostic of lymphedema (commonly, 200-mL volume or 2-cm girth increase from baseline or as compared to the contralateral limb) is very challenging. Without bilateral preop limb measurements for baseline and contralateral limb comparisons, BH might have been diagnosed with lymphedema at postop or at 48 months, when both limbs increased symmetrically. Symptom assessment is also crucial, as symptom report of heaviness and swelling is found to be associated with limb volume changes indicative of lymphedema. Transient hand swelling may be evidence of latent lymphedema and cause for increased risk-reduction education and vigilance in assessment for

  11. Robot-Aided Upper-Limb Rehabilitation Based on Motor Imagery EEG

    Directory of Open Access Journals (Sweden)

    Baoguo Xu

    2011-09-01

    Full Text Available Stroke is a leading cause of disability worldwide. In this paper, a novel robot‐assisted rehabilitation system based on motor imagery electroencephalography (EEG is developed for regular training of neurological rehabilitation for upper limb stroke patients. Firstly, three‐dimensional animation was used to guide the patient image the upper limb movement and EEG signals were acquired by EEG amplifier. Secondly, eigenvectors were extracted by harmonic wavelet transform (HWT and linear discriminant analysis (LDA classifier was utilized to classify the pattern of the left and right upper limb motor imagery EEG signals. Finally, PC triggered the upper limb rehabilitation robot to perform motor therapy and gave the virtual feedback. Using this robot‐assisted upper limb rehabilitation system, the patientʹs EEG of upper limb movement imagination is translated to control rehabilitation robot directly. Consequently, the proposed rehabilitation system can fully explore the patientʹs motivation and attention and directly facilitate upper limb post‐stroke rehabilitation therapy. Experimental results on unimpaired participants were presented to demonstrate the feasibility of the rehabilitation system. Combining robot‐assisted training with motor imagery‐ based BCI will make future rehabilitation therapy more effective. Clinical testing is still required for further proving this assumption.

  12. Robot-Aided Upper-Limb Rehabilitation Based on Motor Imagery EEG

    Directory of Open Access Journals (Sweden)

    Baoguo Xu

    2011-09-01

    Full Text Available Stroke is a leading cause of disability worldwide. In this paper, a novel robot-assisted rehabilitation system based on motor imagery electroencephalography (EEG is developed for regular training of neurological rehabilitation for upper limb stroke patients. Firstly, three-dimensional animation was used to guide the patient image the upper limb movement and EEG signals were acquired by EEG amplifier. Secondly, eigenvectors were extracted by harmonic wavelet transform (HWT and linear discriminant analysis (LDA classifier was utilized to classify the pattern of the left and right upper limb motor imagery EEG signals. Finally, PC triggered the upper limb rehabilitation robot to perform motor therapy and gave the virtual feedback. Using this robot-assisted upper limb rehabilitation system, the patient's EEG of upper limb movement imagination is translated to control rehabilitation robot directly. Consequently, the proposed rehabilitation system can fully explore the patient's motivation and attention and directly facilitate upper limb post-stroke rehabilitation therapy. Experimental results on unimpaired participants were presented to demonstrate the feasibility of the rehabilitation system. Combining robot-assisted training with motor imagery-based BCI will make future rehabilitation therapy more effective. Clinical testing is still required for further proving this assumption.

  13. Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain.

    Science.gov (United States)

    Karl, A; Birbaumer, N; Lutzenberger, W; Cohen, L G; Flor, H

    2001-05-15

    Phantom limb pain (PLP) in amputees is associated with reorganizational changes in the somatosensory system. To investigate the relationship between somatosensory and motor reorganization and phantom limb pain, we used focal transcranial magnetic stimulation (TMS) of the motor cortex and neuroelectric source imaging of the somatosensory cortex (SI) in patients with and without phantom limb pain. For transcranial magnetic stimulation, recordings were made bilaterally from the biceps brachii, zygomaticus, and depressor labii inferioris muscles. Neuroelectric source imaging of the EEG was obtained after somatosensory stimulation of the skin overlying face and hand. Patients with phantom limb pain had larger motor-evoked potentials from the biceps brachii, and the map of outputs was larger for muscles on the amputated side compared with the intact side. The optimal scalp positions for stimulation of the zygomaticus and depressor labii inferioris muscles were displaced significantly more medially (toward the missing hand representation) in patients with phantom limb pain only. Neuroelectric source imaging revealed a similar medial displacement of the dipole center for face stimulation in patients with phantom limb pain. There was a high correlation between the magnitude of the shift of the cortical representation of the mouth into the hand area in motor and somatosensory cortex and phantom limb pain. These results show enhanced plasticity in both the motor and somatosensory domains in amputees with phantom limb pain.

  14. Inclusion of Height and Limb Length when Interpreting Sympathetic Skin Response

    Directory of Open Access Journals (Sweden)

    Mohamadreza Emad

    2016-01-01

    Full Text Available It is more than a decade since scientists are making use of sympathetic skin response (SSR as a clinical and research method to evaluate sympathetic nervous system. A major portion of the efferent pathway of this response is composed of non-myelinated nerves. Thus, the latency of the response may be significantly different in normal individuals with different height and limb lengths. This study was designed to investigate the effect of these parameters on the SSR results. We measured the height and limb length of 65 normal individuals with different heights (divided into 3 groups of height ≤150 cm, 150-170 cm, and ≥170 cm. The participants had neither peripheral nor central neuropathy. They also had none of the exclusion criteria. Then, they underwent SSR testing of both palms and soles. The correlation between the height and limb length in relation to SSR parameters (latency and amplitude was analyzed statistically by Pearson’s correlation. No significant correlation was detected between the height and limb length and the SSR amplitude. However, the results showed significant correlation between SSR latency recorded from all four sites (both palms and soles and the height of participants. Furthermore, there was a significant correlation between SSR latency recorded from any limb and the length of that limb. Regarding the significant effect of the height and limb length on the SSR latency, both the height and limb length should be considered when interpreting the results of SSR.

  15. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances

    OpenAIRE

    Forghani, Ali; Milner, Theodore E.

    2017-01-01

    Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the h...

  16. Extracellular Control of Limb Regeneration

    Science.gov (United States)

    Calve, S.; Simon, H.-G.

    Adult newts possess the ability to completely regenerate organs and appendages. Immediately after limb loss, the extracellular matrix (ECM) undergoes dramatic changes that may provide mechanical and biochemical cues to guide the formation of the blastema, which is comprised of uncommitted stem-like cells that proliferate to replace the lost structure. Skeletal muscle is a known reservoir for blastema cells but the mechanism by which it contributes progenitor cells is still unclear. To create physiologically relevant culture conditions for the testing of primary newt muscle cells in vitro, the spatio-temporal distribution of ECM components and the mechanical properties of newt muscle were analyzed. Tenascin-C and hyaluronic acid (HA) were found to be dramatically upregulated in the amputated limb and were co-expressed around regenerating skeletal muscle. The transverse stiffness of muscle measured in situ was used as a guide to generate silicone-based substrates of physiological stiffness. Culturing newt muscle cells under different conditions revealed that the cells are sensitive to both matrix coating and substrate stiffness: Myoblasts on HA-coated soft substrates display a rounded morphology and become more elongated as the stiffness of the substrate increases. Coating of soft substrates with matrigel or fibronectin enhanced cell spreading and eventual cell fusion.

  17. Limb apraxia in corticobasal syndrome.

    Science.gov (United States)

    Stamenova, Vessela; Roy, Eric A; Black, Sandra E

    2011-04-01

    Corticobasal syndrome (CBS) is a progressive neurodegenerative disorder with asymmetric presentation and course characterized by degeneration of basal ganglia and cortical structures. Limb apraxia is a commonly observed deficit in CBS. Few studies have examined comprehensively the nature of deficits in limb apraxia. The goal of our study was to investigate the severity of deficits in various conceptual and gesture production task modalities. CBS patients were divided in two groups based on the side of brain that was initially affected by the disease. Ten patients with right hemisphere presentation (RHP) and seven with left hemisphere presentation (LHP) were included. The results showed that while selective conceptual tasks deficits were present in both groups, the overall picture suggests preserved conceptual representations of tools and actions in CBS patients with either LHP or RHP. Both groups were impaired relative to controls on gesture production tasks. Performance on transitive gestures was more severely affected in both groups than intransitive gestures. Imitation was more severely affected than pantomime, suggesting deficits in visuomotor transformations. The addition of verbal cuing during concurrent imitation affected only the LHP patients, rendering them more impaired relative to controls in their imitation with verbal cuing as opposed to their imitation only performance. Imitation of non-representational gestures was least accurate and intransitive gestures were most accurate. Patients were more severely impaired relative to controls when holding the object and when they were shown pictures of tools to pantomime. Copyright © 2010 Elsevier Srl. All rights reserved.

  18. Adjustments to amputation and an artificial limb in lower limb amputees

    NARCIS (Netherlands)

    Sinha, Richa; van den Heuvel, Wim J. A.; Arokiasamy, Perianayagam

    Background: Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. Objectives: To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and

  19. Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient's home: study protocol of a randomized clinical trial.

    Science.gov (United States)

    Kairy, Dahlia; Veras, Mirella; Archambault, Philippe; Hernandez, Alejandro; Higgins, Johanne; Levin, Mindy F; Poissant, Lise; Raz, Amir; Kaizer, Franceen

    2016-03-01

    Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the Internet, can contribute to ensure that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance. A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups. Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Lower-Limb Robotic Rehabilitation: Literature Review and Challenges

    Directory of Open Access Journals (Sweden)

    Iñaki Díaz

    2011-01-01

    been developed worldwide for training of both the upper and lower extremities. This work reviews all current robotic systems to date for lower-limb rehabilitation, as well as main clinical tests performed with them, with the aim of showing a clear starting point in the field. It also remarks some challenges that current systems still have to meet in order to obtain a broad clinical and market acceptance.

  1. Transcutaneous oximetry monitoring in patients with type 2 diabetes mellitus and critical limb ischemia

    Directory of Open Access Journals (Sweden)

    O N Bondarenko

    2013-03-01

    Full Text Available Aims. To evaluate transcutaneous oximetry as a method for diagnostics and monitoring in patients with diabetes mellitus (DM and critical limb ischemia (CLI after percutaneous transluminal balloon angioplasty (PTBA.Materials and Methods. We enrolled 126 patients with DM and CLI for participation in this study (148 limbs in total. 22 patients underwent PTBA on both lower limbs, and 104 – on single limb. Transcutaneous oximetry and duplex ultrasonography of lower limb arteries was performed prior to PTBA with subsequent examinations on 5-7th days, 1st, 3rd and 6th month after intervention. Transcu- taneous oxygen tension (TcpO2 was measured by Radiometer (Copenhagen oximeter system. Duplex ultrasonography was performed on Voluson 730® Expert system (GE Medical Systems Kretztechnik GmbH&Co OHG, Austria.Results. Multiple factor analysis suggests that results of TcpO2 monitoring prior to and after PTBA are influenced by presence of ischemic heart disease, severe lower limb infections, serum creatinine, arterial hypertension and lower limb reperfusion edema. We observed a strong correlation of TcpO2 with the degree of anterior tibial artery and dorsal pedis artery occlusion.Conclusion. Transcutaneous oximetry allows evaluation of CLI severity and efficiency of PTBA in the majority oа patients with DM and CLI. Certain comorbidities impose limitations on this technique. Efficiency of endovascular intervention should be evaluated based on complex non-invasive examination, clinical data and signs of CLI.

  2. Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program.

    Science.gov (United States)

    Causey, Marlin W; Ahmed, Ayman; Wu, Bian; Gasper, Warren J; Reyzelman, Alex; Vartanian, Shant M; Hiramoto, Jade S; Conte, Michael S

    2016-06-01

    Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization. This study was designed to prospectively assess limb and patient-based staging for predicting outcomes of hospitalized patients in an amputation prevention program. This study undertook a retrospective analysis of prospectively gathered registry data of consecutive patients with limb-threatening conditions admitted to a fully integrated vascular/podiatry service over a 16-month period. Upon admission, limb risk was stratified using the WIfI system and patient risk was categorized using PIII classification. Patients were assessed for perioperative and postdischarge outcomes, and their relationship to staging at admission was analyzed. There were 174 threatened limbs (143 hospitalized patients) stratified by WIfI stage (1%-12%, 2%-28%, 3%-24%, 4%-28%, 5%-3%, unstaged-5%) and PIII risk (34% low, 49% moderate, and 17% high risk). Diabetes and end-stage renal disease were associated with WIfI stage (P = .006 and P = .018) and PIII risk (P = .003 and P amputation. There were 119 limbs (71%) that underwent revascularization, including 108 infrainguinal reconstructions (endovascular or open revascularization). Rate of revascularization increased with WIfI stage (P procedures, minor amputations, and initial hospital duration of stay (all P procedures, there was a similar distribution of endovascular (46%) and surgical (54%) interventions. Freedom from major adverse limb events was best for

  3. A short overview of upper limb rehabilitation devices

    Science.gov (United States)

    Macovei, S.; Doroftei, I.

    2016-08-01

    As some studies show, the number of people over 65 years old increases constantly, leading to the need of solution to provide services regarding patient mobility. Diseases, accidents and neurologic problems affect hundreds of people every day, causing pain and lost of motor functions. The ability of using the upper limb is indispensable for a human being in everyday activities, making easy tasks like drinking a glass of water a real challenge. We can agree that physiotherapy promotes recovery, but not at an optimal level, due to limited financial and human resources. Hence, the need of robot-assisted rehabilitation emerges. A robot for upper-limb exercises should have a design that can accurately control interaction forces and progressively adapt assistance to the patients’ abilities and also to record the patient's motion and evolution. In this paper a short overview of upper limb rehabilitation devices is presented. Our goal is to find the shortcomings of the current developed devices in terms of utility, ease of use and costs, for future development of a mechatronic system for upper limb rehabilitation.

  4. Work-Related Upper Limb Disorders: A Case Report

    Directory of Open Access Journals (Sweden)

    Zlatka Borisova Stoyneva

    2015-03-01

    Full Text Available In this study the complex interrelationship between physical factors, job stress, lifestyle and genetic factors on symptoms of work-related musculoskeletal disorders of the upper limbs is demonstrated by a case report and discussion of the literature. A 58 year old woman with long lasting complaints of the upper limbs with increasing intensity and duration, generalisation, combined with skin thickness, Raynaud’s phenomenon, joint disorders, arterial and pulmonary hypertension, metabolic lipid dysfunctions is presented. Occupational history proves continuous duration of service at a job with occupational physical static load with numerous repetitive monotonous systematic motions of fingers and hands as a weaver of Persian rugs followed by work at an automated loom and variable labour activities. Though the complaints dated since the time she was a manual weaver, the manifestations of generalized joint degenerative changes, system sclerosis with Raynaud’s phenomenon with similar upper extremities signs and symptoms discount upper limbs musculoskeletal disorder as caused only or mainly by occupational risk factors. The main principles and criteria for occupational diagnosis of musculoskeletal upper limb disorders and legislative requirements for their reglamentation are discussed.

  5. Lower limb length and offset in total hip arthroplasty.

    Science.gov (United States)

    Flecher, X; Ollivier, M; Argenson, J N

    2016-02-01

    Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Ownership of an artificial limb induced by electrical brain stimulation.

    Science.gov (United States)

    Collins, Kelly L; Guterstam, Arvid; Cronin, Jeneva; Olson, Jared D; Ehrsson, H Henrik; Ojemann, Jeffrey G

    2017-01-03

    Replacing the function of a missing or paralyzed limb with a prosthetic device that acts and feels like one's own limb is a major goal in applied neuroscience. Recent studies in nonhuman primates have shown that motor control and sensory feedback can be achieved by connecting sensors in a robotic arm to electrodes implanted in the brain. However, it remains unknown whether electrical brain stimulation can be used to create a sense of ownership of an artificial limb. In this study on two human subjects, we show that ownership of an artificial hand can be induced via the electrical stimulation of the hand section of the somatosensory (SI) cortex in synchrony with touches applied to a rubber hand. Importantly, the illusion was not elicited when the electrical stimulation was delivered asynchronously or to a portion of the SI cortex representing a body part other than the hand, suggesting that multisensory integration according to basic spatial and temporal congruence rules is the underlying mechanism of the illusion. These findings show that the brain is capable of integrating "natural" visual input and direct cortical-somatosensory stimulation to create the multisensory perception that an artificial limb belongs to one's own body. Thus, they serve as a proof of concept that electrical brain stimulation can be used to "bypass" the peripheral nervous system to induce multisensory illusions and ownership of artificial body parts, which has important implications for patients who lack peripheral sensory input due to spinal cord or nerve lesions.

  7. The heart in limb girdle muscular dystrophy

    NARCIS (Netherlands)

    van der Kooi, A. J.; de Voogt, W. G.; Barth, P. G.; Busch, H. F.; Jennekens, F. G.; Jongen, P. J.; de Visser, M.

    1998-01-01

    OBJECTIVE: To assess the frequency, nature, and severity of cardiac abnormalities in limb girdle muscular dystrophy, and its relation to age and weakness in various genotypes. DESIGN: In 26 autosomal dominant, 38 autosomal recessive, and 33 sporadic strictly defined patients with limb girdle

  8. Lower Limb Disabilities Following Motorcyle Crashes | Kortor ...

    African Journals Online (AJOL)

    ... caused by amputation, fracture, post traumatic arthritis and joint stiffness. The objective of this study was to assess the nature and severity of lower limb disability resulting from motorcycle crashes. Methodology: All victims of motorcycle accident with lower limb injuries who were treated at NKST Rehabilitation Hospital from ...

  9. Claimed walking distance of lower limb amputees

    NARCIS (Netherlands)

    Geertzen, JHB; Bosmans, JC; Van der Schans, CP; Dijkstra, PU

    2005-01-01

    Purpose: Walking ability in general and specifically for lower limb amputees is of major importance for social mobility and ADL independence. Walking determines prosthesis prescription. The aim of this study was to mathematically analyse factors influencing claimed walking distance of lower limb

  10. Update on embryology of the upper limb.

    Science.gov (United States)

    Al-Qattan, Mohammad M; Kozin, Scott H

    2013-09-01

    Current concepts in the steps of upper limb development and the way the limb is patterned along its 3 spatial axes are reviewed. Finally, the embryogenesis of various congenital hand anomalies is delineated with an emphasis on the pathogenetic basis for each anomaly. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Sports participation of Dutch lower limb amputees

    NARCIS (Netherlands)

    Bragaru, Mihail; Meulenbelt, Hendrik; Dijkstra, Pieter U.; Geertzen, Jan H.B.; Dekker, Rienk

    2013-01-01

    Objective: To analyze sports participation of Dutch lower limb amputees and factors influencing sports participation. Study design: A cross-sectional survey was performed. Dutch lower limb amputees (N = 2039) were invited to participate in a postal survey addressing personal and amputation

  12. Limb-segment selection in drawing behaviour

    NARCIS (Netherlands)

    Meulenbroek, R G; Rosenbaum, D A; Thomassen, A.J.W.M.; Schomaker, L R

    How do we select combinations of limb segments to carry out physical tasks? Three possible determinants of limb-segment selection are hypothesized here: (1) optimal amplitudes and frequencies of motion for the effectors; (2) preferred movement axes for the effectors; and (3) a tendency to continue

  13. LIMB-SEGMENT SELECTION IN DRAWING BEHAVIOR

    NARCIS (Netherlands)

    MEULENBROEK, RGJ; ROSENBAUM, DA; THOMASSEN, AJWM; SCHOMAKER, LRB; Schomaker, Lambertus

    How do we select combinations of limb segments to carry out physical tasks? Three possible determinants of limb-segment selection are hypothesized here: (1) optimal amplitudes and frequencies of motion for the effectors; (2) preferred movement axes for the effectors; and (3) a tendency to continue

  14. Genetics Home Reference: limb-girdle muscular dystrophy

    Science.gov (United States)

    ... Health Conditions Limb-girdle muscular dystrophy Limb-girdle muscular dystrophy Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Limb-girdle muscular dystrophy is a term for a group of diseases ...

  15. Autologous intramuscular transplantation of engineered satellite cells induces exosome-mediated systemic expression of Fukutin-related protein and rescues disease phenotype in a murine model of limb-girdle muscular dystrophy type 2I.

    Science.gov (United States)

    Frattini, Paola; Villa, Chiara; De Santis, Francesca; Meregalli, Mirella; Belicchi, Marzia; Erratico, Silvia; Bella, Pamela; Raimondi, Manuela Teresa; Lu, Qilong; Torrente, Yvan

    2017-10-01

    α-Dystroglycanopathies are a group of muscular dystrophies characterized by α-DG hypoglycosylation and reduced extracellular ligand-binding affinity. Among other genes involved in the α-DG glycosylation process, fukutin related protein (FKRP) gene mutations generate a wide range of pathologies from mild limb girdle muscular dystrophy 2I (LGMD2I), severe congenital muscular dystrophy 1C (MDC1C), to Walker-Warburg Syndrome and Muscle-Eye-Brain disease. FKRP gene encodes for a glycosyltransferase that in vivo transfers a ribitol phosphate group from a CDP -ribitol present in muscles to α-DG, while in vitro it can be secreted as monomer of 60kDa. Consistently, new evidences reported glycosyltransferases in the blood, freely circulating or wrapped within vesicles. Although the physiological function of blood stream glycosyltransferases remains unclear, they are likely released from blood borne or distant cells. Thus, we hypothesized that freely or wrapped FKRP might circulate as an extracellular glycosyltransferase, able to exert a "glycan remodelling" process, even at distal compartments. Interestingly, we firstly demonstrated a successful transduction of MDC1C blood-derived CD133+ cells and FKRP L276IKI mouse derived satellite cells by a lentiviral vector expressing the wild-type of human FKRP gene. Moreover, we showed that LV-FKRP cells were driven to release exosomes carrying FKRP. Similarly, we observed the presence of FKRP positive exosomes in the plasma of FKRP L276IKI mice intramuscularly injected with engineered satellite cells. The distribution of FKRP protein boosted by exosomes determined its restoration within muscle tissues, an overall recovery of α-DG glycosylation and improved muscle strength, suggesting a systemic supply of FKRP protein acting as glycosyltransferase. © The Author 2017. Published by Oxford University Press.

  16. [Thalidomide (Contergan) induced limb deficiency in Hungary?].

    Science.gov (United States)

    Gidai, János; Bács, Eva; Czeizel, Endre

    2009-06-21

    A 47 year old female with severe deficiency of three limbs visited our Genetic Counselling Clinic and asked us to give her a certificate that her complex limb deficiency was caused by thalidomide (Contergan). According to her explanation, her mother used this drug during pregnancy which was given to her by her sister, who lived in West Germany. The characteristic signs of thalidomide embryopathy are: radial type limb deficiency including most severe forms of phocomelia and amelia, ear abnormalities. In the case of this woman, however, FFU (femoral-fibula-ulna) complex was found: bilateral femur hypoplasia (F), and fibular hypoplasia (F) with the lack of Vth and IVth toes, in addition with ulnar hypoplasia (U) with the deficiency of Vth and IVth fingers in her right upper limb. The left upper limb was not affected. Besides that, she was treated with schizophrenia. In conclusion, there is no association between the supposed thalidomide use during pregnancy and FFU complex.

  17. Limb Regeneration in Xenopus laevis Froglet

    Directory of Open Access Journals (Sweden)

    Makoto Suzuki

    2006-01-01

    Full Text Available Limb regeneration in amphibians is a representative process of epimorphosis. This type of organ regeneration, in which a mass of undifferentiated cells referred to as the “blastema” proliferate to restore the lost part of the amputated organ, is distinct from morphallaxis as observed, for instance, in Hydra, in which rearrangement of pre-existing cells and tissues mainly contribute to regeneration. In contrast to complete limb regeneration in urodele amphibians, limb regeneration in Xenopus, an anuran amphibian, is restricted. In this review of some aspects regarding adult limb regeneration in Xenopus laevis, we suggest that limb regeneration in adult Xenopus, which is pattern/tissue deficient, also represents epimorphosis.

  18. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees.

    Science.gov (United States)

    Poor Zamany Nejatkermany, Mahtab; Modirian, Ehsan; Soroush, Mohammadreza; Masoumi, Mehdi; Hosseini, Maryam

    2016-01-01

    To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation. All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test. There were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP. Phantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation.

  19. Limb Laterality Recognition Score: A Reliable Clinical Measure Related to Phantom Limb Pain.

    Science.gov (United States)

    Wong, Christopher Kevin; Wong, Caitlin Kimberly

    2017-08-24

    To explore the usefulness of the limb laterality recognition score as a clinical measure of phantom limb pain, regarding test-retest reliability and association of limb laterality recognition scores with phantom limb pain measures. Retrospective cohort. Community support group. Eleven adults who averaged 4.8 years since lower limb amputation due to vascular pathologies (N = 9), trauma (N = 1), and cancer (N = 1). Subjects self-reported amputated limb pain using the sensation subsection of the Prosthetic Evaluation Questionnaire and back and sound limb pain. Using numbered iPads that corresponded to the self-reports, subjects played the Recognise Foot game to assess limb laterality recognition ability. Subjects identified the laterality of 20 foot images, within two seconds each. The software collected accuracy and speed scores in basic, vanilla, and context conditions for two rounds in random order. Basic showed feet against black backgrounds, vanilla showed feet with various monochromatic backgrounds, and context showed feet in clothed or environmental contexts. So that greater accuracy in less time meant a better score, accuracy scores were divided by completion speed. Intraclass correlation coefficient (ICC)3,1 assessed test-retest reliability. Correlations between accuracy/speed and phantom limb pain measures were assessed with Spearman's rho (categorical) and Pearson coefficients (continuous). Accuracy/speed test-retest reliability was strong (ICC = 0.72) and inversely associated with phantom limb pain frequency (context rho = 0.72). Limb laterality recognition accuracy/speed in the context condition had good test-retest reliability and correlated strongly with phantom limb pain frequency. Accuracy/speed limb laterality recognition ability relates to phantom limb pain and may be a valid clinical or research measure.

  20. Levosimendan Administration in Limb Ischemia: Multicomponent Signaling Serving Kidney Protection.

    Directory of Open Access Journals (Sweden)

    Peter Onody

    Full Text Available Acute renal failure is a severe complication of lower extremity major arterial reconstructions, which could even be fatal. Levosimendan is a dual-acting positive inotropic and vasodilatory agent, which is suspected to have protective effects against cardiac ischemia. However, there is no data available on lower limb or remote organ ischemic injuries therefore the aim of the study was to investigate the effect of levosimendan on lower limb ischemia-reperfusion injury and the corollary renal dysfunction.Male Wistar rats underwent 180 min bilateral lower limb ischemia followed by 4 or 24 hours of reperfusion. Intravenous Levosimendan was administered continuously (0.2μg/bwkg/min throughout the whole course of ischemia and the first 3h of reperfusion. Results were compared with sham-operated and ischemia-reperfusion groups. Hemodynamic monitoring was performed by invasive arterial blood pressure measurement. Kidney and lower limb muscle microcirculation was registered by a laser Doppler flowmeter. After 4h and 24h of reperfusion, serum, urine and histological samples were collected.Systemic hemodynamic parameters and microcirculation of kidney and the lower limb significantly improved in the Levosimendan treated group. Muscle viability was significantly preserved 4 and 24 hours after reperfusion. At the same time, renal functional laboratory tests and kidney histology demonstrated significantly less expressive kidney injury in Levosimendan groups. TNF-α levels were significantly less elevated in the Levosimendan group 4 hours after reperfusion.The results claim a protective role for Levosimendan administration during major vascular surgeries to prevent renal complications.

  1. Cross-limb interference during motor learning.

    Directory of Open Access Journals (Sweden)

    Benedikt Lauber

    Full Text Available It is well known that following skill learning, improvements in motor performance may transfer to the untrained contralateral limb. It is also well known that retention of a newly learned task A can be degraded when learning a competing task B that takes place directly after learning A. Here we investigate if this interference effect can also be observed in the limb contralateral to the trained one. Therefore, five different groups practiced a ballistic finger flexion task followed by an interfering visuomotor accuracy task with the same limb. Performance in the ballistic task was tested before the training, after the training and in an immediate retention test after the practice of the interference task for both the trained and the untrained hand. After training, subjects showed not only significant learning and interference effects for the trained limb but also for the contralateral untrained limb. Importantly, the interference effect in the untrained limb was dependent on the level of skill acquisition in the interfering motor task. These behavioural results of the untrained limb were accompanied by training specific changes in corticospinal excitability, which increased for the hemisphere ipsilateral to the trained hand following ballistic training and decreased during accuracy training of the ipsilateral hand. The results demonstrate that contralateral interference effects may occur, and that interference depends on the level of skill acquisition in the interfering motor task. This finding might be particularly relevant for rehabilitation.

  2. Motor cortical adaptations to 2 weeks of lower limb immobilization

    DEFF Research Database (Denmark)

    Jensen, Jesper Lundbye; Christensen, Mark Schram; Petersen, Tue Hvass

    It is well established that motor experience is associated with structural and functional plasticity within the central nervous system. It is less well investigated to which extent disuse relating to immobilization is also associated with plastic neuronal changes. The objective of this study...... following immobilization. Two weeks after cast removal virtually all measurements returned to preimmobilization levels.In conclusion 2 weeks of lower limb immobilization induces reversible adaptive changes in the motor cortex....

  3. Functionality of i-LIMB and i-LIMB pulse hands: case report.

    Science.gov (United States)

    van der Niet, Olga; Bongers, Raoul M; van der Sluis, Corry K

    2013-01-01

    The availability of various multiarticulated prosthetic hands makes determining differences in functionality between these hands relevant. The current study asked whether the functionality of these hands increased with time of use and whether grip force and robustness improved. A 45-year-old man with wrist disarticulation used the i-LIMB and the i-LIMB Pulse hands in a series of tests covering all functional levels as described in the framework of the International Classification of Functioning, Disability and Health. Using the i-LIMB for 1 yr improved Southampton Hand Assessment Procedure function scores. However, the i-LIMB Pulse did not improve much over 5 mo of training, possibly because of the intense training in the month prior to the first i-LIMB Pulse tests. The i-LIMB Pulse hand generally showed higher scores on the tests and better grip strength and robustness than the i-LIMB. The i-LIMB Pulse has overcome the shortcomings of the i-LIMB hand. The preset grip patterns simplified the complex control of the multiarticulated i-LIMB hand, which contributed to patient satisfaction.

  4. Observation of limb movements reduces phantom limb pain in bilateral amputees

    Science.gov (United States)

    Tung, Monica L; Murphy, Ian C; Griffin, Sarah C; Alphonso, Aimee L; Hussey-Anderson, Lindsey; Hughes, Katie E; Weeks, Sharon R; Merritt, Victoria; Yetto, Joseph M; Pasquina, Paul F; Tsao, Jack W

    2014-01-01

    Background Mirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy. Objective Since mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP. Methods We randomly assigned 20 bilateral lower limb amputees with PLP to visual observation (n = 11) or mental visualization (n = 9) treatment. Treatment consisted of seven discrete movements which were mimicked by the amputee’s phantom limbs moving while visually observing the experimenter’s limbs moving, or closing the eyes while visualizing and attempting the movements with their phantom limbs, respectively. Participants performed movements for 20 min daily for 1 month. Response to therapy was measured using a 100-mm visual analog scale (VAS) and the McGill Short-Form Pain Questionnaire (SF-MPQ). Results Direct visual observation significantly reduced PLP in both legs (P < 0.05). Amputees assigned to the mental visualization condition did not show a significant reduction in PLP. Interpretation Direct visual observation therapy is an inexpensive and effective treatment for PLP that is accessible to bilateral lower limb amputees. PMID:25493277

  5. Safety Supervisory Strategy for an Upper-Limb Rehabilitation Robot Based on Impedance Control

    Directory of Open Access Journals (Sweden)

    Lizheng Pan

    2013-02-01

    Full Text Available User security is an important consideration for robots that interact with humans, especially for upper-limb rehabilitation robots, during the use of which stroke patients are often more susceptible to injury. In this paper, a novel safety supervisory control method incorporating fuzzy logic is proposed so as to guarantee the impaired limb's safety should an emergency situation occur and the robustness of the upper-limb rehabilitation robot control system. Firstly, a safety supervisory fuzzy controller (SSFC was designed based on the impaired-limb's real-time physical state by extracting and recognizing the impaired-limb's tracking movement features. Then, the proposed SSFC was used to automatically regulate the desired force either to account for reasonable disturbance resulting from pose or position changes or to respond in adequate time to an emergency based on an evaluation of the impaired-limb's physical condition. Finally, a position-based impedance controller was implemented to achieve compliance between the robotic end-effector and the impaired limb during the robot-assisted rehabilitation training. The experimental results show the effectiveness and potential of the proposed method for achieving safety and robustness for the rehabilitation robot.

  6. Studies of limb-dislodging forces acting on an ejection seat occupant.

    Science.gov (United States)

    Schneck, D J

    1980-03-01

    A mathematical theory is being developed in order to calculate the aerodynamic loading to which a pilot is exposed during high-speed ejections. Neglecting the initial effects of flow separation, results thus far indicate that a pilot's musculoskeletal system is not likely to withstand the tendency for limb-flailing if he is ejecting at Mach numbers in excess of about 0.7. This tendency depends very strongly upon the angle at which the pilot's limbs intercept a high-speed flow; the forces that cause limb dislodgement increase dramatically with speed of ejection. Examining the time-course of limb-dislodging forces after the initial onset of windblast, the theory further predicts the generation of a double vortex street pattern on the downstream side of the limbs of an ejection seat occupant. This results in the corresponding appearance of oscillating forces tending to cause lateral motion (vibration) of the limbs. The amplitude and frequency of these oscillating forces are also very dependent on the Mach number of ejection and the angle at which the pilot's limbs intercept the flow. However, even at moderate Mach numbers, the frequency can be as high as 100 cycles per second, and the amplitude rapidly exceeds a pilot's musculo-skeletal resistive powers for Mach numbers above 0.7.

  7. Muscle Selection for Focal Limb Dystonia

    Directory of Open Access Journals (Sweden)

    Barbara Illowsky Karp

    2017-12-01

    Full Text Available Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia.

  8. Muscle Selection for Focal Limb Dystonia.

    Science.gov (United States)

    Karp, Barbara Illowsky; Alter, Katharine

    2017-12-29

    Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia.

  9. Plasma cytokine expression after lower-limb compression in rats

    Directory of Open Access Journals (Sweden)

    Mauricio Wanderley Moral Sgarbi

    2015-02-01

    Full Text Available OBJECTIVES: Muscle injury due to crushing (muscle compression injury is associated with systemic manifestations known as crush syndrome. A systemic inflammatory reaction may also be triggered by isolated muscle injury. The aim of this study was to investigate the plasma levels of interleukins (IL 1, 6 and 10 and tumor necrosis factor alpha (TNF-α, which are markers for possible systemic inflammatory reactions, after isolated muscle injury resulting from lower-limb compression in rats.METHODS: Male Wistar rats were subjected to 1 h of compression of their lower limbs by means of a rubber band. The plasma levels of IL 1, 6 and 10 and TNF-α were measured 1, 2 and 4 h after the rats were released from compression.RESULTS: The plasma levels of IL 10 decreased in relation to those of the other groups, with a statistically significant difference (p < 0.05. The method used did not detect the presence of IL 1, IL 6 or TNF-α.CONCLUSION: Our results demonstrated that the changes in plasma levels of IL 10 that were found may have been a sign of the presence of circulating interleukins in this model of lower-limb compression in rats.

  10. Upper And Lower Limbs Disability And Personality Traits.

    Science.gov (United States)

    Jabeen, Tahira; Kazmi, Syeda Farhana; Rehman, Atiq Ur; Ahmed, Sajjad

    2016-01-01

    It is believed that the study of personality has the potentials to enhance our prognostic abilities and can better to expose the etiology of mental illness through the relationship of revealed mechanisms. The focus of this study was to investigate and compare the habitual patterns of behavior, thought and emotions of upper and lower limb physically disabled students in terms of personality traits. This cross sectional study consisted of 100 upper limbs and lower limbs disabled students taken from Kingston school Inclusive Education System Abottabad, Mashal special education system Haripur, Syed Ahmed Shaheed special education center Abottabad, Al-Munir Foundation Mansehra and Hera Special Education System Haripur and 100 normal students taken from Islamic International School Abottabad, Falcon Public School Haripur, Iqra Academy Mansehra and Alhamd International School Haripur of Hazara Division by purposive sampling technique. This study was conducted during the month of June 2013 to May 2014. Goldberg five big personality scale was used for measuring personality traits of physically disabled and normal students. The significant difference of personality traits scores between physically disabled students (M = 139.2, SD=12.0) and normal students (M=184.5, SD=13.2), t (198) =25.3, pEmotional Stability and Openness to Experience.

  11. Bare bones pattern formation: a core regulatory network in varying geometries reproduces major features of vertebrate limb development and evolution.

    Directory of Open Access Journals (Sweden)

    Jianfeng Zhu

    Full Text Available BACKGROUND: Major unresolved questions regarding vertebrate limb development concern how the numbers of skeletal elements along the proximodistal (P-D and anteroposterior (A-P axes are determined and how the shape of a growing limb affects skeletal element formation. There is currently no generally accepted model for these patterning processes, but recent work on cartilage development (chondrogenesis indicates that precartilage tissue self-organizes into nodular patterns by cell-molecular circuitry with local auto-activating and lateral inhibitory (LALI properties. This process is played out in the developing limb in the context of a gradient of fibroblast growth factor (FGF emanating from the apical ectodermal ridge (AER. RESULTS: We have simulated the behavior of the core chondrogenic mechanism of the developing limb in the presence of an FGF gradient using a novel computational environment that permits simulation of LALI systems in domains of varying shape and size. The model predicts the normal proximodistal pattern of skeletogenesis as well as distal truncations resulting from AER removal. Modifications of the model's parameters corresponding to plausible effects of Hox proteins and formins, and of the reshaping of the model limb, bud yielded simulated phenotypes resembling mutational and experimental variants of the limb. Hypothetical developmental scenarios reproduce skeletal morphologies with features of fossil limbs. CONCLUSIONS: The limb chondrogenic regulatory system operating in the presence of a gradient has an inherent, robust propensity to form limb-like skeletal structures. The bare bones framework can accommodate ancillary gene regulatory networks controlling limb bud shaping and establishment of Hox expression domains. This mechanism accounts for major features of the normal limb pattern and, under variant geometries and different parameter values, those of experimentally manipulated, genetically aberrant and evolutionary early

  12. Bare bones pattern formation: a core regulatory network in varying geometries reproduces major features of vertebrate limb development and evolution.

    Science.gov (United States)

    Zhu, Jianfeng; Zhang, Yong-Tao; Alber, Mark S; Newman, Stuart A

    2010-05-28

    Major unresolved questions regarding vertebrate limb development concern how the numbers of skeletal elements along the proximodistal (P-D) and anteroposterior (A-P) axes are determined and how the shape of a growing limb affects skeletal element formation. There is currently no generally accepted model for these patterning processes, but recent work on cartilage development (chondrogenesis) indicates that precartilage tissue self-organizes into nodular patterns by cell-molecular circuitry with local auto-activating and lateral inhibitory (LALI) properties. This process is played out in the developing limb in the context of a gradient of fibroblast growth factor (FGF) emanating from the apical ectodermal ridge (AER). We have simulated the behavior of the core chondrogenic mechanism of the developing limb in the presence of an FGF gradient using a novel computational environment that permits simulation of LALI systems in domains of varying shape and size. The model predicts the normal proximodistal pattern of skeletogenesis as well as distal truncations resulting from AER removal. Modifications of the model's parameters corresponding to plausible effects of Hox proteins and formins, and of the reshaping of the model limb, bud yielded simulated phenotypes resembling mutational and experimental variants of the limb. Hypothetical developmental scenarios reproduce skeletal morphologies with features of fossil limbs. The limb chondrogenic regulatory system operating in the presence of a gradient has an inherent, robust propensity to form limb-like skeletal structures. The bare bones framework can accommodate ancillary gene regulatory networks controlling limb bud shaping and establishment of Hox expression domains. This mechanism accounts for major features of the normal limb pattern and, under variant geometries and different parameter values, those of experimentally manipulated, genetically aberrant and evolutionary early forms, with no requirement for an independent

  13. Inverse Kinematics for Upper Limb Compound Movement Estimation in Exoskeleton-Assisted Rehabilitation

    OpenAIRE

    Cort?s, Camilo; de los Reyes-Guzm?n, Ana; Scorza, Davide; Bertelsen, ?lvaro; Carrasco, Eduardo; Gil-Agudo, ?ngel; Ruiz-Salguero, Oscar; Fl?rez, Juli?n

    2016-01-01

    Robot-Assisted Rehabilitation (RAR) is relevant for treating patients affected by nervous system injuries (e.g., stroke and spinal cord injury) -- The accurate estimation of the joint angles of the patient limbs in RAR is critical to assess the patient improvement -- The economical prevalent method to estimate the patient posture in Exoskeleton-based RAR is to approximate the limb joint angles with the ones of the Exoskeleton -- This approximation is rough since their kinematic structures dif...

  14. Molecular and evolutionary basis of limb field specification and limb initiation.

    Science.gov (United States)

    Tanaka, Mikiko

    2013-01-01

    Specification of limb field and initiation of limb development involve multiple steps, each of which is tightly regulated both spatially and temporally. Recent developmental analyses on various vertebrates have provided insights into the molecular mechanisms that specify limb field and have revealed several genetic interactions of signals involved in limb initiation processes. Furthermore, new approaches to the study of the developmental mechanisms of the lateral plate mesoderm of amphioxus and lamprey embryos have given us clues to understand the evolutionary scenarios that led to the acquisition of paired appendages during evolution. This review highlights such recent findings and discusses the mechanisms of limb field specification and limb bud initiation during development and evolution. © 2012 The Authors Development, Growth & Differentiation © 2012 Japanese Society of Developmental Biologists.

  15. Ways Children Adjust to Limb Loss

    Science.gov (United States)

    ... children learn these skills so well. About younger children Parents, do not be surprised if your young child ... Kellye Campbell, RN, ARNP published in the magazine, Expectations: Parenting Children and Teens With Limb Differences Atlas of Amputations ...

  16. Limb-effect of rapidly rotating stars

    Directory of Open Access Journals (Sweden)

    A.B. Morcos

    2013-06-01

    Full Text Available Kerr metric is used to study the limb-effect phenomenon for axially rotating massive stars. The limb-effect phenomenon is concerned by the variation of the red-shift from the center to the limb of star. This phenomenon has been studied before for the sun. The solar gravitational field is assumed to be given by Schwarzschild and Lense-Thirring fields. In this trial, a study of the limb-effect for a massive axially symmetric rotating star is done. The line of site of inclination and the motion of the observer are taken into consideration to interpret a formula for this phenomenon using a general relativistic red-shift formula. A comparison between the obtained formula and previous formulae is given.

  17. Upper limb injuries associated with rock climbing.

    OpenAIRE

    Bannister, P; Foster, P

    1986-01-01

    Four cases of upper limb injuries secondary to rock-climbing or training for rock climbing are presented. All four cases had diagnosis and treatment delayed because of unawareness of the range of injuries seen in high grade rock climbing.

  18. Fingernails Yield Clues to Limb Regeneration

    Science.gov (United States)

    ... Spotlight on Research Fingernails Yield Clues to Limb Regeneration By Kirstie Saltsman, Ph.D. | January 5, 2014 ... Diseases has uncovered chemical signals that drive the regeneration of lost digit tips in mice. The findings, ...

  19. Different plantar interface effects on dynamics of the lower limb.

    Science.gov (United States)

    Hao, Z H; Zhou, J B; Jin, D W; Zhou, D W; Li, X D

    2005-01-01

    The moments acting on the lower limb joints influence the life of the arthrosis. These loads may depend on the footwear and action style. The footwear factor was studied with three-dimensional gait measure system. Five young women in their 20s, wear 7 cm high-heeled shoes and sneakers, and walked in 10 m gait laboratory walkway. Inversed dynamics was used to analysis the torques at the ankle, knee and hip. Results showed that peak adduction moments at the knee and ankle increased and flexion/extension moments at hip increased with high-heel shoes compared with the sneakers. The high-heeled shoes result in greater load in lower limb joints especial to the knee and hip.

  20. Acupuncture treatment of phantom limb pain and phantom limb sensation in a primary care setting.

    Science.gov (United States)

    Davies, Arwel

    2013-03-01

    A 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within the constraints of a busy general medical practice.

  1. The social and economic outcome after upper limb amputation.

    Science.gov (United States)

    Kejlaa, G H

    1992-04-01

    This paper reports a study of 66 upper limb amputees in County Funen, Denmark who were visited in their homes by the author. The purpose of this study was to evaluate for the same period of time the social and economic outcome for a population of upper limb amputees compared with the normal population. The number of amputees investigated corresponds to the annual number of persons becoming upper limb amputees in Denmark. The aetiology of registered amputees also corresponds to the Danish Amputation Register. The amputees had become "better placed" in the social system after amputation independent of prosthetic use. The mean age of the amputees corresponded with the age where people reach their best social grouping. Their social migration quotient was higher than the background population and reflected the amputees better income and housing conditions. The reasons for these surprising results must be the high grade social system in a sophisticated industrial county. None of the amputees were required to pay for rehabilitation or prosthetic supply. A lower divorce rate for the amputees was explained by a symbiosis between the amputees and their partners to protect their future existence. Only 14% lived alone. Those who had their sexual debut after amputation were 3 years later in sexual experience than the rest of the amputees because of difficulties during the maturing process.

  2. Mirror Therapy for Phantom Limb Pain

    OpenAIRE

    Kim, Sae Young; Kim, Yun Young

    2012-01-01

    Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. To control this pain, many methods have been used such as medication, physical treatment, nerve block, neuromodulation, surgical treatment and mirror therapy. However, until now, there effects have been uncertain. We report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain.

  3. Muscle Selection for Focal Limb Dystonia

    OpenAIRE

    Barbara Illowsky Karp; Katharine Alter

    2017-01-01

    Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this artic...

  4. Van Nes rotationplasty with segmental limb resection.

    Science.gov (United States)

    Krajbich, J I; Carroll, N C

    1990-07-01

    Segmental limb resection is becoming a practical alternative to limb ablation in tumor surgery. The addition of Van Nes rotationplasty to provide a pseudo knee joint has been found to be a practical, functional addition facilitating prosthesis use. This procedure has now been used successfully in 21 children with malignant neoplasms, with few complications. The surgical technique, as outlined, produces significantly improved functional results over an above-knee amputation or hip disarticulation.

  5. 21 CFR 890.3420 - External limb prosthetic component.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb prosthetic component. 890.3420... External limb prosthetic component. (a) Identification. An external limb prosthetic component is a device... total prosthesis. Examples of external limb prosthetic components include the following: Ankle, foot...

  6. Isolated primary lymphedema tarda of the upper limb.

    Science.gov (United States)

    Shariati, Farzaneh; Ravari, Hasan; Kazemzadeh, Gholamhossein; Sadeghi, Ramin

    2013-03-01

    Primary lymphedema tarda is considered as a congenital disease with late presentation. Primary lymphedema tarda usually affects lower limbs, and primary lymphedema tarda of the upper limbs usually accompanies lower limb lymphedema. In the current case report, we present an 80-year-old male patient with isolated left upper limb swelling that lymphoscintigraphy imaging proved to be lymphedema.

  7. LOWER LIMB ASYMMETRIES IN RHYTHMIC GYMNASTICS ATHLETES.

    Science.gov (United States)

    Frutuoso, Anderson Simas; Diefenthaeler, Fernando; Vaz, Marco Aurélio; Freitas, Cintia de la Rocha

    2016-02-01

    Different limb training demands and limb preference may determine anthropometric and muscle force inter-limb asymmetries in Rhythmic Gymnastics (RG) athletes. The purpose of this study was to evaluate the influence of lateral preference of the lower extremity on anthropometric, range of motion, and isokinetic torque measurements of RG athletes. Cross sectional study. Lower limb anthropometric measurements (girth, estimated anatomical cross-sectional area), hip, knee and ankle range of motion, flexor and extensor isokinetic torques (angular velocities = 60, 180, e 240 °·s(-1)) and bilateral asymmetry index were evaluated in 11 international level Rhythmic Gymnastics athletes (17.9 ± 4.0 years of age; 9.1 ± 5,1 years of experience; 26.8 ± 6.0 weekly training hours). The preferred limb showed larger thigh girth and anatomical cross-sectional area, higher ankle dorsiflexor range of motion, higher hip flexor torque at 60 °·s(-1) and higher plantarflexor torque at 180 °·s(-1) compared to the non-preferred limb. The observed differences seem to be strictly related to lateral preference and rhythmic gymnastics training. 3.

  8. LIMB SALVAGE IN DIABETIC FOOT INFECTION

    Directory of Open Access Journals (Sweden)

    J. Ramanaiah

    2017-02-01

    Full Text Available BACKGROUND Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. Limb salvage procedures may prevent eventual limb loss, the need of a major limb amputation, decrease total cost and may restore full ambulation earlier. MATERIALS AND METHODS Seventy five septic diabetic feet were treated with NPWT between 2014 and 2016. Debridement with or without partial foot amputation was followed. Wound progress was measured using a digital scanner. A limb was considered salvaged if complete healing was achieved without any or with minor amputation through or below the ankle. RESULTS In this series, 33 cases were managed initially by debridement and slough excision, 11 patients underwent incision and drainage for abscess and three patients underwent fasciotomy. Seven cases who presented with gangrene of toes were treated with ray amputation. Below-knee amputation was done in 21 cases. In most of the cases, limb salvage was possible. CONCLUSION A comprehensive treatment approach incorporating surgical and nonsurgical therapies are required to avoid major limb amputations in severe diabetic foot infections.

  9. LIMB Demonstration Project Extension and Coolside Demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Goots, T.R.; DePero, M.J.; Nolan, P.S.

    1992-11-10

    This report presents results from the limestone Injection Multistage Burner (LIMB) Demonstration Project Extension. LIMB is a furnace sorbent injection technology designed for the reduction of sulfur dioxide (SO[sub 2]) and nitrogen oxides (NO[sub x]) emissions from coal-fired utility boilers. The testing was conducted on the 105 Mwe, coal-fired, Unit 4 boiler at Ohio Edison's Edgewater Station in Lorain, Ohio. In addition to the LIMB Extension activities, the overall project included demonstration of the Coolside process for S0[sub 2] removal for which a separate report has been issued. The primary purpose of the DOE LIMB Extension testing, was to demonstrate the generic applicability of LIMB technology. The program sought to characterize the S0[sub 2] emissions that result when various calcium-based sorbents are injected into the furnace, while burning coals having sulfur content ranging from 1.6 to 3.8 weight percent. The four sorbents used included calcitic limestone, dolomitic hydrated lime, calcitic hydrated lime, and calcitic hydrated lime with a small amount of added calcium lignosulfonate. The results include those obtained for the various coal/sorbent combinations and the effects of the LIMB process on boiler and plant operations.

  10. Poststroke hypertonicity: upper limb assessment and treatment.

    Science.gov (United States)

    Marciniak, Christina

    2011-01-01

    Hypertonicity is common in patients with upper limb dysfunction following hemiplegic stroke and is associated with greater impairment, worse function, and lower health-related quality of life. In addition to increased rest activity, abnormal patterns of muscle activation, such as spastic co-contraction, may contribute to disability. In the upper limb, flexor muscles are more commonly involved distally, and at the shoulder, spasticity of adductors, flexors, and internal rotators is most often observed. Prior to interventions, a history regarding prior interventions, comorbid diagnoses, and limitations imposed by abnormal tone should be elicited. Commonly used scales to assess hypertonicity include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment interventions for upper limb hypertonicity include stretching, splinting, strengthening of antagonist muscles, oral medications, and focal injections (phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb tone. For focal injections, correct identification of muscles contributing to problematic tone is evaluated by eliciting resistance to movement at rest and observation of patterns of tightness as the limb is used functionally. The botulinum toxins have been shown to decrease tone in stroke survivors and improve active and passive functioning. Because secondary changes such as contractures and weakness may occur with prolonged hypertonicity, therapy to improve range of motion, strengthen weakened muscles, and incorporate use of the limb should be considered following focal injections, oral medications, or intrathecal pump placement.

  11. Environmental monitoring for the DOE coolside and LIMB demonstration extension projects. Final report, May--August 1991

    Energy Technology Data Exchange (ETDEWEB)

    White, T.; Contos, L.; Adams, L. [Radian Corp., Research Triangle Park, NC (United States)

    1992-03-01

    The purpose of this document is to present environmental monitoring data collected during the US Department of Energy Limestone Injection Multistage Burner (DOE LIMB) Demonstration Project Extension at the Ohio Edison Edgewater Generating Station in Lorain, Ohio. The DOE project is an extension of the US Environmental Protection Agency`s (EPA`s) original LIMB Demonstration. The program is operated nuclear DOE`s Clean Coal Technology Program of ``emerging clean coal technologies`` under the categories of ``in boiler control of oxides of sulfur and nitrogen`` as well as ``post-combustion clean-up.`` The objective of the LIMB program is to demonstrate the sulfur dioxide (SO{sub 2}) and nitrogen oxide (NO{sub x}) emission reduction capabilities of the LIMB system. The LIMB system is a retrofit technology to be used for existing coal-fired boilers equipped with electrostatic precipitators (ESPs).

  12. [Endo-exo prostheses following limb-amputation].

    Science.gov (United States)

    Juhnke, D-L; Aschoff, H-H

    2015-06-01

    Rehabilitation of patients having undergone limb amputation is difficult due to problems related to poor socket fit, which often deteriorates comfort, gait and the ability to take part in everyday life and work. The endo-exo prosthesis has been an alternative provision for people having undergone lower limb amputation for reasons other than diabetes or peripheral vascular disease for more than 10 years. The system consists of an intramedullar, osseointegrated and skin perforating prosthesis, which is implanted in the remaining bone and has an abutment to allow the attachment of the external prosthetic part including the knee joint in the case of a trans-femoral amputation. The idea originates in findings of modern tooth-implantology and involves a two-step operation. This study focuses on one centre's experience with the endo-exo prostheses in Lübeck, Germany, to describe and discuss the reliability of this alternative treatment method after lower limb amputation. This article presents the results of lower limb amputees operated on in Lübeck, Germany between 1999-2013. It focuses on theoretical aspects of osseointegration and different clinically-based findings using the endo-exo technique over the last decade. 74 lower-limb amputees were treated with an endo-exo prosthesis until December 2013. There were only 4 verified intramedullar infections, yet there were many unplanned surgical revisions secondary to soft-tissue infections in the beginning. They were successfully encountered via clinically-based changes that were made concerning implant design, wound treatment and operative technique. Since 1990 a few groups have developed an innovative method that provides an alternative to traditional socket-type prostheses. This involves a skeletally anchored device that is inserted into the remaining stump and provides osseointegration into the bone. The distal part of the implant protrudes transcutaneously and allows attachment to a prosthetic limb. This creates a

  13. Knee functional recovery and limb-to-limb symmetry restoration after anterior cruciate ligament (ACL) rupture and ACL reconstruction

    Science.gov (United States)

    Nawasreh, Zakariya Hussein

    change over time. Further to investigate whether RTAC variables at 6-M following ACLR predict return to the same preinjury activity level at 12 and 24 months following ACLR. The findings of this work revealed that patients who fail on RTAC 6-M after ACLR are more likely to demonstrate impaired knee function and limb-to-limb movement asymmetry at 12-M and 24-M after ACLR. Additionally, RTAC variables can predict the return to participate in the same preinjury activity level at 12-M and 24-M after ACLR. The combination of RTAC variables explain more than one-fourth to one-third of returning to participate in the same preinjury activity level 12-M and 24-M respectively after ACLR. For athletes choosing non-surgical management, the physical therapy recommendation is to administrate progressive strength training augmented with manual perturbation training. Manual perturbation training is a type of specialized neuromuscular training that includes purposeful manipulations of support surfaces by a therapist. While manual perturbation promotes dynamic knee stability, enhances dynamic knee function, mitigates abnormal movement pattern and normalizes the muscle co-contraction, perturbation training is not widely used as part of the ACL rehabilitation program in the United States. Further, the perturbation training requires extensive physical labor and one-on-one time from the treating therapist. The effect of administering perturbation training using mechanical device as part of the ACL rehabilitation program has not investigated. An automated "Reactive Agility System" device provides perturbation stimuli including multidirectional translations similar to those of manual perturbation training. Administrating the perturbation training using a mechanical device may facilitate the use of controlled and standardized training in a wide range of the rehabilitation clinics and allow administering controlled and standardized training. However, it is unknown whether administering

  14. Mechanical Impedance and Its Relations to Motor Control, Limb Dynamics, and Motion Biomechanics.

    Science.gov (United States)

    Mizrahi, Joseph

    The concept of mechanical impedance represents the interactive relationship between deformation kinematics and the resulting dynamics in human joints or limbs. A major component of impedance, stiffness, is defined as the ratio between the force change to the displacement change and is strongly related to muscle activation. The set of impedance components, including effective mass, inertia, damping, and stiffness, is important in determining the performance of the many tasks assigned to the limbs and in counteracting undesired effects of applied loads and disturbances. Specifically for the upper limb, impedance enables controlling manual tasks and reaching motions. In the lower limb, impedance is responsible for the transmission and attenuation of impact forces in tasks of repulsive loadings. This review presents an updated account of the works on mechanical impedance and its relations with motor control, limb dynamics, and motion biomechanics. Basic questions related to the linearity and nonlinearity of impedance and to the factors that affect mechanical impedance are treated with relevance to upper and lower limb functions, joint performance, trunk stability, and seating under dynamic conditions. Methods for the derivation of mechanical impedance, both those for within the system and material-structural approaches, are reviewed. For system approaches, special attention is given to methods aimed at revealing the correct and sufficient degree of nonlinearity of impedance. This is particularly relevant in the design of spring-based artificial legs and robotic arms. Finally, due to the intricate relation between impedance and muscle activity, methods for the explicit expression of impedance of contractile tissue are reviewed.

  15. Estimation of Upper Limb Joint Angle Using Surface EMG Signal

    Directory of Open Access Journals (Sweden)

    Yee Mon Aung

    2013-10-01

    Full Text Available In the development of robot-assisted rehabilitation systems for upper limb rehabilitation therapy, human electromyogram (EMG is widely used due to its ability to detect the user intended motion. EMG is one kind of biological signal that can be recorded to evaluate the performance of skeletal muscles by means of a sensor electrode. Based on recorded EMG signals, user intended motion could be extracted via estimation of joint torque, force or angle. Therefore, this estimation becomes one of the most important factors to achieve accurate user intended motion. In this paper, an upper limb joint angle estimation methodology is proposed. A back propagation neural network (BPNN is developed to estimate the shoulder and elbow joint angles from the recorded EMG signals. A Virtual Human Model (VHM is also developed and integrated with BPNN to perform the simulation of the estimated angle. The relationships between sEMG signals and upper limb movements are observed in this paper. The effectiveness of our developments is evaluated with four healthy subjects and a VHM simulation. The results show that the methodology can be used in the estimation of joint angles based on EMG.

  16. Delay to orthopedic consultation for isolated limb injury

    Science.gov (United States)

    Rouleau, Dominique M.; Feldman, Debbie Ehrmann; Parent, Stefan

    2009-01-01

    ABSTRACT OBJECTIVE To describe referral mechanisms for referral to orthopedic surgery for isolated limb injuries in a public health care system and to identify factors affecting access. DESIGN Cross-sectional survey. SETTING Orthopedic surgery service in a level 1 trauma centre in Montreal, Que. PARTICIPANTS We conducted a prospective study of 166 consecutive adults (mean age 48 years) referred to orthopedic surgery for isolated limb injuries during a 4-month period. MAIN OUTCOME MEASURES Self-reported data on the nature of the trauma, the elapsed time between injury and orthopedic consultation, the number and type of previous primary care consultations, sociodemographic characteristics, and the level of satisfaction with care. RESULTS Average time between the injury and orthopedic consultation was 89 hours (range 3 to 642), with an average of 68 hours (range 0 to 642) for delay between primary care consultation and orthopedic consultation. A total of 36% of patients with time-sensitive diagnoses had unacceptable delays to orthopedic consultation according to the Quebec Orthopaedic Association guidelines. Lower limb injury, consulting first at another hospital, living far from the trauma centre, patient perception of low severity, and having a soft tissue injury were associated with longer delays. CONCLUSION Identifying gaps and risk factors for slower access might help improve referral mechanisms for orthopedic consultation. PMID:19826162

  17. Kinematic asymmetries of the lower limbs during ergometer rowing.

    Science.gov (United States)

    Buckeridge, Erica; Hislop, Simon; Bull, Anthony; McGregor, Alison

    2012-11-01

    Rowing injuries, particularly of the lumbar spine, are often attributed to poor technique. Rowing technique comprises a series of coordinated movements between the back, upper limbs, and lower limbs, and abnormalities in these may lead to injury. The aim of this study was to test the hypothesis that ergometer rowing is symmetrical with respect to lower limb motion and that deviations from symmetry result from rowing experience, work rate, or stroke position. Twenty-two rowers in three levels of ability participated in this study. A motion analysis system was used with an instrumented rowing ergometer, which incorporated load cells at the handle and seat. Kinematic measurements of the knees, hips, lumbar-pelvic joints, and pelvic twist, in addition to measures of handle force, seat force, stroke length, mediolateral seat drift, and mean external power, were made during an incremental step test. Elite rowers exhibited the largest handle force and mean external power (P rowing stroke, particularly at the hips, can contribute to suboptimal kinematics of the lumbar-pelvic region. Quantification of hip ROM asymmetries may therefore be a useful tool in predicting the development of low back pain in rowers.

  18. The functional anatomy of suggested limb paralysis.

    Science.gov (United States)

    Deeley, Quinton; Oakley, David A; Toone, Brian; Bell, Vaughan; Walsh, Eamonn; Marquand, Andre F; Giampietro, Vincent; Brammer, Michael J; Williams, Steven C R; Mehta, Mitul A; Halligan, Peter W

    2013-02-01

    Suggestions of limb paralysis in highly hypnotically suggestible subjects have been employed to successfully model conversion disorders, revealing similar patterns of brain activation associated with attempted movement of the affected limb. However, previous studies differ with regard to the executive regions involved during involuntary inhibition of the affected limb. This difference may have arisen as previous studies did not control for differences in hypnosis depth between conditions and/or include subjective measures to explore the experience of suggested paralysis. In the current study we employed functional magnetic resonance imaging (fMRI) to examine the functional anatomy of left and right upper limb movements in eight healthy subjects selected for high hypnotic suggestibility during (i) hypnosis (NORMAL) and (ii) attempted movement following additional left upper limb paralysis suggestions (PARALYSIS). Contrast of left upper limb motor function during NORMAL relative to PARALYSIS conditions revealed greater activation of contralateral M1/S1 and ipsilateral cerebellum, consistent with the engagement of these regions in the completion of movements. By contrast, two significant observations were noted in PARALYSIS relative to NORMAL conditions. In conjunction with reports of attempts to move the paralysed limb, greater supplementary motor area (SMA) activation was observed, a finding consistent with the role of SMA in motor intention and planning. The anterior cingulate cortex (ACC, BA 24) was also significantly more active in PARALYSIS relative to NORMAL conditions - suggesting that ACC (BA 24) may be implicated in involuntary, as well as voluntary inhibition of prepotent motor responses. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Structured movement representations of a phantom limb associated with phantom limb pain.

    Science.gov (United States)

    Osumi, Michihiro; Sumitani, Masahiko; Wake, Naoki; Sano, Yuko; Ichinose, Akimichi; Kumagaya, Shin-Ichiro; Kuniyoshi, Yasuo; Morioka, Shu

    2015-09-25

    The relation between phantom limb pain (PLP) and the movement representation of a phantom limb remains controversial in several areas of neurorehabilitation, although there are a few studies in which the representation of phantom limb movement was precisely evaluated. We evaluated the structured movement representation of a phantom limb objectively using a bimanual circle-line coordination task. We then investigated the relation between PLP and the structured movement representation. Nine patients with a brachial plexus avulsion injury were enrolled who perceived a phantom limb and had neuropathic pain. While blindfolded, the participants repeatedly drew vertical lines using the intact hand and intended to draw circles using the phantom limb simultaneously. "Drawing of circles" by the phantom limb resulted in an oval transfiguration of the vertical lines ("bimanual coupling" effect). We used an arbitrary ovalization index (OI) to quantify the oval transfiguration. When the OI neared 100%, the trajectory changed toward becoming more circular. A significant negative correlation was observed between the intensity of PLP and the OI (r=-0.66, pphantom limb are necessary for alleviating PLP. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Reorganization of gait after limb-saving surgery of the lower limb.

    NARCIS (Netherlands)

    Visser, E. de; Veth, R.P.H.; Schreuder, H.W.B.; Duysens, J.E.J.; Mulder, T.W.

    2003-01-01

    OBJECTIVE: In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients. DESIGN: All patients were recovering from some form of treatment to tumors of the lower limbs.

  1. Reorganization of gait after limb-saving surgery of the lower limb

    NARCIS (Netherlands)

    de Visser, E; Veth, RPH; Schreuder, HWB; Duysens, J; Mulder, T

    2003-01-01

    Objective: In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients. Design: All patients were recovering from some form of treatment to tumors of the lower limbs.

  2. The role of limb perfusion studies in the paediatric ischaemic limb ...

    African Journals Online (AJOL)

    The causes of limb ischaemia were meningococcal septicaemia (n=9), septic shock (n=6), hypovolaemic shock due to gastroenteritis (n=4), and electrical burns (n=1). The clinical, scan and surgical findings correlated in 40/48 imaged limbs. In one leg the findings did not correlate, but the perfusion scan results predicted the ...

  3. Reacting while moving: influence of right limb movement on left limb reaction.

    Science.gov (United States)

    Kennedy, Deanna M; Wang, Chaoyi; Shea, Charles H

    2013-09-01

    An experiment was designed to determine whether the activation of a muscle group (flexors or extensors) used to produce an ongoing movement of one limb influenced the reaction time and associated initiation of elbow flexion or extension movements of the contralateral limb. Right-handed participants in the bimanual groups were asked to produce a pattern of flexion/extension movements defined by a sine wave (period = 2 s, amplitude = 16°) with the right limb. While performing the right limb movement, participants were instructed that they were to react as quickly as possible by making a flexion or extension movement with their left limb when the cursor they were using to track the sine wave changed color. Participants in the unimanual groups performed the left limb reaction time task but were not asked to make right limb movements. The reaction time stimulus occurred once in each trial and was presented at one of six locations on one of the six cycles comprising the sinusoidal waveform. Participants performed 7 blocks of 6 test trials. Reaction time was calculated as the time interval between the color change of the cursor and the initiation of the response with the left limb. Movement time was calculated as the interval of time between the initiation of the response and the left limb cursor crossing the upper or lower boundary line. Mean reaction of the left limb was significantly influenced by the concurrent type of movement (flexion/extension) of the right limb. Reaction times were shorter on trials in which both limbs were initiating movement with homologous muscles as compared to trials in which the limbs were initiating movement with non-homologous muscles. No differences were detected when the stimuli were presented during the ballistic phase of the right limb movement, and no differences at any position were detected for the unimanual groups. This result is consistent with the notion that neural crosstalk can influence the time required to react to a

  4. Supernumerary and absent limbs and digits of the lower limb: a review of the literature.

    Science.gov (United States)

    Klaassen, Zachary; Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marios

    2011-07-01

    Anatomical history over centuries includes description of a wide variety of malformations involving the lower limbs. This article offers an organized review of these diverse abnormalities, including new understanding of mechanisms through recent discoveries in genetics and molecular biology. In 19th century Europe, a number of unique anomalies were reported, as well as evidence of foot amputations occurring in ancient Peruvian culture. Embryologically, the limbs develop early, with the lower limb being recognizable for the first time at stage 13 of development. By stage 23, the toes are clearly defined and by birth, although the legs appear bowed, the tibia and fibula are straight. Removal of the apical ectodermal ridge results in cessation of limb development, conversely, a second apical ectodermal ridge results in duplication of distal structures. Supernumerary limbs have been documented to occur as part of a teratoma with unique morphology and accompanying blood supply. Additionally, many examples of polydactyly occur in the foot postulating that deletion of chromosome 22q11 is involved in postaxial polydactyly. Such deletions occur near the middle of the chromosome at a location designated q11.2 (i.e., on the long arm of one of the pair of chromosomes 22) and this syndrome is also referred to as DiGeorge syndrome, which has a prevalence estimated at 1:4,000. Absence of the lower limbs has also been noted, with hypoplasia of the fibula being the most common manifestation of congenital bone absences in the lower limb. In addition to fibular aplasia, cases of tibial aplasia have been reported. This article is important for surgeons attempting correctional repair of lower limb anomalies, as well as providing analysis of the historical, anatomical and clinical aspects of supernumerary and absent limbs and digits for the lower limb. Copyright © 2011 Wiley-Liss, Inc.

  5. Construct Validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M) in Adults With Lower Limb Amputation.

    Science.gov (United States)

    Hafner, Brian J; Gaunaurd, Ignacio A; Morgan, Sara J; Amtmann, Dagmar; Salem, Rana; Gailey, Robert S

    2017-02-01

    To assess construct validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M), a self-report mobility measure for people with lower limb amputation (LLA). Cross-sectional study. Private prosthetic clinics (n=37). Current lower limb prosthesis users (N=199; mean age ± SD, 55.4±14.3y; 71.4% men) were assessed before receiving a replacement prosthesis, prosthetic socket, and/or prosthetic knee. Not applicable. Convergent construct validity was examined using correlations between participants' PLUS-M T-scores and measures of physical function, mobility, and balance, including the Amputee Mobility Predictor (AMP), timed Up and Go (TUG), Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Prosthesis Evaluation Questionnaire-Mobility Subscale (PEQ-MS), and Activities-specific Balance Confidence (ABC) Scale. Known-groups construct validity was evaluated by comparing differences in PLUS-M T-scores among participants grouped by Medicare Functional Classification Level (MFCL). PLUS-M T-scores demonstrated a moderate positive relationship with AMP scores (ρ=.54, Pprosthetic mobility. Correlations between PLUS-M and measures of physical function, mobility, and balance indicate convergent construct validity. Similarly, significant differences in PLUS-M T-scores across MFCL groups provide evidence of known-groups construct validity. In summary, evidence indicates that PLUS-M has good construct validity among people with LLA. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Phantom pain in bilateral upper limb amputation.

    Science.gov (United States)

    Modirian, Ehsan; Shojaei, Hadi; Soroush, Mohammad Reza; Masoumi, Mahdi

    2009-01-01

    To alert health professionals on presence and extent of phantom pain and sensation following bilateral upper limb amputation. Of a total of 140 war-related bilateral upper limb amputees in Iran, 103 subjects were thoroughly examined in this cross-sectional study by a physical medicine specialist. The patients were questioned for the presence of phantom pain and sensations, and frequency and intensity of the feeling were recorded. At 17.1 +/- 6.1 years after injury, 82.0% of the 103 amputees suffered from phantom sensation, including varying degrees of phantom limb pain in 53.9% of stumps. Phantom phenomena had a higher frequency in the right extremities, but this was not statistically significant (p > 0.01). Of those amputees who had phantom pain or sensation, 51.2% reported that they 'always' had phantom limb sensation; and approximately one-fourth of the subjects (24.6%) 'always' had phantom pain. Among the stumps who reported phantom pain (N=112), the pain was excruciating (38.5%), distressing (34.9%) or discomforting (25.6%). A significant statistical relation between phantom limb sensation and level of amputation was observed (p phantom pain; medical and surgical modalities only bring temporary relief, and less than 1% of the respondents achieve permanent relief through different treatment methods.

  7. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Science.gov (United States)

    Subedi, Bishnu; Grossberg, George T.

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. PMID:22110933

  8. Pharmacological interventions for phantom limb pain.

    Science.gov (United States)

    Fang, Jun; Lian, Yan-hong; Xie, Kang-jie; Cai, Shu-nü

    2013-02-01

    To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Both Chinese and English language literatures were searched using MEDLINE (1982 - 2011), Pubmed (1982 - 2011) and the Index of Chinese Language Literature (1982 - 2011). Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyl-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyl-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.

  9. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Bishnu Subedi

    2011-01-01

    Full Text Available The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

  10. The unstable knee in congenital limb deficiency.

    Science.gov (United States)

    Mindler, Gabriel T; Radler, Christof; Ganger, Rudolf

    2016-12-01

    Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asymptomatic in daily activity. However, instability can appear during deformity correction and bone-lengthening procedures, leading to flexion contracture or subluxation of the knee. A review of pediatric orthopaedic literature on different factors of knee instability, state-of-the-art treatment options in congenital limb deficiency and in cases of lengthening-related knee subluxation is presented and the authors' preferred treatment methods are described. Leg lengthening and deformity correction in patients with congenital limb deficiencies can be achieved with various techniques, such as guided growth, monolateral or circular external fixation and intramedullary lengthening nails. Radiographic assessment and clinical examination of the knee stability are obligatory to estimate the grade of instability prior to surgical procedures. Preparatory surgery, as well as preventive measures such as bracing, bridging of the knee and intensive physical therapy, can help to avoid subluxation during lengthening in unstable knees. Adequate surgical techniques, preventive measures and early detection of signs of subluxation can lead to good functional results in patients with congenital limb deficiency.

  11. Lower limb surgery in Duchenne muscular dystrophy.

    Science.gov (United States)

    Forst, J; Forst, R

    1999-05-01

    Two hundred and thirteen of 428 patients with Duchenne muscular dystrophy (DMD) of a prospective and open study were operated on bilaterally with hip and knee release, aponeurectomy of the iliotibial band and Achilles tendon lengthening. In 87 patients the operation was carried out during early restrictions of the lower limb joint mobility at an average age of 6.56 years (4.02-8.26, SD 1.42). The follow-up was on average 5.4 years (0.25-9.01, SD 2.7). This group was compared to a control group (natural history) consisting of 100 non-operated DMD patients. A significant (P contrast to the patients of the control group all treated patients between ages 6 and 8 years could walk independently. The positive influence of early lower limb surgery could also be shown by the development of Hammersmith motor ability score, CIDD (Council of Investigation of Duchenne Dystrophy) grading and Vignos scale. Nevertheless, in consideration of the well-known course of DMD not only the prolongation of ambulation but also the achieved prolongation of assisted standing ability with no or mild contractures are aims of lower limb surgery. Since no improvement of muscle strength could be observed after lower limb surgery, further studies have to investigate if additionally administered steroids can prolong ambulation after early lower limb surgery.

  12. Motor and parietal cortex stimulation for phantom limb pain and sensations.

    Science.gov (United States)

    Bolognini, Nadia; Olgiati, Elena; Maravita, Angelo; Ferraro, Francesco; Fregni, Felipe

    2013-08-01

    Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity. The present study investigated whether transcranial direct current stimulation (tDCS), a noninvasive technique of brain stimulation that can modulate neuroplasticity, can reduce PLP. In 2 double-blind, sham-controlled experiments in subjects with unilateral lower or upper limb amputation, we measured the effects of a single session of tDCS (2 mA, 15 min) of the primary motor cortex (M1) and of the posterior parietal cortex (PPC) on PLP, stump pain, nonpainful phantom limb sensations and telescoping. Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or by motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated to a hyperexcitation of PPC that can be normalized by cathodal tDCS. This evidence highlights the relationship between the level of excitability of different cortical areas, which underpins maladaptive plasticity following limb amputation and the phenomenology of phantom limb, and it opens up new opportunities for the use of tDCS in the treatment of PLP. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  13. Evaluating optimal superficial limb perfusion at different angles using non-invasive micro-lightguide spectrophotometry.

    Science.gov (United States)

    Darmanin, Geraldine; Jaggard, Matthew; Hettiaratchy, Shehan; Nanchahal, Jagdeep; Jain, Abhilash

    2013-06-01

    It is common practice to elevate the limbs postoperatively to reduce oedema and hence optimise perfusion and facilitate rehabilitation. However, elevation may be counterproductive as it reduces the mean perfusion pressure. There are no clear data on the optimal position of the limbs even in normal subjects. The optimal position of limbs was investigated in 25 healthy subjects using a non-invasive micro-lightguide spectrophotometry system "O2C", which indirectly measures skin and superficial tissue perfusion through blood flow, oxygen saturation and relative haemoglobin concentration. We found a reduction in skin and superficial tissue blood flow of 17% (p=0.0001) on arm elevation (180° shoulder flexion) as compared to heart level and an increase in skin and superficial tissue blood flow of 25% (p=0.02) on forearm elevation of 45°. Lower limb skin and superficial tissue blood flow decreased by 15% (p=0.004) on elevation to 47 cm and by 70% on dependency (p=0.0001) compared to heart level. However, on elevation of the lower limb there was also a 28% reduction in superficial venous pooling (p=0.0001) compared to heart level. In the normal limb, the position for optimal superficial perfusion of the upper limb is with the arm placed at heart level and forearm at 45°. In the lower limb the optimal position for superficial perfusion would be at heart level. However, some degree of elevation may be useful if there is an element of venous congestion. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Anti-gravity treadmill can promote aerobic exercise for lower limb osteoarthritis patients.

    Science.gov (United States)

    Kawae, Toshihiro; Mikami, Yukio; Fukuhara, Kouki; Kimura, Hiroaki; Adachi, Nobuo

    2017-08-01

    [Purpose] The anti-gravity treadmill (Alter-G®) allows the load on the lower limbs to be adjusted, which is considered useful for patients with lower limb osteoarthritis. The aim of the present study was to examine the effects of aerobic exercise using an anti-gravity treadmill in patients with lower limb osteoarthritis by using a cardiopulmonary exercise load monitoring system. [Subjects and Methods] The subjects were 20 patients with lower limb osteoarthritis. These subjects walked naturally for 8 minutes and then walked on the Alter-G for 8 minutes at their fastest speed at a load where lower limb pain was alleviated. [Results] Subjective and objective exercise intensity did not differ significantly between level ground walking and Alter-G walking neither before nor after walking. Pain before walking did not differ significantly between level ground walking and Alter-G walking, but pain after walking was significantly greater with level ground walking than with Alter-G walking. [Conclusion] Exercise therapy using an anti-gravity treadmill was useful for patients with lower limb osteoarthritis in terms of cardiopulmonary function, which suggested that this could become a new form of exercise therapy.

  15. Limb and Trunk Mechanisms for Balance Control during Locomotion in Quadrupeds

    Science.gov (United States)

    Musienko, Pavel E.; Deliagina, Tatiana G.; Gerasimenko, Yury P.; Orlovsky, Grigori N.

    2014-01-01

    In quadrupeds, the most critical aspect of postural control during locomotion is lateral stability. However, neural mechanisms underlying lateral stability are poorly understood. Here, we studied lateral stability in decerebrate cats walking on a treadmill with their hindlimbs. Two destabilizing factors were used: a brief lateral push of the cat and a sustained lateral tilt of the treadmill. It was found that the push caused considerable trunk bending and twisting, as well as changes in the stepping pattern, but did not lead to falling. Due to postural reactions, locomotion with normal body configuration was restored in a few steps. It was also found that the decerebrate cat could keep balance during locomotion on the laterally tilted treadmill. This postural adaptation was based on the transformation of the symmetrical locomotor pattern into an asymmetrical one, with different functional lengths of the right and left limbs. Then, we analyzed limb and trunk neural mechanisms contributing to postural control during locomotion. It was found that one of the limb mechanisms operates in the transfer phase and secures a standard (relative to the trunk) position for limb landing. Two other limb mechanisms operate in the stance phase; they counteract distortions of the locomotor pattern by regulating the limb stiffness. The trunk configuration mechanism controls the body shape on the basis of sensory information coming from trunk afferents. We suggest that postural reactions generated by these four mechanisms are integrated, thus forming a response of the whole system to perturbation of balance during locomotion. PMID:24741060

  16. The motor cortex and its role in phantom limb phenomena.

    Science.gov (United States)

    Reilly, Karen T; Sirigu, Angela

    2008-04-01

    Limb amputation results in plasticity of connections between the brain and muscles; the cortical motor representation of the missing limb seemingly disappears. The disappearance of the hand's motor representation is, however, difficult to reconcile with evidence that a perceptual representation of the missing limb persists in the form of a phantom limb endowed with sensory and motor qualities. Here, we argue that despite considerable reorganization within the motor cortex of upper-limb amputees, the representation of the amputated hand does not disappear. We hypothesize that two levels of hand-movement representation coexist within the primary motor cortex; at one level, limb movements are specified in terms of arm and hand motor commands, and at another level, limb movements are specified as muscles synergies. We propose that primary motor cortex reorganization after amputation concerns primarily the upper limb's muscular map but not its motor command map and that the integrity of the motor command map underlies the existence of the phantom limb.

  17. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study.

    Science.gov (United States)

    Imaizumi, Shu; Asai, Tomohisa; Kanayama, Noriaki; Kawamura, Mitsuru; Koyama, Shinichi

    2014-01-01

    Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb) has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation). He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic (EMG) activity on deltoids at the patient's stump. These results suggest that phantom motor sensation and EMG activity on the stump depend on visuomotor synchrony and top-down effects.

  18. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    Science.gov (United States)

    Imaizumi, Shu; Asai, Tomohisa; Kanayama, Noriaki; Kawamura, Mitsuru; Koyama, Shinichi

    2014-01-01

    Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb) has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation). He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic (EMG) activity on deltoids at the patient’s stump. These results suggest that phantom motor sensation and EMG activity on the stump depend on visuomotor synchrony and top-down effects. PMID:25120449

  19. Agency over a phantom limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study

    Directory of Open Access Journals (Sweden)

    Shu eImaizumi

    2014-07-01

    Full Text Available Most patients, post-amputation, report the experience of a phantom limb. Some even sense voluntary movements when viewing a mirror image of the intact limb superimposed onto the phantom limb. While delayed visual feedback of an action is known to reduce a sense of agency, the effect of delayed visual feedback on phantom motor sensation (i.e., sense of controlling a phantom limb has not been examined. Using a video-projection system, we examined the effect of delayed visual feedback on phantom motor sensation in an upper-limb amputee (male; left upper-limb amputation. He was instructed to view mirrored video images of his intact hand clasping and unclasping during a phantom limb movement. He then rated the intensity of the phantom motor sensation. Three types of hand movement images were presented as follows: synchronous, asynchronous with a 250-ms delay, and asynchronous with a 500-ms delay. Results showed that phantom motor sensation decreased when the image was delayed by 250 and 500 ms. However, when we instructed the patient to adjust the phase of phantom limb movement to that of the image with a 500-ms delay, phantom motor sensation increased. There was also a positive correlation between intensity of phantom motor sensation and electromyographic activity on deltoids at the patient’s stump. These results suggest that phantom motor sensation and electromyographic activity on the stump depend on visuomotor synchrony and top-down effects.

  20. A virtual reality environment for designing and fitting neural prosthetic limbs.

    Science.gov (United States)

    Hauschild, Markus; Davoodi, Rahman; Loeb, Gerald E

    2007-03-01

    Building and testing novel prosthetic limbs and control algorithms for functional electrical stimulation (FES) is expensive and risky. Here, we describe a virtual reality environment (VRE) to facilitate and accelerate the development of novel systems. In the VRE, subjects/patients can operate a simulated limb to interact with virtual objects. Realistic models of all relevant musculoskeletal and mechatronic components allow the development of entire prosthetic systems in VR before introducing them to the patient. The system is used both by engineers as a development tool and by clinicians to fit prosthetic devices to patients.

  1. Classification of non-weight bearing lower limb movements: towards a potential treatment for phantom limb pain based on myoelectric pattern recognition.

    Science.gov (United States)

    Lendaro, Eva; Ortiz-Catalan, Max

    2016-08-01

    Research in myoelectric pattern recognition (MPR) for the prediction of motor volition has primarily focused on the upper limbs. Recent studies in the lower limbs have mainly concentrated on prosthetic control, while MPR for lower limb rehabilitation purposes has received little attention. In this work we investigated the viability of a MPR system for the prediction of four degrees of freedom controlled in a near natural or physiologically appropriate fashion. We explored three different electrode configurations for acquiring electromyographic (EMG) signals: two targeted (bipolar and monopolar) and one untargeted (electrodes equally spaced axially). The targeted monopolar configuration yielded overall lower signal-to-noise ratios (SNR) but similar accuracy than those of the targeted bipolar configuration. The targeted bipolar and untargeted monopolar configurations were comparable in terms of SNR and offline accuracy when the same number of channels was used. However, the untargeted configuration tested with twice the channels yielded the best results in terms of accuracy. An advantage of the untargeted configuration is that it offers a simpler and more practical electrode placement. This work is the first step in our long-term goal of implementing a phantom limb pain (PLP) treatment for lower limb amputees based on MPR and augmented/virtual reality.

  2. Phantom limb pain: a nursing perspective.

    Science.gov (United States)

    Virani, Anila; Green, Theresa; Turin, Tanvir C

    2014-09-09

    Phantom limb pain (PLP) is a neuropathic pain condition occurring after amputation of a limb. PLP affects amputees' quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions.

  3. Vascular access in critical limb ischemia.

    Science.gov (United States)

    Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L

    2016-01-01

    Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Cross-limb Interference during motor learning

    DEFF Research Database (Denmark)

    Lauber, Benedikt; Jensen, Jesper Lundbye; Keller, Martin

    2013-01-01

    It is well known that following skill learning, improvements in motor performance may transfer to the untrained contralateral limb. It is also well known that retention of a newly learned task A can be degraded when learning a competing task B that takes place directly after learning A. Here we....... Importantly, the interference effect in the untrained limb was dependent on the level of skill acquisition in the interfering motor task. These behavioural results of the untrained limb were accompanied by training specific changes in corticospinal excitability, which increased for the hemisphere ipsilateral...... to the trained hand following ballistic training and decreased during accuracy training of the ipsilateral hand. The results demonstrate that contralateral interference effects may occur, and that interference depends on the level of skill acquisition in the interfering motor task. This finding might...

  5. Limb Girdle Muscular Dystrophy (LGMD): Case Report.

    Science.gov (United States)

    Kanitkar, Shubhangi A; Kalyan, Meenakshi; Gaikwad, Anu N; Makadia, Ankit; Shah, Harshad

    2015-01-01

    We report a young male of autosomal recessive limb girdle muscular dystrophy (LGMD) with positive family history presented with gradual onset proximal muscle weakness in all four limbs since eight years and thinning of shoulders, arms and thighs. Neurological examination revealed atrophy of both shoulders with wasting of both deltoids thinning of thighs and pseudo hypertrophy of both calves, hypotonia in all four limbs. Gower's sign was positive. Winging of scapula was present. Power was 3/5 at both shoulders, 4/5 at both elbows, 5/5 at both wrists, 3/5 at both hip joints, 3/5 at both knees, 5/5 at both ankles. All deep tendon reflexes and superficial reflexes were present with plantars bilateral flexors. Electromyography (EMG) showed myopathic pattern. He had elevated creatinine phosphokinase levels and muscle biopsy findings consistent with muscular dystrophy.

  6. Considerations for designing robotic upper limb rehabilitation devices

    Science.gov (United States)

    Nadas, I.; Vaida, C.; Gherman, B.; Pisla, D.; Carbone, G.

    2017-12-01

    The present study highlights the advantages of robotic systems for post-stroke rehabilitation of the upper limb. The latest demographic studies illustrate a continuous increase of the average life span, which leads to a continuous increase of stroke incidents and patients requiring rehabilitation. Some studies estimate that by 2030 the number of physical therapists will be insufficient for the patients requiring physical rehabilitation, imposing a shift in the current methodologies. A viable option is the implementation of robotic systems that assist the patient in performing rehabilitation exercises, the physical therapist role being to establish the therapeutic program for each patient and monitor their individual progress. Using a set of clinical measurements for the upper limb motions, the analysis of rehabilitation robotic systems provides a comparative study between the motions required by clinicians and the ones that robotic systems perform for different therapeutic exercises. A critical analysis of existing robots is performed using several classifications: mechanical design, assistance type, actuation and power transmission, control systems and human robot interaction (HRI) strategies. This classification will determine a set of pre-requirements for the definition of new concepts and efficient solutions for robotic assisted rehabilitation therapy.

  7. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.

    Science.gov (United States)

    Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao

    2016-02-16

    A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb.

  8. The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs.

    Science.gov (United States)

    Cole, Grayson Lee; Millis, Darryl

    2017-01-16

    Despite the fact that limb amputation is a commonly performed procedure in veterinary medicine, quantitative data regarding outcomes are lacking. The intention of this study was to evaluate the effect of limb amputation on weight distribution to the remaining three limbs at a stance in dogs. Ten dogs with a prior forelimb amputation and ten dogs with a prior hindlimb amputation; all of which had no history of orthopaedic or neural disease in the remaining three limbs were included in the study. Standing weight bearing was evaluated with a commercial stance analyzer in all dogs. Five valid trials were obtained and a mean percentage of weight bearing was calculated for each remaining limb. The dogs with a previous forelimb amputation, and also those with a previous hindlimb amputation, had the largest mean increase in weight bearing in the contralateral forelimb. In conclusion, proactive monitoring of orthopaedic disease in the contralateral forelimb may be advisable in dogs with a previous limb amputation. In addition, when determining candidacy for a limb amputation, disease of the contralateral forelimb should be thoroughly evaluated.

  9. Lower Limb Ischaemia Complicating Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Shiu-Wai Chan

    2012-06-01

    Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.

  10. [Phantom limb pain. Psychological treatment strategies].

    Science.gov (United States)

    Diers, M; Flor, H

    2013-04-01

    Similar to other pain syndromes phantom limb pain is characterized by learning and memory processes that maintain the pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom limb pain but also reverse the associated maladaptive brain changes.

  11. Successful peripheral neuromodulation for phantom limb pain.

    Science.gov (United States)

    Cornish, Philip; Wall, Cindy

    2015-04-01

    For decades, the heterogeneity of the amputee population and the complex interaction of biopsychosocial factors have confounded researchers' attempts to develop an effective treatment for phantom limb pain. Therefore, it remains difficult to treat, and affected patients often experience decreased quality of life, increased psychological distress, and poorer health outcomes. In the case study, we report a novel strategy for the peripheral placement of neuromodulation leads for the treatment of phantom limb pain in a patient who subsequently described complete and consistent pain relief independent of significant variations in psychosocial stress. Wiley Periodicals, Inc.

  12. Cocaine-associated lower limb ischemia.

    LENUS (Irish Health Repository)

    Collins, Chris G

    2011-07-25

    Cocaine-associated thrombosis has been reported in the literature with reports of vascular injuries to cardiac, pulmonary, intestinal, placental, and musculoskeletal vessels; however, injury of the pedal vessels is rare. We report on a 31-year-old man who presented 2 months following a cocaine binge with limb-threatening ischemia without an otherwise identifiable embolic source. Angiography confirmed extensive occlusive disease of the tibioperoneal vessels. The patient improved following therapy with heparin and a prostacyclin analogue. Cocaine-induced thrombosis should be considered in patients presenting with acute arterial insufficiency in the lower limb without any other identifiable cause.

  13. Creation of distal canine limb lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Chen, H.C.; Pribaz, J.J.; O' Brien, B.M.; Knight, K.R.; Morrison, W.A.

    1989-06-01

    A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

  14. Syndecan-3 in limb skeletal development.

    Science.gov (United States)

    Kosher, R A

    1998-10-15

    Syndecan-3 is a member of a family of heparan sulfate proteoglycans that function as extracellular matrix receptors and as co-receptors for growth factors and signalling molecules. A variety of studies indicate that syndecan-3 is involved in several aspects of limb morphogenesis and skeletal development. Syndecan-3 participates in limb outgrowth and proliferation in response to the apical ectodermal ridge; mediates cell-matrix and/or cell-cell interactions involved in regulating the onset of chondrogenesis; may be involved in regulating the onset of osteogenesis and joint formation and, plays a role in regulating the proliferation of epiphyseal chondrocytes during endochondral ossification.

  15. Lower limb amputations in Trondheim, Norway

    OpenAIRE

    Wits?, Eivind; Lium, Arne; Lydersen, Stian

    2010-01-01

    Background and purpose In the city of Trondheim, Norway, diabetic lower-limb amputations accounted for one-third of all lower-limb amputations (LLAs). In an attempt to reduce this rate, a diabetic foot team was established in 1996. We present the incidence of LLA in Trondheim as measured 10 years later. Patients and methods In 2004?07, we registered all LLAs performed in Trondheim and then compared the data with previously published data from 1994?1997. From 1996 through 2006, we registered t...

  16. Measurement properties and usability of non-contact scanners for measuring transtibial residual limb volume.

    Science.gov (United States)

    Kofman, Rianne; Beekman, Anna M; Emmelot, Cornelis H; Geertzen, Jan H B; Dijkstra, Pieter U

    2017-11-01

    Non-contact scanners may have potential for measurement of residual limb volume. Different non-contact scanners have been introduced during the last decades. Reliability and usability (practicality and user friendliness) should be assessed before introducing these systems in clinical practice. The aim of this study was to analyze the measurement properties and usability of four non-contact scanners (TT Design, Omega Scanner, BioSculptor Bioscanner, and Rodin4D Scanner). Quasi experimental. Nine (geometric and residual limb) models were measured on two occasions, each consisting of two sessions, thus in total 4 sessions. In each session, four observers used the four systems for volume measurement. Mean for each model, repeatability coefficients for each system, variance components, and their two-way interactions of measurement conditions were calculated. User satisfaction was evaluated with the Post-Study System Usability Questionnaire. Systematic differences between the systems were found in volume measurements. Most of the variances were explained by the model (97%), while error variance was 3%. Measurement system and the interaction between system and model explained 44% of the error variance. Repeatability coefficient of the systems ranged from 0.101 (Omega Scanner) to 0.131 L (Rodin4D). Differences in Post-Study System Usability Questionnaire scores between the systems were small and not significant. The systems were reliable in determining residual limb volume. Measurement systems and the interaction between system and residual limb model explained most of the error variances. The differences in repeatability coefficient and usability between the four CAD/CAM systems were small. Clinical relevance If accurate measurements of residual limb volume are required (in case of research), modern non-contact scanners should be taken in consideration nowadays.

  17. Bioimpedance profiling of the limbs: Update

    Science.gov (United States)

    Ward, L. C.; Essex, T.; Bartlett, M.; Kilbreath, S.; Brookes, D.

    2010-04-01

    Bioelectrical impedance spectroscopy (BIS) is now commonly used to assess breast cancer-related lymphoedema. Typically, the ratio of impedances of the two arms, determined at zero frequency (Z0), is used as a quantitative index of the presence of excess lymph. Measurement uses skin electrodes spanning the whole limb. However, lymphoedema may be highly localised and may involve changes other than simple fluid accumulation, e.g. increased fat and fibrosis, that also give rise to changes in impedance-related parameters such as capacitance. We have previously reported (13th ICEBI, Graz, 2007) a prototype mobile electrode probe that replaces the distal sense electrode which, when moved proximally along the arm, provides an impedance profile. We report here the further development of this technology to incorporate real-time measurement of impedance integrated with a digital measuring wheel. This allows exact synchronisation of impedance with position on the arm. A commercial BIS instrument (ImpediMed SFB7) was modified to collect impedance (R and Xc) data every msec and the mean impedance computed for each 10-mm slice. The apparent resistivity values for arm tissue were used to calculate slice volumes. These computed volumes were compared to equivalent slice volumes from perometry and DXA. The system is being further validated by correlating slice impedance parameters with lean tissue volume determined by pQCT (StraTec XCT 3000), for multiple positions along the arm. Ultimately, it is hoped that such measurements will not only allow localised tissue volume measurement but will also provide information of tissue composition in conditions such as lymphoedema.

  18. Objective assessment of the compensatory effect of clinical hind limb lameness in horses: 37 cases (2011-2014).

    Science.gov (United States)

    Maliye, Sylvia; Marshall, John F

    2016-10-15

    OBJECTIVE To characterize and describe the compensatory load redistribution that results from unilateral hind limb lameness in horses. DESIGN Retrospective case series. ANIMALS 37 client-owned horses. PROCEDURES Medical records were reviewed to identify horses with unilateral hind limb lameness that responded positively (by objective assessment) to diagnostic local anesthesia during lameness evaluation and that were evaluated before and after diagnostic local anesthesia with an inertial sensor-based lameness diagnosis system. Horses were grouped as having hind limb lameness only, hind limb and ipsilateral forelimb lameness, or hind limb and contralateral forelimb lameness. Measures of head and pelvic movement asymmetry before (baseline) and after diagnostic local anesthesia were compared. The effect of group on baseline pelvic movement asymmetry variables was analyzed statistically. RESULTS Maximum pelvic height significantly decreased from the baseline value after diagnostic local anesthesia in each of the 3 lameness groups and in all horses combined. Minimum pelvic height significantly decreased after the procedure in all groups except the hind limb and contralateral forelimb lameness group. Head movement asymmetry was significantly decreased after diagnostic local anesthesia for horses with hind limb and ipsilateral forelimb lameness and for all horses combined, but not for those with hind limb lameness only or those with hind limb and contralateral forelimb lameness. CONCLUSIONS AND CLINICAL RELEVANCE Results supported that hind limb lameness can cause compensatory load redistribution evidenced as ipsilateral forelimb lameness. In this population of horses, contralateral forelimb lameness was not compensatory and likely reflected true lameness. Further studies are needed to investigate the source of the contralateral forelimb lameness in such horses.

  19. The Haptic Bracelets: Learning Multi-Limb Rhythm Skills from Haptic Stimuli While Reading

    NARCIS (Netherlands)

    Bouwer, A.; Holland, S.; Dalgleish, M.; Holland, S.; Wilkie, K.; Mulholland, P.; Seago, A.

    2013-01-01

    The Haptic Bracelets are a system designed to help people learn multi-limbed rhythms (which involve multiple simultaneous rhythmic patterns) while they carry out other tasks. The Haptic Bracelets consist of vibrotactiles attached to each wrist and ankle, together with a computer system to control

  20. Characteristics of the muscle activities of the elderly for various pressures in the pneumatic actuator of lower limb orthosis

    Science.gov (United States)

    Kim, Kyong; Yu, Chang-Ho; Kwon, Tae-Kyu; Hong, Chul-Un; Kim, Nam-Gyun

    2005-12-01

    There developed a lower limb orthosis with a pneumatic rubber actuator, which can assist and improve the muscular activities in the lower limb of the elderly. For this purpose, the characteristics of the lower limbs muscle activities for various pressures in the pneumatic actuator for the lower limb orthosis was investigated. To find out the characteristics of the muscle activities for various pneumatic pressures, it analyzed the flexing and extending movement of the knees, and measured the lower limbs muscular power. The subjects wearing the lower limbs orthosis were instructed to perform flexing and extending movement of the knees. The variation in the air pressure of the pneumatic actuator was varies from one kgf/cm2 to four kgf/cm2. The muscular power was measured by monitoring electromyogram using MP100 (BIOPAC Systems, Inc.) and detailed three-dimensional motions of the lower limbs were collected by APAS 3D Motion Analysis system. Through this study, it expected to find the most suitable air pressure for the improvement of the muscular power of the aged.

  1. Usefulness of milnacipran in treating phantom limb pain.

    Science.gov (United States)

    Nagoshi, Yasuhide; Watanabe, Akira; Inoue, Saiko; Kuroda, Tomoki; Nakamura, Mitsuo; Matsumoto, Yoshitake; Fukui, Kenji

    2012-01-01

    Amputation of an extremity often results in the sensation of a "phantom limb" where the patient feels that the limb that has been amputated is still present. This is frequently accompanied by "phantom limb pain". We report here the use of milnacipran, a serotonin and norepinephrine reuptake inhibitor, to treat phantom limb pain after amputation of injured or diseased limbs in three patients. The severity of phantom pain before and during treatment was quantified using a visual analog scale. In one case, phantom limb pain responded partially to treatment with high doses of paroxetine, and then replacement with milnacipran further improved the pain relief and long-term full pain relief was achieved. In the two other cases, milnacipran was used as first-line treatment and phantom limb pain responded rapidly. These results suggest that milnacipran administration may be useful in phantom limb pain, possibly as a first-line treatment.

  2. Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics

    Science.gov (United States)

    Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics: Part I -- Prosthetic Design: Basic Concepts Volume 8 · ... wanted to have available a comprehensive explanation of limb prosthetics written in easily understood language for amputee consumers. ...

  3. Management of fibular hemimelia: amputation or limb lengthening

    National Research Council Canada - National Science Library

    Naudie, D; Hamdy, R C; Fassier, F; Morin, B; Duhaime, M

    1997-01-01

    .... There were 12 boys and 10 girls, all with associated anomalies in the lower limbs. Twelve patients (13 limb segments) had early amputation and prosthetic fitting and ten had tibial lengthening using the Ilizarov technique...

  4. Dominant limb asymmetry associated with prospective injury ...

    African Journals Online (AJOL)

    The purpose of the study was to identify associations between dominant lower limb asymmetry in unanticipated agility performance and prospective injury occurrence. Female netball players (N=24) performed unanticipated 180° turn agility sprints on both the dominant and non-dominant legs interspersed with an additional ...

  5. Motor correlates of phantom limb pain.

    Science.gov (United States)

    Kikkert, Sanne; Mezue, Melvin; Henderson Slater, David; Johansen-Berg, Heidi; Tracey, Irene; Makin, Tamar R

    2017-10-01

    Following amputation, individuals ubiquitously report experiencing lingering sensations of their missing limb. While phantom sensations can be innocuous, they are often manifested as painful. Phantom limb pain (PLP) is notorious for being difficult to monitor and treat. A major challenge in PLP management is the difficulty in assessing PLP symptoms, given the physical absence of the affected body part. Here, we offer a means of quantifying chronic PLP by harnessing the known ability of amputees to voluntarily move their phantom limbs. Upper-limb amputees suffering from chronic PLP performed a simple finger-tapping task with their phantom hand. We confirm that amputees suffering from worse chronic PLP had worse motor control over their phantom hand. We further demonstrate that task performance was consistent over weeks and did not relate to transient PLP or non-painful phantom sensations. Finally, we explore the neural basis of these behavioural correlates of PLP. Using neuroimaging, we reveal that slower phantom hand movements were coupled with stronger activity in the primary sensorimotor phantom hand cortex, previously shown to associate with chronic PLP. By demonstrating a specific link between phantom hand motor control and chronic PLP, our findings open up new avenues for PLP management and improvement of existing PLP treatments. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. An approach to the painful upper limb

    African Journals Online (AJOL)

    The clinical findings are key to pinpointing the pain source. History. Cervical and upper limb pain may present in isolation or be associated with altered sensation. .... Positive test is presence of 'electric-like sensations' down spine or extremities. Myelopathy. Hoffmann's sign. Passive snapping flexion of middle finger distal ...

  7. Running With an Elastic Lower Limb Exoskeleton.

    Science.gov (United States)

    Cherry, Michael S; Kota, Sridhar; Young, Aaron; Ferris, Daniel P

    2016-06-01

    Although there have been many lower limb robotic exoskeletons that have been tested for human walking, few devices have been tested for assisting running. It is possible that a pseudo-passive elastic exoskeleton could benefit human running without the addition of electrical motors due to the spring-like behavior of the human leg. We developed an elastic lower limb exoskeleton that added stiffness in parallel with the entire lower limb. Six healthy, young subjects ran on a treadmill at 2.3 m/s with and without the exoskeleton. Although the exoskeleton was designed to provide ~50% of normal leg stiffness during running, it only provided 24% of leg stiffness during testing. The difference in added leg stiffness was primarily due to soft tissue compression and harness compliance decreasing exoskeleton displacement during stance. As a result, the exoskeleton only supported about 7% of the peak vertical ground reaction force. There was a significant increase in metabolic cost when running with the exoskeleton compared with running without the exoskeleton (ANOVA, P exoskeletons for human running are human-machine interface compliance and the extra lower limb inertia from the exoskeleton.

  8. Upper limb injuries associated with rock climbing.

    Science.gov (United States)

    Bannister, P; Foster, P

    1986-01-01

    Four cases of upper limb injuries secondary to rock-climbing or training for rock climbing are presented. All four cases had diagnosis and treatment delayed because of unawareness of the range of injuries seen in high grade rock climbing. PMID:3730754

  9. Scavenging energy from human limb motions

    Science.gov (United States)

    Fan, Kangqi; Yu, Bo; Tang, Lihua

    2017-04-01

    This paper proposes a nonlinear piezoelectric energy harvester (PEH) to scavenge energy from human limb motions. The proposed PEH is composed of a ferromagnetic ball, a sleeve, and two piezoelectric cantilever beams each with a magnetic tip mass. The ball is used to sense the swing motions of human limbs and excite the beams to vibrate. The two beams, which are sensitive to the excitation along the radialis or tibial axis, generate electrical outputs. Theoretical and experimental studies are carried out to examine the performance of the proposed PEH when it is fixed at the wrist, thigh and ankle of a male who travels at constant velocities of 2 km/h, 4 km/h, 6 km/h, and 8 km/h on a treadmill. The results indicate that the low-frequency swing motions of human limbs are converted to higher-frequency vibrations of piezoelectric beams. During each gait cycle, different excitations produced by human limbs can be superposed and multiple peaks in the voltage output can be generated by the proposed PEH. Moreover, the voltage outputs of the PEH increase monotonously with the walking speed, and the maximum effective voltage is obtained when the PEH is mounted at the ankle under the walking speed of 8 km/h.

  10. Limb disparity and wing shape in pterosaurs.

    Science.gov (United States)

    Dyke, G J; Nudds, R L; Rayner, J M V

    2006-07-01

    The limb proportions of the extinct flying pterosaurs were clearly distinct from their living counterparts, birds and bats. Within pterosaurs, however, we show that further differences in limb proportions exist between the two main groups: the clade of short-tailed Pterodactyloidea and the paraphyletic clades of long-tailed rhamphorhynchoids. The hindlimb to forelimb ratios of rhamphorhynchoid pterosaurs are similar to that seen in bats, whereas those of pterodactyloids are much higher. Such a clear difference in limb ratios indicates that the extent of the wing membrane in rhamphorhynchoids and pterodactyloids may also have differed; this is borne out by simple ternary analyses. Further, analyses also indicate that the limbs of Sordes pilosus, a well-preserved small taxon used as key evidence for inferring the extent and shape of the wing membrane in all pterosaurs, are not typical even of its closest relatives, other rhamphorhynchoids. Thus, a bat-like extensive hindlimb flight membrane, integrated with the feet and tail may be applicable only to a small subset of pterosaur diversity. The range of flight morphologies seen in these extinct reptiles may prove much broader than previously thought.

  11. 21 CFR 890.3475 - Limb orthosis.

    Science.gov (United States)

    2010-04-01

    ... extremities to support, to correct, or to prevent deformities or to align body structures for functional... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Limb orthosis. 890.3475 Section 890.3475 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES...

  12. Inducible limb-shaking transitory ischemic attacks

    DEFF Research Database (Denmark)

    Rosenbaum, Sverre; Ovesen, Christian; Futrell, Nancy

    2016-01-01

    with exercise-induced weakness associated with tremor in his right arm. His left internal carotid artery was occluded at the bifurcation. Administration of statin and antiplatelet did not relieve his symptoms, and his stereotypic, exercise-induced "limb-shaking" episodes persisted. He underwent successful...

  13. Limb conservation using non vascularised fibular grafts

    African Journals Online (AJOL)

    graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high .... preserved in a diluted blood with normal saline till ; anastomosis was commenced. He also had cable grafting of the ... arm muscles was performed at the same time. The forearm was supported in below elbow ...

  14. Infantile lipofibromatosis of the upper limb

    Energy Technology Data Exchange (ETDEWEB)

    Teo, Harvey E.L.; Peh, Wilfred C.G. [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Chan, Mei-Yoke [KK Women' s and Children' s Hospital, Department of Paediatric Medicine, Singapore (Singapore); Walford, Norman [Tan Tock Seng Hospital, Department of Pathology, Singapore (Singapore)

    2005-12-01

    The imaging features of extensive lipofibromatosis presenting in a 1-day-old female infant are reported. This lesion involved her entire right upper limb, extending from the axilla to the palm of the hand. Radiographs showed marked deformity and thinning of all the right upper-limb bones due to pressure effect of soft-tissue enlargement, especially affecting the distal humerus and proximal forearm bones. Magnetic resonance imaging showed a huge soft-tissue mass infiltrating most of the muscles of the entire upper limb, with bony erosion. The mass was largely T1-isointense, moderately T2-hyperintense and showed marked enhancement. There were intra-lesional signal changes consistent with fatty elements. A lesion debulking procedure was performed and the histology was that of lipofibromatosis. The limb was found to be non-viable after the procedure and a subsequent above-elbow amputation was performed. Although the resection margins were not clear, she had no further recurrence over a subsequent 3-year follow-up period. (orig.)

  15. Atypical supernumerary phantom limb and phantom limb pain in two patients with pontine hemorrhage.

    Science.gov (United States)

    Yoo, Seung Don; Kim, Dong Hwan; Jeong, Yong Seol; Chon, Jinmann; Bark, Jihea

    2011-06-01

    Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.

  16. The normal radiological anteroposterior alignment of the lower limb in children

    Energy Technology Data Exchange (ETDEWEB)

    Popkov, Dmitry; Popkov, Arnold [Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan (Russian Federation); Lascombes, Pierre [University of Geneva, Division of Pediatric Orthopaedics, Geneva (Switzerland); Berte, Nicolas; Hetzel, Laurent; Baptista, Bruno Ribeiro; Journeau, Pierre [Children' s Hospital of Nancy, Department of Pediatric Orthopaedics, Nancy (France)

    2014-07-05

    The development of reconstructive surgery of the lower limbs aimed at multilevel correction demands a precise knowledge of the physiological variations in general radiological parameters of the lower limbs in children of various age groups. It is crucial in systemic skeletal diseases, when deformities affect limbs and the surgeon does not have an intact limb as a reference. The aim of this retrospective study was to establish the normal radiological values of lower limb parameters used in the surgical correction of deformities in children of various age groups. Teleradiographs of the lower limbs taken in children with unilateral congenital or posttraumatic deformity were retrospectively reviewed. Weight-bearing full-length anteroposterior radiographs of the entire lower extremities were taken in a standing position. The study involved 215 extremities of 208 children (93 girls and 115 boys); the ages ranged from 2 years 1 month to 15 years 11 months old. Key variables included the anatomic medial proximal femoral angle (aMPFA), anatomic lateral distal femoral angle (aLDFA), anatomic medial proximal tibial angle (aMPTA), anatomic lateral distal tibial angle (aLDTA), mechanical axis deviation (MAD), the angle formed by the femoral anatomical axis and the mechanical axis of the lower limb. The means and dynamics of variations, standard deviations (SD) and 95 % confidence intervals of each parameter were calculated for each age and gender group. Simple regression analysis was performed to determine the relationship between the patient's age and the magnitude of aMPFA, aLDFA, aMPTA and aLDTA. Simple regression analysis showed a significant inverse correlation between patient age and the magnitude of aMPFA: the correlation coefficient was -0.77. A statistically significant inverse correlation between the MAD and the angle between the anatomic femoral axis and mechanical limb axis was found: the correlation coefficient was -0.53. In general, the received values were

  17. Neuromodulation of lower limb motor control in restorative neurology

    Science.gov (United States)

    Minassian, Karen; Hofstoetter, Ursula; Tansey, Keith; Mayr, Winfried

    2012-01-01

    One consequence of central nervous system injury or disease is the impairment of neural control of movement, resulting in spasticity and paralysis. To enhance recovery, restorative neurology procedures modify altered, yet preserved nervous system function. This review focuses on functional electrical stimulation (FES) and spinal cord stimulation (SCS) that utilize remaining capabilities of the distal apparatus of spinal cord, peripheral nerves and muscles in upper motor neuron dysfunctions. FES for the immediate generation of lower limb movement along with current rehabilitative techniques is reviewed. The potential of SCS for controlling spinal spasticity and enhancing lower limb function in multiple sclerosis and spinal cord injury is discussed. The necessity for precise electrode placement and appropriate stimulation parameter settings to achieve therapeutic specificity is elaborated. This will lead to our human work of epidural and transcutaneous stimulation targeting the lumbar spinal cord for enhancing motor functions in spinal cord injured people, supplemented by pertinent human research of other investigators. We conclude that the concept of restorative neurology recently received new appreciation by accumulated evidence for locomotor circuits residing in the human spinal cord. Technological and clinical advancements need to follow for a major impact on the functional recovery in individuals with severe damage to their motor system. PMID:22464657

  18. Using commercial video games for upper limb stroke rehabilitation: is this the way of the future?

    Science.gov (United States)

    Pietrzak, Eva; Cotea, Cristina; Pullman, Stephen

    2014-01-01

    The increasing number of people living with poststroke sequelae has stimulated the search for novel ways of providing poststroke rehabilitation without putting additional stress on overburdened health care systems. One of them is the use of commercially available technology and off-the-shelf video games for hemiparetic upper limb rehabilitation. The MEDLINE, EMBASE, and Cochrane Library databases were searched using key word synonyms for stroke, upper limb, and video games. Included studies investigated upper limb stroke rehabilitation using commercially available consoles and video games, reported outcomes that included measures of upper limb functionality, and were published in a peer-reviewed journal written in English. Thirteen studies were identified - 6 published as full articles and 7 as abstracts. Studies were generally small and only 3 were randomized. The gaming systems investigated were the Nintendo Wii (n = 10), EyeToy PlayStation (n = 2), and CyWee Z (n = 1). The Nintendo Wii appears to provide the greatest benefits to patients, with improvements seen in upper extremity function measures such as joint range of motion, hand motor function, grip strength, and dexterity. Three studies indicate that video therapy appears to be safe and that long-term improvements continue at follow-up. At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints.

  19. EEG-based BCI for the linear control of an upper-limb neuroprosthesis.

    Science.gov (United States)

    Vidaurre, Carmen; Klauer, Christian; Schauer, Thomas; Ramos-Murguialday, Ander; Müller, Klaus-Robert

    2016-11-01

    Assistive technologies help patients to reacquire interacting capabilities with the environment and improve their quality of life. In this manuscript we present a feasibility study in which healthy users were able to use a non-invasive Motor Imagery (MI)-based brain computer interface (BCI) to achieve linear control of an upper-limb functional electrical stimulation (FES) controlled neuro-prosthesis. The linear control allowed the real-time computation of a continuous control signal that was used by the FES system to physically set the stimulation parameters to control the upper-limb position. Even if the nature of the task makes the operation very challenging, the participants achieved a mean selection accuracy of 82.5% in a target selection experiment. An analysis of limb kinematics as well as the positioning precision was performed, showing the viability of using a BCI-FES system to control upper-limb reaching movements. The results of this study constitute an accurate use of an online non-invasive BCI to operate a FES-neuroprosthesis setting a step toward the recovery of the control of an impaired limb with the sole use of brain activity. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  20. Immersive VR in Phantom Limb Pain Therapy of Amputee Patients Due to Critical Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Zanfir Ana-Maria

    2017-09-01

    Full Text Available Introduction: Phantom limb pain (PLP occurs in approximately 75% of patients who undergo limb amputation. In identifying the etiopathogenic mechanisms, multidisciplinary approaches are increasingly important in explaining the causality based on neurological and psychological factors. PLP has many negative effects on the amputee's physical and mental integrity, which is why a variety of treatments have been conceived, whose effectiveness is rather limited.

  1. [Phantom limb pain syndrome: therapeutic approach using mirror therapy in a Geriatric Department].

    Science.gov (United States)

    González García, Paloma; Manzano Hernández, M Pilar; Muñoz Tomás, M Teresa; Martín Hernández, Carlos; Forcano García, Mercedes

    2013-01-01

    The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  2. Near-infrared angiography for critical limb ischemia in a diabetic murine model

    Science.gov (United States)

    Garcia, Missael; Zayed, Mohamed A.; Park, Kyoung-mi; Gruev, Viktor

    2017-04-01

    Peripheral arterial disease (PAD) is a highly prevalent disease process that afflicts more than 20% of individuals with diabetes. Progression of PAD in the setting of diabetes can lead to critical limb ischemia (CLI), which is associated with increased risk of wounds, gangrene, and limb loss. Prompt noninvasive evaluation of limbs affected by PAD progression and CLI is currently limited. Here, we evaluate the utility of a custom-designed multispectral imaging system for fluorescence-based near-infrared angiography and compare it to the existing gold standard of laser-scanning Doppler perfusion assessments. Due to its higher resolution and fluorescence sensitivity, near-infrared angiography demonstrates a greater capacity to characterize altered dynamic arterial perfusion in a clinically relevant diabetic murine model for CLI. Furthermore, we demonstrate that our imaging system can accurately track arterial perfusion recovery over time following induced ischemia, and reveal unique phenotypic differences in the setting of diabetes.

  3. Detecting Disordered Breathing and Limb Movement Using In-Bed Force Sensors.

    Science.gov (United States)

    Waltisberg, Daniel; Amft, Oliver; Brunner, Daniel P; Troster, Gerhard

    2017-07-01

    We present and evaluate measurement fusion and decision fusion for recognizing apnea and periodic limb movement in sleep episodes. We used an in-bed sensor system composed of an array of strain gauges to detect pressure changes corresponding to respiration and body movement. The sensor system was placed under the bed mattress during sleep and continuously recorded pressure changes. We evaluated both fusion frameworks in a study with nine adult participants that had mixed occurrences of normal sleep, apnea, and periodic limb movement. Both frameworks yielded similar recognition accuracies of 72.1 ± ∼  12% compared to 63.7 ± 17.4% for a rule-based detection reported in the literature. We concluded that the pattern recognition methods can outperform previous rule-based detection methods for classifying disordered breathing and period limb movements simultaneously.

  4. Catheter-directed thrombolysis for acute limb ischemia

    NARCIS (Netherlands)

    Schrijver, AM

    2016-01-01

    Acute limb ischemia occurs due to a sudden decrease in blood flow to the limb, usually caused by a thrombus or embolus, resulting not only in a potential threat to the viability of the limb, but also a high risk of death. Endovascular techniques have become the preferred treatment over the last

  5. 21 CFR 890.3410 - External limb orthotic component.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb orthotic component. 890.3410 Section... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3410 External limb orthotic component. (a) Identification. An external limb orthotic component is a device...

  6. 21 CFR 890.3500 - External assembled lower limb prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External assembled lower limb prosthesis. 890.3500... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3500 External assembled lower limb prosthesis. (a) Identification. An external assembled lower limb prosthesis...

  7. Facts about Upper and Lower Limb Reduction Defects

    Science.gov (United States)

    ... occur when a part of or the entire arm (upper limb) or leg (lower limb) of a fetus fails ... for each child. Potential treatments include: Prosthetics (artificial limbs) Orthotics (splints or braces) Surgery Rehabilitation (physical or occupational therapy) It is important to ...

  8. Genetic study of congenital limb anomalies among Egyptian children

    African Journals Online (AJOL)

    The remaining eighty five (85) patients constituting (60.7%) of enrolled cases comprised two groups: those with limb defects as part of a well defined genetic syndrome (Syndromic limb defects) (76 patients - 54.3%) and those with limb defects as part of a chromosomal aberration syndrome (9 patients - 6.4%). Genealogical ...

  9. 7 CFR 51.1220 - Leaf or limb rub injury.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Leaf or limb rub injury. 51.1220 Section 51.1220... STANDARDS) United States Standards for Grades of Peaches Definitions § 51.1220 Leaf or limb rub injury. “Leaf or limb rub injury” means that the scarring is not smooth, not light colored, or aggregates more...

  10. Reduction of residual limb volume in people with transtibial amputation

    NARCIS (Netherlands)

    Tantua, Audrey T.; Geertzen, Jan H. B.; van den Dungen, Jan J. A. M.; Breek, Jan-Kees C.; Dijkstra, Pieter U.

    2014-01-01

    The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study was to analyze the reduction of residual limb volume in people

  11. Effects of prosthetic limb prescription on 3-year mortality among Veterans with lower-limb amputation.

    Science.gov (United States)

    Kurichi, Jibby E; Kwong, Pui; Vogel, W Bruce; Xie, Dawei; Cowper Ripley, Diane; Bates, Barbara E

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and 3 yr mortality postsurgery among Veterans with lower-limb amputation (LLA). We conducted a retrospective observational study that included 4,578 Veterans hospitalized for LLA and discharged in fiscal years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3 yr anniversary of the surgical date. Of the Veterans with LLA, 1,300 (28.4%) received a prescription for a prosthetic limb within 1 yr after the surgical amputation. About 46% (n = 2,086) died within 3 yr of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 yr of the surgical anniversary. After adjustment, Veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than Veterans without a prescription, with a hazard ratio of 0.68 (95% confidence interval: 0.60-0.77). Findings demonstrated that Veterans with LLA who received a prescription for a prosthetic limb within 1 yr after the surgical amputation were less likely to die within 3 yr of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics.

  12. The axolotl limb blastema: cellular and molecular mechanisms driving blastema formation and limb regeneration in tetrapods

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    McCusker, Catherine; Bryant, Susan V.

    2015-01-01

    Abstract The axolotl is one of the few tetrapods that are capable of regenerating complicated biological structures, such as complete limbs, throughout adulthood. Upon injury the axolotl generates a population of regeneration‐competent limb progenitor cells known as the blastema, which will grow, establish pattern, and differentiate into the missing limb structures. In this review we focus on the crucial early events that occur during wound healing, the neural−epithelial interactions that drive the formation of the early blastema, and how these mechanisms differ from those of other species that have restricted regenerative potential, such as humans. We also discuss how the presence of cells from the different axes of the limb is required for the continued growth and establishment of pattern in the blastema as described in the polar coordinate model, and how this positional information is reprogrammed in blastema cells during regeneration. Multiple cell types from the mature limb stump contribute to the blastema at different stages of regeneration, and we discuss the contribution of these types to the regenerate with reference to whether they are “pattern‐forming” or “pattern‐following” cells. Lastly, we explain how an engineering approach will help resolve unanswered questions in limb regeneration, with the goal of translating these concepts to developing better human regenerative therapies. PMID:27499868

  13. Experimental induction of a perceived "telescoped" limb using a full-body illusion.

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    Schmalzl, Laura; Ehrsson, H Henrik

    2011-01-01

    Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as "telescoped" with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin's stump with respect to the participants' hand we were able to evoke the sensation of the participants' hand being located either below the stump or, more crucially, "inside" the stump, i.e., telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift). Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and phantom pain in

  14. Experimental Induction of a Perceived “Telescoped” Limb Using a Full-Body Illusion

    Science.gov (United States)

    Schmalzl, Laura; Ehrsson, H. Henrik

    2011-01-01

    Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as “telescoped” with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin's stump with respect to the participants’ hand we were able to evoke the sensation of the participants’ hand being located either below the stump or, more crucially, “inside” the stump, i.e., telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift). Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and phantom

  15. Experimental induction of a perceived telescoped limb using a full-body illusion

    Directory of Open Access Journals (Sweden)

    Laura eSchmalzl

    2011-04-01

    Full Text Available Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as telescoped with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin’s stump with respect to the participants’ hand we were able to evoke the sensation of the participants’ hand being located either below the stump or, more crucially, inside the stump, i.e. telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift. Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and

  16. A Clinical Evaluation of Postamputation Phenomena Including Phantom Limb Pain after Lower Limb Amputation in Dysvascular Patients.

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    Richardson, Cliff; Crawford, Kath; Milnes, Karen; Bouch, Elizabeth; Kulkarni, Jai

    2015-08-01

    To explore the effects of phantom phenomena on a group of dysvascular lower limb amputees. This was a cross-sectional study of dysvascular lower limb amputees. A modified version of the phantom phenomena questionnaire was used to measure the prevalence of phantom phenomena and the effects of those phenomena on daily life. Eighty-nine amputees were recruited. The majority were inpatients (72%) and male (72%). Most had pain before amputation (83%). Sixty-three percent had phantom limb pain. No associations were found between phantom limb pain and preamputation pain (p = .397). Phantom limb pain was present immediately on waking from amputation in 23%. Phantom limb pain is highly fluctuant. It is more likely that phantom limb pain was present with more time passed since amputation (p = .002). Outpatients with unhealed wounds were less likely to have phantom limb pain (p = .007). The effects of postamputation phenomena include sleep loss and social restrictions. These results challenge the belief that phantom limb pain reduces over time as more outpatients reported phantom limb pain than inpatients. Preamputation pain is not linked to the presence of phantom limb pain. The fluctuant nature of phantom limb pain makes its treatment complex. Some may wish intensity to reduce, whereas others may prefer to reduce the number of episodes or duration of each episode instead. More research is needed to clarify the needs of amputees in relation to the postamputation phenomena. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  17. Cortical stimulation mapping of phantom limb rolandic cortex. Case report.

    Science.gov (United States)

    Ojemann, J G; Silbergeld, D L

    1995-04-01

    Findings of intraoperative rolandic cortex mapping during awake craniotomy for a tumor in a patient with a contralateral upper-extremity amputation are presented. This patient sustained a traumatic amputation at the mid-humerus 24 years previously. Initially he had experienced rare painless phantom limb sensations but none in the past 10 years. Functional mapping during an awake craniotomy was performed to maximize safe tumor resection. Typical temporal and frontal speech areas were identified; motor representation of face and jaw extended more superiorly than sensory representation. Shoulder movements were evoked more laterally than usual at the superior aspect of the craniotomy. A small region of precentral gyrus, between the jaw and shoulder representations, elicited no detectable effect when stimulated. Somatosensory mapping showed a similar topographical distribution of face and mouth cortex; however, posterior and inferior to the shoulder motor cortex, right arm and hand (phantom) sensations were evoked. Evidence suggests that significant motor reorganization occurs following an amputation, with expansion of neighboring homuncular representations without loss of somatosensory representation, despite a long period of time without any sensation referable to the amputated limb. Contrary to models of sensory cortex plasticity, the plasticity of the adult cortex may be system specific, with reorganization present in motor, but not in sensory, cortical systems.

  18. Health-related profiles of people with lower limb loss

    Science.gov (United States)

    Amtmann, Dagmar; Morgan, Sara J.; Kim, Jiseon; Hafner, Brian J.

    2015-01-01

    Objective To construct profiles of self-reported health indicators to examine differences and similarities between people with lower limb loss (LLL) and a normative sample (hereafter called the norm), and to compare health indicators between subgroups based on level and etiology of limb loss. Design Survey Setting General community Participants Adults with unilateral lower limb loss (n=1091) participated in this study. Eligibility criteria included LLL resulting from trauma or dysvascular complications and regular use of a prosthesis. Interventions Not applicable Main Outcome Measures Patient-Reported Outcomes Measurement Information System 29-item profile (PROMIS-29) version 1.0 measures physical function, pain interference, fatigue, sleep disturbance, anxiety, depression and satisfaction with participation in social roles. The norms are based on 5,239 individuals representative of the U.S. general population in gender, age, race, ethnicity and education. Results People with LLL reported statistically significantly worse physical function, pain interference and satisfaction with participation in social roles and significantly less fatigue than the norm. People with transfemoral (i.e., above-knee) amputation significantly differed from people with transtibial (i.e., below-knee) amputation on physical function. Similarly, people with amputation due to trauma and dysvascular etiology significantly differed on physical function and satisfaction with social roles after adjusting for relevant clinical characteristics. Conclusions People with LLL generally report worse physical function, pain interference and satisfaction with social roles when compared to norm. People with dysvascular amputation reported worse physical function and satisfaction with social roles than people with traumatic amputation. Health indicator profiles are an efficient way of providing clinically meaningful information about numerous aspects of self-reported health in people with LLL. PMID

  19. Gait Phase Recognition for Lower-Limb Exoskeleton with Only Joint Angular Sensors

    Directory of Open Access Journals (Sweden)

    Du-Xin Liu

    2016-09-01

    Full Text Available Gait phase is widely used for gait trajectory generation, gait control and gait evaluation on lower-limb exoskeletons. So far, a variety of methods have been developed to identify the gait phase for lower-limb exoskeletons. Angular sensors on lower-limb exoskeletons are essential for joint closed-loop controlling; however, other types of sensors, such as plantar pressure, attitude or inertial measurement unit, are not indispensable.Therefore, to make full use of existing sensors, we propose a novel gait phase recognition method for lower-limb exoskeletons using only joint angular sensors. The method consists of two procedures. Firstly, the gait deviation distances during walking are calculated and classified by Fisher’s linear discriminant method, and one gait cycle is divided into eight gait phases. The validity of the classification results is also verified based on large gait samples. Secondly, we build a gait phase recognition model based on multilayer perceptron and train it with the phase-labeled gait data. The experimental result of cross-validation shows that the model has a 94.45% average correct rate of set (CRS and an 87.22% average correct rate of phase (CRP on the testing set, and it can predict the gait phase accurately. The novel method avoids installing additional sensors on the exoskeleton or human body and simplifies the sensory system of the lower-limb exoskeleton.

  20. A Neuromotor Device for Reducing Phantom Limb Pain in Individuals with Spinal Cord Injury

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    Cui Lei

    2016-01-01

    Full Text Available Phantom Limb Pain is a disorder that can be experienced by individuals after amputation or spinal cord injury. In spinal cord injury the paralysis or paresis is often bilateral, thus limiting the application of apparent movement as a therapeutic model for phantom limb pain. This project aimed to develop a robotic rehabilitation device that replicated apparent movement to apply the same therapeutic principles with individuals with lower limb phantom pain that have bilateral paralysis of paresis. The proposed device achieved lower limb planar motion of the knee by a six-bar linkage of a single degree of freedom (DOF. It is driven by a linear actuator while the ankle motion is achieved by a gear motor, reaching an effective 70° range of motion for both joints. The system features closed loop control using feedback from surface electromyography sensors, limit switches and position sensors with an Arduino microcontroller as the control unit. This device will be used to further our understanding of the disorder and create opportunities for robot aided treatment for individuals with phantom limb pain as a result of spinal cord injury.

  1. A doppler study of blood flow change of lower limb arteries after transfemoral angiography

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    Kim, Jong Chul; Park, Chan Sup; Yeon, Kyung Mo; Yun, Yong Soo [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1987-10-15

    Perspective evaluation of lower limb arterial blood flow velocity and vascular complications of percutaneous transfemoral arterial catheterization was carried out in 26 children at S. N. U. H. Children's Hospital from Dec. 1985 to May 1986. Common femoral and popliteal arterial velocity signals of both limbs were monitored and compared by doppler duplex sonography (Diasonics DRF-400) immediately after angiography and at 24-48 hours later. In most cases, the average velocity of proximal femoral artery and popliteal artery of puncture site was slower than that of the other limb vessels. In complication group of thromboembolism (19%), the catheterization time was longer, the catheter size was larger, the velocity discrepancy of both limb arteries was larger, the doppler velocity profile was more irregular, and the diurnal change of arterial velocity discrepancy was slower than in normal control group. It is recommended that the catheterization time is less than 30 minutes and the catheter diameter is less than two-fifths of the femoral arterial diameter. Systemic heparinization within 24 hours is required if the catheterization time is longer of blood flow disturbance is detected on doppler examination. The doppler duplex sonography is a simple, rapid, and noninvasive technique for assessing lower limb hemodynamics, especially in patients undergoing transfemoral arterial catherization.

  2. Intra-limb coordination in karate kicking: Effect of impacting or not impacting a target.

    Science.gov (United States)

    Quinzi, Federico; Sbriccoli, Paola; Alderson, Jacqueline; Di Mario, Alberto; Camomilla, Valentina

    2014-02-01

    This study aimed to investigate the kicking limb coordinative patterns adopted by karate practitioners (karateka) when impacting (IRK), or not impacting (NIRK) a target during a roundhouse kick. Six karateka performed three repetitions of both kicks while kicking limb kinematics were recorded using a stereophotogrammetric system. Intra-limb coordination was quantified for hip and knee flexion-extension from toe-off to kick completion, using the Continuous relative phase (CRP). Across the same time interval, thigh and shank angular momentum about the vertical axis of the body was calculated. For all trials, across all participants, CRP curve peaks and maximum and minimum angular momentum were determined. A RM-ANOVA was performed to test for differences between kicking conditions. The CRP analysis highlighted, during the central portion of both kicks, a delayed flexion of the hip with respect to the knee. Conversely, during the terminal portion of the CRP curves, the NIRK is performed with a more in-phase action, caused by a higher hip angular displacement. The NIRK is characterized by a lower angular momentum which may enhance control of the striking limb. It would seem that the issue of no impact appears to be solved through the control of all segments of the kicking limb, in contrast to the primary control of the lower leg only observed during the IRK. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Design and preliminary evaluation of an exoskeleton for upper limb resistance training

    Science.gov (United States)

    Wu, Tzong-Ming; Chen, Dar-Zen

    2012-06-01

    Resistance training is a popular form of exercise recommended by national health organizations, such as the American College of Sports Medicine (ACSM) and the American Heart Association (AHA). This form of training is available for most populations. A compact design of upper limb exoskeleton mechanism for homebased resistance training using a spring-loaded upper limb exoskeleton with a three degree-of-freedom shoulder joint and a one degree-of-freedom elbow joint allows a patient or a healthy individual to move the upper limb with multiple joints in different planes. It can continuously increase the resistance by adjusting the spring length to train additional muscle groups and reduce the number of potential injuries to upper limb joints caused by the mass moment of inertia of the training equipment. The aim of this research is to perform a preliminary evaluation of the designed function by adopting an appropriate motion analysis system and experimental design to verify our prototype of the exoskeleton and determine the optimal configuration of the spring-loaded upper limb exoskeleton.

  4. Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases

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    Elisabetta Ambron

    2018-02-01

    Full Text Available Up to 90% of amputees experience sensations in their phantom limb, often including strong, persistent phantom limb pain (PLP. Standard treatments do not provide relief for the majority of people who experience PLP, but virtual reality (VR has shown promise. This study provides additional evidence that game-like training with low-cost immersive VR activities can reduce PLP in lower-limb amputees. The user of our system views a real-time rendering of two intact legs in a head-mounted display while playing a set of custom games. The movements of both virtual extremities are controlled by measurements from inertial sensors mounted on the intact and residual limbs. Two individuals with unilateral transtibial amputation underwent multiple sessions of the VR treatment over several weeks. Both participants experienced a significant reduction of pain immediately after each VR session, and their pre-session pain levels also decreased greatly over the course of the study. Although preliminary, these data support the idea that VR interventions like ours may be an effective low-cost treatment of PLP in lower-limb amputees.

  5. Clinical utility of the Taylor spatial frame for limb deformities

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    Keshet D

    2017-05-01

    Full Text Available Doron Keshet, Mark Eidelman Pediatric Orthopedics Unit, Rambam Health Care Center, Haifa, Israel Abstract: The Taylor spatial frame (TSF is a hexapod external fixator that can correct six-axis deformities. The mathematical base of all hexapod systems is projective geometry, which describes complex repositioning of an object in space. The Taylor brothers developed one of the first six-axis correction systems, which is known today as TSF. Over the years, this system has become the most used six-axis deformity correction device. In this review, we describe the history behind TSF development, and describe the principles and clinical utility for application of the TSF in different settings, such as acute trauma, malunions, and various deformities of the lower and upper limb. Keywords: external fixator, deformity correction, hexapod

  6. Reduction of residual limb volume in people with transtibial amputation.

    Science.gov (United States)

    Tantua, Audrey T; Geertzen, Jan H B; van den Dungen, Jan J A M; Breek, Jan-Kees C; Dijkstra, Pieter U

    2014-01-01

    The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study is to analyze the reduction of residual limb volume in people with transtibial amputation and to correlate residual limb volume with residual limb circumference. In a longitudinal cohort study of 21 people who had a transtibial amputation, residual limb volume was measured using a laser scanner and circumference was measured using a tape measure 1 wk postamputation and every 3 wk thereafter until 24 wk postamputation. A linear mixed model analysis was performed with weeks postamputation transformed according to the natural logarithm as predictor. Residual limb volume decreased significantly over time, with a large variation between patients. Residual limb volume does not correlate well with circumference. On average, residual limb volume decreased 200.5 mL (9.7% of the initial volume) per natural logarithm of the weeks postamputation. The decrease in residual limb volume following a transtibial amputation is substantial in the early postamputation phase, followed by a leveling off. It was not possible to determine a specific moment when the residual limb volume had stabilized.

  7. Phantom limb pain from spinal sarcoma: a case report.

    Science.gov (United States)

    Cruz, Ernesto; Dangaria, Harsh T

    2013-07-01

    Phantom limb pain is a frequent sequela of amputation. A high prevalence of residual limb pain and back pain also exists among amputees. We present a case of a new-onset severe phantom limb pain resulting from a metastatic spinal mass in an 81-year-old patient with a history of malignant sarcoma and an old hip disarticulation amputation. The metastatic lesion, upon imaging, was found to involve the L3 vertebra and caused moderate compression of the thecal sac on the right and severe right lateral recess stenosis. After the mass was resected, the patient's phantom limb pain resolved. Our case report demonstrates that spinal metastatic pathologies may be a cause of phantom limb pain and should be included in the differential diagnosis of new-onset phantom limb pain or a change in phantom limb pain. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  8. Usefulness of milnacipran in treating phantom limb pain

    Science.gov (United States)

    Nagoshi, Yasuhide; Watanabe, Akira; Inoue, Saiko; Kuroda, Tomoki; Nakamura, Mitsuo; Matsumoto, Yoshitake; Fukui, Kenji

    2012-01-01

    Background Amputation of an extremity often results in the sensation of a “phantom limb” where the patient feels that the limb that has been amputated is still present. This is frequently accompanied by “phantom limb pain”. We report here the use of milnacipran, a serotonin and norepinephrine reuptake inhibitor, to treat phantom limb pain after amputation of injured or diseased limbs in three patients. Methods and results The severity of phantom pain before and during treatment was quantified using a visual analog scale. In one case, phantom limb pain responded partially to treatment with high doses of paroxetine, and then replacement with milnacipran further improved the pain relief and long-term full pain relief was achieved. In the two other cases, milnacipran was used as first-line treatment and phantom limb pain responded rapidly. Conclusion These results suggest that milnacipran administration may be useful in phantom limb pain, possibly as a first-line treatment. PMID:23185119

  9. Critical analysis of upper limb replantations

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    Rames Mattar Junior

    2006-06-01

    Full Text Available Objective: The authors analyze the follow-up of results in 62 adultpatients who had traumatic amputations in the upper limb andwho underwent successful replantation procedures from 1994 to2004. Methods: The levels of amputation were in fingers or thumbin 48, hand in 5, wrist in 4, forearm in 2 and arm in 3 patients. Allpatients were treated in a rehabilitation program of specializedhand therapy. A simplified questionnaire was used to evaluate thereturn to work activities using the operated limb, either in theformal or informal economy, and the patient’s satisfaction rateconcerning the surgical procedure. Results: It was noted that 85.5%of patients returned to some work activity using the operated limband 96.8% of patients are satisfied with the results. Conclusions:Patients submitted to successful replantation present a high rateof satisfaction and return to work activities.

  10. Can neural blocks prevent phantom limb pain?

    Science.gov (United States)

    Borghi, Battista; D'Addabbo, Marco; Borghi, Raffaele

    2014-07-01

    Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. Nerve blocks have been investigated for the treatment and prevention of PLS. Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain.

  11. A Brief History of Limb Lengthening.

    Science.gov (United States)

    Birch, John G

    2017-09-01

    In the last 35 years, orthopaedic surgeons have witnessed 3 major advances in the technique of limb lengthening: "distraction osteogenesis" facilitated by Gavriil Ilizarov method and infinitely-adaptable circular fixator with fine-wire bone fragment fixation; the introduction of the "6-strut" computer program-assisted circular fixators to effect complex deformity correction simultaneously; and the development of motorized intramedullary lengthening nails. However, the principles and associated complications of these techniques are on the basis of observations by Codivilla, Putti, and Abbott from as much as 110 years ago. This review notes the contribution of these pioneers in limb lengthening, and the contribution of Thor Heyerdahl principles of tolerance and diversity to the dissemination of Ilizarov principles to the Western world.

  12. Intra-limb coordinative adaptations in cycling.

    Science.gov (United States)

    Sides, Deborah; Wilson, Cassie

    2012-03-01

    This study aimed to establish the nature of lower extremity intra-limb coordination variability in cycling and to investigate the coordinative adaptations that occur in response to changes in cadence and work rate. Six trained and six untrained males performed nine pedalling bouts on a cycle ergometer at various cadences and work rates (60, 90, and 120 revolutions per minute (rpm) at 120, 210, and 300W). Three-dimensional kinematic data were collected and flexion/extension angles of the ankle, knee, and hip joints were subsequently calculated. These data were used to determine two intra-limb joint couplings [hip flexion/extension-knee flexion/extension (HK) and knee flexion/extension-ankle plantar-flexion/dorsi-flexion (KA)], which were analysed using continuous relative phase analysis. Trained participants displayed significantly (p cycling is necessary before any recommendations can be made.

  13. Limb-shaking transient ischemic attack

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    Abhijit Das

    2013-01-01

    Full Text Available Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually present with seizure like activity and often misdiagnosed as focal seizures. Only on careful history the important clinical clues-which may help in differentiating from seizure-are revealed: Lack of Jacksonian march or aura; precipitation by maneuvers that lead to carotid compression. We present the case of an elderly gentleman with recurrent limb shaking transient ischemic attacks that was initially diagnosed as a case of epilepsy. His symptoms responded to optimization of blood pressure. The case report highlights the importance of accurate diagnosis as the treatment of the associated carotid artery occlusion may not only abolish the attacks but also reduce the risk of future stroke.

  14. Limb conservation using non vascularised fibular grafts.

    Science.gov (United States)

    Omololu, B; Ogunlade, S O; Alonge, T O

    2002-01-01

    This paper highlights the use of non-vascularised fibular graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high velocity injuries due to road traffic accidents, severe neglected infections, and osteolytic tumours. In majority of cases, the surgeon is left with the only option of an amputation especially where there is no access to microvascular surgery and microvascular bone grafting devices. This is a major problem in the West African subregion hence the need for this article. We present illustrative cases of limb conservation in an adult involved in a high velocity trauma and a child with a destructive osteolytic infection culminating in bone loss. The patients are still been followed up in our surgical outpatient clinics.

  15. Emulating Upper Limb Disorder for Therapy Education

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    Noor Ayuni binti Che Zakaria

    2014-11-01

    Full Text Available Robotics not only contributes to the invention of rehabilitation devices, it can also enhance the quality of medical education. In recent years, the use of patient simulators and part-task trainers in the medical education field has brought meaningful improvements in the training of medical practitioners. Nevertheless, in the context of therapy training for upper limb disorders, trainee therapists still have to engage directly with the patients to gain experience of the rehabilitation of physical diseases. In this work, a high-fidelity part-task trainer that is able to reproduce the stiffness of spasticity and rigidity symptoms of the upper limb, such as those observed in post-stroke patients and Parkinson's disease patients, has been developed. Based on the evaluation carried out by two experienced therapists, the developed part-task trainer is able to simulate different patient cases and help trainee therapists gain pre-clinical experience in a safe and intuitive learning environment.

  16. Lethal neonatal short-limbed dwarfism

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    Kim, Ok Hwa; Yim, Chung Ik; Bahk, Yong Whee [Catholic Medical College, Seoul (Korea, Republic of)

    1986-02-15

    We have detailed our experiences on 6 cases of neonatal lethal short-limbed dwarfism and reviewed the articles. They include, achondrogenesis, thanatophoric dysplasia, asphyxiating thoracic dysplasia, osteogenesis imperfect a congenita, and hypophosphatasia lethals. Five babies were born alive but died soon after birth and one was a stillbirth. The main cause of failure to thrive was respiratory insufficiency. Each case was having quite characteristic radiologic findings, even if the general appearances were similar to the achondroplasts clinically. Precise diagnosis is very important for genetic counselling of the parents and alarm to them the possibility of bone dysplasias to the next offsprings. For this purpose, the radiologists play major role for the correct diagnosis. We stress that when the baby is born with short-limbed dwarfism, whole body radiogram should be taken including lateral view and postmortem radiogram is also very precious.

  17. An Official American Thoracic Society/European Respiratory Society Statement: Update on Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Maltais, François; Decramer, Marc; Casaburi, Richard; Barreiro, Esther; Burelle, Yan; Debigaré, Richard; Dekhuijzen, P. N. Richard; Franssen, Frits; Gayan-Ramirez, Ghislaine; Gea, Joaquim; Gosker, Harry R.; Gosselink, Rik; Hayot, Maurice; Hussain, Sabah N. A.; Janssens, Wim; Polkey, Micheal I.; Roca, Josep; Saey, Didier; Schols, Annemie M. W. J.; Spruit, Martijn A.; Steiner, Michael; Taivassalo, Tanja; Troosters, Thierry; Vogiatzis, Ioannis; Wagner, Peter D.

    2014-01-01

    Background: Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. Purpose: The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. Methods: An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. Results: We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. Conclusions: Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem

  18. [The use of vascular prothesis Gore Viabahn in the managment of the lower limbs ischemia].

    Science.gov (United States)

    Pupka, Artur; Szyber, Przemysław Piotr; Skóra, Jan; Pawłowski, Stanisław

    2011-01-01

    The chronic lower limbs ischaemia is caused mainly by arteriosclerosis. After insufficient conservative treatment only the surgical intervention can salvage the limb. The revascularisation surgery can be performed by open surgery with implantation of the prosthetic bypass or by endovascular angioplasty with stent. This second method seems to be the best alternative for the patients with several concomitant systemic diseases. Nevertheless it is limited by presence of the long-distance arteriosclerotic lesions. The resolve of that problem is use of new generation of long endovascular covered stents. They can be succesfuly used in aorto-femoral and femoro-popliteal segment. Their efficiacy is simmilar to traditional prosthetic grafts.

  19. Quantitative Doppler ultrasound evaluation of occlusive arterial disease in the lower limb

    DEFF Research Database (Denmark)

    Bagi, P; Sillesen, H; Hansen, H J

    1988-01-01

    Forty consecutive patients with lower limb arterial disease were evaluated using a multi-gated pulsed Doppler system. Doppler signals were sampled at 4 sites in each limb, and following spectral analysis, the pulse rise time (PRT) was measured. The value obtained at the location giving the longest...... duration of PRT was used for comparison with ankle/brachial pressure index (A/B index) and angiography. A highly significant correlation was found between PRT and A/B index (r = -0.75, P less than 0.001). Based on receiver operating characteristic curves an overall diagnostic accuracy of 90% in diagnosing...

  20. INFLUENCE OF LIMB DISEASES ON PRODUCTION AND REPRODUCTIVE PERFORMANCE OF DAIRY COWS

    Directory of Open Access Journals (Sweden)

    Benjamin Čengić

    2013-03-01

    Full Text Available Today, cow breeding is production-oriented and focused at achieving the utmost in the shortest time with little extra working hours, food and finances.Healthy extremities are the preconditions for proper conceive and the highiest production in dairy cow. The study included 20 Holstein-Frisean cows with moderate to severe pathological changes in the musculosceletal system, between the first and fifth lactation. In 70% of the cases, pathological changes affected the rear limbs, while in 55% of the cases only a single limb. Out of the total number of udder quarters, 28,75% were suspicious for subclinical mastitis, while the average length of a service period was 144 days. Adequate protection of the hoofs should reduce the frequency of lameness and inflammation as well as direct and indirect losses.Key words: limb diseases, dairy cow, production, reproduction

  1. Ethical considerations in providing an upper limb exoskeleton device for stroke patients.

    Science.gov (United States)

    Bulboacă, Adriana E; Bolboacă, Sorana D; Bulboacă, Angelo C

    2017-04-01

    The health care system needs to face new and advanced medical technologies that can improve the patients' quality of life by replacing lost or decreased functions. In stroke patients, the disabilities that follow cerebral lesions may impair the mandatory daily activities of an independent life. These activities are dependent mostly on the patient's upper limb function so that they can carry out most of the common activities associated with a normal life. Therefore, an upper limb exoskeleton device for stroke patients can contribute a real improvement of quality of their life. The ethical problems that need to be considered are linked to the correct adjustment of the upper limb skills in order to satisfy the patient's expectations, but within physiological limits. The debate regarding the medical devices dedicated to neurorehabilitation is focused on their ability to be beneficial to the patient's life, keeping away damages, injustice, and risks. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  3. Neural correlates of evoked phantom limb sensations.

    Science.gov (United States)

    Andoh, J; Diers, M; Milde, C; Frobel, C; Kleinböhl, D; Flor, H

    2017-05-01

    Previous work showed the existence of changes in the topographic organization within the somatosensory cortex (SI) in amputees with phantom limb pain, however, the link between nonpainful phantom sensations such as cramping or tingling or the percept of the limb and cortical changes is less clear. We used functional magnetic resonance imaging (fMRI) in a highly selective group of limb amputees who experienced inducible and reproducible nonpainful phantom sensations. A standardized procedure was used to locate body sites eliciting phantom sensations in each amputee. Selected body sites that could systematically evoke phantom sensations were stimulated using electrical pulses in order to induce phasic phantom sensations. Homologous body parts were also stimulated in a group of matched controls. Activations related to evoked phantom sensations were found bilaterally in SI and the intraparietal sulci (IPS), which significantly correlated with the intensity of evoked phantom sensations. In addition, we found differences in intra- and interhemispheric interaction between amputees and controls during evoked phantom sensations. We assume that phantom sensations might be associated with a functional decoupling between bilateral SI and IPS, possibly resulting from transcallosal reorganization mechanisms following amputation. Copyright © 2017. Published by Elsevier B.V.

  4. OMPS Limb Profiler Instrument Performance Assessment

    Science.gov (United States)

    Jaross, Glen R.; Bhartia, Pawan K.; Chen, Grace; Kowitt, Mark; Haken, Michael; Chen, Zhong; Xu, Philippe; Warner, Jeremy; Kelly, Thomas

    2014-01-01

    Following the successful launch of the Ozone Mapping and Profiler Suite (OMPS) aboard the Suomi National Polar-orbiting Partnership (SNPP) spacecraft, the NASA OMPS Limb team began an evaluation of instrument and data product performance. The focus of this paper is the instrument performance in relation to the original design criteria. Performance that is closer to expectations increases the likelihood that limb scatter measurements by SNPP OMPS and successor instruments can form the basis for accurate long-term monitoring of ozone vertical profiles. The team finds that the Limb instrument operates mostly as designed and basic performance meets or exceeds the original design criteria. Internally scattered stray light and sensor pointing knowledge are two design challenges with the potential to seriously degrade performance. A thorough prelaunch characterization of stray light supports software corrections that are accurate to within 1% in radiances up to 60 km for the wavelengths used in deriving ozone. Residual stray light errors at 1000nm, which is useful in retrievals of stratospheric aerosols, currently exceed 10%. Height registration errors in the range of 1 km to 2 km have been observed that cannot be fully explained by known error sources. An unexpected thermal sensitivity of the sensor also causes wavelengths and pointing to shift each orbit in the northern hemisphere. Spectral shifts of as much as 0.5nm in the ultraviolet and 5 nm in the visible, and up to 0.3 km shifts in registered height, must be corrected in ground processing.

  5. Sports participation of Dutch lower limb amputees.

    Science.gov (United States)

    Bragaru, Mihai; Meulenbelt, Henk E J; Dijkstra, Pieter U; Geertzen, Jan H B; Dekker, Rienk

    2013-12-01

    To analyze sports participation of Dutch lower limb amputees and factors influencing sports participation. A cross-sectional survey was performed. Dutch lower limb amputees (N = 2039) were invited to participate in a postal survey addressing personal and amputation characteristics, physical limitations, sports participation, skin problems, and prosthesis use. Only data concerning personal and amputation characteristics together with the data concerning sports participation were used for this study. Of the 816 questionnaires received, 780 were suitable for statistical analysis. The mean age of the participants was 59.6 years (SD 14.8), 62% were men and 27% of the amputations was due to vascular diseases or diabetes. Only 15% of all respondents participate in sports at least 5 hours a month. Smoking (odds ratio: 0.55), an age older than 60 (odds ratio: 0.97 per year), and a vascular cause of amputation (odds ratio: 0.42) were negatively associated with sports participation. Less than 15% of the Dutch lower limb amputees participate in sports at least 5 hours per month. Older age, smoking and a vascular cause of amputation have a negative influence on the sports participation of these individuals.

  6. Limb Lengthening in Patients with Achondroplasia.

    Science.gov (United States)

    Park, Kwang-Won; Garcia, Rey-an Niño; Rejuso, Chastity Amor; Choi, Jung-Woo; Song, Hae-Ryong

    2015-11-01

    Although bilateral lower-limb lengthening has been performed on patients with achondroplasia, the outcomes for the tibia and femur in terms of radiographic parameters, clinical results, and complications have not been compared with each other. We proposed 1) to compare the radiological outcomes of femoral and tibial lengthening and 2) to investigate the differences of complications related to lengthening. We retrospectively reviewed 28 patients (average age, 14 years 4 months) with achondroplasia who underwent bilateral limb lengthening between 2004 and 2012. All patients first underwent bilateral tibial lengthening, and at 9-48 months (average, 17.8 months) after this procedure, bilateral femoral lengthening was performed. We analyzed the pixel value ratio (PVR) and characteristics of the callus of the lengthened area on serial radiographs. The external fixation index (EFI) and healing index (HI) were computed to compare tibial and femoral lengthening. The complications related to lengthening were assessed. The average gain in length was 8.4 cm for the femur and 9.8 cm for the tibia. The PVR, EFI, and HI of the tibia were significantly better than those of the femur. Fewer complications were found during the lengthening of the tibia than during the lengthening of the femur. Tibial lengthening had a significantly lower complication rate and a higher callus formation rate than femoral lengthening. Our findings suggest that bilateral limb lengthening (tibia, followed by femur) remains a reasonable option; however, we should be more cautious when performing femoral lengthening in selected patients.

  7. Phantom limb related phenomena and their rehabilitation after lower limb amputation.

    Science.gov (United States)

    Casale, R; Alaa, L; Mallick, M; Ring, H

    2009-12-01

    This paper reviewed the various hypotheses on phantom limb and phantom limb pain as well as all the related rehabilitation techniques to control these symptoms. The uncertainty in their pathophysiology strongly affects all the rehabilitation approaches so far used, as no single parameter has been found to predict or control phantom limb pain as well as no single factor can be quoted as an indicator of rehabilitation success for lower limb amputation. Within a comprehensive rehabilitation plan, behavioral interventions, stimulation techniques, feedback, physical therapies designed to possibly reverse the maladaptive memory traces and enhance its extinction have been described. Although substantially not clinically useful, pharmacological and surgical interventions also have been briefly considered. A reassessment of the actual strategies used is suggested with a role for rehabilitation not only after the amputation but also in the pre-emptive control of the pre-existing painful condition. In this process, rehabilitation should take into account many parameters, not always related to the traditional role of rehabilitation. Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated.

  8. Gray matter changes following limb amputation with high and low intensities of phantom limb pain.

    Science.gov (United States)

    Preissler, Sandra; Feiler, Johanna; Dietrich, Caroline; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2013-05-01

    Limb amputation and chronic phantom limb pain (PLP) are both associated with neural alterations at all levels of the neuraxis. We investigated gray matter volume of 21 upper limb amputees and 14 healthy control subjects. Results demonstrate that amputation is associated with reduced gray matter in areas in the motor cortex representing the amputated limb. Additionally, patients show an increase in gray matter in brain regions that belong to the dorsal and ventral visual stream. We subdivided the patient group into patients with medium to high PLP (HPLP; N = 11) and those with slight PLP (SPLP; N = 10). HPLP patients showed reduced gray matter in brain areas involved in pain processing. SPLP patients showed a significant gray matter increase in regions of the visual stream. Results indicate that all patients may have an enhanced need for visual control to compensate the lack of sensory feedback of the missing limb. As we found these alterations primarily in the SPLP patient group, successful compensation may have an impact on PLP development. Therefore, we hypothesize that visual adaptation mechanisms may compensate for the lack of sensorimotor feedback and may therefore function as a protection mechanism against high PLP development.

  9. Limb-Enhancer Genie: An accessible resource of accurate enhancer predictions in the developing limb.

    Directory of Open Access Journals (Sweden)

    Remo Monti

    2017-08-01

    Full Text Available Epigenomic mapping of enhancer-associated chromatin modifications facilitates the genome-wide discovery of tissue-specific enhancers in vivo. However, reliance on single chromatin marks leads to high rates of false-positive predictions. More sophisticated, integrative methods have been described, but commonly suffer from limited accessibility to the resulting predictions and reduced biological interpretability. Here we present the Limb-Enhancer Genie (LEG, a collection of highly accurate, genome-wide predictions of enhancers in the developing limb, available through a user-friendly online interface. We predict limb enhancers using a combination of >50 published limb-specific datasets and clusters of evolutionarily conserved transcription factor binding sites, taking advantage of the patterns observed at previously in vivo validated elements. By combining different statistical models, our approach outperforms current state-of-the-art methods and provides interpretable measures of feature importance. Our results indicate that including a previously unappreciated score that quantifies tissue-specific nuclease accessibility significantly improves prediction performance. We demonstrate the utility of our approach through in vivo validation of newly predicted elements. Moreover, we describe general features that can guide the type of datasets to include when predicting tissue-specific enhancers genome-wide, while providing an accessible resource to the general biological community and facilitating the functional interpretation of genetic studies of limb malformations.

  10. The biomechanical interaction between vertebral column and limbs in the horse: a kinematical study

    NARCIS (Netherlands)

    Gómez Álvarez, C.B.

    2007-01-01

    Nowadays, horses have to train and perform in high-level sportive and leisure activities. Injuries of the locomotor system with a decreased functionality or pain of the back are often seen in equine hospitals. In general, the relationship between limb and vertebral column function in mammals is

  11. A portable device for the clinical assessment of upper limb motion and muscle synergies

    NARCIS (Netherlands)

    Murgia, A.; Kerkhofs, V.; Savelberg, H.; Meijer, K.

    2010-01-01

    We present a device for recording and analyzing upper limb movements and muscle activities in a single unit. The device's outputs are related to aspects of clinical assessment such as joint coordination, fatigue and muscle synergies. A comparison with an optoelectronic motion capture system was also

  12. Emerging directions in lower limb externally wearable robots for gait rehabilitation and augmentation : A review

    NARCIS (Netherlands)

    Veneman, Jan F.; Burdet, Etienne; Van Der Kooij, Herman; Lefeber, Dirk; Tokhi, Mohammad O.; Virk, Gurvinder S.

    2016-01-01

    Wearable Robots, including those connected externally over the Lower Limbs (LLEWRs) is a growing field of research and development that promises robotic systems to support and augment locomotor functions. The current State of the Art of such products can be seen as a first generation of devices that

  13. A Need for Logical and Consistent Anatomical Nomenclature for Cutaneous Nerves of the Limbs

    Science.gov (United States)

    Gest, Thomas R.; Burkel, William E.; Cortright, Gerald W.

    2009-01-01

    The system of anatomical nomenclature needs to be logical and consistent. However, variations in translation to English of the Latin and Greek terminology used in Nomina Anatomica and Terminologia Anatomica have led to some inconsistency in the nomenclature of cutaneous nerves in the limbs. An historical review of cutaneous nerve nomenclature…

  14. Inter- and intralimb transfer of a bimanual task: generelisability of limb dissociation

    NARCIS (Netherlands)

    Vangheluwe, S.; Puttemans, V.; Wenderoth, N.; Baelen, M.G.M. van; Swinnen, S.P.

    2004-01-01

    The present study examined whether the ability to dissociate bimanual limb movements following learning of a new coordination task (i.e. star-line drawing paradigm) can be generalised to different effector systems, as expressed by inter- and intralimb transfer. In Experiment 1, subjects practised

  15. The Haptic iPod: passive learning of multi-limb rhythm skills

    NARCIS (Netherlands)

    Bouwer, A.; Dalgleish, M.; Holland, S.

    2011-01-01

    Recent experiments showed that the use of haptic vibrotactile devices can support the learning of multi-limb rhythms [Holland et al., 2010]. These experiments centred on a tool called the Haptic Drum Kit, which uses vibrotactiles attached to wrists and ankles, together with a computer system that

  16. Exoskeleton-Based Robotic Platform Applied in Biomechanical Modelling of the Human Upper Limb

    Directory of Open Access Journals (Sweden)

    Andres F. Ruiz

    2009-01-01

    Full Text Available One of the approaches to study the human motor system, and specifically the motor strategies implied during postural tasks of the upper limbs, is to manipulate the mechanical conditions of each joint of the upper limbs independently. At the same time, it is essential to pick up biomechanical signals and bio-potentials generated while the human motor system adapts to the new condition. The aim of this paper is two-fold: first, to describe the design, development and validation of an experimental platform designed to modify or perturb the mechanics of human movement, and simultaneously acquire, process, display and quantify bioelectric and biomechanical signals; second, to characterise the dynamics of the elbow joint during postural control. A main goal of the study was to determine the feasibility of estimating human elbow joint dynamics using EMG-data during maintained posture. In particular, the experimental robotic platform provides data to correlate electromyographic (EMG activity, kinetics and kinematics information from the upper limb motion. The platform aims consists of an upper limb powered exoskeleton, an EMG acquisition module, a control unit and a software system. Important concerns of the platform such as dependability and safety were addressed in the development. The platform was evaluated with 4 subjects to identify, using system identification methods, the human joint dynamics, i.e. visco-elasticity. Results obtained in simulations and experimental phase are introduced.

  17. Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface.

    Science.gov (United States)

    Huang, Stephanie; Ferris, Daniel P

    2012-08-10

    Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user's nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head) and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius) of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step inter-subject variability of these profiles by calculating variance-to-signal ratios. We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee's nervous system.

  18. Muscle activation patterns during walking from transtibial amputees recorded within the residual limb-prosthetic interface

    Directory of Open Access Journals (Sweden)

    Huang Stephanie

    2012-08-01

    Full Text Available Abstract Background Powered lower limb prostheses could be more functional if they had access to feedforward control signals from the user’s nervous system. Myoelectric signals are one potential control source. The purpose of this study was to determine if muscle activation signals could be recorded from residual lower limb muscles within the prosthetic socket-limb interface during walking. Methods We recorded surface electromyography from three lower leg muscles (tibilias anterior, gastrocnemius medial head, gastrocnemius lateral head and four upper leg muscles (vastus lateralis, rectus femoris, biceps femoris, and gluteus medius of 12 unilateral transtibial amputee subjects and 12 non-amputee subjects during treadmill walking at 0.7, 1.0, 1.3, and 1.6 m/s. Muscle signals were recorded from the amputated leg of amputee subjects and the right leg of control subjects. For amputee subjects, lower leg muscle signals were recorded from within the limb-socket interface and from muscles above the knee. We quantified differences in the muscle activation profile between amputee and control groups during treadmill walking using cross-correlation analyses. We also assessed the step-to-step inter-subject variability of these profiles by calculating variance-to-signal ratios. Results We found that amputee subjects demonstrated reliable muscle recruitment signals from residual lower leg muscles recorded within the prosthetic socket during walking, which were locked to particular phases of the gait cycle. However, muscle activation profile variability was higher for amputee subjects than for control subjects. Conclusion Robotic lower limb prostheses could use myoelectric signals recorded from surface electrodes within the socket-limb interface to derive feedforward commands from the amputee’s nervous system.

  19. Soft Smart Garments for Lower Limb Joint Position Analysis

    Directory of Open Access Journals (Sweden)

    Massimo Totaro

    2017-10-01

    Full Text Available Revealing human movement requires lightweight, flexible systems capable of detecting mechanical parameters (like strain and pressure while being worn comfortably by the user, and not interfering with his/her activity. In this work we address such multifaceted challenge with the development of smart garments for lower limb motion detection, like a textile kneepad and anklet in which soft sensors and readout electronics are embedded for retrieving movement of the specific joint. Stretchable capacitive sensors with a three-electrode configuration are built combining conductive textiles and elastomeric layers, and distributed around knee and ankle. Results show an excellent behavior in the ~30% strain range, hence the correlation between sensors’ responses and the optically tracked Euler angles is allowed for basic lower limb movements. Bending during knee flexion/extension is detected, and it is discriminated from any external contact by implementing in real time a low computational algorithm. The smart anklet is designed to address joint motion detection in and off the sagittal plane. Ankle dorsi/plantar flexion, adduction/abduction, and rotation are retrieved. Both knee and ankle smart garments show a high accuracy in movement detection, with a RMSE less than 4° in the worst case.

  20. Assessment of Lower Limb Prosthesis through Wearable Sensors and Thermography

    Science.gov (United States)

    Cutti, Andrea Giovanni; Perego, Paolo; Fusca, Marcello C.; Sacchetti, Rinaldo; Andreoni, Giuseppe

    2014-01-01

    This study aimed to explore the application of infrared thermography in combination with ambulatory wearable monitoring of temperature and relative humidity, to assess the residual limb-to-liner interface in lower-limb prosthesis users. Five male traumatic transtibial amputees were involved, who reported no problems or discomfort while wearing the prosthesis. A thermal imaging camera was used to measure superficial thermal distribution maps of the stump. A wearable system for recording the temperature and relative humidity in up to four anatomical points was developed, tested in vitro and integrated with the measurement set. The parallel application of an infrared camera and wearable sensors provided complementary information. Four main Regions of Interest were identified on the stump (inferior patella, lateral/medial epicondyles, tibial tuberosity), with good inter-subject repeatability. An average increase of 20% in hot areas (P < 0.05) is shown after walking compared to resting conditions. The sensors inside the cuff did not provoke any discomfort during recordings and provide an inside of the thermal exchanges while walking and recording the temperature increase (a regime value is ∼+1.1 ± 0.7 °C) and a more significant one (∼+4.1 ± 2.3%) in humidity because of the sweat produced. This study has also begun the development of a reference data set for optimal socket/liner-stump construction. PMID:24618782

  1. Shaped graft for aneurysmal bone cyst of upper limb bones.

    Science.gov (United States)

    Mostafa, Mohamed F; Abed, Yasser Y; Fawzy, Sallam I

    2017-11-01

    The optimal treatment of aneurysmal bone cyst remains challenging. The aim of this prospective study was to evaluate the results of using bone grafts shaped to the defects caused by aneurysmal bone cysts of upper limb bones. Fifteen patients (12 males and 3 females) with an average age of 12 years (range 6-16 years) were treated for aneurysmal bone cysts of upper limb bones by intralesional resection, argon beam coagulation and shaped bone graft. The grafts were harvested from 14 patients (11 fibulas and 3 iliac bones) and from the mother of one patient (proximal fibula). Osteosynthesis was required to stabilize the graft in four cases. The modified Enneking's scoring system was used for functional evaluation. One patient developed partial recurrence at 6 months and required reoperation. Superficial wound infection was encountered in one patient. Shortening of the humeral segment was seen in two patients (1 and 1.5 cm) but without angular deformity. After a mean follow-up of 45 months (range 24-68 months), the mean functional score was 97.3%. This technique proved to be reliable in obtaining a well reconstructed and growing bone with no or minimal deformity and good function.

  2. Retrieval of ozone profiles from GOMOS limb scattered measurements

    Directory of Open Access Journals (Sweden)

    S. Tukiainen

    2011-04-01

    Full Text Available The GOMOS (Global Ozone Monitoring by Occultation of Stars instrument on board the Envisat satellite measures the vertical composition of the atmosphere using the stellar occultation technique. While the night-time occultations of GOMOS have been proven to be of good quality, the daytime occultations are more challenging due to weaker signal-to-noise ratio. During daytime GOMOS measures limb scattered solar radiation in addition to stellar radiation. In this paper we introduce a retrieval method that determines ozone profiles between 20–60 km from GOMOS limb scattered solar radiances. GOMOS observations contain a considerable amount of stray light at high altitudes. We introduce a method for removing stray light and demonstrate its feasibility by comparing the corrected radiances against those measured by the OSIRIS (Optical Spectrograph & Infra Red Imaging System instrument. For the retrieval of ozone profiles, a standard onion peeling method is used. The first comparisons with other data sets suggest that the retrieved ozone profiles in 22–50 km are within 10% compared with the GOMOS night-time occultations and within 15% compared with OSIRIS. GOMOS has measured about 350 000 daytime profiles since 2002. The retrieval method presented here makes this large amount of data available for scientific use.

  3. Retrieval of ozone profiles from GOMOS limb scattered measurements

    Science.gov (United States)

    Tukiainen, S.; Kyrölä, E.; Verronen, P. T.; Fussen, D.; Blanot, L.; Barrot, G.; Hauchecorne, A.; Lloyd, N.

    2011-04-01

    The GOMOS (Global Ozone Monitoring by Occultation of Stars) instrument on board the Envisat satellite measures the vertical composition of the atmosphere using the stellar occultation technique. While the night-time occultations of GOMOS have been proven to be of good quality, the daytime occultations are more challenging due to weaker signal-to-noise ratio. During daytime GOMOS measures limb scattered solar radiation in addition to stellar radiation. In this paper we introduce a retrieval method that determines ozone profiles between 20-60 km from GOMOS limb scattered solar radiances. GOMOS observations contain a considerable amount of stray light at high altitudes. We introduce a method for removing stray light and demonstrate its feasibility by comparing the corrected radiances against those measured by the OSIRIS (Optical Spectrograph & Infra Red Imaging System) instrument. For the retrieval of ozone profiles, a standard onion peeling method is used. The first comparisons with other data sets suggest that the retrieved ozone profiles in 22-50 km are within 10% compared with the GOMOS night-time occultations and within 15% compared with OSIRIS. GOMOS has measured about 350 000 daytime profiles since 2002. The retrieval method presented here makes this large amount of data available for scientific use.

  4. Literature Review on Needs of Upper Limb Prosthesis Users.

    Science.gov (United States)

    Cordella, Francesca; Ciancio, Anna Lisa; Sacchetti, Rinaldo; Davalli, Angelo; Cutti, Andrea Giovanni; Guglielmelli, Eugenio; Zollo, Loredana

    2016-01-01

    The loss of one hand can significantly affect the level of autonomy and the capability of performing daily living, working and social activities. The current prosthetic solutions contribute in a poor way to overcome these problems due to limitations in the interfaces adopted for controlling the prosthesis and to the lack of force or tactile feedback, thus limiting hand grasp capabilities. This paper presents a literature review on needs analysis of upper limb prosthesis users, and points out the main critical aspects of the current prosthetic solutions, in terms of users satisfaction and activities of daily living they would like to perform with the prosthetic device. The ultimate goal is to provide design inputs in the prosthetic field and, contemporary, increase user satisfaction rates and reduce device abandonment. A list of requirements for upper limb prostheses is proposed, grounded on the performed analysis on user needs. It wants to (i) provide guidelines for improving the level of acceptability and usefulness of the prosthesis, by accounting for hand functional and technical aspects; (ii) propose a control architecture of PNS-based prosthetic systems able to satisfy the analyzed user wishes; (iii) provide hints for improving the quality of the methods (e.g., questionnaires) adopted for understanding the user satisfaction with their prostheses.

  5. Assessment of Lower Limb Prosthesis through Wearable Sensors and Thermography

    Directory of Open Access Journals (Sweden)

    Andrea Giovanni Cutti

    2014-03-01

    Full Text Available This study aimed to explore the application of infrared thermography in combination with ambulatory wearable monitoring of temperature and relative humidity, to assess the residual limb-to-liner interface in lower-limb prosthesis users. Five male traumatic transtibial amputees were involved, who reported no problems or discomfort while wearing the prosthesis. A thermal imaging camera was used to measure superficial thermal distribution maps of the stump. A wearable system for recording the temperature and relative humidity in up to four anatomical points was developed, tested in vitro and integrated with the measurement set. The parallel application of an infrared camera and wearable sensors provided complementary information. Four main Regions of Interest were identified on the stump (inferior patella, lateral/medial epicondyles, tibial tuberosity, with good inter-subject repeatability. An average increase of 20% in hot areas (P < 0.05 is shown after walking compared to resting conditions. The sensors inside the cuff did not provoke any discomfort during recordings and provide an inside of the thermal exchanges while walking and recording the temperature increase (a regime value is ~+1.1 ± 0.7 °C and a more significant one (~+4.1 ± 2.3% in humidity because of the sweat produced. This study has also begun the development of a reference data set for optimal socket/liner-stump construction.

  6. Soft Smart Garments for Lower Limb Joint Position Analysis.

    Science.gov (United States)

    Totaro, Massimo; Poliero, Tommaso; Mondini, Alessio; Lucarotti, Chiara; Cairoli, Giovanni; Ortiz, Jesùs; Beccai, Lucia

    2017-10-12

    Revealing human movement requires lightweight, flexible systems capable of detecting mechanical parameters (like strain and pressure) while being worn comfortably by the user, and not interfering with his/her activity. In this work we address such multifaceted challenge with the development of smart garments for lower limb motion detection, like a textile kneepad and anklet in which soft sensors and readout electronics are embedded for retrieving movement of the specific joint. Stretchable capacitive sensors with a three-electrode configuration are built combining conductive textiles and elastomeric layers, and distributed around knee and ankle. Results show an excellent behavior in the ~30% strain range, hence the correlation between sensors' responses and the optically tracked Euler angles is allowed for basic lower limb movements. Bending during knee flexion/extension is detected, and it is discriminated from any external contact by implementing in real time a low computational algorithm. The smart anklet is designed to address joint motion detection in and off the sagittal plane. Ankle dorsi/plantar flexion, adduction/abduction, and rotation are retrieved. Both knee and ankle smart garments show a high accuracy in movement detection, with a RMSE less than 4° in the worst case.

  7. Adaptive control based on an on-line parameter estimation of an upper limb exoskeleton.

    Science.gov (United States)

    Riani, Akram; Madani, Tarek; Hadri, Abdelhafid El; Benallegue, Abdelaziz

    2017-07-01

    This paper presents an adaptive control strategy for an upper-limb exoskeleton based on an on-line dynamic parameter estimator. The objective is to improve the control performance of this system that plays a critical role in assisting patients for shoulder, elbow and wrist joint movements. In general, the dynamic parameters of the human limb are unknown and differ from a person to another, which degrade the performances of the exoskeleton-human control system. For this reason, the proposed control scheme contains a supplementary loop based on a new efficient on-line estimator of the dynamic parameters. Indeed, the latter is acting upon the parameter adaptation of the controller to ensure the performances of the system in the presence of parameter uncertainties and perturbations. The exoskeleton used in this work is presented and a physical model of the exoskeleton interacting with a 7 Degree of Freedom (DoF) upper limb model is generated using the SimMechanics library of MatLab/Simulink. To illustrate the effectiveness of the proposed approach, an example of passive rehabilitation movements is performed using multi-body dynamic simulation. The aims is to maneuver the exoskeleton that drive the upper limb to track desired trajectories in the case of the passive arm movements.

  8. The application of accelerometers to measure movements of upper limbs: Pilot study

    Directory of Open Access Journals (Sweden)

    Patrik Kutilek

    2017-03-01

    Full Text Available Background: Even though inertial measurement units (IMU are already being used experimentally for evaluating movements of segment of the axial skeleton, no studies have been found which have used IMUs to measure the behavior of the segments of upper limbs during quiet stance. Objective: The objective is to design a suitable application of IMUs to measure movements of the upper extremities in Romberg's test and analyze spontaneous arm movements. Second aim is to identify possible discrepancies between the dominant and non-dominant arm movements. Methods: The dominant and non-dominant upper limb of each participant was identified. Then, the movements of both upper limbs were measured by the Xsens system equipped with MTx motion trackers during the quiet stance on a firm surface with eyes open (EO and eyes closed (EC. The measured data was used to calculate the medians and maximums of the superior-inferior, medio-lateral and anterior-posterior acceleration. Also, tremor intensity was calculated to quantitatively evaluate the measured data. Results: The comparison of values of maximal accelerations of the dominant and non-dominant arms showed significant difference between the arms during EC conditions. The comparison of values of median accelerations of the dominant and non-dominant arms showed significant differences between the acceleration of arms in medio-lateral direction during EO and EC conditions. In all cases, values of maximal and median accelerations and values of tremor intensity of the dominant limb strongly correlated with values on the non-dominant limb. Conclusions: Findings suggest possible usefulness of the designed application of IMUs and evaluation methods for their use in Romberg's test in clinical practice for evaluation of upper limb movements.

  9. Effects of galvanic vestibular stimulation on postural limb reflexes and neurons of spinal postural network.

    Science.gov (United States)

    Hsu, L-J; Zelenin, P V; Orlovsky, G N; Deliagina, T G

    2012-07-01

    Quadrupeds maintain the dorsal side up body orientation due to the activity of the postural control system driven by limb mechanoreceptors. Binaural galvanic vestibular stimulation (GVS) causes a lateral body sway toward the anode. Previously, we have shown that this new position is actively stabilized, suggesting that GVS changes a set point in the reflex mechanisms controlling body posture. The aim of the present study was to reveal the underlying neuronal mechanisms. Experiments were performed on decerebrate rabbits. The vertebral column was rigidly fixed, whereas hindlimbs were positioned on a platform. Periodic lateral tilts of the platform caused postural limb reflexes (PLRs): activation of extensors in the loaded and flexing limb and a decrease in extensor activity in the opposite (unloaded and extending) limb. Putative spinal interneurons were recorded in segments L4-L5 during PLRs, with and without GVS. We have found that GVS enhanced PLRs on the cathode side and reduced them on the anode side. This asymmetry in PLRs can account for changes in the stabilized body orientation observed in normal rabbits subjected to continuous GVS. Responses to platform tilts (frequency modulation) were observed in 106 spinal neurons, suggesting that they can contribute to PLR generation. Two neuron groups were active in opposite phases of the tilt cycle of the ipsi-limb: F-neurons in the flexion phase, and E-neurons in the extension phase. Neurons were driven mainly by afferent input from the ipsi-limb. If one supposes that F- and E-neurons contribute, respectively, to excitation and inhibition of extensor motoneurons, one can expect that the pattern of response to GVS in F-neurons will be similar to that in extensor muscles, whereas E-neurons will have an opposite pattern. We have found that ~40% of all modulated neurons meet this condition, suggesting that they contribute to the generation of PLRs and to the GVS-caused changes in PLRs.

  10. Comparative analysis of speech impairment and upper limb motor dysfunction in Parkinson's disease.

    Science.gov (United States)

    Rusz, Jan; Tykalová, Tereza; Krupička, Radim; Zárubová, Kateřina; Novotný, Michal; Jech, Robert; Szabó, Zoltán; Růžička, Evžen

    2017-04-01

    It is currently unknown whether speech and limb motor effectors in Parkinson's disease (PD) are controlled by similar underlying brain processes. Based on computerized objective analysis, the aim of this study was to evaluate potential correlation between speech and mechanical tests of upper limb motor function. Speech and upper limb motor tests were performed in 22 PD patients and 22 healthy controls. Quantitative acoustic analyses of eight key speech dimensions of hypokinetic dysarthria, including quality of voice, sequential motion rates, consonant articulation, vowel articulation, average loudness, loudness variability, pitch variability, and number of pauses, were performed. Upper limb movements were assessed using the motor part of the Unified Parkinson's Disease Rating Scale, contactless three-dimensional motion capture system, blinded expert evaluation, and the Purdue Pegboard Test. Significant relationships were observed between the quality of voice assessed by jitter and amplitude decrement of finger tapping (r = 0.61, p = 0.003), consonant articulation evaluated using voice onset time and expert rating of finger tapping (r = 0.60, p = 0.003), and number of pauses and Purdue Pegboard Test score (r = 0.60, p = 0.004). The current study supports the hypothesis that speech impairment in PD shares, at least partially, similar pathophysiological processes with limb motor dysfunction. Vocal fold vibration irregularities appeared to be influenced by mechanisms similar to amplitude decrement during repetitive limb movements. Consonant articulation deficits were associated with decreased manual dexterity and movement speed, likely reflecting fine motor control involvement in PD.

  11. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    Science.gov (United States)

    Li, Shengai; Melton, Danielle H; Li, Sheng

    2015-01-01

    Purpose To examine whether there is central sensitization in patients with phantom limb pain (PLP) after traumatic limb amputation. Methods Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST), and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups. Results The novel findings included: 1) electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2) EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups. Conclusion Our results demonstrate central sensitization in the patients with PLP after traumatic limb amputation. PMID:25945065

  12. Phantom Limbs, Neuroprosthetics, and the Developmental Origins of Embodiment.

    Science.gov (United States)

    Blumberg, Mark S; Dooley, James C

    2017-10-01

    Amputees who wish to rid themselves of a phantom limb must weaken the neural representation of the absent limb. Conversely, amputees who wish to replace a lost limb must assimilate a neuroprosthetic with the existing neural representation. Whether we wish to remove a phantom limb or assimilate a synthetic one, we will benefit from knowing more about the developmental process that enables embodiment. A potentially critical contributor to that process is the spontaneous activity - in the form of limb twitches - that occurs exclusively and abundantly during active (REM) sleep, a particularly prominent state in early development. The sensorimotor circuits activated by twitching limbs, and the developmental context in which activation occurs, could provide a roadmap for creating neuroprosthetics that feel as if they are part of the body. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Upper and lower limb muscle activation is bidirectionally and ipsilaterally coupled.

    Science.gov (United States)

    Huang, Helen J; Ferris, Daniel P

    2009-09-01

    There are neural connections between the upper and lower limbs of humans that enable muscle activation in one limb pair (upper or lower) to modulate muscle activation in the other limb pair (lower or upper, respectively). The aims of this study were to extend previous findings regarding submaximal exercise to maximal effort exercise and determine whether there is an ipsilateral or contralateral bias to the neural coupling during a rhythmic locomotor-like task. We measured upper and lower limb muscle activity, joint kinematics, and limb forces in neurologically intact subjects (n = 16) as they performed recumbent stepping using different combinations of upper and lower limb efforts. We found increased muscle activation in passive lower limbs during active upper limb effort compared with passive upper limb effort. Likewise, increased muscle activation in passive upper limbs occurred during active lower limb effort compared with passive lower limb effort, suggesting a bidirectional effect. Maximal muscle activation in the active lower limbs was not different between conditions with active upper limb effort and conditions with passive upper limb movement. Similarly, maximal muscle activation in the active upper limbs was not different between conditions with active lower limb effort and conditions with passive lower limb movement. Further comparisons revealed that neural coupling was primarily from active upper limb muscles to passive ipsilateral lower limb muscles. These findings indicate that interlimb neural coupling affects muscle recruitment during maximal effort upper and lower limb rhythmic exercise and provides insight into the architecture of the neural coupling.

  14. Lower limb amputations in Trondheim, Norway

    Science.gov (United States)

    2010-01-01

    Background and purpose In the city of Trondheim, Norway, diabetic lower-limb amputations accounted for one-third of all lower-limb amputations (LLAs). In an attempt to reduce this rate, a diabetic foot team was established in 1996. We present the incidence of LLA in Trondheim as measured 10 years later. Patients and methods In 2004–07, we registered all LLAs performed in Trondheim and then compared the data with previously published data from 1994–1997. From 1996 through 2006, we registered the activity of the diabetic foot team and we also registered the number of vascular procedures performed on citizens of Trondheim from 1998 through 2006. Results Comparing the two 3-year periods 1994–97 and 2004–07, we observed a decrease in all non-traumatic LLAs. The incidence of diabetic major LLAs per 103 diabetics per year decreased from 4.0 to 2.4, and in patients with peripheral vascular disease we observed a decrease in LLAs from 18 to 12 per 105 inhabitants per year. 5,915 consultations on diabetic subjects were conducted by the diabetic foot team during the period 1996–2006. From 1998 to 2006, the rate of vascular procedures decreased in the non-diabetic population, and was unchanged in diabetic subjects. Interpretation In the population of Trondheim city there appears to have been a reduction in the rate of vascular obstructive lower-limb disease between the two 3-year periods 1994–97 and 2004–07. In our judgment, the decline in diabetic LLA also reflects better care of the diabetic foot. PMID:20860446

  15. Possibilities of prosthetic upper limb fitting in cycling

    OpenAIRE

    Doležalová, Hana

    2011-01-01

    Bachelor thesis give an overview of possible solutions in upper limbs prosthetic fitting which is suitable for cycling. And provide enough information on modifications that should be performed on a bicycle so that it can be used by humans with upper extremity prostheses. It can be an essential guide for anyone looking for a solution that would allow a person with an amputated upper limb again sit on the bike. Keywords: amputation, upper limb prosthesis, prosthetic fitting, cycling

  16. Compressive neuropathy in the upper limb

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

    Full Text Available Entrampment neuropathy or compression neuropathy is a fairly common problem in the upper limb. Carpal tunnel syndrome is the commonest, followed by Cubital tunnel compression or Ulnar Neuropathy at Elbow. There are rarer entities like supinator syndrome and pronator syndrome affecting the Radial and Median nerves respectively. This article seeks to review comprehensively the pathophysiology, Anatomy and treatment of these conditions in a way that is intended for the practicing Hand Surgeon as well as postgraduates in training. It is generally a rewarding exercise to treat these conditions because they generally do well after corrective surgery. Diagnostic guidelines, treatment protocols and surgical technique has been discussed.

  17. Compressive neuropathy in the upper limb

    Science.gov (United States)

    Thatte, Mukund R.; Mansukhani, Khushnuma A.

    2011-01-01

    Entrampment neuropathy or compression neuropathy is a fairly common problem in the upper limb. Carpal tunnel syndrome is the commonest, followed by Cubital tunnel compression or Ulnar Neuropathy at Elbow. There are rarer entities like supinator syndrome and pronator syndrome affecting the Radial and Median nerves respectively. This article seeks to review comprehensively the pathophysiology, Anatomy and treatment of these conditions in a way that is intended for the practicing Hand Surgeon as well as postgraduates in training. It is generally a rewarding exercise to treat these conditions because they generally do well after corrective surgery. Diagnostic guidelines, treatment protocols and surgical technique has been discussed. PMID:22022039

  18. UPPER LIMB FUNCTIONAL ASSESSMENT USING HAPTIC INTERFACE

    Directory of Open Access Journals (Sweden)

    Aleš Bardorfer

    2004-12-01

    Full Text Available A new method for the assessment of the upper limb (UL functional state, using a haptic interface is presented. A haptic interface is used as a measuring device, capable of providing objective, repeatable and quantitative data of the UL motion. A patient is presented with a virtual environment, both graphically via a computer screen and haptically via the Phantom Premium 1.5 haptic interface. The setup allows the patient to explore and feel the virtual environment with three of his/her senses; sight, hearing, and most important, touch. Specially designed virtual environments are used to assess the patient’s UL movement capabilities. The tests range from tracking tasks – to assess the accuracy of movement – tracking tasks with added disturbances in a form of random forces – to assess the patient’s control abilities, a labyrinth test – to assess both speed and accuracy, to the last test for measuring the maximal force capacity of the UL.A new method for the assessment of the upper limb (UL functional state, using a haptic interface is presented. A haptic interface is used as a measuring device, capable of providing objective, repeatable and quantitative data of the UL motion. A patient is presented with a virtual environment, both graphically via a computer screen and haptically via the Phantom Premium 1.5 haptic interface. The setup allows the patient to explore and feel the virtual environment with three of his/her senses; sight, hearing, and most important, touch. Specially designed virtual environments are used to assess the patient’s UL movement capabilities. The tests range from tracking tasks–to assess the accuracy of movement-tracking tasks with added disturbances in a form of random forces-to assess the patient’s control abilities, a labyrinth test-to assess both speed and accuracy, to the last test for measuring the maximal force capacity of the UL.A comprehensive study, using the developed measurement setup within the

  19. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances.

    Directory of Open Access Journals (Sweden)

    Ali Forghani

    Full Text Available Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the hand which is earlier than the onset of changes in ground reaction force, ankle angle or head motion. The latency of the response is sensitive to the perturbation direction. However, neither the latency nor the magnitude of the response is affected by stiffening the arm even though this alters the magnitude and timing of motion of the body segments. Based on the short latency, insensitivity of the change in ankle muscle activation to motion of the body segments but sensitivity to perturbation direction we reason that changes in ankle muscle activation are most likely triggered by sensory signals originating from cutaneous receptors in the hand. Furthermore, evidence that the latency of changes in ankle muscle activation depends on the number of perturbation directions suggests that the neural pathway is not confined to the spinal cord.

  20. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances.

    Science.gov (United States)

    Forghani, Ali; Milner, Theodore E

    2017-01-01

    Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the hand which is earlier than the onset of changes in ground reaction force, ankle angle or head motion. The latency of the response is sensitive to the perturbation direction. However, neither the latency nor the magnitude of the response is affected by stiffening the arm even though this alters the magnitude and timing of motion of the body segments. Based on the short latency, insensitivity of the change in ankle muscle activation to motion of the body segments but sensitivity to perturbation direction we reason that changes in ankle muscle activation are most likely triggered by sensory signals originating from cutaneous receptors in the hand. Furthermore, evidence that the latency of changes in ankle muscle activation depends on the number of perturbation directions suggests that the neural pathway is not confined to the spinal cord.

  1. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances

    Science.gov (United States)

    Forghani, Ali; Milner, Theodore E.

    2017-01-01

    Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the hand which is earlier than the onset of changes in ground reaction force, ankle angle or head motion. The latency of the response is sensitive to the perturbation direction. However, neither the latency nor the magnitude of the response is affected by stiffening the arm even though this alters the magnitude and timing of motion of the body segments. Based on the short latency, insensitivity of the change in ankle muscle activation to motion of the body segments but sensitivity to perturbation direction we reason that changes in ankle muscle activation are most likely triggered by sensory signals originating from cutaneous receptors in the hand. Furthermore, evidence that the latency of changes in ankle muscle activation depends on the number of perturbation directions suggests that the neural pathway is not confined to the spinal cord. PMID:29095888

  2. The role of limb perfusion studies in the paediatric ischaemic limb

    African Journals Online (AJOL)

    All the studies were recorded on a Philips Axis Dual Head camera, previously known as Picker .... 1 arm, 2 hands. Technical di culties: 4 hands. Fig. 5. Correlation between clinical, scan and surgical findings. Fig. 4. Transmission images of the upper limbs of the same patient as in Figs. 1, 2 and 3. The black arrows indicate ...

  3. Management of limb fractures in a teaching hospital: comparison between Wenchuan and Yushu earthquakes

    Directory of Open Access Journals (Sweden)

    MIN Li

    2013-02-01

    Full Text Available 【Abstract】Objective: To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods: We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earth-quake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH of Sichuan University. Results: In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals out-side the Sichuan Province. In Yushu earthquake, the maxi-mum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0% open limb fractures, includ-ing 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb frac-ture was much lower (6/61, 9.8%. The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7% was much higher than that in Yushu earthquake (5/53, 3.8%. In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and sur-vived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion: Provision of suitable and sufficient medi-cal care in a catastrophe can only be achieved by construc-tion of sophisticated national disaster medical system, pre-diction of the injury types and number of injuries, and con-firmation of

  4. Management of limb fractures in a teaching hospital: comparison between Wenchuan and Yushu earthquakes.

    Science.gov (United States)

    Min, Li; Tu, Chong-qi; Liu, Lei; Zhang, Wen-li; Yi, Min; Song, Yue-ming; Huang, Fu-guo; Yang, Tian-fu; Pei, Fu-xing

    2013-01-01

    To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH) of Sichuan University. In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED) 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals outside the Sichuan Province. In Yushu earthquake, the maximum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0%) open limb fractures, including 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower (6/61, 9.8%). The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7%) was much higher than that in Yushu earthquake (5/53, 3.8%). In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and survived except one who died due to multiple organs failure in Wenchuan earthquake. Provision of suitable and sufficient medical care in a catastrophe can only be achieved by construction of sophisticated national disaster medical system, prediction of the injury types and number of injuries, and confirmation of participating hospitals?exact role. Based on the valuable rescue experiences

  5. Prenatal imaging of distal limb abnormalities using OCT in mice

    Science.gov (United States)

    Larina, Irina V.; Syed, Saba H.; Dickinson, Mary E.; Overbeek, Paul; Larin, Kirill V.

    2012-01-01

    Congenital abnormalities of the limbs are common birth defects. These include missing or extra fingers or toes, abnormal limb length, and abnormalities in patterning of bones, cartilage or muscles. Optical Coherence Tomography (OCT) is a 3-D imaging modality, which can produce high-resolution (~8 μm) images of developing embryos with an imaging depth of a few millimeters. Here we demonstrate the capability of OCT to perform 3D imaging of limb development in normal embryos and a mouse model with congenital abnormalities. Our results suggest that OCT is a promising tool to analyze embryonic limb development in mammalian models of congenital defects.

  6. Alien limb syndrome secondary to multimodal treatment of recurrent oligodendroglioma.

    Science.gov (United States)

    Gallant, Rachel E; Bonney, Phillip A; Sughrue, Michael E; Bharucha, Kersi J; Battiste, James D

    2015-10-01

    We present a 41-year-old man who experienced alien limb syndrome as a complication of treatment for recurrent Grade III oligodendroglioma of the right parietal lobe. Alien limb syndrome is a rare phenomenon in which a limb performs involuntary actions and the affected individual feels a sense of estrangement towards the limb. It occurs most commonly as a result of corticobasal syndrome, though a variety of other etiologies have been reported. It is rarely associated with focal lesions, such as stroke or tumors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Electromyography-based analysis of human upper limbs during 45-day head-down bed-rest

    Science.gov (United States)

    Fu, Anshuang; Wang, Chunhui; Qi, Hongzhi; Li, Fan; Wang, Zheng; He, Feng; Zhou, Peng; Chen, Shanguang; Ming, Dong

    2016-03-01

    Muscle deconditioning occurs in response to simulated or actual microgravity. In spaceflight, astronauts become monkey-like for mainly using their upper limbs to control the operating system and to complete corresponding tasks. The changes of upper limbs' athletic ability will directly affect astronauts' working performance. This study investigated the variation trend of surface electromyography (sEMG) during prolonged simulated microgravity. Eight healthy males participating in this study performed strict 45-day head-down bed-rest (HDBR). On the 5th day of pre-HDBR, and the 15th, the 30th and the 45th days of HDBR, the subjects performed maximum pushing task and maximum pulling task, and sEMG was collected from upper limbs synchronously. Each subject's maximum volunteer contractions of both the tasks during these days were compared, showing no significant change. However, changes were detected by sEMG-based analysis. It was found that integrated EMG, root mean square, mean frequency, fuzzy entropy of deltoid, and fuzzy entropy of triceps brachii changed significantly when comparing pre-HDBR with HDBR. The variation trend showed a recovery tendency after significant decline, which is inconsistent with the monotonic variation of lower limbs that was proved by previous research. These findings suggest that EMG changes in upper limbs during prolonged simulated microgravity, but has different variation trend from lower limbs.

  8. Accuracy and precision of equine gait event detection during walking with limb and trunk mounted inertial sensors

    DEFF Research Database (Denmark)

    Olsen, Emil; Andersen, Pia Haubro; Pfau, Thilo

    2012-01-01

    . Accuracy (bias) and precision (SD of bias) was calculated to compare force plate and IMU timings for gait events. Data were collected from seven horses. One hundred and twenty three (123) front limb steps were analysed; hoof-on was detected with a bias (SD) of -7 (23) ms, hoof-off with 0.7 (37) ms...... Measurement Units (IMUs). Four IMUs were mounted on the distal limb and five IMUs were attached to the skin over the dorsal spinous processes at the withers, fourth lumbar vertebrae and sacrum as well as left and right tuber coxae. IMU data were synchronised to a force plate array and a motion capture system...... and front limb stance with -0.02 (37) ms. A total of 119 hind limb steps were analysed; hoof-on was found with a bias (SD) of -4 (25) ms, hoof-off with 6 (21) ms and hind limb stance with 0.2 (28) ms. IMUs mounted on the distal limbs and sacrum can detect gait events accurately and precisely....

  9. Functional Assessment of a Myoelectric Postural Controller and Multi-Functional Prosthetic Hand by Persons With Trans-Radial Limb Loss.

    Science.gov (United States)

    Segil, Jacob L; Huddle, Stephen A; Weir, Richard F Ff

    2017-06-01

    The functional assessment of myoelectric control algorithms by persons with amputation promotes the overarching goal of the field of prosthetic limb design: to replace what was lost. However, many studies use experimental paradigms with virtual interfaces and able-bodied subjects that do not capture the challenges of a clinical implementation with an amputee population. A myoelectric control system must be robust to variable physiology, loading effects of the prosthesis on the limb, and limb position effects during dynamic tasks. Here persons with transradial limb loss performed activities of daily living using a postural controller and multi-functional prosthetic hand in order to verify that the postural controller was robust to these clinical challenges. The Southampton Hand Assessment Procedure was performed by persons with limb loss and able-bodied subjects. The results indicate that persons with limb loss and able-limbed subjects achieved the same performance and therefore that the clinical challenges were overcome. Persons with limb loss achieved 55% of physiological hand function on average. Also, the postural controller is compared to other state of the art myoelectric controllers and prosthetic hands previously tested. This work confirms that the postural controller is potentially a clinically-viable method to control myoelectric multi-functional prosthetic hands.

  10. A survey on robotic devices for upper limb rehabilitation

    Science.gov (United States)

    2014-01-01

    The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future. The patient population needing physical rehabilitation of the upper extremity is also constantly increasing. Robotic devices have the potential to address this problem as noted by the results of recent research studies. However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement. The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices. In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation. This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems. PMID:24401110

  11. Suggested guidelines for treatment of phantom limb pain.

    Science.gov (United States)

    Sherman, R A; Tippens, J K

    1982-12-01

    Eighty to ninety percent of amputees have been shown to suffer significant amounts of phantom limb pain in contrast to the widely accepted level of about 5%. Surveys of the literature, of physicians actively treating phantom pain, and of over 3,000 American veteran amputees have shown that most of the usual treatments are not efficacious when followups of a year or more are done. A diagnostic and therapeutic schemata is presented, which incorporates the above surveys, research, and clinical experience into a unified approach optimizing the few treatments showing a reasonable hope of long term success. Every effort is made to identify the source of pain being referred into the phantom. Stump, back, prosthetic, and other physical problems are corrected prior to initiation of other treatments, including EMG or temperature feedback from the stump, sympathetic system alteration, modulation of anxiety and depression, TENS, and ultrasound. Key indexing terms: phantom pain, treatment, amputees, referred pain. Copyright 2013, SLACK Incorporated.

  12. Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction.

    Science.gov (United States)

    van der Merwe, Lana; Birkholtz, Franz; Tetsworth, Kevin; Hohmann, Erik

    2016-08-01

    The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between July 2006 and December 2014, with an age range between 18 and 80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53±10years were interviewed. Six patients had a SIP 10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8±11.5 for the physical component, and 57.4±7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers. Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. The Effect of Core and Lower Limb Exercises on Trunk Strength and Lower Limb Stability on Australian Soldiers

    OpenAIRE

    Rolf Sellentin; Rhondda Jones

    2012-01-01

    Study Design: A before and after design in the collection of data and using analyses of variance to examine the changes in each test score. Objectives: The objectives and hypotheses of this study are: (1) Do specific core exercises, incorporating the lower limbs improve lower limb stability and trunk core muscle strength?; (2) Can the Star Excursion Balance Test be used as a measure of ankle and lower limb stability without a history of ankle instability?; (3) Can static core test...

  14. Hemiplegic limb synergies in stroke patients.

    Science.gov (United States)

    Welmer, Anna-Karin; Holmqvist, Lotta Widén; Sommerfeld, Disa K

    2006-02-01

    To describe the extent to which the voluntary movements of hemiparetic stroke patients are restricted to the hemiplegic limb synergies (which are marked by the inability to master individual joint movements) described by Brunnström. The study also aimed to describe the extent to which the synergies are related to functioning. In a prospective observational study design, 64 consecutive hemiparetic stroke patients were assessed with Brunnström's hemiplegic limb synergies, the modified Ashworth scale for spasticity, the Rivermead mobility index, and the Barthel ADL index. Three months after stroke, 8 of the 64 patients were moving completely or partly within the synergies. All patients whose movements were restricted to the synergies also exhibited spasticity. Hemiparetic patients whose movements were restricted to the synergies had significantly worse functioning scores than hemiparetic patients whose movements were not restricted to the synergies although severe disabilities were seen in both groups. Three months after stroke, the voluntary movements of only 13% of hemiparetic stroke patients were restricted to the synergies. The synergies were associated with spasticity and activity limitations. The use of the synergies might only be suitable for a small fraction of hemiparetic patients-namely, those displaying spasticity.

  15. A RARE CASE OF ACHONDROPLASIA- SHORT LIMB

    Directory of Open Access Journals (Sweden)

    B. Ravichander

    2017-03-01

    Full Text Available BACKGROUND A 6-year-old boy was presented to the paediatric department with shortening of all the limbs and delay in growth. Clinical examinations revealed height less than third percentile along with other abnormalities like frontal bossing, midfacial hypoplasia, flattened nasal bridge, short neck and rhizomelic type of shortening of all the limbs. These clinical features raised the diagnosis towards achondroplasia, which was further supported by radiologic evidence. Achondroplasia is a disorder involving growth of bone. The conversion of cartilage to bone is hampered. The affection is particularly seen in the long bones of arms and legs. The characterising features of this disorder are dwarfism, limitation in range of motion at the elbows, enlarged size of head, small fingers, but with normal intelligence. Other complications like apnoea, obesity, recurrent ear infections and lordosis of the spine are often associated with achondroplasia. The basic defect in achondroplasia lies in mutations of the FGFR3 gene. It is an autosomal dominant disorder.

  16. Altitude Registration of Limb-Scattered Radiation

    Science.gov (United States)

    Moy, Leslie; Bhartia, Pawan K.; Jaross, Glen; Loughman, Robert; Kramarova, Natalya; Chen, Zhong; Taha, Ghassan; Chen, Grace; Xu, Philippe

    2017-01-01

    One of the largest constraints to the retrieval of accurate ozone profiles from UV backscatter limb sounding sensors is altitude registration. Two methods, the Rayleigh scattering attitude sensing (RSAS) and absolute radiance residual method (ARRM), are able to determine altitude registration to the accuracy necessary for long-term ozone monitoring. The methods compare model calculations of radiances to measured radiances and are independent of onboard tracking devices. RSAS determines absolute altitude errors, but, because the method is susceptible to aerosol interference, it is limited to latitudes and time periods with minimal aerosol contamination. ARRM, a new technique introduced in this paper, can be applied across all seasons and altitudes. However, it is only appropriate for relative altitude error estimates. The application of RSAS to Limb Profiler (LP) measurements from the Ozone Mapping and Profiler Suite (OMPS) on board the Suomi NPP (SNPP) satellite indicates tangent height (TH) errors greater than 1 km with an absolute accuracy of +/-200 m. Results using ARRM indicate a approx. 300 to 400m intra-orbital TH change varying seasonally +/-100 m, likely due to either errors in the spacecraft pointing or in the geopotential height (GPH) data that we use in our analysis. ARRM shows a change of approx. 200m over 5 years with a relative accuracy (a long-term accuracy) of 100m outside the polar regions.

  17. Management of ulcers in lymphoedematous limbs

    Directory of Open Access Journals (Sweden)

    Vishnu M Karnasula

    2012-01-01

    Full Text Available Lymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care.

  18. Limb salvage: When, where, and how?

    Directory of Open Access Journals (Sweden)

    Ajay Puri

    2015-01-01

    Full Text Available From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers.

  19. Altitude registration of limb-scattered radiation

    Science.gov (United States)

    Moy, Leslie; Bhartia, Pawan K.; Jaross, Glen; Loughman, Robert; Kramarova, Natalya; Chen, Zhong; Taha, Ghassan; Chen, Grace; Xu, Philippe

    2017-01-01

    One of the largest constraints to the retrieval of accurate ozone profiles from UV backscatter limb sounding sensors is altitude registration. Two methods, the Rayleigh scattering attitude sensing (RSAS) and absolute radiance residual method (ARRM), are able to determine altitude registration to the accuracy necessary for long-term ozone monitoring. The methods compare model calculations of radiances to measured radiances and are independent of onboard tracking devices. RSAS determines absolute altitude errors, but, because the method is susceptible to aerosol interference, it is limited to latitudes and time periods with minimal aerosol contamination. ARRM, a new technique introduced in this paper, can be applied across all seasons and altitudes. However, it is only appropriate for relative altitude error estimates. The application of RSAS to Limb Profiler (LP) measurements from the Ozone Mapping and Profiler Suite (OMPS) on board the Suomi NPP (SNPP) satellite indicates tangent height (TH) errors greater than 1 km with an absolute accuracy of ±200 m. Results using ARRM indicate a ˜ 300 to 400 m intra-orbital TH change varying seasonally ±100 m, likely due to either errors in the spacecraft pointing or in the geopotential height (GPH) data that we use in our analysis. ARRM shows a change of ˜ 200 m over ˜ 5 years with a relative accuracy (a long-term accuracy) of ±100 m outside the polar regions.

  20. Arterial Stiffness in Lower Limb Amputees

    Directory of Open Access Journals (Sweden)

    Pedro Magalhães

    2011-01-01

    Full Text Available Background A high carotid-femoral pulse wave velocity (PWV has been related to increased cardiovascular morbidity and mortality, but has not been previously evaluated in amputees. The aim of this study was to compare PWV between amputees and nonamputees. Methods In this cross-sectional study, data were collected from 60 male lower limb amputees and 86 male age-matched nonamputees. PWV was measured noninvasively using a Complior ® device. All participants underwent laboratory investigations and anthropometry. The difference in PWV between amputee and nonamputees was estimated. Multivariate regression was used to adjust for differences between the groups as a result of potential confounders. Results PWV was higher in amputees than in nonamputees (10.8 ± 1.9 m/sec versus 9.9 ± 1.8 m/sec, P = 0.008, respectively. This difference remained even after adjusting for confounding factors. Conclusion A higher PWV was demonstrated in lower limb amputees. Routine assessment of PWV may contribute to cardiovascular risk stratification in amputees.