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1
Spencer, Brinn M. « The effects of prolonged prophylactic ankle bracing on dynamic postural control ». Morgantown, W. Va. : [West Virginia University Libraries], 2006. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=4595.
Texte intégralRésumé :
Thesis (M.S.)--West Virginia University, 2006.Title from document title page. Document formatted into pages; contains vii, 85 p. : ill. (some col.). Includes abstract. Includes bibliographical references.
2
Stewart, Leslie-Ann. « Effects of orthotic wear on the kinetic, kinematic and electromyographic characteristics of walking and running ». Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=100211.
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Although custom-made foot orthotics are commonly prescribed to relieve lower limb injuries, few studies have documented their effects on the biomechanics of locomotion. The objective of this project was to quantify the effect of orthotic wear on kinematic, kinetic and electromyographic characteristics of the legs during walking and running. Fourteen subjects with custom-made foot orthotics were asked to run and walk over a 10-m walkway. Kinematic, kinetic and electromyographical parameters were recorded during all trials. One-way repeated measures ANOVA and paired students t-tests were used to evaluate the effect of orthotic wear as well as foot type (flat, normal). With orthotic wear, the activity of the soleus muscle was decreased for both groups of subjects with and without flat feet during running. The effect of orthotic wear on all other parameters was not significant. More in-depth studies are needed to generalize these results on the overall population of orthotic wearers.
3
Crockett, Nathan J. « The effects of prolonged prophylactic ankle brace use in high school basketball athletes on dynamic postural control ». Morgantown, W. Va. : [West Virginia University Libraries], 2007. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=5156.
Texte intégralRésumé :
Thesis (M.S.)--West Virginia University, 2007.Title from document title page. Document formatted into pages; contains vii, 87 p. : col. ill. Includes abstract. Includes bibliographical references.
4
Taylor, Brittany L. « Effects of ankle bracing on dynamic stabilization in subjects with chronic ankle instability / ». Connect to full text in OhioLINK ETD Center, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=toledo1209139437.
Texte intégralRésumé :
Thesis (M.S.E.S.)--University of Toledo, 2008.Typescript. "Submitted as partial fulfillments of the requirements for The Master of Science degree in Exercise Science." "A thesis entitled"--at head of title. Bibliography: leaves 42-46.
5
Ewers, Susan. « Effects of Above-Ankle Orthoses on Individuals with Diabetic Partial Foot ». Thesis, University of Oregon, 2007. http://hdl.handle.net/1794/6055.
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xi, 67 p. : ill. A print copy of this title is available through the UO Libraries under the call numbers: KNIGHT RD756.42 .E83 2007Partial foot amputation is becoming more prevalent and costly and if not treated correctly can lead to higher levels of amputation. Despite this, partial foot orthotic research and development has been inadequate. Furthermore, in order to contribute to improved orthotic management, there is a need to understand the biomechanical discrepancies during gait. Biomechanical goals of orthotic fitting include normalizing the three functional impairments of the transmetatarsal amputee. The first goal is to improve balance, the second is to normalize the toe-off phase of gait, and the third goal involves supporting the plantar surface of the foot to evenly distribute pressure. In this study, all subjects were evaluated with a below-ankle condition and an above-ankle condition. The below-ankle condition consisted of a total contact foot orthosis fitted into Drew' shoes with rocker bottom soles. The below-ankle orthosis was then fitted with a Blue Rocker© ankle foot orthosis and gait was re-evaluated as the above-ankle orthotic gait condition. Three specific goals were proposed in this study: 1) to determine the differing, if any, effects on balance and vertical ground reaction symmetry during level walking and obstacle crossing between the two orthotic designs, 2) to determine the plantar pressure distribution differences between a below-ankle and an above-ankle design, 3) to learn about patient preferences to provide realistic feedback for quality patient care. We hypothesized that improved balance, symmetry and distribution of pressure would occur with the above-ankle design in individuals with greater disability.
Adviser: Li-Shan Chou
6
Chen, Shing-Jye. « Effects of arch supports on foot mechanics during gait ». view abstract or download file of text, 2005. http://www.oregonpdf.org.
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Thesis (Ph. D.)--University of Oregon, 2005.Includes bibliographical references (leaves 119-130). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.
7
Crabtree, Charles A. « Modeling effects of ankle foot orthoses (AFOs) in computer simulations of gait ». Access to citation, abstract and download form provided by ProQuest Information and Learning Company ; downloadable PDF file, 108 p, 2007. http://proquest.umi.com/pqdweb?did=1338917821&sid=4&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Caceres, Andrea Patricia. « The effects of implant design variations on shoulder instability following reverse shoulder arthroplasty ». Thesis, University of Iowa, 2018. https://ir.uiowa.edu/etd/6552.
Texte intégralRésumé :
Reverse shoulder arthroplasty (RSA) is performed to decrease pain and improve function and range of motion (ROM) primarily for patients with rotator cuff arthropathy, an arthritis of the shoulder secondary to rotator cuff insufficiency. However, RSA has suffered from high early to mid-term rates of complication, with instability being one of the most common. The shoulder biomechanics post-RSA depend on multiple factors such as implant geometry, positioning, and cuff integrity. This study built upon prior finite element (FE) analysis of RSA to investigate the effects of glenoid lateralization and retentive liner design on shoulder stability. A previously validated FE model was extended to model shoulder external rotation (ER) after implantation of the Zimmer Trabecular Metal RSA system. The FE model included the scapula bone with an implanted glenosphere implant, the humerus bone with implanted humeral sections of the RSA implant, and muscle tendons representing the subscapularis, infraspinatus, and deltoid. Six different models matched glenospheres in three cases of lateralization (2mm, 4mm, and 10mm) with two humeral poly liner designs (normal: 150° neck shaft angle or retentive: 155° neck shaft angle). Using Abaqus/Explicit FE software, the proximal ends of the soft tissues were pulled to their anatomical positions, and then fixed in space while the humerus was externally rotated 80° about the humeral long axis from a neutral position with the shoulder abducted 25°. The displacements, deltoid and subscapularis forces, impingement-free ROMs, and subluxation gap distances were recorded. Although greater glenosphere lateralization was associated with higher impingement-free ROM, larger deltoid and subscapularis forces developed. Deltoid tension contributes to shoulder stability and control, but elevated amounts of deltoid tension may contribute to scapular fractures and greater stress at impingement sites post-RSA. Further analysis such as inclusion of more anatomical features and additional motions may offer greater insight to orthopedic surgeons when planning for RSA insertion.
9
Bendig, Colleen. « Effect of Multiple Sterilizations on Stainless-Steel Orthopedic Screws ». The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1595416853674582.
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CANTARELLA, DANIELE. « MINIMALLY INVASIVE SURGERY TO FACILITATE MICRO-IMPLANT SUPPORTED MAXILLARY SKELETAL EXPANSION IN ADULT PATIENTS ». Doctoral thesis, Università degli Studi di Milano, 2022. http://hdl.handle.net/2434/914517.
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Introduction
The aim of the present study is to evaluate the skeletal modifications induced by maxillary expansion supported by palatal micro-implants and localized osteotomies produced with minimally invasive surgical technique in young-adult and adult patients.
In the present investigation, osteotomies had a lower extension than the ones used in conventional surgically assisted rapid palatal expansion (SARPE), to adopt a minimally invasive surgical technique that can be performed with greater comfort for the patient and less post-operative sequelae. More in detail, the localized osteotomies were executed only in the anterior part of the midpalatal suture and bilaterally at the basis of the zygomatic process of the maxilla without involvement of the piriform rim. These areas represent a great resistance to the lateral maxillary movement. Furthermore, they are of simple surgical access and don’t present important arterial plexuses.
Patients requiring micro-implant supported maxillary expansion and/or SARPE routinely undergo a pre-treatment cone-beam computed tomography (CBCT) of the skull, to plan the surgical operation and, one month after treatment a secondary CBCT for a surgical and orthodontic control.
CBCT is a low radiation tomography, extensively used in maxillofacial surgery and in dentistry. For the implementation of this study, that aims at evaluating the efficacy of micro-implant-supported maxillary expansion in combination with localized osteotomies, only radiologic exams that are anyway needed for the planning and post-treatment evaluation were used.
Aim
The aim of the present study is to evaluate the advantages introduced in the treatment of maxillary constriction by the therapy with micro-implant supported Maxillary Skeletal Expander (MSE) and localized osteotomies in young-adult and adult patients.
The main objective is to evaluate the efficacy of the technique, by measuring the movement of skeletal landmarks in the midface, particularly on the maxillary and zygomatic bones, and on the lateral wall of the nose, by comparing the pre-treatment and post-treatment CBCT.
For this particular technique, a new methodology for digital planning of position of MSE and miniscrews on patient CBCT was developed. Furthermore, incorporation of 2 additional miniscrews to the original MSE design, which conventionally features only 4 miniscrews, was developed with the aid of computer aided design – computer aided manufactured (CAD-CAM) technology.
Methods
The study presented the following steps:
▪ Development of a digital planning methodology for positioning the miniscrews and MSE appliance on pre-treatment CBCT
▪ Development of a CAD-CAM methodology for incorporating 2 additional miniscrews to the original MSE design with 4 miniscrews
▪ Selection of patients with age above 17 years, without congenital craniofacial syndromes, who require intervention of maxillary skeletal expansion
▪ Acquisition of initial CBCT with 17 x 13.5 cm field of view (FOV)
▪ Intervention of maxillary expansion supported by palatal micro-implants and localized osteotomies executed with minimally invasive surgical technique
▪ One month after treatment, acquisition of post-treatment CBCT with 17 x 13.5 cm FOV
▪ Analysis of skeletal modifications in the midface (maxillary bone, sphenoid bone, zygomatic arch, nasal cavity, etc.), by comparing the pre- and post- treatment CBCT with a 3D software (OnDemand software by Cybermed)
Results
The new methodology allowed the digital planning of MSE and miniscrews positioning on patients’ CBCTs, and the incorporation of two additional miniscrews to the original MSE design through CAD-CAM technology.
In the clinical trial, a total of four patients had an average age of 27.6 years (range 22.1 – 39.9 years).
MSE appliance was activated by an average of 6.0 mm and generated a parallel split of the midpalatal suture of 3.4 mm, 3.0 mm and 3.6 mm at anterior nasal spine (ANS), nasopalatine foramen (NPF) and posterior nasal spine (PNS), respectively.
Skeletal modifications were found in all CBCT sections evaluated in the study (axial palatal, upper nasal, coronal zygomatic, axial zygomatic), indicating that all midfacial bones are affected by maxillary expansion with MSE and localized osteotomies.
Particularly, skeletal changes were noticed also in CBCT sections above the lateral maxillary osteotomies (LMOs), in the maxilla, zygomatic bone, zygomatic arches, and nasal cavity. In the upper nasal section (UNS) the maxilla was laterally displaced by 2.4 mm and 0.9 mm, at its anterior and posterior extremities, respectively.
The frontozygomatic angle (FZA) increased by 1.9° (average of right and left side), while the lower interzygomatic distance increased by 2.9 mm, indicating a rotation of the zygomatic bone in a lateral direction.
The zygomatic arch was affected by bone bending phenomena and was deflected in an outward direction, with increase in the anterior intermaxillary distance by 1.7 mm and in the posterior inter-zygomatic distance by 1.6 mm.
The nasal width (NW) parameter increased by 2.9 mm with treatment: this anatomical finding is the basis for a potential improvement in nasal breathing for patients suffering from increased nasal airway resistance.
The cited modifications in skeletal structures above lateral maxillary osteotomies (LMOs) are most likely due to the fact that LMOs didn’t involve the piriform rim of the maxilla, and this point needs further investigations.
Regarding dentoalveolar modifications, the inter-molar distance increased by 7.4 mm, and molars underwent a small dentoalveolar tipping in a buccal direction by 1.1° (average of right and left side), as evidenced by the change in molar basal bone angle (MBBA).
No intra-operatory hemorrhage nor post-operatory bleeding was reported in treated patients, probably due to the lack of pterygopalatine suture surgical disjunction.
A limitation of the study is its small sample size, represented by 4 patients. A larger number of patients is required to confirm the above results.
11
Clanton, Tameka A. « Prophylactic ankle stabilizers and their effect on lower extremity landing mechanics during drop jump landings to fatigue ». Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/644.
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Polascik, Michael A. « The effect of protective knee braces on agility and muscle performance ». Thesis, Virginia Tech, 1989. http://hdl.handle.net/10919/44653.
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Thirty-two Virginia Tech varsity football players served as subjects to examine the effect of protective knee braces on agility and selected isokinetic strength, power, and endurance measures. Each subject performed the Semo agility test in each of three experimental conditions: braced with the Anderson knee stabler (B,An); braced with the Arco knee guard (Bâ Ar); and unbraced (Un). The order of agility tests was randomized. The subjects were than administered a Cybex knee extension/flexion test at 60 deg/sec and 300 deg/sec. Each subject performed the Cybex tests in each of the three experimental conditions (B-An, B-Ar, and Un). The order of Cybex tests was randomized. The test protocol consisted of three maximal repetitions at 60 deg/sec and 40 maximal repetitions at 300 deg/sec. The following isokinetic variables were recorded: (1) peak torque/body weight ratio of the quadriceps and hamstrings at 60 deg/sec and 300 deg/sec; (2) average range of motion for knee extension/flexion at 60 deg/sec and 300 deg/sec; (3) average power, torque acceleration energy, and endurance ratio of the quadriceps and hamstrings at 300 deg/sec. Repeated measures analysis of variance revealed no significant difference (p > .05) in agility test scores between the three experimental conditions. Repeated measures analysis of variance also revealed no significant difference (p > .05) in the isokinetic responses of subjects as they were tested within the three experimental conditions. The investigator concluded that protective knee braces had no effect on agility, isokinetic strength, power, and endurance.
Master of Science
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Al-Talahma, Mohammad Y. M. « Investigation into the immediate effect of ankle taping on temporal spatial gait parameters and affected ankle kinematics in ambulant adult hemiplegic patients ». Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20057.
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Thesis (MScPhysio)--Stellenbosch University, 2012ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.
14
Godwin, Ellen M. « Long-term effect of single event multiple level orthopedic surgery on the functional classification of children with cerebral palsy ». NSUWorks, 2005. http://nsuworks.nova.edu/hpd_pt_stuetd/29.
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Brumby, Scott Andrew. « The effect of surface roughness and a collar on fixation of cemented femoral stems in vivo / ». Title page, table of contents and summary only, 1996. http://web4.library.adelaide.edu.au/theses/09PH/09phb8934.pdf.
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Lemke, Sean Paul. « Biomechanical Effects of Component Alignment Variability in Total Knee Arthroplasty : A Computer Simulation Study of an Oxford Rig ». The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1338305228.
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Hooks, Heather E. « Effects of Music Intervention on the Patient’s Perception of Pain After Knee Replacement Surgery ». Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etd/2321.
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The purpose of this study was to determine whether therapeutic music affects the patient’s perception of pain, postoperative day 1 after knee replacement surgery in an inpatient hospital. In addition to the patient’s pain levels, the study was an analysis of the quantity of opioids the patient was requested, the length of stay, and the physiological parameters, which included blood pressure, heart rate, respiratory rate, and oxygen saturation. Sixty knee replacement patients were randomly placed in the music group or the quiet group. The Faces Pain Scale Revised with Numeric Rating Scale was used to measure pain levels. Statistical analysis between the music group and the quiet group indicated a significant difference in patient’s pain levels (F = .298; p = .037). Study results support music decreasing patient’s perception of pain. Nurses can suggest music intervention to decrease pain with this patient population knowing evidence based practice supports the efficiency of music.
18
Valle, Boris Deniaud Joël. « Effets de l'expansion maxillaire sur les dimensions transversales des cavités nasales et sur leur perméabilité ». [S.l.] : [s.n.], 2008. http://castore.univ-nantes.fr/castore/GetOAIRef?idDoc=44666.
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Denison, Tracy Adam. « The effect of fluid shear stress on growth plate ». Diss., Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/29603.
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Thesis (Ph.D)--Biomedical Engineering, Georgia Institute of Technology, 2009.Committee Chair: Boyan, Barbara; Committee Co-Chair: Schwartz, Zvi; Committee Member: Bonewald, Lynda; Committee Member: Jo, Hanjoong; Committee Member: Sambanis, Athanassios. Part of the SMARTech Electronic Thesis and Dissertation Collection.
20
Sae-Sia, Wipa. « The effect of pressure duration on sacral skin blood flow and sacral skin temperature in healthy adults and patients with either spinal cord injury or orthopedic trauma / ». Free to MU Campus, others may purchase, 2005. http://wwwlib.umi.com/cr/mo/fullcit?p3189951.
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Paulick, Mark Lloyd. « Effects of Reamer-Femoral Component Offset on Cement Mantle Penetration in Hip Resurfacing Arthroplasty ». DigitalCommons@CalPoly, 2010. https://digitalcommons.calpoly.edu/theses/291.
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Hip resurfacing arthroplasty has changed the treatment of end stage arthritis without severe deformity for young, active adults. Presently, there are varying clinical approaches to implant design selection and cementation techniques. The purpose of this project is to determine what amount of reamer-femoral component offset allows for the best cement penetration into the femoral head.
Rapid prototyped femoral component models were produced with reamer femoral component offsets of 0.0 mm, 0.5 mm, and 1.0 mm. After implantation onto models of reamed femoral heads made from high-density open-cell reticulated carbon foam, cement penetration was assessed from cross-sections of the foam-implant unit. Increased offset was found to decrease the extent of cement over penetration from the dome and chamfer. Increased offset also yielded optimal cement penetration as measured from the walls. Finally, increased offset was found to increase the height of cement mantle formation while maintaining complete seating of all implants.
22
Hösl, Matthias. « Spastic equinus deformity in children with Cerebral Palsy – Treatment effects in terms of muscular morphology and function ». Doctoral thesis, Humboldt-Universität zu Berlin, 2018. http://dx.doi.org/10.18452/18861.
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Die meisten Kinder mit infantiler Zerebralparese (IZP) entwickeln eine spastische Parese, was zu Schwäche, erhöhtem Muskel-Dehnungswiderstand und Kontrakturen führt. Der Spitzfuß ist eines ihrer häufigsten Defizite. Das übergeordnete Ziel dieser Arbeit war es, nicht-invasive Behandlungsstrategien für diese Pathologie näher zu untersuchen. In der ersten Studie wurden die Effekte einer Unterschenkel-Lagerungsorthese auf die Muskelmorphometrie des Gastrocnemius unter zu Hilfenahme von Ultraschall und 3D Bewegungsanalyse untersucht. Lagerungsorthesen konnten das Gangbild verbessern, führten gleichzeitig aber zu Atrophie. Um eine alternative Therapieform zu finden, wurde in der zweiten Studie die kontraktile Aktivität des Gastrocnemius mittels Ultraschall, Bewegungsanalyse und EMG während des Gehens, Vorwärts-Bergauf, bzw. Rückwärts-Bergab, sowie in der Ebene untersucht. Das Bergaufgehen steigerte die konzentrische Exkursion der Faszikel, wohingegen das Rückwärts-Bergabgehen zu vermehrter Exzentrik führte. Da sich exzentrisches Training positiv auf Faszikellängenwachstum auswirken kann, wurde in der dritten Studie das Rückwärts-Bergabgehen mit statischem Dehnen als traditionelle Therapieform verglichen. Ultraschall, Bewegungsanalyse und handgesteuerte Dynamometrie wurden verwendet, um die Plantarflexorenkraft, die passive Sprunggelenksbeweglichkeit, die Gastrocnemius Morphometrie sowie die Steifigkeit und Dehnbarkeit auf Muskel-Sehnen und Gelenkebene zu untersuchen. Dehnen zeigte keinerlei Benefits gegenüber dem Laufbandtraining. Rückwärts-Bergabgehen war dagegen ein effektives Gangtraining und setzt vermutlich neuronale und koordinative Reize. In der Zusammenschau scheinen positive Änderungen im Gangbild bei IZP Kindern sowohl durch Unterschenkelorthesen, als auch durch Rückwärts-Bergabgehen erreichbar zu sein. Beides führte aber nicht zu Muskelwachstum. Funktionelle Verbesserungen scheinen daher auch stark von neuronal, koordinativen Aspekten abhängig zu sein.Most children with Cerebral Palsy (CP) develop spastic paresis, which leads to muscle weakness, increased stretch-resistance and joint contractures. The gastrocnemius muscle is frequently targeted to alleviate a common deficiency known as equinus. The overall objective of this thesis was to investigate several non-invasive treatment strategies for this pathology. The first study investigated the effects of ankle foot orthotics on spastic gastrocnemius morphometrics as well as on gait by using ultrasound and motion capturing. We concluded that braces improved walking function but also lead to atrophy. During the second study, we searched for a readily available, substituting stimulus and compared the contractile activity of the gastrocnemius on treadmills, namely during flat-forward, forward-uphill and backward-downhill gait using ultrasound, motion capturing and EMG. Uphill gait promoted concentric fascicle action, while backward-downhill gait increased eccentric fascicle action. Since eccentric training had been previously shown to increase fascicle length in controls, during the third study, we compared backward-downhill walking versus static, manual stretching. Ultrasound, motion analysis and handheld dynamometry were used to test plantarflexor strength, passive ankle joint flexibility, as well as gastrocnemius morphometrics, stiffness and strain on muscle-tendon and joint level. Backward-downhill walking led to larger single stance dorsiflexion and faster achievable walking velocities while stretching aggravated knee flexion in swing. Strength, joint flexibility, as well as stiffness on muscle-tendon and joint level were not altered. Backward-downhill walking can be an effective gait treatment, probably improving coordination. Nevertheless, more intense training might be necessary to alter muscle-tendon properties. In sum, backward-downhill walking and bracing increased function without promoting or even by harming muscle growth.
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Noble, Garrett John. « Evaluation of a Press Fit, Percutaneous, Skeletally Anchored Endoprosthesis for Prosthetic Limb Attachment : Bone Response and the Effect of Low Intensity Vibration ». The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437649394.
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Menez, Charlotte. « Analyses des modifications cinématiques et affectives générées par les orthèses plantaires lors de la locomotion chez les sujets présentant une inégalité au niveau des membres inférieurs effects of orthotic insoles on gait kinematics and low back pain in subjects with mild leg length discrepency : a pilot study Effects of foot orthoses on gait kinematics and/or low back pain in subjects with leg length inequality : a systematic review Improvement of gait quality and pain due to orthotic insoles in subjects with mild leg length discrepency ». Thesis, Normandie, 2020. http://www.theses.fr/2020NORMR019.
Texte intégralRésumé :
La thèse présentée a pour objectif d’analyser les modifications cinématiques et affectives générées par les orthèses plantaires (OP) lors de la locomotion chez les sujets présentant une inégalité de la longueur des membres inférieurs (ILMI). L’ILMI est une affection courante due soit à des déformations anatomiques, soit à une déformation fonctionnelle. L’ILMI a été associée à plusieurs pathologies et douleurs au niveau des membres inférieurs et du bassin, et est souvent traitée par OP dans le domaine de la podologie. Cependant, il n’existe pas encore de réel consensus quant aux effets des OP sur la cinématique de la marche chez les sujets présentant une ILMI légère (≤ 3,0 cm). L’objectif général de cette thèse est de savoir si les OP peuvent être un traitement adapté pour les sujets présentant une légère ILMI. Une première étude nous a permis de mettre en avant une diminution significative des lombalgies chez les sujets présentant une ILMI légère sans effet significatif sur la symétrie articulaire après 3 semaines d’utilisation de semelles orthopédiques (SO). Ensuite, une revue systématique de la littérature a confirmé l’effet positif des OP sur les douleurs lombaires. Toutefois, les OP semblaient diminuer les déséquilibres cinématiques des sujets présentant une ILMI, seulement lorsque l’ILMI était modérée à sévère. Notre dernière étude révèle un effet immédiat des SO sur la cinématique et la douleur chez des sujets présentant une légère ILMI. Les SO semblent pouvoir améliorer la symétrie articulaire au niveau du bassin dans le plan frontal et de la cheville dans le plan sagittal, ainsi que la douleur des sujets présentant une légère ILMI. Ces trouvailles suggèrent que l’analyse cinématique peut être utile dans le domaine de la podologieThe aim of this doctoral thesis is to analyze the kinematic and affective modifications generated by foot orthoses (FO) during locomotion in subjects with limb length discrepancy (LLD). LLD is a common condition due to either anatomical or functional deformities. LLD has been associated with several pathologies and pain in the lower limbs and pelvis, and is often treated by FO in the field of podiatrist. However, there is not yet consensus regarding the effects of FO on gait kinematics in subjects with mild LLD (≤ 3.0 cm). The main aim of this doctoral thesis is to determine whether FO can be an appropriate treatment for subjects with mild LLD. A first study highlights a significant decrease in low back pain in subjects with mild LLD without significant effect on joint symmetry after 3 weeks of use of orthotics insoles (OI). Then, a systematic review of the literature confirms the positive effect of FO on low back pain. However, the FO appear to decrease kinematic imbalances in subjects with LLD, only when LLD is moderate to severe. Our latest study shows an immediate effect of OI on kinematics and pain in subjects with mild LLD. OI seem likely to improve joint symmetry in the pelvis in the frontal plane and the ankle in the sagittal plane, as well as pain in subjects with mild LLD. These findings suggest that kinematic analysis can be useful in the field of podiatry
25
Ribera, Puig Alba. « Orthopaedic device-related infections : some thoughts on management and antimicrobial efficacy from a clinical and experimental perspective ». Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/587107.
Texte intégralRésumé :
Orthopaedic device-related infections represent a health care problem of first magnitude due to the increasing incidence, complexity of management, and elevated cost. These device related infections have etio-pathogenic features that involve the participation of bacteria in the stationary growth phase as well as mature biofilms, which makes their diagnosis and treatment more challenging. Several studies have been performed to ameliorate the present guidelines. Nevertheless, there are still many points of uncertainty and many relevant clinical questions remain unanswered. This thesis explores some of these unanswered questions in the field of orthopaedic device related infections from the perspective of an infectious diseases specialist.
A. On the management of orthopaedic device-related infections
A.1. Diagnostic aspects of PJI
• Aim 1: to analyse the microbiological and clinical findings in patients with suspected prosthetic joint aseptic loosening, and to compare them to patients with chronic PJI
Conclusions:
1.1 Several patients with suspected prosthetic aseptic loosening have misdiagnosed PJI or some microorganisms in their samples.
1.2 Sonication samples provide additional microbiological information that should help clinicians with the diagnosis of delayed low-grade infections that mimic natural aseptic failure.
1.3 Clinical parameters that determine the final prosthesis removal are correlated with the number of positive peri-prosthetic samples.
A.2. Surgical management of PJI
• Aim 2: to evaluate the risk of re-infection following one-stage and to-stage surgical revision with hip PJI
Conclusions:
2.1 The one-stage revision strategy may be as effective as the two-stage revision strategy.
B. On the assessment of antimicrobial efficacy for the treatment of orthopaedic devicerelated infections
B.1. Infections by Streptococcus spp
• Aim 3: to assess the efficacy of adding rifampicin to β-lactams for the treatment of streptococcal PJI managed with implant retention, and its impact on the prognosis
Conclusions:
3.1 For the largest case series of stretopcoccal PJI managed with DAIR, this pathology showed a not-so-good prognosis as expected.
3.2 The treatment with β-lactams seems ideal for fighting the planktonic component of streptococcal PJI; the addition of rifampin some days or weeks after debridement could have a role in the antibiofilm profile to improve the current modest outcomes.
3.3 A concomitant and optimal surgical procedure is advised, following IDSA criteria and ensuring the exchange of removal components during the debridement. Similar prognosis results were observed when the IDSA criteria for DAIR were cutoff at the third month of revision.
B.2. Infections by MDR Gram-negative bacilli
B.2.1 The use of β-lactams in continuous infusion
• Aim 4: to standardize a measurement procedure based on UHPLC-MS/MS for the simultaneous determination of multiple β-lactam concentrations in human plasma
Conclusions:
4.1 The development of a single UHPLC-MS/MS method for the simultaneous measurement of multiple β-lactam concentrations in human plasma enable the applicability of this method to routine clinical practice and the validation of an easy-to use equation for clinical use.
• Aim 5: to evaluate the efficacy and safety of β-lactams in continuous infusion for difficult-to-treat osteoarticular infections caused by Gram-negative bacilli, and to validate an easy method for clinical use
Conclusions:
5.1 The use of β-lactams in continuous infusion is safe and effective, and may recover previously resistant strains that became susceptible in terms of their pharmacodynamic parameters. Lower doses could be used by BL-CI for susceptible strains.
5.2 A simple equation could help clinicians to estimate the β-lactams continuous infusion dosage and its plasma levels in the early hours of treatment.
B.2.2 The use of antibiotic combinations with colistin
• Aim 6: to evaluate the benefits of the combination of colistin and β-lactams when treating patients with MDR Pseudomonas aeruginosa infections
Conclusions:
6.1 Current recommendations should consider the combination of low-dose colistin with β-lactams as an optimized treatment for osteoarticular infections caused by MDR P.aeruginosa.
6.2 This antibiotic combination is essential for achieving positive outcomes for these difficult-to-treat infections.
• Aim 7: to study the effect of adding colistin to β-lactams against ESBL-producing klebsiella pneumoniae biofilm in an in vitro experimental model
Conclusions
7.1 As expected, colistin in monotherapy was ineffective against biofilm-embedded bacteria and resulted in the emergence of colistin resistant strains.
7.2 Meropenem in monotherapy and its combination with colistin achieved rapid killing rates that were maintained until the end of treatment. However, only the combination showed bactericidal activity in one of the tested strains of ESBL-producing Klebsiella pneumoniae and its effect was more pronounced under conditions that produced a greater biofilm. The combined therapy avoided the emergence of colistin-resistant strains.
7.3 Our preliminary results may indicate a slight overall superiority in vitro of adding colistin to β-lactams against carbapenem-susceptible ESBL-producing K. pneumoniae.Les infeccions osteoarticulars relacionades amb implants ortopèdics són un problema de salut de primera magnitud: per la seva incidència creixent, la seva complexitat i l’alt cost sanitari. Suposen un gran repte per l’especialista en malalties infeccioses, principalment per les seves particularitats etio-patogènicas amb participació de bacteris en fase estacionària de creixement i la formació de biofilm. Els objectius d’aquesta tesi pretenen explorar alguns aspectes no resolts sobre el maneig i la eficàcia antimicrobiana en el marc de la infecció osteoarticular relacionada amb l’implant. Al través de 7 treballs s’han desenvolupat els següents punts: • Estudi de les característiques clíniques i microbiològiques dels casos d’afluixament asèptic protèsic sotmesos a revisió, amb l’objectiu d’entendre millor aquesta entitat (interpretació dels cultius positius aïllats). • Estudi comparatiu del maneig quirúrgic de la infecció protèsica crònica: recanvi en un o dos temps. • Estudi de la infecció protèsica estreptocòccica manejada amb desbridament, antibiòtics i retenció de l’implant (DAIR); amb l’objectiu d’avaluar el pronòstic d’aquesta entitat i els factors que poden millorar la seva taxa de curació. • Estudi sobre l’ús de betalactàmics en infusió continua en les infeccions osteoarticulars relacionades amb implants causades per BGN, amb els objectius: 1) estandarditzar un procediment basat en UHPLC-MS/MS para la determinació dels nivells plasmàtics de betalactàmics, 2) validar una equació senzilla per estimar la dosis de betalactàmics òptima en perfusió continua i els nivells plasmàtics. 3) avaluar la seguretat i eficàcia antimicrobiana de l’ús de betalactàmics en infusió continua. • Estudis sobre l’eficàcia d’afegir colistina al tractament amb betalactàmics en el maneig d’infeccions gram-negatives multiresistents: 1) estudi clínic , 2) model in vitro per la formació de biofilm. Les principals troballes: • Alguns casos amb sospita d’afluixament protèsic asèptic són realment infeccions o presenten microorganismes aïllats sobre la superfície de l’implant. • L`estratègia de revisió protèsica pel tractament de les infeccions de pròtesis articulars en un temps pot ser (en general) tan efectiva com la revisió en dos temps. • La infecció protèsica estreptocòccica manejada amb DAIR va mostrar un pitjor pronòstic del descrit prèviament a la literatura. Un bon maneig de les guies IDSA, el recanvi dels components mòbils i la potencial eficàcia del tractament combinat amb rifampicina podrien millorar aquest modest pronòstic. • L’estandardització d’un mètode UHLPC-MS/MS per la determinació de betalactàmics permet la monitorització de nivells en pacients tractats amb perfusió contínua. • Mitjançant la comparació amb els resultats UHLPC-MS/MS s’ha pogut validar una equació simple per una estimació individualitzada de la dosi òptima de betalactàmics en perfusió continua i de nivells en plasma . • L’ús clínic de betalactàmics en perfusió continua és segur y eficaç. • Afegir colistina als betalactàmics en el tractament de les infeccions osteoarticulars produïdes per BGN multiresistents mostra millors resultats que el tractament en monoteràpia amb betalactàmic. • En el model in vitro per la formació de biofilm, també hem objectivat el benefici de la teràpia combinada amb colistina.
26
Dziedzic, Dilcele Silva Moreira. « Effects of implant surface topography on osteoconduction ». 1995. http://catalog.hathitrust.org/api/volumes/oclc/47014724.html.
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27
Sanchez, Aubrie M. « The effects of orthopedic pathologies on the prevalence of hip osteoarthritis ». Thesis, 2019. https://hdl.handle.net/2144/36630.
Texte intégralRésumé :
Osteoarthritis (OA) is a degenerative joint disease that is a leading cause of
disability among aging adults. In the U.S., many individuals living with total hip
arthroplasties attribute OA as the cause. Because the majority of anthropological OA
research excludes pathological individuals (i.e., individuals with systemic disease,
traumatic injuries, or arthroplasties), little is known about how prostheses and pathologies
impact OA. This project adds to the research surrounding OA by investigating its
relationship with age, disease, and prostheses.
The proximal femora of 186 African- and European-American individuals (21-95
years old) from the Edmonds Orthopedic Pathology Collection (National Museum of
Health and Medicine; Armed Forces Institute of Pathology) were analyzed. These
individuals were grouped into three cohorts: non-disease; disease; and previous
injury/prosthesis. Jurmain’s (1990) method was used to score OA, using an ordinal fourpoint
scale to categorize OA changes as: none/slight; moderate; severe; and ankylosis.
Results show that osteoarthritic hip changes are positively correlated with age and
presence of a prosthesis, and that systemic diseases, such as cancer, increase the
likelihood of OA in an individual. Results from Chi-square tests, exploratory data
analysis, and ordinal logistic regression show that there is a statistically significant
relationship (p<0.000) between degree of OA, age, recorded disease, and evidence of
previous injury or prostheses. In contrast with the expectation that different populations
would exhibit different patterns of OA, no sex or ancestry effects are observed. These
results will help researchers better understand the etiology and contemporary risk factors
of OA, as well as contribute data to OA research on an underrepresented sample.
28
Anderson, Bryan. « The effects of athletic tape on peroneal muscle activation during functional activity ». 2006. http://www.oregonpdf.org.
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Liu, Pao-Hsin, et 劉保興. « Biomechanical and Biomorphic Effects of Orthopedic Force on the Mandible in Class III Malocclusion ». Thesis, 2004. http://ndltd.ncl.edu.tw/handle/55854432772359106950.
Texte intégralRésumé :
博士國立成功大學
醫學工程研究所碩博士班
92
Overdeveloped mandible is one of the features in Class III malocclusion, but the significance of morphological variations in regional configuration of the mandible remains unclear. For Class III malocclusion with or without maxillary retraction, the orthopedic technique with chin cup appliance is frequently required to correct the mandibular prognathism. Class III subjects with a retrognathic maxilla and prognathic mandible could be improved intermaxillary skeletal disharmony by occipito-mental anchorage (OMA) appliance of maxillary protraction combined with chin cup for orthopedic treatment. The effects of orthopedic therapy on the mandible in Class III malocclusion have been investigated extensively through cephalometric analyses. However, the actual sites of skeletal change in the mandible are not detectable with conventional cephalometric analysis. The aims of this study were two folds. First, to investigate the mandibular morphological changes under orthopedic force by the integration of new geometric morphometric analyses, including: Procrustes superimposition, biostatistical estimation, thin-plate spline interpolation, and strain tensor analysis. Second, to analyze the biomechanical responses of orthopedic mandibular treatment under varied force magnitudes and directions with finite element (FE) analysis. Furthermore, the results of the morphological changes are linked with the biomechanical responses from FE analysis to establish the relationship between morphological change and stresses distribution under corrective forces. The results show that the strain tensor analysis effectively demonstrated the morphological differences of the mandible under orthopedic forces. The significant local deformations of size and shape changes were revealed at the region of chin, incisor alveolus as well as the upper portion of the ascending ramus. The growth directions (principal strain vector) of the Class III mandible was significantly redirected to the direction perpendicular to the long axis of general mandibular morphology after orthopedic therapy. The patterns of growth vectors on the Class III mandible were almost the same in both the chin cup and the OMA appliance therapies. Furthermore, the pretreatment effects (without Class III growth) in morphological changes were detected, using the after treatment shape to eliminate the natural growth of Class III mandible. From the finite element analysis of the three-dimensional mandible structure, it revealed that the direction of orthopedic force applied is more important than the magnitude of force. The key factor is the bending effect of the orthopedic force. The relationship between morphological change and stresses and strains distribution could not be identified in this study. The reason might be the simplistic assumptions of this FE pilot study in representing the mandibular biomechanical response to the orthopedic force. Moreover, it may be insufficient to obtain the correlation base on these two different methods especially when their dimensions are mismatch.
30
Hornyik, Maria L. « The effects of 3-months of foot orthotic wear on measures of postural stability in persons with chronic injury and normal lower limb function ». Thesis, 2001. http://hdl.handle.net/1957/29617.
Texte intégralRésumé :
Under researched somatosensory contributions to postural stability, in addition to high
incident rates of foot injury in the physically active population, lead to two investigative
studies. An initial research study compared variables of two postural stability
assessment devices to determine reliability of outcome measures and commonality of
outcome measures to dynamic postural control. A second study assessed which
measures of postural stability were effective in differentiating between injured persons
using foot orthotics and non-injured persons, and also compared effects of 3-month foot
orthotic usage on measures of postural stability among three groups. In the first study,
23 healthy subjects tested on two separate occasions one-week apart, counterbalancing
the testing order. Intraclass correlation coefficients (ICC) and Pearson product moment
correlations were calculated and analyzed. In the second study, 15 patients diagnosed
with plantar fasciitis or medial arch sprain were given custom orthotics and matched
with 15 non-injured subjects given custom orthotics, and 15 healthy control subjects on
gender, age, height, and body mass index. All 45 subjects were assessed on five
postural stability tests (12 dependent variables) on seven occasions over a four-month
period. Repeated measures MANOVA was employed to evaluate group, time and
interaction effects for the outcome variables (α=0.05). Test-retest reliability, in the
first study, ranged from moderate to high (ICC[subscript 2,1]=0.71 to 0.92) for all outcome
measures. Pearson correlations revealed four statistically significant relationships (p<
.05) between outcome measures (r=0.43 to -0.72). In the second study, nine variables
were entered into repeated measures MANOVA demonstrating significant main and
interaction effects. Post hoc univariate analyses demonstrated six variables with group
main effects and three variables with time main effects. Interaction effects in post hoc
analysis were non-significant. The moderate to high test-retest reliability observed for
outcome measures in the first study is encouraging. Correlations between device
outcome measures, while statistically significant, were low enough to suggest that each
device provided unique information regarding postural stability. Results from the
second study provide strong evidence that foot orthotic wear affects postural stability
over time. The nature of test protocols suggests that functional postural stability testing
aids in assessing effectiveness of foot orthotics.Graduation date: 2002
31
Wilson, Amanda Susanne. « The effects of functional ankle instability on performance of the single-limb hurdle and single-limb hopping course in a braced and non-braced condition ». 2006. http://www.oregonpdf.org/index.cfm.
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32
McGill, Jean Seibold. « Orthodontic and orthopedic treatment effects induced by rapid maxillary expansion and facial mask therapy thesis submitted in partial fulfillment ... for the degree of Master of Science in Orthodontics ... / ». 1995. http://catalog.hathitrust.org/api/volumes/oclc/68798510.html.
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33
Liu, Yi Ling, et 劉怡玲. « The patient's satisfaction of orthopedic peri-operative nursing care and its effect factors ». Thesis, 2010. http://ndltd.ncl.edu.tw/handle/59734065502329321410.
Texte intégralRésumé :
碩士長庚大學
護理學系
98
To protect patient rights, safety and enhance care and service satisfaction, patient safety-centered mode of care is the medical institutions to promote the key point. The purpose of study is to investigate the orthopedic surgery patients in the peri-operative nursing care satisfaction and effect factors. This study is a forward-looking and re-measured study design, which is systematic collection of the peri-operative orthopedic information in hospital (n=128). Research tools include: Chinese version of State Trait Anxiety Scale, Chinese version of Mishel’ Uncertainty in Illness Scale, Chinese version of Patient Satisfaction Scale, peri-operative patient safety and nursing care checklist of items. The results are: (1) Orthopedic surgery patient’s preoperative anxiety is 53.96, postoperative anxiety is 44.41, and both are moderate. (2) Orthopedic surgery patient’s preoperative uncertainty is 71.17, single item average is 2.85, postoperative uncertainty is 66.08, single item average is 2.64, and all of them are moderate. (3) Quality of nursing care: the integrity of patient safety is 97.55%, the integrity of nursing care is 93.43%. (4) Patient’s satisfaction with nursing care is 121.48, single item average is 4.04, which indicating patients for peri-operative nursing care satisfaction is high. (5) Univariate analysis include surgical type, surgical method, anesthesia, operation time, preoperative and postoperative anxiety, nursing care and patient safety which are statistical significance on patient’s satisfaction effect factors (p <0.05). Based on Multiple regression analysis, the "nursing care" can predict the variance in the highest up to 40.5%, so the main impact of nursing care is an important factor in patient satisfaction.
34
Faber, Kandy. « The effect of a prophylactic ankle brace on knee torque during a drop landing onto a slanted survace ». 2005. http://www.oregonpdf.org.
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35
Ambegaonkar, Jatin P. « Effect of ankle stabilizers on vertical jump, agility, and dynamic balance ». 2003. http://www.oregonpdf.org.
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36
Michell, Thomas B. « The effect of training in balance shoes on time to stabilization and postural stability in subjects with functional ankle instability ». 2003. http://www.oregonpdf.org.
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37
Baker, Ashley Sarah. « The effect of shoe design and custom foot orthotic intervention on lower extremity dynamics in female runners ». Thesis, 2005. http://www.oregonpdf.org.
Texte intégralRésumé :
Thesis (M.S.)--University of British Columbia, 2005.Includes bibliographical references (leaves 89-94). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.
38
Huber, Michael J. « The fate and effects of implanted autogenous osteochondral fragments on the middle carpal joint of horses ». Thesis, 1991. http://hdl.handle.net/1957/37932.
Texte intégralRésumé :
Residual osteochondral debris represents a clinical problem associated
with arthroscopic debridement and curettage of joint surfaces. At the Oregon
State University Veterinary Teaching Hospital (OSU-VTH), during a period
from January, 1983 to August, 1986, incidence of radiographically recognizable
osteochondral debris in the carpal joints of postarthroscopic equine patients was
excessive. Uncertainty exists regarding the fate and effects of this debris on the
normal equine joint. Reports in human medical literature implicate
osteochondral debris as both an inflammatory stimulus and a mechanical
abrasive in the pathogenesis of osteoarthrosis. This study was designed to
evaluate the fate and effects of surgically implanted autogenous osteochondral
fragments, intended to mimic remaining operative debris, on various physical
and biochemical parameters of normal equine middle carpal joints over a six
month time period.
Four autogenous osteochondral fragments, removed from the lateral
trochlear ridge of the talus, were arthroscopically placed as loose bodies into a
randomly selected middle carpal joint in each of 10 young horses (2 to 4 years
old). The contralateral middle carpal joint, subjected to a sham procedure,
served as control. Postoperative therapy was consistent with usual treatment of
clinical arthroscopic patients. Lameness evaluation, radiographic examination,
carpal circumference measurement, and synovial fluid analysis were performed
preoperatively and at scheduled intervals postoperatively. After two months of
confinement, the horses were subjected to an increasing level of exercise,
intended to mimic a four month conditioning program. Animals were
euthanatized at 1 month (1), 2 months (2), 4 months (1), and 6 months (6).
Gross and microscopic examination of remaining fragments, articular cartilage,
and synovial membrane of each middle carpal joint was performed.
Clinically, increased joint circumference, effusion, lameness, and
radiographic appearance of degenerative joint disease distinguished implanted
from control joints over the six month period. Implanted joints were grossly
characterized by grooved, excoriated cartilage surfaces and synovium which was
thickened, erythematous, and irregular. Loose bodies became adhered to
synovium at their subchondral bone surface within four weeks after placement
into the joint. At four weeks, bone within fragments was undergoing necrosis,
while cartilage was preserved. At eight weeks, fragments were radiographically
inapparent, grossly evident as pale plaques on the synovial surface, and
composed of dense fibrous connective tissue.
Histologically, synovial membrane specimens from implanted joints
demonstrated significant (P < 0.05) inflammatory change two months after
implantation. Mononuclear cells infiltrated the synovial layers. Significant
physical damage (P < 0.05) was apparent within the articular cartilage two and
six months after surgery. Chondrocyte degenerative change was significant
(P < 0.05) six months after surgery. Generalized reduction in Safranin-O uptake
was not apparent within each level of cartilage samples, but focal reduction in
staining was readily apparent in cartilage layers adjacent to physical defects.
Synovitis, physical articular damage, and focal chondrocyte degenerative
change resulted from a combination of 1) direct mechnical abrasion by the
implants or implant-derived debris, 2) an induced effect of osteochondral debris
on the synovium, 3) synovitis-induced cartilage degeneration, and
4) supraphysiologic loading associated with exercise.
In this study, osteochondral loose bodies of a defined size and shape
were resorbed by the synovium within two months after joint implantation.
These fragments directly and indirectly induced synovitis and significant articular
cartilage degeneration. Methods to prevent and reduce residual postoperative
debris and damage associated with its presence are discussed. Implementation
of this methodology should reduce the potential for subsequent articular
pathology.Graduation date: 1991
39
Bartlett, Christopher. « Effect of orthotic intervention on lower extremity kinematics and ground reaction forces in subjects with excessive pronation ». 2005. http://www.oregonpdf.org.
Texte intégralRésumé :
Thesis (M.A.)--University of North Carolina at Chapel Hill, 2004.Includes bibliographical references (leaves 132-135). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.
40
Wulff, Alexander Christopher. « The effect of genetic variance on fracture healing as assessed by callus composition and strength ». Thesis, 2015. https://hdl.handle.net/2144/16206.
Texte intégralRésumé :
Bones have a large capacity for repair and regeneration after an injury. 5-10% of the nearly 8 million fractures that occur every year in the United States do not heal properly. Bone repair and regeneration is a complex process that utilizes molecular and cellular interactions to return to its original structure. Phosphate is essential for healthy bone growth and when phosphate deficient it has been shown to impair the process of fracture healing. It is unknown if replenishing phosphate to the diet will help return the injured bone to its original properties. Some of the differences in fracture repair may be due to genetic variability that contributes to morphology of bone and fracture healing. This study was carried out to assess how genetic variability affects the process of fracture healing.
To determine how genetic differences interact with phosphate deficiency fractures were generated in three different inbred mouse strain (A/J (AJ), C57BL/6J (B6), C3H/HeJ (C3)) that had previously been shown to have different endochondral bone formation. Animals were placed on a phosphate restricted diet two days prior to fracture, and was maintained for 15 days, which covered the normal duration of endochondral bone development. To determine if replenishing phosphate in the diet could recover the normal healing, phosphate was returned to the diet after 15 days. There was also control groups that were on a regular diet for the entire time of the study, which was used for comparison. Micro-computed tomography (micro-CT), biomechanical torsion testing, and contrast enhanced micro-computed tomography (CECT) were methods used to asses the properties of the callus over the course of fracture healing.
Micro-CT and mechanical test results showed that there were significant differences within AJ, B6, and C3 strains of mice at the various post-operative day (POD) time points. Results from micro-CT data showed that as the POD time point increased there was an increase in the amount of mineralized tissue and a decrease in fracture callus. These results were confirmed by with the increase in strength measurements from mechanical testing conclusions. Further, the fracture callus is less rigid at the early time points and as the fracture callus becomes mineralized there is an increase in the rigidity measures. Other measures of mechanical properties showed that there were significant differences in the B6 and C3 strains of mice among the various POD time points and control and phosphate restricted diets. Assessing cartilage content via CECT showed that there were significant differences in the control and phosphate restricted diets at POD 14, however many of these differences were recovered at the later time points. Visualization of the fracture callus using CECT confirmed that there was diminishing cartilage present in the fracture callus.
These results provide insight into the fracture healing process and much information about the return of stability and strength to the fractured bone. Taken together, the outcomes of this study indicate that the bones heal and mechanical strength is recovered once the phosphate has been added back into the diet.
41
Heath, Jacqueline E. « The effect of prefabricated foot orthotics on functional and postural stability in older adults ». 2013. http://liblink.bsu.edu/uhtbin/catkey/1712085.
Texte intégralRésumé :
Background. Accidental falls comprise a serious health concern in older adults. Partially accounting for the high incidence rates is postural instability. While customized foot orthotics can improve certain measures of functional stability, the purpose of this study was to explore the degree to which prefabricated orthotics benefit this population and to expand the evidence base to postural stability.
Methods. Eighteen healthy older adults (72.7 ± 4.8 years) were evaluated with and without foot orthotics, and again following 2-3 weeks of use. Functional stability was evaluated via the Timed-Up-and-Go test and the Fullerton Advanced Balance scale. Computerized posturography was used to assess stability in altered sensory environments (Sensory Organization Test) and to assess overall stability limits (Limits of Stability test). A pressure analysis system assessed gait parameters and pressure distribution patterns.
Results. Foot orthotics improved stability on the Timed-Up-and-Go (p=0.003) and the Fullerton Advanced Balance Scale (p<0.001) and decreased fall occurrence on the Sensory Organization Test. Times based changes of postural stability occurred for medio-lateral sway velocity and area when only the vestibular system providing accurate information (condition 5) (p=0.001, 0.05, respectively), and under sensory conflict (condition 6) for sway velocity (medio-lateral and antero-posterior), sway path length and sway area (p=0.015, 0.021, 0.015, 0.015, respectively). An interaction effect was found for maximum excursion composite score (p=0.001) on the Limits of Stability test, as well as a main effect of time for directional control in the ML direction and composite score (p=0.024.0.043). Contact area increase in the midfoot and rearfoot and peak force decreased in the rearfoot (p=0.001, 0.03, 0.027, respectively).
Conclusions. Results indicate that foot orthotic use can improve functional measures of stability in older adults. It is unclear whether the time-based changes in postural stability are attributable to the orthotics or are a result of learning effects. Regardless, improvements in stability with prefabricated foot orthotics may help decrease the risk of falls in this population.School of Physical Education, Sport, and Exercise Science
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Faber, Kandy. « The effect of a prophylactic ankle brace on knee torque during a drop landing onto a slanted surface ». 2005. http://www.oregonpdf.org.
Texte intégral
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Brumby, Scott Andrew. « The effect of surface roughness and a collar on fixation of cemented femoral stems in vivo / by Scott Andrew Brumby ». Thesis, 1996. http://hdl.handle.net/2440/18921.
Texte intégralRésumé :
Bibliography: leaves 193-206.xiii, 206 leaves : ill. (chiefly col.) ; 30 cm.
This thesis investigates the effect of femoral stem surface roughness and a collar on the fixation of cemented hip hemi-arthroplasty femoral stems in an in vivo sheep model up to nine months following implantation. Plain radiography, micromotion between prosthesis and bone during mechanical testing and histology are used.
Thesis (Ph.D.)--University of Adelaide, Dept. of Orthopaedics and Trauma, 1997?
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Lourens, Jan Jonathan. « The application of carbon fibre reinforced polymers as bone plates and the effect thereof on fracture healing ». Thesis, 2014. http://hdl.handle.net/10210/9750.
Texte intégralRésumé :
D.Ing.This thesis studies the application of newer generation engineering materials, specifically carbon fibre reinforced polymers, as bone plates in cases of fractured bones. The application of bone plates subsequent to bone fracture is a very old orthopaedic technique that has always rendered some problems. The rigidity of the bone plate, and thus the plated system as a whole, is of advantage during the healing phase, but of disadvantage later. Bone remodels itself to most efficiently perform the load bearing required of it. In a plated system, the load is born primarily by the plate and therefore protects the underlying bone, leading to osteoporosis and eventual atrophy. All bone plates are made of a material that is totally foreign to the body, and in most cases these are removed after some healing of the bone had occurred. The majority of current research programmes with respect to bone plates are directed towards biodegradable bone plates that reduces in mechanical strength at approximately the same rate as bone gains in its ability to sustain loads. The principle of stimulating bone growth in cases of delayed union and non-union has been studied since the early 1960's. The studies revealed that bone healing can in fact be enhanced by the introduction of a very small electric current to the fracture site. Variations to the mechanisms and position of application of the current, alternating or direct, are well documented. Although the physiological healing process associated with electrical stimulus remains largely unknown, the principle is well established. The phenomenon of galvanic corrosion has been known since the tum of the century. Where two dissimilar materials are in the presence of a conducting media, the more "reactive" of the two materials will react as an anode or electron donor to the other material. An electric current thus will flow from the one material to the other. Having three existing and known phenomena, namely bone plating, bone healing stimulation and galvanic corrosion raises the question of whether these can be combined to yield a solution superior to any current plating mechanism - a plate that would render sufficient mechanical support but act as an electron source and thus as a bone healing stimulus. The purpose of this study is to assess the biological criteria determining the choice of bone plates (inclusive of mechanical, physiological and electrical criteria) and thereafter selecting a material suitable for this dynamic requirement.
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Ming-JennChen et 陳明鎮. « The Effect of Implementing Tw-DRG on Medical Care Quality and Provider’s Medical behaviors : The Cases of Orthopedic Implants Removals and Appendicitis Related Surgery ». Thesis, 2018. http://ndltd.ncl.edu.tw/handle/b34n6d.
Texte intégralRésumé :
碩士國立成功大學
高階管理碩士在職專班(EMBA)
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Diagnosis-related Groups (DRGs) are prospective hospital bundled-payment systems that have been implemented by National Health Insurance Administration of Taiwan since the year of 2010. The DRG program consists of five stages with the goals to improve the quality of patient care and reduce inefficiencies of hospital resources. With the first two stages of the program having come into effect, the DRG program is temporally paused on progress because challenges on many levels remain unresolved. For instance, some problems have manifested so far: in trying to decrease the medical cost under the financial pressure, most hospitals have incentivized to pass onto physicians the responsibility for the cost beyond DRG reimbursements. As a result, it may induce desirable change on physicians’ practice patterns and the submitted claims. This study is focused on two DRG cases of orthopedic implants removal and appendectomy. We aim to evaluate the change of physicians’ behaviors by comparing the variability of medical charges, the selection of principal diagnosis and procedure codes of the two operations before and after the inception of DRGs. From the database of Chi-Mei Hospital DRG claims, we conducted an audit of each clinical record with an effort to represent the original appearance of the illnesses thereby minimizing the systematic errors. The result showed that the inpatient hospital stays and medical charges of the two diseases significantly decreased after the launch of DRGs. DRGs had little impact on the modification of physicians’ behavior in medical practice. However, it was found that physicians might adjust the severity level of illnesses, principal and secondary diagnoses, or procedure codes to avoid the stress of financial losses per se. It was accounted for the modified pattern of physicians’ group behavior. While promoting DRGs, National Health Insurance Administration should face the problems with regard to the stress physicians are under by not ignoring hospitals’ corresponding financial solution, which led to physicians’ behavior modification out of human nature. The administrators should consider the factors altogether to sustain the medical environment from falling apart.
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Gold-Gosselin, David. « Étude pilote des effets du Tandem Forsus Maxillary Corrector sur la croissance des maxillaires ». Thèse, 2012. http://hdl.handle.net/1866/8720.
Texte intégralRésumé :
Objectif : Récemment, un nouvel appareil issu de la technologie du Forsus™ et visant à corriger les malocclusions de classe III a été mis sur le marché et se popularise dans la pratique orthodontique : le Tandem Forsus Maxillary Corrector (TFMC). L’objectif de la présente étude est de mesurer les effets squelettiques, l’influence réelle sur la croissance, et les effets dento-alvéolaires du port du TFMC.
Matériel et méthodes : 14 patients présentant une malocclusion de classe III (âge moyen de 9 ans 6 mois) traités par le même orthodontiste ont participé à cette étude prospective. Le groupe consiste en 10 garçons et 4 filles. Le Tandem Forsus Maxillary Corrector est porté de 12 à 14 heures par jour jusqu’à l’obtention d’une surcorrection du surplomb horizontal et une relation dentaire de classe I. Le traitement est généralement d’une durée de 8 à 9 mois. Des radiographies céphalométriques latérales prises avant (T1) et après (T2) le traitement ont été analysées afin de déterminer les changements dentaires et squelettiques. Les résultats ont été comparés à un groupe contrôle composé de 42 enfants provenant du Centre de croissance de l’Université de Montréal. Les radiographies ont été tracées et analysées de manière aveugle à l’aide du logiciel Dolphin Imaging (ver 11.0, Patterson Dental, Chatsworth, California). L’erreur sur la méthode a été évaluée avec la formule de Dahlberg, le coefficient de corrélation intra-classe et l’indice de Bland-Altman. L’effet du traitement a été évalué à l’aide du test t pour échantillons appariés. L’effet de la croissance pour le groupe contrôle a été calculé à l’aide d’un test t pour échantillons indépendants.
Résultats : L’utilisation du TFMC produit un mouvement antérieur et une rotation antihoraire du maxillaire. De plus, il procline les incisives supérieures et rétrocline les incisives inférieures. Une rotation antihoraire du plan occlusal contribue aussi à la correction de la malocclusion de classe III. Par contre, le TFMC ne semble pas avoir pour effet de restreindre la croissance mandibulaire.
Conclusion : La présente étude tend à démontrer que le port de l’appareil TFMC a un effet orthopédique et dento-alvéolaire significatif lors du traitement correctif des malocclusions modérées de classe III.Aim: Recently, a new appliance used to correct class III malocclusions, equipped with the Forsus™ technology, has been marketed and is gaining popularity in orthodontic practice: the Tandem Forsus Maxillary Corrector (TFMC). The purpose of the present study is to measure the skeletal and dento-alveolar effects, and the true influence on growth of the TFMC. Materials and Methods: A prospective study was done with 14 growing children (mean age of 9 years 6 months) who had a class III malocclusion and were treated with the TFMC by the same orthodontist. The group consisted of 10 boys and 4 girls. The «Tandem Forsus Maxillary Corrector» was worn 12 to 14 hours a day until a positive overjet and a class I dental relationship was obtained. For each patient, lateral cephalograms taken before (T1) and after (T2) the treatment were analyzed to determine skeletal and dental changes resulting from treatment. These results were compared to a control group randomly selected from the Growth Center of the University of Montreal. The cephalograms were traced and analyzed with the software Dolphin Imaging (ver 11.0, Patterson Dental, Chatsworth, California). Consistency and repeatability of measurements was evaluated with the intraclass correlation, the Dahlberg formula and the Bland-Altman test. The effect of treatment was evaluated with a paired T-test. The effect of growth for the control group was calculated with an unpaired T-test. Results: Use of the TFMC results in an anterior movement and a counterclockwise rotation of the maxilla. The upper incisors proclined and the lower incisors retroclined. A counterclockwise rotation of the occlusal plane also contributed to the correction of the class III malocclusion. Furthermore, the TFMC does not seem to restrain mandibular growth. Conclusion: The TFMC appliance seems to have a significant orthopedic and dento-alveolar effect when correcting a moderate class III malocclusion.