Artykuły w czasopismach na temat „Lower limb elevation”
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Kawasaki, Tota, Tetsuji Uemura, Kiyomi Matsuo, Kazuyuki Masumoto, Yoshimi Harada, Takahiro Chuman i Tomoyuki Murata. "The effect of different positions on lower limbs skin perfusion pressure". Indian Journal of Plastic Surgery 46, nr 03 (wrzesień 2013): 508–12. http://dx.doi.org/10.4103/0970-0358.121995.
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ABSTRACTWe have encountered situations of patients with critical limb ischemia accompanied by pain at rest and necrosis, who hang their legs down from the bed during sleep. This lower limb position is known to be a natural position, which reduces pain in the lower extremity induced by ischemia. However, the effect of this position on blood flow of the lower extremity is poorly understood. We studied whether measurements of skin perfusion pressure (SPP) changes by leg position and the difference between healthy adults and patients with critical limb ischemia. The subjects of this study were 10 healthy adults and 11 patients with critical limb ischemia. Patients with critical limb ischemia, including both dorsum of foot and plantar of foot, having SPP of lower limbs of less than 40 mmHg (supine position) were the object of this study. SPP was measured on four positions (supine position, lower limbs elevation position, sitting position, and reclining bed elevation of 20° position). In sitting position, both the number of healthy adults and critical patients show significant increases in SPP compared with the other three positions. These results suggest that sitting position is effective to keep good blood stream of lower limbs not only in healthy adults but also in patients with critical limb ischemia. However, an appropriate leg position should not have lower limbs hang downwards for long periods time because edema is caused by the fall in venous return in lower limbs, and the wound healing is prolonged.Our clinical research could be more useful in the future, particularly in developing countries, for surgeons managing wounds in leg and foot and preserving ischemic limbs.
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Nakamura, Kensuke, i Norihiko Saga. "A Symmetry Evaluation Method, Using Elevation Angle, for Lower Limb Movement Patterns during Sitting-to-Standing". Applied Sciences 12, nr 19 (21.09.2022): 9454. http://dx.doi.org/10.3390/app12199454.
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In this paper, we propose a method that uses the femoral and tibial elevation angles to quantitatively evaluate the symmetry of lower limb movement during the transition from a sitting position to a standing position. In kinematic analysis of the transition from sitting to standing, the angles of the three joints of the lower limb are often measured. However, due to the large number of variables, it is difficult to evaluate the symmetry of the lower limb movement by comparing data from the six joints of the left and right lower limbs. In this study, therefore, we measured the femoral and tibial elevation angles of healthy participants and rehabilitation patients and visually and numerically evaluated the symmetry and asymmetry of the movement of the left and right lower limbs. We were able to identify the kinematically major lower limbs in the transition from sitting to standing and quantify the symmetry of the movement patterns of the left and right lower limbs. Furthermore, we examined the possibility that the method could be effectively used in the rehabilitation field to evaluate the motor co-ordination that constitutes the lower limb movement pattern in the transition from the sitting to standing position, such as the gait plane rule.
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Barnes, M. D., R. Mani, D. F. Barrett i J. E. White. "Changes in Skin Microcirculation at Periulcerous Sites in Patients with Chronic Venous Ulcers during Leg Elevation". Phlebology: The Journal of Venous Disease 7, nr 1 (marzec 1992): 36–39. http://dx.doi.org/10.1177/026835559200700111.
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Objective: To investigate the effect of limb elevation on the microcirculation of the skin in patients with venous ulceration of the leg. Design: Prospective study in patients receiving in patient treatment for venous ulceration. Setting: Health Service teaching hospital. Patients: Thirteen patients with venous ulceration of the lower limb for more than two years were investigated. Interventions: Patients were admitted to hospital and treated by bedrest with elevation of the lower limbs by 10° above the horizontal. Main outcome measures: Laser Doppler fluximetry and transcutaneous oximetry of the skin surrounding the venous ulcers was undertaken. Results: The laser Doppler fluximetry in the periculcerous region increased by 10.8 A.U. (95% CI 17 to 4.54). However, the transcutaneous oxygen measurements did not change during the period of treatment. Conclusions: Admission to hospital with elevation of the limb for patients with venous ulceration results in ***microcirculatory changes which are probably attributable to reduction in lower limb oedema.
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Masu, Yujiro, i Masanori Nagai. "Characteristics of lower limb muscle activity during upper limb elevation in badminton players". Journal of Physical Therapy Science 28, nr 9 (2016): 2510–14. http://dx.doi.org/10.1589/jpts.28.2510.
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Barnes, M. D., R. Mani, D. F. Barrett i J. E. White. "How to Measure Changes in Oedema in Patients with Chronic Venous Ulcers?" Phlebology: The Journal of Venous Disease 7, nr 1 (marzec 1992): 31–35. http://dx.doi.org/10.1177/026835559200700109.
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objective: To assess changes in limb volume and oedema in Patients admitted to hospital for treatment of venous ulceration. Design: Prospective study in thirteen patients. Setting: Health Service teaching hospital. Patients: Thirteen patients with venous ulceration for 2 years. Interventions: Patients were admitted to hospital for bed-rest and lower limb elevation for a period of 24 hours Main outcome measures: Limb volume was measured by water displacement and impedance plethysmography. Results: During limb elevation there was a mean reduction limb volume of 524 mls (95% CI 377–671 mls) after 24 hours of bedrest. This corresponded with a reduction in impedance measured by the impedance plethysmograph of 19–0 ohms (95% CI 24.3 to 15.6 ohms). Conclusion: Measurement of the lower limb volume by water displacement and by impedance plethysmography are likely to be useful methods in the investigation of Patients with chronic venous insufficiency.
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Koutouzis, Sfyroeras, Moulakakis, Kontaras, Nikolaou, Besias, Maras, Pavlidis, Andrikopoulos i Kyriakides. "Cardiac troponin I in patients with acute upper and lower limb ischemia". Vasa 37, nr 4 (1.11.2008): 327–32. http://dx.doi.org/10.1024/0301-1526.37.4.327.
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Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.
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Tanpowpong, T., P. Kitidumrongsook i A. Patradul. "The deleterious effects of exsanguination with a tight bandage on tourniquet tolerance in the upper arm". Journal of Hand Surgery (European Volume) 37, nr 9 (28.03.2012): 839–41. http://dx.doi.org/10.1177/1753193412442288.
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Tourniquet tolerance is affected by the method of exsanguination. Two commonly used methods, tight elastic bandaging and limb elevation, were tested to determine their effects on upper extremity tourniquet tolerance in 23 healthy adult volunteers. We found that tourniquet tolerance was significantly lower among the bandaging group compared with the limb elevation group (average 19.4 min and 24.1 min, respectively). Overall, the tourniquet tolerance was not affected by hand dominance or arm circumference.
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Gillette, Cordial M., Scott T. Doberstein, Danielle L. DeSerano i Eric J. Linnell. "The Effect of Elevation on Volumetric Measurements of the Lower Extremity". International Journal of Kinesiology and Sports Science 5, nr 3 (31.07.2017): 1. http://dx.doi.org/10.7575/aiac.ijkss.v.5n.3p.1.
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Background: The empirical evidence for the use of RICE (rest, ice, compression, elevation) has been questioned regarding its clinical effectiveness. The component of RICE that has the least literature regarding its effectiveness is elevation. Objective: The objective of this study was to determine if various positions of elevation result in volumetric changes of the lower extremity. Methodology: A randomized crossover design was used to determine the effects of the four following conditions on volumetric changes of the lower extremity: seated at the end of a table (seated), lying supine (flat), lying supine with the foot elevated 12 inches off the table (elevated), and lying prone with the knees bent to 90 degrees (prone). The conditions were randomized using a Latin Square. Each subject completed all conditions with at least 24 hours between each session. Pre and post volumetric measurements were taken using a volumetric tank. The subject was placed in one of the four described testing positions for 30 minutes. The change in weight of the displaced water was the main outcome measure. The data was analyzed using an ANOVA of the pre and post measurements with a Bonferroni post hoc analysis. The level of significance was set at P<.05 for all analyses. Results: The only statistically significant difference was between the gravity dependent position (seated) and all other positions (p <.001). There was no significant difference between lying supine (flat), on a bolster (elevated), or prone with the knees flexed to 90 degrees (prone). Conclusions: From these results, the extent of elevation does not appear to have an effect on changes in low leg volume. Elevation above the heart did not significantly improve reduction in limb volume, but removing the limb from a gravity dependent position might be beneficial.
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Cavadas, Pedro. "Use of limited external fixation for limb elevation in lower extremity free flaps". Journal of Plastic, Reconstructive & Aesthetic Surgery 61, nr 11 (listopad 2008): 1411–12. http://dx.doi.org/10.1016/j.bjps.2008.02.037.
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Angadi, Darshan S., Jose Blanco, Ajit Garde i Simon C. West. "Lower limb elevation: useful and effective technique of exsanguination prior to knee arthroscopy". Knee Surgery, Sports Traumatology, Arthroscopy 18, nr 11 (5.06.2010): 1559–61. http://dx.doi.org/10.1007/s00167-010-1165-6.
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Mane, Arun Y., i Narendra G. Naik. "The cost effective role of Eschmarch tourniquet and psychosocial awareness of disease as a key factor in decompressive therapy of filarial lymphedema". International Surgery Journal 6, nr 8 (25.07.2019): 2895. http://dx.doi.org/10.18203/2349-2902.isj20193338.
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Background: The filiariasis is the most common cause of secondary lymphedema of the lower limb. Due to poor awareness of this disease in the people of the lower socioeconomic strata, the patient understands the importance of conservative modality of therapy very late. The cutaneous changes and its complications develop in patient due to unawareness about the nature of noncurable progressive disease. The self-negligence to their own limb also contributes to increase in the morbidity of the disease. The article discusses about cost effective role of Eschmarch tourniquet as a decompressive therapy. The disease causes socioeconomic impairments, stigmatization due to elephantiasis and job insecurity due to cosmetic and functional disability.Methods: This was a retrospective study done in 28 cases of filarial lymphedema. All patients received limb elevation and decompressive therapy by Eschmarch tourniquet.Results: Out of 28 cases, 14 cases in study group of filarial lymphedema with pitting edema (71.42%) and non-pitting edema feet with minimal cutaneous changes (28.57%) showed significant reduction in size of limb girth and satisfactory fluctuating limb girth during the follow up period in OPD respectively, by adequate limb elevation, elastic stockinet and decompressive therapy by Eschmarch tourniquet as compared to the remaining 14 patients of control who received only limb elevation. The better follow up results are noticed by proper guidance to the patient about the disease and its conservative modality of treatment.Conclusions: It is a challenge for the treating consultant to create early awareness about the nature of the filarial disease and early guidance about the conservative treatment which helps to restrict the rapid growth of limb size in filiariatic lymphedema. The eschmarch tourniquet is one of the cost effective decompressive therapy.
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Abd-Samat, Azlan Helmy. "ST Elevation in Lead aVR with Malperfusion Syndrome: Sign of Severe Aortic Dissection". Medicine & Health 15, nr 2 (31.12.2020): 297–305. http://dx.doi.org/10.17576/mh.2020.1502.26.
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Aortic dissection presenting with ST elevation in lead aVR of electrocardiogram is strongly associated with mortality. It is also associated with dissection involving the root of aorta and coronary vessels. We report a case of young male with hypertension, who presented with severe chest pain and unilateral lower limb pain. Physical examination of the left lower limb was consistent with acute limb ischemia. Electrocardiogram revealed acute anterolateral myocardial infarction together with ST elevation in aVR. Bedside transthoracic echocardiography showed a dilated aortic root measuring 4.51 cm with presence of intimal flap which raised the suspicion of dissection of root of aorta and left coronary artery. Computed tomography angiogram revealed aortic dissection from the root of aorta including the intimal flap near the origin of the left coronary artery, down to common iliac extending to the left iliac artery. Unfortunately, the patient opted for non-surgical intervention and succumbed 48 hours later. This case highlights that in case of aortic dissection, which presents with malperfusion syndrome, the presence of ST segment elevation at lead aVR should raise the suspicion for extensive aortic dissection involving the aortic root and left coronary artery which signifies unfavourable outcome
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de M. Baldon, Rodrigo, Daniel F. M. Lobato, Leonardo Furlan i Fábio Serrão. "Gender Differences in Lower Limb Kinematics During Stair Descent". Journal of Applied Biomechanics 29, nr 4 (sierpień 2013): 413–20. http://dx.doi.org/10.1123/jab.29.4.413.
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The purpose of this study was to compare lower limb kinematics between genders during stair descent. Fifteen females and fifteen males who were healthy and active were included in this study. The lower limb kinematics (pelvis, femur and knee) in the coronal and transversal planes were assessed during stair descent at 30°, 40°, 50° and 60° of knee flexion. The study found that females showed greater knee medial rotation for all the knee flexion angles (P= .02−.001), greater femoral adduction (P= .01 for all variables), with exception for 30° (P= .13), and greater femoral lateral rotation at 60° (P= .04). Females also showed a trend to have greater knee valgus at all the knee flexion angles (P= .06−.11) as well as less contralateral pelvis elevation at 50° and 60° (P= .10 and .12, respectively). This study showed that females carry out the stair descent with a lower limb alignment that might predispose them to develop overuse knee injuries, such as the iliotibial band syndrome and patellofemoral pain syndrome. Further prospective investigations should be carried out to verify whether these variables are factors that could predict these knee injuries.
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Basgaran, Amedra, Sayani Khara i Aravinth Sivagnanaratnam. "Multiorgan thromboembolic shower and its ethical implications". BMJ Case Reports 14, nr 2 (luty 2021): e238580. http://dx.doi.org/10.1136/bcr-2020-238580.
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A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient’s lack of capacity, and input from multiple teams and the patient’s relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.
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Whiston, R. J., M. B. Hallet, I. F. Lane i K. G. Harding. "Lower Limb Neutrophil Oxygen Radical Production is Increased in Venous Hypertension". Phlebology: The Journal of Venous Disease 8, nr 4 (grudzień 1993): 151–54. http://dx.doi.org/10.1177/026835559300800404.
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Objective: To investigate neutrophil free radical production in patients with venous hypertension. Patients: Thirteen legs in patients with venous ulceration were compared with seven legs in patients suffering from lipodermatosclerosis (LDS) only and nine normal controls. Design: Leg and arm venous blood samples were obtained from each patient after a period of 30 min of leg dependency followed by elevation to the horizontal for a further 5 min. Neutrophils were isolated and free radical production assessed by luminol-dependen t chemiluminescence following stimulation with the chemotactic peptide FMLP. Results: The ratio of leg to arm luminescence was significantly higher in patients with venous ulceration (median 1.61; 95% confidence interval (CI) 1.20–3.05; p=0.0002) and those with LDS (median 1.36; 95% CI 1.05–2.01; p=0.0036) when compared with the controls (median 0.97; 95% CI 0.70–1.12). Conclusions: Neutrophil free radical production is increased in the legs of patients with venous hypertension and may be implicated in the underlying pathogenesis of this disease.
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Ogihara, Naomichi, Takeo Kikuchi, Yutaro Ishiguro, Haruyuki Makishima i Masato Nakatsukasa. "Planar covariation of limb elevation angles during bipedal walking in the Japanese macaque". Journal of The Royal Society Interface 9, nr 74 (21.03.2012): 2181–90. http://dx.doi.org/10.1098/rsif.2012.0026.
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We investigated the planar covariation of lower limb segment elevation angles during bipedal walking in macaques to elucidate the mechanisms underlying the origin and evolution of the planar law in human walking. Two Japanese macaques and four adult humans walking on a treadmill were recorded, and the time course of the elevation angles at the thigh, shank and foot segments relative to the vertical axis were calculated. Our analyses indicated that the planar law also applies to macaque bipedal walking. However, planarity was much lower in macaques, and orientations of the plane differed between the two species because of differences in the foot elevation angle. The human foot is rigidly structured to form a longitudinal arch, whereas the macaque's foot is more flexible and bends at the midtarsal region in the stance phase. This difference in midfoot flexibility between the two species studied was the main source of the difference in the planar law. Thus, the evolution of a stable midfoot in early hominins may have preceded the acquisition of the strong planar intersegmental coordination and possibly facilitated the subsequent emergence of habitual bipedal walking in the human lineage.
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Mungovan, Sean, Greg Gass i Elizabeth Gass. "Effects Of Lower Limb Elevation And Compression On Cardiovascular Function In Men Who Are Paraplegic". Medicine & Science in Sports & Exercise 37, Supplement (maj 2005): S313. http://dx.doi.org/10.1249/00005768-200505001-01625.
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Mungovan, Sean, Greg Gass i Elizabeth Gass. "Effects Of Lower Limb Elevation And Compression On Cardiovascular Function In Men Who Are Paraplegic". Medicine & Science in Sports & Exercise 37, Supplement (maj 2005): S313. http://dx.doi.org/10.1097/00005768-200505001-01625.
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Garibaldi, M., N. Romero, J. Böhm, P. Ottaviani, F. Fattori, F. Laschena, J. Laporte, E. Bertini i G. Antonini. "Dominant BIN1-related centronuclear myopathy (CNM) revealed by lower limb myalgia and moderate CK elevation". Neuromuscular Disorders 25 (październik 2015): S275. http://dx.doi.org/10.1016/j.nmd.2015.06.321.
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Cheron, Guy, Ana Bengoetxea, Ethel Bouillot, Francesco Lacquaniti i Bernard Dan. "Early emergence of temporal co-ordination of lower limb segments elevation angles in human locomotion". Neuroscience Letters 308, nr 2 (sierpień 2001): 123–27. http://dx.doi.org/10.1016/s0304-3940(01)01925-5.
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Bohannon, Richard W., i Jason Smutnick. "Pelvifemoral Kinematics while Ascending Single Steps of Different Heights". Journal of Applied Biomechanics 26, nr 3 (sierpień 2010): 290–94. http://dx.doi.org/10.1123/jab.26.3.290.
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Motion of the femur and pelvis during hip flexion has been examined previously, but principally in the sagittal plane and during nonfunctional activities. In this study we examined femoral elevation in the sagittal plane and pelvic rotation in the sagittal and frontal planes while subjects flexed their hips to ascend single steps. Fourteen subjects ascended single steps of 4 different heights leading with each lower limb. Motion of the lead femur and pelvis during the flexion phase of step ascent was tracked using an infrared motion capture system. Depending on step height and lead limb, step ascent involved elevation of the femur (mean 47.2° to 89.6°) and rotation of the pelvis in both the sagittal plane (tilting: mean 2.6° to 9.7°) and frontal plane (listing: mean 4.2° to 11.9°). Along with maximum femoral elevation, maximum pelvic rotation increased significantly (p< .001) with step height. Femoral elevation and pelvic rotation during the flexion phase of step ascent were synergistic (r= .852–.999). Practitioners should consider pelvic rotation in addition to femoral motion when observing individuals’ ascent of steps.
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Borms, Dorien, Annelies Maenhout i Ann M. Cools. "Incorporation of the Kinetic Chain Into Shoulder-Elevation Exercises: Does It Affect Scapular Muscle Activity?" Journal of Athletic Training 55, nr 4 (1.04.2020): 343–49. http://dx.doi.org/10.4085/1062-6050-136-19.
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Context Scapular rehabilitation exercises should focus on selective activation of weaker muscles and minimal activation of hyperactive muscles. For rehabilitation of overhead athletes, single-plane open chain exercises below 90° of shoulder elevation are often recommended. Moreover, incorporating the kinetic chain in shoulder rehabilitation exercises is advised and has been suggested to influence scapular muscle activity levels. Objective To study the influence of kinetic chain incorporation during 5 variations of a shoulder-elevation exercise on scapular muscle activity. Design Cross-sectional study. Setting University laboratory. Patients or Other Participants Thirty-one asymptomatic participants (15 men, 16 women). Main Outcome Measure(s) The electromyographic activity of the upper (UT), middle (MT), and lower (LT) trapezius, and serratus anterior was determined during 5 variations of bilateral elevation with external rotation: (1) open-hand position (reference exercise), (2) closed-hand position, (3) dynamic bipedal squat, (4) static unipedal squat, and (5) dynamic unipedal squat on the contralateral leg. All data were normalized as a percentage of maximal voluntary isometric contraction (MVIC). Results A closed-hand position (exercise 2) instead of an open-hand position (exercise 1) resulted in lower MT (mean difference = 3.44% MVIC) and LT (mean difference = 7.76% MVIC) activity. Incorporating the lower limb (exercises 3–5) increased UT activity when compared with exercise 1 (mean differences = 3.67, 2.68, 5.02% MVIC, respectively), which in general resulted in increased UT : MT ratios. Additionally, LT activity decreased when a dynamic unipedal squat was added (mean difference: 4.90% MVIC). For the serratus anterior, the greatest activity occurred during elevation in a static unipedal squat position (exercise 4, 22.90% MVIC). Conclusions Incorporating the kinetic chain during shoulder-elevation exercises influenced scapular muscle activity and ratios. In particular, incorporating the lower limb resulted in more UT activity, whereas the open-hand position increased MT and LT activity.
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Giovanelli, Nicola, Paolo Taboga, Enrico Rejc, Bostjan Simunic, Guglielmo Antonutto i Stefano Lazzer. "Effects of an Uphill Marathon on Running Mechanics and Lower-Limb Muscle Fatigue". International Journal of Sports Physiology and Performance 11, nr 4 (maj 2016): 522–29. http://dx.doi.org/10.1123/ijspp.2014-0602.
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Purpose:To investigate the effects of an uphill marathon (43 km, 3063-m elevation gain) on running mechanics and neuromuscular fatigue in lower-limb muscles.Methods:Maximal mechanical power of lower limbs (MMP), temporal tensiomyographic (TMG) parameters, and muscle-belly displacement (Dm) were determined in the vastus lateralis muscle before and after the competition in 18 runners (age 42.8 ± 9.9 y, body mass 70.1 ± 7.3 kg, maximal oxygen uptake 55.5 ± 7.5 mL · kg−1 · min−1). Contact (tc) and aerial (ta) times, step frequency (f), and running velocity (v) were measured at 3, 14, and 30 km and after the finish line (POST). Peak vertical ground-reaction force (Fmax), vertical displacement of the center of mass (Δz), leg-length change (ΔL), and vertical (kvert) and leg (kleg) stiffness were calculated.Results:MMP was inversely related with race time (r = –.56, P = .016), tc (r = –.61, P = .008), and Δz (r = –.57, P = .012) and directly related with Fmax (r = .59, P = .010), ta (r = .48, P = .040), and kvert (r = .51, P = .027). In the fastest subgroup (n = 9) the following parameters were lower in POST (P < .05) than at km 3: ta (–14.1% ± 17.8%), Fmax (–6.2% ± 6.4%), kvert (–17.5% ± 17.2%), and kleg (–11.4% ± 10.9%). The slowest subgroup (n = 9) showed changes (P < .05) at km 30 and POST in Fmax (–5.5% ± 4.9% and –5.3% ± 4.1%), ta (–20.5% ± 16.2% and –21.5% ± 14.4%), tc (5.5% ± 7.5% and 3.2% ± 5.2%), kvert (–14.0% ± 12.8% and –11.8% ± 10.0%), and kleg (–8.9% ± 11.5% and –11.9% ± 12%). TMG temporal parameters decreased in all runners (–27.35% ± 18.0%, P < .001), while Dm increased (24.0% ± 35.0%, P = .005), showing lower-limb stiffness and higher muscle sensibility to the electrical stimulus.Conclusions:Greater MMP was related with smaller changes in running mechanics induced by fatigue. Thus, lower-limb power training could improve running performance in uphill marathons.
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Radosz, Zuzanna, i Małgorzata Ptaszyńska. "Non-pharmacological treatment of lower extremity varicose veins in patients who are not classified for surgical treatment". Health Promotion & Physical Activity 2, nr 3 (30.06.2017): 111–20. http://dx.doi.org/10.5604/01.3001.0010.7727.
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The purpose of this study is to discuss non-pharmacological methods of lower limb varices treatment for patients not qualified for surgical procedures. These methods can be used by both nurses and patients. There are the following types of varices treatment: interventional treatment, compression therapy and other non-pharmacological methods. Surgery is a traditional method of treatment, however it is not suitable for lower limb arterial ischemia, deep vein patency, haemorrhagic diathesis, deep vein thrombosis, acute infectious disease, pregnancy and class I obesity (BMI>29). In the abovementioned cases the following types of non-invasive treatment are recommended: compression therapy and other such non-pharmacological methods as; limb elevation, diet, hardening of the arteries in the affected limb, proper footwear selection and physical activity. Despite the degree of severity of the condition and undertaken surgical procedures the preventive medical treatment should be considered in the therapy as it (the therapy) significantly affects the further development of varicose veins and the severity of ailments related to the disease. Results of a number of studies confirm the importance of the integrity between pharmacological and non-pharmacological treatment.
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Prasad, Kailash, i Kalpana K. Bhanumathy. "AGE-RAGE Axis in the Pathophysiology of Chronic Lower Limb Ischemia and a Novel Strategy for Its Treatment". International Journal of Angiology 29, nr 03 (14.05.2020): 156–67. http://dx.doi.org/10.1055/s-0040-1710045.
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AbstractThis review focuses on the role of advanced glycation end products (AGEs) and its cell receptor (RAGE) and soluble receptor (sRAGE) in the pathogenesis of chronic lower limb ischemia (CLLI) and its treatment. CLLI is associated with atherosclerosis in lower limb arteries. AGE-RAGE axis which comprises of AGE, RAGE, and sRAGE has been implicated in atherosclerosis and restenosis. It may be involved in atherosclerosis of lower limb resulting in CLLI. Serum and tissue levels of AGE, and expression of RAGE are elevated, and the serum levels of sRAGE are decreased in CLLI. It is known that AGE, and AGE-RAGE interaction increase the generation of various atherogenic factors including reactive oxygen species, nuclear factor-kappa B, cell adhesion molecules, cytokines, monocyte chemoattractant protein-1, granulocyte macrophage-colony stimulating factor, and growth factors. sRAGE acts as antiatherogenic factor because it reduces the generation of AGE-RAGE-induced atherogenic factors. Treatment of CLLI should be targeted at lowering AGE levels through reduction of dietary intake of AGE, prevention of AGE formation and degradation of AGE, suppression of RAGE expression, blockade of AGE-RAGE binding, elevation of sRAGE by upregulating sRAGE expression, and exogenous administration of sRAGE, and use of antioxidants. In conclusion, AGE-RAGE stress defined as a shift in the balance between stressors (AGE, RAGE) and antistressor (sRAGE) in favor of stressors, initiates the development of atherosclerosis resulting in CLLI. Treatment modalities would include reduction of AGE levels and RAGE expression, RAGE blocker, elevation of sRAGE, and antioxidants for prevention, regression, and slowing of progression of CLLI.
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S., Chatterjee Sasanka. "Venous ulcers of the lower limb: Where do we stand?" Indian Journal of Plastic Surgery 45, nr 02 (maj 2012): 266–74. http://dx.doi.org/10.4103/0970-0358.101294.
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ABSTRACTVenous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.
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Marigold, Daniel S., Allison J. Bethune i Aftab E. Patla. "Role of the Unperturbed Limb and Arms in the Reactive Recovery Response to an Unexpected Slip During Locomotion". Journal of Neurophysiology 89, nr 4 (1.04.2003): 1727–37. http://dx.doi.org/10.1152/jn.00683.2002.
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Understanding reactive recovery responses to slipping is fundamental in falls research and prevention. The primary purpose of this study was to investigate the role of the unperturbed limb and arms in the reactive recovery response to an unexpected slip. Ten healthy, young adults participated in this experiment in which an unexpected slip was induced by a set of steel free-wheeling rollers. Surface electromyography (EMG) data were collected from the unperturbed limb (i.e., the swing limb) rectus femoris, biceps femoris, tibialis anterior, and the medial head of gastrocnemius, and bilateral gluteus medius, erector spinae, and deltoids. Kinematic data were also collected by an optical imaging system to monitor limb trajectories. The first slip response was significantly different from the subsequent recovery responses to the unexpected slips, with an identifiable reactive recovery response and no proactive changes in EMG patterns. The muscles of the unperturbed limb, upper body, and arms were recruited at the same latency as those previously found for the perturbed limb. The arm elevation strategies assisted in shifting the center of mass forward after it was posteriorly displaced with the slip, while the unperturbed limb musculature demonstrated an extensor strategy supporting the observed lowering of the limb to briefly touch the ground to widen the base of support and to increase stability. Evidently a dynamic multilimb coordinated strategy is employed by the CNS to control and coordinate the upper and lower limbs in reactive recovery responses to unexpected slips during locomotion.
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Nagendra, T. Uday. "Significance of elevation of foot in management of varicose veins and its sequelae". Journal of Scientific and Innovative Research 11, nr 4 (31.12.2022): 95–96. http://dx.doi.org/10.31254/jsir.2022.11407.
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Varicose veins are a severe clinical manifestation of chronic venous insufficiency [1] , prolonged standing / sitting causes blood to pool in veins of Lower limbs, there by increases the pressure in veins, then veins stretch from Increased pressure, these may weaken the walls of veins and damage the valves. CVI associated with Impaired blood flow leads to tissue congestion oedema and eventually impairement of tissue nutrition. In advanced venous insufficiency Impaired tissue nutrition can causes statis dermatits and development of varicose ulcer. If varicose ulcer is not treated properly, then it gets Infected leads to cellulitis and gangrene, may require amputation of part of limb. The present article deals with brief introduction regarding aetiopathogenesis of varicose veins and its sequelae related symptoms. The aim of writing article is to express the significance of elevation of foot in varicose veins and its sequelae.
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Aprigliano, Federica, Dario Martelli, Silvestro Micera i Vito Monaco. "Intersegmental coordination elicited by unexpected multidirectional slipping-like perturbations resembles that adopted during steady locomotion". Journal of Neurophysiology 115, nr 2 (1.02.2016): 728–40. http://dx.doi.org/10.1152/jn.00327.2015.
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This study aimed at testing the hypothesis that reactive biomechanical responses elicited by unexpected slipping-like perturbations delivered during steady walking are characterized by an intersegmental coordination strategy resembling that adopted during unperturbed walking. Fifteen healthy subjects were asked to manage multidirectional slipping-like perturbations delivered while they walked steadily. The planar covariation law of elevation angles related to lower limb segments was the main observed variable related to unperturbed and perturbed strides. Principal component analysis was used to verify whether elevation angles covaried, both before and after the onset of the perturbation, and, if so, the orientation of the related planes of covariation was compared. Results revealed that the planar covariation law of the unperturbed limb after onset of the perturbation was systematically similar to that seen during steady walking. This occurred despite differences in range of motion and intersubject variability of both elevation and joint angles. The analysis strongly corroborates the hypothesis that the planar covariation law emerges from the interaction between spinal neural networks and limb mechanical oscillators. In particular, fast and stereotyped reactive strategies may result from the interaction among activities of downstream neural networks encrypting well-trained motor schemes, such as those related to walking, limb dynamics, and sensory motor information gathered during the perturbation. In addition, our results allowed us to speculate that rehabilitative treatment based on unexpected perturbations and relying on the plasticity of the central nervous system may also be effective in eliciting unimpaired intralimb coordination in neurological patients.
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Dierick, Frédéric, Céline Schreiber, Pauline Lavallée i Fabien Buisseret. "Asymptomatic Genu Recurvatum reshapes lower limb sagittal joint and elevation angles during gait at different speeds". Knee 29 (marzec 2021): 457–68. http://dx.doi.org/10.1016/j.knee.2021.02.003.
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MacLellan, Michael J., i Bradford J. McFadyen. "Proximal lower limb muscle energetics and the adaptation of segment elevation angle phasing for obstacle avoidance". Gait & Posture 37, nr 2 (luty 2013): 274–79. http://dx.doi.org/10.1016/j.gaitpost.2012.07.019.
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Courtine, Grégoire, i Marco Schieppati. "Tuning of a Basic Coordination Pattern Constructs Straight-Ahead and Curved Walking in Humans". Journal of Neurophysiology 91, nr 4 (kwiecień 2004): 1524–35. http://dx.doi.org/10.1152/jn.00817.2003.
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We tested the hypothesis that common principles govern the production of the locomotor patterns for both straight-ahead and curved walking. Whole body movement recordings showed that continuous curved walking implies substantial, limb-specific changes in numerous gait descriptors. Principal component analysis (PCA) was used to uncover the spatiotemporal structure of coordination among lower limb segments. PCA revealed that the same kinematic law accounted for the coordination among lower limb segments during both straight-ahead and curved walking, in both the frontal and sagittal planes: turn-related changes in the complex behavior of the inner and outer limbs were captured in limb-specific adaptive tuning of coordination patterns. PCA was also performed on a data set including all elevation angles of limb segments and trunk, thus encompassing 13 degrees of freedom. The results showed that both straight-ahead and curved walking were low dimensional, given that 3 principal components accounted for more than 90% of data variance. Furthermore, the time course of the principal components was unchanged by curved walking, thereby indicating invariant coordination patterns among all body segments during straight-ahead and curved walking. Nevertheless, limb- and turn-dependent tuning of the coordination patterns encoded the adaptations of the limb kinematics to the actual direction of the walking body. Absence of vision had no significant effect on the intersegmental coordination during either straight-ahead or curved walking. Our findings indicate that kinematic laws, probably emerging from the interaction of spinal neural networks and mechanical oscillators, subserve the production of both straight-ahead and curved walking. During locomotion, the descending command tunes basic spinal networks so as to produce the changes in amplitude and phase relationships of the spinal output, sufficient to achieve the body turn.
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Zhang, Leiyu, Jianfeng Li, Junhui Liu, Peng Su i Chunzhao Zhang. "Design and Kinematic Analysis of Co-Exoskeleton with Passive Translational Joints for Upper-Limb Rehabilitation". International Journal of Humanoid Robotics 15, nr 05 (27.09.2018): 1850020. http://dx.doi.org/10.1142/s0219843618500202.
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A key approach for reducing motor impairment and regaining independence after spinal cord injuries or strokes is frequent and repetitive functional training. A compatible exoskeleton (Co-Exoskeleton) with four passive translational joints is proposed for the upper-limb rehabilitation. There are only three passive translational joints to track and assist movements of the glenohumeral joint (GH), where two joints are installed horizontally at the front section and another one at the connecting interface of the upper arm. This type of configuration can lower the influences of gravities of the exoskeleton device and upper extremity. The kinematic models of GH and the corresponding human–machine system are established using the analytical method. A numerical simulation of the kinematic models is implemented with MATLAB to emphatically analyze the kinematic characteristics of passive joints and the center of Co-Exoskeleton. The translational displacements of passive joints in four elevation planes are obtained during the elevating process. The results of the kinematic analysis show that the passive joints have similar motion characteristics under different elevation planes. Additionally, the position changes of GH in three directions can be tracked and compensated approximately. Co-Exoskeleton has an especially good compensation effect for the vertical movement of GH. The compensation effect and kinematic models are verified by using the elevating experiments. This research provides theoretical and methodological guidance for the ergonomic design and kinematic analysis of the rehabilitation exoskeleton.
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Ashurkov, A. V., E. A. Levin, V. I. Murtazin, R. S. Kiselev, K. Yu Orlov, A. L. Krivoshapkin i V. A. Shabalov. "Spinal cord stimulation in treatment of patients with critical lower limb ischemia". Patologiya krovoobrashcheniya i kardiokhirurgiya 21, nr 2 (10.07.2017): 29. http://dx.doi.org/10.21688/1681-3472-2017-2-29-42.
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<p>Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.</p><p>Received 6 April 2017. Accepted 23 April 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>
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MacDonald, Allycia, Jason Dyke, Simon Khangure i Andrew Kelly. "055 An unusual presentation of SOD1-ALS: a case report". Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (lipiec 2019): A18.1—A18. http://dx.doi.org/10.1136/jnnp-2019-anzan.48.
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IntroductionApproximately 10% of amyotrophic lateral sclerosis (ALS) cases are inherited, of which 20% are due to mutations in the superoxide dismutase-1 gene (SOD1). MRI abnormalities are not uncommon in ALS, and there have been previous case reports of peripheral nerve enhancement in patients with SOD1 mutations, typically attributed to rapid neuronal degeneration.CaseA 31-year-old previously well Malaysian woman presented with a 3 month history of progressive lower limb weakness, initially involving the right lower limb but progressing to involve the left, requiring the use of a walking aid. Initial examination demonstrated asymmetric upper and lower motor neuron signs in bilateral upper and lower limbs. EMG findings were of a severe pure motor axonal process. CSF examination revealed elevated protein without significant elevation of white cells. MRI brain and spine demonstrated smooth cauda-equina ventral nerve root thickening and enhancement. Treatment with intravenous immunoglobulin and high dose corticosteroid was commenced for a presumed inflammatory process, with no clinical improvement. A cauda-equina nerve root biopsy was performed, demonstrating features consistent with an immune-mediated demyelinating neuropathy. The patient continued to deteriorate, developing flaccid upper limb weakness and facial involvement. Plasma exchange, azathioprine, cyclophosphamide, and rituximab were sequentially administered over the following two months without altering the rate of disease progression. Genetic testing returned a positive SOD1 heterozygous gene mutation, confirming the diagnosis of ALS.ConclusionsWe present a case of SOD1-ALS with atypical features on imaging and histopathology suggesting an underlying demyelinating process, expanding the known clinical spectrum of this mutation.
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Cearra, Iñigo, Borja Herrero de la Parte, Inmaculada Ruiz Montesinos, Ana Alonso-Varona, Diana Isabel Moreno-Franco i Ignacio García-Alonso. "Effects of Folinic Acid Administration on Lower Limb Ischemia/Reperfusion Injury in Rats". Antioxidants 10, nr 12 (25.11.2021): 1887. http://dx.doi.org/10.3390/antiox10121887.
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Surgery under ischemic conditions, lasting up to 3 h, is routinely performed in orthopedic surgery, causing undesirable injury due to ischemia-reperfusion syndrome, with short and medium-term functional repercussions. To date, there is no established prophylactic treatment. In this work we evaluated folinic acid (FA) in a rodent model of lower limb ischemia-reperfusion (IRI-LL). 36 male WAG rats underwent 3 h of lower limb ischemia. In the saline group, rats received intraperitoneal administration of saline (used as vehicle for treatment). In the experimental group, rats were pretreated with FA (2.5 mg/kg) before the end of ischemia. After ischemia, animals were sacrificed at 3 h, 24 h or 14 days (for biochemical determination (Na+, K+, Cl-, urea, creatinine, CK, LDH, ALP, ALT, and AST), pathological assessment, or functional study using the rotarod test; respectively). Another six animals were used to establish the reference values. The prophylactic administration of FA significantly reduced the elevation of biochemical markers, especially those that most directly indicate muscle damage (CK and LDH). In addition, it also improved direct tissue damage, both in terms of edema, weight, PMN infiltrate and percentage of damaged fibers. Finally, the administration of FA allowed the animals to equal baseline values in the rotarod test; what did not occur in the saline group, where pre-ischemia levels were not recovered. Following 3 h of lower limb ischemia, FA minimizes the increase of CK and LDH, as well as local edema and leukocyte infiltration, allowing a faster recovery of limb functionality. Therefore, it could be considered as a prophylactic treatment when tourniquet is used in clinics.
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MacLellan, M. J., G. Catavitello, Y. P. Ivanenko i F. Lacquaniti. "Planar covariance of upper and lower limb elevation angles during hand–foot crawling in healthy young adults". Experimental Brain Research 235, nr 11 (11.08.2017): 3287–94. http://dx.doi.org/10.1007/s00221-017-5060-y.
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Feipel, Veronique, Sandra Dalenne, Pierre-Michel Dugailly, Patrick Salvia i Marcel Rooze. "Kinematics of the Lumbar Spine During Classic Ballet Postures". Medical Problems of Performing Artists 19, nr 4 (1.12.2004): 174–80. http://dx.doi.org/10.21091/mppa.2004.4029.
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Postural characteristics and three-dimensional (3D) kinematics of the lumbar spine were examined during classic ballet gestures in 25 expert dancers (17 females, 8 males; mean age, 21 ± 4 yrs). The 3D displacements of the thorax to the pelvis were sampled with a 3D-electrogoniometer during right and left arabesque, developpe a la seconde, and pied-en-main, and a photographic technique was used to calculate lower-limb elevation, shoulder inclination, and tragus or C7 displacement. The incidence of low-back (43%) and hip pain (40%) was large. Arabesque was characterized by lumbar extension (20-25°), ipsilateral bending (˜20°), and contralateral rotation (˜10°), and a 90° angle between the thighs. During pied-enmain and developpe a la seconde, lumbar flexion (˜30°), ipsilateral bending (10–15°), and contralateral rotation (˜20°) occurred. The angle between the thighs was 150° and 120°, respectively. There was poor correlation between medical history, anthropometrical characteristics, and postural and kinematics variables, except for shoulder inclination, which differed significantly between dancers with hip or low-back problems and those without complaints. We conclude that no relationship exists between hip flexibility and the lumbar spine contribution to various ballet tasks, suggesting that lower-limb elevation during arabesque and developpe a la seconde depends more on hip flexibility than on a lumbar contribution.
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Bee, J. A., i R. Jeffries. "The relationship between intracellular calcium levels and limb bud chondrogenesis in vitro". Development 100, nr 1 (1.05.1987): 73–81. http://dx.doi.org/10.1242/dev.100.1.73.
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Under standard culture conditions, chondrogenic expression by stage-21 embryonic chick limb bud mesenchyme is dependent upon high cell plating densities. Alternatively, when cultured in suspension aggregating limb bud cells differentiate exclusively as cartilage. We have previously demonstrated that the aggregation of prechondrogenic limb bud cells is specifically mediated by a Ca2+ -dependent mechanism. In the present paper, we examine the involvement of calcium cations in chondrogenic expression in vitro. During cartilage differentiation, we demonstrate that limb bud cells elevate their intracellular Ca2+ levels to achieve a conserved plateau level. This increase in intracellular Ca2+ levels does not occur in sparse cell cultures, which also fail to demonstrate cartilage differentiation. Although elevation of extracellular Ca2+ concentration effects precocious chondrogenesis, ultimately this is substantially lower than in control cultures. In contrast, elevation of intracellular Ca2+ levels by the addition of 0á1 μm-A23187 readily stimulates precocious and extensive cartilage differentiation. 0á1μm-A23187 initially elevates intracellular Ca2+ levels to that required for cartilage differentiation but this then continues to increase concomitant with a reduction in cartilage nodule size. 10μm-retinoic acid completely inhibits chondrogenesis in vitro and elevates intracellular Ca2+ to particularly high levels. Our data indicate the central role of controlled intracellular Ca2+ levels to normal chondrogenic expression. Deviation from this level by cells that either fail to achieve or that exceed it inhibits subsequent cartilage development, and can cause a loss of phenotypic expression by differentiated cartilage.
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Agrawal, Subhash Kumar, Priyanka Agrawal, Sudhakar Dwivedi i Avtar Singh Yadav. "LOWER LIMB ELEVATION AS AN ALTERNATIVE TO PRELOADING FOR PREVENTING HYPOTENSION DURING SPINAL ANAESTHESIA FOR BELOW UMBILICAL SURGERIES". Journal of Evolution of Medical and Dental Sciences 3, nr 12 (21.03.2014): 3130–34. http://dx.doi.org/10.14260/jemds/2014/2255.
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Verouhis, Dinos, Peder Sörensson, Andrey Gourine, Loghman Henareh, Jonas Persson, Nawzad Saleh, Martin Sundqvist i in. "EFFECT OF LOWER LIMB REMOTE ISCHEMIC CONDITIONING ON INFARCT SIZE IN PATIENTS WITH ANTERIOR ST-ELEVATION MYOCARDIAL INFARCTION". Journal of the American College of Cardiology 67, nr 13 (kwiecień 2016): 607. http://dx.doi.org/10.1016/s0735-1097(16)30608-8.
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Verret, Claire Isabelle, Meridith Pollie, Jona Kerluku, Sravan Dhulipala i Duretti Fufa. "Evaluating the Effect of Leg Position and Negative Pressure Wound Therapy on Lower Extremity Oxygenation Measured by Noninvasive Tissue Oximetry: A Pilot Study". Journal of Reconstructive Microsurgery Open 05, nr 02 (lipiec 2020): e79-e81. http://dx.doi.org/10.1055/s-0040-1717110.
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Abstract Background Flap loss is a catastrophic complication following lower extremity reconstructions. Close monitoring can detect circulatory changes, particularly when introducing gravity through dangle protocols. Noninvasive near-infrared spectroscopy (NIRS) tissue oximetry is one such method used for continuous monitoring of tissue perfusion. Recently, negative pressure wound therapy (NPWT) has been for compromised flaps salvage. We used NIRS to study the impact of leg positioning and NPWT on lower extremity perfusion during a mock dangle protocol. Methods A tissue oximeter transcutaneous probe was placed on each lower limb of five normal patients at the location of the highest density of peroneal artery perforators along the distal one-third fibula. The experimental leg probe was covered with NPWT at 100 mm Hg. The contralateral leg served as control. Tissue oxygen saturation (StO2) was measured continuously for 140 minutes. Leg position was changed in every 20 minutes to mimic a dangle protocol. Results Our results showed higher StO2 with leg elevation, and lower StO2 in dependent positions in the control limb. StO2 was consistently higher in the limb with NPWT, which had a slower rate of deoxygenation with introduction of gravity. In both conditions, on returning to neutral position from the dependent, StO2 returned to levels close to baseline. Conclusion These data provide further information on hemodynamic changes introduced by gravity, and how NPWT might modulate these changes.
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Grome, Luke, i William Pederson. "Microsurgical Reconstruction of the Lower Extremity". Seminars in Plastic Surgery 33, nr 01 (luty 2019): 054–58. http://dx.doi.org/10.1055/s-0039-1677878.
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AbstractReconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.
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Alexander, Nick, Giovanni Kurniawan Sudargo i Tiya Setiadi. "Acute limb ischemia in patients after myocardial infarction". International Journal of Research in Medical Sciences 10, nr 7 (28.06.2022): 1539. http://dx.doi.org/10.18203/2320-6012.ijrms20221802.
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Acute limb ischemia is a sudden onset lower extremity emergency that threatens tissue viability and usually occurs within 14 days of symptom onset. Acute limb ischemia is one of the complications of myocardial infarction. In this case, a 54-year-old male patient came to the ER with the chief complaint of shortness of breath 30 minutes before going to the hospital, accompanied by cold sweat and nausea. The patient was diagnosed with acute pulmonary oedema, non-ST elevation myocardial infarction (NSTEMI), hypertensive heart disease with diastolic dysfunction, heart failure with decreased ejection fraction and type 2 diabetes mellitus. On the 6th day of treatment, the patient complained of right leg pain accompanied by coldness and difficulty moving. The patient was diagnosed with acute limb ischemia. This patient did not undergo endovascular revascularization surgery due to limited facilities and experts. The patient was given pharmacological therapy and the complaints improved. Therefore, it is important to be able to identify acute limb ischemia and be able to provide prompt and appropriate treatment.
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Devlin, Michael, Craig Costello, Georgina Hodges i Ravindra Urkude. "091 Poems syndrome treated with autologous stem cell transplant". Journal of Neurology, Neurosurgery & Psychiatry 89, nr 6 (24.05.2018): A36.3—A37. http://dx.doi.org/10.1136/jnnp-2018-anzan.90.
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IntroductionAcquired demyelinating neuropathies comprise a diverse spectrum of individual diseases and pathophysiological processes. Differential diagnoses can be distinguished through assessment of region of involvement, time course, neurophysiology and ancillary testing. Where an atypical presentation of chronic inflammatory demyelinating polyradiculoneuropathy arises, further investigation and changes to management are required. We present a single case report from the Townsville Hospital.CaseA 45 year old man presented with two months of altered sensation in the distal lower extremities. Lower limb weakness developed, and three months after symptoms onset the patient had bilateral foot drop, and developed sensory disturbance in the upper limbs. Electrophysiological testing revealed severely reduced lower limb CMAPs with demyelinating range conduction velocity without conduction block; upper limb SNAPs were normal in amplitude with conduction velocity slowing. A lumbar puncture revealed elevated CSF protein 870 mg/L without raised white cells. A trace lambda IgG band of uncertain significance was detected. IVIG was commenced and symptoms initially stabilised. After four months of monthly IVIG, symptoms worsened and neurophysiology revealed further neurogenic changes. Skeletal survey and whole Spine MR STIR sequences did not reveal any bony lesions, and bone marrow biopsy revealed 5% plasmacytosis. The patient’s functional status deteriorated to full-time wheelchair use despite escalation of therapy. Sural nerve biopsy revealed axonal loss and demyelination without inflammation. A final diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes) syndrome was confirmed with vascular endothelial growth factor elevation, and the patient underwent an autologous stem cell transplant with significant improvement in symptoms and functional status by day 100.ConclusionPOEMS syndrome is a rare disorder and should be suspected in atypical cases of CIDP particularly when treatment resistance is present. Extensive investigation is often required to meet diagnostic criteria for POEMS.
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Dewolf, A. H., Y. Ivanenko, K. E. Zelik, F. Lacquaniti i P. A. Willems. "Kinematic patterns while walking on a slope at different speeds". Journal of Applied Physiology 125, nr 2 (1.08.2018): 642–53. http://dx.doi.org/10.1152/japplphysiol.01020.2017.
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During walking, the elevation angles of the thigh, shank, and foot (i.e., the angle between the segment and the vertical) covary along a characteristic loop constrained on a plane. Here, we investigate how the shape of the loop and the orientation of the plane, which reflect the intersegmental coordination, change with the slope of the terrain and the speed of progression. Ten subjects walked on an inclined treadmill at different slopes (between −9° and +9°) and speeds (from 0.56 to 2.22 m/s). A principal component analysis was performed on the covariance matrix of the thigh, shank, and foot elevation angles. At each slope and speed, the variance accounted for by the two principal components was >99%, indicating that the planar covariation is maintained. The two principal components can be associated to the limb orientation (PC1*) and the limb length (PC2*). At low walking speeds, changes in the intersegmental coordination across slopes are characterized mainly by a change in the orientation of the covariation plane and in PC2* and to a lesser extent, by a change in PC1*. As speed increases, changes in the intersegmental coordination across slopes are more related to a change in PC1 *, with limited changes in the orientation of the plane and in PC 2*. Our results show that the kinematic patterns highly depend on both slope and speed. NEW & NOTEWORTHY In this paper, changes in the lower-limb intersegmental coordination during walking with slope and speed are linked to changes in the trajectory of the body center of mass. Modifications in the kinematic pattern with slope depend on speed: at slow speeds, the net vertical displacement of the body during each step is related to changes in limb length and orientation. When speed increases, the vertical displacement is mostly related to a change in limb orientation.
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Shim, Myounghoon, Jong In Han, Ho Seon Choi, Seong Min Ha, Jung-Hoon Kim i Yoon Su Baek. "Terrain Feature Estimation Method for a Lower Limb Exoskeleton Using Kinematic Analysis and Center of Pressure". Sensors 19, nr 20 (12.10.2019): 4418. http://dx.doi.org/10.3390/s19204418.
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While controlling a lower limb exoskeleton providing walking assistance to wearers, the walking terrain is an important factor that should be considered for meeting performance and safety requirements. Therefore, we developed a method to estimate the slope and elevation using the contact points between the limb exoskeleton and ground. We used the center of pressure as a contact point on the ground and calculated the location of the contact points on the walking terrain based on kinematic analysis of the exoskeleton. Then, a set of contact points collected from each step during walking was modeled as the plane that represents the surface of the walking terrain through the least-square method. Finally, by comparing the normal vectors of the modeled planes for each step, features of the walking terrain were estimated. We analyzed the estimation accuracy of the proposed method through experiments on level ground, stairs, and a ramp. Classification using the estimated features showed recognition accuracy higher than 95% for all experimental motions. The proposed method approximately analyzed the movement of the exoskeleton on various terrains even though no prior information on the walking terrain was provided. The method can enable exoskeleton systems to actively assist walking in various environments.
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Adly, Merna, Kwadwo Mponponsuo i Ranjani Somayaji. "Podoconiosis: an important but forgotten cause of non-filarial lymphoedema". WCET Journal 39, nr 3 (2019): 10–14. http://dx.doi.org/10.33235/wcet.39.3.10-14.
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Podoconiosis is a preventable, non-infectious and non-communicable cause of lymphoedema leading to chronic swelling of the foot and lower leg. Most prevalent in Africa, Central America and India, it is caused by long-term exposure to irritant red volcanic clay soil. Risk factors for disease are related to the absence or inadequacy of footwear. However, not all those at risk develop the disease, indicating that both genetic and environmental predispositions contribute to disease development. Symptoms of podoconiosis include asymmetrical limb swelling with associated itching, burning sensation and lymphatic ooze. Late stages are characterised by irreversible swelling and joint fixation. Due to the disfiguring nature of the disease, those affected often experience social stigmatisation. Associated economic losses result from reduced productivity and absenteeism. The disease must be differentiated from conditions such as filarial lymphoedema and congenital lymphoedema, which can have similar presentations, such that appropriate therapy can be implemented. Primary management of podoconiosis is prevention which involves the regular use footwear such as shoes and education of the disease. In the early stages of podoconiosis, compression therapy and limb elevation delays clinical progression in affected individuals. In later stages, changes are irreversible; however, additional therapy can include surgical intervention and limb elevation for symptom control. Psychosocial care is also needed to address the mental distress associated with the disease. Despite the preventable nature of podoconiosis, it remains prevalent in developing countries, necessitating further investment of resources.
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Hicheur, Halim, Alexander V. Terekhov i Alain Berthoz. "Intersegmental Coordination During Human Locomotion: Does Planar Covariation of Elevation Angles Reflect Central Constraints?" Journal of Neurophysiology 96, nr 3 (wrzesień 2006): 1406–19. http://dx.doi.org/10.1152/jn.00289.2006.
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To study intersegmental coordination in humans performing different locomotor tasks (backward, normal, fast walking, and running), we analyzed the spatiotemporal patterns of both elevation and joint angles bilaterally in the sagittal plane. In particular, we determined the origins of the planar covariation of foot, shank, and thigh elevation angles. This planar constraint is observable in the three-dimensional space defined by these three angles and corresponds to the plane described by the three time-varying elevation angle variables over each step cycle. Previous studies showed that this relation between elevation angles constrains lower limb coordination in various experimental situations. We demonstrate here that this planar covariation mainly arises from the strong correlation between foot and shank elevation angles, with thigh angle independently contributing to the pattern of intersegmental covariation. We conclude that the planar covariation of elevation angles does not reflect central constraints, as previously suggested. An alternative approach for analyzing the patterns of coordination of both elevation and joint (hip, knee, and ankle) angles is used, based on temporal cross-correlation and phase relationships between pairs of kinematic variables. We describe the changes in the pattern of intersegmental coordination that are associated with the changes of locomotor modes and locomotor speeds. We provide some evidence for a distinct control of thigh motion and discuss the respective contributions of passive mechanical factors and of active (arising from neural control) factors to the formation and the regulation of the locomotor pattern throughout the gait cycle.
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KIDA, Tomohiro, Toshihiro OHNUMA i Toshiaki SUZUKI. "Relationships among the Height of Unilateral Lower-limb Elevation, Body Movements, and the Location of Center of Pressure When Sitting". Rigakuryoho Kagaku 33, nr 3 (2018): 481–85. http://dx.doi.org/10.1589/rika.33.481.
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