Thorax, pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees: biomechanical analysis.

BACKGROUND Lower limb amputees exhibit postural control deficits during standing which can affect their walking ability. OBJECTIVES The primary purpose of the present study was to analyze the thorax, pelvis, and hip kinematics and the hip internal moment in the frontal plane during gait in subjects with Unilateral Transtibial Amputation (UTA). METHOD The participants included 25 people with UTA and 25 non-amputees as control subjects. Gait analysis was performed using the Vicon(r) Motion System. We analyzed the motion of the thorax, pelvis, and hip (kinematics) as well as the hip internal moment in the frontal plane. RESULTS The second peak of the hip abductor moment was significantly lower on the prosthetic side than on the sound side (p=.01) and the control side (right: p=.01; left: p=.01). During middle stance, the opposite side of the pelvis was higher on the prosthetic side compared to the control side (right: p=.01: left: p=.01). CONCLUSIONS The joint internal moment at the hip in the frontal plane was lower on the prosthetic side than on the sound side or the control side. Thorax and pelvis kinematics were altered during the stance phase on the prosthetic side, presumably because there are mechanisms which affect postural control during walking.

Multi-parametric evaluation of sit-to-stand and stand-to-sit transitions in elderly people.

The aim of this study was to extract multi-parametric measures characterizing different features of sit-to-stand (Si-St) and stand-to-sit (St-Si) transitions in older persons, using a single inertial sensor attached to the chest. Investigated parameters were transition's duration, range of trunk tilt, smoothness of transition pattern assessed by its fractal dimension, and trunk movement's dynamic described by local wavelet energy. A measurement protocol with a Si-St followed by a St-Si postural transition was performed by two groups of participants: the first group (N=79) included Frail Elderly subjects admitted to a post-acute rehabilitation facility and the second group (N=27) were healthy community-dwelling elderly persons. Subjects were also evaluated with Tinetti's POMA scale. Compared to Healthy Elderly persons, frail group at baseline had significantly longer Si-St (3.85±1.04 vs. 2.60±0.32, p=0.001) and St-Si (4.08±1.21 vs. 2.81±0.36, p=0.001) transition's duration. Frail older persons also had significantly decreased smoothness of Si-St transition pattern (1.36±0.07 vs. 1.21±0.05, p=0.001) and dynamic of trunk movement. Measurements after three weeks of rehabilitation in frail older persons showed that smoothness of transition pattern had the highest improvement effect size (0.4) and discriminative performance. These results demonstrate the potential interest of such parameters to distinguish older subjects with different functional and health conditions.

Dynamic properties of human brain structure: learning-related changes in cortical areas and associated fiber connections.

Recent findings in neuroscience suggest that adult brain structure changes in response to environmental alterations and skill learning. Whereas much is known about structural changes after intensive practice for several months, little is known about the effects of single practice sessions on macroscopic brain structure and about progressive (dynamic) morphological alterations relative to improved task proficiency during learning for several weeks. Using T1-weighted and diffusion tensor imaging in humans, we demonstrate significant gray matter volume increases in frontal and parietal brain areas following only two sessions of practice in a complex whole-body balancing task. Gray matter volume increase in the prefrontal cortex correlated positively with subject's performance improvements during a 6 week learning period. Furthermore, we found that microstructural changes of fractional anisotropy in corresponding white matter regions followed the same temporal dynamic in relation to task performance. The results make clear how marginal alterations in our ever changing environment affect adult brain structure and elucidate the interrelated reorganization in cortical areas and associated fiber connections in correlation with improvements in task performance.

Atypical headache following dural puncture in obstetrics.

BACKGROUND: In obstetrics, post-dural puncture headache is a well-recognised complication. Typical symptoms include fronto-temporal or occipital headache, worsening with ambulation and improving in the decubitus position. Occasionally, patients present with non-postural headache, although relatively little is known about this atypical presentation. The purpose of this study was to determine the incidence, associated signs and risk factors for this atypical manifestation of post-dural puncture headache. METHODS: We analysed a series of 27 064 parturients having a neuraxial procedure between January 2001 and December 2010. Using data from electronic anaesthesia patient records, medical charts and a postpartum quality audit, we identified all parturients with atypical post-dural puncture headache. We assessed the incidence and used uni- and multivariate analysis to identify associated risk factors. RESULTS: Amongst 142 parturients with post-dural puncture headache, eight (5.6%, 95% CI 1.7-9.4%) had atypical non-postural headache. Associated symptoms were stiffness and pain in the cervical, thoracic or lumbar vertebral area, visual disturbances and vertigo. Significant risk factors for developing atypical signs were previous migraine, odds ratio 6.1 (95% CI 1.2-28.7), a more cephalad level of needle insertion, odds ratio 17.2 (95% CI 1.4-210.1) and identification of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter, odds ratio 5.5 (95% CI 1.2-24.4). Following multivariate analysis, recognition of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter was the most significant predictor of non-orthostatic postdural puncture headache. CONCLUSION: Anaesthetists should be aware of this atypical clinical presentation, particularly if there is a past history of migraine, a more cephalad level of needle insertion or identification of dural puncture by aspiration of cerebrospinal fluid from the epidural catheter.

Interventions aiming at balance confidence improvement in older adults: an updated review.

BACKGROUND: Loss of balance confidence is a frequent condition that affects 20-75% of community-dwelling older persons. Although a recent fall is a common trigger, loss of balance confidence also appears independent of previous experience with falls. Maintaining or improving balance confidence is important to avoid unnecessary, self-imposed restrictions of activity and subsequent disability. Holding another person's hand or using an assistive device while walking are simple interventions that are used naturally to address poor balance confidence in daily life. However, more complex interventions have also been developed and tested to achieve more sustained improvement in balance confidence. OBJECTIVES: This review describes interventions that have been tested to improve balance confidence in older community-dwelling persons. METHODS: Based on 2 recent systematic reviews, an additional search for literature was performed to update current information on interventions aiming at balance confidence improvement. Interventions were classified as those directly aimed at increasing balance confidence or not, and further stratified into those using monofactorial or multifactorial approaches. RESULTS: A total of 46 randomized controlled trials were identified. Five of the 8 interventions that directly targeted balance confidence showed benefits. Among those, multicomponent behavioral group interventions provided the most robust evidence of benefits in improving balance confidence and in decreasing activity avoidance. Among interventions not directly aiming at balance confidence improvement (11/21 studies with benefits), exercise (including tai chi) appears as the most promising monofactorial intervention. Nine of the 17 multifactorial fall prevention programs showed an effect on balance confidence, exercise being a main component in 7 of these 9 studies. Interventions that targeted elderly persons reporting poor balance confidence and/or those at risk for falls seemed more likely to be beneficial. CONCLUSIONS: Positive and sometimes sustained improvement in balance confidence can be achieved by various interventions among community-dwelling elderly persons. The effect of these interventions on activity restriction associated with poor balance confidence have been less well studied, but some studies also suggest potential benefits.

Association of working conditions with self-reported work-related symptoms: results from the Swiss dataset of the European Working Conditions Survey

Working conditions are important determinants of health. The aims of this article are to 1) identify working conditions and work characteristics that are associated with workers' perceptions that their work is harmful to their health and 2) identify with what symptoms these working conditions are associated.We used the Swiss dataset from the 2005 edition of the European Working Conditions Survey. The dependent variable was based on the question "Does your work affect your health?". Logistic regression was used to identify a set of variables collectively associated with self-reported work-related adverse health effects.A total of 330 (32%) participants reported having their health affected by work. The most frequent symptoms included backache (17.1%), muscular pains (13.1%), stress (18.3%) and overall fatigue (11.7%). Scores for self-reported exposure to physicochemical risks, postural and physical risks, high work demand, and low social support were all significantly associated with workers' perceptions that their work is harmful to their health, regardless of gender or age. A high level of education was associated with stress symptoms, and reports that health was affected by work was associated with low job satisfaction.Many workers believe that their work affects their health. Health specialists should pay attention to the potential association between work and their patients' health complaints. This is particularly relevant when patients mention symptoms such as muscular pains, backache, overall fatigue, and stress. Specific attention should be given to complaints of stress in highly educated workers.

L'educació vocal en la formació inicial dels docents a l'Estat espanyol: situació i propostes de canvi

Aquest article comença amb un repàs a les situacions de risc vocal que suporten diàriament els docents en el desenvolupament de la seva tasca i continua amb la presentació de les dades més rellevants de salut vocal dels docents de l'Estat espanyol, recollides a les principals recerques específiques. Més endavant, es revisa la situació que ocupa l'educació vocal en la formació inicial dels docents i, finalment, es descriuen els blocs de continguts d'una proposta de formació vocal (treball postural, treball respiratori i treball vocal), i els espais en què aquesta proposta podria ser inserida en els plans d'estudi de formació inicial dels docents de l'Estat espanyol.

Comparació entre dos mètodes d'estiraments ; estàtic i dinàmic, realitzats en l'escalfament de curses i entrenaments de 60, 100 i 110 metres tanques

Aquest estudi es basa en l'idea de que l'escurçament de la cadena musuclar posterior és una causa important del mal d'esquena en nens. És per aquest motiu que es planteja un tractament per a prevenir l'escurçament de la cadena muscular posterior i el mal d'esquena en forma de sessions de Stretching Global Actiu, mètode basat en la Reeducació Postural Global del mateix Ph.E. Souchard, que es posarà en pràctica en 3 escoles diferents de la comarca d'Osona. L'estudi té una durada de 3 cursos escolars (3r, 4t i 5è de primària) en el qual els nens seleccionats per al grup experimental (n=30) realitzaran classes de Stretching Global Actiu dues vegades a la setmana durant 3 mesos en cada curs escolar. Tres escoles més formaran el grup control (n=30) i s'espera que els nens que formen part del grup experimental millorin la flexibilitat de la cadena musuclar posterior (això es podrà observar a través dels resultats del test "sit and reach") i que no presentin mal d'esquena en el transcurs de 3 anys (durada de l'estudi).

La teràpia assistida amb gossos: una eina terapèutica en el tractament de la fisioteràpia en ens amb paràlisi cerebral espàstica

La Teràpia Assistida amb Animals (TAA) mostra antecedents des del segle XX utilitzant diversos animals amb finalitats terapèutiques, però en realitat, hi ha pocs estudis sobre els beneficis de la TAA. Si partim de que hi ha poca informació i recerca en la globalitat d‟aquest tipus de teràpia s‟ha de dir que la recerca clínica de La Teràpia Assistida amb Gossos en l‟àmbit de Rehabilitació Pediàtrica en Fisioteràpia és un món per descobrir. L‟estudi i investigació de “La Teràpia Assistida amb gossos: una eina terapèutica en el tractament de Fisioteràpia en nens amb Lesió Cerebral Espàstica” v ol mostrar de manera qualitativa els beneficis que pot duu a terme aquesta tipologia de treball mitjançant el gos com a eina motivadora en el tractament de Fisioteràpia. L‟estudi consta d‟un grup mostra de 4 nens amb Lesió Cerebral Espàstica que realitzaran un tractament amb Teràpia Assistida amb Gossos d‟un curs de durada, realitzant una sessió per setmana de manera individual on l‟objectiu serà treballar la Rehabilitació Física mitjançant diverses tipologies d‟exercicis enfocades a millorar el control cefàlic, fomentar el control del to muscular , afavorir la bipedestació i/o marxa i estimular la motricitat fina. El recull es farà qualitativament mitjançant diari de camp i visionats d‟imatges.

Preserving the health of ambulance personnel : some preliminary results from a study of pre-hospital emergency interventions

Little is known about the health of ambulance personnel, especially in Switzerland. This lack of knowledge is particularly striking in the specific field of occupational health. This study aims to identify and better understand protective and risk factors affecting the health of ambulance personnel. Both mental and physical health are considered. The approach used comprised two steps. The first step began in July 2008 and consisted in a qualitative study of real work activities performed by ambulance crews involved in pre-hospital emergency interventions. Researchers shadowed ambulance personnel for the duration of their entire work shift, in average for one week. The paper-pen technique was used to note dialogues, interactions, postural aspects, etc. When the situation allowed it, interventions were filmed. Some selected video sequences were used as a support for selfconfrontation interviews. Observations were performed by three researchers and took place in eleven services, for a total of 416 hours of observations (including 72 interventions + waiting time). Analysis, conducted by a multidisciplinary team (an ergonomist, an occupational therapist and a health psychologist), focused on individual and collective strategies used by ambulance personnel to protect their health. The second step, which is currently ongoing, aims to assess global health of ambulance personnel. A questionnaire is used to gather information about musculoskeletal complaints (Nordic questionnaire), mental health (GHQ-12), stress (Effort-Reward imbalance questionnaire), strategies implemented to cope with stress (Brief COPE), and working conditions. Specific items on strategies were developed based on observational data. It will be sent to all ambulance personnel employed in the French-speaking part of Switzerland. Preliminary analyses show different types of strategies used by ambulance personnel to preserve their health. These strategies involve postural aspects (e.g. use doorframe as a support to ease delicate manipulations), work environment adaptations (e.g. move furniture to avoid awkward postures), coping strategies (e.g. humor), as well as organisational (e.g. formal and informal debriefing) and collective (e.g. cooperation) mechanisms. In-depth analysis is still ongoing. However, patient safety and comfort, work environment and available resources appear to influence the choice of strategies ambulance personnel use. As far as possible, the strategies identified will be transformed into educational materials for professional ambulance personnel.

Neck complaints in the pediatric emergency department: a consecutive case series of 170 children.

OBJECTIVES: To describe the spectrum of pathologies responsible for neck ailments in a primary care pediatric emergency setting and evaluate their outcome. METHODS: All children aged 16 years or younger, who presented to the emergency department of the Children's Hospital of Lausanne during a 1-year period, were retrospectively identified and charts were reviewed. Causes of neck complaints were classified as traumatic (group 1), infectious (group 2), postural (group 3), or miscellaneous (group 4) according to the final diagnosis. History and physical examination findings, radiological and laboratory results, as well as patient outcomes were recorded. RESULTS: During the study period, 28,722 children were observed in the emergency department, and 170 were identified as having neck complaints. The number of patients with neck ailments in group 1 was 105 (62%). Group 2 contained 33 patients (19%), of which 28 (16.5%) had a viral infection and 5 (2.9%) had a bacterial infection. Group 3 contained 30 children (17.6%) and group 4 contained 2 children (1.2%). Cervical spine radiography was performed on an emergency basis in 60 children (57 in group 1, 2 in group 2, and 1 in group 3). Significant abnormalities were observed in 6 children. Cervical computed tomography (CT) was performed in 9 children, from which 5 were in group 1, 3 were in group 2, and 1 was in group 4. The CT scan revealed pathologic findings in 6 children. Follow-up data were available in 135 patients (79.4%), of which 129 (95.6%) experienced complete recovery in less than 2 weeks. Admission to the hospital was necessary in 4 children (1 in group 1 and 3 in group 2), including 2 for emergency surgical drainage of retropharyngeal abscesses. One child with posttraumatic torticollis was treated conservatively as an outpatient and recovered in 7 weeks. One child was had his/her condition eventually diagnosed with osteoid osteoma and treated with oral nonsteroidal anti-inflammatory drug. CONCLUSIONS: Most cases of neck ailments in children presenting to the emergency department were due to trauma or infection, which were effectively managed as outpatients. When signs and symptoms suggested an emergent cause, CT provided a definitive diagnosis. The evaluation of a child presenting with acute neck complaints should be based on history and physical examination. Plain radiographs and CT scan are contributive in selected cases.

Programa educativo sobre el cuidado de espalda en niños de 4º de primaria y su posterior valoración a lo largo de 6 años.

Introducción: Según la bibliografía encontrada no está claro de donde procede concretamente el dolor de espalda en la infancia, pero según los últimos estudios realizados se inclinan hacia el factor psicosocial. Aun así no descartan en ningún momento que se deba de realizar una educación desde todos los aspectos, ya que hay varios factores que pueden ayudar a su aparición y perpetuación. Los estudios relacionados con el tema indican que en los programas educativos llevados a cabo los conocimientos se mantienen a lo largo de 2 años. En estas intervenciones no se incluye el lado psicosocial de las personas, sino que se centran solamente en el aspecto mecánico y con muy pocas sesiones o en su mayoría solamente teóricas. Objetivo: valorar la adquisición de conocimientos sobre el cuidado de espalda en 4º de primaria y a lo largo de 6 años. Metodología: para llevar a cabo este proyecto se incluirán dos colegios de Pamplona con alumnos de 4º primaria. Uno de ellos será de control y en el otro se impartirá un programa educativo sobre el cuidado de espalda. Antes de comenzar con el programa se pasarán las encuestas para valorar los conocimientos, la escala de valoración del estado anímico y dolor “face rating scale”. Una vez acabas con ellas, empezará la intervención de 5 semanas, dos clases por semana. Las clases serán de una hora, dos horas por semana, una teórica y otra práctica. Una vez acabado el programa se volverán a pasar las tres encuestas en los dos colegios y a continuación a lo largo de los 6 años que dura el estudio para valorar cómo evolucionan los conocimientos adquiridos.

Capillarity and fibre types in locomotory muscles of wild yellow-legged gulls (Larus cachinnans)

This study analyzes the capillarity and fibre-type distribution of six locomotory muscles of gulls. The morphological basis and the oxygen supply characteristics of the skeletal muscle of a species with a marked pattern of gliding flight are established, thus contributing to a better understanding of the physiology of a kind of flight with low energetic requirements. The four wing muscles studied (scapulotriceps, pectoralis, scapulohumeralis, and extensor metacarpi) exhibited higher percentages of fast oxidative glycolytic fibres (>70%) and lower percentages of slow oxidative fibres (<16%) than the muscles involved in nonflight locomotion (gastrocnemius and iliotibialis). Capillary densities ranged from 816 to 1,233 capillaries mm(-2), having the highest value in the pectoralis. In this muscle, the fast oxidative glycolytic fibres had moderate staining for succinate dehydrogenase and relatively large fibre sizes, as deduced from the low fibre densities (589-665 fibres mm(-2)). All these findings are seen as an adaptive response for gliding, when the wing is held outstretched by isometric contractions. The leg muscles studied included a considerable population of slow oxidative fibres (>14% in many regions), which suggests that they are adapted to postural activities. Regional variations in the relative distributions of fibre types in muscle gastrocnemius may reflect different functional demands placed on this muscle during terrestrial and aquatic locomotion. The predominance of oxidative fibres and capillary densities under 1,000 capillaries mm(-2) in leg muscles is probably a consequence of an adaptation for slow swimming and maintenance of the posture on land rather than for other locomotory capabilities, such as endurance or sprint activities.

Monitoring Fatigue Status with HRV Measures in Elite Athletes : An Avenue Beyond RMSSD?

Among the tools proposed to assess the athlete's "fatigue," the analysis of heart rate variability (HRV) provides an indirect evaluation of the settings of autonomic control of heart activity. HRV analysis is performed through assessment of time-domain indices, the square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals (RMSSD) measured during short (5 min) recordings in supine position upon awakening in the morning and particularly the logarithm of RMSSD (LnRMSSD) has been proposed as the most useful resting HRV indicator. However, if RMSSD can help the practitioner to identify a global "fatigue" level, it does not allow discriminating different types of fatigue. Recent results using spectral HRV analysis highlighted firstly that HRV profiles assessed in supine and standing positions are independent and complementary; and secondly that using these postural profiles allows the clustering of distinct sub-categories of "fatigue." Since, cardiovascular control settings are different in standing and lying posture, using the HRV figures of both postures to cluster fatigue state embeds information on the dynamics of control responses. Such, HRV spectral analysis appears more sensitive and enlightening than time-domain HRV indices. The wealthier information provided by this spectral analysis should improve the monitoring of the adaptive training-recovery process in athletes.