The influence of age on weight-bearing joint reposition sense of the knee

Knee joint-position sensitivity has been shown to decline with increasing age, with much of the research reported in the literature investigating this age effect in non-weight-bearing (NWB) conditions. However, little data is available in the more functional position of weight-bearing conditions. The objective of this study was to identify the influence of age on the accuracy and nature of knee joint-position sense (JPS) in both full weight-bearing (FWB) and partial weight-bearing (PWB) conditions and to determine the effect of lower-extremity dominance on knee JPS. Sixty healthy subjects from three age groups (young: 20-35 years old, middle-aged: 40-55 years, and older: 60-75 years) were assessed. Tests were conducted on both the right and left legs to examine the ability of subjects to correctly reproduce knee angles in an active criterion-active repositioning paradigm. Knee angles were measured in degrees using an electromagnetic tracking device, Polhemus 3Space Fastrak, that detected positions of sensors placed on the test limb. Errors in FWB knee joint repositioning did not increase with age, but significant age-related increases in knee joint-repositioning error were found in PWB. It was found that elderly subjects tended to overshoot the criterion angle more often than subjects from the young and middle-aged groups. Subjects in all three age groups performed better in FWB than in PWB. Differences between the stance-dominant (STD) and skill-dominant (SKD) legs did not reach significance. Results demonstrated that for, normal pain-free individuals, there is no age-related decline in knee JPS in FWB, although an age effect does exist in PWB. This outcome challenges the current view that a generalised decline in knee joint proprioception occurs with age. In addition, lower-limb dominance is not a factor in acuity of knee JPS.

A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 1 of 2): clinical results

Objective: First, to assess the clinical effectiveness of hylan G-F 20 in an appropriate care treatment regimen (as defined by the American College of Rheumatology (ACR) 1995 guidelines) as measured by validated disease-specific outcomes and health-related quality of life endpoints for patients with osteoarthritis (OA) of the knee. Second, to utilize the measures of effectiveness and costs in an economic evaluation (see accompanying manuscript). Design: A total of 255 patients with OA of the knee were enrolled by rheumatologists or orthopedic surgeons into a prospective, randomized, open-label, 1-year, multi-centred trial, conducted in Canada. Patients were randomized to 'Appropriate care with hylan G-F 20' (AC+H) or 'Appropriate care without hylan G-F 20' (AC). Data were collected at clinic visits (baseline, 12 months) and by telephone (1, 2, 4, 6, 8, 10, and 12 months). Results: The AC+H group was superior to the AC group for all primary (% reduction in mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale: 38% vs 13%, P=0.0001) and secondary effectiveness outcome measures. These differences were all statistically significant and exceeded the 20% difference between groups seta priori by the investigators as the minimum clinically important difference. Health-related quality of life improvements in the AC+H group were statistically superior for the WOMAC pain, stiffness and physical function (all P

Outcomes after trans-tibial amputation: The relationship between quiet stance ability, strength of the hip abductor muscles and gait

Background and Purpose Previous research regarding the symmetry of trans-tibial amputees has examined weight distribution and various gait parameters between prosthetic and sound limbs. However, to date, no known research has determined if asymmetry is present in the strength of the hip abductor muscles or if correlations exist between these categories of symmetry. The purpose of the present study was, therefore, to document asymmetry present in stance, strength and gait measures, and to determine the relationship between these variables. Method Twenty-three elderly, unilateral trans-tibial amputees stood on two adjacent forceplates whilst the weight distribution and standard deviation (SD) of the anterior-posterior and the medio-lateral centre of pressure excursion (COPE) under each limb was recorded during four 40 s trials: quiet stance (QS), with eyes open and eyes closed; and even stance (ES), with eyes open and eyes closed. Gait measures (velocity, cadence, step and stride lengths, stance:swing ratio and period of double support) over 10 m of fast, yet safe walking and measures of the strength of hip abductor muscles were also obtained by use of a stride analyser and a dynamometer, respectively. Results No significant differences were found between QS and ES measures. However, significantly more weight was taken on the sound limb than on the amputated limb. Notably, more anterior-posterior movement occurred under the sound limb than the amputated limb, with this becoming more apparent with the eyes closed. Movement in the medio-lateral direction was found to be the same between sides. No differences in muscle strength or gait measures between limbs were demonstrated. However. strong hip abductor muscles were correlated with increased weight-bearing on the amputated limb, improved gait parameters and reduced medio-lateral COPE under the amputated limb. Conclusions This research confirms the asymmetrical nature of amputee stance and demonstrates symmetry of strength and gait measures between limbs. The correlations between hip abductor muscle strength, weight distribution and gait measures illustrates the importance of pre- and postoperative training of these muscles. Copyright © 2002 Whurr Publishers Ltd.

Can the Internet be used as a medium to evaluate knee angle?

Telemedicine promises to revolutionize medical care delivery in rural and remote areas. The ability to accurately evaluate physical impairment via the Internet is important to the possible future provision of Internet-based physiotherapy. This study evaluated the reliability and validity of assessing knee range of motion via the Internet. Two therapists evaluated knee angle on a single subject via two methods of assessment: the Internet and the traditional method (face-to-face). Nine random positions of the knee were chosen with the principal examiner performing 20 face-to-face and two sets of 20 Internet measures in each position (n=540). The secondary therapist performed Internet assessments only. The Internet connection was established at a readily available speed of 17 kbit/s. The Internet-based goniometer was found to be a valid tool for measuring both knee flexion and extension angles. It was shown to possess both high intra and inter-rater reliability. Difference average plots of the scores verified the consistency of measurement between both modes of assessment. The successful evaluation of the physical outcome measure of knee range of motion via the Internet assists the further development of Internet-based physiotherapy applications. (C) 2003 Elsevier Science Ltd. All rights reserved.

Knee muscle strength, balance and functional independence in persons with stroke

Purpose: to investigate the relationship between knee muscle strength, balance and functional independence within the first month after stroke. Relevance: cerebral vascular disease is one of the main causes of morbidity, disability and mortality in developed countries. Problems with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke and addresses impairments related to movement and posture in order to improve motor recovery and restore function.

Consumo energético e eficiência da marcha com dois modelos de joelhos protésicos: estudo de caso

Introdução – Os componentes protésicos têm um papel fundamental na eficiência energética da marcha dos indivíduos amputados. Esta é uma área de conhecimento ainda em desenvolvimento, onde a investigação desempenha um papel central. Objectivos – Comparar e analisar o efeito de dois joelhos protésicos, 3R34, monocêntrico modular, de fricção constante, com auxiliar de extensão incorporado (A) e 3R92, monocêntrico modular, com travão de fricção e controlo pneumático da fase de balanço (B) no consumo energético e eficiência da marcha. Metodologia – Um indivíduo do sexo masculino de 27 anos, com amputação transfemural longa, foi sujeito a um protocolo submáximo de avaliação da resposta ao exercício em passadeira rolante (H/P/Cosmos(R) Mercury), através de um sistema de análise de gases breath‑by‑breath (Cosmed Quark PFT Ergo). Foi efetuado o mesmo protocolo com intervalo de dois dias, primeiro utilizando o joelho A e depois o B. As variáveis analisadas foram o consumo de O2 (VO2), o equivalente metabólico (MET) e a eficiência energética da marcha (Quociente de VO2 esperado de um individuo saudável e o VO2 do individuo em estudo). O esforço percecionado foi medido com a escala RPE de Borg. Resultados – O consumo energético com o joelho A (24,2 ml O2/kg/min; 6,9 MET) foi inferior ao obtido com o joelho B (28,68 ml O2/kg/min; 8,2 MET). A eficiência energética da marcha foi mais elevada para o joelho A (43%) do que para o joelho B (39%). Conclusão – A utilização do joelho A na prótese do indivíduo em estudo resulta numa marcha de menor consumo energético e maior eficiência. No entanto, este valor poderá estar influenciado pelo curto período de adaptação ao joelho B, sendo necessários mais estudos para confirmar os resultados do estudo e a influência deste fator. ABSTRACT - Background – Prosthetic components have a crucial role in the energy efficiency of amputee’s gait. This is an area of knowledge still in development, where research plays a central role. Objective – The purpose of this case study is to compare the impact in energy consumption of two prosthetic knees, titanium single‑axis constant friction knee joint with internal extension assist, 3R34 (A) and a single‑axis pneumatic swing phase control, 3R92 (B). Methodology – The participant was a transtibial amputee, male, with 27 years old, with no other clinical or functional impairments. To measure the energy expenditure a submaximal treadmill (H/P/Cosmos(R) Mercury) exercise stress test combined with a breath‑by‑breath analysis system (Cosmed Quark PFT Ergo) was used. The same test was applied to both knees, separated by two days. The analyzed variables were O2 consumption (VO2), metabolic equivalent (MET) and gait efficiency (VO2 ratio expected from a healthy individual and the studied individual). A rate of perceived exertion (Borg’s Scale) was used. Results – The results were favorable to knee A (24.2 ml O2/kg/min; 6.9 MET, 43% efficiency) compared with knee B (28.68 ml O2/kg/min; 8.2 MET, 39% efficiency). Conclusion – In this case, a less energy consumption gait corresponds to the prosthesis with knee A. These values may be influenced by the short adaptation period with knee B, so it’s necessary to perform more studies to confirm the previous results and to understand the truly impact of correct adaptation factor to the best prosthetics components for different patients.

Knee angular displacement analysis in amateur ballet dancers: a pilot study

Ballet gestures are highly non-anatomical and physiological, leading to compensatory behaviors. The knee joint is most affected by this behavior, leading to an increase risk of injury. Our purpose is to describe the knee angular displacement in amateur dancers, during a demi-plié exercise, with emphasis on valgus mechanisms frequency. Methods: 192 demi-pliés collected in six amateur female dancers (mean age = 15.33 ± 1.37 years), were analyzed regarding sagittal and frontal plane angular displacement, with an electrogoniometer connected to a signal acquisition unit at 1000 Hz. Results: all subjects presented valgus peaks along the trials, despite the global varus tendency of the knee frontal plane behavior. A significant positive correlation between the frequency of valgus and practice time was noted. Discussion: A variable angular frontal displacement was observed, with some trials comprehending a high incidence of valgus peaks along the ascending or descending phase of the demi-plié exercise. Conclusion: the frontal knee angle behavior is variable. It may present fast peaks of valgus or an initial trend of varus/valgus that is different from the global varus trend. The analysis of the activity should be considered in the training. The practice time may be related to the observed behavior.

Lethal lesions and amputation caused by plastic debris and fishing gear on the loggerhead turtle Caretta caretta (Linnaeus, 1758). Three case reports from Terceira Island, Azores (NE Atlantic)

Copyright © 2014 Elsevier Science Ltd.

Danny e o profundo mar azul: introdução da técnica da Meisner em Portugal pela Below de Belt Teatro Co.: relatório de estágio

Relatório de Estágio submetidoà Escola Superior de Teatro e Cinemapara cumprimento dos requisitos necessários à obtenção do grau de Mestre em Artes Performativas- especialização em Teatro-Música

USE OF LOPINAVIR/RITONAVIR ASSOCIATED WITH ERGOTAMINE RESULTING IN FOOT AMPUTATION: BRIEF COMMUNICATION

A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation.

Human activity recognition for an intelligent knee orthosis

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average interval between occurrence of the injury and assessment was 10.2 months (range 2 - 48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60°/sec and 240°/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60°/sec was greater than that at 240°/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60°/sec or at 240°/sec. The average value for the flexor-extensor relationship at 60°/sec on the injured was 60% (( 6), compared to 57% (( 10) on the contra-lateral side. At 240°/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60°/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.

Isokinetic dynamometry of knee flexors and extensors: comparative study among non-athletes, jumper athletes and runner athletes

Participation in intensive sports activities leads to muscular specializations that may generate alterations in involved articular forces and cause static (posture) and dynamic changes (alterations of articular stability, coordination, etc.). Prevention of injury requires specific functional muscular evaluation in all athletes and for any kind of sport. OBJECTIVE: To dynamically evaluate, through isokinetic tests, the peak torque, total work, and average power of the knee flexor and extensor muscles of jumper and runner athletes and compare them to those of a non-athletic population, evaluating dominance and balance between agonistic and antagonistic muscle groups. RESULTS: In the non-athlete group, we noted a higher asymmetry between the dominant and nondominant members. The jumpers had the highest values of the evaluated parameters of all groups, whereas parameters for the runners were intermediate between non-athletes and jumpers.

Isokinetic assessment of knee flexor/extensor muscular strength in elderly women

OBJECTIVE: To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex® 6000 isokinetic dynamometer. The chosen angular velocity was 60 º/s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 ± 9.09 Nm / ND = 40.65 ± 9.38 Nm) and extensor (D = 76.92 ± 13.97 Nm / ND = 77.65 ± 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 º/s is proper and safe for isokinetic assessment of elderly people.

The distribution of fishes found below a depth of 2000 meters.

v.36:no.2(1956)