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BACKGROUND: Muscle mass and phase angle (PhA) can be measured using multi-frequency bioelectrical impedance analysis (BIA). Osteoarthritis of the hip (OAhip) causes decreased muscle mass and PhA in the deformed lower limb. However, previous studies have not accounted for the influence of sex, and thus, the relationship between muscle mass, PhA, and motor function remains unclear. This study aimed to elucidate the relationship between PhA, an index of muscle mass and quality measured using BIA, and motor function during gait and standing in female patients with OAhip. METHODS: Muscle mass and PhA of patients with OAhip were measured using BIA. Motor function was evaluated using the Timed Up and Go test, ground reaction/weight, rate of force development/weight, and load ratio between the osteoarthritic (OA) and contralateral sides when standing up. The difference between the OA side and the contralateral lower limb was tested to clarify the characteristics of the deformed lower limb. The relationship between each motor function was determined using a partial correlation coefficient with age as a control variable and multiple regression analysis with each motor function as the dependent variable and age, OA-side muscle mass/body weight ratio, and PhA as independent variables. RESULTS: This study involved 60 patients with OAhip (age 65.6 ± 7.6 years, height 154.2 ± 6.0 cm, weight 56.8 ± 10.5 kg) scheduled for unilateral total hip arthroplasty. Muscle mass, PhA, and lower limb load ratio were significantly decreased in the lower limbs on the OA side. Furthermore, using a partial correlation coefficient with age as a control variable, PhA showed significant correlations with motor functions related to standing up and walking, and multiple regression analysis revealed that PhA was independently related to each motor function. CONCLUSIONS: Evaluation and interventions that consider muscle quality rather than muscle mass are important.
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Extremidad Inferior , Músculo Esquelético , Osteoartritis de la Cadera , Humanos , Femenino , Osteoartritis de la Cadera/fisiopatología , Estudios Transversales , Anciano , Músculo Esquelético/fisiopatología , Extremidad Inferior/fisiopatología , Persona de Mediana Edad , Marcha/fisiología , Impedancia Eléctrica , Actividad Motora/fisiologíaRESUMEN
Lower limb exoskeleton rehabilitation robots are used to improve or restore the walking and movement ability of people with lower limb movement disorders. However, the required functions for patients differ based on various diseases. For example, patients with weak muscle strength require power assistance, patients with spinal cord injuries require motion compensation, patients with gait abnormalities require gait correction, and patients with strokes require neural rehabilitation. To design a more targeted lower limb exoskeleton rehabilitation robot for different diseases, this article summarised and compared existing lower limb exoskeleton rehabilitation robots according to their main functions and the characteristics and rehabilitation needs of various lower limb movement disorders. The correlations between the functions of existing devices and diseases were summarised to provide certain references for the development of new lower limb exoskeleton rehabilitation robots.
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Dispositivo Exoesqueleto , Extremidad Inferior , Robótica , Traumatismos de la Médula Espinal , Rehabilitación de Accidente Cerebrovascular , Humanos , Extremidad Inferior/fisiopatología , Robótica/instrumentación , Traumatismos de la Médula Espinal/rehabilitación , Rehabilitación de Accidente Cerebrovascular/instrumentación , Rehabilitación de Accidente Cerebrovascular/métodos , Marcha/fisiología , Trastornos del Movimiento/rehabilitación , CaminataAsunto(s)
Dolor de la Región Lumbar , Extremidad Inferior , Radiculopatía , Humanos , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/etiología , Radiculopatía/fisiopatología , Extremidad Inferior/fisiopatología , Calidad del Sueño , Neuralgia/fisiopatología , Neuralgia/etiologíaRESUMEN
Purpose: Iliac vein stenting is the primary treatment for patients with iliac vein compression syndrome (IVCS). However, post-stent placement, patients often experience in-stent restenosis and thrombosis. Despite this, the role of lower limb movements in the functioning of stents and veins in IVCS patients remains unclear. This study aimed to address this knowledge gap by developing a computational model using medical imaging techniques to simulate IVCS after stent placement. Methods: This research used a patient-specific model to analyze the effects of lower extremity exercises on hemodynamics post-stent placement. We conducted a comprehensive analysis to evaluate the impact of specific lower limb movements, including hip flexion, ankle movement and pneumatic compression on the hemo-dynamic characteristics within the treated vein. The analysis assessed parameters such as wall shear stress (WSS), oscillatory shear index (OSI), and residence time (RRT). Results: The results demonstrated that hip flexion significantly disrupts blood flow dynamics at the iliac vein bifurcation after stenting. Bilateral and left hip flexion were associated with pronounced regions of low WSS and high OSI at the iliac-vena junction and the stent segment. Additionally, active ankle exercise (AAE) and intermittent pump compression (IPC) therapy were found to enhance the occurrence of low WSS regions along the venous wall, potentially reducing the risk of thrombosis post-stent placement. Consequently, both active joint movements (hip and ankle) and passive movements have the potential to influence the local blood flow environment within the iliac vein after stenting. Conclusions: The exploration of the impact of lower limb movements on hemodynamics provides valuable insights for mitigating adverse effects associated with lower limb movements post iliac-stenting. Bilateral and left hip flexions negatively impacted blood flow, increasing thrombosis risk. However, active ankle exercise and intermittent pump compression therapies effectively improve the patency.
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Vena Ilíaca , Extremidad Inferior , Síndrome de May-Thurner , Stents , Humanos , Vena Ilíaca/fisiopatología , Síndrome de May-Thurner/fisiopatología , Síndrome de May-Thurner/terapia , Extremidad Inferior/fisiopatología , Extremidad Inferior/irrigación sanguínea , Simulación por Computador , Movimiento/fisiología , Estrés Mecánico , Hemodinámica/fisiología , Modelos CardiovascularesRESUMEN
Lower extremity fractures pose challenges due to prolonged healing times and limited assessment methods. Integrating wearable sensors with machine learning can help overcome these challenges by providing objective assessment and predicting fracture healing. In this retrospective study, data from a gait monitoring insole on 25 patients with closed lower extremity fractures were analyzed. Continuous underfoot loading data were processed to isolate steps, extract metrics, and feed them into three white-box machine learning models. Decision tree and Lasso regression aided feature selection, while a logistic regression classifier predicted days until fracture healing within a 30-day range. Evaluations via 10-fold cross-validation and leave-one-out validation yielded stable metrics, with the model achieving a mean accuracy, precision, recall, and F1-score of approximately 76%. Feature selection revealed the importance of underfoot loading distribution patterns, particularly on the medial surface. Our research facilitates data-driven decisions, enabling early complication detection, potentially shortening recovery times, and offering accurate rehabilitation timeline predictions.
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Extremidad Inferior , Aprendizaje Automático , Dispositivos Electrónicos Vestibles , Humanos , Masculino , Femenino , Persona de Mediana Edad , Extremidad Inferior/fisiopatología , Curación de Fractura/fisiología , Estudios Retrospectivos , Adulto , Anciano , Fracturas Óseas , Marcha/fisiologíaRESUMEN
INTRODUCTION: Approximately, 50% of stroke survivors experience impaired walking ability 6 months after conventional rehabilitation and standard care. However, compared with upper limb motor function, research on lower limbs rehabilitation through non-invasive neuromodulation like repetitive transcranial magnetic stimulation (rTMS) has received less attention. Limited evidence exists regarding the effectiveness of intermittent theta-burst stimulation (iTBS), an optimised rTMS modality, on lower limbs rehabilitation after stroke. This study aims to evaluate the effects of iTBS on gait, balance and lower limbs motor function in stroke recovery while also exploring the underlying neural mechanisms using longitudinal analysis of multimodal neuroimaging data. METHODS AND ANALYSIS: In this double-blinded randomised controlled trial, a total of 46 patients who had a stroke will be randomly assigned in a 1:1 ratio to receive either 15 sessions of leg motor area iTBS consisting of 600 pulses or sham stimulation over the course of 3 weeks. Additionally, conventional rehabilitation therapy will be administered following the (sham) iTBS intervention. The primary outcome measure will be the 10 m walking test. Secondary outcomes include the Fugl-Meyer assessment of the lower extremity, Timed Up and Go Test, Functional Ambulation Category Scale, Berg Balance Scale, modified Barthel Index, Mini-Mental State Examination, montreal cognitive assessment, tecnobody balance assessment encompassing both static and dynamic stability evaluations, surface electromyography recording muscle activation of the lower limbs, three-dimensional gait analysis focusing on temporal and spatial parameters as well as ground reaction force measurements, corticomotor excitability tests including resting motor threshold, motor evoked potential and recruitment curves and multimodal functional MRI scanning. Outcome measures will be collected prior to and after the intervention period with follow-up at 3 weeks. ETHICS AND DISSEMINATION: The study has received approval from the Medical Research Ethics Committee of Wuxi Mental Health Center/Wuxi Central Rehabilitation Hospital (no. WXMHCCIRB2023LLky078). Results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300077431.
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Marcha , Extremidad Inferior , Equilibrio Postural , Rehabilitación de Accidente Cerebrovascular , Estimulación Magnética Transcraneal , Humanos , Método Doble Ciego , Estimulación Magnética Transcraneal/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Extremidad Inferior/fisiopatología , Extremidad Inferior/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/diagnóstico por imagen , Ensayos Clínicos Controlados Aleatorios como Asunto , Masculino , Recuperación de la Función , Femenino , Neuroimagen/métodos , Persona de Mediana Edad , Adulto , Anciano , Imagen por Resonancia Magnética/métodos , Imagen Multimodal/métodosRESUMEN
Background: Asymmetric gait patterns are mostly observed in hemiplegic stroke patients. These abnormal gait patterns resulting in abnormal speed, and decreased ability in daily of activity living. Objective: This study aimed to determine the immediate changes in gait parameters and plantar pressure during elevation by wearing an insole on the sound side lower extremity of patients with hemiplegia. Methods: Thirty-six participants were recruited, comprising those with a post-stroke follow-up of ≥3 months and a functional ambulation category score of ≥2. The participants were asked to walk with and without a 1âcm insole in the shoe of their sound side, and the order of wearing or not wearing the insole was randomized. Gait parameters, bilateral gait parameters, and dynamic plantar pressure were measured using the GAITRite Walkway System. Results: Paired t-test was used to examine immediate changes in gait parameters and plantar pressure with and without insoles during walking in the same group. Overall, gait velocity and step length significantly decreased (pâ<â0.05), whereas step time significantly increased (pâ<â0.05). The swing phase of the affected sidelower extremities significantly increased (pâ<â0.05), and the stance phase significantly decreased (pâ<â0.05). Double-support unloading phase (pre-swing phase) significantly increased (pâ<â0.05). The changes in plantar pressure were significantly increased in some lateral zones and significantly decreased in the medial zone of the mid-hindfoot, both in terms of pressure per time and peak pressure (pâ<â0.05). Conclusion: Although this study did not show immediate positive effects on gait parameters and gait cycle, it is expected that sensory input from the sole of the foot through changes in plantar pressure may help improve gait asymmetry and regulate postural symmetry.
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Hemiplejía , Extremidad Inferior , Caminata , Humanos , Masculino , Femenino , Hemiplejía/rehabilitación , Hemiplejía/fisiopatología , Hemiplejía/etiología , Hemiplejía/terapia , Persona de Mediana Edad , Caminata/fisiología , Anciano , Extremidad Inferior/fisiopatología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Ortesis del Pié , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/rehabilitación , Trastornos Neurológicos de la Marcha/terapia , Trastornos Neurológicos de la Marcha/fisiopatología , Marcha/fisiología , Zapatos , Adulto , Fenómenos Biomecánicos/fisiología , Pie/fisiopatología , Enfermedad Crónica , Rehabilitación de Accidente Cerebrovascular/métodosRESUMEN
BACKGROUND: Ischemic stroke accounts for over 85â¯% of all stroke types. Acyl-CoA synthetase long chain family member 4 (ACSL4) is considered to promote myocardial and cerebral ischaemia/ reperfusion. However, up to now, no study focused on the role of ACSL4 in patients with post-stroke lower limb neurological sequelae. OBJECTIVE: The present study aimed to investigate the predictive value of ACSL4 and collateral circulation for lower limb neurological sequelae of ischemic stroke patients after modified constraint-induced movement therapy (mCIMT). METHODS: This is a prospective cohort study which included 99 ischemic stroke patients with lower limb neurological sequelae who were admitted to our hospital during January 2021 to December 2022. All patients received mCIMT after the admission. Collateral circulation was evaluated by digital subtraction angiography (DSA) and graded by the American Society of Interventional and Therapeutic Neuroradiology/ Society of Interventional Radiology (ASITN/SIR) grading system. Enzyme linked immunosorbent assay (ELISA) was used to detect serum ACSL4. Basic characteristics were collected and lower limb motor function was measured by Fugl-Meyer score (FMS), modified Ashworth score (MAS) and Brunnstrom stage, as well as timed up and go (TUG) test, ten-Meter walk test (10MWT), and six-minute walk test (6MWT) before and after treatment. RESULTS: Serum ACSL4 and percentage of patients with ASITN/SIR 0-1 decreased significantly after treatment compared with the values before treatment. Patients with higher baseline serum ACSL4 values at admission showed significantly lower FMS scores, higher TUG and 10MWT, as well as lower 6MWT. Patients with ASITN/SIR grade 0-1 at admission only showed significantly higher TUG and 10MWT, as well as lower 6MWT. Receiver operating characteristic (ROC) curves showed ACSL4 and ASITN/SIR grade could be used to predict the prognosis. Logistic regression found only national institutes of health stroke scores (NIHSS) was the independent risk factor for post-treatment motor impairment after mCIMT. CONCLUSION: Higher levels of ACSL4 and ASITN/SIR 0-1 are associated with poor recovery of motor functions of patients with post-stroke sequelae after mCIMT.
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Coenzima A Ligasas , Accidente Cerebrovascular Isquémico , Extremidad Inferior , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular , Humanos , Masculino , Femenino , Accidente Cerebrovascular Isquémico/fisiopatología , Accidente Cerebrovascular Isquémico/complicaciones , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/fisiopatología , Rehabilitación de Accidente Cerebrovascular/métodos , Estudios Prospectivos , Valor Predictivo de las Pruebas , Estudios de Cohortes , Circulación Colateral/fisiologíaRESUMEN
BACKGROUND: Evidence-based guidelines are needed to inform rehabilitation practice including the effect of non-paralytic lower limb resistance exercise with abdominal drawing-in technique (ADIM) on recovery of trunk control, balance and daily living after stroke survivors. OBJECTIVE: The purpose of this study was to compare the effects of trunk control strengthening performed in non-paralytic lower limb resistance exercise with ADIM on trunk control, balance, daily living in stroke survivors. METHODS: The 24 participants with stroke were randomly divided into three groups: lower limb resistance exercise group (LRAG; nâ=â8), lower limb exercise group (LAG; nâ=â8), and control group (CG; nâ=â8). The training sessions were conducted three times a week for four weeks. Outcome measures included the Korean version Trunk Impairment Scale (K-TIS), Postural Assessment Scale of Stroke (PASS), Modified Functional Reach Test (mFRT), Berg Balance Scale (BBS), Foot print and Modified Barthel's Index (MBI). RESULTS: The results showed that the LRAG had a significant effect on the K-TIS, PASS, mFRT, Foot print and MBI than the LAG and CG (pâ<â0.05). The BBS results showed a significant difference the CG (pâ<â0.05). CONCLUSION: This study showed that repeated non-paralytic lower limb resistance exercises with ADIM can be used clinically as a training method for general physiotherapy in patients with reduced postural control, balance and daily living.
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Extremidad Inferior , Equilibrio Postural , Entrenamiento de Fuerza , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Proyectos Piloto , Masculino , Rehabilitación de Accidente Cerebrovascular/métodos , Femenino , Persona de Mediana Edad , Entrenamiento de Fuerza/métodos , Equilibrio Postural/fisiología , Extremidad Inferior/fisiopatología , Anciano , Accidente Cerebrovascular/fisiopatología , Actividades Cotidianas , Resultado del Tratamiento , Sobrevivientes , Terapia por Ejercicio/métodosRESUMEN
The purpose was to determine the impact of both cognitive constraint and neuromuscular fatigue on landing biomechanics in healthy and chronic ankle instability (CAI) participants. Twenty-three male volunteers (13 Control and 10 CAI) performed a single-leg landing task before and immediately after a fatiguing exercise with and without cognitive constraints. Ground Reaction Force (GRF) and Time to Stabilization (TTS) were determined at landing in vertical, anteroposterior (ap) and mediolateral (ml) axes using a force plate. Three-dimensional movements of the hip, knee and ankle were recorded during landing using a motion capture system. Exercise-induced fatigue decreased ankle plantar flexion and inversion and increased knee flexion. Neuromuscular fatigue decreased vertical GRF and increased ml GRF and ap TTS. Cognitive constraint decreased ankle internal rotation and increased knee and hip flexion during the flight phase of landing. Cognitive constraint increased ml GRF and TTS in all three axes. No interaction between factors (group, fatigue, cognitive) were observed. Fatigue and cognitive constraint induced greater knee and hip flexion, revealing higher proximal control during landing. Ankle kinematic suggests a protective strategy in response to fatigue and cognitive constraints. Finally, these two constraints impair dynamic stability that could increase the risk of ankle sprain.
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Articulación del Tobillo , Cognición , Inestabilidad de la Articulación , Extremidad Inferior , Fatiga Muscular , Humanos , Masculino , Inestabilidad de la Articulación/fisiopatología , Fenómenos Biomecánicos , Adulto Joven , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/fisiología , Fatiga Muscular/fisiología , Extremidad Inferior/fisiología , Extremidad Inferior/fisiopatología , Cognición/fisiología , Rodilla/fisiología , Rodilla/fisiopatología , Adulto , Ejercicio Pliométrico , Tobillo/fisiología , Tobillo/fisiopatología , Estudios de Tiempo y Movimiento , Movimiento/fisiología , Traumatismos del Tobillo/fisiopatología , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/fisiopatología , Articulación de la Cadera/fisiología , Articulación de la Cadera/fisiopatologíaRESUMEN
The objective of this study is to compare shear modulus of lower limb muscles between children with hypotonia versus typical development (TD) or developmental disorders associated with altered tone. Nineteen children with mild hypotonia (mean age 9.4 ± 2.3y, 13 male) completed assessment of resting shear modulus of rectus femoris, biceps femoris (BF), tibialis anterior (TA) and gastrocnemius lateralis (GL) at short and long lengths using shear wave elastography. Data was compared with previous data from TD children and a scoping review for children with developmental disorders. Data were collated according to Net-Longitudinal Tension Angle (Net-LTA), which is the muscle length expressed as the net proximal and distal joint angles. Effects of Net-LTA (e.g., short, neutral, long) were examined according to sex, age and body mass index (BMI). In children with hypotonia, shear modulus was: higher at longer versus shorter lengths for four muscles (p < 0.01); correlated with age for BF-short (r = 0.60, p < 0.03) and GL-short (r = -0.54, p < 0.03), with BMI for BF-short (r = 0.71, p < 0.05); and not different between sexes (p > 0.05). The shear modulus values for lower limb muscles for children with mild hypotonia were lower than those for children with Duchenne Muscular Dystrophy (TA-neutral), or Cerebral Palsy (GL-neutral), but not TD children (all four muscles). In conclusion, shear modulus increases with longer muscle length (i.e. higher Net-LTA) in mildly hypotonic children. Children with mild hypotonia have lower shear modulus than children with cerebral palsy and Duchenne muscular dystrophy.
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Diagnóstico por Imagen de Elasticidad , Extremidad Inferior , Hipotonía Muscular , Músculo Esquelético , Humanos , Masculino , Niño , Femenino , Hipotonía Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Diagnóstico por Imagen de Elasticidad/métodos , Extremidad Inferior/fisiopatología , Adolescente , Módulo de ElasticidadRESUMEN
Functional mobility tests, such as the L test of functional mobility, are recommended to provide clinicians with information regarding the mobility progress of lower-limb amputees. Smartphone inertial sensors have been used to perform subtask segmentation on functional mobility tests, providing further clinically useful measures such as fall risk. However, L test subtask segmentation rule-based algorithms developed for able-bodied individuals have not produced sufficiently acceptable results when tested with lower-limb amputee data. In this paper, a random forest machine learning model was trained to segment subtasks of the L test for application to lower-limb amputees. The model was trained with 105 trials completed by able-bodied participants and 25 trials completed by lower-limb amputee participants and tested using a leave-one-out method with lower-limb amputees. This algorithm successfully classified subtasks within a one-foot strike for most lower-limb amputee participants. The algorithm produced acceptable results to enhance clinician understanding of a person's mobility status (>85% accuracy, >75% sensitivity, >95% specificity).
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Amputados , Extremidad Inferior , Aprendizaje Automático , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Amputados/rehabilitación , Extremidad Inferior/cirugía , Extremidad Inferior/fisiopatología , Extremidad Inferior/fisiología , Bosques AleatoriosRESUMEN
Background: Sporadic inclusion body myositis (sIBM) is the predominant idiopathic inflammatory myopathy (IIM) in older people. Limitations of classical clinical assessments have been discussed as possible explanations for failed clinical trials, underlining the need for more sensitive outcome measures. Quantitative muscle MRI (qMRI) is a promising candidate for evaluating and monitoring sIBM. Objective: Longitudinal assessment of qMRI in sIBM patients. Methods: We evaluated fifteen lower extremity muscles of 12 sIBM patients (5 females, mean age 69.6, BMI 27.8) and 12 healthy age- and gender-matched controls. Seven patients and matched controls underwent a follow-up evaluation after one year. Clinical assessment included testing for muscle strength with Quick Motor Function Measure (QMFM), IBM functional rating scale (IBM-FRS), and gait analysis (6-minute walking distance). 3T-MRI scans of the lower extremities were performed, including a Dixon-based sequence, T2 mapping and Diffusion Tensor Imaging. The qMRI-values fat-fraction (FF), water T2 relaxation time (wT2), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ1), and radial diffusivity (RD) were analysed. Results: Compared to healthy controls, significant differences for all qMRI parameters averaged over all muscles were found in sIBM using a MANOVA (pâ<â0.001). In low-fat muscles (FFâ<â10%), a significant increase of wT2 and FA with an accompanying decrease of MD, λ1, and RD was observed (p≤0.020). The highest correlation with clinical assessments was found for wT2 values in thigh muscles (r≤-0.634). Significant changes of FF (+3.0%), wT2 (+0.6âms), MD (-0.04 10-3mm2/s), λ1 (-0.05 10-3mm2/s), and RD (-0.03 10-3mm2/s) were observed in the longitudinal evaluation of sIBM patients (p≤0.001). FA showed no significant change (pâ=â0.242). Conclusion: qMRI metrics correlate with clinical findings and can reflect different ongoing pathophysiological mechanisms. While wT2 is an emerging marker of disease activity, the role of diffusion metrics, possibly reflecting changes in fibre size and intracellular deposits, remains subject to further investigations.
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Imagen por Resonancia Magnética , Músculo Esquelético , Miositis por Cuerpos de Inclusión , Humanos , Miositis por Cuerpos de Inclusión/diagnóstico por imagen , Miositis por Cuerpos de Inclusión/fisiopatología , Femenino , Masculino , Anciano , Imagen por Resonancia Magnética/métodos , Estudios Prospectivos , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiopatología , Persona de Mediana Edad , Fuerza Muscular/fisiología , Estudios Longitudinales , Imagen de Difusión Tensora , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/fisiopatologíaRESUMEN
BACKGROUND: Although early rehabilitation is important following a stroke, severely affected patients have limited options for intensive rehabilitation as they are often bedridden. To create a system for early rehabilitation of lower extremities in these patients, we combined the robotic manipulator ROBERT® with electromyography (EMG)-triggered functional electrical stimulation (FES) and developed a novel user-driven Assist-As-Needed (AAN) control. The method is based on a state machine able to detect user movement capability, assessed by the presence of an EMG-trigger and the movement velocity, and provide different levels of assistance as required by the patient (no support, FES only, and simultaneous FES and mechanical assistance). METHODS: To technically validate the system, we tested 10 able-bodied participants who were instructed to perform specific behaviors to test the system states while conducting knee extension and ankle dorsal flexion exercises. The system was also tested on two stroke patients to establish its clinical feasibility. RESULTS: The technical validation showed that the state machine correctly detected the participants' behavior and activated the target AAN state in more than 96% of the exercise repetitions. The clinical feasibility test showed that the system successfully recognized the patients' movement capacity and activated assistive states according to their needs providing the minimal level of support required to exercise successfully. CONCLUSIONS: The system was technically validated and preliminarily proved clinically feasible. The present study shows that the novel system can be used to deliver exercises with a high number of repetitions while engaging the participants' residual capabilities through the AAN strategy.
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Extremidad Inferior , Robótica , Rehabilitación de Accidente Cerebrovascular , Humanos , Rehabilitación de Accidente Cerebrovascular/instrumentación , Rehabilitación de Accidente Cerebrovascular/métodos , Robótica/instrumentación , Masculino , Femenino , Extremidad Inferior/fisiopatología , Adulto , Persona de Mediana Edad , Electromiografía , Accidente Cerebrovascular/fisiopatología , Estudios de Factibilidad , AncianoRESUMEN
BACKGROUND: Chronic ankle instability (CAI) has been associated with lower limb deficits that can lead to altered biomechanics during dynamic tasks. There have been contradictory findings in terms of ankle and hip joint biomechanics to date, influenced by the variety of movement tasks and varying definitions of the CAI condition. RESEARCH QUESTION: How do biomechanical variables of the lower extremity differ during walking, running, and jump-landing in individuals with CAI compared with those without CAI? METHODS: Thirty-two individuals (17 CAI and 15 controls) participated in this retrospective case-control study. Sagittal and frontal plane ankle and hip joint angles and moments, and mediolateral foot balance (MLFB) were calculated during the tasks. Statistical parametric mapping (SPM) was used for the whole trajectory analysis to detect group differences. Discrete variables, including initial contact (IC) and peak angles and moments, were additionally compared. RESULTS: No differences were found between groups during walking. During running, the CAI group exhibited a lower plantar flexor moment (p < 0.001) and more laterally deviated MLFB (p = 0.014) during mid-stance when compared to controls. Additionally, participants with CAI had a significantly greater peak plantar flexion angle in early stance (p = 0.022) and a reduced peak plantar flexor moment (p = 0.002). In the jump-landing, the CAI group demonstrated an increased hip extensor moment (p = 0.008), and a greater peak hip adduction angle (p = 0.039) shortly after ground contact compared to the control group. SIGNIFICANCE: Differences in ankle and hip biomechanics were observed between groups during running and jump landing, but not during walking. These differences may be indicative of impairments in the sensorimotor system or of learnt strategies adopted to try to minimise instability and injury risk and can help to inform future intervention design.
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Articulación del Tobillo , Inestabilidad de la Articulación , Caminata , Humanos , Inestabilidad de la Articulación/fisiopatología , Fenómenos Biomecánicos , Masculino , Estudios de Casos y Controles , Articulación del Tobillo/fisiopatología , Femenino , Estudios Retrospectivos , Caminata/fisiología , Adulto , Adulto Joven , Carrera/fisiología , Articulación de la Cadera/fisiopatología , Extremidad Inferior/fisiopatología , Enfermedad Crónica , Movimiento/fisiologíaRESUMEN
BACKGROUND: Patients with hallux valgus are known to alter lower limb joint kinematics during gait. However, little information is available about gait changes following hallux valgus surgery. We aimed to longitudinally investigate lower limb kinematic changes at the mid and terminal stances of gait after hallux valgus surgery. METHODS: This prospective observational study included 11 female patients (17 feet), who underwent first metatarsal osteotomy. Gait analyses were performed preoperatively and 1- and 2-year postoperatively using a three-dimensional motion capture system. Toe-out angle, ankle, knee, and hip joint angles during gait were calculated from the recorded data. The spatiotemporal parameters and these angles at the mid and terminal stances of gait were statistically compared between preoperative and postoperative periods. FINDINGS: All spatiotemporal parameters remained unchanged postoperatively. The toe-out angle was significantly greater at 1- and 2-year postoperatively. The ankle pronation angle, the knee abduction angle, and the hip adduction angle at the mid and terminal stances of gait were smaller postoperatively compared to the preoperative. These angular changes showed a similar trend at 1 and 2 years postoperatively. However, the postoperative changes of the sagittal joint angles were relatively small. INTERPRETATION: Hallux valgus surgery can affect the toe-out angle and the lower limb coronal kinematics at the mid and terminal stances of gait in patients with hallux valgus. However, surgical correction of hallux valgus deformity did not directly improve the gait characteristics in patients with hallux valgus.
Asunto(s)
Marcha , Hallux Valgus , Humanos , Hallux Valgus/cirugía , Hallux Valgus/fisiopatología , Femenino , Estudios Prospectivos , Fenómenos Biomecánicos , Persona de Mediana Edad , Adulto , Osteotomía/métodos , Extremidad Inferior/fisiopatología , Extremidad Inferior/cirugía , Rango del Movimiento Articular , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , AncianoRESUMEN
OBJECTIVE: The presence of peripheral artery disease (PAD) in patients with diabetic foot ulcers (DFUs) is a significant risk factor for chronicity and amputation. Ankle-brachial pressure index (ABPI) is a screening tool for PAD. Brachial systolic pressure measurement, used as a denominator in the calculation of ABPI, produces inaccurate results in patients with obesity and the presence of heavy clothing. The wrist, however, is easily accessible, and the ankle-wrist pressure index (AWPI), if comparable with ABPI, may be useful in screening selected patients. This study aimed to assess the efficacy of AWPI in diagnosing perfusion in DFUs and compare it to ABPI in patients with DFUs. METHOD: ABPI and AWPI were calculated by measuring systolic blood pressure in the arteries of the ankle, arm and wrist with a handheld Doppler. Actual perfusion was determined by the presence or absence of PAD by duplex ultrasound. RESULTS: A total of 46 lower extremities in 41 patients were studied. The prevalence of PAD was 61%. Duplex ultrasound confirmed that the sensitivity of ABPI and AWPI in detecting PAD in patients with DFUs was 67.9% and 71.4% respectively, whereas the specificity of ABPI and AWPI was 94.4% and 88.9% respectively. On receiver operating characteristic analysis, the area under the curve of ABPI and AWPI was 0.804 and 0.795, respectively. A statistically significant positive correlation between ABPI and AWPI was found (r=0.986; p<0.001). CONCLUSION: There was a good correlation between ABPI and AWPI over a wide range of values. ABPI and AWPI may have a similar role in predicting perfusion in patients with DFUs. AWPI could be used in place of ABPI in selected patients in whom measuring ABPI may be difficult. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.
Asunto(s)
Índice Tobillo Braquial , Pie Diabético , Enfermedad Arterial Periférica , Humanos , Masculino , Proyectos Piloto , Femenino , Pie Diabético/fisiopatología , Persona de Mediana Edad , Anciano , Enfermedad Arterial Periférica/fisiopatología , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/fisiopatología , Sensibilidad y Especificidad , Presión Sanguínea/fisiologíaRESUMEN
OBJECTIVES: To compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. METHODS: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. RESULTS: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. CONCLUSION: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.
Asunto(s)
Extremidad Inferior , Recurrencia , Humanos , Masculino , Femenino , Adolescente , Estudios Transversales , Prevalencia , Extremidad Inferior/fisiopatología , Portugal/epidemiología , Encuestas y Cuestionarios , Dimensión del Dolor , Dolor de Espalda/epidemiologíaRESUMEN
PURPOSE: This study investigated the accuracy of activity trackers in chronic lower limb lymphoedema (LLL) patients and in comparison to matched controls. MATERIALS AND METHODS: Seventeen LLL patients and 35 healthy subjects wore an activity tracker at the hip (Fitbit Zip/Inspire; hip-AT) and one at the wrist (Fitbit Alta/Inspire; wrist-AT) combined with a reference activity monitor (Dynaport Movemonitor; DAM), for 14 consecutive days. To analyze accuracy and agreement, mean daily step count from both AT's were compared to DAM. To evaluate the accuracy as coaching tool, day-by-day differences were calculated. The Kendall correlation coefficient was used to test consistency of ranking daily steps between the AT's and the DAM. RESULTS: The wrist-AT significantly overestimated daily step count compared to DAM in the LLL group (+1221 ± 1754 steps per day, p = 0.011) while the hip-AT underestimated the step count, although not significantly. Similar results were found in the healthy control group. As a coaching tool, both wrist-AT and hip-AT showed a moderate correlation with the DAM (r = 0.507 and 0.622, respectively) in the LLL group regarding consistency of ranking from most to least active days. CONCLUSION: Wrist-AT's significantly overestimate daily step count in a LLL population. As a coaching tool, both trackers show moderate validity, indicating applicability to improve physical activity.