A young lady with residual polio, using axillary crutch since early childhood, presented with tingling, numbness and weakness in ulnar nerve distribution of five months duration. Ulnar motor conduction study revealed proximal conduction block near the axilla, at the point of pressure by the crutch while walking. Distal ulnar sensory conduction studies were normal but proximal ulnar sensory conduction studies showed absence of Erb's point potential. These findings suggested the presence of conduction block in sensory fibers as well. Proper use and change of axillary crutch resulted in clinical recovery and resolution of motor and sensory conduction block. (+info)
Upper-limb pain in long-term poliomyelitis.
BACKGROUND: Late functional deterioration is common in long-term poliomyelitis patients. While upper-limb pain in individual functional regions is common, its overall prevalence and pattern in long-term poliomyelitis is poorly documented. AIM: To assess the nature of upper-limb pain in these patients and examine its association with dependence on mobility aids (and therefore upper limb 'overuse'). DESIGN: Questionnaire-based survey of patients attending a specialist unit. METHODS: Questionnaires were sent to 139 patients with known long-term poliomyelitis (mean 49.8 years post polio), attending the Lane Fox Unit out-patient clinic at St Thomas' Hospital between January 1998 and December 1998. There were questions on the nature of the patient's acute illness, limb involvement at initial infection ('polio-affected' limbs), the site and onset of upper-limb pain, hand dominance, previous injuries and surgery, and the use of mobility aids. Limbs that had sustained an injury or undergone surgery, at or preceding onset of upper-limb pain, were excluded from analysis. RESULTS: Among 103 valid replies, the prevalence of upper limb pain was 64%. Mobility aids were used by 74%, and were associated with an increased risk of upper-limb pain, while 'polio-affected' limbs were at reduced risk. DISCUSSION: These data support 'overuse' due to greater mobility aid dependence as a cause of increasing upper-limb pain in long-term poliomyelitis. (+info)
Hypertrophy of chronically unloaded muscle subjected to resistance exercise.
In an effort to simulate the compromised function and atrophy of lower limb muscles experienced by astronauts after spaceflight, 21 men and women age 30-56 yr were subjected to unilateral lower limb unloading for 5 wk. Whereas 10 of these subjects performed unilateral knee extensor resistance exercise (ULRE) two or three times weekly, 11 subjects (UL) refrained from training. The exercise regimen consisted of four sets of seven maximal actions, using an apparatus that offers concentric and eccentric resistance by utilizing the inertia of rotating flywheel(s). Knee extensor muscle strength was measured before and after UL and ULRE, and knee extensor and ankle plantar flexor muscle volumes were determined by means of magnetic resonance imaging. Surface electromyographic activity measured after UL inferred increased muscle use to perform a given motor task. UL induced an 8.8% decrease (P < 0.05) in knee extensor muscle volume. After ULRE and as a result of only approximately 16 min of maximal contractile activity over the 5-wk course, muscle volume increased 7.7% (P < 0.05). Muscle strength decreased 24-32% (P < 0.05) in response to UL. Group ULRE showed maintained (P > 0.05) strength. Ankle plantar flexor muscle volume of the unloaded limb decreased (P < 0.05) in both groups (UL 10.5%; ULRE 11.1%). In neither group did the right weight-bearing limb show any change (P > 0.05) in muscle volume or strength. The results of this study provide evidence that resistance exercise not only may offset muscle atrophy but is in fact capable of promoting marked hypertrophy of chronically unloaded muscle. (+info)
Comparison of the Easy Strutter Functional Orthosis System and axillary crutches during modified 3-point gait.
The Easy Strutter Functional Orthosis System (ESFOS) was designed to improve assistive device ambulatory efficiency. This crossover design study compared the ESFOS to axillary crutches during modified 3-point gait. Thirty-eight subjects (40-65 years of age) at > 1 year after unilateral total knee or hip replacement participated in this study. Heart rate, mean peak palmar and plantar force magnitude, and onset timing were monitored during self-directed pace ambulation. Between trials, subjects responded to questions on perceived exertion, stability/security, and comfort. One-way analyses of variance were used to evaluate condition differences for ratio or interval data (p < or = 0.01). Statistically significant differences were noted for mean peak palmar forces (reduced 45% and delayed 31%), mean peak plantar force onsets (delayed 30%), and energy expenditure index (EEI) (reduced 25%). Wilcoxon signed rank tests were used to evaluate condition differences for ordinal data. Subjects preferred the ESFOS to axillary crutches for comfort and security/stability on flat surfaces and stairs (p < or = 0.001). Results suggest greater ambulatory gait efficiency during ESFOS use. Further study is indicated with other patient populations. (+info)
Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.
OBJECTIVE: To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT). DESIGN: Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). PARTICIPANTS/ METHODS: Body weight-supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks. Primary outcome measures were the Functional Independence Measure (FIM), 50-foot walking speed (50FW-S), and 6-minute walking distance (6MW-D), tested 3, 6, and 12 months after entry. Secondary measures were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), WISCI, and FIM locomotor score (LFIM), assessed at 6 centers by blinded observers. Data for the 2 arms were combined since no significant differences in outcomes had been found. RESULTS: Correlations with WISCI at 6 months were significant with BBS (r = .90), LEMS (r = .85), LFIM (r = .89), FIM (r = .77), 50FW-S (r = .85), and 6MW-D ( r = .79); similar correlations occurred at 3 and 12 months. Correlations of change scores from baseline WISCI were significant for change scores from baseline of LEMS/BBS/LFIM. Correlation of baseline LEMS and WISCI at 12 months were most significant (r = .73). The R(2) of baseline LEMS explained 57% of variability of WISCI levels at 3 months. CONCLUSION: Concurrent validity of the WISCI scale was supported by significant correlations with all measures at 3, 6, and 12 months. Correlation of change scores supports predictive validity. The LEMS at baseline was the best predictor of the WISCI score at 12 months and explained most of the variance, which supported both predictive and construct validity. The combination of the LEMS, BBS, WISCI, 50FW-S, and LFIM appears to encompass adequate descriptors for outcomes of walking trials for incomplete SCI. (+info)
Upper extremity dynamics during Lofstrand crutch-assisted gait in children with myelomeningocele.
BACKGROUND/OBJECTIVE: We present a 3-dimensional biomechanical model of the upper extremities to characterize joint dynamics during 2 patterns of Lofstrand crutch-assisted gait in children with myelomeningocele. The upper extremity model incorporates recommendations by the International Society of Biomechanics. METHODS: A Vicon motion analysis system (14 cameras) captured the marker patterns. Instrumented crutches measured reaction forces. Five subjects with L3 or L4 level myelodysplasia (aged 9.8 +/- 1.6 years) were analyzed during reciprocal and swing-through Lofstrand crutch-assisted gait. RESULTS: The mean walking speed, cadence, and stride length were greatest during swing-through gait. Although the gait patterns had different morphologies, the thorax and elbows remained in flexion, the wrists remained in extension, and the shoulders demonstrated both flexion and extension throughout the gait cycles. Swing-through gait showed larger ranges of motion for all joints than reciprocal gait. Peak crutch forces were highest during swing-through gait. The model was effective in detecting significant differences in upper extremity joint dynamics between reciprocal and swing-through crutch-assisted gait in children with myelomeningocele. CONCLUSIONS: Results support continued testing. Future work should include clinical and functional assessment in a correlated study of dynamics and function. Knowledge from the study may be useful in treatment planning and intervention. (+info)
The effect of walking with an assistive device and using a wheelchair on school performance in students with myelomeningocele.
An alternating-condition, single-subject research design was used to examine the effect of ambulation on three measures of school performance in three students with myelomeningocele. The subjects, aged 9, 10, and 15 years, had a physiological cost index greater than 1.00 beats per meter when walking with crutches or a walker. Subjects propelled a wheelchair at school for 5 days, ambulated with crutches or a walker for 5 days, and propelled a wheelchair for an additional 5 days. Performance in reading fluency, visuomotor accuracy, and manual dexterity was assessed at the end of each school day. Results were graphed and analyzed using the two-standard-deviation band method. All subjects had significantly lower visuomotor accuracy scores during the assistive-device ambulation phase than during the wheelchair phases. Performance in manual dexterity during the assistive-device ambulation and wheelchair phases varied among the subjects. Reading fluency was not affected by method of mobility. The results suggest that the high energy cost of walking may have a negative effect on certain aspects of the subjects' school performance. [Franks CA, Palisano RJ, Darbee JC. The effect of walking with an assistive device and using a wheelchair on school performance in students with myelomeningocele. (+info)
Towards an instrument targeting mobility-related participation: Nordic cross-national reliability.