Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile.
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BACKGROUND AND PURPOSE: The Emory Functional Ambulation Profile (E-FAP) measures time to walk in different environments and accounts for use of assistive devices. This study assessed the reliability and validity of walking time measurements using these components. SUBJECTS: Twenty-eight subjects who had strokes and 28 subjects without impairment were recruited. METHODS: The E-FAP, Berg Balance Test, Functional Reach Test, and Timed 10-Meter Walk Test were administered in random order during a single data collection session. RESULTS: Interrater reliability for the total E-FAP was > or = .997. Subjects without impairment performed better on all 4 tests than did subjects who had strokes. Increased times on the E-FAP correlated with poor performance on the Berg Balance Test and slow gait speeds on the Timed 10-Meter Walk Test in the subjects who had strokes. The E-FAP scores and the Functional Reach Test scores were not correlated. CONCLUSION AND DISCUSSION: The E-FAP can be administered easily and inexpensively. Because the E-FAP scores differentiated subject groups and correlated with known measures of function, the E-FAP may be a clinically useful measure of ambulation. (+info)
Prevention of hip fracture in elderly people with use of a hip protector.
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BACKGROUND: Hip fractures are common in frail elderly adults worldwide. We investigated the effect of an anatomically designed external hip protector on the risk of these age-related fractures. METHODS: We randomly assigned 1801 ambulatory but frail elderly adults (1409 women and 392 men; mean age, 82 years), in a 1:2 ratio, either to a group that wore a hip protector or to a control group. Fractures of the hip and all other fractures were recorded until the end of the first full month after 62 hip fractures had occurred in the control group. The risk of fracture in the two groups was compared, and in the hip-protector group the risk of fracture was also analyzed according to whether the protector had been in use at the time of a fall. RESULTS: During follow-up, 13 subjects in the hip-protector group had a hip fracture, as compared with 67 subjects in the control group. The respective rates of hip fracture were 21.3 and 46.0 per 1000 person-years (relative hazard in the hip-protector group, 0.4; 95 percent confidence interval, 0.2 to 0.8; P=0.008). The risk of pelvic fracture was slightly but not significantly lower in the hip-protector group than in the control group (2 subjects and 12 subjects, respectively, had pelvic fracture) (relative hazard, 0.4; 95 percent confidence interval, 0.1 to 1.8; P > or = 0.05). The risk of other fractures was similar in the two groups. In the hip-protector group, four subjects had a hip fracture (among 1034 falls) while wearing the protector, and nine subjects had a hip fracture (among 370 falls) while not wearing the protector (relative hazard, 0.2; 95 percent confidence interval, 0.05 to 0.5; P=0.002). CONCLUSIONS: The risk of hip fracture can be reduced in frail elderly adults by the use of an anatomically designed external hip protector. (+info)
OBJECTIVE: To review common repetitive strain injuries (RSIs) that occur in the workplace, emphasizing diagnosis, treatment, and etiology of these conditions. QUALITY OF EVIDENCE: A MEDLINE search from January 1966 to June 1999 focused on articles published since 1990 because RSIs are relatively new diagnoses. MeSH headings that were explored using the thesaurus included "cumulative trauma disorder," "overuse injury," and "repetitive strain injury." The search was limited to English articles only, and preference was given to randomized controlled trials. MAIN MESSAGE: Repetitive strain injuries result from repeated stress to the body's soft tissue structures including muscles, tendons, and nerves. They often occur in patients who perform repetitive movements either in their jobs or in extracurricular activities. Common RSIs include tendon-related disorders, such as rotator cuff tendonitis, and peripheral nerve entrapment disorders, such as carpal tunnel syndrome. A careful history and physical examination often lead to the diagnosis, but newer imaging techniques, such as magnetic resonance imaging and ultrasound, can help in refractory cases. Conservative management with medication, physiotherapy, or bracing is the mainstay of treatment. Surgery is reserved for cases that do not respond to treatment. CONCLUSION: Repetitive strain injury is common; primary care physicians must establish a diagnosis and, more importantly, its relationship to occupation. Treatment can be offered by family physicians who refer to specialists for cases refractory to conservative management. (+info)
Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients.
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The objective of this study was to identify acute spinal and three-dimensional postural adaptations induced by a shoe lift in a population of idiopathic scoliosis (IS) patients. Forty-six IS patients (mean age: 12 +/- 2 years) were evaluated radiologically and with a stereovideographic system for pelvic obliquity. Based on the initial postural and radiological evaluation, a pertinent shoe lift height was chosen for each with the result that 12 patients were tested with 5-mm (S5) lifts, 20 patients were tested with 10-mm (S10) lifts, and 14 patients with 15-mm (S15) lifts. The posture for all 46 patients was then re-evaluated and a spinal radiograph obtained for 14 patients. The implementation of a shoe lift independent of the type of curve and amplitude significantly decreased the Cobb angle. As expected there was a change in the vertical height of the left tibial plateau and greater trochanter that induced a change in pelvic tilt. There was also a significant increase in the vertical height of S1 and T1. There was a significant change in the left and right iliac bone version, as well as a decrease in the difference in version between these two bones. The implementation of the shoe lifts also changed the lateral shift of the pelvis. A relative change between the shoulders and pelvis for tilt and anteroposterior shift was also found to be significant. In conclusion, using a shoe lift resulted in acute postural adaptations which specifically affected the spine and the three-dimensional position and orientation of the pelvis and shoulder girdle. (+info)
Diabetic foot ulcers. Pathophysiology, assessment, and therapy.
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OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with debridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. CONCLUSION: Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration. (+info)
Locomotion studies as an aid in clinical assessment of childhood gait.
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A clinical locomotion laboratory has been developed to provide quantitative information in the management of gait disorders. The biomedical engineering development of this system identified two major clinical constraints: (a) the need for instrumentation that would not alter the natural gait of the patient and (b) the need for data-processing techniques that would permit analysis and correlation of the large volume of electromyographic (EMg) and kinematic information. The net result has been a unit that incorporates a multichannel telemetry system to capture the EMG and foot-switch information and a television computer system to handle the kinematic information. Gait studies on children with hemiparesis, muscular dystrophy and cerebral palsy have yielded quantitative EMG and kinematic information on the pathomechanics of ambulation in these disorders. Because the information obtained is quantitative, an accurate measure of improvement (or lack of it) after treatment can be documented. Therefore, the locomotion laboratory may have an important role in the preoperative and postoperative evaluation of children whose abnormal gait may require surgical corrective procedures or rehabilitative treatment including the use of prostheses or orthoses. (+info)
The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine.
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In 65 consecutive cases of trauma (n=55), pseudo-arthrosis (n=4) and metastasis (n=6), anterior reconstruction of the thoracic and lumbar spine was performed using a new minimal invasive but open access procedure. No operation had to be changed into an open procedure. The thoracolumbar junction was approached by a left-sided mini-thoracotomy (n=50), the thoracic spine by a right-sided mini-thoracotomy (n=8) and the lumbar spine by a left sided mini-retroperitoneal approach (n=7), using a new table-mounted retractor system called SynFrame (Stratec Medical, Switzerland). The anterior column was reconstructed using a variety of materials: autologous tricortical crest (n=11), autologous spongiosa (n=12), allografts (n=4) and cages (n=38). The mean overall operating time was 170 min (range 90-295 min); the time of surgery varied, depending on the spine pathology and the magnitude of the intervention in the anterior part of the spine. Mean overall blood loss was 912 ml, and only 7 out of the 65 patients needed blood transfusions. There were neither intra- nor postoperative complications related to the minimal access in particular, nor visceral/vascular complications. No intercostal neuralgia, no post-thoracotomy pain syndromes, no superficial or deep wound infections and no deep venous thromboses occurred. Four cases of pseudo-obstruction were treated conservatively. In this study, we describe the new minimal access technology to the anterior part of the thoracal and lumbar spine on the basis of 65 cases completed within 1 year. This open, but minimal invasive, access technology offers, in our view, additional advantages to the "pure" endoscopic procedures of spinal surgery. (+info)
Profile of arthritis disability.
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Using the 1994-95 National Health Interview Supplement Disability Supplement, the authors study levels of disabilities and accommodations among US adults with arthritis disability, compared to people with disability due to other conditions. Arthritis-disabled people are defined in two ways. One definition covers a broad range of arthritis and rheumatic conditions, and the other concentrates solely on arthritis. The authors find that arthritis-disabled people have more total disabilities than other-disabled peop e. However, their disabilities are less severe, have shorter durations, and accumulate more gradually over time. Despite more disabilities, people with arthritis disability use fewer assistive and service accommodations than other-disabled people. They do use more mobility aids. Because arthritis is the leading chronic condition for middle-aged and older adults, th s profile of extensive but mild-to-moderate disability is experienced by many millions of adults. Accommodations for arthritis may also be extensive but aimed more toward self-care than toward assistive and medical services. (+info)