Gait variables of patients after lower extremity burn injuries

Functional ambulation is an expected outcome of physical therapy after burn injuries on the lower extremities. The purpose of this study was to document temporal and spatial gait parameters of adult patients with the use of the GAITRite system (CIR Systems Inc, Clifton, NJ) after the patients were burned on their lower extremities and to compare these results with previous data reported for normal subjects. Twenty-five adults with lower extremity burns (19 men and 6 women; mean age, 35.6+/-8.3 years) were evaluated within 5 days of discharge from an acute care facility. The GAITRite system, which consists of an electronic walkway that contains 6 sensor pads encapsulated in a rolled-up carpet, was used to collect temporal and spatial variables. The patients walked at their preferred rate of ambulation and completed 2 passes; the 2 passes were then averaged by the software to determine the patients' gait parameters. A 2-tailed t test was used for comparison of the mean values for the patients and the previously published data. The results indicated that for both men and women, cycle time and base of support were significantly higher (P < or = .01) in the patients with burn injuries than in normal subjects. For men, all of the remaining parameters were significantly lower (P < or = .01) in the patients with burns except stride length, which was not significantly different (P > .05). For women, stance time as a percentage of the gait cycle and cadence, velocity, step length, and stride length, were all significantly lower (P < or = .01) in the patients with burn injuries, whereas double support as a percentage of the gait cycle was not significantly different (P > .05) between the 2 groups. These results indicate that immediately after an acute care hospitalization, patients with lower extremity burns have significantly different gait patterns than gender-and age-matched normal subjects. Future studies are necessary to determine whether these impairments in gait limit the functional abilities of a patient.     

医学训练式治疗对烧伤患者下肢肌肉功能及步行能力的影响

目的:观察医学训练式治疗(MTT)对康复期特重度烧伤患者下肢肌肉功能及步行能力的影响。方法:康复期特重度烧伤患者59例,随机分为MTT组30例和对照组29例,所有患者均进行综合康复治疗,MTT组另外接受下肢MTT训练。治疗前后分别进行下肢肌肉等速测试及步行能力测试。结果:治疗6周后,2组双侧伸、屈膝肌的力矩峰值、总功量和平均功率及6-min步行距离均较治疗前显著增大(P0.01),且MTT组更高于对照组(P0.01,0.05);治疗后,2组10-m步行测试所用时间均较治疗前显著减少(P0.01),2组间比较差异无统计学意义。结论:MTT能有效改善康复期特重度烧伤患者下肢肌肉功能及步行能力。     

胰十二指肠切除术后患者早期下床活动方案的构建

目的:探讨科学、可行的胰十二指肠切除术后早期下床活动方案。方法:于2020年2月成立课题组,经文献循证和专家小组讨论初步拟定早期下床活动方案,采用德尔菲法于2020年6—10月选取来自北京3家三级甲等医院的共11名专家进行2轮函询,计算专家积极系数、专家的权威系数、肯德尔协调系数,根据专家修改意见构建早期下床活动方案。...     

Outcome of lower extremity malignancy survivors treated with transfemoral amputation

OBJECTIVE: To determine outcomes of surviving patients who underwent transfemoral amputation as part of treatment for lower extremity malignancy at a mean 15 years postoperatively, with a minimum 2-year follow-up. DESIGN: Retrospective, case control. SETTING: Tertiary care university medical center. PATIENTS: Thirty-five of 38 consecutively admitted patients free of metastatic disease managed with transfemoral amputation as part of treatment of a lower extremity bone and/or soft tissue malignancy between 1966 and 1997 at 1 institution. The control group included 35 age- and gender-matched subjects recruited from the local driver's license office. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Musculoskeletal Function Assessment (MFA), Short Form-12 General Health Status Survey (SF-12), physical performance battery, cost, and demographic data. RESULTS: Controls showed superior scores as measured by the MFA (P < .0001), the physical component summary of the SF-12 (P = .0002), and the physical performance battery (P < .0001), but had inferior scores on the mental component summary of the SF-12 (P < .0001). With the numbers available, no differences were found between study and control subjects in terms of employment rate (P = .51), education level (P = .66), income level (P =.44), marital status (P = .79), incidence of self-reported health problems (P = .14), and alcohol (P =.42) and tobacco (P = .82) use. Ten patients were included in the cost analysis; the mean cost to obtain and maintain a lower extremity prosthesis was $4225 per year (range, 623 dollars-8517 dollars). CONCLUSIONS: Although the decrease in physical performance was anticipated in the study group, the group differed very little from the control population in terms of employment, education level, income, marital and home status, incidence of self-reported health problems, incidence of self-reported depression, and alcohol and tobacco use. Also, the long-term cost of maintaining a lower extremity prosthesis is noted.     

Motor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: a cohort study

OBJECTIVE: To assess the prognostic value of motor evoked potentials (MEPs) in the lower extremity with respect to motor recovery and functional recovery in stroke patients. DESIGN: Cohort study. SETTING: The department of neurology at a university hospital. PARTICIPANTS: Thirty-eight acute-stroke patients with complete paralysis (paralysis subgroup) or severe paresis (paresis subgroup) of the lower extremity. MEPs of the vastus medialis and the tibialis anterior muscles were recorded between days 3 and 10 after stroke onset. INTERVENTIONS: Not applicable.Main outcome measures A separate proximal leg motor score (maximum, 16 points) and crural motor score (maximum, 2 points) were defined within the lower-limb subset of the original Fugl-Meyer Motor Assessment to evaluate the motor performance at regular intervals until 6 months after stroke. The transfer item of the Barthel Index and the Functional Ambulation Categories scores were used to assess transfer and walking ability. RESULTS: For the paralysis subgroup (n=30), the follow-up was complete in 27 patients (2 patients died, 1 patient underwent above-knee amputation). At 26 weeks, 20 patients experienced proximal motor recovery (mean score +/- standard deviation, 11.70+/-4.48), and 12 of them also showed crural motor recovery (mean score, 1.40+/-.51). Nine patients (33%) could perform an independent transfer safely, and 7 (26%) had learned to walk independently. Analysis revealed significant relationships for tibialis anterior muscle MEPs and motor recovery of crural leg muscles (odds ratio [OR]=18.00; 95% confidence interval [CI], 1.31-894.40), but not for vastus medialis muscle MEPs and proximal motor recovery (OR=6.00; 95% CI,.53-303.00). We found no association between vastus medialis muscle MEPs and recovery of ambulation. However, tibialis anterior muscle MEPs seemed to provide a test with prognostic value for the ability to perform independent transfers (OR=17.50; 95% CI, 1.36-267.00), but not for walking (OR=5.25; 95% CI,.40-77.57). Patients in the paresis subgroup experienced more favorable motor and functional recovery than did those in the paralysis subgroup. CONCLUSIONS: Tibialis anterior muscle MEPs registered in subacute phase after stroke may provide important prognostic information, both for motor recovery of the crural muscles and for the ability to perform independent transfers in patients with initial complete paralysis of the lower extremity. Vastus medialis muscle MEPs were not predictive for motor and functional recovery.     

Evidence-based educational guidelines for stroke survivors after discharge home

Stroke survivors today are discharged home from the hospital more quickly than in the past because of shifting economic realities. Survivors continue to experience significant impairments after discharge and families may be poorly prepared for the full extent of caregiving responsibilities. This article describes 39 comprehensive educational guidelines that have been tested with 72 stroke survivors and families during 1,150 home visits throughout the first 6 months after discharge from inpatient rehabilitation. Two case studies illustrate use of the guidelines with stroke survivors and their families.     

Brain activation of lower extremity movement in chronically impaired stroke survivors

Lower extremity paresis poses significant disability to chronic stroke survivors. Unlike for the upper extremity, cortical adaptations in networks controlling the paretic leg have not been characterized after stroke. Here, the hypotheses are that brain activation associated with unilateral knee movement in chronic stroke survivors is abnormal, depends on lesion location, and is related to walking ability. Functional magnetic resonance imaging of unilateral knee movement was obtained in 31 patients 26.9 months (mean, IQ range: 11.3-68.1) after stroke and in 10 age-matched healthy controls. Strokes were stratified according to lesion location. Locomotor disability (30 ft walking speed) did not differ between patient groups (9 cortical, 12 subcortical, 10 brainstem lesions). Significant differences in brain activation as measured by voxel counts in 10 regions of interest were found between controls and patients with brainstem (P = 0.006) and cortical strokes (P = 0.002), and between subcortical and cortical patients (P = 0.026). Statistical parametric mapping of data per group revealed similar activation patterns in subcortical patients and controls with recruitment of contralateral primary motor cortex (M1), supplementary motor area (SMA), and bilateral somatosensory area 2 (S2). Cortical recruitment was reduced in brainstem and cortical stroke. Better walking was associated with lesser contralateral sensorimotor cortex activation in brainstem, but stronger recruitment of ipsilateral sensorimotor and bilateral somatosensory cortices in subcortical and cortical patients, respectively. A post hoc comparison of brainstem patients with and without mirror movements (50%) revealed lesser recruitment of ipsilateral cerebellum in the latter. Subcortical patients with mirror movements (58%) showed lesser bilateral sensorimotor cortex activation. No cortical patient had mirror movements. The data reveal adaptations in networks controlling unilateral paretic knee movement in chronic stroke survivors. These adaptations depend on lesion location and seem to have functional relevance for locomotion.     

Surveillance after lower extremity arterial bypass

The elements of a surveillance program after lower limb bypass grafting to enhance graft patency continue to evolve. Graft evaluation should include clinical assessment for new or changes in limb ischemia symptoms, measurement of ankle or toe systolic pressure, or both, and duplex ultrasound imaging of the bypass graft, which in the early postoperative period is predictive of the subsequent need for bypass graft revision. The natural history of moderate graft stenosis is known, and these lesions can be safely monitored using serial testing to identify progression. The testing frequency should be individualized to the patient, type of arterial bypass, and duplex scan findings. Graft surveillance should focus on the identification and repair of critical stenosis (peak systolic velocity exceeding 300 cm/s, and peak systolic velocity ratio across the stenosis exceeding 3.5) correlating with more than 70% diameter-reducing stenosis. A graft surveillance program should result in a graft failure rate of less than 3% per year.     

Complications of lower extremity arteriovenous grafts in patients with end-stage renal disease

BACKGROUND: More data are needed to assess lower extremity angioaccess sites for hemodialysis. METHODS: We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. RESULTS: Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58 of 134 patients (43%) and were more prevalent in women, blacks, diabetic, and hypertensive patients, but not of statistical significance. Dialysis was done for a mean duration of 13.3 years, with a mean graft patency rate of 13.8 months. The 12-month survival rate of lower extremity AV grafts was 62% (83/134). Complications in the lower extremity AV graft group (58 patients) included infections in 27 patients (46%), thrombosis within 30 days in 16 (28%), pseudoaneurysm in 9 (16%), and graft hemorrhage in 6 (10%). CONCLUSIONS: There is a decreased patency rate in lower extremity AV grafts.     

早期康复活动在下肢深静脉血栓导管接触性溶栓术后患者中的应用研究

目的 探讨早期康复活动干预在下肢深静脉血栓导管接触性溶栓术后患者中的应用效果。方法 采用便利抽样,选取2018年4月—12月在苏州市某三级甲等医院住院的40例患者纳入试验组,选取2017年6月—2018年3月住院的40例患者纳入对照组。试验组接受早期康复活动干预,对照组接受常规护理。比较两组住院期间患肢髌骨上缘15 cm和髌骨下缘10 cm腿围周径、尿激酶用量、溶栓天数、舒适度评分、疼痛评分、患者对护理满意度评分、穿刺处渗血及溶栓导管移位的发生率;比较两组出院后1个月和3个月的生活质量评分及血栓形成后综合征（postthrombotic syndrome, PTS）评分。 结果 住院期间试验组患侧肢体髌骨下缘10 cm腿围周径差小于对照组、尿激酶用量及溶栓天数少于对照组、疼痛数字评分低于对照组,患者对护理满意度评分高于对照组,差异有统计学意义（P<0.05）;出院后1个月试验组在生理机能、生理职能、躯体疼痛、总体健康状况、情感职能、精神健康方面得分高于对照组,PTS评分低于对照组,差异有统计学意义（P<0.05）;出院3个月后试验组在生理职能、躯体疼痛、总体健康状况方面得分高于对照组,PTS评分低于对照组,差异有统计学意义（P<0.05）;组内比较试验组在出院后3个月的生理机能、精力、社会功能、情感职能方面的得分高于出院后1个月得分,PTS评分低于出院后1个月得分,差异有统计学意义（P<0.05）;对照组在出院后3个月的生活质量8个维度得分均高于出院后1个月得分,PTS评分低于出院后1个月评分,差异均有统计学意义（P<0.05）。 结论 为下肢深静脉血栓导管接触性溶栓治疗术后患者实施早期康复活动干预能改善患者的生活质量,提高患者的舒适度。     

Flaps and grafts revisited: cross-leg and thigh flaps for lower extremity wounds.

Soft tissue reconstruction of the lower extremity has evolved considerably over the last 25 years. We no longer have to rely only on awkward pedicle flaps, or ultimately, amputation in order to heal a leg wound. The following is a brief history of the flaps prior to the development and use of the operating microscope and an increased knowledge of the circulation distal to the knee.     

早期下床无负重活动在踝关节骨折术后患者中的应用

目的探讨早期下床无负重活动在踝关节骨折术后患者中的应用效果。方法按入院先后次序将60例踝关节骨折术后患者分为实验组和对照组,每组各30例。对照组患者术后指导其踝关节制动并尽量抬高患肢高于心脏水平,实验组患者术后第1d指导其拄双拐下地行无负重活动。观察两组患者踝关节周径变化、阿片类药物使用剂量、伤口愈合时间、住院时间和并发症发生情况。结果两组患者踝关节周径变化、阿片类药物使用剂量、伤口愈合时间比较,差异无统计学意义（均P〉0.05）;实验组患者住院时间少于对照组,并发症发生率低于对照组（均P〈0.05）。结论鼓励踝关节骨折患者术后早期下床无负重活动,在预防卧床并发症发生的同时,提高了临床治疗效果,从而缩短患者住院时间。     

心脏起搏器术后早期活动的意义

介绍心脏起搏器术后常规卧床时间，综述了术后缩短卧床时间的概况，以及早期活动的临床意义，并提出早期活动的注意事项。     

心脏起搏器术后早期活动的意义

介绍心脏起搏器术后常规卧床时间,综述了术后缩短卧床时间的概况,以及早期活动的临床意义,并提出早期活动的注意事项。     

Rehabilitation after bilateral lower extremity amputation.

Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. In 26 of the patients bilateral below-knee amputations had been performed. Although diabetes mellitus was present in 26 of the patients, it severely hampered rehabilitation in only four. Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.     

神经外科手术患者术后早期下床活动的影响因素分析

目的调查神经外科手术患者术后早期下床活动情况,并分析相关影响因素。方法采用分层多级抽样法选取2018年1—5月北京某三级甲等医院神经外科收治的220例行神经外科手术治疗患者,采取自制调查表调查其术后早期下床活动情况,依据是否早期下床活动分为早期下床活动组与未早期下床活动组,比较两组患者临床资料(性别、年龄、经济收入、居住地、婚姻状况、术中失血量、手术类型、疾病种类、携带监护仪、绷带拆除、疼痛、负性情绪、留置尿管、肌力问题、引流管、头晕与呕吐等),并采用Logistic回归分析探讨早期下床活动的影响因素。结果220例患者中,120例(54.55%)患者术后未执行早期下床活动,100例(45.45%)患者执行术后早期下床活动。单因素分析显示,两组患者术中失血量、手术类型、携带监护仪、未拆绷带、留置尿管、肌力问题、引流管、头晕与呕吐比较差异有统计学意义(P<0.05);Logistic回归分析显示,手术类型、未拆绷带、留置尿管、肌力问题、引流管、头晕与呕吐是神经外科手术患者术后早期下床活动的独立影响因素(P<0.05)。结论神经外科手术患者术后早期下床活动执行情况不理想,急诊手术、未拆绷带、留置尿管、存在肌力问题、有引流管、发生头晕与呕吐为影响患者开展早期下床活动的主要独立危险因素,临床护理人员可针对危险因素予以合理干预,以促进患者早期下床,改善预后。     

下肢骨折内固定术后膝关节功能障碍的早期综合康复疗效分析

摘要 目的：评价早期综合康复对下肢骨折内固定术后膝关节功能障碍患者的作用。 方法：80例下肢骨折内固定术后出现膝关节功能障碍的患者随机分为两组,治疗组42例,对照组38例,同时给予泥疗、平衡负重及关节活动度（KOM）训练,治疗组在此基础上增加针刺及连续泥疗下关节活动度的训练,并通过视觉模拟评分(VAS）、膝关节水肿程度、ROM和依从性的评定,评价早期综合康复的作用。 结果：治疗后两组患者在疼痛程度、膝关节周径、关节活动度、依从性等方面都有不同程度的改善,其中治疗组明显优于对照组,差异显著（P<0.05）。 结论：早期综合康复能减轻下肢骨折内固定术后的膝关节功能障碍。     

Immediate ambulation of patients with lower-extremity grafts.

Immediate ambulation of patients who have had lower-extremity skin grafting has been practiced in our burn center since 1987. A retrospective review of patients who had lower-extremity skin grafting only and a survey of burn centers in which 109 centers responded were conducted. Average skin graft take in our burn center was 96.4%. Patients in our burn center walked 30 feet independently by postoperative day 1.7, whereas the survey response average was 7.2 days (p less than 0.001). Average length of stay was 12.6 days (p less than 0.012). This review demonstrated that although immediate ambulation after lower-extremity grafting is not a widely adopted procedure, it does not impair graft take and may decrease the average length of stay.