Evaluation of Acti-Wrap: a new cohesive retention bandage

Retention bandages are designed to keep dressings, devices and creams in place without causing discomfort to the patient. They should be lightweight, soft and comfortable and should not cause unwanted compression. Acti-Wrap retention bandage (Activa Healthcare) is a new, conforming bandage which is easy to apply and because of its cohesive nature stays in place. This product focus looks at the ways in which the bandage can be used effectively and the cost-effectiveness of using this type of bandage. The simple evaluation described in this article compares Acti-Wrap with two other frequently used retention bandages.     

Investigating pressure bandaging for snakebite in a simulated setting: Bandage type,training and the effect of transport

Background: The clinical evidence base for the use of pressure bandaging in snakebite is limited. We aimed to investigate if pressure bandages (PB) generated and maintained presumptive optimal pressures in a simulated setting. Methods: A total of 96 subjects were recruited, 78 health professionals and 18 from the general public. Participants were asked to apply PB with crepe and with an elasticized bandage without instruction. A paediatric blood pressure cuff attached to a pressure transducer was used to measure the pressure generated. PB application with elasticized bandages was repeated by 36 participants (18 general public and 18 health professionals) with feedback on pressures attained, and reassessment on the sixth subsequent attempt. Pressure was also measured under correctly applied bandages during an ambulance ride. Results: The median pressure generated under crepe bandages was 28 mmHg (interquartile range [IQR]: 17–42 mmHg) compared with 47 mmHg (IQR 26–83 mmHg) with elasticized bandages, with most subgroups applying the elasticized bandage closer to the estimated optimal pressure (55–70 mmHg). Following training, the median pressure for the 36 participants was 65 mmHg (IQR 56–71 mmHg), closer to the optimal range than initial attempts. On initial bandaging, 5/36 (14%) participants achieved optimal pressure range with elasticized bandages, compared with 18/36 (50%) after training (P = 0.002). Crepe bandages initially correctly applied did not maintain desired pressure during ambulance transport on urban roads over 30 min. Elasticized bandages maintained pressure. Conclusions: PB was poorly done by the general public and health professionals. Crepe bandages rarely generated optimal pressures compared with elasticized bandages, but training did improve participants' ability to apply elasticized bandages. PB recommendations should be modified to specify appropriate bandage types.     

In vivo measurement of compression bandage interface pressures: The first study

Compression therapy has precise technical characteristics but in vivo pressures exerted by bandages are still poorly understood.ObjectiveTo perform in vivo pressure measurements of different compression bandages bearing different technical characteristics with different application methods.MethodInterface pressure was measured on the lower limb of 20 healthy women at 3 different points (B1, C and F) using 6 compression techniques (stockings, non-elastic bandage, elastic bandages with 2 technical characteristics and 3 application methods), and in 3 positions.ResultsAll elastic compression bandages respected the principle of graduated pressure along the length of the limb (P < 0.0001), but not the non-elastic bandage. The pressures increase significantly (P < 0.0001) between the supine position and the sitting or standing position, especially with the non-elastic compression bandage. There is a marked variation in pressures between subjects for some bandages (non-elastic and elastic applied using the figure-of-eight technique). The pressure increases significantly with the number of bandage overlaps (P < 0.01).ConclusionElastic and non-elastic bandages behave differently from one another, and non-elastic bandages not appearing to comply with medical recommendations concerning graduated pressure. There is a high level of variability between subjects for some compression bandages (non-elastic and figure-of-eight methods).     

Physical properties of short-stretch compression bandages used to treat lymphedema.

This study examined the physical properties of six common brands of short-stretch compression bandages used to treat lymphedema. The physical properties examined were (a) maintenance of pressure over a 12-hr period, (b) variability of pressure across the width of the bandages, and (c) variability of pressure when the bandages were wrapped with a 50% overlap. The results of the study indicate that all six brands of bandages tested maintain pressure well over a 12-hr period. Each has a variance of pressure between the middle and edge of the bandage, with the edges measuring (in mmHg) between 6% and 28% lower than the middle. When the bandages were wrapped with an 50% overlap, all six brands measured fairly consistently in pressure readings (in mmHg) across the width. These results indicate that the six brands of short-stretch compression bandages tested have similar physical characteristics.     

Does comprilan bandage have any influence on peripheral perfusion in patients with oedema?

Aim: Comprilan bandage may be an attractive treatment of leg oedema, but theoretically bandage could compromise peripheral circulation. The present study was undertaken to investigate circulation in the first toe before, during, and after treatment with comprilan bandage. Methods and study population: Blood flow rate was measured by the heat‐washout method in the pulp of the first toe of 10 patients (eight women, two men, aged 75–94) with leg oedemas, and systolic toe blood pressure was determined by the strain gauge method. Oedema was scored according to a visual scale, and the patients were treated with comprilan (short stretch) bandage for 1 week. Toe blood flow rate was measured before, during and after the use of the bandages, and toe blood pressure was measured before and after the use of bandages. Results: According to the visual scale, all subject benefited from the treatment by reduction of oedema, and they reported increased well‐being after. Blood flow rate was not significantly altered during and after the treatment. Systolic toe pressure was normal in all patients (R/L = 94/83 mmHg), and no significant change took place during and after the use of the bandages (92/90 mmHg). Conclusion: Comprilan bandage has a positive effect on legs oedemas, visually as well as according to the patients well‐being. The treatment does not have any significant influence on toe blood pressure. It cannot, however, be excluded that the use of comprilan bandage may compromise toe blood flow rate slightly (<5%). A larger study with more subjects has to be made to come this closer, and additional capillary blood flow rate should be measured in an area without arteriovenous anastomoses.     

Evaluation of cohesive and elastic support bandages for joint immobilization

The purpose of this clinical study was to compare the performance of a new cohesive bandage to that of elastic bandages for joint immobilization. The magnitude of joint immobilization by these bandages was quantitated during isokinetic exercise using a computerized dynamometer. The degree to which the cohesive and elastic bandages reduced range of motion and peak torque of plantar and dorsiflexion was not significantly different. After exercising for 1 hour, the elastic bandage loosens, reducing its ability to immobilize the joint. In contrast, the cohesive bandage maintains its configuration, despite active exercise for 1 hour.     

锁骨骨折三种外固定方法的比较

目的比较三种外固定方法治疗锁骨骨折的疗效,探讨锁骨骨折最佳的外固定方法。方法锁骨骨折患者137例,骨折复位后,分别用8字棉纱绷带、8字石膏绷带、8字树脂绷带外固定;比较三种方法的治疗效果。结果均在治疗6月后达骨性愈合,且肩关节功能无明显受限。用8字棉纱绷带、8字石膏绷带外固定有较高比率的畸形愈合,而8字树脂绷带外固定者大部分获解剖位或近解剖位愈合。结论8字树脂绷带外固定治疗锁骨骨折固定牢靠,疗效满意,是锁骨骨折治疗的理想外固定方法。     

Biomechanics of walking with silicone prosthesis after midtarsal (Chopart) disarticulation

Background

Currently accepted understanding is that silicone foot prostheses have little influence on biomechanics of walking; however clinical observations suggest several beneficial effects. The objective of this study was to characterize biomechanics of gait in a group of subjects with disarticulation through the talonavicular (T-N) and calcaneocuboid (C-C) (midtarsal) joints wearing two different prosthetic solutions: silicone prostheses and conventional prostheses.

Methods

Four subjects that underwent Chopart partial foot amputation were included in the study. Silicone prosthesis was custom manufactured for each individual subject. Instrumented gait analysis was performed in each subject in four experimental conditions: barefooted, barefooted and wearing silicon prosthesis, wearing footwear with conventional prosthesis and wearing footwear with silicon prosthesis. Comparisons and statistical analysis were made between both barefooted conditions and both foot-wearing conditions.

Findings

Our results show that silicone prosthesis without reinforced sole increases gait velocity, improves generation of ankle plantarflexion moment throughout the stance phase and enables greater power generation at push-off. The most important changes, however, occur in the frontal plane, where improved hip adduction angles and higher hip abduction moment in the stance enable more normal pelvic movement and consequently also less trunk inclination toward amputated side.

Interpretation

We conclude that silicone prostheses are not solely for cosmetic reasons but may be also biomechanically superior over other prosthetic solutions, especially for walking barefoot.     

A comparative evaluation of oxygen consumption and gait pattern in amputees using Intelligent Prostheses and conventionally damped knee swing-phase control

OBJECTIVE: To compare the gait of amputees wearing conventionally damped pneumatic swing-phase control knees and microchip-controlled Intelligent Prostheses. DESIGN: Crossover trial. SETTING: An amputee rehabilitation centre in a teaching hospital. PARTICIPANTS: Ten established unilateral transfemoral prosthetic users were asked to participate in the trial; all agreed. INTERVENTIONS: The amputees were assessed wearing pneumatic swing-phase control knees and then with the Intelligent Prosthesis. MAIN OUTCOME MEASURES: Oxygen consumption while walking at different speeds on a treadmill, video-recording of gait assessed by a panel and temporal-spatial parameters of gait whilst walking at slow, fast or normal speeds in a gait laboratory. RESULTS: Mean oxygen cost for all subjects at 0.69 m/s was 0.33 ml/kg.m with the conventional limb and 0.30 ml/kg.m with the Intelligent Prosthesis (p = 0.01). At 1.25 m/s the mean oxygen cost for the conventional limb was 0.24 ml/kg.m and for the Intelligent Prosthesis was 0.22 ml/kg.m (not significant). The ANOVA analysis showed that oxygen cost was similar at normal walking speeds but increased more at lower speeds for the pneumatic swing-phase control leg compared to the Intelligent Prosthesis (p < 0.02). There were no significant differences in subjective gait evaluation or temporal and spatial gait parameters. CONCLUSION: At lower speeds oxygen cost was lower with the Intelligent Prosthesis. Gait analysis detected no significant changes between the two legs.     

半掌踝足矫形器与足跟镂空踝足矫形器对脑卒中患者步态影响的比较

目的 观察半掌踝足矫形器和足跟镂空踝足矫形器对脑卒中患者步态的影响。方法 选取符合标准的脑卒中患者25例,采用步态分析系统分别对25例脑卒中后步行功能障碍患者裸足、佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的步行状态进行分析,记录三种状态下患者的步速、步频、健侧摆动相、患侧摆动相、跌倒风险和3 m起立计时行走时间,并进行统计学分析。 结果 受试者佩戴足跟镂空踝足矫形器时的步频为（86.718±17.947）Hz,较裸足和佩戴半掌踝足矫形器时均显著加快,差异均有统计学意义（P<0.05）。受试者佩戴足跟镂空踝足矫形器时的步态不对称系数为（0.086±0.070）,与裸足时比较,差异有统计学意义（P<0.05）。受试者佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的3 m起立计时行走时间较裸足时均显著缩短,差异均有统计学意义(P<0.05)。受试者佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的跌倒风险均显著低于裸足时,差异均有统计学意义(P<0.05);且受试者佩戴足跟镂空踝足矫形器时的跌倒风险亦显著低于佩戴半掌踝足矫形器时,差异有统计学意义（P<0.05）。 结论 佩戴半掌踝足矫形器和足跟镂空踝足矫形器均可有效纠正脑卒中患者的步态,降低其跌倒风险,且佩戴足跟镂空踝足矫形器的优势更加明显。     

Class-3c compression bandaging for venous ulcers: comparison of spiral and figure-of-eight techniques

AIM: This paper reports a study to compare the differences in compression produced on a limb using a spiral and a figure-of-eight bandaging technique. BACKGROUND: Chronic leg ulcers are a major health problem in Western countries. Compression bandaging is the accepted treatment for venous leg ulcers. The spiral and the figure-of-eight techniques are traditional methods of applying compression bandages. But their performance in terms of pressure profiles is unknown. Despite a lack of evidence about technique, class-3c compression bandages are not currently recommended for application in a figure-of-eight as this is thought to produce dangerously high pressure. METHODS: A cross-over experimental design was used with a sample of 26 nurse bandagers. Consistency of performance was tested. Bandage stretch and overlap were measured and analysed by standard deviation to ensure that the techniques were consistent and repeatable. Pressure probes were then applied to the medial, posterior and lateral aspects of the lower limb of a healthy volunteer. The class-3c compression bandage was applied using both techniques and the pressure profiles around the leg were measured under the bandage. The results of each technique were compared using independent sample t-tests. The data were collected in 1999. RESULTS: The figure-of-eight technique provided statistically significantly higher compression at lower areas of the leg than the spiral technique. Mean pressure difference was 20.3 mmHg at the ankle, 22.2 mmHg at the gaiter, 9.4 mmHg at the calf. The pressure differences decrease towards the knee with both techniques and decrease more steeply with the figure-of-eight technique. CONCLUSION: The spiral technique was a safe and comfortable method of bandage application. The figure-of-eight also provided graduated compression but with some high areas of pressure, notably overlying the Achilles tendon. However, before firm practice recommendations are made, replication of the study using a padding layer and a larger sample is needed.     

Comparison of Rosidal K and SurePress in the treatment of venous leg ulcers.

Fifty-two patients (26 in each group) were recruited into this randomized, comparative, controlled trial of Rosidal K short-stretch compression bandage and SurePress long-stretch compression bandage in the treatment of venous leg ulcers. Patients were monitored for a maximum of 12 weeks. Each patient was seen weekly by a research nurse, who recorded the study variables. The mean percentage reduction in the wound bed surface area during the study period was 52% in the SurePress group and 73% in the Rosidal K group. Eight patients in each group saw their ulcers heal within the study period. The average limb volume reduction, based on the first 4 weeks of data collection, was 2.3 cm for those in the Rosidal K group and 3.9 cm in the SurePress group. Ulcer size increased in six patients allocated to SurePress bandages and in four patients allocated to Rosidal K bandages.     

Gait and balance performance improvements attributable to ankle-foot orthosis in subjects with hemiparesis

OBJECTIVE: To assess the change in the balance performance and the improvement in the gait performance of subjects with hemiparesis, as a result of their wearing an ankle-foot orthosis. DESIGN: This was a cross-sectional control trial. Fifty-eight subjects with hemiparesis of a duration of less than 6 mos participated in this study. Each subject was evaluated for the balance and gait performance with and without an ankle-foot orthosis on the affected side. The balance activities were evaluated by the Balance Master System, and the gait performance was measured using GAITRite. RESULTS: The increase in movement velocity and the change in maximal excursion toward the affected side during the balance testing were found to be correlated significantly with the change in walking speed as a result of wearing an ankle-foot orthosis (r=0.274, P=0.039; r=0.325, P=0.020; respectively). Only the change in maximal excursion toward the affected side was found to be significantly correlated with the change in nonaffected step length (r=0.381, P=0.010). CONCLUSION: The maximal excursion toward the affected side improved as a result of wearing an ankle-foot orthosis. This correlated with an increase in step length on the nonaffected side and, hence, an improvement in the walking speed of the subjects with hemiparesis.     

不同弹力绷带联合包扎治疗在乳腺癌相关淋巴水肿患者中的应用效果

目的探讨不同弹力绷带联合包扎治疗在乳腺癌相关淋巴水肿患者中的应用效果。方法选取2018年5—12月淋巴水肿护理门诊收治的38例乳腺癌相关淋巴水肿患者,采用泡沫块绷带+低弹力绷带+高弹力绷带联合包扎,实施综合淋巴消肿治疗。治疗前1 d,治疗后10、20 d测量患侧上肢周径。对比治疗前1 d和治疗20 d后患者肢体周径比率、组织水分比率、皮肤纤维化发生率。结果治疗10、20 d后,患侧上肢5个测量点周径均小于治疗前,差异均有统计学意义(P<0.05)。治疗20 d后患者的患侧上肢肢体周径比率、组织水分比率、皮肤纤维化发生率均较治疗前降低,差异有统计学意义(P<0.05)。结论用不同弹力绷带联合包扎实施综合淋巴消肿治疗可有效地改善乳腺癌患者患侧上肢的淋巴水肿程度,缩短疗程,同时可改善淋巴水肿皮肤纤维化程度,值得临床推广。     

穿戴塑料踝足矫形器对下肢肌肉疲劳性的影响

背景：目前尚未见到系统研究踝足矫形器对下肢肌肉影响的文献。目的：提取正常人穿戴固定踝足矫形器时的下肢肌电信号,分析固定踝足矫形器对下肢肌肉疲劳性的影响。方法：选择5名健康男性受试者参加试验,每名受试者分别进行3组试验：①第1组,在不穿戴任何矫形器的情况下以自然步态行走。②第2组,受试者穿戴平跟踝足矫形器以自然步态行走（此时矫形器踝部包裹超过踝中心1 cm,记1.0 cm）,穿戴同一矫形器但在踝部去掉1.0 cm、踝部塑料边缘刚好通过踝中心时采集（记0 cm）,在踝部再去掉1.0 cm后以自然步态行走（记-1.0 cm）。③第3组,受试者穿戴1.5 cm正常跟高踝足矫形器以自然步态行走,穿戴同一矫形器,但跟高分别改为1.0,2.0 cm后以自然步态行走。行走中采用肌电采集仪检测受试者下肢股二头肌、股直肌、胫骨前肌、腓肠肌的表面肌电信号。结果与结论：①正常不穿戴任何矫形器时,4块肌肉的肌电信号是最弱的。②对于任何一块肌肉,正常不穿戴矫形器时所对应肌电值比穿戴不同硬度矫形器时所对应的肌电值要小。③对于股二头肌,正常不穿戴矫形器时所对应的积分肌电值与穿戴正常跟高矫形器时所对应的值很接近,同时这两个值要比穿戴不正常跟高矫形器时所对应的积分肌电值小。表明固定塑料踝足矫形器会引起股二头肌、股直肌、胫骨前肌、腓肠肌的疲劳,当固定塑料踝足矫形器的跟高不合适时会进一步增加股二头肌的疲劳程度。     

Immediate effects of an elastic arm sling on walking patterns of chronic stroke patients

[Purpose] We developed a new arm sling with an elastic bandage which we hearafter refer to as “the elastic arm sling”. This study investigated the immediate effects of the elastic arm sling on the gait patterns of stroke patients. [Subjects and Methods] Thirteen stroke patients were enrolled in this study after providing their informed consent. They walked on a GAITRite mat twice, with a 5-min rest between the trials. [Results] Significant improvements were seen in cadence and walking velocity during walking while wearing the elastic arm sling. Furthermore, patients who used the elastic arm sling showed significant increases in step lengths of the affected and unaffected limbs. The stride lengths of the affected and unaffected sides while wearing the elastic arm sling and those without the elastic arm sling also significantly differed. [Conclusion] These results demonstrate that the elastic arm sling is a useful tool for the gait training of stroke patients, especially cadence, walking velocity, and the step and stride lengths of both limbs. Therefore, therapists should use the elastic arm sling as a gait-training assistive device for stroke patients.Key words: Elastic arm sling, Hemiplegic gait, Orthotic devices     

Actico: a short-stretch bandage in venous leg ulcer management

Actico compression bandage system (Activa Healthcare) completes the prevention and treatment regime of venous leg ulcer management. Actico gives the patient comfort by being a simple two-layer compression bandage system that is also effective and which stays in place because of its cohesive nature. This product focus looks at the impact of venous leg ulcers, the use of compression and focuses on short-stretch bandages and the Actico bandage system.     

Rosidal K: a short-stretch compression bandage system

Management of venous leg ulcers account for a large proportion of the work of healthcare professionals, especially for those who are community based. Multilayer and long-stretch bandage systems have been used successfully for many years in venous leg ulcer management. Rosidal K, a short-stretch bandage, is now also becoming more widely accepted in this country as an effective and cost-effective bandage system. This product focus looks at bandage systems and examines the research supporting the use of short-stretch bandages and Rosidal K.     

步态时相对称性与假肢穿着者行走功能直观评价的相关分析

用步态时相对称性指数的计算方法与行走功能指数直观评价法对１５位不同残肢的假肢穿着者进行步态检查，得出两者之间的线性相关系数为０．８１７（Ｐ〈０．０１）。回归方程为：Ｙ对称性指数＝４．２０６＋０．８８６Ｘ功能指数。认为假肢穿着者的步态时相对称性指数能够反映其行走功能。     

A comparative study of conventional and energy-storing prosthetic feet in high-functioning transfemoral amputees

OBJECTIVE: To compare the results of gait analysis, timed walking tests, and socket comfort for transfemoral amputees wearing initially a Multiflex conventional prosthetic foot and then a Vari-Flex energy-storing prosthetic foot. DESIGN: Experimental crossover trial. SETTING: A regional prosthetic and amputee rehabilitation tertiary referral center in a teaching hospital. PARTICIPANTS: Six established unilateral transfemoral prosthetic users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait analysis, a timed walking test, and a Prosthetic Socket Fit Comfort Score for each amputee wearing the Multiflex foot and then repeated wearing the Vari-Flex foot. RESULTS: Wearing the Vari-Flex foot, our subjects walked faster in the gait lab (1.38 +/- 0.13 m/s, P < .001) and took more equal step lengths at fast speed (1.063 +/- 0.05, P < .05). They also had greater peak ankle dorsiflexion at push-off on the prosthetic side (18.3 degrees +/-4.73 degrees, P<.001) and 3 times as much power from the prosthetic ankle at push-off (1.13 +/- 0.22 W/kg, P < .001). There were no significant changes in temporal symmetry or loading of the prosthetic limb, in the timed walking test with each foot, or in the comfort score. CONCLUSIONS: A transfemoral amputee who wears an energy-storing foot can have a more symmetric gait with regard to some measures of spatial symmetry, kinetics, and kinematics than one who wears a conventional foot. However, in this study important aspects such as more symmetric loading and comfort did not differ significantly between the 2 foot types.