Characterization of normative angular joint kinematics during two functional upper limb tasks

BackgroundOptical motion capture is a powerful tool for assessing upper body kinematics, including compensatory movements, in different populations. However, the lack of a standardized protocol with clear functional relevance hinders its clinical acceptance.Research questionThe objective of this study was to use motion capture to: (1) characterize angular joint kinematics in a normative population performing two complex, yet standardized upper limb tasks with clear functional relevance; and (2) assess the protocol’s intra-rater reliability.MethodsTwenty non-disabled adults performed the previously developed Pasta Box Task and Cup Transfer Task. The kinematics of the upper body were captured using an optoelectronic motion capture system and rigid plates with reflective markers. Angular joint trajectories, peak angle, range of motion (RoM), and peak angular velocity were extracted for the trunk, shoulder, elbow, forearm, and wrist. Intra-class correlation was used to assess the intra-rater reliability of the kinematic measures.ResultsBoth tasks required minimal trunk motion. Cross-body movements required greater RoM at the trunk, shoulder, and elbow joints compared to movements in front of the body. Reaches to objects further away from the body required greater trunk and elbow joint RoM compared to reaches to objects closer to the body. Transporting the box of pasta required the wrist to maintain an extended position. The two different grasp patterns in the Cup Transfer Task forced the wrist into a flexed and ulnar-deviated position for the near cup, and an extended and radial-deviated position for the far cup. For both tasks, the majority of measures displayed intra-class correlation values above 0.75, indicating good reliability.SignificanceOur protocol and functional tasks elicit a degree of movement sensitivity that is not available in current clinical assessments. Our study also provides a comprehensive dataset that can serve as a normative benchmark for quantifying movement compensations following impairment.     

Functional range of motion in the upper extremity and trunk joints: Nine functional everyday tasks with inertial sensors

BackgroundFunctional range of motion is defined as the required range of motions for individuals to maintain maximal independence, along with optimal conditions for activities of daily living. Intervention plans for rehabilitation are directed towards the acquisition of anatomical range of motion. However, this isn’t always possible based on person’s etiology, prognosis, or severity of disease.Research questionThe aim of this study is to determine functional range of motion during different unilateral, bilateral symmetrical and bimanual asymmetrical tasks of activities of daily living.MethodsParticipants completed nine basic activities of daily living (hand to head, hanging jacket, eating, wallet placement to back pocket, washing hands and face, removing belt, water pouring, brushing teeth) linked according to International Classification of Functioning, Disability and Health, while joint kinematics of the trunk and upper extremity were recorded with inertial measurement units. Peak values of mean joint angles were determined for each activities of daily living. MVN BIOMECH Awinda MTW2-3A7G6 sensors (Xsens Technologies B.V. Enschede, Netherlands) were used for 3D kinematic analysis of activities.ResultsForty-six healthy subjects (right-dominant) were included in this study. Range of motion requirements of all activities were defined 37.85° extension, 91.18° flexion, 1.25° adduction, 39.45° abduction, 63.6° internal rotation, 21.8° external rotation in the dominant shoulder, 124.17° flexion in the dominant elbow, 40.29° extension, 23.66° flexion, 18.31° supination, 12.56° pronation, 18.27 ulnar deviation and, 18.36° radial deviation in the dominant wrist. Maximum trunk range of motions were found to be 29.75° flexion in C7-T1, 10.74° flexion in T12-L1, and 24.16° flexion in L5-S1.SignificanceIt is thought that the results of this research will contribute to the determination of normative data needed for surgical interventions, technological rehabilitation devices and task-spesific rehabilitation programs which based patient's motor skill level.     

The Arm Profile Score: A new summary index to assess upper limb movement pathology

Although three-dimensional movement analysis is being increasingly used to evaluate upper limb (UL) movements, information on how to interpret the complex data is still missing. This paper introduces a new summary index, the “Arm Profile Score” (APS), to evaluate the severity of UL movement pathology based on kinematic data, similar to the “Gait Profile Score”. The APS is calculated from the root mean square (RMS) difference between kinematic data of the individual child with UL movement deficits and average data from typically developing children. The APS can be decomposed into 13 Arm Variable Scores (AVS), representing the different joint angles. The APS, together with the AVSs form the “Arm Movement Analysis Profile” (A-MAP).Face and construct validity were established for eight UL tasks in a group of 20 children with hemiplegic cerebral palsy (HCP). Intra-session variability was low for the different tasks, with median inter-quartile ranges below 2°. Correlation analysis showed few significant correlations between the individual AVSs and between the AVS and APS, implying that the A-MAP provides considerably more information compared to the APS only. The APS also showed good correlations with the House classification, and with measures of muscle tone, manual muscle strength and grip strength.This study provides a sound base to use the APS to evaluate UL movement pathology in children with HCP. Further study will need to confirm its value as an outcome measurement.     

Quantification of abnormal upper limb movement during walking in people with acquired brain injury

BackgroundAbnormal upper limb movements frequently affect people with acquired brain injury (ABI) during walking. Three-dimensional motion analysis (3DMA) can quantify upper limb abnormality kinematically, with composite scores condensing multiple joint axes data into a single score.Research QuestionAre 3DMA-derived composite scores valid (known-groups and convergent validity), reliable and able to quantify speed-related changes in abnormal upper limb movement during walking?MethodsThis observational study compared 42 adults with ABI and abnormal upper limb movements during walking with 36 healthy controls (HC) at a matched walking speed intention. Participants underwent 3DMA assessment of self-selected and fast walking speeds. Composite scores quantified the affected upper limb’s kinematic abnormality. The Arm Posture Score arithmetic mean version (APSam) and 1.96 standard deviation reference-range scaled versions; the Kinematic Deviation Score mean (KDSm) and worst score (KDSw) were evaluated for association with each other and subjective abnormality rating (Pearson’s 'r' correlation), test-retest reliability (intra-class correlation coefficient (ICC)), and ability to quantify speed-related changes in abnormal upper limb movement (Cohen’s d effect size (ES), % change scores).ResultsVery strong correlations existed between composite scores. The KDSm under-classified upper limb abnormality, whereas the KDSw captured the majority of ABI participants. All scores had moderate-strong correlations with subjective rating of abnormal upper limb movements (r = 0.54 - 0.79) and very strong test-retest reliability (ICCs > 0.81). The APSam demonstrated a 16% (ES = 0.76) walking speed-related increase in upper limb abnormality, whilst decreases were demonstrated in the KDSm 26% (ES 0.90) and KDSw 35% (ES 0.96).SignificanceThe APSam, KDSw, and number of abnormal joint axes comprehensively assess the whole upper limb abnormal movements, accurately classifies abnormality, and quantifies severity. This study illustrated notable presence of abnormal upper limb movements at self-selected walking speed and small increase at fast speeds. However, when scaled to HC variability, the fast walk kinematics became less abnormal due to increased HC movement variability.     

Infantile lipofibromatosis of the upper limb

The imaging features of extensive lipofibromatosis presenting in a 1-day-old female infant are reported. This lesion involved her entire right upper limb, extending from the axilla to the palm of the hand. Radiographs showed marked deformity and thinning of all the right upper-limb bones due to pressure effect of soft-tissue enlargement, especially affecting the distal humerus and proximal forearm bones. Magnetic resonance imaging showed a huge soft-tissue mass infiltrating most of the muscles of the entire upper limb, with bony erosion. The mass was largely T1-isointense, moderately T2-hyperintense and showed marked enhancement. There were intra-lesional signal changes consistent with fatty elements. A lesion debulking procedure was performed and the histology was that of lipofibromatosis. The limb was found to be non-viable after the procedure and a subsequent above-elbow amputation was performed. Although the resection margins were not clear, she had no further recurrence over a subsequent 3-year follow-up period. This case (case number 16) was presented at the 31st Closed Meeting of the International Skeletal Society held in Malta, October 2004     

Comparison of glenohumeral and humerothoracical range of motion in healthy controls,osteoarthritic patients and patients after total shoulder arthroplasty performing different activities of daily living

PurposeThe purpose of this study was to examine how total shoulder arthroplasty improves performance of activities of daily living compared to patients with glenohumeral osteoarthritis and how they perform compared to healthy controls.MethodsGlenohumeral and humerothoracical elevation used by patients with primary osteoarthritis (12 participants, 16 shoulders), after total shoulder arthroplasty (16 participants, 24 shoulders) and healthy controls (11 participants, 22 shoulders) for four different activities of daily living were assessed using 3D motion analysis. Analysis of range of motion and angle time series was performed.ResultsRange of motion used for activities of daily living was better in patients treated with anatomical total shoulder arthroplasty than in patients with primary glenohumeral osteoarthritis. Although it was still reduced compared to healthy individuals. Angle time series showed improved kinematics in patients with total shoulder arthroplasty compared to patients with glenohumeral osteoarthritis. Both glenohumeral and humerothoracical elevation kinematic time series were in almost all cases in between the control group’s and the osteoarthritis group’s.ConclusionTotal shoulder arthroplasty improves performance of activities of daily living in patients with primary glenohumeral osteoarthritis but cannot restore the full range of Motion compared to healthy controls. A prospective study with pre- and postoperative examinations is necessary to understand to understand how preoperative status influences the postoperative results.     

Upper extremity kinematics during functional activities: three-dimensional studies in a normal pediatric population

Children with brachial plexus birth palsy, burns, cerebral palsy, spinal cord injury and upper limb malformations may have diminished ability to perform activities of daily living (ADLs) due to limited upper extremity (UE) motion. Three-dimensional (3D) imaging techniques provide a way to document multi-planar functional limitations in the UE. These techniques have not been routinely used for this purpose primarily due to a lack of standardized protocols stemming from the complex nature of UE motion. Before 3D techniques can be routinely used for quantitative analysis and determination of functional limitations, standard activities and nomenclature for UE motion must be determined, and normal arm motion defined. This study establishes a normative pediatric database of 3D kinematic values during selected ADLs, enabling future comparisons with pathologic movements. Regardless of their underlying condition, children with limited UE function and ADL performance can be studied using this protocol and compared with this age-matched normal population.     

1 142例生活性手外伤的流行病学分析

目的 了解生活性手外伤的构成、分布特征及其影响因素。方法 对１９９７年４月￣１９９８年３月应诊的１１４２例急诊生活性手外伤患者进行问卷调查,并随机对其中１０２例患者进行随访。结果 患者的平均年龄为３６．２岁,男女性别比为１．７７：１;２０￣５０岁的青壮年占６２．２％（７１０／１１４２）;在家中发生的手外伤占４８．１％（５４９／１１４２）;开放性外伤占所有生活性手外伤的６９．０％（７８８／１１４２）     

Estimation of sex from the upper limb measurements of Sudanese adults

Sex estimation is the first biological attribute needed for personal identification from mutilated and amputated limbs or body parts in medical-legal autopsies. Populations have different sizes and proportions that affect the anthropometric assessment of sex. Relatively few published works assess the accuracy of sex estimation from soft tissue measurements of upper limb parts, except for the hand and its components, but these studies involve a limited range of global populations. The current study aimed to assess the degree of sexual dimorphism in upper limb measurements and the accuracy of using these measurements for sex estimation in a contemporary adult Sudanese population. The upper arm length, ulnar length, wrist breadth, hand length, and hand breadth of 240 right-handed Sudanese subjects (120 males and 120 females) aged between 25 and 30 years were measured by international anthropometric standards. Demarking points, sexual dimorphism indices and discriminant functions were developed from 200 subjects (100 males and 100 females) who composed the study group. All variables were sexually dimorphic. The ulnar length, wrist breadth and hand breadth significantly contributed to sex estimation. Forearm dimensions showed a higher accuracy for sex estimation than hand dimensions. Cross-validated sex classification accuracy ranged between 78.5% and 89.5%. The reliability of these standards was assessed in a test sample of 20 males and 20 females, and the results showed accuracy between 77.5% and 90%. This study provides new forensic standards for sex estimation from upper limb measurements of Sudanese adults.     

迭代重建技术对低辐射剂量上肢血管内瘘CT造影成像质量的影响

目的 探讨第二代双源CT上肢血管内瘘造影成像中应用迭代重建时,与常规剂量滤波反投影（Filtered back projection,FBP）重建图像质量相当的最适合的低剂量水平。方法 本试验为前瞻性研究,将150例拟行上肢内瘘血管CT造影成像（CTA）检查的患者按照同期随机原则分为常规对照组和4个实验组,每组30例。常规对照组采用常规剂量FBP重建,4个低辐射剂量的实验组应用正弦波图形法迭代重建,管电流分别逐级降低至常规对照组管电流（110 mAs）的70%、60%、50%和40%。取锁骨下动脉近肩关节层面以及桡动脉与头静脉吻合口相近层面作为两个感兴趣区,采用方差分析比较各组图像质量的客观评价指标[信噪比（SNR）、对比噪声比（CNR）]以及辐射剂量（容积CT剂量指数、剂量长度乘积、有效剂量）的差异。图像质量（各组的管腔对比度、边缘锐利度、主观噪声及图像总体质量）的主观评价采用4分法,采用Kruskal-Wallis H非参数检验比较各组主观图像质量评分。结果 测得77、66和55和44 mAs组的辐射剂量分别为常规剂量组的70%、55%、40%和25%。感兴趣区1中77、66和44 mAs组与常规剂量组的SNR和CNR比较,差异均有统计学意义（F=24.018,20.386,P<0.05）;77和66 mAs组的SNR和CNR高于常规剂量组,44 mAs组低于常规剂量组;55 mAs组与常规剂量组比较差异无统计学意义（P>0.05）。感兴趣区2中77、66和55 mAs组SNR和CNR高于常规剂量组,4组差异均有统计学意义（F=15.934、13.818,P<0.05）;44 mAs组与常规剂量组比较,SNR和CNR差异无统计学意义（P>0.05）。主观评价总体图像质量、图像对比度、血管边缘锐利度、主观噪声的结果,77、66和55 mAs组和常规剂量组得分较好,均≥ 3分,44 mAs组图像质量下降出现2分评价。5组图像的对比度、锐利度、主观噪声和总体图像质量差异均有统计学意义（H=10.268、14.542、15.840和11.014,P<0.05）。受试者工作特征曲线（ROC）曲线分析显示55 mAs组为能够维持图像质量等同于常规剂量组的最适合的低剂量组,曲线下面积为0.844,95%置信区间为0.705~0.982。55 mAs组有效剂量为（3.545±1.396）mSv,约为常规剂量组剂量（9.271±2.892）mSv的40%。结论 迭代重建技术可以显著地降低噪声,在剂量降低为常规剂量FBP 40%的条件下仍能保持与之相当的图像质量。由此,可使患者上肢血管内瘘CT造影成像检查的辐射剂量降低至3.545 mSv。     

Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study

ObjectivesTo examine gait parameters in people with gout during different walking speeds while adjusting for body mass index (BMI) and foot-pain, and to determine the relationship between gait parameters and foot-pain and disability.MethodGait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age- and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure.ResultsAt the self-selected speed, gout participants demonstrated increased step time (p = 0.017), and stance time (p = 0.012), and reduced velocity (p = 0.031) and cadence (p = 0.013). At the fast speed, gout participants demonstrated increased step time (p = 0.007), swing time (p = 0.005) and stance time (p = 0.019) and reduced velocity (p = 0.036) and cadence (p = 0.009). For participants with gout, step length was correlated with total MFPDI (r = −0.62, p = 0.008), function (r = −0.65, p = 0.005) and physical appearance (r = −0.50, p = 0.041); stride length was correlated with total MFPDI (r = −0.62, p = 0.008), function (r = −0.65, p = 0.005) and physical appearance (r = −0.50, p = 0.041); and velocity was correlated with total MFPDI (r = −0.60, p = 0.011), function (r = −0.63, p = 0.007) and work/leisure (r = −0.53, p = 0.030).ConclusionGait patterns exhibited by people with gout are different from controls during both self-selected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.     

纹状体内囊梗死上肢运动功能损害的脑桥基底部扩散张量成像

目的应用磁共振扩散张量成像研究纹状体内囊梗死患者脑桥基底部的扩散变化及其与上肢运动功能损害的关系。方法对15例首次急性起病且伴有单侧上肢运动功能损害的纹状体内囊梗死患者,在起病后2周时行DTI扫描,检测两侧脑桥基底部FA、MD值,将两侧FA的不对称指数（AI）与患侧上肢FM功能评分进行相关分析。结果病灶侧脑桥基底部的FA值在起病后2周时较健侧降低,MD无明显改变,AI与患侧上肢的FM评分呈负相关。结论DTI可以早期检测到纹状体内囊梗死患者脑桥基底部的扩散改变,该部位锥体束的完整性与患侧上肢的运动功能关系密切,DTI可以为纹状体内囊梗死的临床评估提供重要的参考指标。     

中国高龄老年人日常活动能力状况及影响因素分析

目的 探讨我国高龄老年人群日常活动能力（activities of daily living,ADL）状况及主要影响因素。方法 根据2014年中国老年健康影响因素跟踪调查结果,纳入80岁及以上高龄老年人群,分析其ADL及失能状况,并探讨重要的影响因素。结果共纳入4 646名≥80岁的高龄老年人,其中男性1 823名,占总人群的41.4%,年龄(91.30±7.77)岁。高龄老年人ADL失能的患病率为32.2%,其中失能的患病率女性(36.0%)高于男性（26.7%）（P<0.001）,且呈现随年龄增加的趋势（P<0.001）。中重度失能占所有失能者的51.3%,其患病率分别为6.7%和9.9%。不同条目比较,洗澡失能的比例最高,达到29.9%;控制大小便失能的比例最低,仅为8.6%。多因素Logistic回归分析结果显示,年龄、居住地、性别、慢性病数量等均是ADL失能的影响因素。结论 我国高龄老年人的失能状况不容乐观,年龄、性别、慢性病等多个因素与失能有关。这也提示我们需要重视高龄老年人尤其是女性、伴有共病者的失能状况,针对性开展防治措施,以提高生活质量,减少疾病和社会负担。     

The envelope of active hip motion in different sporting,recreational, and daily-living activities: A systematic review

BackgroundIn treating patients with limitations of hip motion, it is generally assumed that correction of bony morphology will provide the patient with the joint motion required to resume their activities. However, the positions of impingement and the specific excursions of joint motion required by each sport may vary. This systematic review aimed to define the envelope of active hip joint motion for participation in different sporting, recreational, and daily-living activities.MethodsThe EMBASE, PubMed, Google Scholar, and Cochrane databases were searched to identify studies that reported kinematics of the hip in sporting, recreational, and daily-living activities. Inclusion criteria were (1) peer-reviewed articles reporting hip kinematics in a certain type of activity, and (2) presented in English. To synthesize the kinematic data, the peak values of kinematic components (i.e. flexion/extension, abduction/adduction, and internal/external rotation) during an activity, as well as the concurrent values in a certain phase of the activity were collected from each study.ResultsA total of 67 studies met the inclusion criteria, involving 32 different types of activities. Seventeen activities required at least one component of supra-physiologic hip motion, however, there were eight different combinations of flexion/extension, abduction/adduction, and internal/external rotation observed. Specifically, three activities (sex, sitting cross-legged, and grand ecart lateral of ballet dancing) required simultaneous extreme degrees of all three components, five activities (arabesque, developpe devant right, and developpe a la seconde right of ballet dancing, picking up something, and taekwondo) required high degrees of two components, most commonly hip abduction combined with flexion or internal rotation.SignificanceThis review highlighted that many activities place supraphysiologic demands on hip joint motion, however, the kinematic components affected differ dramatically with the specific activity. This suggests that the demands of each patient’s individual activities must be assessed before recommending or planning treatment rather than assuming that a fixed value of “normal” hip motion is applicable to all.     

Spatiotemporal parameters from instrumented motion analysis represent clinical measurement of upper limb function in children with cerebral palsy

BackgroundThere are various tools that measure upper limb function in children with cerebral palsy(CP) clinically, but these measurement methods are examiner-dependent and scale values are not proportional to the upper limb function which makes it difficult to quantify the function.Research questionThe purpose of this study was to investigate whether the new parameters derived from 3D motion analysis reflect the upper limb function which measured by Melbourne Assessment 2 (MA2) in children with cerebral palsy (CP) compared to the clinical measurements.MethodsForty children with CP (24 boys, 16 girls; mean [SD] age, 6 years 11 months [3 years 5 months]) were recruited. Motion capture was conducted during phases T1–T4 of Reach and Grasp Cycles. New parameters (movement time, number of movement units, index of curvature) were derived from wrist marker data. Range of motion (ROM), accuracy, dexterity, and fluency of unilateral upper limb function were assessed using MA2. Spearman rank coefficients were determined to evaluate correlations between MA2 and the new parameters.Results and significanceIndex of curvature correlated negatively with MA2 accuracy scores during T1 (r_s -0.347, p < 0.05), T2 (r_s -0.471, p < 0.01), and T3 (r_s -0.660, p < 0.01). Number of movement units correlated negatively with MA2 ROM, accuracy, and fluency scores during T1 (ROM r_s -0.334; accuracy r_s -0.331; fluency r_s -0.375; p < 0.05) and T3 (ROM r_s -0.499; accuracy r_s -0.531; fluency r_s -0.515; p < 0.01). Index of curvature and number of movement units are objective, simple parameters showing fair to good correlation with MA2 accuracy and fluency of upper limb function.     

The immediate effect of different loads does not alter muscle co-activation of the upper limb in young adults with dyskinetic cerebral palsy

BackgroundThere is insufficient information on muscle co-activation in the upper limbs to help healthcare providers develop treatment programs for patients with dyskinetic cerebral palsy (DCP).Research questionIs the degree of muscle co-activation greater in adults with DCP than in healthy individuals? Does the use of different arm weights modify co-contraction in individuals with PCD?MethodsFourteen healthy individuals (control group [CG]) and 14 individuals with DCP (dyskinetic group [DG]) participated in the study. The degree of muscle co-activation of the dominant limb during drinking from a mug was compared between the two groups. The task was divided into a going, adjusting, and returning phase. In the DG, an analysis was also performed on using an arm weight during the functional task. The loads corresponded to 10, 20, and 30 % of maximum isometric muscle strength measured in each participant.ResultsIn comparing the two groups, the DG exhibited a greater muscle co-activation in the shoulder and elbow muscles during the going phase, the shoulder, elbow, and wrist during the adjusting phase; and the elbow during the returning phase. The DG also showed a greater mean index of curvature (MIC), time to perform the movement phases, and lesser mean velocity (Vm) to drinking. In analyzing the DG's arm weight, no effect on co-activation, MIC, time to perform the movement phases, and Vm to drinking were found with the loads tested (p > 0.05).ConclusionMuscle co-activation is increased in adults with DCP in comparison to healthy individuals. Moreover, arm weight during the functional activity of drinking from a mug did not alter co-activation, although an immediate effect was expected.     

高压氧综合治疗对颅内动脉瘤术后神经功能障碍和生活能力的康复作用

目的 观察高压氧综合康复治疗对颅内动脉瘤术后患者的神经功能缺损(NFI)和日常牛活活动能力(ADL)的影响,方法术后患者平均分为对照组和高压氧组(每组40例),对照组予常规药物和理疗、针灸治疗;高压氧组在上述治疗基础上加用高压氧治疗,观察治疗前后临床疗效、神经功能缺损评分和Barthel的ADL评分.结果 2组治疗后神经功能缺损评分较治疗前明显降低,治疗后高压氧组与对照组比较,NFI评分差异有统计学意义(分别为7.4±6.0和9.8±4.5,P<0.05);2组治疗后Barthel评分较治疗前有提高,治疗后高压氧组与对照组比较,Barthel评分差异亦有统计学意义(分别为42.7±11.6和35.3±10.4,P<0.01).高压氧治疗的疗效与开始治疗时间和Hunt-Hess动脉瘤分级有关.结论 术后早期积极地运用高压氧综合康复治疗,可使颅内动脉瘤患者神经功能和生活活动能力得到明显改善,生活质量得以提高.     

急性脑梗死早期高压氧治疗疗效观察

目的 研究早期应用高压氧治疗急性脑梗死的疗效和安全性.方法 90例确诊为首次发病的急性前循环脑梗死患者分为2组,每组45例.高压氧组在发病后12 h内开始进行高压氧治疗,对照组不进行高压氧治疗.结果 治疗后第14、28、90天,2组患者的神经功能缺损评分和日常生活能力评分均有改善,高压氧组较对照组提高明显(P＜0.05),2组均未发生严重不良事件.结论 0.22MPa高压氧治疗首次发病的急性前循环脑梗死患者,在发病后12 h以内,能改善患者神经功能缺损,提高日常生活能力.同时,高压氧对急性脑梗死的治疗是安全的.     

Reliability and validity of the protokinetics movement analysis software in measuring center of pressure during walking

Our purpose was to determine the validity and test-retest reliability of the Protokinetics Movement Analysis Software (PKMAS) in measuring center of pressure (COP) during walking as compared to a force plate gold standard. Twenty-five healthy participants (14 females, 11 males; age 20.0 ± 1.5 years) completed 2 testing sessions approximately 5 days apart (mean = 5.5 ± 1.1 days). In each session, participants completed 16 total trials across a 6 m walkway: 8 trials walking on a ProtoKinetics Zeno Walkway using PKMAS and 8 trials walking over 2 force plates arranged in an offset tandem pattern. COP path length (cm) and speed (cm/s) were calculated from data averaged across the 8 trials on a given device for a given foot. Intraclass correlation coefficients (ICC 2, k) were computed to determine between session reliability. Pearson correlation coefficients (r) and Bland-Altman plots were produced between the PKMAS and force plate outcomes for session 1 to determine validity. The PKMAS demonstrated excellent reliability (ICC 2, k ≥ 0.962) for all COP measures. Pearson correlation coefficients between PKMAS and force plates were ≥0.75 for all outcome variables. Bland-Altman plots and 95% levels of agreement revealed a bias where the PKMAS appeared to underestimate COP path length and speed by approximately 4 cm and 6 cm/s, respectively. After correcting for bias, our findings suggest the PKMAS is a reliable tool to measure COP in healthy people during gait. Using the PKMAS with the ProtoKinetics Zeno Walkway may allow for more efficient investigation of dynamic balance variables during functional movement tasks.     

The influence of task type and movement speed on lower limb kinematics during single-leg tasks

BackgroundSingle-leg squats and step-downs are commonly used to assess kinematic variables that may be linked to injuries. Task type and movement speed may influence the outcomes of interest because of different balance requirements.Research questionWhat is the influence of task type and movement speed on lower limb kinematics?MethodsThis is a cross-sectional within-subjects study where 22 physically active females performed three single-leg functional tasks (Squat, Anterior step-down, and Lateral step-down) at three movement speeds (slow [5 s], fast [2 s], and self-selected), while three-dimensional kinematic variables were recorded. Displacement values from the initial position in single-leg support until 60° or peak knee flexion were calculated. Two-way repeated measures ANOVA was used to compare tasks and speeds, and Cohen’s d effect size (ES) was calculated for significant pairwise comparisons.ResultsAt 60°, lateral step-down presented the greatest hip adduction (large ES) and internal rotation (small ES). The anterior step-down had the lowest knee abduction displacement while the squat had the greatest (small to medium ES). At peak knee flexion, values increased but differences between tasks followed a similar pattern. Slow speed induced smaller displacement angles at the knee and hip (trivial to small ES).SignificanceWhen knee abduction is the variable of interest, the SLS may be the best test since it elicits the greatest displacement, but when evaluating hip motion, SD_LAT might be best. Knee abduction and internal rotation were lowest in the slow condition, suggesting that faster speed may be more appropriate to detect abnormal movement patterns. However, the small difference in absolute values (i.e., degrees of movement) may indicate that the differences are not clinically significant, particularly for speed comparisons. Researchers and clinicians should take this into consideration when choosing the most appropriate task and the instruction to give during its execution.