The Effect of Simulating Weight Gain on the Energy Cost of Walking in Unimpaired Children and Children With Cerebral Palsy

Plasschaert F, Jones K, Forward M. The effect of simulating weight gain on the energy cost of walking in unimpaired children and children with cerebral palsy.

Objective

To examine the effect of simulating weight gain on the energy cost of walking in children with cerebral palsy (CP) compared with unimpaired children.

Design

Repeated measures, matched subjects, controlled.

Setting

University hospital clinical gait and movement analysis laboratory.

Participants

Children (n=42) with CP and unimpaired children (n=42).

Interventions

Addition of 10% of body mass in weight belt.

Main Outcome Measures

Energy cost of walking parameters consisting of walking speed, Physiological Cost Index, Total Heart Beat Index, oxygen uptake (V̇o₂), gross oxygen cost, nondimensional net oxygen cost, and net oxygen cost with speed normalized to height were measured by using a breath-by-breath gas analysis system (K4b²) and a light beam timing gate system arranged around a figure 8 track. Two walking trials were performed in random order, with and the other without wearing a weighted belt.

Results

Children with CP and their unimpaired counterparts responded in fundamentally different ways to weight gain. The unimpaired population maintained speed and V̇o₂ but the children with CP trended toward a drop in their speed and an increase in their V̇o₂. The oxygen consumption of children with CP showed a greater dependence on mass than the unimpaired group (P=.043).

Conclusions

An increase of a relatively small percentage in body mass began to significantly impact the energy cost of walking in children with CP. This result highlights the need for weight control to sustain the level of functional walking in these children.     

Changes in plantar surface shape induced by corrective forefoot eversion

An investigation is presented of the change in shape of the plantar surface of the foot when the forefoot is everted (prohated) from its natural unloaded orientation into a corrected position frequently used during shoe insert fabrication. Both free and corrected casts were made of 13 asymptomatic feet using established casting techniques. Digital scans capture each plantar surface shape into a computer where an analysis of the transverse slope of the plane is made at various longitudinal locations between midheel and metatarsal head regions. The profile of the slopes show results which are consistent with pronation about the midtarsal joint. These results may be useful as a first stage in establishing the appropriate shape corrections to be used in a computer-aided design system for shoe insert design.     

The nuclear imperative the Crookshank lecture,1984

The overwhelming destructiveness of thermonuclear weapons is illustrated by some simple comparisons with TNT—the ‘conventional’ military explosive. There is no theoretical upper limit to the size of an H‐bomb. It is recognized that nuclear war cannot be ‘won’ and must therefore be prevented; the current policy of ‘deterrence’ is examined and is seen to lead, not to a stable balance but, inexorably, to escalation. Richardson's mathematical analysis of conflict situations showed that automatic military responses to perceived threats generally lead to an escalating arms race. Human beings, however, need not behave like automata. Instead, they can try to see things from the standpoint of the adversary and seek ways of reducing instead of increasing tension. It is only if such saner responses are made that stability can be achieved. Scientists and technicians must not become so fascinated by the technological interest of weapons development that they ignore its ultimate purpose. Immanuel Kant summed up the conditions for peaceful and happy human society in his ‘categorical imperative’. His later essay On Permanent Peace showed that the same principle must apply between nations. Today this is the ‘nuclear imperative’ and we must throw off old habits of thought and resolve our conflicts in ways that do not include the threat of mutual extinction. Doctors should be in the forefront of this movement.     

Dental materials: 1977 literature review Part I

This paper, which is to be presented in two parts, reviews the work on dental materials published in 1977. Included in Part I are sections on amalgam, casting alloys, acrylic resins, composite filling materials and fissure sealants. A review of the literature relating to impression materials, dental ceramics, model and die materials, cements, dental implants and dental biomechanics will be presented in Part II.     

Preferences for communication in clinic from deaf people: a cross‐sectional study

Aims and objectives To explore the preferences of deaf people for communication in a hospital consultation. Methods Design – cross‐sectional survey, using a structured, postal questionnaire. Setting – survey of readers of two journals for deaf and hard of hearing people. Participants – 999 self‐selected individuals with hearing loss in the UK, including those who use sign language and those who use speech. Main outcome measures – preferred mode of communication. Results A total of 11% of participants preferred to use sign language within everyday life, 70% used speech and 17% used a mixture of sign and speech. Within a clinic setting, 50% of the sign language users preferred to have a consultation via a sign language interpreter and 43% indicated they would prefer to only have a consultation directly with a signing health professional; 7% would accept a consultation in speech as long as there was good deaf awareness from the health professional, indicated by a knowledge of lip‐reading/speech‐reading. Of the deaf speech users, 98% preferred to have a consultation in speech and of this group 71% indicated that they would only accept this if the health professional had good deaf awareness. Among the participants who used a mixture of sign language and speech, only 5% said they could cope with a consultation in speech with no deaf awareness whereas 46% were accepting of a spoken consultation as long as it was provided with good deaf awareness; 30% preferred to use an interpreter and 14% preferred to have a consultation directly with a signing health professional. Conclusions The hospital communication preferences for most people with deafness could be met by increasing deaf awareness training for health professionals, a greater provision of specialized sign language interpreters and of health professionals who can use fluent sign language directly with clients in areas where contact with deaf people is frequent.     

Individual budgets for people with incontinence: results from a ‘shopping’ experiment within the British National Health Service

Background and context Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large. Objective To investigate users’ preferences for four disposable designs (inserts, all‐in‐ones, belted/T‐shaped and pull‐ups) and towelling washable/reusable products, day and night. Design Shopping experiment. Setting and participants Community‐dwelling women and men in England with moderate‐to‐heavy urinary incontinence recruited to a larger trial. Intervention Participants tested each design and selected products they would prefer with a range of different budgets. Main outcome measures Design preferences (rankings); ‘purchasing’ decisions from designated budgets. Results Eighty‐five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull‐ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to ‘mix‐and‐match’ designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to ‘top‐up’ assigned budgets from income to secure preferred designs. Discussion Participants displayed diverse preferences. Enabling user choice of absorbent product design through individual budgets could improve satisfaction of consumers and efficiency of allocation of limited NHS resources. Conclusion Recent policy for the NHS seeks to provide consumers with more control in their care. Extension of the concept of individual budgets to continence supplies could be feasible and beneficial for patients and provide better value‐for‐money within the NHS. Further research is warranted.