Relationships Among Cushion Type,Backrest Height,Seated Posture,And Reach Of Wheelchair Users With Spinal Cord Injury

Abstract

Background: Seated posture and trunk control are important factors affecting upper extremity (UE) function of wheelchair users. A stable pelvis and trunk are required to provide a base from which UE movement occurs, but, conversely, the ability to move one’s trunk and pelvis can increase functional ranges of motion. For wheelchair users, balancing sufficient trunk support with adequate trunk mobility has important functional and medical consequences.

Objective: To determine the effect of cushion and backrest height on posture and reach and to determine the relationship between posture and UE reach using a randomized 2 X 3 repeated-measures factorial design.

Methods: Twenty-two subjects with spinal cord injury were tested in 6 configurations, including 3 types of cushions (segmented air, contoured viscous fluid/foam, and air/foam) and 2 of 3 backrest heights (referenced to Tl 2, inferior scapular angle, and scapular spine) while performing unilateral and bilateral reaching tasks. Seated posture (pelvic tilt and torso angle) and American Spinal Injury Association (ASIA) score were also measured.

Results: Pelvic tilt and ASIA score were significant predictors of reach. No evidence was found indicating cushion type or backrest height affected reach or posture. No consistent patterns of posture were found across cushion types or backrest heights.

Conclusions: The posture adopted by wheelchair users is a more important influence on UE reach than are the cushion or backrest height used. Sitting with increased posterior pelvic tilt enhanced stability and permitted greater reach. Because individuals adopt different postures when using different cushions and backrest heights, clinicians should monitor posture while assessing seating and function of wheelchair users.     

Diabetic gait and posture abnormalities: A biomechanical investigation through three dimensional gait analysis

Background

Diabetic sensorimotor polyneuropathy is a long-term diabetic complication. It is involved in the pathogenesis of the diabetic foot, which is a major cause of morbidity and mortality. The study aims to investigate the effects of diabetic polyneuropathy on gait and posture.

Methods

Sixty seven subjects were enrolled: 21 diabetics without polyneuropathy, 26 with polyneuropathy, 20 controls (respectively, mean age 63.8 (SD 5.4), 63.2 (SD 5.6), 59.0 (SD 5.2) years, mean body mass index 26.3 (SD 2.5), 25.6 (SD 3), 24.0 (SD 2.9)). Postural and morphological evaluation and gait analysis were performed. Physical examination, together with a motion capture system synchronized with two force plates and two baropodometric systems were used. We evaluated lower limb mobility, foot deformities, trunk and pelvic posture, knee and heel position, plantar foot arch, three dimensional kinematics and kinetics during gait. The effect of peripheral vascular disease and microangiopathy on trunk and lower limb motion was also evaluated.

Findings

Trunk and lower limb joint mobility (in static and dynamic states) were more reduced in diabetics either with or without polyneuropathy on each plane; however in diabetics with polyneuropathy significantly lower ranges of motion were registered. Furthermore, both groups showed significant reductions in each joint moment and velocity (P ? 0.003) during gait. In presence of both vasculopathy and microangiopathy a further significant reduction (P ? 0.001) was noticed.

Interpretation

Altered gait and posture were found in diabetic patients irrespective of polyneuropathy. This approach may be relevant to predict the risk ulceration before clinically detectable neuropathy.     

Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury

BACKGROUND: Seated posture and trunk control are important factors affecting upper extremity (UE) function of wheelchair users. A stable pelvis and trunk are required to provide a base from which UE movement occurs, but, conversely, the ability to move one's trunk and pelvis can increase functional ranges of motion. For wheelchair users, balancing sufficient trunk support with adequate trunk mobility has important functional and medical consequences. OBJECTIVE: To determine the effect of cushion and backrest height on posture and reach and to determine the relationship between posture and UE reach using a randomized 2 x 3 repeated-measures factorial design. METHODS: Twenty-two subjects with spinal cord injury were tested in 6 configurations, including 3 types of cushions (segmented air, contoured viscous fluid/foam, and air/foam) and 2 of 3 backrest heights (referenced to T12, inferior scapular angle, and scapular spine) while performing unilateral and bilateral reaching tasks. Seated posture (pelvic tilt and torso angle) and American Spinal Injury Association (ASIA) score were also measured. RESULTS: Pelvic tilt and ASIA score were significant predictors of reach. No evidence was found indicating cushion type or backrest height affected reach or posture. No consistent patterns of posture were found across cushion types or backrest heights. CONCLUSIONS: The posture adopted by wheelchair users is a more important influence on UE reach than are the cushion or backrest height used. Sitting with increased posterior pelvic tilt enhanced stability and permitted greater reach. Because individuals adopt different postures when using different cushions and backrest heights, clinicians should monitor posture while assessing seating and function of wheelchair users.     

A new anatomically based protocol for gait analysis in children

Human movement analysis still suffers from the weakness of the currently used protocols for data collection and reduction. Reliable data comparisons and precise functional assessment require anatomically based definitions of the reference axes and frames, and therefore careful identification and tracking of the landmarks. When impaired children are analysed, the marker-set and other measurement procedures have to be minimised to reduce the time of the experiment and ensure patient collaboration. A new protocol is proposed for the analysis of pelvis and lower limb motion obtained as a compromise between these two requirements.

A marker-set is proposed which involves the attachment of 22 skin markers, the calibration by a pointer of 6 anatomical landmarks, and the identification of the hip joint centre by a prediction approach. Anatomical reference frames and joint rotations are defined according to current recommendations. The protocol was assessed by analysing a single child in several repetitions by different examiners, and a population of 10 healthy children, mean age 9.7-years-old. The entire analysis was repeated after subtraction of the offset by static posture angles. The minimum and maximum means of the standard deviations from five examiners of the same child were respectively 2.1° in pelvic obliquity and 6.8° in knee rotation. The minimum and maximum means of the standard deviations from the 10 healthy children were 2.1° in pelvic obliquity and 9.6° in knee internal–external rotation. The protocol is feasible and allows 3D anatomical-based measurements of segment and joint motion and data sharing according to current standards.     

Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics

The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship among plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This lack of knowledge is determined by the lack of commercially available instruments which allow such a complex analysis. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics, and plantar pressure on foot subareas of diabetic subjects by means of combining three commercial systems. Data were collected during gait on 24 patients (12 controls and 12 diabetic neuropathics) with a motion capture system synchronized with two force plates and two baropodometric systems. A four segment three-dimensional foot kinematics model was adopted for the subsegment angles estimation together with a three segment model for the plantar sub-area definition during gait. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction, and a reduced loading surface on the midfoot subsegment (p<0.04). Furthermore the same subsegment displayed excessive dorsiflexion, external rotation, and eversion (p<0.05). Initial results showed that this methodology may enable a more appropriate characterization of patients at risk of foot ulcerations, and help planning prevention programs.     

基于概念隐喻的中医“时脏相应”理论研究

"时脏相应"是中医藏象学说的重要组成部分,也是中医藏象学说的特色之处。从认知语言学的角度来看,"四时"可以被看做一个与"阴阳五行"同等重要的"认知模型","时脏相应"是一种基于隐喻认知,以经验体验为基础,以相似性为纽带,以四时为始源域,以五脏为目标域构建的概念隐喻。关于"时脏相应"概念隐喻的诠释,需要借助"可能世界"理论,以"肾应冬"为例,是以"冬的世界"构建"肾的世界",是一种隐喻重描。     

Features analysis of five-element theory and its basal effects on construction of visceral manifestation theory

Objective

To study the Chinese ancient five-element theory, one of the philosophical foundations of Traditional Chinese Medicine (TCM) theory construction, from the perspective of comtemporary cognitive science, and to reveal the important functions of five-element theory in the construction of TCM theory.

Methods

The basic effects of five-element theory in the construction of TCM theory are intensively expounded and proved from the following aspects: embodiment of five-element theory in cognizing the world, quasi axiom of five-element theory in essence, classification thery of family resemblance and deductive inference pattern of five-element theory, and the openness and expansibility of five-element theory.

Results

If five-element theory is considered a cognitive pattern or cognitive system related to culture, then there should be features of cognitive embodiment in the cognitive system. If five-element theory is regarded as a symbolic system, however, then there should be a quasi-axiom for the system, and inferential deduction. If, however, five-element theory is taken as a theoretical constructive metaphor, then there should be features of opening and expansibility for the metaphor.

Conclusion

Based on five-element theory, this study provides a cognitive frame for the construction of TCM (a medicine that originated in China, and is characterized by holism and treatment based on pattern identification differentiation) theory with the function of constructing a concept base, thereby implying further research strategies. Useful information may be produced from the creative inferences obtained from the incorporation of five-element theory.     

听骨发育的研究及其临床意义

本文对325侧胚胎第11周至成人颞骨标本按矢状位、垂直位和水平位作连续组织切片。观测结果:砧骨在胚胎第11周,锤骨在胚胎第15周、镫骨在胚胎第16周分别出现软骨化骨中心。各听骨仅有一个骨化中心,各有自身的生长规律,约在胚胎第28周,软骨化骨完成,无骺板存在,听骨大小形态与成人相近。提出胎儿听骨代替成人听骨作同种异体听骨移植重建的理论依据。