Relationship between physiological energy expenditure and biomechanical patterns associated with erect standing

The deviation of the static weight-bearing patterns under the feet of a lower extremity handicapped person may be measured quantitatively in terms of the Static Weight-Bearing Index. This paper describes the correlation between this index and the physiological energy expenditure associated with the erect standing posture. The Static Weight-Bearing Index can be conveniently used for evaluation of the functional status of the human lower extremity system in stance in case of lower extremity disabled persons who maintain basic weight-bearing mode involving both the limbs in double support condition.     

Estimation of the forces generated by the thigh muscles for transtibial amputee gait

The forces generated by the muscles with origin on the human femur play a major role in transtibial amputee gait, as they are the most effective of the means that the body can use for propulsion. By estimating the forces generated by the thigh muscles of transtibial amputees, and comparing them to the forces generated by the thigh muscles of normal subjects, it is possible to better estimate the energy output needed from prosthetic devices. The purpose of this paper is to obtain the forces generated by the thigh muscles of transtibial amputees and compare these with forces obtained from the same muscles in the case of normal subjects. Two transtibial amputees and four normal subjects similar in size to the amputees were investigated. Level ground walking was chosen as the movement to be studied, since it is a common activity that most amputees engage in. Inverse dynamics and a muscle recruitment algorithm (developed by AnyBody Technology^®) were used for generating the muscle activation patterns and for computing the muscle forces. The muscle forces were estimated as two sums: one for all posterior muscles and one for the anterior muscles, based on the position of the muscles of the thigh relative to the frontal plane of the human body. The results showed that a significantly higher force is generated by the posterior muscles of the amputees during walking, leading to a general increase of the metabolic cost necessary for one step.     

Cardiac function and physical working capacity of athletes with altered ventricular repolarization

The structural-functional characteristics of the cardiovascular system in 527 trained athletes were studied. The study has been performed for 10–15 years. All athletes were divided into two groups. Group A (437 persons) included athletes with normal electrocardiogram (ECG) pattern; group B (90 persons), athletes with atypical signs of ventricular repolarization. The results of this study suggest that the characteristic features of the cardiovascular system of the athletes with atypical patterns of ventricular repolarization, as well as that of the athletes with normal ECG patterns, include bradycardia, hypotension, regulated myocardial hypodynamia syndrome, heart chamber dilation, increased weight of the left ventricular myocardium (with an increased functional capability of an arbitrary unit of its chamber and myocardium), an increased stoke volume, more economical cardiac contraction at rest, and an increased physical working capacity. The degree of changes in these parameters was the same as in athletes with normal ECG. This fact allowed us to define the entire complex of characteristics of the blood circulation system in either group (A and B) as a physiological athlete’s heart.     

Biomechanics of below-knee amputee gait

Sagittal plane biomechanical and EMG analyses from eight below knee (B/K) amputee trials demonstrate considerably modified motor patterns from the residual muscles at the hip and knee. Five SACH fittings, two Uniaxial and one Gressinger prostheses were analysed. Moments of force and mechanical power were analysed on all eight trials and EMG profiles are reported for three of the amputees fitted with SACH prostheses. The findings can be summarized as follows: 1. All eight trials had similar internal moment of force patterns at the ankle. A dorsiflexor moment commenced at heel contact and continued for the first third of stance. The prostheses generated a plantarflexor moment for the balance of stance which increased in late stance to about 2/3 that seen in normals. 2. The two Uniaxial prostheses showed a 20% recovery of stored energy which was returned at push-off. The recovery by the Gressinger fitting was 30%. 3. For all but the Gressinger prosthesis the knee moment of force was negligible during early stance (when normals have an extensor moment), below normal in late stance and fairly normal during swing. The amputee wearing the Gressinger prosthesis had a normal but slightly reduced pattern of moments of force over the entire stride. 4. All eight trials had hyperactive hip extensors during early and mid-stance which resulted in above-normal energy generation by these concentrically contracting muscles. This compensation makes up for the loss of the major energy generation by the plantarflexors at push-off. 5. The moment of force and power patterns at the hip for all eight trials during late stance and swing were fairly normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postural changes after sustained neck muscle contraction in persons with a lower leg amputation

Lower leg amputation generally induces asymmetrical weight-bearing, even after rehabilitation treatment is completed. This is detrimental to the amputees’ long term quality of life. In particular, increasing strains on joint surfaces that receive additional weight load causes back and leg pain, premature wear and tear and arthritis. This pilot study was designed to determine whether subjects with lower leg amputation experience postural post-effects after muscle contraction, a phenomenon already observed in healthy subjects, and whether this could improve the weight-bearing on their prosthesis.Fifteen subjects with a unilateral lower leg amputation and 17 control subjects volunteered to participate in this study. Centre of pressure (CP) position was recorded during standing posture, under eyes closed and open conditions. Recordings were carried out before the subjects performed a 30-s voluntary isometric lateral neck muscle contraction, and again 1 and 4 min after the contraction.Postural post-effects characterized by CP shift, occurred in the medio-lateral plane in the majority of the amputated (7/15 eyes closed, 9/15 eyes open) and control (9/17 eyes closed, 11/17 eyes open) subjects after the contraction. Half of these subjects had a CP shift towards the side of the contraction and the other half towards the opposite side. In four amputated subjects tested 3 months apart, shift direction remained constant. These postural changes occurred without increase in CP velocity.Thus, a 30-s voluntary isometric contraction can change the standing posture of persons with lower leg amputation. The post-effects might result from the adaptation of the postural frame of reference to the proprioceptive messages associated with the isometric contraction.     

A position paper in support of hand transplantation in the blind

Blind upper extremity amputees have historically been excluded from consideration for hand allotransplantation. Although no formal position statement regarding their exclusion has been published to date, functional, rehabilitative, and ethical concerns related to blind amputee candidacy for hand transplantation may be inferred. The authors provide a summary of these reservations and a counterargument to their assumptions, drawing on outcomes measures reported for hand transplantations completed to date. The authors therefore provide a rationale for the inclusion of blind amputees in hand transplantation protocols in the future.     

植物提取物槲皮素调节小鼠的能量代谢和氧化应激

为了探讨植物提取物槲皮素对负重游泳小鼠的能量代谢和氧化应激的影响,本研究将45只SPF级雄性昆明小鼠随机分为正常对照组、游泳组和槲皮素组,每组15只。槲皮素组小鼠喂养2 g/kg的槲皮素饲料,其他组小鼠喂养标准饲料,共喂养14 d。然后将游泳组和槲皮素组小鼠按照体重的3%进行负重游泳1 h,测定各组小鼠的血糖、乳酸、尿素氮、游离脂肪酸、琥珀酸脱氢酶、三磷酸腺苷、丙二醛、谷胱甘肽过氧化物酶和总抗氧化活性。结果显示,负重游泳后,槲皮素组血清乳酸和尿素氮水平显著低于游泳组,并且槲皮素组游离脂肪酸水平显著高于游泳组。负重游泳后,游泳组小鼠的肝脏和肌肉组织中的琥珀酸脱氢酶含量均显著降低,槲皮素组小鼠游泳后未见明显降低。负重游泳后,游泳组小鼠肌肉组织中的ATP酶活性显著降低,槲皮素组小鼠游泳后未见明显降低。负重游泳后,槲皮素组的丙二醛含量显著低于游泳组。游泳组和槲皮素组小鼠负重游泳后的谷胱甘肽过氧化物酶含量均显著降低,槲皮素组小鼠的谷胱甘肽过氧化物酶含量未见明显降低。游泳组小鼠血清总抗氧化活性显著低于对照组,而槲皮素组与对照组无显著差异。本研究初步表明,槲皮素可调节负重游泳小鼠的能量代谢来起到抗疲劳作用,主要机制与增加脂肪动员、抑制蛋白质分解和加强三羧酸循环有关。另外,槲皮素可通过抑制脂质过氧化、清除超氧阴离子自由基来防止运动过程中的氧化应激损伤。     

Patterns of protein synthesis in livers of Xenopus laevis during metamorphosis: Effects of estrogen in normal and thyrostatic animals

Two-dimensional gel electrophoresis has been used to analyse protein synthesis in the livers of Xenopus laevis larvae during metamorphosis. The patterns found at different developmental stages have been characterised and compared to those found in developmentally static tadpoles and estrogen-treated tadpoles. The results suggest that the majority of proteins synthesized by the larval liver during metamorphosis can be divided equally into three main categories: those which are synthesized continuously, those whose synthesis is lost, and those whose synthesis is gained during development. The synthesis of proteins tends to be lost earlier in metamorphosis than it is gained. The pattern of liver protein synthesis in thyrostatic animals is not characteristic of any single stage of normal development, and displays features characteristic of many different stages. About half the changes in protein synthesis which occur during normal metamorphosis are dependent upon it. All the stages examined are responsive to estrogen, and each has a characteristic response. Half of the estrogen-induced changes in protein synthesis are independent of metamorphosis, while the other half require metamorphosis.     

Cytogenetic effects of methyl isocyanate exposure in Bhopal

Summary Among human survivors following the methyl isocyanate (MIC) gas tragedy the major complaints have been related to deep-seated suffocation, terrible pain in breathing, and severe ocular irritations. In order to assess the possible genetic effects we have used lymphocyte cultures and screened chromosomes by two techniques; one by looking for chromosomal aberrations and the other by estimating sister-chromatid exchange (SCE) frequencies. Both these paramaters are good indicators of genetic damage in chromosomal DNA. SCE frequencies in lymphocytes have been increased more than three times in MIC-exposed persons. The results were compared to two groups of controls (one group comprising persons present in the same house; the second group of persons were chosen from distant places, 20–50 km away from the incident). Chromosomal breaks have been observed in 10 out of 14 MIC-affected people (71.4%) studied while only 6 out of 28 (21.4%) controls had chromosomal breaks. Some MIC-exposed persons had chromatin bodies in addition to the normal 46 chromosomes. These observations suggest that chromosomal DNA has been damaged.     

Computer simulation modelling and visualization of 3D architecture of biological tissues

Recent technical improvements, such as 3D microscopy imaging, have shown the necessity of studying 3D biological tissue architecture during carcinogenesis. In the present paper a computer simulation model is developed allowing the visualization of the microscopic biological tissue architecture during the development of metaplastic and dysplastic lesions.The static part of the model allows the simulation of the normal, metaplastic and dysplastic architecture of an external epithelium. This model is associated to a knowledge base which contains only data on the nasal epithelium. The latter has been well studied by numerous authors and its lesional states are well known. An inference engine allows the initialization of the static model parameters. A statistical comparison between simulated epithelia and real epithelia is achieved by adjusting the parameter values during the simulation.The dynamic part of the model allows the simulation of a growth process on a 3D representation based on the static model. The main hypothesis is that nasal epithelium is submitted to a continuous transformation from normal to cancer through metaplasia and dysplasia. The evolution of each cell (represented by its nucleus) depends on its local environment and also on its heritage from its mother-cell.Simulation of tissue renewal of the nasal pseudostratified epithelium has been achieved. The evolution from normal to hyperplasia has been simulated. After modification of the cell cycle modelling, the simulation of the development of metaplastic foci has been obtained.     

A new method to quantify liner deformation within a prosthetic socket for below knee amputees

Many amputees who wear a leg prosthesis develop significant skin wounds on their residual limb. The exact cause of these wounds is unclear as little work has studied the interface between the prosthetic device and user. Our research objective was to develop a quantitative method for assessing displacement patterns of the gel liner during walking for patients with transtibial amputation. Using a reflective marker system and a custom clear socket, evaluations were conducted with a clear transparent test socket mounted over a plaster limb model and a deformable limb model. Distances between markers placed on the limb were measured with a digital caliper and then compared with data from the motion capture system. Additionally, the rigid plaster set-up was moved in the capture volume to simulate walking and evaluate if inter-marker distances changed in comparison to static data. Dynamic displacement trials were then collected to measure changes in inter-marker distance due to vertical elongation of the gel liner. Static and dynamic inter-marker distances within day and across days confirmed the ability to accurately capture displacements using this new approach. These results encourage this novel method to be applied to a sample of amputee patients during walking to assess displacements and the distribution of the liner deformation within the socket. The ability to capture changes in deformation of the gel liner will provide new data that will enable clinicians and researchers to improve design and fit of the prosthesis so the incidence of pressure ulcers can be reduced.     

Evaluating the bending response of two osseointegrated transfemoral implant systems using 3D digital image correlation

Osseointegrated transfemoral implants have been introduced as a prosthetic solution for above knee amputees. They have shown great promise, providing an alternative for individuals who could not be accommodated by conventional, socket-based prostheses; however, the occurrence of device failures is of concern. In an effort to improve the strength and longevity of the device, a new design has been proposed. This study investigates the mechanical behavior of the new taper-based assembly in comparison to the current hex-based connection for osseointegrated transfemoral implant systems. This was done to better understand the behavior of components under loading, in order to optimize the assembly specifications and improve the useful life of the system. Digital image correlation was used to measure surface strains on two assemblies during static loading in bending. This provided a means to measure deformation over the entire sample and identify critical locations as the assembly was subjected to a series of loading conditions. It provided a means to determine the effects of tightening specifications and connection geometry on the material response and mechanical behavior of the assemblies. Both osseoinegrated assemblies exhibited improved strength and mechanical performance when tightened to a level beyond the current specified tightening torque of 12 N?m. This was shown by decreased strain concentration values and improved distribution of tensile strain. Increased tightening torque provides an improved connection between components regardless of design, leading to increased torque retention, decreased peak tensile strain values, and a more gradual, primarily compressive distribution of strains throughout the assembly.     

First-order model for the analysis of stump stresses for below-knee amputees

This study extends what had been a purely numerical model that used influence-factor matrices to relate the stump stresses to prosthesis loads for unilateral, below/knee amputees. Previously published influence-factor matrices are now factored into a coefficient matrix times the inverse of a stump geometry matrix. Using actual stump parameters, new information is learned about how the resistive moment of the stump balances the flexion-extension moment of the prosthesis and why certain normal stresses reach a maximum during a specific portion of the stance phase of the prosthesis.     

Surface EMG pattern recognition for real-time control of a wrist exoskeleton

Background  

Surface electromyography (sEMG) signals have been used in numerous studies for the classification of hand gestures and movements and successfully implemented in the position control of different prosthetic hands for amputees. sEMG could also potentially be used for controlling wearable devices which could assist persons with reduced muscle mass, such as those suffering from sarcopenia. While using sEMG for position control, estimation of the intended torque of the user could also provide sufficient information for an effective force control of the hand prosthesis or assistive device. This paper presents the use of pattern recognition to estimate the torque applied by a human wrist and its real-time implementation to control a novel two degree of freedom wrist exoskeleton prototype (WEP), which was specifically developed for this work.     

Leg stiffness in unilateral transfemoral amputees across a range of running speeds

Carbon fiber running-specific prostheses have allowed lower extremity amputees to participate in running activity by providing spring-like properties in their affected limb. It has been established that as running speed increases, stiffness of the leg spring (leg stiffness; k_leg) remains constant in non-amputees. Although a better understanding of k_leg regulation may be helpful for the development of spring-based prostheses, little is known about stiffness regulation in unilateral transfemoral amputees. The aim of this study was to investigate stiffness regulation at different running speeds in unilateral transfemoral amputees wearing a running-specific prosthesis. Nine unilateral transfemoral amputees performed running on an instrumented treadmill across a range of speeds (30, 40, 50, 60, and 70% of their maximum running speed). Using a spring-mass model, k_leg was calculated as the ratio of maximal vertical ground reaction force to maximum leg compression during the stance phase in both affected and unaffected limbs. We found a decrease in k_leg from the slower speed to 70% speed for the affected limb, whereas no change was present in the unaffected limb. Specifically, there was a significant differences in the k_leg between 30% and 70%, 40% and 70%, and 50% and 70%, and the magnitude of the k_leg difference between affected and unaffected limbs varied with variations in running speeds in unilateral TFAs with an RSP. These results suggest the k_leg regulation strategy of unilateral transfemoral amputees is not the same in the affected and unaffected limbs across a range of running speeds.     

Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study

Over the past 4 years at the Massachusetts General Hospital 18 patients have been treated for extensive defects (mean size 130 cm2) of the foot at or below the medial and lateral malleoli. These patients have been treated with free muscle flaps covered with thick split-thickness skin grafts. Full muscle flap survival has been seen in each patient, and all patients are currently ambulatory. A subgroup of nine patients are weight-bearing directly upon their skin grafts covering transferred muscle. All patients are walking without chronic breakdown over a mean follow-up of over 19 months with the exception of a single patient who has had breakdown in a region of redundant improperly tailored muscle flap. None of the skin grafted muscles has significant cutaneous sensibility. Detailed gait analysis of these patients has confirmed the weight-bearing capabilities of free muscle flaps with skin grafts and has proven to be an excellent method of foot reconstruction evaluation. It would appear from this study that cutaneous sensibility may not be necessary for successful reconstruction of the weight-bearing surface of the foot. This method of reconstruction should be considered when local tissues are not suitable for plantar foot reconstruction.     

Assessment of upper extremity muscle function in persons with tetraplegia

The objective was to investigate the actual level of muscle function impairment in tetraplegic persons and, inextricably related to this, the possibilities to compensate function loss using new muscle coalitions. In this cross-sectional group study, 20 persons with a cervical spinal cord injury (SCI) at segmental levels C5C6 or C7C8 and 10 control persons participated. Activity from 21 upper extremity and trunk muscles was recorded during standardised gross upper extremity task performance. No substantial differences in main activation patterns were found between C7C8 and control subjects. In contrast, main activation patterns in C5C6 persons showed an absence of selectivity, which may be explained by the participants activating every controllable muscle in an attempt to perform maximally. In order to identify more intricate differences in muscle activation between control and C7C8 persons a fine motor function task may be necessary. Muscle activation patterns during arm task performance were stable in all three groups.     

Forces in anterior cruciate ligament during simulated weight-bearing flexion with anterior and internal rotational tibial load

This study determined in-vitro anterior cruciate ligament (ACL) force patterns and investigated the effect of external tibial loads on the ACL force patterns during simulated weight-bearing knee flexions. Nine human cadaveric knee specimens were mounted on a dynamic knee simulator, and weight-bearing knee flexions with a 100N of ground reaction force were simulated; while a robotic/universal force sensor (UFS) system was used to provide external tibial loads during the movement. Three external tibial loading conditions were simulated, including no external tibial load (termed BW only), a 50N anterior tibial force (ATF), and a 5Nm internal rotation tibial torque (ITT). The tibial and femoral kinematics was measured with an ultrasonic motion capture system. These movement paths were then accurately reproduced on a robotic testing system, and the in-situ force in the ACL was determined via the principle of superposition. The results showed that the ATF significantly increased the in-situ ACL force by up to 60% during 0-55 degrees of flexion, while the ITT did not. The magnitude of ACL forces decreased with increasing flexion angle for all loading conditions. The tibial anterior translation was not affected by the application of ATF, whereas the tibial internal rotation was significantly increased by the application of ITT. These data indicate that, in a weight-bearing knee flexion, ACL provides substantial resistance to the externally applied ATF but not to the ITT.     

Taxonomy of the microangiological changes in the ocular conjunctiva]

By means of biomicroscopical investigations of bulbar conjunctiva in healthy persons of different age certain characteristics on normal microcirculatory bed have been obtained. Morphometric analysis of the vital microscopical observations has revealed some age peculiarities in microcirculation of the conjunctiva. As a result of clinical examination of the persons, it has been stated that the phenomena noticed at biomicroscopy which characterize certain anomalies of microcirculatory parameters correlate with latent pathology, closely related diseases or developmental anomalies. Therefore, it is possible to consider the method of biomicroscopical investigation of the conjunctiva with a subsequent morphometric analysis of the data obtained as suitable for application not only for clinical but also for prophylactic examination of healthy persons.     

A strategy for research on psychological and social factors in hypertension

Stress-related research has thus far failed to provide an adequate understanding of hypertension and other psychosomatic ailments for three main reasons: First, there has been a continual failure to view stress as a relational phenomenon, that is, as a particular kind of transaction between person and environment. Second, there has been much confusion about the social, psychological and physiological levels of stress analysis; each is to some extent independent of the other, so that what happens at one level cannot stand for what happens at another. Third, the predominant research model has been structural and static. That is, the researcher looks at some environmental or personality characteristic, treating it as a stable property, and attempts to relate it to the risk of hypertension across persons or groups. Such an approach overlooks the key social, psychological and physiological mediating processes (e.g., social supports, cognitive appraisals, and coping) that are concurrent with and have causal significance in blood pressure elevation or change. Structural research models need to be supplemented with process-oriented ones in which the same persons are observed across various adaptational encounters and over time.