Dicianno BE, Gaines A, Collins DM, Lee S. (2009) Mobility, assistive technology use, and social integration among adults with spina bifida. American Journal of Physical Medicine and Rehabilitation. Jul;88(7):533-41.
Human Engineering Research Laboratories, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
OBJECTIVE: Many individuals with spina bifida have impairments that limit mobility and functional independence. Sedentary lifestyles and social isolation are very prevalent. This study evaluated the association between the use of mobility devices and degree of socialization.
DESIGN: A retrospective chart review was performed on 208 adults with spina bifida attending a university-based clinic. Data collected included the Craig Handicap Assessment Reporting Technique-Short Form, Beck Depression Inventory, and data on wheelchair and other assistive technology use. We hypothesized that community and home mobility and social integration, as measured by the Craig Handicap Assessment Reporting Technique-Short Form, would be lower for manual and power wheelchair users than for ambulators, regardless of depression scores or shunt history.
RESULTS: We found that individuals with spina bifida who used both manual and power wheelchairs do have lower daily home and community activity levels compared with ambulators, but that most individuals with spina bifida have low social integration and economic self-sufficiency scores, regardless of whether they can ambulate or use wheelchairs. These findings were not explained by wheelchair quality because most were prescribed high-quality devices. A high prevalence of depression was also found.
CONCLUSIONS: Special considerations for wheelchair provision are discussed. Additional research is needed to identify other barriers to social integration.
PMID: 19542778
Showing posts with label Mobility. Show all posts
Showing posts with label Mobility. Show all posts
Monday, June 29, 2009
Monday, June 8, 2009
Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation.
Gabrieli AP, Vankoski SJ, Dias LS, Milani C, Lourenco A, Filho JL, Novak R. Gait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation. Journal of Pediatric Orthopedics. 2003 May-Jun;23(3):330-4.
Children's Memorial Hospital/Northwestern University Medical School, 680 North Lake Shore Drive, Chicago, IL 60611, USA.
The surgical indications for the treatment of unilateral hip dislocations or subluxations in patients with low lumbar myelomeningocele remain highly debatable. This study examines the influence of unilateral hip dislocation or subluxation on the gait of these patients using three-dimensional gait analysis. Twenty patients with a diagnosis of low lumbar myelomeningocele underwent three-dimensional gait analysis. All patients were community ambulators with solid ankle-foot orthoses and crutches who presented with unilateral hip dislocation or subluxation and no scoliosis. The patients were divided in two groups. Group 1 comprised 10 patients who demonstrated either no evidence of hip flexion or adduction contractures or symmetric hip contractures. Group 2 comprised 10 patients with unilateral hip flexion and/or adduction contractures. Pelvic and hip kinematics were assessed to determine the symmetry of motion between the involved and the noninvolved side during walking. Seven patients from group 1 walked with a symmetric gait pattern; only two patients from group 2 walked with a symmetric pattern. Gait symmetry corresponded to the absence of hip contractures or bilateral symmetrical hip contractures and had no relation to the presence of hip dislocation. The authors concluded that reduction of the hip is unnecessary.
PMID: 12724595
Children's Memorial Hospital/Northwestern University Medical School, 680 North Lake Shore Drive, Chicago, IL 60611, USA.
The surgical indications for the treatment of unilateral hip dislocations or subluxations in patients with low lumbar myelomeningocele remain highly debatable. This study examines the influence of unilateral hip dislocation or subluxation on the gait of these patients using three-dimensional gait analysis. Twenty patients with a diagnosis of low lumbar myelomeningocele underwent three-dimensional gait analysis. All patients were community ambulators with solid ankle-foot orthoses and crutches who presented with unilateral hip dislocation or subluxation and no scoliosis. The patients were divided in two groups. Group 1 comprised 10 patients who demonstrated either no evidence of hip flexion or adduction contractures or symmetric hip contractures. Group 2 comprised 10 patients with unilateral hip flexion and/or adduction contractures. Pelvic and hip kinematics were assessed to determine the symmetry of motion between the involved and the noninvolved side during walking. Seven patients from group 1 walked with a symmetric gait pattern; only two patients from group 2 walked with a symmetric pattern. Gait symmetry corresponded to the absence of hip contractures or bilateral symmetrical hip contractures and had no relation to the presence of hip dislocation. The authors concluded that reduction of the hip is unnecessary.
PMID: 12724595
Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele.
Danielsson AJ, Bartonek A, Levey E, McHale K, Sponseller P, Saraste H.Associations between orthopaedic findings, ambulation and health-related quality of life in children with myelomeningocele. Journal of Children's Orthopedics. 2008 Feb;2(1):45-54.
Department of Orthopaedics, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden, danielsson.aina@telia.com.
PURPOSE: Modern principles for treatment of patients with myelomeningocele include early closure of the neural tube defect, neurosurgical treatment of hydrocephalus and treatment aimed at minimizing contractures and joint dislocations. The aim is to achieve a better survival rate and a better quality of life (QOL). Better ambulatory function is thought to improve the management of activities of daily living. This study focused on evaluating which factors might affect ambulation, function and health-related QOL in children with myelomeningocele.
METHODS: Thirty-eight patients with neurological deficit from myelomeningocele were examined in an unbiased follow-up. This included a physical examination using validated methods for ambulatory function and neuromuscular status, chart reviews and evaluation of radiographs in terms of hip dislocation and spine deformity. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure mobility, self-care and social function, and the Child Health Questionnaire (CHQ-PF50) was used to measure QOL.
RESULTS: Muscle function class, quadriceps strength, spasticity in hip and/or knee joint muscles and hip flexion contracture as well as the ambulatory level all affected functional mobility as well as self-care/PEDI. Patients with hip dislocation, spinal deformity or those who were mentally retarded also had significantly worse functional mobility. Besides being affected by the severity of the neurological lesion, self-care/PEDI was significantly impaired by hip flexion contracture and absence of functional ambulation. General health-related QOL was significantly lower in this patient group than for US norms. Nonambulatory and mentally retarded patients had a significantly lower physical function of their QOL (CHQ).
CONCLUSIONS: The severity of the disease, i.e. reduced muscle strength and occurrence of spasticity around hip/knee, affected ambulation, functional mobility and self-care. Acquired deformities (hip dislocation and spine deformity) affected functional ambulation only. Patients with reduced functional mobility and self-care experienced lower physical QOL. Children with myelomeningocele had significantly reduced QOL compared to healthy individuals.
PMID: 19308602
Department of Orthopaedics, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden, danielsson.aina@telia.com.
PURPOSE: Modern principles for treatment of patients with myelomeningocele include early closure of the neural tube defect, neurosurgical treatment of hydrocephalus and treatment aimed at minimizing contractures and joint dislocations. The aim is to achieve a better survival rate and a better quality of life (QOL). Better ambulatory function is thought to improve the management of activities of daily living. This study focused on evaluating which factors might affect ambulation, function and health-related QOL in children with myelomeningocele.
METHODS: Thirty-eight patients with neurological deficit from myelomeningocele were examined in an unbiased follow-up. This included a physical examination using validated methods for ambulatory function and neuromuscular status, chart reviews and evaluation of radiographs in terms of hip dislocation and spine deformity. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure mobility, self-care and social function, and the Child Health Questionnaire (CHQ-PF50) was used to measure QOL.
RESULTS: Muscle function class, quadriceps strength, spasticity in hip and/or knee joint muscles and hip flexion contracture as well as the ambulatory level all affected functional mobility as well as self-care/PEDI. Patients with hip dislocation, spinal deformity or those who were mentally retarded also had significantly worse functional mobility. Besides being affected by the severity of the neurological lesion, self-care/PEDI was significantly impaired by hip flexion contracture and absence of functional ambulation. General health-related QOL was significantly lower in this patient group than for US norms. Nonambulatory and mentally retarded patients had a significantly lower physical function of their QOL (CHQ).
CONCLUSIONS: The severity of the disease, i.e. reduced muscle strength and occurrence of spasticity around hip/knee, affected ambulation, functional mobility and self-care. Acquired deformities (hip dislocation and spine deformity) affected functional ambulation only. Patients with reduced functional mobility and self-care experienced lower physical QOL. Children with myelomeningocele had significantly reduced QOL compared to healthy individuals.
PMID: 19308602
Monday, May 4, 2009
From neuromuscular activation to end-point locomotion: An artificial neural network-based technique for neural prostheses.
Chang CL, Jin Z, Chang HC, Cheng AC. From neuromuscular activation to end-point locomotion: An artificial neural network-based technique for neural prostheses. Journal of Biomechanics. 2009 Apr 21. [Epub ahead of print]
Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Neuroprostheses, implantable or non-invasive ones, are promising techniques to enable paralyzed individuals with conditions, such as spinal cord injury or spina bifida (SB), to control their limbs voluntarily. Direct cortical control of invasive neuroprosthetic devices and robotic arms have recently become feasible for primates. However, little is known about designing non-invasive, closed-loop neuromuscular control strategies for neural prostheses. Our goal was to investigate if an artificial neural network-based (ANN-based) model for closed-loop-controlled neural prostheses could use neuromuscular activation recorded from individuals with impaired spinal cord to predict their end-point gait parameters (such as stride length and step width). We recruited 12 persons with SB (5 females and 7 males) and collected their neuromuscular activation and end-point gait parameters during overground walking. Our results show that the proposed ANN-based technique can achieve a highly accurate prediction (e.g., R-values of 0.92-0.97, ANN (tansig+tansig) for single composition of data sets) for altered end-point locomotion. Compared to traditional robust regression, this technique can provide up to 80% more accurate prediction. Our results suggest that more precise control of complex neural prostheses during locomotion can be achieved by engaging neuromuscular activity as intrinsic feedback to generate end-point leg movement. This ANN-based model allows a seamless incorporation of neuromuscular activity, detected from paralyzed individuals, to adaptively predict their altered gait patterns, which can be employed to provide closed-loop feedback information for neural prostheses.
PMID: 19389678
Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Neuroprostheses, implantable or non-invasive ones, are promising techniques to enable paralyzed individuals with conditions, such as spinal cord injury or spina bifida (SB), to control their limbs voluntarily. Direct cortical control of invasive neuroprosthetic devices and robotic arms have recently become feasible for primates. However, little is known about designing non-invasive, closed-loop neuromuscular control strategies for neural prostheses. Our goal was to investigate if an artificial neural network-based (ANN-based) model for closed-loop-controlled neural prostheses could use neuromuscular activation recorded from individuals with impaired spinal cord to predict their end-point gait parameters (such as stride length and step width). We recruited 12 persons with SB (5 females and 7 males) and collected their neuromuscular activation and end-point gait parameters during overground walking. Our results show that the proposed ANN-based technique can achieve a highly accurate prediction (e.g., R-values of 0.92-0.97, ANN (tansig+tansig) for single composition of data sets) for altered end-point locomotion. Compared to traditional robust regression, this technique can provide up to 80% more accurate prediction. Our results suggest that more precise control of complex neural prostheses during locomotion can be achieved by engaging neuromuscular activity as intrinsic feedback to generate end-point leg movement. This ANN-based model allows a seamless incorporation of neuromuscular activity, detected from paralyzed individuals, to adaptively predict their altered gait patterns, which can be employed to provide closed-loop feedback information for neural prostheses.
PMID: 19389678
Friday, September 19, 2008
Wheelchair propulsion demands during outdoor community ambulation
Wendy J. Hurd, Melissa M.B. Morrow, Kenton R. Kaufman, Kai-Nan An Wheelchair propulsion demands during outdoor community ambulation Journal of Electromyography and Kinesiology, . 2008 Jun 28.
Abstract
Objective: Quantify manual wheelchair propulsion effort during outdoor community ambulation.
Design: Case series.
Subjects: Thirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints.
Methods: Measurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities.
Results: Propulsion effort, captured by the propulsion moment, work and power, varied across ground conditions (p < 0.001). Propulsion effort was greater as the rolling resistance increased (i.e., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions.
Conclusions: Propulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use.
Keywords: Wheelchair; Propulsion; Mobility; Rehabilitation; Biomechanics
PMID: 18590967
Abstract
Objective: Quantify manual wheelchair propulsion effort during outdoor community ambulation.
Design: Case series.
Subjects: Thirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints.
Methods: Measurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities.
Results: Propulsion effort, captured by the propulsion moment, work and power, varied across ground conditions (p < 0.001). Propulsion effort was greater as the rolling resistance increased (i.e., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions.
Conclusions: Propulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use.
Keywords: Wheelchair; Propulsion; Mobility; Rehabilitation; Biomechanics
PMID: 18590967
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