Improvement of the Soft Socket after Rotationplasty: A Single Case Study

2009 ◽  
Vol 33 (1) ◽  
pp. 10-16
Author(s):  
Martin Wessling ◽  
Mirko Aach ◽  
Jendrik Hardes ◽  
Elmar Janssen ◽  
Dieter Rosenbaum ◽  
...  
Keyword(s):  
Peak Pressure ◽  
Single Case ◽  
Weight Bearing ◽  
Functional Results ◽  
Activity Level ◽  
Pressure Measurements ◽  
Mean Pressure ◽  
The Mean ◽  
Weight Bearing Area

Rotationplasty is established as a functionally improving and partially ablative method of tumour surgery, but good clinical and functional results do not only depend on a successful surgery. Due to the changed biomechanical situation the activity level is limited by the weight bearing capacity of the rotated foot. Painful blisters and callosities may limit the use of the exo-prosthesis, because the skin is overstressed in the soft socket. A 28-year-old patient with a rotationplasty type A2 suffered from painful callosities of the rotated foot. Capacitive pressure measurements were performed as well as a gait analysis for kinematics and kinetic characteristics. Clinically a decrease of the callosities and a pain relieve was obvious and the patient learned skiing without prior knowledge. Biomechanically a decrease of the peak pressure (from 240.6–135.0 kPa) and the mean pressure (from 83.2–66.2 kPa), was observed with an increased weight bearing area. The study has shown that a modification of the heel bench can considerably improve pressure distribution. An increase of the load bearing area appears to enable the skin to compensate even intensive strain during athletic activities.

Examining the Relationship Between Heart Rate and Problem Behavior: A Case Study of Severe Skin Picking in Prader-Willi Syndrome

2013 ◽  
Vol 118 (6) ◽  
pp. 460-474 ◽  
Author(s):  
Scott S. Hall ◽  
Jennifer L. Hammond ◽  
Kristin M. Hustyi
Keyword(s):  
Heart Rate ◽  
Functional Analysis ◽  
Single Case ◽  
Automatic Reinforcement ◽  
Activity Level ◽  
Prader Willi Syndrome ◽  
Activity Levels ◽  
Skin Picking ◽  
The Relationship

Abstract Few studies have examined the relationship between heart rate and self-injurious behavior (SIB) shown by individuals with IDD (intellectual and developmental disabilities). In this single-case study, we simultaneously monitored heart rate and activity levels during a functional analysis of severe skin picking behavior exhibited by a young man with Prader-Willi syndrome (PWS). Results of the functional analysis indicated that the participant's skin picking was maintained by automatic reinforcement. A within-session analysis of the data indicated that skin picking bouts resulted in an increase in heart rate, suggesting a positive- automatic reinforcement function. These data indicate that inclusion of heart rate and activity-level monitoring during a functional analysis may provide important additional information concerning the determinants of SIB.

Calculation of the Behavior of Rubber-Covered Pressure Rollers

1962 ◽  
Vol 35 (2) ◽  
pp. 403-410
Author(s):  
G. J. Parish
Keyword(s):  
Peak Pressure ◽  
Empirical Relations ◽  
Mean Pressure ◽  
The Mean ◽  
Cover Thickness

Abstract Data are given which enable the properties of nips between metal and rubber-covered pressure rollers to be calculated from the parameters of the system. The properties with which the calculation is primarily concerned are the nip width and the mean pressure in the nip, but the principle can be extended to include the peak pressure and the distribution of pressure through the nip. The calculation is based on the well-known Hertzian formula and on empirical relations, which express the important effects of the rubber-cover thickness. The data refer not only to roller systems in which the loading is uniform, but also to non-uniform nips, in particular to those which show what is probably the commonest cause of non-uniformity, roller deflection. Although the calculations refer primarily to nips between one hard roller and one relatively soft, covered, roller, they are directly applicable to nips between two identical covered rollers and may be applied, within limits, to systems in which the rollers are dissimilar in properties.

scholarly journals Design & Development of a Trans Tibial Socket Stabilized by Alternating Areas of Tissue Compression and Release - A Case Study

2021 ◽  
Vol 11 (7) ◽  
pp. 317-321
Author(s):  
Prachi Prava Pattnaik ◽  
Jonathan T
Keyword(s):  
Single Case ◽  
Weight Bearing ◽  
Gait Pattern ◽  
Extensive Study ◽  
Adaptation Period ◽  
Design Development ◽  
Transtibial Amputation ◽  
Prosthetic Socket ◽  
Tissue Compression

The socket is the most important aspect of the artificial limb, constituting the critical interface between the amputee’s stump and prosthesis. The design and fitting of the socket is also the most difficult procedure due to the uniqueness of each amputee’s stump. An uncomfortable socket fit is the most common complaint from lower limb amputees with surveys revealing that amputees believe comfort are the most important aspects of the prosthesis and over half of all wearers are in moderate to severe pain for most of the time whilst wearing the prosthesis. Kristinsson argued that a transtibial socket can be designed to transfer loads primarily to limited areas of the limb such as the patella tendon and the medial flare, which in most cases found both ineffective and uncomfortable. There were inconsistencies in producing satisfactory PTB sockets because of inadequate training of prosthetist in the PTB technique. However, the TSB silicon liner socket has problems such as causing excessive perspiration, heating and odor etc. Therefore, a new socket is designed following the principle of alternative pressure and release to overcome the disadvantages and to check the socket with regard to stability, comfort and satisfaction. Method: A single case study of a person 37-year-old, with transtibial amputation population took part in this study and was selected according to the inclusion criteria. The participant was provided patient information sheet and after taking the informed consent, the assessment and fabrication of the new socket were being proceeded, taking the cast on the first day. On the third day the newly designed socket along with prosthesis was provided with an adaptation period of 7 days. After 7 days the patient was called to check the stability with standing, comfort and satisfaction with a prosthetic socket comfort score. Results and Discussion: The present socket is well suitable for transtibial patient in weight bearing position. It fits well to the contour of the adult patient. The socket was adjusted manually during rectification phase providing respective pressure in areas required. Conclusion: The developed socket had a great effect on gait pattern of transtibial amputee. This socket provides adjustment for pressure, anterior, posterior, medial and lateral of the stump. It also creates surface for the placement of bony prominences. As it is a complex casting procedure, proper care should be taken to fabricate the casting of socket with minimal error. Further, innovative inventions will be required to refine more products and extensive study has to be carried out on the existing mode. Key words: transtibial amputation, transtibial socket, tissue compression and release.

scholarly journals Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists)

2017 ◽  
Vol 07 (01) ◽  
pp. 011-17
Author(s):  
Tahir Sügün ◽  
Murat Kayalar ◽  
Yusuf Gürbüz
Keyword(s):  
Distal Radius ◽  
Screw Fixation ◽  
Functional Results ◽  
High Energy ◽  
Activity Level ◽  
Type B ◽  
Fixation Technique ◽  
Scaphoid Fractures ◽  
Surgical Fixation ◽  
The Mean

Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19–82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert–Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results The average follow-up period was 25 (range: 12–97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0–8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence Level IV.

scholarly journals The impact of articulatory consciousness training on reading and spelling literacy in students with severe dyslexia: an experimental single case study

2021 ◽  
Author(s):  
Anne Cathrine Thurmann-Moe ◽  
Monica Melby-Lervåg ◽  
Arne Lervåg
Keyword(s):  
Single Case ◽  
Multiple Baseline ◽  
Probe Design ◽  
Intervention Programme ◽  
Post Intervention ◽  
Dependent Variables ◽  
The Mean ◽  
The Impact ◽  
Reading And Spelling

AbstractThis study evaluates the effect of an intervention whose aim is to make articulatory consciousness a tool in decoding and spelling. The sample comprises 11 students with severe dyslexia (2 SD below the mean pseudoword scores), and the intervention programme consists of 32 individual sessions over 8 weeks. The study applies a multiple baseline/probe design with five baseline tests that correspond to a control condition, eight tests during the intervention and five post-intervention tests. On average, the results show significant improvement in all reading and spelling outcomes. However, there were also significant effects on an irrelevant control task (the pegboard test), perhaps indicating testing effects on the dependent variables, making it difficult to draw firm conclusions from the study. Consequently, testing the intervention in randomised trials of children with severe dyslexia is recommended to draw more firm conclusions about its efficacy for this group.

scholarly journals Effect of Achilles tendon lengthening on ankle and subtalar joint orientation and load distribution utilizing a novel cadaveric model to simulate weight bearing

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Naven Duggal ◽  
Patrick Williamson ◽  
Stephen Okajima ◽  
Peter Biggane ◽  
Michael Nasr ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Contact Area ◽  
Subtalar Joint ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Joint Orientation ◽  
Ankle Arthroplasty ◽  
Tendon Lengthening ◽  
Mean Pressure ◽  
Achilles Tendon Lengthening

Category: Basic Sciences/Biologics Introduction/Purpose: Ankle arthroplasties are increasingly performed to address ankle arthritis. Patients with long standing ankle arthritis often present with an associated achilles tendon contracture. An open or percutaneous lengthening of the Achilles is commonly performed at the same time as the ankle arthroplasty to improve range of motion. Current ankle arthroplasty implants include mobile bearing and fixed bearing systems. Lengthening the achilles tendon improves dorsiflexion, however the effect of the lengthening on the ankle and subtalar joint is not well documented in the literature. Using a novel system to simulate weight bearing in a cadaveric model, we evaluated achilles tendon lengthening and its effect on ankle and subtalar joint orientation and load distribution. This may have potential implications to polyethylene implant longevity in total ankle arthroplasties. Methods: Five fresh frozen lower limb cadaveric specimens without known skeletal condition were used. The femoral head was potted with PMMA and TekScan pressure sensors were inserted into the ankle and subtalar joint. The specimens were placed on a custom jig, which allowed for load cell modulated loading of the leg; 75 lb load (half body weight)(4) was applied at the femoral head while the foot was supported against a fixed plate keeping the ankle in neutral position. Mean pressure (MP), peak pressure (PP), contact area (CA), and center of force (COF) were measured in both joints under two conditions; baseline (BASE), and following Achilles tendon release (TENDON) to simulate lengthening. Each condition was tested three times per specimen; the results were averaged per specimen and used for final analysis. Displacement of COF was calculated relative to its location at baseline. Results: The Mean Pressure (MP), Peak Pressure (PP) and Contact Area (CA) did not show a statistical difference in the ankle and subtalar joints between baseline (BASE) and TENDON (Achilles tendon release) conditions. (Table 1). Further, the displacement of the COF from the BASE to TENDON was 0.5 mm. In our model, the contracture of the muscle was not fully simulated. Further hindfoot kinetic studies with active achilles contracture may demonstrate a difference in contact forces in the ankle and subtalar joint as compared to normal. Conclusion: Ankle arthroplasty is becoming an effective treatment option for ankle joint arthritis. Our novel study demonstrates that Achilles tendon lengthening did not change the mean pressure, peak pressure, contact area center of force in the ankle and subtalar joint. This model provides validation for further studies evaluating tendon release and contact pressure changes in a cadaver with an implanted fixed bearing versus mobile bearing total ankle prosthesis. Difference in polyethylene wear may effect the longevity of ankle replacements. This study will provide clinicians additional information when evaluating the benefit/risks associated with lengthening the Achilles tendon for ankle arthroplasty patients.

scholarly journals The Effect of Orthotics on Ankle and Subtalar Joint Orientation and Load Distribution Utilizing a Novel System to Simulate Weight Bearing in a Cadaveric Model

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Naven Duggal ◽  
Ara Nazarian ◽  
Michael Nasr ◽  
Patrick Williamson ◽  
Stephen Okajima ◽  
...  
Keyword(s):  
Body Weight ◽  
Femoral Head ◽  
Lower Limb ◽  
Load Distribution ◽  
Subtalar Joint ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Joint Orientation ◽  
Mean Pressure ◽  
Cadaveric Model

Category: Ankle, Basic Sciences/Biologics, Hindfoot, Biomechanics Introduction/Purpose: Orthotics are commonly prescribed by orthopaedic surgeons to address the hindfoot and midfoot deformity resulting from posterior tibial tendon dysfunction. The public however will often purchase over the counter orthotics for generalized complaints of foot pain that is not associated with any significant deformity or foot pathology. The mechanical axis of the lower limb may be altered in patients who use orthotics despite a normal foot alignment. We hypothesize that patients with normal alignment who use orthotics may adversely change ankle and subtalar joint orientation and load distribution. Methods: Five fresh frozen lower limb cadaveric specimens without known skeletal condition were used. The femoral head was potted with PMMA and TekScan pressure sensors were inserted into the ankle and subtalar joint. The specimens were placed on a custom jig, which allowed for load cell modulated loading of the leg; 75 lb load (half body weight) was applied at the femoral head while the foot was supported against a fixed plate keeping the ankle in neutral position. Testing was achieved by placing an orthotic under the medial half of the plantar talonavicular joint level. Mean pressure (MP), peak pressure (PP), contact area (CA), and center of force (COF) were measured in both the ankle and subtalar joints under three conditions; barefoot (BASE), with a 1.5 cm (ORT1) and 3 cm (ORT2) height orthotic. Each condition was tested three times per specimen. Displacement of COF was calculated relative to its location at baseline. Results: The MP, PP and CA showed a constant decrease from BASE to ORT1 and ORT2. Despite this relation, the only comparison that was significantly different was that between peak pressure values of the baseline and ORT2 conditions of the subtalar joint. The average displacement of COF from BASE was 0.14 mm and 0.42 mm medially, and 0.26 mm and 0.46 mm posteriorly at the ankle joint with ORT1 and ORT2 respectively. The average displacement of COF from BASE was 0.03 mm laterally and 0.08 mm posteriorly with ORT1, and 0.2 mm medially and 0.46 mm posteriorly with ORT2 at the subtalar joint. Conclusion: Foot deformities have an impact on the articular forces in the lower limb. Our results agree with previous studies about the role of foot deformity on the distribution of body weight forces and its consequences across the ankle and subtalar joint. Our novel study also demonstrates that orthotics and orthotics of varying sizes can change the mean pressure, peak pressure, contact area center of force in the ankle and subtalar joint. This study proves the feasibility of its design for studying intra-articular pressure changes in a lower limb cadaveric model with simulated weight bearing.

Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses

2018 ◽  
Vol 39 (8) ◽  
pp. 994-1000 ◽  
Author(s):  
Patrick Williamson ◽  
Aron Lechtig ◽  
Philip Hanna ◽  
Stephen Okajima ◽  
Peter Biggane ◽  
...  
Keyword(s):  
Contact Area ◽  
Lower Limb ◽  
Subtalar Joint ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Force Distribution ◽  
Foot Orthoses ◽  
Pressure Mapping ◽  
Mean Pressure ◽  
Pressure Peak

Background: Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. Methods: Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. Results: The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. Conclusion: The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. Clinical Relevance: The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.

scholarly journals Acute Retrograde Tibiotalocalcaneal Nailing for Osteoporotic Ankle Fractures in Fragile Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Mario Herrera-Perez ◽  
Sergio Tejero-Garcia ◽  
Victor Valderrabano
Keyword(s):  
Soft Tissues ◽  
Weight Bearing ◽  
Functional Results ◽  
Ankle Fractures ◽  
Full Weight Bearing ◽  
Term Outcome ◽  
Poor Condition ◽  
Vascular Insufficiency ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: With the rising aging of the population, osteoporotic ankle fractures represent a frequent scenario in daily practice. The coexistence of comorbidities such as poorly controlled diabetes mellitus, vascular insufficiency, and poor condition of the surrounded soft tissues, means that conventional open reduction and internal fixation methods often fail. On the other hand, conservative or orthopaedic treatments in such population are badly tolerated. Our study aims to study the short- term outcome of retrograde tibiotalocalcaneal (TTC) nailing in a selected series of fragile patients. Methods: This study included 15 patients who underwent primary retrograde TTC nailing from January 2016 to July 2018. The mean age of the patients was 83,5 years (range, 75 to 88), and the mean follow-up period was 11,5 months (range, 6 to 24 months) with no patient lost to follow-up. All patients but one were diabetic; 2 were non-ambulatory; and 13 walked with walking aids. The authors implemented a primary nailing without addressing tibiotalar or subtalar joint and without using a tourniquet. Complete weight bearing was allowed early as tolerated. Alignment and healing of the fracture were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up. Results: One of the patients died 8 months after the treatment. Radiographic healing of the fractures were identified in 100% of the cases. In 2 cases, a complete arthrodesis of the ankle joint was achieved by simple nail reaming (Figure 1). No infection or any scarring problems was recorded. Of the 13 patients who walked with difficulty, 4 remained prostrate to a wheelchair, but the rest maintained their previous autonomy. The mean AOFAS score improved from 48 (range, 14 to 71) preoperatively to 71 (range, 44 to 81) postoperatively. Conclusion: In the view of these results, we suggest that primary retrograde TTC nailing is a valid option in selected patients with fragility ankle fractures, high comorbidity, poor condition of the soft tissues and with difficulties to walk before the fracture. This option allows an early full weight bearing, avoids complications due to joint off-loading, and achieves acceptable functional results.

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