scholarly journals Myelomeningocele: a new functional classification

2021 ◽  
Vol 15 (1) ◽  
pp. 1-5
Author(s):  
Luciano S. Dias ◽  
Vineeta T. Swaroop ◽  
Luiz R. A. de Angeli ◽  
Jill E. Larson ◽  
Ana-Marie Rojas ◽  
...  
Keyword(s):  
Plantar Flexion ◽  
Functional Mobility ◽  
External Support ◽  
Knee Extensors ◽  
Functional Classification ◽  
New Classification ◽  
Functional Level ◽  
Level Of Evidence ◽  
Four Levels ◽  
Knee Flexors

Purpose In myelomeningocele, several classifications have been used. The present manuscript proposes a new functional classification to better assess the prognosis and management of these patients. Methods The manual muscle test is what defines the actual group in which the patient should be included. Furthermore, this new classification brings information about the bracing and external supports recommended to each functional level. We also recommend that the patient’s Functional Mobility Scale should always be mentioned together with their functional level. Results The four levels in this classification are MMFC1, MMFC2, MMFC3 and MMFC4. The MMFC1 group includes patients with significant muscle weakness. They need to use high braces crossing the hip joint with a walker to achieve some ambulation. The MMFC2 group includes patients who have functional hip flexors, knee extensors and knee flexors. However, the hip abductors are quite weak. These patients usually need to use a walker - or crutches - and Ankle-Foot Orthosis (AFOs). The MMFC3 group includes patients with functional hip flexors, knee extensors, knee flexors and hip abductors. However, the ankle plantar flexion function is absent. Most of them are able to walk independently, only using AFOs without any external support. The MMFC4 group includes patients who have preserved function in the entire lower limb musculature. These patients don’t need any assistive devices to achieve an adequate ambulation pattern. Conclusions We hope that this new classification is a system that is simple to understand, serves as a gait prognosis guide and facilitates communication among healthcare professionals. Level of evidence V

scholarly journals Neuromuscular electrical stimulation in early rehabilitation of patients with postoperative complications after cardiovascular surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Oleinik ◽  
AN Sumin ◽  
AV Bezdenezhnykh
Keyword(s):  
Postoperative Complications ◽  
Cardiovascular Surgery ◽  
Handgrip Strength ◽  
Left Knee ◽  
Baseline Data ◽  
Knee Extensors ◽  
Federal State ◽  
Control Group ◽  
Initial Strength ◽  
Knee Flexors

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases Introduction The purpose was to evaluate the effectiveness of NMES in patients with complications after cardiac surgery. Methods This study was 37 patients who had significant postoperative complications after cardiovascular surgery. Participants were randomly - NMES group, n = 18; control, n = 19. It was not possible to blind the investigator. Analyzed basic clinical data. The dynamometry of the muscles upper and lower extremities was carried out, as well as a 6-minute walk test (6MWT). Also, the thickness of the quadriceps was measured using ultrasound.The patients underwent NMES on the quadriceps femoris muscle, daily from the third postoperative day, until discharge. The duration session was 90 minutes. Outcomes No differences were found in the baseline characteristics of the groups, including the results of laboratory and instrumental studies. Groups were comparable in the surgery and perioperative parameteres. The initial strength indicators also had no significant differences in the groups. At discharge knee extensors strength (KES) was significantly higher in the NMES group. The knee flexor strength (KFS) and handgrip strength (HF) increased the same in both groups. The quadriceps crosssectional area (CSA) muscle increased more in the NEMS group than in the control to the time of discharge. Average KES increased to a greater extent in the NMES group. At the same time, average and maximum KFS increased equally in both groups. A 6MWT before discharge did not show a difference between groups (P=.166). The NMES course did not affect the duration of hospitalisation (P=.429). Discussion This pilot study show beneficial effects of NMES on muscle strength in patients with complications after cardiovascular surgery. Physical tests initially and in dynamics NEMS Group (n = 18) Control group (n = 19) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 20,3 [17,9; 26,1] 28,05 [23,8; 36,2] * 20,1 [18,6; 25,4] 22,3 [20,1; 27,1] * 0,004 Left knee extensors strength (kg) 17,75 [15,5; 27,0] 27,45 [22,3; 33,1] * 20,8 [17,5; 24,2] 22,5 [20,1; 25,9] * 0,017 Right knee flexors strength (kg) 14,85 [11,7; 19,5] 17,5 [14,1; 23,4] * 16,9 [13,1; 23,8] 19,2 [12,5; 26,4] * 0,971 Left knee flexors strength (kg) 14,7 [12,6; 19,6] 19,75 [15,9; 24,2] * 16,2, [10,4; 25,1] 18,8 [13,1; 27,7] * 0,889 6-MWT (m) 148,5 [108,5; 174,0] 288,0 [242,0; 319,0] * 169,0 [115,0; 217,0] 315,0 [277,0; 400,0] * 0,166 Right handgrip strength (kg) 24,5 [15,0; 33,0] 25,5 [19,0; 36,0] * 27,0 [18,0; 32,0] 30,0 [20,0; 35,0] * 0,795 Left handgrip strength (kg) 17,0 [12,0; 27,0] 21,0 [15,0; 31,0] * 19,0 [14,0; 29,0] 23,0 [16,0; 30,0] * 0,541 * - p-level from baseline data < 0,05 ** - p-level from baseline data ≥ 0,05

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

Effects of the use neuromuscular electrical stimulation of the lower extremities in the prehabilitation of patients in a before cardiac surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
P Oleinik ◽  
AN Sumin ◽  
AV Bezdenezhnykh
Keyword(s):  
Cardiac Surgery ◽  
Handgrip Strength ◽  
Lower Extremities ◽  
Left Knee ◽  
Knee Extensors ◽  
Control Group ◽  
Elective Cardiac Surgery ◽  
Antagonist Muscles ◽  
Muscle Groups ◽  
Knee Flexors

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Research Institute for Complex Issues of Cardiovascular Diseases Aim To evaluate the effects of neuromuscular electrostimulation in the prehabilitation and prevention of muscle weakness in patients awaiting cardiac surgery. Materials and methods 122 patients waiting for elective cardiac surgery were included. Exclusion criteria: age less than 25 and more than 80 years; emergency and urgent surgical interventions; arthropathies; low pain threshold; rhabdomyolysis and other myopathies; cognitive dysfunction. Routine laboratory and instrumental examinations were performed in all patients upon admission to the hospital, as part of a standard examination. 62 patients were randomly selected for the preoperative NMES group, in addition to the standard preoperative preparation and treatment program. The standard program included 60 control patients. Patients of the NMES group underwent quadriceps stimulation for at least 5 sessions, lasting 90 minutes, daily before surgery. Results. The groups were comparable and did not have significant differences in gender and age characteristics, according to the main clinical and anamnestic data and types of operations. Initially, there were no differences in the state of the muscles of the lower extremities, the distance of the six-minute walking test (6MWT), and the strength of the hand grip. After NMES, there was an increase in muscle strength relative to the control group, both stimulated muscle groups and unstimulated antagonist muscles, as well as a greater 6MWT distance and hand compression force. All the differences were significant. Conclusions The course of pre-rehabilitation of NMES before surgery, allowed to maintain, and in some cases improve the condition of the muscle frame of the lower extremities. A positive effect was observed not only in stimulated muscle groups, but also in antagonist muscles Indicators of muscle status NMES (n = 62) Control group (n = 60) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 24,4 [18,3; 31,4] 30,4 [23,8; 36,2]* 24,7 [20,1; 33,2] 22,25 [18,9; 30,4] &lt;0,001 Left knee extensors strength (kg) 23,8 [19,3; 31,3] 29,2 [23,6; 35,4]* 25,75 [19,2; 31,3] 22,9 [18,9; 27,8] &lt;0,001 Right knee flexors strength (kg) 18,9 [13,3; 24,0] 21,7 [16,6; 25,1] 19,55 [13,1; 26,0] 16,7 [12,1; 23,3] 0,006 Left knee flexors strength (kg) 19,3 [14,3; 24,5] 21,9 [17,3; 26,7] 19,5 [13,0; 24,3] 18,2 [13,4; 22,2] 0,005 6-MWT (m) 300,0 [261,0; 371,0] 331,0 [280,0; 375,0] 304,5 [253,0; 380,0] 285,5 [246,0; 342,0] 0,006 Right handgrip strength (kg) 28,5 [20,5; 34,0] 31,5 [22,0; 34,0] 29,0 [19,0; 34,0] 27,0 [19,0; 33,0] 0,054 Left handgrip strength (kg) 25,0 [18,0; 31,0] 25,0 [18,0; 32,0] 24,0 [15,0; 31,0] 22,0 [14,0; 28,0] 0,062 * - p-level from baseline data &lt; 0,05 Abstract Figure. dynamics of stimulated muscles

scholarly journals Isokinetic Profile of Elite Serbian Female Judoists

2021 ◽  
Vol 18 (13) ◽  
pp. 6988
Author(s):  
Wieslaw Blach ◽  
Miodrag Drapsin ◽  
Nemanja Lakicevic ◽  
Antonino Bianco ◽  
Tamara Gavrilovic ◽  
...  
Keyword(s):  
Knee Extensors ◽  
Training Experience ◽  
Lateral Asymmetry ◽  
National Team ◽  
Significant Difference ◽  
Judo Athletes ◽  
Muscle Groups ◽  
Torque Values ◽  
Training Modalities ◽  
Knee Flexors

Elite judo athletes undergo vigorous training to achieve outstanding results. In pursuit of achieving competitive success, the occurrence of injuries amongst judo athletes is not rare. The study aimed to perform a knee flexors and extensors isokinetic torque analysis in elite female judo athletes. Fifty-eight elite female judo athletes of the Serbian national team (21.02 ± 3.11 years; 62.36 ± 11.91 kg, 165.04 ± 10.24 cm, training experience 12.72 ± 2.98 years) volunteered to participate in this study. The range of motion (ROM) was set at 90⁰. Testing was performed in a concentric–concentric mode for the testing speed of 60 ⁰/s. Five maximal voluntary contractions of knee extensors and knee flexors muscle groups were measured for both legs. The obtained data showed a statistically significant difference in absolute torque values among different categories as heavier athletes demonstrated higher values. Post hoc analysis showed a significant difference between weight categories, as heavier athletes demonstrated higher values, while no significant differences in normalized torque values for different weight categories were observed. The implementation of new elements and training modalities may improve performance and prevent lateral asymmetry, thus reducing the risk of injury.

scholarly journals The Effects of Repetitive Drop Jumps on Impact Phase Joint Kinematics and Kinetics

2011 ◽  
Vol 27 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Joshua T. Weinhandl ◽  
Jeremy D. Smith ◽  
Eric L. Dugan
Keyword(s):  
Energy Absorption ◽  
Plantar Flexion ◽  
Knee Extension ◽  
Joint Kinematics ◽  
Knee Extensors ◽  
Initial Contact ◽  
Drop Jumps ◽  
Impact Phase ◽  
The Impact ◽  
Kinematics And Kinetics

The purpose of the study was to investigate the effects of fatigue on lower extremity joint kinematics, and kinetics during repetitive drop jumps. Twelve recreationally active males (n= 6) and females (n= 6) (nine used for analysis) performed repetitive drop jumps until they could no longer reach 80% of their initial drop jump height. Kinematic and kinetic variables were assessed during the impact phase (100 ms) of all jumps. Fatigued landings were performed with increased knee extension, and ankle plantar flexion at initial contact, as well as increased ankle range of motion during the impact phase. Fatigue also resulted in increased peak ankle power absorption and increased energy absorption at the ankle. This was accompanied by an approximately equal reduction in energy absorption at the knee. While the knee extensors were the muscle group primarily responsible for absorbing the impact, individuals compensated for increased knee extension when fatigued by an increased use of the ankle plantar flexors to help absorb the forces during impact. Thus, as fatigue set in and individuals landed with more extended lower extremities, they adopted a landing strategy that shifted a greater burden to the ankle for absorbing the kinetic energy of the impact.

scholarly journals Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up

2017 ◽  
Vol 43 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Amaury Charre ◽  
Stephanie Delclaux ◽  
Costel Apredoai ◽  
Jean-Emmanuel Ayel ◽  
Michel Rongieres ◽  
...  
Keyword(s):  
Grip Strength ◽  
Stage Iv ◽  
Functional Mobility ◽  
Stage Iiib ◽  
Advanced Stage ◽  
Stage Iiia ◽  
Level Of Evidence ◽  
Kienböck Disease

Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. Level of evidence: IV

scholarly journals Posterior malleolar fractures. New classification and treatment algorithm

2020 ◽  
Vol 14 (3) ◽  
pp. 254-259
Author(s):  
Diego Yearson ◽  
Ignacio Melendez ◽  
Federico Anain ◽  
Santiago Siniscalchi ◽  
Juan Drago
Keyword(s):  
Posterior Approach ◽  
Treatment Algorithm ◽  
Case Series ◽  
Fracture Pattern ◽  
Joint Surface ◽  
Medial Malleolus ◽  
New Classification ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolus

Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals BIOMECHANICS OF SHOD AND BAREFOOT RUNNING: A LITERATURE REVIEW

2020 ◽  
Vol 26 (6) ◽  
pp. 551-557
Author(s):  
Vitória da Silveira Jahn ◽  
Clara Knierim Correia ◽  
Elisa Dell’Antonio ◽  
Luis Mochizuki ◽  
Caroline Ruschel
Keyword(s):  
Literature Review ◽  
Plantar Flexion ◽  
Reaction Force ◽  
Individual Characteristics ◽  
Medial Gastrocnemius ◽  
Vertical Ground Reaction Force ◽  
Level Of Evidence ◽  
Barefoot Running ◽  
Foot Strike ◽  
General Studies

ABSTRACT This study aims to analyze and summarize the biomechanical (kinematics, kinetics and neuromuscular) differences between shod and barefoot running, through a literature review. Searches were conducted for complete articles published between 2013 and November 2018 in the Web of Science, PubMed, Scopus and SPORTdiscus databases. The search terms used were Biomechanics, Kinetics, Kinematics, Electromyography, “Surface Electromyography”; and Unshod, Barefoot, Barefeet and Running. The search resulted in 687 articles; after excluding duplicates and selecting by title, abstract and full text, 40 articles were included in the review. The results show that there are important differences in the biomechanics of running when shod or barefoot. In general, studies indicate that in barefoot running: a) individuals present forefoot or midfoot foot strike patterns, while in shod running the typical pattern is the rearfoot strike; (b) greater cadence and shorter stride length are observed; and (c) there is greater knee flexion, lower peak vertical ground reaction force and greater activation of the medial gastrocnemius. In addition, barefoot runners contact the ground with greater plantar flexion, possibly as a strategy to reduce impact when stepping without footwear. These differences, as well as runners’ individual characteristics, should be considered in the prescription of the barefoot running, in order to minimize injuries resulting from the practice. Level of Evidence II; Review.

Developmental Changes in Isometric Strength: Longitudinal Study in Adolescent Soccer Players

2018 ◽  
Vol 39 (09) ◽  
pp. 688-695 ◽  
Author(s):  
Joao Duarte ◽  
João Valente-dos-Santos ◽  
Manuel Coelho-e-Silva ◽  
R. Malina ◽  
Dieter Deprez ◽  
...  
Keyword(s):  
Skeletal Maturity ◽  
Isometric Strength ◽  
Fat Free Mass ◽  
Knee Extensors ◽  
Annual Increment ◽  
Systematic Assessment ◽  
Dependent Variables ◽  
Muscle Groups ◽  
Knee Muscle ◽  
Knee Flexors

AbstractThis study aimed to examine longitudinal changes in isometric strength of the knee extensors (ImKE) and knee flexors (ImKF) at 30° and 60°. The sample was composed of 67 players aged 11.0–13.9 years at baseline over five years. Stature, body mass, skinfolds, and isometric strength (ImKE30°, ImKF30°, ImKE60° and ImKF60°) were measured. Fat mass and fat-free mass (FFM) were derived from skinfolds. Skeletal age was obtained using TW2 RUS. Multilevel random effects regression analyses extracted developmental polynomial models. An annual increment on chronological age (CA) corresponded to 5.6 N (ImKE30°), 2.7 N (ImKF30°), 4.6 N (ImKE60°) and 1.5 N (ImKF60°). An increment of 1 kg in FFM predicted isometric strength as follows: 1.2 N (ImKE30°), 2.1 N (ImKF30°), 3.1 N (ImKE60°) and 2.0 N (ImKF60°). The following equations were obtained: ImKE30°=5.759×CA+1.163×FFM; ImKF30°=−19.369+2.691×CA+0.693×CA2+2.108×FFM; ImKE60°=4.553×CA+3.134×FFM; and, ImKF60°=-19.669+1.544×CA+2.033×FFM. Although skeletal maturity had a negligible effect on dependent variables, age and body size, based on FFM, were relevant longitudinal predictors. During adolescence, systematic assessment of knee extensors and knee flexors are strongly recommended to prevent impairment of knee muscle groups.

Functional Classification System to Aid Contextual Design

2017 ◽  
Vol 2638 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Nikiforos Stamatiadis ◽  
Adam Kirk ◽  
Jeff Jasper ◽  
Samantha Wright
Keyword(s):  
Classification System ◽  
User Needs ◽  
Functional Classification ◽  
System Matrix ◽  
New Classification ◽  
Design Elements ◽  
Contextual Design ◽  
Matrix Cell ◽  
Balanced Designs ◽  
User Groups

A proposed functional classification system has been developed to address context and multimodal accommodation of the existing classification system. The proposed functional classification system is intended to facilitate optimal geometric design solutions while accounting for context, user needs, and functions. The new classification system communicates improved information to the designer so that balanced designs can be achieved through documented prioritization of roadway users. The proposed functional classification system identifies user groups, which include drivers, pedestrians, and bicyclists. Fundamental design elements for each mode are identified, and design ranges for each are provided according to the overall roadway network type. The correlation results of context, roadway types, and users are displayed in the expanded functional classification system matrix, allowing for the development of a multimodal, context-based design with some degree of flexibility. Each matrix cell defines the various users (drivers, bicyclists, and pedestrians) and identifies those characteristics to be balanced.

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