scholarly journals Development of a Feedback Training Protocol and Clinical Force Measuring Walker for Older Patients with Restricted Upper Extremity Weight Bearing

2021 ◽  
Author(s):  
Ansel LaPier
Keyword(s):  
Upper Extremity ◽  
Older Patients ◽  
Patient Adherence ◽  
Callus Formation ◽  
Weight Bearing ◽  
Training Session ◽  
Subsequent Development ◽  
Functional Mobility ◽  
Feedback Training ◽  
Training Protocol

Patients recovering from bone disruption due to trauma or surgery need to limit movement to minimize shear force, thereby protecting callus formation and osteogenesis. Patients often use their arms to assist with functional activities, but pushing is frequently limited to <10 lb (4.5 kg). With only verbal instructions, patients’ ability to accurately limit weight-bearing (WB) force is poor. A therapeutic intervention to improve patient adherence with upper extremity (UE) WB guidelines during functional mobility using an instrumented walker could be beneficial. Therefore, the purpose of this article is to describe a feedback training protocol to improve the ability to modulate weight-bearing force in older adults and then provide an overview of the efficacy of this protocol and subsequent development of a Clinical Force Measuring Walker. An instrumented walker was used to measure UE WB during functional mobility in older healthy subjects (n = 30) before, during, and after (immediately and 2 hours) a visual and auditory concurrent feedback training session. During feedback training, force was significantly reduced with all 3 sessions as compared to baseline. When using the front wheeled walker, UE WB force during the second and third feedback training trials went down compared to the first trial. During the third feedback training trial, force was greater than the two previous trials while transferring sit-to-stand and stand-to-sit. After completion of practice with feedback, UE WB force was significantly reduced and remained so 2 hours later. These findings suggest that feedback training is effective for helping patients to modulate UE WB. Use of an instrumented walker and feedback training would be beneficial in clinical practice, especially with older patients. A more intensive feedback training with additional trials and or simultaneous visual and auditory cues during whole-practice may be needed to get UE WB below a 10 lb threshold.

scholarly journals Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Ansel LaPier ◽  
Kimberly Cleary
Keyword(s):  
Older Patients ◽  
Heart Surgery ◽  
Weight Bearing ◽  
Pectoralis Major Muscle ◽  
Open Heart Surgery ◽  
Pectoralis Major ◽  
Functional Mobility ◽  
Functional Activities ◽  
Feedback Training ◽  
Bearing Force

Patients often need to use their arms to assist with functional activities, but after open heart surgery, pushing with the arms is limited to <10 lb (4.5 kg) to help minimize force across the healing sternum. The main purposes of this study were to determine if older patients (>60 years old) (1) accurately estimated upper extremity (UE) weight bearing force of 10 lb or less and (2) if feedback training improved their ability to limit UE force and pectoralis major muscle contraction during functional activities. An instrumented walker was used to measure UE weight bearing force, and electromyography was used to measure pectoralis major muscle activity simultaneously during 4 functional mobility tasks. After baseline testing, healthy older subjects ( n = 30 ) completed a brief session of visual and auditory concurrent feedback training. Results showed that the self-selected UE force was >10 lb for all tasks (20.0-39.7 lb [9.1-18.0 kg]), but after feedback training, it was significantly reduced (10.6-21.3 lb [4.8-9.7 kg]). During most trials (92%), study participants used >12 lb (5.5 kg) of arm weight bearing force. Pectoralis major muscle peak electromyography activity was <23% of maximal voluntary isometric contraction and was reduced (9.8-14.9%) after feedback training. Older patients may not be able to accurately estimate UE arm force used during weight bearing activities, and visual and auditory feedback improves accuracy and also modulation of pectoralis major muscle activation. Results suggest that an instrumented walker and feedback training could be clinically useful for older patients recovering from open heart surgery.

scholarly journals ORTHOPEDIC INJURIES IN ADOLESCENT GYMNASTS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0011
Author(s):  
Katie Kim ◽  
Michael Saper
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Weight Bearing ◽  
The Body ◽  
Adolescent And Young Adult ◽  
Body Region ◽  
Lower Extremity Injuries ◽  
Common Location ◽  
Orthopedic Injuries ◽  
Extremity Injuries

Background: Gymnastics exposes the body to many different types of stressors ranging from repetitive motion, high impact loading, extreme weight bearing, and hyperextension. These stressors predispose the spine and upper and lower extremities to injury. In fact, among female sports, gymnastics has the highest rate of injury each year. Purpose: The purpose of this study was to systematically review the literature on location and types of orthopedic injuries in adolescent (≤20 years) gymnasts. Methods: The Pubmed, Medline, EMBASE, EBSCO (CINAHL) and Web of Science databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify all studies reporting orthopedic injuries in adolescent and young adult gymnasts. All aspects of injuries were extracted and analyzed including location, type and rates of orthopedic injuries. Results: Screening yielded 22 eligible studies with a total of 427,225 patients. Twenty of 22 studies reported upper extremity injuries of which four specifically focused on wrist injuries. Eight studies reported lower extremity injuries. Nine studies reported back/spinal injuries. Seven studies investigated each body location of injury; one study reported the upper extremity as the most common location for injury and six studies reported the lower extremity as the most common location for injury. Of those seven studies, five (23%) reported sprains and strains as the most common injury. One study reported fractures as the most common injury. Conclusion: There is considerable variation in reported injury location. Some studies focused specifically on the spine/back or wrist. The type of gymnastics each patient participated in was also different, contributing to which area of the body was more heavily stressed, or lacking. Current literature lacks data to fully provide evidence regarding which body region is more frequently injured and the type of injury sustained.

scholarly journals Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 691
Author(s):  
Jan Barcik ◽  
Devakara R. Epari
Keyword(s):  
Fracture Healing ◽  
Bone Healing ◽  
Mechanical Stimulation ◽  
Callus Formation ◽  
Weight Bearing ◽  
Healing Process ◽  
Healing Time ◽  
Mechanical Environment ◽  
Clinically Significant ◽  
The Impact

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

Carpal Instability in the Weight-Bearing Upper Extremity*

1996 ◽  
Vol 78 (12) ◽  
pp. 1838-43 ◽  
Author(s):  
WILLIAM SCHROER ◽  
STEPHEN LACEY ◽  
FREDERICH S. FROST ◽  
MICHAEL W. KEITH
Keyword(s):  
Upper Extremity ◽  
Weight Bearing ◽  
Carpal Instability

scholarly journals A Suspicious Atypical Fracture of 5th Metatarsal Bone: A Case Report

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Byeong-Seop Park ◽  
Seungbum Koo ◽  
Won-keun Park ◽  
Ki-bum Kwon ◽  
Kyoung Min Lee
Keyword(s):  
Callus Formation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Metatarsal Bone ◽  
Atypical Fracture ◽  
Atypical Fractures ◽  
Strenuous Activity ◽  
History Of ◽  
Surgical Fixation ◽  
The Right

Category: Trauma Introduction/Purpose: Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone. Methods: A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1). Results: The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation. Conclusion: Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.

scholarly journals Ankle Taping Effectiveness for the Decreasing Dorsiflexion Range of Motion in Elite Soccer and Basketball Players U18 in a Single Training Session: A Cross-Sectional Pilot Study

2020 ◽  
Vol 10 (11) ◽  
pp. 3759
Author(s):  
Carlos Romero-Morales ◽  
Carlos López-Nuevo ◽  
Carlos Fort-Novoa ◽  
Patricia Palomo-López ◽  
David Rodríguez-Sanz ◽  
...  
Keyword(s):  
Pilot Study ◽  
Range Of Motion ◽  
Elite Athletes ◽  
Weight Bearing ◽  
Training Session ◽  
Ankle Dorsiflexion ◽  
Ankle Sprains ◽  
Basketball Players ◽  
Cross Sectional ◽  
The Right

Ankle sprains have been defined as the most common injury in sports. The aim of the present study was to investigate the ankle taping for the reduction of ankle dorsiflexion range of motion (ROM) and inter-limb in elite soccer and basketball players U18 in a single training session. Methods: A cross-sectional pilot study was performed on 38 male healthy elite athletes divided into two groups: a soccer group and a basketball group. Ankle dorsiflexion ROM and inter-limb asymmetries in a weight-bearing lunge position were assessed in three points: with no-tape, before the practice and immediately after the practice. Results: For the soccer group, significant differences (p < 0.05) were observed for the right ankle, but no differences for the asymmetry variable. The basketball group reported significant differences (p < 0.05) for the right ankle and symmetry. Conclusions: Ankle taping decreased the ankle dorsiflexion ROM in youth elite soccer and basketball players U18. These results could be useful as a prophylactic approach for ankle sprain injury prevention. However, the ankle ROM restriction between individuals without taping and individuals immediately assessed when the tape was removed after the training was very low.

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