Relationship between the weight-bearing ratio of the lower limb and usage of walking aids for elderly patients in care facilities

Free fibula flap (FFF) is one of the reconstructive techniques to treat bone defects, although in septic conditions there are some limitations that have made it less popular. We present our experience with FFF for the reconstruction of lower limb infectious bone defects. From September 2015 to January 2020, 10 patients underwent reconstruction with FFF without rigid internal fixation of septic bone defects of the lower extremities. Demographic, clinical, and operative data were retrospectively collected. All the flaps survived and consolidated. The only major complication was a stress fracture of a fibula that required osteosynthesis. Median time to consolidation and full weight-bearing was 2.5 and 9.8 months, respectively. Bipedal gating was achieved in all the patients, 7 of them without walking aids. Despite it has some limitations and technical difficulties, in our experience FFF is an effective and reliable option in the reconstruction of septic bone defects of the lower limb.

Download Full-text

Effects of Dominant and Nondominant Limb Immobilization on Muscle Activation and Physical Demand during Ambulation with Axillary Crutches

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk6010016 ◽

2021 ◽

Vol 6 (1) ◽

pp. 16

Author(s):

Kara B. Bellenfant ◽

Gracie L. Robbins ◽

Rebecca R. Rogers ◽

Thomas J. Kopec ◽

Christopher G. Ballmann

Keyword(s):

Lower Limb ◽

Muscle Activation ◽

Weight Bearing ◽

Lower Limbs ◽

Medial Gastrocnemius ◽

Bipedal Walking ◽

Lower Limb Muscle ◽

Limb Muscle ◽

Physical Demand ◽

Limb Dominance

The purpose of this study was to investigate the effects of how limb dominance and joint immobilization alter markers of physical demand and muscle activation during ambulation with axillary crutches. In a crossover, counterbalanced study design, physically active females completed ambulation trials with three conditions: (1) bipedal walking (BW), (2) axillary crutch ambulation with their dominant limb (DOM), and (3) axillary crutch ambulation with their nondominant limb (NDOM). During the axillary crutch ambulation conditions, the non-weight-bearing knee joint was immobilized at a 30-degree flexion angle with a postoperative knee stabilizer. For each trial/condition, participants ambulated at 0.6, 0.8, and 1.0 mph for five minutes at each speed. Heart rate (HR) and rate of perceived exertion (RPE) were monitored throughout. Surface electromyography (sEMG) was used to record muscle activation of the medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) unilaterally on the weight-bearing limb. Biceps brachii (BB) and triceps brachii (TB) sEMG were measured bilaterally. sEMG signals for each immobilization condition were normalized to corresponding values for BW.HR (p < 0.001) and RPE (p < 0.001) were significantly higher for both the DOM and NDOM conditions compared to BW but no differences existed between the DOM and NDOM conditions (p > 0.05). No differences in lower limb muscle activation were noted for any muscles between the DOM and NDOM conditions (p > 0.05). Regardless of condition, BB activation ipsilateral to the ambulating limb was significantly lower during 0.6 mph (p = 0.005) and 0.8 mph (p = 0.016) compared to the same speeds for BB on the contralateral side. Contralateral TB activation was significantly higher during 0.6 mph compared to 0.8 mph (p = 0.009) and 1.0 mph (p = 0.029) irrespective of condition. In conclusion, limb dominance appears to not alter lower limb muscle activation and walking intensity while using axillary crutches. However, upper limb muscle activation was asymmetrical during axillary crutch use and largely dependent on speed. These results suggest that functional asymmetry may exist in upper limbs but not lower limbs during assistive device supported ambulation.

Download Full-text

Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00815-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Antonio Rodríguez-Fernández ◽

Joan Lobo-Prat ◽

Josep M. Font-Llagunes

Keyword(s):

Systematic Review ◽

Clinical Efficacy ◽

Lower Limb ◽

Gait Training ◽

Health Conditions ◽

Current Evidence ◽

Clinical Aspects ◽

Gait Rehabilitation ◽

Comprehensive Overview ◽

Walking Aids

AbstractGait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

Download Full-text

Reducing the Risk of Aspiration Pneumonia among Elderly Patients in Long-Term Care Facilities through Oral Health Interventions

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2007.10.003 ◽

2008 ◽

Vol 9 (2) ◽

pp. 128-135 ◽

Cited By ~ 56

Author(s):

Jaya Sarin ◽

Ramesh Balasubramaniam ◽

Amy M. Corcoran ◽

Joel M. Laudenbach ◽

Eric T. Stoopler

Keyword(s):

Oral Health ◽

Elderly Patients ◽

Aspiration Pneumonia ◽

Long Term Care ◽

Health Interventions ◽

Term Care ◽

Care Facilities ◽

Risk Of Aspiration

Download Full-text

The Benefits of a Muscle-Sparing Below Knee Amputation in the Elderly Population

Vascular and Endovascular Surgery ◽

10.1177/15385744211045155 ◽

2021 ◽

pp. 153857442110451

Author(s):

Jared M. Theriot ◽

Prabhat Bhattarai ◽

David J. Finlay

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Blood Supply ◽

Weight Bearing ◽

Complete Healing ◽

Selective Removal ◽

Knee Amputation ◽

Age Related ◽

Estimated Blood Loss ◽

Muscle Sparing

Background It is well accepted that good muscle coverage of the bones at the end of a below knee amputation (BKA) stump is preferable, for both weight bearing and protection against prosthesis failure. Elderly patients often have atrophy of the leg musculature secondary to age-related physiological changes and decreased use. These patients often have poor coverage and bulk in their stumps after the standard BKA. We propose a selective muscle-sparing approach to these patients, utilizing selective removal of muscle bundles with regard to their blood supply and fascial planes. The surgical method technique along with outcomes of patients undergoing the procedure is presented here. Methods A retrospective chart review was performed to identify patients who had undergone a muscle-sparing BKA from March 2008 to October 2017 by a single surgeon. Estimated blood loss, operative time, and perioperative and postoperative complications were assessed. Results Forty-six patients greater than 60 years of age underwent muscle-sparing BKA procedures. Complete healing was seen in 30 (65%) patients, while 7 (15%) were lost to follow-up and 9 (20%) required conversion to an above knee amputation (AKA). Intraoperative outcomes in our series were notable for an average estimated blood loss (EBL) of 84.3 ml, lower than the traditional BKA (average EBL 150-500 ml), with comparable operative times averaging 131 minutes and as short as 85 minutes (skin incision to dressing). No patients in the cohort required postoperative blood transfusions (day 0–4), significantly less than the reported 3–7 ml/kg body weight blood requirements in similar patient populations. Conclusions The muscle-sparing BKA technique should be considered in elderly patients, where the normally bulky posterior calf muscle mass is lacking. The selective removal of muscle bundles with regard to their blood supply leaves maximum coverage of the bone with decreased potential hematoma formation and blood loss.

Download Full-text

Effect of unweighting on skeletal muscle use during exercise

Journal of Applied Physiology ◽

10.1152/jappl.1995.79.1.168 ◽

1995 ◽

Vol 79 (1) ◽

pp. 168-175 ◽

Cited By ~ 62

Author(s):

L. L. Ploutz-Snyder ◽

P. A. Tesch ◽

D. J. Crittenden ◽

G. A. Dudley

Keyword(s):

Lower Limb ◽

Weight Bearing ◽

Muscle Group ◽

Mr Images ◽

Cross Sectional ◽

Quadriceps Femoris Muscle ◽

Before And After ◽

Exercise Induced ◽

The Right ◽

Femoris Muscle

Exercise-induced spin-spin relaxation time (T2) shifts in magnetic resonance (MR) images were used to test the hypothesis that more muscle would be used to perform a given submaximal task after 5 wk of unweighting. Before and after unilateral lower limb suspension (ULLS), 7 subjects performed 5 sets of 10 unilateral concentric actions with the quadriceps femoris muscle group (QF) at each of 4 loads: 25, 40, 55, and 70% of maximum. T2-weighted MR images of the thigh were collected at rest and after each relative load. ULLS elicited a 20% decrease in strength of the left unweighted QF and a 14% decrease in average cross-sectional area (CSA) with no changes in the right weight-bearing QF. Average CSA of the left or right QF showing exercise-induced T2 shift increased as a function of exercise intensity both before and after ULLS. On average, 12 +/- 1, 15 +/- 2, 18 +/- 2, and 22 +/- 1 cm2 of either QF showed elevated T2 for the 25, 40, 55, and 70% loads, respectively, before ULLS. Average CSA of the left but not the right QF, showing elevated T2 after ULLS, was increased to 16 +/- 2, 23 +/- 3, 31 +/- 7, and 39 +/- 5 cm2, respectively. The results indicated that unweighting increased exercise-induced T2 shift in MR images, presumably due to greater muscle mass involvement in exercise after than before unweighting, suggesting a change in motor control.

Download Full-text

Melatonin for prevention of postoperative delirium after lower limb fracture surgery in elderly patients (DELIRLESS): study protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2021-053908 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053908

Author(s):

Stéphanie Sigaut ◽

Camille Couffignal ◽

Marina Esposito-Farèse ◽

Vincent Degos ◽

Serge Molliex ◽

...

Keyword(s):

Elderly Patients ◽

Lower Limb ◽

Postoperative Delirium ◽

Controlled Trial ◽

Functional Decline ◽

Assessment Method ◽

Phase Iii ◽

Double Blind ◽

Prolonged Length ◽

Surgery In Elderly

IntroductionPostoperative delirium (POD) is one of the most frequent complication after surgery in elderly patients, and is associated with increased morbidity and mortality, prolonged length of stay, cognitive and functional decline leading to loss of autonomy, and important additional healthcare costs. Perioperative inflammatory stress is a key element in POD genesis. Melatonin exhibits antioxidative and immune-modulatory proprieties that are promising concerning delirium prevention, but in perioperative context literature are scarce and conflicting. We hypothesise that perioperative melatonin can reduce the incidence of POD.Methods and analysisThe DELIRLESS trial is a prospective, national multicentric, phase III, superiority, comparative randomised (1:1) double-blind clinical trial. Among patients aged 70 or older, hospitalised and scheduled for surgery of a severe fracture of a lower limb, 718 will be randomly allocated to receive either melatonin 4 mg per os or placebo, every night from anaesthesiologist preoperative consultation and up to 5 days after surgery. The primary outcome is POD incidence measured by either the French validated translation of the Confusion Assessment Method (CAM) score for patients hospitalised in surgery, or CAM-ICU score for patients hospitalised in ICU (Intensive Care Unit). Daily delirium assessment will take place during 10 days after surgery, or until the end of hospital stay if it is shorter. POD cumulative incidence function will be compared at day 10 between the two randomised arms in a competing risks framework, using the Fine and Grey model with death as a competing risk of delirium.Ethics and disseminationThe DELIRLESS trial has been approved by an independent ethics committee the Comité de Protection des Personnes (CPP) Sud-Est (ref CPP2020-18-99 2019-003210-14) for all study centres. Participant recruitment begins in December 2020. Results will be published in international peer-reviewed medical journals.Trial registration numberNCT04335968, first posted 7 April 2020.Protocol version identifierN°3–0, 3 May 2021.

Download Full-text

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

10.21203/rs.3.rs-40114/v2 ◽

2020 ◽

Author(s):

Antonio Rodríguez-Fernández ◽

Joan Lobo-Prat ◽

Josep M. Font-Llagunes

Keyword(s):

Systematic Review ◽

Clinical Efficacy ◽

Lower Limb ◽

Gait Training ◽

Health Conditions ◽

Current Evidence ◽

Clinical Aspects ◽

Gait Rehabilitation ◽

Comprehensive Overview ◽

Walking Aids

Abstract Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

Download Full-text