Haganlambert8585

Introduction Falls are associated with numerous risk factors, such as motor and cognitive impairments. However, the neural correlates of falls are poorly understood. Objectives Here, we aimed to assess patterns of structural, and resting-state functional connectivity (FC) alterations related to falls in a group of older adults with a history of falls compared to non-fallers. Methods Fourteen elderly fallers (mean age = 78.1 ± 1.5 yrs, >2 falls previous six months), and 20 healthy controls (mean age = 69.6 ± 1.3 yrs) were examined. All participants underwent a 3T MRI scan obtaining 3D T1-weighted images, and eyes-open resting-state (rs)-fMRI. Voxel-based morphometry was conducted to detect grey matter differences between the groups. Independent component analysis was conducted based on rs-fMRI and number of attention-and-motor related functional networks was identified and compared between groups using an independent-sample T-test. Results No differences were observed in grey matter between the groups after correcting for age and gender (p > 0.01, FWEc). Compared with non-fallers, the fallers had lower FC in cerebellar, frontal and parietal cortical nodes within the sensorimotor network (SMN), lateral motor network (M1), Cerebellar network (CBL), frontal-striatal network (FSN), executive control network (ECN), and dorsal attention network (DAN). Moreover, fallers had increased FC in the basal ganglia network (BGN), Left paracentral in M1 and SMN, and right hippocampus in DAN (p less then 0.01, FWEc). Conclusions Among fallers, reduced connectivity was observed in areas that relate to integration of information, while increased connectivity was found in areas associated with motor and sensory information processing. Together, these results provide evidence to the complex multidimensionality of the neural underpinnings of falls. Furthermore, these findings may help emphasize the importance of interventions that target both motor and cognitive aspects.Background Percutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device. Research question Does residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities? Methods This observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. To simulate diaphyseal bone loading in individuals with lower limb amputations, virtual joints were defined during post-processing at 25, 50, and 75 % of residual limb length of both the femur and the tibia, representing six clinically relevanion of percutaneous OI patients.Background The purpose of this prospective study was to understand the relation between gait outcomes and patient satisfaction one year after total knee arthroplasty (TKA). Methods Seventy-nine patients were evaluated before and one year after TKA using clinical gait analysis. Specific gait outcomes were analyzed gait speed, stance phase, range of motion (ROM) knee flexion and maximal knee flexion. The parameters of interest selected for the statistical analysis were gait speed and maximal knee flexion during gait. The Western Ontario and MacMaster Osteoarthritis Index (WOMAC) and patient satisfaction were also assessed. The satisfaction was evaluated using a questionnaire and was splited in five categories very unsatisfied, unsatisfied, neutral, satisfied or very satisfied. To assess associations between patient satisfaction and maximal knee flexion during gait and gait speed, an unadjusted ordinal logistic regression analysis was used. The analysis was then adjusted for covariates age and Body Mass Index (BMI) before surgery and WOMAC pain one year after surgery. Results All gait outcomes after TKA had significantly improved. The ordinal logistic regression analysis found significant associations between patient satisfaction and maximal knee flexion after TKA (unadjusted and adjusted) but not for gait speed. Conclusion These findings show that all patients improved their gait outcomes one year after TKA but only a higher maximal knee flexion during gait may influence the level of patient satisfaction.Background Pain and proprioception deficits are often associated with knee pathologies and resultant quadriceps muscle inhibition. There is a need for new approaches to mitigate active knee pain and restore muscle function during walking. Activating properties of the somatosensory system with common pain and sensory pathways offers a novel opportunity to enhance quadriceps function during walking. Research question Conduct a controlled clinical trial that investigates the effects of applying intermittent vibrational cutaneous stimulation during walking on knee pain and symptoms and their correlations to gait parameters. Methods This longitudinal controlled cross-over clinical study included thirty-two patients randomly and blindly assigned to active Treatment A and passive Treatment B for 4 weeks with a 2-week washout period between treatments. Results Subjects when wearing active Treatment A for 4 weeks had significant (p = 0.04) improvement in patient reported outcomes, while they had no significant differences with passive Treatment B (p > 0.7) compared to the no treatment condition. For Treatment A, subjects with low knee flexion moment and knee flexion angle in no-treatment condition exhibited the greatest increase in knee flexion moment/angle in the active treatment condition (R > 0.57, p less then 0.001). These changes in gait measures were correlated significantly to changes in pain. Significance This clinical trial indicates that knee pain can be reduced, and gait improved in a manner that enhances quadriceps function by applying intermittent cutaneous stimulation during gait in patients following knee injury or disease. The correlation between decreased pain and improved gait suggests that rehabilitation and exercise therapy may benefit from this treatment.Background A hinged ankle-foot orthosis is prescribed for children with spastic unilateral cerebral palsy to improve gait function by correcting spastic equinus. However, little is known about how orthotic management relates to muscle activity during walking in this population. Research question Does muscle activity in medial gastrocnemius and tibialis anterior change in children with spastic unilateral cerebral palsy when walking with hinged ankle-foot orthoses featuring two different footplate designs? Methods In this prospective, repeated-measures trial, electromyographic activity in medial gastrocnemius and tibialis anterior was recorded from 17 children (mean age 8.4 years ± 1.3 years) with spastic unilateral cerebral palsy walking barefoot and with two designs of hinged ankle-foot orthosis. The orthotic devices consisted of custom-made hinged ankle-foot orthoses with unmodified, flatter footplates and rectified, contoured footplates. Primary outcome measures were total muscle activity, quantified as therthosis with an unmodified footplate corresponded with better performance by facilitating more functional muscle activity while impeding spastic response.Background Children with static encephalopathy often walk with excessive knee and hip flexion throughout the gait cycle. This crouch gait pattern can be debilitating. These children may undergo hamstring-lengthening procedures to correct this crouch gait. Some improve, while others remain in crouch gait or go into knee hyperextension postoperatively, which can ultimately be debilitating. Research question Hamstring muscle-tendon length models are frequently used as indicators when making recommendations for or against hamstring lengthening procedures. According to the literature, most clinicians use the length of the hamstring complex at the initial contact phase of the gait cycle as the primary deciding factor. We hypothesize that the length of this muscle-tendon complex at the midstance phase of the gait cycle is a more stringent criteria for lengthening procedures. Methods A simplified hamstring length model was applied retrospectively to the pre and postoperative three dimensional gait analysis kinematicsct only, but who may benefit from surgery.Background Although the CHADS2 and CHA2DS2-VASc scoring systems are commonly used as measures of thromboembolic risk in patients with nonvalvular atrial fibrillation (NVAF), data are inconsistent as to their value in predicting the presence of left atrial (LA) and/or left atrial appendage (LAA) thrombogenic milieu (TM). The present study aimed to establish a novel risk score to assess the risk of LA and/or LAATM in NVAF patients. Methods This is a retrospective case-control study that included 125 consecutive patients with NVAF plus TM, as evidenced by transesophageal echocardiography (TEE) during a period from1 January 2010 to 1 February 2017. The controls were 1098 NVAF patients without TM during the same period. this website Risk factors for LA and/or LAATM were identified using univariable analysis and multivariable logistic regression. The risk score model was developed based on 10-fold validation and multiple regression. Risk model performance was evaluated using receiver operating characteristic (ROC) curves. Net rcut-off point at 4; when the cut-off point was set at 8, the positive predictive value (PPV) was 85.7%. Compared with CHADS2 and CHA2DS2-VASc score, the present novel risk score has better predictive power [net reclassification improvement (NRI) +96.3% and +66.2%, respectively; all P less then 0.001]. Conclusion This study developed a novel risk score to help predicting LA and/or LAATM in NVAF patients, which had higher accuracy than CHADS2 and CHA2DS2-VASc score system.Background Infection by the 2019 novel coronavirus (COVID-19) has been reportedly associated with a high risk of thrombotic complications. So far information is scarce and rapidly emerging. Methods We conducted a scoping review using a single engine search for studies assessing thrombosis and coagulopathy in COVID-19 patients. Additional studies were identified by secondary review and alert services. Results Studies reported the occurrence of venous thromboembolism and stroke in approximately 20% and 3% of patients, respectively. A higher frequency seems to be present in severely ill patients, in particular those admitted to intensive care units. The thrombotic risk is elevated despite the use of anticoagulant prophylaxis but optimal doses of anticoagulation are not yet defined. Although an increase of biomarkers such as D-dimer has been consistently reported in severely ill COVID-19, the optimal cut-off level and prognostic value are not known. Discussion A number of pressing issues were identified by this review, including defining the true incidence of VTE in COVID patients, developing algorithms to identify those susceptible to develop thrombotic complications and severe disease, determining the role of biomarkers and/or scoring systems to stratify patients' risk, designing adequate and feasible diagnostic protocols for PE, establishing the optimal thromboprophylaxis strategy, and developing uniform diagnostic and reporting criteria.