This study aims to describe the presence and severity of extracranial concomitant injuries in traumatic brain injury (TBI) patients and to ascertain their effect on long-term functional outcome.
Matched MeSH terms: Leg Injuries/epidemiology; Leg Injuries/rehabilitation
This study compared muscle oxygenation (StO2) during arm cranking (ACE), functional electrical stimulation-evoked leg cycling (FES-LCE), and hybrid (ACE+FES-LCE) exercise in spinal cord injury individuals. Eight subjects with C7-T12 lesions performed exercises at 3 submaximal intensities. StO2 was measured during rest and exercise at 40%, 60%, and 80% of subjects' oxygen uptake (VO2) peak using near-infrared spectroscopy. StO2 of ACE showed a decrease whereas in ACE+FES-LCE, the arm muscles demonstrated increasing StO2 from rest in all of VO2) peak respectively. StO2 of FES-LCE displayed a decrease at 40% VO2 peak and steady increase for 60% and 80%, whereas ACE+FES-LCE revealed a steady increase from rest at all VO2 peak. ACE+FES-LCE elicited greater StO2 in both limbs which suggested that during this exercise, upper- and lower-limb muscles have higher blood flow and improved oxygenation compared to ACE or FES-LCE performed alone.
The suspension system and socket fitting of artificial limbs have major roles and vital effects on the comfort, mobility, and satisfaction of amputees. This paper introduces a new pneumatic suspension system that overcomes the drawbacks of current suspension systems in donning and doffing, change in volume during daily activities, and pressure distribution in the socket-stump interface. An air pneumatic suspension system (APSS) for total-contact sockets was designed and developed. Pistoning and pressure distribution in the socket-stump interface were tested for the new APSS. More than 95% of the area between each prosthetic socket and liner was measured using a Tekscan F-Scan pressure measurement which has developed matrix-based pressure sensing systems. The variance in pressure around the stump was 8.76 kPa. APSS exhibits less pressure concentration around the stump, improved pressure distribution, easy donning and doffing, adjustability to remain fitted to the socket during daily activities, and more adaptability to the changes in stump volume. The volume changes were adjusted by utility of air pressure sensor. The vertical displacement point and reliability of suspension were assessed using a photographic method. The optimum pressure in every level of loading weight was 55 kPa, and the maximum displacement was 6 mm when 90 N of weight was loaded.
The purpose of this study was to find the scientific evidence pertaining to various transfemoral suspension systems to provide selection criteria for clinicians. To this end, databases of PubMed, Web of Science, and ScienceDirect were explored. The following key words, as well as their combinations and synonyms, were used for the search: transfemoral prosthesis, prosthetic suspension, lower limb prosthesis, above-knee prosthesis, prosthetic liner, transfemoral, and prosthetic socket. The study design, research instrument, sampling method, outcome measures, and protocols of articles were reviewed. On the basis of the selection criteria, 16 articles (11 prospective studies and 5 surveys) were reviewed. The main causes of reluctance to prosthesis, aside from energy expenditure, were socket-related problems such as discomfort, perspiration, and skin problems. Osseointegration was a suspension option, yet it is rarely applied because of several drawbacks, such as extended rehabilitation process, risk for fracture, and infection along with excessive cost. In conclusion, no clinical evidence was found as a "standard" system of suspension and socket design for all transfemoral amputees. However, among various suspension systems for transfemoral amputees, the soft insert or double socket was favored by most users in terms of function and comfort.
Introduction: Aerobic power reflects the physical fitness of the individual. Evidences support differences in phys-iological responses to exercise. There is less data on VO2 max among common ethnic population of Sabah. Ob-jective of this study was to investigate VO2 max among Kadazan, Dusun, Brunei Melayu, Bugis, Murut and others of Sabah in male and female young adult population. Methods: A total of 385 participants were randomly selected. Monark 894 E leg bicycle ergo meter was used to measure aerobic power VO2 max. Based on the heart rate male and female respectively 450 & 300 kilogram-force meter/minute was chosen. Based on Astrand rhyming nomogram (age correction factor included-VO2 Max multiplied by 1.05) calculations Vo2Max was calculated in l/min. The age correction done VO2 Max (l/min) was multiplied by 1000 and later divided by the body weight to derive the actual VO2Max in ml/kg/min. The recovery heart rate after 1 minute was taken and the difference were calculated for the further analysis. Data was tabulated and analysed by one way ANOVA test - Hocherberg’s GT2. Results: There was no significant difference in VO2 max between the common ethnic young adult population both in males and fe-males. Conclusion: There is no significant difference in VO2 max among the common ethnic adult but have a similar aerobic capacity in the study group.
Tibial hemimelia is a relatively rare congenital tibial longitudinal deficiency (approximately 1 per 1 million live births), unilateral or bilateral, with a relatively intact fibula. Hemimelia results from a disruption of the lower limb developmental field during embryogenesis due to slow or even abort of chondrification process, which results in leg length discrepancy. Affected leg commonly appears short and deformed with knee, ankle, and foot involvement. It may present with a variety of associated anomalies. Surgical treatment varies according to the type and degree of deformity, and reconstructive interventions are still limited. Reported cases of tibial hemimelia are very infrequent, especially tibial hemimelia in twins. Usually, the cases were in single embryo or less frequently in one of the monozygotic twins, but no reported cases regarding tibial hemimelia in one of the dizygotic twins as this article reports.
Tuberculosis (TB) is an ancient disease dated back from ancient Greece time. Once rare in developed countries, now it has re-emerged due to immigration and secondary immunodeficiency. A 27-year-old lady had left knee pain for the past 4 years, went for knee diagnostic arthroscopy procedure, and diagnosed as pigmented villonodular synovitis (PVNS) of the left knee. Despite regular analgesics and physiotherapy, patient symptoms worsen. Two years after the initial treatment, the patient went for a further workout and diagnosed as knee tuberculosis, commenced on anti-TB treatment, the patient still left complicated with a stiff knee and fixed flexion deformity. Identification of knee tuberculosis during the initial phase is crucial as late diagnosis and treatment will leave the patient with debilitating complications.
Antiphospholipid syndrome is a hypercoagulable autoimmune condition that predominantly affect the female and commonly manifest as arterio-venous thrombosis and recurrent miscarriage. Here, we present a unique case of a healthy young man who developed sudden onset of right leg swelling after exercise which was then found to be due to deep vein thrombosis via Doppler ultrasound. His blood investigations showed thrombocytopenia and prolonged coagulation profile. Therefore, antiphospholipid syndrome was suspected and later confirmed by positive autoim- mune antibodies. He was treated with long term moderate intensity oral warfarin. The objective of this case report is to share the uncommon occurrence of an unprovoked deep vein thrombosis secondary to antiphospholipid syn- drome in a healthy young man so that the possibility of deep vein thrombosis should be suspected in selected cases of non-resolving leg swelling after exercise as it can lead to fatal pulmonary embolism.
Work-related Musculoskeletal Disorders (WMSDs) are common occupational injuries among workers in the construction industry. Epidemiological studies indicated that WMSDs include neck pain, lower back pain, knee pain, leg fatigue as well as ankle and feet discomfort. The objectives of this study are to identify the WMSDs experienced by the workers during construction works and discuss the causes of those WMSDs. Subjective approach associated with modified Nordic Musculoskeletal Questionnaire (NMQ) was applied to identify the symptoms of WMSDs. A case study was conducted in several construction sites situated at the southern region of Peninsular Malaysia. During the study, 37 construction workers with different age and scope of works were interviewed to determine the WMSDs that they have experienced. Based on distributed questionnaire, almost all workers experienced pain in the region of lower back, upper back and biceps. These pains were contributed by manipulation of heavy load and high force exertion. Based on discussed causations, control measures via engineering controls method and administrative controls method were proposed to alleviate the risk of WMSDs among construction workers.
Journal of Sports Science and Physical Education 5(2): 9-14, 2016 - Jump squat tests can be
used to investigate the differences in the force - velocity (f-v) profile in movement that is
more a sport-specific than isolated exercises such as open chain leg extension. However,
squat jumps involve multi-joint movement, making it questionable which muscle is the main
contributor for the movement. The main aim of this study is to develop a test of isolated knee
extension that encompasses the entire range of human f-v relationship and to investigate the
correlation between linear encoder and kinematic measurement of angular velocity using a
camera system during unloaded kicking. One healthy male subject volunteered to participate
in the study and performed 10 unloaded kicks (knee extension). A cuff was strapped around
the lower leg, approximately 2 cm above the medial malleoli and connected to a linear
velocity encoder (MuscleLab Ergotest version 4010, Norway). During the test sessions, threedimensional
motion analysis was performed with an Oqus Motion Capture System (Qualisys,
Sweden). Data were transferred to Windows-based data acquisition software (Qualisys Track
Manager). There was a positive linear relationship (r = 0.94). The unloaded kicking test to
determine maximum angular velocity at knee extension measured using the QTM showed
that the mean angular velocity was 362˚.s-1, with the highest value being 528˚.s-1. This
preliminary study suggests isokinetic dynamometry (IKD) can be used to investigate the
entire range of velocities (i.e isometric – velocity maximum) of knee extension in normal
human subjects. Further studies can examine the use of IKD in measuring higher velocities.
Necrotising fasciitis caused by Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a new entity. Although it is recognised worldwide, there have been no reported cases to date in Malaysia. We report a case of necrotising fasciitis of the left lower limb in an otherwise healthy 20-year-old man. He presented with septic shock and despite the paucity of clinical signs in the limb, the infection was aggressive. Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from the deep fascia of the leg. Panton-Valentine leucocidin gene (PVL), which is a stable genetic marker for CA-MRSA strain, was positive in this case. This case of community acquired MRSA necrotising fasciitis is of concern and may herald the emergence of this resistant organism in Malaysia. Vigilant surveillance and microbiological monitoring is needed to follow this CA-MRSA trend.
Brush cutting is a commonly performed activity occupationally as well as recreationally in Malaysia. There are various occupational injuries reported related to brush cutting, for example foreign body penetration. There were 11 reported cases of foreign body penetrated in leg of brush cutting workers admitted to orthopaedic ward in Hospital Raja Permaisuri Bainun from the period of January till October 2009. Among the cases, 4 were surgically removed under local anaesthesia and 7 cases performed under general anesthesia. 2 cases reported foreign body penetrated into tibia bone. There were many contributing factors to the injury, which include lack of protective measures for workers, engineering property of brush cutting machine and education on handling of equipment. It is vital to study the factors separately in order to determine and recommend useful preventive measures. However, the actual numbers of cases are under reported and awareness of the problem is undermined.
This paper presents a fiber Bragg grating (FBG)-instrumented prosthetic silicone liner that provides cushioning for the residual limb and can successfully measure interface pressures inside prosthetic sockets of lower-limb amputees in a simple and practical means of sensing. The liner is made of two silicone layers between which 12 FBG sensors were embedded at locations of clinical interest. The sensors were then calibrated using a custom calibration platform that mimics a real-life situation. Afterward, a custom gait simulating machine was built to test the liner performance during an amputee's simulated gait. To validate the findings, the results were compared to those obtained by the commonly used F-socket mats. As the statistical findings reveal, both pressure mapping methods measured the interface pressure in a consistent way, with no significant difference (P-values ≥0.05). This pressure mapping technique in the form of a prosthetic liner will allow prosthetics professionals to quickly and accurately create an overall picture of the interface pressure distribution inside sockets in research and clinical settings, thereby improving the socket fit and amputee's satisfaction.
Leg exercises through standing, cycling and walking with/without FES may be used to preserve lower limb muscle and bone health in persons with physical disability due to SCI. This study sought to examine the effectiveness of leg exercises on bone mineral density and muscle cross-sectional area based on their clinical efficacy in persons with SCI. Several literature databases were searched for potential eligible studies from the earliest return date to January 2022. The primary outcome targeted was the change in muscle mass/volume and bone mineral density as measured by CT, MRI and similar devices. Relevant studies indicated that persons with SCI that undertook FES- and frame-supported leg exercise exhibited better improvement in muscle and bone health preservation in comparison to those who were confined to frame-assisted leg exercise only. However, this observation is only valid for exercise initiated early (i.e., within 3 months after injury) and for ≥30 min/day for ≥ thrice a week and for up to 24 months or as long as desired and/or tolerable. Consequently, apart from the positive psychological effects on the users, leg exercise may reduce fracture rate and its effectiveness may be improved if augmented with FES.
Muscular strength is an important factor which is crucial for performance and injury prevention in most sports. The purpose of this study was to evaluate the effects of the FIFA's Medical Assessment and Research Centre 11+ and HarmoKnee injury prevention programs on knee strength of young professional male soccer players. Thirty-six soccer players (age: 18.9 ± 1.4 years) were divided equally into three groups; the 11+, HarmoKnee and control groups. The programs were performed for 24 sessions. Hamstring and quadriceps strength was measured using the Biodex System 3 at 30°, 60° and 90° of knee flexion. The 11+ increased quadriceps strength in the dominant leg by 19.7% and 47.8% at 60°and 90° knee flexion, respectively, and in the non-dominant leg by 16%, 35.3% and 78.1 % at 30°, 60° and 90° knee flexion, respectively. The HarmoKnee group, however, showed increased quadriceps strength only at 90° i.e., by 85.7% in the dominant leg and 73.8% in the non-dominant leg. As for hamstring strength, only the 11+ group demonstrated an increment by 24.8% and 19.8% at 30° and 60° knee flexion in the dominant leg, and in the non-dominant leg, by 28.7% and 13.7% at 30° and 60° knee flexion, respectively. In conclusion, both warm-up programs improve quadriceps strength. The 11+ demonstrated improvement in hamstring strength while the HarmoKnee program did not indicate any improvement. We suggest adding eccentric hamstring components such as Nordic hamstring exercise to the HarmoKnee program in order to enhance hamstring strength.
This study investigated bilateral and unilateral asymmetries of strength and flexibility in male young professional soccer players. Thirty-six soccer players (age: 18.9 ± 1.4 years) participated in this study. A Biodex Isokinetic Dynamometer was used to assess the hamstring and quadriceps strength at selected speeds of 60°/s, 180°/s and 300°/s. Hip joint flexibility was measured using a goniometer. No difference was observed in conventional strength ratio, dynamic control ratio and fast/slow speed ratio between the dominant and non-dominant legs (p>0.05). All but one of the players (97.2%) had musculoskeletal abnormality (bilateral imbalance > 10%) in one or more specific muscle groups. The dominant leg had greater hip joint flexibility compared with the non-dominant leg (108.8 ± 10.7° versus 104.6 ± 9.8°, respectively). The findings support the hypothesis that physical performance and movement pattern experienced during soccer playing may negatively change the balance of strength in both legs (bilateral strength balance), but not on the same leg of the young male professional soccer players. The results can be helpful for trainers and coaches to decide whether the players need to improve their balance and strength which in turn may prevent injury. It is suggested that in professional soccer training, quadriceps and hamstrings muscle strength, as well as hip joint flexibility should not be overlooked.
Prosthetic suspension system is an important component of lower limb prostheses. Suspension efficiency can be best evaluated during one of the vital activities of daily living, i.e. walking. A new magnetic prosthetic suspension system has been developed, but its effects on gait biomechanics have not been studied. This study aimed to explore the effect of suspension type on kinetic and kinematic gait parameters during level walking with the new suspension system as well as two other commonly used systems (the Seal-In and pin/lock). Thirteen persons with transtibial amputation participated in this study. A Vicon motion system (six cameras, two force platforms) was utilized to obtain gait kinetic and kinematic variables, as well as pistoning within the prosthetic socket. The gait deviation index was also calculated based on the kinematic data. The findings indicated significant difference in the pistoning values among the three suspension systems. The Seal-In system resulted in the least pistoning compared with the other two systems. Several kinetic and kinematic variables were also affected by the suspension type. The ground reaction force data showed that lower load was applied to the limb joints with the magnetic suspension system compared with the pin/lock suspension. The gait deviation index showed significant deviation from the normal with all the systems, but the systems did not differ significantly. Main significant effects of the suspension type were seen in the GRF (vertical and fore-aft), knee and ankle angles. The new magnetic suspension system showed comparable effects in the remaining kinetic and kinematic gait parameters to the other studied systems. This study may have implications on the selection of suspension systems for transtibial prostheses. Trial registration: Iranian Registry of Clinical Trials IRCT2013061813706N1.
We present a case of gross lower limb edema in a 21-year-old man with an intra-abdominal malignant fibrous histiocytoma. He had a 1-month history of lower limb edema secondary to inferior vena caval obstruction. His edema failed to respond to a combination of diuretics, oral frusemide 40 mg daily and oral spironolactone 100 mg daily. Subcutaneous drainage of both lower limbs with butterfly needles was performed with minimal improvement. However, he gained significant symptomatic relief with multiple subcutaneous punctures and stoma bag drainage. A total of 12.8 L of serous fluid was drained with this simple and effective method. This is the first report of the use of this method.
Infection following total knee arthroplasty can be devastating. Even with established treatment protocols, eradication of the infection may not be feasible. We report 2 patients who required above-knee amputation to eradicate recalcitrant infection.