Efficacy of extension wrist hand orthosis on pain, grip strength and electromyographic activities in lateral epicondylitis: A randomized single-blind clinical trial

BACKGROUND

Lateral epicondylitis (LE) is one of the most common work-related complications characterized by pain, decreased grip strength and dysfunction of upper limb. Although conservative management such as physiotherapy and orthosis is reported as first line of treatment, sufficient evidence to decide their effectiveness is lacking and remains controversial.

PURPOSE

The current study evaluated and compared the efficacy of a custom-made extension wrist hand orthosis adjunct to usual physiotherapy and therapeutics alone for subjects with LE.

STUDY DESIGN

Prospective randomized single-blinded clinical trial.

METHODS

62 subjects with LE were selected as samples using convenience method in this experimental study. They were randomly divided into two groups: usual physiotherapy only and its combination with orthosis. Pain and grip strength were measured using Visual Analog Scale and Jamar hydraulic digital hand dynamometer. Muscle activity of extensor carpi radialis brevis during hand gripping was measured using surface electro-myographic by PowerLab electromyography (AD Instruments, Castle Hill, Australia). Data analysis and comparison were performed for baseline and post-intervention (12weeks).

RESULTS

After 12weeks of treatment, there were significant differences in mean scores of pain (1.22 ± 0.51, p = 0.001), maximum voluntary grip strength (5.82 ± 7.84, p = 0.04), and extensor carpi radialis brevis muscle activation (0.082 ± 0.094, p = 0.02) between the therapeutics alone group and the therapeutics plus orthosis group. Compared to therapeutics alone, those getting a combination of physiotherapy and orthosis had greater treatment efficacy (p < 0.05).

CONCLUSIONS

Both postintervention (12-week) treatments could affect pain scores, grip strength, and extensor muscle activation. Custom-made extension wrist hand orthosis adjunct to usual physiotherapy is more effective than therapeutics alone in subjects with LE. Therefore, the use of wrist orthosis adjunct to physiotherapy should be recommended in rehabilitation settings for LE.

Design and analysis of polycentric prosthetic knee with enhanced kinematics and stability

This paper describes a continuation of earlier work using the finite element method to conduct an engineering failure analysis of an existing polycentric prosthetic knee. The primary purpose of this work is to enhance the quality of the existing knee which has been reported with multiple cases of failure during its clinical practice in India. A modified design of the polycentric knee has been proposed based on the findings of failure analysis. Simulation-based comparative analysis of polycentric knees has been performed as per the ISO 10328:2016 standard in terms of stress distribution, total contour deformation, safety factor, and fatigue life. The upper extension lever is subjected to static and cyclic loads of 4130 and 1230 N, whereas the lower plate has a translational constraint. The modified polycentric knee prosthesis outperforms static and fatigue strength tests. The standard of the existing knee prosthesis has significantly improved as a result of design variations and integration of high-strength and lightweight aluminium 7075-T6 alloy. The modified polycentric knee prosthesis has a predicted maximum deformation of less than 0.7 mm and a minimum safety factor between 1.7 and 2 compared to 2.66 mm and 1.0 for the existing knee prosthesis. Based on the fatigue simulation results, it is predicted that the modified polycentric knee will have a lifespan of at least ten years indicating a safe design. It has improved alignment stability and kinematics, with a significant weight reduction of 33 g, and a high cost-benefit ratio to reach the maximum amputee population in low-income countries like India.

Conformity assessment with structural strength requirements of mechanical polycentric prosthetic knee used for amputee rehabilitation

Prosthetic restoration is an important component of amputee rehabilitation which may be subjected to a static load of nearly five times of amputees' body weight and is continuously administered to cyclic or fatigue loads during its function. This study presents a structural strength analysis of polycentric mechanical prosthetic knee commonly used in National Institutes in India by finite element simulation and its experimental validation. Static and fatigue analyses have been performed to ensure its structural integrity as per the ISO 10328:2006 standard. Accurate dimensioning of knee components have been obtained using coordinate measuring machine and the 3 D CAD model has been generated by CATIA V5 from the 2 D geometry. The model is imported to the ANSYS 20.1 workbench to study stress distribution in the knee for ensuring its safety performance. The selection of reference planes, application of calculated loads, and position of load line have been done as per the ISO test procedure. Static and cyclic loadings of 4130 N and 1230 N are applied at the top and the bottom plate is given with translational constraints to limit its movement in any direction. Results indicate that the prosthetic knee model is moderately strong enough to outstrip the static strength test. However, the calculated strain and predicted fatigue life during the cyclic test suggest that this knee unit has poor fatigue strength. Validation results with an average error percentage of 3.44 and 10 show higher reliability based on previous study results and experimental tests, respectively.

Efficacy of prosthetic rehabilitation in rotationplasty following Ewing's sarcoma: A case study

PURPOSE

Restoration of functional mobility including gait and balance are fundamental to prosthetic rehabilitation in children with rotationplasty. The literature to characterize and investigate the correlation between postural balance and gait following rotationplasty are scarce. This study examines the characteristics of balance and prosthetic gait in a subject with rotationplasty and checks whether any association exists between them.

METHODS

A 14-year-old boy with rotationplasty following Ewing's sarcoma was fitted with a custom made prosthesis. Center of pressure (COP) measures using the HUMAC® Balance & Tilt System (CSMi, Stoughton, MA), temporal-spatial gait parameters, and energy expenditure measured by a 10 meter walk test were recorded using the new and old prosthesis. A control subject was used for comparison.

RESULTS

The stability score, path length, and average velocity of COP improved in a new prosthesis for both standing conditions. Gait parameters were improved and energy expenditure was marginally reduced with the new prosthesis. However, overall prosthetic gait was significantly different compared to the control subject.

CONCLUSION

This subject-centric approach successfully improved balance, gait parameters, and energy expenditure by providing better alignment, fit, and comfort with a custom prosthesis.

Effect of Walking Speed on Gait Parameters and Energy Expenditure in Individuals with Unilateral Trans-tibial Amputatio

Background and Objectives: Analysis of gait parameters and energy expenditure in different walking speeds in trans-tibial amputees has been less investigated. This may provide an insight into how they respond to it. The main aim of this study was to investigate the effect of walking speed changes on gait parameters and metabolic energy consumption in unilateral trans-tibial amputees using the prosthesis. Methods: Thirty trans-tibial amputees fulfilling inclusion criteria were investigated for gait parameters using a ten-meter walk test while these subjects walked with three different walking speeds (comfortable, fast, and slow). Temporal-spatial gait parameters, such as step length, stride length, velocity and cadence, and Physiological Cost Index (PCI) for metabolic energy consumption were analyzed by repeated-measures ANOVA. Results: Step length of a prosthetic side in the fast walking speed (0.67±0.10 m) was higher than the normal comfortable speed (0.56±0.13 m) and least in slow walking (0.42±0.06 m). A similar trend was observed for all gait parameters. PCI (beats/m) was least in normal comfortable speed (0.08±0.09), followed by fast walking speed (0.11±0.08). It was highest when patients walked at a slow speed (0.18±0.12). There was a significant difference in all temporal-spatial gait parameters and PCI in three walking speed conditions (p<0.05). Conclusion: Walking speed significantly affected all temporal-spatial and energy parameters in unilateral trans-tibial amputees.

Successful prosthetic rehabilitation and gait analysis of individual with bilateral transtibial amputation: A case study with comparison to able-bodied gait

Background:

Intensive rehabilitation of individuals with bilateral lower limb loss poses a great challenge to both rehabilitation team and amputees themselves due to unavailability of a sound leg to provide stability in standing and gait. Although gait characteristics of individuals with unilateral transtibial amputations are well documented in the literature, very less is known about those with bilateral limb loss.

Aim:

To examine the gait characteristics of an individual with bilateral transtibial amputation (BTA) and its comparison with an able-bodied (AB). This study also provides a real-life presentation of successful prosthetic rehabilitation.

Case content and methodology:

Temporal–spatial, kinematic and kinetic gait parameters were analysed for a 45-year-old male individual with traumatic BTA using prosthesis in a motion analysis laboratory setting with force platform (BTS P-6000) and cameras with reflective markers (BTS SMART-DX6000).

Findings and conclusion:

Variances in many temporal–spatial, kinematic and kinetic parameters were observed. The findings of temporal–spatial parameters revealed that the individual with BTA walked with slower speed, lower cadence, shorter step lengths and wider step width compared to that of AB. Ankle dorsiflexion, stance knee flexion and swing hip hiking were reduced in an individual with BTA compared to AB. In kinetics, he demonstrated low peak ankle muscle power, increased muscle power amplitudes and phase duration at the hip and knee joints compared to AB individual. The combination of an intensive prosthetic rehabilitation led to completely independent and remarkable degree of functional ambulation.

Comparison of energy cost in transtibial amputees using "prosthesis" and "crutches without prosthesis" for walking activities

BACKGROUND

In a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities.

OBJECTIVES

The purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking.

METHODS

Thirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b(2) oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO(2) rate (mL/min), VO(2) cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min).

RESULTS

It was observed that VO(2) uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (P<0.025). There was significant difference between prosthesis walking and crutches without prosthesis walking in terms of VO(2) uptake rate (P<0.005) and EE/min (P<0.00001). It was noticed the adults with transtibial amputation using prosthesis walked with 21% more efficient in terms of VO(2) uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis.

CONCLUSIONS

The data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.

Ancient skeletal evidence for leprosy in India (2000 B.C.)

Background

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects almost 250,000 people worldwide. The timing of first infection, geographic origin, and pattern of transmission of the disease are still under investigation. Comparative genomics research has suggested M. leprae evolved either in East Africa or South Asia during the Late Pleistocene before spreading to Europe and the rest of the World. The earliest widely accepted evidence for leprosy is in Asian texts dated to 600 B.C.

Methodology/Principal Findings

We report an analysis of pathological conditions in skeletal remains from the second millennium B.C. in India. A middle aged adult male skeleton demonstrates pathological changes in the rhinomaxillary region, degenerative joint disease, infectious involvement of the tibia (periostitis), and injury to the peripheral skeleton. The presence and patterning of lesions was subject to a process of differential diagnosis for leprosy including treponemal disease, leishmaniasis, tuberculosis, osteomyelitis, and non-specific infection.

Conclusions/Significance

Results indicate that lepromatous leprosy was present in India by 2000 B.C. This evidence represents the oldest documented skeletal evidence for the disease. Our results indicate that Vedic burial traditions in cases of leprosy were present in northwest India prior to the first millennium B.C. Our results also support translations of early Vedic scriptures as the first textual reference to leprosy. The presence of leprosy in skeletal material dated to the post-urban phase of the Indus Age suggests that if M. leprae evolved in Africa, the disease migrated to India before the Late Holocene, possibly during the third millennium B.C. at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt. This evidence should be impetus to look for additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of the disease.

Atypical presentations of falciparum malaria

To identify the uncommon presentations of falciparum malaria in an endemic area and to assess the outcome of treatment, a study was carried out on 35 proved cases whose clinical presentations were either dominated by features other than fever or the history of fever was totally absent. Both urban and rural patients were included. Seventeen cases (48.3%) presented with features of cerebral malaria. Acute abdomen, urticaria, and unexplained shock were the other atypical presentations. Five cases (14.3%) of cerebral malaria died. We conclude that awareness of atypical presentations is important to detect cases of falciparum malaria in an endemic area. Intravenous quinine may need to be given promptly even when cerebral malaria is diagnosed empirically.

Contouring by speckle interferometry

An optical method of generating high-constrast contours by using speckle interferometry has been proposed. To demonstrate the use of this technique the conventional dual-index immersion method has been adopted.

Speckle interferometric methods of measuring small out-of-plane displacements

We present two new methods for measuring small out-of-plane displacement. These methods are descendents of Leendertz's method in speckle interferometry but provide fringes of good contrast.