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Biomedical subjects

D C Kerrigan

Publications and source records attributed to D C Kerrigan.

At least 19 recordsLinked to original sources

Pelvis and lower limb anatomical landmark calibration precision and its propagation to bone geometry and joint angles.

Human movement analysis using stereophotogrammetry is based on the reconstruction of the instantaneous laboratory position of selected bony anatomical landmarks (AL). For this purpose, knowledge of an AL's position in relevant bone-embedded frames is required. Because ALs are not points but relatively large and curved areas, their identification by palpation or other means is subject to both intra- and inter-examiner variability. In addition, the local position of ALs, as reconstructed using an ad hoc experimental procedure (AL calibration), is affected by photogrammetric errors. The intra- and inter-examiner precision with which local positions of pelvis and lower limb palpable bony ALs can be identified and reconstructed were experimentally assessed. Six examiners and two subjects participated in the study. Intra- and inter-examiner precision (RMS distance from the mean position) resulted in the range 6-21 mm and 13-25 mm, respectively. Propagation of the imprecision of ALs to the orientation of bone-embedded anatomical frames and to hip, knee and ankle joint angles was assessed. Results showed that this imprecision may cause distortion in joint angle against time functions to the extent that information relative to angular movements in the range of 10 degrees or lower may be concealed. Bone geometry parameters estimated using the same data showed that the relevant precision does not allow for reliable bone geometry description. These findings, together with those relative to skin movement artefacts reported elsewhere, assist the human movement analyst's consciousness of the possible limitations involved in 3D movement analysis using stereophotogrammetry and call for improvements of the relevant experimental protocols.

Biomedical Engineering

Rectus femoris: its role in normal gait.

OBJECTIVE: To analyze the role of the rectus femoris muscle in nondisabled gait at various walking velocities using fine-wire dynamic electromyography. DESIGN: Descriptive study. Fine-wire electromyography data were collected from the rectus femoris during level walking at four walking speeds. Rectus femoris activity patterns in the loading response phase and the pre- and initial-swing phase of the gait cycle were compared using paired t tests. SETTING: A gait laboratory. SUBJECTS: Ten nondisabled adult volunteers. MAIN OUTCOME MEASURES: Amplitude of rectus femoris activity in the loading response phase and the pre- and initial-swing phase during walking at four speeds. RESULTS: There was a bimodal pattern of rectus femoris activity in all subjects, at all speeds, in both phases, with high variability in the onsets, durations, and amplitudes of activity, and paired t tests revealed no significant differences (p > .05) between phases at any walking speed. CONCLUSION: Activity in the rectus femoris in the pre- and initial-swing phase in nondisabled individuals at all speeds suggests that similar activity detected in individuals with stiff-legged gait may not be inappropriate.

Adult

An algorithm to assess stiff-legged gait in traumatic brain injury.

Spastic paretic stiff-legged gait is a frequently encountered gait problem in patients with traumatic brain injury, as well as in many other patients with upper motor neuron disease. Formerly, spasticity of the quadriceps was considered to be the sole cause of stiff-legged gait. Quantitative gait analysis, however, may implicate hip flexor weakness or poor ankle mechanics as the cause of stiff-legged gait. We discuss the use of an algorithm to evaluate stiff-legged gait in traumatic brain injury using a quantitative gait analysis system such that the specific etiology of stiff-legged gait can be identified and can serve as the basis of a treatment plan.

Algorithms

Knee osteoarthritis and high-heeled shoes.

BACKGROUND: Little is known about the effects of walking in high heels on joints in the legs. Since osteoarthritis of the knee is twice as common in women as in men, we investigated torques (forces applied about the leg joints) of women who wore high-heeled shoes. METHODS: We studied 20 healthy women who were comfortable wearing high-heeled shoes. The women walked with their own high-heeled shoes and barefoot. Data were plotted and qualitatively compared; major peak values for high-heeled and barefoot walking were statistically compared. Bonferroni adjustment was made for multiple comparisons. FINDINGS: Measurement showed increased force across the patellofemoral joint and a greater compressive force on the medial compartment of the knee (average 23% greater forces) during walking in high heels than barefoot. INTERPRETATION: The altered forces at the knee caused by walking in high heels may predispose to degenerative changes in the joint.

Adult

Functionally oriented and clinically feasible quantitative gait analysis method.

A protocol for clinical gait analysis is described, and data from 30 normal adult female subjects are presented. Extensive application to pathologic subjects has proven to be feasible and sufficiently accurate. The method is based on a particular location and attachment of retro-reflective markers on the body and on a particular arrangement of four TV cameras. A motion analyser measures the 3D coordinates of each marker. A modelling approach, based on individual anthropometric measurements, and a functional approach, based on kinematical considerations, are used to estimate the location of hip, knee, and ankle joint centers and the orientation of the flexion-extension axis of the knee. 3D relative and absolute movements of pelvis and lower limbs are obtained and shown to be consistent with functional anatomy.

Adult

Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments.

OBJECTIVES: It is not known whether changes in the biomechanics of elderly gait are related to aging per se, or to reduced walking speed in this population. The goals of the present study were to identify specific biomechanical changes, independent of speed, that might impair gait performance in healthy older people by identifying age-associated changes in the biomechanics of gait, and to determine which of these changes persist at increased walking speed. DESIGN: Stereophotogrammetric and force platform data were collected. Differences in peak joint motion (kinematic) and joint moment and power (kinetic) values between healthy young and elderly subjects at comfortable and increased walking speed were measured. SETTING: A gait laboratory. SUBJECTS: Thirty-one healthy elderly (age 65 to 84 years) and 31 healthy young adult subjects (age 18 to 36 years), all without known neurologic, musculoskeletal, cardiac, or pulmonary problems. MAIN OUTCOME MEASURES: All major peak kinematic and kinetic variables during the gait cycle. RESULTS: Several kinematic and kinetic differences between young and elderly adults were found that did not persist when walking speed was increased. Differences that persisted at both comfortable and fast walking speeds were reduced peak hip extension, increased anterior pelvic tilt, and reduced ankle plantarflexion and ankle power generation. CONCLUSION: Gait performance in the elderly may be limited by both subtle hip flexion contracture and ankle plantarflexor concentric weakness. Results of the current study should motivate future experimental trials of specific hip flexor stretching and ankle plantarflexor concentric strengthening exercises to preserve and potentially improve walking performance in the elderly.

Adolescent

Age-related changes in the initiation of gait: degradation of central mechanisms for momentum generation.

OBJECTIVE: To investigate cross-sectionally age-related changes in the expression and biomechanical efficiency of the gait-initiation motor program. DESIGN: Case-control study. PARTICIPANTS AND SETTING: Twenty healthy young research subjects and 20 healthy elderly subjects who volunteered from the community participated in this study at a university research laboratory. MAIN OUTCOME MEASURES: Participants performed gait-initiation trials at three speeds from a starting position on a force platform while ground reaction force data, 3-D motion analysis data, and electromyographic data were collected. Measures included: latency of tibialis anterior (TA) activation and soleus (SOL) and gastrocnemius (GA) inhibition, magnitude of center of pressure (COP) displacement, magnitude of momentum generated, and final walking velocity. RESULTS: The expression of the central motor program governing gait initiation, as evidenced by the invariant timing between TA activation and SOL/GA inhibition, was seen in both the young and elderly populations, but the frequency was diminished in the latter group. The momentum-generating capacity of the COP shift mechanism was present but significantly diminished in the elderly population. CONCLUSIONS: These findings suggest that the central nervous system uses stable, efficient mechanisms for dealing with the inherent instability of upright bipedalism and that the integrity of these mechanisms degrades with aging.

Adolescent

Torque action of two-joint muscles in the swing period of stiff-legged gait: a forward dynamic model analysis.

Stiff-legged gait, characterized by limited knee flexion during the swing period, is a common consequence of upper motor neuron injury. The purpose of this investigation was to determine whether the rectus femoris and hamstrings muscles (which act at both the hip and knee) contribute to stiff-legged gait if active during the swing period of the gait cycle. Ten subjects with unilateral stiff-legged gait due to stroke were evaluated. Swing period free gait data were obtained. A biomechanical model of the affected limb was developed for each subject. Muscle and tendon lengths were scaled to individual subjects while constant nominal values for maximum muscle forces were used for all subjects. Torque driven forward dynamic simulations were employed to determine the sensitivity of swing period maximum knee flexion angle to changes in hip and knee torques. Combined torque and muscle driven simulations were used to access the action of specific two-joint muscles. Both hip flexion torque and knee extension torque were found to influence knee angle, but knee angle was more sensitive to changes in torque at the knee joint. The actions of the rectus femoris and long hamstrings are most marked at the knee, although their action at the hip opposes their action at the knee. Rectus femoris activity during early swing acts to limit knee flexion and contributes to stiff-legged gait. Long hamstring activity in early swing contributes to knee flexion.

Adult

The vertical displacement of the center of mass during walking: a comparison of four measurement methods.

Measuring the vertical displacement of the center of mass (COM) of the body during walking may provide useful information about the energy required to walk. Four methods of varying complexity to estimate the vertical displacement of the COM were compared in 25 able-bodied, female subjects. The first method, the sacral marker method, utilized an external marker on the sacrum as representative of the COM of the body. The second method, the reconstructed pelvis method, which also utilized a marker over the sacrum, theoretically controlled for pelvic tilt motion. The third method, the segmental analysis method, involved measuring motion of the trunk and limb segments. The fourth method, the forceplate method, involved estimating the COM displacement from ground reaction force measurements. A two-tailed paired t-test within an ANOVA showed no statistically significant difference between the sacral marker and the reconstructed pelvis methods (p = 0.839). There was also no statistically significant difference between the sacral marker and the segmental analysis method (p = 0.119) or between the reconstructed pelvis and the segmental analysis method (p = 0.174). It follows that the first method, which is the most simple, can provide essentially the same estimate of the vertical displacement of the COM as the more complicated second and third measures. The forceplate method produced data with a lower range and a different distribution than the other three methods. There was a statistically significant difference between the forceplate method and the other methods (p < 0.01 for each of the three comparisons). The forceplate method provides information that is statistically significantly different from the results of the kinematic methods. The magnitude of the difference is large enough to be physiologically significant and further studies to define the sources of the differences and the relative validity of the two approaches are warranted.

Adult

Biomechanic effects of a contralateral shoe-lift on walking with an immobilized knee.

OBJECTIVES: A previous study demonstrated that when one knee is artificially immobilized, a contralateral shoe-lift improves the oxygen cost of walking. This study was undertaken to evaluate the kinematic and kinetic effects associated with this shoe-lift. DESIGN: Motion analysis and force platform data were collected in subjects walking (1) normally, (2) with one knee immobilized, (3) with one knee immobilized and with a one-half-inch shoe-lift applied to the contralateral, nonimmobilized shoe, and (4) with a one-inch shoe-lift similarly applied. Kinematic and kinetic data from three trials of each condition were compared graphically and statistically using a repeated measures analysis of variance. SETTING: A gait laboratory. SUBJECTS: Eight able-bodied subjects without known neurologic or musculoskeletal problems. MAIN OUTCOME MEASURES: Fifty-two peak kinematic and kinetic variables during various phases of the gait cycle. RESULTS: Statistically significant differences (p < .05) between the normal and immobilized knee conditions were noted in 22 variables; however, significant differences between the immobilized knee conditions were found in only 4 variables. There were small improvements with the shoe-lifts toward normal in peak hip abduction, hip abduction at 20% to 30% of the gait cycle, and in peak knee extension moment on the nonimmobilized side. There was a small change away from normal in peak knee extension moment on the immobilized-side for the 1" shoe-lift. CONCLUSION: Wearing a contralateral shoe-lift when one knee is immobilized is associated with only small changes in kinematic and kinetic parameters. The shoe-lift may slightly reduce the need for compensatory hip abduction and vaulting on the nonimmobilized side. Importantly, no adverse biomechanic effect from the shoe-lift was noted except for a slightly increased peak knee extension moment on the immobilized side found for the 1" but not the 1"/2 shoe-lift.

Adult

Knee recurvatum in gait: a study of associated knee biomechanics.

OBJECTIVES: To quantitatively evaluate peak knee extensor torque values imparted to the posterior knee structures during gait in patients with knee recurvatum compared with torque values observed in control subjects, and to assess the predictive value of the degree of knee hyperextension and other clinical factors in estimating peak knee extensor torque. DESIGN: A retrospective analysis of clinical and quantitative gait data obtained from patients and control subjects. SETTINGS: A gait laboratory. SUBJECTS: Forty-one consecutive patients with neurologically based impairments presenting with knee hyperextension during gait (52 limbs) and 46 able-bodied control subjects. MAIN OUTCOME MEASURE: Peak knee extensor torque during the stance period of the gait cycle. RESULTS: Although overall, the patient average peak extensor torque was significantly greater (p < .001) than the control subjects' average value, knee extensor torques were within or below a +/- 1 standard deviation range for control subjects in 25% (13) of limbs tested. Peak knee hyperextension angle was a poor predictor of peak extensor torque; there was statistical significance (coefficient .061,p < .001) only for hyperextension angles of < or = 4 degrees. Multiple regression incorporating hyperextension angle and other clinical variables to predict peak knee extensor torque resulted in an adjusted r2 of .53. CONCLUSION: Patients with knee recurvatum have variable peak extensor torque values associated with their knee hyperextension. Knowledge of knee hyperextension angle and other clinical factors are only partially useful in predicting a patient's peak knee extensor torque imparted to the posterior knee structures during walking.

Adult

Contralateral shoe-lift: effect on oxygen cost of walking with an immobilized knee.

OBJECTIVE: Evaluate the effect of a contralateral shoe-lift on the oxygen cost of walking with an artificially immobilized knee. DESIGN: A prospective quantitative evaluation of oxygen cost of walking under varying conditions. Subjects walked (1) normally (N), (2) with one knee immobilized (1), (3) with one knee immobilized and with a one-half-inch shoe-lift applied to the contralateral shoe (I1/2"L), and (4) with one knee immobilized and with a one-inch shoe-lift (I1"L). SETTING: Exercise physiology laboratory. SUBJECTS: Ten able-bodied subjects without known cardiopolmonary or musculoskeletal problems. MAIN OUTCOME MEASURE: Breath-by-breath oxygen consumption measurements in mL/kg/m. RESULTS: Oxygen cost on average was 20% more with the knee immobilized (I) compared to normal (N) (mean difference = .0298 +/- .0245mL/kg/m, p = .002). Oxygen cost was significantly less (11% versus 20% above that of normal walking) with the half-inch shoe-lift (mean difference between I1/2" and I = .0167 +/- .0138mL/kg/m, p = .002). Similarly, oxygen cost was significantly less (12% versus 20% above that of normal walking) with the one-inch shoe-lift (mean difference between I1"L and I = .0142 +/- .0116, p = .002). CONCLUSION: This study demonstrates that a subject with an immobilized knee requires less energy to walk with a contralateral shoe-lift and provides scientific evidence for prescribing a shoe-lift in patients with an immobilized knee as a result of knee joint fusion, knee immobilization as a result of casting or orthotics, or spastic paretic stiff-legged gait associated with upper motor neuron disease.

Adult

Fall-related injuries in anticoagulated stroke patients during inpatient rehabilitation.

OBJECTIVE: To compare the frequency and severity of fall-related injuries in anticoagulated patients undergoing rehabilitation after stroke to nonanticoagulated stroke patients undergoing rehabilitation. DESIGN: Retrospective chart review. SETTING: Free-standing rehabilitation hospital. PATIENTS: 264 patients who sustained falls while undergoing intensive inpatient rehabilitation after stroke. MEASUREMENTS: Injuries, categorized as minor (abrasions and bruises) or major (intracranial hemorrhage, fracture, major bleeding). MAIN RESULTS: A total of 400 falls in 264 patients undergoing inpatient stroke rehabilitation were reviewed. One hundred thirty-one falls were sustained by 93 patients receiving anticoagulation, whereas 269 falls were sustained by 175 patients not receiving anticoagulation. In both the anticoagulation group and the control (nonanticoagulated) group, approximately one in five falls resulted in minor injuries (abrasions or bruises). Three fractures occurred, but no major bleeding events or intracranial hemorrhage occurred in either group. CONCLUSIONS: The risk for minor injury secondary to fall is comparable between the two groups, and the risk is low in this setting for hemorrhagic injuries in stroke patients falling while receiving anticoagulation.

Accidental Falls

Physical medicine and rehabilitation residents' educational needs assessment.

A study was done to determine how well residents in Physical Medicine and Rehabilitation (PM&R) believe their educational needs are being met in various clinical and didactic areas. Surveys were sent in April 1989 to the 814 persons on the 1989 American Academy of Physical Medicine and Rehabilitation resident physician registry. Residents were asked to rate how much experience they thought they were getting in their residency for each of 22 clinical and didactic topics such as stroke, spinal cord injury, head injury, prosthetics, chronic pain, sports medicine, pediatric rehabilitation, cardiopulmonary rehabilitation, electromyography, and physical modalities. In addition, they were asked to rate how much they believed they should be given with respect to these same topics. The response rate was 532 out of 814 (65%). Residents expected somewhat more than what they were getting overall; however, there were exaggerated discrepancies in a few specific areas. Residents believed they should be getting significantly more clinical and didactic experience in Industrial Medicine, Sports Medicine, Computer Applications, Therapeutic Injections, and Administration. The results should serve as guidelines for residency training and the study should serve as a model for future routine assessments.

Attitude of Health Personnel

Methylene blue guidance for simplified resection of a lung lesion.

A 60-year-old patient returned 1 year after right pneumonectomy with a new primary squamous cell carcinoma of the left lower lobe. Using fluoroscopic guidance, the lesion and the shortest track to the surface were marked by methylene blue preoperatively. The lesion was easily excised by wedge resection without the need for manipulation or deflation of the lung.

Carcinoma, Squamous Cell

Increase in renal magnesium overflow following aortotomy-induced hemorrhage in pigs.

Hemorrhage causes an increase in plasma Mg++ levels. This article identifies some of the tissues contributing to the hemorrhage induced increase in plasma Mg++. Anesthetized, splenectomized pigs were subjected to a 5 mm aortotomy. Blood samples from the abdominal aorta, inferior vena cava, pulmonary artery, hepatic portal vein, and renal vein were sampled for Mg++ changes caused by this uncontrolled hemorrhage. Aortotomy produced a rapid drop in arterial pressure and cardiac output, both of which remained depressed for the following 120 minutes (P less than 0.05). By 120 minutes, 6 of the 8 pigs survived, but three of the six survivors showed signs of cardiovascular decompensation. A significant increase in arterial plasma Mg++ was indicated by a paired t-test (P less than 0.05). Analysis of the venous samples also revealed a significant increase during the post-aortotomy period. Renal venous and hepatic portal venous plasmas both showed increases greater than that in the arterial plasma. The renal and splanchnic tissues, then, were partly responsible for the increase in the arterial Mg++ which follows hemorrhage.

Animals

Stiff-legged gait in spastic paresis. A study of quadriceps and hamstrings muscle activity.

Stiff-legged gait, ascribed to limited knee flexion during swing in spastic paresis, has previously received little detailed investigation. In this study, data from 23 patients referred for dynamic electromyographic evaluation of spastic stiff-legged gait were analyzed to identify timing of the activity of eight muscles during the gait cycle. Stride characteristics and foot switch data were also analyzed. Inappropriate activity in at least one of the quadriceps muscles during the preswing and/or initial swing phases was found in all 23 patients. Nine patients (39%) had hamstring activity during preswing. This group of 9, compared with the other 14 patients, had a significant reduction in average gait velocity and stride length (P less than 0.05) suggesting that preswing hamstring activity in stiff-legged gait may be counterproductive. No relation was found between biceps femoris (short head) activity and the amount of peak knee flexion attained in swing indicating that other factors are more important in attaining knee flexion. Delayed heel rise was observed in 21 patients (91%), which could imply insufficient calf muscle strength. Further, patients with markedly delayed heel rise achieved less peak knee flexion in swing than patients with normal or only moderately delayed heel rise (P less than 0.05). This may support the notion that adequate calf muscle strength is important in initiating knee flexion in the terminal stance/preswing phase. Results from this study provide preliminary quantitative information about stiff-legged gait that may prove useful in guiding management techniques.

Adult