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Biomedical subjects

D E Krebs

Publications and source records attributed to D E Krebs.

At least 19 recordsLinked to original sources
PubMed1992

In vivo acetabular contact pressures during rehabilitation, Part I: Acute phase.

The authors conducted a two-part study to compare in vivo acetabular contact pressures during the acute and postacute phases of rehabilitation. This report compares in vivo acetabular contact pressures generated during selected "inpatient" rehabilitation activities and their relationship to pain, range of motion, and other clinical indicators. A pressure-instrumented Moore-type endoprosthesis was implanted in a 73-year-old woman who had sustained a femoral neck fracture. Acetabular contact pressures during the first 2 weeks after surgery were rank-ordered. Clinical data, including range of motion, manual muscle test grade, use of pain medication, and independence in gait, were collected simultaneously. Acetabular pressures did not follow the predicted rank order corresponding to the commonly prescribed temporal order of inpatient rehabilitation activities. Isometric hip extension and active hip flexion generated the highest pressures of all the studied activities, including those measured during gait activities. Isometric exercises, therefore, may not be entirely benign preparation for ambulatory activity. Clinical data did not correspond with peak pressure data, suggesting that observed responses to rehabilitation may not be dependable criteria for progressing the acute hip rehabilitation protocol. We discuss applications for rehabilitation programs based on hip contact pressure data as an initial attempt to formulate more defensible rehabilitation approaches for patients with acutely painful hips.

Acetabulum↗
PubMed1992

In vivo acetabular contact pressures during rehabilitation, Part II: Postacute phase.

The authors conducted a two-part study to compare in vivo acetabular contact pressures during the acute and postacute phases of rehabilitation in a single subject with a pressure-instrumented femoral prosthesis. This report compares six common hip rehabilitation activities for resultant in vivo hip pressure magnitudes during the first 5 years after discharge from an acute care hospital. These activities were full, partial, touch-down, and non-weight-bearing ambulation and isometric hip abduction and straight-leg-raising exercises. A pressure-instrumented femoral endoprosthesis implanted in a 73-year-old woman who had sustained a femoral neck fracture provided data for the activities. The activities were rank ordered and compared over time according to peak pressure magnitude. Prescribed weight bearing and exercise type were not good predictors of hip peak pressures in this patient. Maximum pressures occurred by 1 year postdischarge for most activities, with a tendency to stabilize or decline thereafter. Resisted isometric hip abduction exercise demonstrated the most variation over time. The results suggest that hip pressures may be limited by controlling muscle force and movement velocity during postoperative hip rehabilitation activities.

Acetabulum↗
PubMed1992

Trunk kinematics during locomotor activities.

We investigated upper-body (ie, trunk) angular kinematics (motions) during gait, stair climbing and descending, and rising from a chair in two reference frames--relative to the pelvis and to room coordinates. Bilateral kinematic data were collected from 11 healthy subjects (6 female, 5 male), who were 27 to 88 years of age (mean = 58.9, SD = 17.9). During stair climbing, maximum trunk flexion relative to the room was at least double that during stair descending and gait. Arising from a chair required the most trunk flexion/extension range of motion (ROM) but the least abduction/adduction and medial/lateral (internal/external) rotation. Trunk ROM during gait was small (mean less than or equal to 12 degrees) and consistent with previous literature. Trunk range of motion relative to the room during stair climbing and descending was greater than trunk ROM during gait in all planes. The pelvis and trunk rotate in the transverse plane in greater synchrony during stair descending (mean = 8.1 degrees, SD = 5.6 degrees) than during gait (mean = 12.0 degrees, SD = 4.2 degrees). For all activities, trunk frontal and sagittal ROM relative to the pelvis was greater than that relative to the room coordinates. This finding suggests that trunk/pelvis coordination may be used to reduce potentially destabilizing anti-gravity trunk motions during daily activities. We conclude that upper-body kinematics relative to both pelvis and gravity during daily activities are important to locomotor control and should be considered in future studies of patients with locomotor disabilities.

Activities of Daily Living↗
PubMed1992

Bimanual skill development in pediatric below-elbow amputation: a multicenter, cross-sectional study.

The purpose of this study was to investigate the following in children with unilateral below-elbow amputation: (1) development of bimanual functional skills, (2) development patterns relative to able-bodied children, and (3) the relationship between duration of prosthetic wear and bimanual functional performance. Sixty-nine children with unilateral below-elbow amputation, all less than ten years old, were assessed on 14 prosthesis-assisted bimanual ADL, including play, feeding, dressing, and hygiene activities, which have been studied previously in able-bodied children. Bimanual ADL skill development was not delayed in five of the 14 comparisons to previously published standards, but most development patterns had multimodal, nonmonotonic performance profiles. Duration of prosthetic wear and other factors previously believed to contribute to good prosthetic function were not well correlated to ADL skills (r less than .52). Although these children had no CNS dysfunction, it is apparent that below-elbow amputation impedes pediatric ADL skill development. The cause of these delays appears to be complex and is not expressed uniformly among all children; thus, the delays observed are not simply due to mechanical deficiencies of the prosthetic restoration.

Activities of Daily Living↗
PubMed1991

Prosthetic management of children with limb deficiencies.

Children with amputations present challenging management problems. Surgical management, prosthetic fitting options, and training regimens have progressed substantially over the past several decades. Clinicians should be familiar with the available technological options to provide children with amputations the best possible care. The plethora of small components available for lower- and upper-limb prostheses indicates the desirability of managing juvenile patients in an interdisciplinary, specialized clinical setting where the advantages and disadvantages of prosthetic options can be related to the particular needs and wishes of each young client and the client's family. Although prostheses are not anatomical avatars, careful appliance prescription and training, coordinated with the child's growth and developmental changes, can optimize the benefits the child derives from the prosthesis.

Adolescent↗
PubMed1991

Chronic pain--assessment of orthopedic physical therapists' knowledge and attitudes.

Orthopedic physical therapists' knowledge of pain mechanisms and methods of pain management and their attitudes toward working with patients with benign chronic pain were studied. A random sample of 500 members of the American Physical Therapy Association's Section on Orthopaedics received by mail a 36-item questionnaire. Statistical analysis of scores, using frequencies, means, and correlations was performed on the 119 (23.8%) usable returns. All but 4% of the respondents preferred to work with patients who are not likely to have chronic pain. Seventy-two percent believed their entry-level education in pain management and theory was very inadequate or less than adequate to deal with an orthopedic patient population. Pain knowledge scores were low (35.8 out of 46 points), and the scores on positive attitudes toward treating patients with benign chronic pain were lower (20.5 out of 36 points). The study suggests specific deficiencies in orthopedic physical therapists' knowledge of clinical pain mechanisms and management and potentially undesirable attitudes toward treating patients with chronic pain.

Attitude of Health Personnel↗
PubMed1991

Exercise and gait effects on in vivo hip contact pressures.

Virtually all hip rehabilitation programs include exercise for muscle force development. The specific effects of various exercise modes on the hip joint itself are unknown. We will report on the effects of common exercise modalities on in vivo hip pressures. Four years prior to data collection, a pressure-instrumented Austin-Moore-type endoprosthesis was implanted in an otherwise healthy 73-year-old woman with a traumatic right hip fracture. Hip pressures during various experimental maneuvers were recorded periodically over a 5-year period. We compared measurements of peak pressure and rate of pressure rise obtained during gait with those obtained during isokinetic, isometric, and isotonic lower-limb exercises. Maximal exercise generated greater peak pressures than did gait, and tripling the angular velocity during exercise roughly tripled the rate of pressure rise. Torque production and resultant in vivo hip pressures varied directly during all experiments. Peak pressures and rate of pressure rise apparently can be controlled by varying the subject's exertion. The results reported are from a single subject; therefore, little generalizability is possible for these data. We suggest, however, that articular pressures may be important to rehabilitation planning; these data provide a direct insight into this potentially important exercise prescription consideration.

Aged↗
PubMed1989

Isokinetic, electrophysiologic, and clinical function relationships following tourniquet-aided knee arthrotomy.

Few data exist pertaining to the validity of isokinetic muscle function tests, particularly in describing their interrelationships with other common clinical assessments. The purpose of this study was to critically analyze the maximal voluntary knee torque, motor unit activity, range of motion, and gait sequelae in a series of 95 patients who had tourniquet-aided meniscectomy or intra-articular loose-body removal. Prior to arthrotomy, affected and contralateral knee data differed minimally. In the first days following arthrotomy, the patients invariably demonstrated severe gait and muscle mechanical impairments, with grossly abnormal quadriceps femoris muscle motor unit activity. Of 32 patients consenting to one-month postoperative diagnostic electromyographic and nerve conduction velocity testing, 17 (53%) were found to have femoral neuropathies, with 8 of the 17 having other thigh and leg neuropathies as well. Patients with neuropathy recovered more slowly and scored significantly lower on functional and electrophysiological measures than patients without neuropathy. One month postarthrotomy, knee extensor torques, motor unit activity, and gait scores averaged about half the normal values, and knee flexion torques and ROM were about 75% of normal. Isokinetic device measurements were moderately related to other clinical measures of postarthrotomy outcome (.58 less than r less than .80). Knee torque measurements alone do not adequately characterize functional capacity.

Adolescent↗
PubMed1988

Elements of theory presentations in Physical Therapy.

The sustained growth of physical therapy as a profession depends on continual examination of its body of knowledge. Theory articles present and critique this body of knowledge. One mechanism for advancing theory in physical therapy is presented.

Periodicals as Topic↗
PubMed1988

Comparison of plastic/metal and leather/metal knee-ankle-foot orthoses.

Fifteen children with bilateral lower limb disability were fit alternately with plastic/metal (PM) and leather/metal (LM) knee-ankle-foot orthoses. Fit was maintained by periodic growth adjustments. Gait, activities of daily living, and subjective reactions were gathered for each orthosis type. Despite previous anecdotal reports and expert opinion to the contrary, no overall differences were found between the two types of orthoses. Several specific differences were revealed, however; most children preferred the PM orthoses, saying they were lighter and more easily donned and doffed; the PM orthoses also controlled hip and knee sagittal motion and foot valgus/varus during gait more effectively. Individual biomechanical, neuromuscular and psychologic attributes of the disabled child must be carefully matched with the technical attributes of each orthotic option to effect an optimal prescription.

Activities of Daily Living↗
PubMed1988

Acceptability of the NYU Number 1 Child-sized Body-powered Hand. New York University.

The NYU Number 1 Child-sized Body-powered Hand was field tested on 24 children with below-elbow limb deficiency. Identical in size (14.4cm, four-knuckle circumference) and shape to the Systemteknik myoelectric number 1 size hand, this hand offers a new prescription alternative for very young children with upper-limb amputation. The participating children and prosthetic clinic teams reacted very favorably to the hand's appearance, function, and light weight. Maintenance reports during the three-month trial were primarily concerned with glove damage. Overall, the hand was received enthusiastically, and is now in commercial production.

Artificial Limbs↗
PubMed1987

Measurement theory.

The usefulness and truthfulness of assessments, whether performed in the clinic on one patient or in the research laboratory on many subjects, depends on valid measurements. Measurement theory is the thought process and interrelated body of knowledge that form the basis of valid measurements. Translation of measurement theory to behaviors helps to ensure the integrity and relevancy of tests and the data that result from them. In the final analysis, useful and truthful data depend for their existence on scalable and detectable events being translated into pertinent, valid, and reliable measurements. The rules by which numbers are assigned to events form the basis of measurements theory.

Humans↗
PubMed1985

Reliability of observational kinematic gait analysis.

Gait analysis, like all clinical assessments, is subject to measurement error. Specification of the extent of measurement error is imperative before drawing conclusions from any test. The purpose of this study was to determine the within-rater and between-rater reliability of observational gait analysis in a pediatric sample wearing knee-ankle-foot orthoses. Three expert observers, using a 3-point scale, rated videotaped gait kinematics of 15 children who had lower limb disability and who wore braces. The rating sessions were then repeated, with one month between sessions. Total agreement (identical ratings), both between-raters and within-raters, occurred in two-thirds of the observations, and an additional 29% of the observations differed by one point. Between-rater intraclass correlation coefficient type 2, 1 was .73; within-rater Pearson product-moment correlation averaged .60. Observational kinematic gait analysis appears to be a convenient, but only moderately reliable, technique.

Adolescent↗
PubMed1985

Statistical software packages for physical therapists. STATPAK for the IBM PC.

If you have modestly sized files, modest computing requirements, and only a modest budget, look into STATPAK. Despite the limitations of STATPAK's computational accuracy, data-entry capabilities, and file-size restrictions. It is a package that provides many of the more frequently required statistical routines in physical therapy research. Besides, who knows when you'll need Fourier-transformed nonlinear correlations! Be prepared to spend an evening or two getting used to the cryptic program descriptions. Perhaps a future version will contain a tutorial with sample data to help the beginner get started; a general linear-model routine to permit ANOVAs on unbalanced Ns, assess multivariate hypotheses, and test the compound-symmetry assumption of repeated measured ANOVA would also be welcome. I would first recommend, however, that the documentation problems be addressed; at least let us find "Graphics" or "Chart" in the index, without having to guess that we should look under "Plot"!

Computers↗
PubMed1984

Characteristics of the child amputee population.

The characteristics and number of children with limb amputations in North America are not known. In an effort to secure information concerning the nature of the child amputee population (to 21 years of age) in the United States and Canada, a census of patients treated at member clinics of the Association of Children's Prosthetic-Orthotic Clinics (ACPOC) was conducted. It was designed to obtain a rational basis for children's prosthetic design, development, research, and educational activities. Of the 74 ACPOC prosthetic clinics to which the questionnaire was sent, 45 replies were analyzed, representing a total of 4,105 children under treatment at the reporting clinics during 1980, of which 679 cases (17%) were seen for the first time in that year. The results are consistent with prior unpublished censuses. Overall, congenital limb deficiencies outnumbered acquired losses by a ratio of 2:1, but among unilateral cases, more lower-limb amputations were acquired postpartum than congenitally. Eighty percent of all child amputees had had only one limb involved, and 54% of these unilateral cases were left amputees. Males outnumbered females 3:2, and over half of the children currently under treatment at the reporting clinics had been under 6 years of age at the time of first admission.

Adolescent↗