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Biomedical subjects

R L Waters

Publications and source records attributed to R L Waters.

At least 91 records · Page 5Linked to original sources
PubMed1985

Energy cost of paraplegic locomotion.

We measured the physiological energy expenditure that was associated with several modes of mobility in 151 individuals with paraplegia that resulted from spinal cord injury. The relationship of the neurological level of the spinal lesion, extent of paralysis, orthotic requirement, and type of gait pattern was evaluated. The patients who required a bilateral knee-ankle-foot orthosis in order to walk with a swing-through crutch-assisted gait had an average rate of oxygen consumption that was 43 per cent greater than that of the patients who used a wheelchair and 38 per cent greater than was required for normal walking. Their average walking speed was slow in comparison with wheelchair propulsion or normal walking. Furthermore, the paraplegics in whom the hip flexor and knee extensor muscles were intact bilaterally and who were able to walk with a reciprocal crutch-assisted gait, but did not require knee-ankle-foot orthoses, did no better. They had a rate of oxygen consumption that was 20 per cent greater than that required for wheelchair use and 15 per cent greater than that required for normal walking. In addition, their mean walking speed was the slowest of all of the groups. These findings account for the common clinical experience that most paraplegics who require a knee-foot-ankle orthosis bilaterally and use a swing-through crutch-assisted gait prefer to use a wheelchair, and discontinue walking as the primary means of mobilization after gait-training.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

The enigma of "carry-over".

It is well known that after the cessation of treatment by functional electrical stimulation (FES) there is a continuation of the improvement of the muscle function "carry-over". If this could be harnessed and understood then this might lead to permanent improvement. An examination of evidence from FES, spasticity research and biofeedback might well produce the answers.

Biofeedback, Psychology↗
PubMed1983

Comparative cost of walking in young and old adults.

Normative data that summarize the energy requirements and gait characteristics of level outdoor walking were determined in 111 normal subjects between the ages of 20 and 80 years. Subjects were divided into two age groups: young adults (20-59 years) and senior subjects (60-80 years). The mean rate of oxygen consumption for young adults and senior subjects did not significantly differ, averaging 11.9 ml/kg-min for both groups. The data on heart rate paralleled the findings on oxygen consumption, averaging 100 and 103 beats/min, respectively. The net oxygen cost per meter walked for senior subjects, 0.16 ml/kg-m, was significantly greater (p less than 0.0005) than the value for young adults, 0.15 ml/kg-m, due to a decline in the average walking speed. The average gait velocity for senior subjects, 73 m/min, was statistically significantly less (p less than 0.0005) than the values for the younger adults, 80 m/min.

Adult↗
PubMed1983

Energy cost of walking in normal children and teenagers.

Oxygen consumption during free level walking was determined in 114 children and teenaged subjects between the ages of 6 and 19 years and compared with a group of 47 normal adults. Subjects were divided into two age groups: children (6-12 years) and adolescents (13-19 years). The mean rate of oxygen uptake for children was significantly greater, 15.3 ml/kg/min, than the value for teenaged subjects, 12.9 ml/kg/min. The oxygen cost to walk a unit distance (meter) was higher in children than adolescent subjects. The mean values averaged .22 ml/kg/min and .18 ml/kg/min respectively. The data on heart rate paralleled the findings on oxygen consumption. The mean heart rate for children, 114 beats per minute (bpm), was significantly higher than the mean values for adolescent subjects, 97 bpm.

Adolescent↗
PubMed1982

Forceful joint manipulation in head-injured adults with heterotopic ossification.

Twenty-eight joints with heterotopic ossification in 16 head-injured adults were forcefully manipulated 39 times under general anesthesia. The etiology of the heterotopic bone was trauma in seven joints and idiopathic (neurogenic) in 21. Indications for manipulation were inability to participate in therapy due to a lowered pain threshold, uncontrolled spasticity, voluntary muscle guarding or early bony ankylosis. An increase in motion was achieved under anesthesia in 23 joints (82%). Eighteen joints (64%) maintained or gained further motion with rehabilitation. Repeated manipulations were indicated if the patient evidenced neurological improvement. Five of 11 hips were manipulated once, five twice, and one hip three times. Seven hips (63%) gained an average of 52 degrees. Seven of 13 elbows were manipulated once and six twice. Eight elbows (62%) gained an average of 47 degrees. Four shoulders were manipulated, and three of the four increased in degree of external rotation. No exacerbation of the heterotopic process was detected. No fractures of long bones occurred.

Adolescent↗
PubMed1982

Electromyographic gait analysis before and after operative treatment for hemiplegic equinus and equinovarus deformity.

Gait electromyograms were obtained before and after tendon transfer, lengthening, or release in twenty-seven hemiplegic patients with equinus or equinovarus deformities. Abnormal patterns of muscle activity almost always were present preoperatively in the gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, flexor digitorum longus, peroneus brevis, and tibialis anterior muscles in these patients. The surgical procedures to correct the foot deformities altered the gross patterns of activity of most of the muscles operated on by very little. Of particular importance to the surgeon was the finding that the pattern of activity of the muscles whose tendon was transferred, lengthened, or released was not altered after operation. This finding makes the preoperative gait electromyogram a useful means of determining the appropriate surgical plan, since it is an indication of the type of muscle activity to expect postoperatively.

Adult↗
PubMed1982

Current uses of open phenol nerve block for adult acquired spasticity.

Forty-nine open phenol nerve injections were performed for acquired spasticity during a five-year period. The most common etiology of acquired spasticity was closed head injury (70%). Thirteen phenol injections to the musculocutaneous nerve were performed for excessive elbow flexion. The immediate results were absence of biceps and brachialis muscle activity, and an average gain of 43 degrees in extension. The effects of the nerve block subsided within six months. Nine nerve blocks were followed for more than one year. In two patients the upper extremities were almost normal. In the remaining seven the upper extremities were nonfunctional. Twenty-eight phenol injections to the posterior tibial nerve were performed for uncontrolled excessive plantar flexion and/or fixed equinus. The immediate result was cessation of gastrocnemius and soleus activity. Twenty-seven ankles attained a neutral position. The effects of the nerve block subsided within six months. Thirteen patients with 19 blocks were followed for more than eight months. Nine patients underwent lengthening of the Achilles tendon and six patients required orthotic devices for control of plantar flexion spasticity. In general, patients with acquired spasticity who require open phenol nerve blocks are unlikely to have normal functioning extremities when the effects of the nerve block have subsided.

Adolescent↗
PubMed1982

Femoral fractures in head-injuries adults.

The records of 65 head injured adults with 68 concomitant femoral fractures were reviewed. All patients were victims of high energy accidents. Forty-three fractures were treated by nonoperative methods. Treatment of 30 fractures with traction alone or with hip spica casts resulted in greater than 10 degrees of anterior angulation in 12 fractures (40%), greater than 5 degrees of valgus angulation in 13 fractures (43%), and shortening of greater than 2 cm in 13 fractures (43%). of eight fractures treated with a cast brace, two had shortening of 2.5 cm. Cast braces offered better fracture alignment, less shortening and more knee motion than traction and hip spica casts. The average time to union was four months. These fractures generally healed in the same fashion and at a similar rate as those of the general population. Ipsilateral hemiplegia prolonged union by one month but was not associated with excessive callus. Twenty-five fractures were treated by open reduction and internal fixation. Deep wound infection occurred in four femoral (16%) and osteomyelitis in two (8%). Reoperation was required in six femora (24%) as a consequence of the initial surgery. Excessive calculus was noted in 13 fractures (52%). Open reduction and internal fixation of femoral fractures in this population almost invariably required less nursing care, earlier mobilization, fewer angular deformities, less shortening and greater knee motion when compared to traction and hip spica casts.

Adolescent↗
PubMed1982

Energy costs of walking in lower-extremity plaster casts.

The energy cost of walking with axillary crutches and each of three types of plaster casts (long, short, and cylinder) on the lower extremity was measured in twenty normal adult men. The knee and ankle joints were immobilized unilaterally in the neutral positions. Oxygen uptake was measured using a modified Douglas-bag technique. Heart rate, respiratory rate, and step frequency were telemetered from transducers that were attached to the subjects. When walking and bearing full weight on a cast without the use of crutches, the average rates of energy expenditure for subjects wearing the three varieties of casts did not significantly differ from the value for normal walking. Velocity, however, was reduced depending on the extent of immobilization. The average velocity of the subjects was fifty-six meters per minute in a long cast, sixty-four meters per minute in in a cylinder cast, and seventy meters per minute in a short cast, compared with seventy-eight meters per minute without immobilization of the limb. The subjects' average oxygen cost per meter was 0.24 milliliter per kilogram in a long cast, 0.20 milliliter per kilogram in a cylinder cast, and 0.19 milliliter per kilogram in a short cast, compared with 0.15 milliliter per kilogram for normal walking. Using a unilateral non-weight-bearing swing-through gait, the average rate of oxygen uptake for subjects wearing the three types of casts did not differ from the mean value without a cast (21.2 milliliters per kilogram per minute). All values were at least 60 per cent higher than the average for normal level walking.

Adult↗
PubMed1980

Walking efficiency before and after total hip replacement.

The energy cost of walking and gait characteristics of patients with hip disease were studied to determine changes in walking efficiency following total hip replacement. Twenty-nine patients, 24 with unilateral hip disease and 5 with bilateral hip disease, were tested preoperatively and at various times postoperatively. Oxygen uptake was measured by a modified Douglas bag procedure. The temporal and distance characteristics of gait were measured with contact closing heel switches. Results showed postoperative increases in velocity, cadence, and stride length in patients with unilateral disease and with bilateral disease with bilateral replacement. After surgery, energy cost tended toward more normal levels, but the subjects were not within normal limits for oxygen uptake per minute, oxygen uptake per distance walked, or percent of predicted maximum aerobic capacity. Comparison of energy expenditure data with temporal and distance factors of gait indicated that all subjects became more physiologically efficient after hip replacement.

Adult↗
PubMed1980

Physiological work performance in chronic low back disability: effects of a progressive activity program.

Fifteen patients were tested before and after treatment in a multifaceted inpatient program for chronic low back pain to determine if a gradually progressive activity program affected gait performance and physiological capacity. Before treatment, all patients demonstrated decreased physiological conditioning by higher-than-expected values for oxygen consumption and heart rate and by lower-than-normal gait velocity, stride length, and cadence. After treatment, an increase in mean walking velocity of 19 meters/minute reflected parallel gains in cadence and stride length. Improved mechanical performance resulted in improved "energetics." Energy spent per unit of distance walked decreased by 18 percent after treatment, providing a useful measure of increased physiological efficiency. Results indicated that patients with chronic low back disability can derive significant conditioning effects from an exercise program based on general function.

Adult↗
PubMed1980

Periarticular heterotopic ossification in head-injured adults. Incidence and location.

The records of 496 adult patients who sustained severe injuries to the head were reviewed retrospectively in order to reveal the incidence and location of heterotopic ossification. All traumatized joints were excluded from the study. Clinically significant heterotopic bone causing pain and a decrease in the range of motion of the adjacent joint was identified in 100 joints in fifty-seven patients (11 per cent). All fifty-seven patients had some residual spasticity, although the spasticity was not always present about the involved joint. Twenty-seven patients had monoarticular involvement while thirty patients had involvement of more than one joint. Forty-four hips, twenty-seven shoulders, twenty-six elbows, and three knees had heterotopic ossification. Complete ankylosis (16 per cent of all joints) developed in eight elbows, six hips, and two shoulders.

Adolescent↗
PubMed1980

Musculocutaneous neurectomy for spastic elbow flexion in non-functional upper extremities in adults.

The charts of twenty-nine patients who had undergone thirty musculocutaneous neurectomies for acquired spasticity of the elbow in a non-functional upper extremity were reviewed. The most common causes of the spasticity were cerebrovascular accident (59 per cent) and head injury (24 per cent). The aims of the operation were to increase the patient's capacity for self-care and to improve ambulation, personal hygiene, and appearance. Patients who had 30-degree flexion contractures preoperatively did not require a cast postoperatively; those who had 30 to 75-degree flexion contractures preoperatively required a cast postoperatively; and patients who had flexion contractures of more than 75 degrees preoperatively required a concomitant release of soft tissue in the elbow and application of a cast postoperatively. One patient who was operated on to improve appearance had no active elbow flexion postoperatively and was regarded as having a poor result. Musculocutaneous neurectomy is a safe, reliable procedure for treating the spastic elbow in the non-functional upper extremity.

Adult↗
PubMed1980

Electrode effectiveness during transcutaneous motor stimulation.

Four types of electrodes were evaluated for clinical effectiveness in electrically stimulating the quadriceps muscles to gain knee extension for time periods lasting up to 4 days. These electrodes included self-adhering pregelled pads, solvent-activated conductive tape, carbonized conductive silicone rubber, and felt-covered metal plates. The electrodes were compared for ability to produce knee extension torque, electrical impedance, ease of application, durability, comfort, and skin reactivity. Felt-pad electrodes soaked in tap water or saline produced the highest mean torque and lowest electrical impedance, which made them excellent choices for single session stimulation. Carbon-rubber electrodes with either gel produced slightly less torque, slightly higher impedances, and only minor skin reactions. They were relatively easy to apply, and the majority remained intact for the duration of the study period. They were found to be most suitable for prolonged functional electrical stimulation of the quadriceps. Stimulation using pregelled electrodes produced the lowest torque, and they displayed consistently higher electrical impedance. Even though they were easiest to apply and survived better than the other electrodes, they also produced the most skin reactions. The torque and electrical impedance of the activated-tape electrodes were extremely variable and unpredictable, and the process of application was long and involved, making them clinically impractical for either long or short stimulation.

Adult↗
PubMed1979

Electrical stimulation of wrist and fingers for hemiplegic patients.

Passive cyclical electrical stimulation was applied during a four-week treatment program to the wrist and finger extensors of 16 hemiplegic patients with flexor spasticity. The study noted the effects of this treatment on the patients' sensation; spasticity; passive range of motion of the wrist, metacarpophalangeal, and proximal interphalangeal joints; and strength in the wrist extensor muscles. Patients were divided into chronic and subacute groups. Both groups received electrical stimulation for three half-hour periods a day, seven days a week, as a substitute for all other range-of-motion techniques. Flexion contractures were prevented in the subacute group of patients at the wrist, metacarpophalangeal, and proximal interphalangeal joints. A statistically and clinically significant increase in wrist extension range occurred in the chronic group that had wrist flexion contractures before the electrical stimulation. Increased extension was noted at the metacarpophalangeal and proximal interphalangeal joints of patients in the chronic group. Those patients with some voluntary wrist extension before the treatment began were able to increase their extension strength during stimulation. No changes in skin sensation were noted and only a general trend in decreasing spasticity was apparent.

Adult↗
PubMed1979

Stiff-legged gait in hemiplegia: surgical correction.

Selective tenotomy of one or two heads of the quadriceps based on electromyographic criteria improved knee flexion in hemiplegic patients who walked with a unilateral stiff-legged gait. The improvement was greatest in eight patients in whom the rectus femoris was released, either with or without release of the vastus intermedius, with activity in pre-swing stance and initial swing confined to those heads of the quadriceps; in these patients knee flexion improved an average of 20 degrees. Knee flexion improved an average of only 8 degrees in five patients in who activity was present in one head of the quadriceps that was not surgically released. No improvement in knee flexion occurred in seven of eight patients in whom activity was present in two or more of the quadriceps heads that were not surgically released.

Electromyography↗