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Biomedical subjects

S R Skinner

Publications and source records attributed to S R Skinner.

At least 19 recordsLinked to original sources

Measles-mumps-rubella and hepatitis B vaccination uptake in adolescents: a survey in metropolitan Melbourne.

OBJECTIVE: To measure the uptake of preadolescent measles-mumps-rubella (MMR) and adolescent hepatitis B vaccinations and assess the influence of certain demographic factors on the uptake of these vaccines. DESIGN: Prevalence surveys of uptake rates of preadolescent (school Year 6; age 10-11 years) MMR and adolescent (school Year 9; age 13-14 years) hepatitis B vaccination. SETTING: City of Darebin, an inner northern metropolitan region of Melbourne, 1996. SUBJECTS: 1160 Year 6 school students (580 boys) and 1102 Year 9 school students (548 boys). INTERVENTION: School-based vaccination program administered by Darebin Council. RESULTS: 83% of Year 6 students were vaccinated with the MMR vaccine (84.1% of girls and 81.9% of boys). 71.6% of Year 9 students completed the full course of hepatitis B vaccination (68.9% of boys and 74.2% of girls). There was a higher uptake of MMR in non-government primary schools, but no other demographic factors (sex, economic status, non-English-speaking background, parental education, school class size) were associated. CONCLUSIONS: These uptake rates do not meet National Health and Medical Research Council (NHMRC) recommendations. Further study is required to determine and quantify the factors that affect vaccination uptake in adolescence. Programs may then be developed to improve vaccination uptake.

Adolescent

Forearm muscle activation during power grip and release.

The position of the hand during power grip is well-described, but the normal phasic activity of the extrinsic forearm muscles during power grip and release is unknown. People with neurologic impairment may have inadequate power grip or release because of abnormal muscle timing. This study describes the timing of the forearm muscles in 10 normal subjects during power grip and release, which was evaluated using electromyography. During power grip, subjects had consistent timing patterns for extrinsic finger motors and different but individually consistent patterns for wrist motors. This finding supports our hypothesis that different individuals habitually use a specific motor strategy and an intact central nervous system allows them to change their motor strategy to adapt to new environmental parameters.

Adult

A comparison of gait with solid, dynamic, and no ankle-foot orthoses in children with spastic cerebral palsy.

BACKGROUND AND PURPOSE: This study compared the effects of dynamic ankle-foot orthoses (DAFOs) with a plantar-flexion stop, polypropylene solid ankle-foot orthoses (AFOs), and no AFOs on the gait of children with cerebral palsy (CP). These orthoses were used to reduce the excessive ankle plantar flexion during the stance phase of gait. SUBJECTS AND METHODS: Ten children with spastic CP (6 with diplegia and 4 with hemiplegia) were tested after wearing no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for an additional 2 weeks, and DAFOs for 1 month. The effects of the two orthoses and no AFOs on lower-extremity muscle timing, joint motions, and temporal-distance characteristics were compared. RESULTS: Both orthoses increased stride length, decreased cadence, and reduced excessive ankle plantar flexion when compared with no orthoses. No differences were found for the gait variables when comparing the two orthoses. CONCLUSION AND DISCUSSION: Based on the data, the authors believe that although both orthoses would be recommended for children with spastic CP and excessive ankle plantar flexion during stance, additional individual factors should be considered when selecting either orthosis.

Analysis of Variance

Phasic relationships of the intrinsic and extrinsic thumb musculature.

Dynamic electromyography has proven to be useful in testing patients with spastic disorders who are candidates for tendon transfer or lengthening operations. The purpose of this investigation was to define the normal phasic activity of the thumb muscles during simple, reproducible activities. Fine wire electrode pairs were inserted into the extensors pollicis longus and brevis, abductors pollicis longus and brevis, flexors pollicis longus and brevis, opponens pollicis, adductor pollicis, and first dorsal interosseus of 5 normal subjects. Motions of the carpometacarpal joint and the interphalangeal joint of the thumb were recorded by electrogoniometer. Proximal joint positions were controlled by the subject at the elbow, forearm, and wrist. Normal timing was described for each muscle during hand opening and closing, key pinch with and without force, and opposition pinch with and without force. The data support the concept of individual motor strategies: normal persons often select different combinations of muscles to accomplish a functional goal.

Adult

Gait analysis in pediatric lower extremity amputees.

Walking function in 56 children with lower extremity amputations was assessed using a questionnaire and gait analysis. Children with prosthetic lower extremities can be very functional in society, often participating in sports. Limitations are proportional to the extent of the missing limbs. As a group, pediatric amputees walk more slowly than their normal peers with a slower cadence and a longer stride length. Pediatric amputees have higher heart rates when walking than normal children, but they seem willing to pay a higher physiologic price for ambulation.

Adolescent

Phasic relationships of the extrinsic muscles of the normal hand.

The objective of this investigation was to improve the interpretation of dynamic electromyogram studies of upper extremity musculature by providing normal reference data. Fine wire electrodes recorded electromyogram data from the extrinsic forearm and hand muscles of 10 normal adults. Simultaneous wrist and finger motions were recorded by goniometers with the electromyogram data. Subjects performed hand opening and closing while actively maintaining selected elbow, forearm, and wrist positions. Phasic muscle activity was identified in each position for individual subjects. Normal adult subjects use gravity and tenodesis effects in addition to active muscle contraction to achieve motor goals. Individual subjects used different muscles to accomplish the same motor task, but each subject was remarkably consistent in muscle assignment. These findings suggest that individuals employ "motor planning strategies" in hand function.

Adult

Variations in the gait of normal children. A graph applicable to the documentation of abnormalities.

The goal of much orthopaedic treatment of children is to improve their walking. To document the quantitative characteristics of walking, we devised graphic displays of speed, cadence, stride length, and body height on the basis of 2,416 observations of 324 children walking over a range of speeds. The gait graph is an uncomplicated tool for the clinician to use in the documentation and evaluation of gait in children. It also provides the means to relate the walking abilities of patients to the standards for normal children.

Child

Artifacts seen during CT pelvimetry: implications for digital systems with scanning beams.

During computed tomography (CT) pelvimetry of two pregnant women, bony abnormalities of the fetuses were noted on the scout images that were not confirmed at delivery. To explore the cause of these artifacts, specimen long bones were manipulated in various ways during CT scout imaging. Artifacts like those seen during in vivo imaging were found to be caused by motion of the object. The CT scout view is an example of an image produced by a digital system that uses a scanning beam. This type of digital system is being used for several types of body imaging including screening for scoliosis and chest radiography. Attention to motion artifacts should decrease diagnostic errors and aid further development of these systems.

Adult

Gait electromyographic evaluation of the long-toe flexors in children with spastic cerebral palsy.

In a prospective study of the phasic activity of the long-toe flexors of patients with spastic cerebral palsy, the electrical activity of the long-toe flexors in 37 children with varus or valgus hindfoot deformity was measured by wire electrode dynamic electromyography. Although gross abnormalities in the phasic timing of the flexor hallucis longus and flexor digitorum longus were observed, these muscles could not be implicated in the etiology of hindfoot deformity. In planning gait analysis protocols for children with cerebral palsy and hindfoot deformity, electromyography of the long-toe flexors is not necessary unless toe curling is clinically evident.

Cerebral Palsy

"Idiopathic" scoliosis associated with congenital upper-limb deficiency.

Sixty patients with congenital upper-limb deficiency were evaluated for scoliosis in 1972. Twenty-one patients had scoliosis of 5 degrees or more and 15 had scoliosis of 10 degrees or more. Fifteen of these patients had long-term follow-up periods. Thirteen patients had idiopathic scoliosis. Idiopathic scoliosis associated with congenital upper-limb deficiency could be divided into three groups, and the progression of scoliosis was predictable within each group. All but one of these patients had a relatively benign course and did not require treatment. Double curves with rotation progressed throughout the growth period. Double curves with Grade 0 rotation tended not to be progressive. Single curves did not have rotation deformity and resolved spontaneously or remained stable. Magnitude of limb deficiency did not correlate with the curve magnitude, progression, or pattern. Muscle imbalance did not appear implicated as a cause for the scoliosis in these patients. Young age at discovery of the curve did not correlate with progression of the curve.

Adolescent

Functional demands on the stance limb in walking.

In normal human locomotion, the lower extremities must maintain the erect posture while at the same time permitting forward progression of the body. Walking involves a complex interplay of gravity, momentum changes, and muscle action. A quantitative analysis of the effects of gravity and momentum changes on the stance limb in normal gait has been performed. These effects, represented by the ground reaction force, impose challenges to the muscles of the lower extremity. The nature of the torques about the hip, knee, and ankle joints has been investigated and correlated with the timing of muscle action throughout the gait cycle. Mechanical events in the earliest part of stance phase have been more clearly described than in previous work. Analysis of the effects of gravity and momentum changes improves our understanding of the mechanics of normal walking, and can aid in the diagnosis and treatment of disabled patients.

Adult

Unilateral duplication of the femur associated with myelomeningocele.

A case of complete duplication of the left femur is presented. This anomaly was associated with ipsilateral tibial hemimelia, lumbar myelomeningocele, extrophy of the cloaca, ambiguous genitalia, imperforate anus, and omphalocele. The constellation of anomalies implies an insult at about the fourth week of gestation. Maternal ingestion of hydroxyzine was reported in this case. Management of the limb anomaly was by resection of the duplicate femur and malformed leg. Preoperative arteriography was found helpful.

Abnormalities, Multiple

Dynamic EMG findings in varus hindfoot deformity and spastic cerebral palsy.

Dynamic electromyography was used to examine the activity of muscles of 26 children with varus hindfoot deformities as a result of spastic cerebral palsy. Four different patterns of inappropriate muscle activity involving the tibialis anterior, tibialis posterior, gastrocnemius and soleus were seen during walking. Dynamic electromyographic techniques can be very helpful in identifying the specific muscular aberrations which contribute to this deformity.

Adolescent

Posterior transfer of tibialis anterior in low-level myelodysplasia.

A clinical and EMG evaluation was performed on six children with myelomeningocele who previously had undergone bilateral transfer of the tibialis anterior to the heel cord. While the operation was effective in eliminating the calcaneovarus foot deformity, the likelihood of producing a significant new deformity was great. Dynamic EMG studies indicated that the transferred muscle usually did not develop the desired phasic contraction during the stance phase of walking. Bracing requirements at the ankle were unaffected by the procedure. The authors conclude that this transfer is undesirable for children with myelomeningocele.

Child