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Resonant frequencies of arms and legs identify different walking patterns.

The present study is aimed at investigating changes in the coordination of arm and leg movements in young healthy subjects. It was hypothesized that with changes in walking velocity there is a change in frequency and phase coupling between the arms and the legs. In addition, it was hypothesized that the preferred frequencies of the different coordination patterns can be predicted on the basis of the resonant frequencies of arms and legs with a simple pendulum model. The kinematics of arms and legs during treadmill walking in seven healthy subjects were recorded with accelerometers in the sagittal plane at a wide range of different velocities (i.e., 0.3-1. 3m/s). Power spectral analyses revealed a statistically significant change in the frequency relation between arms and legs, i.e., within the velocity range 0.3-0.7m/s arm movement frequencies were dominantly synchronized with the step frequency, whereas from 0.8m/s onwards arm frequencies were locked onto stride frequency. Significant effects of walking speed on mean relative phase between leg and arm movements were found. All limb pairs showed a significantly more stable coordination pattern from 0.8 to 1.0m/s onwards. Results from the pendulum modelling demonstrated that for most subjects at low-velocity preferred movement frequencies of the arms are predicted by the resonant frequencies of individual arms (about 0.98Hz), whereas at higher velocities these are predicted on the basis of the resonant frequencies of the individual legs (about 0.85Hz). The results support the above-mentioned hypotheses, and suggest that different patterns of coordination, as shown by changes in frequency coupling and phase relations, can exist within the human walking mode.

Adult↗

Leg stiffness primarily depends on ankle stiffness during human hopping.

When humans hop in place or run forward, they adjust leg stiffness to accommodate changes in stride frequency or surface stiffness. The goal of the present study was to determine the mechanisms by which humans adjust leg stiffness during hopping in place. Five subjects hopped in place at 2.2 Hz while we collected force platform and kinematic data. Each subject completed trials in which they hopped to whatever height they chose ("preferred height hopping") and trials in which they hopped as high as possible ("maximum height hopping"). Leg stiffness was approximately twice as great for maximum height hopping as for preferred height hopping. Ankle torsional stiffness was 1.9-times greater while knee torsional stiffness was 1.7-times greater in maximum height hopping than in preferred height hopping. We used a computer simulation to examine the sensitivity of leg stiffness to the observed changes in ankle and knee stiffness. Our model consisted of four segments (foot, shank, thigh, head-arms-trunk) interconnected by three torsional springs (ankle, knee, hip). In the model, increasing ankle stiffness by 1.9-fold, as observed in the subjects, caused leg stiffness to increase by 2.0-fold. Increasing knee stiffness by 1.7-fold had virtually no effect on leg stiffness. Thus, we conclude that the primary mechanism for leg stiffness adjustment is the adjustment of ankle stiffness.

Adult↗

Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery.

OBJECTIVE: Harvest site infections are more common than chest surgical infections after coronary artery bypass surgery, yet few studies detail risk factors for these infections. We sought to determine independent risk factors for leg surgical site infections using our institutional Society of Thoracic Surgeons database. METHODS: We retrospectively analyzed data collected from 1980 coronary artery bypass patients undergoing surgery at our institution from January 1, 1996, through June 30, 1999, using The Society of Thoracic Surgeons database. Independent risk factors for leg harvest site infection were identified by multivariate logistic regression. RESULTS: Seventy-six patients (4.5%) were coded as having had a leg harvest site infection, of which 67 were confirmed by infection control. The length of hospital stay after surgery was significantly longer in patients with leg harvest site infection (mean 10.1 days) compared with that of patients without infection (mean 7.1 days, P <.001), and infected patients were more likely to be readmitted to the hospital within 30 days of surgery. Independent risk factors for leg harvest site infection included previous cerebrovascular accident (odds ratio, 2.9), postoperative transfusion of 5 units or more of red blood cells (odds ratio, 2.8), obesity (odds ratio, 2.5), age 75 years or older (odds ratio, 1.9), and female gender (odds ratio, 1.8). CONCLUSIONS: Consistent with previous studies, female gender and obesity were identified as independent risk factors for leg harvest site infection, while previous cerebrovascular accident, postoperative transfusion, and older age are newly described risk factors. The Society of Thoracic Surgeons database is a useful tool for identification of predictors of leg harvest site infections.

Age Factors↗

Gait analysis after total hip arthroplasty with leg-length equalization in women with unilateral congenital complete dislocation of the hip--comparison with untreated patients.

Patients with Crowe Type-IV congenital dislocation of the hip (CDH) show significant clinical improvement after total hip arthroplasty (THA) because this surgery greatly reduces pain. Concomitant leg-length equalization in unilateral patients--a controversial procedure--theoretically should significantly improve these patients' ability to walk efficiently and comfortably. To understand the impact of leg-length equalization on these patients, we compared their gait parameters with those of untreated patients without pain but with leg-length discrepancy. Using a motion analysis system, three force platforms and computer calculation, the gait parameters during level walking of 22 women with unilateral Crowe Type-IV CDH were studied at an average of 58 months (27-98 months) following a successful cementless THA. The socket was placed in the best bone stock, which was close to the level of the true acetabulum. The leg-length discrepancy was equalized to within 2 cm in all patients. The Harris hip score averaged 94.8 (range, 88-100) at the time of the study. Nine women with untreated unilateral Crowe Type-IV CDH without major pain but with an average leg-length discrepancy of 4.7 cm (range, 2.5-6 cm) were also studied for comparison. The treated subjects (Group 1; THA and leg-length equalization) walked faster and had gait parameters with better bilateral symmetry than the untreated subjects (Group 2). We concluded that leg-length equalization in addition to THA in patients with unilateral Crowe Type-IV CDH significantly improves gait symmetry and efficiency.

Adult↗

Muscle energy stores in relation to clinical findings and outcome in acute arterial ischaemia of the lower leg.

Forty-two patients (mean age 79 years) with acute ischaemia of one leg were evaluated in a prospective study. Forty-nine percent of the patients suffered from embolism, 29% from thrombosis while the etiology was uncertain in 22%. In 30 of the ischaemic legs and in 21 contralateral non-ischaemic legs the muscle energy metabolic status (ATP, ADP, AMP, ECP, PC, Cr and lactate) from the gastrocnemius muscle was measured and compared to values obtained from 24 healthy age-matched controls. There was a high degree of energy metabolic impairment in the ischaemic legs. Furthermore, the contralateral non-ischaemic legs were also energy depleted in comparison with those of the healthy controls. Legs with thrombosis were more energy-deprived than legs with embolism. Clinical evaluation of the degree of ischaemia and the level of occlusion correlated with energy metabolic parameters but the duration of ischaemia did not. The degree of metabolic impairment had no prognostic implication for the clinical outcome.

Adenine Nucleotides↗

High-arched runners exhibit increased leg stiffness compared to low-arched runners.

Leg stiffness between high-arched (HA) and low-arched (LA) runners was compared. It was hypothesized that high-arched runners would exhibit increased leg stiffness, increased sagittal plane support moment, greater vertical loading rates, decreased knee flexion excursion and increased activation of the knee extensor musculature. Twenty high-arched and 20 low-arched subjects were included in this study. Leg stiffness, knee stiffness, vertical loading rate and lower extremity support moment were compared between groups. Electromyographic data were collected in an attempt to explain differences in leg stiffness between groups. High-arched subjects were found to have increased leg stiffness and vertical loading rate compared to low-arched runners. Support moment at the impact peak of the vertical ground reaction force was related to leg stiffness across all subjects. High-arched subjects demonstrated decreased knee flexion excursion during stance. Finally, high-arched subjects exhibited a significantly earlier onset of the vastus lateralis (VL) than the low-arched runners. Differences exist in leg stiffness and vertical loading rate between runners with different foot types. Differences in lower extremity kinetics in individuals with different foot types may have implications for new treatment strategies or preventative measures.

Adolescent↗

Muscle pre- and coactivity during downward stepping are associated with leg stiffness in aging.

We have previously reported that elderly compared to young women executed downward stepping with substantially greater leg stiffness. Because antagonist muscle coactivity increases joint stiffness we hypothesized that increased leg stiffness in aging is associated with increased muscle coactivity. We also explored the possibility that the magnitude of the preparatory muscle activity preceding impact also differed between young and old subjects. Young (n=11, 20. 8 yr) and old (n=12, 69 yr) women performed downward stepping from a platform set at 20% body height. The leg was modeled as a simple mass-spring system. From video and ground reaction force data leg stiffness was computed as the ratio of force under the foot and the linear shortening of the limb. EMG activity of the vastus lateralis, biceps femoris, gastrocnemius lateralis, and tibialis anterior were recorded with a telemetric system. Elders compared to young subjects had 64% greater leg stiffness during downward stepping. Muscle activity over a 200-ms period preceding touch down was 136% greater in elderly than in young subjects. Biceps femoris and tibialis anterior coactivity during ground contact was 120% greater in the elders. Muscle pre- and coactivity, respectively, accounted for about 50% of the variance in leg stiffness. In conclusion, elderly people elevate muscle pre- and coactivity during downward stepping to stiffen the leg in compensation for impaired neuromotor functions.

Adolescent↗

Lymph drainage and the development of post-reconstructive leg oedema is not influenced by the type of inguinal incision. A prospective randomised study in patients undergoing femoropopliteal bypass surgery.

OBJECTIVES: To see whether the type of groin incision influenced the degree of postoperative leg oedema and the occurrence of lymphatic damage. DESIGN: Prospective randomised clinical study. SETTING: University Department of Surgery. MATERIALS: Twenty-four patients undergoing femoropopliteal bypass reconstruction with either a lateral groin incision (Group A, n = 12) or a direct incision over the femoral vessels (Group B, (n = 12). CHIEF OUTCOME MEASURES: The leg volume increase was measured according to the formula of a truncated cone. Deep venous thrombosis was excluded by air plethysmography and colour-coded Duplex scanning. Lymphatic lesions were detected by lymphoscintigraphy using 99mTc labelled human serum albumin. MAIN RESULTS: One week following vascular reconstruction the median leg volume increase was 24.5% in Group A vs. 23.3% in Group B (NS). Lymphoscintigraphy revealed obstruction of the lymphatics in five patients of Group A vs. three patients of Group B (NS). Neither the occurrence of lymph cysts nor extravasation of lymph differed between the two groups. In seven patients no lymphatic lesion was observed. Patients with interruption of the lymphatics (n = 8) had a higher leg volume increase compared to the remaining patients with no or minor lymphatic lesions, 31.2% vs. 19.6%, respectively (p < 0.05). CONCLUSIONS: Leg oedema and the occurrence of lymphatic damage following femoropopliteal bypass surgery is not reduced by applying a lateral approach to the femoral artery in the groin. However, the higher leg volume increase in patients with lymphatic obstruction indicates that lymphatic damage could play a part in the leg oedema formation.

Aged↗

Venous haemodynamics and the occurrence of leg oedema in patients with popliteal aneurysm.

OBJECTIVES: To see whether popliteal aneurysms cause venous obstruction and to investigate leg oedema and DVT following repair. DESIGN: Prospective open clinical study. SETTING: University Department of Surgery. MATERIALS: 8 patients undergoing popliteal aneurysm repair in 9 legs (1 bilateral repair). CHIEF OUTCOME MEASURES: CT and plethysmographic evidence of vein compression, the occurrence of postoperative leg oedema and phlebographic evidence of deep venous thrombosis (DVT). MAIN RESULTS: Preoperative CT investigation showed that the aneurysm compressed the popliteal vein in 6/9 limbs where surgery was planned and in 9/10 limbs with popliteal aneurysms (patent or occluded) of > 2 cm diameter (p < 0.01). However, on the CT image, increased collateral network could be observed and most patients had normal venous drainage prior to operation as assessed by air plethysmography. Postoperatively, leg volume was measured by the formula of a truncated cone. Following vascular reconstruction, leg volume increased by 23%. Except for one patient with a confirmed DVT preoperatively, postoperative venous congestion and DVT was not observed in the operated leg as assessed by phlebography and plethysmography. CONCLUSIONS: Popliteal artery aneurysms "2 cm diameter usually compress and dislocate the popliteal vein prior to operation. However, sufficient venous drainage is maintained, possibly because of an increased collateral venous network. Disruption of lymph channels with secondary lymphoedema is probably the most important mechanism behind the leg swelling observed in patients following popliteal aneurysm repair.

Aged↗

Outcome of unreconstructed chronic critical leg ischaemia.

OBJECTIVE: To assess the outcome of unreconstructed chronic critical leg ischaemia with a special reference to the definition of CLI. DESIGN AND SETTING: A retrospective study with 1 year follow-up in an academic referral center (Fourth Department of Surgery, Helsinki University Central Hospital). MATERIAL: 105 consecutive unreconstructed patients with 136 critically ischaemic legs as defined by the European Consensus Document on Chronic Critical Leg Ischaemia. MAIN OUTCOME MEASURES: Major amputations and mortality. RESULTS: 81% of the 136 critically ischaemic legs survival 1 month, 70% three months and 54% one year. Of the 105 patients 93%, 77% and 46% were alive at 1, 3 and 12 months, respectively, whereas survival of patients with nonamputated leg was only 71%, 56% and 28%. Patients with bilateral CLI had a worse prognosis in terms of survival and leg salvage. The leg outcome was not worsened by the presence of diabetes nor by the distal extent of arterial changes. CONCLUSIONS: Although the selection of the present material is likely to cause some bias, unreconstructed CLI seemed to predict a very poor outcome in terms of survival and limb salvage.

Adult↗

Repeated episodes of transient radiating back and leg pain following spinal anesthesia with 1.5% mepivacaine and 2% lidocaine.

BACKGROUND AND OBJECTIVES: Transient radiating back and leg pain defined as pain or dysesthesias in the buttocks, thighs, or calves within 24 to 48 hours after recovery from spinal anesthesia has been described with the use of 2% and 5% lidocaine. These symptoms have also been associated with other local anesthetics such as bupivacaine and tetracaine, although with a much lower incidence. A recent case report and prospective study have described transient radiating back and leg pain occurring following spinal anesthesia with 4% mepivacaine. METHODS: We describe a case of transient radiating back and leg pain following spinal anesthesia with 1.5% mepivacaine in a patient with unrecognized spinal stenosis who had had repeated episodes of transient radiating back and leg pain associated with lidocaine spinals. RESULTS: Spinal anesthesia with 1.5% mepivacaine was associated with transient radiating back and leg pain, which was similar in quality and duration to prior episodes following spinal anesthesia with lidocaine. CONCLUSIONS: Transient radiating back and leg pain may occur with lower concentrations (1.5%) of mepivacaine, as it does with lidocaine. The relationship between transient radiating back and leg pain and spinal stenosis is also discussed.

Aged↗

Impaired venous hemodynamics in a minority of patients with chronic leg ulcers due to sickle cell anemia.

BACKGROUND: Chronic or recurrent leg ulceration occurs in 25% of sickle cell anemia patients, but not in the remaining 75%. Doppler studies of venous function were normal in 16 sickle cell anemia patients with leg ulcers. PATIENTS AND METHODS: Venous Duplex Ultrasound was used to study 33 sickle cell anemia patients with chronic leg ulcers. RESULTS: Six of the 33 patients had venous reflux in at least one leg. CONCLUSIONS: Venous insufficiency may contribute to the development of leg ulcers in a minority of sickle cell anemia patients. A minority of sickle cell anemia patients with chronic leg ulcers can be shown to have leg venous reflux by duplex ultrasound imaging.

Adult↗

Peak and kinetic cardiorespiratory responses during arm and leg exercise in patients with spinal cord injury.

STUDY DESIGN: A paired comparison of the peak and submaximal responses of oxygen uptake and heart rate in patients with spinal cord injury (SCI) performing voluntary arm cycle exercise and functional electrical stimulation (FES) leg cycling exercise. OBJECTIVES: To test if the blunted heart rate response and slower rate of adjustment of oxygen uptake seen in patients with SCI performing FES leg cycle exercise are also characteristic of arm exercise in these patients. METHODS: Eight paraplegics performed incremental and constant work rate (CWR) exercise with the legs and arms. Mean response times (MRT) for Vo2 during exercise (on) and in recovery (off) were calculated from the breath-by-breath Vo2 profile. RESULTS: Peak heart rate was higher during incremental arm exercise, and uncorrelated with that observed during incremental FES leg cycling. For the same increase in Vo2, constant work rate arm exercise was associated with faster (and normal) Vo2 kinetics, greater increase in heart rate, and lower end-exercise blood lactate, compared to FES leg cycling. CONCLUSIONS: The consistently higher peak heart rate and Vo2, and faster Vo2 kinetics, for voluntary arm compared to FES leg cycle exercise suggest no intrinsic dysfunction of heart rate control in these paraplegics. Rather, these data suggest that during FES leg cycling the changes seen are due to some characteristic specific to the injury, such as reduced muscle mass and/or deconditioning of the remaining muscle. SPONSORSHIP: This research was supported by The Department of Veterans Affairs, Rehabilitation Research and Development Project #B603-RA. Spinal Cord (2000) 38, 340 - 345.

Adult↗

Effects of leg muscle pumping and tensing on orthostatic arterial pressure: a study in normal subjects and patients with autonomic failure.

1. The effects of leg muscle pumping (tiptoeing) and tensing (leg-crossing) on orthostatic blood pressure were investigated in six healthy adult subjects (aged 28-34 years) and in seven patients with severe hypoadrenergic orthostatic hypotension (aged 20-65 years). 2. Finger arterial pressure was monitored. Relative changes in left ventricular stroke volume were computed by a pulse contour method. 3. Tiptoeing increased mean arterial pressure (7 +/- 5 mmHg) in the healthy subjects, but not in the patients, whereas cardiac output increased in both groups, although by more in the healthy adults than in the patients (35 +/- 10% versus 20 +/- 11%, P < 0.05). Systemic vascular resistance decreased substantially in both groups while tiptoeing. Leg-crossing did not affect arterial pressure in the healthy subjects, although stroke volume had increased. In contrast, in the patients an increase in cardiac output (16 +/- 12%) and mean blood pressure (13 +/- 13 mmHg) was observed. 4. Tiptoeing and leg-crossing have different effects on orthostatic blood pressure in healthy adult subjects and in patients with autonomic failure. In normal humans, tiptoeing increases arterial pressure, whereas leg-crossing has little effect. In the patients, in contrast, tiptoeing has little effect, whereas leg-crossing increases arterial pressure considerably. Patients with autonomic failure should be instructed to apply leg-crossing to combat orthostatic dizziness.

Adult↗

Postural vasoconstriction and leg ulceration in homozygous sickle cell disease.

1. Chronic leg ulceration is a major cause of morbidity in patients with homozygous sickle cell disease; the ulcers commonly resolve on bed rest. We have therefore compared the cutaneous vascular response to dependency in three groups of eight patients with sickle cell disease (those with an active ulcer, with an ulcer scar and with no history of ulceration) and in eight subjects with normal haemoglobin and no history of leg ulceration. 2. We monitored, with a laser Doppler flowmeter, the change in red cell (erythrocyte) flux induced in the skin of the leg, at two sites proximal to the malleoli, with the leg horizontal and 5 and 10 min after moving the leg to the dependent position. 3. With the leg horizontal, mean cutaneous red cell flux was substantially higher in normal skin of patients with sickle cell disease than in normal subjects and was higher still at the site of the ulcer or scar. On dependency, red cell flux fell not only in normal subjects but also in the patients with sickle cell disease, both in the normal skin and at the site of the ulcer or scar; there was no difference in any group between the 5- and 10-min values. The fall in red cell flux in normal skin of patients with sickle cell disease was smaller than in normal subjects when considered as a percentage of the control values (32%, 36%, 30% and 61% respectively in sickle cell patients with an active ulcer, with an ulcer scar and with no history of ulceration and in normal subjects), but in absolute terms the falls in red cell flux were similar in sickle cell patients and normal subjects. By contrast, the fall in red cell flux at the ulcer or scar site was greater than in normal skin from sickle cell patients whether considered as a percentage of the control value (48% and 49% respectively in those with an active ulcer or ulcer scar) or in absolute terms. 4. We propose that high resting perfusion is important in patients with sickle cell disease to maintain normal integrity of cutaneous tissue and that pronounced vasoconstriction on dependency hinders the healing and encourages recurrence of leg ulcers.

Adult↗

Chronic leg ulceration in homozygous sickle cell disease: the role of venous incompetence.

Chronic leg ulceration is a common cause of morbidity in Jamaican patients with homozygous sickle cell (SS) disease. Ulcers heal more rapidly on bed rest and deteriorate on prolonged standing, suggesting a role of venous hypertension in their persistence. This hypothesis has been tested by Doppler detection of venous competence in SS patients and in matched controls with a normal haemoglobin (AA) genotype in the Jamaican Cohort Study. Venous incompetence was significantly more frequent in SS disease [137/183 (75%)] than in non-pregnant AA controls [53/137 (39%)]. Past or present ulceration occurred in 78 (43%) SS patients, with a highly significant association between leg ulceration and venous incompetence in the same leg (P < 0.001). Prominence and/or varicosities of the veins and spontaneous leg ulcers were more common among patients with multiple sites of incompetence. The association of venous incompetence with chronic leg ulceration identifies a further pathological mechanism contributing to the morbidity of SS disease. The cause of venous incompetence is unknown but the sluggish circulation associated with dependency, turbidity and impaired linear flow at venous valves, hypoxia-induced sickling, the rheological effects of high white cell counts, and activation of components of the coagulation system may all contribute. Venous hypertension in SS patients with leg ulceration suggests that firm elastic supportive dressings might promote healing of chronic leg ulcers.

Adult↗

Leg ulcers: a review of their impact on daily life.

BACKGROUND: Current nursing care for leg ulcer patients often focuses on wound care and providing compression therapy. Nurses perceive leg ulcer patients as 'under-served' with regard to problems patients experience in daily life. An overview of patient problems is a first and essential step in the development of comprehensive nursing care. AIMS AND OBJECTIVES: To gather information about the impact of leg ulcers on patient's daily life as described in quantitative and qualitative studies. DESIGN: Systematic literature review. METHODS: Medline and Cinahl databases were searched for venous leg ulcer studies, up to 2002; this was followed by the 'snowball method'. Studies were selected in accordance with preset criteria. RESULTS: A total of 37 studies was included. All studies report that leg ulcers pose a threat to physical functioning. Furthermore, a negative impact on psychological functioning is reported and, to a lesser degree, on social functioning. Major limitations are pain and immobility, followed by sleep disturbance, lack of energy, limitations in work and leisure activities, worries and frustrations and a lack of self-esteem. Patients have a significantly poorer quality of life compared with healthy people. Finally, patients report problems with regard to follow-up treatment. CONCLUSIONS: Having a leg ulcer has a major impact on a patient's life. There are indications of under-treatment of pain. RELEVANCE TO CLINICAL PRACTICE: Keeping in mind that leg ulceration is notorious for its chronic character, the negative impact on patient's life implies that many patients suffer over longer periods of time. This emphasizes the need to focus on quality of life aspects in patient care. There is much to gain, especially concerning pain and mobility. The development of comprehensive care programmes is essential.

Activities of Daily Living↗

Nd:YAG 1064 nm laser in the treatment of facial and leg telangiectasias.

BACKGROUND: Facial and leg telangiectasias are a frequent cosmetic concern for both females and males with various skin types and ages. To date the different treatments for these problems, in particular leg telangiectasias, have frequently failed or led to negative side-effects. OBJECTIVE: This study examines the clinical effects and safety of applications with a 1064-nm Nd:YAG laser system (SmartEpil II, DEKA M.e.l.a., Florence, Italy) to treat vessels on the face and legs. MATERIALS AND METHODS: Twenty-five subjects with facial telangiectasias underwent one treatment at 100 J/cm2, 10 ms and 2 Hz repetition rate. Thirty-two subjects with leg telangiectasias, measuring 0.1-3 mm in diameter, were treated at 125-200 J/cm2, 10-30 ms and 2 Hz repetition rate. Subjects in this group underwent one to five treatment sessions at 8 week intervals. RESULTS: All subjects showed visible improvement, with 95-100% clearing of the face telangiectasias after only one treatment, and 50-100% clearing of the lower extremity vessels after three to five treatments. Transitory hypopigmentation was seen in two cases subjected to leg vessel treatment. CONCLUSIONS: Treatment of facial and leg telangectasias using a true long pulse 1064 nm Nd:YAG laser is an effective and safe method. The relative lack of discomfort combined with a high degree of individual satisfaction should play a part in the fairly high level of acceptance of this new form of therapy for the treatment of leg and face telangiectasias.

Adult↗