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PubMed1983

Efficacy of graded elastic compression in the lower leg.

Graded elastic compression stockings on the lower leg were evaluated for their ability to (1) decrease leg volume, (2) decrease circumference, and (3) alleviate discomfort. One hundred three test subjects participated in this study, including 30 normal, asymptomatic control subjects. The conditions of the 73 symptomatic patients were categorized by pain and swelling, varicose veins, venous stasis, lymphedema, and phlebitis, which constituted symptoms in 120 legs. Although total body weight did not change during the week of observation, the volume, circumference, and pain decreased in the symptomatic group. The volume of the stockinged leg decreased in comparison with the nonstockinged control leg in the asymptomatic subjects as well. We conclude that non-custom-made graded elastic stockings with 24 mm Hg of pressure at the ankle are effective in decreasing volume, circumference, and symptoms in the lower leg in patients with minimal problems during a one-week period.

Ankle↗
PubMed1983

Accurate measurements of the lower leg length and the ulnar length and its application in short term growth measurement.

A new method of lower leg measurement for the determination of endochondral growth has been described quite different from the techniques commonly utilized. Endochondral growth of the lower leg can now be detected after one week (in provided case) the growth is at least 0.15 mm. The results of the lower leg measurement were compared with those of the ulnar length measurements in a four months lasting longitudinal growth study on twenty-one normal growing children. It appeared that the new lower leg length measuring technique with a margin of error in hundreds of millimeters is even more sensitive than the ulnar length measuring technique and a substantial improvement to conventional measuring methods in which the error fault is commonly expressed in millimeters. The new technique is especially suited for the assessment of short term growth in children whose ulnar length can not be measured accurately enough. Short term growth can now be followed in children from about the age of two years without using X-rays. This new technique permits: 1. Short term growth studies; 2. Studies of drug effects on tibia in single individuals within short time intervals; 3. Comparison of the growth in length of the lower leg and the ulna within time intervals as short as three weeks. 4. Studies in biorhythms of the lower leg length.

Adolescent↗
PubMed1983

A study of combined arm and leg exercise with application to nordic skiing.

A laboratory test was developed to study the metabolic and gas exchange effects of arm, leg and combined arm and leg work. The test incorporated movement patterns similar to those used in cross-country skiing. The work rate for the arm test at maximal effort was 33% (125 watts) and the leg test was 81% (302 watts) of that for the combined test (375 watts). The maximum oxygen uptake (VO2 max) was not significantly different when comparing the leg test to the combined test, but VO2 at submaximal work levels was significantly less during the combined test. The anaerobic threshold (AT) occurred at 68, 73 and 76% of VO2 max for the arm, leg, and combined test, respectively. Although there were no significant differences in VO2 and percent of VO2 max, at the AT between the leg test and the combined test, AT was significantly delayed with respect to time and work rate in the latter condition. Application of these results to cross-country skiing supports the proposal for greater upper body involvement in skiing.

Arm↗
PubMed1995

Leg cramps: differential diagnosis and management.

Leg cramps are a common problem, especially in the elderly. The differential diagnosis is extensive and includes the following conditions: true cramps, such as those related to heat, hemodialysis and electrolyte disturbances, as well as idiopathic cramps (the most common type); contractures occurring in conditions such as metabolic myopathies and thyroid disease; tetany, which is usually related to electrolyte disturbances, and dystonias, such as occupational cramps and those related to antipsychotic medications. Other leg problems that are not cramps, such as restless legs syndrome and periodic leg movements, also must be distinguished. The etiology of idiopathic leg cramps is not clear. Treatments for leg cramps include stretching exercises, quinine sulfate and vitamin E, but no treatment is conclusively effective. Nonetheless, in many patients relief of symptoms is achieved with one or more of these treatments.

Diagnosis, Differential↗
PubMed1995

A study of leg-crossing in a German sample.

When a person is asked to cross their flexed legs then one thigh crossed over the other. This paper reviews the previous literature on leg crossing, and reports new data. In this study about 62% of the population (n = 292) are right leg-crossers, 26% are left leg-crossers, and the remaining 12% report that they have no preference or are indifferent. The incidence of left leg-crossing differs between the sexes, being higher in males, although there seems to be no association with age. Leg-crossing is correlated to some extent with footedness, handedness and eyedness.

Adult↗
PubMed1994

Arthropathica ulcerosa: a study of reduced ankle movement in association with chronic leg ulceration.

OBJECTIVE: To quantify the clinical impression that reduced ankle movement occurs in association with chronic lower leg ulceration, to obtain data on the relation between severity and duration, and to assess the role of other factors such as age, smoking, and lipodermatosclerosis. METHODS: Ipsilateral and contralateral passive range of movement (ROM) of the tibiotalar joint were measured in 38 patients with chronic ulceration of the lower leg. Passive ROM in 40 elderly patients without venous ulceration was also measured. Subjects with chronic ulceration had a mean duration of current ulceration of 3.4 years but a mean total duration of ulcer disease of 19.2 years. RESULTS: A significant difference in passive ROM was noted between ipsilateral and contralateral legs (ROM ipsilateral leg 36.3 +/- 10 degrees; ROM contralateral leg 45.3 +/- 13 degrees, t = -3.27, p = 0.002). No significant difference in equilibrium position at the ankle was observed between normal and affected legs. Multiple regression analysis revealed that for every year of life the patient lost 0.36 degree of tibiotalar movement and for every year of active ulceration the patient lost 0.78 degree of movement. This restriction of movement was not associated with the presence of lipodermatosclerosis nor with smoking history. CONCLUSION: A reduction in movement in the dorsovolar plane occurs in the ankle joint adjacent to chronic ulceration and, the longer the period of ulceration, the greater the restriction of movement.

Aged↗
PubMed1993

Responsiveness of leg alignment changes associated with articular pressure testing to spinal manipulation: the use of a randomized clinical trial design to evaluate a diagnostic test with a dichotomous outcome.

OBJECTIVE: A study was undertaken to assess the stability of leg alignment reaction to a pressure challenge and its responsiveness to an adjustive intervention. DESIGN: Prospective, double-blind clinical trial of a diagnostic test. SETTING: Laboratory: Center for Technique Research. PARTICIPANTS: Forty-two chiropractic college students, faculty and staff. INTERVENTIONS: A high-velocity, low-amplitude, short lever adjustment of a single vertebra from among C1 and T3-T7; or a sham adjustment similar to a manual diagnostic pressure test at C1, T3-T7 or T9-T10. MAIN OUTCOME MEASURES: Leg alignment reactivity: An increase in leg alignment discrepancy (yes or no) following a metered pressure challenge to a vertebra. RESULTS: On average, stability was poor at T3-T7 (Kappa = 0.04), moderate at C1 (K = 0.47), and fair for sham pressure tests (K = 0.30). Responsiveness: The proportion of positive baseline leg alignment reactions that responded (became negative) to sham adjustment was 95% at T3-T7 and 55% at C1. Further analysis was untenable since too few vertebrae were implicated for an adjustment. CONCLUSIONS: For the population investigated, the majority of the responsiveness of the leg alignment diagnostic test to a rotatory adjustment appears to be a diagnostic illusion (i.e., background noise unrelated to a treatment intervention). Further research with different subject populations, regions of investigation, leg alignment measurement techniques and vertebral challenge techniques are indicated.

Adult↗
PubMed1996

Local control of leg movements and motor patterns during grooming in locusts.

This study demonstrates that the thoracic and abdominal nervous system of locusts is sufficient to mediate several site-specific and distinct grooming leg movements. Locusts can use a hindleg or middle leg to groom at least four ipsilateral thoracic and abdominal sites, without input from the brain, subesophageal ganglion, or prothoracic ganglion. The hindleg is used to groom the posterior abdomen, the ventral or posterior hindleg coxa, and the ear; the middle leg is used to groom the anterior hindleg coxa. Grooming movements are often rhythmic and display site-specific intralimb coordination patterns. During grooming of the posterior abdomen or ventral hindleg coxa, for example, hindleg tibial extension occurs nearly simultaneously with femur elevation, in contrast with locust hindleg movements during walking. Electromyographic (EMG) recordings during these movements show that rhythmic bursts of tibial extensor activity occur nearly in-phase with those of trochanteral levators, in contrast to hindleg EMGs during walking. During grooming of the ear, hindleg tibial extension/flexion and tibial extensor/flexor muscle bursts can occur independently of the femur elevation/depression and trochanteral levator/depressor muscle bursts, suggesting that the neural modules controlling tibial and femoral movements can be uncoupled during this behavior. Tibial extension can occur before, or even in the absence of, tibial extensor muscle activity, suggesting that spring-like properties of the leg and energy transfer from femur motion may play important roles in such leg movements. Adjacent legs sometime show coordinated femur movement during grooming with one hindleg, suggesting that grooming may also involve interlimb coordination.

Animals↗
PubMed1997

Leg ulcers in Klinefelter's syndrome--further evidence for an involvement of plasminogen activator inhibitor-1.

An abnormality in platelet aggregability or fibrinolysis, namely elevated activity of plasminogen activator inhibitor-1 (PAI-1), has been recently documented in patients suffering from Klinefelter's syndrome associated with leg ulceration without underlying venous insufficiency. To determine whether increased PAI-1 activity is a general feature of Klinefelter's syndrome, or more specifically associated with leg ulceration, we investigated PAI-1 influencing parameters and PAI-1 activity in two groups of patients: (i) Klinefelter patients suffering from leg ulceration (n = 7); and (ii) Klinefelter patients without leg ulceration (n = 6). On analysing PAI-1 influencing parameters such as age, body mass index, triglycerides, C-reactive protein, testosterone, smoking behaviour, the presence of diabetes mellitus, and arterial hypertension, respectively, we found no statistically significant differences between the two groups. However, PAI-1 activity in group 1 was highly significantly elevated compared with that in group two patients (P < 0.005). We conclude that (i) PAI-1 activity is not elevated in Klinefelter's syndrome in general; (ii) elevation of PAI-1 activity in patients suffering from Klinefelter's syndrome does not appear to be secondary to PAI-1 influencing parameters; and (iii) elevation of PAI-1 activity may play a crucial role in the pathogenesis of leg ulceration in Klinefelter's syndrome. Therefore, a therapy for leg ulceration in Klinefelter's syndrome that aims to return the elevated PAI-1 activity to normal should be explored.

Arterial Occlusive Diseases↗
PubMed1996

Premotor interneurons in generation of adaptive leg reflexes and voluntary movements in stick insects.

We investigated the role of local nonspiking interneurons involved in motor control of legs in the stick insects, Carausius morosus. In a preparation that allowed the animals to perform active leg movements such as adaptive tactile reflexes, proprioceptive reflexes, and walking, we gathered the following results. Almost all tested nonspiking interneurons that provide synaptic drive onto moto-neurons of the proximal leg muscles contribute to all of the motor programs underlying tactile reflexes and voluntary leg movements such as walking, searching, and rocking. Most of them are also involved in the generation of proprioceptive reflexes. All motor programs for coactivation, avoidance reflexes, resistance reflexes, and voluntary leg movements result from parallel pathways including nonspiking interneurons that support and others that oppose the motoneuronal activity. The contribution of a single interneuron to the different motor program is specific: it can be supporting for one motor program but opposing for the other. Even for the same motor program, for example, coactivation, the contribution of an individual interneuron can depend on the stimulus site from where the response is elicited. Our results support the idea that the different motor patterns for adaptive tactile reflexes, resistance reflexes, and voluntary leg movements emerge from a multifunctional neuronal circuit that is reorganized corresponding to the motor behavior performed. The actual motor pattern is then shaped by distributed information processing in parallel supporting and opposing pathways.

Acclimatization↗
PubMed2000

Convergence of load and movement information onto leg motoneurons in insects.

The interaction of two feedback loops was investigated: one regulating cuticular stress in the stick insect's leg and the other controlling leg posture. Exclusive stimulation of either of the two relevant sense organs, the load-sensitive trochantero-femoral campaniform sensilla (CS) or the position-/movement-sensitive ventral coxal hairplate (cxHPv), elicits resistance reflex responses in the retractor and the protractor coxae motoneuron pools. Concurrent application of both stimulus modalities reveals that the strength of the postural feedback response is dependent on sign and amplitude of the load feedback response and vice versa. This superposition of the two reflex responses appears to be non-linear. The results indicate that the CS information is underlying a force control function in this six-legged animal. It is hypothesized that the force control of each single leg could help to optimize the force distribution of the six-legged system, even - due to the mechanical coupling - without explicit neuronal pathways. On the level of the single leg control it was studied whether the different information provided by the two feedback transducers converge on the level of retractor coxae motoneurons or whether this information is fully preprocessed at the level of premotor interneurons. It is shown here that the hairplate afferents make direct, excitatory connections with the retractor motoneurons. Studies of the motoneurons' membrane conductances during exclusive CS stimulation reveal that both, excitatory as well as inhibitory synaptic drive is delivered onto the retractor motoneurons. Thus, the motoneuronal membrane is shown to be an important stage for the sensor fusion of the two modalities.

Animals↗
PubMed2006

Electromagnetic therapy for treating venous leg ulcers.

BACKGROUND: Leg ulceration is a common, chronic, recurring condition. The estimated prevalence of leg ulcers in the UK population is 1.5 to 3 per 1000. Venous ulcers (also called stasis, or varicose ulcers) comprise 80 to 85% of all leg ulcers. Electromagnetic therapy is sometimes used as a treatment to assist the healing of chronic wounds such as venous leg ulcers. OBJECTIVES: To assess the effects of electromagnetic therapy on the healing of venous leg ulcers. SEARCH STRATEGY: For this first review update, we searched the Cochrane Wounds Group Specialised Register (last searched October 2005); CENTRAL (The Cochrane Library 2005, Issue 4); MEDLINE (1966 to October 2005); EMBASE (1980 to October 2005); and CINAHL (1982 to October 2005). SELECTION CRITERIA: Randomised controlled trials comparing electromagnetic therapy with sham electromagnetic therapy or other treatments. DATA COLLECTION AND ANALYSIS: For the original review, details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing data by contacting authors. A second reviewer checked data extraction. Meta-analysis was applied to combine the results of trials where the interventions and outcome measures were adequately similar. For this first update, two reviewers independently scrutinized the results of the search to identify relevant RCTs and obtained full reports of potentially eligible studies. In the case of disagreements, a final decision was made either after discussion between two reviewers or consultation with a third party (a member of the Cochrane Wounds Group). MAIN RESULTS: This update identified no new trials. A total of three eligible RCTs were identified by the original review. Two trials compared the use of electromagnetic therapy with sham therapy and one trial compared it with standard topical treatments. One trial found a difference in healing rates of borderline statistical significance between electromagnetic therapy and sham therapy, although the direction of treatment effect was consistently in favour of electromagnetic therapy, the difference was not statistically significant. AUTHORS' CONCLUSIONS: There is currently no reliable evidence of benefit of electromagnetic therapy in the healing of venous leg ulcers. Further research is needed.

Electric Stimulation Therapy↗
PubMed1988

A population of ascending intersegmental interneurones in the locust with mechanosensory inputs from a hind leg.

A population of some 35 intersegmental interneurones with somata in the metathoracic ganglion has been characterized by intracellular recording and staining. These interneurones integrate signals from extero- and proprioceptors on a hind leg. The somata are clustered in an anterior and lateral region of the dorsal cortex, and the axons project to more anterior ganglia in either the ipsilateral or contralateral connectives. Some of these interneurones are excited by afferents from a proprioceptor at the femorotibial joint, the femoral chordotonal organ. An afferent spike evokes a chemically mediated EPSP in an interneurone with a latency and consistency that suggest that the connection is direct. An individual interneurone codes particular features of the movement about the femorotibial joint, responding to flexion, extension, or both directions of movement with either phasic or tonic responses. These interneurones have an extensive field of fine branches ipsilateral to the hind leg from which they receive input. These branches are in lateral and intermediate regions of neuropil to which the afferents of the chordotonal organ also project. Axonal branches, from either an ipsilateral and contralateral axon, are sparse and varicose and occur in dorsal neuropil. Other interneurones are excited by afferents from exteroceptive hairs (trichoid sensilla). An individual interneurone is excited by a particular array of hairs on specific regions of a hind leg. The connections between the afferents and the interneurones appear direct. These interneurones have a dense and compact array of fine branches ipsilateral to the hind leg from which they receive input. These branches are in the most ventral region of neuropil, to which the hair afferents also project. Branches from the ipsilateral axons are sparse and varicose and occur in more dorsal neuropil. The interneurones can thus provide the more anterior ganglia with precise information about the movement of a joint in a hind leg and of the location of an exteroceptive stimulus. This information would be of importance in ensuring the correct co-ordination of the legs during walking.

Animals↗
PubMed1993

Muscle contraction increases the structural capacity of the lower leg: an in vivo study in the rat.

A model to study the contribution of muscle contraction to the structural capacity of the rat tibia was developed. The right lower leg was tested to failure in three-point ventral bending during electrically stimulated muscle contraction. The left lower leg was tested without stimulation, as a control. The mean ultimate bending moment for the stimulated legs was 0.603 Nm, compared with 0.492 Nm for the unstimulated legs (p < 0.001). The ultimate energy absorption was 0.313 and 0.188 J in the stimulated and unstimulated legs, respectively (p < 0.01). Fracture strength has been studied nearly exclusively in dissected bone stripped of all soft tissues. The present investigation suggests that studies of dissected bone are incomplete compared with the in vivo situation, as contraction of the muscles substantially increased the fracture strength of the lower leg in rats.

Animals↗
PubMed1994

Periwound skin microcirculation of venous leg ulcers.

Chronic venous ulceration has an estimated prevalence of from 0.06 to 1.3% with about 57 to 80% of patients with leg ulcers having demonstrable venous disease. The sequence of events whereby chronic venous insufficiency leads to leg skin ulceration is not yet worked out. Venous hypertension may set the stage for subsequent ulcer development via linkages to observed changes in skin microvessel metrics, morphology, rheology, permeability, hemodynamics, and the interstitium. Periulcer measurements show decreased transcutaneous oxygen and elevated carbon dioxide tensions, yet the skin blood perfusion measured with laser Doppler fluxometry (LDF) is reported to be elevated. This elevated perfusion, (Q), could be due to independent changes in blood velocity (U), and volume (V), with different mechanistic implications depending on the mode. Thus, we sought to determine the relative contributions of these two components with the aim of clarifying the mechanism responsible for the reported skin flow changes. Patients studied (n = 16) had unilateral venous ulcers, an ankle/brachial BP index > 0.8, and venous pathology demonstrated by duplex imaging. Ulcer areas ranged from 0.6 to 76.9 cm2 (mean = 13.7 cm2) and were present for 2 to 144 months, mean = 32. With the patient supine, Q (ml/min/100 g), V (%), and U (mm/sec) were measured by LDF (Vasamedics, BPM403A) at two to three sites on periulcer skin and compared with measurements at corresponding sites on the nonulcerated limb at local skin temperatures of 35 and 44. Results confirm an elevation in basal periulcer flow (7.0 vs 1.8 ml/min/100 g, P = 0.001) and show this to be due to elevations in both circulating blood volume (1.24 vs 0.62%, P < 0.001) and velocity (1.23 vs 0.65 mm/sec, P = .004). Maximal Q, V, and U were also higher on the ulcer leg, being for Q, 11.2 vs 6.42 ml/min/100 g, P = 0.03; for V, 1.49 vs 1.13%, P = .002; and for U, 1.76 vs 1.33 mm/sec, P = 0.020. Expressing each leg's basal values as a percentage of its own maximal response shows the ulcerated leg to have higher values for Q, V, and U, with (ulcer leg/control leg) ratios being 2.5, 1.8, and 1.4, respectively. These findings show that the LDF perfusion increase is due to roughly equal increases in microvessel circulating blood volume and velocity.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Motion analysis of leg joints associated with escape turns of the cockroach, Periplaneta americana.

Considerable information is now available on the neural organization of the escape system of the American cockroach. To relate these data to the behavior, we need detailed information on the movements made at the principle leg joints that produce the turn. We used motion analysis of high speed video records to acquire such information. Records from both free ranging and tethered animals were analyzed. 1. We analyzed individual joint movements using a tethered preparation. Stimuli from 4 different angles around the animal were used. For all wind angles, the femur-tibia (FT) joint on the mesothoracic leg that is ipsilateral to the wind source extended while the contralateral mesothoracic FT joint flexed. This moved both of these legs laterally toward the wind source. In freely moving animals the FT movements provide forces that turn the animal away from the wind source. 2. The ipsilateral mesothoracic coxa-femur (CF) joint extended for all wind angles. The contralateral mesothoracic CF joint extended in response to most winds from the rear, but switched to flexion in response to wind from the side and front. As a result of these joint movements, rear wind resulted in rearward movements of the contralateral mesothoracic leg, while side and front wind resulted in more forward movements of that leg. 3. The CF and FT joints for both ipsilateral and contralateral metathoracic legs extended to wind from the rear and switched to flexion as the wind was placed at more anterior positions around the animal. In freely moving animals, extension of these joints would push the animal forward. Flexion would pull the animal backward. 4. Several of the joints showed correlations between rate of movement and initial joint angle. That is, joints that were already flexed at the onset of stimulation tended to move at a faster rate to a final position than joints that started at a more extended position. 5. Metathoracic FT and CF joints showed a high degree of positive correlation during the escape movements. Indeed, many curves showing movement of metathoracic FT and CF joints with time were virtually identical.

Animals↗
PubMed1976

An analysis of muscle weight variations in the wing and leg of Sturnus vulgaris.

Dry weights of 18 wing and 23 leg muscles from both sides of 15 adult male starlings (Sturnus vulgaris) were determined. By means of factor analysis it is calculated which part of the variance in a muscle's weight can be accounted for by common factors and which part by the characteristics of the muscle itself (residual variance). Wing and leg muscles are analysed separately. From the wing muscle analysis one can draw the following inferences: 1. Three hierarchically ordered factors represent 66%, 8% and 6% of the total variance in the wing muscles. The first common factor will most likely reflect the size variation of the starlings. 2. It appeared advisable to perform rotation of the original factor solution because the second and third factor are bipolar. 3. The three rotated factors can not be interpreted as embryological sources of weight variations and are not related to the segmental or peripheral innervation of the muscles, but generally correspond with three groups of actions that the wing muscles perform. 4. Muscles correlated with the first rotated factor generally move the humerus, while muscles that move the forearm and (parts of) the hand are correlated with the third and second rotated factor, respectively. From the leg muscle analysis it follows that: 1. Five hierarchically ordered factors represent 57%, 13%, 7%, 6% and 4% of the total variance in the leg muscles. Body size (factor 1) plays a more important role in the wing than it does in the leg. 2. It was advisable to rotate the original factor solution since four bipolar factors are present. 3. As in the wing, residual variance shows no particular relation with the mean weight of a muscle. 4. As in the wing, the five rotated factors can only be related to five groups of muscle actions. 5. Muscles correlated with the five rotated factor cause protraction, adduction or inward rotation of the leg or combinations of these movements, whereas muscles correlated with the fourth rotated factor can perform the antagonistic actions. Muscles related to the third rotated factor flex the tarsometatarsus of flex more digits simultaneously, while muscles related to the second rotated factor flex a single digit or extend the tarsometatarus. The fifth rotated factor is a peculiar one since only the mm. peronei are correlated with it. The possibility to apply factor analysis also to experimental stimulated hypertrophy studies and to interspecific muscle weight analyses is discussed.

Animals↗
PubMed2005

[The influence of the C-leg knee-shin system from the Otto Bock Company in the care of above-knee amputees. A clinical-biomechanical study to define indications].

The C-Leg microprocessor-controlled knee-shin system for the above-knee amputees is introduced as a dramatic improvement over all other prosthetic knees. This is due to its combination of on-board microprocessor and the hydraulic controls acting both on the swing and stance phase. A more secure, natural and efficient gait is expected. Following the recommendations of Otto Bock the indications for the prescription of the C-leg are: Amputees with mobility level "able to walk outdoors without limitations" (AK3) and "able to walk outdoors without limitations plus engage in high performance activities" (AK4) if they face at least one extra obstacle as listed in the Otto Bock catalogue of indications. In this article it is aimed to critically review the indications for the C-leg. In particular the question is posed, whether a different or sophisticated indication of mobility levels might be suggested. Therefore this study does not concentrate on the 3C-100 C-Leg((R)) component but on the system patient + C-leg. So the testing is done by comparing the C-Leg against the regular knee, which is assumed to be an adequate choice for this patient and to which he is accustomed. So far 25 patients with activity levels AK 2 (5), AK 3 (13) and AK 4 (7) have participated in the study. 23 patients, i.e. all patients except one AK 2 and one AK 3 exhibit functional improvement at least according to one criterion. On the other side, only three patients (2 AK 4), fulfill all criteria of functional improvement, which have been defined for this test. It is concluded, that multi-handicapped patients of all activity levels generally experience substantial improvement due to this system. AK 2 patients may show significant functional improvement. As a prerequisite, however, they must not exhibit deficiencies regarding stump movement, muscular status or cognitive abilities. Active patients (AK 3 and AK 4) benefit in the majority of cases. However, some highly active patients of AK 4 complain about interferences between their intended movement and the microprocessor control of knee movements.

Adolescent↗