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Arm to leg coordination in elite butterfly swimmers.

This study proposed the use of four time gaps to assess arm-to-leg coordination in the butterfly stroke at increasing race paces. Fourteen elite male swimmers swam at four velocities corresponding to the appropriate paces for, respectively, the 400-m, 200-m, 100-m, and 50-m events. The different stroke phases of the arm and leg were identified by video analysis and then used to calculate four time gaps (T1: time gap between entry of the hands in the water and the high break-even point of the first undulation; T2: time gap between the beginning of the hands' backward movement and the low break-even point of the first undulation; T3: time gap between the hands' arrival in a vertical plane to the shoulders and the high break-even point of the second undulation; T4: time gap between the hands' release from the water and the low break-even point of the second undulation), the values of which described the changing relationship of arm to leg movements over an entire stroke cycle. With increases in pace, elite swimmers increased the stroke rate, the relative duration of the arm pull, the recovery and the first downward movement of the legs, and decreased the stroke length, the relative duration of the arm catch phase and the body glide with arms forward (measured by T2), until continuity in the propulsive actions was achieved. Whatever the paces, the T1, T3, and T4 values were close to zero and revealed a high degree of synchronisation at key motor points of the arm and leg actions. This new method to assess butterfly coordination could facilitate learning and coaching by situating the place of the leg undulation in relation with the arm stroke.

Acceleration↗

[Regional hyperthermic fibrinolytic perfusion in postoperative deep venous thrombosis of the leg].

Four days after an operation for fusion of lumbar and sacral vertebrae a 30-year-old man developed bilateral deep-vein thrombosis in the legs, extending on the left from the fibular group of veins to the popliteal vein. On the right all deep veins of the lower leg were occluded, including the confluence of the popliteal vein. As systemic fibrinolysis was contraindicated, surgical thrombectomy was undertaken. After incomplete removal of the thrombi, regional hyperthermic perfusion with streptokinase was performed using a heart-lung machine. After a compression bandage had been applied to the right leg above the veins the leg was perfused via the common femoral vein at 40 degrees C from the heart-lung machine, at a flow rate of 600-800 ml/min, for 60 min with a solution containing 1 million IU streptokinase. Measurement of various components in the perfusate indicated marked fibrinolysis (fibrinogen: not measurable; fibrinogen breakdown products: > 80 micrograms; streptokinase: 100 FU/ml after 30 min, 62 FU/ml after 60 min). At the same time there was no demonstrable fibrinolytic activity in the systemic circulation. Fibrinogen concentration fell from 340 mg/dl 30 min before the onset of perfusion to 245 mg/dl 90 min after it. After 60 min of perfusion the blood from the right leg was discarded and the leg flushed through with 1.5 l of an electrolyte solution and then filled up with previously obtained and stored patient's own blood concentrate. Subsequent phlebography and venous occlusion plethysmography demonstrated complete recanalization of the deep-vein system with normal venous valve function.

Adult↗

The effect of 10-degree leg elevation and 30-degree head elevation on body displacement and sacral interface pressures over a 2-hour period.

OBJECTIVE: This pilot study was undertaken to determine the effects of a 10-degree leg elevation for 30-degree head-up position on body displacement and sacral interface pressure for 2 hours. DESIGN: The study used a comparative, quasi-experimental design with repeated measures. SETTINGS AND SUBJECTS: A convenience sample of 10 healthy Japanese women was used. INSTRUMENTS: Body displacement was defined as the difference over time between the top edge of the mattress and subject's acromion and was measured every 10 minutes by tape measure (in centimeters). Sacral interface pressure was measured every 10 minutes using a pneumatic pressure sensor. METHODS: The subject was placed supine on a standard hospital bed. The head of the bed was then elevated to 30 degrees according to 2 protocols: (1) supine for 10 minutes without leg elevation alternating with 10 minutes of side-lying, or (2) supine for 10 minutes with leg elevation at 10 degrees alternating with side-lying every 10 minutes. Body displacement and mean sacral interface pressures in both protocols were compared by using repeated measures analysis of variance. RESULTS: The 30-degree head-up position with 10-degree leg elevation significantly reduced the amount of body displacement at the acromion compared with no elevation of the legs. There were no significant differences in mean sacral interface pressure in either position. CONCLUSION: Leg elevation at 10 degrees in the 30-degree head-up position was effective for reducing body displacement at the acromion; it was not effective for reducing sacral interface pressures.

Adolescent↗

Is bilateral ultrasound scanning of the legs necessary for patients with unilateral symptoms of deep vein thrombosis?

PURPOSE: The purpose of this study was to determine the necessity of bilateral lower-extremity venous duplex ultrasound scanning in patients with unilateral symptoms of deep vein thrombosis (DVT). PATIENTS AND METHODS: A retrospective review of 1080 bilateral venous duplex scans was performed. Patients were randomly selected from a total of 7922 studied between May 1998 and May 2000. Data on patient age, sex, comorbidity, and the reason for ultrasound scan were compiled. Forty percent (435/1080) of patients presented with unilateral symptoms of lower-extremity DVT. This group was further analyzed according to their status as inpatients or outpatients. RESULTS: DVT was diagnosed in 26.9% (117/435) of the patients. Of the inpatients found to have DVT, the thrombus was confined to the symptomatic leg in 23.8% (38/159), thrombus was present just in the asymptomatic leg in 8/159 (5.0%), and thrombus was found in both legs in 8/159 (5.0%). In the outpatient group, thrombus was confined to the symptomatic leg in 21.0% (58/276) and found in both legs in 1.8% (5/276). None of the 276 outpatients had DVT isolated in the asymptomatic leg. CONCLUSION: Routine bilateral lower-extremity venous duplex studies are not necessary in outpatients presenting with unilateral symptoms. In many outpatients, a single-limb study will suffice. If a patient is found to have a DVT on the symptomatic side, then we believe that a bilateral study is indicated. We do believe that routine bilateral scanning of inpatients remains justified. This algorithm may save technician time and increase vascular laboratory efficiency.

Algorithms↗

Twisted legs in broilers.

The effect of various factors on the incidence of leg abnormalities, with particular reference to twisted leg, in broilers was studied. The incidence of twisted legs was influenced by strain and for males was twice that for females. There was also a higher incidence in cages than on litter with the type of cage floor having an effect: broilers reared on floors of metal wire and perforated sheets had more leg problems than those reared on plastic mats and plastic-covered wire. Although vitamin and mineral supplementation had no effect on caged broilers, a restriction of metabolisable energy (ME) intake during the first 14 d after hatching halved the frequency of leg abnormalities compared with those fed ad libitum. Studies of cage size and location of water suggested that a lack of exercise increases the incidence of leg abnormalities.

Animals↗

Joint-space width in the weight-bearing radiogram of the tibiofemoral joint. Should the patient stand on one leg or two?

PURPOSE: The aim of the study was to compare the minimal joint-space (MJS) width of the tibiofemoral joint (TFJ) in weight-bearing radiograms with the patient in two different positions. MATERIAL AND METHODS: From a study of 54 patients with chronic knee pain (aged 42-59 years, mean 52 years), we selected 21 consecutive patients for this study. In these 21 patients, both knees were examined by means of p.a. weight-bearing radiograms in semiflexion with fluoroscopic guidance. The patient stood with the weight: 1) almost entirely on the examined leg; and 2) equally distributed on both legs. The MJS was measured with a scale loupe in tenths of a millimeter in the medial and lateral compartments of the TFJ. RESULTS: With the patient standing on one leg, the MJS was 0.18 mm wider (p<0.006) in the medial compartment and 0.18 mm narrower (p<0.029) in the lateral compartment as compared to standing on both legs. CONCLUSION: With the technique used, the assessment of the MJS width in the p.a. view of the TFJ in weight-bearing examinations should be performed with equal weight on both legs. Standing on only the examined leg might be an option in cases of suspected narrowing in the lateral compartment.

Adult↗

A Device for Preventing Occupational Diseases of Lower Legs.

Physiological processes characteristic of the fatigue of legs mainly appear when the worker's activity requires standing. If the processes are intensive and regular, various diseases of legs, such as varicose veins and musculoskeletal disorders of legs and feet, can develop. Therefore, methods of reducing the fatigue of legs are important in occupational health protection. Air jet massage technology was developed and an appropriate massage device was built by the authors. The massage head turning around the lower leg and moving up and down gradually covers the leg's surface. To determine the efficiency of the massage, fatigue processes were studied. These studies showed that jet massage effectively reduces both the subjective and objective fatigue symptoms. The device is convenient for use in industry, services, and at home.

Journal Article↗

Ground scratching and preferred leg use in domestic chicks: changes in motor control in the first two weeks post-hatching.

Lateralisation of a variety of visual functions: food discrimination, fear response, copulation, and performance of topographical and other tasks, such as olfactory and auditory functions, have been described in the domestic chick, Gallus gallus domesticus. A bias to left hemisphere control on day 8 and to the right on day 11 has also been demonstrated in the domestic chick. In this study we show that motor control as to foot preference in initiating a scratching bout and a tape-removing task is lateralised in both adults and chicks. There was a preference for the right leg to initiate a bout of ground scratching in both male and female adult birds. Second, foot preference is also affected by the changes in shifts of bias on day 8 and day 11. The right leg preference in initiating a ground scratching bout observed on day 5 is reversed to a left leg preference on day 8. This then reverts to the right leg preference after day 11. Hence it is postulated that the hemisphere that is not activated due to the bias of age controls the first leg to be used in initiating routine movements such as ground scratching. For the tape-removing task the right leg was used to remove a tape adhered to the beak of the chick for the trained group on day 8; but there was no preference in the naive group. Similarly, on day 11 a left foot bias was observed for the trained group and right foot bias for the naive group. To remove a tape the activated hemisphere on days of bias is used; whereas in a novel situation the foot use is reversed. Thus, footedness is affected by age, type of task, and changing hemispheric dominance.

Journal Article↗

Evidence for a non-linear relationship between leg strength and gait speed.

Although the relationship between strength and physical performance in older adults is probably non-linear, few empirical studies have demonstrated that this is so. In a population-based sample of adults aged 60-96 years (n = 409), leg strength was measured in four muscle groups (knee extensor, knee flexor, ankle plantar flexor, ankle dorsiflexor) of both legs using an isokinetic dynamometer. A leg strength score was calculated as the sum of the four strength measurements in the right leg. Usual gait speed was measured over a 15.2 metre course. With a linear model, leg strength explained 17% of the variance in gait speed. Non-linear models (quadratic and inverse) explained significantly more variance (22%). The nature of the non-linear relationship was that, in stronger subjects, there was no association between strength and gait speed, while in weaker subjects, there was an association. Body weight and age also explained significant amounts of variance in gait speed, while sex and height did not. The results supported the hypothesis of a non-linear relationship between leg strength and gait speed that is similar for older men and women. This finding represents a mechanism for how small changes in physiological capacity may have substantial effects on performance in frail adults, while large changes in capacity have little or no effect in healthy adults.

Adult↗

Direct leg lengthening.

Twenty patients with an average posttraumatic leg length shortening of 4.6 cm (range 2.5-9) underwent direct leg lengthening. The operation time averaged 210 min and the peroperative blood loss was 1,800 ml. Angular and rotational malalignment, when present, were corrected. Lengthening averaged 3 cm. At follow-up, two patients had serious sequelae after vascular injuries. Seven patients had postoperative neurological complications, which in four cases resolved completely. The time required for solid union of the lengthened segment averaged 10 months. Bone grafting two or more times was performed in six patients. Seventeen patients were assessed an average of 7 years (range 3-10) after surgery. Thirteen of these were satisfied with the results of the lengthening. Complications of the procedure and/or a remaining major leg length inequality could explain the dissatisfaction of the others. A majority of the patients complained of low-back pain both preoperatively and at follow-up. Few complaints about the joints in the long leg were expressed. Preoperative pain about the hip and knee in the short leg existed in more than half of the patients, and these complaints were reduced on a weak statistical level at follow-up. Walking ability improved in 12 patients, working ability in 10, and recreational activity level in eight. Direct leg lengthening is generally regarded as major, demanding surgery, entailing potential risks of serious complications, and should be used with great care and only in selected cases.

Adolescent↗

Clinical evaluation of bowed legs in children.

Early radiographic screening and/or referral to a clinical specialist are often used to distinguish between physiologic bow leg deformity and infantile tibia vara disease in young children. These practices are a consequence of the clinician's inability (based upon the clinical examination) to distinguish between the deformities associated with physiologic and pathologic bow legs. Because the great majority of these children have physiologic bowing, routine radiographic screening and referral are not cost effective and expose children to unnecessary radiation. This study describes and evaluates the efficacy of a simple clinical examination technique, the 'cover up' test, to identify young children with bow legs who are at high risk for having infantile tibia vara. The 'cover up' test qualitatively assesses the alignment of the proximal portion of the shank or lower leg relative to the thigh or upper leg. Obvious valgus alignment is considered a negative test and is indicative of physiologic bowing. Neutral or varus alignment is considered a positive test and suggests that the child is at greater risk for having infantile tibia vara. Eighteen children with infantile tibia vara, evaluated initially prior to 3 years of age, and followed to the time of surgical correction, were compared with 50 children with physiologic bowing, also evaluated initially prior to 3 years of age and followed to resolution (mean follow-up 3 years and 10 months). All of the children with infantile tibia vara had a positive 'cover up' test (sensitivity = 1.00). Eighteen of 25 children with a positive 'cover up' test actually had or developed infantile tibia vara (positive predictive value = 0.72). Forty-three of 50 children with physiologic bowing had a negative 'cover up' test (specificity = 0.86). All of the children with a negative 'cover up' test actually had physiologic bowing (negative predictive value = 1.00). We conclude that the 'cover up' test is an effective screening tool for the assessment of bow legs in children between 1 and 3 years of age. Children with a negative 'cover up' test do not require radiographic evaluation and should be followed clinically for resolution of the bowing. Children with a positive 'cover up' test should have radiographic evaluation of the lower extremities or be referred to a specialist for further evaluation and treatment.

Bone Diseases, Developmental↗

Running in the real world: adjusting leg stiffness for different surfaces.

A running animal coordinates the actions of many muscles, tendons, and ligaments in its leg so that the overall leg behaves like a single mechanical spring during ground contact. Experimental observations have revealed that an animal's leg stiffness is independent of both speed and gravity level, suggesting that it is dictated by inherent musculoskeletal properties. However, if leg stiffness was invariant, the biomechanics of running (e.g. peak ground reaction force and ground contact time) would change when an animal encountered different surfaces in the natural world. We found that human runners adjust their leg stiffness to accommodate changes in surface stiffness, allowing them to maintain similar running mechanics on different surfaces. These results provide important insight into mechanics and control of animal locomotion and suggest that incorporating an adjustable leg stiffness in the design of hopping and running robots is important if they are to match the agility and speed of animals on varied terrain.

Animals↗

Older patients' experience of dressing changes on venous leg ulcers: more than just a docile patient.

AIM AND OBJECTIVE: The aim of this paper was to describe the lived experiences of older patients with venous leg ulcers, during dressing changes as out patients with a focus of their concerns about care interventions. Research on wound care management has focused on treatment of venous leg ulcer, wound assessments and the choice of dressing material. Few studies have focused on the patients' experience of dressing changes. DESIGN: Fifteen older people with verified venous leg ulcers were recruited in a metropolitan area of Sweden. Data were collected with research interviews in the form of dialogue. METHOD: Data were analysed with an interpretative phenomenological method developed by Benner. RESULTS: Twelve women and three men participated. The themes were: 'being cared for with a skillful touch', 'feelings of belonging, continuity and affinity', and 'being suppressed into a state where one loses control, leading to feelings of discomfort'. The participants' experiences varied. Some were satisfied and felt that there was a mutual understanding between caregivers and patients, while others were dissatisfied and felt objectified. Understanding the patients as human beings and considering illness as lived experience helped the care providers to perform skillful wound care, in an atmosphere of mutual understanding. CONCLUSION: The patients suffering from venous leg ulcers wanted to feel worthy of wound treatment and to meet skillful, confident and gentle nurses in a sharing atmosphere. Nurses must be perceptive to the individual's bodily experience of the leg ulcer. RELEVANCE TO CLINICAL PRACTICE: Wound care requires a multidimensional clinical approach that involves not only medical and technical care strategies of dressings and bandages, but also aspects that concern the situated-based illness experience that persons suffering from leg ulcers may face.

Aged↗

Cryopreserved and lyophilized cultured epidermal allografts in the treatment of leg ulcers: a pilot study.

BACKGROUND: In the conservative therapy of venous leg ulcers modern types of dressings are used most frequently. In the past 20 years 'active wound dressings' - cultured epidermal keratinocytes as autografts and allografts - were also introduced in the management of leg ulcers. METHODS: The aim of our study was to compare the effect of cryopreserved and lyophilized cultured epidermal allografts in the treatment of venous leg ulcers. Evaluation of the therapy was documented as photodocumentation, planimetry, healing time and evaluation of pain relief over a 3-month period after application. Fifty patients with venous leg ulcers were selected. Twenty-five patients (group I) were treated with cryopreserved keratinocytes and 25 (group II) with lyophilized keratinocytes. RESULTS: The final evaluation 3 months after the application of allografts showed 84% of healed ulcers in group I and 80% in group II. The number of healed ulcers and the healing rate both showed no statistically significant differences. The size of the ulcer was reduced by half during the first week in both groups. The size differences during the first week are statistically significant in both groups and they are comparable (P < 0.001). The intensity of the pain was statistically significantly reduced during the first week after application in both groups (P < 0.001). CONCLUSIONS: The cryopreserved and lyophilized cultured allografts are comparable in healing rate, course of healing and relief of pain, and also in planimetric changes during the healing of venous leg ulcers. Lyophilized allografts are more convenient for routine use than cryopreserved allografts as they can be stored at room temperature. These results could give rise to the more frequent use of lyophilized allografts in slow-healing venous leg ulcers.

Adult↗

Laser therapy of spider leg veins.

BACKGROUND: Spider leg veins are a common aesthetic problem in females. The standard treatment is sclerotherapy but lasers have been used for decades to solve this problem as well. AIM: To review recent advances in laser physics and its tissue interactions with skin vessels. The different laser types used to treat spider leg veins are discussed, including their advantages, limitations and possible adverse effects. METHOD: The international literature on laser therapy for spider leg veins has been reviewed with particular emphasis on the last decade. RESULTS: Recent developments in laser technology allow a more selective and well-tolerated therapy. Efficacy has also improved. Most studies report a greater than 75% improvement in spider leg veins as a realistic goal for laser therapy. Clinic response depends upon wavelength, fluence, pulse width and pulse duration, cooling and the diameter and colour of spider leg veins. CONCLUSIONS: Sclerotherapy remains the gold standard treatment for spider leg veins. Nevertheless, laser therapy has become increasingly efficacious and convenient. Laser selectivity has been improved by technological progress. The ideal laser, however, has yet to be invented.

Journal Article↗

Static contraction of the quadriceps muscle in man: cardiovascular control and responses to one-legged strength training.

Knee extension strength training of one leg (ST) (120 maximal contractions per day, 5 days per week for 9 weeks) was performed by 9 healthy young men. Before and after ST, biopsies were obtained from the vastus lateralis muscle of each leg and static quadriceps contractions (SQC) lasting 2 min were performed with each leg under control conditions and after combined vagal and beta-adrenergic blockade with atropine and metoprolol. Maximal voluntary contraction strength (MVC) increased more for the trained leg (TL) than for the untrained leg (UTL) but thigh circumferences and muscle fibre diameters gave little evidence for muscle hypertrophy. In pre- vs. post-training comparisons during SQC at the same relative force (40% of MVC) mean blood pressure (MBP), heart rate (HR) and smoothed rectified electromyographic activity were similar for TL and UTL. Similar findings were obtained for MBP after attenuation of the HR response by autonomic blockade, indicating that MBP, per se, was closely linked to the relative force of SQC. Pre- to post-training reductions in MBP and HR during SQC with each leg at an absolute force of 40% of pre-training MVC were likely due to changes in the pattern of motor unit activation. A lower MBP response to SQC and TL than of UTL after training correlated with a greater capillary density and a lower muscle lactate level for TL.

Adaptation, Physiological↗

An analysis of leg abnormalities of boars in the Queensland performance testing station.

An analysis was made of the results of leg inspections of boars in the Queensland boar testing station at the start and end of their performance tests. The frequency among boars of 12 specific faults ranged from zero to 90% at the start and 7% to 73% and the end of testing. Of the 362 boars examined, 20% suffered from leg weakness. 11% of these had to be slaughtered and 9% recovered after return to the farm. The only faults significantly associated with leg weakness were: "up on toes" of the front feet and excessive flexion of the front knees ("over at knee"). The sire, breed and herd of origin of a boar had little effect on its having any one of the 12 faults. However, herds were found to differ in the total number of faults per boar and Large White had more front leg faults than Landrace. The correlation between number of leg faults and growth rate of a boar during test was + 0.12. Although lef weakness was an important cause of boar wastage, neither it nor leg faults were significant sources of error in evaluating the performance of boars which completed testing.

Animals↗

A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study.

OBJECTIVES: To compare the therapeutic effect of two different exercise protocols in athletes with jumper's knee. METHODS: Randomised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises. Measurement was performed at baseline and after six and 12 weeks. Primary outcome measures were pain (visual analogue scale 1-10) and return to sport. Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30 degrees/second. Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 (group) x 3 (time) analysis of variance. Two by two contingency tables were used to test differences in rates of return to sport. Analysis of variance (2 (injured versus non-injured leg) x 2 (group) x 3 (time)) was also used to determine differences for secondary outcome measures. RESULTS: Over the 12 week intervention, pain diminished by 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. There was a significant main effect of both exercise protocols on pain (p<0.01) with no interaction effect. Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks, but five of those subjects still had low level pain. Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain. There was no significant difference between groups in numbers returning to sporting activity. There were no differences in the change in quadriceps or hamstring muscle moment of force between groups. CONCLUSIONS: Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper's knee in a 12 week period and permit a high proportion of patients to return to sport. Not all patients, however, return to sport by that time.

Adolescent↗