Ankle Level Research Articles

Experimental investigation into thermal comfort and energy utilization efficiency of stratum ventilation under heating mode

Stratum ventilation (SV) can energy-efficiently provide satisfactory thermal comfort under cooling mode. However, thermal comfort and energy efficiency of SV under heating mode can be different from those under cooling mode due to the distinct airflow patterns. In this study, thermal comfort and energy utilization efficiency of SV were investigated for six cases under heating mode. Air velocity and temperature were measured in the occupied zone of a multi-occupant room with dimensions of 8.4 m (L) ×5.4 m (W) ×2.6 m (H). Based on the measured air velocity and temperature, the thermal comfort indicators including vertical air temperature between head and ankle levels (ΔT), draught rate (DR), predicted mean vote (PMV) and energy utilization efficiency were calculated. The results showed that the energy utilization efficiency of SV was higher than one under heating mode, indicating energy saving. The draught rate under SV satisfied the requirement of Category B of thermal environments stipulated in ISO 7730. The PMV of SV can meet the acceptable range for general thermal comfort under the cases with suitably high supply air temperature according to ASHRAE 55-2017. The vertical air temperature difference between head and ankle levels can achieve acceptable results for SV under heating mode.

Experimental study on the performance evaluation of active chilled beams in cooling operation under varied boundary conditions

This study investigates the thermal comfort and indoor air quality performance of Active Chilled Beams (ACB) in cooling operation mode in an open office environment with asymmetrical loads. Many studies on thermal comfort using ACB in cooling mode have been conducted; most of the studies confirm that thermal comfort is satisfactory because the temperature gradient and the airspeeds are acceptable at the occupant level. However, these studies do not specifically address the local discomfort in cooling mode. Furthermore, these studies do not consider performance under different ACB configurations or varied boundary conditions such as those found in real offices. This paper reports the results of an experimental study that addresses the above issues. A laboratory experiment was designed to simulate a multi-occupant open office with an ACB subjected to asymmetric boundary conditions. The results demonstrate that discomfort draft risk at the ankle level is higher when the ACB is oriented parallel to the window. Furthermore, the results suggest that shape (the type of ACB) and throw of ACB affect air distribution. The results emphasize the importance of properly selecting, orienting, and designing ACB, not just to offset the room loads, but to match the proportions and boundary conditions of the office.

Порівняльна оцінка результатів хірургічного та консервативного лікування хворих з цукровим діабетом та хронічною критичною ішемією нижньої кінцівки

Мета. Порівняти результати консервативного лікування та ендоваскулярних і відкритих хірургічних втручань у хворих з цукровим діабетом та хронічною критичною ішемією нижньої кінцівки.
 Матеріали і методи. Проаналізовано результати лікування 240 пацієнтів з цукровим діабетом (ЦД) 2-го типу та хронічною критичною ішемією нижньої кінцівки (ХКІНК), виразково-некротичним ураженням стопи на тлі стенотично - оклюзійного ураження артерій підколінно-гомілково-стопового сегмента. До групи А включили 143 (54,6%) пацієнти, яким було проведено хірургічне лікування, до групи Б – 97 (40,4%) пацієнтів, яких лікували консервативно. У свою чергу групу А розподілили на дві підгрупи: А1 – 42 (29,4%) пацієнти, яким виконали операцію шунтування до гомілкових або стопових артерій, та А2 - 101 (70,6%) пацієнт, якому виконали балонну ангіопластику. З метою коректного порівняння результатів різних видів лікування нами була розроблена методика розрахунку коефіцієнта рівня ампутації (КРА).
 Результати. Із 42 хворих підгрупи А1 у 4 (9,5%) була виконана ампутація на рівні стегна, у 3 (7,1%) - на рівні гомілки, у 6 (14,3%) – трансметатарзальна резекція стопи, у 14 (33,3%) – ампутація пальців. У 15 (35,7%) хворих опорна функція стопи не порушилась. КРА у пацієнтів підгрупи А1 дорівнював 1,48. Із 101 хворого підгрупи А2 у 2 (2,0%) була виконана ампутація на рівні стегна, у 4 (4,0%) - на рівні гомілки, у 16 (15,8%) – трансметатарзальна резекція стопи, у 19 (18,8%) – ампутація пальців. У 60 (59,4%) хворих опорна функція стопи не порушилась. КРА у пацієнтів підгрупи А2 дорівнював 0,78. Із 97 хворих групи Б у 22 (22,7%) була виконана ампутація на рівні стегна, у 29 (29,9%) - на рівні гомілки, у 6 (6,2%) – трансметатарзальна резекція стопи, у 11 (11,3%) – ампутація пальців. У 29 (29,9%) хворих опорна функція стопи не порушилась. КРА у пацієнтів групи Б дорівнював 2,79.
 Висновки. Розроблена методика розрахунку КРА може бути використана для порівняння результатів лікування хворих з ЦД та ХКІНК на тлі стенотично-оклюзійного ураження артерій підколінно-гомілково-стопового сегмента, у яких були застосовані різні методи лікування. Найкращі річні результати збереження опорної функції нижньої кінцівки спостерігали у хворих, яким виконали балонну ангіопластику, найгірші - у хворих, яким було проведено консервативне лікування.

A comparison of the thermal comfort performances of a radiation floor cooling system when combined with a range of ventilation systems

This study conducted a series of computational fluid dynamics simulations to evaluate the thermal comfort performance of a radiant floor cooling system when combined with different ventilation systems, including mixed ventilation (MV), stratum ventilation (SV), displacement ventilation (DV) and ductless personalized ventilation (DPV). A window temperature of 32°C and three different floor temperatures including 20, 22 and 24°C were set in summer. We used the vertical air temperature differences (VATD) at ankle and head level, the percentage of dissatisfied, the draught rate at the ankle level and the equivalent temperature as our main evaluation indices. Our results show that the VATD in DV system can reach up to about 5°C, compared with about 2°C in MV and SV systems. For the DPV system, there is only a marginal drop in the VATD. For the DV and DPV cases, with a rate of air changes per hour (ACH) of 2.4−1, we recorded a higher draught rate at the ankle level, ranging from 6.55% to 9.99%. The lower equivalent temperature values for the foot and calf segments occur when the floor temperature is 20°C. In all cases, the equivalent temperature values of the whole body indicate an acceptable level of thermal discomfort.

CFD study of the air distribution and occupant draught sensation in a patient ward equipped with protected zone ventilation

Effective ventilation in general hospital wards is important for controlling the transmission of airborne infectious agents that may cause respiratory diseases. Recently, a new ventilation concept called protected occupied zone ventilation (POV) has been shown to have the ability to improve the quality of inhaled air compared to that of traditional ventilation strategies. This study numerically investigates the percentage of people dissatisfied due to draught close to the health-care worker (HCW) and patient in a single-bed isolation room equipped with POV. The CFD validation results showed that out of the three examined turbulence models, the SST k–ω models predicted the velocity and temperature profiles agreeably according to the experimental findings. The SST k–ω model was further used to visualize the airflow distribution in the patient ward and investigate the influence of the supply velocity and temperature on the draught risk. Supply velocities of 1.0, 1.5 and 2.0 m/s did not exceed the suggested comfort criterion of 20% even at lower supply temperatures. The draught risk at ankle level of the sitting patient exceeded the maximum allowed value at supply velocities of 2.5 and 3.0 m/s at both lower and higher supply temperatures.

Experimental Evaluation of the Ventilation Effectiveness of Corner Stratum Ventilation in an Office Environment

An experimental study was conducted in a room resembling an office in a laboratory environment. The study involved investigating the ability of corner-placed stratum ventilation in order to evaluate the ventilation’s effectiveness and local thermal comfort. At fixed positions, the air temperature, air velocity, turbulence intensity, and tracer gas decay measurements were carried out. The results show that corner-placed stratum ventilation behaves very similar to a mixing ventilation system when considering air change effectiveness. The performance of the system was better at lower supply air flow rates for heat removal effectiveness. For the heating cases, the draught rates were all very low, with the maximum measured value of 12%. However, for the cooling cases, the maximum draught rate was 20% and occurred at ankle level in the middle of the room.

Mathematical and experimental analysis of the thermal effectiveness of an oscillating jet with side-to-side swing louvers in a cassette split type air conditioner

The impact of air supply control strategies (louvers movement) on indoor thermal environment were evaluated in this study. The temperature uniformity was evaluated by: (i) the air distribution performance index (ADPI) to determine the air diffusion performance in heating mode; (ii) the air draught rate (DR%) on the face to determine the local discomfort due to cold draught; (iii) the mathematically determined vertical temperature stratification in a room with Beta distributions. A comparison of the conventional type with three different oscillating type airflows (louvers swing angle ±20°, ±40° and ±60°) were experimentally analysed to determine appropriate air supply control strategies. The results indicated that Beta distributions could capture the overall trend of the oscillating airflow, to establish the acceptable thermal uniformity and higher thermal effectiveness. The oscillating airflow as generated by the side-to-side swing type delivery louvers mounted inside a cassette split type air conditioner could shorten heating time by 20% to attain room temperature from 9°C. The data reveal that oscillating airflow can provide a better thermal sensation to feeling warm in the heating mode at both ankle and neck level. The ADPI is approximately 85% in the occupied zone. The actual draught rates on the face ranged 0–35%.

Sizing of medical below-knee compression stockings in an Indian population: A major risk factor for non-compliance.

Background The compliance to compression stockings in India is poor. One of the reasons is related to the inadequacy of sizing tables of compression stockings sold in India by western companies. Methods In 922 Indian patients, three circumference measurements of leg were taken in a standing position at different levels: Instep (level Y), Ankle (level B) and largest part of the calf (level C). We compared these measurements with the standard sizing tables according to the recommendations of the manufacturers’ sizing tables. The statistical analysis method: mean comparison of the circumferences was tested with the Wilcoxon test. Result The measurements found do not allow a satisfactory adaptation of compression stockings marketed in India by Medi®, Sigvaris® and Jobst®. The risk of threading difficulties is 15% with Medi® and Sigvaris® compression stockings. The risk of slippage is 61% for Sigvaris® and 48% for Medi®. With the Jobst® sizing table, no knitting makes it possible to reach a pressure at point C equal to at least 50% of the pressure of point B. Conclusion These data underline the need to adapt the measurements of compression stockings to the morphologies of patients' lower limbs in India, to improve compliance.

High tolerance of progressive elastic compression in peripheral arterial disease.

Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6x6 plan) evaluating the short-term tolerance of progressive compression stockings (18±2mmHgat calf and 8±2mmHgat ankle level) in patients with PAD (ankle brachial index ABI>0.60<0.75) and chronic venous insufficiency (C1s-C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease>15% of ABI on each side, no decrease>15% of toe brachial index (TBI) on each side and no decrease>25% of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8%, mean age was 77.3±7.5years and no patient were diabetic. At inclusion, the mean low ABI was 0.60±0.04 and the mean high ABI was 0.77±0.18. The mean low TBI was 0.32±0.09 and the mean high TBI 0.46±0.15. The mean number of active standing plantar flexions was 33.0±5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7%, class C2s: 27.8%, class C3: 44.4%, class C4: 5.6% and class C4s: 5.6%). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18±2mmHgat calf and 8±2mmHgat ankle level) in symptomatic PAD.

Experimental study of local thermal comfort and ventilation performance for mixing, displacement and stratum ventilation in an office

Satisfactory thermal comfort and efficient removals of airborne contaminants are crucial to the work efficiency and health of occupants. Different air distributions can generate distinct airflow patterns, thus affecting thermal comfort and ventilation performance. The experiments were conducted to study the performances of three air distribution methods (i.e. mixing ventilation (MV), displacement ventilation (DV) and stratum ventilation (SV)). Local thermal comfort was evaluated for the three air distribution methods with their individual thermally neutral temperatures. Three gaseous point pollutant sources located at the desktop, floor and manikin armpit respectively were applied to study the impact of the pollutant source locations on their ventilation performances. The distributions of air velocity, air temperature and contaminant concentration were measured. Results showed that a vertical air temperature difference of above 3 °C between the head and ankle levels appeared with DV, but the draught ratings (DR) under SV were higher than those under both MV and DV. Pollutant source locations exerted different effects on contaminant dispersion and contaminant removal effectiveness (CRE) for the three air distribution methods. SV always removed the contaminants effectively with all the three pollutant source locations to maintain good inhaled air quality, which was superior to MV and DV.

IF02. Angiographic Patterns at the Ankle and Foot Level in Patients With Critical Limb-Threatening Ischemia Correlate With Healing of Transmetatarsal Amputation

Patients with critical limb-threatening ischemia with chronic forefoot wounds often need transmetatarsal amputation (TMA). Lower extremity revascularization improves healing and prevents major amputation. Additionally, the condition of the pedal arch plays an important role in the healing process and is, therefore, possibly associated with major amputation conversion. The aim of this study was to investigate the relation between TMA healing and distal angiographic arterial patterns using two anatomic classification systems. Cases were selected from a single-center retrospective review conducted among patients who had all of the following: TMA, endovascular revascularization intervention, and available angiographic imaging of the leg including the ankle and foot. All patients were included from the University of California San Francisco Medical Center from January 1, 2008, to December 31, 2016. A total of 38 cases with TMA, endovascular revascularization intervention and available imaging was obtained. All angiographic images were scored using two anatomic classifications—the Pedal Outflow Modifier of the Global Anatomic Staging System and the Pedal Arch Classification developed by Kawarada et al (Table I). Scoring was done separately by two observers who reached consensus on all scores. The primary end point was TMA healing after 6 months. A clear trend was seen when it comes to TMA healing in relation to both the Pedal Outflow Modifier and Pedal Arch Classification (Table II). However, owing to the small number of cases there was no statistical significance (P = .078). There seems to be a clear trend in the correlation between the condition of the pedal arch and wound healing after TMA. To achieve statistical significance, additional cases as well as bypass surgery will be added. Anatomic classification of the pedal arch in the future may become an adjunct to the clinical decision making process on determining amputation level.Table IPedal outflow modifier and pedal arch classificationMeasureDescriptionPedal outflow modifier P0Target artery crosses ankle into foot, with intact pedal arch P1Target artery crosses ankle into foot; absent or severely diseased pedal arch P2No target artery crossing ankle into footPedal arch classification Type 1Both dorsalis pedis and plantar artery patent Type 2AOnly dorsalis pedis patent Type 2BOnly plantar artery patent Type 3Both dorsalis pedis and plantar artery not patent Open table in a new tab Table IITransmetatarsal amputation (TMA) healing rates by anatomic class after 6 monthsTMA healedPedal outflow modifier P02/3 (67%) P15/26 (19%) P21/9 (11%)Pedal arch classification Type 12/3 (67%) Type 2A4/15 (27%) Type 2B1/8 (13%) Type 31/12 (8%) Open table in a new tab

The role of the anterior talofibular ligament area as a morphological parameter of the chronic ankle sprain

BackgroundRepetitive microtrauma can result in a hypertrophied ATFL. Previous studies have found that the anterior talofibular ligament thickness (ATFLT) is correlated with lateral ankle sprains, ligament injuries and chronic stroke in patients, and thickened anterior talofibular ligament (ATFL) has been considered to be a major morphologic parameter of hypertrophied ATFL. However, hypertrophy is different from thickness. Thus, we devised the anterior talofibular ligament area (ATFLA) as a new morphological parameter to evaluate the hypertrophy of the whole ATFL. MethodsATFL samples were collected from 53 patients with sprain group and from 50 control subjects who underwent magnetic resonance imaging (MRI) of the ankle and revealed no evidence of lateral ankle injury. Axial T1-weighted MRI images were collected at the ankle level from all subjects. We measured the ATFLA and ATFLT at the anterior margin of the fibular malleolus to the talus bone on the MRI using a picture archiving and communications system. The ATFLA was measured as the whole cross-sectional ligament area of the ATFL that was most hypertrophied in the axial MR images. The ATFLT was measured as the thickest point between the lateral malleolus and the talus of the ankle. ResultsThe average ATFLA was 25.0 ± 6.0 mm2 in the control group and 47.1 ± 10.4 mm2 in the sprain group. The average ATFLT was 2.3 ± 0.6 mm in the control group and 3.8 ± 0.6 mm in the hypertrophied group. Patients in sprain group had significantly greater ATFLA (p < 0.001) and ATFLT (p < 0.001) than the control subjects. A Receiver Operator Characteristics curve analysis showed that the best cut-off point of the ATFLA was 34.8 mm2, with 94.3% sensitivity, 94.0% specificity, and an AUC of 0.97 (95% CI, 0.94–1.00). The optimal cut-off point of the ATFLT was 3.1 mm, with 86.8% sensitivity, 86.0% specificity, and AUC of 0.95 (95% CI, 0.92–0.99). ConclusionATFLA is a new morphological parameter for evaluating chronic ankle sprain, and may even be more sensitive than ATFLT.

Overground wearable powered exoskeleton for gait training in subacute stroke subjects: clinical and gait assessments.

Wearable powered exoskeletons provide intensive overground gait training with patient's active participation: these features promote a successful active motor relearning of ambulation in stroke survivors. The aim of this study was to investigate the feasibility and the clinical effects of an overground exoskeleton-assisted gait training (OEAGT) in subacute stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. Four Italian neurological rehabilitation centers. Forty-eight subacute stroke patients were enrolled. Two patients dropped out because of medical problems. Data analysis was conducted on 46 subjects (56.84±14.29 years; 27 male; 29 ischemic; 24 left hemiparesis). Patients underwent 15±2 sessions (60 min/session, 3-5 times/week) of OEAGT. Clinical and gait assessments were performed at the beginning (T1) and at the end (T2) of the training period: modified Barthel Index (BI), modified Ashworth Scale at Hip (MAS-H), Knee (MAS-K), and Ankle (MAS-A) level, Motricity Index (MI), Trunk Control Test (TCT), Functional Ambulation Classification (FAC), Walking Handicap Scale (WHS), 10-Meter Walking Test (10MWT), 6-Minute Walking Test (6mWT), Timed Up-and-Go test (TUG). The Technology Acceptance Model (TAM) questionnaire evaluated the acceptance of OEAGT by patients. Data stratification was performed using the time post the acute event and the onset of rehabilitation treatment, and the MI at T1. Wilcoxon's test (P<0.05) was used. All clinical scales significantly improved at T2; no statistically significant changes were reported for MAS-H, MAS-K, MAS-A. The 69.57% patients were able to walk at T1; 17.39% were not able to walk at T1 but regained ambulation at T2; and 13.04% were not able to walk at either T1 or T2. The ambulant patients showed a statistical improvement in speed measured during the 10MWT and in the distance covered over a time of 6 minutes (6mWT). The results from the TAM questionnaire showed that all subjects perceived the OEAGT positively. The data stratification analysis suggests that the OEAGT does not have any restriction of use. The OEAGT improved the clinical and gait outcomes in subacute patients. Randomized studies on larger samples are needed to confirm these data and to assess the efficacy of OEAGT. Introduce innovative rehabilitation strategies based on customized OEAGT.

A Knee–Ankle–Foot Orthosis to Assist the Sound Limb of Transfemoral Amputees

As a consequence of limb loss, trans-femoral amputees exert 60% additional knee extension torque and 50% more plantar flexion torque in the healthy limb compared to non-amputees. In this paper, we developed an active knee–ankle–foot orthosis (KAFO) designed to assist the healthy leg of trans-femoral amputees in activities of daily living, such as walking, ascending/descending stairs, and transitioning from sit-to-stand with adequate range of motion, speed, and peak torque. Our KAFO was designed to exceed the performance of similar assistive devices reported in literature in terms of: 1) portability; 2) power; 3) compliance; and 4) versatility. It is based on one-degree-of-freedom active series-elastic actuators in both the knee and ankle, with an additional passive degree of freedom at the ankle level to allow natural inversion/eversion. The knee module consists of a worm-gear surrounded by two pre-compressed springs. The ankle actuator relies on a mechanically adjustable compliance system combined with a 4-bar linkage transmission. The actuators were designed to optimize the torque output at the joints while fulfilling low-power requirements. This novel KAFO is controlled with a three-layer structure. The optimized low level, based on a closed-loop torque controller, has adequate performances for the targeted application. The device is also shown to fulfill the three pre-defined functional requirements for all locomotion modes.

Korelasi antara Ankle-Brachial Index, Pulse Oximetry, dan Ankle Peak Systolic Velocity Penderita Diabetes Melitus tanpa Obesitas Abdominal

Background: Diabetes Mellitus is the most common complication of vascular complications, one of which is peripheral arterial disease (PAD), which can increase morbidity and mortality in diabetic patient.Early screening parameter and diagnosis of PAD that currently still largely accepted are Ankle-Brachial Index (ABI) and pulse oximetry. ABI and pulse oximetry each has advantages and disadvantages. Patients with diabetes, especially if accompanied by abdominal obesity often have arterial sti?ness so that the value of ABI actually increased, in this case pulse oximetry has a higher sensitivity. Ankle Peak Systolic Velocity (APSV) which is the average of Peak Systolic Velocity (PSV) of anterior and posterior tibial artery at ankle joint level is a new parameter for assessing ischemia of the lower limb and is not in?uenced by arterial sti?ness. The purpose of this study was to determine and analyze the correlation between ankle-brachial index, pulse oximetry and ankle peak systolic velocity in DM patients without abdominal obesity.Materials and methods: This study was observational analytic with cross-sectional design study in subjects with DM without abdominal obesity who meet the inclusion and exclusion criteria.Results: The subjects consisted of 38 limbs from 19 people, 11 (57.9%) males and 8 (42.1%) women aged 47-68 years. Spearman test showed a positive correlation was signifcant between ABI with APSV (r = 0.549, p &lt;0.001). Correlation between ABI and pulse oximetry; pulse oximetry and APSV showed weak signifcant negative correlation (r = -0.347, p &lt;0.05 and r = -0.369, p &lt;0.05). Only APSV which has a strong positive correlation with clinical PAD signifcantly (r = 0.743, p &lt;0.001).Conclusions: There is no strong correlation between ABI, pulse oximetry and APSV in DM patients without abdominal obesity. APSV can replace ABI and pulse oximetry as a non-invasive examination of diabetic patients for screening and follow-up PAD

PLX-PAD Cell Treatment of Critical Limb Ischaemia: Rationale and Design of the PACE Trial

Critical limb ischaemia (CLI) is a life threatening condition with a considerable risk of major amputation and death. Besides revascularisation, no treatment has been proven to reduce the risks. Therapeutic angiogenesis by gene or cell therapy has not demonstrated definitive evidence in randomised controlled trials. PLX-PAD is an "off the shelf" allogeneic placental derived, mesenchymal like cell therapy, which, in preclinical studies, has shown pro-angiogenic, anti-inflammatory, and regenerative properties. Favourable one year amputation free survival (AFS), and trends in reduction of pain scores and increase of tissue perfusion have been shown in two small, open label, phase I trials. The PACE study is a phase III randomised, double blind, multicentre, multinational placebo controlled, parallel group study to evaluate the efficacy, tolerability, and safety of intramuscular injections of PLX-PAD cells to treat patients with atherosclerotic CLI with minor tissue loss (Rutherford Category 5) up to the ankle level, who are unsuitable for revascularisation or carry an unfavourable risk benefit for that treatment. The study will enroll 246 patients, who after screening are randomised in a ratio of 2:1 to treatment with intramuscular injections of PLX-PAD 300×106cells or placebo on two occasions, eight weeks apart. The primary efficacy endpoint is time to major amputation or death (amputation free survival), which will be assessed in follow up of at least 12 months and up to 36 months. Based on favourable pre-clinical and initial clinical study results, the PACE phase III randomised controlled trial will evaluate placenta derived PLX-PAD cell treatment in patients with critical limb ischaemia, with an unfavourable risk benefit for revascularisation. Clinicaltrials.gov: NCT03006770.

The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study.

The anterior lateral malleolar artery (ALMA), which usually originates from the anterior tibial artery (ATA), courses transversely and laterally, passing under the extensor digitorum longus and peroneus tertius tendons. Variations in the origin of the ALMA from the ATA can occur. Branches of the ATA, such as the ALMA, are prone to pseudoaneurysm. This study reviewed the origin of the ALMA from the ATA and aimed to identify problems in anterior ankle arthroscopy that might cause injury to the ALMA. Enhanced computed tomography scans of 24 feet of 24 fresh cadavers (13 males, 11 females; average age 78.1 years) were assessed. The limb was injected with barium sulfate suspension through the external iliac artery; the origin of the ALMA from the ATA on the sagittal plane was recorded. The origin was at the ankle joint level in 4 specimens and below the ankle joint in 17 specimens. The distance from the ankle joint to the branching point of the ALMA on the sagittal plane was 5.2 mm distal to the joint. The level of origin of the ALMA from the ATA was established. Instruments should not be inserted from the distal direction when placing anterolateral portals. Levels of Evidence: Level IV, cadaveric study.

Sex differences in the gait kinematics of patients with Down syndrome: A preliminary report.

Sex-specific medicine requires understanding of the specific therapeutic needs and patho-physiology of men and women. In these terms, we investigated sex-related differences in the gait kinematics of patients with Down syndrome. Retrospective observational cohort study. A sample of 230 patients (103 females) aged 7-50 years underwent a standard gait-analysis test from 2000 to 2015. Spatiotemporal gait parameters and synthetic indexes were computed as Gait Profile Score (GPS) and pelvis/lower limbs as Gait Variable Scores. Although speed, normalized step width, %stance and %swing were similar, in female patients step length was shorter and GPS was higher than in male patients, with no significant effect of age, speed and body mass index. Sex-specific features were found at the pelvis, hip and knee level (sagittal plane), and at the ankle level (transverse plane). Overall, in people with Down syndrome, the gait function of females tends to be more impaired than in males, with the exception of foot progression. Therapists should consider these differences when evaluating the severity of gait impairment and designing rehabilitation strategies.

Analyzing human balance recovery action using calculated torques of a double pendulum model

Assessment of balancing abilities require quantification of balancing motion response, typically using a kinematic or dynamic model of the human body. In this proof of concept work, we demonstrate a 4 degrees-of-freedom, two-link double pendulum model of the human body created according to the Denavit-Hartenberg convention and its utility in a sudden perturbation balance test. The model is used to calculate the estimated forward and sideways torques at the ankle and hip level based on measured position data from a motion capture system. From the joint torques, the total mechanical work of each joint can be obtained. Eleven healthy, young participants (9M/2F; age: 22.8±1.7yrs, height: 179±11cm, body mass: 80.6±19.9 kg) were studied to obtain the motion capture data in bipedal and unipedal stance. The model shows an estimation of the proportional contribution of the major joints to the balance response motion. A simple joint strategy index, defined as the proportion of ankle contributions can indicate the use of an ankle or a mixed ankle-hip joint strategy in the different stances. Using ratio-like variables, the model was able to detect a correlation between the joint works applied in the different directions and the corresponding platform motion. Overall, the model allows to further analyze and better understand balance maintenance and the complex balance recovery action. In the future, the model could be evaluated for different types of balancing tests used in clinical practice

Combining muscle morphology and neuromotor symptoms to explain abnormal gait at the ankle joint level in cerebral palsy

BackgroundIndividuals with spastic cerebral palsy (CP) have neuromotor symptoms contributing towards their gait patterns. However, the role of altered muscle morphology alongside these symptoms is yet to be fully investigated. Research questionTo what extent can medial gastrocnemius and tibialis anterior volume and echo-intensity, plantar/dorsiflexion strength and selective motor control, plantarflexion spasticity and passive ankle dorsiflexion explain abnormal ankle gait. MethodIn thirty children and adolescents with spastic CP (8.6 ± 3.4 y/mo) and ten typically developing peers (9.9 ± 2.4 y/mo), normalised muscle volume and echo-intensity were estimated. Both cohorts also underwent three-dimensional gait analysis, whilst for participants with spastic CP, plantar/dorsi-flexion strength and selective motor control, plantarflexion spasticity and maximum ankle dorsiflexion were also measured. The combined contribution of these parameters towards five clinically meaningful features of gait were evaluated, using backwards multiple regression analyses. ResultsWith respect to the typically developing cohort, the participants with spastic CP had deficits in normalised medial gastrocnemius and tibialis anterior volume of 40% and 33%, and increased echo-intensity values of 19% and 16%, respectively. The backwards multiple regression analyses revealed that the combination of reduced ankle dorsiflexion, muscle volume, plantarflexion strength and dorsiflexion selective motor control could account for 12–62% of the variance in the chosen features of gait. SignificanceThe combination of altered muscle morphology and neuromotor symptoms partly explained abnormal gait at the ankle in children with spastic CP. Both should be considered as important measures for informed treatment decision-making, but further work is required to better unravel the complex pathophysiology.