Assisted Ambulation Research Articles

A 73‐year‐old woman with chronic pelvic pain, burning toes, and an eighty‐pound weight loss

A 73-year-old woman developed malaise and a wasting illness that led to a weight loss of 80 pounds over the 5 years before presentation. During this time, her body mass index declined from 30.3 to 17.0 kg/m (1). At approximately the same time her weight loss began, the patient began to experience chronic pelvic and bladder pain. These symptoms, particularly uncomfortable when she was sitting, were partly relieved by micturition. The pain was associated with intermittent dysuria, severe urinary urgency, and frequency. She urinated approximately 9 times a day, and also awoke to urinate approximately 9 times at night. She denied incontinence and did not have recurrent urinary tract infections. However, her symptoms were associated with dyspareunia. She was not sexually active because of pain. Gynecologic and urologic evaluations revealed that the external genitalia, perineum, anus, and rectum were normal, as was the strength of the pubococcygeal and external anal sphincter muscles. Her gynecologist had detected mild urethral tenderness on palpation, but there was no urethral or bladder prolapse. The cul-desac between the posterior vagina and anterior rectum was normal, without nodularity or an enterocele. Catheterized urine specimens showed reactive uroepithelial cells, many neutrophils, and some red blood cells, suggesting abundant acute inflammation. A computed tomography (CT) scan of the pelvis showed generalized thickening of the bladder wall (Figure 1). A cystoscopic examination revealed no uroepithelial masses, but demonstrated a trabeculated bladder surface. Biopsies obtained at cystoscopy revealed nonspecific bladder inflammation. No neoplasm was identified. Following these urologic evaluations, the patient was diagnosed with interstitial cystitis/painful bladder syndrome (IC/PBS) (2). Over the next 5 years, she was treated with a variety of medications, including neurontin, pentosan polysulfate sodium, oxybutynin, and dimethyl sulfoxide. She also underwent cystoscopy with hydrodistention. None of these interventions provided more than mild, temporary relief of her bladder symptoms. In this same 5-year period, the patient had a variety of persistent abdominal symptoms. She reported loose bowel movements but denied diarrhea, constipation, hematochezia, fevers, arthritis, or eye problems. She noted consistent anorexia and early satiety, and reported a band-like abdominal pain that started just above her umbilicus. She had grown increasingly weak since becoming ill, and usually required assistance for ambulation. Over the course of her abdominal symptoms, she had undergone upper and lower endoscopy, as well as sonograms and CT scans of her abdomen. Biopsies of the small intestine had been negative for Tropheryma whipplei. Assays for IgA anti-endomysial antibodies, IgA antibodies to transglutaminase, and IgG and IgA directed against gliadin were all negative. A variety of diagnoses for her gastrointestinal symptoms had been entertained, including the postcholecystectomy syndrome, lactose intolerance, and Julius Birnbaum, MD, Michael Polydefkis, MD, MHS: The Johns Hopkins University School of Medicine, Baltimore, Maryland; Toby C. Chai, MD, Tehmina Z. Ali, MD: University of Maryland School of Medicine, Baltimore; John H. Stone, MD, MPH: Massachusetts General Hospital, Boston. Address correspondence to John H. Stone, MD, MPH, Massachusetts General Hospital, 55 Fruit Street, Yawkey 2, Boston, MA 02114. E-mail: jhstone@partners.org. Submitted for publication April 2, 2008; accepted in revised form July 31, 2008. Figure 1. Computed tomography scan of the bladder. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 59, No. 12, December 15, 2008, pp 1825–1831 DOI 10.1002/art.24051 © 2008, American College of Rheumatology

P064 The African disability scooter: for assisted ambulation

P064 The African disability scooter: for assisted ambulation

Comparison of gait characteristics between older rolling walker users and older potential walker users

The purpose of this study was to investigate whether there are differences in gait parameters between true walker users and potential walker users during ambulation. Subjects consisted of 18 rolling walker (RW) users (true user group, TUG) and 15 RW non-users (potential user group, PUG). The older adults in the PUG had a history of at least one fall in the last 12 months or a non-surgery hospitalization in the last 3 months. All subjects traversed the GAITRite ® walkway using a RW appropriately adjusted for the subject's height until three successful trials were obtained. The PUG performed three additional trials walking on the GAITRite ® walkway without RW assistance. Walking with a RW, the PUG users demonstrated decreased cadence, speed, swing time, step and stride length, and increased double support and stance time compared to walking without a RW. When comparing the TUG and PUG, both walking with a RW, the TUG subjects demonstrated decreased cadence, speed, swing time, step length and stride length, and increased double support and stance time. These results revealed that using a RW for ambulation might result in the user developing a gait pattern with a slower speed, smaller steps, increased stance time, and decreased swing time. The results seemed to indicate that this altered gait pattern may become more apparent the longer an individual uses a RW for ambulation assistance.

Assessment of dependence on assistive ambulatory devices among older adults: A new tool

The use of an assistive ambulatory device (AAD) such as a cane or walker may potentially be linked to a greater risk of falling. This study examined the test and re-test reliability of an instrument developed by the authors: the Ambulatory Device Dependence Efficacy Scale (ADDES), which assesses older institutionalized adults’ level of dependence on an AAD, with the aim of determining the relationship (if any) between AAD dependence and falling. Thirty-five AAD users from two assistive living facilities qualified to participate in this study. The validity of the ADDES was evaluated by three experienced physical therapists working in geriatric settings. The test reliability of the ADDES and how it related to history of falling were also assessed and analysed. This study found the ADDES scale to be highly reliable in testing how dependent an AAD user is on his/her AAD during walking. Findings showed that dependence on an AAD is positively correlated with the length of time it has been used. ADDES scores may indicate the level of falls risk, although a follow-up study is suggested to explore this relationship further.

A Comparison of Shoulder Joint Forces During Ambulation With Crutches Versus a Walker in Persons With Incomplete Spinal Cord Injury

Lighthall Haubert L, Gutierrez DD, Newsam CJ, Gronley JK, Mulroy SJ, Perry J. A comparison of shoulder joint forces during ambulation with crutches versus a walker in persons with incomplete spinal cord injury. Objective To compare 3-dimensional (3D) shoulder joint reaction forces and stride characteristics during bilateral forearm crutches and front-wheeled walker ambulation in persons with incomplete spinal cord injury (SCI). Design Cross-sectional cohort study. Setting Biomechanics laboratory. Participants Fourteen adult volunteers with incomplete SCI recruited from outpatient rehabilitation hospital services. Interventions Not applicable. Main Outcome Measure Peak force, rate of loading, and force-time integral were compared for each component of the net 3D shoulder joint reaction force during ambulation with crutches and a walker. Stride characteristics were also compared between assistive device conditions. Results The largest weight-bearing force was superiorly directed, followed by the posterior force. The superior joint force demonstrated a significantly higher peak and rate of loading during crutch walking (48.9N and 311.6N/s, respectively, vs 45.3N and 199.8N/s, respectively). The largest non-weight-bearing force was inferiorly directed with a significantly greater peak occurring during crutch ambulation (43.2N vs 23.6N during walker gait). Walking velocity and cadence were similar; however, stride length was significantly greater during crutch walking (62% vs 58% of normal). Conclusions Shoulder joint forces during assisted ambulation were large. Crutch use increased the superior force but did not increase walking velocity.

Predicting In-Hospital Falls

Falling is the most common hospital accident, and up to 15% of fallers sustain a serious injury. This study focused on developing a simple, practical fall risk screener using routine admission and daily in-hospital stay data. A case-control design was used. Logistic regression identified individual characteristics associated with an increased risk of a fall. Four variables were identified: history of falls, ambulation assistance, disoriented, and bowel control problems, creating a fall risk model with 70% sensitivity and 57% specificity.

An Instrument to Measure Skeletal Burden and Predict Functional Outcome in Fibrous Dysplasia of Bone

An instrument to measure skeletal burden in fibrous dysplasia was developed. Biological and clinical relevance was shown by correlating skeletal burden scores with bone markers, quality of life, and ambulatory status. Childhood scores predict adult ambulatory status, and scores were unaffected when bone markers decreased with bisphosphonate treatment or aging. Fibrous dysplasia (FD) is a skeletal disease with a broad clinical expression. There is no objective method to assess the extent of skeletal involvement or predict outcome. We developed an instrument to measure skeletal burden that correlates with physical function, health-related quality of life (HRQL), and ambulatory status. Seventy-nine patients with FD underwent bone scintigraphy. The skeletal burden score was derived from a weighted score based on the regional measurement using bone scintigraphy to estimate the amount of FD in anatomical segments. Six readers scored 20 scans twice to determine the inter- and intrareader agreement. To assess biological significance, scores were correlated with bone markers. To assess functional outcome, scores on the SF-36 (adults) or CHQ-PF50 (children) were correlated with skeletal burden scores. In a group of patients who had bone scans as children and adults (n = 6), the ability to predict ambulatory status was tested. Skeletal burden scores were assessed in patients before and after treatment with pamidronate (n = 5). The inter- and intrareader agreement of burden scores were r = 0.96, and 0.98, respectively (p < 0.001 for both). The scores correlated with markers of bone metabolism and HRQL (Spearman rho, 0.54-0.67 p < 0.001 and -0.43, p = 0.001, respectively). The mean score of patients who ambulated unassisted was significantly lower than those requiring assistance (p < 0.001 unassisted versus crutch and/or wheelchair). In unassisted ambulators, younger patients had higher scores, suggesting high childhood scores may predict adulthood impairment. In six patients with childhood and adulthood scans, childhood scores >30 predicted assisted ambulation in adulthood. There was a negative correlation between bone markers and age (Spearman rho, -0.42 to -0.70; p < 0.001), but not age and skeletal burden score. Pamidronate treatment decreased serum alkaline phosphatase but had no effect on the skeletal burden score. This is a validated and reliable instrument for the measurement of skeletal burden of FD and is able to predict functional outcome.

Triple arthrodesis with an external rail fixator: A review of 8 cases

The results of 8 patients who underwent triple arthrodesis with a rail external fixator were reviewed retrospectively. The frame construct allowed immediate axial loading and unrestricted ankle joint mobilization. Assistive ambulatory equipment was not required postoperatively. Periodic adjustment to compression was performed weekly until evidence of radiographic consolidation. The mean duration of frame application was 11.5 weeks. Follow-up averaged 15.9 months. Fusion occurred in all joints. One superficial pin-tract infection developed that resolved with oral antibiotics. The results of this study indicate that the rail frame system provides a viable fixation alternative for triple arthrodesis and warrants further investigation.

Osteogenesis imperfecta in childhood: Impairment and disability. a prospective study with 4-year follow-up

Engelbert RH, Uiterwall CS, Gerver W-J, van der Net J-J, Pruijs HE, Helders PJ. Osteogenesis imperfecta in childhood: impairment and disability. A prospective study with 4-year follow-up. Arch Phys Med Rehabil 2004;85:772-8. Objectives To study (1) changes in anthropometrics, joint range of motion (ROM), muscle strength, functional ability, caregiver assistance, and level of ambulation in children with osteogenesis imperfecta (OI) and (2) the prediction of clinical characteristics at the level of ambulation at follow-up and the prediction of clinical characteristics on progression or regression at the level of ambulation over time. Design Prospective study with follow-up of 4 years. Setting A children’s hospital that serves a nationwide center for treatment and research in children with OI in the Netherlands. Participants At follow-up, 49 children (24 boys, 25 girls; mean age ± standard deviation, 11.3±3.8y; range, 5.2–19.4y) participated. Interventions Not applicable. Main outcome measures Anthropometry, joint ROM, muscle strength, fracture frequency, intramedullary rodding, level of ambulation, functional ability, and caregiver assistance. Results In type I OI, total joint ROM decreased significantly over time, especially in the lower extremities, with a significant decrease in generalized joint hypermobility according to Bulbena (median start, 7.5; interquartile range [IQR], 4–9; median end, 6; IQR, 2–7; P<.001). In types III and IV, a severe decrease in total joint ROM was present without significant changes over time. No significant changes in total muscle strength (upper or lower extremities) in the different types of OI were measured at follow-up. In OI type I, a significant increase in self-care ( P=.003) and social function ( P=.008) was measured; in type III, a significant increase in self-care ( P=.003), mobility ( P=.004), and social function ( P=.005) was measured, with a significant decrease in parental assistance in self-care ( P=.02) and mobility ( P=.005). In type IV, a significant increase was observed in the self-care ( P=.01) and social function domains ( P=.02). Type of OI (regression coefficient=−1.0; 95% confidence interval [CI], −1.64 to −0.47) and total muscle strength were the only significant predictors for level of ambulation (regression coefficient=.01; 95% CI, .17–.32). Body weight was significantly lower in the group that progressed in level of ambulation ( P=.03), whereas children with a decline in level of ambulation had significantly higher body weight ( P=.05). Conclusions Ours is the first study with a long-term follow-up that provides information concerning the natural course of developmental outcome parameters of OI in childhood. Joint ROM and muscle strength did not change significantly over time, possibly because of the biomechanical skeletal properties of the different OI types. Functional ability improved significantly over time, but, especially in types III and IV, did not reach normative values, possibly because of a plateau phase in functional ability. Knowledge of the natural course of the disease is essential to interpret the results from intervention studies.

IMPROVING ASSISTED AMBULATION IN A MAN WITH MULTIPLE DISABILITIES THROUGH THE USE OF A MICROSWITCH CLUSTER

We assessed the use of a microswitch cluster to improve assisted ambulation in a man with multiple disabilities. The cluster included two optic microswitches at the man's heels to detect his steps and a pressure microswitch under his right arm to detect his body posture (i.e. whether he had an upright, appropriate posture or was leaning forward). The man received 2.5 seconds of favourite stimulation at each step provided that his posture was appropriate. The results showed that there was a large increase in the man's appropriate posture during walking throughout the intervention phases and the 3-month follow-up.

Functional Performance in Community Living Older Adults

Purpose: Routinely, physical therapists use a variety of physical performance tests to determine functional status of older adults. Whereas many commonly used instruments have been evaluated for some aspects of reliability and validity, few studies report typical performance for community living older adults, especially those who are 80 years and older and use an assistive ambulatory device. The aim of this study was to determine reference values of 7 functional tests for older adults by decade of age, gender, and assistive device use. Methods: Seventy-six older adults (age 66–101 years) participated in functional assessment clinics that included measures of comfortable gait speed, fast gait speed, Berg Balance Scale, Timed Up and Go, timed sit to stand, 6 minute walk, and Physical Performance Test. Results: For each functional test administered, means, standard deviations, and confidence intervals are presented by age, gender, and assistive device use. Regression analyses suggest that age and assistive device use are important factors in performance on functional tests. Conclusion: This study reports typical functional status of community living older adults. Such information may be useful in describing functional limitations and monitoring change in physical performance of older adults.

The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury

Englander J, Cifu DX, Wright JM, Black K. The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury. Arch Phys Med Rehabil 2003;84:214-20. Objective: To ascertain the association between early computed tomography (CT) scan findings and the need for assistance with ambulation, activities of daily living (ADLs), and supervision at rehabilitation discharge and at 1 year after traumatic brain injury (TBI). Design: Prospective longitudinal design. Setting: Seventeen Traumatic Brain Injury Model Systems (TBIMS) centers. Participants: A total of 1839 adults with TBI admitted to TBIMS trauma centers with subsequent acute rehabilitation; 849 were followed to 1 year after injury. Interventions: Not applicable. Main Outcome Measures: Accumulated CT scan pathology from the first week after injury; FIM[trade ] instrument and Disability Rating Scale at rehabilitation discharge and 1 year after injury; and Supervision Rating Scale at 1 year. Results: Chi-square analyses showed that individuals with a midline shift greater than 5mm (lateral compression) were more likely to require the assistance of another person at discharge from acute rehabilitation with ambulation (29% vs 17%[ndash ]19%, P=.02), toileting (47% vs 33%[ndash ]38%, P=.05), lower-body dressing (57% vs 39%[ndash ]46%, P=.015), bladder continence (32% vs 19%[ndash ]23%, P=.03), and overall supervision (53% vs 44%, P=.0006) than patients with a midline shift of lesser degree. At 1 year, 57% of patients with a midline shift greater than 5mm on acute CT scans were being supervised in the home versus 30% to 39% of those with a shift of lesser degree (P=.003); there were no significant differences in the percentages of those needing assistance for ambulation or ADLs. The association of subdural hematoma with ambulation, self-care, and supervision needs was related to the degree of midline shift but not to the presence of subdural hematoma. Individuals with subcortical contusions were more likely to require assistance at rehabilitation discharge for ambulation (32% vs 18%, P[lt ].0001), lower-body dressing (61% vs 44%), toileting (52% vs 35%), bladder continence (34% vs 22%), and overall supervision (61% vs 44%) than those without subcortical contusions (P[lt ].0001). At 1 year, individuals with acute subcortical contusions were more likely to need assistance with ambulation (15% vs 8%, P=.004) and stair climbing (15% vs 9%, P=.03). Those with bilateral frontal (54% vs 46%, P=.009) or bilateral temporal (58% vs 46%, P=.03) contusions were more likely to need assistance with overall supervision at rehabilitation discharge, compared with those with unilateral or no cortical contusions. Conclusions: The presence of either a midline shift greater than 5mm or a subcortical contusion on acute CT scans is associated with a greater need of assistance with ambulation, ADLs, and global supervision at rehabilitation discharge. Patients with bilateral cortical contusions require more global supervision at rehabilitation discharge but no more supervision for ambulation and ADLs. These findings may aid health care professionals and potential caregivers in planning for rehabilitation and supervision needs after rehabilitation discharge and, to a lesser extent, at 1 year after TBI. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Orthoses in haemophilia.

In haemophilia patients, orthoses are used for the prevention and management of bleeds and their effects on the musculoskeletal system. The characteristics of these devices vary according to the joint to which they are applied, although two basic types are distinguished: static and functional. The upper limbs make up a functional unit that is adapted to prehension, or the action of grasping or seizing objects. The most affected joints of this unit in haemophilia are the elbow and shoulder, which require immobilization, followed by stabilization and protection and in the case of disability, assistance in the performance of function. The lower limbs, on the other hand, are adapted to the action of ambulation. The knee, ankle and hip joints frequently sustain damage in haemophilia, and in the acute phase they should be immobilized and the patient discouraged from walking. Once bleeding has ceased, and motion and muscle balance improved, a gradual return to normal activity may commence. The principle aim of orthotics in these cases is to immobilize and unburden the affected body segment, and to provide stability and assistance for ambulation. Shoe insoles cushion and modify stance, and therefore may help prevent lesions. Crutches and walking frames are used for restoring normal gait. Orthotic devices improve the quality of life of haemophilia patients with musculoskeletal lesions and are useful for preventing lesions resulting from strenuous activities, whether performed in the course of daily living or in the pursuit of games and sports.

New low-contrast vision charts: reliability and test characteristics in patients with multiple sclerosis

The quantitative assessment of visual function in multiple sclerosis (MS) clinical trials has been limited to Snellen visual acuity. The purpose of this study was to examine the inter-rater reliability and test characteristics of a new visual outcome measure, the Low-Contrast Sloan Letter Charts, in patients with MS and visually-asymptomatic volunteers. Contrast letter acuity scores (letter scores) were measured at each of four contrast levels (100, 5, 1.25 and 0.6%) by two independent raters. Inter-rater agreement was described with the intraclass correlation coefficient (ICC) and comparison of mean scores. Excellent inter-rater agreement (ICC=0.86 - 0.95) was demonstrated at each contrast level among MS patients (n=100) and visually-asymptomatic volunteers (n=33). Average letter scores at the lowest contrast level (0.6%) were highly variable in the MS group, even among patients with visual acuities of 20/20 or better, and among those who required no assistance for ambulation. Low-Contrast Sloan Letter Chart testing is a highly reliable method of visual assessment, and provides information on an aspect of neurologic impairment in MS which is not captured by Snellen visual acuity or ambulation status. This new method demonstrates excellent potential as a visual function outcome measure for future MS clinical trials.

Abductor Paralysis and External Oblique Transfer

Eighteen patients with hip abductor paralysis owing to poliomyelitis underwent external oblique muscle transfer. Five male and 13 female patients with a mean age of 15 years 5 months (range, 10-23 years) with an average follow-up of 5 years (range, 2-11 years) were studied. An improvement in gait with decreased limp and swaying and increased ability to walk long distances was seen in 17 patients. Nine patients became free of their assistive ambulatory devices. Subjective improvement was observed in 16 patients (the improved appearance being the main element of satisfaction). According to a detailed scoring system, six excellent, six good, three fair, and three poor results were identified. There was very good correlation between the scoring system and the final outcome, making it a valuable predictive point system. The transfer was suitable for flail lower limb as well.

REFRACTORY HIP PAIN AFTER HIKING AND PHEASANT HUNTING

791 HISTORY: A 37 y/o previously healthy professional walleye fisherman presents to Mayo Clinic's Sports Medicine Center after developing left hip/groin pain. Symptoms began after returning from a pheasant hunting expedition during which he hiked 5-8 miles/day in tall grass. He described the pain as a dull ache at rest which increased to sharp pains upon weight-bearing. His symptoms were exacerbated by a near fall on the winter ice, with hip flexed, adducted and the knee extended. He denied radicular symptoms, back pain or previous injury. He was unable to ambulate without crutches. PHYSICAL EXAMINATION: Exam showed marked antalgic gait, positive Stinchfield and FABER's tests, negative straight leg raise bilaterally. Mildly decreased passive range of motion of the left hip with guarding. Pain elicited with hip internal/external rotation and abduction. Moderate thigh atrophy. Normal reflexes and sensory exam. Muscular strain or tear Femoral stress fracture Avascular necrosis/osteonecrosis Inflammatory or infectious arthritides Bony or soft tissue tumor Focal demineralization/osteoporosis Plain radiographs→ tiny vague lucency and decreased trabeculation left femoral head and neck, preserved joint space, no osseous erosion, or collapse. Bone Scan→ homogeneous 'target-like' uptake left femoral head/neck. MRI hip/pelvis→ small left hip joint effusion, bone marrow edema left femoral head/neck, atrophy of gluteal, iliopsoas, and quadriceps muscles. Repeat MRI at 7 months → complete interval resolution of edema and effusion. DIAGNOSIS: Transient Osteoporosis of the Hip (TOH) (aka: Regional Osteopenia; Algodystrophy; Transient Focal Demineralization.) Prolonged (1-3 months) rest/ non-weight bearing to prevent microfracture/ stress fracture. Analgesics/NSAID for pain management; not likely to alter natural course of disease. Progressive assisted ambulation, ROM exercise, hip group strengthening. Steroids, calcitonin, bisphosphonates & surgical core decompression have been shown to be effective but were not employed in this case.

Evaluation of a training program for persons with SCI paraplegia using the Parastep®1 ambulation system: Part 2. Effects on physiological responses to peak arm ergometry

Objective: To examine the task-nonspecific effects of functional neuromuscular stimulation (FNS)—assisted ambulation training on the physiological responses of persons with paraplegia to upper extremity exercise challenge. Design: Before-after trial. Setting: Human spinal cord injury (SCI) applied research laboratory. Participants: Twelve men and three women with motor- and sensory-complete thoracic-level SCI (T4–T11), mean age 28.2 ± 6.8yrs (range, 21.1 to 45.2yrs), mean injury duration 3.7 ± 3.Oyrs (range, 7 to 8.8yrs). Intervention: Thirty-two sessions of FNS ambulation training using a commercial six-channel system (Parastep® 1). This system is composed of a microprocessor-controlled electrical stimulation unit and a walking frame outfitted with finger switches that allow the user to independently control the system and stimulation parameters. Outcome Measures: Peak and subpeak physiological responses to arm ergometry testing and upper extremity strength measures, obtained before and after the FNS ambulation training. Results: Statistically significant increases in peak values for time to fatigue, peak power output, and peak V̇O 2 (all p < .001). Heart rate was significantly lower throughout subpeak levels of arm ergometry after the ambulation training ( p < .05). Values of upper extremity strength were not significantly altered after training. Conclusions: FNS ambulation by persons with SCI paraplegia results in task-nonspecific training adaptations. Central cardiovascular adaptations were indicated as the primary source of these beneficial alterations in exercise responses.

TOTAL HIP REPLACEMENT IN PATIENTS WITH OSTEOARTHRITIS OF THE HIP: IMPROVEMENT IN PAIN AND FUNCTIONAL STATUS

A simple, self-rating questionnaire was developed to assess the clinical outcome related to pain and function after total hip replacement surgery followed by physical therapy. Twenty-two patients, 57 to 86 years of age, with osteoarthritis of the hip who underwent total hip replacement surgery and received physical therapy following surgery, participated in the study. A questionnaire consisting of 11 items was developed to ascertain the level of pain, functional ability and the assistive ambulatory device used to perform selected activities of daily living. A maximum cumulative score of 55 points was possible. The functional categories monitored included: sitting, standing, sleeping, functional walking, distance walking, stair climbing, sitting/standing from a toilet seat, driving, and sexual activities. The questionnaires were completed preoperatively, and postoperatively at 3 and 6 months. The results showed an overall improvement of 56% at 3 months and 64% at 6 months after surgery. Twenty of 22 patients obtained "excellent" results with total hip replacement surgery and follow-up physical therapy. Results of this study indicated that total hip replacement followed by physical therapy decreases joint pain and improves function in patients with osteoarthritis of the hip.

The effects of assistive devices on the oxygen cost, cardiovascular stress, and perception of nonweight-bearing ambulation.

Nonweight-bearing ambulation with the aid of an assistive device is often prescribed in the clinical setting. Little is known about the oxygen cost, cardiovascular stress, and perception of effort of these devices when applied to the same sample of subjects. Therefore, the present study compared the oxygen cost, cardiovascular stress [measured by heart rate (HR), blood pressure (BP) responses, and rate pressure product (RPP)], and perception of effort [measured by ratings of perceived exertion (RPE)] of unassisted ambulation (UA), nonweight-bearing ambulation using axillary crutches (AC), a standard walker (SW), and a wheeled walker (WW). Nine female subjects ambulated at self-selected velocities for 7 minutes during each ambulation mode. Oxygen consumption, HR, BP, and RPEs were obtained. As expected, UA resulted in the lowest VO2 (11.2 +/- 1.4 ml/kg.min-1) and greatest velocity (1.24 +/- 0.27 m/sec). Results also indicated that AC ambulation resulted in lower oxygen consumption per meter (0.4 +/- 0.1 ml/kg.m-1) and greater velocity (0.74 +/- 0.18 m/sec) than either SW ambulation (0.6 +/- .1 ml/kg.-1, 0.39 +/- 0.09 m/sec) or WW ambulation (0.6 +/- .1 ml/kg.m-1, 0.40 +/- 0.12 m/sec) (p < .05). No differences were observed among assisted ambulation modes for HR, BP responses, RPP, or RPE values. Because patients typically ambulate for a set distance (rather than a set time) and because the oxygen cost per unit distance was lowest for AC, it is suggested that, when possible, AC should be prescribed for non-weight-bearing ambulation.

Chronic inflammatory demyelinating polyradiculoneuropathy.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents an important acquired condition characterized by progressive, symmetrical, proximal and distal weakness. Muscle stretch reflexes are depressed and sensory loss is variable. Patients may have mild to severe weakness and may require assisted ambulation or wheelchairs. Rarely do patients require respiratory support. Laboratory features include nerve conduction changes and nerve biopsy pathology indicative of demyelination. Cerebrospinal fluid protein is characteristically elevated without pleocytosis. The condition is responsive to immunosuppressive therapy, especially prednisone and plasmapheresis (plasma exchange). CIDP frequently follows a chronic or relapsing course.