Contralateral Intact Limb Research Articles

Influence of graft type on sagittal plane knee biomechanics during stair ambulation following anterior cruciate ligament reconstruction

BackgroundBoth graft type and surgical technique for anterior cruciate ligament reconstruction can affect knee biomechanics. Several studies reported the influence of graft type, but few have controlled the surgical technique and fully investigated stair ambulation. This study aimed to compare knee biomechanics during stair ambulation between patients treated with hamstring tendon graft and those treated with patellar tendon graft when anterior medial portal technique was used to drill femoral tunnel. MethodsTwo groups of patients (patellar tendon, n = 18; hamstring tendon, n = 18) at average 12 months after reconstruction surgery were recruited to ascend and descend a customized staircase in a gait lab. Joint kinematics and kinetics were calculated for both operated and contralateral intact limbs based on kinematic analysis and inverse dynamics. The influence of graft type on knee flexion angle and moment was identified using one-way mixed (graft type and limb side) analysis of variance with post-hoc paired t-test. FindingsSignificant interaction between graft and limb was found for knee flexion and range of motion. Only the hamstring tendon group had significant kinematic deficits on the operated limb than the contralateral limb during stair ascent and descent. No significant interaction was found for knee flexion moment. Both graft groups had significant deficits in peak knee flexion moment on the operated side during stair ascent and descent. InterpretationWhile the choice of graft type does not affect the restoration of knee dynamic loading, patellar tendon graft better restores knee flexion-extension kinematics during stair ambulation.

An intention-based online bilateral training system for upper limb motor rehabilitation

Bilateral rehabilitation training robotic systems have potential to promote the upper limb motor recovery of post-stroke hemiparesis patients through providing the synchronization motion between the impaired limb and contralateral limb. The active rehabilitation training based on patients’ intention can also promote the recovery effect by stimulating the activity of the ipsilateral hemisphere and contralateral hemisphere. In this paper, a novel intention-based bilateral training system using biomedical signals which represents the muscle activity information and active motion intention was proposed to promote the rehabilitation training effect. The proposed system can provide the synchronization motion to the impaired limb by the exoskeleton device according to the sEMG signals from the contralateral intact limb. A BPNN model using a novel multi-features input vector was employed for establishing the relationship between the sEMG signals and the motion intention. To verify the intention prediction performance, the comparison experiments involving both the offline phase and online phase were carried out using three different kinds of feature input vectors of sEMG. Furthermore, the real-time bilateral control experiments were conducted to verify the feasibility and effectiveness of the proposed bilateral rehabilitation system, in terms of motion synchronization tracking and the real-time characteristics.

Inter-Limb Transfer of Grasp Force Perception With Closed-Loop Hand Prosthesis.

Sensory feedback of grasp forces provides important information about physical interactions between the hand and objects, enabling both reactive and anticipatory neural control mechanisms. The numerous studies have shown artificial sensory feedback of various forms improves force control during grasping tasks by prosthetic hand users through a closed-feedback loop. However, little is known about how perceptual information is transferred between an intact limb and a closed-loop prosthetic limb, and the extent to which training inter-limb transfer may improve myoelectric prosthetic control. We addressed these gaps by using a contralateral force-matching task in which able-bodied participants were asked to generate grasp forces with their native hand, and then match it using the contralateral hand or a soft-synergy prosthetic hand worn on the contralateral arm that was coupled with a mechanotactile feedback device. We found that absolute matching error and matching time were greater when using the prosthetic system than the native hand. However, with contralateral specific training, subjects were able to produce similar relative matching error with the prosthetic system and the native hand, especially at the untrained force level. These findings suggest that an association can be established between the perception produced by the prosthetic limb and the contralateral intact limb, and provide novel insights about potential applications to training and design of the closed-loop prosthesis.

Provocative infrared testing in amputees

Previous studies suggest autonomic dysfunction in amputees, yet the methodology for testing this is problematic. The common techniques of sympathetic skin response and skin conduction response require soles, palms and digits, so we further investigated the use of quantitative InfraRed Telethermography (qIRT) to assess vasomotor (sympathetic) tone. In prior work, IRT demonstrates residual limbs of amputees are significantly cooler than contralateral intact limbs. This study investigates provocative IRT (pIRT) to assess sympathetic (vasomotor) responsiveness in residual vs.

Biomechanical models in the study of lower limb amputee kinematics

Optoelectronic motion capture may provide a platform for the development of objective biomechanical outcome measures applicable to the young, active individual with lower limb loss. In order to create valid and robust tools, the modelling strategy applied must adequately represent both natural and prosthetic segments and joints. To explore existing usage of optoelectronic motion capture and modelling strategies for the analysis of amputee function. Literature review. Systematic search of Medline (OVID) and keyword search of the Journal of Prosthetics and Orthotics. Over 60% (n = 32) of the 51 studies extracted adopted a conventional three degree-of-freedom modelling approach. Linear segment representation (15%) and six degree-of-freedom techniques (19%) were employed in the remaining papers. Prosthetic modelling strategies were poorly reported. Landmarks were estimated from corresponding positions on the contralateral intact limb, mechanical joint centres and regression equations. No model defined the residuum and socket independently. In the absence of a definitive solution, it is essential that the limitations of any model are understood in the development and establishment of reliable outcome measures for this population using motion capture technology. Poor reporting and a lack of consistency make comparison of results between studies and institutions impractical. Standard modelling techniques may not consistently represent the body and prosthesis adequately to produce valid results for the analysis of function of persons with lower limb loss. Variation in modelling techniques limits the utility of findings reported in the literature. Development and application of a uniform, robust modelling strategy would benefit research and clinical practice.

Quantitative, structural, and image-based mechanical analysis of nonunion fracture repaired by genetically engineered mesenchymal stem cells

Stem cell-mediated gene therapy for fracture repair, utilizes genetically engineered mesenchymal stem cells (MSCs) for the induction of bone growth and is considered a promising approach in skeletal tissue regeneration. Previous studies have shown that murine nonunion fractures can be repaired by implanting MSCs over-expressing recombinant human bone morphogenetic protein-2 (rhBMP-2). Nanoindentation studies of bone tissue induced by MSCs in a radius fracture site indicated similar elastic modulus compared to intact murine bone, eight weeks post-treatment. In the present study we sought to investigate temporal changes in microarchitecture and biomechanical properties of repaired murine radius bones, following the implantation of MSCs. High-resolution micro-computed tomography (micro-CT) was performed 10 and 35 weeks post MSC implantation, followed by micro-finite element (micro-FE) analysis. The results have shown that the regenerated bone tissue remodels over time, as indicated by a significant decrease in bone volume, total volume, and connectivity density combined with an increase in mineral density. In addition, the axial stiffness of limbs repaired with MSCs was 2–1.5 times higher compared to the contralateral intact limbs, at 10 and 35 weeks post-treatment. These results could be attributed to the fusion that occurred in between the ulna and radius bones. In conclusion, although MSCs induce bone formation, which exceeds the fracture site, significant remodeling of the repair callus occurs over time. In addition, limbs treated with an MSC graft demonstrated superior biomechanical properties, which could indicate the clinical benefit of future MSC application in nonunion fracture repair.

Residual Limbs of Amputees Are Significantly Cooler than Contralateral Intact Limbs

To test the hypothesis that distal residual limbs (DRLs) have significant vasomotor abnormalities. Comparative surface temperature studies of DRLs using paired samples (DRL vs. similar site on intact contralateral limb). Thirty-six volunteer subjects with unilateral, upper or lower limb amputations were recruited and evaluated at a pain research center in an urban academic rehabilitation facility. Our main outcomes were subjects' residual limb temperature as measured by quantitative infrared telethermography (qIRT), temperature strips, and examiner's palpation, compared with the contralateral limb. The qIRT showed that the DRLs were significantly cooler than the corresponding area of the contralateral intact limbs (P < 0.01). The difference using temperature strips supported this finding (P < 0.05); while on physical examination, 39% of the residual limbs were perceived by the examiner as cooler than the corresponding unaffected limbs. DRLs as measured by qIRT were significantly cooler than the corresponding area of the contralateral intact limbs. A better understanding of these findings may be important in elucidating the pathophysiology of relevant clinical features such as a potential sympathetic component of postamputation pain.

Lack of an effect of sodium zeolite A on rat tibia histomorphometry

Cell culture studies suggest that the aluminum silicate polymer sodium Zeolite A (SZA) increases bone cell proliferation and extracellular matrix production. This study in rats investigated the short-term (2 weeks) and long-term (18 weeks) in vivo effects of SZA on growth rate (weight gain) and tibia histomorphometry. In separate short-term experiments, female (experiment 1) or male (experiment 2) Sprague-Dawley rats grown and maintained on normal calcium diets were gavaged daily during a 2 week treatment period with 30 mg/kg, 100 mg/kg, or 500 mg of SZA/kg of rat body weight. In the long-term study (experiment 3) ovariectomized (OVX) rats were fed a low calcium diet containing 0, 1.80, and 9.00 g of SZA/kg of diet (0, 125, and 617 mg/kg of body weight, respectively). Short- and long-term treatment of growing rats with SZA resulted in a dose-dependent increase in bone aluminum. In the first experiment, growing intact female rats showed no significant SZA dose-dependent response in growth rate (weight gain) or histomorphometry of cortical bone in the tibial diaphysis or cancellous bone in the secondary spongiosa of the tibial metaphysis. In the second experiment, growing male rats, with right hind limbs immobilized by unilateral sciatic neurotomy, showed no SZA dose-dependent response in growth rate. The longitudinal growth of cancellous bone in the tibia of the denervated limb and the intact contralateral limb were not influenced by sciatic neurectomy and/or by treatment with SZA. Histomorphometry demonstrated that cortical bone mass and formation was reduced in the sciatic-sectioned limb when compared with the contralateral intact limb of vehicle-treated rats, as evidenced by significant reductions in static measurements of cortical bone area (-8.5%) and cross-sectional area (-4.8%) and in calculations of the periosteal formation rate (-33.8%) and mineral apposition rate (-31.6%), and the endocortical formation rate (-35.5%) and mineral apposition rate (-37.9%). The cancellous bone mass of denervated limbs of vehicle-treated rats was also deficient, as evidenced by decreased cancellous bone area (-39.1%) and perimeter (-31.9%). The bone mineral apposition rate was decreased (-26.7%) indicating reduced osteoblast activity. Treatment with SZA did not influence these indices in the tibiae of either sciatic-sectioned limbs or contralateral intact limbs. In the long-term experiment, OVX resulted in a dramatic 88% decrease in cancellous bone volume which was prevented by treatment with 17 beta-estradiol and not influenced by treatment with Zeolite A. The increases in osteoblast and osteoclast number following OVX were not influenced by SZA. The results indicate that SZA treatment has no anabolic effect on cortical and cancellous bone formation and mass in normal growing female rats and that this compound does not protect against osteopenia due to reduced load bearing in the growing male rat or gonadal hormone deficiency in adult female rats.

Depression of osteoblastic activity in immobilized limbs of suckling rats

Recently we characterized the immobilization-related osteopenia in adult rats and showed that it is caused by increased bone resorption and decreased bone formation (Weinreb et al. 1989 Bone 10:187). To assess the effect of age on disuse osteopenia, this study investigated the effects of immobilization on bone turnover in very young, suckling rats. The 15-day-old rats underwent unilateral hind limb immobilization by sciatic neurectomy; the contralateral limb was left intact and served as control. Experimental or sham-operated animals were killed after 0, 2, 4, or 12 days postsurgery. Dry, fat-free weight and ash weight were determined in both femora, and both tibiae were subjected to static and dynamic histomorphometry. Immobilization caused a progressive deficit in bone mass in the immobilized limb compared to the contralateral intact limb but did not affect femoral longitudinal growth. The total mineral content in the immobilized femora was 13.6% less than that in the intact limb by day 12. Concomitantly, tibial cancellous bone area and perimeter declined in the immobilized limb by 37.3 and 32.2%, respectively. This reduction in bone mass in the tibiae of immobilized limbs was associated with increased bone resorption, expressed as osteoclast perimeter, number of osteoclasts per mm surface, and number of osteoclasts per mm2 tissue area. Bone formation was reduced as a result of impaired osteoblast activity as evidenced by (1) decreased endocortical and trabecular mineral apposition rate; (2) reduced trabecular mineral formation rate; (3) decreased percentage of ash of the femoral dry weight; and (4) increased volume of unmineralized osteoid in the tibial metaphysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Immobilization-related bone loss in the rat is increased by calcium deficiency

The object of this study was to investigate whether a calcium-deficient diet increases the bone loss produced by mechanical hypofunction (disuse) in the rat. Male Sprague-Dawley rats of approximately 150 g were placed on either a normal diet or a calcium-deficient diet. After 7 days, all rats underwent unilateral hind-limb immobilization by sciatic neurectomy and were sacrificed 30 hours, 72 hours, or 10 days postsurgery. Femora were ashed and the total mineral content (ash weight) was determined. Tibiae were embedded, sectioned, and stained. The metaphyseal secondary spongiosa and the diaphyseal cortical bone were subjected to histomorphometric analysis. Femoral length and serum calcium were not affected by calcium intake or immobilization. Serum parathyroid hormone levels were elevated in rats on the calcium-deficient diet compared to those on the normal diet. Calcium deficiency caused a significant reduction in femoral ash weight (20-35%), tibial cortical thickness (16-20%), and trabecular bone volume (TBV) (33-39%) at 72 hours and 10 days postsurgery. Additional loss of bone mass occurred in the immobilized limb compared to the contralateral intact limb of both dietary groups. This loss occurred earlier (30 hours postsurgery versus 72 hours) in the animals on a calcium-deficient diet and was larger compared to animals on a normal diet (10.6% versus 4.8% at 72 hours and 17.9% versus 12.45% at 10 days). The total bone loss induced by the combination of a calcium-deficient diet and immobilization in this experiment was estimated to equal 46% of femoral ash weight and 79% of tibial TBV.(ABSTRACT TRUNCATED AT 250 WORDS)

Reflex effects of thoracic aorta wall stretch on regional vascular resistance.

In anesthetized, vagotomized cats with both carotid arteries occluded, a stretch of the walls of the thoracic aorta, performed without obstructing aortic flow, induced a significant reflex increase in arterial pressure (35 +/- 2-26 +/- 1 mmHg; systolic-diastolic). This pressure increase was accompanied by significant increases in peripheral resistance in the superior mesenteric (+30%), renal (+23%), and external iliac (+23%) vascular beds. The increase in iliac resistance observed in the skinned leg was comparable with that observed in the contralateral intact limb. All these vascular responses were drastically reduced by the administration of phenoxybenzamine. After alpha-adrenergic blockade no signs of reflex vasodilatation could be detected during aortic stretch in any of the vascular beds examined.

The conditions of occurrence of phantom limbs

ALMOST ninety years ago Weir Mitchell (9) coined the term phantom, limb to describe the amputee's experience of the continued presence of a limb which has been lost. Immediately after amputation, as he awakes from the anesthesia, the patient may not believe that the arm or leg has been removed until he can convince himself by looking under the covers. But even once he knows beyond doubt that the extremity is gone, he typically continues to feel it as if it were still present. In the days-and years-to come, the foot of the amputated leg may itch and, as the patient reaches down to scratch it, he reaches for an empty space. He may feel the bedsheets on the arm or leg, he may feel a mild, perhaps pleasant tingling-a phenomenon which Henderson and Smyth (5) regard as basic-or, much more rarely, he may feel pain. He may feel that he can wiggle his finger or toes, flex or extend the wrist or ankle, and that he can perform these movements more or less at will. Despite his knowledge that the amputation has been performed the patient may forget and reach out with the missing hand to grasp something, or to steady himself, or he may step on the phantom foot and fall. At least initially a good many amputees report that they are more aware of the phantom extremity-even though painless-than of the contralateral intact limb, an observation already recorded by Weir Mitchell (9). When the phantom first appears the experience is usually-though not always-that of the limb as if it were still present, i.e. the phantom has normal size, shape, etc. In time, however, certain changes take place. The less articulated parts, such as the calf or the forearm, may fade and eventually drop out altogether, leaving only the foot, and eventually perhaps only the toes, or, correspondingly, leaving only the hand and finally only the fingers. Furthermore, the remaining parts may gradually move towards the stump-