Limb Disability Research Articles

Treatment of Partial-Thickness Rotator Cuff Tears with Bio-Inductive Collagen Implant for Paraplegic Tennis Player: A Case Report

In patient with lower limb disability, rotator cuff disorders are prevalent, with partial thickness tears occurring at nearly twice the rate of full thickness tears. For those with acromion spurs unresponsive to conservative treatment, rotator cuff repair via the take-down method poses a retear risk and requires extensive rehabilitation. Conversely, surgery utilizing bio-inductive collagen implants shows a lower retear risk and enables faster recovery, making it an appealing option for wheelchair athletes. Thus, the authors aim to present favorable outcomes from isolated bio-inductive collagen implant repair in a 45-year-old female wheelchair tennis player with a bursal side partial thickness tear, alongside a literature review.

Long-term outcomes and trends in elbow arthroplasty with Coonrad-Morrey prosthesis: a retrospective study in large group of patients.

Total Elbow Arthroplasty (TEA) was first developed to treat severe rheumatoid arthritis, but its uses have grown to encompass end-stage osteoarthritis, post-traumatic arthritis, and distal humeral fractures. This study analyzes indications changes, long-term survival, complications, and post-operative functional results of the Coonrad-Morrey prostheses, enhancing the existing literature on this technique and substantial case history. We included 122 arthroplasties in 117 patients, 28 males and 89 females (mean age of 67 years) treated in our hospital between 2002 and 2016. Minimum follow-up was four years. We collect functional parameters of 48 patients (51 elbows), due to death of patients due to old age and loss at follow-up. Survival rate at five years was 90%, 85% at 10 years and 83% at 15 years. The overall medium Mayo elbow score was 79.7 ± 18.3 with the highest result in osteoarthritis patients (p < 0.005); QuickDASH score was 33.1 ± 25.5 with the worse result in rheumatoid group. Average post-operative arc of motion (ROM) was 95°±27°. There were complications in 46 out of 122 cases (37.7%) and revision surgeries were performed in 12 of them (9.8%): seven aseptic loosening, four late septic loosening, one bushing wear. In 27 instances (22.1%) was reported ulnar nerve involvement. Coonrad-Morrey prosthesis has shown satisfactory clinical results in the treatment of a wide range of pathologies. The long-term implant survivorship was satisfactory, yet the occurrence of failures and complications cannot be overlooked, above all the ulnar nerve paresthesia. There was a good recovery in quality of life, pain-free with limited residual limb disability.

Visuospatial function impairment in patients with subacute-chronic isolated frontal lobe ischemic stroke: A cross-sectional study using MoCA-Ina in a private hospital

Background. Stroke is one of the leading causes of disability, resulting in both limb disability and also cognitive impairment. Cognitive impairment can occur post-stroke due to lesions in specific cortex areas. Visuospatial function, a domain of cognitive function related to visual imaging, is commonly affected by parietal lobe lesions. However, visuospatial processing also requires sustained attention, planning, and error correction, functions of the frontal lobe. There is a paucity of studies evaluating the relationship between isolated frontal lobe stroke and patients’ visuospatial function. Objective. To analyze the relationship between subacute-chronic frontal lobe ischemic stroke and visuospatial function in post-ischemic stroke patients using the MoCA-Ina. Material and methods. Patients from Siloam Karawaci General Hospital’s neurology outpatient department with ages under 65 years, Glasgow Coma Scale of 15, diagnosis of first-time stroke based on CT scan result, and ischemic lesion confined to one brain lobe were recruited using non-probability consecutive sampling for this cross-sectional study. Patients were divided into frontal lobe and non-frontal lobe stroke subgroups. Visuospatial function was assessed using MoCA-Ina and analyzed using Mann Whitney U test. Outcomes. Fifty patients were included; 25 had frontal lobe stroke, and 25 had non-frontal lobe stroke. The median visuospatial score was lower in the frontal lobe group (2, min/max = 0/4) compared to the non-frontal lobe group (3, min/ max = 0/5), with a p-value of 0.044. There was no significant difference in visuospatial scores between different frontal hemisphere locations. Conclusion. Subacute-chronic frontal lobe ischemic stroke affects visuospatial function in post-ischemic stroke patients.

Inhibition of KIF5b-mediated Nav1.8 transport by ropivacaine contributes to axonal regeneration following sciatic nerve injury in rats

Peripheral nerve injury (PNI), typically caused by traumatic accidents or medical events, is currently one of the most common diseases that leads to limb disability. After PNI, tetrodotoxin-resistant voltage-gated sodium channel Nav1.8 is upregulated at the lesion site. Our earlier study suggested that ropivacaine promotes axon regrowth by regulating Nav1.8-mediated macrophage signaling. Nevertheless, the mechanism of ropivacaine in regulation of Nav1.8 expression remains incompletely understood. Kinesin family 5b (KIF5b) was reported to mediate the Nav1.8 axonal transport from dorsal root ganglia (DRGs) to lesion site. Herein, we investigated whether ropivacaine promotes axon regeneration through inhibition of KIF5b-mediated Nav1.8 transport. Reduced levels of KIF5b and Nav1.8 in DRGs coincide with their increase at the lesion site. Nav1.8 mRNA was significantly increased at the lesion site but not in DRGs. Surprisingly, ropivacaine reversed the alterations of Nav1.8 and KIF5b protein expression without affecting Nav1.8 mRNA level. Due to KIF5b overexpression in DRGs, Nav1.8 protein level was significantly decreased in DRGs and increased at the lesion site. We also found KIF5b overexpression significantly impaired behavioral functions, reduced the recovery index of compound muscle action potential (CMAP) amplitude, inhibited axonal regrowth, slowed M1 macrophage infiltration and shift to M2 phenotype, and delayed myelin debris clearance. Notably, all aforementioned results caused by KIF5b overexpression were alleviated by ropivacaine. Furthermore, we demonstrated that inhibition of Nav1.8 transport by A-803467 produced mitigating effects on the impairment of regenerative capacity induced by KIF5b overexpression similar to ropivacaine. These results suggest that ropivacaine promotes axonal regeneration at least partially by inhibiting KIF5b-mediated Nav1.8 forward transport.

Simultaneous tibial osteotomy and total knee arthroplasty in posttraumatic and obese patient: a case report

Deforming osteoarthritis of the knee joint alters the mechanical axis of the lower limb. This, combined with extra articular deformity of the tibia or femur leads to serious dysfunction of the limb and great disability for the patient. These rare cases present great challenge for the orthopedic surgeon. Most of the cases with mild to moderate deformities can be successfully managed by adjusting intra articular resections, but in those with severe extra articular deformity, an extra articular correctional osteotomy may be required in order to achieve good flexion-extension balance of the knee. We report a case of total knee replacement performed together with correctional osteotomy of the tibia due to extra articular deformity of about 20 degree varus.

Effectiveness of Two Models of Telerehabilitation in Improving Recovery from Subacute Upper Limb Disability after Stroke: Robotic vs. Non-Robotic.

Finding innovative digital solutions is fundamental to ensure prompt and continuous care for patients with chronic neurological disorders, whose demand for rehabilitation also in home-based settings is steadily increasing. The aim is to verify the safety and the effectiveness of two telerehabilitation (TR) models in improving recovery from subacute upper limb (UL) disability after stroke, with and without a robotic device. One hundred nineteen subjects with subacute post-stroke UL disability were assessed for eligibility. Of them, 30 patients were enrolled in the study and randomly assigned to either the Robotic Group (RG), undergoing a 20-session TR program, using a robotic device, or the Non-Robotic Group (NRG), undergoing a 20-session TR program without robotics. Clinical evaluations were measured at baseline (T0) and post-intervention (T1, 5 weeks after baseline), and included assessments of quality of life, motor skills, and clinical/functional status. The primary outcome measure was the World Health Organization Disability Assessment Schedule 2.0, evaluating the change in perceived disability. Statistical analysis shows that patients of both groups improved significantly over time in all domains analyzed (mean decrease from baseline in the WHODAS 2.0 of 6.09 ± 2.62% for the NRG, and of 0.76 ± 2.21% for the RG), with a greater improvement of patients in the NRG in motor (Fugl-Meyer Assessment Upper Extremity-motor function, Box and Block Test) and cognitive skills (Trail Making Test-A). This study highlights the potential of TR programs to transform stroke rehabilitation by enhancing accessibility and patient-centered care, promoting autonomy, improving adherence, and leading to better outcomes and quality of life for stroke survivors.

Movement-Based Prosthesis Control with Angular Trajectory Is Getting Closer to Natural Arm Coordination.

Traditional myoelectric controls of trans-humeral prostheses fail to provide intuitive coordination of the necessary degrees of freedom. We previously showed that by using artificial neural network predictions to reconstruct distal joints, based on the shoulder posture and movement goals (i.e., position and orientation of the targeted object), participants were able to position and orient an avatar hand to grasp objects with natural arm performances. However, this control involved rapid and unintended prosthesis movements at each modification of the movement goal, impractical for real-life scenarios. Here, we eliminate this abrupt change using novel methods based on an angular trajectory, determined from the speed of stump movement and the gap between the current and the 'goal' distal configurations. These new controls are tested offline and online (i.e., involving participants-in-the-loop) and compared to performances obtained with a natural control. Despite a slight increase in movement time, the new controls allowed twelve valid participants and six participants with trans-humeral limb loss to reach objects at various positions and orientations without prior training. Furthermore, no usability or workload degradation was perceived by participants with upper limb disabilities. The good performances achieved highlight the potential acceptability and effectiveness of those controls for our target population.

Optimization of Joint Space Trajectories for Assistive Lower Limb Exoskeleton Robots: Real-Time and Flexible Gait Patterns

This research focuses on designing a real-time, flexible gait planner for lower limb exoskeleton robots to assist patients with lower limb disabilities. Given the dynamic nature of gait parameters, which vary according to ground conditions and user intent, the challenge lies in developing a gait planner capable of adapting to these changes in real-time. To avoid planning complications in the cartesian space and to comply with the speed constraints of joint motors, this paper proposes planning in joint space. Furthermore, the approach also considers the maximum speed capabilities of the joint motors, aiming to generate an executable gait pattern and simultaneously enhance the robot’s walking speed by determining the minimum time required for implementation. The introduced gait planner optimizes joint trajectories for minimal angular acceleration. To provide flexibility, generalized boundary conditions suitable for different scenarios are defined. The effectiveness of the proposed planner is validated through comprehensive performance analysis, simulations, and successful implementation trials on the Exoped® robot in various scenarios.

The association between dexterity and upper limb impairment during stroke recovery.

Stroke-induced upper limb disabilities can be characterized by both motor impairments and activity limitations, commonly assessed using Fugl-Meyer Motor Assessment for Upper Extremity (FMMA-UE) and Action Research Arm Test (ARAT), respectively. The relationship between the two assessments during recovery is largely unstudied. Expectedly they diverge over time when recovery of impairment (restitution) plateaus, but compensation-driven improvements still occur. The objective of this study is to evaluate the alignment between FMMA-UE and ARAT in defining upper limb functional recovery categories by ARAT scores. We aimed to establish cut-off scores for both measures from the acute/early subacute, subacute and chronic stages of stroke recovery. Secondary analysis of four prospective cohort studies (acute/early subacute: n = 133, subacute: n = 113, chronic: n = 92) stages post-stroke. Receiver operating characteristic curves calculated the area under the curve (AUC) to establish optimal FMMA-UE cut-offs based on predefined ARAT thresholds distinguishing five activity levels from no activity to full activity. Weighted kappa was used to determine agreement between the two assessments. We used minimally clinically important difference (MCID) and minimal detectable change (MDC95) for comparison. FMMA-UE and ARAT scores showed no relevant divergence across all recovery stages. Results indicated similar cut-off scores in all recovery stages with variability below MCID and MDC95 levels. Cut-off scores demonstrated robust AUC values from 0.77 to 0.86 at every recovery stage. Only in highly functional patients at the chronic stage, we found a reduced specificity of 0.55. At all other times sensitivity ranged between 0.68 and 0.99 and specificity between 0.71 and 0.99. Weighted kappa at the acute/early subacute, subacute and chronic stages was 0.76, 0.83, and 0.81, respectively. Our research shows a strong alignment between FMMA-UE and ARAT cut-off scores throughout stroke recovery, except among the subgroup of highly recovered patients at the chronic stage. Discrepancies in specificity potentially stem from fine motor deficits affecting dexterity outcomes that are not captured by FMMA-UE. Additionally, the high congruence of both measures suggests they are not suited to distinguish between restitution and compensation. Calling for more comprehensive assessment methods to better understand upper limb functionality in rehabilitation.

Speech-language performance and comorbid disorders in children with perisylvian syndrome induced by viral encephalitis.

Viral encephalitis is one of the main causes of the perisylvian syndrome, which can cause damage to children's language-speech, feeding, and swallowing functions. Comprehensive assessment of language-speech and swallowing function and comorbidity research on these children will help children's rehabilitation workers to better understand the disease and strengthen the systematic management of comorbid disorders. To describe speech and language pathology and the occurrence of comorbid disorders in children with perisylvian syndrome induced by viral encephalitis. Twenty-two children with acquired perisylvian syndrome were recruited in this study. Language and speech functions, including oral motor function, swallowing function, language ability, and dysarthria were assessed in these patients. Craniocerebral magnetic resonance imaging (MRI), electroencephalogram examination, and intelligence evaluation were performed to determine brain lesions and comorbid disorders. All children exhibited different degrees of oral movement, dysphagia, and speech and language disorders. There was a significant difference between expressive and receptive language ability (P<0.05). There were 10, 8, and 12 children who had an intellectual disability, limb disability, and epilepsy, respectively. In addition to the damage of the peri-tegmental cortex found in MRI, thalamus lesions occurred in 19 cases and white matter involvement in six cases. Children with acquired perisylvian syndrome caused by viral encephalitis are characterized by persistent pseudobulbar dysfunction, speech and language impairment, and orofacial diplegia. They have a high probability of secondary epilepsy and are prone to motor and cognitive impairment, which need systematic management.

Development of a Body Weight Support System Employing Model-Based System Engineering Methodology

Partial body weight support systems have proven to be a vital tool in performing physical therapy for patients with lower limb disabilities to improve gait. Developing this type of equipment requires rigorous design process that obtains a robust system, allowing physiotherapy exercises to be performed safely and efficiently. With this in mind, a “Model-Based Systems Engineering” design process using SysML improves communication between different areas, thereby increasing the synergy of interdisciplinary workgroups and positively impacting the development process of cyber-physical systems. The proposed development process presents a work sequence that defines a clear path in the design process, allowing traceability in the development phase. This also ensures the observability of elements related to a part that has suffered a failure. This methodology reduces the integration complexity between subsystems that compose the partial body weight support system because is possible to have a hierarchical and functional system vision at each design stage. The standard allowed requirements to be established graphically, making it possible to observe their system dependencies and who satisfied them. Consequently, the Partial Weight Support System was implemented through with a clear design route obtained by the MBSE methodology.

Upper Limb Function in People With Upper and Lower Limb Loss 8Years Postinjury: The Armed Services Trauma Outcome Study (ADVANCE) Cohort Study.

Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss. A volunteer sample of injured (n= 579) and uninjured (n= 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores. DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group. People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20years. For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.

Upper Limbs Muscle Co-Contraction Changes Correlate With The Physical Motor Impairments in CMT.

Subjects with Charcot-Marie-Tooth (CMT) disease show hands impairment which is a relevant problem affecting the quality of life. This symptom is related to muscle weakness and reduced motor coordination of the upper limb. However, most studies focus on lower limb impairment, therefore the investigation of upper limb disability is necessary to identify biomarkers able to monitor disease-specific features and to tailor rehabilitation. This study aimed at characterizing upper limb muscle co-contraction using the co-contraction index (CCI) in CMT population. Upper limb kinematic and electromyography (EMG) data were collected from fourteen CMT subjects (6-CMT1A and 8-CMT1X) during motor tasks typical of daily living activities. Rudolph's CCI was used to quantify muscle co-contraction of four muscle pairs acting on shoulder, elbow and wrist. All CMT subjects underwent clinical examination. Thirteen healthy subjects served as the normative reference (HC). CMT1X and CMT1A showed a significant reduction in CCI for distal and proximal muscle pairs compared to HC. Furthermore, CMT1A showed greater values of CCI compared to CMT1X mainly for the axial and axial-to-proximal muscle pairs. Movement speed and smoothness were not altered compared to HC. In addition, EMG metrics showed moderate-to-strong significant correlations with clinical outcomes. CCI was able to quantify disease-specific deficits with respect to the normative reference, highlighting motor control alterations even before motor output impairment. CCI was also sensitive in detecting CMT subtypes-based differences and adopted compensatory strategies. Our findings suggest that CCI can be an outcome measure for CMT disease monitoring and interventional studies.

The Growing Role of Telerehabilitation and Teleassessment in the Management of Movement Disorders in Rare Neurological Diseases: A Scoping Review.

Background: People with rare neurological diseases (RNDs) often experience symptoms related to movement disorders, requiring a multidisciplinary approach, including rehabilitation. Telemedicine applied to rehabilitation and symptom monitoring may be suitable to ensure treatment consistency and personalized intervention. The objective of this scoping review aimed to emphasize the potential role of telerehabilitation and teleassessment in managing movement disorders within RNDs. By providing a systematic overview of the available literature, we sought to highlight potential interventions, outcomes, and critical issues. Methods: A literature search was conducted on PubMed, Google Scholar, IEEE, and Scopus up to March 2024. Two inclusion criteria were followed: (1) papers focusing on telerehabilitation and teleassessment and (2) papers dealing with movement disorders in RNDs. Results: Eighteen papers fulfilled the inclusion criteria. The main interventions were home-based software and training programs, exergames, wearable sensors, smartphone applications, virtual reality and digital music players for telerehabilitation; wearable sensors, mobile applications, and patient home video for teleassessment. Key findings revealed positive outcomes in gait, balance, limb disability, and in remote monitoring. Limitations include small sample sizes, short intervention durations, and the lack of standardized protocols. Conclusion: This review highlighted the potential of telerehabilitation and teleassessment in addressing movement disorders within RNDs. Data indicate that these modalities may play a major role in supporting conventional programs. Addressing limitations through multicenter studies, longer-term follow-ups, and standardized protocols is essential. These measures are essential for improving remote rehabilitation and assessment, contributing to an improved quality of life for people with RNDs.

Comparing clinical outcomes of patients with severe lower limb trauma undergoing orthoplastic and orthopedic surgeries: A long-term study protocol

This long-term study protocol aims to compare the clinical outcomes of patients with severe lower limb trauma undergoing orthoplastic and orthopedic surgeries, focusing on their physical and psychological status. Patients with lower limb injuries and open fractures have been recruited since October 2019 and will be followed up until October 2024. The patients will be divided into two groups: (1) Orthoplastic group, where single-stage debridement, fixation, and soft tissue repair will be performed, and (2) Orthopedic group, where soft tissue repair will be done in a delayed-stage. The follow-up period will be one year, during which clinical data, limb function recovery, psychological scores, and health-related quality of life (HRQOL) will be evaluated to assess postoperative recovery and clinical outcomes. Additional clinical data, such as socio-demographic information, baseline features, Enneking score, Visual Analogue Scale (VAS) score, two-point discrimination score, and blood test parameters will also be collected. The 36-Item Short Form Health Survey (SF-36) will be used to evaluate HRQOL, while the Post-traumatic Stress Disorder Checklist (PCL) will assess the severity of self-reported post-traumatic stress disorder. The results of this study will provide valuable insights into prognostically relevant targets and contribute to improving the management and outcomes of patients with lower limb injuries and open fractures, who often face challenges related to limb disability and potential amputation postoperatively, significantly impacting their psychological and physical well-being.

Musculoskeletal Disorders Related to Upper Limb Disability after One-Year Lung Cancer Resection.

Lung resection represents the main curative treatment in lung cancer; however, this surgical process leads to several disorders in tissues and organs. Previous studies have reported cardiovascular, pulmonary, and muscular disturbances that affect the functional capacity of these patients in the short, mid, and long term. However, upper limb impairment has been scarcely explored in the long term, despite the relevance in the independence of the patients. The aim of this study was to characterize the upper limb impairment in survivors of lung cancer one year after pulmonary resection. In this observational trial, patients who underwent lung cancer surgery were compared to control, healthy subjects matched by age and gender. Upper limb musculoskeletal disorders (shoulder range of motion, pain pressure threshold, nerve-related symptoms) and functional capacity (upper limb exercise capacity) were evaluated one-year post-surgery. A total of 76 survivors of lung cancer and 74 healthy subjects were included in the study. Significant differences between groups were found for active shoulder mobility (p < 0.05), widespread hypersensitivity to mechanical pain (p < 0.001), mechanosensitivity of the neural tissue (p < 0.001), and upper limb exercise capacity (p < 0.001). Patients who undergo lung cancer surgery show upper limb musculoskeletal disorders and upper limb functional impairment after a one-year lung resection. This clinical condition could limit the functionality and quality of life of patients with lung cancer.

Applications of Brain Wave Classification for Controlling an Intelligent Wheelchair

The independence and autonomy of both elderly and disabled people have been a growing concern in today’s society. Therefore, wheelchairs have proven to be fundamental for the movement of these people with physical disabilities in the lower limbs, paralysis, or other type of restrictive diseases. Various adapted sensors can be employed in order to facilitate the wheelchair’s driving experience. This work develops the proof concept of a brain–computer interface (BCI), whose ultimate final goal will be to control an intelligent wheelchair. An event-related (de)synchronization neuro-mechanism will be used, since it corresponds to a synchronization, or desynchronization, in the mu and beta brain rhythms, during the execution, preparation, or imagination of motor actions. Two datasets were used for algorithm development: one from the IV competition of BCIs (A), acquired through twenty-two Ag/AgCl electrodes and encompassing motor imagery of the right and left hands, and feet; and the other (B) was obtained in the laboratory using an Emotiv EPOC headset, also with the same motor imaginary. Regarding feature extraction, several approaches were tested: namely, two versions of the signal’s power spectral density, followed by a filter bank version; the use of respective frequency coefficients; and, finally, two versions of the known method filter bank common spatial pattern (FBCSP). Concerning the results from the second version of FBCSP, dataset A presented an F1-score of 0.797 and a rather low false positive rate of 0.150. Moreover, the correspondent average kappa score reached the value of 0.693, which is in the same order of magnitude as 0.57, obtained by the competition. Regarding dataset B, the average value of the F1-score was 0.651, followed by a kappa score of 0.447, and a false positive rate of 0.471. However, it should be noted that some subjects from this dataset presented F1-scores of 0.747 and 0.911, suggesting that the movement imagery (MI) aptness of different users may influence their performance. In conclusion, it is possible to obtain promising results, using an architecture for a real-time application.

The Reliability and Validity of the OneStep Smartphone Application for Gait Analysis among Patients Undergoing Rehabilitation for Unilateral Lower Limb Disability.

An easy-to-use and reliable tool is essential for gait assessment of people with gait pathologies. This study aimed to assess the reliability and validity of the OneStep smartphone application compared to the C-Mill-VR+ treadmill (Motek, Nederlands), among patients undergoing rehabilitation for unilateral lower extremity disability. Spatiotemporal gait parameters were extracted from the treadmill and from two smartphones, one on each leg. Inter-device reliability was evaluated using Pearson correlation, intra-cluster correlation coefficient (ICC), and Cohen's d, comparing the application's readings from the two phones. Validity was assessed by comparing readings from each phone to the treadmill. Twenty-eight patients completed the study; the median age was 45.5 years, and 61% were males. The ICC between the phones showed a high correlation (r = 0.89-1) and good-to-excellent reliability (ICC range, 0.77-1) for all the gait parameters examined. The correlations between the phones and the treadmill were mostly above 0.8. The ICC between each phone and the treadmill demonstrated moderate-to-excellent validity for all the gait parameters (range, 0.58-1). Only 'step length of the impaired leg' showed poor-to-good validity (range, 0.37-0.84). Cohen's d effect size was small (d < 0.5) for all the parameters. The studied application demonstrated good reliability and validity for spatiotemporal gait assessment in patients with unilateral lower limb disability.

Death of a one-armed blackback male due to severe injuries in a group of wild western lowland gorillas (Gorilla gorilla gorilla) in Moukalaba-Doudou National Park, Gabon.

The survival of limb-disabled primates in the wild has been widely reported. Nevertheless, their ultimate fate is little documented. It is important to understand the influence of limb disability on primate survival from a conservation perspective, as many African great apes suffer from limb injuries caused by entrapment in snares. Here, we report the death of a one-armed blackback male in a large one-male group of wild western lowland gorillas. The subject was a blackback male (14 years old) named Dodo, who lost his right forearm in August 2008. On 8 December 2019, Dodo was found to have suffered serious bleeding injuries to the front of his body, including large lacerations and puncture wounds. On 14 December his corpse was found in the forest. We provide evidence to suggest that his injuries were more likely caused by intraspecific aggression, though a predatory attack by a leopard could not be completely ruled out. His one-armed disability could have made him more vulnerable to attack from either a gorilla or leopard and led to his fatal injury. This report shows that a gorilla who had previously overcome a disability in one arm in childhood may die prematurely, in part, owing to this disability in young adulthood.

Electrospun multi-functional medicated tri-section Janus nanofibers for an improved anti-adhesion tendon repair

The occurrence of limb disability resulting from tendon injuries is not uncommon due to the limited treatment options available. Among these methods, physical barriers are often used during and after operation. In this study, we developed a new type of nanofibrous barrier using a tri-fluid side-by-side electrospinning process. The nanofibers consisted of three sections arranged in an eccentric Janus manner, each loaded separately with three functional ingredients beeswax (BW), quercetin and ketoprofen. Hydrophobic polylactic acid and polycaprolactone were utilized as the polymeric matrices, and the outer crescent section’s beeswax content was adjusted to enhance the barriers’ hydrophobicity. Scanning electron microscopy and transmission electron microscopy revealed the linear morphology and tri-section Janus stricture of the nanofibers. X-ray diffractometry and Fourier transform infrared spectroscopy confirmed the amorphous state of the drugs and the compatibility between the drugs and polymers. Tensile experiments showed that the nanofibers have the desired mechanical properties to support tendon growth. In vitro drug release experiments demonstrated that the nanofibers could effectively extend the drug release time periods enabling a continuous drug treatment during the slow tendon repair process. Both in vitro and in vivo anti-adhesion tests verified the effective applications of the nanofibrous barriers. The anti-adhesion nanofibrous barriers prepared by tri-fluid side-by-side electrospinning in this study are potential candidates in the clinic application of tendon repair. The methodologies presented here can be explored to develop a range of novel functional nanomaterials with three side-by-side sections to load with three different active ingredients, where each section contributes a distinct function for a synergistic therapy.