Limb Position Research Articles

Sagittal femoral bowing contributes to distal femoral valgus angle deviation in malrotated preoperative radiographs

BackgroundThe coronal whole-leg radiograph is generally used for preoperative planning in total knee arthroplasty. The distal femoral valgus angle (DFVA) is measured for distal femoral bone resection using an intramedullary guide rod. The effect of coronal and sagittal femoral shaft bowing on DFVA measurement in the presence of malrotation or knee flexion contracture has not been well reported. The objectives of this study were: (1) to investigate the effects of whole-leg malrotation and knee flexion contracture on the DFVA in detail, (2) to determine the additional effect of coronal or sagittal femoral shaft bowing.MethodsWe studied 100 consecutive varus and 100 valgus knees that underwent total or unicompartmental knee arthroplasty. Preoperative CT scans were used to create digitally reconstructed radiography (DRR) images in neutral rotation (NR, parallel to the surgical epicondylar axis), and at 5° and 10° external rotation (ER) and internal rotation (IR). The images were also reconstructed at 10° femoral flexion. The DFVA was evaluated in each DRR image, and the angular variation due to lower limb malposition was investigated.ResultsThe DFVA increased as the DRR image shifted from IR to ER, and all angles increased further from extension to 10° flexion. The DFVA variation in each position was 1.3° on average. A larger variation than 2° was seen in 12% of all. Multivariate regression analysis showed that sagittal femoral shaft bowing was independently associated with a large variation of DFVA. Receiver operating characteristic analysis showed that more than 12° of sagittal bowing caused the variation.ConclusionIf femoral sagittal bowing is more than 12°, close attention should be paid to the lower limb position when taking whole-leg radiographs. Preoperative planning with whole-leg CT data should be considered.

Action imitation via trajectory-based or posture-based planning.

Imitation is a significant daily activity involved in social interaction and motor learning. Imitation has been theorized to be performed in at least two ways. In posture-based imitation, individuals reproduce how the body should look and feel, and are sensitive to the relative positioning of body parts. In trajectory imitation, individuals mimic the spatiotemporal motion path of the end effector. There are clear anecdotal situations in which one might benefit from imitating postures (when learning ballet) or trajectories (when learning to reach around objects). However, whether these are in fact distinct methods of imitation, and if so, whether they may be applied interchangeably to perform the same task, remain unknown. If these are indeed separate mechanisms that rely on different computational and neural resources, a cost should be incurred when switching from using one mechanism to the other within the context of a single task. Therefore, observing a processing cost would both provide evidence that these are indeed two distinct mechanisms, and that they may be used interchangeably when trying to imitate the same stimulus. To test this, twenty-five healthy young adults performed a sequential multitasking imitation task. Participants were first instructed to pay attention to the limb postures or the hand path of a video-recorded model, then performed a neutral, congruent, or incongruent intervening motor task. Finally, participants imitated the modeled movement. We examined both spatial and temporal imitation accuracy as well as individual spatial consistency. When the primary task involved imitating trajectories, analysis of individual consistency suggested a processing cost: movements following the posture-matching intervening task were less consistent with baseline (neutral) performance, suggesting performance may be disrupted by the incongruence. This effect was not observed when imitating limb postures. In summary, we present initial evidence for a difference between posture matching and trajectory imitation as a result of instructions and intervening tasks that is consistent with the existence of two computationally distinct imitation mechanisms.

Transcutaneous Electrical Acupoint Stimulation Improved Preoperative Blood Pressure in Gynecological Malignant Tumor Patients With Hypertension: A Randomized, Controlled Trial.

ObjectiveGynecological malignant tumor patients with hypertension, even if blood pressure is well controlled, are prone to hypertension before surgery. We plan to verify the effect of transcutaneous electrical acupoint stimulation (TEAS) on stabilizing blood pressure before operation.MethodsWe enrolled 91 patients and randomly divided them into TEAS group (n=46) and control group (n=45). Patients in TEAS group received TEAS at acupoints Hegu and Neiguan. Patients in control group received transcutaneous electrical stimulation at the nonacupoint position of the upper limbs. After entering the operating room, the blood pressure before and after induction was measured. The main results were the occurrence of preinduction hypertension and postinduction hypotension.ResultsThere was no difference in the general information of the two groups. There were four cases (9%) of preinduction hypertension in TEAS group and 13 cases (29%) in control group. The incidence in TEAS group was significantly lower (P=0.013). There were five cases (11%) of postinduction hypotension in TEAS group and eight cases (18%) in control group. There was no significant difference between the two groups (P=0.346). The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) of the highest blood pressure before induction in TEAS group were lower than those in control group (P=0.002, 0.002, and 0.001). There was no difference in SBP, DBP, or MBP between the two groups on the day before the operation. There was no difference in the lowest blood pressure before operation between the two groups after inductionConclusionTEAS can prevent preinduction hypertension in patients with gynecological malignant tumors.Clinical Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=143276, identifier ChiCTR2100054336.

Evaluation of feature projection techniques in object grasp classification using electromyogram signals from different limb positions.

A myoelectric prosthesis is manipulated using electromyogram (EMG) signals from the existing muscles for performing the activities of daily living. A feature vector that is formed by concatenating data from many EMG channels may result in a high dimensional space, which may cause prolonged computation time, redundancy, and irrelevant information. We evaluated feature projection techniques, namely principal component analysis (PCA), linear discriminant analysis (LDA), t-Distributed Stochastic Neighbor Embedding (t-SNE), and spectral regression extreme learning machine (SRELM), applied to object grasp classification. These represent feature projections that are combinations of either linear or nonlinear, and supervised or unsupervised types. All pairs of the four types of feature projection with seven types of classifiers were evaluated, with data from six EMG channels and an IMU sensors for nine upper limb positions in the transverse plane. The results showed that SRELM outperformed LDA with supervised feature projections, and t-SNE was superior to PCA with unsupervised feature projections. The classification errors from SRELM and t-SNE paired with the seven classifiers were from 1.50% to 2.65% and from 1.27% to 17.15%, respectively. A one-way ANOVA test revealed no statistically significant difference by classifier type when using the SRELM projection, which is a nonlinear supervised feature projection (p = 0.334). On the other hand, we have to carefully select an appropriate classifier for use with t-SNE, which is a nonlinear unsupervised feature projection. We achieved the lowest classification error 1.27% using t-SNE paired with a k-nearest neighbors classifier. For SRELM, the lowest 1.50% classification error was obtained when paired with a neural network classifier.

Objective Quantification of Limb Position in Mouse Spared Nerve Injury Reveals New Motor Phenotypes

Difficulties translating basic animal research into novel pharmacotherapies for neuropathic pain can, in part, be attributed to a lack of predictive efficacy in preclinical pain models. Most animal models of neuropathic pain rely heavily on targeted nerve injuries quantified using reflexive measures in response to an applied noxious stimulus. However, data from these approaches fail to capture spontaneous and ongoing pain – a critical component of neuropathic pain in human patients. Furthermore, the common spared nerve injury (SNI) model damages the tibial and common peroneal nerves that should result in motor phenotypes not typically captured in preclinical literature. To overcome these limitations, we employed deep learning-based markerless pose estimation software (DeepLabCut) to quantify spontaneous limb position in C57BL/6J mice during a one-minute tail suspension following either SNI or sham surgery. Using this granular detail, we were able to characterize previously unidentified injury-induced motor behaviors that persist up to six weeks following SNI. In particular, we found a decrease in the median distance between body midline and injured limb position in the SNI group compared to sham controls. We also found some evidence for a decrease in toe movement relative to the heel movement. We repeated these analyses in subsequent cohorts of SNI mice to determine whether these outputs could be reversed by multiple analgesics with diverse mechanistic actions and thus far do not see evidence that these behaviors are reversed by analgesics. Furthermore, we do not see these phenotypes in the Complete Freund's Adjuvant model of inflammatory pain. Together these results suggest SNI causes previously unobserved motor phenotypes unrelated to altered sensation that are likely underappreciated while interpreting preclinical pain research. Grant support from R01 NS117899-01 F31 NS124301-01 Rita Allen Foundation.

Gait control to step into a lowered surface with one limb with different demands for accuracy in younger and older adults.

Walking in a daily life context requires constant adaptations to meet the environment's requirements for successful locomotion. We investigated the walking adaptations of younger and older adults when dealing with holes of different lengths in the pathway (60-cm long and 1.3 times foot length [critical point] conditions). We used the critical point condition to increase the demand for accuracy as it reduces the safety margin between the foot and the borders of the hole. Fifteen younger and fifteen older adults walked barefoot on a wooden walkway in three conditions: no-hole, 60-cm hole (length: 0.60m | width: 0.80m | depth: 0.095m), and critical point hole (length: participant's foot length×1.3 | width: 0.80m | depth: 0.095m). Participants stepped into the hole with only one foot. We assessed the impulses based on the ground reaction forces, trunk and lower limb joint angles, stride speed, and the margin of stability based on the concept of the extrapolated center of mass in the sagittal plane. Across walking conditions, older adults exhibited a larger margin of stability than younger adults. Before the hole, both age groups increased the braking impulse and adopted a more flexed posture of the lower limbs to help to lower the body in the subsequent step. Only older adults increased the vertical braking impulse and markedly reduced stride speed when stepping into both holes. Both age groups adopted a more vertically oriented trunk posture as a strategy to contribute to stability control when stepping into the hole. The two age groups showed a larger margin of stability and a more flexed trunk posture after the hole than the no-hole condition. Older adults were able to control body stability adequately and even better than younger adults. Younger and older adults used the same anticipatory and compensatory locomotor adjustments before and after the hole. These adjustments resulted in improved stability control. The differences between younger and older adults were confined to the moment of stepping into the hole. Older adults used a more cautious strategy that ensured task accuracy and gait progression.

Lower limb posture and joint mobility in young Soccer players

Soccer practice can induce marked changes in the lower limbs with dreaded short and long term consequences. We evaluated the possible effects of sport practice on lower limb posture and their relationships with ankle joint mobility (AJM). In 61 male Soccer players mean age 11.6±1.8 years, and in 50 Volleyball and Basketball players matched for age, sex and body mass index, lower limb posture and AJM in both plantar flexion and dorsiflexion were evaluated on the sagittal plane in supine position using, respectively, images analysis and an inclinometer. A multivariate analysis of variance was carried out to assess if the practice of different sports affects the leg posture (FP: angle between foot and leg) and foot posture (LP: angle between the foot and the line perpendicular to the ground). The sport practiced showed a significant multivariate effect on the lower limb posture. Soccer players showed a greater LP angle (169.2±4.3° vs 164.9±4.5°; p<0.001) and a lesser FP angle in both Basketball and Volleyball players (298.0±12.6° vs 305.6±10.9°; p<0.002). These differences were not present between the Basketball and Volleyball players. Soccer players showed a reduced AJM (127.6±15.7° vs. 138.8±21.6°; p<0.002) compared to the other subjects evaluated. The AJM was found directly correlated to the FP angle (p<0.005). The results of this study indicate that young Soccer players could show an altered posture of the leg and foot and a reduced AJM. The alterations of these parameters seem to be a consequence of the sport practice.

A Re-examination of the Measurement of Foot Strike Mechanics During Running: The Immediate Effect of Footwear Midsole Thickness.

PurposeMidsole cushioning thickness (MT) is a key component of running footwear that may influence the stiffness setting of the joints, performance enhancement, and injury prevention. Most studies that have investigated the influence of manipulating shoe midsole characteristics on foot strike patterns and vertical force loading rates have not considered the dynamic conditions of initial landing and the associated initial lower limb joint stiffness. In this study, we examined the effect of running in shoes with large changes in MT on both the posture and dynamics associated with foot strike.Methods12 injury-free runners with habitual rearfoot strike patterns ran at 4.5 m/s along a 40-m runway in shoe conditions with MT of 30, 42, and 54 mm, respectively. Ground reaction force and the right leg kinematic data were collected. One-way repeated measures ANOVA was conducted to statistically analyze the effect of MT on key variables linked to foot strike.ResultsIncreased midsole thickness resulted in a slightly flatter foot strike posture (p < 0.05), a decreased shank retraction velocity (p < 0.05), and an increase in forward horizontal foot velocity (p < 0.05), all at initial ground contact. Vertical force loading rates were reduced with increasing MT (p < 0.05), but this was associated with large increases in the initial ankle and knee joint stiffness (p < 0.05).ConclusionAdjustments in the initial conditions of contact with the ground during running were seen in both the posture and dynamics of the lower limbs. To help to mitigate the impact severity from foot-ground collision with the thinnest shoe condition, there was an increased shank retraction velocity and decreased forward velocity of the foot at landing. These active impact-moderating adaptations likely served to reduce the changes in impact severity expected due to midsole material properties alone and should be considered in relation to altering the risk of running-related injuries.

Analysis of cervical and upper thoracic spinal segmental rotation angles during end-range neck rotation: Comparison with and without neck pain

ABSTRACT Background Neck pain is a common manifestation of musculoskeletal disorders of the cervical and thoracic spine. Manual therapy interventions to the thoracic spine are recommended for treating patients with several types of neck pain. However, only a few studies have investigated the thoracic spine mobility associated with neck movement. Objectives Compare cervical and upper thoracic rotation angles in subjects with and without neck pain. Methods The subjects included nine individuals who experienced neck pain (pain, Group P) and 11 who did not (non-pain, Group N). The rotation angle was measured using MRI. The imaging limb position was at 90% of the maximum neck rotation. The MR images were analyzed using image analysis software to calculate the rotation angle of C1 to Th3. The rotation angle of the segment was then calculated by subtracting the rotation angle corresponding to the lower vertebra from that corresponding to the upper vertebra. The total rotation of each segment was calculated as the sum of the right and left rotation angle. Then, the segmental rotation angles were compared between groups. Results/findings The rotation angles of C3-C4, C7-Th1, and Th1-Th2 were significantly smaller in Group P than in Group N, and C5-C6 and C6-C7 were significantly larger in Group P than in Group N. There was no statistical difference in rotational angle at all other spinal levels measured. Conclusions The results of this study indicate subjects with neck pain had hypermobility of the lower cervical spine and hypomobility of the cervico-thoracic junction and upper thoracic spine compared with subjects without neck pain. These results add to current understanding of biomechanical factors that may be related to neck pain.

Spatial variation in mechanical properties along the sciatic and tibial nerves: An ultrasound shear wave elastography study

Ultrasound shear wave elastography has become a promising method in peripheral neuropathy evaluation. Shear wave velocity, a surrogate measure of stiffness, tends to increase in peripheral neuropathies regardless of etiology. However, little is known about the spatial variation in shear wave velocity of healthy peripheral nerves and how tensile loading is distributed along their course. Sixty healthy young adults were scanned using ultrasound shear wave elastography. Five regions of the sciatic (SciaticPROXIMAL, SciaticDISTAL) and tibial nerve (TibialPROXIMAL, TibialINTERMEDIATE, and TibialDISTAL) were assessed in two hip positions that alter nerve tension: 1) neutral in supine position; and 2) flexed at 90°. Knee and ankle remained in full-extension and neutral position. We observed spatial variations in shear wave velocity along the sciatic and tibial nerve (P < 0.0001). Shear wave velocities were significantly different between all nerve locations with the exception of SciaticDISTAL vs. TibialINTERMEDIATE (P = 0.999) and TibialPROXIMAL vs. TibialINTERMEDIATE (P = 0.708), and tended to increase in the proximal-distal direction at both upper and lower leg segments. Shear wave velocity increased with hip flexion (+54.3%; P < 0.0001), but the increase was not different among nerve locations (P = 0.233). This suggests that the increase in tensile loading with hip flexion is uniformally distributed along the nerve tract. These results highlight the importance of considering both limb position and transducer location for biomechanical and clinical assessments of peripheral nerve stiffness. These findings provide evidence about how tension is distributed along the course of sciatic and tibial nerves.

Effect of Rehabilitation Robot Combined with Upper Limb Rehabilitation Training on Hemiplegic Patients in Recovery Stage of Stroke

<bold>Objective:</bold> To observe the effect of upper limb rehabilitation robot combined with upper limb rehabilitation training on motor function of upper extremity of hemiplegic patients in recovery stage of stroke. <bold>Methods</bold> A total of 40 hemiplegic patients in recovery stage of stroke who were treated in the Zhujiang Hospital of Southern Medical University from October 2018 to January 2020, which were randomly divided into the control group and the observation group according to the random number table method, with 20 cases in each group. Both groups received basic medication and conventional rehabilitation therapy (including good limb position, active and passive joint movement, sitting and standing balance training, walking function training, assistive device use training, speech and swallowing therapy, conventional physical therapy, etc.). The control group received upper limb rehabilitation training on the basis of basic medication and conventional rehabilitation therapy, 60 minutes a time, once a day, seven days a week, continuous treatment for two weeks. The observation group received upper limb rehabilitation robot training on the basis of the control group, upper limb rehabilitation training for 30 minutes a time, upper limb robot rehabilitation training for 30 minutes a time, once a day, seven days a week, continuous treatment for two weeks. Before and after treatment, the Fugl-Meyer assessment-upper limb (FMA-UL) was used to evaluate the motor function of upper extremity, including the FMA shoulder and elbow (FMA-SE) score and the FMA wrist and hand (FMA-WH) score; the Barthel index (BI) was used to evaluate activities of daily living; the root mean square (RMS) and integral electromyography (iEMG) values of the biceps, triceps, deltoid of anterior and middle fiber of the affected upper limbs of the subjects during maximal isometric contraction were measured by surface electromyography to assess muscle activation and synchronization of motor recruitment of the upper limbs. <bold>Results</bold> A total of 38 hemiplegia patients in the recovery stage of stroke completed the whole course of treatment. Compared with before treatment, FMA-UL score, FMA-SE score, FMA-WH score, BI score, RMS values of biceps, triceps, deltoid of anterior and middle fiber, and iEMG values of the both groups after treatment were significantly higher, with statistically significant differences (<italic>P</italic>&lt;0.05). Compared with the control group, the FMA-UL score, FMA-SE score, BI scores, triceps RMS value, deltoid of middle fiber RMS value and iEMG value of observation group were significantly higher, with statistically significant differences (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> Upper limb rehabilitation robot combined with upper limb rehabilitation training can effectively improve motor function of upper limb, muscle activation and motor unit recruitment synchronization of hemiplegic upper limb, and improve the activities of daily living of hemiplegic patients in recovery stage of stroke, which is worthy of clinical promotion.

788 Upper Extremity and Lower Extremity Net Devices for Use after Application of Cultured Epidermal Autograft

IntroductionEarly positioning of the burn patient to prevent scar contracture is a fundamental aspect of the therapy treatment plan1. Positioning is complicated by different types of grafting including cultured epidermal autograft (CEA). Use of CEA requires a period of airing out and therefore positioning devices must allow adequate air flow to the posterior aspect of the grafted limb while immobilizing the extremity. Previous lower extremity net devices have been presented for use2-3, however this design increases hip flexion which can promote contracture. Additionally, there is no similar net device presented for use for the upper extremity.MethodsBoth the upper extremity and lower extremity net device designs are made using 1” PVC pipe. A mix of Tee, 90⁰ and 45⁰ couplers are used to link together the PVC pipe. A PVC cutter is needed to cut the pieces. Once the pieces have been fit together and are aligned, the pieces are secured with a bonding PVC adhesive. The devices are then sanitized for patient use. A double layer of burn netting is used over the device to support the extremity while not allowing too much slack. The following graphics provide a basic template for an average adult adjusting lengths and width as needed. For the lower extremity, a measurement from the fold of the buttocks to the heel is needed to determine overall length of the device. The average cost for 1 lifter is $15-20. Additional custom plantar foot plates can be added to the lower extremity device to prevent ankle dorsiflexion as demonstrated by the poster presentation by Dean et. al. 3 For the upper extremity, an armboard or use of bedside table can be used to support the device. These particular designs are an outline for adult patients, although could be modified for pediatrics.ResultsNet devices for the upper and lower extremity allow good positioning of limb while providing adequate air flow and off-loading during the required air out periods using CEA. These designs provide a template for burn therapists to utilize as a baseline. This particular lower extremity device decreases hip flexion as compared to other existing devices. The upper extremity template provides an option that has not previously been articulated.ConclusionsPositioning the upper and lower extremity after CEA application can be achieved using custom net devices. Net devices provide a cost-effective, quick and simple solution that allow adequate ventilation to the posterior aspect of the limb while maintaining a good position during immobilization.

Limb Elevation by Transcalcaneal Steinmann Pin in Lower Extremity Free Flap Reconstruction.

Lower limb elevation after free flap reconstruction is essential to achieve a satisfactory outcome, avoid pressure (on the flap or over the anastomosis), reduce edema, and prevent venous insufficiency during the first postoperative week. In the upper extremity and head and neck regions, postural measures are easier for the patient. However, achieving the required elevation and immobility for lower extremity free flaps can be a challenge. Different methods have been reported for this purpose, such as simple kickstands, kickstand external fixators,1 and transtibial pins.2,3 In our experience, a Steinmann transcalcaneal pin, described for lower limb traction,4 may offer advantages (Fig. 1).Fig. 1.: Steinmann transcalcaneal pin placed in position. The limb is raised with a Bohler stirrup and a gauze bandage.It is technically simple and rapid to place. Usually far from the surgical field, it can be used in case of tibial reconstruction. It has a low infection rate, and it can be performed under local anesthesia at the bedside if needed. Further advantages of the Steinmann pin are that it allows easier dressing changes in the postoperative period, thereby relieving patients from strict positioning and allowing them to move somewhat while in bed. The pin is placed through the calcaneus, 2 cm below the apex of the inner malleolus and 2 cm from the posterior aspect of the calcaneus in a medial to lateral direction, to avoid the calcaneal branch of the tibial nerve and the retromalleolar neurovascular bundle.5 No radiographic control is needed. The pin is tied with a Bohler stirrup and a gauze bandage to the bed box frame, thus controlling the position of the lower limb, without any pressure on the flap, and allowing correction of the equine foot tendency if needed. In the absence of stirrups, the pin can be fixed directly to a cast. This low-demand mechanical device grants a safer method than simple kickstands, is easier to use than kickstand external fixators, which require multiple pins, and prevents tibial osteomyelitis risk caused by a transtibial pin. [See Figure, Supplemental Digital Content 1, which shows tibia osteomyelitis caused by transtibial pin placement, https://links.lww.com/PRS/F39.] The only precaution to be taken should be to protect the tips of the pin. In conclusion, use of a transcalcaneal Steinmann pin allows for safe and comfortable elevation in lower extremity free flaps. DISCLOSURE The authors declare no conflicts of interest, and did not receive any form of financial or nonfinancial support.

Quantifying the Elasticity Properties of the Median Nerve during the Upper Limb Neurodynamic Test 1.

Background The upper limb neurodynamic test 1 (ULNT1) consists of a series of movements that are thought to detect an increase in neuromechanical sensitivity. In vivo, no trail was made to quantify the association between the nerve elasticity and different limb postures during ULNT1. Objectives (1) To investigate the relationship between nerve elasticity and limb postures during ULNT1 and (2) to investigate the intra- and interoperator reliabilities of shear wave elastography (SWE) in quantifying the elasticity of median nerve. Methods Twenty healthy subjects (mean age: 19.9 ± 1.4 years old) participated in this study. The median nerve was imaged during elbow extension in the following postures: (1) with neutral posture, (2) with wrist extension (WE), (3) with contralateral cervical flexion (CCF), and (4) with both WE and CCF. The intra- and interoperator reliabilities measured by two operators at NP and CCF+WE and intraclass correlation coefficients (ICCs) were calculated. Results The intraoperator (ICC = 0.72–0.75) and interoperator (ICC = 0.89–0.94) reliabilities for measuring the elasticity of the median nerve ranged from good to excellent. The mean shear modulus of the median nerve increased by 53.68% from NP to WE+CCF. Conclusion SWE is a reliable tool to quantify the elasticity of the median nerve. There was acute modulation in the elasticity of the median nerve during the ULNT1 when healthy participants reported substantial discomfort. Further studies need to focus on the elasticity properties of the median nerve in patients with peripheral neuropathic pain.

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF-INSTRUCTIONAL MODULE ON KNOWLEDGE AND PRACTICE REGARDING PERIPHERAL INTRAVENOUS CATHETERIZATION AMONG NURSING STAFFS OF R.B.MEMORIAL HOSPITAL BIHAR

Peripheral intravenous catheters (PIVC) are the most commonly used intravenous device in hospital emergency departments and inpatient units. They are primarily used for therapeutic purposes such as administration of medications, fluids and/or blood products as well as blood sampling. Unsuccessful PIVC first attempts increase pain, and lead to treatment and diagnostic delays. Traditionally, PIVC involves vein and equipment selection before catheterization. Clinicians select peripheral veins based upon vein palpability and visibility, and may use vein stimulation, limb positioning, tourniquets or other techniques to improve first attempt success. There has been an increasing concern among health professional and the general public about HCAI. HCAI is a major cause of morbidity and mortality every year and up to 8.5% of hospitalized patient suffer from HCAI. In a national and multicenter studies reported, it was identified that the prevalence of hospitalized patients who acquired at least one HCAI ranged from 3.5% to 12%. This increasing concern in number of HCAI has prompted the need for further research into the area of asepsis. The importance of asepsis in PIVC therapy has become an integral part of modern patient care because; almost 60% or more patients admitted to hospital require the insertion of an PIVC.

Perception and Recognition of Upper Limb Movement Trajectory of Aerobics Based on Multi-Intelligent Sensors

Aerobics is an indispensable part of school teaching. Aerobics can exercise the human body’s flexibility, muscle extension, and cardiopulmonary function. However, there are many details in the aerobics movements that need attention, so this article mainly studies the perception and recognition of the upper limb movement trajectory of aerobics. This article is mainly based on multi-intelligent sensors to perform motion capture and recognition of upper limb movements in aerobics. Therefore, in order to design a multismart sensor-based aerobics upper limb movement perception recognition system, this paper proposes to combine the VM-i three-axis magnetic sensor and MEMS smart sensor to capture the upper limb movement trajectory. Then, the aerobics upper limb movement trajectory and posture mathematical description method to obtain the model of the action perception recognition system are written. In order to verify the system, this paper also designed the actual effect of attitude calculation and A-RRM algorithm verification experiment. Finally, it is optimized with the data obtained from the experiment, and the accuracy and efficiency comparison experiment with the traditional motion perception recognition system is carried out. Experimental results show that the motion recognition accuracy of the aerobics upper limb movement trajectory recognition system based on multi-smart sensors is improved by 13%-23% compared with the traditional motion recognition system. The recognition efficiency of the action perception recognition system based on multismart sensors is 9%-15% higher than that of the traditional action recognition system.

Does a suspensory lifestyle result in increased tensile strength? Organ-level material properties of sloth limb bones.

The material composition of vertebrate connective tissue is highly conserved across taxa. Existing data suggest that the compressive and tensile strength of limb bones are very similar despite marked variation in limb posture and locomotor patterns. However, the material properties of limb bone tissue from suspensory taxa have not been formally evaluated. Sloths are nearly obligatory in their use of below-branch suspensory locomotion and posture, thus placing their limb bones and associated soft tissue structures under routine tensile loading. It is possible that sloth limb bones are modified for enhanced tensile strength, perhaps at the expense of compressive strength. Forelimb and hindlimb bones of two-toed (Choloepus hoffmanni) and three-toed (Bradypus variegatus) sloths were tested in compression and bending to evaluate this hypothesis. Strength and elastic (Young's) modulus were similarly lower in sloth limb bones during both compression and bending, as compared with pronograde taxa. Ratios of peak bending strength to compressive strength additionally were elevated (sloths: 1.4-1.7; upright taxa: 0.6-1.2) for sloth limb bones. Overall, the material properties measured from the limb bones of tree sloths support our hypothesis of predicted function in a tensile limb system. Future studies should aim to directly test bones in tension to confirm indications of elevated axial tensile strength. Nevertheless, the results herein expand understanding of functional adaptation in mammalian tissue for a range of locomotor/postural behaviors that were previously unexplored.

Optimizing femur symmetry judgment using three-dimensional data correction scheme in fractures of the proximal femur

BackgroundThe application of the 3D printing mirror image model is based on the symmetry of the limbs. Different from image fusion to judge the similarity, based on the commonality of the limb morphology of the same organism and the isotropic of the long bone cross-section, the symmetry of the femur has been determined by calculating the dimension difference of the corresponding cross-section of the non-fractured area. However, the previous version used equidistant cross-sections for measurement and two-dimensional data correction, and there were problems with insufficient reliability and data failure. The purpose of this study is to achieve a more accurate and universal symmetry verification scheme for bilateral tubular bones through an improved method. MethodsForty-five imaging data of proximal femoral fracture and osteopathy were selected from October 2015 to September 2017. 10%, 30%, and 50% of the full-length of the bilateral femur is sliced to judge the similarity between paired femurs. Long and short axes of the bilateral femoral cross-sections on the two-dimensional slices were measured and compared. A stylized trigonometric were used to correct the measured axes lengths such that they more closely match with measurements taken from slices perpendicular to femoral shaft axis. Results540 valid data items from the long axis and short axis of the bilateral side of the distal femur were obtained, and 192 of these were corrected. There were no significant differences between the left and right of the long and short axis of each cross-section in paired cases (P>0.05). ConclusionsThis study have demonstrated symmetricity of the left and right femurs. The availability of CT data at any position of the patient's lower limbs is realized through replacing the previous “two-dimensional data correction” with “three-dimensional data correction”.

Preterm Infant with Craniofacial Dysmorphic Features and Posture.

Preterm Infant with Craniofacial Dysmorphic Features and Posture.

Effects of Kinesio taping on skin deformation during knee flexion and extension: a preliminary study

BackgroundKinesio Taping (KT) is proved useful to many musculoskeletal disorders. But the mechanism remains unclear. The kinesio tape works by sticking to the skin surface. So exploring the interaction between the tape and the skin and analyzing its biomechanical influence may be an effective way to explore the mechanism of the tape.ObjectivesThis study aimed to investigate the effect of Kinesio taping and taping methods on skin deformation during knee joint flexion and extension motion and further explore its possible functional mechanisms.MethodsTen healthy and pain-free subjects (4 males, 6 females) were recruited in this study. The skin observation area on the anterior side of the right thigh of the subjects was divided into 11 segments by 12 reflective marker points for distance measurement, from the distal knee to the proximal knee, the length of the interval was L1 to L11, and the total length was L0. Subjects were treated with no KT (NT), resting positive taping (RPT), resting negative taping (RNT), stretching positive taping (SPT), and stretching negative taping (SNT). A Qualisys infrared high-speed three-dimensional spatial coordinate capture system was used to observe changes in the length of the observed skin surface on the right anterior thigh during right knee flexion and extension in the sitting position.ResultsDuring right knee flexion and extension in the seated position in 10 subjects, all skin segment deformations produced significant differences between intervention groups (P < 0.05), except for L1 during flexion (P = 0.07). During right knee flexion and extension, total length, L0, and spacing lengths, L1, L6, and L11, were longer in the NT group than in all other groups. L0 and L1 were both longer in the stretched position than in the rest position; L11 also showed this trend.ConclusionsThe usage of the KT had an effect on the biomechanical changes of the skin, resulting in changes in skin deformation. I-tape, natural tension taping can shorten the skin distance between the two ends of the tape. Limb position during taping may influence the KT’s effects. However, the change in taping direction showed no significant effects on skin deformation during exercise. KT may apply a pre-stress in the biomechanics of the skin.