Locomotor Disabilities Research Articles

DESCRIPTIVE EPIDEMIOLOGY OF PHYSICAL ACTIVITY IN UNIVERSITY GRADUATES WITH LOCOMOTOR DISABILITIES 106

The descriptive epidemiology of physical activity (PA) was assessed by mail survey in a sample of 577 University of Illinois graduates (1952-1991) with locomotor disabilities. Demographic information; age, gender, marital status, income and a rating of current and PA levels during college compared to others their age [5 point scale; (1) much less active to (5) much more active] was obtained from 229 alumni (40%) [59 semi-ambulatory (SA), 115 paraplegic (P), 55 quadriplegic (Q), 152 men - 77 women, mean age 53 yrs]. Current PA was associated with mobility limitation. With more severe mobility limitations the percent reporting being less/much less active increased (42.4% SA, 56.5% P, 66.7% Q, p <.001) and the percent reporting being more active decreased (20.3% SA, 16.5% P, 13.0% Q, p <.001). Current PA was lower (p <.05) with increasing age, lower self-rated health, higher disability severity and in those who were sedentary during college. PA did not differ by gender, marital status or household income. Health status was a predictor of current PA in all mobility categories (p <.001) after adjusting for age, gender, income, disability severity and college PA. Among both P and Q, PA during college was associated with current PA (P, p <.001; Q, p <.01). These results document a low level of PA in a well educated sample of individuals with locomotor disabilities and suggests that exposure to PA during college may be important for increasing PA in this population.

Chronic respiratory failure in limb-girdle muscular dystrophy: Successful long-term therapy with nasal bilevel positive airway pressure

Chronic respiratory failure is a major factor contributing to mortality in progressive neuromuscular disorders. Among the muscular dystrophies, respiratory failure most commonly occurs with Duchenne dystrophy, while in Becker, limb-girdle, and facioscapulo-humeral dystrophies, respiratory failure is infrequent and generally occurs in the more severe cases that have progressed to a nonambulatory, advanced functional stage. We report two brothers with a myopathic disease in which the distribution of weakness, initial clinical course, heredity, and muscle pathology most closely resembled a limb-girdle type of dystrophy. Both brothers, however, presented with chronic alveolar hypoventilation and respiratory failure when their locomotor disabilities were still mild. Respiratory failure was reversed, and satisfactory ventilation has been maintained for more than a year using a type of non-invasive intermittent positive pressure ventilation, with a bilevel positive airway pressure device (Bi-PAP), administered through a nasal mask during sleeping hours. These cases demonstrate an unusual presentation of limb-girdle dystrophy, and document that nocturnal, nasal administration of continuous airway pressure using the Bi-PAP device may be sufficient to maintain adequate long-term ventilation in some patients with neuromuscular causes of respiratory failure, and thus significantly improve quality of life and delay the need for more complex or invasive forms of assisted ventilation.

The ActionAid disability programmes: experiences in early identification and early intervention.

The World Health Organisation (WHO) estimates that about 10% of the world's population has some form of disability, while statistics from different sources show that about 3.8% of India's population has locomotor, visual or communication disabilities or mental retardation. The Disability Division of ActionAid-India supports 38 non-governmental organisations involved in disability programmes in India. This paper touches upon the experiences of some of its project partners in the areas of early identification and early intervention.

Trunk kinematics during locomotor activities.

We investigated upper-body (ie, trunk) angular kinematics (motions) during gait, stair climbing and descending, and rising from a chair in two reference frames--relative to the pelvis and to room coordinates. Bilateral kinematic data were collected from 11 healthy subjects (6 female, 5 male), who were 27 to 88 years of age (mean = 58.9, SD = 17.9). During stair climbing, maximum trunk flexion relative to the room was at least double that during stair descending and gait. Arising from a chair required the most trunk flexion/extension range of motion (ROM) but the least abduction/adduction and medial/lateral (internal/external) rotation. Trunk ROM during gait was small (mean less than or equal to 12 degrees) and consistent with previous literature. Trunk range of motion relative to the room during stair climbing and descending was greater than trunk ROM during gait in all planes. The pelvis and trunk rotate in the transverse plane in greater synchrony during stair descending (mean = 8.1 degrees, SD = 5.6 degrees) than during gait (mean = 12.0 degrees, SD = 4.2 degrees). For all activities, trunk frontal and sagittal ROM relative to the pelvis was greater than that relative to the room coordinates. This finding suggests that trunk/pelvis coordination may be used to reduce potentially destabilizing anti-gravity trunk motions during daily activities. We conclude that upper-body kinematics relative to both pelvis and gravity during daily activities are important to locomotor control and should be considered in future studies of patients with locomotor disabilities.

Physiological cost index of paraplegic locomotion using the ORLAU ParaWalker.

Energy expenditure is an important parameter in the assessment of gait and orthotic treatment of locomotor disabilities. Up until now oxygen uptake measurement has been the most common method used to assess this. In able bodied subjects heart rate monitoring is also increasingly used. In high thoracic level lesion paraplegics monitoring heart rate was considered to be unreliable because of suspicion of injury to the sympathetic contribution to the cardiac plexus. Bar-On & Nene found that in paraplegics below the lesion level T3 heart rate still shows linear relation to oxygen uptake. MacGregor combined the heart rate and speed of locomotion to produce a single index called physiological cost index. This study consists of monitoring heart rate and speed of 16 adult thoracic level paraplegics walking with the ORLAU ParaWalker, calculation of their physiological cost index, and establishing a range of physiological cost index of paraplegic locomotion using the ORLAU ParaWalker.

Walking reeducation with partial relief of body weight in rehabilitation of patients with locomotor disabilities

This study was undertaken to investigate the contribution of a weight-relieving system on the gait of patients with severe locomotor disabilities. Temporal parameters of gait and subjective evaluations of the effect of the system were studied in 24 patients and 6 healthy subjects. Partial weight relief was accomplished through a pneumatic system mounted in the ceiling over a conductive walkway which was placed between parallel bars. Subjects were tested in three walking trials: free walking, walking while harnessed to the system but without weight relief, and walking with relief of 20 percent of their body weight. Temporal measurements indicated a positive effect of the system on duration of the stance and swing phases. The percentage of the stance period of the involved lower limb relative to the uninvolved one increased by 148 percent; at the same time, the swing period of the involved limb relative to the sound one decreased to 68 percent of that value in free ambulation. A substantial increase in gait symmetry and velocity were also noted. Subjective information from the patients and observers also pointed to a facilitative effect of the system on the patients' ambulation. Conversely, natural gait velocity of the healthy subjects was impeded by weight relief through the system.

Locomotor disability in very elderly people: value of a programme for screening and provision of aids for daily living.

To assess the prevalence of potentially reversible locomotor disabilities in elderly subjects and the cost effectiveness of providing aids for daily living. Population based randomised controlled trial of subjects aged greater than or equal to 85 living independently in an inner London borough. 21 Electoral wards of the London Borough of Hackney. 1255 Subjects aged greater than or equal to 85 living in their own home whose names were obtained from general practitioner lists and cross checked against the electoral register, 511 of whom were subsequently found to be ineligible. Of the 744 remaining, those with disability on screening were randomised and allocated to an intervention group (36) or a control group (43), in which intervention was postponed until four weeks, after the follow up assessment. Subjects with aids supplied previously were excluded from the intervention phase. Provision of raised toilet seat, teapot tipper, tap turner, shoe horn and elastic laces, and double handled saucepan. Degree of difficulty (grades 1-4) with specific tasks (getting on and off a toilet, pouring from a teapot into a cup, turning taps on and off, carrying a saucepan of standard weight, and putting on shoes) and time taken to perform them. 545 (73%) Of the 744 eligible subjects assessed; 428 had no disability and 118 had difficulty with at least one task. Some had had their disability recognised before the study and already had aids, representing half of those with difficulty getting on and off the toilet but 24% for putting on shoes and 13% for pouring from a teapot and turning on a tap. The mean number of difficulties was similar between the groups (intervention group 1.7, control group 1.6). Time taken to complete the tasks corresponded with the observed grade of difficulty. All aids were associated with reduced difficulty according to observer assessment (% improvement intervention group v control group: raised toilet seat, 71 v 13 teapot tipper 100 v 33; tap turner 100 v 0; saucepan 88 v 0; shoe horn 50 v 13) and time taken to complete the tasks. A cost benefit analysis of this screening-intervention programme suggested a total cost of 32 pounds per individual benefit. Appreciable degrees of unrecognised locomotor disability are detected on screening of very elderly people living independently. Providing aids offers a feasible and cost effective means of improving function in such people.

Energetics: Application to the Study and Management of Locomotor Disabilities

Energetics: Application to the Study and Management of Locomotor Disabilities

Medical Aspects of Fitness to Drive Vehicles: A Guide for Medical Practitioners, edited by Leslie G. Norman. (Report by the Medical Commission on Accident Prevention). London : Royal College of Surgeons, 50 Brompton Road, London, S.W. 7, 1968, 48 pp. 5 shillings ($0.10)

This little paperback of about 50 pages contains valuable and difficult to locate information to help the physician whose advice is sought about a person's fitness to operate a motor vehicle. There are seven chapters dealing with important problems which may adversely affect an individual's fitness to drive. These are: cardiac conditions, diabetes, epilepsy, the nervous system, drugs, vision, ageing, locomotor disabilities, and fatigue and boredom resulting from long uninterrupted penods sitting behind the steering wheel.