Lower Limb Muscle Weakness Research Articles

Identification of muscle weakness in older adults from normalized upper and lower limbs strength: a cross-sectional study

BackgroundTo propose cut-off points for older adults’ weakness for upper and lower limbs muscle strength normalized by body size with the ratio standard/muscle quality and allometric scaling.MethodsNinety-four community-dwelling older adults (69.1% women) were assessed for 49 body-size variables (anthropometry, body composition and body indexes), handgrip strength (HGS), one maximum repetition measurement for knee extensors (1RM), isokinetic knee extension peak torque at 60°/s (PT), and six-minute walk test (6MWT). Ratio standard or muscle quality (muscle strength/body size) and allometric scaling (muscle strength/body sizeb; when b is the allometric exponent) were applied for body-size variables significantly correlated with HGS, 1RM and PT. Cut-off points were computed according to sex based on mobility limitation (6MWT < 400 m) with ROC curve and Youden index.ResultsAbsolute HGS, 1RM and PT cut-off points were not adequate because they were associated with body size (r > 0.30). But it was corrected with muscle strength normalization according to body size-variables: HGS (n = 1); 1RM (n = 24) and PT (n = 24). The best cut-off points, with the highest area under the curve (AUC), were found after normalization for men: HGS/forearm circumference (1.33 kg/cm, AUC = 0.74), 1RM/triceps skinfold (4.22 kg/mm, AUC = 0.81), and PT/body mass*height0.43 (13.0 Nm/kg*m0.43, AUC = 0.94); and for women: HGS/forearm circumference (1.04 kg/cm, AUC = 0.70), 1RM/body mass (0.54 kg/kg, AUC = 0.76); and PT/body mass0.72 (3.14 Nm/kg0.72; AUC = 0.82).ConclusionsUpper and lower limbs muscle weakness cut-off points standardized according to body size were proposed for older adults of both sexes. Normalization removes the effect of extreme body size on muscle strength (both sexes) and improves the accuracy to identify weakness at population level (for women, but not in men), reducing the risk of false-negative/positive cases.

First pilot study of extracellular volume MRI measurement in peripheral muscle of systemic sclerosis patients suggests diffuse fibrosis.

Peripheral muscle involvement in SSc may comprise myositis or a non-inflammatory myopathy. There is little understanding of the nature of SSc myopathy. This pilot study aimed to evaluate the presence of diffuse fibrosis in the peripheral muscle of patients with SSc by determining extracellular volume (ECV) MRI measurement. SSc patients, with either suspected myopathy or no muscle involvement, and healthy controls (HCs) had native T1 and ECV MRI quantification of the thigh and creatine-kinase (CK) measured. Suspected myopathy was defined as current / history of minimally raised CK (>320; <600 IU/l) ± presence of clinical signs/symptoms (including proximal lower-limb muscle weakness and/or myalgia) ± a Manual Muscle Testing (MMT) 8 score of <5 in the thighs. Twelve SSc patients and 10 HCs were recruited. Of the 12 patients, 9 had limited cutaneous SSc, 4 had interstitial lung disease, and 7 had suspected myopathy. The higher skeletal muscle ECV was recorded for SSc patients compared with HCs [mean (s.d.) 23 (11)%, vs 11 (4)%, P = 0.04]. Peripheral muscle ECV was associated with CK (rho = 0.554, P = 0.061) and was higher in SSc patients with myopathy than in those with no myopathy [mean (s.d.) 28 (10) vs 15 (5), P = 0.023]. It was determined that an ECV of 22% best identified myopathy (with a sensitivity of 71% and a specificity of 80%). This hypothesis-generating study showed higher ECV in SSc patients compared with HCs, as well as association of ECV with suspected myopathy, suggesting the presence of diffuse fibrosis in the peripheral muscle of SSc patients. Further studies are needed to understand the nature of SSc myopathy.

Surgical Treatment of Sacral Metastatic Tumors.

ObjectiveThis study intends to retrospectively analyze the data of patients with sacral metastases in our center, and analyze the treatment methods and therapeutic effects of sacral metastases.Methods73 patients with sacral metastases treated in our hospital from June 2013 to June 2019 were retrospectively analyzed. There were 54 cases of neurological symptoms, 42 cases of sacroiliac joint instability, 24 cases of lower limb muscle weakness and 19 cases of abnormal urination and defecation. Four patients with tumors below S3 underwent complete tumor resection, 23 patients with tumors above S3 and without sacroiliac joint instability underwent tumor curettage and nerve root lysis, 34 patients with tumors above S3 and sacroiliac joint instability underwent tumor curettage, nerve root release and screw rod reconstruction. 12 patients with multiple metastases underwent percutaneous radiofrequency ablation and sacroplasty. VAS was used to evaluate the preoperative and postoperative pain scores, and the postoperative pain relief, neurological function, bowel function, wound healing and complications were evaluated.ResultsThere were no perioperative death, 8 cases of poor wound healing, 5 cases of nerve injury, postoperative sensory and motor loss of lower limbs. Cerebrospinal fluid (CSF) leak in 7 cases. The patients were followed up for 6-25 months (mean 12 months). The VAS scores of patients with pain symptoms were 7 points before operation and 1.44 points after operation, In 19 patients with abnormal urination and defecation function, 12 patients recovered to normal 3-6 months after operation, 5 cases had no significant change compared with preoperative, and 2 cases had aggravated symptoms; 17 cases of patients with lower limb muscle strength were significantly recovered after operation, and the average muscle strength was increased by 2 grades; 30 cases of patients with unstable sacroiliac joint got internal fixation had significantly pain relief. Pain symptoms of 9 patients were significantly relieved after percutaneous radiofrequency ablation.Conclusionthe operation of sacral metastases mainly adopts a relatively conservative surgical method, which can effectively improve the quality of life of patients with sacral metastases by retaining the nerve function and relieving the pain of patients, combining with radiofrequency ablation, sacroplasty and targeted drugs.

Hashimoto’s Thyroiditis Presenting With Hoffman’s Syndrome in a Patient With the Coronavirus Disease 2019 (COVID 19): Hormone Replacement in the Time of the Pandemic

Introduction: Hoffmann’s syndrome is a very rare and reversible manifestation of hypothyroidism presenting as classic features of hypothyroidism with muscle stiffness, weakness, and pseudohypertrophy.Clinical Case: A 62-year-old man was admitted to our institution due to dyspnea. He also had progressive muscular weakness and recurrent cramps four months prior. On admission, he was seen in respiratory distress and was eventually intubated and hooked to mechanical ventilation for acute respiratory failure brought about by COVID-19 pneumonia (confirmed by a reverse transcriptase-polymerase chain reaction of a nasopharyngeal swab on admission). He had an unremarkable head and neck examination; both of his calf muscles were hypertrophied. On neurological examination, he had mild proximal lower limb muscle weakness (power 4/5) and deep tendon reflexes were sluggish (+1). The patient was subsequently admitted into the intensive care unit. Laboratory data showed inflammatory markers associated with COVID-19 were elevated: Lactate Dehydrogenase (857 u/L; NV: 120-246 u/L) and Interleukin-6 (137 pg/mL; NV: 0-50 pg/mL). He was given tocilizumab, convalescent plasma therapy, and underwent hemoperfusion. His serum chemistry was unremarkable. Thyroid function tests were consistent with primary hypothyroidism from Hashimoto’s thyroiditis: TSH (22.6712 UIU/mL; NV: 0.35-4.94 UIU/mL), fT3 (<2.30 PMOL/L; NV: 2.89-4.88 PMOL/L), fT4 (<5.15 PMOL/L; NV: 9.01-19.05 PMOL/L), anti-Tg Ab (1810.3 IU/mL; NV: <50 IU/mL) and Anti-TPO Ab (2610.4 IU/mL; NV: <100 IU/mL). There was a consideration of Hoffman’s syndrome; muscle enzymes were noted to be elevated also: CK-Total (2589 U/L; NV: 55-170 U/L) and CK-MB (85.7 U/L; NV: 0-16 U/L). This is consistent with Hoffman’s syndrome. He was supposed to start hormone replacement therapy. However, he developed ileus (attributed to sepsis and hypothyroidism) which precluded the use of oral levothyroxine. To circumvent this roadblock, levothyroxine was given as an enema via the rectal route at 300 mcg once daily (approximately twice the oral dose). Upon initiation of hormone replacement, his sensorium, hemodynamic parameters, and bowel movement improved. Thus, we were able to shift to oral levothyroxine eventually. Unfortunately, he went into sudden cardiac arrest and expired after the 11th hospital day.Conclusion: COVID 19 infection could lead to exacerbations of pre-existing conditions such as Hashimoto’s Thyroiditis (in this case, manifesting with Hoffman’s syndrome). Hormone replacement is still the treatment of choice. Concomitant COVID 19 infection and treatment is not a contraindication to delay hormone replacement.Reference: (1) Senanayake, Hemal Ms et al. “Hoffmann syndrome: a case report.” International archives of medicine vol. 7,1 2. 6 Jan. 2014, doi:10.1186/1755-7682-7-2.

Grip myotonia

A 39-year-old woman presented with a 2-year history of distal lower limbs muscle weakness and bilateral finger stiffness without pain. She reported of inability to stand on her toes and...

Hypokalaemic paralysis and metabolic alkalosis in a patient with Sj\xf6gren syndrome: a case report and literature review

BackgroundAcquired Gitelman syndrome is a very rare disorder reported in association with autoimmune disorders, mostly Sjögren syndrome. It is characterized by the presence of hypokalaemic metabolic alkalosis, hypocalciuria, hypomagnesaemia and hyper-reninaemia, in the absence of typical genetic mutations associated with inherited Gitelman syndrome.Case presentationA 20 year old woman who was previously diagnosed with primary Sjögren syndrome and autoimmune thyroiditis presented with two week history of lower limb weakness and salt craving. Examination revealed upper limb and lower limb muscle weakness with muscle power of 3/5 on MRC scale and diminished deep tendon reflexes. On evaluation, she had hypokalaemia with high trans-tubular potassium gradient, metabolic alkalosis and hypocalciuria, features suggestive of Gitelman syndrome. New onset hypokalaemic alkalosis in a previously normokalaemic patient with Sjögren syndrome strongly favored a diagnosis of acquired Gitelman syndrome. Daily potassium supplementation and spironolactone resulted in complete clinical recovery.ConclusionsAcquired Gitelman syndrome associated with Sjögren syndrome is rare. It should be considered as a differential diagnosis during evaluation of acute paralysis and hypokalaemic metabolic alkalosis in patients with autoimmune disorders, especially Sjögren syndrome.

Case report of a Tillaux Chaput fracture in an adult having Becker muscular dystrophy with fracture of medial and posterior malleloli

Tillaux fractures are the avulsion of the distal tibial physis caused by the stress placed on the anterior tibio-fibular ligament, which are very rare in case of an adult. Due to severe swelling and overlapping of bones they are often missed in an innocuous looking X ray. Our case includes a 40 year old presented with severe pain and swelling of the ankle joint following trauma on a background history of Becker’s muscular dystrophy .While, the patient had proximal muscle weakness in lower limbs due to the comorbidity, Investigations also revealed the tillaux fracture with fractures of posterior and medial malleolus, which roughly outlines the injury mechanism to be of Supination-external rotation type. The objective of this publication is to highlight this unusual injury, to avoid incorrect diagnosis and its management which focuses on different challenges in achieving absolute reduction with early rehabilitation of the patient keeping in view of the existing co-morbidity. Keywords: Ankle injury, Adult Tillaux fracture, Chaput fracture syndesmotic injury, Tibiofibular ligament, Becker muscular dystrophy.

Acceptability and feasibility of a community-based strength, balance, and Tai Chi rehabilitation program in improving physical function and balance of patients after total knee arthroplasty: study protocol for a pilot randomized controlled trial

BackgroundThe rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to explore alternative strategies to enhance balance and physical functioning in post-TKA patients. As Tai Chi is a proven strategy for improving balance in older people, the proposed study aims to determine the feasibility and acceptability of a 12-week community-based post-TKA multimodal Tai Chi program and to collect preliminary data with respect to the efficacy of such a program in improving balance and physical functioning in post-TKA patients as compared to usual postoperative care.MethodsA single-blinded 2-arm pilot randomized controlled trial will recruit 52 community-dwelling post-TKA patients (aged > 60 years) in Hong Kong. In addition, 26 untreated asymptomatic controls will be recruited for comparison purposes. The TKA patients will be randomized into either a 12-week multimodal Tai Chi rehabilitation group or a postoperative usual care group (26 each). Participants will perform the outcome assessments at baseline, 6, 12, 24, and 52 weeks after TKA, while asymptomatic controls will have the same assessments at baseline, 12, and 52 weeks after baseline. The rate of recruitment, retention, and attrition, as well as adherence to the intervention, will be measured and used to determine the feasibility of the study and whether a full-scale effectiveness trial is warranted. Further, qualitative interviews will be conducted to explore the acceptability and possible barriers to the implementation of the intervention. Primary and secondary outcomes including both patient-reported surveys and performance-based tests will be compared within and between groups.DiscussionThe study will determine the feasibility and acceptability/potential efficacy of community-based rehabilitation for post-TKA patients and assess whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the study design and guide the conduction of a future definitive randomized controlled trial.Trial registrationClinicalTrials.gov NCT03615638. Registered on 30 May 2018. https://clinicaltrials.gov/ct2/show/NCT03565380

4 Case Reports On Patients with Acute Lower Limb Muscle Weakness Treated by Spinal Mobilization With Leg Movement(SMWLM) Combined with Korean Medicine Treatment

Objectives The purpose of this study was to investigate the possibility of spinal mobilization with leg movement (SMWLM) using Korean Medicine treatment on acute lower limb muscle weakness through four case studies. Methods SMWLM , with other Korean Medicine treatments, was performed on four patients who underwent treatment at OOOO Korean Medicine Hospital from August 2017 to July 2018. Additionally, results of the Numerical Rate Scale(NRS), EuroQol-FiveDimensions(EQ-5D),Oswestry lowback pain disability questionnaire(ODI), Straight Leg Raise(SLR) test, and Manual Muscle Test(MMT) were evaluated. Results There was a significant increase in NRS, ODI, and EQ-5D scales with im-rovements of SLR angle and MMT figures to a normal range. Conclusions This study suggested that Korean Medicine treatment combined with SMWLM may affect treating acute lower limb muscle weakness. Further clinical studies are needed to establish a definite conclusion.

Clinical Screening for Lower Limb Muscle Weakness in Community-Dwelling Older Women

The objective of the present study was to evaluate the ability of the five times sit to stand test (5TSST), grip strength (GS) and step test (ST) to detect older women with reduced lower-limb muscle strength (LLMS), and to investigate the clinical usefulness of the combination of such tests. One hundred and nineteen older women were submitted to the 5TSST, GS, ST and lower limb peak torque by an isokinetic dynamometer. The capacity of the clinical tests to detect older women with reduced LLMS was measured using the ROC curve, followed by calculation of posttest probability (PoTP). The results show that a ST score of 0.24 cm per cm of participant’s height shows the best PoTP for a positive test (72%). However, the combination of the ST and 5TSST enhances the accuracy from 48% (prevalence of weakness in the population) to 82.6% if both tests are positive, and decreases the PoTP from 48% to 11.4% if both tests are negative. The inclusion of GS provided additional benefits of small magnitude. In conclusion, the ST performed alone or in combination with 5TSST could be an alternative for clinical screening of LLMS reduction in older women. The early identification of impairment of lower-limb muscle strength in independent older adults may favor early intervention and prevention of negative outcomes such as falls and functional limitations.

Hubungan Karakteristik Individu dan Riwayat Stroke dengan Kekuatan Otot Pada Pasien Stroke

Stroke merupakan penyebab ketiga tertinggi kematian di dunia. Kecacatan dan kelumpuhan jangka panjang menjadi beban bagi penderita stroke yang hidup. Kecacatan diakibatkan oleh kelemahan otot dan syaraf ekstremitas atas dan bawah. Penelitian ini bertujuan untuk mengidentifikasi hubungan karakteristik individu dan riwayat stroke pertama dengan kekuatan otot pasien stroke di unit rawat jalan dan inap, rumah sakit pemerintah di Kalimantan Barat. Penelitian ini menggunakan pendekatan analisis deksriptif cross-sectional dengan kuesioner dan Manual Muscle Testing (MMT). Total sampel pada penelitian ini sebanyak 99 responden. Penelitian ini dilakukan pada bulan April hingga Juni tahun 2018. Hasil uji statistik menunjukkan terdapat hubungan yang signifikan antara umur ( p =0,026), jenis kelamin ( p =0,029), dan riwayat stroke ( p =0,036) dengan kekuatan otot. Kekuatan otot dapat ditingkatkan dengan latihan penguatan yang dilakukan secara konsisten dan berulang. Latihan ini juga harus disesuaikan dengan usia, jenis kelamin, dan keadaan atropi otot yang dialami pasien sebelumnya untuk mencegah kecacatan jangka panjang.

A novel pathogenic variant in DYNC1H1 causes various upper and lower motor neuron anomalies

ObjectiveTo perform genotype-phenotype, clinical and molecular analysis in a large 3-generation family with autosomal dominant congenital spinal muscular atrophy. MethodsUsing a combined genetic approach including whole genome scanning, next generation sequencing-based multigene panel, whole genome sequencing, and targeted variant Sanger sequencing, we studied the proband and multiple affected individuals of this family who presented bilateral proximal lower limb muscle weakness and atrophy. ResultsWe identified a novel heterozygous variant, c.1826T > C; p.Ile609Thr, in the DYNC1H1 gene localized within the common haplotype in the 14q32.3 chromosomal region which cosegregated with disease in this large family. Within the family, affected individuals were found to have a wide array of clinical variability. Although some individuals presented the typical lower motor neuron phenotype with areflexia and denervation, others presented with muscle weakness and atrophy, hyperreflexia, and absence of denervation suggesting a predominant upper motor neuron disease. In addition, some affected individuals presented with an intermediate phenotype characterized by hyperreflexia and denervation, expressing a combination of lower and upper motor neuron defects. ConclusionOur study demonstrates the wide clinical variability associated with a single disease causing variant in DYNC1H1 gene and this variant demonstrated a high penetrance within this large family.

A Rare Case of Statin-Induced Necrotizing Autoimmune Myopathy

Necrotizing autoimmune myopathy (NAM) is a rare side-effect of statin therapy. We report the case of a patient who developed statin-induced NAM with a review of the clinical presentation and management of this rare entity. The case illustrates the importance of including NAM in the differential diagnosis of persistent myopathy in a statin-exposed individual. A 74-year-old male was referred to endocrinology for hypercholesterolemia management in the context of a statin contraindication. He previously developed myositis and rhabdomyolysis secondary to statin therapy, but continued to have persistent proximal lower limb muscle weakness despite statin discontinuation. Rheumatologic and metabolic work-up were negative and neurologic work-up was negative except for a myopathic pattern in the glutei found on electromyography. Due to the persistence of proximal myopathy despite statin discontinuation and myopathic pattern seen on electromyography, NAM was suspected and antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase were sent and came back positive. The patient was treated with the immunosuppressant azathioprine, which resulted in clinical improvement. The patient was started on a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolucumab for hypercholesterolemia, which resulted in significant improvement in his lipid panel. The case illustrates the presentation and management of statin-induced NAM. We demonstrate the necessity for prompt diagnosis and timely management, as statin therapy is contraindicated and immunosuppressive therapy is warranted. Statin-induced NAM is rare however, it should be included in the differential diagnosis of persistent myopathy despite statin discontinuation. PCSK9 inhibitors are the only alternative therapy for hypercholesterolemia management in patients with statin-induced NAM.

Abstract TP380: Significant Factors of Early Independent Gait in Acute Ischemic Stroke Patients

Introduction: Acute stroke patients have problems with gait disturbance. Independent gait in hospitalized patients is important for early discharge to home. Therefore, we must find factors of disturbing independent gait following acute stroke and intensively treat them. Hypothesis: Impaired trunk control and cognitive function are factors of disturbing early independent gait. Methods: We included acute ischemic stroke patients who were admitted in our hospital from June 2017 to May 2018 and excluded patients with disturbed level of consciousness. We defined a score of 6 (modified Independence) or 7 (complete independence) in the Functional Independence Measure (FIM) as gait independence. We evaluated association of stroke subtypes, Brunnstrom recovery stage (BRS) of upper limbs, fingers and lower limbs, trunk control test (TCT) score and Mini-Mental State Examination (MMSE) score with early gait independence on the 7th day of a stroke onset. Results: One hundred twenty- six patients met our inclusive criteria and we analyzed them. Stroke subtypes had no relation to early gait independence. In gait independent and dependent patients on the 7th day, median BRS score of upper limbs was 5 and 5 (ns), median BRS score of fingers was 5 and5 (ns), median BRS score of lower limbs was 6 and 5 (p&lt;0.01), TCT score was 100and 75 (p&lt;0.01) and MMSE score was 28.5 and 24.5 (p&lt;0.01), respectively. Multiple logistic regression analysis that TCT (p&lt;0.01) and BRS lower limbs (p&lt;0.01) were independent factors for early independent gat. Receiver operating characteristic curve (ROC) for early gait independence demonstrated that cut-off values of TCT score and BRS of lower limbs and were 100 and 5. Conclusions: Impaired trunk control and muscle weakness of lower limbs were significant factors of disturbing early gait independence.

A patient with McLeod syndrome showing involvement of the central sensorimotor tracts for the legs

BackgroundMcLeod syndrome is a rare X-linked recessive acanthocytosis associated with neurological manifestations including progressive chorea, cognitive impairment, psychiatric disturbances, seizures, and sensorimotor axonal polyneuropathy. However, no studies have investigated the functioning of central sensorimotor tracts in patients with McLeod syndrome.Case presentationA 66-year-old man had experienced slowly progressive chorea and gait disturbance due to lower limb muscle weakness since his early fifties. Blood examinations showed erythrocyte acanthocytosis and the reduction of Kell antigens in red blood cells. Brain magnetic resonance imaging showed atrophy of the bilateral caudate nuclei and putamen. The diagnosis of McLeod syndrome was confirmed by the presence of a mutation of the XK gene on the X chromosome. Somatosensory-evoked potential and transcranial magnetic stimulation studies demonstrated that the central sensory and motor conduction times were abnormally prolonged for the lower extremity but normal for the upper extremity.ConclusionsThis is the first report of the involvement of the central sensorimotor tracts for the legs in a patient with McLeod syndrome. The clinical neurophysiological technique revealed the central sensorimotor tracts involvements clinically masked by neuropathy.

Investigation the EMG Activities of Lower Limb Muscles When Doing Squatting Exercise in Water and on Land.

(1) Background: Squatting is one of the common closed-kinetic chain (CKC) exercises for knee rehabilitation. Some patients cannot perform squatting exercises on land occasionally due to knee pain. Several studies had suggested that lower limb muscle activities are lower in water than on land while performing CKC exercises. The purpose of this study is to investigate the surface electromyography (sEMG) activities of Rectus femoris (RF) and Biceps femoris (BF) muscles when doing a squatting exercise in water and on land. (2) Methods: This was a cross-sectional experimental study. A total of 20 healthy participants (10 males, 10 females) were recruited by convenience sampling. The sEMG of RF and BF muscles in water and on land were collected and the knee motions were videotaped. Participants were instructed to perform closed kinetic-chain back squatting exercises at a specific speed (30 beats per minute) in water and on land at angular speed of 45°/s. Eight repetitions of the squatting exercise (0–90° knee flexion) were performed. The mean percentage maximal voluntary contraction (%MVC) between two muscles was compared in two conditions. The %MVC of RF and BF muscles at different specific knee flexion angles (30°, 60° and 90° knee flexion) was also identified. (3) Result: Muscle activities of RF (p = 0.01) and BF (p < 0.01) muscles were significantly lower in water than on land. The %MVC of RF and BF muscles was found to be 15.01% and 10.68% lower in water than on land respectively. For different knee angle phases, the differences in %MVC between land and water had significant difference for both RF muscles and BF muscles. (4) Conclusion: This study found a difference of mean percentage MVC of RF and BF muscles between land and water in different phases of squatting. The water medium reduced the two muscles’ activities to a similar extent. The result showed that the aquatic environment allows an individual to perform squatting with less muscle activation which may serve as an alternative knee exercise option for patients who encounter difficulty in land squatting due to lower limb muscle weakness or a high level of knee pain.

Design of an adjustable stance-control knee-ankle-foot orthosis for pediatric population.

Conventional knee-ankle-foot orthoses (KAFOs) are generally prescribed for children with lower limb muscle weakness and joint instabilities. The main function of KAFOs is to provide stability during gait by locking the knee in full extension. However, walking with the knee joint in a fully extended position requires excessive energy consumption, leading to early fatigue and inducing non-physiological gait patterns. A new generation of KAFOs was developed to allow free knee flexion during the swing phase and to lock the knee joint during the stance phase to provide the required stability. These are commonly labeled as stance-control knee-ankle-foot orthoses (SCKAFOs). Nevertheless, commercial SCKAFOs are not available for the pediatric population. Especially in early ages, children must frequently replace the orthosis due to their growth. Hence, the proposed design presents a solution for a SCKAFO with adjustable length adaptable to children's dimensions ranging from two to six years old.

317. Postoperative new shoulder imbalance in severe thoracic scoliosis treated with PVCR: risk factor analysis and countermeasure

BACKGROUND CONTEXT Preoperative shoulder imbalances are more common and significant in severe scoliosis than in AIS patients. Because of the special correction mechanism, a well deformity correction and well trunk balance rebuilding could lead to a new shoulder imbalance in PVCR. There is a lack of analysis of relevant risk factors to help surgeons to reconstruct shoulder balance better. PURPOSE The purpose of this study was to research the shoulder imbalances in patients with severe thoracic scoliosis after PVCR and analyze the associated risk factors. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE The study included 92 severe thoracic scoliosis patients. OUTCOME MEASURES The Cobb angle, correction rate, RSH, trunk drift and coronal plane balance were measured on routine posteroanterior standing radiographs preoperatively and postoperatively. METHODS Patients with severe thoracic scoliosis who received PVCR were retrospectively analyzed. Patients with pelvic obliquity>2 cm, leg length discrepancy (> 2cm) and muscle weakness of lower limbs were excluded. All patients performed routine posteroanterior standing radiographs before and after surgery. All patients were divided into two groups: Group A was the postoperative shoulder balance group (shoulder balance was defined as standing RSH 1cm). The Cobb angle, correction rate, RSH, trunk drift and coronal plane balance were measured preoperatively and postoperatively, and the above data were compared between the two groups. RESULTS The study included 92 severe thoracic scoliosis patients. The mean preoperative major curve of 123±21° was corrected to 43±13° (correction rate: 66±12%). The mean preoperative upper curve of 58±16° was corrected to 29±10° (correction rate: 49±10%). The trunk shift was 2.53±0.63cm before surgery and 1.54±0.33cm after surgery. The mean preoperative SH was 27.2±6.8mm, the mean postoperative SH was 11.7±4.3mm (mean change: 32.4mm) (P CONCLUSIONS Patients with severe thoracic scoliosis are prone to new shoulder imbalances after PVCR. The large angle of the major thoracic curve and the better correction rate of PVCR lead to the elevation of the concave shoulder and the new imbalance. The key to avoid a new shoulder imbalance after PVCR is to avoid excessive major curve correction and to pay attention to the matching of the correction of the major curve and upper curve. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Lysosome Fission: Planning for an Exit

Lysosomes are acidic and degradative organelles that receive and digest a plethora of molecular and particulate cargo delivered by endocytosis, autophagy, and phagocytosis. The mechanisms responsible for sorting, transporting, and ultimately delivering membranes and cargo to lysosomes through fusion have been intensely investigated. Much less is understood about lysosome fission, which is necessary to balance the incessant flow of cargo into lysosomes and maintain steady-state number, size, and function of lysosomes. Here, we review the emerging picture of how lipid signals, coat and adaptor proteins, and motor-cytoskeletal assemblies drive budding, tubulation, splitting, and 'kiss-and-run' events that enable fission and exit from lysosomes and related organelles.

Efficacy of an exercise program on balance and lower limb functional level among elderly population of Gujarat, India: A randomized controlled trial to prevent falls

Background: Altered balance and lower limb muscle weakness are the common risk factors associated with falls in elderly. Objectives: The purpose of this study was to assess the efficacy of an exercise program on balance and lower limb functional level in elderly population with moderate risk of fall. Materials and Methods: An exercise program, including warm-up exercises, balancing exercises, strengthening exercises, flexibility, and cool-down exercises, was designed for this interventional study. A total of 50 participants were selected by simple random sampling method from the physiotherapy department of the hospital, Ahmedabad, and they were randomly allocated into an interventional group of 25 and a control group of 25 participants. The inclusion criteria included, age: 60–80 years, both men and women, and Berg balance scale (BBS) score of ≤45. The intervention group received the exercise program for 4 times/week for up to 6 weeks and the control group was kept in waiting period. Pre- and post-exercise programs, a comparison of all measures was done with focus on BBS and lower extremity functional scale as primary outcome measures to find out the efficacy of the treatment protocol. The general linear model: Repeated measures analysis of variance and the independent t-test was used for analysis and values of P < 0.05 were considered statistically significant. Results: A total of 50 participants including 28 females and 22 males aged 60–80 years with an average age of 69.2 ± 6.6 years were included in the study. The balance and lower limb functional level of the intervention group were significantly higher than the baseline values with large effect size. Furthermore, the intervention group showed statistically significant improvement in balance and lower limb function when compared with the control group. Conclusion: The randomized controlled trial indicated that the designed exercise program for elderly was effective, and there was a significant improvement in balance and lower limb functional level in participants who received the exercise program. This study suggested that elderly people with moderate risk of fall can minimize falls and related fractures by better balance and strength with exercises.