Use Of Cane Research Articles

THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown
 Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis
 Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. 
 Results: The TUG time of aid-free walking is 4.75 (p < 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p < 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral.
 Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

Interactive effects between sugar source and pelleting temperature on processing, digestibility and blood metabolites in nursery piglets

The aim of this study was to evaluate the effect of pelleting temperature (60°C or 90°C) and the type of sugar source (refined sugar cane or sugar cane molasses), on post-processed diet characteristics and on animal body weight gain, apparent total tract digestibility of energy and nutrient, and blood metabolites. Thirty-two recently-weaned piglets of both sexes were randomly assigned to 1 of the 4 treatments in a 2 (sugar source, refined sugar cane or sugar cane molasses) x 2 (pelleting temperature, 60°C or 90°C) factorial arrangement. The physicochemical characteristics of the diets evaluated were pellet durability index, fine content and starch gelatinization index. After seven days of adaptation, partial fecal samples were collected for apparent digestibility analyses for five days. For weight gain evaluation, the animals were weighed at 28, 35, 40 and 63 days of age. Blood samples were collected at the beginning (28 days) and the end of the experiment (63 days). Data were submitted to variance analysis and the means were compared by the Tukey test. There was interaction between pelleting temperature and sugar source on the pellet durability index, on the fine content and on the starch gelatinization index (P < 0.05) of the diets. Pelletizing at 90°C increased the pellet durability index in treatment with sugar cane molasses. The fine content was reduced in treatments with pelleting temperature at 90°C and increased in treatments with sugar cane molasses. There was an increase of the starch gelatinization index with refined sugar cane at 90°C. There was no interaction between pelleting temperature and sugar source on starch composition of the diets. The pelleting temperature and the type of sugar source did not influence the levels of resistant and non-resistant starch (P > 0.05). The total starch index was higher in treatments using sugar cane molasses. There was no interaction between pelleting temperature and sugar source on nutrient apparent total tract digestibility. The use of sugar cane molasses promoted higher apparent digestibility of gross energy and ash (A), and pelleting at 90°C increased the apparent digestibility of Ca, P and A (P < 0.05). There was interaction between pelleting temperature and sugar source on the gamma-glutamyltransferase (GGT) enzyme (P < 0.05), where the use of sugar cane molasses reduced GGT levels in the pelleted diet at 60°C. There was no effect of pelleting temperature and the type of sugar source on animal body weight gain, high density cholesterol (HDL), total cholesterol, triglycerides, urea and albumin. Therefore, sugar cane molasses can replace refined sugar cane as the palatable ingredient in the diet of nursery piglets without affecting animal body weight gain and levels of blood metabolites of the animals, promoting greater apparent digestibility of gross energy and ash, although it had altered the physicochemical characteristics of the diet. The use of sugar cane molasses allowed for the exploration of higher pelleting temperatures (90°C) in the feed processing, leading to increasing the apparent digestibility of Ca, P and A of the diets.

The Prototype of Assistive Cane for Climbing Up the Stair

The elder and patient with osteoarthritis knee had the problem to climb up the stair. The purpose of this research was to design and construct the prototype of assistive cane for climb up the stair. The assistive cane use Arduino to control the motor, send the power to the gear set to lift the user up the stair. The lifting plate help to reduce the burden at the knee joint while climbing up the stair. The foot force sensing device used to measure and collect the force act on the insole while walking on the floor, climbing up the stairs and climbing up the stairs using the assistive cane. The assistive cane could be help to reduce the burden at the knee joint and the force on the insole when climbing up the stair.

Short-term cane use in subacute stroke patients affects the nonparetic upper extremity nerves.

Overuse of the nonparetic upper extremity can lead to entrapment neuropathies in chronic stroke patients. However, little is known about the effects of cane use in subacute stage of stroke. The aim of this study was to investigate the short-term effects of cane use on the upper extremity nerves in subacute stroke patients recovering from a bedridden state. Thirty subacute hemiparetic stroke patients who were initially bedridden participated when they were able to walk with a cane. Symptoms and signs related to the median or ulnar nerves were checked, and nerve conduction studies were performed. The largest cross-sectional area (CSA) of these nerves from the wrist to elbow was measured with ultrasound. After 3 weeks of cane use, electrophysiologic and ultrasonographic reevaluation was performed. Nerve conduction studies and CSA of the nerves at the nonparetic upper extremity showed significant changes, whereas those of the hemiparetic upper extremity did not. Walking with a cane for a short period can induce the enlargement of the median and ulnar nerves at the nonparetic extremity of subacute hemiparetic stroke patients. Attention should be placed on correct cane usage from the beginning of rehabilitation.

The White Cane. Its Effectiveness, Challenges and Suggestions for Effective Use: The Case of Akropong School for the Blind

The article analyses the effectiveness and challenges of the use of the white cane and makes suggestions for its effective use. We explain that the white cane is one of the widely used and famous orientation and mobility (O&amp;M) tools designed for pupils with visual impairment to move independently in their environment. By employing the descriptive qualitative design, we draw our findings from 12 participants who were pupils of the Akropong School for the Blind in Ghana. We make implications and conclude on the findings for policy formulation on the white cane, and make suggestions for future research work.

The Effect of Perceived Level of Social Support on the Fear of Falling

ABSTRACT Background: Perhaps the most prevalent cause of anxiety among the elderly is the fear of falling, considering that a fall can lead to serious complications and decline of health. The purpose of this study was to examine the relationship between perceived social support and the fear of falling among people ages 60 and up. Methods: Upon completing informed consent, participants (n = 33) in assisted living facilities, living independently, or with a loved one completed a demographic questionnaire, the Falls Efficacy Scale-International and the Multidimensional Scale of Perceived Social Support. Results: There was not a statistically significant relationship between fear of falling and perceived social support (p = .14); however, there was a significant, strong positive correlation between age and fear of falling (r = .41, p = .05) and cane use and fear of falling (r = .54, p = .05). There were no statistically significant group differences in fear of falling (p = .48) for living status. There was a statistically significant difference in fear of falling between cane use (p = .001), with individuals using a cane reporting a significantly greater fear of falling (M = 48.21, SD = 12.95) than individuals not using a cane (M = 30.56, SD = 12.74). The results provide further insight into the relationship between fear of falling, perceived social support, cane use, and living status. Interventions and future research should examine the impact of social support and physical activity on fear of falling and reducing in cane use.

Biomass Yield and Carbohydrate Composition in Sugarcane and Energy Cane Grown on Mineral Soils

A better understanding of sugarcane and energy cane (Saccharum spp.) in biomass accumulation and carbohydrate composition can improve the knowledge of crop production sustainability and optimal utilization. The objectives of this study were to identify sugar composition and concentrations of stalk juice in sugarcane and energy cane grown on two sandy soils during ripening and to determine differences between the two types of canes in nonstructural and structural carbohydrate partitioning and concentrations in dry biomass for the mature plant-cane, first-ratoon, and second-ratoon crops. A field study was conducted at two locations with mineral (sand) soils in south Florida, USA, using two commercial sugarcane cultivars of CP 78-1628 and CP 80-1743 and two energy cane genotypes (US 78-1013 and US 84-1066) to determine their biomass yields and carbohydrate composition and concentrations. Averaged across the three crops and two locations, energy cane had significantly higher biomass yield, lower nonstructural carbohydrate (reducing sugars and sucrose) concentrations, and higher concentrations of cellulose, hemicelluloses, and lignin than sugarcane. Although there were no differences between sugarcane and energy cane in total carbohydrate concentration (839 to 842 g kg−1 DW), energy cane had 80% higher cellulose, 63% higher hemicelluloses, and 76% higher lignin; 69, 64, and 56% lower sucrose, glucose, and fructose concentrations, respectively, than sugarcane, when averaged across the three crops and two locations. These results can be useful for potential use of canes for both sucrose and cellulosic ethanol production on marginal sand soils to improve sustainability and profitability in the future.

Bardet-Biedl-Syndrom – Diagnose und klinischer Verlauf

The Bardet-Biedl syndrome (BBS) is a rare inherited ciliopathy, which is accompanied by retinal disease, i.e. rod-cone dystrophy (retinitis pigmentosa, RP) and other symptoms, especially truncal obesity, polydactyly, renal abnormalities as well as reduced intelligence or learning difficulties. 25 BBS genes are currently known, and these are responsible for the structure and function of primary cilia. Because ciliary integrity is crucial for numerous pathways of developmental signaling, their dysfunction may cause multisystemic disorders - like BBS. Physicians benefit greatly from new molecular genetic methods that have made genetically heterogeneous conditions diagnostically accessible: By next-generation sequencing (NGS), all BBS-associated genes can be analysed simultaneously in a gene panel. As regards the retinal phenotype, genotype-phenotype correlations are not significant. Besides classical autosomal recessive inheritance, oligogenic/triallelic traits have been reported, but these seem to play a minor role, if any (as a growing number of large-scale NGS-based studies suggests). In the absence of causal therapy, the mainstay of ophthalmological endeavour is focused on visual rehabilitation with low vision aids, use of the white cane and training to develop everyday life skills.

Contralateral canes for knee osteoarthritis.

Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.

To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.

To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Interprofessional Peer Teaching: Assistive Device Training and Medications Impacting Safe Ambulation

Purpose: An interprofessional peer teaching activity was designed and implemented to provide students with an opportunity to practice interprofessional education collaborative (IPEC) competencies while improving student knowledge of assistive devices for gait and medications impacting safe ambulation. Method: During the activity, second year physical therapy students instructed third year pharmacy students in the accurate fit and counseling for use of canes, crutches, and walkers. Pharmacy students then demonstrated these skills and were checked off on their ability to accurately fit and instruct consumers on basic gait patterns. The pharmacy students in turn educated the physical therapy students about medications that impact safe ambulation and gait training. The activity was designed to meet the interprofessional competencies of roles and responsibilities, interprofessional communication, teams and teamwork, in addition to specific course objectives. Students completed a 15-item pre- and post-knowledge assessment and a perceptions survey to evaluate the effectiveness of the peer teaching activity. Results: Significant improvements in knowledge and performance were demonstrated following participation in the activity, and students reported positive perceptions of the activity and its impact on their learning about assistive devices and medications reviewed during the session. Our results indicate that physical therapy and pharmacy students can effectively teach each other and learn about assistive devices and medications impacting safe ambulation through an interprofessional peer teaching activity. Conclusion: Peer teaching across disciplines can help prepare students to communicate and collaborate with other healthcare providers.

Gait improvement in adults with hemiparesis using a rolling cane: A cross-over trial.

To assess the changes in gait parameters in adults with hemiparesis using a rolling cane (quadripod cane with small wheels; Wheeleo®) compared with a classical quadripod cane. A prospective, multicentric, cross-over randomized trial. Thirty-two ambulatory adults with hemiparesis. Participants were assessed using a quadripod cane and a rolling cane. Outcome measures were changes in: walking speed during a 10-m walk test and a 6-min walk test; frequency of 2-step gait; physiological cost index; number of therapist interventions to control the balance; perceived exertion; and participant satisfaction. The following outcomes were improved with the use of a rolling cane: walking speed during a 10-m walk test at comfortable (+22%: p<0.001) and maximal (+30: p<0.001) speeds; walking speed (+50%: p<0.001) and distance (+49%: p<?0.001) during a 6-min walk test; and the frequency of 2-step gait. The physiological cost index, perceived exertion, and number of therapist interventions to control the balance remained unchanged. Participant satisfaction improved. A rolling cane, Wheeleo®, increases walking speed in adults with hemiparesis without additional risk of falls.

Effect of cane use on the balance function in elderly patients with dizziness

Effect of cane use on the balance function in elderly patients with dizziness

P.179 The use of cane (Camberwell evaluation of need for older people) for needs assessment in old age population

P.179 The use of cane (Camberwell evaluation of need for older people) for needs assessment in old age population

Use of rice polishing and sugar cane molasses as supplements in dual-purpose cows fed Leucaena leucocephala and Pennisetum purpureum

This study was conducted on a cattle farm in Yucatan, Mexico. The objective was to assess the effect of energy supplementation on milk yield and composition, and on the efficiency of use of dietary N in cows fed Leucaena leucocephala foliage (30% of total diet) and grass Pennisetum purpureum. Four multiparous crossbred Bos indicus × B. taurus cows in the first third of lactation were used in a 4 × 4 Latin square design. Treatments consisted of two energy sources: sugar cane molasses and rice polishing, offered individually or mixed, and a control group (Ctrl) without energy supplementation. The supplements were iso-proteic and iso-energetic and were formulated to provide 25% of the daily energy requirement. Supplementation increased dry matter intake (3 kg/cow/d). Milk yield was 13% higher (P = 0.048) in the supplemented treatments (7.86 kg/cow/d) than in the Ctrl group (6.97 kg/cow/d). Milk yield did not differ (P > 0.05) among supplemented treatments. Milk fat was higher for the Ctrl treatment compared with molasses and rice polishing. Concentrations of protein, lactose and solids non-fat in milk were not significantly affected by energy supplementation. The lower concentrations of blood urea nitrogen (BUN) found in the treatments with supplementation (9.77 mg/dl) compared with Ctrl (15.61 mg/dl) indicates greater efficiency in capturing N by rumen microorganisms. No differences in BUN were found among supplemented groups. It is concluded that energy supplementation with rice polishing alone or in combination with molasses, can improve the efficiency of use of dietary N, and milk yield, in cows fed 30% L. leucocephala foliage.

The walking cane length influences the postural sway of community-dwelling older women.

Mobility-related problems in older people may be relieved by the use of walking canes. However, the influence of the cane length on the postural stability of cane users has not been explored. The objective of this study is to examine the influence of a single-point cane with different lengths on the postural sway of regular cane users, older women during two stance positions, with feet parallel and semi-tandem stance. Eighteen older women, who used a single-point walking cane for at least 6 months, stood on a force plate with feet parallel or in semitandem position for 40 s. They always used a cane that was adjusted to one of three different lengths resulting from the distance between the wrist crease and the floor, named WF, or this distance plus 7.5 or 10 cm. Amplitude and speed of the centre of pressure (COP) and its components (rambling and trembling) in the anterior-posterior and medial-lateral directions and mean vertical force applied to the cane were compared across cane lengths. The amplitude and velocity of COP, rambling and trembling increased with the cane length. This effect was observed for the anterior-posterior with the feet parallel and in the medial-lateral direction with the semi-tandem position. More force was applied on the shorter cane (WF) in semitandem position. Longer canes increased the postural sway in the older women and restricted the body weight loaded on the cane. Improper cane length influences the postural sway particularly in a semitandem stance of regular cane users. This may cause a negative impact on postural stability required in daily life activities. The current findings may contribute to the prescription of this assistive device for older adults.

Effect of cane use on bone marrow lesion volume in people with medial tibiofemoral knee osteoarthritis: randomized clinical trial

To evaluate effects of daily cane use for 3 months on medial tibiofemoral bone marrow lesion (BML) volumes in people with medial tibiofemoral osteoarthritis (OA). In this randomized controlled trial (RCT), 79 participants with medial tibiofemoral OA were randomized to either a cane group (using a cane whenever walking) or control group (not using any gait aid) for 3 months. The cane group received a single training session by a physiotherapist, using a biofeedback cane to teach optimal technique and body weight support and motor learning principles to facilitate retention of learning. The primary outcome was change in total medial tibiofemoral BML volume (per unit bone volume) measured from magnetic resonance imaging (MRI) at 3 months. Secondary outcomes were BML volumes (per unit bone volume) of the medial tibia and femur, and patient-reported outcomes of overall knee pain, knee pain on walking, physical function, perceived global symptom changes and health-related quality of life. MRI analyses were performed by a blinded assessor. Seventy-eight participants (99%) completed the primary outcome. Mean (standard deviation) daily cane use was 2.3 (1.7) hours over 3 months. No evidence of between-group differences was found for change in total medial tibiofemoral BML volume (mean difference:-0.0010 (95% confidence intervals:-0.0022, 0.0003)). Most secondary outcomes showed minimal differences between groups. Daily use of a cane during walking for 3 months aiming to reduce knee joint loading did not change medial tibiofemoral BML volumes compared to no use of gait aids. Australian New Zealand Clinical Trial Registry (ACTRN12614000909628).

SUN-368 Fatty Hypertrophy of the Hip as a Clinical Manifestation of Cushing Syndrome

Background: Increased fat deposition is a hallmark of exogenous and endogenous hypercortisolism (Cushing’s syndrome, CS). Fat accumulates not only in the abdomen and liver, but also in unusual locations such as the temporal and supraclavicular fossae, intrascapular fat pads and spinal epidural space (1). Here we describe, to our knowledge, the first report of intracapsular fat deposition at the hip in a patient (pt) with CS. Case Presentation: A 47 year old African American male presented with a six year history of diabetes and hypertension. He also reported abdominal weight gain, moodiness, facial flushing, blurry vision, fatigue, joint aches (especially knee and hips), muscle weakness leading to falls, difficulty with ambulation, straie, and decreased memory. Physical exam on admission revealed a rounded face with bitemporal fat pads, supraclavicular and dorsocervical fat pads, central obesity, +1 pitting edema of the lower extremities, 4/5 strength in shoulders and hips, ankle flexion and hand grip strength 5/5, wide violaceous striae on the abdomen. Biochemical evaluation revealed urine free cortisol 1460.8 and 1031.2 mcg/24h (ref: 3.5-45 mcg/24h), and plasma ACTH levels of 51.3-158 pg/ml (ref:5-46pg/ml). Pituitary MRI showed an 8mm lesion, CRH stimulation test showed 52% increase in cortisol level (29.8 to 43.1 mcg/dl) and a 79% increase in ACTH level, (95.9 to 175 pg/ml), suggestive of Cushing’s disease. However, cortisol increased by 41% after 8mg dexamethasone (23.2 to 32.8 mcg/dL), and IPSS also was consistent with an ectopic source of ACTH. A 10mm right hilar lesion was identified by CT, MRI, and 68Ga-DOTATATE. While awaiting surgical resection, pt was treated with ketoconazole and metyrapone. Three weeks after initiation of medical therapy, pt reported new unprovoked bilateral hip pain with antalgic gait. MRI hip revealed only bilateral symmetric intracapsular fat abutting the superolateral aspects of the femur in the subcapital region. There was no evidence of avascular necrosis of bone, osteoarthritis, or collagen tear. Physiatry evaluation reported functional hip strength in the 4- range, hip extension bilaterally 2+, unchanged ability from a prior admission to stand from sitting position without the use of upper extremities, and ability to ambulate independently across a room, but necessary use of a single point cane for longer distances. Physical therapy noted a decline in his mobility status since last visit, and recommended use of a wheeled walker. Discussion: This is the first time we have identified a patient with increased fat in the hip joint explained by no other comorbidities other than Cushing’s Syndrome. This new finding adds another unusual location for increased adipose in the clinical presentation of patients with CS. Further studies are needed to better assess the correlation between the finding of intracapsular hip fat, pain and hypercortisolism.

Gait and Mobility Session: Teaching the Neurology and Neuroanatomy of Spinal Cord Injuries

Medical student knowledge of key ascending and descending pathways (dorsal column/medial lemniscal, spinothalamic, lateral corticospinal) is essential to their ability to identify and assess spinal cord injuries (SCI). In addition, evaluation of gait is an important component of the neurological examination. To incorporate these clinical and neuroanatomical concepts into an interactive session, which is part of an integrated nine‐week neuroscience/neurology/psychiatry module, we combined a gait observation and analysis activity, a review of spinal cord anatomy and lesions, and a question and answer interview with the patient. Before the session, students watched a short, high‐resolution video of the patient, who has a Brown‐Sequard syndrome lesion, navigating stairs and level ground, with and without his cane. They were required to submit at least three observations on the patient's gait and mobility, but were not provided with specific prompts, nor given any information about the location or nature of the lesion. Analysis of over 750 student responses from four years of the module is ongoing, and includes tabulation of lesion localization (e.g. right or left side, upper motor neuron vs. lower motor neuron, cerebral cortex vs. cerebellum vs. spinal cord), aspects of mobility (e.g. use of cane, placement of feet on stairs, turning, balance), and gait descriptors (e.g. circumduction, foot drop, wide‐based). For example, in 2015, 83/213 students correctly identified the side with lower extremity weakness/stiffness, 17/213 identified the incorrect side, and the remainder (113/213) did not indicate the side on which weakness was observed. 66/213 students compared the patient's gait with and without his cane, and 62/213 noted the patient's foot placement while ascending or descending stairs. These classifications of student observations, combined with in‐class analysis and discussion of the video guided by neurology faculty, provide insight into the development of medical student observation skills and familiarity with the neurological examination and terminology. Moreover, the question and answer session with the patient (who is a physician) adds depth to the narrative, and encourages empathy for the mobility challenges faced by individuals who have SCI.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.