Walking Disorders Research Articles

Large Necrosis: A Rare Complication of Medial Thighplasty

Obesity is a major public health problem in Western societies. After failure of diet and exercise, patients can have bariatric surgery. Weight loss causes excess skin on the body, including the thighs. This leads to difficulty walking and psychological disorders such as devalued self-image. Medial thighplasty is an intervention to reduce excess skin and fat in the thighs. The main complications are scar migration, scar infection, hematoma, lymphedema, gaping vulva, and, rarely, skin necrosis. We describe a case of flap necrosis after a reoperation of medial thighplasty. Treatment included debridement of necrotic tissue and healing of the wound by secondary intention (vacuum-assisted closure and dressings with calcium alginate). Complete healing was achieved in 4months. As the patient refused any new procedure, skin grafting was not performed. The aesthetic results of plastic surgery procedures are often imperfect. Patients should be clearly prepared and informed about the results expected from the operation. Surgeons should know contraindications for reoperation.

Advanced Content Management System in Murdoch Research Institute

The Hugh Williamson Gait Analysis Laboratory is a world leader in the analysis of walking disorders in children. Using state of the art equipment, highly specialised staff are able to determine why children walk the way they do. Knowing this, it is then possible to plan treatment individually for each child. Gait Lab aims to make thorough and reliable measurements of children’s walking ability in an efficient and friendly manner. It provides considered interpretations of these measurements to referring clinicians and conducts research to advance the understanding of human walking. This paper introduces The Gait Analysis Laboratory Content Management System, a contemporary approach using a Content Management System for surgery and research alike. The system provides the ability for surgeons to edit data and extract specific reports for research using the Internet from any location and at any time. The CMS has the functionality to save patient details, create referrals and make appointments, information which can be used for specific reports, during the surgery process, and for research around the world.

Intramuscular myxoma of the left leg—Case report of the lesion observed for several years

Aim The aim of this study was to present the process of diagnosis and treatment of a patient with diagnosed intramuscular myxoma in the left lower limb. Background Myxomas are benign neoplasms which can be found within large muscle groups. Histologically, these neoplasms are composed of a few elongated or star-shaped cells lying in abundant mucoid stroma. These tumours are characterized by expanding growth without forming distant metastases. Case description A man, 58, came to the Surgical Oncology Outpatient Clinic due to pain ailments and a growing tumour located in the rear group of the left shank muscles. The patient had been observing the lesion for several years, but related the occurrence of pain to the change in the nature of his job – from sedentary to standing. The patient underwent diagnostic imaging, a magnetic resonance imaging test, in which a tumour was described. A surgery was carried out where the tumour was resected together with the lateral head of the gastrocnemius muscle. No significant walking disorders, neurological deficits, either sensory or motor were observed. The follow-up imaging examinations, which were carried out a year after the surgery, did not reveal a relapse. The patient remains under the care of the Surgical Oncology Outpatient Clinic. Conclusion Myxomas are a group of benign neoplasms whose first symptom is the appearance of a palpable tumour whose stretching growth causes painful ailments. After magnetic resonance imaging and a diagnosis, it is necessary to plan the surgery. Radical resection of the lesion is a method of choice which guarantees long-lasting recovery.

Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people

BackgroundFalls in frail elderly are a common problem with a rising incidence. Gait and postural instability are major risk factors for falling, particularly in geriatric patients. As walking requires attention, cognitive impairments are likely to contribute to an increased fall risk. An objective quantification of gait and balance ability is required to identify persons with a high tendency to fall. Recent studies have shown that stride variability is increased in elderly and under dual task condition and might be more sensitive to detect fall risk than walking speed. In the present study we complemented stride related measures with measures that quantify trunk movement patterns as indicators of dynamic balance ability during walking. The aim of the study was to quantify the effect of impaired cognition and dual tasking on gait variability and stability in geriatric patients.MethodsThirteen elderly with dementia (mean age: 82.6 ± 4.3 years) and thirteen without dementia (79.4 ± 5.55) recruited from a geriatric day clinic, walked at self-selected speed with and without performing a verbal dual task. The Mini Mental State Examination and the Seven Minute Screen were administered. Trunk accelerations were measured with an accelerometer. In addition to walking speed, mean, and variability of stride times, gait stability was quantified using stochastic dynamical measures, namely regularity (sample entropy, long range correlations) and local stability exponents of trunk accelerations.ResultsDual tasking significantly (p < 0.05) decreased walking speed, while stride time variability increased, and stability and regularity of lateral trunk accelerations decreased. Cognitively impaired elderly showed significantly (p < 0.05) more changes in gait variability than cognitive intact elderly. Differences in dynamic parameters between groups were more discerned under dual task conditions.ConclusionsThe observed trunk adaptations were a consistent instability factor. These results support the concept that changes in cognitive functions contribute to changes in the variability and stability of the gait pattern. Walking under dual task conditions and quantifying gait using dynamical parameters can improve detecting walking disorders and might help to identify those elderly who are able to adapt walking ability and those who are not and thus are at greater risk for falling.

La importancia de evaluar síntomas y alteraciones funcionales en enfermedades neurológicas crónicas: experiencia en cuidado paliativo y rehabilitación en una institución colombiana

Existe un incremento en la prevalencia de enfermedades neurológicas y su carga de enfermedad. Debido a ello, identificar la frecuencia de síntomas y las alteraciones funcionales es de vital importancia para definir un adecuado plan de tratamiento. Se llevó a cabo un estudio de corte transversal para identificar los síntomas principales y las alteraciones funcionales en pacientes neurológicos de un centro de referencia colombiano para manejo de rehabilitación. Se encontraron como síntomas y alteraciones funcionales más frecuentes: alteraciones de la marcha (65,5%), desórdenes de comunicación (36,98%), alteraciones emocionales y de memoria (38%), dolor (29,45%) y alteraciones en las actividades básicas cotidianas (24,3%). El 50% de los pacientes que reportaron dolor, el 30% de los que manifestaron insomnio y el 80% de los que refirieron estreñimiento no recibieron tratamiento en la primera consulta. Algunos de los síntomas identificados no son características que definen la enfermedad, y no siempre son objeto de intervención. Los resultados de este estudio pueden contribuir a reconocer la carga de los síntomas de las enfermedades neurológicas, sensibilizando a los profesionales de la salud acerca de la importancia del cuidado paliativo en pacientes con enfermedades progresivas no oncológicas.

115 Diagnostic and management of patients with heart failure with preserved systolic function in hospital settings: a French observational cohort survey

Few data are available about real life and management of patients heart failure with preserved systolic function (HF-PSF). To describe patients, disease characteristics and treatment strategies implemented in HF-PSF patients hospitalized for confirmed acute HF with LVEF≥45%. An observational study was conducted in 68 hospital in France with 2 steps: (1) a registry part in patients hospitalized for confirmed acute HF for estimation of proportion of HF-PSF patients in the overall HF patients. (2) a detailed part with data collection of patients recently diagnosed for HF-PSF (LVEF ≥ 45% evaluated within 8 days following hospitalization date). 707 HF patients were enrolled in the registry with a proportion of 51% with HF-PSF. In detailed part 364 HF-PSF patients were selected, with a mean age of 79 years, 59%female, and a mean BMI 27.7kg/m. Main cardiovascular characteristics of HF-PSF patients were: atrial fibrillation (51%), coronary heart disease (32%), peripheral arterial disease (15%) and stroke (13%) as CV antecedents and hypertension (78%), obesity (45.5%) and diabetes (29%) as risk factors. Mean values were: blood pressure 133/86mmHg, HR 92beats/min, creatinine 13.8mg/l, haemoglobin 12.0g/dl. BNP was performed in 243 patients with a median value of 684 pg/ml and Nt-pro-BNP in 77 patients with a median value of 3999 pg/ml. Mean ejection fraction was 58±8%. Non CV co-morbidities were: renal failure(39%), COPD(20%), walking disorders (22%), depression(12%),cognitive disorders(8%)and cancers(5%). Treatment at discharge included: diur. (85%), ACE-i(57%), βB (56%), Ca antag (27%), ARB (20%), aldosterone blockers (13%), digoxin (16%), anticoagulants (52%), statins (48%), aspirin (32%) and amiodarone (28.5%). Much is not known about the epidemiology and management of HF-FSP in France but our study try to improve the knowledge on this disease with real life data even if until today there is no specific treatment.

Endoscopic removal of a suprasellar arachnoid cyst: an anatomical study with special reference to skull base

Suprasellar arachnoid cysts are rare entities in adults, representing 10% of all cysts. Endoscopic treatment is now preferred for this pathology, allowing a new anatomical approach to skull base structures. The aim of this study is to present the relevant anatomy of the skull base viewed during an endoscopic procedure for a suprasellar arachnoid cyst. A 77-year-old man with 6 months history of walking disorder was referred for neurosurgical evaluation. Physical examination did not show any oculomotor or endocrine disorder. Sagittal T1-weighted MRI demonstrated a large suprasellar arachnoid cyst. The patient underwent a ventriculocystocisternostomy without complications. Postoperative neurologic examination showed an initial improvement of walking disorders. Cerebral CT scan showed a slight reduction in cyst dimensions. During the endoscopic procedure, the anatomical view of the skull base was demonstrative. From the interior of the cyst we were able to identify the following structures: the clivus, pituitary stalk, pituitary gland, basilar artery, posterior cerebral arteries, posterior communicating arteries, oculomotor nerves and the superior wall of cavernous sinus. We identified a slit valve mechanism in the arachnoid next to the basilar artery. Ventriculocystocisternostomy is a useful procedure in treating arachnoid cyst. Moreover, during this procedure, the endoscope allows for better and safer visualization of skull base structures.

A smart sensing platform for the classification of ambulatory patterns

This paper describes an innovative sensing approach allowing capture, discrimination, and classification of transients automatically in gait. A walking platform is described, which offers an alternative design to that of standard force plates with advantages that include mechanical simplicity and less restriction on dimensions. The scope of the work is to investigate as an experiment the sensitivity of the distributive tactile sensing method with the potential to address flexibility on gait assessment, including patient targeting and the extension to a variety of ambulatory applications. Using infrared sensors to measure plate deflection, gait patterns are compared with stored templates using a pattern recognition algorithm. This information is input into a neural network to classify normal and affected walking events, with a classification accuracy of just under 90 per cent achieved. The system developed has potential applications in gait analysis and rehabilitation, whereby it can be used as a tool for early diagnosis of walking disorders or to determine changes between pre- and post-operative gait.

Walking along circular trajectories in Parkinson's disease

We hypothesized that gait capacities would be more stressed in patients with Parkinson's disease (PD) when walking along curved than straight trajectories, owing to the complex adaptations required for this walking task. Twenty on-phase patients with PD and 20 healthy subjects walked eyes-open along straight and curved trajectories for 1 minute at self-paced cadence and velocity. Step frequency along straight and curved trajectories was computed from video-recordings of the lower limbs. Step frequency was not affected by trajectory shape in either patients with PD or healthy subjects. Distances run by the patients were shorter than normal under both conditions. However, in PD, distances were relatively shorter during curved than straight walking; therefore, decreased distances in PD were connected with decreased mean step length (as the ratio between distance and step number). No correlation was found between the above mentioned variables and the severity or duration of the disease or the frequency of falls. Walking along curved trajectories can highlight impaired gait control in on-phase patients with PD, and can be suitable for the routine evaluation of possible walking disorders when straight walking is not significantly affected.

ASPECTOS EPIDEMIOLÓGICOS DE UM FOCO DE TUNGÍASE (Tunga penetrans, SIPHONAPTERA) EM UM SISTEMA INTENSIVO DE SUÍNOS CRIADOS AO AR LIVRE

The outdoors intensive-type pig production is characterized by maintaining swine during reproductive, pregnancy and nursing periods on pasture limited by wiring and/or electric fences. The aim of the present report was to describe the epidemiological aspects of an outbreak of Tunga penetrans in an outdoor pig production system. A total of six mature boars, 9 lactating sows, 13 pregnant sows, 9 mating sows, 20 suckling pigs and 34 weaned pigs were clinically examined. None of the boars were infested, while 50% of all sows examined had the parasite lesions, most frequently observed in the breast area, thus resulting in agalactia in lactating sows due to obstruction of the galactophorus channel, with subsequent involution of the mammary gland. In 90% of suckling piglets walking difficulty was observed, caused by the presence of the parasite in the hoofs, with 25% of these animals also showing hock lesions (farm number 1, n = 48). Similar lesions were observed in 100% of 40-47 days old weaned pigs (farm number 2, n = 24) and in 80% of 70 days old weaned pigs (farm number 3, n = 10), all of which had been transferred to finishing units in a confinement system. Therefore we conclude that Tunga penetrans can infest pigs reared or kept outdoors, causing agalactia in lactating sows, and walking disorders in suckling and weaned pigs. KEY-WORDS: Chiggers, agalactia in sows; outdoors pig production.

The role of executive function and attention in gait

Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk.

Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions

Objective: We compared falling and non-falling healthy elderly subjects to identify balance disorders associated with falling. Gait parameters were determined when carrying out single and dual tasks. Design: Case comparison study. Setting: Subjects were studied in the gait laboratory at Hopital Roger Salengro, Lille, France. Subjects: A group of 40 healthy elderly women were assigned to one of two groups according to their falling history: 21 fallers aged 70.4±6.4 years and 19 non-fallers aged 67.0±4.8 years. All subjects performed first a single leg balance test with two conditions (eyes open/closed). Then, gait parameters were analysed under single-task and dual motor-task conditions (walking with a glass of water in the hand). Main measures: Falls, number of times suspended foot touched the floor during the single leg balance test, cadence, speed, stride time, step time, single-support time, stride length and step length during walking under single- and dual-task conditions. Results: During the single leg balance test, fallers placed their feet on the floor three times more often than non-fallers under eyes open conditions (P < 0.05) and twice as often under eyes closed conditions (P < 0.05). In the single-task condition, no significant difference in gait parameters was reported between fallers and non fallers. There was a significant difference (P < 0.05) in the gait parameters (cadence, speed, stride and step time, single-support time) between fallers and non-fallers under dual-task conditions. Conclusions: Dual tasks perturb walking in fallers, who exhibit deteriorated static balance. Consequently, walking under dual-task conditions plus a single leg balance test could be helpful in detecting walking disorders and planning physiotherapy to prevent falls.

Influence des variations de la température sur la symptomatologie clinique dans la sclérose en plaques : étude épidémiologique

The effects of the modifications of temperature are well known in patients affected by multiple sclerosis (MS). They are variable and can influence daily living. This sensibility can be used in the management of the disabilities. Method. – An epidemiological study was realized on a cohort of 191 patients suffering from MS referred to the MS clinic of Rennes (France). All the patients were questioned about the influence of heat and cold on their clinical symptoms (fatigue spasticity, walking disorders, vision, …). Correlations with the main clinical characteristics were studied. Population. – One hundred ninety-one patients, 129 women and 62 men with an average age of 47.6 ± 10 years were interviewed. Average score EDSS was of 5.2 ± 1.5. The mean duration of MS was 13.5 ± 10 years. Results. – One hundred forty-seven patients (77%) reported a sensibility to the temperature. Heat deteriorated function in 104 cases and 82 patients improved with cold. Paradoxically 20 patients reported to be deteriorated with cold and 19 improved with heat. Fatigue and walking were the most sensitive to temperature fluctuations. No particular clinical profile could be established. Fifty percent of the patients used this sensibility with therapeutic aim in everyday life. Discussion. – The clear influence of temperature fluctuations on the clinical symptom was confirmed in this study. However, there is a great variability from one patient to another. Different hypotheses have been evoked to explain this phenomenon. The most likely is an influence on the nervous specific conductivity. In routine practice cold physiotherapy will be proposed on case by case basis and still has an interesting place in the rehabilitation management.

Walking difficulties in patients with Alzheimer’s disease might originate from gait apraxia

Objectives: To investigate whether gait apraxia is a possible cause for some of the walking abnormalities shown by patients with Alzheimer’s disease. Methods: 60 patients with Alzheimer’s disease, selected as...

Hysterical Conversion Disorder in a Young Girl at Moderate Altitude

Case report A 10-year-old girl hiked with other members of her group to a summit at a height of 2400 m in Switzerland. They left in the morning from their residence altitude of 600 m, were dropped off with a 4-wheel-drive car at a shelter at 1400 m, and started to hike from this point. During the ascent and after 2 hours of walking, the young girl complained of a headache and a sensation of oppression, but she reached the top together with the rest of the group. The group spent 1 hour having lunch on the summit. After lunch, her headache and her sensation of being unable to take a deep breath were exacerbated, and she became ataxic and unable to stand up; yet she did not lose consciousness. She was carried by several adults and brought down to a shelter at 1400 m after a lapse of 3 hours without improvement of her symptoms. The accompanying adults were in a hurry, and a call for help was sent out. The medical team arrived within 20 minutes by helicopter due to the inaccessibility of the shelter. The helicopter’s physician noticed that the patient was conscious, with no sensory or motor deficiency; the pupils and osteotendinous reflexes were normal. She presented dyskinetic movement of both arms and slight dysarthria, and she spoke in a hushed voice; she was completely unable to stand up (falling backward with exaggerated movements) and also had a tendency to somnolence. Arterial pressure, heart rate, respiratory rate, temperature, and oxygen saturation were all normal, yet her intense headache and her sensation of being unable to get enough air were persistent symptoms. Quite strikingly, she appeared to be completely indifferent and did not ask for any explanations about her clinical condition. She did not report any medical history. At the shelter, oxygen was administered, and an intravenous line was inserted. She was thereafter transported to the

Disorders in trunk rotation during walking in patients with low back pain: a dynamical systems approach

Objective. (1) To introduce an evaluation tool for the assessment of walking disorders in low back pain patients. (2) To investigate whether walking patterns in low back pain patients are different from those of control subjects. Design. Relative phase measures of movement coordination are applied in the assessment of trunk function in a small group of patients with non-specific low back pain and in control subjects. Background. Normal subjects change the coordination of pelvic and thoracic rotations from an in-phase to an out-of-phase pattern with increasing walking speed. Low back pain patients may have a reduced ability to counter rotate pelvis and thorax at higher walking speeds (from 1.0 m/s onwards) as a result of hyperstable coordination patterns. Methods. Six patients with non-specific low back pain and six healthy control subjects walked on a treadmill at comfortable walking speeds and during a systematic variation of the treadmill velocity. Coordination of arm and leg movements as well as of pelvic and thoracic rotations was analyzed using a relative phase algorithm. Results and Conclusions. The comfortable walking speed was reduced in the patient group. In contrast to the control subjects, four of the six patients were not able to establish an out-of-phase coordination pattern between thorax and pelvis at higher walking speeds. This coincided with an increased stability of movement coordination, indicating guarded behavior. In addition, an increased asymmetry between the phase-relations of left and right side of the body was found in some of the patients. Relevance The assessment of coordination between the movements of arms and legs and between rotations of pelvis and thorax during walking may be useful in the evaluation of low back pain. Further research could indicate whether this approach towards movement coordination allows for a classification of spine patients based on the influence of low back pain on gait.

Effects of atropine, trimedoxime and methylprednisolone on the development of organophosphate-induced delayed polyneuropathy in the hen

In this study we have examined the effects of atropine, trimedoxime (TMB-4) and methylprednisolone (MP) on the development of organophosphate-induced delayed polyneuropathy (OPIDP) in the hen. The birds were treated with standard neuropathic dose of diisopropylfluorophosphate (DFP) (1.1 mg/kg, sc), which produced OPIDP that could be graded as 5 on the 8-point scale, and the development of OPIDP was observed for the next 22 days. The results obtained have shown that atropine (20 mg/kg, ip), TMB-4 (15 mg/kg, im) and MP (2 or 10 mg/kg, ip) either alone or in different combinations are able to improve the condition of the birds. The most potent effect was obtained with atropine, TMB-4 (given 20 min before DFP) and MP (2 mg/kg, sc, given 20 min before and at 48 hour intrevals after poisoning) since the signs of OPIDP could hardly be seen (grade 1 at the 8-point scale). When TMB-4 and MP were given 15 or 40 min after DFP the protective/therapeutic effects of these drugs appeared to be diminished since walking disorders were more serious and graded as 2 or 4, respectively. The possible mechanisms of the action of the drugs in respect to OPIDP are discussed. In conclusion, the results of this study have shown that it is possible to prevent the development of DFP-induced OPIDP in the hen by treatment with atropine, trimedoxime and methylprednisolone when they were given before or soon after DFP.

An assessment of gait analysis in the rehabilitation of children with walking difficulties

Purpose: To assess the current status of computerized gait analysis techniques in the management of children with cerebral palsy or spina bifida who have significant walking disorders. Method: Synthesis of available data from a review of the literature, drawing on MEDLINE, EMBASE, PRE-MEDLINE, HealthStar and PsychInfo. Other information was obtained from persons with expertise in computerized gait analysis. Cost data were obtained from Canadian rehabilitation centres and the provincial health ministry. Results: This technology seems helpful in detecting gait changes. However, available evidence is insufficient to draw conclusions about the influence of computerized gait analysis on treatment outcomes. Part of the rationale for use of the technology is that costs of gait analysis (of the order of $CAN 2,000 per examination) would be offset by a decrease in followup surgical procedures and associated hospital care. There could also be a major influence on children's independence and quality of life. However, there are as yet no convincing data to support these propositions. Conclusions: Computerized gait analysis is a potentially useful technology in the management of children with walking disabilities, but its efficacy is not established. It should be regarded as a developing technology and its clinical application linked to systematic collection and assessment of outcomes data.

A Marker for Language Disorders

Toe walking unassociated with an autistic disorder or cerebral palsy generally has been considered a normal infant gait. The incidence of toe walking in various diagnostic subgroups of 799 developmentally disabled children presenting to a tertiary-level multidisciplinary assessment clinic was reviewed to investigate the authors' clinical impression that toe walking may be a marker for language dysfunction. Toe walking was found to be more frequent in those diagnostic subgroups with more severe language disorders. Toe walking also correlated with lower IQ scores (p &lt; 0.0001). The sensitivities, specificities, predictive validities and odds ratios all supported the hypothesized association between toe walking and language disorders. Further prospective studies of the neurodevelopmental outcome of children with toe walking are needed to determine whether this behavior can identify children at risk for language disorders.

Determination of the oxygen cost of level walking.

We have developed devices and methods for the determination of the oxygen cost of level walking. Oxygen uptake is determined with an argon dilution method. The validity of this technique is demonstrated. Walking speed is recorded and controlled by means of a speedometer cart. The reproducibility of a convenient, self-selected walking speed and of a predetermined speed was studied. Coefficients of variation were below two per cent. Corresponding values of the oxygen cost of walking at a predetermined speed were three per cent or less up to an interval between tests of six months. We conclude that the proposed methods are suited for longitudinal studies of the oxygen cost of level walking, for example in patients with walking disorders.