Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sophie Tasseel-Ponche, Hélène Le Liepvre, Florence Colle, Cédric Andriantsifanetra, Pierre-Paul Vidal, Isabelle Véronique Bonan, Alain-Pierre Yelnik
BackgroundBalance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here.HypothesisVI could have different influence depending on the task for a given individual.MethodsWe retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS.ResultsWe analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=−0.3, p=0.01 and r=−0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=−0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04).Discussion - conclusionA patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation — perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
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Σάββατο 5 Αυγούστου 2017
Inter-individual similarities and variations in muscle forces acting on the ankle joint during gait
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles’ peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles’ peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Hamstring and calf muscle activation as a function of bodyweight support during treadmill running in ACL reconstructed athletes
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Rod and frame test and posture under optokinetic stimulation used to explore two complementary aspects of the visual influence in postural control after stroke
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sophie Tasseel-Ponche, Hélène Le Liepvre, Florence Colle, Cédric Andriantsifanetra, Pierre-Paul Vidal, Isabelle Véronique Bonan, Alain-Pierre Yelnik
BackgroundBalance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here.HypothesisVI could have different influence depending on the task for a given individual.MethodsWe retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS.ResultsWe analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=−0.3, p=0.01 and r=−0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=−0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04).Discussion - conclusionA patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation — perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
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Source:Gait & Posture, Volume 58
Author(s): Sophie Tasseel-Ponche, Hélène Le Liepvre, Florence Colle, Cédric Andriantsifanetra, Pierre-Paul Vidal, Isabelle Véronique Bonan, Alain-Pierre Yelnik
BackgroundBalance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here.HypothesisVI could have different influence depending on the task for a given individual.MethodsWe retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS.ResultsWe analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=−0.3, p=0.01 and r=−0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=−0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04).Discussion - conclusionA patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation — perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
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Inter-individual similarities and variations in muscle forces acting on the ankle joint during gait
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles’ peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles’ peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Hamstring and calf muscle activation as a function of bodyweight support during treadmill running in ACL reconstructed athletes
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Rod and frame test and posture under optokinetic stimulation used to explore two complementary aspects of the visual influence in postural control after stroke
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sophie Tasseel-Ponche, Hélène Le Liepvre, Florence Colle, Cédric Andriantsifanetra, Pierre-Paul Vidal, Isabelle Véronique Bonan, Alain-Pierre Yelnik
BackgroundBalance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here.HypothesisVI could have different influence depending on the task for a given individual.MethodsWe retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS.ResultsWe analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=−0.3, p=0.01 and r=−0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=−0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04).Discussion - conclusionA patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation — perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
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Source:Gait & Posture, Volume 58
Author(s): Sophie Tasseel-Ponche, Hélène Le Liepvre, Florence Colle, Cédric Andriantsifanetra, Pierre-Paul Vidal, Isabelle Véronique Bonan, Alain-Pierre Yelnik
BackgroundBalance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here.HypothesisVI could have different influence depending on the task for a given individual.MethodsWe retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS.ResultsWe analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=−0.3, p=0.01 and r=−0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=−0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04).Discussion - conclusionA patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation — perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
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Inter-individual similarities and variations in muscle forces acting on the ankle joint during gait
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles’ peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles’ peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Hamstring and calf muscle activation as a function of bodyweight support during treadmill running in ACL reconstructed athletes
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite “entire” activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Effect of hearing aids on static balance function in elderly with hearing loss.
| Related Articles |
Effect of hearing aids on static balance function in elderly with hearing loss.
Gait Posture. 2017 Jul 24;58:126-129
Authors: Negahban H, Bavarsad Cheshmeh Ali M, Nassadj G
Abstract
While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes-foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.
PMID: 28772132 [PubMed - as supplied by publisher]
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Baseline vestibular and auditory findings in a trial of post-concussive syndrome
| Related Articles |
Baseline vestibular and auditory findings in a trial of post-concussive syndrome
Undersea Hyperb Med. 2016 Aug-Sept;43(5):567-584
Authors: Meehan A, Searing E, Weaver LK, Lewandowski A
Abstract
Previous studies have reported high rates of auditory and vestibular-balance deficits immediately following head injury. This study uses a comprehensive battery of assessments to characterize auditory and vestibular function in 71 U.S. military service members with chronic symptoms following mild traumatic brain injury that did not resolve with traditional interventions. The majority of the study population reported hearing loss (70%) and recent vestibular symptoms (83%). Central auditory deficits were most prevalent, with 58% of participants failing the SCAN3:A screening test and 45% showing abnormal responses on auditory steady-state response testing presented at a suprathreshold intensity. Only 17% of the participants had abnormal hearing (⟩25 dB hearing loss) based on the pure-tone average. Objective vestibular testing supported significant deficits in this population, regardless of whether the participant self-reported active symptoms. Composite score on the Sensory Organization Test was lower than expected from normative data (mean 69.6 ±vestibular tests, vestibulo-ocular reflex, central auditory dysfunction, mild traumatic brain injury, post-concussive symptoms, hearing15.6). High abnormality rates were found in funduscopy torsion (58%), oculomotor assessments (49%), ocular and cervical vestibular evoked myogenic potentials (46% and 33%, respectively), and monothermal calorics (40%). It is recommended that a full peripheral and central auditory, oculomotor, and vestibular-balance evaluation be completed on military service members who have sustained head trauma.
PMID: 28771392 [PubMed - as supplied by publisher]
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[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society].
| Related Articles |
[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society].
HNO. 2017 Aug 02;:
Authors: Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A
Abstract
This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes two categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 min and 12 h. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 min to 24 h.
PMID: 28770282 [PubMed - as supplied by publisher]
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Effect of hearing aids on static balance function in elderly with hearing loss.
| Related Articles |
Effect of hearing aids on static balance function in elderly with hearing loss.
Gait Posture. 2017 Jul 24;58:126-129
Authors: Negahban H, Bavarsad Cheshmeh Ali M, Nassadj G
Abstract
While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes-foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.
PMID: 28772132 [PubMed - as supplied by publisher]
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Baseline vestibular and auditory findings in a trial of post-concussive syndrome
| Related Articles |
Baseline vestibular and auditory findings in a trial of post-concussive syndrome
Undersea Hyperb Med. 2016 Aug-Sept;43(5):567-584
Authors: Meehan A, Searing E, Weaver LK, Lewandowski A
Abstract
Previous studies have reported high rates of auditory and vestibular-balance deficits immediately following head injury. This study uses a comprehensive battery of assessments to characterize auditory and vestibular function in 71 U.S. military service members with chronic symptoms following mild traumatic brain injury that did not resolve with traditional interventions. The majority of the study population reported hearing loss (70%) and recent vestibular symptoms (83%). Central auditory deficits were most prevalent, with 58% of participants failing the SCAN3:A screening test and 45% showing abnormal responses on auditory steady-state response testing presented at a suprathreshold intensity. Only 17% of the participants had abnormal hearing (⟩25 dB hearing loss) based on the pure-tone average. Objective vestibular testing supported significant deficits in this population, regardless of whether the participant self-reported active symptoms. Composite score on the Sensory Organization Test was lower than expected from normative data (mean 69.6 ±vestibular tests, vestibulo-ocular reflex, central auditory dysfunction, mild traumatic brain injury, post-concussive symptoms, hearing15.6). High abnormality rates were found in funduscopy torsion (58%), oculomotor assessments (49%), ocular and cervical vestibular evoked myogenic potentials (46% and 33%, respectively), and monothermal calorics (40%). It is recommended that a full peripheral and central auditory, oculomotor, and vestibular-balance evaluation be completed on military service members who have sustained head trauma.
PMID: 28771392 [PubMed - as supplied by publisher]
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[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society].
| Related Articles |
[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society].
HNO. 2017 Aug 02;:
Authors: Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A
Abstract
This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes two categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 min and 12 h. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 min to 24 h.
PMID: 28770282 [PubMed - as supplied by publisher]
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Auditory Acclimatization to Bilateral Hearing Aids: Effects on Sentence-in-Noise Processing Times and Speech-Evoked Potentials.
Objectives: Using a longitudinal design, the present study sought to substantiate indications from two previous cross-sectional studies that hearing aid (HA) experience leads to improved speech processing abilities as quantified using eye-gaze measurements. Another aim was to explore potential concomitant changes in event-related potentials (ERPs) to speech stimuli. Design: Groups of elderly novice (novHA) and experienced (expHA) HA users matched in terms of age and working memory capacity participated. The novHA users were acclimatized to bilateral HA fittings for up to 24 weeks. The expHA users continued to use their own HAs during the same period. The participants' speech processing abilities were assessed after 0 weeks (novHA: N = 16; expHA: N = 14), 12 weeks (novHA: N = 16; expHA: N = 14), and 24 weeks (N = 10 each). To that end, an eye-tracking paradigm was used for estimating how quickly the participants could grasp the meaning of sentences presented against background noise together with two similar pictures that either correctly or incorrectly depicted the meaning conveyed by the sentences (the "processing time"). Additionally, ERPs were measured with an active oddball paradigm requiring the participants to categorize word stimuli as living (targets) or nonliving (nontargets) entities. For all measurements, the stimuli were spectrally shaped according to individual real-ear insertion gains and presented via earphones. Results: Concerning the processing times, no changes across time were found for the expHA group. After 0 weeks of HA use, the novHA group had significantly longer (poorer) processing times than the expHA group, consistent with previous findings. After 24 weeks, a significant mean improvement of ~30% was observed for the novHA users, leading to a performance comparable with that of the expHA group. Concerning the ERPs, no changes across time were found. Conclusions: The results from this exploratory study are consistent with the view that auditory acclimatization to HAs positively impacts speech comprehension in noise. Further research is needed to substantiate them. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Auditory Acclimatization to Bilateral Hearing Aids: Effects on Sentence-in-Noise Processing Times and Speech-Evoked Potentials.
Objectives: Using a longitudinal design, the present study sought to substantiate indications from two previous cross-sectional studies that hearing aid (HA) experience leads to improved speech processing abilities as quantified using eye-gaze measurements. Another aim was to explore potential concomitant changes in event-related potentials (ERPs) to speech stimuli. Design: Groups of elderly novice (novHA) and experienced (expHA) HA users matched in terms of age and working memory capacity participated. The novHA users were acclimatized to bilateral HA fittings for up to 24 weeks. The expHA users continued to use their own HAs during the same period. The participants' speech processing abilities were assessed after 0 weeks (novHA: N = 16; expHA: N = 14), 12 weeks (novHA: N = 16; expHA: N = 14), and 24 weeks (N = 10 each). To that end, an eye-tracking paradigm was used for estimating how quickly the participants could grasp the meaning of sentences presented against background noise together with two similar pictures that either correctly or incorrectly depicted the meaning conveyed by the sentences (the "processing time"). Additionally, ERPs were measured with an active oddball paradigm requiring the participants to categorize word stimuli as living (targets) or nonliving (nontargets) entities. For all measurements, the stimuli were spectrally shaped according to individual real-ear insertion gains and presented via earphones. Results: Concerning the processing times, no changes across time were found for the expHA group. After 0 weeks of HA use, the novHA group had significantly longer (poorer) processing times than the expHA group, consistent with previous findings. After 24 weeks, a significant mean improvement of ~30% was observed for the novHA users, leading to a performance comparable with that of the expHA group. Concerning the ERPs, no changes across time were found. Conclusions: The results from this exploratory study are consistent with the view that auditory acclimatization to HAs positively impacts speech comprehension in noise. Further research is needed to substantiate them. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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The Disputed Discovery of Facial and Trigeminal Nerve Function: Revisiting the Contributions of Herbert Mayo and Charles Bell.
Background: The first description of the voluntary motor function of the facial nerve and separate sensory-motor contributions of the trigeminal nerve is most commonly attributed to Charles Bell. However, a review of the original scientific accounts and subsequent historical publications question the validity of this credit. The objective of the present historical analysis is to clarify the contributions of Herbert Mayo toward discovering the functions of the fifth and seventh cranial nerves and to raise awareness of this historical controversy within the medical literature. Methods: Review of Charles Bell's and Herbert Mayo's original dissertations published between 1821 and 1823, and subsequent reports relevant to these primary works. Results: Bell's submissions to the Royal Society of London in 1821 and 1822 describe the seventh nerve as the "respiratory nerve of the face" responsible for involuntary coordination of facial movement with the organs of respiration. Separately, Bell states that the fifth nerve is responsible for sensibility and voluntary movement of the facial muscles. In these accounts, Bell only peripherally alludes to the motor function of the seventh nerve and often comments inaccurately on fifth and seventh cranial nerve innervation. In contrast, in 1822 and 1823, Herbert Mayo first accurately and unequivocally defined the voluntary motor function of the facial nerve and sensory-motor function of the trigeminal nerve on the basis of his detailed experiments. The ultimate transfer of acknowledgment to Bell was rooted in surreptitious reworking of Bell's original dissertations and personal attacks against Mayo rather than arguments of scientific merit. Conclusion: Several notable clinicians and anatomists have contributed to our current understanding of the anatomy and physiology of the facial and trigeminal nerves, including Charles Bell; however, Herbert Mayo should be remembered for first providing a more accurate and clear description of their separate functions. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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The Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome.
Objective: CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This study aims to describe a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess. Patients: Three children with profound hearing loss secondary to CHARGE syndrome. Intervention: Transcanal cochlear implantation with closure of the ear canal via a modified Rambo meatoplasty. Main Outcome Measure(s): Retrospective chart review of temporal bone anomalies associated with CHARGE syndrome, technical nuances of this transcanal approach, and cochlear implant outcomes. Results: The mean patient age was 2.5 years (range 1.5-3.8 yr). Two were male and two were left ears. All patients had a hypoplastic mastoid, semicircular canal aplasia, and had some degree of cochlear dysplasia. A full cochlear implant insertion was achieved in all cases, even in the presence of grossly abnormal middle ear and facial nerve anatomy. There were no intraoperative or postoperative complications. The mean follow-up was 12.4 months (range, 3.9-25.2 mo). All three patients use their device daily. Their guardians report improved vocalization and environmental awareness. Conclusions: The modified Rambo transcanal approach provides a safe corridor for cochlear implantation in patients with CHARGE syndrome. This approach minimizes the anatomical variations associated with the syndrome and may reduce the risk of electrode extrusion. Implant outcomes in this patient population remain highly variable based on the patient's global cognitive capacity. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Patient-Reported Outcomes From the United States Clinical Trial for a Hybrid Cochlear Implant.
Objective: To assess patient-reported outcomes (PROs) in individuals with significant residual low-frequency hearing and severe-to-profound high-frequency sensorineural hearing loss (SNHL) who received the hybrid cochlear implant (CI). Study Design: Prospective, multicenter, nonrandomized, single-arm repeated measures, single-subject design. Setting: Tertiary centers, ambulatory care. Patients: Fifty adults with severe-to-profound high-frequency SNHL and residual low-frequency hearing with aided word recognition scores between 10 and 60% in the ear to be implanted, and in the contralateral ear greater than or equal to implant ear less than or equal to 80%. Intervention: Therapeutic; hybrid CI. Main Outcome Measures: Speech, spatial and qualities of hearing scale (SSQ), device use questionnaire (DUQ), University of Washington Clinical Assessment of Music Perception (UW-CAMP) assessed preoperatively and after 6 and 12 (SSQ and DUQ only) months of hybrid CI use. Results: Significant improvements in mean SSQ ratings were demonstrated at 6 and 12 months postactivation overall and for domains related to speech hearing, spatial hearing, and sound quality. Significant improvement was also found for overall satisfaction on the DUQ and across a number of specific listening situations in addition to aspects related to social engagement. UW-CAMP pitch discrimination and melody and timbre recognition abilities were not compromised postoperatively, allowing hybrid subjects to maintain superior music perception abilities than typically observed with standard CIs. Conclusions: Patients who received the hybrid CI demonstrated significant PRO benefits on the SSQ and the DUQ after 6 and 12 months of CI use. In addition, given the opportunity to maintain useful low-frequency acoustic hearing, patients retained music listening abilities, as assessed by the UW-CAMP. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Auditory Acclimatization to Bilateral Hearing Aids: Effects on Sentence-in-Noise Processing Times and Speech-Evoked Potentials.
Objectives: Using a longitudinal design, the present study sought to substantiate indications from two previous cross-sectional studies that hearing aid (HA) experience leads to improved speech processing abilities as quantified using eye-gaze measurements. Another aim was to explore potential concomitant changes in event-related potentials (ERPs) to speech stimuli. Design: Groups of elderly novice (novHA) and experienced (expHA) HA users matched in terms of age and working memory capacity participated. The novHA users were acclimatized to bilateral HA fittings for up to 24 weeks. The expHA users continued to use their own HAs during the same period. The participants' speech processing abilities were assessed after 0 weeks (novHA: N = 16; expHA: N = 14), 12 weeks (novHA: N = 16; expHA: N = 14), and 24 weeks (N = 10 each). To that end, an eye-tracking paradigm was used for estimating how quickly the participants could grasp the meaning of sentences presented against background noise together with two similar pictures that either correctly or incorrectly depicted the meaning conveyed by the sentences (the "processing time"). Additionally, ERPs were measured with an active oddball paradigm requiring the participants to categorize word stimuli as living (targets) or nonliving (nontargets) entities. For all measurements, the stimuli were spectrally shaped according to individual real-ear insertion gains and presented via earphones. Results: Concerning the processing times, no changes across time were found for the expHA group. After 0 weeks of HA use, the novHA group had significantly longer (poorer) processing times than the expHA group, consistent with previous findings. After 24 weeks, a significant mean improvement of ~30% was observed for the novHA users, leading to a performance comparable with that of the expHA group. Concerning the ERPs, no changes across time were found. Conclusions: The results from this exploratory study are consistent with the view that auditory acclimatization to HAs positively impacts speech comprehension in noise. Further research is needed to substantiate them. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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