Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): María B. Sánchez, Ian Loram, John Darby, Paul Holmes, Penelope B. Butler
Full trunk control in sitting is demonstrated only when the head-trunk are aligned and upper limbs remain free of contact from mechanical support. These components represent a Controlled Kinetic Chain and can be evaluated in people with neuromotor disability using the Segmental Assessment of Trunk Control (SATCo) when a therapist provides manual trunk support at different segmental levels. However, the SATCo, as with other clinical assessments of control, is subjective. The SATCo was translated to objective rules relating the position of the hands and elbows to the head-trunk and then tested to determine the extent to which this automated objective method replicated the clinical judgement.Clinical evaluation used video to determine whether the upper limb was free of mechanical support while the objective evaluation used 3D motion capture of the trunk and upper limbs with a classification rule. The agreement between clinical and objective classification was calculated for three conditions of a distance-from-support-surface threshold parameter in five healthy adults and five children with cerebral palsy.The unfitted (zero-threshold values) method replicated the clinical judgement in part (68.26%±15.7, adults, 48.3%±33.9 children). The fitted (level-of-support determined) agreement showed that the process could be refined using trial specific parameters (88.32%±5.3 adults, 89.84%±10.2 children). The fixed-values agreement showed high values when using general group parameters (80.80%±3.1 adults, 74.31%±21.5 children).This objective classification of the upper limb component of trunk control largely captures the clinical evaluation. It provides the first stages in development of a clinically-friendly fully automated method.
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Σάββατο 12 Αυγούστου 2017
Predictive simulation of diabetic gait: Individual contribution of ankle stiffness and muscle weakening
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Gilmar F. Santos, Aline A. Gomes, Isabel C.N. Sacco, Marko Ackermann
Diabetic neuropathic individuals present massive muscle strength reduction at the ankle plantar- and dorsiflexors and increased joint stiffness. Our aim is to investigate the adaptation strategies to these musculoskeletal alterations during walking by means of predictive simulations. We used a seven segment planar musculoskeletal model actuated by eight Hill-type muscles in each leg. The effect of all passive tissue in muscles and other joint structures was modeled by net passive joint moment curves. The predictive simulations were generated by solving an optimal control problem that minimized a cost function, including effort and tracking terms, using direct collocation and a commercial optimal control package. We simulate four conditions to represent the weakening of the distal muscles triceps sural (TS) and tibialis anterior (TA), and five conditions to represent the effect of increasing nonlinear ankle stiffness in flexion. The weakening of the distal muscles leads to a delayed action of the TS and a progressive decrease of the gastrocnemius peak force in the push-off phase. This distal deficit is compensated by a larger hip flexion moment resulting from an increase in the iliopsoas muscle force in this phase, known as the hip strategy. The adaptation mechanisms observed in response to an increase in ankle stiffness include the hip strategy and the exploitation of the passive joint structures as springs, which store energy during midstance and release it during push-off, reducing TS force and power in this phase and leading to a consistent decrease in the overall muscle force levels.
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Source:Gait & Posture, Volume 58
Author(s): Gilmar F. Santos, Aline A. Gomes, Isabel C.N. Sacco, Marko Ackermann
Diabetic neuropathic individuals present massive muscle strength reduction at the ankle plantar- and dorsiflexors and increased joint stiffness. Our aim is to investigate the adaptation strategies to these musculoskeletal alterations during walking by means of predictive simulations. We used a seven segment planar musculoskeletal model actuated by eight Hill-type muscles in each leg. The effect of all passive tissue in muscles and other joint structures was modeled by net passive joint moment curves. The predictive simulations were generated by solving an optimal control problem that minimized a cost function, including effort and tracking terms, using direct collocation and a commercial optimal control package. We simulate four conditions to represent the weakening of the distal muscles triceps sural (TS) and tibialis anterior (TA), and five conditions to represent the effect of increasing nonlinear ankle stiffness in flexion. The weakening of the distal muscles leads to a delayed action of the TS and a progressive decrease of the gastrocnemius peak force in the push-off phase. This distal deficit is compensated by a larger hip flexion moment resulting from an increase in the iliopsoas muscle force in this phase, known as the hip strategy. The adaptation mechanisms observed in response to an increase in ankle stiffness include the hip strategy and the exploitation of the passive joint structures as springs, which store energy during midstance and release it during push-off, reducing TS force and power in this phase and leading to a consistent decrease in the overall muscle force levels.
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In vivo kinematics of early-stage osteoarthritic knees during pivot and squat activities
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Keisuke Matsuki, Kei O. Matsuki, Tomonori Kenmoku, Satoshi Yamaguchi, Takahisa Sasho, Scott A. Banks
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43–57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or −2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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via IFTTT
Source:Gait & Posture, Volume 58
Author(s): Keisuke Matsuki, Kei O. Matsuki, Tomonori Kenmoku, Satoshi Yamaguchi, Takahisa Sasho, Scott A. Banks
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43–57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or −2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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Foot strike pattern in children during shod-unshod running
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Pedro Ángel Latorre Román, Fernando Redondo Balboa, Felipe García Pinillos
The purpose of this study was to determine the foot strike patterns (FSPs) and neutral support (no INV/EVE and no foot rotation) in children, as well as to determine the influence of shod/unshod conditions and sex. A total of 713 children, aged 6 to 16 years, participated in this study (Age=10.28±2.71years, body mass index [BMI]=19.70±3.91kg/m2, 302 girls and 411 boys). A sagittal and frontal-plane video (240Hz) was recorded using a high-speed camcorder, to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/eversion (INV/EVE) and foot rotation on initial contact. RFS prevalence was similar between boys and girls in both shod and unshod conditions. In the unshod condition there was a significant reduction (p<0.001) of RFS prevalence both in boys (shod condition=83.95% vs. 62.65% unshod condition) and in girls (shod condition=87.85% vs. 62.70% unshod condition). No significant differences were found in INV/EVE and foot rotation between sex groups. In the unshod condition there was a significant increase (p<0.001) of neutral support (no INV/EVE) both in boys (shod condition=12.55% vs. 22.22% unshod condition) and in girls (shod condition=17.9% vs. 28.15% unshod condition). In addition, in the unshod condition there is a significant reduction (p<0.001) of neutral support (no foot rotation) both in boys (shod condition=21.55% vs. 11.10% unshod condition) and in girls (shod condition=21.05% vs. 11.95% unshod condition). In children, RFS prevalence is lower than adult’s population. Additionally, barefoot running reduced the prevalence of RFS and INV/EVE, however increased foot rotation.
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Source:Gait & Posture, Volume 58
Author(s): Pedro Ángel Latorre Román, Fernando Redondo Balboa, Felipe García Pinillos
The purpose of this study was to determine the foot strike patterns (FSPs) and neutral support (no INV/EVE and no foot rotation) in children, as well as to determine the influence of shod/unshod conditions and sex. A total of 713 children, aged 6 to 16 years, participated in this study (Age=10.28±2.71years, body mass index [BMI]=19.70±3.91kg/m2, 302 girls and 411 boys). A sagittal and frontal-plane video (240Hz) was recorded using a high-speed camcorder, to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/eversion (INV/EVE) and foot rotation on initial contact. RFS prevalence was similar between boys and girls in both shod and unshod conditions. In the unshod condition there was a significant reduction (p<0.001) of RFS prevalence both in boys (shod condition=83.95% vs. 62.65% unshod condition) and in girls (shod condition=87.85% vs. 62.70% unshod condition). No significant differences were found in INV/EVE and foot rotation between sex groups. In the unshod condition there was a significant increase (p<0.001) of neutral support (no INV/EVE) both in boys (shod condition=12.55% vs. 22.22% unshod condition) and in girls (shod condition=17.9% vs. 28.15% unshod condition). In addition, in the unshod condition there is a significant reduction (p<0.001) of neutral support (no foot rotation) both in boys (shod condition=21.55% vs. 11.10% unshod condition) and in girls (shod condition=21.05% vs. 11.95% unshod condition). In children, RFS prevalence is lower than adult’s population. Additionally, barefoot running reduced the prevalence of RFS and INV/EVE, however increased foot rotation.
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The potential of an automated system to identify the upper limb component of a controlled sitting posture
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): María B. Sánchez, Ian Loram, John Darby, Paul Holmes, Penelope B. Butler
Full trunk control in sitting is demonstrated only when the head-trunk are aligned and upper limbs remain free of contact from mechanical support. These components represent a Controlled Kinetic Chain and can be evaluated in people with neuromotor disability using the Segmental Assessment of Trunk Control (SATCo) when a therapist provides manual trunk support at different segmental levels. However, the SATCo, as with other clinical assessments of control, is subjective. The SATCo was translated to objective rules relating the position of the hands and elbows to the head-trunk and then tested to determine the extent to which this automated objective method replicated the clinical judgement.Clinical evaluation used video to determine whether the upper limb was free of mechanical support while the objective evaluation used 3D motion capture of the trunk and upper limbs with a classification rule. The agreement between clinical and objective classification was calculated for three conditions of a distance-from-support-surface threshold parameter in five healthy adults and five children with cerebral palsy.The unfitted (zero-threshold values) method replicated the clinical judgement in part (68.26%±15.7, adults, 48.3%±33.9 children). The fitted (level-of-support determined) agreement showed that the process could be refined using trial specific parameters (88.32%±5.3 adults, 89.84%±10.2 children). The fixed-values agreement showed high values when using general group parameters (80.80%±3.1 adults, 74.31%±21.5 children).This objective classification of the upper limb component of trunk control largely captures the clinical evaluation. It provides the first stages in development of a clinically-friendly fully automated method.
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Source:Gait & Posture, Volume 58
Author(s): María B. Sánchez, Ian Loram, John Darby, Paul Holmes, Penelope B. Butler
Full trunk control in sitting is demonstrated only when the head-trunk are aligned and upper limbs remain free of contact from mechanical support. These components represent a Controlled Kinetic Chain and can be evaluated in people with neuromotor disability using the Segmental Assessment of Trunk Control (SATCo) when a therapist provides manual trunk support at different segmental levels. However, the SATCo, as with other clinical assessments of control, is subjective. The SATCo was translated to objective rules relating the position of the hands and elbows to the head-trunk and then tested to determine the extent to which this automated objective method replicated the clinical judgement.Clinical evaluation used video to determine whether the upper limb was free of mechanical support while the objective evaluation used 3D motion capture of the trunk and upper limbs with a classification rule. The agreement between clinical and objective classification was calculated for three conditions of a distance-from-support-surface threshold parameter in five healthy adults and five children with cerebral palsy.The unfitted (zero-threshold values) method replicated the clinical judgement in part (68.26%±15.7, adults, 48.3%±33.9 children). The fitted (level-of-support determined) agreement showed that the process could be refined using trial specific parameters (88.32%±5.3 adults, 89.84%±10.2 children). The fixed-values agreement showed high values when using general group parameters (80.80%±3.1 adults, 74.31%±21.5 children).This objective classification of the upper limb component of trunk control largely captures the clinical evaluation. It provides the first stages in development of a clinically-friendly fully automated method.
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Predictive simulation of diabetic gait: Individual contribution of ankle stiffness and muscle weakening
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Gilmar F. Santos, Aline A. Gomes, Isabel C.N. Sacco, Marko Ackermann
Diabetic neuropathic individuals present massive muscle strength reduction at the ankle plantar- and dorsiflexors and increased joint stiffness. Our aim is to investigate the adaptation strategies to these musculoskeletal alterations during walking by means of predictive simulations. We used a seven segment planar musculoskeletal model actuated by eight Hill-type muscles in each leg. The effect of all passive tissue in muscles and other joint structures was modeled by net passive joint moment curves. The predictive simulations were generated by solving an optimal control problem that minimized a cost function, including effort and tracking terms, using direct collocation and a commercial optimal control package. We simulate four conditions to represent the weakening of the distal muscles triceps sural (TS) and tibialis anterior (TA), and five conditions to represent the effect of increasing nonlinear ankle stiffness in flexion. The weakening of the distal muscles leads to a delayed action of the TS and a progressive decrease of the gastrocnemius peak force in the push-off phase. This distal deficit is compensated by a larger hip flexion moment resulting from an increase in the iliopsoas muscle force in this phase, known as the hip strategy. The adaptation mechanisms observed in response to an increase in ankle stiffness include the hip strategy and the exploitation of the passive joint structures as springs, which store energy during midstance and release it during push-off, reducing TS force and power in this phase and leading to a consistent decrease in the overall muscle force levels.
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Source:Gait & Posture, Volume 58
Author(s): Gilmar F. Santos, Aline A. Gomes, Isabel C.N. Sacco, Marko Ackermann
Diabetic neuropathic individuals present massive muscle strength reduction at the ankle plantar- and dorsiflexors and increased joint stiffness. Our aim is to investigate the adaptation strategies to these musculoskeletal alterations during walking by means of predictive simulations. We used a seven segment planar musculoskeletal model actuated by eight Hill-type muscles in each leg. The effect of all passive tissue in muscles and other joint structures was modeled by net passive joint moment curves. The predictive simulations were generated by solving an optimal control problem that minimized a cost function, including effort and tracking terms, using direct collocation and a commercial optimal control package. We simulate four conditions to represent the weakening of the distal muscles triceps sural (TS) and tibialis anterior (TA), and five conditions to represent the effect of increasing nonlinear ankle stiffness in flexion. The weakening of the distal muscles leads to a delayed action of the TS and a progressive decrease of the gastrocnemius peak force in the push-off phase. This distal deficit is compensated by a larger hip flexion moment resulting from an increase in the iliopsoas muscle force in this phase, known as the hip strategy. The adaptation mechanisms observed in response to an increase in ankle stiffness include the hip strategy and the exploitation of the passive joint structures as springs, which store energy during midstance and release it during push-off, reducing TS force and power in this phase and leading to a consistent decrease in the overall muscle force levels.
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In vivo kinematics of early-stage osteoarthritic knees during pivot and squat activities
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Keisuke Matsuki, Kei O. Matsuki, Tomonori Kenmoku, Satoshi Yamaguchi, Takahisa Sasho, Scott A. Banks
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43–57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or −2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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Source:Gait & Posture, Volume 58
Author(s): Keisuke Matsuki, Kei O. Matsuki, Tomonori Kenmoku, Satoshi Yamaguchi, Takahisa Sasho, Scott A. Banks
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43–57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or −2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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Foot strike pattern in children during shod-unshod running
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Pedro Ángel Latorre Román, Fernando Redondo Balboa, Felipe García Pinillos
The purpose of this study was to determine the foot strike patterns (FSPs) and neutral support (no INV/EVE and no foot rotation) in children, as well as to determine the influence of shod/unshod conditions and sex. A total of 713 children, aged 6 to 16 years, participated in this study (Age=10.28±2.71years, body mass index [BMI]=19.70±3.91kg/m2, 302 girls and 411 boys). A sagittal and frontal-plane video (240Hz) was recorded using a high-speed camcorder, to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/eversion (INV/EVE) and foot rotation on initial contact. RFS prevalence was similar between boys and girls in both shod and unshod conditions. In the unshod condition there was a significant reduction (p<0.001) of RFS prevalence both in boys (shod condition=83.95% vs. 62.65% unshod condition) and in girls (shod condition=87.85% vs. 62.70% unshod condition). No significant differences were found in INV/EVE and foot rotation between sex groups. In the unshod condition there was a significant increase (p<0.001) of neutral support (no INV/EVE) both in boys (shod condition=12.55% vs. 22.22% unshod condition) and in girls (shod condition=17.9% vs. 28.15% unshod condition). In addition, in the unshod condition there is a significant reduction (p<0.001) of neutral support (no foot rotation) both in boys (shod condition=21.55% vs. 11.10% unshod condition) and in girls (shod condition=21.05% vs. 11.95% unshod condition). In children, RFS prevalence is lower than adult’s population. Additionally, barefoot running reduced the prevalence of RFS and INV/EVE, however increased foot rotation.
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Source:Gait & Posture, Volume 58
Author(s): Pedro Ángel Latorre Román, Fernando Redondo Balboa, Felipe García Pinillos
The purpose of this study was to determine the foot strike patterns (FSPs) and neutral support (no INV/EVE and no foot rotation) in children, as well as to determine the influence of shod/unshod conditions and sex. A total of 713 children, aged 6 to 16 years, participated in this study (Age=10.28±2.71years, body mass index [BMI]=19.70±3.91kg/m2, 302 girls and 411 boys). A sagittal and frontal-plane video (240Hz) was recorded using a high-speed camcorder, to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/eversion (INV/EVE) and foot rotation on initial contact. RFS prevalence was similar between boys and girls in both shod and unshod conditions. In the unshod condition there was a significant reduction (p<0.001) of RFS prevalence both in boys (shod condition=83.95% vs. 62.65% unshod condition) and in girls (shod condition=87.85% vs. 62.70% unshod condition). No significant differences were found in INV/EVE and foot rotation between sex groups. In the unshod condition there was a significant increase (p<0.001) of neutral support (no INV/EVE) both in boys (shod condition=12.55% vs. 22.22% unshod condition) and in girls (shod condition=17.9% vs. 28.15% unshod condition). In addition, in the unshod condition there is a significant reduction (p<0.001) of neutral support (no foot rotation) both in boys (shod condition=21.55% vs. 11.10% unshod condition) and in girls (shod condition=21.05% vs. 11.95% unshod condition). In children, RFS prevalence is lower than adult’s population. Additionally, barefoot running reduced the prevalence of RFS and INV/EVE, however increased foot rotation.
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The potential of an automated system to identify the upper limb component of a controlled sitting posture
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): María B. Sánchez, Ian Loram, John Darby, Paul Holmes, Penelope B. Butler
Full trunk control in sitting is demonstrated only when the head-trunk are aligned and upper limbs remain free of contact from mechanical support. These components represent a Controlled Kinetic Chain and can be evaluated in people with neuromotor disability using the Segmental Assessment of Trunk Control (SATCo) when a therapist provides manual trunk support at different segmental levels. However, the SATCo, as with other clinical assessments of control, is subjective. The SATCo was translated to objective rules relating the position of the hands and elbows to the head-trunk and then tested to determine the extent to which this automated objective method replicated the clinical judgement.Clinical evaluation used video to determine whether the upper limb was free of mechanical support while the objective evaluation used 3D motion capture of the trunk and upper limbs with a classification rule. The agreement between clinical and objective classification was calculated for three conditions of a distance-from-support-surface threshold parameter in five healthy adults and five children with cerebral palsy.The unfitted (zero-threshold values) method replicated the clinical judgement in part (68.26%±15.7, adults, 48.3%±33.9 children). The fitted (level-of-support determined) agreement showed that the process could be refined using trial specific parameters (88.32%±5.3 adults, 89.84%±10.2 children). The fixed-values agreement showed high values when using general group parameters (80.80%±3.1 adults, 74.31%±21.5 children).This objective classification of the upper limb component of trunk control largely captures the clinical evaluation. It provides the first stages in development of a clinically-friendly fully automated method.
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Source:Gait & Posture, Volume 58
Author(s): María B. Sánchez, Ian Loram, John Darby, Paul Holmes, Penelope B. Butler
Full trunk control in sitting is demonstrated only when the head-trunk are aligned and upper limbs remain free of contact from mechanical support. These components represent a Controlled Kinetic Chain and can be evaluated in people with neuromotor disability using the Segmental Assessment of Trunk Control (SATCo) when a therapist provides manual trunk support at different segmental levels. However, the SATCo, as with other clinical assessments of control, is subjective. The SATCo was translated to objective rules relating the position of the hands and elbows to the head-trunk and then tested to determine the extent to which this automated objective method replicated the clinical judgement.Clinical evaluation used video to determine whether the upper limb was free of mechanical support while the objective evaluation used 3D motion capture of the trunk and upper limbs with a classification rule. The agreement between clinical and objective classification was calculated for three conditions of a distance-from-support-surface threshold parameter in five healthy adults and five children with cerebral palsy.The unfitted (zero-threshold values) method replicated the clinical judgement in part (68.26%±15.7, adults, 48.3%±33.9 children). The fitted (level-of-support determined) agreement showed that the process could be refined using trial specific parameters (88.32%±5.3 adults, 89.84%±10.2 children). The fixed-values agreement showed high values when using general group parameters (80.80%±3.1 adults, 74.31%±21.5 children).This objective classification of the upper limb component of trunk control largely captures the clinical evaluation. It provides the first stages in development of a clinically-friendly fully automated method.
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via IFTTT
Predictive simulation of diabetic gait: Individual contribution of ankle stiffness and muscle weakening
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Gilmar F. Santos, Aline A. Gomes, Isabel C.N. Sacco, Marko Ackermann
Diabetic neuropathic individuals present massive muscle strength reduction at the ankle plantar- and dorsiflexors and increased joint stiffness. Our aim is to investigate the adaptation strategies to these musculoskeletal alterations during walking by means of predictive simulations. We used a seven segment planar musculoskeletal model actuated by eight Hill-type muscles in each leg. The effect of all passive tissue in muscles and other joint structures was modeled by net passive joint moment curves. The predictive simulations were generated by solving an optimal control problem that minimized a cost function, including effort and tracking terms, using direct collocation and a commercial optimal control package. We simulate four conditions to represent the weakening of the distal muscles triceps sural (TS) and tibialis anterior (TA), and five conditions to represent the effect of increasing nonlinear ankle stiffness in flexion. The weakening of the distal muscles leads to a delayed action of the TS and a progressive decrease of the gastrocnemius peak force in the push-off phase. This distal deficit is compensated by a larger hip flexion moment resulting from an increase in the iliopsoas muscle force in this phase, known as the hip strategy. The adaptation mechanisms observed in response to an increase in ankle stiffness include the hip strategy and the exploitation of the passive joint structures as springs, which store energy during midstance and release it during push-off, reducing TS force and power in this phase and leading to a consistent decrease in the overall muscle force levels.
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Source:Gait & Posture, Volume 58
Author(s): Gilmar F. Santos, Aline A. Gomes, Isabel C.N. Sacco, Marko Ackermann
Diabetic neuropathic individuals present massive muscle strength reduction at the ankle plantar- and dorsiflexors and increased joint stiffness. Our aim is to investigate the adaptation strategies to these musculoskeletal alterations during walking by means of predictive simulations. We used a seven segment planar musculoskeletal model actuated by eight Hill-type muscles in each leg. The effect of all passive tissue in muscles and other joint structures was modeled by net passive joint moment curves. The predictive simulations were generated by solving an optimal control problem that minimized a cost function, including effort and tracking terms, using direct collocation and a commercial optimal control package. We simulate four conditions to represent the weakening of the distal muscles triceps sural (TS) and tibialis anterior (TA), and five conditions to represent the effect of increasing nonlinear ankle stiffness in flexion. The weakening of the distal muscles leads to a delayed action of the TS and a progressive decrease of the gastrocnemius peak force in the push-off phase. This distal deficit is compensated by a larger hip flexion moment resulting from an increase in the iliopsoas muscle force in this phase, known as the hip strategy. The adaptation mechanisms observed in response to an increase in ankle stiffness include the hip strategy and the exploitation of the passive joint structures as springs, which store energy during midstance and release it during push-off, reducing TS force and power in this phase and leading to a consistent decrease in the overall muscle force levels.
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In vivo kinematics of early-stage osteoarthritic knees during pivot and squat activities
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Keisuke Matsuki, Kei O. Matsuki, Tomonori Kenmoku, Satoshi Yamaguchi, Takahisa Sasho, Scott A. Banks
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43–57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or −2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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Source:Gait & Posture, Volume 58
Author(s): Keisuke Matsuki, Kei O. Matsuki, Tomonori Kenmoku, Satoshi Yamaguchi, Takahisa Sasho, Scott A. Banks
Kinematic changes have been shown to accompany severe knee osteoarthritis, but no studies have analyzed early-stage osteoarthritic knee kinematics in the transverse plane during functional activities. The purpose of this study was to analyze kinematics of early-stage osteoarthritic knees using model registration techniques. Fifteen early-stage osteoarthritic knees from eight females with a mean age of 52 years old (range, 43–57years old) were involved in this study. A radiologist confirmed with plain radiographs that knees had Kellgren-Lawrence grade-1 or −2 arthritic changes. Fluoroscopic images of squat and pivot activities were recorded for each subject. Three-dimensional surface models of the distal femur and proximal tibia were created from CT images, and anatomic coordinate systems were embedded in each model. The three-dimensional position and orientation of the femur and the tibia were determined using model-image registration techniques, and tibial anteroposterior translation and internal/external rotation relative to the femur were calculated. The contact points of the medial and lateral femoral condyle were also computed. Compared to healthy knees, osteoarthritic knees showed lateral contact points that were significantly shifted anteriorly in both pivot (P<0.001) and squat (P=0.001) activities and greater tibial external rotation in pivot activity (P=0.007). The medial contact point location was similar to healthy knees, but the amount of anteroposterior translation was smaller (P<0.001). These kinematic changes might change stress distributions in the medial compartment during weight-bearing activities. The changes in kinematics possibly have some influence on initiation or progression of knee osteoarthritis.
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Foot strike pattern in children during shod-unshod running
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Pedro Ángel Latorre Román, Fernando Redondo Balboa, Felipe García Pinillos
The purpose of this study was to determine the foot strike patterns (FSPs) and neutral support (no INV/EVE and no foot rotation) in children, as well as to determine the influence of shod/unshod conditions and sex. A total of 713 children, aged 6 to 16 years, participated in this study (Age=10.28±2.71years, body mass index [BMI]=19.70±3.91kg/m2, 302 girls and 411 boys). A sagittal and frontal-plane video (240Hz) was recorded using a high-speed camcorder, to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/eversion (INV/EVE) and foot rotation on initial contact. RFS prevalence was similar between boys and girls in both shod and unshod conditions. In the unshod condition there was a significant reduction (p<0.001) of RFS prevalence both in boys (shod condition=83.95% vs. 62.65% unshod condition) and in girls (shod condition=87.85% vs. 62.70% unshod condition). No significant differences were found in INV/EVE and foot rotation between sex groups. In the unshod condition there was a significant increase (p<0.001) of neutral support (no INV/EVE) both in boys (shod condition=12.55% vs. 22.22% unshod condition) and in girls (shod condition=17.9% vs. 28.15% unshod condition). In addition, in the unshod condition there is a significant reduction (p<0.001) of neutral support (no foot rotation) both in boys (shod condition=21.55% vs. 11.10% unshod condition) and in girls (shod condition=21.05% vs. 11.95% unshod condition). In children, RFS prevalence is lower than adult’s population. Additionally, barefoot running reduced the prevalence of RFS and INV/EVE, however increased foot rotation.
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Source:Gait & Posture, Volume 58
Author(s): Pedro Ángel Latorre Román, Fernando Redondo Balboa, Felipe García Pinillos
The purpose of this study was to determine the foot strike patterns (FSPs) and neutral support (no INV/EVE and no foot rotation) in children, as well as to determine the influence of shod/unshod conditions and sex. A total of 713 children, aged 6 to 16 years, participated in this study (Age=10.28±2.71years, body mass index [BMI]=19.70±3.91kg/m2, 302 girls and 411 boys). A sagittal and frontal-plane video (240Hz) was recorded using a high-speed camcorder, to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/eversion (INV/EVE) and foot rotation on initial contact. RFS prevalence was similar between boys and girls in both shod and unshod conditions. In the unshod condition there was a significant reduction (p<0.001) of RFS prevalence both in boys (shod condition=83.95% vs. 62.65% unshod condition) and in girls (shod condition=87.85% vs. 62.70% unshod condition). No significant differences were found in INV/EVE and foot rotation between sex groups. In the unshod condition there was a significant increase (p<0.001) of neutral support (no INV/EVE) both in boys (shod condition=12.55% vs. 22.22% unshod condition) and in girls (shod condition=17.9% vs. 28.15% unshod condition). In addition, in the unshod condition there is a significant reduction (p<0.001) of neutral support (no foot rotation) both in boys (shod condition=21.55% vs. 11.10% unshod condition) and in girls (shod condition=21.05% vs. 11.95% unshod condition). In children, RFS prevalence is lower than adult’s population. Additionally, barefoot running reduced the prevalence of RFS and INV/EVE, however increased foot rotation.
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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
| Related Articles |
Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
Int J Audiol. 2004;43(2):61-65
Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD
Abstract
The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.
PMID: 28793845 [PubMed]
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Modelling the risk of noise-induced hearing loss among military pilots.
| Related Articles |
Modelling the risk of noise-induced hearing loss among military pilots.
Int J Audiol. 2004;43(2):79-84
Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ
Abstract
Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.
PMID: 28793844 [PubMed]
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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
| Related Articles |
Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
Int J Audiol. 2004;43(2):61-65
Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD
Abstract
The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.
PMID: 28793845 [PubMed]
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Modelling the risk of noise-induced hearing loss among military pilots.
| Related Articles |
Modelling the risk of noise-induced hearing loss among military pilots.
Int J Audiol. 2004;43(2):79-84
Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ
Abstract
Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.
PMID: 28793844 [PubMed]
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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
| Related Articles |
Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
Int J Audiol. 2004;43(2):61-65
Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD
Abstract
The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.
PMID: 28793845 [PubMed]
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Modelling the risk of noise-induced hearing loss among military pilots.
| Related Articles |
Modelling the risk of noise-induced hearing loss among military pilots.
Int J Audiol. 2004;43(2):79-84
Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ
Abstract
Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.
PMID: 28793844 [PubMed]
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Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
| Related Articles |
Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.
Int J Audiol. 2004;43(2):61-65
Authors: Hamzavi J, Marcel Pok S, Gstoettner W, Baumgartner WD
Abstract
The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.
PMID: 28793845 [PubMed]
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Modelling the risk of noise-induced hearing loss among military pilots.
| Related Articles |
Modelling the risk of noise-induced hearing loss among military pilots.
Int J Audiol. 2004;43(2):79-84
Authors: Kuronen P, Toppila E, Starck J, Pa A Kko Nen R, Sorri MJ
Abstract
Noise is a significant risk factor in aviation, especially in military aviation. Even though our earlier studies have shown that the risk of noise-induced hearing loss (NIHL) among military pilots is small and the monitoring of their hearing is effective, we still need to develop methods of assessing the risk of NIHL more effectively at both the general and individual levels. In addition, many other risk factors are considered to contribute to the development of hearing impairment. The novel NoiseScan data management system enables assessment of the risk of developing hearing impairment on the basis of known risk factors. This study investigates the risk of hearing impairment among Finnish Air Force pilots using reasonably accurate noise exposure data and other risk factors for hearing impairment. This risk is also compared with that of industrial workers, whose risk followed the ISO 1999 prediction. Hearing among Finnish military pilots turned out to be better than predicted by the ISO 1999 model. The industrial workers had a larger number of risk factors than the pilots. Owing to the small number of risk factors, the hearing of pilots corresponds to approximately the 80th percentile, being 9-13 dB better than the 50th percentile obtained with the industrial population.
PMID: 28793844 [PubMed]
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The Prevention of Recurrent Cholesteatoma in CWU Surgery: The Use of Titanium Sheeting.
Objective: Assessment of the outcomes of a technique of prevention of recurrent cholesteatoma in canal wall up (CWU) mastoidectomy, using titanium sheeting to repair the external auditory canal wall. Patients: Sixty four cholesteatoma cases were managed during a period from 2007 to 2015. The cases were unselected; the surgery was performed by the senior author. Cholesteatoma Patterns Were: Forty two attic, nine pars tensa, seven combined attic-pars tensa, three congenital, and three other. Primary surgery was undertaken in 33 cases. Interventions: All cases underwent CWU surgery that employed canal wall repair using fine titanium sheeting combined with overlying organic material to repair canal wall defects. Drum repairs employed cymba conchae cartilage-perichondrium composite grafts. Chain reconstruction used Spanner struts or Grace Alto PORPs or TORPS. Results: Two cases suffered mesotympanic residual disease, and three, mesotympanic recurrence one of which extended into the attic. Two other cases incurred atticomastoid residues. Transient myringitis occurred in three cases. Conclusion: The surgery was judged on its ability to avoid atticomastoid recurrence, and was regarded as highly successful. The titanium sheeting offers a relatively simple but effective technique. The mesotympanic complications are those also commonly found in both CWD and other CWU methods. As in other CWU procedures, the problems of the open cavity were avoided. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Evaluation of Maximal Speech Intelligibility With Vibrant Soundbridge in Patients With Sensorineural Hearing Loss.
Objective: The study investigated improvements in maximal speech intelligibility after Vibrant Soundbridge (VSB) implantation and analyzed the effect of the hearing loss pattern on maximal speech intelligibility represented by a phonetically balanced word score (PBmax). The effect of middle ear implants on PBmax has not been evaluated yet. Study Design: Study. Setting: Tertiary academic medical center. Patients/Interventions: Sixty patients who underwent VSB from December 2011 to January 2016 were retrospectively reviewed. All the patients had hearing aids preoperatively. Main Outcome Measures: Pure-tone and speech audiometry were checked with and without hearing aids and then with the VSB. The patients were divided into two groups: flat and down-sloping type of hearing loss. PBmax score was evaluated at the most comfortable listening level before and after VSB implantation and compared with scores with/without HA. Results: PBmax for both conventional HA and VSB were significantly higher compared with the unaided condition. The improvement in speech recognition was significantly better using VSB than using HA (p = 0.003). However, there was no significant difference in the improvement provided by VSB and HA in patients with a flat hearing loss. Patients with a down-sloping audiogram showed significantly better improvement with VSB than with HA (p = 0.003). Moreover, patients with greater preoperative high-frequency hearing loss had greater improvement in PBmax after VSB implantation. Conclusion: Speech intelligibility can be significantly improved by VSB implantation, especially in patients with a down-sloping hearing loss. This finding can help select patients who will benefit most from VSB implantation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Single-center Experience of Over a Hundred Implantations of a Transcutaneous Bone Conduction Device.
Objective: To assess outcomes with a novel passive transcutaneous bone conduction device (t-BCD). Study Design: Prospective data collection and patient review. Setting: Tertiary referral center. Patients: Patients who underwent implantation with the t-BCD between November 2013 and September 2016. Intervention: Implantation of BAHA Attract. Main Outcome Measures: Surgical outcome, patient reported outcomes including the "Glasgow Benefit Inventory" and the "Client Oriented Scale of Improvement" for adults and the "Speech, Spatial and Qualities of Hearing scale" (SSQ-12) for children. Results: One hundred five patients were implanted. Numbness superior to the incision was commonly noticed. Four patients (3.8%) developed skin tenderness and redness that settled with conservative measures. Among those patients who had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD) to the t-BCD (n=15), 1 (0.9%) developed seroma and 2 (1.9%) developed skin dehiscence at the edge of the implant magnet. Significant improvement in Client Oriented Scale of Improvement and Glasgow Benefit Inventory scores with a global satisfaction of 84% and 77.4% was observed for those previously aided and unaided respectively, with use of the device. A 22% improvement in SSQ-12 mean score was observed in the pediatric population. Conclusion: This is the largest single-center series reported on this t-BCD. The complication rate is small but caution is required in patients of conversion from a percutaneous BCHD. The patients' satisfaction is high and the need for aftercare is minimal. Cost-effectiveness evaluation of these devices, development of core outcome sets and well-designed, prospective trials to compare the different BCHDs should be the focus of future research. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Discrimination of Voice Pitch and Vocal-Tract Length in Cochlear Implant Users.
Objectives: When listening to two competing speakers, normal-hearing (NH) listeners can take advantage of voice differences between the speakers. Users of cochlear implants (CIs) have difficulty in perceiving speech on speech. Previous literature has indicated sensitivity to voice pitch (related to fundamental frequency, F0) to be poor among implant users, while sensitivity to vocal-tract length (VTL; related to the height of the speaker and formant frequencies), the other principal voice characteristic, has not been directly investigated in CIs. A few recent studies evaluated F0 and VTL perception indirectly, through voice gender categorization, which relies on perception of both voice cues. These studies revealed that, contrary to prior literature, CI users seem to rely exclusively on F0 while not utilizing VTL to perform this task. The objective of the present study was to directly and systematically assess raw sensitivity to F0 and VTL differences in CI users to define the extent of the deficit in voice perception. Design: The just-noticeable differences (JNDs) for F0 and VTL were measured in 11 CI listeners using triplets of consonant-vowel syllables in an adaptive three-alternative forced choice method. Results: The results showed that while NH listeners had average JNDs of 1.95 and 1.73 semitones (st) for F0 and VTL, respectively, CI listeners showed JNDs of 9.19 and 7.19 st. These JNDs correspond to differences of 70% in F0 and 52% in VTL. For comparison to the natural range of voices in the population, the F0 JND in CIs remains smaller than the typical male-female F0 difference. However, the average VTL JND in CIs is about twice as large as the typical male-female VTL difference. Conclusions: These findings, thus, directly confirm that CI listeners do not seem to have sufficient access to VTL cues, likely as a result of limited spectral resolution, and, hence, that CI listeners' voice perception deficit goes beyond poor perception of F0. These results provide a potential common explanation not only for a number of deficits observed in CI listeners, such as voice identification and gender categorization, but also for competing speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Discrimination of Voice Pitch and Vocal-Tract Length in Cochlear Implant Users.
Objectives: When listening to two competing speakers, normal-hearing (NH) listeners can take advantage of voice differences between the speakers. Users of cochlear implants (CIs) have difficulty in perceiving speech on speech. Previous literature has indicated sensitivity to voice pitch (related to fundamental frequency, F0) to be poor among implant users, while sensitivity to vocal-tract length (VTL; related to the height of the speaker and formant frequencies), the other principal voice characteristic, has not been directly investigated in CIs. A few recent studies evaluated F0 and VTL perception indirectly, through voice gender categorization, which relies on perception of both voice cues. These studies revealed that, contrary to prior literature, CI users seem to rely exclusively on F0 while not utilizing VTL to perform this task. The objective of the present study was to directly and systematically assess raw sensitivity to F0 and VTL differences in CI users to define the extent of the deficit in voice perception. Design: The just-noticeable differences (JNDs) for F0 and VTL were measured in 11 CI listeners using triplets of consonant-vowel syllables in an adaptive three-alternative forced choice method. Results: The results showed that while NH listeners had average JNDs of 1.95 and 1.73 semitones (st) for F0 and VTL, respectively, CI listeners showed JNDs of 9.19 and 7.19 st. These JNDs correspond to differences of 70% in F0 and 52% in VTL. For comparison to the natural range of voices in the population, the F0 JND in CIs remains smaller than the typical male-female F0 difference. However, the average VTL JND in CIs is about twice as large as the typical male-female VTL difference. Conclusions: These findings, thus, directly confirm that CI listeners do not seem to have sufficient access to VTL cues, likely as a result of limited spectral resolution, and, hence, that CI listeners' voice perception deficit goes beyond poor perception of F0. These results provide a potential common explanation not only for a number of deficits observed in CI listeners, such as voice identification and gender categorization, but also for competing speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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from #Audiology via ola Kala on Inoreader http://ift.tt/2wRkboT
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Discrimination of Voice Pitch and Vocal-Tract Length in Cochlear Implant Users.
Objectives: When listening to two competing speakers, normal-hearing (NH) listeners can take advantage of voice differences between the speakers. Users of cochlear implants (CIs) have difficulty in perceiving speech on speech. Previous literature has indicated sensitivity to voice pitch (related to fundamental frequency, F0) to be poor among implant users, while sensitivity to vocal-tract length (VTL; related to the height of the speaker and formant frequencies), the other principal voice characteristic, has not been directly investigated in CIs. A few recent studies evaluated F0 and VTL perception indirectly, through voice gender categorization, which relies on perception of both voice cues. These studies revealed that, contrary to prior literature, CI users seem to rely exclusively on F0 while not utilizing VTL to perform this task. The objective of the present study was to directly and systematically assess raw sensitivity to F0 and VTL differences in CI users to define the extent of the deficit in voice perception. Design: The just-noticeable differences (JNDs) for F0 and VTL were measured in 11 CI listeners using triplets of consonant-vowel syllables in an adaptive three-alternative forced choice method. Results: The results showed that while NH listeners had average JNDs of 1.95 and 1.73 semitones (st) for F0 and VTL, respectively, CI listeners showed JNDs of 9.19 and 7.19 st. These JNDs correspond to differences of 70% in F0 and 52% in VTL. For comparison to the natural range of voices in the population, the F0 JND in CIs remains smaller than the typical male-female F0 difference. However, the average VTL JND in CIs is about twice as large as the typical male-female VTL difference. Conclusions: These findings, thus, directly confirm that CI listeners do not seem to have sufficient access to VTL cues, likely as a result of limited spectral resolution, and, hence, that CI listeners' voice perception deficit goes beyond poor perception of F0. These results provide a potential common explanation not only for a number of deficits observed in CI listeners, such as voice identification and gender categorization, but also for competing speech perception. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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