Anatomy of the larynx and pharynx: effects of age, gender and height revealed by multidetector computed tomography.

Although oropharyngeal and laryngeal structures are essential for swallowing, the three-dimensional (3D) anatomy is not well understood, due in part to limitations of available measuring techniques. This study uses 3D images acquired by 320-row area detector computed tomography ('320-ADCT'), to measure the pharynx and larynx and to investigate the effects of age, gender and height. Fifty-four healthy volunteers (30 male, 24 female, 23-77 years) underwent one single-phase volume scan (0.35 s) with 320-ADCT during resting tidal breathing. Six measurements of the pharynx and two of larynx were performed. Bivariate statistical methods were used to analyse the effects of gender, age and height on these measurements. Length and volume were significantly larger for men than for women for every measurement (P < 0.05) and increased with height (P < 0.05). Multiple regression analysis was performed to understand the interactions of gender, height and age. Gender, height and age each had significant effects on certain values. The volume of the larynx and hypopharynx was significantly affected by height and age. The length of pharynx was associated with gender and age. Length of the vocal folds and distance from the valleculae to the vocal folds were significantly affected by gender (P < 0.05). These results suggest that age, gender and height have independent and interacting effects on the morphology of the pharynx and larynx. Three-dimensional imaging and morphometrics using 320-ADCT are powerful tools for efficiently and reliably observing and measuring the pharynx and larynx.

Ability of obstacle crossing is not associated with falls in independent ambulatory patients with spinal cord injury.

STUDY DESIGN: A 6-month prospective design. OBJECTIVE: To investigate the relationship between ability of obstacle crossing and falls in independent ambulatory participants with spinal cord injury (SCI). SETTING: A tertiary rehabilitation center. METHODS: Ninety-four participants were evaluated for their SCI characteristics, ability of walking over small obstacles and functional ability relating to dynamic balance control, lower-extremity motor strength (LEMS) and walking ability. Their fall data were then prospectively monitored every month for 6 months. RESULTS: Twenty-four participants failed in obstacle crossing. However, only eight of the thirty-three participants who fell during the follow-up period were unable to clear the obstacle while walking. The LEMS and functional ability of the participants who failed were significantly poorer than those of individuals who passed an obstacle-crossing test (P⩽0.001). For the falls, significant differences between the groups were found only in age and tactile scores. The findings further indicated that failures on obstacle crossing were not significantly associated with falls (P>0.05). CONCLUSION: Ability of obstacle crossing in a closed/controlled environment clearly correlated with intrinsic causes, whereas a fall in an open environment may be associated with not only intrinsic but also extrinsic causes. Therefore, apart from functional ability, rehabilitation professionals may need to consider extrinsic factors around falls in order to manage risk of injury to the patients.

Ambulatory assistive devices and walking performance in patients with incomplete spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To primarily explore types of ambulatory assistive device (AAD) used and secondarily describe walking performance in independent ambulatory patients with spinal cord injury (SCI) who walked without and with various AADs as determined using walking speed and distance walked in 6 min. SETTING: A tertiary rehabilitation center and community hospitals, Thailand. METHODS: The data of 195 independent ambulatory patients with SCI were used to describe the use of an AAD. Among these, only 140 subjects were assessed for their walking speed and distance walked in 6 min. RESULTS: More than half of the subjects (64%) walked with an AAD in which most of them used a standard walker (45%), followed by a single-tip cane (11%) and bilateral crutches (8%), respectively. The walking speed and distance showed significant differences among the groups (P<0.001), except those who used walker versus crutches, and those who used crutches versus cane (P>0.05). Among the significant variables, types of AAD used had the greatest influence on walking speed and distance of the subjects. CONCLUSION: More than half of ambulatory subjects with SCI walked with an AAD in which most of them used a standard walker. However, the non-significant differences of walking performance between the groups may suggest the heterogeneity of walking ability in subjects who used the same type of AAD. Therefore, a method to facilitate the use of an AAD with less supportive ability would increase levels of independence for the patients.

Immediate effects of obstacle crossing training in independent ambulatory patients with spinal cord injury.

STUDY DESIGN: A 2 × 2 cross-over design. OBJECTIVES: To compare immediate effects of obstacle crossing training and conventional overground walking training on functional ability among independent ambulatory patients with spinal cord injury (SCI). SETTING: A tertiary rehabilitation center, Thailand. METHODS: Twenty independent ambulatory participants with SCI received a 1-day overground walking training and a 1-day obstacle crossing training program in a randomized cross-over design with a 2-day washout period. Immediately prior and after each training program, the functional ability of all participants was measured using the timed up and go test (TUGT), five times sit-to-stand test (FTSST) and 10-m walk test (10MWT). RESULTS: The TUGT, FTSST and 10MWT data were significantly better after obstacle crossing training (P<0.001) but not after the overground walking training (P>0.05). The improvement following obstacle crossing training was also significantly different from that of the overground walking training (P<0.05). CONCLUSION: Obstacle crossing training immediately enhanced functional ability related to walking of ambulatory participants with SCI. However, a further longitudinal study using a randomized controlled trial is needed to support benefits of incorporation of obstacle crossing training into rehabilitation practice.