Strength and endurance of knee extensors in subjects after paralytic poliomyelitis.

PURPOSE: To compare the strength and endurance of knee extensors in subjects after paralytic poliomyelitis as well as to extend the comparison to healthy subjects. METHOD: Twenty subjects after poliomyelitis with new symptoms (SYM group), 10 without new symptoms (ASYM group) and 15 healthy controls were included. To determine strength, isometric maximal voluntary contraction (MVC) torque of knee extensors in both legs was determined by Biodex dynamometer at 60 degrees knee angle. To determine endurance, the subjects were asked to maintain force in the knee extensors in the same position, in the range between 40-45% of MVC torque, as long as possible. The 'tensiomyography' method was applied to measure the radial displacement of m. rectus femoris during submaximal continuous electrical stimulation until recording a flat response. RESULTS: No significant difference in MVC torque and endurance was found between SYM and ASYM group, as well between the duration of m. rectus femoris response of both groups to submaximal electrical stimulation. MVC torque and endurance of knee extensors with 'normal' strength was significantly lower in post-polio subjects compared to healthy controls. CONCLUSION: Endurance of knee extensor muscles in post-polio subjects is generally and significantly lower than that of knee extensors in healthy subjects, regardless of the implication of normal strength and subjective observations of post-polio subjects.

Knee muscle activity during ambulation of trans-tibial amputees.

Gait analysis of trans-tibial amputees brings to light asymmetries of different gait parameters between the amputated and sound legs. The present study investigated the activity of the vastus medialis and biceps femoris muscles during ambulation of trans-tibial amputees. Peak activities of the vastus medialis were reached similarly in both legs (6.06+/-4.9% and 8.84+/-3.6% of gait cycle, in the sound and amputated leg, respectively). Biceps femoris peak activities were reached at 92.43+/-6.6% of gait cycle in the sound leg, and significantly later (at 9.81+/-4.8% of gait cycle) in the amputated leg (p < 0.05). Integrated EMG activity ratios, between swing and stance periods, were similar for the vastus medialis (0.33 in the sound and 0.35 in the amputated leg). However, these ratios differed significantly for the biceps femoris since the amputated leg presented a substantial (p < 0.05) smaller ratio (0.22) compared with the sound leg (0.83). The use of prosthesis in trans-tibial amputees requires further activity of the biceps femoris during stance period to improve support of the amputated leg knee joint.

Functional testing of elderly subjects after lower limb amputation.

The aim of the present study was to find out if it is possible to use the same functional tests for elderly subjects after lower limb amputation who live independently at their homes as for healthy ones. Will these tests discriminate among different problems in subjects with different levels and different causes of amputation and will they discriminate between active and sedentary subjects? The study examined 83 volunteers who lived independently at their homes (55 healthy sedentary, 17 after trans-tibial amputation, 11 after trans-femoral amputation). All subjects were aged 60 or older. All subjects after lower limb amputation were found to have significantly worse results in almost all tests in comparison with the healthy sedentary men. The subjects after transfemoral amputation needed significantly more time at the "up and go" test, walked a shorter distance in 9 minutes. and performed fewer stand-ups from a chair and fewer steps in two minutes than the subjects after trans-tibial amputation. The active subjects after lower limb amputation had better balance, were quicker at the "up and go" test and walked longer in a minute than the sedentary subjects after lower limb amputation. It can be concluded that this test battery can also be used to test subjects after lower limb amputation because it discriminates among different severity of problems in subjects with different level and cause of amputation as well as between active and sedentary ones.

The use of outcome measures in physical medicine and rehabilitation within Europe.

The aim of the study was to survey the use of outcome measures in rehabilitation within Europe. It was envisaged that this would provide the basis for further studies on the cross-cultural validity of outcome measures. A postal questionnaire was distributed in November 1998 to 866 units providing rehabilitation. In total, 418 questionnaires were returned, corresponding to a response rate of 48%. These 418 centres treated an estimated 113,000 patients annually, undertaking 360,000 assessments. The survey focused on nine diagnostic groups: hip and knee replacement, low back pain, lower limb amputees, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke and traumatic brain injury. It identified a relatively small number of dominant outcome assessments for each diagnostic group and some variation in the preference for measures across regions. A large number of measures, however, are being used in one or a small number of locations and with relatively few patients. For rehabilitation of orthopaedic patients the majority of assessments undertaken are at the impairment level. For patients with neurological disorders the emphasis is mostly upon measures of disability.

Physical activity for elderly persons with neurological impairment: a review.

The paper reviews studies conducted on physical activities and exercise in elderly persons with neurological impairment due to stroke, Guillain-Barre syndrome, Parkinson's disease, multiple sclerosis or post-polio syndrome. The paper concludes: (i) it is not possible at present to draw conclusions regarding persons with Guillain-Barre syndrome and Parkinson's disease; (ii) individuals with multiple sclerosis and post-polio syndrome benefit from physical activity, but all studies have so far been conducted on those under 65 years of age, and its effect on elderly persons with these diseases is not known; (iii) exercise and customary activities (walking and swimming) should be encouraged and promoted in elderly persons after stroke.

The influence of post-polio syndrome on independence and life satisfaction.

PURPOSE: The aim of the study was to find out the influence of the new symptoms on life satisfaction and independent living and the most frequent disabilities in patients with post-polio syndrome that are affecting the satisfaction and independence. METHOD: A questionnaire was sent to all the post-polio survivors (207) who visited the Rehabilitation Institute in Ljubljana at least once in the last ten years. We got 100 answers, which were analysed by SPSS (statistical package for social sciences). RESULTS: Sixty nine reported that they had new symptoms that may be classified as post-polio syndrome. CONCLUSIONS: We have found that the new symptoms in post-polio survivors, which may be classified as post-polio syndrome, increased their walking and climbing stairs disability, increased their disability to perform daily activities and also decreased their satisfaction with life.

Mobility of persons after traumatic lower limb amputation.

The objective of this study was to determine the influence of time span since amputation on mobility of persons experiencing traumatic lower limb amputation. A special questionnaire was sent to such persons and responses were analysed statistically. The subjects comprised 223 persons after traumatic lower limb amputation, residents of Slovenia. We discovered that 186 (74.2%) are using their prosthesis for more than 7 hours per day, 109 (52.2%) are able to walk outdoors without crutches, and 129 (57.8%) climb more than 20 stairs per day. In addition, those who are walking without crutches, walking longer distances, still cycling and driving a care are, on average, 5-10 years younger than the others. However, around one-third of persons who were young at the time of amputation face limitations of mobility later in life. A total of 76 (35.3%) are able to walk only up to 500 m out of doors, 38 (18.2%) can walk only with a pair of crutches, 62 (29.7%) need a cane or one crutch, and 37 (16.6%) cannot climb stairs. We conclude that successful fitting and usage of a prosthesis by persons after lower limb amputation promotes independent walking and mobility in everyday life. The level of independence achieved is related to time span since amputation.

Double-limb support and step-length asymmetry in below-knee amputees.

The sequence of gait events and symmetry of kinematic parameters between both lower limbs are compromised in below-knee amputees. In the present study the periods of double-limb support and the step length in below-knee amputees were investigated. The symmetry of the two periods of double-limb support occurring in each stride was obviously abnormal (ratio: 0.74) among temporal and distance parameters. The time of double-limb support (0.211 +/- 0.05 seconds) measured from heel-strike of the amputated leg until toe-off of the normal leg was significantly longer (p = 0.011) when compared with the contralateral leg (0.173 +/- 0.04 seconds). The step length of the normal leg (0.709 +/- 0.07 m) was significantly (p = 0.045) shorter than that of the amputated leg (0.752 +/- 0.08 m). Most of these differences between measured kinematic parameters can be explained by the limited ability of the prosthesis ankle-foot component to reproduce the normal functions of both foot and ankle.

The life style of young persons after lower limb amputation caused by injury.

In order to determine whether lower limb amputation changes the social life and free time activities of persons who were at the time of amputation young, a questionnaire was sent to 519 persons after trans-tibial or higher level of lower limb amputation who were at the time of amputation younger than 51 years, amputated because of injury, permanently resident in Slovenia and had visited the outpatient prosthetics clinic of the Rehabilitation Institute of Slovenia at least once in the last five years (1989-94). There 228 responses, which were statistically analysed. It was found that after amputation most persons participated less frequently in social activities, especially persons who were older at the time of amputation and also those who are older today. Changes in participation in social activities were not influenced by level of education. Free time activities changed after amputation. Some 93 persons completely changed their free time activities and only 30 were still interested in the same activities as before. The three most frequent free time activities before amputation were cycling, team ball games and farm work. After amputation they were reading, watching television and/or listening to radio and music and housekeeping. It is concluded that lower limb amputation severely changes the social life and free time activities of persons who were young at the time of amputation.

Influence of speed on gait parameters and on symmetry in trans-tibial amputees.

Normal gait is characterised by a high level of inter-leg symmetry of gait parameters. Therefore, efforts in rehabilitation of amputees are directed at the construction of a prosthesis which provides normal leg function and allows a more symmetrical gait. Analysis of the gait of trans-tibial amputees was performed when they were ambulating at their own freely selected speed and at a faster speed. The effect of speed on selected gait parameters in each leg was evaluated and the influence on symmetry established by comparing the inter-leg changes for each of the selected parameters. The faster gait trail affected significantly all temporal and distance parameters in both legs but not the level of symmetry between legs. At the faster speed, the hip angles at heel-strike and during swing and the knee angle during load response, in the normal leg, and the knee angle during swing in the amputated leg, all increased significantly. Speed of gait significantly affected symmetry between knee angles as reflected by the increased differences measured during load response (from 2.62 +/- 5.2 to 7.06 +/- 4.2 degrees) and during toe-off (from 1.80 +/- 7.4 to 9.50 +/- 9.1 degrees). Timing and sequence of selected gait events, as related to stride time, were not significantly affected by speed of gait. These results might contribute to a better understanding of gait characteristics in trans-tibial amputees and provide design guidance for prosthetic components.

Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees.

Stump length and the thigh muscles strength of the amputated limb are among the major factors influencing outcome of prosthetic rehabilitation of trans-tibial amputees. In the present study the authors evaluated and compared the strength of quadriceps and hamstrings muscles of both limbs in trans-tibial amputees, as measured by means of an electrical dynamometer. The obtained results showed that the thigh muscles of the sound limbs are significantly stronger than those of the amputated limbs (p < 0.01). The results obtained for amputees with shorter stumps were compared with those with longer stumps. In the group of amputees (n = 9) with a stump shorter than 15.1 cm, values of peak torque (in isokinetic contraction) and maximal average torque (in isometric contraction) were significantly (p < 0.5) weaker when compared to those (n = 9) with a stump longer than 15.1 cm. The results obtained for amputees with a higher rate of thigh muscle atrophy were compared to those with lesser atrophy. In the group of amputees where muscle atrophy was accompanied by decrease in thigh girth of over 5.9 cm, muscles strength did not significantly decrease (p < 0.5) as compared to amputees where thigh girth decrease was less than 5.9 cm. It is concluded that atrophy of the thigh muscles of trans-tibial amputees is accompanied with a significant decrease in strength. In amputees with a short stump, the short lever action provided by the stump interferes with the ability of the thigh muscles to control the prosthesis efficiently during daily activities such as standing and walking.

Properties of musculus gluteus maximus in above-knee amputees.

The present study aimed at evaluating possible changes of the gluteus maximus muscle bulk size and in the contracting properties of gluteus maximus in the amputated above-knee limb. Seven male above-knee amputees, with a mean age of 47.4 years volunteered to participate in the present study. Twenty-one healthy subjects with a mean age of 34.0 years served as the control group. Muscle belly displacement was measured by means of a precision electromagnetic sensor dc-dc displacement transducer while performing maximal voluntary isometric contractions. The muscle twitch contraction has been quantified by the latency period (T1), time to peak tension (T2) and the slope of the record. A statistically significant decrease in muscle belly displacement on the amputated side has been observed in comparison with controls and non-amputated side. The latency period on the amputated side was significantly longer and the slope less steep than in the control group. These results indicated atrophied and slower gluteus maximus on the amputated side of above-knee amputees.

Upper limb prosthetic use in Slovenia.

The article deals with the use of different types of upper limb prostheses in Slovenia. Four hundred and fourteen upper limb amputees were sent a questionnaire on the type of their prosthesis, its use and reasons for non-use, respectively. The replies were subject to statistical analysis. Most of the questioned upper limb amputees (70%) wear a prosthesis only for cosmesis. The use of a prosthesis depends on the level of upper limb amputation, loss of the dominant hand, and time from amputation. Prosthetic success appears to be unrelated to age at the time of amputation and the rehabilitation programme. The most frequent reason for not wearing a prosthesis is heat and consequent sweating of the stump. More than a third of amputees are dissatisfied with their prostheses.

The iron hand from Slovenia.

The iron hand prosthesis now in the custody of the Rehabilitation Institute Ljubljana, was excavated some 80 years ago in the ruins of the Vransko castle. The hand, its form and function are described. It was manufactured somewhere in Europe between the years 1500-1650. The owner, probably one of the local nobles, has remained unknown.

Community-based rehabilitation--the challenge and opportunity.

The Yugoslav Government has supported the establishment of a special service to assist the development of community-based rehabilitation in developing countries. Early experience has highlighted the problems of introducing high-technology orthotic and prosthetic devices into these countries because of the difficulty of sustaining supply and local training and manufacture. Much better regional organization is required if the rehabilitation needs of the majority of disabled people are to be met in the developing countries.

Arm cycloergometry and kinetics of oxygen consumption in paraplegics.

A report is given on studies to determine the best methodological approach in exercise testing of paraplegics. Arm cyclometry was found to be very suitable for wheelchair users with normal upper limbs. Oxygen consumption during exercise was studied and analysed by computer.