Venous Thromboembolism (VTE) in May-Thurner Syndrome: Decision-Making Related to Long-Term Anticoagulation.

May-Thurner syndrome (MTS) involves the compression of the left iliac vein between the right iliac artery anteriorly and the lumbar vertebrae posteriorly. Patients may remain asymptomatic throughout their lives or experience unilateral lower limb swelling and symptoms of deep vein thrombosis (DVT), such as redness and pain in the limb, or features of its complication (pulmonary embolism) such as chest pain or shortness of breath. We present the case of a 34-year-old female exhibiting acute pain and tightness in her left leg, due to DVT of the left common femoral vein, extending up to the pelvic veins, which, on further diagnostic imaging, was found to be due to MTS. The patient was initiated on lifelong anticoagulation to prevent further complications. The rising incidence of MTS, coupled with frequent delays in its diagnosis, highlights the need to raise awareness among healthcare providers, especially acute medics (who are often the first point of contact for the patient) to expand their diagnostic umbrella of differentials to include MTS as a potential cause of such presentations and to look and think beyond DVT of the lower limb. This is especially important in females presenting with non-specific DVT symptoms, as early suspicion and referral to the respective medical teams including vascular medicine, can improve diagnostic accuracy and provide more management options, thereby improving long-term outcomes.

Idiopathic Spinal Epidural Hematoma: A Near Miss of a Rare Entity.

Spinal epidural hematomas (SEH) are rare, and cases with a spontaneous etiology are even more infrequent. Management of spontaneous SEH varies, with surgical or conservative approaches determined by the severity of deficits and symptom resolution. Adverse prognostic factors may include thoracic segment location, anticoagulation use, severe neurologic deficits at admission, sphincter dysfunction, and rapid progression. We report a patient with a sudden onset of bilateral lower limb weakness and reduced urinary output. Magnetic resonance imaging was conducted and indicated an epidural hematoma extending from T11 to L4. Surgical decompression and hematoma extraction were performed successfully resulting in the complete resolution of symptoms. This case underscores the importance of considering spontaneous SEH in patients lacking conventional risk factors, such as a history of trauma, when presenting with symptoms of bilateral lower limb weakness and decreased urine output. Depending on the severity of symptoms and the occurrence of spontaneous and rapid improvement, the patient may benefit from surgical intervention, which ameliorated the patient's symptoms in this case.

Smartphone-Based Sit-to-Stand Analysis for Mobility Assessment in Middle Age.

Background and Objectives: Mobility can decline in middle age and growing evidence highlights the importance of assessing mobility at this stage of life. Smartphone-based accelerometry during sit-to-stand has been shown to identify mobility impairments, but its utility in detecting subtle mobility deterioration in middle age has not been tested. This study aimed to examine whether smartphone-based accelerometry data measured during sit-to-stand tests performed on a regular chair and a cushioned sofa could be useful for detecting subtle changes in mobility in middle age. Research Design and Methods: Twenty-three young (25.0 ± 2.5 years), 25 middle-aged (52.0 ± 5.2 years), and 17 older adults (70.0 ± 4.1 years) performed the 5-times sit-to-stand test on both a standard chair and a sofa. A smartphone attached to the participants' lower back was used to measure lower-limb muscle power, maximal vertical velocity (MVV) during rising, the duration of the total task and the subphase of transition from sitting to standing (SiToSt), and repetition variability using the dynamic time warping method. Results: Middle-aged adults had reduced lower-limb muscle power compared to young adults (5.25 ±â€…1.08 vs 6.19 ±â€…1.38 W/kg, p = .034), being more pronounced on the sofa (6.23 ±â€…1.61 vs 8.08 ±â€…2.17 W/kg, p = .004). Differences between middle-aged and young adults in terms of MVV (p = .011) and SiToSt duration (p = .038) were only detected on the sofa, and the middle-aged adults showed less variability compared to the older adults on the chair (p = .018). There was no difference in total task duration between the middle-aged group and the young or older adults in either condition. Discussion and Implications: Most common tests are limited in their ability to detect early mobility deterioration in midlife due to a ceiling effect. Our results, which show the potential of smartphone-based sit-to-stand assessment in detecting subtle mobility decline in midlife, could serve as a screening tool for this purpose.

A mechanical comparison of the translational traction of female-specific and male soccer boots.

The studded outsole of a soccer boot provides additional traction to players to minimise the risk of slipping while performing high-speed manoeuvres. As excessive traction can lead to foot fixation and injury risk, there has been significant research surrounding the influence of stud configuration on the level of traction generated. This previous research, however, has predominately focused on the stud patterns, foot morphology and lower limb loading patterns of male players. As the popularity of women's soccer increases, the aim of this investigation was to examine the differences in translational traction of female-specific soccer boots and male soccer boots currently available. A custom-built apparatus was used to determine the translational traction on both natural and artificial grass for four different movement directions. It was hypothesised that the female-specific boot in each pair would produce lower levels of translational traction as they are designed to be safer for female players who are more at risk of lower limb fixation injuries compared to males. An independent samples T-test showed that while there were some loading conditions where female boots produced lower translational traction compared to male boots, across all loading scenarios there was no significant difference between male and female boots (p = 0.818), thus the null hypothesis was rejected.

Integrated Rehabilitation of Longitudinal Extensive Transverse Myelitis: Study of a Complex Case.

Longitudinal extensive transverse myelitis (LETM) is a rare neurological disorder portrayed by inflammation of the spinal cord spanning three or more vertebral segments. It can lead to severe symptoms such as weakness, sensory abnormalities, and dysfunction in various parts of the body. LETM can be idiopathic or associated with autoimmune conditions like Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO). Diagnosis of LETM requires MRI imaging of the spine, and treatment often involves corticosteroids, intravenous immunoglobulins (IVIG), and plasma exchange. Physical therapy plays a crucial role in managing LETM, focusing on improving functional abilities, mobility, and quality of life. This study outlines a 62-year-old male who was admitted with a complaint of bilateral weakness of both upper and lower limbs, predominantly on the left side, seizures, falls, and stiffness of the left limbs. He also complained of a cough with sputum, cluster headache, bowels and bladder dysfunction, and impaired vision. Neurologic examination showed hypotonia and reduced muscle strength in all four limbs with impairment of the optic nerve. The following investigations were conducted: MRI, Chest X-ray, and ultrasound. He was advised for physiotherapy, after which he showed improvement in functional independence and a general recovery following the treatment.

Clinical Presentation, Diagnosis, and Genetic Insights of Miyoshi Myopathy: A Case Report and Literature Review.

Miyoshi myopathy (MM) is an autosomal recessive dysferlinopathy caused by a mutation in the dysferlin (DYSF) gene on chromosome 2p. Recent findings indicate that MM and Lower Girdle Muscular Dystrophy R2 (LGMD2B) are the same disease. We present the case of a 44-year-old male who first experienced symptoms of MM at the age of 19, initially noticing difficulty climbing stairs and standing on his toes. By the age of 29, he had developed significant calf muscle atrophy and weakness, which led to difficulties with walking. Electromyography and nerve conduction studies showed axonal damage and myogenic features. Genetic testing ruled out Charcot-Marie-Tooth disease but identified a pathogenic variant in the DYSF gene. Laboratory tests revealed elevated creatine kinase levels. Photographs of the patient's lower limbs showed significant calf muscle atrophy. Based on clinical, laboratory, and electrophysiological findings, he was diagnosed with MM. This case highlights the importance of genetic testing in diagnosing muscular dystrophies and underscores the need for continued research into gene and cell therapies. To the best of our knowledge, this is one of the first studies reporting a case of MM in Poland.

User-centered design of a personal-use exoskeleton: a clinical investigation on the feasibility and usability of the ABLE Exoskeleton device for individuals with spinal cord injury to perform skills for home and community environments.

Introduction: The ABLE Exoskeleton has been tested to be safe and feasible for persons with spinal cord injury (SCI) to complete basic skills in clinical settings but has not been tested for use in home and community environments. A user-centered design process was employed to test the feasibility of the current ABLE Exoskeleton (designed for clinical use) for persons with SCI to perform the basic and advanced skills required for home and community environments, to gain crucial feedback for the development of a novel personal-use exoskeleton. Methods: In this prospective pretest-posttest quasi-experimental study across two SCI centers (Germany, Spain), in-and outpatients with SCI were included into a 22-session training and assessment protocol, utilizing the ABLE Exoskeleton. Feasibility and usability measures [level of assistance (LoA) for basic and advanced skills, donning/doffing-time and LoA] were recorded together with safety outcomes, and participant and therapist satisfaction with the device. Results: 10 participants (44.4 ± 24 years), with SCI from C5 to T11, (American Spinal Injury Association Impairment Scale A-D) completed the study. In 209 sessions, six device-related adverse events (pain and skin lesions) were reported. Average total time for don and doff was 10:23 ± 3:30 min. Eight participants were able to complete don and doff with minimal assistance or less. Independence to carry out all skills in the device increased significantly for all participants (p < 0.05). Participants with chronic SCI required a significantly (p < 0.05) lower LoA for six of the nine advanced skills than those in the sub-acute phase. Discussion: This study shows that the ABLE Exoskeleton is safe, feasible and usable for people with SCI in respect to independent donning, doffing and performance of basic and advanced exoskeleton skills. The supervised exoskeleton use in the clinical environment was a highly valuable approach for identifying the challenging tasks and the necessary technological developments that need to be carried out for a personal-use exoskeleton, including a more independent sit-to-stand transition, faster speed of transitions between states and a richer display on the remote control for the user. Clinical trial registration: https://clinicaltrials.gov/study/NCT05643313.

A systematic review and meta-analysis of outcomes associated with development of surgical site infection after lower-limb revascularization surgery.

OBJECTIVES: Although surgical site infection (SSI) is a commonly used quality metric after lower-limb revascularization surgery, outcomes associated with development of this complication are poorly characterized. We conducted a systematic review and meta-analysis of studies reporting associations between development of an SSI after these procedures and clinical outcomes and healthcare resource use. METHODS: We searched MEDLINE, Embase, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 4th, 2023) for studies examining adjusted associations between development of an SSI after lower-limb revascularization surgery and clinical outcomes and healthcare resource use. Two investigators independently screened abstracts and full-text citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Heterogeneity was assessed using I2 statistics. GRADE was used to assess estimate certainty. RESULTS: Among 6671 citations identified, we included 11 studies (n = 61,628 total patients) that reported adjusted-associations between development of an SSI and 13 different outcomes. Developing an SSI was associated with an increased adjusted-risk of hospital readmission (pooled adjusted-risk ratio (aRR) = 3.55; 95% CI (confidence interval) = 1.40-8.97; n = 4 studies; n = 13,532 patients; I2 = 99.0%; moderate certainty), bypass graft thrombosis within 30-days (pooled aRR = 2.09; 95% CI = 1.41-3.09; n = 2 studies; n = 23,240 patients; I2 = 51.1%; low certainty), reoperation (pooled aRR = 2.69; 95% CI = 2.67-2.72; n = 2 studies; n = 23,240 patients; I2 = 0.0%; moderate certainty), bleeding requiring a transfusion or secondary procedure (aRR = 1.40; 95% CI = 1.26-1.55; n = 1 study; n = 10,910 patients; low certainty), myocardial infarction or stroke (aRR = 1.21; 95% CI = 1.02-1.43; n = 1 study; n = 10,910 patients; low certainty), and major (i.e., above-ankle) amputation (pooled aRR = 1.93; 95% CI = 1.26-2.95; n = 4 studies; n = 32,859 patients; I2 = 83.0; low certainty). Development of an SSI >30-days after the index operation (aRR = 2.20; 95% CI = 1.16-4.17; n = 3 studies; n = 21,949 patients; low certainty) and prosthetic graft infection (aRR = 6.72; 95% CI = 3.21-12.70; n = 1 study; n = 272 patients; low certainty) were both associated with an increased adjusted-risk of major amputation. Prosthetic graft infection was also associated with an increased adjusted-risk of mortality >30-days after the index procedure (aRR = 6.40; 95% CI = 3.32-12.36; n = 1 study; n = 272 patients; low certainty). CONCLUSIONS: This systematic review and meta-analysis suggests that development of an SSI after lower-limb revascularization surgery significantly increases patient morbidity and healthcare resource use. SSI is therefore a valuable quality metric after these surgeries. However, current estimates are based on heterogenous, low-to-moderate certainty evidence and should be confirmed by large, multicenter, cohort studies.

Corrigendum: Genome-wide association study identifying variants related to performance and injury in high-performance athletes.

[This corrects the article DOI: 10.1177/15353702231198068.].

Technical note: Measuring bicondylar length in computed tomography data.

OBJECTIVES: With the increased use of 3D-generated images in biological research, there is a critical need to adapt classical anatomical measurements, traditionally conducted with calipers, to a virtual environment. We present detailed protocols for measuring bicondylar length, a critical dimension of the femur, using three different imaging software programs-3D Slicer™, Amira™, and Simpleware™. These protocols provide researchers and practitioners in radiology, orthopedics, biomechanics, and biological anthropology with accurate and reproducible measurement techniques. The objective is to standardize and support virtual osteology in biomechanical research, stature estimation, and related medical and anthropological studies. MATERIALS AND METHODS: Adhering to standardized protocols, we adapted femoral bicondylar length measurements for computed tomography images from a New Mexican collection (n = 10). The method was designed for applicability and reproducibility across three software platforms. By comparing measurements from the same sample across different observers and different platforms, this study validates the accuracy and consistency of the adapted protocol, demonstrating its utility for research and clinical assessments. RESULTS: We present a step-by-step guide for each program, detailing bone alignment and measurement. We illustrate each step and provide video tutorials via links for an enhanced understanding of the process. DISCUSSION: Bicondylar length can be measured effectively in each software program following the provided instructions. However, ease of measurement varied among the programs, with some offering a more straightforward process. This variability underscores the importance of choosing appropriate software for the user's needs and proficiency. It also suggests areas for improvement and standardization in software design and instructional clarity.

Transcutaneous spinal cord stimulation phase-dependently modulates spinal reciprocal inhibition induced by pedaling in healthy individuals.

Reciprocal inhibition (RI) between leg muscles is crucial for smooth movement. Pedaling is a rhythmic movement that can increase RI in healthy individuals. Transcutaneous spinal cord stimulation (tSCS) stimulates spinal neural circuits by targeting the afferent fibers. Pedaling with simultaneous tSCS may modulate the plasticity of the spinal neural circuit and alter neural activity based on movement and muscle engagement. This study investigated the RI changes after pedaling and tSCS and determined the phase of pedaling in which tSCS should be applied for optimal RI modulation in healthy individuals. Eleven subjects underwent three interventions: pedaling combined with tSCS during the early phase of lower extension (phase 1), pedaling combined with tSCS during the late phase of lower flexion (phase 4) of the pedaling cycle, and pedaling combined with sham tSCS. The RI from the tibialis anterior to the soleus muscle was assessed before, immediately after, 15 min, and 30 min after the intervention. RI increased immediately after phase 4 and pedaling combined with sham tSCS, whereas no changes were observed after phase 1. These results demonstrate that tSCS modulates RI changes induced by pedaling in a stimulus phase-dependent manner in healthy individuals. However, the mechanism involved in this intervention needs to be explored to achieve higher efficacy.

Diagnostic performance of dual-energy CT in detecting bone marrow edema in lower limb joint injuries: a meta-analysis.

OBJECTIVE: We aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) in detecting bone marrow edema (BME) in patients with lower limb joint injuries. METHODS: A thorough literature search was conducted across the PubMed, Embase, and Web of Science databases to identify relevant studies up to April 2024. Studies examining the diagnostic performance of DECT in detecting BME in lower limb joint injuries patients were included. Sensitivity and specificity were evaluated using the inverse variance method and transformed via the Freeman-Tukey double arcsine transformation. Furthermore, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to evaluate the methodological quality of the included studies. RESULTS: This meta-analysis included 17 articles involving 625 patients. The pooled sensitivity, specificity, and AUC for DECT in detecting BME in lower limb joint injuries patients were 0.82 (95 % CI: 0.76-0.87), 0.95 (95 % CI: 0.92-0.97), and 0.95 (95 % CI: 0.93-0.97), respectively. The pooled sensitivity of DECT for detecting BME in knee, hip, and ankle joint injuries was 0.80, 0.84, and 0.80, with no significant difference among these joints (P = 0.55). The pooled specificity for knee, hip, and ankle injuries was 0.95, 0.97, and 0.89. Specificity differed significantly among the joints (P < 0.01), with the highest specificity in hip injuries. CONCLUSIONS: Our meta-analysis indicates that DECT demonstrates high diagnostic performance in detecting BME in patients with lower limb joint injuries, with the highest specificity observed in hip joint injuries. To validate these findings, further larger prospective studies are necessary.

Clinical Characteristics Associated with the PLP-PLS Index, a New Potential Metric to Phenotype Phantom Limb Pain.

BACKGROUND: Phantom limb pain (PLP) is highly prevalent after amputation. However, the influence of non-painful sensations (PLS) remains unclear. This study examines the PLP-PLS index as a novel tool to differentiate PLP from PLS and explores the association of clinical factors with the index. METHODS: We conducted a cross-sectional analysis of baseline data from 112 participants in a previous factorial trial in patients with unilateral traumatic lower limb amputation. Linear regression models were used to examine the associations between the index and various demographic, psychological and clinical factors. Logistic and Poisson regression, and e-value calculation were utilized for sensitivity analyses. RESULTS: Adjusted multivariable linear regression models demonstrated significant associations of phantom movement sensation (ß: -1.532; 95% CI: -2.615 to -0.449; p = 0.006) and time since amputation (ß: 0.005; 95% CI: 0.0006 to 0.0101; p = 0.026) with the PLP-PLS index. These findings were confirmed by multivariable logistic regression (phantom movement sensation OR: 0.469; 95% CI: 0.200 to 1.099, p = 0.082; time since amputation OR: 1.003; 95% CI: 1.00003 to 1.007; p = 0.048) and sensitivity analyses. CONCLUSIONS: Time since amputation and phantom movement sensation likely reflect distinct phenotypes and potential mechanisms for PLP and PLS. The PLP-PLS index is a promising clinical tool for selecting therapies to prevent/treat PLP and for measuring treatment effects to modulate phantom pain. These findings emphasize the importance of understanding the mechanisms underlying PLP and PLS for improving clinical management and guiding future research.

A Systematic Review of Lower Limb Strength Tests Used in Elite Basketball.

BACKGROUND: Basketball players rely on their lower limb strength for speed and agility. Therefore, it is important for strength and conditioning coaches to seek methods to assess and develop lower limb strength. OBJECTIVES: This study aimed to identify tests and variables used to assess lower body strength among elite basketball players and to provide normative values for the commonly used strength tests. METHODS: A review of PubMed, MEDLINE, Scopus, and SPORTDiscus was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The risk of bias was assessed using the Joanna Briggs Institute cross-sectional and cohort checklists. RESULTS: Among the twelve reviewed studies, seven strength tests and five outcome variables were used. The most frequently used lower limb strength tests were the back squat (nine studies) and isometric mid-thigh pull (IMTP) (three studies), both reporting one repetition maximum (1RM) and peak force metrics. The most frequently used lower limb strength test was the back squat among males and IMTP among females. CONCLUSIONS: Among elite basketball players, the back squat 1RM is the most used lower limb strength test. However, across studies, a large variability was evidenced, which suggests that lower limb testing procedures are heterogeneous in this population.

Using Wavelet Analysis of Blood Flow Oscillations to Investigate Differences in Skin Blood Flow Regulations Between the Upper and Lower Limbs.

BACKGROUND: The objective of this study was to investigate the differences in skin blood flow regulations between the upper and lower limbs in healthy adults using wavelet analysis of skin blood oscillations. To the best of our knowledge, this is the first study investigating the dominant skin blood flow control of the upper and lower limbs in healthy adults. METHODS: Skin blood flow of the forearm and leg was simultaneously measured by laser Doppler flowmetry (LDF) in 17 healthy adults. Skin blood flow oscillations were analyzed using wavelet analysis to assess the dominant control among the metabolic endothelial (0.0095-0.02 Hz), neurogenic (0.02-0.05 Hz), myogenic (0.05-0.15 Hz), respiratory (0.15-0.4 Hz), and cardiac (0.4-2 Hz) origins. RESULTS: Skin blood flow in the leg (11.13 ± 4.90 perfusion unit) was significantly higher than in the forearm (6.90 ± 2.50 perfusion unit, p < 0.001). The metabolic endothelial control is more dominant in the forearm (1.19 ±0.51 au) compared to the leg (0.73 ± 0.41 au, p < 0.01). The myogenic control is more dominant in the leg (1.18 ± 0.28 au) compared to the forearm (0.96±0.18 au, p < 0.05). CONCLUSION: Through wavelet analysis of skin blood flow oscillations, the results indicate that metabolic endothelial control is more dominant in the forearm (upper limbs) and myogenic control is more dominant in the leg (lower limbs).

Two Acute Stroke Patients Whose Lower Back and Lower Limb Pain Hampered Their Rehabilitation: The Effectiveness of Peripheral Nerve Blocks.

Lower back and lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7th post-stroke day, she reported right buttock and dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29th post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 was an 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superior and middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain.

The Role of Downsizing of Large-Bore Percutaneous Femoral Access for Pelvic and Lower Limb Perfusion in Transfemoral Branched Endovascular Aortic Repair.

Background: Transfemoral access (TFA) is a valuable alternative to upper extremity access (UEA) for branched endovascular aortic repair (bEVAR). However, TFA requires large introducer sheaths, which can reduce blood flow to lower limbs and the pelvis. This study aimed to evaluate the efficacy of sheath downsizing to maintain lower limb perfusion during TFA-bEVAR. Methods: A single-center retrospective review was conducted including patients managed with TFA-performed bEVAR between December 2020 and May 2021. Intra-operative lower limb perfusion was assessed using non-invasive ankle blood pressure measurements and great toe pulse oximetry, with measurements being taken prior to puncture (baseline), one minute after 10F-sheath insertion, three minutes after the main body delivery system insertion, and three minutes after downsizing to a 14F sheath. Outcomes included the incidence of limb perfusion reduction (LPR), defined as a drop in the ankle-brachial index (ABI) < 0.5 or peripheral oxygen saturation (SpO2) < 90%. Results: Out of 47 patients, 24 met the inclusion criteria. LPR occurred in 4.2% of cases after 10F-sheath placement, and 87.5% after main body delivery system placement, and decreased to 12.6% after downsizing to a 14F sheath. No periprocedural major bleeding occurred. Two patients required revision for inadequate hemostasis post-operatively. SCI occurred in 16% of patients, all recovered by discharge. Pre-operative hypogastric artery occlusion was related to persistent LPR after downsizing (100% vs. 16%, p = 0.009). Conclusions: Downsizing the introducer sheath during bEVAR is feasible and safe to restore lower limb and pelvic perfusion. Further research is needed to clarify the access downsizing value during bEVAR.

Research on the Motion Control Strategy of a Lower-Limb Exoskeleton Rehabilitation Robot Using the Twin Delayed Deep Deterministic Policy Gradient Algorithm.

The motion control system of a lower-limb exoskeleton rehabilitation robot (LLERR) is designed to assist patients in lower-limb rehabilitation exercises. This research designed a motion controller for an LLERR-based on the Twin Delayed Deep Deterministic policy gradient (TD3) algorithm to control the lower-limb exoskeleton for gait training in a staircase environment. Commencing with the establishment of a mathematical model of the LLERR, the dynamics during its movement are systematically described. The TD3 algorithm is employed to plan the motion trajectory of the LLERR's right-foot sole, and the target motion curve of the hip (knee) joint is deduced inversely to ensure adherence to human physiological principles during motion execution. The control strategy of the TD3 algorithm ensures that the movement of each joint of the LLERR is consistent with the target motion trajectory. The experimental results indicate that the trajectory tracking errors of the hip (knee) joints are all within 5°, confirming that the LLERR successfully assists patient in completing lower-limb rehabilitation training in a staircase environment. The primary contribution of this study is to propose a non-linear control strategy tailored for the staircase environment, enabling the planning and control of the lower-limb joint motions facilitated by the LLERR.

Impact of lower limb movements on iliac vein stenting in iliac vein compression syndrome patients: insights from computational modeling.

Purpose: Iliac vein stenting is the primary treatment for patients with iliac vein compression syndrome (IVCS). However, post-stent placement, patients often experience in-stent restenosis and thrombosis. Despite this, the role of lower limb movements in the functioning of stents and veins in IVCS patients remains unclear. This study aimed to address this knowledge gap by developing a computational model using medical imaging techniques to simulate IVCS after stent placement. Methods: This research used a patient-specific model to analyze the effects of lower extremity exercises on hemodynamics post-stent placement. We conducted a comprehensive analysis to evaluate the impact of specific lower limb movements, including hip flexion, ankle movement and pneumatic compression on the hemo-dynamic characteristics within the treated vein. The analysis assessed parameters such as wall shear stress (WSS), oscillatory shear index (OSI), and residence time (RRT). Results: The results demonstrated that hip flexion significantly disrupts blood flow dynamics at the iliac vein bifurcation after stenting. Bilateral and left hip flexion were associated with pronounced regions of low WSS and high OSI at the iliac-vena junction and the stent segment. Additionally, active ankle exercise (AAE) and intermittent pump compression (IPC) therapy were found to enhance the occurrence of low WSS regions along the venous wall, potentially reducing the risk of thrombosis post-stent placement. Consequently, both active joint movements (hip and ankle) and passive movements have the potential to influence the local blood flow environment within the iliac vein after stenting. Conclusions: The exploration of the impact of lower limb movements on hemodynamics provides valuable insights for mitigating adverse effects associated with lower limb movements post iliac-stenting. Bilateral and left hip flexions negatively impacted blood flow, increasing thrombosis risk. However, active ankle exercise and intermittent pump compression therapies effectively improve the patency.

Effects of different sensory integration tasks on the biomechanical characteristics of the lower limb during walking in patients with patellofemoral pain.

Purpose: This study aimed to analyze the biomechanical characteristics of the lower limb in patients with patellofemoral pain (PFP) while walking under different sensory integration tasks and elucidate the relationship between these biomechanical characteristics and patellofemoral joint stress (PFJS). Our study's findings may provide insights which could help to establish new approaches to treat and prevent PFP. Method: Overall, 28 male university students presenting with PFP were enrolled in this study. The kinematic and kinetic data of the participants during walking were collected. The effects of different sensory integration tasks including baseline (BL), Tactile integration task (TIT), listening integration task (LIT), visual integration task (VIT) on the biomechanical characteristics of the lower limb were examined using a One-way repeated measures ANOVA. The relationship between the aforementioned biomechanical characteristics and PFJS was investigated using Pearson correlation analysis. Results: The increased hip flexion angle (P = 0.016), increased knee extension moment (P = 0.047), decreased step length (P < 0.001), decreased knee flexion angle (P = 0.010), and decreased cadence (P < 0.001) exhibited by patients with PFP while performing a VIT were associated with increased patellofemoral joint stress. The reduced cadence (P < 0.050) achieved by patients with PFP when performing LIT were associated with increased patellofemoral joint stress. Conclusion: VIT significantly influenced lower limb movement patterns during walking in patients with PFP. Specifically, the increased hip flexion angle, increased knee extension moment, decreased knee flexion angle, and decreased cadence resulting from this task may have increased PFJS and may have contributed to the recurrence of PFP. Similarly, patients with PFP often demonstrate a reduction in cadence when exposed to TIT and LIT. This may be the main trigger for increased PFJS under TIT and LIT.