Achieving functional ambulation in a patient with Chopart amputation.

Chopart amputation provides an interesting functional dilemma for the patient, physiatrist, and prosthetist. This problem is further complicated when the patient develops an equinus contracture from an unbalanced short forefoot lever. Also, genu recurvatum occurs as a consequence of recurrent knee hyperextension from this contracture.

Prevention and treatment of frailty in the postmenopausal woman.

Frailty is a complex subject, and all aspects of frailty are intertwined. This article identifies and discusses the individual aspects of frailty. These aspects, including sarcopenia, nutrition, obesity, relative strength, inflammatory markers, osteopenia and osteoporosis, aerobic capacity, absolute strength, balance, and prevention of frailty, must be reunited, albeit in varying combinations, if the effects of frailty on women are to be understood and treated.

The National Institute on Disability and Rehabilitation Research burn model system database: a tool for the multicenter study of the outcome of burn injury.

Advances in critical care and surgical management have significantly improved survival after burn injury over the past several decades. However, today, survival alone is an insufficient outcome. In 1994, the National Institute on Disability and Rehabilitation Research (NIDRR) created a burn model system program to evaluate the long-term sequelae of burn injuries.

Optimal resistance training: comparison of DeLorme with Oxford techniques.

Objective: Progressive resistive exercises, such as the DeLorme or Oxford techniques, improve strength by adding weights to arrive at the ten-repetition maximum (10RM; DeLorme) or by starting at the 10RM and removing weight (Oxford). The goal of this study was to examine the efficacy of each training method.

Design: In this randomized, prospective, group design, evaluator-blind clinical trial, 50 subjects performed either the Oxford or DeLorme weight-training techniques.

Factors associated with willingness to try different pain treatments for pain after a spinal cord injury.

Objective: To develop and establish the psychometric properties of a pain treatment willingness scale and identify factors associated with willingness to try specific pain treatments for spinal cord injury (SCI)-related pain.

Design: As part of a larger study, a questionnaire was designed to assess willingness to use various pain medications and other types of pain treatments. This questionnaire, which included measures of pain severity, pain interference, mood, hope, and current use of pain treatments, was completed by persons with SCI recruited through the mail or in person.

Community integration after burn injuries.

Evaluation of community integration is a meaningful outcome criterion after major burn injury. The Community Integration Questionnaire (CIQ) was administered to 463 individuals with major burn injuries. The CIQ results in Total, Home Integration, Social Integration, and Productivity scores.

Determinants of disability after lower extremity fracture.

Background: Factors influencing the progression of physical impairment to patient-perceived disability are not well known. We sought to better understand this relationship in the setting of injury.

Methods: We followed a cohort of 302 patients with lower extremity fractures over a 1-year period.

Exercise: effects on physical functional performance in independent older adults.

Background: Age-related loss in physiologic capacities contributes to the decline in physical function in the elderly population. Despite the beneficial effects of exercise interventions on maximal physiologic capacity measures, the functional benefits have not been shown in independently living older adults. The objective of this study was to evaluate exercise in independent older adults for significant and meaningful improvements in physical function, not detected by commonly used measures of physical function.

Return to work following injury: the role of economic, social, and job-related factors.

Objectives: This study examined factors influencing return to work (RTW) following severe fracture to a lower extremity.

Methods: This prospective cohort study followed 312 individuals treated for a lower extremity fracture at 3 level-1 trauma centers. Kaplan-Meier estimates of the proportion of RTW were computed, and a Cox proportional hazards model was used to examine the contribution of multiple risk factors on RTW.

Correlation between the measures of impairment, according to the modified system of the American Medical Association, and function.

We performed a prospective study of 302 patients who had a fracture of the lower extremity. Our purpose was to determine whether there was any association between impairment ratings of the lower extremity, derived with use of the Guides to the Evaluation of Permanent Impairment by the American Medical Association, and measurements of task performance based on direct observation as well as the patient's own assessment of activity limitation and disability as recorded on the Sickness Impact Profile. The mean residual impairment of the lower extremity according to the Guides was 27 per cent one year after the injury.

Continuous-scale physical functional performance in healthy older adults: a validation study.

Objective: The continuous-scale physical functional performance test (CS-PFP) is an original instrument designed to provide a comprehensive, in-depth measure of physical function that reflects abilities in several separate physical domains. It is based on a concept of physical function as the integration of physiological capacity, physical performance, and psychosocial factors.

Setting: The test was administered under standard conditions in a hospital facility with a neighborhood setting.

The Sickness Impact Profile as a tool to evaluate functional outcome in trauma patients.

Because the ultimate goal of trauma care is to restore injured patients to their former functional status, reliable evaluation of functional status is needed to assess fully the effectiveness of trauma care. We hypothesized that the Sickness Impact Profile (SIP), a widely used measure of general health status, would be a useful tool to evaluate the long-term functional outcome of trauma patients and that the SIP would identify unexpected problems in the recovery process and groups of patients at high risk for long-term disability. A prospective cohort of 329 patients with lower extremity fractures admitted to three level I trauma centers were interviewed using SIP at 6 and 12 months postinjury.

Comprehensive analysis of energy storing prosthetic feet: Flex Foot and Seattle Foot Versus Standard SACH foot.

This study compared the mechanical and biomechanical functions, metabolic demand, and shock absorption of two dynamic elastic response (DER) prosthetic foot designs with the SACH foot. Nine individuals who had undergone unilateral below knee amputation were studied. Mechanical properties of the feet were related to gait biomechanics.

Physical impairment and functional outcomes six months after severe lower extremity fractures.

To determine functional outcomes after lower extremity fracture (LEF), a prospective follow-up study of patients admitted to three level I trauma centers for treatment of unilateral LEFs was conducted. In this paper we describe outcomes at 6 months after discharge from the initial hospitalization and examine the relationship between impairment and disability. A total of 444 patients met the entry criteria for the study.

Influence of cryotherapy on spasticity at the human ankle.

The application of cryotherapy to temporarily reduce spasticity is a widespread clinical practice. A method of quantifying spasticity, based on viscoelastic stiffness measurements at the ankle, was applied to objectively determine the efficacy of cryotherapy in reducing spasticity of the calf. Baseline, cryotherapy and one-hour postcryotherapy measurements of spasticity were performed in 25 subjects with clinical signs of spasticity secondary to traumatic brain injury, spinal cord injury, and stroke.

Patient-oriented functional outcome after unilateral lower extremity fracture.

To determine patient-perceived functional outcome after lower extremity fracture (LEF), a prospective, follow-up study of patients managed at three level I trauma centers was conducted. Patients with unilateral LEF involving the acetabulum and distally were eligible for the study. A total of 444 patients were enrolled.

Concentric versus combined concentric-eccentric isokinetic training programs: effect on peak torque of human quadriceps femoris muscle.

To determine the effects of isokinetic resistance training of the quadriceps, 25 male volunteers were randomly assigned to five training groups: Concentric Slow (CS), Concentric Fast (CF), Concentric-Eccentric Slow (MS), Concentric-Eccentric Fast (MF), and Control (C). In training, subjects performed 20 contractions of each quadriceps using either 60 degrees/sec or 180 degrees/sec, for both sides, five days per week for 12 weeks. Testing consisted of measurement of peak torque, at intervals of 60 degrees/sec across a spectrum of velocities ranging from plus to minus 240 degrees/sec, at 0, 4, 8, and 12 weeks.