By P. Onatas. Chicago School of Professional Psychology. 2018.
Contents About Dynamics of Human Gait vii About Gait Analysis Laboratory ix Acknowledgments xi Chapter 1 In Search of the Homunculus 1 Top-Down Analysis of Gait 2 Measurements and the Inverse Approach 4 Summary 6 Chapter 2 The Three-Dimensional and Cyclic Nature of Gait 7 Periodicity of Gait 8 Parameters of Gait 12 Summary 14 Chapter 3 Integration of Anthropometry purchase 260 mg extra super avana, Displacements buy generic extra super avana 260 mg online, and Ground Reaction Forces 15 Body Segment Parameters 16 Linear Kinematics 22 Centres of Gravity 29 Angular Kinematics 32 Dynamics of Joints 36 Summary 43 Chapter 4 Muscle Actions Revealed Through Electromyography 45 Back to Basics 45 Phasic Behaviour of Muscles 52 Relationship Between Different Muscles 55 Summary 62 Chapter 5 Clinical Gait Analysis A Case Study 63 Experimental Methods 64 Results and Discussion 65 Summary 76 v vi CONTENTS Appendix A Dynamic Animation Sequences 77 Appendix B Detailed Mathematics Used in GaitLab 83 Appendix C Commercial Equipment for Gait Analysis 107 References 133 Index 137 About Dynamics of Human Gait This book was created as a companion to the GaitLab software package cheap extra super avana 260mg with amex. We try to serve readers with diverse experience and areas of interest by discussing the basics of human gait as well as some of the theoretical purchase 260mg extra super avana mastercard, biomechanical, and clinical aspects. In chapter 1 we take you in search of the homunculus, the little being inside each of us who makes our walking patterns unique. We represent the walking human as a series of interconnected systems neural, muscular, skeletal, mechanical, and anthropometric that form the framework for detailed gait analysis. The three-dimensional and cyclical nature of human gait is described in chapter 2. We also explain how many of the relevant parameters can be expressed as a function of the gait cycle, including kinematics (e. In chapter 3 we show you how to use the framework constructed in the first two chapters to integrate anthropometric, 3-D kinematic, and 3-D force plate data. For most readers this will be an important chapter it is here that we suggest many of the conventions we believe to be lacking in three- dimensional gait analysis. Although conceptually rigorous, the mathemati- cal details are kept to a minimum to make the material accessible to all stu- dents of human motion. We discuss some of the techniques involved and then illustrate the phasic behaviour of muscles dur- ing the gait cycle and describe how these signals may be statistically analysed. One of the purposes of this book is to help clinicians assess the gaits of their patients. We have a complete set of 3-D data for him that can be processed and analyzed in GaitLab. Beginning in Appendix A we use illustrated animation sequences to em- phasize the dynamic nature of human gait. By carefully fanning the pages of vii viii ABOUT DYNAMICS OF HUMAN GAIT the appendixes, you can get a feel for the way the human body integrates muscle activity, joint moments, and ground reaction forces to produce a repeatable gait pattern. These sequences bring the walking subject to life and should provide you with new insights. The detailed mathematics used to integrate anthropometry, kinematics, and force plate data and to generate 3-D segment orientations, and 3-D joint forces and moments are presented in Appendix B. This material, which is the basis for the mathematical routines used in GaitLab, has been included for the sake of completeness. It is intended for researchers who may choose to include some of the equations and procedures in their own work. The various pieces of commercially available equipment that may be used in gait analysis are described and compared in Appendix C. This summary has been gleaned from the World Wide Web in late 1998 and you should be aware that the information can date quite rapidly. Dynamics of Human Gait provides a solid foundation for those new to gait analysis, while at the same time addressing advanced mathematical tech- niques used for computer modelling and clinical study. As the first part of Gait Analysis Laboratory, the book should act as a primer for your explora- tion within the GaitLab environment. About Gait Analysis Laboratory Gait Analysis Laboratory has its origins in the Department of Biomedical Engineering of Groote Schuur Hospital and the University of Cape Town. It was in the early 1980s that the three of us first met to collaborate on the study of human walking. Our two-dimensional analysis of children with cerebral palsy and nondisabled adults was performed with a movie camera, followed by tedious manual digitizing of film in an awkward minicomputer environment. We concluded that others travelling this road should have access on a personal com- puter to material that conveys the essential three-dimensional and dy- namic nature of human gait. There are three parts to Gait Analysis Laboratory: this book, Dynamics of Human Gait, the GaitLab software, and the instruction manual on the inside cover of the CD-ROM jewel case. In the book we establish a framework of gait analysis and explain our theories and techniques.
Participants who experienced a relapse reported signiﬁcantly fewer behavioural and cognitive strategies to cope with high-risk situations cheap 260 mg extra super avana visa, compared to participants who did not relapse discount extra super avana 260 mg overnight delivery. These ﬁndings suggest that acquiring effective strategies to cope with high-risk situations may prevent relapse buy extra super avana 260 mg visa. Relapse prevention training (Simkin and Gross order 260mg extra super avana, 1994) involves teaching individuals that a lapse from exercising (e. The individual is encouraged to identify situations that are likely to cause a lapse. Potential high-risk situations relevant to exercise can include bad weather, an increase in work commitments, change in routine, injury or illness. Individuals are encouraged to develop a plan to cope with these high- risk situations. For example, increased work commitments could be overcome by rescheduling an activity session or engaging in a shorter bout of activity. Studies have used relapse prevention strategies to improve exercise adher- ence in the general population (King and Fredrickson, 1984; Belisle, et al. Description of how each component of the TTM is addressed during exercise consultation Component of Exercise Consultation Description of Strategy TTM Strategy Decisional balance Decisional balance table Perceived pros and cons of being active Self-efﬁcacy Exploring activity options Providing realistic and setting goals opportunities for success and achievement Experiential Processes Consciousness raising Decisional balance table Providing information about the beneﬁts of physical activity and discuss the current physical activity recommendations Dramatic relief Decisional balance table Discussing the risks of inactivity Environmental Decisional balance table Emphasise the social and reevaluation environmental beneﬁts of physical activity Self-reevaluation Review current physical Review current physical activity status and assess activity status and assess values related to physical values related to physical activity activity Social liberation Exploring suitable activity Raise awareness of options potential opportunities to be active and discuss how acceptable and available they are to the individual Behavioural Processes Counterconditioning Exploring suitable activity Discussion of how to options substitute inactivity for more active options (e. Another study evaluated the effect of relapse prevention techniques to maintain physical activity for six months after completion of a six-month home-based exercise programme (King, et al. Fifty-one sub- jects were randomised either to receive strategies for improving exercise adherence, including daily self-monitoring of activity and relapse prevention, or to a comparison group who underwent weekly self-monitoring of activity. The intervention group engaged in signiﬁcantly more exercise sessions over the six-month period, relative to the comparison group. Therefore, daily self- monitoring of activity levels and relapse prevention training is associated with exercise adherence. Overall, these behaviour change models have been used to understand exer- cise behaviour change in non-clinical and, to a lesser extent, in clinical popu- lations. These theories have identiﬁed factors inﬂuencing physical activity participation: exercise self-efﬁcacy, perceived pros and cons, use of cognitive and behavioural processes and ability to cope with high-risk situations. In addi- tion, evidence suggests that interventions based on these models are effective in increasing and maintaining physical activity. CONDUCTING AN EXERCISE CONSULTATION In 1995, Loughlan and Mutrie published guidelines for health professionals on conducting an exercise consultation (Loughlan and Mutrie, 1995). However, more recently it has been adapted for use with clinical populations, including people with Type II diabetes and CR participants (Hughes, et al. This section describes the components involved in delivering the exer- cise consultation to cardiac rehabilitation participants. Counselling skills A key element of the intervention is that the consultation is client-centred, which means that individuals should consider their own reasons for being active and should choose their own activity goals. In addition, the activ- ity goals should be tailored to the individuals’ needs and lifestyle. Good inter- personal skills are essential, which consist of communication (verbal and non-verbal), active listening and expressing empathy. Active listening shows the individual that the consultant has listened care- fully and understands what he or she has said. Empathy involves showing individuals that you understand what it is like to be in their world. Empathy can be expressed using examples of other patients who have been in a similar situation to the individual. As the exercise consultation is a client-centred approach, the consultant should try to avoid preaching, lecturing or providing solutions for the client. The consultant can offer suggestions, such as how to overcome a certain barrier to activity, but this is best achieved by using examples of how other individuals overcame this barrier. Further information on the client-centred approach and the interpersonal skills involved in behaviour change coun- selling is provided in guidelines on exercise consultation (Loughlan and Mutrie, 1995), and there is also a variety of books on this topic (Rollnick, et al. COMPONENTS OF AN EXERCISE CONSULTATION Assessing stage of exercise behaviour change The consultation should begin by assessing the individual’s stage of exercise behaviour change in order to select the most appropriate strategies to use in the consultation. Those who have recently completed a phase III exercise programme are likely to be either regularly physically active (i.
The older population that came out of these developments was now plagued by hypertension purchase 260 mg extra super avana with amex, arthritis best extra super avana 260 mg, and diabetes as well as numerous con- ditions that reflected the lifestyles that emerged within the U order extra super avana 260 mg on line. The Evolving Societal and Healthcare Context 61 This section cannot begin to address all of the demographic trends that have contributed to the changing healthcare environment; it focuses on the key demographic trends and notes their likely implications for health- care marketing extra super avana 260 mg. Changing Age Structure The first, and perhaps most important, demographic trend in the United States is the population’s changing age distribution. The aging of America has obviously been one of the most publicized demographic trends in his- tory. The implications of this trend for health services demand have been well documented, with age arguably the single most important predictor of the demand for health services. The internal restructuring of the age distribution of the population has particular significance for the demand for health services. Population growth within the older age cohorts (age 55 and older), particularly among the oldest old (age 85 and older), is currently faster than that in the younger cohorts. The total population increased by 13 percent between 1990 and 2000, whereas the population 85 and older increased by more than 36 per- cent. The movement of the baby boomers into middle age will make the 45- to 65-year-old age group the largest age cohort in the next decade. The factor with the most significant implications for future health- care demand is the movement of the huge baby boom cohort into middle age. This cohort grew up in affluence and comfort, and they are used to hav- ing things, including their health, in working order. When they have to contend with the onset of chronic disease and the natural deterioration that comes with aging, the healthcare system will be significantly affected. This cohort grew up during the marketing era and is more comfortable with healthcare marketing than any previous generation. As will be dis- cussed later, this is also a very savvy consumer population that requires spe- cial consideration from healthcare marketers. The nature of the future senior population will be determined to a great extent by the characteristics of the baby boomers. Nearly 78 million Americans were born between 1946 and 1964, and the oldest among them were in their 50s as the twentieth century ended. Boomers are determined to reinvent retirement, a process that appears to already be underway. Retirement is no longer seen as a type of default condition but as a con- 62 arketing Health Services text for new and different lifestyles. Boomers have already influenced the healthcare delivery system in significant ways. They were primarily respon- sible for the establishment of health maintenance organizations, birthing centers, urgent care centers, and outpatient surgery centers as features on the healthcare landscape. Now they are driving the demand for a wide range of new services such as laser eye surgery, skin rejuvenation, and menopause management. An automatic accompaniment to the aging of America has been the feminization of its population. The changing age distribution has impor- tant implications for the population’s male–female ratio. Among sen- iors, females outnumber males two to one, and at the oldest ages there may be four times as many women as men. These statistics on the female population have important implica- tions for healthcare marketers. Perhaps even more important, women bear much of the burden for healthcare decision making, not only for them- selves but for their families. Thus, a growing body of healthcare marketing lore highlights women as both healthcare consumers and decision makers.
Some kitchen systems allow for adjustment with changing circumstances: seek advice from your occupational therapist or specialist kitchen manufacturer about what is available order extra super avana 260 mg free shipping. The point at which you decide to order extra super avana 260mg mastercard, or indeed have to buy 260 mg extra super avana overnight delivery, make some major changes in your kitchen area varies so much between individuals and the household situation generic extra super avana 260 mg, that it is difﬁcult to make hard and fast rules about when you should embark on them. Other factors will be critical, particularly resources, and whether you can get additional ﬁnancial help for such alterations from your local Social Services Department, usually through your occupational therapist. The ﬁrst way focuses on using foods which are pre-prepared in various forms, thus minimizing the amount of food preparation that you or members of your household have to undertake. There has been a revolution in this area over the last few years, leading to a major increase in prepared foods, instigated by changing lifestyles and the vastly increased number of women who are undertaking several jobs at once, both inside and outside the home. MOBILITY AND MANAGING EVERYDAY LIFE 117 Although almost all people, and especially women, feel that they may be neglecting their families by using the staggeringly wide range of convenience foods, many now use such food increasingly to save time and energy. If people with MS do the same, they are not doing anything unusual, but just following a general trend. Many of those foods that are harder for people with mobility problems to prepare – potatoes, salads and vegetables, for example – can now all be purchased in pre-prepared form. Although there is an additional price to pay for these foods, and maybe a minor loss in nutrition, this is more than compensated for by the saving in time and energy that is spent preparing everything yourself – just like most people without MS! You have to strike a balance between convenience and possible modest drawbacks in terms of nutrition. If you are worried about any nutritional issues, you should consult your doctor, or ask for a referral to a dietitian or nutritionist. The second way is to consider additional aids and equipment that may be available to help you in the kitchen area. These may range from things like non-slip mats to secure mixing bowls, to high stools to work on, special trolleys, and padded handles to ensure a better grip. A wide range of everyday kitchenware, such as knives, forks, spoons, ladles, and so on, are now available in a form that will help you get a better grip. Try and phase what you do, so that you do not feel exhausted from working overlong on single tasks without a break. Look for special recipe books that not only suggest nutritious foods, but also show short cuts in food preparation. Using a microwave oven, especially the modern combination types, can be easier than a conventional one and, although it can be seen as just another short cut, cooking interesting food in such an oven can be quite a challenge. One of the additional beneﬁts of a microwave oven is that it generates less external heat than a conventional oven and this could be an important point for people with MS who are very sensitive to heat. Many people with MS have a problem with grip or sensation, and this, together with a hot food or utensil, is not a recommended combination! It is important to keep your eyes on whatever you are carrying, and to use this as a double check to ensure that you are carrying it ﬁrmly enough. By and large you should hold things with both hands, rather than with one or two ﬁngers. In particular, try to carry hot liquids in containers with ﬁtted lids so that, if you do drop them, there is less danger. For the most part, carrying and holding things is just a question of getting 118 MANAGING YOUR MULTIPLE SCLEROSIS used to the changes in your sensations and grip, and being deliberate and careful about moving things, especially items that are hot. Writing aids Conventional pens and pencils are amongst the most difﬁcult items to use if you have problems with grip, or indeed tremor. Pens or pencils that are much bigger in diameter than normal ones and have a less smooth surface are becoming fashionable now because they are ergonomically better for everyone’s ﬁngers, and you should be able to ﬁnd a selection of these in a large stationery shop or suppliers of products for people with disabilities. You could try putting elastic bands around pens and pencils to make them easier to use. The issue of tremor is in some ways more complex: it is of limited use being able to grip a pen if your writing is such that people have difﬁculty in reading it. This problem can be managed by weighting your wrist, for example, or by using weighted pens etc. In this case there are various devices, writing guides for example, which help you to form letters and words, lessening the effect of the tremor.
Supporting Evidence: Davis and colleagues (30) (moderate evidence) studied imaging studies in 23 patients that compared contrast-enhanced Chapter 10 Adults and Children with Headache 187 MRI with double dose-contrast enhanced CT extra super avana 260 mg without prescription. Contrast-enhanced MRI demonstrated more than 67 deﬁnite or typical brain metastases buy extra super avana 260 mg otc. The authors concluded that MRI with enhancement is superior to double dose-contrast enhanced CT scan for detecting brain metastasis proven 260mg extra super avana, anatomic localization purchase 260 mg extra super avana fast delivery, and number of lesions. All patients were studied with contrast-enhanced CT scan and gadolinium-enhanced MRI. Both contrast-enhanced CT and gadolinium-enhanced MRI detected lesions greater than 2cm. For lesions less than 2cm, 9% were detected only by gadolinium-enhanced T1-weighted images. The authors concluded that gadolinium-enhanced T1-weighted images remain the most accurate technique in the assessment of cerebral metastases. Sze and colleagues (32) performed prospective and retrospective studies in 75 patients (moderate evidence). In 26 patients, however, results were dis- cordant, with neither CT nor MRI being consistently superior; MRI demonstrated more metastases in nine of these 26 patients, but contrast- enhanced CT better depicted lesions in eight of 26 patients. Theses guidelines reinforce the primary impor- tance of careful acquisition of the medical history and performance of a thorough examination, including a detailed neurologic examination (33). Among children at risk for brain lesions based on these criteria, neuro- imaging with either MRI or CT is valuable in combination with close clinical follow-up (Fig. Supporting Evidence: In 2002 the American Academy of Neurology and Child Neurology Society published evidence-based neuroimaging recom- mendations for children (34). Six studies (one prospective and ﬁve retro- spective) met inclusion criteria (moderate evidence). Data on 605 of 1275 children with recurrent headache who underwent neuroimaging found only 14 (2. Suggested guidelines for neuroimaging in pediatric patients with headache Persistent headaches of less than 1 month’s duration Headache associated with abnormal neurologic examination Headache associated with seizures Headache with new onset of severe episodes or change in the type of headache Persistent headache without family history of migraine Family or medical history of disorders that may predispose one to CNS lesions, and clinical or laboratory ﬁndings that suggest CNS involvement 188 L. Neuroimaging should be considered in children with an abnormal neuro- logic examination or other physical ﬁndings that suggest CNS disease. Variables that predicted the presence of a space-occupying lesion included (a) headache of less than 1 month’s duration, (b) absence of family history of migraine, (c) gait abnormalities, and (d) occurrence of seizures. Medina and colleagues (33) performed a 4-year retrospective study of 315 children with no known underlying CNS disease who underwent brain imaging for a chief complaint of headache (moderate evidence). Clinical data were correlated with ﬁndings from MRI and CT, and the ﬁnal diagnosis, by means of logistic regression. Thirteen (4%) of patients had surgical space-occupying lesions—nine malignant neoplasms, three hemorrhagic vascular malformations, and one arachnoid cyst. Medina and colleagues identiﬁed seven independent multivariate predictors of a sur- gical lesion, the strongest of which were sleep-related headache [odds ratio 5. Other predictors included vomiting, absence of visual symptoms, headache of less than 6 months’ duration, confusion, and abnormal neurologic examination ﬁndings. A positive correlation between the number of predictors and the risk of sur- gical lesion was noted (p <. No difference between MRI and CT was noted in detection of surgical space-occupying lesions, and there were no false-positive or false-negative surgical lesions detected with either modal- ity on clinical follow-up. Neuroimaging is sug- gested for patients who meet any of the guidelines in Table 10. For patients who do not meet these criteria or those with negative ﬁndings from imaging studies, clinical observation with periodic reassessment is recommended. Diagnostic performance of imaging Variable Baseline (%) Range (%) Reference Diagnostic tests MR imaging Sensitivity 92 82–100 33, 39, 40 Speciﬁcity 99 81–100 33, 40 CT Sensitivity 81 65–100 33, 39, 40 Speciﬁcity 92 72–100 33, 39, 40 VII. What Is the Sensitivity and Speciﬁcity of Computed Tomography and Magnetic Resonance Imaging? Summary of Evidence: The sensitivity and speciﬁcity of MRI are greater than those of CT for intracranial lesions. For surgical intracranial space- occupying lesions, however, there is no difference between MRI and CT in diagnostic performance.
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