Pipatana Amatachaya

External cues benefit walking ability of ambulatory patients with spinal cord injury

Abstract Background/objectives Sensorimotor dysfunction following spinal cord injury (SCI) reduces ability of the patients to perceive information and control movements. They may need alternative sources of input to optimize their walking ability. This study investigated effects of external cues on walking ability in 33 independent ambulatory participants with SCI. Methods Participants’ walking ability was cross-sectionally assessed under three conditions including self-determined fastest walking speed (uncued condition), and fastest walking speed with the use of external cues (visual cue and visuotemporal cue conditions). Walking ability was measured in terms of walking speed, stride length, cadence, and percent step symmetry. Findings of the three conditions were compared using the one-way analysis of variance with repeated measures. Results When using external cues particularly the visuotemporal cue, participants showed a significant increase in walking speed, stride length, and cadence as compared with those of the uncued condition (P < 0.005). The increment of walking speed was demonstrated even in participants at a chronic stage of injury (post-injury time ≥12 months), with severe SCI (American Spinal Injury Association Impairment Scale C), or who required a walking device. Conclusion The results suggested the benefit of external cues, particularly the visuotemporal cues, as a potential rehabilitation tool to improve walking speed of individuals with SCI.

Concurrent Validity of Occiput-Wall Distance to Measure Kyphosis in Communities

Background: The occiput-wall distance (OWD) is a quick and easily administered method to assess kyphosis. Thus it is likely used in epidemiologic studies. However, there are no data to warrant validity of the tool. This study evaluated concurrent validity of the OWD using a Flexicurve as a standard method. Methods: Subjects were 158 well-functioning elderly, aged at least 60 years old and had a perpendicular distance from the bony prominence of C7 to the wall >0 cm. They were assessed kyphosis using Flexicurve and OWD in a random order. The Pearson correlation coefficient was applied to determine levels of correlation. Results and conclusion: The OWD correlated extremely well with the Flexicurve (r = 0.902, p<0.001), thereby the data confirmed concurrent validity of the OWD. Although the method did not measure spinal angle, the findings suggested benefit of OWD to quantify and monitor degrees of kyphosis in a large number of populations.

Is walking symmetry important for ambulatory patients with spinal cord injury

Abstract Purpose: To assess and compare the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI) who had different degrees of lesion severity, levels of walking ability, and fall history. In addition, the study explored the relationship between the levels of walking symmetry and variables related to the ability of well-controlled walking of the participants. Study design: Cross-sectional study. Methods: Sixty-six eligible participants were assessed and interviewed for levels of walking symmetry, walking speed, functional endurance, symmetrical lower limb support ability, balance control, and fall history over the last 6 months. Results: Participants walked asymmetrically (85%) similar to those with unilateral impairments (i.e., patients with stroke and amputee, 79–93%). The levels of walking symmetry were significantly correlated to walking speed, functional endurance and balance ability of the participants (p < 0.05). The problem and correlation were particularly apparent in those with the history of multiple falls (79%, r = 0.613–0.765, p < 0.005) Conclusions: The findings confirm problems of asymmetrical walking and the importance of walking symmetry for the ability of well-controlled walking and a risk of multiple falls in ambulatory participants with SCI. Therefore, apart from the levels of independence, the improvement of walking symmetry is crucial for these individuals. Implications for Rehabilitation: Ambulatory individuals with spinal cord injury walked asymmetrically at the same level as those with unilateral impairments such as patients with stroke and amputee. Their levels of walking symmetry were significantly related to the ability of well-controlled walking, particularly in those with the history of multiple falls. The finding confirmed the importance of walking symmetry as a crucial parameter to detect walking improvement and fall risk reduction. Apart from the levels of independence, rehabilitation professionals also need to emphasize on the improvement of symmetrical walking for these patients.

Is the occiput-wall distance valid and reliable to determine the presence of thoracic hyperkyphosis?

BACKGROUND Hyperkyphosis may be frequently found nowadays due to the change in current lifestyles of sustained flexion postures and age-related system decline. The occiput-wall distance (OWD) is a practical measure that is commonly used to screen and monitor thoracic hyperkyphosis in epidemiologic studies. However, there was no clear evidence to support the clinical utility of the tool as compared to the data from direct standard measures. OBJECTIVES To investigate psychometric properties-including validity, reliability, and appropriate cut-off point-of the OWD to determine the presence of thoracic hyperkyphosis, as compared to a standard Cobbs method. DESIGN Observational study. METHODS This study was conducted in ninety-nine participants, aged 10 years and above who had different degrees of thoracic hyperkyphosis from several communities. All participants were assessed for their severity of thoracic hyperkyphosis using the OWD, and 14 participants were involved in a reliability study. Within 7 days later, all participants were at a hospital to complete a radiographic examination. RESULTS Outcomes from OWD had good concurrent validity with the Cobb angles (r = 0.683, P < 0.001) and excellent rater reliability when assessed by well-trained health professionals (ICCs > 0.9, P < 0.001). The OWD of at least 6.5 cm had the best diagnostic properties to determine the presence of thoracic hyperkyphosis (sensitivity = 71.4%, specificity = 76.6%, and area under the curve = 0.846). CONCLUSION The findings support validity and reliability of OWD, and offer a clear cut-off point to determine the presence of thoracic hyperkyphosis for clinical utility in various settings.

Energy Balance in Al-Co Open-Celled Foam of Transpiration Cooling

Numerical model of one-dimensional steady-state on Alumina-Cordierite (Al-Co) open-celled foam using in transpiration cooling system have been conducted to investigate the local energy balance (LEB) of gas and solid phase within porous plate. Physical properties, i.e., porosity (f), pores per inch (PPI) and thickness (x), of Al-Co open-cellular porous material were 0.87, 13 and 0.103 m, respectively. Two equations of the conservative energy consisting of the gas and solid phase were analyzed. From study, it was found that heat convection (HVF) balanced with heat transfer between two phases/ energy of interaction (INT) for the gas phase case. In the solid phase, heat transfer between two phases (INT) tended to offset heat radiation (HRS). Remarkably, heat conduction of both phases (HDF and HDS) was not effected to the present cooling system. Thus, characteristic of fluid flow effecting by HVF and heat transfer governed from HRS was strongly efficient to transpiration cooling system.