Sheng-Che Lin

THE GAIT ANALYSIS OF PREGNANT WOMEN

During pregnancy, a woman changes obviously in body weight, body shape, and endocrine system. Those changes make the posture and gait pattern of the pregnant women different from those of the non-pregnant women. At the same time, activities of daily living become more difficult. But there was still no published paper discussing the posture and gait changes of the pregnant women in details and in a whole. In this study, we used the optimization method to define the hip joint center of the pregnant women. The optimization method could compensate the lack of the anthropometric data of the pregnant women. Due to the variations of physiological changes in the pregnant women, it was difficulty to standardize the gait analysis of pregnant women, even in the same gestational age. The results revealed that there really was some correlation between the significant finding of gait analysis and sacroiliac pain of the pregnant women. The sacroiliac pain often occurred in the following conditions of gait analysis: (1) when the hip extension moment increased; (2) when the knee extension moment decreased; (3) when the angle of ankle plantar-flexion decreased; and (4) when the sacroiliac ajoint torsion increased. The gait analysis of the pregnant is a feasible, but complicated method for study. The data of gait analysis were also compare with questionnaires for further analysis.

The force synergy of human digits in static and dynamic cylindrical grasps.

This study explores the force synergy of human digits in both static and dynamic cylindrical grasping conditions. The patterns of digit force distribution, error compensation, and the relationships among digit forces are examined to quantify the synergetic patterns and coordination of multi-finger movements. This study recruited 24 healthy participants to perform cylindrical grasps using a glass simulator under normal grasping and one-finger restricted conditions. Parameters such as the grasping force, patterns of digit force distribution, and the force coefficient of variation are determined. Correlation coefficients and principal component analysis (PCA) are used to estimate the synergy strength under the dynamic grasping condition. Specific distribution patterns of digit forces are identified for various conditions. The compensation of adjacent fingers for the force in the normal direction of an absent finger agrees with the principle of error compensation. For digit forces in anti-gravity directions, the distribution patterns vary significantly by participant. The forces exerted by the thumb are closely related to those exerted by other fingers under all conditions. The index-middle and middle-ring finger pairs demonstrate a significant relationship. The PCA results show that the normal forces of digits are highly coordinated. This study reveals that normal force synergy exists under both static and dynamic cylindrical grasping conditions.

MOTION ANALYSIS OF MOUTH MOVEMENT UTILIZING CHALLIS TECHNIQUE-EXPERIMENT MODEL AND CLINICAL STUDY USING VIDEO-BASED SYSTEM

An Expert Vision motion analysis system with five analog video cameras was used to evaluate the mouth movement during two facial animations (smile and puffy face). Sixteen skin markers were adhered to the face of subject according to the anatomic landmarks to represent the functional movement of the facial muscles. The trajectory of the four or eight peri-oral skin markers was simultaneously evaluated by Challis technique, instead of individual movement of single marker. The 4-marker method is a little less accurate than 8-marker method. But the 4-marker method can be incorporated as a part of our modality of facial motion analysis, including two/three dimensional displacement of individual marker and absolute/relative displacement of paired markers. It was much easy for data acqusition and no extra marker was needed in the whole modality of our facial motion analysis. Physicians can use this Challis technique to evaluate grouped movement of facial markers, as a whole, in different animation.

Modified Negative Pressure Therapy in Clinical Wound Care-National Cheng Kung University Hospital Experience

Background: Negative pressure therapy has been shown to be an effective way to accelerate the wound healing process and stimulates the rapid formation of granulation tissue. However, the cost to rent the vaccum assisted closure (VAC) device is high and the indication for its application is limited by National Health Insurance. Aim and Objectives: A system of ”modified negative pressure therapy (MNPT)” in clinical wound care was applied in this hospital and the experience of treatment is delineated in this article. Materials and Methods: There were 49 cases (male: 27, female: 22, mean age: 56.8 years old) received MNPT from 2007 Nov. to 2008 Aug. The sponges are disinfected. The negative pressure system included wall suction in ward with the negative pressure set about 120 mmHg with two hours on and one hour off alternately from 8AM to 12PM and lower continuous pressure (60 mmHg) from 12PM to 8AM. Several parameters were measured such as wound size, depth, vital structure exposure, wound culture, patient wound pain scale, and patient satisfaction scale before and after MNPT. Results: The wound size is 247.95cm^2 in average (1.5~1875cm^2). The final reconstruction methods after MNPT were STSG (16 patients, 63.3%), flap reconstruction (9 patients, 18.3%), healed by secondary intention healing (4 patients, 8.2%), wound closure (3 patients, 6.1%) and amputation (2 patients, 4.1%). Overall complication rate was 6.1%. Daily decrease of wound size was 3.43% per day, the shrinkage rate of vital structure exposure area was 6.82% per day and wound depth decrease rate was 5.58% per day. Overall nursing time in MNPT method is significantly shorter than that in wet dressing group (7.53mins vs. 23.76mins per day) There was no difference of daily cost in MNPT group and wet dressing group. The period of therapy was 10.86 days in average, and the duration of MNPT for deeper wounds with vital structure exposure was 13.67 days in average. The satisfaction and pain scales were better in MNPT group. Conclusion: Negative pressure therapy provides as the alternative way that accelerates the wound healing process and stimulates the rapid formation of granulation tissue. The commercial VAC device offers a constant negative pressure, good alarm system and good result of granulation. For financially unfavorable patients without coverage of National Health Insurance or those still awaiting for the approval of VAC, the MNPT was a good alternative method for obstinate wounds management compared with wet dressing method, not only in facilitating wound healing but also in saving nursing times as well as in reducing patients suffering.

Replantation of Pediatric Multiple Digit Amputation Caused by an Automatic Cup-sealing Machine

In Taiwan, many bubble tea booths provide convenience and choice of soft drinks. Automatic cup-sealing machines designed to package drinks in seconds are widely used in these shops. However, these machines have a hidden risk of causing disastrous hand injuries in children, especially toddlers. We treated a child, aged two years and four months, who was a victim of multiple digit amputation caused by an automatic cup-sealing machine. The trauma mechanism was the child’s accidental grasp of the machine through curiosity, which caused his right hand to be pulled in and compressed by the sealing device. These traumatic effects included both crushing force and contact burn. The affected right index and middle fingers were salvaged successfully in the first operation, but the replanted right ring finger needed a resuscitation procedure involving a venous graft, after which we achieved a promising result. This kind of pediatric finger amputation is preventable by redesigning the automatic cup sealer in a higher level of safety and by restricting access to the machine to employees only.

Comparison of Open and Closed Reduction in Subcondylar Fracture

The aim of this study was to evaluate the long term result of open reduction plus rigid internal fixation as compared with that of closed reduction and intermaxillary fixation in the cases of dislocated mandibular subcondylar fracture. Twenty three patients were enrolled into the series, with 12 cases undergoing open reduction and 11 others having intermaxillary fixation alone. Patients treated with open or closed methods were assessed according to the maximum interincisal opening, protrusive movement, deviation on opening, scar quality, motor function, sensory perception, contour change, occlusion and intensity of joint pain. Long term follow-up results revealed that cases treated with closed reduction tend to have suboptimal outcome, especially in cases with axial inclination of the condylar head, intracapsular fractures, dislocation of the condyle from the confines of the glenoid fossa, and their clinical manifestation include symptoms like severe pain, jaw deviation/deflection upon mouth opening or malocclusion. (J Plast Surg Asso R.O.C. 2006; 15:241~250)

Endoscope-Assisted Reduction of Frontal Bone Fracture-A Case Report

Coronal incision has been the standard approach for the open reduction of frontal sinus fractures. In cases where only the anterior table is involved, the surgical indication is mainly for cosmesis. In such circumstances, coronal incision may solve the fracture problem but it may lead to other aesthetic complications such as long and ugly scars and alopecia over the incision site. In the advent of endoscopic surgery, another option is provided to the placement of incision sites where they not only are smaller in size but also can be easily hidden. A case of frontal sinus fracture using the endoscope assisted reduction with promising aesthetic result was reported.

Simultaneous Quantitation of Three-Dimensional Absolute and Relative Displacements in Facial Movements-A Local Face Frame Technique

Facial motion analysis has been developed in recent years for quantitative analysis of facial expressions. Usually, the vector of absolute movement of facial markers is evaluated for quantitative analysis, such as two-dimensional evaluations of Johnson. Although it is a practical method, the major problem of measurement of absolute displacement is how to maintain the head of subject in a stationary position during facial expression. Trotman recommends the three-dimensional measurement of inter-landmark separation of paired markers as a complementary method of absolute displacement to solve this problem. In our study, the three-dimensional absolute displacement of paired facial markers was used to compare the relative displacement, with a technique of local face frame to solve the problem of head movement. A motion analysis with an Expert Vision HiRes system was used to quantitatively evaluate five facial expressions: brow lift, eye closure, smile, puffy face, and whistle in thirty subjects. The results reveal that the measurement of absolute displacement in a local face frame is a repeatable, quantifiable, and practical method in clinical application. The relative displacement of paired markers is not suitable in the quantitative analysis of eye closure, whistle, and puffy face, and it also under-estimates the absolute displacement of facial movement in brow lift and smile (P＜0.001). The local face frame technique is recommended to prevent the errors caused by position changes of head during measurements, instead of relying on relative displacement of paired facial markers. Surgeons can use this system of facial motion analysis to objectively evaluate the progression and surgical outcome of patients with facial palsy.

Temperature Changes in Ipsilateral Palmar Skin after Radial Forearm Flap Harvest-A Prospective Study by Thermography

The temperature changes of both palms were prospectively evaluated by infrared thermography in 15 patients undergoing radial forearm flap surgery at the National Cheng-Kung University Hospital. All patients were hospitalized for at least 2 weeks. And the temperature changes of both palms were measured preoperatively, on 2 weeks, 1 month and 1 year postoperatively. The average temperature of left palm were 31.493, 31.880, 31.513 and 31.440℃ for these four time points. The corresponding values of right palm were 31.447, 31.967, 31.473 and 31.407℃ respectively. At 2 weeks after surgery, the palmar temperature for both hands were elevated and then decreased thereafter (P＜0.0001). The Tukey HSD method showed significant differences in palmar temperature between 2 weeks postoperatively and other three time points in both palms (all P＜0.005). However, the differences between the left and right palmar temperature (Δ:L-R) were not significant different (P=0.3532) at the four time points of observation. A tendency of decrease in difference of left to right palmar temperature was observed, though, at 2 weeks postoperatively. Recognition of these patterns might lead to better understanding of the temperature change of palms after radial forearm flap and the role of anticoagulant drugs.

Motion Analysis of Facial Animation by Video-Based System-A Preliminary Result

Three dimensional motion analysis was widely used in the kinematic study of upper and lower extremities disorders, such as cerebral palsy, stroke patient…. But application of this method to the study of facial animations was rarely utilized. We tried to use the video-based system (VICON system) to evaluate the quantitative analysis of five facial move-ment: eyebrow lift, eye closure, smile, puffy face and whistle. The preliminary result revealed that 2D amplitudes significantly underestimated the 3D amplitudes for all animations. When the 2D amplitudes were expressed in the percentage of the 3D amplitudes, however, the difference were as large as 57% for the left lateral canthus point during eye closure. So we recommended that 3D analysis by video-based system is much more appropriate for detecting the differences in facial movement than 2D analysis by the image of camera.