Thesis (Ph. D.)--Washington State University. / Includes bibliographical references.

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Thesis (M.D.)—Boston University

Evaluating side-to-side symmetry in the lower extremity has been significant in assessing injury risk and the success of rehabilitation programs. Considering limb dominance in the lower limbs is also important as limb dominance could influence symmetry measures. There is a need to assess symmetry, particularly in healthy populations, in tasks other than walking and running and establish how the dominant limb can impact symmetry. By evaluating symmetry in healthy adults, how the limbs function with respect to one another can be determined. Therefore, the first purpose of this study was to investigate the impact of lower limb dominance on walking and sitting-to-standing. Data was collected from 49 healthy older adults, aged 50-89 years old. Using loadsol® sensors (Novel, St. Paul, MN, USA), plantar loading data such as peak impact force and loading rate was calculated. Participants completed one sit-to-stand trial and three 10-meter walking trials, as these serve as prime examples of daily activities. The secondary purpose of this study was to assess the impact of lower limb dominance on athletic tasks like running and agility. The pedar-X® pressure insoles (Novel, St. Paul, MN, USA) were used to collect plantar loading data such as peak force, contact area, and contact time, from 10 athletes. Participants completed five t-drill trials and five agility ladder drill trials. The acceleration phase of the t-drill served as standard running. A mixed effects model was used to test if differences existed in various plantar loading outcome measures based on limb dominance. Non-parametric tests were used for non-normally distributed data. The statistical analysis determined that no significant differences existed between the dominant limb and non-dominant limb for the 10-meter walking trials peak impact force (p=0.245) or average loading rate (p=0.943). During the sit-to-stand trial, no significant differences existed in peak impact force (p=0.317) or average loading rate (p=0.943). For the agility ladder drill, the maximum force (p=0.427), contact area (p=0.517), or contact time (p=0.734) showed no significant differences. In the T-drill, the maximum force (p=0.385), contact area (p=0.571), or contact time (p=0.571) had no significant differences. These drive the conclusion that limb dominance does not need to be considered when assessing side-to-side symmetry. / Master of Science / Understanding how the left and right lower limbs of the body compare is important to preventing injuries and measuring if rehabilitation interventions are beneficial. A factor in that is knowing how the dominant limb can affect how the lower limbs compare to one another. Through symmetry, especially in healthy adults, a greater comprehension for over limb functionality can be better understood. There is need to assess the lower limb symmetry in healthy populations in tasks aside from walking and running as well as establish how the dominant limb is impacting that symmetry. The first purpose of this study was to observe how lower limb dominance affects walking and standing from a seated position. Data was collected from 49 healthy older adults, aged 50-89 years old. Insoles were placed in participants' shoes to collect plantar loading data. Each participant did two tasks: one trial of the sit-to-stand and three trials of 10-meter walking. The second purpose of this study was to observe how lower limb dominance affects athletic tasks such as running and agility. Loading insoles were used to collect data from 10 current or previous athletes. Each participant did five t-drill trials and five agility ladder trials. Statistical analyses established no significant differences were shown between the dominant and non-dominant limbs peak impact force for the 10-meter walking trials (p=0.245) nor for the average loading rate (p=0.943). For the sit-to-stand trial, no significant differences were seen in peak impact force (p=0.317) or average loading rate (p=0.943). In the agility ladder drill, no significant differences were shown for the maximum force (p=0.427), contact area (p=0.517), or contact time (p=0.734). In the agility ladder drill, no significant differences existed for the maximum force (p=0.385), contact area (p=0.571), or contact time (p=0.571). These findings suggested that the dominant limb does not impact lower limb comparisons.

Human locomotion is a topic that has been studied for many years in biomechanics. To perform athletic tasks or everyday tasks, balance and symmetry is needed. Symmetry is the perfect balance and correspondence of the body or parts of the body. This concept has often been used to evaluate the normality of movements. Limb symmetry, specifically, is the equal actions of the lower limbs during movement. This is needed to perform tasks safely and efficiently without injury. Gait and movement symmetry has been used to predict lower limb injury risk for many populations and improve performance for athletes. It has also been used in assessment for rehabilitation processes and return to sport processes following injury or surgery. For many years, healthy gait was considered to be symmetrical for simplification purposes. However, many studies have contradicted that conclusion showing that even for has asymmetrical patterns. Deficits in symmetry can reduce quality of life for some individuals and can have detrimental health effects. Many measures have been used to assess symmetry in various tasks that have important implications on gait patterns. Another component of gait and movement that affects performance and injury risk is limb stiffness. Limb stiffness is the body's resistance to deformation when moments and forces are applied to it. The body has been shown to be modeled as a spring mass system that can restore and reuse energy. This is associated with the stretch shortening cycle during cyclic movements, such as running and walking. Limb stiffness is also associated with musculoskeletal loading that impacts performance and injury. Therefore, optimizing limb stiffness is important to improve utilization of elastic energy for athletic performance and reduce injuries associated with high and low limb stiffness values. Imbalances in limb stiffness have been shown to increase injury risk during walking and other tasks. Studying these imbalances using symmetry indices could give insight into the injury risk associated with this metric. In addition, limb stiffness in humans has been shown to change with the type of contact surface. This is associated with compensation methods used by humans when contacting different surfaces. Studying the relationship between limb stiffness symmetry and different surfaces during walking is important to observe how humans adjust and how it impacts injury risk. The purpose of this research was to assess the impact that surface stiffness has on limb stiffness symmetry during walking in healthy adults. To assess limb stiffness differences when transitioning to different surface stiffnesses anteriorly and posteriorly, the Normalized Symmetry Index (NSI) was determined for the two transition conditions and the control. The results showed that limb stiffness NSI was significant between the conditions (p=0.012). More specifically, a difference was seen between the stiff to compliant transition and the control (p=0.020) and the compliant to stiff transition and the control (p=0.032). These results show that humans do compensate when transitioning onto different surfaces. This is essential for understanding how humans adjust during real world walking and what patterns are used to maintain stability. To assess limb stiffness symmetry, when surface stiffness is different between limbs, the limb stiffness NSI was compared between two conditions. This included the side-to-side stiffness difference condition and the control condition. The results revealed that surface stiffness was not significant between conditions (p=0.244). Based on these results, limb stiffness symmetry is not significantly impacted when the surface stiffness is different between limbs. This contradicts prior studies that observed changes limb stiffness and symmetry depending on the surface stiffness. This may be due to overcompensation or the ability of the healthy adult population to quickly adjust to the surface stiffness changes before the measurements were taken. Simulating uneven surfaces is important to understand how humans compensate to maintain stability on surfaces in real world walking and for imbalances due to disorders. Further research is needed to study the changes in limb stiffness symmetry on different surfaces during walking to improve injury prevention methods. / Master of Science / Humans perform many daily tasks and athletic tasks that have been observed in human movement analysis. To perform these tasks safely and efficiently, many factors must be considered. One of the important factors in performing tasks is symmetry. Symmetry is the perfect balance between parts of the body, such as the lower limbs during walking or gait. Gait in healthy adults was considered to be symmetrical for simplification purposes. However, studies have revealed that gait asymmetry is present in the healthy adult population during walking and other movements. Gait symmetry has been used to assess normality of gait patterns in healthy individuals and in clinical populations. Asymmetrical gait patterns can lead to injury and have detrimental effects on health. Therefore, limb symmetry has been an important metric to assess lower limb injury risk and improving injury prevention methods to correct asymmetrical patterns in healthy adults and other populations. Another aspect of human movement that impacts injury is limb stiffness. Limb stiffness is the body's resistance to deformation under applied forces. High limb stiffness values have been associated with bony injuries due to increased loading. However, low stiffness values have been associated with soft tissue injuries. Therefore, regulating limb stiffness is important to reduce injuries in the long term. The type of contact surface during walking and other tasks has been shown to change limb stiffness values. Humans often encounter changes to surfaces when walking. For example, hikers who encounter uneven terrain or everyday walking on uneven pavement. Uneven surfaces have been shown to require more energy and work to move forwards during walking. Therefore, simulating uneven surfaces in the real world is important to understand how humans compensate on different surfaces. This could be important for understanding how limb stiffness imbalances on different surfaces affect injury. To quantify these imbalances, the metric of limb stiffness symmetry will be used. Limb stiffness imbalances due to surface stiffness are essential to assess how humans adapt to instability during real world walking. Therefore, this study aims to determine how humans adjust when transitioning to different surface stiffnesses and when surface stiffness is different between limbs. To determine how humans adjust when transitioning to different surfaces of different stiffnesses, the limb stiffness symmetry was calculated using the Normalized Symmetry Index (NSI). This was calculated for three different surface stiffness conditions, consisting of a stiff to compliant transition, a compliant to stiff transition, and the control condition. The results showed that there was a significant difference between the NSI values of the three conditions. However, there was no difference between the two transition conditions. This indicated that there was no difference between the transition order. Based on the results, limb stiffness symmetry does change when transitioning to different surface stiffness conditions. This agrees with previous literature that suggests that surface stiffness has an impact on limb stiffness. This information is beneficial to understand the patterns humans use to compensate to maintain stability. To determine how limb stiffness symmetry is impacted when surface stiffness is different between limbs, the limb stiffness NSI was calculated for two surface conditions. This included the side-to-side condition and the control condition. The results showed that there was no statistical difference between the limb stiffness NSI values of the two conditions. This shows that limb stiffness symmetry doesn't change when the surface stiffness is different between limbs, which disagrees with previous literature. Overall, this information is important to understand how humans compensate when transitioning on different surfaces or walking on uneven surfaces. This is important to understand how stability is maintained despite imbalances for improvement of injury prevention methods.

Objective: To assess the safety and efficacy of lyophilized milled human amnion as a wound dressing of experimentally created equine distal limb wounds. Animals: Four clinically normal adult horses (3 Thoroughbred and 1 Paint, median age 11 years) obtained via donation. Procedures: One forelimb of each horse was randomly assigned to the treatment group, and the contralateral limb was assigned as the control. Full-thickness skin wounds were created on each metacarpus. Treatment limb wounds were dressed with lyophilized, milled, human-derived amnion material delivered under triple antibiotic ointment. Control wounds were dressed with triple antibiotic ointment. All wounds were covered in non-adherent dressings and distal limb bandages were applied. Digital photographs were taken of the wounds at each bandage change, performed every 2-4 days throughout a 98-day study period. Biopsies were collected at days 7, 21, 35, and 84. Results: One horse developed unilateral cellulitis that resolved with additional treatment. All treatment limbs exhibited an inflammatory response characterized by focal edema and discharge from the wounds. Wounds were completely epithelialized in control limbs sooner than treatment limbs in all horses, although there was no statistical difference between control (mean 46.8 days) and treatment (mean 51.8 days) wounds. Histologic scores were better in control wounds than in amnion-treated wounds at all time points. Conclusions and Clinical Relevance: Because wounds treated with amnion material in this study exhibited an inappropriate inflammatory response that resulted in delayed time to wound closure, human lyophilized milled amnion is not recommended for use in equine wound management. / Master of Science

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Short Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg 2017 / This research project described the outcomes for upper limb motor function (ULMF) and personal management (PM) for patients attending occupational therapy at Chris Hani Baragwanath Academic Hospital post-stroke. A quantitative, descriptive correlation design was used. A purposive sample of adult patients who met the inclusion criteria was selected. The researcher completed initial assessments of ULMF using the Fugl–Meyer assessment and the South African Data for Functional Measurements: Beta Scale to assess independence in PM. Research participants received rehabilitation as usual. The same measurements were administered on discharge and during out-patient follow up appointments at one, two and three months. Data was analysed using descriptive statistics. Results indicated that recovery of ULMF was influenced by the site of lesion. Gender and age did not influence recovery of ULMF. Severe motor disability, which resulted in poor recovery of UL and LL, yielded poor independence in PM. / MT2017