Showing papers on "Stair climbing published in 1982"

The influence of total knee-replacement design on walking and stair-climbing.

Abstract: The relationship between gait and prosthetic design was studied during level walking and stair-climbing for twenty-six asymptomatic patients after total knee replacement. An age-matched group of fourteen control subjects was also studied. Five designs of total knee replacement Geomedic, Gunston, total condylar, duopatellar, and Cloutier were used. Differences in gait could be identified on the basis of prosthetic design. The more stressful stair-climbing test produced more clearly differentiated function among the different designs. Patients who were treated with the least-constrained cruciate-retaining (Cloutier) design of prosthesis were the only group that had a normal range of motion during climbing up and down stairs. Two groups of patients with semiconstrained (total condylar and Geomedic) designs had a lower than normal range of knee fiexion while descending stairs. Patients with the other designs of prosthesis had a normal range of knee motion on stair-climbing. Kinematic and anatomical differences among the five designs did not have as great an influence on function during level walking as they did during stair-climbing. The results of this study indicate that after total knee replacement even asymptomatic patients with excellent clinical results have an abnormality of gait. The features of the abnormality were common to most of the patients in the series, and consisted of a shorter than normal stride length, reduced mid-stance knee flexion, and abnormal patterns of external flexion-extension moment of the knee. Although an explanation of these abnormalities of gait is not completely possible at this time, they appear to be related to the interaction of the kinematics of the knee and surrounding soft tissues. CLINICAL RELEVANCE: It appears that patients with less constrained cruciate-retaining designs of total knee replacement have a more normal gait during stairclimbing than patients with more constrained cruciate-sacrificing designs. During level walking, patients with five quite different designs all had abnormalities of gait in spite of a successful clinical result. There is currently a great deal of controversy regarding which type of total knee prosthesis provides better Funded in part by National Institutes of Health Grants KO4AMO()493 and ROIAM2O7O2 and by the Arthritis Foundation. 1 Department of Orthopedic Surgery . Rush-Presbyterian-St. Luke’s N’lcdical Center. 753 Wcst Congress Parkway, Chicago. Illinois 60612. gait. An improved understanding of gait and the variables associated with total knee designs is essential in addressing this controversy. Quantitative studies of gait during activities of daily living are needed to generate this information, and will be useful for the evaluation of total kneereplacement devices and for providing understanding of the loading patterns that may occur during normal activity. Several studies have evaluated gait in patients with knee disease. These investigations included kinematic analyses I .6.7.9.I i.2I , time-distance measurements, and force-plate measurements. There have also been several kinetic and force-analysis studies of function in normal subjects and in patients after treatment for knee disabilitiesaIa14l7ao. The common finding of these studies was that patients who appear to be clinically asymptomatic after joint replacement have abnormal gait patterns. Currently, little is known about the nature of the gait abnormality in patients after total knee replacement or its relationship to total knee-replacement design. The purpose of this study was to evaluate the relationship between gait and total knee-replacement design. The prosthetic knees that were selected for this study were considered to be representative of cruciate-sacrificing and sparing designs with varying amounts of constraint. The parameters ofgait that we observed included time-distance patterns and motion and moments of the knee joint. The gait of patients who had received one of five different designs of total knee replacement was evaluated and cornpared with that of control subjects. Materials and Methods Twenty-six patients. in five experimental groups. were studied during level walking and stair-climbing. Patients were grouped according to which of five total knee designs they had received. The five implants selected for this study were the Geomedic, Gunston, total condylar. duopatellar, and Cloutier designs. The five designs of prosthesis were selected to represent varying shapes of the articular surfaces and the retention of one, both, or neither cruciate ligament. The Geomedic prosthesis has fairly congruous articular surfaces. requires removal of the anterior cruciate ligament, permits retention of the ps)sterior cruciate ligament. and does not include a patellar flange or resurfacing. The Gunston prosthesis consists of two separate semicircular runners that articulate with two independent tibial components, permits retention of both cruciate ligaments. and does not include patellar resurfacing or a patellar flange. The total condylar design requires the sacrifice of both cruciate ligaments. with anterior-posterior stability provided by the conformity of the tibial articulating surfaces; all patients with this design had patellar resurfacing. The duopatellar prosthesis permits retention of the posterior cruciate ligament. includes a patellar flange. and allows patellar resurfacing, which was performed in all of the patients whom we examined. The Cloutier prosthesis allows retention of both cruciate ligaments and the femoral condyles are asymmetneal, diverge. and have varying radii of curvature. The tibial component of the Cloutier device consists of flat articular surfaces supported on a metal retainer, and the design has a patellar flange. but patellar resurfacing was not performed in our patients. The patients selected for this study were matched according to postoperative pain. function, passive range of motion, and joint stability. A point system based on The Hospital for Special Surgery knee.rating system was used to quantitate

Teaching Profoundly Retarded Adults to Ascend Stairs Safely.

Abstract: The present study describes an attempt to modify the stair-climbing behavior of two profoundly retarded residents. A training package consisting of backward shaping with graduated guidance, edible rewards, a correction procedure, and a 30-second time-out was used to increase appropriate stair climbing. The validity of the training was demonstrated through the use of a multiple baseline design across subjects. Both residents showed an increase in the number of correct steps used while ascending the stairs. Addi tionally, the amount of time one resident required to ascend the stairs was modified to within normal limits. Method The behavioral literature for teaching protarded clients and assessed the effects of foundly retarded adults various self-care training on both familiar and unfamiliar sets skills is well documented (Azrin & Armof stairs. strong, 1973; Azrin & Foxx, 1971; Horner & Keilitz, 1975; Matson, Marchetti, & Ad kins, 1980; Stimbert, Minor, & McCoy, 1977; Treffry, Martin, Sameis, & Watson, c , ■ , , c ... i ' ,T.. ' . . . ' , .... Subjects and Setting 1970). The acquisition of other motor skills could increase retarded clients' capacity for Two profoundly retarded female residents freedom of movement in their environment: of a large state institution for the develop teaching clients to perform daily exercise mentally disabled, aged 53 and 31, served as (Allen & Iwata, 1980), independent walking subjects. The Fairview Self-Help Scale re (Angney & Hanley, 1979), consistently putvealed behavioral quotients of 7 and 10, re ting on hearing aids independently (Tucker spectively. Both clients lived in a cottage with & Berry, 1980), independent travel (Gruber, 55 other severely and profoundly retarded Reeser, & Reid, 1979), and opening doors residents, and both required much physical by turning the doorknob (Cipani, Augusassistance from cottage staff in the most tine, & Blomgren, 1980). basic self-care skills. Neither had any func Another common mobility skill deficit in tional expressive speech and both displayed profoundly retarded clients is that of approlimited receptive language ability, priate stair-climbing behavior. Such clients need to be held or watched closely while asJ d Behavw and R g Definition cending or descending stairs, and may be housed in living environments that minimize The clients exhibited extensive problems in the opportunity to walk up and down stairs. walking up a set of stairs and required staff Consequently, this deficit restricts their momembers' physical assistance. Both would bility. attempt to ascend several steps or more in This study attempted to modify the stairone leap. Client 1 would leap three to four climbing behavior of two profoundly resteps at a time (sometimes using hands and Teaching Profoundly Retarded Adults to Ascend Stairs Safely / 51 This content downloaded from 207.46.13.43 on Wed, 25 May 2016 06:08:24 UTC All use subject to http://about.jstor.org/terms feet), frequently stopping in her ascent to 98.6%). The reliability of length of time re body rock and exhibit other inappropriate quired for client 1 to ascend the stairs was behaviors for extended periods of time. assessed by dividing the number of agree Client 2 would not hold the guard rail and ments by the number of agreements plus would ascend several steps at one time with disagreements. Observers were said to agree her right foot. if their estimates fell within one second of The target behavior (appropriate stair each other. The percentage of observer climbing) was defined as placing the lead agreement ranged from 88% to 100% (mean foot on one step followed by the other foot = 98.6%). on the following step while the right hand held the guard rail. Each step was scored as Training correct or incorrect. A correct performance b was scored when the back foot was placed Training sessions were conducted for each on the next step while the client's hand held subject in a time-staggered fashion in accor the guard rail. Because client 1 exhibited a dance with a multiple baseline design. The number of inappropriate behaviors while training package involved a backward shap ascending the stairs, the total length of time ing procedure, graduated guidance, edible taken to ascend the stairs was also assessed. reinforcement, a correction procedure, and (Client 2 ascended the stairs within a reasona 30-second time-out. The number of steps able amount of time.) One set of stairs was in all training stairways was 11; training ses used for assessment sessions; three different sions were approximately 25 minutes in sets of stairs were used during training trials. length. Clients were started from two steps be . _ , , _ ,. .... neath the top of the stairs in the first few Observation Procedures and Reliability . . r. .. , . , training sessions. The client s hand was During assessment trials, clients were posiplaced on the guard rail and she was given tioned at the bottom of the stairs with their the command to go up the stairs. The ther right hands on the guard rail and given the apist then guided the client to climb the last command, "Go up the stairs!" The number two steps, one at a time. If the client reached of correct steps ascended was counted by an the top by correctly taking one step at a time, observer. To reduce the possibility of the she was rewarded with edibles. Contingent client falling, the observer remained a few upon the occurrence of an inappropriate re steps behind her. As the client reached the sponse (i.e., attempting more than one step last step, she was guided (verbally and/or at a time), the therapist said "No" loudly, physically) down the stairs and another trial and physically guided the client back to the was initiated. Neither client exhibited any original starting point (correction proce inappropriate behaviors descending the dure). The client was then held at the start stairs. For client 1, the total time taken to ing point for 30 seconds (time-out) before ascend the stairs was measured from the another trial was initiated. time the command was given until both feet When the client demonstrated 80% cor were placed on the top step. During assessrect performance with no physical guidance ment sessions, each client was given eight necessary for two consecutive sessions, she trials; the number of steps correct was rebegan her trial at three steps from the top. corded for each trial. The number of steps required for reinforce Reliability was assessed in 41% of the sesment was increased by one each time the sions by having a second observer indepen80% criterion level was reached. However, dently count the number of correct steps as once the criterion level was reached at five well as record the time that client 1 took to steps from the top, the remaining trials were ascend the stairs. The reliability for the started from the bottom of the 11 stairs. number of correct steps was determined by Training progressed through these five dividing the smaller estimate of correct steps stages (steps 2, 3, 4, 5, and 11) for both by the larger estimate for each entire session clients. and ranged from 88% to 100% (mean = When the client demonstrated 80% cor 52 / Education and Training of the Mentally Retarded-February 1982 This content downloaded from 207.46.13.43 on Wed, 25 May 2016 06:08:24 UTC All use subject to http://about.jstor.org/terms Saseline Training Baseline Training 11 10—

Stair climbing transport device, especially for goods

Abstract: not available for EP0009005Abstract of corresponding document: US4310166A transport apparatus having a loading bridge, is movable by hand for transporting loads over stairs. There are two front rollers (3), which are either extendable or variable in their angular position, and two rear rollers (7), which are secured to downwardly extending arms (6). The loading bridge (1) takes up a rearwardly tilted position when the transport apparatus rests with the rollers (3, 7) on a horizontal surface. The spacing between the front and rear rollers (3, 7) and the roller diameters are selected so that, when climbing a stair, the front rollers (3) rest on an upper tread while the rear rollers (7) simultaneously rest on a lower tread. When the apparatus is not in use, it may be folded to take up but a small space by folding the tiltable hand levers (14) inwardly and by tilting the arms (6) upwardly.