By S. Denpok. Oregon Graduate Institute of Science and Technology. 2018.
DST file generated in GaitLab proven prednisolone 5 mg, provides all the body segment parameters that are required for de- 22 DYNAMICS OF HUMAN GAIT tailed 3-D gait analysis of the lower extremities order 5 mg prednisolone amex. In addition to the body segment masses and moments of inertia already discussed in this section order prednisolone 5mg free shipping, no- tice that there are also segment centre-of-mass data buy discount prednisolone 10 mg online. These are expressed as ratios and are based on knowing the segment endpoints for the thigh, calf, and foot. These points are between the hip and knee joints, the knee and ankle joints, and the heel and longest toe, respectively. We think you will agree that the BSPs have been personalised by means of linear measurements that do not require much time or expensive equipment. In Appendix B, we show that these equations are also reasonably accurate and can therefore be used with some confidence. Though we believe that our BSPs are superior to other regression equa- tions that are not dimensionally consistent (e. The moments of inertia are really only needed to calculate the resultant joint moments (see Equation 3. Their contribution is relatively small, par- ticularly for the internal/external rotation axis. For example, in stance phase, the contributions from the inertial terms to joint moments are very small be- cause the velocity and acceleration of limb segments are small. Linear Kinematics As described in the previous section on anthropometry, each of the segments of the lower extremity (thigh, calf, and foot) may be considered as a separate entity. Modelling the human body as a series of interconnected rigid links is a standard biomechanical approach (Apkarian, Naumann, & Cairns, 1989; Cappozzo, 1984). When studying the movement of a segment in 3-D space we need to realise that it has six degrees of freedom. This simply means that it requires six independent coordinates to describe its position in 3-D space uniquely (Greenwood, 1965). You may think of these six as being three cartesian coordinates (X,Y, and Z) and three angles of rotation, often referred to as Euler angles. In order for the gait analyst to derive these six coordi- nates, he or she needs to measure the 3-D positions of at least three noncolinear markers on each segment. The question that now arises is this: Where on the ANTHROPOMETRY, DISPLACEMENTS, & GROUND REACTION FORCES 23 lower extremities should these markers be placed? Ideally, we want the mini- mum number of markers placed on anatomical landmarks that can be reliably located, otherwise data capture becomes tedious and prone to errors. Use of Markers Some systems, such as the commercially available OrthoTrak product from Motion Analysis Corporation (see Appendix C), use up to 25 markers. We feel this is too many markers, and the use of bulky triads on each thigh and calf severely encumbers the subject. Kadaba, Ramakrishnan, and Wootten (1990) of the Helen Hayes Hospital in upstate New York proposed a marker system that uses wands or sticks about 7 to 10 cm long attached to the thighs and calves. The advantage of this approach is that the markers are easier to track in 3-D space with video-based kinematic systems, and they can (at least theoretically) provide more accurate orientation of the segment in 3-D space. Heel head II 9 O Y b 24 DYNAMICS OF HUMAN GAIT The major disadvantage is that the wands encumber the subject, and if he or she has a jerky gait, the wands will vibrate and move relative to the underlying skeleton. After careful consideration we have adopted the 15 marker loca- tions illustrated in Figure 3. The X, Y, and Z coordinates of these 15 markers as a function of time may then be captured with standard equipment Table 3. The data in the DST files in GaitLab were gath- ered at the Oxford Orthopaedic Engineering Centre (OOEC), the National Institutes of Health (NIH) Biomechanics Laboratory, the Richmond Childrens Hospital, and the Kluge Childrens Rehabilitation Center in Charlottesville, Virginia (where all laboratories use the VICON system from Oxford Metrics). Marker Placement for Current Model One of the problems in capturing kinematic data is that we are really inter- ested in the position of the underlying skeleton, but we are only able to mea- sure the positions of external landmarks (Figure 3. Because most gait studies are two-dimensional and concentrate on the sagittal plane, researchers have assumed that the skeletal structure of interest lies behind the external marker. We obviously cannot do that with our 3-D marker positions, but we can use the external landmarks to predict internal positions. The 3- step strategy used to calculate the positions of the hip, knee, and ankle joints on both sides of the body is as follows: 1. Use prediction equations based on anthropometric measurements and the uvw reference system to estimate the joint centre positions.
Free aerobics (FA) has some disadvantages: • It is more difﬁcult to control intensity; • Monitoring patients/participants is more difﬁcult; • It is harder to provide alternative moves; •Position and proximity of the participants require close attention safe prednisolone 5mg. The advantages of FA include: •The cost is low; •There is no need for equipment; • More motor skill balance and co-ordination are required by the group and leader; • More independence is required of participants generic prednisolone 40 mg line. The exercise leader performs the skill of structuring foot and arm patterns to the beat and phrase of the music cheap prednisolone 40mg without a prescription. The most basic method of choreography is to do one foot/arm pattern for eight counts prednisolone 20mg visa, a second one for eight counts, a third for eight counts and a fourth for eight counts. The ﬁrst beat of each phrase tends to be the strongest one, and it is this one that should be used to start a new move. More recently Murrock (2002) found that playing upbeat music during cardiac rehabilitation exercise sessions did not reduce perceived exertion but signiﬁcantly enhanced mood (measured on a feelings scale). Class Design and Use of Music 159 SUMMARY This chapter has described the practical aspects of design and delivery of group exercise, using both circuits and free aerobics. It is the choice and preference for the exercise leader as to which method they use. The use of music is also at the discretion of the leader, either as background to dictate circuit time, or to use with the free aer- obics section. REFERENCES American College of Sports Medicine (ACSM) (1998) Position Stand: The recom- mended quantity and quality of exercise for developing and maintaining cardiores- piratory and muscular strength and ﬂexibility in healthy adults. American College of Sports Medicine (ACSM) (2000) Guidelines for Exercise Testing and Prescription, 6th edn, Lippincott, Williams and Wilkins, Baltimore, MD. Association of the Chartered Physiotherapists Interested in Cardiac Rehabilitation (ACPICR) (2003) Standards for the Exercise Component of the Phase III Cardiac Rehabilitation,The Chartered Society of Physiotherapy, London. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular ﬁtness, and ﬂexibility in healthy adults. Scottish Intercollegiate Guidelines Network (SIGN) (2002) Cardiac Rehabilitation,no. Chapter 6 Leadership, Exercise Class Management and Safety in Cardiac Rehabilitation Fiona Lough Chapter outline The previous chapters have covered the main requirements of exercise pre- scription, delivery and design. To date there is very little information on the professional competencies and core skills required by exercise leaders to deliver supervised exercise-based CR programmes in the UK. This chapter aims to provide guidelines for UK exercise professionals in CR and addresses leadership roles, class management and safety issues. The focus is on leading phase III CR exercise classes, but much of the chapter is applicable to phase IV classes. THE UK CONTEXT Engaging patients in a rehabilitation activity programme and delivering effective exercise require a combination of clinical knowledge, exercise pre- scription and behavioural management skills. In addition, the exercise leader should have skills of good leadership and organisation of people, exercise loca- tions, equipment and resources. Exercise-based CR is best provided by a multi-professional team of clinical and exercise specialists able to undertake cardiovascular assessment, individ- ualised exercise prescription, progression and monitoring. This must be in the context of a behavioural approach, in order to meet patients’ lifestyle and activity needs. ISBN 0-470-01971-9 162 Exercise Leadership in Cardiac Rehabilitation Competencies and core skills Guidelines on the professional competencies and core skills required to deliver supervised phase III exercise programmes are provided in other coun- tries, for example, the Australian and American Guidelines (Southard, et al. However, there has been limited work in the UK on describing either the role or functions of CR health pro- fessionals or their competencies, qualiﬁcations and continuing professional development and the education they require. Under the auspices of Skills for Health and the Knowledge Skills Framework (2004) there is increasing acknowledgement of the need for competency-based pro- grammes for health professionals. However, it is generally accepted that all members of the CR team should hold a recognised qualiﬁcation, i. Most nurses coming into the speciality would ideally have done so via coronary care or similar background. In most countries the minimum requirement to work in the speciality would be attendance at a short course in CR, many of which are delivered by speciﬁc interest groups and professional associations, i. Numerous UK academic institutions now offer modular courses appropriate for CR professionals up to Masters level. A small survey of phase III CR physiotherapists in the West of Scotland (Thow, et al. It established that, in addition to cardiac assessment and exercise prescription responsibilities with patients, the physiotherapists had a consid- erable role in managing, modifying, advising and educating patients with associated non-cardiac physical conditions affecting their exercise programme.
Could the exercise consultation be delivered successfully in a group or by post prednisolone 5mg with visa, telephone or World Wide Web? The possibility of delivering this intervention to patients in a group setting at the end of phases II and III is a promising area for further study prednisolone 40 mg visa. First 20 mg prednisolone amex, deliv- ering this intervention to groups of patients as an alternative to one-to-one consultations would be more feasible for CR services in terms of time and staff resources cheap prednisolone 10 mg on-line. In addition, conducting an exercise consultation in a group setting would provide patients with the opportunity to discuss issues with each other, such as potential barriers to remaining active, problem solving for these bar- riers and identifying high-risk situations for relapse. Furthermore, group dis- cussion on exercise opportunities in the community, such as phase IV classes, might encourage patients to attend these programmes together. In general, patients routinely receive a discharge interview at the end of phase III that provides cardiac rehabilitation staff with an ideal opportunity to review the patients’ goals for remaining active, devised during the group consultations. Studies using physical activity counselling in the general population and other clinical groups have successfully delivered this type of intervention in a group setting (Dunn, et al. The exercise consultation may be useful between all phases of CR both to improve adherence to supervised exercise programmes and to encourage patients to participate in physical activity outside of the exercise classes. Patients at the start of phase III are likely to be in the contemplation or prepa- ration stages, and the focus of the consultation should be on encouraging these individuals to increase their physical activity. A pilot study found that web- based and one-to-one exercise consultations were equally effective in increas- ing physical activity in a group of patients participating in a phase III supervised exercise programme (McKay, et al. Other strategies could be included in the exercise consultation to increase its efﬁcacy. Recently, physical activity intervention programmes have found the addition of pedometers to be effective in promoting physical activity (Chan, et al. Thus, pedometers, in conjunction with exercise consultation, may be a promising strategy for encouraging par- ticipation in physical activity. SUMMARY Many beneﬁts are associated with participation in exercise-based CR for patients with established coronary heart disease. Sustaining these beneﬁts requires maintenance of regular long-term physical activity. However, many patients ﬁnd it difﬁcult to maintain exercise participation and an active lifestyle. The exercise consultation is an effective intervention for maintaining Maintaining Physical Activity 215 physical activity and could be applied through all phases of CR. In addition, several randomised controlled trials have shown the exercise consultation to be successful in promoting and maintaining physical activity in the general population and for people with type II diabetes. Exercise consultation is based on established theoretical models of behaviour change, and it uses strategies to increase and maintain physical activity. This intervention is practical and could feasibly be incorporated into all phases of CR programmes to encour- age patients to remain active. With minimal training, any member of the cardiac rehabilitation team could deliver the exercise consultation. However, in order to be trained to deliver the exercise consultation, exercise leaders need to understand the behaviour change theories on which the consultation is based and the counselling skills and strategies required to deliver the inter- vention. Should holders wish to contact the Publisher, we will be happy to come to some arrange- ment with them. Apart from any fair dealing for the purposes of research or private study, or criti- cism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.