Abstract
The primary concern of the sit-to-stand and walk training tasks, prominent in the health institutions target patients with knee problems or those recovering from surgical operations as a safe means of initiating rehabilitation or healing process. The use of gait initiation process sustains the efficiency with which the patients gain their mobility through the dynamic processes anchored for coordinating center of pressure and the body center of mass of the individual patient. The demonstration of the ability to sit, stand and walk is a clear expression of the positive progress made by patients in their recovery plans. The observable symmetric presentation during motion provides an ideal indication of the balanced center of mass that depends on the force the legs receive. The research covers the process as well as the limitations encountered by patients under such clinical training that require the use of sit-to-walk initiatives in the treatment of patients with knee problems. The designated movements of higher amplitudes and force on the proximal muscle need normal variation in the body weight that relies on the smaller surface of the support. The research establishes the impact of age and health condition of patients in the moving limbs under the gait initiatives.
Key words: Stroke, sit-to-stand-to-walk, inter-limb muscles, dynamic stability, gait initiation and Tukey tests.
Introduction
The process of sit-to-stand and walk is the prominent therapeutic technique developed to help in the safe handling of the patients by the care provider operating within the outlined capability limits through the recommended training without affecting the recovery process. The activity guidelines during the training is an essential concern to the clinicians that considers the patient's status while defining the training approach adopted and the equipment appropriate in the patient handling process linked to the obvious medical risks the training strive to eliminate. The implementation of total hip arthroplasty presents a clear clinical surgery process intended to yield remarkable benefits for the patients' mobility recovery at a reduced pain in the hip joint. The initiative accelerates the development of osteoarthritis on the legs that increases the risk of the inability of the patient to fall based on the motor simulations of the sit-to-stand and walk tasks. Critical evaluation of the sit-to-stand is a continuous process employed in evaluating progress made in limb treatments among the sickest patients. The presence of Parkinson's and paraplegic diseases among the patients harmonizes the disparity in the content presentation that improves the performance of patients with joint problems (Harkema, Behrman, & Barbeau, 2011, p. 67). At the point of investigation of the patients' recovery, the implementation of the sit-to-stand and walk activities offer elementary training needed in boosting the performance of limbs in balancing the body mass upon the COP and BCOM guarded by the gait initiation.
The process of sit-to-stand and walk rely on the weight limits and numerical guide for successful implementation of patient handling tasks depending on the environmental suitability while maintaining proper posture and spinal alignment to balance the body masses within the COP, mid-body range, and BCOM. The training improves the recovery of patients through the process of adjusting body components while positioning the feet in a shoulder separation distance with one leg slightly forward to maintain the required stability. The gait initiative recommends the trainer ensures the patient do not twist while retaining the shoulder-pelvis alignment, bend the knee while keeping the spinal curve and avoid stooping through slight bends at the hips. Further, ensures the patient maintains the head up during the movement process while avoiding the fixed holds of the training device (Biswas, 2013, p. 56).
The process of standing the sitting patients takes into account the basic concepts that involve the transfer of loads bearing limbs to help in the handling activities based on the ability of the patient to tolerate simple processes. Hence, gains the stability through consideration of the health condition of the patient, age, ability to use the walking aids and the nature of the current environment. The training of patients uses a different approach based on the complexity of the case present for the patients. The training ranges from independent through care guided to equipment usage that depends on the severity of the patients' case and recovery process (Vernikos, 2011, p. 97). The gait initiative outlines the concepts based on the mental conditions regulating motor functions on the patients.
Experimental Methodology
The clinical pathologists link the mobility impairment to adverse health risks or operational activities that interfere with the upper motor neurons through impaired coordination of activities in the brain. Thus, requires the rehabilitation tasks of the patients concerning postural locomotion activities through the sit-to-stand and walk training process for the patients. The training considers the essential elements relating to the knee height, required direction of mobility and the resulting ground reaction forces that stabilize the patient in the standing position before initiation motion (Jones, James, Thacker and Green, 2016, p. 1).
Participants
The analysis of limb loading of patients recovering from a stroke of other physical health impairment captures the unilateral hip replacement based on the loading weights during the training. The performances of the gait initiatives for the sit-to-stand and walk training process rely on the sample size of n=10 patients, including both female and males in the age range of 32 to 80 years. The existing physical conditions of the patient at the time of investigation influenced the task allocation and adaptability of the training mechanisms in place. The process facilitates reduction of pain during the exercises at the contralateral hip and knee joints in conformity to the Helsinki's medical practitioner's guide requiring the patients to participate in studies (Umphred, 2012, p. 34).
Experimental design
The gait lab provides a suitable condition for conducting the investigation relevant to the development an essential guide for the patient training suffering from different ailments impairing the ability to initiate motion as well as the best options appropriate in handling the patient on the case based concept. The existing tracking software alongside the motion multipliers in the system provide significant data regarding the dynamic performance of the patients observed through the cameras in the lab. The coverage made during the self-initiated and assisted motions of the patients in the gait lab presented in either two or three-dimensional models accelerate the performance analysis of progress raised by the patients during the training sessions. The definition of trajectory loci covered by the joint movement in the mechanical sketches enables medical practitioners to make important decisions on the consistent approach to initiate for the successful analysis of the degree of freedom in the linkages that requires regular training of the patients recovering from the illness (Biswas, 2013, p. 77).
Data Collection
The researcher gathers basic information that covers the four sections under investigation for instance distance covered about the standing process from the seated position, the time taken to initiate motion, the observed voluntary contraction, and quiet standing parameters define the primary elements in the research based on the sit-to-stand and walk strategy. The performance of the experiment in the gait lab within a duration of one hour while maintaining the inter-task duration to 10 minutes provide better recovery and commencement of the other task on the higher tone compared to the expected outcome (Vernikos, 2011, p. 105).
The data generated by the isometric contraction for the knee flexors, extensors, hip and leg abductors reflect the performance of biarticular muscles. Thus, the coordinated magnitude of force recorded to contribute to lateral stability and weight bearing asymmetry during the walk training process for sampled patients suffering from a stroke or other mental complication that interferes with a muscular response. Provision of a piece of advice to the patients during data collection facilitated a smooth transition and data collection through different stages in the process of data recovery as the training gauge provides essential readings of the horizontal force components applicable in the system of the data analysis. Pre-test calibration of the instrument facilitates accurate data collection significant in the realization of an accurate and actual performance of the motion tasks investigated in the health and wellness of the patients’ conditions. The knee angle of flexion provides an accurate estimation of the arm's force relevant in the determination of isometric moments of the hip force abductors (Jones, James, Thacker and Green, 2016, p. 6). The fixed frame anchors the strain gauge sensor used in establishing horizontal force components in the system during the test.
The process of quiet standing requires the patient places their barefoot on the stable platform with the heels 10cm apart under the bilateral loadings. The collection of three trial data provided the average vertical force used in the experiment for every step made. The presence of postural asymmetry index provided a consistent basis for the experimental progress necessary in achieving the improved versions of the sit-to-stand and walked training (Harkema, Behrman, & Barbeau, 2011, p. 82).
The patients sit on the armless seats without backrest though adjustable to attain a recommended horizontal position of the sampled patients with varied knee and leg heights that facilitate force monitoring. The incorporation of several trials provides relevant solutions to the acoustic elements that trigger the signal to stand up and execute movements in the system at the natural pace with an eye open or eye closed at the rate of 3000Hz and 16 bit A/D converter. The use of force plate improves filtration of data in the trials based on pneumatic sensors (Vernikos, 2011, p. 112).
Subjecting the sampled patients to cover some distance after standing provided strong data that are critical in the determination of recovery rates. Making several trials needed to provide an average speed that is fairly accurate as may dictate the swing phase necessary in reflecting the gait cycle applicable to the side to side comparison of the asymmetric performance of the patients (Umphred, 2012, p. 37).
Data Analysis
The data generated through observation and graphical representation in the gait diagrams provided significant values for the asymmetric index estimation within different sets of patients about the natural variability. The lateral center of pressure position and spine or pelvis location variation affected by the gravity line as the patient maintains the upright position in the exercise. The prominent positioning of the body mass presents a variety of loadings on the legs provide challenging parameters linked to the famous regression that coordinated the body movements about the variation in the system (Umphred, 2012, p. 44). Coverage of the swing phase of the fully loaded leg provides performance proportional to the mass of the body, thus coordinating the behaviour of the patient in the training units within the medical facility. Adoption of averages provide significant determinant of the progress made during the incorporation of the sit-to-stand and walk process among different patients suffering from joint problems or cases of acute stroke.
Statistics
The research data analysis relies on the ANOVA concept with a degree of freedom set at 0.05 for the maximum isometric voluntary efforts that influence the patient's motor mobility parameters requires in providing a clear picture regarding the movement elements. The Tukey tests adopted in the process provided relevant information regarding the optimization of research progress relevant in evaluating the patients' recovery trends reflected through the asymmetric indexes. The possibility of the leg to attain isometric voluntary construction, rely on the absolute values influencing the swing phase durations applicable in the non-parametric test performed by Mann-Whitney that compares the asymmetric index of different patients depending on the assisted walking. Through linear regression, the adoption of Pearson's correlation coefficient provides a positive estimation of the current asymmetric indices for various activities scheduled in the sit-to-stand and walk processes (Biswas, 2013, p. 78).
Results
Graph: Performance of gait initiated trials
Discussion
The experimental analysis of the body transformations organizes the elements of sit-to-walk or sit-to-stand and walk mechanisms constituting relevant links for the parametric progress on principle of sections in the treatment of patients suffering from locomotion impairment caused by disease infection or surgical complications. The health practitioners often use the guiding principles to attain optimal performance of the experimental evaluation of the essential elements linked with the principle progress in patient recovery (Biswas, 2013, p. 85). The gait lab experimental environment provides a favorable atmosphere for both the patients and the research team to analyse the progress made under ideal conditions that paint a reflection of the intended statistical concerns displayed in the actual analysis of the training task of the joint flexibility. The speed of movements indicates the dynamic balance attained by the patients linked to the recovery trends in the treatment programs.
The level of dynamic imbalance present in an individual patient shows the extent of neural degeneration and impairment of the inter-limb coordinated muscles. The steady involvement of motion control mechanisms in realign the patients to the ecologically favorable means of performing the body mass orientation to the horizontal momentum under the gait initiative coordinate the lifting of legs about the body mass index. The 3D coverage provides suitable performance indicators that help the health practitioners in drawing supporting remarks on the progress of patients concerning recovery rates. The evidence of force plate synchronization in the gait lab analysis models relies on the motor movements. Hence, limits the error margin attained in the data at the location of every force plate requires critical care necessary in the validation of the result accuracy achieved during the experimental investigations (Jones, James, Thacker and Green, 2016, p. 9)
The research finding reveals the successful performance of the healthcare program through the training on a motion for the patients with mobility impaired cases while adopting gait approach. Thus, relates the pressure distribution as a mechanism for successful training intended to coordinate the neuron performance as well as the COP and BCOM approach that rely on continued training of the patient to gain muscle stability necessary in anchoring the body mass without toppling. The process of training is usually systematic and proactively focused on developing the modern tools that sustain free mobility of patients during the recovery stages. The initial use of walking aids and assistance accelerate the healing process with which the patients gain their mobility status (Umphred, 2012, p. 49). The COP- BCOM approach is the most dominant method applicable in the healthcare sector either at the healthcare facility or the home-based care services for training patients to attain the mobility with limited pain. The task follows steady and systematic processes that improve the performance of the patients on their path to recovery from either an infection surgery.
The prominent limitation encountered during the experimental investigation in the gait lab is the harmonization of data linking patients with mobility issues as a result of several provisions relating to the courses of impairment attracts a different level of treatments. The percentage of error associated with the progress of statistical estimation provides standard deviation and variance affect the advances in the design of treatment plans and training of the patients to attain physical improvement. The harmonization of such limitations compels the research team to gather bulk data that harmonizes the findings. The effect of neuroplasticity affects the recovery process for patients with mobility impairment related to the motor performance. The tendency to balance the forces supported by the limp hinders the progress of the tasks in the task analysis (Harkema, Behrman, & Barbeau, 2011, p. 93).
Conclusion
The dynamic instability of patients subjected to the sit-to-stand and walk programs focuses on the body mass distribution on the supporting limbs thus incorporate the accelerometric concepts relevant in defining the movement of legs based on the biomechanical mechanisms designed with high efficiency while providing increased degree of freedom. The research improves the original understanding possessed by the student about the short or long-term perception of patient recovery based on the selected mobility training, rehabilitation programs that increase the pace of the patient recovery process. The results present an open view on the manner through which the asymmetric interpretation trains the joints on the loading criteria for active habitual mobility in the recovery process of the patients suffering from limb related problems based on the particular health parameters. The influence of the sensor motor in the coordination of the process of tissue performance and progress harmonizes the therapeutic performance of the patient associated with the sensory motor disorder that reflects the changing task requirements based on the simulation. The gait experimental approach adopts the electrical simulation applicable in the rehabilitation of the patients with motor impairment. The concept provides the oddest and ethical processes for the medical practitioners and the caregivers in the implementation of the sit-to-stand and walks tasks.
The design recommendations for the improved research on the mobility training medication programs need to incorporate larger sample sizes to harmonize the error margin thus improve the quality of the research findings. Further investigation of the performance of the limbs promotes the progress in the mobility training.
Bibliography
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Harkema, S. J., Behrman, A. L., & Barbeau, H. 2011. Locomotor Training: Principles and practice. Oxford: Oxford University Press.
Jones Gareth D., James Darren C., Thacker Michael and Green David A. 2016.Sit-to-stand-and-walk from 120% Knee Height: A Novel Approach to Assess Dynamic Postural Control Independent of Lead-limb.Journal of Visualized Experiments. 114: 1–17.
Umphred, D. A. 2012. Neurological rehabilitation. St. Louis, MO: Elsevier Mosby.
Vernikos, J. 2011. Sitting kills, moving heals: How simple everyday movement will prevent pain, illness, and early death-- and exercise alone won't. Fresno, CA: Quill Driver Books.
