Faculty Bibliography

Thrombocytopenia-absent radius (TAR) syndrome is defined by bilateral absence of the radius and hypomegakaryocytic thrombocytopenia (<150,000/mm3). Lower extremity and nonorthopaedic anomalies also are frequently present. Charts and radiographs of 23 patients with TAR syndrome were reviewed, with extremity and other anomalies documented. Upper and lower extremity management, which included surgery and multiple attempts at orthotic and prosthetic fitting, was evaluated. Upper extremity prostheses were generally rejected, as most patients were able to perform tasks by approximating themselves closely enough to an object to use their own hands. Adaptive devices for feeding, dressing, and toileting were well tolerated. In the lower extremity, most affected patients either rejected any lower extremity intervention or had involvement that eventually precluded functional ambulation, necessitating power wheelchair or motorized cart use. The greatest degree of independence for these patients comes not from surgical, prosthetic, or orthotic intervention, but from the use of simple adaptive devices and powered mobility aids if required

Measurements of stride length, gait speed, and distance walked during seven days were obtained from 15 postpolio and eight control subjects. Pedometers were used to measure distance walked. Measurements of stride length and speed were performed three times, and there was a high correlation between tests (R = .852-.969). The pedometers failed to record accurately in some postpolio subjects, and these subjects were dropped from analysis when ambulation distance was used as a variable. There were significant differences between the postpolio subjects and controls with respect to gait speed (47.7 +/- 14.0 vs 74.9 +/- 15.9 m/min, p less than 0.0005), stride length (55.3 +/- 11.7 vs 69.8 +/- 8.6 cm, p = .006), and average kilometers walked per day for seven days (1.97 +/- 1.3 vs 3.89 +/- 1.7, p = .016). The postpolio subjects had their serum creatine kinase (CK) levels measured at the end of the study. Forty percent of subjects had a level above the normal limits of our laboratory. There was a significantly positive correlation between CK levels and the distance walked during the previous 24 hours (R = .75, p = .012). The findings of this study illustrate the impact of gait abnormalities on the ambulatory abilities of the postpolio population. The correlation of CK with ambulation supports the association of exercise as a source of elevated CK levels in the postpolio population

Measurements of stride length, gait speed, and distance walked during seven days were obtained from 15 postpolio and eight control subjects. Pedometers were used to measure distance walked. Measurements of stride length and speed were performed three times, and there was a high correlation between tests (R = .852-.969). The pedometers failed to record accurately in some postpolio subjects, and these subjects were dropped from analysis when ambulation distance was used as a variable. There were significant differences between the postpolio subjects and controls with respect to gait speed (47.7 +/- 14.0 vs 74.9 +/- 15.9m/min, p less than 0.0005), stride length (55.3 +/- 11.7 vs 69.8 +/- 8.6cm, p = .006), and average kilometers walked per day for seven days (1.97 +/- 1.3 vs 3.89 +/- 1.7, p = .016). The postpolio subjects had their serum creatine kinase (CK) levels measured at the end of the study. Forty percent of subjects had a level above the normal limits of our laboratory. There was a significantly positive correlation between CK levels and the distance walked during the previous 24 hours (R = .75, p = .012). The findings of this study illustrate the impact of gait abnormalities on the ambulatory abilities of the postpolio population. The correlation of CK with ambulation supports the association of exercise as a source of elevated CK levels in the postpolio population