Otolaryngologists
23 years of experience
Video profile
Accepting new patients
West Bloomfield
Henry Ford Medical Center at Maplegrove
6777 W Maple Rd
West Bloomfield, MI 48322
248-661-6472
Locations and availability (3)

Education ?

Medical School Score
Wayne State University (1987)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2013)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. Gardner is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Henry Ford Wyandotte Hospital
    Otolaryngology
    2333 Biddle Ave, Wyandotte, MI 48192
    • Currently 4 of 4 crosses
    Top 25%
  • Henry Ford Hospital
    Otolaryngology
    2799 W Grand Blvd, Detroit, MI 48202
    • Currently 3 of 4 crosses
    Top 50%
  • Henry Ford Macomb Hospitals
    Otolaryngology
    15855 19 Mile Rd, Clinton Township, MI 48038
    • Currently 2 of 4 crosses
  • Henry Ford Medical Center at Maplegrove
    6777 W Maple Rd, West Bloomfield, MI 48322
  • Publications & Research

    Dr. Gardner has contributed to 50 publications.
    Title Operative Adaptation for Endoscopic Identification of Zenker's Diverticulum.
    Date June 2009
    Journal The Laryngoscope
    Title Epigenetic Events Underlie the Pathogenesis of Sinonasal Papillomas.
    Date December 2007
    Journal Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
    Excerpt

    Benign inverted papillomas have been reported as monoclonal but lacking common genetic alterations identified in squamous cell carcinoma of the head and neck. Epigenetic changes alter the heritable state of gene expression and chromatin organization without change in DNA sequence. We investigated whether epigenetic events of aberrant promoter hypermethylation in genes known to be involved in squamous head and neck cancer underlie the pathogenesis of sinonasal papillomas. Ten formalin-fixed paraffin DNA samples from three inverted papilloma cases, two exophytic (everted) papilloma cases, and two cases with inverted and exophytic components were studied. DNA was obtained from microdissected areas of normal and papilloma areas and examined using a panel of 41 gene probes, designed to interrogate 35 unique genes for aberrant methylation status (22 genes) using the methylation-specific multiplex-ligation-specific polymerase assay. Methylation-specific PCR was employed to confirm aberrant methylation detected by the methylation-specific multiplex-ligation-specific polymerase assay. All seven cases indicated at least one epigenetic event of aberrant promoter hypermethylation. The CDKN2B gene was a consistent target of aberrant methylation in six of seven cases. Methylation-specific PCR confirmed hypermethylation of CDKN2B. Recurrent biopsies from two inverted papilloma cases had common epigenetic events. Promoter hypermethylation of CDKN2B was a consistent epigenetic event. Common epigenetic alterations in recurrent biopsies underscore a monoclonal origin for these lesions. Epigenetic events contribute to the underlying pathogenesis of benign inverted and exophytic papillomas. As a consistent target of aberrant promoter hypermethylation, CDKN2B may serve as an important epigenetic biomarker for gene reactivation studies.

    Title Deglutition Syncope.
    Date February 2004
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Management of Common Voice Problems: Committee Report.
    Date June 2002
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: This report provides the reader with a state-of-the-art update on a number of common voice problems that require phonosurgical intervention. STUDY DESIGN AND SETTING: This multiauthor review is not a position statement of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and may reflect institutional preference and/or bias. It arose from a panel discussion at the AAOHNS meeting in 2000. RESULTS: We provide a review of the genesis and management of papillomatosis, dysplastic glottal epithelium, arytenoid granulomas, Reinke's edema, and vocal-fold paralysis. CONCLUSIONS AND SIGNIFICANCE: In the past decade, there has been a dramatic expansion of knowledge regarding a variety of voice disorders and associated treatment. There has been a convergence of basic science investigations in anatomy, physiology, and pathology with clinical trials of treatment, both surgical and nonsurgical. This information should provide the reader with current insight into critical management issues of the aforementioned disorders.

    Title Posterior Glottic Stenosis and Bilateral Vocal Fold Immobility: Diagnosis and Treatment.
    Date October 2000
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Posterior glottic stenosis and bilateral vocal fold immobility cause obstruction of the airway at the glottis. Presentation of this problem may vary according to the cause. Full evaluation of the status of the larynx is crucial with regard to the mobility of the arytenoid cartilage and innervation of the laryngeal musculature. There are many techniques for surgically treating this condition, each with advantages and disadvantages. The surgeon should be familiar with a variety of these procedures and be able to adapt to each patient's situation.

    Title Pediatric Vocal Fold Medialization with Silastic Implant: Intraoperative Airway Management.
    Date April 2000
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Vocal fold immobility accounts for 10% of all congenital laryngeal abnormalities, second only to laryngomalacia. Acquired unilateral vocal fold immobility (UVFI) is generally due to surgical trauma. The problems associated with this condition include a breathy dysphonia, weak cough, and aspiration. Treatment involves observation, voice and swallowing therapy, and various surgical options. Medialization laryngoplasty with silastic implant (ML-s) is a very successful procedure with consistent results in the adult population. It is usually done under local anesthesia with sedation to allow the voice to be monitored during the procedure. The surgeon can then fashion a custom implant or use a specific prefabricated implant. Additionally, use of the flexible fiberoptic nasopharyngolaryngoscope (FFNPL) allows the surgeon to see the endolarynx during the procedure, thus avoiding overmedialization and airway obstruction. Children, however, do not tolerate such invasive procedures under local anesthesia and sedation, have much smaller airways and, therefore, present several problems when addressing this problem surgically. Management of the pediatric airway during ML-s can be achieved using a laryngeal mask airway (LMA) and the FFNPL. While this does not allow the voice to be assessed intraoperatively, appropriate medialization of the vocal fold can be judged via the FFNPL, and airway obstruction avoided. ML-s using the LMA and FFNPL was performed in two children aged 8 and 4 years old. Both had excellent voice results and no complications. The details of these cases are reported. The literature on treatment of UVFI in children is reviewed, and practical and theoretical issues discussed.

    Title Cervicofacial Subcutaneous Emphysema in a Patient with Munchausen Syndrome.
    Date September 1998
    Journal Ear, Nose, & Throat Journal
    Title Preliminary Results on the Management of Unruptured Intracranial Aneurysms with Magnetic Resonance Angiography and Computed Tomographic Angiography.
    Date July 1997
    Journal Neurosurgery
    Excerpt

    OBJECTIVE: The goal was to assess the capability of magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) to replace catheter angiography in the evaluation of unruptured intracranial aneurysms. METHODS: A prospective evaluation of a 1-year period included all patients suspected of harboring unruptured intracranial aneurysms at a single institution. All patients underwent magnetic resonance imaging, MRA, and CTA, for comparison with intraoperative findings or results from catheter angiography. Both MRA and CTA now provide submillimeter resolution of vascular structures, with accurate detection of intracranial aneurysms of a diameter greater than or equal to 3 mm. This resolution calls into question the universal need for catheter angiography in the care of patients with suspected intracranial aneurysms. When the catheter angiography can be avoided, radiological costs can be reduced by as much as two-thirds while eliminating the risk of arterial injury and stroke. RESULTS: Excellent visualization of the intracranial vasculature was provided by both MRA and CTA. No vascular lesion was detected at surgery or by formal angiography that was not visualized by noninvasive angiographic techniques. The three-dimensional anatomy of the aneurysm complex (unavailable with catheter angiography) was well depicted by both MRA and CTA. CTA was unique in its capacity to display the relationship of vascular structures to bone, information that is invaluable for planning operative strategies for lesions such as carotidophthalmic artery aneurysms. Additionally, acquisition of CTA images was very rapid, with a scanning time of less than 1 minute. Both MRA and CTA allowed for retrospective manipulation of data into an infinite number of views, including views that paralleled those encountered through the operative microscope. Additionally, both MRA and CTA can depict the internal anatomy of aneurysms, an ability not possessed by intra-arterial angiography. This ability alerts the surgeon to possible intraoperative risks, such as plaque in the lumen of an aneurysm or calcium within the walls of the arteries. CONCLUSION: Both MRA and CTA provide several advantages over digital subtraction angiography, in addition to reduced costs and avoidance of arterial injury and stroke. These include retrospective manipulation of data in a 360-degree format, visualization of the internal anatomy of arteries and aneurysms, three-dimensional depiction of anatomy, and rapid data acquisition. Preliminary data and a review of the literature suggest that MRA, when used in concert with CTA, can replace catheter angiography in the assessment of select patients harboring unruptured intracranial aneurysms. Although no firm conclusions or generalizations can be drawn from this small cohort of patients, it is hoped that this report will stimulate interest and further study at other institutions.

    Title Morbidity of Combined Therapy for the Treatment of Supraglottic Carcinoma: Supraglottic Laryngectomy and Radiotherapy.
    Date March 1997
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Many surgeons find that patients have increased morbidity after supraglottic laryngectomy if postoperative irradiation is given, but this remains poorly documented. Twenty-nine patients undergoing supraglottic laryngectomy were retrospectively reviewed. Seventeen received postoperative radiotherapy, and 12 did not. The mean follow-up was 64 months. When compared to patients treated with supraglottic laryngectomy alone, irradiated patients had a significantly higher incidence of lifelong gastrostomy dependency (35% versus 0%; p = .03) and acute upper airway obstruction (29% versus 0%; p = .05). There was a trend toward greater tracheotomy dependency (24% versus 0%), aspiration pneumonia (35% versus 9%), and delayed independent swallowing (34.8 weeks versus 7.8 weeks) in the patients treated with combined therapy, but this difference was not significant. A morbidity index score was developed to evaluate the overall lifelong morbidity of these patients, and this was found to be significantly higher in patients treated with surgery and radiotherapy (2.29 versus 0.83; p = .04). Overall survival was equal in both groups. We have shown that radiotherapy increases the morbidity of supraglottic laryngectomy. This should be considered when planning treatment for patients with supraglottic carcinoma.

    Title Adult Onset Laryngeal Papillomatosis.
    Date September 1996
    Journal Ear, Nose, & Throat Journal
    Title Vocal Fold Nodules and Acute Vocal Fold Hemorrhage.
    Date August 1996
    Journal Ear, Nose, & Throat Journal
    Title Advances in the Development of the Interferometric Otoscope.
    Date June 1996
    Journal The Laryngoscope
    Excerpt

    Present measurement techniques for middle ear function have inherent limitations because they are either spatially insensitive (acoustic immittance) or descriptive and qualitative in nature (otoscopy). By integrating advances in electrooptic technology (fiber optics, miniature diode lasers, solid-state detector arrays) and digital processing, further advances are possible. On the basis of measurements taken with electronic speckle-pattern interferometry on human temporal bones and models, we demonstrate quantitative static and dynamic vibration/displacement characteristics of the tympanic membrane with high spatial resolution. Our presentation emphasizes advantages of optically based methods and demonstrates computerized signal processing capable of fringe localization, enhancement, and counting. Miniaturization and real-time digital image processing in the clinical setting is the goal of this research.

    Title Operative Evaluation of Airway Obstruction.
    Date November 1995
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Endoscopic evaluation is a crucial component in the assessment of chronic airway obstruction. Acute airway obstruction is a potentially devastating complication of this invasive procedure. This article discusses a systematic approach to endoscopically assessing the airway safely and obtaining the information necessary for long-term management of the chonically obstructed airway.

    Title Endoscopic Vocal Fold Microflap: a Three-year Experience.
    Date May 1995
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Surgical techniques for the removal of vocal fold (VF) disorders that arise within the lamina propria must permit the preservation and/or restoration of VF vibratory characteristics. The endoscopic VF microflap is designed to do such. A retrospective study was undertaken to evaluate the efficacy of this procedure. Forty microflaps (7 bilateral, 1 revision) were performed on 32 patients. Charts and surgical pathology findings were reviewed. Preoperative and 3-month postoperative video recorded voice samples and stroboscopic examination results were compared. Findings on perceptual voice analysis did not significantly change. Stroboscopic examinations revealed improved postoperative VF closure in 27 of 29 patients with impaired preoperative closure and return of mucosal wave in 18 of 24 VFs operated on for the excision of cysts or polyps. When present preoperatively (6 patients), the mucosal wave was preserved. Most patients (28 of 30) rated themselves as clinically improved. The endoscopic VF microflap is efficacious in the treatment of selected VF disorders. The surgical technique is discussed.

    Title Electronic Speckle Pattern Interferometry of the Vibrating Larynx.
    Date February 1995
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Laser holography is a technique that creates a three-dimensional image of a static object. This technique can be applied to the analysis of vibrating structures. Electronic speckle pattern interferometry uses a laser for illumination of the vibrating object and solid state detectors and digital hardware technology for capturing and processing the image in real time. This was performed on a human cadaver larynx and is the first time an interferogram of vibrating vocal cords has ever been obtained. Dark and bright interference fringes are seen that represent the vibratory motion of the vocal folds. These are presented in still photos as well as real-time on videotape. This method can provide advantages over current techniques of laryngeal study: it is sensitive to motion in the vertical dimension, and the digital data can be quantitatively analyzed. Application of this technique to study the larynx should eventually be a valuable clinical tool and provide quantitative research data.

    Title Long-term Morbidity and Mortality in Patients Undergoing Surgery for Unilateral Vocal Cord Paralysis.
    Date June 1992
    Journal The Laryngoscope
    Excerpt

    Fifty-six patients who had undergone surgery for unilateral vocal cord paralysis (UVCP) were reviewed retrospectively. The etiologies; indications for surgery; timing of onset, diagnosis and surgery; complications; and survival rates are presented. Forty patients had neoplasms of which 32 were malignant and 8 were benign. UVCP was due to direct tumor involvement in 16 cases and surgical trauma in 21 cases. Mean survival for patients who presented with UVCP which was due directly to a malignancy was 5 months versus 22 months for those patients with UVCP due to surgical trauma during resection of malignancies. Mean survival for lung cancer patients was 5 months versus 24 months for patients with other malignancies. The etiology and manner of presentation of UVCP are important prognostic indicators which should be considered when planning surgical intervention for UVCP.

    Title Bilateral Vocal Cord Hematomas Associated with Shoulder Harness Use.
    Date March 1991
    Journal The American Journal of Emergency Medicine
    Excerpt

    A case of bilateral vocal cord hematomas caused by a shoulder harness injury is presented. The patient was restrained by a three-point belt system and was involved in a front-end collision. She presented with mild facial and chest injuries and a contusion of the neck. One hour after injury she began to complain of hoarseness without airway compromise. Fiberoptic laryngoscopy showed bilateral true vocal cord hematomas. The patient had an uneventful hospital course and a full recovery. The importance of the mechanism of injury and associated injuries is discussed.

    Title Family Cancer Syndrome: a Study of the Kindred of a Man with Osteogenic Sarcoma of the Mandible.
    Date January 1991
    Journal The Laryngoscope
    Excerpt

    Several familial cancer syndromes have been identified. The syndrome of sarcomas, breast cancer and other neoplasms, known as Li-Fraumeni syndrome, is characterized by several different neoplasms presenting at young ages with autosomal dominant transmission and a high incidence of second primaries. In this paper, we studied six generations (51 people) of the family of a 24-year-old man with osteogenic sarcoma of the mandible. Twelve malignancies in 11 people, including several rare tumors, were revealed. Mean age of presentation was 24 years old. Nine of the 11 patients died of disease. One developed a second primary. Two tumors presented in the head and neck. Transmission was autosomal dominant. The karyotypes of two family members were normal. Identification of Li-Fraumeni syndrome in a family is important in determining appropriate follow-up for the patient and family. Such families are models for studying carcinogenesis.

    Title Function Following Partial Fibulectomy.
    Date August 1987
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    The fibula is a valuable source of a bone graft, but because the fibula has a role in lower extremity function, it is important to determine whether partial removal results in dysfunction or other problems. Forty-one patients (48 +/- 10 years of age) had a portion of their fibula removed for a bone graft. At evaluation 27 +/- 8 months later, 24 had no pain, 11 mild pain, and six moderate or severe pain. Sixteen had no complaints of any kind, but four without pain had minor difficulties with vigorous activities, and three complained of ankle swelling. There were no differences in range of motion between the operated and nonoperated side. Average muscle torque was lower on the operated than on the nonoperated side, but this difference was statistically significant only for ankle evertors in men. This study demonstrates that most patients will have subjective complaints and mild muscular weakness after removal of a portion of the fibula.

    Title Neck Pain: a Long-term Follow-up of 205 Patients.
    Date May 1987
    Journal Spine
    Excerpt

    Two hundred five patients with neck pain were evaluated clinically and roentgenographically for a minimum of 10 years after onset of symptoms. Seventy-nine percent had a decrease in pain, and 43% were free of pain; however, 32% had moderate or severe residual pain. Patients who had been injured and initially had severe pain were the most likely to have an unsatisfactory outcome; however, no other clinical features were of value in predicting the final result. The presence or severity of pain was not related to the presence of degenerative changes, the sagittal diameter of the spinal canal, the degree of cervical lordosis, or to any changes in these measurements over the evaluation period.

    Title Roentgenographic Findings of the Cervical Spine in Asymptomatic People.
    Date December 1986
    Journal Spine
    Excerpt

    The purpose of this study was to determine the incidence and severity of degenerative changes seen on lateral roentgenograms in 200 asymptomatic men and women in five age groups with an age range of 20-65 years and to determine the normal values of cervical lordosis and spinal canal sagittal diameters and their relationship to degenerative changes. It was found that by age 60-65, 95% of the men and 70% of the women had at least one degenerative change on their roentgenograms. A small sagittal diameter correlated with the presence of degenerative changes at the same disc level, and the strongest correlation was with the size of the posterior osteophytes at C5-6 (r = 0.52). Cervical lordosis measurements did not relate to degenerative changes except for subjects over age 50 with moderate or severe intervertebral narrowing. It is important to realize that although roentgenographic abnormalities represent structural changes in the spine, they do not necessarily cause symptoms.

    Title Roentgenographic Findings Following Anterior Cervical Fusion.
    Date December 1986
    Journal Skeletal Radiology
    Excerpt

    We reviewed the pre- and postoperative lateral cervical roentgenograms in 90 patients who had anterior fusions and compared their findings with age and sex-matched people without neck problems. The average interval from surgery to review was 5 years. Preoperatively, all patients had a higher incidence of degenerative spondylosis at the levels to be fused than their asymptomatic counterparts. Postoperatively, there was no difference in the incidence of degenerative change between the operated and the control group at the levels above and below the fusion with the exception of anterior osteophyte formation which was more frequent in those with fusions.

    Title Correlations Between Objective Measures of Function and a Clinical Knee Rating Scale Following Total Knee Replacement.
    Date December 1986
    Journal Orthopedics
    Excerpt

    Few objective measurements of function, other than range of motion, have been reported for patients with total condylar knee replacement. Moreover, to our knowledge, no studies have been reported which assess the degree of relationship between clinical ratings and measurements of function in these patients. Kinesiologic tests of function and the Hospital for Special Surgery (HSS) Knee Rating Form were used to evaluate 34 patients before and 2 years after 39 total condylar knee replacements. Prosthetic alignment was also evaluated postoperatively. The kinesiologic studies showed postoperative improvement in muscle strength, weight-bearing ability, and use of assistive devices, and in velocity, knee flexion-extension, and lateral head motion during walking. A moderate but significant degree of improvement was measured by the HSS score. Correlation coefficients showed that the postoperative knee rating score was significantly related to almost all of the postoperative objective measurements of function. Correlation coefficients between the prosthetic alignment scores and measurements of function were not statistically significant. The study strengthens the validity of use of the HSS Knee Rating Form as a tool for evaluating functional performance, particularly during the postoperative period.

    Title Comparison of Function Two Years After Revision of Failed Total Hip Arthroplasty and Primary Hip Arthroplasty.
    Date August 1986
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Because of the known high complication rate, it is important for both the patient and physician to know as much as possible about the outcome of revision operations for loosened total hip arthroplasties. This study evaluates the changes in subjective ratings and objective kinesiologic measurements from before revision operations through two years after revision operations. The object is to compare these measurements with the measurements of a group of patients with primary replacements. Both groups of patients showed significant improvement in most parameters from before to after surgery. These parameters included walking performance, hip muscle strength, range of motion, forces applied to canes, and the amount of weight borne on the operated limb during quiet standing. Compared to the control group with primary replacements, the group with revision used more assistive devices, had less pain relief, walked slower, had less hip motion, and had more lateral lurch. While results after revision surgery were not as gratifying as those after primary hip replacement, patients requiring revision can still anticipate substantial improvement.

    Title Strength and Range of Motion in the Ankle in Two Age Groups of Men and Women.
    Date May 1986
    Journal American Journal of Physical Medicine
    Excerpt

    Strength and range of motion of the ankle were measured in 20 normal men and 20 normal women divided equally into two age groups (25-35 and 50-60 years). Total range of dorsiflexion/plantar flexion averaged 75 degrees and the total range of inversion/eversion averaged 28 degrees. Few significant differences in range of motion were found between age groups, between men and women, or between dominant and nondominant limbs. Mean torque values for the men were greater than those for the women for all four muscle groups tested (plantar flexors, dorsiflexors, invertors and evertors). Strength of the women ranged from 62 to 70 percent of that of the men, depending upon muscle group. A multiple regression analysis showed that after the variability in muscle strength due to height and lean body weight had been taken into account, the additional variance accounted for by gender was very small. Differences in torque between age groups were not statistically significant. Differences in strength between dominant and nondominant limbs were significant only for the plantar flexors and dorsiflexors of the men.

    Title Shoulder-muscle Strength and Range of Motion Following Surgical Repair of Full-thickness Rotator-cuff Tears.
    Date March 1986
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    Postoperative measurements of the range of motion and muscle strength of the shoulder and ratings of pain and the ability to perform daily activities were made in fifty-eight patients (sixty-three shoulders) who had a repair of a full-thickness rotator-cuff tear. Postoperatively, the patients had an average of 126 degrees of active flexion of the shoulder and an average of 130 degrees of active abduction. Passive motion averaged 21 degrees more than active motion. The strength of the abductor muscles of the shoulder averaged approximately 86 per cent of normal. Most patients reported marked relief of pain and rated themselves as having mild or no deficits in their ability to perform daily activities. The length of the cuff tear significantly affected the functional results. Short tears (less than 2.5 centimeters) were associated with greater strength and range of motion than were long tears. Fifteen of the nineteen patients who were unable to work preoperatively because of the shoulder returned to work after surgery, but not necessarily to the same type of work that they had done before the onset of the problem with the shoulder.

    Title Hip Function After Total Vs. Surface Replacement.
    Date January 1986
    Journal Acta Orthopaedica Scandinavica
    Excerpt

    Kinesiologic measurements were made in two groups of 20 men before and 6 and 24 months after resurfacing or conventional replacement. Before surgery the group to have resurfacing was younger, had less pain, slightly more hip motion, greater muscle strength, walked faster, and used fewer assistive devices during walking than the group to have the conventional replacement. After surgery, the group with resurfacing maintained its advantage in muscle strength and walking velocity.

    Title Treadmill Vs. Floor Walking: Kinematics, Electromyogram, and Heart Rate.
    Date October 1985
    Journal Journal of Applied Physiology (bethesda, Md. : 1985)
    Excerpt

    To identify the degree of difference between treadmill and floor walking, kinematic, electromyographic (EMG), and heart rate measurements were recorded in seven normal female subjects during walking at three speeds on the treadmill and on the floor. During treadmill walking, subjects tended to use a faster cadence and shorter stride length than during floor walking. In addition the displacements of the head, hip, and ankle in the sagittal plane showed statistically significant differences between floor and treadmill walking. Average EMG activity was usually greater on the treadmill than on the floor; however, this difference was only significant for the quadriceps. Heart rate was significantly higher during fast treadmill walking than floor walking. In general, treadmill walking was not found to differ markedly from floor walking in kinematic measurements or EMG patterns.

    Title Functional Performance After Tibial Rotationplasty.
    Date April 1985
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    We measured muscle strength, joint motion, and gait parameters and determined the electromyographic activities of the ankle and knee during walking, running, and stair-climbing in two children who had had a tibial rotationplasty for osteosarcoma of the distal end of the femur. Both had marked loss of strength in the plantar flexors on the side of the prosthesis compared with the sound side, although electromyographic recordings showed that the rotated calf muscles, to a substantial degree, had assumed the function of extensors of the prosthetic knee. Despite some abnormalities in gait, both children walked at speeds that were comparable to those of normal children. They could also run, climb stairs by stepping up with both limbs, and participate in many recreational activities. The functional abilities of these children suggested that rotationplasty, in patients with a similar lesion, is a worth-while alternative to above-the-knee amputation.

    Title Shoulder Motion and Muscle Strength of Normal Men and Women in Two Age Groups.
    Date February 1985
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Normal age- and sex-related standards for shoulder range of motion (ROM) and muscle strength are unavailable in the literature. Active range of shoulder motion and maximum isometric strength (torque) of several shoulder muscle groups were measured in normal healthy men and women between 25 and 36 and between 55 and 66 years of age. Values for joint motion were similar for the two age and sex groups. The strength of the women was 45% to 66% of that in men, and strength of the older subjects was 66% to 93% of that in younger subjects. Strength of the second attempt at contraction was greater than that of the first attempt. Arm dominance did not significantly affect strength values.

    Title Kinematic and Emg Patterns During Slow, Free, and Fast Walking.
    Date December 1984
    Journal Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
    Excerpt

    Kinematics and electromyographic (EMG) activity were recorded in seven normal women during walking at slow, free, and fast speeds. Speed-related differences were found in the stride dimensions, temporal components, and most of the simultaneous displacement patterns of body segments measured. For most of the muscles tested, the amplitude of normalized EMG activity decreased as walking speed decreased. The findings emphasize the importance of accounting for the effect of speed itself on measurements of gait.

    Title Function After Revision of Failed Total Hip Arthroplasty.
    Date April 1984
    Journal Acta Orthopaedica Scandinavica
    Excerpt

    Measurements of functional performance were made before and 6 months after 31 primary total hip replacements and 31 total hip revisions for prosthetic loosening. After revision, functional performance returned to levels substantially the same as after primary hip replacement except for greater reliance on canes for patients in the revised group. Ratings of hip status and hip pain were slightly less satisfactory after revision as compared to after the primary operation.

    Title Gait Patterns in Above-knee Amputee Patients: Hydraulic Swing Control Vs Constant-friction Knee Components.
    Date September 1983
    Journal Archives of Physical Medicine and Rehabilitation
    Excerpt

    Multiple displacement patterns, stride dimensions, and temporal components during slow, free-speed, and fast walking were compared in the same seven above-knee amputees using prostheses with constant-friction knee components and using hydraulic swing-control knee components. During walking with the hydraulic-type prostheses, the amputees showed a wider range of walking speeds, improvement in the equality of the durations of successive swing and stance phases, and greater uniformity of forward progression. Improvements toward normal were also seen in several of the displacement patterns of the prosthetic limb during walking with the hydraulic knee. Several gait abnormalities persisted with both types of prostheses.

    Title Kinematic and Electromyographic Patterns of Olympic Race Walkers.
    Date June 1983
    Journal The American Journal of Sports Medicine
    Excerpt

    The performance of two Olympic race walkers was studied during free-speed, fast, and race walking. Measurements of the stride and temporal components of gait, as well as the simultaneous displacement patterns of the body segments, and the electromyographic activity of muscles of the trunk and upper and lower limbs were recorded during the three walking speeds. During the testing, the race walkers achieved an average speed of 12.5 km/hr as compared to the 8.7 km/hr average speed achieved by normal men of the same age during fast walking. Race walking was characterized by an increase in cadence and stride length beyond that of normal controls (in a prior study) during fast walking, with stride lengths averaging 125% of stature during race walking, and 115% during normal fast walking. In the two race walkers the amplitudes of most of the movement patterns of the trunk and upper and lower limbs were exaggerated during race walking as compared to normal controls' fast walking. Several mechanisms were used by the race walkers to minimize the vertical excursion of the center of gravity of the body during race walking. All of the muscles monitored in the race walkers showed an increase in the amplitude of electromyographic activity during race walking as compared to fast walking; duration of muscle activity was also usually increased during race walking. Several suggestions for prevention of injuries associated with race walking are made.

    Title Kinesiologic Measurements of Functional Performance Before and After Double Compartment Marmor Knee Arthroplasty.
    Date April 1983
    Journal Clinical Orthopaedics and Related Research
    Title Anterolateral Compared to Posterior Approach in Total Hip Arthroplasty: Differences in Component Positioning, Hip Strength, and Hip Motion.
    Date July 1982
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    In order to identify the functional advantages or disadvantages between the anterolateral and the posterior approaches to total hip arthroplasty, measurements of prosthetic position, hip-muscle strength, and hip joint mobility were made after Müller total hip arthroplasty without osteotomy in 52 patents operated through a posterior approach and 41 patients operated through an anterolateral approach. Men and women who had the posterior approach had less prosthetic component anteversion and longer neck lengths, with resultant more lateral and distal placement of the greater trochanter than groups with the anterolateral approach. Groups with the posterior approach had more normal hip abductor-muscle strength and more inward rotation on the operated side than group with the anterolateral approach. Groups with the anterolateral approach had more outward rotation on the operated side than groups with the posterior approach. These differences in function were related to the surgical approach rather than to differences in component position. An understanding of these observations should be used for selection of the surgical approach for the patient on an individual basis.

    Title Comparison of Müller Total Hip Replacement with and Without Trochanteric Osteotomy. Kinesiologic Measurements of 82 Cases 2 Years After Surgery.
    Date November 1981
    Journal Acta Orthopaedica Scandinavica
    Excerpt

    Function of 37 patients with osteotomy of the greater trochanter during total hip replacement (41 hips) is compared to function of 38 patients (41 hips) without osteotomy. Subjective assessments and cane force measurements were slightly more favorable in the group without osteotomy. Objective measurement of hip motion, hip abductor and adductor muscle strength, weight distribution during standing, and multiple components of free-speed and fast walking showed no statistically significant differences between performance of the groups with and without osteotomy before surgery or 6 months or 2 years after. This suggests that osteotomy provides no functional advantages to the patient beyond those obtained in total hip replacements without osteotomy.

    Title Gait Patterns of Above-knee Amputees Using Constant-friction Knee Components.
    Date October 1981
    Journal Bulletin of Prosthetics Research
    Title Strength of Isometric and Isokinetic Contractions: Knee Muscles of Men Aged 20 to 86.
    Date May 1980
    Journal Physical Therapy
    Excerpt

    Maximum isometric and isokinetic torques of the knee flexor and extensor muscles were measured at three knee joint positions in 72 normal, health men in three age groups from 20 to 86 years. The isokinetic contractions were performed at a speed of 36 degrees per second. The isometric contractions were sustained for five seconds. Strength of the men in the older age groups was significantly less than that of the youngest group. The strength of the isokinetic contractions was significantly less than that of the isometric contractions for all joint positions. The men in the oldest age group generally took longer than the younger men to reach peak torque during the isometric contractions. The torque values provide base-lines for evaluating patients with knee joint disabilities.

    Title A Comparison of the Funtional Performance of Patients with Charnley and Müller Total Hip Replacement. A Two-year Follow-up of Eighty-nine Cases.
    Date March 1980
    Journal Acta Orthopaedica Scandinavica
    Excerpt

    Measurements of functional performance in 35 cases with Charnley total hip replacement were compared with those of 54 cases with Müller replacement before surgery and at 6- and 24-month follow-up intervals. The measurements included strength of the hip abductor and adductor muscles, hip motion, the amount of weight borne on the involved limb during standing posture, multiple components of free-speed and fast walking, and force applied to canes and crutches. Both replacement groups improved significantly in most components of function. In fact, both groups reached or nearly reached the lower limits of normal variability in weight-bearing ability, cadence, and some components which relate to smoothness of walking performance. The groups with Müller and Charnley replacement differed most in some components of range of hip motion, hip muscle strength, and lateral lurching during walking.

    Title Walking Patterns of Men with Parkinsonism.
    Date April 1979
    Journal American Journal of Physical Medicine
    Excerpt

    Interrupted-light photography was used to record the simultaneous displacement patterns of multiple body segments of 44 patients with parkinsonism during free-speed and fast walking to quantitatively characterize their gait peculiarities. The patients were categorized into three disability groups according to their independence in activities of daily living. Their measurements of walking performance were compared to those of normal men. The gait components of the patients, which related systematically to the degree of disability, were: step lengths, vertical excursions of the head, extension of the hip and knee of the backward-directed limb at the onset of contralateral weight bearing, toe-floor distance at the onset of weight bearing, and rotation of the thorax.

    Title Function of the Triceps Surae During Gait. Compensatory Mechanisms for Unilateral Loss.
    Date September 1978
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    We studied the gait of a woman who was normal except for surgical excision of the gastrocnemius and soleus muscles. She was able to compensate for nearly all of her abnormalites of gait by excessive lateral pelvic tilt and prolonged quadriceps activity. Her mild disability, as regards gait, consisted of inability to increase walking speeds beyond the normal pacing. However, despite uneven step lengths, she had uniform forward progression. She had excessive dorsiflexion of the ankle and diminished plantar flexion on the involved side even though the retained plantar flexors could provide 38 per cent of her normal plantar flexor strength.

    Title Kinesiologic Measurements of Functional Performance Before and After Geometric Total Knee Replacemtn: One-year Follow-up of Twenty Cases.
    Date March 1978
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Kinesiologic measurements were made in patients with severe arthritis before and after geometric total knee replacements to evaluate the nature, rate and extent of change in their functional ability. Preoperatively, patients with rheumatoid arthritis functioned at lower levels than patients with osteoarthritis. Most patients with rheumatoid arthritis improved steadily after surgery, while progress of those with osteoarthritis was often irregular. The group with rheumatoid arthritis improved more than those with osteoarthritis, but they did not generally reach the functional level attained by the patients with osteoarthritis, and neither group reached the lower limits of normal variability 1 year postoperatively. On the average, both groups gained knee extensions, lost knee flexion, and gained isometric knee flexor muscle strength postoperatively. Every patient with osteoarthritis lost extensor muscle strength 1 year after surgery, while most with rheumatoid arthritis gained. During quiet standing, most patients had straighter knees postoperatively and bore a greater percent of body weight on the operated limb. Patients with rheumatoid arthritis improved more than patients with osteoarthritis in the type and amount of force applied to canes and crutches. Most patients walked faster postoperatively, took longer and more rapid steps, improved the pattern of knee motion used, and had smoother forward, lateral and vertical head motion.

    Title Roentgenographic Measurements After Müller Total Hip Replacement. Correlations Among Roentgenographic Measurements and Hip Strength and Mobility.
    Date November 1977
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    In fifty-two patients with Müller total hip replacement, roentgenographic measurements of prosthetic component positioning were correlated with hip-muscle strength and mobility measurements. Compared with the normal side, the average position of the center of the prosthetic head was more medial and superior in the pelvis, and the greater trochanter was more distal and lateral. Increasing neck length (distance from the center of the prosthetic head to the lesser trochanter) and a more distal position of the greater trochanter were among the measurements that related favorably to measurements of patient function. More superior placement of the center of the prosthetic head in the pelvis was associated with a more superior position of the lesser trochanter, which related adversely to function.

    Title Maximum Isometric Knee Flexor and Extensor Muscle Contractions: Normal Patterns of Torque Versus Time.
    Date July 1977
    Journal Physical Therapy
    Excerpt

    Isometric torque of the knee flexor and extensor muscles were recorded for 5 seconds at three knee joint positions. The subjects included healthy men in age groups from 20 to 35 and 45 to 65 years of age. The amplitudes and duration of peak torque and the time to peak torque were measured for each contraction. Peak torque was usually maintaned less than 0.1 second and never longer than 0.9 second. At each of the three angles, the mean extensor muscle torque was higher than the mean flexor muscle torque in both age groups, and the mean torque for both muscle group was higher among the younger than among the older man. The highest average torque was recorded at the knee angle of 60 degrees for the extensor muscles and 45 degrees for the flexor muscles, but this was not always a stereotyped response either for a given individual or among individuals.

    Title Comparison of Functional Performance After Mckee-farrar, Charnley, and Muller Total Hip Replacement. A Six-month Follow-up of One Hundred Sixty-five Cases.
    Date January 1977
    Journal Clinical Orthopaedics and Related Research
    Excerpt

    Measurements of functional performance were compared before and at 6 months after 58 McKee-Farrar, 50 Charnley, and 57 Muller total hip replacements in 143 patients. The measurment included: range of motion of the hip, hip abductor and adductor-muscle torque, weight-bearing activity during standing, forces applied to canes or crutches, and multiple components of walking performance. Each group of patients improved significantly after surgery in all of the components measured. Early postoperative differences among the 3 groups were found with respect to pain ratings, impressions of hip status, hip motions, muscle torque, the number of patients using assistive devices, and certain components of walking performance. There is nothing to suggest that the performance of any 1 group is distinctly better or worse than that of any other group 6 months after surgery. On the basis of average values, each group improved in every component of function and it is gratifying that, except for a few patients who developed postoperative infection, each patient could be considered to have successful reconstruction.

    Title A Comparison of Plantar Flexion Torque with and Without the Triceps Surae.
    Date July 1976
    Journal Acta Orthopaedica Scandinavica
    Excerpt

    Torque generated about the ankle joints during maximum isometric contraction of the plantar flexor muscles was measured on a subject 4 months after unilateral excision of the entire triceps surae. Resulting torque output on the operated limb was 327 kg-cm, or 38 per cent of the 871 kg-cm total for the sound limb.

    Title Walking Patterns of Men with Unilateral Surgical Hip Fusion.
    Date November 1975
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    The gait of men with unilateral hip fusion is somewhat slow, asymmetrical, and arrhythmic as compared with that of normal men. Compensation for absent hip motion is accomplished by increased transverse and sagittal rotation of the pelvis, increased motion in the sound hip, and increased flexion of the knee throughout the stance phase on the fused side. Relationships between the fusion position, certain physical traits, and walking performance suggest that the best gait can be expected in young patients who have free motion of the lumbar spine, the sound hip, and the knee on the side of fusion, and who have equal limb lengths and a hip fused in a position that does not include excessive adduction.

    Title A Method of Measuring the Duration of Foot-floor Contact During Walking.
    Date August 1975
    Journal Physical Therapy
    Excerpt

    A new method for monitoring the durations of foot-floor contact during walking is described. The method uses a screen walkway and conducting paper on the soles of the shoes as parts of an electrical circuit. The materials used are identified and circuit diagrams are provided. Several clinical applications and advantages and disadvantages of the method are discussed.

    Title Light-induced Absorbance Changes of Cytochromes and Carotenoids in a Sulfur Bacterium Containing Bacteriochlorophyll B.
    Date May 1969
    Journal Biochimica Et Biophysica Acta

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