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fitbyfred

Development Team Member
Registered:
Posts: 168
 #1 
Client situation: 

- history of lower leg compartment / tendon trouble
-- known respiratory limitations
--- MOXY X 2 placements are measured / symmetrical 
---- Client is moving on a Woodway Curve - Manual Treadmill

Which lower leg is historionic ? Which is the one to focus some attention on ?  IMG_6782.JPG 

fitbyfred

Development Team Member
Registered:
Posts: 168
 #2 
Earlier screen pic shows the reload.
This image shows the unload. 

IMG_6781.JPG 

Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #3 
First of all for regular readers, that's  how a  future  fitness  room will look like  a  direct feedback on the quality of the workout  your coach  provides  plus super  motivation  for all in the room   as they concentration on what they  do on a screen  and not just     music  and show ( which  is needed as well  sometimes )
 You find this futuristic  looking   center in NS  Halifax.  So  for people form that region visit  Fred  and you have one of the most innovative  centers in Canada     and  one of The  most personal services  you can get   today. The other one  in  the east is Sandy  . look on her  guest Blog on nutrients   in the MOXY main page  and you find her place, where you get  this great service  plus much more.
 YESSSSS
 this is   PR  because this people  send  incredible feedbacks  to us  an challenge us regular    and we  need  that.  This example is another great challenge  as  this  maybe a very great   way to explain  many    extremity  reactions  and or  reactions  based on respiratory problems.
 Here  2   feed backs. One a  study  in that direction. the other a request.
 Fred  ,  when you saved the  test on peripedal  go to the  Forum tech  help and  download the  Peri pedal converter  to CSV  file   and than   sent me this file as I like to use  some     ideas  here to look somewhat closer  to some data's   you collected  before I try to  explain  what I may see.  Cheers Juerg

Related trends in locomotor and respiratory muscle oxygenation during exercise.

Legrand R, Marles A, Prieur F, Lazzari S, Blondel N, Mucci P.

Source

Laboratory of Human Movement Studies, Faculty of Sports Sciences and Physical Education, Lille University, Lille, France.

Abstract

PURPOSE:

We investigated the potential effect of respiratory muscle work on leg muscle oxygenation without artificial intervention in non-endurance-trained young subjects and searched for the range of intensity when this effect could occur.

METHODS:

We simultaneously monitored accessory respiratory and leg muscle oxygenation patterns with near-infrared spectroscopy (NIRS) in 15 healthy young men performing maximal incremental exercise on a cycle ergometer. Pulmonary gas exchange was measured. The respiratory compensation point (RCP) was determined. Oxygenation (RMO2) and blood volume (RMBV) of the serratus anterior (accessory respiratory muscle) and of the vastus lateralis (LegO2 and LegBV) were monitored with NIRS. The breakdown point of accessory respiratory muscle oxygenation (BPRMO2) and the accelerated (BP1LegO2) and attenuated fall (BP2LegO2) in leg muscle oxygenation were detected.

RESULTS:

BPRMO2 occurred at approximately 85% .VO2max and was related to RCP (r = 0.88, P < 0.001). BP2LegO2 appeared at approximately 83% .VO2max and was related to RCP (r = 0.57, P < 0.05) and with BPRMO2 (r = 0.64, P = 0.01). From BP2LegO2 to maximal exercise, LegBV was significantly reduced (P < 0.05).

CONCLUSION:

In active subjects exercising at heavy exercise intensities, we observed that the appearance of the accelerated drop in accessory respiratory muscle oxygenation-associated with high ventilatory level-was related with the attenuated fall in leg muscle oxygenation detected with near-infrared spectroscopy. This suggests that the high oxygen requirement of respiratory muscle leads to limited oxygen use by locomotor muscles as demonstrated in endurance-trained subjects. The phenomenon observed was associated with reduced leg blood volume, supporting the occurrence of leg vasoconstriction. These events appeared not only at maximal exercise but onward above the respiratory compensation point.

PMID:

17218889

[PubMed - indexed for MEDLINE]

fitbyfred

Development Team Member
Registered:
Posts: 168
 #4 
Juerg, hi, and thanks for comments on the fitness room. I have set up the ANT+ dongle hanging form the middle of the room, along with two large monitor, one on each end. This is working very well for the space. 

I use the MOXYs for 7-8 client sessions each day, and sometimes do not save the files on exiting the session. Unfortunately this session was not saved. Any guesses you want to offer up will be interesting for sure.  
Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #5 
Thanks  will  look closer  again on what we see  and we have a  small  hint on the tHb  as  the  trend  shows  up  i  the numbers. Here  some ideas.
  I was looking into this     for  some of my clients.
  I am not  convinced, that by using  just SmO2  as  an indicator  we  can get a  good conclusion or better observation. BU  if we  add the trend in  tHb  and look at the reaction we  can see in occlusion  reactions  b at rest  but as well under  activity we may be able to use a pain free  assessment tool  for  at least some indications of  compartment  syndrome  versus   claudicatio intermittent.
 Here  some of the common  used  studies  to   explain  NIRS. 
Here  some  to read  and than go back to the picture e from Fred.  You are the  judges.


Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg.

Shuler MS, Reisman WM, Kinsey TL, Whitesides TE Jr, Hammerberg EM, Davila MG, Moore TJ.

Source

Grady Memorial Hospital, Atlanta, Georgia, USA. msimmss@hotmail.com

Abstract

BACKGROUND:

Near-infrared spectroscopy estimates soft-tissue oxygenation approximately 2 to 3 cm below the skin. The purpose of the present study was to evaluate muscle oxygenation in the setting of an acute compartment syndrome of the leg and to determine if near-infrared spectroscopy is capable of detecting perfusion deficits.

METHODS:

Fourteen patients with unilateral lower extremity trauma were enrolled after the diagnosis of an acute compartment syndrome was made clinically and confirmed with intracompartmental pressure measurements. Lower extremity muscle compartments were evaluated with near-infrared spectroscopy, and near-infrared spectroscopy values of the uninjured, contralateral leg of each patient were used as internal reference values. The compartment perfusion gradient was calculated as the diastolic blood pressure minus the intracompartmental pressure.

RESULTS:

Intracompartmental pressures ranged from 21 to 176 mm Hg (mean, 79 mm Hg) and exceeded 30 mm Hg in all compartments but two (both in the same patient). Thirty-eight compartments had a perfusion gradient of < or = 10 mm Hg (indicating ischemia). Among ischemic compartments, near-infrared spectroscopy values in the anterior, lateral, deep posterior, and superficial posterior compartments of the injured limbs were decreased by an average 10.1%, 10.1%, 9.4%, and 16.3% in comparison with the corresponding compartments of the uninjured leg. Differences in near-infrared spectroscopy values (the near-infrared spectroscopy value for the injured leg minus the near-infrared spectroscopy value for the uninjured leg) were positively correlated with compartment perfusion gradient within each compartment (r = 0.82, 0.65, 0.67, and 0.62, for the anterior, lateral, deep posterior, and superficial posterior compartments, respectively; p < 0.05 for all).

CONCLUSIONS:

Normalized near-infrared spectroscopy values decrease significantly with decreasing lower limb perfusion pressures. Near-infrared spectroscopy may be capable of differentiating between injured patients with and without an acute compartment syndrome.

Near-infrared spectroscopy for monitoring of tissue oxygenation of exercising skeletal muscle in a chronic compartment syndrome model.

 

Breit GA, Gross JH, Watenpaugh DE, Chance B, Hargens AR.

 

Collaborators (1)

 

Hargens AR.

 

Source

 

National Aeronautics and Space Administration Ames Research Center, Moffett Field, California 94035-1000, USA.

 

Abstract

 

Variations in the levels of muscle hemoglobin and of myoglobin oxygen saturation can be detected non-invasively with near-infrared spectroscopy. This technique could be applied to the diagnosis of chronic compartment syndrome, in which invasive testing has shown increased intramuscular pressure associated with ischemia and pain during exercise. We simulated chronic compartment syndrome in ten healthy subjects (seven men and three women) by applying external compression, through a wide inflatable cuff, to increase the intramuscular pressure in the anterior compartment of the leg. The tissue oxygenation of the tibialis anterior muscle was measured with near-infrared spectroscopy during gradual inflation of the cuff to a pressure of forty millimeters of mercury (5.33 kilopascals) during fourteen minutes of cyclic isokinetic dorsiflexion and plantar flexion of the ankle. The subjects exercised with and without external compression. The data on tissue oxygenation for each subject then were normalized to a scale of 100 per cent (the baseline value, or the value at rest) to 0 per cent (the physiological minimum, or the level of oxygenation achieved by exercise to exhaustion during arterial occlusion of the lower extremity). With external compression, tissue oxygenation declined at a rate of 1.4 +/- 0.3 per cent per minute (mean and standard error) during exercise. After an initial decrease at the onset, tissue oxygenation did not decline during exercise without compression. The recovery of tissue oxygenation after exercise was twice as slow with compression (2.5 +/- 0.6 minutes) than it was without the use of compression (1.3 +/- 0.2 minutes).

 

PMID:

 

9199380

 

[PubMed - indexed for MEDLINE]

 

 

 


Juerg Feldmann

Fortiori Design LLC
Registered:
Posts: 1,530
 #6 
Let's  do some loud thinking on this interesting feedback. Keep the picture in mind.
  Above trace  has a  higher max  SmO2  in load  and unload  and a higher  tHb    in both   situations compared to the lower. So  we  could jump  immediately on a conclusion, that the lower  is the problem  leg ??
  Risk:
 The   chance, that we have equal SmO2  and tHb  readings, when  fixing  2 moxy's  on 2 different legs  is  small  so  using  simply  SmO2  as  an absolute value  and compare  is not  an optimal  way to go  and most likely  to much  errors.
  With tHb  as a  trend info  even  worse.
 So we  have to move that   fast  decision out of the way  and look at closer at  possible physiological trends   a  compression  syndrome  could produce..
a)  An increase in compression  on   the working muscle   will  depend how it is applied   first create a  compression  out  flow  and if  compression increases  a  venous occlusion followed  by if extreme  an arterial occlusion.
 We do not have here the CSV  files  to look at this  situation.
 Here a picture  ( not  form a  compression syndrome but  form an actual  work  ( activity )  who creates  this picture  when we look closer. See pic  1 as a  venous occlusion during activity.  You will  first always see a  small drop in tHb  due to   first  compression  from  muscle contraction  so tHb  outflow  before you see  an increase  due to   reduction in outflow  due to a start of a venous occlusion. See pic 2  as a " research " occlusion  with  occlusion  away  from the moxy test area    and no activity of the muscle   besides  an occlusion.  So very different story  as  no compression in the test area  but  an increase in tHb  due to  outflow restriction.
 So in an  compartment syndrome  we would have more likley   the first  type  to look at.
  Now  in the compartment syndrome leg  we would have an increase in compression  due to the problem  and therefor a    bigger drop of optimal tHb  ( blood volume) than we would   expect  on the other side.
  So  IF the load is  in an intensity , where the  "good " leg  is still able to  oxygenate  above and beyond the initial  start  level   than we  may see in the  " bad " leg   at the same load  due to lower tHb   a less optimal O2  supply  (  Compartment syndrome  would be  for us a  delivery problem.
  The compensator  for a  delivery  would be a  faster  need  to utilize  SmO2  so a  drop in SmO2.
  So what I would look is  in an 5/1/5   is 2 areas.
  Deloading  at the start after the 1   followed by  the trend of  SmO2  increase  flat decrease  and   than when we stop the reloading.
 Why.
  The   initial start  would show a faster  droop in tHb   compared to the good side  with a  faster and deeper   SmO2  trend  due  to needed  compensation   of the  lower  tHb  (  delivery ) . Than  we would have a  section, where we  suddenly  would see in the good side  a   initial drop  at the load as usual  followed  by a slow  increase  of SmO2  till to the next 1 min rest.
 On the " Bad' side  same intensity we  would see  as well an initial drop  but than   already a flat  or even nicer  a    drop in SmO2  as a  sign of a delivery problem   and the need for a higher utilization.
  The problem in step test  is  as usual duration but as well the   problem , that we  have no loading  deloading  in a clear way . the 5/1/5  will give this information.
  So when you look carefully on the peri pedal  pic.
 look at the SmO2  trend.  Do you see  whether  one leg is increasing SmO2 in the  load  and one  at the same   intensity decreasing ????  Yes  I think  even on the pic  we could see  that.
 Next up is  in a compartment syndrome the  problem of relaxation  due to  a higher load  . So we would see in a  5/1/5  or even on here a  much slower  re-oxygenation  ability  due to  lag in relaxation of  the pressure but as well due  to the situation, that  some of the O2  coming back in  will be  used  to potentially  fill up the   slightly overused " storage  " area  so we would see a  much lower  rebound of O2.
  So  this is what i am looking if I have clients  with this possible  problem.
 Now let's see, what  the study I showed  you had  to say?

  With external compression, tissue oxygenation declined at a rate of 1.4 +/- 0.3 per cent per minute (mean and standard error) during exercise. After an initial decrease   ( Why  you know  now  why )at the onset, tissue oxygenation did not decline during exercise without compression. (  falt or even increase  but they  did not  to a 5/1/5    so  just tried one load   and whre lucky )The recovery of tissue oxygenation after exercise was twice as slow with compression (2.5 +/- 0.6 minutes) than it was without the use of compression (1.3 +/- 0.2 minutes).



In teh " recovery look at teh  angle  inteh recovery an dteh heigth of teh SmO2  recovery. Hope this helps  and more hopefull  teh cleint  had  really in that leg teh problme otehrwise  eitehr a great theroy is out teh window  and we have to reviwe  or  teh diagnosis  comartment syndrmoe  couyld be  worng.

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