Measurement of Milwaukee Brace Pad Pressure in Adolescent Round Back Deformity Treatment

STUDY DESIGN: In this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment. PURPOSE: We evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace. OVERVIEW OF LITERATURE: A fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction. METHODS: Interface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation. RESULTS: The mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (p=0.001).There were no statistically significant differences between right and left shoulder pad pressures (p>0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (p<0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (p=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction. CONCLUSIONS: In the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.

A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?

STUDY DESIGN: Clinical pilot study. PURPOSE: To objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs. OVERVIEW OF LITERATURE: Wearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects. METHODS: Twelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire. RESULTS: The mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (p=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (p<0.001, p=0.02, respectively). CONCLUSIONS: The compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.

effect of rocker shoe on the ground reaction force parameters in patients with rheumatoid arthritis

Foot and ankle problems are common complications in rheumatoid arthritis disease. Gait pattern such as normal foot and ankle rocker is impaired in patients with rheumatoid arthritis. Rocker sole as an external shoe modification is commonly prescribed in this pathology. The aim of this study was to investigate the effect of rocker shoe on vertical ground reaction force parameters during walking in patients with rheumatoid arthritis. Sixteen female participants with rheumatoid arthritis were recruited in this study. All patients were prepared with a pair of high-top, heel-to-toe rocker shoe and were asked to wear the shoes for one month. Ground reaction force parameters including peak forces and peak force times were evaluated in the first session, and after seven days and thirty days follow up were carried on. First maximal vertical force was significantly increased with rocker shoe compared to barefoot after 7 days follow up. Walking with rocker shoe reduced the minimal vertical force after 7 days. The second maximal vertical force showed to be statistically lower with rocker shoe than barefoot after 7 and 30 days. Furthermore, stance time decreased with rocker shoe after one month. Results of this study revealed that vertical ground reaction force parameters changed in rheumatoid arthritis patients with heel-to-toe rocker shoe, both immediately and after one month follow up. This might suggest the effectiveness of rocker shoes in improving gait in rheumatoid arthritis patients

Comparative evaluation of core and knee extensor mechanism muscle activation patterns in a stair stepping task in healthy controls and patellofemoral pain patients

Background: Patellofemoral pain [PFP] is a common affliction and complex clinical entity. Deficit in neuromotor control of the core may be a remote contributing factor to the development of PFPS. Comparative evaluation of core and extensor mechanism muscle activation patterns between healthy group and patients involved by patellofemoral pain syndrome [PFPS] in a stair stepping task is the aim of this study

Methods: In this non-randomized interventional study fifteen males with PFPS and fifteen asymptomatic controls participated. Electromyographic [EMG] activity of Vastusmedialisobliquus [VMO], Vastuslateralis [VL], Gluteus medius [GMED], Gluteus Maximus [GMAX], Internal oblique [IO] and Erector spinae [ES] were recorded and EMG onsets were assessed in both stepping up [SU] and down [SD]. The time of foot contact determined by a foot switch

Results: During SU: Onset times of all muscles except, VL and ES in the controls were significantly less than PFPS group [P<0.05]. In PFPS group the temporal sequence of ES, VL and VMO were different from control groups. During SD: Onset times of all muscles except, GMAX and ES in the control group were significantly less than PFP group [P<0.05]. The sequence of muscle activity in both healthy and PFP groups were the same

Conclusion: Our findings are in line with previous researches about the effects of core on function and control of lower extremity. Activation patterns of core and vasti muscles are different between control and PFPS group during stair stepping task. Designing exercises to correct inappropriate timing of core muscles may have a role in management of PFPS and it needs more future researches

Isokinetic evaluation of quadriceps strength in open and closed kinetic chains in patients with anterior cruciate ligament reconstruction

Strength of knee extension and squat were compared between anterior cruciate ligament reconstructed [ACLR] patients and healthy subjects. Twenty ACLR and twenty control subjects were participated in this non-exprimental study. Isokinetic peak strength of knee extension and squat in involved and uninvolved side of the ACLR patient and control group were measured. Concentric and eccentric knee extension strength of the involved leg was decreased but squat strength showed no difference. In spite of return to sport activity and normal squat strength weakness of knee extensor muscles in the involved side of the ACLR patient was existed

[Test- retest reliability of coordination and movement pattern stability measures during repetitive trunk bending in healthy and non specific low back pain groups]

To define the dynamic organization of the neuromuscular system, we need useful tools that allow for the expression of the neuromuscular system in low dimensional term [i.e one variable], so it seems that relative phase provides a better measure of organization of the neuromuscular system. Besides, selection of a measure for research or clinical use should be motivated by several factors, including the measure reliability. To our knowledge there seems to exist no study that have ever investigated the reliability of the relative phase and deviation phase in healthy or Low back pain subjects in dynamic movement tasks. Twelve healthy volunteers and 12 low back pain patients performed repeated trunk bending motion in eight different conditions of high and low speed, in symmetric and asymmetric planes, with or without external load. All measurements were repeated on a second session, 7-10 days later. Mean absolute relative phase and deviation phase of lumbar-thorax and pelvis-lumbar were used to calculate coordination pattern and variability. Relative reliability was assessed using intra class correlation coefficient [ICC] and absolute reliability was assessed using standard error measurement, minimum detectable change and coefficient of variation. Results in healthy subjects revealed that relative phase and deviation phase showed good to excellent reliability, with ICC range of 5.3-8.4 and in low back pain group ICC range was0 /52-0/85 except in three asymmetric test conditions and one symmetric test condition. SEM values range for healthy subjects were 0/92-4/8 and for low back patients were 1/2-5/8. Relative phase and deviation phase are suggested as good parameter to use for evaluating coordination and variability in dynamic situations such as lifting and complex trunk movement and also for discrimination low back pain patients from healthy subjects.

test-retest reliability of the onset of core and vasti electromyographic activity while ascending and descending stairs in healthy controls and patellofemoral pain patients

Patellofemoral pain [PFP] is a common affliction and complex clinical entity. It is hypothesized to result from abnormal patellar tracking caused by altered motor control. Deficit in neuromotor control of the core may be a remote contributing factor to the development of PFP. Application of reliable EMG measures would be helpful to handle this theory. Therefore, the purpose of this study was to determine the test-retest reliability of the core and vasti EMG onsets, while ascending/descending stairs. Ten males with PFP and ten healthy controls participated in this study. Vasti and Core EMG onsets during stair stepping were assessed two times a day. Intraclass correlation coefficients [ICCs] and standard errors of measurement [SEMs] were calculated. Ten males with PFP and ten healthy controls participated in this study. Vasti onsets of control cases [ICC 3,1 >/= 0.70] except Quadratus Lumborum [QL] which showed a moderate reliability [ICC for ascending=0.59 and for descending = 0.61]. In controls, Vasti in both tasks showed the highest absolute reliability. During ascending, high reliability [ICC >/= 0.70] in PFP group was demonstrated for all EMG onsets except Gluteus maximus [GMAX] and QL which showed a moderate reliability [ICC = 0.69 and 0.63 respectively]. In this group while descending stairs, all EMG onsets showed high relative reliability [ICC >/= 0.70]. Moderate to high absolute reliability was obtained for onset times while ascending/descending stairs in PFP group. During both ascending/descending, high reliability was found for all EMG reliability. Most EMG onsets during stair ascending/descending had moderate to high