Stiffness degree of ankle range of motion in diabetic patients with atypical amputation

SUMMARY In diabetics, foot deformities are risk factors that increase the risk of amputation as a result of developing ulcers. However, knowledge of the influence of plantar stiffness is still limited. The main objective was to describe connections between the degree of stiffness of the ankle, atypical amputation, and the Foot Posture Index (FPI). METHODS 62 diabetic patients, 58 with type 2 and 4 with type 1 (average age 63.35 years) were included. Records of foot deformities were included; A range of motion test of the ankle joint was used to determine the degree of stiffness. An exploratory analysis of the association of foot position and the degree of rigidity was performed. RESULTS The dorsal flexion range of the ankle was 9.6 ± 5.1 0, 13.8 ± 5.9 0 and 17.2 ± 6.5 0 and 20.5 ± 6.8 0 to 45, 67, 89 and 111 N respectively in the amputated feet., And 14 patients (22.58%) had a high level of pronation of IPF with an average value of 3.7 ± 2.629, CI (3.032.-4.367) in amputated feet compared to non-amputees. We use the device "Iowa ankle range of motion" (IAROM) to determine the differences in ankle stiffness. Proper IPF was associated with the presence of amputation and an increase in stiffness CONCLUSIONS There was an increase in the degree of limitation of movement of the ankle, as a greater force was applied. Comparing FPI between the groups, there was a higher frequency of prone feet in the group of amputees

RESUMO Nos diabéticos, as enfermidades nos pés são fatores de risco, que aumentam o risco de sofrerem uma amputação, como resultado do desenvolvimento de úlceras. Contudo, o conhecimento sobre a influência da rigidez plantar ainda é limitado. O objetivo principal foi descrever conexões entre o grau de rigidez do tornozelo, a amputação atípica e o Foot Posture Index (FPI). MÉTODOS 62 diabéticos, 58 com tipo 2; e 4 com tipo 1 (idade média de 63.35 anos). Incluindo o registro de deformidades do pé; teste de classificação do movimento da articulação do tornozelo, para determinar o grau de rigidez. Realizou-se uma análise exploratória da associação da posição do pé com o grau de rigidez. RESULTADO A classificação de flexão dorsal do tornozelo foi de 9.6 ± 5.1 0, 13.8 ± 5.9 0 e de 17.2 ± 6.5 0 e 20.5 ± 6.8 0 a 45, 67, 89 e 111 N respectivamente nos pés amputados, e 14 pacientes (22.58%) teve alto nível de pronação de FPI com um valor médio de 3.7 ±2.629, IC(3.032.-4.367) em pés amputados com relação aos não amputados. Utilizamos o dispositivo "Iowa ankle range of motion" (IAROM) para determinar as diferenças de rigidez do tornozelo. O FPI pronado foi associado à presença de amputação e um aumento da rigidez. CONCLUSÕES Aumento do grau de limitação do movimento do tornozelo; à medida que se aplicava uma força maior. Comparando FPI entre os grupos existentes maior frequência de pés pronados no grupo de amputados.

Inestabilidad crónica lateral de tobillo. Técnica modificada / Chronic lateral ankle instability. Modified technique

Resumen: Introducción: La inestabilidad crónica de tobillo se define como un estado clínico caracterizado por la presencia de esguinces de repetición. Puede ser funcional o mecánica. Objetivo: El objetivo general del presente trabajo es determinar mediante la escala de AOFAS y radiografías, los resultados de la técnica de Broström-Gould modificada con anclas en pacientes con inestabilidad crónica lateral de tobillo en el Instituto Nacional de Rehabilitación (INR) en un período comprendido de 2008-2016. Material y métodos: Es un estudio transversal, prospectivo, descriptivo, con pacientes del INR que contaron con el diagnóstico de Inestabilidad crónica lateral de tobillo manejados mediante el procedimiento de Broström-Gould modificado con anclas. Resultados: Fueron 13 en seguimiento, un hombre y 12 mujeres, con promedio de edad de 38 años (± 13), con predominio del tobillo izquierdo siete (54%) sobre el derecho seis (46%). En la escala AOFAS, el promedio prequirúrgico obtenido fue de 39.3 (± 13.1) en comparación con el postquirurgico a seis meses de 73.4 (± 18). Conclusión: El uso de anclas aunado a la técnica de Broström-Gould modificado con anclas es una alternativa simple y efectiva, que permite la sustitución y/o reparación de los ligamentos peroneoastragalino anterior y peroneocalcáneo.

Abstract: Introduction: Chronic ankle instability is defined as a clinical condition characterized by the presence of repetitive sprains. It can be functional or mechanical. Objective: The general objective of this study is to determine the results of the technique using the AOFAS scale and radiographs. of Broström-Gould modified with anchors in patients with chronic lateral ankle instability in the INR in a period comprised of 2008-2016. Material and methods: This is a cross-sectional, prospective, descriptive study with INR patients who had the diagnosis of chronic lateral ankle instability managed using the Broström-Gould procedure modified with anchors. Results: 13 were in follow-up, 1 man and 12 women, with an average age of 38 years (± 13), with predominance of the left ankle 7 (54%) over the right 6 (46%). On the AOFAS scale, the pre-surgical average obtained was 39.3 (± 13.1) compared to the 6-month post-surgery of 73.4 (± 18). Conclusion: The use of anchors combined with the modified Broström-Gould technique with anchors is a simple and effective alternative that allows the replacement or repair of the anterior peroneal and peroneocalcaneal fibular ligaments.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.

Effects of eccentric exercise in pressure pain threshold in subjects with functional ankle equinus condition

SUMMARY Stretching exercises are widely used by the population before sporting activities. One of the most common technique is eccentric exercise. Here, we made a clinical examination of 98 subjects with equinus condition before activity and after 30 min of running (49 participants with previous eccentric exercise and 49 with no previously eccentric exercise). The clinical assessment of the Achilles tendon was based on the pressure pain threshold (PPT). We identified significant PPT changes between the previous eccentric stretching and the non-previous eccentric stretching group in the Achilles tendon evaluations. Based on our findings, we propose that subjects with equinus condition could use eccentric stretching in order to improve the Achilles tendon status.

RESUMO Exercícios de alongamento são amplamente utilizados pela população antes da atividade esportiva. Uma das técnicas mais comuns é o exercício excêntrico. Aqui, fizemos um exame clínico de 98 indivíduos com condição de pé equino antes da atividade e após 30 minutos de corrida (49 corredores com exercício excêntrico anterior e 49 sem exercício excêntrico anterior). A avaliação clínica do tendão de Aquiles foi baseada no limiar de dor à pressão (PPT). Identificamos modificações significativas no PPT entre alongamentos prévios excêntricos e nenhum exercício anterior excêntrico de alongamento para as avaliações do tendão de Aquiles. Com base em nossos achados, propomos que sujeitos com condição de pé equino poderiam fazer alongamentos com exercícios excêntricos para melhorar o status do tendão de Aquiles.

Osteocondroma como hallazgo Incidental en Úlcera Varicosa Sobreinfectada en miembro inferior / Osteochondroma as an incidental finding in Superinfected Varicose Ulcer in the lower limb

El osteocondroma es la lesión tumoral más frecuente del hueso. Éste presenta características radiológicas patognomónicas con continuidad cortical y medular, con lesión exofítica iniciada en metáfisis, protruyendo hasta la diáfisis de huesos largos, con predominio en la porción distal del fémur, fíbula y tibia proximal. Para el diagnóstico de esta patología, por lo general sólo se necesita una imagen radiológica simple en dos planos, en casos ocasionales necesitando tomografía computarizada para verificarlo. En la mayoría de los casos el diagnóstico ocurre de forma incidental, en pacientes asintomáticos, en contados casos, se observa impotencia funcional, bursitis, parestesias o fracturas en hueso patológico. El riesgo de transformación es menor al 1 %, siendo el tumor maligno más frecuente el condrosarcoma. Se describe el reporte de un hallazgo imagenológico incidental de un tumor óseo en un paciente de 65 años con úlcera varicosa sobreinfectada en conjunto con la discusión sobre la importancia de la imagenología para estos diagnósticos.

Osteochondroma is the most frequent tumor lesion in bone. This presents pathognomonic radiological features with cortical and medullary continuity, with exophytic lesion initiated in metaphysis, protruding to the diaphysis of long bones, predominating in the distal portion of the femur, fibula and proximal tibia. For the diagnosis of this pathology, usually only a simple radiological image is needed in two planes, in occasional cases needing computed tomography to verify it. In most cases the diagnosis occurs incidentally, in asymptomatic patients, in few cases, functional impotence, bursitis, paresthesias or fractures in pathological bone are observed. The risk of transformation is less than 1 %, with the malignant tumor being more frequent chondrosarcoma. Following the report of an incidental imaging finding of a bone tumor on 65 years old patient with varicose ulcer infected in conjunction with the discussion of the importance of these diagnostic imaging to be described.

Preliminary study of robot-assisted ankle rehabilitation for children with cerebral palsy / 北京大学学报(医学版)

OBJECTIVE@#To propose a kind of robotic ankle-foot rehabilitation system for children with cerebral palsy and to preliminarily verify its feasibility in clinical application.@*METHODS@#A robot assisted ankle-foot rehabilitation system was specially designed and developed for children with cerebral palsy and a preliminary clinical study was conducted in Department of Rehabilitation Medicine, Peking University First Hospital. Modified Tardieu Scale and joint biomechanical properties (ankle plantar flexion resistance torque under different ankle dorsiflexion angles) were measured to analyze the muscle tone and soft tissue compliance of the ankle plantar flexors pre- and post-robotic training intervention. Six children with cerebral palsy (4 girls and 2 boys, mean age: 7 years) were recruited in this study. Each subject received 5 session robotic training and each session included 10-cycle passive stretching and static hold. SPSS 19.0 software was used for data statistical analysis.@*RESULTS@#Both R1 and R2 angles of Modified Tardieu Scale for ankle plantar flexors after training were significantly higher than those before the treatments (Gastrocnemius: PR1=0.003, PR2=0.029; Soleus: PR1=0.002, PR2=0.034). The difference between R2 and R1 was of no statistical difference before and after the training (P=0.067 and P=0.067, respectively). After training, the ankle plantar flexion resistance torque under different dorsiflexion angles (0°, 10°, 20°, 30°) were significantly reduced than those before training (P=0.001, P=0.001, P=0.014, P=0.002, respectively).@*CONCLUSION@#The robot assisted ankle-foot rehabilitation system can improve the contracture and soft tissue compliance of cerebral palsy children's ankle plantar flexors. All the children in the study were well tolerated and interested with the training, easy to accept and cooperate with it. This device may be suitable for application in the rehabilitation of children with cerebral palsy. However, further randomized clinical trials with larger sample size are still needed to verify the long term efficacy of this device.

Effect of Rhythmic Auditory Stimulation on Hemiplegic Gait Patterns

PURPOSE: The purpose of our study was to investigate the effect of gait training with rhythmic auditory stimulation (RAS) on both kinematic and temporospatial gait patterns in patients with hemiplegia. MATERIALS AND METHODS: Eighteen hemiplegic patients diagnosed with either cerebral palsy or stroke participated in this study. All participants underwent the 4-week gait training with RAS. The treatment was performed for 30 minutes per each session, three sessions per week. RAS was provided with rhythmic beats using a chord progression on a keyboard. Kinematic and temporospatial data were collected and analyzed using a three-dimensional motion analysis system. RESULTS: Gait training with RAS significantly improved both proximal and distal joint kinematic patterns in hip adduction, knee flexion, and ankle plantar flexion, enhancing the gait deviation index (GDI) as well as ameliorating temporal asymmetry of the stance and swing phases in patients with hemiplegia. Stroke patients with previous walking experience demonstrated significant kinematic improvement in knee flexion in mid-swing and ankle dorsiflexion in terminal stance. Among stroke patients, subacute patients showed a significantly increased GDI score compared with chronic patients. In addition, household ambulators showed a significant effect on reducing anterior tilt of the pelvis with an enhanced GDI score, while community ambulators significantly increased knee flexion in mid-swing phase and ankle dorsiflexion in terminal stance phase. CONCLUSION: Gait training with RAS has beneficial effects on both kinematic and temporospatial patterns in patients with hemiplegia, providing not only clinical implications of locomotor rehabilitation with goal-oriented external feedback using RAS but also differential effects according to ambulatory function.

Elevated Brachial-Ankle Pulse Wave Velocity Is Independently Associated with Microalbuminuria in a Rural Population

Microalbuminuria is a marker of generalized endothelial dysfunction resulting from arterial stiffness or insulin resistance, and brachial-ankle pulse wave velocity (baPWV) is a good measure of arterial stiffness. We aimed to investigate whether elevated baPWV is independently associated with microalbuminuria. This study included 1,648 individuals aged over 40 who participated in the baseline Multi-Rural Cohort Study conducted in Korean rural communities between 2005 and 2006. Participants were classified into less than 30 mg/g as normoalbuminuria or 30-300 mg/g as microalbuminuriausing urinary albumin creatinine ratio (UACR). The median and Q1-Q3 baPWV values were significantly higher in the microalbuminuric group both in men (1,538, 1,370-1,777 cm/s vs. 1,776, 1,552-2,027 cm/s, P < 0.001) and women (1,461, 1,271-1,687 cm/s vs. 1,645, 1,473-1,915 cm/s, P < 0.001). BaPWV was independently associated with microalbuminuria in both genders after adjusting for pulse rate; fasting blood glucose; triglyceride; homeostatic model assessment insulin resistance (HOMA(IR)) and, history of hypertension and diabetes. Fasting blood sugar and HOMA(IR) were judged as having nothing to do with multicolinearity (r = 0.532, P < 0.001). Elevated baPWV was independently associated with microalbuminuria regardless of insulin resistance among rural subjects over 40 yr.

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent / Pacientes diabéticos com e sem a neuropatia periférica mostram diferentes estratégias biomecânicas de quadril e tornozelo ao descer escada

BACKGROUND: The progression of diabetes and the challenge of daily tasks may result in changes in biomechanical strategies. Descending stairs is a common task that patients have to deal with, however it still has not been properly studied in this population. OBJECTIVES: We describe and compare the net joint moments and kinematics of the lower limbs in diabetic individuals with and without peripheral neuropathy and healthy controls during stair descent. METHOD: Forty-two adults were assessed: control group (13), diabetic group (14), and neuropathic diabetic group (15). The flexor and extensor net moment peaks and joint angles of the hip, knee, and ankle were described and compared in terms of effect size and ANOVAs (p<0.05). RESULTS: Both diabetic groups presented greater dorsiflexion [large effect size] and a smaller hip extensor moment [large effect size] in the weight acceptance phase. In the propulsion phase, diabetics with and without neuropathy showed a greater hip flexor moment [large effect size] and smaller ankle extension [large effect size]. CONCLUSION: Diabetic patients, even without neuropathy, revealed poor eccentric control in the weight acceptance phase, and in the propulsion phase, they showed a different hip strategy, where they chose to take the leg off the ground using more flexion torque at the hip instead of using a proper ankle extension function.

CONTEXTUALIZAÇÃO: A progressão do Diabetes Mellito e as atividades desafiadoras do dia a dia podem resultar em mudanças da estratégia biomecânica adotada. Descer escadas é uma tarefa comum do dia a dia, vivenciada pelos pacientes, mas ainda não foi satisfatoriamente estudada nessa população. OBJECTIVOS: Descrever e comparar os momentos articulares e a cinemática de membros inferiores em indivíduos diabéticos com e sem a neuropatia periférica e controles saudáveis durante o descer escadas. MÉTODO: Quarenta e dois adultos foram avaliados: grupo controle (13), grupo diabético (15) e grupo de diabéticos neuropatas (14). Os picos flexores e extensores dos momentos articulares e os ângulos articulares de quadril, joelho e tornozelo foram comparados e descritos por análise do tamanho do efeito e ANOVAs (p<0,05). RESULTADOS: Na fase de aceitação do peso, ambos os grupos diabéticos apresentaram maior ângulo de dorsiflexão de tornozelo [tamanho de efeito grande] e menor momento extensor de quadril [tamanho de efeito grande]. Na fase de propulsão, diabéticos com e sem a neuropatia apresentaram maior momento flexor de quadril [tamanho de efeito grande] e menor ângulo de extensão de tornozelo [tamanho de efeito grande]. CONCLUSÃO: Pacientes diabéticos, mesmo antes da neuropatia instalada, revelaram um pobre controle excêntrico na fase de aceitação do peso e, na fase de propulsão, esses pacientes mostraram uma estratégia diferente ao levar o membro inferior à frente a partir de um maior torque flexor de quadril ao invés de usar uma função extensora apropriada de tornozelo.

Validity and reliability of clinical tests for assessing passive ankle stiffness / Validade e confiabilidade de medidas clínicas para avaliação da rigidez passiva da articulação do tornozelo

BACKGROUND: The presence of inadequate levels of passive ankle stiffness have been associated with the occurrence of movement disorders, the development of pathological conditions and the reduction in the performance of functional activities such as walking, running and jumping. Therefore, clinical tests to evaluate ankle stiffness may be useful for the physical therapy assessment. OBJECTIVES: To investigate the concurrent validity and the intra- and inter-examiner reliability of clinical measures developed to assess passive stiffness of the ankle joint during dorsiflexion movement. METHODS: Fifteen healthy participants underwent to test-retest evaluations of their ankles by two examiners. Two clinical measures were performed: 'position of first detectable resistance' and 'change in passive resistance torque'. The results of these tests were compared to the passive stiffness measured with an isokinetic dynamometer, in which the electromyography activity of specific muscles was monitored to ensure that the test was performed passively (gold standard measure). RESULTS: Pearson correlation coefficients ranged from r=-0.81 to -0.88 (p<0.001) for the correlation between the passive ankle stiffness measured with the isokinetic dynamometer and the results of the clinical measure 'position of the first detectable resistance'. For the measure of 'change in passive resistance torque', these coefficients ranged from r=0.72 to 0.83 (p<0.004). The Intraclass Correlation Coefficients (ICCs) for the intra- and inter-examiner reliability ranged from 0.75 to 0.98. CONCLUSION: The clinical measures presented satisfactory validity and reliability to be used in clinical practice.

CONTEXTUALIZAÇÃO: Níveis inadequados de rigidez passiva do tornozelo têm sido associados à ocorrência de disfunções de movimento, ao desenvolvimento de patologias e à redução no desempenho em atividades como marcha, corrida e salto. Testes clínicos para investigar a rigidez dessa articulação podem ser úteis no processo de avaliação fisioterápica. OBJETIVOS: Investigar a validade concorrente e as confiabilidades intra e interexaminadores de medidas clínicas para avaliação da rigidez passiva do tornozelo durante o movimento de dorsiflexão. MÉTODOS: Quinze voluntários saudáveis foram submetidos a avaliações teste-reteste do tornozelo por dois examinadores. Duas medidas clínicas foram realizadas: "posição de primeira resistência detectável" e "mudança do torque passivo de resistência". Os resultados desses testes foram comparados à medida da rigidez passiva realizada com um dinamômetro isocinético, no qual a atividade eletromiográfica dos músculos foi monitorada para garantir que o teste fosse realizado passivamente (medida padrão-ouro). RESULTADOS:Os Coeficientes de Pearson variaram de r=-0,81 a -0,88 (p<0,001) para a correlação entre a medida da rigidez com o dinamômetro isocinético e os resultados da medida "posição de primeira resistência detectável". Para a medida "mudança do torque passivo de resistência", esses coeficientes variaram de r=0,72 a 0,83 (p<0,004). Os Coeficientes de Correlação Intraclasse (CCIs) obtidos para as confiabilidades intra e interexaminadores variaram de 0,75 a 0,98. CONCLUSÃO: Os testes propostos apresentaram validade e confiabilidades satisfatórias para serem utilizados na prática clínica.

Análise do uso de suporte parcial de peso corporal em esteira e em piso fixo durante o andar de crianças com paralisia cerebral / Analysis of partial body weight support during treadmill and overground walking of children with cerebral palsy

OBJETIVO: Analisar características espaço-temporais e ângulos articulares de crianças com paralisia cerebral andando sem o uso de suporte parcial de peso corporal (SPPC) em piso fixo e com 0 por cento e 30 por cento de SPPC em piso fixo e em esteira. MÉTODOS: Seis crianças com paralisia cerebral hemiplégica espástica (7,70±1,04 anos) foram filmadas andando com velocidade confortável sem o uso de SPPC, com 0 por cento e 30 por cento de SPPC em piso fixo e com 0 por cento e 30 por cento de SPPC em esteira. Marcadores refletivos foram afixados nos principais pontos anatômicos dos dois hemicorpos para registro das coordenadas "x", "y", "z". RESULTADOS: As crianças andaram mais rapidamente e com passadas mais longas e mais rápidas, com duração dos períodos de apoio simples e balanço maiores e apoio duplo menor no piso fixo do que na esteira, independentemente do uso do SPPC. O quadril foi a única articulação que apresentou diferenças entre os hemicorpos e entre as condições, sendo que o hemicorpo plégico apresentou menor amplitude de movimento (ADM) que o hemicorpo não plégico, e a ADM foi maior na condição sem o uso de SPPC do que com 30 por cento de SPPC em piso fixo. CONCLUSÃO: Crianças com paralisia cerebral hemiplégica espástica são capazes de andar em piso fixo e esteira com diferentes porcentagens de SPPC, sendo que seus desempenhos foram melhores no piso fixo, independentemente do uso de SPPC, do que na esteira.

OBJECTIVE: To analyze the spatial-temporal characteristics and joint angles during overground walking without body weight support (BWS) and with 0 percent and 30 percent BWS, and during treadmill walking with the same BWS in children with cerebral palsy. METHODS: Six children with hemiplegic and spastic cerebral palsy (7.70 ± 1.04 years old) were videotaped during overground walking at a comfortable speed with no BWS, with 0 percent and 30 percent BWS, and during treadmill walking with 0 percent and 30 percent BWS. Reflective markers were placed over main bony landmarks in both body sides to register the coordinates "x", "y", "z". RESULTS: During overground walking, children walked faster and presented longer and faster strides, longer duration of single-stance and swing periods, and shorter duration of double-stance period, than treadmill walking, regardless of BWS use. The hip was the only joint that presented a difference between body sides and experimental conditions; i.e. range of motion (ROM) was reduced in the plegic side when compared to the nonplegic side, and during overground walking without BWS when compared to 30 percent BWS. CONCLUSION: Children with hemiplegic and spastic cerebral palsy were able to walk overground and on a treadmill with different percentages of BWS, and their performance was superior during overground walking, regardless of BWS use.

Avaliação sensório-motora do tornozelo e pé entre idosos diabéticos e não diabéticos / Sensory-motor assesment of ankle and foot among diabetic and non-diabetic elderly

A expressão “qualidade de vida” tem sido utilizada sob diversos enfoques e é tema de pesquisas imprescindíveis na área da saúde. Muitas pesquisas têm-se dedicado a estudar a velhice sob novas óticas, mas a maioria desses estudos se refere a idosos que habitam ambientes urbanos, sendo poucas as pesquisas que abordam o tema do envelhecimento no ambiente rural. O instrumento utilizado foi o WHOQOL-OLD, modificado para pessoas idosas, com o objetivo de avaliar e comparar a qualidade de vida de idosas residentes em ambientes urbano e rural. A amostra foi constituída de 30 mulheres, com idade igual ou superior a 60 anos. O tratamento estatístico foi composto por análise descritiva e inferencial. Os dados foram analisados através SPSS, versão 13.0 para Windows. O nível de significância e erro estatístico considerado foi de 5% (p<0,05). Após análise dos resultados, as idosas foram classificadas com média do Qvg-old igual ou superior a 13 como sendo detentoras de qualidade de vida suficiente; 46% das idosas residentes na área urbana apresentaram níveis iguais ou acima de 13, sobrepondo-se aos 40% dos indivíduos residentes na zona rural, que obtiveram níveis superiores a 13. Constatou-se que o fato de residir em regiões geograficamente diferentes não interferiu nos níveis de qualidade de vida. Recomenda-se a realização de outros estudos, a fim de complementar e comparar os resultados de qualidade de vida com idosos de outras regiões, na perspectiva de obter uma classificação qualitativa da qualidade de vida da população idosa com diversas características sócio-demográficas e culturais.

Fatores preditivos da marcha em pacientes diabéticos neuropático e não neuropáticos / Predictive factors of gait in neuropathic and non-neurophatic diabetic patients

OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo envolvidas na marcha de pacientes portadores de diabetes com e sem neuropatia periférica. CASUÍSTICA E MÉTODO: 36 indivíduos divididos em três grupos: Controle - GC: 10 indivíduos sem diabetes, Diabetes - GD: 10 indivíduos portadores de diabetes sem neuropatia periférica e Neuropatia - GDN: 16 indivíduos portadores de diabetes e neuropatia diabética periférica. Foi realizada análise da marcha - AMTI® OR6/6, e da amplitude de movimento articular tíbio-társica - Sistema Vicom 640® - de todos os participantes. RESULTADOS: O primeiro e segundo pico de força vertical de reação do solo são maiores no grupo Neuropatia e a amplitude de movimento articular do tornozelo é menor nos grupos Diabetes e Neuropatia. CONCLUSÃO: A amplitude de movimento da articulação tíbio-társica está diminuida nos diabetéticos, independente da presença ou ausência de neuropatia periférica, e os diabéticos com neuropatia periférica, apresentaram aumento no primeiro e no segundo pico da força de reação vertical do solo durante a marcha.

OBJECTIVE: The purpose of this study was to analyze the range of movement of the ankle and the vertical ground reaction force involved in gait among diabetic patients with and without peripheral neuropathy. SAMPLE AND METHOD: 36 individuals were divided into three groups: Control group - CG: 10 individuals without diabetes, Diabetic group - DG: 10 individuals with diabetes without peripheral neuropathy and Neuropathy, and Diabetic neuropathic group - DNG: 16 individuals with diabetes and peripheral diabetic neuropathy. Gait - AMTI® OR6/6m and range of tibiotarsal joint movement - System Vicom 640® was carried out in all the participants. RESULTS: The first and second vertical ground reaction force peaks were statistically higher in the neuropathy group, and the range of ankle motion was lower in the Diabetes and Neuropathy groups. CONCLUSION: The range of movement of the tibiotarsal joint is lower in diabetics, regardless of the presence or absence of peripheral neuropathy, and diabetics with peripheral neuropathy show an increase in the first and second vertical ground reaction force peaks during walking.

Effect of serial casting in spastic cerebral palsy.

OBJECTIVE: Cerebral palsy (CP) is a range of non progressive syndromes of posture and motor impairment due to an insult to developing brain. Spasticity and incoordination are major causes of disability in these children which can be managed by different modalities like casting, botulinum toxin, surgery etc. Cast application in spastic equinus is a well established procedure in CP but cast application in patients of CP with bilateral involvement of hip, knee and ankle is not document. METHODS: A study was conducted on 22 children of spastic CP in age range of 3-8 years with bilateral involvement of hip, knee and ankle in 20 cases, hip and ankle in one case and only ankle in one case. Sixty eight % children were spastic diplegics. Serial weekly cast with (11 cases) or without abductor bar (11 cases) was applied for four weeks. They were followed up variably with an average period of 7 months. RESULTS: Significant improvement was noticed in range of motion around hip, knee and ankle which as maintained over hip and knee after average follow up. Spasticity was also reduced as measured by Modified Ashworth Scale (MAS). This ultimately improved the ambulatory status and functional ability of these children. CONCLUSION: Thus serial casting is a very simple, safe and cost effective procedure which can be applied even in children with mental sub normality having all three major joints involved bilaterally.

Limited joint mobility and plantar pressure in type 1 diabetic subjects in India.

AIM: Limited joint mobility and plantar pressure in the foot has not been assessed in type 1 diabetes. The aim of this study was to investigate the joint mobility and plantar foot pressure in Asian Indian type 1 diabetic subjects and to see its association with duration of diabetes. MATERIAL AND METHODS: The joint mobility and plantar pressure were measured in 115 consecutive subjects attending the foot clinic. The study groups were: Control- non diabetic controls (n=40) (M:F 19:21) and type 1 diabetic patients (n=75) (M:F 42:33). Joint mobility was assessed using a goniometer at two sites, in the subtalar joint and in the hallux. Plantar pressure was measured using the RS-Scan platform system. Data obtained on the metatarsal heads were used for analysis. RESULTS: Patients with type 1 diabetes had significantly lesser joint mobility (p < 0.0001) and higher plantar pressure (p < 0.0001) compared with the control group. Duration of diabetes had an inverse association with joint mobility (p < 0.0001). The degree of joint mobility was more restricted in patients with longer duration of diabetes. Plantar pressure increased with increasing duration of diabetes. CONCLUSION: In conclusion, type 1 diabetic patients in India had limited joint mobility which decreased further with longer duration of diabetes and they had high plantar pressure also.

Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis

INTRODUCTION: The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP) gait. Reported information about this type of orthosis is insufficient. PURPOSE: The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. METHODS: A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs) had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 ± 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15°); Group II, with moderate limited extension (maximum knee extension between 15° and 30°) and Group III Crouch (maximum knee extension in stance more than 30°). RESULTS: Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. Conclusion: when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective.

INTRODUÇÃO: A órtese de reação ao solo é freqüentemente prescrita com o objetivo de reduzir a flexão do joelho durante a fase de apoio na marcha de pacientes com paralisia cerebral. Não há informações suficientes relatadas na literature sobre este tipo de órteses. OBJETIVOS: O objetivo deste estudo foi determinar o efeito que a órtese de reação ao solo tem na cinamática angular das articulações do quadril, joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral, comparando a marcha descalça e com o uso das órteses MÉTODOS: Após um estudo retrospectivo de 2200 pacientes avaliados no laboratório de marcha, 71 pacientes com diagnóstico de paralisia cerebral do tipo diparesia espástica e idade média de 12.2 ± 3.9 foram selecionados (142 membros). Nenhum deles apresentou contratura em flexão dos quadris, joelhos e tornozelos. Todos usavam órteses do tipo reação ao solo articulada durante a avaliação da marcha. Os pacientes foram divididos em três grupos: Grupo I Extensão Limitada (pico de extensão do joelho menor que 15°); Grupo II Extenão Moderadamente Limitada (pico de extensão do joelho entre 15° e 30°) e Grupo III Agachamento (pico de extensão do joelho no apoio maior que 30°). RESULTADOS: Os resultados demostraram que o pico de extensão do joelho e o pico de dorsiflexão tiveram alterações significantes nos grupos II e III enquanto que o grupo I não apresentou alteração. O pico de extensão do quadril não mostrou alteração nos três grupos CONCLUSÃO: A órtese de reação ao solo é eficaz quando indicada para aumentar a extensão do joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral.

Soft Tissue Surgery for Equinus Deformity in Spastic Hemiplegic Cerebral Palsy: Effects on Kinematic and Kinetic Parameters

The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.

Star excursion balance training: effects on ankle functional stability after ankle sprain.

OBJECTIVES: To study the effects of Star Excursion Balance training on functional stability of athletes with ankle sprain. MATERIAL AND METHOD: Thirty-two male athletes with grade 2 ankle sprain, aged 15-22 years old were enrolled. They were random sampling into training group (n=15) and control group (n=17). All received conventional physical therapy program for 4 weeks. The training group also underwent the Star Excursion Balance training 3 days per week for 4 weeks. Single leg stance time (SLST) was assessed at pre- and post-training. Re-injuries were recorded during 3 months follow-up. RESULTS: After the program, subjects from both groups demonstrated significant improvement in SLST The training group gained SLST of the injured sides 2 times more than the control group (p = 0.002 tested with eyes closed, p = 0. 007 tested with eyes open), and also improved the SLST during eyes closed of the normal sides (p = 0.015). Re-injuries were found in 1/15 of the training group and 2/17 of the control group. CONCLUSION: Star Excursion Balance training is more effective than the conventional therapy program in improving functional stability of the sprained ankle.