The Effect of Leg Dominance and Group Difference in Star Excursion Balance Test between Individuals with Chronic Ankle Instability, Ankle Sprain Copers and Healthy Controls.

Objectives: To evaluate patients with chronic ankle instability (CAI), copers who had a sprain without instability, and healthy controls using the Star Excursion Balance Test (SEBT). In addition, the reach distance was assessed between the both legs in terms of dominant and non-dominant in all groups. Methods: A total of 75 subjects (25 healthy, 25 CAI, and 25 Coper) participated. The maximum reach distance in SEBT was assessed in anterior (ANT), postero-medial (PM), and postero-lateral (PL) directions in both legs for each subject. All data were analyzed by SPSS version 21. Tukey post hoc test was used to compare all groups. Paired T-test was used to compare dominant and non-dominant legs in each group. Results: In 75 subjects have participated in the data collection, no significant differences were reported among all groups for age and BMI measurements. Significant lower reach distance in scores of ANT in the dominant leg of the CAI was demonstrated when compared with the control and the coper groups (P=0.008). No statistical significant difference was determined between the dominant and non-dominant legs in each group (P>0.05). Conclusion: It seems that relevant strategies for postural control should be taken into account in the rehabilitation setup of individuals with CAI.

Validity and test-retest reliability of photogrammetry in adolescents with hyperkyphosis.

BACKGROUND: A variety of noninvasive instruments have been introduced in the literature to assess thoracic curvature, although the psychometric properties of many of these instruments have not been satisfactory. Photogrammetry is a safe, accessible, and reliable technique. However, its validity in adolescents with hyperkyphosis has not yet been investigated. OBJECTIVES: To investigate the validity and test-retest reliability of photogrammetry in the measurement of thoracic kyphosis among adolescents with hyperkyphosis. METHODS: Fifty adolescents with hyperkyphosis participated in this study. The kyphosis angle was measured using radiography and photogrammetry. A two-way random model of the intraclass correlation coefficient (ICC2,3) was used to estimate relative reliability. Absolute reliability was assessed by calculating the standard error of the measurements (SEM) and the minimal detectable change (MDC). Pearson's correlation coefficient was calculated to evaluate the validity of the photogrammetry technique. Bland-Altman plots were plotted to determine the agreement between the angles measured by radiography and photogrammetry. RESULTS: There was a strong correlation between the values obtained from the photogrammetry technique and those from the radiography method (r = 0.94). The 95% limits of agreement indicated that the photogrammetric measurements of thoracic kyphosis angle might range from 2.4 degrees greater to 10.2 degrees lower than the Cobb radiographic angle. Photogrammetric measurements of thoracic kyphosis showed excellent test-retest reliability (ICC = 0.97; SEM = 1.67; MDC = 4.62). CONCLUSION: High reliability of photogrammetry technique and its strong correlation with radiographic Cobb angle support the application of this technique for the measurement of thoracic kyphosis in clinical practice.

Attentional Demands of Postural Control in Chronic Ankle Instability, Copers and Healthy Controls: A Controlled Cross-sectional Study.

BACKGROUND: It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI). RESEARCH QUESTION: Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects? METHODS: A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions. RESULTS: The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05). SIGNIFICANCE: Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.

Translation, cross-cultural adaptation, reliability, and validity of the Identification of Functional Ankle Instability questionnaire in Persian speaking participants with a history of ankle sprain.

Purpose: To cross-culturally translate the Identification of Functional Ankle Instability (IdFAI) questionnaire into Persian and to assess its psychometric properties and factor structure. Methods: The Persian version of IdFAI questionnaire was prepared after a forward-backward translation and cultural adaptation process. One hundred and twenty patients with a history of lateral ankle sprain completed the Persian version of this questionnaire and the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure, Foot and Ankle Outcome Score, Fear Avoidance Belief questionnaire and the Tampa Scale of Kinesiophobia in the first test session. Afterwards, 60 randomly selected patients completed the questionnaires in the second session. Psychometric testing which included test-retest reliability, internal consistency, standard error of measurement (SEM) and minimal metric detectable change (MMDC), weighted kappa coefficient and construct validity were performed using Spearman's correlation coefficient and confirmatory factor analysis of the three-factor structure of the IdFAI. Results: The interclass correlation coefficient, Cronbach's alpha, SEM and MMDC were 0.91, 0.95, 2.43, and 6.73 (95% confidence interval, 0.86-0.95) for the IdFAI, respectively. The repeatability of all the questions after one week was rated good to excellent (kappa = 0.60-0.93, p < 0.001). The IdFAI total score had strong correlation with CAIT measure, but had moderate correlation with other questionnaires. The results of factor analysis showed an adequate fit of the model to the data and goodness-of-various fit indices. Conclusions: The Persian version of IdFAI is a reliable and valid tool to identify patients with functional ankle instability which have a history of ankle sprain. Its original three-factor structure was replicated in this study. Implications for Rehabilitation The Persian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire is a reliable and valid instrument in order to identify Iranian patients with functional ankle instability in both clinical practice and research. The Persian IdFAI questionnaire may be considered as a standardized clinical instrument that can be used to classify degree of ankle instability in Iranian Persian-speaking people with a history of lateral ankle sprain. People with a history of ankle sprain can be assessed using IdFAI questionnaire before and after rehabilitative interventions in an attempt to determine any change in their degree of ankle instability over time.

Translation, cross-cultural adaptation and factor analysis of the Persian version of ankle instability instrument.

Background: Ankle Instability Instrument (AII) is a questionnaire for determination of ankle stability status. The aim of this study is to cross-culturally translate and investigate the reliability and validity of AII in a sample of Persian-speaking Iranians, suffering from ankle sprain. Methods: One hundred twenty persons with a history of ankle sprain were recruited in the study. All participants completed the Persian version of Ankle Instability Instrument, Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) at the baseline. Out of them, 60 randomly selected subjects completed the questionnaires once more, one week later. Face validity, Test-retest reliability, internal consistency, standard error of measurement, minimal metric detectable change, spearman's correlation coefficient and confirmatory factor analysis of AII measured. We used Lisrel v 8.80 software with significant level of p<0.05. Results: Persian version of AII is clear and unambiguous and its qualitative face validity was confirmed in the pilot study on the 20 subjects with a lateral ankle sprain. The interclass correlation coefficient, Cronbach's alpha, standard error of measurement and minimal metric detectable change were 0.93, 0.87, 0.81 and 2.25 (95% confidence interval, 0.85-0.96). The Spearman correlations coefficients between AII, and CAIT, FAAM and FAOS measures were 0.91, 0.71 and 0.69 respectively. The original three factor structure of AII was replicated based on the confirmatory factor analysis. Which showed an adequate fit of the model to the data and goodness-of-various fit indices. Conclusion: The Ankle Instability Instrument Persian Version (AII-PV) is a reliable and valid measure for assessing the ankle stability status.

A comparison between the dimensions of positive transtibial residual limb molds prepared by air pressure casting and weight-bearing casting methods.

BACKGROUND: Creating a socket with proper fit is an important factor to ensure the comfort and control of prosthetic devices. Several techniques are commonly used to cast transtibial stumps but their effect on stump shape deformation is not well understood. This study compares the dimensions, circumferences and volumes of the positive casts and also the socket comfort between two casting methods. Our hypothesis was that the casts prepared by air pressure method have less volume and are more comfortable than those prepared by weight bearing method. METHODS: Fifteen transtibial unilateral amputees participated in the study. Two weight bearing and air pressure casting methods were utilized for their residual limbs. The diameters and circumferences of various areas of the residual limbs and positive casts were compared. The volumes of two types of casts were measured by a volumeter and compared. Visual Analogue Scale (VAS) was used to measure the sockets fit comfort. RESULTS: Circumferences at 10 and 15 cm below the patella on the casts were significantly smaller in air pressure casting method compared to the weight bearing method (p=0.00 and 0.01 respectively). The volume of the cast in air pressure method was lower than that of the weight bearing method (p=0.006). The amputees found the fit of the sockets prepared by air pressure method more comfortable than the weight bearing sockets (p=0.015). CONCLUSION: The air pressure casting reduced the circumferences of the distal portion of residual limbs which has more soft tissue and because of its snug fit it provided more comfort for amputees, according to the VAS measurements.

The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle.

BACKGROUND AND OBJECTIVE: Corrective exercise interventions are often utilized to manage subjects with thoracic hyper-kyphosis, yet the quality of evidence that supports their efficiency is lacking. In this study, the efficacy of local and comprehensive corrective exercise programs (LCEP and CCEP) on kyphosis angle was evaluated. MATERIAL AND METHOD: A prospective, randomised controlled design was used in the present study. Sixty patients with postural hyper-kyphosis deformity (⩾ 42°) entered the study for 12 weeks. Subjects were randomly assigned to a LCEP (n=20), CCEP (n=20), or Control groups (n=20). Pre- and post-participation levels of kyphosis angle were measured by flexicurve ruler. RESULTS: Both the LCEP and CCEP groups demonstrated statistically significant reductions in thoracic kyphosis angle compared to the control group (p=0.001). Furthermore, based on Cohen's d-value, the efficiency of CCEP was larger than LCEP. CONCLUSIONS: Considering the extremely large effect size of the CCEP, we recommend that this program be used in the correction of postural hyper-kyphosis deformity in future.

Effects of prosthetic mass distribution on the spatiotemporal characteristics and knee kinematics of transfemoral amputee locomotion.

This study was designed to investigate the effect of changing the location of the center of mass (COM) of transfemoral prostheses on the spatiotemporal and kinematical characteristics of the amputee gait, while maintaining the prosthetic mass fixed. Ten men with unilateral traumatic transfemoral amputation participated in gait analysis, 2-min walk and subject preference tests. Weights were added to the original prosthetic legs in three conditions: 600g added to the ankle, 600g added at 10cm distal to the prosthetic knee, and 300g added to the ankle, and 300g at 10cm distal to the knee. For each prosthetic mass condition, the stride and step lengths, stepping speed, stance, swing and gait cycle durations, self-selected walking speed, cadence, and knee flexion angle, were measured. We found no significant change in the spatiotemporal variables and the knee kinematics with alteration of the prosthetic COM, for both the prosthetic and the intact limbs. With the mass added to the ankle, the stepping speed, and the step and stride lengths of the prosthetic limb were significantly larger than those of the intact limb. Subject's preference revealed that 8 of 10 preferred their original no-added mass prostheses or mass added prostheses with minimal change of the COM. It was concluded that a short-term intervention with changed prosthetic mass distribution has no significant effect on the spatiotemporal and knee kinematical characteristics of the transfemoral amputee gait, although it can affect the spatiotemporal symmetry of locomotion.

The effects of a prophylactic knee brace and two neoprene knee sleeves on the performance of healthy athletes: a crossover randomized controlled trial.

Knee injury is one of the major problems in sports medicine, and the use of prophylactic knee braces is an attempt to reduce the occurrence and/or severity of injuries to the knee joint ligament(s) without inhibiting knee mobility. The aim of the present study was to examine the effect of one recently designed prophylactic knee brace and two neoprene knee sleeves upon performance of healthy athletes. Thirty-one healthy male athletes (age = 21.2 ± 1.5) volunteered as participants to examine the effect of prophylactic knee brace/sleeves on performance using isokinetic and functional tests. All subjects were tested in four conditions in a random order: 1. nonbraced (control) 2. using a neoprene knee sleeve 3. using a knee sleeve with four bilateral metal supports and 4. using a prophylactic knee brace. The study design was a crossover, randomized, controlled trial. Subjects completed single leg vertical jump, cross-over hop, and the isokinetic knee flexion and extension (at 60, 180, 300°/sec). Data were collected from the above tests and analyzed for jump height, cross-over hop distance, peak torque to body weight ratio and average power, respectively. Comparisons of these variables in the four testing conditions revealed no statistically significant difference (p>0.05). The selected prophylactic brace/sleeves did not significantly inhibit athletic performance which might verify that their structure and design have caused no complication in the normal function of the knee joint. Moreover, it could be speculated that, if the brace or the sleeves had any limiting effect, our young healthy athletic subjects were well able to generate a mean peak torque large enough to overcome this possible restriction. Further studies are suggested to investigate the long term effect of these prophylactic knee brace and sleeves as well as their possible effect on the adjacent joints to the knee.

The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) often demonstrate postural control difficulties. Orthotic management may assist in improving postural control in these children. OBJECTIVE: The purpose of this investigation was to examine the influence of floor reaction ankle foot orthosis (FRAFO) on postural flexion called the crouch position in children with CP. STUDY DESIGN: Quasi-experimental. METHODS: Eight children with spastic diplegic CP and eight matched typically developing children participated in this study. Postural control of children with CP was assessed in a static standing position on a force platform with/without a FRAFO. The parameters used were centre of pressure (CoP) measures, calculated from force platform signals including the standard deviation (SD) of excursion; phase plate portrait and SD of velocity in anteroposterior (AP) and mediolateral (ML) directions. RESULTS: The maximum knee extension was statistically significant in children with CP when barefoot compared to wearing braced footwear (p < 0.05, t = 10.01). AP and ML displacement, AP velocity and AP phase plate portrait of CoP were not statistically significant between children with CP with/without a FRAFO (p < 0.05). CONCLUSION: FRAFO can improve the alignment of the knee, but may not be helpful in improving postural control in children with CP in a short time period.