Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase.

Background: This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods: Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results: At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < |r| <0.4) and plantarflexion (0.2 < |r| <0.4), as well as hindfoot internal rotation (0.2 < |r| <0.6) and inversion (0.2 < |r| <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < |r| <0.4) and dorsiflexion (0.4 < |r| <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < |r| <0.4) and inversion (0.2 < |r| <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions: The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.

Comparison of clinical outcomes following early rehabilitation in 3 cases of nephrotic syndrome with different treatment courses.

There have been few published reports regarding rehabilitation for nephrotic syndrome. We compared the clinical outcomes of three cases of nephrotic syndrome with different treatment courses during 5 weeks of early rehabilitation.We report on three cases of nephrotic syndrome. Case 1 was a 67-year-old male who showed good progress after steroid treatment. Quadriceps torque and exercise capacity were increased after intervention. Case 2, a 78-year-old male, demonstrated resistance to steroid treatment. Quadriceps torque was decreased and exercise capacity was increased after intervention. Case 3 was an 83-year-old male who received nutrition therapy and diuretics without steroid treatment. Quadriceps torque and exercise capacity were decreased post-intervention.Early rehabilitation should be considered even if the steroid treatment course is different; furthermore, it is necessary to carefully consider the optimal exercise load in patients with nephrotic syndrome for whom regardless of whether or not steroid treatment is used.

The influence of trunk muscle strength on walking velocity in elderly people with sarcopenia.

[Purpose] Sarcopenia increases the risk of falls and fractures. However, its relationship with walking, which is the generation mechanism of falls, has not been clarified. The purpose of this study was to clarify the trunk muscle strength and the characteristics of walking, in elderly people with sarcopenia. [Participants and Methods] The participants were 40 elderly people aged 65 years and over. The participants were able to walk without assistance and were attending outpatient rehabilitation or community day-care centers. The assessment and measurement items included: the presence or absence of sarcopenia (using the diagnostic criteria of the Asian Working Group for Sarcopenia), lower limb and trunk muscle strength, and characteristics of walking. The participants were divided into two groups depending on the presence or absence of sarcopenia, and a comparison was made between the two groups. [Results] The participants in the sarcopenia group had significantly lower trunk extension muscle strength as compared to the participants in the non-sarcopenia group. In addition, the hip joint maximum flexion moment, ankle joint maximum plantar flexion moment, and walking velocity of participants in the sarcopenia group were significantly lower than those in the non-sarcopenia group. [Conclusion] This study revealed that weakness of the trunk muscle strength causes a decrease in walking velocity in elderly people with sarcopenia.

Evaluation of the safety, effectiveness, and health-related QOL impact of early rehabilitation in patients with nephrotic syndrome.

BACKGROUND: The aim of this study was to evaluate the safety, effectiveness, and health-related QOL impact of early rehabilitation in patients with nephrotic syndrome. METHODS: Subjects consisted of 23 patients with nephrotic syndrome who had previously received steroid treatment. Patients worked performed quadriceps resistance training and aerobic training 5 days per week for 5 weeks. Urinary protein, albumin (Alb), creatinine (Cre), and blood urea nitrogen (BUN) were monitored once every week over a 5-week period based on medical records. The 36-item short form health survey (SF-36) score was used to evaluate health-related QOL. RESULTS: There was no significant difference in quadriceps force and no significant effect of age as shown by ANCOVA. Anaerobic threshold (AT) and peak oxygen consumption (peak VO2) both increased significantly. AT was affected by the degree of change in body weight according to ANCOVA. Cre and BUN were not significantly altered. Urinary protein showed a significant decrease and Alb was significantly increased. Only physical function (PF) in the SF-36 showed a significant improvement following the intervention. CONCLUSION: Our data indicate that early rehabilitation involving quadriceps resistance training and aerobic training for nephrotic syndrome is safe and effective.

A pilot study to relationship between urinary protein excretion and muscle strengthening in patients with acute onset renal disease.

PURPOSE: The purpose of this study was to investigate urine protein excretion and the effect of muscle strengthening in patients with renal disease. SUBJECTS: Twenty-eight patients (18 to 87 years old) with acute onset renal disease were treated with steroids at the Hospital of Shiga University of Medical Science. Maximum quadriceps force was measured, and 20-minutes sessions in resistance training were started. After 5 weeks, maximum quadriceps force was measured again. RESULTS: Quadriceps force showed no significant difference between before and after intervention. There was negative correlation between mean urinary protein excretion and amount of change in quadriceps force over the 5 weeks (r=-0.40, p=0.038). CONCLUSIONS: We observed the patients with reduced urine protein excretion are tends to easier to obtain muscle strengthening. On the other hand, there is a possibility that the patients with increased urine protein excretion are hard to obtain muscle strengthening, during the intervention.

Estimations of One Repetition Maximum and Isometric Peak Torque in Knee Extension Based on the Relationship Between Force and Velocity.

We aimed to investigate whether a linear regression formula based on the relationship between joint torque and angular velocity measured using a high-speed video camera and image measurement software is effective for estimating 1 repetition maximum (1RM) and isometric peak torque in knee extension. Subjects comprised 20 healthy men (mean ± SD; age, 27.4 ± 4.9 years; height, 170.3 ± 4.4 cm; and body weight, 66.1 ± 10.9 kg). The exercise load ranged from 40% to 150% 1RM. Peak angular velocity (PAV) and peak torque were used to estimate 1RM and isometric peak torque. To elucidate the relationship between force and velocity in knee extension, the relationship between the relative proportion of 1RM (% 1RM) and PAV was examined using simple regression analysis. The concordance rate between the estimated value and actual measurement of 1RM and isometric peak torque was examined using intraclass correlation coefficients (ICCs). Reliability of the regression line of PAV and % 1RM was 0.95. The concordance rate between the actual measurement and estimated value of 1RM resulted in an ICC(2,1) of 0.93 and that of isometric peak torque had an ICC(2,1) of 0.87 and 0.86 for 6 and 3 levels of load, respectively. Our method for estimating 1RM was effective for decreasing the measurement time and reducing patients' burden. Additionally, isometric peak torque can be estimated using 3 levels of load, as we obtained the same results as those reported previously. We plan to expand the range of subjects and examine the generalizability of our results.

Forefoot flexibility and medial tibial stress syndrome.

PURPOSE: To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches. METHODS: 131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL). RESULTS: The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff-MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively. CONCLUSION: Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.

Flexibility of the transverse arch of the forefoot.

PURPOSE: To measure the percentage of the transverse arch length (%TAL) in 2 positions using a 3-dimensional motion capture system to determine the flexibility of the transverse arch of the forefoot. METHODS: 19 men and 10 women with no lower extremity injury or deformity were included. The %TAL of the left foot was measured using a digital caliper in the standing position and the lower leg maximum anterior tilting (LMAT) position. The difference in the %TAL between the 2 positions (δ%TAL) was calculated. 10 markers were mounted on skin over each metatarsal head and base of the left foot. Motion was captured using a 3-dimensional motion capture system. Coordinates of each marker were manually digitised. The percentage of the transverse arch height (%TAH) and angle between the first and fifth metatarsals (M1M5) were calculated, and differences in each forefoot parameter in the 2 positions were defined as δ%TAL, δ%TAH, δM1M5, and the fore foot flexibility magnitude (FFM) was calculated. Subjects were divided into 3 groups based on their δ%TAL: <25th percentile (hypo-flexibility group, n=7), >26th percentile to <74th percentile (control group, n=15), and >75th percentile (hyperflexibility group, n=7). The 3 groups were compared in terms of the δ%TAL. δ%TAH, δM1M5, and FFM. RESULTS: The δ%TAL correlated with δM1M5 (r=0.61, p<0.001) and FFM (r=0.60, p=0.001). For the δM1M5, the hyper-flexibility group differed significantly from other groups (p=0.01). For the FFM, the hyperflexibility group differed significantly from the hypoflexibility group (p=0.02). CONCLUSION: Measurement of the %TAL in both the standing and LMAT positions provides a simple and quantitative method of assessing the flexibility of the transverse arch of the forefoot.

Effect of low-repetition jump training on bone mineral density in young women.

The hypothesis of the present study was that low-repetition and high-impact training of 10 maximum vertical jumps/day, 3 times/wk would be effective for improving bone mineral density (BMD) in ordinary young women. Thirty-six female college students, with mean age, height, and weight of 20.7+/-0.7 yr, 158.9+/-4.6 cm, and 50.4+/-5.5 kg, respectively, were randomly divided into two groups: jump training and a control group. After the 6 mo of maximum vertical jumping exercise intervention, BMD in the femoral neck region significantly increased in the jump group from the baseline (0.984+/-0.081 vs. 1.010+/-0.080 mg/cm2; P<0.01), although there was no significant change in the control group (0.985+/-0.0143 vs. 0.974+/-0.134 mg/cm2). And also lumbar spine (L2-4) BMD significantly increased in the jump training group from the baseline (0.991+/-0.115 vs. 1.015+/-0.113 mg/cm2; P<0.01), whereas no significant change was observed in the control group (1.007+/-0.113 vs. 1.013+/-0.110 mg/cm2). No significant interactions were observed at other measurement sites, Ward's triangle, greater trochanter, and total hip BMD. Calcium intakes and accelometry-determined physical daily activity showed no significant difference between the two groups. From the results of the present study, low-repetition and high-impact jumps enhanced BMD at the specific bone sites in young women who had almost reached the age of peak bone mass.