Gait dynamic stability evaluation in patients undergoing hip joint fractures - tools to measure rehabilitation effectiveness.

A hip joint fracture includes a break in the thigh (femur) or coxa bone near the pelvis. During fracture healing, stability and weight bearing by the affected limb are key indicators to measure patients' improvement. Conventionally, the rehabilitation effectiveness is monitored through clinical examinations, patients' feedback, and few studies also reported instrumented gait evaluations. A gap remains there to numerically quantify the recovery in patients' stability and weight bearing in response to rehabilitation therapies. This study introduces Nyquist and Bode (N&B) methods to analyse the instrumented gait signals further and evaluate gait stability in hip fracture patients during weight loading and unloading transitions. The centre of pressure (CoP) data was recorded using force plates for conditions: coxa hip fracture (HC), femur hip fracture (HF), and normal hip joint (NH). The time rate of CoP signals illustrated two major impulses during the loading and unloading phases which were modelled in time and frequency domains. The frequency models were further analysed by applying N&B methods and stability margins were computed for both impaired and healthy conditions. Results illustrated a significant decrease (Kruskal-Wallis's test, p < 0.001) in the intralimb walking stability of both fracture conditions. Further, Spearman's correlation between CoP velocities of fractured and intact limbs illustrated significant interlimb dependencies to maintain walking stability (p < 0.001) during weight loading and unloading transitions. Overall, the HF impairment illustrated the least intralimb walking stability and relatively greater interlimb dependencies. Clinically, these methods and findings are important to measure the recovery in patients undergoing rehabilitation after a hip joint or other lower limb impairments.

Evaluation of an ankle-foot orthosis effect on gait transitional stability during ramp ascent/descent.

Wearable ankle-foot orthoses (AFO) are widely prescribed clinically; however, their effect on balance control during ramp ascent/descent walk remains unknown. This study evaluates walking stability on a ramp during weight loading and unloading transitions of the stance phase with the effect of an adjustable AFO. An AFO is tuned firstly by tuning dorsiflexion only and then combining dorsi-plantarflexion adjustments. Gait stability is assessed from neuromotor input (centre-of-mass) and output (centre-of-pressure) responses obtained through motion-capture system and force platform. Stability margins are quantified from Nyquist and Bode methods illustrating the loading phase as stable and the unloading phase as unstable transition in all walking conditions. Further, a significant decrease in stability (p < 0.05) is observed by wearing AFO in its free mode which gets improved (p < 0.05) by tuning AFO. Results from neuromotor outputs also illustrated a strong interlimb correlation (p < 0.001), which implies a compensatory interaction between opposite limbs loading and unloading transitions. Neuromotor inputs illustrated unstable responses both in loading and unloading transitions and were observed to be greater in magnitudes compared with output margins. The overall results support the hypothesis that a wearable AFO affects gait stability during transitional phases, and by applying AFO adjustments, neuromotor balance control achieves stability margins closer to normal range.

Evaluation of an adjustable ankle-foot orthosis impact on walking stability during gait transitional phases.

Walking stability evaluation during gait transitional phases (loading and unloading) has been remained indistinct mainly due to methodological limitations and multiple biomechanical signals being used. This study introduces Nyquist and Bode methods using resultant neuromechanical output/input (O/I) responses to evaluate gait transitional stabilities. The centre of pressure and ground reaction force data are recorded experimentally as output and somatosensory input responses by the neuromotor. Six different walking conditions are simulated by wearing an adjustable orthosis using eleven healthy subjects. The rate of change in O/Is are modelled in time and frequency domains applying linear regression and stability margins are quantified applying N&B methods. Results from outputs showed loading phase as stable and unloading phase as unstable gait phases whereas the margins quantified from inputs showed unstable response during both phases. Stability margins quantified from outputs are decreased (p < 0.05) and instability margins are increased (p < 0.05) on applying ankle-foot restrictions. Overall, the neuromotor output stability margins are greater than the instabilities quantified from inputs. Furthermore, a strong interlimb negative correlation (p < 0.001) was found between loading and unloading phases computed from outputs. This study introduces new stability assessment methods with applications like evaluating lower limb impairments, varying terrains, and stability impacts of wearable devices.

The surgical-orthodontic management of combined impacted maxillary second and third molars.

BACKGROUND: A correlation between impacted maxillary third molars on the eruption potential of the maxillary second molar has been identified. There is little published evidence available in the literature regarding a treatment modality for this presentation. AIMS  : The aim of this case series is to propose a joint surgical and orthodontic approach for the management of such cases. METHOD  : A retrospective search of all patients treated for impacted second and third maxillary molars from 2014 to 2020 revealed 24 cases. Surgical planning was facilitated with the use of a CBCT to help orientate the teeth in 3-D and assess any associated pathology to nearby structures. Twenty-three cases were treated via surgical removal of the impacted third molar and subsequently monitored for spontaneous maxillary second molar eruption. CONCLUSION:  All treated cases showed complete or partial spontaneous eruption followed by orthodontic repositioning if required.

Clinical efficacy of photodynamic therapy and laser irradiation as an adjunct to open flap debridement in the treatment of chronic periodontitis: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analyses was to assess the quality of evidence and efficacy of antimicrobial photodynamic therapy (aPDT) and laser irradiation (LI) as an adjunct to open flap debridement (OFD) in the treatment of chronic periodontitis. METHODS: Electronic searches were conducted in databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to March 2019. Randomized clinical trials (RCTs) comparing clinical efficacy of either aPDT and/or LI, placebo, or no treatment were included. Primary outcomes included clinical attachment level (CAL), while secondary outcomes were reduction in probing depth (PD) and gingival recession (GR) depth. The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Six RCTs were included. For aPDT studies, the overall mean difference for CAL gain (WMD = -0.61, 95% CI = -1.22 to -0.016, P = .044) and PD reduction (WMD = -1.79, 95% CI = -3.44 to -0.14, P = .034) was significant between aPDT and OFD groups at follow-up. No significant overall mean difference was observed for GR depth (WMD = 0.02, 95% CI = -0.75 to 0.79, P = .95). For LI studies, none of the clinical periodontal parameters including CAL gain (WMD = 0.23, 95% CI = -0.09 to 0.55, P = .159, Figure 3A), PD reduction (WMD = 0.31, 95% CI = -0.67 to 1.31, P = .52, Figure 3B) and GR depth (WMD = -0.34, 95% CI = -2.47 to 1.78, P = .74, Figure 3C) were found to be significant between LI and OFD groups at follow-up. CONCLUSION: With the limited data available, only aPDT as an adjunct to OFD showed superior results for clinical periodontal parameters compared to OFD alone in the treatment of chronic periodontitis. Further RCTs are warranted in order to obtain robust conclusions with regard to laser therapy.