Comparison of gait variability and symmetry in trained individuals with transtibial and transfemoral limb loss.

PURPOSE: Gait variability is a determinant of qualified locomotion and is useful for monitoring the effects of therapeutic interventions. The aim of this study was to compare gait variability and symmetry in trained individuals with transtibial (TT) amputation and transfemoral (TF) amputation. METHODS: The design of this study was planned as observational. Eleven individuals with TF amputation, 14 individuals with TT amputation, and 14 healthy individuals (HI) were evaluated with a motorized treadmill. The mean step length, the step length variability, an ambulation index, and the time on each foot (stance phase symmetry) of participants were recorded. RESULTS: There were differences between the three groups in the residual/non-preferred limb (RNp) step length ( p = 0.031), the intact/preferred (IP) limb step length variability ( p = 0.001), the RNp step length variability ( p < 0.001), the time on each foot ( p < 0.001), and the ambulation index score ( p < 0.001). There was a similarity between the groups (TF, TT, HI) in IP limb step lengths ( p = 0.127) and duration of prosthesis usage since amputation in individuals with lower limb loss ( p = 0.224). CONCLUSIONS: This study provided basic data about gait variability and symmetry in individuals with traumatic lower limb loss. The results of the study showed that the variability of gait increased with the level of loss, and individuals with TT amputation showed partially equivalent performance with the healthy group. Similarities in gait characteristics may have resulted from effective prosthetic usage or effective gait rehabilitation.

The effect of different foot orthoses on pain and health related quality of life in painful flexible flat foot: a randomized controlled trial.

BACKGROUND: Foot orthoses are widely used in conservative treatment of painful flexible flatfoot (PFFF) however research is limited to choose the best option in orthotic treatment. AIM: We aimed to compare the effects of computer-aided design/computer-aided manufacturing (CAD-CAM) and conventional insole types in comparison with sham insole, on pain and health related quality of life in patients with PFFF. DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation clinic. POPULATION: Sixty-seven people with PFFF, aged between 18 and 45 years, were assigned to CAD-CAM (N.=22), conventional (N.=22) or sham (N.=23) groups. METHODS: In addition to insoles, a home-based exercise program was followed by all participants for eight weeks. Foot pain intensity and quality of life were assessed at the initial evaluation and at the end of two-month follow-up. RESULTS: Pain intensity (Mean±SD, mm on VAS) was significantly lower in CAD-CAM (27.84±18.41) and conventional (27.05±16.82) insole groups than sham group (46.39±20.18) after two months (P<0.05), but there was no difference between conventional and CAD-CAM (P>0.05). All groups had significantly higher physical health scores at the second assessment (P<0.05), but there was no intergroup difference (P>0.05). CONCLUSIONS: CAD-CAM and conventionally designed insoles are both more effective than having sham insole in alleviating pain in PFFF. CLINICAL REHABILITATION IMPACT: CAD-CAM and conventionally designed semicustom insoles in conjunction with a home-based exercise program are both effective in controlling pain compared with sham insole and exercise in PFFF. Clinicians can prescribe both types of semicustom insoles as a part of conservative treatment instead of each other.

Effects of arm swing on spatiotemporal characteristics of gait in unilateral transhumeral amputees.

BACKGROUND: Gait is an autonomic process consisting of coordinated movements of the upper extremities, lower extremities, trunk and pelvis. However, researches regarding effects of upper extremity problems on gait parameters are limited. RESEARCH QUESTION: The aim of this study was to investigate the effects of arm swing on spatiotemporal characteristics of gait in individuals with unilateral transhumeral amputations. METHODS: A total of 25 unilateral transhumeral amputees and 25 healthy subjects were included. Information on the demographic features of individuals, amputations, and prosthetic devices were recorded. Spatiotemporal characteristics of gait were obtained using the GAITRite electronic walkway, and the arm swing was evaluated with the two video-cameras and analyzed using the Dartfish Pro Suite 7 software. RESULTS: The groups were similar regarding their age, height and weight. Mean duration from the amputation was 14.91 ± 10.90 years, and the mean weight of the prostheses was 1.44 ± 0.39 kg. Amputees had a less ambulatory arm swing on their amputated sides compared to their intact arms and healthy individuals. When the amputee group was compared to the healthy individuals, their step and stride lengths were shorter and their foot progression angle was higher, their gait velocity and cadence were lower than the healthy group. SIGNIFICANCE: The reduction of arm swing on the amputated side in unilateral transhumeral amputees is thought to be due to (1) use of the contralateral side in functional activities, (2) restriction of shoulder joint movement of socket boundaries and (3) fixed mechanical elbow joint. It has been thought that a decrease in the arm swing during walking may lead to a decrease in step length, stride length, and gait velocity.

Associations among physical activity, comorbidity, functional capacity, peripheral muscle strength and depression in breast cancer survivors.

Physical inactivity may an important outcome in the prognosis of breast cancer. Physical activity levels decrease significantly for breast cancer patients following the treatment and remain low after oncology treatment is completed. The aim of this study was to determine physical activity levels and to examine associations among physical activity, comorbidity, functional capacity, peripheral muscle strength, and psychosocial status in breast cancer patients. Forty breast cancer survivors were included in this study. Demographic and clinical characteristics were recorded. Physical activity was assessed with a short form of the International Physical Activity Questionnaire (IPAQ). We defined comorbid diseases according to the Charlson Comorbidity Index (CCI). Functional capacity was evaluated with a six-minute walk test (6MWT). Peripheral muscle strength was measured for quadriceps femoris muscle with a hand-held dynamometer. Psychosocial status was measured with the Hospital Anxiety Depression Scale (HADS). Forty percent of patients were inactive. The IPAQ total score was significantly related with quadriceps muscle strength (r=0.492; p<0.001) and HADS depression score (r=0.341; p<0.05). Marked correlations were also observed between IPAQ walking score and quadriceps muscle strength (r=0.449; p<0.001), HADS depression score (r=0.341; p<0.05), and CCI (r=-0.433; p<0.001). The CCI score was also markedly associated with quadriceps muscle strength (r=-0.413; p<0.001). 6MWT distance was not significantly correlated with any of the parameters. Regression analyses revealed that psychosocial status and peripheral muscle strength were significant predictors of physical activity estimated with the IPAQ short form and when combined, they explained 35% of the variance. Comorbidities, peripheral muscle strength and psychosocial status partially explain the variability of physical activity level in breast cancer survivors. These results suggest that physical inactivity contributes to worsening health in breast cancer survivors.

Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors?

AIM: The aim of the study was to compare the effects of aerobic exercise training and yoga on the functional capacity, peripheral muscle strength, quality of life (QOL), and fatigue in breast cancer survivors. MATERIAL AND METHODS: A total of 52 patients with a diagnosis of breast cancer were included in the study. The patients were randomly assigned to 2 groups: aerobic exercise (n = 28) and yoga added to aerobic exercise (n = 24). Both groups participated in submaximal exercise 30 minutes/d, 3 d/wk for 6 weeks. The second group participated in a 1-hour yoga program in addition to aerobic exercise training. Functional capacity was assessed by the 6-Minute Walk Test (6MWT). Peripheral muscle strength was evaluated with a hand-held dynamometer. The fatigue severity level was assessed with the Fatigue Severity Scale (FSS). The QOL was determined by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS: There were statistically significant increases in peripheral muscle strength, the 6MWT distance, and the perception of QOL in both groups (P < .05). Additionally, the group with aerobic exercise and yoga showed marked improvement compared with the aerobic exercise group in fatigue perception (P < .05). CONCLUSION: According to the data from this study, aerobic exercise training and yoga improved the functional capacity and QOL of breast cancer patients. Aerobic exercise programs can be supported by body mind techniques, such as yoga, in the rehabilitation of cancer patients for improving functional recovery and psychosocial wellness.

Footwear suitability in Turkish preschool-aged children.

BACKGROUND: Unsuitable footwear worn in childhood may cause some foot problems by interfering normal development of foot. OBJECTIVES: To compare footwear suitability rate of indoor and outdoor footwear at all points in preschool children and investigate factors which could affect footwear suitability. STUDY DESIGN: A cross-sectional survey study. METHODS: A total of 1000 healthy preschool children (4-6 years old) participated in this study. Indoor and outdoor footwear of children were evaluated through Turkish version of Footwear Assessment Score. Effect of factors like age, sex, number of siblings, educational and occupational situation of parents, and behavior of school management about selecting footwear was investigated. RESULTS: Children got better footwear score for outdoor than indoor ones (p < 0.001). Boys got statistically better footwear score for both indoor and outdoor ones than girls (p < 0.001). Also significant difference in footwear score was found in favor of children who were going to schools that gave guidance about selecting footwear for both indoor and outdoor in comparison to children going to other schools (p < 0.001). CONCLUSIONS: For healthy foot development, parents need an education about suitable footwear for their children. Performing education programs and investigation of their effect with comprehensive follow-up studies in future is essential. CLINICAL RELEVANCE: This study reflects footwear habits of Turkish preschool children and factors affecting this issue. Results may give way to education programs about suitable footwear worn in childhood for healthy foot development.

Functional outcome after prosthetic rehabilitation of children with acquired and congenital lower limb loss.

The purpose of this study was to compare the functional status of children with acquired and congenital lower limb loss after 3 weeks and 6 months of prosthetic rehabilitation. Forty-one children aged between 8 and 17 years participated in the study. The children underwent prosthetic fitting, prosthetic training and rehabilitation after physiotherapy evaluations. Gait patterns and weight bearing values were assessed, and the Amputee Mobility Predictor (AMP) Questionnaire was applied. The congenital group had better gait patterns, weight bearing values and AMP scores in the initial assessment and after 3 weeks. The statistical analyses of the same parameters after 6 months showed that there were no significant differences between the two groups (P>0.05). It was determined that all congenital patients and only 16 of 20 acquired patients were wearing their prostheses for more than 8 h a day. When the outcomes of the first assessments were compared, the congenital group showed a better functional level, gait pattern and weight bearing value. At the end of 6 months, an improvement was observed in the functional level, gait pattern and weight bearing value in both the groups. The functional state, gait pattern and weight bearing value of children with limb loss can be improved if they actively use their prosthesis.

Cross cultural adaptation and reliability of the Turkish version of Amputee Body Image Scale (ABIS).

OBJECTIVES: The Amputee Body Image Scale (ABIS) is a self assessed questionnaire with 20 items created to measure body image perception of amputees. The questions assess how an individual perceives and feels about his or her body experience. But no Turkish version is available. The aim of this study was to cross-culturally adapt the ABIS for use with Turkish speaking lower limb amputees and to determine reliability. METHODS: The sample consisted of 50 transtibial amputees. The mean age of the participants was 43.14, SD: 14.66. The ABIS has been filled by the patients for two times. RESULTS: Internal consistency of the ABIS was very high (Cronbach alpha 0.834 for test and 0.842 for retest). The test-retest reliability was excellent for the ABIS (ICC = 0.939, 95% CI 0.895-0.965). CONCLUSIONS: The Turkish version of the ABIS is a reliable instrument to assess body image in lower limb amputees.

Effectiveness of phantom exercises for phantom limb pain: a pilot study.

OBJECTIVE: To investigate the effects of phantom limb exercises on phantom limb pain. METHODS: A total of 20 traumatic amputees participated in the study. Ten received phantom exercises and prosthetic training, and 10 were treated with routine prosthetic training and a general exercise programme. Intensity of pain was evaluated using a 10-cm visual analogue scale before therapy and after 4 weeks of therapy. RESULTS: Baseline scores on the visual analogue scale were similar between the groups. Pain intensity decreased in all subjects after 4 weeks of treatment in both groups. According to the visual analogue scale scores at the end of 4 weeks, the phantom exercises group differed significantly from the general exercise group (p < 0.05). CONCLUSION: Phantom exercises appear to be effective in reducing phantom pain, but further research is required to confirm this.The results of this study indicate that phantom exercises can be used safely to alleviate phantom limb pain in lower and upper limb amputees.