Musculoskeletal System and Gait Characteristics in Patients with Osteogenesis imperfecta.

OBJECTIVES: The aim of the study was to assess the muscoloskeletal system and spatiotemporal gait parameters of patients in three types of osteogenesis imperfecta. DESIGN STUDY: Retrospective observational study. SETTINGS: The Department of Rehabilitation, Children's Memorial Health Institute in Warsaw, Poland. PARTICIPANTS: This study investigated individuals with various types of osteogenesis imperfecta: 33 with osteogenesis imperfecta I (aged 13.9), 16 with osteogenesis imperfecta III (aged 10.4), and 14 with osteogenesis imperfecta IV (aged, 15.8), as well as a reference group of 400 healthy individuals. MAIN MEASURES: The musculoskeletal assessment included: medical record review, clinical evaluation, functional tests, long bone deformity assessment via clinical and X-ray examination, and objective gait analysis with the Vicon Motion Systems (Ltd, Oxford, UK). RESULTS: The study revealed notable differences in clinical presentation, deformities within the musculoskeletal system, gait parameters across the various types of osteogenesis imperfecta (p < 0.001). The most affected gait parameters were: cadence, gait speed and step length. The greatest deformities of lower limbs and spine were presented in patients with osteogenesis imperfecta type III. CONCLUSIONS: These findings are significant for understanding gait abnormalities in osteogenesis imperfecta patients and designing customized physiotherapy programs to help them participate fully in daily life. Improvement of muscle strength is one of the key for easier engagement in activities like walking or stair-climbing.

Comparison of 2 Conservative Treatment Approaches for the Flat Foot in Children Aged 5 to 10: Foot Orthoses Versus Foot Orthoses Supplemented With Zukunft-Huber Manual Therapy.

The aim was to find if foot orthotics alone can improve flat feet in children and analyze how the addition of Zukunft-Huber manual therapy and corrective bandaging changes the outcome. Forty-nine children aged 5 to 10 with asymptomatic flexible flat feet were divided into 2 groups. The first was treated with foot orthoses alone, in the second wearing foot orthoses was supplemented with Zukunft-Huber manual therapy and corrective bandaging. Pedobarography during gait was performed before the therapy and after a year. In the first group decrease in arch index, width, force, and area of midfoot, increase in force MH2 and area hindfoot was found, in the second decrease in arch index, width, force, and area of midfoot, increase in force under metatarsal head second, third, fourth, and fifth, area metatarsal head fourth and area hindfoot. Both methods showed positive changes, but foot orthoses with additional intervention were more effective.

Foot Plantar Pressure Abnormalities in Near Adulthood Patients with Type 1 Diabetes.

Increased ulcer risk diminishes the quality of life in diabetes. This study assessed abnormalities in foot plantar pressure distribution in adolescents with T1D to detect early signs of ulcer risk. A total of 102 T1D patients, without diabetic neuropathy, were included (mean age 17.8 years, mean diabetes duration 7.4 year). Pedography was captured using Novel emed. Data from the study group were compared with reference data. The study revealed a statistically significant reduced foot contact area in both feet in the entire foot and under the head of the fifth metatarsal bone and the second toe. In both feet, the peak pressure was increased under the entire foot, hindfoot, midfoot, first metatarsal head, big toe, and second toe. There was no statistically significant difference in peak pressure. The mean plantar pressure rating was statistically significantly increased in both feet across the entire sole, in the hindfoot, midfoot, and first metatarsal head. T1D patients of age near adulthood without neuropathy have increased values in mean pressure and reduced contact area, pointing to the need of monitoring and preventive measures. These results point to the need of further research and analysis which should include various risk factor such as foot anatomy, body posture, or certain metabolic factors.

How to Define Pediatric Flatfoot: Comparison of 2 Methods: Foot Posture in Static and Dynamic Conditions in Children 5 to 9 Years Old.

LEVELS OF EVIDENCE: Prospective cohort study.

Kinematic and Electromyography Responses to Increasing Proprioception Demand and a Lack of Visual Feedback in Healthy, Middle-Aged Women Tested on an Unstable Platform.

The purpose of the study was to investigate which changes in kinematics and muscle activity in healthy, middle-aged women are introduced to maintain balance on an unstable platform. Biodex Balance System tests were used in stable and unstable modes (sudden with eyes open/closed and gradual with eyes open). Simultaneously, lower-extremity kinematics and surface electromyography of back and legs muscles were captured. The dependence between balance scores, movement ranges, and root mean square of electromyography was assessed with multiple regression to evaluate the strategy used. The results showed multisegmental movements in sudden instability, and activity of at least one of the following muscles: gluteus maximus, erector spinae, and soleus in all conditions. Best balance scores were achieved when movements appeared in pelvis in transverse, and hip in frontal planes, worst when in pelvis in frontal, hip, and ankle in sagittal planes, and when mentioned muscles were activated. Further research is needed to identify the determinants of strategy choice.

Using the TUG Test for the Functional Assessment of Patients with Selected Disorders.

One of the tests used for quantitative diagnostics is Timed Up-and-Go (TUG), however, no reports were found regarding the percentage share of individual test components, which seems to have a greater diagnostic value in differentiating the functional status of the patients. The aim of the study was to analyze the percentage of the individual components of the TUG test in functional assessment in a population of healthy children and in clinical trials patients with various diseases. MATERIAL AND METHODOLOGY: The material consisted of patients with orthopedic (n = 165), metabolic (n = 116) and neurological dysfunctions (n = 96). RESULTS: The components of the TUG test that differentiated the studied groups of patients to the greatest extent were in the order: relapse tug3%, initial transition tug2%, sitting tug5% and standing up tug1%, while during the final transition tug4% statistically significant differences were found only between healthy children and the studied groups of patients. CONCLUSIONS: The TUG test turned out to be a good diagnostic tool, differentiating the studied groups of patients. The analysis of the percentage of the components of the TUG test can help in assessing the mobility of children and adolescents, monitor the effects of physiotherapy or the effects of surgical procedures.

The impact of two weeks of traditional therapy supplemented with virtual reality on balance control in neurologically-impaired children and adolescents.

BACKGROUND: The aim of the study was to assess whether two weeks of therapy (traditional and VR) may improve balance in children and adolescents with neurological problems of different origins and whether the deterioration in gait dynamic balance showed by patient's ground reaction forces (GRF) determinates therapy effectiveness. METHODS: 29 participants aged 9-17 attended traditional therapy supplemented by tailor-made games. Therapy comprised exercises improving balance, range of motion, posture control, proprioception, muscle strength. Biodex Balance System was used for main assessment before and after therapy in tests: Postural Stability, modified Clinical Test of Sensory Integration and Balance, and Limits of Stability. Participants underwent gait analysis before the therapy to determine GRF. An increased maximal lateral component or decreased maximal anterior component in the push-off phase taking place in both legs were regarded as deterioration. This enabled the division into two groups with and without such a deterioration. Results were compared between the groups before and within groups before and after therapy. RESULTS: The precision of forward-backwards body sway improved most significantly in the group with decreased GRF and reached the level of the second group, who worsened antero-posterior repeatability during stance on an unstable surface with eyes open. CONCLUSION: Two weeks of combined traditional and VR therapy tailored to patients' functional weakness positively influenced the balance of neurologically impaired children. The group with decreased gait dynamic balance improved the tasks, which were intensively trained in the games. The second group remained more spontaneous in the trained direction.

Are Gait and Balance Problems in Neurological Patients Interdependent? Enhanced Analysis Using Gait Indices, Cyclograms, Balance Parameters and Entropy.

BACKGROUND: Balance and locomotion are two main complex functions, which require intact and efficient neuromuscular and sensory systems, and their proper integration. In many studies the assumption of their dependence is present, and some rehabilitation approaches are based on it. Other papers undermine this assumption. Therefore the aim of this study was to examine the possible dependence between gait and balance in patients with neurological or sensory integration problems, which affected their balance. METHODS: 75 patients (52 with neurological diseases, 23 with sensory integration problems) participated in the study. They underwent balance assessment on Kistler force plate in two conditions, six tests on a Balance Biodex System and instrumented gait analysis with VICON. The gait and balances parameters and indices, together with entropy and cyclograms were used for the analysis. Spearman correlation, multiple regression, cluster analysis, and discriminant analysis were used as analytical tools. RESULTS: The analysis divided patients into 2 groups with 100% correctly classified cases. Some balance and gait measures are better in the first group, but some others in the second. CONCLUSIONS: This finding confirms the hypothesis that there is no direct link between gait and balance deficits.

Effect of Plano-Valgus Foot on Lower-Extremity Kinematics and Spatiotemporal Gait Parameters in Children of Age 5-9.

Aim of the study was to see how a definition of the flexible flat foot (FFF) influences the results of gait evaluation in a group of 49 children with clinically established FFF. Objective gait analysis was performed using VICON system with Kistler force platforms. The gait parameters were compared between healthy feet and FFF using two classifications: in static and dynamic conditions. In static condition, the ink footprints with Clarke's graphics were used for classification, and in dynamic condition, the Arch Index from Emed pedobarograph while walking was used for classification. When the type of the foot was based on Clarke's graphics, no statistically significant differences were found. When the division was done according to the Arch Index, statistically significant differences between flat feet and normal feet groups were found for normalized gait speed, normalized cadence, pelvic rotation, ankle range of motion in sagittal plane, range of motion of foot progression, and two parameters of a vertical component of the ground reaction force: FZ2 (middle of stance phase) and FZ3 (push-off). Some statically flat feet function well during walking due to dynamic correction mechanisms.

Balance assessment in healthy children and adolescents aged 6-18 years based on six tests collected on AMTI AccuSway force platform.

PURPOSE: The aim of the study was to compare the results of six balance tests collected on AMTI AccuSway Plus ACS force platform between healthy female and male children and adolescents. We also searched for possible correlation of the balance measures with subjects' age. METHODS: 228 healthy 6- to 18-year-old subjects (111 boys and 117 girls) participated in the study. Six balance tests were performed with the use of AMTI AccuSway Plus ACS platform: quiet standing for 30s, maximal voluntary sways of the body in the sagittal plane (anterior-posterior - AP test) for 30 s, and in the frontal plane (left-right - ML test) for 30s. All tests were performed in two conditions: eyes open and eyes closed. RESULTS: During quiet standing with eyes open, most balance measures were lower in girls ( p < 0.05). In AP and ML tests with eyes open, a few balance parameters were different between boys and girls ( p < 0.05). In quiet standing, AP and ML tests with eyes closed, there were no between-gender differences ( p > 0.05). In quiet standing with eyes open and closed most balance parameters were negatively correlated with age ( p < 0.05). CONCLUSIONS: Quiet standing postural sway characteristics depended on gender under normal visual conditions and it was similar in boys and girls under visual deprivation conditions. The vision was differently used by females and males in balance tasks. Static postural stability improved with age regardless of visual conditions.

Balance control of children and adolescents suffering from vertigo symptoms: in what way posturography is helpful in clinical evaluation of vestibular system pathology?

PURPOSE: The aim of the study was to determine balance parameters in a group of young patients with vertigo symptoms and to verify posturography helpfulness in clinical evaluation of vestibular system pathology. METHODS: 77 children and adolescents of age 3-18 suffering from vertigo episodes participated in the study (46 girls, 31 boys). They underwent audiology objective tests and balance test on stable surface. Calculated balance parameters were analyzed in reference to: eyes opened and closed, age influence, sway comparison in anterior-posterior and medial-lateral, differences between subgroups with and without vestibular deficits. Discriminant analysis was performed to assess classification ability to impaired group in two cases: only balance parameters and both audiology and balance parameters. RESULTS: Patients with vertigo symptoms generally keep their balance properly on stable surface. Balance parameters do not depend on presence of vestibular system pathology. Values increased in eyes closed conditions. Left/Right and Anterior/Posterior differences were not statistically significant. The negative correlation between age and some balance parameters is present, stronger in the case of eyes opened and weaker or absent in vestibular impaired group. Also, correlations between axes were found, higher in impaired group in comparison with not impaired one. CONCLUSIONS: Discrimination based on balance parameters is poor not comparable to one built on combined: audiology and balance parameters, so typical balance parameters' analysis is not so useful in clinical practice when the reason of vertigo episodes should be assessed, but verify compensation process and measure with objective numbers the progress of recovering, the actual functional patient's status.

Gait changes in patients after reconstruction of facial bones with fibula and iliac crest free vascularized flaps.

PURPOSE: Patients with malignant tumours of the oral cavity require its surgical removal and reconstruction of the bone and soft tissues. The grafts are obtained either from leg (fibula) or pelvis (iliac crest). The removal of grafts from the locomotor apparatus can impair the gait. The aim of this study was to find out how the localization of donor site influences the gait pattern. METHODS: Results obtained for 30 patients were analyzed (16 fibula graft, 14 iliac crest graft). Patients underwent instrumented gait analyses three times (VICON system): before surgery, 2-4 month after the surgery, and 4-8 months after the surgery. RESULTS: In both groups several gait parameters were changed. Two parameters changed in both groups: gait speed and cadence. In patients receiving iliac crest graft the changed gait variables were: pelvic rotation, hip range in sagittal plane (operated side), knee range in sagittal plane (operated side), foot dorsiflexion in swing on both sides. In patients receiving fibula flap the changed gait variables were: tilt, range motion of the tilt, minimum hip flexion (operated side), time to maximum knee flexion (non-operated side), GGI (non-operated side) and step length (nonoperated side). CONCLUSIONS: The primary gait deviations occurring after surgery, and the compensatory mechanisms which subsequently arise depend on the localization of graft donor site. The results indicate that the patients in whom fibula flap was used have less problems with gait pattern after the surgery than the patients receiving iliac crest graft.

Could lower leg Wartenberg test be used as a predictor of restrictions in temporomandibular joint movements in CP patients?

PURPOSE: Patients with spasticity suffer not only from neurological problems but also from various dentistry problems due to spasticity of the jaw muscles. Measurements of motion in temporomandibular joints should reflect the amount of abnormal muscle tone of these muscles. The aim of this study was to find out if the measurements of temporomandibular joint movements performed with the ultrasound Zebris device are different in cerebral palsy patients than in healthy subjects; and to find out if the information on the degree of spasticity in the lower legs provided by the Wartenberg test could be used to predict the degree of spasticty in the jaw muscles. METHOD: Twenty five healthy subjects and 25 cerebral palsy patients participated in the study. Two types of measurements were performed: temporomandibular movements measured with Zebris device, and instrumented Wartenberg test. RESULTS: The laterotrusion and opening movements are different in CP patients than in healthy subjects. Laterotrusion movement correlates with velocity measured during the Wartenberg test. CONCLUSION: This finding suggests that high spasticity in the lower legs could indicate jaw movement restrictions in CP patients.

Ground reaction force analysed with correlation coefficient matrix in group of stroke patients.

Stroke is the third cause of death in contemporary society and causes many disorders. Clinical scales, ground reaction force (GRF) and objective gait analysis are used for assessment of patient's rehabilitation progress during treatment. The goal of this paper is to assess whether signal correlation coefficient matrix applied to GRF can be used for evaluation of the status of post-stroke patients. A group of patients underwent clinical assessment and instrumented gait analysis simultaneously three times. The difference between components of patient's GRF (vertical, fore/aft, med/lat) and normal ones (reference GRF of healthy subjects) was calculated as correlation coefficient. Patients were divided into two groups ("worse" and "better") based on the clinical functional scale tests done at the beginning of rehabilitation process. The results obtained by these two groups were compared using statistical analysis. An increase of median value of correlation coefficient is observed in all components of GRF, but only in non-paretic leg. Analysis of GRF signal can be helpful in assessment of post-stroke patients during rehabilitation. Improvement in stroke patients was observed in non-paretic leg of the "worse" group. GRF analysis should not be the only tool for objective validation of patient's improvement, but could be used as additional source of information.

The comparison of two physiotherapeutic approaches for gait improvement in sub-acute stroke patients.

The functional gait problems encountered by stroke patients include impaired balance, abnormal gait pattern with marked asymmetry, pathological trunk and spinal motion. Many different methods of physiotherapy are used to improve functional ability (especially gait) in stroke patients, but their efficacy and outcome are often not objectively assessed. The goal of this paper is to compare two therapeutic programs: one that is traditionally used in our rehabilitation facilities (exercises in lying position, "open chain" exercises, isolated movements of extremities with trunk stabilization) and the new one (exercises in vertical position, sitting or standing, "closed chain" exercises involving whole paretic side of the body). Fifty one stroke patients, aged 34 to 79 years, participated in the study. Patients were randomly allocated to one of the two groups. Patients underwent clinical assessment (Fugl-Meyer, Rivermead Motor Assessment, Berg Balance Scale) and instrumented gait analysis (using six-camera VICON 460 system) simultaneously three times: prior to the beginning of the rehabilitation program, after 6 weeks of the program, and after another 6 weeks of physiotherapy, at the end of rehabilitation program. Results demonstrated that both rehabilitation programs improved the gait function and clinical status in patients suffering from stroke. Despite the differences between the two programs the progress achieved by the patients in locomotor function is similar. Two equivalent physiotherapy programs could be applied during rehabilitation process depending on the patient's individual preferences and needs, as the amount of functional improvement provided by them is comparable.

Influence of the structural deformity of the spine on the gait pathology in scoliotic patients.

Scoliosis is not only a spinal deformity, but also leads to the development of a pathological gait pattern. Nearly all studies examining walking in scoliotic patients report some degree of gait abnormality, however the results are somewhat contradictory. Therefore the aim of this study is to explore the relationship between gait pathology and degree of scoliotic deformity in a group of patients with idiopathic scoliosis. Sixty three females with idiopathic scoliosis, aged between 12 and 17 participated in the study. They were not treated previously, neither surgically, nor conservatively. They underwent objective gait analysis with a VICON 460 system. Data for the following parameters were analysed: gait velocity, cadence, step length, pelvic tilt, pelvic retraction, pelvic range of motion in the transverse plane, pelvic obliquity, hip and knee range of motion in the sagittal plane, knee flexion at initial contact, ankle dorsiflexion in swing, foot progression angle. Additionally a Gillette Gait Index (GGI) was calculated. Prior to the gait analysis all patients underwent a clinical examination, an X-ray, clinical tests and anthropometric measurements. In conclusion our results indicate that the gait pathology of the patients with idiopathic thoraco-lumbar (i.e. double curve) scoliosis depends on the severity of the spinal deformity and the type of pelvic deformity.

The influence of knee marker placement error on evaluation of gait kinematic parameters.

Vicon motion system is an accurate equipment for objective gait analysis. According to clinical experience the most important source of errors in kinematics is marker misplacement. It seems that knee marker placement is especially important because of its direct influence on two body segments: thigh and shank. There is little data in the literature on how the misplacement of knee marker determines the changes of kinematic parameters. Therefore the aim of this study was to collect the kinematic data of subjects with different knee pathologies (one with knee flexion contracture, the second with knee hyperextension) while knee marker position was changed in a systematical way. They were walking with their natural, preferred speed. The data were collected using VICON460 motion system, the Helen Hayes marker set and Plug-In-Gait model. Then they were processed based on Polygon software. The results of both subjects showed the changes of kinematics, depending on the knee marker misplacement. The assessed joint ranges of angle change were: in knee, 18° in sagittal plane and 20° in frontal plane; in hip, 10° in sagittal plane and 24° in transversal plane; in ankle, 10° in sagittal plane and 25° in transversal plane. This paper presents the detailed data which could help the users of such systems to interpret the kinematic data.

Does the gait pathology in scoliotic patients depend on the severity of spine deformity? Preliminary results.

The gait pattern in scoliotic patients differed from the gait pattern of the healthy subjects. The aim of the present paper was to describe the dependence of the gait pathology on the severity of the spinal deformity. Thirty five patients with confirmed scoliosis participated in the study. All patients underwent the clinical examination (X-ray and anthropometric measurements) as well as the objective gait analysis. Based on clinical examination the patients were divided into subgroups according to six different criteria. The gait parameters were compared between these subgroups. Most of the assessed variables do not depend on the clinical variables, describing the severity of the spinal deformity. The two gait parameters which depend on the clinical variables are pelvic obliquity and step length. The results show that the obliquity increases with the Cobb angle. The step length decreases with the increasing Cobb angle and with the sum of angles describing the spinal deformity in sagittal and frontal planes. The evaluation of the gait pattern of scoliotic patients and the establishment of its dependence on the spinal deformity are of importance for the treatment of these subjects.

Functional outcome following the implantation of the modal/bipolar radial head endoprosthesis. Preliminary results.

Radial head fractures constitute 33% of all elbow fractures. In cases of unreconstructible fractures, the resection of the head was advocated. Radial head arthroplasty is an alternative way of the treatment. As the implantation could end up with complications, thus new and better designs are constantly looked for. One of such designs is modal/bipolar radial head endoprosthesis. The aim of this paper is to assess the functional outcome following the implantation of this endoprosthesis using movement analysis system. Seven patients participated in the study: 5 after implantation of endoprosthesis and 2 after surgical reconstruction of the radial head. The upper extremity movements with EMG were assessed during gait and pronation/supination movements with and without the external load. The functional abilities of patients with radial head endoprosthesis do not differ from those of the patients after the elbow reconstruction. This allows the patients normal, daily activity, with no restrictions and pain.