Moderate disability has negative effect on spatiotemporal parameters in patients with chronic low back pain.

BACKGROUND: It is known that the patients with chronic low back pain (CLBP) has different spatiotemporal characteristics than healthy controls such as average speed, cadence, step and stride length parameters. CLBP is a heterogeneous phenomenon in terms of causing various level of disability. RESEARCH QUESTION: Does disability levels make a difference on spatiotemporal characteristics of patients with CLBP? METHODS: 66 patients with CLBP and 32 healthy controls between the ages of 25 and 65 years participated to study. The patients who had neurological, orthopedic, cardiovascular, metastatic history excluded from study. Resting, activity and night pain and functional disability were evaluated with Visual Analog Scale (VAS), Oswestry Disability Index (ODI) respectively. The patients were divided into two groups according to their disability level: moderate and severe. Gait analyses were performed with Optogait treadmill-based photocell system (Version 1.6.4.0, Microgate, Bolzano, Italy). After two trials were done, the spatiotemporal characteristics recorded for one minute while patients walked their preferred speed on the treadmill. One-way ANOVA was used to compare these parameters among the perceived disability level (moderate, severe) and healthy controls.The level of significance was accepted as 0.05. RESULTS: Step length, stride length, and preferred walking speed were the parameters that differentiate the gait between healthy controls and patients with CLBP (p < 0.05). According to post-hoc analyses, moderate CLBP was identified as the group most different from the healthy controls (p < 0.05). SIGNIFICANCE: Results of this study describe how compensating mechanism were seen in CLBP subgroups. As opposed to expectations, an increase in disability would not create higher difference in spatiotemporal characteristics between healthy controls and patients with severe disability. We propose that patients with severe and moderate disability had different ways to normalize their gait.

Demography and function of children with limb loss.

This retrospective study was designed for the period 1982-2002 to collect the basic data on the demography, level and side of the amputation, involved limbs, age, gender, and prosthetic functional level in children with limb loss. A total of 232 children were assessed through their prosthetic records. Seventy-two percent (195 children) presented lower-limb involvement, and 28% (77 children) had upper-limb loss. The age of the children varied between 1 and 15 years with a mean age of 9.90 +/- 2.32 years. Results of the study revealed that the leading amputation cause in children was congenital limb absence. The most frequent levels were determined as trans-tibial and trans-radial in lower and upper limbs, respectively. Findings showed that more boys (60%) were affected, and 84% of all amputations were found to be unilateral. It was also seen that right-side amputations (54%) were more common than left-side amputations (46%). The outcome of the study showed that 96% of children with lower-limb loss reached a functional gait pattern without any aids, while the percentage of independence in activities of daily living was found to be 88% in upper-limb loss.

A comparison of traditional prosthetic training versus proprioceptive neuromuscular facilitation resistive gait training with trans-femoral amputees.

Reports in the rehabilitation literature suggest that patients with trans-femoral amputation ambulate well after suitable prosthetic treatment. The effects of exercise protocols on function, however, have not been documented in this population. This study was conducted to compare the outcome of traditional and proprioceptive neuromuscular facilitation (PNF) techniques on weight bearing and gait. Fifty unilateral trans-femoral amputees who were attending for their first prosthesis, participated in this study. Amputees were randomly assigned into groups receiving the traditional training or PNF. Traditional treatment was consisted of weight-shifting, balancing, stool-stepping and gait exercises. In the other group the same activities were given by PNF. Amputees were trained 30 minutes daily, for a total of 10 treatments. Pre- and post-training assessment included weight bearing measurements by using two bathroom scales and time-distance characteristics of gait from footprints. A statistically significant difference was found in all parameters within the groups due to pre- and post-training evaluation data (p<0.05), but more obvious improvement was observed in the group who received PNF (p<0.05). The results of the study suggest that the prosthetic training based on proprioceptive feedback was more effective to improve weight bearing and gait when compared with a traditional programme.