Impact of step width on trunk motion and gait adaptation in elderly women with knee osteoarthritis.

BACKGROUND: Step width during walking can provide important information about aging and pathology. Although knee osteoarthritis (OA) is a common disease in elderly women, little is known about how different step widths influence gait parameters in patients with knee OA. OBJECTIVE: To address this, we investigated the differences between narrower and wider step width on the center of mass (CoM) and gait biomechanics of elderly women with knee OA. METHODS: Gait and CoM data were measured using a three-dimensional motion capture system and anthropometric data were acquired via standing full-limb radiography. Thirty elderly women with knee OA were divided into two groups depending on the average step width value (0.16 m). Specifically, the narrower step width group included those with a below average step width (n= 15) and the wider step width group included those with an above average step width (n= 15). The differences between the two groups were analyzed using an independentt-test. RESULTS: Walking speed, step length, knee and ankle sagittal excursion, and medial-lateral CoM range were significantly greater in the narrower group. In contrast, the medial-lateral CoM velocity, medial-lateral ground reaction force (GRF), and foot progression angle were significantly higher in wider group. The external knee adduction moment, vertical GRF, and vertical CoM did not differ between the groups. CONCLUSIONS: Our data indicate that step width in women with knee OA is associated with trunk motion and gait patterns. People with a narrower step might improve their gait function by increasing trunk frontal control to maintain gait stability. In contrast, in those with a wider step, greater toe out angle and shorter step length might be a compensatory adaptation to reduce knee loading.

Changes in the Suicide Rate of Older Adults According to Gender, Age, and Region in South Korea from 2010 to 2017.

BACKGROUND: South Korea's suicide rates are the highest among Organization for Economic Co-operation and Development (OECD) countries, making it one of the most important societal issues in South Korea. METHODS: the statistics on causes of death and resident registration central population (RRCP) provided by the National Statistical Office were used to calculate the suicide rate among older adults in Korea. We examined gender (male, female), age (young-old, old-old), and region (urban, rural) by conducting latent growth modeling to estimate changes in the overall older adult suicide rate and verify its relationship. RESULTS: over a period of 8 years, the older adult suicide rate was 104.232 on average in 2010 and it decreased by approximately 10.317 every year, and the rate of decrease gradually slowed down. The initial value of the older adult suicide rate was found to be higher among males, the old-old group, and those living in rural regions. In the quadratic function change rate, only males and the old-old group were statistically significant. CONCLUSION: in this study, the direction of and the rate of change in the older adult suicide rates and the relationship between gender, age, and region were examined. It is expected that this study will provide basic data to assist in establishing older adult suicide prevention policies, considering the gender, age, and region of the aging population.

The Effects of Children's Smartphone Addiction on Sleep Duration: The Moderating Effects of Gender and Age.

BACKGROUND: Smartphones are an important part of children's and adolescents' lives, and they often spend a lot of time using them. This study aims to precisely discover the effects of smartphone addiction on sleep duration as moderated by age and gender. MATERIALS AND METHODS: The data utilized in this study are from the 'Korean Children and Youth Panel Survey 2018' by the National Youth Policy Institute; a total of 4940 youths (2399 in grade 4 and 2541 in grade 7) from the survey were analyzed by Stata 15.0 S. The dependent variable is sleep duration, and the independent variables are the sub-factors of smartphone addiction: disturbance of adaptive functions, virtual life orientation, withdrawal, and tolerance. An independent t-test was conducted to confirm the differences in the main variables according to gender and age. Multiple regression analysis was conducted to verify the moderating effects of gender and age in the relationship between children's smartphone addiction and sleep duration. RESULTS: First, the average sleep duration among grade 4 students was 9.17 h and grade 7 students was 7.96 h. Second, sleep duration was significantly higher for males than females, while there was no difference in smartphone addiction by gender. Third, smartphone addiction, particularly the sub-factor of tolerance significantly affected sleep duration. Fourth, age significantly affected sleep duration and gender had a moderating effect on sleep duration. CONCLUSIONS: Interventions to develop a healthy smartphone usage culture on family and societal levels would be beneficial for increasing awareness of smartphone addiction and its adverse effects on children and adolescents. Furthermore, targeted intervention would be more effective at modifying addictive behavior and sleep duration than trying to administer blanket interventions to youths as a whole.

Endoscopic Transverse Gastrocsoleus Recession in Children With Cerebral Palsy.

Aim: The aim of this study was to evaluate the surgical outcome, in terms of gait improvement, of endoscopic transverse Vulpius gastrocsoleus recession in children with cerebral palsy compared to the traditional open surgery. Methods: Twenty-seven children with cerebral palsy who had undergone endoscopic transverse Vulpius gastrocsoleus recession were reviewed. For the comparison of gait improvement, independent ambulatory spastic diplegic patients who had undergone only endoscopic transverse Vulpius gastrocsoleus recession on both legs were selected. Seven (14 legs) children were included and the median age was 7 years (6-9 years). Seven age-matched patients with the same inclusion/exclusion criteria who underwent open surgery were selected as the control group. Physical examination and gait parameters were evaluated and compared between groups, including the gait deviation index (GDI), and gait profile score (GPS). Results: There was no significant complication in twenty-seven children after endoscopic transverse Vulpius gastrocsoleus recession. However, one patient required a revision open surgery at postoperative 1 year 9 months due to the recurrence of equinus and the incomplete division of the midline raphe which was noted during surgery. When comparing gait improvements, there were no differences between the endoscopic and open surgery groups in ankle dorsiflexion angle, ankle kinetics, GDI, and GPS. The postoperative peak ankle dorsiflexion during stance phase was slightly higher in the open group. Conclusion: This is the first study that evaluates gait improvement exclusively for children with spastic diplegia after endoscopic transverse Vulpius gastrocsoleus recession. The gait improvements after endoscopic surgery were comparable to the open surgery, however, the possibility of reduced improvement in ankle kinematics should be considered.

Effect of spinal kypho-orthosis to gait and forward flexion in Parkinson disease.

[Purpose] The gait characteristics, such as short step, decreased arm swing and stooped posture, in Parkinson disease (PD) are well established. Pharmacological and non-pharmacological treatments have been attempted to improve the gait in patients with PD. Among the non-pharmacological approaches to improve gait, spinal orthosis can be applied for patients with spinal deformity. The purpose of our study was to investigate the effect of spinal kypho-orthosis to gait in PD by using a three-dimensional analysis. [Participants and Methods] Twenty-six patients with PD with gait disturbance with forward bend posture >15°. All participants were instructed to walk along a 6-m track and turn 180° and come back to the starting point under three-dimensional motion capture. The participants performed the test again with spinal kypho-orthosis. Gait parameters during examination is compared with and without spinal kypho-orthosis. The degree of forward flexion after kypho-orthosis in patients with PD was compared. [Results] Wearing the spinal kypho-orthosis significantly improved turning performance but did not affect locomotion. The severity of forward bend posture is mildly improved after the application of spinal kypho-orthosis. [Conclusion] Spinal kypho-orthosis has a short-term effect for gait performance, particularly during turning and erect posture. Spinal kypho-orthosis can be potentially used for management of turning deficits in PD.

Strategy on navigating obstacle in patients with lumbar spinal stenosis: Relationship among trunk and pelvic movement, swing toe clearance, and muscle coordination of the stance limb.

BACKGROUND AND OBJECTIVE: Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects gait, muscle activity, and trunk-pelvis-limb coordination because the lumbar spine and muscles interact to allow load transfer between the lower back and pelvis during sagittal trunk movement. Therefore, we investigated the relationships among trunk and pelvic movement, swing toe clearance, and muscle coordination (isolated contraction ratios) of the stance limb during obstacle-crossing by patients with LSS. METHODS: Ten patients with LSS and ten control subjects were enrolled. All navigated an obstacle during walking. Kinematic data from the trunk and lower extremities were monitored using a three-dimensional motion analysis system. In addition, we measured the isolated contraction ratios of the gluteus medius (GMed) and vastus lateralis (VL) using surface electromyography. RESULTS: The normalized lead limb distance was significantly lower in the LSS group than in controls. The spine flexion angle when the swinging limb toe was above the obstacle was higher, but the pelvic anterior tilting angle was lower, in the LSS group. LSS patients also had a significantly lower isolated contraction ratio of the GMed in the trailing stance limb but a significantly higher VL. CONCLUSIONS: Patients with LSS adapted a poor posture and their thoracic and spinal regions were hyperflexed with restricted pelvic obliquity. This created an inefficient gait, a shorter leading limb step, and less stable muscle coordination in the stance limb. Our findings may help healthcare professionals manage patients with LSS.

Effects of Soft Tissue Surgery on Pelvic and Hip Rotation in Patients with Spastic Diplegia: A Meta-Analysis.

BACKGROUND: There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia. METHODS: We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed. RESULTS: The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to -1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001). CONCLUSIONS: In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery.

Effect of initial position on the muscle activity of the hip extensors and amount of pelvic tilt during prone hip extension.

[Purpose] The aim of this study was to identify the effects of initial position of the hip joint with changes in the hip joint angle on the respective muscle activities of the bilateral erector spinae (ES), unilateral gluteus maximus (GM), and biceps femoris (BF) and the amount of pelvic anterior tilt during prone hip extension (PHE). [Subjects] Fifteen healthy volunteers were enrolled in this study. [Methods] The subjects performed PHE in three positions: neutral, 20°, and 45° flexed hip joint. The activities of the ES, GM, and BF were measured using surface electromyography, and kinematic values for pelvic anterior tilt were calculated using a motion capture system. [Results] There was a significant decrease in muscle activity of the contralateral ES at 45°, and an increase in the GM muscle activity and decrease in the BF muscle activity at 20°. The amount of pelvic anterior tilt was lower at 20°. [Conclusion] These results suggest that a hip flexion position of 20° would have an advantage over the other measured positions.

The effects of an exercise with a stick on the lumbar spine and hip movement patterns during forward bending in patients with lumbar flexion syndrome.

BACKGROUND AND OBJECTIVE: Forward bending is frequently performed in daily activities. However, excessive lumbar flexion during forward bending has been reported as a risk factor for low back pain. Therefore, we examined the effects of an exercise strategy using a stick on the angular displacement and movement onset of lumbar and hip flexion during forward-bending exercises in patients with lumbar flexion syndrome. METHODS: Eighteen volunteers with lumbar flexion syndrome were recruited in this study. Subjects performed forward-bending exercises with and without a straight stick in standing. The angular displacement and movement onset of lumbar and hip flexion during forward-bending exercises were measured by using a three dimensional motion analysis system. The significances of differences between the two conditions (with stick vs. without stick) was assessed using a one-way repeated analysis of variance. RESULTS: When using a stick during a forward-bending exercise, the peak angular displacement of lumbar flexion decreased significantly, and those of right and left-hip flexion increased significantly compared with those without a stick. The movement onset of lumbar flexion occurred significantly later, and the onset of right-hip flexion occurred significantly earlier with than without a stick. CONCLUSIONS: Based on these findings, a stick exercise was an effective method to prevent excessive lumbar flexion and more helpful in developing hip flexion during a forward-bending exercise. These findings will be useful for clinicians to teach self-exercise during forward bending in patients with lumbar flexion syndrome.

Three-dimensional analysis of foot motion after uphill walking with mobilization with movement using tape applied to the talocrural joint in women with limited ankle dorsiflexion.

BACKGROUND: Previous studies that investigated mobilization with movement (MWM) treatment assessed only improvements in passive range of motion (ROM). No information is currently available regarding the efficacy of modified MWM by application of tape. Therefore, we investigated the effect of uphill walking with modified MWM using tape applied to the talocrural joint (uphill walking with MWM taping) in women with limited ankle dorsiflexion. METHODS: Twelve feet of 12 women with ankle dorsiflexion < 8 degrees were studied. Passive ROM measured using a goniometer was used to select participants. Participants walked on a level walkway under 3 conditions: before exercise, after uphill walking, and after uphill walking with MWM taping. The Oxford Foot Model using 3D motion analysis system was used to examine dynamic foot kinematics, and statistical significance was determined by 1-way repeated-measures analysis of variance. RESULTS: After uphill walking with MWM taping, peak hindfoot dorsiflexion relative to the tibia was significantly greater than that before exercise and after uphill walking. Furthermore, peak forefoot plantarflexion relative to the hindfoot, peak hindfoot plantarflexion relative to the tibia, and backward tilt of the tibia were greater than those before exercise. CONCLUSIONS: Uphill walking with MWM taping resulted in an immediate alteration in foot motion during walking, increasing hindfoot dorsiflexion in particular. CLINICAL RELEVANCE: Further studies are needed to investigate the long-term effects of uphill walking with MWM taping and its potential use in rehabilitation training.

Changes in kinetic, kinematic, and temporal parameters of walking in people with limited ankle dorsiflexion: pre-post application of modified mobilization with movement using talus glide taping.

OBJECTIVE: The purpose of this study was to investigate the changes in passive ankle dorsiflexion range of motion (ROM), maximum plantar force, force-time integral, and time to heel off during walking between pre- and postapplication of modified mobilization with movement (MWM) using talus glide taping in people with limited ankle dorsiflexion. METHODS: Eighteen feet with limited ankle dorsiflexion in 13 people were examined. Participants performed 3 different walking tasks in the following order: walking before and immediately after applying the modified MWM using talus glide taping and walking after 5-minute walking with the modified MWM using talus glide taping. A floor-mat pressure measurement system (HR-mat) was used to measure maximum plantar force, force-time integral, and time to heel off; and passive ankle dorsiflexion ROM was measured using a standard goniometer. The significance of differences was assessed using repeated one-way analysis of variance. RESULTS: Passive ankle dorsiflexion ROM and time to heel off were significantly increased after 5-minute walking with the modified MWM using talus glide taping compared with walking before and immediately after applying the tape. Significantly increased maximum plantar force and force-time integral on the hindfoot and significantly decreased force-time integral on the forefoot during walking after 5-minute walking were observed with the modified MWM using talus glide taping compared with before applying the tape. No significant difference between before and immediately after applying the tape was observed in any variable. CONCLUSIONS: Our results suggest that walking an additional 5-minute with the modified MWM using talus glide taping increased passive ankle dorsiflexion ROM and time to heel off and improved dynamic plantar loading during walking.

Plantarflexor and Dorsiflexor Activation during Inclined Walking with and without Modified Mobilization with Movement Using Tape in Women with Limited Ankle Dorsiflexion.

[Purpose] This study compared the EMG activities of the plantarflexor and dorsiflexor muscles during inclined walking with and without modified mobilization with movement (modified MWM) using tape in women with limited ankle dorsiflexion. [Subjects] Fifteen women with limited dorsiflexion in their feet (22 feet in total) were recruited for this study. [Methods] The subjects walked with and without modified MWM using tape on a treadmill at 6 degrees with a speed of 1.25 m/s for 5 minutes. The EMG activities of the medial gastrocnemius (GCM) and tibialis anterior (TA) muscles were measured using a surface EMG system. [Results] During incline walking with modified MWM using tape, the mean EMG activity of the GCM significantly increased, and that of the TA decreased between heel strike and heel off. There was no difference between heel off and toe off in the two muscles. [Conclusions] Modified MWM using tape on the talus during incline walking could alter the muscle activities of the GCM and TA between heel strike and heel off in women with limited ankle dorsiflexion.

Influence of the strap-length on the trunk motion and gait symmetry in Korean women carrying a single-strap bag.

OBJECTIVE: The purpose of this study was to examine whether strap length influences the trunk motion and gait symmetry of the ground reaction forces while walking with a single-strap bag. METHODS: Seventeen Korean women participated in this study. The kinematics of trunk motion and ground-reaction forces was recorded while the participants walked at a self-paced speed under three conditions: no bag, a short-strap bag and a long-strap bag. RESULTS: The amplitude of trunk rotation on the ipsilateral side (the bag side) decreased while walking with a short-strap bag compared to walking with a long-strap bag or no bag (p< 0.05). The amplitude of trunk lateral bending toward the contralateral side and asymmetry in the mediolateral ground-reaction force significantly increased while walking with a long-strap bag compared to walking with a short-strap bag or no bag (p< 0.05). CONCLUSIONS: These results demonstrate that carrying a long-strap bag during walking resulted in increased trunk lateral bending and asymmetry in the mediolateral ground-reaction forces. It is therefore important to select the correct strap length when carrying a single-strap bag to prevent musculoskeletal disorders.

Effect of the number of involved spinal cord segments on gait function in patients with cervical spondylotic myelopathy.

STUDY DESIGN: Retrospective. PURPOSE: To determine the effect of severity of cervical spondylotic myelopathy (CSM) on gait parameters according to the number of involved spinal cord segments. OVERVIEW OF LITERATURE: Although there are a large number of studies on CSM, almost all studies have focused on hand function and only a few studies have examined the gait function in patients with CSM. METHODS: Twenty-three patients with CSM underwent magnetic resonance imaging and gait analysis. The subjects were divided into 2 groups; group I consisted of 9 patients with a single-level stenotic lesion and group II comprised 14 patients with multi-level stenotic lesions. Gait parameters were compared between the 2 groups and the normal control group. RESULTS: There was no significant difference in the Japanese Orthopaedic Association score between the 2 groups. Cadence, walking speed, stride length, and step length were decreased in group II compared to group I and normal control group. Peak ankle plantar flexion moments during the stance phase and peak knee flexion angle during the swing phase were decreased in group II. Peak ankle, knee, and hi p power generation during the stance phase were decreased in group II; in addition, the peak ankle power generation was decreased in group II than in the normal control group. CONCLUSIONS: Patients with multi-level stenotic lesions had decreased gait ability compared to that in patients with a single-level stenotic lesion. The number of involved spinal cord segments can be one cause of gait deterioration in patients with CSM. Performing a gait analysis is useful for accurate evaluation of the patient.

Comparisons of the gait parameters of young Korean women carrying a single-strap bag.

This study compared the gait parameters of young women using various methods to carry a single-strap bag during walking. Twenty-one Korean healthy women walked on a GAITRite-instrumented carpet at a self-paced speed for each of the four following conditions in random order: no bag, carrying a bag over the shoulder, carrying a bag on the forearm, and carrying a bag by the hand on the dominant (right) side. There was a significant reduction in the stride length for the contralateral leg when carrying a bag on the forearm, a significant decrease in the heel-to-heel base of support, and a significant increase in the toe angle on the ipsilateral leg when carrying a bag by hand. The results of our study suggest that, among the asymmetric bag-carrying methods preferred by Korean young women during walking, the "over-the-shoulder" method has the least effect on gait parameters relative to not carrying a bag.

Differences in activities of the lower extremity muscles with and without heel contact during stair ascent by young women wearing high-heeled shoes.

BACKGROUND: The purpose of this study was to identify any differences in the activity patterns of lower extremity muscles with and without heel contact during stair ascent by women in their twenties wearing high-heeled shoes. METHODS: Twenty healthy female subjects wearing high-heeled shoes walked up a step with a height of 20 cm with and without heel contact, during which the activities of the vastus medialis oblique, vastus lateralis, and gastrocnemius were recorded using surface electromyography. RESULTS: During stair ascent the activities of the vastus lateralis and vastus medialis oblique were significantly higher and that of the gastrocnemius significantly lower with high-heel contact than without high-heel contact. CONCLUSION: We suggest that young women wearing high-heeled shoes should step up with heel contact on the stair surface during stair ascent to activate the quadriceps muscle.

A thermosensitive poly(organophosphazene) hydrogel for injectable tissue-engineering applications.

A poly(organophosphazene) hydrogel has been synthesized which exhibits thermoreversible sol-gel transition behavior against temperature. Viscometric measurements indicated that a thermosensitive hydrogel exhibiting excellent strength could be formed at body temperature from the polymer solutions, at concentrations of 10 wt%. In this study, we have conducted an evaluation of this poly(organophosphazene) hydrogel with regard to its efficacy and suitability as an injectable tissue-engineering matrix within an in vivo system. A 10 wt% solution of poly(organophosphazene) containing MC3T3-E1 mouse preosteoblasts and collagen was injected subcutaneously into nude mice, thereby forming an in situ gelation-injected site. In order to determine the optimal conditions for subcutaneous injection, various cell numbers and collagen concentrations were tested in this nude mouse model. Cellular proliferation was found to depend on the collagen concentration employed (0.001-0.1 wt%), as well as the number of cells ((2-10) x 10(5)). Cellular proliferation increased gradually after injection into nude mouse (1, 3, 5 and 7 days) at the given collagen concentration (0.01 wt%). The proliferative characteristics of MC3T3-E1 cells were shown to be enhanced dramatically in the poly(organophosphazene)-based collagen containing construct when injected into the model nude mice, whereas no increases in proliferation were observed in the only poly(organophosphazene) gel lacking collagen.