Gait patterns in hemiplegic patients with equinus foot deformity.

Equinus deformity of the foot is a common feature of hemiplegia, which impairs the gait pattern of patients. The aim of the present study was to explore the role of ankle-foot deformity in gait impairment. A hierarchical cluster analysis was used to classify the gait patterns of 49 chronic hemiplegic patients with equinus deformity of the foot, based on temporal-distance parameters and joint kinematic measures obtained by an innovative protocol for motion assessment in the sagittal, frontal, and transverse planes, synthesized by parametrical analysis. Cluster analysis identified five subgroups of patients with homogenous levels of dysfunction during gait. Specific joint kinematic abnormalities were found, according to the speed of progression in each cluster. Patients with faster walking were those with less ankle-foot complex impairment or with reduced range of motion of ankle-foot complex, that is with a stiff ankle-foot complex. Slow walking was typical of patients with ankle-foot complex instability (i.e., larger motion in all the planes), severe equinus and hip internal rotation pattern, and patients with hip external rotation pattern. Clustering of gait patterns in these patients is helpful for a better understanding of dysfunction during gait and delivering more targeted treatment.

Botulinum toxin type A versus phenol. A clinical and neurophysiological study in the treatment of ankle clonus.

AIM: To reduce ankle clonus in patients with spastic paresis either phenol nerve block of the tibialis posterior nerve or botulinum toxin type A (BTA) injection in triceps surae muscles can be used. This study aims to compare the efficacy over time of phenol nerve block and BTA injection in the inhibition of ankle clonus. METHODS: Twenty-two patients with spastic paresis presenting with ankle clonus were randomly treated with phenol nerve block of the tibialis posterior nerve or BTA injection in triceps surae muscles. Ankle passive dorsiflexion, clonus, M and H responses and H/M ratio were measured in all patients prior to treatment and 15 days afterwards, as well as one, three and six months later in 12 patients. Patient satisfaction was also recorded. RESULTS: Both patient groups showed significant clonus reduction over time with the effect of phenol being greater than that of BTA. In one month, the degree of passive dorsiflexion significantly increased in both groups without any significant difference between them. H/M ratio reduced after phenol treatment and remained almost constant during the following six months, whereas it remained at baseline level after BTA treatment. CONCLUSION: While both treatments led to reduction in ankle clonus, phenol showed greater clinical efficacy. The difference in the neurophysiological results suggests that the two drugs have different action mechanisms with a more prevalent reduction of alpha motoneuron excitability in phenol-treated patients.

Sagittal plane kinematic analysis of the six-minute walk test: a classification of hemiplegic gait.

AIM: The aim of this study was to propose a kinematic classification of gait according to six minute walk test performance. METHODS: Thirty-four hemiplegic subjects were enrolled. Six-minute walk test (SMWT), gait analysis and Walking Handicap Scale score (WHS) were measured. A k-means cluster analysis was used to classify the sample into three sub-groups which were homogeneous in spatio-temporal parameters, kinematic variables, and which reflected three meaningful levels of walking competency. RESULTS: Three clusters were identified: low-functioning walkers (Cluster 1) walked for 88-172 m; intermediate-functioning walkers (Cluster 2) walked for 180-302 m and high-functioning walkers (Cluster 3) were able to cover 349-430 m. The authors found homogeneous gait profiles in these subgroups. Between-group differences on kinematic data and WHS scores were also underlined. CONCLUSIONS: Cluster analysis was able to identify consistent gait characteristics of spatio-temporal, walking endurance and sagittal plane kinematic profiles in hemiplegic subjects and is useful for categorizing the levels of walking competency in these subjects.

Um protocolo inovativo para avaliação tridimensional do pé na análise de marcha / An innovative protocol for 3D avaliation of lower limb in Gait analysis

A analise de marcha é um instrumento de grande utilidade no diagnostico funcional de pacientes com problema na deambulação. Os protocolos disponíveis atualmente não fornecem dados tridimensionais dos movimentos das articulações do membro inferior completo e baseado na convenção biomecânica utilizada. O objetivo deste estudo foi de apresentar um novo protocolo para analise tridimensional do membro inferior e de mostrar em particular as vantagens das análises tridimensionais do complexo tíbio-társico em pacientes com deformidade típica consequente de acidente vascular encefálico (AVE). Cinco pacientes com pé equino varo supinado em consequência de AVE foram submetidos a uma análise de marcha utilizando o protocolo Total 3D Gait e o convencional Plug-in-Gait model (PIG). Um paciente com análoga deformidade foi submetido à análise da marcha antes e após a correção cirúrgica do pé. O protocolo Total 3D Gait apresentado forneceu, em relação ao protocolo convencional PIG, dados essenciais e únicos do movimento do pé nos três planos de espaço permitindo um diagnóstico funcional mais preciso da complexidade do movimento durante a deambulação e avaliou com maior eficácia os resultados do tratamento.

Gait analysis is an instrument of great value in the functional diagnosis of patients with altered gait. The currently available protocols do not provide tridimensional (3D) data of complete lower limb joint movements based on common biomechanics convetion. The aim of this study was to present an innovative protocol of lower limb 3D analysis and to demonstrate the advantages of 3D analysis of the tibiotarsal joint in patients with typical stroke deformities. Five patients with equinus foot due to cardiovascular accident were submitted to gait analysis with the Total 3D gait protocol and the convetional Plug-in-Gait model (PiG). One patient with the same type of deformity wasanalyzed before and after foot surgical intervention. The novel protocol provided, in contrast to the PiG conventional protocol, essential and unique data from foot movement in the three movement planes, allowing a more precise functional diagnosis of the movement complexity during gait along with efficienty assessing treatment results.

A sequence analysis of the genomic regions involved in the rearrangements between TPM3 and NTRK1 genes producing TRK oncogenes in papillary thyroid carcinomas.

Papillary thyroid carcinomas have frequently been found to display oncogenic rearrangements of the NTRK1 gene, which encodes the high-affinity nerve growth factor receptor. Replacement of its extracellular domain by sequences coding for the 221 amino-terminal residues of the TPM3 gene was responsible for the oncogenic NTRK1 activation in three of eight of these tumors. In all of them, the illegitimate recombination involved the 611-bp NTRK1 intron placed upstream of the transmembrane domain and the TPM3 intron located between exons 7 and 8. Therefore, due to the splicing mechanism, all of the TPM3/NTRK1 gene fusions encoded an invariable transcript and the same chimeric protein of 70 kDa, which was constitutively phosphorylated on tyrosine. In two of the three tumors the simultaneous presence of the reciprocal products of the TPM3/NTRK1 recombination, 5'TPM3-3'NTRK1 and 5'NTRK1-3'TPM3 sequences, respectively, and the previously demonstrated localization of both genes on the long arm of chromosome 1 lead us to suggest that an intrachromosomal inversion could be responsible for their recombination. In an attempt to understand the molecular basis that predisposes NTRK1 and TPM3 genes to be a recurrent target of illegitimate recombination, we have determined the nucleotide sequence around the breakpoints of the recombination products in all three patients as well as those of the corresponding regions from the normal TPM3 and NTRK1 genes. In these regions, a search for common features usually involved in illegitimate recombination in mammalian cells revealed the presence of some recombinogenic elements as well as pal-indromes, direct and inverted repeats, and Alu family sequences.

Molecular characterization of a thyroid tumor-specific transforming sequence formed by the fusion of ret tyrosine kinase and the regulatory subunit RI alpha of cyclic AMP-dependent protein kinase A.

The ret oncogene frequently has been found activated in papillary thyroid carcinomas. A previous characterization of ret activation revealed recombination of its tyrosine kinase domain and sequences derived from an uncharacterized locus (D10S170). The mechanism leading to this recombination was identified as a paracentric inversion of the long arm of chromosome 10, inv(10)(q11.2q21), with the breakpoints occurring where ret and D10S170 were mapped. To further characterize the activation of ret in papillary thyroid carcinomas, we have now isolated and sequenced a second type of ret oncogenic rearrangement not involving the D10S170 locus. The nucleotide sequence indicated that the transforming activity was created by the fusion of the ret tyrosine kinase domain with part of the RI alpha regulatory subunit of protein kinase A (PKA). This is the first example of an oncogenic activity involving a PKA gene. PKA is the main intracellular cyclic AMP receptor, and its RI alpha subunit gene is located on chromosome 17q. RI alpha-ret transcripts encode two isoforms of the chimeric protein (p76 and p81), which display constitutive tyrosine phosphorylation as well as a tyrosine kinase enzymatic activity. Under nonreducing conditions, both isoforms are found in a dimeric configuration because of both homo- and heterodimer formation. Thus, the in vivo activation of ret in human papillary thyroid carcinomas is provided by the fusion of its tyrosine kinase domain with different genes and can be mediated by different mechanisms of gene rearrangement.

Biofeedback treatment of genu-recurvatum using an electrogoniometric device with an acoustic signal. One-year follow-up.

The aim was to evaluate the effect of a biofeedback electrogoniometer in the control of recurvation of the knee while walking in patients with neurological diseases. Eighteen patients were trained daily for 12.8 sessions on average with an electrogoniometer attached to the knee, which gave a signal at a threshold value of 180 degrees in order to avoid hypertension of the knee. The improvement was statistically significant even after one year.