Residual deficits of knee and hip joint coordination and clinical performance after return to sports in athletes with anterior cruciate ligament reconstruction.

BACKGROUND: Biomechanical changes and neuromuscular adaptations have been suggested as risk factors of secondary injury in individuals after anterior cruciate ligament reconstruction (ACLr). To achieve a better understanding of preventive mechanisms, movement quality is an important factor of consideration. Few studies have explored time-series analysis during landing alongside clinical performance in injured and non-injured individuals. The purpose of the study was to investigate the biomechanical risks of recurrent injury by comparing clinical and jump-landing performance assessments between athletes with ACLr and healthy controls. METHOD: This study was observational study. Sixteen athletes with and without ACLr voluntarily participated in clinical and laboratory measurements. Single-leg hop distance, isokinetic tests, landing error score, and limb symmetry index (LSI) were included in clinical report. Lower limb movements were recorded to measure joint biomechanics during multi-directional landings in motion analysis laboratory. Hip-knee angle and angular velocity were explored using discrete time-point analysis, and a two-way mixed analysis of variance (2 × 4, group × jump-landing direction) was used for statistical analysis. Time series and hip-knee coordination analyses were performed using statistical parametric mapping and descriptive techniques. RESULTS: Significantly lower single-leg hop distance was noted in ACLr group (158.10 cm) compared to control group (178.38 cm). Although the hip and knee moments showed significant differences between four directions (p < 0.01), no group effect was observed (p > 0.05). Statistical parametric mapping showed significant differences (p ≤ 0.05) between groups for hip abduction and coordinate plot of hip and knee joints. Athletes with ACLr demonstrated a higher velocity of hip adduction. Time-series analysis revealed differences in coordination between groups for frontal hip and knee motion. CONCLUSIONS: Athletes with ACLr landed with poor hip adduction control and stiffer knee on the involved side. Multi-directions landing should be considered over the entire time series, which may facilitate improved movement quality and return to sports in athletes with ACLr.

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus.

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen's d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.

Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case-control study.

BACKGROUND: Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups. METHODS: Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables. RESULTS: There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking. CONCLUSIONS: Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.

Effects of Different Montages of Transcranial Direct Current Stimulation on Haemodynamic Responses and Motor Performance in Acute Stroke: A Randomized Controlled Trial.

OBJECTIVE: Transcranial direct current stimulation (tDCS) has shown positive results in neurorehabilitation. However, there is limited evidence on its use in acute stroke, and unclear evidence regarding the best tDCS montage (anodal-, cathodal-, or dualtDCS) for stroke recovery. This study investigated the effects of these montages combined with physical therapy on haemodynamic response and motor performance. METHODS: Eighty-two eligible acute stroke participants were allocated randomly into anodal, cathodal, dual, and sham groups. They received 5 consecutive sessions of tDCS combined with physical therapy for 5 days. Cerebral mean blood flow velocity (MFV) and motor outcomes were assessed pre and post-intervention and at a 1-month follow-up. RESULTS: None of the groups showed significant changes in the MFV in the lesioned or non-lesioned hemispheres immediately post-intervention or at a 1-month follow-up. For motor performance, all outcomes improved over time for all groups; between-group comparisons showed that the dual-tDCS group had significantly greater improvement than the other groups for most of the lower-limb performance measures. All 5-day tDCS montages were safe. CONCLUSION: MFV was not modulated following active or sham groups. However, dual-tDCS was more efficient in improving motor performance than other groups, especially for lower-limb performance, with after-effects lasting at least 1 month.

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial.

OBJECTIVE: To determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke. MATERIALS AND METHODS: Twenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up. RESULTS: The primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS. CONCLUSION: The combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.

Concurrent Validity and Reliability of Two-dimensional Frontal Plane Knee Measurements during Multi-directional Cutting Maneuvers.

BACKGROUND: Excessive knee valgus has been strongly suggested as a contributing key factor for anterior cruciate ligament (ACL) injuries. Three-dimensional (3D) motion analysis is considered the "gold standard" to assess joint kinematics, however, this is difficult for on-field assessments and for clinical setting. PURPOSE: To investigate the concurrent validity of 2D measurements of knee valgus angle during cutting in different directions and to explore intra-rater and inter-rater reliability of the 2D measurements. STUDY DESIGN: Descriptive laboratory study. METHOD: Seven recreational soccer players participated in this study. Participants performed three trials of cutting maneuvers in three different directions (30º, 60º, and 90º) with the dominant leg. Cutting maneuvers were recorded simultaneously with a video camera and a ViconTM motion capture system. Knee valgus angle from 2D and 3D measurements at initial contact and at peak vertical ground reaction force (vGRF) were extracted. The Pearson's correlation was used to explore the relationship between the 2D and 3D measurements, and reliability of the 2D measurements were performed using intraclass correlation coefficients (ICC). RESULT: Significant correlations between 2D and 3D knee valgus measurements were noted for 60º (r = 0.45) and 90º (r = 0.77) cutting maneuvers at initial contact. At peak vGRF, significant correlations between 2D and 3D knee valgus measurements were noted for 30º, 60º, and 90º cutting maneuvers (r=0.45, r=0.74, r=0.78), respectively. Good-to-excellent intra-rater and inter-rater reliability of the 2D knee valgus measurements was observed during cutting in all directions (ICCs: 0.821-0.997). CONCLUSION: Moderate-to-strong correlation between 2D and 3D knee valgus measurements during 60°-90° cutting maneuvers, and good-to-excellent intra-rater and excellent inter-rater reliability for the 2D measurements in the present study supports the use of 2D knee valgus measurements in the evaluation of targeted interventions, although the limitations of examining cutting maneuvers using 2D measurement in complex movement still need to be considered. LEVEL OF EVIDENCE: 3.

Effects of home-based dual-hemispheric transcranial direct current stimulation combined with exercise on upper and lower limb motor performance in patients with chronic stroke.

PURPOSE: This study aimed to determine the effects of home-based dual-hemispheric transcranial direct current stimulation (dual-tDCS) combined with exercise on motor performance in patients with chronic stroke. MATERIALS AND METHODS: We allocated 24 participants to the active or sham group. They completed 1-h home-based exercise after 20-min dual-tDCS at 2-mA, thrice a week for 4 weeks. The patients were assessed using the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test, Timed Up and Go test, Five Times Sit-to-Stand Test, Six-meter Walk Test, and muscle strength assessment. RESULTS: Compared with the sham group, the active group showed improved FMA scores, which were sustained for at least 1 month. There was no between-group difference in the outcomes of the functional tasks. CONCLUSION: Home-based dual-tDCS could facilitate motor recovery in patients with chronic stroke with its effect lasting for at least 1 month. However, its effects on functional tasks remain unclear. tDCS is safe and easy for home-based self-administration for patients who can use their paretic arms. This could benefit patients without access to health care centres or in situations requiring physical distancing. This home-based tDCS combined with exercise has the potential to be incorporated into telemedicine in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONTwelve sessions of home-based dual-tDCS combined with exercises (3 days/week for 4 weeks) facilitated upper and lower limb motor recovery in patients with chronic stroke compared with exercise alone, with a post-effect for at least 1 month.Home-based tDCS could be safe and easily self-administrable by patients who can use their paretic arms.This intervention could be beneficial for patients living in the community without easy access to a health care centre or in situations where physical distancing is required.

Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients.

Action observation (AO) has been proved to be of benefit in several neurological conditions, but no study has previously been conducted in idiopathic normal pressure hydrocephalus (iNPH). OBJECTIVE: This study aimed to investigate the feasibility of AO in iNPH patients. METHODS: A single-group pretest-posttest design was conducted in twenty-seven iNPH patients. Gait and mobility parameters were assessed using the 2D gait measurement in the timed up and go (TUG) test for two trials before and after immediate AO training. The outcomes included step length and time, stride length and time, cadence, gait speed, sit-to-stand time, 3-m walking time, turning time and step, and TUG. In addition, early step length and time were measured. AO consisted of 7.5 min of watching gait videos demonstrated by a healthy older person. Parameters were measured twice for the baseline to determine reproducibility using the intraclass correlation coefficient (ICC3,1). Data between before and after immediately applying AO were compared using the paired t-test. RESULTS: All outcomes showed moderate to excellent test-retest reliability (ICC3,1=0.51 0.99, p<0.05), except for the step time (ICC3,1=0.19, p=0.302), which showed poor reliability. There were significant improvements (p<0.05) in step time, early step time, gait speed, sit-to-stand time, and turning time after applying AO. Yet, the rest of the outcomes showed no significant change. CONCLUSIONS: A single session of AO is feasible to provide benefits for gait and mobility parameters. Therapists may modify this method in the training program to improve gait and mobility performances for iNPH patients.

A observação de ação (OA) teve benefícios comprovados em diversas condições neurológicas, mas nenhum estudo foi conduzido anteriormente em Hidrocefalia de Pressão Normal idiopática (HPNi). OBJETIVO: O presente estudo teve como objetivo investigar a viabilidade da OA em pacientes com HPNi. MÉTODOS: Um projeto de pré-teste e pós-teste de grupo único foi realizado em 27 pacientes com HPNi. Parâmetros de marcha e mobilidade foram avaliados por meio de parâmetros 2D para a medida da marcha com o teste timed up and go (TUG) com duas tentativas antes e imediatamente depois do OA. Os resultados incluíram comprimento e tempo do passo, comprimento e tempo da passada, cadência, velocidade da marcha, tempo para sentar-e-levantar, tempo de caminhada de 3 metros, tempo de virada e passo, e tempo do teste (TUG). Além disso, o comprimento do passo inicial e o tempo da etapa inicial foram medidos. A OA consistia em assistir 7,5 minutos de vídeos de marcha demonstrados por um idoso saudável. Os parâmetros foram medidos duas vezes para a linha de base para determinar a reprodutibilidade usando o coeficiente de correlação intraclasse (CCI3,1). Os dados entre antes e depois da aplicação imediata de OA foram comparados com o teste t pareado. RESULTADOS: Todos os resultados mostraram confiabilidade teste-reteste moderada a excelente (CCI3,1=0,51 0,99, p<0,05), exceto para o tempo do passo (CCI3,1=0,19, p=0,302), que apresentou confiabilidade pobre. Houve melhorias significativas (p<0,05) no tempo do passo, tempo do passo inicial, velocidade da marcha, tempo sentar-e-levantar e tempo de virar após a aplicação de OA. Os demais resultados não mostraram nenhuma mudança significativa. CONCLUSÕES: Uma única sessão de aplicação de OA é viável para proporcionar benefícios aos parâmetros de marcha e mobilidade. Os terapeutas podem modificar esse método no programa de treinamento para obter desempenho de marcha e mobilidade para pacientes com HPNi.

Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients / Viabilidade do efeito de observação da ação na marcha e mobilidade de pacientes com hidrocefalia de pressão normal idiopática

ABSTRACT. Action observation (AO) has been proved to be of benefit in several neurological conditions, but no study has previously been conducted in idiopathic normal pressure hydrocephalus (iNPH). Objective: This study aimed to investigate the feasibility of AO in iNPH patients. Methods: A single-group pretest-posttest design was conducted in twenty-seven iNPH patients. Gait and mobility parameters were assessed using the 2D gait measurement in the timed up and go (TUG) test for two trials before and after immediate AO training. The outcomes included step length and time, stride length and time, cadence, gait speed, sit-to-stand time, 3-m walking time, turning time and step, and TUG. In addition, early step length and time were measured. AO consisted of 7.5 min of watching gait videos demonstrated by a healthy older person. Parameters were measured twice for the baseline to determine reproducibility using the intraclass correlation coefficient (ICC3,1). Data between before and after immediately applying AO were compared using the paired t-test. Results: All outcomes showed moderate to excellent test-retest reliability (ICC3,1=0.51 0.99, p<0.05), except for the step time (ICC3,1=0.19, p=0.302), which showed poor reliability. There were significant improvements (p<0.05) in step time, early step time, gait speed, sit-to-stand time, and turning time after applying AO. Yet, the rest of the outcomes showed no significant change. Conclusions: A single session of AO is feasible to provide benefits for gait and mobility parameters. Therapists may modify this method in the training program to improve gait and mobility performances for iNPH patients.

RESUMO. A observação de ação (OA) teve benefícios comprovados em diversas condições neurológicas, mas nenhum estudo foi conduzido anteriormente em Hidrocefalia de Pressão Normal idiopática (HPNi). Objetivo: O presente estudo teve como objetivo investigar a viabilidade da OA em pacientes com HPNi. Métodos: Um projeto de pré-teste e pós-teste de grupo único foi realizado em 27 pacientes com HPNi. Parâmetros de marcha e mobilidade foram avaliados por meio de parâmetros 2D para a medida da marcha com o teste timed up and go (TUG) com duas tentativas antes e imediatamente depois do OA. Os resultados incluíram comprimento e tempo do passo, comprimento e tempo da passada, cadência, velocidade da marcha, tempo para sentar-e-levantar, tempo de caminhada de 3 metros, tempo de virada e passo, e tempo do teste (TUG). Além disso, o comprimento do passo inicial e o tempo da etapa inicial foram medidos. A OA consistia em assistir 7,5 minutos de vídeos de marcha demonstrados por um idoso saudável. Os parâmetros foram medidos duas vezes para a linha de base para determinar a reprodutibilidade usando o coeficiente de correlação intraclasse (CCI3,1). Os dados entre antes e depois da aplicação imediata de OA foram comparados com o teste t pareado. Resultados: Todos os resultados mostraram confiabilidade teste-reteste moderada a excelente (CCI3,1=0,51 0,99, p<0,05), exceto para o tempo do passo (CCI3,1=0,19, p=0,302), que apresentou confiabilidade pobre. Houve melhorias significativas (p<0,05) no tempo do passo, tempo do passo inicial, velocidade da marcha, tempo sentar-e-levantar e tempo de virar após a aplicação de OA. Os demais resultados não mostraram nenhuma mudança significativa. Conclusões: Uma única sessão de aplicação de OA é viável para proporcionar benefícios aos parâmetros de marcha e mobilidade. Os terapeutas podem modificar esse método no programa de treinamento para obter desempenho de marcha e mobilidade para pacientes com HPNi.

Association among pain, disability, and functional capacity in patients with chronic non-specific low back pain: A cross-sectional study.

BACKGROUND: Patients with chronic non-specific low back pain (CNSLBP) have pain, disability, and decreased functional capacity, however, the association is still unknown. OBJECTIVE: This study aimed to examine the association between pain, disability, and functional capacity in patients with CNSLBP. METHODS: Thirty participants with CNSLBP were interviewed for demographic data and assessed for pain intensity by visual analog scale (VAS), disability level by Oswestry Disability Index (ODI), and functional capacity comprising functional reach (FR), five times sit-to-stand (5STS), and two-minute step (2MS). The association and linear regression were analyzed using the Spearman correlation coefficient, point-biserial correlation, and multiple linear regression, respectively. RESULTS: A significant association was found between VAS and ODI, VAS and 5STS, 5STS, and 2MS. For demographic data, some variables were significantly correlated to VAS and functional capacity. VAS was also correlated with sex and age, FR was correlated with height, 5STS was correlated with age, and 2MS was correlated with age, body mass index, and physical activity level. CONCLUSIONS: The association among pain intensity, disability level, functional capacity, and demographic data suggests that apart from pain and disability level, functional capacity is associated with pain, which can be recommended for objective assessment regarding some demographic variables that can contribute to clinical outcome measures.

Thai version of the foot function index: a cross-cultural adaptation with reliability and validity evaluation.

BACKGROUND: The study aimed to translate the foot function index (FFI) questionnaire to Thai and to determine psychometric properties of the questionnaire among individuals with plantar foot complaints. METHODS: The Thai version of the FFI (FFI-Th) was adapted according to a forward and backward translation protocol by two independent translators and analyzed by a linguist and a committee. The FFI-Th was administered among 49 individuals with plantar foot complaints to determine internal consistency, reliability, and validity. Cronbach's alpha and the Intraclass Correlation Coefficient (ICC3,1) were used to test the internal consistency and test-retest reliability. The Principal Component Analysis with varimax rotation method was used to test the factor structure and construct validity. Furthermore, the criterion validity was tested using Pearson's correlation coefficient (rp) between the FFI-Th and the visual analogue pain scale (pain-VAS) as well as the EuroQol five-dimensional questionnaire (EQ-5D-5L). RESULTS: The FFI-Th showed good to excellent internal consistency and test-retest reliability in the total score, pain, disability, and activity limitation subscales. The Principal Component Analysis produced 4 principal factors from the FFI-Th items. Criterion validity of the FFI-Th total score showed moderate to strong correlations with pain-VAS and EQ-5D-5L, and EQ-VAS scores. CONCLUSION: The FFI-Th was a reliable and valid questionnaire to assess the foot function in a Thai population. TRIAL REGISTRATION: NCT03161314 (08/05/2017).

Decreased Functional Capacity in Individuals with Chronic Non-Specific Low Back Pain: A Cross-Sectional Comparative Study.

PURPOSE: This study aimed to compare functional capacity tests between individuals with and without chronic non-specific low back pain and to investigate the effects of demographic data on functional capacity tests. METHODS: Thirty individuals with chronic non-specific low back pain (CNSLBP) and thirty healthy individuals underwent three functional capacity tests comprising functional reach test (FRT), five-time sit to stand test (5 TSST), and two-minute step test (2 MST). CNSLBP were assessed in pain intensity using a visual analog scale (VAS) and disability level using the modified Oswestry disability questionnaire (MODQ) Thai version. RESULTS: The results found significant differences in five-time sit to stand and two-minute step tests between individuals with chronic non-specific low back pain and healthy individuals. The mean differences between healthy and CNSLBP for the 5 TSST were -3.24 seconds (95% CI=-4.47--2.02) and for the 2 MST they were 13.13 steps (95% CI=2.62-23.64). Age significantly influenced the 5 TSST (P=0.004) and 2 MST (P=0.008), while gender (P=0.028) and height (P=0.002) affected the FRT. CONCLUSION: Individuals with chronic non-specific low back pain had lower functional capacity assessed by five-time sit to stand and 2-minute step tests compared to healthy individuals, and the therapeutic programs were emphasized. With increasing age, the 5 TSST and 2 MST would both be declined.

Responsiveness of pain, functional capacity tests, and disability level in individuals with chronic nonspecific low back pain.

BACKGROUND: Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP). OBJECTIVE: This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP. METHODS: Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM). RESULTS: The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES -0.986, SRM -0.928) and five-time sit-to-stand test (5 TSST) (SRM -0.846). CONCLUSION: This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.

Knee joint coordination during single-leg landing in different directions.

Knee joint coordination during jump landing in different directions is an important consideration for injury prevention. The aim of the current study was to investigate knee and hip kinematics on the non-dominant and dominant limbs during landing. A total of 19 female volleyball athletes performed single-leg jump-landing tests in four directions; forward (0°), diagonal (30° and 60°) and lateral (90°) directions. Kinematic and ground reaction force data were collected using a 10-camera Vicon system and an AMTI force plate. Knee and hip joint angles, and knee angular velocities were calculated using a lower extremity model in Visual3D. A two factor repeated measures ANOVA was performed to explore limb dominance and jump direction. Significant differences were seen between the jump directions for; angular velocity at initial contact (p < 0.001), angular velocity at peak vertical ground reaction force (p < 0.001), and knee flexion excursion (p = 0.016). Knee coordination was observed to be poorer in the early phase of velocity-angle plot during landing in lateral direction compared to forward and diagonal directions. The non-dominant limb seemed to have better coordination than the dominant limb during multi-direction jump landing. Therefore, dominant limbs appear to be at a higher injury risk than non-dominant limbs.

Alteration of the multi-segment foot motion during gait in individuals with plantar fasciitis: a matched case-control study.

PURPOSE: The objective of this study was to compare the ground reaction forces (GRFs) and the multi-segment foot motion between individuals with plantar fasciitis (PF) and healthy controls. METHODS: Twenty-one individuals with PF and 21 matched-case healthy controls who passed the criteria participated in the study. Gait data were assessed during their self-selected comfortable speeds by the 3D motion analysis system. The multi-segment foot motions were determined by the Oxford Foot Model. Outcome measures included the vertical and antero-posterior ground reaction forces (GRFs) and the multi-segment foot motions [the dorsiflexion (DF), plantarflexion (PF), inversion (Inv), eversion (Eve), adduction (Add), and abduction (Abd) peak angles for the forefoot with respect to hindfoot (FFHF) and the DF, PF, Inv, Eve, internal rotation (IR), and external rotation (ER) peak angles for the hindfoot with respect to tibia (HFTB) as well as their ranges (R)]. RESULTS: Comparisons between individuals with PF and healthy controls showed no significant differences in any of the GRFs. Significant reductions were found in the FFHF-DF, FFHF-DF-R, FFHF-Inv, and HFTB-Inv/Eve-R in individuals with PF. In addition, there were tendencies of the increased angles of the FFHF-PF, HFTB-DF, HFTB-Inv, and HFTB-ER, but not significantly for individuals with PF, compared to healthy controls. CONCLUSIONS: Adaptations of the intra-foot motion showed the reduction of some angles but no change for the GRFs in individuals with PF compared to the healthy controls when both groups walked at a similar gait speed.

Effects of Strengthening and Stretching Exercises on the Temporospatial Gait Parameters in Patients With Plantar Fasciitis: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of physical therapy interventions using strengthening and stretching exercise programs on pain and temporospatial gait parameters in patients with plantar fasciitis (PF). METHODS: Eighty-four patients with PF participated in the study and were randomly assigned to the strengthening or stretching exercise groups. All patients received 8 physical therapy interventions two times per week in the first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they continued the assigned exercise programs every day for 8 weeks. Pain visual analogue scale (VAS) scores at the worst and in the morning and temporospatial gait parameters were evaluated at the baseline, intermediate of the intervention, end of the intervention, and the first and second month follow-up. RESULTS: There were significant effects of the time on the worst pain, morning pain, cadence, stride time, stride length, total double support, and gait speed, but there was no effect on step width. In addition, the main effect of the group and the interaction effects of the time and the group were not found in any parameters. For intra-group comparisons, there were significant differences in worst pain, morning pain, cadence, and stride time among the assessment times in both groups. For inter-group comparisons, there were no significant differences in all parameters. CONCLUSION: Both strengthening and stretching exercise programs significantly reduced pain and improved gait in patients with PF.

Effect of spinal tap test on the performance of sit-to-stand, walking, and turning in patients with idiopathic normal pressure hydrocephalus.

The aim of the study was to investigate the effect of the spinal tap test on sit-to-stand (STS), walking, and turning and to determine the relationship among the outcome measures of STS, walking, and turning in patients with iNPH. Twenty-seven patients with clinical symptoms of iNPH were objectively examined for STS, walking, and turning by the Force Distribution Measurement (FDM) platform connected with a video camera. Assessments were performed at before and 24 hours after spinal tap. Motor abilities were assessed by the STS time, time of walking over 3 meters, and time and number of steps when turning over 180 degrees. Significant improvements were found in the STS time (p = 0.046), walking time (p = 0.048), and turning step (p = 0.001). In addition, turning time was improved but not statistically significant (p = 0.064). Significant relationships were found among all outcome measures (p < 0.001). The relationship among these outcome measures indicated that the individuals had similar ability levels to perform different activities. This may serve as a new choice of outcome measures to evaluate the effect of intervention in different severity levels of patients with iNPH.

Side-to-side differences in lower extremity biomechanics during multi-directional jump landing in volleyball athletes.

Side-to-side differences of lower extremities may influence the likelihood of injury. Moreover, adding the complexity of jump-landing direction would help to explain lower extremity control during sport activities. The aim was to determine the effects of limb dominance and jump-landing direction on lower extremity biomechanics. Nineteen female volleyball athletes participated. Both dominant limbs (DLs) and non-dominant limbs (NLs) were examined in single-leg jump-landing tests in four directions, including forward (0°), diagonal (30° and 60°), and lateral (90°) directions. Kinematic marker trajectories and ground reaction forces were collected using a 10 camera Vicon system and an AMTI force plate. Repeated measures ANOVA (2 × 4, limb × direction) was used to analyse. The finding showed that, at peak vertical GRF, a significant interaction of limb dominance and direction effects was found in the hip flexion angle and lower extremity joint kinetics (p < .05). NLs and DLs exhibited significantly different strategies while landing in various directions. Significantly higher increase of ankle dorsiflexion angle was observed in lateral direction compared to other directions for both DLs and NLs (p < .05). Increasingly using ankle dorsiflexion was observed from the forward to the lateral direction for both DLs and NLs. However, NLs and DLs preferentially used different strategies of joint moment organization to respond to similar VGRFs in various directions. The response pattern of DLs might not be effective and may expose DLs to a higher injury risk, especially with regard to landing with awkward posture compared with NLs.

Knee Muscular Control During Jump Landing in Multidirections.

BACKGROUND: Jump landing is a complex movement in sports. While competing and practicing, athletes frequently perform multi-planar jump landing. Anticipatory muscle activity could influence the amount of knee flexion and prepare the knee for dynamic weight bearing such as landing tasks. OBJECTIVES: The aim of the present study was to examine knee muscle function and knee flexion excursion as athletes naturally performed multi-direction jump landing. MATERIALS AND METHODS: Eighteen male athletes performed the jump-landing test in four directions: forward (0°), 30° diagonal, 60° diagonal, and lateral (90°). Muscles tested were vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), semitendinosus (ST), and biceps femoris (BF). A Vicon(TM) 612 workstation collected the kinematic data. An electromyography was synchronized with the Vicon(TM) Motion system to quantify dynamic muscle function. Repeated measure ANOVA was used to analyze the data. RESULTS: Jump-landing direction significantly influenced (P < 0.05) muscle activities of VL, RF, and ST and knee flexion excursion. Jumpers landed with a trend of decreasing knee flexion excursion and ST muscle activity 100 ms before foot contact progressively from forward to lateral directions of jump landing. CONCLUSIONS: A higher risk of knee injury might occur during lateral jump landing than forward and diagonal directions. Athletes should have more practice in jump landing in lateral direction to avoid injury. Landing technique with high knee flexion in multi-directions should be taught to jumpers for knee injury prevention.

Plantar Pressure Distribution Pattern during Mid-Stance Phase of the Gait in Patients with Chronic Non-Specific Low Back Pain.

OBJECTIVE: To examine the characteristics of the plantar pressure distribution patterns during mid-stance phase of the gait cycle in subjects with chronic non-specific low back pain and asymptomatic subjects. MATERIAL AND METHOD: Twenty-three males and 17 females with chronic non-specific low back pain and age- and gender-matched asymptomatic subjects walked barefoot along a gait mat at comfortable speedfor three trials. The left and right plantar pressure distributions were recorded during mid-stance phase and divided into 12 areas. Descriptive statistics including mean and standard deviation of demographic data and plantar pressure were calculated, and plantar pressure distribution patterns were described. RESULTS: Mean and standard deviation of numeric pain rating scale of chronic non-specific low back pain group were 4.04±1.58. The average mean peak pressure of both chronic non-specific low back pain and asymptomatic subjects located at the fifth area (lateral aspect offorefoot) in both feet. However the modes of the peak pressure of subjects with chronic non-specific low back pain were in the different areas in the left and right feet. The distribution patterns of the average mean peak pressure were not the same in chronic non-specific low back pain and asymptomatic subjects. This altered foot contact in the subjects with chronic non-specific low back pain may be used to avoid pain or to compensate for limited mobility of the lower limbs at pre-swing phase. CONCLUSION: At mid-stance phase of walking, the pressures on the plantar surface were unequally distributed in subjects with chronic non-specific low back pain.