Energy expenditure during cane-assisted gait in patients with knee osteoarthritis.

OBJECTIVE: To compare the energy expenditure in patients with unilateral knee osteoarthritis while walking with canes of different lengths. METHODS: A quasi-experimental study (single-group) was carried out on thirty patients with unilateral knee osteoarthritis. An adjustable aluminum cane was used, and three different cane lengths were determined for each subject: C1--length from the floor to the greater trochanter; C2--length from the floor to the distal wrist crease; and C3--length obtained by the formula: height x 0.45 + 0.87 m. Resting and walking heart rates were measured with a Polar hear rate meter. Walking speed was calculated by the time required for the patient to walk 10 m. Gait energy cost was estimated using the physiological cost index, and results were compared. RESULTS: The sample consisted of 25 women and five men (average age of 68 years). Statistically significant differences in physiological cost index measurements were observed between unassisted walking and assisted walking with a cane of any length (p<0.001), as well as between walking with a C2-length cane and unassisted walking, and walking with a C1-length cane and walking with a C3-length cane (p=0.001; p = 0.037; p=0.001; respectively). CONCLUSION: These data demonstrate that small alterations in the length of canes used for weight-bearing ambulation in patients with unilateral knee osteoarthritis increase the energy expenditure measured by the physiological cost index during walking. Further studies are needed for a more precise quantification of the increase in energy expenditure during cane-assisted gait and an assessment of the effectiveness of cane use in relieving pain and improving function in patients with knee osteoarthritis.

Use of cryotherapy to enhance mouth opening in patients with cerebral palsy.

This study was conducted to assess the effect of cryotherapy on masseter spasticity on mouth opening, which is required for oral hygiene and dental treatment. The inter-incisal distance was measured before cryotherapy in 24 patients with cerebral palsy who had spasticity of the tetraparesis type. Ice was then applied on the skin surface with sliding movements over the masseter, bilaterally for one minute. Inter-incisal distance was then measured again. The results showed a significant increase of the inter-incisal distance after the application of cold to the masseter. We conclude that the action of cryotherapy on the masseter muscle produced a temporary reduction of spasticity, facilitating access to the occlusal and palatal surfaces of the maxillary molars. This improved access can be useful during dental treatment as well as preventive dental care such as oral hygiene.