Ankle Active Range Of Motion Research Articles

Multivariate analysis of influencing functional recovery after ankle fracture of typeⅡand above supination-external rotation

To explore influencing factors of functional recovery after ankle fracture of typeⅡdegree and above supination-external rotation. Clinical data of 120 patients with ankle fractures of typeⅡdegree and above supination-external rotation admitted from February 2019 to April 2021 were retrospectively analyzed. According to American Orthopaedic Foot and Ankle Society (AOFAS), patients were divided into excellent group with 73 patients (90 to 100 points), good group with 35 patients (75 to 89 points), and fair group with 12 patients(<50 points). The differences of ankle active range of motion (ROM) and AOFAS score were compared among three groups at the latest follow-up. Multivariate Logistic regression analysis was performed to analyze the factors related to functional recovery after ankle fracture of supination-external rotation. There were significant differences in postoperative ROM (dorsoextension, plantar flexion, varus and valgus) and complications between excellent group and good and acceptable group (P<0.05). Univariate analysis showed there were differences in age above 50 years old, Ⅳ degree of supination-external rotation fracture, lower tibiofibular ligament injury, posterior ankle fracture, no drainage tube placed, infection, antibiotic use time above 7 days (P<0.05). Multivariate Logistic regression analysis showed age above 50 years old[OR=2.829, 95%CI(1.049, 7.628), P=0.040], Ⅳ degree fracture of supination-external rotation[OR=6.13, 95%CI(1.153, 32.593), P=0.033], lower tibiofibular ligament injury[OR=10.785, 95%CI(3.338, 34.894), P=0.000], and posterior ankle fracture[OR=6.349, 95%CI(1.869, 21.560), P=0.003] were independent risk factors for functional recovery after ankle fracture of supination-external rotation (P<0.05). The postoperative excellent outcome of ankle fracture was good, and the recovery of joint motion was better. The older age of patient, Ⅳ degree of supination-external rotation fracture, the lower tibiofibular ligament injury, and posterior ankle fracture are all adverse factors affecting functional recovery after supination-external rotation ankle fracture. In clinical, effective measures should be taken to deal with these influencing factors, and strive to improve the functional recovery after the operation of this type of fracture and reduce the occurrence of related complications.

Photo Bio-stimulation on Acupuncture Points: Impact on Selected Measures in Children with Spastic Cerebral Palsy

This study aims to investigate the effect of adding photo bio-stimulation to standard physical therapy on spasticity, ankle active range of motion (ROM), gross motor function, plantar surface area (PSA), hind foot peak pressure, and quality of life (QoL) in children with spastic cerebral palsy (CP). Fifty-one children with spastic CP were randomly assigned to the laser therapy group (LG) and received regular physical therapy plus laser acupuncture over three acupuncture points (GB34, LR3, LIV3), and the control group received regular physical therapy three times per week for 4 weeks. Muscle tone using the modified Ashworth scale, ankle active ROM using goniometry, PSA and the peak pressure on the hind foot (PPHF) by E-Med system, motor function by Gross Motor Function Measure (88 items), and pediatric QoL questionnaire were assessed before and after intervention and after 3 months. Posttreatment values of ankle plantar flexion (AP), ankle dorsiflexion (AD), and PPHF demonstrated statistically significant differences and medium to high effect size in favor of LG ( P = 0.005 and d = 0.73, P = 0.02 and d = 0.57, P = 0.01 and d = 0.61, respectively). At the 3-month follow-up analysis, the same outcomes (AD, AP, and PPHF) demonstrated statistically significant differences and medium to high effect size ( P = 0.000 and d =1.46, P = 0.02 and d = 0.86, P = 0.01 and d = 0.75, respectively) in favor of the LG. Adding laser acupuncture on GB34, LR3, and LIV3 to standard physical therapy can reduce spasticity, and improve ankle ROM, gross motor function, PSA, hind foot peak pressure, and QoL for children with spastic CP.

PedBotLab: A Novel Video Game–Based Robotic Ankle Platform Created for Therapeutic Exercise for Children With Neurological Impairments

Aims Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance. Methods Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial. Results Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes. Conclusions The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device.

Relationship between ankle pain, range of motion, strength and balance in individuals with functional ankle instability: a cross-sectional study

BackgroundAbout 15–60% of individuals with ankle sprains may develop functional ankle instability (FAI), which is characterised by ankle pain, decreased muscle strength, limited range of motion, and impaired balance, causing a decline in social activity and quality of life. However, the relationship between those characters is still unclear. This study aimed to investigate whether a relationship existed between ankle pain, active range of motion (AROM), strength and balance and if ankle pain, AROM and strength can predict balance in individuals with FAI.MethodsSeventy-seven subjects (46 males; 31 females) with unilateral FAI participated in this study. Ankle pain was measured by the visual analogue scale (VAS), ankle AROM was measured using a universal goniometer, ankle strength was measured using a handheld dynamometer, the static balance was measured by the Time in Balance Test (TBT) and the dynamic balance was measured by the modified Star Excursion Balance Test (mSEBT). Pearson product-moment correlations were used to determine the correlations between ankle pain, AROM, strength and balance. Multiple linear regressions were used to investigate if ankle pain, AROM and strength can predict balance in individuals with FAI.ResultsVAS and AROM-plantarflexion predicted 25.6% of the TBT (f2 = 0.344, P < 0.001). AROM-dorsiflexion predicted 24.6% of the mSEBT-anterior reach (f2 = 0.326, P < 0.001). VAS, AROM-plantarflexion and strength-plantarflexion predicted 33.5% of the mSEBT-posteromedial reach (f2 = 0.504, P < 0.001). AROM-plantarflexion and strength-plantarflexion predicted 28.2% of the mSEBT-posterolateral reach (f2 = 0.393, P < 0.001).ConclusionThis study shows that ankle plantarflexion strength, AROM of dorsiflexion and plantarflexion and pain are predictors of balance in individuals with FAI. These factors could be considered in the rehabilitation of FAI.Trial registrationTrial registration number: ChiCTR2200063532.

A Multidimensional Assessment of a Novel Adaptive Versus Traditional Passive Ankle Sprain Protection Systems

Background: Ankle braces aim to reduce lateral ankle sprains. Next to protection, factors influencing user compliance, such as sports performance, motion restriction, and users’ perceptions, are relevant for user compliance and thus injury prevention. Novel adaptive protection systems claim to change their mechanical behavior based on the intensity of motion (eg, the inversion velocity), unlike traditional passive concepts of ankle bracing. Purpose: To compare the performance of a novel adaptive brace with 2 passive ankle braces while considering protection, sports performance, freedom of motion, and subjective perception. Study Design: Controlled laboratory study. Methods: The authors analyzed 1 adaptive and 2 passive (one lace-up and one rigid brace) ankle braces, worn in a low-cut, indoor sports shoe, which was also the no-brace reference condition. We performed material testing using an artificial ankle joint system at high and low inversion velocities. Further, 20 male, young, healthy team sports athletes were analyzed using 3-dimensional motion analysis in sports-related movements to address protection, sports performance, and active range of motion dimensions. Participants rated subjective comfort, stability, and restriction experienced when using the products. Results: Subjective stability rating was not different between the adaptive and passive systems. The rigid brace was superior in restricting peak inversion during the biomechanical testing compared with the passive braces. However, in the material test, the adaptive brace increased its stiffness by approximately 400% during the fast compared with the slow inversion velocities, demonstrating its adaptive behavior and similar stiffness values to passive braces. We identified minor differences in sports performance tasks. The adaptive brace improved active ankle range of motion and subjective comfort and restriction ratings. Conclusion: The adaptive brace offered similar protective effects in high-velocity inversion situations to those of the passive braces while improving range of motion, comfort, and restriction rating during noninjurious motions. Clinical Relevance: Protection systems are only effective when used. Compared with traditional passive ankle brace technologies, the novel adaptive brace might increase user compliance by improving comfort and freedom of movement while offering similar protection in injurious situations.

The Effects of Prolonged Vibrotactile EMG-Based Biofeedback on Ankle Joint Range of Motion During Gait in Children with Spastic Cerebral Palsy: A Case Series

Aims The objective of this case series was to examine the feasibility of vibrotactile EMG-based biofeedback (BF) as a home-based intervention tool to enhance sensory information during everyday motor activities and to explore its effectiveness to induce changes in active ankle range of motion during gait in children with spastic cerebral palsy (CP). Methods Ten children ages 6 to 13 years with spastic CP were recruited. Participants wore two EMG-based vibro-tactile BF devices for at least 4 hours per day for 1-month on the ankle and knee joints muscles. The device computed the amplitude of the EMG signal of the target muscle and actuated a silent vibration motor proportional to the magnitude of the EMG. Results Our results demonstrated the feasibility of the augmented sensory information of muscle activity to induce changes of the active ankle range of motion during gait for 6 children with an increase ranging from 8.9 to 51.6% compared to a one-month period without treatment. Conclusions Preliminary findings of this case series demonstrate the feasibility of vibrotactile EMG-based BF and suggest potential effectiveness to increase active ankle range of motion, therefore serving as a promising therapeutic tool to improve gait in children with spastic CP.

Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury.

Objective The aim of this study is to study the application effects of doctor-nurse-patient co-decision-making nursing intervention based on evidence-based problems in the rehabilitation of acute ankle lateral collateral ligament injury. Methods 150 patients with acute ankle lateral collateral ligament injury who were treated in the hospital between December 2020 and December 2021 were selected, and they were divided into the routine group and the evidence-based group by the random number table method, with 75 cases in each group. The patients in the routine group received routine nursing intervention, while the patients in the evidence-based group adopted doctor-nurse-patient co-decision-making nursing intervention based on evidence-based problems, and both groups were intervened for 1 month. The rehabilitation time (swelling subsidence time, fixation removal time, and normal walking time), ankle active range of motion (dorsiflexion and plantar flexion), ankle function (ankle Kofoed score) before and after intervention, and the total incidence rate of complications (tendon injury, ankylosis, and traumatic arthritis) within 1 month of intervention were compared between the two groups of patients. Results The swelling subsidence time, fixed removal time, and normal walking time in the evidence-based group were significantly shorter than those in the routine group (P < 0.05). After 1 month of intervention, the ranges of motion of dorsiflexion and plantar flexion and ankle Kofoed scores of the two groups were significantly higher than those before intervention, and the abovementioned indicators in the evidence-based group were significantly higher than those in the routine group (P < 0.05). Within 1 month of intervention, the total incidence rate of tendon injury, ankylosis, and traumatic arthritis was significantly lower in the evidence-based group than that in the routine group (P < 0.05). Conclusion Nursing intervention of doctor-nurse-patient co-decision-making based on evidence-based problems in patients with acute ankle lateral collateral ligament injury can promote postoperative rehabilitation and restore the ankle function of patients.

Prevention of muscle atrophy in ICU patients without nerve injury by neuromuscular electrical stimulation: a randomized controlled study

BackgroundExtensive muscle atrophy is a common occurrence in orthopaedics patients who are bedridden or immobilized. The incidence is higher in intensive care unit (ICU) inpatients. There is still controversy about how to use neuromuscular electrical stimulation (NMES) in ICU patients. We aim to compare the effectiveness and safety of NMES to prevent muscle atrophy in intensive care unit (ICU) patients without nerve injury.MethodsICU patients without central and peripheral nerve injury were randomized into experimental group I (Exp I: active and passive activity training (APAT) + NMES treatment on the gastrocnemius and tibialis anterior muscle), experimental group II (Exp II: APAT + NMES treatment on gastrocnemius alone), and control group (Ctl: APAT alone). Changes in the strength of gastrocnemius, the ankle range of motion, and the muscle cross-section area of the lower leg were evaluated before and after the intervention. Also, changes in prothrombin time, lactic acid, and C-reactive protein were monitored during the treatment.ResultsThe gastrocnemius muscle strength, ankle joint range of motion, and cross-sectional muscle area of the lower leg in the three groups showed a downward trend, indicating that the overall trend of muscle atrophy in ICU patients was irreversible. The decrease in gastrocnemius muscle strength in Exp I and Exp II was smaller than that in the control group (P < 0.05), but there was no difference between Exp I and Exp II. The decrease in active ankle range of motion and cross-sectional area of the lower leg Exp I and Exp II was smaller than that in the control group (P < 0.05), and the decrease in Exp I was smaller than that of Exp II (all P < 0.05). The curative effect in Exp I was better than in Exp II. There were no significant differences in the dynamic changes of prothrombin time, lactic acid, and C-reactive protein during the three groups (P > 0.05).ConclusionIn addition to early exercise training, NMES should be applied to prevent muscle atrophy for patients without nerve injury in ICU. Also, simultaneous NMES treatment on agonist/antagonist muscle can enhance the effect of preventing muscle atrophy.Trial registrationThis study was prospectively registered in China Clinical Trial Registry (www.chictr.org.cn) on 16/05/2020 as ChiCTR2000032950.

Reliability of Bi-Axial Ankle Stiffness Measurement in Older Adults.

This study involves measurements of bi-axial ankle stiffness in older adults, where the ankle joint is passively moved along the talocrural and subtalar joints using a custom ankle movement trainer. A total of 15 elderly individuals participated in test–retest reliability measurements of bi-axial ankle stiffness at exactly one-week intervals for validation of the angular displacement in the device. The ankle’s range of motion was also compared, along with its stiffness. The kinematic measurements significantly corresponded to results from a marker-based motion capture system (dorsi-/plantar flexion: r = 0.996; inversion/eversion: r = 0.985). Bi-axial ankle stiffness measurements showed significant intra-class correlations (ICCs) between the two visits for all ankle movements at slower (2.14°/s, ICC = 0.712) and faster (9.77°/s, ICC = 0.879) speeds. Stiffness measurements along the talocrural joint were thus shown to have significant negative correlation with active ankle range of motion (r = −0.631, p = 0.012). The ankle movement trainer, based on anatomical characteristics, was thus used to demonstrate valid and reliable bi-axial ankle stiffness measurements for movements along the talocrural and subtalar joint axes. Reliable measurements of ankle stiffness may help clinicians and researchers when designing and fabricating ankle-foot orthosis for people with upper-motor neuron disorders, such as stroke.

Reliability of a close-range photogrammetry technique to measure ankle kinematics during active range of motion in place

BackgroundAs the risk of ankle turn during daily activity is very high, studying ankle kinematics in place is important for ankle sprain prevention. The close-range photogrammetry (CRP) technique is used to measure ankle kinematics during active range of motion (AROM) in place. The purpose of the study was to assess the reliability of CRP to measure ankle kinematics. MethodsTwenty adults were recruited and fourteen retro-reflective targets were mounted on the skin of their right feet. Imaging sensors were self-calibrated using a bundle adjustment technique, and the images were downloaded with Australis photogrammetric software. Three trials were conducted and reliability coefficients were used to assess agreement between them. ResultsReliability was almost perfect and the results show that the intraclass correlation coefficient (ICC) of ankle angle values were (dorsiflexion = 0.96), (plantarflexion = 0.81), (inversion = 0.92), (eversion = 0.95), (internal rotation = 0.92), and (external rotation = 0.78). The overall intraclass correlation coefficient was 0.89 and the standard error of the measurement (SEM) values ranged from (0.37° to 6.18°). ConclusionsThe results indicate that the CRP technique was able to reliably measure ankle kinematics. The results may support and enhance knowledge related to ankle AROM in the clinical arena.

Influence of type 1 diabetes on the postural control of women in the third gestational trimester

BackgroundDiabetes can cause biomechanical alterations that may be responsible for additional changes to those existing in a regular gestational period. The way a maternal body responds when affected by diabetes has not been clearly understood. This study aimed to describe the influence of type 1 diabetes on pregnant women's postural control. MethodsForty pregnant women in their third gestational trimester were allocated in two equal groups - the control group and the type 1 diabetic group. The variables related to postural control and balance were assessed using photogrammetry (head protrusion; cervical lordosis; thoracic kyphosis; lumbar lordosis; pelvic anteversion, knee flexion, tibiotarsal and foot inclination angles were measured), and baropodometry (anteroposterior and mediolateral distance trajectory of the center of pressure, amplitude and average speed of displacement of the center of pressure). FindingsThe results of the type 1 diabetic group showed, in the postural analysis, lower head protrusion and pelvic anteversion angles, while there was higher cervical lordosis, thoracic kyphosis, and lumbar lordosis angles. In the baropodometry, the anteroposterior distance and the amplitude of the center of pressure displacement with eyes open and closed were higher. InterpretationThe findings suggest that type 1 diabetes mellitus in the third trimester of pregnancy is associated with postural changes, a decrease in the active ankle range of motion and increase in the anteroposterior oscillation of the center of pressure, with negative repercussions for postural control.

The effects of instrument-assisted soft tissue mobilization on active range of motion, functional fitness, flexibility, and isokinetic strength in high school basketball players.

Although many studies have focused on stretching techniques for athletes, no comprehensive studies have investigated the use of the instrument-assisted soft tissue mobilization (IASTM) technique in young basketball players. The active properties of muscle and subjective reporting of functional ability were used to identify the effects of IASTM on the calf muscle. Active range of motion (AROM), functional fitness, and isokinetic lower strength in the knees and ankles were measured in 40healthy young basketball players. They were divided into the IASTM group (n= 20) and a control group (CG, n= 20). Twenty asymptomatic young basketball players were treated with IASTM six times per week for 8weeks. The remaining 20participants did not receive a treatment intervention between tests and served as the control. Ankle AROM (two knee positions of 0∘ and 45∘ flexion), functional fitness at the knee and ankle (side-step and vertical jump), and isokinetic peak torque were determined during ankle dorsiflexion (DF) and plantar flexion (PF) and knee extension (EX) and flexion (FX). The data were analyzed using repeated-measures analysis of variance. Significant differences were observed between the two groups in IASTM and control AROM 0∘ knee flexion (right: DF; p< 0.001 and PF; p< 0.001; left: DF; p< 0.001 and PF; p= 0.011), AROM 45∘ knee flexion (right: DF; p< 0.001 and PF; p= 0.009; left: DF; p< 0.001 and PF; p= 0.001), functional fitness (side step; p= 0.001, sit and reach; p= 0.025, vertical jump; p= 0.001), ankle isokinetic strength 30∘/sec (right: DF; p= 0.001 and PF; p= 0.001; left: DF; p< 0.001 and PF; p= 0.002), ankle isokinetic strength 120∘/sec (right: DF; p= 0.049 and PF; p= 0.001; left: DF; p= 0.023 and PF; p< 0.001), knee isokinetic strength 60∘/sec (right: EX; p= 0.001, FX; p= 0.001 and hamstring and quadriceps ratio [H/Q]; p= 0.001, left: EX; p= 0.001, FX; p= 0.001 and H/Q; p= 0.001), and knee isokinetic strength 180∘/sec (right: EX; p= 0.001, FX; p= 0.001 and H/Q; p= 0.001; left: EX; p= 0.001, FX; p= 0.010 and H/Q; p= 0.001). These results suggest that IASTM improves functional fitness and lower body muscle strength in young basketball players.

Metatarsophalangeal joint flexion affects dorsiflexor activity in subjects with a dominant extensor hallucis longus.

Normal dorsiflexion (DF) required for normal gait is achieved through balance of the tibialis anterior (TA) and extensor hallucis longus (EHL). Imbalance may induce ankle and foot deformities and exacerbate pathology. EHL dominance is associated with progressive TA weakness, attributable to muscle non-use. When the EHL dominantly dorsiflexes the ankle, the big toe extends at the metatarsophalangeal joint (MTPJ) and pure ankle DF is absent. The effects of active MTPJ flexion on TA and EHL muscles, TA/EHL ratio, and the force applied during active DF in EHL-dominant (EHL-D) and EHL-non-dominant (EHL-ND) subjects were compared. The 38 subjects were divided into EHL-D and EHL-ND groups. All subjects performed active ankle DF with and without active MTPJ flexion. Surface electromyographic data, ankle active range of motion, and DF force were measured. Two-way mixed analysis of variance was used to evaluate differences in dependent variables. Compared to the EHL-ND group, the EHL-D group exhibited less TA activity, more EHL activity, and a reduced TA/EHL activity ratio. Active application of MTPJ flexion during DF significantly reduced muscle imbalance, whereas EHL activity decreased and the TA/EHL activity ratio increased. The DF force decreased significantly with MTPJ flexion in both groups. Active MTPJ flexion can reduce EHL and/or increase TA activity and increase the TA/EHL activity ratio during active ankle DF in both EHL-D and EHL-ND subjects.

Effects of instrument-assisted soft-tissue mobilization on ankle range of motion and triceps surae pressure pain sensitivity

BackgroundWithin the practice of physical medicine, instrument-assisted soft-tissue mobilization (IASTM) is increasing in popularity. However, the intervention is still in its infancy and important clinical issues require elucidation; among these are the effects on asymptomatic individuals.MethodsTwenty healthy males were allocated randomly to either 3 minutes of high-pressure IASTM or active self-stretch of the triceps surae muscles. Each individual served as his own control. Pre-post observations of active ankle range of motion, pressure-pain sensitivity and the occurrence of postintervention petechial haemorrhage were made.ResultsA significant within-group increase in ankle range of motion was observed for both groups, but no significant between-group differences were noted. Pressure-pain sensitivity remained essentially unchanged. No petechiae were detected postintervention.ConclusionNotwithstanding the limitations of this relatively small study and in relation to healthy individuals, IASTM increased active range of motion to the same extent as active self-stretch. Heavydose IASTM did not influence pain-pressure sensitivity and petechiae did not develop.LAY ABSTRACTThe aim of this study was to observe whether treatment with a steel mobilization tool would relax muscles, reduce pain (by reducing sensitivity to pressure) and, if used aggressively, would result in superficial bleeding under the skin. Healthy men were asked to perform a calf stretch in one leg. Then 3 min of instrument-assisted soft-tissue mobilization was performed on their other calf using strong pressure. Relaxation was observed in both ankles after the intervention, indicating a similar degree of improved stretch. Surprisingly, pressure sensitivity did not change, indicating that the participants’ bodies did not get used to the pressure. Finally, the instrument caused no superficial bleeding despite being applied with heavy pressure and over a long period of time.

Pilates Reformer exercises for fall risk reduction in older adults: A randomized controlled trial

ObjectiveTo investigate the effects of Pilates exercises using a Reformer on measures of fall risk, balance and mobility, self-efficacy, and active range of motion in adults age 65 and over at risk for falls compared to a control group. DesignRandomized Controlled Trial. MethodsFifty-five subjects (27 Pilates intervention, 28 control; 38 females, 17 males; mean age 77.6 years, range 65–95) were randomly assigned to either a Pilates Reformer intervention group or a control group (no intervention). Subjects in the intervention group attended a Pilates Reformer exercise program in a group format once a week over a 10-week period. The primary outcome measures were the Sensory Organization Test (SOT) composite scores on the NeuroCom® system, Timed Up-and-Go (TUG), and Activities-specific Balance Confidence (ABC) scale. The secondary outcome measures were the Adaptation Test (ADT), straight leg raise (SLR), hip extension, and ankle dorsiflexion active range of motion (AROM), Berg Balance Scale (BBS), and 10 Meter Walk Test (10MWT). ResultsThere was a significant interaction between group and time on the TUG, BBS, 10MWT, and SLR, hip extension, and ankle dorsiflexion AROM measurements. Over time, subjects in the Pilates intervention group improved their scores significantly on all mentioned measures, whereas subjects in the control group did not (P ≤ 0.05). Significantly improved AROM was found between groups following the Pilates intervention for hip extension, left SLR, and right ankle dorsiflexion. ConclusionPilates Reformer exercises performed once per week for 10 weeks resulted in reduced fall risk and significant improvements in static and dynamic balance, functional mobility, balance self-efficacy, and lower extremity AROM in adults age 65 and older at risk for falling, whereas the control group did not significantly improve in any measures. Pilates Reformer exercises are more effective compared to no exercise intervention at improving hip and ankle AROM.

Curative analysis of individual surgery for chronic Achilles tendon rupture

To investigate the effectiveness of individual surgery for chronic Achilles tendon rupture. A retrospective analysis was made on the clinical data of 25 patients (26 Achilles tendons) with chronic Achilles tendon rupture between September 2009 and March 2016, including 22 males and 3 females with a mean age of 38 years (range,18-59 years). The median disease duration was 12 weeks (range, 4 weeks to 12 years). The repairing method depended on the defect size, injury site, and tissue condition of the involved Achilles tendon: 9 Achilles tendons were repaired by end-to-end anastomosis, 8 by a gastrocnemius turndown flap, and 9 by auto free tendon (4 ipsilateral hamstring tendon and 5 ipsilateral 2/3 peroneus longus tendon). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, heel lifting of the affected leg, active ankle range of motion (plantar flexion and dorsiflexion), maximum calf circumference, and complications were applied to assess the effectiveness. Hypersensitivity occurred in 1 incision, and stage I healing was obtained in the other incisions. No complication of re-rupture, infection, nerve injury, or deep venous thrombosis occurred. All the patients were followed up 8-85 months (mean, 34 months). The AOFAS ankle-hind foot score was significantly improved to 95.81±5.34 at last follow-up from preoperative 50.54±5.52 ( t=-34.844, P=0.000); the excellent and good rate was 100% (excellent in 21 cases and good in 4 cases). The active dorsiflexion of the operated side [(13.9±2.4)°] was significantly lower than that of normal side [(16.7±2.0)°] ( t=-9.099, P=0.000), but the active plantar flexion showed no significant difference between affected side [(39.8± 3.2)°] and normal side [(40.6±2.6°)] ( t=-1.917, P=0.068). The maximum calf circumference of the operated side [(379.4±18.8) mm] was significantly lower than that of normal side [(387.1±16.6) cm] ( t=-5.053, P=0.000). The other patients could finish heel lifting of the affected leg without limitation except for 1 patient. All patients returned to normal work and activity, and 12 patients returned to normal sports. Individual surgery depending on the defect, injury site, and tissue condition of the involved Achilles tendon can repair all kinds of chronic Achilles tendon rupture with a low rate of complications.

The immediate effects of ankle balance taping with kinesiology tape on ankle active range of motion and performance in the Balance Error Scoring System

ObjectivesThis study investigated the changes in ankle active range of motion (AROM) and performance on the Balance Error Scoring System (BESS) in cases in which no tape, placebo taping or ankle balance taping (ABT) with kinesiology tape was used. DesignRandomized cross-over trial. SettingUniversity laboratory. ParticipantsFifteen physically active individuals (7 men, 8 women). Main outcome measurementsPostural control was assessed based on performances on the BESS. Active ankle flexibility was assessed by measuring the ankle AROM of both ankles under each taping condition in a random order at 1-week intervals. ResultsThe ankle AROM among the taping conditions were not significantly different. There were no significant differences in the error scores of single-leg and tandem stances on a firm surface among the taping conditions. Compared to those obtained in the absence of taping, the error scores of the single-leg and tandem stances on a foam surface were significantly lower with ABT, but they did not significantly differ from the placebo taping scores. ConclusionsThis study showed that ABT with kinesiology tape immediately improved postural control on unstable surfaces without changes in ankle AROM.

Abstract TP156: Robot-Guided Ankle and Knee Therapeutic Training Improves Motor Functions in Stroke

Introduction: Stroke survivors develop substantial disability such as weakness, spasticity, increased stiffness, and reduced range of motion in lower limbs, contributing to reduced quality of life. It is important to stretch impaired ankle and knee to increase range of motion and reduce spasticity, and to conduct active movement training to improve balance and locomotion. Hypothesis: We addressed the hypotheses that robot-aided ankle and knee training will reduce motor impairments and improve balance and gait functions, and the improvements will maintain to the 6-weeks follow-up. Methods: Seven male stroke survivors participated in the robot-guided ankle and knee rehabilitation training using a pair of ankle and knee rehabilitation robots over 18 training sessions (3 sessions/week for 6 weeks). Three evaluations were done before and after training, and 6 weeks follow-up. Each session involved passive stretching under intelligent control and active movement training under real-time, audiovisual and haptic feedback. About equal time was spent on the ankle and knee training. Results: We found significant improvement in 6-Minute Walk Test (6MWT: 294.8 m pre-training to 386.4 m post training; p&lt;0.01), Berg Balance Scale (BBS, 45 pre to 52 post; p&lt;0.05), ankle active range of motion (AROM) (-11.7° pre to 1.7° post; p&lt;0.05, a negative value means not being able to reach 0° dorsiflexion), passive ROM in dorsiflexion (12.7° pre to 23.3° post; p&lt;0.01), and dorsiflexion muscle strength (-0.3 Nm pre to 5.7 Nm post; p&lt;0.05, negative means lower than the passive torque at 0° ankle dorsiflexion). The knee had significant improvement in AROM in extension against the load of the robot (34.8° pre to 15.9° knee flexion post; p&lt;0.05) and maximal flexion strength at 90° knee flexion (19.3 Nm pre to 31.7 Nm post; p&lt;0.01). At the follow-up, the outcomes were found as similar results of post evaluation, e.g., 379m (p&lt;0.05) in 6MWT, 51 (p&lt;0.05) in BBS, and 5.2 Nm (p=0.05) in dorsiflexion strength. Conclusions: In conclusions, robot-guided stretching and active movement training reduced impairments at the knee and ankle of stroke survivors resulting in improved mobility. Furthermore, the effect of training was maintained at the 6-weeks follow-up after the treatment.

Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study.

[Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion.

Relative index of ankle muscle activations on agonistic phase between subjects with and without flat foot

Background: Although co-activation of ankle muscles has been reported, relative ankle muscle activation in subjects with flat foot has not been carefully investigated. The aim of this study was to compare the relative activation index (RAI) on the tibialis anterior (TA) and medial gastrocnemius (GTN) muscles during active ankle range of motion (ROM) between subjects with and without flat foot. Methods: There were 17 subjects with flat foot and 17 age- and gender-matched control subjects who participated in this study. The RAI based on electromyography (EMG) was measured during the agonist phase at a controlled velocity of ankle motion (10°/second). The subject was seated upright with the tested foot held firmly onto a footplate that was attached to a torque sensor. The ankle being measured was strapped to the leg support of the Intel stretch device at 60° of knee flexion. The RAI was analyzed by the summation of EMG activity from the agonistic time window divided by the total EMG activity during full active ankle ROM. Results: The RAI was significantly different on the TA muscle (t = 3.08, P = 0.004), but no difference was found on the GTN muscle (t = -1.24, P = 0.23) in subjects with flat foot. There was an interaction between group and RAI (F =7.89, P = 0.007); however, the RAI demonstrated no interaction with age (F = 2.59, P = 0.14), height (F = 3.73, P = 0.06), or weight (F = 2.96, P = 0.09). Conclusions: The RAI indicated a lack of TA muscle activation in the flat foot group. Such dissociated activation in the flat foot group might be relevant to the inefficiency of synergistic motions. The relative activation of the agonistic phase needs to be further investigated to compare co-activation of synergistic muscle activation with various functional tasks.