Anteroposterior Displacement Research Articles

Use of an Instrumented Ankle Arthrometer and External Strain Gauge to Assess Ankle Dorsiflexion Motion and Plantarflexor Stiffness.

Ankle dorsiflexion motion and plantarflexor stiffness measurement offer clinical insight into the assessment and treatment of musculoskeletal and neurologic disorders. We aimed to determine reliability and concurrent validity of an ankle arthrometer in quantifying dorsiflexion motion and plantarflexor stiffness. Ten healthy individuals were assessed for dorsiflexion motion and plantarflexor stiffness using an ankle arthrometer with a 6 degree-of-freedom kinematic linkage system and external strain gauge to apply dorsiflexion torque. Two investigators each performed five loads to the ankle at different combinations of loads (10 or 20 Nm), rates (2.5 or 5 Nm/sec), and knee angles (10° or 20°). Anteroposterior displacement and inversion-eversion rotation were also assessed with arthrometry, and functional dorsiflexion motion was assessed with the weightbearing lunge (WBL) test. Good-to-excellent intrarater reliability was observed for peak dorsiflexion (intraclass correlation coefficient [ICC][2,k] = 0.949-0.988) and plantarflexor stiffness (ICC[2,k] = 0.761-0.984). Interrater reliability was good to excellent for peak dorsiflexion (ICC[2,1] = 0.766-0.910) and poor to excellent for plantarflexor stiffness (ICC[2,1] = 0.275-0.914). Reliability was best for 20-Nm loads at 5 Nm/sec. Strong correlations were observed between peak dorsiflexion and anteroposterior displacement (r = 0.666; P = 0.035) and WBL distance (r = -0.681; P = 0.036). Using an ankle arthrometer to assess peak dorsiflexion and plantarflexor stiffness seems reliable when performed to greater torques with faster speeds; and offers consistency with functional measures. Use of this readily available tool may benefit clinicians attempting to quantify equinus and dorsiflexion deficits in pathological populations.

Postural control in male ten-pin bowlers of different level of competitiveness

Ten-pin bowling is considered a highly skilled recreational activity with players demonstrating various anthropometric and physiological characteristics. The purpose of the current study was to assess both static and dynamic body balance, in ten-pin bowlers of different level of competitiveness. Thirty four ten-pin bowlers who competed at a high (Level-A, n=17) and a lower level (Level-B, n=17) as well as eighteen individuals without experience in ten-pin bowling (Non-bowlers) participated in the study. Static balance was determined based on the anteroposterior (APd) and mediolateral displacement (MLd) of the center-of-foot-pressure (CoP) that was recorded during single-leg-stance with open and close eyes as well as with open eyes and head extension. Dynamic balance was determined based on the APd and MLd of CoP as well as the normalized distances reached during execution of the Star Excursion Balance Test (SEBT) in the posterior, posterolateral and lateral directions. Significantly better dynamic balance, in terms of the distances reached during SEBT execution, was demonstrated by Level-A bowlers compared to Level-B bowlers and Non-bowlers. The differences between groups regarding APd and MLd, during both static and dynamic balance testing, were in general not significant. Our findings revealed that ten-pin bowlers who compete at a higher level demonstrate better dynamic balance ability. Sports scientists and coaches should be aware of these differences to optimize performance or distinguish ten-pin bowlers with different level of competitiveness.

Condylar changes in patients with idiopathic condylar resorption: retrospective 2-year follow-up CBCT-based case-control study.

To compare condylar development and changes in condylar radiological appearance in patients with idiopathic condylar resorption (ICR) to a healthy, age- and gender matched, control group. This case-control study included 16 ICR patients [mean age: 15years, 9 months; standard deviation (SD): 4 years) and 16 controls (mean age: 16 years, 8 months; SD: 4 years, 7 months), with diagnostic (T0) and 2-year follow-up (T1) CBCT examinations. Condylar changes were evaluated through changes in condylar neck angle (CNA), and the transversal, vertical and anteroposterior displacement of five condylar points between T0 and T1. The magnitude and direction of condylar changes were evaluated using vector analyses. A qualitative radiological evaluation of the TMJ was performed based on healthy, erosive and repaired morphological appearance. Linear and angular measurements were assessed using ANOVA and a Tukey post-hoc test, and vectors were tested using an independent-sample 2-tailed t-test. Fisher's exact test was used for the qualitative evaluation. At T0, ICR patients exhibited decreased condylar height, smaller condylar width and posteriorly inclined CNA compared with the control group (P < 0.05). During observation, condylar vertical growth was smaller in the ICR group than in the control group (P < 0.05). Vector analysis showed an upward direction of vertical displacement for all condylar points in the control group; the ICR group showed a downward direction (P < 0.003). The radiological appearance of 75% of the ICR condyles and 94% of the control condyles did not change during the 2-year follow-up period. ICR condyles displayed reduced vertical development compared with control condyles. The radiological appearance remained unchanged for most joints. Observed changes in radiological appearance did not always follow a progressive model of degenerative joint disease.

Comparison of knee biomechanical characteristics during exercise between pinnacle and step trainers

BackgroundA novel stair-climber called a pinnacle trainer (PT) provides both sagittal and frontal plane exercise, making it different from a step trainer (ST), which provides only sagittal plane exercise. Exercise with different trajectories may produce different biomechanical responses. There are currently no guidelines for choosing between a PT and a ST for different training or rehabilitation purposes. Research questionsAre there differences in the electromyographic patterns of lower extremity musculature and biomechanical responses of the knee joint during exercise between using a PT and a ST? MethodsThis study utilizes a prospective observational study design. Eighteen healthy males participated in the study. A six-axis force and torque transducer embedded in the machine pedal synchronized with a three-dimensional motion capture system were utilized to measure kinematic and kinetic data of the right knee during the stepping movement. The activities of six lower extremity muscles of the same limb were captured with surface electromyography during exercise on the two trainer types. ResultsThe co-activation index of the vastus lateralis (VL) and the biceps femoris (BF) recorded during ST exercise was significantly greater than that for the PT exercise. Moreover, exercise using the ST produced a significantly greater knee downward force compared to that for the PT. Exercise with the PT produced a significantly greater internal knee varus moment compared to that for the ST. SignificanceThe ST provided greater co-activation of the BF and VL and a greater knee joint downward force, which may decrease the antero-posterior displacement of the tibia relative to the femur. Exercise with the PT produced a significant internal knee varus moment and a more balanced muscular activation on the vastus medialis and VL compared to that for the ST, which may decrease the maltracking of the patella.

Positive Balance Recovery in Ischemic Post-Stroke Patients with Delayed Access to Physical Therapy.

Background Since patient's prognosis after stroke depends on its severity, brain location, and type early intervention is strongly recommended. Objective We aimed to determine whether it is still possible to improve balance in chronic patients, who suffered Intracerebral Hemorrhagic Strokes (ICHS) or Ischemic Strokes (IS), after later intervention. Methods 34 patients who had unilateral ICHS or IS and involved the motor cortex or sub-cortical areas took part in the study. The patients underwent clinical balance evaluation (using the Berg Balance Scale) and posturographic assessment (with a capacitive pressure platform) at the time of admission to the physiotherapy and at the end of the study. The physiotherapy intervention consisted of 20 sessions of 60 minutes carried out 3 times per week, following standard protocols: stretching; passive range of motion (ROM); active assistive ROM; active ROM; resistance training; coordination and balance activities while sitting and standing, and Large-muscle activities such as walking, treadmill, stationary cycle, combined arm-leg ergometry, arm ergometry, seated stepper and circuit training. Results In the posturographic assessment, the IS group had significant lower amplitude of center of pressure (COP) anteroposterior displacement, after physical therapy intervention. Also, the 95% confidence ellipse area of the COP and the total COP displacement showed significant interaction between the subtype of stroke and the assessment period, meaning the IS group improved their balance after treatment on the contrary of ICHS. The structural analysis of the COP reinforced these results. On the other hand, no difference was observed in the clinical scale, between the assessment periods, for any subtype of stroke. Conclusion Only IS patients have shown balance improvements after conventional intervention. COP measurements are more sensible to assess balance in chronic patients than Berg Balance Scale.

The effect of spinal bracing on stability in patients with adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) may change the physical orientation of body segments and affect balance in individuals. Spinal/trunk brace is commonly used for the management of idiopathic scoliosis. The aim of this study was to compare the standing stability of AIS patients with and without a brace, and to compare them with healthy subjects. Twenty subjects (10 healthy subjects and 10 AIS with thoracolumbar/lumbar curve) were recruited for the study. Stability of the scoliotic subjects was evaluated while standing with and without orthosis. A Kistler force plate was employed to estimate the mediolateral and anteroposterior displacements of center of pressure. The results of this study indicated that there was no significant difference between center of pressure variables in healthy subjects and scoliotic patients. Moreover, trunk bracing only influenced the center of pressure (CoP) excursion in mediolateral direction (p< 0.05). Although further research studies are needed, results showed that there was no difference between stability of scoliotic and normal subjects. Moreover, the use of orthosis did not improve their standing stability.

P1557 Predictive significance of right ventricle dysfunction on clinical outcome in patients with HFpEF

Abstract Background the volume and function of the right ventricle (RV) are the parameters that determine the echo predictive factors of mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). In the concept of the mechanism of the contraction of the heart the global RV ejection fraction consist of combined longitudinal, radial and anteroposterior displacement of the RV walls. RV pump function realized by shortening of the longitudinal axis with the traction of the tricuspid annulus towards the apex; inward movement of the RV free wall; bulging of the interventricular septum into the RV and stretching the free wall over the septum. In case of HFpEF the longitudinal mechanism of RV reduction is more sensitive than others. Longitudinal strain of RV free wall (RVFWS) and 3DRVEF has been proposed as a more accurate and sensitive tool to evaluate RV function in longitudinal displacement of patients with HFpEF. Methods and Results—A total of 73 patients with HFpEF (age, from 26 to 77 years; the clinical manifestations of HFpEF corresponded to NYHA III in 52 patients (71%), NYHA IV in 21 patients (29%); LV EF ≤ 35%) with preserved TAPSE (≤15 mm) underwent RV function assessment using 4DETomTec, speckle-tracking TTE to measure peak RVFWS, GLS, 4DEEF. After a median follow-up period of 36 months, 61 (83%) patients reached the primary composite end point of all-cause death/Heart transplantation. Median RVFWS was −12.3% (interquartile range, −20.3% to −9.4%). Median RVGLS was −15.3% (interquartile range, −21.3% to −10.54%). Median RV4DEF was 31.6% (interquartile range, 21,1% to 36,2%). By Kaplan–Meier plot, RVFWS &amp;gt; -15%, (p &amp;lt; 0,02), GLS &amp;gt;-20%, (p &amp;lt; 0,04), 4DETomtecEF &amp;lt;30% (p &amp;lt; 0,0001) were an independent predictor of outcome in patients with HFpHF. Conclusions: In patients with HFpEF the fast and accurate quantification of RV free-wall strain and 4DTomtecEF provides incremental prognostic information and improved risk stratification.

Ankle muscles activation and postural stability with Star Excursion Balance Test in healthy individuals

IntroductionThe ankle joint, a part of the kinetic chain of the lower limb, plays a significant role in the maintenance of postural stability during bipedal and unipedal balancing activities. This study aimed to evaluate the neuromuscular control of the ankle joint and the postural stability while executing the Star Excursion Balance Test (SEBT), by recording the EMG activity of the extrinsic ankle musculature and the displacement of the center of pressure (CoP). MethodsThe EMG activity of the tibialis anterior (TA), the peroneus brevis (PB) and the medial and lateral gastrocnemius (GM, GL), along with the anteroposterior and mediolateral displacements (APd and MLd) of CoP as well as the plantar pressure distribution of the supportive lower limb were recorded during reaching to the eight directions of SEBT in 29 healthy, physically active college students (15 males and 14 females; mean ± SD of age 25.6 ± 4.5 yrs.; height: 172.5 ± 8.2 cm; body weight: 67.7 ± 13.6 kg; and BMI: 22.6 ± 2.9 kg/m2). ResultsThe tibialis anterior muscle demonstrated the greatest EMG activity during SEBT, followed by the PB, GL and GM muscles. The increased EMG activity of TA and PB during the execution of all posterior-oriented and lateral directions coincided with a decreased APd of CoP and increased reaching distances. The opposite occurred during the execution of all the anterior-oriented and medial directions. The differences among the directions of SEBT regarding the EMG activity of GL, GM and the mediolateral displacement of CoP were, in general, not significant. ConclusionsThe neuromuscular control of the ankle joint and the associated postural stability during SEBT was highly depended upon the activation level of TA and PB, which should be considered by clinicians and sports specialists when using this test for screening and/or rehabilitation purposes.

Plantar Cutaneous Sensory Stimulation Improves Foot Sensibility and Gait Speed in Older Adults With Diabetes: A Clinical Trial.

To determine the effect of an intervention involving muscular ankle strengthening and feet sensory stimuli to improve gait speed and balance in older adults with diabetes mellitus type 2 (DM2). A clinical trial with concealed allocation, assessor blinding, and intention-to-treat analysis. The trial enrolled 66 people 60 years or older with DM2 who were physically independent (did not require assistance with activities of daily living). The experimental group performed 12 weeks of plantiflexor and dorsiflexor muscle strengthening exercises with resistance bands, proprioceptive exercises on balance boards and a buoy, and plantar sensory stimulation with bristle brushes and cloths, as well as general foot care instructions. The control group received foot care instructions only. The primary outcome was plantar cutaneous sensibility as measured with Semmes-Weinstein monofilaments. Secondary outcomes included muscular strength (plantar flexion and dorsiflexion torque as measured with an isokinetic dynamometer), gait speed, and balance (total displacement area, mediolateral displacement, anteroposterior displacement, mediolateral displacement speed, and anteroposterior displacement speed) on right and left bipedal and unipedal supports. In comparison with the control group, the experimental group demonstrated improved plantar cutaneous sensibility on the right foot (3.46 points; 95% confidence interval [CI], 3.85-9.80), left foot (3.46 points; 95% CI, 4.06-9.76), and an increase in gait speed (0.15 m/s; 95% CI 0.12-0.42). There were no meaningful changes in participants' ankle muscle strength or balance. This study showed that plantar cutaneous sensory stimulation can improve foot sensibility and increase the gait speed of older adults with DM2. However, there were no meaningful dorsiflexor or plantiflexor gains after 12 weeks.

Effect of ultrasound-guided percutaneous neuromodulation in ankle instability: a case study

Abstract Background and Aims Ankle proprioception can be tested in many ways. Some studies have found improvements in individuals with chronic ankle instability after receiving treatment and training proprioceptive acuity and speed. Currently, there is a scarcity of evidence concerning percutaneous neuromodulation. The first findings were reported in the post-surgical stage after total knee arthroplasty and in neural improvements and symptoms in patients with hyperactive bladder. Aim To evaluate the effectiveness of percutaneous neuromodulation on the tibial nerve for the improvement of various proprioception parameters in patients with chronic ankle instability. Material and Methods Five men (age: 24.8 ± 4.9 years; height: 1.78 ± 0.08 m; weight: 86 ± 9.8 kg) with chronic ankle instability, who regularly practiced sports activities participated in the present study. People who had undergone an injury in the previous three months were excluded from the speed. Currently, there is a scarcity of evidence concerning test before and immediately after percutaneous neuromodulation. A single leg balance test was performed with eyes open and closed, maintaining the single-legged position on a force plate during 30 seconds (Accupower; AMTI, Watertown, MA) registering 1000 Hz. The displacement of the center of pressure (DOT) was determined based on the distances of its antero-posterior axes (DOT_AP) and medio-lateral (DOT_ML). Furthermore, the amplitudes of anteroposterior and mediolateral displacement were evaluated (ACPap and ACPml). The posterior tibial nerve was stimulated under ultrasound guidance using a 100 Vpp current, with a pulse width of 250 μs and a repetition frequency of 2 to 10 Hz. The process was performed on three occasions during 30 seconds, with an intensity that was acknowledged by the patient but which did not go beyond a score of 3 in the visual analog scale (VAS). The means and standard deviations were calculated for all variables. The effect size was calculated establishing the confidence interval at 90% and the probability of the change being significant was qualitatively calculated. Results A decrease was found in the ACPap (Pre-test eyes open: 5.42 ± 0.62 and eyes closed: 15.99 ± 0.60; Post-test eyes open 4.05 ± 0.36 and eyes closed 10.33 ± 0.49) after the neuromodulation intervention on the tibial nerve. This was a significant change and a “possible” effect size was found in the closed eyes condition (-0.54; ± 0.72), according to Hopkins. For the remaining variables, no significant differences were observed. Conclusions A decreased displacement of the center of mass was found in the antero-posterior axis after performing the neuromodulation technique on the tibial nerve in patients with chronic ankle instability.

Correlation Between the Trajectory of the Center of Pressure and Thermography of Cancer Patients Undergoing Chemotherapy

ObjectiveTo correlate the potential of the stabilometric parameters of baropodometry with the superficial temperature of the legs of cancer patients during and after treatment. MethodThis study included 30 volunteers of both sexes, divided into the following groups: chemotherapy–radiotherapy group (CRG) (n = 15; age = 57.13 ± 16.74 years) and cancer group without current treatment (n = 15; age = 63.29 ± 7.34 years). They were assessed for superficial temperature of the legs using infrared thermography with anterior and posterior views. Assessment of postural balance was conducted using a baropodometer in 2 conditions—participants’ open eyes and closed eyes—to obtain the center of pressure (COP) of anteroposterior displacement, COP of mediolateral displacement, and COP of displacement area. ResultsWhen their eyes were open, the CRG participants presented a high correlation between the displacement of the ML and the surface anterior temperature of both legs (right: r = 0.578, P = .030; left: r = 0.619, P = .018) and posterior region of the right leg (r = 0.571; P = .033), and they presented a high correlation between COP with anterior surface temperature of both legs (right: r = 0.585, P = .028; left: r = 0.540, P = .046). When patients’ eyes were closed, no correlation was found between the thermography and the stabilometric parameters evaluated. ConclusionDuring the chemotherapy-radiotherapy, cancer patients present ML and COP displacement that correlates with infrared thermography evaluation when their eyes are open.

Evaluation of the intraoperative kinematics during double-bundle anterior cruciate ligament reconstruction using a navigation system

Background/objectiveThere is controversy regarding the biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles in isolated tibiofemoral rotation during double-bundle anterior cruciate ligament (ACL) reconstruction. This study aimed to evaluate the biomechanical function of the AM and PL bundles of the ACL using a computer navigation system. MethodsThis study involved 15 patients who underwent double-bundle ACL reconstruction. Anteroposterior and isolated rotational knee laxity were measured with a navigation system. The measurements were performed four times, namely, before fixation, after temporary PL bundle fixation, after AM bundle fixation, and after double-bundle reconstruction. With knee flexion ranging from 20° to 60°, we continuously measured the anterior tibial displacement under an anterior drawer stress (100 N using a spring balance). The total range of tibial rotation was also measured under an external and internal rotational torque of 3 Nm. ResultsFixation of either the AM or the PL bundle significantly reduced the anteroposterior displacement at all knee flexion angles. Although the anteroposterior displacement after AM bundle fixation was relatively similar throughout the range of motion (2.4–3.2 mm), the anteroposterior displacement after PL bundle fixation increased continuously with knee flexion (2.2–4.6 mm). With respect to the total range of tibial rotation under external and internal rotational torque, there was no significant difference between AM and PL bundle fixation throughout the range of motion. The total range of tibial rotation was significantly reduced only on double-bundle reconstruction at 20° and 25° knee flexion compared to the pre-reconstruction range (P = 0.015 and 0.036, respectively). ConclusionThe AM and PL bundles function differently for controlling anterior knee laxity throughout the range of motion. The function of the AM and PL bundles was similar for controlling isolated tibiofemoral rotation. Isolated tibiofemoral rotation was significantly controlled only on double-bundle reconstruction at knee flexion angles of 20° and 25°.

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age.

Sagittal craniosynostosis (SCS), the most common type of premature perinatal cranial suture fusion, results in abnormal head shape that requires extensive surgery to correct. It is important to find objective and repeatable measures of severity and surgical outcome to examine the effect of timing and technique on different SCS surgeries. The purpose of this study was to develop statistical models of infant (0-6months old) skull growth in both normative and SCS subjects (prior to surgery). Our goal was to apply these models to the assessment of differences between these two groups in overall post-natal growth patterns and sutural growth rates as a first step to develop methods for predictive models of surgical outcome. We identified 81 patients with isolated, non-syndromic SCS from Seattle Children's Craniofacial Center patient database who had a preoperative CT exam before the age of 6months. As a control group, we identified 117 CT exams without any craniofacial abnormalities or bone fractures in the same age group. We first created population-level templates from the CT images of the SCS and normal groups. All CT images from both groups, as well as the canonical templates of both cohorts, were annotated with anatomical landmarks, which were used in a growth model that predicted the locations of these landmarks at a given age based on each population. Using the template images and the landmark positions predicted by the growth models, we created 3D meshes for each week of age up to 6months for both populations. To analyze the growth patterns at the suture sites, we annotated both templates with additional semi-landmarks equally spaced along the metopic, coronal, sagittal and lambdoidal cranial sutures. By transferring these semi-landmarks to meshes produced from the growth model, we measured the displacement of the bone borders and suture closure rates. We found that the growth at the metopic and coronal sutures were more rapid in the SCS cohort than in the normal cohort. The antero-posterior displacement of the semi-landmarks also indicated a more rapid growth in the sagittal plane in the SCS model than in the normal model. Statistical templates and geometric morphometrics are promising tools for understanding the growth patterns in normal and synostotic populations and to produce objective and reproducible measurements of severity and outcome. Our study is the first of its kind to quantify the bone growth for the first 6months of life in both normal and sagittal synostosis patients.

The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group (P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group (P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm (P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.

Correlation Between the Trajectory of the Center of Pressure and Thermography of Cancer Patients Undergoing Chemotherapy

ObjectiveThe purpose of this study was to correlate potential the stabilometric parameters of baropodometry with the superficial temperature of the legs of cancer patients during and after treatment. MethodsThis study included 30 volunteers of both sexes, divided into the following groups: chemotherapy-radiotherapy group (n = 15; age = 57.13 ± 16.74 years) and cancer group without current treatment (n = 15; age = 63.29 ± 7.34 years). They were assessed for superficial temperature of the legs using infrared thermography with anterior and posterior views. Assessment of postural balance was conducted using a baropodometer, in 2 conditions—participants’ open and closed eyes—to obtain the center of pressure (COP) of anteroposterior displacement, center of pressure of mediolateral displacement (COP-ML), and center of pressure of displacement area. ResultsWhen their eyes were open, the chemotherapy-radiotherapy group presented a high correlation between the displacement of the ML and the surface anterior temperature of both legs (right: r = 0.578; P = .030; left: r = 0.619; P = .018) and posterior region of the right leg (r = 0.571; P = .033), and they presented a high correlation between COP with anterior surface temperature of both legs (right: r = 0.585; P = .028; left: r = 0.540; P = .046). When patients’ eyes were closed, no correlation was found between the thermography and the stabilometric parameters evaluated. ConclusionDuring the chemotherapy-radiotherapy, cancer patients present ML and COP displacement that correlates with infrared thermography evaluation when their eyes are open.

Do the type of walking surface and the horse speed during hippotherapy modify the dynamics of sitting postural control in children with cerebral palsy?

BackgroundHippotherapy is described as a rehabilitation method for postural control in children with cerebral palsy. Horse's movements can be manipulated during hippotherapy's sessions with horse walking on different surfaces and at different speeds. The purpose of this study was to assess if dynamic sitting postural control in children with cerebral palsy in hippotherapy is modified when surfaces (sand or asphalt) and horse's walking speed (slow or faster) are changed. MethodsSixteen children participated in this crossover study. Eight bilateral spastic cerebral palsy children, age range (6–12 years), with Gross Motor Function Classification System levels III to IV, practicing hippotherapy and eight children with typical development (reference group), matched for age and sex. All children were evaluated during riding a horse on sand and asphalt surfaces and at slow (self-selected) and faster (30%) horse's walking speed. Center of pressure parameters were determined by a portable pressure measurement system positioned on the saddle. FindingsMediolateral displacement amplitude of the center of pressure was larger when the horse was on sand. Mediolateral and anteroposterior displacements amplitude and velocities of the center of pressure increased at horse's faster walking speed. InterpretationOur study test empirical procedures used in clinical practice and with a population widely reached by hippotherapy. In order to increase the demand for sitting postural control in children with cerebral palsy during horse riding, faster horse speed or riding on sand should be used.

Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study.

Retrospective multicenter study. Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures. Treatment of odontoid fractures in aged population is still debatable. One hundred fourty-seven consecutive odontoid fractures in elderly patients were classified according to Anderson-D'Alonzo and Roy-Camille classifications. Philadelphia type collar was always positioned and kept as a treatment whenever acceptable. Halo-vest, anterior screw fixation, C1-C2 posterior arthrodesis, and occipito-cervical fixation were the other treatments adopted. Conservative or surgical treatment strategy was more significantly influenced by antero-posterior displacement (< or >5 mm) and by surgeon decision. On admission ASA, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI) were assessed. Modified Rankin scale (mRS-post), Neck Disability Index (NDI), and Smiley Webster Pain Scale (SWPS) were administered 12 to 15 months after treatment to estimate functional outcome in terms of general disability, neck-related disability, and ability to return to work/former activity. Risk of treatment crossover was calculated considering factors affecting outcome. Fracture healing process in terms of fusion-stability, no fusion-stability, no fusion-no stability was evaluated at 12 months through a cervical computed tomography (CT) scan. Dynamic cervical spine x-rays were obtained whether necessary. No fusion-stability was considered an adequate treatment goal in our geriatric population. Chi square/Fisher exact test and logistic regression were performed for statistical anal. Overall 67 patients were treated conservatively whereas 80 underwent surgery. Collar was adopted in 45 patients, while anterior odontoid fixation and C1-C2 posterior arthrodesis were preferred for 30 patients each. 79.8% of patients showed good outcomes according to NDI. No significant differences were observed between patients of 65 to 79 years and more than or equal to 80 years (P = 0.81). CCI greatly correlated with mRS-post, with higher indexes in 68.8% of cases characterized by good outcomes (P = 0.05). mRS-pre correlated with NDI (P < 0.000001) and mRS-post (P = 0.04). CCI, mRS-pre, and surgery were associated with worse NDI, while both C1-C2 posterior arthrodesis and occipito-cervical stabilization were associated with worse mRS-post, respectively in 40% and 30% of cases. Younger patients had a higher risk of treatment crossover. mRS-pre and CCI provided two independent predictive values respectively for functional outcome and post-treatment disability. Compared with conservative immobilizations, surgery revealed no advantages in the elderly in terms of functional outcome. 3.

Balance Performance With and Without Visual Information: A Comparison of Elite Players With Chronic Ankle Instability

Introduction: This research was conducted to determine whether professional athletes with Chronic Ankle Instability (CAI) exhibit differences in maintaining balance under conditions of with and without visual information Materials and Methods: Forty-five elite players with CAI were classified into soccer, volleyball, and basketball groups (n=15 each). All participants performed a static single-leg balance test in conditions wherein visual information was provided and withheld. Also, their center of pressure (CoP) oscillation parameters was measured. The data were examined through an analysis of variance (ANOVA) and the Tukey test. Results: A significant difference was found between the soccer and volleyball players (P=0.034) in anteroposterior CoP displacement. Furthermore, there was a significant difference between soccer compared with volleyball (P=0.001) and basketball (P=0.02) groups regarding mediolateral sway and sway area (P=0.003 and P=0.03, respectively) when they performed the test with their eyes open. A significant difference occurred between the soccer and volleyball players concerning anteroposterior and mediolateral sway (P=0.002 and P=0.04, respectively) and sway area (P=0.004) when they performed the test with their eyes closed. Conclusion: Given the necessity of maintaining a good balance in sports, volleyball coaches should design practices that reduce players’ reliance on visual information. These practices should strengthen their proprioceptive abilities through an increased challenge to their proprioceptive senses.

Étude des atteintes posturales chez les patients déficients visuels

IntroductionBalance is an active system allowing the body to maintain individual stability despite external stimuli. It relies on many senses which provide data to compensate for external variations such as visual information. It is thus necessary that the senses be in good condition and transmit accurate data. We wished to study postural adaptations made by visually impaired people. Material and methodsWe performed a prospective study of patients with macular degeneration with visual acuity less than 20/40, glaucoma with a mean visual field defect less 12 decibels, and a control population. All subjects underwent a dynamic equilibrium test on a stabilometric platform with Win-Posturo software. We assessed their postural profile in various situations : eyes open, eyes closed, balance, anteroposterior displacement and lateral displacement. ResultsThe first group consisted of 16 patients with age macular degeneration (AMD), the second of 17 patients with glaucoma and the third of 18 control subjects. In static equilibrium, for the parameter “length vs. surface area,” all groups had an improvement in their performance with eyes open (P=0.05). There was a significant difference between the subject and control groups (P<0.01). In addition, subjects in the group with peripheral visual impairment had significantly greater tendency to lean forward. In dynamic equilibrium, we did not demonstrate any significant difference between the groups. DiscussionIn static equilibrium, patients with poor peripheral vision have better quality somatosensory compensation, but they have a tendency to lean forward, which increases the risk of falling forward. For the three groups, the tests showed that the subjects are vision-dependent, which implies that somatosensory compensation could be developed to limit this dependency. In dynamic equilibrium, the subjects in the disease groups perform significantly worse than the controls. All the visually impaired have a more developed somatosensory mechanism than the controls. The subjects in the first and third groups have the same postural profile, they are vision-dependent. Subjects in the second group have an instability and change in their postural strategy, increasing the risk of falling. Visual acuity has a lesser impact on the risk of falling than the visual field. ConclusionComparing postural responses in these different situations, it appears that postural profiles are modified in the case of visual disability, although the postural profile of the group with central visual loss is similar to that of the controls. Retinal involvement, whether central or peripheral, leads to postural imbalance that may result in falls in certain cases. To limit the prevalence of these falls, it would be interesting to address visually impaired patients by examination and postural rehabilitation to decrease the effects of this visual impairment.

Physiological motion of the optic chiasm and its impact on stereotactic radiosurgery dose.

Avoidance of radiation-induced optic neuropathy (RION) from stereotactic radiosurgery (SRS) requires precise anatomical localization; however, no prior studies have characterized the physiologic motion of the optic chiasm. We measured the extent of chiasm motion and its impact on SRS dose. In this cross-sectional study, serial MRI was performed in multiple planes in 11 human subjects without optic pathway abnormalities to determine chiasm motion across time. Subsequently, the measured displacement was applied to the hypothetical chiasm dose received in 11 patients treated with SRS to a perichiasmatic lesion. On sagittal images, the average anteroposterior chiasm displacement was 0.51 mm [95% confidence interval (CI) 0.27 - 0.75 mm], and the average superior-inferior displacement was 0.48 mm (95% CI 0.22 - 0.74 mm). On coronal images, the average superior-inferior displacement was 0.42 mm (95% CI 0.13 - 0.71 mm), and the average lateral displacement was 0.75 mm (95% CI 0.42 - 1.08 mm). In 11 patients who underwent SRS to a perichiasmatic lesion, the average displacements increased the maximum chiasm dose (Dmax) by a mean of 14 % (range 6-23 %; p < 0.001). Average motion of the optic chiasm was approximately 0.50-0.75 mm, which increased chiasm Dmax by a mean of 14%. In the occasional patient with higher-than-average chiasm motion in a region of steep dose gradient, the increase in chiasm Dmax and risk of RION could be even larger. Similarly, previously reported chiasm dose constraints may underestimate the true dose received during radiosurgery. To limit the risk of RION, clinicians may consider adding a 0.50-0.75 mm expansion to the chiasm avoidance structure.