Dorsiflexor Strength Research Articles

An Analytical Insight Into How Walking Speed and Spatial and Temporal Symmetry Are Related to Ankle Dysfunctions in Children With Hemiplegic Cerebral Palsy.

The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy. This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed. The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R2 = 0.38, P < 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R2 = 0.15, P < 0.001) and the highest portion of the variance in spatial walking symmetry (R2 = 0.18, P = 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R2 = 0.10, P = 0.021). In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles.

Changes in walking velocity and stride parameters with age in children with Charcot-Marie-Tooth disease

The purpose of this study is to assess how Charcot-Marie-Tooth disease, a group of inherited peripheral neuropathies that result in distal weakness, affects walking velocity over time in comparison to age-matched controls. Comprehensive gait analysis of 57 children (mean age 12.0, SD 3.7 years) compared to 76 age-matched controls (mean age 10.1, SD 3.4 years) demonstrated slower walking velocity (p<0.001) due to both shorter stride length (p<0.001) and diminished cadence (p=0.01). There was higher walking velocity (p<0.001), stride length (p=0.002) and cadence (p<0.001) in patients with dorsiflexor strength ≥3 and higher walking velocity (p=0.001) and cadence (p=0.03) in patients plantar flexor strength ≥4. Analysis of Charcot-Marie-Tooth type 1 and type 2 subgroups showed that walking velocity increased significantly with age in controls (p=0.001) but did not increase in children with either subtype (p>0.54). Stride length increased significantly with age in all groups (p<0.001) but at a slower rate in type 1 and 2 compared to controls. These differences contributed to increasing deficits in walking velocity and stride length with age in type 1 and 2 in comparison to controls, with deficits appearing earlier in type 2. Since the slower walking velocity in children with Charcot-Marie-Tooth disease is primarily due to short stride length, treatments that enable improved stride length, such as plantar flexor strengthening and bracing, may improve walking velocity and associated gait function.

Factors influencing physical activity in patients with colorectal cancer.

Physical activity (PA) is a modifiable health behaviour in patients with colorectal cancer (CRC). Knowing the possible predictors of PA will contribute to producing physical and psychological benefits for CRC patients. To investigate the factors that influence PA in patients with CRC. This cross-sectional study was conducted with 47 participants with CRC. Demographic and clinical characteristics, neuropathic pain (Douleur Neuropathique 4 (DN4)), peripheral muscle strength (knee extensor and flexor, hip extensor and flexor, and ankle dorsiflexor muscle strength), balance (Balance Master System (BMS) and Berg Balance Scale (BBS)), fatigue (Brief Fatigue Inventory (BFI)), PA (International PA Questionnaire Short Form (IPAQ-SF)), and quality of life (36-item Short Form Health Survey (SF-36)) were evaluated. Multiple linear regression analysis was used to determine the variables that have the greatest influence on PA. IPAQ-SF score had moderate correlations with knee extensor muscle strength (r = 0.310, p = 0.034), BBS (r = 0.361, p = 0.013), and limit of stability test (movement velocity) score (r = 0.385, p = 0.008), BFI- severity of fatigue (r = - 0.488, p = 0.001), impact of fatigue on daily functioning (r = - 0.421, p = 0.003), and the SF-36 sub-parameters (role limitations due to physical health problems, physical functioning, general health perceptions and vitality) (p < 0.05). Role limitations due to physical problems, knee extensor muscle strength, and severity of fatigue had the greatest influence on PA in patients with CRC with explaining 43% of the variance in PA. This study suggests that quality of life, knee extensor muscle strength, and fatigue have the greatest influence on PA in patients with CRC.

Comparison of Tibialis Anterior Muscle Activity and Dorsiflexor Strength according to Toe Postures

Comparison of Tibialis Anterior Muscle Activity and Dorsiflexor Strength according to Toe Postures

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series.

Introduction:The study purpose was to determine the safety/efficacy of a split anterior tibialis tendon transfer (SPLATT) to the peroneus tertius or brevis in children with static encephalopathy and varus feet.Methods:A retrospective review of short- and long-term complications, change in ankle range of motion, strength, and gait kinematics. Predictors of postoperative varus or valgus were examined.Results:One hundred thirty-three patients were included (average age [SD] 10.3 [3.7]), with an average follow-up of 3.9 (3.4) years. Forefoot/hindfoot eversion range of motion improved (P ≤ 0.05), dorsiflexor strength was maintained or improved in 76.9% of patients, and dorsiflexion in swing phase was maintained. Complications occurred in 6 of 133 patients (4.5%) and included 1 transfer failure, 1 wound dehiscence, and four pressure areas from casts. Successful correction was achieved in 77% of patients. Later onset of recurrent varus (14.4%, 10.6% requiring revision surgery) and pes valgus (8.7%, 4.8% requiring revision surgery) occurred. The length of the follow-up predicted the development of the pes valgus (odds ratio 1.28, 95% CI 1.0 to 1.6).Discussion:SPLATT to the peroneus tertius or brevis is effective, and complications are rare. Subsequent valgus or recurrent varus deformities may occur, possibly requiring repeat surgery.

Obesity and foot muscle strength are associated with high dynamic plantar pressure during running

Obese people are often encouraged to lose body mass by exercise. The aim of the study was to determine the effect of body mass and ankle muscle strength on the dynamic foot-pressure distribution before and after running. Twenty-five normal weight (72.0±5.3kg), 25 overweight (80.8±5.6kg) and 25 obese (96.8±6.5kg) age- and height-matched male recreational runners joined the study. Before and after 30min running, dynamic foot-pressure distribution during running, and ankle plantarflexor, dorsiflexor, invertor and evertor muscle strength were measured using a foot-scan pressure-plate and isokinetic dynamometer, respectively. Body mass index and percentage fat mass correlated positively to almost all components of foot-pressure distribution; this explantion was extracted from 14% (for toe 1) to 52% (for dynamic arch index) of peak foot pressure and between 21% (for metatarsal 1) to 48% (for midfoot) of the impulse underneath different foot zones. Only plantarflexor muscle strength significantly predicted plantar pressure and impulse underneath the T1, T2-5, midfoot area and the dynamic arch index. After running, plantarflexor and invertor muscle strength predicted from 30% (for metatarsal 2) to 58% (for metatarsal 1) of peak foot-pressure and impulse underneath the different foot zones. Obesity is associated with excessive plantar loading that is aggravated after running by fatigue-related reductions in plantar flexor and invertor muscle strength. To prevent foot pain and injuries related to excessive foot pressures, at the start of the weight control process non-weight bearing rather than weight-bearing exercise is advisable.

The association between anthropometric, lower limb strength, and balance variables with 5-repetition sit-to-stand test performance in physically active elderly women

BACKGROUND: Sit-to-stand test is very often used as measure of lower limb strength in elderly adults. However, the recent findings indicate that performance in this test is also influenced by other factors. OBJECTIVE: To investigate the association between anthropometric, lower limb strength, and balance variables with the 5-repetition sit-to-stand test (5RSTST) in elderly women. METHODS: Forty physically active elderly women ⩾ 60 years underwent the 5RSTST and anthropometric, balance, and lower limb strength assessment. Anthropometric measurements included height and weight. Balance was quantified in the bipedal upright stance on the basis of the centre of pressure sway in the anteroposterior (CoPAP) and mediolateral (CoPML) direction. Bilateral concentric strength of the ankle plantarflexors and dorsiflexors, knee flexors and extensors, and hip extensors was measured. RESULTS: The time to complete the 5RSTST was significantly but mildly associated with height (r= 0.356, p= 0.024), ankle dorsiflexor strength (r=-0.413, p= 0.017), knee flexor strength (r=-0377, p= 0.030), knee extensor strength (r=-0.411, p= 0.017), hip flexor strength (r=-0.359, p= 0.040) on dominant limb, and balance in both directions (AP, r= 0.651, p&lt; 0.001; ML, r= 0.647, p&lt; 0.001). Balance control in AP direction and knee extensor strength on dominant limb were the only factors that contributed independently to 5RSTST, accounting for 55% of the variance. Balance control in AP direction alone explained 41% of the variance in 5RSTST. CONCLUSIONS: Balance control in AP seems to be the most important factor explaining the 5RSTST performance.

Strength training and aerobic exercise training for muscle disease.

Background Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004. Objectives To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease. Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012). Selection criteria Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease. We did not use the reporting of specific outcomes as a study selection criterion. Data collection and analysis Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies. Main results We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1. In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported. Authors' conclusions Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke currently remain uncertain. This is an update of the review published in 2017. To assess the effects of rPMS in improving activities of daily living and functional ability in people after stroke. On 7 January 2019, we searched the Cochrane Stroke Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); Occupational Therapy Systematic Evaluation of Evidence (OTseeker); the Physiotherapy Evidence Database (PEDro); ICHUSHI Web; and six ongoing trial registries. We screened reference lists, and we contacted experts in the field. We placed no restrictions on the language or date of publication when searching electronic databases. We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only. Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias, undertook data extraction, and used the GRADE approach to assess the quality of evidence. We contacted trial authors to request unpublished information if necessary. We resolved all disagreements through discussion. We included four trials (three RCTs and one cross-over trial) involving 139 participants. Blinding of participants and physicians was well reported within all trials. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We observed a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03; P = 0.03; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-quality evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the quality of evidence related to the primary outcome as low, owing to the small sample size of the studies. Available trials provided insufficient evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Effect of Ankle Weight during Gait Training on Dorsiflexors Strength in Hemiparetic Children

AbstractBackground: Affected side toe walking is a common problem in hemiparetic cerebral palsy children, that may occur due to spasticity of planter flexors muscles and inhibition of anterior tibial muscles, walking with equines foot lead to abnormal gait pattern, frequent falling down, pain at the metatarsal heads and compensatory reaction that affects hip and trunk and may cause contracture of calf muscle which may need surgery. Using ankle weight during gait training may be an effective treatment tool in hemiparetic children.Aim of Study: The current study was conducted to inves-tigate the effect of using ankle weight during gait training in hemiparetic children.Subjects and Methods: Thirty hemiparetic children par-ticipated in this study, their ages range from 3 to 6 years, all subjects were recruited from the outpatient clinic at the Faculty of Physical Therapy, Cairo University. They were assigned randomly in to two group of equal number; Group A control group received a specific physical therapy program and Group B study group received the same specific physical therapy program as in Group A in addition to weight started 1/2kg placed above ankle of the affected side during gait training. Hand held dynamometer was used to measure ankle dorsiflex-ors muscle strength and Kinovea software was used to measure dorsiflexion angle during initial foot contact.Results: There was a significant increase in ankle dorsi-flexors muscle strength and a significant decrease of dorsi-flexion angle during initial contact in the study group compared to the control group.Conclusion: Ankle weight during gait training can be an effective treatment tool in improving dorsiflexors muscle strength in hemiparetic children.

Effect of Sensory Impairment on Balance Performance and Lower Limb Muscle Strength in Older Adults With Type 2 Diabetes.

ObjectiveTo compare balance performance and lower limb muscle strength between older adults with type 2 diabetes mellitus (DM), with and without sensory impairments and non-DM groups. Influence of a number of sensory impairments, and muscle strength on balance performance were explored.MethodsNinety-two older adults with and without type 2 DM, were examined relative to visual function with the Snellen chart, Melbourne Edge test, and Howard-Dolman test, vestibular function with the modified Romberg test, proprioception of the big toe, and diabetic peripheral neuropathy with the Michigan Neuropathy Screening Instrument. Balance performances were evaluated with the Romberg test, Functional Reach Test (FRT), and Timed Up and Go test (TUG). Strength of knee and ankle muscles was measured.ResultsFRT of type 2 DM groups with at least two sensory impairments, was lower than the non-DM group (p<0.05). TUG of all DM groups, was worse than the non-DM group (p<0.01). Lower limb muscle strength of type 2 DM groups with two and three sensory impairments, was weaker than non-DM group (p<0.05). Regression analysis showed that type 2 DM with three sensory impairments, ankle dorsiflexors strength, and age were influential predictors of TUG.ConclusionThere were significant differences, of muscle strength and balance performance among groups. Poorer balance and reduced lower limb strength were marked in older adults with type 2 DM, even ones without sensory impairment. Muscle weakness seemed to progress, from the distal part of lower limbs. A greater number of sensory impairments, weaker dorsiflexors, and advanced age influenced balance performance.

Combined Ankle/Knee Stretching and Pivoting Stepping Training for Children With Cerebral Palsy.

After the SS-POINT program, subjects with CP showed reduced knee stiffness and intoeing angle, and improvements in both joint and leg functions in terms of ankle and knee active range of motion, ankle dorsiflexor strength, proprioception, walking speed, balance, and minimum pivoting angle. Furthermore, improvements in proprioceptive acuity and minimum pivoting angle after the SS-POINT were greater than those after the POINT. The SS-POINT approach can be used as a subject-specific training program for improving leg and walking functions and reducing intoeing during gait. This approach can serve as an individualized intervention at the joint and walking levels to maximize intervention effects by adjusting training targets, sequences, and intensities to meet the individual needs of children with CP.

The Acute Effect of Talocrural Joint Mobilization on Dorsiflexor Muscle Strength in Healthy Individuals: A Randomized Controlled Single-Blind Study

Mobilization has been used for enhancing muscle strength. The aim of this study was to investigate the acute effect of talocrural joint mobilization on ankle dorsiflexor muscle strength in healthy individuals, which has not yet been studied. Randomized controlled single-blind study. University laboratory. Forty-eight healthy individuals. Maitland grade III (study group) versus Maitland grade I (control group) mobilizations. Muscle strength measurements were performed using a handheld dynamometer at baseline, immediately after the mobilization, and 30 minutes after mobilization. At baseline, the physical characteristics and muscular strength were similar in both groups (P > .05). According to Friedman analysis, a significant difference was detected following the mobilization in the study group (P < .001), and while the muscle strength at immediately after the mobilization and at 30 minutes after mobilization was significantly higher than baseline (P < .001), no significant differences were observed between 30 minutes after mobilization and immediately after the mobilization (P = .17). However, no significant changes were detected in the control group. The study group was found superior to the control group in terms of muscle strength differences following the mobilization (P < .001). The ankle dorsiflexor muscle strength might be increased by performing Maitland grade III mobilization, and this increase might be preserved for 30 minutes, while Maitland grade I mobilization did not lead to such an improvement in healthy individuals.

Effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training for contracture management: a randomized controlled trial

Objective: To determine the effectiveness of a programme comprising serial casting, botulinum toxin, splinting and motor training in contracture management. Design: A randomized trial with concealed allocation and assessor blinding, a deferred treatment cross-over design within the control group, was conducted. Setting: Inpatient Brain Injury Unit of a rehabilitation centre. Subjects: A total of 10 patients with severe acquired brain injury (13 ankles). Interventions: The intervention group received botulinum toxin and then serial casting. The control group was placed on a wait list for six weeks (control phase) and then received the same interventions as the intervention group (intervention phase). Both groups received splinting and motor training following serial casting. Main measures: The primary outcome was passive ankle dorsiflexion range. Secondary outcomes included spasticity, ankle dorsiflexor strength, Functional Independence Measure score for the walking item and walking speed. Results: The mean between-group difference for passive ankle dorsiflexion range at completion of casting was 26° (95% confidence interval (CI): 17–35); at Week 2, after casting was 24° (95% CI: 14–33). The mean within-group differences for passive ankle dorsiflexion at completion of casting, Week 2 after casting and Week 8 after casting were 26° (95% CI: 20–31), 26° (95% CI: 18–33) and 24° (95% CI: 19–30), respectively. These improvements were sustained at Week 2 and Week 8 after casting. Conclusions: A programme for contracture management comprising serial casting, botulinum toxin, motor training and splinting can be useful in improving joint range.

The characteristics of plantar flexors and dorsiflexors strength in patients after complete three-bundle Achilles tendon reconstruction

The characteristics of plantar flexors and dorsiflexors strength in patients after complete three-bundle Achilles tendon reconstruction

Effects of neuromuscular electrical stimulation on gait performance in chronic stroke with inadequate ankle control - A randomized controlled trial.

Neuromuscular electrical stimulation (NMES) has been used to improve muscle strength and decrease spasticity of the ankle joint in stroke patients. However, it is unclear how NMES could influence dynamic spasticity of ankle plantarflexors and gait asymmetry during walking. The study aimed to evaluate the effects of applying NMES over ankle dorsiflexors or plantarflexors on ankle control during walking and gait performance in chronic stroke patients. Twenty-five stroke participants with inadequate ankle control were recruited and randomly assigned to an experimental or a control group. The experimental group received 20 minutes of NMES on either the tibialis anterior muscle (NMES-TA) or the medial gastrocnemius muscle (NMES-MG). The control group received 20 minutes of range of motion and stretching exercises. After the 20 minutes of NMES or exercises, all participants received ambulation training for 15 minutes. Training sessions occurred 3 times per week for 7 weeks. The pre- and post-training assessments included spatio-temporal parameters, ankle range of motion, and dynamic spasticity of ankle plantarflexors during walking. Muscle strength of ankle dorsiflexors and plantarflexors as well as static spasticity of ankle plantarflexors were also examined. The results showed that the static and dynamic spasticity of ankle plantarflexors of the NMES-TA group were significantly decreased after training. Reduction in dynamic spasticity of ankle plantarflexors of the NMES-TA group was significantly greater than that of the NMES-MG group. When compared to the control group, the NMES-TA group had greater improvements in spatial asymmetry, ankle plantarflexion during push off, and muscle strength of ankle dorsiflexors, and the NMES-MG group showed a significant decrease in temporal asymmetry. In summary, NMES on ankle dorsiflexors could be an effective management to enhance gait performance and ankle control during walking in chronic stroke patients. NMES on ankle plantarflexors may improve gait symmetry.

Absence of a Transcranial Magnetic Stimulation-Induced Lower Limb Corticomotor Response Does Not Affect Walking Speed in Chronic Stroke Survivors.

Background and Purpose- Transcranial magnetic stimulation is used to measure the functional integrity of the corticomotor system via motor evoked potentials (MEPs) in stroke. The association between corticomotor mechanisms and walking recovery is still not completely understood. This study determined the association between transcranial magnetic stimulation-induced MEPs and walking outcomes and examined the contribution of the contralesional hemisphere to walking recovery. Methods- Contralateral and ipsilateral transcranial magnetic stimulation responses from the contralesional and ipsilesional hemispheres were collected from 61 chronic stroke survivors. Clinical assessments included gait speeds, 6-minute walk distance, Timed Up and Go test, Fugl Meyer lower extremity scale, and strength measurements. Results- Stroke participants were classified based on the presence (MEP+ [n=28]) or absence (MEP- [n=33]) of MEPs in the paretic tibialis anterior and rectus femoris muscles. A between-group analyses showed no significant differences for any gait variable. MEP+ group showed significantly higher Fugl Meyer lower extremity and ankle dorsiflexor strength. Ipsilateral conductivity was not significantly different between groups. Finally, in the MEP+ group, MEP parameters did not predict gait recovery. Conclusions- Our study investigated the association between walking outcomes and neurophysiological parameters of lower limb function in a large cohort of stroke survivors. We did not find an associations between transcranial magnetic stimulation-induced tibialis anterior and rectus femoris MEPs and walking speeds. Further work is required to develop more comprehensive models in stroke for predicting walking recovery.

기능적 발목관절의 비대칭성 및 안정성 향상을 위한 통합적 기능운동프로그램 적용효과

The purpose of this study was to investigate the effect of asymmetric and stability enhancement of functional ankle joint to use integrative functional exercise program. For this study, 18 adult males who experienced a functional instability based on the effects on the potential strength and strength injuries of vertical force on the ankle joint. For evaluating isokinetic muscular functional, the ankle joint were evaluated for plantarflexor and dorsiflexor strength of 30°/sec and 120°/sec. The conclusions based on the results of this study are as follows. As a result of applying the 8-week integrated functional exercise program, plantarflexor of the right and left, and ipsilateral muscular strength ratio of the right of 30°/sec, plantarflexor of the right and ipsilateral muscular strength ratio of the right and left of 120°/sec, and the vertical axis of the ground reaction force statistical significance. Therefore, the results obtained for the purpose of this study can be used to construct an active protocol for prevention and treatment of chronic and functional lesion injuries of not only the functional ankle joint function but also the rehabilitation A more positive and strategic approach can be achieved through functional approaches such as prevention and strengthening of muscles, improvement of balance ability, and maintenance of posture.

Correlates and predictors of paediatric leg pain: a case–control study

Paediatric leg pains, long described as 'growing pains', frequently present to clinicians, are prevalent in early childhood, disrupt sleep, and distress affected children and parents. There are many cited associations, but no defined leg pain sub-types, nor revealed predictive factors. We explored the implicated factors (viz. foot arches, foot strength, joint mobility, vitamin D, iron) in children with leg pain versus a control group. Leg pain sub-groups-growing pains (GP), restless legs (RLS), both (mixed)-are defined for the first time. A case controlled study design, in a primary care setting, Mumbai, India. A total of 77 children with leg pains (n = 64) and controls (n = 13), aged 3-12years, identified by paediatricians, completed data collection. Blood assays for iron and vitamin D, pain, Beighton score, foot arch, foot strength and anthropometrical data were collected. All outcome measures were validated, with standardised protocols. Leg pain (all groups) was predicted by increased joint mobility and increased ankle dorsiflexion strength (β = 0.56, P < 0.05). GP sub-group was predicted by increased ankle dorsiflexion strength (β = - 0.06, P < 0.05). Mixed (GP/RLS) and RLS sub-groups were predicted by increased ankle dorsiflexion strength (β = 0.66, P < 0.05) and pain questionnaire (β = 0.11, P < 0.05). Hypovitaminosis D was detected in 87% of the sample, and anaemia in 13%. Increased strength of ankle dorsiflexors and joint flexibility were each found predictive for leg pain. Increased body weight, waist girth, and BMI were all associated with leg pain.

Strength of the lower limb and trunk muscles is associated with gait speed in individuals with sub-acute stroke: a cross-sectional study

ObjectivesTo investigate the association between measures of strength of the lower limb and trunk muscles and gait speed and to identify the muscle group that would best predict gait speed in individuals with sub-acute stroke. MethodsUsing a cross-sectional observational study design, forty-four individuals with sub-acute stroke (62 years, SD=14; 4 months, SD=1 post-stroke) were assessed. The evaluations were performed at a university laboratory, participants’ homes, or community-based settings. Bilateral maximum isometric strength (hip, knee, and ankle flexors/extensors, hip abductors, trunk flexors/extensors, and trunk lateral flexors and rotators) was measured using a portable dynamometer. Comfortable and maximum gait speeds were measured using the 10-m walk test. ResultsWeak to moderate associations were found between measures of strength of the lower limb muscles and comfortable (0.36≤r≤0.53; p<0.05) and maximum (0.37≤r≤0.59; p<0.05) gait speeds, except for the non-paretic knee flexors and comfortable gait speed (p=0.06). Weak to moderate associations were also found between measures of strength of the trunk muscles and comfortable (0.39≤r≤0.50; p<0.05) and maximum (0.39≤r≤0.61; p<0.05) gait speeds. Stepwise multiple regression analyses revealed that the non-paretic dorsiflexors and the left lateral trunk flexors explained 29% and 42% of the variance in the maximum and comfortable gait speeds, respectively. ConclusionsThe strength of the lower limb and trunk muscles was positively associated with comfortable and maximum gait speeds. The muscle strength of the non-paretic dorsiflexors and the left lateral trunk flexors might have a role to play in determining comfortable and maximum gait speeds of individuals with sub-acute stroke.