Passive Dorsiflexion Range Of Motion Research Articles

Impact of lower muscle stiffness on ankle dorsiflexion restriction in children with cerebral palsy evaluated using ultrasound elastography

BackgroundPlantar flexor muscles always contribute to limiting the range of motion of ankle dorsiflexion in children with spastic cerebral palsy, but the individual contributions of these muscles are not well defined. This study aimed to identify which muscles' stiffness impacts the dorsiflexion range of motion in children with cerebral palsy. MethodsTwenty-five children with cerebral palsy were included. The maximum passive dorsiflexion range of motion was measured in two positions: hip and knee joints in flexion, and both joints in full extension. Strain ratios indicating muscle stiffness were measured using strain elastography of the lateral and medial gastrocnemius, soleus, flexor hallucis longus, peroneus longus, peroneus brevis, and tibialis posterior muscles. To analyze which muscles impact the limitation of the dorsiflexion range, multiple regression analyses were conducted. The values of muscle stiffness were included as independent valuables, and the values of the dorsiflexion range were included as dependent valuables. A p-value <0.05 was considered statistically significant. FindingsIn the analyses, the soleus and flexor hallucis longus muscle stiffness were significant independent factors for the dorsiflexion range of motion of hip and knee flexion (adjusted R2: 0.50). The lateral gastrocnemius muscle stiffness was a significant independent factor for the dorsiflexion range of motion with both joints in full extension (adjusted R2: 0.61). InterpretationFlexor hallucis longus muscle stiffness, in addition to triceps surae muscle stiffness, was shown to impact dorsiflexion range; attention should be paid to muscle stiffness in children with cerebral palsy.

Evaluation of arthrokinematics and posterior soft tissues of the ankle during ankle dorsiflexion using ultrasound

BackgroundArthrokinematics (caudal and posterior movements of the talus) and posterior soft tissues of the ankle during ankle dorsiflexion have not been objectively evaluated in detail. This study aimed to investigate the characteristics of arthrokinematics and posterior soft tissues of the ankle during ankle dorsiflexion using ultrasound. MethodsThirteen healthy adults participated in the study. Participants whose passive dorsiflexion range of motion (ROM) of the ankle joint was <35° were classified as the restricted group (n = 6), and participants whose passive ankle dorsiflexion ROM was ≥35° were classified as the control group (n = 7). Passive ankle dorsiflexion was performed to measure the ankle arthrokinematics. Strain elastography was performed to measure the elasticity of the flexor hallucis longus (FHL) and Kager's fat pad (KFP) at each dorsiflexion angle. ResultsA significant difference in the posterior movement of the talus at the ankle dorsiflexion of 30° was observed between the two groups (P = 0.04). The elasticity of the restricted group was increased at all angles in both FHL and KFP (P < 0.05). ConclusionThis study showed that it is possible to objectively evaluate the direction of ankle arthrokinematics and posterior ankle soft-tissue restrictions using ultrasound.

Kilohertz-frequency interferential current induces hypoalgesic effects more comfortably than TENS

Recent research on transcutaneous electrical stimulation has shown that inhibiting nerve conduction with a kilohertz frequency is both effective and safe. This study primarily aims to demonstrate the hypoalgesic effect on the tibial nerve using transcutaneous interferential-current nerve inhibition (TINI), which injects the kilohertz frequency produced by the interferential currents. Additionally, the secondary objective was to compare the analgesic effect and comfort of TINI and transcutaneous electrical nerve stimulation (TENS). Thirty-one healthy adults participated in this cross-over repeated measures study. The washout period was set to 24 h or more. Stimulus intensity was set just below the pain threshold level. TINI and TENS were applied for 20 min each. The ankle passive dorsiflexion range of motion, pressure pain threshold (PPT), and tactile threshold were measured at the baseline, pre-test, test (immediately before ceasing intervention), and post-test (30 min after ceasing intervention) sessions. After the interventions, the participants evaluated the level of discomfort for TINI and TENS on a 10 cm visual analog scale (VAS). As the results, PPT significantly increased compared to baseline in test and posttest sessions of TINI, but not in those of TENS. Also, participants reported that TENS was 36% more discomfort than TINI. The hypoalgesic effect was not significantly different between TINI and TENS. In conclusion, we found that TINI inhibited mechanical pain sensitivity and that the inhibitory effect persisted long after electrical stimulation ceased. Our study also shows that TINI provides the hypoalgesic effect more comfortably than TENS.

Effects of gastrocnemius stretching with talus-stabilizing taping on ankle dorsiflexion and balance in individuals with limited ankle dorsiflexion: A randomized controlled trial

BACKGROUND: Various interventions have been recommended to increase ankle dorsiflexion range of motion (DFROM); however, few studies have investigated the long-term effects of applying gastrocnemius stretching with talus-stabilizing taping (GSTST). OBJECTIVE: To compare the effects of gastrocnemius stretching (GS) and GSTST on DFROM and balance in subjects with limited DFROM. METHODS: Twenty-six subjects with limited DFROM were randomly allocated to either the GS group (n= 13) or GSTST group (n= 13) for 6 weeks. Maximum DFROM before heel-off during gait, passive DFROM, posterior talar glide, flexibility of the gastrocnemius, and the lower-quarter Y-balance test (YBT-LQ) were assessed pre-intervention and post-intervention. Two-way repeated-measures analysis of variance was used to compare the changes in variables. RESULTS: The GSTST group had greater maximum DFROM before heel-off, passive DFROM, and posterior talar glide than the GS group. Gastrocnemius flexibility and YBT-LQ scores increased significantly post-intervention in both groups; however, there was no significant difference between the groups. CONCLUSIONS: GSTST is recommend for improving ankle DFROM and balance in subjects with limited DFROM.

Is the Outcome of Diagnostic Nerve Block Related to Spastic Muscle Echo Intensity? A Retrospective Observational Study on Patients with Spastic Equinovarus Foot.

To investigate the relationship between spastic calf muscles echo intensity and the outcome of tibial nerve motor branches selective block in patients with spastic equinovarus foot. Retrospective observational study. Forty-eight patients with spastic equinovarus foot. Each patient was given selective diagnostic nerve block (lidocaine 2% perineural injection) of the tibial nerve motor branches. All patients were evaluated before and after block. Outcomes were: spastic calf muscles echo intensity measured with the Heckmatt scale; affected ankle dorsiflexion passive range of motion; calf muscles spasticity measured with the modified Ashworth scale and the Tardieu scale (grade and angle). Regarding the outcome of tibial nerve selective diagnostic block (difference between pre- and post-block condition), Spearman's correlation showed a significant inverse association of the spastic calf muscles echo intensity with the affected ankle dorsiflexion passive range of motion (p = 0.045; ρ = 00-0.269), modified Ashworth scale score (p = 0.014; ρ = -0.327), Tardieu grade (p = 0.008; ρ = -0.352) and Tardieu angle (p = 0.043; ρ = -0.306). These findings support the hypothesis that patients with spastic equinovarus foot with higher spastic calf muscles echo intensity have a poor response to selective nerve block of the tibial nerve motor branches.

Effects of Ankle Self-Mobilization with Movement Intervention on Ankle Dorsiflexion Passive Range of Motion, Timed Up and Go Test, and Dynamic Gait Index in Patients with Chronic Stroke

Effects of Ankle Self-Mobilization with Movement Intervention on Ankle Dorsiflexion Passive Range of Motion, Timed Up and Go Test, and Dynamic Gait Index in Patients with Chronic Stroke

Short-wave diathermy for spastic equinus foot in chronic stroke patients: a proof-of-concept pilot study.

Physical modalities may be useful to manage poststroke spasticity. Shortwave diathermy has been demonstrated to improve extensibility of the myotendinous tissue. Spasticity may alter morphology of the muscle and its elastic properties. Our main aim was to evaluate the effects of shortwave diathermy on spastic equinus foot in stroke patients. Ten chronic stroke patients with spastic equinus foot received 10 shortwave diathermy sessions, 5 days/week for 2 consecutive weeks to the spastic calf muscles. Clinical (modified Ashworth Scale and ankle dorsiflexion passive range of motion) and ultrasound (spastic gastrocnemius muscle echo intensity and hardness percentage measured by sonoelastography) evaluation was done before, after treatment, and at two weeks of follow-up. A significant difference in calf muscle spasticity (P=0.004), ankle passive range of motion (P=0.014), and spastic gastrocnemius muscle hardness percentage (P=0.004) was found after treatment. A significant difference in calf muscle spasticity (P=0.004) was found also at the follow-up evaluation. Our preliminary findings support the hypothesis that shortwave diathermy might improve calf muscle tone, ankle passive range of motion, and gastrocnemius muscle elasticity in chronic stroke patients with spastic equinus. This might be due to the deep thermal effects coupled with the rheological direct action of shortwave diathermy on spastic muscles.

Relationship Between Gastrocnemius Muscle Length and Overhead Squat Movement Compensations Among Active-Duty Firefighters

Restricted gastrocnemius length may impair movement efficiency during functional movements. However, this is yet to be examined among tactical athletes. This study examined the relationship between gastrocnemius muscle length and movement compensations during a two-leg overhead squat among career firefighters. Bilateral ankle dorsiflexion passive range of motion data were collected from 50 firefighters, and movement compensations observed during a two-leg overhead squat were recorded. Firefighters with reduced average ankle dorsiflexion passive range of motion were more likely to demonstrate movement compensations during the overhead squat. Clinicians should utilize interventions that lengthen gastrocnemius musculature to improve the squat movement efficiency of firefighters.

The Effects of Ankle Joint Mobilization on Dorsiflexion Range and Gait Parameters in Chronic Stroke Survivors: A Systematic Review and Meta-analysis

Background: Ankle dorsiflexion movement restriction is a common presentation in most of the chronic stroke survivors. Spasticity and connective tissue changes around ankle, limits dorsiflexion, and interferes with balance and gait performances. Improving functional range of dorsiflexion is essential in post-stroke rehabilitation. Objectives: This meta-analysis analyzed the effects of ankle mobilization techniques in improving dorsiflexion range and gait parameters among chronic stroke survivors. Method: Articles published up to July 2020 were searched in CINAHL, PubMed, Embase, PsyINFO, and OpenGrey. English version of randomized controlled trials (RCTs) assessing the effects of ankle joint mobilization among chronic stroke subjects, with dorsiflexion range of motion (ROM) and gait parameters as outcome, were included. Characteristics of participants, interventions, outcome measure, and measures of variability were extracted. Methodological quality of included trials was assessed using PEDro scale and Cochrane Collaboration tool for the risk of bias. Pooled standardized mean difference was calculated using random effects model for dorsiflexion ROM, gait velocity, step length, cadence, and timed up and go (TUG). Results: Eight RCTs including 226 stroke patients, with mean methodological score of 6 out of 10 in PEDro, were eligible for this meta-analysis. Ankle joint mobilization demonstrated statistically significant improvement on passive dorsiflexion ROM, gait velocity, step length (affected side), and cadence outcomes. Nonsignificance was found in step length (unaffected side) and in TUG. Conclusion: The ankle mobilization techniques are effective in improving passive dorsiflexion ROM, gait velocity, and cadence in chronic stroke survivors. However, the retention effect of ankle mobilization among stroke subjects is not known.

Does Botulinum Toxin Treatment Affect the Ultrasonographic Characteristics of Post-Stroke Spastic Equinus? A Retrospective Pilot Study.

Equinovarus/equinus foot is a pattern most commonly treated with botulinum toxin type A in patients with post-stroke spasticity involving the lower limbs; the gastrocnemius is the muscle most frequently injected. Spastic equinovarus/equinus can present a mixture of conditions, including spasticity, muscle/tendon shortening, muscle weakness and imbalance. In this study, we wanted to determine whether botulinum toxin treatment affects the ultrasonographic characteristics of post-stroke spastic equinus. The same dose of AbobotulinumtoxinA was injected into the gastrocnemius medialis and lateralis of 21 chronic stroke patients with spastic equinus. Clinical (Ashworth scale and ankle range of motion) and ultrasound (conventional and sonoelastography) evaluation of the treated leg was carried out before and 4 weeks after injection. No significant effects of botulinum toxin treatment on the ultrasonographic characteristics of spastic equinus were observed. As expected, there were significant improvements in ankle passive dorsiflexion range of motion and calf muscle spasticity at 1 month after treatment. There was a direct association between Achilles tendon elasticity and calf muscle spasticity at baseline evaluation. Larger studies with a long-term timeline of serial evaluations are needed to further investigate the possible effects of botulinum toxin injection on spastic muscle characteristics in patients with post-stroke spasticity.

Effects of Walking With Talus-Stabilizing Taping on Passive Range of Motion, Timed Up and Go, Temporal Parameters of Gait, and Fall Risk in Individuals With Chronic Stroke: A Cross-sectional Study

ObjectiveThe purpose of this study was to determine the effects of walking with talus-stabilizing taping on ankle dorsiflexion passive range of motion, the timed up-and-go test, temporal parameters of gait, and fall risk in individuals with chronic stroke. MethodsIn this cross-sectional design study, 20 participants with chronic stroke (9 female, 11 male), aged 60.5 ± 8.1 years, were included. Three conditions were evaluated: barefoot, immediately after applying talus-stabilizing taping, and after 5 minutes of walking with talus-stabilizing taping. One-way repeated-measures analysis of variance was used to determine the differences in ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk across the 3 conditions. ResultsAnkle dorsiflexion passive range of motion, walking speed, and single-limb support phase were significantly improved after 5 minutes of walking with talus-stabilizing taping compared to those in the barefoot and immediately-after-taping conditions. The timed up-and-go test, double-limb support phase, and fall-risk results significantly decreased more after 5 minutes of walking with talus-stabilizing taping compared to barefoot and immediately after taping. ConclusionAfter the application of talus-stabilizing taping, ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk were reduced in individuals with chronic stroke.

Isolated Shear Fracture of the Metatarsal Head in Lesser Toes Treated With ORIF: Case Series.

Isolated shear fractures of a metatarsal head in the lesser toes are rare in clinical practice. We report the clinical and imaging characteristics, and treatment results, of these fractures. A retrospective consecutive case-series study was performed on 7 patients with symptomatic isolated shear fracture of a metatarsal head in the lesser toes who were operatively treated using open reduction and internal fixation (ORIF). Radiographs and computed tomographic (CT) scans of the patients were analyzed. The American Orthopaedic Foot & Ankle Society-lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS) score, and passive dorsiflexion range of motion (ROM) of the metatarsophalangeal (MTP) joint were determined preoperatively and at final follow-up. Postoperative complications were also recorded. There were 5 males and 2 females, with a mean age of 21 years (range, 16-36) at the time of surgery. Four fractures occurred at the fourth metatarsal. There were 3 chronic cases, 1 was not diagnosed initially; the other 2 failed conservative treatment. The main symptom of the chronic fractures was limited dorsiflexion at the MTP joint. Preoperative radiographs and CT scans revealed dorsal displacement of the fragment without dislocation of the MTP joint. At the final follow-up (mean, 17.4 months; range 9-27), the AOFAS-LMI scores had improved from 70.6 (range, 59-79) preoperatively to 93.3 (range, 92-100) (P = .001). VAS scores showed a decrease in pain from 4.0 to 0.0 (P = .016). Mean passive dorsiflexion ROM of the MTP joint improved significantly from 8.6 degrees preoperatively to 35.7 degrees at final follow-up (P < .001). All patients returned to their respective preinjury activity levels. Patients with an acute or chronic isolated shear fracture of a metatarsal head in the lesser toes treated by ORIF achieved good short-term clinical and radiologic outcomes. Level IV, retrospective case series.

Ground Reaction Forces Are Predicted with Functional and Clinical Tests in Healthy Collegiate Students.

Increased vertical and posterior ground reaction forces (GRFs) are associated with anterior cruciate ligament (ACL) injury. If a practical means to predict these forces existed, ACL injury risk could be attenuated. Forty-two active college-age individuals (21 females, 20.66 ± 1.46 y, 70.70 ± 2.36 cm, 82.20 ± 7.60 kg; 21 males, 21.57 ± 1.28 y, 65.52 ± 1.87 cm, 64.19 ± 9.05 kg) participated in this controlled laboratory study. GRFs were ascertained by having the subjects perform a unilateral landing task onto a force plate. Several clinical measures (Fat Free Mass (FFM), dorsiflexion passive range of motion (DPROM), isometric peak force of the lateral hip rotators, knee flexor/extensor peak force ratio (H:Q), the completion of the overhead deep squat), two functional tests (Margaria–Kalamen, Single Leg Triple Hop (SLTH)), and sex served as the predictor variables. Regression models to predict the GRFs normalized to the FFM (nGRFz, nGRFy) were generated. nGRFz was best predicted with a linear regression equation that included SLTH and DPROM (adjusted R2 = 0.274; p = 0.001). nGRFy was best predicted with a linear regression equation that included H:Q, FFM, and DPROM (adjusted R2 = 0.476; p < 0.001). Simple clinical measures and functional tests explain a small to moderate amount of the variance associated with the FFM normalized vertical and posterior GRFs in active college-age individuals.

The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis

BackgroundLower limb serial casting is commonly used therapeutically in paediatric clinical practice with some evidence to support its efficacy. This systematic review aimed to determine the effects of serial casting in isolation or combination with other therapies for the management of lower limb dysfunction in children with Cerebral Palsy (CP).MethodsA systematic literature search was conducted in February 2019 across eight databases (PUBMED, EMBASE, CINAHL, PEDro, OTSeeker, Cochrane, Scopus and Proquest) using key terms ‘Cerebral Palsy’ and ‘serial casting’ and associated synonyms. A meta-synthesis and meta-analysis were undertaken when sufficient results were available showing the effect of serial casting on functional outcomes including: Ankle range of motion; neurological measures of hypertonicity and spasticity, functional gait measures and; gross motor function.ResultsTwenty-five articles from 3219 possible citations were included. Serial casting was found to be effective for: Improving ankle dorsiflexion (DF) passive range of motion (PROM) in the immediate to short-term, decreasing hypertonicity measured by Modified Ashworth Scale (MAS) in the short-term and, enhancing functional gait outcomes in the mid-term. Serial casting with or without botulinum toxin type-A (BTX-A) did not significantly affect gross motor capacity measured by Gross Motor Function Measure (GMFM). Serial casting with pharmacological intervention achieved significantly more DF PROM than serial casting alone (MD − 3.19 degrees; 95% CI − 5.76 to − 0.62; P = 0.01; I2 = 0%), however the clinical importance of improving ankle DF PROM by an additional three degrees remains unclear.ConclusionsLower limb serial casting, improves several outcomes relevant to lower limb function supporting its clinical use for improving DF PROM, reducing hypertonicity and improving gait in children with CP. Further research using stronger methodological study designs, is indicated to explore long-term effects of serial casting on functional lower limb outcomes such as gross motor function in children with CP. Clinicians can use this information when developing individualised treatment plans for children who have CP during shared decision-making consultations.

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study.

To evaluate the role of diagnostic nerve block in predicting the outcome of subsequent botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke. Retrospective observational study. Fifty chronic stroke patients with spastic equinovarus foot. Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale. Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection. This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.

Effects of talus stabilization taping versus ankle kinesio taping in patients with chronic stroke: a randomized controlled trial

Talus stabilization taping (TST) can be utilized to stabilize posteriorly glide of the talus and allows active ankle dorsiflexion movement during walking. The purpose of this study was to compare the effects of ankle kinesio taping with those of TST on ankle dorsiflexion passive range of motion, static balance, the Timed Up and Go test, and the fall risk in patients with chronic stroke and limited ankle dorsiflexion. Participants were randomized into the kinesio taping (n=11) and TST groups (n=11). Both groups were applied the appropriate taping and were asked to walk on the treadmill for 10 min. The ankle dorsiflexion passive range of motion, static balance ability, Timed Up and Go test, and fall risk were assessed in all participants before and after the intervention. The TST group showed greater improvement than the ankle kinesio taping group in all outcomes measured (P<0.05). Furthermore, both groups had significantly decreased in the Timed Up and Go results (P<0.05). This study shows that TST improves functional ability of the ankles of patients with chronic stroke in comparison to the kinesio taping method.

Four-week training involving self-ankle mobilization with movement versus calf muscle stretching in patients with chronic stroke: a randomized controlled study

ABSTRACTBackground: In self-ankle mobilization with movement (S-MWM) therapy, a strap can be utilized to stabilize the posterior glide of the talus during ankle dorsiflexion movements.Objectives: Our objective was to compare the effects of 4-week self-mobilization with movement (S-MWM) with those of calf muscle stretching (CMS) on ankle dorsiflexion passive range of motion (DF-PROM), gait parameters, and fall risk in patients with chronic stroke with limited ankle dorsiflexion.Methods: Participants were randomized into the S-MWM (n = 19) and CMS groups (n = 19). Both groups received conventional physiotherapy for 30 minutes per session. In addition, S-MWM and CMS techniques were performed 3 times per week for 4 weeks and were performed by the participants themselves. Ankle DF-PROM, gait parameters, and fall risk were measured after 4 weeks of training.Results: After 4 weeks of training, both groups showed significant improvement in all outcome measures (p < .05). Furthermore, ankle DF-PROM, gait parameters (gait speed, cadence, and stride lengths on both sides), and fall risk showed greater improvement in the S-MWM group than in the CMS group (p < .05).Conclusions: This study shows that S-MWM training combined with conventional physiotherapy improved ankle DF-PROM, gait parameters, and fall risk in patients with chronic stroke.

The time-course effects of talus taping on ankle dorsiflexion range of motion

Background/Aims Talus taping may be an effective physiotherapeutic treatment for equinus (passive dorsiflexion range of motion &lt;10°). However, the time-course effects of this intervention are unknown. The aims of this study were to identify the effect that the application of talus tape for 48 hours during normal functional activities has on dorsiflexion range of motion, and to determine whether any changes in dorsiflexion range of motion persisted until 5 days after removal (study day 7). Methods A total of 16 healthy participants (mean age 28.3 ± 8 years) were recruited. Participants' were randomly assigned to control and intervention conditions. Baseline measures of dorsiflexion range of motion were taken in both ankles using the weight-bearing lunge test. The intervention ankle had talus tape applied, which remained in place for 48 hours during normal functional activities. To determine the time-course effects, dorsiflexion range of motion was reassessed in the control and intervention ankles immediately following removal of the tape (at 48 hours) and again 5 days later, on day 7. Findings Dorsiflexion range of motion in the taped intervention ankle increased significantly between the baseline and 48-hour measures. However, when reassessed at day 7, participants' dorsiflexion range of motion had returned to baseline levels. There were no significant differences in the control ankle across all three measures. Conclusions Applying talus tape for 48 hours during normal functional activities results in immediate but not long-lasting changes in dorsiflexion range of motion.

Commentary on "Progression of Ankle Plantarflexion Contractures and Functional Decline in Duchenne Muscular Dystrophy: Implications for Physical Therapy Management".

“How might I apply this information?” This information can be best applied by establishing early and ongoing intervention programs to minimize development of plantar flexor contractures in individuals with Duchenne muscular dystrophy (DMD) and being aware of trends and correlations suggesting the need for additional interventions. Trends reported showed progressive decline in ankle dorsiflexion passive range of motion (PROM) with age, progressive functional decline after 7 years of age as measured by North Star Ambulatory Assessment (NSAA), and correlation between functional decline and decline in ankle dorsiflexion PROM. Understanding and acting on the relationship between contracture and functional losses are critical in providing preventive, anticipatory care in DMD as shown across all ages in this study. Decreases in ankle dorsiflexion PROM emerged before the age of 7 years despite increasing function, supporting the importance of initiating early preventive intervention to minimize contracture development rather than waiting for functional losses, especially in those younger than 7 years. Older individuals who were walking had less extreme ranges of plantar flexor contracture than those 7 to 15 years of age despite lower NSAA functional scores, highlighting the functional importance of minimizing plantar flexor contractures over time, with adequate dorsiflexion range a potential requirement for walking with increased age and weakness. Challenges in preventing plantar flexor contractures, evidenced by variability in the data, support the need for comprehensive individualized approaches described, including home stretching, regular direct skilled physical therapy, orthotic intervention, serial casting, optimal positioning, supported standing, and assessment of PROM and muscle extensibility with sufficient frequency to identify needs for additional interventions. “What I might be mindful of when applying this information?” Individual correlations between ankle dorsiflexion PROM, functional scores, walking status, genetic mutations, steroid use, and therapeutic intervention in participants were not reported, details that might provide insight into individual interactions between factors in the successful prevention of plantar flexor contractures and optimizing function. Laura E. Case, PT, DPT, MS, PCS Doctor of Physical Therapy Division Duke University School of Medicine Durham, North Carolina Julie Coats, PT, DPT Department of Physical Therapy and Occupational Therapy Duke University Medical Center Durham, North Carolina

Four-week training involving ankle mobilization with movement versus static muscle stretching in patients with chronic stroke: a randomized controlled trial

ABSTRACTBackground: Patients with stroke generally have diminished balance and gait. Mobilization with movement (MWM) can be used with manual force applied by a therapist to enhance talus gliding movement. Furthermore, the weight-bearing position during the lunge may enhance the stretch force.Objectives: This study aimed to compare the effects of a 4-week program of MWM training with those of static muscle stretching (SMS). Ankle dorsiflexion passive range of motion (DF-PROM), static balance ability (SBA), the Berg balance scale (BBS), and gait parameters (gait speed and cadence) were measured in patients with chronic stroke.Methods: Twenty patients with chronic stroke participated in this study. Participants were randomized to either the MWM (n = 10) or the SMS (n = 10) group. Patients in both groups underwent standard rehabilitation therapy for 30 min per session. In addition, MWM and SMS techniques were performed three times per week for 4 weeks. Ankle DF-PROM, SBA, BBS score, and gait parameters were measured after 4 weeks of training.Results: After 4 weeks of training, the MWM group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, SBA, BBS, and cadence showed greater improvement in the MWM group compared to the SMS group (p < 0.05).Conclusions: This study demonstrated that MWM training, combined with standard rehabilitation, improved ankle DF-PROM, SBA, BBS scores, and gait speed and cadence. Thus, MWM may be an effective treatment for patients with chronic stroke.