Limited Walking Research Articles

Total Knee Replacement in Alkaptonuric Ochronosis.

Alkaptonuria is a rare disease characterized by the accumulation of homogentisic acid (HGA). Over time, these patients may develop disabling ochronotic arthropathy. We present 2 cases of patients with end-stage arthropathy treated with total knee arthroplasty (TKA). Both patients complained of disabling knee pain and reported limited walking distance (200-300 m). One had a history of osteotomy for medial knee arthtritis and ignored his underlying condition. The other presented with valgus gonoarthrosis and diagnosis of alkaptonuria. Intraoperatively, the characteristic dark-blue color in the joint was observed. Both patients evolved favorably after TKA with excellent results according to the Knee Society Scores (KSS) at three years of follow-up. We believe TKA is the right treatment for patients with end-stage disease because it offers considerable relief from pain and allows patients to recover function.

Factors Associated With Walking Adaptability and Its Relationship With Falling in Polio Survivors

ObjectiveTo explore factors associated with walking adaptability and associations between walking adaptability and falling in polio survivors. DesignCross-sectional study. SettingOutpatient expert polio clinic. ParticipantsPolio survivors (N=46) who fell in the previous year and/or reported fear of falling. InterventionsNot applicable. Main Outcome MeasuresWalking adaptability was assessed on an interactive treadmill and operationalized as variable target-stepping and reactive obstacle avoidance performance. Further, we collected walking speed and assessed leg muscle strength, balance performance (Berg Balance Scale and Timed-Up-and-Go Test), balance confidence (Activities-specific Balance Confidence scale), ambulation level, orthosis use, fear of falling, and number of falls in the previous year. ResultsWith walking speed included as a covariate, muscle weakness of the most affected leg and balance confidence explained 54% of the variance in variable target-stepping performance. For reactive obstacle avoidance performance, muscle weakness of the most affected leg and knee extensor strength of the least affected leg explained 32% of the variance. Only target-stepping performance was significantly related to the number of falls reported in the previous year (R2=0.277, P<.001) and mediated the relation between leg muscle weakness and balance confidence with falling. ConclusionOur exploratory study suggests that leg muscle weakness and reduced balance confidence limit walking adaptability in polio survivors. Because poorer target stepping rather than obstacle avoidance performance was associated with falling, our results indicate that a limited ability to ensure safe foot placement may be a fall risk factor in this group. These findings should be confirmed in a larger sample.

Effect of walking exercise on the human body

Recent studies have demonstrated that brisk walking help to reduce anxiety and tension and assist in weight loss. Regular walking helps improve cholesterol profile, help control hypertension, and slow the process of osteoporosis. The purpose of this paper is to summarise the benefits of walking on physical and mental health to encourage people to participate in walking as a regular and sustainable exercise, and to determine of the limitation of regular walking. The researcher used the descriptive approach for achieve the research objectives. Research finding indicated that walking can relieve the human body fat, improve their heart health and decrease the possible risk of heart attack and stroke. Additionally walking improve their ability in lowering high blood pressure, reduce risk of diabetes, and Decrease stress and prevent depression.

Effectiveness analysis of metatarsal mortise and tenon shortening osteotomy in treatment of macrodactyly in children

To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children. The clinical data of 17 children with macrodactyly (18 feet and 27 toes) admitted between January 2018 and January 2020 were retrospectively analyzed. There were 12 males (12 feet and 18 toes) and 5 females (6 feet and 9 toes); the age ranged from 1 to 13 years, with a median age of 5 years. All children were treated with metatarsal mortise and tenon shortening osteotomy. Ten cases of single-segment metatarsals were shortened, 7 cases of 2-segment metatarsals, and 1 case of 3-segment metatarsals; involved 1 foot of single toe, 9 feet of 2 toes, 3 feet of 3 toes, 3 feet of 4 toes, and 2 feet of 5 toes. Five cases had lameness, and 1 case had limited walking with the big toes of both feet, and there was no obvious pain in all children. X-ray films showed that the involved phalanges were thickened and increased in 18 feet, and the deformity of the distal segment was heavier than that of the proximal segment in 13 feet, and the two were similar in 5 feet. The length of metatarsal shortening was 0.7-2.5 cm, with an average of 1.2 cm. The clinical healing of shortened metatarsal fractures in children was observed after operation, and the occurrence of related complications was recorded. All 17 children were followed up 6-22 months, with an average of 14 months. All incisions healed by first intention. The osteotomy ends of 27 toes were clinically healed after operation, and the healing time was 4-8 weeks. No nonunion, fracture displacement, malunion, epiphyseal plate premature closure, and needle tract infection occurred. Metatarsal mortise and tenon shortening osteotomy is a good osteotomy method. It can improve the stability of the osteotomy end and increase the contact surface of the osteotomy end, which is conducive to the healing of the osteotomy end and is suitable for the treatment of macrodactyly.

Using multiple imputation and intervention-based scenarios to project the mobility of older adults

BackgroundProjections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland.MethodsWe applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health – Longitudinal Opportunities and Synergies (ATHLOS) project (N = 24,982).ResultsBased on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9% between 2012 and 2026.ConclusionsA physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.

Scedosporium apiospermum infection of the lumbar vertebrae: A case report

BACKGROUND Scedosporium apiospermum (S. apiospermum) is a clinically rare and aggressive fungus mainly found in contaminated water, wetlands, decaying plants, stagnant water, and potted plants in hospitals. The lung, bone, joint, eye, brain, skin, and other sites are easily infected, and there is a marked risk of misdiagnosis. There have been few case reports of infection by S. apiospermum of the lumbar vertebrae; most reports have focused on infection of the lung.CASE SUMMARYAn otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain, stooping, and limited walking. The symptoms were significantly aggravated 10 d prior to hospitalization, and radiating pain in the back of his left lower leg developed, which was so severe that he could not walk. Movement of the lumbar spine was significantly limited, anterior flexion was about 30°; backward extension, right and left lateral curvature, and rotational mobility were about 10°; tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident, and the muscle strength of both lower limbs was grade IV. Imaging suggested bony destruction of the lumbar 3, 4, and 5 vertebrae and sacral 1 vertebra; in addition, the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable. Lumbar vertebral infection was also noted, and the possibility of lumbar tuberculosis was considered. We first performed surgical intervention on the lesioned lumbar vertebrae, cleared the infected lesion, and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device, which restored the stability of the lumbar vertebrae. Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S. apiospermum infection of the lumbar vertebrae; on this basis, the patient was administered voriconazole. At the 6-mo follow-up, efficacy was significant, no drug-related side effects were observed, and imaging examination showed no evidence of recurrence.CONCLUSION S. apiospermum infection can occur in immunocompetent individuals with no history of near drowning. Voriconazole is effective for the treatment of S. apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.

Post-Acute COVID-19 Syndrome after a Critical COVID-19: A Case Report

Introduction: The COVID-19 pandemic has caused many impacts in health, economic and social aspect worldwide. Infection of SARS-CoV-2 affects many organ systems. Post-COVID-19 syndrome is a condition when some of those infected with SARS-CoV-2 are complaining symptoms that persist for weeks to months even the PCR was negative. Case Illustrations: We present a case of post-acute COVID-19 syndrome in a 59 years old man with persistent respiratory symptoms for 3 months since the onset of a critical COVID-19. He was admitted to the hospital with critical COVID-19 which he received treatment for COVID-19 according to protocol and mechanical ventilation via tracheostomy in intensive care unit (ICU). In the post-acute COVID-19 conditions, he complained of persistent fatigue, shortness of breath, cough, limited walking activity and palpitations. Discussion: In most cases of asymptomatic, mild and moderate COVID-19 symptoms, patients usually resolve without complications. However, in cases with severe symptoms, systemic hyperinflammation of the immune system occurs due to activation of the SARS-CoV-2 virus which causes various complications in several organs. The management of patients with post-COVID-19 syndrome is determined based on clinical assessment of the patient, radiological examination, and laboratory and pulmonary function tests if possible. Patients with radiological abnormalities without clinical symptoms, evaluation is carried out 8 to 12 weeks after therapy and can be earlier if patients have any complains. Meanwhile patients with clinical symptoms with or without radiological abnormalities, need to evaluate after 4 weeks to see if there is any improvements. In addition to symptomatic treatment, oxygen therapy, rehabilitation, psychotherapy and nutritional therapy can also be given in patients with post-COVID-19 syndrome. Conclusion: Post-COVID-19 syndrome is a condition that affected almost all of the organ system in the body. The most common symptoms are persistent fatigue, shortness of breath, cough, myalgia, malaise and headache. This condition impact both physical and mental health that persists for weeks or months after being infected with SARS-CoV-2. Patient with post-COVID-19 syndrome should be prioritized due to their impact on the global health burden. Those who diagnosed with post-COVID-19 syndrome also needed psychological and emotional support to deal with persistent symptoms caused by post-COVID-19 condition so the survivors can return to living their lives as before. Keywords: Post-COVID-19 Syndrome, Long COVID, Post-Acute COVID-19 Syndrome, Critical COVID.

Optical Design of a 4× Zoom Lens with a Stable External Entrance Pupil and Internal Stop

Zoom lens with stationary external entrance pupil and internal stop is a type of special optical system that can be used in cascaded optics to meet the requirements of long focal length or variable magnification. We proposed a 4× zoom lens to improve the pupil walking limitation observed in the conventional design. Varifocal- and pupil-stable differential equations are presented and a paraxial design of the lens with two moving parts was developed. Moreover, the zoom lens, which functions in the visible waveband 500 nm~750 nm, is designed using seven types of common optical glasses, has a constant f-number of 10 and focal range of 100 mm~400 mm, and achieves pupil walking in the range −3.9 mm to +4.3 mm. The results demonstrate that the design had good image quality and tolerance characteristics. Owing to the limited pupil walking and zoom capability, the scheme is of considerable interest for application in electrical optical systems.

High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model

Peripheral arterial disease (PAD) is a significant cause of morbidity resulting from chronic exposure to atherosclerotic risk factors. Patients suffering from its most severe form, chronic limb-threatening ischemia (CLTI), face substantial impairments to daily living, including chronic pain, limited walking distance without pain, and nonhealing wounds. Preclinical models have been developed in various animals to study PAD, but mouse hindlimb ischemia remains the most widely used. There can be significant variation in response to ischemic insult in these models depending on the mouse strain used and the site, number, and means of arterial disruption. This protocol describes a unique method combining femoral artery and vein electrocoagulation with the administration of a nitric oxide synthase (NOS) inhibitor to reliably induce footpad gangrene in Friend Virus B (FVB) mice that resembles the tissue loss of CLTI. While traditional means of assessing reperfusion such as laser Doppler perfusion imaging (LDPI) are still recommended, intracardiac perfusion of the lipophilic dye 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) is used to label the vasculature. Subsequent whole-mount confocal laser scanning microscopy allows for high-resolution, three-dimensional (3D) reconstruction of footpad vascular networks that complements traditional means of assessing reperfusion in hindlimb ischemia models.

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey.

ObjectiveTo investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.DesignCross-sectional survey study.SubjectsA total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.MethodsUse and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.ResultsA total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).ConclusionThe majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.LAY ABSTRACTKnee-ankle-foot orthoses for knee instability are commonly prescribed in polio survivors to enhance safe ambulation. This survey investigated the use of knee-ankle-foot orthoses in daily life and differences in factors of usability between users and discontinued users. Seventy-six percent of polio survivors used their custom-made knee-ankle-foot orthosis in daily life. Important usability factors that were related to continued use of knee-ankle-foot orthoses were low perceived walking ability status without orthosis, previous orthosis experience, high perceived effectiveness and satisfaction when standing and walking with a knee-ankle-foot orthoses. When prescribing a custom-made knee-ankle-foot orthoses it is important to consider these factors and discuss goals of use and expected benefits of the knee-ankle-foot orthoses with the patient, especially in relation to perceived walking limitations and activities in daily life.

Prise en charge des tentatives de suicide graves : expérience d’un service transdisciplinaire de psychiatrie

IntroductionSuicide is the second leading cause of death in young adults. Suicide attempts by violent methods predict later completed suicide and premature mortality. Suicide prevention is a major public health issue in this specific population. The French Student Health Foundation (FSEF) developed a psychiatric ward that includes psychiatric and somatic approaches. This transdisciplinary unit provides mixed psychiatric and rehabilitation treatments for those persons who have attempted suicide and have severe somatic injuries. MethodsWe conducted a retrospective study including all subjects admitted into the transdisciplinary unit from 1st January 2011 to 31 December 2017, after a suicide attempt by jumping from a height, in front of a moving object, or by crashing of a motor vehicle. Data was obtained from the medical and administrative records of the clinic. ResultsIn total, 215 persons were admitted into the transdisciplinary unit after a suicide attempt by a violent mean. Among them, 91.6% had jumped from a height, 7.4% had jumped in front of a train or a metro and 0.9% had crashed a motor vehicle. They were on average 25.5years old and 50.2% were men. 45.1% had a diagnosis of schizophrenic disorders and 34.4% of mood disorders. A total of 35.6% presented at least one previous suicide attempt, and among them 40.3% had previously attempted suicide with a violent mean. Substance abuse, mostly alcohol and/or cannabis, featured in 40.8% of subject history. The subjects hospitalised in the transdisciplinary unit had multiple, severe injuries: 78.1% had spine fractures, 69.8% had lower limb fractures, 47.9% had pelvic fractures and 43.3% had upper limb fractures. Moreover, 25.5% of them had sacral root damages. The length of stay averaged 184days and varied in a large range (less than a month to more than two years). The Activities of Daily Living scores were higher than 3 (out of a maximum score of 4) reflecting an important need of assistance. These scores decreased significantly during the hospitalisation for dressing, feeding, continence and locomotion but remained high for comportment and communication. At discharge, the physical sequelae were still important: 61% of people hospitalised had pain that required step 2 or 3 analgesics, 44% had analgesics for neuropathic pain, 80% had lower limb impairments, most often with walking limitation, and 26% had continence disorders. The psychotropic treatments at discharge were related to the psychiatric disorders observed and included 42% antidepressants, 63% neuroleptics and 16% mood stabilizers. ConclusionThis study highlights the severity of the somatic and psychiatric disorders affecting people who are admitted into this transdisciplinary unit. These subjects who have attempted suicide require particular care with multidisciplinary management in order to promote their rehabilitation, reintegration and prevent a suicide reattempt.

Living with heart failure: patient experiences and implications for physical activity and daily living.

AimsHeart failure (HF) substantially limits the ability of patients to engage in physical activities. A detailed understanding of how patients experience these limitations is required to develop valid and sensitive measures for use in clinical research. This qualitative study was designed to provide a thorough description of how HF patients experience physical activity limitations in their daily lives.Methods and resultsSemi‐structured interviews were conducted with 40 HF patients. Interview transcripts were coded with the aim of identifying key aspects of physical activity. Patients were divided between HF with preserved ejection fraction (n = 21, 52.5%) and HF with reduced ejection fraction (n = 19, 47.5%); the majority of patients were New York Heart Association Class II (n = 22, 52.5%) or Class III (n = 16, 40.0%). Relevant physical activity themes, including mobility and broader daily function areas, were identified. The most frequently reported mobility limitations involved difficulty walking (up a steep incline, up steps, and long distances), limited walking speed, difficulty standing for long periods of time, and difficulty carrying and lifting objects. These limitations were principally related to three HF symptoms: dyspnoea, tiredness/fatigue, and peripheral oedema. Patients adapted to their symptoms and related mobility limitations in several ways, including taking rests during an activity, doing an activity more slowly, and avoiding/refraining from an activity altogether. The broader daily function areas most commonly impacted by the mobility limitations were housework, exercising or playing sports, and going shopping.ConclusionsHeart failure patients report numerous physical activity limitations. These specific mobility and daily function areas can be measured using clinical outcome assessments (e.g. patient‐reported outcomes and performance outcomes) in clinical trials and observational research. Accelerometry can be used to contribute to a holistic picture of patient functioning by passively collecting this type of data.

Physical Activity and Sedentary Behaviour in People with Myasthenia Gravis: A Cross-Sectional Study.

Despite improvements in the medical management of myasthenia gravis (MG) in recent years, patients continue to report poor health and wellbeing outcomes such as high levels of fatigue, reduced quality of life (QoL), walking limitation and lowered balance confidence. Physical activity has been shown to be associated with these outcomes in other populations, however, there has been limited research in adults with MG. To describe physical activity and sedentary behaviour in adults with MG and to explore associations between these behaviours and fatigue, QoL, balance confidence and walking limitation. A self-report online survey was used to assess physical activity, sedentary behaviour, fatigue, QoL, balance confidence and walking limitation in adults with MG. Multiple linear regression was used to examine associations and descriptive statistics were used to analyse participant characteristics, physical activity, and sedentary behaviour. Eighty-five adults with MG were included (mean age 48±16 years). Over half of participants (n = 53, 62.4%) reported sufficient physical activity to meet public health guidelines. Participants reported an average of 9 h/day of sedentary time (mean 9.0±3.5). Physical activity and fatigue (R2 = 0.196), QoL (R2 = 0.330), walking limitation (R2 = 0.305) and balance confidence (R2 = 0.304) were significantly (p < 0.05) and positively correlated, with no associations found for sedentary behaviour. When patterns of physical activity and sedentary behaviour were combined, lower fatigue (R2 = 0.213), higher QoL (R2 = 0.364), reduced walking limitation (R2 = 0.341) and higher balance confidence (R2 = 0.279) was observed in patients who had greater physical activity levels (> 150 mins/week) and lower sedentary time (< 10 h/day). Higher physical activity and lower sedentary behaviour is associated with favorable health and wellbeing outcomes in adults with MG. Further research is required to ascertain whether these behaviours may be an appropriate target intervention to improve outcomes in this population.

ECCENTRIC EXERCISE IN THE TREATMENT OF TIBIALIS POSTERIOR TENDINOPATHY: A CASE REPORT

Introduction Tibialis posterior tendinopathy is a disabling, frustrating, and progressive musculo-skeletal condition that is commonly seen in middle-aged women. The etiology of this overuse injury is likely to be multifactorial, so it is necessary to take into account intrinsic and extrinsic risk factors for effective treatment. Evidence of treatment protocol is insufficient and of limited quality. Conservative treatment is generally undertaken in the early stages of the condition. In conservative treatment, physical therapy and a program of eccentric strengthening exercises are especially emphasized. Case report We present a case of a 48-years-old woman diagnosed with tibialis posterior tendinopathy. The patient could not participate in recreational sports activities and had a significant limitation in walking. Over a five-weeks period the patient had ten sessions of physical therapy. The applied individually tailored physical therapy program was based on eccentric strengthening exercises. Conclusion The implemented physical therapy program has led to a significant reduction in pain and a return to sports activities. This case report shows that physical therapy program based on eccentric exercise regime can relieve symptoms and restore functional ability for short period in patient with tibialis posterior tendinopathy.

Results of Ponseti Method in the Management of the Congenital Clubfoot

Background: Clubfoot is a debilitating pathology and a source of abnormal gait in children. Treatment with the Ponseti method is the treatment used in the management of congenital clubfoot in children under 9 years old. This study aims to identify the proportion of children with clubfoot supported by the Ponseti method and to evaluate their effectiveness. Materials and Method: A multicenter retrospective descriptive study for six (06) months from June 1st to November 30th, 2019 concerning the evaluation of the Ponseti method in the management of clubfoot in Madagascar was conducted. Results: One hundred ninety-one (191) children with club feet were screened during the study period. One hundred and fifty children, or 226 congenital equine varus clubfoot were treated with the Ponseti method during the study period. The male gender was the most affected compared to the female gender with a sex ratio of 1.75. The clubfoot was bilateral in 50.66% of cases and idiopathic in 92.66%. The initial Pirani score was on average (±SD) 5.04/4.98 (±1.22/1.20). A proportion of 23.33% of cases of recurrence was recorded at 3 months of use of brace abduction splint. Conclusion: In Madagascar, the incidence of congenital clubfoot remains relatively low but clubfoot is still the main limitation of walking and a lack of footwear in children. Ponseti method is the gold standard in the management of this pathology. However, it requires a long-term follow-up.

Clinico-Radiological assesment of lumbar spinal canal stenosis and evaluation of its surgical treatment

Objective: This study aimed to predict the absolute criteria for surgical intervention and study the outcome of surgical intervention. Materials and Methods: A prospective study was conducted from June 2002 to July 2003. A total of 35 patients were included in the study. Pre- and postoperative Oswestry Disability Index (ODI) scores were evaluated for all the patients. All patients underwent magnetic resonance imaging (MRI). The surgical indications were disabling backache with radicular pain, limited walking capacity, and neurological deficits leading to a poor ODI score. Surgical procedures done were discectomy and laminectomy with or without fixation with pedicle screws on a case-to-case basis. Follow-up was done for up to 1 year at three-monthly intervals. The final ODI score was taken at the last follow-up and was compared with preoperative scores. Results: A 50 ± 10 years was the average age of patients included in the study. The average walking capacity was 40 m; the average duration of symptoms was 41 months. ODI improved from average score of 71% ± 4% preoperatively to 22% ± 6% postoperatively. L4–L5 was the level most severely narrowed, with a mean cross-sectional area of 75 mm2. The most common surgical interventions done were discectomy and laminectomy, which were performed in 54% of the cases. We had good-to-excellent results in all our cases. None of the cases deteriorated after surgery. Conclusion: The findings in this study have important implications in clinical practice. The radiological findings in the MRI correlated well with the clinical signs and symptoms of the patients, i.e., patients with significant findings in the MRI had profound clinical symptoms and neurological deficits. Clinical Significance: Lumbar canal stenosis is a clinicoradiological diagnosis. ODI score is related to canal narrowing on MRI. Clinical improvement is related to preoperative disability and canal narrowing on MRI.

Foot kinematics and leg muscle activation patterns are altered in those with limited ankle dorsiflexion range of motion during incline walking

BackgroundLarger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM. Research questionWould the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces? MethodsTen Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups. ResultsParticipants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher. SignificanceStudy results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.

Perpendicular Diffusion of Energetic Particles: A Complete Analytical Theory

Abstract Over the past two decades scientists have significantly improved our understanding of the transport of energetic particles across a mean magnetic field. Due to test-particle simulations, as well as powerful nonlinear analytical tools, our understanding of this type of transport is almost complete. However, previously developed nonlinear analytical theories do not always agree perfectly with simulations. Therefore, a correction factor a 2 was incorporated into such theories with the aim to balance out inaccuracies. In this paper a new analytical theory for perpendicular transport is presented. This theory contains the previously developed unified nonlinear transport theory, the most advanced theory to date, in the limit of small Kubo number turbulence. New results have been obtained for two-dimensional turbulence. In this case, the new theory describes perpendicular diffusion as a process that is sub-diffusive while particles follow magnetic field lines. Diffusion is restored as soon as the turbulence transverse complexity becomes important. For long parallel mean-free paths, one finds that the perpendicular diffusion coefficient is a reduced field line random walk limit. For short parallel mean-free paths, on the other hand, one gets a hybrid diffusion coefficient that is a mixture of collisionless Rechester &amp; Rosenbluth and fluid limits. Overall, the new analytical theory developed in the current paper is in agreement with heuristic arguments. Furthermore, the new theory agrees almost perfectly with previously performed test-particle simulations without the need of the aforementioned correction factor a 2 or any other free parameter.

Parental subjective assessment of gait limitations: Comparison with objective gait variables

BackgroundSubjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited. Research questionWhat are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis? MethodsParent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn’s post hoc test with Bonferroni adjustment. Spearman’s rank correlations were performed to determine the relationship between responses and gait parameters. ResultsData from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = −0.31 p = 0.000), normalised step length (r = −0.30 p = 0.0000) and normalised gait speed (r = −0.24 p = 0.0001). SignificanceSubjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.

Advances in nonparametric item response theory for scale construction in quality-of-life research

We introduce the special section on nonparametric item response theory (IRT) in Quality of Life Research. Starting from the well-known Rasch model, we provide a brief overview of nonparametric IRT models and discuss the assumptions, the properties, and the investigation of goodness of fit. We provide references to more detailed texts to help readers getting acquainted with nonparametric IRT models. In addition, we show how the rather diverse papers in the special section fit into the nonparametric IRT framework. Finally, we illustrate the application of nonparametric IRT models using data from a questionnaire measuring activity limitations in walking. The real-data example shows the quality of the scale and its constituent items with respect to dimensionality, local independence, monotonicity, and invariant item ordering.