Lower Extremity Function Research Articles

여성 노인의 하지 기능 향상을 위한 홈-트레이닝 운동 개발

This study aims to develop a home-training exercise program to improve lower extremity function in elderly women. Accordingly, through the Plan-Do-Check-Act (hereinafter PDCA) model, a program was developed and applied to evaluate its usability. In the first cycle, the program was developed (P), applied (D), and structured (A) through qualitative evaluation (C). The program was developed by combining baseball massage and self-resistance exercise, and was applied to seven elderly women over 65 years of age twice a week for a total of 12 weeks. The program was implemented non-face-to-face (Zoom, Jitsi-meet) with an instructor once a week, and at-home exercise was conducted through home training once a week. In the process of running the program, operations that needed to be excluded or modified were identified, and the program was structured to reflect this. In the second cycle, the structured program from the first cycle was applied to 15 elderly women twice a week for a total of 8 weeks, and changes in lower limb function of a total of 15 people were evaluated. As a result, compared to before participating in the program, there was a positive improvement in all items, including lower limb flexibility (p-value<.001), lower limb strength (p-value<.001), and dynamic agility (p-value<.001). appear. Baseball massage and self-resistance exercise to improve the lower limb function of the elderly through 2 cycles of PDCA is a program with a high compliance rate and no injuries or side effects, and can be used as a home-training method that can contribute to improving lower limb function. This has been confirmed.

Thalamic connectivity topography in newborns with spina bifida: association with neurological functional level but not developmental outcome at 2years.

Spina bifida affects spinal cord and cerebral development, leading to motor and cognitive delay. We investigated whether there are associations between thalamocortical connectivity topography, neurological function, and developmental outcomes in open spina bifida. Diffusion tensor MRI was used to assess thalamocortical connectivity in 44 newborns with open spina bifida who underwent prenatal surgical repair. We quantified the volume of clusters formed based on the strongest probabilistic connectivity to the frontal, parietal, and temporal cortex. Developmental outcomes were assessed using the Bayley III Scales, while the functional level of the lesion was assessed by neurological examination at 2 years of age. Higher functional level was associated with smaller thalamo-parietal, while lower functional level was associated with smaller thalamo-temporal connectivity clusters (Bonferroni-corrected P < 0.05). Lower functional levels were associated with weaker thalamic temporal connectivity, particularly in the ventrolateral and ventral anterior nuclei. No associations were found between thalamocortical connectivity and developmental outcomes. Our findings suggest that altered thalamocortical circuitry development in open spina bifida may contribute to impaired lower extremity function, impacting motor function and independent ambulation. We hypothesize that the neurologic function might not merely be caused by the spinal cord lesion, but further impacted by the disruption of cerebral neuronal circuitry.

A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial.

Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, "Olitor," designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called "Olitor" and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR -0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. This pilot study revealed the potential of the mobile intervention "Olitor" in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712.

Adults with cerebral palsy and chronic pain experience: A cross-sectional analysis of patient-reported outcomes from a novel North American registry

BackgroundChronic pain is common among adults with cerebral palsy (CP) and an area of priority for research and treatment. ObjectiveDescribe the pain experience and its functional and quality of life impact among adults with CP with chronic pain in the community. MethodsCross-sectional analysis of adult patient-reported outcomes collected by the Cerebral Palsy Research Network Community Registry. ResultsAmong all participants in the Community Registry, n = 205 reported having chronic pain, and 73 % of those (n = 149) completed the Chronic Pain Survey Bundle (75 % female; mean age 43 years (SD 14 years); 94 % White; 91 % non-Hispanic). Back and weight-bearing joints of lower extremities were most frequently reported as painful. There were no differences in average pain severity scores between varying GMFCS levels (H = 6.25, p = 0.18) and age groups (H = 3.20, p = 0.36). Several nonpharmacologic interventions were most frequently reported as beneficial. Participants with moderate to severe average pain scores (5-10) had higher levels of pain interference (p < 0.01) and depression (p < 0.01), and lower levels of satisfaction with social roles (p < 0.01) and lower extremity function (p < 0.01). Pain interference was significantly positively correlated with depression, and negatively correlated with upper and lower extremity function and satisfaction with social roles. ConclusionsChronic pain is experienced by adults with CP of varying ages and functional levels and is associated with several adverse quality of life and functional outcomes. Improved understanding of chronic pain in this population will facilitate the development and study of treatment interventions optimizing health, function, participation, and quality of life.

Relationship between phase angle and lower-extremity function in older adults: Itabashi Longitudinal Study on Aging

ObjectiveEvaluating muscle quality instead of its mass has gained attention in diagnosing sarcopenia. The aim of this study was to examine whether phase angle (PhA) as a bioelectrical impedance analysis (BIA)-derived muscle quality indicator is associated with overall lower extremity function better than appendicular skeletal muscle mass index (ASMI) in community-dwelling older adults. MethodsThis cross-sectional study used data from the Itabashi Longitudinal Study on Aging, a community-based cohort study. A sex-stratified multivariate logistic regression analysis was conducted using PhA and ASMI as exposures, and low physical function defined as short physical performance battery score <10 as the outcome, adjusted for age, being overweight, knee pain, and non-communicable diseases. Discrimination of low physical function was compared using the receiver operating characteristic curve. ResultsThis study included 1464 participants (age 76 [73–80] y; 757 women), with 58 men (8%) and 66 women (9%) exhibiting low physical function. The multivariate odds ratio (OR; 95% confidence interval [CI]) for low physical function among the highest quartile, compared with the lowest quartile were significant in PhA in multiple sites (e.g., OR, 0.09; 95% CI, 0.03–0.32] for men and 0.12; 95% CI, 0.04–0.33 for women in the left leg) but not in ASMI (OR, 0.51; 95% CI, 0.19–1.34 for men and 0.56; 95% CI, 0.21–1.47 for women). Legs and whole-body PhA outperformed the ASMI in discriminating low physical function (P < 0.001). ConclusionPhA reflected physical function better than ASMI; using PhA instead of ASMI in BIA-based morphometric evaluation may add information on low physical function and enhance the diagnostic value of sarcopenia.

The Immediate Effect of Static and Dynamic Stretching on Flexibility of Hamstring, Dynamic Balance Ability, Function of Lower Extremity: Randomized Controlled Trial

The Immediate Effect of Static and Dynamic Stretching on Flexibility of Hamstring, Dynamic Balance Ability, Function of Lower Extremity: Randomized Controlled Trial

The effect of multi-function swing suspension training on upper and lower extremities function and quality of life in multiple sclerosis women with different disability status

BackgroundMultiple sclerosis (MS) can lead to impaired upper and lower extremity function (ULEF), which reduces the quality of life (QoL). Exercise is beneficial for symptom management, but newer approaches like multi-function swing suspension training (MFSST) need further investigation. Additionally, tailoring exercises to individual needs remains a challenging area of investigation. AimTo investigate the effect of an MFSST program on ULEF, and QoL in MS women according to the expanded disability status scale (EDSS) score. MethodsForty-seven MS women meeting selection criteria were randomly assigned to intervention groups A (EDSS 2–4) and B (EDSS 4.5–6.5), and the control group (EDSS 2–6.5). Intervention groups did an 8-week MFSST program with 3 × 1hr sessions/week. Prior to the intervention, and after 4, 6, and 8 weeks, the 9-hole peg test (9HPT) and the timed 25-foot walk (T25FW) test were performed for both the intervention groups and the control group. The Short Form questionnaire (SF-36) was used to measure their QoL. ResultsSignificant main effects for time were observed in both the 9HPT (F = 52.48, p = 0.001, Pη2 = 0.78) and the T25FW (F = 85.63, p = 0.000, Pη2 = 0.859). Speed increased between the pre-test, 4th week, 6th week, and 8th week in both tests. These tests revealed significant interaction effects between group and time. The 9HPT had an F-value of 9.01 (p = 0.001, Pη2 = 0.392), while the T25FW had an F-value of 13.812 (p = 0.000, Pη2 = 0.497). Across both tests, Group B, with higher EDSS scores, demonstrated greater speed improvement over the three-time measurements (4th week, 6th week, and 8th week) than Group A. The control group did not exhibit any improvement in speed. Intervention groups showed improvement in all QoL subscales except emotional role limitation. ConclusionsAn 8-week MFSST improves ULEF and QoL in women with MS, particularly those with higher EDSS scores (more than 4.5). Notably, significant improvements were observed after four weeks of the intervention. The incorporation of a variety of exercises in a single device provides a significant advantage over traditional exercise programs. Therefore, MFSST can be a valuable and efficient tool for improving symptoms and QoL in MS patients. Trial registrationIRCT20220526054997N1.

Measurement of Healthy and Injured Triceps Surae Morphology.

Achilles tendon injuries occur throughout the lifespan and can negatively affect quality of life and overall health. Achilles tendinopathy is generally classified as an overuse injury associated with fusiform tendon thickening, neovascularization, and interstitial tendon degeneration. Current literature suggests these structural changes are associated withsymptoms and lower physical activity levels, as well assymptoms and lower extremity function in the long term. Surgically and non-surgically managed Achilles tendon ruptures result in increased tendon cross-sectional area (CSA) and a lengthened Achilles tendon. Both structural outcomes have clinical implications, as larger CSA positively predicts function, whereas increased tendon lengthening predicts reduced function after Achilles tendon rupture. Given the relationship between structural changes associated with Achilles tendon injuries for both injury severity and injury recovery, it is critical to be able to quantify Achilles tendon structure reliably and accurately. Silbernagel's group has established a valid and reliable method for efficiently evaluating triceps surae muscle and tendon structure. In this protocol, B-mode musculoskeletal ultrasound imaging is used to measure triceps surae structure, including Achilles tendon thickness and CSA, soleus thickness, and the presence of additional findings (calcifications and bursitis). B-mode extended field-of-view is used to measure Achilles tendon length and gastrocnemius anatomical CSA. Finally, power Doppler is used to identify intratendinous neovascularization. Quantification of triceps surae structure allows for comparison between limbs as well as longitudinal changes in response to exercise and treatment for healthy individuals and those with Achilles tendon injuries. This protocol has been used in many research studies to date and proves valuable in understanding the relationship between tendon structure and injury development, severity, and recovery. As ultrasound devices are becoming more affordable and portable, this protocol proves promising as a clinical tool, given its quick and efficient methods.

The Effect of Core Training Practices on Some Strength, Lower Limb Functions and Balance Performance in Judo Athletes

This study investigates the effects of core training on some strength, lower extremity functions, and balance performances in judoka. The study was based on a two-group pretest-posttest experimental design with repeated measures. The study included 12 female (F) judo athletes aged 12-18 years and 10 male (M) judo athletes aged 12-17 years. Three measurements for core strength (push-ups, planks, sit-ups), six different single leg hop tests (SLHT) for lower extremity muscle strength and YBT for balance were performed before and after 6-week core training. Shapiro-Wilk, Levene, and Paired sample t-tests were used in statistical analyses. The increases in limb symmetry index (LSI) scores were remarkable. When the push-up and plank times and sit-up scores of F and M participants were compared with the pre-test, a significant increase was observed in favor of the post-test. When we examined the dominant (D) leg hop for distance, we found that M and F judoka's SLD, THD, MSTHD, MRHD, and CHD post-test scores all increased (except F; CHD) and also M and F showed better performance in SL6MD. Similar performance outputs were seen in the non-dominant (ND) leg hop for distance measurements (only not changed F; THND). Finally, it was valuable to note that both right and left leg YBT scores showed a considerable rise in the post-test assessments. As a result, core exercise practices may improve the sit-up score by improving the time in push-ups and planks in judoka. In addition, it may improve balance performance by affecting lower extremity functions.

Translation, Adaptation, and Validation of a Spanish Version of the Japanese Orthopaedic Association Cervical Myelopathy Questionnaire.

Translation and psychometric testing of a questionnaire. Translation, adaptation, and validation of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) to the Spanish language. Degenerative cervical myelopathy (DCM) has a clear impact on quality of life (QoL). The JOACMEQ is a self-administered questionnaire used to assess DCM-related disability and its impact on QoL. It is compound of five domains: Cervical Function, Upper Extremity Function, Lower Extremity Function, Blader Function, and QoL. Despite its increasing use, the JOACMEQ has not yet been translated and validated for Spanish-speaking patients. A total of 180 patients completed the Spanish version. Of these, 145 (80%) had DCM (mean age: 62.53; SD: 9.92), while 35 had neck pain without DCM (age: 52.71; SD: 10.29). The psychometric properties measured were construct validity, internal consistency, reproducibility, concurrent validity, and discriminatory ability. We recruited 145 patients with DCM (mean age: 62.5) and 35 with cervical pain (mean age: 52.7). After factor analysis, our data showed very strong construct validity, with questions strongly loaded and clustered for five factors. Internal consistency proved high (Cronbach's α coefficient of 0.912). The intraclass correlation coefficient showed very good reproducibility for all domain (intraclass correlation coefficient range between 0.85 and 0.95). A high correlation between the JOACMEQ QoL domain and neck disability index was also found (Spearman's ρ=-0.847, P <0.01) confirming concurrent validity. The receiver operating characteristic curves proved to be significant in the upper (area under the curve=0.65, P =0.006) and lower (area under the curve=0.661, P =0.003) extremities, confirming discriminatory ability. Our proposed Spanish version of the JOACMEQ retains the psychometric characteristics of the original JOACMEQ and could prove useful for the evaluation of patients with DCM in Spanish-speaking countries.

Quantitative assessment of painful diabetic peripheral neuropathy after high-frequency spinal cord stimulation: a pilot study.

Randomized trials have demonstrated efficacy of spinal cord stimulation (SCS) for treatment of painful diabetic neuropathy (PDN). Preliminary data suggested that treatment of PDN with high-frequency SCS resulted in improvements on neurological examination. The purpose of the present study was to explore whether patients with PDN treated with high-frequency SCS would have improvements in lower-extremity peripheral nerve function. Prospective cohort study in an outpatient clinical practice at a tertiary care center. Patients with PDN were treated with high-frequency SCS and followed up for 12 months after SCS implantation with clinical outcomes assessments of pain intensity, neuropathic symptoms, and neurological function. Small-fiber sudomotor function was assessed with the quantitative sudomotor axon reflex test (QSART), and large-fiber function was assessed with nerve conduction studies (NCS). Lower-extremity perfusion was assessed with laser Doppler flowmetry. Nine patients completed 12-month follow-up visits and were observed to have improvements in lower-extremity pain, weakness, and positive sensory symptoms. Neuropathy impairment scores were improved, and 2 patients had recovery of sensory responses on NCS. A reduction in sweat volume on QSART was observed in the proximal leg but not at other sites. No significant differences were noted in lower-extremity perfusion or NCS as compared with baseline. The improvement in pain relief was concordant with improvement in neuropathy symptoms. The findings from this study provide encouraging preliminary data in support of the hypothesis of a positive effect of SCS on peripheral neuropathy, but the findings are based on small numbers and require further evaluation. ClinicalTrials.gov ID NCT03769675.

Investigation of parameters related to lower extremity muscle strength and proprioception in Patients with Multiple Sclerosis: a cross-sectional study

BackgroundPatients with Multiple Sclerosis (PwMS) may experience a decline in balance, gait, and mobility as well as an increase in fear of falling (FoF) and fatigue due to weaker muscles and proprioceptive loss in their lower limbs. The study aimed to compare lower extremity muscle strength and proprioception, balance, functional mobility, gait, FoF, and fatigue between PwMS and healthy controls and to investigate the relationship between lower extremity muscle strength and proprioception and balance, functional mobility, gait, FoF, and fatigue in PwMS. MethodsThe study was completed with 35 PwMS and 35 healthy controls with matching age and gender. The 5 Repetition Sit-to Stand Test (5-STS-test), knee and ankle reposition tests (using a digital inclinometer), the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, the Dynamic Gait Index (DGI), the Falls Efficacy-International (FES-I), and the Fatigue Severity Scale (FSS) were used for evaluations. ResultsThe 5-STS test, knee and ankle reposition tests, TUG, FES-I, and FSS Test scores were higher and BBS and DGI scores were lower in PwMS compared to healthy controls (p < 0.05). BBS, DGI, TUG, FES-I, and FSS were associated with 5-STS test and knee and ankle reposition tests except for some nondominant reposition tests in PwMS (r between 0.342 and -0.714; p < 0.05 for all). ConclusionLower extremity muscle strength and proprioception were associated with balance, functional mobility, gait, FoF, and fatigue in PwMS. These results suggested that detailed assessment of neuromuscular parameters in lower extremity function is important in determining the appropriate rehabilitation programs.

Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation.

The supplementary motor area (SMA) is important for motor and language function. Damage to the SMA may harm these functions, yet tools for a preoperative assessment of the area are still sparse. The aim of this study was to validate a mapping protocol using repetitive navigated transcranial magnetic stimulation (rnTMS) and extend this protocol for both hemispheres and lower extremities. To this purpose, the SMA of both hemispheres were mapped based on a finger tapping task for 30 healthy subjects (35.97 ± 15.11, range 21-67 years; 14 females) using rnTMS at 20 Hz (120% resting motor threshold (RMT)) while controlling for primary motor cortex activation. Points with induced errors were marked on the corresponding MRI. Next, on the identified SMA hotspot a bimanual finger tapping task and the Nine-Hole Peg Test (NHPT) were performed. Further, the lower extremity was mapped at 20 Hz (140%RMT) using a toe tapping task. Mean finger tapping scores decreased significantly during stimulation (25.70taps) compared to baseline (30.48; p < 0.01). Bimanual finger tapping led to a significant increase in taps during stimulation (28.43taps) compared to unimanual tapping (p < 0.01). Compared to baseline, completion time for the NHPT increased significantly during stimulation (baseline: 13.6 s, stimulation: 16.4 s; p < 0.01). No differences between hemispheres were observed. The current study validated and extended a rnTMS based protocol for the mapping of the SMA regarding motor function of upper and lower extremity. This protocol could be beneficial to better understand functional SMA organisation and improve preoperative planning in patients with SMA lesions.

P72 Sensor-derived measurements of upper and lower extremity function in people with type II and III SMA

P72 Sensor-derived measurements of upper and lower extremity function in people with type II and III SMA

Patient-Reported Outcomes Following Breast Reconstruction With the Transverse Myocutaneous Gracilis Flap Using the BREAST-Q and Lower Extremity Function Scale.

The transverse myocutaneous gracilis (TMG) flap is a viable and safe option for breast reconstruction in patients with limited abdominal tissue or other contraindications for abdominal-based flaps. Although it is one of the most common flaps employed for breast reconstruction, data on patient-reported outcomes is limited. The authors seek to evaluate patient satisfaction and aesthetic outcome after breast reconstruction with the TMG flap. All patients who underwent breast reconstruction with a TMG flap between March 2010 and October 2020 were identified. Invitation to a digital version of the BREAST-Q reconstructive module and the Lower Extremity Function Scale (LEFS) was sent to 105 patients. Patient demographics, complications, and surgical details were collected and retrospectively analyzed. BREAST-Q and LEFS scores were calculated and compared to the literature. Eighty-two patients participated in the study. Median follow-up was 5.9 years, with a mean patient age of 45.7 years. Most patients (90.2%) received treatment due to previous cancer of the breast, and 17.1% underwent immediate reconstruction. The mean score for "Satisfaction with Breast" was 66/100. Postoperative lower extremity function was high, with a median LEFS score of 78/80. A LEFS score below the median value was found to be significantly associated with active smoking (P = .049). Patients also reported high satisfaction with donor sites (8/11). Patient satisfaction and aesthetic outcome after breast reconstruction with TMG flaps is high and comparable to other common techniques. Lower extremity function is not impaired after flap harvest.

Association between PROMIS10, SF-36 and NeuroQoL in persons with multiple sclerosis

BackgroundPatient reported outcome measures (PROs) are considered promising tools for use in clinical settings to measure the impact of disease on physical, mental and social well-being from the patient's perspective. The Patient Reported Outcome Measurement Information System Scale v1.1-Global Health (PROMIS-10) is a measure that is well-suited to clinical practice, but the relationships between this measure and longer PRO measures used in multiple sclerosis (MS) research are unknown. MethodsSubjects enrolled in SysteMS: A Systems Biology Study of Clinical, Radiological, and Molecular Markers in Subjects with MS at the Brigham and Women's Hospital were eligible to contribute to the study. 349 subjects completed three PRO measures at study entry: PROMIS-10, Medical Outcomes Study Short-Form 36 (SF-36), and Quality of Life in Neurological Disorders (Neuro-QoL™). All questions and global scores from PROMIS-10 were correlated with all domain and summary component scores for SF-36 and all domain scores for Neuro-QoL using Pearson's correlation coefficient. Further, the global scores from PROMIS-10 were correlated with the expanded disability status scale (EDSS) and compared between disease categories (relapsing vs progressive MS). ResultsStrong correlations were observed between PROMIS-10 questions and SF-36 domains aimed at measuring the same construct. Further, the PROMIS-10 Global Physical Health score was correlated with the Physical Component Score from the SF-36 (r = 0.798), and the PROMIS Global Mental Health score was correlated with the Mental Component Score from the SF-36 (r = 0.726). Strong correlations between PROMIS-10 questions and two Neuro-QoL domains (fatigue and lower extremity function) were observed, but other Neuro-QoL domains were not strongly correlated with PROMIS-10 questions. PROMIS-10 Global Physical Health had stronger relationship to EDSS and disease category compared to the Global Mental Health. ConclusionsPROMIS-10 questions and global scores are highly correlated with the corresponding domains of SF-36 in PwMS. Neuro-QoL provides different information regarding HRQOL since different domains are being measured.

Changes in functional outcomes in people with high-energy ankle trauma after the use of the ReAktiv Posterior Dynamic Element™ orthosis and a rehabilitation program: A case series.

The aim of this study was to examine lower-limb function in 2 patients that received a ReAktiv Posterior Dynamic Element™ (PDE) orthosis and 6-week rehabilitation program after a high-energy trauma injury to the lower limb. Lower-limb function was assessed using the lower extremity functional score, walking performance through the 2-minute walk test, and dynamic mobility and balance through the single-leg balance, timed stair ascent, and the 4-square step test. A 6-week physiotherapy-led rehabilitation program was also implemented. Data showed improvements in lower extremity function, walking performance, mobility, and balance measures after 8 weeks of wearing the ReAktiv PDE™ orthosis and completion of the rehabilitation program. The ReAktiv PDE™ orthosis combined with a lower-limb rehabilitation program shows potential as a treatment option to improve lower-limb function and walking performance and return sufferers of high-energy trauma injury to functional levels seen in healthy cohorts.

Dynamometric outcomes of the donor site leg after vastus lateralis free flap harvest

The vastus lateralis muscle is one of the four muscles that make up the quadriceps femoris muscle, and it is also the largest of them. Some studies have shown that patients experience lower quality of life and muscle weakness after surgical treatment of thigh muscles in order to perform reconstructive surgery of the head and neck.The aim of our study was to assess the quantitative and qualitative function of the lower extremities using an isokinetic dynamometer and a validated questionnaire on subjective difficulties in patients who underwent reconstructive surgery with the vastus lateralis free flap.Fourteen participants aged 20-70 years who suffered from malignant tumor in the head and neck region. The free vastus lateralis flap was used for reconstruction. All patients underwent isokinetic dynamometric measurement with the isokinetic dynamometer to test the isokinetic functions of the thigh muscles after surgery. In addition, subjective assessment of the lower extremities was performed using the validated questionnaire Lower Extremity Functional Scale.All isometric dynamometer measurements of the donor leg were compared with those of the unoperated leg. Peak torque and average power were significantly lower in the operated leg compared with the unoperated leg after 60°/s extension (p = 0.018 for peak torque, p = 0.021 for average power) and 180°/s extension (p = 0.019 for peak torque, p = 0.015 for average power). On the other hand, there was no statistically significant difference in dynamometer measurements after 60°/s flexion (p = 0.700 for peak torque, p = 0.854 for average power, and 180°/s flexion (p = 0.634 for peak torque, p = 0.571 for average power). The median value for the LEFS was 65.5 (40.00-71.25).The results of this study showed that there is a significant deterioration regarding the biophysical properties of the operated leg after harvesting vastus lateralis free flap.

Effectiveness of 3D printed carbon fiber composite strut in customized ankle foot orthosis

This study aims to fabricate customized Ankle Foot Orthosis (cAFO) using Additive Manufacturing (AM), for investigating the effectiveness of straight Carbon Fibre Strut (CFS) that enhances push-off limits of drop foot (DF) gait. Three patients with unilateral DF were studied and two different host materials were used to fabricate cAFO from two different AM machines. A comparative quantitative study between the gait pattern of normal foot and DF (on affected side for same patient) for CFS efficacy was done by conducting two gait trials: with and without cAFO. The study shows CFS with cAFO is an effective additive manufactured mechanical component for DF patients to improve lower extremity functionality. CFS stores and releases energy during various phases of the gait cycle required for normal gait functionality for instance an improvement can be seen in deviation in ankle power to +36.84 % and +60.57 % for patients under consideration. In design domain, previous studies confined to L shaped strut, also clinical validation of straight strut is very limited. In this article clinical validation of straight strut with rectangular cross-section on DF patient is presented by using state-of-the-art tools, gait lab and design software's, resulting in better customization and ankle–foot mobility with reduced plantarflexion.

The rate of force relaxation scaling factor is highly sensitive to detect upper and lower extremity motor deficiencies in mildly affected people with multiple sclerosis.

The motor symptoms affecting upper and lower extremity functioning in people with multiple sclerosis (PwMS) are considered the cardinal symptoms of multiple sclerosis. There is still a need for outcome measures that can sensitively evaluate these symptoms. We aimed to investigate the sensitivity of the isometric outcomes (maximum force; Fmax, maximum rate of force development; RFDmax, rate of force development scaling factor; RFD-SF, and rate of force relaxation scaling factor; RFR-SF) and standard clinical tests (9-hole peg test; 9HPT and timed 25-feet walk test; T25FW) in detecting the upper and lower extremity motor deficiencies in PwMS and also in a subgroup of mildly affected PwMS whose performance in standard clinical tests were similar to controls. Twenty-nine PwMS (age: 47.9 (8.6) years, relapsing-remitting type, expanded disability status scale: 2.5 (1.5)) and their age- and gender-matched controls completed an identical testing protocol in the upper (grip force muscles) and lower (knee extensors) extremities. For each extremity, we assessed Fmax, RFDmax, RFD-SF, and RFR-SF. Additionally, participants completed standard clinical tests for the evaluation of upper- (9HPT) and lower-extremity (T25FW) function. Comparisons were made between controls and PwMS 1) using all study participants and 2) including only mildly affected PwMS whose performance in standard functional tests was comparable to controls. Independent sample t-tests were utilized to compare groups, with a p-value set at 0.01 to correct for multiple comparisons. P-values and effect sizes were used to evaluate the sensitivity of the outcome measures in detecting group differences. Our results indicate that most isometric outcomes and standard functional tests were sensitive in detecting motor deficiencies in both upper and lower extremities between groups (p<0.001). Among participants, 16 PwMS in 9HPT and 11 PwMS in T25FW demonstrated performance similar to that of the control group (9HPT: 18.85 (2.20) s vs 17.81 (2.19) s; p=0.19) and (T25FW: 3.60 (0.42) s vs 3.58 (0.29) s; p=0.92). The results of the comparisons between mildly affected PwMS and their controls indicate that RFR-SF is the only sensitive isometric outcome to detect differences between groups in the upper (-8.24 (0.76) 1/s vs -8.93 (0.6) 1/s; p=0.008) and lower extremity (-5.86 (1.13) 1/s vs -7.71 (1.11) 1/s; p<0.001). The rate of force relaxation scaling factor, which assesses the ability to rapidly relax muscle forces after quick contractions, demonstrates high sensitivity in detecting motor deficiencies in PwMS, even when the current standard clinical outcomes fail to detect these differences. Our findings emphasize the importance of future randomized controlled trials focusing on rehabilitative and therapeutic interventions that specifically target muscle force relaxation to enhance motor functioning in PwMS.