Mediolateral Research Articles

Does One Size Really Fit All? Morphometric Analysis of Distal Femur and Proximal Tibia in an Ethnic Indian Population and Correlation to the Sizing of Existing Total Knee Arthroplasty Implants.

Total knee arthroplasty (TKA) has been proven to be a highly efficacious procedure for patients with end-stage osteoarthritis who have persistent symptoms not managed by conservative treatment. A large percentage of standard commercially available total knee arthroplasty (TKA) implants are imported and designed based on morphometric data of Western populations, which are known to have a larger build compared to their Asian counterparts. Hence, these prostheses may sometimes not be the best fit for Indian patients. We conducted this study to examine the anthropometry of osteoarthritic knees of Indian patients, analyze anatomical differences between males and females, and compare these measurements with commercially available five TKA implants. Morphometric data were collected from 150 Indian patients with osteoarthritis of the knee using computed tomography (CT) scans. The mediolateral (ML) and anteroposterior (AP) dimensions of the distal femur and proximal tibia were measured, and aspect ratios (ML/AP) were calculated. These measurements were correlated with current commercially available implant sizes. We examined CT scans of100 female and 50 male patients' knees with a combined average age of 58.2 ± 7.5 years. The mean mediolateral and anteroposterior dimensions of the distal femur for Indian knees were 74.5 ± 5.8 mm and 58.0 ± 4.2 mm, respectively, whereas for the proximal tibia, 69.1 ± 5.5 mm and 43.8 ± 3.6, respectively. The mean aspect ratio for the femur was 129.0 ± 6.0 and for the tibia was 158.1 ± 9.1. Male dimensions were found to be greater than female dimensions in all measured aspects of the distal femur and proximal tibia for the Indian population. However, the aspect ratio of the tibia was not found to vary with gender. When compared with the dimensions of other ethnic groups, the size of Indian knees was found to be smaller than Caucasians. There is a mismatch between the anatomy of Indian knees and currently available TKA implants, and these implants may have drawbacks when implanted in Indian patients. The obtained anthropometric data may provide useful directions for designing TKA implants of more suitable sizes and aspect ratios for Indian patients.

Study on the Difference of Human Body Balance Stability Regulation Characteristics by Time-Frequency and Time-Domain Data Processing Methods.

In all, 16 subjects were tested, including 8 from the Chinese national team who had won the world championships of freestyle skiing aerials, with 10+ years of training (age: 23 ± 23.1 years, Height: 176 ± 2.1 cm, and weight: 69 ± 3.5 kg), and 8 ordinary graduate students of Shenyang Institute of Physical Education (age: 22.6 ± 4.6 years, Height: 179 ± 3.3 cm, and weight: 73 ± 4.1 kg). When performing the tasks, the research subjects were required to stand on the steady support surface (with eyes closed and legs closed) for 30 s in each testing. The displacement data of the anteroposterior (AP) direction and the mediolateral (ML) direction of their centre of pressure (COP) were recorded. Then, WT and OSI were calculated. Two dissimilar methods were compared to analyse the characteristics of balance ability. (1) The athletes' WT values in the AP direction and the ML direction were concentrated in the interval of 22~30 s and 0-8 s, respectively, while the ordinary graduate students' WT values in the AP direction and the ML direction were concentrated in the interval of 10~25 s and 0-7 s, respectively; (2) the WT values of the regular graduate students in the AP direction and the ML direction were higher than those of the athletes (p < 0.01); and (3) the OSI value in the AP direction of the athletes was higher than of the ordinary graduate students, while the OSI value in the ML direction of the athletes was lower than that of regular graduate students. Compared to the OSI, WT can analyse the characteristics of balance control ability more effectively. The COP displacement frequencies of the athletes and ordinary graduate students were concentrated in the low-frequency bands. The athletes had superior adjustment ability in an imbalanced state and could adjust to the best position without effort. In addition, the athletes had a stronger adaptive ability. In comparison, the ordinary graduate students had comparatively poor adaptive ability and weak adjustment ability in the imbalanced state, so it was difficult for them to attain the best angle after adjustment.

Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear

Background: A retear after rotator cuff repair is a common problem; however, there is little information related to the prognosis after a retear. In addition, some patients with retears have satisfactory outcomes, which raises the question of whether a retear leads to a poor prognosis. Purpose: To identify radiological factors that influence the prognosis after a retear. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 51 patients with retears confirmed by magnetic resonance imaging at 1 year after arthroscopic rotator cuff repair with a minimum follow-up of 24 months were enrolled in this study. Patients were divided into 2 groups according to whether they achieved the minimal clinically important difference for clinical outcome measures. Range of motion and radiological variables, including preoperative and postoperative anteroposterior (AP) and mediolateral (ML) tear sizes, sagittal extent of the retear, acromiohumeral distance (AHD), and degree of fatty degeneration, were analyzed using magnetic resonance imaging. Results: Overall, 36 patients were allocated to the good prognosis (GP) group and 15 to the poor prognosis (PP) group. The 2 groups had no significant differences in baseline demographics and preoperative radiological parameters. Postoperative range of motion was decreased in the PP group at the last follow-up. The AP and ML retear sizes decreased in both groups after arthroscopic rotator cuff repair, but the retear size was significantly larger in the PP group (both P < .05). The AHD increased in the GP group (P < .001) but decreased in the PP group (P = .230) postoperatively. Logistic regression analysis revealed that postoperative AHD (P = .003), fatty degeneration of the infraspinatus tendon (P = .001), posterior (P = .007) and anterior (P = .025) sagittal extent of the retear, and change in the AP tear size (P = .017) were related to poor outcomes after a retear. However, change in the ML tear size (P = .105) and middle sagittal extent of the retear (P = .878) were not related to a poor prognosis. Also, further analysis showed that posterior (P = .006) and anterior (P = .003) sagittal extent of the retear were related to rotator cable involvement. Conclusion: An increased AP retear size and decreased AHD were radiological parameters that were associated with poor clinical outcomes after a retear. In particular, patients who had posterior and anterior sagittal extent of the retear, possibly with rotator cable involvement and more severe fatty degeneration of the infraspinatus tendon, showed worse outcomes.

Comparison of verticality perception and postural sway induced by double temple-mastoidal and bipolar binaural 20 Hz sinusoidal galvanic vestibular stimulation.

Galvanic vestibular stimulation (GVS) is believed to be one of the most valuable tools for studying the vestibular system. In our opinion, its combined effect on posture and perception needs to be examined more. The present study was conducted to investigate the effect of a 20 Hz sinusoidal Galvanic Vestibular Stimulation (sGVS) on the body sway and subjective visual vertical (SVV) deviation through two sets of electrode montages (bipolar binaural and double temple-mastoidal stimulation) during a three-stage experiment (baseline, threshold, and supra-threshold levels). While the individuals (32 normal individuals, 10 males, the mean age of 25.37±3.00 years) were standing on a posturography device and SVV goggles were put on, the parameters of the body sway and SVV deviation were measured simultaneously. Following the baseline stage (measuring without stimulation), the parameters were investigated during the threshold and supra-threshold stages (1 mA above the threshold) for 20 seconds. This was done separately for each electrode montage. Then, the results were compared between the three experimental stages and the two electrode montages. In both electrode montages, "the maximum amplitude" of the mediolateral (ML) and anteroposterior (AP) body sway decreased and increased in the threshold and supra-threshold stages, respectively, compared to the baseline stage. Comparison of the amount of "amplitude change" caused by each electrode montages showed that the double temple-mastoidal stimulation induced a significantly greater amplitude change in body sway during both threshold and supra-threshold stages (relative to the baseline stage).The absolute mean values of the SVV deviation were significantly different between the baseline and supra-threshold levels in both electrode montages. The SVV deviation in double temple-mastoidal stimulation was a bit greater than that in the bipolar binaural stimulation. Double temple-mastoidal stimulation has induced greater amount of change in the body sway and SVV deviation. This may be due to the more effective stimulation of the otoliths than semicircular canals.

A prospective study to assess and quantify the setup errors with cone-beam computed tomography in head-and-neck cancer image-guided radiotherapy treatment.

This study was done to quantify the translational setup errors with cone-beam computed tomography (CBCT) in the image-guided radiation therapy (IGRT) treatment of head-and-neck cancer (HNC) patients. The objective was to quantify the setup errors by CBCT. One hundred patients of HNC were enrolled from March 2020 to March 2021 for IGRT treatment. Pretreatment kV-CBCT images were obtained at the first 3 days of irradiations, and setup error corrections were done in the mediolateral (ML), superior-inferior (SI), and anterior-posterior (AP) directions. Subsequently, a weekly kV-CBCT was repeated for whole duration of radiotherapy for the next 6-7 weeks. Adequacy of planning target volume (PTV) margins was assessed by van Herk's formula. Total 630 CBCT scans of 100 patients were analyzed. Setup errors greater than 3 mm and 5 mm were seen in 11.4% and 0.31% of the patients, respectively. Systematic errors and random errors before correction in ML, SI, and AP directions were 0.10 cm, 0.11 cm, and 0.12 cm and 0.24 cm, 0.20 cm, and 0.21 cm, respectively. Systematic errors and random errors after correction in ML, SI, and AP directions were 0.06 cm, 0.07 cm, and 0.07 cm and 0.13 cm, 0.10 cm, and 0.12 cm, respectively. CBCT at the first 3 fractions and then weekly during radiotherapy is effective to detect the setup errors. An isotropic PTV margin of 5 mm over clinical target volume is safe to account for setup errors, however, in the case of close organ at risk, or with IGRT, a PTV margin of 3 mm can be considered.

Lower Limb Ground Reaction Force and Center of Pressure Asymmetry During Bodyweight Squats.

BackgroundPerformance asymmetries between the lower limbs have been reported across a variety of variables and for numerous motor tasks including double leg squats. Additionally, the degree of symmetry is often used as a recovery metric during rehabilitation programs.Hypothesis/PurposeThe purpose of this investigation was to examine leg asymmetry during a bodyweight double leg squat task and assess the effects of squat speed in a physically active population.Study DesignCross-over Study Design.MethodsEighteen healthy individuals completed two sets of 20 squats at two tempos (preferred tempo and 60 bpm) while ground reaction force and center of pressure data were recorded using dual force plates. Peak vertical ground reaction force, force impulse, and center of pressure (COP) standard deviation in the anterior-posterior (AP) and mediolateral (ML) direction were calculated and analyzed to identify any differences between legs, tempo, and as a function of repetitions. Significance was set at ρ ≤ .05.ResultsThe subjects exhibited greater ground reaction forces during the self-paced tempo compared to the metronome-paced tempo (F1,79 = 14.48, p < .001) with the preferred leg generating larger values than the non-preferred leg during the self-paced condition. There was also a significant tempo x leg interaction for force impulse (F1,79 = 5.927, p = 0.015). A greater amount of COP variability was found in the preferred leg compared to the non-preferred leg in both the AP (F1,79 = 30.147, p < 0.001) and ML (F1,79 = 41.204, p < 0.001) directions.ConclusionsThese findings highlight the importance of considering multiple levels of analysis when assessing lower limb symmetry as separate variables may provide differential evidence for asymmetry. Practically, these results emphasize the need for coaches and practitioners to consider different degrees of lower limb asymmetries that may impact the development and design of strength and rehabilitation programs.Level of Evidence3

Postural control in Parkinsonisms during a short static sway

Neurological diseases, such as Parkinsonisms, are often associated with static postural instability. Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease classified among atypical Parkinsonisms. In the earliest stages, PSP is similar to Parkinson’s disease (PD) [1]. Static postural stability is an important contributor to the balance control framework and balance impairment can be quantified with a postural sway measure [2]. The main goal of our study was to compare postural sway changes in both PSP and PD subjects, using a standing single task of 5-6 seconds, in order to prove that a shorter sway time may be useful to distinguish Parkinsonisms. We assessed fifteen individuals with early PSP and fifteen individuals with recent diagnosis of PD (De Novo PD). Stabilometric analysis was performed for the evaluation of balance through a BTS Bioengineering system. The patient was instructed to stand on the force plate with the eyes open and measures of 5-6 seconds were taken. To find differences between the groups, univariate statistical analysis on sway data was conducted, and an alpha significance level was set to p-value < 0.05. The statistical analysis showed significant differences between De Novo PD and PSP groups for Medio- Lateral (M-L) sway (p-value=0.01), M-L range (p-value=0.023) and radius (p-value=0.026); minimum oscillation from the center of gravity and area showed a statistical trend with a p-value slightly above the 0.05 (p-value=0.056 and p-value=0.061, respectively). Several studies have demonstrated that balance dysfunction in PD is directionally dependent [2,3]. In agreement with our data, patients with atypical Parkinsonism show balance impairment on M-L direction as attested by augmented M-L sway, M-L range and radius. These results indicate that a short static sway of 5-6 seconds, could provide the clinician with a reliable and non-invasive tool to distinguish PSP from PD since the earliest stages.

Age-related differences in stepping stability following a sudden gait perturbation are associated with lower limb eccentric control of the perturbed limb.

Falls are a leading cause of severe injuries and a major threat to quality of life in older adults. Elderly fallers demonstrate insufficient eccentric quadriceps control during the weight acceptance phase of initial single limb stance. However, the functional role of eccentric control of the perturbed (leading) leg during walking balance recovery and its age-related differences have not yet been studied; thus we investigated age-related differences in eccentric control at the knee of the perturbed leg and its influence on the postural sway and stability of the trailing leg during balance recovery following unexpected surface drop perturbations. Ten younger and ten older healthy adults were compared during balance recovery following an 8cm unexpected surface drop perturbation at gait initiation. Outcomes related to perturbed leg included 1) eccentric knee extensor work; 2) electromyography (EMG) peak amplitude, peak latency, and eccentric EMG burst duration of the rectus femoris (RF); and 3) knee flexion angle during the single limb support. Outcomes related to stability of the trailing leg included 4) margin of stability (MoS) at first compensatory step touchdown after the perturbation. 5) Postural sway (standard deviation of center of mass acceleration) was measured in the anterior-posterior (A-P), medio-lateral (M-L), vertical directions during the single limb support. Compared to younger adults, older adults demonstrated lower eccentric knee extensor work (p=0.034), shorter RF EMG burst duration (p<0.01), delayed RF EMG peak latency (p=0.01), smaller knee flexion angle (p=0.01) and MoS (p=0.04), and higher postural sway (M-L (p=0.02), vertical (p<0.01)). There was a positive correlation between eccentric work and MoS (p=0.03) and a negative correlation between M-L postural sway and 1) RF eccentric EMG burst duration (p=0.04), and 2) eccentric work (p=0.01). Older adults demonstrated deficits in eccentric knee extensor control in the perturbed leg during single limb support, which contributed to reduced stability of the trailing leg compensatory step and greater postural sway during balance recovery. This finding provides insight into mechanisms of fall recovery from an unexpected unilateral postural perturbation and directions for lower limb strengthening exercises for aging populations.

Quantitative Changes in Gait Parameters after Cycling among Multiple Sclerosis Patients withAtaxia:APilot Study

Introduction: Cerebellar ataxia is a common symptom of multiple sclerosis (MS), particularly in progressive forms, where gait and balance problems are the most debilitating symptoms. Exercise training is a critical component of rehabilitation in managing equilibrium dysfunction, and stationary bicycling is a safe, feasible, and effective method to reduce the symptom. Clinical walking performance tests are typically used to assess gait in these patients. However, gait analysis technologies are more sensitive and accurate at detecting subtle and subclinical changes. The purpose of this study was to determine the changes in gait parameters in MS patients with ataxic gait after using a stationary bicycle.&#x0D; Materials and Methods: Ten secondary progressive MS patients with ataxic gait and a mean expanded disability status scale (EDSS) of four were recruited. The participants cycled on a stationary bike. Gait analysis was performed before and after 12 sessions of cycling. It included spatiotemporal and balance parameter measurements.&#x0D; Results: Gait analysis showed statistically significant changes in spatiotemporal parameters, including speed (P=0.02, r=-0.51), and stride length (P=0.01, r=-0.63). Of balance-related indices, the mediolateral (ML) center of pressure (COP) displacement, anterior and posterior COP overshoot, and COP velocity changes were statistically remarkable after the intervention respectively. (P=0.01, r=-0.63), (P=0.02, r=-0.51), (P=0.03, r=-0.49), (P=0.01, r=-0.54).&#x0D; Conclusion: Gait analysis is applicable to track changes following rehabilitation in individuals with MS. The results indicate that using a stationary bicycle can improve some spatiotemporal and COP-related parameters.

Tandem Gait Center Of Pressure Following Sport-related Concussion

Tandem gait is becoming a widely used sideline tool to evaluate dynamic postural control following sport-related concussion (SRC). Little to no research has evaluated tandem gait center of pressure (COP) following SRC compared to the traditional temporal characteristics. PURPOSE: Compare the differences from baseline to acute SRC post-injury using temporal and COP metrics in tandem gait. METHODS: 8 NCAA Division 1 athletes (age = 20 ± 1 years) performed tandem gait prior to their competitive season (PRE) and within 24-48 hours post-injury (POST) using an instrumented walkway (30 Hz, Tekscan Strideway, Tekscan Inc., South Boston, MA). The head team physician independently verified and diagnosed the SRC. During tandem gait, student-athletes were instructed to walk 3-meters, turning en pointe, and returning to the start position walking heel-to-toe as fast as possible. Three randomized trials of single-task (ST) and dual-task (DT) were completed and the raw center of force from the Strideway was exported and further analyzed. COP excursion in the mediolateral (ML) and mean velocity in the anteroposterior (AP and ML directions were calculated using a custom MATLAB code along with time to completion were evaluated during the entire trial. Multiple RM ANOVAs compare the baseline to post-injury tandem gait. RESULTS: There were no significant differences for ST ML excursion (PRE = 2.78 ± 0.47, POST = 3.61 ± 1.9; p = 0.25), for ST ML velocity (PRE = 16.57 ± 4.38, POST = 22.83 ± 17.68; p = 0.30), for ST AP velocity (PRE = 82.15 ± 16.12, POST = 107.82 ± 64.29; p = 0.196), and for ST time (PRE = 9.9 ± 1.81, POST = 11.82 ± 3.45; p = 0.62). CONCLUSION: The results indicate there are no significant differences between PRE and POST SRC. Although the data does not show any significant difference between times, SRC does generally slow an individual’s velocity thus suggesting a causal relationship exists.

Tai Chi Practitioners Have Superior Visuospatial Ability And Postural Stability During Goal-directed Movements

PURPOSE: To explore the effects of long-term Tai Chi (TC) practice on visuospatial ability and postural stability among older adults during goal-directed upper body movements. METHODS: Thirty-seven TC practitioners and control group participants aged from 65 to 77 years were recruited from local communities. Goal-directed touch task (TT) and blind touch task (BTT) were performed in a fixed order. A force plate and a 12-camera motion analysis system were used to collected center of pressure (COP), ground reaction force and the markers’ three-dimensional data. The target positioning error (TPE), time to stabilization (TTS) and COP-related variables during the tasks were evaluated. RESULTS: Under both TT and BTT conditions, TC practitioners had less TPE in vertical direction (TC group: 20.3 ± 3.9 mm; control group: 34.9 ± 4.4 mm, p = 0.019, d = 0.848) and 3-dimensional space (TC group: 61.0 ± 6.9 mm; control group: 101.3 ± 10.3 mm, p = 0.003, d = 1.065), shorter time to stabilization (TTS) in anterior-posterior (AP) (p = 0.001, η2p = 0.458) and mediolateral (ML) directions (p < 0.001, η2p = 0.557), smaller 95% confidence ellipse area (Area, p < 0.001, η2p = 0.757), maximum distance (Dmax) in AP (p = 0.025, η2p = 0.263) and ML (p = 0.014, η2p = 0.304) directions, root mean square (RMS) of COP in AP (p = 0.02, η2p = 0.280) and ML (p < 0.001, η2p = 0.718) directions, compared to control group participants. Among both TC and control groups, larger Area (p = 0.012, η2p = 0.352), Dmaxap (p = 0.001, η2p = 0.496), Dmaxml (p = 0.002, η2p = 0.434), RMSap (p = 0.016, η2p = 0.297) and RMSml (p = 0.032, η2p = 0.256) were detected under TT conditions, compared to BTT conditions. CONCLUSION: Long-term TC practitioners have superior visuospatial stability and postural stability, indicated that long-term TC practice could decrease the fall risks among older adults.

The Effects Of Height On Smoothness Of Gait In Adolescent Athletes

PURPOSE:To determine the relationship between height and changes in motion, using the harmonic ratio (HR) of adolescent athletes during walking before and after fatiguing exercises. METHODS: Participants were 21 females (mean 12.05 yrs, range 9-15 yrs) and 32 males (mean 13.46 yrs, range 10-16 yrs) athletes. Athletes completed a treadmill warm-up, during which their self-reported preferred walking speed (PWS) and walk-to-run transition speed were determined. These were used to calculate speeds slower (SWS), and faster than PWS (FWS). Subsequently, athletes completed two 9-minute treadmill walking trials (pre- and post-fatigue), consisting of 3-minute segments at each of the three speeds (SWS, PWS, FWS). Between the two trials, subjects completed a 10-minute series of exercises to induce lower extremity muscle fatigue. During walking, acceleration was measured in three planes of motion: Anterior-Posterior (AP), Medio-Lateral (ML), and Vertical (V). HR of acceleration, an indicator of smoothness of gait, was calculated for AP, ML, and V. RESULTS:: In pre-fatigue walking, there was a significant positive relationship between height and HR for males (R2 = 0.336, p = 0.001). Females had no significant relationship in pre-fatigue (R2 = 0.024, p = 0.56). In post-fatigue walking there was significant interaction by sex, with males retaining a significant positive association between height and HR (R2 = 0.265, p = 0.01) and females showing a significant negative association between height and HR (R2 = 0.393, p = 0.007). This relationship was not seen at PWS or FWS. CONCLUSIONS: Following fatiguing conditions, adolescent female athletes showed a greater change in the HR of the upper trunk in the vertical direction compared to males. Taller females had significantly decreased smoothness in vertical trunk motion compared to shorter females, while taller males had increased smoothness in vertical trunk motion in both pre- and post-fatigue conditions compared to shorter males.

Effects of age on dynamic balance measures and their correlation during walking across the adult lifespan

In this study, we aimed to discover (1) the effects of age on dynamic balance measures, including the margin of stability (MOS), whole-body angular momentum (H), and misalignment of the desired and measured centers of pressure (dCOP and mCOP, respectively) in the anteroposterior (AP) and mediolateral (ML) directions, (2) the relationship between gait parameters and these balance measures, and (3) the relationships between these balance measures. We used the kinetic and kinematic data of 151 participants aged 20–77 years from a publicly available database. Participants were divided into three groups: young, middle-aged, and old. The step width of the old group was higher than that of the young group. Age-related differences in dynamic measures were found in the ML direction and not in the AP direction: MOS, peak-to-peak range of H, and dCOP–mCOP in the old group were greater than in the young group. ML MOS positively correlated with the frontal peak-to-peak range of H. The ML peak-to-peak range of H positively correlated with ML dCOP–mCOP across the adult lifespan. Our findings provide new insights for understanding the effects of age on dynamic balance and the relationships between the metrics. Older adults walked with a larger step width, resulting in a large stability margin in the ML direction, although with increased moment and momentum around the center of mass in the frontal plane.

Immediate Effect of Augmented Reality, Virtual Reality, and Neurofunctional Physiotherapy on Postural Control and Executive Function of Individuals with Parkinson's Disease.

Objective: To assess the immediate effect of augmented reality (AR), virtual reality (VR), and neurofunctional physiotherapy (NPT) on postural control (PC) and executive function (EF) of individuals with Parkinson's disease (PD). Materials and Methods: Forty subjects from mild-to-moderate PD stages, with no cognitive impairment were submitted to one session of NPT, one session of AR, and one session of VR for 50 minutes each (7 days interval between them). PC was evaluated before and after each therapy, using force platform in bipedal positions: tandem with eyes opened (EO), eyes closed (EC), and with double-task and one-legged stance. We recorded the center of pressure area, and anteroposterior (AP) and mediolateral (ML) displacement amplitude and velocity. EF was assessed by Trail Making Test (TMT). Results: PC improved (pre- vs. postintervention) after the three modalities: AP velocity decreased after AR (tandem EC 2.3 [1.7 to 2.9] vs. 2.1 [1.5 to 2.9], one-legged 3.0 [1.9 to 4.0] vs. 2.9 [1.9 to 3.6]), NPT (tandem EC 2.2 [1.7 to 3.1] vs. 2.1 [1.6 to 3.0]), and VR (tandem EO 1.9 [1.4 to 2.6] vs. 1.8 [1.4 to 2.4], tandem EC 2.3 [1.6 to 3.0] vs. 2.0 [1.5 to 2.8]); ML velocity decreased after AR in one-legged (P = 0.04); and permanence time in one-legged position increased in AR (Δ: 2.5 [-0.2 to 6.9]). There was also improvement in EF: TMT part A (TMTA)'s time decreased after AR (-9.3 [-15.7 to 1.9]), and TMT part B (TMTB)'s time decreased after the three modalities (ΔNPT: -7.7 [-29.4 to 0.0] vs. ΔAR: -4.6 [-34.6 to 0.6] vs. ΔVR: -4.9 [-28.2 to 0.9]). There were no differences between the modalities. Conclusion: The three treatment modalities improved PC and EF of subjects with PD. Moreover, AR and VR generated similar immediate effects to NPT on both outcomes in these patients. Trial registration: Brazilian Clinical Trial Registration: RBR-5r5dhf.

Evaluation of the Foot Center of Pressure Estimation from Pressure Insoles during Sidestep Cuts, Runs and Walks.

Estimating the foot center of pressure (CoP) position by pressure insoles appears to be an interesting technical solution to perform motion analysis beyond the force platforms surface area. The aim of this study was to estimate the CoP position from Moticon pressure insoles during sidestep cuts, runs and walks. The CoP positions assessed from force platform data and from pressure insole data were compared. One calibration trial performed on the force platforms was used to localize the insoles in the reference coordinate system. The most accurate results were obtained when the motion performed during the calibration trial was similar to the motion under study. In such a case, mean accuracy of CoP position have been evaluated to mm along anteroposterior (AP) axis and mm along mediolateral (ML) axis for sidestep cuts, mm along AP axis and mm along ML axis for runs, mm along AP axis and mm along ML axis for walks. The accuracy of the CoP position assesment from pressure insole data increased with the vertical force applied to the pressure insole and with the number of pressure cells involved.

Incongruity of Geometric and Spectral Markers in the Assessment of Body Sway.

Different measurements of body oscillations in the time or frequency domain are being employed as markers of gait and balance abnormalities. This study investigates basic relationships within and between geometric and spectral measures in a population of young adult subjects. Twenty healthy subjects stood with parallel feet on a force platform with and without a foam pad. Adaptation effects to prolonged stance were assessed by comparing the first and last of a series of eight successive trials. Centre of Foot Pressure (CoP) excursions were recorded with Eyes Closed (EC) and Open (EO) for 90s. Geometric measures (Sway Area, Path Length), standard deviation (SD) of the excursions, and spectral measure (mean power Spectrum Level and Median Frequency), along the medio-lateral (ML) and antero-posterior (AP) direction were computed. Sway Area was more strongly associated than Path Length with CoP SD and, consequently, with mean Spectrum Level for both ML and AP, and both visual and surface conditions. The squared-SD directly specified the mean power Spectrum Level of CoP excursions (ML and AP) in all conditions. Median Frequency was hardly related to Spectrum Level. Adaptation had a confounding effect, whereby equal values of Sway Area, Path Length, and Spectrum Level corresponded to different Median Frequency values. Mean Spectrum Level and SDs of the time series of CoP ML and AP excursions convey the same meaning and bear an acceptable correspondence with Sway Area values. Shifts in Median Frequency values represent important indications of neuromuscular control of stance and of the effects of vision, support conditions, and adaptation. The Romberg Quotient EC/EO for a given variable is contingent on the compliance of the base of support and adaptation, and different between Sway Area and Path Length, but similar between Sway Area and Spectrum Level (AP and ML). These measures must be taken with caution in clinical studies, and considered together in order to get a reliable indication of overall body sway, of modifications by sensory and standing condition, and of changes with ageing, medical conditions and rehabilitation treatment. However, distinct measures shed light on the discrete mechanisms and complex processes underpinning the maintenance of stance.

The Long Term Follow Up of Helmet Therapy Following Endoscopic Suturectomy For Infants with Sagittal Craniosynostosis

Objective: Infants with sagittal craniosynostosis are treated with endoscopic suturectomy and remodeling helmets. The long term effects and the effects that occur after the completion of remodeling helmet treatment have not been investigated. The purpose of this study is to investigate the long term effects of remodeling helmet and effects that occur after the completion of remodeling helmet treatment. Material and Methods: 14 infants were included in the study. The children were assessed post-op, after the completion of remodeling helmet and at 6 months’ follow-up using a 3D laser acquisition system. The anterior-posterior(AP), medio-lateral(ML) cranial measurements, cranial circumference(CC), diagonal measurements, cephalic ratio(CR) and cranial vault asymmetry index(CVAI) were assessed. Results: The infants used the remodeling helmet for 35±3.4 weeks. When the post-op and completion results are examined, it can be seen that during remodeling helmet usage duration, AP, ML, CC measurements, the CR and CVAI have statistically improved, resulting in normalization of cranial shape (p&amp;lt;0.05). When the follow up results are examined, it can be seen that there was no deterioration in the symmetry of the cranial shape and the AP, ML, CC measurements and the CR and CVAI were preserved (p&amp;gt;0.05) whilst the infants’ craniums continued to grow at a normal rate. Conclusion: The present study shows that when remodeling helmet therapy is completed, cranial development continues at normal rates. There is no deterioration in cranial symmetry in the long term, and the effectiveness of the treatment continues after the remodeling helmet therapy is completed.

Sex differences in the effect of muscle fatigue on static postural control under different vision and task conditions.

The main aim of this study was to compare the effects of ankle plantar flexors fatigue on postural control between healthy young adult males and females. The secondary aim was to determine the effects of vision on the fatigue-induced postural changes. Ten healthy young males and nine females were asked to perform quiet standing (QS) and standing forward lean (FL) tasks with eyes open (EO) and closed (EC) before and immediately following exercise, and throughout a 15-min recovery period. A sustained isometric exercise of ankle plantar flexors was performed until participants were no longer able to maintain a target torque of 50% of maximal voluntary isometric contraction (MVIC). Mean anteroposterior (AP) and mediolateral (ML) positions of the center of pressure (COP), mean COP sway velocity, and 95% ellipse area of COP sway were measured. Ankle plantar flexors fatigue had significant effects on all dependent variables, except for sway area. A fatigue X sex interaction was found for sway velocity with the most challenging task condition (FL-EC), where males showed a significant increase in sway velocity up to 15 min following exercise, whereas females did not. Fatigue X vision interactions for AP position were also found, with the withdrawal of vision leading to a greater backward shift during recovery for both the QS (5 to 15 min) and FL (5 to 10 min) tasks. Our findings suggest the use of different postural control strategies with ankle fatigue between males and females, and also a contribution of vision to compensate for fatigue-induced instability that is not dependent on task difficulty.

The effect of peripheral arterial disease and intermittent claudication on gait regularity and symmetry

Peripheral arterial disease (PAD) affects 20–30% of older adults and is associated with intermittent claudication (IC), which is walking-induced pain. This study compared the regularity and symmetry of gait between healthy older adults and adults with PAD, and between IC and non-IC conditions in the PAD group.Eighteen control (70.7 ± 6.3 years) and 11 PAD participants (67.0 ± 10.1 years) walked overground at a continuous, self-selected speed. A waist-mounted accelerometer determined step time, stride time, gait speed and mediolateral (ML), vertical (V) and anteroposterior (AP) gait regularity (step/stride) and symmetry. Correlations between ankle-brachial index (ABI) scores and PAD gait regularity/symmetry were also investigated.PAD step and stride times were greater (p < 0.01), while gait speed, ML and AP step regularity and ML and V stride regularity were significantly less than the controls (p < 0.05). There were no significant differences in gait symmetry. Within the PAD group, post-IC step/stride time and speed increased and decreased, respectively, (p < 0.05), while post-IC step and stride regularity were significantly less in all three directions (p < 0.01). Similarly, ML and V post-IC gait asymmetry increased significantly (p < 0.05). ABI was significantly correlated with pre-and post-IC vertical stride regularity (p < 0.01), and with pre- and post-IC ML gait symmetry (p < 0.05).The results demonstrate that gait regularity decreases as a result of PAD and IC. The association between gait regularity/symmetry and ABI should be investigated further, as it may have clinical application to the assessment of PAD severity.

Comparison of Postural Control of Females with and without Urinary Incontinence: A Case-Control Study.

Background: So far, there is much less information about the effects of urinary incontinence on postural control. Therefore the aim of this study is to investigate the differences in postural control using linear and non-linear analyses of the center of pressure (COP) time-series in anteroposterior (AP) and mediolateral (ML) directions between females with and without stress urinary incontinence (SUI). Methods: This case-control study included 22 continent females and 22 SUI females. In this study, static postural control during four different postural tasks was evaluated using a force plate. All participants performed separate 60-sec standing trials with eyes open in the empty bladder and full bladder conditions. Mean, range, velocity, area circle of COP displacements, and approximate entropy (ApEn) of COP time-series were calculated from the 60-sec standing trials for all participants. The independent sample t-test was also used to compare COP variables between the two groups and paired sample t-test was used to assess changes between the full bladder and empty bladder conditions within each group. The effect size of Cohen's d was used to assess the magnitude of the differences between the two groups. Results: The findings revealed a significant group × task interaction for the mean of ML displacement and ApEn of COP. SUI females showed more AP displacement range in the full bladder (pvalue= 0.020, effect size=0.74) and a higher velocity (empty bladder: p=0.040, effect size=0.63) (full bladder: p=0.020, effect size=0.75) than the continent group. Generally, the SUI females had lower ApEn than the continent females, although the differences were not significant. While the variables of COP were unaffected by bladder fullness in the continent group, the SUI group in full bladder condition experienced more AP range (p=0.030), and area circle (p=0.007) of COP sway in quiet standing. Conclusion: These results provide more support for the hypothesis that postural control can be impaired following SUI, although future investigations on this topic are recommended.