Proximal Stability Research Articles

Biaxial system using the Benchmark intracranial guide catheter for placement of a Pipeline Embolization Device for intracranial aneurysms.

The Benchmark (Penumbra, Alameda, CA) is a novel intracranial guide catheter that provides optimized proximal stability combined with a hyperflexible and atraumatic tip. We assessed the use of a biaxial catheter system consistent with the Benchmark and Marksman microcatheter for placement of a Pipeline embolization device (PED) for intracranial aneurysms. We reviewed consecutive patients with aneurysms undergoing Pipeline embolization for an aneurysm using the biaxial system from April to October 2015 at a major academic institution in the United States. Benchmark performance was measured by the number of 90° turns the catheter could safely cross. Landing and final positions of the Benchmark were recorded. A total of 26 procedures were performed in 25 patients (mean age 59.5 ± 10.3 years; male:female = 1:4). In one case (3.8%) the biaxial system had to be substituted for a traditional triaxial system. The Benchmark was able to cross one, two, or three 90° turns in 48%, 40%, and 8% of cases, respectively. There was one (3.8%) thromboembolic event and no arterial dissections. In the period from January 2014 to March 2015 and prior to adopting the biaxial system we encountered three thromboembolic events (6.4%) and one (2.1%) dissection potentially related to the triaxial system in 47 PED procedures. Preliminary experience shows that a biaxial system using the Benchmark is a safe and efficacious alternative to the traditional triaxial guide catheter system for placement of PED and may reduce the complexity and duration of the procedure.

Obstacle Crossing During Gait in Children With Cerebral Palsy: Cross-Sectional Study With Kinematic Analysis of Dynamic Balance and Trunk Control.

Balance problems are common in children who have cerebral palsy (CP) but are active and ambulant. Control of the whole-body center of mass is critical in maintaining dynamic stability during challenging mobility tasks, such as clearing an obstacle while walking. The objective of this study was to compare trunk and lower limb kinematics and center-of-mass control in children with CP and those in children with typical development during obstacle crossing. This was a cross-sectional study. Thirty-four children who were 5 to 17 years of age (17 with CP and 17 with typical development) and matched in age and height completed 2 gait trials involving crossing a 10-cm obstacle. Three-dimensional kinematic and kinetic data were captured with a general-purpose 3-dimensional motion tracking system and forceplates. Trunk data were captured with a validated model. All children cleared the obstacle with similar hip and knee kinematics, step length, and single-support duration. In children with CP, step width was increased by 4.81 cm, and center-of-mass velocity was significantly slower at lead limb toe-off (0.31 m/s) and during lead limb clearance (0.2 m/s). Children with CP showed altered trunk and pelvis movement, characterized by significantly greater pelvic obliquity, pelvic tilt, and trunk rotation throughout the task, increased lateral trunk lean during lead limb crossing (3.7°), and greater sagittal trunk movement as the trail limb crossed (5.1°). The study was not powered to analyze differences between children with diplegia and those with hemiplegia. Children with CP required greater adjustments at the trunk and pelvis to achieve successful obstacle crossing. The increase in trunk movement could have been compensatory for reduced stability distally or for a primary problem reflecting poor proximal control. The findings suggest that rehabilitation should focus on both proximal trunk control and distal stability to improve balance.

Validation of Patellar Stabilization Surgical Algorithm Based on Congruence

Background:Multiple algorithms exist for proximal and/or distal stabilisation surgery for patellar instability with no consensus in the literature.Aim:To validate our surgical algorithm based on patellofemoral congruence for patellar instability.Algorithm:Once patellar stabilization surgery is clinically indicated, we determine patellofemoral congruence abnormality based on quadriceps active CT and intraoperative arthroscopic assessment. Arthroscopic lateral release is carried out if indicated. For patients with minimal incongruence post lateral release, MPFL reconstruction alone (MPFL group) is performed, and we perform tibial tubercle transfer and MPFL reconstruction (TTT group) for significant incongruenceMethods:Retrospective study with prospective follow up of patients operated on between 2008 and 2015. We excluded patients with skeletal immaturity, previous patellofemoral surgery, and distalisation of tibial tubercle. Chart review, pre and post operative quadriceps active CT, Kujala score, and patient’s subjective stability analysed.Results:98 patients were reviewed with mean follow up 37 weeks. 14 patients had MPFL alone. Recurrence of instability occurred in 4% of patients, all in TTT group. Reoperation rate was 19%, almost all in TTT group, with removal of hardware being the most common reason. There was no significant difference in TTTG between the two groups on pre operative CT measurement.Conclusion:Patellar stabilization surgical algorithm based on congruence is valid in preventing further instability. Reoperation rate is high due to majority of patients receiving TTT procedure.

Coupling effect of neuromuscular electrical stimulation on glutei and transcutaneous electrical nerve stimulation on hip adductors in scissoring gait

Introduction: Spasticity and weakness are the two most important factors effecting gait in children with spastic diplegia. Spasticity in hip adductors and associated weakness in hip extensors and abductors leads to scissoring gait pattern. Proximal muscle stability is essential for distal mobility; this study focuses more on proximal muscle group facilitation for correction of deviations in scissoring gait. Objective: The objective of this study was to study the coupled effect of neuromuscular electrical stimulation (NMES) on glutei and transcutaneous electrical nerve stimulation (TENS) on hip adductors in improving gait parameters. Materials and Methods: The experimental group received NMES to hip extensors and hip abductors followed by TENS to hip adductors as an adjunct to conventional therapy for a period of 3 weeks whereas the control group received only conventional therapy. In experimental group, NMES was applied to gluteus maximus and medius for 10 min each and were asked them to perform the muscle action voluntarily. Later, TENS was applied to hip adductors for 10 min with passive hip abduction (HAB). Both the group received home program for the next 2 months. Results: A significant improvement was noted in spasticity, active range of motion (AROM) to HAB, extension, and gait parameters with P Conclusion: The coupled effect of NMES on glutei and TENS on hip adductors in children with scissoring gait gives rise changes in muscle tone, AROM, and gait parameter. All these contribute in improving the gait. These gains persist atleast for 3 months compared to the individuals who receive only conventional therapy. The improvement is seen within a short period of 3 weeks time compared to conventional therapy alone group which takes longer period of 12 weeks time.

Saciedade subjetiva, aceitação sensorial e aspectos tecnológicos de salsicha com adição de fibra de trigo

Resumo O objetivo deste trabalho foi a elaboração de salsichas com diferentes concentrações de fibra de trigo e a avaliação de suas características tecnológicas, aceitação sensorial e saciedade subjetiva causada por sua ingestão. Foram produzidas salsichas com adição de zero (Controle), 1,5% e 3% de fibra de trigo. Os aspectos tecnológicos avaliados foram: composição centesimal (teores de proteínas, lipídios, umidade e cinzas), valor de pH, textura instrumental, cor objetiva, estabilidade de emulsão e rendimento do processo. Para análise sensorial foi realizado teste afetivo de aceitação com 60 consumidores que avaliaram os atributos sabor, textura, suculência e aceitação global, utilizando escala hedônica de 9 pontos. Para a análise de saciedade, 30 consumidores relataram, em uma escala visual analógica, a sensação de fome sentida antes, imediatamente depois e a cada 30 minutos após comerem as salsichas, durante 2 horas. Os resultados demonstraram que, exceto para a luminosidade (L*), as salsichas com adição de fibras (1,5% e 3%) não diferiram em nenhum dos aspectos tecnológicos em relação à amostra Controle. Na avaliação sensorial, as salsichas com 3% de fibra foram consideradas mais suculentas e tiveram melhor aceitação global (p<0,05) que as com 1,5%, ambas não diferindo da amostra Controle. A aceitação dos atributos sabor e textura não diferiu entre todas as amostras. Em relação à avaliação da saciedade, não houve diferença entre as amostras, ou seja, a adição de até 3% de fibra de trigo nas salsichas não foi suficiente para promover maior saciedade nos consumidores em comparação com a salsicha sem adição de fibra. Pode-se concluir que, apesar de não ter sido observada maior sensação de saciedade pela adição de fibra de trigo, salsichas contendo 1,5% e 3% desta fibra podem ser produzidas sem prejuízo das características tecnológicas e com boa aceitação sensorial, podendo favorecer o aumento do consumo de fibras pela população.

Biomechanical evaluation of periprosthetic refractures following distal femur locking plate fixation.

Distal femur fractures proximal to total knee femoral component constitutes the most prevalent type of periprosthetic fracture, and plate fixation treatment is associated with a 7.7% incidence of refracture proximal to the plate. The primary objective of this study was to compare proximal fixation techniques of a periprosthetic distal femur fracture plate in an osteoporotic bone model. The secondary objective was to determine the subsequent periprosthetic plate fracture pattern and/or complexity associated with each proximal plate fixation configuration. A segmental defect was created in 21 synthetic osteoporotic adult femurs 6 cm proximal to the distal femur and all specimens were stabilised with a 246 mm locking femur plate. Fixation in the most proximal hole was varied by use of either a cerclage cable, unicortical locking screw, or a bicortical locking screw. Specimens were tested to failure in simultaneous eccentric compression and torsion. Proximal cerclage fixation demonstrated higher mean maximum axial force at failure (4142.67±178.71 N, p<0.001), stiffness (443.8±61.64 N/mm), and maximum torque (20.9±0.93 N m, p<0.001). Unicortical and bicortical screw refractures occurred at the screw, cerclage wire refractures occurred at the first proximal screw distal to the cerclage. In periprosthetic distal femur fracture locking plate fixation, proximal hole stabilization with a cerclage wire tolerates significantly higher failure forces while distributing forces distal to the area within the plate fixation. Cerclage wiring may be an option in distal femur periprosthetic fractures to alleviate stress risers in vulnerable bone.

Upper extremity coordination strategies depending on task demand during a basic daily activity

Injury conditions affecting the upper extremity may lead to severe functional impairment and an accurate evaluation is needed in order to select the most effective treatment in a rehabilitation program. This study focused on simultaneous electromyographic and kinematic analysis to assess movement patterns of upper extremity during a basic daily activity, considering different demands existing within the task.Twenty-five healthy subjects, average age 19.8 ys SD 1.7 ys, with no upper extremity impairment, were assessed by means of electromyography (EMG) and a 3D motion capture system while performing a task that required reach, transport and release. Integrated EMG (iEMG), timing of muscle onset and active range of motion (AROM) were calculated for each subject. Data were compared within each phase and between the three phases and a repeated measure ANOVA was used for statistical analysis.We found early activation of upper trapezius associated with high activity of serratus anterior for proximal stability while anterior deltoid and triceps brachii performed shoulder flexion and elbow extension, in Reach phase. In Transport phase there was early and higher activation of upper trapezius, higher muscle activity of almost all muscles and increased AROM of all joints. No change in flexion/extension wrist posture with increased forearm muscles activity were identified as the main control strategy to keep optimal grasping. Triceps brachii was found to act as an important synergist in shoulder abduction and extension in free load conditions. Such information can lead clinicians to more specific assessment and subsequent better intervention in upper extremity rehabilitation.

Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head

The purpose of our study was to determine the relative contributions of the annular ligament, proximal band, central band, and distal band of the interosseous membrane in preventing dislocation of the proximal radius. In part 1 of the study, 8 forearms were loaded transversely with the forearm intact, and the central band, proximal band, and annular ligament were sequentially sectioned to determine the percentage contribution of each structure in preventing transverse radial displacement. In part 2, 12 forearms were cyclically supinated and pronated while optical sensors measured radial and ulnar motion. Transverse radial head motion was computed as the distal band, central band, and proximal band (and annular ligament) were sequentially sectioned. In part 1, there was no significant difference in the percentage contribution of each structure in preventing radial transverse displacement. In part 2, only after sectioning of the central band did significant radial head displacement occur. Greater displacements occurred in supination than in pronation. Dislocation of the proximal radius occurred in 2 arms after sectioning of all 3 structures. Under pure transverse displacement, the central band, annular ligament, and proximal band equally contributed to stabilizing the radius. However, during forearm rotation, the central band contributed more to radial head stability than the annular ligament and proximal band. Our study contributes to our knowledge of forearm biomechanics, demonstrating the importance of the central band in providing proximal radial head stability. Forceful supination should be avoided after surgical procedures designed to stabilize the radial head.

Spatial–temporal evolution of aeolian blowout dunes at Cape Cod

This paper explores historical evolution of blowouts at Cape Cod National Seashore (CCNS), USA — a site that hosts one of the world's highest densities of active and stabilized blowouts. The Spatial–Temporal Analysis of Moving Polygons (STAMP) method is applied to a multi-decadal dataset of aerial photography and LiDAR to extract patterns of two-dimensional movement and morphometric changes in erosional deflation basins and depositional lobes. Blowout development in CCNS is characterized by several geometric (overlap) and movement (proximity) responses, including: i) generation and disappearance, ii) extension and contraction, iii) union or division, iv) clustering and v) divergence by stabilization. Other possible movement events include migration, amalgamation and proximal stabilization, but they were not observed in this study. Generation events were more frequent than disappearance events; the former were highest between 1985 and 1994, while the latter were highest between 2000 and 2005. High rates of areal change in erosional basins occurred between 1998 and 2000 (+3932m2a−1), the lowest rate (+333m2a−1) between 2005 and 2009, and the maximum rate (+4589m2a−1) between 2009 and 2011. Union events occurred mostly in recent years (2000–2012), while only one division was observed earlier (1985–1994). Net areal changes of lobes showed gradual growth from a period of contraction (−1119m2a−1) between 1998 and 2000 to rapid extension (+2030m2a−1) by 2010, which is roughly concurrent with rapid growth of erosional basins between 2005 and 2009. Blowouts extended radially in this multi-modal wind regime and, despite odd shapes initially, they became simpler in form (more circular) and larger over time. Net extension of erosional basins was toward ESE (109°) while depositional lobes extended SSE (147°). Lobes were aligned with the strongest (winter) sand drift vector although their magnitude of areal extension was only 33% that of the basins. These differences in extension responses likely result from more complex and evolving flow-form interactions inside erosional basins. Historical photographs and CCNS documents suggest that blowout evolution may be influenced by land-use changes, such as revegetation campaigns in 1985 that were followed by high blowout generation. High magnitude regional storm events (e.g., hurricanes) also play a role. The analytical framework presented provides a systematic means for two-dimensional geomorphic change detection and pattern analysis that can be applied to other landscapes.

Type Ia endoleaks after fenestrated and branched endografts may lead to component instability and increased aortic mortality

Fenestrated and branched endografts allow for proximal sealing zone extension into or above the visceral aorta to optimize landing in healthy aorta. We describe the incidence, causes, and implications of proximal endoleak development in patients undergoing complex endovascular aortic aneurysm repair. All patients undergoing a fenestrated/branched repair were entered onto a prospective database, and this analysis included all those with at least one postoperative contrast computed tomography scan. Preoperative and postoperative three-dimensional imaging was reanalyzed to characterize morphology and identify endoleak. A blinded assessor used the preoperative imaging to resize the repairs in the endoleak group and a matched cohort of patients without endoleak. The outcome measures were proximal endoleak development, mortality, and component stability, and a comparison was made with all patients undergoing complex aortic repair. From 2001 to July 2013, 969 patients underwent repair in a physician-sponsored investigational device exemption trial. Excluded were 24 emergency patients and 21 patients without requisite imaging, leaving 924 available for analysis. A proximal type Ia endoleak developed in 26 patients (2.8%). Poor choice of landing zone was implicated in most cases, with an area of sealing in the visceral aorta, compared with the thoracic aorta, being significantly associated with endoleak development (P< .01). Aortic-related mortality was significantly higher in the endoleak group (26.9%) than in the group without endoleak (6.2%; P= .001). These patients also experienced a higher incidence of component instability of 30.8% compared with 9.6% in patients without type Ia endoleak (P< .01). Fenestrated/branched endovascular repair has a low incidence of sealing zone failure despite the increased complexity. However, development of a proximal endoleak destabilizes the repair and leads to increased mortality. Increasing complexity of design seems to improve the long-term outcome for patients requiring complex aortic repair.

Studies on the preparation of stem amaranth pickle

Fresh stem amaranth was analyzed for proximate composition and the developed pickles were analyzed for proximate composition, microbiological status, sensory attributes and overall storage stability of the pickles. Pickle was prepareded with sugar, salt, oil and vinegar. Five formulations of stem amaranth were prepared. Fresh stem amaranth contains 96.0% moisture, 1.0% ash, 0.01% fat, 2.0% protein and 30 mg/100g vitamin-C. The chemical analysis of pickles showed that moisture content was highly reduced in all processed samples. The microbiological studies revealed that total viable counts of bacteria and fungal growth were high in the pickles prepared without vinegar and sugar but it was low with vinegar-sugar-oil mix. The panelists marked for colour, flavor, texture and overall acceptability and analyzed statistically. Among five samples, the pickles prepared with vinegar-sugar-oil mix were the best. Storage studies were carried out up to six months at room temperature. Minor change was observed for color and flavor. DOI: http://dx.doi.org/10.3329/jbau.v12i1.21409 J. Bangladesh Agril. Univ. 12(1): 177-182, June 2014

Effect of muscle weakness distribution on balance in neuromuscular disease.

To assess balance and identify the effects of muscle weakness distribution on balance in children with different neuromuscular diseases. Forty ambulant, pediatric patients with neuromuscular disease were enrolled in the study. Patients were separated into two groups according to muscle weakness distribution as group 1 (proximal) and group 2 (distal). Demographic data were recorded. Functional level (Brooke lower extremity functional classification), muscular strength (manual muscle testing), balance (pediatric functional reach test [PFRT], timed up-and-go test [TUGT], stabilometric platform) and functional performance (6 min walk test [6MWT]) were assessed. Group 1 consisted of 20 Duchenne muscular dystrophy patients, and group 2, of 20 neuropathy patients. The total lower, upper limbs and trunk muscles muscle strength (P < 0.05); forward and right side reach subsections of the sitting position, and PFRT total score (P < 0.01) were significantly different between the groups. TUGT results were 7.79 ± 1.54 s and 10.13 ± 2.63 s, respectively, in group 1 and 2 (z = -2950; P < 0.01). No statistically significant difference between groups in any performance parameters of the 6MWT was found (P ≥ 0.05). Anterior body balance was found to be dominant in group 1, while posterior body balance was dominant in group 2 (P ≤ 0.05) measured by stabilometric platform. The distal group was particularly affected regarding dynamic balance, and the proximal group regarding static balance. Muscle strength was important for providing dynamic stability in the distal group, and for maintaining proximal stabilization during dynamic activities in the proximal group.

The Effect Of Peroneus Brevis Tendon Anatomy On Stability Of Fractures At The Fifth Metatarsal Base

Objectives:Fractures of the fifth metatarsal base are not uncommon. Both fracture management and outcomes can differ greatly depending on fracture location. The purpose of the present study is to evaluate the influence of the peroneus brevis (PB) tendon on proximal fifth metatarsal fracture stability. We hypothesize that proximal fifth metatarsal fractures distal to the PB tendon footprint are inherently less stable than more proximal fractures.Methods:We utilized 5 matched pairs of fresh-frozen cadaveric specimens. We carefully exposed the 5th metatarsal and PB tendon. We measured the length of the PB insertion at the base of the fifth metatarsal with calipers. The PB and Achilles tendons were then whip-stitched proximally to facilitate loading. A custom leg holder was fabricated to allow loading and fluoroscopic evaluation. Two conditions were utilized for biomechanical testing; (1) a simulated fracture distal to the PB insertion (Jones equivalent) and (2) a simulated fracture within the footprint of the PB insertion (avulsion equivalent). All fractures were carefully created with a narrow osteotome. Following fracture creation, the plantar flexed foot was statically loaded through the Achilles and PB tendons. Oblique images with and without loading and digital measurements were performed to evaluate for fracture separation. We utilized a paired student T test and intraclass correlation coefficient (ICC) for all statistical analysis.Results:The average length of the PB footprint was 15.2 mm. Compared to fractures within the PB footprint, fractures distal to the PB tendon insertion demonstrated greater fracture widening following loading of the PB tendon. Fractures within the PB footprint widened 0.4 mm on loading (Figure 1A to 1B) compared to 1.1 mm of widening in the fractures distal to the PB insertion (Figure 1C to 1D). This difference was significant (p = 0.02). Intraobserver reliability for all radiographic measurements showed substantial agreement.Conclusion:Avulsion fractures at the base of the fifth metatarsal have much better healing potential than the so-called Jones fracture. Poor vascularity has been cited as a cause for poor healing potential following Jones fractures. The principal findings of this study demonstrate that proximal fifth metatarsal fractures distal to the PB insertion are significantly more unstable than more proximal fractures. In our study, the PB exerts a deforming force on the proximal fragment of fractures distal to the PB footprint. This deforming force was less pronounced in fractures within the PB footprint. Our findings help support the notion that a mechanical component may contribute to the poor healing potential of Jones fractures secondary to deformation exerted by the PB tendon. This would help explain why screw fixation is often recommended to address Jones fractures. Further research is needed to evaluate the biomechanics of these fractures.

Is stability of the proximal tibiofibular joint important in the multiligament-injured knee?

The incidence of proximal tibiofibular joint instability in the setting of the multiligament-injured knee has not been previously reported. The integrity of the proximal tibiofibular joint is required to perform a fibular-based, lateral-sided knee reconstruction. We report (1) the frequency of proximal tibiofibular joint instability in patients presenting with multiligament knee injuries and evaluate (2) our ability to restore stability to this joint, (3) patient-reported outcome scores, and (4) complications in patients surgically treated for proximal tibiofibular joint instability at the time of treatment of multiligament knee instability. From 2005 to 2013, 124 patients (129 knees) sustaining multiligament knee injuries with Grade 3 instability to at least two ligaments were treated at our institution. We defined proximal tibiofibular joint instability as a dislocated or dislocatable proximal tibiofibular joint at the time of surgery. These patients underwent surgery to restore proximal tibiofibular joint stability and ligament reconstruction or repair and were followed with routine clinical examination, radiographs, and subjective outcome measures, including Lysholm and IKDC scores. Minimum followup was 12 months (mean, 32 months; range, 12-61 months). Twelve knees (12 patients, 9% of 129 knees) showed proximal tibiofibular joint instability. Knee stability in 10 patients was restored to Grade 1 or less in all surgically treated ligaments. No proximal tibiofibular joint instability has recurred. No patients have complained of ankle stiffness or pain. In the ten patients with subjective scores, mean Lysholm score was 75 (range, 54-95) and mean IKDC score was 58 (range, 22-78). There were four complications: one failed posterolateral corner reconstruction, one proximal tibiofibular joint screw removal secondary to pain over the screw head, one deep infection treated with serial irrigation and débridements with graft retention, and one closed manipulation secondary to arthrofibrosis and loss of ROM. In the setting of multiligament-injured knees, our series demonstrated a 9% incidence of proximal tibiofibular joint instability. The technique we describe successfully restored stability to the proximal tibiofibular joint and resulted in satisfactory patient-reported outcomes with low complication rates. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

PROXIMATE ANALYSIS AND OXIDATIVE STABILITY OF WAX FROM THE NUTS OF KRABOK (IRVINGIA MALAYANA)

Proximate analysis and oxidative stability of Krabok nuts were carried out in order to obtain more extensive information pertaining to their suitability as the raw material for a food supplement. It was found that 100 g of the nuts consist of 1.79 g of ash, 2.08 g of moisture content, 66.78 g of crude fat, 9.07 g of total carbohydrate, 3.40 g of crude protein, 61.43 mg of iron and 103.30 mg of calcium. The oxidative stability of the nuts was studied during storage at four different conditions including 4°C, 45°C, room temperature (23-25°C) and sun light exposure. Peroxide values were measured every 30 days for 4 months. At 45°C, the peroxide values were found in the range 2.31-3.94 meq ROOH/kg of fat, which is higher than at other conditions. The nuts stored at 4°C showed the lowest peroxide value, ranging from 1.37 to 2.70 meq ROOH/kg of wax. Where as, they were 1.1446-1.1877 meq ROOH/kg of fat at room temperature. It was concluded that the preferred temperature for keeping the nuts is at 4°C.

Gross Motor Function of A Child With Neurodegeneration With Brain Iron Accumulation (NBIA)

Introduction. Neurodegeneration with brain iron accumulation (NBIA) involves a group of progressive extrapyramidal disorders characterised by iron accumulation in the brain. Objective. to de­scribe the gross motor function of a child with clinical diagnosis of NBIA. Method. This is a case report involving a 7-year-old child and clinical diagnosis of NBIA. This study evaluated the history of the disease and the neuromotor functions of the child using a neurological physiotherapy evaluation form. The GMFM - Gross Motor Function Measure, a system of quantitative assessment of gross motor function in five broad dimensions, was applied. Case Presentation. Magnetic resonance imaging (MRI) showed the eye-of-the-tiger sign in the me­dial globus pallidus. Clinical examination presented extrapyramidal signs like dystonia, choreoathetosis, dysarthria and visual impairment. In this case, the combination of clinical and MRI findings was con­sistent with NBIA. Results. In the A dimension (down and roll) of GMFM, the child achieve a score of 39 points (76% of the gross mo­tor function); in the B dimension (sit) she achieve a total score of 60 points (30% of the function); in the C dimension (crawl and kneel) she achieve a score of 1 point (2% of the function); in the D dimen­sion (standing position) and in the E dimension (walk, run and jump) she did not score in any item. Conclusion. The significant deficit in proximal stability and frequent extensor dystonic spasms affected the child’s functional performance.

PROXIMAL ULNAR STUMP STABILITY AFTER USING THE PRONATOR QUADRATUS MUSCLE TRANSFER COMBINED WITH THE SUAVÉ-KAPANDJI PROCEDURE IN RHEUMATOID WRIST

The pronator quadratus muscle transfer combined with the Sauvé-Kapandji procedure was used to treat the distal radioulnar joint disorder in ten rheumatoid wrists for prevention against instability of the proximal ulnar stump. All patients were female with a mean age of 46.6 years. The mean follow-up time was 24.2 months. Postoperatively, supination increased in all patients with a mean of 50 degrees. Pain decreased significantly and none complained of prominence of the proximal ulnar stump in normal pronated position and during a tight grip. The wrist radiographs of both coronal and sagittal planes in normal and stress fisting views were used to evaluate the postoperative static and physiologic loaded stability of the proximal ulnar stump. It had shown this procedure provided good static proximal ulnar stump stability in both coronal and sagittal planes. However, in physiologic loaded condition, it was able to provide stability only in the sagittal plane.

Gross Motor Function of A Child With Neurodegeneration With Brain Iron Accumulation (NBIA)

Introduction. Neurodegeneration with brain iron accumulation (NBIA) involves a group of progressive extrapyramidal disorders characterised by iron accumulation in the brain. Objective. to de­scribe the gross motor function of a child with clinical diagnosis of NBIA. Method. This is a case report involving a 7-year-old child and clinical diagnosis of NBIA. This study evaluated the history of the disease and the neuromotor functions of the child using a neurological physiotherapy evaluation form. The GMFM - Gross Motor Function Measure, a system of quantitative assessment of gross motor function in five broad dimensions, was applied. Case Presentation. Magnetic resonance imaging (MRI) showed the eye-of-the-tiger sign in the me­dial globus pallidus. Clinical examination presented extrapyramidal signs like dystonia, choreoathetosis, dysarthria and visual impairment. In this case, the combination of clinical and MRI findings was con­sistent with NBIA. Results. In the A dimension (down and roll) of GMFM, the child achieve a score of 39 points (76% of the gross mo­tor function); in the B dimension (sit) she achieve a total score of 60 points (30% of the function); in the C dimension (crawl and kneel) she achieve a score of 1 point (2% of the function); in the D dimen­sion (standing position) and in the E dimension (walk, run and jump) she did not score in any item. Conclusion. The significant deficit in proximal stability and frequent extensor dystonic spasms affected the child’s functional performance.

Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: A systematic review

Trunk control has been identified as an important early predictor of functional outcome after stroke but there is insufficient evidence that proximal stability of the trunk is a pre-requisite for sitting and standing balance, walking, and functional activities. We systematically reviewed the literature on trunk training exercises (TTE) in adult patients with stroke. To establish if TTE can improve trunk performance and sitting balance. CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, REHABDATA Database, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos were searched and reference lists screened to identify randomised controlled trials (RCTs) of trunk training exercises in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed trial quality. The primary outcomes were trunk performance and sitting balance. Due to the heterogeneity of included studies meta-analysis was not possible. A total of 11 studies with 317 participants were analysed. Trunk training exercises showed a moderate evidence to improve trunk performance and dynamic sitting balance. Trunk training exercises, performed with either stable or unstable surface, could be a good rehabilitation strategy and might help improving trunk performance and dynamic sitting balance after stroke.

Stability of Acute Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint: A Biomechanical Study

We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects). Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred. No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67° (range, 10° to 90°) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14° (range, 4° to 40°). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1mm in the 80% group. Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability. Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations.