Weight-bearing Research Articles

Effect of Dual-Task Training on Balance and Knee Proprioception in Weight Bearing and Non-Weight Bearing Position among Older Adults

Aims To investigate the effect of dual-task training on balance and knee proprioception in both weight-bearing and non-weight-bearing conditions in older adults with significant imbalance and high risk of falling. Methods This pre-posttest experimental design included 83 older adults (43 males, 40 females), selected based on age criteria (65–75 years) and specific inclusion and exclusion criteria. Participants underwent dual-task training consisting of 30-minute sessions, three times per week, for four weeks (totaling 12-sessions). Measures included Berg Balance Scale and knee proprioception deficit before and after dual-task training. Results The study showed statistically significant effect of dual-task training on balance (p < 0.001) and knee proprioception in both weight-bearing (p < 0.001) and non-weight-bearing (p < 0.001) in older adults. Pre-and post-measurements of independent variables between male and female older adults showed no significant difference. Conclusions Dual-task training improves balance and knee proprioception in both weight-bearing and non-weight-bearing conditions in older individuals, thereby enhancing stability and reducing the risk of falls.

Not Just Small Adults: Operative Versus Nonoperative Treatment in Adolescent Tibial Shaft Fractures.

The standard of care for tibial shaft fractures in young children is nonoperative management, while in adults, operative treatment is considered the mainstay. There are no clear guidelines on preferred treatment for adolescents. This paper aims to 1) identify clinical and radiographic characteristics predictive of malalignment and 2) determine if treatment type affects malalignment risk. This retrospective cohort study identified patients aged 12 to 16 years old with a tibial shaft fracture at a Level 1 pediatric trauma center. The primary outcome of interest was malalignment, classified as meeting one or more of the following: >5° coronal angulation, >5° sagittal angulation, translation (cortical width or 100% displaced), and/or rotational deformity. Comparative analyses were done to identify risk factors for malalignment. A total of 162 patients were included-initial treatment was "planned nonoperative" for 102 patients and "planned operative" for 60 patients. The malalignment rate was 34% in the planned nonoperative group versus 32% in the planned operative group. In a multivariate regression, older patients [odds ratio (OR)=-0.07, 95% CI: -0.13 to -0.01; P =0.024] and those with 100% initial displacement (OR=-0.35, 95% CI: -0.64 to -0.05; P =0.021) had decreased odds of malalignment, and having increased sagittal angulation (OR=0.02, 95% CI: 0.01-0.04; P =0.002) and a fibula fracture (OR=0.22, 95% CI: 0.03-0.41; P =0.023) increased the odds of malalignment. There was no difference in the rate of malalignment by initial treatment ( P =0.289). Having a planned nonoperative treatment (OR=22.7, 95% CI: 14.0-31.5; P <0.001) and having a fibula fracture (OR=8.52, 95% CI: 0.59-16.45; P =0.035) increased the time immobilized. This study provides insight into factors affecting tibial shaft fracture alignment among patients aged 12 to 16 years. This study suggests that the risk of malalignment is higher among patients with increased initial sagittal angulation and concomitant fibula fractures, but the risk of malalignment is comparable in patients initially treated nonoperatively and operatively. Although healing parameters on average were similar, nonoperative treatment results in longer immobilization time and time for unrestricted weight bearing. Level III-retrospective comparative study.

Quadriceps recovery and pain relief in knee osteoarthritis rats by cog polydioxanone filament insertion.

Quadriceps muscles play a pivotal role in knee osteoarthritis (OA) progression and symptom manifestation, particularly pain. This research investigates the therapeutic effectiveness of muscle enhancement and support therapy (MEST), a recently developed device intended for intramuscular insertion of cog polydioxanone filaments, in quadriceps restoration to alleviate OA pain. Knee OA was induced in Sprague Dawley rats via monoiodoacetate injections. MEST or sham treatment was performed in OA or Naive rat quadriceps. Pain was assessed using paw withdrawal threshold and weight bearing. Quadriceps injury and recovery via MEST were evaluated using biomarkers, tissue morphology, muscle mass, contractile force and hindlimb torque. Satellite cell and macrophage activation, along with their activators, were also assessed. Data were compared at 1- and 3-weeks post-MEST treatment (M-W1 and M-W3). MEST treatment in OA rats caused muscle injury, indicated by elevated serum aspartate transferase and creatinine kinase levels, and local β-actin changes at M-W1. This injury triggered pro-inflammatory macrophage and satellite cell activation, accompanied by heightened interleukin-6 and insulin-like growth factor-1 levels. However, by M-W3, these processes gradually shifted toward inflammation resolution and muscle restoration. This was seen in anti-inflammatory macrophage phenotypes, sustained satellite cell activation and injury markers regressing to baseline. Quadriceps recovery in mass and strength from atrophy correlated with substantial OA pain reduction at M-W3. This study suggests that MEST-induced minor muscle injury triggers macrophage and satellite cell activation, leading to recovery of atrophied quadriceps and pain relief in OA rats.

CHRONIC STRESS RESULTS IN INCREASED PAIN PERCEPTION IN OSTEOARTHRITIS IN VIVO

Osteoarthritis (OA) affects the whole joint and leads to chronic pain. The sympathetic nervous system (SNS) seems to be involved in OA pathogenesis, as indicated by in vitro studies as well as by our latest work demonstrating that sympathectomy in mice results in increased subchondral bone volume in the OA knee joint. We assume that chronic stress may lead to opposite effects, such as an increased bone loss in OA due to an elevated sympathetic tone. Therefore, we analyzed experimental OA progression in mice exposed to chronic stress. OA was induced in male C57BL/6J mice by surgical destabilization of the medial meniscus (DMM) and Sham as well as non-operated mice served as controls. Half of these groups were exposed to chronic unpredictable mild stress (CUMS). After 12 weeks, chronic stress efficiency was assessed using behavioral tests. In addition to measuring body weight and length, changes in subchondral bone were analyzed by μCT. Dynamic Weight Bearing system was used to monitor OA-related pain. Histological scoring will be conducted to investigate the severity cartilage degeneration and synovial inflammation. CUMS resulted in increased anxiety and significant decrease in body weight gain in all CUMS groups compared to non-CUMS groups. CUMS also increased serum corticosterone in healthy mice, with even higher levels in CUMS mice after DMM surgery. CUMS had no significant effect on subchondral bone, but subarticular bone mineral density and trabecular thickness were increased. Moreover, CUMS resulted in significant potentiation of DMM-associated pain. Our results suggest that the autonomic imbalance with increased sympathetic nervous activity induced by chronic stress exacerbates the severity of OA pain perception. We expect significantly increased cartilage degeneration as well as more severe synovial inflammation in CUMS DMM mice compared to DMM mice.

AO FRACTURE MONITOR: CONTINUOUS SENSOR MONITORING FOR PERSONALIZED FRACTURE CARE

In absence of available quantitative measures, the assessment of fracture healing based on clinical examination and X-rays remains a subjective matter. Lacking reliable information on the state of healing, rehabilitation is hardly individualized and mostly follows non evidence-based protocols building on common guidelines and personal experience. Measurement of fracture stiffness has been demonstrated as a valid outcome measure for the maturity of the repair tissue but so far has not found its way to clinical application outside the research space. However, with the recent technological advancements and trends towards digital health care, this seems about to change with new generations of instrumented implants – often unfortunately termed “smart implants” – being developed as medical devices.The AO Fracture Monitor is a novel, active, implantable sensor system designed to provide an objective measure for the assessment of fracture healing progression (1). It consists of an implantable sensor that is attached to conventional locking plates and continuously measures implant load during physiological weight bearing. Data is recorded and processed in real-time on the implant, from where it is wirelessly transmitted to a cloud application via the patient's smartphone. Thus, the system allows for timely, remote and X-ray free provision of feedback upon the mechanical competence of the repair tissue to support therapeutic decision making and individualized aftercare.The device has been developed according to medical device standards and underwent extensive verification and validation, including an in-vivo study in an ovine tibial osteotomy model, that confirmed the device's capability to depict the course of fracture healing as well as its long-term technical performance. Currently a multi-center clinical investigation is underway to demonstrate clinical safety of the novel implant system. Rendering the progression of bone fracture healing assessable, the AO Fracture Monitor carries potential to enhance today's postoperative care of fracture patients.

Influence of Critical Shoulder Angle and Rotator Cuff Tear Type on Load‐Induced Glenohumeral Biomechanics: A Sawbone Simulator Study

Glenohumeral (GH) biomechanics after rotator cuff (RC) tears are not fully understood. The purpose of our study was to determine if the critical shoulder angle (CSA), type of RC tears, and level of weight bearing increase GH translation, instability based on the instability ratio, muscle forces and joint reaction force (JRF), and shifts the center of force (CoF) superiorly. A GH simulator with muscle‐mimicking cable systems was used to simulate 30° abduction in the scapular plane. A Sawbone humerus and five specimen‐specific scapular anthropometries were used to test six types of RC tears, three weight‐bearing loads, and the native and adjusted (to different CSAs) deltoid origin sites. Linear mixed effects models (CSA, RC tear type, and weight bearing) with random effects (specimen and sex) were used to assess differences in GH biomechanics. With increasing CSA, GH translation increased, JRF decreased, and the CoF position was more inferior. RC tears did not significantly alter GH translation but shifted the CoF position superiorly, close to where glenoid erosion occurs in patients with RC tears with secondary osteoarthritis. Weight bearing significantly increased GH translation and JRF. RC and deltoid muscle forces increased with the presence of RC tears and increased weight bearing. The remaining RC muscles of intact tendons compensated for the torn RC tendons but not for the altered CoF position. GH translation remained comparable to shoulders with intact RC. These findings highlight the importance of early detection, clinical management, and targeted rehabilitation strategies for patients with RC tears.

Weight bearing versus non-weight bearing total contact cast in the management of active Charcot foot: A systematic review.

Diabetic Charcot neuro-osteoarthropathy carries a significant worldwide disease burden including diabetic foot infection, ulceration and amputation. The current accepted standard of treatment during the active phase of Charcot neuro-osteoarthropathy is offloading with total contact casting; however, controversy remains regarding weight-bearing status during this period. A systematic review was performed following PRISMA guidelines of Pubmed, EMBASE, MEDLINE and the Cochrane central register of controlled trials for clinical studies from inception until June 2024 investigating weight-bearing and non-weight-bearing total contact casting for active Charcot neuro-osteoarthropathy. Four hundred ninety-three studies were identified in the search strategy of which 5 studies met the inclusion criteria comprising 158 patients. These studies found that allowing patients to weight-bear during total contact casting does not have a negative impact on the healing process. There were no comparative studies between weight-bearing and non-weight-bearing total contact casting. There is limited evidence to support current practice of non-weight bearing in a total contact casting for active Charcot neuro-osteoarthropathy. Allowing patients to weight bear carries advantages to patient independence and quality of life. Further investigation with randomised control trial should be considered to investigate if weight bearing is associated with negative outcomes.

Dual Plate Fixation of Periprosthetic Distal Femur Fractures.

Dual implants for distal femur periprosthetic fractures (DFPF) is a growing area of interest for these challenging fractures with dual plating (DP) emerging as a viable construct for these injuries. In the current study we review our experience with DP constructs. Retrospective case series with comparison group. Level 1 academic trauma centerPatients/Participants: Adults >50 years old sustaining comminuted OTA/AO 33-A2 or 33-A3 DFPF treated with either DP or a single distal femur locking plating (DFLP). Patients with simple 33-A1 fractures were excluded. Prior to 2018 patients underwent DFLP after which the treatment of choice at our institution became DP. 34 patients treated with DFLP and 38 with DP met inclusion and follow up criteria. The average patient age in the DFLP group was 74.8 +/- 7.3 years compared to 75.9 +/- 11.3 years in the DP group. Dual plating or single DFLP. Reoperation rate, alignment, and complications. Average follow up was 18.2 +/- 13.8 months in the DFLP group and 19.8 +/- 16.1 months in the DP group (p=0.339). There were no statistical differences in demographics, fracture morphology, loss of reduction, or reoperation for any cause (p>.05). However, DP patients were more likely to be weight bearing in the twelve-week postoperative period (p <0.001) and return to their baseline ambulatory status (p = 0.004) compared to DFLP patients. Dual plating of distal femoral periprosthetic fractures maintained coronal alignment with a low reoperation rate even with immediate weight bearing and these patients regained baseline level of ambulation more reliably as compared to patients treated with a single distal femoral locking plate.

The coronal alignment differs between two-dimensional weight-bearing and three-dimensional nonweight bearing planning in total knee arthroplasty.

The goal of this study is (1) to assess differences between two-dimensional (2D) weight-bearing (WB) and three-dimensional (3D) nonweight-bearing (NWB) planning in total knee arthroplasty (TKA) and (2) to identify factors that influence intermodal differences. Retrospective single-centre analysis of patients planned for a TKA with patient-specific instruments (PSI). Preoperative WB long-leg radiographs and NWB computed tomography were analysed and following radiographic parameters included: hip-knee-ankle angle (HKA) (+varus/-valgus), joint line convergence angle (JLCA), femorotibial subluxation and bony defect classified according to Anderson. Preoperative range of motion was also considered as possible covariate. Demographic factors included age, sex, and body mass index. A total of 352 knees of 323 patients (66% females) with a mean age of 66 ± 9.7 years were analysed. The HKA differed significantly between 2D and 3D planning modalities; varus knees (n = 231): 9.9° ± 5.1° vs. 6.7° ± 4°, p < 0.001; valgus knees (n = 121): -8.2° ± 6° vs. -5.5° ± 4.4°, p < 0.001. In varus knees, HKA (β = 0.38; p < 0.0001) and JLCA (β = 0.14; p = 0.03) were associated with increasing difference between 2D/3D HKA. For valgus knees, HKA (β = -0.6; p < 0.0001), JLCA (β = -0.3; p = 0.0001) and lateral distal femoral angle (β = -0.28; p = 0.03) showed a significant influence on the mean absolute difference. The coronal alignment in preoperative 3D model for PSI-TKA significantly differed from 2D WB state and the difference between modalities correlated with the extent of varus/valgus deformity. In the vast majority of cases, the 3D NWB approach significantly underestimated the preoperative deformity, which needs to be considered to achieve the planned correction when using PSI in TKA. Level III.

Postural Control and Weight Bearing Symmetry Patterns in Patients Post Lumbar Spinal Decompression Surgery

Background Prolapsed intervertebral disc is one of the most common reasons for low back pain often causing altered postural control and weight bearing symmetry of foot. Although these components are known to be affected there is limited literature available explaining the postural control and weight bearing symmetry post spinal decompression surgical procedures.Objective The study was formulated with the objective to understand postural control and symmetry of weight bearing patterns among patients post lumbar spinal decompression surgery.Methods The study was conducted involving 65 patients who were assessed pre-and post-lumbar decompression surgery. Nintendo Wii balance board was used to assess the patients at all intervals.Results The post-surgical values at discharge showed a clinical improvement in postural control bilaterally left P0.068 and right P0.031 but showed deterioration at one month with right P0.076 and significant on left side P0.009. Contrary to this the follow up values at one month showed a significant improvement in weight bearing symmetry P0.001. Pain values both on activity and at rest taken at both follow-up intervals F1 and F2 showed a statistically significant reduction P0.001.Conclusion Postural control assessed with single limb stance shows worsening at one month post decompression procedure. Weight bearing symmetry parameters may demonstrate a decline immediately post lumbar decompression surgery but may show a significant improvement along with reduction in pain post surgically as early as one month.

Reduction of Edema and Pain in Transcutaneous Electrical Nerve Stimulation Treated-Arthritic Rat

Transcutaneous electrical nerve stimulation (TENS) has been used to reduce pain or improve motor function in musculoskeletal and neurological disorders in the clinic. Although some studies have suggested electrotherapy as an intervention for edema, the effects and mechanisms of TENS on inflammation-induced edema remain unclear. Thus, we aimed to investigate the effects of TENS on arthritic pain with edema. 1% carrageenan was injected into the right tibiofemoral joint of 69 male Sprague-Dawley rats (200-250 g). After the development of arthritic pain, low-frequency (4-Hz, Low-TENS, n = 25) and high-frequency (100-Hz, High-TENS, n = 25) TENS with sub-motor threshold or placebo-TENS (n = 19) was applied for 20-min to medio-lateral part of the ipsilateral side. Weight bearing and knee-bend tests were used to assess pain-like behaviors. Also, we examined the size of edema and measured tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) levels in the synovium by western blot. Eight rats in each of the two TENS groups were injected with Naloxone. Edema was reduced in the low- and high-frequency TENS groups at 6-h. TENS-treated rats showed reduced pain in the knee-bend test at 6-h. We observed decreased weight load shifts on the ipsilateral side in TENS groups. Naloxone reduced these effects. TNF-α and IL-1β expression decreased in the synovial membrane at 6-h. These results suggest that low- and high-frequency TENS have acutely positive effects on inflammatory edema, with the management of arthritic pain and reduction in pro-inflammatory mediators. Therefore, Low-TENS and High-TENS may be useful in treating acute inflammatory pain and edema.

Effects of 6 weeks of cryotherapy plus compression therapy after total or unicompartmental knee arthroplasty: protocol for a single-centre, single-blind randomised controlled trial

IntroductionEffective rehabilitation after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is often impeded by pain and swelling. Beneficial short-term effects in terms of pain and opioid use after...

Efeito agudo da terapia por ondas de choque na pressão plantar e equilíbrio de indivíduos hemiparéticos

Abstract Introduction: Cerebral vascular accident (CVA) is the second leading cause of death and is one of the diseases that most generate disability Hemiparesis is the most common motor deficit, and one of its characteristics is asymmetry in weight bearing and in the plantar sup-port area, leading to balance deficits. extracorporeal shock-wave therapy (ESWT) has been shown to be effective in reducing post-stroke spasticity. Objective: To evaluate the effect of a ESWT session on the distribution of plantar pressure and on the static and dynamic balance of hemiparetic individuals after stroke. Methods: Twelve individuals with hemiparesis as a result of stroke in the chronic stage participated in the study. Data collection was divided into two days. On the first day, anamnesis and tests were performed: timed up and go (TUG), four square step test (FSST), and short physical performance battery (SPPB). After carrying out the tests, the distribution of plantar pressure was evaluated using baropodometry. Also on the first day, participants received ESWT in the muscle belly of the gastrocnemius muscle on the hemiparetic side. At the end of the ESWT session and after 7 days, the individuals were reassessed. Results: The results referring to the static and dynamic balance and baropodometry evaluations performed before, immediately after and one week after the application of ESWT did not show a significant difference between the three evaluations in any of the tests and in any of the moments performed. Conclusion: One ESWT session did not affect plantar pressure distribution and static and dynamic balance of hemiparetic individuals after stroke.

Ab. No. 158 Lack of Rural Rehab: A Case Report of Chronic Stiffness Post Tibia Fracture

Introduction: Even after 7 decades, referral depends on acceptance of physiotherapy as an independent profession. Even if prescribed, rural rehabilitation is not always executed with regular follow up.Neither documentation of rural physiotherapist-population ratio requirements, nor regulatory body to standardize rehabilitation level is available. Only 3% Anganwadi workers were informed about physiotherapy, though Maharashtra has 214 PHCs with wellness room for physiotherapy/yoga. Regain quality of life, return to employment, which was lacking a year after proximal tibial fracture, due to lack of referral to post-operative physiotherapy in Maharashtra’s Mangaon taluka. Methods: A 41-year-old patient with right undisplaced lateral tibial condyle fracture complained of limited knee range, stiffness, pain on standing, prolonged sitting, stairclimbing, reduced walking speed, loss of job as a coal miner. He was explained that restricted flexion was due to internal bony fragments, which caused fear of end range flexion, and was advised to undergo a revision surgery inspite of poor expected outcome. 4-week protocol included strengthening for quadriceps, hamstrings, hip abductors, flexors, calf, stretching, weight bearing exercises. Home exercises were regularly progressed. Adjuncts used were dry cupping, IASTM, dry needling. Result: Range increased from 10°-86° to 0°-112°, extensor lag, antalgic gait was corrected, thigh girth increased by 1.5 cm. Pain reduced while climbing stairs (4/10 to 0/10), standing after prolonged sitting (6/10 to 4/10), and walking (1/10 to 0/10). Squatting, cross leg sitting with minimal pain, return to work as a full-time coal miner was achieved. Revision surgery and disability were prevented. Conclusion: Rural early rehabilitative protocol could have prevented 1 year of unemployment, pain, stiffness. Implications: Highlights need for streamlined referral system to match evidence that recommends early ROM and weight bearing. Stimulate public –private partnerships for creating the role of physiotherapy assistant/technician at the existent PHCs. Facilitate followed-up tele-rehabilitation for rural physiotherapy.

Outcomes of Minimally Invasive Locking Plate Osteosynthesis for Periprosthetic Distal Femur Fractures following Primary Total Knee Arthroplasty

Abstract Introduction: Periprosthetic distal femur fractures have been on the rise with an increasing number of total knee arthroplasties being performed. In addition to regular fixation principles in distal femur fractures, periprosthetic fractures pose additional challenges due to osteoporotic bone and preexisting medical comorbidities. Materials and Methods: We retrospectively analyzed 31 patients who underwent surgical fixation with a locking plate using a minimally invasive technique for periprosthetic distal femur fractures at a single level 1 orthopedic hospital for 4 years. Results: Out of the 31 patients included in the study, 21 were female. The mean age of the study population was 65.63 years, ranging from 51 to 82 years. The mean time to union was 14.32 weeks, with a range from 12 to 22 weeks. The average Knee Society Score was 78.2, which is considered a good outcome. There was one case of implant failure in our case series, which could be attributed to immediate weight bearing. Conclusion: In conclusion, we found that fixation of supracondylar femur fractures associated with stable nonstemmed total knee arthroplasty with a locking plate using a minimally invasive technique yielded good results.

Outcome of home-based rehabilitation program following arthroscopic anterior cruciate ligament reconstruction in nonathletic patient

Abstract Background: Rehabilitation following anterior cruciate ligament (ACL) reconstruction is thought to be important by almost all surgeons. It has even been considered by some to be as important as surgery itself. As the surgical procedure for these injuries evolved, so has the rehabilitation. A traditional approach to rehabilitation which focused on delayed weight bearing and mobilization is now being replaced by accelerated rehabilitation which advocates early weight bearing and results in early return to sports. Materials and Methods: This is a observational case-control comparative study conducted in our department from September 2019 to February 2021. About 30 cases of more than 20 years of age with comparable matching group are included in our study. Assessment of Lysholm score, International Knee Documentation Committee (IKDC) score, ACL quality of life score, and Tegner activity level is done. Functional assessment was carried out by Carioca test, one leg hop test, and Shuttle test. Assessment of clinical status is done by anterior drawer test, Lachman test, and Pivot shift test. Results: All patients participating in study although nonathletic had complaints of instability and giving away episodes of knee in their day to day activities and therefore were considered as candidates for surgery. Following an arthroscopic ACL reconstruction, they were given written home-based protocols with goals and exercises being explained to them at the time of discharge. All the patients participating in the study were able to return to their preinjury activity level as assessed by the Tegner activity scale at the final follow up. Their functional outcome as measured by Lysholm score, IKDC score, and ACL quality of life score was significantly lower when compared to an age, sex, and activity matched control group. The patients functional performance as assessed by one leg hop test, Carioca test, and Shuttle test was also below the level of what was seen in control groups. More than 90% patients had a stable knee as assessed by the anterior drawer test, Lachman test and pivot shift test (29 patients has anterior drawer of ≤5 mm, 27 patients had Lachmann test ≤5 mm and all 30 patients had pivot shift grades in absent or glide category). Conclusions: Home-based rehabilitation is an effective method of rehabilitation in low demand individuals following ACL reconstruction. In the future, adequately powered randomized controlled trials are needed to assess the usefulness of one rehabilitation protocol over other in these group of low demand patients.

Ab. No. 180 Association between Balance Confidence and Activities of Daily Living in Community Dwelling Elderly

Introduction: Balance confidence and FOF are essential psychological factors to consider when developing fall intervention strategies to enhance ability of elderly to remain active at home and within the community, and avoid injurious falls. Psychological factors like balance confidence and fear of falling (FOF) are related to balance impairment and falling. Ability to perform activities without falling may have positive effect on confidence in balancing. Study was aimed at obtaining better understanding of association of level activity of daily living (ADL) with individual’s estimation ability to avoid fall or maintain their balance. Methods: 315 ambulatory community dwelling elderly ageing 60 to 85 years were recruited by personal interview from parks, and housings of various areas of city. Elderly with MMSE score &lt; 18, neurological disorders (e.g. Stroke, Parkinson’s disease), any acute injury, hearing/communication problems, nonstable medical conditions, painful osteoarthritis with weight bearing, vestibulopathy were excluded. In this cross-sectional study, all individuals were screened for cognition using MMSE along with demographic details. The participants were assessed using Activities-specific balance confidence (ABC) scale, Katz Index of Independence in ADL and Lawton IADL Scale. Result: Mean sample age was 69.2±6.33 with 46.2% females. ABC score showed significant correlation with the criterion (p&lt;0.000). The multiple regression model with all four predictors produced R²=0.454, F=64.316, p&lt;0.000. MMSE, Lawton and Katz scale had significant positive regression (B=1.232,0.329,3.402 respectively). Age had significant negative weight (B=-0.786). Conclusion: Katz Index was the best predictor of balance confidence followed by MMSE, age and Lawton IADL Scale. Implications: Result provides better understanding of factors predicting balance confidence.

SpeedBridge Repair in Degenerative Achilles Tear: A Novel Technique.

Retrocalcaneal pain in late adulthood and athletes has been attributed to insertional Achilles tendinosis (IAT). Another presentation of IAT is a degenerative Achilles tear, which can be partial or complete. Symptomatic patients with failed conservative management are treated by debridement and repair of the Achilles tendon. Often, they need augmentation with a tendon transfer. The flexor hallucis longus (FHL) is the most commonly used tendon for augmentation. The Speed Bridge technique to repair the degenerated tendoachilles tear gives better pullout strength and provides a larger surface area of contact between the bone and tendon. We included 12 patients with symptomatic degenerative Achilles tears repaired with the Speed Bridge technique and FHL augmentation. Post-operatively, all patients were allowed active ankle mobilization on day 1 and were allowed weight bearing as tolerated in an airwalker shoe. All patients went through an accelerated rehabilitation protocol. Pre-operative and post-operative American Orthopedic Foot and Ankle Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scores were compared for all the patients. The mean age was 58.1 (range 50-68) years. The mean follow-up period was 13.1 (range 12-15) months. The mean pre- and post-operative AOFAS score at 12 months was 59.5 (range 58-71) and 90.2 (range 87-100), respectively. The mean pre-operative VAS for pain was 6.8 (range 6-8), and the mean post-operative VAS score was 0.5 (range 0-2). The mean interval to weight bearing was 8.4 days (range 7-10) days. Our study indicates that accelerated early rehabilitation and an early return to active life are possible with the Speed Bridge technique and FHL augmentation in degenerative Achilles tears. The mean post-operative AOFAS scores were comparable to other studies, but early return to activity, minimal need for immobilization, and accelerated rehabilitation were the advantages of the Speed Bridge technique in the repair of degenerative Achilles tears.

Development of a Wearable Device for Partial Weight Bearing with Prismatic Joints

Development of a Wearable Device for Partial Weight Bearing with Prismatic Joints

EMG Activity of Core and Global Muscles of Spine during Functional Exercises in Basketball Players with Chronic Ankle Instability: A Pilot Study

Introduction: Assessing the Electromyography (EMG) activity of core muscles during various exercises might be extremely important to understand the neuro-muscular strategies used by basketball athletes with Chronic Ankle Instability (CAI). Aim: To compare the EMG activity of the core/global muscles during different functional exercises in basketball athletes with versus without CAI. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, SGT University, Gurugram, Haryana, India. A total of eight basketball players subjects aged 18-30 years with (n=4) and without CAI (n=4) were recruited using convenience sampling. Players with atleast 2 years of competitive experience were enrolled. CAI was diagnosed if there was a history of atleast two ankle inversion injuries in the same ankle for the past 2 years, which had required a period of protected weight bearing or immobilisation or any complaint of giving way of the ankle during functional activities and score of less than 24 on the Cumberland ankle instability tool. Surface EMG was recorded for multifidus, rectus abdominis, transverse abdominis and erector spinae during six functional exercises (single leg squat, Y balance exercise, quadrant hop, toe touch down, box jump and medicine ball slams). 2×5×4 repeated measures Analysis of Variance (ANOVA) was employed to test the study hypothesis. Results: A significant difference was found between the activation patterns of the core and global muscles in basketball players with CAI and without CAI. Conclusion: It can be concluded that CAI alters the activation of core and global spinal muscles significantly. CAI is not restricted to distal joint but has an impact on proximal muscles as well. Neuromuscular training for the muscles, which alters motor control strategy because of CAI, could be taken into consideration when planning rehabilitation for CAI.