Postural control during a transition task in haemophilic children, adolescents and young adults with haemophilic ankle arthropathy.

BACKGROUND: The aim of this study was to determine whether young haemophilic boys with and without MRI-based signs of ankle arthropathy demonstrate reduced balance ability during a transition task with eyes open and eyes closed. METHODS: Thirty-four haemophilic bodies and 28 typically developing boys aged 6-20 years participated to this study. Structural integrity of the tarsal foot joints of all haemophilic boys was assessed with MRI. All participants performed a standard transition task from double-leg stance to single-leg stance with eyes open and eyes closed. Comparison of balance features derived from the centre of pressure displacement captured by a single force platform was performed between the different haemophilia subgroups and sex-age-height matched peers. FINDINGS: The haemophilic boys without signs of arthropathy presented only a higher intermediate phase velocity during the eyes closed condition (P = .05). The haemophilic boys with signs of arthropathy had significantly higher displacement after the time to new stability point, and 95% Ellipse Sway Area and Balance Area compared to their matched peers during eyes open test (P < .05). Similar findings were observed during the eyes closed test for the displacement after the time to new stability point and 95% Ellipse Sway Area (P < .05). No significant differences were observed between affected and non-affected side of the unilateral affected patients. INTERPRETATION: We suggest that the pathophysiological cascade associated with chronic bleeding episodes should not be considered as a "simple" musculoskeletal injury, hence more as a complex neurophysiological dysfunction which may originate both from unilateral and bilateral deterioration of the musculoskeletal system.

Biomechanical markers and theoretical concepts related to haemophilic ankle and subtalar joint arthropathy: introducing the term 'haemophilic tarsal pan-arthropathy'.

BACKGROUND: Although regular factor replacement can reduce the incidence of joint bleeds and slow down the development of haemophilic arthropathy, the ankle joint remains particularly vulnerable even in children with haemophilia on primary or secondary prophylaxis and is now the primary joint affected. The heterogeneity in the pathoaetiology of haemophilic ankle arthropathy means that the functional consequences of early stage of ankle arthropathy are difficult to define as early morphological and structural changes can be observed in clinically asymptomatic ankles. In this context, understanding biomechanics of the normal and arthritic foot is complex and difficult to quantify unless considering the foot as multiple functional segments using more sophisticated assessment tools such as multisegment foot models. However, this understanding can undoubtedly aid in the analysis of an underlying clinical problem and provide a strategic basis for a more optimal management. AIMS: The purpose of this narrative review was firstly to revise information on the anatomy and biomechanics of the foot and ankle. Finally, related biomechanical markers of human motor performance, which are potentially implicated in the development of haemophilic ankle arthropathy, will be discussed based on published literature and expert opinion. MATERIALS AND METHODS: Searches in published literature were limited to the year 2000 onwards. RESULTS: Although the ankle (tibiotalar joint) is the most commonly affected joint, associated subtalar joint (SJT) involvement is often seen. This would therefore imply that an alternative phraseology might be better. DISCUSSION AND CONCLUSION: In this context, the authors propose the use of 'haemophilic tarsal pan-arthropathy' (HTPA) which encompasses both tibiotalar and subtalar joints.

Review of clinical approaches and diagnostic quantities used in pedobarographic measurements.

The non-invasive nature of pedobarographic measurements is particularly attractive to researchers for analyzing and characterizing the impact of specific pathological foot conditions. However, adequate clinical use of pedobarographic technology requires a profound technical and methodological knowledge. Several papers summarized the technical capacities of pedobarographic technology. Moreover, methodological expertise has grown considerably during the last two decades. Therefore, two crucial decisions have to be made before pathomechanical modelling or functional interpretation of foot and lower limb disorders can be pursued. The first is the selection of the specific method to analyse the dynamic plantar footprint, and the second is the choice of parameters to quantify the results. In the first part of this paper, we review the different methods used to analyse the dynamic plantar footprint and discuss their conceptual backgrounds. We also aim to illustrate the clinical relevance of each method and elaborate on the future perspectives. In the second part, we review quantification methods of pedobarographic measurements. The latter is of primary relevance to clinicians and investigators with a special interest in foot and lower limb biomechanics.

Influence of shoes and foot orthoses on lower extremity muscle activation onset times in healthy subjects during the transition from double-leg stance to single-leg stance.

AIM: The aim of this study was to evaluate the influence of shoes and foot orthoses on lower extremity muscle activation patterns in healthy subjects during the transition from double-leg stance to single-leg stance. METHODS: Eight male and seven female young asymptomatic adults who wear foot orthoses were recruited. Muscle activation onset times of 9 lower extremity muscles were recorded using surface electromyography during the transition from double-leg stance to single-leg stance, performed with eyes open and with eyes closed. This was tested in 4 experimental conditions: 1) barefoot (BF); 2) shoes only (SO); 3) shoes with standardized FO (SSFO); and 4) shoes with customized FO (SCFO). RESULTS: Based on a four-way (condition-region-leg-vision) linear model for repeated measures, we found a significant condition effect (P=0.025). Differences between conditions did not depend on the leg and/or the vision condition, but on the region (ankle-knee-hip). Based on a two-way (condition-muscle) linear model within each region, only significant differences between conditions for peroneus longus (P=0.003) were found. The onset times of peroneus longus were significantly earlier in SO (P=0.029) and SCFO (P=0.001) compared to BF. CONCLUSION: These results indicate that SO and SCFO can accelerate peroneus longus muscle activation onset times during the transition from double-leg stance to single-leg stance. Further research is required to determine how these adaptations may develop over time.

Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes.

BACKGROUND: Reduction in foot mobility has been identified as a key factor of altered foot biomechanics in individuals with diabetes mellitus. This study aimed at comparing in vivo segmental foot kinematics and coupling in patients with diabetes with and without neuropathy to control adults. METHODS: Foot mobility of 13 diabetic patients with neuropathy, 13 diabetic patients without neuropathy and 13 non-diabetic persons was measured using an integrated measurement set-up including a plantar pressure platform and 3D motion analysis system. In this age-, sex- and walking speed matched comparative study; differences in range of motion quantified with the Rizzoli multisegment foot model throughout different phases of the gait cycle were analysed using one-way repeated measures analysis of variance (ANOVA). Coupling was assessed with cross-correlation techniques. FINDINGS: Both cohorts with diabetes showed significantly lower motion values as compared to the control group. Transverse and sagittal plane motion was predominantly affected with often lower range of motion values found in the group with neuropathy compared to the diabetes group without neuropathy. Most significant changes were observed during propulsion (both diabetic groups) and swing phase (predominantly diabetic neuropathic group). A trend of lower cross-correlations between segments was observed in the cohorts with diabetes. INTERPRETATION: Our findings suggest an alteration in segmental kinematics and coupling during walking in diabetic patients with and without neuropathy. Future studies should integrate other biomechanical measurements as it is believed to provide additional insight into neural and mechanical deficits associated to the foot in diabetes.

Persisting anorectal dysfunction after rectal cancer surgery.

AIM: Sphincter-saving rectal cancer management affects anorectal function. This study evaluated persisting anorectal dysfunction and its impact on patients' well-being. METHOD: Seventy-nine patients with a follow-up of 12-37 (median 22) months and 79 age- and sex-matched control subjects completed questionnaires. RESULTS: The median number of diurnal bowel movements was three in patients and one in controls (P < 0.0001). Nocturnal defaecation occurred in 53% of patients. The median Vaizey score was 8 in patients and 4 in controls (P < 0.0001). Urgency without incontinence was reported by 47% of patients and 49% of controls (P = 0.873), soiling by 28% of patients and 3% of controls (P < 0.0001), incontinence for flatus by 73% of patients and 49% of controls (P = 0.0019), and incontinence for solid stools by 16% of patients and 4% of controls (P = 0.0153). Incontinence of liquid stools occurred in 17 of 20 patients and in one of five controls who had liquid stools (P = 0.0123). Incontinence for gas, liquid or solid stool occurred once or more weekly in 47%, 19% and 6% of patients respectively. Evacuation difficulties were reported by 98% of patients, but also by 77% of controls. Neoadjuvant radio(chemo)therapy adversely affected defaecation frequency and continence. Incontinence was associated with severe discomfort in 50% of patients, severe anxiety in 40% and severe embarrassment in 48%. CONCLUSION: Anorectal dysfunction is a frequent problem after management of rectal cancer with an impact on the well-being of patients.

Treatment options to improve anorectal function following rectal resection: a systematic review.

AIM: Common problems after rectal resection are loose stools, faecal incontinence, increased frequency and evacuation difficulties, for which there are various therapeutic options. A systematic review was conducted to assess the outcome of treatment options aimed to improve anorectal function after rectal surgery. METHOD: Publications including a therapeutic approach to improve anorectal function after rectal surgery were searched using the following databases: MEDLINE, PubMed, EMBASE, Pedro, CINAHL, Web of Science, PsychInfo and the Cochrane Library. The focus was on outcome parameters of symptomatic improvement of faecal incontinence, evaluation of defaecation and quality of life. RESULTS: The degree of agreement on eligibility and methodological quality between reviewers calculated with kappa was 0.85. Fifteen studies were included. Treatment options included pelvic floor re-education (n=7), colonic irrigation (n=2) and sacral nerve stimulation (SNS) (n=6). Nine studies reported reduced incontinence scores and a decreased number of incontinent episodes. In 10 studies an improvement in resting and squeeze pressure was observed after treatment with pelvic floor re-education or SNS. Three studies reported improved quality of life after pelvic floor re-education. Significant improvement of the Fecal Incontinence Quality of Life Scale was found in three studies after SNS. CONCLUSION: Conservative therapies such as pelvic floor re-education and colonic irrigation can improve anorectal function. SNS might be an effective solution in selected patients. However, methodologically qualitative studies are limited and randomized controlled trials are needed to draw evidence-based conclusions.

Incontinent women have altered pelvic floor muscle contraction patterns.

PURPOSE: Pelvic floor exercises are invaluable for regaining continence but mechanisms are not fully understood. To contribute to the understanding of these mechanisms we investigated the contraction sequence of superficial vs deep pelvic floor muscles in 6 positions in continent and incontinent women. MATERIALS AND METHODS: The onset of contraction of the superficial and deep pelvic floor muscles was recorded by perineal and intravaginal surface electromyography in 32 continent and 50 incontinent women. The agreement between perineal and intravaginal recordings was calculated with the kappa statistic and the percent of agreement. Differences in onset between superficial and deep pelvic floor muscle contractions are reported as the median and IQR. RESULTS: Perineal and intravaginal electromyography recordings used to define the onset of muscle activity showed a high level of agreement. In the continent group the superficial muscles almost always contracted before the deep muscles in all 6 positions. In the incontinent group the reverse sequence was observed in 3 of 6 positions. Higher and less consistent time differences in the onset of contraction of the 2 muscle layers were found in incontinent vs continent women. CONCLUSIONS: Contractions of the superficial and deep pelvic floor muscles can be recorded by intravaginal or perineal electrodes. A consistent contraction sequence can be found in continent women but it is lacking in incontinent women. This might be a possible explanation for incontinence. Including differentiated muscle contraction exercises in pelvic floor muscle exercise programs may further optimize treatment outcomes.

Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain.

AIM: To document the prevalence of low back pain (LBP) in Flemish adolescents and to recognize the association between perceived social support and affect and medical consultation and reduction of activities. METHODS: The study comprised 620 adolescents. A questionnaire was used to elicit the characteristics of LBP. Perceived social support and affect were investigated using the Personal Resource Questionnaire (PRQ) and the Positive Affect Negative Affect Scale (PANAS), respectively. Comparisons were made between adolescents with LBP and adolescents without LBP. Within the LBP group, answers from adolescents appealing for medical advice were compared with those who did not seek advice. Another comparison was done between adolescents who reduced their activities and those who did not. Descriptive statistics, the median test for two samples, a chi2 test or Fisher's exact probability test and logistic regression analysis were used for data analysis. RESULTS: Month prevalence of LBP was 24.7%. Thirteen adolescents visited a physician or received treatment, pain severity being the sole factor associated with the decision. Fifteen adolescents reduced their sports activities and 11 reduced or stopped other leisure activities. Pain severity and negative affect were the main associated factors. CONCLUSION: The results of the present study encourage further research on the role of pain perception and the influence of psychosocial factors on back pain in adolescents.

Torque variations during repeated passive isokinetic knee movements in persons with multiple sclerosis.

The purposes of this study were to investigate the effect of movement repetitions on resistive torque during passive isokinetic dynamometry of the knee and to determine the role of electromyographic activity in the stretched muscles on the torque measurements. Ten persons with multiple sclerosis and hypertonia of the knee muscles were compared with 10 healthy age- and gender-matched control subjects. During series of 10 flexion and extension movements of the knee at 60, 180 and 300 degrees/s, torque and electromyographic activity in the stretched muscles were registered. The persons with hypertonia presented a significantly larger torque reduction (p < 0.05) than the control subjects in all test conditions except for repeated knee flexion at 300 degrees/s. Electromyographic activity in the stretched muscles was not identified as the only explanatory mechanism for the reduction in hypertonia during the movement repetitions, suggesting that other factors were also involved.

Shoulder girdle elevation during neurodynamic testing: an assessable sign?

One of the signs advocated for monitoring during neurodynamic testing in the assessment of patients with upper quadrant disorders, is the response of the shoulder girdle. It is stated that a protective rising of the shoulder girdle is present when patients with neurogenic disorders are assessed and that the elevation is absent in asymptomatic subjects. As sensory responses are elicited in the majority of asymptomatic subjects and as the range of motion (ROM) is often limited during neurodynamic testing, it is questionable whether the elevation of the shoulder girdle would be absent in asymptomatic subjects. The aim of this study was to measure the shoulder girdle elevation force during five variants of the neural tissue provocation test for the median nerve. Thirty-five asymptomatic male subjects were assessed. A load cell was used to measure the amount of shoulder girdle elevation force and two electrogoniometers were used to measure the ROM at the elbow and wrist. When the ROM at the end of the test was restricted, a gradual increase in shoulder girdle elevation force could be observed throughout the test. Compared to the initial force at the start of the test, all variants resulted in a significant increase in force. It is concluded that a gradual increase in shoulder girdle elevation force should not be regarded as an abnormal sign in the interpretation of neurodynamic tests.

Addition of test components during neurodynamic testing: effect on range of motion and sensory responses.

STUDY DESIGN: Single session, repeated-measures design. OBJECTIVES: To analyze the impact of different components of the neural tissue provocation test for the median nerve (NTPT1) on the range of motion (ROM) of the elbow and wrist and the sensory responses elicited by the test. BACKGROUND: The assessment of minor peripheral nerve injuries by neurodynamic tests is becoming more integrated in physical therapy practice. The influence of different test components on the nervous system has been analyzed in numerous in vitro studies, but in vivo studies are still lacking. METHODS AND MEASURES: Five test variations were performed on 35 asymptomatic men (23.5 +/- 2.3 years). Elbow extension was performed (1) without additional components (NTPT1NEUTRAL), (2) with wrist extension (NTPT1WE), (3) with cervical contralateral lateral flexion (NTPT1CLLF), and (4) with both wrist extension and cervical contralateral lateral flexion (NTPT1WE+CLLF). In the fifth variant, the wrist was extended from a preloaded position (WENTPT1). The range of elbow and wrist extension when a submaximal discomfort was elicited was measured with 2 electrogoniometers. RESULTS: The addition of each test component resulted in a significantly reduced ROM (NTPT1NEUTRAL: 179.5 +/- 8.8 degrees, NTPT1WE: 169.0 +/- 13.9 degrees, NTPT1CLLF: 154.7 +/- 13.2 degrees, NTPT1WE+CLLF: 143.9 +/- 16.1 degrees; WENTPT1: 67.1 +/- 11.0 degrees). Sensory responses were predominantly evoked at the region of the added component. CONCLUSIONS: The different test components, whose mechanical influence on the nervous system has been demonstrated in anatomical studies, also have an effect on joint ROM and sensory responses during neurodynamic testing, when individually or simultaneously added. If the nerve bedding is elongated throughout its whole length, the available ROM is markedly reduced and sensory responses can be elicited throughout the entire arm.

Reproducibility of repeated measurements on healthy skin with Minolta Chromameter CR-300.

BACKGROUND/AIMS: In this report the reproducibility of measurements with the Minolta Chromameter CR-300 on healthy skin was investigated. METHODS: Intra- and inter-rater reproducibility, reproducibility with two instruments and repeated measurements with a 1 week time lapse were examined on healthy skin of 30 volunteers by means of intra-class correlation coefficients (ICC) and standard error of measurements (SEM). RESULTS: Results showed excellent values for ICC in all the four conditions. CONCLUSIONS: On the basis of these results we concluded that the instrument provides reliable information and can be used in comparative clinical trials.

Comparison of self-administration and face-to-face interview for surveys of low back pain in adolescents.

UNLABELLED: The aim of this study was to compare self-administration with face-to-face interview in the investigation of low back pain in adolescents. Fifty-seven adolescents with low back pain (mean age 17.3 y; range 16-18) first completed a questionnaire and were then invited to an interview. Analysis included item completion, percentages of agreement and weighted kappa. Item completion rates were high and comparable between self-administration and interview. Information between both methods was analogous for severity and localization of problems, sleep behaviour, medical consultation and sports/leisure activities. Onset, progression, duration of low back pain and some items on the influence of movement/positions presented less comparable data. CONCLUSION: Even when two different methods of data acquisition are used, results suggest that the method used does not change the interpretation of results in the case of most items.

Visual analogue scale for the perceived influence of exertion and movements/positions on low back problems in surveys of adolescents.

UNLABELLED: The test-retest reproducibility of visual analogue scales for the perceived influence of exertion and movements/positions on low back problems in adolescents was investigated. The study was performed on 61 adolescents with low back problems. Item completion, median score, interquartile range and weighted kappa were calculated. Results showed that visual analogue scales produce repeatable information for all items tested (weighted kappa: 0.59-0.83), except for the influence of pulling materials on back problems (0.45). CONCLUSION: The results of this study suggest that adolescents, aged 16-18 y, can reproduce their visual analogue scores.

Time use of stroke patients in an intensive rehabilitation unit: a comparison between a Belgian and a Swiss setting.

PURPOSE: Functional improvement after stroke has been related to the intensity of treatment. The present study was set up to observe how stroke patients spend their time in a rehabilitation unit. METHOD: Behavioural mapping was performed throughout a full working day in a Belgian and Swiss stroke unit. RESULTS: Patients were most frequently involved in therapeutic activities, 28% of the day in Belgium and 45% in Switzerland. Physiotherapy accounted for the majority of the therapy time. The Belgian patients spent 27% of the day in their own room and Swiss patients 49% of the day. The most striking finding was that the Swiss patients spent nearly 1.5 hours per day more in therapy. CONCLUSIONS: Differences between the two settings could only partially be explained by more favourable patient-staff ratios in the Swiss setting. Autonomous practice, group therapy sessions and family involvement have to also be considered.

Do posture and straining influence urinary-flow parameters in normal women?

The influence of posture of the pelvis and straining on urinary flow was investigated in 21 normal women, mainly physiotherapists, who were asked to urinate on an uro-flow chair at their usual time and frequency. Subjects were at random instructed to urinate in five different test situations: anteversion, anteversion with straining, retroversion, retroversion with straining, and forward bending without straining. The urinary-flow parameters investigated were volume, peak flow, time to peak, peak-to-end time, total time, and mean flow. The analysis was done by means of analysis of variance but only for micturition volumes >150 mL. The morphology of the urinary-flow curves was examined for the presence of irregularities and increasing (after top) or decreasing (for top) curve tops and after-dribbling. Results demonstrated no significant differences for peak flow, total time, and mean flow in the anteversion, retroversion, and the forward-bending position. This holds for test situations and re-test controls. However, straining increased the peak flow and mean flow rates in all positions and in all women, whereas it reduced the total voiding time. The voided volumes were lowest in anteversion. Irregularities were less frequent in the forward-bending position. It can be concluded that the forward-bending position is the most preferable urinating position to relax the pelvic floor muscles. Neurourol. Urodynam. 19:3-8, 2000.

Reproducibility of a survey questionnaire for the investigation of low back problems in adolescents.

A test-retest design was used to investigate the reproducibility of the results obtained using a survey questionnaire for low back problems in adolescents. A 1-wk interval between test and retest was chosen. Participants were recruited from four schools. Selection of schools was based on geographic location, size of the school and educational level. Sixty-seven adolescents (mean age = 16.62 y; SD = 0.57; range = 16-18) suffering from low back problems agreed to participate. A questionnaire on perceived characteristics of back problems and functional limitations was designed. Item completion rate and the reproducibility of results were investigated by means of percentage agreement and (weighted) kappa. High levels of reproducibility were found for items that evaluated perceived characteristics of back problems and functional limitations (Kw = 0.70-0.93). Results suggest that the questionnaire used in the present study provided reproducible information. Detailed information on low back problems in adolescents could be obtained using this questionnaire.

A qualitative assessment of shoulder girdle elevation during the upper limb tension test 1.

The 'feel through range' and the 'end-feel' of the elbow extension, and the elevation of the shoulder girdle during the upper limb tension test for the median nerve are considered important in clinical decision making. As no objective measurements have been published regarding these parameters, a special device was designed in order to obtain objective information on the force by which the shoulder girdle is elevated during the test. The purpose of this technical note is to describe the technical aspects of the device and its practical application. In a pilot study, five asymptomatic subjects have been assessed. The relationship between the elevation of the shoulder girdle and the range of elbow extension has been analysed. The data of five subjects and representative curves of one subject are presented. All five subjects demonstrate a considerable increase in force elevating the shoulder girdle. The results show that the device can be used to measure the force by which the shoulder girdle is elevated throughout the test. Although the number of subjects and the number of repetitions is limited, the data suggest that the method is accurate and that the phenomenon of shoulder girdle elevation during the upper limb tension test in asymptomatic subjects is consistent.

Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte (VDP) endoprosthesis: a prospective randomized study.

A prospective randomized study was set up, comparing a compression hip screw with the Vandeputte (VDP) endoprosthesis treatment for fresh, unstable peritrochanteric fractures, according to the Evans-Jensen and AO systems. Ninety patients, ages > or = 70 years, 47 of whom were treated with a compression hip screw and 43 with a VDP endoprosthesis, were included. All patients were being followed for 3 months. No difference between the two groups was found for operating time, wound complications, and mortality rate, but there was a higher transfusion need in VDP treatment. Severe fracture redisplacement or total collapse of the fracture occurred in 11 (26%) compression hip screw patients, two of whom had revision surgery. Only one patient needed reintervention after VDP treatment. Functional capacity of preoperative independent patients at hospital discharge did not differ for the two groups. In conclusion, the compression hip screw seemed to be an appropriate implant for most of the peritrochanteric fractures, but for very old patients with advanced osteoporosis, with a complex, unstable peritrochanteric fracture, and who are eligible for early mobilization, primary cemented endoprosthesis might be the best treatment.