Feasibility and effectiveness of telerehabilitation on mobility and balance function in multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Multiple Sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system with a significant impact on mobility and balance function. Telerehabilitation is an emerging branch of telemedicine which has the potential to deliver rehabilitation remotely through the use of information and communication technology. The aim of this systematic literature review and meta-analysis is to synthesise and analyse the evidence on the effectiveness of telerehabilitation in improving mobility and balance function in MS and to determine its feasibility. METHODS: Four electronic databases (PubMed, the Cochrane Library, Science Direct and Cinahl) were searched in January 2024 using some of the following terms: "Multiple Sclerosis" AND "Telerehabilitation" OR "Exergaming" OR" Virtual Reality". The risk of bias was assessed using the Cochrane Risk of Bias assessment tool. The meta-analysis was conducted using Cochrane Collaboration Review Manager Software (version 5.4.1). RESULTS: Five Randomised Controlled Trials were included with a total sample size of 225 participants who had MS. The meta-analyses found significant statistical and clinical effects of telerehabilitation for both Mobility ((P = 0.02; SMD = 0.41; 95 % CI: 0.05, 0.77) and Balance (P = 0.0001; SMD = 0.64; 95 % CI: 0.31, 0.97) outcomes. Feasibility was found to be >90 %. CONCLUSION: This review found evidence in favour of telerehabilitation using exergaming and Pilate-based interventions. Further studies are needed with larger sample sizes of high methodological quality. The findings of this review highlight the potential of telerehabilitation to fulfil an unmet need in care pathways which currently exists in MS rehabilitation.

Physical Telerehabilitation interventions for Gait and balance in Multiple sclerosis: A Scoping review.

BACKGROUND: Gait and balance impairments affects approximately a quarter of people with multiple sclerosis (pwMS) at onset and increases to almost half by five years. Physical rehabilitation has been recognised as the gold standard method to restore physical function in multiple sclerosis (MS). Emerging evidence in the literature is suggesting that a remote therapy rehabilitation platform (Telerehabilitation) is cost-effective, beneficial, and satisfying for patients and health care practitioners. The overarching aim of this review is to identify and summarise the evidence on the different types of telerehabilitation interventions available to manage gait and balance. METHODS: This review followed a methodological framework for conducting scoping reviews. PubMed, Science Direct and Web of Science were searched in April 2023 for relevant published literature. The inclusion criteria were peer-reviewed journal articles written in English which included telerehabilitation interventions for pwMS. Search keywords included multiple sclerosis and telerehabilitation. A reviewer screened titles and abstracts and eligible articles were fully reviewed. The included studies were categorised based on the type of intervention. RESULTS: Eight studies were included in this review. The participants (n = 355) had an average age of 48 years (SD = 9.9) with 50% who had relapsing remitting multiple sclerosis who were living with MS for 12 years on average. Study designs included randomised control trials (n = 3), pilot studies and feasibility studies (n = 4). Two types of interventions were identified: Exergaming (n = 5) and Web-Based Physical Therapy (n = 2) of which exergaming appeared to be optimal in improving gait and balance. CONCLUSION: This scoping review identified and summarised the evidence on telerehabilitation interventions used for gait and balance in MS. The evidence is showing that telerehabilitation could be used as an alternative to conventional rehabilitation methods for improving gait and balance. More robust trials with larger sample sizes are needed to build on the current evidence to enable telerehabilitation to be integrated into care pathways in the future.

Eye movement as a simple, cost-effective tool for people who stutter: A case study.

BACKGROUND:  Access to services remains the biggest barrier to helping the most vulnerable in the South African Stuttering Community. This novel stuttering therapy, harnessing an unconscious link between eye and tongue movement, may provide a new therapeutic approach, easily communicated and deliverable online. OBJECTIVES:  This study provides both objective and subjective assessments of the feasibility of this intervention. Assessment tools holistically address all components of stuttering in line with comprehensive treatment approaches: core behaviours, secondary behaviours, anticipation and reactions. METHOD:  On receipt of ethical approval, this single-subject case design recruited one adult (21-year-old) male with a developmental stutter (DS). The participant gave informed consent and completed four scheduled assessments: baseline, after 5-week training, 3 months post-intervention and 24 months post-completion. The study used objective assessment tools: Stuttering Severity Instrument-4 (SSI-4); Subjective-assessment tools: SSI-4 clinical use self-report tool (CUSR); Overall Assessment of Speaker's Experience of Stuttering (OASES-A); Premonitory Awareness in Stuttering (PAiS) and Self-Report Stuttering Severity* (SRSS) (*final assessment). RESULTS:  The participant's scores improved across all assessment measures, which may reflect a holistic improvement. The participant reported that the tool was very useful. There were no negative consequences. CONCLUSION:  This case report indicates that this innovative treatment may be feasible. No adverse effects were experienced, and the treatment only benefited the participant. The results justify the design of a pilot randomised feasibility clinical trial.Contribution: The results indicate that this is a needed breakthrough in stuttering therapy as the instructions can be easily translated into any language. It can also be delivered remotely reducing accessibility barriers.

"The best of a bad situation?" A mixed methods survey exploring patients' perspectives on physiotherapy-led online group exercise programmes.

INTRODUCTION: The COVID-19 pandemic saw the migration of many physiotherapy-led group exercise programmes towards online platforms. This online survey aimed to ascertain the patients' views of online group exercise programmes (OGEP), including their satisfaction with various aspects of these programmes, the advantages and disadvantages and usefulness beyond the pandemic. METHODS: A mixed-methods design was utilised with a cross-sectional national online survey of patients who had previously attended a physiotherapy-led OGEP in Ireland. The survey collected both qualitative and quantitative data. Descriptive statistics were used to summarise the ordinal and continuous data and conventional content analysis was used to analyse the free-text responses. RESULTS: In total, 94 patients completed the surveys. Fifty percent of patients questioned would prefer in-person classes. Despite only a quarter of patient respondents preferring online classes going forward, satisfaction with the OGEPs was high with nearly 95% of respondents somewhat or extremely satisfied. Decreased travel and convenience were cited as the main benefits of OGEPs. Decreased social interaction and decreased direct observation by the physiotherapist were the main disadvantages cited. CONCLUSION: Patients expressed high satisfaction rates overall with online classes, but would value more opportunities for social interaction. Although 50% of respondents would choose in-person classes in the future, offering both online and in-person classes beyond the pandemic may help to suit the needs of all patients and improve attendance and adherence.

To assess the effects of cross-education on strength and motor function in post stroke rehabilitation: a systematic literature review and meta-analysis.

BACKGROUND: Cross-education refers to the increase in motor output of the untrained limb following unilateral training of the opposite limb. Cross education has been shown to be beneficial in clinical settings. OBJECTIVES: This systematic literature and meta-analysis aims to assess the effects of cross-education on strength and motor function in post stroke rehabilitation. DATA SOURCES: MEDLINE, CINAHL, Cochrane Library, PubMed, PEDro, Web of Science, ClinicalTrails.gov and Cochrane Central registers were searched up to 1st October 2022. STUDY SELECTION: Controlled trials using unilateral training of the less affected limb in individuals diagnosed with stroke and English language. DATA SYNTHESIS: Methodological quality was assessed using Cochrane Risk-of-Bias tools. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. Meta-analyses were performed using RevMan 5.4.1. RESULTS: Five studies capturing 131 participants were included in the review and three studies capturing 95 participants were included in the meta-analysis. Cross education was shown to have a statistically and clinically significant effect on upper limb strength (p < 0.003; SMD 0.58; 95% CI 0.20-0.97; n = 117) and upper limb function (p = 0.04; SMD 0.40; 95% CI 0.02-0.77; n = 119). LIMITATIONS: Small number of studies, with all studies identified as having some risk of bias. Quality of evidence graded 'low' due to limitations and imprecision. CONCLUSION: Cross education may be beneficial in improving strength and motor function in the more affected upper limb post stroke. Further studies are needed as the research into the benefits of cross education in stroke rehabilitation is still limited. Systematic Review Registration Number: PROSPERO (CRD42020219058).

What are the effects of pilates in the post stroke population? A systematic literature review & meta-analysis of randomised controlled trials.

OBJECTIVE: Stroke is a leading cause of death and disability worldwide. Pilates, a programme of mind-body exercises is theorised to have beneficial effects on strength, postural control, balance, proprioception, coordination and gait in people with deficits due to a neurological condition. However, the evidence of pilates in stroke patients has never been systemised. The objectives of this systematic literature review are to investigate the effects of pilates in post stroke individuals and compare this intervention to other forms of exercise, standard care and/or physiotherapy. DATA SOURCES: A comprehensive search was conducted in the following databases: Pubmed (including MEDline), Web of Science, the Cochrane library, Science Direct, Embase and PEDro. STUDY SELECTION: Studies were selected, screened, filtered and reviewed in detail to identify those that met the inclusion criteria. DATA EXTRACTION: Data was extracted to a table with specific headings for analysis and studies were rated using the Physiotherapy Evidence Database (PEDro) scale. DATA SYNTHESIS: Data from a total of 5 included studies with 122 participants was pooled and analysed using the Revman 5 software. Significant findings were found in favour of the pilates intervention groups on balance (P<0.00001), quality of Life (P=0.0002), and gait parameters (P=0.001), when results from the studies were combined and analysed. CONCLUSIONS: This review found moderate evidence for pilates exercises improving balance in post stroke individuals and limited evidence for improvements in quality of life, cardiopulmonary function and gait. Future studies should examine long term follow up, home programmes and comparisons with other forms of exercise in post stroke patients.

Online neuropilates classes in chronic stroke patients: Protocol for a randomised controlled feasibility study.

Introduction: Stroke survivors often demonstrate low physical activity levels and experience barriers to physical exercise including embarrassment, low self-efficacy and a shortage of tailored community exercise programmes. Access to physical activity programmes for stroke survivors could be improved by providing tailored, online programmes, although little is known about the safety and feasibility of online exercise classes for stroke survivors. One such programme of exercise which has received little attention in the literature is neuropilates. Neuropilates is the practice of a modified pilates programme in those with neurological conditions and is theorised to have beneficial effects on strength, balance and proprioception in stroke survivors. No previous study has been conducted to investigate online, remotely supervised neuropilates exercise classes in the stroke survivors. Method and Analysis: This single assessor blinded randomised controlled feasibility study will compare a 6-week online, remotely instructed neuropilates programme to a 6-week online, remotely instructed generalised exercise programme and a 6-week unsupervised generalised home exercise programme in chronic stroke patients. Twenty adults, at least 6 months post stroke, and finished their formal rehabilitation will be recruited to the study. Primary feasibility outcome measures will include patient tolerance of the programme, adherence rates, adverse events, recruitment and retention. Secondary clinical outcomes will include; balance, gait, tone and quality of life. Assessments will be completed at baseline, on programme completion and 3 months post completion by a Physiotherapist blinded to the group allocation. Ethics and dissemination: This study has received ethical approval from the Sligo University Hospital Ethics committee and ATU ethics board. Results will be published in peer-reviewed journals and presented at national and international conferences.The trial has been registered on clinicaltrials.gov (Identifier: NCT04491279).

Sensory substitution for orthopaedic gait rehabilitation: A systematic review and meta-analysis for clinical practice guideline development.

Introduction: Sensory Substitution is a biofeedback intervention whereby at least sensory system is utilised to supplement environmental information which is traditionally gathered by another sense. Objective: To present an evidence-based overview of the feasibility and effectiveness of wearable Sensory Substitution devices on gait outcomes in orthopaedic patient populations. Methods: This Systematic Review and Meta-Analysis was reported according to the PRISMA 2020 statement. PubMed, the Cochrane Library, Web of science and PEDro were searched for relevant published literature. Inclusion criteria limited the search strictly to patients diagnosed with an orthopaedic condition and who were randomly grouped to a Sensory Substitution intervention or conventional therapy/training or an equivalent placebo intervention. Results: Nine Randomised Controlled Trials and three Crossover Trials investigating the effectiveness of Sensory Substitution supplemented gait training were identified and included participants with a variety of orthopaedic conditions. Meta-Analyses revealed positive findings of feasibility as well as statistical and clinical effect of the interventions in improving measures of gait speed, weight-bearing control, measures of functionality and subjective self-reporting. Meta-Analyses also revealed the interventions effects were not significant in the management of pain and retention of gait speed. Negatively reinforced Sensory Substitution biofeedback was statistically and clinically effective, whilst positively reinforced biofeedback was not. Conclusion: For orthopaedic patient populations to improve gait speed, weight-bearing control, functionality, pain and self-report measures, the authors recommend a Sensory Substitution supplemented gait training programme with negative biofeedback on performance. The intervention should be undertaken for 20 min per day, 3 days per week for 5 weeks. The intervention should coincide with structured analgesia administration to facilitate effective pain management. Limitations of the data included some low sample sizes and large age-ranges. No financial support was provided for this study.

Effects of sensory substituted functional training on balance, gait, and functional performance in neurological patient populations: A systematic review and meta-analysis.

INTRODUCTION: Sensory Substitution (SS) is the use of one sensory modality to supply environmental information normally gathered by another sense while still preserving key functions of the original sense. OBJECTIVE: This systematic literature review and meta-analysis summarises and synthesise current evidence and data to estimate the effectiveness of SS supplemented training for improving balance, gait and functional performance in neurological patient populations. METHODS: A systematic literature search was performed in Cochrane Library, PubMed, Web of Science, and ScienceDirect. Randomized controlled trials (RCTs) using a SS training intervention were included. RESULTS: Nine RCTs were included. Outcome measures/training paradigms were structured according to the balance framework of Shumway-Cook and Woollacott: Static steady-state, Dynamic steady-state and Proactive balance. Meta-analyses revealed significant overall effects of SS training for all three outcomes, as well as self-assessment and functional capacity outcomes, with Dynamic Steady-State balance and ability of stroke survivors to support bodyweight independently on paretic side lower limb found to have had the largest statistical and clinical effects. Meta-analyses also revealed non-significant retention effects. CONCLUSION: This review provides evidence in favour of a global positive effect of SS training in improving Static steady-state, Dynamic steady-state and Proactive balance measures, as well as measures of self-assessment and functional capacity in neurological patient populations. Retention of effects were not significant at follow-up assessments, although no intervention met training dosage recommendations. It is important for future research to consider variables such as specific patient population, sensor type, and training modalities in order identify the most effective type of training paradigms.

Unilateral Strength Training and Mirror Therapy in Patients With Chronic Stroke: A Pilot Randomized Trial.

OBJECTIVE: The aim of the study was to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared with cross-education alone in poststroke upper limb recovery. DESIGN: A pilot randomized controlled parallel group study was carried out. Thirty-two patients with chronic stroke followed a 4-wk isometric strength training program performed with the less-affected upper limb three times per week. Participants in the mirror and strength training group observed the reflection of the exercising arm in the mirror. Participants in the strength training only group exercised without a mirror entirely. Participant compliance, adverse effects, and suitability of outcome measures assessed feasibility. Effectiveness outcomes included maximal isometric strength measured with the Biodex Dynamometer, the Modified Ashworth Scale, and the Chedoke Arm and Hand Activity Inventory. RESULTS: Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (P > 0.05) in patients with chronic stroke when training isometrically. CONCLUSIONS: This pilot trial established the feasibility of a randomized controlled trial comparing mirror-aided cross-education with cross-education alone for poststroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate that the combination of interventions should be investigated further applying an altered training protocol.

Unilateral dorsiflexor strengthening with mirror therapy to improve motor function after stroke: A pilot randomized study.

BACKGROUND: Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting. OBJECTIVES: This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke. METHODS: Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining. RESULTS: Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity. CONCLUSION: Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.

Peak torque, rate of torque development and average torque of isometric ankle and elbow contractions show excellent test-retest reliability.

BACKGROUND: Peak Torque (PT), Rate of Torque Development (RTD) and Average Torque (AT) over a single contraction assess the three components of muscle function during isometric contractions. Surprisingly, AT has never been reported or its reliability confirmed. OBJECTIVES: This study aims to establish protocol reliability for ankle dorsiflexion and elbow extension isometric muscle function (PT, RTD, AT) in healthy participants using the Biodex System 3 Dynamometer. METHODS: Twelve participants (6 male, 6 female, mean age 39 . 8 ± 16 . 0 years) performed four maximal isometric contractions on two occasions. Intraclass Correlation Coefficient (ICC), Typical Error (TE) and Coefficient of Variation (CV) for PT, RTD and AT were reported. RESULTS: The ICC for all strength parameters varied from 0.98-0.92. TE for ankle dorsiflexion PT was 1.38 Nm, RTD 7.43 Nm/s and AT 1.33 Nm, CV varied from 6 . 26 ± 6 . 25 % to 11 . 72 ± 8 . 27 % . For elbow extension, TE was 3.36 Nm for PT, 14.87 Nm/s for RTD and 3.03 Nm for AT, CV varied from 5 . 97 ± 4 . 52 % to 18 . 46 ± 14 . 78 % . CONCLUSION: Maximal isometric ankle dorsiflexion and elbow extension PT, RTD and AT can be evaluated with excellent reliability when following the described protocol. This testing procedure, including the application of AT, can be confidently applied in research, exercise or clinical settings.

Mirror therapy and treadmill training for a patient with chronic stroke: A case report.

INTRODUCTION: A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both mirror therapy and treadmill training have been shown to improve aspects of lower limb functioning in patients with stroke. This case report examined whether a new combination of both interventions would lead to improvements in lower limb functional disability for a patient with chronic stroke. CASE DESCRIPTION: The participant was a 50-year-old female who had a left middle cerebral artery infarction (47 months' post stroke). Due to hemiparesis, she had lower limb motor impairment and gait deficits. INTERVENTION: The participant engaged in a combination of mirror therapy and treadmill training for 30 minutes per day, 3 days per week, for 4 weeks. OUTCOMES: Modified Ashworth Scale, Fugl-Meyer Assessment-Lower Extremity and the 10 m Walk Test demonstrated clinically meaningful change. The 6 Minute Walk Test did not demonstrate meaningful change. DISCUSSION: The positive outcomes from this new combination therapy for this participant are encouraging given the relatively small dose of training and indicate the potential benefit of mirror therapy as an adjunct to treadmill training for enhancing lower limb muscle tone, motor function and walking velocity in patients with chronic stroke.

Cross-education of strength has a positive impact on post-stroke rehabilitation: a systematic literature review.

BACKGROUND: Since its discovery in 1894 cross-education of strength - a bilateral adaptation after unilateral training - has been shown to be effective in the rehabilitation after one-sided orthopedic injuries. Limited knowledge exists on its application within the rehabilitation after stroke. This review examined the evidence regarding the implication of cross-education in the rehabilitation of the post-stroke hemiplegic patient and its role in motor function recovery. METHODS: Electronic databases were searched by two independent assessors. Studies were included if they described interventions which examined the phenomenon of cross-education of strength from the less-affected to the more-affected side in stroke survivors. Study quality was assessed using the PEDro scale and the Cochrane risk of bias assessment tool. RESULTS: Only two controlled trials met the eligibility criteria. The results of both studies show a clear trend towards cross-educational strength transfer in post-stroke hemiplegic patients with 31.4% and 45.5% strength increase in the untrained, more-affected dorsiflexor muscle. Results also suggest a possible translation of strength gains towards functional task improvements and motor recovery. CONCLUSION: Based on best evidence synthesis guidelines the combination of the results included in this review suggest at least a moderate level of evidence for the application of cross-education of strength in stroke rehabilitation. Following this review it is recommended that additional high quality randomized controlled trials are conducted to further support the findings.

Increasing the number of gait trial recordings maximises intra-rater reliability of the CODA motion analysis system.

OBJECTIVE: This study investigates the optimum number of gait trial recordings to maximise intra-rater reliability with the CODA motion analysis system in a normal population. Potential sources of variability in test-retest experimental procedures will be discussed. BACKGROUND: The most recent study by [Maynard V, Bakheit AMO, Oldham J, Freeman J. Intra-rater and inter-rater reliability of gait measurements with CODA mpx30 motion analysis system. Gait Posture 2003;17:59-67] that evaluated the Cartesian Optoelectronic Dynamic Anthropometer (CODA) motion analysis system exhibited poor correlation for intra-rater reliability of kinematic and kinetic parameters. It is unknown what the optimum number of gait trials is required during testing to represent an individuals gait pattern during normal walking. DESIGN: Ten healthy subjects (mean 28.5 years) were tested on two occasions by an experienced well trained rater during normal walking to establish intra-rater reliability using 1-2, 1-4, 1-6, 1-8, and 1-10 gait trial recordings to represent the mean. The 3D kinematic, kinetic parameters of hip, knee and ankle joints and spatio-temporal parameters were recorded during normal walking. Intra-class correlation coefficient and Bland and Altman limits of agreement were chosen to analyse the results. RESULTS: Spatio-temporal parameters exhibited least test-retest variability, as measurement of only two gait trials to represent the mean produced similar variability in test-retest as when higher numbers of trials were measured. Kinematic parameters were more variable than kinetic while for both variability decreased with increasing numbers of trials measured and would advocate measuring 10 gait trials for future analysis when measuring these parameters. CONCLUSIONS: Generally intra-rater reliability improves when larger number of gait trial recordings represent a subject's gait.

Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump.

The purpose of this study was to identify differences in 3D kinematics, kinetics, and ankle joint muscle activity in subjects with functional instability (FI) of the ankle joint during a drop jump. Twenty-four subjects with the subjective complaint of FI of the ankle joint and 24 noninjured control subjects performed 10 single leg drop jumps onto a force-plate. Timing and magnitude of kinetic data, timing of kinematic data, and integrated EMG (IEMG) activity of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles during two 200-ms time periods either side of initial contact (IC) with the ground were analyzed and compared between groups. Subjects with FI demonstrated a significant decrease in pre-IC peroneus longus IEMG activity, which was accompanied by a change in frontal plane movement at the ankle joint during the same time period. Following IC, FI subjects were less efficient than control group subjects in reaching the closed packed position of the ankle joint. Significant differences were seen between the groups' time-averaged and peak vertical and sagittal components of ground reaction force. The altered pre-IC peroneus longus IEMG and increased inversion of the ankle joint observed in FI subjects could help to explain why subjects with FI may suffer from inversion injury to their ankle joint when subjected to an unanticipated ground contact. The kinematic and kinetic differences observed in subjects with FI may lead to repeated injury and damage to the supporting structures of the ankle joint.

Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint.

BACKGROUND: The ankle joint requires very precise neuromuscular control during the transition from terminal swing to the early stance phase of the gait cycle. Altered ankle joint arthrokinematics and muscular activity have been cited as potential factors that may lead to an inversion sprain during the aforementioned time periods. However, to date, no study has investigated patterns of muscle activity and 3D joint kinematics simultaneously in a group of subjects with functional instability compared with a noninjured control group during these phases of the gait cycle. PURPOSE: To compare the patterns of lower limb 3D joint kinematics and electromyographic activity during treadmill walking in a group of subjects with functional instability with those observed in a control group. STUDY DESIGN: Controlled laboratory study. METHODS: Three-dimensional angular velocities and displacements of the hip, knee, and ankle joints, as well as surface electromyography of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles, were recorded simultaneously while subjects walked on a treadmill at a velocity of 4 km/h. RESULTS: Before heel strike, subjects with functional instability exhibited a decrease in vertical foot-floor clearance (12.62 vs 22.84 mm; P < .05), as well as exhibiting a more inverted position of the ankle joint before, at, and immediately after heel strike (1.69 degrees , 2.10 degrees , and -0.09 degrees vs -1.43 degrees , -1.43 degrees , and -2.78 degrees , respectively [minus value = eversion]; P < .05) compared with controls. Subjects with functional instability were also observed to have an increase in peroneus longus integral electromyography during the post-heel strike time period (107.91%.millisecond vs 64.53%.millisecond; P < .01). CONCLUSION: The altered kinematics observed in this study could explain the reason subjects with functional instability experience repeated episodes of ankle inversion injury in situations with only slight or no external provocation. It is hypothesized that the observed increase in peroneus longus activity may be the result of a change in preprogrammed feed-forward motor control.

Ankle function during gait in patients with chronic ankle instability compared to controls.

BACKGROUND: Despite much research, the reasons behind the development of chronic ankle instability in individuals post ankle inversion sprain are unknown. Chronic ankle instability has not previously been investigated dynamically using 3D motion analysis during walking. We hypothesised that chronic ankle instability subjects would exhibit a different kinematic and kinetic pattern during normal walking when compared with a control group. METHODS: Gait analysis was carried out on fifty subjects (25 chronic ankle instability, and 25 age, gender, activity, and gait velocity matched controls) during walking. Kinematic and kinetic pattern differences using the 3D motion analysis system combined with a force plate were established during 100 ms pre-heel strike and 200 ms post-heel strike, between the chronic ankle instability subjects and controls during normal walking. FINDINGS: Chronic ankle instability subjects were significantly (P<0.01) more inverted in the frontal plane compared to controls from 100 ms pre-heel strike to 200 ms post-heel strike. The joint angular velocity was significantly (P<0.05) higher at heel strike in the chronic ankle instability group. During the early stance phase of gait chronic ankle instability subjects appear to be controlled by an evertor muscle moment working concentrically compared to an invertor muscle moment working eccentrically in the controls. INTERPRETATION: These changes in kinematics and kinetics which arise are likely to result in increased stress being applied to ankle joint structures during the heel strike and loading response phases of the gait cycle. This could result in repeated injury and consequent damage to ankle joint structures.