RESUMO
[Purpose] Currently, there are a limited number of amputee-specific instruments for measuring prosthesis-related quality of life with good psychometric properties in Turkey. This study translated the Prosthetic Evaluation Questionnaire to Turkish and analyzed as well as discussed its construct validity and internal consistency. [Subjects and Methods] The Prosthetic Evaluation Questionnaire was adapted for use in Turkish by forward/backward translation. The final Turkish version of this questionnaire was administered to 90 unilateral amputee patients. Second evaluation was possible in 83 participants within a median 28 day time period. [Results] Point estimates for the intraclass correlation coefficient ranged from 0.69 to 0.89 for all 9 Prosthetic Evaluation Questionnaire scales, indicating good correlation. Overall Cronbach's alpha coefficients ranged from 0.64 to 0.92, except for the perceived response subscale of 0.39. The ambulation subscale was correlated with the physical functioning subscales of Short Form-36 (SF-36) (r=0.48). The social burden subscale score of the Prosthetic Evaluation Questionnaire was correlated with social functioning subscales of SF-36 (r= 0.63). [Conclusion] The Turkish version of the Prosthetic Evaluation Questionnaire is a valid and reliable tool for implementation in the Turkish unilateral amputee population.
RESUMO
The Functional Independence Measure for Children (WeeFIM) instrument has recently been adapted and validated for non-disabled children in Turkey. The aim of this study was to validate the instrument in children with cerebral palsy (CP). One hundred and thirty-four children with CP were assessed using the WeeFIM. Reliability was tested by internal consistency, intraclass and interrater correlation coefficients (ICCs), internal construct validity by Rasch analysis, and external construct validity by correlation with the Denver II Development Test (Denver II). Mean age of the participants (70 females, 64 males) was 4y 6mo (SD 3y 8mo, range 6mo-16y). CP type was: diplegia in 37.3%, hemiplegia in 20.2%, quadriplegia in 8.2%, 'baby at risk' (i.e. infants who show neuromotor delay but cannot be classified in a CP type) in 29.9%, and other in 4.5%. Reliability of the WeeFIM was excellent with high Cronbach's alpha and ICC values ranging between 0.91 and 0.98 for the motor and cognitive scales. After collapsing response categories, both motor and cognitive scales met Rasch model expectations. Unidimensionality of the motor scale was confirmed after adjustment for local dependency of items. There was no substantive differential item functioning and strict unidimensionality for both scales was shown by analysis of the residuals. External construct validity was supported by expected high correlations with developmental ages determined by the social, fine motor function, language, and gross motor function domains of the Denver II. We conclude that the WeeFIM is a reliable and valid instrument for evaluating the functional status of Turkish children with CP.
Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Avaliação da Deficiência , Indicadores Básicos de Saúde , Fatores Etários , Criança , Pré-Escolar , Cognição , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Atividade Motora , Psicometria , Reprodutibilidade dos Testes , TurquiaRESUMO
Gait analysis is one of the essential steps of clinical examination in musculoskeletal medicine. Gait can be measured by various qualitative and quantitative techniques. In this article, the advantages and limitations of three-dimensional quantitative gait analysis will be discussed.
Assuntos
Paralisia Cerebral/fisiopatologia , Marcha/fisiologia , Fenômenos Biomecânicos , Paralisia Cerebral/diagnóstico , Interpretação Estatística de Dados , Eletromiografia/métodos , Humanos , Imageamento TridimensionalRESUMO
OBJECTIVE: To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. INTERVENTIONS: Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). RESULTS: The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS. CONCLUSIONS: In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.
Assuntos
Mãos/fisiopatologia , Espasticidade Muscular/reabilitação , Modalidades de Fisioterapia/instrumentação , Reabilitação do Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Probabilidade , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Valores de Referência , Índice de Gravidade de Doença , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Resultado do TratamentoRESUMO
The within- and between-session repeatability of time-distance and sagittal plane kinematic gait parameters were evaluated in 20 hemiparetic patients with sub-acute stroke. A test-retest design was used in which the patients were tested during two sessions within a 2h period. Each session comprised three consecutive trials. The intraclass correlation coefficients (ICCs) for time-distance parameters ranged from 0.82 to 0.99. The within- and between-session repeatability of pelvis, hip, knee and ankle kinematic waveforms were high: the mean coefficient of multiple correlations (CMCs) ranged from 0.85 to 0.95. The within-session coefficient of variation (CV%) for time-distance parameters ranged from 3.9 to 14.1, whereas, between-session CV% ranged from 6.1 to 17.2, showing similar but higher variability. The within- and between-session CV% for sagittal plane kinematics of the paretic lower limb ranged from 3.6 to 32.4. The results indicate that time-distance parameters and sagittal plane gait kinematics of the paretic lower limb, measured by the Vicon 370 gait analysis system, are repeatable and can be used to assess treatment effects after stroke.
Assuntos
Marcha/fisiologia , Extremidade Inferior/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estatura , Peso Corporal , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paresia/fisiopatologia , Pelve/fisiopatologia , Postura/fisiologia , Amplitude de Movimento Articular/fisiologia , Caminhada/fisiologiaRESUMO
We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean+/-S.D. age 57.7+/-12.5 years and time since stroke 5.99+/-6.46 months). Subgroups were based on "gender", "side of paresis", "lesion type", "motor recovery level", "sensory status", "time since stroke" and "walking velocity". Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p<0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p<0.01), single support time (CV 11.9% versus 6.3%, p<0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p<0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p<0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability. For better interpretation of quantitative gait data, clinicians should consider that variation in step length, single support time, peak hip extension in stance and knee flexion in swing differs according to walking velocity after stroke.
Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Sexuais , Estatísticas não ParamétricasRESUMO
PURPOSE: Assessment of cognitive impairment with a valid cognitive screening tool is essential in neurorehabilitation. The aim of this study was to test the reliability and validity of the Turkish-adapted version of the Middlesex Elderly Assessment of Mental State (MEAMS) among acquired brain injury patients in Turkey. METHODS: Some 155 patients with acquired brain injury admitted for rehabilitation were assessed by the adapted version of MEAMS at admission and discharge. Reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and person separation index; internal construct validity by Rasch analysis; external construct validity by associations with physical and cognitive disability (FIM); and responsiveness by Effect Size. RESULTS: Reliability was found to be good with Cronbach's alpha of 0.82 at both admission and discharge; and likewise an ICC of 0.80. Person separation index was 0.813. Internal construct validity was good by fit of the data to the Rasch model (mean item fit -0.178; SD 1.019). Items were substantially free of differential item functioning. External construct validity was confirmed by expected associations with physical and cognitive disability. Effect size was 0.42 compared with 0.22 for cognitive FIM. CONCLUSION: The reliability and validity of the Turkish version of MEAMS as a cognitive impairment screening tool in acquired brain injury has been demonstrated.
Assuntos
Lesões Encefálicas/complicações , Transtornos Cognitivos/diagnóstico , Programas de Rastreamento/instrumentação , Testes Neuropsicológicos , Adolescente , Adulto , Lesões Encefálicas/reabilitação , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , TurquiaRESUMO
BACKGROUND: Flatfoot in which a normal arch fails to develop is a common deformity in both children and adults. A frequently-used treatment is an over-the-counter insole to normalize foot mechanics and relieve pain. This study was designed to evaluate the effects of over-the-counter silicone insoles on the gait patterns of patients with flexible flatfoot. METHODS: Thirty-four adults (24 women and nine men, average age 43.7 +/- 9.7 years) with bilateral symptomatic flatfoot deformities were included in the study. Flatfoot was diagnosed by a lateral talometatarsal angle of more than 4 degrees and a talocalcaneal angle of more than 30 degrees. Three-dimensional gait analysis and video recordings were done at a single session. All patients walked at self-selected speeds over a 10-meter walkway with and without insoles. Time-distance parameters and kinematic and kinetic characteristics of gait in the sagittal plane were evaluated by a quantitative gait analysis system. RESULTS: Mean lateral talometatarsal and talocalcaneal angles were 6.3 +/- 2.5 degrees and 56.1 +/- 8.6 degrees, respectively. There was no difference in gait parameters with or without the insoles. CONCLUSIONS: Over-the-counter insoles have no beneficial effect in normalizing forces acting on the foot and on the entire lower extremity in adults with flexible flatfoot.
Assuntos
Pé Chato/fisiopatologia , Pé Chato/terapia , Marcha , Aparelhos Ortopédicos , Adulto , Feminino , Humanos , Masculino , Silicones , Resultado do TratamentoRESUMO
In this study we intended to evaluate the gait characteristics of children who had bilateral operated clubfeet, and to compare the results with gait parameters of children without clubfeet or lower extremity abnormalities. Fifteen children with bilateral plantigrade and asymptomatic clubfeet, operated bilaterally with posteromedial release method, were included in group P. Means+/-SD of age and follow-up time were 8.5+/-2.6 years (range, 4-14 years) and 7.7+/-2.8 years (range, 3-10 years), respectively. Age, sex, height-and weight-matched 24 children without clubfeet or lower extremity abnormalities were included in the control group (group C). Three-dimensional computerized gait analysis was performed for all subjects, and time-distance, kinematic and kinetic gait characteristics of the groups were compared. Time-distance characteristics of the groups were identical. Ankle plantar flexion angles, plantar flexor moment and generated power were significantly decreased in group P (P<0.05). Knee hyperextension during midstance was observed in 17 of 30 (57%) knees in the P group. Kinetic analysis revealed excessive knee valgus and flexion moments, as well as decreased second peak values of vertical ground reaction forces for group P. This study shows that even successfully operated, plantigrade and clinically asymptomatic children with bilateral clubfeet have significant gait deviations involving all lower limb joints. Future studies are needed to investigate the accountable factors of gait deviations and possible long-term musculoskeletal morbidity of operated children with bilateral clubfeet.
Assuntos
Pé Torto Equinovaro/fisiopatologia , Pé Torto Equinovaro/cirurgia , Marcha/fisiologia , Procedimentos Ortopédicos , Adolescente , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia , Estudos RetrospectivosRESUMO
The objectives of this study were to investigate the effects of Hylan G-F 20 (Synvisc; Genzyme Biosurgery, Ridgefield, New Jersey, USA) injections on clinical and biomechanical gait characteristics of patients with knee osteoarthritis. The design was a before-after trial, set in the gait laboratory of the rehabilitation unit of a university hospital. Twelve patients participated with an average age (+/-SD) of 63.2+/-4.4 years, and Kellgren and Lawrence grade II or III knee osteoarthritis. The main outcome measures were the Western Ontario McMaster Universities Osteoarthritis Index, and time-distance, kinematic and kinetic parameters of gait. The intervention used was a single course of three bilateral intra-articular injections of 2 ml Hylan G-F 20. One week after the treatment, the pain subscore and total score of WOMAC decreased from 9.2+/-2.7 to 4.8+/-3.1 and from 42.1+/-15.2 to 37.9+/-13.5, respectively. There was improvement in sagittal plane excursions of the knee (from 40.2+/-8.1 to 43.3+/-8.5), in extensor and adductor moments (from 0.26+/-0.2 to 0.14+/-0.1 and from 0.45+/-0.1 to 0.41+/-0.1, respectively), and in scaled vertical forces (from 85.8+/-4.5 to 88.4+/-5.4). All these differences were statistically significant. In conclusion, intra-articular Hylan G-F 20 injections not only decrease pain in patients with knee osteoarthritis, but can alter the natural history of the disease by decreasing excessive loads in the knees.
Assuntos
Marcha/efeitos dos fármacos , Ácido Hialurônico/análogos & derivados , Articulação do Joelho/efeitos dos fármacos , Osteoartrite do Joelho/tratamento farmacológico , Dor/tratamento farmacológico , Idoso , Fenômenos Biomecânicos , Feminino , Nível de Saúde , Humanos , Ácido Hialurônico/farmacologia , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Resultado do TratamentoRESUMO
BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) impairs cardiovascular autonomic responses to exercise and, depending on the level of injury, may result in hypotension and pathologic fatigue with exertion. Other clinical populations with sympathetic regulatory dysfunction, but without skeletal muscle paralysis, exhibit similar signs and symptoms. Their ability to engage in physical activity improves with elevation of blood pressure through pharmacologic treatment: Midodrine, an oral alpha-sympathomimetic agent, has been shown to be safe and efficacious for this purpose. Use of this medication in individuals with SCI merits investigation. METHODS: Double-blind, placebo-controlled, randomized, crossover, within-subjects protocol. Four participants with chronic, motor-complete injuries from C6 to C8 underwent 4 peak exercise tests (PXT) using a wheelchair ergometer, following administration of midodrine, 5 mg, 10 mg, and placebo, in random order. Heart rate, blood pressure, oxygen consumption (VO2), and perceived exertion were measured. RESULTS: Treatment with midodrine, 10 mg, was associated with elevated systolic blood pressure during peak exercise in 3 participants. Two participants showed a concurrent decrease in perceived exertion and increase in VO2. No adverse effects of midodrine were evident. CONCLUSION: Midodrine enhances exercise performance in some individuals with SCI, similar to other clinical populations with cardiovascular autonomic dysfunction.
Assuntos
Agonistas alfa-Adrenérgicos/farmacologia , Tolerância ao Exercício/efeitos dos fármacos , Midodrina/farmacologia , Traumatismos da Medula Espinal/fisiopatologia , Agonistas alfa-Adrenérgicos/administração & dosagem , Adulto , Pressão Sanguínea/efeitos dos fármacos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Teste de Esforço , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Midodrina/administração & dosagem , Esforço Físico/efeitos dos fármacos , Projetos PilotoRESUMO
The aim of this study was to investigate the energy expenditure of walking with different aids in patients with spinal cord injury (SCI) and to compare the results with normal able-bodied control subjects. The tests were performed on a 20 m indoor path in a comprehensive rehabilitation clinic of a university hospital. Nine male patients with incomplete SCI at various levels from C6 to L2 and nine age- and gender-matched normal able-bodied subjects were enrolled in the study. Two different walking aids were evaluated: walker and crutch. The main outcome parameters--walking velocity, oxygen uptake and oxygen cost--were measured during ambulation with the two different walking aids. There was a statistically significant difference between controls and SCI patients in terms of walking velocity (P<0.001), and oxygen cost (crutches P<0.01; walker P<0.001). SCI patients walked more slowly and less efficiently. When we compared SCI patients' walking with the two different aids, a statistically significant difference was observed in velocity and oxygen cost (P<0.05) in favour of crutches. We concluded that energy expenditure studies are useful tools for giving objective measures to patients at the time of discharge and to encourage them to use efficient assistive devices in their daily activities.
Assuntos
Metabolismo Energético , Paraplegia/metabolismo , Paraplegia/reabilitação , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/reabilitação , Adulto , Bengala , Muletas , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Equipamentos Ortopédicos , Consumo de OxigênioRESUMO
The objectives of this study were to investigate the development and pathogenesis of osteoporosis in stroke in-patients, to compare the bone mineral density (BMD) of the paretic and non-paretic sides, to study longitudinal changes during the period on the rehabilitation ward and to relate BMD to demographic, impairment and disability variables. Participants were 32 first-stroke in-patients (19 men), with an average age of 62.4 +/- 8.1 years. Demographic and clinical characteristics were documented. The BMD of lumbar spine, bilateral distal radius and femoral neck were measured and compared at admission and discharge. The associations between bone loss and age, sex, time since stroke, Brunnstrom motor recovery scores and functional independence measure motor (mFIM) scores were assessed. The mean percentage differences in BMD between paretic and non-paretic arms at discharge were 12% (P < 0.001) and 3.5% (P < 0.05), respectively, and between paretic and non-paretic legs were 5% (P < 0.01) and 2% (P < 0.05), respectively. There was a statistically significant correlation between BMD loss and Brunnstrom stage (r = -0.41) and mFIM score at admission (r = -0.42). In conclusion, patients with hemiparesis due to stroke are at increased risk of developing osteoporosis on the paretic side. Higher motor impairment and functional dependency at admission increases the risk. New strategies are needed for stroke patients to prevent further decreases in BMD and reduce the risk of fractures.
Assuntos
Osteoporose/etiologia , Acidente Vascular Cerebral/complicações , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular CerebralRESUMO
The aim of this study was to identify the efficacy of in-patient stroke rehabilitation, to evaluate the relationship between clinical characteristics and functional outcome, and to determine factors predicting functional outcome at discharge in Turkish stroke patients with a team approach. Retrospective data were collected from 102 of 116 patients with first stroke who were admitted to our rehabilitation unit at Ankara University. Demographic data, length of hospital stay (LOHS), onset to admission interval (OAI), type, side and location of stroke lesion, and most common medical complications were recorded. Functional Independence Measure (FIM) and Brunnstrom's motor recovery stages (BMRS) were assessed on admission and at discharge. The mean age was 61.6 +/- 10.9 years and the mean LOHS was 69.7 +/- 28.2 days. The mean FIM total scores were 69.2 +/- 27.4 and 83.2 +/- 25.7 on admission, and at discharge, respectively. The mean FIM total score was significantly correlated to age, LOHS and motor recovery. The FIM total scores of patients with aphasia and depression were found to be lower than those of patients without aphasia and depression. In a stepwise multiple regression analysis, FIM total score on admission, age and OAI were found to be valid predictors of FIM total score at discharge. Functional Independence Measure total score on admission was the strongest variable. Our results suggest that knowledge of the poor prognostic factors effecting functional outcome on admission can provide information to clinicians in identifying severity of stroke. Admission FIM total score, can be used to predict the patients' functional recovery. Advanced age, aphasia and post-stroke depression contribute to lower FIM scores.
Assuntos
Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Reabilitação do Acidente Vascular Cerebral , Fatores Etários , Afasia/fisiopatologia , Depressão/psicologia , Avaliação da Deficiência , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Transtornos das Habilidades Motoras/fisiopatologia , Admissão do Paciente , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Análise de Regressão , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , TurquiaRESUMO
BACKGROUNDS AND OBJECTIVES: Hemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological and socioeconomic problems in children with hemophilia and reduces their quality of life. The purpose of this study was to evaluate joint damage through various parameters and to determine functional deterioration in the musculoskeletal system during walking using kinetic and kinematic gait analysis. MATERIAL AND METHOD: Physical examination and kinetic and kinematic gait analysis findings of 19 hemophilic patients aged 7-20 years were compared with those of age, sex and leg length matched controls. RESULTS: Stride time was longer in the hemophilia group (p=0.001) compared to the age matched healthy control group, while hip, knee and ankle joint rotation angles were more limited (p=0.001, p=0.035 and p=0.001, respectively). In the hemophilia group, the extensor moment of the knee joint in the stance phase was less than that in the control group (p=0.001). Stride time was longer in the severe hemophilia group compared to the mild-moderate hemophilia and control groups (p=0.011 and p=0.001, respectively). Rotation angle of the ankle was wider in the control group compared to the other two groups (p=0.001 for both). Rotation angle of the ankle joint was narrower in the severe hemophilia group compared to the others (p=0.001 for each). Extensor moment of the knee joint was greater in the control group compared to the other two groups (p=0.003 and p=0.001, respectively). Walking velocity was higher in the control group compared to the severe hemophilia group. CONCLUSION: Kinetic and kinematic gait analysis has the sensitivity to detect minimal changes in biomechanical parameters. Gait analysis can be used as a reliable method to detect early joint damage.
Assuntos
Articulação do Tornozelo/fisiopatologia , Marcha/fisiologia , Hemofilia A/fisiopatologia , Artropatias/fisiopatologia , Articulação do Joelho/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adolescente , Fenômenos Biomecânicos/fisiologia , Criança , Feminino , Hemofilia A/complicações , Humanos , Artropatias/etiologia , Masculino , Qualidade de Vida , Caminhada/fisiologia , Adulto JovemRESUMO
We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings.
Assuntos
Marcha , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/fisiopatologia , Fusão Vertebral/métodos , Vértebras Torácicas/lesões , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/cirurgiaRESUMO
OBJECTIVE: To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. METHODS: A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). RESULTS: Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05). CONCLUSION: This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.
Assuntos
Córtex Cerebral/fisiopatologia , Paresia/reabilitação , Modalidades de Fisioterapia , Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral , Adulto , Idoso , Córtex Cerebral/patologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios-Espelho/patologia , Plasticidade Neuronal/fisiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Modalidades de Fisioterapia/tendências , Acidente Vascular Cerebral/patologiaRESUMO
OBJECTIVES: In this study gait deviations symmetry and asymmetry in patients with unilateral partial hip arthroplasty was determined. PATIENTS AND METHODS: Gait characteristics and time since operation (11.9+/-6.1; range 7 to 29 months) of 16 patients (9 females, 7 males; mean age 61.5+/-16.5 years; range 27 to 86 years) with unilateral partial hip arthroplasty were evaluated. Ten healthy volunteers (3 females, 7 males; mean age 54.1+/-11.9 years; range 35 to 65 years) were included in the study as control group. Quantitative gait data was collected with the Vicon 370 System (Oxford Metrics, Oxford, UK). Spatio-temporal (walking velocity, cadence, step time, step length, double support time) and kinematic (joint rotation angles of pelvis and hip in sagittal plane) data were processed by using Vicon Clinical Manager software package. Spatio-temporal and kinematic gait symmetry indices of both groups were calculated. RESULTS: Spatio-temporal and kinematic gait characteristics, but not the symmetry indices, of patients with unilateral partial hip arthroplasty were different from the control group (p>0.05). CONCLUSION: Findings of this study reveal that patients with unilateral partial hip arthroplasty had various gait deviations compared to healthy subjects, but that symmetry was preserved.
Assuntos
Artroplastia de Quadril/métodos , Marcha/fisiologia , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Lateralidade Funcional , Transtornos Neurológicos da Marcha/epidemiologia , Transtornos Neurológicos da Marcha/etiologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/fisiopatologia , Valores de Referência , CaminhadaRESUMO
Anatomical reconstruction of high riding hips by total hip arthroplasty (THA) and subtrochanteric shortening osteotomy aims to normalise gait pattern and improve functional hip scores. We present the medium-term clinical results of a group of patients with high riding dislocated hips in whom a cementless THA and subtrochanteric shortening osteotomy had been performed. We compared them with their preoperative status, with patients who had undergone a cementless THA for primary osteoarthritis, and also with a group of healthy gender and age-matched controls. Prospective computerized, three-dimensional gait analyses were performed in 8 female patients with uni-/ or bilateral severe developmental dysplasia of the hip (Group I). Gait analysis was performed preoperatively and at a mean of 12.5 months postoperatively. A group of 8 individuals who received cementless hip replacement for primary osteoarthritis (Group II), and a control group of 8 able-bodied individuals (Group III) were recruited for comparison. Patients in Group I improved and approached the values of Group II. However both were behind Group III. Limb length discrepancy was reduced from a mean of 4.3 cm (range, 1 - 8 cm) to a mean of 0.8 cm (range, 0 - 2 cm) at the latest follow-up. Pain was reliably relieved and activities of daily living were improved in patients with high riding developmental dysplasia of the hip, but they were still behind the normal population average. Nevertheless, the results can be as satisfactory as those in patients who undergo a THA for primary osteoarthritis.
Assuntos
Artroplastia de Quadril , Marcha/fisiologia , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Feminino , Luxação Congênita de Quadril/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Estudos Prospectivos , Radiografia , Recuperação de Função Fisiológica , Resultado do Tratamento , Caminhada/fisiologiaRESUMO
OBJECTIVES: In this study, we aimed to evaluate the functional results of patients operated for unilateral clubfoot who had good clinical outcome with gait analysis. We also investigated the deviation from the normal, and determined the compensation mechanisms by comparing this data with the unaffected feet and with the feet of healthy children. METHODS: Sixteen children [10 boys, 6 girls; mean age, 6.8 years (range 4-9 years)] with surgically treated unilateral clubfoot and 24 age-matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion, and radiographic measurements were recorded. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle in sagittal, coronal and transverse planes), and kinetic (ground reaction forces, moments, and powers of hip, knee, and ankle) data were evaluated. RESULTS: Calf circumference and ankle range of motion of involved extremity were significantly less than the unaffected side (p<0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 m/sec vs. 1.02±0.18 m/sec, p=0.01), shorter stride length (0.72±0.23 m vs. 0.91±0.05 m, p=0.01) than healthy children group. Affected foot of unilateral clubfoot patients had more toe-in than healthy children (-14.24±21.78° vs. 18.54±7.90°, p=0.001). Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane. CONCLUSION: Even asymptomatic well-treated children with unilateral clubfoot may have gait deviations both in the affected and unaffected sides. These alterations may also be the result of the subclinical involvement of the so called healthy foot by disease (clubfoot) as well as the compensatory mechanisms.