The Midfoot Joint Complex (Foot Arch) Contributes to the Upper Body Position in Bipedal Walking and Coordinates With the Lower Limb Joints.

This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior-posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints' contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ -.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints' contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (≅70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.

Atuação da fisioterapia na síndrome de fragilidade: revisão sistemática / Physical therapy treatment on frailty syndrome: systematic review

Objetivo: Revisar sistematicamente a literatura sobre intervenções fisioterapêuticas e seus efeitos em idosos frágeis da comunidade. MÉTODOS: Revisão sistemática de estudos publicados até junho de 2008 nas bases de dados Medline, Embase, PEDro, SciELO, LILACS e Biblioteca Cochrane. Foram excluídos os artigos cuja amostra era constituída de idosos não frágeis, institucionalizados e hospitalizados; aqueles cujas intervenções propostas não foram a fragilidade e não eram específicos de fisioterapia. RESULTADOS: De acordo com os critérios de exclusão, dos 152 artigos encontrados no Medline, apenas 15 foram incluídos para análise; dos 71 artigos encontrados na base de dados PEDro, apenas um, uma vez que os outros 10 artigos encontrados já haviam sido selecionados pelo MEDLINE, e dos 461 artigos encontrados na base de dados Embase, apenas dois que não haviam sido selecionados nas outras bases de dados foram incluídos neste estudo. Foi verificado um total de sete diferentes tipos de intervenções: 1) fortalecimento muscular; 2) exercícios de fortalecimento muscular, equilíbrio, coordenação, flexibilidade, tempo de reação e treinamento aeróbico; 3) treino funcional; 4) fisioterapia; 5) fisioterapia realizada no domicílio; 6) adaptação ambiental e prescrição de dispositivo e 7) exercício na água. Os resultados de alguns estudos foram contraditórios mesmo com intervenções semelhantes. Os estudos analisados utilizaram formas distintas para definir fragilidade, o que dificultou as comparações dos resultados. CONCLUSÃO: Existem poucas evidências dos efeitos da intervenção fisioterapêutica em idosos frágeis comunitários, dificultando estabelecer consenso ou conclusões sobre a eficácia das propostas terapêuticas nessa complexa síndrome.

Objective: To carry out a systematic review of the literature on physical therapy interventions and their effect on frail community-dwelling elders. METHODS: Systematic review of studies published until June 2008 in the databases Medline, Embase, PEDro, SciELO, LILACS and Cochrane Library. We excluded studies with samples composed of institutionalized, hospitalized and non-frail participants, studies not aimed at treating frailty, and studies that were not specifically related to physical therapy. RESULTS: In accordance with the exclusion criteria, out of the 152 Medline articles, only 15 were considered for analysis, out of the 71 PEDro articles only one was considered as the other ten had already been selected in Medline, and out of the 461 Embase articles only two that had not been selected in others databases were included in this study. A total of seven different types of interventions were verified: 1) muscle strengthening; 2) exercises for muscle strengthening, balance, coordination, flexibility, reaction time and aerobic training; 3) functional training; 4) physical therapy; 5) at-home physical therapy; 6) environment adaptation and prescription of assistive device; 7) water exercise. The results of some studies were contradictory even with similar interventions. The analyzed studies had different definitions for fragility, which made it difficult to compare the results. CONCLUSION: There is little evidence of the effect of physical therapy intervention on frail community-dwelling elders; thus, it is not possible to reach a consensus or conclusion on the effectiveness of the therapeutic regimens proposed for this complex syndrome.