Sensitivity and specificity of normalized truncated navicular height in assessment of static foot posture in children aged 6-12 years.

BACKGROUND: Normalized truncated navicular height (NTNH) is a non-invasive, easy to perform, and simple clinical measure of static foot posture. However, its sensitivity and specificity in evaluation of the static foot posture in children have not been investigated yet. OBJECTIVE: To investigate the intra-rater reliability, sensitivity, and specificity of NTNH in evaluation of the static foot posture in children using radiographic measure as a gold standard measure. METHODS: A cross-sectional study of a random sample of 300 school children aged 6-12 years old. Intra-rater reliability, minimal detectable change, sensitivity, and specificity of NTNH were investigated. NTNH as a clinical measure of static foot posture was calculated and compared to the radiographic measure and displayed on the receiver operating characteristic (ROC) curve. RESULTS: NTNH demonstrated an intra-rater reliability of ICC = 0 . 98 . The sensitivity and specificity of NTNH were 88.1% and 99.5%, respectively. The optimal cutoff point for the diagnosis of flat foot using NTNH in children aged 6-12 years is NTNH ≤ 0 . 19 . CONCLUSION: NTNH is a sensitive and specific measure of static foot posture in the children aged 6-12 years. It is recommended to be used as a screening measure of static foot posture in children as it is easy, simple to perform, and a non-invasive clinical measure.

Can the stroke impact scale 3.0 detect cognitive impairments in patients with a recent stroke?

[Purpose] The aim of this study was to identify cognitive impairments in patients with a recent stroke using Stroke Impact Scale 3.0 (SIS). [Participants and Methods] A retrospective cohort study was conducted to evaluate 50 medical records in patients with a recent stroke who have completed a stroke rehabilitation programme. All data were evaluated at St. Finbarr's Hospital in Cork, Ireland. [Results] A total of 41 records met the inclusion criteria, of which 53.7% were male. Regarding the risk factors, most patients complained of hypertension (85.4%), with most being diagnosed with embolic stroke (56.1%). The SIS identified numerous issues in stroke patients, such as persistent problems with memory (36.6%), concentration (29.3%), and solving everyday problems (43.9%). In addition, some patients' responses were negative regarding their emotion such as feeling sad (51.2%), not enjoying things as much as ever (39%), feeling life is not worth living (85.4%) and not smiling or laughing at least once a day (80.5%). [Conclusion] The inclusion of the SIS in the stroke review clinic identified cognitive deficits that may not have otherwise been detected. By using SIS in a systematic and standardised way, deficits can be identified, and appropriate rehabilitation can be provided.

Kinematic characteristics of reaching in children with hemiplegic cerebral palsy: A comparative study.

BACKGROUND: Practitioners need more sensitive measures to quantify reaching movement for judgement of the treatment effects and reflecting the degrees of motor impairment in upper extremities. OBJECTIVE: The purposes of this study were to differentiate between spastic and normal reaching using three-dimensional (3D) motion analysis and to quantify the interference of spasticity on reaching movement in children with congenital hemiplegic cerebral palsy. METHODS: Fifteen children with hemiplegic CP as a study group and 15 normal typically-developing (TD) children as a control group were studied. Participants were asked to reach forward, at a self-selected pace, toward one target at a normalized distance. A motion analysis system was used to record the trajectory of reaching performance. Kinematic parameters were computed and analysed. RESULTS: There were significant differences between the normal and spastic reaching (p < 0.001). Hemiplegic CP demonstrated slower and less smooth (higher normalized jerk score and more movement units) movement than the TD group, this reflects feedback guidance to correct spatial inaccuracy of reaching in hemiplegic CP. CONCLUSION: Kinematic analysis quantifies reaching characteristics and provides objective information about the motor strategies associated with goal-oriented tasks.

Cardiopulmonary Response in Post-COVID-19 Individuals: A Cross-Sectional Study Comparing the Londrina Activities of Daily Living Protocol, 6-Minute Walk Test, and Glittre Activities of Daily Living Test.

This study addresses the imperative need for reliable assessment protocols in guiding rehabilitation interventions for individuals post-COVID-19, considering the enduring physiological effects of the virus. A cohort of 40 post-COVID-19 individuals underwent assessments using the Londrina ADL protocol, Glittre ADL test, and the 6-minute walk test (6MWT). Physiological parameters were recorded during and after each test, including heart rate, respiratory rate, and oxygen saturation. The post hoc comparisons between the pre-test and post-test cardiopulmonary response of the three tests showed significant differences, except diastolic blood pressure (6MWT vs. Londrina ADL protocol), heart rate (6MWT vs. Londrina ADL protocol), respiratory rate (6MWT vs. Londrina ADL protocol), blood oxygen level (SpO2) (6MWT vs. Londrina ADL protocol), dyspnea (Londrina ADL protocol vs. Glittre ADL test), and fatigue (Londrina ADL protocol vs. Glittre ADL test). The Londrina ADL protocol demonstrated cardio-pulmonary responses comparable to the Glittre ADL test, as well as the 6MWT, emphasizing its effectiveness in evaluating walking-related outcomes. The study concludes that the Londrina ADL protocol is a robust and practical tool for the routine clinical testing of daily living activities in post-COVID-19 individuals. While the 6MWT remains valuable for assessing walking-related outcomes, a combined approach employing the Londrina ADL protocol and 6MWT offers a comprehensive strategy for evaluating multifaceted functional capacities in this population.

Physiotherapists' practice patterns for the diagnosis and management of patients with chronic contracted frozen shoulder in the United Arab Emirates.

BACKGROUND: Adhesive capsulitis or contracted shoulder, known as frozen shoulder, is a persistent painful condition that may last for more than three months. It is a common disease-causing morbidity that causes pain and loss of shoulder range of motion. Physical therapy is advocated for the restoration of a pain-free state and normal use of the upper extremity, along with other interventions. PURPOSE: This study aimed to explore the level of current clinical practice for managing chronic contracted frozen shoulder (CCFS) among physiotherapy professionals in the United Arab Emirates (UAE) compared to well-established evidence-based practices, and to identify the most common therapy practiced in UAE to manage CCFS. METHOD: This study was based on a cross-sectional quantitative analysis using an adapted questionnaire. The main themes of questions were the presence of a special interest in CCFS, management options, symptoms, diagnosis, referral, and best physiotherapy intervention recommendations. The results were analyzed using simple descriptive analyses, such as frequency, mean, and percentage of total responses; additionally, thematic and content analyses were performed for open-ended questions. RESULTS: Overall, 101 physiotherapy professionals participated in the survey: 62% female and 38% male; 59% were bachelors- and 36% masters-degree holders, respectively. In the closed ended question regarding the interest in CCFS, male physiotherapists (PTs) were more interested than females (82% vs. 68%). For the most common indication of CCFS, 76% of the participants selected "Limitation of movement" as the main indication. However, only 42% confirmed the presence of clinical protocols in their employment setting. In their opinion, the most effective therapies were patient education, superficial heat or cold, manual joint mobilization, and sustained stretching exercises. CONCLUSION: A well-established professional competence exists among physiotherapists in the UAE to manage and treat patients with CCFS. The findings showed sufficient standard, theoretical, and practical knowledge among the study groups.

Effect of Different Foot Orthosis Inverted Angles on Walking Kinematics in Females with Flexible Flatfeet.

Background: Although the inverted technique was shown to be more effective compared to other orthotic designs for the treatment of flatfeet, the biomechanical mechanisms underlying the therapeutic effect of the inverted angle orthoses is still unclear. Therefore, the aim of this study was to examine the effect of different inverted angles of foot orthoses on walking kinematics in females with flexible flatfeet. Methods: Thirty-one female adults with flexible flatfeet aged 18-35 years old participated in this study. Kinematic data of the hip, knee, and ankle were collected via BTS motion-capture system during walking under three test conditions in random order: with shoes only; with 15° inverted orthoses; and with 25° inverted orthoses. Results: Compared to the shoes only condition, both the 15° and 25° inverted orthotic conditions significantly decreased the maximum ankle plantarflexion angle during loading response, maximum ankle dorsiflexion angle during mid-stance, maximum ankle external rotation angle, and maximum ankle internal rotation angle. The maximum ankle plantarflexion angle at toe-off showed a significant decrease with the 25° inverted angle orthosis compared to both the 15° inverted angle and shoes only conditions. No significant differences were found in the knee kinematic variables, maximum hip extension angle, and maximum hip adduction angle between test conditions. Conclusion: Using inverted orthoses at 15° and 25° inverted angles resulted in significant changes in ankle joint kinematics during walking in female adults with flexible flatfeet. A 25° inverted angle orthosis significantly decreased ankle plantarflexion during push-off, potentially impacting gait mechanics. This suggests that a smaller inverted angle may be more effective for managing flexible flatfeet in female adults.

Cardiorespiratory Response to Six-Minute Step Test in Post COVID-19 Patients-A Cross Sectional Study.

BACKGROUND AND PURPOSE: New coronavirus disease 2019 (COVID-19) can cause persistent symptoms and physical weakness that can lead to a limitation in activities of daily living (ADL). There is a lack of evidence about the performance in the six-minute step test (6MST) of post-COVID-19 patients and healthy subjects. The aim of this study is to investigate the cardiorespiratory response induced by the 6MST in post-COVID-19 patients and compare it with the response of the six-minute walk test (6MWT). METHODS: This cross-sectional study was conducted on 34 post-COVID-19 patients and 33 healthy subjects. The assessment was performed at one month from a non-severe SARS-CoV-2 infection. Both groups were assessed by using the 6MST, 6MWT, and the pulmonary function test (PFT). Post COVID functional status (PCFS) scale was used for the post-COVID-19 group to assess functional status. Physiological responses; heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP), and Borg scale for fatigue and dyspnea were recorded before and after the 6MST and 6MWT. RESULTS: the performance of the post-COVID-19 group was worse than the healthy group in both tests. In 6MWT, the distance walked by the post-COVID-19 group (423 ± 7) was 94 m less than the healthy group, and the number of climbed steps in the 6MST (121 ± 4) was 34 steps less than the healthy group. Both results were statistically significant (p < 0.001). There was a moderate positive correlation between the 6MST and 6MWT in walked distance versus steps number (r = 0.5, p < 0.001). In addition, there was a moderate correlation between the two tests in the post (HR, RR, SpO2, systolic blood pressure SBP, diastolic blood pressure DBP, dyspnea, and fatigue) with p < 0.001. CONCLUSIONS: Six-minute step tests produced similar cardiorespiratory responses when compared to a 6MWT. The 6MST can be used as an assessment tool for COVID-19 patients to evaluate their functional capacity and ADL.

Knowledge, Attitude, Practice, and Fear of COVID-19: an Online-Based Cross-cultural Study.

The study aimed to measure Knowledge, Attitude, and Practice (KAP) and fear level towards COVID-19 and explore its cross-cultural variances in knowledge by sociodemographic factors among the general population of 8 different countries over 5 continents. It was a cross-sectional online survey. This survey was conducted in April 2020 among 1296 participants using the "Google Form" platform. Considering the social distancing formula and pandemic situation, we collect data using popular social media networks. Univariate and bivariate analyses were used to explore the collected data on KAP, fear, and sociodemographic factors. Overall knowledge score was 9.7 ± 1.7 (out of 12), and gender differences (female vs male: 9.8 ± 1.6 vs 9.5 ± 1.9) were significant (p = 0.008) in the bivariate analysis. Knowledge score variances were found significant in some regions by gender, marital status, and education qualification. The highest and lowest mean knowledge scores were recorded in the Middle East (10.0 ± 1.7) and Europe (9.3 ± 2.0). Despite having a high fear score (22.5 ± 5.6 out of 35), 78.35% of respondents were positively and 81.7% in a good practice level. Fear score rankings: Middle East (1st; 23.8 ± 5.5), Europe (2nd; 23.2 ± 5.8), Africa (3rd; 22.7 ± 5.0), South Asia (4th; 22.1 ± 5.7), Oceania (5th; 21.9 ± 5.8), and North America (6th; 21.7 ± 5.5). Fear and knowledge were not correlated. KAP and fear variation exist among geographical regions. Gender, marital status, and education qualification are factors in knowledge variances for some regions. KAP and fear measures can help health education programs consider some sociodemographic factors and regions during an outbreak of highly contagious disease and uplift a positive attitude and good practice. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-021-00638-4.

Prevalence of Upper Limb Musculoskeletal Disorders and Their Association with Smartphone Addiction and Smartphone Usage among University Students in the Kingdom of Saudi Arabia during the COVID-19 Pandemic-A Cross-Sectional Study.

This study aimed to investigate the prevalence of upper limb musculoskeletal disorders (MSDs) and their association with smartphone addiction and smartphone usage among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic. A total of 313 university students aged 18 years and older who owned a smartphone and used it during the preceding 12 months participated in this cross-sectional study. The prevalence of upper limb MSDs, smartphone addiction/overuse, and levels of physical activity were recorded using the standardized Nordic musculoskeletal questionnaire, the smartphone addiction scale (short version), and the international physical activity questionnaire (short form), respectively. Data collection was performed on campus between March and May 2021. Binary logistic regression was used to determine the association between the prevalence of upper limb MSDs and smartphone addiction/overuse and levels of physical activity. The 12-month prevalence of MSDs of the shoulder, elbow, and wrist/hand regions due to smartphone use among participants was found to be 20.13%, 5.11%, and 13.42%, respectively. Shoulder (odds ratio (OR) = 11.39, 95% confidence interval (CI) = 4.64−27.94, p < 0.001), elbow (OR = 15.38, 95% CI = 1.92−123.26, p = 0.01), and wrist/hand MSDs (OR = 7.65, 95% CI = 2.75−21.22, p < 0.001) were more prevalent among participants who were categorized as having smartphone addiction/overuse measures. Promoting awareness about the healthy use of smartphones, including postural education and decreasing screen time, is necessary to reduce smartphone-related MSDs.

Physiotherapists' perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study.

BACKGROUND: There are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists. SUBJECTS AND METHODS: An observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents. RESULTS: The findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups. CONCLUSION: More efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.

Contrasting effects of three breathing techniques on pulmonary function, functional capacity and daily life functional tasks in patients following valve replacement surgery- A pilot randomized clinical trial.

BACKGROUND: Valve replacement surgeries affect the physiological mechanisms of patients leading to various postoperative pulmonary complications. Lung expansion therapy consisting of numerous techniques is routinely used for the prevention and treatment of these complications. OBJECTIVES: Our study aimed to compare the effects of diaphragmatic breathing (DB), flow (FS) and volume-oriented incentive spirometer (VS) in patients following valve replacement surgery. METHODS: 29 patients posted valve replacement surgeries were randomly assigned to VS, FS and DB groups. Patients underwent preoperative training and seven-day rehabilitation post-surgery. Pulmonary function tests were performed before surgery and for seven days afterward. On the seventh postoperative day, patients performed a six-minute walk test and completed a functional difficulties questionnaire (FDQ). RESULTS: Pulmonary function test values reduced in all three groups postoperatively when compared to the preoperative values but improved by the seventh postoperative day (p < 0.05). On comparing the seventh postoperative day values to the preoperative values, the VS group had no significant difference (p = 1.00) (Forced Vital Capacity- % change: DB-37.76, VS-1.59, FS-27.98), indicating that the value had nearly returned to the baseline. As compared to the DB and FS groups, FVC showed a greater improvement in the VS group (p = 0.01 and p = 0.06 respectively). No significant differences were observed between groups for distance walked (p > 0.05), however, FDQ scores demonstrated positive changes in favor of VS when contrasted with FS or DB (p < 0.05). CONCLUSION: Diaphragmatic breathing, flow or volume-oriented spirometer could improve pulmonary function in the postoperative period. The volume-oriented spirometer, however, was found to be the most beneficial among the three techniques in improving patients' pulmonary function and daily life functional tasks. Further research is warranted to confirm these findings.

Effect of postoperative high load long duration inspiratory muscle training on pulmonary function and functional capacity after mitral valve replacement surgery: A randomized controlled trial with follow-up.

OBJECTIVES: Although, pre-operative inspiratory muscle training has been investigated and reported to be an effective strategy to reduce postoperative pulmonary complications, the efficacy of postoperative inspiratory muscle training as well as the proper load, frequency, and duration necessary to reduce the postoperative pulmonary complications has not been fully investigated. This study was designed to investigate the effect of postoperative high-load long-duration inspiratory muscle training on pulmonary function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries. DESIGN: Prospective randomized controlled trial. METHODS: A total of one hundred patients (mean age 38.3±3.29years) underwent mitral valve replacement surgery were randomized into experimental (n = 50) and control (n = 50) groups. The control group received conventional physiotherapy care, while experimental group received conventional care in addition to inspiratory muscle training, with 40% of the baseline maximal inspiratory pressure targeting a load of 80% by the end of the 8 weeks intervention protocol. Inspiratory muscle training started on the patient's first day in the inpatient ward. Lung functions, inspiratory muscle strength, and functional capacity were evaluated using a computer-based spirometry system, maximal inspiratory pressure measurement and 6MWT respectively at 5 time points and a follow-up assessment was performed 6 months after surgery. Repeated measure ANOVA and post-hoc analyses were used (p <0.05). RESULTS: Group-time interactions were detected for all the studied variables (p<0.001). Between-group analysis revealed statistically significant postoperative improvements in all studied variables in the experimental group compared to the control group (p <0.001) with large effect size of η2 ˃0.14. Within-group analysis indicated substantial improvements in lung function, inspiratory pressure and functional capacity in the experimental group (p <0.05) over time, and these improvements were maintained at follow-up. CONCLUSION: High intensity, long-duration postoperative inspiratory muscle training is highly effective in improving lung function, inspiratory muscle strength, and functional capacity after mitral valve replacement surgeries.

Evidence based physiotherapy practice in cardiopulmonary subdiscipline: A survey in United Arab Emirates.

BACKGROUND: Evidence based practice (EBP) is widely used by cardiopulmonary physical therapists worldwide. Therefore, it is important to identify whether the therapists have the required knowledge, skills and resources in order to deliver the best evidence-based practice. OBJECTIVES: The main objective of this cross-sectional study is to analyse the self-reported characteristics of behaviour, knowledge, skills and resources, opinion and barriers related to evidence-based practice among cardiopulmonary physical therapists of United Arab Emirates (UAE). METHODS: An electronic questionnaire was circulated among 60 licensed cardiopulmonary physical therapists, of either gender, practicing in UAE with a minimum experience of 1 year via e-mail. The response was further subjected to descriptive analysis. RESULTS: The rate of response was 55% (33/60). The physical therapists of cardiopulmonary disciple reported that they understand the term Evidence Based Practice and frequently update themselves through scientific papers obtained via accessing various databases. Respondents also believe that the exposure in undergraduate or postgraduate course was not sufficient. However, they were also satisfied with amount of discussions taking place regarding EBP at their work place. The barriers commonly reported were difficulty in obtaining full-text papers, lack of time and lack of evidence-based training. CONCLUSION: Thus, concluding that physical therapists from UAE who practiced in cardiopulmonary subdiscipline believe that they have knowledge and skills to use evidence-based practice. Although, they have favourable opinions regarding its application and they still encounter difficulties in implementing it successfully.

Effect of lidocaine iontophoresis combined with exercise intervention on gait and spasticity in children with spastic hemiplegic cerebral palsy: A randomized controlled trial.

BACKGROUND: Gait deviations and spasticity are common impairments seen in children with cerebral palsy (CP) and may interfere with functional performance and effective walking pattern. Lidocaine iontophoresis is effective for reducing muscle spasticity in adults. PURPOSE: To investigate the effect of lidocaine epinephrine iontophoresis combined with exercises on gait and spasticity in children with spastic hemiplegic cerebral palsy (HCP). METHODS: Thirty children with spastic HCP aged 4-6 (5.20±0.32) years were randomly assigned to the experimental group (n = 15) and control group (n = 15). Children in both groups received one hour of exercises, three times a week for three months. Children in the experimental group received 2% lidocaine iontophoresis immediately before the exercises. The lidocaine iontophoresis was delivered for 20 minutes (1mA/min). Spatio-temporal gait parameters were assessed within one week before and after the intervention using 3D motion analysis. Surface electromyography was used to assess muscle tone using H/M ratio of the soleus muscle. ANOVA was used to investigate the differences between experimental and control groups. Statistical significance was set at P value less than 0.05. RESULTS: There was no difference between groups at baseline. Post-intervention, the experimental group showed significant improvements when compared to the control group for gait speed (p = 0.03), stride length (p = 0.04), cadence (p = 0.0001), cycle time (p = 0.0001), and H/M ratio (p = 0.02). CONCLUSION: Lidocaine iontophoresis combined with exercises was effective in improving gait spatiotemporal parameters and reducing spasticity in children with CP.

Validity and diagnostic accuracy of foot posture Index-6 using radiographic findings as the gold standard to determine paediatric flexible flatfoot between ages of 6-18 years: A cross-sectional study.

BACKGROUND: Diagnosis of flexible flatfoot is usually based upon radiographic or clinical measures. Radiographic measures pose a potential risk of radiation exposure especially in Paediatric population. Clinicians need a valid, accurate, easily used, noninvasive and cost effective measure to evaluate static foot posture clinically. Although, foot posture index-6 (FPI-6) are commonly used in clinical practice, its validity and diagnostic accuracy in evaluation of paediatric flexible flatfoot have not been fully proven yet. OBJECTIVES: To investigate validity and diagnostic accuracy of FPI-6 to determine Paediatric flexible flatfoot between ages of 6-18 years using radiographic findings as the gold standard measure. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study conducted on 612 participants (1224 feet) with flexible flatfoot aged 6-18 years (mean age ± standard deviation of 12.36 ± 3.39 years). The results of FPI-6 were compared to the gold standard radiographic measures and displayed on the receiver operating characteristic curve. Intra-rater reliability, sensitivity, specificity, predictive values and likelihood ratios were calculated. Posttest probability was calculated from Fagan nomogram. RESULTS: FPI-6 demonstrate high intra-rater reliability (ICC = 0.96) with p value < 0.001. FPI-6 showed a sensitivity of 83.7%, a specificity of 80.4, a positive predictive value of 64.7, a negative predictive value of 92, a positive likelihood ratio of 4.62 and a negative likelihood ratio of 0.20. FPI-6 shows moderate diagnostic accuracy [AUC = 0.82; 95%CI (0.78-0.85)]. CONCLUSION: FPI-6 is valid with moderate diagnostic accuracy to determine paediatric flexible flatfoot between ages of 6-18 years.

Validation of normalized truncated navicular height as a clinical assessment measure of static foot posture to determine flatfoot in children and adolescents: A cross sectional study.

BACKGROUND: Reliability of clinical measures of static foot posture has been widely debated. However, validity of these measures has not been fully established especially in a pediatric population. The purpose of the study was to investigate reliability and validity of normalized truncated navicular height (NTNH) in assessment of static foot posture to determine flatfoot in children and adolescents using radiographic measures as a criterion gold standard measure. METHODS: A sample of 612 participants aged 6-18 years (12.3±3.3) were enrolled in the study. Clinical assessment of static foot posture using NTNH was compared to the gold standard radiographic measures. Reliability, validity and diagnostic accuracy were investigated. The optimal cutoff point for flatfoot using NTNH was calculated. RESULTS: NTNH demonstrated sensitivity of 98.4%, high positive predictive (PV +) value of 89.2%. The positive likelihood ratio was 19 and the negative likelihood ratio was 0.02. The area under the receiver operating curve (AUC) was 0.96 indicating high validity and diagnostic accuracy of NTNH. The optimal cutoff point for diagnosing flatfoot was NTNH≤0.195. CONCLUSION: NTNH is a valid and diagnostically accurate clinical measure of static foot posture in children and adolescents.

Biodex balance training versus conventional balance training for children with spastic diplegia.

OBJECTIVE: The purpose of this study was to compare the effectiveness of balance training using the Biodex balance system and a conventional balance training programme on balance score and on gross motor skills of children with spastic diplegia. METHODS: A randomized controlled study was conducted on 48 spastic diplegic children with cerebral palsy (26 boys and 22 girls) in the age range of 5-8 years. The children were randomly allocated to two equal groups. The investigators performed balance and gross motor function assessments for every child using the paediatric Berg balance scale and the gross motor function measure -88 scale (dimensions D and E) before and after the treatment programme. Passive repositioning sense was measured by a Biodex III isokinetic dynamometer. The study group received Biodex balance training and traditional physical therapy programme training, whereas the control group received conventional balance training in addition to the traditional physical therapy programme training, 3 times per week for 12 weeks. RESULTS: Significant improvement was observed in all outcome measures of the two groups, comparing their pre- and post-treatment mean values. Furthermore, the results revealed a significant (P < 0.05) improvement in mean post-treatment values for the Biodex balance training group. CONCLUSION: Balance training using the Biodex balance system is superior to conventional balance training for improving the balance abilities and gross motor functions of children with cerebral palsy and spastic diplegia.

Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects?

OBJECTIVE: To test the hypothesis that improvement of cervical lordosis in cervical spondylotic radiculopathy (CSR) will improve cervical spine flexion and extension end range of motion kinematics in a population suffering from CSR. METHODS: Thirty chronic lower CSR patients with cervical lordosis < 25° were included. IRB approval and informed consent were obtained. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received stretching exercises and infrared; the SG received 3-point bending cervical extension traction. Treatments were applied 3 × per week for 10 weeks, care was terminated and subjects were evaluated at 3 intervals: baseline, 30 visits, and 3-month follow-up. Radiographic neutral lateral cervical absolute rotation angle (ARA C2-C7) and cervical segmental (C2-C7 segments) rotational and translational flexion-extension kinematics analysis were measured for all patients at the three intervals. The outcome were analyzed using repeated measures one-way ANOVA. Tukey's post-hoc multiple comparisons was implemented when necessary. Pearson correlation between ARA and segmental translational and rotational displacements was determined. RESULTS: Both groups demonstrated statistically significant increases in segmental motion at the 10-week follow up; but only the SG group showed a statistically significant increase in cervical lordosis (p < 0.0001). At 3-month follow up, only the SG improvements in segmental rotation and translation were maintained. CONCLUSION: Improved lordosis in the study group was associated with significant improvement in the translational and rotational motions of the lower cervical spine. This finding provides objective evidence that cervical flexion/extension is partially dependent on the posture and sagittal curve orientation. These findings are in agreement with several other reports in the literature; whereas ours is the first post treatment analysis identifying this relationship.

Effectiveness of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic cerebral palsy.

AIMS: To investigate the effect of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic CP. DESIGN: Cross-sectional study. PARTICIPANTS: A convenient sample of 18 ambulant children with spastic hemiparetic CP was evaluated. Fifteen matched normal children acted as a control group. METHODS: Using two calibrated scales, measurements of weight supported on each lower limb were obtained under four different standing conditions. RESULTS: During quiet standing, the percentage of weight supported on the paretic limb was 35.59% with symmetry index equals 0.57. Standing with the non-paretic foot is placed on a lateral foot wedge, was the best condition that increased the percentage of weight supported on the paretic limb to 47.18% and improved the symmetry index to 0.90. Non-significant improvement of symmetry index 0.61 was recorded when carrying a weighted bag with the paretic hand, but carrying with the non-paretic hand unnecessarily loads the non-paretic limb and further decreases the symmetry index to 0.49. CONCLUSIONS: Using a lateral foot wedge beneath the non-paretic foot and carrying a weighted bag with the paretic hand improve the loading function of the paretic limb and relief the non-paretic limb from overloading.

Influences of purposeful activity versus rote exercise on improving pain and hand function in pediatric burn.

PURPOSE: To explore the influences of purposeful activities versus rote exercises on pain, range of motion and hand function in children with hand burn. METHODS: Thirty patients had superficial and deep partial and full-thickness burns, including hand and wrist with less than 25% total body surface area (TBSA) was included in this study. The patients were randomly allocated to one of the two groups; purposeful activity group (PA-group, n=15) and rote exercises group (Rex-group, n=15). Outcomes measured were pain severities using the self-report faces scale and analogue scale (VAS), total active motion (TAM) using standard dorsal hand goniometer, and hand function using Jebsen-Taylor hand function test (JTHFT). Measurements were recorded 72 h post-burn, after 1, 2, and 3 weeks, at the time of discharge and at 3 months follow up. RESULTS: In PA-group, results regarding to pain modulation (p<0.05), TAM (p<0.01), and JTHFT (p<0.01) was statistically significance in comparison to Rex-group. CONCLUSION: This study supports the belief that the purposeful activity based on playing, and games can reduce pain, improve hand movement and functions better than rote exercise. As well as its reusability and versatility, suggesting another option in the rehabilitation of children with hand burn.