Early spontaneous movements and spatiotemporal gait characteristics in preterm children.

This study aimed to analyze spatiotemporal gait characteristics of preterm children from 3 to 4 years of age according to different gestational age groups and to examine the relationship between the detailed general movements assessment and spatiotemporal gait characteristics. A total of 74 preterm children, 32 extremely preterm and very preterm (EP-VP, < 32 weeks gestational age) and 42 moderate to late preterm (MLP, 32 to < 37 weeks gestational age), were included in this prospective study, along with 38 term children. Early spontaneous movements of preterm children were assessed from videos at 9-20 weeks post-term according to the general movements assessment, which determines the Motor Optimality Score-Revised (MOS-R). The spatiotemporal gait characteristics of all children were evaluated using the GAITRite®electronic walkway at self-selected walking speeds. EP-VP children walked with shorter step lengths (p = 0.039), and MLP children walked with greater step length variability (p = 0.003) than their term peers. The MOS-R results were related to step length (r = 0.36, p = 0.042), step length variability (r = -0.56, p = 0.001), and base of support (r = -0.37, p = 0.038) in EP-VP children. The MOS-R subcategories, age-adequate movement repertoire, and postural patterns were related to some of the spatiotemporal gait characteristics, including step length, step length variability, and base of support (p < 0.05).  Conclusion: EP-VP and MLP children might catch up to their term peers at 3 to 4 years of age in terms of most gait parameters. In addition to the MOS-R, age-adequate movement repertoire and postural patterns of preterm children without cerebral palsy in early life may be a marker of later neurodevelopmental dysfunction. What is Known: • Preterm children walk with a wider step width, a greater step length asymmetry and step time, and a shorter stride length at 18 to 22 months of age compared with term children at a self-selected speed, while these differences disappear in children 4.5-5 years old and older. What is New: • Early spontaneous movements were related to some spatiotemporal gait characteristics. • Preterm children might catch up to term children at 3-4 years of age in spatiotemporal gait characteristics while walking at a self-selected speed.

Investigation of postural control and spatiotemporal parameters of gait during dual tasks in ataxic individuals.

BACKGROUND: Concurrent cognitive and motor tasks in ataxic individuals cause functional limitations and negatively affect the independence of patients in daily life. OBJECTIVES: This study aimed to examine the effects of dual task on postural control and spatiotemporal parameters of gait in ataxic individuals. METHODS: The study included 20 individuals with ataxia. Disease severity was evaluated using the International Cooperative Ataxia Rating Scale. A force platform was used to evaluate postural sway and limits of stability and a GAITRite electronic walkway to evaluate the spatiotemporal parameters of gait. Postural control and gait were evaluated without a simultaneous task (task-1) and with dual tasks consisting of counting the names starting with "a selected letter such as A" (task-2), counting backwards aloud in threes from 100 (task-3), carrying a glass of water with a tray (task-4), and speaking on a mobile phone (task-5). The effects of dual task on postural control and gait parameters were examined with multiple comparisons. RESULTS: The tasks requiring cognitive skills (tasks 2, 3, 5) were determined to have a greater effect on the increase of body sway, and gait was seen to be affected by motor and/or cognitive tasks (tasks 2, 4, 5). CONCLUSION: From the results of the present study, it is thought that evaluations of postural control and gait performance of ataxic individuals together with the dual tasks they may encounter in daily life are important in terms of their independence in activities of daily living.

Investigation of surface electromyography amplitude values during stair climbing task in children with Duchenne muscular dystrophy.

OBJECTIVE: The aims of this study were (a) to examine the surface electromyography (sEMG) amplitude values of the lower limb muscles during stair climbing both between different functional levels of Duchenne muscular dystrophy (DMD), in comparison with healthy children, and (b) to investigate the relationships between sEMG amplitudes and physical performance. METHODS: sEMG amplitudes of the lower limbs of twenty-one children with DMD between levels I and III according to the Brooke Lower Extremity Functional Classification Scale and eleven healthy peers were evaluated by using sEMG during stair climbing task. Physical performance was evaluated by 6-min walk test and ascending 4-step timed performance test. RESULTS: The lower limb sEMG amplitude values of children with DMD were statistically higher than healthy children (p < 0.001). sEMG amplitudes of the right (p = 0.01) and left (p = 0.003) biceps femoris, the right (p < 0.001) and left (p = 0.001) gastrocnemius medialis, and the right vastus lateralis (p = 0.02) muscles were higher in children with levels 2-3 than those in level 1. Moderate-to-strong relations were found between the gastrocnemius medialis and biceps femoris sEMG amplitudes and physical performance assessments (p < 0.05). CONCLUSION: Increased sEMG amplitude values in the lower limbs during stair climbing task are thought to be caused by the effort to compensate for progressive muscle weakness and are associated with lower physical performance in children with DMD. Further, sEMG amplitude values are determined to increase as the functional level deteriorates. CLINICAL TRIAL REGISTRATION NUMBER AND URL: NCT04287582 ( https://clinicaltrials.gov/ct2/show/NCT04287582?term=merve+bora&draw=2&rank=1 ).

Assessment of core and lower limb muscles for static/dynamic balance in the older people: An ultrasonographic study.

BACKGROUND: sufficient research has not been conducted to determine the role of core and lower limb muscles in providing balance in older people. OBJECTIVE: to investigate the relationships between the thickness of core/lower limb muscles and static/dynamic balance in older people. METHODS: the study included a total of 68 older people (≥ 65 years) and 68 gender-matched young subjects, aged 20-40 years. Balance, knee proprioception sense, regional and total muscle measurements and grip strength were assessed using a force platform system, isokinetic dynamometer, ultrasound imaging, bioelectrical impedance analysis and Jamar dynamometer, respectively. RESULTS: all the static (postural sway) parameters were higher and all the dynamic (limits of stability) parameters were lower in the older adults compared to the young adults (all P<0.05). The diaphragm was thicker and all the other muscles (except for multifidus and tibialis anterior) were thinner in the older group (all P<0.05). A higher error of knee proprioception sense was determined at 45 and 70 degrees in the older subjects (both P<0.001). According to the multivariate analyses, significant predictors for balance were age, gender, height, and rectus femoris, vastus intermedius and diaphragm muscle thicknesses in the older group, and age, gender, height, grip strength, and rectus abdominis, internal oblique, longissimus, tibialis anterior and soleus muscle thicknesses in the young group (all P<0.05). CONCLUSIONS: the thickness of core/lower limb muscles are important determinants of balance in both older and young adults. These findings could provide a strong rationale for strengthening specific (abdominal and quadriceps) muscles to prevent falls and regional sarcopenia, and to improve posture/balance in the older population. CLINICAL TRIAL REGISTRATION NUMBER: NCT03791047. ETHICS COMMITTEE APPROVAL: Hacettepe University Non-interventional Clinical Research Ethics Board. Decision number:GO 18/506-39.

The validity and reliability of the Turkish version of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD)

Background/aim: The aim of this study is to assess the validity and reliability of Turkish translation of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) in a disabled Turkish population. Materials and methods: Following the translation protocol of the PASIPD, the Turkish version of the PASIPD, Short Form-36, and International Physical Activity Questionnaire were administered to 198 developmentally and physically disabled individuals. Results: The Turkish version of the PASIPD was found to be reliable. The domains of the Turkish version of the PASIPD were also found to be valid. Four factors were obtained from the questionnaire. The ICC was 1.0 since all the respondents reported the same answers in the test and retest. The Cronbach α for the PASIPD was 0.60. Conclusion: The Turkish version of the PASIPD survey is valid and reliable for developmentally and physically disabled Turkish individuals and professionals can use it to assess physical activity level.

Clarifying the relationships between trunk muscle endurance, respiratory muscle strength and static/dynamic postural control in Latin dancers.

Sufficient study has not been performed to clarify the role of trunk/respiratory muscles strength/endurance in providing postural control in dancers. The purpose of this study was to identify predictors affecting static/dynamic postural control in Latin dancers and to compare these measurements with non-dancers. The study included 38 (26F; 12 M) Latin dancers and 33 (21F; 11 M) non-dancers. Static/dynamic postural control, trunk muscle endurance, respiratory muscle strength/pulmonary functions, flexibility, and reaction tests were assessed with a force platform system, the McGill battery, spirometer, sit-and-reach test and Nelson-reaction-tests, respectively. Trunk muscle endurance times, respiratory muscle strength, FEV1/FVC, gender, hours of training per week and dancing experience were significant predictors of static/dynamic postural control in dancers (p < 0.05). All the trunk muscle endurance times, reaction tests results, and maximal inspiratory pressure were higher in the dancers compared to the non-dancers (p < 0.05). The limits of stability for forward and backward directions were higher, and anteroposterior sway in normal stability with eyes open was lower in the dancers compared to the non-dancers (p < 0.05). Trunk muscles endurance, respiratory muscle strength, dancing experience, and hours of training per week were positively associated with static/dynamic postural control. These predictors should be taken into consideration to improve postural control in dancers.

Investigation of Spatiotemporal Gait Characteristics, Balance, and Pain in Forefoot and Rearfoot Problems: Preliminary Results.

BACKGROUND: Foot problems are common in the general adult population. Whereas older people experience foot problems because of multiple chronic diseases, younger people often have musculoskeletal foot problems related to overuse. Symptoms and severity may differ depending on the anatomical location of the problem, such as forefoot and rearfoot problems. We aimed to compare the differences in spatiotemporal gait characteristics, balance, and pain in musculoskeletal forefoot and rearfoot problems. METHODS: Twenty-six patients with forefoot (14 participants) and rearfoot (12 participants) problems participated in this prospective study. Spatiotemporal gait characteristics (velocity, cadence, step time, step length, step-extremity ratio, stride length, base support, percentage of swing phase, percentage of stance phase, swing time, and stance time) were evaluated using an electronic walkway, and balance assessment was made using a balance check screener and trainer. The visual analog scale foot and ankle was used to determine patient pain levels. The Mann-Whitney U test was used to determine differences between groups. RESULTS: There were no significant differences between groups regarding spatiotemporal gait characteristics (P > .05). The eyes closed normal stability and eyes open perturbed stability scores were lower in patients with rearfoot problems (P < .05). Pain intensity evaluated with the visual analog scale foot and ankle was higher in patients with rearfoot problems (P < .05). CONCLUSIONS: Pain levels and balance deficits in this study were higher in patients with rearfoot problems. The balance evaluation and possible effects of pain management on balance should be considered, especially in patients with rearfoot problems, in aspects of treatment.

Effects of cycling training on balance and gait in children with Duchenne muscular dystrophy: A randomized controlled study.

BACKGROUND AND AIMS: Although aerobic exercises such as cycling and swimming are increasingly being recommended in Duchenne muscular dystrophy (DMD), their effect on gait and balance parameters is unclear. This study was aimed to investigate the effect of cycling training on balance and spatio-temporal gait parameters in children with DMD. METHODS: Ambulant children (age range: 6.17-11.33 years) were randomly divided into two groups: home-based exercise training applied in the control group (n = 12) while 12 weeks of supervised submaximal lower extremity cycling training in addition to home-based exercise training performed in the study group (n = 11). Gait and balance parameters were evaluated using the GAITRite electronic walkway system and the Bertec Balance Check Screener™, respectively. Assessments were applied before and after 12 weeks of training. RESULTS: The mean ages of the children in the study and control groups were 8.20 (SD:1.34) and 8.86 (SD:1.30) years, consecutively (p > 0.05). Considering the baseline values, the balance and spatio-temporal gait parameters of the children were similar except for the antero-posterior postural sway on the perturbed surface with eyes open (p > 0.05). There was a significant time x group interaction effect in favor of the study group for the antero-posterior postural sway of children on the normal surface with eyes open (F (1,58) = 12.62, p = 0.002). It was found that the antero-posterior postural sway on the normal surface with eyes open was improved in the study group within group comparison (F (1,10) = 8.50, p = 0.015). CONCLUSIONS: The study showed that both the cycling and the home-based exercise training groups may maintain gait and balance parameters during the study. Adding a cycling training to the rehabilitation program can also provide additional contribution to improve antero-posterior balance.

The effect of mirror therapy on joint movement, pain and functionality in acute upper limb burns.

OBJECTIVE: Mirror therapy is aimed at developing a normal proprioceptive perception for the area with pain or movement restriction by making use of the person's monitoring of the healthy side movements thanks to the mirror's reflective feature. The aim of this study is to investigate the effect of mirror therapy on joint range of motion, pain and functionality in acute upper extremity burn injuries. METHODS: Demographic and burn-specific data of individuals with upper extremity burns were recorded. Individuals were divided into two groups. Standard treatment was applied to the first group, and mirror treatment in addition to the standard treatment was applied to the second group for 30 sessions, 5 days a week for 6 weeks. In the standard treatment program, passive, active-assisted and active ROM, strengthening, stretching, resistant and functional exercises were applied. In the mirror therapy group, active exercises were performed on the healthy side by covering the burn area in the mirror box. Before and after the treatment, joint range of motion(ROM) was evaluated with Universal Goniometer, pain intensity was evaluated with Visual Analog Scale and upper extremity functions were evaluated with QuickDASH. RESULTS: A total of 32 (23 Male, 9 Female) individuals between the ages of 18-65 were included. The mean total burn surface area was 12.93 ± 9.80 in the standard treatment and 6.12 ± 2.96 in the mirror treatment. The groups were similar in terms of ROM change (p > 0.05). The pretest/posttest pain scores of both the standard therapy and mirror therapy groups were similar (p > 0.05). There was no statistically significant difference in terms of pretest and posttest QuickDASH scores according to the groups (p > 0.05). The difference between the pretest/posttest QuickDASH scores of both Standard treatment and Mirror treatment groups was statistically significant. CONCLUSION: This study showed that the standard physiotherapy and rehabilitation program applied in the acute period in upper extremity burns and the mirror treatment applied in addition to this program provide similar improvements in joint range of motion and pain.

A Modified Version of the Forgotten Joint Score-12 in Lower Limb Amputees: Validity and Reliability Study.

Adaptation to prosthesis is important for occupation, quality of life, and participation in social life, so it needs to be evaluated. The aim of this study was to determine the validity and reliability of the Forgotten Joint Score-12 (FJS-12) in lower limb amputees. The FJS-12 was applied to 80 amputees. Criterion-referenced validity was assessed using the activity restriction subparameter of Trinity Amputation and Prosthesis Experience Scale (TAPES). The internal consistency of the FJS-12 was high (Cronbach's α = .943). A statistically significant very good negative correlation was determined between the FJS-12 and the activity restriction subparameter of TAPES (r = -.641; p < .001). The results of this study showed that FJS-12 is a valid and reliable measurement tool that can be used to assess the adaptation to prosthesis in amputees. Evaluation of prosthesis awareness in daily living activities of amputees is important in terms of establishing occupational therapy and rehabilitation programs.

Smartphone use affects gait performance, spinal kinematics and causes spinal musculoskeletal discomfort in young adults.

BACKGROUND: Smartphone use may lead to alterations in spinal kinematics and musculoskeletal discomfort. OBJECTIVES: The aim of this study was to evaluate the effect of smartphone use on spinal kinematics, and to examine the relationship between smartphone addiction, spinal discomfort, and gait parameters. DESIGN: Cross-Sectional Study. METHODS: The study included 42 healthy adults aged 18-30 years. A photographic method was used for spinal kinematic evaluation in sitting, standing and at the end of a 3-min walk. GAITRite electronic walkway was used for spatiotemporal gait parameters. Smartphone addiction was evaluated with the Smartphone Addiction Scale - Short Version (SAS-SV). The Cornell Musculoskeletal System Discomfort Questionnaire (CMDQ) was used to evaluate feelings of discomfort and pain. RESULTS: There was an increase in head, cervical, and thoracic flexion angles while sitting, standing, and at the end of a 3-min walk. Similarly, an increase in thoracolumbar and lumbar flexion angles was observed only in the sitting position (p < 0.05). While using a smartphone during walking, cadence, walking speed, step length decreased, while step duration and double support duration increased (p < 0.05). A statistically significant correlation was determined between the SAS-SV and CMDQ scores (p < 0.05). CONCLUSION: The study showed that smartphone use has an impact on spinal kinematics during sitting, standing and at the end of a 3 min-walk, as well as on the spatiotemporal parameters of gait. This study suggest that smartphone addiction should be taken into consideration due to its potential to cause musculoskeletal discomfort and there may be a need to raise public awareness on this matter.

Development of a new instrument to evaluate gait characteristics of individuals with Duchenne Muscular Dystrophy: Gait Assessment Scale for Duchenne Muscular Dystrophy, and its validity and reliability.

BACKGROUND: Patients with Duchenne Muscular Dystrophy (DMD) have gait disorders. Therefore, specific gait assessment tools are needed. AIMS: The aim of this study was to develop a gait assessment instrument for DMD patients (DMD-GAS), and investigate its validity and reliability. STUDY DESIGN: The scale was developed considering the expert opinions which included 10 physiotherapists who had experience in the management of patients with DMD, and the Content Validity Index (CVI) was calculated. The final version of the DMD-GAS that was agreed upon the experts consisted of 10 items, and each item scored between 0 and 2. The intra-rater reliability was established by the video analysis of children with a 1-month interval and inter-rater reliability was determined by the scores of 3 physiotherapists. SUBJECTS: The study included 56 patients with DMD. OUTCOME MEASURES: The criterion validity was determined by investigating the relationship between the total score of the DMD-GAS and Motor Function Measure (MFM), 6 Minute Walk Test (6MWT), and the data obtained from GAITRite. RESULTS: The CVI of the DMD-GAS was 0.90 (p < 0.05). The construct validity and internal consistency of the DMD-GAS were excellent as well as the intra- and inter-rater reliability (>0.90). Moderate-to-very strong correlations were found between the total score of the DMD-GAS and the MFM-total score (r = 0.78), 6MWT (r = 0.71), gait speed (r = 0.50), stride length (r = 0.56), and base of support (r = -0.70) (p < 0.01). CONCLUSIONS: The results indicated that DMD-GAS was a reliable and valid instrument to determine gait characteristics of the patients with DMD in clinical settings. CLINICAL TRIAL NUMBER: NCT05244395.

Validity, reliability, and Rasch analysis of the orthotics and prosthetics users' survey: Turkish version of the lower-extremity functional status.

BACKGROUND: It is well known that questionnaires and scales are easy to use, cheap, and provide fast results. In the clinical setting, it will be easier and more comfortable to evaluate lower-extremity functions in both prosthesis and orthosis users with a single questionnaire. OBJECTIVES: To study the Turkish version of the orthotics and prosthetics users' survey lower-extremity functional status (OPUS-LEFS) and investigate its reliability and validity in the Turkish prosthesis and orthosis users. STUDY DESIGN: After forward and backward translation process, test-retest, internal consistency, validity, dimensionality, and Rasch analysis were done for 139 participants. METHODS: Participants with a lower-limb prosthesis or orthosis were recruited in this study. Test and retest of the survey was done 1-3 days apart. For convergent validity, Nottingham Health Profile was used. Pearson correlation coefficient was used to analyze test-retest reliability; Cronbach's alpha for internal consistency, Spearman's correlation coefficient for validity, exploratory factor analysis by means of Kaiser-Meyer-Olkin and Bartlett's value of sphericity for dimensionality, and Rasch analysis were used. RESULTS: Test-retest reliability of OPUS-LEFS showed very strong correlation (0.994) and for internal consistency with Cronbach's alpha value 0.71 of the Turkish version of OPUS-LEFS. Analyses showed that OPUS-LEFS is valid ( p < 0.001) and significant ( p < 0.001). CONCLUSIONS: The Turkish version of the OPUS-LEFS has been shown to be a valid and reliable tool in evaluating both orthosis and prosthesis users with a self-administered questionnaire for LEFS.

Gait initiation in multiple sclerosis patients with and without functional loss.

BACKGROUND: Gait initiation (GI) is an important functional task related to balance and gait performance. In addition, it has predictive importance for falls and postural instability in patient with multiple sclerosis (MS). However, it is uncertain how GI is affected in patients in the early stage of MS (Expanded Disability Status Scale (EDSS) ≤3). In this study, it was aimed to investigate the anticipatory postural adjustments (APAs), posterior center of pressure (COPap) displacement, and spatiotemporal variability during GI in patients with and without functional loss in the early stage of MS. METHODS: Forty-four participants (31 MS patients and 13 healthy subjects) involved in this prospective cross-sectional study were divided into three groups: Group-I: Patients without functional loss (EDSS 0 to 1.5) (n = 14), Group-II: Patients with functional loss (EDSS 2 to 3) (n = 17) and Group-III: Healthy subjects (n = 13). Electromyographic activity of the bilateral tibialis anterior (TA) and gastrocnemius medialis (GM) and COPap displacement were recorded during the postural phase of GI. Additionally, spatiotemporal parameters were recorded within the first three steps, and the coefficient of variation was calculated with 40 walks for variability. RESULTS: There were significant differences in the Kruskal-Wallis tests of variables (p<0.05). Group-I demonstrated smaller APAs magnitudes in TA [stance (p = 0.01), swing (p = 0.01)], GM of swing limb (p<0.0001), and smaller COPap displacement (p<0.0001) compared to group-III. Group-II demonstrated smaller APAs magnitudes in all muscles (p<0.0001) compared to group-III and the smallest COPap displacement (p<0.0001). Group-I showed a significant increase in stride width variability compared to group-III (p = 0.01). Group-II showed a significant increase in several variabilities [first stride length (p<0.0001), second stride time (p<0.0001), first double support time (p<0.0001), stride width (p<0.0001)] compared to group-III. CONCLUSION: Patients in the early stage of MS had impairment in both the postural and locomotor phases of GI with more obvious in the patients with functional loss. The results indicate that MS patients without functional loss have difficulty initiating gait. Although there is no functional loss, the patients have a risk of falls, postural instability, and gait impairment due to their inability to initiate gait effectively. As a result, rehabilitation is necessary even if there is no functional loss in patients with MS.

Examination of the relationship between foot-body posture and balance and gait in Duchenne muscular dystrophy.

BACKGROUND: Although the gait and balance disturbances of Duchenne muscular dystrophy (DMD) patients were evaluated by using different methods in literature, the impact of the foot and body posture on gait and balance has not been clearly described yet in DMD. AIM: The aim of this study was to examine the relationship between foot-body posture and gait and balance in patients with DMD. METHODS: Ambulatory patients with DMD who had > 90° range of motion at ankle joint were included in the study. Foot and body posture were evaluated with the Foot Posture Index (FPI-6) and the New York Posture Rating (NYPR). The limitation degree at the ankle joint (ALD) was recorded. Gait characteristics and balance were evaluated objectively by using the GAITRite system and the Bertec Balance Check Screener™ force platform system, respectively. RESULTS: A total of 38 ambulatory patients with DMD (age: 92.44 ± 17.91 months) were recruited. Both the right and left foot FPI-6 scores were correlated with GAITRite parameters such as ambulation time, gait speed, number of steps, and left and right stride lengths (p < 0.05). A relationship was determined between right foot FPI-6 score and anterior-posterior limits of stability (LoS) obtained by force platform (p < 0.05). NYPR score was also correlated with the postural control parameters such as left and right base of support and anterior posterior LoS (p < 0.05). CONCLUSION: The current findings indicate a contribution of foot and body posture to gait and balance disorders of children with DMD. CLINICAL TRIAL NUMBER: NCT04353167, Date of registration: April 16, 2020.

Relationships of Fall Risk With Frailty, Sarcopenia, and Balance Disturbances in Mild-to-Moderate Alzheimer's Disease.

BACKGROUND AND PURPOSE: Cognitive impairment is one of the main risk factors for falls, and hence it commonly coexists with balance issues. Frailty and sarcopenia are intertwined and prevalent in dementia, and are closely related to falls. We aimed to determine the relationships of the fall risk with balance disturbances, sarcopenia, and frailty in mild-to-moderate Alzheimer's disease (AD). METHODS: The study enrolled 56 patients with probable AD. A comprehensive geriatric assessment was performed, and muscle strength and mass, performance status, gait, and balance were evaluated. All parameters were compared between fallers and nonfallers with AD. RESULTS: Fallers comprised 53.6% of the study population. The demographic features and AD stages did not differ between fallers and nonfallers. Fallers were more frail than nonfallers (p<0.05). Frailty was found to be independently associated with fall history (odds ratio=2.15, 95% confidence interval=1.20-3.82, p=0.031). We found that falls were not associated with AD stage, muscle mass and function, balance and geriatric syndromes except urinary incontinence in patients with AD (p>0.05). CONCLUSIONS: We found that falls were not influenced by AD stage. Both physical and cumulative frailty were strongly associated with falls in patients with mild-to-moderate AD.

The role of ultrasonographically measured rectus femoris muscle on falls in community-dwelling older adults: a single-center study.

BACKGROUND: There are many risk factors for falls and sarcopenia has emerged as an important risk factor. Measuring muscle mass is a useful method to determine sarcopenia. Our aim was to determine the difference in muscle mass between older adults with (fallers) and without history of falls (non-fallers) using ultrasonography (US). METHODS: Two hundred ten geriatric patients were enrolled. Fall was defined as an event declared by the person who fell. Sarcopenia was defined by EWGSOP2 criteria. Muscle mass was assessed by muscle ultrasonography of five different muscles. RESULTS: The mean age of the whole study group was 74.1 ± 6.3 years and 58.1% (n = 122) of the total study population was female. Among the participants, 69 patients (31.3%) had a fall history. The sarcopenia ratio was 23.2% in the fallers, and it was 13.7% in the non-fallers, the difference was statistically insignificant (p > 0.05), the measurement of rectus femoris muscle (RF) thickness and cross-sectional area (RFCSA) were significantly smaller among the fallers than non-fallers (p < 0.05). The ROC analysis revealed that RF and RFCSA could determine the history of falls [for RF area under curve (AUC): 0.606, 95% confidence interval (CI) 0.526-0.686, p = 0.010 and for RFCSA AUC: 0.621, 95% CI 0.538-0.704, p = 0.004]. RFCSA was statistically relevant with a history of falls, regardless of age, sex, multimorbidity, incontinence, nutritional status, and frailty status. CONCLUSION: Decreased RF and RFCSA determined by muscle US is a potentially modifiable risk factor for falls in older adults. Muscle US may be used for determining the risk of falls in older adults.

Do Children with Attention Deficit and Hyperactivity Disorder Present with Different Spatio-Temporal Gait Parameters? An Evaluation of the Relationship Between Gait and Gross Motor Skills.

Objective: The aim of the current study was to compare the spatio-temporal parameters of gait and gross motor skills in children with attention deficit hyperactivity disorder-combined type with those of typically developing children and to search the effect of motor skills on gait parameters in children with attention deficit hyperactivity disorder-combined type. Methods: A total of 50 children (n = 25 attention deficit hyperactivity disorder-combined type, n = 25 typically developing children) aged 5-12 years were included. Gross motor skills were evaluated using the Bruininks-Oseretsky Test Second Edition-Short Form. Spatio-temporal parameters of gait were assessed with a GAITRite® computer-based system. Results: In the subtests of Bruininks-Oseretsky Test Second Edition-Short Form (bilateral coordination (P < .001), balance (P = .013), running speed and agility (P = .003)), lower scores were obtained by the children with attention deficit hyperactivity disorder-combined type. The swing phase of gait was found to be longer in children with attention deficit hyperactivity disorder-combined type (P = .01). Conclusion: The current study results show that gross motor skills are affected negatively and the swing phase is prolonged in children with attention deficit hyperactivity disorder-combined type. Upper limb coordination and balance were also seen to have an effect on the velocity, step, and stride length. It is important to include an objective gait assessment as well as gross motor skills in the comprehensive clinical evaluation of children with attention deficit hyperactivity disorder-combined type.

Does immobilization of the shoulder in different positions affect gait?

BACKGROUND: The shoulder joint is immobilized in various positions after injury or reconstructive operative intervention. It is not clear how these immobilization positions in the shoulder joint affect gait. RESEARCH QUESTION: Does the immobilized shoulder joint in different positions following shoulder surgery or injury affect gait? METHODS: A total of 38 healthy individuals with a mean age of 25.94 years and BMI of 25.66 kg/m2, underwent gait analysis in 4 different immobilized positions and normal gait. Gait parameters were evaluated using the GAITRite electronic walkway, and to determine symmetry, the bilateral spatiotemporal gait parameters were calculated using the Symmetry Index. Repeated-measures one way analysis of variance was used to compare the walking parameters in different positions. RESULTS: Velocity, step length and stride length were significantly decreased, and step width and single support time were increased in some immobilized positions (p < 0.05). Differences in asymmetry were determined in the gait parameters of the immobilized positions but not significantly. When the shoulder was immobilized in abduction, step width asymmetry tended to increase but it was not significant. SIGNIFICANCE: This cross-sectional simulation study may be important in demonstrating the clinical changes of gait in injuries, pathologies, and postoperative rehabilitation that require the immobilization of the shoulder joint. It could be recommended that arm swing is included in gait rehabilitation, gait and balance training can be provided to patients after shoulder immobilization.

Treadmill versus overground gait training in patients with lower limb burn injury: A matched control study.

INTRODUCTION: Gait impairment is commonly seen in patients with a lower limb burn injury (LLBI). Therefore, the aim of this study was to investigate the effects of two different gait training modes on gait symmetry, functional mobility and kinesiophobia in patients with LLBI. METHODS: This matched control study was conducted between January 2017 and August 2018. Patients with LLBI (n=28) were allocated to 2 different groups by matching according to burn localization, age, and gender. Group 1 (overground group: n=14) received overground gait training in addition to standard burn rehabilitation, and Group 2 (treadmill group: n=14) received treadmill gait training in addition to standard burn rehabilitation. The rehabilitation program and gait training were started when the patient was admitted to the hospital and ended on discharge. These physical therapy interventions were performed 5 days per week. The gait training intensity, including walking speed and duration, was determined according to patient tolerance. Gait parameters, functional mobility, kinesiophobia and pain values were evaluated with GAITRite, the timed up-and-go test (TUG), Tampa Kinesiophobia Scale and Visual Analogue Scale, respectively. These evaluations were made twice; on admission and immediately prior to discharge. Gait symmetry was calculated using the Symmetry Index. RESULTS: The baseline characteristics of the groups and initial outcome values were similar. In the comparison of the differences between the overground and treadmill groups, the change in kinesiophobia and TUG values were significantly higher in the treadmill group (p=0.01, p=0.02, respectively). The intragroup comparisons showed significant differences in SI in respect of step length (p=0.004), swing (p=0.006), stance (p=0.008) and velocity (p=0.001), cadence (p=0.001), TUG (p=0.001), kinesiophobia (p=0.001) and pain (p=0.001) in the overground group. Statistically significant differences were determined in step length (p=0.01), swing (p=0.01), stance (p=0.02) and velocity (p=0.001), cadence (p=0.001), TUG (p=0.001), kinesiophobia (p=0.001) and pain (p=0.001) in the treadmill group, when pre and post-training values were compared. CONCLUSIONS: The results of this study have shown that treadmill gait training was more effective in the improvement of functional mobility and reduction in kinesiophobia levels of patients with LLBI compared to overground gait training. Both overground and treadmill gait training also provide greater improvements in the velocity and cadence, and gait symmetry for step length, swing and stance in patients with LLBI. CLINICAL TRIAL REGISTRATION NUMBER: NCT03217526.