Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial.

Background/aim: Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually or combined. Materials and methods: This randomized trial was conducted between December 1st, 2018, and May 15th, 2019, at Gazi University, Department of Physiotherapy and Rehabilitation. Randomly assigned into groups were 27 independently ambulant patients with unilateral/bilateral SCP, where PFEs were applied to the DF, PF, or DPF muscles. Muscle tone, balance, and functional mobility were assessed. The MVC was evaluated by surface electromyography. PFEs were performed 4 times a week, for 6 weeks. Results: The spasticity of the PF muscles decreased in all of the groups. PFE of the DF muscles led to an increase in ankle joint range of motion (ROM) and improved functional mobility (p < 0.05). PFE of the PF muscles resulted in improvements in balance and functional mobility (p < 0.05). PFE of the DPF muscles brought about improvements in balance but not in functional mobility (p < 0.05). No significant difference in the MVC was observed in any of the groups (p > 0.05). Conclusion: Gains are obtained according to the function of a muscle group. By training the DF muscles, it is possible to improve function and ROM. Furthermore, training the PF muscles led to improvements in balance and functional mobility, indicating that it is possible to bring about positive changes in spastic muscles. This study showed that muscle groups must be exercised according to the intended goal.

Test-retest reliability and minimal detectable change for measures of wearable gait analysis system (G-Walk) in children with cerebral palsy.

BACKGROUND: Cerebral Palsy (CP) is the most frequent cause of physical disability in childhood. CP causes primary deficits such as impairments in muscle tone, muscle weakness, problems in selective motor control and secondary deficits such as contractures and deformities. These deficits lead to motor disorders during movement causing limitations in gait. Sixty percent of children with CP can walk independently despite these problems, however, they present with various gait abnormalities. Gait analysis is used in the quantitative assessment of gait disturbances providing functional diagnosis, assessment for treatment, planning, and monitoring of progress. G-Walk is a wearable sensor device which provides quantitative gait analysis via spatiotemporal parameters and pelvic girdle angles. In literature, there is no study investigating the reliability of the G-Walk in children with CP. The purpose of this study was to confirm the test-retest reliability of a commercially available body-worn sensor 'BTS G-WALK sensor system' for spatiotemporal gait parameters in children with CP. METHODS: Fifty-four children with CP (mean age: 9.19 ± 3.49 years), Gross Motor Function Classification System (GMFCS) level I-II completed the test-retest protocol with 5 days between tests. The test-retest reliability was calculated using intra-class correlation coefficients (ICC). Minimal detectable changes were calculated using standard error measurements. RESULTS: According to the analysis, ICC varied from 0.799 to 0.977 in all of the gait parameters. The statistical analysis showed that all G-Walk parameters' measurements were found to have almost perfect test-retest reliability. DISCUSSION: The G-Walk was found to be reliable in gait parameters for children with CP between ages 5 and 15, in GMFCS level I-II. A gait analysis carried out with the G-Walk system is a reliable method to assess gait in children with CP in a clinical setting.

Evaluation of proprioception in patients who underwent ACL reconstruction: measurement in functional position

Background/aim: Anterior cruciate ligament (ACL) injuries cause mechanoreceptor loss in the joint; therefore, proprioceptive deficits are observed after injury. In particular, proprioceptive measurements made in the functional position give more accurate results, and this is an area that requires further studies. This study aimed to evaluate proprioception in patients who had undergone ACL reconstruction (ACLR) in functional positions used in daily life (closed kinetic chain position), according to joint angles where ACL injuries occur more frequently, in comparison with healthy controls. Materials and methods: Thirty-four participants who underwent ACLR using a hamstring tendon graft (aged 29.18 ± 8.16 years; body mass index (BMI), 26.58 ± 4.02 kg/cm2) and 31 healthy participants (aged 27.35 ± 5.74 years; BMI, 24.76 ± 2.98 kg/cm2) were included. Proprioception was assessed with an active angle repetition test, using an inclinometer in the closed kinetic chain position while standing. Participants were asked to perform single-leg squats until the angle at the knee joint was 30°. After the targeted angle was defined, the participants were asked to find the targeted angle. The difference between the targeted angle and the angle reached by the participants was calculated. Results: A statistically significant difference in the active joint position sense was found among the ACLR extremity, uninvolved extremity, and control extremity (p < 0.05). The proprioceptive sense between the two extremities in the ACLR group was similar, and the proprioceptive sense was worse than that of the control group. Conclusion: To our knowledge, this is the first study to evaluate closed kinetic chain position in patients who underwent ACLR, and it showed that proprioceptive sense was still poor in patients with ACLR compared with the control group, even if an average of 24 months have elapsed since surgery.

Test-Retest Reliability of Isokinetic Wrist Strength and Proprioception Measurements.

CONTEXT: The evaluation of the wrist strength and proprioception gives clinicians and researchers information about effectiveness of their rehabilitation protocol or helps diagnosis of various neuromuscular and somatosensorial disorders. Isokinetic dynamometers are considered the gold standard for these evaluations. However, the studies about test-retest reliability of isokinetic dynamometer are inadequate. OBJECTIVE: The purpose of this study was to determine the test-retest reliability of isokinetic wrist strength and proprioception measurements using the Cybex isokinetic dynamometer. DESIGN: Test-retest reliability study. SETTING: University laboratory. PARTICIPANTS: Thirty participants were enrolled (age 23.2 [2.8] y, height 171.1 [7] cm, weight 66.6 [11.6] kg) in this study. INTERVENTION: Cybex isokinetic dynamometer was used for strength and proprioception measurements. MAIN OUTCOME MEASURES: Concentric flexion-extension strength test was performed at 90°/s angular velocity, and eccentric flexion-extension strength test was performed at 60°/s angular velocity. The proprioception of the wrist was assessed via active joint position sense. The 30° extension of the wrist, which is accepted as the functional position of the wrist, was selected as the targeted angle. The intraclass correlation coefficient (ICC2,1) method was used for test-retest analysis (P < .05). RESULTS: The active joint position sense measurements of dominant (ICC2,1: .821) and nondominant (ICC2,1: .763) sides were found to have good test-retest reliability. Furthermore, with the exception of dominant eccentric extension strength (moderate reliability) (ICC2,1: .733), eccentric and concentric flexion (dominant: ICC2,1 = .890-.844; nondominant: ICC2,1 = .800-.898, respectively), and extension (dominant: ICC2,1 = .791 [concentric], nondominant: ICC2,1 = .791-.818, respectively) strength measurements of both sides were found to have good reliability. CONCLUSIONS: This study shows that the Cybex isokinetic dynamometer is a reliable method for measuring wrist strength and proprioception. Isokinetic dynamometers can be used clinically for diagnosis or rehabilitation in studies which contain wrist proprioception or strength measurements.

Investigation of muscle activation during kinetic chain based exercises in individuals with and without forward head posture.

BACKGROUND: The Band Pull-Apart (BPA) exercise is used to strengthen the periscapular muscles. It was recently stated that the lower extremity and trunk movements should be included in the shoulder rehabilitation programs to optimize an effective energy transfer throughout the kinetic chain. OBJECTIVE: The aim of this study is to investigate the effects of kinetic chain based BPA exercise on the muscle activations of the sternocleidomasteideous (SCM) and the trapezius muscles in individuals with and without forward head posture (FHP). METHODS: Eighteen individuals with FHP and 18 individuals without FHP were included. Photographic measurements were made to identify individuals with FHP. The muscle activations of SCM, Upper Trapezius (UT), Middle Trapezius (MT), and Lower Trapezius (LT) were measured with surface EMG. BPA exercise was performed in the standing, unipedal standing, squat, unipedal squat, and Bulgarian split squat (BSS). RESULTS: There was no Group × Exercise interaction for the SCM, UT, MT, LT muscle activations, or for the UT/MT and UT/LT ratios (p> 0.05). While there was a difference in the activation of all muscles between individuals with and without FHP (p< 0.05), both ratios were similar (p> 0.05). There was a statistically significant difference between exercises for SCM, MT, and LT muscle activations (p< 0.000 for these muscles), UT/MT (p< 0.000) and UT/LT ratios (p= 0.004). SCM muscle activation in squat was lower than activation in standing (Mean Difference (MD) = 2.5% Maximal Voluntary Isometric Contractions (MVIC); p= 0.004) and in unipedal standing (MD = 2.1% MVIC; p= 0.002). MT muscle activation in squat was higher than activation in standing (MD = 9.7% MVIC), unipedal standing (MD = 7.8% MVIC), unipedal squat (MD = 6.9% MVIC) and BSS (MD = 9.4% MVIC; p< 0.000 for these positions). LT muscle activation in the squat was higher than activation in the standing (MD = 8.5% MVIC) and unipedal squat (MD = 8.1% MVIC; p< 0.004 for these positions). UT/MT ratio in the squat was lower than standing (MD = 0.3), unipedal standing (MD = 0.2) and BSS (MD = 0.3; p< 0.000 for these positions). UT/LT ratio in squat was lower than unipedal squat (MD = 0.5) and BSS (MD = 0.6; p= 0.002; for these positions). CONCLUSION: Performing the BPA exercise in the squat position is suggested in cases where lower SCM and UT muscle activation, lower UT/MT, and UT/LT ratios and higher MT and LT muscle activations are needed for individuals with and without FHP.

Relationship between sensation and balance and gait in multiple sclerosis patients with mild disability.

BACKGROUND: Patients with Multiple Sclerosis (PwMS) often experience sensory, balance, and gait problems. Impairment in any sensation may increase imbalance and gait disorder in PwMS. This study aimed to (1) compare foot plantar sensations, knee position sense, balance, and gait in PwMS compared to Healthy Individuals (HI) and (2) examine the relationship between plantar sensations, knee position sense, balance, and gait in PwMS. METHODS: Thirty PwMS with mild disability and 10 HI participated in this study. Light touch threshold, two-point discrimination, vibration duration, and knee position sense were examined on the Dominant Side (DS) and Non-Dominant Side (NDS). Balance and spatio-temporal gait analysis were evaluated in all participants. RESULTS: PwMS had higher postural sway with eyes closed on the foam surface, longer swing phase of DS, longer single support phase of NDS, and shorter double support phase of DS compared to HI (p < 0.05). The results of regression analysis showed that the light touch thresholds of the 1st and 5th toes of the DS were associated with postural sway in different sensory conditions (p < 0.05). In contrast, the light touch thresholds of the 1st and 5th toes, two-point discrimination of the heel, vibration duration of the 1st metatarsal head and knee position sense of the NDS, and light touch threshold in the medial arch of both sides were associated with the gait parameters (p < 0.05). CONCLUSION: PwMS, even with mild disabilities needs neurorehabilitation to improve plantar sensation and knee position sense.

An online pilates exercise program is effective on proprioception and core muscle endurance in a randomized controlled trial.

BACKGROUND: Proprioception is important for stability of body segments, postural control, and functionality. However, there are no studies in literature showing effects of online Pilates exercises that create proprioceptive inputs on vertebra on trunk proprioception. AIMS: This study aims to reveal effect of online Pilates exercises conducted on trunk proprioception and core muscle endurance in healthy individuals. METHODS: We included thirty-three healthy individuals between ages of 18 and 25 in study. Individuals were randomly divided into two groups. There were 17 individuals in Pilates group (PG), and 16 individuals in control group (CG). The PG was given online Pilates exercises by the physiotherapist in groups 3 days a week for 6 weeks, 1 h a day. There was no exercise program recommended for individuals in CG. We evaluated trunk proprioception with an inclinometer, core muscle endurance with three core endurance tests created by McGill, and prone bridge tests. All evaluations completed just before start of study and 2 days after 6-week training. RESULTS: Two groups had similar demographic characteristics, and there was no difference between baseline measurements (p > 0.05). While improvement observed in PG in trunk proprioception and all of core muscle endurance tests (p < 0.05), no statistically significant difference reported in CG (p > 0.05). CONCLUSIONS: We revealed that online Pilates exercises performed at mat level for 6 weeks in healthy individuals had positive effects on trunk proprioception and core muscle endurance with this study. Contribution of Pilates exercises to development of both muscular endurance and proprioceptive senses, even if performed at a distance, is important.

Profile of Ankle Isokinetic Strength and Proprioception in Elite Female Handball Players / Perfil de Fuerza Isokinética del Tobillo y Propiocepción en Jugadoras de Balonmano de Élite

SUMMARY: The evaluation of the invertor and evertor muscle strength and proprioception are important in terms of determining the risk of injury in handball players. The aim of this study was to determine the isokinetic strength and proprioception profile of the ankle invertor and evertor muscles of elite female handball players. Fifteen elite female handball players were included. Ankle invertor and evertor muscle strength and proprioception were evaluated using the isokinetic system. The isokinetic strength test was performed in concentric mode at 30°/s (5 repetitions) and 120°/s (10 repetitions). Proprioception sense was evaluated as active joint position sense. There was no statistically significant difference between the dominant and nondominant sides in terms of invertor and evertor muscle strength, evertor/invertor (Ever/Inver) ratio, and active joint position sense at both angular speeds (p>0.05). The Ever/Inver ratio on both sides was lower than normal values. It was concluded that the female handball players showed bilateral symmetry in the invertor and evertor muscles. However, the fact that the Ever/Inver strength ratio was lower than normal values on both sides suggested that caution should be exercised in terms of risks such as ankle sprain or chronic ankle instability. Pre-season evaluations should be made and it would be beneficial to add strengthening exercises to related muscle groups in training programs to normalize the unilateral ratios in these athletes.

La evaluación de la fuerza muscular inversora y eversora y la propiocepción son importantes para determinar el riesgo de lesión en los jugadores de balonmano. El objetivo de este estudio fue determinar la fuerza isocinética y el perfil de propiocepción de los músculos inversores y eversores del tobillo de jugadoras de balonmano de élite. Se incluyeron 15 jugadoras de élite de balonmano. La fuerza muscular inversora y eversora del tobillo y la propiocepción se evaluaron mediante el sistema isocinético. El test de fuerza isocinética se realizó en modo concéntrico a 30º/s (5 repeticiones) y 120º/s (10 repeticiones). El sentido de propiocepción se evaluó como sentido activo de posición articular. No hubo diferencias estadísticamente significativas entre los lados dominante y no dominante en términos de fuerza muscular inversora y eversora, relación eversor/inversor (Ever/ Inver) y sentido activo de la posición de la articulación en ambas velocidades angulares (p>0.05). La relación Ever/Inver en ambos lados fue inferior a los valores normales. Se concluyó que las jugadoras de balonmano presentaron simetría bilateral en los músculos inversores y eversores. Sin embargo, el hecho de que la relación de fuerza Ever/Inver fuera inferior a los valores normales en ambos lados sugirió que se debe tener precaución en términos de riesgos como el esguince de tobillo o la inestabilidad crónica de tobillo. Se deben realizar evaluaciones de pretemporada y sería beneficioso agregar ejercicios de fortalecimiento a los grupos musculares relacionados en los programas de entrenamiento para normalizar las proporciones unilaterales en estas atletas.

Reliability, Validity, and Cross-Cultural Adaptation of the Turkish Version of the Bournemouth Questionnaire.

STUDY DESIGN: Validation of a self-report questionnaire. OBJECTIVE: The purpose of this study was to investigate adaptation, validity, and reliability of the Turkish version of the Bournemouth Questionnaire. SUMMARY OF BACKGROUND DATA: Low back pain is one of the most frequent disorders leading to activity limitation. This pain affects most of people in their lives. The most important point to evaluate patient's functional abilities and to decide a successful therapy procedure is to manage the assessment questionnaires precisely. METHODS: One hundred ten patients with chronic low back pain were included in present study. To assess reliability, test-retest and internal consistency analyses were applied. The results of test-retest analysis were assessed by using Intraclass Correlation Coefficient method (95% confidence interval). For internal consistency, Cronbach alpha value was calculated. Validity of the questionnaire was assessed in terms of construct validity. For construct validity, factor analysis and convergent validity were tested. For convergent validity, total points of the Bournemouth Questionnaire were assessed with the total points of Quebec Back Pain Disability Scale and Roland Morris Disability Questionnaire by using Pearson correlation coefficient analysis. RESULTS: Cronbach alpha value was found 0.914, showing that this questionnaire has high internal consistency. The results of test-retest analysis were varying between 0.851 and 0.927, which shows that test-retest results are highly correlated. Factor analysis test indicated that this questionnaire had one factor. Pearson correlation coefficient of the Bournemouth Questionnaire with Roland Morris Disability Questionnaire was calculated 0.703 and it was found with Quebec Back Pain Disability Scale is 0.659. These results showed that the Bournemouth Questionnaire is very good correlated with Roland Morris Disability Questionnaire and Quebec Back Pain Disability Scale. CONCLUSION: The Turkish version of the Bournemouth Questionnaire is valid and reliable. LEVEL OF EVIDENCE: 3.