Balance Control and Plantar Pressure Distribution in Hyperkyphotic Adolescent and Young Adults.

AIM: To assess differences in static/dynamic balance and plantar pressure distribution (PPD) in hyperkyphotic adolescents and young adults based on sagittal spinopelvic alignment changes. MATERIAL AND METHODS: Twelve hyperkyphotic patients and 12 normal subjects were included in the study group and control group, respectively. Lateral spine X-rays were used to evaluate spinopelvic parameters, thoracic kyphosis, lumbar lordosis (LL), and sagittal vertical axis offsets. A Balance Master device was used to evaluate the balance and postural control of subjects, and an EMED pedobarography device was used to record dynamic PPDs. Radiologic parameters, center of pressure (COP) velocity, COP alignment, and PPDs were compared in both groups to determine significance. RESULTS: A positive correlation was found between kyphosis and lordosis (r = 0.573, p=0.03) in the study group. No significant difference was found in COP alignment and mean sway velocity between the two groups (p > 0.05). Statistically significant differences were found in the endpoint excursion values in the forward direction between groups in terms of dynamic balance measurement (p=0.09). The dynamic pedobarographic measurements did not reveal any intergroup differences (p < 0.05). CONCLUSION: Delayed balance control may be observed during forward reach in hyperkyphotic adolescents and young adults. Compensatory LL may be effective to maintain normal gravity projections, static balance control, and PPDs as a response to thoracic hyperkyphosis.

Investigation of the Relationships Among Clinical Measures of Foot Posture in Individuals with and Without Pronated Foot.

Background: Many indirect clinical techniques have been developed to assess foot posture; however, there is relatively little research investigating the relationships among these techniques. We investigated the relationships among the most commonly used clinical measures of foot posture-Foot Posture Index-6 (FPI-6), navicular drop (NDP), navicular drift (NDT), and static and dynamic arch indices (SAI and DAI)-in individuals with normal foot posture and those with pronated foot. Methods: Sixty-three individuals with FPI-6 scores of 0 to 12 were included. A digital caliper was used to measure NDP and NDT; SAI and DAI were measured by electronic pedobarography. Assessments were applied on the dominant foot. Pearson correlation coefficients were calculated to determine the relationships among measures. Participants were classified into two groups, pronated foot (n = 33) and normal foot posture (n = 30), based on FPI-6 scores, providing a multisegmental and multiplanar assessment. The independent-samples t test was used to compare groups regarding NDP, NDT, SAI, and DAI. Results: We found a high correlation between NDP and FPI-6 (r = 0.754) and between NDP and NDT (r = 0.778) (all P < .001). A moderate correlation was found between NDT and FPI-6 (r = 0.599) and between DAI and SAI (r = 0.519) (all P < .001). A negligible correlation was found between NDP and DAI (r = 0.268; P = .033). Furthermore, NDP, NDT, and DAI values were higher in individuals with pronated foot compared with those with normal posture (P < .001 for NDP and NDT; P = .022 for DAI), whereas SAI values were not (P = .837). Conclusions: These results suggest that there are moderate-to-strong relationships among FPI-6, NDP, and NDT and between SAI and DAI. The NDP, NDT, and DAI are suitable for the classification of foot posture based on FPI-6 scores. This study can guide clinicians and researchers to associate the foot posture measures with each other.

Reliability of Different Clinical Techniques for Assessing Foot Posture.

OBJECTIVE: The aim was to determine the interrater and intrarater reliability of navicular drop (NDP), navicular drift (NDT), and the Foot Posture Index-6 (FPI-6), and test-retest reliability of the static arch index (SAI) and dynamic arch index (DAI). METHODS: Sixty healthy individuals were assessed for intrarater and test-retest reliability. From 60 participants, 30 individuals were assessed for interrater reliability. A digital caliper was used to measure NDP and NDT. Electronic pedography was used to calculate SAI and DAI. The FPI-6 was also performed. All assessments were performed on the dominant foot. The NDP, NDT, SAI, and DAI were repeated 3 times. The NDP and NDT were analyzed separately using both first measurement and the average, but the SAI and DAI were analyzed using only the average. The NDP, NDT, and FPI-6 were conducted by 2 raters to determine interrater reliability and were repeated by a single rater after 5 days from initial assessment to determine intrarater reliability. The SAI and DAI were also repeated after 5 days to determine test-retest reliability. RESULTS: Intrarater intraclass correlation coefficients (ICCs) were 0.934 and 0.970 for NDP, 0.724 and 0.850 for NDT, and 0.945 for FPI. Interrater ICCs were 0.712 and 0.811 for NDP, 0.592 and 0.797 for NDT, and 0.575 for FPI. Test-retest ICCs of the SAI and DAI were 0.850 and 0.876, respectively. CONCLUSION: Navicular drop is relatively more reliable than other traditional techniques. Also, the FPI-6 has excellent intrarater reliability, but only moderate interrater reliability. The results can provide clinicians and researchers with a reliable way to implement foot posture assessment.

Investigation of the effects of flat cushioning insole on gait parameters in individuals with chronic neck pain.

PURPOSE: Individuals with chronic neck pain (CNP) walk with a stiffer spine known to cause an increase in dynamic loading on the spine. They also exhibit altered spatiotemporal gait variables, however, it is still unclear whether flat cushioning insole, which reduces dynamic loading on the musculoskeletal system by absorbing the ground reaction force, affects gait parameters in individuals with CNP. The aim of this work was to investigate the effects of flat cushioning insole on neck pain during walking and gait parameters in individuals with CNP. METHODS: Twenty-one individuals with CNP and 21 asymptomatic controls were included. Assessments of gait parameters and pain were conducted in two sessions, standard shoe only and standard shoe with flat cushioning. In both sessions, all participants performed the 10-meter walk test in two walking conditions: preferred walking, walking at maximum speed. The force sensitive insoles and the video analysis method were used to assess plantar pressure variables and spatiotemporal gait variables, respectively. Pain was assessed using the Visual Analogue Scale. RESULTS: Our results indicated that flat cushioning reduced the maximum force and force-time integral in both groups (p < 0.05). Flat cushioning increased walking speed and step length in both walking conditions and reduced neck pain during walking at maximum speed in individuals with CNP (p < 0.05). In asymptomatic individuals, no difference was found in spatiotemporal gait variables between two sessions (p > 0.05). CONCLUSIONS: These results have suggested that the use of flat cushioning insole may improve neck pain during walking and spatiotemporal gait variables in individuals with CNP.

Gait speed and gait asymmetry in individuals with chronic idiopathic neck pain.

BACKGROUND: Recent studies have shown that individuals with chronic idiopathic neck pain (CINP) exhibit altered spatiotemporal gait parameters. Problems arising from the neck joints and related soft tissues, and most mechanical neck pain appear asymmetric. However, whether individuals with CINP have an asymmetric gait has not been clarified. OBJECTIVES: The aim was to investigate if there was a significant difference in gait speed (GS) and gait asymmetry (GA) between individuals with CINP and healthy controls. DESIGN: Case-Control Study. METHOD: Twenty individuals with CINP and 20 healthy controls were included. All participants performed the 10-m walking test in three walking conditions: preferred walking (PW), preferred walking with head rotation and walking at maximum speed (MAXW). The timing gate system and pressure sensitive insoles were used to calculate GS and GA, respectively. GA was calculated using the difference between right and left swing durations. RESULTS/FINDINGS: Individuals with CINP had slower GS in all walking conditions compared to controls (p < 0.05). In PW and MAXW conditions, gait was found to be asymmetric in individuals with CINP compared to controls (p < 0.05). There was no difference in GA between the walking conditions in either group (p > 0.05). CONCLUSIONS: Individuals with CINP had a slower and more asymmetrical gait. GA should be evaluated as a part of the routine gait analysis since it has potential to cause asymmetric loading on joints which could cause other musculoskeletal problems in the long-term. Also, future research is needed to clarify the reasons why gait is more asymmetric in individuals with CINP.

Association of quadriceps angle with plantar pressure distribution, navicular height and calcaneo-tibial angle.

OBJECTIVE: The aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA). METHODS: A total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19-33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight. RESULTS: There were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (ß = -0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (ß = 0.37, p < 0.001) and MH5-MxF (ß = -0.21, p < 0.037). CONCLUSION: These findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

Reliability and Validity of the Turkish Version of the ABILHAND Questionnaire in Rheumatoid Arthritis Individuals, Based on Rasch Analysis.

OBJECTIVES: This study aims to assess the reliability and validity of the Turkish version of the ABILHAND questionnaire in individuals with rheumatoid arthritis (RA) [ABILHAND-RA (TR)] using the Rasch analysis. MATERIALS AND METHODS: A total 90 individuals (15 males, 75 females; mean age 51.8±10.9 years; range, 20 to 65 years) diagnosed as RA according to the criteria of the American College of Rheumatology were included. The ABILHAND-RA (TR) was used to determine manual ability, while disease activity was evaluated by the use of Disease Activity Score 28 (DAS28). Jamar hand dynamometer and pinch-meter were used to examine grip and pinch strength of the participants. Nine Hole Peg Test (NHPT) and Duruoz Hand Index (DHI) measured hand disability level. Nottingham Health Profile (NHP) was used to assess quality of life. ABILHAND-RA (TR) results were analyzed using the Rasch analysis method. RESULTS: Item 20 was excluded from the 27-item ABILHAND-RA (TR) as 96% of the individuals rated this item as "easy". The new set of 18 items (7 subtests and 11 items) were found to sustain item invariance and fit to the Rasch model. Significant relationships were found between ABILHAND-RA (TR) and DAS28, bilateral grip strength, NHPT dominant side results, DHI, and NHP. CONCLUSION: Turkish version of the ABILHAND-RA was found to be clinically valid, reliable, and sensitive enough to be used in clinical evaluations, rehabilitation interventions, and for progression follow-up in individuals with RA.

Generalized hypermobility syndrome (GHS) alters dynamic plantar pressure characteristics.

BACKGROUND: In the relevant literature generalized hypermobility syndrome (GHS) has been shown to alter the kinetic and kinematic patterns of the human movement system. Although GHS affects the general body biomechanics of individuals, the body of knowledge in plantar pressure distribution in GHS is far from sufficient. OBJECTIVE: The aim of this study was to determine whether individuals with joint hypermobility syndrome have abnormal plantar pressure distribution during normal gait compared to healthy individuals. METHODS: A total of 37 participants (mean age: 22.16 ± 2.58 years) diagnosed with GHS and 37 aged-matched participants (mean age: 23.35 ± 2.85 years) without GHS were included in the study. Dynamic plantar pressure distribution was obtained as each participant walked in barefoot at a self-selected pace over EMED-m system (Novel GmbH, Munich, Germany). Correlations between hypermobility score (HS) (Beighton score) and plantar pressure variables, and between group differences in peak pressure (PP), pressure-time integral (PTI), average pressure (AP) and maximum force (MxF) were computed for 10 regions under the sole. RESULTS: HS was significantly correlated with peak pressure under the mid-foot (MF) (r= 0.24, p= 0.043), 5th metatarsal head (MH5) (r= 0.33, p= 0.001), big toe (BT) (r= 0.44, p< 0.001), and second toe (ST) (r= 0.38, p= 0.001). A similar trend was observed for pressure-time integrals under hindfoot (HF) (r= 0.24, p= 0.04), MF (r= 0.30, p= 0.009), MH5 (r= 0.25, p= 0.033), BT (r= 0.37, p= 0.001) and ST (r= 0.34, p= 0.003). The only significant MxF detected was under the ST (r= 0.23, p= 0.048), and AP was determined to be significantly higher as HS increases indicated by APs under MH5 (r= 0.24, p= 0.042), BT (r= 0.32, p= 0.005) and ST (r= 0.40, p< 0.001). Peak pressure values under HF were significantly higher in the hypermobile group (p= 0.023), MH5 (p= 0.001), BT (p< 0.001) and ST (p= 0.003). AP and PTI were also found to be significantly higher in the hypermobile group under MH5 (p= 0.009), BT (p= 0.037), and ST (p= 0.003). MxF was higher only under MF5 (p= 0.029) and SF (p= 0.041) in the hypermobile group. CONCLUSION: The forefoot regions received a higher load in GHS during gait. This could be useful in clinical evaluation of the foot in GHS, preventing potential injuries of lower extremity, and also in processes related to decision making for foot orthotics and/or rehabilitation protocols.

Analysis of the reliability and validity of the Turkish version of the intermittent and constant osteoarthritis pain questionnaire.

OBJECTIVE: The aim of this study was to analyze the validity and reliability of the Turkish version (ICOAP-TR) of the intermittent and constant osteoarthritis pain (ICOAP) questionnaire in patients with knee osteoarthritis (OA). METHODS: Thirty-eight volunteer patients diagnosed with knee OA answered the questionnaire twice with an interval of 2-4 days. The reliability of the measurement was assessed using Cronbach's alpha coefficient and intraclass correlation (ICC) for test-retest reliability. Criterion validity was tested against the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score and visual analog scale (VAS) designed to assess the perceived discomfort rated by the patient. RESULTS: Test-retest reliability was found to be ICC=0.942 for total score, 0.902 for constant pain subscale, and 0.945 for intermittent pain subscale. Internal consistency was tested using Cronbach's alpha and was found to be 0.970 for total score, 0.948 for constant pain subscale, and 0.972 for intermittent pain subscale. For criterion validity, the correlation between the total score of ICOAP-TR and WOMAC pain subscale was r=0.779 (p<0.05), and correlation between total score of ICOAP-TR and VAS was r=0.570 (p<0.05). CONCLUSION: The ICOAP-TR is a reliable and valid instrument to be used with patients with knee OA.

Factors related to the impact of chronically disabled children on their families.

BACKGROUND: This study to investigated the effects of chronically disabled children (CDC) on their families. METHOD: The study included 655 CDD and their families from 45 cities located in Turkey representing the seven regions of the country. Sociodemographic characteristics, presence of mental retardation, primary care-giver, presence of social insurance, the number of other children and other family members living in the family, duration of the disorder, disabling conditions in the other children, time spent for care giving, and level of income were recorded. WeeFIM (Functional Independence for Children) and Impact on Family Scale (IPFAM) were administered to evaluate the level of functional independence and the overall burden on the families, respectively. RESULTS: IPFAM and WeeFIM scores were not different between geographical regions (P > 0.05). Functional independence level of the child and the level of education of the mothers were significant contributors to the disruption of social relations subscale of IPFAM (P < 0.05). WeeFIM score, presence of mental retardation, and income were significant contributors to general impact subscale. WeeFIM, mothers' level of education, and income were significant factors for the financial support subscale (P < 0.05). WeeFIM score, presence of mental retardation, mothers' level of education, and income also were found to contribute to the total impact subscale scores (P < 0.05). None of the evaluated factors were found to contribute to coping subscale of IPFAM (P > 0.05). CONCLUSION: Although some are expected, certain intriguing results, such as the impact of the mothers' literacy level, warrant further larger scale comprehensive studies to investigate the factors that contribute to the impact of CDC on their families. Also, policies that focus on family centered rehabilitation approaches should be encouraged in an effort to decrease the overall impact of CDC on families.

Home-based general versus center-based selective rehabilitation in patients with posterior tibial tendon dysfunction.

OBJECTIVE: The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD). METHODS: The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56 ± 17.59) group or center-based rehabilitation (28 cases; mean age: 28.57 ± 14.74 years). The patients in the home-based rehabilitation group followed a home program of cold application, strengthening exercises for the posterior tibial and intrinsic muscles, and stretching in the subtalar neutral position. The patients in the center-based rehabilitation group followed a selective, supervised treatment consisting of the home protocol plus re-education of the non-functional tibialis posterior, proprioceptive neuromuscular facilitation methods, electrical stimulation, joint mobilization and taping techniques. Both groups received appropriate orthotics. All subjects were assessed before and after treatment for pain, muscle strength, foot function index (FFI) scores and specific tests for PTTD. RESULTS: Statistical analysis showed significant differences between pre- and post-treatment results for pain, first metatarsophalangeal angle, forefoot abduction angle, FFI scores and foot and ankle muscle strengths in the center-based group and for the tibialis posterior muscle strength in the home-based group (p<0.05). Intergroup comparison, however, showed no differences between the groups at the end of the treatment program with the exception of posterior tibial muscle strength (p<0.05). CONCLUSION: Home- and center-based forms of rehabilitation seem to be equally effective in relieving pain and improving functional outcome in patients with Grade 1 to 3 PTTD. A patient-selective, supervised program may provide a better improvement in tibialis posterior strength than home-based rehabilitation.

The Turkish version of the family impact of assistive technology scale: a validity and reliability study.

OBJECTIVE: The purpose of the current study is to estimate the preliminary measurement properties of the Turkish version of Family Impact of assistive technology scale (FIATS-tr). METHOD: The validity and reliability of the scale was performed in two phases. Phase I focused on construction of the Turkish version of the instrument and pilot testing. The scale was translated using the back-translation technique. The comprehensiveness and clarity of the scale was assessed with 20 participants. Phase II included psychometric assessment of the scale using a classical test theory approach. The final version of the scale was pretested with Turkish-speaking parents (46 mothers, four fathers and five caregivers) of 55 chronically disabled children. RESULTS: Test-retest reliability was found to be ICC = 0.931 (95% CI 0.881-0.960) for FIATS-tr total. Cronbach's alpha for the overall FIATS-tr was 0.858. Individual alpha values for FIATS-tr subscales ranged from 0.199 to 0.838. The FIATS-tr total was moderately correlated with the functional independence measure for children (WeeFIM) total (r = 0.688, p < 0.001). CONCLUSIONS: This study showed that overall FIATS-tr appears to have acceptable levels of validity and reliability when used to measure the functional impact of assistive devices. Further study of the constructs and homogeneity of its total and subscales may further improve the internal consistency, validity, and other measurement properties of the FIATS-tr.

The effects of Kinesio® taping on sitting posture, functional independence and gross motor function in children with cerebral palsy.

PURPOSE: The aim of this study was to investigate the effects of Kinesio® tape (KT) application on sitting posture, gross motor function and the level of functional independence. METHOD: The study included 31 cerebral palsied children scored as level III, IV or V according to gross motor functional classification system (GMFCS). Children were randomly separated into two groups as study (n = 15, receiving KT and physiotherapy) and control (n = 15, receiving only physiotherapy). KT application was carried out for 12 weeks. Gross motor function measure (GMFM), functional independence measure for children (WeeFIM) and Sitting Assessment Scale (SAS) were used to evaluate gross motor function, independency in the activities of daily living and sitting posture, respectively. RESULTS: Compared to initial assessments, both groups showed a significant difference in parameters of GMFCS sitting subscale, GMFCS total score and SAS scores (p < 0.05). At the end of 12 weeks, only SAS scores were significantly different in favour of the study group when the groups were compared (p < 0.05). Also, post-intervention WeeFIM scores of the study group were significantly higher compared to initial assessment (p < 0.05), however, no difference was detected in the control group (p > 0.05). CONCLUSIONS: No direct effects of KT were observed on gross motor function and functional independence, though sitting posture (head, neck, foot position and arm, hand function) was affected positively. These results may imply that in clinical settings KT may be a beneficial assistive treatment approach when combined with physiotherapy.

The effects of osteopathic treatment on constipation in children with cerebral palsy: a pilot study.

OBJECTIVE: This pilot study was designed to investigate the effectiveness of osteopathic treatment in children with cerebral palsy and chronic constipation. METHODS: This study included 13 children with cerebral palsy diagnosed as having chronic constipation by a gastroenterologist. The subjects were separated into 2 groups. Group 1 was treated with osteopathic methods and group 2 underwent both medical and exactly the same osteopathic treatments of group 1. Osteopathic treatments included fascial release, iliopsoas muscle release, sphincter release, and bowel mobilizations. Gross Motor Functional Classification System, Functional Independence Measure for Children, and Modified Ashworth Scale were used to determine the level of disability, functional independence, and muscle tonus, respectively. In addition, Constipation Assessment Scale was administered to the subjects to determine the severity of constipation. The satisfaction from the treatment was measured using a Visual Analogue Scale at 3 and 6 months. RESULTS: Most of the children included in this study were determined as level IV or V according to Gross Motor Functional Classification System. The satisfaction of the subjects or the families with the treatments was not different when the groups were compared (P > .05). Constipation Assessment Scale scores decreased significantly in both groups (P < .05). Pretreatment (initial evaluation) and posttreatment (follow-ups at 3 and 6 months) results revealed no difference between the groups in either aspects (P > .05). However, both groups showed significant improvements compared with baseline evaluations (P < .05). CONCLUSION: Osteopathic methods were as effective as osteopathic methods in addition to medical care for both treatment groups. The results of this study suggest that osteopathic methods may be helpful as an alternative treatment in constipation. Additional advanced studies should be conducted.

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study.

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 - 100 degrees abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.

The cultural adaptation, reliability and validity of neck disability index in patients with neck pain: a Turkish version study.

OBJECTIVES: The aim of this study was to conduct the cross-cultural adaptation of Neck Disability Index (NDI) and investigate the validity and reliability of Turkish version in patients with neck pain. SUMMARY OF BACKGROUND DATA: The NDI is a reliable evaluation instrument for disability but there are no published Turkish version. METHODS: Eighty-eight patients with neck pain for at least 3 months were included in the study. NDI, The Neck Pain and Disability Scale and Visual Analogue Scale (VAS) were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson's correlation analysis. For the determination of concurrent validity, the relation between NDI and VAS was examined by Pearson's correlation analysis and for the determination of construct validity, the relation between NDI and Neck Pain and Disability Scale was investigated. RESULTS: Intraclass correlation coefficient score for test-retest reliability was 0.979 (95%, confidence interval = 0.968-0.986). For concurrent validity, the relation between NDI and VAS was investigated, the r value for test and retest was 0.508 and 0.620, respectively (P < 0.0001). For construct validity, the relation between NDI and the Turkish version of NPDA was investigated, the r value for test and retest was 0.659 (P < 0.0001) and 0.728 (P < 0.0001), respectively. CONCLUSION: The Turkish version of NDI was found to be a valid and reliable method of measurement for evaluating disability, caused by problems of the neck region as it is easy to comprehend by the patients and the time needed to apply is short in clinics.