Fatigue of the intrinsic foot core muscles had a greater effect on gait than extrinsic foot core muscles: A time-series based analyze.

BACKGROUND: The Heel Rise endurance (HRE) which indicates the extrinsic foot core (ECO) muscle's performance and the paper grip endurance (PGE) which indicates the intrinsic foot core (ICO) muscle's performance are essential components of a healthy foot function. However, the foot core muscles' fatigue response on spatial and temporal gait parameters after the HRE and the PGE tests were not adequately investigated. The purpose of this study was to determine whether the fatigue of the ICO and the ECO muscles affect gait parameters. MATERIAL AND METHODS: A prospective, cross-sectional study was conducted on 22 sedentary individuals (44 feet). Gait was investigated pre and after the Heel Rise (HR) endurance test and the paper grip (PG) endurance test by inertial sensors. At least 500 consecutive steps were collected for each individual. Spatial-temporal gait parameters were used as outcome measures. RESULTS: ECO fatigue and ICO fatigue led to increases in the step length (p < 0.05) and the stride lengths (p < 0.05), the single support (p < 0.05), and the terminal stance durations (p < 0.05). It was also seen that ICO fatigue had a greater effect on gait than ECO fatigue. The ECO fatigue had a medium to large effect on the gait parameters (d=0.313-0.646). The ICO fatigue affected gait with a large effect (d=0.524-2.048). CONCLUSION: The ECO fatigue and the ICO fatigue led to clinically important changes in long-range gait parameters and the ICO fatigue had a greater effect on gait than ECO fatigue. It was suggested that clinicians add ICO muscle endurance training to improve the physical performance of individuals.

Effects of online education on prosthetics orthotics education during COVID-19.

BACKGROUND: It is obvious that educational activities were affected globally due to the pandemic. OBJECTIVE: This study was planned to examine the effects of online education on undergraduate degree (UD) and associate degree (AD) Orthotics and Prosthesis education in the COVID-19 pandemic. STUDY DESIGN: A crossectional online survey. METHOD: The Google Forms questionnaire was delivered to students of Orthotics and Prosthesis in the level of undergraduate degree and AD and academicians conducted in the study. Next, the participants were reviewed regarding their knowledge about devices used for online education and related technical problems. A 5-point Likert-type questionnaire with 18 questions that was developed specifically for this study was applied to examine their views on online education. RESULTS: The study included 472 participants who had a mean age of 21.30 ± 0.22 years. Among the participants, 262 were AD students (55.5%). Approximately 82% of the participants were used their mobile phones for connection. The connection problems, and inappropriateness of online education in applied course, preference of online education for theoretical courses, insufficiency of digital course materials, failure to access education easily, insufficiency of online examinations for measurement and evaluation, and preference of homework over online education were stated by 79%, 88.3%, 41.9%, 54.5%, 70.1%, 41.7%, and 42.8% of the participants, respectively. CONCLUSION: Both academicians and students experienced connection problems, and applied courses were not suitable for online education. Motivation to attend the courses was low in online education, relevant workload increased, online examinations were not sufficient for measurement and evaluation, and studies were more unplanned. It is necessary to switch to formal education after the pandemic.

A content comparison of 4 commonly used adult upper limb amputee outcome measurements with application of the refinements of International Classification of Functioning, Disability, and Health linking rules.

INTRODUCTION: The application of the refinements of linking rules to the outcome measurement methods provides an opportunity to obtain information concerning what the available instruments actually measure and how the instrument measures certain outcomes. The purpose of the study was to analyze the content of 4 commonly used upper limb amputee scales using the refined International Classification of Functioning, Disability, and Health (ICF) linking rules. METHODS: The Upper Extremity Functional Status module of the Orthotics and Prosthetics User Survey (OPUS-UEFS), Trinity Amputation and Prosthesis Experience Scales, Southampton Hand Assessment Procedure (SHAP), and Quick Disability of the Arm, Shoulder, and Hand were analyzed by 2 health professionals for a content comparison based on ICF categories. The Kappa statistic was used to calculate the degree of agreement between 2 professionals. RESULTS: The scale questions were linked with 43 different ICF codes in this study. Trinity Amputation and Prosthesis Experience Scale addresses all ICF domains. All items of SHAP and most items of OPUS-UEFS were linked to the activity-participation domain. Quick Disability of the Arm, Shoulder, and Hand items were linked with activity-participation and body function domains. The perspectives of OPUS-UEFS and SHAP are descriptive. The perspectives of Quick Disability of the Arm, Shoulder, and Hand were descriptive and appraisal. The perspectives of Trinity Amputation and Prosthesis Experience Scale subscales were descriptive, appraisal, and needs or dependency. Estimated kappa values ranged from 0.44 to 0.91 for ICF codes. CONCLUSIONS: Most concepts in the scales were frequently linked to the activity-participation domain. We think that the results of this study will be a useful guide to clinicians and researchers in selecting relevant and appropriate outcome measurements for upper limb amputee rehabilitation.

Postural stability and flexibility responses of yoga training in women: Are improvements similar in both sexes?

The researchers' aim is to examine the postural stability and flexibility responses of yoga training in women. The authors conducted the yoga training program 2 days a week and they assessed flexibility using the sit and reach test, trunk hyperextension test and trunk lateral flexion test. The researchers measured static and dynamic balance employing the device and database system. Then, the authors repeated all assesments were at the end of the first, the fifth and the tenth sessions. As a result of this study, the researchers revealed that the male participants had significantly poorer results in a single parameter (longitudinal sway) when compared with the female group, but the groups were statistically equivalent in this parameter after the first yoga training session. The authors also revealed that yoga was effective in improving flexibility among healthy young adults of both sexes, although the males showed greater improvement than females in the flexibility results.

Individuals with a COVID-19 history exhibit asymmetric gait patterns despite full recovery.

COVID-19 is a multisystem infectious disease affecting the body systems. Its neurologic complications include -but are not limited to headache, loss of smell, encephalitis, and cerebrovascular accidents. Even though gait analysis is an objective measure of the neuro-motor system and may provide significant information about the pathophysiology of specific diseases, no studies have investigated the gait characteristics in adults after full recovery from COVID-19. This was a cross-sectional, controlled study that included 12 individuals (mean age, 23.0 ± 4.1 years) with mild-to-moderate COVID-19 history (COVD) and 20 sedentary controls (CONT; mean age, 24.0 ± 3.6 years). Gait was evaluated using inertial sensors on a motorized treadmill. Spatial-temporal gait parameters and gait symmetry were calculated by using at least 512 consecutive steps for each participant. The effect-size analyses were utilized to interpret the impact of the results. Spatial-temporal gait characteristics were comparable between the two groups. The COVD group showed more asymmetrical gait patterns than the CONT group in the double support duration symmetry (p = 0.042), single support duration symmetry (p = 0.006), loading response duration symmetry (p = 0.042), and pre-swing duration symmetry (p = 0.018). The effect size analyses of the differences showed large effects (d = 0.68-0.831). Individuals with a history of mild-to-moderate COVID-19 showed more asymmetrical gait patterns than individuals without a disease history. Regardless of its severity, the multifaceted long-term effects of COVID-19 need to be examined and the scope of clinical follow-up should be detailed.

Primary dysmenorrhea and postural control: Is it a problem only during menstruation?

BACKGROUND: The effects of the menstrual cycle and primary dysmenorrhea (PD) on phase-related cognitive and physical functions are controversial. This study was carried out to examine whether women with PD showed a different physical function or dual-tasking response than women without PD at times other than menstruation. METHODS: Women with or without PD were recruited for the study. Individuals assessed on the first day of the menstruation and the day they reported themselves as well being (feeling good day-FGD). Zebris © FDM Type Force Platform was used to evaluate postural stability. Individuals have were asked to perform to a 3-step balance test protocol; the first session: comfortable upright standing; the second session: standing with a motor task; the third session: standing with a cognitive task (counting backward). Correctly calculated numbers were also recorded. RESULTS: The number of correct answers given by individuals during the cognitive dual-task was similar on the first day of menstruation and FGD (p > 0.05). In the control group, no difference was observed between the first days of menstruation and the evaluations on FGD days with dual-task (p > 0.05). In individuals with PD, there was no difference between the measurements at different times (p > 0.05). However, in the assessment with the motor dual-task on the first day of menstruation; postural sway increased (p < 0,05). In FDG measurement; distortion in postural stability was observed with the cognitive task (p < 0,05). In the assessments performed on the first day of menstruation, there was no difference in any parameters between the groups (p > 0.05). In the measurements made on FGD day with the cognitive task; there was a difference between the groups (p < 0,05). Individuals with PD had higher postural sway. SIGNIFICANCE: This study showed that the primary dysmenorrhea is not only a problem for females during menstruation, primary dysmenorrhea causes impaired ability of the individual to perform dual-tasking and continuously affects postural stability.

The trunk control: Which scale is the best in very acute stroke patients?

Background: It is important to evaluate trunk control, given that it is one of the indicators of adequate functional and motor recovery in patients following a stroke. The assessment should be feasible and adequate in clinical conditions in the acute phase. Objectives: The aim of this study was to detect the most appropriate scale used for trunk control assessment in very acute stroke patients in terms of time and ease of implementation. Methods: Sixty-five patients with very acute stroke were included in the study. The patients were assessed with the Trunk Impairment Scale-1 (VTIS), the Trunk Impairment Scale-2 (FTIS), the Motor Assessment Scale trunk subscale (T-MAS) and the Trunk Control Test (TCT), and Functional Impairment Measure (FIM). Floor/ceiling effects, reliability, validity responsiveness of all trunk control scales analyzed. The correlation between all scales and FIM were calculated. Results: All scales had similar reliability, responsiveness and construct validity level. T-MAS and TCT were more advantageous than other scales according to time. TCT and VTIS showed floor effect. The best predictive validity values were observed for the T-MAS and TCT. Conclusions: Four scales investigated in this study can also be used to evaluate the patients with very acute stroke. On the other hand, the advantages and disadvantages of the scales should be thoroughly assessed and researchers can use one of four scales considering their aim, patient populations and clinical characteristics of patients.

Comparison of gait variability and symmetry in trained individuals with transtibial and transfemoral limb loss.

PURPOSE: Gait variability is a determinant of qualified locomotion and is useful for monitoring the effects of therapeutic interventions. The aim of this study was to compare gait variability and symmetry in trained individuals with transtibial (TT) amputation and transfemoral (TF) amputation. METHODS: The design of this study was planned as observational. Eleven individuals with TF amputation, 14 individuals with TT amputation, and 14 healthy individuals (HI) were evaluated with a motorized treadmill. The mean step length, the step length variability, an ambulation index, and the time on each foot (stance phase symmetry) of participants were recorded. RESULTS: There were differences between the three groups in the residual/non-preferred limb (RNp) step length ( p = 0.031), the intact/preferred (IP) limb step length variability ( p = 0.001), the RNp step length variability ( p < 0.001), the time on each foot ( p < 0.001), and the ambulation index score ( p < 0.001). There was a similarity between the groups (TF, TT, HI) in IP limb step lengths ( p = 0.127) and duration of prosthesis usage since amputation in individuals with lower limb loss ( p = 0.224). CONCLUSIONS: This study provided basic data about gait variability and symmetry in individuals with traumatic lower limb loss. The results of the study showed that the variability of gait increased with the level of loss, and individuals with TT amputation showed partially equivalent performance with the healthy group. Similarities in gait characteristics may have resulted from effective prosthetic usage or effective gait rehabilitation.

Learning effect of dynamic postural stability evaluation system.

BACKGROUND: Repeated exposure to a given perturbation of the postural control system has been shown to cause learning of more efficient postural strategies for maintaining balance both within a session and over time. It is important to show whether outcomes from treatment strategies are related to the effectiveness of training or are the result of the learning of the test process. OBJECTIVE: To investigate the learning effect of the dynamic postural stability evaluation system. METHODS: We studied 20 healthy young subjects (13 females and 7 males), with a mean age of 22.3 ± 1.9 years. Limits of stability and postural sway were assessed. All participants completed the standardized dynamic postural stability evaluation test (Bertec, Bertec Corporation, Columbus, OH, USA) seven times. The test was performed in both eyes open and eyes closed conditions. RESULTS: There were differences in the limits of stability scores for backward (p= 0.042), left side (p= 0.05), and the total score (p= 0.04). There were significant differences in postural sway anteroposterior direction in perturbed surface with eyes closed condition (p= 0.004) and total limits of stability scores of perturbed surface with eyes closed condition (p= 0.046). CONCLUSIONS: The study showed that balance test scores stabilized at different sessions from 1st to 3rd assessment period. Maximum normalized scores were reached at the third trial.

Effects of arm swing on spatiotemporal characteristics of gait in unilateral transhumeral amputees.

BACKGROUND: Gait is an autonomic process consisting of coordinated movements of the upper extremities, lower extremities, trunk and pelvis. However, researches regarding effects of upper extremity problems on gait parameters are limited. RESEARCH QUESTION: The aim of this study was to investigate the effects of arm swing on spatiotemporal characteristics of gait in individuals with unilateral transhumeral amputations. METHODS: A total of 25 unilateral transhumeral amputees and 25 healthy subjects were included. Information on the demographic features of individuals, amputations, and prosthetic devices were recorded. Spatiotemporal characteristics of gait were obtained using the GAITRite electronic walkway, and the arm swing was evaluated with the two video-cameras and analyzed using the Dartfish Pro Suite 7 software. RESULTS: The groups were similar regarding their age, height and weight. Mean duration from the amputation was 14.91 ± 10.90 years, and the mean weight of the prostheses was 1.44 ± 0.39 kg. Amputees had a less ambulatory arm swing on their amputated sides compared to their intact arms and healthy individuals. When the amputee group was compared to the healthy individuals, their step and stride lengths were shorter and their foot progression angle was higher, their gait velocity and cadence were lower than the healthy group. SIGNIFICANCE: The reduction of arm swing on the amputated side in unilateral transhumeral amputees is thought to be due to (1) use of the contralateral side in functional activities, (2) restriction of shoulder joint movement of socket boundaries and (3) fixed mechanical elbow joint. It has been thought that a decrease in the arm swing during walking may lead to a decrease in step length, stride length, and gait velocity.

Sensorimotor integration training in Parkinson`s disease.

OBJECTIVE: To determine the effects of sensorimotor integration training on postural control in Parkinson`s disease. METHODS: This prospective, randomized controlled trial was conducted at Hacettepe University (Ankara, Turkey). The study was carried out from August 2012 until March 2015 and included 24 Parkinson`s patients with stage 2-3 according to the Modified Hoehn&Yahr Rating Scale. The patients were divided into 2 groups (control and study). The control group received conventional physiotherapy; the study group received sensorimotor integration training combined with conventional physiotherapy, 2 times per week for 6 weeks. We assessed the patients with clinical balance tests and computerized dynamic posturography. Assessments were performed at baseline, 7- and 12-weeks follow-up. RESULTS: Computerized dynamic posturography posturography values (5th and 6th positions, composite balance, and vestibular system scores) were higher in the study group than in the control group. The improvements were maintained at the 12-week follow up except 6th positions scores (p<0.05). CONCLUSION: Sensorimotor integration training combined with conventional physiotherapy approach ameliorated postural control by improving vestibular system in patients with Parkinson`s disease by improving sensory processes.

Investigating the dynamic plantar pressure distribution and loading pattern in subjects with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a complex disorder affecting subjects by multiple system impairments. Gait problems are common in subjects with MS and various factors such as; ataxia, hypertonic muscles or/and seconder musculoskeletal system deformities affect the normal plantigrade contact by disturbing accommodation of foot to the ground while walking. The aim of this study was investigating the dynamic plantar pressure distribution and time of maximum pressure in subjects with MS and determining the differences from healthy subjects (HS). METHODS: Fifty-five subjects with MS (110 foot) and 20 HS (40 foot) were the participants of the study. The dynamic pedobarograph was utilized for evaluation of dynamic loading parameters; maximum pressure (N/cm2) and time of maximum pressure (ms) collected from heel medial, heel lateral, midfoot, heads of first, second, third, fourth and fifth metatarsal bones. RESULTS: There were differences between the groups in maximum pressure of heel medial (p < .001) and heel lateral (p < .001) was higher in HS. Also, there were differences between the groups the time of maximum pressure of all metatarsal head areas, midfoot, heel medial and heel lateral (p < .001). Subjects with MS spent lesser time to reach maximum pressure for forefoot loading and longer time for hindfoot loading. CONCLUSION: The study provided basic data about foot pressure distribution and time of maximum pressure in subjects with MS. Results of the study showed that the hindfoot loading was disrupted and inappropriate timing during load transfer from hindfoot to forefoot is exist in subjects with MS.

A randomized controlled study on the efficiency of soft tissue mobilization in babies with congenital muscular torticollis.

BACKROUND: Soft tissue mobilization techniques (STM) are used in clinical practice in treatment of congenital muscular torticollis(CMT).However, little is known about its effectiveness. OBJECTIVES: To investigate whether using STM to manage CMT in babies with mild to moderate head tilt was effective or not. METHODS: Twenty-nine babies with CMT aged between 0-6 months, who had a head tilt from 5 to 20 degrees were allocated to two groups. Both groups received a baseline home program (positioning, handling strategies, stretching and strengthening exercises, environmental adaptations). The study group (SG) also received STM three times a week. Babies were evaluated initially, at six weeks, at 12 weeks and for follow-up at 18 weeks with muscle function scale, head tilt and range of motion for neck lateral flexion and rotation. RESULTS: Both groups showed significant improvements in all measured parameters (p< 0.05). In comparison of groups, there were differences at six weeks in favor of the SG for neck rotation (0.001) and head tilt (= 0.006); but at 12 weeks and follow up, there were no longer any differences between the groups in any of the measured parameters. CONCLUSIONS: STM techniques are effective in getting faster positive results in the treatment of CMT.

Validity and reliability of the International Cooperative Ataxia Rating Scale (ICARS) and the Scale for the Assessment and Rating of Ataxia (SARA) in multiple sclerosis patients with ataxia.

BACKGROUND: Ataxia is an extremely common problem in multiple sclerosis (MS) patients. Thus, appropriate scales are required for detailed assessment of this issue. The aim of our study was to investigate the reliability and validity of the Turkish version of the International Cooperative Ataxia Rating Scale (ICARS) and Scale for the Assessment and Rating of Ataxia (SARA), which are widely used in ataxia evaluation in the context of other cerebellar diseases. METHOD: This cross-sectional study included 80 MS patients with Kurtzke cerebellar functional system score (C-FSS) greater than zero and slight pyramidal involvement. The Expanded Disability Status Scale (EDSS), C-FSS, and Berg Balance Scale (BBS) were administered. SARA and ICARS were assessed on first admission by two physical therapists. Seven days later, second assessments were repeated in same way for reliability. RESULTS: Intra-rater and inter-rater reliability were found to be high for both ICARS and SARA (p< 0.001) The Cronbach's α coefficients were 0.922 and 0.921 for SARA (reviewer 1 and reviewer 2 respectively) and 0.952 and 0.952 for ICARS (reviewer 1 and reviewer 2, respectively). There were no floor or ceiling effects determined for either scale except for item 17 of ICARS (p= 0.055). The EDSS total score had significant correlations with both SARA and ICARS (rho: 0.557 and 0.707, respectively). C-FSS had moderate correlation with SARA and high correlation with ICARS (rho: 0.469 and 0.653, respectively). BBS had no significant correlation with SARA and ICARS. (rho: -0.048 and -0.008 respectively). According to the area under the curve (AUC) value, ICARS is the best scale to discriminate mild and moderate ataxia. (AUC: 0.875). Factor analyses of ICARS showed that the rating results were determined by five different factors that did not coincide with the ICARS sub-scales. CONCLUSION: Our study demonstrated that ICARS and SARA are both reliable in MS patients with ataxia. Although ICARS has some structural problems, it seems to be more valid given its high correlations with EDSS and C-FSS. SARA also can be preferred as a brief assessment.

Effects of taping the hand in children with cerebral palsy.

BACKGROUND: Thumb in palm deformity restricts hand function by preventing somatosensory input in children with cerebral palsy who have spasticity in their hands. OBJECTIVES: To investigate the effects of thenar palmar tape application with and without pressure on upper extremity function in children with cerebral palsy. METHOD: 45 children were randomly assigned to one of the thenar taping groups either with or without pressure or to the control group. Nine hole peg test and nine parts puzzle test were used to measure upper extremity function. The two study groups were evaluated initially, with taping 20 min later and 20 min after taping was removed. The control group was evaluated initially, 20 min later and again after 20 min. RESULTS: Intragroup analyses showed that initially there was a difference in favor of the control group: number of pegs placed in the hole in 25 s (p = 0.032); number of puzzle parts placed in the hole in 25 s (p = 0.028). Following 20 min of application, there was no longer any difference between the groups (p = 0.458, p = 0.286 respectively). This was accepted as a manifestation of the effectiveness of taping. Intergroup analyses also showed a carry over effect 20 min after removing the tape only in the palmar pressure group (p = 0.004 and p = 0.014). CONCLUSION: It was concluded that taping can be an effective option for repositioning the thumb and improves upper extremity function by controlling the thumb in palm mechanically and enabling sensorial input by maintaining the correct hand position.