Ana Cristina de David

Variáveis espaço-temporais da marcha de crianças com paralisia cerebral submetidas a eletroestimulação no músculo tibial anterior

Spatiotemporal gait variables of children with cerebral palsy undergoing electrostimulation in the anterior tibial muscle Objective: This study had the objective of describing spatiotemporal gait variables of four to five-year-old children with spastic hemiplegic cerebral palsy, before and after sessions of electrostimulation of the anterior tibial muscle on the paralyzed side. Method: Five children underwent 12 sessions of electrostimulation (three times a week). To collect biomechanical data, the gait was analyzed using the Peak Motus system, version 7.0, with two S-VHS video cameras with an acquisition rate of 60 Hz. Threedimensional reconstruction of the movements was performed using the direct linear transformation (DLT) method. Results: Following the intervention, all the children presented smaller differences in step length between the paralyzed and non-paralyzed sides (p= 0.009). Four children presented increased cycle amplitude. Two children presented increased cadence, speed and single support time on the paralyzed side. Thus, it was found that there was an improvement in gait symmetry in relation to the step lengths seen before and after the intervention, although the increase in the spatiotemporal variables did not occur in the same way for all the children. Conclusion: Despite the difficulties in defining larger and more homogeneous samples for studies of this type, the present data suggest the need for identification of and greater control over the variables that affect gait and its treatment among children with cerebral palsy.

Effects of changing speed on knee and ankle joint load during walking and running.

Abstract Joint moments can be used as an indicator of joint loading and have potential application for sports performance and injury prevention. The effects of changing walking and running speeds on joint moments for the different planes of motion still are debatable. Here, we compared knee and ankle moments during walking and running at different speeds. Data were collected from 11 recreational male runners to determine knee and ankle joint moments during different conditions. Conditions include walking at a comfortable speed (self-selected pacing), fast walking (fastest speed possible), slow running (speed corresponding to 30% slower than running) and running (at 4 m · s−1 ± 10%). A different joint moment pattern was observed between walking and running. We observed a general increase in joint load for sagittal and frontal planes as speed increased, while the effects of speed were not clear in the transverse plane moments. Although differences tend to be more pronounced when gait changed from walking to running, the peak moments, in general, increased when speed increased from comfortable walking to fast walking and from slow running to running mainly in the sagittal and frontal planes. Knee flexion moment was higher in walking than in running due to larger knee extension. Results suggest caution when recommending walking over running in an attempt to reduce knee joint loading. The different effects of speed increments during walking and running should be considered with regard to the prevention of injuries and for rehabilitation purposes.

Obese children experience higher plantar pressure and lower foot sensitivity than non-obese.

BACKGROUND Children obesity is a risk factor for several dysfunctions and diseases, with negative effects on the morphology of the locomotor system, plantar pressure and body stability. A relationship between postural control and sensorimotor information has been assumed. However, there is few data on the effects of children obesity on the availability of sensorial information from the foot during standing. METHODS Twenty obese and twenty non-obese children were evaluated for foot sensitivity and plantar pressure during unipedal and bipedal stance. Data were compared between obese and non-obese participants, between foot regions and between legs. FINDINGS Obese children experiences higher plantar pressure and have lower foot sensitivity than non-obese. Additionally, obese children had similar sensitivity for different foot regions, as compared to the non-obese. INTERPRETATION Children obesity negatively influences foot sensitivity. Bipedal stance seemed more sensitive to differentiate between obese and non-obese. Higher plantar pressure and lower foot sensitivity in obese children may affect performance of weight bearing activities, contribute to higher risk of foot injuries and have potential implication for children footwear design and clinical physical examination.

Healthy preterm infants: global motor coordination and early intervention

Introduction Studies recommend a participation by preterm children (PT) in Early Intervention Programs (EIP), as the coordination dysfunctions appear to occur more frequently in premature school children. Objectives Describe the global motor coordination (MC) in PT children that participate in an EIP; verify the difference in MC between the sexes and correlate the coordination results of PT children and those with gestation age (GA) and the birth weight (BW); and compare the results of MC between PT children and full-term children (FT). Materials and methods 57 children (5-6 years old) – 20 PT that participate in EIP, and 37 FT. For the analysis of MC, it was used the Korperkoordination fur Kinder (KTK) – Test of Body Coordination for Children. To the comparisons, it was used independent-samples T-test and the Mann-Whitney test (α = 0.05), and the Pearson correlation to verify the influence of GA and BW in the coordinated results. Results 80% of the PT children presented normal MC; the girls demonstrated a better performance on the tasks balance beam and lateral jumps and with regard to the MC corresponding to the sum of the gross scores on the tasks; the GA and BW did not influence MC; and, there was no difference between MC in PT and FT children. Conclusion The PT children presented, in their majority, satisfactory levels of MC, and the girls presented better results. In addition, the GA and BW did not interfere in the MC results. Lastly, there was no difference in the coordination performance between PT and FT children.

The association between body adiposity measures, postural balance, fear of falling, and fall risk in older community-dwelling women

Background and Purpose: Recent investigations demonstrate an association between obesity and the propensity of older adults to fall. The aim of this study was to investigate the association between body adiposity measures, postural balance, fear of falling, and risk of falls in older women. Methods: One hundred forty-seven volunteers took part in this cross-sectional study. Participants underwent body composition assessment using dual-energy x-ray absorptiometry and had body mass index, waist circumference (WC), and body adiposity index measured. Postural balance was assessed using a force platform, while fear of falling and risk of falls were, respectively, evaluated by the Falls Efficacy Scale—International and the QuickScreen Clinical Falls Risk Assessment. Results and Discussion: All adiposity measures were correlated to at least 1 postural stability parameter and to fear of falling (ρ= 0.163, P < .05 to r = 0.337, P < .001); however, WC was the index most strongly correlated to risk of falls (ρ= 0.325; P < .001). When obesity was classified using WC, it was observed that compared with nonobese individuals (n = 51), obese individuals (n = 96) exhibited greater center of pressure displacement in the anteroposterior and mediolateral axes, especially during conditions with feet apart (P < .05). The obese group also exhibited an increased fear of falling (28.04 vs 24.59; P = .002) and had a higher proportion of individuals with increased fall risk (72% vs 35%; P < .001). Conclusion: In summary, adiposity measures are associated with risk of falls in older women, which might be mediated by reduced postural balance and increased fear of falling. Among these indices, WC, an easy and low-cost assessment, demonstrated the strongest association with falls-related outcomes.

Comparação do equilíbrio postural unipodal entre crianças e adultos

The aim of this study was to compare postural balance in single leg stance between typically developing children aged 8 to 11 years old and healthy adults. The participants were divided into 3 groups: 8-9 years old, 10-11 years old and 18-30 years old. A force plate (AccuSway Plus, AMTI, Inc.) was used to measure the postural balance. Each subject performed three trials lasting 30 seconds in dominant single leg stance. The parameters recorded were: center of pressure amplitude the in the anteroposterior and mediolateral directions, total path length, average velocity and 95% of the ellipse area. SPSS (version 13.0) was used for statistical analysis. Shapiro-Wilk test, One-way Anova, Bonferroni post hoc and Pearson correlation were applied. The level of significance used was p < 0.05. The results showed significant differences (p < 0.01), between children and adult groups in all variables. Between groups of children (8-9 years and 10-11 years) there was no significant difference in any variables. The results suggest that children aged 08-11 years old have not reached complete maturation of postural balance. This information may be important to aid in the diagnosis of disorders or deficits of balance, both in children and in adults.

Knee flexor strength and balance control impairment may explain declines during prolonged walking in women with mild Multiple Sclerosis

BACKGROUND Physiological factors such as muscle weakness and balance could explain declines in walking distance by multiple sclerosis (MS) patients. The purpose of this study was to characterize levels and examine associations among decline in walking distance, balance and muscular strength in women with mild MS. METHODS Participants included 28 women with mild relapsing-remitting MS and 21 women without MS. We executed the 6-min walk test (6MWT) to verify declines in walking distance. Isokinetic knee flexion (KF) and extension (KE) muscle strength was measured using a dynamometer. Balance was quantified using a force platform, with eyes open and closed, on a rigid and foam surface. RESULTS The MS patients presented declines in walking, lower KF muscle strength, and worse balance than controls. KF strength and balance correlated with walking in the MS group. The KF strength explained differences between groups in walking. The KF strength and balance presented as predictors of walking slowing down in the 6MWT, in mild MS. CONCLUSION Women with mild MS have strength impairment of knee flexor muscles and balance control impairment that may explain walking related motor fatigability during prolonged walking.

Vitamin d is related to gait recovery after total hip arthroplasty: A prospective analysis

OBJECTIVES To investigate the association between baseline serum levels of 25-hydroxyvitamin D (25(OH)D) and gait pattern in patients undergoing total hip arthroplasty (THA). METHODS Prospective study of patients with hip osteoarthritis undergoing primary THA between January 2012 and December 2013. Blood samples were collected on the day of hospital admission. Gait analyses were performed before surgery and 3 months postoperatively. Internal moments were captured. RESULTS Major improvements were observed in gait data after THA. 25(OH)D levels correlated with change in peak extension (R=0.25, p=0.017) and peak power generation (R=0.25, p=0.04). Multiple linear regression analyses were performed. In model 1, 25(OH)D and change in gait speed explained the variability of peak extension (R2=0.1, p=0.004). In model 2, only 25(OH)D explained the variability of peak power generation (R2=0.05, p=0.044). CONCLUSIONS 25(OH)D levels were correlated with change in peak extension and peak power generation. The effect of 25(OH)D on change in gait variables after THA is modest.

Hippotherapy on postural balance in the sitting position of children with cerebral palsy – Longitudinal study

ABSTRACT Purpose: To verify the effects of 12, 24, 36 hippotherapy sessions over time on postural balance while sitting in children with cerebral palsy as well the effects of treatment after one interruption period of 45 days. Methods: Hippotherapy program with a twice-weekly treatment with a total of 13 children aged 5–10 years old. Measurements of postural balance during sitting were performed using the AMTI AccuSway Plus platform. Results: There was a statistically significant reduction in mediolateral and anteroposterior sway after the first 12 hippotherapy sessions, and further significant sway reduction occurred as the treatment progressed. Changes in the center of pressure displacement velocity variable began to occur after 24 sessions. Conclusion: Seated postural balance improved in children with cerebral palsy, as evidenced by lower COP displacement, particularly after a greater number of sessions. After the last evaluations, when completing 36 sessions of hippotherapy, it was verified that the improvements to the postural balance continued to occur. Therefore, further studies with a longer treatment period may help to clarify if, at some point, there is stabilization in the improvement of postural balance. Furthermore, it is important to analyze the impact of hippotherapy on functional activities over time.

Plantar pressure distribution during running in early childhood

INTRODUCTION Plantar loads represent a reliable estimation of the mechanical efficiency of movement. The aim of this study was to describe and compare plantar pressure measures during running in children 4-6 years of age. METHODS Twenty-eight children were divided into three groups (4, 5 6 year-olds). Plantar pressure during running at self-selected speed was recorded using an Emed-AT platform (Novel). Contact area, peak pressure, relative maximum force, and relative contact time were analyzed under five different plantar regions. Foot length and dynamic plantar arch index were calculated. The MANOVA and Bonferroni post-hoc were used to compare groups. Level of significance was set at p < 0.05. RESULTS BMI and arch index did not differ between the age groups. When compared to the younger groups, 6-year-old children produced higher loads of peak pressure (p < 0.01) and maximum force (p < 0.01), larger contact area (p < 0.01) and longer contact time (p < 0.05) under most foot regions, except for maximum force under the midfoot (p < 0.05). CONCLUSIONS Foot structure and plantar loads during running seem to be still developing in 6-year-olds. These children present different values of peak pressure, maximum force, contact time, and contact area than 4 and 5-year-olds, with higher values in the forefoot and lower values in the midfoot.INTRODUCTION Plantar loads represent a reliable estimation of the mechanical efficiency of movement. The aim of this study was to describe and compare plantar pressure measures during running in children 4-6 years of age. METHODS Twenty-eight children were divided into three groups (4, 5 6 year-olds). Plantar pressure during running at self-selected speed was recorded using an Emed-AT platform (Novel). Contact area, peak pressure, relative maximum force, and relative contact time were analyzed under five different plantar regions. Foot length and dynamic plantar arch index were calculated. The MANOVA and Bonferroni post-hoc were used to compare groups. Level of significance was set at p < 0.05. RESULTS BMI and arch index did not differ between the age groups. When compared to the younger groups, 6-year-old children produced higher loads of peak pressure (p < 0.01) and maximum force (p < 0.01), larger contact area (p < 0.01) and longer contact time (p < 0.05) under most foot regions, except for maximum force under the midfoot (p < 0.05). CONCLUSIONS Foot structure and plantar loads during running seem to be still developing in 6-year-olds. These children present different values of peak pressure, maximum force, contact time, and contact area than 4 and 5-year-olds, with higher values in the forefoot and lower values in the midfoot.