Isabel de Camargo Neves Sacco

Confiabilidade da fotogrametria em relação a goniometria para avaliação postural de membros inferiores

Reliability of photogrammetry in relation to goniometry for postural lower limb assessment Background: Postural assessment and joint range-of-motion measurements are fundamental in diagnosing, planning and following up the evolution and results from physical therapy treatment. These can be done with the aid of goniometry – the most common method in physical therapy practice – and also, through technological advances, by means of photogrammetry. Objective: To investigate the parallel reliability of computerized photogrammetry, using two software tools (Corel Draw and SAPo), in relation to goniometry, in four angles of the lower limbs. Method: Twenty-six asymptomatic volunteers of both sexes, aged between 18 and 45 years, were studied. None of them had leg length discrepancy greater than 1 cm. The tibiotarsal angle (TT), knee flexion/extension angle (F/E), quadriceps angle (Q) and subtalar angle (S) were measured. The measurement was done first with a manual goniometer and then with digital photogrammetry by means of the Corel Draw v. 12 and SAPo v.0.63 software. Results: There were no statistical differences between the three evaluation methods for the TT (p= 0.9991), S (p= 0.2159) and F/E (p= 0.4027) angles. However, for the Q angle there was a significant difference between goniometry and the software used in photogrammetry (p= 0.0067), although there was no significant difference between two software tools (p= 0.9920). This showed that the photogrammetry results were not influenced by the software used. Conclusion: In these healthy young subjects, computerized photogrammetry showed good parallel reliability in comparison with goniometry, for all the angles evaluated except for the Q angle. Therefore, in physical therapy practice, caution is needed in using Q angle measurements coming from different postural assessment methods.

Muscle Activation During Four Pilates Core Stability Exercises in Quadruped Position

UNLABELLED Queiroz BC, Cagliari MF, Amorim CF, Sacco IC. Muscle activation during four Pilates core stability exercises in quadruped position. OBJECTIVE To compare the activity of stabilizing trunk and hip muscles in 4 variations of Pilates stabilizing exercises in the quadruped position. DESIGN Repeated-measures descriptive study. SETTING A biomechanics laboratory at a university school of medicine. PARTICIPANTS Healthy subjects (N=19; mean age +/- SD, 31+/-5y; mean weight +/- SD, 60+/-11kg; mean height +/- SD, 166+/-9cm) experienced in Pilates routines. INTERVENTIONS Surface electromyographic signals of iliocostalis, multifidus, gluteus maximus, rectus abdominis, and external and internal oblique muscles were recorded in 4 knee stretch exercises: retroverted pelvis with flexed trunk; anteverted pelvis with extended trunk; neutral pelvis with inclined trunk; and neutral pelvis with trunk parallel to the ground. MAIN OUTCOME MEASURES Root mean square values of each muscle and exercise in both phases of hip extension and flexion, normalized by the maximal voluntary isometric contraction. RESULTS The retroverted pelvis with flexed trunk position led to significantly increased external oblique and gluteus maximus muscle activation. The anteverted pelvis with trunk extension significantly increased multifidus muscle activity. The neutral pelvis position led to significantly lower activity of all muscles. Rectus abdominis muscle activation to maintain body posture was similar in all exercises and was not influenced by position of the pelvis and trunk. CONCLUSIONS Variations in the pelvic and trunk positions in the knee stretch exercises change the activation pattern of the multifidus, gluteus maximus, rectus abdominis, and oblique muscles. The lower level of activation of the rectus abdominis muscle suggests that pelvic stability is maintained in the 4 exercise positions.

Plantar pressure distribution patterns during gait in diabetic neuropathy patients with a history of foot ulcers

OBJECTIVE: To investigate and compare the influence of a previous history of foot ulcers on plantar pressure variables during gait of patients with diabetic neuropathy. INTRODUCTION: Foot ulcers may be an indicator of worsening diabetic neuropathy. However, the behavior of plantar pressure patterns over time and during the progression of neuropathy, especially in patients who have a clinical history of foot ulcers, is still unclear. METHODS: Subjects were divided into the following groups: control group, 20 subjects; diabetic neuropathy patients without foot ulcers, 17 subjects; and diabetic neuropathy patients with at least one healed foot ulcer within the last year, 10 subjects. Plantar pressure distribution was recorded during barefoot gait using the Pedar-X system. RESULTS: Neuropathic subjects from both the diabetic neuropathy and DNU groups showed higher plantar pressure than control subjects. At midfoot, the peak pressure was significantly different among all groups: control group (139.4±76.4 kPa), diabetic neuropathy (205.3±118.6 kPa) and DNU (290.7±151.5 kPa) (p=0.008). The pressure-time integral was significantly higher in the ulcerated neuropathic groups at midfoot (CG: 37.3±11.4 kPa.s; DN: 43.3±9.1 kPa.s; DNU: 68.7±36.5 kPa.s; p=0.002) and rearfoot (CG: 83.3±21.2 kPa.s; DN: 94.9±29.4 kPa.s; DNU: 102.5±37.9 kPa.s; p=0.048). CONCLUSION: A history of foot ulcers in the clinical history of diabetic neuropathy subjects influenced plantar pressure distribution, resulting in an increased load under the midfoot and rearfoot and an increase in the variability of plantar pressure during barefoot gait. The progression of diabetic neuropathy was not found to influence plantar pressure distribution.

Global Body Posture Evaluation in Patients with Temporomandibular Joint Disorder

AIM: To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified. INTRODUCTION: Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint. METHODS : Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview. RESULTS: Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups. CONCLUSION: Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.

The effect of diabetic neuropathy and previous foot ulceration in EMG and ground reaction forces during gait

BACKGROUND We aimed at investigating the influence of diabetic neuropathy and previous history of plantar ulcers on electromyography (EMG) of the thigh and calf and on vertical ground reaction forces during gait. METHODS This study involved 45 adults divided into three groups: a control group (n=16), diabetic neuropathic group (n=19) and diabetic neuropathic group with previous history of plantar ulceration (n=10). EMG of the right vastus lateralis, lateral gastrocnemius and tibialis anterior were studied during the stance phase. The peaks and time of peak occurrence were determined and a co-activation index between tibialis anterior and lateral gastrocnemius. In order to represent the effect of the changes in EMG, the first and second peaks and the minimum value of the vertical ground reaction force were also determined. Inter-group comparisons of the electromyographical and ground reaction forces variables were made using three MANCOVA (peaks and times of EMG and peaks of force) and one ANCOVA (co-activation index). FINDINGS The ulcerated group presented a delayed in the time of the lateral gastrocnemius and vastus lateralis peak occurrence in comparison to controls. The lateral gastrocnemius delay may be related to the lower second vertical peak in diabetic subjects. However, the delay of the vastus lateralis did not cause any significant change on the first vertical peak. INTERPRETATIONS The vastus lateralis and lateral gastrocnemius delay demonstrate that ulcerated diabetic neuropathic patients have a motor deficit that could compromise their ability to walk, which was partially confirmed by changes on ground reaction forces during the push-off phase.

Influence of the diabetic neuropathy on the behavior of electromyographic and sensorial responses in treadmill gait.

OBJECTIVE We describe and interpret self-cadence treadmill walking by neuropathic diabetic subjects under biomechanical and somatosensorial considerations. DESIGN EMG variables during stance phase of neuropathic diabetic subjects were acquired and analyzed. We also evaluated sensorial and motor aspects of the feet and legs. METHODS The experimental procedures are divided as follows: (a) determination of the sensitive cronaxie and pain tolerance in selected plantar areas, (b) determination and description of temporal aspects of EMG patterns of the vastus lateralis, tibialis anterior and lateral gastrocnemius of both sides during treadmill walking. We analyze and compare the results of the sensitive cronaxie, pain tolerance and the EMG parameters obtained by two experimental groups: diabetic neuropathic (n=20) and non-diabetic control subjects (n=20). RESULTS The somatosensorial responses and pain tolerance threshold in the diabetic neuropathic group were significantly higher and considered far from the normal patterns. The EMG responses of the thigh and leg muscles in the diabetic neuropathic group were delayed if compared to the normal recruitment pattern, especially the tibialis anterior and vastus lateralis. CONCLUSIONS These findings lead us to conclude that probably central and/or peripheral control mechanisms of the gait of neuropathic diabetic patients are altered due to somatosensorial and motor deficits. The mechanism of load reduction during walking was considered inefficient because of the activation delay of the vastus lateralis and tibialis anterior. We have concluded that the peripheral diabetic neuropathy damages not only somatosensorial and motor sources but also intrinsic mechanisms of motor control leading to alterations in the ankle efficiency in gait. This resulting distal inefficiency compromises some of the principal requirements for gait, such as progression and balance. RELEVANCE This investigation is based on an innovating thematic approach involving the diabetic peripheral neuropathy. This innovation concerns the use of EMG and an instrumented treadmill in a clinical application to study and interpret the motor control during gait in neuropathic diabetic patients.

A study of biomechanical parameters in gait analysis and sensitive cronaxie of diabetic neuropathic patients.

OBJECTIVE The present investigation aims at studying the sensitive cronaxie in neuropathic and non-neuropathic diabetic patients as a measure of sensorial deficit. We seek to describe the gait using dynamic and temporal parameters. We have compared the results of the neuropathic patients to the results of a non-diabetic group. We have looked for relationships between peak plantar pressure and sensitive cronaxie in selected plantar areas. DESIGN AND METHODS The experimental procedures were divided in: (a) determination of the sensitive cronaxie in four selected plantar areas, (b) determination and description of peak plantar pressure, ground reaction force variables and single and double stance time. We analyzed and compared the results of the sensitive cronaxie and the biomechanical parameters obtained by three experimental groups: diabetic, neuropathic and non-diabetic subjects. RESULTS The pathological response of the sensitive cronaxie worsened progressively for neuropathic and diabetic patients, respectively. Longer double and single stance times, lower minimum vertical force and lower growth rates were seen in the neuropathic patients when compared to diabetic and non-diabetic subjects. CONCLUSIONS These results indicate an alteration in the neuropathic patient movement structure. We have speculated that compensatory musculoskeletal mechanisms have been developed by neuropathic patients to compensate for their sensorial deficit. Future research is necessary to verify the relationship between neurophysiological and dynamic variables, since this relationship seems to be a good parameter for the interpretation and comprehension of the peripheral neuropathy. RelevancePeripheral neuropathy is one of the most insidious chronic complications of diabetes. It has been observed that dynamic changes in gait are usually associated with the peripheral neuropathy somatosensory deficits. Biomechanical studies have highlighted that dynamic gait evaluation can identify functional alterations, besides the analysis of sensitive cronaxie as a measure of sensorial deficits. They are also useful as a complimentary routine in the clinic treatment of diabetes and its further long-term complications.

In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners

The type of surface used for running can influence the load that the locomotor apparatus will absorb and the load distribution could be related to the incidence of chronic injuries. As there is no consensus on how the locomotor apparatus adapts to loads originating from running surfaces with different compliance, the objective of this study was to investigate how loads are distributed over the plantar surface while running on natural grass and on a rigid surface--asphalt. Forty-four adult runners with 4+/-3 years of running experience were evaluated while running at 12 km/h for 40 m wearing standardised running shoes and Pedar insoles (Novel). Peak pressure, contact time and contact area were measured in six regions: lateral, central and medial rearfoot, midfoot, lateral and medial forefoot. The surfaces and regions were compared by three ANOVAS (2 x 6). Asphalt and natural grass were statistically different in all variables. Higher peak pressures were observed on asphalt at the central (p<0.001) [grass: 303.8(66.7)kPa; asphalt: 342.3(76.3)kPa] and lateral rearfoot (p<0.001) [grass: 312.7(75.8)kPa; asphalt: 350.9(98.3)kPa] and lateral forefoot (p<0.001) [grass: 221.5(42.9)kPa; asphalt: 245.3(55.5)kPa]. For natural grass, contact time and contact area were significantly greater at the central rearfoot (p<0.001). These results suggest that natural grass may be a surface that provokes lighter loads on the rearfoot and forefoot in recreational runners.

Role of ankle mobility in foot rollover during gait in individuals with diabetic neuropathy

BACKGROUND The purpose of this study was to investigate the ankle range of motion during neuropathic gait and its influence on plantar pressure distribution in two phases during stance: at heel-strike and at push-off. METHODS Thirty-one adults participated in this study (control group, n=16; diabetic neuropathic group, n=15). Dynamic ankle range of motion (electrogoniometer) and plantar pressures (PEDAR-X system) were acquired synchronously during walking. Plantar pressures were evaluated at rearfoot, midfoot and forefoot during the two phases of stance. General linear model repeated measures analysis of variance was applied to investigate relationships between groups, areas and stance phases. FINDINGS Diabetic neuropathy patients walked using a smaller ankle range of motion in stance phase and smaller ankle flexion at heel-strike (P=0.0005). Peak pressure and pressure-time integral values were higher in the diabetic group in the midfoot at push-off phase when compared to heel-strike phase. On the other hand, the control group showed similar values of peak pressure in midfoot during both stance phases. INTERPRETATION The ankle mobility reduction observed could be associated to altered plantar pressure distribution observed in neuropathic subjects. Results demonstrated that midfoot and forefoot play a different role in subjects with neuropathy by receiving higher loads at push-off phase that are probably due to smaller ankle flexion at stance phase. This may explain the higher loads in anterior areas of the foot observed in diabetic neuropathy subjects and confirm an inadequate foot rollover associated to the smaller ankle range of motion at the heel-strike phase.

A comparison of lower limb EMG and ground reaction forces between barefoot and shod gait in participants with diabetic neuropathic and healthy controls

BackgroundIt is known that when barefoot, gait biomechanics of diabetic neuropathic patients differ from non-diabetic individuals. However, it is still unknown whether these biomechanical changes are also present during shod gait which is clinically advised for these patients. This study investigated the effect of the participants own shoes on gait biomechanics in diabetic neuropathic individuals compared to barefoot gait patterns and healthy controls.MethodsGround reaction forces and lower limb EMG activities were analyzed in 21 non-diabetic adults (50.9 ± 7.3 yr, 24.3 ± 2.6 kg/m2) and 24 diabetic neuropathic participants (55.2 ± 7.9 yr, 27.0 ± 4.4 kg/m2). EMG patterns of vastus lateralis, lateral gastrocnemius and tibialis anterior, along with the vertical and antero-posterior ground reaction forces were studied during shod and barefoot gait.ResultsRegardless of the disease, walking with shoes promoted an increase in the first peak vertical force and the peak horizontal propulsive force. Diabetic individuals had a delay in the lateral gastrocnemius EMG activity with no delay in the vastus lateralis. They also demonstrated a higher peak horizontal braking force walking with shoes compared to barefoot. Diabetic participants also had a smaller second peak vertical force in shod gait and a delay in the vastus lateralis EMG activity in barefoot gait compared to controls.ConclusionsThe change in plantar sensory information that occurs when wearing shoes revealed a different motor strategy in diabetic individuals. Walking with shoes did not attenuate vertical forces in either group. Though changes in motor strategy were apparent, the biomechanical did not support the argument that the use of shoes contributes to altered motor responses during gait.