Renata Noce Kirkwood

Efficacy of ankle-foot orthoses on gait of children with cerebral palsy: systematic review of literature.

Purpose: To perform a literature review evaluating the quality of current research on the influence of ankle-foot orthoses (AFOs) on gait in children with cerebral palsy (CP). Methods: A qualitative systematic review of intervention studies including the following words/phrases in the title/abstract: children with CP, AFO, gait and inferential statistical analysis, and outcomes related to gait. Databases searched included PubMed, Cochrane Library, PEDro, OTSeeker, Lilacs, and Scielo. Level of evidence was graded using the PEDro Scale. Results: Two between-group and 18 within-group studies met the inclusion criteria indicating a low level of evidence. Between-group studies each scored 4 on the PEDro Scale, and 17 within-group studies scored 3 and 1 scored 2, indicating low quality. Standard terminology for AFOs was not used and only 6 studies described functional status using appropriate instruments. Conclusions: Studies using high quality methods are still needed to support evidence-based decisions regarding the use of AFOs for this population.

Step length appears to be a strong discriminant gait parameter for elderly females highly concerned about falls: a cross-sectional observational study

OBJECTIVE To determine if gait parameters and the Timed Up and Go test can discriminate between elderly females with high and low concern about falls. Knowledge of these parameters could help in the development of rehabilitation programmes focused on the prevention of falls, fear of falling and functional decline. DESIGN Cross-sectional, observational study. SETTING Human motion laboratory. PARTICIPANTS One hundred and fifty-four elderly females (aged 64 to 83 years), divided into two groups based on their Falls Efficacy Scale International score: high concern (n=81) and low concern (n=73) about falls. MAIN OUTCOME MEASURES Eight gait parameters recorded with the GAITRite system and the Timed Up and Go test score. RESULTS Factor 2 (composed of step length, gait velocity and Timed Up and Go mobility test) explained 20% of the variability of the data and was the only factor to discriminate between the groups, with 63% correct classifications. Step length proved to be the variable with the greatest discriminant ability, with a much higher discriminant coefficient (0.889) than the Timed Up and Go test (-0.369) and gait velocity (-0.268). CONCLUSIONS High concern about falls is primarily associated with decreased step length. Step length could be used as a screening tool to identify elderly women with low and high concern about falls in order to target these groups in a rehabilitation programme aimed to slow reduction in gait velocity and mobility.

Aplicação da análise de componentes principais na cinemática da marcha de idosas com osteoartrite de joelho

BACKGROUND: The applicability of gait analysis has been implemented with the introduction of the principal component analysis (PCA), a statistical data reduction technique that allows the comparison of the whole cycle between groups of individuals. OBJECTIVES: Applying PCA, to compare the kinematics of the knee joint during gait, in the frontal and sagittal planes, between a group of elderly women with and without diagnosis in the initial and moderate stages of Osteoarthritis (OA). METHODS: A total of 38 elderly women (69.6±8.1 years) with knee OA and 40 asymptomatic (70.3±7.7 years) participated on this study. The kinematics was obtained using the Qualisys Pro-reflex system. RESULTS: The OA group showed decreased gait velocity and stride length (p<0.05) and was characterized with higher WOMAC pain score. In the frontal plane, the between-group differences of the components were not significant. In the sagittal plane, three principal components explained 99.7% of the data variance. Discriminant analysis indicated that component 2 and 3 could classify correctly 71.8% of the individuals. However, CP3, which captures the difference in the flexion knee angle magnitude during gait, was the variable with higher discrimination power between groups. CONCLUSIONS: PCA is an effective multivariate statistical technique to analyse the kinematic gait waveform during the gait cycle. The smaller knee flexion angle in the OA group was appointed as a discriminatory factor between groups, therefore, it should be considered in the physical therapy evaluation and treatment of elderly women with knee OA.

The effects of walking sticks on gait kinematics and kinetics with chronic stroke survivors

BACKGROUND There are robust clinical paradigms against the prescription of walking sticks for people with stroke. However, there is little information on the biomechanics of gait with and without these devices to guide clinical practice. Therefore, this study investigated how the use of walking sticks (canes or crutches) affected both the kinematics and kinetics of gait in people with chronic stroke after their walking had stabilized. METHODS Nineteen people with chronic stroke walked at both comfortable and fast speeds. A 3-D motion analysis system and one force platform were used to obtain kinematic and kinetic data of the paretic lower limb during four conditions: With and without walking sticks, and at comfortable and fast speeds. Outcomes included linear kinematics (walking speeds) and angular kinematics (maximum joint angles), power, and work of the paretic hip, knee and ankle joints in the saggital plane. FINDINGS The use of walking sticks resulted in increases in speed during both fast (P<0.001) and comfortable (P=0.001) walking, but did not result in changes in maximum joint angles. This also led to increases in ankle plantar flexion (P<0.01), knee extension (P<0.01), and hip flexion (P<0.001) power generation, but did not result in changes in work. There were no greater changes as a result of using walking sticks during fast versus comfortable walking for any outcome. INTERPRETATIN: The outcomes with the use of walking sticks were beneficial, which suggests that the prescription of these devices is not detrimental to walking that was stabilized in people with stroke.

Late Rearfoot Eversion and Lower-limb Internal Rotation Caused by Changes in the Interaction between Forefoot and Support Surface

BACKGROUND The influence of distal mechanical factors that change the interaction between the forefoot and the support surface on lower-limb kinematics is not well established. This study investigated the effects of the use of lateral wedges under the forefoot on the kinematics of the lower extremity during the stance phase of walking. METHODS Sixteen healthy young adults participated in this repeated-measures study. They walked wearing flat sandals and laterally wedged sandals, which were medially inclined only in the forefoot. One wedged sandal had a forefoot lateral wedge of 5 degrees and the other wedged sandal had a forefoot lateral wedge of 10 degrees. Kinematic variables of the lower extremity, theoretically considered clinically relevant for injury development, were measured with a three-dimensional motion analysis system. The variables were evaluated for three subphases of stance: loading response, midstance, and late stance. RESULTS The 5 degrees laterally wedged sandal increased rearfoot eversion during midstance and the 10 degrees laterally wedged sandal increased rearfoot eversion during mid- and late stances, in comparison to the use of flat sandals. The 10 degrees laterally wedged sandal produced greater internal rotation of the shank relative to the pelvis and of the hip joint, during the midstance, also compared to the use of flat sandals. CONCLUSIONS Lateral wedges under the forefoot increase rearfoot eversion during mid-and late stances and may cause proximal kinematic changes throughout the lower-extremity kinetic chain. Distal mechanical factors should be clinically addressed when a patient presents late excessive rearfoot eversion during walking.

Decreased gastrocnemius temporal muscle activation during gait in elderly women with history of recurrent falls

Gait dysfunction is a strong issue in elderly women with a history of falls. The purpose of this study was to compare the temporal activity of the ankle muscles during gait in elderly women with and without a history of recurrent falls. Eighty-nine (89) elderly women - one group with a history of falls (45) and another group without (44) - participated in the study. The mean range of temporal activation of the gastrocnemius, tibialis anterior and soleus muscles during gait was obtained using electromyography. The muscles were considered active when the signal magnitude surpassed two standard deviations of the minimal magnitude of the average signal per individual. The results showed that the mean range of gastrocnemius muscle activation of the group of recurrent fallers was significantly shorter, 2.9% (16.9±5.7%) compared to the group without recurrent falls (19.8±6.6%) (p=0.004). The shorter duration in the gastrocnemius muscle activation during stance could possibly affect stability in the support phase, since the gastrocnemius is the main decelerator of the trunk. Clinically, this finding shows the importance of rehabilitation programs for elderly women that focus on strengthening the plantar flexor musculature aiming to reestablish the function and stability of gait and possibly avoiding falls.

Mensuração da amplitude de movimento cervical em crianças respiradoras orais

Measurement of neck range of motion among mouth-breathing children Introduction: By clinical definition, mouth breathers use the mouth as their main air pathway during breathing. This results in modifications to tongue and head positioning and may have an influence on craniofacial mechanics during development. Bringing the head forward is also common among mouth breathers and may lead to misalignments in adjacent segments of the human body. Objective: To evaluate neck (cervical) range of motion (ROM) among mouth-breathing children and compare this with a group of nose-breathing children. Method: Ten mouth-breathing children of both sexes aged 6.90 ± 1.37 years and ten nose- breathing children aged 7.70 ± 1.42 years participated in this study. The ROM for neck flexion, extension and protrusion of the head were evaluated. Students t test for independent samples was used for the statistical analysis, considering p< 0.05 as the statistical significance level. Results: The mouth-breathing children had a significantly smaller ROM for neck extension (59.0° ± 10.79°), compared with the nose-breathing group (72.9° ± 8.82° ) (p= 0.001). The ROM for flexion and protrusion was not statistically different between groups (59.0° ± 10.79°). Conclusion: The mouth-breathing children presented smaller neck extension ROM than the nose-breathing children did, but for protrusion and flexion ROM there was no difference between the groups.

Validade e confiabilidade intra e interexaminadores da Escala Observacional de Marcha para crianças com paralisia cerebral espástica

CONTEXTUALIZACAO: A avaliacao observacional da marcha e uma abordagem clinica importante para a avaliacao das desordens da marcha. Sistemas de analise quantitativa da marcha oferecem informacoes acuradas, entretanto o alto custo desses instrumentos tornam a analise observacional mais acessivel para a pratica clinica. OBJETIVOS: Desenvolver uma escala observacional de marcha (EOM) para caracterizar a marcha de criancas com paralisia cerebral espastica (PCE) e testar sua confiabilidade e validade de criterio, comparando-a com o sistema computadorizado de analise de movimento, padrao ouro para avaliacao cinematica da marcha. METODOS: Vinte e tres videos de criancas com PCE (9,54±2,22 anos) foram avaliados por meio da EOM por quatro fisioterapeutas em duas sessoes. Dados cinematicos do complexo tornozelo/pe, joelho, quadril e pelve foram obtidos usando o sistema de analise de movimento Qualisys Pro-reflex. Para estabelecer a validade de criterio e a confiabilidade intra e interexaminadores, os resultados obtidos da EOM foram comparados com os dados do sistema de analise de movimento, entre as duas sessoes e entre examinadores. Teste Kappa ponderado foi aplicado para analisar a concordância entre as avaliacoes. RESULTADOS: A EOM apresentou validade muito boa para joelho (r=0,64, p<0,05) e boa para o complexo tornozelo/pe (r=0,59, p<0,05). A confiabilidade intraexaminadores foi muito boa para o complexo tornozelo/pe (r=0,79, p<0,05), joelho (r=0,77, p<0,05) e quadril (r=0,73, p<0,05) e boa para a pelve (r=0,59, p<0,05). A confiabilidade interexaminadores foi muito boa para o complexo tornozelo/pe (r=0,68, p<0,05) e joelho (r=0,65, p<0,05) e boa para o quadril (r=0,48, p<0,05). CONCLUSOES: A EOM demonstrou bons indices de confiabilidade e validade para a observacao do tornozelo/pe e joelho. Novas estrategias de observacao devem ser criadas para melhorar as propriedades psicometricas dos itens relativos ao quadril e pelve.

The Relationship Between Diabetes Mellitus, Geriatric Syndromes, Physical Function, and Gait: A Review of the Literature.

Diabetes mellitus is a common and growing problem worldwide, especially in the elderly population imposing a huge economic burden for individuals and healthcare services. The purpose of this narrative review was to summarize the current state of knowledge about the relationship between diabetes and important geriatric syndromes, physical function measures, and gait variables. Studies pertaining to the topics were identified through on-line search of databases. Seniors with diabetes are more likely to experience falls, depression, and frailty. Furthermore, in older patients, diabetes has been associated with disability, including basic and instrumental activities of daily living, and with poorer performance on objective measures of physical function, such as sit-to-stand test, handgrip strength, Timed Up and Go (TUG) test, and Short Physical Performance Battery (SPPB). Diabetic seniors also have an altered gait pattern characterized by lower velocity and stride length, and higher step width, stance time, double support time, and stride length variability compared to non-diabetic seniors. Little is known about fear of falling in older adults with diabetes. The relationship between these outcomes and diabetes in older people is still outstanding and merits further investigation.

Validation of the Human Activity Profile Questionnaire as a Measure of Physical Activity Levels in Older Community-Dwelling Women

The purpose of this study was to assess the validity of the Human Activity Profile (HAP) by comparing scores with accelerometer data and by objectively testing its cutoff points. This study included 120 older women (age 60–90 years). Average daily time spent in sedentary, moderate, and hard activity; counts; number of steps; and energy expenditure were measured using an accelerometer. Spearman rank order correlations were used to evaluate the correlation between the HAP scores and accelerometer variables. Significant relationships were detected (rho = .47−.75, p < .001), indicating that the HAP estimates physical activity at a group level well; however, scatterplots showed individual errors. Receiver operating characteristic curves were constructed to determine HAP cutoff points on the basis of physical activity level recommendations, and the cutoff points found were similar to the original HAP cutoff points. The HAP is a useful indicator of physical activity levels in older women.