Senem Güner

Effects of Different Strength Training on Muscle Architecture: Clinical and Ultrasonographic Evaluation in Knee Osteoarthritis

Different strengthening exercises are generally prescribed to overcome the undesirable effects of decreased muscular function on the osteoarthritic joint. Although a few studies have shown the effects of strengthening on the muscle structure in healthy individuals, the literature lacks relevant data concerning knee osteoarthritis.

Yoga therapy and ambulatory multiple sclerosis Assessment of gait analysis parameters, fatigue and balance.

BACKGROUND AND OBJECTIVE Gait impairment, falls due to balance problems and fatigue are among the most important complaints in patients with multiple sclerosis (MS) and cause significant functional limitation. Use of complementary and alternative medicine (CAM) to help symptom management and to improve quality of life is growing among MS patients. Yoga is widely used as one of these CAM interventions, however, the number of studies that show the efficacy of yoga training in MS is inadequate. In this study, we aimed to evaluate the effects of a short term yoga program on fatigue, balance and gait in patients with MS. METHOD Eight volunteer ambulatory MS patients with clinically definite relapsing remitting MS whose Expanded Disability Status Score (EDSS) is less than or equal to 6.0, and eight healthy subjects were included in the study. Patients participated in 12 weeks of a bi-weekly yoga program under supervision. At their baseline and after yoga therapy, the Fatigue Severity Scale (FSS) and Berg Balance Scale (BBS) are used to assess fatigue and balance. Three dimensional gait analysis is done using the Vicon 612 system with six cameras and two Bertec force plates, before and after therapy. RESULTS After short term yoga therapy, statistically significant achievements were obtained in fatigue, balance, step length and walking speed. Although sagittal plane pelvis and hip angles, ankle plantar flexor moment, powers generated at the hip and ankle joints at the pre-swing were improved, the improvements were not statistically significant. CONCLUSION Yoga therapy is a safe and beneficial intervention for improving fatigue, balance and spatiotemporal gait parameters in patients with MS. Further studies with a larger sample size and longer follow-up will be needed to evaluate the long term effects of yoga therapy.

Knee muscle strength in multiple sclerosis: relationship with gait characteristics

[Purpose] To investigate the relationship between isokinetic knee muscle strength and kinematic, kinetic and spatiotemporal gait parameters of patients with multiple sclerosis (MS). [Subjects and Methods] Twenty-nine MS patients (mean age 31.5±6.5) were investigated in this study. The isokinetic knee muscle strength and gait parameters of MS patients with moderate and severe disability, as determined by the expanded disability status scale (EDSS): EDSS=1–4.5 (n=22, moderate disability) and EDSS>4.5 (n=7, severe disability) were measured. [Results] Isokinetic knee muscle strength, kinematic, kinetic and spatiotemporal gait parameters differed between moderate (EDSS=1–4.5, n=22) and severe disability (EDSS>4.5, n=7). The correlation between each of gait speed, stride length, total range of knee joint movement and the four strength parameters (minimum and maximum quadriceps and hamstring muscle strengths) were significant for the MS group as a whole. Within subgroups, the correlation between minimum hamstring strength and total range of knee movement was significant only in group EDSS>4.5; minimum hamstring correlated with peak knee extensor moment in group EDSS=1–4.5, but at a reduced level of significance. [Conclusion] The present study revealed significant correlations between gait characteristics and isokinetic strength parameters of the quadriceps and hamstring muscles. Our study suggests that rehabilitation protocols for MS patients should include a critical strength training programme particularly for the hamstring and quadriceps muscles.

Effect of two different kinesio taping techniques on knee kinematics and kinetics in young females

[Purpose] The application of kinesio taping may improve strength and performance, inhibit and facilitate motor activity, and increase range of motion. The aim of this study was to compare the effects of kinesio taping facilitation and inhibition applications on spatiotemporal knee kinematics and kinetics during walking activity in healthy subjects. [Subjects and Methods] A three-dimensional quantitative gait evaluation was performed without tape and with, facilitation and inhibition kinesio taping application on the knee. Sixteen healthy female college students (age, 19.7 ± 0.4 years; height, 1.64 ± 3.4 cm; body mass, 51.5 ± 4.8 kg) participated in the study. [Results] Spatiotemporal parameters (cadence, walking speed, stride length) were significantly different among the trials. Knee joint sagittal plane range of motion was not different with either kinesio taping application. Knee external flexion moment during the early stance phase decreased significantly with facilitation kinesio taping and increased with the inhibition kinesio taping. Knee external extension moment during the mid-stance phase increased with facilitation kinesio taping. Knee power parameters, eccentric activity in the rectus femoris during the pre-swing phase was significantly increased with inhibition kinesio taping application, while eccentric activity of the hamstrings during the terminal swing of gait was decreased. [Conclusion] These findings showed that facilitation kinesio taping application affected the terminal stance phase and that inhibition kinesio taping influenced the terminal swing phase compared with the no tape condition.

Orthotic variations in the management of infantile tibia vara and the results of treatment

Background: Infantile tibia vara is an acquired form of tibial deformity associated with tibial varus and internal torsion. Several methods have been described for orthotics treatment. The purpose of this study was to determine the effectiveness of orthotics treatment in infantile tibia vara. Study design: Controlled trial. Objective: The aim of this study was to compare the effect of different types of orthoses and correction methods on decreasing the curve in children with severe genu varum. Methods: Three different types of knee–ankle–foot orthoses were applied to 35 lower extremities of 22 pediatric participants who were 19–38 months of age. The same orthotic design principles were used to correct the femur, while different designs were applied to correct the tibia. The orthoses used on 20 participants were evaluated for differences among them and their effects on the treatment process. In addition, methods used in the treatment, problems encountered, production of different types of orthoses, convenience of application of the orthoses, and degree of patients satisfaction are discussed in this article. Results: The mean duration of treatment of the participants until completion of treatment was 25.3 ± 9.7 weeks with a minimum of 9 weeks and a maximum of 41 weeks. No statistically significant correlation was found between the duration of orthotic use in patients with a successful outcome and percentile height and percentile weight. When the duration of treatment using the different types of orthoses was analyzed, significant differences were found between Type 1 and Type 2, and Type 1 and Type 3 orthoses (p < 0.05), while no difference was observed between Type 2 and Type 3 orthoses (p > 0.05). Conclusion: We found that bracing is an effective form of treatment for infantile tibia vara up to 38 months of age. We conclude that full-time use of knee–ankle–foot orthoses exerting corrective forces from five points along the full length of the limb was effective. Clinical relevance: The localization of the distal tibial correction, the quality of the midtibial correction band, and the importance of the application of corrective forces from five points with rigid methods were found.

Functional results in periacetabular osteotomy: is it possible to obtain a normal gait after the surgery?

Introduction Gait analysis is one of the poorly understood dimensions of the functional results obtained after periacetabular osteotomy (PAO) due to dysplasia of the hip. Materials and methods Spatiotemporal parameters as well as coronal and sagittal plane kinematics and moments were compared among three demographically similar groups of subjects: (i) 23 patients with excellent results according to the Harris Hip Score (HHS) (mean 6.6 years of follow-up); (ii) 12 patients with good and fair results according to the HHS (mean 9.3 years of follow-up); and (iii) 35 asymptomatic controls. Results 50% of the analysed sagittal plane kinematic parameters were significantly better (p<0.05) in the control group not only for the hip joint but also for the ipsilateral knee and ipsilateral ankle. A vast majority of the other evaluated gait parameters resulted similar among the groups (p>0.05). Conclusions In our experience, most of the gait parameters after PAO are close to those observed in control subjects; however, the obtained pattern cannot be classified as a completely normal gait. The excellence in terms of functional results seems not to be determined by the achievement of this theoretical goal.

Efficacy of splinting variations in two different treatment protocols in trigger thumb

ABSTRACT Introduction: The aim of this study was to evaluate the comparative final outcome of two different conservative treatment protocols for trigger thumb using three different types of splints with varying restrictions of interphalangeal (IP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joint motions of the thumb and with additional exercise programs. Materials and Methods: Twenty-nine patients with 43 trigger thumbs were included in this study. Participants were divided into two treatment protocol groups and used three different types of thumb splints (1 daytime consistent to both groups and 2 different nighttime) with an additional exercise program and connective tissue manipulation (CTM). Patients were seen for follow-up after 10 weeks of the treatment; the preoutcome and postoutcome measures were assessed by stages of stenosing tenosynovitis (SST) and Visual Analog Scale (VAS). The data were analyzed to determine the efficacy of splint protocol intervention in relation to each other. Results: After using the thumb splints, there were statistically significant improvements in both SST and VAS scores in both groups (P < 0.05). This study demonstrates the benefit of splint usage and an additional exercise program with CTM in the conservative treatment of trigger thumb. Conclusions: Keeping in mind that splint 3 was used with both groups, splint 1 of the night splints that limited IP, MCP, and CMC joint flexion and extension was found to be more effective for conservative treatment in trigger thumb.

Orthosis Effects on the Gait of a Child with Infantile Tibia Vara

Infantile tibia vara (ITV) is an acquired form of tibial deformity associated with tibial varus and internal torsion. As there is currently insufficient data available on the effects of orthotics on gait parameters, this study aimed to document the influence of orthosis on walking. A male infant with bilateral tibia vara used orthoses for five months. Gait evaluations were performed pre- and posttreatment for both legs. The kinematic parameters were collected by using a motion analysis system. The orthotic design principle was used to correct the femur and tibia. Posttreatment gait parameters were improved compared to pretreatment parameters. After 5 months, there was remarkable change in the stance-phase degrees of frontal plane hip joint abduction and knee joint varus. We found that orthoses were an effective treatment for the infantile tibia vara gait characteristics in this patient. Full-time use of single, upright knee-ankle-foot orthosis with a drop lock knee joint and application of corrective forces at five points along the full length of the limb were effective.