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P002 The influence of increased femoral anteversion on crouch gait
Gait & Posture 28S (2008) S49–S118
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Abstracts of the 17th Annual Meeting of ESMAC, Antalya, Turkey, 8–13 September 2008 Poster Presentations Thursday 11 September 2008 P001 Effect of constrained induced therapy on Barthel Index in stroke patients M. Nazzal1 , M. Al-Jarrah1 , M. Abu Sammour2 . 1 Physical Therapy, 2 Occupational Therapy, Jordan Univ of Scie and Tech, Jordan Summary: Barthel index is as an ADL assessment intended for long-term patients in hospital with neuromuscular or musculoskeletal disorders and it is one of the most widely used generic disability measures. In this study we investigated the effect of CIT on BI and we found significant improvement in ADLs following stroke. Conclusions: The effect of CIT as promising therapy for stroke is not very well investigated in clinical settings. In this study we found that Barthel index as a measure for ADLs was significantly improved after CIT. Introduction: Following stroke it is common to exhibit deficits in mobility of the upper extremity. Barthel index as an ADLs assessment tool is a widly used measure to assess ADLs in stroke patints. The main goal of this study is to investigate the effect of constrained induced therapy (CIT) on Barthel index in stroke patients. Patients/Materials and Methods: Twenty subjects 16 men, mean age (58±10.8) and four women, mean age (60±6.3) were participated in the study. Upper limb of contraletral side was constrained in removable cast for 6 hours per a day during the day for 3 weeks. Barthel index was assessed on admission and on discharge from rehabilitation program. Results: Mean duration of stroke was (81.75 days±25). Side of weakness was 9 right side and 11 left side where all of the subjects were right hand dominants. Barthel index was (70.7±9.7) and (97.1±3.4) on admission and on discharge respectively. There was a significant improvement of Barthel index after CIT rehabilitation, p value <0.05 = 0.0008. Discussion: Improvement of motor activity may occur after stroke. It may be because of recovery of marginally functional neurons. It may also occur by relearning, a process that strengthens existing pathways and may lead to new functional or structural changes – neuroplasticity. Constraint-Induced Movement therapy is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. CIT might improve these pathways and consequently improve motor activities in patients following stroke.
References [1] Nagayoshi M, Takahashi M, Saeki S, Hachisuka K. Disability and lifestyle of subacute myelo-optico-neuropathy and stroke patients and elderly persons living at home: A comparison of the Barthel Index score and the Frenchay Activities Index score. J UOEH. 2007 Dec 1; 29(4): 407−15. [2] Ong CT, Wu CS. Neurological deterioration in patients with first-ever ischemic stroke. Acta Neurol Taiwan. 2007 Sep; 16(3): 143−9. [3] Lo RS, Cheng JO, Wong EM, Tang WK, Wong LK, Woo J, Kwok T. Handicap and its determinants of change in stroke survivors: one-year follow-up study. Stroke. 2008 Jan; 39(1): 148−53. Epub 2007 Nov 29. [4] Sadaria KS, Bohannon RW, Lee N, Maljanian R. Ratings of physical function obtained by interview are legitimate for patients hospitalized after stroke. J Stroke Cerebrovasc Dis. 2001 Mar-Apr; 10(2): 79−84.
P002 The influence of increased femoral anteversion on crouch gait N.E. Akalan1 , Y. Temelli2 , S. Kuchimov3 . 1 Child Neurology, Istanbul Medical School; 2 Orthopedics and Traumathology, Istanbul Medical School; 3 Biomedical Engineering, Bogazici University, Turkey Summary: The purpose of the study was to investigate the interactions between the gait abnormalities seen in children with cerebral palsy and the increased femoral anteversion (IFA). We studied healthy subjects capable of toe-in gait and subjects with spastic diplegia (SD) who have toe-in gait pattern related with increased femoral anteversion. We compared walking pattern of normal, voluntary toe-in and SD subjects using gait analysis laboratory. Conclusions: The kinetic and kinematic results were changed in voluntary toe-in gait group as seen in subjects with SD who has increased femoral anteversion. Clinical point of this study was increased femoral anteversion which is thought to force the patients to walk in crouch gait pattern. The orthopedic surgeons may consider the priority of planning femoral derotational osteotomy with the muscle release operations in the surgical treatment procedures. Introduction: In most cases crouch gait originates from contracture or tightness of hamstring muscles combined with hip flexors deformity [1]. However, the lengths of hamstring were studied and found normal for most of the cases while the iliopsoas muscles were short [2]. Although muscle lengthening is the common treatment on crouch gait, many patients show no improvement or even get worse. This necessitates further studies into mechanisms of crouch gait [3]. The hypothesis of IFA contributing factor of crouch gait pattern was tested in the present study.
S50
Abstracts of the 17th Annual Meeting of ESMAC, Poster Presentations / Gait & Posture 28S (2008) S49–S118
Patients/Materials and Methods: 6 neurogically intact subjects aged 21−23 (mean 22) were selected to analyze normal gait (Figure 1A) and voluntary toe in gait (Figure 1B). The gait pattern of 6 subjects aged 17−30 (mean 21) with SD who have IFA were also analyzed (Figures 1C and 1D). To investigate the kinetic, kinematic and temporal spatial parameters in self selected speed, 3D BTS Motion Analysis System was used. Pelvis, hip, knee and ankle movements in sagital plane were analyzed using mean, statistical techniques as follows; paired t-test for comparing normal and voluntary gait data, unpaired t-test for voluntary gait and patients gait data. Results: The extension of the knee and hip and excursion of the hip and ankle during the gait cycle reduced, anterior pelvic tilt and dorsi-flexion of the ankle at initial contact increased significantly (p < 0.01) in the voluntary toe-in and SD gait group relative to normal. Dorsi-flexion moment and power generation between 30−60% of gait cycle reduced at the ankle, flexion moment of the knee between 30−60% of gait cycle and extension moment of the hip increased significantly (p < 0.01). There was no significant correlation in temporal spatial parameters between normal, voluntary and SD gaits. Discussion: The present study indicated, there is a positive relationship between IFA and the kinematic and kinetic changes which forces to children with cerebral palsy into crouch gait. Although the number of subjects was not enough to conclude an existing connection between IFA and crouch gait, it was a plot study which encourages us to plan further investigations on the influences of IFA onto children with SD. References [1] J.R. Gage, The Treatment of Gait Problems in Cerebral Palsy, Mac Keith Press, London, UK (2004). [2] Arnold et al., Gait and Posture 23 (2006), pp. 273–281. [3] Z. Matjaci´c et al., J. Biomech., accepted 27 Feb 2006, article in press.
P003 Normal percentage body-weight/weight-bearing (pbw/wb) values in common activities of daily living: an original research study Y. Kaplan. Lerner Sports Center, Hebrew University of Jerusalem, Israel Summary: This original research study presents accurate data for normal subjects with regards to body weight percentage values in weight-bearing (BWP/WB) for four basic activities of daily living. Conclusions: The table of normal data allows the precise analysis and comparison of weight-bearing changes in subjects that exhibit deviation from the norm as a result of lower-limb pathology due to injury or following surgery. These results may form the basis of rehabilitation protocols which aim to restore normal weightbearing in some activities of daily living. Introduction: The achievement of normal and bilaterally symmetrical weight-bearing ability is an important pre-requisite in the rehabilitation protocols following lower limb pathology or surgery. The accurate and objective percentage body weight/weight-bearing (PBW/WB) analysis of basic activities of daily living (ADL) has until now alluded research investigation. This has primarily been due to the technical inability to measure these paradigms. Patients/Materials and Methods: A new revolutionary weightbearing analysis system (Smartstep™, Figure 1) was utilized to
accurately measure the BWP/WB in a sample of 42 asymptomatic subjects between the ages of 19−72 years of age (Average = 34). The test measurements were conducted in walking, ascending stairs, descending stairs and jogging (8.5 km/hr).
Figure 1. Smartstep weight-bearing analysis system Results: The group PBW/WB values are displayed as a table in the attached word document. Discussion: It is now possible to precisely analyze and compare changes in these weight-bearing parameters in subjects that exhibit changes from the norm as a result of lower-limb pathology due to injury or following surgery. These results may form the basis of rehabilitation protocols which aim to restore normal weightbearing in some ADL. References [1] Isakov E. Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. Eura Medicophys 2007 Mar; 43(1): 21−6. Epub 2006 Oct 3. [2] Kaplan Y. The use of a new biofeedback insole weight-bearing measuring device in the assessment and rehabilitation of soccer players: A case study review. Journal of Sports Science and Medicine. 2007; 6 Suppl 10: S30−34.
P004 Weight-bearing deficits following anterior cruciate ligament reconstruction Y. Kaplan. Lerner Sports Center, Hebrew University of Jerusalem, Israel Summary: Clinicians involved in designing and executing postAnterior Cruciate Ligament reconstruction rehabilitation protocols should place more emphasis on encouraging hind-foot weightbearing as early on as possible following the surgical procedure. Conclusions: Initial results may indicate the choice of the allograft over the other graft types in terms of post-surgical pain and functional weight-bearing ability in the short-term following Anterior Cruciate Ligament reconstruction. Introduction: Asymmetric gait patterns persist up to one year after Anterior Cruciate Ligament reconstruction (ACLR). Early
www.elsevier.com/locate/gaitpost
Abstracts of the 17th Annual Meeting of ESMAC, Antalya, Turkey, 8–13 September 2008 Poster Presentations Thursday 11 September 2008 P001 Effect of constrained induced therapy on Barthel Index in stroke patients M. Nazzal1 , M. Al-Jarrah1 , M. Abu Sammour2 . 1 Physical Therapy, 2 Occupational Therapy, Jordan Univ of Scie and Tech, Jordan Summary: Barthel index is as an ADL assessment intended for long-term patients in hospital with neuromuscular or musculoskeletal disorders and it is one of the most widely used generic disability measures. In this study we investigated the effect of CIT on BI and we found significant improvement in ADLs following stroke. Conclusions: The effect of CIT as promising therapy for stroke is not very well investigated in clinical settings. In this study we found that Barthel index as a measure for ADLs was significantly improved after CIT. Introduction: Following stroke it is common to exhibit deficits in mobility of the upper extremity. Barthel index as an ADLs assessment tool is a widly used measure to assess ADLs in stroke patints. The main goal of this study is to investigate the effect of constrained induced therapy (CIT) on Barthel index in stroke patients. Patients/Materials and Methods: Twenty subjects 16 men, mean age (58±10.8) and four women, mean age (60±6.3) were participated in the study. Upper limb of contraletral side was constrained in removable cast for 6 hours per a day during the day for 3 weeks. Barthel index was assessed on admission and on discharge from rehabilitation program. Results: Mean duration of stroke was (81.75 days±25). Side of weakness was 9 right side and 11 left side where all of the subjects were right hand dominants. Barthel index was (70.7±9.7) and (97.1±3.4) on admission and on discharge respectively. There was a significant improvement of Barthel index after CIT rehabilitation, p value <0.05 = 0.0008. Discussion: Improvement of motor activity may occur after stroke. It may be because of recovery of marginally functional neurons. It may also occur by relearning, a process that strengthens existing pathways and may lead to new functional or structural changes – neuroplasticity. Constraint-Induced Movement therapy is a recognized rehabilitation approach for persons having stroke with mild to moderately severe motor upper extremity deficits. CIT might improve these pathways and consequently improve motor activities in patients following stroke.
References [1] Nagayoshi M, Takahashi M, Saeki S, Hachisuka K. Disability and lifestyle of subacute myelo-optico-neuropathy and stroke patients and elderly persons living at home: A comparison of the Barthel Index score and the Frenchay Activities Index score. J UOEH. 2007 Dec 1; 29(4): 407−15. [2] Ong CT, Wu CS. Neurological deterioration in patients with first-ever ischemic stroke. Acta Neurol Taiwan. 2007 Sep; 16(3): 143−9. [3] Lo RS, Cheng JO, Wong EM, Tang WK, Wong LK, Woo J, Kwok T. Handicap and its determinants of change in stroke survivors: one-year follow-up study. Stroke. 2008 Jan; 39(1): 148−53. Epub 2007 Nov 29. [4] Sadaria KS, Bohannon RW, Lee N, Maljanian R. Ratings of physical function obtained by interview are legitimate for patients hospitalized after stroke. J Stroke Cerebrovasc Dis. 2001 Mar-Apr; 10(2): 79−84.
P002 The influence of increased femoral anteversion on crouch gait N.E. Akalan1 , Y. Temelli2 , S. Kuchimov3 . 1 Child Neurology, Istanbul Medical School; 2 Orthopedics and Traumathology, Istanbul Medical School; 3 Biomedical Engineering, Bogazici University, Turkey Summary: The purpose of the study was to investigate the interactions between the gait abnormalities seen in children with cerebral palsy and the increased femoral anteversion (IFA). We studied healthy subjects capable of toe-in gait and subjects with spastic diplegia (SD) who have toe-in gait pattern related with increased femoral anteversion. We compared walking pattern of normal, voluntary toe-in and SD subjects using gait analysis laboratory. Conclusions: The kinetic and kinematic results were changed in voluntary toe-in gait group as seen in subjects with SD who has increased femoral anteversion. Clinical point of this study was increased femoral anteversion which is thought to force the patients to walk in crouch gait pattern. The orthopedic surgeons may consider the priority of planning femoral derotational osteotomy with the muscle release operations in the surgical treatment procedures. Introduction: In most cases crouch gait originates from contracture or tightness of hamstring muscles combined with hip flexors deformity [1]. However, the lengths of hamstring were studied and found normal for most of the cases while the iliopsoas muscles were short [2]. Although muscle lengthening is the common treatment on crouch gait, many patients show no improvement or even get worse. This necessitates further studies into mechanisms of crouch gait [3]. The hypothesis of IFA contributing factor of crouch gait pattern was tested in the present study.
S50
Abstracts of the 17th Annual Meeting of ESMAC, Poster Presentations / Gait & Posture 28S (2008) S49–S118
Patients/Materials and Methods: 6 neurogically intact subjects aged 21−23 (mean 22) were selected to analyze normal gait (Figure 1A) and voluntary toe in gait (Figure 1B). The gait pattern of 6 subjects aged 17−30 (mean 21) with SD who have IFA were also analyzed (Figures 1C and 1D). To investigate the kinetic, kinematic and temporal spatial parameters in self selected speed, 3D BTS Motion Analysis System was used. Pelvis, hip, knee and ankle movements in sagital plane were analyzed using mean, statistical techniques as follows; paired t-test for comparing normal and voluntary gait data, unpaired t-test for voluntary gait and patients gait data. Results: The extension of the knee and hip and excursion of the hip and ankle during the gait cycle reduced, anterior pelvic tilt and dorsi-flexion of the ankle at initial contact increased significantly (p < 0.01) in the voluntary toe-in and SD gait group relative to normal. Dorsi-flexion moment and power generation between 30−60% of gait cycle reduced at the ankle, flexion moment of the knee between 30−60% of gait cycle and extension moment of the hip increased significantly (p < 0.01). There was no significant correlation in temporal spatial parameters between normal, voluntary and SD gaits. Discussion: The present study indicated, there is a positive relationship between IFA and the kinematic and kinetic changes which forces to children with cerebral palsy into crouch gait. Although the number of subjects was not enough to conclude an existing connection between IFA and crouch gait, it was a plot study which encourages us to plan further investigations on the influences of IFA onto children with SD. References [1] J.R. Gage, The Treatment of Gait Problems in Cerebral Palsy, Mac Keith Press, London, UK (2004). [2] Arnold et al., Gait and Posture 23 (2006), pp. 273–281. [3] Z. Matjaci´c et al., J. Biomech., accepted 27 Feb 2006, article in press.
P003 Normal percentage body-weight/weight-bearing (pbw/wb) values in common activities of daily living: an original research study Y. Kaplan. Lerner Sports Center, Hebrew University of Jerusalem, Israel Summary: This original research study presents accurate data for normal subjects with regards to body weight percentage values in weight-bearing (BWP/WB) for four basic activities of daily living. Conclusions: The table of normal data allows the precise analysis and comparison of weight-bearing changes in subjects that exhibit deviation from the norm as a result of lower-limb pathology due to injury or following surgery. These results may form the basis of rehabilitation protocols which aim to restore normal weightbearing in some activities of daily living. Introduction: The achievement of normal and bilaterally symmetrical weight-bearing ability is an important pre-requisite in the rehabilitation protocols following lower limb pathology or surgery. The accurate and objective percentage body weight/weight-bearing (PBW/WB) analysis of basic activities of daily living (ADL) has until now alluded research investigation. This has primarily been due to the technical inability to measure these paradigms. Patients/Materials and Methods: A new revolutionary weightbearing analysis system (Smartstep™, Figure 1) was utilized to
accurately measure the BWP/WB in a sample of 42 asymptomatic subjects between the ages of 19−72 years of age (Average = 34). The test measurements were conducted in walking, ascending stairs, descending stairs and jogging (8.5 km/hr).
Figure 1. Smartstep weight-bearing analysis system Results: The group PBW/WB values are displayed as a table in the attached word document. Discussion: It is now possible to precisely analyze and compare changes in these weight-bearing parameters in subjects that exhibit changes from the norm as a result of lower-limb pathology due to injury or following surgery. These results may form the basis of rehabilitation protocols which aim to restore normal weightbearing in some ADL. References [1] Isakov E. Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. Eura Medicophys 2007 Mar; 43(1): 21−6. Epub 2006 Oct 3. [2] Kaplan Y. The use of a new biofeedback insole weight-bearing measuring device in the assessment and rehabilitation of soccer players: A case study review. Journal of Sports Science and Medicine. 2007; 6 Suppl 10: S30−34.
P004 Weight-bearing deficits following anterior cruciate ligament reconstruction Y. Kaplan. Lerner Sports Center, Hebrew University of Jerusalem, Israel Summary: Clinicians involved in designing and executing postAnterior Cruciate Ligament reconstruction rehabilitation protocols should place more emphasis on encouraging hind-foot weightbearing as early on as possible following the surgical procedure. Conclusions: Initial results may indicate the choice of the allograft over the other graft types in terms of post-surgical pain and functional weight-bearing ability in the short-term following Anterior Cruciate Ligament reconstruction. Introduction: Asymmetric gait patterns persist up to one year after Anterior Cruciate Ligament reconstruction (ACLR). Early