Short-term outcomes of treatment in children presenting with DDH in walking age - An analysis of 84 hips

BackgroundDevelopmental Dysplasia of Hip (DDH) presenting at walking age is not uncommon, particularly in developing countries. The available treatment modalities in this age group are closed reduction (CR), open reduction (OR), OR with additional femoral and/or pelvic osteotomy. This study was done in patients who presented between 12 and 36 months of age to assess the following: 1) Percentage of hips amenable for successful CR, 2) failure rate after CR and OR in walking age DDH and 3) the need for secondary procedures to address subluxation and residual dysplasia within first 2 years.Methodology: After IRB approval, the institutional database was searched for patients admitted with a diagnosis of DDH from January 2009 to January 2019. We identified 142 patients, of which 65 patients with 84 hips formed the study cohort after applying inclusion and exclusion criteria. Demographic details, details of the interventions, brace wear, revision procedures and radiological data were collected from Hospital Information System. We divided the patients in three groups: Group I - CR, Group II –OR, and Group III - OR with an additional bony procedure in the form of femoral and/or pelvic osteotomy.ResultsThe mean age at presentation was 20.1 months. We had 10 (11.9%) hips in group I, 39 (46.4%) hips in group II and 35 (41.6%) hips in group III. The mean follow-up was 44.8 months (24–132 months). In Group I, 5 (50%) had re-dislocation and 2 (20%) needed revision intervention for residual dysplasia. In Group II, 4 (10%) had re-dislocation and 4 (10%) needed revision intervention. In Group III, 5 (14.2%) hips needed revision intervention for residual dysplasia. The mean final AI was 24.6°in Group I, 28.2° in Group II and 26.3°in Group III. There was no significant difference in the final AI between the groups (p > 0.05).ConclusionsAn attempted closed reduction has a 50% failure rate, and we recommend a low threshold for open reduction. There is a 10% rate of re-dislocation following open reduction with or without additional bony procedure. About 50% of the dysplastic hips treated without pelvic osteotomy at the time of index procedure fail to remodel and have residual acetabular dysplasia.     

脑卒中患者步行功能的恢复

目的：探讨康复治疗对脑卒中患者行步功能恢复的影响，方法：采用以Ｂｏｂａｔｈ和Ｂｒｕｎｎｓｔｒｏｍ方法为主的康复治疗技术，并配合传统按摩疗法和功能性电刺激，对急性脑卒中患者进行了临床对照性研究，对恢复期患者进行了临床观察。结果康复治疗后，病程在１个月的患者的独立步行恢复率为７２．００％，与对照组（１４．７１％）相比差异显著（Ｐ〈０．００１）；恢复早期（病后１～３月）患者的独立步行恢复率为７７．７８％     

Construct and predictive validity of a self-reported measure of preclinical mobility limitation

OBJECTIVES: To validate self-reported preclinical mobility limitation concept and self-report assessment method against muscle power and walking speed, and to study the predictive validity of preclinical mobility limitation with respect to future risk of manifest mobility limitation. DESIGN: Observational prospective cohort study and cross-sectional analysis. SETTING: Research laboratory and community. PARTICIPANTS: A total of 632 community-living (age range, 75-81 y) women and men took part in the baseline assessments and 302 persons in the semi-annual interviews on mobility limitation over 2 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Walking speed, muscle power, and self-reported preclinical and manifest mobility limitation. Preclinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty. At baseline, 4 subgroups were created according to self-reported preclinical mobility limitation in any of 3 mobility tasks (walking 2 km, walking 0.5 km, climbing up stairs): no limitation, preclinical limitation, and minor and major manifest limitation. RESULTS: At baseline, participants with preclinical mobility limitation showed intermediate levels of walking speed and muscle power, compared with those with no limitation or manifest mobility limitation. Participants reporting baseline preclinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline, whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation. CONCLUSIONS: The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability.     

The effects of a temporarily manipulated dental occlusion on the position of the spine: a comparison during standing and walking

Background context

The relationship between dental occlusion and body posture or even the spine position is often analyzed and confirmed. However, this relationship has not been systematically investigated for standing and walking.

Purpose

To examine whether a symmetric or asymmetric dental occlusion block, using 4 mm thick silicon panels, can significantly change the spine position (cervical, thoracic, or lumbar region) during standing and walking.

Study design

The following study is a cross-sectional study.

Patient sample

This study was carried out with 23 healthy subjects (18 women, 5 men) without discomfort in the temporomandibular system or body movement apparatus.

Outcome measures

Position changes (millimeter) of the spine (cervical, thoracic, lumbar) in frontal, sagittal, and transverse planes of motion.

Methods

The upper spine position was quantified with an ultrasonic distance measurement system (sonoSens Monitor). Every subject placed the 4 mm thick silicon panel systematically between the left/right premolars or the front teeth. Differences between the habitual and manipulated occlusion positions were determined by the Friedman test, followed by pairwise comparisons with applied Bonferroni-Holm correction.

Results

During standing and walking there were significant (p≤.05) differences between the occlusion block conditions and the habitual dental position in all body planes except in the right lumbar region during walking. In addition, differences within the manipulated occlusion position could be detected. Significant differences were also shown between the standing and walking trials in the frontal, sagittal, and transverse planes, particularly with respect to the lumbar region (p≤.001).

Conclusions

Symmetrical and asymmetrical occlusion blocks in the premolar region can be associated with changes in all three spine regions during standing and walking. The results showed highly similar reaction patterns in all spine positions, regardless of the location of the silicon panel. Between standing and walking, the main differences were in the lumbar spine. The results suggest a relationship between the chewing and the movement system. However, it must be stated that this study has no direct clinical impact. The study design cannot determine the causality of the observed associations; also the clinical significance of the small postural changes remains unknown.     

Longitudinal construct validity and responsiveness of measures of walking capacity in individuals with lumbar spinal stenosis

Background contextWalking capacity is a primary outcome indicator for individuals with lumbar spinal stenosis (LSS). Therefore, there is a demand for psychometrically sound measures of walking that are responsive to change.PurposeThe primary objective of this study was to examine longitudinal construct validity of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire (PF Scale), the Oswestry Disability Index (ODI), and the walking capacity items from these scales specifically for the assessment of walking capacity in LSS using the objective Self-Paced Walking Test (SPWT) as the external standard. A secondary objective was to examine responsiveness of measures of walking using a self-reported walking capacity change scale as the external criterion standard.Study designPatients were prospectively enrolled.Patient sampleTwenty-six patients were included in this study (17 women and 9 men), with an average age of 68.5 years (SD, 9.2). All participants had LSS diagnosed by a spine specialist surgeon based on both clinical examination and imaging, as well as self-reported walking limitations (neurogenic claudication).Outcome measuresThe self-reported outcome measures included in this study were PF Scale, ODI, and self-reported walking capacity change score.Functional measuresThe functional measure used in the study was SPWT.MethodsLongitudinal construct validity was assessed using the correlational method. Internal responsiveness was examined using Guyatt responsiveness index and external responsiveness using receiver operating characteristic analysis. Change in the SPWT and the self-reported walking capacity change score were used as external criteria for the analysis.ResultsThe highest correlations with change in the SPWT were 0.78 for the ODI walking item and 0.78 for the walking capacity change score. Changes in the PF Scale and ODI score were correlated with change in the criterion SPWT at r=0.56 and r=0.70, respectively. There were no differences observed between the PF Scale and ODI for any of the responsiveness indices.ConclusionsThe PF Scale, ODI, and walking capacity change score are able to detect changes in walking capacity in people with LSS. The individual walking capacity item from the ODI appears to be the most valid and responsive to changes in measured walking and may be a reasonable alternative for measuring walking when an objective test such as the SPWT is not feasible.     

A pilot study of mindful walking training on physical activity and health outcomes among adults with inadequate activity

IntroductionMindful walking is a meditation practice that combines physical activity and mindfulness practice. Some mindful walking interventions expect four weeks of attendance (as compared with the traditional 8-week models of mindfulness-based interventions, or MBIs), a practice that could make MBIs more accessible to working-age adults. This study examined whether a 4-week mindful walking intervention increased physical activity and improved mental health outcomes.MethodsWe conducted a randomized experiment among adults with inadequate physical activity (N = 38), whereby the intervention group received a four-week, one-hour-per-week mindful walking intervention and the control group received instructions to increase physical activity. Everyone in both groups received a wrist-worn step count device as participation incentive. Physical activity (as measured by the Rapid Assessment of Physical Activity questionnaire, RAPA) and other health outcomes were assessed with online surveys at baseline (T1), post-intervention (T2), and one month after the intervention (T3). Those mental health outcomes included perceived stress (Perceived Stress Scale), depression (Brief Edinburgh Depression Scale), and Mental Health Inventory (MHI). The primary outcome of device-measured step count was recorded at T1 and T2. Independent two-sample t-tests were used to compare the primary outcomes at T1. Generalized linear mixed models (GLMM) with a random intercept for each subject were used to compare the two groups on the primary outcomes at all time points. The independent variables in the model included a binary variable for group assignment (intervention vs. control), a 3-level categorical variable for time, and their interaction. Age, gender and race/ethnicity are used as covariates in the model. Estimated changes (either differences or ratios between outcomes at time points T1 and T2/T3) are reported to assess change within groups.ResultsBoth groups exhibited significant improvements in the RAPA measures of physical activity and depression. However, between-group differences were not statistically significant. There was no within-group or between-group difference on device-measured step count, though both groups yielded an average daily step count close to the recommended level of 8,000 steps per day for older adults. The intervention group exhibited a significant reduction in perceived stress, and this reduction was significantly greater than that of the control group at T2 (p = .025) although the difference was insignificant at T3. No significant difference in MHI was found.DiscussionWhile these adults with inadequate physical activity increased their physical activity, no significant between-group differences in physical activity were identified. Potential reasons for the lack of significant findings could be due to the ceiling effect (the step count device for everyone in both groups might have encouraged more activity in both groups), limited sample size and low-dose 4-week intervention used in this study. On the other hand, it is encouraging to see that this low-dose, short-duration 4-week intervention (as compared with those popular 8-week MBIs) achieved significantly greater stress reduction among the intervention group than among the control group, even though the between-group difference at one-month follow-up was statistically insignificant. Further studies with larger sample sizes and longer follow-up are needed to assess the possible benefits of these short-duration mindful walking interventions.     

功能矫正贴扎技术改善脑卒中后足下垂患者步行功能的即刻效果观察

目的:评价肌内效贴中较常用的功能矫正贴扎技术改善脑卒中后足下垂患者步行功能的即刻效果。方法:选取60例脑卒中后足下垂患者,随机分为试验贴扎组(KT组)、安慰贴扎组(PT组)、空白贴扎组(ZT组)各20例。KT组使用肌内效贴布实施足下垂功能矫正贴扎技术,PT组使用相同品牌、规格、颜色的肌内效贴布施行安慰性贴扎,ZT组不实施任何贴扎。KT组、PT组患者贴扎前后分别进行评估,ZT组患者间隔20min进行2次评估,评估指标采用10m步行测试(10MWT)、TUGT起立-行走计时测试及Berg平衡量表(BBS)等。结果:3组患者行功能矫正贴扎后,KT组10m步行及TUGT所需的时间较贴扎前及PT组和ZT组均明显减少(P0.05),PT组和ZT组干预前后比较差异无统计学意义。3组贴扎前后及组间的BBS评分比较均差异无统计学意义。结论:功能矫正贴扎技术能即刻改善脑卒中后足下垂患者步行功能,在平衡能力的改善及长期疗效方面仍有待进一步研究。     

The dynamic relationship between cognitive function and walking speed: the English Longitudinal Study of Ageing

Cognitive deficiency and oxidative stress have been well documented in aging and in neurodegenerative disorders such as Alzheimer’s disease. In this study, we assessed the therapeutic effect of polyprenols on d-galactose-induced cognitive impairment in mice by testing on of behavioral and cognitive performance. In order to explore the possible role of polyprenols against d-galactose-induced oxidative damages, we assessed various biochemical indicators. Chronic administration of d-galactose (150 mg/kg·d, s.c.) for 7 weeks significantly impaired cognitive performance (both in step-through passive and active avoidance tests) and locomotor activity (in open-field test) and the ability of spatial learning and memory (in Morris water maze test) compared with the control group. The results revealed that polyprenols treatment for 2 weeks significantly ameliorated model mice’s cognitive performance and oxidative defense. All groups of polyprenols enhanced the learning and memory ability in step-through passive and active avoidance tests, locomotor activity in open-field test, and the ability of spatial learning and memory in Morris water maze test. Furthermore, high and middle level of polyprenols significantly increased total antioxidative capacity (T-AOC), glutathione peroxidase (GSH-Px), super oxide dismutase (SOD) activity, neprilysin (NEP), and β-site AβPP cleaving enzyme 1 (BACE1) expression, while nitric oxide (NO), nitric oxide synthase (NOS) activity, malondialdehyde (MDA) concentration, and the level of Aβ1-42 and presenilin 1 (PS1) were decreased. Polyprenols have a significant relieving effect on learning, memory, and spontaneous activities in a d-galactose-induced mouse model and ameliorates cognitive impairment and biochemical dysfunction in mice. In summary, we have demonstrated that polyprenols may ameliorate memory and cognitive impairment via enhancing oxidative defense and affecting generation and dissimilation of Aβ-related enzymes, suggesting that polyprenols represent a novel drug for treating Alzheimer’s disease.     

Kinematic changes in patients with severe knee osteoarthritis are a result of reduced walking speed rather than disease severity

BackgroundKinematic changes in patients with knee osteoarthritis (OA) have been extensively studied. Concerns have been raised whether the measured spatiotemporal and kinematic alterations are associated with disease progression or merely a result of reduced walking speed.Research question: The purpose of this study was to investigate the effect of walking speed on kinematic parameters in patients with knee OA using statistical parametric mapping (SPM).MethodsTwenty-three patients with unilateral knee OA scheduled for a total knee replacement and 28 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal plane kinematics were measured in the hip, knee, and ankle using the inertial sensors system RehaGait® while walking at a self-selected normal (patients and controls) and slow walking speed (controls) for a distance of 20 m. Gait parameters were compared between groups for self-selected walking speed and for matched walking speed using SPM with independent sample t tests.ResultsAt self-selected walking speed, patients had significantly lower knee flexion during stance (maximum difference, -6.8°) and during swing (-11.0°), as well as higher ankle dorsiflexion during stance phase (+12.5°) and lower peak hip extension at the end of stance compared to controls (+4.2°). At matched speed, there were no significant differences in joint kinematics between groups.SignificanceDifferences in sagittal plane gait kinematics between patients with knee OA and asymptomatic controls appear to be mainly a result of reduced walking speed. These results emphasize the importance of considering walking speed in research on gait kinematics in patients with knee OA and in clinical trials using gait parameters as outcome measures.     

The impact of motor task and environmental constraints on gait patterns during treadmill walking in a fully immersive virtual environment

BackgroundVirtual environments (VE) are increasingly used in rehabilitation settings for gait training, and positive effects are reported. However, little is known about how walking under environmental constraints and solving motor tasks in fully immersive VEs impact gait patterns.Research QuestionHow are gait patterns in healthy adults impacted by walking under environmental constraints and solving motor tasks on a treadmill, in a fully immersive VE?Methods29 healthy adults (age: 28.9±4.8 yrs) were included. Basic gait parameters (step length, cadence, walk ratio) and gait variability in the anteroposterior, mediolateral and vertical directions were measured using an inertial sensor attached to the lower back. A familiarisation treadmill walk >2 min was performed, followed by 200 m familiarisation walk in the VE with no task or environmental constraints The participants were then exposed to height, two grabbing tasks, a balancing task and narrow-path walking. Gait patterns were captured for 15–25 seconds during each of the conditions. The Simulator Sickness Questionnaire was completed before and after the session.ResultsGait regularity decreased when solving all the motor tasks, and under all the environmental constraints, except when being familiarised to height exposure, where regularity returned to pre-exposure levels. Step length and walk ratio decreased, and cadence increased during height exposure and while performing the grabbing tasks and the balancing task. The different tasks and environments appeared to have specific impact on gait patterns. There was no increase in simulator sickness symptoms.SignificanceGait patterns were impacted by solving motor tasks, and by environmental constraints, in healthy young adults, suggesting increased need for balance control. We suggest that VE-training on a treadmill holds potential for improving gait and balance control.