Changes to foot pressure pattern in post-stroke individuals who have started to walk independently during the convalescent phase

BackgroundAbnormal foot contact patterns following stroke affect functional gait; however, objective analysis targeting independent walking is lacking.Research questionHow do walking abilities and foot pressure patterns differ between post-stroke individuals who achieved independent walking and healthy controls? Secondarily, how do the abilities and patterns in post-stroke individuals change before and after achieving independent walking? Can these changes become criteria for permitting independent walking?MethodsTwenty-eight individuals with hemiplegia and 32 controls were enrolled. Motor dysfunction score (MDScore), walking speed (WSpeed), and foot pressure patterns were measured when they were first able to walk without orthosis or physical assistance (1st assessment) and when they achieved independent walking around discharge (2nd assessment). Foot pressure patterns were measured using insole-type foot pressure-measuring system. Ratios of partial foot pressure to body weight (%PFP), ratios of anteroposterior length of center of pressure (COP; %Long), and backward moving distance of COP to the foot length (%Backward) were calculated. Parameters during the 2nd assessment were compared with those of controls and those during the 1st assessment. During the 2nd assessment, relationships among the parameters, MDScore, and WSpeed were analyzed.ResultsDuring the 2nd assessment, no difference was observed in both %Long and %Backward between the non-paretic limbs and the controls. While the %Backward was higher, the %PFP of toes and %Long were lower in the paretic limb than in the controls. Although the %Backward was lower, both %PFP of toes and %Long of the paretic limb were higher in the 2nd assessment than in the 1st assessment. During the 2nd assessment, both %Long and % Backward values of the paretic limb moderately correlated with MDScore and WSpeed.SignificanceAfter improvement of foot pressure in toes, both an increase in anteroposterior length and a decrease in backward moving of COP path were objective signs permitting independent walking.     

儿童踝关节背屈在步行中后期完成足廓清动作的作用分析

目的：探讨儿童踝关节背屈在步行中后期完成足廓清动作的重要性分析。方法将100例存在异常步态患儿随机分成两组，一组作为治疗组给予加强摆动相中后期踝关节背屈活动的康复训练，另一组作为对照组只给予常规康复训练。结果特别加强踝关节背屈训练组步行时足廓清动作显著改善，异常步态明显纠正。结论踝关节背屈对步行中后期完成足廓清动作进而纠正异常步行姿势有重要作用。     

更昔洛韦治疗小儿手足口合并病毒性脑炎122例疗效观察

目的：探讨更昔洛韦治疗小儿手足口合并病毒性脑炎的临床疗效。方法：122例患儿按入院顺序随机分为研究组和对照组，各61例，所有患儿均根据临床不良反应给予对症的物理降温、水电解质平衡纠正、补液、抗病毒治疗、脑神经营养等，研究组在此基础上加用更昔洛韦。结果：经治疗研究组患儿总有效率明显高于对照组，数据经统计学比较具有显著差异(P<0.05)。患儿退热时间比较两组间数据无显著差异(P>0.05)，研究组疱疹消退时间、神经体征缓解时间和平均住院时间均明显短于对照组，数据经统计学比较具有极显著差异(P<0.01)。结论：更昔洛韦不仅可达到更好的治疗效果，还有助于提高治疗效率、加快改善患儿的临床不良反应，适合于手足口病合并病毒性脑炎的临床治疗。     

Imaging of haemophilic arthropathy in growing joints: pitfalls in ultrasound and MRI

The purpose of this review was to summarize the current knowledge on the utilization of magnetic resonance imaging (MRI) and ultrasound (US) for assessing arthropathy in children and adolescents with haemophilia and to recognize the limitations of each imaging modality and pitfalls in the diagnosis of soft tissue and osteochondral abnormalities. Awareness of MRI and US limitations and pitfalls in the assessment of joints in persons with haemophilia is essential for accurate diagnosis and optimal management of haemophilic arthropathy.     

EFAS Score —Validation of Persian Version by the Score Committee of the European Foot and Ankle Society (EFAS)

BackgroundThe Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish). From other languages under validation, the Persian version finished data acquisition and underwent further validation.MethodsThe Persian version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Persian version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.ResultsThe internal consistency was confirmed in the Persian version (Cronbach’s Alpha 0.82). The Standard Error of Measurement (SEM) was 0.38 and is similar to other language versions. Between baseline and follow-up, 97% of patients showed an improvement on their EFAS score, with excellent responsiveness (effect size 1.93).ConclusionsThe Persian EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.     

Relapse of Clubfoot after Treatment with the Ponseti Method and the Function of the Foot Abduction Orthosis

Ponseti clubfoot treatment has become more popular during the last decade because of its high initial correction rate. But the most common problem affecting the long-term successful outcome is relapse of the deformity. Non-compliance with Ponseti brace protocol is a major problem associated with relapse. Although more comfortable braces have been reported to improve the compliance, they all have the same design and no significant changes have been made to the protocols. After refinement in the Ponseti method and emphasizing the importance of brace to parents, the relapse rate has been markedly decreased. Nevertheless, there are patients who do not have any recurrence although they are not completely compliant with the brace treatment, whereas other patients have a recurrence even though they are strictly compliant with the brace treatment. The aim of this article is to review the relapse of clubfoot and the function of the brace and to develop an individualized brace protocol for each patient by analyzing the mechanism of the brace and the biomechanical properties of muscles, tendons, and ligaments.     

The effect of emphasis and position on word identification by adult cochlear implant listeners

Phonological awareness has been claimed to play an important role in the development of language skills, and it is essential that the child's phonological skills be assessed accurately in order to predict and to take early measures to help those that may encounter problems. Although the mora has attracted much attention in the discussion of phonological knowledge and phonological skills of Japanese, to our knowledge there are no previous studies that have assessed disordered speech of Japanese purely from the viewpoint of prosodic levels higher than the mora. In order to fill in this gap, this paper will present data from a child with ‘unintelligible speech’. The longitudinal data (4; 11 to 8;6) collected from spontaneous Japanese speech were analysed from the perspective of phonological markedness. The evidence so far indicates that even within severely distorted speech, it may be possible to tease out systematic errors that seem to suggest the existence of unmarked phonological structures such as the bimoraic foot. This finding suggests that in order to accurately assess a child's phonological ability, many different levels within the phonological hierarchy should be taken into consideration.     

足针配合项针治疗重型脑卒中的临床疗效观察

目的：观察足针配合项针治疗重型脑卒中的临床疗效。方法：足针疗法治疗重型脑卒中，有吞咽困难或失语患者配合项针治疗。结果：治疗后总有效率为95％。结论：足针配合项针治疗脑卒中疗效显著。