Hypothesis: To better understand individual variability by examining overall neurocognitive underlying features in children with cochlear implants (CIs), and to investigate whether previous findings hold constant in Asian-language users. Background: Studies have tried to explain the individual variability in children with CIs. However, performance on experience-dependent tasks does not seem to be sensitive enough to explain the underlying reason why children have language difficulties even after the surgical procedure. Thus, this current research has focused on underlying neurocognitive functions to better explain the reason for the wide variability in this population. Methods: Using a separate univariate analysis paradigm, performance on processing-based tasks was compared between children with CIs and children with normal hearing. A total of 34 children ranging from 10 to 12 years old participated in the study. There were two different categories of processing-based tasks tapping processing capacity and processing speed. This study used nonword repetition (NWR), competing language processing task (CLPT), and counting span (CS) for examining processing capacity, while rapid naming (RAN) in color, shape, and color shape were used to investigate processing speed. Results: Children with NH outperformed children with CIs on all processing-capacity tasks, except CS. Children with CIs performed similarly to children with NH on processing speed tasks. Conclusions: We found children with CIs still experienced difficulties with processing capacity. Due to cross-linguistic features, we also discovered some interesting findings that differed from previous studies. Lastly, we found processing speed was fairly intact in children with CIs, which is a new finding. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Παρασκευή 1 Σεπτεμβρίου 2017
Editorial Board
Source:Journal of Voice, Volume 31, Issue 5
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Calendar Listings
Source:Journal of Voice, Volume 31, Issue 5
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Gardasil Vaccination for Recurrent Laryngeal Papillomatosis in Adult Men Second Report: Negative Conversion of HPV in Laryngeal Secretions
Source:Journal of Voice
Author(s): Ryoji Hirai, Kiyoshi Makiyama, Hiroumi Matsuzaki, Takeshi Oshima
BackgroundIn our first report on antibody levels in middle-aged and older men with recurrent laryngeal papillomatosis (RLP), we reported increases in human papillomavirus (HPV) antibody levels similar to those seen in adult women and young men. We posited that HPV antibodies produced in laryngeal mucus by Gardasil would prevent postoperative reinfection in patients with RLP.Study DesignThis is a case series study.PurposeThe purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence of RLP. Specifically, in this second report, whether HPV antibodies produced in laryngeal secretions by Gardasil are capable of causing negative conversion of HPV-DNA (deoxyribonucleic acid) in laryngeal mucosa was investigated.MethodsA total of 11 patients for whom antibodies were measured in the first report were studied. Before vaccination and after 1 year Post-vaccination, HPV screening tests were performed on laryngeal secretions, and whether HPV-DNA negative conversion had occurred was evaluated. At the time of collection of laryngeal secretions, the presence or absence of laryngeal papillomas was examined.ResultsBefore vaccination, all patients were HPV low-risk positive on laryngeal secretion screening tests. After vaccination, three patients were positive. Laryngeal papillomas remained in five patients.ConclusionsThe HPV-DNA test showed negative conversion in eight of 11 (72.7%) patients after vaccination. Residual laryngeal papillomas were found in five of 11 (45.5%) patients. The serum HPV antibody titer did not differ significantly between the group in which laryngeal secretions showed HPV negative conversion and the group in which conversion did not occur. The serum antibody titer did not differ significantly as a function of whether there were residual tumors.
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Proton Pump Inhibitor-related Mortality: Let Us Not Be Dead Wrong
Source:Journal of Voice, Volume 31, Issue 5
Author(s): Brian J. McKinnon, Mary J. Hawkshaw, Robert T. Sataloff
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Hyaluronidase Injection in the Vocal Folds for Vocal Hemorrhage, Reinke Edema, and Hyaluronic Acid Overinjection: A Novel Application in the Larynx
Source:Journal of Voice
Author(s): Peak Woo
Hyaluronidase (HAase) injection into the vocal folds is an off-label use of an enzyme for liquefaction of hyaluronic acid (HA). HAase injection was performed in 14 cases in 13 patients. Office and operative injections of HAase were performed. The indications were five cases of overinjection of HA, six cases of Reinke edema and polypoid corditis, and three cases of acute vocal hemorrhage with early fusiform polyp formation. All the patients tolerated the HAase without complications. Significant voice improvements were noted between pre- and postinjection procedures as evaluated by a self-rating of voice by the Voice Handicap Index-10. A marked decrement in the mass on the side of the injection of HAase was noted in all groups successfully injected upon viewing by videostroboscopy. HAase prevented an additional operative phonosurgery in 10 patients. In conclusion, HAase injection can be used in the vocal folds with good effect in patients. The indications are polypoid corditis with overproduction of HA, acute vocal hemorrhage, and correction of iatrogenic HA overinjection.
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Instructions for Contributors
Source:Journal of Voice, Volume 31, Issue 5
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The Impact of Glottal Configuration on Speech Breathing
Source:Journal of Voice
Author(s): Elizabeth S. Heller Murray, Carolyn M. Michener, Laura Enflo, Gabriel J. Cler, Cara E. Stepp
ObjectiveThe purpose of this study was to examine whether changes in respiratory patterns occurred in response to volitional changes in glottal configuration.MethodsTwelve vocally healthy participants read a passage while wearing the Inductotrace respiratory inductive plethysmograph, which measures the excursions of the rib cage and abdomen. Participants read the passage 5 times in a typical speaking voice (baseline phase), 10 times in an experimental voice, which was similar to a breathy vocal quality (experimental phase), and 5 times again in a typical speaking voice (return phase). Kinematic estimates of lung volume (LV) initiation, LV termination, and LV excursion were collected for each speech breath.ResultsParticipants spoke with larger LV excursions during the experimental phase, characterized by increased LV initiation and decreased LV termination compared with the baseline phase.ConclusionIn response to volitional changes in glottal configuration, healthy individuals spoke with increased LV excursion. They both responded to changes (decreasing LV termination) and planned for more efficient future utterances (increasing LV initiation) during the experimental phase. This study demonstrated that respiratory patterns change in response to changes in glottal configuration; future work will examine these patterns in individuals with voice disorders.
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Emotional recognition of dynamic facial expressions before and after cochlear implantation in adults with progressive deafness
Publication date: Available online 31 August 2017
Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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The Ida Institute Celebrates its 10th Anniversary
The Ida Institute (http://ift.tt/16PvbiE) celebrates 10 years of providing hearing health professionals with the resources they need to offer patient-centered care on Sept. 1. To date, the nonprofit based in Denmark has built a community of 12,000 members, and has developed a large portfolio of counseling tools that address various issues from client motivation and engagement as well as adult and pediatric rehabilitation to more specific issues like tinnitus and balance disorders.
The Ida Institute also has a telehealth platform that allows audiologists to extend their services beyond the appointment and a new learning and discussion online space, the Ida Learning Hall, where hearing health professionals can hone their counseling skills and learn more about person-centered care.
Founder and managing director of the Ida Institute Lise Lotte Bundesen said their work in promoting person-centered care is more relevant than ever. "Despite the sophisticated technology that is available today, the uptake and acceptance of hearing technology is still lacking," she said. "This is a problem both for individuals with hearing loss and for society as a whole. We believe the only way forward is to find ways to motivate and engage people in their own treatment, and this is essentially what the Ida Institute is about."
Published: 9/1/2017 9:29:00 AM
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Emotional recognition of dynamic facial expressions before and after cochlear implantation in adults with progressive deafness
Publication date: Available online 31 August 2017
Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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The Ida Institute Celebrates its 10th Anniversary
The Ida Institute (http://ift.tt/16PvbiE) celebrates 10 years of providing hearing health professionals with the resources they need to offer patient-centered care on Sept. 1. To date, the nonprofit based in Denmark has built a community of 12,000 members, and has developed a large portfolio of counseling tools that address various issues from client motivation and engagement as well as adult and pediatric rehabilitation to more specific issues like tinnitus and balance disorders.
The Ida Institute also has a telehealth platform that allows audiologists to extend their services beyond the appointment and a new learning and discussion online space, the Ida Learning Hall, where hearing health professionals can hone their counseling skills and learn more about person-centered care.
Founder and managing director of the Ida Institute Lise Lotte Bundesen said their work in promoting person-centered care is more relevant than ever. "Despite the sophisticated technology that is available today, the uptake and acceptance of hearing technology is still lacking," she said. "This is a problem both for individuals with hearing loss and for society as a whole. We believe the only way forward is to find ways to motivate and engage people in their own treatment, and this is essentially what the Ida Institute is about."
Published: 9/1/2017 9:29:00 AM
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The Ida Institute Celebrates its 10th Anniversary
The Ida Institute (http://ift.tt/16PvbiE) celebrates 10 years of providing hearing health professionals with the resources they need to offer patient-centered care on Sept. 1. To date, the nonprofit based in Denmark has built a community of 12,000 members, and has developed a large portfolio of counseling tools that address various issues from client motivation and engagement as well as adult and pediatric rehabilitation to more specific issues like tinnitus and balance disorders.
The Ida Institute also has a telehealth platform that allows audiologists to extend their services beyond the appointment and a new learning and discussion online space, the Ida Learning Hall, where hearing health professionals can hone their counseling skills and learn more about person-centered care.
Founder and managing director of the Ida Institute Lise Lotte Bundesen said their work in promoting person-centered care is more relevant than ever. "Despite the sophisticated technology that is available today, the uptake and acceptance of hearing technology is still lacking," she said. "This is a problem both for individuals with hearing loss and for society as a whole. We believe the only way forward is to find ways to motivate and engage people in their own treatment, and this is essentially what the Ida Institute is about."
Published: 9/1/2017 9:29:00 AM
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Emotional recognition of dynamic facial expressions before and after cochlear implantation in adults with progressive deafness
Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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Emotional recognition of dynamic facial expressions before and after cochlear implantation in adults with progressive deafness
Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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Emotional recognition of dynamic facial expressions before and after cochlear implantation in adults with progressive deafness
Source:Hearing Research
Author(s): Emmanuèle Ambert-Dahan, Anne-Lise Giraud, Halima Mecheri, Olivier Sterkers, Isabelle Mosnier, Séverine Samson
Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post-lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post-lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant-pleasant) and arousal potential (relaxing-stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard et al., 2017). Altogether these results suggest there to be a trade-off between the processing of linguistic and non-linguistic visual stimuli.
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Biomechanical analysis of gait waveform data: exploring differences between shod and barefoot running in habitually shod runners
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Nicholas Tam, Danielle Prins, Nikhil V. Divekar, Robert P. Lamberts
The aim of this study was to utilise one-dimensional statistical parametric mapping to compare differences between biomechanical and electromyographical waveforms in runners when running in barefoot or shod conditions.Fifty habitually shod runners were assessed during overground running at their current 10-km race running speed. Electromyography, kinematics and ground reaction forces were collected during these running trials. Joint kinetics were calculated using inverse dynamics. One-dimensional statistical parametric mapping one sample t-test was conducted to assess differences over an entire gait cycle on the variables of interest when barefoot or shod (p<0.05).Only sagittal plane differences were found between barefoot and shod conditions at the knee during late stance (18–23% of the gait cycle) and swing phase (74–90%); at the ankle early stance (0–6%), mid-stance (28–38%) and swing phase (81–100%). Differences in sagittal plane moments were also found at the ankle during early stance (2, 4–5%) and knee during early stance (5–11%). Condition differences were also found in vertical ground reaction force during early stance between (3–10%).An acute bout of barefoot running in habitual shod runners invokes temporal differences throughout the gait cycle. Specifically, a co-ordinative responses between the knee and ankle joint in the sagittal plane with a delay in the impact transient peak; onset of the knee extension and ankle plantarflexion moment in the shod compared to barefoot condition was found. This appears to affect the delay in knee extension and ankle plantarflexion during late stance. This study provides a glimpse into the co-ordination of the lower limb when running in differing footwear.
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Source:Gait & Posture, Volume 58
Author(s): Nicholas Tam, Danielle Prins, Nikhil V. Divekar, Robert P. Lamberts
The aim of this study was to utilise one-dimensional statistical parametric mapping to compare differences between biomechanical and electromyographical waveforms in runners when running in barefoot or shod conditions.Fifty habitually shod runners were assessed during overground running at their current 10-km race running speed. Electromyography, kinematics and ground reaction forces were collected during these running trials. Joint kinetics were calculated using inverse dynamics. One-dimensional statistical parametric mapping one sample t-test was conducted to assess differences over an entire gait cycle on the variables of interest when barefoot or shod (p<0.05).Only sagittal plane differences were found between barefoot and shod conditions at the knee during late stance (18–23% of the gait cycle) and swing phase (74–90%); at the ankle early stance (0–6%), mid-stance (28–38%) and swing phase (81–100%). Differences in sagittal plane moments were also found at the ankle during early stance (2, 4–5%) and knee during early stance (5–11%). Condition differences were also found in vertical ground reaction force during early stance between (3–10%).An acute bout of barefoot running in habitual shod runners invokes temporal differences throughout the gait cycle. Specifically, a co-ordinative responses between the knee and ankle joint in the sagittal plane with a delay in the impact transient peak; onset of the knee extension and ankle plantarflexion moment in the shod compared to barefoot condition was found. This appears to affect the delay in knee extension and ankle plantarflexion during late stance. This study provides a glimpse into the co-ordination of the lower limb when running in differing footwear.
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Associations of prolonged standing with musculoskeletal symptoms—A systematic review of laboratory studies
Source:Gait & Posture, Volume 58
Author(s): Pieter Coenen, Sharon Parry, Lisa Willenberg, Joyce W. Shi, Lorena Romero, Diana M. Blackwood, Genevieve N. Healy, David W Dunstan, Leon M. Straker
While prolonged standing has shown to be detrimentally associated with musculoskeletal symptoms, exposure limits and underlying mechanisms are not well understood. We systematically reviewed evidence from laboratory studies on musculoskeletal symptom development during prolonged (≥20min) uninterrupted standing, quantified acute dose-response associations and described underlying mechanisms.Peer-reviewed articles were systematically searched for. Data from included articles were tabulated, and dose-response associations were statistically pooled. A linear interpolation of pooled dose-response associations was performed to estimate the duration of prolonged standing associated with musculoskeletal symptoms with a clinically relevant intensity of ≥9 (out of 100).We included 26 articles (from 25 studies with 591 participants), of which the majority examined associations of prolonged standing with low back and lower extremity symptoms. Evidence on other (e.g., upper limb) symptoms was limited and inconsistent. Pooled dose-response associations showed that clinically relevant levels of low back symptoms were reached after 71min of prolonged standing, with this shortened to 42min in those considered pain developers. Regarding standing-related low back symptoms, consistent evidence was found for postural mechanisms (i.e., trunk flexion and lumbar curvature), but not for mechanisms of muscle fatigue and/or variation in movement. Blood pooling was the most consistently reported mechanism for standing-related lower extremity symptoms.Evidence suggests a detrimental association of prolonged standing with low back and lower extremity symptoms. To avoid musculoskeletal symptoms (without having a-priori knowledge on whether someone will develop symptoms or not), dose-response evidence from this study suggests a recommendation to refrain from standing for prolonged periods >40min. Interventions should also focus on underlying pain mechanisms.
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Clinical measures of balance in people with type two diabetes: A systematic literature review
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): C.J. Dixon, T. Knight, E. Binns, B. Ihaka, D. O’Brien
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN.Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool.Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index.Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Source:Gait & Posture, Volume 58
Author(s): C.J. Dixon, T. Knight, E. Binns, B. Ihaka, D. O’Brien
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN.Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool.Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index.Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Effects of flexible and rigid rocker profiles on in-shoe pressure
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Roy Reints, Juha M. Hijmans, Johannes G.M. Burgerhof, Klaas Postema, Gijsbertus J. Verkerke
Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.
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Source:Gait & Posture, Volume 58
Author(s): Roy Reints, Juha M. Hijmans, Johannes G.M. Burgerhof, Klaas Postema, Gijsbertus J. Verkerke
Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.
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Factors influencing knee adduction moment measurement: A systematic review and meta-regression analysis
Source:Gait & Posture, Volume 58
Author(s): Scott Telfer, Moritz J. Lange, Amanda S.M. Sudduth
The external knee adduction moment has been identified as a key biomarker in biomechanics research, with associations with this variable and degenerative diseases such as knee osteoarthritis. Heterogeneity in participant characteristics and the protocols used to measure this variable may however complicate its interpretation. Previous reviews have focused on interventions or did not control for potential moderator variables in their analysis. In this meta-regression analysis, we aimed to determine the influence of factors including the cohort type, footwear, and walking speed on the measurement of knee adduction moment. We performed a systematic review of the literature, identifying articles that used the Plug-in-Gait inverse dynamics model to calculate the knee adduction moment during level walking, and used a mixed effect model to determine the effect of the previously described factors on the measurement. Results for 861 individuals were described in 19 articles. Walking speed had the largest influence on knee adduction moment (p<0.001), and participants with medial knee osteoarthritis had an increased knee adduction moment (p=0.008) compared to healthy subjects. Footwear was found to have a significant overall effect (p=0.024). Participants tested barefoot or wearing their own shoes had lower adduction moments than those tested in footwear provided by the researchers. Overall, the moderators accounted for 60% of the heterogeneity in the results. These results support the hypothesis that an increased knee adduction moment is associated with medial compartment knee osteoarthritis, and that footwear choice can influence the results. Gait speed has the largest effect on knee adduction moment measurement and should be carefully controlled for in studies investigating this variable.
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Aging effect on step adjustments and stability control in visually perturbed gait initiation
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Ruopeng Sun, Chuyi Cui, John B. Shea
Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.
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Source:Gait & Posture, Volume 58
Author(s): Ruopeng Sun, Chuyi Cui, John B. Shea
Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.
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Adding motor control training to muscle strengthening did not substantially improve the effects on clinical or kinematic outcomes in women with patellofemoral pain: A randomised controlled trial
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Nayra Deise dos Anjos Rabelo, Leonardo Oliveira Pena Costa, Bruna Maria de Lima, Amir Curcio dos Reis, André Serra Bley, Thiago Yukio Fukuda, Paulo Roberto Garcia Lucareli
DesignRandomized controlled trial.BackgroundPatients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.MethodsThirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.ResultsThe MC&S group did not present significantly better function (MD −2.5 points, 95% CI;−10.7–5.5) or pain (MD −0.3 points, 95% CI;−1.7–1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD −8.5 points; 95% CI;−16.8 to −0.3). No significant between-group differences were observed for the other outcomes.ConclusionMovement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Source:Gait & Posture, Volume 58
Author(s): Nayra Deise dos Anjos Rabelo, Leonardo Oliveira Pena Costa, Bruna Maria de Lima, Amir Curcio dos Reis, André Serra Bley, Thiago Yukio Fukuda, Paulo Roberto Garcia Lucareli
DesignRandomized controlled trial.BackgroundPatients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.MethodsThirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.ResultsThe MC&S group did not present significantly better function (MD −2.5 points, 95% CI;−10.7–5.5) or pain (MD −0.3 points, 95% CI;−1.7–1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD −8.5 points; 95% CI;−16.8 to −0.3). No significant between-group differences were observed for the other outcomes.ConclusionMovement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson’s disease: A randomized controlled trial
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Roné Grobbelaar, Ranel Venter, Karen Estelle Welman
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
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Source:Gait & Posture, Volume 58
Author(s): Roné Grobbelaar, Ranel Venter, Karen Estelle Welman
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
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Biomechanical analysis of gait waveform data: exploring differences between shod and barefoot running in habitually shod runners
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Nicholas Tam, Danielle Prins, Nikhil V. Divekar, Robert P. Lamberts
The aim of this study was to utilise one-dimensional statistical parametric mapping to compare differences between biomechanical and electromyographical waveforms in runners when running in barefoot or shod conditions.Fifty habitually shod runners were assessed during overground running at their current 10-km race running speed. Electromyography, kinematics and ground reaction forces were collected during these running trials. Joint kinetics were calculated using inverse dynamics. One-dimensional statistical parametric mapping one sample t-test was conducted to assess differences over an entire gait cycle on the variables of interest when barefoot or shod (p<0.05).Only sagittal plane differences were found between barefoot and shod conditions at the knee during late stance (18–23% of the gait cycle) and swing phase (74–90%); at the ankle early stance (0–6%), mid-stance (28–38%) and swing phase (81–100%). Differences in sagittal plane moments were also found at the ankle during early stance (2, 4–5%) and knee during early stance (5–11%). Condition differences were also found in vertical ground reaction force during early stance between (3–10%).An acute bout of barefoot running in habitual shod runners invokes temporal differences throughout the gait cycle. Specifically, a co-ordinative responses between the knee and ankle joint in the sagittal plane with a delay in the impact transient peak; onset of the knee extension and ankle plantarflexion moment in the shod compared to barefoot condition was found. This appears to affect the delay in knee extension and ankle plantarflexion during late stance. This study provides a glimpse into the co-ordination of the lower limb when running in differing footwear.
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Source:Gait & Posture, Volume 58
Author(s): Nicholas Tam, Danielle Prins, Nikhil V. Divekar, Robert P. Lamberts
The aim of this study was to utilise one-dimensional statistical parametric mapping to compare differences between biomechanical and electromyographical waveforms in runners when running in barefoot or shod conditions.Fifty habitually shod runners were assessed during overground running at their current 10-km race running speed. Electromyography, kinematics and ground reaction forces were collected during these running trials. Joint kinetics were calculated using inverse dynamics. One-dimensional statistical parametric mapping one sample t-test was conducted to assess differences over an entire gait cycle on the variables of interest when barefoot or shod (p<0.05).Only sagittal plane differences were found between barefoot and shod conditions at the knee during late stance (18–23% of the gait cycle) and swing phase (74–90%); at the ankle early stance (0–6%), mid-stance (28–38%) and swing phase (81–100%). Differences in sagittal plane moments were also found at the ankle during early stance (2, 4–5%) and knee during early stance (5–11%). Condition differences were also found in vertical ground reaction force during early stance between (3–10%).An acute bout of barefoot running in habitual shod runners invokes temporal differences throughout the gait cycle. Specifically, a co-ordinative responses between the knee and ankle joint in the sagittal plane with a delay in the impact transient peak; onset of the knee extension and ankle plantarflexion moment in the shod compared to barefoot condition was found. This appears to affect the delay in knee extension and ankle plantarflexion during late stance. This study provides a glimpse into the co-ordination of the lower limb when running in differing footwear.
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Associations of prolonged standing with musculoskeletal symptoms—A systematic review of laboratory studies
Source:Gait & Posture, Volume 58
Author(s): Pieter Coenen, Sharon Parry, Lisa Willenberg, Joyce W. Shi, Lorena Romero, Diana M. Blackwood, Genevieve N. Healy, David W Dunstan, Leon M. Straker
While prolonged standing has shown to be detrimentally associated with musculoskeletal symptoms, exposure limits and underlying mechanisms are not well understood. We systematically reviewed evidence from laboratory studies on musculoskeletal symptom development during prolonged (≥20min) uninterrupted standing, quantified acute dose-response associations and described underlying mechanisms.Peer-reviewed articles were systematically searched for. Data from included articles were tabulated, and dose-response associations were statistically pooled. A linear interpolation of pooled dose-response associations was performed to estimate the duration of prolonged standing associated with musculoskeletal symptoms with a clinically relevant intensity of ≥9 (out of 100).We included 26 articles (from 25 studies with 591 participants), of which the majority examined associations of prolonged standing with low back and lower extremity symptoms. Evidence on other (e.g., upper limb) symptoms was limited and inconsistent. Pooled dose-response associations showed that clinically relevant levels of low back symptoms were reached after 71min of prolonged standing, with this shortened to 42min in those considered pain developers. Regarding standing-related low back symptoms, consistent evidence was found for postural mechanisms (i.e., trunk flexion and lumbar curvature), but not for mechanisms of muscle fatigue and/or variation in movement. Blood pooling was the most consistently reported mechanism for standing-related lower extremity symptoms.Evidence suggests a detrimental association of prolonged standing with low back and lower extremity symptoms. To avoid musculoskeletal symptoms (without having a-priori knowledge on whether someone will develop symptoms or not), dose-response evidence from this study suggests a recommendation to refrain from standing for prolonged periods >40min. Interventions should also focus on underlying pain mechanisms.
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Clinical measures of balance in people with type two diabetes: A systematic literature review
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): C.J. Dixon, T. Knight, E. Binns, B. Ihaka, D. O’Brien
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN.Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool.Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index.Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Source:Gait & Posture, Volume 58
Author(s): C.J. Dixon, T. Knight, E. Binns, B. Ihaka, D. O’Brien
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN.Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool.Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index.Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Effects of flexible and rigid rocker profiles on in-shoe pressure
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Roy Reints, Juha M. Hijmans, Johannes G.M. Burgerhof, Klaas Postema, Gijsbertus J. Verkerke
Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.
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Source:Gait & Posture, Volume 58
Author(s): Roy Reints, Juha M. Hijmans, Johannes G.M. Burgerhof, Klaas Postema, Gijsbertus J. Verkerke
Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.
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Factors influencing knee adduction moment measurement: A systematic review and meta-regression analysis
Source:Gait & Posture, Volume 58
Author(s): Scott Telfer, Moritz J. Lange, Amanda S.M. Sudduth
The external knee adduction moment has been identified as a key biomarker in biomechanics research, with associations with this variable and degenerative diseases such as knee osteoarthritis. Heterogeneity in participant characteristics and the protocols used to measure this variable may however complicate its interpretation. Previous reviews have focused on interventions or did not control for potential moderator variables in their analysis. In this meta-regression analysis, we aimed to determine the influence of factors including the cohort type, footwear, and walking speed on the measurement of knee adduction moment. We performed a systematic review of the literature, identifying articles that used the Plug-in-Gait inverse dynamics model to calculate the knee adduction moment during level walking, and used a mixed effect model to determine the effect of the previously described factors on the measurement. Results for 861 individuals were described in 19 articles. Walking speed had the largest influence on knee adduction moment (p<0.001), and participants with medial knee osteoarthritis had an increased knee adduction moment (p=0.008) compared to healthy subjects. Footwear was found to have a significant overall effect (p=0.024). Participants tested barefoot or wearing their own shoes had lower adduction moments than those tested in footwear provided by the researchers. Overall, the moderators accounted for 60% of the heterogeneity in the results. These results support the hypothesis that an increased knee adduction moment is associated with medial compartment knee osteoarthritis, and that footwear choice can influence the results. Gait speed has the largest effect on knee adduction moment measurement and should be carefully controlled for in studies investigating this variable.
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Aging effect on step adjustments and stability control in visually perturbed gait initiation
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Ruopeng Sun, Chuyi Cui, John B. Shea
Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.
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Source:Gait & Posture, Volume 58
Author(s): Ruopeng Sun, Chuyi Cui, John B. Shea
Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.
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Adding motor control training to muscle strengthening did not substantially improve the effects on clinical or kinematic outcomes in women with patellofemoral pain: A randomised controlled trial
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Nayra Deise dos Anjos Rabelo, Leonardo Oliveira Pena Costa, Bruna Maria de Lima, Amir Curcio dos Reis, André Serra Bley, Thiago Yukio Fukuda, Paulo Roberto Garcia Lucareli
DesignRandomized controlled trial.BackgroundPatients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.MethodsThirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.ResultsThe MC&S group did not present significantly better function (MD −2.5 points, 95% CI;−10.7–5.5) or pain (MD −0.3 points, 95% CI;−1.7–1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD −8.5 points; 95% CI;−16.8 to −0.3). No significant between-group differences were observed for the other outcomes.ConclusionMovement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Source:Gait & Posture, Volume 58
Author(s): Nayra Deise dos Anjos Rabelo, Leonardo Oliveira Pena Costa, Bruna Maria de Lima, Amir Curcio dos Reis, André Serra Bley, Thiago Yukio Fukuda, Paulo Roberto Garcia Lucareli
DesignRandomized controlled trial.BackgroundPatients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.MethodsThirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.ResultsThe MC&S group did not present significantly better function (MD −2.5 points, 95% CI;−10.7–5.5) or pain (MD −0.3 points, 95% CI;−1.7–1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD −8.5 points; 95% CI;−16.8 to −0.3). No significant between-group differences were observed for the other outcomes.ConclusionMovement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson’s disease: A randomized controlled trial
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Roné Grobbelaar, Ranel Venter, Karen Estelle Welman
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
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Source:Gait & Posture, Volume 58
Author(s): Roné Grobbelaar, Ranel Venter, Karen Estelle Welman
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
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Biomechanical analysis of gait waveform data: exploring differences between shod and barefoot running in habitually shod runners
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Nicholas Tam, Danielle Prins, Nikhil V. Divekar, Robert P. Lamberts
The aim of this study was to utilise one-dimensional statistical parametric mapping to compare differences between biomechanical and electromyographical waveforms in runners when running in barefoot or shod conditions.Fifty habitually shod runners were assessed during overground running at their current 10-km race running speed. Electromyography, kinematics and ground reaction forces were collected during these running trials. Joint kinetics were calculated using inverse dynamics. One-dimensional statistical parametric mapping one sample t-test was conducted to assess differences over an entire gait cycle on the variables of interest when barefoot or shod (p<0.05).Only sagittal plane differences were found between barefoot and shod conditions at the knee during late stance (18–23% of the gait cycle) and swing phase (74–90%); at the ankle early stance (0–6%), mid-stance (28–38%) and swing phase (81–100%). Differences in sagittal plane moments were also found at the ankle during early stance (2, 4–5%) and knee during early stance (5–11%). Condition differences were also found in vertical ground reaction force during early stance between (3–10%).An acute bout of barefoot running in habitual shod runners invokes temporal differences throughout the gait cycle. Specifically, a co-ordinative responses between the knee and ankle joint in the sagittal plane with a delay in the impact transient peak; onset of the knee extension and ankle plantarflexion moment in the shod compared to barefoot condition was found. This appears to affect the delay in knee extension and ankle plantarflexion during late stance. This study provides a glimpse into the co-ordination of the lower limb when running in differing footwear.
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Source:Gait & Posture, Volume 58
Author(s): Nicholas Tam, Danielle Prins, Nikhil V. Divekar, Robert P. Lamberts
The aim of this study was to utilise one-dimensional statistical parametric mapping to compare differences between biomechanical and electromyographical waveforms in runners when running in barefoot or shod conditions.Fifty habitually shod runners were assessed during overground running at their current 10-km race running speed. Electromyography, kinematics and ground reaction forces were collected during these running trials. Joint kinetics were calculated using inverse dynamics. One-dimensional statistical parametric mapping one sample t-test was conducted to assess differences over an entire gait cycle on the variables of interest when barefoot or shod (p<0.05).Only sagittal plane differences were found between barefoot and shod conditions at the knee during late stance (18–23% of the gait cycle) and swing phase (74–90%); at the ankle early stance (0–6%), mid-stance (28–38%) and swing phase (81–100%). Differences in sagittal plane moments were also found at the ankle during early stance (2, 4–5%) and knee during early stance (5–11%). Condition differences were also found in vertical ground reaction force during early stance between (3–10%).An acute bout of barefoot running in habitual shod runners invokes temporal differences throughout the gait cycle. Specifically, a co-ordinative responses between the knee and ankle joint in the sagittal plane with a delay in the impact transient peak; onset of the knee extension and ankle plantarflexion moment in the shod compared to barefoot condition was found. This appears to affect the delay in knee extension and ankle plantarflexion during late stance. This study provides a glimpse into the co-ordination of the lower limb when running in differing footwear.
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Associations of prolonged standing with musculoskeletal symptoms—A systematic review of laboratory studies
Source:Gait & Posture, Volume 58
Author(s): Pieter Coenen, Sharon Parry, Lisa Willenberg, Joyce W. Shi, Lorena Romero, Diana M. Blackwood, Genevieve N. Healy, David W Dunstan, Leon M. Straker
While prolonged standing has shown to be detrimentally associated with musculoskeletal symptoms, exposure limits and underlying mechanisms are not well understood. We systematically reviewed evidence from laboratory studies on musculoskeletal symptom development during prolonged (≥20min) uninterrupted standing, quantified acute dose-response associations and described underlying mechanisms.Peer-reviewed articles were systematically searched for. Data from included articles were tabulated, and dose-response associations were statistically pooled. A linear interpolation of pooled dose-response associations was performed to estimate the duration of prolonged standing associated with musculoskeletal symptoms with a clinically relevant intensity of ≥9 (out of 100).We included 26 articles (from 25 studies with 591 participants), of which the majority examined associations of prolonged standing with low back and lower extremity symptoms. Evidence on other (e.g., upper limb) symptoms was limited and inconsistent. Pooled dose-response associations showed that clinically relevant levels of low back symptoms were reached after 71min of prolonged standing, with this shortened to 42min in those considered pain developers. Regarding standing-related low back symptoms, consistent evidence was found for postural mechanisms (i.e., trunk flexion and lumbar curvature), but not for mechanisms of muscle fatigue and/or variation in movement. Blood pooling was the most consistently reported mechanism for standing-related lower extremity symptoms.Evidence suggests a detrimental association of prolonged standing with low back and lower extremity symptoms. To avoid musculoskeletal symptoms (without having a-priori knowledge on whether someone will develop symptoms or not), dose-response evidence from this study suggests a recommendation to refrain from standing for prolonged periods >40min. Interventions should also focus on underlying pain mechanisms.
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Clinical measures of balance in people with type two diabetes: A systematic literature review
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): C.J. Dixon, T. Knight, E. Binns, B. Ihaka, D. O’Brien
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN.Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool.Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index.Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Source:Gait & Posture, Volume 58
Author(s): C.J. Dixon, T. Knight, E. Binns, B. Ihaka, D. O’Brien
Approximately 422 million people have diabetes mellitus worldwide, with the majority diagnosed with type 2 diabetes mellitus (T2DM). The complications of diabetes mellitus include diabetic peripheral neuropathy (DPN) and retinopathy, both of which can lead to balance impairments. Balance assessment is therefore an integral component of the clinical assessment of a person with T2DM. Although there are a variety of balance measures available, it is uncertain which measures are the most appropriate for this population. Therefore, the aim of this study was to conduct a systematic review on clinical balance measures used with people with T2DM and DPN.Databases searched included: CINAHL plus, MEDLINE, SPORTDiscus, Dentistry and Oral Sciences source, and SCOPUS. Key terms, inclusion and exclusion criteria were used to identify appropriate studies. Identified studies were critiqued using the Downs and Black appraisal tool.Eight studies were included, these studies incorporated a total of ten different clinical balance measures. The balance measures identified included the Dynamic Balance Test, balance walk, tandem and unipedal stance, Functional Reach Test, Clinical Test of Sensory Interaction and Balance, Berg Balance Scale, Tinetti Performance-Oriented Mobility Assessment, Activity-Specific Balance Confidence Scale, Timed Up and Go test, and the Dynamic Gait Index.Numerous clinical balance measures were used for people with T2DM. However, the identified balance measures did not assess all of the systems of balance, and most had not been validated in a T2DM population. Therefore, future research is needed to identify the validity of a balance measure that assesses these systems in people with T2DM.
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Effects of flexible and rigid rocker profiles on in-shoe pressure
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Roy Reints, Juha M. Hijmans, Johannes G.M. Burgerhof, Klaas Postema, Gijsbertus J. Verkerke
Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.
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Source:Gait & Posture, Volume 58
Author(s): Roy Reints, Juha M. Hijmans, Johannes G.M. Burgerhof, Klaas Postema, Gijsbertus J. Verkerke
Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.
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Factors influencing knee adduction moment measurement: A systematic review and meta-regression analysis
Source:Gait & Posture, Volume 58
Author(s): Scott Telfer, Moritz J. Lange, Amanda S.M. Sudduth
The external knee adduction moment has been identified as a key biomarker in biomechanics research, with associations with this variable and degenerative diseases such as knee osteoarthritis. Heterogeneity in participant characteristics and the protocols used to measure this variable may however complicate its interpretation. Previous reviews have focused on interventions or did not control for potential moderator variables in their analysis. In this meta-regression analysis, we aimed to determine the influence of factors including the cohort type, footwear, and walking speed on the measurement of knee adduction moment. We performed a systematic review of the literature, identifying articles that used the Plug-in-Gait inverse dynamics model to calculate the knee adduction moment during level walking, and used a mixed effect model to determine the effect of the previously described factors on the measurement. Results for 861 individuals were described in 19 articles. Walking speed had the largest influence on knee adduction moment (p<0.001), and participants with medial knee osteoarthritis had an increased knee adduction moment (p=0.008) compared to healthy subjects. Footwear was found to have a significant overall effect (p=0.024). Participants tested barefoot or wearing their own shoes had lower adduction moments than those tested in footwear provided by the researchers. Overall, the moderators accounted for 60% of the heterogeneity in the results. These results support the hypothesis that an increased knee adduction moment is associated with medial compartment knee osteoarthritis, and that footwear choice can influence the results. Gait speed has the largest effect on knee adduction moment measurement and should be carefully controlled for in studies investigating this variable.
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Aging effect on step adjustments and stability control in visually perturbed gait initiation
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Ruopeng Sun, Chuyi Cui, John B. Shea
Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.
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Source:Gait & Posture, Volume 58
Author(s): Ruopeng Sun, Chuyi Cui, John B. Shea
Gait adaptability is essential for fall avoidance during locomotion. It requires the ability to rapidly inhibit original motor planning, select and execute alternative motor commands, while also maintaining the stability of locomotion. This study investigated the aging effect on gait adaptability and dynamic stability control during a visually perturbed gait initiation task. A novel approach was used such that the anticipatory postural adjustment (APA) during gait initiation were used to trigger the unpredictable relocation of a foot-size stepping target. Participants (10 young adults and 10 older adults) completed visually perturbed gait initiation in three adjustment timing conditions (early, intermediate, late; all extracted from the stereotypical APA pattern) and two adjustment direction conditions (medial, lateral). Stepping accuracy, foot rotation at landing, and Margin of Dynamic Stability (MDS) were analyzed and compared across test conditions and groups using a linear mixed model. Stepping accuracy decreased as a function of adjustment timing as well as stepping direction, with older subjects exhibited a significantly greater undershoot in foot placement to late lateral stepping. Late adjustment also elicited a reaching-like movement (i.e. foot rotation prior to landing in order to step on the target), regardless of stepping direction. MDS measures in the medial-lateral and anterior-posterior direction revealed both young and older adults exhibited reduced stability in the adjustment step and subsequent steps. However, young adults returned to stable gait faster than older adults. These findings could be useful for future study of screening deficits in gait adaptability and preventing falls.
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Adding motor control training to muscle strengthening did not substantially improve the effects on clinical or kinematic outcomes in women with patellofemoral pain: A randomised controlled trial
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Nayra Deise dos Anjos Rabelo, Leonardo Oliveira Pena Costa, Bruna Maria de Lima, Amir Curcio dos Reis, André Serra Bley, Thiago Yukio Fukuda, Paulo Roberto Garcia Lucareli
DesignRandomized controlled trial.BackgroundPatients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.MethodsThirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.ResultsThe MC&S group did not present significantly better function (MD −2.5 points, 95% CI;−10.7–5.5) or pain (MD −0.3 points, 95% CI;−1.7–1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD −8.5 points; 95% CI;−16.8 to −0.3). No significant between-group differences were observed for the other outcomes.ConclusionMovement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Source:Gait & Posture, Volume 58
Author(s): Nayra Deise dos Anjos Rabelo, Leonardo Oliveira Pena Costa, Bruna Maria de Lima, Amir Curcio dos Reis, André Serra Bley, Thiago Yukio Fukuda, Paulo Roberto Garcia Lucareli
DesignRandomized controlled trial.BackgroundPatients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.MethodsThirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement Control & Strengthening group (MC&S group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.ResultsThe MC&S group did not present significantly better function (MD −2.5 points, 95% CI;−10.7–5.5) or pain (MD −0.3 points, 95% CI;−1.7–1.0) at 4 weeks. There was a small difference in favour of the MC&S group for AKPS scores at 3 months (MD −8.5 points; 95% CI;−16.8 to −0.3). No significant between-group differences were observed for the other outcomes.ConclusionMovement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.
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Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson’s disease: A randomized controlled trial
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Roné Grobbelaar, Ranel Venter, Karen Estelle Welman
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
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Source:Gait & Posture, Volume 58
Author(s): Roné Grobbelaar, Ranel Venter, Karen Estelle Welman
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Int J Audiol. 2017 Aug 31;:1-8
Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E
Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.
PMID: 28857620 [PubMed - as supplied by publisher]
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Translation and validation of the dizziness handicap inventory in Greek language.
Translation and validation of the dizziness handicap inventory in Greek language.
Int J Audiol. 2017 Aug 30;:1-6
Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A
Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.
PMID: 28854827 [PubMed - as supplied by publisher]
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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Int J Audiol. 2017 Aug 31;:1-8
Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E
Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.
PMID: 28857620 [PubMed - as supplied by publisher]
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Translation and validation of the dizziness handicap inventory in Greek language.
Translation and validation of the dizziness handicap inventory in Greek language.
Int J Audiol. 2017 Aug 30;:1-6
Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A
Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.
PMID: 28854827 [PubMed - as supplied by publisher]
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Bionic balance organs: progress in the development of vestibular prostheses.
Bionic balance organs: progress in the development of vestibular prostheses.
N Z Med J. 2017 Sep 01;130(1461):56-65
Authors: Smith PF
Abstract
The vestibular system is a sensory system that is critically important in humans for gaze and image stability as well as postural control. Patients with complete bilateral vestibular loss are severely disabled and experience a poor quality of life. There are very few effective treatment options for patients with no vestibular function. Over the last 10 years, rapid progress has been made in developing artificial 'vestibular implants' or 'prostheses', based on cochlear implant technology. As of 2017, 13 patients worldwide have received vestibular implants and the results are encouraging. Vestibular implants are now becoming part of an increasing effort to develop artificial, bionic sensory systems, and this paper provides a review of the progress in this area.
PMID: 28859067 [PubMed - in process]
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Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.
Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.
Auris Nasus Larynx. 2017 Aug 27;:
Authors: Nemade SV, Shinde KJ, Sampate PB
Abstract
INTRODUCTION: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane.
OBJECTIVE: To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty.
METHODS: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results.
RESULTS: Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant.
CONCLUSION: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.
PMID: 28855058 [PubMed - as supplied by publisher]
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A four-domain approach of frailty explored in the Doetinchem Cohort Study.
A four-domain approach of frailty explored in the Doetinchem Cohort Study.
BMC Geriatr. 2017 Aug 30;17(1):196
Authors: van Oostrom SH, van der A DL, Rietman ML, Picavet HSJ, Lette M, Verschuren WMM, de Bruin SR, Spijkerman AMW
Abstract
BACKGROUND: Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty.
METHODS: The study sample included 4019 men and women (aged 40-81 years) examined during the fifth round (2008-2012) of the Doetinchem Cohort Study. Four domains of frailty were considered: physical (≥4 of 8 criteria: unintentional weight loss, exhaustion, strength, perceived health, walking, balance, hearing and vision impairments), psychological (2 criteria: depressive symptoms, mental health), cognitive (<10th percentile on global cognitive functioning), and social frailty (≥2 of 3 criteria: loneliness, social support, social participation). Logistic regression was used to study the cross-sectional association of sociodemographic factors, lifestyle, life events and chronic diseases with frailty domains.
RESULTS: About 17% of the population was frail on one or more domains. Overlap between the frailty domains was limited since 82% of the frail population was frail on one domain only. Low educated respondents were at higher risk of being psychologically and socially frail. Having multiple diseases was associated with a higher risk of being physically and psychologically frail. Being physically active was consistently associated with a lower risk of frailty on each of the four domains. Short or long sleep duration was associated with a higher risk of being physically, psychologically, and socially frail.
CONCLUSIONS: Sociodemographic factors, lifestyle and multimorbidity contributed differently to the four frailty domains. It is important to consider multiple frailty domains since this helps to identify different groups of frail people, and as such to provide tailored care and support. Lifestyle factors including physical activity, smoking and sleep duration were associated with multiple domains of frailty.
PMID: 28854882 [PubMed - in process]
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Bionic balance organs: progress in the development of vestibular prostheses.
Bionic balance organs: progress in the development of vestibular prostheses.
N Z Med J. 2017 Sep 01;130(1461):56-65
Authors: Smith PF
Abstract
The vestibular system is a sensory system that is critically important in humans for gaze and image stability as well as postural control. Patients with complete bilateral vestibular loss are severely disabled and experience a poor quality of life. There are very few effective treatment options for patients with no vestibular function. Over the last 10 years, rapid progress has been made in developing artificial 'vestibular implants' or 'prostheses', based on cochlear implant technology. As of 2017, 13 patients worldwide have received vestibular implants and the results are encouraging. Vestibular implants are now becoming part of an increasing effort to develop artificial, bionic sensory systems, and this paper provides a review of the progress in this area.
PMID: 28859067 [PubMed - in process]
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Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.
Comparison between clinical and audiological results of tympanoplasty with double layer graft (modified sandwich fascia) technique and single layer graft (underlay fascia and underlay cartilage) technique.
Auris Nasus Larynx. 2017 Aug 27;:
Authors: Nemade SV, Shinde KJ, Sampate PB
Abstract
INTRODUCTION: Surgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich Tympanoplasty is the combined overlay and underlay grafting of tympanic membrane.
OBJECTIVE: To describe and evaluate the modified sandwich graft (mediolateral double layer graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty.
METHODS: A total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay fascia technique. 48 patients (Group C) underwent type one tympanoplasty with underlay cartilage technique. We assessed the healing and hearing results.
RESULTS: Successful graft take up was accomplished in 47 patients (97.9%) in Group A, in 40 patients (83.3%) Group B, and in 46 (95.8%) patients in Group C. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB, in Group B, it was 22.5±3.5dB and in group C, it was 19.8±2.6dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant.
CONCLUSION: Double layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.
PMID: 28855058 [PubMed - as supplied by publisher]
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A four-domain approach of frailty explored in the Doetinchem Cohort Study.
A four-domain approach of frailty explored in the Doetinchem Cohort Study.
BMC Geriatr. 2017 Aug 30;17(1):196
Authors: van Oostrom SH, van der A DL, Rietman ML, Picavet HSJ, Lette M, Verschuren WMM, de Bruin SR, Spijkerman AMW
Abstract
BACKGROUND: Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty.
METHODS: The study sample included 4019 men and women (aged 40-81 years) examined during the fifth round (2008-2012) of the Doetinchem Cohort Study. Four domains of frailty were considered: physical (≥4 of 8 criteria: unintentional weight loss, exhaustion, strength, perceived health, walking, balance, hearing and vision impairments), psychological (2 criteria: depressive symptoms, mental health), cognitive (<10th percentile on global cognitive functioning), and social frailty (≥2 of 3 criteria: loneliness, social support, social participation). Logistic regression was used to study the cross-sectional association of sociodemographic factors, lifestyle, life events and chronic diseases with frailty domains.
RESULTS: About 17% of the population was frail on one or more domains. Overlap between the frailty domains was limited since 82% of the frail population was frail on one domain only. Low educated respondents were at higher risk of being psychologically and socially frail. Having multiple diseases was associated with a higher risk of being physically and psychologically frail. Being physically active was consistently associated with a lower risk of frailty on each of the four domains. Short or long sleep duration was associated with a higher risk of being physically, psychologically, and socially frail.
CONCLUSIONS: Sociodemographic factors, lifestyle and multimorbidity contributed differently to the four frailty domains. It is important to consider multiple frailty domains since this helps to identify different groups of frail people, and as such to provide tailored care and support. Lifestyle factors including physical activity, smoking and sleep duration were associated with multiple domains of frailty.
PMID: 28854882 [PubMed - in process]
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Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Int J Audiol. 2017 Aug 31;:1-8
Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E
Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.
PMID: 28857620 [PubMed - as supplied by publisher]
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Translation and validation of the dizziness handicap inventory in Greek language.
Translation and validation of the dizziness handicap inventory in Greek language.
Int J Audiol. 2017 Aug 30;:1-6
Authors: Nikitas C, Kikidis D, Katsinis S, Kyrodimos E, Bibas A
Abstract
OBJECTIVE: The aim of the study was to test the reliability and validity of the Dizziness Handicap Inventory in the Greek language (DHI).
DESIGN: This study was performed in a university tertiary centre. Internal consistency was estimated using Cronbach's alpha for the DHI, physical (DHI-P), functional (DHI-F) and emotional (DHI-E) subscale scores. Correlation between DHI (total and subscales) and the SOT (sensory organisation test) as well as correlation between the DHI and FGA (functional gait assessment) was tested using Spearman's correlation coefficient. Test-retest reliability was tested using ICC (Intraclass Correlation Coefficient).
SAMPLE SIZE: Ninety (90) patients were included in the study.
RESULTS: Internal consistency was excellent for the total score and very good for the physical functional and emotional subscale scores. No statistically significant correlation was found between SOT and DHI. There was a moderate correlation between FGA and total DHI scores (r = -0.472; p < 0.0001) and poor to moderate between FGA and DHI subscale scores (DHI-E r1 = -0.342; p1 = 0.001, DHI-F r2 = -0.448 p2 < 0.0001, DHI-P r3 = -0.472 p3 < 0.0001). Test-retest reliability was excellent.
CONCLUSION: Greek version of DHI is recommended as a valid measure for patients with vestibular disorders.
PMID: 28854827 [PubMed - as supplied by publisher]
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via IFTTT
Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia.
Int J Audiol. 2017 Aug 31;:1-8
Authors: Bravo-Torres S, Der-Mussa C, Fuentes-López E
Abstract
OBJECTIVE: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge™.
DESIGN: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile.
STUDY SAMPLE: All patients implanted with the Bonebridge were included (N = 15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates.
RESULTS: The average hearing threshold one month after switch on was 25.2 dB (95%CI 23.5-26.9). Hearing thresholds between 0.5 and 4 kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4 kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables.
CONCLUSIONS: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.
PMID: 28857620 [PubMed - as supplied by publisher]
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