Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Stephanie L. King, Natalie Vanicek, Thomas D. O’Brien
ObjectiveTo determine the lower limb joint kinetic strategies during stair descent in claudicants with peripheral arterial disease (PAD-IC).DesignCross-sectional observation study.SettingUniversity laboratory.ParticipantsA total of 22 participants; 10 healthy controls and 12 patients diagnosed with PAD-IC.Main Outcome MeasuresBetween-group comparisons of ground reaction force (GRF) and, hip, knee and ankle kinetics during steady-state stair descent.ResultsThe claudicating-limb group demonstrated reduced vertical and posterior GRF compared to healthy controls (ES = −1.46 [−2.32,−0.69] and ES = −1.08 [−0.42,−0.26]) as well as demonstrating an greater contribution to support moment from the ankle and trends towards a smaller hip contribution (42 ± 14% vs 28 ± 7%, P=.005 and Hip 16 ± 8% vs 21 ± 11%, P=.056, respectively). A unique sub-group was identified within the PAD-IC cohort demonstrating different hip moment strategies during weight acceptance: a novel hip extensor group (PAD-IC HExt) and stereotypical hip flexor group (PAD-IC HFlex). Compared to both healthy controls and the PAD-IC HFlex groups, the PAD-IC HExt group demonstrated increased hip extensor moment (ES = 3.05 [1.67,4.42] and ES = 3.62 [1.89,5.35]) and reduced knee extensor moment (ES = −2.00 [−3.15,−0.85] and ES = −1.36 [−2.60,-0.11] respectively) during weight acceptance.ConclusionsA novel hip extensor strategy was identified in a sub-group of claudicants which acts to reduce the demand on the knee extensors, but not the plantarflexors. Weakness in the knee extensors may prevent redistribution of the task demand, typically seen in older adults in stair descent, away from the functionally limited plantarflexor muscle group. Further investigation into multi-level joint strength and the relationship to functional tasks is warranted to inform targeted intervention programmes.



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Net Ankle Quasi-Stiffness is influenced by Walking Speed but not Age for Older Adult Women

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): John D. Collins, Elisa S. Arch, Jeremy R. Crenshaw, Kathie A. Bernhardt, Sundeep Khosla, Shreyasee Amin, Kenton R. Kaufman
BackgroundInsufficient plantar flexor resistance due to plantar flexor weakness, an impairment common in patient populations, causes substantial gait deficits. The bending stiffness of passive-dynamic ankle-foot orthoses (PD-AFOs) has the capacity to replace lost plantar flexor resistance. Many patients who are prescribed PD-AFOs are older adults. While PD-AFO bending stiffness should be customized for patients, a method to objectively prescribe this stiffness does not exist. Quantifying natural plantar flexor resistance during non-pathological gait could provide a reference value for objectively prescribing PD-AFO bending stiffness.Research questionThis study investigated the effect of age on plantar flexor resistance in 113 participants above the age of 65 years. We did so while also considering the confounding influence of gait speed, an aspect known to be reduced with old age.MethodsAmbulatory, community-dwelling older adult women (ages 65-91 years) with no current or recent lower-extremity injuries or surgeries underwent an instrumented gait analysis at a self-selected speed. Plantar flexor resistance was quantified via net ankle quasi-stiffness (NAS) defined as the slope of ankle joint moment-angle curve during late stance.Resultsshowed that NAS was not significantly influenced by age (r = −0.11, p = 0.12), and that the confounding factor of walking speed had a significant, positive relationship with NAS (r = 0.59, p < 0.001).SignificanceBy determining that gait speed, not age, is related to NAS in older adults, this study represents the initial step towards objectively prescribing PD-AFO bending stiffness to achieve a targeted gait speed for older adults with plantar flexor weakness.



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Self-reported sleep duration affects tandem gait, but not steady-state gait outcomes among healthy collegiate athletes

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): David R. Howell, Brant Berkstresser, Francis Wang, Thomas A. Buckley, Rebekah Mannix, Alexandra Stillman, William P. Meehan
BackgroundSleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion.Research questionDoes the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance?MethodsOne hundred and fourteen healthy collegiate athletes (mean age 18.8 ± 0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait and instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy.ResultsParticipants who reported sleeping < 7 hours of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ± 2.2 vs. 10.1 ± 2.0 seconds and 14.5 ± 4.3 vs. 12.3 ± 2.6 seconds, respectively; p = .009) compared to those who reported sleeping ≥ 7 hours (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy.SignificanceSelf-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing.



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Acute and mid-term (six-week) effects of an ankle-foot-orthosis on biomechanical parameters, clinical outcomes and physical activity in knee osteoarthritis patients with varus malalignment

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Maik Sliepen, Elsa Mauricio, Dieter Rosenbaum
BackgroundKnee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods.Research questionThe aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients.Methods29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers.ResultsThe AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4–2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters.SignificanceThe six-week AFO application significantly reduced the KAM. The patients’ physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable.



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Femoral Anteversion Assessment: Comparison of Physical Examination, Gait Analysis, and EOS Biplanar Radiography

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): David E. Westberryt, Linda I. Wackt, Roy B. Davist, James W. Hardins
BackgroundMultiple measurement methods are available to assess transverse plane alignment of the lower extremity.Research questionThis study was performed to determine the extent of correlation between femoral anteversion assessment using simultaneous biplanar radiographs and three-dimensional modeling (EOS imaging), clinical hip rotation by physical examination, and dynamic hip rotation assessed by gait analysis.MethodsSeventy-seven patients with cerebral palsy (GMFCS Level I and II) and 33 neurologically typical children with torsional abnormalities completed a comprehensive gait analysis with same day biplanar anterior-posterior and lateral radiographs and three-dimensional transverse plane assessment of femoral anteversion. Correlations were determined between physical exam of hip rotation, EOS imaging of femoral anteversion, and transverse plane hip kinematics for this retrospective review study.ResultsLinear regression analysis revealed a weak relationship between physical examination measures of hip rotation and biplanar radiographic assessment of femoral anteversion. Similarly, poor correlation was found between clinical evaluation of femoral anteversion and motion assessment of dynamic hip rotation. Correlations were better in neurologically typical children with torsional abnormalities compared to children with gait dysfunction secondary to cerebral palsy.SignificanceDynamic hip rotation cannot be predicted by physical examination measures of hip range of motion or from three-dimensional assessment of femoral anteversion derived from biplanar radiographs.



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WHICH IS THE BEST PREDICTOR OF EXCESSIVE HIP INTERNAL ROTATION IN WOMEN WITH PATELLOFEMORAL PAIN: REARFOOT EVERSION OR HIP MUSCLE STRENGTH? EXPLORING SUBGROUPS

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Amanda Schenatto Ferreira, Danilo de Oliveira Silva, Ronaldo Valdir Briani, Deisi Ferrari, Fernando Amâncio Aragão, Marcella Ferraz Pazzinatto, Fábio Mícolis de Azevedo
BackgroundPatellofemoral pain (PFP) has been linked to increased patellofemoral joint stress as a result of excessive hip internal rotation. Lower hip strength and/or excessive rearfoot eversion have been used to explain such altered movement pattern; however, it is unknown which one is the best predictor of excessive hip internal rotation.Research questionTo investigate if peak rearfoot eversion and/or peak concentric hip abductor strength can predict peak hip internal rotation during stair ascent in women with PFP.MethodsThis cross-sectional study included thirty-seven women with PFP which underwent three-dimensional kinematic analysis during stair ascent and hip abductor strength analysis in an isokinetic dynamometer. A forced entry linear regression model analysis was carried out to determine which independent variables present the best capability to predict the hip internal rotation.ResultsPeak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R² = 0.27, p = 0.001). Peak rearfoot eversion did not predict peak hip internal rotation during stair ascent (R² < 0.01, p = 0.62). A Post-hoc analysis was conducted to explore if a subgroup with excessive rearfoot eversion would predict hip internal rotation. Based on a previous reported cut-off point, 48.6% of the participants were classified as excessive rearfoot eversion. For the subgroup with excessive rearfoot eversion, peak concentric hip abductor strength and peak rearfoot eversion significantly predicted peak hip internal rotation during stair ascent (R² = 0.26, p = 0.02; R² = 0.42, p = 0.003, respectively). For non-excessive rearfoot eversion subgroup, peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R² = 0.53; p < 0.001); and peak rearfoot eversion did not (R² = 0.01; p = 0.65).SignificanceFindings indicate that hip muscle strength seems to be related with hip internal rotation in all women with PFP. Rearfoot eversion seems to be related with hip internal rotation only in a subgroup with excessive rearfoot eversion.



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Foot posture development in children aged 5 to11 years: a three-year prospective study.

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Alfonso Martínez-Nova, Gabriel Gijón-Noguerón, Pilar Alfageme-García, Jesús Montes-Alguacil, Angela Margaret Evans
BackgroundThe paediatric flatfoot is a common presentation but it is unclear whether the condition will resolve on its own as the child gets older or whether treatment is required. Therefore, the study objective was to evaluate paediatric foot posture, and anthropometry, in children at two time points, three years apart.Material and methodsA sample of 1032 healthy children (505 boys, 527 girls; aged 5–11 years) was recruited for foot posture index (FPI) and anthropometry assessment (weight, height and body mass index, BMI). Assessment was repeated when the children were aged 8 years to 14 years. Paired t-tests, Anova, frequency tables and a multiple regressions were conducted.ResultsInitially, approximately 70% had a neutral FPI range, 20% pronated, 3% highly pronated, and 4% supinated. Initial mean FPI was 3.6 ± 2.8, being higher in boys 3.7 ± 2.8 than in girls 3.4 ± 2.7 (p = 0.034). All FPI categories changed over time, with supinated and neutral FPI increased by 19.5% and 4.7% respectively. In contrast, pronated and highly pronated FPI reduced by 10.6% and 55.6% respectively. Regression showed only 1% FPI change was explained by increased height. FPI scores were significantly reduced after three years (3.57 to 3.33; p < 0.001).ConclusionChildren’s foot posture shifts toward neutral as age increases. There is minimal relationship with weight, height or BMI. Appreciation of developing foot posture could reduce over diagnosis and unnecessary treatment of paediatric flatfeet.



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Lower extremity power training improves healthy old adults’ gait biomechanics

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Azusa Uematsu, Tibor Hortobágyi, Kazushi Tsuchiya, Norio Kadono, Hirofumi Kobayashi, Tomoya Ogawa, Shuji Suzuki
PurposeAge-related slowing of gait speed predicts many clinical conditions in later life. We examined the kinematic and kinetic mechanisms of how lower extremity power training increases healthy old adults’ gait speed.MethodsWe randomly allocated old adults to a training (age 74.3 y, 9 males, 6 females) and a control group (age 73.6 y, 3 males, 4 females) and compared the biomechanics of habitual and fast gait before and after 16 sessions (8 weeks) of lower extremity power training.ResultsTraining increased maximal leg press load by ∼40% (P < 0.05) and maximal voluntary force in five groups of leg muscles by ∼32% (P < 0.05) in the training group. Training vs. control tended to increase habitual (10.8 vs. 7.6%) and fast gait speed (17.6 vs. 9.0%; all P < 0.05) more. In the training group only, these increases in gait speed correlated with increases in stride length (habitual: r² = 0.84, fast: r² = 0.89). Training made old adults’ gait more erect: hip and knee extension increased in the stance phase of gait. Training increased ankle joint positive work by 3.3 J (control: −0.4 J, Group by Time interaction: P < 0.05), which correlated r² = 0.58 and r² = 0.67 with increases in habitual and fast gait speed without changes in hip and knee joint powers.ConclusionIncreases in leg muscle power increased healthy old adults’ gait speed through correlated increases in stride length and ankle plantarflexor work generation.



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Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Stephanie L. King, Natalie Vanicek, Thomas D. O’Brien
ObjectiveTo determine the lower limb joint kinetic strategies during stair descent in claudicants with peripheral arterial disease (PAD-IC).DesignCross-sectional observation study.SettingUniversity laboratory.ParticipantsA total of 22 participants; 10 healthy controls and 12 patients diagnosed with PAD-IC.Main Outcome MeasuresBetween-group comparisons of ground reaction force (GRF) and, hip, knee and ankle kinetics during steady-state stair descent.ResultsThe claudicating-limb group demonstrated reduced vertical and posterior GRF compared to healthy controls (ES = −1.46 [−2.32,−0.69] and ES = −1.08 [−0.42,−0.26]) as well as demonstrating an greater contribution to support moment from the ankle and trends towards a smaller hip contribution (42 ± 14% vs 28 ± 7%, P=.005 and Hip 16 ± 8% vs 21 ± 11%, P=.056, respectively). A unique sub-group was identified within the PAD-IC cohort demonstrating different hip moment strategies during weight acceptance: a novel hip extensor group (PAD-IC HExt) and stereotypical hip flexor group (PAD-IC HFlex). Compared to both healthy controls and the PAD-IC HFlex groups, the PAD-IC HExt group demonstrated increased hip extensor moment (ES = 3.05 [1.67,4.42] and ES = 3.62 [1.89,5.35]) and reduced knee extensor moment (ES = −2.00 [−3.15,−0.85] and ES = −1.36 [−2.60,-0.11] respectively) during weight acceptance.ConclusionsA novel hip extensor strategy was identified in a sub-group of claudicants which acts to reduce the demand on the knee extensors, but not the plantarflexors. Weakness in the knee extensors may prevent redistribution of the task demand, typically seen in older adults in stair descent, away from the functionally limited plantarflexor muscle group. Further investigation into multi-level joint strength and the relationship to functional tasks is warranted to inform targeted intervention programmes.



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Net Ankle Quasi-Stiffness is influenced by Walking Speed but not Age for Older Adult Women

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): John D. Collins, Elisa S. Arch, Jeremy R. Crenshaw, Kathie A. Bernhardt, Sundeep Khosla, Shreyasee Amin, Kenton R. Kaufman
BackgroundInsufficient plantar flexor resistance due to plantar flexor weakness, an impairment common in patient populations, causes substantial gait deficits. The bending stiffness of passive-dynamic ankle-foot orthoses (PD-AFOs) has the capacity to replace lost plantar flexor resistance. Many patients who are prescribed PD-AFOs are older adults. While PD-AFO bending stiffness should be customized for patients, a method to objectively prescribe this stiffness does not exist. Quantifying natural plantar flexor resistance during non-pathological gait could provide a reference value for objectively prescribing PD-AFO bending stiffness.Research questionThis study investigated the effect of age on plantar flexor resistance in 113 participants above the age of 65 years. We did so while also considering the confounding influence of gait speed, an aspect known to be reduced with old age.MethodsAmbulatory, community-dwelling older adult women (ages 65-91 years) with no current or recent lower-extremity injuries or surgeries underwent an instrumented gait analysis at a self-selected speed. Plantar flexor resistance was quantified via net ankle quasi-stiffness (NAS) defined as the slope of ankle joint moment-angle curve during late stance.Resultsshowed that NAS was not significantly influenced by age (r = −0.11, p = 0.12), and that the confounding factor of walking speed had a significant, positive relationship with NAS (r = 0.59, p < 0.001).SignificanceBy determining that gait speed, not age, is related to NAS in older adults, this study represents the initial step towards objectively prescribing PD-AFO bending stiffness to achieve a targeted gait speed for older adults with plantar flexor weakness.



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Self-reported sleep duration affects tandem gait, but not steady-state gait outcomes among healthy collegiate athletes

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): David R. Howell, Brant Berkstresser, Francis Wang, Thomas A. Buckley, Rebekah Mannix, Alexandra Stillman, William P. Meehan
BackgroundSleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion.Research questionDoes the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance?MethodsOne hundred and fourteen healthy collegiate athletes (mean age 18.8 ± 0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait and instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy.ResultsParticipants who reported sleeping < 7 hours of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ± 2.2 vs. 10.1 ± 2.0 seconds and 14.5 ± 4.3 vs. 12.3 ± 2.6 seconds, respectively; p = .009) compared to those who reported sleeping ≥ 7 hours (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy.SignificanceSelf-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing.



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Acute and mid-term (six-week) effects of an ankle-foot-orthosis on biomechanical parameters, clinical outcomes and physical activity in knee osteoarthritis patients with varus malalignment

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Maik Sliepen, Elsa Mauricio, Dieter Rosenbaum
BackgroundKnee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods.Research questionThe aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients.Methods29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers.ResultsThe AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4–2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters.SignificanceThe six-week AFO application significantly reduced the KAM. The patients’ physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable.



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Femoral Anteversion Assessment: Comparison of Physical Examination, Gait Analysis, and EOS Biplanar Radiography

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): David E. Westberryt, Linda I. Wackt, Roy B. Davist, James W. Hardins
BackgroundMultiple measurement methods are available to assess transverse plane alignment of the lower extremity.Research questionThis study was performed to determine the extent of correlation between femoral anteversion assessment using simultaneous biplanar radiographs and three-dimensional modeling (EOS imaging), clinical hip rotation by physical examination, and dynamic hip rotation assessed by gait analysis.MethodsSeventy-seven patients with cerebral palsy (GMFCS Level I and II) and 33 neurologically typical children with torsional abnormalities completed a comprehensive gait analysis with same day biplanar anterior-posterior and lateral radiographs and three-dimensional transverse plane assessment of femoral anteversion. Correlations were determined between physical exam of hip rotation, EOS imaging of femoral anteversion, and transverse plane hip kinematics for this retrospective review study.ResultsLinear regression analysis revealed a weak relationship between physical examination measures of hip rotation and biplanar radiographic assessment of femoral anteversion. Similarly, poor correlation was found between clinical evaluation of femoral anteversion and motion assessment of dynamic hip rotation. Correlations were better in neurologically typical children with torsional abnormalities compared to children with gait dysfunction secondary to cerebral palsy.SignificanceDynamic hip rotation cannot be predicted by physical examination measures of hip range of motion or from three-dimensional assessment of femoral anteversion derived from biplanar radiographs.



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WHICH IS THE BEST PREDICTOR OF EXCESSIVE HIP INTERNAL ROTATION IN WOMEN WITH PATELLOFEMORAL PAIN: REARFOOT EVERSION OR HIP MUSCLE STRENGTH? EXPLORING SUBGROUPS

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Amanda Schenatto Ferreira, Danilo de Oliveira Silva, Ronaldo Valdir Briani, Deisi Ferrari, Fernando Amâncio Aragão, Marcella Ferraz Pazzinatto, Fábio Mícolis de Azevedo
BackgroundPatellofemoral pain (PFP) has been linked to increased patellofemoral joint stress as a result of excessive hip internal rotation. Lower hip strength and/or excessive rearfoot eversion have been used to explain such altered movement pattern; however, it is unknown which one is the best predictor of excessive hip internal rotation.Research questionTo investigate if peak rearfoot eversion and/or peak concentric hip abductor strength can predict peak hip internal rotation during stair ascent in women with PFP.MethodsThis cross-sectional study included thirty-seven women with PFP which underwent three-dimensional kinematic analysis during stair ascent and hip abductor strength analysis in an isokinetic dynamometer. A forced entry linear regression model analysis was carried out to determine which independent variables present the best capability to predict the hip internal rotation.ResultsPeak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R² = 0.27, p = 0.001). Peak rearfoot eversion did not predict peak hip internal rotation during stair ascent (R² < 0.01, p = 0.62). A Post-hoc analysis was conducted to explore if a subgroup with excessive rearfoot eversion would predict hip internal rotation. Based on a previous reported cut-off point, 48.6% of the participants were classified as excessive rearfoot eversion. For the subgroup with excessive rearfoot eversion, peak concentric hip abductor strength and peak rearfoot eversion significantly predicted peak hip internal rotation during stair ascent (R² = 0.26, p = 0.02; R² = 0.42, p = 0.003, respectively). For non-excessive rearfoot eversion subgroup, peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R² = 0.53; p < 0.001); and peak rearfoot eversion did not (R² = 0.01; p = 0.65).SignificanceFindings indicate that hip muscle strength seems to be related with hip internal rotation in all women with PFP. Rearfoot eversion seems to be related with hip internal rotation only in a subgroup with excessive rearfoot eversion.



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Foot posture development in children aged 5 to11 years: a three-year prospective study.

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Alfonso Martínez-Nova, Gabriel Gijón-Noguerón, Pilar Alfageme-García, Jesús Montes-Alguacil, Angela Margaret Evans
BackgroundThe paediatric flatfoot is a common presentation but it is unclear whether the condition will resolve on its own as the child gets older or whether treatment is required. Therefore, the study objective was to evaluate paediatric foot posture, and anthropometry, in children at two time points, three years apart.Material and methodsA sample of 1032 healthy children (505 boys, 527 girls; aged 5–11 years) was recruited for foot posture index (FPI) and anthropometry assessment (weight, height and body mass index, BMI). Assessment was repeated when the children were aged 8 years to 14 years. Paired t-tests, Anova, frequency tables and a multiple regressions were conducted.ResultsInitially, approximately 70% had a neutral FPI range, 20% pronated, 3% highly pronated, and 4% supinated. Initial mean FPI was 3.6 ± 2.8, being higher in boys 3.7 ± 2.8 than in girls 3.4 ± 2.7 (p = 0.034). All FPI categories changed over time, with supinated and neutral FPI increased by 19.5% and 4.7% respectively. In contrast, pronated and highly pronated FPI reduced by 10.6% and 55.6% respectively. Regression showed only 1% FPI change was explained by increased height. FPI scores were significantly reduced after three years (3.57 to 3.33; p < 0.001).ConclusionChildren’s foot posture shifts toward neutral as age increases. There is minimal relationship with weight, height or BMI. Appreciation of developing foot posture could reduce over diagnosis and unnecessary treatment of paediatric flatfeet.



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Lower extremity power training improves healthy old adults’ gait biomechanics

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Azusa Uematsu, Tibor Hortobágyi, Kazushi Tsuchiya, Norio Kadono, Hirofumi Kobayashi, Tomoya Ogawa, Shuji Suzuki
PurposeAge-related slowing of gait speed predicts many clinical conditions in later life. We examined the kinematic and kinetic mechanisms of how lower extremity power training increases healthy old adults’ gait speed.MethodsWe randomly allocated old adults to a training (age 74.3 y, 9 males, 6 females) and a control group (age 73.6 y, 3 males, 4 females) and compared the biomechanics of habitual and fast gait before and after 16 sessions (8 weeks) of lower extremity power training.ResultsTraining increased maximal leg press load by ∼40% (P < 0.05) and maximal voluntary force in five groups of leg muscles by ∼32% (P < 0.05) in the training group. Training vs. control tended to increase habitual (10.8 vs. 7.6%) and fast gait speed (17.6 vs. 9.0%; all P < 0.05) more. In the training group only, these increases in gait speed correlated with increases in stride length (habitual: r² = 0.84, fast: r² = 0.89). Training made old adults’ gait more erect: hip and knee extension increased in the stance phase of gait. Training increased ankle joint positive work by 3.3 J (control: −0.4 J, Group by Time interaction: P < 0.05), which correlated r² = 0.58 and r² = 0.67 with increases in habitual and fast gait speed without changes in hip and knee joint powers.ConclusionIncreases in leg muscle power increased healthy old adults’ gait speed through correlated increases in stride length and ankle plantarflexor work generation.



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Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Stephanie L. King, Natalie Vanicek, Thomas D. O’Brien
ObjectiveTo determine the lower limb joint kinetic strategies during stair descent in claudicants with peripheral arterial disease (PAD-IC).DesignCross-sectional observation study.SettingUniversity laboratory.ParticipantsA total of 22 participants; 10 healthy controls and 12 patients diagnosed with PAD-IC.Main Outcome MeasuresBetween-group comparisons of ground reaction force (GRF) and, hip, knee and ankle kinetics during steady-state stair descent.ResultsThe claudicating-limb group demonstrated reduced vertical and posterior GRF compared to healthy controls (ES = −1.46 [−2.32,−0.69] and ES = −1.08 [−0.42,−0.26]) as well as demonstrating an greater contribution to support moment from the ankle and trends towards a smaller hip contribution (42 ± 14% vs 28 ± 7%, P=.005 and Hip 16 ± 8% vs 21 ± 11%, P=.056, respectively). A unique sub-group was identified within the PAD-IC cohort demonstrating different hip moment strategies during weight acceptance: a novel hip extensor group (PAD-IC HExt) and stereotypical hip flexor group (PAD-IC HFlex). Compared to both healthy controls and the PAD-IC HFlex groups, the PAD-IC HExt group demonstrated increased hip extensor moment (ES = 3.05 [1.67,4.42] and ES = 3.62 [1.89,5.35]) and reduced knee extensor moment (ES = −2.00 [−3.15,−0.85] and ES = −1.36 [−2.60,-0.11] respectively) during weight acceptance.ConclusionsA novel hip extensor strategy was identified in a sub-group of claudicants which acts to reduce the demand on the knee extensors, but not the plantarflexors. Weakness in the knee extensors may prevent redistribution of the task demand, typically seen in older adults in stair descent, away from the functionally limited plantarflexor muscle group. Further investigation into multi-level joint strength and the relationship to functional tasks is warranted to inform targeted intervention programmes.



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Net Ankle Quasi-Stiffness is influenced by Walking Speed but not Age for Older Adult Women

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): John D. Collins, Elisa S. Arch, Jeremy R. Crenshaw, Kathie A. Bernhardt, Sundeep Khosla, Shreyasee Amin, Kenton R. Kaufman
BackgroundInsufficient plantar flexor resistance due to plantar flexor weakness, an impairment common in patient populations, causes substantial gait deficits. The bending stiffness of passive-dynamic ankle-foot orthoses (PD-AFOs) has the capacity to replace lost plantar flexor resistance. Many patients who are prescribed PD-AFOs are older adults. While PD-AFO bending stiffness should be customized for patients, a method to objectively prescribe this stiffness does not exist. Quantifying natural plantar flexor resistance during non-pathological gait could provide a reference value for objectively prescribing PD-AFO bending stiffness.Research questionThis study investigated the effect of age on plantar flexor resistance in 113 participants above the age of 65 years. We did so while also considering the confounding influence of gait speed, an aspect known to be reduced with old age.MethodsAmbulatory, community-dwelling older adult women (ages 65-91 years) with no current or recent lower-extremity injuries or surgeries underwent an instrumented gait analysis at a self-selected speed. Plantar flexor resistance was quantified via net ankle quasi-stiffness (NAS) defined as the slope of ankle joint moment-angle curve during late stance.Resultsshowed that NAS was not significantly influenced by age (r = −0.11, p = 0.12), and that the confounding factor of walking speed had a significant, positive relationship with NAS (r = 0.59, p < 0.001).SignificanceBy determining that gait speed, not age, is related to NAS in older adults, this study represents the initial step towards objectively prescribing PD-AFO bending stiffness to achieve a targeted gait speed for older adults with plantar flexor weakness.



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Self-reported sleep duration affects tandem gait, but not steady-state gait outcomes among healthy collegiate athletes

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): David R. Howell, Brant Berkstresser, Francis Wang, Thomas A. Buckley, Rebekah Mannix, Alexandra Stillman, William P. Meehan
BackgroundSleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion.Research questionDoes the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance?MethodsOne hundred and fourteen healthy collegiate athletes (mean age 18.8 ± 0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait and instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy.ResultsParticipants who reported sleeping < 7 hours of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ± 2.2 vs. 10.1 ± 2.0 seconds and 14.5 ± 4.3 vs. 12.3 ± 2.6 seconds, respectively; p = .009) compared to those who reported sleeping ≥ 7 hours (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy.SignificanceSelf-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing.



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Acute and mid-term (six-week) effects of an ankle-foot-orthosis on biomechanical parameters, clinical outcomes and physical activity in knee osteoarthritis patients with varus malalignment

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Maik Sliepen, Elsa Mauricio, Dieter Rosenbaum
BackgroundKnee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods.Research questionThe aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients.Methods29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers.ResultsThe AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4–2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters.SignificanceThe six-week AFO application significantly reduced the KAM. The patients’ physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable.



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Femoral Anteversion Assessment: Comparison of Physical Examination, Gait Analysis, and EOS Biplanar Radiography

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): David E. Westberryt, Linda I. Wackt, Roy B. Davist, James W. Hardins
BackgroundMultiple measurement methods are available to assess transverse plane alignment of the lower extremity.Research questionThis study was performed to determine the extent of correlation between femoral anteversion assessment using simultaneous biplanar radiographs and three-dimensional modeling (EOS imaging), clinical hip rotation by physical examination, and dynamic hip rotation assessed by gait analysis.MethodsSeventy-seven patients with cerebral palsy (GMFCS Level I and II) and 33 neurologically typical children with torsional abnormalities completed a comprehensive gait analysis with same day biplanar anterior-posterior and lateral radiographs and three-dimensional transverse plane assessment of femoral anteversion. Correlations were determined between physical exam of hip rotation, EOS imaging of femoral anteversion, and transverse plane hip kinematics for this retrospective review study.ResultsLinear regression analysis revealed a weak relationship between physical examination measures of hip rotation and biplanar radiographic assessment of femoral anteversion. Similarly, poor correlation was found between clinical evaluation of femoral anteversion and motion assessment of dynamic hip rotation. Correlations were better in neurologically typical children with torsional abnormalities compared to children with gait dysfunction secondary to cerebral palsy.SignificanceDynamic hip rotation cannot be predicted by physical examination measures of hip range of motion or from three-dimensional assessment of femoral anteversion derived from biplanar radiographs.



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WHICH IS THE BEST PREDICTOR OF EXCESSIVE HIP INTERNAL ROTATION IN WOMEN WITH PATELLOFEMORAL PAIN: REARFOOT EVERSION OR HIP MUSCLE STRENGTH? EXPLORING SUBGROUPS

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Amanda Schenatto Ferreira, Danilo de Oliveira Silva, Ronaldo Valdir Briani, Deisi Ferrari, Fernando Amâncio Aragão, Marcella Ferraz Pazzinatto, Fábio Mícolis de Azevedo
BackgroundPatellofemoral pain (PFP) has been linked to increased patellofemoral joint stress as a result of excessive hip internal rotation. Lower hip strength and/or excessive rearfoot eversion have been used to explain such altered movement pattern; however, it is unknown which one is the best predictor of excessive hip internal rotation.Research questionTo investigate if peak rearfoot eversion and/or peak concentric hip abductor strength can predict peak hip internal rotation during stair ascent in women with PFP.MethodsThis cross-sectional study included thirty-seven women with PFP which underwent three-dimensional kinematic analysis during stair ascent and hip abductor strength analysis in an isokinetic dynamometer. A forced entry linear regression model analysis was carried out to determine which independent variables present the best capability to predict the hip internal rotation.ResultsPeak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R² = 0.27, p = 0.001). Peak rearfoot eversion did not predict peak hip internal rotation during stair ascent (R² < 0.01, p = 0.62). A Post-hoc analysis was conducted to explore if a subgroup with excessive rearfoot eversion would predict hip internal rotation. Based on a previous reported cut-off point, 48.6% of the participants were classified as excessive rearfoot eversion. For the subgroup with excessive rearfoot eversion, peak concentric hip abductor strength and peak rearfoot eversion significantly predicted peak hip internal rotation during stair ascent (R² = 0.26, p = 0.02; R² = 0.42, p = 0.003, respectively). For non-excessive rearfoot eversion subgroup, peak concentric hip abductor strength significantly predicted peak hip internal rotation during stair ascent (R² = 0.53; p < 0.001); and peak rearfoot eversion did not (R² = 0.01; p = 0.65).SignificanceFindings indicate that hip muscle strength seems to be related with hip internal rotation in all women with PFP. Rearfoot eversion seems to be related with hip internal rotation only in a subgroup with excessive rearfoot eversion.



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Foot posture development in children aged 5 to11 years: a three-year prospective study.

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Alfonso Martínez-Nova, Gabriel Gijón-Noguerón, Pilar Alfageme-García, Jesús Montes-Alguacil, Angela Margaret Evans
BackgroundThe paediatric flatfoot is a common presentation but it is unclear whether the condition will resolve on its own as the child gets older or whether treatment is required. Therefore, the study objective was to evaluate paediatric foot posture, and anthropometry, in children at two time points, three years apart.Material and methodsA sample of 1032 healthy children (505 boys, 527 girls; aged 5–11 years) was recruited for foot posture index (FPI) and anthropometry assessment (weight, height and body mass index, BMI). Assessment was repeated when the children were aged 8 years to 14 years. Paired t-tests, Anova, frequency tables and a multiple regressions were conducted.ResultsInitially, approximately 70% had a neutral FPI range, 20% pronated, 3% highly pronated, and 4% supinated. Initial mean FPI was 3.6 ± 2.8, being higher in boys 3.7 ± 2.8 than in girls 3.4 ± 2.7 (p = 0.034). All FPI categories changed over time, with supinated and neutral FPI increased by 19.5% and 4.7% respectively. In contrast, pronated and highly pronated FPI reduced by 10.6% and 55.6% respectively. Regression showed only 1% FPI change was explained by increased height. FPI scores were significantly reduced after three years (3.57 to 3.33; p < 0.001).ConclusionChildren’s foot posture shifts toward neutral as age increases. There is minimal relationship with weight, height or BMI. Appreciation of developing foot posture could reduce over diagnosis and unnecessary treatment of paediatric flatfeet.



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Lower extremity power training improves healthy old adults’ gait biomechanics

Publication date: Available online 26 March 2018
Source:Gait & Posture
Author(s): Azusa Uematsu, Tibor Hortobágyi, Kazushi Tsuchiya, Norio Kadono, Hirofumi Kobayashi, Tomoya Ogawa, Shuji Suzuki
PurposeAge-related slowing of gait speed predicts many clinical conditions in later life. We examined the kinematic and kinetic mechanisms of how lower extremity power training increases healthy old adults’ gait speed.MethodsWe randomly allocated old adults to a training (age 74.3 y, 9 males, 6 females) and a control group (age 73.6 y, 3 males, 4 females) and compared the biomechanics of habitual and fast gait before and after 16 sessions (8 weeks) of lower extremity power training.ResultsTraining increased maximal leg press load by ∼40% (P < 0.05) and maximal voluntary force in five groups of leg muscles by ∼32% (P < 0.05) in the training group. Training vs. control tended to increase habitual (10.8 vs. 7.6%) and fast gait speed (17.6 vs. 9.0%; all P < 0.05) more. In the training group only, these increases in gait speed correlated with increases in stride length (habitual: r² = 0.84, fast: r² = 0.89). Training made old adults’ gait more erect: hip and knee extension increased in the stance phase of gait. Training increased ankle joint positive work by 3.3 J (control: −0.4 J, Group by Time interaction: P < 0.05), which correlated r² = 0.58 and r² = 0.67 with increases in habitual and fast gait speed without changes in hip and knee joint powers.ConclusionIncreases in leg muscle power increased healthy old adults’ gait speed through correlated increases in stride length and ankle plantarflexor work generation.



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Implementing Evidence-Based Practice: Selecting Treatment Words to Boost Phonological Learning

Purpose

Word selection has typically been thought of as an inactive ingredient in phonological treatment, but emerging evidence suggests that word selection is an active ingredient that can impact phonological learning. The goals of this tutorial are to (a) review the emerging single-subject evidence on the influence of word characteristics on phonological learning in clinical treatment, (b) outline hypotheses regarding the mechanism of action of word characteristics, and (c) provide resources to support clinicians incorporating word selection as an active ingredient in their approach to phonological treatment.

Method

Research demonstrating the influence of the word frequency, neighborhood density, age of acquisition, and lexicality of treatment stimuli on phonological learning is summarized. The mechanism of action for each characteristic is hypothesized. Methods from the research studies are used to create a free set of evidence-based treatment materials targeting most of the mid-8 and late-8 consonants.

Results

Clinicians have numerous evidence-based options to consider when selecting stimuli for phonological treatment including (a) high-frequency and high-density words, (b) low-frequency and high-density words, (c) high-frequency and mixed-density words, (d) low-frequency and late-acquired words, and (e) nonwords.

Conclusion

Incorporating word characteristics into phonological treatment may boost phonological learning.

KU ScholarWorks Supplemental Material

http://hdl.handle.net/1808/24767

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The Complexity Approach to Phonological Treatment: How to Select Treatment Targets

Purpose

There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection.

Method

Evidence related to selecting targets for treatment based on characteristics of the targets (i.e., developmental norms, implicational universals) and characteristics of children's knowledge of the targets (i.e., accuracy, stimulability) is reviewed. Free resources are provided to aid clinicians in assessing accuracy and stimulability of singletons and clusters. Use of treatment target selection and generalization prediction worksheets is illustrated with 3 preschool children.

Results

Clinicians can integrate multiple pieces of information to select complex targets and successfully apply the complexity approach to their own clinical practice.

Conclusion

Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders.

Supplemental Material S1

https://doi.org/10.23641/asha.6007562

KU ScholarWorks Supplemental Material

http://hdl.handle.net/1808/24767

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Implementing Evidence-Based Practice: Selecting Treatment Words to Boost Phonological Learning

Purpose

Word selection has typically been thought of as an inactive ingredient in phonological treatment, but emerging evidence suggests that word selection is an active ingredient that can impact phonological learning. The goals of this tutorial are to (a) review the emerging single-subject evidence on the influence of word characteristics on phonological learning in clinical treatment, (b) outline hypotheses regarding the mechanism of action of word characteristics, and (c) provide resources to support clinicians incorporating word selection as an active ingredient in their approach to phonological treatment.

Method

Research demonstrating the influence of the word frequency, neighborhood density, age of acquisition, and lexicality of treatment stimuli on phonological learning is summarized. The mechanism of action for each characteristic is hypothesized. Methods from the research studies are used to create a free set of evidence-based treatment materials targeting most of the mid-8 and late-8 consonants.

Results

Clinicians have numerous evidence-based options to consider when selecting stimuli for phonological treatment including (a) high-frequency and high-density words, (b) low-frequency and high-density words, (c) high-frequency and mixed-density words, (d) low-frequency and late-acquired words, and (e) nonwords.

Conclusion

Incorporating word characteristics into phonological treatment may boost phonological learning.

KU ScholarWorks Supplemental Material

http://hdl.handle.net/1808/24767

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The Complexity Approach to Phonological Treatment: How to Select Treatment Targets

Purpose

There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection.

Method

Evidence related to selecting targets for treatment based on characteristics of the targets (i.e., developmental norms, implicational universals) and characteristics of children's knowledge of the targets (i.e., accuracy, stimulability) is reviewed. Free resources are provided to aid clinicians in assessing accuracy and stimulability of singletons and clusters. Use of treatment target selection and generalization prediction worksheets is illustrated with 3 preschool children.

Results

Clinicians can integrate multiple pieces of information to select complex targets and successfully apply the complexity approach to their own clinical practice.

Conclusion

Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders.

Supplemental Material S1

https://doi.org/10.23641/asha.6007562

KU ScholarWorks Supplemental Material

http://hdl.handle.net/1808/24767

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Implementing Evidence-Based Practice: Selecting Treatment Words to Boost Phonological Learning

Purpose

Word selection has typically been thought of as an inactive ingredient in phonological treatment, but emerging evidence suggests that word selection is an active ingredient that can impact phonological learning. The goals of this tutorial are to (a) review the emerging single-subject evidence on the influence of word characteristics on phonological learning in clinical treatment, (b) outline hypotheses regarding the mechanism of action of word characteristics, and (c) provide resources to support clinicians incorporating word selection as an active ingredient in their approach to phonological treatment.

Method

Research demonstrating the influence of the word frequency, neighborhood density, age of acquisition, and lexicality of treatment stimuli on phonological learning is summarized. The mechanism of action for each characteristic is hypothesized. Methods from the research studies are used to create a free set of evidence-based treatment materials targeting most of the mid-8 and late-8 consonants.

Results

Clinicians have numerous evidence-based options to consider when selecting stimuli for phonological treatment including (a) high-frequency and high-density words, (b) low-frequency and high-density words, (c) high-frequency and mixed-density words, (d) low-frequency and late-acquired words, and (e) nonwords.

Conclusion

Incorporating word characteristics into phonological treatment may boost phonological learning.

KU ScholarWorks Supplemental Material

http://hdl.handle.net/1808/24767

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The Complexity Approach to Phonological Treatment: How to Select Treatment Targets

Purpose

There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection.

Method

Evidence related to selecting targets for treatment based on characteristics of the targets (i.e., developmental norms, implicational universals) and characteristics of children's knowledge of the targets (i.e., accuracy, stimulability) is reviewed. Free resources are provided to aid clinicians in assessing accuracy and stimulability of singletons and clusters. Use of treatment target selection and generalization prediction worksheets is illustrated with 3 preschool children.

Results

Clinicians can integrate multiple pieces of information to select complex targets and successfully apply the complexity approach to their own clinical practice.

Conclusion

Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders.

Supplemental Material S1

https://doi.org/10.23641/asha.6007562

KU ScholarWorks Supplemental Material

http://hdl.handle.net/1808/24767

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The Wall of Sound

The hearing aid tech industry may owe the Grateful Dead a long overdue thank you. In the 1960s and 1970s, live music performances were limited due to the PA systems of the time. Pumping all feeds from mics to amps in a stereo-like manner muddied sound that couldn’t travel far and led to a disconnect between performers and audience. Enter Augustus Owsely “Bear” Stanley III, an audio visionary who is given credit, among other things, as the primary architect and designer of The Wall of Sound.

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Cochlear Implants: Educational Planning for School-Age Children

This course will address the numerous planning considerations for school age children using cochlear implant technology. It will discuss the many interwoven factors that impact student outcomes, effective educational placements and supports, and recommended planning considerations for students who may be enrolled in any educational setting.

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Cochlear Implants: Educational Planning for School-Age Children

This course will address the numerous planning considerations for school age children using cochlear implant technology. It will discuss the many interwoven factors that impact student outcomes, effective educational placements and supports, and recommended planning considerations for students who may be enrolled in any educational setting.

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Cochlear Implants: Educational Planning for School-Age Children

This course will address the numerous planning considerations for school age children using cochlear implant technology. It will discuss the many interwoven factors that impact student outcomes, effective educational placements and supports, and recommended planning considerations for students who may be enrolled in any educational setting.

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