Τετάρτη 21 Νοεμβρίου 2018

Full length foot orthoses have an immediate treatment effect and modify gait of children with idiopathic toe walking

Publication date: Available online 20 November 2018

Source: Gait & Posture

Author(s): Joanne Michalitsis, Anna T Murphy, Barry Rawicki, Terry P Haines, Cylie Williams

Abstract
Background

There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW.

Research Question

Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters?

Methods

This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite® mat were compared to barefoot walking and shod walking.

Results

An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001).

Significance

These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group.



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Dynamic walking stability of elderly people with various BMIs

Publication date: Available online 20 November 2018

Source: Gait & Posture

Author(s): Xing Gao, Li Wang, Fei Shen, Yingnan Ma, Yubo Fan, Haijun Niu

Abstract
Background

Falls are one of the major causes of injury in the elderly. Obesity may be related to the risk of falling. Understanding the dynamic stability mechanisms of obese elderly people during gait is important as it may be associated with fall protection.

Research question

Does obesity affect the dynamic walking stability of elderly people?

Methods

This is a prospective study. Fifty-three elderly participants, aged 60–82 years, were categorized into body mass index (BMI) groups. In single-limb support experiments, the center of mass velocity (COMv), center of mass acceleration (COMa), region of velocity stability (ROSv) and region of acceleration stability (ROSa) were calculated using kinematic data sampled from a motion analysis system. In addition, all participants were assessed for the dynamic balance ability test scale (DBATS). Statistical analyses were performed by one-way ANOVA, Kruskal–Wallis/Wilcoxon nonparametric tests, or bivariate Pearson/Spearman correlation analysis.

Results

During walking, peak COMv and COMa decreased with increasing BMI (Normal BMI: 1.20 ± 0.14 m/s, 1.66 ± 0.36 m/s2; High BMI: 1.14 ± 0.11 m/s, 1.56 ± 0.30 m/s2; Higher BMI: 1.04 ± 0.15 m/s, 1.47 ± 0.25 m/s2). At toe-off (TO), the normalized participants’ center of mass (COM) is significantly more anterior in the Higher BMI group (Normal BMI: -0.30 ± 0.09, High BMI: -0.23 ± 0.07, Higher BMI: -0.16 ± 0.10), their normalized COMv and COMa (Normal BMI: 1.40 ± 0.16, 0.53 ± 0.11; High BMI: 1.33 ± 0.13, 0.49 ± 0.11; Higher BMI: 1.21 ± 0.16, 0.46 ± 0.11) are slower. The mean DBATS score of the Higher BMI group was the highest, indicating the weakest dynamic balance ability.

Significance

The COM dynamic stability parameters indicate that obesity may worsen balance, with the peak COMv and ROSv most affected. With increasing BMI, the dynamic stability and balance of elderly people both decreased.



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Full length foot orthoses have an immediate treatment effect and modify gait of children with idiopathic toe walking

Publication date: Available online 20 November 2018

Source: Gait & Posture

Author(s): Joanne Michalitsis, Anna T Murphy, Barry Rawicki, Terry P Haines, Cylie Williams

Abstract
Background

There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW.

Research Question

Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters?

Methods

This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite® mat were compared to barefoot walking and shod walking.

Results

An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001).

Significance

These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group.



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Dynamic walking stability of elderly people with various BMIs

Publication date: Available online 20 November 2018

Source: Gait & Posture

Author(s): Xing Gao, Li Wang, Fei Shen, Yingnan Ma, Yubo Fan, Haijun Niu

Abstract
Background

Falls are one of the major causes of injury in the elderly. Obesity may be related to the risk of falling. Understanding the dynamic stability mechanisms of obese elderly people during gait is important as it may be associated with fall protection.

Research question

Does obesity affect the dynamic walking stability of elderly people?

Methods

This is a prospective study. Fifty-three elderly participants, aged 60–82 years, were categorized into body mass index (BMI) groups. In single-limb support experiments, the center of mass velocity (COMv), center of mass acceleration (COMa), region of velocity stability (ROSv) and region of acceleration stability (ROSa) were calculated using kinematic data sampled from a motion analysis system. In addition, all participants were assessed for the dynamic balance ability test scale (DBATS). Statistical analyses were performed by one-way ANOVA, Kruskal–Wallis/Wilcoxon nonparametric tests, or bivariate Pearson/Spearman correlation analysis.

Results

During walking, peak COMv and COMa decreased with increasing BMI (Normal BMI: 1.20 ± 0.14 m/s, 1.66 ± 0.36 m/s2; High BMI: 1.14 ± 0.11 m/s, 1.56 ± 0.30 m/s2; Higher BMI: 1.04 ± 0.15 m/s, 1.47 ± 0.25 m/s2). At toe-off (TO), the normalized participants’ center of mass (COM) is significantly more anterior in the Higher BMI group (Normal BMI: -0.30 ± 0.09, High BMI: -0.23 ± 0.07, Higher BMI: -0.16 ± 0.10), their normalized COMv and COMa (Normal BMI: 1.40 ± 0.16, 0.53 ± 0.11; High BMI: 1.33 ± 0.13, 0.49 ± 0.11; Higher BMI: 1.21 ± 0.16, 0.46 ± 0.11) are slower. The mean DBATS score of the Higher BMI group was the highest, indicating the weakest dynamic balance ability.

Significance

The COM dynamic stability parameters indicate that obesity may worsen balance, with the peak COMv and ROSv most affected. With increasing BMI, the dynamic stability and balance of elderly people both decreased.



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The Influence of Stimulus Repetition Rate on Tone-Evoked Post-Auricular Muscle Response (PAMR) Threshold

Objectives: Post-auricular muscle response (PAMR) is a large myogenic potential that can be useful in estimating behavioral hearing thresholds when the recording protocol is optimal. The main aim of the present study was to determine the influence of stimulus repetition rate on PAMR threshold. Design: In this repeated-measures study, 20 normally hearing adults aged between 18 and 30 years were recruited. Tone bursts (500, 1000, 2000, and 4000 Hz) were used to record PAMR thresholds at 3 different stimulus repetition rates (6.1/s, 11.1/s, and 17.1/s). Results: Statistically higher PAMR thresholds were found for the faster stimulus rate (17.1/s) compared with the slower stimulus rate (6.1/s) (p This study was part of a research project funded by Short Term Grant (P4122), Universiti Sains Malaysia. The authors have no conflicts of interest to disclose. Address for correspondence: Mohd Normani Zakaria, Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. E-mail: mdnorman@usm.my Received October 15, 2017; accepted September 18, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A New Speech, Spatial, and Qualities of Hearing Scale Short-Form: Factor, Cluster, and Comparative Analyses

Objectives: The objective of this work was to build a 15-item short-form of the Speech Spatial and Qualities of Hearing Scale (SSQ) that maintains the three-factor structure of the full form, using a data-driven approach consistent with internationally recognized procedures for short-form building. This included the validation of the new short-form on an independent sample and an in-depth, comparative analysis of all existing, full and short SSQ forms. Design: Data from a previous study involving 98 normal-hearing (NH) individuals and 196 people with hearing impairments (HI), non hearing aid wearers, along with results from several other published SSQ studies, were used for developing the short-form. Data from a new and independent sample of 35 NH and 88 HI hearing aid wearers were used to validate the new short-form. Factor and hierarchical cluster analyses were used to check the factor structure and internal consistency of the new short-form. In addition, the new short-form was compared with all other SSQ forms, including the full SSQ, the German SSQ15, the SSQ12, and the SSQ5. Construct validity was further assessed by testing statistical relationships between scores and audiometric factors, including pure-tone threshold averages (PTAs) and left/right PTA asymmetry. Receiver-operating characteristic analyses were used to compare the ability of different SSQ forms to discriminate between NH and HI (HI non hearing aid wearers and HI hearing aid wearers) individuals. Results: Compared all other SSQ forms, including the full SSQ, the new short-form showed negligible cross-loading across the three main subscales and greater discriminatory power between NH and HI subjects (as indicated by a larger area under the receiver-operating characteristic curve), as well as between the main subscales (especially Speech and Qualities). Moreover, the new, 5-item Spatial subscale showed increased sensitivity to left/right PTA asymmetry. Very good internal consistency and homogeneity and high correlations with the SSQ were obtained for all short-forms. Conclusions: While maintaining the three-factor structure of the full SSQ, and exceeding the latter in terms of construct validity and sensitivity to audiometric variables, the new 15-item SSQ affords a substantial reduction in the number of items and, thus, in test time. Based on overall scores, Speech subscores, or Spatial subscores, but not Qualities subscores, the 15-item SSQ appears to be more sensitive to differences in self-evaluated hearing abilities between NH and HI subjects than the full SSQ. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors wish to thank Jeremy Montagnat-Misson for technical help during the data collection. C. M. is supported by Starkey Hearing Technologies, a private entity and manufacturer of hearing technology. S. G. is supported by Audition Conseil, a private company and group of audiology clinics. Other than through funding of these two coauthors’ salaries, the sponsors for this study had no involvement in the design of the study, the data analysis, or the writing of the manuscript. This work was supported in part by the “Auvergne-Rhône-Alpes” region (research program “Effecbruit”); the “Fondation de l’Avenir” and “Visaudio” (research program ET4-738-VI4-001); the LABEX CELYA (ANR-11-LABX-0060) of Université de Lyon, France; and the LABEX CORTEX (ANR-11-LABX-0042) of Université de Lyon, within the program “Investissements d’Avenir” (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR). The authors have no conflicts of interest to disclose. Address for correspondence: Annie Moulin, Dynamique Cérébrale et Cognition (DYCOG), Centre de Recherche en Neurosciences de Lyon, CRNL, Inserm U1028-CNRS UMR5292, CH Le Vinatier, Bâtiment 452, 95 Bd Pinel, 69675 Bron Cedex, France. E-mail: annie.moulin@cnrs.fr Received July 16, 2017; accepted September 8, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Influence of Stimulus Repetition Rate on Tone-Evoked Post-Auricular Muscle Response (PAMR) Threshold

Objectives: Post-auricular muscle response (PAMR) is a large myogenic potential that can be useful in estimating behavioral hearing thresholds when the recording protocol is optimal. The main aim of the present study was to determine the influence of stimulus repetition rate on PAMR threshold. Design: In this repeated-measures study, 20 normally hearing adults aged between 18 and 30 years were recruited. Tone bursts (500, 1000, 2000, and 4000 Hz) were used to record PAMR thresholds at 3 different stimulus repetition rates (6.1/s, 11.1/s, and 17.1/s). Results: Statistically higher PAMR thresholds were found for the faster stimulus rate (17.1/s) compared with the slower stimulus rate (6.1/s) (p This study was part of a research project funded by Short Term Grant (P4122), Universiti Sains Malaysia. The authors have no conflicts of interest to disclose. Address for correspondence: Mohd Normani Zakaria, Audiology and Speech Pathology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. E-mail: mdnorman@usm.my Received October 15, 2017; accepted September 18, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A New Speech, Spatial, and Qualities of Hearing Scale Short-Form: Factor, Cluster, and Comparative Analyses

Objectives: The objective of this work was to build a 15-item short-form of the Speech Spatial and Qualities of Hearing Scale (SSQ) that maintains the three-factor structure of the full form, using a data-driven approach consistent with internationally recognized procedures for short-form building. This included the validation of the new short-form on an independent sample and an in-depth, comparative analysis of all existing, full and short SSQ forms. Design: Data from a previous study involving 98 normal-hearing (NH) individuals and 196 people with hearing impairments (HI), non hearing aid wearers, along with results from several other published SSQ studies, were used for developing the short-form. Data from a new and independent sample of 35 NH and 88 HI hearing aid wearers were used to validate the new short-form. Factor and hierarchical cluster analyses were used to check the factor structure and internal consistency of the new short-form. In addition, the new short-form was compared with all other SSQ forms, including the full SSQ, the German SSQ15, the SSQ12, and the SSQ5. Construct validity was further assessed by testing statistical relationships between scores and audiometric factors, including pure-tone threshold averages (PTAs) and left/right PTA asymmetry. Receiver-operating characteristic analyses were used to compare the ability of different SSQ forms to discriminate between NH and HI (HI non hearing aid wearers and HI hearing aid wearers) individuals. Results: Compared all other SSQ forms, including the full SSQ, the new short-form showed negligible cross-loading across the three main subscales and greater discriminatory power between NH and HI subjects (as indicated by a larger area under the receiver-operating characteristic curve), as well as between the main subscales (especially Speech and Qualities). Moreover, the new, 5-item Spatial subscale showed increased sensitivity to left/right PTA asymmetry. Very good internal consistency and homogeneity and high correlations with the SSQ were obtained for all short-forms. Conclusions: While maintaining the three-factor structure of the full SSQ, and exceeding the latter in terms of construct validity and sensitivity to audiometric variables, the new 15-item SSQ affords a substantial reduction in the number of items and, thus, in test time. Based on overall scores, Speech subscores, or Spatial subscores, but not Qualities subscores, the 15-item SSQ appears to be more sensitive to differences in self-evaluated hearing abilities between NH and HI subjects than the full SSQ. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors wish to thank Jeremy Montagnat-Misson for technical help during the data collection. C. M. is supported by Starkey Hearing Technologies, a private entity and manufacturer of hearing technology. S. G. is supported by Audition Conseil, a private company and group of audiology clinics. Other than through funding of these two coauthors’ salaries, the sponsors for this study had no involvement in the design of the study, the data analysis, or the writing of the manuscript. This work was supported in part by the “Auvergne-Rhône-Alpes” region (research program “Effecbruit”); the “Fondation de l’Avenir” and “Visaudio” (research program ET4-738-VI4-001); the LABEX CELYA (ANR-11-LABX-0060) of Université de Lyon, France; and the LABEX CORTEX (ANR-11-LABX-0042) of Université de Lyon, within the program “Investissements d’Avenir” (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR). The authors have no conflicts of interest to disclose. Address for correspondence: Annie Moulin, Dynamique Cérébrale et Cognition (DYCOG), Centre de Recherche en Neurosciences de Lyon, CRNL, Inserm U1028-CNRS UMR5292, CH Le Vinatier, Bâtiment 452, 95 Bd Pinel, 69675 Bron Cedex, France. E-mail: annie.moulin@cnrs.fr Received July 16, 2017; accepted September 8, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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