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Assessment of Gait Symmetry Improvements in National Athletes after Anterior Cruciate Ligament Reconstruction during Rehabilitation

Hadizadeh M, Amri S, Roohi SA, Mohafez H

Int J Sports Med, 2016 Nov;37(12):997-1002.
PMID: 27551935

This study aimed to quantify changes in gait parameters and their symmetries among athletes with anterior cruciate ligament (ACL) reconstructions during a rehabilitation program. Twenty-two national players with ACL reconstructions and 15 healthy athletes were recruited. The gait data were collected between postoperative weeks 4-5, 8-9 and 12-13 using a three-dimensional motion analysis system. The spatio-temporal gait parameters and symmetry indexes (SIs) were evaluated for the patients and the control group. One-way and repeated-measures multivariate analysis of variance were used to analyse the data. The results demonstrated significant differences among spatio-temporal (P<0.001) and SIs (P=0.007) of patients for Test 1 and the control group. Repeated measure analysis revealed significant changes in the linear combinations of spatio-temporal gait variables (P=0.002) and SIs (P=0.043) over time. The injured limb's step length, cadence and weight acceptance time presented significant improvement across time (P<0.001). Moreover, the SI of the stance time was reduced significantly by 46.48% (P=0.004) among SI parameters. After three months, no significant differences were found between patients and healthy controls for the measured gait components (P>0.05). The rehabilitation program allowed national athletes to restore symmetry in spatio-temporal gait parameters toward the control group's range 12-13 weeks post-reconstruction.

Matched MeSH terms: Gait/physiology*
Combined effects of knee brace, laterally wedged insoles and toe-in gait on knee adduction moment and balance in moderate medial knee osteoarthritis patients

Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA

Gait Posture, 2018 03;61:243-249.
PMID: 29413792 DOI: 10.1016/j.gaitpost.2018.01.024

OBJECTIVE: To test the hypothesis that toe-in gait (TI) will further reduce first peak (Knee Adduction Moment) KAM and decrease balance when combined with a knee brace (KB) and laterally wedged insoles (LWI) in medial knee osteoarthritis (kOA) patients.
PARTICIPANTS: Twenty patients with bilateral symptomatic medial kOA.
INTERVENTIONS: 4-point leverage-based KB, full-length LWI with 5° inclination and toe-in gait (TI).
MAIN OUTCOME MEASURES: First and second peak knee adduction moment (fKAM and sKAM respectively), balance and pain.
METHODS: The fKAM and sKAM were determined from 3-dimensional gait analysis with six randomized conditions: (1) N (without any intervention), (2) KB, (3) KB + TI, (4) LWI, (5) LWI + TI, (6) KB + LWI + TI. Balance was assessed by Biodex Balance System using three stability settings, (i) Static (ii) Moderate dynamic setting for fall risk (FR12) and (iii) High dynamic setting for fall risk (FR8).
RESULTS: The reduction in fKAM and sKAM was greatest (19.75% and 12%) when TI was combined with KB and LWI respectively. No change in balance was observed when TI combined with KB, and LWI and when used concurrently with both the orthosis at static and FR12 conditions. Significant balance reduction was found at FR8 for KB + TI (22.22%), and KB + LWI + TI (35.71%). Pain increased significantly for KB (258%), KB + TI (305%), LWI + TI (210%) and KB + LWI + TI (316%). LWI showed no effect on pain.
CONCLUSIONS: There is a synergistic effect of TI when combined with KB and LWI concurrently in sKAM reduction. However, the concurrent use of TI, KB and LWI decreases balance and pain as assessed on a highly dynamic platform.
Study site: Department of Sports Medicine, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Gait/physiology*
Fulltext The effects of suction and pin/lock suspension systems on transtibial amputees' gait performance

Gholizadeh H, Abu Osman NA, Eshraghi A, Ali S

PLoS One, 2014;9(5):e94520.
PMID: 24827560 DOI: 10.1371/journal.pone.0094520

The suction sockets that are commonly prescribed for transtibial amputees are believed to provide a better suspension than the pin/lock systems. Nevertheless, their effect on amputees' gait performance has not yet been fully investigated. The main intention of this study was to understand the potential effects of the Seal-in (suction) and the Dermo (pin/lock) suspension systems on amputees' gait performance.

Matched MeSH terms: Gait/physiology*
Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia

Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al.

J Am Med Dir Assoc, 2014 Feb;15(2):95-101.
PMID: 24461239 DOI: 10.1016/j.jamda.2013.11.025

Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia.

Matched MeSH terms: Gait/physiology
Combined effects of knee brace, laterally wedged insoles, and toe-out gait on knee adduction moment and fall risk in moderate medial knee osteoarthritis patients

Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA

Prosthet Orthot Int, 2019 Apr;43(2):148-157.
PMID: 30192706 DOI: 10.1177/0309364618796849

BACKGROUND:: Knee osteoarthritis is a major contributor to the global burden of disease. There is a need of reducing knee joint load and to improve balance and physical function among knee osteoarthritis patients.
OBJECTIVES:: To test the hypothesis that toe-out gait will reduce second peak knee adduction moment further and increase fall risk when combined with knee brace and laterally wedged insole in knee osteoarthritis patients.
STUDY DESIGN:: Single visit study with repeated measures.
METHODS:: First and second peak knee adduction moments, fall risk and comfort level. First and second peak knee adduction moments were determined from three-dimensional gait analysis, completed under six randomized conditions: (1) natural, (2) knee brace, (3) knee brace + toe-out gait, (4) laterally wedged insole, (5) laterally wedged insole + toe-out gait, and (6) knee brace + laterally wedged insole + toe-out gait. Fall risk was assessed by Biodex Balance System using three randomized stability settings: (1) static, (2) moderate dynamic setting (FR12), and (3) high dynamic setting (FR8).
RESULTS:: The reduction in first peak knee adduction moment and second peak knee adduction moment was greatest (7.16% and 25.55%, respectively) when toe-out gait combine with knee brace and laterally wedged insole. Significant increase in fall risk was observed with knee brace + laterally wedged insole + toe-out gait (42.85%) at FR12. Similar significant balance reductions were found at FR8 condition for knee brace + toe-out gait (35.71%), laterally wedged insole + toe-out gait (28.57%), and knee brace + laterally wedged insole + toe-out gait (50%) as compared to natural. However, knee brace decreased fall risk at FR12 by 28.57%.
CONCLUSION:: There is a synergistic effect of toe-out when combined with knee brace and laterally wedged insole concurrently in second peak knee adduction moment reduction but with a greater degree of fall risk. Simultaneous use of conservative treatments also decreases comfort level.
CLINICAL RELEVANCE: Patients with mild and moderate knee osteoarthritis are usually prescribed conservative treatment techniques. This study will provide an insight whether or not a combination of these techniques have a synergistic effect in reducing knee joint load.

Matched MeSH terms: Gait/physiology*
Donor-site morbidity of free fibula and DCIA flaps

Ling XF, Peng X, Samman N

J Oral Maxillofac Surg, 2013 Sep;71(9):1604-12.
PMID: 23810616 DOI: 10.1016/j.joms.2013.03.006

This study evaluated and compared the long-term donor-site morbidity of the free fibula flap with the deep circumflex iliac artery (DCIA) flap in maxillofacial reconstruction.

Matched MeSH terms: Gait/physiology