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Cimolin V, Premoli C, Bernardelli G, Amenta E, Galli M, Donno L, Lucini D, Fatti LM, Cangiano B, Persani L, Vitale G. ACROMORFO study: gait analysis in a cohort of acromegalic patients. J Endocrinol Invest 2024:10.1007/s40618-024-02340-3. [PMID: 38416368 DOI: 10.1007/s40618-024-02340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE In acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly. STUDY POPULATION Thirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study. MEASUREMENTS Kinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population. RESULTS The acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern. CONCLUSION Acromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls' risk and improve QoL.
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Affiliation(s)
- V Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
- IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Strada Luigi Cadorna 90, 28824, Piancavallo, Italy
| | - C Premoli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
| | - G Bernardelli
- DISCCO Department, University of Milan, 20122, Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135, Milan, Italy
| | - E Amenta
- DISCCO Department, University of Milan, 20122, Milan, Italy
| | - M Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - L Donno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - D Lucini
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135, Milan, Italy
| | - L M Fatti
- Department of Endocrine and Metabolic Medicine, IRCCS, Istituto Auxologico Italiano, 20149, Milan, Italy
| | - B Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Medicine, IRCCS, Istituto Auxologico Italiano, 20149, Milan, Italy
| | - L Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Medicine, IRCCS, Istituto Auxologico Italiano, 20149, Milan, Italy
| | - G Vitale
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy.
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, IRCCS, Istituto Auxologico Italiano, 20145, Milan, Italy.
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Kabul EG, Yenil S, Ulutas F, Bali M, Calik BB, Cobankara V. Evaluation of balance in patients with systemic sclerosis. Clin Biomech (Bristol, Avon) 2023; 110:106122. [PMID: 37844542 DOI: 10.1016/j.clinbiomech.2023.106122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The aim was to examine static/dynamic balance and proprioception of Systemic Sclerosis by comparing healthy and relationship with demographic and disease-related data. METHODS 21 Systemic Sclerosis and 19 healthy were included.Berg Balance Scale (functional balance), Sensamove Sensbalance Maxiboard Software (static, dynamic balance:reaction time and travel time and proprioception), Scleroderma Health Assessment Questionnaire/Health Assessment Questionnaire (health status), Medsger's Disease Severity Scale, Modified Rodnan Skin Score were used in evaluation. FINDINGS Comparing the groups, there was significant difference in Berg Balance Scale (p:0.036); Health Assessment Questionnaire/Scleroderma Health Assessment Questionnaire (p:0.001); Static balance-center (p:0.001), front (p:0.001), back (p:0.001), left (p:0.001), right (p:0.021); proprioception-front (p:0.025);Reaction Time-front (p:0.031) and left (p:0.010);Travel Time-front (p:0.041) and left (p:0.014) in favor of healthy group.In Systemic Sclerosis, disease severity had moderate correlation with static balance-back (r:-0.504,p:0.020).Skin thickness had low correlation with Reaction Time-front (r:-0.449,p:0.041).Age had low correlation with Travel time-front (r:0.458,p:0.037) and proprioception-left (r:0.450,p:0.041); moderate with Travel time-back (r:0.515;p:0.017) and proprioception-front (r:0.539,p:0.012). INTERPRETATION Compared to healthy, Systemic Sclerosis had worse health status, functional balance, static/dynamic balance and proprioception.This situation is related to disease severity, skin thickness and age. Evaluations made with objective methods may have the potential to determine the extent of the problem.Clinicians can guide the treatment of patients with SSc by evaluating their static/dynamic balance and proprioception.With early treatment, additional problems that may occur due to worsening of balance and proprioception can be prevented.Proprioception and dynamic balance evaluation can be performed for older patients, static balance when disease activity is high, and dynamic balance when skin thickness score is high.
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Affiliation(s)
- Elif Gur Kabul
- Faculty of Health Sciences, Physiotherapy and Rehabilitation, Usak University, Usak, Turkey.
| | - Sinem Yenil
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Firdevs Ulutas
- Department of Rheumatology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Merve Bali
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Bilge Basakci Calik
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Veli Cobankara
- Department of Rheumatology, Medical Faculty, Pamukkale University, Denizli, Turkey.
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Kurzeja P, Gąsienica-Walczak B, Ogrodzka-Ciechanowicz K, Prusak J. Analysis of the Ability to Tolerate Body Balance Disturbance in Relation to Selected Changes in the Sagittal Plane of the Spine in Early School-Age Children. J Clin Med 2022; 11:jcm11061653. [PMID: 35329977 PMCID: PMC8955683 DOI: 10.3390/jcm11061653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Abstract
The study aimed to estimate the ability to tolerate body balance disturbance in relation to selected changes in the sagittal plane of the spine in early school-age children. The study involved 189 children with an average age of 8.3 ± 0.7 years (aged 7−10). The tests included an interview, clinical examination (measurement of body weight and height, assessment of the course of the spinous processes of the thoracic and lumbar vertebrae, assessment of the location of selected anatomical landmarks of the torso), and a physical examination in which the shape of the spine surface was examined with the use of the photogrammetric method and the moiré effect projection. Body balance disturbance tolerance skills (BBDTS) were measured with the rotational test (RT). In the rotational test, the results of body balance disturbance tolerance skills show a slight but statistically significant correlation with the bodyweight of the examined children (Rs = 0.35, p < 0.001). This relationship was also statistically significant in the groups by gender. Among the measured indicators of the curvature of the spine in the sagittal plane, the correlation with the RT test result was mostly related to the α angle and the value was Rs = 0.15 (p = 0.04). In the group of girls, this correlation was stronger and amounted to Rs = 0.26 (p = 0.015). Among other measured correlations, the dependence of variables such as the bodyweight of the subjects and the α angle was shown. In conclusion, increasing lumbar lordosis results in the deterioration of balance disturbance tolerance skills. As body weight increases, body balance disturbance tolerance skills decrease.
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Affiliation(s)
- Piotr Kurzeja
- Institute of Health Sciences, Podhale State College of Applied Sciences, 34-400 Nowy Targ, Poland; (P.K.); (B.G.-W.); (J.P.)
| | - Bartłomiej Gąsienica-Walczak
- Institute of Health Sciences, Podhale State College of Applied Sciences, 34-400 Nowy Targ, Poland; (P.K.); (B.G.-W.); (J.P.)
| | - Katarzyna Ogrodzka-Ciechanowicz
- Institute of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education, 31-571 Krakow, Poland
- Correspondence:
| | - Jarosław Prusak
- Institute of Health Sciences, Podhale State College of Applied Sciences, 34-400 Nowy Targ, Poland; (P.K.); (B.G.-W.); (J.P.)
- Institute for Tuberculosis and Lung Diseases, 34-700 Rabka-Zdrój, Poland
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Ashnagar Z, Hadian MR, Olyaei G, Talebian S, Rezasoltani A, Saeedi H, Yekaninejad MS, Mahmoodi R. Iliopsoas muscle thickness and pelvic alignment in pronated and normal foot postures. J Bodyw Mov Ther 2020; 24:20-23. [PMID: 33218512 DOI: 10.1016/j.jbmt.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/13/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
It is hypothesized that the subtalar hyperpronation may provoke the development of a biomechanical chain of events in lower extremity alignment. Several studies have shown that pelvic alignment may alter in the presence of immediate foot hyperpronation induced by external forces. It is unknown whether these alterations are presented in chronic foot hyperpronation or not. It is also unknown if these potential postural changes could affect iliopsoas muscle size. Therefore, it appears necessary to carry out thorough research in this study. Twenty nine females with pronated foot posture and twenty seven females with normal foot posture participated in this study. The iliopsoas muscle was measured using ultrasound imaging (USI). Pelvic angle (PA) was measured using reflective markers and digital photography. Intrarater reliability of USI for the iliopsoas muscle thickness was also measured. The results indicated that the iliopsoas muscle thickness and the PA were not different in individuals with pronated foot compared to the normal foot group. However, a good intrarater reliability of USI was found for measuring the iliopsoas muscle thickness.
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Affiliation(s)
- Zinat Ashnagar
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad-Reza Hadian
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamreza Olyaei
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Talebian
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Asghar Rezasoltani
- Faculty of Rehabilitation Sciences, Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Saeedi
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Rahimeh Mahmoodi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Ludwig O, Kelm J, Hammes A, Schmitt E, Fröhlich M. Neuromuscular performance of balance and posture control in childhood and adolescence. Heliyon 2020; 6:e04541. [PMID: 32775721 PMCID: PMC7398941 DOI: 10.1016/j.heliyon.2020.e04541] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
This study examined a potential age-dependency of both posture and stability (balance) control in children and adolescents in a healthy population. Body posture with open and closed eyes was examined for a total of 456 test persons (age 6.7–17.6 years. Posture parameters (posture index, upper body tilt, trunk tilt) were assessed in the sagittal plane. Additionally, the oscillation of the center of pressure with open and closed eyes was additionally analyzed in a sub-sample of 318 subjects. Absolute values of stability control parameters changed significantly during childhood and adolescence for both boys (p = 0.005) and girls (p = 0.01). Relative changes of stability and posture parameters when closing the eyes did not change (p > 0.05) and were independent of age, gender or sports activity in healthy children and adolescents. The shifting of the body segments towards each other, as a result of the loss of visual information, does not seem to be primarily responsible for the increase in COP fluctuation. This is a further indication that stability control and posture control are complex interdependent mechanisms whose interaction is not yet fully understood.
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Affiliation(s)
- Oliver Ludwig
- Fachgebiet Sportwissenschaft, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany
- Sportwissenschaftliches Institut, Universität des Saarlandes, 66123 Saarbrücken, Germany
- Corresponding author.
| | - Jens Kelm
- Chirurgisch-orthopädisches Zentrum, 66557 Illingen, Germany
| | - Annette Hammes
- Medicover Medizinisches Versorgungszentrum, 66111 Saarbrücken, Germany
| | - Eduard Schmitt
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, 66424 Homburg, Germany
| | - Michael Fröhlich
- Fachgebiet Sportwissenschaft, Technische Universität Kaiserslautern, 67663 Kaiserslautern, Germany
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de Azevedo Oliveira B, Araujo B, Dos Santos TM, Ongaratti BR, Rech CGSL, Ferreira NP, Pereira-Lima JFS, da Costa Oliveira M. The acromegalic spine: fractures, deformities and spinopelvic balance. Pituitary 2019; 22:601-606. [PMID: 31556014 DOI: 10.1007/s11102-019-00991-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Axial skeleton arthropathy and osteoporotic vertebral fractures are common findings in acromegalic patients and can result in severe spinal deformity. OBJECTIVE To investigate the presence of spinal fractures and deformities, sagittal imbalances, and spinopelvic compensatory mechanisms in acromegalics. PATIENTS AND METHODS 58 patients with acromegaly from a referral neuroendocrinology center were prospectively evaluated by panoramic spine radiographs to detect the presence of fractures and scoliosis, to measure thoracic kyphosis, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sagittal vertical axis (SVA). Sagittal imbalance criteria were considered: thoracic kyphosis > 50°, PI-LL > 10°, PT > 20° and SVA > 5 cm. Their medical records were analyzed for clinical and laboratorial data. RESULTS The prevalence of fractures was 13.8%, predominantly in the thoracic spine, with mild and anterior wedge compressions. Scoliosis was present in 34.5% of the cases, all with degenerative lumbar curve apex. Thoracic kyphosis > 50º occurred in 36.8% of patients, PI-LL > 10° in 48.3%, PT > 20° in 41.4% and SVA > 5 cm in 12.1%. CONCLUSION Increased number of vertebral fractures and high prevalence of spinal deformities related to sagittal imbalance were detected, indicating the importance of monitoring bone comorbidities in acromegaly, with radiological evaluation of the spine as part of the follow up.
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Affiliation(s)
- Bruno de Azevedo Oliveira
- Programa de Pós-Graduação Em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Bruna Araujo
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Rua Sarmento Leite, 245; sala 402, prédio 1 /90050-170 - Porto Alegre, Porto Alegre, RS, Brasil
| | - Tainá Mafalda Dos Santos
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Rua Sarmento Leite, 245; sala 402, prédio 1 /90050-170 - Porto Alegre, Porto Alegre, RS, Brasil
| | - Bárbara Roberta Ongaratti
- Programa de Pós-Graduação Em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Carolina Garcia Soares Leães Rech
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Rua Sarmento Leite, 245; sala 402, prédio 1 /90050-170 - Porto Alegre, Porto Alegre, RS, Brasil
| | - Nelson Pires Ferreira
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Rua Sarmento Leite, 245; sala 402, prédio 1 /90050-170 - Porto Alegre, Porto Alegre, RS, Brasil
| | - Júlia Fernanda Semmelmann Pereira-Lima
- Programa de Pós-Graduação Em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Rua Sarmento Leite, 245; sala 402, prédio 1 /90050-170 - Porto Alegre, Porto Alegre, RS, Brasil
| | - Miriam da Costa Oliveira
- Programa de Pós-Graduação Em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil.
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Rua Sarmento Leite, 245; sala 402, prédio 1 /90050-170 - Porto Alegre, Porto Alegre, RS, Brasil.
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Lima TRL, Kasuki L, Gadelha M, Lopes AJ. Physical exercise improves functional capacity and quality of life in patients with acromegaly: a 12-week follow-up study. Endocrine 2019; 66:301-309. [PMID: 31317523 DOI: 10.1007/s12020-019-02011-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although the focus of acromegaly treatment is the hormonal control of the disease, a new perspective must be given to the functional rehabilitation of these patients, especially when considering the recent increase in survival. The aim of this study was to evaluate the effects of therapist-oriented home rehabilitation (TOHR) on patients with acromegaly. PATIENTS AND METHODS Seventeen adults with acromegaly followed an exercise programme from a booklet with instructions for each exercise prescribed, for 2 months, and were reassessed after 1 month of washout. At each of the 3 timepoints (before and after the intervention and at the 1-month follow-up), the participants were subjected to the following assessments: body composition through bioimpedance, health-related quality of life (HRQoL) using the Acromegaly Quality of Life (AcroQoL) questionnaire, general fatigue through the Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength, lower extremity functionality using isometric dynamometry and the Lower Extremity Functional Scale (LEFS), body balance through stabilometry, and functional capacity through 6-minute walking distance (6MWD). RESULTS After performing TOHR, improvements in general fatigue, quadriceps muscle strength, LEFS, 6MWD, balance control and all AcroQoL dimensions were observed (all P < 0.05). After 1 month of washout, however, these gains were lost for all parameters, except the LEFS and balance control. CONCLUSIONS In acromegaly, TOHR results in improvements in muscle function, functional capacity, general fatigue, body balance, and HRQoL. Large randomized controlled trials are needed to replicate these benefits and to recommend rehabilitation, especially for those with long-term illness.
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Affiliation(s)
- Tatiana Rafaela Lemos Lima
- Rehabilitation Sciences Post-graduate Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Gadelha
- Neuroendocrinology Research Centre/Endocrinology Section, Medical School and Clementino Fraga Filho University Hospital, Federal University of the Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Neuroendocrine Unit, Paulo Niemeyer State Brain Institute, Secretary of State for Health of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Sciences Post-graduate Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.
- Post-graduate Programme in Medical Sciences, School of Medical Sciences, State University of the Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
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Haliloglu O, Topsakal N, Camliguney F, Polat Korkmaz O, Sahin S, Cotuk B, Kadioglu P, Erkut O. Static and dynamic balances of patients with acromegaly and impact of exercise on balance. Pituitary 2019; 22:497-506. [PMID: 31368031 DOI: 10.1007/s11102-019-00979-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly. METHODS This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device. RESULTS The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior-posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left-right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward-backward and medial-lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A. CONCLUSIONS Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.
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Affiliation(s)
- Ozlem Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nuri Topsakal
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
| | - Filiz Camliguney
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
| | - Ozge Polat Korkmaz
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Birol Cotuk
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Oya Erkut
- Department of Sport Health and Science, School of Physical Education and Sports, Marmara University, Istanbul, Turkey
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Abstract
PURPOSE To determine both static and dynamic plantar data of acromegalic subjects while barefoot. METHODS Seventy acromegalic patients and 48 age-, sex-, weight- and height-matched healthy controls were included. Plantar variables were measured using the footscan gait system. The data included the width and length of each foot, relative force distribution in each quadrant, mean force applied to each foot and maximum pressure while walking. Maximum pressure data were obtained from ten parts of the foot. Injury risk assessments of five different regions were performed. To analyze balance, center of pressure (CoP) measurements were performed. The patients with acromegaly were compared with the controls. Furthermore, a comparison of patients with active and controlled acromegaly was performed. RESULTS The foot was wider in acromegalic patients. The mean force on each foot was higher in cases of acromegaly (acromegaly: 1027 ± 180 N, control: 908 ± 180 N, p = 0.001). In the acromegalic individuals, the maximum pressure in the midfoot was higher, while the medial heel maximum pressure was lower (midfoot maximum pressure acromegaly: 11.3 ± 3.5 N/cm2, control: 8.9 ± 3.7 N/cm2, p = < 0.001). Injury risk was similar. CoP measurements elicited intact balance. In terms of static and dynamic plantar data, there was no difference between patients with active and controlled acromegaly. CONCLUSIONS This is the first study to demonstrate that compared with healthy controls, patients with acromegaly experience great force on their feet while standing and high pressure in the midfoot during walking. Podiatric evaluation, custom molded orthotics and individualized rehabilitation programs for acromegalic patients may provide better force and pressure distribution throughout the foot and improve gait and skeletal symptoms.
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Affiliation(s)
- Suleyman Nahit Sendur
- Department of Endocrinology and Metabolism, Hacettepe University Medical School, Sihhiye, 06100, Ankara, Turkey.
| | - Seda Oguz
- Department of Endocrinology and Metabolism, Hacettepe University Medical School, Sihhiye, 06100, Ankara, Turkey
| | - Selcuk Dagdelen
- Department of Endocrinology and Metabolism, Hacettepe University Medical School, Sihhiye, 06100, Ankara, Turkey
| | - Tomris Erbas
- Department of Endocrinology and Metabolism, Hacettepe University Medical School, Sihhiye, 06100, Ankara, Turkey
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The effectiveness of a therapist-oriented home rehabilitation program for a patient with acromegaly: A case study. J Bodyw Mov Ther 2019; 23:634-642. [PMID: 31563382 DOI: 10.1016/j.jbmt.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acromegaly causes numerous functional limitations that negatively impact patients' performance of activities of daily living (ADLs) and contribute to the deterioration of health-related quality of life (HRQoL). Thus, the purpose of the present case study was to evaluate the effect of therapist-oriented home rehabilitation (TOHR) for a patient with acromegaly. CASE DESCRIPTION We report the case of a 53-year-old man who was diagnosed with primary acromegaly 17 years ago. He complained of difficulties performing tasks that involved his hands, pain in the lower limbs, and fatigue when he climbed a few flights of stairs. Although he performed ADLs independently, he reported some difficulties or discomfort when performing them. INTERVENTION AND OUTCOME The patient underwent a booklet-guided physical exercise program that lasted two months (three times per week, 60 minutes per session). The activities included overall stretching, muscle strengthening, and endurance exercises, along with aerobic conditioning through functional circuit training. After two months of exercise, he reported improved HRQoL as assessed with the Acromegaly Quality of Life Questionnaire, with increases in quadriceps muscle strength and 6-min walking distance. However, none of these benefits remained when the patient was assessed after a 1-month washout period. CONCLUSION This study showed that patients with acromegaly may benefit markedly from TOHR, which could provide a novel therapeutic approach as an adjunct to hormone control therapy.
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The Effects of Leg Length Discrepancy on Stability and Kinematics-Kinetics Deviations: A Systematic Review. Appl Bionics Biomech 2018; 2018:5156348. [PMID: 30116295 PMCID: PMC6079584 DOI: 10.1155/2018/5156348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
Abstract
Various studies have examined body posture stability, including postural sway and associated biomechanical parameters, to assess the severity effects of leg length discrepancy (LLD). However, various viewpoints have been articulated on the results of these studies because of certain drawbacks in the comprehensive analysis of the effect of variations in LLD magnitude. Therefore, this systematic review was performed to help focus on the current findings to help identify which biomechanical parameters are most relevant, commonly used, and able to distinguish and/or have specific clinical relevance to the effect of variations in LLD magnitude during static (standing) and dynamic (walking) conditions. Several electronic databases containing studies from the year 1983 to 2016 (Scopus, ScienceDirect, PubMed, PMC, and ProQuest) were obtained in our literature search. The search process yielded 22 published articles that fulfilled our criteria. We found most of the published data that we analyzed to be inconsistent, and very little data was obtained on the correlation between LLD severity and changes in body posture stability during standing and walking. However, the results of the present review study are in line with previous observational studies, which describe asymmetry in the lower limbs corresponding to biomechanical parameters such as gait kinematics, kinetics, and other parameters described during static (standing) postural balance. In future investigations, we believe that it might be useful to use and exploit other balance-related factors that may potentially influence body posture stability.
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Silva PO, Ferreira AS, Lima CMDA, Guimarães FS, Lopes AJ. Balance control is impaired in adults with sickle cell anaemia. Somatosens Mot Res 2018; 35:109-118. [PMID: 30010483 DOI: 10.1080/08990220.2018.1481829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Musculoskeletal involvement and cerebrovascular disease are common in sickle cell anaemia (SCA). These changes are potentially important factors that modify the control of balance in this population. OBJECTIVE To assess balance control in adults with SCA and investigate the associations among balance, posture and muscle function. METHODS Twenty neurologically intact (i.e. without previous episodes of overt stroke or transient ischaemic attack) adults with SCA and 18 controls were evaluated. All participants underwent static balance measurement through stabilometry, postural evaluation through photogrammetry and assessment of muscle function through handgrip and respiratory muscle strength. RESULTS Compared to the controls, the adults with SCA exhibited greater displacement of the centre of mass, particularly in the mediolateral direction. Moreover, the adults with SCA exhibited greater postural deviations for the following variables: angles of the right and left hip, horizontal asymmetry of the scapula in relation to T3, angles of the right and left leg-heel and horizontal alignment of the pelvis. Handgrip strength, respiratory muscle strength and haemoglobin (Hb) levels were significantly correlated with postural balance measurements. Significant correlations between balance and posture were only observed between the variables of balance and the postural parameters that involved the angulations calculated from the vertical alignment of the pelvis, hip and ankle. CONCLUSIONS Neurologically intact adults with SCA exhibit damage in static balance, particularly in the mediolateral direction. These patients present postural deviations due to changes in the hip and ankle joints. In addition, balance control is related to posture, Hb level and muscle function.
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Affiliation(s)
- Priscila Oliveira Silva
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | - Arthur Sá Ferreira
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | | | - Fernando Silva Guimarães
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | - Agnaldo José Lopes
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil.,b Postgraduate Programme in Medical Sciences , State University of Rio de Janeiro , Rio de Janeiro , Brazil
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Antoniolli A, Candotti CT, Gelain GM, Schmit EFD, Ducatti LMA, Melo MDO, Loss JF. Influence of feet position on static postural assessment by means of photogrammetry: a comparative study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1435719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Arthur Antoniolli
- Escola de EducaçãoFísica, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cláudia Tarragô Candotti
- Escola de EducaçãoFísica, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Grazielle Martins Gelain
- Escola de EducaçãoFísica, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Mônica de Oliveira Melo
- Núcleo de Pesquisa em Ciências e Artes do Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Jefferson Fagundes Loss
- Escola de EducaçãoFísica, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Ashnagar Z, Hadian MR, Olyaei G, Talebian Moghadam S, Rezasoltani A, Saeedi H, Yekaninejad MS, Mahmoodi R. Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types. J Bodyw Mov Ther 2017; 21:704-710. [PMID: 28750988 DOI: 10.1016/j.jbmt.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/25/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
AIM The aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types. METHODS Thirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software. RESULTS All measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79-0.93) and normal feet type (ICC: 0.84-0.97) groups. CONCLUSION The findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups.
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Affiliation(s)
- Zinat Ashnagar
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Hadian
- School of Rehabilitation, Brain and Spinal Injury Research Center (BASIR), Tehran University of Medical Sciences, International Campus (TUMS, TUMS-IC), Tehran, Iran.
| | - Gholamreza Olyaei
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Talebian Moghadam
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Asghar Rezasoltani
- Faculty of Rehabilitation, Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Saeedi
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Rahimeh Mahmoodi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Lima TRL, Guimarães FS, Neves RS, Menezes SLS, Lopes AJ. Scleroderma: Assessment of posture, balance and pulmonary function in a cross-sectional controlled study. Clin Biomech (Bristol, Avon) 2015; 30:438-43. [PMID: 25804523 DOI: 10.1016/j.clinbiomech.2015.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Systemic sclerosis leads to significant physical limitations in patients, such as diffuse weakness, skin sclerosis, loss of joint function and lung damage. This study aimed to assess posture and balance in systemic sclerosis patients and secondarily to verify correlations between such measurements and lung function. METHODS Thirty-one patients and a similar number of control subjects matched for age, gender, weight, height and body mass index underwent postural assessment using photogrammetry, balance measurement using the Berg Balance Scale and stabilometry, and pulmonary function tests. FINDINGS When compared to healthy volunteers, the patients had postural deviations in hip angle (P=0.009 in anterior view and P=0.028 for the right side), horizontal alignment of the pelvis (P=0.002 for the right side and P=0.004 for the left side), vertical alignment of the trunk (P=0.012 for the right side) and ankle angle (P=0.019 for the right side). Postural balance was similar between the two groups as assessed by the Berg Balance Scale and stabilometry. We observed significant correlations between balance measures and posture variables involving the knee and ankle, and between postural control and lung function (ratio between forced vital capacity and diffusing capacity for carbon monoxide). INTERPRETATION Our results suggest that posture and balance should be assessed in systemic sclerosis patients in clinical practice, as significant postural changes and compensations are needed to maintain balance. Furthermore, it is important to monitor lung function because vascular injury impacts on postural control in these patients.
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Affiliation(s)
- Tatiana Rafaela Lemos Lima
- Rehabilitation Sciences Master's Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, 21041-010, Rio de Janeiro, Brazil.
| | - Fernando Silva Guimarães
- Rehabilitation Sciences Master's Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, 21041-010, Rio de Janeiro, Brazil; Physical Therapy Department, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, 21941-913, Rio de Janeiro, Brazil.
| | - Rafael Santos Neves
- Rehabilitation Sciences Master's Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, 21041-010, Rio de Janeiro, Brazil.
| | - Sara Lucia Silveira Menezes
- Rehabilitation Sciences Master's Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, 21041-010, Rio de Janeiro, Brazil; Physical Therapy Department, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, 21941-913, Rio de Janeiro, Brazil.
| | - Agnaldo José Lopes
- Rehabilitation Sciences Master's Program, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, 21041-010, Rio de Janeiro, Brazil; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170, Rio de Janeiro, Brazil.
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