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Hernández-Sánchez A, Parra-Sánchez L, Montolio M, Rueda-Ruzafa L, Ortiz-Comino L, Sánchez-Joya MDM. Family Involvement and at-Home Physical Therapy on Duchenne Muscular Dystrophy: A Randomized Controlled Trial. Pediatr Neurol 2024; 152:34-40. [PMID: 38184986 DOI: 10.1016/j.pediatrneurol.2023.12.015] [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: 01/31/2023] [Revised: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a genetic condition that causes muscle weakness and begins in early childhood. To treat its complications, the rehabilitation program includes physical therapy, mainly on the musculoskeletal and the respiratory complications that appear on the evolution of the disease. This study aims to explore the effects of physical therapy with or without an at-home program on motor function among children with DMD. METHODS A randomized controlled trial was carried out for one year (one group with at-home and conventional physical therapy and another with conventional physical therapy). Motor function was measured using the Motor Function Measure (MFM) scale, the Vignos and Brooke scales, the Timed-up-and-Go test, and the six-minute walk distance test. RESULTS Twenty-seven participants with DMD participated in this study. In the at-home and conventional physical therapy group, better motor function at the distal and global level was maintained, per the results of the MFM scale (P < 0.05). The rest of the variables did not achieve statistically significant changes. CONCLUSIONS Our results suggest that complementing conventional treatment with at-home treatment in which the family is involved maintains better motor function, in participants with DMD.
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Affiliation(s)
- Andrea Hernández-Sánchez
- Faculty of Health Sciences, Department of Nursing, Physical Therapy and Medicine, University of Almería, Almería, Spain
| | | | - Marisol Montolio
- Duchenne Parent Project España, Madrid, Spain; Faculty of Biology, Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona, Spain
| | - Lola Rueda-Ruzafa
- Faculty of Health Sciences, Department of Nursing, Physical Therapy and Medicine, University of Almería, Almería, Spain
| | - Lucía Ortiz-Comino
- Faculty of Health Sciences (Melilla), Department of Physical Therapy, University of Granada, Melilla, Spain; Sport and Health Research Center (IMUDs), Granada, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain.
| | - María Del Mar Sánchez-Joya
- Faculty of Health Sciences, Department of Nursing, Physical Therapy and Medicine, University of Almería, Almería, Spain
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Lv W, Liu K, Zhou P, Huang F, Lu Z. Surface EMG analysis of weakness distribution in upper limb muscles post-stroke. Front Neurol 2023; 14:1135564. [PMID: 37181551 PMCID: PMC10166840 DOI: 10.3389/fneur.2023.1135564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/21/2023] [Indexed: 05/16/2023] Open
Abstract
Weakness is a common symptom after a stroke. This study aims to depict weakness distribution among forearm muscles given that joints in the upper limb are usually driven by a group of muscles. Multi-channel electromyography (EMG) was applied to assess the muscle group, and an EMG-based index was proposed to quantify the weakness of individual muscles. By using this method, four weakness distribution patterns were observed in extensor muscles from five out of eight subjects after stroke. Complex weakness distribution patterns were observed in flexor muscles from seven out of the eight subjects when they performed grasp, tripod pinch, and hook grip. The findings can help determine the weak muscles in a clinic and facilitate the development of appropriate interventions in stroke rehabilitation targeting specific muscle weakness.
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Affiliation(s)
- Wenwen Lv
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
| | - Kai Liu
- Department of Rehabilitation Medicine, University of Health and Rehabilitation Sciences Qingdao Hospital (Qingdao Municipal Hospital), Qingdao, China
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Fei Huang
- School of Rehabilitation Medicine, Binzhou Medical University, Yantai, China
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
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Aldirmaz E, Uğur F, Yilmaz Ö, Karaduman A, Alemdaroğlu-Gürbüz İ. A New Instrument to Assess Dynamic Balance in Children with Duchenne Muscular Dystrophy: Four Square Step Test and Its Validity, Reliability and Feasibility. Dev Neurorehabil 2023; 26:27-36. [PMID: 36367327 DOI: 10.1080/17518423.2022.2143924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to investigate validity, reliability and feasibility of the Four Square Step Test (FSST) in children with Duchenne Muscular Dystrophy (DMD). METHODS The study included 44 children with DMD aged 5-12 years. The functional level of the children was determined by using the Brooke Lower Extremity Functional Classification (BLEFC). The concurrent validity of the FSST, a dynamic balance assessment, was investigated by analyzing the association between FSST and Timed Up and Go Test (TUG), North Star Ambulatory Assessment (NSAA) and Six-Minute Walk Test (6MWT) distance. The intra- and inter-rater reliability of the FSST was determined by using the Intra Class Correlation Coefficient (ICC) while the feasibility of the test was determined by calculating the percentage of children who successfully completed the test in accordance with the test instructions. RESULTS The FSST score of the children (mean age 9.25 ± 2.14 years) was 11.91 ± 3.43 and the BLEFC level ranged from Level 1 (65.9%) to Level 3 (9.1%). FSST had positive, moderate relation with BLEFC (r = 0.447; p = .002); positive, strong relation with TUG (rs = 0.623), and negative, moderate correlations with NSAA (rs = -0.529) and 6MWT distance (rs = -0.592) (p < .001). Intra-rater (ICC: 0.965) and inter-rater (ICC: 0.991) reliability was "excellent," and the test was feasible with successful performance of 88% children. DISCUSSION The FSST is a valid, reliable and feasible instrument to assess dynamic balance as well as having the ability to reflect falling risk and different functional levels of children with DMD.
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Affiliation(s)
- Esra Aldirmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Turkey
| | - Fatma Uğur
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Turkey
| | - Öznur Yilmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altındağ, Turkey
| | - Ayşe Karaduman
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Lokman Hekim University, Çankaya, Turkey
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Kurt M, Savaş D, Şimşek TT, Yiş U. Factors associated with balance ability in Duchenne and Becker muscular dystrophies. Gait Posture 2023; 99:139-145. [PMID: 36435068 DOI: 10.1016/j.gaitpost.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/08/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Problems such as progressive muscle function loss, postural deteriorations, and contractures seen in patients with Duchenne and Becker muscular dystrophies (D/BMD) may affect children's balance ability, and impaired balance ability may lead to limitations in children's functional level. RESEARCH QUESTION What factors are associated with balance ability in children with D/BMD? METHODS Twenty participants with D/BMD were included in the study. Participants' ages were asked; height, body weight, and body mass index (BMI) were recorded. Children's functional level was assessed with the Motor Function Measurement-32 (MFM-32), Brooke and Vignos Scales. Muscle strength of hip flexion and extension, knee flexion and extension, and ankle dorsiflexion was measured with a handheld dynamometer. Balance measurements were performed using the Balance Master System. The relationship between balance and continuous independent variables was determined using Spearman's test. RESULTS The mean age of the participants was 8.57 ± 3.27 years. The balance abilities of children with BMD were better than those of children with DMD (p < 0.05). The balance diminished with age (p < 0.05), while there was a positive correlation between balance and weight, height, BMI (p < 0.05). There was a positive correlation between the balance and the MFM-32 total and subsection scores. Muscle strength was positively related to balance (p < 0.05). SIGNIFICANCE The results showed the balance ability in children with D/BMD was affected by age, height, weight, BMI, functional level, and muscle strength. Based on the results of this study, balance and strength training should be an integral part of the rehabilitation of children with D/BMD.
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Affiliation(s)
- Merve Kurt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey; Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Dilan Savaş
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
| | - Tülay Tarsuslu Şimşek
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
| | - Uluç Yiş
- Dokuz Eylül University Department of Pediatrics, Pediatric Neurology, İzmir, Turkey.
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Seated Outcome Measures in Children With Duchenne Muscular Dystrophy. Pediatr Phys Ther 2022; 34:375-380. [PMID: 35653235 DOI: 10.1097/pep.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Quantifiable motor strength measures to assess disease severity throughout the continuum of Duchenne muscular dystrophy (DMD) are needed. To study the feasibility of seated trunk strength using hand-held dynamometry (HHD) and caregiver-reported subjective functional independence measures in boys with DMD. METHODS Prospective, cross-sectional, observational study of 18 participants with DMD enrolled from pediatric muscular dystrophy clinic during routine clinical assessment. Hand-held dynamometry, seated reach distance test and Pediatric Evaluation of Disability Inventory (PEDI) were administered. RESULTS All study participants regardless of the walking status were able to complete the seated function tests demonstrating feasibility. The age of the participants correlated negatively with PEDI mobility and positively with HHD extension scores. The seated measures did not statistically correlate with PEDI mobility scores. CONCLUSIONS Seated motor strength measures and PEDI mobility scores are feasible. The PEDI mobility and HHD extension scores correlate with age. Study limitations included single-center experience and cross-sectional data. VIDEO ABSTRACT LINK https://www.dropbox.com/s/s4r0k7o6s0tfbkb/PT-Seated-Measures-And-DMD-2022.mp4?dl=0.
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Tolchin DW. Rehabilitation in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Use of a Single Wearable Sensor to Evaluate the Effects of Gait and Pelvis Asymmetries on the Components of the Timed Up and Go Test, in Persons with Unilateral Lower Limb Amputation. SENSORS 2021; 22:s22010095. [PMID: 35009638 PMCID: PMC8747521 DOI: 10.3390/s22010095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
The Timed Up and Go (TUG) test quantifies physical mobility by measuring the total performance time. In this study, we quantified the single TUG subcomponents and, for the first time, explored the effects of gait cycle and pelvis asymmetries on them. Transfemoral (TF) and transtibial (TT) amputees were compared with a control group. A single wearable inertial sensor, applied to the back, captured kinematic data from the body and pelvis during the 10-m walk test and the TUG test. From these data, two categories of symmetry indexes (SI) were computed: One SI captured the differences between the antero-posterior accelerations of the two sides during the gait cycle, while another set of SI quantified the symmetry over the three-dimensional pelvis motions. Moreover, the total time of the TUG test, the time of each subcomponent, and the velocity of the turning subcomponents were measured. Only the TF amputees showed significant reductions in each SI category when compared to the controls. During the TUG test, the TF group showed a longer duration and velocity reduction mainly over the turning subtasks. However, for all the amputees there were significant correlations between the level of asymmetries and the velocity during the turning tasks. Overall, gait cycle and pelvis asymmetries had a specific detrimental effect on the turning performance instead of on linear walking.
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Filiz MB, Toraman NF, Kutluk MG, Filiz S, Doğan ŞK, Çakır T, Yaman A. Effects of lumbar lordosis increment on gait deteriorations in ambulant boys with Duchenne Muscular Dystrophy: A cross-sectional study. Braz J Phys Ther 2021; 25:749-755. [PMID: 34119442 DOI: 10.1016/j.bjpt.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/24/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Increment of lumbar lordosis, a frequent spinal finding in Duchenne Muscular Dystrophy (DMD), is a compensatory mechanism secondary to muscle weakness. However, excessive lumbar lordosis may change the position of the center of mass, and lead to balance and walking difficulties. OBJECTIVE To study the relationship between factors that may influence ambulatory function in boys with DMD and to investigate the effects of lumbar lordosis increment on gait and balance perturbations. METHODS Twenty-one ambulant patients with DMD and 10 healthy boys were included. Lumbar lordosis and thoracic kyphosis angles, dynamic and static balance tests, ambulatory function, muscle strength, and disease severity were assessed. Usage of steroids and orthotic devices were recorded. Scoliosis was assessed on radiographs. Receiver operator characteristic curves were formed and area under curve (AUC) measurements were performed to assess the ability of the tests to discriminate ambulatory status and optimal cut-off values were established according to the Youden index. RESULTS The amount of lumbar lordosis correlated strongly and negatively with quality of ambulation (r = -0.710) and moderately with performance on balance tests. The strength of both upper limbs and lower limbs muscles were not associated with any of the variables. According to the AUC analysis, patients with a lumbar lordosis higher than 36° had worse scores on gait and dynamic balance tests. CONCLUSION Ambulation and dynamic balance are negatively affected by the increment of lumbar lordosis with a cut-off point of 36°in boys with DMD.
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Affiliation(s)
- Meral Bilgilisoy Filiz
- Antalya Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya, Turkey; Antalya Training and Research Hospital, Neuromuscular Disease Center, Health Sciences University, Antalya, Turkey.
| | - Naciye Füsun Toraman
- Antalya Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya, Turkey; Antalya Training and Research Hospital, Neuromuscular Disease Center, Health Sciences University, Antalya, Turkey
| | - Muhammet Gültekin Kutluk
- Antalya Training and Research Hospital, Department of Pediatric Neurology, Health Sciences University, Antalya, Turkey; Antalya Training and Research Hospital, Neuromuscular Disease Center, Health Sciences University, Antalya, Turkey
| | - Serkan Filiz
- Antalya Training and Research Hospital, Department of Pediatric Allergy and Immunology, Health Sciences University, Antalya, Turkey; Antalya Training and Research Hospital, Neuromuscular Disease Center, Health Sciences University, Antalya, Turkey
| | - Şebnem Koldaş Doğan
- Antalya Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Health Sciences University, Antalya, Turkey
| | - Tuncay Çakır
- Department of Physical Medicine and Rehabilitation, Private ASV Life Hospital, Antalya, Turkey
| | - Aylin Yaman
- Antalya Training and Research Hospital, Department of Neurology, Health Sciences University, Antalya, Turkey; Antalya Training and Research Hospital, Neuromuscular Disease Center, Health Sciences University, Antalya, Turkey
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Senesac CR, Barnard AM, Lott DJ, Nair KS, Harrington AT, Willcocks RJ, Zilke KL, Rooney WD, Walter GA, Vandenborne K. Magnetic Resonance Imaging Studies in Duchenne Muscular Dystrophy: Linking Findings to the Physical Therapy Clinic. Phys Ther 2020; 100:2035-2048. [PMID: 32737968 PMCID: PMC7596892 DOI: 10.1093/ptj/pzaa140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 12/31/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a muscle degenerative disorder that manifests in early childhood and results in progressive muscle weakness. Physical therapists have long been an important component of the multidisciplinary team caring for people with DMD, providing expertise in areas of disease assessment, contracture management, assistive device prescription, and exercise prescription. Over the last decade, magnetic resonance imaging of muscles in people with DMD has led to an improved understanding of the muscle pathology underlying the clinical manifestations of DMD. Findings from magnetic resonance imaging (MRI) studies in DMD, paired with the clinical expertise of physical therapists, can help guide research that leads to improved physical therapist care for this unique patient population. The 2 main goals of this perspective article are to (1) summarize muscle pathology and disease progression findings from qualitative and quantitative muscle MRI studies in DMD and (2) link MRI findings of muscle pathology to the clinical manifestations observed by physical therapists with discussion of any potential implications of MRI findings on physical therapy management.
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Affiliation(s)
| | | | | | - Kavya S Nair
- Department of Physical Therapy, University of Florida
| | - Ann T Harrington
- Center for Rehabilitation, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania
| | | | - Kirsten L Zilke
- Oregon Health & Science University, Shriners Hospitals for Children, Portland, Oregon
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida
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Kennedy RA, Carroll K, McGinley JL, Paterson KL. Walking and weakness in children: a narrative review of gait and functional ambulation in paediatric neuromuscular disease. J Foot Ankle Res 2020; 13:10. [PMID: 32122377 PMCID: PMC7052968 DOI: 10.1186/s13047-020-0378-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Weakness is the primary impairment in paediatric neuromuscular diseases, impacting gait and gait-related functional activities in ambulant children affected by these rare and often degenerative diseases. Gait speed is an indicator of health and disability, yet gait is a complex, multi-faceted activity. Using the International Classification of Function, Health and Disability (ICF) model, assessment of gait and functional ambulation should consider the impairments, activity limitations and participation restrictions due to disease, and factors related to the environment and the individual person. Methods This narrative review involved a literature search of databases including Medline, Embase and Pubmed from 1946 to October 2019. Inclusion criteria included assessments of gait, endurance and ambulatory function in paediatric (0–18 years) neuromuscular diseases. Results Fifty-two papers were identified reporting assessments of gait speed, timed function, endurance and ambulatory capacity, gait-related balance and qualitative descriptive assessments of gait function and effect of disease on gait and gait-related activities. Gait speed is an indicator of disability and children with neuromuscular disease walk slower than typically developing peers. Increasing disease severity and age were associated with slower walking in children with Duchenne muscular dystrophy and Charcot-Marie-Tooth disease. The six-minute walk test is used widely as a test of endurance and ambulatory capacity; six-minute walk distance was substantially reduced across all paediatric neuromuscular diseases. Endurance and ambulatory capacity was more limited in children with spinal muscular atrophy type 3, congenital muscular dystrophy and older boys with Duchenne muscular dystrophy. Only a few papers considered normalisation of gait parameters accounting for the effect on gait of height in heterogeneous groups of children and linear growth in longitudinal studies. Balance related to gait was considered in five papers, mainly in children with Charcot-Marie-Tooth disease. There was limited investigation of factors including distance requirements and terrain in children’s typical environments and personal factors related to self-perception of disease effect on gait and gait-related function. Conclusion Assessments of gait and functional ambulation are important considerations in documenting disease progression and treatment efficacy in the clinical setting; and in clinical trials of disease-modifying agents and physiotherapeutic interventions in paediatric neuromuscular diseases. There is a need for expert consensus on core gait and functional ambulation assessments for use in clinical and research settings.
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Affiliation(s)
- Rachel A Kennedy
- Department of Neurology, The Royal Children's Hospital, Parkville, Vic, Australia. .,Murdoch Children's Research Institute, Parkville, Vic, Australia. .,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia.
| | - Kate Carroll
- Department of Neurology, The Royal Children's Hospital, Parkville, Vic, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
| | - Jennifer L McGinley
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
| | - Kade L Paterson
- Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
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Mangano GR, Valle MS, Casabona A, Vagnini A, Cioni M. Age-Related Changes in Mobility Evaluated by the Timed Up and Go Test Instrumented through a Single Sensor. SENSORS 2020; 20:s20030719. [PMID: 32012930 PMCID: PMC7038469 DOI: 10.3390/s20030719] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 01/04/2023]
Abstract
Mobility across people with a large range of age was evaluated, for the first time, by using an instrumented timed up and go test (iTUG) based on signals acquired by a single wearable inertial sensor. Eighty healthy participants, from childhood to old age, performed the test, covering walking distances of 3 m and 7 m. Total time, temporal, and velocity parameters of linear and turning subcomponents of the test were quantified. While children, adults, and senior adults exhibited similar values for all the parameters, older adults showed increases in duration and reductions in velocity during the turning phases when compared with the other groups. an increase in velocity was observed during mid turning when the test was performed along the longer distance. Similarity across children, adults, and senior adults indicates that healthy individuals develop the abilities performed in the iTUG early, while the slowing down shown during the turning phases by the older adults may reflect the need to implement adaptive adjustments to face changes of direction. These results emphasize the idea that reducing equipment to a single sensor provides an appropriate quantification when the iTUG is used to investigate a broader age range or different levels of complexity.
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Affiliation(s)
- Giulia R.A. Mangano
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Residency Program of Physical Medicine and Rehabilitation, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Maria S. Valle
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Correspondence: ; Tel.: +39-095-7381328
| | - Antonino Casabona
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Residency Program of Physical Medicine and Rehabilitation, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | | | - Matteo Cioni
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Residency Program of Physical Medicine and Rehabilitation, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
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Iolascon G, Paoletta M, Liguori S, Curci C, Moretti A. Neuromuscular Diseases and Bone. Front Endocrinol (Lausanne) 2019; 10:794. [PMID: 31824418 PMCID: PMC6886381 DOI: 10.3389/fendo.2019.00794] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/30/2019] [Indexed: 02/05/2023] Open
Abstract
Neuromuscular diseases (NMDs) are inherited or acquired conditions affecting skeletal muscles, motor nerves, or neuromuscular junctions. Most of them are characterized by a progressive damage of muscle fibers with reduced muscle strength, disability, and poor health-related quality of life of affected patients. In this scenario, skeletal health is usually compromised as a consequence of modified bone-muscle cross-talk including biomechanical and bio-humoral issues, resulting in increased risk of bone fragility and fractures. In addition, NMD patients frequently face nutritional issues, including malnutrition due to feeding disorders and swallowing problems that might affect bone health. Moreover, in these patients, low levels of physical activity or immobility are common and might lead to overweight or obesity that can also interfere with bone strength features. Also, vitamin D deficiency could play a critical role both in the pathogenesis and in the clinical scenario of many NMDs, suggesting that its correction could be useful in maintaining or enhancing bone health, especially in the early phases of NMDs. Last but not least, specific disease-modifying drugs, available for some NMDs, are frequently burdened with adverse effects on bone tissue. For example, glucocorticoid therapy, standard of care for many muscular dystrophies, prolongs long-term survival in treated patients; nevertheless, high dose and/or chronic use of these drugs are a common cause of secondary osteoporosis. This review addresses the current state of knowledge about the factors that play a role in determining bone alterations reported in NMDs, how these factors can modify the biological pathways underlying bone health, and which are the available interventions to manage bone involvement in patients affected by NMDs. Considering the complexity of care of these patients, an interdisciplinary and multimodal management strategy based on both pharmacological and non-pharmacological interventions is recommended, particularly targeting musculoskeletal issues that are closely related to functional independence as well as social implications.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Characterizing postural oscillation in children and adolescents with hereditary sensorimotor neuropathy. PLoS One 2018; 13:e0204949. [PMID: 30304007 PMCID: PMC6179247 DOI: 10.1371/journal.pone.0204949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/16/2018] [Indexed: 11/19/2022] Open
Abstract
Charcot Marie Tooth disease (CMT) has negative functional impact on postural control of children; however, it has not been widely studied. Stabilometry can provide insights about postural control and guide preventive interventions in immature perceptual and musculoskeletal systems as those seen in children with CMT. This cross-sectional study aimed to identify and interpret stabilometric variables that reflect the postural control of children with CMT. 53 subjects (age 6-17) were assigned to one of the two groups: CMT (15 males and 14 females with CMT) or Control (13 males and 11 females healthy). Quiet standing was tested in different conditions: with open and closed eyes on regular surface (open-regular, closed-regular) and foam surface (open-foam, closed-foam) using a force platform. The minimum of 2 and maximum of 3 trials of 30 seconds for each test condition provided the classical stabilometric variables and Romberg Quotient (RQv). CMT group showed increase of confidence ellipse area, mean velocity, mediolateral and anteroposterior velocities associated with decreased mean body oscillation frequency, as the complexity of tasks increased. CMT postural deficit was identified by greater and faster sway associated with these lower frequencies, when compared to Control.
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Cao CJ, Dou CY, Zhou KH, Liu JB, Lai H. POEMS syndrome presentation with progressive weakness in upper and lower limbs: A case report. Oncol Lett 2017; 14:5197-5202. [PMID: 29113155 PMCID: PMC5656028 DOI: 10.3892/ol.2017.6904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 05/11/2017] [Indexed: 12/13/2022] Open
Abstract
Polyneuropathy, organomegaly, endocrinopathy, M proteins, and skin changes (POEMS) syndrome is a rare variant of plasma cell disorders with multiple systemic manifestations. A 50-year-old female patient presented with progressive weakness in her upper and lower limbs; tingling, numbness and burning in her feet; polyneuropathy (demyelinating in the majority of cases of POEMS syndrome); monoclonal plasma cell disorder (typicallyλ-restricted in cases of POEMS syndrome); sclerotic lesions on the spine and pelvis; organomegaly, including hepatomegaly, splenomegaly and lymphadenopathy; edema; pleural effusion; adrenal, thyroidal, pituitary, gonadal and pancreatic endocrinopathy; skin changes, including hyperpigmentation, dry skin and hypertrichosis; thrombocytosis; pulmonary hypertension; low vitamin B12 and weight loss. Following the diagnosis of POEMS syndrome, the patient was treated only with pain-alleviating corticosteroids. Respiratory failure-induced mortality occurred 24 months after the patient first experienced difficulty walking and numbness in her lower extremities. The present study suggests that abnormal symptoms in cases of POEMS syndrome should be further evaluated during the diagnosis and treatment.
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Affiliation(s)
- Chuang-Jie Cao
- Department of Pathology, The First Affiliated Hospital of Sun Yat-san University, Guangzhou, Guangdong 510080, P.R. China
| | - Cheng-Yun Dou
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ke-Hua Zhou
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jin-Bo Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hong Lai
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Talu B, Bazancir Z. The effect of different ankle and knee supports on balance in early ambulation of post-stroke hemiplegic patients. Neurol Sci 2017; 38:1811-1816. [PMID: 28726053 DOI: 10.1007/s10072-017-3065-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare the effects of different ankle and knee supports on balance in early ambulation of post-stroke hemiplegic patients. This is a randomized experimental study. The study sample included 20 hemiplegic patients who were able to stand with support and who had been diagnosed with a cerebrovascular accident within the last month. A knee immobilization brace (KIB) was first placed on each individual (first application), followed by placement of knee immobilizer brace and Foot Lifter Orthosis ® (FLO) (second application), and lastly, placement of KIB and rigid taping (RT) (third application). The balance parameters of the patients were evaluated using the Korebalance system. The mean age of the patients was 65.1 ± 4.7 years, and the mean number of days that had passed since stroke occurred was 14.6 ± 4.97. In calculating the front/left balance scores of the applications, statistically significant differences were observed in the comparisons of all three supports and first-second applications performed (p = 0.041 and p = 0.021, respectively). Regarding the total scores between the applications, statistically significant differences were determined in balance in the comparisons on all three supports, in comparisons between the first and second applications, and in the comparisons between the second and third applications (p = 0.004, p = 0.007, and p = 0.001, respectively). Based on the findings from this study, it is recommended that the use of a knee immobilizer brace in combination with a foot lifter orthosis for post-stroke hemiplegic patients in early ambulation can lead to considerably improved standing balance.
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Affiliation(s)
- Burcu Talu
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Inonu University, Malatya, Turkey.
| | - Zilan Bazancir
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Inonu University, Malatya, Turkey
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Alkan H, Mutlu A, Fırat T, Bulut N, Karaduman AA, Yılmaz ÖT. Effects of functional level on balance in children with Duchenne Muscular Dystrophy. Eur J Paediatr Neurol 2017; 21:635-638. [PMID: 28259452 DOI: 10.1016/j.ejpn.2017.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study was planned to compare the static and dynamic balance in children with Duchenne Muscular Dystrophy (DMD) at different functional levels with each other and with healthy peers. MATERIAL AND METHODS Sixty nine children between the ages of 6 and 11 were included in this study where 52 of them were diagnosed with DMD in Level I (18 patients), Level II (17 patients), and Level III (17 patients) according to Brooke Functional Classification Scale and 17 of them healthy peers were included. In order to assess static and dynamic balance pediatric functional reach test (PFRT) and timed up and go test (TUGT) were used. RESULTS When compared in terms of the TUGT, differences were found between all groups, i.e. Level 1 and 2, Level 2 and 3, Level 1 and 3, Healthy peers and Level 1, Healthy peers and Level 2, and Healthy peers and Level 3 (p < 0.0083). When compared in terms of the PFRT in the standing positions, there was difference between level 3 and healthy peers (p < 0.0083), but not between the other groups. CONCLUSIONS We found poor functional level in DMD to affect the dynamic and static balance parameters in this study. The dynamic balance of a child with DMD at Level 3 is decreased to a third of a healthy peer.
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Affiliation(s)
- Halil Alkan
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazarı, Ankara, Turkey.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazarı, Ankara, Turkey.
| | - Tüzün Fırat
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazarı, Ankara, Turkey.
| | - Numan Bulut
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazarı, Ankara, Turkey.
| | - Aynur Ayşe Karaduman
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazarı, Ankara, Turkey.
| | - Öznur Tunca Yılmaz
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazarı, Ankara, Turkey.
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Quantitative analysis of upright standing in adults with late-onset Pompe disease. Sci Rep 2016; 6:37040. [PMID: 27845393 PMCID: PMC5109234 DOI: 10.1038/srep37040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/24/2016] [Indexed: 11/08/2022] Open
Abstract
Pompe disease is a rare disorder producing muscle weakness and progressive impairments in performing daily motor activities, such as walking and standing. Most studies have focused on dysfunctions at cellular level, restricting the examination of gross motor functions to qualitative or subjective rating scales evaluations. With the aim of providing an instrumented quantification of upright standing in Pompe disease, we used a force platform to measure the center of pressure over three foot positions and with eyes open and closed. Amplitude and variability of body sway were measured to determine the level of postural stability, while power spectrum analysis and nonlinear computations were performed to explore the structure of the postural control. In comparison with healthy participants, patients with Pompe disease showed a reduced level of postural stability, but irrelevant variations in frequency content and spatio-temporal structure of the sway motion were detected. Changes in foot position did not increase the postural instability associated with Pompe disease, but prominent worsening occurred in the patients when they stand with eyes closed, particularly along the anterior-posterior direction. These results provide objective elements to monitor deficiencies of upright standing in Pompe disease, emphasizing the specific contributions of sway direction and sensory deficits.
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