1
|
Carroll K, Kennedy RA, Koutoulas V, Werake U, Bui M, Kraan CM. Comparability between wearable inertial sensors and an electronic walkway for spatiotemporal and relative phase data in young children aged 6-11 years. Gait Posture 2024; 111:30-36. [PMID: 38615566 DOI: 10.1016/j.gaitpost.2024.04.003] [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: 12/04/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Approaches to gait analysis are evolving rapidly and now include a wide range of options: from e-patches to video platforms to wearable inertial measurement unit systems. Newer options for gait analysis are generally more inclusive for the assessment of children, more cost effective and easier to administer. However, there is limited data on the comparability of newer systems with more established traditional approaches in young children. RESEARCH QUESTION To determine comparability between the Physilog®5 wearable inertial sensor and GAITRite® electronic walkway for spatiotemporal (stride length, time and velocity, cadence) and relative phase (double support time, stance, swing, loading, foot flat and push off) data in young children. METHODS A total 34 typically developing participants (41% female) aged 6-11 years old median age 8.99 years old (interquartile range 2.83) were assessed walking at self-selected speed over the GAITRite® electronic walkway while concurrently wearing shoe-attached Physilog®5 IMU sensors. Level of agreement was analysed by Lin's concordance correlation coefficient (CCC), Bland-Altman plots and 95% limit of agreement. Systematic bias was assessed using 95% confidence interval of the mean difference. RESULTS Excellent to almost perfect agreement was observed between systems for spatiotemporal metrics: cadence (CCC=0.996), stride length (CCC=0.993), stride time (CCC=0.996), stride velocity (CCC=0.988). The relative phase metrics adjusted for stride velocity showed improved comparability when compared to the unadjusted metrics: swing adjusted (adj) (CCC=0.635); stance adj (CCC: 0.879); loading adj: (CCC=0.626). SIGNIFICANCE Spatiotemporal metrics are highly compatible across GAITRite® electronic walkway and Physilog®5 IMU systems in young children. Relative phase metrics were somewhat compatible between systems when adjusted for stride velocity.
Collapse
Affiliation(s)
- K Carroll
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria, Australia; Neurosciences, Clinical Sciences, Murdoch Children's Research Institutee, Parkville, Victoria, Australia
| | - R A Kennedy
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - V Koutoulas
- Faculty of Medicine, Dentistry and Health Sciences Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - U Werake
- Diagnosis and Development, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - M Bui
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - C M Kraan
- Faculty of Medicine, Dentistry and Health Sciences Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Diagnosis and Development, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| |
Collapse
|
2
|
Critchley ML, Bonfield S, Ferber R, Pasanen K, Kenny SJ. Relationships Between Common Preseason Screening Measures and Dance-Related Injuries in Preprofessional Ballet Dancers. J Orthop Sports Phys Ther 2023; 53:703-711. [PMID: 37787614 DOI: 10.2519/jospt.2023.11835] [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] [Indexed: 10/04/2023]
Abstract
OBJECTIVE: To examine modifiable and nonmodifiable factors for associations with dance-related injury among preprofessional ballet dancers over 5 academic years. DESIGN: Prospective cohort study. METHODS: Full-time preprofessional ballet dancers (n = 452; 399 female; median age [range], 15 years [11-21]) participated across 5 academic years at a vocational school. Participants completed baseline screening and online weekly injury questionnaires including dance exposure (hours/week). Zero-inflated Poisson regression models were used to examine associations between potential risk factors measured at baseline and self-reported dance-related injury. RESULTS: In count model coefficients, left one leg standing score (log coefficient estimate, -0.249 [95% CI: -0.478, -0.02]; P = .033) and right unipedal dynamic balance time (log coefficient estimate, -0.0294 [95% CI: -0.048, -0.01]; P>.001) carried a protective effect with increased years of training when adjusted for Athletic Coping Skills Inventory (ACSI) score. A significant association was found for left unipedal dynamic balance time and dance-related injury (log coefficient estimate, 0.013 [95% CI: 0.000, 0.026]; P = .045) when adjusted for years of training and ACSI score. There were no significant associations between dance-related injury and ankle and hip range of motion, active straight leg raise, or Y Balance Test measures. CONCLUSION: When adjusted for years of previous dance training and psychological coping skills, there was a significant association between limb-specific lumbopelvic control and dynamic balance tasks, as well as self-reported dance-related injury in preprofessional ballet. J Orthop Sports Phys Ther 2023;53(11):703-711. Epub 3 October 2023. doi:10.2519/jospt.2023.11835.
Collapse
|
3
|
Steinberg N, Siev-Ner I, Zeev A, Tenenbaum S. Is there an association between joint range of motion and muscle strength in young female dancers? And, does it depend on the effects of age and menarche? Res Sports Med 2023; 31:663-678. [PMID: 35075955 DOI: 10.1080/15438627.2022.2031199] [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: 11/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Aiming to determine the association between joint range of motion (ROM) and muscle strength; and, the effect of age and menarche on those two factors; 132 pre-and post-menarche dancers, aged 12-14 years were assessed for joint ROM and for muscle strength at the hip, knee and ankle and foot joints. En-pointe ROM was significantly correlated with ankle plantar-flexors' (r = -.184) and with ankle dorsiflexors' muscle strength (r = -.221). Hip external rotation ROM was significantly correlated with knee extensors' strength (r = -.263). Pre-menarche dancers had higher joint ROM compared with post-menarche dancers; yet, dancers at post-menarche were stronger compared to dancers at pre-menarche. The slope coefficient was negative at the age of 12 in hip external rotation and in en-pointe (-0.80 and -0.52, respectively) and became steeper with age (age 13: -3.52 and -3.28, respectively; age 14: -6.31 and -4.42, respectively). Along maturation, dancers with high joints ROM showed reduced muscle strength. Pre-menarche dancers have higher joint ROM, yet reduced muscle strength, compared with post-menarche dancers. As the association between joint ROM and muscle strength might be involved with growth and development, young dancers should be screened along pubertal stages in order to decide the correct curricula and to prevent future injuries.
Collapse
Affiliation(s)
- Nili Steinberg
- The Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Itzhak Siev-Ner
- Orthopedic Rehabilitation Department, Sheba Medical Center, Tel-Hashomer, Israel
| | - Aviva Zeev
- The Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Kenny SJ, Critchley ML, Whittaker JL, Kodalore Vijayan VW, Emery CA. Association between pre-participation characteristics and risk of injury amongst pre-professional dancers. Phys Ther Sport 2021; 52:239-247. [PMID: 34653772 DOI: 10.1016/j.ptsp.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Prospective Cohort Study. BACKGROUND Few investigations utilize evidence-informed pre-participation evaluation, inclusive injury definitions, and prospective surveillance to identify risk factors for dance-related injuries. OBJECTIVE To evaluate pre-participation characteristics that may be associated with greater odds of dance-related musculoskeletal complaints in pre-professional dancers. METHODS Full-time pre-professional ballet [n = 85, 77 females, median (range) age 15-years (11-19)] and contemporary [n = 60, 58 females, 19-years (17-30)] dancers underwent pre-participation evaluation: baseline questionnaire, coping skills, body mass index, bone mineral density, ankle range-of-motion, active standing turnout, lumbopelvic control, and balance tests. Self-reported complaints (any physical problem making dance participation difficult, irrespective of medical attention or time-loss) were captured weekly via online questionnaires for one academic year. Self-reported musculoskeletal complaints were recorded weekly (yes/no). Potential risk factors were identified a-priori through systematic review. Associations between potential risk factors and musculoskeletal complaints were examined with generalized linear mixed method regression models. RESULTS Response rate was 99%, with 81% of dancers reporting at least one musculoskeletal complaint. Of 1521 complaints (19% first-time, 81% ongoing), the ankle (22%), knee (21%), and foot (12%) accounted for the majority. Injury history [odds ratio (OR) 7.37 (95% CI 3.41, 15.91)] and previous week's dance hours [OR 1.02 (1.01, 1.03)] were associated with dance-related musculoskeletal complaints. CONCLUSIONS Prevalence of musculoskeletal complaints amongst pre-professional dancers is high and associated with injury history and training volume. Further understanding of the relationship between training load and injury is needed, with particular consideration of the dynamic and recursive nature of dance injury etiology. LEVEL OF EVIDENCE Therapy / Prevention, Aetiology / Harm, level 2b.
Collapse
Affiliation(s)
- Sarah J Kenny
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - Meghan L Critchley
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
5
|
Zunko H, Vauhnik R. Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application. PeerJ 2021; 9:e11977. [PMID: 34616594 PMCID: PMC8464192 DOI: 10.7717/peerj.11977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background Weight-bearing ankle dorsiflexion range of motion measurement (weight-bearing lunge test) is gaining in popularity because it mimics lower extremity function in daily physical activities. The purpose of the study is to assess the intra-rater and the inter-rater reliability of the weight-bearing ankle dorsiflexion range of motion measurement with a flexed knee using a smartphone application Spirit Level Plus installed on an Android smartphone. Methods Thirty-two young, healthy subjects participated in the study and were measured in four sessions by two examiners. One measurement was taken on each ankle in every session. Eight measurements were taken from each participant. A total of 256 were taken from all the participants. The measurements for the individual subject were repeated no sooner than 24 hours after the first session. In order to assess the reliability, intraclass correlation coefficients (ICC), standard error measurements (SEM) and minimal detectable change (MDC) at the 95% confidence interval were calculated. Results Statistical data analysis revealed moderate intra-rater reliability for the right ankle (ICC = 0.72, 95% CI [0.49–0.85]) and good intra-rater reliability for the left ankle (ICC = 0.82, 95% CI [0.66–0.91]). Inter-rater reliability is moderate for the right (ICC = 0.73, 95% CI [0.52–0.86]) and the left ankle (ICC = 0.65, 95% CI [0.39–0.81]). Conclusion The observed method is moderately reliable and appropriate when the main objective is to assess ankle dorsiflexion mobility in weight-bearing when weight-bearing is not contraindicated. The concurrent validity of the Spirit Level Plus application is excellent.
Collapse
Affiliation(s)
- Helena Zunko
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia
| | - Renata Vauhnik
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia.,Arthron, Institute for Joints and Sport Injuries, Slovenia, Ljubljana, Slovenia
| |
Collapse
|
6
|
Gosse G, Ward E, McIntyre A, Banwell HA. The reliability and validity of the weight-bearing lunge test in a Congenital Talipes Equinovarus population (CTEV). PeerJ 2021; 9:e10253. [PMID: 33505779 PMCID: PMC7792513 DOI: 10.7717/peerj.10253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Question What is the intra and inter-rater reliability and concurrent validity of the weight-bearing lunge test within a Congenital Talipes Equinovarus population? Design Test retest design for reliability and validity. The measure was taken, following preconditioning of the participants, using distance from wall, angle at distal posterior tibia using a digital inclinometer and the iPhone level function, twice by each rater. The raters included a clinician, clinician in training and a parent/carer. Outcome measures Weight bearing lunge test as a measure of ankle dorsiflexion. Results Twelve children aged 5–10 years were eligible to participate and consented, along with their parents. Intra-reliability of distance measures for all raters were good to excellent (ICC clinician 0.95, ICC training clinician 0.98 and ICC parent 0.89). Intra-rater reliability of the iPhone for all raters was good (ICCs > 0.751) and good to excellent for the inclinometer (ICC clinician 0.87, ICC training clinician 0.90). Concurrent validity between the clinician’s and parents distance measure was also high with ICC of 0.899. Inter-rater reliability was excellent for distance measure (ICC = 0.948), good for the inclinometer (ICC = 0.801) and moderate for the iPhone (ICC = 0.68). Standard error of measurement ranged from 0.70–2.05, whilst the minimal detectable change ranged from 1.90–5.70. Conclusion The use of the WBLT within this CTEV population has demonstrated good to excellent reliability and validity amongst clinicians, clinicians in training and parents/carers, supporting its use as an assessment measure of dorsiflexion range of motion. There is support for parents/carers to use the WBLT at home as a monitoring assessment measure which may assist with early detection of a relapse. Trial registration University of South Australia’s ethics committee (ID: 201397); Women’s and Children’s Hospital ethics committee (AU/1/4BD7310).
Collapse
Affiliation(s)
- Georgia Gosse
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Emily Ward
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Auburn McIntyre
- Physiotherapy, Allied Health Department, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Helen A Banwell
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
7
|
The Effects of a 9-Week Hip Focused Weight Training Program on Hip and Knee Kinematics and Kinetics in Experienced Female Dancers. J Hum Kinet 2020; 75:29-39. [PMID: 33312293 PMCID: PMC7706665 DOI: 10.2478/hukin-2020-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Increased involvement of the hip musculature during some movements is associated with enhanced performance and reduced injury risk. However, the impact of hip dominant weight training methods on movement strategy has seen limited attention within the literature. The aim of this study was to evaluate if a 9-week hip dominant weight training intervention promotes a more hip dominant movement strategy leading to an improvement in countermovement jump performance. Twenty-two experienced female dancers were recruited and separated into an intervention (age 24.4 ± 6.3 years, body height 165.5 ± 5.8 cm, body mass 65.9 ± 5.6 kg) and a control (age 22.9 ± 5.6 years, body height 163.3 ± 5.4 cm, body mass 57.4 ± 6.8 kg) group. The intervention group participated in a 9-week hip dominant training intervention, which consisted of a wide stance back squat, Romanian deadlift, hip thrusters, and a bent over row. Hip and knee kinematics and kinetics, and countermovement jump performance were assessed pre and post training. Significant interaction effects were found for peak hip joint moment (p = 0.030, η2 = 0.214) and countermovement jump performance (p = 0.003, η2 = 0.356), indicating an increase in peak hip joint moment and countermovement jump performance for the intervention group. Specifically, the intervention group showed a mean increase in jump height of 11.5%. The data show that the use of a hip dominant weight training strategy can improve hip contribution in the propulsion phase of the countermovement jump. Strength and conditioning specialists should incorporate hip dominant weight training exercises to increase hip strength and improve performance.
Collapse
|
8
|
Abstract
Dancing, like athletics, is physically demanding, but dancing also involves aesthetics. Although athletes often use supplemental training, little information exists about its use in dancers. A review of types and effects of supplemental training on dancers' performance and injury risk indicates that, among largely female collegiate dancers, supplemental training enhances the dancers' performance, but limited evidence exists for injury risk reduction.
Collapse
|
9
|
Abstract
Because of increased choreographic demands, early specialization, multi-genre dancers, and high incidence of career-ending injuries, there is a need for enhanced training methodologies to address the unique needs of today's professional dancer. It is imperative for company directors, instructors, choreographers, and dance medicine practitioners to consider implementing the most specific conditioning and training programs to prepare their dancers to meet or exceed expectations without resultant injury. Quantifying effectiveness of choreography-specific training programs is an area for further research. The implementation of scientific principles can and should be used to enhance dancers' health, performance, athleticism, and artistry.
Collapse
|
10
|
Does forced or compensated turnout lead to musculoskeletal injuries in dancers? A systematic review on the complexity of causes. J Biomech 2020; 114:110084. [PMID: 33338756 DOI: 10.1016/j.jbiomech.2020.110084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/24/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022]
Abstract
Injury prevalence in dancers is high, and misaligned turnout (TO) is claimed to bear injury risk. This systematic review aimed to investigate if compensating or forcing TO leads to musculoskeletal injuries. A systematic literature review was conducted according to the PRISMA Guidelines using the databases of PubMed, Embase, Emcare, Web of Science, Cochrane Library, Academic Search Premier, and ScienceDirect. Studies investigating the relationship between compensated or forced TO and injuries in all genders, all ages, and levels of dancers were included. Details on misaligned TO measurements and injuries had to be provided. Screening was performed by two researchers, data extraction and methodological quality assessment executed by one researcher and checked by another. 7 studies with 1293 dancers were included. Methodological quality was low due to study designs and a general lack of standardised definition of pathology and methods of assessment of misaligned TO. The studies investigating the lower extremities showed a hip-focus only. Non-hip contributors as well as their natural anatomical variations were not accounted for, limiting the understanding of injury mechanisms underlying misaligned TO. As such no definite conclusions on the effect of compensating or forcing TO on musculoskeletal injuries could be made. Total TO is dependent on complex motion cycles rather than generalised (hip) joint dominance only. Objective dual assessment of maximum passive joint range of motion through 3D kinematic analysis in combination with physical examination is needed to account for anatomical variations, locate sites prone to (overuse)injury, and investigate underlying injury mechanisms.
Collapse
|
11
|
Effects of the infrared laser on classical ballerinas' feet: Analysis of plantar foot and static balance. J Bodyw Mov Ther 2020; 26:246-252. [PMID: 33992253 DOI: 10.1016/j.jbmt.2020.09.007] [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: 01/17/2020] [Revised: 08/27/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Overuse injuries and painful symptoms in athletes and dancers (especially classical ballerinas) may lead to reduced functional performance. However, laser application may reduce pain and increase physical conditioning. The aim of the current study was to evaluate the immediate and long-term effects of infrared laser on classical ballerinas' feet. METHODS Eight female adults who perform classical ballet training and feel pain in their foot, but report no injuries in the last 6 months participated in the study. Infrared laser (808 nm) was applied on ballerina's feet twice a week during three months. The laser parameters utilized were 100 mW average optical power and spot size of 0.04 cm2 applied during 1 min, leading to 6 J and 125 J/cm2 per point. Thermography, algometry and unipodal static standing balance test were performed. RESULTS There was a significant increase in plantar arch temperature (1.6 °C for center and 2.3 °C for border, p < 0.05) immediately after laser treatment for all ballerinas. The pressure pain thresholds (PPT) were significantly increased for 5 of 7 analyzed sites (p < 0.05). Regarding to the static standing balance, the time on one-foot showed a significant increases (from 23 ± 12 s to 34 ± 13 s, p < 0.05) only when the test was performed on the left foot (support foot). CONCLUSION Then, there were pain relief and improvement of functional performance in ballerinas. The possible mechanism of laser action in reducing pain and thus enhancing performance, like higher blood flow of foot due to an increase of cutaneous temperature, will be discussed.
Collapse
|
12
|
Uygur AG, Polat S, Ayvazoğlu S, Yücel AH. The physical features suitable for classical ballet training. J Back Musculoskelet Rehabil 2019; 32:569-578. [PMID: 30530960 DOI: 10.3233/bmr-181173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prerequisite physical features of classical ballet education. METHODS Students who enrolled and were rejected for the applications of State Conservatory Ballet Main Art Branch in the academic year 2013-2014 and 2014-2015 were compared with their exam results. This study involves defining the physical ability and determining physical fitness by using Eurofit tests including the Flamingo Balance test (FB), Plate Tapping (PT), Sit and Reach (SITR), Standing Broad Jump (SBJ), Handgrip test (HG), Sit Up in 30 Seconds (SU) and Shuttle Run 10 × 5 meter (SR), Heath-Carter somatotyping method and anthropometric measurements which determine ballet students' body type and physical abilities. Sixty-nine girls between 8-11 years old who applied for ballet education at the State Conservatory Ballet Main Art Branch were included in the study. While the average of age, height and weight measurements of enrolled students were 9.40 ± 0.74 year, 1.38 ± 0.08 m and 30.03 ± 4.73 kg respectively, the same dimensions were found in rejected students, i.e. 9.79 ± 0.94 year, 1.40 ± 0.10 m and 35.59 ± 7.31 kg respectively. RESULTS Measurements of diameter, circumference and subcutaneous fat were lower (p< 0.05) for enrolled students. The major body type of enrolled students was identified as mesomorphy, whereas the major body type of rejected students was identified as endomorphy. All dimensions of the Eurofit tests, except the strength test, were significantly different in enrolled students (p< 0.05). CONCLUSIONS The parameters used in this study can be convenient in objectively evaluating classical ballet education.
Collapse
Affiliation(s)
- Ayşe Gül Uygur
- Department of Anatomy, Faculty of Medicine, Cukurova University, Sarıçam, Adana, Turkey
| | - Sema Polat
- Department of Anatomy, Faculty of Medicine, Cukurova University, Sarıçam, Adana, Turkey
| | - Seda Ayvazoğlu
- Department of Performing Arts, State Conservatory, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Hilmi Yücel
- Department of Anatomy, Faculty of Medicine, Cukurova University, Sarıçam, Adana, Turkey
| |
Collapse
|
13
|
Banwell HA, Uden H, Marshall N, Altmann C, Williams CM. The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study. J Foot Ankle Res 2019; 12:37. [PMID: 31333763 PMCID: PMC6617898 DOI: 10.1186/s13047-019-0347-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ankle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the 'Measure application'), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer. Methods To determine intra-rater reliability, inter-rater reliability and concurrent validity, 168 measures were conducted on 21 participants. Participants were preconditioned prior to assessment, and two experienced raters measured ankle dorsiflexion range of motion in the knee extended and knee flexed positions of the weight bearing lunge test, using an iPhone level function (of the Measure application) and a digital inclinometer in a randomised order, over two timepoints. Concurrent validity was also determined by comparison of measures of the two devices at known surface angles (0 and 15 degrees) in multiple planes. Reliability and validity were determined with intraclass correlation coefficients, concurrent validity was explored with the Bland Altman plot and an intraclass correlation coefficient. The Standard Error of the Mean and the minimal detectable change were also explored. Results The intra-rater reliability using the iPhone and inter-rater reliability using the digital inclinometer, in the knee extended position, were ICC 0.85 respectively, indicating good reliability. All other intra-rater reliability and inter-rater reliability for both devices and both leg positions were over ICC 0.90, indicating excellent reliability. Concurrent validity between the two devices on a flat and known angle surface were ICC 1.0 (Limits of Agreement - 1.0 to 0.61), indicating excellent validity, with good validity demonstrated by a Bland Altman plot of all measures in all positions (ICC of 0.84 (Limits of agreement = - 4.51 to 6.49)). Conclusion The use of the iPhone level measure, within the Measurement App has demonstrated to be an easy and reliable measurement tool to determine ankle joint dorsiflexion during the weightbearing lunge test in healthy adults.
Collapse
Affiliation(s)
- Helen A Banwell
- 1International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia 5001 Australia.,2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Hayley Uden
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Nicole Marshall
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Carlie Altmann
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Cylie M Williams
- 2School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia.,3Allied Health, Peninsula Health, Frankston, Victoria 3199 Australia.,4School of Primary and Allied Health, Monash University, Frankston, Victoria 3199 Australia
| |
Collapse
|
14
|
Association Between Previous Injury and Risk Factors for Future Injury in Preprofessional Ballet and Contemporary Dancers. Clin J Sport Med 2019; 29:209-217. [PMID: 31033614 DOI: 10.1097/jsm.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the prevalence of self-reported 1-year injury history and examine its association with preparticipation evaluation components aimed at predicting future injury risk (PPE-IP) among preprofessional ballet and contemporary dancers. DESIGN Cross-sectional study. SETTING Preprofessional ballet school, university contemporary dance program. PARTICIPANTS Full-time preprofessional ballet and contemporary dancers. ASSESSMENT OF RISK FACTORS Preparticipation evaluation consisted of the Athletic Coping Skills Inventory-28, body mass index, total bone mineral density, ankle range of motion, active standing turnout, lumbopelvic control, unipedal dynamic balance, and Y-Balance test. MAIN OUTCOME MEASURE Self-reported 1-year history of dance-related medical attention and/or time-loss injury. RESULTS A total of 155 ballet [n = 90, 80 females, median age 15 years (range 11-19)] and contemporary [n = 65, 63 females, median age 20 years (range 17-30)] dancers participated. Forty-six percent (95% confidence interval (CI), 38.4-54.6) reported a 1-year injury history. Self-reported injury history was not associated with any PPE-IP, however, an influence of age and psychological coping skills on the relationship between 1-year injury history and PPE-IP was identified. Multivariable analyses revealed that prevalence of 1-year injury history did not differ by age [referent group <15 years; 15-18 years: odds ratio (OR) 0.80 (95% CI, 0.35-1.79); >18 years: OR 0.69 (95% CI, 0.30-1.56)], or level of psychological coping skills [OR 1.35 (95% CI, 0.61-2.94)]. CONCLUSIONS The prevalence of self-reported 1-year injury history among preprofessional ballet and contemporary dancers is high. Although measures of PPE-IP did not differ based on injury history, it is important that age and psychological coping skills are considered in future dance injury prevention and prediction research. LEVEL OF EVIDENCE Level 3 evidence.
Collapse
|
15
|
Abraham A, Gose R, Schindler R, Nelson BH, Hackney ME. Dynamic Neuro-Cognitive Imagery (DNI TM) Improves Developpé Performance, Kinematics, and Mental Imagery Ability in University-Level Dance Students. Front Psychol 2019; 10:382. [PMID: 30881328 PMCID: PMC6407436 DOI: 10.3389/fpsyg.2019.00382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
Dance requires optimal range-of-motion and cognitive abilities. Mental imagery is a recommended, yet under-researched, training method for enhancing both of these. This study investigated the effect of Dynamic Neuro-Cognitive Imagery (DNITM) training on developpé performance (measured by gesturing ankle height and self-reported observations) and kinematics (measured by hip and pelvic range-of-motion), as well as on dance imagery abilities. Thirty-four university-level dance students (M age = 19.70 ± 1.57) were measured performing three developpé tasks (i.e., 4 repetitions, 8 consecutive seconds hold, and single repetition) at three time-points (2 × pre-, 1 × post-intervention). Data were collected using three-dimensional motion capture, mental imagery questionnaires, and subjective reports. Following the DNITM intervention, significant increases (p < 0.01) were detected in gesturing ankle height, as well as in hip flexion and abduction range-of-motion, without significant changes in pelvic alignment. These gains were accompanied by self-reported decrease (p < 0.05) in level of difficulty experienced and significant improvements in kinesthetic (p < 0.05) and dance (p < 0.01) imagery abilities. This study provides evidence for the motor and non-motor benefits of DNITM training in university-level dance students.
Collapse
Affiliation(s)
- Amit Abraham
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Kinesiology, College of Education, University of Georgia, Athens, GA, United States
| | - Rebecca Gose
- Department of Dance, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Ron Schindler
- Department of Mathematics, The Weizmann Institute of Science, Rehovot, Israel
| | - Bethany H. Nelson
- Department of Kinesiology, College of Education, University of Georgia, Athens, GA, United States
| | - Madeleine E. Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, United States
| |
Collapse
|
16
|
Yin AX, Geminiani E, Quinn B, Owen M, Kinney S, McCrystal T, Stracciolini A. The Evaluation of Strength, Flexibility, and Functional Performance in the Adolescent Ballet Dancer During Intensive Dance Training. PM R 2019; 11:722-730. [DOI: 10.1002/pmrj.12011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/04/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Amy X. Yin
- Department of OrthopedicsKaiser Permanente Northern California, Podiatry, and Sports Medicine 2500 Merced St, 4th Floor, San Leandro CA 94577
| | - Ellen Geminiani
- Department of Orthopedics, Division of Sports MedicineBoston Children's Hospital Boston MA
- Harvard Medical School Boston MA
- The Micheli Center for Sports Injury Prevention Waltham MA
| | - Bridget Quinn
- Department of Orthopedics, Division of Sports MedicineBoston Children's Hospital Boston MA
- Harvard Medical School Boston MA
- The Micheli Center for Sports Injury Prevention Waltham MA
| | - Michael Owen
- Director of Dance, Walnut Hill School for the Arts Natick MA
| | | | | | - Andrea Stracciolini
- Department of OrthopedicsDivision of Sports Medicine, Boston Children's Hospital Boston MA
- Harvard Medical School Boston MA
- The Micheli Center for Sports Injury Prevention Waltham MA
- Department of Medicine, Division of Emergency MedicineBoston Children's Hospital Boston MA
| |
Collapse
|
17
|
Michalitsis J, Murphy AT, Rawicki B, Haines TP, Williams C. Full length foot orthoses have an immediate treatment effect and modify gait of children with idiopathic toe walking. Gait Posture 2019; 68:227-231. [PMID: 30522020 DOI: 10.1016/j.gaitpost.2018.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW. RESEARCH QUESTION Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters? METHODS This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite® mat were compared to barefoot walking and shod walking. RESULTS An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001). SIGNIFICANCE These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group.
Collapse
Affiliation(s)
- Joanne Michalitsis
- Monash Children's Hospital, Victorian Paediatric Rehabilitation Service, Clayton Rd, Clayton, VIC, 3168, Australia.
| | - Anna T Murphy
- Monash Health, Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC, 3192, Australia
| | - Barry Rawicki
- Monash Children's Hospital, Victorian Paediatric Rehabilitation Service, Clayton Rd, Clayton, VIC, 3168, Australia
| | - Terry P Haines
- Monash University, School of Primary and Allied Health Care, Frankston, VIC, 3199, Australia
| | - Cylie Williams
- Monash University, School of Primary and Allied Health Care, Frankston, VIC, 3199, Australia; Peninsula Health, Allied Health, 4 Hastings Rd, Frankston, VIC, 3199, Australia
| |
Collapse
|
18
|
McCormack MC, Bird H, de Medici A, Haddad F, Simmonds J. The Physical Attributes Most Required in Professional Ballet: A Delphi Study. Sports Med Int Open 2018; 3:E1-E5. [PMID: 30581984 PMCID: PMC6301851 DOI: 10.1055/a-0798-3570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/30/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022] Open
Abstract
Background It is commonly accepted that dancers are undoubtedly athletes, with ballet perhaps the most demanding dance form. No previous study has sought to define the physical attributes most desired for classical ballet by professional companies and vocational schools. These are likely to include both aesthetic features and attributes that reduce the risk of injury as well as enhance performance. Method An initial survey question using the modified Delphi technique was sent using Opinio Survey Software to a selected international expert panel. This was drawn both from those involved in selection of elite professional ballet dancers, and the international medical professionals involved in the care of dancers. The first questionnaire was open-ended to scope for all the physical attributes most favoured by the professional experts. Results There were 148 responses from the panel of international experts. In total 34 physical attributes were suggested. The 2 most recommended physical criteria for selection into the profession were overall flexibility and overall strength. These results are discussed in the context of the published literature on the mechanics, anatomy and physiology of ballet. Conclusion Flexibility and strength are the 2 features most sought after in elite ballet dancers.
Collapse
Affiliation(s)
- Moira Cameron McCormack
- Institute of Sport Exercise and Health, University College London, London, United Kingdom of Great Britain and Northern Ireland.,The Royal Ballet Company, Healthcare, London, United Kingdom of Great Britain and Northern Ireland
| | - Howard Bird
- Institute of Sport Exercise and Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Akbar de Medici
- Institute of Sport Exercise and Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Jane Simmonds
- Institute of Sport Exercise and Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
19
|
Dixon S, Nunns M, House C, Rice H, Mostazir M, Stiles V, Davey T, Fallowfield J, Allsopp A. Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits. J Sci Med Sport 2018; 22:135-139. [PMID: 30057365 DOI: 10.1016/j.jsams.2018.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This prospective study investigated anatomical and biomechanical risk factors for second and third metatarsal stress fractures in military recruits during training. DESIGN Prospective cohort study. METHODS Anatomical and biomechanical measures were taken for 1065 Royal Marines recruits at the start of training when injury-free. Data included passive range of ankle dorsi-flexion, dynamic peak ankle dorsi-flexion and plantar pressures during barefoot running. Separate univariate regression models were developed to identify differences between recruits who developed second (n=7) or third (n=14) metatarsal stress fracture and a cohort of recruits completing training with no injury (n=150) (p<0.05). A multinomial logistic regression model was developed to predict the risk of injury for the two sites compared with the no-injury group. Multinomial logistic regression results were back transformed from log scale and presented in Relative Risk Ratios (RRR) with 95% confidence intervals (CI). RESULTS Lower dynamic arch index (high arch) (RRR: 0.75, CI: 0.63-0.89, p<0.01) and lower foot abduction (RRR: 0.87, CI: 0.80-0.96, p<0.01) were identified as increasing risk for second metatarsal stress fracture, while younger age (RRR: 0.78, CI: 0.61-0.99, p<0.05) and later peak pressure at the second metatarsal head area (RRR: 1.19, CI: 1.04-1.35, p<0.01) were identified as risk factors for third metatarsal stress fracture. CONCLUSIONS For second metatarsal stress fracture, aspects of foot type have been identified as influencing injury risk. For third metatarsal stress fracture, a delayed forefoot loading increases injury risk. Identification of these different injury mechanisms can inform development of interventions for treatment and prevention.
Collapse
Affiliation(s)
- Sharon Dixon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK.
| | - Michael Nunns
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Carol House
- Institute of Naval Medicine, Alverstoke, Hampshire, PO12 2DL, UK
| | - Hannah Rice
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Mohammod Mostazir
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, UK
| | - Victoria Stiles
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, UK
| | - Trish Davey
- Institute of Naval Medicine, Alverstoke, Hampshire, PO12 2DL, UK
| | | | - Adrian Allsopp
- Institute of Naval Medicine, Alverstoke, Hampshire, PO12 2DL, UK
| |
Collapse
|
20
|
Francia P, Toni S, Iannone G, Seghieri G, Piccini B, Vittori A, Santosuosso U, Casalini E, Gulisano M. Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship? Pediatr Diabetes 2018; 19:801-808. [PMID: 29493073 DOI: 10.1111/pedi.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/OBJECTIVE It is known that patients with diabetes can develop limited joint mobility (LJM) and that this can depend on the metabolic control maintained and the duration of the disease. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in both plantar and dorsiflexion in young type 1 diabetic patients (T1D) considering also the possible role of sport practiced as a further factor, able to modify AJM. METHODS AJM was evaluated by an inclinometer in 82 T1D patients (M/F: 48/34), mean age 12.9 ± 2.6 years, body mass index (BMI) 19.7 ± 3.6 kg/m2 , duration of diabetes 5.6 ± 3.3 years, mean HbA1c 7.5 ± 1.0% and in 226 healthy controls (M/F: 146/80), age-, gender-, and BMI-matched practicing different sports (soccer, volleyball, basketball, and dance). RESULTS The patients' ankle range of motion was significantly lower than that in controls (132.7 ± 22.3° vs 126.1 ± 17.9°; P < .017). In particular, ankle plantar flexion was significantly lower in the patients group (31.6° ± 7.9° vs 28.5° ± 6.6°; P < .002). Soccer players showed lower AJM in both groups: patients (120.1 ± 15.9° vs 127.3 ± 18.1) and controls (119.4 ± 21.1° vs 142.0 ± 18.1; P < .0001) than subjects practicing other sports or who were sedentary. In both groups, patients and controls, age, sex, duration of disease, hemoglobin 1Ac, and BMI have not been shown to be correlated to the mobility assessed. CONCLUSIONS The results of this study, in addition to confirming the negative effect of diabetes on AJM of young T1D patients, suggest that during these evaluations the sport-related effect should be considered because it can induce significant changes of AJM.
Collapse
Affiliation(s)
- Piergiorgio Francia
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Sonia Toni
- Diabetes Unit, Meyer Children's Hospital, Florence, Italy
| | - Giulia Iannone
- National Association of Movement Sciences (ANIMO), Florence, Italy
| | | | | | - Alessandro Vittori
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Ugo Santosuosso
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | | | - Massimo Gulisano
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| |
Collapse
|
21
|
The association between menarche, intensity of training and passive joint ROM in young pre-professional female dancers: A longitudinal follow-up study. Phys Ther Sport 2018; 32:59-66. [PMID: 29758506 DOI: 10.1016/j.ptsp.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/06/2018] [Accepted: 05/04/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the association between the status of menarche (yes/no), the intensity of training and the potential to improve passive joint range of motion (ROM) over a 12-month period of dance training. DESIGN Prospective cohort study. SETTING Dance studio. PARTICIPANTS Fifty-nine female dancers aged 12.8 ± 0.5. MAIN OUTCOME MEASURES The dancers were asked about their dance intensity and screened for anthropometric parameters and passive joint ROM in Grades 7 and 8. RESULTS Along the 12 months of dance training, we found significantly increased ankle-foot en-pointe, hip abduction, and hip external rotation (ER); significantly decreased hip internal rotation (IR); and significant increased hip ER:IR ratio. In Grade 7, 26 dancers (44.1%) reached menarche (Yes menarche); in Grade 8 an additional 23 dancers (39.0%) reached menarche (No/Yes menarche); and 10 dancers (16.9%) had not reached menarche (No menarche). MANOVA (mixed models) with repeated measures to compare joint ROM between the three menarche groups (Yes; No/Yes; No), with h/week dance practice as a co-variant, showed that hip ER, ankle-foot en-pointe, and ER:IR were significantly correlated with h/week in all three menarche groups. CONCLUSIONS Most passive joint ROM can be improved over 12 months of dancing around the age onset of menarche. H/week of dance practice is a main factor contributing to improved hip ER, ankle-foot en-pointe and ER/IR ratio.
Collapse
|
22
|
Gontijo KNS, Amaral MAD, Santos GCD, Candotti CT. Métodos usados para avaliar o en dehors ou turnout de dançarinos e bailarinos clássicos: revisão da literatura. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/17100124042017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A técnica do ballet clássico exige a realização máxima do en dehors ou turnout, caracterizado pela rotação externa de membros inferiores. Considerando a sua importância, diversos protocolos para a sua avaliação e mensuração têm sido propostos. O objetivo desta revisão foi investigar sistematicamente quais os métodos utilizados para avaliar o turnout de bailarinos clássicos e/ou praticantes de ballet clássico existentes atualmente. A busca foi feita nas bases de dados Scopus, Science Direct e PubMed, no mês de fevereiro de 2016, e os artigos encontrados deveriam: estar redigidos na língua inglesa, avaliar bailarinos clássicos ou dançarinos que praticassem ballet clássico e mensurar o en dehors ou turnout. Foram encontrados 593 artigos, dos quais 25 foram pré-selecionados para esta revisão, apresentando quinze diferentes métodos e instrumentos de mensuração do turnout: cinemetria; inclinômetro; turnout protactor ou transferidor para medir o turnout; goniômetro; Dupuis Tropometer; transferidor original; fotos dos sujeitos; discos rotacionais; teste de flexibilidade de Nicholas; flexímetro; desenho clínico dos pés; sujeito sobre um pedaço de papel ou solo ou quadro branco; ressonância magnética; filmagem do sujeito executando sequência de passos; Dasco Pro Angle Finder. Esta revisão apresenta forte evidência para afirmar que não há, até o presente momento, um método ou instrumento padrão-ouro para mensuração do turnout de bailarinos, de modo que esta costuma ser adaptada e escolhida de acordo com o objetivo de cada estudo.
Collapse
|
23
|
Kennedy R, Carroll K, Paterson KL, Ryan MM, McGinley JL. Deterioration in gait and functional ambulation in children and adolescents with Charcot–Marie–Tooth disease over 12 months. Neuromuscul Disord 2017; 27:658-666. [DOI: 10.1016/j.nmd.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023]
|
24
|
Alfaro Santafé JJ, Gómez Bernal A, Lanuza Cerzócimo C, Sempere Bonet C, Barniol Mercade A, Alfaro Santafé JV. Results of the weight-bearing Lunge test on patients with functional hallux limitus: A cross sectional case–control study. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
25
|
Alfaro Santafé JJ, Gómez Bernal A, Lanuza Cerzócimo C, Sempere Bonet C, Barniol Mercade A, Alfaro Santafé JV. Resultados del test de Lunge en pacientes con hallux limitus funcional: estudio transversal de casos y controles. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
26
|
Watson T, Graning J, McPherson S, Carter E, Edwards J, Melcher I, Burgess T. DANCE, BALANCE AND CORE MUSCLE PERFORMANCE MEASURES ARE IMPROVED FOLLOWING A 9-WEEK CORE STABILIZATION TRAINING PROGRAM AMONG COMPETITIVE COLLEGIATE Dancers. Int J Sports Phys Ther 2017; 12:25-41. [PMID: 28217414 PMCID: PMC5294944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Dance performance requires not only lower extremity muscle strength and endurance, but also sufficient core stabilization during dynamic dance movements. While previous studies have identified a link between core muscle performance and lower extremity injury risk, what has not been determined is if an extended core stabilization training program will improve specific measures of dance performance. HYPOTHESIS/PURPOSE This study examined the impact of a nine-week core stabilization program on indices of dance performance, balance measures, and core muscle performance in competitive collegiate dancers. STUDY DESIGN Within-subject repeated measures design. METHODS A convenience sample of 24 female collegiate dance team members (age = 19.7 ± 1.1 years, height = 164.3 ± 5.3 cm, weight 60.3 ± 6.2 kg, BMI = 22.5 ± 3.0) participated. The intervention consisted of a supervised and non-supervised core (trunk musculature) exercise training program designed specifically for dance team participants performed three days/week for nine weeks in addition to routine dance practice. Prior to the program implementation and following initial testing, transversus abdominis (TrA) activation training was completed using the abdominal draw-in maneuver (ADIM) including ultrasound imaging (USI) verification and instructor feedback. Paired t tests were conducted regarding the nine-week core stabilization program on dance performance and balance measures (pirouettes, single leg balance in passe' releve position, and star excursion balance test [SEBT]) and on tests of muscle performance. A repeated measures (RM) ANOVA examined four TrA instruction conditions of activation: resting baseline, self-selected activation, immediately following ADIM training and four days after completion of the core stabilization training program. Alpha was set at 0.05 for all analysis. RESULTS Statistically significant improvements were seen on single leg balance in passe' releve and bilateral anterior reach for the SEBT (both p ≤ 0.01), number of pirouettes (p = 0.011), and all measures of strength (p ≤ 0.05) except single leg heel raise. The RM ANOVA on mean percentage of change in TrA was significant; post hoc paired t tests demonstrated significant improvements in dancers' TrA activations across the four instruction conditions. CONCLUSION This core stabilization training program improves pirouette ability, balance (static and dynamic), and measures of muscle performance. Additionally, ADIM training resulted in immediate and short-term (nine-week) improvements in TrA activation in a functional dance position. LEVEL OF EVIDENCE 2b.
Collapse
Affiliation(s)
- Todd Watson
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC
| | - Jessica Graning
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC
| | - Sue McPherson
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC
| | | | | | | | | |
Collapse
|
27
|
Williams CM, Michalitsis J, Murphy AT, Rawicki B, Haines TP. Whole-Body Vibration Results in Short-Term Improvement in the Gait of Children With Idiopathic Toe Walking. J Child Neurol 2016; 31:1143-9. [PMID: 27071469 DOI: 10.1177/0883073816643405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/07/2016] [Indexed: 11/17/2022]
Abstract
This study aimed to determine the impact of multiple doses of whole-body vibration on heel strike, spatial and temporal gait parameters, and ankle range of motion of children with idiopathic toe walking. Whole-body vibration was applied for 5 sets of 1 minute vibration/1 minute rest. Gait measures were collected pre intervention, 1, 5, 10, and 20 minutes postintervention with the GaitRite(®) electronic walkway. Ankle range of motion was measured preintervention, immediately postintervention, and 20 minutes postintervention. The mean (SD) age of the 15 children (n = 10 males) was 5.93 (1.83) years. An immediate increase in heel contact (P = .041) and ankle range of motion (P = .001 and P = .016) was observed. These changes were unsustained 20 minutes postvibration (P > .05). The gait improvement from whole-body vibration could potentially be due to a rapid increase in ankle range of motion or a neuromodulation response.
Collapse
Affiliation(s)
- Cylie M Williams
- Physiotherapy Department, Monash University, Victoria, Australia Allied Health Research Unit, Monash Health, Monash Children's Hospital, Victoria, Australia
| | | | - Anna T Murphy
- Clinical Gait Analysis Service, Monash Health, Victoria, Australia
| | - Barry Rawicki
- Victorian Paediatric Rehabilitation Service, Victoria, Australia
| | - Terry P Haines
- Physiotherapy Department, Monash University, Victoria, Australia Allied Health Research Unit, Monash Health, Monash Children's Hospital, Victoria, Australia
| |
Collapse
|
28
|
Cranage S, Banwell H, Williams CM. Gait and Lower Limb Observation of Paediatrics (GALLOP): development of a consensus based paediatric podiatry and physiotherapy standardised recording proforma. J Foot Ankle Res 2016; 9:8. [PMID: 26949416 PMCID: PMC4778335 DOI: 10.1186/s13047-016-0139-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/23/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Paediatric gait and lower limb assessments are frequently undertaken in podiatry and physiotherapy clinical practice and this is a growing area of expertise within Australia. No concise paediatric standardised recording proforma exists to assist clinicians in clinical practice. The aim of this study was to develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0-18 years. METHOD Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel using the online Qualtrics(©) survey platform. The first round of the survey consisted of open-ended questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round responses. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age-specific normative data with acceptable reliability of outcome measures. RESULTS There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final Gait and Lower Limb Observation of Paediatrics (GALLOP) proforma. CONCLUSION The GALLOP proforma is a consensus based, systematic and standardised way to collect information and outcome measures in paediatric lower limb assessment. This standardised recording proforma will assist professions to collect information in a standardised format based on best evidence assessment methods whilst aiding consistency in communication between health professionals.
Collapse
Affiliation(s)
- Simone Cranage
- />Peninsula Health-Community Health, PO Box 52, Frankston, Victoria 3199 Australia
| | - Helen Banwell
- />School of Health Sciences, University of South Australia, PO Box 2471, Adelaide, South Australia 5001 Australia
| | - Cylie M. Williams
- />Peninsula Health-Community Health, PO Box 52, Frankston, Victoria 3199 Australia
- />School of Health Sciences, University of South Australia, PO Box 2471, Adelaide, South Australia 5001 Australia
- />School of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria 3199 Australia
| |
Collapse
|
29
|
Rose KJ, Hiller CE, Mandarakas M, Raymond J, Refshauge K, Burns J. Correlates of functional ankle instability in children and adolescents with Charcot-Marie-Tooth disease. J Foot Ankle Res 2015; 8:61. [PMID: 26543504 PMCID: PMC4634800 DOI: 10.1186/s13047-015-0118-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional ankle instability (FAI) is commonly reported by children and adolescents with Charcot-Marie-Tooth disease (CMT), however,, the specific variables associated with FAI remain unknown. An improved understanding of these variables may suggest interventions to improve ankle stability and possibly prevent the long-term complications associated with ankle instability in this population. The aim of this study was to therefore investigate the relationship between FAI and other functional, structural, anthropometric and demographic characteristics in a cross sectional sample of children and adolescents with CMT. METHODS Thirty children and adolescents with CMT aged 7-18 years were recruited from the Peripheral Neuropathy Clinics of a large tertiary paediatric hospital. Measures of FAI were obtained using the Cumberland Ankle Instability Tool (CAIT). Demographic and anthropometric data was also collected. Other variables collected included foot structure (Foot Posture Index), ankle range of motion (weight bearing lunge) and functional parameters (balance, timed motor function and falls). Descriptive statistics were calculated to characterise the participants. Pearson's correlation coefficients were calculated to investigate the correlates of right and left FAI and demographic (age), anthropometric (height, weight, BMI), foot/ankle (foot structure and ankle flexibility) and functional parameters (balance task, timed motor function and falls frequency). Point biserial correlation was employed to correlate gender with right and left FAI. RESULTS All but one study participant (n = 29) reported moderate to severe bilateral FAI with females reporting significantly greater ankle instability than males. FAI was significantly associated with cavus foot structure (r = .69, P < .001), female gender (r = -.47, P < .001) and impaired balance (r = .50, P < .001). CONCLUSIONS This study confirms FAI is common in children and adolescents with CMT. An examination of the correlates of FAI suggests interventions, which target balance, and normalise foot structure should be explored to evaluate whether they might help to improve ankle stability in this population.
Collapse
Affiliation(s)
- Kristy J Rose
- Institute for Neuroscience and Muscle Research at The Children's Hospital at Westmead, Sydney, NSW Australia ; Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia ; School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| | - Claire E Hiller
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| | - Melissa Mandarakas
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| | - Jacqueline Raymond
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia ; Exercise Physiology and Nutrition Research Team, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| | - Kathryn Refshauge
- Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| | - Joshua Burns
- Institute for Neuroscience and Muscle Research at The Children's Hospital at Westmead, Sydney, NSW Australia ; Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| |
Collapse
|
30
|
Pohjola H, Sayers M, Mellifont R, Mellifont D, Venojärvi M. Three-dimensional analysis of a ballet dancer with ischial tuberosity apophysitis. A case study. J Sports Sci Med 2014; 13:874-880. [PMID: 25435780 PMCID: PMC4234957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this case study was to describe the three-dimensional biomechanics of common ballet exercises in a ballet dancer with ischial tuberosity apophysitis. This was achieved by comparing kinematics between the symptomatic (i.e. ischial apophyseal symptoms) and contralateral lower limbs, as well as via reported pain. Results suggest consistent differences in movement patterns in this dancer. These differences included: 1) decreased external rotation of contralateral hip, hence a decreased hip contribution to 'turn out'; 2) increased contralateral knee adduction and internal rotation; 3) an apparent synchronicity in the contralateral lower limb of the decreased hip external rotation and increased knee adduction; and 4) minimal use of ankle plantar/dorsiflexion movement for symptomatic side. Pain related to the left ischial apophysitis was associated with reduced amplitudes especially in fast ballet movements that required large range of motion in flexion and adduction in the left hip joint. These findings suggest that ischial apophysitis may limit dancer's ballet technique and performance. Key PointsThe pain related to the left ischial apophysitis was associated with reduced amplitudes especially in fast ballet movements that require large range of motion. This may affect to the lower limbs kinematics, and limit dancer's technique and performance.Compensatory strategies in the kinetic chain, differences in the joint angles between the lower limbs, traction forces, velocity and amplitude demands should be taken in consideration while training and rehabilitation of the ischial apophyseal injury within classical ballet.
Collapse
Affiliation(s)
- Hanna Pohjola
- University of Eastern Finland , Finland ; Theatre Academy , Finland
| | - Mark Sayers
- University of the Sunshine Coast , Australia
| | | | | | | |
Collapse
|
31
|
Williams C, Tinley PD, Curtin M, Nielsen S. Foot and ankle characteristics of children with an idiopathic toe-walking gait. J Am Podiatr Med Assoc 2014; 103:374-9. [PMID: 24072365 DOI: 10.7547/1030374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers. METHODS Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non-toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance. RESULTS There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non-toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-6 in the ITW cohort. CONCLUSION Children with an ITW gait demonstrated reduced flexibility at the ankle joint but similar weightbearing foot posture compared with non-toe-walking children, showing that for children 4 to 8 years old, an ITW gait affects the available ankle dorsiflexion but seems to have a limited effect on weightbearing foot posture as measured by the FPI-6.
Collapse
Affiliation(s)
- Cylie Williams
- Allied Health Research Unit, Monash Health, Cheltenham, Australia
| | | | | | | |
Collapse
|
32
|
Williams CM, Tinley P, Rawicki B. Idiopathic toe-walking: have we progressed in our knowledge of the causality and treatment of this gait type? J Am Podiatr Med Assoc 2014; 104:253-62. [PMID: 24901584 DOI: 10.7547/0003-0538-104.3.253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment options available for ITW. Therefore, a literature review was conducted to determine what treatment options are supported by the evidence as having the best long-term effect on ITW gait. METHODS After extraction of relevant articles, 21 manuscripts reporting treatment options for ITW gait were appraised against the levels of evidence. RESULTS From these articles, there was no single treatment option reported as having a long-term effect on the gait of children with ITW. There was support in the literature for surgical interventions, serial casting, and the use of botulinum toxin type A. There was limited evidence that footwear or orthoses changed the gait pattern. CONCLUSIONS This review updates the knowledge of podiatric physicians, enhances how children who present with this gait style can be managed, and highlights areas for future research.
Collapse
Affiliation(s)
| | - Paul Tinley
- Department of Community Health, Charles Sturt University, Albury, New South Wales, Australia
| | - Barry Rawicki
- Victorian Paediatric Rehabilitation Service, Monash Health, Clayton, Victoria, Australia
| |
Collapse
|
33
|
Normative reference values for lower limb joint range, bone torsion, and alignment in children aged 4-16 years. J Pediatr Orthop B 2014; 23:15-25. [PMID: 23852035 DOI: 10.1097/bpb.0b013e328364220a] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Normative reference values are essential to identify deviation from normal and evaluate response to treatment. As joint range of motion datasets specific to the pediatric population are infrequently reported in the literature, we determined lower limb passive joint range of motion and bone torsion values from 53 typically developing children aged 4-16 years. Our reference values were consistent with previously published norms, although for some measures, large variability in the literature exists. A clear correlation between joint range and age was observed in most measures. Our results highlight the importance of applying age-matched norms when attempting to identify deviation from normal in the growing child.
Collapse
|
34
|
Moore IS, Jones AM, Dixon SJ. Mechanisms for improved running economy in beginner runners. Med Sci Sports Exerc 2013; 44:1756-63. [PMID: 22525760 DOI: 10.1249/mss.0b013e318255a727] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Controversy surrounds whether running mechanics make good predictors of running economy (RE) with little known about the development of an economical running gait. PURPOSE The aim of this study was to identify if mechanical or physiological variables changed during 10 wk of running in beginners and whether these changes could account for any change in RE. METHODS A 10-wk running program (10 wkRP) was completed by 10 female beginner runners. A bilateral three-dimensional kinematic and kinetic analysis, in addition to RE and lower body flexibility measurements, was performed before and after the 10 wkRP. The Balke-Ware graded walking exercise test was performed before and after the 10 wkRP to determine VO2max. RESULTS Seven kinematic and kinetic variables significantly changed from before to after training, in addition to a significant decrease in calf flexibility (27.3° ± 6.3° vs 23.9° ± 5.6°, P < 0.05). A significant improvement was seen in RE (224 ± 24 vs 205 ± 27 mL · kg(-1) · km(-1), P < 0.05) and treadmill time to exhaustion (16.4 ± 3.2 vs 17.3 ± 2.8 min, P < 0.05); however, VO2max remained unchanged from before to after training (34.7 ± 5.1 vs 34.3 ± 5.6 mL · kg(-1) · min(-1)). Stepwise regression analysis showed three kinematic variables to explain 94.3% of the variance in change in RE. They were a less extended knee at toe off (P = 0.004), peak dorsiflexion occurring later in stance (P = 0.001), and a slower eversion velocity at touchdown (P = 0.042). The magnitude of change for each variable was 1.5%, 4.7%, and 34.1%, respectively. CONCLUSIONS These results show that beginner runners naturally developed their running gait as they became more economical runners.
Collapse
Affiliation(s)
- Isabel S Moore
- Bioenergetics and Human Performance Research Group, Sport and Health Sciences, College of Life and Environmental Sciences, St Luke's Campus, University of Exeter, Exeter, United Kingdom
| | | | | |
Collapse
|
35
|
Dixon S, Nunns M, House C, Rice H, Stiles V. Ankle joint kinematics influence risk of third metatarsal stress fracture in military recruits. FOOTWEAR SCIENCE 2013. [DOI: 10.1080/19424280.2013.799595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
36
|
The TiltMeter app is a novel and accurate measurement tool for the weight bearing lunge test. J Sci Med Sport 2013; 16:392-5. [PMID: 23491138 DOI: 10.1016/j.jsams.2013.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/20/2013] [Accepted: 02/10/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The weight bearing lunge test is increasing being used by health care clinicians who treat lower limb and foot pathology. This measure is commonly established accurately and reliably with the use of expensive equipment. This study aims to compare the digital inclinometer with a free app, TiltMeter on an Apple iPhone. DESIGN This was an intra-rater and inter-rater reliability study. Two raters (novice and experienced) conducted the measurements in both a bent knee and straight leg position to determine the intra-rater and inter-rater reliability. Concurrent validity was also established. METHODS Allied health practitioners were recruited as participants from the workplace. A preconditioning stretch was conducted and the ankle range of motion was established with the weight bearing lunge test position with firstly the leg straight and secondly with the knee bent. The measurement device and each participant were randomised during measurement. RESULTS The intra-rater reliability and inter-rater reliability for the devices and in both positions were all over ICC 0.8 except for one intra-rater measure (Digital inclinometer, novice, ICC 0.65). The inter-rater reliability between the digital inclinometer and the tilmeter was near perfect, ICC 0.96 (CI: 0.898-0.983); Concurrent validity ICC between the two devices was 0.83 (CI: -0.740 to 0.445). CONCLUSIONS The use of the Tiltmeter app on the iPhone is a reliable and inexpensive tool to measure the available ankle range of motion. Health practitioners should use caution in applying these findings to other smart phone equipment if surface areas are not comparable.
Collapse
|
37
|
Whitting J, Steele J, McGhee D, Munro B. Passive dorsiflexion stiffness is poorly correlated with passive dorsiflexion range of motion. J Sci Med Sport 2013; 16:157-61. [DOI: 10.1016/j.jsams.2012.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 11/24/2022]
|
38
|
Williams CM, Michalitsis J, Murphy A, Rawicki B, Haines TP. Do external stimuli impact the gait of children with idiopathic toe walking? A study protocol for a within-subject randomised control trial. BMJ Open 2013; 3:e002389. [PMID: 23454667 PMCID: PMC3612749 DOI: 10.1136/bmjopen-2012-002389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/01/2013] [Accepted: 02/07/2013] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Frequently, toe walking gait is the result of disease processes, trauma or neurogenic influences. Idiopathic toe walking (ITW) is, by definition, the diagnosis of a toe walking gait adopted in the absence of one of these medical conditions. Long-term ITW has been associated with reduced ankle range of motion. Reported treatments have included serial casting, Botulinum toxin type A or surgery to improve the ankle range of motion. Investigating the impact of simple and non-invasive treatment options for ITW is important for future research and clinical outcomes. This study investigates the immediate impact of footwear, footwear with orthotics and whole body vibration on ITW to determine if any one intervention improves heel contact and spatial-temporal gait measures. This determination is important for future clinical trials into treatment effectiveness. METHODS AND ANALYSIS DESIGN this protocol describes a within-subject randomised controlled trial that measures changes in gait following changes in external stimuli. PARTICIPANTS 15 children diagnosed with an ITW gait will be recruited from the Victorian Paediatric Rehabilitation Service at Monash Children's Hospital Toe Walking Clinic provided they have ITW and meet the inclusion criteria. PROCEDURE participants will have their gait recorded walking barefoot, in usual footwear, a custom-made, full-length carbon fibre orthotic in usual footwear and following whole body vibration. Outcome measures will include the presence of bilateral heel contact preintervention and postintervention, stride length (cm), stride width (cm), left and right stride time (s), left and right stance and swing percentage of the gait cycle, gait velocity (m/s), left and right foot toe in/toe out angle (°) and weight-bearing lunge pre and post each condition. ETHICS AND DISSEMINATION The results of this study will be published at the conclusion and have been approved by Southern Health HREC:12102B. CLINICAL TRIAL REGISTRY NUMBER ACTRN12612000975897.
Collapse
Affiliation(s)
- Cylie M Williams
- Allied Health Clinical Research Unit, Southern Health, Cheltenham, Victoria, Australia
- Department of Physiotherapy, Monash University, Frankston, Australia
| | - Joanne Michalitsis
- Victorian Paediatric Rehabilitation Service, Monash Medical Centre, Clayton, Victoria, Australia
| | - Anna Murphy
- Clinical Gait Analysis Service, Kingston Centre, Cheltenham, Victoria, Australia
| | - Barry Rawicki
- Victorian Paediatric Rehabilitation Service, Monash Medical Centre, Clayton, Victoria, Australia
| | - Terry P Haines
- Allied Health Clinical Research Unit, Southern Health, Cheltenham, Victoria, Australia
- Department of Physiotherapy, Monash University, Frankston, Australia
| |
Collapse
|
39
|
Fourchet F, Materne O, Horobeanu C, Hudacek T, Buchheit M. Reliability of a novel procedure to monitor the flexibility of lower limb muscle groups in highly-trained adolescent athletes. Phys Ther Sport 2013; 14:28-34. [DOI: 10.1016/j.ptsp.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/09/2012] [Accepted: 02/14/2012] [Indexed: 11/25/2022]
|
40
|
Abstract
STUDY DESIGN Case report. BACKGROUND Symptomatic accessory navicular can be a source of pain and disability. The treatment considerations for accessory navicular in dancers may differ due to increased demands on the foot, the repetitive nature of the movements, and the specific footwear required. The purpose of this report is to describe the management (1 conservative and 1 postoperative) of 2 adolescent dancers with symptomatic accessory navicular. CASE DESCRIPTIONS Case 1 was an 11-year-old female who underwent surgical excision of a symptomatic accessory navicular. Case 2 was a 15-year-old female who, following a traumatic injury that caused pain judged to be related to her accessory navicular, was managed nonsurgically. Treatment included pain management, range-of-motion exercises, trunk and lower extremity strengthening, balance and proprioception training, orthoses, crosstraining, and a guided return-to-dance progression. OUTCOMES Both patients had improved pain, dance technique, strength, and patient-reported outcome scores that allowed a full return to dance. DISCUSSION The 2 dancers presented here had foot pain believed to be related to a symptomatic accessory navicular. In both cases, treatment targeted specific impairments to improve function and disability. The guided progression of activities was intended to facilitate a return to dance that protected healing tissues and prevented a recurrence of symptoms. Clinicians should be aware of the effect of a symptomatic accessory navicular in the young dancer and potentially effective nonsurgical treatment options for this condition.
Collapse
|
41
|
Evans AM, Rome K, Peet L. The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study. J Foot Ankle Res 2012; 5:1. [PMID: 22230105 PMCID: PMC3283490 DOI: 10.1186/1757-1146-5-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 01/09/2012] [Indexed: 11/22/2022] Open
Abstract
Background Outcome measures are important when evaluating treatments and physiological progress in paediatric populations. Reliable, relevant measures of foot posture are important for such assessments to be accurate over time. The aim of the study was to assess the intra- and inter-rater reliability of common outcome measures for paediatric foot conditions. Methods A repeated measures, same-subject design assessed the intra- and inter-rater reliability of measures of foot posture, joint hypermobility and ankle range: the Foot Posture Index (FPI-6), the ankle lunge test, the Beighton scale and the lower limb assessment scale (LLAS), used by two examiners in 30 healthy children (aged 7 to 15 years). The Oxford Ankle Foot Questionnaire (OxAFQ-C) was completed by participants and a parent, to assess the extent of foot and ankle problems. Results The OxAFQ-C demonstrated a mean (SD) score of 6 (6) in adults and 7(5) for children, showing good agreement between parents and children, and which indicates mid-range (transient) disability. Intra-rater reliability was good for the FPI-6 (ICC = 0.93 - 0.94), ankle lunge test (ICC = 0.85-0.95), Beighton scale (ICC = 0.96-0.98) and LLAS (ICC = 0.90-0.98). Inter-rater reliability was largely good for each of the: FPI-6 (ICC = 0.79), ankle lunge test (ICC = 0.83), Beighton scale (ICC = 0.73) and LLAS (ICC = 0.78). Conclusion The four measures investigated demonstrated adequate intra-rater and inter-rater reliability in this paediatric sample, which further justifies their use in clinical practice.
Collapse
Affiliation(s)
- Angela M Evans
- Podiatry, AUT University, Akoranga Drive, Auckland, New Zealand.
| | | | | |
Collapse
|
42
|
Dunleavy K. Outcomes of hip resurfacing in a professional dancer: a case report. Physiother Theory Pract 2011; 28:142-60. [PMID: 21801098 DOI: 10.3109/09593985.2011.574784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new surgical option (hip resurfacing arthroplasty) is now available for younger patients with hip osteoarthritis. A more aggressive rehabilitation program than the typical total hip arthroplasty protocol is needed for active individuals. This case report describes interventions used to maximize function in a 46-year-old professional dancer after hip resurfacing with a progressive therapeutic exercise program. Exercise choices were selected to address dance-specific requirements while respecting healing of the posterior capsular incision. Strengthening focused on hip abduction, extension, and external rotation. Precautions included avoiding gluteal stretching until 6 months. Pelvic alignment and weight-bearing distribution were emphasized. The patient was able to return to rehearsal by 7 months, at which time strength was equivalent to the unaffected leg. Range of motion reached unaffected side values at week 8 for internal rotation, week 11 for extension, week 13 for adduction, and week 28 for flexion. External rotation and abduction were still limited at 1 year, which influenced pelvic alignment with resultant pain on the unaffected side. Functional and impairment outcomes are presented with timelines to provide a basis for postoperative benchmarks for active clients after hip resurfacing. Although this case report presents a dance-specific program, exercise progressions for other active individuals may benefit from similar exercise intensity and sports-specific focus. Future rehabilitation programs should take into account possible flexion and external rotation range limitations and the need for gluteal muscle strengthening along with symmetry and pelvic alignment correction. Long-term studies investigating intensity of rehabilitation are warranted for patients intending to participate in higher level athletic activity.
Collapse
Affiliation(s)
- Kim Dunleavy
- Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Physical Therapy Program, Detroit, Michigan 48201, USA.
| |
Collapse
|
43
|
Rein S, Fabian T, Zwipp H, Rammelt S, Weindel S. Postural control and functional ankle stability in professional and amateur dancers. Clin Neurophysiol 2011; 122:1602-10. [DOI: 10.1016/j.clinph.2011.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/06/2011] [Accepted: 01/08/2011] [Indexed: 11/27/2022]
|
44
|
Dixon S, Nunns M, House C, Fallowfield J. Does limited ankle dorsi-flexion increase forefoot loading during running in military recruits? FOOTWEAR SCIENCE 2011. [DOI: 10.1080/19424280.2011.575391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Carol House
- b Institute of Naval Medicine , Gosport , UK
| | | |
Collapse
|
45
|
Russell JA, Kruse DW, Nevill AM, Koutedakis Y, Wyon MA. Measurement of the extreme ankle range of motion required by female ballet dancers. Foot Ankle Spec 2010; 3:324-30. [PMID: 20581228 DOI: 10.1177/1938640010374981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Female ballet dancers require extreme ankle motion, especially plantar flexion, but research about measuring such motion is lacking. The purposes of this study were to determine in a sample of ballet dancers whether non-weight-bearing ankle range of motion is significantly different from the weight-bearing equivalent and whether inclinometric plantar flexion measurement is a suitable substitute for standard plantar flexion goniometry. Fifteen female ballet dancers (5 university, 5 vocational, and 5 professional dancers; age 21 ± 3.0 years) volunteered. Subjects received 5 assessments on 1 ankle: non-weight-bearing goniometry dorsiflexion (NDF) and plantar flexion (NPF), weight-bearing goniometry in the ballet positions demi-plié (WDF) and en pointe (WPF), and non-weight-bearing plantar flexion inclinometry (IPF). Mean NDF was significantly lower than WDF (17° ± 1.3° vs 30° ± 1.8°, P < .001). NPF (77° ± 2.5°) was significantly lower than both WPF (83° ± 2.2°, P = .01) and IPF (89° ± 1.6°, P < .001), and WPF was significantly lower than IPF (P = .013). Dorsiflexion tended to decrease and plantar flexion tended to increase with increasing ballet proficiency. The authors conclude that assessment of extreme ankle motion in female ballet dancers is challenging, and goniometry and inclinometry appear to measure plantar flexion differently.
Collapse
Affiliation(s)
- Jeffrey A Russell
- Department of Dance, University of California, Irvine, CA 92697-2775 , USA.
| | | | | | | | | |
Collapse
|
46
|
Williams CM, Tinley P, Curtin M. The Toe Walking Tool: a novel method for assessing idiopathic toe walking children. Gait Posture 2010; 32:508-11. [PMID: 20692159 DOI: 10.1016/j.gaitpost.2010.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 07/10/2010] [Accepted: 07/13/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND The diagnosis of idiopathic toe walking (ITW) is achieved by the exclusion of all medical causes associated with toe walking. In order to identify children with this gait type, an online Toe Walking Tool questionnaire was developed that utilized questions to identify healthy idiopathic toe walkers and excluded those who toe walk as a result of a medical condition. METHOD A Delphi panel process was conducted to establish the relevance and validity of the questions. A group of 10 allied health professionals assessed 12 children utilizing the Toe Walking Tool. A kappa was calculated to determine reliability. RESULTS Clinicians agreed the questionnaire was an appropriate and effective assessment tool. The tool proved valid in that no child tested who toe walked as a result of a medical condition was able to progress through the testing process. Testing group of practitioners had a Fleiss Kappa agreement of 0.928. CONCLUSION The Toe Walking Tool is a valid and reliable method of assessing children who present to the general allied health clinician with toe walking. This tool can assist with the decision of when to refer a child for further specialist investigation of their toe walking.
Collapse
Affiliation(s)
- Cylie M Williams
- Southern Health, Cardinia Casey Community Health Service, 140-155 Sladen St., Locked Bag 2500, Cranbourne, VIC 3977, Australia.
| | | | | |
Collapse
|
47
|
Burns J, Scheinberg A, Ryan MM, Rose KJ, Ouvrier RA. Randomized trial of botulinum toxin to prevent pes cavus progression in pediatric Charcot-Marie-Tooth disease type 1A. Muscle Nerve 2010; 42:262-7. [PMID: 20544937 DOI: 10.1002/mus.21685] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pes cavus in Charcot-Marie-Tooth disease type 1A (CMT1A) is thought to be due to muscle imbalance of the lower leg. Botulinum toxin type A (BoNT-A) can modify foot deformity in other conditions of muscle imbalance. We tested the safety and effectiveness of BoNT-A on pes cavus progression in pediatric CMT1A. A 24-month, randomized, single-blind trial of BoNT-A was undertaken in 10 affected children (20 legs), aged 3-14 years. The treated leg received intramuscular BoNT-A injections at 6-month intervals in the tibialis posterior and peroneus longus. The control leg received no injections. Primary outcome was radiographic alignment at 24 months. Secondary outcomes were foot posture, ankle flexibility, and strength, assessed every 6 months. Radiographically, BoNT-A produced a small non-significant reduction in cavus progression. There was no effect of BoNT-A on secondary outcomes. There were no serious adverse events. At 24 months, the intramuscular BoNT-A injections proved safe and well-tolerated but did not affect the progression of pes cavus in CMT1A.
Collapse
Affiliation(s)
- Joshua Burns
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
48
|
Rose KJ, Raymond J, Refshauge K, North KN, Burns J. Serial night casting increases ankle dorsiflexion range in children and young adults with Charcot-Marie-Tooth disease: a randomised trial. J Physiother 2010; 56:113-9. [PMID: 20482478 DOI: 10.1016/s1836-9553(10)70041-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
QUESTION Does 4 weeks of serial night casting followed by 4 weeks of stretching of the gastrocnemius and soleus improve ankle dorsiflexion range and other outcomes compared with no intervention in children and young adults with Charcot-Marie-Tooth disease? DESIGN Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS 30 children and young adults with Charcot-Marie-Tooth disease and restricted ankle dorsiflexion range. INTERVENTION The experimental group received 4 weeks of serial night casting followed by 4 weeks of weightbearing stretches. The control group received no intervention. OUTCOME MEASURES Primary outcome was ankle dorsiflexion range; secondary outcomes included foot deformity, mobility, balance, falls, and self-reported activity limitations. Outcomes were measured at baseline, 4, and 8 weeks. RESULTS By 4 weeks, serial night casting had increased ankle dorsiflexion range by a mean of 4 deg (95% CI 2 to 6) more in the experimental group than the control group. After a further 4 weeks of weightbearing stretches, the experimental group still had a mean of 3 deg (95% CI 0 to 5) more ankle dorsiflexion range than the control group. Other than reduced time to walk 10 metres at self-selected pace favouring night casting at 4 weeks, outcomes did not differ between groups at any time point. Two minor adverse events were reported in the experimental group. CONCLUSION 4 weeks of serial night casting increased ankle dorsiflexion range compared with no intervention, but at 8 weeks there was no significant difference between groups.
Collapse
Affiliation(s)
- Kristy J Rose
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia.
| | | | | | | | | |
Collapse
|
49
|
Rose KJ, Burns J, North KN. Factors associated with foot and ankle strength in healthy preschool-age children and age-matched cases of Charcot-Marie-Tooth disease type 1A. J Child Neurol 2010; 25:463-8. [PMID: 19671887 DOI: 10.1177/0883073809340698] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Charcot-Marie-Tooth disease affects foot and ankle strength from the earliest stages of the disease; however, little is known about factors influencing normal strength development or the pathogenesis of foot weakness and deformity in Charcot-Marie-Tooth disease. The authors investigated factors associated with foot and ankle strength in healthy preschool-age children and compared to age-matched cases of Charcot-Marie-Tooth disease type 1A. In healthy children, ankle dorsiflexion range of motion was one of the strongest independent correlates of foot and ankle strength. Compared with healthy children, those with Charcot-Marie-Tooth disease type 1A had significantly less dorsiflexion strength and range as well as imbalance in inversion-to-eversion and plantarflexion-to-dorsiflexion strength ratios. Given the association between ankle dorsiflexion strength and range in the healthy children, and the abnormality of these parameters in Charcot-Marie-Tooth disease, investigation of the cause-effect relationship is warranted to identify more targeted therapy and further understand the pathogenesis of foot deformity in Charcot-Marie-Tooth disease.
Collapse
Affiliation(s)
- Kristy J Rose
- Discipline of Paediatrics & Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
| | | | | |
Collapse
|
50
|
Burns J, Ryan MM, Ouvrier RA. Evolution of foot and ankle manifestations in children with CMT1A. Muscle Nerve 2009; 39:158-66. [PMID: 19145658 DOI: 10.1002/mus.21140] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the timing and progression of foot and ankle changes in 81 children with genetically confirmed Charcot-Marie-Tooth disease type 1A (CMT1A) and determined their impact on motor function and walking ability. Foot deformity, weakness, pain, cramps, and instability were a common feature of CMT1A. Foot structure evolved toward pes cavus from early childhood to adolescence, although a subgroup with normal and planus feet remained. Foot strength increased with age, although compared to age-equivalent norms it declined from 4 years. Factors associated with evolving foot deformity included muscle weakness/imbalance, restricted ankle flexibility, and joint hypermobility. Regression modeling identified dorsiflexion weakness, global foot weakness, and difficulty toe-walking as independent predictors of motor dysfunction, while pes cavus and difficulty heel-walking were predictors of poor walking ability. Foot problems are present from the earliest stages of the disease and can have a negative impact on function. Early foot and ankle intervention may prevent long-term disability and morbidity in CMT1A.
Collapse
Affiliation(s)
- Joshua Burns
- Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney/Institute for Neuromuscular Research, Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145 Australia.
| | | | | |
Collapse
|