Postural Control Strategies and Balance-Related Factors in Individuals with Traumatic Transtibial Amputations

Mechanisms behind compromised balance control in people with transtibial amputation need to be further explored, as currently little is known specifically about postural control strategies in people with traumatic transtibial amputation (tTTA). The aim of this study is to assess automatic and voluntary postural control strategies in individuals with unilateral tTTA compared to those in control subjects and to define the effect of balance-related factors on these strategies. Automatic posture reactions and volitional motion toward given direction using standardized posturographic protocols (NeuroCom) of the Motor Control Test (MCT) and Limits of Stability (LOS) were assessed in eighteen participants with tTTA and eighteen age-matched controls. Compared to the controls, the participants with tTTA bore less weight on the prosthetic leg (p < 0.001) during the MCT and had reduced inclination toward the prosthetic leg (p < 0.001) within the LOS. In the tTTA group, the weight-bearing symmetry and the inclination toward the prosthetic leg (p < 0.05) was positively correlated with prosthesis use duration (p < 0.05). The current study indicates that decreased utilization of the prosthetic leg in tTTAs represents adaptive postural control strategy, but as prosthesis use duration increased, the engagement of the prosthetic leg improved.

The effect of physiotherapy intervention on the load of the foot and low back pain in pregnancy

OBJECTIVE

Pregnant women are at elevated risk for functional and structural changes in the movement system. Common problems are loss of foot arch height and low back pain which can have strong influence on the decrease in quality of life.

AIMS

The aim of the study was to assess effect of physiotherapy intervention for preventing and treating changes in foot structure as well as low back pain during pregnancy.

DESIGN

Parallel intervention study.

SETTING

Department of Midwifery, Faculty of Health Sciences, Palacký University Olomouc.

METHODS

Twelve healthy pregnant women were randomly divided into the experimental and control groups. The women in the experimental group performed daily exercises aimed at the foot arch. The McGill Pain Questionnaire and the Pregnancy Mobility Index were used to measure level of pain and its impact on quality of life. The Foot Posture Index, Navicular Drop test, Chippaux-&#352;mirák index, and a podoscope were used to evaluate load and anthropometry of the foot. The data were collected at the turn of the first and second trimester and in the third trimester of pregnancy.

RESULTS

Statistically significant differences between the baseline and post-intervention were found only in the control group. Pain score obtained from the visual analogue scale as well as the Pregnancy Mobility Index score increased significantly (p = 0.04, p = 0.03 resp.). The Foot Posture Index results increased significantly on both the right (p = 0.04) and left (p = 0.04) lower limb. Chippaux-&#352;mirák index significantly increased on the right lower limb (p = 0.03).

CONCLUSIONS

The intervention prevented or reduced the changes in the foot structure and low back pain. This intervention can be recommended in primary or secondary prevention to increase quality of life in pregnant women.

Electrical stimulation of hyoid muscles in post-stroke dysphagia

AIMS

The purpose of this study was to evaluate swallowing changes in post-stroke patients with dysphagia after four weeks of suprahyoid muscles electrical stimulation.

METHODS

This was a prospective randomized study of early stage stroke patients with dysphagia. Electrical stimulation of suprahyoid muscles was given to a group of 54 patients (26 men, average age 70 years) for 20 minutes a day, 5 days a week. Standard orofacial rehabilitation without electrical stimulation was carried out on a control group of 54 patients (31 men, average age 69 years). Swallowing was evaluated at the beginning of the study and at the end, by videofluoroscopy - measuring the time for oral and pharyngeal phases.

RESULTS

The difference in duration of oral transit time (OTT) after the therapy between the study group (average: 0.55 ± 0.01) and the control group (average: 0.29 ± 0.03) was statistically significant (P=0.01). Difference in duration of the pharyngeal transit time (PTT) after the therapy between the study group (average: 0.37 ± 0.02) and control group (average: 0.15 ± 0.02) was also statistically significant (P=0.009).

CONCLUSION

Electrical stimulation of suprahyoid muscles significantly reduced the duration of the oral and pharyngeal phases: in the post-stroke patients with dysphagia used in this study. The result is improved swallowing. This is a recently recommended approach and your study confirms its efficacy.

Evaluation of Explosive Power Performance in Ski Jumpers and Nordic Combined Competitive Athletes: A 19-Year Study

Between 1992 and 2010, a total of 334 males participated in this study that assessed the differences and relationships between anthropometric variables and lower limb muscle strength in young and adult ski jumpers (n = 207) and Nordic combined (NC, n = 127) athletes. All athletes completed a maximal vertical jump from an in-run position and a maximal relative isometric force (MRIF) of the knee extensor measurement in a laboratory setting. The body mass index (BMI) in young competitors was lower than in adult groups (NC: p < 0.001; ski jumping [SJ]: p < 0.001). Similarly, the MRIF in both limbs was lower for both disciplines in the groups of young competitors. The vertical jump height (VJH) was lower for young competitors than for adults (NC: p ≤ 0.05; SJ: p < 0.001). When comparing SJ and NC athletes, BMI was lower in SJ athletes. In addition, the adult SJ competitors exhibited greater values of bilateral MRIF (p ≤ 0.05) and VJH (p < 0.01). There was a strong positive correlation in MRIF between the left and right lower limbs (p < 0.001) for all groups of SJ and NC athletes; therefore, it was determined to be sufficient to measure the MRIF on a single limb. Application of the new training methods (e.g., less emphasis on maximum resistance exercises) resulted in improved explosive power in ski jumpers even at lower-body weights. These changes are in accordance with the change in ski jump techniques.

Central facial paresis and its impact on mimicry, psyche and quality of life in patients after stroke

AIM

Using functional scales and face video analysis, changes in central facial paresis are monitored in patients with stroke after orofacial therapy and correlations between changes in mimicry, mental function and overall quality of life of patients after stroke are made.

MATERIALS AND METHODS

A prospective randomized study of patients after stroke with facial paresis. The functional status of the experimental group of 50 cases with orofacial regulation therapy and 49 control cases without mimicry therapy is observed after four weeks of rehabilitation.

RESULTS

Changes in mimicry functions evaluated by the House-Brackmann Grading System (HBGS) clinical range and using 2D video analysis of the distance between the paretic corner of the mouth and earlobe at rest and during smiling were statistically better in the experimental group than in controls. Changes in mental function - depression using Beck Depression Inventory and changes in the quality of life using Bartle index and modified Rankin score (scale) were significantly greater in the experimental group. There was a very close relationship between the changes in mimicry, mental state and overall quality of life according to the Spearman correlative coefficient.

CONCLUSION

Orofacial rehabilitation therapy for patients with paresis after stroke has a significant influence on the adjustment of mimicry, mental functions and overall quality of life after 4 weeks of treatment.

Variability of kinetic variables during gait in unilateral transtibial amputees

BACKGROUND

Prosthetic gait increases demands on stability. Some variability measures can be used to investigate the stability of movement for prosthetic feet.

OBJECTIVES

The purpose of this study was to determine the influence of the prosthetic foot on ground reaction force variability for transtibial amputee gait.

STUDY DESIGN

Comparative analysis.

METHODS

Eleven male unilateral transtibial amputees participated in this study. Each subject walked at self-selected speed with both conventional (SACH) and energy storing (Sureflex) feet. Time and ground reaction force variables and their coefficients of variation were calculated for each foot type and limb.

RESULTS

Mediolateral force variables had high variability for all conditions. The Sureflex had a larger variability than the SACH foot for the braking peak (p < 0.05), which may have been caused by gait instability after the heel strike. There were significant differences between intact and prosthetic limbs in total loading (force impulses) with the SACH foot (p < 0.05).

CONCLUSIONS

The prosthetic foot and alignment issues related to the foot influence GRF variability. During the braking phase the SACH foot is characterized by higher variability in mediolateral direction and Sureflex by higher variability in anterior-posterior direction.

CLINICAL RELEVANCE

Differences in variability in ground reaction force variables can represent a person's stability. Observing variability can contribute to better understanding of critical events in gait cycle with the use of various prosthetic feet.

Facial paresis after stroke and its impact on patients' facial movement and mental status

OBJECTIVE

The aims of this study were: (i) to monitor changes in central facial paresis in patients with stroke after orofacial therapy, using functional scales and video analysis of the face; and (ii) to investigate correlations between changes in facial movement and mental function of patients after stroke.

METHODS

A prospective blind randomized study of patients after stroke with facial paresis. The functional status of the experimental group of 50 cases treated with regulation orofacial therapy was compared with 49 control cases after 4 weeks of rehabilitation.

RESULTS

There were changes in facial movement, evaluated with the House-Brackmann Grading System (HBDS), clinical range and two-dimensional video analysis of the distance between the paretic corner of the mouth and earlobe at rest and during smiling, were measured. Facial movement was found to be significantly better in the experimental group after orofacial therapy compared with the control group. Changes in mental status (depression observed using the Beck Depression Inventory (BDI-II) were significantly greater in the experimental group. There was a close correlation between the changes in facial movement and mental status according to Spearman's correlation coefficient.

CONCLUSION

Orofacial therapy has a significant effect after 4 weeks of treatment on facial movement and mental state in patients with stroke. Based on the results in our study we can say that the improvements are a significantly better in the experimental group (Difference value) in the parameters HBGS, distance between the corner of the mouth and earlobe and BDI-II.

The choice of on- or off-pump coronary bypass grafting--a surgeon's dilemma

BACKGROUND

Off-pump coronary bypass grafting (OPCAB) is a routine method of heart revascularization. This study was designed to compare the results of OPCAB and ONCAB performed by a single surgeon at our institution over a 3-year period.

METHODS

The study enrolled 345 patients undergoing elective myocardial revascularization procedures, of which 173 (50.1%) were OPCAB and 172 (49.9 %) were ONCAB. The postoperative outcomes of both groups were analyzed, retrospectively.

RESULTS

The mean number of grafts was significantly lower in the OPCAB group (2.9) than in the ONCAB group (3.7). There were no postoperative myocardial infarctions or hospital deaths in any of the patients. The postoperative total blood loss was significantly higher in the ONCAB group. The frequencies of postoperative confused states, strokes, postoperative transfusions, reoperations for bleeding, and atrial fibrillation, and the durations of intubation, ICU stay, and hospital stay did not differ significantly between the two groups.

CONCLUSIONS

The OPCAB procedures are safe and provide good clinical outcomes, similar to those of ONCAB operations. The outcomes of this study favor neither of the compared techniques.