The effect of hand fine motor skills on peritoneal dialysis-related peritonitis

INTRODUCTION

We aimed to evaluate the relationship between the hand fine motor skills of peritoneal dialysis (PD) practitioners and PD-related peritonitis.

METHODS

This multicenter prospective observational study was conducted with 120 incident PD patients. Patients were divided into two groups who had PD-related peritonitis within the first year as Group 1, and those who did not as Group 2. Hand fine motor skills were evaluated by Nine-Hole Peg Test (NHPT) and Nut Screwing Test (NST).

RESULTS

Initial NHPT (28.5 ± 6.0 s vs. 25.8 ± 5.0 s, p = 0.011) and NST (82.3 (61.5-102.8) s versus 65.3 (52.3-88.5) s p = 0.023) scores were significantly higher in Group 1 than Group 2. In multivariate logistic regression analysis, NHPT, Body Mass Index, Mini-Mental Test, self PD practitioner, and catheter complications were found to be independent variables in predicting PD-related peritonitis.

CONCLUSION

Decreased hand fine motor skills of PD patients is a risk factor for peritonitis.

Assessment of Five-Foot Plantar Morphological Pressure Points of Children with Cerebral Palsy Using or Not Dynamic Ankle Foot Orthosis

People with spastic cerebral palsy (CP) often experience a decline in gait function and flexion. The children's posture and hip strategy, which leads to knee flexion, predisposes these children to increased contact area in the medial foot region. This study investigated the use of DAFO (dynamic ankle-foot orthosis) prescribed to patients with cerebral palsy (CP) to determine the plantar pressure distribution with orthosis use. Eight children with spastic CP (age 4-12 years) were classified as Gross Motor Function Classification System (GMFCS) levels I-II with a maximum spasticity level of 3 in their ankle muscles according to the Modified Ashworth Scale. We assessed the plantar distribution by using eight WalkinSense sensors in each trial and exported data from the proprietary software (WalkinSense version 0.96, Tomorrow Options Microelectronics, S.A.). The plantar pressure distribution was conducted under two conditions: only shoes and DAFO with shoes. The activation percentages for sensor number 1 under the 1st metatarsal and sensor number 4 under the lateral edge of the heel were significantly different under the DAFO condition. The 1-point sensor activation percentage significantly decreased, while the 4-point sensor activation percentage increased during DAFO walking. According to our study findings, there was an increase in pressure distribution in the lateral part of the foot during the stance phase in DAFO. DAFO improved the gait cycle and influenced the plantar foot pressure in children with mild cerebral palsy.

The effect of orthotics on plantar pressure in children with infantile tibia vara (Blount's disease)

Albeit some studies have revealed the effectiveness of the orthosis use in infantile tibia vara (ITV), hitherto no study has shown the effects of these orthosis on plantar pressures. This study aims to reveals the effects of orthosis on plantar pressure in infantile tibia vara. Fourteen children (mean age: 27.14 ± 5.00 months) with infantile tibia vara made up the study group and 14 healthy children (mean age: 26.42 ± 5.33 months) constituted the control group. The plantar pressure distribution was evaluated with WALKINSENSE. ITV group was evaluated before and after orthosis. The control group did not use orthosis and was evaluated once. After orthosis, it was determined that lateral foot pressure decreased, and medial foot pressure increased in the hindfoot. After orthosis, medial pressure decreased in the forefoot (p < 0.05). The pressure in the forefoot of the control group was significantly higher than that in the ITV group (before and after orthosis) (p < 0.05). After orthosis, the pressure was similar in the posterior and mid-foot sensors between the ITV group and the control group (p˃0.05). The orthosis can be effective in achieving the normalization of the soles pressure distribution in children with ITV.

Paediatric flat foot and foot dimension in Central Anatolia

Background

Information on the foot structures of Central Anatolian children is limited. Foot structures of children aged 6–10 years were shown to be different according to sex and increasing age.

Objective

This study aimed to compare the foot anthropometric values by age and sex and collect the foot anthropometric data to reveal the relationship between pes planus and pes cavus in the arches of children according to age.

Methods

Footprints of 335 children (180 boys and 155 girls) aged 6–10 years were taken by the pedigraph method and evaluated using 18 different parameters. The TFL (Truncated foot length), FL (foot length), Arch Index, Chippaux Smirak Index, Staheli Arc Index, and foot rotation values of the children were examined. To examine the relationship between the parameters, normality values were examined. Independent samples t-test was used to analyze sex differences in terms of foot size and shape.

Results

Correlations between other parameters were determined using the correlations analysis method. TFL, metatarsal circumference, and FL were strongly correlated with age in the children. Foot rotation increased with body mass index in the girls compared to that in the boys. According to the evaluation results with the classification made with the Staheli arch index, 63.3% pes planus, 9.8% pes cavus and 27.7% of the normal arch structure were identified.

Conclusions

Planning shoe production accordingly will contribute to the development of healthy feet in children. This article focused on foot structures of in Central Anatolia and to identify early foot deformities in children. This study found that the length of the TFL was smaller in boys than in girls.

Kinesiotaping Techniques to Alter Static Load in Patients With Foot Pronation

Objective

This study aimed to assess the effect of kinesio tape (KT) application on foot pronation using the laser postural alignment system.

Methods

Twenty participants (10 females and 10 males, mean age 19.7 ± 1.2 years) with foot pronation were included in the study. The laser line projected on the participant by the laser postural alignment system showed the joint load carrying line. The location of the joint load carrying line was assessed during barefoot static standing with one foot on the force plate before KT application, immediately after application, then 24 and 48 hours later. Displacement of the load-carrying line was measured using a ruler placed tangentially to the patella and ankle joint at the level of the joint line. Weight bearing on the barefoot was assessed before KT application, immediately after, then 24 and 48 hours later.

Results

Weight bearing was not significantly changed after KT application. The load-carrying line measured using KT did not notably move with KT versus without KT in the ankle joint. Immediately after KT application, significant lateral knee joint movement was measured, but this change was not importantly 24 and 48 hours later.

Conclusion

KT was not altered in changing weight bearing or moving the lower extremity load-carrying line in people with foot pronation. KT of the foot can amplify sensory input and improve perceived comfort; therefore, it can be used with an orthotic insole in footwear.

Improved Gait Parameters After Orthotic Treatment in Children with Infantile Tibia Vara

The aim of this study was to investigate the modification of gait kinematics before and after orthotic treatment in patients with ITV. Vicon instrumented gait analysis was performed on three patients with ITV, pre and post treatment. Orthoses were applied a total of eighteen participants with ITV who were 25-38 months. 34 extremities were treated and radiographic evidence evaluated before and after orthotic treatment. Treatment duration for orthotic treatment ranged between 11 and 41 (25.9 ± 10.0) months. Only three patients were evaluated in gait analysis due to application difficulties. Three patients kinematic and kinetic instrumented gait analysis were found flatfoot, varus and internal rotation of the foot, hip flexion and external rotation. Study were reported an improvement in gait kinematics after orthotic treatment, in patients with ITV.

The effects of domestic mechanical knee joints on pelvic motion in transfemoral amputees

PURPOSE

Pelvic asymmetry in the sagittal and horizontal planes among prosthesis users is related to the strength of the abdominal and back muscles. Considering that lumbosacral pathologies and pain in long-term transfemoral prosthesis users can cause asymmetric pelvic motion, it is necessary to investigate pelvic asymmetry caused by prosthetic components. The aim was to compare the gait symmetry of the pelvis of active transfemoral amputees using different types of prosthetic knee joints (Non-microprocessor-controlled prostheses (NMCPs) and microprocessor-controlled prostheses (MCP) knees).

METHODS

The two patient groups comprised eight transfemoral amputees: four patients had NMCP joints (Turkish products), and four patients had MCP knees. The reference group consisted of ten normal volunteers. In this work, the 3-D motion of the pelvis, hip, knee and ankle was assessed using the VICON system.

RESULTS

The results revealed that during stance, the kinematics of pelvic movement in the amputee group differed from those of the control group in terms of the total excursion anterior pelvic tilt (APT) and maximum and minimum degrees of APT (p < .05). We evaluated the graphics of the NMCP and MCP knee joints and found that the prosthesis-side APT was closer to that of the control group during the stance phase among the NMCP users, while the APT of the MCP users was closer to that of the control group during the swing phase.

CONCLUSION

The investigated MCP benefitted the patients considerably. The NMCP did not provide as much walking as the MCP but produced less APT.Implications for RehabilitationThe MCP may not provide symmetrical pelvic motion during all phases of the gait cycle. In transfemoral amputees using MCP, focusing on pelvis in walking training will contribute to pre-prosthetic and post-prosthetics rehabilitation.The NMCP knee joint may be closer in terms of APT.

Effect of two different kinesio taping techniques on knee kinematics and kinetics in young females

[Purpose] The application of kinesio taping may improve strength and performance, inhibit and facilitate motor activity, and increase range of motion. The aim of this study was to compare the effects of kinesio taping facilitation and inhibition applications on spatiotemporal knee kinematics and kinetics during walking activity in healthy subjects. [Subjects and Methods] A three-dimensional quantitative gait evaluation was performed without tape and with, facilitation and inhibition kinesio taping application on the knee. Sixteen healthy female college students (age, 19.7 ± 0.4 years; height, 1.64 ± 3.4 cm; body mass, 51.5 ± 4.8 kg) participated in the study. [Results] Spatiotemporal parameters (cadence, walking speed, stride length) were significantly different among the trials. Knee joint sagittal plane range of motion was not different with either kinesio taping application. Knee external flexion moment during the early stance phase decreased significantly with facilitation kinesio taping and increased with the inhibition kinesio taping. Knee external extension moment during the mid-stance phase increased with facilitation kinesio taping. Knee power parameters, eccentric activity in the rectus femoris during the pre-swing phase was significantly increased with inhibition kinesio taping application, while eccentric activity of the hamstrings during the terminal swing of gait was decreased. [Conclusion] These findings showed that facilitation kinesio taping application affected the terminal stance phase and that inhibition kinesio taping influenced the terminal swing phase compared with the no tape condition.

Knee muscle strength in multiple sclerosis: relationship with gait characteristics

[Purpose] To investigate the relationship between isokinetic knee muscle strength and kinematic, kinetic and spatiotemporal gait parameters of patients with multiple sclerosis (MS). [Subjects and Methods] Twenty-nine MS patients (mean age 31.5±6.5) were investigated in this study. The isokinetic knee muscle strength and gait parameters of MS patients with moderate and severe disability, as determined by the expanded disability status scale (EDSS): EDSS=1–4.5 (n=22, moderate disability) and EDSS>4.5 (n=7, severe disability) were measured. [Results] Isokinetic knee muscle strength, kinematic, kinetic and spatiotemporal gait parameters differed between moderate (EDSS=1–4.5, n=22) and severe disability (EDSS>4.5, n=7). The correlation between each of gait speed, stride length, total range of knee joint movement and the four strength parameters (minimum and maximum quadriceps and hamstring muscle strengths) were significant for the MS group as a whole. Within subgroups, the correlation between minimum hamstring strength and total range of knee movement was significant only in group EDSS>4.5; minimum hamstring correlated with peak knee extensor moment in group EDSS=1–4.5, but at a reduced level of significance. [Conclusion] The present study revealed significant correlations between gait characteristics and isokinetic strength parameters of the quadriceps and hamstring muscles. Our study suggests that rehabilitation protocols for MS patients should include a critical strength training programme particularly for the hamstring and quadriceps muscles.

Orthotic variations in the management of infantile tibia vara and the results of treatment

BACKGROUND

Infantile tibia vara is an acquired form of tibial deformity associated with tibial varus and internal torsion. Several methods have been described for orthotics treatment. The purpose of this study was to determine the effectiveness of orthotics treatment in infantile tibia vara.

STUDY DESIGN

Controlled trial.

OBJECTIVE

The aim of this study was to compare the effect of different types of orthoses and correction methods on decreasing the curve in children with severe genu varum.

METHODS

Three different types of knee-ankle-foot orthoses were applied to 35 lower extremities of 22 pediatric participants who were 19-38 months of age. The same orthotic design principles were used to correct the femur, while different designs were applied to correct the tibia. The orthoses used on 20 participants were evaluated for differences among them and their effects on the treatment process. In addition, methods used in the treatment, problems encountered, production of different types of orthoses, convenience of application of the orthoses, and degree of patients satisfaction are discussed in this article.

RESULTS

The mean duration of treatment of the participants until completion of treatment was 25.3 ± 9.7 weeks with a minimum of 9 weeks and a maximum of 41 weeks. No statistically significant correlation was found between the duration of orthotic use in patients with a successful outcome and percentile height and percentile weight. When the duration of treatment using the different types of orthoses was analyzed, significant differences were found between Type 1 and Type 2, and Type 1 and Type 3 orthoses (p < 0.05), while no difference was observed between Type 2 and Type 3 orthoses (p > 0.05).

CONCLUSION

We found that bracing is an effective form of treatment for infantile tibia vara up to 38 months of age. We conclude that full-time use of knee-ankle-foot orthoses exerting corrective forces from five points along the full length of the limb was effective.

Effect of elastic bandaging and prosthesis on the decrease in stump volume

OBJECTIVES

The aim of this study was to compare the effect of elastic bandaging, pneumatic prosthesis, and temporary prosthesis on postoperative stump management.

METHODS

This study included 14 patients, between 15 and 70 years old, whose causes of amputation were tumor, diabetes, Burger's disease, osteomyelitis, and traffic accident. Fifteen stumps in 14 patients, one of whom was bilateral, were evaluated. The elastic bandaging was applied for five stumps, the pneumatic prosthesis for five stumps, and temporary prosthesis for five stumps.

RESULTS

A decrease in stump volume was observed for at least 2 or 3 weeks after the use of all three methods in patients who came to the Prosthetics and Orthotics Laboratory at Ankara University. The volume decrease induced by temporary prosthesis fitting was more significant than that achieved using elastic bandaging or pneumatic prosthetics (p<0.01). The greatest volume changes were identified distally for the elastic bandage group, proximally for the pneumatic group, and medially for the temporarily applied prosthesis group. The temporary prosthesis group took less time to permanent prosthesis (39 days) and required less prosthesis training (p<0.01). Three amputees in the elastic bandaging group had postoperative contractures.

CONCLUSION

Use of a temporary prosthesis results in ideal shaping of the stump in the shortest period of time. This approach also shortens the period of transition to permanent prosthesis, improves the quality of life of the amputee, and re-integrates the patient to normal life over a shorter period of time.

First ray reconstruction with distraction osteogenesis

Disarticulation of the thumb at the metacarpophalangeal joint level is not beneficial either aesthetically or functionally without additional surgery because it requires a bulky and an unacceptable prosthesis to be made for this amputation level. In this study, the authors have presented our experience of 12 metacarpal distractions in thumb amputated patients. Twelve male patients who had thumb amputation due to gunshot wounds were included in the study. Before the operation, aesthetic hand prostheses were made for 5 of the 12 patients. Callus distraction was performed with the use of a mini Ilizarov type external fixator in 7 cases and uniplanar dynamic mini external fixator in 5 cases too. External fixators were removed after the completion of the radiographic consolidation. Five patients whose prosthesis had been made before the operation wore their prosthesis for an average 6.8 months (5 - 14) due to poor appearance and poor construction. Union of the lengthened segment was observed in all cases. Average lengthening was 28.9 mm (range from 25 - 37). Average healing time was 2.1 months (range from 1.8 - 2.5). Average healing index was 0.73 month/cm (range from 0.65 - 0.88). Pin tract infection was seen in 7 cases (58.3%). Volar angulation developed after removing the external fixator in 1 case. Webplasty was performed in all cases. Patients were evaluated by means of Disability of the Arm, Shoulder and Hand (DASH) score and pick-up test. It was concluded that the metacarpus lengthening by callus distraction technique may be a functionally and cosmetically effective reconstruction method for traumatic thumb amputations. It is believed that the possibility for a functionally and aesthetically acceptable fabrication of a thumb prosthesis, by providing a suction suspension with distraction and/or webplasty procedures.

Splint satisfaction in the treatment of traumatic radial nerve injuries

Between the years 1986-2001, 135 patients who have had traumatic radial nerve injury, were supplied with dynamic wrist-hand orthoses (WHOs). The aim of this study is to examine the applied splints, considering aspects such as apperance, practicality of use, function, comfort and endurance. The author's assessments show that the biggest problem was due to the unaesthetic appearance of the finger extensor spring of the splints. For this reason, modification of these finger extensor outriggers has been attempted. Also, aspects of the splints such as the problems faced and regeneration of the nerve, have been considered and modifications made in order to eliminate any disfunction. This study reflects the reactions and satisfaction of 83 patients concerning the splints they have used. Conventional wire springs have been used in the splints of 71 patients, and 12 had modifications done on their outriggers. In terms of appearance, there were significant differences between modified outriggers and conventional outrigger (p < 0.05). Also, when the modified outriggers were compared in terms of appearance and durability, there was a statistically significant opinion in favour of them (p < 0.01).

No association between oxidative stress and IL-6 in NIDDM patients with nephropathy

Oxidative stress is hypothesized to play a role in the development of diabetes with and without nephropathy. In addition, it has been suggested that some metabolic abormalities associated with diabetes may be due to cytokine overproduction. In the light of this knowledge, we aimed to measure MDA levels as a marker of oxidative stress and the IL-6 level in diabetes with and without different stages of nephropathy. Plasma MDA levels in the group of NIDDM patients with advanced nephropathy were significantly higher than in the group of NIDDM patients without nephropathy, which had significantly higher levels compared with the control group. Although IL-6 levels were elevated in diabetic groups with and without nephropathy in comparison with the control, no significant difference was found between patient groups. As a conclusion, oxidative stress may play an important role in diabetes with and without nephropathy, but the IL-6 level may not be useful in the evaluation of diabetic nephropathy.

Three dimensional measurements of pelvic tilt in trans-tibial amputations: the effects of pelvic tilt on trunk muscles strength and characteristics of gait

The aim of this study was to determine the degree of pelvic tilt in the three dimensions, the trunk muscle strength and effects on gait in trans-tibial amputated patients. This study comprised of 22 unilateral trans-tibial amputated patients who were seen at the authors' Prosthetics and Orthotics Laboratory for the purpose of prosthetic provision. Measurements were made using plurimeter and caliper and gait observations were made by video camera. In the sagittal and horizontal planes respectively the pelvic tilt was measured to be 12 degrees and 5.73 degrees, and such measurements in relation to the trunk extensor and flexor muscles were shown to be statistically significant (p < 0.05). On the contrary, the same could not be said for frontal plane measurements. In addition, in 9 cases excessive knee flexion was noted during the stance phase having a direct influence on the pelvic tilt (p < 0.05).

Effect on knee disarticulation on bone growth in immature rabbits

This study was designed by the University of Ankara Experimental and Research Laboratory for animals in 1997. In the study an anteroposterior skin flap technique was used for 20 knee disarticulation amputations and also in 20 trans-femoral amputations on immature rabbits, in order to investigate their effects on the femoral epiphyseal growth plate. The femurs of the rabbits were observed radiographically for 8 weeks. It was observed that the femurs tended to grow at a slower rate compared to the normal contralateral femur. These studies showed that the disarticulated limb femurs grew 0.68 cm shorter on average compared to the contralateral femurs and the femurs in the trans-femoral amputated limbs 3.58 cm shorter on average compared to the contralateral ones. These results were found to be statistically significant.