Physical Therapy

Static postural control does not strongly predict dynamic gait stability recovery following a trip in adults with and without vestibular dysfunction

Unilateral peripheral vestibular disorder (UPVD) negatively affects upper and lower body motor performance, but postural control during quiet stance in UPVD patients has not been directly compared with dynamic stability control after an unexpected perturbation during locomotion. We analysed centre of pressure (COP) characteristics during static posturography in UPVD patients and healthy controls and compared this with performance of a trip recovery task. 17 UPVD patients and 17 healthy controls were unexpectedly tripped while walking on a treadmill. The margin of stability (MoS) was calculated at touchdown (TD) of the perturbed step and the first six recovery steps. Posturography was used to assess postural stability during 30 seconds of standing with eyes open and closed using a force plate. The trip reduced the MoS of the perturbed leg (p<0.05) with no significant differences in MoS between the groups. Controls returned to MoS baseline level in five steps and patients did not return within the six steps. UPVD patients showed a greater total COP sway path excursion (closed eyes only), anterior-posterior range of COP distance and a more posterior COP position in relation to the posterior boundary of the base of support. There were no significant correlations between COP sway path excursion and MoS values. We concluded that UPVD patients have a diminished ability to control and recover dynamic gait stability after an unexpected trip and lower static postural stability control compared to healthy matched controls, but that trip recovery and static postural control rely on different control mechanisms.
Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy, Posturography


Auditory Cues on Postural Control in Parkinson&#039;s Disease: A Pilot Study

Objective: To evaluate the effect of auditory cues toward postural control in patients with Parkinson's disease (PD). Background: Auditory cues have been proved to be one of rehabilitation strategies for PD [1]. Most of Parkinson's Disease patients present postural instabilities regarding the severity of the disease [2, 3]. Rhythmic Auditory Stimulation (RAS) has been justified to be a standardized neurological motor therapy (NMTs) in PD, which cue-ing benefits may be associated with the activation of cerebellum-thalamic-cortical circuitry [4]. A potential method to stimulate the putamen that might help regulate PD brain's circuits could be providing music as a rhythmical cue [4]. A distinct manifestation in PD is also the arm swing reduction [5] which limits the capability of maintaining balance. It is rare to explore the static standing balance in Parkinson's Disease. Methods: 5 idiopathic PD patients (5 female) aged 72.6 ± 2.51 years, duration of the disease 15 ± 1.22 years (mean ± SD), H&Y 2.5-3 participated in this study. They were recruited from Yawata Medical Center, Ishikawa, Japan in June and November, 2014. The subjects were instructed to stand on the balance platform (Nintendo Wii Fit) and swing arm; Alternation (Alt) and Synchronization (Syn) in 3 scenarios; with no auditory cues (AC), with AC 5% increased and with AC 5 % decreased. The data were analyzed by Wilcoxon Signed Ranks Test and the dimensional clustering method [6] on MATLAB. Results: Tempo at 95% improved area, RMS and Min ML in Alternation, and decreased the path length in rest 2. Tempo at 105% decreased area and RMS in rest 2 statistically significant. A case with H&Y stage 3 showed poorer postural control in both Antero-Posterior (AP) and Medio-Lateral (ML) directions. Most cases presented the higher Center of Pressure (CoP) displacement in ML direction. AC with arm swing regulated the pattern of CoP trajectories. Conclusions: Auditory cues with arm swing - Alternation improved postural control in the PD patients. This concept might be considered clinically to be a rehabilitation program for Parkinson's disease (PD) to improve standing balance. It is a need to enlarge the sample size and develop more rehabilitation programs for improving balance in PD.
Listed In: Physical Therapy, Posturography


Effect of Transcutaneous Electrical Nerve Stimulation on Gait Kinematics in Subjects with Anterior Knee Pain

Knee pain is 1 of 5 leading causes of disability by altering lower-extremity muscle function and gait mechanics. While transcutaneous electrical nerve stimulation (TENS) mitigates deficits of muscle function due to pain, it is unclear whether TENS improves gait mechanics. Each of 15 participant (24±3yrs, 71±12kg, 178±7cm) was assigned to the TENS or matched placebo group (23±2yrs, 72±14kg, 177±9cm). Participants underwent 3 different experimental saline infusion sessions (hypertonic, isotonic, control) in a counterbalanced order, separated by 48-h. Hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was infused into the infrapatellar fat pad for 50-min. No infusion was administered to the control session. Participants and investigators were blinded to the saline solution. A 20-min TENS or placebo treatment was administered, which was blinded to participants. Gait kinematic data were collected using the high-speed video (240 Hz) and force-sending tandem treadmill (1200 Hz) at each time interval (baseline, infusion, treatment, post-treatment). Functional ANOVA (α=0.05) were used to evaluate difference between 2 groups (TENS, placebo) over time. Pairwise comparison functions with 95% confidence interval were plotted to determine specific difference. Hypertonic saline infusion (pain) resulted in increased (1) ankle dorsiflexion (38-75% of stance), (2) knee valgus (20-40%), (3) knee flexion (40-90%), (4) hip adduction (72-100%), (5) hip flexion (50-90%). However, there was no group x time interaction for all kinematics. Altered gait strategies due to pain may play a role in long-term compensation that could have consequences for the joint. TENS treatment, however, did not acutely reduce the deficits in aforementioned kinematic variables.


Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy


Influence of femur rotation and knee valgus on patellofemoral stress

Background: Patellofemoral pain (PFP) is a common condition seen in orthopedic practice. A commonly cited hypothesis as to the cause of PFP is increased patellofemoral joint (PFJ) stress secondary to abnormal lower extremity kinematics (ie. excessive hip internal rotation and knee valgus). However, the influence of these motions on PFJ contact mechanics is unknown. Purpose: To assess the influence of hip rotation and knee valgus on PFJ stress using finite element (FE) analysis. Methods: Patella cartilage stress profiles for a healthy participant were quantified utilizing a subject-specific FE model. Input parameters included: joint geometry, quadriceps muscle forces, and weight-bearing PFJ kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify patella cartilage stress during a static squatting maneuver (45° knee flexion). To simulate hip rotation (0-8°) and knee valgus (0-12°), the femur and tibia were rotated in the transverse and frontal plane respectively in 2° increments. Results: Increasing hip rotation resulted in a linear increase in patella cartilage stress. In contrast, increasing knee valgus resulted in a decrease in patella cartilage stress. The combination of hip rotation and knee valgus did not result in higher PFJ cartilage stress compared to isolated hip rotation. Conclusions: Patella cartilage stress appears to be influenced to a greater degree by hip internal rotation as opposed to knee valgus. Surprisingly, higher degrees of knee valgus resulted in decreased cartilage stress (in the absence of hip rotation). Our finding supports the premise that persons exhibiting excessive hip internal rotation may be pre-disposed to elevated patella cartilage stress.
Listed In: Biomechanics, Gait, Physical Therapy


Improved Prosthetic Gait Following Amputee-Specific Physical Therapy.

Following amputation, an amputee must learn to walk again using a prosthesis. A goal of prosthetic rehabilitation is to reduce and eliminate asymmetries between the prosthetic leg and sound leg which may decrease the negative effects of long term force and work demands on the sound leg. An amputee-specific physical therapy program provides structured motor learning to aid in developing proper gait mechanics. However, physical therapy is not standard of care for all individuals receiving their first prosthesis due to limited evidence showing improved gait. Thus, the purpose of this study was to determine whether amputees receiving physical therapy have better gait mechanics than those that do not. It was hypothesized that those who underwent an amputee-specific physical therapy program would display a more symmetrical gait pattern. Transtibial amputees walked overground at self-selected pace while kinetic (600Hz) and kinematic (60Hz) data were collected. The therapy group had previously received 2-3 therapy sessions per week for 3 months. Asymmetries were determined through dependent t-tests (α=0.05) comparing sound leg and prosthetic leg kinetic variables. Of the 23 kinetic variables tested, 17 variables showed significant difference between the sound leg and prosthetic leg for the group that did not receive the amputee-specific physical therapy. For the group that had previously received the therapy, only 4 variables showed differences between the sound and prosthetic leg. Thus, we showed that individuals partaking in amputee-specific physical therapy have a more symmetrical gait which results on less force and energy demands on the sound leg.
Listed In: Biomechanics, Gait, Physical Therapy


Biochemical markers of type II collagen degradation and synthesis are not associated with biomechanical variables in patients following ACL reconstruction.

This study investigated the association of serum C-propeptide (sCPII), urinary CTX-II (uCTX-II), and uCTX-II:sCPII with peak vertical ground reaction force (PVGRF) and quadriceps strength during jump-landing in patients with ACL reconstruction (ACLR). METHODS: twenty two patients with ACLR (Male=14, age=19.6 ± 4 yr) were tested 20 weeks after the surgery. Blood and urine samples were collected. sCPII and uCTX-II, biomarkers of articular degradation and synthesis respectively, were analyze using commercial ELISAs. Subjects performed 3 trials of a forward drop land and a drop vertical jump. Subjects started on a 20 cm step and landed on a force platform (AMTI). PVGRF was analyzed on the surgical side. Quadriceps strength (PKET) was assessed with an isokinetic dynamometer (60°/s). PVGRF and PKET were normalized to body weight (BW). Pearson’s correlation, with and without adjustment for age, was used to analyze associations among variables. RESULTS: Mean (± SD) log concentrations were 2.88 ± 0.19 and 3.32 ± 0.49 ng/mmol for sCPII and uCTX-II respectively; and for uCTXII:CPII was 1.16 ± 0.18. PVGRF was 3.2 BW ± 0.3 and 1.4 BW ± 0.3 for the forward drop land and drop vertical jump tasks, respectively; PKET was 0.92 BW ± 0.2. There were no significant correlations among variables (p≥0.2), except for a trend towards a positive correlation between PKET and uCTXII:sCPII (r = 406, p = .076). CONCLUSSIONS: Biomarkers of type II collagen metabolism were not associated with jump-landing forces. However, higher quadriceps strength may be associated with a shift in articular cartilage metabolism towards degradation.


Listed In: Biomechanics, Orthopedic Research, Physical Therapy, Sports Science


The Influence of Trunk Posture on Hip and Knee Moments during Over-ground Running

A high incidence of lower extremity injuries has been reported in runners, with half of the injuries occurring at the knee joint. Sagittal plane trunk posture was shown to influence hip and knee kinetics during landing. This suggests trunk posture may be a risk factor of running injuries. The purpose of this study was aimed to examine the influence of sagittal plane trunk posture on hip and knee kinetics during running. Forty runners were recruited. Three-dimensional kinematics (250Hz, Qualisys) and ground reaction force data (1500Hz, AMTI) were collected while subjects ran with a self-selected trunk posture (speed: 3.4m/s). Mean trunk flexion angle and peak hip and knee extensor moments during the stance phase were calculated. Subjects were dichotomized into High-Flex and Low-Flex groups based on trunk flexion angles. On average, the two groups demonstrate 7.4°difference in trunk flexion. Independent t-tests showed that the Low-Flex group demonstrated significantly higher knee extensor moments and lower hip extensor moments compared to the High-Flex group. Pearson correlations showed that trunk flexion angle was positively correlated with peak hip extensor moment (r=0.44) and inversely correlated with peak knee extensor moment (r=-0.51). The results suggested a small difference in trunk flexion angle has significant influences on hip and knee kinetics. Individuals who run with a more upright trunk posture may be predisposed to a higher risk of patellar tendinopathy and patellofemoral pain. Incorporating a forward lean trunk may be utilized as an intervention strategy to reduce knee loading and risk of knee injuries in runners.


Listed In: Biomechanics, Physical Therapy, Sports Science


HIP JOINT TORQUES DURING A GOLF SWING AFTER A TOTAL HIP REPLACEMENT: A CASE SERIES

Purpose: Total Hip Replacements (THR) are common procedures for older people who suffer from degenerative joint disease. Golf is a popular leisure sport played by older Americans including those with THR. Hip torques encountered in a golf swing after THR has not been reported. The purpose of this study is to describe 3D hip joint torques generated during a golf swinging by those with THR. Methods: Three male amateur golfers who were at least 1 year post THR (ages 59-71 year old and right hand dominant, (2 were left THR) participated. Golf handicap ranged from 16-18. All participants completed the Hip Harris Score. Passive reflective markers were placed on key boney anatomical landmarks. During data collection, participants completed ten swings using a standardized driver, after a warm up. Kinetics and kinematics were captured using a 10 camera Motion Analysis system and two AMTI forceplates. Inverse dynamics procedure was used to calculate peak hip torques in all three planes. Hip torques were normalized and presented as internal torques. Comparisons were made to previously collected similarly aged senior group. Results: Average Club head velocity was slower than senior group. Sagittal Plane: THR golfers exhibited the greatest torque similar to senior group. Frontal plane: THR golfers demonstrated a lower hip adductor torque on the lead leg compared to the trail leg and senior group. Transverse plane: THR exhibited higher hip external rotation torques compared to the internal rotation torques and the senior group. Conclusion: 3-D peak hip torques generated during the golf swing by persons with a THR are greatest in the sagittal plane. THR golfers demonstrated slower club head speed but generated higher hip torques in the transverse plane as compared to those without a THR. Hip external rotation torque was higher in all of the THR compared to the senior group. Clinical Significance: Subjects with a THR may be prone to abnormal forces in the transverse plane during the golf swing. Future studies are needed to determine impact on return to golf decisions following a THR.
Listed In: Biomechanics, Physical Therapy, Sports Science