Inclusion of persons with disabilities in systems of social protection: a population-based survey and case-control study in Peru.

OBJECTIVE: This study aims to assess the needs of people with disabilities and their level of inclusion in social protection programmes. DESIGN: Population based-survey with a nested case-control study. SETTING: Morropon, a semiurban district located in Piura, northern Peru. PARTICIPANTS: For the population survey, a two-stage sampling method was undertaken using data from the most updated census available and information of each household member aged ≥5 years was collected. In the nested case-control study, only one participant, case or control, per household was included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Disability was screened using the Washington Group short questionnaire. A case, defined as an individual aged ≥5 years with disabilities, was matched with one control without disabilities by sex and age (±5 years). Information was collected on socioeconomic status, education, health and rehabilitation and social protection participation. RESULTS: The survey included 3684 participants, 1848 (50.1%) females, mean age: 36.4 (SD: 21.7). A total of 290 participants (7.9%; 95% CI 7.0% to 8.7%) were classified as having disability. Adults with disabilities were more likely to be single (OR=3.40; 95% CI 1.54 to 7.51) and not to be working (OR=4.36; 95% CI 2.26 to 8.40), while those who did work were less likely to receive the national minimum wage (ie, 750 PEN or about US$265; p=0.007). People with disabilities were more likely to experience health problems. There was no difference between those enrolled in any social protection programme among participants with and without disabilities. CONCLUSIONS: People with disabilities were found to have higher needs for social protection, but were not more likely to be enrolled in social protection programmes. The Peruvian social protection system should consider adding disability status to selection criteria in their cash transfer programmes as well as implementing disability-specific interventions

Postoperative Foot and Ankle Kinematics in Rheumatoid Arthritis

Introduction Rheumatoid arthritis (RA) is a systemic autoimmune disease that can cause weakening and destruction of various joints of the foot and may result in pain and deformity. This clinical presentation can cause eventual loss of function, shoe-wear difficulties, and altered gait patterns. Purpose The goal of this prospective study was to quantify changes in temporal-spatial parameters and multisegmental foot and ankle kinematics in a group of patients with RA of the forefoot following surgery. Methods Three-dimensional (3-D) motion analysis was conducted preoperatively and postoperatively using a 15-camera Vicon Motion Analysis System (Vicon Motion Systems, Inc.; Lake Forest, CA) on 14 feet in 13 patients with forefoot RA. The Milwaukee foot model was used to characterize segmental kinematics and temporal-spatial parameters. Preoperative and postoperative data were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Results Preoperatively, the hallux was in a valgus position, the forefoot was abducted and in valgus, and range of motion was limited in various phases in all segments. Walking speed and stride length were decreased and stance prolonged when compared with normal controls. Postoperatively, the hallux alignment was restored to normal but a limited range of motion remained. Kinematics also demonstrated forefoot valgus and tibial internal rotation compared with the control population. Comparisons to healthy ambulators also showed decreased stride lengths and prolonged stance phase durations. Conclusion Surgery effectively restored alignment and weight-bearing capacity of the rheumatoid feet. Temporal-spatial parameters and kinematics, however, were not restored to control values, but rather were consistent with first metatarsophalangeal joint fusion effects. The altered mechanics after surgery demonstrate the importance of quantitative assessment in understanding the geometric and kinematic effects of surgical realignment with implications for postoperative rehabilitation and gait training

Promoting global clinical care and research for children with orthopaedic disabilities through motion analysis technology

Human motion analysis is a tool used to understand orthopaedic disabilities in children and to plan and monitor treatment strategies. It enables clinicians to quantitatively describe rehabilitative progress, plan surgeries, and conduct research. While this technology is prevalent in major academic medical centers, access is lacking in many regions throughout the world. This paper presents a novel approach to offer more accessible technology at greatly reduced cost. Current applications are underway in the Philippines, Mexico, and Colombia. Through international partnerships, improvements in clinical care, medical education, and research have been observed

Development of a Hybrid Foot Model Using an Able-Bodied Population for Prospective Application in Parkinsonian Gait

We developed a technique incorporating a foot accelerometer with a multisegmental foot and ankle kinematic model to study gait disturbances. Initially, our ± 10g triaxial accelerometer was validated by comparing its radial acceleration with the predicted radial acceleration of a Biodex dynamometer. We then mounted our accelerometer on 10 able-bodied adults as they performed walking trials, comparing the resultant accelerations collected by our sensor to those measured by the Vicon 524 optical motion analysis system. The accelerometer was successfully validated with the Biodex for measuring g-levels ranging from 0.621g to 2.98g. Walking trials recorded with the accelerometer resulted in an average vertical peak acceleration of 5.11g (± 1.30g) compared to 4.77g (± 3.07g) average peak acceleration seen during the gait cycle in the current literature. Therefore, our accelerometer is appropriate and can be used for further application in persons with ambulatory disorders and rehabilitative needs

Multisegmental Foot and Ankle Motion Analysis After Hallux Valgus Surgery

Background: Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus. Methods: A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool. Results: Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively. Conclusion: Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics. Clinical Relevance: Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics

Motion of the Multisegmental Foot in Hallux Valgus

Hallux valgus is a common condition characterized by lateral deviation of the large toe and medial deviation of the first metatarsal. While some gait analyses of patients with hallux valgus have been performed using plantar pressures, very little is known about the kinematics of gait in this population. The purpose of this study was to evaluate triplanar kinematics in patients with hallux valgus using a multisegmental foot model. Materials and Methods: A 15-camera Vicon Motion Analysis System was used to evaluate the gait of 38 feet in 33 patients with mild to severe hallux valgus. The Milwaukee foot model was used to characterize dynamic foot and ankle kinematics and temporal-spatial parameters. Values were compared with normal subjects. Outcomes were evaluated using the SF-36 assessment tool. Results: Patients with hallux valgus showed significantly decreased velocity and stride length and prolonged stance. Significant alterations in gait kinematics were observed in various planes in all segments (hallux, forefoot, hindfoot, and tibia) of the foot and ankle, particularly in the ranges of motion of the hallux and the forefoot. Conclusion: The results demonstrate significantly altered kinematic and temporal-spatial parameters reflective of reduced ambulatory function in patients with hallux valgus. As reports describing multisegmental foot and ankle kinematics in this population are limited, this study is valuable in characterizing gait in patients with hallux valgus. Clinical Relevance: A better understanding of altered gait dynamics of the multisegmental foot in patients with hallux valgus provides valuable insight on how distal pathology affects proximal segments

Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture

The objective of the study was to evaluate the long-term strength and gait outcomes after intramedullary nailing of isolated tibial diaphyseal fractures. This retrospective cohort study was conducted at an academic Level I trauma center. Fifteen participants with isolated tibial diaphyseal fractures (OTA/AO 42) at least 2 years postoperative from intramedullary nailing (IMN) provided informed consent. The average age was 40 ± 14 (range, 24-69); there were nine men and six women. Knee flexion-extension strength data were collected. Temporal-spatial, kinematic, and kinetic gait parameters were measured and compared to historic control data. Participants completed the SF-36 and shortened musculoskeletal function assessment questionnaires. The mean length of follow-up between surgery and gait analysis was 6 ± 2 years. The fractured limb demonstrated deficits in quadriceps strength between 9.8% and 23.4% compared to the unaffected limb. Temporal-spatial parameters revealed slower walking speed, shorter stride length, decreased cadence, and shorter single-limb support time in the fractured limb. Altered kinematic and kinetic findings included a knee extension shift during stance, with an increased knee flexor moment demand and decreased total knee power during loading and midstance. These findings represent deficits in concentric and eccentric knee extensor activity. Additionally, the fractured limb demonstrated decreased ankle dorsiflexion during stance and diminished ankle push-off power. Long-term outcomes after IMN of tibial diaphyseal fractures demonstrate decreased quadriceps strength and altered gait parameters that may have implications to the high incidence of knee and ankle pain in the fractured limb

Distribution of Segmental Foot Kinematics in Patients With DegenerativeJoint Disease of the Ankle

Degenerative joint disease (DJD) of the ankle is a debilitating chronic disease associated with severe pain and dysfunction resulting in antalgic gait alteration. Little information is available about segmental foot and ankle motion distribution during gait in ankle osteoarthritis. The aim of the current study was to dynamically characterize segmental foot and ankle kinematics of patients with severe ankle arthrosis requiring total ankle replacement. This was a prospective study involving 36 (19 M, 17 F) adult patients with a clinical diagnosis of ankle arthrosis (“DJD” group) and 36 (23 M, 13 F) healthy subjects (“Control” group). Motion data were collected at 120 Hz using a 3‐D motion camera system at self‐selected speed along a 6‐m walkway and processed using the Milwaukee Foot Model (MFM). The SF‐36 Health Survey and Orthopaedic Foot and Ankle Society (AOFAS) ankle‐hindfoot scale were administered to evaluate functional levels. Findings include decreases in walking speed, cadence, stride length and swing phase, and reduced outcomes scores (SF‐36 and AOFAS). Multisegemental motion in patients with ankle DJD demonstrates significant changes in foot mechanics characterized by altered segment kinematics and significant reduction in dynamic ROM at the tibia, hindfoot, forefoot, and hallux when compared to controls. The results demonstrate decreased temporal‐spatial parameters and low outcomes scores indicative of functional limitations. Statement of clinical significance: Altered segment kinematics and reduced overall range of motion demonstrate how a single joint pathology affects kinematic distribution in the other segments of the foot and ankle and alters patients’ overall gait