Comparison Between Successful and Failed Sit-to-Stand Trials of a Patient After Traumatic Brain Injury

Comparison between successful and failed sit-to-stand trials of a patient after traumatic brain injury. Objective: To compare the peak whole-body center of mass (COM) velocities and joint angular contributions in successful and unsuccessful sit-to-stand (STS) trials in a subject with traumatic brain injury (TBI). Design: Single-case study. Setting: Motion research laboratory. Participant: A 24-year-old man who was 3.5 years post-TBI. Interventions: Not applicable. Main Outcome Measures: Peak horizontal and vertical velocities of the whole-body COM and peak angular velocities of the ankle, knee, hip, and shoulder joints. Results: The peak whole-body COM vertical velocity was significantly lower in the unsuccessful STS trials. Angular velocities at the hip, knee, ankle, and shoulder joints in successful trials exceeded those in unsuccessful trials (P Conclusions: For this subject, sit-back failures occurred in STS attempts characterized by peak whole-body COM vertical velocities that were lower than those generated in successful rising trials. These unsuccessful rising attempts were primarily the result of the subject’s inability to generate sufficient knee extension angular velocity

Nonoperative and operative intervention for hallux rigidus

Study Design: Case study of the management of an individual with hallux rigidus deformity. Objective: To describe the outcome of nonoperative and operative treatment, including kinematic and kinetic changes following cheilectomy surgery, for an individual with hallux rigidus deformity. Background: Hallux rigidus is a common disorder of the first metatarsophalangeal joint characterized by progressive limitation of hallux dorsiflexion, prominent dorsal osteophyte formation, and pain. Surgery may be considered when nonoperative management strategies have proven unsuccessful. Kinematic and plantar pressure changes during dynamic activities have not been previously described following cheilectomy surgery for hallux rigidus deformity. Methods and Measures: The patient was a 54-year-old man who sustained a traumatic injury to the great toe. Conservative treatment included nonsteroidal anti-inflammatory drugs, custom insole fabrication, and footwear outersole modification. Because of continued pain, loss of motion, and restrictions in daily activities, the patient elected to have surgery, and a cheilectomy procedure was done. Presurgical and postsurgical kinematic data of first metatarsophalangeal joint motion were collected using an electromagnetic tracking device during clinical motion tests and walking. Peak plantar pressures were assessed during gait. The patient was evaluated preoperatively, at 6 months, and again at 18 months following surgery. Results: The outcome of surgery proved favorable, both subjectively and objectively. Peak dorsiflexion increased significantly (a minimum of 20°) for all clinical tests and walking trials at the first metatarsophalangeal joint when compared with preoperative measurements. Peak plantar pressures also increased over the medial forefoot (68%) and hallux (247%) between preoperative testing and follow-up, indicating increased loading to this region of the foot. Conclusions: Restrictions in motion and daily activities and persistent pain may warrant surgical intervention for individuals with hallux rigidus deformity. A successful outcome, as measured by the patient\u27s self-reported pain, return to recreational activities, and kinematic and plantar pressure changes at the follow-up examination, was demonstrated in this case study

Electromyographic effects of foot orthotics on selected lower extremity muscles during running

Objective: To study the effects of foot orthotics on the mean electromyographic amplitude of proximal and distal lower extremity muscle groups during the first 50% of the stance phase during treadmill running. Design: Repeated measures. Setting: Subjects were recruited from the general community. Participants: Twelve recreational runners who were symptomatic for lower extremity pain. Clinical and radiographic findings confirmed the presence of structural malalignment of the foot. Intervention: Semirigid orthotics were fabricated for each subject, and like footwear provided. Main Outcome Measures: Surface electromyogram activity from the tibialis anterior, medial gastrocnemius, vastus medialis, vastus lateralis, and biceps femoris was collected during treadmill running at self-selected speeds for orthotic and nonorthotic conditions. Root mean square values were averaged across 10 cycles, normalized to time and expressed as a percentage of the nonorthotic condition. Results: Paired t test results showed statistically significant changes (p \u3c .05) for the biceps femoris (-11.1%) and tibialis anterior (+37.5%) muscle groups during the orthotic condition. Electromyographic activity in the medial gastrocnemius, vastus medialis, and vastus lateralis with orthotic use was not significantly different from the nonorthotic condition. Conclusion: Although subjects\u27 electromyographic responses to orthotic use were highly individualized, the findings of this study may enhance our understanding of muscle activity changes associated with positive outcomes from orthotic use

The effect of forefoot and arch posting orthotic designs on first metatarsophalangeal joint kinematics during gait

Study Design: Repeated-measures analysis of variance. Objective: To examine the effect of 2 different orthotic posting designs on first metatarsophalangeal (first MTP) joint kinematics during gait. Background: Common orthotic designs used to control abnormal pronation incorporate the use of a medial post in the forefoot and/or rearfoot locations. Although this design may favorably alter rearfoot and lower-limb kinematics, the incorporation of a forefoot post has been theorized to negatively impact first MTP joint function by limiting hallux dorsiflexion during push off. An alternative design that has been proposed to be more favorable for function of the hallux and first metatarsal is the medial arch support. Methods and Measures: Eighteen subjects with a mean age of 28.2 years (SD, 8.3 years) completed the study. All subjects were judged to have excessive pronation based on a clinical orthopaedic examination. Two different pairs of orthoses were custom molded for each subject. One design incorporated an extrinsic rearfoot and forefoot post and the second design had a high medial longitudinal arch in combination with an extrinsic rearfoot post. The Flock of Birds electromagnetic tracking device was used to collect 3-dimensional position and orientation data of 3 body segments (hallux, first metatarsal, and calcaneus) during the stance phase of walking for 3 conditions (no orthosis and each of the 2 different orthotic designs). A repeated-measures analysis of variance was used to assess differences in first MTP joint dorsiflexion at midstance and during the push-off period of gait, as well as metatarsal declination angle changes during relaxed stance. An exploratory regression analysis was used to investigate factors that related to the change in peak dorsiflexion for the orthotic conditions. Results: Peak first MTP joint dorsiflexion averaged between 38° and 40° across all conditions. Although slight increases in first MTP joint dorsiflexion values were noted with both types of orthotic designs, these differences were not significant at either phase of the stance cycle (P = .50). The metatarsal declination angle in relaxed stance significantly increased (P = .001) under both orthotic conditions. Considerable individual variability was present. For the rearfoot-forefoot posted orthosis, a change in the declination angle of the first metatarsal during relaxed stance with the orthosis was a significant nonlinear predictor of change in peak dorsiflexion during push off. Conclusions: Foot orthoses that incorporate a medial forefoot post do not have a consistent negative effect of reducing first MTP joint dorsiflexion during walking

Dynamic kinematic and plantar pressure changes following cheilectomy for hallux rigidus: A mid-term followup

Background: Hallux rigidus leads to significant loss of first metatarsophalangeal (MTP) joint motion. Cheilectomy surgery aims to increase motion, decrease pain, and facilitate a return to activity. Limited data exist regarding restoration of dynamic kinematics and loading responses following cheilectomy. This prospective study assessed three-dimensional in vivo first MTP joint kinematics and loading characteristics following cheilectomy. Materials and Methods: Twenty patients were evaluated prior to undergoing cheilectomy for hallux rigidus. Fifteen subjects returned for mid-term followup at 1.7 years. Eleven subjects were surveyed at 6 years. Plantar pressure data were acquired during barefoot walking. Comparisons of average pressures were determined for 4 different regions of the foot. Pressure differences were compared within, and between symptomatic and asymptomatic feet. First MTP joint dorsiflexion and abduction were assessed during standing, active motion and gait. Results: Only four out of 15 patients showed increased lateral metatarsal loading preoperatively. Pressures shifted medially following surgery. Significant increases in dorsiflexion were found for active motion (pre-op = 13.3 ± 12.7 degrees; post-op = 21.7 ± 14.7 degrees, p = 0.005) and dorsiflexion during gait (pre-op = 19.3 ± 12 degrees; post-op = 30.8 ± 14.8 degrees, p = 0.01). Hallux abduction also increased. During standing, the hallux remained in plantarflexion relative to the first metatarsal. Conclusion: Cheilectomy was effective in maintaining balanced plantar loading. First MTP motion increased but dorsiflexion was still less than normative values. The magnitude of dorsiflexion relative to abduction favorably improved during gait. These findings suggest that kinematics continue to be altered and may lead to further degenerative joint changes. Exploration of alternative surgical techniques is warranted. Copyright © 2008 by the American Orthopaedic Foot & Ankle Society

How healthy is circuit resistance training following paraplegia? Kinematic analysis associated with shoulder mechanical impingement risk

The purpose of the study was to determine whether wheelchair-based circuit resistance training (CRT) exercises place the shoulder at risk for mechanical impingement. Using a novel approach, we created a mechanical impingement risk score for each exercise by combining scapular and glenohumeral kinematic and exposure data. In a case series design, 18 individuals (25-76 yr old) with paraplegia and without substantial shoulder pain participated. The mean mechanical impingement risk scores at 45-60 degrees humerothoracic elevation were rank-ordered from lowest to highest risk as per subacromial mechanical impingement risk: overhead press (0.6 +/- 0.5 points), lat pulldown (1.2 +/- 0.5 points), chest press (2.4 +/- 2.8 points), row (2.7 +/- 1.6 points), and rickshaw (3.4 +/- 2.3 points). The mean mechanical impingement risk scores at 105-120 degrees humerothoracic elevation were rank-ordered from lowest to highest risk as per internal mechanical impingement risk: lat pulldown (1.2 +/- 0.5 points) and overhead press (1.3 +/- 0.5 points). In conclusion, mechanical impingement risk scores provided a mechanism to capture risk associated with CRT. The rickshaw had the highest subacromial mechanical risk, whereas the overhead press and lat pulldown had the highest internal mechanical impingement risk. The rickshaw was highlighted as the most concerning exercise because it had the greatest combination of magnitude and exposure corresponding with increased subacromial mechanical impingement risk