The Progress of the Gait Impairment and Brain Activation in a Patient with Post-stroke Hemidystonia

Objective: We explore the effects of body weight-supported (BWS) treadmill training, including the change of cortical activation, on a patient with post-stroke hemidystonia. Patient: The patient was a 71-year-old man with left thalamus hemorrhage. His motor symptoms indicated slight impairment. There was no overactive muscle contraction in the supine, sitting, or standing positions. During his gait, the right initial contact was the forefoot, and his right knee showed an extension thrust pattern. These symptoms suggested that he had post-stroke hemidystonia. Methods: The patient performed BWS treadmill training 14 times over 3 weeks. The effects of the BWS training were assessed by a step-length analysis, electromyography and functional magnetic resonance imaging (fMRI). Results: The patient''s nonparetic step length was extended significantly in the Inter-BWS (p<0.001) and Post-BWS (p=0.025) periods compared to the Pre-BWS session. The excessive muscle activity of the right gastrocnemius medialis in the swing phase was decreased at the Inter-BWS, Post-BWS, and follow-up compared to the Pre-BWS session. The peak timing difference of the bilateral tibialis anterior muscle became significant (p<0.05) on the first day of the intervention. The fMRI revealed that the cortical areas activated by the motor task converged through the intervention (p<0.05, family-wise error corrected). Conclusion: These results suggest that there was improvement of the patient''s symptoms of post-stroke hemidystonia due to changes in the brain activity during voluntary movement after BWS intervention. Body weight-supported treadmill training may thus be an effective treatment for patients with poststroke hemidystonia.     

Recovery process of respiratory muscle strength in patients following stroke: A Pilot Study

Objective: To determine the recovery process of respiratory muscle strength during 3 months following stroke, and to investigate the association of change in respiratory muscle strength and physical functions. Additionally, we compared respiratory muscle strength with those of healthy subjects. Method: In this prospective, observational study, 19 stroke patients and 19 healthy subjects were enrolled. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), motricity index, trunk control test, 6-minute walk test (6MWT) and functional independence measure were assessed at 1, 2, and 3 months from stroke onset in stroke patients. MIP and MEP were assessed at arbitrary times in healthy subjects. Repeated one-way analysis of variance with Bonferroni post-hoc test was used to compare the change in respiratory muscle strength in each period in stroke patients. Pearson''s correlation coefficient was computed for changes in respiratory muscle strength and physical functions. Student''s t-test was used to compare respiratory muscle strength between stroke patients at 3 months from onset and healthy subjects. Results: MIP was significantly increased at 3 months compared to 1 month. MEP was significantly increased in 2 months and 3 months, compared to 1 month. MIP changes associated with 6MWT changes. Compared to healthy subjects, MIP and MEP at 3 months were significantly lower in stroke patients. Conclusion: Respiratory muscle strength significantly increased during 3 months following stroke. However, the trend of recovery may be different. MIP changes may associated with walking endurance changes. During 3 months following stroke, respiratory muscle strength did not recover to healthy subjects.     

Association Between Social Network and Physical Function in Community-Dwelling Older Adults in Japan

Objective: A poor social network and the decline of physical function are known to be critical risk factors for functional decline in older adults. The aim of this study was to investigate the relationships between social network and physical function in Japanese community-dwelling older adults. Methods: Participants were 339 adults aged 65 years or older (mean age : 73.0 years, women :70.2%), living independently in their communities. A self-reported questionnaire was used to assess social network on two different scales―the 6-item Lubben Social Network Scale (6LSNS) and frequency of contact with other people. Handgrip strength, knee extension strength, gait speed, Timed Up and Go Test (TUG) results, and 5-repetition chair stand test (CST) scores were used to determine physical function. A multiple regression analysis that adjusted for confounding factors was used to analyze the relationship between the social network scales and each physical function test. Results: According to the results of a multiple regression analysis, a high 6LSNS score was significantly associated with greater handgrip strength (B = 0.63, p = 0.03), faster CST (B = −0.23, p = 0.01), and faster TUG (B = −0.12, p = 0.03), and high frequency of contact was significantly associated with greater handgrip strength (B = 1.08, p = 0.01). Conclusions: Social network was associated with muscle strength and physical performance. Consequently, older adults with poor social networks require an assessment of physical function, since their physical functions have possibly deteriorated.     

The Relationship between Age and Change in Physical Functions after Exercise Intervention. Trainability of Japanese Community-Dwelling Older Elderly

The purposes of this study were to evaluate the relationship between age and changes in physical measurements after exercise intervention and to investigate the trainability of the older elderly. Two hundred seventy-six community-dwelling people aged 60 years and older practiced exercise intervention for 3 months. The measurements of physical functions were one-legged standing with eyes open and closed (OLS-O, OLS-C), functional reach test (FR), timed up and go test (TUG), maximum walking velocity, flexibility, and muscle strength. We evaluated the associations between age and the changes in these physical measurements. All measurements except for OLS-C significantly improved after intervention. The magnitude of the changes in hand-grip strength and FR after the intervention showed weak negative correlations with the subject''s age, but other measurements showed no correlations. In addition, there were no differences between younger elderly persons and older elderly persons with regard to changes in any measurements. These results suggested that the exercise intervention we applied could improve physical fitness in community-dwelling older people, regardless of their age. The older elderly were comparable to the younger elderly in trainability to improve physical fitness.     

Aging Effects on the Structure Underlying Balance Abilities Tests

Balance impairment is one of the biggest risk factors for falls reducing inactivity, resulting in nursing care. Therefore, balance ability is crucial to maintain the activities of independent daily living of older adults. Many tests to assess balance ability have been developed. However, few reports reveal the structure underlying results of balance performance tests comparing young and older adults. Covariance structure analysis is a tool that is used to test statistically whether factorial structure fits data. This study examined aging effects on the factorial structure underlying balance performance tests. Participants comprised 60 healthy young women aged 22 ± 3 years (young group) and 60 community-dwelling older women aged 69 ± 5 years (older group). Six balance tests: postural sway, one-leg standing, functional reach, timed up and go (TUG), gait, and the EquiTest were employed. Exploratory factor analysis revealed that three clearly interpretable factors were extracted in the young group. The first factor had high loadings on the EquiTest, and was interpreted as ‘Reactive’. The second factor had high loadings on the postural sway test, and was interpreted as ‘Static’. The third factor had high loadings on TUG and gait test, and was interpreted as ‘Dynamic’. Similarly, three interpretable factors were extracted in the older group. The first factor had high loadings on the postural sway test and the EquiTest and therefore was interpreted as ‘Static and Reactive’. The second factor, which had high loadings on the EquiTest, was interpreted as ‘Reactive’. The third factor, which had high loadings on TUG and the gait test, was interpreted as ‘Dynamic’. A covariance structure model was applied to the test data: the second-order factor was balance ability, and the first-order factors were static, dynamic and reactive factors which were assumed to be measured based on the six balance tests. Goodness-of-fit index (GFI) of the models were acceptable (young group, GFI=0.931; older group, GFI=0.923). Static, dynamic and reactive factors relating to balance ability had loadings 0.21, 0.24, and 0.76 in the young group and 0.71, 0.28, and 0.43 in the older group, respectively. It is suggested that the common factorial structure of balance abilities were static, dynamic and reactive, and that for young people reactive balance ability was characterized and explained by balance ability, whereas for older people it was static balance ability.     

Changes in Hip and Knee Muscle Strength in Patients Following Total Hip Arthroplasty

Objective: To investigate changes in hip and knee muscle strength in patients before and after total hip arthroplasty (THA) in comparison with that in healthy adults. Methods: The study included 21 women who underwent unilateral THA (THA group) and 21 age-matched healthy women (healthy group). Maximal isometric strengths of hip flexors, extensors, and abductors, and knee extensors and flexors were measured before surgery and at 4 weeks and 6 months after surgery. Results: Before surgery, muscle strength on both sides, except for hip flexors on the uninvolved side, was significantly lower in the THA group than the corresponding muscle strength in the healthy group. Up to 6 months after THA, strength of all muscle groups on both sides was significantly improved compared with their preoperative status, although the knee extensor strength on the involved side temporarily worsened at 4 weeks. However, the strength of hip extensors and knee extensors on the involved side, and hip abductors on both sides in the THA group remained below that in the healthy group. Conclusions: Our results suggest that rehabilitation specialists should consider increasing the focus on the uninvolved side and encourage patients to continue strength training beyond 6 months after surgery.     

Using Bidimensional Multiscale Entropy Analysis of Ultrasound Images to Assess the Effect of Various Walking Intensities on Plantar Soft Tissues

Walking performance is usually assessed by linear analysis of walking outcome measures. However, human movements consist of both linear and nonlinear complexity components. The purpose of this study was to use bidimensional multiscale entropy analysis of ultrasound images to evaluate the effects of various walking intensities on plantar soft tissues. Twelve participants were recruited to perform six walking protocols, consisting of three speeds (slow at 1.8 mph, moderate at 3.6 mph, and fast at 5.4 mph) for two durations (10 and 20 min). A B-mode ultrasound was used to assess plantar soft tissues before and after six walking protocols. Bidimensional multiscale entropy (MSE_2D) and the Complexity Index (CI) were used to quantify the changes in irregularity of the ultrasound images of the plantar soft tissues. The results showed that the CI of ultrasound images after 20 min walking increased when compared to before walking (CI₄: 0.39 vs. 0.35; CI₅: 0.48 vs. 0.43, p < 0.05). When comparing 20 and 10 min walking protocols at 3.6 mph, the CI was higher after 20 min walking than after 10 min walking (CI₄: 0.39 vs. 0.36, p < 0.05; and CI₅: 0.48 vs. 0.44, p < 0.05). This is the first study to use bidimensional multiscale entropy analysis of ultrasound images to assess plantar soft tissues after various walking intensities.     

Evaluation of cartilage defect at medial femoral condyle in early osteoarthritis of the knee

OBJECTIVE: The purpose of this study was to evaluate cartilage defect at medial femoral condyle on MRI in early osteoarthritis and to compare with early osteoarthritis with meniscal tear without clear cartilage defect. MATERIALS AND METHODS: Twelve patients with medial pain of the knee and cartilage defect without meniscal tear by MRI were studied for cartilage defect. There were two males and 10 females with cartilage defect, and they were between 42 and 61 years of age (average, 51.6). Fifteen patients with medial pain of the knee and meniscal tear and without clear cartilage defect had been studied as meniscal tear cases. There were five males and 10 females with meniscal tear, and they were between 45 and 61 years of age (average 54.5). In both groups, knee injuries by trauma and Kellgren radiographic grade III and IV osteoarthritis were excluded. We compared cartilage defect cases and meniscal tear cases by gender, age, medial meniscus displacement ratio from the edge of the tibial medial joint surface, femorotibial angle (FTA) and Mikulicz line. We measured medial meniscus displacement ratio by the proportion of medial meniscus lesion protruding from the edge of tibial medial joint surface to all the medial meniscus width on MRI. For the evaluation of Mikulicz line, we measured the score by the length from tibial medial joint surface to Mikulicz line to tibial plateau width. chi(2) Test was used for gender, and Mann-Whitney U test was used for age, medial meniscus displacement ratio, FTA and Mikulicz line. RESULTS: Statistically significant difference was not observed between cartilage defect cases and meniscal tear cases for age and gender. Medial meniscus displacement ratio was 13+/-12.3% in cartilage defect cases and 50.4+/-20.1% in meniscal tear cases. Medial meniscus displacement ratio in cartilage defect cases was significantly smaller than in meniscal tear cases (P=.0001). FTA was 174.9+/-2.2 degrees in cartilage defect cases and 178.3+/-4.8 degrees in meniscal tear cases. FTA in cartilage defect cases was significantly smaller than in meniscal tear cases (P=.00390). The score by the length from tibial medial joint surface to Mikulicz line to tibial plateau width was 35.8+/-11.8% in cartilage defect cases and 21.7+/-15.8% in meniscal tear cases. Mikulicz line in cartilage defect cases passes more laterally than in meniscal tear cases significantly (P=.0264). CONCLUSION: In this study, we reported cartilage defect cases at medial femoral condyle in the early osteoarthritis of the knee. We think that these cases were different from early osteoarthritis with meniscal tear in alignment of lower limb and onset mechanism. It is necessary to evaluate meniscus and cartilage in MRI when we diagnose middle-aged patients with medial pain of the knee and without remarkable changes of X-ray.     

Assessment of the Effectiveness of Rehabilitation after Total Knee Replacement Surgery Using Sample Entropy and Classical Measures of Body Balance

Exercises in virtual reality (VR) have recently become a popular form of rehabilitation and are reported to be more effective than a standard rehabilitation protocol alone. The aim of this study was to assess the efficacy of adjunct VR training in improving postural control in patients after total knee replacement surgery (TKR). Forty-two patients within 7–14 days of TKR were enrolled and divided into a VR group and a control group (C). The C group underwent standard postoperative rehabilitation. The VR group additionally attended twelve 30-min exercise sessions using the Virtual Balance Clinic prototype system. Balance was assessed on the AMTI plate in bipedal standing with and without visual feedback before and after the four-week rehabilitation. Linear measures and sample entropy of CoP data were analyzed. After four weeks of rehabilitation, a significant reduction in parameters in the sagittal plane and ellipse area was noted while the eyes remained open. Regression analysis showed that sample entropy depended on sex, body weight, visual feedback and age. Based on the sample entropy results, it was concluded that the complexity of the body reaction had not improved. The standing-with-eyes-closed test activates automatic balance mechanisms and offers better possibilities as a diagnostic tool.     

MRI description of knee medial collateral ligament abnormalities in the absence of trauma: edema related to osteoarthritis and medial meniscal tears

A retrospective case series regarding the knees of 12 adult patients with MRI abnormalities of the medial collateral ligament (MCL), but without clinical history of trauma to the MCL, were collected and compared with six knee MR images from patients with clinical traumatic injuries to their MCLs. The MR images were studied for the extent of edema of the MCL, as well as other associated findings. Edema of the MCL on MRI could be found in three distinct categories of patients: (a) those with trauma to the MCL, which was an expected finding; (b) those without trauma but with medial compartment osteoarthritis; and (c) those without trauma but with degenerative medial meniscal tears. The clinical significance, if any, of the edema found in MCLs without trauma remains unclear. Atraumatic MCL edema may serve as a marker for medial knee compartment osteoarthritis or for a degenerative medial meniscal tear and should not be confused with traumatically induced MCL injuries, although this distinction can often be difficult to make based on MRI findings alone.     

Incidence of postoperative complications and non- periprosthetic fractures after total hip arthroplasty: A more than 10-year follow-up retrospective cohort study

Objective: Postoperative complications and non-periprosthetic fractures (NPPFs), which was defined as a fracture existing non- periprosthetic implant, after total hip arthroplasty (THA) have a negative effect on the patients'' ability to perform activities of daily living. Thus, investigating these incidences of patients after THA will be valuable as it lead to a more strategic physical therapy interventions and advanced research to prevent these problems. The purpose of this study was to investigate the incidence of postoperative complications related to implants and NPPFs in patients after THA, a more than 10-year follow-up. Methods: This is a retrospective cohort study. A total 892 patients with hip osteoarthritis who underwent primary THA were analyzed (age at surgery was 45-79 years; 805 women; the average follow-up period was 12.4-year). The postoperative complications related to implants and NPPFs were calculated using data from their medical records. Results: The postoperative complications occurred in 37 patients, and NPPFs occurred in 72 patients, who were significantly older, and hip and knee OA diagnosis, compared to patients without NPPFs ( p <.05). The most common cause of NPPFs was minor trauma. In patients aged ≧ 65 years, significantly more NPPFs occurred during the first year after surgery( p <.05). Conclusion: More than 10-year after THA, the incidence of NPPFs was higher than that of postoperative complications related to implants. Older patients who had hip and knee OA were a significantly higher risk of developing NPPFs due to falls within the first year after surgery.     

Deep Learning for Walking Behaviour Detection in Elderly People Using Smart Footwear

The increase in the proportion of elderly in Europe brings with it certain challenges that society needs to address, such as custodial care. We propose a scalable, easily modulated and live assistive technology system, based on a comfortable smart footwear capable of detecting walking behaviour, in order to prevent possible health problems in the elderly, facilitating their urban life as independently and safety as possible. This brings with it the challenge of handling the large amounts of data generated, transmitting and pre-processing that information and analysing it with the aim of obtaining useful information in real/near-real time. This is the basis of information theory. This work presents a complete system aiming at elderly people that can detect different user behaviours/events (sitting, standing without imbalance, standing with imbalance, walking, running, tripping) through information acquired from 20 types of sensor measurements (16 piezoelectric pressure sensors, one accelerometer returning reading for the 3 axis and one temperature sensor) and warn the relatives about possible risks in near-real time. For the detection of these events, a hierarchical structure of cascading binary models is designed and applied using artificial neural network (ANN) algorithms and deep learning techniques. The best models are achieved with convolutional layered ANN and multilayer perceptrons. The overall event detection performance achieves an average accuracy and area under the ROC curve of 0.84 and 0.96, respectively.     

Effects of back extensor strengthening exercises on postural alignment,physical function and performance,self-efficacy,and quality of life in Japanese community-dwelling older adults: A controlled clinical trial

Objective: To examine the changes in postural alignment and kyphosis-correlated factors after 6 months of back extensor strengthening exercise in a group of community-dwelling older adults aged ≥65 years. Methods: We quasi-randomized 29 subjects into an intervention group treated with a back extensor strengthening program and a control group treated with a full-body exercise program. These groups completed 20-30 minutes of exercise directed by a physical therapist one or more times per week and were instructed to exercise at home as well. The participants were assessed prior to and after the intervention using the following criteria: postural alignment of “usual” and “best” posture, physical function, physical performance, self-efficacy, and quality of life. The differences between two factors (group and period) were compared for each of the measurement variables. Results: Subjects who adequately completed the exercises were analyzed. A reduced knee flexion angle was noted in the “best” posture of both groups, as were improved physical function and performance with the exception of one-leg standing time. Verifying the effect size in the post-hoc analysis, the body parts that showed changes to postural alignment after the intervention differed between groups. Conclusions: Back extensor strengthening exercises improved physical function and performance, but did not improve spinal alignment. The changes due to these interventions were not significantly different from changes observed in the full-body exercise group. However, post-hoc analysis revealed that the effect size of posture change was different, possible indicating that the two groups experienced different changes in the postural alignment.     

Importance of knee flexion range of motion during the acute phase after total knee arthroplasty

Background: We investigate the association with knee flexion range of motion (ROM) during the acute phases and that at 12 months after total knee arthroplasty (TKA). We also clarified the cut-off ROM during the acute phases in predicting the goal of knee flexion ROM at 12 months. Methods: In this retrospective study, 193 patients with knee osteoarthritis (female:144 patients, age:73.2 ± 7.7 years) who underwent unilateral TKA at an orthopedic clinic were recruited. They underwent assessments of knee flexion ROM at 5 days, 1 month, and 12 months after TKA. The goal of knee flexion ROM at 12 months after TKA was set at 120°. Single and logistic-regression analyses were performed with the dependent variables including the outcome of the goal of knee flexion ROM at 12 months, and the independent variables included knee flexion ROM at 5 days and 1 month, separately. We calculated the cut-off ROM at 5 days and 1 month for predicting the goal of knee flexion ROM at 12 months with receiver operating curve analysis. Results: Knee flexion ROM at 5 days and 1 month were significantly associated with the goal of that at 12 months (p < 0.01). The cut-off ROM were 85° at 5 days and 105° at 1 month separately. Conclusions: Our results suggest the importance of early improvement in knee flexion ROM after TKA, and that at 1 month postoperatively indicates the likelihood of achievement of the goal of knee flexion ROM at 12 months after TKA.     

Association of objectively measured physical activity with combined bilateral knee and low-back pain in older adults with knee osteoarthritis: A cross-sectional study

Objective: Knee pain (KP) and low-back pain (LBP) are common sites of pain and major public health issues among older adults. We investigated the combined association of bilateral KP and LBP with objectively measured physical activity (PA) among adults with knee osteoarthritis (OA). Methods: We recruited 150 knee OA adults and measured steps and PA intensity, including sedentary behavior (SB), low PA (LPA), and moderate-to-vigorous PA, using an accelerometer. KP and LBP were measured using a numerical rating scale. They were classified into 4 groups based on the presence of KP and LBP: with the only unilateral KP (UKP), with the combined UKP and LBP (UKP and LBP), with the bilateral KP (BKP), and with the combined bilateral KP and LBP (BKP and LBP). One-way analysis of covariance was performed to compare physical activity variables (intensity or steps) between the four groups. Results: Overall, 126 patients were enrolled. The prevalence of UKP, BKP, UKP and LBP, and BKP and LBP were 29.4%, 23.8%, 18.3%, and 28.6%. The proportion of SB was higher in the BKP and LBP group than in the other groups (F = 6.51, p < 0.01). The proportion of LPA was lower in the BKP and LBP group than in the other groups (F = 6.21, p < 0.01). Conclusions: The proportions of SB and LPA were significantly worse in knee OA adults with BKP and LBP than in those with UKP. Our findings may be a basis for considering knee OA adults for improving PA.     

Evidence of Improvement in Various Impairments by Exercise Interventions in Patients with Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Purpose: To investigate improvement in various impairments by exercise interventions in patients with knee osteoarthritis (OA). Methods: We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, and position sense were synthesized. The Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of the evidence. Results: Thirty-three RCTs involving 3,192 participants were identified. Meta-analysis provided highquality evidence that exercise intervention improves maximal oxygen uptake, and moderate-quality evidence that exercise intervention also improves pain, stiffness, knee extensor and flexor muscle strength, and position sense. The evidence that exercise intervention improves knee extension and flexion range of motion was deemed as undetermined-quality. Conclusion: In patients with knee OA, improvement in pain, stiffness, muscle strength, maximal oxygen uptake, and position sense with the use of exercise intervention can be expected. Although the quality of evidence of the effect of exercise intervention on range of motion was inconclusive, exercise intervention should be recommended for patients with knee OA to improve various impairments.     

Relationship between the shape of tibial spurs on X-ray and meniscal changes on MRI in early osteoarthritis of the knee

OBJECTIVE: The purpose of this study was to evaluate the relationship between the shape of tibial spurs on plain X-rays and the meniscal changes on magnetic resonance imaging (MRI) in early osteoarthritis of the knee. MATERIALS AND METHODS: Sixty-three patients (age range, 40 to 59 years; average, 51.8) underwent X-ray and MRI examinations of their knees. Ligament injuries caused by trauma and Kellgren Radiographic Grades III and IV on X-ray were excluded. The shapes of the medial and lateral tibial spurs on X-ray were classified into four types: (a) normal type; (b) horizontal type, in which the spur protruded horizontally; (c) upward type, in which the spur protruded upward; and (d) downward type, in which the spur protruded downward. The femorotibial angle (FTA) on the X-rays was also measured. The medial and lateral meniscal displacement rates on MRI were measured by the proportion by which the meniscal lesion protruded from the edge of the tibial joint surface to the overall meniscal width. The medial and lateral meniscal signal changes on MRI were classified into three types: (a) normal type; (b) intrameniscal type, which showed a high signal within the meniscus; and (c) tear type, which showed a high signal extending to the tibial joint surface. The relationships between the shape of the medial and lateral tibial spur classification on X-ray, the medial and lateral meniscal displacement rates on MRI, the medial and lateral meniscal signal changes on MRI and the FTA were evaluated statistically. RESULTS: Statistically significant correlations were observed between the medial tibial spur classification on X-ray, the medial meniscal displacement rate on MRI and the medial meniscal signal change classification on MRI. In the downward type of medial tibial spur, the medial meniscal displacement rate (50.46+/-17.95%) and the percentage (8 out of 8 cases; 100%) involving the tear type of medial meniscus were greater than the other types. Statistical significance was not observed among the lateral tibial spur classification on X-ray, the lateral meniscal displacement rate on MRI and the lateral meniscal signal change classification on MRI. However, in the horizontal type of lateral tibial spur, the percentage (7 out of 10 cases; 70%) involving the tear type of lateral meniscus was greater than the other types. Correlations tended to be observed between the medial meniscal displacement rate on MRI and the FTA. CONCLUSIONS: In this study, there was a relationship between the shape of the tibial spur on X-ray and the meniscal changes on MRI in early osteoarthritis of the knee. The shape of the medial tibial spur on X-ray can be a useful indicator for predicting the progression of osteoarthritis of the knee. A downward type of medial tibial spur classification on X-ray may be a risk factor for developing severe osteoarthritis of the knee.     

Isokinetic trunk and knee muscle strengths and gait performance in walking patients with T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP)

The aim of this study was to investigate the isokinetic trunk and knee muscle strengths, and examine the clinical relevance of dynamic muscle strengths and gait performance in walking patients with human T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP). Thirteen patients with HAM/TSP (8 females and 5 males, aged 38–76) and 13 sex- and age-matched healthy control subjects participated in the study. We assessed gait speed, stride length, cadence; and maximal isokinetic torque of trunk and knee extensors and flexors at 30°/s, 60°/s and 90°/s using a Biodex System 3 dynamometer. Furthermore, we calculated the isokinetic trunk extensor/flexor (E/F) and hamstrings/quadriceps (H/Q) strength ratios (parameter of the muscle strength balance about the trunk and knee joint). Compared with the age-matched controls, the patients with HAM/TSP had significantly reduced gait speed, stride length and cadence (P < 0.05). Peak torque values related to body weight (PTBW) were significantly reduced, especially for the knee flexors (P < 0.05). For the knee extensors, the PTBW values were significantly reduced at an increased angular velocity (P < 0.05). The PTBW of knee flexors was positively correlated with gait speed and cadence in the patients with HAM/TSP. The H/Q ratio but not E/F ratio was significantly decreased compared with the control. Our results indicated that the isokinetic trunk and knee muscle performance had reduced from the ambulatory stage, and suggested the deterioration in knee muscle performance to be associated with gait disturbance in walking HAM/TSP patients.     

Walking behavior in technicolored GUTs

There exist two ways to obtain walk behavior: assuming a large number of technifermions in the fundamental representation of the technicolor (TC) gauge group, or a small number of technifermions, assuming that these fermions are in higher-dimensional representations of the TC group. We propose a scheme to obtain the walking behavior based on technicolored GUTs (TGUTs), where elementary scalars with the TC degree of freedom may remain in the theory after the GUT symmetry breaking.     

Clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty: A prospective cohort study

Objective: To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty. Methods: This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule. Results: The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%. Conclusions: The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.