Assessment of Gait after Treatment of Tibial Nonunion with the Ilizarov Method

Background: Tibial nonunion is a common bone union disorder leading to abnormal gait, and thus reducing quality of life in the social dimension. Research question: The aim of our work was to comprehensively assess gait parameters of patients who had undergone Ilizarov treatment for tibial nonunion compared to a control group of healthy individuals. Methods: This study evaluated patients treated for aseptic tibial nonunion with the Ilizarov method. 24 patients with a mean age of 55.0 years were included in the study. The control group consisted of 32 healthy volunteers with no significant medical history who were selected to match the gender and age of patients in the study group so that the groups were homogeneous. A Zebris Medical GmbH pedobarographic platform was used to assess the gait parameters. Results: For all gait parameters examined, force forefoot max, force backfoot max, step length, stance phase, swing phase and step time, we observed statistically significant differences between the group that had undergone treatment and the control group. In the group of patients, statistically significant differences between the operated lower limb and the non-operated limb were only observed for the force forefoot max and step time parameters (p = 0.029 and p = 0.045, respectively). Patients presented a longer loading of the operated limb (0.720 s) than the non-operated limb (0.635 s). For the stride time, step cadence and gait velocity parameters, healthy subjects achieved much better results during locomotion, and these differences were statistically significant at p < 0.001. Significance: Treatment of tibial nonunion with the Ilizarov method did not restore normal gait parameters in our group of patients. In fact, the gait parameters of patients were significantly worse than the healthy individuals in the control group. Furthermore, gait parameters following treatment were not symmetrical, and the dynamics of the musculoskeletal system remained impaired.

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Dynamic Gait Parameters in Patients with Nonunion of the Tibia Following Treatment with the Ilizarov Method

Journal of Biomechanical Engineering ◽

10.1115/1.4051432 ◽

2021 ◽

Author(s):

Andzelika Pajchert Kozlowska ◽

Lukasz Pawik ◽

Lukasz Szelerski ◽

Slawomir Zarek ◽

Radoslaw Górski ◽

...

Keyword(s):

Maximum Force ◽

Control Group ◽

Ilizarov Method ◽

Dynamic Parameters ◽

Symmetrical Distribution ◽

Gait Parameters ◽

Tibial Nonunion ◽

Parameter Values ◽

Dynamic Gait ◽

Experimental Group

Abstract INTRODUCTION: The purpose of this study was a comprehensive assessment of the dynamic parameters of gait in patients who underwent Ilizarov treatment for nonunion of the tibia. MATERIALS AND METHODS: The experimental group consisted of24 individuals treated with the Ilizarov method for nonunion of the tibia.The control group comprised31healthy individuals,matched for BMI,sex,and age.The dynamic gait parameters in patients and in the control group were measured with a Zebris pedobarographic platform. RESULTS: The treatment group and the control group showed statistically significant differences in terms of the following gait parameters:Maximum force 1NOL(non-operated-limb),Time maximum force1OL(operated-limb),Time maximum force 1 NOL,Maximum force 2NOL,Time maximum force 2OL,and Maximum force forefoot OL.Most of the evaluated gait parameters were bilaterally similar in patients group.The only significant differences between the operated and non-operated limb were seen in terms of Time maximum force 2and Maximum force forefoot. CONCLUSIONS: The most pronounced abnormalities in dynamic gait parameters were observed in the forefoot.The patients treated with the Ilizarov method did not achieve a complete normalization of dynamic gait parameters,as their gait parameters did not equal those measured in the control group.The Ilizarov method for the treatment of tibial nonunion helps restore a symmetrical distribution of gait parameter values between the affected limb and the healthy limb.Patients with tibial nonunion treated with the Ilizarov method continue to show some abnormalities in their dynamic gait parameters after treatment.

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Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02202-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Łukasz Pawik ◽

Malwina Pawik ◽

Zdzisława Wrzosek ◽

Felicja Fink-Lwow ◽

Piotr Morasiewicz

Keyword(s):

Quality Of Life ◽

Lower Limb ◽

Limb Length Discrepancy ◽

Limb Length ◽

Control Group ◽

Ilizarov Method ◽

Healthy Individuals ◽

Self Assessment ◽

Length Discrepancy

Abstract Background Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group. Methods Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy. Results Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used. Conclusions After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.

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Gait Symmetry Analysis in Patients after Treatment of Pilon Fractures by the Ilizarov Method

Symmetry ◽

10.3390/sym13020349 ◽

2021 ◽

Vol 13 (2) ◽

pp. 349 ◽

Cited By ~ 1

Author(s):

Łukasz Pawik ◽

Paweł Wietecki ◽

Artur Leśkow ◽

Andżelika Pajchert Kozłowska ◽

Sławomir Żarek ◽

...

Keyword(s):

Lower Limb ◽

Healthy Subjects ◽

Lower Limbs ◽

Control Group ◽

Ilizarov Method ◽

Study Group ◽

Stride Time ◽

Gait Symmetry ◽

Gait Parameters ◽

Pilon Fractures

The aim of this study was to comprehensively assess the gait parameters in patients who had undergone treatment of pilon fractures by the Ilizarov method. We analyzed gait parameters in patients who had undergone treatment for pilon fractures by the Ilizarov method; 20 patients aged 47.0 years (25.2–78.6) were included in the study. The control group consisted of 32 healthy volunteers. Gait examination was performed using the pedobarographic platform. Statistically significant differences in the following gait parameters: maximum forefoot force (%), step length (cm), and step time (s) were found between the study group and the control group, between the nonoperated leg, and both the operated leg and the dominant limb. Statistically significant differences in the study group between the treated lower limb and the healthy lower limb were only observed in the case of the maximum forefoot force parameter (%). Healthy subjects from the control group obtained significantly higher values during locomotion for stride time, cadence step, and velocity than the patients, with stride time being statistically significantly shorter and the velocity and the cadence step higher. We observed symmetry in the gait parameters after treating pilon fractures by the Ilizarov method. This method of stabilization allows the restoration of gait parameters, with results similar to those obtained after the treatment of other motor organ pathologies described in the literature, although different from those observed in healthy subjects. In particular, the biomechanics of the lower limbs remain disturbed.

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Assessment of body balance of patients treated with the Ilizarov method for tibial nonunion

Acta of Bioengineering and Biomechanics ◽

10.37190/abb-01633-2020-01 ◽

2020 ◽

Vol 22 (3) ◽

Author(s):

Andżelika Pajchert-Kozłowska ◽

Łukasz Pawik ◽

Łukasz Szelerski ◽

Sławomir Żarek ◽

Radosław Górski ◽

...

Keyword(s):

Musculoskeletal System ◽

Control Group ◽

Ilizarov Method ◽

Study Group ◽

Control Groups ◽

Body Balance ◽

Centre Of Gravity ◽

Tibial Nonunion ◽

Axis Length ◽

And Control

Purpose: The biomechanics of the musculoskeletal system in patients after tibial nonunion treatment using the Ilizarov method have not yet been fully explored. From the orthopaedic and patient point of view, after the treatment, an assessment should be carried out of the biomechanics of the musculoskeletal system. The aim of this study was to assess the body balance of patients treated with the Ilizarov method for tibial nonunion. Methods: The research group included 24 individuals with a mean age of 55 years, who were treated for aseptic tibial nonunion with the Ilizarov method. The control group was matched to the study group in terms of gender and age, and consisted of 32 subjects with a mean age of 50.5 years and no significant medical history. This study evaluated the balance of patients with the use of pedobarography. Results: In the control group, a statistically significantly shorter path of centre of gravity was observed. There were no statistical differences between the study and control groups for the field area of the centre of gravity. There were no statistical differences between the study and control groups for the minor axis length or major axis length of the centre of gravity. There was a relationship between the centre of pressure path length and the age of the participants in both the control group and the study group. Conclusions: Treatment of patients with tibial nonunion with the Ilizarov fixator achieves similar balance to healthy volunteers. In the pedobarographic evaluation, patients treated for tibial nonunion using the Ilizarov method had similar statics of the musculoskeletal system to healthy volunteers.

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Motor determinants of gait in 100 ambulatory patients with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1176oa ◽

2005 ◽

Vol 11 (4) ◽

pp. 485-491 ◽

Cited By ~ 120

Author(s):

P Thoumie ◽

D Lamotte ◽

S Cantalloube ◽

M Faucher ◽

G Amarenco

Keyword(s):

Sensory Loss ◽

Gait Velocity ◽

Control Group ◽

Strongly Correlated ◽

Clinical Form ◽

A Value ◽

Individual Assessment ◽

Gait Parameters ◽

The Individual ◽

Disability Level

A prospective analysis of gait and strength parameters was performed in 100 patients diagnosed with MS and pyramidal involvement admitted in a rehabilitation unit. The patients were divided into two groups based on their ability to walk in daily life (nonassisted or cane-assisted gait) and into four clinical subgroups depending on associated involvements such as sensory loss or cerebellar ataxia. Twenty healthy subjects were studied as a control group. Gait parameters were evaluated with a Locometre and muscle strength with an isokinetic dynamometer. The results showed that the average velocity and strength of the hamstring and quadriceps were strongly correlated and reduced in the MS group in comparison with the control, and in the cane-assisted group compared with the nonassisted group. Gait velocity tended to be more correlated to hamstring strength in the nonassisted group with a determination coefficient (r2) reaching a value of 0.44 in the sensory subgroup. These findings provide evidence that a correlation between strength reduction and gait impairment is obvious whatever the clinical form in patients with MS. This correlation is higher with hamstrings but may change depending on the disability level and the clinical form. This could be taken into account in the individual assessment of further rehabilitation programmes.

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Prevalence of Toxoplasma gondii and Toxocara canis among Myositis Patients in Southwest of Iran

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666191231123159 ◽

2019 ◽

Vol 20 ◽

Author(s):

Jasem Saki ◽

Karim Mowla ◽

Reza Arjmand ◽

Forough Kazemi ◽

Somayeh Fallahizadeh

Keyword(s):

Toxoplasma Gondii ◽

Nested Pcr ◽

Healthy Subjects ◽

Toxocara Canis ◽

Control Group ◽

Igg Antibodies ◽

Healthy Individuals ◽

High Prevalence ◽

Acute Toxoplasmosis ◽

Southwest Of Iran

Introduction: Parasitic myositis is caused by some parasites such as T. gondii and T. canis. So, the aim of the study was to evaluate the prevalence T. gondii and T. canis in patients with myositis and healthy individuals. Methods: A total of 108 samples were randomly selected as the control (54 healthy individuals) and test (54 myositis patients) groups. IgG and IgM antibodies against T. gondii and IgG antibodies against T. canis were measured by the ELISA. The detection of chronic and acute toxoplasmosis was performed by the ELISA IgG avidity. The presence of T. gondii in blood was evaluated by the nested-PCR. Results: Of 108, 33 (30.6%) cases were detected positive for IgG against T. gondii that 19 (35.2%) and 14 (25.9%) were observed in myositis patients and healthy individuals, respectively (P=0.296). Of 19 positive cases, 12 (63.2%) and 7 (36.8%) cases were detected as chronic and acute toxoplasmosis, respectively, while, all positive cases in the control group had chronic toxoplasmosis (P=0.013). One (1.9%) sample was detected positive for anti- Toxoplasma gondii IgM and two (3.7%) samples were found positive for IgG against T. canis by the ELISA that these positive cases were observed only in myositis patients (P=1.000 P=0.495, respectively). B1 T. gondii gene was amplified in 12 (63.2%) and 1 (7.1%) in myositis patients and healthy subjects (P=0.001). Conclusions: Our findings showed that there was a relatively high prevalence of acute toxoplasmosis in myositis patients in comparison with the control subjects in southwest of Iran.

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Efficacy of axial TheraTogs on gait pattern in children with dyskinetic cerebral palsy: a randomized controlled trial

Bulletin of Faculty of Physical Therapy ◽

10.1186/s43161-021-00030-2 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Shamekh Mohamed El-Shamy ◽

Ehab Mohamed Abd El Kafy

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Muscle Tone ◽

Controlled Trial ◽

Gait Pattern ◽

Controlled Study ◽

Control Group ◽

Randomized Controlled ◽

Gait Parameters ◽

Experimental Group

Abstract Background TheraTogs promotes proprioceptive sense of a child with cerebral palsy and improves abnormal muscle tone, posture alignment, balance, and gait. Therefore, the aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on gait pattern in children with dyskinetic cerebral palsy. Thirty children with dyskinetic cerebral palsy were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Gait parameters were measured at baseline and after 3 months of intervention using Pro-Reflex motion analysis. Results Children in both groups showed significant improvements in the gait parameters (P < 0.05), with significantly greater improvements in the experimental group than in the control group. Conclusions The use of TheraTogs may have a positive effect to improve gait pattern in children with dyskinetic cerebral palsy. Trial registration This trial was registered in the ClinicalTrial.gov PRS (NCT03037697).

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Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial

Medicina ◽

10.3390/medicina57070713 ◽

2021 ◽

Vol 57 (7) ◽

pp. 713

Author(s):

Cristiano Sconza ◽

Francesco Negrini ◽

Berardo Di Matteo ◽

Alberto Borboni ◽

Gennaro Boccia ◽

...

Keyword(s):

Crossover Trial ◽

Gait Training ◽

Treatment Session ◽

Control Group ◽

Walk Test ◽

Robot Assisted ◽

Randomized Controlled ◽

Gait Parameters ◽

Before And After

Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.

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Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320981942 ◽

2021 ◽

Vol 35 (2) ◽

pp. 131-144

Author(s):

Maijke van Bloemendaal ◽

Sicco A. Bus ◽

Frans Nollet ◽

Alexander C. H. Geurts ◽

Anita Beelen

Keyword(s):

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Step Length ◽

Gait Training ◽

Control Group ◽

Significant Group ◽

Gait Symmetry ◽

Gait Parameters ◽

Walking Capacity ◽

Experimental Group

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

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Study of cognitive functions in major idiopathic interstitial pneumonias

Egyptian Journal of Bronchology ◽

10.1186/s43168-020-00046-7 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Mohamed W. Zakaria ◽

Reem I. El-Korashy ◽

Mostafa O. Shaheen ◽

Samah Selim ◽

Kwashi J. Amum

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Dysfunction ◽

Mini Mental State Examination ◽

Mmse Score ◽

Control Group ◽

Healthy Individuals ◽

Co Morbidity ◽

Impaired Lung Function ◽

State Examination

Abstract Background Cognitive dysfunction in idiopathic interstitial pneumonia (IIP) is an important clinical co-morbidity that is associated with impaired lung function. The aim of the work is to assess cognitive function in major IIP and to find out the relation between cognitive dysfunction and the oxygenation parameters. Results Fifty individuals were involved in the study; 30 patients with major IIP and 20 healthy individuals. Patients with IIP had significantly lower mini mental state examination (MMSE) score compared to the control group (P < 0.001). Wechsler Deterioration Index (WDI) revealed that 33.3% (n = 10) of the patients with IIP had sure cognitive impairment and 26.6% (n = 8) had ongoing cognitive deterioration. Patients with idiopathic pulmonary fibrosis (IPF) had lower cognitive function than other IIP. Conclusion There is an impairment of cognitive function in patients with major IIP, particularly in IPF, as measured by WDI and MMSE. Further large studies are needed to assess the possible predictors of cognitive impairment and their effects on the patients’ outcome.

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