PHYSIOTHERAPY REHABILITATION IN A PATIENT WITH ANKLE LACERATION

The foot is a complex structure of more than 26 bones, 30 joints, numerous tendons, ligaments, and muscles responsible for our ability to stand upright, supporting the entire body's weight, and providing the basis for the bipedal gait mechanism. Ankle joint is the commonest joint injured in the musculoskeletal injuries without adequate rehabilitation function can be severely impaired, but access to the physiotherapy rehabilitation service can be limited due to geographical remoteness and inadequate or absence of services in the rural areas. Wound complications have been reported to occur in 1.4% to18.8% of patient with ankle injuries. In 2005, nearly 12 per cent of all ER visits or 13.8 million visits for laceration care were reported. Depending on the location and severity of the injury, lacerations can be managed in the ambulatory environment as well. Foot and ankle conditions are common in older adults. The commonest ankle injury is ankle sprain, ankle instability these type on injury are more commonly seen in sports person. Ankle Laceration is a debilitation condition which leads to lack of mobility and if not treated properly may lead to wound infection. As the tendon in the ankle region are more superficial there is high chances of tendon or nerve injury in the cases of ankle laceration. Here presenting a 19 year old girl with a laceration injury on the left ankle while mowing the lawn, she has undergone grafting and since then on physical therapy management.

Osteoarthritis Induces Gender Related Changes in the Knee Range of Motion

In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motion of joints (ROM), we wanted to evaluate how gender impacts gait dynamics in OA patients. For this study we have compared 106 OA patients (male=32, female=74) to age matched controls. All participants had their right leg as dominant. Video recording of normal gait was analysed with a digital goniometry tool phone application, and the knee’s ROM was measured in midstance and midswing of the gait. During midstance, significant extension and flexion of the knee excursion have been observed in both males and females. During midswing, knee OA presents more differences, whereas subjects with hip and knee OA present changes on the dominant knee. Midstance changes suggest that the knee’s joint degenerative changes can be linked to hip OA secondary changes. Midswing changes in lower limb OA suggest a connection to the activities of daily life. Gender differences generated by OA must furthermore be studied in both lower limbs so that the best therapeutic approach can be chosen.

Spinal lumbar dI2 interneurons contribute to stability of bipedal stepping

Peripheral and intraspinal feedback is required to shape and update the output of spinal networks that execute motor behavior. We report that lumbar dI2 spinal interneurons in chicks receive synaptic input from afferents and premotor neurons. These interneurons innervate contralateral premotor networks in the lumbar and brachial spinal cord, and their ascending projections innervate the cerebellum. These findings suggest that dI2 neurons function as interneurons in local lumbar circuits, are involved in lumbo-brachial coupling, and that part of them deliver peripheral and intraspinal feedback to the cerebellum. Silencing of dI2 neurons leads to destabilized stepping in P8 hatchlings, with occasional collapses, variable step profiles and a wide-base walking gait, suggesting that dI2 neurons may contribute to the stabilization of the bipedal gait.

Amplitude setting and dopamine response of finger tapping and gait are related in Parkinson's disease

Objective: Movement amplitude setting is affected early in Parkinson's disease (PD), clinically manifesting as bradykinesia. Our objective was to determine if amplitude setting of upper limb bimanual movements and bipedal gait are similarly modulated in PD. Methods: 27 PD and 24 control participants were enrolled. Participants performed a bimanual anti-phase finger tapping task wearing gloves with joint angular sensors, and an instrumented gait assessment. Motor load was varied by asking participants to perform movements at a normal and fast pace. PD participants were evaluated OFF (PD-OFF) and ON (PD-ON) levodopa. Results: PD-OFF participants had shorter tap interval, smaller tap amplitude, and greater tap amplitude variability than controls in the more affected hands (all p<0.05). Tap amplitude and stride length (p=0.030), and tap frequency and gait cadence (p=0.011) were correlated in PD-OFF. Tap frequency and amplitude were also correlated with motor UPDRS (p<0.005) and bradykinesia motor (p<0.05) and ADL (p<0.005) UPDRS subscales. Levodopa improved mean tap amplitude and stride length during fast tapping in PD participants. Conclusion: In PD-OFF, mean finger tapping amplitude and gait stride length were correlated and showed similar dopaminergic response. Significance: Future studies manipulating upper limb amplitude could help provide greater understanding of the networks responsible for amplitude setting in PD.

Whole-Body Vibration Approaches in Neurological Disorders

Bipedalism in humans is associated with an upright spine, however, this condition is not found in other animals with that skill. This may have favored the ability to harness the influence of the gravitational forces on the body. Furthermore, it is suggested that human feet have evolved to facilitate bipedal locomotion, losing an opposable digit that grasped branches in favor of a longitudinal arch that stiffens the foot and aids bipedal gait. Gait is a repetition of sequences of body segments to move the body forward while maintaining balance. The bipedal gait favors the contact of the feet of the individual with the floor. As a result, the mechanical vibration (MV) generated during walking, running or other activity with the feet are, normally, are added to the body. In these various situations, the forces would induce the production of MV with consequent transmission to the whole body of the individual and there is the generation of whole-body vibration (WBV) exercise naturally. However, when a person has a disability, this normal addition of the MV to body does not occur. This also happens with the sedentary or bedridden individual due to illness. In this case, there are the MV yielded in vibrating platforms. The exposure of the individual to the WBV leads to physiological responses at musculoskeletal, neurological, endocrinological, and vascular levels. Considering the state of the art of this theme and the previously cited scientific information, it is plausible to assume that WBV could be a useful tool to be used on the management of individuals with neurological conditions, such as in Parkinson’s disease, stroke, cerebral palsy, multiple sclerosis, spinal cord injuries, spinocerebellar ataxia and Duchenne muscular dystrophy, and neuropathy (diabetes- and chemotherapy-related), among others. Indeed, improvements due to the WBV have been described regarding motor, and other impairments, in patients with neurological conditions, and these approaches will be presented in this chapter.

A loss-of-function mutation in RORB disrupts saltatorial locomotion in rabbits

Saltatorial locomotion is a type of hopping gait that in mammals can be found in rabbits, hares, kangaroos, and some species of rodents. The molecular mechanisms that control and fine-tune the formation of this type of gait are unknown. Here, we take advantage of one strain of domesticated rabbits, thesauteur d’Alfort, that exhibits an abnormal locomotion behavior defined by the loss of the typical jumping that characterizes wild-type rabbits. Strikingly, individuals from this strain frequently adopt a bipedal gait using their front legs. Using a combination of experimental crosses and whole genome sequencing, we show that a single locus containing the RAR related orphan receptor B gene (RORB) explains the atypical gait of these rabbits. We found that a splice-site mutation in an evolutionary conserved site ofRORBresults in several aberrant transcript isoforms incorporating intronic sequence. This mutation leads to a drastic reduction of RORB-positive neurons in the spinal cord, as well as defects in differentiation of populations of spinal cord interneurons. Our results show thatRORBfunction is required for the performance of saltatorial locomotion in rabbits.

Perspectives on Pliocene and Pleistocene Pedal Patterns and Protection

As a framework for interpreting Pliocene and Pleistocene hominin footprints, the functional implications of australopith and Homo pedal remains are reviewed. Despite minor variations in pedal proportions and articular morphology, all of these remains exhibit tarsometatarsal skeletons fully commensurate with an efficient (human) striding bipedal gait. The Middle and Late Pleistocene Homo pedal phalanges exhibit robust and distally flattened metatarsal 1 heads, hallux valgus, relatively short lateral digits with largely straight proximal phalanges with dorsally oriented metatarsal facets, all similar to those of recent humans. The Pliocene and Early Pleistocene halluces lack hallux valgus and have bulbous metatarsal 1 heads. The australopith pedal remains have lateral proximal phalanges that are relatively long and dorsally curved and have more proximally oriented metatarsal facets. In addition, pre-Upper Paleolithic Homo lateral phalanges have robust diaphysis implying the habitual absence of protective footwear, whereas the Upper Paleolithic ones are variably gracile, especially at higher latitudes, indicating more consistent use of footwear. These paleontological considerations provide a framework for interpreting the distal portions of earlier hominin footprints (especially with respect to hallucal orientation and digital length) and suggest that many of the Late Pleistocene footprints may be unrecognized given the use of footwear.