After a stroke, gait and balance are often affected and an orthosis is typically required to facilitate postural control. This study has been conducted to examine how the Range of Motion in an Ankle-Foot-Orthosis (AFO) impacts on stroke patients’ dynamic balance. It was hypothesized that better dynamic balance would be recorded when individuals were wearing a flexible AFO. The tests that was used in this study were the Timed Up and Go test (TUG), and the Center of Pressure (CoP)/Center of Mass (CoM) inclination angle, both in Anterior-Posterior (AP) and Medio-Lateral (ML) planes. The three patients participating in this study were all users, or had been users of AFO’s, and during the study they were asked to wear a customized AFO with the possibility to change the settings to open, flexible and rigid ankle joints. The order was randomized within each patient. No clear pattern was observed across all patients, either in the TUG test or CoP/CoM inclination angles. Further studies are required to explore the impact that AFO flexibility has on dynamic balance in individuals who have had a stroke.

A osteoartrite do quadril é uma grande causa de incapacidade da população idosa. A doença é caracterizada pela deterioração da cartilagem articular, perda do espaço cartilaginoso, esclerose do osso subcondral e presença de osteofitos. O teste Timed Up And Go (TUG) tem sido considerado como uma das ferramentas para avaliar a função do membro inferior, mobilidade e risco de quedas. O presente estudo visa determinar a influência da amplitude de movimento (ADM) do quadril no resultado do teste TUG em pacientes com osteoartrite de quadril, visto que há poucos estudos sobre o tema. Fizeram parte do estudo um total de 40 indivíduos divididos em dois grupos, 20 indivíduos no grupo controle e 20 no grupo de osteoartrite de quadril (grupo OA) com idade entre 40 e 75 anos. Para a inclusão dos indivíduos no grupo OA, utilizamos os critérios clínicos do American College of Rheumatology e para graduar a intensidade do comprometimento articular utilizamos a classificação de Tönnis. Os critérios de exclusão foram a presença de cirurgia prévia no membro inferior, fratura prévia no membro inferior, osteoartrite bilateral, dor lombar, obesidade mórbida, pacientes com estado geral comprometido por doenças sistêmicas graves, comprometimento cognitivo ou comprometimento neurológico. Através de um goniômetro examinadores independentes realizaram a medida de ADM ativa do quadril e com um cronômetro digital o tempo do teste TUG. Foi aplicado o Questionário de Western Ontario Universities (WOMAC) e a escala visual analógica de dor (EVA). Realizou-se a somatória da ADM de todos os movimentos do quadril e através do coeficiente de correlação de Pearson observamos a associação linear entre as variáveis ADM total ativa do quadril e tempo do teste TUG, nos grupos controle e OA. Nos resultados a ADM total ativa do quadril e o tempo do TUG do grupo OA apresentaram uma correlação negativa e moderada (r = - 0,69; p < 0,0001) porém no grupo controle observou-se fraca correlação (r = -0,08; p = 0,46). Os dados do estudo demonstram uma moderada correlação entre o tempo do TUG e a ADM total ativa do quadril em indivíduos com OA. Porém, mais estudos são necessários para determinar todas as variáveis que influenciam o resultado do teste. / Hip osteoarthritis is a major cause of disability in the elderly population. The disease is characterized by deterioration of articular cartilage, loss of cartilaginous space, sclerosis of subchondral bone and presence of osteophytes. The Timed Up And Go (TUG) test has been considered as one of the tools for assessing lower limb function, mobility, and risk of falls. The present study aims to determine the influence of the range of motion (ROM) on the TUG test result in patients with hip osteoarthritis, since there are few studies on the subject. A total of 40 individuals were divided into two groups, 20 in the control group and 20 in the group of hip osteoarthritis (OA group) aged between 40 and 75 years. For the inclusion of the individuals in the OA group we used the clinical criteria of the American College of Rheumatology and to grade the severity of the joint degeneration we used the Tönnis classification. Exclusion criteria were the presence of previous surgery on the lower limb, previous lower limb fracture, bilateral osteoarthritis, low back pain, morbid obesity, patients with poor general condition due to severe systemic diseases, cognitive impairment or neurological impairment. With a goniometer independent examiners performed the measurement of active ROM of the hip and with a digital timer the TUG test time. Western Ontario Universities Questionnaire (WOMAC) and visual analogue pain scale (VAS) were applied. We performed the summation of the ROM of all hip movements and through the Pearson correlation coefficient we observed the linear association between the active total ROM of the hip and the time of the TUG test in the control and OA groups. In the results, the total active ROM of the hip and the TUG time of the OA group presented a negative and moderate correlation (r = -0.64; p <0.0001), but in the control group there was a weak correlation (r = -0.08; p =0.46) . Data from the study demonstrate a moderate correlation between TUG time and total active ROM in subjects with OA. However, more studies are needed to determine all the variables that influence the test result.

No description available.

Estudos pregressos têm investigado causas e fatores de risco para quedas e incapacidade funcional em idosos. Porém, no que se refere a fatores biomecânicos envolvidos no desempenho funcional e controle postural, a contribuição dos grupos musculares proximais de quadril e de tronco ainda recebe pouca atenção. Assim, o objetivo deste estudo foi verificar a associação entre a função muscular dos abdutores e adutores do quadril e dos extensores e flexores do tronco com o desempenho do equilíbrio semi-estático e dinâmico e da funcionalidade de idosos independentes que vivem na comunidade. Métodos: oitenta e um idosos de ambos os sexos foram submetidos à avaliação do equilíbrio e da funcionalidade por meio dos testes: (1) marcha tandem sobre a plataforma de força Balance Master (Neurocom International Inc., Clackamas, OR) para obtenção das variáveis velocidade da marcha tandem e velocidade de oscilação corporal ao final da marcha tandem; e (2) testes clínicos de apoio unipodal e Timed Up and Go (TUG). Também foram submetidos à avaliação da função muscular em dinamômetro isocinético (Biodex System 4 Pro, Nova York, EUA) por meio de 3 contrações isométricas máximas de abdução e adução do quadril e flexão e extensão do tronco para obtenção das variáveis pico de torque (PT) e taxa de desenvolvimento de força (TDF) proporcionais ao peso corporal. Após aplicação do teste de normalidade de Shapiro-Wilk, foi realizado teste de correlação de Pearson (dados com distribuição normal) e de Spearman (dados com distribuição não-normal). Para aquelas variáveis com coeficiente de correlação significativo, foi aplicado teste de regressão linear para quantificar o índice de determinação (r2) da função muscular do quadril e tronco no equilíbrio e funcionalidade de idosos. Foi adotado nível de significância de 5% (p < 0,05). Resultados: houve correlação com índice de determinação significativo do PT dos grupos musculares do quadril e do tronco sobre o desempenho dos testes de equilíbrio e funcionalidade. Em relação à TDF, foi encontrada correlação com índice de determinação significativo da TDF de abdução de quadril e de extensão de tronco sobre a velocidade de oscilação ao final da marcha tandem e sobre o TUG e também da TDF de extensão de tronco sobre o apoio unipodal. Conclusões: esses 10 achados podem ser clinicamente relevantes considerando que (1) diferentes parâmetros da função muscular (como PT e TDF) apresentam diferentes estratégias de intervenção para seu aprimoramento e que (2) problemas de equilíbrio e/ou de funcionalidade em idosos podem estar associados com comprometimentos da TDF e do PT da musculatura proximal, os quais são parâmetros passíveis de intervenção. / Previous studies have investigated causes and risk factors for falls and functional disability in the elderly. However, regarding biomechanical factors involved in the functional performance and postural control, the contribution of the proximal muscle groups of the hip and trunk still receives little attention. The objective of this study was to assess the association between muscle function of hip abductors and adductors and trunk flexors and extensors muscles with the performance of static and dynamic balance and functionality of community-dwelling older adults. Methods: eighty-one elderly of both sexes underwent assessment of balance and functionality through: (1) tandem gait test on the Balance Master force platform (Neurocom International Inc., Clackamas, OR) to obtain the variable tandem gait speed and body sway velocity in the end of tandem gait; and (2) clinical tests of single-leg stance and Timed Up and Go (TUG). The participants also underwent assessment of muscle function in isokinetic dynamometer (Biodex System 4 Pro, New York, USA) through 3 maximal isometric contractions of abduction and adduction of the hip and flexion and extension of the trunk to obtain the variables peak torque (PT) and rate of force development (RFD) in proportion to body weight. The Shapiro-Wilk normality test was performed and then, Pearson correlation test (data with normal distribution) and Spearman (data with non-normal distribution) were applied. Linear regression test was applied to quantify the determination index (r2) of muscle function of the hip and trunk in balance and functionality of the elderly for those variables with significant correlation coefficient. It was adopted a significance level of 5% (p < 0.05). Results: there was correlation with a significant determination index of PT of muscle groups of the hip and trunk in the performance of balance and functionality tests. Regarding the RFD, it was found correlation with significant determination index of RFD of the hip abduction and trunk extension in the body sway velocity in the end of tandem gait and TUG; and of RFD of the trunk extension in single-leg stance. Conclusions: These findings may be clinically relevant considering that (1) different parameters of muscle function (such as PT and RDF) have different intervention strategies for their improvement and (2) problems of balance and / or functionality in the elderly may be 12 associated with impairments of RFD and PT of proximal muscles, which are parameters that can be treated.

No description available.

Vitamin D deficiency and insufficiency are now seen as a contemporary health problem in Australia with possible widespread health effects not limited to bone health1. Despite this, the Vitamin D status (measured as serum 25-hydroxyvitamin D (25(OH)D)) of ambulatory adults has been overlooked in this country. Serum 25(OH)D status is especially important among this group as studies have shown a link between Vitamin D and fall risk in older adults2. Limited data also exists on the contributions of sun exposure via ultraviolet radiation and dietary intake to serum 25(OH)D status in this population. The aims of this project were to assess the serum 25(OH)D status of a group of older ambulatory adults in South East Queensland, to assess the association between their serum 25(OH)D status and functional measures as possible indicators of fall risk, obtain data on the sources of Vitamin D in this population and assess whether this intake was related to serum 25(OH)D status and describe sun protection and exposure behaviors in this group and investigate whether a relationship existed between these and serum 25(OH)D status. The collection of this data assists in addressing key gaps identified in the literature with regard to this population group and their Vitamin D status in Australia. A representative convenience sample of participants (N=47) over 55 years of age was recruited for this cross-sectional, exploratory study which was undertaken in December 2007 in south-east Queensland (Brisbane and Sunshine coast). Participants were required to complete a sun exposure questionnaire in addition to a Calcium and Vitamin D food frequency questionnaire. Timed up and go and handgrip dynamometry tests were used to examine functional capacity. Serum 25(OH)D status and blood measures of Calcium, Phosphorus and Albumin were determined through blood tests. The Mean and Median serum 25-Hydroxyvitamin D (25(OH)D) for all participants in this study was 85.8nmol/L (Standard Deviation 29.7nmol/L) and 81.0nmol/L (Range 22-158nmol/L), respectively. Analysis at the bivariate level revealed a statistically significant relationship between serum 25(OH)D status and location, with participants living on the Sunshine Coast having a mean serum 25(OH)D status 21.3nmol/L higher than participants living in Brisbane (p=0.014). While at the descriptive level there was an apparent trend towards higher outdoor exposure and increasing levels of serum 25(OH)D, no statistically significant associations between the sun measures of outdoor exposure, sun protection behaviors and phenotypic characteristics and serum 25(OH)D status were observed. Intake of both Calcium and Vitamin D was low in this sample with sixty-eight (68%) of participants not meeting the Estimated Average Requirements (EAR) for Calcium (Median=771.0mg; Range=218.0-2616.0mg), while eighty-seven (87%) did not meet the Adequate Intake for Vitamin D (Median=4.46ug; Range=0.13-30.0ug). This raises the question of how realistic meeting the new Adequate Intakes for Vitamin D is, when there is such a low level of Vitamin D fortification in this country. However, participants meeting the Adequate Intake (AI) for Vitamin D were observed to have a significantly higher serum 25(OH)D status compared to those not meeting the AI for Vitamin D (p=0.036), showing that meeting the AI for Vitamin D may play a significant role in determining Vitamin D status in this population. By stratifying our data by categories of outdoor exposure time, a trend was observed between increased importance of Vitamin D dietary intake as a possible determinant of serum 25(OH)D status in participants with lower outdoor exposures. While a trend towards higher Timed Up and Go scores in participants with higher 25(OH) D status was seen, this was only significant for females (p=0.014). Handgrip strength showed statistically significant association with serum 25(OH)D status. The high serum 25(OH)D status in our sample almost certainly explains the limited relationship between functional measures and serum 25(OH)D. However, the observation of an association between slower Time Up and Go speeds, and lower serum 25(OH)D levels, even with a small sample size, is significant as slower Timed Up and Go speeds have been associated with increased fall risk in older adults3. Multivariable regression analysis revealed Location as the only significant determinant of serum 25(OH)D status at p=0.014, with trends (p=>0.1) for higher serum 25(OH)D being shown for participants that met the AI for Vitamin D and rated themselves as having a higher health status. The results of this exploratory study show that 93.6% of participants had adequate 25(OH)D status-possibly due to measurement being taken in the summer season and the convenience nature of the sample. However, many participants do not meet their dietary Calcium and Vitamin D requirements, which may indicate inadequate intake of these nutrients in older Australians and a higher risk of osteoporosis. The relationship between serum 25(OH)D and functional measures in this population also requires further study, especially in older adults displaying Vitamin D insufficiency or deficiency.

Estudos pregressos têm investigado causas e fatores de risco para quedas e incapacidade funcional em idosos. Porém, no que se refere a fatores biomecânicos envolvidos no desempenho funcional e controle postural, a contribuição dos grupos musculares proximais de quadril e de tronco ainda recebe pouca atenção. Assim, o objetivo deste estudo foi verificar a associação entre a função muscular dos abdutores e adutores do quadril e dos extensores e flexores do tronco com o desempenho do equilíbrio semi-estático e dinâmico e da funcionalidade de idosos independentes que vivem na comunidade. Métodos: oitenta e um idosos de ambos os sexos foram submetidos à avaliação do equilíbrio e da funcionalidade por meio dos testes: (1) marcha tandem sobre a plataforma de força Balance Master (Neurocom International Inc., Clackamas, OR) para obtenção das variáveis velocidade da marcha tandem e velocidade de oscilação corporal ao final da marcha tandem; e (2) testes clínicos de apoio unipodal e Timed Up and Go (TUG). Também foram submetidos à avaliação da função muscular em dinamômetro isocinético (Biodex System 4 Pro, Nova York, EUA) por meio de 3 contrações isométricas máximas de abdução e adução do quadril e flexão e extensão do tronco para obtenção das variáveis pico de torque (PT) e taxa de desenvolvimento de força (TDF) proporcionais ao peso corporal. Após aplicação do teste de normalidade de Shapiro-Wilk, foi realizado teste de correlação de Pearson (dados com distribuição normal) e de Spearman (dados com distribuição não-normal). Para aquelas variáveis com coeficiente de correlação significativo, foi aplicado teste de regressão linear para quantificar o índice de determinação (r2) da função muscular do quadril e tronco no equilíbrio e funcionalidade de idosos. Foi adotado nível de significância de 5% (p < 0,05). Resultados: houve correlação com índice de determinação significativo do PT dos grupos musculares do quadril e do tronco sobre o desempenho dos testes de equilíbrio e funcionalidade. Em relação à TDF, foi encontrada correlação com índice de determinação significativo da TDF de abdução de quadril e de extensão de tronco sobre a velocidade de oscilação ao final da marcha tandem e sobre o TUG e também da TDF de extensão de tronco sobre o apoio unipodal. Conclusões: esses 10 achados podem ser clinicamente relevantes considerando que (1) diferentes parâmetros da função muscular (como PT e TDF) apresentam diferentes estratégias de intervenção para seu aprimoramento e que (2) problemas de equilíbrio e/ou de funcionalidade em idosos podem estar associados com comprometimentos da TDF e do PT da musculatura proximal, os quais são parâmetros passíveis de intervenção. / Previous studies have investigated causes and risk factors for falls and functional disability in the elderly. However, regarding biomechanical factors involved in the functional performance and postural control, the contribution of the proximal muscle groups of the hip and trunk still receives little attention. The objective of this study was to assess the association between muscle function of hip abductors and adductors and trunk flexors and extensors muscles with the performance of static and dynamic balance and functionality of community-dwelling older adults. Methods: eighty-one elderly of both sexes underwent assessment of balance and functionality through: (1) tandem gait test on the Balance Master force platform (Neurocom International Inc., Clackamas, OR) to obtain the variable tandem gait speed and body sway velocity in the end of tandem gait; and (2) clinical tests of single-leg stance and Timed Up and Go (TUG). The participants also underwent assessment of muscle function in isokinetic dynamometer (Biodex System 4 Pro, New York, USA) through 3 maximal isometric contractions of abduction and adduction of the hip and flexion and extension of the trunk to obtain the variables peak torque (PT) and rate of force development (RFD) in proportion to body weight. The Shapiro-Wilk normality test was performed and then, Pearson correlation test (data with normal distribution) and Spearman (data with non-normal distribution) were applied. Linear regression test was applied to quantify the determination index (r2) of muscle function of the hip and trunk in balance and functionality of the elderly for those variables with significant correlation coefficient. It was adopted a significance level of 5% (p < 0.05). Results: there was correlation with a significant determination index of PT of muscle groups of the hip and trunk in the performance of balance and functionality tests. Regarding the RFD, it was found correlation with significant determination index of RFD of the hip abduction and trunk extension in the body sway velocity in the end of tandem gait and TUG; and of RFD of the trunk extension in single-leg stance. Conclusions: These findings may be clinically relevant considering that (1) different parameters of muscle function (such as PT and RDF) have different intervention strategies for their improvement and (2) problems of balance and / or functionality in the elderly may be 12 associated with impairments of RFD and PT of proximal muscles, which are parameters that can be treated.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24135号 / 医博第4875号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 川上 浩司, 教授 阪上 優 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Title: The effect of chosen manual techniques on static and dynamic postural stability in physiotherapy students. Aims: The main aim of this study is to assess the effect of chosen manual techniques on participants' static and dynamic postural stability. Summary: The study was done from May to December 2019. A total of 100 subjects aged 19-38years took part in the study. Participants were randomly divided into two groups - experimental and control. Postural stability was measured by the following tests: Star Excursion Balance test, Unipedal Stance test, Timed Up and Go test and Sit to Stand test. These standardised measurements were taken before intervention, after intervention and a week from intervention. Experimental group undertook the intervention by manual techniques, which took 20 minutes. Outcomes were written into recording sheets. Final data were processed using Microsoft Excel 2013, IBM SPSS Statistics V26 and TIBCO Statistica 13.3.0. To calculate differences, the following statistical methods were used: Shapiro-Wilk test, independent T-test and Mann-Whitney U test. To measure effect size, Cohen's d was used. The level of statistical significance was determined to α = 0,05. The clinical significance was assessed by these levels: d = 0,2-0,49 (small effect), d = 0,5-0,79 (medium effect),...