Introduction The relationship of tibialis anterior (TA) muscle architecture including muscle thickness (MT), cross-sectional area (CSA), pennation angle (PA) and fascicle length (FL) to strength and ankle function was examined in ambulatory individuals with CP and unilateral foot drop. Methods Twenty individuals with CP participated in muscle ultrasound imaging, unilateral strength testing, and 3D gait analysis. Results Muscle size (MT and CSA) were positively related to strength, fast gait velocity, and ankle kinematics during walking. Higher PA was related to a more dorsiflexed ankle position at initial contact and inversely with fast gait velocity. FL was related to strength, fast velocity, and step length at self-selected speed. Discussion Muscle architecture partially explains the degree of impairment in strength and ankle function in CP. Treatments to increase TA size and strength may produce some gait improvement, but other factors that may contribute to ankle performance deficits must be considered.

Primary objective Given the major impact of traumatic brain injury (TBI) on society and the fact that effective therapies for common deficits in balance and gait are not known, the purpose of this review was to investigate the efficacy or effectiveness of non-aerobic exercise interventions to improve balance and gait in functionally mild to moderate individuals with TBI (those who demonstrate the ability or capacity to ambulate) and to provide evidence-based guidelines for clinical practice. Methods We searched eight databases (limits: January 1980 to December 2009) for papers including exercise interventions to improve gait and balance post TBI. Out of 984 unique citations, 20 fully met inclusion criteria. The methodological quality of studies was determined by the Physiotherapy Evidence Database (PEDro) scale and strength by Sackett's Levels of Evidence. Results We found limited evidence of the positive effects of balance, gait, or the combination of both interventions, in TBI rehabilitation. Most studies included small sample sizes with heterogeneous groups, and the interventions were variable and lacked standardization. The outcome measures were variable and low in quality. These limitations make it difficult to draw useful evidence-based recommendations for clinical practice. Conclusions The state of evidence for gait and balance interventions in patients with mild to moderate TBI is surprisingly poor. Greater consideration and conformity in the choice of outcome measures and attention in the design and standardization treatment approaches are essential in future research to advance practice.

The purpose of this study was to identify risk factors for management failure in pediatric minimally displaced lateral condyle fractures of the distal humerus (LCHFx) and compare outcomes between initial nonoperative and operative cohorts. A retrospective chart review of LCHFx was conducted to identify children treated with displacement <2 mm and initial nonoperative management. Classification and Regression Trees (CART) were constructed to identify predictors for failure of nonoperative management (further displacement requiring operative intervention). One hundred forty nonoperative children met initial inclusion. CART analysis identified the internal oblique measurement of pre-treatment fracture displacement of >1.2 mm to be the most predictive of nonoperative failure. Fractures with displacement of >1.2 mm had a 58.3% rate of failure compared to 1.3% for those <1.2 mm of initial displacement (P < 0.001). Thirty-seven percent of nonoperative children required revision treatment compared to only 12% of operative children (P = 0.034). LCHFx with minimal displacement (1–2 mm) have a relatively high risk for failure when initially managed without surgery and should either be monitored closely or considered for early operative management when appropriate.

Level III.