The risk of falls is common in the aging and Parkinson’s disease (PD) populations. There is limited research on dynamic gait stability, i.e., margin of stability (MOS), in the PD population while turning. The purpose of this exploratory study was to examine the dynamic balance control in individuals with mild to moderate PD and healthy individuals while walking and performing 90° turns utilizing computerized three-dimensional gait analysis. Specifically, we examined the anteroposterior and mediolateral margins of stability and their effect on the dynamic balance during turning in participants. A total of 11 individuals with mild to moderate idiopathic PD and 10 healthy controls (CON) participated in this study. Individuals with PD were tested during the “on phase” of PD medication. The Vicon Nexus camera system, force plates, and Visual3D software were utilized for three-dimensional motion analysis of three right and three left turning trials. A mixed-model ANOVA was used to analyze the primary dependent variables of dynamic balance (p < 0.0028) and the secondary dependent variables of spatiotemporal gait parameters (p < 0.0056). No significant differences in the spatiotemporal parameters or dynamic balance variables were observed between the groups. Gait velocity, center of mass-center of pressure (COM–COP) inclination angle at midstance, and MOS variables showed marginally significant group differences. We found no differences in dynamic balance during gait while performing turns betweenthe healthy elderly and individuals with PD. This finding may be related to the early stage of disease progression in the PD group.
Background: Postpartum women are at an increased risk of falls. Maintaining standing balance is multifactorial, involving abdominal wall/pelvic floor muscle responsivity, quick generation of intra-abdominal pressure, and glottis position. Objective: To identify whether using voicing tasks improves balance in postpartum women. Study Design: Research report. Methods: Eleven postpartum women and 10 age-matched nulliparous controls stood on a force plate when balance was perturbed to the front or back of their bodies while performing 6 different breathing and voicing tasks. Tasks modified glottis position and lung volume. Primary outcome measure was maximal displacement of center of pressure immediately following perturbation. Results: When comparing the 2 groups' responses, postpartum women showed worse balance during the “Ah” sound and “normal exhale without breath hold” (P = .049 and P = .031, respectively). When comparing all responses to each task, participants in both groups showed no significantly different response to any tasks when they were perturbed anteriorly. The nulliparous group also had no significantly different responses when perturbed posteriorly. Postpartum women showed a significant difference in response to “normal exhale without breath hold” compared with “counting” (P = .01), with better balance for “counting.” Conclusion: Postpartum women showed improved balance during the “counting” task, which incorporates the glottis into the balance mechanism. Tasks that did not incorporate the glottis (exhalation) and relied more on the abdominal wall/pelvic floor produced worse balance in postpartum women. For recently postpartum women, counting may be a helpful strategy to improve balance and reduce fall risk.
Category: Ankle; Ankle Arthritis Introduction/Purpose: Deficits in ankle joint kinetics following total ankle arthroplasty (TAA) may be attributed to a reduction in the force-generating capacity of ankle joint muscles, but it is also important to consider the alterations to joint structure that may accompany this procedure. One key parameter indicative of joint structure with the potential to be influenced by TAA is the plantarflexion moment arm of the Achilles tendon (ATma). ATma is an indicator of the potential for the tendon force to produce plantarflexion moment that is determined by the three-dimensional line of action of the tendon relative to the ankle joint axis. The purpose of this study was to assess pre-to-post TAA changes in ATma; we hypothesized that pre- and post-TAA moment arms would not be different. Methods: We tested 10 TAA patients (age at surgery: 62.86 +- 9.72 y; height: 1.72 +- 0.08 m; body mass: 97.81 +- 20.89 kg) at pre-operative (˜ 1 mo pre) and post-operative (˜6 mo post) visits. All procedures involving testing of human subjects were approved by the Penn State Hershey Medical Center Institutional Review Board. ATma were measured using a method that combined ultrasound imaging of the tendon with 3D motion tracking of both the ultrasound probe and the ankle joint. The tendon and joint axis were located during trials in which the patients were seated with the knee extended while the ankle joint was voluntarily rotated in the sagittal plane. We also examined sagittal-plane weightbearing radiographs (pre- and post-op) to determine the AP distance from the center of the talar dome to the posterior margin of the calcaneus. Pre- and post-op ATma were compared using a paired t-test and regression. Results: No significant mean differences were found between post-op ATma and pre-op ATma (p = 0.360). Despite this, some patients were found to have large differences between pre- and postoperative ATma. For example, participants 1, 3, and 8 exhibited changes of -54.22%, +64.14% and +123.98% (pre-to-post) respectively (Figure 1). A moderate correlation between pre- and post-op ATma was found (r2 = 0.461, p = 0.031), indicating that only 46.1% of the variance in post-op ATma was explained by pre-op ATma (Figure 1). The normalized AP distance measured from the radiographs did not significantly change on average pre- to post-TAA (p = 0.561), and we found the change in this distance to correlate with the change in ATma (r2 = 0.370, p = 0.062). Conclusion: This is the first investigation of whether TAA alters ATma. Our results supported our hypothesis that pre-operative ATma predicts post-operative ATma. However, our hypothesis is supported only when the mean differences are considered, as there were sizeable differences for individuals. Despite a non-significant average change in ATma following TAA, at the individual level substantial changes in ATma were observed in seven of the 10 patients. Change in ATma was only partly explained by change in the AP position of the talar dome. Change in ATma has potential consequences for function in terms of ankle plantarflexor strength and walking velocity.
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